Long-term Care

HC Deb 04 December 1997 vol 302 cc489-99 3.35 pm

The Secretary of State for Health (Mr. Frank Dobson)

With permission, Madam Speaker, I should like to make a statement.

As people approach old age, many become anxious about how they will be looked after, how much it will cost and who will pay. At the general election, we promised that we would establish a royal commission to work out a fair system of funding long-term care for the elderly. Today, I can announce that the Queen has agreed to the setting up of the royal commission, whose terms of reference will encompass the United Kingdom as a whole. The new Government are keeping yet another of their election promises.

The royal commission is to be chaired by Professor Sir Stewart Sutherland, principal and vice-chancellor of Edinburgh university. I am confident that he will bring to the commission the skills and experience necessary to ensure rapid and vigorous scrutiny of the issues involved and practical cost-effective proposals to deal with them.

Sir Stewart will be joined by 11 other commissioners: Professor Dame June Clark, professor of community nursing at the university of Swansea; Sir Nicholas Goodison, deputy chairman of the Lloyds TSB Group and former chairman of the stock exchange; Dr. Iona Heath, a GP in Kentish town who represents the Royal College of General Practitioners on the British Geriatrics Society; Joel Joffe, a human rights lawyer, founder director and former deputy chairman of Allied Dunbar Assurance and chairman of Oxfam; David Lipsey, political editor ofThe Economist and a public interest director on the Personal Investment Authority; Professor Mary Marshall, director of the dementia services centre at the university of Stirling; Claire Rayner, writer, broadcaster and president of the Patients Association and a former nurse; Paula Ridley, the chair of the Liverpool housing action trust; Professor Robert Stout, professor of geriatric medicine at Queen's university Belfast; Robin Wendt, the former secretary of the Association of County Councils and a former civil servant at the then Department of Health and Social Security; and Len Woodley QC, a recorder who chaired the Laudat Mental Health Act inquiry.

Briefly, the commission's terms of reference will be to examine the short and long-term options for a sustainable system of funding of long-term care for elderly people, both in their own homes and in other settings, and to recommend how, and in what circumstances, the cost of such care should be apportioned between public funds and individuals. I have placed the full terms of reference in the Library of the House.

The commission will consider the implications of its recommendations for younger people who have long-term care needs because of illness or disability, and will have regard to the Government's continuing review of pensions.

The Government want both sound and swift advice, so the commission has been asked to report within 12 months—thus it will be different from previous royal commissions. This royal commission will be different from its predecessors in other ways, too. In the past, some royal commissions have included representatives of pressure groups that were involved in the topics to be covered. This one does not. The commissioners are not supposed to be representatives. They are there to take a fresh look. However, pressure groups and representatives of users and carers should have their say, so the commission will establish a reference group of organisations to help to gather views and receive advice.

The chairman of the commission is today inviting a range of organisations to serve on that reference group. It will include charities and other groups that are involved in long-term care, the financial services sector, the health service, local government and other service providers, together with representatives of the major religious faiths in the United Kingdom. By that means, the commission will be able to draw on the most up-to-date experience of users and carers.

The commissioners will make visits throughout the country to listen to other users and carers. They plan to be "out and about," so that they can really get the full flavour of the current concerns in different parts of the country.

The task of this royal commission is neither simple nor easy, but it is important. The present situation cannot go on much longer. People are entitled to security and dignity in their old age, so we must find a way in which to fund long-term care which is fair and affordable both for the individual and for the taxpayer. With the independent advice of the royal commission, I hope that we shall be able to establish a consensus from which we can fashion a sustainable system of long-term care that will meet the needs of elderly people well into the new century.

Mr. John Maples (Stratford-on-Avon)

This is a very serious problem; a long lead time is required to do anything through policy changes. Before the election, the Labour party was critical of the means test and of people being forced to sell their homes, but its only policy was to set up a royal commission. I am concerned about the use of a royal commission. It is usually a way of kicking things into the long grass for a long time.

Will the Secretary of State assure us that he will ensure that it sticks to the 12-month timetable, unlike the previous royal commission that was set up by a Labour Government, which was asked in the 1970s to examine the health service, and which succeeded in reporting two months after Labour had lost the 1979 general election—although, if that sequence of events is followed this time, we shall be happy to wait five years for it?

