Orders of the Day — Community Care

Part of the debate – in the House of Commons at 12:40 am on 19th December 1988.

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Photo of Tom Clarke Tom Clarke Shadow Minister (Disability) 12:40 am, 19th December 1988

I warmly congratulate my hon. Friend the Member for Bristol, South (Ms. Primarolo) not only on her success in the ballot for the debate, but on introducing the debate with an outstanding speech that was comprehensive and sincere. It helped the House to identify the many problems associated with community care.

Had my hon. Friend the Member for Halifax (Mrs. Mahon) been successful in participating in the debate, she would have said a great deal about social security, lodging allowances and so on. That underlines how crucial it is to have a full-scale debate on community care, preferably in Government time. It is a great pity that tonight's debate has underlined the fact that no such full-scale debate has taken place.

I also wish to congratulate my hon. Friend the Member for Wakefield (Mr. Hinchliffe) who spoke with considerable authority, as one might expect, given his experience in social services. I know that the House listened carefully to many of the points that he made. The hon. Members for Mid-Kent (Mr. Rowe) and for Bolton, North-East (Mr. Thurnham) gave outstanding support to the Disabled Persons (Services, Consultation and Representation) Act 1986. I am particularly grateful that they mentioned that Act in their speeches tonight.

As my hon. Friends have said, we are not without information, research, advice and opinion on this matter. Hon. Members have mentioned the Griffiths report. When the Minister replies, I hope that he will be more forthcoming about that report. Time after time, we have asked his right hon. Friends, including the Prime Minister, to tell us what they think of that report. It was published in March and it is extremely thoughtful.

Months before, when we asked questions about personal social services and community care, we were told that we should wait for the Griffiths report. We did so patiently, but now we are asked to be even more patient in awaiting the Government's response to it. I hope that the Minister will seize the opportunity tonight to tell us precisely what the Government will do about Sir Roy Griffiths' views. Virtually everyone who has spoken tonight has asked for such a response.

We have also heard mention of the 1985 report of the Social Services Select Committee, which contained 101 recommendations, and of the Audit Commission report. My hon. Friend the Member for Wakefield rightly reminded us that that report talked of community care being in disarray. All of our concerns about community care find some refuge in almost every section of the Disabled Persons (Services, Consultation and Representation) Act and I am grateful for the references made to it tonight.

The hon. Member for Mid-Kent spoke about advocacy. As he knows, that is in the Act. The hon. Member for Bolton, North-East spoke about consumers. If ever an Act attempted to reflect the views of consumers and to give them a say in service provision, this was it: its very title uses the word "consultation". Two and a half years on, it is extremely distressing to find that only a modest attempt has been made to implement that Act. Sections 1, 2, 3, 7 and 11—some would say these constitute the meat of the provisions for community care—have still not been implemented by the Government. We are entitled to ask, why not? At the time of the Act's passage, there was a great deal of support for it in both Houses. There still is, but millions of people with disabilities and their carers still wait for its full implementation.

As Christmas approaches, we should think about the problems of community care, if only because 90 per cent. of these people—the elderly, the mentally handicapped and the mentally ill—live in the community. Government funding does not reflect that proportion: quite the reverse. It concentrates on residential care or on the NHS. We certainly want proper funding for the NHS, but on the basis of a clearly identified strategy for community care, which recognises that people are entitled to enjoy independence in the community, properly supported by occupational therapy, the home help service and so on. People should not be driven as a matter of necessity, rather than of choice, into residential care, which may not be in their interests.

How can we ignore, particularly at this time of year, the housing crisis in this country? Housing investment has been cut in real terms by 60 per cent. under this Government. Council house starts are at an all-time low. Housing subsidies have been eroded. The consequences of this have been brought to our attention repeatedly, not least in Scotland by Mr. Laurie Naumann, the director of the Scottish Council for the Single Homeless. His document, called "The First Four Weeks", deals with unemployed homeless young people who know all about lost income support and YTS jobs that do not exist.

We condemn the Government's approach because it offers no clear strategy for community care or for evolving a relationship between the providers and consumers of care.

The Government talk of cost-effectiveness. There is not much evidence even of that, as was clear from the Griffiths and Audit Commission reports. The revolving door syndrome can be seen especially in the discharging of patients from long-stay psychiatric hospitals. There is nothing efficient about that. Section 7 of the 1986 Act makes it possible at least to deal with people who have been in psychiatric hospitals for six months or more. Many of them are sent out into community care that does not exist. Many find themselves in prison, or in places entirely unsuited to their needs. The Government's policy of running down hospital provision and closing wards and of not providing sufficient bridging funding is not a substitute for proper community care. In many ways, it weakens the concept of community care, as the Opposition understand it. The tragedy is that the Government are not even attempting to identify the problems nationally. Several times I have tabled questions to the former Minister, the hon. Member for Derbyshire, South (Mrs. Currie), and in reply after reply it appears that central information does not exist. There is no incentive for people to provide local plans.

I realise that time is running short and I am anxious to accommodate the Minister, so I end on this note. The Opposition's attitude to proper provision of community care represents a challenge to poverty, homelessness and neglect. For that reason, we cannot place all our faith in the free market. How can we, when in New York it has produced 30,000 former psychiatric patients on the streets? How can we do that, when we know of the problems that exist in London and in many other parts of Britain? We believe in a policy of mutuality of concern for service provision; in insisting on the rights of the consumer; and in a community care priority that is crying out to be met.