Nursing Care for the Elderly: Funding (Hansard, 27 June 2001)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, we shall shortly be consulting on draft guidance to health authorities on people's need for nursing care. We shall be providing additional funding to health authorities for the provision of free nursing care as part of their overall cash-limited allocation. It will be for health authorities and primary care trusts to 358 determine individuals' nursing needs. Ultimately, it will be for them to decide how best to use their total funding to meet local and national priorities.

§ Baroness Walmsley
My Lords, I thank the Minister for that Answer. However, will he tell the House whether the system for funding nursing care will be based on the real cost or the fantasy figures that date back to 1999 on which the Government costed their policy and which will clearly be insufficient to cover the real cost? In view of that, does the Department of Health have Treasury approval for exceeding the provision made in the Comprehensive Spending Review?

§ Lord Hunt of Kings Heath
My Lords, I certainly do not recognise the term "fantasy figures" as regards the Department of Health. On funding, we believe that there is sufficient provision within the general allocation to fund the free nursing care that will be provided as a basis of the assessment procedure which is now to be worked through. We intend to issue draft guidance shortly. That will give a much clearer indication of both the assessment process and indicative figures. We shall await the response with interest and consider the comments.

§ Baroness Turner of Camden
My Lords, is the Minister aware of the report that elderly people in nursing homes will in future have to pay VAT on the cost of that care? Will not that extra cost cancel out what has been allocated for nursing care? Is that not a very unwelcome development?

§ Lord Hunt of Kings Heath
My Lords, I understand that a VAT tribunal has ruled that the activities of Kingscrest, which runs residential homes for children and the mentally handicapped, are not exempt from VAT. The ruling could have serious implications. That matter has just come to our attention. I assure noble Lords and my noble friend that we shall work closely with Customs and Excise to assess the consequences of that tribunal decision.

§ Baroness Greengross
My Lords, does the Minister agree with me that it would not be possible to cash limit nursing care if it was given on the basis of assessed health needs already provided by the NHS free at the point of delivery in other settings? Would not that be a better way to deliver fairer and better care to people, particularly frail elderly people who happen to be in nursing homes rather than in hospital or in their own home?

§ Lord Hunt of Kings Heath
My Lords, as the noble Baroness will know, our decision in relation to free nursing care was designed to end the anomaly that applies at the moment whereby nursing care in nursing homes has to be paid for as opposed to nursing care either within the NHS or in residential homes. I believe that the decision we have taken to make nursing care free, using an assessment on which we are working and on which we shall consult shortly, is the most 359 appropriate way to deal with the matter. We are due to introduce a scheme on 1st October this year that will constitute an appreciable advance on current arrangements.

§ Baroness Carnegy of Lour
My Lords, the noble Lord will remember that when the relevant legislation proceeded through the House many of us were doubtful about its definition of "nursing care". The Government insisted that the definition was correct. Are they now redefining it through the draft guidance?

§ Lord Hunt of Kings Heath
My Lords, that is absolutely not the case. The definition in the Act refers to services provided by a registered nurse involving either the provision of care, or the planning, supervision or delegation of the provision of care other than services that do not need to be provided by a registered nurse. That definition best represents the extra care received in a nursing home compared with a residential home; in other words, the care that can be provided only by a registered nurse. We stick by that definition.

§ Lord Clement-Jones
My Lords, further to that, will the Minister confirm that the definition of what nursing care will be needed will be at the discretion of the registered nurse making the assessment? The Minister has stated his confidence that the resource will be available but the essence of the matter is the definition of what nursing care is needed.

§ Lord Hunt of Kings Heath
My Lords, that is why we are working at the moment with organisations such as the Alzheimer's Society, the Royal College of Nursing and other key stakeholders to ensure that we have an appropriate assessment procedure, that there is consistency throughout the country and that the allocation of finance is appropriate and fair to that assessment procedure. The noble Lord will study the draft guidance with interest when it is published. I shall be keen to debate it and to receive comments from noble Lords and other interested parties. We want to make sure that we have a fair and practical system.

§ Earl Howe
My Lords, the Minister will doubtless recall that during the passage of the legislation concern was expressed by a number of noble Lords reflecting the anxiety of local authorities about the very short time frame available for preparing for the policy's implementation date prior to October 2001. Is the Minister satisfied that the timetable for introducing free nursing care in residential homes is on track?

§ Lord Hunt of Kings Heath
My Lords, I understand the point the noble Earl raises. Time is short before 1st October. However, it is important that we get the matter right. It is appropriate for us to take a little more time in issuing draft guidance in order to ensure that the arrangements to be introduced from 1st October are as practically based as possible and consistent and fair. It will require a great deal of effort 360 to ensure that those arrangements are firmly in place by 1st October, but I am confident that we shall make progress towards that.