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Commons Chamber

Volume 503: debated on Tuesday 12 January 2010

House of Commons

Tuesday 12 January 2010

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Dentistry (Shropshire)

The Department has invested a record £2 billion in dentistry and set up a national access programme to help the national health service deliver its commitment to providing, by 2011, access for all who seek it. It is, of course, the responsibility of Shropshire County primary care trust to plan and develop appropriate services, including dental services, to meet the needs of its resident population.

I thank the Minister for that answer, but I must tell her that my experience of trying to find an NHS dentist in Shrewsbury for myself and my family has been an absolute nightmare. Can she provide me with a list of NHS dentists in Shrewsbury and Atcham that are currently taking on patients, so that I can share that with my constituents?

I am sorry that the hon. Gentleman and his family were troubled with uncomfortable dental pain at some time, but I know that he accessed the advice line and that he was assisted. I would be happy to talk outside the Chamber about any particular points that he wants to make on that. Of course, access to NHS dentistry has grown in Shropshire. Over the past 12 months the number of people who have seen an NHS dentist has risen by more than 11,000. I am aware that the PCT is tendering three new contracts—in Market Drayton, Oswestry and Bridgnorth—which are due to start in April 2010, and a new contract was tendered in 2006 for Shrewsbury as a high-priority area.

Trafficked Women

2. What recent representations the health taskforce on violence against women and girls has received on the role and response of health services in respect of trafficked people. (310017)

The taskforce has heard evidence from many groups representing women and children who are victims of all forms of violence, including trafficking. The taskforce on the health aspects of violence against women and girls, chaired by Sir George Alberti, is currently considering the report and the recommendations of the sub-group on harmful traditional practices and trafficking, which it established for that purpose.

Is the Minister aware that many trafficked women display multiple problems, both physical and mental, and that when they go to accident and emergency units in hospitals, as well as to general practitioners, they are not readily identified as trafficked women, but viewed as victims of violence? Will she therefore consider whether we could improve training for both GPs and hospital staff, so that when they actually meet battered or mentally disturbed women who have been trafficked, they recognise that, rather than seeing them simply as victims of violence?

First, I am sure the whole House congratulates the hon. Gentleman on his work with the all-party group. He has been such a force for good, and not only in our own country: he has often visited other European countries to see what is happening.

I know that Devon black and minority ethnic community development workers engage with vulnerable communities, but the taskforce is such an important one and the questions are so relevant. The training that health care workers receive for meeting difficult situations will be covered in Sir George Alberti’s report, which we expect to be published in early February. A specific training mandate will, I feel, be put in place from those recommendations.

I doubt whether anyone can match the hon. Member for Totnes (Mr. Steen) for the work he has done on this issue, but my limited experience of it prompts me to ask whether the interface that trafficked women have with health services in the voluntary sector can be assisted by overcoming the linguistic barriers, which are part of the problem. In many cases there is a heavy dependence on people who are themselves part of refugee communities to act as translators. Often, they have real difficulties facing the Home Office when addressing their own problems regarding deportation. Will the Minister ask for a coherent interface between key workers and those within the refugee communities in that process, to ease the problems that those women face?

My hon. Friend raises some more excellent points. Those areas are covered by the research and the report’s findings, and we are working across Government with other Ministers, particularly Home Office Ministers, to address that very point.

NHS Funding

Deprivation is accounted for in the NHS funding formula, which reflects both deprived and older populations’ greater need for health care. An additional health inequalities component in the formula directs funding to the places with the worst health outcomes, targeting health inequalities better than ever before.

Can the Secretary of State tell the House whether he has any further plans to try to reduce health inequalities by targeting resources further towards the most deprived areas of the country? Does he agree that the Opposition’s premium pledge is just a sham, because the policy is already being implemented by the Government?

I can say to my hon. Friend that next year County Durham PCT will receive £1,800 per head of population, £200 more than the England average, reflecting the fact that there are higher levels of disease and deprivation in her local community. Obviously that has been a component of the formula since 1999. The Advisory Committee on Resource Allocation in the NHS keeps the matter under review, and it says that the decision is an interim step to give more money to tackle health inequalities. We keep the matter under review, and I can advise my hon. Friend that Professor Marmot will shortly give us his report on further action to tackle health inequalities, which we shall consider in due course.

Surely the purpose of the NHS is simply to treat individuals, wherever they happen to live around the country, with the treatment that they need to deal with their particular problems. Will the Secretary of State confirm that all health spending will be given on that basis, and that basis alone, rather than basing it on the socio-economic environment in which an individual lives?

I am told that there is a general election not too far off. May I respectfully point out to the hon. Gentleman that it might help him to read his party’s draft manifesto from last week, which included the commitment to

“weight public health funding so that extra resources go to the poorest areas”?

He is going to be standing on that manifesto in a few months, so he had better read it—and pretty quickly, I would say.

I can say to the Chairman of the Select Committee on Health that the England average next year will be £1,600 per head of population. Turning the clock back 10 years, we see that it used to be £426 per head of population. That figure demonstrates the change that this country voted for when it elected a Labour Government. The country was saying, “Our NHS needs to be put back on its feet. We need to invest in it to give people in all parts of the country the best possible health care.” In that figure alone we can see the difference that this Labour Government have made.

The Secretary of State will be aware that GP practices in deprived communities lose out financially and that there are 18 per cent. fewer GPs working in poorer communities. He will also be aware that the Health Committee heard evidence of the failure of the incentive scheme for payments to GPs to do anything effective about health inequalities. There is evidence supporting the call for radical action to change the way in which the qualities and outcomes framework works. When will the Government take action to change the current completely unacceptable situation, whereby GPs in richer areas are paid better than those in poorer communities?

Of course we keep such matters under review at all times. However, the funding formula for general practice contains a minimum practice income guarantee, which protects precisely those practices to which the hon. Gentleman referred. I would also point him towards the respected international Commonwealth Fund, which late last year published a comparison of primary care in the 12 most developed countries around the world. It is a source of huge pride to me and to every Member on the Government Front Bench—indeed, to every Member on the Labour Benches—that primary care under this Labour Government is the envy of the world.

Is my right hon. Friend aware that the alternative formula that was put forward in this Chamber three years ago by the hon. Member for South Cambridgeshire (Mr. Lansley) would reduce the funding going to our local NHS in Gloucestershire by £109 for every man, woman and child who lives there? Will my right hon. Friend resist that 9 per cent. cut to our local NHS?

What I would say to my hon. Friend is that we have sat in the House over the past five years of this Parliament and heard every member of the shadow health team criticise the Government for allocating more resources to communities with higher health needs and more deprivation. So when we read what the Opposition’s policy in their draft manifesto is, I do not know how they have the brass neck to sit there today and look as though it was always their policy: it beggars belief. The Opposition need to spell out which PCTs will win and which will lose under the new policy. I suspect that my hon. Friend’s PCT might lose from a policy that gave more money to deprivation, on top of what we give such communities today.

May I just say how much we will miss David Taylor at our Health questions and health debates? He was always here, and always had good insights and real commitment to the national health service. He will be much missed, as he was a good colleague to us all.

Will the Secretary of State confirm that patients should be able to expect equivalent access to treatment from the NHS wherever they are in the country? Will he explain why in his Leigh constituency, the NHS spends over 40 per cent. more on cancer services per cancer patient than it does in my constituency?

I would like to begin by echoing the shadow Health Secretary’s remarks about David Taylor, who was a regular attender at Health questions and health debates; I am sure that his voice will be sorely and genuinely missed by Members on all sides of the House.

The answer to the hon. Gentleman’s question is that my constituency has more deprivation and ill health than his does, and that is picked up in the funding formula. I am amazed that the hon. Gentleman is asking this question when his manifesto of last week said in terms that his party will adopt precisely the same policy—so how can he stand at the Dispatch Box and criticise the fact that my constituency of Leigh, a former mining area, receives more for its greater health needs?

The Secretary of State just doesn’t get it. I was quoting the figures on the amount spent by the NHS in each of those areas per cancer patient—not the overall allocation between the areas, but the amounts spent per cancer patient. Let me give him another example. Perhaps he can explain why, although higher NHS allocations go to more deprived areas, the money is spent on responding to the consequences of ill health rather than on preventing disease, which is the reason why it is allocated. Why is there one hospital bed for every 245 people in the north-east of England, but one bed for every 408 people in South Central?

I am genuinely confused, because for five years, from his side of the Dispatch Box, the hon. Gentleman has accused us of spending too much money in constituencies such as mine. The reason why my area can spend more on cancer is that, historically, smoking has been higher in the constituency. It was the hon. Gentleman’s manifesto of last week that said that the Conservatives would weight public health funding so that more went to deprived areas. So he would give my constituency more money than it gets today—yet every one of the Conservative Front-Bench team has criticised our funding plans. The hon. Gentleman should either accept the situation today and tell us which primary care trusts will get more and which will get less, or realise that his policy will have no credibility whatever.

He still doesn’t get it, does he? Will he explain why the local PCT in his constituency presently spends £39 a head on its management costs but just £31 a head on its healthy individuals programme, which is preventive spend. That is the point; this is about prevention. What is needed is higher public health budgets for the areas with the poorest health: less bureaucracy, more prevention—that is our health premium. Will he not just accept that we need real help to reduce health inequalities through preventive health care—because we can’t go on like this?

It is our policy to allow local PCTs to decide where they spend the money on the areas that they think will have the most impact, whether that be prevention or cancer. For the last five years the hon. Gentleman has accused me of giving too much money to those areas, and now he has completely abandoned that pledge. It would appear that it is not him but his party leader who is now writing his shadow health policy. Let me tell the hon. Gentleman, who sits there and gives out the orders, that he has had his policy on single rooms dropped, and he has had his policy on health resources dropped, so why does he not book himself—

Order. I am extremely grateful to the Secretary of State, and I know that he wants to say something about other parties’ policies, but he must now focus exclusively upon his own.

My right hon. Friend will know that my constituency has had significantly increased funds. None the less, we have very high death rates from heart problems and cancer in low-income wards. How can we manage that situation? What education and community programmes are there to help people in low-income families understand the serious dangers from smoking and poor nutrition?

My hon. Friend is right. We need to give the resources to areas such as hers so that they can spend them on smoking cessation programmes and improving access to primary care. Research has shown that communities of that kind benefit greatly from improved primary care, and also that national targets have played an important role in improving health outcomes in the most deprived communities. I assure my hon. Friend that that will remain a central tenet of this Government’s health policy.

Mental Health

4. What recent assessment he has made of the effectiveness of psychiatric intensive care units in the provision of mental health care. I note that the Minister of State is to answer this question, which will give the Secretary of State a chance to calm down. (310019)

Acute care services, including psychiatric intensive care units, remain an essential component of the Government’s drive to improve and modernise our mental health services. Moreover, as a result of nine consecutive years of increased mental health spending, more people with acute mental health problems are being treated in the community than ever before.

I give the Government full credit for the creation of the psychiatric intensive care unit at Woodhaven hospital in my constituency. That is why I am so concerned about the fact that it has been “temporarily” closed for the last three months. Six patients from the New Forest who are in desperate need of its assistance have been farmed out to Havant and Basingstoke. May I appeal once more to the Minister to intervene to ensure that Ellingham ward at Woodhaven is reopened as soon as possible?

The hon. Gentleman has raised this matter with me before, both at Question Time and during debates in Westminster Hall. Since our debate last October, Hampshire Partnership NHS Foundation Trust and Hampshire primary care trust have established an independent review panel to examine their proposals to change services provided by the psychiatric intensive care unit. An updated report will be sent to the Hampshire health overview and scrutiny committee on 26 January, and the full report will be completed within a month. The independent review will be conducted by a panel of experts, including an independent consultant psychiatrist and an independent director of nursing.

I hope that that reassures the hon. Gentleman that his concerns are being heard, that action is being taken and that an independent review will ensure that we secure the best possible outcome for patients, based on a clinical assessment of their needs.

Cancer Treatment

6. What plans he has to increase the speed of treatment of people presenting to their GPs with symptoms consistent with cancer. (310021)

Over 94 per cent. of patients currently see a cancer specialist within two weeks of urgent referral for suspected cancer by their GP. Of those subsequently diagnosed, 85.7 per cent. commenced treatment within 62 days. We have plans to offer patients in England access to diagnostics that may confirm or exclude cancer within one week.

Can my right hon. Friend confirm that if the Government’s cancer pledge that patients will be referred within a week comes to fruition, it will save 10,000 lives every year? That is very significant, given that cancer is still seen not simply as a major killer but as a major condition, in terms of people’s view of health care in this country. Is there any chance of my right hon. Friend being able to persuade Opposition parties that consensus would be in the national interest?

