§ Motion made, and Question proposed, That this House do now adjourn.-[Mr. Kevin Hughes.]
§ 10 pm
§ Mr. Michael Colvin (Romsey)I am very pleased to have won the privilege of making the first Adjournment debate speech in the Parliament, although I am sorry to be making it from the Opposition Benches. I endorse what was said in the previous debate by other hon. Members about your appointment, Mr. Deputy Speaker, to preside over our affairs. I wish you well, and I am sure that you will conduct our affairs from the Chair with distinction and good grace.
Long-term residential and nursing home care for the elderly concerns most of us who have an interest in politics—both at national and local level. During a general election campaign, there is certainly ample opportunity repeatedly to visit homes in our constituencies and to talk to many of the residents about the problems that concern them.
I had hoped that tonight would turn out to be an exclusively Southampton evening, representing as I do the Bassett and Swaythling wards of the city. My next-door constituency neighbour, the hon. Member for Southampton, Itchen (Mr. Denham), who is now a Minister in the Department of Social Security, might have replied to the debate. Both he and I have taken a very special interest in the problems associated with long-term residential and nursing care for the elderly and therefore joined in applauding the campaign run by our local newspaper, The Southern Evening Echo, which was the first paper to draw attention to the crisis in long-term care and the iniquitous impact of the means test rules on families who had saved or had bought their homes.
From early 1995, the newspaper consistently campaigned under the slogan "The Old Guard" for a change in the rules in order to allow elderly people in residential and nursing homes to keep their savings, homes and any inheritance that they intended to pass on to their children. "The Old Guard" campaign was taken up by other newspapers and helped to create the climate that led to the previous Government raising the assets disregard to the new threshold of £16.000.
Given that the lead Department on the subject is now the Department of Health, I am pleased to welcome the Under-Secretary of State for Health to the Dispatch Box and congratulate him most sincerely on his appointment. He has a reputation for being sharp-witted. He is a sharp dresser, and I trust that we will hear some sharp answers to the three questions that I shall put to him, about which I told his Department earlier.
I should first set out the scale of the problem. Thanks to the growing success of the national health service, we are all living longer. The number of over-65-year-olds will have grown by 50 per cent. by 2030. In 1945, there was one pensioner for every five workers, but by 2030, there will be three pensioners for every five workers. At present, there are 330,000 people in residential care homes and 170,000 in nursing homes. The demand for both will increase substantially.
Secondly, long-term care costs are met by an accumulation of funding from the individual, social services and the NHS: £3 billion a year from private 153 individuals in residential care, £6 billion from local authority social services departments and £8 billion from hospital community health services. A residential care home place can cost around £250 a week, and a nursing home place £350 a week. In the London area, the costs are some 25 per cent. higher. The average cost of a complete stay per individual is £36,000 in a residential home and £26,000 for the usually shorter stay in a nursing home. Therefore, we are talking about substantial amounts of money.
The proportion of the burden falling on individuals is determined by the means test, which needs a radical overhaul, and that is the third problem. The care provided in residential and nursing homes is intended to meet almost all an individual's needs. The means test takes into account most of the resident's resources in assessing his or her contributions towards those costs.
The 1995 Budget set a new higher ceiling of £16,000 of capital assets, above which all costs needed to be met by the individual. That tapers down to £10,000, below which all the costs are met by the taxpayer.
The higher disregard limits are welcome, but they do not prevent an estimated 40,000 homes a year having to be sold in order to help to pay nursing costs, because the value of the home is generally taken into account in the means test.
There are exceptions to that. The social services authority must ignore the value of the home where it continues to be occupied by either a husband or wife or a partner who lived with someone in residential care as if they were married, or a relative who is aged 60 or over or incapacitated, or a relative under 16 whom a person in residential care is legally liable to support.
There is, however, deep and mounting public concern about the means test. Most people now own their own homes and many feel acute anxiety about having to sell them to meet all or part of their care costs. That anxiety is likely to grow in future, particularly as home ownership among people over 80, which is the group most likely to need care, is expected to rise to about 70 per cent. during the next 15 years.
