HC Deb 01 March 1999 vol 326 cc741-52 3.31 pm
The Secretary of State for Health (Mr. Frank Dobson)

At the general election in May 1997, we promised to set up a royal commission on the long-term care of the elderly. In December 1997, I announced to the House the establishment of that royal commission, to be chaired by Professor Sir Stewart Sutherland, principal and vice-chancellor of Edinburgh university.

Since then, the commission has met formally on 15 occasions, taken oral evidence from 67 individuals, conducted seven public hearings in different parts of the country and received evidence from 400 organisations and a total of 2,040 written submissions. Between them, the commissioners met over 1,000 individuals, made more than 100 visits and held 140 meetings. They were assisted by a reference group representing the leading organisations concerned with the care of the elderly.

The commission presented its report to me on Friday 26 February, after it had been submitted to the Queen. It is being published today. I am grateful to Sir Stewart Sutherland and all the members of the commission for their diligence and the swift delivery of their report. All 12 commissioners signed the report. Two of them have submitted a note of dissent on three particular aspects—and even they were not unanimous.

The task of the commission was to look into how best to provide sustainable long-term funding for good-quality care of the elderly and how the costs should be shared between taxpayers and the individual. The report rightly makes it clear that there is no obvious answer and calls for an "informed debate" on the recommendations. I support that call. The Government's response must await the outcome of that debate, which I hope and expect will begin with the publication of the report today. [Interruption.] I shall not divert my remarks to respond to the ridiculous noises from the Conservatives.

I hope that it will be useful to the House for me to highlight the royal commission's major conclusions and recommendations. First, it concludes that there is not a demographic time bomb that our economy and society cannot cope with. Secondly, it concludes that the possible need for long-term care is a risk that cannot be met adequately from individual income or savings, so some pooling of risk is necessary. Thirdly, it concludes that private insurance will not deliver the necessary cover at an acceptable cost. Fourthly, it concludes that the costs will have to be met by contributions from the taxpayer and individuals. Fifthly, it concludes that the costs of long-term care can and should be separated into living costs, housing costs and personal care costs. Sixthly, it recommends that people receiving care should be expected to contribute to their living costs and to their housing costs, but the costs of their personal care should be met by the taxpayer.

The note of dissent rejects that separation and the proposal that individuals should not contribute to the cost of the care element. It gives greater priority to the quality of care.

The commission estimates that to adopt its proposals would cost the taxpayer between £800 million and £1.2 billion a year at 1995 prices. It estimates additional costs to the taxpayer of lesser options such as a short-term disregard of house value at £90 million a year; changing the limits of the present means test at between £150 million to £200 million a year; and making nursing care in nursing homes free at £220 million a year. As the report states: This is a complex issue and none of the options is easy. We have to get this right.

In considering the commission's proposals, we will all need to bear in mind, first, that taxpayers' money used to relieve the costs to individuals cannot be used also to improve the quality of care or to extend it, although that might be a higher priority for some older people. Secondly, the proposals, like all aspects of taxation and benefits, would shift money from one income group to another—in this case, to some better-off people from some who are worse off. The report recommends that the best way to help carers is to improve the services provided for the people for whom they care. The note of dissent argues that priority should be given instead to respite care.

The report emphasises the need to improve cultural awareness in services offered to ethnic minority elders. It also recommends that the Government should consider applying to the personal care needs of younger disabled people the same principles that they recommend for the care of the elderly.

While the commission has been sitting, the Government have been getting on with making improvements to the treatment and care available to elderly people. We have already made a start on a number of aspects covered by the report. These include: extending direct payments to over-65s; breaking down barriers between the health and social services; improving local standards through the long-term care charter—a clear manifesto commitment; changing the law to allow local NHS and local councils to pool budgets; providing £750 million over three years for initiatives to promote rehabilitation and prevention; providing for more consistent standards of care in health and social services; preparing for independent inspection of nursing homes, old peoples' homes and social care through regional care commissions; starting work on a national service framework for older people to lay down how the NHS and local councils should provide them with high-quality services in every part of the country; encouraging care providers to promote independence rather than dependency; and launching a new strategy for carers, financed with £140 million over the next three years.

