HC Deb 30 June 1986 vol 100 cc797-804

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Durant.]

10 pm

Mr. Terry Lewis (Worsley)

I am grateful for the opportunity to bring to the attention of the House the grave threat to the current and future prospects for providing community care for mentally ill and handicapped people in the city of Salford and elsewhere. This is entirely due to an incredible blunder by the North-Western regional health authority. Before I go into the detail of that, I should like to remind the House of the Government's commitment to providing care in the community through joint funding between local authorities, social services departments and the National Health Service through regional and district health authorities.

When the Government came to power in 1979 they almost immediately nailed their colours to the mast of community care. The then Secretary of State for Social Services commissioned a study to clarify policies for the development of community care in the health and personal social services. The study reported, among other considerations, upon the need for interaction between the National Health Service and the personal social services. As a result of this exercise, Government policy developed along three lines. They were, first, the creation of a local service in those districts that still had little provision; second, provision in every district of enough suitable accommodation for the care of people with mental illness; and, third, the making of satisfactory arrangements for patients and staff locally concerning the closure over the next 10 years or so of mental illness hospitals that were not well placed to provide a service reaching out into the community and that were already near the end of their useful lives.

The Government announced their decisions on care in the community in a written answer on 28 July, 1982 when the present Secretary of State said that he was: convinced that it would be right to press ahead with a programme aimed to get out of hospital and into community care as many people as possible who do not require hospital care. My decisions fall into two parts: those which can be acted upon without legislation: and those which require changes in the law when the opportunity can be taken.— —[ Official Report, 28 July 1982: Vol. 28, c. 522–3.] In the first category, he said that he had three main proposals: first, that health authorities would in future be able to guarantee continuing annual payments to local authorities and voluntary organisations for people moving from hospital to community care; second, that schemes jointly financed from the NHS would be available for extended periods for projects for moving people out of hospital; and, third, that a programme of pilot projects would be promoted and that up to £50 million of joint finance funds would be centrally reserved over the following five years in order to develop and assess the programme.

The initiatives which did not require legislation were launched in a circular on 14 March, 1983. Those which did require legislation were enacted by the Health and Social Services and Social Security Adjudications Act 1983. I remind the House that on Second Reading of that Bill the then Minister for Health again stressed the importance to the Government of community care. He went on to outline four main objectives of the Bill, The first is to provide more care for the elderly, the mentally ill and the handicapped at the place where the patients and their families would prefer to be, that is, at home or in small units near to home. Too many patients still have to live in large, impersonal institutions, occupying hospital beds for long periods simply because the community services are not there to support them at or near home. He went on to say: Last July"— Two or three years ago— we announced the details or a very important ini titati ve, which we called the 'Care in the Community' programme. The most important change is that for the first time ever district health authorities will be able to offer to local authorities and voluntary organisations guaranteed annual payments without limit of time to provide for people moving out of hospitals into community care. We want to see resources moving with the patient so that the funds go with him to provide him with the right sort of care in or near his home." —[0flicial Report, 17 February 1983; Vol. 37, c. 492.] I think that I have shown conclusively that care in the community and its reliance on the partnership between the National Health Service and the personal social services is the cornerstone of the Government's mental health care strategy.

However, I understand that up to the present time, according to evidence given to the Select Committee on Social Services, only about 20 per cent. of local authorities are committing themselves to the joint financing arrangements that I have mentioned. I am not surprised at that low response, if the recent experience of Salford city council is typical.

Salford city council social services committee has embraced, and is embracing, the policy with energy, inventiveness and, in view of the current financial circumstances, with great courage. Therefore, it is with regret that I am forced to bring the matter of the mental health day care centre at Little Hulton in my constituency to the attention of the House.

In March 1984, the joint care planning team for mental health in my area established a working group on day care to examine the opportunities for a joint day care service in the Little Hulton, Worsley, area and proposed an entirely new facility.

