§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
Comprehensive guidance was issued to local authorities in December 1992 and is regularly updated.
§ Mr. Sims
At present, anyone with capital of more than £3,000 is expected to contribute towards the cost of his care, and anyone with more than £8,000 has to pay in full. Will my hon. Friend confirm that the figures were 137 inherited in 1993 from the income support system and have not been altered since? In fact, they date back to 1990. Does he agree that they are perhaps due for review?
Will my hon. Friend consider clarifying the guidance that he gives local authorities, which take into account the full occupational pension of a person in a residential nursing home? This often means that the spouse left in the family home has no income whatever and may have to resort to income support.
§ Mr. Bowis
My hon. Friend's statement of the figures is correct. They were brought into line with income support figures in 1993, when the threshold was raised from £1,200 to £3,000. We do indeed keep the figures under review and will continue to do so.
As for the occupational pension, local authorities have a discretion to enable a spouse to remain at home with the same standard of living to which he or she has been accustomed. My noble Friend Lord Mackay asked in another place for any evidence that this discretion was not being used properly to be brought to the Government's attention. I repeat that request today; to date we have received no such evidence. We shall, however, consider the matter, as we promised to do, in another place.
§ Mrs. Dunwoody
Is the Minister aware that literally thousands of people are terrified that they will become so frail that they will be removed—forcibly, if need be—from an NHS bed and sent to a private home, leaving their families unable to make up the difference between the fees and the amounts available? That not only frightens large numbers of people but implies that the system is on the verge of breaking down.
§ Mr. Bowis
I refer the hon. Lady to the guidance that we recently issued on continuing care and on discharge; and to one of the conditions of the special transitional grant—that there should be agreement between the social services and hospitals. There has been no change to the system for charging introduced in 1948 by the then Labour Government. This Government introduced the discretion and the requirement that the value of the house be ignored for spouses and other members of a family who may remain at home.
§ Mr. Wilkinson
Will my hon. Friend publish the results of his review? As my hon. Friend the Member for Chislehurst (Mr. Sims) has made clear, in parts of outer London, such as my constituency of Ruislip-Northwood, a place in a residential nursing home can cost several hundred pounds a week, which can lead to a spouse eventually having to sell the family home, causing great distress over and above that of looking after the sick patient. Will my hon. Friend publish the review and re-examine the criteria?
§ Mr. Bowis
There is no review as such. I said that we kept the matter under review. If we decide to make a change, we shall announce it. However, I can reassure my hon. Friend that, where a spouse remains at home, there is no question under this Government of that spouse being turned out of the family home. That is precisely the requirement that we put into law which was not there under the previous Labour Government. We have also 138 given the discretion to enable that spouse to remain in the family home according to the standard of living to which he or she has been accustomed.
§ Mr. Wigley
Does the Minister accept that people with on-going medical needs are being pressurised to move from hospitals into private nursing homes because of the in-built financial structure of the health care authority and its lack of beds? Surely anyone with an on-going medical need should be able to stay on in an NHS hospital.
§ Mr. Bowis
The hon. Gentleman is correct. If someone is deemed by a doctor to have a continuing in-patient health care need, that should be provided by the NHS, whether in a hospital or a bed purchased by the NHS. It is only if doctors decide that there is no longer an in-patient health need that a patient will be discharged into the community where the community health services will continue to be free to that individual. However, as has been the case since 1948, the social care needs would be paid for by the individual unless that individual's income warrants support by previously the benefit and now the community care system.
§ Mr. Sumberg
Does my hon. Friend recognise that there is considerable concern among elderly people and their relatives that the family home, for which they have saved over many years, may well have to be sold? Will my hon. Friend urgently and radically consider proposals to exempt such homes?
§ Mr. Bowis
My hon. Friend is correct to raise the concern of his constituents. I am happy to give him the assurance that we will continue to review the situation to ensure that the family is looked after. We already have in place assurances that we can give to families, and to spouses in particular, and now we must consider whether the figures that are in place are still adequate to meet the needs.
§ Mr. Hinchliffe
Does the Minister recall that one of the key objectives of the assessment process was the avoidance of unnecessary institutional care? Is it not a fact that many people are still being placed unnecessarily in care homes because of the requirement to spend the bulk of the community care grant in the private sector? Will the Minister make it clear which is more important—the proper assessment of individual needs or propping up the private care market?
§ Mr. Bowis
Yet again, we see the naked hostility to the private sector that has been so apparent from the Labour party ever since we introduced the community care policy. It is clear that the assessment of the individual is central to community care. The individual takes part in that assessment and the individual and the individual's carers take part in discussions on how to meet the needs of that assessment.
It is then a question of whether it is possible to enable the individual to stay at home with a package of care or whether it is better to place the person in residential care. That is a matter for the assessment, which should involve the appropriate medical input. We have no dogmatic view on whether someone should stay at home or go into residential care. We want the individual to receive the best care, irrespective of from which sector that care comes.