§ [Relevant reports of the Social Services Committee: second report, Session 1989–90, Community Care: Future funding of Private and Voluntary Residential Care (House of Commons Paper No. 257); third report, Session 1989–90, Community Care: Funding for local authorities (House of Commons Paper No. 277); fifth report, Session 1989–90, Community Care: Carers (House of Commons Paper No.410); sixth report, Session 1989–90, Community Care: Choice for Service Users (House of Commons Paper No. 444); eighth report, Session 1989–90, Community Care: Planning and Co-operation (House of Commons Paper 580-I) and the Government's reply to the second report of Session 1989–90 (Cm. 1100).]
§ Mr. Speaker
I have selected the amendment in the name of the Prime Minister. In view of the late start, I appeal not only to Back-Bench Members, whom I hope will limit their contributions to 10 minutes, although I have no authority to impose that rule, but also to Front-Bench Members to have some consideration for those who are waiting to speak.
§ Mr. Robin Cook (Livingston)
I beg to move,
That this House recalls the repeated assurances of the Secretary of State for Health that provisions to strengthen the local authority role in community care would take effect in April 1991 and that adequate resources would be transferred through the revenue support grant to support the new responsibilities of local authorities; records its concern at the statement last week by the Leader of the House that implementation now depends on the availability of resources; is aware of the desperate need of growing numbers of elderly and disabled people in the community for more help in their home and of the carers who look after them for more support; notes that the solution adopted by Her Majesty's Government to meet the shortfall in Department of Social Security payments for claimants in private residential care depends on local authority contracts being in place next April; and calls upon Her Majesty's Government to proceed with implementation of the full community care programme in April 1991 and to ensure adequate funding to enable local authorities to improve on the social service support for elderly and disabled citizens in the community.I anticipate that some objection will be taken to the motion.
It is now almost four years since the Audit Commission began the present chain of reform in community care, with a report that recommended to the House:If nothing changes the outlook is bleak.At that time in 1986, fewer than 700,000 people in Britain were over 85. It is now more than two years since Sir Roy Griffiths presented to the Department of Health his report entitled "Community Care", with a sub-title that now reads rather ironically, "Agenda for Action". Sir Roy Griffiths recommended:Merely to tinker with the present system would not address the central issues.It took Ministers in the Department of Health longer to respond to Sir Roy Griffiths's report than it took him to write it. Nevertheless, last autumn the Secretary of State 1019 presented a White Paper to the House. In that White Paper the Secretary of State observed that progress on community care
has been slower than the Government would like.Today, after his announcement to the House, we are left with the conclusion that progress is to be even slower than the Government promised. We have now to wait until April 1993 for the central changes that were recommended by Sir Roy Griffiths in 1988.
By April 1993 almost 1 million people in Britain will be over 85. During the seven years that it has taken the Government to get their act together since the publication of the Audit Commission report, the number of people over 85 will have increased by more than one third. Every day of delay brings social service departments across Britain another 30 elderly people who need whole-body bathing. That is the urgency of the problem and the urgency of the human need that has to be measured against the timetable that was announced by the Secretary of State today.
It is only three weeks since the Secretary of State wrote to the coalition of community care campaigners on 25 June. The Secretary of State said:I am not at the moment convinced by the arguments made for delay.Plainly a moment is a long time in politics. Is the Secretary of State really convinced by those arguments now? Should we perhaps send round Dominic Lawson to inquire into his private thoughts after lunch? If he is convinced, when was he convinced, and what was it that convinced him? The Secretary of State has told the House that he has been convinced by what he referred to in a reply to one of my hon. Friends as the problem of the poll tax, which, it would appear, we are to believe the Secretary of State has noticed only since 25 June.
The Secretary of State cannot get away with pretending—as he has pretended so far this afternoon—that the problem of the poll tax has been invented by the local authorities, as if they thought it up. The local authorities had the poll tax thought up for them by the Government. The Government imposed the poll tax on the local authorities. The Government chose the poll tax deliberately because they wanted to impose the most painful and unpopular tax that they could think up to stop local authorities spending money.
The problem with the poll tax is that if local authorities are stopped spending money, they are also stopped improving their local services. I predict that the Secretary of State for Health will be only the first of many Ministers who will have to come to the House and admit that the real price of the poll tax is worse public services.
In the light of the Secretary of State's statement, I must ask, whatever happened to local accountability? Whatever happened to the principle that the poll tax would enhance the accountability of local authorities to their electors, thus making it possible for the Government to take a more relaxed view of local authority expenditure?
Mr. Thomason, the chair of the Association of District Councils, has put a figure on the impact of the community care programme on the poll tax. He has priced it at 15 per poll tax payer. It seems perfectly rational and reasonable to ask local electors to choose whether they are prepared to pay an additional £15 a year so that the old people in their community can be properly looked after and so that 1020 they themselves, when they are old, can be looked after properly. If local electors are prepared to make that choice, what possible logic is there in the Government saying that they will deny the electors the opportunity of making that choice?
There is a gaping hole in the logic that the Secretary of State advanced to the House this afternoon—that delay is necessary because of problems with the poll tax. Local authorities will have to add the cost of community care on to the poll tax only if they do not get the resources to pay for community care from central Government. The Secretary of State always denied that this would happen. In my 16 years as a Member of this House and in 11 years shadowing the Government, I have never been involved in debating an issue on which Ministers were so generous with their promises of resources. Only three weeks ago, when we were debating the Lords amendments, the Minister for Health assured the House:
we have always said that adequate resources will be available".—[Official Report, 27 June 1990; Vol. 175, c. 440.]Indeed, she had said that—I am glad to receive her agreement on that point—as did Lord Henley and Baronness Hooper in another place. Indeed, so did the Secretary of State because his letter of 25 June continued:On the issue of resources, Virginia Bottomley and I have constantly reiterated our commitment to ensuring that resources will be adequate. I repeat that assurance now.I hope this is reassuring.It is perhaps unfortunate that the Secretary of State did not add to that sentence the phrase "for the moment" that he used earlier in the letter, and conclude, "I hope this is reassuring for the moment."
What happened after 25 June? What happened to render inoperable the assurance in the letter of 25 June and the assurance that the Minister gave the House on 27 June? It is not that the Government were suddenly struck by the problem of the poll tax and noticed that it was high in many local authority areas. No—the Department of Health had a meeting with the Treasury, and when the Treasury saw the size of the cheques that it was supposed to sign, it bounced the Secretary of State.
When we last debated the matter three weeks ago, it was in connection with the Lords amendment relating to ring-fencing the grants for community care. You will recall, Mr. Deputy Speaker, that our case for ring-fencing was that it would force Ministers out into the open. It would oblige them to come clean about how much or how little they were prepared to put on the table to pay for community care. If ever there was a case for ring-fencing, that case has been made by the shameful and shifty way in which those Ministers are now sliding out of the commitments that are only three weeks old.
Against that landscape of speeches strewn with broken promises, we are now asked to believe that this roll of bounced cheques cannot find the resources to improve the provision of social services before the general election, but that once polling day is out of the way the Government will buckle down and find the resources. Anyone who is capable of falling for that one really forfeits his right to the franchise—
§ Mr. Thurnham
The hon. Gentleman keeps asking Ministers to come clean, so will he come clean and say how much a future Labour Government would put on the table? If there is a total of £24 billion-worth of unpaid voluntary care, will a Labour Government pick up the whole of that bill, half of it or a quarter? Will the hon. Gentleman now come clean and give us a figure?
§ Mr. Cook
No party could commit itself to replicating the £24 billion-worth of effort that is made by informal carers in our community. Indeed, I have not met a carer who has asked the Government to take over the entirety of the effort made by those informal carers. They have asked for a reasonable degree of support from the state for the efforts that they make. That £24 billion-worth of effort on their part is likely to fall through the floor unless we provide the respite care, training, help and relief that they need. That is what the hon. Gentleman's Government are proposing to postpone for two years.
§ Mr. Cook
What is now clear is that the Government never intended to transfer to the local authorities any resources other than the money that is at present spent by the Department of Social Security. The big problem with that is that the money now spent by the DSS is not adequate for it to do even the job that it purports to fulfil.
The people who will not forget today's statement are those who will be reminded of it every month for the next two years when they receive a bill that they cannot pay for their residential private care. Many people will not be able to pay those bills even when they are stripped of the £10.05 that they receive for personal allowances; and when, as a result of surrendering those personal allowances, people cannot buy toothpaste, postage stamps or a newspaper, they still will not be able to pay the bill for the home.
It is all the more remarkable that the Secretary of State has allowed himself to be convinced on this issue because this is the one issue on which the Government have been defeated since the last general election. That defeat in March forced Ministers to come up with a lifeline for those people in homes where the DSS charge does not meet the charge of the home. That lifeline is section 9 of the Social Security Act 1990. It received Royal Assent on Friday, but became a dead letter this Wednesday. That section enables the Department of Social Security from next April to track local authority contracts with private homes and thereby reflect the real charges in the real world. There will now be no local authority contracts next April. There will not be any until April 1993.
However, April 1993 will be too late for the people who cannot pay their bills this month. The average length of residence in a nursing home is less than three years. Most of the residents who need support now will be dead before April 1993. It will be too late for the relatives who are seeing their savings disappear, because those savings will have vanished before April 1993. The average shortfall in meeting nursing home charges is currently £60 per week. By April 1993, that will mean an accumulated bill of 1022 £7,000. April 1993 will also be too late for many proprietors, an increasing number of whom will solve the problem by clearing out the residents who are dependent on the DSS to pay the bill.
April 1993 will also be too late for many charities. This morning I received a letter from the Anchor housing association for the elderly which provides residential care for 1,300 elderly people. This year, Anchor has made a loss of over £500,000 as a result of the failure of the DSS to match what Anchor charges, even on its non-profit making basis. Anchor can bear that loss this year. It cannot bear that same loss in each of the next two years. It said to me:We will not force any residents on the DSS level … to leave but we will have to ration the number of people without private means and paying only the DSS rate … to say .50 per cent. of all new residents we house. As a charity this is a strategy of last resort but we may have no choice".It is perverse that the House is making charities unable to afford to accept people supported by DSS payments, the poorest people in our community.
Today's statement makes a mockery of the vote that the hon. Member for Maidstone (Miss Widdecombe) and I forced in the House last March. We forced the Government to recognise the problem to which they are shutting their minds once again.
§ Miss Ann Widdecombe (Maidstone)
Does the hon. Gentleman agree that the solution given to us a few months ago was that there would be some immediate relief —which has been provided—and further reviews and that, in the light of the reforms, the Government would consider whether assessment procedures were adequate? Does he agree that the independent inquiry is absolutely necessary before we know which costs are reasonable? Does he accept that there is no doom and gloom in the statement today but only a responsible fulfilment of that promise?
§ Mr. Cook
I remind the hon. Lady that the reason why she and several of her hon. Friends voted with the Opposition in March was precisely that they did not trust the language "annual review of the charges". She referred to the Price Waterhouse independent inquiry. If Conservative Members say that the inquiry will solve the problem of coming up with a new national recommended rate, and, to take the area represented by the Minister of State, if that rate is set at a level to solve the problem in Surrey, the inquiry will have to recommend a new national rate which will be wildly extravagant in other areas. It will cost the Treasury vastly more to solve the problem than it would if the Government implemented the changes in April next year and allowed their preferred method to be introduced
The other people who will pay the price for the delay are elderly people who are in not residential but community care and the carers who cannot put off caring for those people for another two years and cannot wait until help is at hand. Already, some of their organisations have expressed their views on the prospect of delay. The director of the Carers National Association said:
Our members feel angry, cheated and betrayed … The Government has demonstrated that when it comes to us or the poll tax, we are not priority, because they know we cannot stop doing what we are doing.Rather extraordinarily, in replying to a question on the statement, the Secretary of State said that Mencap would welcome the phasing that he had announced. I have before 1023 me a letter of 11 July addressed to him. I do not know whether it has yet percolated through to his inner office. It says:The promise of care in the community has been the lifeline for these parents and carers. Now this promise is not to be honoured because of Government fears that the estimated costs of implementing community care reforms would add 30p per week to poll tax bills … And so for less than the price of a cup of tea a week, community care is to be sold down the river.It does not seem to me that Mencap welcomes the phasing that has been announced to the House today.
The language of both the organisations to which I referred may be more intemperate than the Secretary of State's. They may lack the cultivated urbanity of the Secretary of State. That is because they have to talk directly with their members, who wake every morning to the task of constant nursing care if, indeed, they slept through the night. Such people include a couple described by the Spastics Society in a circular which it sent to several hon. Members, but which appears to have missed the hon. Member for Suffolk, South (Mr. Yeo), who until the last election was director of the Spastics Society. In that letter the society described a couple in their 60s who care for their 40–year-old son who has cerebral palsy and very challenging behaviour. He cannot walk; he needs constant care; he cannot bathe himself; he constantly soils himself. The father has recently undergone heart surgery, the mother is being treated for cancer. It is doubtful whether they will last the two years until the care in the community package is implemented. The letter says:Both parents … are desperate for a break, but have not been able to obtain any respite care for their son for over 5 years. His mother says she has got to the point where she has contemplated drowning him because the situation seems so hopeless.I believe that that couple deserve hope. They deserve it before 1993. The Opposition will vote tonight to restore that hope to them.