I can confirm that the aim of reducing to one week the wait that people experience during what is probably the most stressful time of their lives is very much the Government’s policy. The national cancer director has estimated that that would indeed save 10,000 lives every year. As my hon. Friend says, the key challenge is early diagnosis. We must focus, and are focusing, all our efforts on that. I do not believe that some of the policies promoted by others would get us anywhere. In fact, they would return us to the days of a postcode lottery for those important services.

I am well aware that that exchange constituted an attempt to shed light on Conservative policy. Of course the Conservative party wants to see improvements in the provision of cancer services. As the Secretary of State said, there must be a much greater focus on prevention, earlier presentation leading to earlier diagnosis, faster access to innovative drugs and treatments, swifter implementation of survivorship initiatives, and implementation of quality indicators. All those will improve under a future Conservative Government. The key question that the Secretary of State needs to answer is why, despite the Government’s 12 years in office, Britain’s five-year cancer survival rates are still among the worst in Europe.

Without going into all the nonsense and waffle with which the hon. Gentleman began his question, may I just give him his answer? In a letter to me last year, which prefaced the “Cancer Reform Strategy” annual report, the national cancer director said that there had been a further fall in cancer mortality in the last two years for which figures were collected. Overall, therefore, there has been a decrease of 19.3 per cent. among under-75s since 1995-97. In his words:

“We are well on track to achieve the target of a 20 per cent. reduction by 2010.”

The hon. Gentleman did not say that he would remove targets, but he needs to explain how we would achieve such improvements if we were to simply drop all the targets.

GP Surgeries

Some 77 per cent.—three quarters—of GP surgeries in England are open outside normal surgery hours, offering their patients routine appointments. We expect this figure to continue to rise.

I thank my right hon. and learned Friend for that answer. As somebody who, unfortunately, had to make extensive use of GP services over the Christmas recess, including the out-of-hours service at the new Tameside walk-in centre, may I say how massively convenient it is now that my local GP services are operating extended hours? However, what more is being done for patients of GPs who are not yet offering that provision?

My hon. Friend is right to say that we need to do more to ensure that extended hours are offered. We intend to give patients a right to register with a practice of their choice—perhaps one that offers extended hours. Furthermore, neighbouring doctors can apply to be paid for seeing patients of practices that do not offer extended hours. The Government’s extended hours policy has been an increasing success—but of course if the Tories are elected, they will get rid of it.

This is an issue of great concern to my constituents. I note the Minister’s response to the previous question, but is he confident that the full range of GP services, such as pharmacies and access to a nurse, are available during weekend and extended hours in south-east London?

We are increasingly moving towards getting a larger range of services, particularly for GPs. Levels of nursing and pharmacy services vary between practices, but we want to ensure that we increase the number. However, when the hon. Gentleman stands on his party’s manifesto, he will have to recognise that his party would get rid of those requirements: that appears to be its announced policy.

What contribution are the new GP-led health centres making to greater access to GPs? In my own area, a new health centre is being built in Biddulph. It will be the first time that my constituents have had access to out-of-hours GP services in the evenings and at weekends.

The new GP-led health centres are providing a real incentive for practices that up to now have not offered extended hours. They can see that GP-led health centres are there, and that some patients will start to use them unless GPs start to offer the extended hours. GPs can also see that, with £161 million available in the coffers of PCTs, additional funding is available for GP practices that offer extended hours.

NHS (Charitable Funding)

8. What his estimate is of the amount of charitable giving to NHS institutions in the latest period for which information is available. (310023)

In 2008-09, NHS trusts and primary care trusts in England received contributions from all charitable sources totalling £62 million in expenditure and £65 million in fixed assets. The Department does not collect that information for NHS foundation trusts, which report directly to Monitor.

Is the Minister aware that the Burnham-on-Sea memorial hospital extension was funded by its magnificent league of friends, and that that form of local charitable giving would be betrayed if it were regarded as part of the general NHS budget and used by the Government to make offsetting reductions in the funding for the NHS trust concerned? Will the Government give an absolute assurance that such a change, which is being considered, will not happen?

Indeed, as my hon. Friend says, it never has been the case.

Charity trustees will continue to have full responsibility for charitable funds; they are not, and will not be, part of NHS budgets. There is a question about accounting requirements—I think that that is what the right hon. Gentleman was referring to—but that is not a matter of Department of Health jurisdiction. However, I continue to work with the Treasury, Monitor, the Charity Commission and other stakeholders to seek ways of strengthening the independent governance of NHS charities, to ensure that we meet that standard without invoking the requirement for consolidation, and that matter is currently under discussion.

(Liverpool, Wavertree) (Lab): What are the latest figures for charitable giving to the Royal Liverpool Children’s NHS Trust? If my hon. Friend does not have those figures to hand, may I, through him, pass on an invitation from the hospital to our right hon. Friend the Secretary of State? The hospital invites the Secretary of State to visit it so that, on his way to Goodison Park, he can see for himself the tremendous contribution that charitable giving makes to the new hospital that will be built with funds from the £1.2 billion committed by this Government to Merseyside for new hospitals.

My right hon. Friend is absolutely right to say that charitable giving makes a huge difference. Many people who have experience of the national health service want as a result to make a gift or donation to thank it for the support and care it has given them, or a loved one. Many charities work closely with NHS institutions and NHS charities. This is a cause for celebration, and I want to make it clear today how much we value that, and that that independence is absolutely right. There is no question whatever that charitable funds could be used as part of NHS budgets; I want that very important message to go out from the House today.

But the Minister will be aware that this question is causing enormous concern. Why has the confusion been allowed to continue for so long, given that the Charity Commission alerted the Treasury and the Department of Health to the problem in August 2008? The Charity Commission has made it clear that such an arrangement is not necessary or appropriate for charities in the state sector. The accounting rules concerned apply in the private sector. Why can we not rule it out once and for all?

As I hope I have already suggested, we are actively looking into the dilemma that the hon. Gentleman describes, and I hope that he and all other Members of this House, as well as charities and the NHS, will join me in ensuring that we do not spread confusion and mislead people about the consequences of looking at those accounting standards. Let us be absolutely clear: we very much welcome people making contributions through charities to support those receiving health services. The role of NHS charities is crucial. Only one in 10 NHS charities are even affected by this possible accountancy change. It makes no difference to the NHS; it is not part of the NHS. I would hope that the hon. Gentleman would join me in ensuring that we put the record straight, and do not mislead or misguide people and deter them in any way from making such contributions.

My local hospital—the wonderful Chorley hospital—is part of the Lancashire Teaching Hospitals NHS Foundation Trust. Why can we not ask for information, but our question has to go to Monitor instead? Surely, as a Member of Parliament, I should have the same rights as other MPs in being able to ask questions for Ministers to answer. Does the Minister not agree?

My view is that Members of Parliament can ask Monitor for information, and can receive that information. I think that is entirely appropriate, and I would encourage Members who have questions they want to ask of Monitor to put them with the usual vigour with which they put question to Ministers here at the Dispatch Box.

Despite the answers that the Minister has just given—this is of particular relevance to those of us who are trustees of charities and are finding that this problem is exercising us a lot in respect of our various fiduciary duties—the Government are still allowing there to be a risk of charitable donations being subsumed into hospital accounts. When people give to charity, they expect that money to be for extra things, rather than for those that are part of the established costs in the NHS budget. Will the Minister give an absolute guarantee that under the Treasury’s new rules there will be no danger whatever of money given to charity being counted as part of the NHS budget, and that there will be no resultant offsetting?

The short answer is yes. The long answer is that NHS charities are not part of the NHS, have never been part of the NHS and, under this Government, never will be part of the NHS. They are independent bodies, governed by an independent regulator, doing fantastic work in providing fantastic services. I hope that the hon. Gentleman—and the hon. Member for North Norfolk (Norman Lamb), who speaks for the Liberal Democrats—will stop putting out misleading information, and instead will reinforce the fact that NHS charities remain independent.

GP Telephone Numbers

9. What recent guidance his Department has issued to GP practices on their use of 0844 telephone number systems; and if he will make a statement. (310024)

The Department issued guidance and directions to the NHS in England on 21 December, just before Christmas, that patients should not be expected to pay more than the cost of a local call to contact the NHS, including doctors’ surgeries. GPs will have this year to end the practice completely and get out of any contracts that cause that to happen.

I thank the Minister for that response, but he will be aware that the practice is continuing. He says that it must end this year, but there is an awful lot of this year left, so when does he expect the practice to end? Not only does it make it expensive for people to call their local general practitioner, but older people in particular often prefer a human being to answer the phone, rather than be responded to by a machine.

I agree that we need to ensure that this practice of some GPs charging more than a local rate for contact ends as quickly as possible. We have made it absolutely clear to GPs that they must get out of these contracts—a number of practices have signed up to and are legally bound by them—and they have the year to do so. We have engaged with some of the companies involved and, to be fair to them, they have said they are prepared to negotiate equitable arrangements with the GPs to see whether we can get them all out of this as soon as possible. They have all got to be out by 21 December, but we want them to be out now, or as soon as they possibly can be.

This situation is not just in the hands of GPs; the provider that the patient is using is also ripping them off. For instance, when someone phones a GP’s surgery on an 0845 number from a call box, the charges will be over the top, and people will still be charged even on the new 0300 numbers. Will the Minister examine why these patients are still being ripped off by their providers, as well as by GPs?

Our objective is to ensure that anyone trying to contact the NHS locally pays a local rate, and we need to ensure that such practice is adopted. If the hon. Gentleman has evidence to suggest that particular issues are arising, I would be happy to discuss them with him.

Alternative Medicine

10. When he expects to publish his proposals for the regulation of practitioners of acupuncture, herbal medicine and traditional Chinese medicine, following his Department’s consultation on the matter; and if he will make a statement. (310025)

More than 6,000 responses to the consultation, which closed on 16 November, have been received and are being analysed. Our response will be published as soon as possible.

This has been going on since 2004, so surely the Department can give us a date. Is the Minister aware that the Northern college of traditional Chinese medicine, which is in its 21st year, has had its university accreditation withdrawn by the university of Central Lancashire because there is no statutory regulation of this sphere? That is the fault of Ministers and something needs to be done—they need to get on with it.

I understand the hon. Gentleman’s frustration with the amount of time that has been taken, but I know that he also understands that any regulation would need to be balanced and proportionate. These are complex issues and we want to get this right. I assure the House that Ministers are keen to see publication as soon as possible.

Purley Hospital

Croydon primary care trust and the Mayday Healthcare NHS Trust are firmly committed to the redevelopment of Purley hospital. It is for those organisations to determine a timetable, and both have assured me that they will seek to keep the hon. Gentleman informed of the progress. I understand that he had recent meetings with at least one of them.

I would have thought that the Minister would include a degree of humility and an apology in his answer. It is eight years since his predecessor stood at that Dispatch Box promising a new hospital in Purley. We are in desperate need of services in the south of our borough, so will he please give orders straight away to get on with this development and do so in such a way as to ensure that if there is a change of Government in a few months’ time, the orders will stand and the development will still go ahead?

I am not surprised that the hon. Gentleman is anxious to avoid there being a change of Government, because we know that the new announced policy of his party may well mean that he will not get his hospital—I understand his concern.

I shall now deal with the specific point about Purley hospital. As the hon. Gentleman knows, it was to be developed by a private sector company called Translloyd, but as it was unable to get a retail developer on to the site, the original plan was declared to be no longer feasible. Translloyd still owns the site and Croydon council is trying to find ways to release it for development. As he knows, the problems arose in 2008.

NHS Funding

12. To what extent levels of deprivation in local communities are taken into account by his Department in determining NHS resource allocations. (310027)

As my right hon. Friend the Secretary of State has said, deprivation is a key feature of the NHS funding formula, which reflects both deprived and older people’s needs in health care. We are clear that we want to ensure that that remains part of the formula.

I am grateful to my right hon. and learned Friend for that answer. I wanted to ask him further about the deprivation experienced by pensioners in the community in view of the very tragic deaths of two of my constituents, Derek and Jean Randall, in quite appalling circumstances. In view of my lack of confidence in some of our local arrangements, will he ensure that his Department has very careful national oversight of the local review of the case that is going to take place? Will he ensure that any lessons that can be learned that apply nationally are rolled out and applied nationally to ensure that no one else has to endure something like this? It is completely inappropriate in 21st century Britain that pensioners should experience such ordeals and should die such very tragic deaths.

My hon. Friend is right. The case of Derek and Jean Randall is deeply tragic and we need to ensure that it is fully and properly investigated. I understand that a local multi-agency safeguarding board is undertaking a serious case review. I cannot comment until all the details are available—I have only read the front page of the Daily Mail today, and it certainly seems a very worrying case. I want to ensure that this is fully investigated and that the results of the investigation are open. We will take a keen interest in the outcome and we want to ensure that any lessons that need to be learned are learned and that this sort of thing does not happen in the future.

