Community Care

HC Deb 18 July 1990 vol 176 cc999-1014

Mr. Speaker

Statement—Mr. Secretary Clarke.

Mr. Jerry Hayes (Harlow)

On a point of order, Mr. Speaker.

Mr. Speaker

I shall take it after the statement.

Mr. Hayes

It relates to the statement, Mr. Speaker.

Mr. Speaker

How can it be related to the statement when we have not heard it yet?

Mr. Hayes

It is, Mr. Speaker. We have a statement on community care and a debate on community care. I suspect that both are exactly the same—[HON. MEMBERS: "No."] I suspect that both are exactly the same. So that the maximum number of hon. Members might be called, may I suggest that supplementary questions on the statement should be short? That was my point of order.

Mr. Speaker

That is a helpful suggestion. As we have a statement and a debate, in fairness to the House, I shall allow the statement to go on for about half an hour—depending, of course, on the length of the statement. I now call upon—

Mr. Joseph Ashton (Bassetlaw)

On a point of order, Mr. Speaker. Two weeks ago you had to suspend the House because of the disruption caused by the Secretary of State for Health making a statement and taking up time on an Opposition Supply day. He is now doing exactly the same again. He is cutting into the time of a Supply day by making a statement on exactly the subject that we shall be debating. Opposition parties have no rights to fair play in this House apart from your protection, Mr. Speaker. May I ask what you can do to a Minister who persists in doing this time and time again?

Mr. Speaker

In view of what happened the other day, I have made it my business to find out whether there has been agreement that this statement should be made. I understand that there has.

3.33 pm

The Secretary of State for Health (Mr. Kenneth Clarke)

With permission, Mr. Speaker, I wish to make a statement about the Government's policies for improving care in the community for elderly, disabled, mentally ill and mentally handicapped people. A similar approach is being taken by my right hon. Friends the Secretaries of State for Scotland and for Wales. Their plans will be announced separately in written answers today.

Our policies are aimed at improving social care services by ensuring that they are properly tailored to the needs of individual people. This requires a clear, locally determined set of priorities, and effective collaboration between public, private and voluntary agencies. Our proposals are linked to changes in the financial arrangements for people needing public support in residential care and nursing homes. Local authorities will take over a new responsibility to assess the individual needs of people and to meet the costs of residential or domiciliary care for the particular person in need.

As we have already said, the Government recognise that the local authorities will need adequate resources to enable them to discharge their new responsibilities. The Government will transfer to the local authorities the resources they would otherwise have provided to finance care through social security payments to people in residential and nursing homes. I reaffirm the Government's commitment to the totality of those policies, which have received a wide measure of support.

It has always been clear that the new policies represent a substantial new responsibility for local authorities. Before we implement the new proposals in full, the Government must be satisfied that local authorities can sensibly take on the new duties in a way that is fair both to the people who require services and to their local taxpayers.

Since I announced the Government's proposals last July it has become overwhelmingly clear that many local authorities are not managing their services and their spending so that they deliver good quality services effectively within reasonable spending limits. In many cases—[Interruption.]—as even Opposition Members must have noticed—local authorities have imposed excessive levels of community charge on their residents.[Interruption.]

Mr. Speaker

Order. This statement has been foreshadowed in the press. The whole House is anxious to hear what the Secretary of State has to say.

Mr. Clarke

In those circumstances it is only sensible for any additional new burdens on local government in 1991–92 to be kept to an absolute minimum. Local authorities have made it clear that the changes that we propose in community care would lead to many authorities increasing their expenditure and their levels of community charge. This would place a further unacceptable burden on charge payers.

The Government have therefore decided that it would not be right to implement all the new proposals for care in the community simultaneously on 1 April next year. Instead, implementation will go ahead on a phased timetable so that local authorities have longer to come to terms with the need to discharge their duties efficiently and at a cost which their community charge payers can afford.

I intend that as far as possible, the momentum of preparation for the new policy that has already been achieved should be maintained. Therefore, in phase 1, from 1 April next year, I propose to introduce the new inspection units within local authorities, and new complaints procedures. Next year, development work will continue on the new planning arrangements, assessment and case management procedures, and the realignment of commissioning and providing responsibilities within social services departments.

In phase 2, from 1 April 1992, I intend to implement the new planning arrangements for local authorities and health authorities and to continue with the remaining development work. The new system, including the new benefit arrangements, will be fully implemented from 1 April 1993.

The cost of phase 1 of the proposals in 1991–92 has been taken into account in the figures for the local authority settlement which my right hon. Friend the Secretary of State for the Environment expects to announce shortly. Help through special income support payments will continue to be available to people in private or voluntary residential and nursing homes until phase 3 of the revised programme is implemented. The White Paper proposals on preservation of benefit rights for people already in homes will also be implemented from April 1993.

