HC Deb 11 November 1970 vol 806 cc391-8
The Secretary of State for Social Services (Sir Keith Joseph)

With permission, Mr. Speaker, I should like to make a statement about how the Government propose to spend the English share of the extra £110 million which they have planned to make available to the National Health Service over the next four years.

For the next year, 1971–72, the resources available for the hospital and local health and welfare services will now be about £75 million more, at constant prices, than during the present financial year, an increase of 6 per cent. overall, compared with 4.7 per cent. envisaged in the plans of the previous Administration; and with an increase of 4.3 per cent. during 1969–70. This means that it will be possible not only to continue the normal development of the services—building programmes, improved treatment and diagnostic services, more staff in hospitals and the community—but also to speed progress in vulnerable sectors such as the care of the mentally handicapped, mentally ill and the elderly.

Hospital and local authorities are expected to spend at least £100 million over the next four years on improved services for the mentally handicapped over and above present running expenditure. Of this about £40 million will come from the £110 million.

Another area for expansion is the improvement of hospital and local authority services for old people and for the mentally ill. Nearly £300 million additional to present running expenditure will be spent over the next four years on improved services, of which about £40 million will be new money from the £110 million.

I hope to make a statement soon on the Government's intentions in respect of family planning. We need to improve the accident and emergency services. A review of what should be done is under way, and when it is complete I shall be issuing further guidance. Meanwhile, boards will be expected to aim at faster progress out of the increased allocations. I am setting aside an extra £3 million over the next four years for special units for the young chronic sick, and an extra £2 million to improve facilities and counsel for alcoholics. The whole problem of alcoholism is to be reviewed.

The Government will encourage high quality national voluntary services. About half a million pounds will be available next year in support of voluntary effort for the National Health Service—roughly twice as much as this year. Further announcements will be made from time to time about developments in other special areas of the service.

Mrs. Shirley Williams

We on this side of the House very much welcome the additional help that the right hon. Gentleman will provide, particularly for the mentally handicapped and the mentally ill. I should, however, like to ask him four brief questions, as in some ways this is a rather obscure statement.

First, will he tell us how the division is to lie between hospital services, for which he is directly responsible, and local authority services, for which he is only indirectly responsible, in the fields first of the mentally handicapped and secondly of the mentally ill? The right hon. Gentleman will recall that he said that £40 million of new money would come forward for both categories, but that the total sum of additional money is very much greater than that.

Secondly, arising from that, does this depend in any way upon the outcome of rate support grant negotiations and upon the willingness of local authorities to increase their rates for these purposes?

Thirdly, does the right hon. Gentleman propose to take particular steps to increase staffing, in particular in hospitals for the mentally handicapped? He will know that plans within his Department when he came into it allowed for £87 million more to be spent in the next four years, and I should like specifically to ask him about the additional staffing for these very understaffed hospitals.

Fourthly, in his view, is the provision of units for the young chronic sick, which we welcome as an earnest of the Government's intention to carry out this important Act, sufficient to enable all the young chronic sick to be dealt with outside geriatric wards within a four year period?

Sir K. Joseph

I welcome the hon. Lady's words of courtesy at the beginning. The answers to her four questions I will give briefly.

The share between hospital and local authority expenditure in the fields she mentioned will vary round about the fifty-fifty mark. Some will be just under 50 per cent. hospital and just over 50 per cent. local authority, and some will be the other way.

The announcement which I have made is not dependent on the outcome of the rate support grant negotiations. The money embodied is incorporated in the money already proposed for the rate support grant, although the use to which the local authorities put their money is ultimately in their hands.

The staffing in hospitals for the mentally handicapped will certainly benefit from the extra resources.

Not all the young chronic sick will be rescued from general hospital wards by what we propose, although a big step will be taken in that direction.

Mrs. Knight

How will my right hon. Friend's proposals help the isolated elderly? Will he bear in mind the strong advisability of giving more financial help to provide telephones for them?

Sir K. Joseph

I hope that local authorities, by their own efforts and with our help, will be able to expand the home help service, so far as the women are available where they are needed, and also the meals on wheels service, Part III accommodation, day centres and clubs for the elderly.