We accept—as does the royal commission—that there is a strong case in principle for phasing out the payment of the £600 million of residential allowances and transferring those resources, via a special grant, to local authorities. However, we will need carefully to work through the implications of the change on both the benefit system and the independent care sector before we take any final decisions.

The royal commission's major recommendation—that a national care commission should be established to monitor trends, set standards and represent consumers—will need to be considered in the light of the changes that are already taking place or are in the pipeline.

The Government have been taking other action to help elderly people. Those measures include: restoring free eye tests for pensioners; commissioning a report from the health advisory service on the treatment of elderly people in acute hospitals; instructing all hospitals to take immediate action to improve the supply of bed linen, food and drink to elderly people; making a start on providing greater financial security by reform of the pension system; improving the Government's overall approach through the better government for older people initiative; and establishing an inter-ministerial group to take the initiative forward across Government.

Along with the rest of the country, the Government will study the report of the royal commission with great care. During our consideration, we will apply the principles set out in our welfare reform Green Paper—in particular: expecting people to insure against foreseeable risks and to make provision for their retirement; making sure that those most in need can enjoy a dignified and fulfilling life; providing public services of high quality to the whole community; and making sure that the system is flexible, efficient and easy to use.

At the general election, we committed ourselves to setting up the royal commission because we recognised that, although only one in five old people need long-term personal care, as people approach old age, many become anxious about how well they will be looked after, who will look after them, how much it will cost and who will pay.

I hope that the royal commission's report and the debate that it will stimulate will help us to find a way of ensuring that people have access to high-quality long-term care that is fair to both individuals and the taxpayer. I hope that it will be founded on a consensus that will stand the test of time: a dependable contract across the generations. That is of great importance because, second only to good health, elderly people seek financial certainty and security, and that is what the Government are determined to deliver.

Mr. Philip Hammond (Runnymede and Weybridge)

I thank the Secretary of State for his statement and for allowing me to have a copy of the report half an hour before he began to speak. I offer the apologies of my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe). Many hon. Members will know that she has recently suffered a family bereavement. We, too, will need time to study the weighty report, but we recognise the unfairness in the present system of financing long-term care, and the perverse signals that it delivers, penalising those who are thrifty and responsible and rewarding those who are not. The previous Government significantly raised the threshold for the asset test to bring some immediate relief. The problem requires an immediate response from this Government.

If the Government, having established a royal commission and delayed acting for two years, do not intend to accept the commission's recommendations, they must urgently propose alternatives. We have offered an alternative: a system of insurance as part of a partnership between the state and the individual that would protect people's homes and savings, bring security and peace of mind to those who have worked hard to accumulate assets, and go a considerable way towards removing the sense of unfairness in the present system.

Labour has rejected that eminently sensible approach. As several Labour Members observed over the weekend, Labour in opposition implied that a Labour Government would act swiftly and radically to tackle the whole problem; but, as with so many pre-election pledges, the Government have ducked the issue and, 22 months after the general election, 40,000 people a year are still forced to sell their homes to pay for long-term care.

The establishment of a royal commission gave the Government an alibi for inaction. That alibi is now gone, and the Government must tell the people of Britain what their policy is. The longer that they dither, the more people will lose their homes. What is the time scale for some definite proposals? Is not the truth that the Government would rather drive the issue into the long grass until after the next general election—another example of a cynical promise made to buy votes from the elderly and vulnerable at the previous one?

Media interest has focused on the recommendations on payment for the nursing element of care, and the main report has defined that very widely. Even so, at least half the total cost of residential care would not be met by the state even if the commission's proposals were implemented in full. The proposals on nursing care will not stop people being forced to sell their houses and consume their savings but they will impose a considerable burden on public spending.

The Secretary of State cited a figure for the immediate cost of the commission's recommendations. What is the estimated cost of those proposals projected forward to 2051, as calculated by the commission? A proper solution must address the whole problem, as it affects today's pensioners and those soon to retire, and as it affects future generations of pensioners: those who are in a position, if the Government send the right signals, to take a broader view of provision for care in old age.