There is also the vexed question of conflict between people who need care services and the ability of the local authority to pay for all those services. A final legal appeal to the House of Lords—the Gloucestershire case—looked at that conflict. The Lords judgment means that, if local authorities have insufficient resources to meet all care services demands, they can tighten the eligibility criteria for their services.
Age Concern, which campaigned hard and long on the matter, believes that that is contrary to the intention and spirit of the community care legislation to enable people to live in their own homes rather than having little option but institutional care, thus putting additional burdens on taxpayers.
Another recent High Court judgment involving the metropolitan borough of Sefton means that, if a local authority has insufficient resources, older people in homes may have to spend nearly all their savings before authorities help financially.
In a recent case concerning Somerset county council, which was reported in The Times, the High Court ruled that a man who had given up his job to look after his ailing mother must sell his home to pay for her care. That 154 landmark ruling means that people who move back into the family home to look after someone who is ill risk losing the roof over their heads if the sick relative has to move into residential care.
The implications of those judgments are alarming for anyone who has any savings or assets which may be taken to pay for care costs. They also conflict with other measures proposed by the previous Government to give some financial help and therefore partial protection of assets.
So much for the background. I now have three key questions for the Government. First, why cannot the family home be fully disregarded in the means test? If the owner goes into a residential or nursing home the family home could then be let on a shorthold tenancy from which the rent should be tax exempt if it is used to pay part of the residential or nursing home costs.
My second question relates to the previous Conservative Government's consultation paper "A New Partnership for Care in Old Age", which was published just over a year ago. It built on the success story of the tax-approved occupational and personal pension schemes, which were designed to encourage people to save for their retirement. Those incentives proved effective, and more than 17 million people are members or beneficiaries of occupational pension schemes and about 7 million people belong to personal pension schemes worth more than £600 billion in total in the United Kingdom, which is more than in the whole of the rest of the European Union put together.
The Conservative Government also proposed a new option for disregards based on the amount of money paid in premiums for immediate needs annuities. Under their proposed partnership scheme announced on 12 March, those who choose to take out partnership insurance to cover the costs of their long-term care would receive extra protection of their assets of £1.50 for every £1 of insurance value covered. Thus, £20,000 of insurance cover would protect £50,000 of assets in addition to the £16,000 means test threshold.
The partnership scheme would also provide protection for people who required care in their own home, and would help people currently in care or about to go into care. For those who cannot take advantage of the partnership scheme proposals, the state would continue to honour its obligations to provide long-term care. However, the more people who go down the insurance path, the more public money is available to assist others in real need. The House would welcome the Government's views on those proposals this evening.
My third and last question is about the Government's own plans. I looked in the Labour party's general election manifesto for a policy on funding for long-term care for the elderly. Like many other policies, it was missing. There was lots of politics but not many policies. Instead, we found a promise of yet another royal commission to work out a fair system for funding long-term care for the elderly and a charter to define standards that people could expect from health, housing and social services. I look forward this evening to hearing the Under-Secretary tell us a little more about the Government's terms for the royal commission.
I hope that the royal commission will include in its work a thorough review of the way in which local authority social services departments and local health 155 authorities determine who pays what when the criteria for help with nursing charges are met by residents. We want to see the end of the arguments that can occur between authorities over assessments and payment obligations.
When people reach old age, they want independence, choice and dignity. They do not want to be a burden on their families or the state. Many of them want to help their children by passing on some of their savings or other assets. I believe that the proposals that I have outlined would help people to achieve all those objectives. I trust that the new Government's plans will do likewise. If they do, the campaign called "The Old Guard", to which I referred earlier, will have won a victory. The continuing care conference, Age Concern, Help the Aged, the Carers National Association and the Registered Nursing Home Association, all of which have campaigned long for reform, would welcome such a move as progress. The nation as a whole—facing up to the spiralling cost of the welfare state—will raise not only a cheer but a sigh of relief.