Three other important developments will also be implemented straight away from 1 April 1991. First, the new specific grant in support of services for the mentally ill will start from next April. I am confident that the grant will encourage closer co-operation between health and local authorities. It will ensure that in future local authorities give higher priority to services for this group. The grant next year will be paid at the rate of 70 per cent. and will support total expenditure of £30 million.

Secondly, the new specific grant for local authority funding of voluntary bodies which provide services for drugs and alcohol misusers, which the House voted to include in the NHS and Community Care Act 1990 three weeks ago, will commence in 1991. It will be paid at the same rate a s the mental illness specific grant and support expenditure of £2 million. Like the grant for mentall illness services, this will promote the development of more services for a group which has often been afforded low priority.

Thirdly, the specific grant for training of social services staff will be increased to support expenditure of £35.5 million in 1991–92. That is £7.5 million more than in the current financial year. That will enable us to extend the support at present available to those working with the elderly and children to new groups of staff working with mentally ill, mentally handicapped and physically disabled people. It will also enable us to increase our support for post-qualification training. Together, the expenditure supported by those three grants amounts to about £70 million. That has been taken into account in the 1991 settlement for local authority spending, details of which my right hon. Friend expects to announce shortly.

The new policies for care in the community have been almost universally welcomed and they will undoubtedly be put into effect. We are proceeding on a phased basis because of the problems posed by excessive levels of community charge. I hope that everyone will take advantage of the extra time to ensure that they will be even better prepared for successful implementation over the next three years.

Mr. Robin Cook (Livingston)

Does the Secretary of State recognise that his statement today will be almost universally greeted with anger for its neglect of the most vulnerable people in our community and its contempt for the broken promises it leaves behind? There will also be contempt for the cowardice with which he attempts to palm off the blame on to local authorities.

Does not the Secretary of State appreciate that nobody who works with elderly or handicapped people will be fooled by his efforts to scapegoat the very local authorities that have been working flat out to implement his plans? Does he not know that the local authority associations have furnished his Department with reams of detailed papers on how much it would cost to set up the assessment systems that he wants, to plug the shortfall on DSS payments that he has left behind and to improve the help in the community for which he has asked?

Will the Secretary of State confirm that none of his officials has ever challenged one of those figures? Which of those estimates is wrong and which one, in his judgment, is not reasonable? If he cannot get the resources from the Treasury, why does he not just put into care in the community the hundreds of millions of pounds he is pouring into his other plans to commercialise the NHS?

What will happen to the old people trapped in homes that charge more than the DSS will pay? Has the Secretary of State forgotten that the remedy proposed by his Government was for the DSS to pay the price of contracts placed by local authorities? Now, no contracts will be placed by local authorities until April 1993. How many elderly people will be put out on the streets by home owners who have given up waiting for the Government to honour their commitments? To those elderly people it will not be the local authorities that are unacceptable—it will be the Government.

Does not the Secretary of State appreciate the irony of his making this statement on the very day that the Prime Minister is billed to make a major statement on the family? How will he explain to more than 1 million carers of elderly parents or handicapped children that, for another two years, the DSS will pay to put granny into a home, but will not pay to provide for help in the carers' homes? Does he not realise the danger that those carers will regard the chatter about the party of the family as so much cant? What instructions will the Secretary of State for Health give hospital managers about how to respond to his own delay on the care in the community proposals? Now that he has put them off for two years, will he put off for two years the flood of closures of geriatric wards around the country?

The House has today heard a shameful statement which breaks a commitment that the Secretary of State has repeatedly made to the House. In a more honourable period in the history of the House, the statement would have ended with his resignation. Will he accept that we are grateful to him for his statement for one reason: he has removed all doubt as to the priority the Government attach to elderly and disabled people—they come at the bottom of the Treasury's spending commitments. I promise the Secretary of State that we shall ensure that that message is understood by all elderly or disabled people who need care in the community, and by everyone who cares for them.

Mr. Clarke

Every time this subject is raised in the House, the hon. Member for Livingston (Mr. Cook) rises to his feet and puts forward with great vigour some opinion or other. I say "some opinion or other" because he has spun like a top on the whole subject ever since we produced the White Paper. He has attacked the policy; he has supported the policy; he has said that we are going too fast; he has said that we are going too slow. When we produced the White Paper he attacked it as "Thatcherism's last hurrah"; today he defends it and criticises me because I am phasing in the introduction of our policy for improving services to the elderly, the disabled, the mentally ill and the mentally handicapped. He supports the policy vigorously, telling me to go faster. That is because the Labour party has no policy whatever to improve services to these disadvantaged groups.

