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National Health Service And Community Care Bill

Volume 169: debated on Tuesday 13 March 1990

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As amended ( in the Standing Committee), considered.

[The following Reports and Minutes of Evidence of the Social Services Committee are relevant: Eighth Report, Session 1988–89, resourcing the National Health Service: the Government's plans for the future of the NHS (House of Commons Paper No. 214-III); Second Report, Session 1989–90, Community Care: Future funding of Private and Voluntary Residential Care (House of Commons Paper No. 257); Third Report, Session 1989–90, Community Care: Funding for local authorities (House of Commons Paper No. 277); Minutes of Evidence taken on 17th, 24th and 31st January 1990 (House of Commons Papers Nos. 148-i, 173-i and 194-i); and the Government's Reply to the Eighth Report of Session 1988–89 (Cm. 851).]

4.44 pm

I shall take a point of order on the new clause that we are about to debate.

You referred, Mr. Speaker, to the debate that lasted almost six hours on the hon. Member for Winchester (Mr. Browne). The public had a good view of it because it was on television, certainly on some channels. As a result, people heard an hon. Member saying, "I'm awfully sorry that I didn't put this firm and this money in the register."

My hon. Friend the Member for Workington (Mr. Campbell-Savours) raised a point of order on the Bill that we are about to debate. The people who are watching television will think that it is a bit strange that we are debating the shifting of money from the public to the private sector, lining the pockets of trusts and the Tory Members who are involved in those trusts, yet this quaint little cock-eyed place, the House of Commons, will do nothing about it. They will find that odd.

Order. We had a full debate on the matter last week. I do not know whether the hon. Gentleman was not called due to the shortage of time.

No, I did not put my name down. I tried to catch your eye, Mr. Speaker.

Perhaps the hon. Gentleman should have sought to be called in order to make those points. However, I repeat that the House knows that Mr. Speaker has to interpret the rules as they are.

Further to that point of order, Mr. Speaker. Is it not ironic that the hon. Member for Workington (Mr. Campbell-Savours), who is about as easy on the ear and as original as a neeedle stuck in a gramophone record, is the one member of the Standing Committee which considered the Bill whose election expenses are paid for by a Health Service union?

If they are, no doubt the hon. Member for Workington (Mr. Campbell-Savours) will declare that.


That the National Health Service and Community Care Bill, as amended, be considered in the following order, namely, new Clauses, Amendments to Clauses 1and 2, Schedule 1, Clause 26, Schedule 5, Clauses 3, 4, 28 and 5, Schedule 2, Clauses 6 to 11, Schedule 3, Clauses 29 to 31, Schedule 6, Clauses 12, 35, 13 to 17, 32, 18, 33, 19 and 20, Schedule 4, Clauses 34, 21, 36, 22, 37, 23, 38, 24, 25, 27, 39, 52, 40, 53, 41 to 43, 48, 44, 51, 45, 49, 46, 47, 50 and 54 to 56, Schedule 7, Clauses 57 to 61, Schedule 8, new Schedules, and Amendments to Schedule 9 and Clause 62.—[Mr. Kenneth Clarke.]

On a point of order, Mr. Speaker. Will you confirm that I, like every Labour Member of Parliament who might be sponsored, receive nothing personally from a union either as income or expenses? Despite the fact that the rules state clearly that hon. Members can vote on these matters, you have a discretion, in the light of public concern, to advise hon. Members not to vote in the Divisions that will take place during the next two and a half days, so will you please do so?

Order. I cannot answer the hon. Gentleman's first question. I have no idea what remuneration he may receive as a result of being sponsored by a union.

Order. I draw the hon. Gentleman's attention to what the hon. Member for Copeland (Dr. Cunningham) said last week in relation to sponsorship by a union.

The Register of Members' Interests shows the position. May I ask you, Mr. Speaker, to withdraw your statement that you have no idea?

I take the hon. Gentleman's word for it.I have no responsibility for the personal declarations that are made in the register. That is not a matter for me. The hon. Gentleman has declared his interest.

Order. Will the hon. Gentleman please sit down so that we can get on with the debate?

New Clause 74

Special Health Boards

'In section 2 (Health Boards) of the 1978 Act—

(a) in subsection (1)—

  • (i) after the words "Secretary of State" there shall be inserted the word "(a)"; and
  • (ii) after the words "Health Boards" there shall be inserted—
  • "and

    (b) Subject to subsections (1A) and (1C), may by order constitute boards, either for the whole of Scotland or for such parts of Scotland as he may so determine, for the purpose of exercising such of his functions under this Act as he may so determine; and those boards shall, without prejudice to subsection (1B), be called Special Health Boards.";

    (b) after subsection (1) there shall be inserted the following subsections—

    "(1A) An order made under subsection (1)(b) may determine an area for a Special Health Board constituted under that subsection which is the same as the areas determined—

  • (a) for any other Special Health Board; or
  • (b) for any Health Board or Health Boards constituted by an order or orders made under subsection (1)(a).
  • (1B) An order under subsection (1)(b) may specify the name by which a board constituted by the order shall be known.

    (1C) The Secretary of State may by order provide that such of the provisions of this Act, or of any orders, regulations, schemes or directions made under or by virtue of this Act, as apply in relation to Health Boards shall, subject to such modifications and limitations as may be specified in the order, so apply in relation to any Special Health Board so specified."; and

    (c) in subsection (2), for the word "(1)" there shall be substituted the word "(1)(a)".'.— [Mr. Michael Forsyth.]

    Brought up, and read the First time.

    I beg to move, That the clause be read a Second time.

    With this it will be convenient to take Government amendments Nos. 266 to 268.

    The new clause and the amendments are important as they allow the Secretary of State for Scotland to set up a special health board in Scotland. Those powers do not exist in Scotland, and I should explain to the House why my right hon. and learned Friend the Secretary of State would like to have them. This arises out of the review that we have undertaken of health education in Scotland—a review carried out on the Secretary of State's behalf by Touche Ross—and a report that has been produced on the incidence of coronary heart disease in Scotland.

    Although in Scotland we spend about 25 per cent. more per head on health than is spent in England, we still have very high levels of coronary heart disease and lung cancer, and life expectancy is still lower in Scotland than it is south of the border. The Government have made health education and the promotion of good health part of their priorities for the Health Service in Scotland. Following the reports that have been made to the Government, it has become apparent that there is a need for a body in Scotland with the status and standing to ensure that our health promotion policies are given the centre-stage position that is required.

    At present, health education is the responsibility of the Scottish Health Education Group, which is part of the Common Services Agency. The Secretary of State would very much like to create a new body that would be a special health board with responsibilities for health education and promotion throughout Scotland. That body would have as its purpose the implementation of a policy statement of priorities in health education and would be responsible for achieving the targets set by central Government. It would work closely with health boards.

    It is for those reasons that we are proposing the new clause and the amendments. It is our intention to establish the new body and to have it set up and working by 1 April 1991. It is essential that we move with speed. The Public Accounts Committee has drawn attention to the need to focus our health education programmes more effectively, and I accept the advice given and the criticism made in the past. Having said that, I believe that we have made great progress in health education. I make no criticism of those who have worked so hard to achieve that in the past.

    I hope that the new clause and amendments will be welcomed on both sides of the House. This is a positive step forward. It is an attempt to meet the SHARPEN priorities, which we set out more than a year ago, in which health promotion and education were given a centre-stage position. I have considerable pleasure in commending the new clause and amendments to the House.

    The hon. Member for Wirral, South (Mr. Porter) has asked me to declare my interest. I can tell the House that I am a member of the Management, Science and Finance union, but I receive no sponsorship for elections from that union and am not a sponsored member of it. I am not sponsored by any union except very indirectly, I suppose one might say, through the new clause, as the money for my expenses comes from the Labour club, and drinking and smoking provide a lot of its income. But that is another matter.

    I think that everybody must welcome this new clause, but the problem that we have with it is that it makes no reference to health education. It is a broad, general clause dealing with special health boards in Scotland. It gives the Secretary of State powers considerably wider than those of health education. Opposition Members are suspicious that it is being done in this way, especially as the new clause was put down on Friday, which meant that the Opposition had no opportunity to table amendments to make it specific to health education. That arouses our suspicions about the Minister's intentions.

    The Minister's problem in Scotland is that no one trusts him. He may have the best intentions in the world about this legislation and the new clause, but the people of Scotland, particularly when he takes such wide powers, simply do not believe him. They always look for ulterior motives and other things for which he intends to use such powers.

    Increasingly, people in Scotland distrust not only the Minister's intentions, but his competence. One can only assume, as the Prime Minister stayed at the hon. Member's house for the night that she was in Scotland, that he was the person who advised her on her whole trip to Scotland. If he can create that sort of public relations disaster, we have every right to distrust his competence in anything at all, particularly since the Prime Minister went to Ibrox to make the draw for the Scottish Cup. If hon. Members wonder why this is relevant, I will tell them exactly why. Until last year the Scottish Health Education Group sponsored the Scottish Cup; therefore the Prime Minister and the Minister had a direct interest at that time, although they have not now. To advise the Prime Minister to go to Ibrox in connection with the draw for a cup in which Rangers Football Club is no longer involved really takes a bit of beating and could cause considerable distress to many football supporters in Scotland. Her performance on television was appalling. That she should describe herself as a Scot by saying "we in Scotland" all the time takes a bit of believing.

    The hon. Gentleman, with his interesting ancestry, is trying to lay claim to a Scottish background and history. He should remember that some of us are real Scots.

    I do not know whether the hon. Member can make the claim that I can, that both his mother and his father were born in the constituency that he now represents. If that does not make me a Scot, I do not know what does.

    The Minister's intentions and competence in this matter make us a bit suspicious and I think that we ought to ask him to explain why he is taking broad powers instead of specific powers. Why did not he simply table a clause to set up a new body in Scotland to deal with health education? What else will he use these powers for? The House is entitled to answers to those questions.

    I still do not understand, even from what the Minister said, what exactly will be different in health education compared with what was done by the Scottish Health Education Group, for which I have a very high regard. I criticised it in an article that I wrote in The Runner magazine in Scotland because it did not sponsor enough running but sponsored football. However, a lot of its work in health education led the field not just in Scotland but in Britain, and in some cases in Europe; it was very advanced.

    I did not have the opportunity to read that article, but I am sure that it was interesting, because I have enjoyed reading other things that the hon. Gentleman has written. Does the hon. Gentleman believe that, when one writes articles and is paid for them, one should make a declaration in speeches in the Chamber, particularly if an article has been on Health Service matters?

    The hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) may have an interest to declare. For myself, if the hon. Member for Tayside, North (M r. Walker) knew anything about The Runner magazine in Scotland, he would know that it runs on a shoestring and does not pay contributors anything, so I did not get paid for the article.

    The hon. Gentleman should bear in mind that that may be the story he was told when the magazine got his copy.

    5 pm

    That is always possible. However, I know the people who run the magazine and I think it fair to say that they do not have any money. That is taking us rather wide of the new clause.

    The Scottish Health Education Group has done good work in Scotland. In his brief speech, the Minister did not give us reasons why the group should disappear and a new body should be established. We need to know more about the relationship between a new health board and the other health boards in Scotland in regard to health promotion.

    I shall give one example from my area—the "Good Hearted Glasgow" campaign run by the Greater Glasgow health board. I do not know how effective it is, but it has done well in publicity. Whether it has stopped large numbers of people smoking or eating foods with high cholesterol is another matter. In that respect there is a question mark over health education. Certainly we need to know whether such a campaign would be taken over by the new health board or would remain with the Greater Glasgow health board. If it is taken over by the new health board, where is the division in responsibility? The "Good Hearted Glasgow" campaign is not just about advertising and education; it is also about the provision of screening of blood pressure and so on, particularly of men of a certain age. Will the Greater Glasgow health board continue to do that while the new board takes over publicity? I hope that the Minister will give us more information on that.

    When I first read the new clause, before the Minister kindly told me exactly what he intended, I wondered whether it had a relationship to the new Health Service executive which the Minister suddenly announced last week. Does he intend giving the new executive legislative standing by creating a special health board which would have power over all the other health boards in Scotland? That suspicion still remains. The Minister may set up such a body, but I am not sure that it would have great legislative standing under this legislation or under the National Health Service (Scotland) Act 1978. Does the Minister intend to use the new clause later to give that body powers?

    The clause is broad enough to allow the Minister to explain to the House exactly who he intends to appoint to the new executive body, how much each will be paid for being a member, what contracts they will have, and the terms of the contract. We have grave suspicions about the body, as we have about Mr. Cruickshank, the chief executive of the Health Service in Scotland. We do not believe that the Health Service can be run as a private business like Virgin Records. It should be run for the benefit of the health of patients in Scotland.

    I hope that the Minister will say more about the health education side, how it links with the other health boards and how it will help education in Scotland to have the new body as opposed to the existing arrangement. Will he also say more about the new Health Service executive?

    I congratulate my hon. Friend the Under-Secretary on bringing forward the new clause. He will recollect that in Committee the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and I tried to introduce amendments to the Bill. Because we were not as astute as my hon. Friend and his advisers, we were unable to come up with an amendment that was technically able to do the job. We put down an amendment which gave us the opportunity to speak——

    It was discourteous of me not to say, in introducing the new clause, that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) and my hon. Friend the Member for Tayside, North (Mr. Walker) raised the matter in Committee, when I undertook to bring forward amendments. The genesis of the new clause and the other amendments was in that debate. I apologise for not having said that when I introduced them.

    I thank my hon. Friend for his intervention. I gathered that that was the logic behind the new clause.

    That brings me to the point behind the interesting contribution of the hon. Member for Glasgow, Cathcart (Mr. Maxton). He will have realised that the hon. Member for Ross, Cromarty and Skye and I had difficulty in Committee because, if we had made the amendment too narrow, it would have been out of order. We were grateful to the Clerk of the Committee for his assistance in framing an amendment to which we could speak.

    I am pleased that the new board will be able to determine policy. Because of the special health problems in Scotland there should be a positive approach to the promotion of health care. I hope that the new clause will receive support on both sides of the House because we are all united on the prevention of health problems.

    The meandering of the hon. Member for Cathcart through Ibrox was an interesting way to consider the promotion of good health care. We should encourage more anticipation in sport. The approach of the hon. Gentleman to health care is a splendid example; I give him that.

    Almost the only criticism I have of the Scottish Health Education Group is that for so many years it sponsored professional footballers in Scotland and did not put money into activity sports such as running and amateur football, as it should have done.

    I do not disagree with the hon. Gentleman; we should do more to assist amateurs in whatever activity they are involved. Like me, the hon. Gentleman is a great believer in the fact that we can prevent illness by looking after our own bodies, by exercise, and so on.

    Because the hon. Gentleman wandered into Ibrox to talk about public relations exercises, perhaps I may refer to the best public relations flop last week when the leader of his party missed the boat to Dunoon. The chap who caught that boat was not the Leader of the Opposition but the vice-chairman of the Conservative party, myself. If it were a question of missing boats, I might draw the attention of the hon. Gentleman to the early-day motion about that, but I would probably be ruled out of order, so I will not refer to it. I am responding to the hon. Gentleman's meandering into Ibrox park. I would never have dreamt of going into Ibrox park until the hon. Gentleman did so. Because of that I had to respond.

    This important debate was delayed because of points of order. The reaction of some Opposition Members to a fairly straightforward question, touching a fundamental aspect of the new clause, that when people earn money writing articles——

    Order. The hon. Gentleman should address himself to the new clause about special health boards.

    The new clause has been the subject of many interesting articles. I hope that you, Mr. Deputy Speaker, are not suggesting that it is wrong for me to refer to them. The hon. Member for Cathcart made his view clear about the support for professional football of the body that the special health boards will replace. If it was in order for him to do that, it must be in order for me to draw attention to the many articles that have appeared in the Scottish media on that matter. I cannot believe that you are suggesting that I am out of order in drawing attention to those articles.

    Many of the authors of those articles are hon. Members and they have been commenting in those articles and have been paid for them. Perhaps the hon. Member for Cathcart would like to consider who is writing those articles. He should read the Glasgow Herald from time to time and he might recognise the names of the authors of articles in that paper. The new clause is very important because it will provide the machinery in Scotland to deal with important aspects of health care.

    The only part of the Minister's speech with which I could possibly agree was the reference to the importance of health education. That is hardly surprising since my knowledge of health education was gained when I was convenor of the health and welfare committee of Aberdeen town council. The health officer at the time was the formidable Dr. I. A. G. MacQueen, who was one of the foremost protagonists of health education and the role of the health visitor.

    I do not intend to discuss health education at length save td say that when the Health Service was reorganised in Scotland and we moved from the old regional hospital boards to the present health boards there was a great deal of concern that the removal of responsibility for health education from local authorities to the new health boards would lead to health education being subsumed under a huge area of responsibility. We were afraid that it would lose its importance and that the focal point would be lost.

    I do not want to criticise the Scottish Health Education Group, but I suspect from the Minister's remarks that there is need for a higher profile, a greater focus and more attention to be given to health education. Over the years, health education has clearly not had the impact that we hoped it would have. The health of the nation is not determined simply by the hospital service or by general practitioners. It is certainly not determined by politicians. The health of our nation is determined by good social and housing conditions.

    It is incongruous that we spend a great deal of money on unhealthy practices such as drinking and smoking. If we have to declare an interest in either of those pastimes, I must admit to partaking occasionally of the liquids that come from the vine and the rye and I occasionally indulge in tobacco. I hope that that does not prevent me from participating in the debate.

    A good life style and good living habits should be encouraged at an early age and health education is extremely important. I would not quarrel with any of the Government's proposals to improve health education. However, I wonder why it is necessary to have such a portmanteau provision as new clause 74.

    As the Minister said, the new clause sets up special health boards. However, it states that the Secretary of State
    "may by order constitute boards, either for the whole of Scotland or for such parts of Scotland as he may so determine, for the purpose of exercising such of his functions".
    The Secretary of State is taking power here not just to set up special health boards to deal with health education or with HIV; he can also set up boards in particular parts of Scotland.

    5.15 pm

    I hope that the Minister does not believe that the new clause will weaken the comprehensive role of the existing health boards. There has been much discussion and argument about the functions of the new health boards. It was decided that they should cover the widest possible spectrum covering primary health care, secondary health care and community care.

    We know that community care is to be removed. Will there be a special health board to deal with community care once it disappears to local government? That would seem to be inconsistent, but it might be a possibility. Will there be special health boards in local areas? Will there be special health boards in local areas to deal with specific functions? Does the Minister believe that if a particular health board is recalcitrant about privatisation—and. I regret to say that Grampian health board is enthusiastic about privatisation——

    I can see the Minister nodding and smiling, but we will return to that point later.

    For the purposes of this new clause, if a health board decided that it would not pursue privatisation for particular services, does the Minister have the power under the new clause to establish a special health board to deal with those areas that he wants to privatise? He must give us a clear answer on why he needs special local health boards. He gave no reasons in his opening remarks. It is not good enough to table such broad sweeping new clauses without providing a clear explanation of their meaning.

    I want now to consider the Health Service executive I assume that the Minister has legislative authority over that, although he is not taking such powers in the new clause. What is the legislative purpose of the new Health Service executive? Will it be a special health board under new clause 74?

    We need to know how much the executive staff will be paid. I have seen estimates that they may be paid as much as £50,000 a year. What binding contracts will be provided? Anyone thinking of taking up such a contract must be aware that if he is appointed arbitrarily with an arbitrary contract, he will be subject to arbitrary dismissal if there is a change of Government.

    The Minister cannot provide five-year or 10-year contracts believing that they will tie staff down, because there will have to be compensation if the executive is disbanded if there is a change of Government. I hope that no one will take such a job under the illusion that he has a fat, juicy contract with £50,000 a year and that he will get compensation if we decide that the executive will not exist after the next general election.

    The new clause looks innocuous and it would appear to be a reasonable tidying-up measure. Most uncharacteristically, the Minister introduced it in such a modest and moderate way that it is hardly surprising if we wonder what is going on in his little mind behind his smiling, bland little face. We need more explanation before we accept the new clause, although I emphasise that we support entirely the idea of giving health education a much higher profile and more new money.

    I begin by declaring an interest in that I am sponsored by the Transport and General Workers Union, although not a penny of that money enters my pockets. It is spent campaigning against Conservative policies in Maryhill—and that is an easy job.

    I want more information from the Minister on the proposals for special health boards and health education than he has so far troubled to give us. The Minister has not said anything about how the membership will be decided. We must remember the way in which the composition of the local health boards has been changed over the years, so that more and more people of Conservative persuasion seem to serve on them while fewer and fewer of Labour persuasion are chosen. That makes me wonder how these boards will be chosen. Might trade unionists who are involved in health education find a place or two on them?

    What are the Minister's plans for choosing women to serve on the boards? Very few women serve on the public bodies in Scotland—boards of various types—over which the Minister has some influence or control. The proportion is tiny. Women chair only one or two. Generally speaking, those in which women participate in any great extent relate directly to things that are seen as women oriented. I also wonder about the resources that the new health education board will have——

    I may have misheard the hon. Lady, but is she suggesting that very few health boards are chaired by women? If so, she could not be more incorrect. If the hon. Lady checks, she will see that a number of health boards are chaired by women, for example, Lanarkshire and Forth Valley. The most recent appointment that we made—in Forth Valley—was bitterly criticised by the Labour party, but it was another example of another woman being appointed to a health board. Others, such as in Fife and the Western Isles, are also chaired by women.

    If the Minister had been listening to what I had been saying, he would have heard me refer to public bodies in general, across the whole spectrum. Few women serve on or chair such bodies. Of course, I do not simply want there to be more women—I want more women of progressive views to be involved, who will want to do something for their communities. Clearly, not all women fall into that category—as is only too obvious in this place.

    The Minister has not spelt out whether the new boards will have more or fewer resources than the present health education body. I hate to suggest this to the hon. Gentleman in case I am putting ideas in his mind, but has he any thoughts about the bodies being funded by the commercial interests that would benefit from increased health education, such as Outspan and Jaffa? Who knows, perhaps this is the first time that that has entered the Minister's head. I hope that I have not given him a new idea.

    I do not see the point of leaving it up to the new boards to determine their priorities and targets. I should have thought that medical advice on the major problems confronting us would be the best way in which they could decide their priorities.

    We have enormous health problems in Scotland. Indeed, the Minister identified the problems of heart disease and bronchitis from which we know that Scotland suffers especially. There is not much point in advising people that their housing conditions are unhealthy when they can do precious little about it. Will the Minister run a course in health education for his hon. Friend the Minister for Housing and Planning so that they can do something about achieving the major improvement in people's health that would result if they were removed from the damp-ridden housing that is wrecking their health?

    Problems such as drug abuse are widespread in parts of Glasgow. I know that useful work had been done on that, but I should like to know whether special funding will be provided for it. Quite apart from the horrific impact on people's lives if they themselves are abusing drugs and on those of their families, drug abuse creates extremely unpleasant living conditions for their neighbours and those who live in the vicinity. Children in parts of my constituency find needles lying in untended grass on wasteland.

