HC Deb 22 November 1971 vol 826 cc957-64
The Secretary of State for Social Services (Sir Keith Joseph)

With permission, Mr. Speaker, I should like to make a statement about developments decided by the Government in the health and personal social services.

The Government have decided to allocate a further £118 million to speed progress in improving conditions in some of the most vulnerable sectors of the health and personal social services over the next four years. Taking into account the extra £110 million which the Chancellor enabled me to announce in the House of Commons in November last year, this means that since the Government came to office 17 months ago they have made resources totalling some £250 million at present prices available for special improvements in the services over and above, and completely additional to, the cumulative increase of the order of £80 million each year which is included in the expenditure programme for normal development.

My right hon. Friends the Secretaries of State for Scotland and Wales will be informing the House of their proposals for development of services in those countries. The English share of the latest addition, amounting to £100 million, will in the main be spent on expanding and improving services for the elderly and the mentally ill.

I envisage that about £45 million of the money will go to the hospital service. The Government intend to improve hospital accommodation for both the elderly and the mentally ill. Some of the money will also be spent on improving the standards of such things as staffing, furnishing and food, and on increasing the number of places for the elderly.

The extra provision will certainly not enable us to overcome all the problems of these hospitals but it will be enough to secure substantial improvements. In the five years ending in 1975–76 hospital authorities are expected to spend about £150 million over and above the level of expenditure last year on improved ser- vices in non-acute hospitals. Of this about two-thirds will come from the special additional allocations.

About one-third of the latest £100 million has been earmarked for the health and personal social services provided by local authorities. In particular, I am sure that local authorities will wish to join me in a determined effort to sweep away all the former Poor Law institutions still being used as old people's homes and to replace them with modern buildings. I hope this programme will be completed within the next five years. In this way we should at last dispose of the old workhouse and its Dickensian associations. I also hope that local authorities will be able to go a long way towards replacing the many old and not always satisfactory houses which have been adapted to accommodate old people and that they will, in general, make special efforts to provide more and better accommodation for both the elderly and the mentally ill. Additional loan authorisations of £30 million will be available to enable the local authorities to undertake these programmes.

I am also making provision from the extra money to meet the costs of reorganising the National Health Service. The balance of the money is to be spent on a number of improvements: I intend, for example, to provide for increases in key staff for accident and emergency departments, and I shall have particularly in mind the need to provide more facilities for people with epilepsy, and the need both to develop, and to evaluate and spread information about aids and equipment of all kinds for the disabled. Where appropriate, I shall be seeking the co-operation of the voluntary organisations as well as that of public authorities. The response of the hospital authorities in improving arrangements for the younger chronic sick has been such as to exceed the money I set aside from last year's £110 million and I am therefore providing the further sum required from the extra money now available. I shall be making announcements about these, and other developments later.

The whole House will, I am sure, welcome the Government's allocation of these substantial extra resources and will recognise the importance of the contribution they will make to improving the health and personal social services.

Mrs. Shirley Williams

I am sure that the House will indeed congratulate the right hon. Gentleman on the additional resources which he has found for the Health Service, but I am also sure that the House will note that, under the pressure of both circumstances and unemployment, some of the Government's earlier pledges about public expenditure are being very wisely abandoned.

May I ask the right hon. Gentleman the following questions? First, can we assume that this additional £118 million is all to be new money and does not depend on raising money through any further charges on the Health Service?

Second, will the right hon. Gentleman make arrangements to ensure that the additional expenditure for the personal social services provided by local authorities will be properly distributed throughout the country, so far as he is able? Also, will it be followed by an addition to community care? As the right hon. Gentleman will appreciate, the one disturbing feature of this statement is that almost all the additional money is to go to institutional care, when, as he himself rightly pointed out, much needs to be done in the field of home care for the elderly and the mentally ill. I should be grateful for anything which the right hon. Gentleman can say about that, in respect of the implications of this on the rate support grant negotiations in future.

Lastly—the statement is not clear on this point—is the one-third of the additional £100 million to be earmarked for services to be provided by the local authorities the same £30 million embodied in the additional loan authorisations? I presume that it is, but the statement does not make it clear.

