Long-term Residential Care (Hansard, 21 November 2000)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, we announced our policy in our response to the Royal Commission on Long-Term Care of the Elderly. We believe that our proposals to invest in intermediate care and to improve standards of care and fair access to services, together with the changes that we are making 654 to the funding of long-term care, will generate important benefits of health and independence for older people.

§ Lord Ashley of Stoke
My Lords, my noble friend is invariably helpful, but how can he speak about fair access to services when the Government's policy to pay only for nursing care in residential homes and refuse to pay for personal care discriminates against some disabled people? It cannot be right that someone who suffers from, say, Alzheimer's disease is forced to pay for his or her personal care, whereas the different costs of people with other disabilities are fully paid for by the state. The policy to refuse to help with the personal care of people who must be fed, washed, dressed and toileted by others is unacceptable. The wise politicians of Scotland have said that they are to reconsider that matter. Why can we not do so?

§ Lord Hunt of Kings Heath
My Lords, my understanding is that Scotland has committed itself to a review of existing policies without prejudging the outcome. I have enormous respect for my noble friend; however, the Government believe that their proposals represent a better targeting of resources. Three-quarters of those in residential nursing care already get some or all of their personal care costs from public funds. To make personal care free for everyone would carry high and increasing cost without in itself improving services, and it would consume many of the additional resources that we are making available to people through the NHS Plan, including the important provision of intermediate care.

§ Lord Astor of Hever
My Lords, as 760 nursing and residential care homes closed last year with the loss of 15,000 beds, does the Minister agree with the chairman of the Nursing Home Association that if the trend continues there will not be any nursing care homes left in three years' time?

§ Lord Hunt of Kings Heath
My Lords, I do not agree with that assessment. I understand that in some parts of the country a number of nursing homes have come under financial pressure. I also accept that there was a drop in the number of nursing home and residential home care beds between 1998 and 1999, but the picture is very mixed throughout the country. Between 1995 and 1999 there was a net increase in nursing home beds. Laing and Buisson, the consultants who observe the private health care sector, consider that there is still excess capacity in the residential care and nursing home sector in many parts of the country.

§ Baroness Greengross
My Lords, will the Minister agree that there is enormous anxiety among elderly and disabled people and their families and carers because the Government have not clearly defined what is meant by "personal care"? We know that some care which is delegated, supervised or authorised by nurses will be paid for. But that just increases the anxiety. We must now have clarification.

§ Lord Hunt of Kings Heath
My Lords, I am sorry if—particularly older—people are anxious about the 655 intentions of the Government because I believe that the package of proposals that we have announced will lead to an enhanced package of care and support. The noble Baroness raised the important consideration of the definition of nursing care. The Royal Commission—indeed the dissenting note in the Royal Commission—accepted that it was perfectly possible to define nursing care. I can inform the noble Baroness that we are developing what is called an "assessment framework" in order to ensure that there is a proper definition which will be applied consistently throughout the country. We are consulting with a number of relevant organisations on just such an assessment and definition, including the RCN and the Alzheimer's Disease Society.

Noble Lords
Order!

§ The Lord Privy Seal (Baroness Jay of Paddington)
My Lords, as we have only reached 25 minutes, there is probably enough time for everyone to get in. Perhaps the noble Baroness next, and then my noble friend.

§ Baroness Knight of Collingtree
My Lords, will the Minister reassure the House that there will not be elderly and disabled people in need of care but unable to get it for reasons of funding or anything else?

§ Lord Hunt of Kings Heath
My Lords, that is the intent of the policy in relation to long-term care that we announced in the NHS Plan. We want to ensure that people get the right support, not just in nursing residential care homes but also in the community and in rehabilitation programmes. We want to see the development of intermediate care in order to promote independence through active recovery and rehabilitation. We will spend an extra £900 million by 2003 to 2004. We are making strides. I believe we can do more in the future.

§ Lord Morris of Manchester
My Lords, the House is indebted to my noble friend Lord Ashley for raising this timely and very important question. Can my noble friend the Minister say what work has been done on quantifying and costing to the National Health Service the effects of the inequity of present arrangements? How many NHS beds are now being taken up by people who would be more appropriately cared for in other accommodation if the inequity was removed?

§ Lord Hunt of Kings Heath
My Lords, it is not possible to answer all those specific questions. The latest statistics show that just under 6,000 people over the age of 75 had their discharge from hospital delayed in the second quarter. Some of that delay was because of issues in relation to social services funding and some was due to people waiting for an appropriate residential care or nursing home place. The sooner we can implement intermediate care to enable people who are unnecessarily awaiting discharge in hospital beds, the better we can provide services to those people through rehabilitation, wherever that is possible, or, if not, in an appropriate nursing home. The quicker we deal with 656 delayed discharges the sooner beds in our hospitals will be available for members of the public requiring treatment.
I believe that the package of measures of intermediate care and the decision to pay for nursing care in nursing homes will be an important part of the drive to improve the situation.

§ Baroness Barker
My Lords, will the Minister confirm that if an older person at home receives a change of dressing for an ulcer from a district nurse, that is free, but that the same person in a residential home receiving the same treatment from someone who is not a nurse will have to pay? Does he agree therefore that when such anomalies exist the Government's claim in the NHS Plan that any contribution people will have to make towards the cost of their care will be fair, predictable and related to their ability to pay is in severe doubt?

§ Lord Hunt of Kings Heath
My Lords, I do not follow the noble Baroness. My understanding is that, for instance, district nursing services will be available in a residential home provided by the National Health Service. In relation to a registered nursing home, the proposals we are making will ensure that nursing care provided by a registered nurse will be available and paid for by the National Health Service.