§ The Secretary of State for Health (Mr. Kenneth Clarke)
I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
'continues to support the Government's policy towards care in the community as set out in the White Paper, Caring for People, as an effective means of securing and delivering services on behalf of those people in need of social care; and endorses the approach towards implementation which the Government has adopted.'We all echo the sentiments expressed by the hon. Member for Livingston (Mr. Cook) towards the end of his speech about the need to give added support to all those who care for elderly, disabled, mentally ill or mentally handicapped people.
This is a most unusual debate. As I said in my answers on the statement, we are no longer debating the merits of the Government's policy proposals. The Opposition have decided to give them their wholehearted support. They press us to implement the proposals at the pace which we originally intended and which, indeed, was my intention when the Bill was taken through the House.
So the House accepts that the Government's policies for care in the community set us on a path which is likely to lead us to enhance the support that we give both to people who suffer a disability of some kind and to those who care for a member of their family or a friend who is 1024 in need. What divides us is that the Opposition have decided that it is right to go ahead in 1991 despite all the reasons that we have given of cost, difficulty of preparation and the impact of the community charge.
The hon. Gentleman asked me when I was driven to the conclusion that we should examine the timetable on which we were proceeding. It was in the aftermath of the local authorities' announcements of their community charge levels. My constituents and those of most hon. Members were surprised and taken aback by the level of the community charge. That above all worried them. We all appreciate that, in the light of those community charge levels, we must take stock of the pace at which we can allow local government expenditure to continue to rise, the extent to which the pace of progress in many desirable policies must be matched with the ability of the local taxpayer to afford it, and the pace at which we continue to put new burdens and responsibilities on local authorities.
§ Mr. Clarke
I shall give way in a second.
In general, the first reaction of my hon. Friends was to accept, although with great disappointment in many cases, the common sense of what we propose. I feel sure that the common sense will be apparent to many in local government and to many community charge payers throughout the country when they put it in the context of all the other increases in local government spending and other new duties on local councils.
§ Mr. Clarke
I give way to the hon. Member for Coventry, South-East (Mr. Nellist), because he sought to intervene earlier.
§ Mr. Nellist
The Secretary of State has just repeated a point that he made in his statement. He said that the local authorities are not ready for the new responsibilities. Is he aware that, on Monday, I received a letter from the director of social services in Coventry, saying that, if Coventry were given Government resources, it would be ready? Is he further aware of a survey by the Association of Directors of Social Services which showed that 95 out of 96 directors of social services said that, given the resources, they would be ready by April 1991? Is not the only problem not the local authorities but the fact that central Government funding is not available? That is what is needed to give carers and those who would benefit from care in the community the necessary support without adding to the intolerable burden of the poll tax.
§ Mr. Clarke
I accept that the overwhelming majority of directors of social services felt that they were ready to implement the new policies. I have no basis on which to challenge that. I accept that most of the voluntary organisations were ready to go ahead, and I correct what I said about Mencap earlier, when I was in error. I misunderstood the cue that I thought I was being given by the question. I now clearly recall that Mencap wanted to go ahead, and Sir Brian Rix, with whom I have had many conversations about this policy over the years, made some angry statements when he first heard of the speculation about delay.
1025 I understand the disappointment, because one fact on which both sides of the House agree is that we look forward to the day when we can move from the present income support arrangements to the transfer of resources and the development of steadily improved care in the community. We are improving it now, with ever-growing levels of local authority spending, but there is a need to phase the introduction of all the new duties and responsibilities for local authorities. Many people, including Select Committee members, feel that there is a good management and social policy reason for moving forward more steadily than either the directors of social services or Ministers were first inclined to accept.
§ Mr. Clarke
I want to give a short speech; I cannot give way all the time. I have just answered one intervention and if I immediately give way again, I shall not get on. I shall give way but not too often, otherwise you, Mr. Deputy Speaker, will quite correctly pull me up.
Let us put in context the pace at which we are increasing spending and services. Total local government spending has gone up by 25 per cent. in the past two years alone. That is the background to the present problem in local authority financing. As I said, personal social services spending by local authorities tends to go up about twice as fast as the generality of their expenditure. Personal social services current spending in local authorities in real terms has gone up 21 per cent. between 1984–85 and 1989–90—nearly double the increases for all local authority expenditure, which was 11 per cent.
During the Government's period of office, local authority personal social services expenditure on community care has risen 34 per cent. in real terms. That rise is flowing through into all kinds of increased provision of service, including 25 per cent. more home helps and meal services for the disabled up by 13 per cent. Such increases will presumably continue, and I have no doubt that there will be increased resources in future.
My announcement today is not an announcement of any reduction in resources. Tomorrow's statement by my right hon. Friend the Secretary of State for the Environment on the totality of aggregate Exchequer grant to local authorities will no doubt determine the pace of events for spending next year. It is wrong to say that it is the policy of any political party that all social services expenditure will be met out of central taxation, not local taxation.
§ Mr. Clarke
In his intervention a moment ago, the hon. Member for Coventry, South-East implied that the expenditure would not affect the community charge payer, and the only problem was that central Government would not put in all the money. No party is offering to put all the money in. The way in which we are transferring responsibility to local authorities means that they will eventually decide how much is spent on the policy in the light of whatever grant they receive from central Government. The community charge will be determined by the difference between the standard spending assessment established by the Government of the day and the level of spending on which they choose to embark.
1026 I think that the hon. Member for Livingston said that the community charge would go up by only £15—but no one knows what the figure will be. That is his assessment, based on one set of local authority figures, of the amount by which the charge is likely to go up, in the first year alone, for care in the community policies. We all know that assessments of local authority spending are notoriously difficult to make. We also know that authorities such as Lancashire, Suffolk and Derbyshire are inclined to take no notice of such assessments, and are free to put the community charge level wherever they want.
Given that we all share the same concern for disadvantaged people, I submit that it is impossible for us to turn a deaf ear to the concerns of charge payers, many of whom are not well off. It is not right for the hon. Member for Livingston to say that another £15 next year for one policy alone should blithely be assumed as acceptable. I am not sure whether it is an accurate figure for the hon. Gentleman to put forward—
§ Mr. Clarke
I am about to refer to the hon. Gentleman, so I shall definitely give way when I have finished my point.
Earlier, I referred to the hon. Gentleman's reported comments about the likely level of expenditure next year if our proposals were implemented without phasing. I admit that the press cutting that I have is from the Morning Star, but the hon. Gentleman was also quoted in other newspapers. In the Morning Star he is quoted as saying:
Local councils will need an extra £1.5 billion over the next three years if they are to take over responsibility for the elderly and mentally ill from next April.The hon. Gentleman then quoted figures showing that the report was a little inconsistent. The figure to which he referred was for one year. He was solemnly suggesting that £1.5 billion should be added to personal social services expenditure—an increase of 40 per cent.—in one year. He has not explained—he did not do so to my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) when he intervened—how much of that would come from the taxpayer and by how much the community charge would go up in local authorities across the country if we followed his advice.
People caring for the disabled and elderly would find themselves at the receiving end of excessive community charge levels if we recklessly continued on the basis of the figures suggested by the hon. Gentleman.
§ Mr. Cook
I shall put two points to the Secretary of State. First, as he quotes those figures, may I point out that he does not need to read the Morning Star to obtain them; he can merely summon his own officials, who have those figures in copious detail in the document submitted to them by the settlement working group which negotiates with the local authority associations. Those figures show that local authorities put the estimate of care in the community at £829 million in the coming year—£400 million of which would come from the transfer of DSS money.
I repeat the question that I put to the Secretary of State at the end of his statement, to which he did not reply in his supplementary, and which he has had a long time to think about. Will he confirm that at no stage since those figures were submitted almost two months ago have his officials 1027 queried a single one of the estimates? If he does not regard those estimates as acceptable, with which figure does he disagree and which one does he find excessive?
Secondly, I shall correct the record before the figure of £15 enters history as my invention. The figure of £15 came from Mr. Thomason, chair of the Association of District Councils who, until the Secretary of State addressed the House, I had believed was a member of the Conservative party.
I shall repeat the other question that I posed to the Secretary of State: if the figure is £15 or more, why does he have to make the decision about how much should go on the poll tax of every authority in Britain? Why, on the principle of local accountability about which we have heard so much from the Government, cannot the Government leave that to be resolved by the local electorate?
§ Mr. Clarke
My officials in the Government have never accepted as bound to be paid out the estimates that the hon. Gentleman is defending. I know that they are the local authority estimates—that is why I know that they are for one year, not three years, as he was reported as having said in the newspaper. It is a one-year increase, which he, as a shadow Minister, is extraordinarily accepting at face value and endorsing. He is telling the House that we should go ahead, which will cost another £1.5 billion. The implication of what he said is clearly that that money should be found.
As I said, £1,500 million is presumably the local authorities' best estimate of the amount by which they intend to increase their spending on personal social services alone. It is a total guestimate. We do not know where it will be spent, but the history of local government spending leads most of us to suspect that the figure is as likely to be an underestimate as an overestimate. We have no idea where the local authorities, in current hands and under current control, intend the money to go.
If the hon. Gentleman were ever a member of a Government, he would know that this is the process that we have been going through in discussing the consequences of this year's community charge levels. He takes a blinkered view. We are talking about personal social services, and he cheerily says that, next year alone, an extra £1.5 billion must go on personal social services expenditure by local government. As I said in my response to questions, next year local authorities are taking on new duties under the Children Act 1989 and the Food Safety Act 1990, and they have important new duties in relation to education.
The totality of that expenditure and the community charge will be a crushing burden on taxpayers throughout the country. It is no good the hon. Member for Livingston talking about accountability. I certainly have been using the language of accountability when arguing about the level of community charge in my county, as have most of my right hon. and hon. Friends.
The Opposition refute any idea of local authority accountability for this. They are in favour of high spending and high taxation by local government. They face the difficulty that they have no idea in what form the bill should be presented to local taxpayers. They do not have 1028 a tax of their own, and they have no idea how this immense burden to the taxpayer—paying for burgeoning local government—will be parcelled up and shared out.
The hon. Member for Livingston is one of those who refuses to pay his local tax: he is a refusenick on the community charge. For that reason, I can only describe his attitude as cavalier and irresponsible when he attacks us for a policy that he supports and cheerily says that we should underwrite a bill which is fairly uncertain but is perhaps of the order of an extra £1.5 billion. The combination of his support of our policy and his criticism of its pace and his belief that we should simply go ahead without regard for any of the other consequences is quite incredible to the electorate and totally irresponsible on the part of the Labour party.
§ Mr. Worthington
On the issue of accountability, whether rightly or wrongly, the Secretary of State for Scotland has said that, after one year of the poll tax, the local authorities in Scotland are now accountable. That is one excuse for not introducing the policy; the lack of readiness of social work departments is said to be another, but they want to go ahead. As the Secretary of State believes that local authorities are now accountable, and as local authorities want to go ahead, why can we have the poll tax but not community care a year ahead?
§ Mr. Clarke
The hon. Member for Coventry, South-East made it clear that he wishes to go ahead. When he produces a hugely increased community charge bill for his electors, he will say that the reason is that not enough central Government money has been put in.
The hon. Member for Livingston adopts the same approach, and appears to be promising vast amounts of central Government money next year for personal social services alone. We all know that the hon. Member for Livingston has no authority from his Front-Bench colleagues to promise that money. I do not believe for one moment that the Labour party would put that sum of money in, or anything like it.
The hon. Gentleman sees that there is a debate, sees a way to attack, his beard bristles in that engaging way, and up he gets to say that £1.5 billion is needed next year by local authorities for one small part of the policy area for which he has shadow responsibility. That is not a sensible way to proceed, and it is no way to demonstrate real care and concern for the client groups which are looking for continued development of policy along the lines that we have already seen, and for the evolution of that policy into a proper policy for care in the community.
I repeat what I said when I replied to questions on my statement: my announcement today did not contain any reductions in resources. There is no announcement of any cuts in social services provision. No one is withdrawing the entitlement to income support of those in residential care homes. My right hon. Friend the Secretary of State for Social Security is looking at the basis on which we must adjust income support in the next few years, until we are able to introduce the policy in full.
The hon. Member for Livingston talks about how my right hon. Friend might resolve some of the problems to do with a proper level of income support. My hon. Friend the Member for Maidstone (Miss Widdecombe) has been harrying the Government to improve the present arrangements and has succeeded in getting the level up. We have increased expenditure on that front by £145 1029 million, as a result of our defeat in the House, when we added £45 million. We also have the Price Waterhouse study on costs.
We can also go in for local variations. Sections of the Social Security Act 1990 pave the way for local variations based on local authority policy in future, but we do not have to wait for section 9. My right hon. Friend can already consider what evidence exists to justify a local variation system, but, as he has often explained, it is extremely difficult to get an effective local variation system in place. We are proceeding with a pattern of services in which I expect to see continued development and growth of support for all these disadvantaged groups, better preparation for and advantage taken of the time for the introduction of the new policy, and then the change to care in the community in 1993.