Mr. Crossman

I congratulate the Secretary of State on his statement. Will he publish a White Paper on the mentally handicapped in the near future, and will he give us a little more information about the rate support grant? As I understand it, he said that the money was not dependent on the grant but that the local authorities would be free either to spend it or not. That means that it is extremely dependent on the total amount of grant. What assurance has he that the grant will not be so severely cut back that the local authorities will be unable to spend £40 million on this because there will be higher priorities for it?

Sir Keith Joseph

There will be guidance on policy on the mentally handicapped which will be issued by the Government probably in the early spring. On the rate support grant, I meant to say that the money embodied in my statement has been offered by the Government to the local authorities. It is not subject to any cut.

Sir D. Renton

Is not my right hon. Friend's statement further evidence of the Government's ability to improve the social services while reducing Government expenditure and taxation, which our opponents at election time said was impossible? Will my right hon. Friend say what are his intentions about further research into mental health and the causes and cure of mental illness and disease?

Sir K. Joseph

Yes, rapidly rising expenditure on research in mental health has been included in our budget for the next four years.

Mr. Alfred Morris

I welcome the right hon. Gentleman's reference to expenditure on special units for the young chronic sick, but how long will it be before we can say that geriatric wards are used only for geriatric patients?

Secondly, under the heading of local authority expenditure, can the right hon. Gentleman say anything about the young disabled who are in Part III accommodation? Will there be enough money to provide special units for the young disabled who far too often are in Part III accommodation for the very elderly managed by local authorities?

Sir K. Joseph

Further progress with the young chronic sick will depend upon even more resources that I shall try to get for the National Health Service. I shall be discussing the subject of the young disabled in local authority accommodation, among other subjects, with the local authorities.

Mr. John Wells

Will my right hon. Friend say a little more about day centres, particularly for those suffering from mental illness? Can he say anything about the provision of joint registrar places between provincial hospitals and the great London teaching hospitals? This would improve the status of the provincial hospitals and create a generally improved atmosphere which, as he knows, is of particular importance in the southeastern area?

Sir K. Joseph

While both questions sound eminently sensible, I would not be able to give other than a very general answer without notice.

Mr. Roy Jenkins

On the rate support grant point, which admittedly is always complicated, is the right hon. Gentleman saying that the ability or willingness of local authorities to spend the money, as is suggested in the statement that they should, is totally independent of the rate support grant settlement?

Sir K. Joseph

I would rather put it in another way about which I am absolutely certain. The local authority element coming from the Government is that already offered by the Government in the negotiations now going on. I merely reserve formally the right of local authorities to make their final choices between the different services. But there is no reason for me to cast any doubt upon the figures I have given for the local government contribution. There always remains the difficulty in some areas of getting enough home helps, for instance, to spend the money which local government intends to spend.

Dr. Trafford

Can my right hon. Friend tell the House in what way his statement will affect general practitioners and dentists?

Sir K. Joseph

In addition to the £75 million of extra resources for the hospital and local authority health and welfare services, there will be about £14 million for the family practitioner, pharmaceutical and dentist services.

Dr. Summerskill

In considering Health Service expenditure, will the right hon. Gentleman promote the concept of preventive medicine and consider putting far more money into occupational health and prevention of industrial accidents and industrial diseases where real savings can be made?

Sir K. Joseph

The answer to the first part of the hon. Lady's supplementary question is "Certainly, yes." I should like to reserve judgment about the methods of encouraging preventive medicine.

Dame Irene Ward

It would be helpful if my right hon. Friend could at some time let us know the weaknesses in the services which will be helped by his new plan in relation to the different regions. Is my right hon. Friend aware that, when one is trying to help in one's region, it is very difficult to know whether the services of a particular region are better or worse than those in other regions. In other words, it would be a good thing if the House could be better informed over the whole plan so that we might be able to help the Minister in the tasks which he has in mind.

Sir K. Joseph

That suggestion is eminently sensible and I should like to consider how we can best take advantage of it.

