Lords amendment: No. 4, after clause 3, insert the following new clause—
—(1) After section 13 of the 1978 Act there shall be inserted the following sections—
"Co-operation in planning of services for disabled persons, the elderly and others.
13A. — (1) The duty under section 13, in relation to persons to whom this section applies, includes—
(2) This section applies to—
Joint Liaison Committees
13B.—(1) The Secretary of State may, after consultation
with such Health Boards, local authorities, education authorities, associations of such authorities and other organisations and persons as appear to him to be appropriate, by order provide for the formation and as to the functions of committees, to be known as joint liaison committees, to advise Health Boards and local and education authorities on the performance of such of their duties under section 13 as consist of co-operation in the planning and operation of services of common concern to Health Boards and such authorities.
(2) An order under subsection (1) may contain provisions relating to the role of voluntary organisations in joint liaison committee.".
(2) Section 15 of the Disabled Persons (Services, Consultation and Representation) Act 1986 is hereby repealed.".
§ The Parliamentary Under-Secretary of State for Scotland (Mr. Ian Lang)
I beg to move, That this House doth agree with the Lords in the said amendment.
§ Mr. Lang
This new clause is an important step in the development of joint planning in Scotland. Its introduction follows a commitment given by the Government during the passage of the Disabled Persons (Services, Consultation and Representation) Act 1986. I am glad to see that the hon. Member for Monklands, West (Mr. Clarke) is here, having returned hotfoot from collecting his "Man of the Year" award earlier today.
The new clause achieves two purposes. First, it sets out the duty that the health boards and local authorities have for co-operation in joint planning of services. Secondly, it confers on the Secretary of State for Scotland a new power to enable him, if necessary, to produce regulations for the statutory direction of the process of joint planning.
Amendment No. 8, which amends the long title of the Bill, is necessary so that it can apply to arrangements for joint planning in Scotland. When the new clause was introduced in another place, it was generally welcomed, and I commend it to the House.
§ Mr. John Maxton (Glasgow, Cathcart)
I apologise to the Minister for not speaking in the previous debate. I gather that he had a speech prepared for it, too, which he was obviously longing to make.
I am a little disappointed that it is the hon. Gentleman who is moving the amendment because we in Scotland are disappointed that our Minister responsible for health is now in the other place, and cannot answer questions in the democratically elected House of Parliament, as was the case until the recent reshuffle. It is interesting to note that this amendment was moved in another place by Baroness Trumpington, not by Lord Glenarthur, who is the Minister with responsibility for these matters—I gather luckily, and much to the annoyance of his predecessor, the hon. Member for Argyll and Bute (Mr. MacKay)—because he was at a conference in the Bahamas at the time.
We welcome the new clause. We must congratulate my hon. Friend the Member for Monklands, West (Mr. Clarke) on it, just as we must congratulate him on being one of the 12 men of the year. I am sure that we will find that his work on this subject will be suitably rewarded in the House as well. It was due to his efforts that the English Bill was brought about and it is to the Government's credit that they have brought forward the clause.
Scotland has not done as well as England in regard to joint planning, especially between health boards and local authorities. Successive Governments have been remiss in 1001 that respect. Far too many people in Scotland are institutionalised. I refer especially to the mentally handicapped at hospitals such as Lennoxcastle and the Scottish national hospital at Larbert, who ought to be living in the community. Recent reports have shown that conditions in some of those hospitals make removal of patients from them very necessary. It is only by joint planning such as is proposed that patients can be brought out of those hospitals. It is no use having a commitment to putting patients back into the community if all that we do is put them under the care of a general practitioner who has time only to feed them valium and keep them quiet. They must be given proper support by the combined efforts of the Health Service, health visitors, housing authorities and social services departments. The Bill at least starts us along the road in that direction.
Just last week I spoke at a conference on dementia at Crieff hydro. I was the amateur among the experts, but it is clear that there will be an 80 per cent. increase in the number of people aged over 85 in Scotland during the next 20 years. If, as is the case now, one in six of those people suffers from dementia, we must work on the principle that they should be kept in the community for as long as possible, but we can do that only if we have joint planning arrangements.
It is essential that we include all relevant organisations, including regional and district authorities. We want social work care provided at regional council level and district council involvement through sheltered housing.
What finance do the Government intend to put in? There is little point in setting up joint committees which will make a lot of plans if, for lack of money, nothing happens locally and patients do not receive the care that they need. The system will not work unless we have extra home helps, lunch clubs and meals on wheels, and more social workers involved with the elderly and the handicapped. There has been a decline in the number of home helps, lunch clubs and the number of people going to them in Scotland during the past six years. There must be resources as well as a commitment to the idea. I hope that the Minister will take some time to deal with that.