The solution must be sustainable, not based on half-costed promises and blank cheques that future generations of taxpayers and politicians may decline to sign. Above all, it must be a fair solution that does not penalise those who have worked hard and saved, bought their own homes, and taken responsibility for themselves.

Does the Secretary of State acknowledge the problem, identified in the note of dissent, of under-resourcing by social services departments for independent sector placements, and the resulting pressure that that is placing on the independent care sector? What does he intend to do about that? Does he agree that it is scandalous that, while many people assessed as needing residential care are being forced to wait on a waiting list for it, some local authorities persist in wasting money on direct provision of care, which is often 40, 50 or 60 per cent. more expensive to provide than comparable or better care provided by the independent sector?

The Secretary of State said in his statement that he would consider this report in the light of the principles set out in the welfare reform Green Paper. One of those principles to which he referred is expecting people to be insured against foreseeable risks and make provision for their retirement. Does he regard long-term care as a foreseeable risk and, if so, does he intend to propose an insurance-based solution?

Mr. Dobson

I made no reference in my statement—because I would like to establish a consensus about the future of long-term care and its funding—to the fact that the present shambles is one that we inherited from the previous Government, who did virtually nothing about it over 19 years. The hon. Gentleman recommends to the House some measures that the previous Government were contemplating but did not get round to introducing in those 19 years. I refer him to paragraph 5.13 of chapter 5 of the report, which says of the scheme he talked about: The scheme as presented by the previous Government was rather complex, and it was difficult to see where the benefits lay, and to whom. That is generous royal commission-speak for, "It was a load of rubbish."

At the election, we made no easy promises. We promised that we would establish a royal commission. We set one up and it reported in the second-shortest period of any royal commission in the past 40 years. I am very pleased that it has done so and the time that it took is greatly to its credit. We will consider what to do in response to its detailed and thoughtful points and, in the case of the note of dissent, conflicting points that it has put to us and the whole country after its 14 months of deliberations.

I have spelled out the 10 steps that the Government are already taking, which are referred to in the report. Many of those steps are welcomed in the report. Far from postponing progress, we got on with things even before the royal commission started sitting. We are not interested in making half-costed promises. That is what the country got sick of under the previous Government. We want to consider the report carefully and listen to all the representations that are made by all the various interest groups in the light of the royal commission's proposals and the detailed background to them. Then we will come to some decisions.

Mr. Alan Duncan (Rutland and Melton)


Mr. Dobson

The hon. Gentleman who purports to sit on the Front Bench groans at that, but he did not groan during the 19 years in which his Government did nothing, nor when they made short-term and ridiculous decisions.

The hon. Member for Runnymede and Weybridge (Mr. Hammond) asked the estimated costs of the proposals in 2051. The estimated costs are more than £6 billion and, if they turn out to be true, I shall come back to haunt the House of Commons. No estimates over such a period of time have ever turned out to be true, and I am sure that these will not.

What we have in the report is a series of thoughtful points. The royal commission has gone into the matter in great depth and, in due course, we shall give our response to the new points that it has raised—just as we got on with 10 of the report's recommendations even before it was published.

Mr. Malcolm Wicks (Croydon, North)

I welcome the publication of the royal commission report. This morning, I met the elderly relative of a lady aged 91 who is in a nursing home. The relative had just had the sorry task of selling the lady's terraced house—worth £26,000—to meet nursing home costs. Does my right hon. Friend agree that it cannot be right for people in the final months of their lives to suffer from distress and uncertainty instead of enjoying dignity and comfort?

We need to consider the royal commission recommendations carefully, as the expenditure implications are significant. However, in an earlier era, people said that we could never afford a national health service, yet the country proved more optimistic. This is a big problem, and I urge my right hon. Friend and the Government to come up with a big solution.