Mr. Pavitt

Does the right hon. Gentleman recall that over the last four years of economic difficulty the last Administration found £543 million—E136 million for each year'? Does the £27 million a year for each of the next four years to which he refers mean an addition above the 3 per cent. annual rise over ordinary hospital administrative expenses? Will he ensure that, as a result of the £2 million cut last week in research, there is no hindrance of research into mental illness and the mentally handicapped?

Sir K. Joseph

I can assure the hon. Gentleman that there will be no cut in that side of research. I did not come to the House prepared to compare precise figures, but I can assure hon. Members that a 6 per cent. increase in resources for the hospital and local authority health and welfare services represents a better performance than the performance in any of the last few years.

Miss Fookes

Will my right hon. Friend tell us more precisely how he will allocate the extra £500,000 to the voluntary services?

Sir K. Joseph

This is a doubled allocation for the coming year and it will go to encourage services of quality which offer new provision and new ways of handling existing problems or enable existing voluntary bodies to expand their efforts in support of the Health Service.

Mr. Marsh

What proportion of the increase takes into account the effect on the National Health Service of the recent wage increase for local government workers?

Sir K. Joseph

These increases are in real terms, in terms of resources—that is, at constant prices—and are in comparison with the expenditure last year on the same price level. They do not take account of changing prices. They are a measurement of resources and not of expenditure.

Mr. MacArthur

Is expenditure on improved services in Scotland included in my right hon. Friend's very welcome statement? If not, can he say what the figures for Scotland will be?

Sir K. Joseph

I understand that my right hon. Friend the Secretary of State for Scotland gave an Answer this afternoon on how he proposes to use his extra resources.

Mr. Denis Howell

Reverting to the question about voluntary activity in hospitals, is the right hon. Gentleman aware that his statement will be widely welcomed by organisations like the Young Volunteer Force Foundation, but, notwithstanding the circular sent out by the Labour Administration, there is still a great deal of inborn resistance in hospitals particularly to finding jobs for volunteers to do? What steps will the right hon. Gentleman take to deal with that situation? Also, will he give some more detailed information about who can qualify to receive the £500,000 he is producing?

Sir K. Joseph

National voluntary services will qualify, and the more successful voluntary service is, the more the barriers will be eliminated.

Mr. Maxwell-Hyslop

Will my right hon. Friend bear in mind that in terms of cost-effectiveness any increase in public expenditure on family planning services will far outweigh the cost which is likely to fall on the nation from chronic over-population in the predictable future?

Sir K. Joseph

I note my hon. Friend's comment.

Mr. Bob Brown

Has the Secretary of State determined the extra allocation for the northern regional hospital boards? As he accepts the desirability of expenditure on preventive medicine, will he investigate the number of local authorities which have cut back on the home help service?

Sir K. Joseph

No. We are shortly to discuss the allocation between regions with the regional hospital boards.

Mr. Crawshaw

Is the right hon. Gentleman satisfied about present medical thinking on the proper treatment of mentally handicapped children? Will the extra money which is to be given be spent on treatment as opposed to merely providing beds in hospitals for children, as has happened so often in the past?

Sir K. Joseph

A great deal of knowledge which has accumulated over the last decade is still to be put into practice for the good of the public, and that we shall try to do.

Mr. William Price

Is the Secretary of State aware that, even when money is available, the amount of time taken in planning, designing and building hospital projects is ludicrously long? Will he look at the possibility of speeding up the process?

Sir K. Joseph

Yes, Sir.

Mr. Ben Ford

When considering the allocation of the extra expenditure in relation to the hospital building programme, will the right hon. Gentleman take urgent steps to finalise the programme for the City of Bradford, which has suffered from an unfortunate delay?

Sir K. Joseph

As the hon. Gentleman knows, there is a considerable dilemma facing my Department in deciding what to do in response to Bradford's needs.

Mr. Skinner

Will the Secretary of State assure the House that the allocation which he has just announced is entirely unconnected with the rate support grant negotiations which are taking place this month and that the domestic element of the rate support grant will be increased, as in the previous four years?

Sir K. Joseph

It is entirely unconnected. The element which stems from this year's rate support grant negotiations is not in dispute.

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