I assume that there is some way in which to amend the Bill's financial memorandum. The proposed new clause is not included in the financial memorandum, but nobody can say that it has no financial implications. I assume that the Government will deal with that problem unless, of course, they maintain that there is no financial implication. If that is so, we are passing just a load of verbiage. Although this is the way forward when it comes to looking after the disabled and the elderly, the Government must recognise the financial commitment if it is to mean anything.
§ Mr. Tom Clarke (Monklands, West)
I thank the Minister and my hon. Friend the Member for Glasgow, Cathcart (Mr. Maxton) for their generous comments. I think that it was Harold Macmillan who said at a difficult time for his Government that, in politics, a few kind words go a long way. I feel exactly as he did.
The proposed new clause will be warmly welcomed by many of the people who supported the Disabled Persons (Services, Consultation and Representation) Act 1986. It represents a new principle in Scotland. It also represents a step forward. Many organisations such as the Care in the Community Scottish Working Group, the Scottish Society 1002 for the Mentally Handicapped and the Glasgow Forum on Disability will welcome the principles enshrined in the new clause, although they might not quite consider the details line by line as exactly what they wanted.
I do not, however, want to be churlish. I agree with my hon. Friend the Member for Cathcart that the principle of joint planning has been in operation in England and Wales for more than 10 years. The evidence seems to be that it is working and that a democratic input into decision-taking has been welcomed. It appears to make sense and to lead to efficiency and effectiveness. It must he good for it to apply to Scotland.
There are a few matters on which I should like some clarification. Paragraph 13A(1)(b) speaks of "organisations providing services". Do the Government have in mind advice, the giving of advice, consultation and organisations in Scotland which perform a very useful role? Will they be regarded as providing services in the Scottish context as I understand is the case in England and Wales? Paragraph 13A(1)(c) mentionsthe publication, at such times and in such manner as the bodies who have made joint plans under paragraph (a) consider appropriate".Will the Minister take on board the suggestion that there should be an annual report? People involved in the Health Service, social services, mental health care and others might then feel that these matters could be considered at least annually.
Paragraph 13B(1) mentions liaison. Will the Minister confirm that that word refers also to planning so that people who know about the problems which ought to invite joint planning are involved?
My hon. Friend the Member for Cathcart rightly mentioned Lennoxcastle. I should have preferred to say this in the presence of the hon. Member for Argyll and Bute (Mr. MacKay), but it seemed that the Government were throwing money at that problem. There had been a great deal of criticism of Lennoxcastle. The staff were doing an excellent job, but some of the things being done there could not be defended. As a result of a television programme, the Scottish Minister responsible for health announced that much more money would be spent, but there seems to have been very little consideration of the Government's approach to community care. It seems wrong for the House simply to commit itself to the principle of community care when we have the opportunity to phase out a large Victorian hospital that does not fit in with modern attitudes to community care. It seems to me and to many others that the Government are simply throwing money at the problem.
If joint planning took place in Scotland to the extent that it takes place in England and Wales, those involved with these problems on a day-to-day basis would argue that perhaps there is a better way to spend the money. If resources are limited—and we can have a wider debate about that — the Government are gravely mistaken if they simply make them available to the health board without taking account of the views of the voluntary organisations and social works departments that are called upon to advise on finding solutions to these problems. It would be interesting to know precisely what the Secretary of State intends to do about regulations.
Subsection 13B(2) refers to "voluntary organisations". I hope that that genuinely means that the consumer groups that assist with the problems of mental illness, the mentally handicapped and those with learning difficulties will be 1003 involved in the joint planning process. It would be a great pity if organisations such as the Scottish Society for the Mentally Handicapped — which has done a quite outstanding job — and which recognise the need for genuine community care were not involved in the Government's proposals. I am not suggesting that that is the Government's thinking, but it would be helpful to know exactly where they stand.
The parents of profoundly mentally handicapped children, speaking from their experience, have much to say about these matters, as do the organisations that deal with the mentally ill. Many patients themselves are capable of expressing a view. They all want to see progress on joint planning. In an endeavour to be helpful, I hope that the Government, who were slow to accept the principle of joint planning in Scotland, will accept the view of another place and this House that joint planning in Scotland is essential if resources are to be used effectively, if we are to provide the best possible service for patients, if patient care is to mean anything and if community care is to become a reality.
Despite their earlier misgivings — clearly expressed when the Disabled Persons (Services, Consultation and Representation) Act was debated on Second Reading—I hope that the Government will unreservedly commit themselves to the principle of making joint planning work in Scotland.
§ Mr. Kirkwood
I reinforce what has been said by the hon. Member for Monklands, West (Mr. Clarke) and I associate myself with the remarks made earlier about the part he has played both in this regard and in steering through his Disabled Persons (Services, Consultation and Representation) Act. I understand that a significant award has been bestowed on the hon. Gentleman this very day in that he shares the "Man of the Year" award with 11 others. I do not know which other 11 men could possibly measure up to the hon. Gentleman's qualities.