Will the Minister tell the House whether the level of deprivation featured in the decision of the Department of Health to end the reciprocal health agreement with the Government of the Isle of Man? That agreement, which has been in place since 1948, is to be ended on 1 April this year. This is a very serious matter. May I have an answer?

My right hon. Friend the Secretary of State will be meeting the Manx Minister in due course. We are not minded to change our policy on this. We take the view that our approach is the right one, and we will see what the outcomes are of the discussions with the Isle of Man.


13. If he will bring forward proposals to protect small pharmacy businesses from the effects of in-house pharmacies opening in supermarkets. (310028)

Independent pharmacies play an important and valuable role in providing pharmaceutical services. The NHS pharmaceutical services regulations treat all providers equally and there are no plans to change this.

After a powerful campaign by the local community in my constituency, we were able to keep open Mr. Mistry’s pharmacy, a local community pharmacy in my constituency, and Tesco withdrew its application to have an in-house pharmacy nearby. That is a good outcome for everyone in the community, but will the Department pull together some of the big supermarkets and the representatives of the pharmacy associations to discuss a sensible way forward so that such battles do not take place and local communities keep effective pharmacy services?

Pharmacists such as Mr. Mistry and many others up and down the country provide an excellent service to their local community, and my hon. Friend is quite right to campaign for a vibrant and diverse range of pharmacies. The truth is that the public value and use a range of provisions from supermarkets through to local pharmacies. Perhaps we can look to the provisions of the Health Act 2009, which will mean that the local NHS will be able to assess local needs and to meet them.

Does the Minister accept that there is a particular problem in rural areas, where the predatory practices of supermarkets might lead to the closure of pharmacies, depriving large geographical areas that are thinly populated? Will she take some steps specifically in that case?

The provisions of the Health Act will mean that the local NHS will be able to assess local needs, to fill the gaps and to monitor quality better. This is all about being driven more by the needs of the patient, whether they are in rural or urban areas, than by those of the provider of the services, as is the case at present. It is important to say that the supermarket sector provides some 5 per cent. of the market, whereas the larger contractors—such as Boots, the Co-op and Lloyds pharmacy—provide something like one third. There is no evidence that supermarkets are driving the smaller operator out of business.

Ambulance Turnaround Times

14. What his most recent assessment is of the performance of NHS ambulance trusts regarding ambulance turnaround times; and if he will make a statement. (310029)

Information on ambulance turnaround times is not collected by the Department, so in a sense we do not have that information. There is quite a wide range of data in relation to how long people get for lunchtimes and so on. We do, of course, keep response times and that sort of data.

Does the Minister agree with Unison that the new eight-minute target for ambulance response times could put patient lives at risk by forcing ambulance crews to go from two to one? Would it not be better to find a bottom-up solution and force ambulance trusts to publish their data on websites so that the public could see individual ambulance response times?

We certainly take the view that improving the response times of ambulances is very important. That is why the new response times have been put in—to take away the period of time for the call, which was one of the issues causing delays. In the past, the clock did not start ticking until after the call was put through, whereas we now include the time from the point at which the call is made. That is a better reflection of the standard of service that patients get. As for publishing every ambulance time, I think that might be somewhat bureaucratic, but information can now be provided in general terms about average ambulance times.

Topical Questions

Today, Sir Michael Parkinson has published his report on his year as the national dignity ambassador. I thank him on behalf of the Government for the time that he has given to raising awareness of the issues that affect us all and for the personal insight that he has brought to considering how we can improve care for older people. The fact that there are now 12,000 dignity champions working at a local level illustrates the difference that Sir Michael has made, and we will look to build on that.

As the cold weather continues, staff across the NHS, particularly ambulance services and accident and emergency staff, have been working extremely hard to minimise the impact on patients. Although it is under greater pressure, I can tell the House that the NHS in all parts of the country is coping well. I am sure that Members on both sides of the House will want to join me in thanking health and social care staff for their efforts to help to protect vulnerable people at this time.

I certainly endorse the last part of the Secretary of State’s comments. May I bring to his attention the rather long waiting list that people who suffer from acute back pain have to go through before they see a consultant? As a long-standing and regular sufferer myself, I know that it is no laughing matter. The waiting time is such that if the problem is serious, it can progress a great deal in that time. If it is a less serious problem, it will no doubt have corrected itself in that time. Whichever situation applies, the waiting time is far too long. Can the Government do anything about that?

The hon. Gentleman is right to say that back pain creates many problems, not just for the people involved but for the economy in general. That is why we now have a system of self-referral to a physiotherapist. I believe that all patients should have that right. We will also be looking at the development in the chief medical officer’s recent report on pain clinics and how chronic pain is managed, including how chronic and acute back problems can be managed.

T4. In 1997, there were 284,000 people waiting more than six months for NHS treatment. What is the figure today, and what are the Government doing to prevent the situation from sliding back to the bad old days when the Conservatives were in power? (310045)

My hon. Friend is quite right: we must prevent a drift back to the bad old days. In his area, Yorkshire and Humberside, in 1997, there were 26,719 people waiting more than 26 weeks. In November—these are the latest figures I have—the number was zero, so nobody was waiting. Whereas we will lock in that achievement as a right, the Conservative party would remove the guarantee. The Conservatives will have to explain to the public why they would do that.

T2. This morning, I faxed to the Public Health Minister’s office some documents provided to me by the investigative journalist Jane Symons. Those documents show that the Human Fertilisation and Embryology Authority has not only spent millions of pounds pursuing, ultimately failingly, an individual clinician, but that the new chief executive who was brought in to sort out the problem had argued for an externally led inquiry last year. Why has that inquiry not happened? Does the Minister have any proposals to ensure that we know why millions of pounds of taxpayers’ money was wasted in that way? (310042)

I am grateful to the hon. Gentleman for his courtesy in forwarding the documents, but I remain of the view that it would not be in the public interest to pursue an inquiry. There have been a number of significant changes at the authority since the time of the incidents covered in the memo, which I would be happy to write to him about. However, the interim chief executive has acknowledged that the authority is not free from criticism, and there is to be an internal governance review to consider all these issues.

T5. Given the very harsh winter that we are suffering at present, I have no doubt that my right hon. and learned Friend the Minister of State will recall the annual winter crises that we used to have more than a decade ago. People—mainly elderly people—were lying on trolleys in our hospitals for days before they died, after which their bodies were stuffed in refrigerated vans outside. What can he do to assure me that those crises will never return to this country, and how do we manage to cure that problem? (310046)

Elderly people are of course now able to benefit from flu jabs, winter fuel payments, pension credits and, when it gets very cold, cold weather payments. In 1997, the NHS spent £426 per person on health, but today it spends £1,612. Whereas the Tories were frozen in the ice of their own indifference to older people, this Government actually care.

T3. Will the Minister match the very helpful answer that I had from the Minister of State at the Department for Transport on Thursday about how that Department and the Department of Health have been working closely together to provide the preventive medicine of road gritting, so that hospitals receive fewer people with fractures? In Croydon’s Mayday hospital, fractures are currently up 40 per cent., but at the beginning of the crisis they were up 316 per cent. (310044)

It is certainly the case that we need to ensure that the NHS works with local authorities to make sure that ambulances can get through, that ambulance crews can get to their ambulances, and also that the service is geared up to deal with the various problems arising from the recent very bad weather. We need to make sure that the various bodies work together, and the information that we have so far suggests that they are doing so.

T9. The Autism Act 2009 was a great success for Back Benchers across the House, in co-operation with a caring and receptive Government. It calls for the autism strategy for helping adults with autism and Asperger’s syndrome to be published. Will my hon. Friend the Minister of State make sure that it is published before we are diverted by other matters a little later in the year? (310050)

I am grateful to my hon. Friend for his comments. The 2009 Act was a landmark piece of legislation, which was passed on a cross-party basis. I can reassure him that the autism strategy is due to be published before 1 April this year. Discussions on the strategy are going on as we speak. Indeed, the external reference group that has been advising us on it—and which involves service users, family carers, voluntary organisations, professionals and so on—met only today to consider its contents. The strategy will be backed up by a clear delivery plan, and further guidance for health and social care providers later this year. So yes, the Government are going to deliver on autism.

T6. What does the Secretary of State consider will be the most effective way to reduce binge drinking in the young? (310047)

I recognise that the public mood is changing when it comes to alcohol—not just binge drinking, but the general intake of alcohol by the wider population. There is rising public concern, as reflected in last week’s report from the Health Committee. The hon. Gentleman will remember the report on obesity that was published when I used to serve on the Committee with him. That report changed the nature of the debate, and it is possible that last week’s report will come to do the same. We are looking at the next steps on tackling alcohol, and considering the consultation on the mandatory code and the measures to combat the irresponsible promotion of alcohol. We are also considering going further on labelling, but of course I remain open to further discussions with him and the Committee on how we may go even further.

Order. I want to get several more colleagues in, so I need very short questions and short answers.

I thank the Secretary of State for agreeing to meet the Chief Minister of the Isle of Man about the future of the reciprocal health agreement. Will he get his officials to look particularly at the impact that that decision could have on his and my constituents who are TT enthusiasts—motorcyclists—and the impact that it would have on NHS North West if the Isle of Man took its elective surgery purchases away from there to Edinburgh, Belfast or Dublin?

As the Minister of State, my right hon. and learned Friend the Member for North Warwickshire (Mr. O'Brien), mentioned a moment ago, I have agreed to meet the Manx Health Minister to discuss these issues. As a north-west MP, I know that the island has a long-standing relationship with the north-west of England and its health service, and I will commission the work that my hon. Friend mentions on the potential effect of purchasing being switched. I am not minded at present to change our position but I will, of course, listen to what the Minister has to say.

T7. I thank the Minister of State, the right hon. and learned Member for North Warwickshire (Mr. O'Brien), for his support for the Better Healthcare Closer to Home project so far. Is the Department on track to complete the review of the project by the end of this month, and is the Treasury ready to pick up the baton immediately afterwards? (310048)

We want to move the project on as fast as we reasonably can, and we hope to be able to get things sorted through by the end of the month. Let us remember that there are some local decisions to be made over which we do not have entire control, but the objective is to get the project moving.

Has my right hon. and learned Friend received any recent requests from the Ministry of Justice for up-to-date estimates of the increase in the number of secondary pleural plaques in order to enable it to come to a decision on a compensation package?

My hon. Friend has indicated that she wants to ensure that we are working with the Ministry of Justice on the matter. I assure her that we will be in regular contact in future with the Ministry of Justice to develop the Government’s strategy as a whole in relation to pleural plaques.

T8. I strongly endorse the question asked by my hon. Friend the Member for Carshalton and Wallington (Tom Brake), but may I ask the Minister about another matter, which is related to autism, which has been raised already? Eight out of 10 GPs confirm that they feel they need more training so that they can better understand autism and care for the condition better. What will the Government do to ensure that there are sufficient resources, will and determination to deliver that extra training? (310049)

The consultations that we have had and the development of the strategy, which we will publish shortly, have made clear the importance of the GP understanding, knowing, diagnosing and being able to refer on appropriately individuals who may have any condition on the autism spectrum. An important part of the strategy that we wish to pursue is the training of professionals—not only GPs, although they are a key and vital part of the front-line services. Training of professionals and raising awareness among professionals of what autism is, how to respond to it and what services are available is a critical part of the strategy going forward.

At the last Health questions, I raised the issue of lab technicians who make dentures and crowns for dentists, and I thank my hon. Friend the Under-Secretary of State for agreeing to meet me and my constituent, Andrew Taylor, this afternoon. In advance of that meeting, can she confirm what her Department is doing to encourage UK dentists to use UK lab technicians?

I look forward to meeting my hon. Friend in the next half-hour to discuss that in more detail with officials.

It is estimated that there are more than 20,000 men and women in this country who are HIV-positive, and who have not been tested or diagnosed and therefore do not know that they are HIV-positive. Does my hon. Friend agree that the Department should aim to reduce that figure by at least 50 per cent.? What action is the Department taking to achieve that objective?

Obviously, early identification is crucial. We have talked at some length with the all-party group on AIDS about measures that we can take, and I am happy to continue those conversations.

I have a young mum in my constituency dying of breast cancer and desperate to prolong her life, with two young daughters who rely on her. She has been prescribed Herceptin. It is not working because of the size of the molecules. She is told by her specialist that Lapatinib would work for her. It costs less than two thirds of the cost of Herceptin, yet she is being denied it. I wrote to the Secretary of State on 19 November and I have chased him twice since, but I have still not had a reply. Will he please look at the matter urgently?

I have indeed been looking into the issue of Herceptin, and I am aware of the way in which the National Institute for Health and Clinical Excellence has approached it. These are important and difficult issues, and I can assure the hon. Gentleman that, if he has an outstanding letter on this matter, I will chase it up with my officials.

