Elderly Patients in Care Homes: NHS Treatment (Hansard, 9 April 2001)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, GP services are free for registered patients in all settings, including residential and nursing homes. GPs sometimes contract with homes to provide additional services; for example, training for staff. That is different from individual direct patient services, for which GPs should not be charging their registered patients. We shall investigate any allegations of abuse within the system. In addition, the department has commissioned a survey to check whether appropriate medical services are being provided to care homes.

§ Lord Ashley of Stoke
My Lords, is my noble friend aware that a report by the Association of Charity Officers recently revealed that thousands of old people in residential homes and nursing homes are being forced to pay for medical services which should be provided free by the National Health Service? I warmly welcome my noble friend's assurance that the department will investigate any evidence; but if the allegations are proven, will the Government act immediately? This is a total reversal of the principle of a free National Health Service. It is those who most need medical services who are affected. Will my noble friend ensure that there are proper administrative arrangements for old people in care homes to receive medical care?

§ Lord Hunt of Kings Heath
My Lords, I confirm again that, except for a very limited range of specific items, GPs may not charge NHS patients for medical services. That applies as much to individuals living in their own home as it does to individuals in care homes.
I am aware of the report that my noble friend has brought to the attention of the House. I have arranged for officials in the department to meet the authors of that report very shortly to discuss its implications. 991 I make it clear to the House that if general practitioners are in breach of their terms of service, we shall expect local health authorities to take action.

§ Lord Astor of Hever
My Lords, bearing in mind the inadequate fees paid by social services departments and the increasing levels of regulation by the Government, is the Minister concerned at the large number of care homes that are having to close?

§ Lord Hunt of Kings Heath
My Lords, the position regarding care homes generally is that, although there have been a number of closures over the past few years, taking the country as a whole there are still a number of vacant places. As regards fees, we discuss these matters with the local authority associations. We have encouraged a much closer dialogue between local authorities and the owners of care homes. Notwithstanding those questions, the issue of whether GP services should be available to registered patients in care homes has to be answered in the affirmative.

§ Lord Clement-Jones
My Lords, the Minister mentioned GP services, but is not one of the key questions also whether intermediate care is charged for in care homes, as well as in people's own homes? Can the noble Lord give the House a categorical assurance that no charges will be levied for intermediate care, whether in care homes or in people's own homes?

§ Lord Hunt of Kings Heath
Yes, my Lords; intermediate care is an NHS service.

§ Lord Morris of Manchester
My Lords, having been one myself, I well appreciate my noble friend's position as a departmental Minister. But is it not unjust, downright discriminatory and, thus, morally reprehensible that 15,000 severely disabled people in Leonard Cheshire homes are subjected to charging for essential services that would be free of charge if they were cared for elsewhere? Moreover, should not all of us in this House, not least those of us on these Benches, strongly insist that what is morally reprehensible ought not to be legally permissible?

§ Lord Hunt of Kings Heath
My Lords, I recognise my noble friend's longstanding interest and concern in these areas. However, we have decided to make care provided by registered nurses free in nursing homes. That will remove the greatest anomaly in the current system of care funding in relation to the distinction between care homes where NHS services are provided free and nursing homes where, up until now, nursing services have had to be paid for either by the local authority or by the resident concerned. Taking that with the additional investment in intermediate care is, I believe, the right way to spend the extra resources that have been made available.

§ Baroness Gardner of Parkes
My Lords, can the Minister tell us when we are likely to see some real interim care to a much larger extent as regards the 992 framework for the elderly that was announced just a week or so ago? It has been made quite clear that the present crisis within the NHS is due to the fact that people cannot be moved from accident and emergency departments into other wards because of all the beds that are occupied by elderly people who are unable to get into care homes. Surely that problem would be solved by providing proper intermediate national health care. Instead of just producing a document, can the Minister tell us when we shall actually see some of these improvements happening?

§ Lord Hunt of Kings Heath
My Lords, the target that has been set is for 5,000 extra intermediate care and 1,700 supported intermediate care places to be available by 2004, which will benefit around 150,000 more older people each year. We are making progress towards that aim. One has to create the right infrastructure, but we have seen much enthusiasm and have received a great deal of support at local level for developing those plans.

§ Lord Skelmersdale
My Lords, when answering a supplementary question from one of his noble friends, the Minister mentioned nursing care. Is the noble Lord aware that there is a great deal of confusion in what I would describe as the care industry and the nursing home industry as regards exactly what the expression "nursing care" means? Can he tell the House whether the Government intend purely to pay for that care provided by registered state nurses or those under contract to the NHS—but none other—or whether there is some other way in which residents of these homes can receive the treatment that they require?

§ Lord Hunt of Kings Heath
My Lords, residents of all homes, whether residential care homes or nursing homes, should be able to receive the care that they require. As far as concerns residential care homes, it is a responsibility of the NHS through GPs and community nursing services to provide such nursing care. As for nursing homes, much of that care is provided in the homes by registered nurses. The decision of the Government following the Royal Commission report is to ensure that the care provided by those registered nurses will be free.