Secondly, the hon. Gentleman tosses out words about the expenditure figures that might be involved. Last week, he was reported as saying that local authorities will require £1,500 million more next year for personal social services policies—a 40 per cent. increase. He gave no explanation of where that money was going to come from. I do not believe for a moment that he had the authority of his shadow Treasury colleagues to put that view forward. What annoyed me and would annoy other people was his total indifference to charge payers—[HON. MEMBERS: "Answer the question."] I am answering the question. The hon. Gentleman is wrong—[HON. MEMBERS: "Answer".] I am answering the hon. Gentleman's question about figures.

The hon. Gentleman was wrong when he gave the reasons for the postponement. The reason for postponement is to protect the charge payer against the costs of proceeding with the policy so quickly when it will be implemented by people who are as irresponsible about public spending as the hon. Gentleman.

Finally, the hon. Gentleman asked me about the position of people in homes. The present system will continue for the next two years. The Government are already spending more than £1 billion, through income support, to support people living in residential homes. My right hon. Friend the Secretary of State for Social Security has uplifted the contribution from income support to such homes, and he is reviewing the system again, with the assistance of a Price Waterhouse inquiry into costs.

The Government have put unprecedented sums of money into the care of elderly, mentally ill, mentally handicapped and disabled people in private homes, and in public and private sector community care. We intend to continue to do so. My statement today is a common-sense way to proceed with that policy in the light of irresponsible behaviour by largely socialist local authorities, up and down the country, who cannot keep their polices within reasonable costs.

Sir David Price (Eastleigh)

Will my right hon. and learned Friend accept from the many Conservative Members with some experience of care in the community that his announcement today that the Government now accept that the new enhanced care in the community policy requires phasing means that they are at last facing reality? Will he accept that the need out there is vast, and that neither side of the House—

Mr. William O'Brien (Normanton)

When did the Tories realise?

Sir David Price

Many years ago, and I have practised it for the past 26 years. Neither side of the House has the funds or the authority to commit the necessary funds to the problem—we have been raising expectations unrealistically.

What will be the new formula for care in the community within the total grant support formula for local authorities to make it possible to make progress? Making progress is the most that any of us can realistically expect to do.

Mr. Clarke

I am grateful to my hon. Friend, who is a distinguished member of the Social Services Select Committee which only yesterday commended a more phased approach to the policy, and said that it had always had doubts about our proceeding at the pace originally proposed.

I agree with my hon. Friend about the enormous extent of demand which can be met by improved care in the community policies. We have to ensure that the resources and the arrangements for management are put in place properly to meet priority needs, within the ability of the charge payer and the taxpayer to afford them. We have been giving those resources. Local authority personal social services spending is up 47 per cent. in real terms during the lifetime of this Government. We have nothing to be ashamed of in our record. We have to ensure that our new improved policies are put in place in a sensible and paced way.

Mr. Frank Field (Birkenhead)

Does the Secretary of State accept that those private and voluntary bodies that are lethargic or have never taken the Government's programme seriously have nothing to fear from his statement, but those bodies that are anxious to provide community care as the Government think they should, that have shown entrepreneurial skills and already have projects up and running, because the Government gave a commitment on when they could compete for contracts, are left in a no man's land? I give an example: the Vincent Harkness day care centre in Birkenhead is paying £100,000 a year out of its funds because it believed the Government's word. Will an announcement be made about extra funds so that those bodies—private and voluntary—that believed the Government and have projects up and running will not be left stranded and, in the end, bankrupted?

Mr. Clarke

I do not know the voluntary body to which the hon. Gentleman referred, but voluntary bodies that are opening day centres for various groups of clients usually look to income support for most of their income. Most accept that income support cannot meet the entire cost, and they expect to top up the amount with either their charitable funds or funds from the local authority.

The income support arrangements will continue. Those voluntary bodies that rely on income support will get it for two years until the new system is introduced. A body that at the moment has a day care centre up and running without income support must be relying on local authority grant, and a local authority that makes that provision out of aggregate Exchequer grant will continue to do so. No money is flowing to any voluntary body today under the new community care proposals. I have announced a phased timetable which will enable that money to flow in due course when the local authorities can manage the policy sensibly.

Miss Emma Nicholson (Torridge and Devon, West)

I welcome my right hon. and learned Friend's commitment to community care and the phased introduction, which is sensible and timely. I particularly welcome his funding for the mentally ill and his specific assurance that this will bring the care of the mentally ill into higher profile in the public eye and among those who serve them, Will my right hon. and learned Friend confirm that this will give the lie to those who stated that the introduction of the community charge would ensure that services to the mentally ill would dwindle and vanish? He has given that assurance and ensured that the mentally ill will be properly cared for, in a way that will certainly never happen under a Labour Government.

