Community Care

Part of the debate – in the House of Commons at 4:47 pm on 17 October 1989.

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Photo of Robin Cook Robin Cook , Livingston 4:47, 17 October 1989

The hon. Gentleman should be on this side of the Chamber. The Government propose to leave registration inspection in the hands of local authorities. The Labour party proposes that registration inspection should be carried out by a national agency and not left with local authorities, but that is a debate that the hon. Gentleman can have with his hon. Friends and not Labour Members.

Local authorities are being invited to make long-term dispositions about residential care homes on the basis of the rigged market that will be introduced in 1991. The next Government will remove the absurd discrimination against the public sector. We shall restore to local authorities the right to compete fairly and the ability to be direct providers of residential care.

That brings me to the Secretary of State's second major departure from Griffiths. Griffiths recommended a specific community care grant to meet half the total expenditure of local authorities on community care. No specific grant was included in the Secretary of State's statement to the House. I was astonished when the Minister said that the Government had not yet made up their mind about that. It is perfectly clear from the Secretary of State's statement on 12 July that he had made up his mind. I asked a specific question about this issue, to which the Secretary of State replied: As to money and resources, we are following Sir Roy Griffiths's recommendation to transfer resources and the care element of social security to local authority budgets … We have not followed Sir Roy's recommendation for a specific grant."—[Official Report, 12 July 1989; Vol. 156, c. 982.] If the Minister is saying that the Secretary of State is having second thoughts, that is most welcome, but I should like to tempt the Secretary of State in his second thoughts to go beyond the specific minor element to which he referred—the transfer of the present social security provision to those in residential care. If that is the only commitment to money being diverted to local authorities and a specific grant, I warn hon. Members that we are not talking about large sums. We are talking not about the £1 billion that is currently given to those in residential care who are on social security, but about only the care element of funds that the Department of Social Security would otherwise pay out on persons admitted for the first time to residential care after April 1991.

The increase last year in DSS expenditure on residential care was less than £200 million. The Minister has not told us how much of that is the care element, but if we assume that it is about one third, we are talking about a transfer from DSS funds to local authorities of less than £100 million—perhaps £750,000 for every social services authority in England and Wales. We are not talking about sufficient grants to meet 50 per cent. of their community care expenditure. Local authorities are worried that they will not be receiving enough even to carry out the function of substituting for the DSS and maintaining people in residential care.

It is not enough for the Minister to dismiss the intervention of my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) as Dickensian. The point that she made about the under-funding of those who are currently on social security in residential care is well documented. A study carried out in Oxford identified almost one third of those residents having a shortfall in excess of £30 a week. A firm of accountants, on behalf of the British Medical Association, is studying that picture.

There is no mystery about it—the gap dates from 1985, when the Department of Health and Social Security changed the rules, no longer met the full fee of the homes and residential care and annually uprated only a flat charge, which in every year since 1985 has gone up by less than the rate of inflation. Tens of thousands of elderly people are driven frantic with worry because of a shortfall between what they receive in benefit and what is required to keep the roof over their heads. The nightmare for local authorities is that, if and when they get this new money transferred from the DSS, it will entirely vanish on topping up the shortfall that already occurs on existing provision, never mind fresh provision.

That brings me to the key question. If the Under-Secretary of State wishes to choose a question to which to reply from the multiple choice questions, this is the one that I would most prefer him to tackle. A new duty has been placed on local authorities to sponsor elderly and disabled persons who are admitted to residential care. Along with that, there is the duty to assess whether they are appropriately admitted to residential care. In this new system, if the local authority carries out the assessment and decides that residential care is appropriate, will it then be obliged to find a place and will it be guaranteed the resources to meet the cost of that place, or will applicants be told, "Yes, you are entitled to residential care and you pass the assessment for residential care but, sorry, we have hit our cash limits and we cannot afford to place you in residential care"?