§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)The quality and security of the provision made available for the long-term residential care of the elderly is the hallmark of a civilised society, and one by which we will all be judged. Therefore, in the first Adjournment debate of this Parliament, and under what all parties in the House believe will be a distinguished term of deputy speakership for you, Mr. Deputy Speaker, it is entirely fitting, right and appropriate that the House should deal with this issue, not least because it is of such particular concern to so many of our fellow citizens, who are at the age when either they are approaching it or their family members are affected by it.
The hon. Member for Romsey (Mr. Colvin) referred to the national health service and all that flows from it, and I am sure that he will understand why, as the first Labour Health Minister for 18 years to have the privilege and responsibility of addressing the House, I shall take the opportunity to set out briefly the Government's intended approach to general health policy, before I move on to deal with the specific concerns that the hon. Gentleman raised, and the three questions that he asked the Government.
The national health service is the Government's—the Labour party's—greatest achievement; it is the nation's most valued institution. It will shortly enter its 50th year, and we intend that anniversary to mark a new beginning for the service. We want our country to have a national health service of which it can feel proud again. We want a national health service in which the millions of patients who rely on it can also feel a sense of pride and value, in which the staff who work with such dedication and commitment can also join.
We must face the fact that the stewardship of the national health service by the Conservative Government, of which the hon. Member for Romsey has been a steadfast and loyal supporter these many years, has been found wanting in many respects, as has its approach to the long-term care of the elderly.
What the new Government say is that we will listen to the concerns of all the people about the national health service. We shall harness their energies and their talents 156 in rebuilding that sense of partnership that is essential if the NHS is again to become the envy of the world. That is why action in that regard was signalled today in the Gracious Speech, and why it lies at the heart of new Labour's vision for a new and better Britain.
However, action to review the NHS is only one part of our programme to make this country a healthier place for all our people. That is why the Prime Minister made clear today the importance that we attach to public health, which was signalled by the appointment of the Minister of State, Department of Health, my hon. Friend the Member for Dulwich and West Norwood (Ms Jowell), to take on that particular responsibility.
We are concerned to prevent people from falling ill in the first place, and to promote higher standards of public health throughout our society. We want to address the systematic causes of ill health that can affect everyone, whether those be air pollution or drug abuse, poverty or poor housing.
We must also recognise that raising the standard of public health and renewing our health care system is part of a wider programme that must be integrated. It must have within it a special place for the long-term care of the elderly, and for the interface between the NHS and the social services that is so vital if we are to get things right. We are determined to address that question too, because it lies at the heart of ensuring that we succeed in responding to the challenges that long-term care of the elderly presents.
Turning to the specifics raised by the hon. Gentleman, our policy is to ensure the best possible care for those who need it. We intend to ensure that that care is delivered in a way that focuses on outcomes for the user. We will drive up standards and ensure best value for money, and we will make sure that public money is used to deliver good-quality care for those who need it. We have already met the local government associations to begin that process. We have signalled our clear commitment in this area, and they have responded positively.
We are committed to the principle that, as far as possible, people should be given the support and services that allow them to remain at home. We recognise, as does the hon. Gentleman, the importance that people attach—particularly in their later years—to the home in which they have lived all their lives and which, if they are home owners, they hope to pass on to those they leave behind. The tragedy of Government policy in the past few years is the way in which that hope has been dashed for so many, as the hon. Gentleman recognised.
We are committed to the principles of planned care: to assessing the needs of the individual effectively and to seeing how those needs can best be met. We must recognise that there is no longer widespread confidence in the long-term care system. On the contrary, particularly with regard to residential care, there has been growing concern and a sense of insecurity that "The Old Guard" campaign—to which the hon. Gentleman referred and which he and the Under-Secretary of State for Social Security, my hon. Friend the hon. Member for Southampton, Itchen (Mr. Denham) supported—reflects. There are real worries, real fears and a demand for change.