    Many health education issues need our attention. I am arguing for women to be involved in the boards not simply on the grounds of sexual equality, but because many health matters affect women especially. Women tend to be greater users of the Health Service, both in their own right and because they bring their children to the surgeries. It would be a pity if we did not ensure that women are involved in those bodies in appropriate numbers, and not only in the tiny minority that is the case now in most of the different boards that operate in Scotland. Obviously, I want women of progressive views to be involved, and not too many Conservative women.

    I welcome this important new clause. Any idea that was cobbled together by my hon. Friend the Member for Ross, Cromarty and Skye (Mr. Kennedy) and the hon. Member for Tayside, North (Mr. Walker)—an unholy alliance if ever I saw one—must be worth supporting, but perhaps that is going too far.

    Since being elected to the House, I have tried to take a particular interest in preventive medicine in its broadest sense because I believe that moving health care in general in the direction of prevention is an entirely good and proper thing, and health education is an important element in that.

    The only reason why I am dragged to my feet now is to ask about the independence that the new body will enjoy. I do so because some worrying parallels could be drawn with the situation that arose in 1986 when the right hon. Member for Sutton Coldfield (Sir N. Fowler), the then Secretary of State for Social Services, abolished the health body that was then independent of the Government and established a new Health Education Authority. That provides a parallel with the contents of the new clause. I do not need to remind the House that real misgivings were voiced at that time. When the right hon. Gentleman introduced that change in 1986, he said that he was doing so to deal with the special problems of AIDS. Everyone supported the move for that reason. However, it subsequently became clear that the Government were using undue influence and bringing to bear departmental methods of working and priorities in a way that was not possible before, when the previous English and Welsh body had more independence from Government Departments.

    There is a great deal of value in any health education body having an element of independence. If such a body is to be successful, it must operate in areas that are difficult for any Government because they embrace, for example, dietary provision and nutrition. That immediately involves a confrontation with the direct commercial interests of the food industry. I fully accept the difficulties of that. We have had arguments about sugar and about cholesterol-free diets around which many commercial interests have been built up. Similarly, we must confront the difficult area of alcohol abuse in terms of, on the one hand, what is good for the population's health, and, on the other, what is good for the industry that is supplying liquor of all sorts. There are also similar problems with the tobacco industry, about which I have been concerned for some time.

    Any health education body worth that description will have to look closely at the impact of the produce and the products that such commercial enterprises are purveying to the public. If that body is under direct Government guidance and control, that puts the Government in a difficult position. I hope that that matter has been properly addressed and that the things that went so badly wrong in 1986 when the Department in England took over the previous health education body for England and Wales are corrected for Scotland in the future.

    Following that train of thought one step further, I hope that the voluntary sector will be able to interface closely with the new body that the Minister is setting up. I also hope that funds will be made available so that it can undertake work in some of the sensitive areas with which the Government find it difficult to cope, such as AIDS. I pay tribute to what has been done north of the border in that area. An awful lot more needs to be done. It is valuable to establish a health education authority to look at the specific Scottish aspects of the development of the disease. I am grateful that the Minister is nodding his assent.

    I fully understand that for any Government advertising campaigns are necessary to confront the problem adequately. It is difficult for Government Departments to do so. There is a value in having pressure groups and voluntary groups that can work alongside AIDS sufferers and HIV positive patients in a way that Ministers, officials and civil servants never could. That is no criticism of them; it is simply recognising reality. I hope that the new body will have a wide scope, flexibility and independence and will be free from the influence of the Minister's Department. If not, he will be wasting his time and the body will not succeed.

    It would be helpful if we could be given a steer about the amounts of money and the resources that might be available to the authority. Is it likely that there will be new money or will budgets have to be trimmed to give the new health education authority an acceptable budget with which to work? I hope that the Minister will consult widely—I mean widely, to the extent of consulting the voluntary sector—before he puts together the membership of the new body. That, too, is crucial. I agree with the hon. Member for Glasgow, Maryhill (Mrs. Fyfe) that we must have more women on all such bodies. We must have a spread of membership to embrace all the difficult matters that must be dealt with if the body is to succeed.

    I welcome the initiative. The body has great potential for confronting some of the difficulties that are peculiar to north of the border, such as coronary heart disease and short life expectancy, to which the Minister referred. The body can do so only if it is genuinely free of day-to-day Government interference and control.

    5.30 pm

    I shall be brief because many of the points that I should have made have been touched upon by other hon. Members. The Minister has shown an administrative commitment to the establishment of the boards and we are asking for details to flesh out the ideas behind them. A great deal of importance should be attached to who the members of the boards will be and what budget will be available to them.

    We all recognise the great importance of health education. One point that has not been touched upon by other hon. Members is how the boards will interface with our education system. We all recognise that a great deal of health education work has been undertaken in our primary and secondary schools. We owe a great debt to many teachers, particularly physical education teachers, who, through their classes, have made youngsters aware of the implications of diet and habits for their health. Many parents have told me that they have stopped smoking because such an impact has been made on their children during lessons at school that the parents feel guilty arid give up the habit. Perhaps I should have some children who could come home and give me that lesson because, like the hon. Member for Aberdeen, North (Mr. Hughes), I admit to particular vices.

    It is important to know how the health boards will tie in with our education system, and use the expertise that is already present in our schools and the information that the Scottish Health Education Group so readily supplies to them. We want that to continue and to be expanded. It will be interesting to hear what interface the Minister has in mind.

    As the Minister was either generous enough or grotesque enough to give me joint B-film scripting accreditation on the new clause with the hon. Member for Tayside, North (Mr. Walker), it seems appropriate for me to say a few words. My hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) described that partnership as an unholy alliance. I hope that the House understands that on these Benches we can speak about that term with particular insight.

    I echo the question put to the Minister on the structure that he has chosen. The hon. Member for Aberdeen, North (Mr. Hughes) said that, like so much else in the Bill, the new clause opens up fairly wide-ranging powers. Under various clauses, we have heard time and again that the Secretary of State is taking powers unto himself. More often than not, we are told, "Don't worry because he does not intend to exercise them." Some of us fear that from time to time those powers will be exercised. We should never ascribe to this Health Minister some of the mean motives that might be in the hearts or minds of other Health Ministers, but the successors to his office may want to use those powers in a different way. What safeguards are there?

    The hon. Member for Glasgow, Cathcart (Mr. Maxton) referred to prevention when he spoke about sport. The Health Minister is also responsible for sport in Scotland. He wears two hats. I repeat the point made earlier in this short debate, that over the century the greatest contributors to better and healthier living have been improved housing, water supplies and working and environmental conditions. In that context, and without straying beyond the parameters of the debate, I hope that the Minister will recognise that there are slightly wider social obligations, in terms of broader Government social policy. Much of that resides with the Secretary of State for Social Security. We shall go on to one aspect of that later. Those obligations must be borne in mind as well as worthwhile and valuable initiatives such as the Minister outlined.

    Like the two other smoking sinners, and as the third member of that triumvirate in the House, and with national no-smoking day almost upon us, such is the extent to which I am moved by the Minister that I shall have a real go this year to kick the habit once and for all.

    I am delighted that, even before the new clause has been accepted by the House, we have at least one convert in the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). If the House accepts the new clause and amendments, when we lay down regulations to establish the new health boards in Scotland responsible for health education, the hon. Gentleman will be able to give us a full report on the progress that he has made in the intervening period.

    The hon. Gentleman was kind enough to raise the matter in Committee when I was considering the report that we had received from Touche Ross and the advisory council. The hon. Gentleman said that the Secretary of State was taking more powers. The new clause and amendments do not give the Secretary of State more powers. They enable him to delegate his powers to new bodies. In that sense, the new clause does not increase the Secretary of State's powers but merely allows him to set up bodies that will act as his agents. That is the constitutional position of the health boards. I pointed that out when we first discussed competitive tendering in Scotland.

    Perhaps the Minister will tell the House in what other circumstances he expects the Secretary of State to use the power to delegate responsibilities. For what reasons would he do so?

    If the hon. Gentleman is patient, I shall come back to the point that he raised. I was simply responding to the points raised by the hon. Member for Ross, Cromarty and Skye.

    The hon. Member for Ross, Cromarty and Skye also said that housing, water supplies and so on were important for public health. I agree, but he will recognise that both those areas are the responsibility of local government, not central Government. There is certainly much room for improvement in both areas and in local government. No doubt people will take the opportunity in respect of water supplies on 3 May.

    The hon. Member for Glasgow, Cathcart (Mr. Maxton) raised several points. He asked why there was no reference in the new clause and amendments to health education and why they were widely drawn. To be perfectly honest, when we were contemplating what steps we might take it struck me as remarkable that the Secretary of State for Scotland could not delegate his powers to new bodies that he might constitute, as my right hon. and learned Friend the Secretary of State for Health can south of the border. We discussed the matter in Committee and it seemed appropriate that we should give the Secretary of State those powers.

    I am surprised that the hon. Member for Aberdeen, North (Mr. Hughes) thinks that there is some Machiavellian plot involved in my moving the new clause. There is nothing sinister or underhand going on. The powers in the new clause and amendments mean that the Secretary of State would have to come to the House to make regulations which would be subject to negative resolution. Therefore, the House would have every opportunity to consider the arrangements in respect of this new health education body.

    The hon. Member for Cathcart was suspicious and, in line with the hon. Member for Aberdeen, North, suggested that this was all part of putting the management executive, which we have established in the NHS, on a statutory basis. We do not require these changes in the law to establish the management executive. We have been able to do so. Mr. Cruickshank, the chief executive of the NHS, is a civil servant, not a political appointee. I was distressed to hear what the hon. Member for Aberdeen, North said. I take it that he was not speaking for his Front Bench when he suggested that members of the management executive, who are being recruited to get the best possible deal for the patient, would not enjoy job security under a Labour Government. In that respect they would share the fate of many thousands of fellow Scots, if that is what he sought to imply.

    We must get this exactly right. What is the status of the new executive body? Will the individuals be appointed under normal Civil Service terms and conditions? If so, that is another matter. However, if they are to be appointed on individual binding contracts with high salaries, we need to be told. There is a big difference.

    The hon. Gentleman is absolutely right. The appointment of people on fixed-term contracts which are performance related is different. It is also desirable and important. The chief executive of the Health Service certainly is appointed on that basis, as are the general managers of the health boards. That is a great step forward and I am sure that the hon. Gentleman will welcome accountability of those whose function it is to hold the Health Service accountable for the targets which are set in the interests of patients.

    All of us would be interested to know exactly who the Minister has in mind for these jobs. The newspapers have said that the chief medical officer for Scotland will be one person on the executive. Who will the others be? I appreciate the Minister's remark about Mr. Cruickshank because he was appointed against the Minister's wishes. The Minister wanted Mr. Laurence Peterken from the Greater Glasgow health board. Is not this a back door through which the Minister can put Mr. Peterken on the executive?

    What the hon. Gentleman says is completely untrue. The appointment of the chief executive was made in the normal way, on a recommendation from the Civil Service Commission, and was approved by Ministers. The hon. Gentleman should not make such comments unless he is sure of his facts. He is wrong.

    The management executive has nothing whatever to do with the new clause. It has come into the debate only because the hon. Member for Aberdeen, North asked me to give an assurance that we do not intend to create a special health board, which is the management executive. I am happy to give him that undertaking which I hope means that we can now leave the matter behind us and look forward to a better managed, better run Health Service. I know that Opposition Members are opposed to that——

    In a moment. The Official Report will show that the hon. Member for Cathcart said that we cannot run the NHS like a business, and a business is run in a businesslike manner. A Health Service run in that way will be better able to meet the needs of the patients and those who send us to the House.

    5.45 pm

    The Minister should not be allowed to get away with the statement that Labour Members do not want the Health Service run in a businesslike manner. It is utterly untrue. In all the years I have been involved in the Health Service, whether as a councillor, a member of the regional hospital board or a Minister, we have always been anxious to ensure that it is run properly and we get value for money. That is different from what is happening now. The Health Service is being run not on businesslike methods, but to put business the way of the Minister's friends. The way that it has been prostituted for his political ideals is a disgrace.

    If the hon. Gentleman is arguing that the Labour Government ran the Health Service well, he will forgive me for pointing out that they presided over a cut in the hospital building programme and a cut in nurses' pay of more than a quarter. The contrast with our record could not be clearer. He may not wish me to go over what is certainly ancient history, because it is so long since we had a Labour Government, but perhaps I may remind him of the Labour party's attitude to the appointment of business men to take charge of Health Service management. It opposed that on the grounds that business men were not appropriate. Yet business methods and a businesslike way of running the Health Service are in the interests of patients.

    I have been good in giving way and I should make progress, but I give way to the hon. Member for Aberdeen, North.

    The Minister should be reminded that the Labour Government set up a special commission to look into nurses' pay. That was done thoroughly. I remember a business man in Aberdeen who was appointed by one of the Minister's predecessors to be vice chairman of the then North-East of Scotland regional hospital board with a view to making it more business-efficient. He became chairman of the finance committee. Within a year he said, "What are those so-and-sos who used to be friends of mine doing to my Health Service?" Business men who are appointed know what is happening. The Health Service is not being run properly in the interests of patients. and the Minister should stop pretending that it is.

    If the hon. Gentleman is saying that everything is not perfect in the Health Service, I agree. That is why we are introducing the Bill and providing for the service to be run in a more businesslike way. If he thinks that it is any consolation to nurses that when his colleagues were in government they set up a commission into nurses' pay, he does not live in the real world. The Labour Government cut nurses' pay by a quarter whereas we have increased it by——

    Order. This is a long way from the new clause before the House. I hope that the Minister will return to it.

    I apologise, Mr. Deputy Speaker, if to speak of the good news in the Health Service is to stray from the new clause.

    The hon. Member for Cathcart asked about the "Good Hearted Glasgow" campaign. I appreciate his kind comments about it. It is a good example of a health board being involved in health promotion and doing it extremely well. That sort of campaign would not be threatened in any way by the creation of a new body with national responsibilities for health promotion, as he claimed. We intend to have a national policy statement about health education for which the new body will he responsible. The health boards will work with the new body to achieve that. We particularly want to place more emphasis on the prevention of coronary heart disease. The campaign in Glasgow and that in my own constituency, which is run by the Forth Valley health board, are excellent examples of what can be done in that area.

    Since this seems to be a rather rushed affair, and since the Under-Secretary has referred to the important subject of health education, will he tell the House what consultations he or the Secretary of State have had with people responsible for health education at the moment?

    I do not think that the hon. Gentleman was here at the beginning of our deliberations and lie therefore missed what I had to tell the House——

    I am surprised, because I told the House that we had asked Touche Ross to carry out a review of health education policy in Scotland. The company spoke to nearly all the interested parties in health education and produced a report which is now in the Library. I commend it to the hon. Gentleman. It sets out Touche Ross's recommendations, which reflect the views that were given as it went around Scotland speaking to interested groups. The report recommends the establishment of a special body, although not of the kind that we are discussing. Having commissioned those reports, we should proceed with all due speed to ensure that the body is up and running by 1 April next year.

    My hon. Friend the Member for Tayside, North (Mr. Walker), who is no longer in the Chamber, raised a number of important issues. As the hon. Member for Ross, Cromarty and Skye said, we should give him and my hon. Friend credit for having raised the matter in Committee.

    The hon. Member for Moray (Mrs. Ewing) asked me about the detailed nature of the body, who would be appointed and other such matters. Assuming that the amendments are passed, that will be decided by the House. There will be an opportunity to discuss the issue in the House, if the hon. Lady cares to ensure that, because the new clause provides for powers to make regulations which will be subject to negative resolution. I have no doubt that we will get a great deal of advice now that we have made our policy clear.

    The hon. Lady also highlighted the importance of health education in schools, and I entirely agree. We shall expect the new body to strengthen links with education authorities and schools. When I was Education Minister I was particularly conscious of the great work that is being done in our schools, particularly on drugs and AIDS, and all credit is due to the education authorities involved in that.

    The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) asked me about independence—[Interruption.] Not the kind of independence with which the hon. Member for Moray is concerned. That seems to be becoming less fashionable, if recent polls are to be believed.

    The hon. Member for Roxburgh and Berwickshire asked me about the independence of this body. It will be active as the agent of the Secretary of State. I agree that there are times when it is helpful for Ministers to be distanced from some of the campaign that is necessary on a health education fund, for the reasons that the hon. Gentleman outlined. There will be a national policy statement and it will be the job of the board to give effect to it and obviously that will be at arm's length.

    I heard what the hon. Gentleman said about the nature of the board, and the composition of chairman and members, and I shall ensure that people with the talent and ability to provide the best possible service will be recruited to the body—as we have done with all the health boards.

    The hon. Member for Roxburgh and Berwickshire also asked me about resources that will be deployed. If he looks at the Touche Ross report in the Library, he will see that credit is given for the increasing resources that have been provided. The report points out that this area may have been under-resourced in the past. That was a problem not of funding but of structure. We are determined to commit resources to health education because it is one of our priorities.

    The hon. Member for Glasgow, Maryhill (Mrs. Fyfe) asked me about women appointees. I think that we have done extremely well in appointing women to health boards—not because they are women, but because they had the talent and expertise required—and they have done extremely well. The hon. Lady also asked me about funding for drug abuse. She will know that we have made available considerable additional resources to deal with the problems of drug abuse and AIDS. In the space of a little more than a year we have doubled resources. I hope that the hon. Lady will recognise the progress that has been made.

    I sense that, having given those assurances to Opposition Members, there may be some support across the House for our proposals. The strengthening of health education is a key link in achieving our objectives for a better health service and better health care in Scotland. I hope that I have been able to persuade the House to support the new clauses.

    I do not think that the Minister should be surprised if some hon. Members feel that we should take up some of his remarks, albeit briefly.

    The Under-Secretary of State said that he was not sure whether I had been listening to his remarks about the Touche Ross report, but I do not think that he was listening to my intervention. I clearly asked whether people involved in health education had been consulted. He gave no evidence that they had been consulted on the conclusions and the recommendations of the report. Therefore, there is a great temptation for Opposition Members—perhaps because of the Minister's speech—to have greater doubts about the new clause.

    In all honesty, perhaps the only redeeming feature is that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), who was positive at all times in Committee, made some contribution to the new clause. I hope that he and the House will not mind when I say that the Opposition—having heard the Under-Secretary's particularly vague explanation in response to my hon. Friend the Member for Aberdeen, North (Mr. Hughes), who asked a direct question about the legislative purpose of the boards—will judge the Government's real intentions when we deal with the regulations.

    I am not convinced that the new clause represents the answer that all hon. Members would wish for in creating a broad strategy for the Health Service in Scotland, and for the major thrust necessary to deal with heart disease, respiratory conditions and the problem of an earlier mortality rate than elsewhere in the United Kingdom. The Minister did not convince us that much time had been devoted to real consultations on health education. I hope he will not mind if I return to the painful subject of what was once the responsibility of the Scottish Film Council. I think he is now able to distinguish that organisation from the Scottish film library. It works closely with the health education unit, which deserves to be congratulated on the way that it has promoted the campaign against AIDS and drugs. The Opposition want to be absolutely certain that the quality of those campaigns will not be diminished but will increase. We are not convinced, by any stretch of the imagination, by the Minister's arguments. Some of us are worried, in view of his speech, that there he was, sitting on the roof of St. Andrew's house feeding the vultures and coming up with even more crazy ideas about what he will do with the Scottish Health Service.

    Notwithstanding the Minister's weak arguments, we shall not oppose the new clause. However, we shall look carefully at the regulations that will be laid before the House.

    Question put and agreed to.

    Clause read a Second time, and added to the Bill.

    New Clause 1

    Preserved Right To Income Support

    '(1) The Secretary of State shall, in respect of every person specified in Section 40 and who is in receipt of Income Support on the date on which Parts III and IV come into force:

  • (a) determine whether the appropriate amount of income support for that category of residential or nursing care is adequate to meet the charges levied by the residential care home or nursing home; and where it is inadequate establish the difference between the appropriate amount of income support and the charge; and
  • (b) pay to that person an additional amount of income support representing the figure determined in accordance with paragraph (a) above except that no such payment shall be made in respect of any proportion of a charge which an adjudication officer considers to be unreasonable, having regard to the nature of the premises and of the services provided; and
  • (c) by means of annual adjustments, maintain the value of the amount described in paragraph (b) above by reference to an index reflecting the average movement of charges made by proprietors of relevant premises.
  • (2) In this section:

    "relevant premises" has the same meaning as in section 40. "appropriate amount of income support" has the same meaning as in paragraph 5, 6 and 7 of Schedule 4 to the Income Support General Regulations l987.'.— [Mr. Robin Cook.]

    Brought up, and read the First time.

    6 pm

    I beg to move, That the clause be read a Second time.

    Before I turn to the substance of the new clause, I intend to make two comments on why the Opposition have chosen this as the first of the Opposition new clauses to be considered on Report. The Opposition deliberately chose a community care topic to be debated first. The Bill is the response, such as it is, of Ministers to the Griffiths report on community care and their response to the explosion in the numbers of the very elderly which, during the next decade, will be a major challenge to the health and social services.

    The clauses on community care are to be found at the very end of the Bill. We were anxious from the moment that we saw the Bill that those clauses should not be ignored. It is a measure of the success of our strategy in Committee—a success that has been much appreciated by voluntary organisations—that we were able to pace our Committee debates in such a way that four days were spent on debating those clauses. We were equally determined that community care and the needs of the elderly should not be forgotten on Report. It was partly for that reason that we chose to debate new clause 1 at the start of our debates on Report.

    I am sure that it has not escaped Ministers' attention that there is a second reason for the Opposition having chosen first to debate new clause 1: this is an issue which unites both sides of the House. I stand at the Dispatch Box under the novel burden of speaking to a new clause that has attracted the signatures of more than 30 Conservative Members. I respect their support, in return for which I shall seek to be as non-partisan as it is possible for me to be. I may have to compensate later tonight for that non-partisan spirit, but on this occasion I shall endeavour to curb my enthusiasm.

    It is understandable that so many Conservative Members should want to support our attempt to provide justice for the people who are referred to in the new clause. Ironically, Conservative Members represent more social security claimants than do Opposition Members. They represent constituencies in parts of the country that tend to have more private residential care homes. I doubt whether there is a single Conservative Member who does not know of at least one constituent in his or her constituency who falls into the trap that is addressed by the new clause. The trap catches elderly residents who entered private residential care homes or private nursing homes after being assured by the Department of Social Security that it would meet the charges through income support. Now, however, they find that they are being short-changed on income support and that they have no means of bridging the gap.

    During the last two months I have seen and heard of so many such cases that it is difficult for me to select only one for the purposes of illustration. However, I shall share with the House the experience of Mrs. Renninson, who appeared with me at a press conference last week. Mrs. Renninson's father experienced a stroke at the age of 86 and had to go into residential care. He was admitted to a home that was able to cope with his needs. However, from the moment that he entered the home he faced the familiar problem that the charges increased faster than the increase in income support. Four years later, at the age of 90, he was put out of the home by the owners. Seven weeks later he died. The discontinuance of familiar surroundings is one notorious way in which death among elderly people can be precipitated. However, we cannot tell whether in this case death was associated with a change in surroundings; we can only make a reasonable presumption.