I was listening to what the Minister said about ambulance response times. They are of course important, but more important are patient outcomes—whether a patient lives or dies and what actually happens to them. What progress is the Department making on ways of measuring patient outcomes so that ambulance trusts can be more sophisticated in the way they deploy their resources?

I have heard the term “outcomes” being bandied about, but it is not always entirely clear what the Opposition mean by it; they seem to have different views of what it means at different times. As far as the Government are concerned, the important thing is that we ensure that the ambulance service is there when patients need it, that its response times are within the criteria that we have set for it, and that targets are met. The Opposition would get rid of the targets that save lives; we would keep them.

Was the threat of 65,000 British swine flu deaths an unscientific exaggeration that has cost the country dearly, not only financially but in terms of stress and distorted NHS priorities?

We had to take every possible step to keep the country safe through what was declared a world health pandemic, not by this Government but by the World Health Organisation. We saw the events in Mexico in the spring, followed by the exceptional spike in flu cases in this country in the summer. There were understandably high levels of public concern, and I make no apology for making all the necessary preparations to keep the public safe through that. We have come through the pandemic because of the strength of the plans and preparations that this Government put in place.

Does the Secretary of State agree that, to allow waiting times for cancer treatment to be monitored, specific data should be collected individually for each of the most common cancers, so that a better picture can be seen? I was not sure from his previous answer.

I refer the hon. Gentleman to the report issued by the national cancer director at the end of last year. He will see in it the publication of data, primary care trust by primary care trust, that have not been published in this form before. The report shows how many patients are being referred on the two-week urgent referral pathway, and there is a whole wealth of data on survival rates. I am always prepared to go further, however. The complaint from the Opposition is always that we collect too much data, but if the hon. Gentleman wants me to go further, I am prepared to consider doing so.

On Saturday, I met the Plymouth and South Devon Dystonia Support Group, which was celebrating its first anniversary. Will the appropriate Minister please meet me to discuss research and development, and treatment and support for that group of sufferers?

The Minister of State, Department of Health, the right hon. and learned Member for North Warwickshire (Mr. O’Brien), made a welcome announcement over the Christmas break about payments to the Thalidomide Trust. Did I miss the statement to the House confirming that announcement? The news was very welcome, but I would just like to know whether it is now on the record.

The Secretary of State knows that I have raised concerns about the awarding of the contract for the Eccleshill independent sector treatment centre in Bradford. He will now be aware that the decision to award that contract has been suspended for another five months. I have said that it should not go ahead in the light of the concerns, and that there should be a public consultation. Can he tell me why that decision was made, and whether we will now get that consultation?

We are still looking at that matter and I hope that I will be able to give the hon. Gentleman a fuller answer on the details in due course.

Earlier, the Secretary of State referred to the Health Committee’s report on alcohol, and said that he was open-minded about it. Does that mean that the Government are prepared to consider minimum pricing for a unit of alcohol?

I suggest that the hon. Gentleman look at this Government’s record on tackling tobacco over the past decade. That shows that we will continue to take the bold steps necessary to improve the health of the nation. I have said that we will do more on labelling, and on our mandatory code. Pricing is of course a key issue in this debate. I do not know whether he has concluded that minimum unit pricing is now essential, but we must also consider the issues of deep discounting and selling below cost price, which also form part of the equation. This is a time not for shouting across the Floor of the House but for both parties to address the issues and to ask whether the public mood has changed and whether we need to take a different approach to alcohol in our communities.

The Royal British Legion says that little effective progress has been made on the veterans’ NHS priority treatment scheme. What steps is the Minister taking to ensure that PCTs and hospitals monitor progress on this and that veterans get the care to which they are entitled?

Yesterday I was able to make an announcement, together with Combat Stress, one of the veterans’ organisations, to ensure that we deal in particular with some of the issues that arise as a result of people being involved in combat. We also want to ensure that GPs are more fully aware of the rights of veterans. We have asked that all PCTs ensure that they have somebody at a director level who is responsible for ensuring that this information gets out, and that strategic health authorities have someone in place at a director level—on the board—who is responsible for ensuring that this sort of information gets out and that veterans, who have served their country, get the service from the NHS that they deserve.

Point of Order

On a point of order, Mr. Speaker. While you are in the Chair before the House goes into Committee, I wanted to ask for your guidance. The Minister of State, Department of Health, the hon. Member for Corby (Phil Hope), has written to my hon. Friend the shadow Secretary of State for Health stating that the costings in the published impact assessment on the Personal Care at Home Bill, which we are about to consider, are wrong. On 5 January, he told me in a parliamentary answer:

“A one-off transition cost of £335 million is set out in the impact assessment”.—[Official Report, 5 January 2010; Vol. 503, c. 277W.]

On 8 January, he told my hon. Friend that, strictly speaking, the one-off cost should be zero. Could you guide me, and indeed the rest of us, Mr. Speaker, as to whether it is acceptable under our rules for the House to be considering a measure today, particularly on the Floor of the House, when it does not have the full information before it, and despite the Government’s having had adequate notice to correct their errors and to ensure that they furnished us with the information in advance of the debate?

I am grateful to the hon. Gentleman for his point of order. I do not know whether a Minister present wishes to say anything; he or she is under no obligation to do so. The hon. Gentleman has registered his point very forcefully on the record. However, I hope that he will understand when I say that on the strength of his 12 and a half years’ service as the hon. Member for Eddisbury, he knows that that is a perfectly legitimate point of debate but it is questionable whether it constitutes a point of order.

Bill Presented

Sustainable Energy (Local Action) bill

Presentation and First Reading (Standing Order No. 57)

Alan Simpson, supported by Mr. John Gummer, Mr. Gordon Prentice, Andrew Stunell, Mr. David Amess, Mr. Andrew Dismore, David Howarth, Mark Durkan, Andrew George, Mr. David Drew, Bob Russell and Steve Webb, presented a Bill to promote energy efficiency; to require specified bodies to publish sustainable energy plans; to make provision for the transfer of functions to principal councils; and for connected purposes.

Bill read the First time; to be read a Second time on 30 April, and to be printed (Bill 46).

I apologise to the hon. Member for Eddisbury (Mr. O’Brien) for extending his service in the House by two years. He has been here for 10 and a half years; I will not say that it feels like 12 and a half.

Video Recordings (Exemption from Classification)

Motion for leave to introduce a Bill (Standing Order No. 23)

Mr. Andrew Dismore (Hendon) (Lab): I beg to move,

That leave be given to introduce a Bill to extend the criteria under which music and sports video works and documentaries lose their exemption from classification.

Although we passed—or perhaps I should say re-passed—the Video Recordings Bill last week, for technical reasons of urgency it was not practical to propose amendments at that stage. However, some small but highly significant amendments are needed to ensure a more robust regime for child protection. As chair of the Joint Committee on Human Rights, I am an ardent supporter of the right to free speech and expression, but I acknowledge the need for a system of regulation that protects children from harmful content in film, videos and DVDs.

At the current time, we have a very effective system of classification. The British Board of Film Classification undertakes extensive research into public opinion about what is acceptable content. The BBFC also takes account of research evidence and the advice of psychologists, health care professionals and the police, among others, to produce guidelines, which are updated every four years, that ensure that the content that reaches children in the UK legally in the form of film, DVDs and videos is of an age-appropriate nature and is not harmful to them.

However, there are gaps in the current regime covering videos and DVDs under the Video Recordings Act 1984—the VRA—and that is what my Bill aims to address. The VRA permits a number of exemptions to the classification regime. Currently they relate not only to video games but to other video works such as music and sports videos. When the Act was passed in 1984, the assumption was that such works were unlikely to cause any concern. My right hon. Friend the Secretary of State for Culture, Media and Sport has recognised that the regime for video games needs to be updated, and the Digital Economy Bill, currently in the other place, is intended to do that. As an aside, it is important to note that in doing so it should in no way undermine the classification regime for linear—non-interactive—material by confusing the responsibilities of the BBFC and those of the Video Standards Council, which is intended to be the statutory authority for classifying video games.

Except in relation to video games, exemptions are unfortunately not addressed in the Digital Economy Bill. That is a missed opportunity and the reason I have chosen to bring forward my Bill, which would extend the criteria under section 2 of the VRA to result in specified video works losing exemption from classification. At present, exemption can be claimed for video works such as music and sports videos, which can be very popular with children. Those videos can then be sold to children perfectly legally, even if they contain material that is potentially harmful. My Bill is not intended to extend the VRA to all such exempted works, only to those that contain content that is potentially harmful, such as graphic violence, sexual content falling short of actual sexual activity, imitable dangerous behaviour and drug use. Harmless video works of football matches or artists from the “The X Factor” would remain exempt.

I have seen some of the less benign sport and music videos myself. For example, the Ultimate Fighting Championship’s “UFC Best of 2007” is a combat video featuring martial arts and other fighting techniques. It is available on the high street to any child because its distributor has, quite legally, claimed exemption from BBFC classification under the VRA. It therefore carries no age rating or consumer advice. It contains close-up images of bloody and sustained head blows, which are replayed in slow motion from every conceivable angle to ensure that the best possible view is given of the moments of impact.

Another work that I have seen is Mötley Crüe’s “Greatest Video Hits”, which features topless lap dancing and a George W. Bush lookalike in a limousine with a prostitute. The packaging carries an E for exempt rating. Gorgoroth’s “Ad Majorem Sathanas Gloriam” features bloody bodies being crucified and a sheep’s head on a spike. The American band Slipknot is hugely popular with children, some as young as 10, as well as with teenagers. As expected from the band’s reputation, its 10th anniversary DVD features strong content designed to offend parents. Among the most concerning images are those of the consequences of self-mutilation carried out by two teenage girls who have carved the name “Slipknot” into their arm and torso respectively, yet the video carries a letter E in a green triangle indicating that it is exempt from VRA classification.

Those are all works that parents could and should legitimately expect to be regulated, yet under the current legislation they can all be sold legally without any age restriction. Indeed, it is worth noting that some of that material is rated and age-restricted in other countries. For example, the German film classification body rated the Slipknot DVD as suitable only for those aged 16 and above and the Gorgoroth DVD as suitable only for adults.

Trading standards officers would welcome the power to prosecute the supply of such unclassified works, but believe that the current legislation exempts them because, for example, they do not contain gross violence, which is a very high threshold, or actual sexual activity. Local Authorities Co-ordinators of Regulatory Services, which represents local authorities on this matter, and the BBFC both support my Bill’s minor amendments to section 2 of the VRA in order to broaden the criteria that determine when a video work loses its exemption. Such amendments would enable law enforcement agencies to prosecute the supply of video works that are currently exempted, to protect children from potentially harmful media content.

I understand that the Government believe that the enforcement authorities can already take such action. However, the view of those who actually have that responsibility is that they cannot, because of the very high bar set by the VRA in order to lose an exemption. For example, had the Slipknot DVD shown the two girls actually in the process of mutilating themselves with a sharp blade, that may well have constituted gross violence under the VRA, but showing the scars after the event almost certainly does not constitute violence sufficient to lose exemption from classification.

Many responsible members of the home entertainment industry voluntarily seek classification certificates for exempted video works that contain such potentially harmful material. Members of the British Video Association—the BVA—do so even though they are not legally obliged so to do. Their actions in this regard are to be commended. I understand that BVA members support amendments to the Video Recordings Act that would make it a legal obligation on distributors to have potentially harmful material classified, as proposed in my Bill, but there are distributors who do not take the same responsible attitude. That lack of a level playing field serves only to add to consumer confusion.

A parent looking through a shelf of music or fighting videos, some of which are rated 15 or 18, but some of which are marked E for exempt, is likely reasonably to draw the conclusion that the E video is suitable for younger children. Otherwise, the parents would assume, surely it would have been classified. Yet often, the content of E for exempt videos is virtually identical to or worse than that of an age-restricted product. I would therefore like to urge my hon. Friend the Minister to support this Bill.

To conclude, this Bill is aimed at modernising the VRA and improving consumer—and most particularly—parental empowerment, to protect their vulnerable children from harmful video material. I commend this Bill to the House.

Question put and agreed to.


That Mr. Andrew Dismore, Mike Gapes, Rob Marris, Mr. Virendra Sharma, Mr. Edward Timpson, John Austin, Ms Karen Buck, Clive Efford, Mr. John Whittingdale, Judy Mallaber and Keith Vaz present the Bill.

Mr. Andrew Dismore accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 26 February and to be printed (Bill 45).

Personal Care at Home Bill

[Relevant documents: The uncorrected transcripts of oral evidence taken before the Health Committee on 3 December 2009 and 7 January 2010, on Social care, HC 22-iii and iv.]

Considered in Committee

[Sir Alan Haselhurst in the Chair]

In view of the selection of amendments to clause 1—the only substantive clause—I am not minded to allow a debate on clause stand part. That is open to reconsideration if there is any great gap in the discussion. I have tried to select a wide range of amendments and I hope that that will enable all the main issues to be debated.

