HC Deb 13 February 1996 vol 271 cc795-7
8. Mr. O'Hara

To ask the Secretary of State for Health what recent assessment he has made of the provision of care to elderly people living in the community. [13311]

13. Mrs. Fyfe

To ask the Secretary of State for Health what guidelines he has issued about the provision of care to elderly people living in the community. [13316]

Mr. Bowis

Various guidelines have been issued to local and health authorities in relation to the care of elderly people.

There is clear evidence that community care is a success both from our own monitoring and from independent reports.

Mr. O'Hara

Can the Minister confirm that 40,000 old people have had to sell their homes to finance their care in old age, and does he agree that, therefore, a whole generation has been betrayed, especially those who fought in the second world war, who were promised a better Britain and care from the cradle to the grave? They now find that they must pay twice for their care in old age; they have already paid once through their taxes, and now they must pay once again through private provision.

Mr. Bowis

The people who fought through the war then lived through a Labour Government, and it was the Labour—[Interruption.] The hon. Gentleman may think that that is funny now, but many people remember that with horror.

Let me remind the hon. Gentleman that it was that Labour Government in 1948 that introduced the charging system for residential care that applies to this day. The Labour party has made no proposals about that. As a Government, we have made proposals on occupational pensions and on the capital disregard and, as announced in the Budget, we are consulting on partnership schemes to alleviate the problem that some people have in that respect. If Labour Members would make constructive proposals instead of sniping from the sidelines and trying to frighten people, they would do a lot better.

Mrs. Fyfe

Would that we had the welfare state that was introduced by Labour in 1945.

Does the Minister agree that, if Beveridge were alive today, he would be horrified to think of what is happening to old people? If the Minister disagrees with that, does he agree with me that a royal commission should be appointed to inquire into the condition of old people and care in the community?

Mr. Bowis

May I welcome the hon. and Scottish Lady to English Health questions? I suggest to her that, if Beveridge, Bevan and others were alive today, they would be astonished at the rates of investment by the taxpayer in the care of elderly people, and they would notice that, in the past six years, investment in personal social services has increased from £3.6 billion to £7.4 billion—I suspect, more than either of those two gentlemen would ever have dreamed of.

Mr. Sims

To ensure that the resources devoted to community care are used in the most cost-effective manner, should not local authorities be required to publish the true cost of care in residential homes run by local authorities, so that a comparison may be made with similar residential care provided in the private sector?

Mr. Bowis

My hon. Friend makes an interesting and valid suggestion. When those who are interested in value-for-money reviews of social service provision—not least the Audit Commission and district auditors—seek to discover whether that value is being provided by a local authority, they need to be able to compare like with like. It is easy to see the price of residential care in the private or voluntary sectors; it is very difficult to see the price in the state sector. That is something that we shall certainly inquire into and which may emerge from our review of inspection regulation as a whole.

Sir Jim Spicer

On the subject, not of residential care but, care in the community, does my hon. Friend agree that the social services budget has doubled in the past six years? Can there be any excuse for county councils such as Liberal-controlled Dorset increasing their charges for home care help and all other aspects of care in the community and spending the resulting funds on unrelated services? Is it not time to reconsider responsibility for social services? Is there not a strong case for social services to move over to community trusts, which are non-political and not manipulated by Liberals?

Mr. Bowis

My hon. Friend makes a long-term suggestion of a solution. It is true that, in the county of Dorset, during the last six years resources have increased from £43 million to £93.8 million. Those resources are fair by anyone's standards.

As to the county's charging policy for domiciliary and day services, the hon. Gentleman will be aware that that is entirely at the discretion of the elected local authority. If anyone is unhappy with that authority's charging policy, he or she knows where to look—the elected leaders of the council are accountable and responsible for it.

Mr. Milburn

By passing the buck to individual health authorities and allowing them to decide eligibility criteria for long-term care, have not the Government created a lottery in health provision for elderly people? Do not the care that elderly people receive and the price that they pay for it now depend on where they live? When will the Minister take responsibility for defining the boundaries between provided and paid-for care, so that once again we have a one-nation national health service where access to care is a matter of right and not a matter of chance?

Mr. Bowis

The hon. Gentleman is right to point out the distinction between social care and health care, which was introduced by the Labour Government in 1948. We want a fair system and we shall be as open as possible about the definitions on either side of the dividing line. That is why we have introduced our guidance in that regard, which has been widely welcomed, and why authorities up and down the country have been consulting on the future eligibility criteria for those services.

The truth is that the hon. Gentleman and his party want a standard society: they do not like flexibility or choice and, above all, they do not like the independent sector. As new Labour marches on, it reminds us ever more of "Nineteen Eighty-Four".

Mr. Nicholas Winterton

I pay tribute to my hon. Friend's commitment to the care of the elderly in the community. However, does he accept that today many elderly people must pay for services which, until relatively recently, they received free under the national health service? Will my hon. Friend join me in campaigning for some form of assistance for those people—whether it is through fiscal means or other ways—which will help them to meet the cost that they must now pay for care that is essential for their health and well-being?

Mr. Bowis

My hon. Friend is right: one of the great successes of our health service is that many people who would have spent their last days in geriatric wards are now able to have operations, receive treatment and take new medication which allows them to return home or to a homely setting. That is a triumph for the health service. Taxpayers—and the Government on their behalf—must now plan ahead to ensure that the cost is reasonable and affordable and that they make the necessary preparations to meet it. I believe that we have taken those steps through our various announcements, both before and in the Budget.

The other side of the coin is that we must keep pressure on the authorities to ensure that they provide services at a reasonable cost. That means using the independent sector as well as the part 3 sector—which is something that the Opposition are remarkably reluctant to do.