The worrying feature is that we are moving from a system in which cash from the DSS is awarded to the individual on individual entitlement to a system that will be based on a fixed budget and will therefore be cash-limited. It is difficult not to conclude that the elaborate rhetoric of a new direction in community care conceals the fact that the Treasury has now got what it has long been looking for—a device to cap the bounding social security expenditure on residential care. The device will consist of sitting back and letting local authorities take the strain or, as Chris Heginbotham of the King's Fund expressed it rather bluntly, but tellingly, there is a real danger that local authorities will be "politically stuffed".

That brings me to the critical question of why there is no specific grant for the transfer of resources. As we understand it, the transfer of resources will be buried in the revenue support grant, where they will be so small that even the Secretary of State will require his best pair of ornithologist's binoculars to spot it. Certainly no one else will be capable of seeing what is going on, and that, of course, is what local authorities suspect is the intention behind not ring-fencing this transfer of resources.

The Minister asked about the voluntary organisations that I consulted. Every one of them pleaded for the transfer of resources to be ring-fenced so that it could be separately identified. The Minister keeps referring to the importance of the private sector. The joint care committee, which represents the commercial sector, is terrified about what will happen if the transfer is not ring-fenced, because it is worried that local authorities will not have the resources to meet the claims of the claimants currently in their homes.

I raised the matter with the Secretary of State in July. In responding to my intervention, he said that the separate specific grant proposed by Griffiths was intended as a control menchanism—the implication was that local authorities should be pleased that he was not imposing this control mechanism on them. Possibly the most remarkable voice in support of a specific separate grant is that of local authorities. They are willing to accept the deal of a specific grant for specific services. That is a control mechanism that they are confident they can meet. They want it also because it will be a control mechanism on the Secretary of State as well. A specific grant would make it clear to everyone how much he was putting into community care and who was responsible if it was not enough. the person dodging the control mechanism is the Secretary of State; it is not the local authorities.

The Minister's comment on the carers of those in need of care was welcome and generous. However, the House should recognise that the bulk of care in the community is met by informal carers, by which—let us be blunt about it —we mean the nearest female relative, time after time. It is impossible not to salute the dedication and sacrifice of those carers. The Minister of State went to the AMA conference the day after I did, and no doubt found as I did that every delegate to that conference had been deeply moved at the plenary session when a number of carers had been specifically selected by Tessa Jowell to talk about their experiences and needs. They included one woman for whom that was the first hour in two years in which she had been out of the house and away from the person for whom she was caring.

The Minister is right to say that we cannot be pious in deriving a warm glow of satisfaction from contemplating the devotion of those carers, but the response of the House in contemplating that dedication and devotion should be shame—shame that we provide so little help to them, that we do not provide any training for them and that we provide little respite care and minimal relief for them.

There are undoubtedly a number of pertinent questions that can be asked about the Government's intentions. One set relates to how the Government intend meeting the need of those carers for an income of their own. I am glad that the Minister for Social Security is with us, because the way in which this Parliament has treated the benefit rights of carers is a disgrace. If the carer lives with somebody who claims social security, it is almost certain that, by definition, that person was one of those getting higher social security levels, based on allowances and extra payments for heating, diet and other needs, all of which were abolished in April 1988. Therefore it is likely that such a carer now finds himself or herself stuck in a household on transitional protection, with a frozen income for the past three years. If the carer was on social security in April 1988, she would have found herself in April 1988 in the only group on long-term supplementary benefit which got no premium on transfer to transitional protection, and therefore she would have lost the equivalent of £5 a week.

I was deeply moved a couple of months ago when I read an article by a woman who gave up work four years ago to nurse her terminally ill sister. She explained how she got out of the house only twice a week. At the end of those four years of constant nursing and after her sister died, she applied for unemployment benefit because her invalid care allowance had expired. When she applied for benefit, she was told that she did not qualify because, as a result of the Social Security Act 1988, credits for ICA no longer counted towards unemployment benefit.