    When Mrs. Renninson spoke to the press conference she said that she felt that it was a mercy that death occurred after her father's second stroke because he really did not know what was happening to him. As I listened o Mrs. Renninson, I thought how amazingly reasonable and calm she was, despite all that she had been through.

    I am bound to ask how we, as a legislature, can have permitted circumstances in which elderly men and women—too confused and too disoriented to know what is happening to them—are evicted from residential care homes because the benefit that they receive, in the name of this House, is not sufficient to keep a roof over their head.

    That case occurred in the constituency of the Minister for Health, who is responsible for community care. In fairness to the Minister, Mrs. Renninson told me that she appreciated the support that she received from the Minister during the years throughout which she struggled to meet the fees at the home. As Mrs. Renninson expressed it to me, the Minister had written many letters of support to her, but unfortunately she was trapped because of the way in which the regulations are framed.

    The new clause provides the House with an opportunity to change the regulations. It would help many people who are in the same position as Mrs. Renninson's father. Study after study throughout the past two years has confirmed that the present level of income support for those in private residential care is hopelessly inadequate to meet the fees. Only last month, Counsel and Care for the Elderly published its latest survey which showed that, of the homes it had investigated, only one in three charges fees that are within the income support limits. When it looked at homes in the London area, out of the 132 homes that it surveyed only seven charged fees that were within the income support limits.

    The British Federation of Care Home Proprietors says that the average shortfall is £40 a week. The Independent Hospitals Association says that the average shortfall is £60 a week. That shortfall is calculated on the basis of typical weekly expenditure per resident. It makes no allowance for capital borrowing and it allows only £14 a week for the food of each resident. When I referred to that figure in Committee, perhaps in an unfortunately partisan spirit I asked how many Conservative Members could feed themselves for a week on £14. In the non-partisan spirit in which I move the new clause, I ask my hon. Friends how many of them could feed themselves for a week on £14.

    Lest it be thought that the shortfall that the figures represent includes an excessive and unreasonable profit for the homes, let me consider the case of those residential care homes in the private sector that do not seek to make a profit. The National Federation of Housing Associations has made a survey of 500 homes. All of them are provided by voluntary organisations or housing associations. All of them are organisations that the Government seek to foster. In none of these cases is a profit, excessive or otherwise, being made. Few of the 500 homes came up with charges within the limits for income support. In most cases they were £30 above the limit, and, in one fifth of cases, more than £60 above the limit.

    Counsel and Care for the Elderly has sent to a number of hon. Members examples of the cases in respect of which it has been asked for assistance. I should like to refer to two or three of them. The first demonstrates beyond any argument how even organisations that do not seek to make a profit cannot run their homes within the limits set by the Department of Social Security. Let me cite the case of Mrs. B, aged 95. In 1985 Mrs. B moved into a voluntary nursing home run by an order of Roman Catholic nuns. Over the past five years the nuns have been faced with escalating costs, and the fees of this non-profit-making home are now £275 per week. Mrs. B is therefore unable to meet the full charge out of her income support. Her daughter is retired and is unable to make up the shortfall. Six charity funds have now been persuaded to make long-term grants, leaving the retired daughter to make what is described as a manageable contribution to top up the social security. This is a home run by nuns—people who patently do not seek to make an excessive or unreasonable profit, people who have themselves taken vows of poverty, yet who, within the limits set by the Department of Social Security, cannot make ends meet. I should like the House to note how many charities had to be approached in order that the gap might be bridged.

    Let me refer to another case history that has been supplied by Counsel and Care for the Elderly. It relates to a woman of 92 who has been in a private nursing home in Sussex for four years. She is confused and requires heavy physical care. The fees of the home have increased steadily, and there is now a shortfall of £90 per week. As in the other case, this lady's only daughter is retired. Nevertheless, she contributed her entire state pension to try to meet the amount by which income support fell short of the fee. That situation cannot be maintained for long. Currently. Counsel and Care for the Elderly is negotiating with 10 separate charities to meet the top-up. It says that if all 10 can help, Mrs. V will be able to remain in the home.

    What makes many of these cases so perverse is that they involve elderly people who were placed in private residential care by NHS hospitals desperately anxious to recover the beds that were being occupied. Time and again those people, having been placed in that care, are left in an impossible financial situation. Just before coming to the Chamber I received, by fax, from the National Association of Citizens Advice Bureaux, details of the latest case. It involves an elderly lady who is in need of full-time nursing. She is incontinent and is unable even to feed herself. She has been in a private nursing home for a number of years. The home has now asked her son to remove her because it is no longer prepared to tolerate the loss that it sustains by way of the difference between income support and the fee that it charges. The irony is that neither the son nor the lady herself was responsible for her being in the nursing home in the first place; a local NHS hospital put her there without consulting the son because it wanted access to the bed that she was occupying.

    6.15 pm

    As this matter was debated by the Select Committee, we have the advantage of the Committee's report, which came out last week. It confirms every point that was put to Ministers in the Standing Committee on the Bill. In particular—and I found this startling—the report confirms that the Government themselves admit that income support levels do not meet the needs of many of those in private residential care. It quotes Ministers as having said that 58 per cent. of people in private residential care in receipt of income support are paying fees that are within income support limits. Therefore, even on the basis of the Government's own figures, two out of five of those in private residential care are faced with fees that are outside income support limits.

    I have to say to the Secretary of State for Social Security, whose presence for this debate I welcome, that, given his knowledge that 42 per cent. of those people are now faced with charges that exceed income support levels, it is impossible to believe that the uprating this year or last year turned on a careful calculation of what it would take to meet a reasonable fee.

    As the House will be aware, the uprating that was announced last autumn will take effect next month. I remember the figure particularly well—it is £10—as at that time I was shadowing also the Minister who will reply to this debate. I can tell the House how the right hon. Gentleman arrived at that figure. He did not do so by measuring the fees and by doing a careful calculation of what was needed; it just happens that £10 is the round figure nearest to 5·4 per cent. of the £190 that was the previous limit for care in private nursing homes. This is the standard application of the uprating, across social security, to these levels, although that uprating is hopelessly out of touch.

    Last year, for instance, private nursing homes had to meet the cost of the nurses' pay award. This year they have to meet the additional burden of high interest rates. These place a particularly heavy burden on those homes that borrowed in order to get into business. The Select Committee's report quotes the Minister as having said that it was never intended that fees should be met in full. In other words, it was never intended, and apparently never claimed, that income support levels should be measured against the fees of homes. I put it to the Secretary of State and to the Minister of State that, as a simple statement, that is just not true.

    The original basis on which income support was made available to people moving into private residential care was that of the regulations on board and lodgings, under which local social security officers were empowered to meet the full reasonable cost of accommodation. There is no suggestion there that it was not intended that those payments should not meet the full cost of private residential care. Let me put to the Secretary of State what, in a sense, is a more important consideration: that statement not only is not true in history but is a novel principle in social security law. The whole function of income support is to meet the full subsistence needs of those in receipt of it. After all, they are broke. They have no other means of subsistence. If it were otherwise, those other means would be deducted from the income support entitlement.

    That prompts a question to which a straight answer from the Secretary of State would be appreciated by many people: if he and the Minister of State are now saying that it is not their intention that the full reasonable charges of these homes should be met through income support, who is it intended should make up the balance? Who should absorb the shortfall? Will it be the homes? Are they expected to make a loss as a condition of accepting as residents people who are on income support? I can tell the Secretary of State what their response will be. Indeed, there are two possible responses.

    As the hon. Gentleman will know, I put my name to the new clause. I put this question to him in good faith so that I may be able to think through the point that he is making. I am sure he agrees that, under the old system, there was gross exploitation by a proportion of nursing home owners, in the sense that they increased their rates knowing that the individuals concerned would have only to apply to the DHSS, as it then was, to have the shortfall automatically made up. We are now in a new situation. I understand completely the points that the hon. Gentleman is making. However, I ask him quite genuinely how he thinks this problem should be overcome. It seems to me that there are two possible solutions: either there should be a blanket increase in all levels, or either the DHSS or the social services departments of county councils should be allowed to assess cases and make a proportionate increase to meet the costs. Which is the best path to go down—or does the hon. Gentleman have an alternative?

    The hon. Gentleman makes a rich intervention and it will take me a little time to respond to it. On his point about the genesis of the situation, I do not wish to introduce a partisan note, but if it were possible for us to go back to 1980, we would not have wished to start out on the path that the Government followed. We would have preferred the large sums that were made available through the social security budget for private residential care to be channelled into local authority residential care, which would have meant that we would not now face our present difficulty.

    Ministers made the deliberate decision to subsidise the expansion of private residential care through social security provision. The resultant expansion cannot have come as a surprise to them, because the policy was intended to achieve that expansion. I accept the point made by the hon. Member for Brighton, Kemptown (Mr. Bowden); indeed, the Opposition criticised the consequences. Some homes came into existence at that time with, let us be frank, an eye to the main chance, to take advantage of the new bonanza.

    I would not necessarily criticise the 1985 system to introduce fiat-rate payments for people in private residential care, although I believe that they should have been subject to regional variation. I criticise the fact that, since 1985, those flat-rate payments have been uprated in such a meagre and unrealistic way that they have precipitated a major crisis among those in receipt of those allowances.

    To follow the point raised by the hon. Member for Kemptown, and letting all that go as water under the bridge, how do we get out—if that is not a hopelessly mixed metaphor? Perhaps I should say, how do we get up-river from where we are? As the hon. Gentleman said, there are two alternatives. The alternative proposed in my new clause, to which the hon. Gentleman has added his name, is that we should oblige the Department of Social Security to carry out a realistic evaluation of what charges are reasonable. The new clause gives protection and gives the Department the right to refuse to make payments where the charge is unreasonable and to pay the money to the resident.

    I am not immediately attracted to the alternative of empowering local authorities to top up the amounts. Every other clause on community care imposes additional burdens and liabilities on local authorities. The Opposition doubt whether those local authorities will achieve the necessary finance to discharge them. I should be hesitant about passing on to those local authorities the additional expenditure of meeting that top-up. I can warn the hon. Member for Kemptown about the immediate arid predictable consequences of such a change: the Secretary of State for Social Security would never uprate those limits again and the burden would fall on local authorities. That is why I chose the path followed by the new clause. I hope that I have responded to the points raised by the hon. Member for Kemptown without jeopardising his support for that approach.

    To return to my previous remarks, I was posing to the Secretary of State this question: who does he expect to meet the top-up payment if Ministers no longer intend to meet the full bill? Is it the home? Is it expected to absorb a loss? If so, the home can make two responses. First, it can reduce the facilities that can be made available to people on income support, and that is already happening. A study carried out last year by a firm of financial analysts discovered that only 11 per cent. of homes providing private residential care were willing to provide single rooms for residents on income support. Virtually 90 per cent. now provide only shared accommodation for such residents. Those homes have drawn to our attention the fact that two-tier accommodation is emerging in the private residential sector. The National Association of Citizens Advice Bureaux refers in its briefing to many hon. Members to its information that there are homes where residents on income support receive inferior meals compared with other residents. I cannot believe that any hon. Member would knowingly wish to have a public policy that resulted in that tasteless, undignified and damaging discrimination.

    The second response that a home can make is simply to go bankrupt, and a number of homes are contemplating making that response. In Standing Committee, the Minister of State was good enough to say that she was tremendously impressed by the work of the Anchor Housing Association for the Elderly. I do not know whether she has had an opportunity to study the Select Committee's report, but it contains the evidence that that association provided to the Select Committee. The Anchor Housing Association said that its shortfall was £30 a week per resident and pointed out that in 1988–89 the association lost £250,000 on its residential care schemes, which, as the association said, was
    "a loss it cannot, as a charity, continue to sustain".
    If it is not the homes that have to absorb the top-up amounts, will it be the relatives? I put it to the Secretary of State, who knows social security law as well as any other Member, that the liability to pay the fees is a liability on the resident, not on the relatives. In any event, often those relatives are elderly. We are talking about residents of private residential care homes who are in their 90s. It is in the nature of people of that age that their sons and daughters are themselves retired. As hon. Members will have seen from the briefing circulated to them, NACAB knows of at least one retired pensioner couple, in Cheshire, who have been obliged to take part-time employment solely to pay the top-up on the fee charged for their mother's accommodation.

    Does the hon. Gentleman agree that one of the tragedies of the problem is that, however severely incapacitated, the elderly person may live on for 10 or more years? I know of someone who lived on for 17 years. Even if the relatives have reasonable funds, they can soon be dissipated and they could be in penury.

    The hon. Gentleman makes a fair, although infelicitously expressed, point. There is no doubt that one of the great stresses felt by relatives with an elderly parent in this position is that they have no idea how long it will continue, so they have no idea whether they will have any savings left. They do not even know whether their savings will last long enough to keep their relative in private residential care. When their savings are gone, who will meet their liabilities when they in turn require private residential care?

    I come to the last possibility in terms of who fills the gap. Are the residents expected to make up the balance? If so, how? By definition, they are people who have no income of their own, except for the £10 a week that they are allowed for personal expenses. Although it is contrary to social security law, many of these residents do not receive even that miserable personal allowance; it goes to fill the gap on the fee, leaving those residents with no money for telephone calls home, stamps and toiletries and even, for some, no money to purchase the incontinence pads that they need but now cannot obtain on prescription.

    Ministers have a wonderful phrase to describe what will happen to people in those circumstances under the Bill. It is said that they will have "preserved rights". There is no security in having preserved rights that will leave people unable to afford toothpaste or incontinence pads. The reality is that for "preserved rights" we should read "excluded rights". The only provision in the Bill that affects those people is clause 40, which is in the Bill with only one purpose—to exclude those people presently in private residential care from the new arrangements to take effect from April 1991.

    There is a real danger that those people will become the forgotten people. Local authorities will have no powers to make the top-up, the Department of Health will have no duty towards them and the Department of Social Security, which plainly regards them as imposing irritating costs on the social security budget, wants to be shot of them as fast as possible.

    I hope that the House will not be bought off by the formula that the Minister of State put to the Committee when we debated this matter. The Minister drew attention to clause 40 on the basis that
    "there is scope for making a regulation power to provide for people who otherwise would be homeless or suffer severe hardship in the ultimate circumstances."—[Official Report, Standing Committee E, 13 February 1990; c. 866.]
    In other words, it would be possible to contemplate regulations that would protect the position of those people at the moment of eviction.

    That proposal does not address what happens in the years leading up to the moment of eviction. We are talking about people in their 80s or 90s. We cannot ask them to sleep easily in their beds on the basis that there may be regulations to cater for them at the point of eviction when the home finally boots them out. Moreover, such a regulation would be entirely pointless because the bizarre result of clause 39 and clause 40, read together, is that if the home evicts a resident and that resident qualifies for assessment by the local authority, qualifies under assessment as being eligible for residential care and is placed by that local authority in another residential care home, he becomes a new resident under the Bill at that point and will qualify for top-up.

    We are creating a ludicrous message to send out from this House to the owners of private residential care homes. We are saying to them, "If you are reasonable, if you absorb the loss, and if you do not evict the residents, we shall not help. But if you are unreasonable and evict that resident, we shall intervene and meet the bill." I cannot think of a more confused or hopelessly limited response to the problem.

    The truth is that that response is intended not to meet the problem but to defuse the political pressure to solve the problem. I urge the House not to be defused. I can guarantee Conservative Members plenty of opportunities for partisan votes in our proceedings on the Bill. They will have the opportunity to redeem themselves in the eyes of the hon. Member for Derby, North (Mr. Knight) before the night is out. I beg them to vote not to please the hon. Member for Derby, North on new clause 1, but to assist their constituents. I commend the new clause to the House.

    I am grateful for the opportunity to take part in the debate, which concerns the most vulnerable of our constituents. The Government are to be congratulated on their recognition that the present position is unsatisfactory. If they had not recognised that, they would not have brought about the courageous and welcome changes in their implementation of the Griffiths report and in the Bill. However, in saying that the proposals will relate only to elderly residents who come into private residential homes in future, the Government have eliminated from their wise and humane reforms all who are currently in such homes and who are having to suffer the unsatisfactory position that has led the Government to make changes in respect of future residents.

    The hon. Member for Livingston (Mr. Cook) has quoted several of his constituents and I suspect that we shall hear many specific cases tonight. I have raised the issue on many occasions, as has my hon. Friend the Member for Romsey and Waterside (Mr. Colvin), who deserves the thanks of the House for the persistence with which he has raised the matter over the past year. We have raised the topic in Adjournment debates, in Consolidated Fund debates, in the inquiry held by the Select Committee on Social Services and in many other convenient fora. I record my gratitude to my hon. Friend the Under-Secretary of State for Social Security for her many letters to me in response to a particular problem with one of my constituents. That problem is not solved and cannot be solved under the present circumstances. Although I have quoted the case of Florence Smith so frequently that she has become almost a byword to describe such a situation, I have many other cases.

    It is a question not only of the problems of our immediately suffering constituents, but of the effect that lack of recognition of the problem to the point of being unwilling to solve it will have on future provision for the elderly. It has been estimated that we need to provide about 40 new beds a week if we are to be able to take care of the ever-increasing number of elderly people by the end of the century. That means that there must be an incentive, and not a disincentive, to the homes to expand and to build them in the first place.

    There have been two principal reasons for the immense distortion between the charges being levied by the reasonable homes—I set aside for the moment the unreasonable homes—and the level of income support. First, there has been an immense rise in interest rates which means that any home that has new property attached to it, or is a new property itself, is having to pay immense sums to service the capital investment. The owners have to pass on those sums, which is not greed or unscrupulous profiteering, but basic business sense such as the Government normally applaud. Secondly, there was a welcome and wholly justifiable rise in the pay of nurses the year before last, when the average rise was 15 per cent. Once again, that charge has to he passed on in our nursing homes.

    It is significant that some of the homes that have managed to depress their charges artificially are those where the proprietor is herself a qualified nurse and can, therefore, take on many of the duties that would normally fall to other staff. However, if she is also to take on more residents—as she must if we are to meet our target for caring for the elderly—she will be unable to carry that burden indefinitely. That means that she will have to employ qualified staff at an ever-increasing cost, which also has to be passed on.

    Other distortions have been caused by regional variations. An established home with no new building in the north-west, for example, may be able to cope and set a charge within the level payable under income support, but there is no way that that can be done in areas where property is vastly more expensive, such as the south-east, and where the home is new. It is not insignificant that many Conservative Members who first started to draw attention to the problem have come from areas where property is expensive.

    Is my hon. Friend aware that even in the north-west it is extremely expensive for charities such as the Abbeyfield Society, in which I have a particular interest, to build extra care homes, service the debt and run them?

    My hon. Friend is right and I was not suggesting that the problem did not exist in other parts of the country. While the problems in the south-east are extra acute, we must examine the issue on a nationwide basis.

    I shall rehearse again the case of Florence Smith. She is aged 93 and until January 1989 was happy in a residential home, where she could afford the charges. Her income support more or less matched them and there was no problem. Then, like many elderly ladies—many of them much younger than 93—she developed specific nursing needs and could not be accommodated in a residential home. She was transferred to the Poplars, a reasonably priced nursing home in my area. Having telephoned my constituency to check on average charges, I assure the House that the home's charges are most reasonable. It is well respected, well known and a much sought after home. In other words, it is not a ruthlessly profiteering establishment. Florence Smith was moved there and it immediately became apparent that the total benefits payable to her would not cover the costs involved. At that stage the gap was about £10 and was manageable by her daughter. But her daughter depends on a pension, so as the gap grew and the £10 became a larger sum, the pressures on the daughter increased.

    The Florence Smiths of this world remain in such homes largely because the homes subsidise them. There must be a limit on how long we can expect the better homes to go on doing that. Somebody entering a home at the age of 93 may have six or seven years left, and the relatives are faced with the problem of meeting the ever increasing gap in payments. That is bad enough. But for somebody aged 70 with nursing needs and with perhaps 20 years to spend in a home, the relatives face an extremely worrying prospect.

    I could detail other cases, such as that of a professional, quite well-off couple who faced great problems. The wife developed Parkinson's disease, the husband could not look after her at home and there were no children able to help. Eventually she was moved into a nursing home. The husband took responsibility for that decision and he has run down his capital to the point where there is nothing left. What is to happen to that lady? The benefits available to her do not cover the charges.

    Last Saturday a lady told me that her father was terminally ill. Generous income support is available to the terminally ill and that lady has put her father in a home where the charges are eminently reasonable. Indeed, they are on the low side for the area. Yet those charges are not covered and the gap is £50 a week, which is a lot of money. The lady in that case is of working age, and told me that she would be willing to go to work to keep her father in that home for the last two or three months of his life. Unfortunately, she must also care for a sick son, so she must stay at home and cannot go out to work.

    The new clause poses the basic question of who pays. There is no answer to that question in any of the provisions that the Government have suggested. They have acknowledged the problem and have taken many courageous decisions, and we are grateful for that, but all hon. Members have in their constituencies cases such as that of Florence Smith and they know that there will be more of them with the passage of time. In other words, the problem will grow in magnitude and certainly will not go away.

    What happens if nobody pays? The Florence Smiths of this world fear what will happen to them if they are turned out of their homes. I do not paint a terrible picture of people being turned out of homes and wandering the streets with nowhere to go, but a sick elderly person in that situation, who either has no relatives or whose relatives cannot cope, will have to go into hospital. It is not even a cost-effective option to transfer people from homes to hospitals.

    The Government's policy of closing the larger mental hospitals with the aim of getting people cared for in the community is jeopardised by the situation I am describing. The sick elderly will be returning to hospital, from where nobody will be able to discharge them because there will be nowhere else for them to go. That will put an enormous strain on the Health Service and on the individuals.

    6.45 pm

    Is the hon. Lady aware that we have lost from the NHS about 6,500 beds in which many of the elderly people about whom she is speaking used to be accommodated? It is not realistic to suggest that returning the sick elderly to hospital is an option because there are so few long-stay beds available. I worked on a geriatric ward in the early 1980s. At that time the Government encouraged the practice of lists of private homes being put up in wards so that relatives could read them and consider putting their elderly folk into homes. There are no beds available in the NHS to take people on a long-term basis.

    I accept that the option is limited, but the fact remains that if someone is evicted from a home, that person must go somewhere, and if he or she is sick and has nursing needs, the inevitable end is a hospital. I accept that that will put immense pressure on the limited facilities that exist.

    We must also consider the problem of unreasonable fees. The Government are right to say that, whatever system is created, we must not encourage homes to increase their fees by £20 the instant income support is increased by £20. The Government are right to fear that happening. That is why the proposal in the new clause—that an adjudication officer should be able to refuse to pay any part of fees that appear to him to be unreasonable—should take care of the situation.

    The problem of fees is bound to arise with new residents. Nobody is saying that a contracting authority, when taking a certain number of beds in a home, will say, "No matter what you charge, we will go on paying it." There must be a system by which authorities can negotiate reasonable charges. That process will establish what is a reasonable charge and, once established, it can be applied to existing establishments. So, because of the Government's proposals, the bogy of the unreasonable charge will be less real than it may have been in the past. That will certainly be the case after April 1991.