We also need a cast-iron guarantee on the timetable because of the Department of Health's failure to meet its timetable on the White Paper, which we expected in September, were told we would get in October and were promised in November. Will the Secretary of State assure us that we shall have it before Christmas? Is it true that the Prime Minister is so dissatisfied with the White Paper that he has taken over the drafting? Does that mean that the Secretary of State will be overruled on this, as he was on the formula one exemption? Will he assure us that his Department will not make as big a shambles of this as it has of the tobacco advertising directive? Today, his party's proposals have been contemptuously rejected at a meeting in Brussels, where he has succeeded in putting a new blocking minority in place.

Anyone who fought the election knows how important long-term residential care is for the elderly. People feel that it is desperately unfair that the present system often requires them to sell their homes before they qualify for public funding, but we all know that, without a means test, public spending would soar, and, with an aging population, the problem is getting worse.

During the previous Parliament, the previous Government raised the means test threshold substantially and, in May 1996, they published a White Paper entitled "A New Partnership for Care in Old Age". We proposed a partnership scheme to encourage people to take out insurance, enabling them to protect an additional £1.50 of assets for each £1 of insurance. Our Community Care (Residential Charges) Bill would have achieved that.

As the royal commission will take some time to report, will the Secretary of State consider bringing that Bill back before the House as a Government Bill, because it would give relief to many elderly people who will not be able to afford to wait for the royal commission to report? Will he ensure that the Bill's proposals are put before the royal commission?

We know that about 5 per cent. of 75 to 85-year-olds and 20 per cent. of people aged over 85 go into care for an average of about three years, at an average cost of £15,000 to £20,000. Does the Secretary of State agree that that is a clearly insurable risk, and that the solution in the long term must lie, at least in part, in greater private provision, via increased saving through pensions or life insurance, or some similar arrangement? Will he ensure that the royal commission examines how private savings might help to finance long-term care for the elderly, whether such provision should become a required part of people's pension packages, and, if so, how that might be encouraged?

Saving against the possibility of requiring long-term care through a working lifetime is feasible for a great many people, but it will take a generation to have a noticeable effect. Does the Secretary of State agree that we need schemes now that will enable more people to bear the costs of their care, while protecting their assets from the means test? Will he ensure that the royal commission looks carefully into possible ways to achieve that?

Will the right hon. Gentleman also ensure that the royal commission looks objectively at the relative merits of local authority and private sector provision and, in particular, at the way in which such competition is often stacked by local authorities in their own favour? Is he aware that several Labour-controlled local authorities are flying in the face of the law by giving active preference to their own homes? Will he ensure that the royal commission considers our proposals to separate the functions of commissioning care, providing care and acting as the inspector of private care homes? Does he agree that it is not right for all those functions to be in the same hands?

Finally, will the Secretary of State give the royal commission an honest estimate of the additional cost of running such homes that will arise from the imposition of a minimum wage?

Mr. Dobson

The chairman of the royal commission has been asked to complete the work of the commission within 12 months, and has said that he will. I have a suspicion that he will convince the other members of the commission that they had better do what he wants, so I am confident that, subject to the usual caveats, they will do it within 12 months. I am not prepared to speculate on the conclusions that they may come to. There would be no point in appointing a group as distinguished and independent-minded as these people are, if I were to lay down the law as to what they could conclude before they had even met. We were used to the Tories as a Government of know-alls, and it appears that they are now the Opposition of know-alls and they want to tell the royal commission what to conclude. That is not our approach, even if it is that of the Tories.

We and older people in this country want a properly thought-out system—not a few spatchcocked arrangements— that will work to their advantage, will stay in place and will preferably commend the consensus support of all parties and thinking people at the end of the process. That is what we are aiming to do.

Mr. John Austin (Erith and Thamesmead)

Will my right hon. Friend confirm that the question to be addressed by the royal commission is not whether we can afford adequate long-term care, but how it is paid for? Does he share the view of the Select Committee on Health that we do not face a demographic time bomb that requires panic measures? Does he also share the view of that Committee that nursing care is a function of the health service and ought to be provided free, no matter what setting it is provided in?

