§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]
§ 11.41 p.m.
§ Mr. Colin Shepherd (Hereford)I am grateful to the Minister for coming to the House to answer the matters that I wish to raise on the provision of services for the mentally handicapped children of Hereford. This is a subject that is of great concern to those in the city of Hereford and the old county of Herefordshire. I know that my hon. Friend the Member for Leominster (Mr. Temple-Morris) shares my concern.
It is necessary for me to think in terms of the old county of Herefordshire as a single county, and I can best explain the matter to the Minister by suggesting that he should consider it as a bicycle wheel with all the spokes leading towards Hereford in the centre. I know that my hon. Friend will forgive me when I make reference to the town of Leominster in my remarks. It is essential for the sake of the debate that we treat Herefordshire as being one entity.
The shift of emphasis from institutional care to the community, as indicated in the White Paper "Better Services for the Mentally Handicapped", has given rise to a number of problems, and Herefordshire has its share of them. I find myself very much in sympathy with the aims of the White Paper and I do not seek to criticise its objectives. I am not critical of those involved in Hereford— the staff of the social services, the health team and the National Society for the Mentally Handicapped. These groups work together closely and I have great admiration for what they have achieved in view of their resources. They have done a magnificent job, and the mentally handicapped in Herefordshire have benefited very much from their intelligent comprehension of their needs.
I set out to isolate three problems in respect of the provision of services for the mentally handicapped in Hereford—namely, occupation, accommodation and hospitalisation. These are three big problems, but there are many other minor ones.
994 The first major problem is that of occupation. The question that I think it right to ask is, what happens to the children who leave school at the age of 16 or 17 years? I refer to their physical age. The schooling at Black Marston School and Barns Court School is in the devoted hands of splendid people, but parents must ask themselves "What happens now?" when their child comes to that age. There are about five of them each year, and about four are assessed as capable of going out into the community or living at home. That means that 20 per cent. have to go to hospitals.
The current position is that Hereford city has 50 adult training centre places. There are a small number of adult training places in Leominster. There is a total of, say, 65. If we have four graduates—if they can be called that—a year and there is a life span of 50 years after leaving school, that indicates immediately that we need 200 places if we are to cater for these people.
The situation in Hereford is that the adult training centre has a static population. There is nowhere for people to go when they have been trained. They cannot leave the adult training centre, which means that there is no nowhere for those leaving school to go. Therefore, there is a real need for a sheltered workshop or, as I prefer to call it, an occupation centre, since the sheltered workshop implies something of the Remploy kind for the physically handicapped. An occupation centre for the mentally handicapped is very different, not least because they can turn out substantially less constructive work in a given period of time, so that the financing problems are different.
The children who have nowhere to go or nothing to do are forced to remain at home, apart from two or three days a week at the Folly House day care centre. This is not satisfactory. It produces an intolerable burden on parents and, I am told, can induce regression. This is disappointing in view of the valuable work which has been done in the schools.
If there is nowhere for them to go during the day, a short-stay facility somewhere in the city of Hereford is essential, but there is a serious lack. The various options open at present are the occasional places in Ivy House and the provision of 995 three places in the new hostel at Leominster. Otherwise it is Lee Castle, in Kidderminster.
This problem of short-stay facilities leads me to the second problem, which is that of accommodation itself. Most of the mentally handicapped in Herefordshire are mentally handicapped children. It is fair to say that, since the adult age mentally is never reached, in effect a person is a child for most of his life. Most of them live at home and remain in the community. That is desirable and good. But the fear which parents express to me is what happens when they can no longer look after their children. What happens if illness strikes or there is death in the family? What happens if circumstances remove the ability of parents to look after their children?
As matters stand at the moment, the social services take charge. But they take charge after the event, when the crisis has happened. They find suitable accommodation according to the mental level of the child. Their first priority is to provide accommodation in the area concerned. Their second priority is to provide it in the county. Their third is to provide it outside the county, and their fourth is to provide it in hospital. It is desirable that the area be considered first. On a number of occasions, however, it has been necessary to find accommodation outside the county—and that is the county of Hereford and Worcester, not even the county of Hereford.
I have touched on the case of the parent who asks "What happens when I die?" This fear gets more and more nagging in the case of elderly parents. A place cannot be found when the parents are fit. Hence, the decision is delayed. The parents are then forced to hang on. Because they are devoted people, they do not press as individuals for their child to be taken off their hands. They look after him. But always there is that nagging doubt and worry, and always the difficulties are amplified at the inevitable moment. It is desirable to take charge of the problem before it happens and to encourage the child to be able to leave home before the moment when his parents can no longer cope.
