HC Deb 28 January 1986 vol 90 cc777-9
1. Mr. Blair

asked the Secretary of State for Social Services what progress has been made in implementing the recommendations of the second report of the Social Services Committee on community care.

14. Mr. Patchett

asked the Secretary of State for Social Services what progress has been made in implementing the recommendation on day care for the mentally ill of the second report of the Social Services Committee on community care.

The Minister for Health (Mr. Barney Hayhoe)

The Committee's report and the Government response to it have made a valuable contribution to clarifying aims and encouraging progress in developing comprehensive local mental health services. Day hospital and day centre places have both increased in recent years, consistent with Government policy and priorities.

Mr. Blair

Does the Minister accept that there are still tremendous competing pressures on areas such as my own, where Winterton hospital is situated? The pressure is on the hospitals to release people into the community and on the ground from people who want people put into hospitals, particularly elderly people. Does he agree that there is still a real danger that, in the name of community care, we are simply loading a burden off the state on to families that cannot cope?

Mr. Hayhoe

That is not the intention of successive Governments or of those who have studied the matter with great care. The whole concept of community care is not a cheap option; it is a desirable social policy. Of course, I appreciate that there are the difficulties to which the hon. Gentleman has referred.

Mr. Patchett

The report comments on the need for special care units for the severely handicapped. Will the right hon. Gentleman assure the House that he will not handicap local authorities which are already developing the units by any further cuts in the National Health Service, thereby perhaps discouraging other local authorities from taking the initiative that the report recommends?

Mr. Hayhoe

I accept that there is pressure on resources, but I must repudiate any suggestion that there have been cuts in the financial provision for the NHS. There have not been cuts; there have been increases in real terms over the period of this Government.

Mr. Galley

The policy of community care is obviously right for the patients, and my right hon. Friend is to be congratulated on the progress that has been made so far in implementing that policy. However, does he accept the Select Committee's concern that there should be individual care plans for everyone discharged from hospital, and is he taking steps to implement that recommendation?

Mr. Hayhoe

I believe that patients must be treated as individuals. To treat them in any way as groups is entirely wrong.

Mr. Heathcoat-Amory

Does my right hon. Friend know that the report also recognised that the fashion for community care has, in some respects, gone too far? Does he accept that many mental patients need continuing institutional care and should not be placed in the community, however alluring that phrase may sound?

Mr. Hayhoe

Of course a proper balance must be struck, but I believe that, generally speaking, the move from institutional care to community care is desirable. I think that anyone who knows about, for example, young children who have been kept in Victorian institutions and who have now been released into the community to a fuller and better life must see the advantages of the policy. Of course, that does not extend to everyone, as my hon. Friend has rightly said.

Mrs. Renée Short

I am sure the Minister understands that his policy is generally accepted. However, does he understand that the major obstacle preventing the policy from being implemented is the lack of resources for local authorities and voluntary organisations, which are expected to take over the responsibilities for patients who are removed from large mental institutions? If he understands that, will he ensure that resources are made available to those organisations and local authorities to start the process?

Mr. Hayhoe

I am grateful to the hon. Lady, who speaks with authority as the Chairman of the Social Services Select Committee, for her broad endorsement of the policy. Having met representatives of the local authority associations and voluntary organisations that are principally concerned, I understand their desire to obtain more resources, especially bridging finance. These matters must be considered in the context of the overall constraints on public expenditure, which, in the Government's judgment, are absolutely essential.

Mr. Watts

Is my hon. Friend aware of the imaginative proposals put forward by East Berkshire health authority in conjunction with Berkshire county council for the development of community care for the mentally handicapped? Will he consider carefully the need for some bridging finance to facilitate that transfer?

Mr. Hayhoe

Regrettably, I have not the knowledge that my hon. Friend clearly has of those particular plans, but he will undoubtedly draw them more firmly to my attention in future.

Mr. Kennedy

What evidence and figures does the Minister have, regarding the welcome policy on community care, about mentally ill and mentally handicapped people being readmitted as a result of insufficient back-up services and support mechanisms in the community?

Mr. Hayhoe

I have no figures before me on that matter. I shall certainly write to the hon. Gentleman if those statistics are available.

Mr. Meacher

As there are 5 million carers in the community providing sustained care for elderly and disabled relatives, without whom the cost to the state of providing alternative institutional care would be enormous, why are carers uniquely denied any special support, such as a premium, under the Social Security Bill? How can the Government seriously claim to believe in community care when tens of thousands of severely disabled people will lose between £40 and £50 a week under the Bill, as a result of which they will be forced against their will from their homes into institutions, at a far higher cost to the state?

Mr. Hayhoe

The hon. Gentleman's comments are most revealing. He should believe in what most of us would regard as normal civilised behaviour, namely, being concerned about members of our own families who need care. Yet he believes that that responsibility should devolve to the state and that the state should have a primary responsibility in that area. The hon. Gentleman's view—it certainly is not mine—is of a great big nanny state.