The people feel betrayed-and rightly so. They are concerned about the cost of residential care and about seeing their lifetime's savings depleted. They are 157 concerned that the homes that they have worked to pay for all their working lives will be swallowed in fees. They are concerned also that, if the council does not help to pay for their residential care, they will receive second-class care that they must top up from their own pockets.
We are no longer prepared to countenance the continuation of a two-tier system. We are determined to set in place a framework that ensures a fair system and provides good-quality care for the many, not just the few. We shall promote equity of access, opportunity and choice.
I make one thing absolutely clear to the hon. Gentleman as I begin to answer his three questions: we believe in choice. Dogma will not rule the day under this new Labour Government. Such dogma has led previous Governments, which the hon. Gentleman supported, to recite time and again—so that the people of this country are sick of hearing it—the mantra that private is good and public is bad. We do not go in for that sort of dogma. I do not claim that the hon. Gentleman has recited that mantra, but he sits on the same side as those who have and he has passed through the Division Lobby time and again in support of those who have.
We have no time for dogma. We shall ask one question: how do we get best value, and what meets the care needs of the individual and the community? In asking that question, and in requiring social services departments and the national health service to address it, we believe that the public interest will be best served. Our objective is consistency and fairness. We will introduce a long-term care charter that tells people the standards and the services that they are entitled to expect from health, social services and housing. We will discuss the charter with users of the service as we prepare it, to make sure that their views are taken on board. Another difference between this new Government and the previous Government is that we believe in consultation and in listening to the people.
The previous Government, who were recently so resoundingly defeated at the polls, belatedly began a process of consultation on insurance provision as a response to the crisis in long-term care. I must tell the hon. Member for Romsey that the overwhelming message from the responses received to that consultation was hostile to the previous Government's proposals. The responses were hostile because people saw the proposals as piecemeal and unfair, and because they believed that the taxpayer would, in effect, be required to subsidise the private insurance industry. We will not go down that road.
We want to work for the many and not for the few, and I am here to tell the hon. Member for Romsey that we will not proceed with the previous Government's proposals in 158 that regard. We are looking for a new way forward and, in due course, my right hon. Friend the Secretary of State will outline how we propose to consult and to engage the skills, enthusiasm and commitment of the many voluntary and private sector institutions, local authorities, academia and others that have addressed their minds to the challenges that exist in the provision of care for the elderly.
We recognise that there are no easy answers, and it is a mistake to believe that there are. I know that the hon. Member for Romsey, who has made a particular study of this matter and has real concerns, does not make that mistake. There are costs and charges that must be borne by the Revenue and we have a duty to protect taxpayers' money, as well as to ensure equity, fairness and universality in the provision of care. We will do that. My right hon. Friend the Secretary of State will announce how we intend to take forward our manifesto commitments in this area. The hon. Member for Romsey need have no fear on that score.
There will be an opportunity for the hon. Member to make such input as he sees fit to the process, which will be designed to arrive at a genuine national consensus around this issue. For us, consensus is not a dirty word. For us, consensus on how we provide for our senior citizens—"The Old Guard", as they have been described in the Southampton campaign—is a critical issue that we do not intend to shirk. He will have an opportunity to put forward his interesting proposals. I tend to feel that they are flawed in respect of the potential burden they place on the Exchequer, and in terms of the disparity of treatment between those who have houses capable of being let and those who do not. Nevertheless, his proposals are welcome and will be considered in due course.
The debate will continue, and we are grateful to the hon. Member for Romsey for enabling it to take place tonight. As I have outlined, we will ensure that the universality and equality of access that are vital to a fair system of residential care—working in the interests of the many, not the few—will be safeguarded. On this, the first day of a new Parliament, we can and must look to the future and not allow ourselves to be buried in the battles of the past. I hope that the hon. Gentleman will seize the opportunity in the campaign in which he and my hon. Friend the Under-Secretary of State for Social Security are engaged to work together with the public and independent sectors to arrive at a better provision for those whose age or infirmity require—
The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order. Adjourned accordingly at half-past Ten o'clock.