    The new clause provides an adequate solution, and while the Government may complain about its wording, its aim is right. If we do nothing, the most vulnerable of our constituents will suffer greatly. Homes will have no incentive to build and expand when such developments should take place. Undue pressure will be placed on hospital services, which are already highly pressurised.

    While I support the Government totally in their general aims in the matter, I urge hon. Members to support the new clause and thereby protect existing residents, whose situation, we are told, will remain the same. In other words, it will remain grossly unsatisfactory, a grievous worry to them in their declining years and a growing burden for their relatives.

    I support the remarks of my hon. Friend the Member for Livingston (Mr. Cook) and the hon. Member for Maidstone (Miss Widdecombe). There are honourable reasons why many of our constituents find themselves in the land of limbo. I refer to our desire to offer our older citizens a better deal than they got in the geriatric wards of the past. Such a better deal appeared to be offered by many of the residential and nursing homes that sprung up.

    In the same spirit in which my hon. Friend the Member for Livingston moved the new clause, I do not wish to spend time drawing attention to the number of times that Opposition Members begged the Government not to go down that road—or, when they were going down it, not to have a gatekeeper to prevent expenditure from expanding, whether people needed to go into residential care or not. As the hon. Member for Maidstone said, we are now in that position, and must address ourselves to the question of what to do to protect some of our most vulnerable constituents.

    It is important to underline that we are discussing this matter tonight because there was a genuine agreement on both sides of the House that the geriatric ward was not the most desirable place for people to end their days. Nevertheless, it is also important to remind the House, and people outside, that when we were offering the alternative there was never any question that families would have to foot bills, let alone large bills.

    There has been a significant change in what I regard as the rights of citizenship. We are talking about people who may have been through two world wars; many of them have never been unemployed, and they have paid all their rates and taxes. One of the benefits that they thought would result from the contract struck with the state was the certainty that, if they needed to go into hospital or have nursing care, they or their relatives would not be faced with a bill. Now we discover that, because we wanted to offer them a better deal and because hospitals thought that it was a way of cutting costs, they and their families will face the sort of charges that the hon. Members have mentioned.

    Giving evidence to the Select Committee on Social Services last week, a witness from the Alzheimer's Disease Society said that families faced a deficit of £90 per week. As was pointed out by both the hon. Member for Maidstone and my hon. Friend the Member for Livingston, the deficits are growing. The Government must acknowledge that there are now pressures from the National Health Service, which will make the position worse. The Committee also heard evidence from clinicians who look after the Acton hospital in west London, which has a £1·5 million deficit. Some of those clinicians feel that the authorities are rushing into a scheme with the private sector in the hope of closing all the geriatric beds, because even under the current Government terms—which in the long run may prove unsatisfactory to the families of patients—as a result of closing its geriatric beds, the hospital will be able to halve its deficit. The picture painted by my hon. Friend the Member for Halifax (Mrs. Mahon), of those beds no longer being there when the ambulances bring people back, is a reality.

    A constituent of mine was informed that her aged mother had only three or four months to live, and that the consultant required the bed. She was not given a choice, and her mother was placed in an old people's home. Owing to nursing care and her own abilities, that old lady was still alive 18 months later. However, the fee in the home was more than £60 per week in excess of the family income.

    My constituent must now work part time, and she is assisted at the weekend by her son. The doubly incontinent 87-year-old woman is now cared for at home because the old people's home could not continue to keep her: the family could not meet the £60 per week deficit. Their family life has been destroyed, and they are distraught. There is no possibility of their finding care or respite in the public or private sector, because that facility has been denied to them.

    I am always pleased to give way to my hon. Friend, especially when he takes me on to my next point.

    We have now entered a new phase: there is no individual test of income on the recipient, but in respect of many families we have returned to the hated household means test. When Ministers appeared before the Select Committee, they made it plain that they would not tolerate that when the new scheme came into existence, and we applaud that. However, those who are already caught in limbo will continue to have a household means test applied to them.

    The examples given by my hon. Friend the Member for Livingston and by the hon. Member for Maidstone show that even families that want to make up the difference often cannot, because they are pensioners themselves. What shall we do about them, and also to prevent the position from deteriorating? As my hon. Friend the Member for Livingston said, once the new scheme is in operation we know perfectly well what decent owners of nursing homes will do. They will arrange swaps: ambulances will move between homes, because once an ambulance touches down in a new home the person will be a new resident, and the fees will be paid in full. We can decide tonight whether that is desirable, and whether the Government should be building that into the Bill. The hon. Member for Maidstone asked what would happen between now and the time when the new reform is implemented—and beyond, for those who are caught in limbo. Those residents will face eviction when their families have been broken by the cost of trying to make up the shortfall in fees, or when the owners face bankruptcy because they can no longer continue cross-subsidising—either from other tenants or from their own reserves.

    I, too, am a sponsor of the new clause. Does the hon. Gentleman agree that one of the arguments of those opposing the new clause is that we are asking for a blank cheque—that anything goes, and that anything that is asked for should be granted? Does he further agree—given his very proper record—that all that those who support the new clause are saying is that it should be costed out? Of course, the state should not be penalised, but for goodness sake let us not penalise those in the homes, and throw them on the scrap heap.

    I am pleased that I gave way to the hon. Gentleman, as his remarks take me on to my next point.

    I recall a statement that was made by Ernest Bevin. He said, "When looking at a motion, do not bother to read the text; see who is moving it." Let me point out to Conservative Members, who may be worried about the new clause giving a blank cheque, that the name of the hon. Member for Maidstone is on the motion. The hon. Lady would not be proposing any solution that was in the nature of a blank or open cheque. Both she and my hon. Friend the Member for Livingston have tackled that argument head-on. We are not pretending that, if we signed a blank cheque, all those who provide private residential or nursing care would behave honourably to the taxpayer: the sad fact is that they would riot. Therefore, built into the new clause is the important proviso that the costs should be covered if they are reasonable. It is not for us to decide whether they are reasonable; that is for an adjudication officer appointed by the Department of Social Security.

    The new clause does not create a blank cheque. We are not just throwing money at the problem. We are targeting it and we are discriminating in the help that is to he given. I hope that people will be mindful of the gains that have been made. We have moved away from the situation where many of our older constituents could expect care, freely given, in the hospital to a much better quality of care in many of the residential nursing homes in our constituencies. Our constituents went there thinking that their fees would be paid in full, but a growing number, almost half of those on income support, are not having their fees paid in full and, increasingly, families cannot meet those fees.

    We have a chance tonight to ensure that that system does not continue and to deal some justice to some of our older citizens who have paid their rates and taxes during long and often distinguished lives in order to ensure that they do not face a summary eviction or a crude attempt to beat the Government at their own game by moving them around in ambulances. I hope that the House will agree with the arguments put so well by my hon. Friend the Member for Livingston and the hon. Member for Maidstone and will accept the new clause.

    7 pm

    I apologise to the hon. Member for Livingston (Mr. Cook) for being unable to hear his opening remarks, but I was interested in the comments by the hon. Member for Birkenhead (Mr. Field). However, I am not convinced about the new clause. They, along with my hon. Friend the Member for Maidstone (Miss Widdecombe) and others who have signed the new clause, do not see the new clause as a blank cheque, but it would allow benefits for people in private old-age pensioner homes to be uprated to whatever a home charged.

    We should be aware that a large variety of private nursing homes offer many different standards. There are those that offer poor standards and there are those that offer all sorts of luxurious standards. My family live in west Sussex, so I recently had the opportunity to visit one of the cream of the nursing homes on the south coast, the costa geriatrica. It was a wonderful home with superb standards. All its residents were offered a glass of sherry every morning. [Interruption.] I make no complaint about that. It is important that all private homes should aspire to the best service for the prices charged. But we must acknowledge that there will always be homes that will try to row in behind the standards set by the most expensive homes. Even the most expensive homes will have residents in receipt of the full benefits paid by the Department of Social Security.

    It may not be obvious in the new clause, but we are in danger of writing a blank cheque. How on earth will the Secretary of State be able to provide the resources for the individual adjudication that the new clause invites?

    I must ask my hon. Friend, with courtesy, not sarcasm, whether he understands what is being proposed. How will the Secretary of State determine between those variable charges for new residents? If he can do that for new residents, he can do it for existing residents.

    I cannot accept what my hon. Friend says because the private sector offers a variety of services.

    I am not sure which Secretary of State is being referred to, but I can assure my hon. Friend that this Secretary of State for Health has no intention of leaping in to try to decide what is a reasonable charge for each person under the new arrangements. We all accept that the new arrangements are a big improvement on the arrangements that we shall be glad to see the back of, as the hon. Member for Birkenhead (Mr. Field) said, but under them the local authority will have to assess an individual's needs for residential care and will then have to negotiate with a home that is acceptable to that client what the local authority is prepared to regard as a reasonable contract. That is not the same as addressing each existing resident in whatever home of whatever quality he or she might be in now. I share my hon. Friend's confusion, because that point has been slicked over in all the speeches so far.

    The new clause cheerily says that there should be no payment beyond that which is reasonable, but how on earth is the Department of Social Security's adjudicating officer meant to decide what is reasonable? Does it mean reasonable for that resident, reasonable for that home or reasonable on the costs of a particular proprietor? My hon. Friend is being barracked, but he is making a good point. He should not give way to interventions that imply that my Department or the Department of Social Security is in any position to answer the questions posed by the new clause.

    I am grateful to my right hon. and learned Friend. I share his view that there is an element of confusion within the new clause. There is an element of a blank cheque in it. I should be the first to acknowledge, as the tone of interventions from a sedentary position suggest, that there may well be within the arena of private nursing homes those who are unscrupulous. It is those very unscrupulous owners of old-age pensioners' private homes whom the new clause will aid and comfort. If we want to introduce some decent common standards——

    Since the hon. Gentleman is making a speech that hon. Members can use as a clothes-peg on which to hang our queries, let me put it to the Secretary of State through the hon. Gentleman that he is fearful that the new clause will make it difficult for the local adjudication officers to establish what is reasonable or unreasonable. But it is admitted that every local authority will have to establish that for its area under the new arrangements, so what is to prevent the Secretary of State for Social Security and his local officers at least meeting what the local authorities define as reasonable?

    I would not envy any Department of Health or Department of Social Security officer in the task that is being suggested by the hon. Gentleman. I simply see a black hole or a bottomless pit that would ultimately prevent value for money being obtained for the taxpayer or the patient in private rented homes.

    I have given way generously to hon. Members on both sides of the House and I shall not give way any more because many hon. Members wish to speak.

    Notwithstanding the assurances that have been given, the new clause creates a black hole. Much taxpayers' money will be wasted and that will not ultimately benefit residents in private homes. As has been acknowledged, some unscrupulous people run such homes and they will be the first to take advantage of the loopholes in the new clause.

    I feel somewhat alarmed. I expected that tonight we might get all-party support for the new clause, because it is a very good clause. We are talking about large numbers of increasingly frail, elderly people. I should like the hon. Member for Brigg and Cleethorpes (Mr. Brown) or some of his hon. Friends who will be opposing the new clause to tell us what is to happen to these elderly, often very sick, people. What policy will the Government put forward to take care of them?

    We referred in Committee—and I do not say this in any flippant sense but because the hon. Member for Maidstone (Miss Widdecombe) and others mentioned it—to the Florence Smith gap that applies to every constituency in the land, and increasing numbers slot into it.

    I have just looked at one or two statistics. In west Yorkshire, the average gap for a normal residential care home for the over-65s—not the very elderly—is £24·19. The gap for a nursing home is £19·59. That is the average, and I know that it is much higher in other areas. A constituent came to my surgery whose mother was in an ordinary residential home for elderly people. She was caught in this gap. The proprietor was not the decent kind of person that we would all wish to see in charge of such homes but was quite unscrupulous. When my constituent, who was the only daughter, went to see her mother, she was locked out because she had said that she could not meet the difference in cost. Eventually she had to be moved. The daughter was subjected not only to the worry of finding somewhere cheaper for her mother but also to harassment by the proprietor. I suggest that such treatment will increase, and that there will be evictions.

    What will the Minister do about these elderly people, because proprietors will not go on funding the gap? If we do not get evictions, will we experience the other kind of home that we have all heard about? Will we move back to the 10-bedroom situation, where neither the residents nor the people who see them in the home get any satisfaction?

    I want to concentrate briefly on the Government's response to the problem so far. I hope that it will be different tonight. I am an eternal optimist.

    The Government's response in Committee was to accept that there are problems. It was said in Committee that there were many bleeding hearts among Government Members, and that is true; there was a lot of sympathy about these problems. The Government described the existing system as being not satisfactory and then proceeded to ignore it. If the hon. Member for Brigg and Cleethorpes is anything to go by—and he has taken the Government line—they intend to carry on ignoring the situation. Even worse, Social Security Ministers suggest that people who are unable to meet their fees should turn to the National Health Service. There will simply not be the beds available.

    As my hon. Friend the Member for Birkenhead (Mr. Field) said, we tried to get rid of care in the geriatric hospitals because we thought that care in the community was better. Is it seriously suggested that we should go back to the philosophy of the very long stay bed? I hope not. I do not want to see any more geriatric beds closed down; the British Geriatric Society says that that process has gone much too far and that we need more beds for geriatric patients, either long or short stay. To suggest that as an alternative, as Social Security Ministers have, is to fly in the face of the philosophy that we are all supposed to support.

    Apart from anything else, there will not be any beds available. In fact, my own district health authority, because of the cuts imposed upon it as the cash allocated to it is not sufficient, is faced with the necessity of closing beds across the whole spectrum of disciplines, and one of the options is to take another 15 geriatric beds out of service. I think that that will become the norm.

    I return to the major question that Ministers must answer tonight. They must tell us what they intend to do with the large numbers of elderly people who will be very anxious indeed, the ones who are still mentally able to grasp what is happening. As for the others, their relatives and the people who care for them will be desperately anxious. The Minister must tell us tonight, if he will not support this new clause, exactly what message he has for the thousands and thousands of Florence Smiths. There is all-party support for this new clause, and I hope that the Minister will not let us down.

    7.15 pm

    For some strange reason, Leamington Spa, which I represent, seems to be the mecca for old people. I believe that I have more residential homes in my constituency than even Bournemouth, and even more perhaps than my hon. Friend the Member for Brighton, Kemptown (Mr. Bowden). I suppose that it is because we are in the heart of England, but anyway the numbers have increased greatly in recent years.

    I agree with every speech made in this debate so far, with the exception of that made by my hon. Friend the Member for Brigg and Cleethorpes (Mr. Brown). I congratulate the hon. Member for Livingston (Mr. Cook) on his moderation on this occasion, and the case that has been predicated is unassailable. I know that there are considerable difficulties in finding the right form of words to get this problem tackled by the Department of Social Security, but I have absolutely no doubt that it must be tackled. This is a modern phenomenon caused by the fact that people are living longer. As we approach the next century it will become a critical matter and one which will have to be tackled whichever party is in power.

    All of us who represent areas in which there are elderly people know only too well the sad and sorry stories of aged people, many of them incontinent and perhaps slightly deranged, who live on for 10 or even 20 years. Many of them have savings when they first go into a home, but gradually their savings dwindle because they have to pay for the growing gap between their income support and the cost charged by the homes.

    I have seen many cases of families faced with an enormous moral dilema: should they try to help their mother or father to sustain what good quality of life there is in a residential home, or should they give up? These people are often of very modest means and may well be in early middle life, with young children. As every hon. Member knows, it is a very expensive time for families. Or they may be getting on themselves and perhaps reaching pensionable age, at which time every penny of their own savings will count for their own retirement. Are they to divest themselves of all their savings to help a mother or father, only to find that they finish up in a similar situation?

    Therefore, this problem demands a very careful look by the Department of Social Security. Otherwise we shall end up, as I think the hon. Member for Birkenhead intimated, with large numbers of geriatric wards which will be very unpleasant compared with the residential homes which we have today and the numbers of which have expanded in recent years. Surely we cannot as a society face such a situation. We cannot allow old people to suffer the great indignity of being kicked out and moved around until a billet can be found for them. That would not be tolerated, and it would put an extra strain on the hospital system.

    We must work out something far better than we have at present. I support the idea that we must be able to get the income support to cover the vast majority of the fees which are charged. At the same time we have to evolve a system whereby the homes concerned charge a reasonable sum for the people staying there. We must curb exploitation and sustain those who are managing, sometimes at a disadvantage to themselves, because they are able to cut corners. They are conscious that they need to support their inmates of whom they are quite fond; for them it is not just a commercial proposition.

    I hope that the Minister will give us some assurance, because we shall not be able to get the new clause carried—[HON. MEMBERS: "Why not?"' I am being realistic. We want an assurance that the Government have taken note of the concern of hon. Members on both sides of the House. I hope that he can satisfy us that the safety and well-being of thousands of old people will be safeguarded by the Administration, because it is a growing problem.

    I find it difficult to be as charitable about the Government's record as some of my hon. Friends, including my hon. Friend the Member for Birkenhead (Mr. Field), whose work in the Select Committee on Social Services I respect very much. I also find it difficult to accept what I can only describe as the bleating from the Government side. The Government are directly responsible for the shambles because of the policies that they have pursued over the last 10 years. They need to be reminded of that.

    The Government have failed adequately to fund alternatives to institutional care. They have failed to take account of the demographic trends that have led to a huge increase in the number of people over the age of 85. They have cut back on the resourcing of domiciliary care, which is the alternative to institutional provision. At local authority level they have slashed the rate support grant which has had a direct impact on the provision of home helps, meals on wheels and other preventive services. They have also slashed Health Service preventive spending.

    I give as an example a case with which the Secretary of State for Social Services is familiar. Recently he took part in a Yorkshire Television programme which featured the case of a constituent of mine, Mike Frobisher. That man is in care now, directly as a result of the fact that health services in Wakefield have been cut by the Government. Twice a week someone came along to help him bath; that was cut to once a week. He was affected in many other ways. Respite care in the local hospital was reduced. Finally, his wife collapsed. As the Secretary of State is aware, Mr. Frobisher is now in a home where he has to manage on 5p per week. That is all that is left for him to live on when everything else is taken into account. He does not have any spending money apart from that.

    Alongside the cuts there has been an explosion in free market care which has been generated deliberately by a Government committed to market forces. The result is that we have hundreds of thousands of cases such as that of Florence Smith. The floating of open-ended income support arrangements has led to an increase in private residential care. There has been talk of blank cheques, but we have had those already. That is why there has been a huge explosion in private residential care that is not appropriate to the vast numbers of elderly and disabled people. A total of £5 billion a year is involved. It is big business now. Some people are making vast amounts of money in the private sector out of elderly, dependent people.

    What concerns me most is the way in which the Government have created an institutional climate. There is an institutional vision of what is needed for old people. I do not believe that institutional care is the answer for elderly and handicapped people. There are alternatives, but the Government have slashed them and have forced people to enter institutional care, which is completely inappropriate.

    The problems that people face in the community are horrendous. In many instances their problems are only beginning when they enter care because they cannot meet the fees. In Committee the Government said that existing residents will have a preserved right to income support. That is fine, but what about the future of non-assessed residents who end up in institutional care on the basis of their capital resources, who spend those resources and have to apply for income support? The Government have failed to consider that category. I understand that they may be covered by upratings in income support, inadequate as they are.

    The Association of Metropolitan Authorities estimates on the basis of DSS figures that there is a £40 a week gap in residential care payments and about £60 a week in nursing home payments. What happens to people when they cannot pay the fees? In a recent report the Select Committee on Social Services said that many elderly persons will face eviction if the Government's policies are implemented as they stand. When I moved an amendment in Committee on security of tenure, contracts for residents and the prevention of eviction, it was resisted by the Government. So the Government are prepared to accept that because of the free market a proprietor may say, "I am sorry; it is hard lines that you cannot meet what we are charging. You will have to leave. Get on your bike. We are not prepared to continue caring for you."

    What are the options for such people when they cannot meet the fees? We all have such people in our constituencies. In most instances it is a matter of begging or borrowing. They may ask voluntary organisations for assistance. Many people are assisted by voluntary organisations which are in great difficulty because of the number of people whom they have to fund. Many elderly people are forced to go cap in hand to relations to ask for a supplement of £20 or £30 a week. That is not acceptable.

    When I asked the Minister for Social Security about the problem in November he could see nothing offensive in relatives helping those in homes with fees. I find it offensive that people have to go out to earn money to supplement payments for relatives. That is simply not on, particularly when the elderly people have paid national insurance and taxes all their lives. Some of them are 90, 95 or even 100.

    We should also take into account the feelings of the elderly and handicapped people who have to beg and borrow from relatives to supplement their income. When they have saved up all their lives, how do they feel when they find they can no longer look after themselves financially? It is appalling that the Government are prepared to allow them to seek help from relatives. Many elderly people still have pride. We should respect it. We should say that it is inappropriate for them to be subsidised by their relatives.

    At my previous surgery a man was desperately concerned about his inability to meet the fees for his adult son in a private home. He and his wife were worried that the fees were increasing beyond what they could pay. His wife was seriously considering volunteering to work in the home to offset the increase in fees. These people are not young. They have a handicapped lad of about 29. They have gone through hard times. Even though their son is in care, they still have to worry about meeting the fees.

    If people cannot afford the fees, they have the choice of going down market. They can go into a home which does not have sherry on offer. Surely the offer of a glass of sherry should not figure in the evaluation of care in a home. After I had spoken at a meeting last Friday night, a lady came up to me and said, "I am in the private sector. Come to my home. We have bone china." She told me that the residents got a drink of whisky, I think it was, before they went to bed. That was her advertisement of the care in her home. I suspect that description of care. That is not the care that I would want if I ended up in a residential home. That is not a way of evaluating the quality of care.

    Age Concern has expressed anxiety about how the income support problem is forcing down standards in many homes. There are lower levels of care and people are having to move from single rooms to shared rooms simply because the resources are not available.

    Does the hon. Gentleman agree that one of the least acceptable solutions to the problem that he has described is that residents who cannot meet the costs in registered homes will be moved into unregistered homes with three or fewer guests where there is no inspection of the services on offer?

    7.30 pm

    I hope that Conservative Members were listening to that very valid point. The Opposition were concerned about that, which is why we pressed in Committee for the registration of smaller homes. What the hon. Gentleman described is happening now. I hope that the hon. Member for Portsmouth, North (Mr. Griffiths) will be in the Chamber later when we discuss the new clauses on the registration of smaller homes. I am sure that Conservative Members as well as Opposition Members are concerned about that.

    Many of the people who can no longer pay private sector fees are now forced to look to local authorities to provide residential care. Clause 37 excludes local authority homes from the new funding arrangements and places them at a clear financial disadvantage. Local authorities are getting rid of direct provision because they can no longer afford to offer the provision by part III accommodation. As well as people being passed on to part III accommodation, that accommodation at local level is now disappearing.

