Ms Tessa Jowell (Dulwich)

I join other hon. Members in congratulating you, Mr. Deputy Speaker, on your appointment. I have been elected to represent Dulwich, a constituency in south London a few miles from here. Within it are extremes of prosperity and poverty which mirror the country as a whole.

Dulwich is principally a residential area. What industry there was has mostly long since gone. Employment, being mainly service-based, has been heavily hit by the recession, and unemployment has increased locally by 99 per cent. since March 1990. One person in six is now out of work, and the fear of unemployment is a fact of life.

Action to end recession, to combat poverty and to see improvements in health care, raise standards in our local schools, the development of nursery education and nursery care, and the regeneration of our inner cities are all policies for which people in Dulwich voted and which led them to elect me as their Labour Member of Parliament and to displace my Conservative predecessor.

I take the opportunity to pay a sincere tribute to Gerald Bowden, who was the Conservative Member for Dulwich until the election. He served my constituents well and conducted the election campaign with dignity and integrity. He earned widespread respect for his active lobby against the rail link, an issue that 1 will continue to pursue along with local groups such as Peckham Against the Rail Link on the sure foundation that he laid.

I also record the debt that Dulwich owes to its previous Labour Member, Sam Silkin, the former Attorney-General, who represented the seat for 19 years until 1979. Local people say about him, "Sam was Dulwich". There was nothing more important to him than the attentive and conscientious care with which he addressed the problems and issues affecting his constituents. That is a fine tradition which I will do my best to follow in my work as the new Member for Dulwich.

I used to work at the Maudsley hospital in Dulwich, where my brief was to re-establish and resettle in the local community people with long-term and chronic mental illness. I want to talk about a very big question for my constituents—how we care for our elderly people, for people with mental illness and for people with disabilities, and how we get the best from community care.

In Dulwich, one person in five is over 65. The number of very elderly people living alone is on the increase. Serious problems are emerging in the local health service on the care of elderly people which arise partly from the loss over the past three years of 52 beds previously provided for elderly people. The closure of those beds has increased pressure for elderly people to be admitted to other beds, generally acute and surgical. The evidence of that pressure exists in the notorious and scandalous queues of people waiting on trolleys in the casualty department of King's College hospital until a bed in the hospital becomes free.

The risks to elderly people are especially great. If they are confused, they may become even more so. There are attendant risks of dehydration, and pressure sores may develop even after a relatively short time lying on a trolley. A wait on a casualty trolley may set back the time of recovery. A longer hospital stay may be caused by the difficulties of the hospital's admission procedure.

Some of the elderly people seeking admission to hospital could be looked after at home if the community services were still available. I spoke recently to an elderly lady who had been waiting for six hours to be admitted to King's and who had been lying on a casualty trolley. She had broken her arm, but she did not really need to be in hospital. However, there was no one to put her to bed at home, so hospital was the only safe alternative. Until a year ago, it would have been possible to get a district nurse to put her to bed, but the service has been cut.

Two Government policies are clashing headlong, and that elderly lady is the victim. The hospital needs to reduce its costs as it prepares to become a trust. That clashes with the other Government policy to provide responsive and individually appropriate care to elderly people in their own homes wherever possible.

If the community care policy is to work properly, elderly people must also have immediate access to the medical treatment they need. That is important if they are to have a real chance of being able to cope in their own homes, even with support. An elderly man is, for example, today waiting in a Dulwich hospital for a hip replacement. He cannot manage at home until his hip is repaired. However, by the time that he has his operation, it is likely that he will be so dependent that he will be unable to manage in his own home. Residential care will be the only alternative.

"Going into a home" and "arranging a residential placement" are bureaucratic carespeak which obscures the personal tragedy which the loss of a home invariably represents. Let us pause for a moment and consider what it means to leave one's home for ever and enter a residential or nursing home, however good the care, however much safer and however unavoidable. It means the loss of freedom to run one's life in the way that one chooses; to make a cup of tea when one wants; to wear the clothes that one wants to wear; to cook one's own choice of food and watch the television programmes that one prefers. Those are the freedoms which we properly take for granted and which define us as individuals. That is why it is so important to make the community care policy work and to understand the impediments to its success.

We will hear a lot during this Session about the need to measure the performance of our public services and about the role of the citizens charter. However, we should not be carried away by the creation of a new science to help us to recognise a good service. The delivery of health and community care should be measured against a simple question: hon. Members, as they take decisions about the care of vulnerable elderly people, should ask themselves whether what they are deciding is what they would want for themselves or for their families. If the answer is that it is not, the policy is unacceptable. That simple test should set our standards for the judgment of effective community care.

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