Community Care

Part of the debate – in the House of Commons at 4:01 pm on 17 October 1989.

Alert me about debates like this

Photo of Mr David Mellor Mr David Mellor , Putney 4:01, 17 October 1989

It is an interesting question, but my response will not give my hon. Friend any satisfaction. Tax relief is a matter for my right hon. Friend the Chancellor of the Exchequer.

I was saying by way of introduction that, while we all can agree on the need for an effective framework for community care, it is not a policy that can be easily implemented successfully. We have increased sharply the resources and the manpower that are devoted to community care over the past 10 years. As I shall demonstrate, these have been years of achievement in community care. As a central starting point and as an evidential base on which the debate can proceed, I shall explain what the achievements have been. It is equally clear, however, that, notwithstanding the achievements, we must recognise that progress in developing adequate services has not been as even or as rapid as we would like; hence the need for further effort.

Over the past 10 years there has been unprecedented expansion. For example, during the financial year 1978–88, the cost, as best as we can estimate it, of core community care services, not including administration or joint finance, was £3,444 million as against £1,169 million in 1979–80. In eight years we have witnessed an increase of 68 per cent. in expenditure of core community care services in real terms.

Back in 1979, about 55 per cent. of local authority gross expenditure was on residential care for elderly people, younger disabled people, mentally handicapped children and adults and mentally ill people, with 45 per cent. on domiciliary services. By 1987–88, local authority gross expenditure was more evenly balanced, with slightly over 50 per cent. on residential care and just under 50 per cent. on community-based services, especially on home helps, day-care centres, meal services and adult training centres.

That is a sign of movement in the direction of domiciliary services that I am sure we would all like to see enhanced as a result of our acceptance of the new framework that Roy Griffiths proposes. Most of us who deal with these matters in practical ways at our advice centres week in and week out are aware that most people would rather stay in their own homes for as long as possible if proper support can be provided, and go into long-term residential care only as a last resort.

We are in the middle of a two-decade span, when the number of the old elderly in our society—that is, those over the age of 85—will double, and it is quite clear that there will be an enhanced, not a diminished, need for long-term residential placements. We must be aware of the impact of demographics on provision, because not only do we aspire to do better for those in need of community care now, but we must recognise that, year on year, as we progress through the 1990s, there will be more people in that category. That poses a challenge not only in making resources available, but in ensuring that they are used to the maximum benefit to provide the best possible care. There is manifestly no room for waste at such a key time.

During this decade there has been a sharp increase in the number of places at day centres—up by 16 per cent.; an increase in home help staff of almost 30 per cent.; an increase in the number of meals served by meals-on-wheels and lunchtime clubs of about 14 per cent.; and a significant growth in a whole range of other personal social service provision. I am confident, looking ahead to the next decade, that there will be a similar increase in that provision; and some even envisage an enhanced increase.

In the presence of my hon. Friend the Minister for Social Security, I should also point out that the same period has witnessed a striking growth in social security payments to people in need. I have already singled out the increase in independent sector residential and nursing home support, which has risen a hundredfold, from £10 million to £1 billion in May this year. I must repeat that, when committing such large sums of public money, it is our duty to ensure that it is spent in the best and most appropriate way to provide care for the clients that best meets their needs. It is in that spirit that we asked Roy Griffiths to undertake his analysis. It is in that spirit that. I believe he delivered one of the most cogent and worthwhile reports in recent times on this or any related topic. It is in that positive spirit that we have accepted his analysis and are inviting the House to debate and discuss it.