Community Care

Orders of the Day — Opposition Day – in the House of Commons at 10:25 pm on 1st March 1994.

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Photo of Mr John Bowis Mr John Bowis , Battersea 10:25 pm, 1st March 1994

I beg to move, That the Special Grant Report (No. 10) (House of Commons Paper No. 218), which was laid before this House on 17th February, be approved. This report sets out the proposed allocation of the special transitional grant to local authorities in England for the next financial year for expenditure on community care services. It also describes the main features of the grant and the conditions that the Government intend to attach to its use.

I am always happy to discuss the success of community care policy. At this time last year, we were knee-deep in predictions of doom and disaster, and I am pleased—but far from surprised—that we can now look back on a very sound and promising beginning.

No one was more keen to forecast doom and gloom than the Labour party. The Opposition are like Christopher Robin on an off day—kneeling at the foot of their beds praying that something will go wrong. How cross they were when it did not. They said that community care would be underfunded by about £1 billion. Then they dropped their bid to £70 million—I suppose that that was a mere blip in Labour economics.

Social services departments had the nerve to say that they thought that the funding was fair and were savaged by the hon. Member for Sheffield, Brightside (Mr. Blunkett), to the extent that he provoked a response in Community Care magazine from the director of social services in the London borough of Croydon, who said: Having failed to alter the national political map for the past 13 years, Blunkett, like so many other disgruntled and frustrated politicians, goes home and kicks the cat; In this case local councillors and directors of social services. They kicked in vain, however.

The report represents the Government's tangible commitment to the continued success of the new arrangements. It transfers about £736 million to local authorities. Taken together with the funding rolled forward from the current year, that means that, next year, authorities will have more than £1·2 billion available to meet their new community care responsibilities.

Most authorities now realise that, used sensibly, that is sufficient for the job. That sum is, of course, in addition to the personal social services standard spending assessment resources, a substantial part of which has always been used for domiciliary and day services and public sector residential care.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Environment, Food and Rural Affairs)

I have just come to the House from a meeting about the Government's proposed plans to run down Guy's hospital. Do the figures—in Southwark's case a little more than £6 million—allow for the additional burden on the community care budget of the plans for reducing services in some parts of the capital's health service?

Photo of Mr John Bowis Mr John Bowis , Battersea

The hon. Gentleman referred to the increase that Southwark council is to receive this year. He got the figure wrong, but he got right the fact that it is an increase—from about £56 million to about £66 million, which is an increase of 16·4 per cent. If Southwark council is well managed and can use its resources efficiently—he will have to tell me whether it is, and whether it is capable of doing that—it will certainly be able to cater for the community care needs of people in the borough during the coming year.

I was saying that I was especially glad that this year we have been able to include a further £20 million in next year's grant over and above the total that had previously been announced. I hope that that will please the hon. Member for Southwark and Bermondsey. The aim is to encourage the further development of respite and home care services.

Indeed, the level of diversification, enabling people to have a real choice between staying in their own home—where possible—and moving to residential care is one of the success stories of the past 11 months. In many parts of the country, diversion to domiciliary care is proceeding faster than anyone had expected, and we are getting reports of rates of 10 per cent. or more. That is one of the factors that have allowed us to speed up some of the transitional aspects of the grant.

In particular, we have been able to phase out the use of historical data about income support claims from residents of care homes and nursing homes as a basis for distributing the grant between authorities. Instead, we can now use the personal social services standard spending assessments exclusively, the same basis as for virtually all other social services funding. The effects of the move will benefit more than two thirds of authorities.

Another of this year's successes has been our commitment to real choice for users of community care services, whether residential or domiciliary. Continued success depends on a continuing diversity of service providers, especially in the. independent sector. I have, however, been disturbed by the number of complaints that I have received from proprietors and managers of private and voluntary care homes who allege that some local authorities are willing to waste money by ignoring the independent sector and placing people in much more expensive council-owned establishments.

The importance of the independent sector to community care reforms can hardly be overstated, and the Government will continue to support its role.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

As the Minister said, choice is an important issue. Will he acknowledge that the requirement in the current and the next financial year to spend 85 per cent. of the special transitional grant in the independent sector restricts choice? In many instances, it means forcing people into expensive institutional care because of the lack of domiciliary care and support at a local level.

Photo of Mr John Bowis Mr John Bowis , Battersea

Of course it does not. Before community care, 100 per cent. of the moneys that came from social security went to the independent sector. We are talking now about the 85 per cent. of the transfer element that we are asking—indeed, requiring—local authorities to spend in the independent sector. It is a modest demand and has nothing to do with the disbursement of the moneys that were previously spent on domiciliary and day care and which came from the broad social service budgets.

I hope that the hon. Gentleman will encourage his colleagues in local government to play their part in ensuring that the independent sectors—private and voluntary—can diversify and help to provide a wider choice for people, whether for residential or domiciliary care.

Local authorities should use their purchasing power to develop and stimulate new independent sector services, especially in the day and domiciliary spheres. I expect authorities to consider all potential providers and to strive for quality and value for money at all times. The independent sector has been a major player in community care services for many years, and its expertise must be harnessed to the challenges of the new policy. I want private and voluntary providers to be fully involved in the planning and provision of the range of services needed.

Photo of Hugh Bayley Hugh Bayley , City of York

Will the Minister acknowledge that changing from a formula based partly on income support payments and partly on SSAs to a formula based wholly on SSAs seriously disadvantages some authorities? In a letter to me three weeks ago, he said that such a distribution mechanism involves both winners and losers". He went on: I recognise that there are some authorities, like North Yorkshire, whose special transitional grant will be lower next year than they had been anticipating. In fact, it will be more than £3 million lower, even after assurances that the change would be phased in over a number of years. How does the Minister expect an authority such as North Yorkshire, which has a traditionally low spend—in my view, too low a spend —on social services for the elderly to deal suddenly with a £3 million cut in its budget without severely disadvantaging the elderly people who rely on its services?

Photo of Mr John Bowis Mr John Bowis , Battersea

I know that the hon. Gentleman will be in close touch with the North Yorkshire social services department, and I ask him to go back and discuss with it the precise figure that we are offering this year. He will find that, instead of a cut, there is an increase of about £10 million—or 15·2 per cent.—for social services as a whole. Will he then ask why, if the social services department in his county is so concerned about its ability to look after local people in need, the authority has underspent by about £5 million on its social services budget in the current year? There was £55 million in its standard spending assessment for this year, but only £50 million in its budget.

We shall again require all authorities to use most of their grant on services provided by the independent sector. Moreover, that condition is cumulative, so that next year authorities' independent sector expenditure must increase significantly over that for this year. I shall also give some thought to our definition of the word "independent". [Laughter.]

The hon. Member for Brightside laughs, and I am not surprised. Many people have laughed at some of the devices employed. I have serious doubts about some homes that in theory have been transferred from councils to charitable trusts and so on, but which do not seem to be truly free from local authority interference and influence. If I think it necessary, I shall amend the definition in the condition accordingly.

Photo of Alan Simpson Alan Simpson , Nottingham South

Will the Minister comment on our experience in Nottinghamshire, where, when the county council was forced to contemplate the closure of homes, several housing associations and not-for-profit associations in the voluntary sector went through the books with the council to find out whether they could run the schemes?

What am I to say to the housing associations whose representatives have written to me explaining their reason for pulling out of such a transfer was that, on the basis of the existing formula, they would not be able to run the homes without reducing staffing standards to dangerously low levels that would threaten the standard of care for the residents?

Photo of Mr John Bowis Mr John Bowis , Battersea

For a start, the hon. Gentleman would do well to examine the current record of Nottinghamshire social services department, which is indeed giving us great cause for concern. I have had to invite the director and chairman to come to my office to discuss the situation, and to see how they can put Nottinghamshire social services back on a proper, fair and just footing.

I also suggest that the hon. Gentleman considers the figures and, realising that this year Nottinghamshire's resources will increase from £108 million to £122 million, sees whether he can persuade the county to provide a decent service in the best interests of the people of Nottinghamshire.