    The Government must address the problems that have been raised by hon. Members on both sides of the Chamber. New clause 1 attempts to deal with the consequences of what can be described only as the Government's free market experiment with care. If the Government see fit to leave the provision of welfare in the hands of market forces—as they clearly have done over the past 10 years—if they are not willing to develop clear alternatives to institutional care in terms of prevention and keeping people out of care, and if they believe that the institutional model is the only major response that society can give to the needs of handicapped and disabled people, the least that they can do is ensure that when people end up in institutional care or are forced into it because of the lack of alternatives, those people can live their lives in financial security and not worry daily and weekly where their fees will come from.

    I will be astonished if the Government accept the new clause. With the best will in the world, there is no way of preventing charges rising universally to meet income support levels. It is perfectly clear that the supporters of the new clause have no desire to write a blank cheque. However, it will be impossible to avoid that consequence. If it happens, it will shrink other budgets which will be needed to care for the vulnerable. In the end, the effects will filter through the system so that the new community care system, which we are so anxious to see succeed, will be put at risk.

    It would, however, be foolish and wrong to suggest that there is no problem. Therefore, what are we going to do about it? There are some strengths in the present position. The number of people in the category about which we are concerned is finite and known. After the Bill is passed there will be no increase in that number. The new customers under the new system will be covered by a contract that will not allow public services to renege on their responsibility to those people. We are concerned tonight with a number of people, many of whom did not have a serious contract except in so far as if they paid the bill, or it was paid, they would receive care. I can understand and applaud the desire of Health Ministers not to overload social service departments, which will already be heavily burdened, by giving them responsibility for that particular group of people.

    In parenthesis, I must state that homes are at great danger at the moment. We must consider the stock of places that exist at the moment. It is all very well for the hon. Member for Wakefield (Mr. Hinchliffe) to refer to the private sector for making vast amounts of money. With the exception of a tiny handful of fortunate, skilled or highly selective proprietors, the exact reverse is the case. The hon. Member for Livingston (Mr. Cook) and others have said that many homes are vulnerable. As my hon. Friend the Member for Maidstone (Miss Widdecombe) stressed, those homes have large debts to service. Proprietors have told me with great force that they a re very worried about how long the new local authority assessment procedures take to supply them with replacement customers if their customers die or move out of their homes. There may be too big a gap to fund and proprietors will be vulnerable.

    With regard to the hon. Gentleman's point about the profitability of the private sector not being very high, can he explain why, if that is the case, a great number of companies of national renown are moving into the private care sector? Such companies include Stakis plc, the amusement arcade business Kunick plc, Buckingham the international disco and leisure complex company, Vaux plc, Boddington's brewery and Ladbrokes. Are those companies moving into the sector because there are no profits to be made?

    It would be foolish to imagine that there a re no profits to be made. However, I believe that where profits are to be made, they can be made only in most cases by companies large enough to weather the difficult periods as well as the relatively easy periods.

    The hon. Gentleman is aware that many small and medium-sized homes have been started by people from the highest possible motives. Homes have been started by people who could not find appropriate care for their children so they decided to set up a home to cope with their children and with others as well. The impression that is sometimes given by Opposition Members that we are talking about a sector into which people move only because they can make profits by exploiting the vulnerable is wrong.

    Will the hon. Gentleman answer his own question: what should the Government do?

    I am sorry. I was distracted slightly by interventions. I had intended to discuss that now.

    Central to any solution to the avowed problem must be a predictable budget which can be foreseeen and provided for. That is why I am completely against any suggestion of a blank cheque.

    Does the hon. Gentleman accept that the Government have already given a blank cheque in housing to the private landlords because they are committed to paying housing benefit at whatever level? If that is the case in housing, why can there not be funding in care as well?

    I do not want to pursue that avenue too far. The hon. Gentleman should be careful about suggesting to Treasury Ministers that there are blank cheques anywhere.

    Given that there has to be a discernible, predictable and finite budget to deal with what is, after all, a predictable and finite number of people, Ministers might profitably consider two elements. First, perhaps there could be a regional differentiation in the amount of income support that is available for this purpose. That is a crude measure, but it is better than giving a United Kingdomwide level of support because there are discernible differences in different parts of the country. Like my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman), I am not suggesting that one can make a crude division between north and south or east and west, but it is possible to make a division between areas where prices are relatively low and areas where they are far higher, as in my area. Nor is it unreasonable to consider the debt burden relating to the age and capitalisation of such a home.

    When it comes to assessing individuals, the Government have a precedent to hand. The independent living fund has been a substantial success at making a whole range of difficult and sensitive decisions. Perhaps providing an organisation at arm's length with a finite budget and saying, "You take over the difficult issue of assessing people for the additional support", may be a help.

    Finally, the new clause as drafted is manifestly flawed because it cannot come into effect until next year which, for many of the people with whom we are concerned, will be too late. Therefore, although I am opposed to the new clause, I advise Ministers that they must come forward with some concrete suggestions about how we can meet the needs of the most vulnerable people in our community.

    The speech made by the hon. Member for Maidstone (Miss Widdecombe) was a most powerful and, I hope in its effect, an influential contribution to this important debate. I am glad to note her return to the Chamber.

    Much of my parliamentary life has been spent trying, both as a private Member and as a Minister, to improve residential and community care for frail elderly and disabled people. If we are to ensure humane standards the essential principle is that, in every case of need, the right care should be available in the right place and at the right time. Otherwise people in special need are left in despair, as happens in so many cases now when residential care fees cannot be met. The relatives share that despair.

    After a decade in which the financing of residential care was shifted, in an unplanned and officially unpredicted way, on to the social security budget, the Government are returning in this Bill to the old system of local authority sponsorship. Although there were always tough negotiations between local authorities and voluntary organisations, the old system is now acknowledged to have been the best method of ensuring both value for money and special provision for those with special needs.

    The new clause seeks to protect those who are trapped in the system that is now being discarded, which has proved to be a Procrustean bed. In the original format, which was introduced by the right hon. Member for Brent, North (Sir R. Boyson), payments were practically open-ended and costs expanded rapidly. A series of panic measures were introduced to cut the costs, but national yardsticks have proved just as insensitive as the old Greek bandit who either stretched his guests or cut off their limbs to fit the accommodation provided.

    The new clause is concerned with those whom our modern Procrustes in the Department of Social Security has maimed. Almost half the residents on income support do not have their full costs met, as my hon. Friend the Member for Birkenhead (Mr. Field) said in oral questions on 5 March. In response to my subsequent question, from the Opposition Front Bench, asking the Minister at least to
    "ensure that income support payments keep pace with the charges agreed by local authorities for new residents"
    the right hon. Member for Chelsea (Mr. Scott) appeared to misunderstand the question, which he failed to answer, and he referred to extra resources for community care. No extra resources are being provided for existing residents. Moreover, in Committee Ministers resisted the imposition of any duty on local authorities to assess current residents for a possible return to care in the community.

    Later amendments are concerned with rights to residential community care, where it is needed and desired. In reply to my question on 5 March, the right hon. Member for Chelsea referred to the
    "perverse incentive for people to go into residential care"—[Official Report, 5 March 1990; Vol. 168, c.574.]
    But the Government seem determined to swing the pendulum too far the other way, in that there is now often a perverse ministerial insistence on sweeping under the carpet the needs of people for whom such care is a vital necessity.

    7.45 pm

    Very old and frail people, who have been in residential care for several years and who have grown accustomed to the idea that this will be their last home, need the assurance that the Government will continue to meet their costs until the day they die. The attitude of Ministers is causing extreme distress, not only to residents, but to their relatives, who are often poor and disabled themselves, and who are approached to make up the difference between fees and benefits. That piles handicap upon handicap for the very needful people this new clause seeks to help.

    The record shows that I was one of those who repeatedly warned the Government where the policy that they are now discarding would lead. In the spirit of the speech made by my hon. Friend the Member for Livingston (Mr. Cook), however, I am not concerned tonight to say "I told you so." Give or take the speech made by the hon. Member for Brigg and Cleethorpes (Mr. Brown), there has been scant controversy in the debate.

    The new clause is eminently fair. It has strong all-party backing and the House should accept it. I sense deep and widespread unease on both sides of the House about the problem that the new clause seeks to resolve. The only proper way to give effective expression to that unease is in the Aye Lobby tonight.

    I shall be brief, because many other hon. Members still want to speak. The Government would be unwise to accept the new clause as it stands. That is not to say that there are not problems, because it would be foolish to pretend otherwise. There may well be regional variations and differences that need to be considered positively, sympathetically and constructively, but that does not mean that we should put on the statute book legislation that may have an open-ended commitment.

    When my right hon. Friend the Secretary of State replies to the debate, it would be interesting if he could give some idea of the likely envisaged costs of implementing the new clause, if that has been worked out. We are usually told that we should be prepared to understand the commitment that we are entering into. Being a canny Scot, I do not want us to enter into open-ended commitments for which the taxpayers will be required to pick up the tab. As I have said, I believe that we would be wise to look at the problem, bearing in mind the regional variations that may exist.

    In that context, I must declare an interest because I have many such homes in my constituency. Obviously, therefore, lots of patients are my constituents. Many such homes have been opened recently and, as far as I can tell from the visits that I have made—and I still have quite a number to visit after already visiting a substantial number—the patients appear, in the main, to be well looked after.

    One must acknowledge that problems exist in some areas. It would be foolish to pretend otherwise. Another factor that must be considered is the variation in input costs. One thing that has struck me on my visits to different homes is that some homes are more expensive to run than others. The people who pay are those who pay for the patient, or inmate, depending on what one wishes to call them, but in any case those who are staying in the home and are not part of the team that operates the unit. People pay through taxpayer funding, whether partially or totally. The House and the Government must look carefully at the matter and deal with it positively and constructively. I am not prepared to vote for the new clause as it is drafted.

    With one exception, everyone acknowledges that there is a problem. I even saw the Secretary of State for Social Security nod when his hon. Friend the Member for Tayside, North (Mr. Walker) said that there was a problem. So at least we have reached first base on the matter.

    Some possible solutions which have asserted themselves among some Conservative Members would not be acceptable. The hon. Member for Mid-Kent (Mr. Rowe) acknowledged that there are problems. He seemed to finish up by suggesting that in some areas—such as his—more money was required. Any suggestion that a solution could be found by providing more money for the south-east would not find wide favour.

    The hon. Gentleman also suggested that we could take some comfort from the fact that the problem is finite and is not growing. But it will grow for a little while. I understand that the present system will operate until April 1991. All those entering homes before April 1991 will be in the position that we describe. The current number of people claiming income support and living in residential homes is 176,000, a considerable number. They do not all have relatives, but some do. If we add their relatives, that makes a large number of people who are exercised by and worried about this problem.

    Clearly cost is a pertinent question. Why are the Government so coy about it? They must be fixing their special income support level by reference to some calculation of costs, unless they simply pick it out with a pin. They must have some method of deciding how much they will give. Do they say, "We shall give 60 per cent. of the average", or "We shall give 90 per cent. of the average"? What do they regard as the average? What do they regard as the range? They are surprisingly coy on the matter.

    In a parliamentary answer on 24 January, the Department said:
    "When taking decisions on increases, we took account of a wide range of information on costs and charges in homes. This primarily came from the Department's own local office returns, independent research and detailed representations from outside bodies,"—[Official Report, 24 January 1990; Vol. 165, c. 1029.]
    Outside bodies which have an opinion on and knowledge of the matter all say that the Government have got their figures wrong.

    The Government should look with kindness on the Select Committee's recommendation to
    "immediately commission a rapid independent investigation of the costs of residential care and nursing homes. The results of this research should be published."
    That is the key point. The Government should have the research done and should publish the results. Then we can all see whether the true picture is one of profiteering, we shall have a much better idea who the profiteers are, and we shall see the extent of the burden being tackled in examples such as that given by my hon. Friend the Member for Livingston (Mr. Cook). He referred to the problems faced by a group of Roman Catholic nuns in running their residential home. If independent research were carried out and published, the whole discussion would be on a much firmer footing.

    No Opposition Member wants to make life easy for profiteers, in particular those who profit from the needs of the elderly. It is astonishing to us that some Conservative Members invoke profiteering as a reason for leaving elderly people without sufficient resources to meet bills which may well be legitimate. If people are profiteering, there are probably other things wrong with the home. Clearly such people are in the business for the wrong reasons. There should be a means of tackling that problem. Perhaps that could be explored later when the House considers matters of quality.

    In view of the representations made by the National Council for Voluntary Organisations and others, I am not willing to say that all homes overcharge. I do not believe that that is the case, nor do the Government make that case. They do not make any case on costs. They simply produce a figure and then upgrade it by £10 without publishing any groundwork or justification for it.

    These are serious matters and they will have serious results. The Minister for Social Security believes that it is in order for relatives and charities to be a central part of funding care for the elderly. However, that has not been the intention of the House. Relatives may not be able to afford to contribute. There may be no relatives. Surely charities raise money for purposes other than to take on the burdens which should rightly belong to the state and to us all. It is unacceptable to say, "Let relatives and charities pay."

    If, despite their best efforts, an elderly person's relatives cannot pay, the result may be that he or she cannot have residential care even if it is the most appropriate type of care. Community care may become forced community care by relatives who cannot afford the extra fees to make up the income support. Relatives will be left to do the caring without proper back-up from the community.

    This is not a proper community care Bill. I do not wish to make too many waves in this all-party atmosphere, but to leave five days between the publication of a White Paper on community care and the tagging of clauses on to the Bill is fraught with dangers. I cannot understand why, after 15 months of blank silence between the publication of the Griffiths report and the Government's response, the Government went to the other, equally undesirable extreme of acting with precipitate haste and producing something which has not been properly thought out.

    There will be other anomalies with regard to relatives, as the Select Committee pointed out. The relatives of people entering residential care after April 1991 will suddenly face fewer burdens. Suddenly it will be all right for them to say, "We cannot afford it." The Government will tell local authorities that it is their job to pay for care. Is that the difference? After April 1991 the local authorities will have the responsibility. Do the Government not mind giving local authorities extra tasks, however difficult they claim those tasks to be?

    I am sure that you are aware, Madam Deputy Speaker, although Tory Members may not be, that the shortfall which is affecting individuals and their relatives will also affect local authorities. We shall have an opportunity under a later clause to explore the dangers and problems that will arise. At present we are looking at the effect of the shortfall on the unfortunate individuals who are termed "protected". One hon. Member, I am not sure on which side of the House, called them "excluded", and that is a much truer description.

    8 pm

    The possibilities range from eviction. The Select Committee on Social Services does not go in for extravagant language, yet we contemplate elderly people, some of whom are frail, facing eviction. They will not be protected against it.

    When at the beginning of her speech my hon. Friend gave the figures, I calculated them on a constituency basis. She is right to say that not everyone will be evicted, but everyone risks eviction. There are about 160 residents per constituency in that category. In my constituency, that means two full streets. If we talked about two full streets of residents in every constituency risking eviction, the atmosphere of this debate would be even more tense than it is.

    I thank my hon. Friend for that apt picture. In case anybody thinks that we are trying to overstate the case, I point out that, according to the Government, not all the 176,000 are unable to meet the costs from their own resources. The Government say that a majority can meet the costs from their resources. That majority turns out to be 58 per cent. If, instead of my hon. Friend's two whole streets, I was terribly generous and suggested one whole street not just of people but of frail, elderly people who risked eviction, even on that modest evaluation, we and they still face a worrying situation.

    The hon. Lady's remarks may be a little unnecessarily harsh, particularly on those who run private rest homes. I know from constituency experience of many elderly people whose condition has deteriorated and who need much better nursing care than the rest home can provide, yet the owners of the homes feel a deep obligation to them. They are caring people who look after their elderly residents. Although they need more money to do so, they keep them on the same premises and do not throw them on to the streets.

    The hon. Gentleman has misunderstood my point completely. I am not blaming the owners of the homes. From the beginning I have said that those who profiteer and are unsuitable should be dealt with in some other way. My concern is with the wide range of homes such as those described by my hon. Friend the Member for Livingston—for example, the homes of the Roman Catholic nuns. I fully agree with the hon. Gentleman that the owners may wish to provide care, but, however keen they are, they cannot do it on fresh air. Presumably they must pay wages and buy food, and many other costs are involved. I am not discussing the intentions of the owners or those who run these homes. For the purposes of this debate I am prepared to accept that they are all splendid. The fact is that they cannot run a home without money.

    In a way the hon. Gentleman has reinforced my point, although he did not intend to do so. He has added a whole new category of desperately worried people—those who try honestly, legitimately and properly to care for elderly people and provide them with a home. Whether they are in the private sector or the voluntary sector, they cannot do so with the sort of shortfall which has been described by the National Council for Voluntary Organisations and which is regularly described by our constituents. It is not often that the hon. Member for Maidstone (Miss Widdecombe) and I are found on the same side, but, whether we like it or not, the inescapable facts of this issue drive us together. It is a remarkable cross-party experience.

    The Government are taking us towards this disaster deliberately, and they know it. My hon. Friend mentioned a figure of 168,000 people. In a letter to me on 8 January the Under-Secretary of State for Social Security gave me the Government figure of 176,000 people in residential care or nursing homes claiming benefit. Therefore, although the Government expect the number of people who need income support to continue to grow, they deny them help.

    I thank my hon. Friend for that intervention. Indeed, the interventions have been extremely helpful to me.

    The universality of our experience across different types of area is unusual. I can describe it in Preston where, generally speaking, people do not have much spare money with which to pay the shortfall on behalf of their elderly relatives, however much they desire to do so. We have heard of it in Kent where costs are higher, so although people may have more resources, they find it proportionately difficult. The Secretary of State for Social Security needs to do more than simply acknowledge the problem. He should accept this solution on offer to him or, failing that, outline an equally comprehensive and satisfactory one.

    There are other likely consequences. Homes, whether for good or bad reasons, may, in an attempt to cover the shortfall, pay wages to staff which are too low. That would have bad effects not only on the staff but on the people for whom they care. It may affect the quality of staff whom they can recruit. That is undesirable. We want our elderly people to be looked after by people who are properly paid.

    My hon. Friend makes an important point about staffing arrangements. Last week I attended a meeting of the all-party personal social services committee when a representative from the British Association of Social Workers said that in Liverpool 16-year-old girls employed in old people's homes were changing catheters of men and women alike. They were untrained and were being paid about £1 an hour. I am sure that my hon. Friend will share my anxiety about what is going on in the private sector.

    I think that anxiety is too mild a word. The right word is horror. If that is the road down which people are travelling, it is a disgrace—a blot on the House—because the House bears the final responsibility for ensuring that there are adequate resources. When we have ensured that, we can follow it up by ensuring that there is adequate quality of care resulting from those resources. We cannot say care properly but do it without the proper resources; that is impossible.

    As has been graphically and dreadfully illustrated by my hon. Friend the Member for Wakefield (Mr. Hinchliffe), there will be skimping and the use of unsuitable and unqualified staff—probably overworked staff as well. Overworked and underpaid is not a good recipe for proper care.

    That is a valuable point. Of course not everybody would be willing to undertake care in such an unsuitable way, and not everybody would be willing to be driven into jobs for which they were unsuited, despite the best efforts of the Conservative party.

    The hon. Member for Cambridgeshire, South-West (Sir A. Grant) asked whether one would he able to get people to work in such situations. There is no difficulty in getting people to work in the many regions of the country which still have high unemployment and where people—especially women—are forced into low-paid jobs because there are no other jobs available for them.

    I had better acknowledge that intervention and then I shall give way to the hon. Member for Cambridgeshire, South-West (Sir A. Grant).

    In some areas—mine in particular—nursing homes have enormous difficulties in getting staff to help those poor old people. Much as they would like to do so, they cannot go down to Wales to recruit them. It is very sad.

    That is another illustration of the universality of the experience. Although the emphasis is different in different areas, there is a problem. I think we are on common ground and without resources it is impossible to get properly trained staff who will give the proper quality of care. I do not want people who run residential and nursing homes to have the excuse of lack of resources. I want to be able to come down on them like a ton of bricks if their care is unsuitable, but I fear that the Government are putting us in a false position.

    As hon. Members have pointed out, there will be two tiers of residential care. In fact, it seems that that already exists, as hon. Members have pointed out. I do not want people to be accused of dumping elderly relatives if they enter a residential home with that accusation being true because those homes are dumps. People will face bills that they cannot pay or tasks that they cannot undertake in their own home or they will have to dump relatives, and that is an intolerable choice.

    Surely we can manage to get some cross-party support on the matter. I fear that some Conservative Members are shielding themselves from the arguments by not coming into the Chamber. I hope that those Conservative Members who are acquainted with the arguments, and who are here tonight, will pass on the message.

    This issue could give the Government more problems. I shall give the Government a little advice, because if this works out well and our suggestions are accepted the Government will get the credit. The Government usually get the credit in the end for any extra payments or extra care that come from the state. Therefore, given the general context in which the Government are operating, I should have thought that, in self-defence, the Secretary of State for Social Security would positively welcome the new clause.

    If he does not welcome it, and if it is rejected, I am driven to the conclusion that this is due to the extra burdens they intend to force on to local authorities. If more money is made available for the individual to meet the costs, more money will also have to be made available for local authorities to meet the costs. If the new clause is rejected against all the excellent advice given to the Secretary of State by his hon. Friends, I fear that that will be the reason, and it is a disreputable reason.

    My hon. Friend the Member for Maidstone (Miss Widdecombe) spoke for me and I suspect for a large number of my hon. Friends when she made a moving speech describing the problems that face Florence Smith, and the many others throughout the country like her. I am always amazed at the sacrifices that so many families make to keep an elderly relative in their home. Those sacrifices go way beyond what might be legitimately expected.

    8.15 pm

    I welcome two decisions that the Government have taken in this broad area. First, they are quite right to have a cut-off point on 1 April next year, and to say to local authorities that the new Griffiths regime for care in the community should apply to new residents and claimants only from 1 April. That strategic decision was justified because there was no way in which local authorities could have coped with existing residents if they were to get the new structure going.

    Secondly, the Government were right to prevent local authorities from topping up existing residents, because if they had done so it would have been a drain on the inevitably limited resources for getting the new care in the community package going.

    We are all agreed that there is a residual problem of resourcing residents who are "protected" and who will continue to look to the DSS for income support to pay their bills. There will be new claimants, because anyone in a home at the moment who is not claiming because he has his own resources but who runs out of resources in the future will have to look to the existing DSS regime for help and not to the local authorities. It is not the case that the number of claimants is finite. There can and will be new claimants as existing residents run out of resources.

    One issue has not been adequately raised—the pressure on housing associations, charities and organisations that run homes. Servite House in Ealing is an example. It recently closed an excellent home in Ealing simply because it had to make such huge inroads that it could not afford into its own reserves to keep it going. Hon. Members who have met housing associations and other charities know of the pressure on their resources caused by the present regime. It is a matter not simply of people digging into their own pockets to keep the structure going, but of private and voluntary organisations digging into limited reserves to keep things going. There is a limit to how long that can go on.