Mr. Clarke

I am grateful to my hon. Friend. There has been speculation in advance of today's statement to the effect that community care for mentally ill people was threatened by the postponement. That is not the case. We recognise the urgent need to develop the community side of services for mentally ill people and to help local authorities to give it much higher priority in their plans. We are going ahead with the new specific grant. The expenditure that it supports—£30 million in the first year—is almost double local authority spending on residential personal social services for the mentally ill which, according to the last available figure, was £32 million.

Mr. Archy Kirkwood (Roxburgh and Berwickshire)

Does not the Secretary of State accept that the timing of this afternoon's announcement has more to do with the timing of the next election than anything else? Does he accept that the misery which is being imposed for another two or three years on the millions of people who require care must be added to the list of casualties that are a direct result of the introduction of the community charge—

Mr. Bob Cryer (Bradford, South)

Poll tax.

Mr. Kirkwood

—or poll tax? Is the right hon. and learned Gentleman aware that community care is already in operation in many constituencies? Is he aware also that, if he does not provide the money over the next two years, it will have to be found by reducing existing services?

Mr. Clarke

The policy was proceeding with a general welcome—once the Opposition decided that they had nothing to put in its place and were going to support it —until we reached the problem with the community charge. The hon Gentleman is certainly not the last to say that we have a problem with the overall level of the community charge. It is producing unacceptable burdens on some taxpayers in those local authorities where the level is excessive.

Any hon. Member who proposes seriously to address the worries of his or her constituents about the community charge should look to next year when we are implementing the Children Act 1989 and the Food Safety Act 1990, which are an important part of my Department's responsibilities, and the national curriculum, which is a new responsibility for local authorities. There is nothing wrong with the charge, but there is a great deal wrong with the level of charge that has been imposed in many places. It is common sense not to add to that list of responsibilities next year and to phase in policies such as this one, with enormous implications, in order to ensure that they are introduced as local authorities become better able to deliver their duties while paying proper regard to the ability of their electors to pay for them.

Mr. Roger Sims (Chislehurst)

I am sure that my right hon. and learned Friend is aware that there is bound to be a sense of disillusionment among directors of social services at his announcement, which will also demoralise social workers who have been busy preparing to implement his proposals in April in acordance with the assurances that he and the Government have given until recently. Were the directors of social services and the local authority associations consulted about the implications of the delay in implementing the proposals? If so, what was their reaction? Will my right hon. and learned Friend think again about the point made by the hon. Member for Birkenhead (Mr. Field), that some community care schemes have been put forward and are on the point of being put into operation in anticipation of local authority funding from next April? Will they be funded from additional resources, or is there a danger of their withering on the vine?

Mr. Clarke

I expect that those who have been working hard in health authorities and local authorities to prepare the new plans will be disappointed. When my hon. Friend gets a chance to study the phasing that I have announced, I hope that he will see that we have done our best to ensure that momentum is maintained and that rapid progress is made on the complaints and inspection procedure next year. If community care plans are ready now, there is no reason why they cannot be implemented without a statutory duty. Undoubtedly, the pace will tend to slow and we shall have to ensure that momentum is maintained.

Of course I am aware of the views of local authorities. Most of the social services authorities felt that they were ready to go ahead and wanted to do so. The Association of District Councils was the only local authority association that thought that we should postpone. The phasing that we have announced will revive some of the people who are disappointed. It follows closely the phasing suggested in the report published yesterday by the Select Committee on Social Services.

As I told the hon. Member for Birkenhead (Mr. Field), the statement will not lead to any reduction in funding for voluntary bodies from any source that is providing it at the moment. We are postponing the transfer from my right hon. Friend's budget to local authorities, and therefore postponing the introduction of the full new policy until 1993. Any increase in expenditure by local authorities next year will follow the pattern set out in the statement that my right hon. Friend will soon make about the local authority spending settlement and the overall level of the average Exchequer grant. Before this change of policy, there was a rapid increase in expenditure on personal social services and a rapid expansion of services. There is no reason why that cannot continue within the resources available, subject to what my right hon. Friend announces tomorrow.

Mr. Alfred Morris (Manchester, Wythenshawe)

Has the Secretary of State seen the well-argued statement issued today by the Association of Directors of Social Services, making it quite clear that local authorities are both ready and able fully to proceed next April? Is he aware that, by April 1993, six years will have elapsed since Sir Roy Griffiths was commissioned to report on community care? Is not that disgraceful? Is not it also disgraceful that crucial sections of the Disabled Persons (Services, Consultation and Representation) Act 1986, more especially sections 1, 2, and 3, still await implementation four years after they became law?