Sir K. Joseph

The answer to the last point is "Yes". The hon. Lady and the House will observe that, as during the past 13 years of Conservative Government, my right hon. Friend the Chancellor is able simultaneously to cut taxation and to increase expenditure on the social services. Second, the allocation of extra money is not dependent on any agreement or proposal to increase charges.

Third, the local authority money will not be distributed by the Government. It is up to local authorities to make their own decisions in the knowledge that increased loan sanctions are available. I would judge that those who come first will be first served, because I am sure that most of them will want to join me in the programme which I have spelled out. Fourth and last, the hon. Lady should consider the public expenditure White Paper when it is published, to see the provision made by the Government for what is expected to be the rising local authority programme of community care.

Sir D. Renton

I also welcome my right hon. Friend's statement. Does what he has said about the provision being made for local authorities to help the mentally ill mean that the emphasis will be on long-term care? If that is so, will he bear in mind the desirability of not having places which are too large for these people to be cared for, that they can do better in a more intimate atmosphere?

Sir K. Joseph

Yes, certainly, but the local authority provision will, I expect, be primarily for those who can be returned to the community under sheltered conditions from the non-acute hospitals.

Mr. Russell Kerr

Can the right hon. Gentleman assure the House that a fair share of the new resources made available will go to the para-medical technical staff, who have been very much the Cinderellas of this service, and whose salaries are long overdue for a big rise?

Sir K. Joseph

I congratulate the hon. Gentleman on introducing a subject which I know is important to him, but the Cinderellas above all have been the elderly and the mentally ill. It is for them that this statement is primarily intended.

Mrs. Kellett-Bowman

Will my right hon. Friend accept that I welcome this statement most warmly, particularly since two very large mental institutions are in my constituency and one of them is for the mentally subnormal, who desperately need more hospital accommodation? I hope that this will enable them to get it.

Sir K. Joseph

My hon. Friend will realise that a large part of the £110 million announced by the Chancellor and me last year was intended for the mentally handicapped. This statement is for the other two Cinderella groups.

Mr. Prentice

The right hon. Gentleman made the familiar political point that the Government are reducing taxation and increasing expenditure at the same time. Does it not follow from that that they could be doing a great deal more for the elderly and the mentally sick and that they could have announced it much earlier if they had not given such urgent priority to improving the conditions of the surtax payer?

Sir K. Joseph

But the right hon. Gentleman is conveniently forgetting that this time last year we allocated £110 million extra for the elderly and mentally handicapped over and above the normal increase in the basic provision.

Sir D. Walker-Smith

Are we to understand from my right hon. Friend's answer to the hon. Member for Hitchin (Mrs. Shirley Williams) that local authorities will have a discretion in the use of this welcome increase in loan sanction as between institutional aid and community care? Is he satisfied that there will be no delay in the implementation of these increases by reason of the local government reforms?

Sir K. Joseph

No, my right hon. and learned Friend is misunderstanding the position on this point. The increased loan sanctions are addressed to capital expenditure only. It is the rate support grant provision for which my right hon. and learned Friend would be right to look in the new public expenditure White Paper. It allows local authorities to extend their community care services. I should not have thought, on the second point, that local government reorganisation will interfere with the programme.

Mr. Mayhew

On the question of hospitals for the mentally sick and handicapped, will the right hon. Gentleman bear in mind the enormous importance of increasing the amount of individual attention which can be given to the individual patient by a trained nurse? Second, will he look again at the advice he gives to hospital authorities about the minimum proper expenditure on food for hospitals for the mentally ill and handicapped? Finally, on community care, will he remember that there seems to be a general view that the smaller and simpler the residential accommodation given to ex-patients the better? Would he say how this £30 million might be used towards this—perhaps undertaken by voluntary organisations?

Sir K. Joseph

I can agree with every one of the right hon. Gentleman's observations. I know that, from his very ardent voluntary service activities—which led him recently actually into a mental illness hospital for experience—he knows a great deal about what is needed. He will recognise, as I do, that the extra money available will not be able satisfactorily to meet all the needs. It is a great help towards meeting the needs, and the needs include more nurses, more trained staff, better food and smaller wards. All these are accepted.