    Another issue that has not so far been mentioned is that next year there will be a transfer of resources, in regard to income support, from the DSS to the local authorities. Under the new regime local authorities can buy contracts with homes. That transfer of resources will be based on existing income support levels. If that is the basis of transfer, local authorities will get inadequate compensation with which to get the Griffiths regime going. It would be disastrous to under-resource the new structure—in which I have great confidence. It is not simply a matter of getting it right for people who are in homes at the moment. The figure that will be used will reflect how much of the resources—ring-fenced or otherwise—will be transferred to social service departments to get the new package going. I hope that we can avoid the risk.

    There will be some difficulties with the solution advocated in new clause 1. I am not wild about adjudication officers going round to decide whether a tariff is right. Nor am I particularly enamoured of the regional variation solution put forward by my hon. Friend the Member for Mid-Kent (Mr. Rowe). The solution that I like has been touched on in the debate, and lies in part III of the Bill.

    As from 1 April next year local authorities will be inviting all the organisations that we have been talking about to tender for contracts. When that happens, the organisations will have to put in a price. They will state the fee that they will charge if the local authority wants to continue to place people in a residential or nursing home. The local authority will either agree that that is a fair price and place a contract with them or it will reject it. That price could be used by the Department of Social Security to validate the payments that are made to those on income support. It is a price that the home believes to be fair; it is a price that it will have used in the bid that it made to the local authority; it is a price that the local authority believes to be fair because it will have agreed it when it placed the contract. Given that it is satisfactory both to the home and to the local authority, I see no reason why my right hon. Friend's Department cannot say, "We shall uprate income support for residents in that home to the agreed level."

    That would avoid the problem of having two classes of resident in one home: one resident on income support, who perhaps receives an inferior standard of service, and another resident who entered the home under a new contract that was negotiated by the local authority at a higher price and who is offered a higher standard of service. I feel that that problem will arise if we do not do something about it. It would be avoided if income support were uprated to the agreed contract price that had been negotiated between the local authority and the home.

    If my right hon. Friend the Secretary of State were to say that he could not agree to new clause 1, for whatever reason, but that he was minded to go in the direction that I have outlined by validating prices that had been negotiated, I should be happy to vote against new clause 1.

    I shall try to speak briefly; the argument was made—game, set and match—in the first three speeches. I pay credit to hon. Members on both sides of the House for sticking to the facts and making a convincing case.

    We are talking about elderly people who, by definition, will die in the next few years. However, others will come along who need income support as their incomes decline. Much of the debate has focused on the blank cheque element of the proposals. We are talking about a finite number of people, but a dangerous blank cheque will be involved if we do nothing about them. Where will they go if, as we suspect, some are evicted from the homes in which they live? They will go into hospital. However, they will not go into geriatric beds, because there are not enough. They will go instead into acute beds. The National Health Service needs those beds. They are in heavy demand for all kinds of treatments.

    Apart from the cost implications of elderly people occupying those beds for, perhaps, years, there is also a political implication in terms of waiting lists. Many hospitals could tackle their waiting list problem far more effectively if some of the beds that are now occupied by elderly people could be released. At the moment, however, there are no satisfactory alternative placements. If more of those beds are to be occupied on a long-term basis, the House ought to bear in mind the political implications of such a blank cheque.

    We should also consider the implications for those whom we should subsidise if the new clause were accepted. Some hon. Members have suggested that we are offering a golden opportunity to those who wish to make a quick buck out of the elderly. A few may do that. However, I have read carefully the representations that were made to me by the voluntary bodies and I am not convinced that the majority of the homes involved would do that. The National Care Homes Association told the Select Committee that seven out of 132 nursing homes and one third of residential homes charged fees that were in line with social security levels but that two thirds of the homes for the elderly could not cover their costs by means of income supplement. The National Federation of Housing Associations said that income support levels had not kept pace with the true cost of care. These are not the Rachmans or people who are making vast profits out of the elderly. They are trying to supply a genuine service at cost, but they find it increasingly difficult to achieve their objective.

    The new clause would redress the imbalance. Reference has been made to avoiding exploitation by the appointment of an adjudicator. I listened with interest to the suggestion that there may be a better method of assessing what is the fair rate for a particular home. However, I should have to consider the implications for residents who may be in homes which do not have contracts with local authorities and which would fall foul of that suggestion.

    After 1991, new residents will not have to contend with the problem. Their full fees will be covered. However, we are referring to about 100,000 most vulnerable people whose needs will not be met. They have to turn to local authorities, charities and their families to make up the shortfall. We are referring to the very elderly, many of whose relatives are also elderly. The point was brought home to me recently when I visited a geriatric ward and was introduced to a very elderly man and then to his daughter who occupied a bed in the same ward. Those who are well into their 80s or 90s have children who are between 60 and 70 years of age. All that they can be expected to do is to cope with their own problems and to make financial provision for their own future without having to take responsibility for their elderly relatives.

    To do nothing is not an option. If continuity of care for these people is to be assured and if they are to have peace of mind, the new clause must be passed. It will provide security for the most vulnerable members of our society. Without such a change, the omens are gloomy. The National Council for Voluntary Organisations conducted a number of in-depth interviews with a variety of organisations that revealed some of the highly unsatisfactory measures that already have to be taken. They include the closure of homes in order to cover losses, or a policy change so that only those who are able to pay the fees are admitted—inevitably at the expense of those who are in the greatest financial need—inability to attract staff because of low wages, development plans deferred or scrapped, inability to carry out maintenance, refurbishment or the upgrading of buildings so that there is a more appropriate environment for residents, and a general reduction in the quality of life for residents.

    It is abundantly clear that such cuts and measures, at a time when the number of elderly people in our midst is increasing and will continue to increase, are highly undesirable. I shall not detain the House any longer; other hon. Members are anxious to speak. The case for the new clause has been made convincingly.

    I, too, will be brief. Nearly all the arguments have already been deployed. Nearly all of them go against the Government, I regret to say, and in favour of the broad principle in the new clause. The hon. Member for Greenwich (Mrs. Barnes) summed it up admirably. I agree with nearly every word that she said.

    I put my name to the new clause not because I am wedded to every single detail or because I think that it is a perfect piece of drafting. Drafting is never perfect. We have all been around long enough to know that if the principle can be accepted the Government will find a way to meet that principle. I was moved to put my name to the new clause because of an experience in my constituency. It contains a number of excellent private nursing homes, and one of them highlights the problem. The Weald nursing home looks after a number of very elderly people whose elderly children come to see them. Those people a re admirably cared for by the proprietors who have dedicated their lives to the problem. They have provided them with a wonderful service. That home was expanding. Indeed, I opened an extension for it a few years ago.

    The problem is quite simple: the elderly residents carne in on the basis of income support, but that support has not kept pace with inflation. There is now a shortfall, and these people are unable to obtain a top-up to rectify the situation. As a result, unfortunate elderly and worthy people are in danger of being moved out. However, because the proprietors are very compassionate they go to great lengths to avoid that. They move residents into other accommodation. They squeeze them in. They make economies here, there and everywhere, and in some cases almost subsidise residents. In this day and age, that cannot possibly be right. It cannot be right that people who have lived honourable lives should find themselves in such an undignified, worrying and anxious position.

    8.30 pm

    The new clause may be defective in some way, but I do not accept the "blank cheque" argument. Nobody wants a blank cheque to be provided. As I understand the situation, however—and I am open to correction—it will be possible to have restraint in the case of new residents. If that is the case, why on earth can it not be applied to existing residents? If there is a problem, I cannot conceive of its being beyond the wit of the Government, with all their resources, to find ways to ensure that solving it does not involve signing a blank cheque.

    I hope that the Secretary of State will say that he realises that there is a problem. Perhaps he will say that, for some reason, the new clause would be ineffective. Perhaps he thinks that the suggestion of my hon. Friend the Member for Ealing, Acton (Sir G. Young) is a better one. In any case, he should tell the House that he will deal with the problem. Perhaps he could urge withdrawal of the new clause, on the clear understanding that the Government will produce something along the lines of this principle. I am bound to tell my right hon. Friend that, if that is not done, I will find myself in a great dilemma. I have been a loyal supporter of the Government for many years.

    It would not be the first time I had rebelled, nor would it be the last. I do not like to vote against the Government. I believe that, in this Bill, they are, in general, doing the right thing, but if I do not receive a reasonable assurance from my right hon. Friend I shall feel inclined to vote against them.

    The Minister is a compassionate and sensible man. We often come across Ministers who are sensible but not compassionate, and Ministers who are compassionate but not sensible, but this Minister is both compassionate and sensible. I know that he will take on board, with all their weight, the arguments that have been put before him on behalf of very worthy, decent people, who have a right, in the twilight of their years, to live in reasonable peace and dignity, without anxiety.

    If we do not get a reasonable response, what shall I do? I suppose I could go home—that would be one solution—or I could abstain. Instead, I will listen very carefully, and with an open mind, to what I hope will be a reasonable, compassionate and sensible response from my right hon. Friend.

    I am a member of the Select Committee that went into this matter on numerous occasions—since it was first brought to attention in 1987. What we are discussing tonight is a problem that has been building up for seven years. As a result of deliberate Government policy in 1983 to expand the private sector and to introduce market forces into the area of care of the elderly and of other specific groups, resources were unleashed in an unplanned way. That led to limits being set at local level for board and lodging, for residential care, and for nursing home care. In different areas the limits for residential care could vary between £51 and £215 per week, and for nursing homes between £80 and £290. In one financial year—1984—the effect was such that the Government tried to put limits on the activities of local social security offices. Indeed, by September 1984, they had restricted the ability of the Department to make decisions at local level. In those 12 months the Government unleashed forces with which, for the past seven years, they have been unable to cope. I refer both to the financial situation and to the unplanned and unstructured way in which the sector developed.

    In 1985 that system was scrapped. Over the next two years the Select Committee on Social Services received evidence—first in a trickle, and then in an avalanche—about the growing gap between the cost being met by the Department and what a resident or his family had to pay from his own resources. During the same period local authority provision grew by 4 per cent. annually, whereas in the private sector the rate of growth was 350 per cent. More than 40 per cent. of all residents in board and lodging, residential care or nursing homes are in the private sector. At a time of such massive explosion, although there was an average of 4 per cent. growth in local authority provision, in many areas there was actually an absolute loss of provision, by way of homes being taken into the private sector or as a result of closure, or by reason of local authorities' joint arrangements with health authorities to operate exclusively in the private sector.

    During that period I was a member of the Social Services Committee and of the planning committee. The avalanche of planning applications was such that special arrangements had to be set up between the social services committee and the planning authority to monitor the quality and nature of applications. At the same time, the social services department, with the health authority, set up an allocation system to deal with bed allocation. Consultants at Billinge hospital refused to accept frail elderly patients both from the private sector and from the local authority. There was a tit-for-tat arrangement, and I believe that it continues. If someone in part III or part IV local authority accommodation—even at that intensive nursing level—was incapable of being sustained by the local authority, the health authority would accept him back into its care if the local authority could accept someone from an acute bed in return. Bearing in mind the reduction in the number of beds, that is not always possible.

    Some months ago I visited a local authority home where an elderly lady who had been refused admission to Billinge hospital was being cared for by staff who were on their day off. Those staff members worked in shifts. They were the only people who were prepared to accept responsibility for that frail elderly lady. That is the position in which we find ourselves because of the unplanned explosion of market forces in health care.

    As my hon. Friend the Member for Preston (Mrs. Wise) said, irrespective of political views, what we have heard from both sides of the House today drives us to ask what we can do to extricate ourselves from this morass. The Minister, whether he accepts or rejects the new clause, owes it to the House and to all those involved in community care to state precisely what his intentions are. I pressed the Minister for Social Security many times to advise us what the Department would do to protect residents from the problem of eviction. He ignored those opportunities to clarify the Government's position.

    This matter has been treated with cynicism. We are talking about a finite group, many of whom are elderly and frail. Some people believe that, if we wait four, five or six years, most of those elderly people will die, and the problem will die with them. If that is the conclusion of advisers to the Department, it is totally unacceptable. For every elderly frail person in a private residential home, there is at least one elderly frail person at home trying to cope financially or socially.

    Many of the people who see me about their parents are themselves either pensioners or are coming up to pensionable age. Many people have mentally or physically handicapped relatives at home and have seen their parents die. The brothers and sisters are left to cope with the handicapped person. The problem is passed on from generation to generation. If we do not accept the new clause, we shall pass on the problem of caring financially and socially not only to parents but to grandchildren. That is unacceptable in social and economic terms.

    Like other hon. Members, I could tell horror stories about what happens to our constituents. Families find themselves in serious financial problems, some needing £10 or £15 a week and others needing £60 or £70 a week. Unbelievable sacrifices are made by people individually and collectively to maintain the family in the home, but they are driven to suffering illness and to seeking expensive respite care or other assistance from a local authority or the NHS.

    The proposed system in the new clause is not only financially fair to those who will benefit from it but in the medium and longer term will be much more cost effective to the Government in terms of the votes of money to the local authority, the NHS or the Department of Social Security. Given the total votes to those three organisations involved in community care, it would seem far easier to provide, as the new clause does, a consistent means of maintaining financial assistance to those who will remain in residential or nursing home care. The new clause is a genuine attempt to find a way through a serious and increasing problem in the private sector.

    I have been a Member for only a short time, but I know that hon. Members are usually in conflict and that some can take what I say or leave it. Whatever region we come from and whatever political party we represent, the same problem arises. We are driven inexorably to the same possible solution. Even if the Government will not say that they are wrong, we hope that they will accept, just as they did in evidence to the Select Committee, that a serious problem exists. I hope that, because of practical debate on an all-party basis, for the first time since I became a Member we have come up with a solution that is acceptable to our constituents and in terms of the Government's financial targets.

    8.45 pm

    Many families look to this debate for not only a financial solution but a solution to the long-term care needs of those families. I should like the Minister to investigate one matter involving Springfield home in Wigan. It is a local authority home which, as a result of negotiation, last year moved into the voluntary sector because of an agreement between the local authority, the care organisation and residents. At the time of the transfer, there were negotiations as to which residents could apply for and receive attendance allowance at the higher or lower rates. In about September, agreements were reached on specific residents. I understand that, in the past few weeks, the Department decided that residents who came under the control of the local authority before last August were no longer eligible for the allowances, which have now been withdrawn. That is astonishing and unacceptable. I ask the Minister to investigate that as a matter of urgency.

    Hon. Members have seen such transfers take place in their areas on the basis of additional allowances being made available to assist the people in those homes. If that is not to be Government policy, it will have serious effects in terms of the transfer arrangements and the financial requirements of the residents. For those reasons, I ask the Minister to accept the new clause.

    Some of my hon. Friends invited me to sign my name to the new clause. Although I said that I had considerable sympathy with it, I declined to append my name. I felt that it was desirable to have a debate on the subject and for my right hon. and learned Friend the Secretary of State to know that there were those who had not made up their mind about how to vote before hearing what was said.

    The position that I should like to describe has been well rehearsed by hon. Members—including the hon. Member for Livingston (Mr. Cook) and my hon. Friend the Member for Maidstone (Miss Widdecombe)—Who have said that the problem will exist not just between now and April 1991 but will continue for those who are either already in residential homes or who will need to turn to income support to meet their costs.

    A city such as Portsmouth, which I represent with my hon. Friend the Member for Portsmouth, South (Mr. Martin), has particular problems. Portsmouth is the second, or perhaps third, most densely populated area in this country. Land and property are extremely expensive. Until a few years ago, it was a low-wage area, dependent on the Navy, the dockyard and the women's clothing industry. Many of the elderly who live in residential homes did not enjoy the high wages and salaries that younger people in Portsmouth can enjoy because of the high-tech industries. If they made savings, as many did, they did so out of pitifully low wages. They assumed that they would be able to look after themselves in their old age as far as possible, but they believed that if their savings fell short of the amount necessary to meet their needs—they would, of course, be sorry if that happened—they could carry on living reasonably comfortably and in reasonable dignity. They did not have especially high demands. They have moved into residential care, often initially at their expense, and paid the costs, only to find later that they have had to turn to income support to meet the costs of their continued residence.

    The difficulty is that the costs are high in a city such as Portsmouth. As I have said, it is an extremely densely populated city and property is expensive. We now have the problem of high interest rates, which make it difficult for the owners of homes to expand and to carry out repairs. We also have higher wages than we had before, which means that to find the high quality of staff required is an expensive business. It is not the case that there is a one-off shortfall between the rates that are paid by income support and the charges in the residential homes, but that there is a growing shortfall. It has grown over recent years and shows no sign of ceasing. That problem must be addressed.

    There are always hard cases, and the most extreme case may not be the most suitable to use in developing an argument. However, I want to mention briefly one case which, I should have thought, would commend itself to the Government. It is the case of a maiden lady who spent her lifetime caring for her parents and kept them out of care by looking after them. When she became too frail to look after herself living alone—she has no children, of course—she moved into residential care using her savings. She intended to look after herself and such self-reliance commends itself to the Government. I also find such self-reliance extremely commendable. That lady made proper provision. The trouble was that, as the years passed, her savings dwindled. In the end, her savings fell below the level at which she could turn to income support.

    There is a gap between the income support payable and the fees. No one could say that the fees in that home are unreasonable. They are the fees that this lady chose and she was willing to spend her life savings on them. It is not likely that they are excessive or unreasonable. They are the fees necessary to maintain the service in that home. However, this lady can no longer pay. The owner of the home is allowing her to stay there. In fact, he is accepting that she pays less than others in the home, which means that his business is damaged. He could not do that for a steadily increasing number of people. The next stage is that those in the home who are paying their own way from their savings have to pay a little bit more to cover the costs of those who are drawing income support, which means that their savings are going down faster than they would have done otherwise. They are moving towards the same position that this lady is in at a rate that they did not anticipate.

    That is a case in which there is need for a clear-cut approach to the problem. I asked the former Under-Secretary of State for Social Security, my hon. Friend the Member for Fareham (Mr. Lloyd), what was the position in this lady's case. He said that, unfortunately, income support did not meet the total cost of residential care. I wrote back and said, "I know that, but what is the old lady to do?" I am sorry to say that the answer was, "Are there no charities that could be found to help?" Was it suggested that the old lady should find a charity or that I should go round looking for charities to support my elderly constituent, who had made every effort after a lifetime of caring to look after herself? Such a solution will not do.

    That old lady may stay in that home until she dies. If the numbers of such people increase, they will have to be moved from one residential home to another. I hope that my right hon. Friend the Secretary of State for Social Security will answer me later. Is it reasonable that if someone has expended all his savings at a particular home in which he was prepared to meet the costs, assuming that his savings would last his lifetime, and if he lives rather longer, he should, in the twilight of his life, be moved out into less suitable accommodation, which he would not have chosen for himself? Is that what my right hon. Friend is suggesting? If it is, it will not do any more than the suggestion that I should look for a charity. We need something better than that.

    I do not suggest that the new clause is the only way to deal with the problem. There may be other and better solutions. I realise that there is a problem that if, in effect, we increased the resources available to the Department of Social Security clients in residential homes, charges might rise, which would place an unreasonable burden on those trying to pay for themselves. I can see that there is a difficulty, and I understand that it is not a simple matter, but a complex problem.

    My right hon. Friend tonight does not have to accept the new clause, but he must accept the responsibility. I do not mind how he discharges that responsibility as long as he tells me tonight what I should say at the weekend to the proprietor of the residential home about the old lady. "You are to go on looking after her, come what may, out of your own pocket. You are to charge everyone else in the home a bit more. You are to put the old lady into cheaper and less satisfactory accommodation or go back to your Member of Parliament and tell him to look for anothercharity." Are those the solutions? If they are not, what is the Government's way of dealing with the problem? If it is convincing, I shall vote against the new clause tonight. However, unless there is an answer to those questions, I shall go into the Lobby in favour of the new clause, which will be the only thing that I can do in good conscience.

    The speech of the hon. Member for Portsmouth, North (Mr. Griffiths) neatly, elegantly and beautifully encapsulated the practical and the moral dimensions of the problem. I hope that he will forgive me for not responding to his speech in particular. There have been three other contributions from Conservative Members that I found of particular interest.

    Listening to the flow of this debate, only one or two rocks seem to have resisted the general current from hon. Members of all parties. I am reminded of a social security debate a few years ago. Some hon. Members will remember it and may have participated in it. The then Secretary of State was introducing a social security review. One controversial nugget was how child benefit would be dispensed—in the wage packet or directly to the mother.

    There was an important debate that night in which every voice on the Government and Opposition Back Benches was of one view, and at the end of the debate the Secretary of State had to bow to pressure. He promised to re-examine the issue, and in due course, in another place, the proposals were amended. That was a sensible and welcome victory for Members in all parts of the House. I hope that much the same will happen tonight because the measured, reasonable and constructuve tones of the majority of speeches demand that a change be made.

    9 pm

    The hon. Member for Cambridgeshire, South-West (Sir A. Grant) echoed my feelings when he fastened on to one of only three arguments that have been adduced against the new clause by Conservative Members. That argument is that we would be signing a blank cheque. Like the hon. Member for Cambridgeshire, South-West, I do not buy that idea—if one can buy a blank cheque—because, as the hon. Member for Maidstone (Miss Widdecombe) pointed out, if there can be a definition for one category of people, there is no reason why another category cannot be defined. The problem can be overcome.

    The second argument was advanced by the hon. Member for Brigg and Cleethorpes (Mr. Brown), who thought that the clause would open the way for unscrupulous proprietors to ratchet up prices at the expense of the public purse. The few Conservative Members who support that argument are on thin ice because normally when we debate provision for the elderly there are exchanges between Labour Members, who are instinctively hostile to the private sector and would like to see social care provided in the public sector, and Conservative Members, who regard that as a pathological outlook and are critical of those on the Left who do not like private provision.

    Perhaps I should make my position clear. I believe that it is inescapable, indeed essential, that we have a mixed economy in welfare, given the clear demographic trends in Britain. Conservative Members are on a hiding to nothing in saying that the new clause is defective because unscrupulous private profiteers would cause a strain on the public purse by trying to corrupt the system.

    The same Conservative Members, when debating in other contexts, accuse Labour Members of being hysterical in complaining about private provision. They can argue one way or the other. They cannot invoke one side of the argument for one set of conditions and appeal to the other side of the argument for a different set of conditions. While I would not seek to defend the Socialist outlook, because I do not concur with it——

    The hon. Gentleman is older and greyer than I, but I suspect, from his choice of party, that he may not yet be wiser. We live in hope for him.

    The third argument adduced by Conservative Members is always trotted out. It is that the drafting is indelicate and that technically the new clause would not meet the situation. I agree with the hon. Member for Cambridgeshire, South-West that where there is a will there is a way. We are not pushing the new clause in its present state. If the Minister accepts the spirit of it, and promises to introduce an amendment to achieve its purpose, we shall be satisfied. I hope that the Minister can pledge—even if he cannot accept the new clause as drafted—that the spirit behind it can be incorporated into the legislation at a later stage. I also hope—this refers to our initial discussions in Committee—that, when there is no legislation to be considered, a fresher, more detached, view will be given to social policy in terms of the split between the Department of Social Security and the Department of Health.