The amendment is welcome, and I am happy to endorse it. However, it is only a limited reserve power. What circumstances do the Government foresee before implementing it?
It was said earlier that the situation in Scotland is not as far advanced as in England. That is perfectly true. That is my experience, and it is not for want of trying by those who wish to make the system work north of the border. The Government do not seem to be actively promoting the idea of joint planning as energetically as they could, and they certainly have not been providing the finance through the health boards and the joint planning system to make it work properly.
This measure, described by Baroness Trumpington as "a useful sanction", is all very well, but I hope that it is only a token of things to come and that it will presage a change in emphasis by the Government by putting resources into the system north of the border.
The hon. Member for Monklands, West spoke of the lack of publication of joint annual reports. I endorse that. There should be publication of some type of annual report. I do not mean that there should be a vast bureaucracy or expenditure, but regular reports on progress in the implementation of joint plans and details of changes and additions to any existing joint plans would be helpful so that we can chart the progress being made in the different 1004 regions of the country. That is a minimum requirement before we take decisions about whether or not to implement these reserve powers.
Secondly, there should be mandatory guidelines, or better still a code of practice, on the establishment and operation of joint planning and liaison committees. That would also be a minimal requirement to allow the spirit of the amendment to take effect and flourish.
Thirdly, there is concern about the definition of "voluntary organisations". It would be a shame if it were restricted to voluntary groups that contributed financially to the process in Scotland. It should be extended to include consumer and other voluntary groups that act as representatives. That may be possible at a later stage through regulations that are spawned as a result of this primary legislation. At present the definition is fairly vague and I hope that the Government will interpret it widely.
All this entirely depends on resources. I am prepared to give this change a cautious welcome on behalf of my hon. Friends, but the Government should understand that they are hastening slowly in respect of community care and joint financing north of the border. I hope that the amendment will spur them on to greater efforts in the future.
§ Mr. Lang
By leave of the House, Mr. Deputy Speaker. The House has given a welcome to the new clause. I am grateful for that, even though, in the case of the hon. Member for Glasgow, Cathcart (Mr. Maxton), his welcome was somewhat grudging.
My hon. Friend the Member for Argyll and Bute (Mr. MacKay) very much regrets his inability to be here today. As the hon. Member for Cathcart knows, my hon. Friend is in Brussels where he is engaged upon agricultural matters, for which he also has responsibility. The Government agree that there is a need for joint planning, and I hope that the new clause makes that clear. The Government also agree with the hon. Gentleman on the need for care in the community, another useful point that he raised in the debate.
The hon. Member for Cathcart asked about the involvement of regional and district councils. I confirm that both regional and district councils are involved in joint planning in all health board areas. The clause is not, however, about spending but about making statutory provision for the formation and function of joint liaison committees. It is about the planning and the arrangements for these committees rather than about cash considerations. Joint liaison committees already exist in all areas. There should not, therefore, be any appreciable increase in cost.
The hon. Member for Monklands, West (Mr. Clarke) referred to voluntary organisations. I assure him of the Government's commitment to encouraging the very significant contribution that is made by the voluntary organisations to the provision of community care. If he looks at circular NHS/18 of 1985, he will find in paragraph 31 and onwards the Secretary of State's commitment to the provision of community care.
The hon. Gentleman asked about the terms of the provision that might restrict the extent of voluntary organisation involvement. The Government are very much aware of the considerable amount of work that is done by the voluntary sector and recognise the part that it plays in 1005 the joint planning process. Joint liaison committees are encouraged in the existing guidance on joint planning to involve the voluntary organisations. It is important to allow for some selectivity to prevent committees from foundering through sheer weight of numbers. It is desirable that committees should have the opportunity to structure themselves in a way that best reflects local interests so as best to use the expertise of those who are most closely concerned with the issues. The intention of the clause is to provide for that kind of discretion.
The hon. Gentleman also referred to public accountability. Provision is made for the publication of plans. It is important that this should be done and that the plans should be made available to the public. Clearly, however, it would be counter-productive to have detailed discussion on every minor change to the plans. We do not want great bureaucratic arrangements to be established. Instead, we want to recognise the need for public involvement. It is important to get the broad principles right and then to get on with the job. With the implementation of this clause, I hope that the hon. Gentleman feels that the last brick in his edifice falls into place.
Finally, the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) asked what factors the Government might use in deciding whether or not to activate their statutory planning power. We have made it clear, as he recognised in his speech, that this is a reserve power. We would expect to use it only if there were inordinate delay in progress, or if the plans that were produced failed to address the issues that had been put to the joint liaison committees. It is important that the present arrangements should be given a reasonable time within which to produce results. The Scottish Home and Health Department has written to boards to obtain information on progress. Following the passage of the Bill, the intention is to issue guidance to reinforce the Government's commitment to joint planning.
With those comments, I commend the clause to the House.
§ Question put and agreed to.
§ Lords amendment No. 5 agreed to. [Special Entry.]