Mr. Dobson

All I can say is that I have never said that we cannot afford the propositions advanced either by those commissioners who presented the note of dissent, or by the majority on the commission. The national health service was first established by a Labour Government, as a result of boldness and real commitment, and the welfare state was also established by a Labour Government. Both projects were implemented on a basis of consensus which even the Tory party of the day had to accept and which prevailed for 25 to 30 years.

That is what I want to achieve with the proposals for long-term care. We shall do no service to old people unless we can establish a system that, broadly speaking, commands the support of all the parties in the country, and of the people of this country. That is the only way in which we can provide the certainty and security that people want, and it may take us quite a time to wrangle out and agree what we should do. I hope that the odd Conservative Member might even see some merit in that.

Mr. Paul Burstow (Sutton and Cheam)

First, I thank the Secretary of State for his courtesy in allowing me to see the report shortly before his statement. We welcome the opportunity for constructive dialogue. What older people want more than anything in later life is certainty: if we can give them certainty by building a consensus about the long-term care system, we shall play our part.

Does not the royal commission report offer a practical means of ending the heartache and anger felt by many older people and their families when they are forced to sell their homes to pay for care? Does the Secretary of State understand how disappointed many people will be to learn that he has no plans to end the perverse financial incentive that means that elderly people go into nursing homes instead of being cared for at home?

Is the Secretary of State aware that the sum of £750 million to fund rehabilitation and prevention over the next three years, which he announced in his statement, adds up to little more than 71p per person per day? Will he say more about the timetable of the debate that he is launching? We need to know when the debate will be concluded, as do the people facing the prospect of selling their homes to pay for care.

When will the House see the Secretary of State's proposals to safeguard long-term care for the elderly? The Secretary of State was right to say that the royal commission, which considered more than 2,000 submissions over 14 months, was one of the quickest in recent years. There were numerous leaks from various quarters, and much raising of expectations. Does the Secretary of State agree that, although his statement contains many warm and encouraging words, it rests on cold economics? We need a debate, but when will the Secretary of State come back with his proposals?

Mr. Dobson

It is not me but the royal commission that is calling for an informed debate throughout the country, and I assume that the commission expects the Government to await that debate's outcome before reaching any major decisions. The hon. Gentleman suggested that I should immediately adopt as Government policy the proposal that people should—

Mr. Simon Hughes (Southwark, North and Bermondsey)

That is not what he said.

Mr. Dobson

Either I am deaf or the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) is stupid.

Madam Speaker

Order. I do not think that that was necessary. In addition, the Select Committee on Modernisation recommended that I have statements completed in 45 minutes. Many hon. Members are standing and, unless questions and answers are brisk, a lot of them will be disappointed.

Mr. Dobson

I was trying to answer the six or seven questions put by the hon. Member for Sutton and Cheam (Mr. Burstow), Madam Speaker.

The hon. Gentleman said that, if we agree that the state should pay for personal care, all the problems about people not being able to afford long-term care would be resolved. At least, that is what I understood him to say. However, it is not so. It is quite possible that, if people must pay their living and housing costs, some of them will have to make a contribution that they cannot afford. The problems will not be resolved by adopting in full the proposals of the royal commission.

The hon. Gentleman talked also about getting rid of the perverse arrangement that encourages people who are being looked after properly in their own homes to move out of them and into residential care. Unless my memory fails me, I thought that I had referred to our consideration of shifting the residential allowance so that it would be paid not to care homes, but to local authorities, as the royal commission has suggested.

Policy is moving in the right direction. In deference to Madam Speaker's reasonable wish that I should sit down quickly, let me add only that the royal commission has asked for an informed debate. Today starts that debate, and we shall respond at the end of it.

Mr. Frank Field (Birkenhead)

Does the Secretary of State accept that his distinction between the costs that all of us will have to meet in retirement—that is, for a pension—and the risk of long-term care costs that some of us will have to meet is most important in the debate for which he and the royal commission have called? On the pensions side, it is appropriate that we all save, but most of us will not need long-term care and there is a need for insurance cover. If such cover is made universal, the costs for each of us will be cheaper.