    There was much frustration in Committee because we felt that we were tilting at absent friends—the Ministers at the Department of Social Security. The Bill is being sponsored by the Department of Health. I am not sure that the split makes any sense any longer. I hope that, after the Bill is out of the way, fresh consideration will be given to which is the best all-encompassing sponsoring Department for a crucial and growing area of social provision and social policy.

    The arguments on this vexed matter have been compellingly presented by Members on both sides of the House with remarkable unanimity. Because of that, and because I spoke on the matter in Committee, I do not intend to detail them again. However, I must express my surprise and disappointment at the Government's failure to deal with the problem.

    The Government have accepted that there is a problem and have built it into the White Paper and the Bill so that those who enter the system from April 1991 will not be affected. It is extraordinary that they apparently propose to do nothing about those already on income support. I say "apparently" because that appeared to be the evidence that Ministers from both Departments gave to the Select Committee, and it is also what emerged in Standing Committee. It is not as if that is a new problem that has suddenly arisen; it has existed for a year or more. I have corresponded with the Department about cases in my constituency for at least that long.

    An important point was made by my hon. Friend the Member for Ealing, Acton (Sir G. Young). The money at present allocated to income support will—for new entrants after April—he allocated to local authorities to use as they think best. If that money is inadequate now, it will be inadequate then. Surely funding will be the basis of whether the proposals in the Bill succeed or fail.

    The evidence is there in abundance. We all know the results of the research carried out by a variety of organisations, which have presented us with the facts and figures. It appears that the only place where research is thin on the ground is at the Department. It may have the material, but apparently it is reluctant to offer it to us. I invite Ministers to examine the Select Committee report, in which we have analysed the evidence and the inevitable conclusions.

    To those figures, I will add two from my constituency, which is part of the suburbia to which the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) referred. The limit for income support there is £163. The charges for homes in my constituency vary from the lowest shared rooms at £185 to others at £280. I am referring not to luxurious places, but to houses that offer people a reasonable, fairly basic standard of accommodation.

    The other case to which I wish to draw attention involves the Cheshire home in my constituency. Its administrator says:
    "we are…fortunate in that a few Local Authorities, in spite of the regulations, have…agreed to 'top-up'…This still leaves us with two residents for whom there is a shortfall of £84·86 per week (the difference between our current fee…and the DSS maximum of £258)".
    That current fee is audited by the local authority. In any case, one would hardly expect a Cheshire home to overcharge. As a result, the home is losing nearly £9,000 a year in income, and that clearly cannot go on.

    Not all people in residential homes are in difficulty. Some have their own capital from which they can pay fees. Some find themselves on income support but the family can bridge the gap, and that may not be unreasonable if they are a family of some means. But, alas, some families simply do not have such means. As we have heard, they have to scrape round charities finding £10 here and £10 there to fill the gap. Yet others simply have no family and no other source of income. Therefore, as in the case of the Cheshire home to which I have just referred, they have to be subsidised.

    Surely those are the poeple whom we should be trying to help. If we do not do so now, after April 1991 there will be two classes of resident in residential homes—those who have recently entered whose costs will be fully met by the local authority, and those who entered before April 1991 who will be subject to the social security rate of benefit as it is now and presumably will be then. That problem must be addressed not in April 1991 but now. The problem exists now and will continue to do so.

    It is the Government's policy not to dish out resources willy-nilly but to target help where it is most needed. If the debate has done nothing else, it has demonstrated that those are just the people to whom the help should be targeted. I cannot believe that it is beyond the wit of man or woman to devise a scheme to ensure that that is done.

    I have no doubt that when my right hon. Friend the Minister replies he will say, as others have, that for all sorts of reasons the clause is defective. But if all that he can offer us is that he will bear in mind what has been said at the next uprating, that will not be good enough. The next uprating will not be announced until October to take effect the following April. In telling us that the new clause is unacceptable, I hope that he will be able to tell us what the Government intend to do about the matter. If he cannot do so, I shall have no alternative but to support the new clause.

    The quickest and simplest solution to the problem that we are debating would be for the Government to stop the move towards private homes and to provide such services within the NHS and the social services. We would not then need to work out a formula for a top-up payment for someone receiving income support.

    On a number of occasions, I have written to the Department of Social Security and the Department of Health about the problem that we are debating and their answers would be amusing if it were not for the tragedies behind them. The first time I wrote was November 1989 in response to a letter that I received from Bristol Old People's Welfare Incorporated on the upgrading that had been announced. They were complaining about the increase of £10. They pointed out that out of 175 residents they had 80 who relied on income support, and that in 1987 their loss was £35,000, in 1988 it was £83,000, and in 1989 they expected it to be £100,000; and that as a charity they could not afford to continue to draw on their resources and therefore would have to close some of their places.

    9.15 pm

    The Minister's reply was, first, that he was sorry to hear about the difficulties facing the charity. Secondly, he was sorry that it felt that the £10 was ungenerous. But then he went on to say of the £10:
    "This is an indication of our appreciation of the difficulties facing some people in homes and is a clear statement of our commitment towards helping those who need care and funding of community care."
    He went on to say:
    "It is our policy to target the available resources to where the need is greatest and where such targeting would prove most effective."
    It comes back to the point that my hon. Friend the Member for Livingston (Mr. Cook) made in opening the debate. If these people are on income support, they have no other money. Therefore, how could targeting be any more effective than by giving it to the very people who have nothing? The Minister said:
    "It was never the intention from the introduction of income support that it would meet the cost of all the fees".
    He went on to say:
    "other methods of topping up"—by relatives, charities and other sources—"—[Official Report, 27 November 1989; Vol. 162, c. 422.]
    are essential to this part of the system.

    We have heard about relatives and about the difficulties with charities. Perhaps the Minister will tell us what the "other sources" are, because those people on income support do not have any other resources; that is why they are on income support.

    I can assure my hon. Friend that when we had the first wave of elderly people being moved out of long-stay hospitals into the private sector there was no hint whatsoever that there would be any shortfall between the income of the elderly people and the cost of the home.

    I agree with my hon. Friend. In fact, such a role for charities and relatives was never made explicit, either, at the beginning of the introduction of this policy.

    I turn briefly to the case of the chronically sick, who also come within this clause. I shall use the example of a constituent because it demonstrates the utter disaster zone of the Bill. This woman—I will not name her, for personal reasons expressed by the family—is 48 years old and is suffering from Huntington's chorea, a tragic and unpleasant disease for anybody, let alone somebody so young. Her husband gave up work in 1986 in order to care for his wife and their 13-year-old daughter in the home rather than have his wife in hospital.

    Unfortunately, the disease has progressed and even with respite care, which the family has had to use frequently, the husband is incapable of providing the intensive nursing care which his wife needs. Dearly as he loves her, there is no way he can afford to provide that care. His wife is currently in a hospital which is due for closure. She is in an acute bed which is not satisfactory for her treatment. In addition, the hospital is outside the district health authority region in which the woman resides. She is a resident of Bristol and Weston district health authority which is in the final stage of opting out as a district health authority.

    The hospital's advice to the husband, who is unemployed, is to seek a suitable nursing home for his wife. There are no public sector nursing homes in Avon. She can go only to a private home. The husband has gone to 16 private nursing homes. Because of the intensity of the nursing that she requires, only one will accept her. She has to get out of hospital but she cannot go home and the only private nursing home which will accept her wants her to pay £320 per week. Her total entitlement to benefit is £235 a week, which leaves a shortfall of £85. The husband has been round an untold number of charities and has finally been able to reduce the deficit to £45. The family cannot get the woman into a nursing home because it cannot find the £45. What are we doing to the so-called care of the vulnerable chronically sick through the Bill?

    I wrote to the Department of Social Security and also to the Department of Health from who I got interesting replies. I was told again that the policy of the DSS was to direct available resources where they were most needed, that there was no provision in the National Health Service for providing nursing care and that it had never been the intention to fund all care from social security. The Department of Health told me that the National Health Service has a responsibility for providing continual nursing care and medical care for people in need of full-time care. However, it is for local health authorities to determine the level of care. Our district health authority is on its way out of the integrated NHS.

    The Department of Health also told me that if the woman was in a private home she could not be moved, but she has not got into a home yet. The recommended course was to see the family general practitioner who is obliged to provide all the necessary medical evidence to patients, including referral to a hospital for care, if needed, and is medically responsible for that care. If necessary, the Department said that the woman should be admitted as an emergency case. That would mean that she would go straight back into an acute bed in the NHS simply because the Department will not make up the shortfall through income support. I cannot believe that the entire retinue of civil servants in the Department of Social Security and the Department of Health cannot work out a solution to this dreadful problem.

    I have an offer to make to both the Secretary of State for Health and the Secretary of State for Social Security. If they feel unable to persuade their civil servants and to help them to reach a certain conclusion and so bridge the gap on income support, if my hon. Friend the Member for Livingston does not jump at the chance, I will help those civil servants to find a way of solving this disgusting and tragic problem. Anyone who claims that the problem cannot be solved is ignorant of people's ability to solve problems. Either Ministers have the political will to solve the problem or they have not. Voting in favour of the new clause is a solution to the problem.

    My right hon. Friend the Secretary of State for Social Security is aware that a need exists which must be met. The Government's provisions to meet the requirements of the Griffiths report and the Bill go a long way—and a brave way—towards meeting the needs for the future. I believe that the provisions will work. That leaves my right hon. Friend the Secretary of State to face the needs of today.

    To some extent, I believe that we are the victims of our own success and that may be a happy circumstance. The residential care of the elderly has improved dramatically over the past 10 years. We inherited a shambles and a system in which the standard of care was bad in many cases. The facilities were poor and not infrequently the management of homes was greedy or corrupt.

    The Registered Homes Act 1984 did much to improve the position and the financial provisions made by the Government have solved many of the problems and cured much of the greed that existed earlier. Although the present system is by no means perfect—I speak from experience in my constituency—we have many residential and nursing homes in which the facilities are excellent and the standard of care is very good. In those homes the standard of training is also good and school leavers are no longer thrown straight into the deep end without training. In my constituency the Thanet technical college provides excellent care training.

    There have been many improvements, but they have all had to be paid for—and they have all been paid for—by the proprietors of homes. Inevitably, the fees in those homes now reflect necessity and not avarice. As my hon. Friends have heard tonight, many residents in those homes cannot now meet the legitimate financial needs of the proprietors.

    My hon. Friend the Member for Maidstone (Miss Widdecombe) in her excellent speech referred to many of the problems and I do not propose to repeat them. Many of us believe that it is right that children should make some provision for their elderly parents. However, in many of the cases about which we are concerned, the children are not 30, 40 or 50-year-old working people, but 60 and 70-year-old children keeping 80 or 90-year-old parents—such is the level of care that is being provided. That is why in some respects we are victims of our own success. That gap must be met and my right hon. Friend the Secretary of State for Social Security must find a way of meeting it.

    I listened with great care to my hon. Friend the Member for Mid-Kent (Mr. Rowe) and I agreed with a great deal of what he said. I believe that the new clause is flawed and I do not believe that it meets the needs that nearly every hon. Member who has spoken tonight agrees exists.

    The awards should not be inconsistent with contracts awarded to new entrants under the new scheme. There are still homes that provide an inadequate standard of care and existing contracts may well he of a lower quality than that demanded for the award of new contracts. It would be bizarre if had homes were protected at the expense of good ones.

    My hon. Friends the Members for Mid-Kent and for Chislehurst (Mr. Sims) referred to the priority of need. We have a tremendous priority of need in Kent for the care of the physically handicapped and the mentally handicapped young. My hon. Friend the Member for Chislehurst referred to the problems that are faced by the Cheshire homes and to their inadequate resources. Given that I am told that young people in need of considerable care represent a cost to those homes of between £350 and £400 per week, it is clear that the Cheshire homes are running at a considerable cost, as is borne out by the Strode Park Foundation for the Disabled, which has a youth unit in my constituency.

    9.30 pm

    The funding is inadequate and that gap must be made up. However, I would not wish that gap to be made up from the funding that will be made available to local authorities in the next few years because inevitably the resources that are needed for other areas of care will be depleted to meet the needs of the present.

    I also listened with great care to the speech of my hon. Friend the Member for Ealing, Acton (Sir G. Young). Of all the proposals that I have heard in three and a half hours in the Chamber, my hon. Friend's proposal struck me as the best. I repeat what I said at the beginning of my speech: the Secretary of State has taken on board and recognised the needs of the future. That is reflected in the Bill. It is essential that he now recognises the needs of the present. Therefore, I hope that he will pay particular attention to the suggestion of my hon. Friend the Member for Ealing, Acton.

    In every sense of the term, it is far too late for us to be trying to interest the Government in a whole range of possible solutions. The opportunities for that lie further back down the track. We are now faced with the start of a new and complicated system of which the matter that we are discussing forms an important part.

    I do not identify myself with those hon. Members of all parties who have tried to entertain the Government with a range of possible solutions to this difficulty. Although it is teasing, I do not find it tempting to see the hon. Member for Ealing, Acton (Sir G. Young) in action because he:is never a man to back up against a wall without first designing several different doorways. I identify myself much more strongly with the hon. Member for Chislehurst (Mr. Sims) who said clearly that now—tonight—when the Secretary of State replies to the debate is the time at which there can be an answer. We cannot go on debating a clear, obvious and substantial problem without having a definite answer on the table.

    It is right and proper that the Government should find the answer themselves, because the problem with which we are wrestling is largely a creation of the Government's policies. The hon. Member for Thanet, North (Mr. Gale) referred to the position when the Government came into power, when there were 12,000 claimants on what was then supplementary benefit, but which is now residential care and nursing home support. In 1984, that figure had risen to only 40,000. However, the figure is now in excess of 180,000 and the number is rising rapidly. That has not happened by accident. It has happened as a result of a clear, conscious, definite and decided policy. In 1984 that policy substantially increased the levels of supplementary benefit—now income support—to encourage that trend and from then on rolled down the number of long-stay hospital provisions in which such people were then located.

    The magical "perverse incentive" that has been mentioned as increasing those numbers does not exist. What has driven those numbers up is the Government's own policy of closing down long-stay hospitals and—more importantly—of preventing people from entering them because they were no longer there to be entered. That policy may well have had its good aspects, but tonight we are dealing with some of its unfortunate and bad consequences. What has happened has been as a result of the Government's clear policies and the Government must now find an answer to the difficulty that they have created.

    We are talking not only about the 180,000 people who are dependent now on income support for residential care and nursing home provision but the several tens of thousands of people who, by April 1991, will be in that position. Conservative Members and several of my hon. Friends, including my hon. Friend the Member for Bristol, South (Ms. Primarolo), spoke about the wave of transfers into dependency on income support as the shift out of the NHS sector gathers enormous speed.

    In my city at least five different schemes will transfer many hundreds of people from NHS care into dependence on income support by April 1991. We are talking about not only the 200,000 who are dependent now but the extra tens of thousands who will have been put in that position by April 1991.

    I agree with the hon. Member for Ealing, Acton on one point. Residential care rates under income support will be the basic building blocks of the funding of the system after April 1991. All the difficulties of the present system that we have debated tonight will be exported into the new system. That is why the matter is urgent and why it is proper for the Government to come up with some definite answers to a problem that is massively important in human, financial and institutional terms and that they have created.

    An interesting factor lies behind the problem. We have seen the creation of a whole new industry of providing care to people who are dependent on income support. As little as five or six years ago it was a cottage industry but since then we have seen one of the most massive industrial rationalisation schemes that the Government have carried out. The voluntary sector mobilised itself to provide huge numbers of additional places to take advantage, as they thought, of residential care income support rates, only to be disappointed. We have heard tales of woe from Anchor Housing, Cheshire homes and other agencies. They are all true. Charities moved into the provision of such care thinking that the 1984 income support rates would be the basic building blocks of the new system only to find that in the years after 1984 the rates did not keep up with inflation.

    We now find ourselves in grave difficulty. The Minister must find an answer to the problem. When he replies, he must say clearly how he intends to pitch the new scales that will come into force in April 1991 for people who are dependent on income support now. That flow of funds will be the stream that carries us on to the system of community care after April 1991.

    The matter is important and urgent. We have seen an enormous industrial rationalisation in human care and the generation of a big business out of a cottage industry. I doubt whether the provision of care should be big or business, but that is what we have come to. Tonight, not to start a new debate that will rattle on for the foreseeable future, but to close the existing debate, the Minister must be definite and talk specifics about levels of funding, not only for the 200,000 people who now depend on income support but the whole rafts of other people whose futures will depend on it.

    The wave of stress and anxiety about the figures is enormous. In 1989 the range of scales under income support went from £140 to £255. Payments were pitched to the individual average claimant at £120. In other words, average claimants do not depend entirely on income support. They have not reached the crisis point, but their savings are being bled through the means testing of the income support system. They demand answers and want rescue The ocean of anxiety that they represent must be drained and that cannot be postponed any longer.

    I have been listening carefully to hours of this important debate. Nobody can ignore the issue which my right hon. Friend the Secretary of State needs to address in his remarks.

    New clause 1 is not precisely the solution to the problem, nor is a return of the whole private care machinery to the public sector, as Labour Members have suggested. I am encouraged in that view by the statistics for Lancashire. In the county council budget debate on the community charge, it was made clear that if the council's part III accommodation were offered to the private sector, 38 per cent. of it would not pass the county council's own care standards of inspection.

    I reject new clause 1 because of a case in my constituency. A rest home was upgraded to nursing home status and went from an income support level base of fees to one geared to income support, because it knew that the people in the rest home could afford to pay those fees and no more. Down the road somebody thought that he could do better, so he upgraded an old rest and nursing home to a high quality one and put it on the market at £330 a week. It will not surprise hon. Members to hear that the market, if one can call it that, quickly made it clear that it would attract too few residents, so the price came down to £300 a week in an attempt to attract more people.

    We have heard about differentials. That is one of £60. I have visited both establishments and I am still left wondering which one—the former rest home providing an excellent standard of individual care for £240 a week or the new luxurious nursing home which charges £300 a week—is better and should be supported.

    I reluctantly decline to give way because I want to finish in a few moments.

    The matter is a deal more complex than simply needing additional money for the existing system of income support. In all sincerity I would not for a moment dispute that we need to consider the adequacy of some of those rates because costs vary. It is not just a case of tightening the system.

    Labour Members who understand the income support system will realise that if elderly people adjust their financial circumstances in advance of going to a rest home, their family may be the beneficiary of a large sum and they may end up being able to claim income support. If we are to make the best use of the large sums rightly invested in income support, my right hon. Friend in reaching a conclusion must look further than simply the straightforward rate for the job. Income support anomalies create difficulties. If one of two elderly friends who bought a house together goes into a nursing home and seeks income support because as part-owner of the house his capital is tied up, he cannot get that much-needed benefit. I urge my right hon. Friend to encompass such cases when he comes to a conclusion.

    Nobody would for a moment dispute the excellent job done by private rest and nursing homes, but already there is a big difference in the price charged. For example, one person in my constituency who runs a rest home has been innovative in order to improve business potential and has developed a domiciliary care service. That adds greatly to services and to his cash flow and it improves the work that he does. It means that he can maintain care for people in his rest home at a rate equal to what they can get on income support. I ask my right hon. Friend to reconsider the rate. To those hon. Members who are seduced by the simplicity of new clause 1, I say that the issue is not as straightforward as they imagine.

    9.45 pm

    I have sat throughout most of the debate and have heard the almost unanimous view of hon. Members on both sides of the House that something must be done about a group of people who find themselves in great difficulty. Many hon. Members have said that they are a particularly vulnerable group of elderly people.

    What has been remarkable about the debate is that there is no political divide in the House, as both sides agree that this is a major problem which the Government must resolve. The old adversarial system of politics in the Chamber has been put to one side in a remarkable way. We have been able to set aside that style of politics because we have an unanswerable case for the Government and they must come up with a solution. The case is unanswerable because no hon. Member from either side of the House has resorted to the safe haven of trading statistics. Whenever we have an empty case which we cannot support we seek refuge in statistics, but no hon. Member has done that tonight.

    We have all had personal experience of constituents coming to us with problems, and we know that the Government must find a solution. Some Conservative Members have agreed with the principle behind new clause 1, but they are not happy about the wording, as it could lead to what some hon. Members have described as a blank cheque. Those Conservative Members have offered their own solution to the problem, and have suggested an answer different from that contained in new clause 1, but that clause has not been drafted to be perfect in every dot and comma. I accept that the clause could be amended. However, the House needs to give the Government a clear message tonight that something must be done. Unless the Government accept that, a group of elderly and vulnerable people will be devoid of assistance.

    The will of the House is clear. Conservative Members who agree about this issue, but do not agree with every dot and comma in new clause 1, should realise that the only way to keep pressure on the Government is to vote for new clause 1. I am convinced that the Government will have to bow to that pressure.

    Until recently, I had not expected to find myself once again confronting the hon. Member for Livingston (Mr. Cook). He was kind enough to say that it was a pleasure for him but, in the circumstances of the debate, I am not so sure that it is a pleasure for me.

    We have certainly had an important and worthwhile debate, and I shall seek to respond in like fashion. I always look for common ground in an issue of this nature, and today the common ground is that the present system of income support limits is less than perfect, to put it mildly, for supporting the provision of residential and nursing care.

    Since 1985, the system has sought to reflect variations in the needs of defined categories of people, but it has no mechanism or capacity to assess—in a medical or social work sense, as is often required—the needs and circumstances of an individual. As a consequence of that, and of the high level of such payments by comparison with what is often available in terms of other forms of support, for example, in the home, it is widely held to have been inconsistent with the drive towards care in the community to have created some scope—some people would say more than some scope—for exploitation and to have left very considerable room for doubt whether the resources involved were being used to best effect.

    The Government's clear acknowledgement of the unsatisfactory nature of the system—which in my case goes back many years to my earlier experience as a Social Security Minister—led to the proposal contained in the community care part of the Bill: that from April 1991, for new cases, the social security entitlement should be confined to the usual income support and housing benefit entitlement and that beyond that it should be the task of local authorities' social services departments or social work departments to assess an individual's care needs and to provide support for those needs in what is judged to be the most appropriate way, whether by paying for care in a residential care or nursing home or by paying for care in the person's own home. That approach is also, I believe, common ground.

    The difficulty that we all face—sparticularly by me in the context of this debate—is the classic one for politicians on many political issues of getting from where we are to where we should like to be. The Government's judgment, which again is widely shared, is that it is not practicable to undertake a complete switch from one system to another at one particular point in time and that the change must be carried through in a phased and manageable way.

    There are two main reasons for that judgment. The first is the one on which most stress has been placed: the huge burden that would be imposed on local authorities if the assessment process had to be undertaken not only for new cases but for nearly 200,000 existing cases, which could well make the whole thing unworkable. The second reason, which is certainly not to be dismissed or minimised, is that it was not thought right to withdraw existing entitlements to income support from those who are already in residential homes, with all the uncertainty that that could involve, especially in circumstances where it would be possible for local authorities to assess such people as not needing to be in a home at all. There is broad agreement that for those two reasons it was right not to attempt a wholesale switch at once.