Clause 1

Free provision of personal care at home

I beg to move amendment 9, page 1, line 7, leave out from ‘in’ to end of line 8 and insert—

‘(i) extra care housing;

(ii) sheltered accommodation;

(iii) warden controlled accommodation;

(iv) care home without nursing;

(v) care home with nursing.’.

With this it will be convenient to discuss amendment 10, page 1, line 8, at end insert—

‘(2A) After subsection (4) insert—

“(4A) In subsection (4) “care home”—

(a) in relation to England and Wales, has the same meaning as in the Care Standards Act 2000 (c. 14), and

(b) in relation to Northern Ireland, means a residential care home as defined by Article 10 of the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 (S.I. 2003/431 (N.I. 9)) or a nursing home as defined by Article 11 of that Order.”’.

The background to this Bill is the fact that social care provision is currently means and needs-tested. The needs test places an individual in one of four categories—critical, substantial, moderate or low. The mean test assesses assets. If someone has more than £23,000, including property, they are liable for the full cost of their care. Those who have more than £14,000 are liable for some of the cost. After the assessment of needs, and if someone is below the means threshold, the council will agree a care plan with them. For those in the critical or substantial groups, that may include entry to residential care; otherwise, care will be provided in the domestic setting. Free personal care will be targeted at critical needs only through regulations to be passed on the back of this Bill.

I hope that that was a useful scene-setter, because we should be under no illusion about what is happening in the Chamber today. The Secretary of State has said, in relation to this group of amendments and the Bill—it is effectively a one-clause Bill, because its substantive operation is in only one clause—that he wants to make social care one of the top three election messages. He did not say “priorities”; he used the word “messages”.

The Prime Minister announced the policy under discussion in his address to the Labour party conference, where it was cleared with only 20 minutes to spare. The policy goes utterly against the grain of the Government’s Green Paper on social care, not least because it is being funded from general taxation. The impact assessment on costings covers only two and a half years, because the Government know that the expense will sky-rocket after that. It is perhaps some small consolation that the Government are behaving like a Government who may not be in office in the next Parliament.

Nothing attests to the politics of the measure more than the fact that we are discussing it in a Committee of the whole House—a procedure normally limited to excessively controversial legislation, particularly legislation that is in free-vote territory. The Government are rushing the Bill through to prevent the fullest possible scrutiny. We will do our utmost to get through all the groups of amendments today, but I fear that that will be at the expense of the necessary wider scrutiny of the underlying issues of the policy behind the Bill. Another small consolation is that the fiercest attacks—certainly if the record to date is correct—will come from the Government’s own side when the Bill continues its pell-mell progress in the other place.

The Secretary of State has said that he wants to create an “unstoppable momentum” for reform of social care. This piecemeal measure, which affects around 270,000 people—not even 5 per cent. of social care users—has already put a spanner in the works of the Green Paper process, preventing the full publication of the costings, so Ministers claim. Making the Bill work will put a spanner in the whole process of reform which, I fear, is the social care legacy the Secretary of State is aiming to leave. That comes on top of the point of order that I just raised with Mr. Speaker, prior to you, Sir Alan, taking the Chair for the Committee of the whole House. The impact assessment was prepared in a way that has not stood the test of time—even in the weeks since the publication of the Bill.

Amendment 9 would prevent care from being provided free of charge for more than six weeks to someone in any of the named institutions. It is deliberately a probing amendment, so that we can get to the bottom of the matter in the glare of the fullest scrutiny on the Floor of the House. I confess that we have had only smoke and mirrors from the Government on the matter.

Amendment 10 simply defines a care home. The Northern Ireland proposal is not relevant, but why has the Minister gone for the convoluted phrase,

“the provision of personal care to a person living in accommodation that an establishment provides to the person together with the care”

rather than using a statutory definition that is already in force?

I am grateful to the hon. Gentleman for giving way at this early stage in his speech. Somebody living in “extra care” accommodation—one of the categories that his amendment would exclude—is by definition living in their own home and able to organise care services separately from the tenure of their own home. Even for the purposes of probing, what possible justification can there be for proposing to exclude “extra care”?

I am glad that the hon. Gentleman recognises that amendment 9 is a probing amendment. Quite genuinely, it probes the Government on the difficulty of their definition of home and the answer to the question what is a home. I hope he bears with me, because we will discuss the matter in some detail in relation to an amendment on transitional arrangements—I am sure he will immediately understand the connection between those and “extra care”. The reason why “extra care” is particularly relevant is that the Government have chosen not to pick up the definition that already exists in statute, which was the point I was making when he helpfully intervened.

I cannot remember where the hon. Gentleman was in his ministerial career at the time of the Care Standards Act 2000; he might not at that stage have reached the Health team. Section 3 of the 2000 Act, passed by this Government, defines care homes thus:

“For the purposes of this Act, an establishment is a care home if it provides accommodation, together with nursing or personal care, for any of the following persons.”

They include:

“persons who are or have been ill…persons who have or have had a mental disorder…persons who are disabled or infirm…persons who are or have been dependent on alcohol or drugs.”

However, an establishment is not a care home if it is

“a hospital…an independent clinic; or…a children’s home…or if it is of a description excepted by regulations.”

There is therefore already something in legislation that could have been helpfully used for the purposes of describing what is meant in the Bill by being in one’s home or not in one’s home. I hope that the hon. Gentleman will understand that the Government rightly need to be probed on that issue, because it will have a major effect on whether people qualify for the help that it is intended they should receive. Free personal care at home will be of significant interest to those who qualify for it and those who do not.

Just to be helpful, I want to continue the discussion about extra care housing, which is referred to by amendment 9. The explanatory notes for the Bill specifically say that extra care housing qualifies under the new arrangements that the Government want to put in place. I am therefore bewildered that the hon. Gentleman should propose in his amendment to exclude extra care housing, because it can be the individual’s home. I am listening with interest to his definition of residential care, but we also need to clarify what is meant by a person’s own home, and the explanatory notes include a reference to extra care housing.

Given the way in which the amendments have been selected and the Chairman’s strictures at the outset of consideration, I am conscious that, to stay in order in our debate on amendment 9, I shall have to postpone a more detailed discussion about extra care until our debate about transitional arrangements, which is where it will feature most strongly. I hope that the hon. Lady will bear with me, because the issue warrants discussion. However, as she will recognise, amendment 9 is a genuinely probing attempt to elucidate from the Minister, we hope, how we can get a much clearer and, more importantly, more secure definition of those who are likely to be eligible. After all, that is what will matter most to the people whom we are talking about, who are the most in need and, often, the most vulnerable.

Do not the two interventions that my hon. Friend has just taken illustrate a rather broader point than the narrow definitional point? The effect of his amendment 9 has been to draw the Committee’s attention to those who are excluded from the category of people who benefit from the Prime Minister’s election pledge. Should we not focus on why one group of people benefits from that pledge and why another does not? Those interventions illustrate the injustice of the new anomaly that, effectively, the Bill will create.

I am extremely grateful to my right hon. Friend, whose expertise and experience in this area are matched by none in the House and few outside it. We know the provenance of the Government’s proposals as set forth in the Bill—we know that it was a rushed job, with only a 20-minute clearance time between decision and announcement at the Labour party conference—but even putting that to one side, he is quite right that it is vital to consider who is to be included. That question warrants proper scrutiny, because the fact that some people will be included means, by whatever definition is used, that the rest are excluded, and that will cause potential injustice.

My right hon. Friend will find that that is so from our discussions on later amendments, although I am conscious of how difficult it will be to remain in order, because things are so tightly drawn, not least the selection of amendments. That has been extremely constrained by the deliberately tight drafting by the Government of the money resolution, to try to exclude discussion on the much wider processes promised in the Green Paper and suggested by others, who have made some extremely interesting and sensible proposals in considering the reform of the whole of social care, rather than one small aspect of it, relative to the overall demand. I suspect that my right hon. Friend’s concerns will be most clearly addressed when we come to an important discussion on compliance—how we ensure retained compliance with the European convention on human rights and the ability of the Secretary of State to issue the certificate under the Human Rights Act 1998, as stated on the front of the Bill. I very much hope that my right hon. Friend will have the opportunity to look at that aspect when we reach that point.

Building on what my right hon. Friend has just helpfully mentioned, the Bill attempts to cut out residents of care homes from eligibility for free care. Last year, 50,000 people—yes, fortunate people, but also hard-working people who have done the right thing in investing, perhaps through a mortgage, in their own homes—had to sell their homes to pay for their long-term care, notwithstanding the fact that some sales did not occur until after people had died. That applied under a system that is available, but not often taken up, concerning whether people sell at the time they enter care or, indeed, when they leave it—under the home protection scheme or whatever.

I want to ensure that the hon. Gentleman is not inadvertently misleading the Committee, as he has said—in his opening comments—that the means assessment for care includes people’s savings and their property. That is not the case with this Bill, because it deals with people living in their own home, and the value of their own home is excluded from the means test in deciding eligibility for care. The value of one’s home becomes a matter for the means test only when people are going to leave their own home and go into residential accommodation.

I am grateful. The hon. Gentleman is quite right that the words we use in this place matter greatly, but I think that when he checks the record he will find that in my introductory remarks I used the word “assets” rather than saying “their own home”—quite deliberately, because of the distinction that he has rightly pointed out. The question of one’s own home becomes relevant only at the time when one is being adjudged by proper assessment criteria as needing to leave that home in order to go permanently—or where it is expected to be permanent—into a residential care or other home setting. As we go through these definitional issues, it is important to recognise that these are real situations often involving vulnerable people in emergency situations.

I have the feeling that we may have more time than the hon. Gentleman thinks; I cannot recall a clause being given a whole day for consideration, but we will make the most of the time we have. The hon. Gentleman is putting a quite serious amendment before the Committee, as it ranges from “extra care housing” all the way through to “care home without nursing” and “care home with nursing”. If we were to endorse his amendment, what would be the implications, particularly financially, for local authorities?

I hope that the right hon. Gentleman has been listening—well, he has obviously been listening, but I hope that he heard my saying that this was a probing amendment, so the Committee will not have the opportunity to endorse it. As I said, it is deliberately intended to probe the Government’s intentions on who should be included, as well as who should be excluded, as my right hon. Friend the Member for Charnwood (Mr. Dorrell) said. With great respect to the doubtless very thorough briefing prepared by Labour’s backroom people, it would be helpful—particularly given that all the questions relate to the same issue—if it were recognised that tabling a probing amendment does not necessarily invite Members to pass it. The amendment was tabled as a probing amendment and it was designed to elucidate information from the Government. That is precisely the official Opposition’s job.

I have already mentioned that the real debate on the issue will take place when we reach the amendment dealing with transitional arrangements, so I am keen not to get deflected by being forced to answer a question that really requires an answer from the Government. It is thus for me to ask the Minister whether he is happy with the drafting of provisions intended to cut out residents of care homes altogether. Are there no grey areas or any difficult marginal issues? Is the Bill drafted in such a way and is the money resolution so tightly drafted as to make it explicit that people who have done the right thing could none the less be automatically excluded because they own their own homes?

Is the Minister happy to put this issue on the backburner, since the Bill has thwarted the Green Paper’s aim? The Minister has asserted outside the House that all this is consonant with the Green Paper process. On the contrary, it has thrown a spanner in the works of the process of examining social care as a whole. That means taking account of those who own their homes as well as those who do not, and those who have assets as well as those who have none. It means taking account of very different levels of care need, and of problems relating to the interrelationship between health and social care. Many Members have reflected their constituents’ concerns in referring to efforts to persuade the NHS and social care providers to be a little more flexible at the margins in order to prevent the terrible difficulties that people experience in trying to gain access to appropriate care and support.

I wonder why the Minister could not at least consider—we invited him to do so on a number of occasions—presenting this Bill in tandem with a measure similar to our home protection scheme. It would have been fine for him to claim authorship for it if he had wished. That would have dealt with the difficulties confronted both by homes and by those receiving care in them, as well as by those receiving care in a different setting. Is the Minister satisfied that what I hope he will accept is the somewhat clunky drafting of subsection (2) is strong enough to prevent a legal challenge?

On Second Reading, we drew attention to the dangerous impact that the subsection could have on residential care supply. If people are given an incentive to invest in extra care at the expense of residential care, that could distort provision. There is also another issue of more immediate concern. I shall exaggerate it for the sake of the argument, but I hope the Minister will accept what I say in the spirit in which it is meant. The whole point of scrutinising legislation is to ensure that a Minister has no defence if he subsequently says that the consequences of that legislation were unintended. If at this point I describe the problems and mischief that the drafting allows, and if those problems and mischief indeed come to pass, it will be wholly legitimate for me to say, “No, Minister, I warned you, and it was therefore entirely intended for this to go wrong”, and the Minister will have no defence.