Mr. Clarke

The directors of social services continue to assure us that from a management point of view they are ready to deliver the new services. The right hon. Gentleman's own party has calmly said that they need £1.5 billion to do so. That is a 40 per cent. increase in their personal social services budgets, a large part of which, I assume, is expected to come from the community charge payer. For the reasons that I have given, that is not acceptable. Local authority spending has increased by 25 per cent. in the last two years alone. We can phase the introduction of community care and continue the rapid progress that has been made in expanding the services provided by local authorities, which have a good record.

Dame Jill Knight (Birmingham, Edgbaston)

Is not there a marked difference between the way that my right hon. and learned Friend is wrestling with the severe difficulties of finding the necessary cash, and the Opposition's attitude, which appears to be that there is simply no limit to the cash available?

In his statement, my right hon. and learned Friend announced that there would be £7.5 million additional funding for training of social workers dealing with, among others, the elderly. Is he aware that many Conservative Members remain anxious about the plight of the elderly in nursing homes? Can he assure us that our concern will be borne in mind because, if the elderly are thrown out of their nursing homes, will they not have to go into geriatric beds in national health service hospitals?

Mr. Clarke

I am grateful to my hon. Friend for her opening remarks. The Opposition's attitude is quite clear—they support our policies in full and they cannot understand why we do not go ahead and implement them and put up the community charge to pay for them. That is a summation of their policy.

I understand my hon. Friend's concern for those in residential care and our constant problem in getting the level of income support right. That is being wrestled with by my right hon. Friend the Secretary of State for Social Security. He is obtaining further information about the cost of providing a good level of care in residential homes. He has heard my hon. Friend's remarks and he will have to make a judgment about the uprating next year.

Rev. Martin Smyth (Belfast, South)

I welcome the Secretary of State's recognition of some of the aspects of the Select Committee's report. Will he undertake to follow the rest of its advice? When will there be an announcement about Northern Ireland? I welcome the presence of a Minister from the Northern Ireland Office. Is not Northern Ireland part of the community? As there is no community charge in Northern Ireland, will the community care policy be implemented, or is the right hon. and learned Gentleman's statement that it will be tailor-made for individuals simply another short cut—as Belfast people say, "see more suits"?

Mr. Clarke

I shall study the remainder of the Select Committee's report with care and respond in due course. I thought that I should draw attention to the fact that, on this rare occasion, I had rather more support than I expected in the Select Committee's report. I have discussed the position of Northern Ireland with my right hon. Friend the Secretary of State and I know that he intends to make a statement. I think that he will follow a similar process to mine.

Mr. Andrew Bowden (Brighton, Kemptown)

Does my right hon. and learned Friend accept that carers are saving the nation more than £20 billion a year and that a large number of them are quite literally killing themselves by their caring efforts? Will he give special consideration to additional resources for respite arrangements, because if we do not give a great many of those people help, and quite quickly, many of them will collapse and that will cost the state even more?

Mr. Clarke

There is already a flow of additional resources into personal social services. I have already said that, overall, local government spending has risen by 25 per cent. during the past two years. In fact, spending on personal social services tends to rise twice as fast as spending on the generality of local authority services. There is no reason why local authorities should suddenly reverse that trend.

I appreciate what my hon. Friend said about the position of carers. Beyond anything provided by the statutory bodies, it is the families and the friends who carry the main burden of coping with the problems of the elderly and the disabled. Since we took office, the number of home helps has risen by 25 per cent., the number of adult training places for the mentally handicapped has risen by 25 per cent., and there has been a 30 per cent. increase in the number of day centre places for the mentally ill. We intend to maintain that progress, phasing in an even better policy of assessing people for care and delivering it.

Mr. John Home Robertson (East Lothian)

What would the Secretary of State say to patients and their families at the East Fortune geriatric hospital in my constituency, which is threatened with closure in anticipation of further care in the community? If the hospital closure goes ahead, what will happen to those patients who have to wait for two years before suitable accommodation is made available for them in the community?

Mr. Clarke

We are steadily moving away from long-term, long-stay provision in hospital wards. This country probably has finer services for elderly people than can be found anywhere in the world. Modern rehabilitation services have enabled us greatly to reduce the number of long-stay geriatric wards. Those patients are discharged either into residential care or into community care, and alternatives are provided. My ministerial colleagues and I do not approve closures in England unless we are satisfied that adequate and better services are available in place for the patients.

The same policy is followed by my right hon. and hon. Friends in Scotland. I am told by the Minister responsible for health in Scotland, my hon. Friend the Member for Stirling (Mr. Forsyth) that no decision has yet been reached on the East Fortune hospital, and I am sure that he will approach a decision on the same basis as I would with my hon. Friends.