One further point arises from the distinction made by the royal commission on the covering of nursing home costs and hotel costs. Does the commission give any idea of the percentage of pensioners who currently cover those costs from their pension and other income? If it does not, could my right hon. Friend's Department provide that information so that the debate may commence? May I emphasise how right my right hon. Friend was to say that, if we are to have a lasting solution, we need to approach the problem on the basis of consensus, even if the Opposition are slightly reluctant to join us?

Mr. Dobson

I thank my right hon. Friend for what he has said. We certainly need a consensus. To the best of my recollection, having read the report fairly carefully—

Mr. Field

And the appendices?

Mr. Dobson

No, I have not read them. I did not even bring them to the Chamber in case I suffered a double hernia carrying them in. If I had, I might need care rather more prematurely than I would wish it.

The risk of needing long-term care and the scale of the cost is such that people cannot be expected to afford it, as the report says, without some form of pooling of risk. The report considers various options. On the details of distribution and separation of costs, and the ability to pay them, the distinction is not—to the best of my recollection—in the body of the report. My memory may be failing me, but I think that that is the case. The distinction may appear in the vast appendices, but the information asked for by my right hon. Friend is vital to the debate, and it is related to the points that I made in response to the hon. Member for Sutton and Cheam.

Mr. John MacGregor (South Norfolk)

I welcome the speed with which the royal commission has completed its report. I must press the Secretary of State on one question, which he has so far refused to answer—the increasing concern among the elderly, and their relatives, who have saved for retirement or bought a home, not least a council home, on fairly modest incomes about what they see as the unfairness and social injustice of what they have to pay for retirement in residential nursing care when others have it paid for them. I understand that the royal commission has put forward a recommendation that does not seem very expensive. Also, it is not merely a case of the injustice because, now that the issue has been so highlighted, unless the right hon. Gentleman deals with it, it will become more difficult to persuade people to provide for their retirement. Will he deal with that issue quickly and, if he does not accept the royal commission's recommendation, find some other solution to the problem?

Mr. Dobson

The right hon. Gentleman, in making that fairly reasonable contribution, should bear in mind that the basic position of the royal commission is that personal care should be paid for by the taxpayer, but that it has a number of intermediate stages, which are considerably cheaper and would bring about some changes and a amelioration of the situation about which people are rightly concerned. We have to consider all of those. Under the royal commission's proposal, there would be a transfer of taxpayer's money. Some money would come from people who are worse off than those receiving the benefit of it.

Ms Joan Walley (Stoke-on-Trent, North)

I thank the royal commission for the herculean task that it has performed and I thank my right hon. Friend the Secretary of State for the 10 steps that he has already taken. It is crucial now to engage in informed public debate throughout the country. He is well aware of concerns in north Staffordshire about the closure of national health service continuing care beds. Will he assure the House that he will continue to take a keen interest in what is happening in north Staffordshire so that, together, we can build consensus around what is needed for genuine long-term care for the elderly?

Mr. Dobson

As my hon. and well-informed Friend knows, the range of arrangements that can be made for people who need long-term care is great. Clearly, we must try to encourage as many people as can be properly cared for in their own homes to be so cared for, and a range of assistance is available. Certainly, the review of the number, nature and location of NHS beds, which I set in train in September, has to be related to the royal commission's proposals, because they are clearly related.

Mrs. Margaret Ewing (Moray)

We would all give the publication of the report a general welcome. However, is not a responsibility placed on elected representatives to participate in the ensuing debate and a particular responsibility placed on the Government to lead it? In light of the right hon. Gentleman's most recent answer, what emphasis will he place on respite care, which often seems to be left out of our debates, although those working in such care contribute so much in looking after the elderly, and, in many cases, people with disabilities? Does he agree that progressive taxation might mean a redistribution of wealth, which might resolve some of the problems?

Mr. Dobson

The hon. Lady raised two points. First, if I stated the Government's position now, no one would believe for a minute that we were going to take a blind bit of notice of any of the public debate. Everyone knows that and so it would be silly of me to give our view, which will no doubt be modified as a result of the discussions and representations. Secondly, let me illustrate the dilemma on carers and respite care. The bulk of the members of the royal commission do not think that particular help should be given to carers, other than by improving the services that are provided for the people whom the carers care for. The minority note of dissent is that greater priority should be given to carers. The Government are finding £140 million extra for them in the next three years and so, in that matter, tend to be going along with the note of dissent before people have dissented.