When a care home owner wakes up on the day that the Bill is passed and seeks to outsource provision to a company that he or she wholly owns, will it still constitute care and accommodation provided by “one establishment”? What, in fact, is the legal definition of “establishment”? Can the Minister confirm the possibility of a loophole in the legislation? He has confirmed to me in a written answer that

“It is open to any residential care home to reshape their service”.—[Official Report, 8 December 2009; Vol. 502, c. 281W.]

Will he also tell us the potential cost of the exploitation of such a loophole to the taxpayer? What if 100 per cent. of those in care homes with critical care needs became eligible for free personal care? I would have hoped that if the Minister could not answer that question now he might write to me, but he has already said that he is not prepared even to do that.

The legislation was drafted in haste on the basis of a back-of-the-envelope impact assessment. The Minister has already confessed in writing that that impact assessment was wrong and needs to be corrected. It consists almost entirely of estimates. Given the mess that the Labour party has made of our public finances, it is more important than ever for the Committee to be informed of the potential liabilities of the taxpayer should there be loopholes in the Bill.

I can probably find common cause with the hon. Member for Eddisbury (Mr. O'Brien) in certain respects. I understand his desire to probe the Government and secure greater clarity. As was observed by the right hon. Member for Charnwood (Mr. Dorrell), a former Secretary of State, it is plain that at some point the Government will have to go further. I see no moral justification for excluding a group of people with fairly serious care needs from Government help, whether they are in their own homes or in residential accommodation. At some point in the near future, we will require a personal care not at home Bill to address that need.

I might part company from the hon. Member for Eddisbury on this point: he and his party have proposed the idea of a home protection system, under which, for a fee, the totality of a person’s residential costs will be met. I believe that that would create a strange precedent, because for the first time an individual in this country would not be responsible for providing their own board and lodging. It has always been a principle that we are all responsible for providing our own board and lodging. Even if we have to pay for it out of benefits, that is still taken into account. The Opposition’s solution to the problem would go against that principle.

In probing the matter before us, the hon. Gentleman has set running some hares that perhaps need not be set running. I am particularly concerned about the fact that he is attempting to exclude extra care housing, because I believe that it is a model for the provision of care for older people in the future. Indeed, the huge majority of older people tell us they would aspire to such an arrangement were they to develop a care need because it means that they could live in their own accommodation.

If the hon. Gentleman looks at the Department of Health website, he will find a clear definition of extra care housing, not least in the guidance for a competition in which developers were invited to bid for an £80 million fund to build extra care accommodation. One of the key elements of the definition is that the individual lives in their own home. They might have bought their extra care accommodation or be living in it as a tenant, but they will have security of tenure; they will have self-contained facilities so that they can cook and have access to their own bathroom and sanitary facilities; they will have their own front door that they can close to the world if they so wish, and they will be able to arrange their care needs themselves.

The current system of means-testing people has the added advantage that, given that the accommodation will be the person’s own home, the value of that home cannot be taken into account in the means test. The person might be looking to protect some of their savings, and that is a good way of preserving equity and passing it on to children—that might be important to them. I believe passionately, therefore, that extra care housing is a model that we need to promote. I believe that the Government have accepted that, and until we started debating the Personal Care at Home Bill and amendments to it, I always thought that the Opposition wanted to promote it as well. However, in the light of Second Reading and—on the face of it—amendment 9, I am now seriously worried about whether they understand the nature of extra care housing and its importance in the future.

Is the hon. Gentleman not missing the point? We all agree that the desirable developments being debated represent the direction of travel that we should be encouraging. However, given the artificial divide in such services that the Government are creating, my hon. Friend the Member for Eddisbury (Mr. O'Brien) was seeking to establish on which side those listed in the amendment will fall.

I understand the purpose of the probing amendment, but I would be less worried had the shadow Secretary of State not shown on Second Reading what to my mind was a vague understanding of what extra care housing is all about. He seemed to misunderstand completely the function and nature of extra care accommodation. I became doubly worried when I read amendment 9 and saw that once again the Opposition were seeking to list it as one type of accommodation that should perhaps be excluded from free personal care.

I was reassured to hear the hon. Member for Eddisbury say that this is a probing amendment and that he did not intend to exclude extra care from the provisions. I look forward to engaging with him later in the debate about transitional arrangements when perhaps we can explore the matter a little more, and I encourage my hon. Friend the Minister, when he responds to the amendment, to provide the clarity that the Opposition are seeking about the types of accommodation in which one would be eligible, under the Bill, for free personal care, and to reaffirm the Government’s support for extra care accommodation. If that is his response to the amendment, I hope that later in the day we might hear an acknowledgement from the Opposition that they also understand the importance of extra care, and that they, too, will support it in their future policy.

Although I am pleased that we are having the Committee stage of a Bill on social care, I must begin by saying that the Liberal Democrats, too, have real concerns about the timing and process in respect of this Bill. The Bill has one clause and covers less than two sides of A4 paper. The way that it was announced was regrettable; it was announced not to the House, but to the Labour party conference. It is also only one piece of the jigsaw in terms of the great social care crisis. It was announced mid-Green Paper consultation and pre the White Paper that is supposed to be published in a few years, and came with a clearly inadequate impact assessment. Regardless of what the policy is, this is, as Lord Lipsey said,

“a very bad way to do policy”.

Turning to the amendments, it is very important that we start with accurate definitions, not only of what is a care home, but of what we mean by personal care. I regret that the amendments that were selected do not include one that probes what we mean by personal care. An understanding of that definition is even more fundamental than what we mean by people living in their own homes, or care homes. I draw the House’s attention to the detailed and interesting definition of personal care suggested by Help the Aged and Age Concern, and I regret that we will not get a chance to debate that.

We must also look at the experience in Scotland—at the situation that has developed there arising from a lack of clarity about what is meant by personal care. This Bill presented us with a great opportunity to look again at, and clarify, what we mean by personal care, but that opportunity has been missed.

The definition of personal care is already very thoroughly covered in existing legislation, which is why it does not need to be in this legislation, and why the hon. Gentleman’s criticism of the Chair for not choosing an amendment on that is rather unfair.

Order. The hon. Member for South Thanet (Dr. Ladyman) should not presume a degree of censoriousness on the part of the Chair, which the occupant of the Chair had not leapt to make clear. So I think the hon. Member for Leeds, North-West (Greg Mulholland) has got away with it.

I thank you for that, Sir Alan. The hon. Member for South Thanet (Dr. Ladyman) is entitled to his opinion, but Help the Aged and Age Concern are equally entitled to theirs, and I know who I would listen to first and foremost when discussing policy of this nature.

Turning to the two amendments of the hon. Member for Eddisbury (Mr. O'Brien), I share the concern that there is insufficient clarification of what is meant. The right hon. Member for Charnwood (Mr. Dorrell) has put his finger on the key point: what is crucial to consider is who is excluded by the Bill. It touches only a tiny number of the people who are affected by the problems of the social care crisis, which has been getting worse for many years.

In terms of the amendments, however, I have some concerns about the definition offered. Concerns have rightly been expressed about what is meant by extra care housing, but we must also consider the meaning of “sheltered accommodation” and “warden controlled accommodation”, which are mentioned in the list in amendment 9. What do we mean by “sheltered accommodation”? Is there an absolute definition of that? I suggest that there probably is not—there certainly is not from a legislative point of view. Is it not possible for someone to buy and own or, indeed, to rent what is clearly their own home in which they live but for it to be subject to some oversight from an organisation and thus fall under the category of “sheltered accommodation”? We are in danger of entering a minefield here, so we must be clear on this issue.

As the hon. Member for Eddisbury made clear, this is a probing amendment, so I just ask the Minister to give the Committee clarity. He must show that the Bill and the Government are clear about what is meant by people who are “at home” and need to receive this accommodation. They must make it clear that there is no possibility, in respect of sheltered accommodation, extra care housing or warden controlled accommodation, of people who are clearly living in their own home—in a way that any normal person would recognise—falling outside the remit of this Bill.

I congratulate my hon. Friend the Member for Eddisbury (Mr. O'Brien) on his amendment, and not because I think that he is seriously suggesting that it should be included in the Bill—he has made it explicitly clear that that is not his intention. He intends to focus the Committee’s attention on the large group of people who are defined out of, or excluded from, the category of beneficiaries of the Prime Minister’s pledge; as I said in my intervention, these are the people who are excluded from benefiting from the pledge.

Of course, across the House, we all acknowledge that this long-standing aspect of public policy has not been satisfactory. It was the former Prime Minister who, soon after the 1997 election, made it clear that payment for social care needed to be the subject of rigorous and profound examination. That is not the purpose of this amendment; it is an attempt to define clearly the large group of people who are excluded from benefiting from this Prime Minister’s pledge, rather than focusing attention on the relatively small number who will benefit from it. The reason for focusing on the people who are excluded is to remind the Committee of the very much larger group of people who remain, as they have since 1997, suffering from a system of payment for social care that Members from across the House acknowledge to be inadequate.

The right hon. Gentleman is right to point out the large number of people who are excluded from this Bill, but this goes further than that, does it not? The imposition of the duty in respect of the small group of people who will be included within the terms of the provision could well adversely affect all those who are excluded, particularly those who are currently benefiting from care provided by local authorities on a discretionary basis—they could well see their care cut back.

The hon. Gentleman is entirely right, because of course the cost of even this limited pledge is significant in public expenditure terms and the Government have made it crystal clear that no additional money will be provided to local authorities to allow them to meet the additional burdens that this pledge imposes on them. Thus, it must be assumed that somebody, somewhere else, who benefits from local government expenditure—as he says, it is likely to be other people who benefit from social service expenditure—will pay for this pledge from the Prime Minister.

As a result of the amendment tabled by my hon. Friend the Member for Eddisbury, I wish to focus on the implications of creating this distinction between the small group of people who will benefit because they receive “personal care at home” and the much larger group who will still have to pay for personal care under the old rules. What are the implications of creating that new distinction? I suggest that there are three such implications on which the Committee should focus.

The first is the short-term implication. A group of people who change their care arrangements according to their requirements will suddenly find themselves taking decisions based on a major cost implication that ought to be taken based on their care need. There will be two categories: those who are at home, who get all their personal care free; and those who are defined as out of the “at home” category, who will still have to pay for their personal care according to the old rules. It therefore matters hugely who is “at home” and who is not “at home”, and the amendment tabled by my hon. Friend the Member for Eddisbury is an attempt to define precisely who is not “at home”.

The former Minister, the hon. Member for South Thanet (Dr. Ladyman), reacted to my hon. Friend’s amendment by saying, “Oh, these people who receive extra care ought to benefit from the pledge.” Perhaps they ought to benefit from the pledge, but if they do, the cost will go up immeasurably from the £500-odd million that the Government say that it will already cost. My hon. Friend is drawing attention to the fact that the much larger group of people who do not receive personal care “at home” will be the losers from this prime ministerial election pledge.

That is the first implication: where there is currently a logical development of care provision, in future there will be two categories and an anomaly created by the move from one category to the other. That is the first and immediate consequence. The second consequence, which is, in my view, much more malign, is that if this policy were to endure for any length of time, people would change their behaviour to ensure that they fell on the right side of the line to benefit from the pledge rather than on the wrong side of it.

Let me pose a few questions to the Committee. If personal care at home is free, but personal care delivered not at home is not free, is somebody allowed to move their home in order to ensure that their personal arrangements move from one side of the line to the other? Members of this House have learned over the past 12 months the dangers of moving their house from one place to another in order to qualify under rules under which one did not previously qualify. If we create a group of people for whom personal care is free and say that it is available only to those who are at home, we should not be surprised if people who receive personal care and do not qualify immediately change their arrangements in order to ensure that they qualify. The definition of what constitutes “at home”—of who is included and who is excluded—will be the subject of constant challenge as people change their arrangements to ensure that they qualify, although they originally did not.

I was reading the definition that the Government have offered of people who are excluded from the benefit of the pledge. Let me repeat it to the House. People are excluded if there is

“the provision of personal care to a person living in accommodation that an establishment provides to the person together with the care”.

If I provide accommodation and personal care to my parents in my grannexe, will that be included or excluded? Is a grannexe where I or my family provide personal care to my elderly relative included or excluded? Is my grannexe an “establishment” according to the definition in this statute? It is unclear to me.

My right hon. Friend makes a very important point. He also raises the issue of whether the provision of personal care by a relative is likely to be acceptable, as it is in the Netherlands and some other countries within Europe, or not.

Absolutely. If, as I profoundly hope given all the pressures on public expenditure, we are not going to get into the business of using taxpayer resources to pay relatives to give care, where will the dividing line be drawn, given that we are creating a very powerful incentive to people to change their behaviour?