Mr. Dobson

Again—forgive me for my laryngitis or whatever it is, Madam Speaker—my hon. Friend is certainly right to say that the question that has to be addressed is how we put in place arrangements for looking after elderly people properly. I am sure that that is what everyone wants. As for the demographic time bomb, it is worth pointing out that we expect an increase in the number of the very old of about 100,000 in the next decade, whereas that number has increased by 300,000 in the past decade. Therefore, in some senses at least, if one describes the next decade as the immediate future, the pressures will be declining rather than increasing. The object must be to ensure that all those who are growing old are looked after properly whatever their incomes, wherever they live and whatever their circumstances.

Mr. Simon Hughes (Southwark, North and Bermondsey)

As distinct from the Conservative Front-Bench spokesman, I welcome the creation of the royal commission and will not take issue with the Secretary of State today on matters that have nothing to do with his announcement.

First, can the right hon. Gentleman say whether the commission is to consider long-term care for the elderly alone, or whether that is intended to include the care of other members of society, such as people with disabilities and the frail, who are also in need of such care? Secondly, will he say that the commission has been asked to study the needs both of present pensioners, who are in an established position in terms of what they expect, and of those who will become pensioners, as the two groups are in different situations?

Thirdly, and very important, will the right hon. Gentleman ensure that the Commission pays particular attention to those who are being looked after at home?

That raises issues not only of domiciliary care and carers, but of the provision of care local to home. Take a constituency such as mine: many of the places to which one can go for care are in Eastbourne, which is hardly any good to someone who wants to stay with family in south London. The situation is the same in many other parts of the country.

Fourthly, will the commission have a remit to look into issues of prevention, rehabilitation and medication, which are relevant to how people can best be looked after? Is the commission to have the responsibility of ensuring that the quality of care is assured? I have been to many places that allegedly give care, but are more than grim and basically consign people to a live of inactivity—dead ends, which have nothing to do with care, loving support or attention.

Finally, I want to pick up on the question asked by the hon. Member for Erith and Thamesmead (Mr. Austin). Will the Secretary of State make it absolutely clear that, among the options that the commission may put forward, it will be able to include the option that either national health service care or all care should be publicly funded? Will he make it clear that there will be no assumption on anyone's part—not least that of the Government—that all future care for the elderly will have to be privately funded through private insurers? Unlike the Tories, we do not think that that is an automatic solution to everything.

Mr. Dobson

I thank the hon. Gentleman for his general welcome. I thought that I had made it clear in my statement that, although the royal commission will focus on long-term care of the elderly, it will bear in mind the impact of any propositions that it puts forward or principles that it enunciates on other, younger people who are in need of long-term care. The commission will certainly address the needs of present pensioners and, even more certain, it will address the needs of those who, like everyone in the Chamber, have every intention of becoming a pensioner. We also want it to look at care provided either in people's homes or outside. That applies to local services that can make it possible for people to live in their own home, provided that it is just down the road and is of decent quality.

On the issues of health care and prevention, at least four people on the commission are professional experts in geriatric care and are concerned not only about the generality of provision, but about the quality of provision. I am sure that they will go into those issues. The question of funding remains open: we want the advice of these people of intelligence, who have knowledge of various spheres. It is fairly likely that, in the end, there will be a proposition that some of the funding should be paid by the individual and some by the taxpayer. I am not telling the members of the commission that they should come to that conclusion, but I would be amazed if they did not.

Audrey Wise (Preston)

May I, too, give a fairly cautious welcome—but a welcome nevertheless—to the setting up of the royal commission? There are some knotty problems to be sorted out and, as long as the commission's work is not distorted into deciding how to design private insurance schemes, it might well be a valuable exercise. In the meantime, does my right hon. Friend accept the principle that there should be national standard setting and registration of those who go into people's homes to give domiciliary care? That is not currently regulated. Surely those who are vulnerable are entitled to that protection.

Mr. Dobson

I can give my hon. Friend the guarantees that she requires. We have already made it clear that we intend to put in place a national setting of standards and a national enforcing of standards for domiciliary care. That will be spelled out in a White Paper, to be published next year, before the royal commission has reported.

Sir Nicholas Lyell (North-East Bedfordshire)

The Secretary of State is right to recognise that the way in which we are enabled to provide for ourselves in old age is one of the great challenges of our generation. Therefore, we welcome his announcement to that extent.