We provide more than financial support. We have put in place a careful programme of monitoring and evaluation, and every authority has been visited at least twice to discuss progress, and to offer advice where appropriate. The outcome of the monitoring has been encouraging, and I have already referred to some of it. Not only are the basic structures all in place, but it is clear that people are already being offered more appropriate support.

Generally, people who would previously have looked to the social security system for-support can now get a timely assessment of their needs. There do not seem to be widespread backlogs. However, a number of authorities report that their procedures have turned out to be over-complex. They are reviewing them, and I hope that that will lead to simpler and more comprehensive procedures. I am also conscious of the message that I have received from my own national users and carers group that the information and communications for users and potential users leaves room for considerable improvement.

Fortunately, a great deal of enthusiasm and energy seem to be going into improving consultation with and involvement of both users and carers. There are welcome signs of users and carers becoming much more involved in the assessment procedures, although there is still a long way to go.

Photo of Mr Michael Stephen Mr Michael Stephen , Shoreham

Is my hon. Friend aware that many independent care home proprietors are worried because local authorities are unfairly preferring local authority homes when making referrals, and also unfairly applying much higher inspection standards to private care homes than they apply to their own premises?

Photo of Mr John Bowis Mr John Bowis , Battersea

I am aware that that is alleged, and also that, if it were happening, it would be wrong, because public sector homes are required to be inspected and assessed according to the same standards as are set for voluntary and private sector homes.

I am equally aware, as my hon. Friend says, that, in some parts of the country, perhaps in parts of his own area, there are examples of people being persuaded to go into residential care homes in the public sector which are more expensive than appropriate and suitable accommodations available in the independent sectors.

Photo of Mr John Bowis Mr John Bowis , Battersea

I am responding to an intervention from my hon. Friend.

The Audit Commission is one of the monitoring organisations which consider the cost and value for money of community care, and I expect it to draw it to the attention of local authority social services departments should it find that that is the case. Of course, that will become apparent as the year progresses.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

On the issue of the choice of people and the question of the use of local authority accommodation, is it not a simple fact that vast numbers of older people prefer to go into local authority accommodation because that accommodation is of a good standard, and especially because it is often located in areas where those people have lived all their lives? The Government are destroying that choice, because they are deliberately attempting to close down local authority accommodation. Where does the choice of local authority homes lie in the Government's policy?

Photo of Mr John Bowis Mr John Bowis , Battersea

It is for local people, local authorities and local social services to decide the sort of provision they may or may not wish to provide in their own sector. It is also up to them to purchase, on behalf of people whose needs they have assessed, suitable accommodation in residential care where that is the preference—as opposed to domiciliary care—of the individual who has been assessed. That individual should then have a choice under our statutory direction of choice on the home to which he or she is directed. That choice can be there in the public sector as in the independent sectors.

What I am saying, what my hon. Friend the Member for Shoreham (Mr. Stephen) is saying and what far too many care home managers and owners are saying, is that, all too often, that choice is not real in Labour authorities, which seek to promote their own homes at the expense of choice for the individuals who wish to choose homes in the independent sectors. I hope that the hon. Member for Wakefield (Mr. Hinchliffe) will begin to support us on that line, instead of showing his innate hostility to the private sector.

On bed blocking, the dire predictions of some people have also happily proved unfounded. Some parts of the country are reporting lower levels than before April. There have been some small isolated problems, for which local managers have been prepared and which they have been able to deal with, as we expected.

Joint working between local authorities and the national health service is also generally good. The agreements we required them to make on discharge arrangements and placements in nursing homes have had a positive effect, and there are welcome signs of commitment to joint development. That condition is one that I am repeating this year.

That is the big picture, but I have also been impressed by earlier reports of what it has been possible to achieve for individual users of services. For example, the lady with a husband suffering from dementia who wanted him to be cared for at home has been able to receive 28 hours of home help each week, district nursing, and two weeks' respite care in every six.

Another lady with significant health problems, who would previously have had to enter a residential care home, has been able to stay in her own home, thanks to a comprehensive package of care—meals on wheels, home help seven days a week, respite care to ease her isolation, district nursing, various aids and adaptations and a laundry service. All the ladies so worried about coping alone—

Photo of Mr John Bowis Mr John Bowis , Battersea

Of course, the Opposition do not want to hear these things, because they are examples of the success of the policy. As I began by saying, they are only happy when they think that the policy is not working. If they will listen, I am giving examples of people who are benefiting from the policy, such as the lady who was so worried about coping alone that she was thinking of moving into residential care, but was reassured when her local authority arranged for someone to visit each night before she went to bed to ensure that the gas was turned off and the house was locked up.

Photo of Mr John Bowis Mr John Bowis , Battersea

In a minute.

Equally, I have seen good examples of the provision of residential care, such as the lady who woke up one night to find a burglar in her room and decided that she needed to move to a home for reassurance and company, and who was able to choose a home where friends of her Church of denomination were living.

Photo of Tessa Jowell Tessa Jowell , Dulwich

I am sure that hon. Members on both sides of the House celebrate examples where community care is working well. Can the Minister tell the House which authorities these examples have been taken from?

Photo of Mr John Bowis Mr John Bowis , Battersea

I wish that the hon. Lady would replace some Labour Front-Bench Members, because this is the first time that I have heard from Labour Members a recognition that the reforms are going well? When we produce examples selected—

Photo of Mr John Bowis Mr John Bowis , Battersea

—from around the country as a result of the monitoring process, the hon. Lady will celebrate those successes, even if Labour Front-Bench Members will not.

It has been said that the implementation of the community care reforms marked the beginning of a decade of change, rather than an overnight revolution. That is perfectly true. It is now clear that the early days of the reforms represent a satisfactory foundation for that decade —a view shared by many other observers, including the Audit Commission and the Association of Directors of Social Services. [Interruption.] The Opposition spokesman on health is in the wrong debate. This is about local authorities in England. If he listens, perhaps he will learn some lessons for Wales as well.

Photo of David Blunkett David Blunkett Shadow Secretary of State for Health, Member, Labour Party National Executive Committee, Party Chair, Labour Party

Given the Minister's flattery of my hon. Friend the Member for Dulwich (Ms Jowell), perhaps he will now answer her question and tell us which English authorities he drew his examples from.

Photo of Mr John Bowis Mr John Bowis , Battersea

I have already told the hon. Gentleman that the examples come from a variety of areas of the country, and we could give him many more if he so wishes.

The point is that the policy's success is a tribute to the considerable efforts made up and down the country by local authorities, health authorities and users and carers. We need to be vigilant to ensure that that progress continues. I look forward to the next year of community care with some confidence, and I commend the report to the House.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield 10:46 pm, 1st March 1994

The Opposition welcome this opportunity to have an albeit brief debate on Special Grant Report (No. 10). I think that people would be alarmed if they knew how rarely we get the opportunity in the House to discuss such an important subject as community care. As the Minister said, the report contains the amount of grant to be made available to individual local authorities during the second year of operation of the changed community care arrangements.

In view of the Minister's comments, it is worth reminding the House that Labour supported the broad thrust of the community care provisions in the National Health Service and Community Care Act 1990 as a means of unravelling the mess created by the Government's ill-thought-out, publicly funded expansion of private institutional care.

In many respects, the arrangements set out in the report are still constrained by the same Government preoccupation with the market that we heard throughout the Minister's speech. That preoccupation led to the need for the 1990 changes in the first place. Labour believe that as long as Government policy remains more concerned about the interests of private providers of care than about service users and their carers, genuine community care reform will remain a long way away.

As the Minister is well aware, the central motivation for the changes introduced last April was Exchequer anxiety over the soaring cost of DSS expenditure on income support claims made by residents of care and nursing homes. Following a change of policy in 1981, those rose from £11 million per annum to £2·5 billion per annum in the past financial year, and constituted a £10 billion investment in the resurrection of institutional care as the central plank of the Government's community care policy. A vast number of people entered private residential care and nursing homes without any formal assessment whatever, and many could and would have been able to remain in their own homes if some of those resources had been invested in genuine community care.