Dame Elaine Kellett-Bowman (Lancaster)

I agree with my hon. Friend the Member for Eastleigh (Sir D. Price), who has such a deep knowledge of these matters, that it is far better to phase in proposals than to rush helter-skelter before the arrangements are properly ready. We should wait until they can be implemented without an intolerable burden on charge payers.

I welcome the specific grant for support services for the mentally ill. Can my right hon. and learned Friend assure me that the elderly people in residential homes will not face a hiatus because of the change in the arrangements that he has made to preserve their funding? That is absolutely crucial.

Mr. Clarke

I am grateful that my hon. Friend accepts that it is sensible to proceed at the pace I propose. I am glad that she welcomes the increased provision for mentally ill people. The policy is totally new, because that specific grant—which will support almost double the expenditure that local authorities had previously—will be released to the local authorities by the health authorities, when the two have got together, to produce proper plans for community care of patients who either have been in hospital or might otherwise be in hospital. That is as important to my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman), who has large mental hospitals near her constituency, as it is to many others.

I agree that it is important to provide residential care provision for people in homes. It has filled an enormous gap in recent years. We have problems in getting the level of income support right. The transition from the present arrangements to the new arrangements will take place in 1993. We have to ensure that nobody slips in between when that changeover is made.

Mrs. Audrey Wise (Preston)

Is the Secretary of State not aware that, if the implementation of community care will put a large burden on poll tax payers, that is entirely because his Government intend to refuse adequate central funding? Is he not also aware that, whether implementation is in 1991, 1992 or 1993, it will require large resources? Is he suggesting that delay will enable local authorities to make that provision using buttons instead of the resources that his Department should supply?

Mr. Clarke

With the greatest respect, the hon. Lady does not understand the position of her own party—or perhaps I do not. Labour is not urging on the Government—as the hon. Lady appears to do—that central Government should pay all those costs. The Leader of the Opposition's answer is, "Bung up the community charge—that is how it should be paid for." I do not believe that that is acceptable.

If the hon. Lady believes that Labour's record might be better than ours on central Government financing, I can only say that it certainly was not when Labour was in power. The Government have vastly increased provisions for personal social services, which went up by only about 2.5 per cent. a year in real terms when Labour was in power. That is far below the level of growth in services since a Conservative Government came to power.

Mr. Tim Yeo (Suffolk, South)

Does my right hon. and learned Friend agree that anyone who attacks his extremely sensible decision to phase in these proposals is paying warm tribute to the wisdom of his policies? Unless the hon. Member for Livingston (Mr. Cook) gives full support to the Government in the coming debate, he will be setting a level of inconsistency that is breathtaking, even by the standards of the Labour party.

Mr. Clarke

Like my hon. Friend, I wait with bated breath. The line today appears to be that the Government have a magnificent policy, the best policy ever devised for elderly, disabled, mentally handicapped and mentally ill people. The hon. Gentleman cannot understand why we do not introduce it tomorrow and just let the community charge wind up, wherever it might be. Our sensible, phased approach will commend itself both to those who look after disadvantaged people in society and to those who face the community charge bill, which has to be in line with increased local government expenditure.

Mr. Andrew Welsh (Angus, East)

The Government's policies represent a complete sell-out in terms of community care. The right hon. and learned Gentleman has made excuses about the poll tax and phasing, but they do not apply to Scotland. Given that 1.2 million Scots are in need of community care, and that 250,000 of them have severe care needs, why is the Secretary of State for Scotland not here to make a statement? Why is there this bitty, piecemeal approach to community care? The whole House wants community care, but the Government have clearly failed to deliver it.

Mr. Clarke

The Opposition have chosen this subject for debate today, a Supply day. I brought forward the statement from tomorrow because it seemed to be pointless to have a community care debate if nobody knew what we were doing and reliance had to be placed on newspaper reports. If my right hon. and learned Friend the Secretary of State for Scotland and my right hon. Friend the Secretary of State for Wales had followed me, we should not have had much of a Supply day.

My right hon. and learned Friend the Secretary of State for Scotland is announcing the details of his proposals today. I understand that in the near future he will be making a statement on the Floor of the House about the community charge. All related matters can be examined then.

The community charge is not an excuse. If we had followed what is urged upon us by the hon. Member for Livingston, I do not think that the hon. Gentleman would have found his community charge payers allying themselves with the Labour party for having pressed the Government to drive it up so high.

Several Hon. Members

rose—

Mr. Speaker

Order. I know that this is an important statement. Because of its importance, I have allowed questions upon it to continue for rather longer than I originally stated. However, there is to be a debate on care in the community. There is also a ten-minute rule motion. I propose to call three hon. Members from each side, then we shall move on to the ten-minute Bill.