I suggest that there is a need for the development of a foster care facility in Hereford which would permit families in the first instance to make their own 996 short-stay arrangements by telephoning and booking in. An experiment was carried out by Somerset County Council in its pilot project in the South Sedgemore area which showed encouraging results. It appears to me that it could go a long way towards helping us over the difficulties in Hereford—the need for acclimatisation of the child in circumstances other than home and for the development of some long-term foster care facility as well.
The third problem is that of hospitalisation. For the one out of four who cannot be cared for in the community, hospitalisation is the only answer. For those of the four who cannot be cared for at home, for whom a place cannot be found in a hostel either in the county or outside it, and for those who cannot cope with group homes, hospitalisation will be the eventual end. If we are to take the matter along the lines of the White Paper, it would be desirable that hospitalisation should be provided in the area concerned, in the community.
Currently, the only facility of that kind is at Lee Castle Hospital, near Kidderminster. Kidderminster is about 50 miles from Hereford, and for residents of Herefordshire who have to travel 14, 15 or 20 miles to Hereford City before they can leave it on public transport to get to Kidderminster it is a substantially tough exercise to visit a relative or even to deposit such a relative in Kidderminster for a short stay.
The cost is also significant. The cheapest that I can find is £2 on the bus and £2.40 by train, with a bus journey of two and a half hours or a train journey of one and a half hours. It is not an easy journey for relatives to make with regularity—in fact, it is damned difficult. What is needed is hospital facilities for the mentally handicapped in Hereford itself, and these should provide long-term care as well as cater for additional short stays and treatment.
I have isolated three needs. The first is for more adult training-type or occupation centre places. Compared with the national guidelines of 150 places to 100,000 population. Herefordshire should have 225 places. My own crude arithmetic indicates that it has 200. But even Herefordshire and Worcestershire County Council is short of places, having only 997 453 against the national guideline total of 893. Seen in this light, 50 at Rochfield Road and 50 at Leominster, some of them for the mentally ill, are grossly inadequate in number.
The second need is for short-stay provision in Hereford, and I have already suggested a scheme. The three places in the new hostel at Leominster go a little way to help, but Leominster is 13 miles from Hereford. The third problem is the need for hospitalisation facilities in Hereford.
All these needs are related to resources, which are short. I am not asking for additional public expenditure to solve the problem of hospital provision for mentally handicapped children. My interest is in the redeployment of resources. I draw attention to the switch in rate support grant which has left the county council some £9 million short in its resources. One result is that the social services department is unable to meet even the full cost of opening the hostel at Leominister, and considerations of joint funding for various desirable projects have had to be shelved.
In theory, joint funding with Hereford health district in this matter should be a first-class way of overcoming the problem. In practice, the county council—not differently from any other shire county—is unable to risk using this method owing to future uncertainties both of inflation and the rate support grant. What is needed is the redeployment of resources. Will the Under-Secretary of State draw the problem of Herefordshire's provision for the mentally handicapped to the attention of the Resource Allocation Working Party of his Department?
One of the objectives of the Hereford health district is to bring into Hereford the facility presently provided by Lee Castle. Does the Minister concur with the desirability of this? If so, will he give his help to the regional health authority to achieve it? If the Minister were to be asked by the health authority to underwrite the purchase of suitable premises, would he agree?
I referred to the premises of the college of education in Hereford which are currently in process of being sold by the county council. Personally I express no 998 preference for any of the three bids before the county council, since all will benefit Hereford in one way or another, but as a piece of plant the college can provide for an occupation centre as well as for residential and care accommodation. As it stands, however, the health council's bid cannot be considered on an equal basis with the others because it cannot be backed with hard cash.
The National Society for Handicapped Children is under the impression that in the spring of 1976 or thereabout the Government promised special help for the mentally handicapped through the expenditure of about £50 million. Will the Minister say whether this is so? If it is, will he ensure that an equitable part of the money is directed towards solving Hereford's problem?
The most able of the mentally handicapped children are well provided for compared with the less able. It is with the less able that the troubles lie. The three areas that I have explored could provide for these children if ways and means could be found.
I end by quoting the case of Philip, who is aged 14 and who suffers from hyperactivity. He came to Hereford as a result of his father's promotion in his office. When Philip's parents discovered the future for their child in Hereford, the father was prepared to sacrifice his promotion and to return to where he had come from. When I find that happening in Hereford, I know that all is not well for the handicapped children there.
§ 11.53 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)I congratulate the hon. Member for Hereford (Mr. Shepherd) on securing this Adjournment debate on a matter which is clearly of very genuine concern to him. In raising the question of the provision of services for mentally handicapped children, he has focused on a subject which is of national as well as local concern.