Last April's changes aimed to address what has been now recognised as the gross misuse of public funding. The Opposition fully supported the introduction of care planning at local authority level and, in particular, the arrangements for assessing care needs. Our worry, however, is that in the funding arrangements for both the first and the second year of care, the changes are placing deliberate barriers in the way of the achievement of progress in community care provision.

When the House debated the current year's funding arrangements on 11 February and 3 March 1993, as set out in the special grant reports 6 and 7, I made clear the Opposition's concern over the adequacy of grant mechanisms used for its distribution, and the requirement on local authorities to spend 85 per cent. of that in what the Government call the independent sector. I wish to reiterate some of these concerns tonight, but, before I do, perhaps I can issue one word of welcome to the Minister. He should make the best of it, as it might be the only one he gets.

The Minister is aware that the Opposition felt that the formula used to distribute the current year's special transitional grant was profoundly unfair, and that it verged on the bizarre. The grant was based 50 per cent. on the individual local authority's standard spending assessment and 50 per cent. on the previous income support claims by people in private care and nursing homes in the area. The nonsense of that formula was that it was weighted heavily in favour of councils with the most private care and nursing homes, despite the fact that many of the residents concerned originated from other local authority areas and had preserved their entitlement to continuing income support payments being unaffected by the changes.

I know that the Minister was concerned about the unfairness of the formula. He intervened during the speech of the hon. Member for Suffolk, South (Mr. Yeo) during the debate on 3 March, and said: the allocation is perhaps weighted towards rural areas—as opposed to the inner cities"—[Official Report, 3 March 1993; Vol. 220, c. 401.] The Minister shares my concern about that point.

The unfairness of the formula to which I have referred was brought home to me most strongly when I went to an establishment in the constituency of my hon. Freind the Member for Tooting (Mr. Cox). Nightingale House, which may be known to the Minister, is a Jewish home which is jointly registered as a care and nursing home, and offers nearly 400 places. Many of the residents receive income support and their claims counted in the grant calculation for the local authority in which the home is situated, even though most of the claimants originated from other local authority areas.

It is clearly coincidental that the local authority gaining grant in this way is Wandsworth, because, in certain other respects, that authority, like nearly all London boroughs and many metropolitan authorities, lost out badly under the formula used during the current year. If the funding had been distributed on the basis of SSA—as it will be in 1994–95—Wandsworth would have nearly £900,000 more in its existing budget.

The fact that London boroughs alone lost nearly £25 million as a result of the first year of community care changes puts the Secretary of State's announcement last Thursday of an extra £10 million for London's mental health provision into some perspective.

Regardless of arguments about the overall care funding, the majority of local authorities—68 out of 108—lost substantially on the grant that they received during the first year. Sheffield lost over £2 million, Southwark lost £1·7 million, and Leeds lost £1·3 million. Smaller authorities such as Wakefield—my own local authority—lost nearly £1 million. Those are huge chunks of resources which should have been made available on the basis of the Government's calculation of population needs.

Many councils have struggled desperately to make decent care available against a background of the totally inadequate special transitional grant and, according to the Association of Directors of Social Services, alongside spending freezes and cuts in the base budgets of social services departments in the current year. The association obviously welcomes the fact that the Government have abandoned their previously discredited distribution formula and, in this report, are moving to SSA as a basis for the formula.

While the Opposition applaud the Government's long-overdue conversion to common sense, we would strongly press the Minister to address the problems that have arisen during this first year because the formula was completely wrong.

First, the Minister should address the serious difficulties facing those authorities that have lost out on millions of pounds in the current year. Secondly—this point was made by my hon. Friend the Member for York (Mr. Bayley); my hon. Friend has left the Chamber, but he made an important point—the Minister should recognise that authorities that gained in the first year will, in many instances, come down to earth with a severe bump as a result of the contents of the report. The Government have bungled the funding arrangements badly and made the proper planning of community care year on year a total impossibility.

The original funding formula was badly skewed because the Government acceded to pressure from the private care home industry, which feared the impact of the care changes. The difficulties facing so many local authorities stem from the fact that the Government take more notice of the business interests of private providers than the needs of users and carers. They relate to a manifestly inappropriate market ideology at Government level, which is holding back in so many ways properly planned and thought-out responses to the needs of users and carers. The Minister's speech was full of phrases such as "use of the independent sector". The Government's policy is not to provide what people positively choose or need. It is use of the independent sector, right or wrong. That is not good enough.

The Government have conceded that their previous distribution formula was wrong. But in this report, they continue to shackle the development of genuine community care, again by insisting that 85 per cent. of the special transitional grant should be spent in the so-called independent sector. That requirement stems purely and simply from an ideological desire by the Government to protect the interests of private care providers and extend their involvement into domiciliary care.

The Government are again putting their obsession with market forces before the real interests of those who receive services. That obsession is clearly preventing the provision of a range of services geared to offering alternatives to institutional care.

I am sure that the Minister will be aware that social services directors and local authority associations have urged the Government to review their 85 per cent. requirement because it obstructs proper community care provision. I have no doubt that the Department of Health's intelligence networks have advised the Minister that in the past few weeks the Labour party has undertaken a survey of directors of social services on the impact of the 85 per cent. requirement. We shall publish the detailed results within the next few weeks and, as usual, I shall sent the Minister a copy.

The initial findings of the survey are worrying. It is clear from the range of responses received that the 85 per cent. requirement means for many people unnecessary admissions to residential care because in various parts of the country private or voluntary sector domiciliary care remains either non-existent or minimal. It says a great deal about the Government's priorities on community care that they are prepared to see unnecessary and expensive institutional care used inappropriately because of a dogmatic refusal to allow special transitional grants to be used to extend and improve local authority care home provision.

The Minister will recall that, shortly before Christmas, the chief social services inspector and the chief executive of the national health service management executive wrote local authorities a letter saying that their decisions on community care expenditure should be based on value-for-money grounds. But we have been told by local authorities in the survey that we have undertaken in the past couple of weeks that the requirement to spend 85 per cent. in the independent sector is bringing them into direct conflict with that directive. It is causing them to misuse and waste their scarce resources in unnecessary admissions to institutional care. Will the Minister state which directive has precedence—the 85 per cent. requirement or the Laming-Langlands letter? I shall give way if the Minister wishes to respond to this point because I could do with a drink of water.

Photo of Mr John Bowis Mr John Bowis , Battersea

If the hon. Gentleman had listened to what I said in response to his intervention in my speech, he would recall that I reminded him that, in the past, what is represented by the 85 per cent. for the independent sector was 100 per cent. for the independent sector. We are talking about the money that previously went direct to the independent sector to look after the residents in those homes. Substantial resources are available from the social services general budget which traditionally have been used to support people in part III homes and in domiciliary and day care.

I should like to know what the hon. Gentleman is doing to ensure that authorities controlled by his party look to use that money sensibly, wisely and in the best interests of individuals. It is in their interests that the widest possible choice is made available. That includes, of course, the services provided by the independent sectors, private and voluntary.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

The House will have noticed that the Minister failed to answer the question that I put to him. I repeat that question. Does the 85 per cent. requirement take precedence over the Laming-Langlands letter? it is as simple as that. The House requires an answer—[Interruption.] If the Minister has now received a message from his officials, I shall willingly give way to him again.

We have clear evidence that the 85 per cent. requirement is forcing people into unnecessary and expensive institutional care that they do not need. Local authority directors are telling us that, and they must be telling the Department of Health. What will the Minister do to unravel that mess? Does he wish to intervene?

Photo of Mr John Bowis Mr John Bowis , Battersea

indicated dissent.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

He does not wish to do so—the House will draw its own conclusions from that.

I want to make it clear that the Opposition's argument is not simply that there has been an underinvestment in community care. The Government, through their obsession with private provision—which the Minister mentioned throughout his speech—have grossly misused the resources provided.

What could have been achieved if much of the £10 billion investment, through supplementary benefit and income support payments in private residential and nursing homes, had been used instead to develop real community care where people need it? People need home care, day care, day and night sitting services, meals provision, communication technology, aids and adaptation, respite provision and the range of mental welfare services that can provide safe and caring alternatives to psychiatric hospitals. What could have been achieved if the Government had not abandoned community care to the market?

