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Dr Peter Brand: That is the problem with it.
Dr Peter Brand: Will the hon. Gentleman give way?
Dr Peter Brand: Is it not true that if our proposals—or the amendment tabled by the hon. Member for Lancaster and Wyre; or the amendments tabled by the hon. Member for Runnymede and Weybridge—were accepted, the NHS could recruit more nursing assistants, train them within a nursing team and deliver the very service that all parties want?
Dr Peter Brand: I would hate the Committee to be misled: our proposal this time is to soak the rich and put some extra money on those people who earn more than £100,000.
Dr Peter Brand: Does the hon. Gentleman recognise that the same holds true for nursing care given in NHS hospitals?
Dr Peter Brand: The hour is quite late. I do not want to repeat yesterday's excellent debate other than to express my disappointment that the Government and the Conservative Opposition have not taken on board properly the message from the Sutherland report. They also failed to take on board three reports from the Select Committee on Health, which set out the difficulties involved in charging regimes that got...
Dr Peter Brand: I am grateful to the hon. Gentleman for that clarification. Would he clarify another matter, which is to do with resources and devolved governance? Does he suggest that the Barnett formula should be abandoned so that the Scots would not be in a position to have a more favourable package?
Dr Peter Brand: I am slightly confused by the term exploited. The Liberal Democrats in Scotland, and indeed in Wales, are using the powers bestowed on them by the electorate to meet our commitment to that electorate.
Dr Peter Brand: In an ideal world, the Secretary of State would set out strategies that local authorities would have the will, ability and resources to deliver. The real world is not like that. Luckily, it is rare for things to go completely amiss or disastrously wrong, but the Secretary of State is rightly held accountable when they do. However, it is unreasonable to hold him accountable if he does not have...
Dr Peter Brand: I support the points being made. I draw the Minister's attention to the debate on the Food Standards Agency. It was recognised that the Secretary of State needed to have the power to withdraw a function if it was deliberately not carried out effectively. In that case, there was a prescribed process, which provided the checks and balances mentioned by the right hon. Member for North-West...
Dr Peter Brand: That is an interesting observation. I disagree with the hon. Gentleman, because environmental health is a local authority direct function, just as the delivery of social services and some of the health provision is a direct function of local authorities. Serious checks and balances should be in place before the Secretary of State has the ability to override a locally elected, democratic body....
Dr Peter Brand: Would it be possible to have an ad hoc arrangement for a small group of clients of a local authority to have their services provided by a care trust even though the local authority is not a signed up member of the trust?
Dr Peter Brand: My concern was not that the Minister might extend charges; I would not be so uncharitable. I warned that the existence of charges as at present in social services militates against the joint working relationships that we are so keen to see. That was clearly one of the findings of the Select Committee on Health.
Dr Peter Brand: It has been a useful debate. The right hon. Member for North-West Hampshire expressed his anxieties, and my hon. Friend the Member for Sutton and Cheam made perceptive points, which dealt with the position of local government and governance of the proposed care trusts. To pick up the analogy just used, I am sure that the Government are travelling in the right direction, although I warn the...
Dr Peter Brand: Does my hon. Friend agree that if consultation produced significant or even universal opposition to such mergers the Government should pay attention—unlike previous Governments who, for instance, established national health service trusts according to a pattern set down by the Secretary of State rather than by the communities concerned, and in complete disregard of consultations?
Dr Peter Brand: The hon. Gentleman is making a great deal of sense. Does he not agree that the Government's definition would undermine desirable team working between nurses and nursing assistants? They all have high status and do a proper job. However, once nursing actions are carried out by non-registered nurses and people are charged for them, those members of the teams will be treated as second-class citizens.
Dr Peter Brand: If the hon. Lady is so concerned about a social services budget closed to any extension to free personal care, is it her understanding that the nursing budget given to health authorities is to be open-ended? Will the Government's definition of nursing care not also have its restrictions?
Dr Peter Brand: Will the hon. Lady give way?
Dr Peter Brand: The royal commission correctly pointed out that there is no prospect of a demographic time bomb and that most of the expenditure on health and personal care happens during the last six months of people's lives, irrespective of age. That weakens the Minister's argument about the awful prospect that the Government cannot cope without extraordinarily high expenditure.
Dr Peter Brand: Will the Minister give way?