Does the right hon. Gentleman recognise also that the Chancellor of the Exchequer has recently made a series of attacks on pensions and seems to threaten a series of further attacks on savings? Will the right hon. Gentleman ensure that the royal commission's recommendations are borne carefully in mind by the Chancellor before he makes any such further attacks, lest he should weaken the opportunity of individuals to care for themselves, which the right hon. Gentleman clearly recognises is one of the solutions to a difficult problem?

Mr. Dobson

I have noticed that my right hon. Friend the Chancellor of the Exchequer has attacked pensioners by giving them extra money for this Christmas. He has attacked them also by reducing the rate of value added tax on fuel. I cannot tell the royal commission what to do, and when it reports, I have no doubt that its findings will have an impact on what the Government do. If we are really fortunate, its report may influence even the Opposition's thinking.

Mr. Robin Corbett (Birmingham, Erdington)

May I commend my right hon. Friend's statement, as will 20,000 elderly residents in my constituency? May I urge the royal commission to pay particular attention to the essential component of consulting both public and private providers of housing? Will my right hon. Friend undertake to consider transitional arrangements until any recommendations that the commission may make are put into place, which could be three or four years away?

Mr. Dobson

The royal commission will be putting in place, at my request, a great deal of machinery for consulting people in both the private and public sectors as well as the voluntary sector. I cannot give my hon. Friend any guarantees about putting temporary arrangements in place, because I do not know what the commission will recommend. As I have said, we believe that the present situation is so unsatisfactory that it cannot be allowed to continue for much longer.

Mr. John MacGregor (South Norfolk)

Everyone recognises the importance of new policies and actions to deal with the new challenges that we face in these areas in the years ahead. However, there is often wide suspicion that setting up a royal commission is a means of procrastinating instead of introducing policies and actions. Can the Secretary of State possibly justify spending seven months setting up a royal commission and then asking it to report within 12 months? How can he possibly justify such a delay in setting up the commission? Given this further example of dither and delay on the part of the right hon. Gentleman and his colleagues, will he give an assurance that when the commission reports, he will demonstrate much more urgency than he has shown in setting it up?

Mr. Dobson

I shall quote some figures. We had 18 years of the Tories doing nothing, and within seven months the Labour Government have recruited an extremely distinguished group, led by an extremely distinguished chairman, who is happy with the proposition that the work should be done within 12 months. If the work is done within 12 months, that will be 18 times better than that which the Tories did.

Mr. Dennis Skinner (Bolsover)

Is my right hon. Friend aware that one of the constant problems of Members of this place is dealing with the complaints that we receive from our constituents whose relatives are residing in residential homes that are not run as well as they should be? Will my right hon. Friend give an assurance that that is a likely area to be examined, given that there is a distinction between homes that are controlled by the local authority and inspected by it and those that are controlled and inspected by the health authority, where there is no democracy?

It is my experience that I can cause inspections to be carried out much more quickly when the local authority has accountability and there is democracy than I can when the home comes under the health authority, where those responsible are either indirectly elected or not elected at all. Will the royal commission's attention be drawn to that matter, so that we can assure people in future that we in this place will be able to take up their complaints in a proper manner?

Mr. Dobson

I can give my hon. Friend the guarantee that he requires. We are determined to improve the regulation of provision for old people in residential homes, whoever provides those homes, because it is not satisfactory at the moment. I shall go further and say that, because we are dissatisfied with the treatment of some old people in general hospitals, I have asked the Health Advisory Service to produce a report on the treatment of elderly people in general hospitals. The situation is simply not satisfactory, and must be changed.

Sir Teddy Taylor (Rochford and Southend, East)

I wish the commission well. Will the Secretary of State ask it to look urgently at the nightmare in Essex and some other places, whereby a huge amount of public money is wasted and a great deal of distress is caused within families because of people being retained in hospital beds for the simple reason that local authorities cannot afford to fund retirement homes? Will he ask the commission to look at that serious problem, which also existed under the previous Government, and, perhaps, consider whether the remedy might be to transfer the responsibility for paying for homes from local authorities to health authorities?

