---

Older People's Rights (Health Care)

I do not think that that is an argument solely about care of the elderly. Whatever someone's age, if they need residential care it is likely to be means-tested. We know that there is pressure on the people running the budgets of any publicly funded service for which 100 per cent. of the funding is provided by the state to move people into means-tested care. I know that the hon. Member for Eddisbury (Mr. O'Brien) has an interest in that dilemma. The situation is inevitable, when in many contexts there is a boundary between NHS and means-tested social care; it occurs more often in the context of care of the elderly, but I was not making exactly that point. Finally, I want to mention population screening. The Committee heard from Age Concern, which has been pretty consistent about the matter. Its view was that an upper age limit for screening programmes was discrimination on the grounds of age. I argued against that necessarily being so: when consideration is given to the question of which populations should be brought in for population screening, it is possible to analyse cost-effectiveness. That captures a great many aspects of the matter, such as the sensitivity and specificity of the test, its acceptability, and the effectiveness of treatment for those who are found to be true positives. A calculation can be done of the overall cost-effectiveness by population, according to age—or, indeed, according to other factors, although age is commonly used. There are some age groups in which it is simply not cost-effective to screen. It would be wrong to take resources from effective and cost-effective treatments, to provide a screening programme that might sound good and be popular, but would not be cost-effective. I think we must accept that, which is why I disagreed with Age Concern's view that an age cut-off for calling in people to be screened is always inappropriate, and why I intervened on that point in the speech of the hon. Member for Hendon. That is not to say that if someone wants breast screening, for example, but is over the age at which people are called in for it, they should not have access to it on request. That is permitted in the NHS and I make no criticism—nor, I think, does the report—of Government screening programmes, at least on those grounds. It is not gender discrimination to provide breast screening only for women; it is a question of effectiveness, and cost-effectiveness, in the end. In conclusion, I want to comment on the meaning of the term ““public authority””. The hon. Member for Hendon hid his light under a bushel, to some extent, in his speech. The Joint Committee on Human Rights has an interest of long standing in the question of the failure—in practice and on the part of the courts—to understand the meaning of ““public authority”” as including those private companies and organisations that provide a public function, particularly with respect to health care. The hon. Member for Hendon has a long history of effective campaigning, as a Back-Bench MP and as Chairman of the Committee, to push the Government to move more quickly than they have towards a resolution of the problem—even after the Leonard Cheshire case, and before the YL case. I think there is a huge expectation in society, within NGOs and in the House, that there will be effective provision—even if it is not the whole story, for reasons that we understand—by the Government in the House of Lords. I know that the Minister will want to reassure us that that is so, because I know that he and his colleagues, including the Minister of State, Ministry of Justice, the hon. Member for North Swindon (Mr. Wills), have been lobbied about the matter. They have heard the arguments and have had a series of meetings with hon. Members and outside groups, so they are not blind to the issues. We hope that progress will be made now, with the Bill that is currently going through Parliament, even if a wider solution is needed in later legislation. I add my thanks to those offered by the hon. Member for Hendon to the people who supported the Committee in its work, those who gave evidence, those who helped us with the report and our specialist advisers. It is an excellent report, and I join the hon. Gentleman in commending it.