§ Mr. Frank Field
The Secretary of State is saying that nothing has changed as a result of the statement today. The point that I made about the statement was that a large number of organisations believed that the Government's word was their bond, and they have acted upon that. Perhaps the Secretary of State for Social Security has now told the right hon. and learned Gentleman that the answer that he gave was incorrect: people in day care facilities do not get help from income support.
A number of organisations which the Government, given their rhetoric, ought to applaud—those which have got up and shown entrepreneurial skills—believed that the Government were going to bring in the proposal by next year and have put their money where the Government's mouth is. They have got projects not merely on the drawing board but up and running, but they now face closure unless the Government come up with new money for them.
The Government believe in targeting. Will the Secretary of State give a commitment that he will go away and try to seek resources which can be targeted on the projects which are running because the Government said that the scheme would start next year?
§ Mr. Clarke
I agree that I said, first, that I did not know of the particular voluntary body in Birkenhead. Then I picked up on the hon. Gentleman's sedentary remark—
§ Mr. Clarke
They are not all over the country. The hon. Gentleman must allow me to answer his intervention. If centres provide only day facilities and have no residents, they cannot obtain income support and cannot have been expecting to do so in future—[Interruption.] The hon. Gentleman will not allow me to reply. He makes a case which frankly does not stand up, and he is trying to sustain it during my answer. We are not withdrawing any funds at the moment. If people are planning projects—
§ Mr. Clarke
There was no such promise. That is total nonsense—[Interruption.] The hon. Gentleman must allow me to reply.
If a flow of funds is going to a voluntary body of any kind at the moment, I have not said anything that will end that. If a body was anticipating a flow of money next year, presumably it was anticipating a decision to be taken by the local authority, which it has not yet taken, which it cannot have yet taken and which was not backed by any 1030 promise made by the Government—[Interruption.] The hon. Gentleman made a bad point and is trying to barrack me throughout the answer. There has been no withdrawal of funds and no promise of funds next year. The hon. Gentleman has merely described a body which, no doubt with worthy intentions, has anticipated a decision by the local authority next year to give it added support. It is ridiculous to suggest that the country is full of people banking on some promise that we made to pay, because no such promise was made—[Interruption.]
§ Mr. Deputy Speaker (Mr. Harold Walker)
Order. The hon. Member for Birkenhead (Mr. Field) must not sustain this constant barracking from a sedentary position.
§ Mr. Clarke
It would be a ridiculous method of debating if both sides regarded themselves as entitled to speak at the same time throughout the debate.
No money has been withdrawn from any voluntary body. No plans have been drawn up for expenditure by any local authority next year. If the voluntary body was expecting expenditure by the local authority next year, it must look to the local authority to meet it. I do not accept the validity of the hon. Gentleman's point. Hon. Members say that nothing has changed—[Interruption.] If hon. Members decide that it is as well to conduct this debate among themselves, it is because they are reduced to making a case against the phasing which they cannot sustain, and they are doing so in an absurd fashion.
Various things have changed. We have announced additional resources for the care of the mentally ill, the beginnings of a specific grant for voluntary bodies giving help to people suffering from alcohol abuse and drug abuse, and greatly enhanced grants for training. Our announcement is a substantial advance for mentally ill people. The expenditure that we propose to support by the new specific grant is almost double existing expenditure by local authorities on residential care. We have given this specific grant because history shows that local authorities tend to give a low priority to mentally ill people compared with other groups that they are accustomed to supporting through social services.
We believe that there should be much closer collaboration between health authorities and local authorities providing for mentally ill people. We are therefore introducing, at a generous level, a specific grant which will oblige them to collaborate to unlock the resources which they will then spend on improving the community end of care for mentally ill people.
On alcohol and drug abuse, I acknowledge that the amount of spending that will be supported in the first year by the new specific grant is quite small—£2 million—but we were contemplating the new specific grant coming in to replace the income support income that voluntary bodies usually have. As there is no transfer of income support but also no ending of income support, income support revenue will still go to the voluntary bodies until the changeover in 1993. The £2 million which we now propose in support is in addition to existing expenditure. It will be new money. It is a benchmark for that specific grant, which will obviously have to be enlarged significantly in 1993 once the income support revenue for the voluntary bodies comes to an end.
1031 I shall leave the issue of training to my hon. Friend the Minister for Health, who will speak at the end of the debate. The increased expenditure on the training of social workers which we have announced will mean a significant increase in the training activity of local authorities. That is an important part of how we must use the next three years. I expect local authorities to continue to expand and develop personal social services of all kinds over the next year or two, taking account of available resources and the ability of their local taxpayers to afford the pace of advance.
I believe that the collaboration between health authorities, local authorities and voluntary bodies in preparing for the new policy will continue. We shall see them getting closer and taking advantage of the work that they have already done. If they follow the phased steps which I have announced, the momentum will be maintained in the policy, and in 1993 we will see a much improved policy of care in the community for all the disadvantaged groups whom the House wishes to help.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I never thought that I would hear the Secretary of State make a disingenuous speech, but we have just heard a disingenuous speech and a disingenuous statement. I am surprised at his attempt to make out that the proposed changes will improve provision for disabled people and their carers. He must know that that will not happen. In fact, it will do the opposite.
The Secretary of State had the brass nerve to say that he was annoyed at the response by my hon. Friend the Member for Livingston (Mr. Cook) and his policies. Disabled people and their carers feel more than annoyed. My hon. Friend used the words "angry, cheated and betrayed"—not his words or my words, but the words of the Carers National Association. That is how disabled people and their carers feel. They feel let down by the Government. The Secretary of State made out that there were wonderful improvements and craftily implied that there would be a small, marginal improvement because funds for the mentally ill were ring-fenced and the rest of it, conveniently omitting to say that all the other funds for which we asked will not be ring-fenced. This delay means putting back schemes that many local authorities have already drawn up.
The announcement by the Secretary of State is a serious setback for disabled people and their carers. He is a skilful debater, but no amount of rationalising can obscure the fact that the Government have let disabled people down badly. We all know that the poll tax has backfired on the Tory Government. Instead of blaming local authorities, the electorate is blaming the Government, rightly, for the poll tax. To win votes—which is what this manoeuvre is all about—the improvements put in hand by local authorities are being deferred. The poll tax—the Government's baby—is the real reason for deferring important schemes.
Disabled people have become the sacrificial victims of the poll tax. That is a simple equation. I do not know how the Secretary of State sees that political morality, but it is appalling to conduct the affairs of state in such a way that the rights and interests of severely disabled people and their carers are sacrificed. The Opposition would not do 1032 that, nor would some Conservative Back Benchers who are waiting to speak—their priorities would be to put disabled people and their carers first.
§ Mr. Ashley
I am sorry, but I have only 10 minutes to speak.
Under this Government, disabled people have gone to the bottom of the queue. Community care reform means a higher poll tax because the Government plan to hand over responsibility without sufficient cash. Despite all the manoeuvring by the Secretary of State, that is the bottom line of the debate. There is inadequate central funding for community care. We cannot blame things on the poll tax or on town halls; it is the Government's responsibility and their failure. That is what the debate is all about. The Secretary of State, seasoned debater though he is, cannot get round that basic fact, and that is why the public and disabled people will blame the Government. The Government cannot circumvent that reality. It is ironic that community care charges were introduced, not because of the plight of disabled people or of their carers but because of the rising costs of claims for income support for people in residential homes. I do not believe that anyone will dispute that. It is doubly ironic that cash considerations are forcing this decision. That is the reason for this damaging delay. We are coming full circle.
The Secretary of State says one thing about his projects, plans and policies; but clear, eloquent statements are being made by not only my hon. Friend the Member for Livingston, whose speech I admired, but organisations representing disabled people that are working at the coal face as it were, and know at first hand how people are suffering. I think that I can claim that all of them—I am open to challenge—are appalled at the Government's actions. I do not see how any responsible Minister can find a hint of evidence to support the Government. I should not say to the people who are working with crippled, blind, deaf, spastic or mentally handicapped people that they are wrong. They unanimously condemn the Government. [Interruption.] It does not matter what the Government Whip says to the Secretary of State. All organisations representing disabled people are saying that. I shall sit down if I am challenged on that point and the Minister or the Whip can name one organisation that backs the Government, but I see that I need not give way.
If the changes are delayed, will the guidance still be published in September and will health authorities still be required to commit funds for community care projects? Delay is bound to mean that people in hard-pressed local authorities and the national health service will simply turn their attention to other matters. Like Ministers, they are busy people and delay means that they will carry out bypass operations and other projects that are dear to the hearts of voters. As a result of the Secretary of State's announcement, thousands of disabled people will be pushed aside. I regret that.
The care problems of disabled people cannot be solved overnight. As my hon. Friend the Member for Livingston said, we have waited six years for changes and now they have been put further back. The Government's failure is politically embarrassing for the Secretary of State, but to many disabled people and their carers the proposals are not simply an embarrassment, but a disaster. Ministers should be ashamed of themselves.
§ Mr. Timothy Kirkhope (Leeds, North-East)
I have not spoken in the House before about community care but I have a special interest in it. For the first three years of its life I was a legal commissioner with the Mental Health Act Commission and during that time I played a small part in the drafting of those parts of the biennial report and the code of practice dealing specifically with community care for the mentally ill.
I support the Secretary of State's proposals. Even if he had not spoken about the community charge, I should have urged a transitional introduction of community care in the way that he suggested. One of my reasons is that during my time with the commission we were concerned, especially in the early days, about demands from the progressive wing—the psychiatrists, psychologists and some Opposition Members who are active in these matters—to put pressure on the authorities to empty the mental hospitals and return freedoms and rights to the patients. They thought that that could be done only by emptying our hospitals and making people go back into the community, whether ready or not. In the first year or two it was part of our task to bring quite clearly to the minds of those concerned that that was not necessarily always appropriate and that the proper provisions were not available on the ground to deal with the problem.
The community, in the sense of us all and not just those concerned with mental health or disabled people, is not ready to accept many people into the community and to treat them with the sympathy and understanding that they deserve. I regret to say that then and even now there are clear signs that the education of the public in such matters is not sufficiently developed.
During our discussions we met many people from the social services departments of local authorities. I pay tribute to many of them, especially directors, who were keen to play a much greater role in community care, not only for the mentally ill but more generally for other groups. Their keenness to do so did not hide the fact that they were often ill-equipped to provide the necessary facilities. Opposition Members may think that I am about to mention resources, which of course play a part. We did not conclude that the majority of the problems stemmed from lack of resources. Many of them stemmed from the fact that organisations, the number of people who had been trained to the right level in mental health care, and the number of approved social workers in place were quite inadequate. Sometimes in their keenness to be of help, social services directors ran away with the idea that they could manage when they could not. That is why I welcome in our proposals the assistance with greater training of those who in due course will carry out community care.
The people whom I have mentioned were in a great hurry and were not well equipped. As a result of the work carried out by the commission and other interested people, the progress towards community care for the mentally ill was slowed—I do not use the word delayed—so that we could take account of the needs. It is right to apply the same concept to other areas of community care. That is why I welcome the proposals.
Little has been said about the great work that is being carried out by other people who are interested and work in community care. Not only district health authorities, local authorities and the Government are concerned, because voluntary and charitable organisations are keen to accept 1034 responsibility in an area in which they have a great deal of expertise. I should be sorry to see that expertise lost. I have already mentioned the community as a whole. Of course, we need more education and more help. People in families with someone who is disabled in some way will appreciate the extra resources which, whether the Opposition like it or not, have been provided by the Government for greater community care.
§ Mr. Kirkhope
No, by the Government.
My mother-in-law recently broke her hip and has just left hospital. I can speak highly of the assistance that she received from the voluntary sector and from the local authority social services department. She is grateful for that assistance and many other elderly and disabled people have good reason to be grateful for what they receive. However, it is a matter not just of gratitude but of our responsibility to such people. Plainly, the Government accept that responsibility in the implementation of the community care proposals and they are ready and willing to discharge it.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I listened with some interest to the speech of the hon. Member for Leeds, North-East (Mr. Kirkhope). I do not know how he can justify his conclusion because, although large sums of money are involved—we should not treat large sums lightly—those sums demonstrate beyond peradventure that out in the community there is an existing unmeasured and unmet need. The Government propose to postpone the resources required to meet that need which inevitably will mean that they will be ignoring the need during the period of postponement. None of us should ever forget that.
The Secretary of State's statement was deeply disappointing. The Government's decision and the reason for it have obvious political overtones and implications. However, I wish to concentrate on the implications of the delay for the management of the implementation of community care, which already has a sorry history. The original Griffiths study commenced more than 10 years ago. Community care was marched to the top of the agenda and the professions geared themselves to face the consequences of fundamental change in the new approach to community care. That was welcome then and continues to be welcome now on all sides.