Dr. Stuttaford

I know that my right hon. Friend will be aware of the pleasure which this greater sum will give to the medical profession. Will he assure us that some of this sum will go for the care of the dying—terminal care—whose plight at the moment can often be described only as outrageous?

Sir K. Joseph

But my hon. Friend will be aware that what is needed for the care of the dying is above all the wider use of existing techniques. There are places all over the country which provide loving care for the dying. There are places which specialise in it, and it would not be proper for me to mention them. It is not better accommodation but a greater spread of good practice in handling these poignant days and weeks which is needed among the medical profession.

Mr. Cronin

I welcome the right hon. Gentleman's statement. When he allocates these additional resources to the hospital services, would he bear in mind that there is room for considerable improvement of operating theatres in hospitals all over the country, so many of which are sub-standard?

Sir K. Joseph

The hon. Gentleman must recollect that there is an £80 million a year cumulative increase in the money made available by the Government for the normal improvement of the health and personal social services. It is out of this normal cumulative increase that such improvements should be made.

Mr. Pardoe

I welcome the contribution which this money will of course make to the development of the health and personal services. Would the Secretary of State care to estimate how much this investment will mean in terms of new jobs, and also how much will be spent in the development areas, particularly the South-West development area.

Sir K. Joseph

The Government recently announced through my right hon. Friend the Secretary of State for the Environment an extra programme of expenditure for the regions including £22 million for improvements in the health and personal social services. My announcement today is over and above that, and will be spread evenly over the country, including the development areas. It will place some increased demand on the construction industries and quite a substantial increased demand on women's labour, and particularly skilled labour in the hospitals.

Dame Irene Ward

How will my right hon. Friend arrange for all local authorities to take advantage of this very good offer which he is making? May I tell him how glad I am, considering the criticisms that have come from the benches opposite, that we have a Conservative Government in power—[Interruption.]—who are providing money which we believe is essential for those who require it? Will my right hon. Friend see that advantage is taken of this offer—[Interruption.]—from the Government and tell hon. Gentlemen opposite to stop carping?

Sir K. Joseph

My hon. Friend is right to emphasise that it is a Conservative Chancellor of the Exchequer who is enabling two successive increases to be made in public expenditure on these services. I would hope that as from the availability of this news on the radio, from now on, local authorities will be considering their applications for increased loan sanctions.

Mr. Orme

Though he is getting plaudits from his hon. Friends, may I ask the right hon. Gentleman to be aware that many of us remember the recent parsimonious Social Security Bill which took away unemployment, sick, industrial injury and short-time working benefits from millions of industrial workers who needed them? Is he aware that we recognise the unevenness of the policies of this Government and that many of my hon. Friends still believe in a free National Health Service?

Sir K. Joseph

The Bill to which the hon. Gentleman referred contained no initiatives which his right hon. Friends had not suggested originally, and they are not among those who believe in a free National Health Service.

Several Hon. Members

rose—

Mr. Speaker

Order. We must get on.

Mr. William Hamilton

On a point of order. Are you aware, Mr. Speaker, that in his statement the right hon. Gentleman referred to some Scottish figures and indicated that they would be made available? I ask you what protection we, as representatives of Scottish constituencies, have to make certain that we can question the Secretary of State for Scotland on this matter so far as it pertains to Scottish hospitals and the care of the elderly and mentally handicapped in Scotland. Are you aware, Sir, that we are getting this practice consistently, with Ministers purporting to speak for the Secretary of State for Scotland, who can surely defend his own position?

Mr. Speaker

That is not a point of order. I am sure, however, that the point raised by the hon. Gentleman will have been noted.

Mr. Rankin

Further to the point of order raised by my hon. Friend the Member for Fife, West (Mr. William Hamilton), may I ask you to bear in mind that evidently I was wrong in assuming that, following the right hon. Gentleman's statement in relation to England, there would be a similar one, perhaps in better terms, relating to Scotland? Will such a statement be made today? If not, when are we likely to receive it?

Mr. Speaker

That is not a point of order for me. Again, however, I am sure that it will have been noted.