The Government are now trapped. Private home owners are screaming at them because referrals for permanent care are falling—we have heard their views represented tonight by Conservative Back Benchers. How sad it is that the Government seem to see their task as ensuring a continued and wholly inappropriate use of outdated institutional provision simply because it is in the private sector. The Opposition recognise that the non-statutory sector has a role to play in care provision, but that role has to advance the development of community care, not hold it back.

Photo of Mr David Congdon Mr David Congdon , Croydon North East

If the hon. Gentleman means what he says, why does he not encourage social service departments to promote the development of the private sector in domiciliary and home help services rather than obstruct their development?

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

Unlike, I suspect, the hon. Gentleman, I worked for many years in a social services department. When dealing with someone in need, one does not bother about which sector provides the services, but merely tries to provide for that person's needs. The hon. Gentleman suggests that social services departments, with all their massive daily pressures, should have to spend time on trying to find entrepreneurs, who simply do not exist in many areas.

The second issue that the hon. Gentleman should consider is that such providers are not regulated or inspected. They are not registered, and could come straight out of prison or from the courts, with all sorts of convictions. They could enter people's homes and offer domiciliary and physical care. They could be dealing with an old person's finances—the Labour party do not believe that such people should offer community care.

Photo of Mr Andrew Rowe Mr Andrew Rowe , Kent Mid

The hon. Gentleman paints a picture of a divided Britain that I find distressing. In my local district, the purchasing authority has made it perfectly clear that it will not buy services from people who do not meet the standards that it has laid down. It has had no difficulties, and I do not understand why other local authorities cannot make the same decisions.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

I know that the hon. Gentleman takes an interest in social services, for which I commend him. But he has missed a fundamental aspect of the checks and guidelines on domiciliary care, as has the Minister. We are assuming—as the Minister does constantly—that all domiciliary care is provided through the contracting process. Vast numbers of elderly and disabled people purchase domiciliary care directly, without the involvement of the local authority. They have no safeguards. The fact that the Government are not acting on that is disgraceful, and the Minister knows it.

Photo of Mr John Bowis Mr John Bowis , Battersea

The hon. Gentleman is missing the point. Greatly increased resources are available to social services departments. He said that he used to work in a social services department; I bet that he never had a year such as Wakefield did this year. with resources increasing from £29 million to £40 million. More money is available, and if we are asking for a proportion of that to be spent in the independent sector, that means more money for domiciliary care in the independent sector, over which there is control through the contractor. We are able to ensure that standards are required of the voluntary or private sector placing tenders for domiciliary services.

The problem is that too many authorities run by the hon. Member's party refuse to put out a specification so that the independent sector can tender at all.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

I am happy to debate until the cows come home the position of Wakefield social services and its financial situation. Nobody was more surprised than the acting director of social services in Wakefield when the Minister quoted those figures last Tuesday. I have a letter here which, if the Minister cares to read it, I will pass over to him and which shows that the way in which the Minister has come to calculate the questions is beyond everybody in Wakefield.

If the transitional grant is put to one side, there is to be a real reduction in the revenue budget for 1994–95 of £400,000, in order that the council can avoid being capped. When the Minister talks about SSA, special transitional grant and all the other things that he mentions, he seems to forget that, although we are being given all these generous resources, local authorities, including a responsible local authority such as Wakefield, are also being capped. I am proud of my local authority and I will debate with the Minister, if he wishes, the issues of deep concern to me in my own locality.

I was saying that the Opposition genuinely recognise that the non-statutory sector has a role to play when it is developing community care, innovating, offering new services; but the sad fact is that in so many respects the private sector, in particular, is hanging on to outdated models of institutional provision that are totally inappropriate to this day and age.

I have certainly seen in the private sector excellent examples that can offer something of genuine relevance to people's comunity care needs. I have looked in some detail, as I think the Minister is aware, at communication technology, where what is on offer from the private sector enhances real choices and opportunities for those in need of care and does not hold back the development of community care, as is unfortunately happening in some respects at present.

I urge the Minister seriously to consider the problem being caused by the 85 per cent. requirement. I am not suggesting that he drop the specific quota in its entirety, as I understand the need to safeguard the voluntary sector, in particular, for example, in those areas concerning drug and alcohol provision where the voluntary sector has a specific role to play—a role of which the Minister is well aware and which, like me, he values very much. But the 50:50 split suggested by the local authority associations would, I am sure, enable a radical improvement in care provision and overcome many of the problems that I have mentioned.

The Minister has again implied that the Government have been somehow generous in their special transitional grant provision. It is important to make it clear that the STG is money for new local authority responsibilities which would have been spent anyway by the Department of Social Security. May I press him again on the point that he did not answer in last week's health Question Time and which he has not referred to tonight? If the funding is, as he suggests, so generous, why are the Government urging local authorities to introduce charges for basic care services that have been freely provided in many areas from the time that they were first introduced? He must be aware that that is a matter of huge concern in various parts of the country, especially, for example, to the parents of young people with learning disabilities who find themselves being charged quite high prices for the attendance of their sons and daughters at day care establishments. Many people feel that to be totally inappropriate and highly insensitive. I should welcome the Minister's comments on that point.

Our debate takes place against the background of growing public concern about the Government's community care policy. As the Minister knows, my party has consistently supported the development of community care, but we recognise that the Government's commitment to market forces in health and care obstructs and undermines strategic planning at national and local level and the achievement of a seamless service.

It is an unfortunate coincidence that tonight's debate takes place only a few days after the publication of two separate reports concerning the care of the mentally ill, both of which expose the fundamental contradictions of Government policy. The first, with which the Minister will be familiar, was commissioned by the North West Thames health authority and found that managers of a proposed health trust were so obsessed with achieving trust status that they neglected disturbing shortcomings in care that may have contributed to the deaths of some 14 patients.

The second report concerns the case of Mr. Christopher Clunis. I am surprised that the Minister did not refer to that important and tragic case. Mr. Clunis, who suffered from schizophrenia, caused the death of Mr. Jonathan Zito in December 1992. The report clearly demonstrates that the Government have yet to start proper co-ordination and collaboration of care provision at a local level. It exposes how the lack of resources contributed to that appalling tragedy and shows how limited the alternatives to hospital care still are.

I am genuinely sorry that the Secretary of State, who is not present in the Chamber tonight, chose to try to make political capital out of this issue at the weekend, singling out a Labour council for specific mention, when page 105 of the report clearly states: We do not single out just one person, service or agency for particular blame". I pay sincere tribute to Jonathan Zito's widow, Jayne, who, since her husband's death, has campaigned ceaselessly and courageously for proper care and help to be given to the likes of Christopher Clunis. I urge the Minister to listen to her message—a message not of vengeance and malice but of genuine concern for the likes of her husband's killer who, as she says, have been condemned to a life of degradation and poverty. On Thursday, she said: It is not enough to make a market out of mental health. These people need care and supervision. You cannot compete when you are dealing with people's lives". For those very reasons and the other concerns that I have expressed, I urge all hon. Members who share our anxieties about community care to join us in the No Lobby at the end of the debate.

Photo of Mr Barry Field Mr Barry Field , Isle of Wight 11:11 pm, 1st March 1994

May I congratulate you, Mr. Deputy Speaker, on the 20th anniversary yesterday of your arrival in this House? My hon. Friends and I hope that it will be many years before you require community care.

I am pleased to follow the hon. Member for Wakefield (Mr. Hinchliffe) because he attended the conference on the Isle of Wight when my right hon. Friend the Secretary of State announced the ring fencing of funds for community care. I know from recent conversations with the hon. Gentleman how seriously he takes community care. He observed me in the Members' car park with my car engine running and was so concerned about my welfare that he returned three hours later to make sure that I was all right.

On the Isle of Wight, 26·4 per cent. of the population are of pensionable age. That is the 17th highest percentage in England and Wales, where the national average is 18·7 per cent. Moreover, 18·8 per cent. of households consist of one pensioner living alone, which is 3·7 per cent. above the national average of 15·1 per cent. Care in the community is, therefore, of considerable importance to the island.