A long time afterwards, in spring 1988, the Griffiths consultation paper was published. Community care was again marched up and then down the hill. Then there was a long and worrying hiatus between 1988 and 1989, and finally in the winter of 1989 the White Paper was published. Expectations were again raised and people were led to believe that that was the final version of the scheme that the Government would implement. Like the proverbial grand old Duke of York, the Secretary of State has once again marched everyone back down the hill with today's announcement.
Whether the Secretary of State thinks that community care is good, bad or indifferent, his approach is a totally stupid way to govern. Local authorities and care professionals do not know whether they are coming or going. It is quite disingenuous for the Secretary of State to 1035 say that his announcement will change nothing. Whether he likes it or not, people have sensibly been making professional arrangements to take advantage of the scheme in April 1991. Now, all those plans have crumbled into dust in their hands. The Secretary of State may say that it is merely phasing-in, but in fact it is a two-year or more delay. That is significant in the time scale that we are discussing, especially bearing in mind the few years that some elderly people live in residential homes before they die. The right hon. and learned Gentleman is making a severe and fundamental change.
The Government have not taken into account the real costs of such a sudden change of direction. My local authority has, quite properly, made painful sacrifices in an attempt to use its present resources to anticipate the changes and so meet the previous target date of April 1991. That work has now been wasted; it will have to be set aside and begun again in two years. The delay will mean that a great deal of work, such as case management pilot projects and assessment procedures, in which my local authority has engaged diligently and thoroughly, has now gone out of the window. That is a shame because the results of that work and what could have been achieved by April 1991, had the Government allowed the policy to proceed, were encouraging.
Irrespective of what we think of "Working for Patients", "Providing Better Health" and "Caring for People", which embrace the health board changes, and whatever we think of the general practitioner contract changes, which embrace a systematic survey of the health needs of the elderly, they could have been introduced and administered much better as an integrated package. My local social work authority has found that general practitioners in rural areas are now referring greater numbers of elderly people who require occupational therapy. It could cope with that much more easily if it had the advantage of the care in the community package that was due to be implemented next April. It now has to go back to the drawing board to find a way to meet that additional demand on resources, without the initial assistance that was expected from the implementation of the package. If I had longer, I could illustrate the confusion and the disruption that will be caused, and I am sure that other hon. Members could do the same.
There is another problem to which the Government have paid no attention. Although the changes are not so fundamental in Scotland, the changes to the child care services law in England and Wales will be imposed on local authorities in Scotland not, as the Secretary of State said, in April, but in two or three years' time. The social work department in my constituency will have to cope with the fundamental changes in community care at the same time as trying to cope with the changes in child care services. That works against the Government's argument in favour of delaying the policy.
I can cite a case similar to that cited by the hon. Member for Birkenhead (Mr. Field). It is a Borders region authority problem. It has inherited a home that was recently closed by a religious order. It is situated in the constituency of my right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), and it was closed for valid reasons. However, the local authority now has to cater for another 54 people. It was in the 1036 process of setting up a community care package for all those people between now and April 1991, and it does not know what the dickens it can do now that the right hon. and learned Gentleman has delayed the care in the community policy. I am sure that the local authority will, in the end, make sensible and proper provision, but it will now have to be at the expense of existing services.
The key to community care is the importance of the individual assessment, which measures individual needs. We cannot have the real benefit of community care until the Government properly fund and support that part of the community care package. I accept that large sums of money are involved, but the way to unlock funds for community care is to give local authorities a single budget and the flexibility to provide the domiciliary support to take people out of institutions. That would generate money that is currently locked up in inappropriate care in institutions. The Secretary of State cannot say that no changes have been made to his plans because the crucial key that will open the door to the resources needed and to treatment in the community has been thrown away and lost for another two years. That is deeply worrying and the right hon. and learned Gentleman deserves all the criticism that he has received from hon. Members.
I welcome the earmarked fund that the right hon. and learned Gentleman announced this afternoon. It is a positive step in dealing with mental illness. Can it be deployed in providing residential care for the demented elderly? I refer to not just the frail elderly, but to those who are demented and require a much higher and more consistent package of care. They need higher staff ratios and must be cared for in residential establishments. It would help if residential accommodation for the demented elderly could be paid for under the scheme.
§ Mr. Kirkwood
I am grateful for that small mercy. I should also like to know when the Price Waterhouse report will be published, as that will be important.
Community care has been organised since the mid–1980s, and that is to be welcomed. However, I say with all the sincerity that I can muster that the right hon. and learned Gentleman's announcement today will simply shave off from existing services the money that local authorities need to provide community care now. That is not in anyone's interests and it will mean misery for a large number of our most vulnerable citizens. It is another direct consequence of the hated poll tax, which should have never reached the statute book and which, I hope, will be withdrawn at an early stage.
§ Mr. Nicholas Winterton (Macclesfield)
I am always pleased to participate in any debate in which the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) also participates. He and I have devoted many years and a great deal of time to the quality of life and the interests of the most vulnerable groups in society. However, on this occasion I have not reached the same conclusion as he did about my right hon. and learned Friend the Secretary of State's statement. In fact, in a quiet way I warmly endorse the phasing in of community care. My right hon. and 1037 learned Friend knows that, over the years, I have warned that we have been proceeding at too fast a rate and that many people would suffer as a result.
I wish to pick up one or two points made by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). I refer him to the Select Committee's report on community care, "Planning and Co-operation". The report states:We call upon the Government to ensure that, in the event of a delay"—or the phasing in that was announced this afternoon—sufficient money is allocated to local authorities to enable them to purchase services from those new community care projects which have been set up this year in the expectation that their costs would be met by local authorities in the coming year … If there is to be a delay, we recommendthat the Department of Health requiresthat local authorities use the intervening period to prepare joint health and social services community care plans for their area.That is still lacking, and I do not think that it could have been achieved if the policy had been implemented, as originally planned, on 1 April 1991.
The report also recommended that sufficient money be allocatedto train staff in assessment and case management.My hon. Friend the Member for Eastleigh (Sir D. Price) and I know from our work on the Select Committee that there are inadequate numbers of people yet able to undertake that task. It also recommended that sufficient money be made availableto put in place workable collaborative structures with health authorities and other local authority departments such as housing departments and with voluntary organisations; and to draw up contractual agreements with statutory bodies and with voluntary organisations.I have no doubt that my right hon. and learned Friend will study with great care not only that report but the other reports on community care recently published by the Select Committee. I do not think that all is doom, as has been prophesied by one or two hon. Members during the debate.
I wish briefly to mention the Select Committee's report, Session 1984–85, on community care for the adult mentally handicapped and mentally ill. The Committee pointed out that the policy of community care
means more than reducing the number of hospital beds".The report went on that it means instead
the creation of a whole variety of alternative facilities, supportive services for people and their families who have little contact with statutory services…and the redeployment of thousands of staff and the switch of capital resources.Perhaps it is also appropriate to quote the 1986 Audit Commission report, to which the hon. Member for Livingston (Mr. Cook) referred. It pointed out that the reduction in NHS provision for the mentally ill had run ahead of the build-up of community services. The commission also highlighted geographical variations in standards, the need for bridging finance, the organisational confusion between statutory agencies, and inadequate service staffing.
For all those reasons—and many are still relevant today—I warmly support my right hon. and learned Friend's decision to phase in community care. That will produce a better community care policy, improved facilities, and more understanding.
The 1985–86 report of the Social Services Select Committee on the prison medical service expressed grave concern about the number of discharged mentally ill patients who ended up in prison because of the failure of community care and the lack of hospital beds for 1038 psychiatric cases. Prison is not the place for individuals who have offended because of mental illness. Community care is not a panacea for all the evils that are with us today, and it should never be considered as such. It is the approach of management that can pay real dividends for the patient. In too many cases, it is based on a pecuniary policy introduced by health authorities to save on the cost of long-stay psychiatric and geriatric facilities.
In my own constituency, the people of Macclesfield have been raped and pillaged by the avaricious activities of Mersey regional health authority and its aggressive bulldog of a chairman, Sir Donald Wilson. The birthright of the people of Macclesfield has been stolen from under their very noses by a politically appointed, unelected manager who too often has appeared more interested in achieving capital receipts than in providing health care and services for my constituents.
The Macclesfield infirmary branch, which houses a geriatric ward, was closed down and sold for £3.5 million to Sainsbury to build a superstore. The Mary Dendy hospital has been sold off to Messrs. Barratt for houses, so that the mentally handicapped do not now have the same range of facilities that they did when that hospital existed. Part of Parkside hospital for the mentally ill in my constituency—a fantastic area of peace and tranquility in the heart of Macclesfield—has been sold off to McAlpine for houses against the wishes of an overwhelming majority of the people of my constituency. I say that with some regret, but I am concerned about what is happening to the facilities for vulnerable people in my constituency.
I have served for many years on the Social Services Select Committee, and my experience has been that in too many cases health authorities have discharged too many patients, too soon—and for the wrong reasons into a community that is unprepared, unwilling, and, in some cases, unable to accept them.
§ Mr. Winterton
No, I shall not give way, because I have a lot to say. I feel deeply on this subject, and I want to call on my experience and knowledge gained in recent years.
Why do not we follow the example of the Dutch? I recently led the Select Committee on a valuable visit to Denmark and to the Netherlands. We visited a large community for mentally handicapped people in Noordwijk, which is close to Amsterdam. That village community has 1,000 mentally handicapped residents—850 of whom live on the main site and 150 in group homes nearby. A small number of them are severely handicapped. Residents live not in the old conventional Victorian hospital which is so typical and which we say that we need to get rid of, but in about 30 houses around a large site, each containing about 25 residents. They live in proper apartments of between eight and nine people. The site is well landscaped and contains a swimming pool, horticultural plots, a supermarket where residents pay for their goods by Giro bank card, a hairdresser, a clothes store, and a new activity centre with impressive education and recreational facilities. It also includes hydrotherapy and—dare I use this word in the House—a "snoozlroom", which is amazing in aiding the rehabilitation and calm of some of the mentally handicapped who require that sort of treatment.
1039 That village community has its own doctor, dentist and physiotherapy service. There are also nurses' homes on the site and a creche for the children of the staff. There are more than 1,000 staff. Not all are full time, but 650 are nursing staff. There is a nurse training school as well.
That village community is using the fantastic facilities that exist and is not selling them off for houses or other forms of development. It is using them for the progressive treatment of mentally handicapped people. My hon. Friend the Member for Harlow (Mr. Hayes) also visited that community, and he was as impressed as I was with the facilities. I am concerned for the future—
§ Mr. Clarke
I hope that my hon. Friend will allow me to put in a word for Sir Donald Wilson, whom he described as raping and pillaging Macclesfield. He must realise that the 19th century large mental hospitals are being sold to produce money for capital investment in a successful region. Mersey is developing its policies for the mentally ill and will do so with the aid of the new grant. It is one of the most successful regions in the country in reducing its waiting list for non-urgent operations, and it has recorded many other achievements. Will my hon. Friend moderate his language and his attacks on one of our most successful health authorities?
§ Mr. Winterton
I will not alter a single word of my comments about the actions of Mersey regional health authority in my constituency. I am fully supported by an overwhelming number of my constituents, including those who deal with the vulnerable groups of mentally handicapped people and others.
My concern for the future—and I am glad that my right hon. and learned Friend is still present to hear this—is heightened by his somewhat unfortunate action in refusing to ring-fence local authority funds for all community care, to prevent that provision being chipped away at, siphoned off or downright plundered to boost budgets to provide more high-profile and electorally advantageous services.
Is it correct that my right hon. and learned Friend will be meeting only about 70 per cent. of the costs to local authorities of looking after mentally ill people who are discharged from hospital? If that is the case, it is a fraud. He owes it to these people to advance 100 per cent. of the cost. I am delighted that the resources for the mentally ill have been ring-fenced, but the amount given is important and should represent 100 per cent. of the cost.
We are gambling with the welfare and lives of the weakest and the most vulnerable people whose care is our responsibility. We cannot and must not turn a blind eye to the fact that we have failed so far to ensure that we have put in place the appropriate infrastructure and support that is necessary if that policy is even to stand a chance of working.
A group of people who include the right hon. Member for Stoke-on-Trent, South and my hon. Friend the Member for Eastleigh, and other members of the Select Committee, are deeply concerned about the carers. They are a vital part of the success of community care. Of the 6 million carers in Great Britain, 3.7 million carry the main 1040 caring responsibility; 1.4 million devote at least 20 hours a week to caring, with more than half of them spending at least 50 hours a week on their caring duties. That staggering resource should be nurtured and supported in a planned, proper and systematic manner. I may well rile my hon. Friend the Member for Maidstone (Miss Widdecombe) when I say that its continuation and extension cannot and must not in future be left to chance. If community care is to work, positive steps must be taken to ensure that local authority social services departments are obliged to make it a prime objective to bring together and disseminate information about the statutory and voluntary services in their areas that would be of assistance to carers and their dependants.
Furthermore, local authorities must consult carers and their representatives regularly about their community care plans; high priority must be given to developing domiciliary support services for carers; greater resources must be made available for training; many more respite facilities must also be made available. Failing that, many of these carers will collapse. Those whom they look after will then automatically become the responsibility of the social services departments.