Mr. Michael Morris (Northampton, South)

Is my right hon. and learned Friend aware that his measured approach is greatly to be welcomed? Some would wish that the same had applied to the health proposals. Is my right hon. and learned Friend also aware that his decision to ring-fence the mentally ill budget is equally to be welcomed? He referred to the need for momentum in preparing for community care and for individual needs to be taken into consideration. Will my right hon. and learned Friend take it from me that, in my part of the country, individual assessment has not been carried out and that there is a great need for it, to ensure that we know which individuals should come under community care and which should come under health care? Will my right hon. and learned Friend ensure that that work is done in good time for implementation in 1993?

Mr. Clarke

I am grateful to my hon. Friend. He and I agree about the timing of the change, although I realise that he has reservations about other aspects. I strongly agree with him that there is a lot of work to be done in the next two years. Local authorities need to improve their collaboration with the health authorities. There is nothing to stop either of them producing community care plans showing how they intend to co-operate when they are ready.

We need to have a good training programme to ensure that people are able to handle personal assessment which, as my hon. Friend rightly says, needs to be done properly by those who are responsible for it. Therefore I join him in believing that the next two years could be used to great advantage to maintain momentum and to ensure that when the policy is introduced in 1993 it works better than it might otherwise have done.

Mr. Gerald Bermingham (St. Helens, South)

Does not the Secretary of State realise that some constituencies face very great problems, particularly the St. Helens area which is part of the St. Helens district health authority? Rainhill hospital in that area has been proposed for closure and it has been offered for sale to the public at large before the patients have even left it. The best part of 1,200 people will have to be decanted into the community.

In view of the phasing in of the community care proposals, could not special arrangements be made for areas such as St. Helens, so that where a problem already exists, the needs of those who have already been decanted and of those who would have been taken into long-stay hospitals lead to special facilities and grants being provided, so that they can be cared for during the next two years? It is not fair to sell off such institutions and leave nothing in their place. I remind the Secretary of State that we have the lowest number of geriatric beds per head of population anywhere on Merseyside, and we need help now.

Mr. Clarke

It can be a good, caring policy to sell off a hospital ahead of its final closure. [HON. MEMBERS: "Rubbish."] If the Opposition had ever got to power recently, they would have been faced with the problem that old and decrepit Victorian hospitals cannot be closed and alternative facilities provided if we have to wait for the sale price. If there is a sale date some years ahead, one can advance some of the money, provide better care for the patients and residents and then proceed with the closure and recover the money already expended. That is a proper way of going on.

We have introduced a generous new capital loans scheme to meet the same problem. Areas with particular problems can borrow money out of our capital allocations which they use to provide better facilities to replace the old rundown ones. They can repay the loan when they are able to sell the redundant buildings.

Miss Ann Widdecombe (Maidstone)

Will my right hon. and learned Friend join me in deploring the irresponsible and inflammatory rhetoric of the hon. Member for Livingston (Mr. Cook) in talking about grannies on the street and old people being thrown out of their homes? Does he agree that, given that there is a review of costs in progress and that income support will be reviewed regularly between now and 1993, the only thing likely to result in grannies being ejected from their homes is the scaremongering and deliberate spread of misinformation that we have heard from the hon. Gentleman?

Mr. Clarke

I agree with my hon. Friend. The hon. Member for Livingston is never knowingly undersold. He works up such fiery rhetoric on every occasion. Sometimes he flatly contradicts the position he has taken on previous occasions and, as my hon. Friend rightly pointed out, he sometimes causes alarm and damage.

Mr. Ieuan Wyn Jones (Ynys Môn)

On 25 June, when the Secretary of State obviously knew what the levels of poll tax would be in England and Wales, he wrote to Mencap to say that he had not been convinced by the arguments for delay and was convinced that he and his colleagues would be arguing for resources for community care. What has happened since that time to make him change his mind?

Mr. Clarke

I am always in listening mode when developing policy. I pay most attention to those who are complaining about the excessive levels of community charge they are facing. It is also the case that organisations such as Mencap share the views of many others that it would be advantageous to phase in the policy. Once the dust has settled—I do not think that the hon. Member for Livingston will raise much of it—he will find that most people working in this area will accept that the policy can be improved by phasing it in.

Mr. Tim Rathbone (Lewes)

Does my right hon. and learned Friend accept that the two-year delay will place an additional burden on income support? Can he give an assurance to those who live in Sussex and other parts of the south of England where income support is insufficient already, that it will be increased sufficiently to make up the difference?