I wish to raise two points. The first concerns Haylands farm at Ryde, which was formed under the auspices of Mencap in 1977 and provides sheltered work for mentally handicapped students. It has a number of sheep and goats, sells 300 eggs locally, and rears pigs that are sold as meat. The farm extends to more than 16 acres, most of which are owned by the Isle of Wight county council, which charges a fair and unsubsidised rent. One acre is owned by Mencap.

The farm is entirely supported by donations of money and its own manpower and materials. It is now recognised as a day centre unit by the Isle of Wight county council and receives very limited funding. The local authority should purchase the services and facilities offered by the farm under the care in the community legislation. The farm meets all the requirements of a provider of services but does not get much of the cash. For the past three years, the county council has promised to put the farm on a permanent financial basis but, unfortunately, it still staggers from month to month. A number of us on the island are concerned that that excellent facility continues to have that problem.

My second point is about the concerns of members of the Isle of Wight Registered Care Homes Association. We seem to have made a little progress on funding. When the funding was first announced, we were told that it would run out in July. We are now told that it might stretch until September. Clearly, things have moved on a little.

I should like to explore the possibility of using any notified underspending by councils against their 1993–94 special transitional grant allocation. First, let me make it quite clear that the Isle of Wight county council has not suffered a cut in community care funding in 1993–94. The council received £2·354 million in special transitional grant funding. The figure for 1994–95 is £3·376 million, an increase of just under £1 million on the pervious year. I should like my hon. Friend to tell me in due course whether he has yet reached a decision on the possibility of the unused STG money being reallocated to the Isle of Wight and I hope to hear from him shortly as to whether that is possible.

There is and always has been considerable mistrust on the island between the councillors and the private sector. To try to reduce that, I asked the private sector to set up its own association, which it did, and by and large that has done a great deal to break down the barriers of suspicion and mistrust so often voiced by Liberal councillors about the private sector when I was a county councillor. The private sector still has misgivings about the county councillors' operation of Islecare and the way it was financed, the subsidies that the county council day care facilities receive and the almost total lack of opportunity for the private sector to participate in the provision of those care facilities. Having said that, while I would like to see the councillors take a step back from the management of the companies providing these facilities, as well as the residential homes in competition with the private sector, the district auditor might yet feel compelled to insist that the whole arrangement must become more transparent and arm's length—at least, I hope so.

Despite that caveat, community care is working well on the island, and to some extent I suspect that part of the difficulty is the fact that so many elderly people are now being maintained in their own homes—the very intention of community care. However, I believe—and the Minister's letter shows—that the formula has worked against the interests of the Isle of Wight this year and that there is a problem.

I consider it my job to separate the hype and attention-seeking tendencies of the leader of the council whose ability to deploy extravagant language has created more tension in the Isle of Wight than Lindy St. Clair's stays and whose contribution to a reasoned debate is about as welcome as woodworm in a rowing boat, but I would be remiss not to bring the concerns of Haylands farm and the Isle of Wight Registered Care Homes Association to the attention of my hon. Friend and my right hon. Friend the Secretary of State.

As so often happens in the House, the truth lies somewhere in the middle. I therefore leave the last word to Mike Leyshon, the editor of the association's newsletter entitled, "Homing In". On page 17 he writes: What are we really faced with here? A few less social service funded placements each. A faster rate of contraction of our market than originally predicted. A dozen or so businesses pushed over the edge on which they may have been teetering for some time. It may be most care homes will survive this year's struggle, some may even prosper".

Photo of Ms Liz Lynne Ms Liz Lynne , Rochdale 11:18 pm, 1st March 1994

The report that we are discussing tonight gives us a rare chance to debate community care, an issue of great importance to many constituents of many right hon. and hon. Members.

Unfortunately, we are limited tonight to debating the money that the Government consider sufficient to fund community care and how they have decided that that money should be allocated.

On the first point, it is quite clear to me that the resources that the Government have allocated to fund care in the community are totally inadequate. One need not take my word for it; one has just to read the report of the inquiry into the Christopher Clunis case. In what has been universally acclaimed an excellent report—including by Jonathan Zito's widow, Jayne—the inquiry team declared that the care and treatment of Christopher Clunis was a catalogue of failure and missed opportunity in which lack of resources played a part.

Photo of Mr John Bowis Mr John Bowis , Battersea

The hon. Lady and the hon. Member for Wakefield (Mr. Hinchliffe) raised the Clunis case. It is a tragic case. We take it seriously, as indeed we would any other instance of a breakdown in the care of people with mental health problems. But the hon. Lady should recall and remind the House that the Clunis-Zito case pre-dates community care. We are talking about a case in 1992, as the hon. Gentleman acknowledged. We are now talking about resources for community care that started on 1 April 1993. The hon. Lady should recall that the background to that case and the report, as the hon. Gentleman said, mentioned a number of areas in terms of discharge, information, communication and so on. Reference was made to the resources for medium-secure units, particularly in London, but that does not relate to the report, important as it is.

Photo of Ms Liz Lynne Ms Liz Lynne , Rochdale

I am grateful to the Minister. He must realise, however, that the report stated that lack of resources played a part. We must address that in this debate on resources for community care. I do not think that we can ignore it. I know that other parts of the report stress that lack of monitoring was a problem. I sincerely wish that when the Government brought in care in the community —I am grateful that they did—they had set up the proper monitoring. If they had, we might not be in the state that we are now in. Resources played a part and there is no way that the Government can get away from that fact.

Photo of Mr John Bowis Mr John Bowis , Battersea

That was before community care.

Photo of Ms Liz Lynne Ms Liz Lynne , Rochdale

It might have been before community care, but that does not make it—[Interruption.] The lack of resources is still there—[Interruption.] Will the hon. Gentleman allow me to continue with my speech? In response to that, the Secretary of State announced a further £10 million—[Interruption.]

Photo of Mr Michael Morris Mr Michael Morris , Northampton South

Order. I should be most grateful if the hon. Member for Cardiff, West (Mr. Morgan) would either listen to the hon. Lady, who is making an important speech, or retire—[Interruption.] Order. I do not know who the hon. Gentleman is pointing to, but I am not interested. He should either stay quiet and listen to the hon. Lady or go out of the Chamber.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield

I am grateful to the hon. Lady for giving way. The point that she is making is important. In response to her comments on the Clunis case, the Minister seems to imply that community care suddenly began on 1 April last year. Community care has existed for generations, before most if not all those in the Chamber tonight were born. She is right to say that of course community care existed when the Clunis tragedy happened. The Minister must address that fact.

Photo of Ms Liz Lynne Ms Liz Lynne , Rochdale

I agree with the hon. Gentleman about that.

Photo of Mr John Bowis Mr John Bowis , Battersea

The point is that this tragic case pre-dates community care as funded under the report this year, and the report of last year.

Photo of Mr Rhodri Morgan Mr Rhodri Morgan , Cardiff West

That is not what the hon. Gentleman said.

Photo of Mr John Bowis Mr John Bowis , Battersea

It is exactly what I said.

Mr. Deputy Chairman:


Photo of Mr John Bowis Mr John Bowis , Battersea

Thank you, Mr. Deputy Speaker.

The hon. Lady should address her remarks to the resources for community care that she would like to see, bearing in mind that over the four years we are raising them to £2·2 billion.

Photo of Ms Liz Lynne Ms Liz Lynne , Rochdale

I am grateful to the Minister. I will reach that point in my speech, but we must take into account the Christopher Clunis report, because it was extremely damning of the Government. It is essential to remember that.

What was the response by the Secretary of State for Health? She announced a further £10 million for mental health care in the capital. That is a nice round figure, and appears to be generous, but do we have any idea whether that is enough? I do not think that we do, because there is no monitoring system. Will that money be new, or will it be diverted from another cash-starved programme? I would like the Minister to answer that when he replies.

Another illuminating comment arising from the Clunis inquiry was in section 52.0.1 of the report, which says: it has been noticeable how little routine attention appears to have been paid by anybody to the quality or outcome measurement of the community management of mentally ill people. The report added, in section 52.0.2: purchasers do not know what they are buying nor do providers know what they are selling. No one has a means of telling whether the community service provided is an effective or an efficient use of resources. Essentially, no one knows what they are doing, how much it costs or whether they are meeting the needs of the people whom they are meant to serve.