This is a critical debate. Sadly, party politics and political sparring have formed far too large a part of it. We are seeking to do our best for these most vulnerable groups. Through my work on the Select Committee and elsewhere, I shall continue to seek to represent their best interests and improve their quality of life, come hell or high water, come pressure from Government Whips, come pressure from any other source. I believe that the House has a duty to safeguard the future of these people.
§ 6.1 pm
§ Ms. Mildred Gordon (Bow and Poplar)
Before the debate began I was extremely angry both about the community charge and about the lack of implementation of care in the community. I did not think that I could be angrier, but the laughter of the Secretary of State and of other Conservative Members when the hon. Member for Macclesfield (Mr. Winterton) described what was happening to the health service in his constituency has made me angrier than ever. So has the statement that the Secretary of State made today.
One thing that his statement has made clear to us is that one of the purposes of the so-called community charge is to destroy all sense of community and to turn the most vulnerable sections of society against one another. The Secretary of State said that people must be protected from having too great a burden of community charge laid upon them and that therefore the implementation of the provisions relating to care in the community must be delayed. However, it is the poorest and the most overcrowded families who suffer the most from this unfair tax. They have to pay far more than those who live in big, spacious properties.
It is these same poor people who have to pick up the pieces of the shattered welfare state that is under attack by the Government. They have to do the extra unpaid work of caring for people in the community. They have no assistance. The result of more and more cuts is that they receive less and less help. If he was really concerned about their problems, the Secretary of State could relieve their burden by abolishing the community charge.
1041 There is a hospital for the mentally ill in my constituency. Proposals are afoot to close St. Clement's hospital and sell the land and buildings. The Secretary of State says that he never allows such a hospital to be sold off without ensuring that even better provision is made for the mentally ill patients in the community. I hope that he will do that when the closure of St. Clement's is considered.
There is no provision for severely mentally ill and severely disabled people in the community. If the Secretary of State's Department always makes sure that there is good provision for these people in the community when hospitals are closed, how does he explain the fact that people are living on the streets in cardboard boxes? Mentally ill patients are being discharged from hospitals every day, their possessions in a plastic bag, and given a list of hostels where they can look for accommodation, even though everybody knows that those hostels are already full. They therefore end up on the streets, and their condition gets worse and worse.
If the community charge is cut, due to cuts in public expenditure, that will lead to more money in the pockets of the rich, but public expenditure cuts will lead to misery, uncertainty and suffering for the most disadvantaged people. After a lifetime of work, when they become old, frail, sick or disabled, having been squeezed dry in order to profit others, little provision is to be made for them. They are thrown on the scrap heap. They are told, "Wait a few years; you can go swing your hook in the meantime."
I have tried to discover the scale of the problem in Tower Hamlets. In particular, I have tried to find out how many young severely disabled people need care in the community, and what it will cost. I have received no answers during the last three months, although I know personally of six cases. Two of them are severely disabled young men, paralysed from the neck down as a result of injuries in rugby matches.
I digress in order to say that something ought to be done about the rules of that dangerous game. Protective clothing should be worn, similar to that which is worn by those who play American football. That might prevent terrible accidents, leading to total paralysis and the ruin of young men's lives. Those injuries are not uncommon. When my son was a young boy, I spent endless time in the accident and emergency department of my local hospital because of injuries that he and his friends suffered in rugby games.
There are four young disabled people in Charles Key lodge who would like to live in the community with support. There is a frail elderly lady whose husband can no longer look after her on his own, and other people who suffer from multiple sclerosis. All those people, as well as mentally ill and handicapped patients, will be very expensive to look after. Rehabilitation programmes in national health service hospitals need to be funded to enable them to prepare for life in the community. However, money for that purpose has not been provided. We need central funding that is ring-fenced so that they can be properly looked after in the community.
From the cases that I have examined, it seems that one of the problems is the demarcation line between the national health service and social services. That applies to both funding and the work that is done. If someone is paralysed and needs a catheter and help for bowel functions, the question is whether that is to be regarded as medical help or dealt with by a carer who has been trained 1042 just for that purpose. That question has not been answered. It has resulted in help for individuals who are waiting for release from hospital being delayed.
I have referred before to the case of Corporal Bill Blackburn, but I have been unable to talk about him for more than a few seconds. His case graphically illustrates what is happening but what should not be happening. Corporal Bill Blackburn was injured three years ago in a rugby accident. He is tetraplegic and paralysed from the neck down. That young man, who is not yet 30, was admitted to the Odstock spinal injuries unit near Salisbury three years ago. Two years ago, he was admitted to the Queen Elizabeth military hospital on the premise that he would soon be able to live in a specially adapted flat that we had obtained for him in the area where his mother lives, on the Isle of Dogs. We used pressure to obtain that flat for him.
A dispute arose over who would be responsible for funding his care in the community. The health authority offered a district nurse, but the service could not guarantee that he would be taken out of bed before 11 am. He was also told that he would have to be put back in bed before 7 pm. That is no life for a young man. He rejected that proposal and asked whether alternative arrangements could be made, with three carers taking it in turns to look after him. While a number of case conferences took place, Corporal Blackburn got on with his rehabilitation programme. In April 1989 he went to New York, where he won medals in sports for the disabled.
He says that he does not want or need sympathy—that all he wants to do is to get on with his life. He has waited for three years to get into his flat so that he can again live a full life. However, the conflict between the NHS and the local authority social services continues.
He was given a discharge date of November 1989, but it was not kept because of the disputes over money and who should do which job. After pressure from me, the director of social services went to the military hospital to see Bill Blackburn and promised him that he would definitely be discharged by the end of January 1990. Because it was the director of social services who made that promise, Bill spent money on a washing machine and fitting his flat with blinds. He really believed that this time he would be discharged. It was not to be. I have a letter from the social services department which says that, if the Government cannot be made to understand the problems for local authorities of funding these cases, which cost perhaps upwards of £30,000 a year, some even double that, the legislation will be meaningless.
The local authority says that it cannot find the money to look after Bill Blackburn without a financial contribution from the health authority. The health authority said that the health service contribution has to be in relation to the provision of health care skills and that it does not accept that it is a district health authority responsibility to contribute directly towards Mr. Blackburn's social care needs.
It requires the judgment of Solomon to decide which are social care needs and which are health care needs. It gives the local authority an opportunity to yo-yo backwards and forwards and continue arguing, while Bill Blackburn is still in the military hospital. The Secretary of State's statement today just adds to that yo-yo effect.
Bill told me recently that he hides his head when the consultant goes around the hospital because he knows that he will be asked whether there is any news from Tower 1043 Hamlets council. There is no news. He knows that the bed has been needed for years to help the rehabilitation of others who have had accidents or who are severely disabled. He does not want to settle for life in an institution, and why should he have to do so when he is a young man? It would not be right and proper for him. Surely the proposals for care in the community should be able to be used to help someone like Bill live a full life, yet they are not working.
The Secretary of State and his team must suffer either from a lack of imagination or from a lack of conscience when they can come here and blandly make proposals which will postpone help for all such people. Perhaps they do not realise the heartbreak involved. I challenge the Secretary of State to go down to the Queen Elizabeth military hospital to see Bill Blackburn and explain his policies and tell Bill when he will be able to use his flat on the Isle of Dogs.
§ Mr. Peter Thurnham (Bolton, North-East)
The hon. Member for Bow and Popular (Ms. Gordon) is calling for extra spending but she seems to forget how relatively low the level of spending was when the Labour party was last in power. In 1979 spending on community care services was just over £1 billion. The latest figure is well over £3 billion—an increase of 68 per cent. in real terms over eight years. She should bear that in mind.
§ Ms. Gordon
The hon. Gentleman must realise that many hospital wards and beds have been closed since then and there is far more need for care in the community than there was when the hospital service was more full and efficient.
§ Mr. Thurnham
More hospitals closed under the previous Labour Government than under this Government.
The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) said that he thought that people with disabilities would be disappointed with the Government. I think that they will be disappointed with the Opposition. I would have thought that we could have had a full-day's debate on something as important as care in the community and I am disappointed that it is only a half-day debate. The Opposition's motion calls upon Her Majesty's Government to "ensure adequate funding". When I asked the hon. Member for Livingston (Mr. Cook)—I am grateful that he gave way to me—about what level of funding the Labour party would provide if it were in power, he was not able to give me an answer. I should like to take him to the kiosk at the side of the Chamber and buy him a tin of humbugs because that is what it is. The motion calls on the Government to provide funding, but the Opposition cannot provide an answer when asked about their proposals.
People with disabilities will be disappointed that the Opposition have not come forward with proper policies. However, we can see their difficulty. The Leader of the Opposition has gone on record as saying that 15 out of 16 working taxpayers would not pay anything extra if his party were in power. I understand that the hon. Member for Livingston will not pay his community charge. Therefore, there would be no resources to put into extra 1044 community care. That is why the hon. Member for Livingston cannot provide an answer and why he has to talk in vague terms about adequate funding. All he could say was that he would want to provide a reasonable amount. The Government have increased spending on community care substantially. We have done more than the Labour party is offering to do.
The Government are right to phase in community care because it would be wrong to go for a big-bang approach. The chief executive of Bolton local authority has sent me a fax saying that Bolton is willing and ready to take on implementation of the Act, provided there is the necessary financial support. However, it has overspent on the budget for Network homes by about £500,000. The cost of providing for those in Network homes is far too high. The figures I have show an average cost per resident of about £22,000 a year. In a voluntary home a few miles away with what I believe to be a higher standard of care, the cost is £12,000 a year. The existing resources are not being used efficiently. Before calling for extra resources we must see that existing resources are used more efficiently. I call on the Government to issue strict guidelines to local authorities to use the phasing-in period to involve voluntary groups much more fully.
I received a letter today from Fidelity Simpson, the parliamentary adviser to the Spinal Injuries Association. She said:The delay gives local authorities ample opportunity to fully consult with organisations of disabled people in their area and we urge the Government to stress this in their guidance on planning. The Social Services Inspectorate Report on the Disabled Persons Act issued in January 1990 highlights how 'service developments for physically disabled people are often given a lower priority than service developments for other groups of service users.' It goes on to recommend that 'social services authorities should progress the direct involvement of disabled people in the strategic and operational planning of services at elected member and officer levels'.That is excellent. It shows that one voluntary group sees this time as an opportunity to become more involved. I call on both Bolton local authority and other local authorities to involve voluntary groups to a much greater extent.
The Bolton Handicap Action Group has set up a charitable trust and wants to play a part. It should be helped to do so. If voluntary groups have not had enough help in the past, they should be given more help to organise themselves to provide a service which can be done much more efficiently and effectively than by local authorities which are riddled with high overheads and restrictive practices and are concerned far more with bureaucracy than providing care for individuals.
In my constituency there is a severely disabled young man by the name of Paul Hargreaves. He desperately wants more care. His mother has told me repeatedly that she cannot go on any longer. However, the local authority has failed to provide care for him. It has to reconsider its priorities and provide help where it is needed. If necessary, we should look carefully at the proposals to allow local authorities to give cash for care. We were not able to secure an amendment on that the other day, but we should devolve packages of care whereby people in need can have money to buy in care services far more efficiently than they could be provided by local authorities. I call on local authorities to use this phasing-in time to improve the standard of care and the way in which they organise it.
§ Mr. John McAllion (Dundee, East)
The idea of care in the community is one to which all hon. Members subscribe. People who need not remain hospitalised in long-term institutions must be given the opportunity to live independently in the community.
We can all agree at least on that point, but what separates the Opposition from the Government is the context in which we place the idea of care in the community. For us, it must be pursued for its own sake. It represents a substantial and qualitative leap forward for thousands of citizens who do not receive the quality of care that should be theirs of right. The Opposition regard care in the community as an end in itself, albeit one with massive resource implications for the Government and the taxpayer. The Government regard it not as an end but as a means to an end that has little to do with improving the quality of services for people in need, as a means of cutting the cost of the national health service and as a cheaper alternative to other options.
The Government further regard care in the community as a means by which the private sector can be allowed inside the national health service to pick off, one by one, the nice little earners that they have identified. I do not doubt for a minute that the Government's friends in the private sector will be able to provide private care under the new community care proposals, but in the main they will put profit first and patients second. Despite the rhetoric of Conservative Members, that is a fundamental reality which they will not be able to overcome. They cannot deny that the Government are promoting the private sector through their care in the community policies.
I consulted the excellent magazine Labour Research for 1987, which showed that there were 100,000 elderly and mentally and physically handicapped people in private nursing and residential homes in the United Kingdom. Yesterday, I telephoned the Library to ask how the statistics had changed in the intervening period. It told me that in March 1989, according to the review of private health care, there were not 100,000 but 231,800 elderly, chronically sick and physically disabled people in private nursing and residential homes. That figure does not include mentally handicapped people, so it is actually even higher. Hon. Members know from constituency experience that since March 1989 the number of private residential and nursing homes has mushroomed further. The intention of the Government is to encourage the private sector to provide for mentally and physically handicapped and elderly people.