The hon. Gentleman has described some of the very trying problems faced by parents with mentally handicapped children. He described the parents as devoted people, and that was a worthy tribute. He has told the House how in 999 Herefordshire there is no hospital provision at all for such children, no short-stay facilities to enable them to be cared for while their parents take a holiday, and too little provision once the children have left school.
Mentally handicapped children who are referred to hospital have to travel to Bromsgrove or Kidderminster, with journeys that are difficult, if not impossible, by public transport, and parents must find it hard to retain the regular contact with their children which is so important.
If Herefordshire's problems were unique, they could more readily be solved. Unfortunately, however, virtually all that the hon. Gentleman has said of Herefordshire is true also of other parts of the country. If we take the West Midlands alone, there are 22 health districts, of which Herefordshire is one.
Only five of these districts contain any hospital beds for mentally handicapped children: Bromsgrove, Kidderminster, Walsall, Mid-Staffordshire and North Warwickshire. At 1st January, 1976, the latest date for which the information is readily available, only nine of the districts contained local authority social services accommodation for mentally handicapped children. These were Central Birmingham, Coventry, Walsall, South Warwickshire, Kidderminster, Wolverhampton and the three districts of Staffordshire.
The reason for this lack of provision in many districts is distressingly simple. For a long period the main form of residential provision for seriously mentally handicapped people was the large single-purpose hospital, with which we are all familiar, often sited well away from any centre of population. The effect of this provision was all too often "out of sight, out of mind", and, despite the efforts of their staffs, conditions in many such hospitals were not good. Fortunately, there is now much wider recognition of the potentialities of many mentally handicapped people. It is accepted that with the right sort of training and support they can often live fairly independent lives and certainly do not need to spend their lives in hospital. It is accepted also that even those who still need hospital care can live much more satisfying lives, and can more easily keep in touch with 1000 their families, when cared for as near their family home as possible.
Successive Governments have encouraged a move away from the old regime for the mentally handicapped to one where the emphasis is on providing a satisfactory environment, either at home or in residential accommodation, avoiding unnecessary segregation, developing ability by education and training, and giving families the necessary support. This is the philosophy which was developed by Dick Crossman. It was set out in the last Conservative Government's White Paper "Better Services for the Mentally Handicapped" which this Government have endorsed.
Moving from the old regime is not only expensive but will inevitably take many years. Reaching the levels of provision set as targets in the White Paper is expected to take about 20 years. We regard this time scale as realistic, and our consultative document "Priorities for Health and Personal Social Services in England" suggests priorities for the period until 1979–80 which, if met, would sustain the White Paper's strategy.
Though the major realignment of services must take time, there is much that can be done now. Not all improvements in service need cost a lot of money. The House has been informed of the pamphlet "Mentally Handicapped Children—A Plan for Action" which was recently issued by the National Development Group for the Mentally Handicapped, a body set up in 1975 by my right hon. Friend, the Member for Blackburn (Mrs. Castle), then Secretary of State for Social Services, to advise on mental handicap policy. The pamphlet contains a number of constructive suggestions for improving services for mentally handicapped children, many of which do not require extra resources for their implementation. I am pleased to say that it is achieving a wide readership. I was going to arrange for a copy to be sent to the hon. Member, but I am glad to see that he has one. I am sure that he will agree with my assessment.
Again, there is widespread discussion on the report of the Court Committee, which also contained important proposals for the assessment and care of handicapped children. My right hon. Friends last December invited comments from field authorities and from a wide range 1001 of professional and other organisations on the Court Committee's major recommendations, including in particular that for a district handicap team for children. The closing date for comments is 30th June. It will clearly take some time after the end of June to assess the comments received, but the Government hope to make a statement of their position on the major issues as soon as possible thereafter.
I often hear the complaint that mentally handicapped people do not benefit from legislation applying to handicapped people generally. It is even thought by some people that the mentally handicapped are expressly excluded from all benefit under the Chronically Sick and Disabled Persons Act 1970. Yet the Act applies, as appropriate, as much to mentally handicapped people as to the physically handicapped. I want to make this abundantly clear in this debate. Moreover, unless it is explicitly limited in a way that excludes mentally handicapped people, all legislation applying to handicapped people applies to mentally handicapped people. As the Act's author I was deeply concerned, as were others on both sides of both Houses, to ensure that mentally handicapped people were given as much entitlement as people with any other type of handicap to receive help under the provisions of the Act.
As regards cash benefits, about one-third of all children for whom attendance allowance is paid are mentally handicapped, and when such children reach the age of 16 they are also likely to qualify for our new non-contributory invalidity pension. Again, the new invalid care allowance may enable a qualifying relative to care for such a child at home, and where a mentally handicapped child is also physically disabled and unable to walk mobility allowance may be payable on top of the other cash benefits.