    Unless that basic judgment is challenged—which it has not been throughout the debate—there is an inescapable need to run the two systems side by side, despite the fact that that must entail some problems. What I and my right hon. and learned Friend the Secretary of State for Health intend to do is to ensure that, to the best of my ability, both systems operate effectively.

    The new clause is directed towards one aspect of those problems—the future basis of income support payments under the existing system to those who will have preserved entitlements. I say at once, fairly and squarely to the House, that I cannot advise it to accept the new clause. It contains two main elements: first, that any gap between the income support limit and the actual charge should be measured and then met. I shall turn in a moment to the apparent safeguard. The second element is that the amount then defined should be increased according to an index of the average by which those charges are subsequently increased.

    There is an attempted safeguard. I acknowledge that my hon. Friend the Member for Maidstone (Miss Widdecombe) and other hon. Members have attached some weight to it: that payment could be withheld in respect of some part of the charge that is held by a social security adjudication officer to be "unreasonable", having regard to the nature of the premises and the services provided. That is a judgment which social security adjudication officers do not have, and could not sensibly acquire, the training or the knowledge to make. It involves social work skills and assessment skills of a kind that are outwith the ordinary operation of the social security system. Even attempting to make it work would entail imposing a burden on local authority social services departments. It would be essential to use their advice on a large scale, and that would multiply their problems in implementing the new system.

    Has not the hon. Member for Ealing, Acton (Sir G. Young) given the answer? Adjudication officers will not act in a vacuum. Running parallel to their decisions will be local authority market decisions about private homes. In deciding whether a rate is reasonable, it will be possible to look at all those decisions. The hon. Member for Maidstone (Miss Widdecombe) has provided a formula which, with that back-up, would work.

    That is a helpful and entirely reasonable comment, as I should expect from the hon. Gentleman. Indeed, later in my remarks I shall come to the very constructive contribution of my hon. Friend the Member for Ealing, Acton (Sir G. Young). The very way in which the hon. Member for Birkenhead (Mr. Field) framed his remarks implies acceptance that, certainly as things stand, social security adjudication officers do not have the capacity to make judgments——

    I have told the hon. Gentleman that I will come to that point. He knows a great deal about how the social security system works and about the training and skills of adjudication officers. I do no more than make the point that, as things stand, they do not have the capacity to make the judgments that that apparent safeguard would entail.

    Anybody who doubts that might look back at what happened when we had a system rather similar to that proposed in the new clause. I refer to the period before 1981 and running up to 1985, when adjudication officers were responsible for establishing what was a reasonable charge in each local office area. Let me take from the list two examples that are particularly striking. In the case of charges thought to be reasonable for nursing homes, there was a variation from £296 in Leytonstone to £140—less than half—in Romford, which is just down the road.

    In the case of residential care homes in East Anglia, there was a variation from £90 in Bury St. Edmunds to £177 in Colchester. Manifestly, that reflects the extent to which adjudication officers found it impossible to make judgments of the sort envisaged in this new clause.

    The figures that the Minister has just quoted are impressive, but they are irrelevant to this argument. We are not moving back to the system that pertained in the period up to 1985; we are moving to a system under which local authorities will have to negotiate care packages from the private sector. Adjudication officers, in deciding whether a rate is reasonable, will be able to consider what the market will bear.

    I should be grateful if the hon. Gentleman would let me do what I have already undertaken to do. I have said that I will come to that point later. In the context of the debate and of my response to it, it is sensible for me to comment on the new clause as it stands and to convey my clear sense—this view has been reflected in the speeches of at least five of my hon. Friends—of the substantial degree of open-ended commitment which would raise costs all round.

    Perhaps it is simply an oversight on the part of the authors of the new clause—I have no wish to rest my case on technical drafting—but no provision is proposed to take account of whether it is reasonable for the accommodation, however elaborate and expensive, to be provided at public expense.

    In my judgment, there would be three principal effects were the proposal, in the form that it takes in this new clause, to be carried into law. First, and most obviously, there would be an immediate transfer to the taxpayer of a large amount of expenditure that is currently undertaken privately. That would by no means be only the private expenditure undertaken in the circumstances that concern my hon. Friend the Member for Maidstone. The system that we operated until 1985 has been criticised by hon. Members and the Social Services Select Committee in earlier reports. At the time of the change to national limits specified by categories of home, it was specifically made clear that the Government did not think it right to set the limits at a level that would cover all charges in all homes. The package introduced unique provisions in relation to what was formerly supplementary benefit——

    It being Ten o'clock, the debate stood adjourned.


    That, at this day's sitting, the National Health Service and Community Care Bill may be proceeded with, though opposed, until any hour.—[Mr. Greg Knight.]

    Question again proposed, That the clause be read a Second time.

    Those provisions which are unique to what was supplementary benefit and is now income support allow relatives to make payments in support of residents in such homes without the amounts being immediately knocked off their income support. In any other circumstances, a payment of, say, £50 a week would immediately reduce income support by £50 a week.

    I do not want to place too much weight on this point, because I am conscious of the sort of cases that concern hon. Members. Those provisions were introduced specifically in recognition of the fact that there would be cases where either relatives or, perhaps even more often, charitable bodies would wish to make payments to support someone in care beyond what the state could be expected to provide. In recent weeks, that has been acknowledged by some people from charitable bodies in conversations with me. As I said, I do not want to place too much weight on it, but I need to make it clear to the House that part of the topping up does not have the character attributed to it by some hon. Members, although of course part does.

    I suspect that there would be almost universal agreement on my next point. Throughout the past 10 years, what the Department of Social Security pays has been a powerful influence on the prices charged. The immediate effect of the new clause would be to drive up prices all round, to the disadvantage not least of local authorities seeking to negotiate care packages under the new system. That risk cannot be dismissed, given the Laing and Buisson survey—to which little reference has been made, somewhat to my surprise—which shows a bunching of minimum charges in homes at, or just above, the level set by the DSS. That has been the tendency throughout the lifetime of these arrangements. The new clause would aggravate that position and would bid up prices, to the disadvantage of those paying privately in such homes—of whom there are more than 100,000—and of local authorities in bargaining under the new system.

    Does not the new clause put the power to judge in the hands of the Secretary of State?

    No, it does not. It puts the power to judge in the hands of adjudication officers—

    The hon. Member for Birkenhead (Mr. Field) knows that the entire social security system has been set up to protect adjudication officers from being told what to do by the Secretary of State, and the hon. Member for Oldham, West (Mr. Meacher) knows that, too. That is the essential safeguard of the independence—if one likes, the judicial role-—of those making decisions in the social security system.

    Thirdly, I have little doubt that the new clause, as it stands, would greatly reinforce, especially in the latter part of this year, all the so-called "perverse incentive" effects of income support arrangements, notably attracting into homes people who might be better cared for in the community. I also suspect-—I direct this point to Opposition Members, including the hon. Member for Wakefield (Mr. Hinchliffe)—that the new clause would tend to aggravate still further the extent to which some local authorities seek to shed some of their existing responsibilities on to the social security system. I suspect that such an outcome would not be welcomed universally by the Opposition, although there might be two views about it in some other quarters.

    As I said earlier, anyone who doubts such risks need only look at the experience in the early 1980s, when we had a system of local office limits set by adjudication officers, varying as I have described. Between 1979 and 1984—the hon. Member for Newcastle upon Tyne, Central used the figures to make a slightly different point—expenditure on supplementary benefit in this respect rose 20 times, from £10 million to £200 million, while the number of people being helped rose little more than three times, from 12,000 to 40,000. There has been widespread criticism of exploitation of the system by home owners, which was echoed by the Select Committee on Social Services in the 1986 report. I do not believe that any hon. Member wants to go back down that path, which is the risk with the new clause as it stands.

    I shall come to the hon. Gentleman's point.

    Although I cannot recommend the new clause to the House, that is not the same as declining to recognise the concern expressed by hon. Members of all parties or as being unwilling to seek to offer some clear assurance of our determination to fulfil our responsibilities to those with preserved income support entitlements.

    Before I comment on my approach to the future increases of income support limits, I want to make two important points about two aspects of the Bill which were discussed extensively in Committee, and about the powers that my right hon. and learned Friend the Secretary of State proposes to take under clause 40. They are important in judging the balance of policy in this area.

    First, as the House knows, my right hon. and learned Friend's intention under clause 40 is to bring forward regulations that will enable local authorities to top up preserved entitlements—as they may now, and in some cases do—for people under pensionable age. Their ability in that respect will be extended to people in nursing homes. That power will, as now, extend to people over pensionable age if the authority concerned had been topping up for two years or more before they reached that age.

    Secondly, my right hon. and learned Friend also intends to ensure, through an amendment to this Bill—I know that this subject was the topic of considerable discussion in Committee—that local authorities will continue to have the role that they have always had, and which applies in the present system, to act as providers of last resort for those over pensionable age by making places available in their own residential accommodation to those whom they judge would otherwise be made homeless. I stress that not because I suggest that it answers the concerns tonight, but because it is relevant and answers the concern expressed elsewhere—which I share—that, as a result of inadvertence in drafting, an important part of the rights of those already in homes was being altered in an unintended way by the Bill: that is, the withdrawal of the right to be accommodated in part III accommodation should the need arise. It is important to ensure that that right is preserved.

    Will my right hon. Friend tell the House what the many of us whose constituents are at the stage where they could be turned out, and whose relatives have no more money arid whose local authority has no accommodation, are to tell them?

    I hope I made it clear that I was raising the point because it has been important in the context of the discussions on this matter as a whole, but that I was not presenting it as an answer to the concerns that have been expressed, and I was about to touch on the social security points that have been made in the debate.

    Before departing from my comments on the Bill, I should say—this has been the subject of considerable discussion here and in Committee—that my right hon. and learned Friend has asked me to underline his flan commitment to monitoring carefully future developments on the use of the power under clause 40. The House will know that that is a wide power and that it was inserted in the Bill in consultation with me. It gives a great deal of flexibility to respond, should experience show that further steps are needed in respect of action by local authorities.

    I have deliberately put those points first because I recognise that the focus of the debate has been about, and the request to me by Members in all parts of the House has been for me to recognise, the importance of the social security dimension of the problem.

    I assure the House—I do so with more than conventional strength—that I have listened carefully to what has been said in almost all of the debate and that I can give a number of undertakings which, I must point out, do not constitute specific commitments about what financial limits will be in place, for example in April 1991, and about the spirit in which I shall approach that difficult task in the light of the important points that have been made in the debate.

    As hon. Members—certainly the Chairman of the Select Committee, my hon. Friend the Member for Eastleigh (Sir D. Price), and others who play an important role in that Committee—will be aware, the Social Services Select Committee has recently produced an important report containing a number of points, not least on the need to improve the quality and quantity of information on which decisions about social security entitlement in this area can be based.

    The hon. Member for Livingston (Mr. Cook) will acknowledge, in the way in which he normally approaches these issues, that that difficulty has faced successive Ministers and Social Services Select Committees for some time, and not only in respect of the information that we gather through the social security system, which is dependent on the accuracy—not always to be guaranteed—of the information from private and voluntary homes, especially perhaps the former.

    In some ways, the Laing and Buisson report, to which I and others have referred, revealed the difficulty. The response rate was only 28 per cent., and it left a number of question marks over the validity of the information as a whole. There is also the problem, in assessing precisely what information one requires and how best to get it, that many homes do not cater for residents or potential residents who are likely to be dependent on Department of Social Security payments. So there are difficult issues as to precisely about which homes one needs the information on which to base realistic judgments concerning social security entitlement.

    Having said all that to demonstrate the difficulties that have faced us, I should say clearly that I accept that we need more and better information, and when I respond to the Select Committee, as I hope to do before long, I shall make specific proposals to meet the suggestion in one of its recommendations on that front.

    I am sure that not only the Select Committee but the whole House is grateful for the right hon. Gentleman's assurances about his desire to collect better statistics. Taking collectively our elderly constituents who are not having their fees paid in full—this was stated earlier in the debate—each hon. Member has the equivalent of two whole streets of people facing eviction. These are frail, elderly, often confused old people. Although we are grateful that in future we shall have better statistics, we want answers from the Minister about what we should do with those 160 on average elderly people whom each of us has in our constituencies facing possible eviction.

    I understand the hon. Gentleman's point; he made it in his speech. The new clause, however, relates to the position after April 1991. For the hon. Gentleman to suggest that I can respond now to a suggestion about a regime to be set up in 12 or 13 months' time lacks the reasonableness that I expect from him. I am seeking to show, as clearly and as forthcomingly as I can, how I propose to respond to the concern that is reflected in the new clause—to which I am properly directing my attention—about the position after April 1991.

    10.15 pm

    In bracketing nursing care homes and residential care homes together, my right hon. Friend has not addressed the special needs of nursing homes. In the past four years there has been a welcome increase of about 50 per cent. in nurses' pay, which constitutes about 60 per cent. of the direct operating costs of nursing homes. In that period Government support has increased by 17 per cent., while the direct operating costs of nursing homes have increased by 39 per cent. There is a 20 per cent. shortfall. Does not my right hon. Friend think that he should make special provision for nursing homes, although he may not fully meet what we want for residential care homes?

    I acknowledge the need to examine the particular circumstances of certain types of home. If my hon. Friend's memory is long enough—we go back to a period when I was the Minister for Social Security—he will remember that that problem was clearly acknowledged in 1985 and 1986 by substantial increases in the limits for nursing homes. That means that in the past five or six years—since the present arrangements started—there has been a significant real increase in help for nursing homes. That is not to say that I will not examine the special case of nursing homes. I give my hon. Friend that clear undertaking.

    To use my right hon. Friend's words, there is a significant and real problem that is widely recognised. Can he hang the phraseology and accept the principle?

    I am not absolutely clear what the principle is. Is my hon. Friend asking me to accept the principle of the new clause—that we should measure the gap between what a home is charging and what income support is available without regard to the factors that I have mentioned, including whether it is reasonable to expect accommodation to be provided at public expense, regardless of how elaborate it may be? That is what the new clause says, and for that reason I cannot give my hon. Friend the simple answer that he obviously wants.

    I am not seeking to trip up my right hon. Friend; I am merely trying to help him. There is a problem that is widely recognised and broadly identified in the new clause. There is a principle there that can be accepted. Can my right hon. Friend say unequivocally that he accepts it, and that in another place a Government-devised clause will be introduced to meet the essential points that have been made repeatedly during this debate?

    Several of my hon. Friends have made suggestions relating to the possibility of greater geographical variation of limits. More particularly, there has been the suggestion referred to several times by the hon. Member for Birkenhead, adverting to an important speech made by my hon. Friend the Member for Ealing, Acton, that it may be possible, using the information that will become available as a result of practical decisions and negotiations by local authorities after 1991, to reflect what I think my hon. Friend wants, which is income support limits that he would regard as more realistic than those which he is looking at today.

    Does my right hon. Friend accept the conclusion in the Select Committee's report that

    "the problem is basically an expression of present inadequacies in the level of social security benefits. It is not caused by the plans in the White Paper, but it will be exacerbated by them"
    so it is open to an immediate solution?

    As I said, the new clause is directed at the position after April 1991. Therefore, my comments are properly directed principally to that end. In the course of considering the uprating of the income support rates following the £10 increase that is about to come into effect, which I announced in the uprating statement last October, and in looking ahead at future upratings which have been the focus of concerns expressed in the debate, I shall look at—again I use the phrase with more than conventional force-—the points that have been made about geographical variation and, in particular, at the comments of my hon. Friend the Member for Ealing, Acton.

    Geographical variation already applies to London.I looked at the matter carefully in the course of making the decision last October about the uprating that is about to come into effect, and I was predisposed in its favour. However, I came to the conclusion that there was no sufficiently safe basis for drawing geographical distinctions in the way that some people have urged, not least for the reason that has been echoed in the debate—that the apparently common sense presumption that costs are likely to be higher in the south-east than in the north-west did not appear to be borne out entirely by the information that we had at our disposal. Without a secure basis for drawing up such distinctions, I thought it best to put the £100 million of additional resources into the rates generally.

    My reservations at that time about geographical limits have been reflected in some of the comments in the debate. I shall look seriously at the scope for greater geographical variations, which might be particularly important to some of my hon. Friends from Kent and Hampshire, for example, but I am much more attracted to the suggestion of my hon. Friend the Member for Ealing, Acton that we should make greater use of something that could be dealt with on a rather more localised basis—I doubt whether it could be used in each local DSS office area—which is what local authorities will negotiate on individual cases rather than with actual homes.

    We understand that my right hon. Friend is a compassionate man, but does he accept that this is not just a matter of regional variation? We are not talking about statistics; we are talking about people. Does my right hon. Friend understand the point that was made at the beginning of the debate about whether, if people are not being exploited—I hope that there is a way of checking that—the Government are willing to protect them, or do people have to go into old-fashioned geriatric wards? If my right hon. Friend can answer that, we shall know which way to vote.

    My hon. Friend has asked me a question that I can answer in reasonably straightforward terms. It is certainly our wish to protect the kind of people who have been the focus of so much concern in this debate. The cause of my unwillingness to accept the new clause as it stands is that it would not enable me to fulfil the other half of what my hon. Friend has pressed upon me, which is to prevent exploitation in some circumstances, including exploitation of the very people whom we are seeking to help.

    I said that I wished to say a word or two more about the suggestion of my hon. Friend the Member for Ealing, Acton, endorsed by the hon. Member for Birkenhead, about using the additional information that will become available from 1991 onwards. It must be acknowledged that there will not be much information around in advance of 1991. There are, of course, a number of uncertainties about precisely how the new system will operate in this respect with local authorities. From my conversations with, for example, leaders of the Association of Directors of Social Services, and with some of the charitable arid voluntary bodies, it is clear that thought is being given to and discussions are taking place on negotiating in certain circumstances on a national or regional basis rather than leaving the negotiation to individual local authorities. So we would have to take account of that. It might be helpful in some ways, but it does not lend itself straightforwardly and simply to the sort of proposition that the hon. Gentleman was urging on me.

    Equally, there may well be people in homes in which local authorities would not choose to place people, in which case that would not give us the sort of information that is required. Again, it is a complicating factor in the point that has been pressed on me. There is the possibility that some local authorities will negotiate packages of care and contracts that are not directly comparable with the arrangements under income support.

    I mention those points only to show that it is not possible for me simply to say snap to the proposition urged on me at this moment, but that does not detract in any way from my undertaking to seek, in considering how we are to carry out uprating and respond to the concerns that have been expressed from all parts of the House, to use the better practical information that will arise, as the hon. Member for Birkenhead has stressed, from the workings of the new system.

    Will my right hon. Friend also undertake that in that important survey of the information as it becomes available he will include a regular survey of the number of places in residential homes that remain available? At present there is serious danger that the introduction of the new system and the shortfall that we have been discussing will lead to an incomparably rapid closure of very large numbers of homes.

    I am not sure that I accept the latter part of my hon. Friend's suggestion, but I can certainly respond with a clear-cut yes to the first part of what he said.

    My right hon. Friend has been most helpful in outlining a possible solution. Does he have the powers to pay income support to residents on the basis that he has just outlined? If he does not, is he prepared to amend the Social Security Bill to give himself those powers?

    My hon. Friend refers to the basis that I have just outlined. I have indicated some convincing reasons, I think and certainly hope, why the simple proposition that income support limits shall be based on what local authorities pay in particular homes is not one to which I can readily assent in quite that form, for the reasons that I have given. We have extensive powers to set limits. My intention would be to use those powers in a way which made use of the sort of information to which my hon. Friend has referred. If on further reflection in the aftermath of the debate—I shall certainly do some further reflection—I come to the conclusion that there is an additional power that I could sensibly take to assist us in dealing with these problems in the future, I would be prepared to seek the appropriate amendment to the Social Security Bill.

    It is in the nature of the changes on which we are embarked, with widespread agreement on the objectives, that no one can be certain a year ahead of all the circumstances at the time, but I hope that what I have been able to say in explaining to the House why I cannot accept the new clause has shown our readiness not only to acknowledge legitimate concerns but to do everything to meet them, consistent with the aim we all share, which is the best interests of people in these homes.

    10.30 pm

    I am conscious that the House wishes to come to a decision and I shall make my response to the debate brief. We have had a full debate since I initiated it some five hours ago. Many hon. Members have addressed the House. I think that those who have been present throughout would agree that the debate was without party spirit. In my concluding remarks I shall try to address the matter again without party spirit, as I sought to do in my opening remarks.

    Before turning to the Secretary of State's speech, may I say that I was impressed time and again by the way in which so many hon. Members who addressed the question with the open mind came back to the same two difficult questions posed early in the debate by the hon. Member for Maidstone (Miss Widdecombe).

    The first question is, if we say that it is right and proper that there should be a gap between income support payments and the charges levied by residential care homes, who do we say should meet the gap and pay the extra? It cannot be the residents, because they are on income support. By definition they have no means themselves to meet the gap. I noticed that the Secretary of State did not reply to that question which has lingered throughout the debate. I pose it to him again. Who does he imagine will fill the gap if he does not? Is it assumed that it will be the relatives? If so, what is assumed to be a reasonable contribution from relatives, who are themselves frequently pensioners? It is a question to which local authorities would like to know the answer, because from April of next year they will accept the responsibility for new residents. Are they expected to look for a contribution from relatives in the way that we seem to be implying in the Bill?

    The second question that ran through the debate is very simple. Those same local authorities are expected from April of next year to negotiate payments to private residential care homes for the residents who will enter the homes from that date. It is assumed that they will be capable of negotiating presumably reasonable charges which will not result in exploitation of the public purse or unreasonable profits for those running the homes. Although it is assumed that local authorities will be capable of doing that from April of next year, we are told there is no way in which the Department of Social Security can achieve the same in relation to those who are already in private residential care homes. If the Department of Social Security cannot do it, what is to stop the Department using as its local benchmark the figure that local authorities can negotiate, using block contracts? Or are we seriously being asked to accept a position which may exist from April of next year in which the local authority payments may be higher than the income support levels being paid to private residents living in the same residential care homes, and unable to meet a payment which the local authority accepts as reasonable?

    I want to respond to some of the Secretary of State's replies. It would be unreasonable not to begin by saying that he addressed the House with his characteristic urbanity and frankness which I remember. I remind him that a telling speech was made by the hon. Member for Chislehurst (Mr. Sims). He said that it would not be enough to ask us to wait for an uprating in April 1991, which is more than a full year away.

    I have read the submissions from the many voluntary organisations that have written to hon. Members on both sides of the House, and it is clear that by April 1991 thousands of elderly people will have faced' eviction from residential care homes because they cannot afford the fees. The Secretary of State referred to safeguards. What safeguards can he offer to the House? What comfort can he offer to people who face the prospect of eviction within the next 12 months? [HON. MEMBERS: "What would you do?"] I have moved a new clause that is drafted to address the matter. If hon. Members want to do something about it, they should support the new clause.

    The hon. Gentleman would not want to mislead the House. The new clause is directed towards producing something that will happen in April 1991.