The reality is that thousands of the most vulnerable people in our community are being shipped out of the national health service, which has looked after them for most of their lives, and handed to private providers, the motivation of most of whom is to make money from their predicament. Does not the realisation that that is happening send a shiver of apprehension down the spines of those Conservative Members who still have a conscience? If it does not, it should be doing precisely that.
§ Mr. McAllion
The right hon. Gentleman will have to forgive me—I do not have time to give way.
A report was recently issued by the director of social work on Tayside regional council. It questions the ethics of the Government's encouragement of health boards to use 1046 private contractors and to make an alternative provision for the chronically sick and elderly in their hospitals. He writes:
Given the vulnerability of the client groups affected by these arrangements, the question of whether they can give informed consent to these changes must be in doubt, and questions have been raised about whether the quality of care they will receive will be equal to that available in a hospital environment. This latter issue was raised recently when general practitioners in one Scottish Region objected to providing services free of charge to the many nursing home residents who previously had received medical and nursing care in Health Service hospitals.Surely the report is right to question the ethics of a deal struck between the Government, health boards and private contractors—a deal that is essentially about money —the consequence of which is to transfer vulnerable patients into potentially exposed circumstances in which the quality of care that they receive can be significantly reduced. Does not it give hon. Members pause for thought that we have just passed legislation that makes it much more likely that many more vulnerable people will be transferred into such potentially exposed circumstances?
One of the most revealing documents on the Government's attitude to care in the community is the recent Scottish Office consultation paper on specific grants for mental illness. The basic concept behind it is good: first, that the current level of community-based services for people with mental illnesses is far too low; and, secondly, that something must be done to improve those services. No one would argue with that, but on reading into the document a different picture emerges. Page 1 states:
The policy aim is twofold: to reduce the numbers of mentally ill people requiring admission to hospital … and to enable mentally ill people to leave hospital.Page 2, under the heading,types of project eligible for assistance",states that themain criterion for judging applicationsis the
extent to which the proposed project could assist in providing for, or supporting community living … and in so doing help to reduce the need for hospital admissions or facilitate the discharge of persons from hospital.It would appear that the true purpose behind the provision of specific grants on mentall illness is simply to empty hospitals. The director of social work in Tayside region described it as placing
excessive emphasis on hospital discharge programmes.I can understand the Government's reasons for introducing care in the community. It reduces costs in the health service, transfers the financial burden from the Government to local authorities and, possibly more important, reduces the requirement for beds in psychiatric hospitals, particularly those located in prime development sites, thereby making it easier for the Government to sell them and to acquire a capital receipt.
Has that anything to do with helping mentally ill people? Are they a priority in the Government's policies? The answer to those questions must be a resounding no. If they had been a priority, the Government would have adopted a different approach. First, they would have assessed the need for community-based services. Secondly, they would have targeted resources to increase annually the level of such services that could be provided. Thirdly, they would have geared hospital discharge programmes to the community-based services that are available for those leaving hospitals.
1047 The fact that the Government have made a priority of the hospital discharge programmes and geared funding to maximise the emptying of those hospitals reveals the true nature of their commitment to care in the community. They put buildings, costs, revenue and profits before people who depend on services.
This afternoon, the Secretary of State made the absurd suggestion that local authorities had not prepared plans to implement the care in the community proposals, which excused the delays that he announced. That is sheer nonsense. The plans that have been made by councils are ready for implementation. I have three lengthy reports from Tayside regional council on the plans that it has developed to implement it. Its convenor of social work, Councillor Jim Mudie, who is the convenor of the social work committee of the Convention of Scottish Local Authorities, was quoted this morning in the Scottish press as saying that councils in Scotland are ready and willing to meet the Government's original deadline of 1 April next year. What is lacking is the Government's resolution to make available the resources that would make it possible to keep to their timetable. They realise that if they do not provide the resources to proceed in April 1991 it will have an impact on poll tax levels in a general election year.
Ultimately, that means that the Government have decided their priorities. They had to choose between implementing their care in the community policies and backing off and trying to save their political skins in an election year. The fact that they chose the latter speaks much of the Government's attitude over the past three or four years and explains why they will not be the Government after the next general election.
§ Mr. Jerry Hayes (Harlow)
As a wholehearted supporter of the Government's policy on community care, I was disappointed to learn that we cannot go ahead on 1 April 1991 in the way intended. I found most offensive the rather unpleasant way in which the hon. Member for Livingston (Mr. Cook) was suggesting that elderly, frail and disabled people will be decanted into the streets. That is simply not true; it will not happen. I find it deeply offensive that the old and the frail should be cynically manipulated and used as a political football.
Sir Roy Griffiths, the author of the splendid report which led to the legislation, said a few weeks ago:There is a serious situation out there which needs tackling.He said that if there was a delay, hewould like to see a lot of justification".I agree wholeheartedly.
I was pleased to learn that my right hon. and learned Friend the Secretary of State and his ministerial team will not be postponing their excellent proposals, but will be phasing them in sensibly. I and many professionals in the caring community were concerned that the proposals would be put on ice. There were worrying reports in the newspapers that the delay would save the community charge payer £15 a year, or 30p a week. If that had been the reason for the decision, it would have been immoral nonsense.
Sir Roy Griffiths stressed the need for justification and said that there will never be precisely enough money for 1048 community care. It is an untapped resource. The Select Committee said that carers save the community £24 billion a year. We owe them a debt, and they will not be forgotten.
It is quite sensible and proper that local authorities do not implement the proposals with a big bang, because the Government would be held hostage by left-wing authorities—[Laughter.] It is all very well for hon. Gentlemen to laugh, but left-wing authorities would not cut their women's units, their gay units, their police monitoring units or their civic newspapers; they would cut care in the community. They would bring in the television cameras to show elderly people being thrown out of homes to gain some political advantage.
§ Mr. Hayes
I have always supported ring fencing, as has Sir Roy Griffiths.
I was pleased that my right hon. and learned Friend has met his road to Damascus today as he announced a new specific grant to support services for the mentally ill to ensure a higher priority for those services; a new, specific grant for the funding of voluntary bodies providing services for drug and alcohol misusers who were given low priority in the past; a new specific grant of £35.5 million for training social services staff; more support for those working with the elderly, children, the mentally handicapped and the physically disabled; and more support for post-qualification training courses.
It is a welcome change of policy, which could be called creeping ring fencing. The Government clearly appreciate that, as we are about to spend £800 million or £1 billion of taxpayers' and charge payers' money, we must ensure that it is properly spent.
The House has agreed to legislation suggesting that we should be kind to small, terrified, furry animals, so I shall be particularly kind to the hon. Member for Livingston. He suggested that disabled people would be severely disadvantaged. Has he forgotten my right hon. Friend the Secretary of State for Social Security's 20–point plan specifically to help the disabled? Has he forgotten the carers' premium? Admittedly it is only £10, but it is a start and recognition of the valuable work that they do. Are we totally to ignore the Government's record on the abolition of the invalidity trap and the increase in public expenditure on social services of something like 37 per cent. in real terms since 1979? We would be foolish to forget all that.
I regret the cynical manipulation by the Opposition of the elderly and those most at risk. I stress that the decision that had to be made will not be a cheap decision or a soft option. I refer my hon. Friend the Minister for Health to one of the most important parts of the Griffiths report —that which deals with residential care and nursing homes and the difficulties that many people face. A few weeks ago we had a debate about the many people on income support who are out of pocket by £40 a week in residential care and by up to £80 a week for nursing care. That is totally unsatisfactory, but between now and 1993 local authorities will gradually move people from voluntary homes to other homes, resulting in the Department of Social Security picking up an extremely large bill. Unless the Government set their mind to that problem, they will face an even larger bill.
1049 I regret that that decision had to be made, but the justification shows that unfortunately it was absolutely necessary.
§ Mr. David Hinchliffe (Wakefield)
In a couple of minutes, before the Front-Bench spokesmen wind up the debate, I should like to pick up one point which has not been mentioned in the debate. In addition to the Government's concern about the politics of the poll tax, there is a more sinister reason behind the Secretary of State's announcement that the proposals are being deferred.
The Government have caved in to extensive lobbying from the private care sector. Those involved in private care are deeply alarmed that the assessment of individual cases may well result in the redirection of individuals away from private institutional care. They realise that the legislation will well and truly put the brakes on the private care bonanza under the present Government, in which vast numbers of businesses have made a huge amount of money out of people's need for care. That has not been mentioned so far in the debate.
The Secretary of State spoke about new money for local authorities, but we should examine the gross misuse of existing resources through the income support system. We know that vast numbers of people unnecessarily end up in private institutional care without any assessment whatsoever. They are placed there to serve the interests of the private care business. The Government have announced that the legislation will be deferred for two or three years, but it should be stressed that a huge amount of public money will continue to be grossly misused and wasted on institutional care instead of preventive care.
It is important to note that the Association of County Councils' briefing paper states:It will cost at least as much to continue with the existing system as to move to the new community care regime.Conservative-controlled councils have also said that. If we look at the matter from a financial point of view, deferral makes no sense. The continuation of open-ended income support payments for institutional care, whether or not people need it, is absolute nonsense and a gross misuse of public money.
Public resources are being misdirected towards private institutional care businesses at the expense of genuine community care which should be directed towards keeping people in their own homes. We should consider the human cost of deferral: by his statement today, the Secretary of State is imprisoning in institutional care people who do not need that care, and he is doing so at huge public cost. Vast numbers of people in institutional care are getting deeper into debt as a result of inadequate income support payments, and that will continue over the next few years.
Has the Secretary of State discussed with the Secretary of State for Social Security what deferral means in terms of public expenditure on social security payments? The Government's actions make no sense. It is clear that there is a need for a Minister for community care—something that the Labour party proposes—who does not consider one narrow interest of one Department, but who considers the roles of all the Departments across the board and also considers the needs of people in the community rather than in institutional care.
§ Mr. Tom Clarke (Monklands, West)
In this all too brief debate in Labour party time, a number of interesting and important points have been made. There were many disappointments, the most important of which was the statement which the Secretary of State made earlier and his defence of it during this debate. I also found it disappointing—this is the first community care debate that I can recall in which I must say this—that every Conservative Member found it necessary to support everything that the Secretary of State did. One assumes that someone must have whispered the date of the general election in their ears because there can be little other justification for the Secretary of State's pathetic performance this afternoon.
The Secretary of State reduced the role of Minister into a spectator sport. I hope that Conservative Members will not regard "spectator" as too offensive a word. However, that is a clear description of his role. Instead of fighting for his Department and for the objectives that he set, he has surrendered completely and care in the community in Britain is all the poorer for that.
The Secretary of State would not upset the Hush Puppies of the Chief Secretary to the Treasury. Indeed, we almost expect the Chief Secretary to enter the Chamber any minute to pat the Secretary of State on the head. He would be one of the few people who would do that. If it was the intention of Conservative Members to improve the Secretary of State's image, they should be aware that his relationship with carers is similar to that between the right hon. Member for Cirencester and Tewkesbury (Mr. Ridley) and the British-German friendship society.
As my colleagues have said, we are dealing with promises that were made clearly by the Government not just in the White Paper or in response to the Griffiths report, which the Secretary of State failed to mention, but as recently as 24 June. The Secretary of State quoted figures like confetti today, but he did not give us his figures, his thinking or his reasons for one of the most spectacular U-turns in the history of social services.
The Secretary of State lambasted the local authorities, but ignored the assistance that they have given to his Department time after time. He referred to the figure of £1.5 billion, but conveniently overlooked several things: the fact that the local authorities' quotation was £1.02 billion; that they were bearing in mind that their estimate of £826 million for community care included £500 million in the social security budget which the Secretary of State had told us until today would be transferred to the local authorities in any case. No one would welcome the gross exaggeration about the local authority figures which the Secretary of State put before the House today.
In this retreat, it is clear that the real reason behind the Government's thinking is that they have created a monster in the shape of the poll tax. There should be no doubt, if the Government's previous rhetoric must be believed, that they have panicked in the face of an approaching general election and the vulnerable in our community, the physically disabled, the elderly, the mentally ill, the mentally handicapped and their carers will have to pay for that panic.
The Secretary of State said that he has thought about these matters and that he is worried about the community charge. Where did this sudden proposal for phasing-in come from? Why did not it appear in the White Paper or 1051 in earlier statements to the House? Why did the Secretary of State not once in Committee tell my right hon. and hon. Friends that things would be phased in like this or that we would have a timetable? Why did he not once say that the Government were going to disown Sir Roy Griffiths's main recommendation? That is what the Secretary of State's statement today really means.
Conservative Members have said that they welcome the delay and postponement. The hon. Member for Bolton, North-East (Mr. Thurnham) could quote only one local voluntary organisation. I repeat the challenge of my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley): can the Secretary of State tell us of one voluntary organisation—the Royal Association for Disability and Rehabilitation, the Spastics Society, the Care in the Community Scottish group and many others—that would support the delay? The opposite is the case. Voluntary organisations have made their views known to hon. Members and they will be as shocked as Opposition Members at the Secretary of State's announcement this afternoon.