How, then, did the Government reach the conclusion that £10 million was enough? How, for that matter, did they reach the conclusion that the money that we are debating tonight was adequate for the various needs that must be met by social services departments across the country? The Government need to set standards for community care, and then openly determine the resources that are needed to meet those standards. If that is more than they can currently afford to pay, let them at least have the decency to be honest with the electorate and say so. Perhaps they could also consider giving the electorate the freedom to decide whether they want more resources to be spent on community care.

If we cannot be convinced that the Government have provided enough resources for community care nationally, can we be convinced that the available resources have been distributed fairly? Again, I am not convinced. Last year, the DSS transfer was distributed in a way that took into account the historic income support expenditure. As I am sure hon. Members know, that was done to take account of the past costs to the DSS of supporting people in residential and nursing homes.

It had been suggested that the use of past income support data would continue for the next few years, although it would be tapered off. Instead, the Government have decided to rely entirely on the standard spending assessment as the means of calculating the amount required by each local authority. As my hon. Friend the Member for Cheltenham (Mr. Jones) pointed out in a debate on this issue last year, it has been admitted by many—including the Government, or so it seemed at the time—that the SSA system was not right.

At that time, there was a commitment to review the system. Has that review taken place, and did it take community care responsibilities into account? Did the Minister or his Department consult local councils? I am sure that such consultation must have taken place, but I should be delighted to hear that from the Minister. Did he and his Department ask local authority representative bodies for their views on the decision?

It is possible that the decision to rely wholly on the SSA will not affect all regions, although a social services director in my region said that it was too early to say. There is particular concern, however, in areas with especially high numbers of older people. Many retired people have moved to one of our pleasant coastal towns, and social services departments in such areas fear that the SSA does not take into account the effect of that movement. In the south-west, for example, more that £35 million has been taken away; not surprisingly, that is regarded as a devasting blow to the region.

Although any money for community care is welcome, it still concerns me that there is not enough, and that the Government are not open in how they determine what is needed and where it is needed. I also hope that the Minister will look again at the requirement to spend 85 per cent. in the independent sector; I am sure that many social services directors have asked him to do so. I hope that some of my concerns can be remedied.

Photo of Mr Andrew Rowe Mr Andrew Rowe , Kent Mid 11:28 pm, 1st March 1994

I shall be brief, but I think it important to contribute my view that community care is working a great deal better than the picture painted by Opposition Members suggests. Recently I met representatives of two of my local health trusts, along with the social services departments and local general practitioners. Morale was extraordinarily high; tribute was paid to the work done by care managers and the way in which they work together to ensure that patients' transition from hospital into the community is as smooth as possible. That is very encouraging.

Sod's law dictates that, as I speak, something is going badly wrong somewhere in a case in Kent. There are millions of relationships every day between social service staff, the private or public sector and individual clients and inevitably things will go wrong. One of the things that has been remarkable about the development of community care in Kent is the willingness of local staff of social services departments, the health department, the general practices, the caring organisations and the voluntary organisations to work together to achieve as good an outcome as possible for their clients.

Speaking as a Member of Parliament, I point out that we have had a dramatic decrease in the number of letters complaining about the way in which people are cared for and I believe that that reflects great credit on the development of community care in Kent. Of course, there are shortcomings. There always will be. We have a rapidly escalating number of people aged over 65; we have a growing number of young people coming from broken homes. Everyone knows that. We could spend twice or three times as much and still be asking for more.

I have drawn the attention of my hon. Friend the Parliamentary Under-Secretary of State, the hon. Member for Battersea (Mr. Bowis), to the fact that my local social services people are a little anxious about the cost of some of the equipment that is required to enable people to stay in their own homes. I have no doubt that in the years to come we shall have to consider carefully the sophistication and technological advances of equipment which makes it possible for people to stay in their own homes but which is very expensive.

I believe that we shall also need to make rapid progress towards giving the public the assurance that social workers are properly qualified. Everyone knows that some staff in social services departments have had an exhaustive training whereas others have not. The introduction of national vocational qualifications has made, or will make, a dramatic difference to the self-confidence and competence of many staff, especially residential care staff and domiciliary staff. I welcome it enormously. I hope, however, that my hon. Friend the Parliamentary Under-Secretary of State is taking seriously the many occasions on which I and others have urged him to make progress with the social work council, because I think that it is not fair to attack social workers for a lack of professional self-confidence and competence while denying them the right to register as fully qualified professionals or, at any rate, giving them a level of competence that the public can recognise. They may not be fully qualified, but if at least there were a council which said what their qualifications were, the expectations of them would become more realistic.

I strongly believe that community care has been a tremendous improvement on what went before. A vast amount remains to be done, but I have to pay tribute to the remarkable way in which all the people concerned, as far as I can see, in my county, where they have been pioneers in the development of social services, are working together, and to their very clear perception that they are only at the beginning of the type of fruitful relationship that will result in ever-increasing improvements in the care delivered to clients in the community.

Photo of Tessa Jowell Tessa Jowell , Dulwich 11:33 pm, 1st March 1994

There is nothing that divides the House about the desirability of community care. It is beyond dispute that elderly or disabled people are best, and indeed prefer to be, cared for in their own homes for as long as possible. What Opposition Members find so frustrating is the extent to which ideology has replaced a practical debate about what will deliver that objective for elderly and disabled people throughout the country.

I pressed the Minister to give the names of the authorities and people for whom community care was working so well and I recognised them all because of my previous work with the Labour-controlled authorities in Birmingham and Islington and with my present council, in Southwark. They are good news and we should celebrate them. They should not be the subject of ideological point scoring.

Opposition Members are concerned to persuade the Government to remove the obstacles that stand in the way of the community care that people want and need being delivered to people in their own homes. What users of community care and their carers tell us time and again is pretty consistent. It is of little importance who provides what they get. In many cases, people do not even know who provides the care that they receive. A recent study shows that about 40 per cent. of people thought that social security was provided by the local authority.

Flexibility, reliability and affordability are what matters. Research evidence about what residents of homes for the elderly value shows that it has little to do with whether the home is run by the local authority or by an independent provider. However, elderly people view the sudden and often unannounced changes of management that are a feature of the private sector as one of the most disruptive influences. Homes change owners about every three years—that is a good run—and every change is profoundly disrupting for the elderly residents.

The Minister talked about local authorities giving preference to putting people into their homes, when the Government have erected every obstacle to local authorities continuing to act as providers of residential care. The role of local authorities in the provision of that care for the elderly has never been more important. Elderly people are being admitted, on average, to residential care when they are 10 years older than they were 10 years ago —[Laughter.] Will hon. Members just listen to my point, because it is a serious matter?

Ten years ago people were admitted to residential care when they were in their early 70s, but the average age for admission now is the early 80s, when people are much more frail and dependent. Invariably, their care needs are beyond the resources of most independent, private care homes. It is relatively easy to find an independent care home for someone who is not dependent, incontinent or demented. It is much more difficult to find a place in the private sector for an elderly person who requires that level of care. The local authority, therefore, has to provide the essential backstop of reliable, available care. The Government have put every conceivable obstacle—financial and otherwise—in the way of local authorities trying to continue to offer that choice to the relatives of elderly people contemplating residential care.

My constituents have little access to nursing homes locally—I believe that there are about 12 nursing home beds in the whole of Southwark. If my constituents need to be admitted to a nursing home, they have to move many miles away to get the care that they need, which makes journeys difficult for families who wish to visit them. That leads me to another component of the complex web of factors which cannot be ignored in judging the success of community care.

One reason why the independent or private nursing home sector has grown at such a rate is that it is an aspect of care which was previously provided free of charge by the national health service and which is now almost entirely in the private sector. If one is looking for an element of care which was previously provided free by the health service and which has now been effectively privatised, one needs look no further than nursing home care for elderly people.