Mr. Dobson

I agree that the situation is unsatisfactory. Beds in general hospitals are occupied by people who would be better off, safer, more secure and healthier at home. We took considerable steps over the summer—in preparation for this winter—to try to make it easier to get people back into their own homes or other residential care. Some of the additional £300 million that we have given to the national health service for this winter will be spent on social services. I made it clear that no one would get any of that money unless they had a joint programme with their local social services department to stop old people being taken into hospital unnecessarily or staying too long in hospital unnecessarily.

Mr. Gerry Sutcliffe (Bradford, South)

I welcome my right hon. Friend's statement. The timetable that he has set the commission is indeed tight, but is not one reason why we are having a royal commission the political dogma of the Conservatives when they were in government? They would not let local authorities keep homes that provided good accommodation and services, and they pushed everything into the private sector and caused a great deal of concern among elderly people.

Mr. Dobson

There is a great deal of truth in what my hon. Friend said.

Mr. Nicholas Winterton (Macclesfield)

I personally, from the Conservative Benches, warmly welcome the Secretary of State's announcement. It brings the prospect of an end to the grotesquely unfair situation today, in which many elderly people who have worked hard during their lives, who have saved and been wise and thrifty, have to spend all their savings—sometimes including the asset of their own home—on paying for residential care. That is grotesquely unfair and causes a great deal of resentment.

I am grateful to the Secretary of State for the very talented people whom he has appointed to the commission. Professor Robert Stout, from Belfast, is a man for whom I have great regard, and Robin Wendt was not only the secretary of the Association of County Councils but chief executive of Cheshire county council. Will the Secretary of State give me an assurance that when the royal commission reports to him and to the House, legislation will very quickly follow?

Mr. Dobson

I thank the hon. Gentleman for his welcome and for his very appropriate but generous comments about the members of the royal commission, who, indeed, are very distinguished. I cannot give him a guarantee that legislation will immediately follow. He is an older hand than me, and he will know that I cannot guarantee parliamentary time, but I can say that my statement was made on behalf of the whole Government, and we believe that the present situation cannot be allowed to continue for much longer.

Mr. John Gunnell (Morley and Rothwell)

I thank my right hon. Friend for his statement. Is he aware of the fact that many social services departments are now under such pressure that they do not make assessments if they feel that they will be unable to meet the need? The Select Committee on Health intends to produce its report on the relationship between health and social services during the current Session. The timing of that report will ensure that it is available to the commission that he has announced. I hope that he will do his best to ensure that the commission is ready to take advantage of that thorough study of the way in which the structures could help to provide for the part of the service that should remain in public hands.

Dobson

I thank my hon. Friend for his comments. He draws on a vast depth of experience in those matters. I am sure that the royal commission will welcome the report of the Select Committee on Health as soon as it is available.

Mr. Simon Burns (West Chelmsford)

May I say in passing that one of the right hon. Gentleman's political knockabout lines was extremely unfair to the dedicated civil servants in his Department? I know from first-hand experience that they have worked hard on long-term care.

Last winter, the previous Government made a number of announcements on regulation, registration and improvements on the split between residential homes and nursing homes. The Labour party, which was then in opposition, warmly welcomed some of those moves. Why is a White Paper required next year, given that time could be made up by going ahead with some of the proposals that the Labour party welcomed?

Mr. Dobson

I made it clear in reply to what was purported to be the Opposition's official response to my statement that we want a well thought out, comprehensive proposal, and not merely odd bits and pieces introduced as and when. We shall produce a White Paper that will spell out our comprehensive response on certain aspects. I expect the royal commission to do a good job, and we shall carefully consider its report. We are under an obligation to do something about this problem, which has gone on for far too long. It certainly went on for a long time under the previous Government, who may have made proposals, but they never got round to doing anything about them.

Ann Clwyd (Cynon Valley)

As a member of the last royal commission to be established by a Labour Government, may I say how much I welcome the announcement of this royal commission? I particularly welcome the speed with which it is to report. The commission of which I was a member spent three years working on its report. I remember the chairman saying that it would be different from all the others because it would not gather dust. That report had the misfortune to fall on the desk of an incoming Tory Government. Does my right hon. Friend agree that, if that Government had acted on the report's recommendations, the NHS would not be in the mess that it is in today?