About one-third of the families helped by the Family Fund have been those in which there is a mentally handicapped child. Mentally handicapped people can also share in the full range of health and social services provisions. This kind of help can greatly ease the burdens of families caring for a mentally handicapped child at home. I understand that the fund has helped 233 families in Hereford 1002 and Worcester county, at an average cost per family of £279. Approximately 75 of these families will have a mentally handicapped child if the national pattern applies in the area.
My brief review of national policy would be incomplete without some reference to the initiative that we took last year in introducing, for the first time, an element of joint financing between health and local social services authorities. The hon. Gentleman referred to this. The new scheme enables health authorities to support local authorities, and in certain circumstances voluntary organisations also, spending on personal social services where this offers the best way of providing for a particular group of people.
In the first year, a very high proportion of the money available went to mental handicap projects. As my right hon. Friend recently announced, the amount of money available for this purpose is to be increased significantly from £8 million to £21 million in 1977–78 compared with 1976–77. He has also completed a review of the arrangements in the light of comments made on our consultative circular and of the first year's operation.
To enable authorities to make full and imaginative use of the possibilities of this scheme, we have decided to relax the general rule that initial support should not exceed 60 per cent.; to provide for review after three years of the period of NHS revenue support to consider its extension to a maximum of seven years; to permit the pattern of tapering off that support to be reviewed annually; and to agree to the use of joint financing money to encourage voluntary organisations to meet local needs, provided that the local authority and the health authority agree on the project and its future funding.
Having sought to put the debate in its national context, I now want to focus more particularly on the problems of Herefordshire. In some respects, the Hereford health district is more fortunnately placed than a number of other districts. It has a special care baby unit and a purpose-built child assessment unit, which are so vital in the prevention and early detection of mental handicap, where this is a possibility. It has a hospital for mentally handicapped adults which, although a former workhouse 1003 building, has been and is being substantially upgraded. On the local authority side, there are three special schools for children up to 16 and a day centre for pupils during the school holidays. There is a small residential home for adults in Hereford, and there are adult training centres in Hereford and Leominster.
Further, the county council has just completed an 18-place hostel for mentally handicapped children in Leominster, and half the places will definitely be brought into use during the summer. The county council and the Hereford and Worcester Area Health Authority are at present discussing whether the remaining places can be brought into use through the funds that we have made available for the joint financing of projects of mutual benefit to the health and social services. I hope that it proves possible for the two authorities to reach agreement and to bring all 18 places into use soon.
The county council has indicated that, when all 18 places are in use, some will be available for short-term placements to provide holiday relief for parents who usually care for their children at home. When fully open, this hostel will bring the council above the long-term target for residential places for children which was set in the White Paper. This is not to say that no gaps in services will remain. The county council, along with most, if not all, other social services authorities, still has quite a way to go to meet all the White Paper's targets for adults as well as for children.
Turning now to health service provision, as the hon. Gentleman has said the main gap in services is clearly the absence of hospital services for children in the district. The Hereford Health District management team is anxious for services for children to be provided. It does not believe that an appropriate service for adults or for children could be provided by making provision at the present hospital, Dean Hill, because of its structure. As I have said, it is a former workhouse, and upgrading can only be taken so far before further 1004 improvement is prevented by the very structure of the building. What is more, Dean Hill is situated in Ross-on-Wye and the management team favours a development in Hereford, which is the focus of communications in the district.
The management team has come up with an imaginative proposal, namely, to adapt part of the Hereford College of Education into a unit for mentally handicapped adults and children when, after 1978, the college is no longer required for its present purpose. The team has gone so far as to seek the views of the Development Team for the Mentally Handicapped on the suitability of the college for this purpose and to cost out the alterations that would be necessary and the revenue consequences.
Whether this proposal can come to fruition depends on two factors. First, it is common knowledge in Hereford that the college is being considered for other purposes, one of which is its possible use as replacement premises for the Royal National College for the Blind. Second, there is the key question whether the Hereford and Worcester Area Health Authority and the West Midlands Regional Health Authority will rate the project as one justifying high area and regional priority. A major factor here will undoubtedly be the cost of acquisition, and at present this is not clear.
I cannot anticipate whether the county council will offer the college to the NHS or, if it does, whether the area and regional authorities will look with favour on the project, given the many badly-needed developments in the region. I shall, however, seek to ensure that the hon. Gentleman is kept closely informed—
§ The Question having been proposed after Ten o'clock on Monday evening, and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at eleven minutes past Twelve o'clock.