The right hon. Gentleman makes a very good point about the danger of a partial solution changing behaviour and having perverse consequences, but does he not agree that the Conservative proposal carries the same risk in that the pledge relates only to providing for the cost, through insurance, of care in residential homes? That is also a partial solution that would influence people’s decisions.

The difference is that my party is committed to moving quickly to the development of a total solution. We have made it clear, and it has been clear in our thinking right back to my days as the Secretary of State, that we cannot do that by landing the bill, in either small or large stages, on the taxpayer. The Government also took that view until the summer; indeed, until a day in October the Government took the view that this was an unaffordable bill for the taxpayer. That conclusion must underlie sensible policy in this area, but it is under challenge as a result of the Prime Minister’s pledge.

May I take my right hon. Friend back to the difficulties that he rightly outlined about the definitional point and how things might change? Earlier, I gave an example about how an owner of accommodation might be able to change things by having two companies. I am reminded that on Second Reading the hon. Member for South Thanet (Dr. Ladyman) helpfully described as extra care accommodation a specific type of accommodation in which people might buy into a retirement village and be able to move around within it as tenants and leaseholders. It is precisely because such arrangements can be changed both by the owners and, as has been pointed out, by the tenants that we are having to raise these doubts through this probing amendment.

I am grateful to my hon. Friend for his comments, and I agree with him. What is clearly illustrated here is that any attempt to write into the statute book crude rules that create one category of free personal care and another of paid personal care will be fraught with difficulty, particularly when one is trying to do it at 20 minutes’ notice, on the run, on the way to the podium at the Labour party conference. I agree with Lord Lipsey that that is one way not to make policy.

I have a final question to put to the Minister.

I shall look forward to putting my question to the Minister, but I shall give way one more time.

The right hon. Gentleman is making some important points, but will he reconsider his statement that this is a crude way of achieving the objective? The measure simply removes the six-week limitation on free care from another piece of legislation that has been operating very successfully for some years. It is therefore anything but crude. The precedents and definitions have all been set, and all that the clause does is say that instead of the free care being limited to six weeks, it can be provided for much longer.

With respect, I think that the hon. Gentleman is being disingenuous. My recollection is that the six-week limitation was introduced specifically to prevent policy from migrating in this direction, while still allowing the discharge of patients from hospital when they should no longer be in there. It was introduced to facilitate orderly discharge out of the NHS, rather than as precursor to the development of free personal care in the social care sector.

I certainly was not trying to be disingenuous. The legislation that is being amended says that the Government can tell local authorities in certain circumstances to provide people’s care for free in their own home for a period of six weeks. The measure simply takes the six-week limit away. The rules and precedents that define the system are already established, so this is actually quite a neat and elegant way of achieving the aim quickly.

I genuinely listen to what the hon. Gentleman has to say, and I recognise that he has knowledge in this area, but I think that he is wrong on this point. He says that the measure simply removes a bureaucratic rule, but doing so changes the nature of the rule on free personal care at home. The six-week rule was designed to facilitate the discharge of patients at the end of their NHS care in NHS hospitals. It was not designed as a means of funding social care for anything other than the shortest terms in that context.

I have spoken about people changing their behaviour and so forth, but they will not do that in anything other than the most convenient way to ensure that they qualify for the six-week limit. Social care can go on for years, or even decades in some cases, so all the points that I have made about changing behaviour and the pattern of provision apply in a way that they do not in the context of the six-week rule.

My final question to the Minister is very important. Under the direct payments legislation, individual beneficiaries of social care can convert their entitlement to social care into a direct payment, but will that apply to personal care provided in the context of this pledge? If so, that is another extremely powerful incentive for people to change their behaviour in order to qualify under the rules.

The Minister says that of course it will, but I challenge the Government on that. If the direct payments legislation does apply to care provided on this basis, I simply do not believe that, beyond the first few months, the cost of the scheme could be limited to anywhere near the £530-odd million that the Government have estimated for the scheme as a whole.

I am generally in favour of one-clause Bills, and most of us have sat in Committees considering Bills of 200 or 300 clauses. Nevertheless, such a short Bill means that trying to find out its implications presents a problem, and that Opposition Front-Bench Members must show ingenuity in engendering a debate that allows information to be put on the record. That information is needed so that the people who provide and receive the care can learn a little more.

I agree with my right hon. Friend the Member for Charnwood (Mr. Dorrell). I listened to what the hon. Member for South Thanet (Dr. Ladyman) said, and he has participated in this debate for a long time, but the change in the six-week rule does make quite substantial differences to the overall pattern of care.

If Opposition Members are cynical about the proposal that may be because one of the first things that the Government did after 1997 was to set up a royal commission that recommended free personal care, but that got dropped. Now here we are at the fag end of a Parliament and we get this rushed Bill, with questionable costings, which will fall after the election, and big implications for many of our constituents. Although amendments 9 and 10 may not be perfect, they at least allow us the opportunity to raise important questions.

The Government themselves produced the Green Paper, and I thought that it was a good effort at looking at the whole system comprehensively. The Select Committee on Health is looking at personal care, so it is a pity that we are rushing ahead with this option without taking a comprehensive look at things. When one rushes ahead one creates cliff edges and biases in a system that benefit some and exclude others. As I think the hon. Gentleman said, the implication is that, subject to the funding arrangements, we will have to add another bit to the Bill to make it more comprehensive in the future. Definitions are very important, and I am still not sure that we have got to the bottom of that argument.

Costings are also very important, and the Government are using the “magic pot of gold” argument that I have heard time and time again. The efficiency savings that they propose will be made at the expense of local government, which is going to have a difficult time over the next few years. Amendments 9 and 10 give us the opportunity to say a few words about that.

When the Minister responds, I hope that he can answer some of the very important questions that have been raised and give some reassurance that the Government have thought through the Bill’s implications rather more comprehensively than seems to be the case at first glance. However, I fear that perverse incentives are now going to be built into the system. If local authorities have to provide more money but do not have the budget to do so, my concern is that they will deal with the changes by spreading what they have rather more thinly. That could mean that although 380,000 people will benefit from the legislation, if the funding is not sufficiently robust, they will not benefit to the extent expected.

May I pursue briefly the point raised by the right hon. Member for Charnwood (Mr. Dorrell) with regard to direct payments? The Minister, from a sedentary position, said that of course the Bill provided for the support to be given by way of a direct payment, but when we sought to table an amendment to clarify that, we were told that it was outside the money resolution, and that that was not what the Bill provided for, because it provided for care at home.

If that is the case, the Bill will pursue policy in a very different direction from that which the Government have followed up till now, and the outcome will be the perverse situation that someone receiving care under means-tested arrangements will be encouraged to receive their care by way of a direct payment, giving them maximum flexibility in how they chose to spend that money, whereas someone receiving care as an entitlement by virtue of the Bill will be entitled only to receive care imposed on them, in a sense, by the local authority.

It is self-evidently important for the Minister to clarify whether the Bill provides for the provision of support by way of a direct payment. If it does not, it is clear that an amendment needs to be tabled by the Government if it is beyond the scope of Opposition parties to do so.

May I emphasise, as other hon. Members have done, that it is vital that whatever pressures are put on local government, it is given the full funding by central Government to pay for the measures, and that that funding is not expected to come from existing budgets, or it will not be viable and will not happen?

I am pleased to be taking the Bill through its Committee stage on the Floor of the House. In addressing the amendments, I should like to place my remarks in a slightly wider context.

The hon. Member for Leeds, North-West (Greg Mulholland) said that the Bill was very small, but I can tell him that it will have a very big impact. As the Minister of State with responsibility for care services, I am hugely proud to take the Bill through its Committee stage and Third Reading this evening. The Bill will provide support and relief to some 400,000 older people with the greatest personal care needs in their own home—people with advancing conditions such as Parkinson’s, dementia and motor neurone disease—and 280,000 people who require high levels of intimate personal care on a day-to-day basis at home will now get those services free.

As has been remarked, many of those people have faced the burden of paying large amounts of their own money—they do not lose their own homes; my hon. Friend the Member for South Thanet (Dr. Ladyman) rightly corrected the hon. Member for Eddisbury (Mr. O'Brien) on that—for care as their conditions deteriorate. The Bill will remove that millstone.

Is it not the case, though, that a significant proportion of those people whom the Minister identifies as benefiting already benefit by way of the means-tested system, that the net number will be significantly smaller than the number that he cites, and that, as the Government’s own impact analysis demonstrates, the wealthiest group of pensioners will benefit most?

I do not want to stray from the amendments, but the hon. Gentleman is right to say that a number of people who will benefit for the first time are self-funders, and a number of people who pass the means test and qualify for free personal care will have that free personal care safeguarded as a result of the Bill. That is particularly important, given the uncertainties of the future.

I am grateful to the Minister for giving way. On a point of information, if the Bill were to become law and came into effect on 6 April, would people who are currently self-funding their care qualify, or would only new patients with medical conditions developing who required help be covered by the Act, as it would then be?

First, it is social care, not medical care, that is being provided. The hon. Gentleman’s phraseology suggested that he was talking about medical care, and I want to make it clear that this is about personal care for people whose need is most critical and who need help with toileting, and so on. This is about intimate personal care.

A number of guidelines and regulations are out for consultation, and they will need to be enacted when the Bill receives Royal Assent. People will qualify from 1 October this year. The process by which that will happen will also be the subject of guidance, to ensure a smooth transition as people who are currently in their own home and who qualify under the appropriate criteria start to qualify for free personal care. The provisions apply not only to new entrants; people who are currently living in their own home and paying for personal care because they failed the means test will now start to get their care for free. A further 130,000 will receive free reablement or rehabilitation to help them to recover their independence after a fall, a bereavement or a serious illness. I will say more about that when we discuss the later amendments.

The Bill is based on the simple principle that we must do everything that we can to help people to live as well as they can and for as long as they can in their own home. That is what people tell us they want. This Government policy has been shared by both parties, at least since 1998 when the Griffiths report was produced. Indeed, the right hon. Member for Charnwood (Mr. Dorrell), when he was Secretary of State, supported the view that we should give as much support as possible to people in their own home, because that is what they want. I have listened to his remarks and those of his Front-Bench colleagues today, and I hope that that position has not changed. I hope that all parties in the House will support and respect the wishes of people—young adults as well as older people—to live in their own home.

Amendment 9 would amend section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 so as specifically to list a number of settings in relation to which a six-week restriction on the ability of regulations to require provision of personal care for free would remain. The hon. Member for Eddisbury described it as a probing amendment, and I understand that, although I think that Labour Members listened quite carefully to ensure that that was the case and that the Conservatives’ position had not changed.

The list in amendment 9 is entirely inappropriate, as it includes some settings that are more appropriately described in the way that clause 1(2) describes them, and some settings that we would describe as falling within the notion of living at home—such as extra care housing, sheltered accommodation and warden-controlled accommodation, all of which are listed in the amendment.

My hon. Friend the Member for South Thanet spoke from his experience as a Minister in this Department, and from his own professional experience, when he described the importance of extra care housing. I very much share his view. I listened carefully to the concern expressed by the hon. Gentleman that there might be game-playing among care home owners trying to change the status of their homes—[Interruption.] That was indeed mentioned on Second Reading; if I said this on Second Reading, I am certainly happy to put it on the record again.

It is for the Care Quality Commission to register care homes and extra care housing. Only care homes that genuinely change the nature of the care they provide to create extra care housing would be registered as such. As my hon. Friend said, we do not need to write all that into the Bill, because we have a regulator to ensure that the kind of behaviour described by the hon. Gentleman would not happen. The right hon. Member for Charnwood gave the example of granny annexes. People living in such accommodation would also qualify for free personal care because they are not in residential care accommodation.

The Bill does not list all types of accommodation. Its provisions are straightforward. Apart from the one circumstance of adult placements—we will discuss an amendment on that later—we have excluded anybody in a residential care home from qualifying for free personal care. Everybody else is included by default because they are not excluded. That is how the Bill is designed. It is an elegant way—my hon. Friend described it as such—of achieving the policy goal that we want to achieve, which is to provide for and help people with the greatest possible needs who are living in their own homes.

The right hon. Gentleman suggested that we have identified one group but ignored everybody else. The problem with his approach is that it would be a case of saying that we should either do everything or do nothing—that we should not introduce this extremely important measure to help people in the most need in their own homes. Why did we introduce a carers strategy? Why did we introduce a dementia strategy? Why did we introduce a strategy on valuing people with learning difficulties? We did those things because we are building on, improving and raising the quality of care step by step.