The project was intended to provide the facilities that are needed in the local community. It sought to take advantage of th legislation, to which I have already referred, to provide for the transfer to the local authority of a substantial sum of health revenue to meet recurring costs in a manner designed to achieve the maximum value for money. It offered a model for the redistribution of resources from health to local authority to ensure that appropriate care would be delivered locally and efficiently. The proposal offered the opportunity to establish a new model for the delivery of subacute mental illness care, together with more conventional day care in a jointly managed setting.

Salford city council was to make available a suitable building for the purpose. The NHS was expected to provide the staff since it would function primarily to meet the deficiencies in NHS day care. It was predicted that there would be a reduced demand on in-patient NHS facilities and at the same time improved opportunities for early discharge.

Salford city council responded to the recommendation by enthusiastically endorsing the need for the facility at Little Hulton and there was a clear commitment b) the Salford health authority to accept responsibility for staffing.

Imagine, then, the horror with which the Salford social services committee learned at its meeting on 23 April 1986 that the North-Western regional health authority would not, after all, be funding the centre through the Salford health authority as previously agreed. That came after the centre had been built at a cost to the city council of £310,000.

In the interests of making myself absolutely clear, let me quote one or two relevant facts. The social services committee, at its meeting on 22 February 1984, authorised tenders to be invited for the construction of a new mental health day care centre at Little Hulton at an estimated cost of £350,000. Then the finance sub-committee, at its meeting on 1 March 1984, approved the proposals for the construction of the centre, subject to the revenue costs being met by the district health authority. The social services committee, at its meeting on 27 March 1985, accepted a tender for the construction of the centre. The total cost, including provision for furniture and so on, amounted to about £309,000. It was then informed by the director of social services that he had received a letter from Salford health authority indicating that it would meet the revenue costs for starting the centre, amounting to approximately £120,000 per annum.

If the House will bear with me, I shall read some of that letter. It was sent by the general manager of Salford health authority to the director of social services at Salford, and says The Policy and Resources Panel of the Authority have agreed to my recommendation that this Authority commit itself to the funding of the staffing revenue implications for the proposed Mental Health Centre in Walkden"— It is, in fact, in Little Hulton— It is my understanding that Salford City Council will make available the building and will meet the costs of running the Centre other than staffing. Salford Health Authority will provide the staffing on the basis that it will function primarily to meet the deficiencies in NHS day care. The Health Authority will seek money from the following sources:

  1. 1 A bid for revenue support to the Regional Health Authority and to the Non-Capital Led Programme for 1986/87.
  2. 2. That in the event of the RHA funding not being received, the Authority will, over the period of two years up to completion and commissioning of the Centre, identify staffing resources within Prestwich and Peel Hall for transfer to the Unit."
Thus, there was something of a guarantee in that letter.

I shall not quote that letter further, because the paragraphs that I have read out show the commitment that the district health authority had given to the city council. It was only upon receipt of that notification from Salford health authority that the council finally committed itself to embarking upon the construction of the centre. The building is now completed, and the committee was extremely surprised to hear at the final moment that no finance would be available for running the centre. Consequently, that building, which is desperately needed in order to realise the Government's commitment to care in the community in relation to the transfer of mentally ill persons from hospitals into the community, cannot be opened.

The present position is that despite fulsome praise from Sir John Page, the chairman of the regional health authority, for "the commendable progress" Salford health authority has made on the plans which have been developed for the build-up of community mental handicap and illness places in 1985–1986 and over the next two years, a costly facility will remain closed because the right hand does not seem to know what the left hand is doing at Gateway house in Manchester. The excuse for breaking the staffing agreement is that funds are available for only one of two projects. That should have been apparent before the go-ahead was given to build the centre, and I am amazed at the staggering incompetence shown by the health authorities.