The Secretary of State referred to the need for co-ordination between the national health service and local authorities. In the light of his statement this afternoon, the morale of GPs and that in local authorities, in the health service and social services and social work departments must be at a new low. None of that is good news for co-operation and nothing that we have heard from the Secretary of State this afternoon is good for the patient.
The provisions relating to community care were the only part of the National Health Service and Community Care Bill that anyone wanted. The Government have rushed ahead with the parts that no one wants and now tell us that they are going to delay the implementation of the small features of the Bill that were practicable. The deputy Prime Minister told us that the implementation would take place according to the availability of resources. We have heard that before. We heard it in connection with the Disabled Persons (Services, Consultation and Representation) Act 1986, and if the Government really believe what they say about the consumer, choice and representation and if they are really listening to 6.5 million disabled people and their carers, they would have implemented all the provisions of that Act by now. Who can believe the Government's intentions when they refer to 1993 with regard to community care when the Disabled Persons (Services, Consultation and Representation) Act 1986 has been on the statute book for four years and not all its provisions have been implemented?
Conservative Members accused my hon. Friend the Member for Livingston (Mr. Cook) and others of exaggerating the problems of the elderly and of income support and the care gap in private residential homes. If they do not think that there is a problem now, they should listen carefully to the directors of social services. I cannot understand why they think that there is no problem now. We saw on television just the other night some of the problems that already exist. The directors of social services are warning hon. Members that people will increasingly go to their surgeries because of the demographic time bomb 1052 and because of the problem of income support. We know that the elderly are already suffering because of the lack of planning. Conservative Members ignore that at their peril.
This all too brief debate has failed to consider in the detail that we would wish the Government's real strategy for community care. The Prime Minister seems to believe in seminars to study characteristics. Why does not she call a seminar to study the real characteristics of the elderly, the disabled, people suffering from Alzheimer's disease and their carers? Why does not she consider how they can be properly supported in their own homes? The Prime Minister lectures us, today of all days, when we have had such a pathetic response to the problems of community care within our society. Nothing could be more devastating to millions of families than the Government's proposals for community care.
In that spirit, I invite hon. Members to support the motion. I invite the British public in due course not just to dismiss a Secretary of State who can produce such lethargic proposals but to throw out with him the Government who have made such lethargy possible.
§ The Minister for Health (Mrs. Virginia Bottomley)
Let me make it quite clear that we are not discussing abandoning the policy of community care or of cancelling the policy of community care; we are discussing carrying forward our policies in a practical, sensible and responsible manner. My right hon. and learned Friend the Secretary of State has made it only too clear that next April we shall begin with the new provision for the mentally ill. Many hon. Members have referred to the importance of proper community care provision for the mentally ill.
My hon. Friends the Members for Macclesfield (Mr. Winterton) and for Leeds, North-East (Mr. Kirkhope) and the hon. Member for Bow and Poplar (Ms. Gordon) referred to the need for the mentally ill to have proper provision made for them when they are established in the community. We are not satisfied that sufficient work on that matter has already been undertaken by local authorities. Local authority expenditure on the mentally ill amounts to about 3 per cent. Nor are we satisfied that the proper provision that the public need to satisfy them as well as those who need care has been arranged. That is why the specific grant allowing spending of £30 million will be established from next April, thus ensuring—this should satisfy my hon. Friend the Member for Macclesfield—that no individual will leave a long-term mental hospital without a proper care package and without a named individual being responsible for his or her care as he or she goes out into the community.
Again, my right hon. and learned Friend announced that we intend to make headway with particular assistance for those who suffer from drug or alcohol misuse, thus ensuring that resources are provided for the voluntary sector. My hon. Friend the Member for Bolton, North-East (Mr. Thurnham) referred to the importance of the voluntary sector. It has done excellent pioneering work, and headway will most certainly be made.
Many hon. Members have referred to the importance of carers, and the White Paper and the National Health Service and Community Care Act 1990 particularly refer to the importance of carers. We are funding caring organisations to the tune of about £100,000 this year. They are deeply involved in our consultation on guidance and 1053 the implementation of their important work. The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) asked when the guidance will be made available. I give him the clear assurance that the guidance will be available in the autumn. As he will know, we have already issued draft guidance on plans, assessment, inspection and several other matters. We have been consulting widely with local authorities, and that guidance will further inform our plans as we take forward the important work.
Many hon. Members have rightly and properly drawn attention to the very great change that we are seeking to create. We know full well that health authorities and family health service authorities are busy taking on their new responsibilities, thereby putting them in a good position to provide for the health care of their resident populations. District health authorities, family health services authorities and general practitioners, through the new contract, can be active partners in the provision of care in the community.
The Select Committee, in its most recent report, suggested, perhaps with some justification, that the tight timetable means that it will be difficult for local authorities to implement care in the community policies to the standards that we all would want. That allows a further period for local authorities, voluntary organisations and the private sector to implement, to carry forward, to consult and to co-ordinate, so that in April 1993, when they take on the full responsibility—when the social security money is transferred to local authorities, when there is no longer the safety valve of social security payments to provide for those who need residential care—they will be able properly and effectively to undertake their responsibilities.
We in the Department, the social services inspectorate and local authorities have a great deal of work to undertake in the two years. We shall be continuing our training and seminars. We shall be issuing a newsletter on implementation to make sure that we can continue to develop and promote further the momentum of an important policy. My right hon. and learned Friend the Secretary of State made it clear that the amount of money to be available for training local authorities will increase to about 25 per cent. next year. Training money will be available not only for the elderly and for children but for the mentally ill, the physically disabled and the mentally handicapped. I hope that my hon. Friends will believe that this is not a cancellation or an end to the policy. This is a moment so that we can spend more time actually preparing and ensuring that we make the headway that we should properly and rightly make. It will be hard work. We need to ensure that all the necessary steps are taken.
Several hon. Members referred to the provision of social security payments. As was well said by my right hon. and learned Friend, our right hon. Friend the Secretary of State for Social Security has set up a study. There have already been extra resources to the degree of £145 million to provide additional assistance to the likes of Florence Smith and others about whom we heard during the detailed debate earlier in the year.
Care in the community policy will take time to implement fully and effectively. Over the past 10 years—[Interruption.] Over the past 11 years we have seen dramatic advances. We have seen a phenomenal increase in provision in terms of adult training centres for the mentally handicapped–11,000 more places, which is a 25 per cent. increase. We have seen a great increase in the 1054 number of day centre places for the mentally ill–30 per cent. more; another 1,500 places. We have seen a tremendous increase in the number of social workers—I may need to declare a vested interest. There are 5,000 more social workers—an extra 23 per cent. There are an extra 12,000 more home helps—25 per cent. more and, again, many more community psychiatric nurses. We have seen a dramatic increase in personal social services spending to the degree of 47 per cent.
That is the record of a Government who have been investing in the community and developing community care services. We believe in the policy. We now have the legislation on the statute book. We believe that there are urgent tasks to be undertaken. We believe in quality. We believe in safeguarding the interests of the frail and the vulnerable. That is why the complaints procedures and the inspection units will go ahead from next April, together with the other specific grants in areas of special and important need, to which my right hon. and learned Friend referred.
It is essential that nobody should for a moment forget the challenge that is ahead of us—to ensure that over the next decade we can achieve these community care policies. I urge hon. Members most sincerely and strongly to reject the motion.
§ Question put, That the original words stand part of the Question:—
§ The House divided: Ayes 224, Noes 335.1058
|Division No. 301]||[7 pm|
|Adams, Allen (Paisley N)||Clwyd, Mrs Ann|
|Allen, Graham||Coleman, Donald|
|Alton, David||Cook, Robin (Livingston)|
|Anderson, Donald||Corbett, Robin|
|Archer, Rt Hon Peter||Corbyn, Jeremy|
|Ashdown, Rt Hon Paddy||Cousins, Jim|
|Ashley, Rt Hon Jack||Crowther, Stan|
|Ashton, Joe||Cryer, Bob|
|Banks, Tony (Newham NW)||Cummings, John|
|Barnes, Harry (Derbyshire NE)||Cunliffe, Lawrence|
|Barnes, Mrs Rosie (Greenwich)||Cunningham, Dr John|
|Barron, Kevin||Dalyell, Tam|
|Beckett, Margaret||Darling, Alistair|
|Beggs, Roy||Davies, Rt Hon Denzil (Llanelli)|
|Beith, A. J.||Davies, Ron (Caerphilly)|
|Bell, Stuart||Davis, Terry (B'ham Hodge H'l)|
|Benn, Rt Hon Tony||Dewar, Donald|
|Bennett, A. F. (D'nt'n & R'dish)||Dixon, Don|
|Bermingham, Gerald||Dobson, Frank|
|Bidwell, Sydney||Doran, Frank|
|Blair, Tony||Douglas, Dick|
|Blunkett, David||Duffy, A. E. P.|
|Boateng, Paul||Dunnachie, Jimmy|