Mr. Dobson

I entirely agree with my hon. Friend. I shall say no more, because I need to save my voice.

Dr. Jenny Tonge (Richmond Park)

I know that the Secretary of State is aware of the difficulties that occur between health services and social services, especially when it comes to care of the elderly. Will he give us an assurance that the commission will examine ways of forging permanent links between health services and community health services, because that is where the delay occurs?

Mr. Dobson

I confirm that the commission will examine that issue. At the risk of falling foul of you, Madam Speaker, I predict that our forthcoming White Paper on the national health service will emphasise the importance of that issue, as will the other White Paper to which I referred.

Mr. Denis MacShane (Rotherham)

In warmly welcoming the Secretary of State's announcement and in deploring the rather churlish and mean-minded response by the official Opposition, which shows that they have learnt nothing and forgotten nothing, may I invite my right hon. Friend to ask the commission to consider that the founding premise, indeed promise, of the national health service—our insurance system of cradle-to-grave protection—has never, through its 50 years, been properly financed? In particular, the refusal of the previous Government to oblige all citizens to pay their fair share of inter-solidarity support has undermined it.

Can he assure me that the commission will look at collective provision, tax provision, mutual provision, compulsory insurance provision, such as exists for motor cars, and voluntary private provision? Finance is the key, and it must provide the answer. Labour can provide that answer, but the previous Government, because of their hatred of the NHS and local authority provision, refused to tackle the problem.

Mr. Dobson

I cannot guarantee what the royal commission's recommendations will be, but I can guarantee that it will examine all the options to which my hon. Friend refers.

Mr. Andrew Lansley (South Cambridgeshire)

Does not the Secretary of State realise that his statement will be cold comfort to one of my constituents who, at the general election, was reduced to tears at the prospect of having to sell her home to pay for residential care? Does not he realise that the Prime Minister used exactly that kind of example at the general election and said that he would do something about it? A scheme based on partnership funding through insurance was available. The Secretary of State has said nothing to show why it is not necessary and desirable to proceed with exactly that kind of scheme, which would provide assets for long-term care and give hope to people in that situation. He took seven months to initiate the commission and is allowing 12 months for it to sit. Heaven knows how long the Secretary of State will take to act.

Mr. Dobson

All I can say is that the old people in the hon. Gentleman's area and in the rest of the country will not be impressed by a Tory party that apparently thinks that it can carry conviction when it shifts from being Genghis Khan to Mother Teresa in the space of seven months.

Mr. John Bercow (Buckingham)

I thank the Secretary of State for his statement. While he is wise not to seek to prejudge the royal commission's conclusions, will he put it on the record that the terms of reference allow a thorough study of the private insurance and personal provision options? Will he take this opportunity—one that he has not been afforded to date—to acknowledge that much of what is already provided by the public and private sectors is admirable and that those who provide it should be congratulated? Does he accept that I genuinely hope that he shortly recovers from laryngitis, because we on the Conservative Benches wish him a long, healthy and happy retirement from the Front Bench?

Mr. Dobson

I can guarantee few things in this world, but I can guarantee that the royal commission will look at all the options that have been mentioned and perhaps many more. I certainly pay tribute to the quality of care and treatment that are provided for the majority of old people. Sadly, not all are in that majority. There are failings, and the present regulatory system has been quite unsatisfactory for a long time. We are sorting it out before the royal commission reports.

Dr. Peter Brand (Isle of Wight)

I am sure that anyone who has had to work within the present muddle of continuing care will welcome the statement. Will the royal commission also consider day care and its quality and funding as part of the continuing care package?

Mr. Dobson

I can guarantee that it is imperative that the commission looks at all aspects of care. Most people would rather stay in their own homes, where they have lived for donkeys' years and where they feel comfortable and know the neighbours, than have to be moved out because they are no longer capable of being sustained at home. The ambition of all hon. Members is to stay in their own homes, and that is what most other people want. We must provide services to people's homes and perhaps local services that they can just about toddle out to, provided crime and disorder are not at such a level that they are frightened to do that. That is a major consideration for old people. We must improve the quality and availability of those services. I expect, but I cannot guarantee, that the royal commission will make recommendations on those lines.