When I met the Minister last week, he made the point —with which I agree—that the NHS rightly devolves decision-making to a local level. He gave the impression that such problems are best resolved locally. Ordinarily, I would concur with that. However, because of the implications for the Government's own committed policies, which I have already explained, I implore the Minister to intervene. He has the power. He is backed by his own Government's stated aims.

Failure to assist will mean that a brand-new facility will remain idle while the patients for whom it was intended will be released from the big institutions into a world that is not ready for them. Those already in the community who are in need of help will be denied it. As long as it remains empty, the centre will stand as a visible condemnation of the blundering bureaucrats at Gateway house, and will be a mockery of the Government's care in the community policy. I urge the Minister to act.

10.14 pm
The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

I am glad to have the opportunity of replying to the hon. Member for Worsley (Mr. Lewis). I recognise his serious interest in the issue. As he said, we had a discussion a few days ago about it. I acknowledge that he recognises that this is a local problem. The National Health Service structure is designed so that local problems and difficulties can be solved locally, between the region and the district.

I shall outline what has happened. Salford health authority has made an agreement with Salford city council that it is now unable to fulfil, because the district considers it must give other needs priority. The district health authority was to staff a day centre for mentally ill people at Little Hulton in Walkden and Worsley, a part of Salford that lacks these facilities. The revenue cost to the health authority would have been up to £150,000 per annum. The local authority was to provide the building. The building cost £310,000. The DHA provided £70,000 of this capital from joint finance moneys allocated by the regional health authority. That is an indication of the Government's and the National Health Service's commitment to funding care in the community projects. The £70,000 was part of the continuing huge investment in Salford's health facilities.

The DHA's agreement was given in a letter dated 26 March 1985 from the district health authority to the director of social services for Salford. In the letter, the general manager described how many would be raised to staff the day centre. An application would be made to the RHAs non-capital led development fund. This is one of four regional development funds against which districts may bid. Districts have to support their case with detailed costed proposals, showing how the bid fits into their overall strategies and how patients will benefit. A recent but very sensible requirement is that a district must show that it can maintain financial discipline and balance its budget. Bidding is competitive and priorities have to be decided. That is in the nature of politics and economics in the National Health Service. In this way the region aims to ensure value for money for patients. If such funds were not forthcoming, the district general manager said, the district health authority would make the necessary staff available from Prestwich and Peel Hall hospitals.

Bids were made for non-capital led funds in 1984 and in 1985. Sir John Page, the regional health authority chairman, discussed the 1985 bid with the Salford chairman at the district's annual accountability review last November. However, this was not the DHA's only bid for development money. An assessment unit for the elderly mentally infirm at Hope hospital was also proposed. When asked to rank its schemes in priority, the DHA put the Hope hospital scheme first.

The RHA was left with the understanding from the district that they could release staff for the day unit by better use of their existing resources. Accordingly, the follow-up letter to the district's accountability review said that the region would not be funding the day centre.

Plans for the day centre emerged from the joint care planning team which brings together the DHA and the local authority. I understand, progress was regularly discussed in this forum. The social services committee discussed the matter in April and last month, on 22 May, the city administrator wrote to the hon. Member.

On 2 June, the district first told the region that staff could not be released after all. On 9 June, the district general manager suggested the solution that the region advance funds committed to certain future developments. Rightly, the region is cautious about mortgaging the future to pay for the present in this way. But the proposal is being examined, although it is too soon to say what solution will be found.

The hon. Gentleman has tried to draw conclusions from all this, but the position is that Salford and the northwest region are better funded now than ever before. Care in the community —the hon. Gentleman referred to my right hon. Friends and their commitment to the concept —is total and genuine, and this has been demonstrated. It is being established in the region on a sound basis.

The Government are proud of their record in the northwest region. The region is better funded and better managed and it is treating more patients than ever before. Since 1979, Health Service spending in the region has increased from £380 million to £807 million in 1984–85. That is growth in real terms of just short of 20 per cent. Taken together with the region's allocation for 1985–86 and 1986–87, real terms expenditure in the region is forecast to rise by about 23 per cent., compared with an average of 19 per cent. for health authorities in England as a whole. This includes the recent increase of £50 million to the NHS to take account of pay review body awards.

