Joint Financing (Hansard, 14 March 1984)

§ 8. Mr. Hugh Brown
asked the Secretary of State for Scotland how many agreements have been reached on joint financing between health boards and local authorities; what is the cost to health boards to date; and if he will make a statement

§ Mr. John MacKay
Seventy-two support finance agreements have been made since 1980, involving nearly £5 million of NHS expenditure in the four years to March 1984. Because of the improved response to the scheme, I am making £4.6 million available in 1984–85.

§ Mr. Brown
I believe that we would all welcome the fact that in recent years there has been an improvement in the take-up of this concept. Does the Under-Secretary of State agree that it is now four years to the day since the original circular was sent out and that overall progress has been disappointing? We all want to see some of the most seriously disadvantaged people returned to their homes. Unfortunately, often they live in seriously disadvantaged areas and, therefore, need the encouragement of more Government resources.

§ Mr. MacKay
My Department is reviewing the terms of the support finance scheme. I hope to come to a conclusion reasonably soon about new terms for the scheme. In much of Scotland the uptake has been encouraging. I wish that I could say the same for the Strathclyde region, which, unfortunately, for various reasons, has not been very keen to take part in the scheme. I hope that, given the extra money during the corning financial year—an increase of 37 per cent. over this year—the region will review its position and cooperate with the health board in getting some joint schemes off the ground.

§ Lord James Douglas-Hamilton
Given the increase in resources, does my hon. Friend accept the principle that the resources should follow the patient?

§ Mr. MacKay
That is easier in theory than it is in practice. The simple reason is that there will always be a number of mentally handicapped patients who will require hospital treatment. The health boards must try to improve the conditions in hospitals that care for the mentally handicapped and, therefore, spend money on the patients who remain in the hospitals. That is a difficult balance to strike, but one that the support finance scheme is helping to achieve.

§ Mr. Bruce
I am pleased that the Under-Secretary of State is reviewing the terms of the scheme. Will he take the opportunity to bring the joint financing scheme into line with the practice in England, where the take-up of such schemes has been at twice the level in Scotland? Will he acknowledge that, for example, the health board in my area has expressed reservations about taking up joint financing because it feels that it does not have the resources or the revenue to fulfil that arrangement and that the scheme will take funds from elsewhere? Will the hon. Gentleman bear that point in mind when considering the scheme in England?

§ Mr. MacKay
The hon. Member means that his regional council is worried because the health board does not have the long-term financing of the project after the joint funding phase is over. That is with the regional council. That matter is part and parcel of the review that we are undertaking. The English reviewed their scheme after five of six years. We are reviewing ours after four years. I am aware of the terms of the English scheme. It is plainly something that I am studying carefully. I shall be consulting COSLA and the health boards about the new terms that I would propose to put before them.

§ Mr. Millan
Speaking as someone who is anxious that Strathclyde participates in the scheme, I ask the Minister whether he is aware that the reason for the lack of enthusiasm is the much inferior financial arrangements for Scottish local authorities compared with the position in England? Why is he being so dilatory about reviewing the scheme? We have had the new Act for nearly a year. We were promised a consultation paper. When shall we see an improvement in the terms of the scheme for Scotland?

§ Mr. MacKay
The English review was conducted only in the past year or two, and the new English terms are only now coming through. Our terms were the same as the old English scheme. I accept the point that the right hon. Gentleman is making, that we need to make progress on the matter. I also accept that Strathclyde region has used the terms as an excuse. It is interesting to note that the other Scottish regions have not felt constrained by the terms.

§ Mr. O'Neill
While I agree that the Minister has been helpful in this matter and has gone some way to fulfil the undertaking that he gave during the Bill's passage, even under the old arrangements in England £96 million was spent. In Scotland we will get only £4.6 million next year. Will the Minister assure us that he will produce the appropriate new arrangement as quickly as possible? I am sure the take-up rate will increase, because about 96 per cent. of the available money has been taken up during the 386 past 12 months. Will he ensure that this will be new money and will not be taken from other parts of the social services budget?

§ Mr. MacKay
The money that goes to the joint fund comes from the National Health Service budget and, therefore, comes off the amount that is up for distribution among the health boards. As I have already said, I shall try to expedite the matter of the renewed terms of the scheme, because I think that it is an important scheme. Every year since the scheme started the take-up has not reached the figure that we had laid aside. Last year we laid aside £3.1 million; the take-up reached £2.9 million. That was encouraging and was better than in the past. This year I have £4.6 million and I hope that it will all be taken up.