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Caring for the Elderly

At the beginning of the debate, I was quite depressed by the partisan nature of the contributions, so I am delighted to speak towards the end and follow three or four excellent contributions that show the willingness of Members on both sides of the House to take this matter seriously. I welcome the debate as an attempt to look at the problems of long-term care realistically, sensibly and openly, and, I hope, to achieve consensus. I absolutely agree that the proposals have been rather slow in coming. I have spent quite a bit of time looking back at the Select Committee on Health's report on continuing care, published in April 2005. I had to examine the membership of the Committee to ensure that the Secretary of State himself was not a member at that time, because, as far as I can see, most of the recommendations in that report are covered in the Government's proposals and the Green Paper. I shall go through one or two of those recommendations and what we discovered. The frequently identified problems were listed at the time:""Inconsistency of criteria between PCTs/SHAs"—" primary care trusts and strategic health authorities—""leading to inequity.""Gap between eligibility criteria on paper and application and interpretation in practice.""Inconsistent approaches to assessment and a lack of fit with the Single Assessment Process.""Inaccessible or incomprehensible criteria (both for professionals and patients).""Concerns over exclusion of many chronic needs (especially dementia) because of focus on physical care"," and""Confusion over relationship between high band RNCC—" registered nursing care contribution—""and fully funded continuing care."" The whole thing was an absolute nightmare, and I hope that the Green Paper will set about solving some of the problems. I shall quickly go through one or two of the recommendations that the Committee made. Early in the report, we stated:""We therefore recommend that the Government's review of continuing care funding arrangements take the form of a full, formal public consultation, in line with Cabinet Office recommendations."" It appears that, thank goodness, we have got there now. We asked the question""what is health and what is social care"," and we got no meaningful answer, so we moved on to the absolutely obvious, stating:""We strongly recommend that the Government remove once and for all the wholly artificial distinction between a universal and free health care service operating alongside a means-tested and charged for system of social care."" We got the answer that we expected from the Government, as the right hon. Member for Charnwood (Mr. Dorrell) might think:""If by recommending that the Government remove the distinction between health and social care, the Committee is really recommending the removal of means testing for care services, then this would have significant cost implications."" The cost implications that we identified then were a mere £1.5 billion, estimated to rise to more than £3 billion by 2020, not taking into account the costs of looking after patients, such as food and residence costs. The figure of £20 billion is possibly more nearly correct, and that is obviously quite unaffordable from taxation. There appears to be a general consensus about that. The Government are to be congratulated on the fact that at a time of recession, they have introduced a Green Paper inviting consultation on how we can find the money. I cannot help hoping that that spills over into the national health service as a whole, because we have to ration money for the NHS as well.