This growth comes from real growth in Health Service resources. It comes also from redistribution from historically well-off regions in the south to the north. I invite the House to take note of how under this Government the north-west region has moved towards its resource allocation working party target. In 1977–78, it was 11 per cent. below that target, but this year it is only 0.8 per cent. below it. This also comes from making better use of existing resources. The region estimates that its cost improvements for 1985–86 will be about 2.3 per cent. That includes cash releases through efficiency of £10.7 million.

Out of this impressive growth, Salford has clone especially well. Last year the £27 million first phase redevelopment of Hope hospital — the region's third teaching hospital—was opened by Princess Anne. Plans are now being made for the second phase. Last year alone over £2 million in development funds were invested by the region in the district. Discussions are going on about over £400,000 of developments in Salford in this financial year. If these are successful—that is if Salford can meet the region's sensible requirements, which I have already mentioned—examples would include the following: 52 extra renal dialysis places, new consultants in child and adolescent psychiatry, and in neuropathology, and new work on AIDS. No one doubts that Salford has serious health needs. The difference between the Government and the hon. Gentleman is that the Government are getting on and doing something instead of just talking about needs.

Day centre staffing has become a problem despite increased investments. For several years the DHA has been overspending its already adequate cash limits. By last year, accumulated over-spending was £2.8 million. In the main, the cause was unplanned growth—in other words, making commitments without ensuring that the resources were available. Even Labour Governments have seen that this is the road to ruin for patients' services, and have required health authorities to live within their cash limits. Last year the region and the district agreed a three-year action plan to balance the DHA's books. Left unchecked, Salford's health authority's overspending — and the entering into of commitments without resources—would inevitably have pre-empted development moneys intended for other less advantaged parts of the region.

That would have been the real risk to care in the community. But, in fact, the region is developing ambitious plans to provide people in the North-Western region with mental illness services in their district hospitals and in the community. Careful plans are being made to move long-stay patients out of institutions to care in the community tailored to their needs. In 1985–86, North-Western region earmarked £492,500 of growth money as development funds specifically for care in the community. A total of 71.5 per cent. of that was spent on nine projects in Salford. This year, £843,000:s earmarked by the region, and already some 50 per cent. is committed to Salford.

What I have described and demonstrated is the Government's fundamental commitment to Salford, their commitment to improving the health provision in the Salford area, and to improving the level of care in the community. I hope that that will provide the basis of continuing collaboration between the district health authority and the local health authority. In that spirit, I am absolutely certain that the particular problem of the day centre to which the hon. Gentleman referred can be solved.

Following our discussions, I asked the regional health authority to investigate how the problem arose and to confirm that it is considering the district health authority's proposals. I agree with the hon. Gentleman that no one wants to see the new facility standing empty. I emphasise that local priorities must be decided locally — in the region. As I have said, Salford already receives a large proportion of the North-Western's development funds, and the region is absolutely right to ensure that the district health authority lives within its means. More for Salford must inevitably mean less for elsewhere. There is an important lesson here: local collaboration in providing people's health services is too important to risk on poor planning and commitments that cannot be backed up.

I am quite certain that the correct decisions will be taken. I have asked for the regional health authority to report to me in due course following its further consultations with the district health authority. It does so against a background of a continuing and steady real increase in the taxpayers' resources which are being committed and devoted to the North-Western region. Within that commitment to the region, it is perfectly clear from the details I have offered to the House that the Salford district is rightly benefiting. It is now up to those concerned with the decisions in that area to resolve the problem. I am quite convinced and confident that they will do so. When they do so, I shall be happy to inform the hon. Gentleman of the outcome of their deliberations.

Question put and agreed to.

Adjourned accordingly at twenty-eight minutes past Ten o'clock.