The hon. Member for Poole (Mr. Syms) indicated, as he did on Second Reading, that he favours the Green Paper. I am delighted that I have a convert from the Conservative party. Indeed, many of his colleagues praised quite lavishly the Green Paper, which is being considered with a view to transforming the whole system. I am proud to be the Minister of State standing at this Dispatch Box leading on the proposal to create a national care service—how good can it get?—but that does not mean that I am going to stand still while I am waiting for that to happen; I want change now, as well. Step by step, the building blocks towards creating a national care service are being put in place, and this measure is a key part of that.

Amendment 10, as an alternative to the approach that we are taking, would insert a definition of “care home” into the Bill. We regard that as unnecessary. The description that the Bill uses in amending section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 is

“accommodation that an establishment provides to the person together with the care”.

We do not propose to change that. The hon. Member for Eddisbury proposes in his probing amendment that we should use the definition in the Care Standards Act 2000, but that is not right in this context because it includes some exemptions and exceptions and therefore would not accurately reflect the range of settings that we want to exclude from free personal care. We think that our approach is the right way forward.

In response to the hon. Member for North Norfolk (Norman Lamb), yes, direct payments would be a method of providing such free personal care if someone chose to go down that road. This is an important point about the very nature of the transformation of the care system. Increasingly, we want people to have more choice and more control over their care budgets, and direct payments are one way of doing that. Personal budgets, which are a development of that approach, are being rolled out across the country, with more than 100,000 individuals now receiving their care in that way, giving them choice and control. This is free care for the people in the most need. If they choose to have it through a direct payment or as a personal budget, that is absolutely the right thing to do. It will be up to local authorities to develop and implement this approach—that is what our extra £500 million for the transforming social care budget is all about. Some authorities are getting there quicker than others. I hope that the measure will provide an incentive for some of those authorities to start to develop their services in a way that we, and I hope the whole House, would like them to offer in taking forward their care provision.

I am grateful to the Minister for clarifying that narrow point. However, should there not be an entitlement for the person to receive the help by way of a direct payment instead of leaving it up to the local authority to decide?

We will discuss issues to do with local authority discretion under subsequent amendments, so I will deal with that question then.

I think that I have answered all hon. Members’ questions. I have explained why the Bill is framed as it is and why amendments 9 and 10 are inappropriate and unnecessary. I therefore ask the hon. Member for Eddisbury to withdraw the amendment.

The debate has been extremely helpful and constructive in bringing out precisely what the amendments were intended to probe and elucidate. It has been acknowledged that where the dividing line falls is an issue to consider, and that we need greater clarification. It is possible that as the Bill progresses through its next stages in the other place, their lordships may wish to take up some of our questions to get that clarification, but we have had a good exploration of the matter.

As I said, these are probing amendments. I am glad that the hon. Member for South Thanet (Dr. Ladyman) felt reassured by the way in which I dealt with his concerns about whether there is mutual understanding on extra care communities and the home settings to which they relate. However, at one point he asserted that there was a principle that people do not get free board and lodging, as though that were somehow not to be challenged. That is not true either in a hospital setting or in many other settings. We need to be careful about announcing principles as though they were inviolate, when I am not sure that they stand a true examination.

As was reflected in the comments of my right hon. Friend the Member for Charnwood (Mr. Dorrell) and others, it is important to recognise that despite some of the discussion that has taken place, we must not look at the matter as though it were simply about removing a six-week time limit and not changing any other circumstances. The hon. Gentleman gave the game away when he talked about certain circumstances, because circumstances have changed. The 2003 Act, which the Bill is intended to amend, addressed a different mischief that needed remedying—inappropriate bed blocking in hospital settings. This Bill is not about that; it is about doing something to support people in their own homes. It is not about removing people from one setting but about what they get in another, so the circumstances have changed. It was helpful that the Minister made that clear, but the way in which the matter was discussed at other times was not particularly appropriate. We need to be very careful, because the clause does not provide for some kind of simple removal of an element of a Venn diagram. It is definitional, because it deals with who can qualify. We even heard the Minister try to explain the understandably complicated matter of how on 1 October, if the Bill receives Royal Assent, the system will include both people who currently receive some care support, who may have to pay for it or may get it free, and others with different transitional arrangements. Later amendments will cover that matter.

This discussion has helped set us off towards a greater understanding of the complications of how the Bill is drafted and the concept that lies behind it. More importantly, it has helped to ensure that we get as much clarity on the record as we possibly can. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

With this it will be convenient to discuss amendment 12, page 1, line 13, at end insert—

‘(b) to such other arrangements for the provision of personal care as the Secretary of State may, by regulations, specify.’.

Amendments 11 and 12 are intended to allow secondary legislation to stop the six-week restriction on free personal care. Amendment 12 is the operative amendment, upon which the Committee may wish to express its opinion depending on what the Government say. I flag up the fact that although it is not the lead amendment, it will be the appropriate one on which to divide if there is to be a Division.

It is somewhat disingenuous of the Minister to suggest that the provision in question is the direction of travel of the Green Paper. It is in fact a fully taxpayer-funded option, which was previously rejected by the Government in explicit terms, not least by the Secretary of State and the present Minister, because the working population of this country is shrinking as a proportion of the total population. That has been discussed and is widely recognised both in this place and by many experts and advisers outside. I refer the Minister to the Secretary of State’s reply when he was keenly questioned by Members of his own party below the Gangway. He resisted their calls for taxpayer-funded options for social care, saying that it would not be

“fair across the generations to ask the working age population to pay”

for care. He continued by saying that

“it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation.”—[Official Report, 29 October 2009; Vol. 498, c. 479-81.]

We agree, and that is part of the challenge in the Green Paper that we are all considering. However, this Bill proposes, for the class of people outlined in it, to provide an option for care fully funded by taxation. That is inconsonant, to put it one way, with the direction of the travel in the Green Paper, although some might call it disingenuous.

The Minister confessed, in a parliamentary answer:

“It is very important not to conflate the funding for a national care service with the funding for the Government’s Personal Care at Home Bill. The Green Paper”—

unlike this Bill—

“is about building a sustainable system for the future”.—[Official Report, 5 January 2010; Vol. 503, c. 277W.]

We all agree with that, but does it mean that the Minister is suggesting that this Bill is not sustainable for the future? Does he in fact agree with the point made by my right hon. Friend the Member for Charnwood (Mr. Dorrell) in the debate on the previous group of amendments that the Bill is a step along a path that may be distinguishable in legal terms, but will certainly be superseded in policy and legislative terms. That is a genuine question, and it is why we have included enabling powers in amendment 12.

The Minister has also said in a parliamentary answer that the measure in the Bill

“was not considered in the Green Paper”—

that is a confession—

“because it is a step towards that National Care Service. The Green Paper puts forward fundamental proposals”.—[Official Report, 9 December 2009; Vol. 502, c. 497W.]

If this is not a fundamental proposal, does that mean that the Government plan it only as an interim measure?

The best way for the Government to make earnest on their pledge that this Bill is a step towards the full reform of social care would be to make this Bill more enabling in terms of additional policy options. One of those could be our asset protection scheme, which would involve the option of paying £8,000 at age 65 by those who have sufficient assets. Those who do not have such assets would continue to be protected, and those who did not take up the option would be in no worse position than they are today. Those who did take up the option would be entitled to residential care for life, should it be necessary. Who is to say that similar schemes could not work alongside the Government’s measure in domiciliary care? We are not precious about the scheme, and it would provide an opportunity to widen the Bill and bring in a much more comprehensive approach that would genuinely be consonant with the Green Paper, which was welcomed—and urged on the Government—by both sides of the House.

My hon. Friend makes an important point, but one of the problems with providing free personal care is that it tends to undermine the argument for a private insurance option, which may have to be one of a range of options if we are to look after people in old age.

My hon. Friend makes an important observation. I do not wish to underestimate the importance of this issue. We all accept that we face a serious challenge on this issue, and the question is how we measure up as policy makers and legislators. The issues include access, fairness, quality and appropriateness of care, both in the home and in a residential setting. It also involves major social issues such as the intergenerational responsibilities that we all have as members of the working age population for those who are beyond earning age or who have never had the capacity to earn or look after themselves because of some form of difficulty or care need.

My hon. Friend is entirely right to set the Bill in the context of the Green Paper process. We are challenging the fact that it does not sit well with that process, which the Government have already defined. Whether or not we end up with the social insurance model for all aspects of care need—he mentioned that, but I note he did not necessarily advocate it—is part of the discussion and the consultation. I fully accept that the Government have been conducting a consultation and I look forward to their assessment, which will inform us of the context of today’s discussion, including on amendments 11 and 12.

We feel strongly that amendment 12—the operative amendment—gives an opportunity to air the questions that my hon. Friend asks in the context of the Green Paper process, which is vital. As the Government know, that process has been widely welcomed, even if it has come late and been postponed. It follows a series of other Green Papers and consultations, but is none the less a step in the right direction. The concern is that the Bill does not feel as if it is consonant with the process.

I support the idea behind the hon. Gentleman’s statement that what we ultimately need is a comprehensive model for providing social care, and I have made it clear in my remarks on the Bill that more finance from people themselves is going to be necessary if we are to have that. However, will he confirm whether amendment 12 is a probing amendment? My understanding is that the proposal would give the Secretary of State power to introduce such new arrangements by diktat, without ever having to come back to the House for a proper debate or to discuss a new Bill in future. That seems to me to be an awful lot of power over an awful lot of expenditure to put in the hands of a Secretary of State, even one who is as good as our current Secretary of State.

Aside from the enjoyable little tail to that question, which I am absolutely sure deserves a job, I have not confirmed whether amendment 12 is a probing amendment, because I genuinely wanted to test the opinion of the Committee. I am not suggesting that I will therefore press it to a Division; rather, I am seeking to test whether there is an opinion in the Committee that the way the Bill has been introduced fits well with the overall direction of travel. I dare say that there could have been a touch of irony in a debate on amendment 12—if Hansard can record irony—because it might have revealed whether the hon. Gentleman was confident that a Labour Secretary of State would be exercising the powers, or whether he thought there would be a Conservative Secretary of State. However, I would not presume to take such powers on behalf of my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) if the electorate decided that he should be Secretary of State.

The amendment seeks to test whether the Committee thinks it appropriate that we should be discussing the matter in a wider context. The hon. Member for Leeds, North-West (Greg Mulholland), who speaks for the Liberal Democrats, twice mentioned that the extreme tightness of the drafting in the money resolution, which is deliberate on the part of the Government—but that is how it is—has clearly made the selection of the amendments particularly tight and challenging. Amendment 12 has given us the opportunity to at least have a sense of getting that discussion moving. We will decide whether the Committee needs to give it a better airing once we have had our discussion.

To pursue the point raised by the hon. Member for South Thanet (Dr. Ladyman), does the hon. Member for Eddisbury (Mr. O'Brien) accept that amendment 12 could allow the Secretary of State, whichever party wins the election, to implement wide-ranging reform, without this House having any opportunity to debate it properly? Does he accept that that would be inappropriate, and that there should be primary legislation in the new Parliament to implement fundamental reform?

The hon. Gentleman fully accepts, I think, that although the Secretary of State, in his current role, has made it clear that, as part of a legacy, or whatever he wishes to claim for it, he seeks an unstoppable momentum beyond the next election, our concern is that, strangely enough, the Bill is in danger of not creating that momentum. Indeed, it could do the opposite, because it is not consonant with the whole approach to the reform of social care that we hope the Green Paper process, which so many of us have bought into, will achieve.

I fully accept that, ultimately, there is only one way forward, which is for the country, through its elected representatives across the House, to seek a genuinely broad consensus. We will never satisfy either those who think there should be a fully taxpayer-funded option or those who think we should have a complete free-for-all in the private market. The solution lies somewhere between the two. We have had that discussion with Government Members. We know that a number of them would not go along with what has been proposed, so reaching that point will be a tough challenge. That is why amendment 11 is important in clarifying the intent. However, I will wait to see how the Committee feels about the issue before I make a decision on whether to press the amendment to a vote, because I take seriously the idea that we need the best and most solid consensus that we can achieve.

One thing that I should say—I see that the Minister is in discussion at the moment—is that it would be helpful in building that consensus if there were a genuine willingness on the part of the Government to start some discussions and to invite in those of us who wish to build that consensus. However, while we remain only in discussion across the Dispatch Box, which is necessarily a somewhat scrutinising and adversarial approach, we diminish our chance of achieving consensus. However, that is perhaps the nature of the run-up to the election, with the tribalism now being displayed.

I would like to bring my hon. Friend back to amendment 12, which is excellent. I thought that its drafting was intended to engender a debate not about what the Government are doing in the Bill, but about what they are doing in guidance and consultation. We do not know whether there will be statutory instruments or whether they will use the positive or negative procedure. A lot of the detail will be discussed in consultation and decided after the Bill has been passed. We will therefore not know the shape of the Bill until we see what comes forward. Is that not one of the arguments against rushing the Bill? Should we not have the consultation and then the Bill, rather than the Bill and then the consultation?