|Boyes, Roland||Dunwoody, Hon Mrs Gwyneth|
|Bradley, Keith||Eadie, Alexander|
|Bray, Dr Jeremy||Evans, John (St Helens N)|
|Brown, Nicholas (Newcastle E)||Ewing, Harry (Falkirk E)|
|Brown, Ron (Edinburgh Leith)||Ewing, Mrs Margaret (Moray)|
|Bruce, Malcolm (Gordon)||Faulds, Andrew|
|Buckley, George J.||Field, Frank (Birkenhead)|
|Caborn, Richard||Fisher, Mark|
|Callaghan, Jim||Flannery, Martin|
|Campbell, Menzies (Fife NE)||Flynn, Paul|
|Campbell, Ron (Blyth Valley)||Foot, Rt Hon Michael|
|Campbell-Savours, D. N.||Forsythe, Clifford (Antrim S)|
|Canavan, Dennis||Foster, Derek|
|Carlile, Alex (Mont'g)||Foulkes, George|
|Carr, Michael||Fraser, John|
|Cartwright, John||Fyfe, Maria|
|Clark, Dr David (S Shields)||Galbraith, Sam|
|Clarke, Tom (Monklands W)||Galloway, George|
|Clay, Bob||Garrett, John (Norwich South)|
|Clelland, David||Garrett, Ted (Wallsend)|
|George, Bruce||Morgan, Rhodri|
|Gilbert, Rt Hon Dr John||Morley, Elliot|
|Godman, Dr Norman A.||Morris, Rt Hon A. (W'shawe)|
|Golding, Mrs Llin||Morris, Rt Hon J. (Aberavon)|
|Gordon, Mildred||Mullin, Chris|
|Gould, Bryan||Murphy, Paul|
|Graham, Thomas||Nellist, Dave|
|Grant, Bernie (Tottenham)||O'Brien, William|
|Griffiths, Nigel (Edinburgh S)||O'Neill, Martin|
|Griffiths, Win (Bridgend)||Orme, Rt Hon Stanley|
|Grocott, Bruce||Owen, Rt Hon Dr David|
|Hardy, Peter||Parry, Robert|
|Harman, Ms Harriet||Patchett, Terry|
|Haynes, Frank||Pendry, Tom|
|Heal, Mrs Sylvia||Pike, Peter L.|
|Healey, Rt Hon Denis||Powell, Ray (Ogmore)|
|Henderson, Doug||Prescott, John|
|Hinchliffe, David||Primarolo, Dawn|
|Hoey, Ms Kate (Vauxhall)||Quin, Ms Joyce|
|Hogg, N. (C'nauld & Kilsyth)||Randall, Stuart|
|Home Robertson, John||Redmond, Martin|
|Howarth, George (Knowsley N)||Rees, Rt Hon Merlyn|
|Howell, Rt Hon D. (S'heath)||Reid, Dr John|
|Howells, Geraint||Richardson, Jo|
|Howells, Dr. Kim (Pontypridd)||Robertson, George|
|Hoyle, Doug||Rooker, Jeff|
|Hughes, John (Coventry NE)||Ross, Ernie (Dundee W)|
|Hughes, Robert (Aberdeen N)||Ross, William (Londonderry E)|
|Hughes, Roy (Newport E)||Rowlands, Ted|
|Hughes, Simon (Southwark)||Ruddock, Joan|
|Illsley, Eric||Salmond, Alex|
|Janner, Greville||Sedgemore, Brian|
|Jones, Barry (Alyn & Deeside)||Sheerman, Barry|
|Jones, Ieuan (Ynys Môn)||Sheldon, Rt Hon Robert|
|Jones, Martyn (Clwyd S W)||Shore, Rt Hon Peter|
|Kennedy, Charles||Sillars, Jim|
|Kilfedder, James||Skinner, Dennis|
|Kirkwood, Archy||Smith, C. (Isl'ton & F'bury)|
|Lambie, David||Smith, Rt Hon J. (Monk'ds E)|
|Lamond, James||Smyth, Rev Martin (Belfast S)|
|Leadbitter, Ted||Snape, Peter|
|Leighton, Ron||Soley, Clive|
|Lewis, Terry||Spearing, Nigel|
|Litherland, Robert||Steel, Rt Hon Sir David|
|Livingstone, Ken||Steinberg, Gerry|
|Lloyd, Tony (Stretford)||Stott, Roger|
|Lofthouse, Geoffrey||Strang, Gavin|
|McAllion, John||Taylor, Mrs Ann (Dewsbury)|
|McAvoy, Thomas||Taylor, Matthew (Truro)|
|McCartney, Ian||Thomas, Dr Dafydd Elis|
|Macdonald, Calum A.||Turner, Dennis|
|McKay, Allen (Barnsley West)||Vaz, Keith|
|McKelvey, William||Wallace, James|
|Maclennan, Robert||Walley, Joan|
|McWilliam, John||Wardell, Gareth (Gower)|
|Madden, Max||Wareing, Robert N.|
|Mahon, Mrs Alice||Watson, Mike (Glasgow, C)|
|Marek, Dr John||Welsh, Andrew (Angus E)|
|Marshall, David (Shettleston)||Welsh, Michael (Doncaster N)|
|Marshall, Jim (Leicester S)||Wigley, Dafydd|
|Martin, Michael J. (Springburn)||Williams, Rt Hon Alan|
|Martlew, Eric||Williams, Alan W. (Carm'then)|
|Maxton, John||Wilson, Brian|
|Meacher, Michael||Winnick, David|
|Meale, Alan||Wise, Mrs Audrey|
|Michael, Alun||Worthington, Tony|
|Michie, Bill (Sheffield Heeley)||Young, David (Bolton SE)|
|Michie, Mrs Ray (Arg'l & Bute)|
|Mitchell, Austin (G't Grimsby)||Tellers for the Ayes:|
|Molyneaux, Rt Hon James||Mr. John McAllion and|
|Moonie, Dr Lewis||Mr. Ken Eastham.|
|Alexander, Richard||Arnold, Sir Thomas|
|Alison, Rt Hon Michael||Ashby, David|
|Amery, Rt Hon Julian||Aspinwall, Jack|
|Amess, David||Atkins, Robert|
|Amos, Alan||Atkinson, David|
|Arbuthnot, James||Baker, Rt Hon K. (Mole Valley)|
|Arnold, Jacques (Gravesham)||Baker, Nicholas (Dorset N)|
|Baldry, Tony||Fishburn, John Dudley|
|Banks, Robert (Harrogate)||Fookes, Dame Janet|
|Batiste, Spencer||Forman, Nigel|
|Beaumont-Dark, Anthony||Forsyth, Michael (Stirling)|
|Bellingham, Henry||Fowler, Rt Hon Sir Norman|
|Bendall, Vivian||Fox, Sir Marcus|
|Bennett, Nicholas (Pembroke)||Franks, Cecil|
|Benyon, W.||Freeman, Roger|
|Bevan, David Gilroy||French, Douglas|
|Biffen, Rt Hon John||Fry, Peter|
|Blackburn, Dr John G.||Gale, Roger|
|Blaker, Rt Hon Sir Peter||Gardiner, George|
|Bonsor, Sir Nicholas||Garel-Jones, Tristan|
|Boscawen, Hon Robert||Gill, Christopher|
|Boswell, Tim||Gilmour, Rt Hon Sir Ian|
|Bottomley, Peter||Glyn, Dr Sir Alan|
|Bottomley, Mrs Virginia||Goodhart, Sir Philip|
|Bowden, A (Brighton K'pto'n)||Goodson-Wickes, Dr Charles|
|Bowden, Gerald (Dulwich)||Gorman, Mrs Teresa|
|Bowis, John||Gorst, John|
|Boyson, Rt Hon Dr Sir Rhodes||Gow, Ian|
|Braine, Rt Hon Sir Bernard||Grant, Sir Anthony (CambsSW)|
|Brandon-Bravo, Martin||Greenway, Harry (Ealing N)|
|Brazier, Julian||Gregory, Conal|
|Bright, Graham||Griffiths, Peter (Portsmouth N)|
|Brooke, Rt Hon Peter||Grist, Ian|
|Brown, Michael (Brigg & CI't's)||Ground, Patrick|
|Browne, John (Winchester)||Grylls, Michael|
|Bruce, Ian (Dorset South)||Gummer, Rt Hon John Selwyn|
|Buchanan-Smith, Rt Hon Alick||Hague, William|
|Buck, Sir Antony||Hamilton, Neil (Tatton)|
|Budgen, Nicholas||Hampson, Dr Keith|
|Burns, Simon||Hanley, Jeremy|
|Burt, Alistair||Hannam, John|
|Butcher, John||Hargreaves, A. (B'ham H'll Gr')|
|Butler, Chris||Hargreaves, Ken (Hyndburn)|
|Butterfill, John||Harris, David|
|Carlisle, Kenneth (Lincoln)||Haselhurst, Alan|
|Carrington, Matthew||Hayes, Jerry|
|Carttiss, Michael||Hayhoe, Rt Hon Sir Barney|
|Cash, William||Hayward, Robert|
|Channon, Rt Hon Paul||Heathcoat-Amory, David|
|Chapman, Sydney||Heseltine, Rt Hon Michael|
|Chope, Christopher||Hicks, Robert (Cornwall SE)|
|Churchill, Mr||Hill, James|
|Clark, Hon Alan (Plym'th S'n)||Hind, Kenneth|
|Clark, Dr Michael (Rochford)||Hogg, Hon Douglas (Gr'th'm)|
|Clark, Sir W. (Croydon S)||Holt, Richard|
|Clarke, Rt Hon K. (Rushcliffe)||Hordern, Sir Peter|
|Colvin, Michael||Howard, Rt Hon Michael|
|Conway, Derek||Howarth, Alan (Strat'd-on-A)|
|Coombs, Anthony (Wyre F'rest)||Howarth, G. (Cannock & B'wd)|
|Coombs, Simon (Swindon)||Howe, Rt Hon Sir Geoffrey|
|Cormack, Patrick||Howell, Rt Hon David (G'dford)|
|Couchman, James||Howell, Ralph (North Norfolk)|
|Cran, James||Hughes, Robert G. (Harrow W)|
|Critchley, Julian||Hunt, David (Wirral W)|
|Currie, Mrs Edwina||Hunt, Sir John (Ravensbourne)|
|Curry, David||Hunter, Andrew|
|Davies, Q. (Stamf'd & Spald'g)||Irvine, Michael|
|Davis, David (Boothferry)||Irving, Sir Charles|
|Day, Stephen||Jack, Michael|
|Devlin, Tim||Jackson, Robert|
|Dickens, Geoffrey||Janman, Tim|
|Dicks, Terry||Jessel, Toby|
|Dorrell, Stephen||Johnson Smith, Sir Geoffrey|
|Douglas-Hamilton, Lord James||Jones, Gwilym (Cardiff N)|
|Dover, Den||Jones, Robert B (Herts W)|
|Dunn, Bob||Jopling, Rt Hon Michael|
|Dykes, Hugh||Kellett-Bowman, Dame Elaine|
|Eggar, Tim||Key, Robert|
|Emery, Sir Peter||King, Roger (B'ham N'thfield)|
|Evans, David (Welwyn Hatf'd)||King, Rt Hon Tom (Bridgwater)|
|Evennett, David||Kirkhope, Timothy|
|Fairbairn, Sir Nicholas||Knapman, Roger|
|Fallen, Michael||Knight, Greg (Derby North)|
|Favell, Tony||Knight, Dame Jill (Edgbaston)|
|Fenner, Dame Peggy||Knowles, Michael|
|Field, Barry (Isle of Wight)||Knox, David|
|Finsberg, Sir Geoffrey||Lamont, Rt Hon Norman|
|Lang, Ian||Morrison, Rt Hon P (Chester)|
|Latham, Michael||Moss, Malcolm|
|Lawrence, Ivan||Moynihan, Hon Colin|
|Lawson, Rt Hon Nigel||Mudd, David|
|Lee, John (Pendle)||Neale, Gerrard|
|Leigh, Edward (Gainsbor'gh)||Needham, Richard|
|Lester, Jim (Broxtowe)||Nelson, Anthony|
|Lightbown, David||Neubert, Michael|
|Lilley, Peter||Nicholls, Patrick|
|Lloyd, Sir Ian (Havant)||Nicholson, David (Taunton)|
|Lloyd, Peter (Fareham)||Nicholson, Emma (Devon West)|
|Lord, Michael||Norris, Steve|
|Luce, Rt Hon Richard||Onslow, Rt Hon Cranley|
|Lyell, Rt Hon Sir Nicholas||Page, Richard|
|McCrindle, Robert||Paice, James|
|MacGregor, Rt Hon John||Parkinson, Rt Hon Cecil|
|MacKay, Andrew (E Berkshire)||Patnick, Irvine|
|Maclean, David||Patten, Rt Hon Chris (Bath)|
|McLoughlin, Patrick||Patten, Rt Hon John|
|McNair-Wilson, Sir Michael||Pattie, Rt Hon Sir Geoffrey|
|McNair-Wilson, Sir Patrick||Pawsey, James|
|Madel, David||Peacock, Mrs Elizabeth|
|Major, Rt Hon John||Porter, Barry (Wirral S)|
|Malins, Humfrey||Porter, David (Waveney)|
|Mans, Keith||Portillo, Michael|
|Maples, John||Powell, William (Corby)|
|Marland, Paul||Price, Sir David|
|Marlow, Tony||Raffan, Keith|
|Marshall, John (Hendon S)||Raison, Rt Hon Timothy|
|Marshall, Sir Michael (Arundel)||Rathbone, Tim|
|Martin, David (Portsmouth S)||Redwood, John|
|Mates, Michael||Renton, Rt Hon Tim|
|Maude, Hon Francis||Rhodes James, Robert|
|Mawhinney, Dr Brian||Ridsdale, Sir Julian|
|Maxwell-Hyslop, Robin||Rifkind, Rt Hon Malcolm|
|Mayhew, Rt Hon Sir Patrick||Roberts, Sir Wyn (Conwy)|
|Mellor, David||Roe, Mrs Marion|
|Meyer, Sir Anthony||Rossi, Sir Hugh|
|Miller, Sir Hal||Rost, Peter|
|Mills, Iain||Rowe, Andrew|
|Miscampbell, Norman||Rumbold, Mrs Angela|
|Mitchell, Andrew (Gedling)||Ryder, Richard|
|Mitchell, Sir David||Sackville, Hon Tom|
|Moate, Roger||Sayeed, Jonathan|
|Monro, Sir Hector||Scott, Rt Hon Nicholas|
|Montgomery, Sir Fergus||Shaw, David (Dover)|
|Moore, Rt Hon John||Shaw, Sir Giles (Pudsey)|
|Morris, M (N'hampton S)||Shaw, Sir Michael (Scarb')|
|Morrison, Sir Charles||Shelton, Sir William|
|Shephard, Mrs G. (Norfolk SW)||Tracey, Richard|
|Shepherd, Colin (Hereford)||Tredinnick, David|
|Shepherd, Richard (Aldridge)||Trippier, David|
|Shersby, Michael||Trotter, Neville|
|Skeet, Sir Trevor||Twinn, Dr Ian|
|Smith, Tim (Beaconsfield)||Viggers, Peter|
|Soames, Hon Nicholas||Wakeham, Rt Hon John|
|Speller, Tony||Walden, George|
|Spicer, Michael (S Worcs)||Walker, Bill (T'side North)|
|Squire, Robin||Waller, Gary|
|Stanbrook, Ivor||Ward, John|
|Stanley, Rt Hon Sir John||Wardle, Charles (Bexhill)|
|Steen, Anthony||Warren, Kenneth|
|Stern, Michael||Watts, John|
|Stevens, Lewis||Wells, Bowen|
|Stewart, Allan (Eastwood)||Wheeler, Sir John|
|Stewart, Andy (Sherwood)||Whitney, Ray|
|Stewart, Rt Hon Ian (Herts N)||Widdecombe, Ann|
|Stradling Thomas, Sir John||Wiggin, Jerry|
|Sumberg, David||Wilkinson, John|
|Summerson, Hugo||Wilshire, David|
|Tapsell, Sir Peter||Winterton, Mrs Ann|
|Taylor, Ian (Esher)||Winterton, Nicholas|
|Taylor, John M (Solihull)||Wolfson, Mark|
|Taylor, Teddy (S'end E)||Wood, Timothy|
|Tebbit, Rt Hon Norman||Woodcock, Dr. Mike|
|Temple-Morris, Peter||Yeo, Tim|
|Thompson, D. (Calder Valley)||Young, Sir George (Acton)|
|Thompson, Patrick (Norwich N)||Younger, Rt Hon George|
|Thornton, Malcolm||Tellers for the Noes:|
|Thurnham, Peter||Mr. Alastair Goodland and|
|Townend, John (Bridlington)||Mr. Tony Durant.|
|Townsend, Cyril D. (B'heath)|
§ Question accordingly negatived.
§ Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.
§ MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.
That this House continues to support the Government's policy towards care in the community as set out in the White Paper, Caring for People, as an effective means of securing and delivering services on behalf of those people in need of social care; and endorses the approach towards implementation which the Government had adopted.