I refer now to some of the comments made in the wake of the thorough inquiry into the murder of Jonathan Zito by Christopher Clunis. I think that all hon. Members will accept that the Christopher Clunis case sets back the cause of community care by 20 years. One tragedy obscures the hundreds of thousands of success stories that have been part of community care for people with mental illness for the best part of 30 years.

It is important not to forget what a long haul mental illness is for many people who may suffer from it for most of their life. I was reminded of that recently when I opened the Ivydale centre in my constituency. It provides excellent community mental health support for people living in south Southwark. I met again three or four regular users of the centre whom I knew from working as a psychiatric social worker at the Maudsley day hospital in the early 1970s. For them, mental illness and the certainty of a recurrence is a way of life.

I remember very well a man whom I will call Terry. He is in touch with people who use the Ivydale centre. When I worked at the Maudsley day hospital, he was being admitted for the 17th time. The consultant psychiatrist reminded everyone that it was a cause for celebration that he had stayed out for three weeks longer than ever before. It is no good regarding care for people who suffer from mental illness as a series of one-off, acute episodes. It is important to consider the type of care that will support people who become chronically ill for the rest of their life.

The conclusions of the Christopher Clunis inquiry make it important that the debate is conducted on the basis of fact, not muddied by some of the myths that are creeping in as a substitute for fact. How many Christopher Clunises are there likely to be? About 1 per cent. of the population suffers from schizophrenia and, of that 1 per cent., a further 1 per cent. is likely to become seriously mentally ill as Christopher Clunis became seriously mentally ill—a top estimate of no more than 4,000 at any one time.

We also need to remember that all those people who have committed serious offences while disturbed were known to their local services, all were young, and none had ever been long-stay patients in hospitals. So their circumstances had nothing to do with the closure of long-stay mental hospitals. However, what the Christopher Clunis inquiry has raised so sharply is need, and the desperate need in south-east London, for guaranteed funding for the number of medium secure places needed for people who suffer from serious mental illness so that the rest of the mental health services can function properly. I hope that the Minister will give a guarantee that such places will be provided.

Photo of Ian McCartney Ian McCartney , Makerfield

Will my hon. Friend highlight one more important aspect of the Clunis case —the fact that the introduction of the market system has made self-referral almost impossible in inner London and other inner city areas for people suffering from an acute illness? The introduction of the contract system has eradicated self-referral within the system, which in turn makes it almost impossible for the individual concerned to seek emergency services.

Photo of Tessa Jowell Tessa Jowell , Dulwich

I shall bring my remarks quickly to a close, but I must reiterate my concern that medium secure places in south-east London should receive the planned funding that is needed, and that the Government's current proposal to require 75 per cent. of funding for people who are mentally abnormal offenders to be met from capitation funding should be dropped.

Photo of Mr David Hinchliffe Mr David Hinchliffe , Wakefield 11:47 pm, 1st March 1994

With the leave of the House, Mr. Deputy Speaker, I shall make one or two concluding comments. I am pleased to follow the speech by my hon. Friend the Member for Dulwich (Ms Jowell), who speaks with such great knowledge and experience of the issues before us. I repeat what she said—that we want community care to be a success. Although there are significant differences between us, which have been aired tonight, there is a consensus in the House that we all wish to aim in that direction.

I shall reinforce some points that have been made by other hon. Members and make one or two points that have not yet been made. The position of carers is one of the issues that we have not touched on specifically, and there should have been more comment on it in the context of the report. Carers do not now have any statutory right to demand a service or even an assessment. Moreover, in the present arrangements for community care there is no provision for grievance procedures after assessment, for appeals on assessment or for reassessment or review, which would often be helpful.

The other question that worries many people in social services is the confusion that has arisen concerning the measurement of unmet need. Local authorities appear to have been discouraged from making a note of unmet need —yet surely the Minister must accept that measurement of a national care deficit would help any Government to address the problems that we face in developing a proper community care policy.

It would have been helpful if there had been some discussion on the problems arising from the rundown of the Independent Living Fund, which to my knowledge is having an impact on community care in many cases. The limit of £500 is pushing people into institutional care when that could have been avoided. According to parliamentary answers that I have received, that is happening in various parts of the country. Housing provision, too, should have been touched upon, because in anybody's book housing is one of the most fundamental elements of community care.

There have also been some important contributions on wider issues connected with social work. I commend the hon. Member for Mid-Kent (Mr. Rowe) for his reference to a general social services council. He made a point that Ministers should take up. It is no good people, especially Conservative Members, bashing social workers about lack of professionalism when social workers themselves are saying that they want a professional body that will regulate and ensure good standards. The Government cannot sit back and ignore the demands of the profession for such an important body.

The significant and profound difference in ideology between speeches by Opposition Members and most of those by Conservative Members has come across clearly. The differences really do come down to what my hon. Friend the Member for Dulwich called ideology, The Minister was obsessed with the need to use the independent and private sector, and his speech was riddled with comments on that theme.

The speech of the hon. Member for the Isle of Wight (Mr. Field) consisted of his desire to see beds filled in private homes. Conservative Members see care as a business. That is the fundamental difference between the Government and the Opposition. Community care is not a business. Community care is about addressing the real needs of vast numbers of people which will not be met by simply leaving the provision to the market.

Photo of Mr John Bowis Mr John Bowis , Battersea 11:50 pm, 1st March 1994

May I reply to some of the points which were raised? The hon. Member for Wakefield (Mr. Hinchliffe) raised a number of items which he said were not addressed. Let us concentrate on those that were. He referred to the question of charging, which is, of course, one way in which to bring a contribution from users into the provision of social services. It is discretionary. It is always supposed to be according to ability to pay and not to exceed that and it is perfectly reasonable.

My hon. Friend the Member for the Isle of Wight (Mr. Field) raised an important point about the Mencap home. I hope that the Isle of Wight social services will listen to the points that he made and we shall certainly consider that further with him. He also referred to matters affecting the island's budget. He will know, as I know, that the island's budget for social services as a whole will rise by 12·4 per cent. in the current year. He will know as I know that the authorities there have had problems in the past because of their especial cost of fire prevention provision, being an island. He will also know, because we have discussed it before, that in social services we cannot take on board the other aspects of local government funding. The island's council has to use its resources efficiently and sensibly. I must say to him that his director of social services was the only one in the whole country who had not understood that the money from the first year's transitional grant was going to the standard spending assessment in the second year. We shall consider the points that my hon. Friend raised on the question of the underspent reallocation.

The hon. Member for Rochdale (Ms Lynne) referred to the allocation for her borough. That represents an increase in the current year of 12·7 per cent. for Rochdale. She also referred to the south-west and, in the case of Devon, there has been a 13·5 per cent. increase in total resources in the current year and an increase of 17·7 per cent. for Cornwall. I hope that she will tell her political friends in that part of the world that that settlement is generous. It requires in return the efficient use of resources.

My hon. Friend the Member for Mid-Kent (Mr. Rowe) was correct in his assessment of what has been achieved. He talked of good progress and that is the message which has come from all the monitoring that we have conducted in the first 11 months of community care. The right assessment is that good progress has been made and that there is more progress to be made. It is a programme for a decade, not for one year, and we shall build on that. My hon. Friend referred to the general social services council. I have discussed that with him before and I know how closely he is associated with the arguments on that issue. It is certainly an issue which we are considering and we shall have to see the sort of social work level of qualification which one may consider in such a council. Other hon. Members referred to a council which would cover everybody working in social work. There are different arguments, but we welcome the debate.

The hon. Members for Rochdale, for Wakefield, for Dulwich (Ms Jowell) and others referred to the tragic Clunis case. It is not directly relevant to the debate because it pre-dates the way in which we fund community care and goes beyond it. Nevertheless, I accept the points that have been raised about the need to take on board the lessons of that and other comparable cases if we are to reassure the public, people who have mental health problems, their families and the professionals as a whole. Let nobody suggest that we are not doing just that. It is not only a question of £10 million in response to that inquiry. That was an important £10 million towards resources in London, but it is by no means the whole answer. The whole answer begins with the £2 billion that we are putting into mental health provision in the current year and it continues through the code of practice, which I am sure that the hon. Member for Dulwich recalls was laid before Parliament in the past year and is now revised and in current usage. The whole answer also refers to the £45 million programme for the medium secure unit building programme. It refers to the key workers training, which is so important and on which I shall be addressing a conference later in the week. It refers to the supervision register which we are requiring should be in the programme by 1 April for contracts from from that time.