Mr. Clarke

The new grants I have announced will be an increased burden for the general taxpayer. My statement included announcements of increased expenditure to be taken account of in local authority settlements. I accept that this is likely to lead to an increase in income support, but we cannot anticipate exactly how much. The care element of that income support will be transferred to local authorities at whatever level it has reached in April 1993.

I agree with my hon. Friend that an important issue to be addressed over the next two years, particularly by my right hon. Friend the Secretary of State for Social Security, is reviewing the levels of income support to ensure that they reflect changes in cost, about which more information is being sought. This is always a difficult matter. No Government have ever claimed that income support can always meet the full charges, let alone the full cost, of every residential care home.

Mr. David Young (Bolton, South-East)

Apart from lacking resources, my local authority was ready in every way for the implementation of the policy and it had not anticipated the prevarication of the Secretary of State. We are concerned not about apportioning blame but about the fact that many old people may find their lives shortened because of the hiatus that has been created. I trust that no hon. Member on either side of the House is in favour of that sort of involuntary euthanasia. Will the right hon. and learned Gentleman pay attention to the patients he has now put in an impossible position? They are often the most disadvantaged in the community.

Mr. Clarke

The hon. Gentleman's reference to involuntary euthanasia, or however he described it, is breathtaking. I have announced increased provision for care in the community and three new specific grants totalling £70 million; I have not announced a reduction in service or provision. I accept that the hon. Gentleman's local authority may have been in a position to go ahead. I have no idea what view it would have taken on how much it would spend or how much its community charge payers would be asked to meet. Many people in Bolton will appreciate the need to get the new system under control and to get the community charge properly managed before we go ahead with the full policy. To suggest that I have announced something that will kill old people is to take political rhetoric to absurd extremes.

Several Hon. Members

rose—

Mr. Speaker

Order. I have received notice of one point of order from a Front-Bench spokesman, but before taking it, may I repeat that I am not responsible for the timing of statements, although I understand that there was an agreement on this one? Today is an Opposition day, and some hon. Members who have been rising will be called in that debate; others will be remembered.

Mr. Donald Dewar (Glasgow, Garscadden)

On a point of order, Mr. Speaker. In the circumstances, I intend to be extremely brief.

The Secretary of State for Health has made a statement dealing with the position in England and Wales. I presume that Scotland again is being treated by the Secretary of State for Scotland as something of an afterthought to be fobbed off with a written answer.

I understand that in Scotland, too, financial confusion about the poll tax is the root cause of the Government's retreat. The position in Scotland, whatever it may be elsewhere, is that local authorities are willing and ready to go and organised and determined. I know from personal contact today that the announcement that has been made will be a bitter disappointment. Scots will want to know why the most vulnerable in our society will, in effect, be victims of the Government's own poll tax blunders.

There is no obvious opportunity, despite what the Secretary of State for Health has said, to question the Secretary of State for Scotland between now and when the House rises. A statement will be made by the Scottish Office on overall head totals of the revenue support grant settlement, but that will not enable us to consider in detail the policy behind community care. I simply want, through you, Mr. Speaker, to express my disappointment and dismay that a major matter of policy is being passed without an opportunity for scrutiny on the Floor of the House.

Mr. Barry Jones (Alyn and Deeside)

Further to the point of order, Mr. Speaker. The Secretary of State for Wales has proffered not an oral statement to the House but a wretched written answer on the important matter of care in the community.

I seek your guidance, Sir, because, besides not making a statement to the House, the Secretary of State for Wales has attacked the local authorities of Wales, and he has used an unjust and disgraceful means to do so.

Wales has a higher proportion of disabled people than other areas of Britain because so many of our people worked in our coal mines, foundries and steelworks. Disabled and elderly people and carers have been treated shabbily. I ask how you, Sir, may bring the Secretary of State for Wales to the House to make an important statement on the most vulnerable members of our community.

Mr. William O'Brien (Normanton)

Further to that point of order, Mr. Speaker.

Mr. Speaker

I will take it, but this is Opposition time.

Mr. O'Brien

I am aware of that, but not one hon. Member from the Yorkshire region was called. There are many chronically sick and disabled people in Yorkshire. We should have been given an opportunity to make our point.

Mr. Speaker

I am afraid that there are many disappointed hon. Members, and I regret that the hon. Gentleman is one of them. As I have already said, I am not responsible for the timing of statements or of the Opposition day. I must do my best to ensure a fair balance. I have already said that some hon. Members who have not been called will be called in the coming debate. It would have been unfair to call them on the statement as well.

The matter raised by the Front-Bench spokesmen is not a matter for me. I have allowed complaints to be made and they have been heard by the Government. There will be other opportunities before we rise, such as the debate on the Consolidated Fund (Appropriation) Bill and the summer Adjournment motion.