Mr. Dale Campbell-Savours (Workington)

Will my right hon. Friend clarify the position for the record? Are not those people who advocate a system of private insurance in effect advocating higher taxation? Private contributions to a private insurance scheme are a substitute for taxation. From that, can we not adduce that the Tories want to put people's taxes up to pay for it?

Mr. Dobson

There is a great deal of truth in what my hon. Friend says. The only trouble is that, if people continue to advocate that, they do so in the face of all the evidence that the private insurance market could not cope, even if people did pay in.

Mr. Eric Forth (Bromley and Chislehurst)

Is it not obvious that the Government led the elderly up the garden path before the general election? Not only that, but the Secretary of State is shocked at the speed with which the royal commission reported and desperate to find ways of putting off making any decisions. How long will the national debate continue? How long does he expect to be able to continue to put off making a decision? When will the people who are so desperately anxious about all this learn their fate?

Mr. Dobson

I think that the concept of "ignorance is strength" was introduced in the book "Nineteen Eighty-Four", but it certainly survives in 1999. In our general election manifesto, we promised to set up a royal commission on the long-term care of elderly, so no one was misled by that. The right hon. Gentleman suggests that I have been astonished and disappointed that the royal commission reported in 14 months. As, in its terms of reference, I asked it to report in 12 months, I think that his charge falls.

Mr. Dennis Canavan (Falkirk, West)

Will my right hon. Friend reverse the Tory Government's policy of massive cuts in the number of national health service beds for frail elderly people with the aim of shunting more and more elderly people into the private sector? Will he give an absolute guarantee that every frail elderly person who requires a national health service bed will be offered one? It would be a gross betrayal of the generation that built the NHS if those people were denied an NHS bed in their time of need.

Mr. Dobson

We must ensure that every frail old person who needs care gets it the most appropriate setting. For many, being in their own home but properly looked after by people who come in is infinitely preferable to going into any other set up. One of the merits of being at home is that people do not catch things from other people. Large institutions with many frail old people are very susceptible to cross-infection and people suffer as a result. One of the reasons why I decided to establish a review of the number and nature of beds in the health service was because we must ensure that everyone who needs an NHS bed of whatever nature gets one when they need it, whatever part of the country they are in.

Mrs. Virginia Bottomley (South-West Surrey)

The royal commission sounds very much in line with the findings of the Commission on Social Justice some years ago for the Labour party. However, there is a greater spirit of disillusion now. Pension funds have been raided so that those who thought that they were preparing for their futures are worse off. Those who were providing for their health care have lost their tax relief. The Government have shown little courage on pensions. As the right hon. Gentleman well knows, the home counties are having their social services and health budgets squeezed so that they are unable to deliver even the objectives set by the Government. The words on carers are fine, but tell that to Surrey county council, which lost £6 million from its social services budget. Will he consider the challenge in The Times today, where the Prime Minister is accused of propaganda imagery rather than political debate? We need decisions, not propaganda, because many worried older people want to know what they can rely on. They want the reality, not the rhetoric.

Mr. Dobson

All the old people who are worried are worried about the system that the country inherited from the Government of whom the right hon. Lady was such a distinguished member. She complains about pension funds being raided, but it was the Conservative Government who specially made them susceptible to raiding, and their friends who mis-sold pensions and so robbed people—those are the main sources of robbery of pensioners. As I said before, we are trying, and I continue to try, to get everyone to look carefully at the royal commission's report and the note of dissent, to listen to what other people say and take notice of that, and to see whether we can establish something approaching a consensus. In my opening statement, I made no reference to the Conservative party or its record; it is only since Conservative Members have risen that politics has entered into this matter.

