§ 2.53 p.m.
§ Baroness Barkerasked Her Majesty's Government:
What difficulties have arisen owing to the distinction between nursing care and personal care for the purpose of funding arrangements.
§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)My Lords, National Health Service nurses have applied the registered nursing care contribution tool to assess the needs of nursing home residents. A full evaluation of the implementation of the policy has been commissioned and is due to report this autumn.
§ Baroness BarkerMy Lords, in this week when, as a result of devolution, which has just been mentioned, personal care in Scotland became free for older people, will the Minister comment on the report issued this March by nursing home co-ordinators and health authorities that found that six out of 10 nursing homes were passing on costs in increased fees to older people? 123 At a time when older people in Scotland are receiving free personal care, what is his department doing to stop older people in England paying for what is supposed to be free nursing care by the back door?
§ Lord Hunt of Kings HeathMy Lords, it is the glory of devolution that Scotland can choose which way it wishes to go and that we in England can choose a different course. We chose a different course because we believed that if we instituted free personal care, we should not produce a single extra service as a result but would benefit many better-off people. We considered that the £1 billion cost of free personal care in England would be better spent on providing services such as intermediate care for all older people to enjoy and to help them rehabilitate, rather than having to enter institutionalised care.
Of course, I have read comments concerning where the money being provided for free nursing care has gone. I understand that the majority of individuals are already benefiting financially from the introduction of NHS-funded nursing care, but, in March, my honourable friend Jacqui Smith announced a package of measures designed to ensure much greater transparency, so that self-funded residents in such homes know exactly what money is being spent where.
§ Lord Ashley of StokeMy Lords, does my noble friend agree that sickness and disability lead to a wide variety of needs—for surgery, for medical drugs, for physiotherapy and for wheelchairs—that are properly met by the National Health Service free of charge? By charging for the other important need arising from sickness and disability—personal care—the Government are being both illogical and unfair. The sooner that that policy is reversed, the better for disabled people.
§ Lord Hunt of Kings HeathMy Lords, my noble friend speaks forcefully on the matter, as he has done for many years. But the treatment of personal care and NHS services has been consistently applied for many years. When we are faced with the prospect of £1 billion extra having to be spent on free personal care in England, if we adopt the Scottish model, searching questions must be asked about whether that money would be wisely spent. As I said, the Government decided that it would be much better spent on intermediate care, which is designed to rehabilitate older people, in particular, and return them wherever possible to their own home. Surely, that is where the incentive should lie, not in institutionalised care
§ Lord SwinfenMy Lords, does the noble Lord agree that if personal care is neglected, that will frequently lead to expensive nursing and medical care and, in the long run, cost the country a great deal more?
§ Lord Hunt of Kings HeathYes, my Lords. That is why we announced that under the next spending 124 review, personal social services will, over a three-year period, receive an increase of about 6 per cent in real terms. That recognises the noble Lord's point.
§ Lord LipseyMy Lords, does my noble friend agree that any transitional problems that we may be experiencing in moving from nursing homes pale into insignificance when compared to the dog's breakfast of a policy of free personal care favoured, alas, by the Scots and by the noble Baroness, Lady Barker? Beside being unaffordable and doing nothing to improve care standards, it represents a massive transfer of money from poorer to richer people.
§ Lord Hunt of Kings HeathMy Lords, my noble friend speaks with authority as a member of the royal commission. What he says is surely to the point. Some propose that we spend £1 billion extra on free personal care. Many of those people are better off. Is that really where the priority should lie? The Government say no, it should lie in rehabilitation, trying to ensure that as many people as possible are kept from entering homes in the first place.
§ Earl RussellMy Lords, did the Minister read in today's paper a report of an old lady of 108 who committed suicide by hunger strike because she was turned out of the care home in which she had lived because she could no longer afford it? Will he consider that there may be more concerns in heaven and earth than are dreamt of in his philosophy?
§ Lord Hunt of Kings HeathMy Lords, it is always dangerous to rely too much on newspaper reports. I am sure that we shall want to study the results of any review led by the local authority. My understanding of the case is that the council worked closely with the family to find new accommodation for that person. Of course, one's sympathy goes out to Mrs Knight's relatives. However, I understand that the owner was retiring.
The allegation is that the regulations set by the National Care Standards Commission were at too high a level. I must make the point that the National Care Standards Commission has allowed for flexibility and has allowed more time for new standards to come into operation. It was the care homes themselves who wished to see a national system of regulation.
§ Baroness Masham of IltonMy Lords, if somebody living in a care home needs physiotherapy, occupational therapy or speech therapy, would that come under personal care or nursing care?
§ Lord Hunt of Kings HeathMy Lords, it depends on the individual. Many people in nursing homes receive continuing care, which is provided entirely by the National Health Service. The Government's commitment is to free nursing care. The assessment is concerned with care that is either provided or supervised by a registered nurse.