It applies to the discharge guidelines on which we are consulting at present. It applies to the supervised discharge and extended leave proposals for which we are awaiting legislation. It applies to the £20 million homeless mentally ill initiative, which supports 2,000 people in the community. It applies to the £35 million supporting £50 million of specific grant—800 schemes supporting 64,000 people.

We are talking about the cost of community care doubling from £565 million to £1·2 billion this year. We are talking about £6·4 billion for social services, which is an increase of 48 per cent. in real terms since 1990–91. I have no hesitation in asking the House to support the generous settlement for this year which is provided in the report for the benefit of people in community care.

Question put:—

The House divided: Ayes 185, Noes 52.

Division No. 152][11.54 pm
Ainsworth, Peter (East Surrey)Douglas-Hamilton, Lord James
Alexander, RichardDover, Den
Amess, DavidDuncan, Alan
Arbuthnot, JamesDuncan-Smith, Iain
Arnold, Jacques (Gravesham)Durant, Sir Anthony
Arnold, Sir Thomas (Hazel Grv)Eggar, Tim
Ashby, DavidElletson, Harold
Atkinson, Peter (Hexham)Emery, Rt Hon Sir Peter
Baker, Rt Hon K. (Mole Valley)Evans, Jonathan (Brecon)
Baker, Nicholas (Dorset North)Evans, Nigel (Ribble Valley)
Bates, MichaelEvans, Roger (Monmouth)
Batiste, SpencerFaber, David
Beggs, RoyFabricant, Michael
Blackburn, Dr John G.Fairbairn, Sir Nicholas
Bonsor, Sir NicholasForman, Nigel
Booth, HartleyForsyth, Michael (Stirling)
Boswell, TimFoster, Don (Bath)
Bottornley, Peter (Eltham)Fox, Dr Liam (Woodspring)
Bowis, JohnFreeman, Rt Hon Roger
Brandreth, GylesFrench, Douglas
Brazier, JulianGale, Roger
Bright, GrahamGallie, Phil
Brown, M. (Brigg & Cl'thorpes)Gardiner, Sir George
Browning, Mrs. AngelaGill, Christopher
Bruce, Malcolm (Gordon)Gillan, Cheryl
Bums, SimonGoodson-Wickes, Dr Charles
Carlile, Alexander (Montgomry)Gorst, John
Carrington, MatthewGreenway, Harry (Ealing N)
Cash, WilliamGriffiths, Peter (Portsmouth, N)
Chapman, SydneyHague, William
Clappison, JamesHamilton, Rt Hon Sir Archie
Clifton-Brown, GeoffreyHamilton, Neil (Tatton)
Coe, SebastianHampson, Dr Keith
Congdon, DavidHannam, Sir John
Conway, DerekHarris, David
Coombs, Simon (Swindon)Harvey, Nick
Cope, Rt Hon Sir JohnHaselhurst, Alan
Cran, JamesHawkins, Nick
Davies, Quentin (Stamford)Hawksley, Warren
Day, StephenHayes, Jerry
Devlin, TimHeald, Oliver
Hendry, CharlesPorter, David (Waveney)
Hogg, Rt Hon Douglas (G'tham)Portillo, Rt Hon Michael
Howard, Rt Hon MichaelRathbone, Tim
Howarth, Alan (Strat'rd-on-A)Riddick, Graham
Hughes Robert G. (Harrow W)Robertson, Raymond (Ab'd'n S)
Hunt, Rt Hon David (Wirral W)Robinson, Mark (Somerton)
Hunter, AndrewRoss, William (E Londonderry)
Jenkin, BernardRows, Andrew (Mid Kent)
Jessel, TobyRyder, Rt Hon Richard
Jones, Gwilym (Cardiff N)Sackville, Tom
Jones, Nigel (Cheltenham)Shaw, David (Dover)
Jones, Robert B. (W Hertfdshr)Shaw, Sir Giles (Pudsey)
Kennedy, Charles (Ross, C&S)Shepherd, Colin (Hereford)
Kilfedder, Sir JamesSims, Roger
Kirkwood, ArchySpencer, Sir Derek
Knapman, RogerSpink, Dr Robert
Knight, Mrs Angela (Erewash)Spring, Richard
Knight, Greg (Derby N)Squire, Robin (Hornchurch)
Knox, Sir DavidStanley, Rt Hon Sir John
Kynoch, George (Kincardine)Stephen, Michael
Lait, Mrs JacquiStern, Michael
Lawrence, Sir IvanSweeney, Walter
Legg, BarrySykes, John
Lennox-Boyd, MarkTaylor, Ian (Esher)
Lidington, DavidThomason, Roy
Lightbown, DavidThompson, Patrick (Norwich N)
Lloyd, Rt Hon Peter (Fareham)Thornton, Sir Malcolm
Luff, PeterThurnham, Peter
Lyell, Rt Hon Sir NicholasTownend, John (Bridlington)
Lynne, Ms LizTownsend, Cyril D. (Bexl'yh'th)
MacGregor, Rt Hon JohnTracey, Richard
MacKay, AndrewTrend, Michael
Maclean, DavidTrotter, Neville
Maddock, Mrs DianaTwinn, Dr Ian
Maitland, Lady OlgaVaughan, Sir Gerard
Malone, GeraldWallace, James
Mans, KeithWaller, Gary
Marlow, TonyWardle, Charles (Bexhill)
Mawhinney, Rt Hon Dr BrianWatts, John
Merchant, PiersWells, Bowen
Mitchell, Andrew (Gedling)Whitney, Ray
Mitchell, Sir David (Hants NW)Whittingdale, John
Montgomery, Sir FergusWiddecombe, Ann
Moss, MalcolmWilkinson, John
Nelson, AnthonyWilletts, David
Neubert, Sir MichaelWinterton, Mrs Ann (Congleton)
Newton, Rt Hon TonyWinterton, Nicholas (Macc'f'ld)
Nicholls, PatrickWood, Timothy
Norris, SteveYoung, Rt Hon Sir George
Oppenheim, Phillip
Ottaway, RichardTellers for the Noes
Paice, JamesMr. Irvine Patnick, and Mr. Timothy Kirkhope.
Pattie, Rt Hon Sir Geoffrey
Pickles, Eric
Ainsworth, Robert (Cov'try NE)Home Robertson, John
Barnes, HarryHoon, Geoffrey
Bermingham, GeraldHowarth, George (Knowsley N)
Betts, CliveHughes, Kevin (Doncaster N)
Blunkett, DavidIllsley, Eric
Caborn, RichardJowell, Tessa
Coffey, AnnKennedy, Jane (Lpool Brdgn)
Connarty, MichaelKilfoyle, Peter
Corbyn, JeremyLewis, Terry
Cryer, BobLlwyd, Elfyn
Cunliffe, LawrenceLoyden, Eddie
Cunningham, Jim (Covy SE)McAllion, John
Darling, AlistairMcCartney, Ian
Davidson, IanMacdonald, Calum
Dixon, DonMcMaster, Gordon
Donohoe, Brian H.McWilliam, John
Etherington, BillMahon, Alice
Foster, Rt Hon DerekMarek, Dr John
Foulkes, GeorgeMarshall, Jim (Leicester, S)
Graham, ThomasMartin, Michael J. (Springburn)
Gunnell, JohnMichael, Alun
Hall, MikeMichie, Bill (Sheffield Heeley)
Hanson, DavidMorgan, Rhodri
Hinchliffe, DavidPrimarolo, Dawn
Simpson, Alan
Skinner, DennisTellers for the Noes:
Taylor, Mrs Ann (Dewsbury)Mr. Hugh Bayley and Mr. Malcolm Chisholm.
Wray, Jimmy

Question accordingly agreed to.

Resolved, That the Special Grant Report (No. 10) (House of Commons Paper No. 218), which was laid before this House on 17th February, be approved.