Mr. Peter L. Pike (Burnley)

The issue is one that causes many older people great anxiety, and no one knows what will happen to them in the final years of their life. As part of trying to achieve consensus, is it not important to ensure that there is universal interpretation of the rules and regulations throughout the whole country, and that everyone has the same opportunity to receive the care that they need, wherever they happen to live? Is it not also important that, when the sale of old people's houses is considered, we recognise that, sometimes, other people live in the property, and address that problem?

Mr. Dobson

As my hon. Friend probably recollects, we make it clear in the social services White Paper that we expect social services and other authorities to pursue a national policy both on provision of care and on anything connected with the sale of assets belonging to those who are helped. We must aim for a universal approach. My hon. Friend touches on the most upsetting aspect of all, which arises when an old person finally goes into care: a member of the family who might have devoted two decades to looking after that old person can, under the current system, which we did not introduce, be thrown out on to the street. That is probably the biggest injustice of the lot.

Sir Geoffrey Johnson Smith (Wealden)

I welcome the report. I have to say, with all respect to the right hon. Gentleman, that I have never regarded him as a particularly consensual person. Will he give an undertaking that he will make a decision, whether or not he believes that there is a consensus, before the next election, so that we can get on with dealing with an urgent problem? While we are on the subject, when will the Secretary of State and his Department respond to the Centre for Policy on Ageing report on national required standards for residential care and nursing homes? We know that those institutions face serious problems—in my county, they have been underfunded to the tune of £4 million from social services—and they face high compliance costs unless the matter is properly worked out.

Mr. Dobson

My answer to the right hon. Gentleman's first question is, yes. As for his second question, we are producing a consultation document on that very matter, and it should go out shortly.

Mr. Bill O'Brien (Normanton)

I congratulate my right hon. Friend on having established the commission and published the report so quickly; it will be beneficial to millions of people. May I draw his attention to representations that I have received from people who suffer from Alzheimer's disease? They have to go into private homes for respite care, because organisations such as the Wakefield and Pontefract Community Health NHS trust are closing hospital beds and driving people into the private sector. Will he take action to ensure that no more hospital beds that cater for care of the elderly and for long-term care will be closed and that people who require respite care in an NHS hospital will be given that facility?

Mr. Dobson

I shall certainly do my best to ensure that people who need respite care get that care. However, as my hon. Friend knows, I cannot stand at the Dispatch Box not knowing the details of a specific case and give a blank undertaking that such-and-such a place will never close. After all, in some cases, places are closed because they are of such a standard that we would not want our relatives to go there, so we have to be careful about the undertakings that we give. It must be our mission to ensure that every old person in need of long-term care gets the appropriate care in the appropriate bed. I am sure that, for many old people, the most appropriate bed is their own, where they can be looked after properly.

Mr. Anthony Steen (Totnes)

I do not think that this is a party political issue, and the right hon. Member for Birkenhead (Mr. Field) is wrong to say that we are being slow and reserved. It will be a non-party political matter until the Government produce their recommendations.

Is the Secretary of State satisfied with what the Liberals are up to with regard to residential and nursing homes in Torbay? They are increasing council tax expenditure by building new residential and nursing homes and commandeering existing buildings for homes that they will run, while the private sector—which comprises small local residential homes that do a splendid job—are half empty. Is the Secretary of State happy to see the council tax payer paying more when such splendid residential homes stand empty?

Mr. Dobson

I generally assume, almost on principle, that the Liberals are up to no good. However, I should not comment about their particular activities in the Torbay area as there may be another side to the story.

Dr. Howard Stoate (Dartford)

During my years as a GP, I came across many cases involving people who stayed in totally inappropriate surroundings for far too long—causing great distress to not only themselves but their carers and families—because they were worried literally sick about whether they could afford long-term care. Will my right hon. Friend reassure my constituents—both present and future pensioners—that they will be treated with respect and dignity?

Mr. Dobson

The crucial point that we must bear in mind at all times is that everybody in our society has the right to be treated with dignity. All generations owe it to previous generations to ensure that they receive such treatment. Of all generations throughout the history of this country, the present working generation owes a tremendous debt of gratitude to retired people, who defeated Hitler, founded the welfare state and the national health service and then paid for it.