HC Deb 05 March 1991 vol 187 cc127-9
10. Mr. Michael

To ask the Secretary of State for Health what fresh initiatives he plans to take to ensure that elderly and disabled people receive a high standard of care in the community.

Mrs. Virginia Bottomley

Local authorities will be introducing the new inspection and complaints arrangements as the first part of the Government's community care policies in April.

Mr. Michael

Is that really the best that. the Minister can do? Does she not realise that having promised care in the community, the Government have failed to ring-fence it, delayed its implementation for three years and now appear to be about to abandon it altogether? Does she not also realise that we want care in the community now for those people— the number of whom is increasing—who are already in the community? It is about time that the Minister made way and allowed the Secretary of State to promise us real care in the community for the people who need it now.

Mrs. Bottomley

Frankly; the soap box will get nowhere in terms of producing effective community care. The policy is on course with implementation. In April we are moving ahead with complaints, with inspection, with special help for drug and alcohol abusers, with extra care for the mentally ill and a very substantial increase in money for training. Local authorities and health authorities are working with voluntary organisations and the private sector to make a real success of this popular and important policy which now needs to be implemented with care and detail with the extra resources that we have made available.

Mrs. Currie

Does my hon. Friend realise that there are real fears in Derbyshire about the funding for care in the community being switched from the central Government to Derbyshire county council, which has already declared its opposition to placing any money with the private sector, particularly in relation to private residential homes? Does she also accept that it might not be a good idea to make that switch when we are seriously considering abolishing the county councils altogether? Would it not be better, if the money is to be shifted from central Government, to give it to the health authorities which we know and trust to do a good job?

Mrs. Bottomley

Derbyshire county council could well take to heart the remarks of my right hon. Friend the Prime Minister speaking at the local government conference on Saturday. He said that in local government we need less paper and more action. Less empire-building and more innovation; less government and more service. A local authority like Derbyshire, which believes that there is great virtue in providing a home help for one in three people aged over 75 and not charging any of them for that, must think again. We are committed to the implementation of care in the community. It is important to achieve value for money and to consult users and carers. It is good policy which makes sense and it will bring an end to the warehousing of those with disadvantages and it will treat them with dignity and privacy in their own homes. We shall certainly ensure that all local authorities understand the realities of the policy and exercise the disciplines that are necessary in taking that care forward.

Mr. Wigley

Does the Minister recall that when the Government decided not to implement in full the Disabled Persons (Services, Consultation and Representation) Act 1986, the reason given was that they were pressing ahead with care in the community legislation? Now that that has been delayed for up to another two years before any benefit comes through, surely the Government should implement now—and in full—the 1986 Act?

Mrs. Bottomley

It would be a travesty for the hon. Gentleman to think that no action has been taken on care in the community for two years. A great deal of work has been carried out by local authorities and health authorities to improve their assessment procedures, to ensure that they bring forward their community care plans— and, especially, in keeping with the spirit of the Act to which the hon. Gentleman referred— to ensure that the users and carers are given the consideration that they require. Part VII of the Act deals with the policy being introduced by my hon. Friend the Parliamentary Under-Secretary in the mental illness care programme for proper procedures for those discharged from hospital.

Mr. Thurnham

Does my hon. Friend agree that the most disadvantaged in society— the elderly, the disabled and the sick—suffer most from waste and inefficiency? Does she also agree that high standards in community care require good management, not the practices of loony left Labour councils?

Mrs. Bottomley

My hon. Friend is right. I am sure that he is well aware that in his speech on Saturday, the Prime Minister said that the Opposition often think that the answer to every problem is to appoint an officer, whereas we believe that often the answer is to dis-appoint an officer.

We want to achieve value for money, to introduce good community care policies of the type toward which many health and local authorities are already making excellent progress. I pay a warm tribute to all of them and to the way in which they have collaborated with our draft guidance and have taken part in consultations to ensure that they have the practical tools to undertake their new responsibilities.

Mr. Rooker

Does the Minister accept that if the policy was as good as she claims it is, it would have received overwhelming support from both sides of the House if it had not been abandoned but had been implemented? Does not she also accept that there is now abundant independent evidence that the cost of delaying the implementation of care in the community far outweighs the benefits in both financial and human terms and puts a continuing strain on the carers and the cared for? The Secretary of State himself expressed that view to the Select Committee on Health only a few days ago. All parties have wanted to end the uncertainty surrounding the policy since the Audit Commission's report of December 1986. We shall expect full support from both sides of the House when we announce implementation in April 1992 after the summer election.

Mrs. Bottomley

I very much hope that no local authority or health authority is under the misapprehension peddled by the hon. Gentleman. A great deal of work is already under way. Implementation begins on 1 April this year. With that in mind, we have increased the training available to local authorities by 20 per cent. this year to enable them to spend £35 million on training. We have increased the standard spending assessment for local authorities by 23.5 per cent., which is the largest increase in social service spending for 15 years.

Mr. Rowe

Does my hon. Friend accept that one of the great inhibitions to giving good community care to the elderly and the disabled is the accommodation in which they frequently have to live? Will she speak to her hon. Friend the Minister for Housing and Planning to add her weight and that of her Department to the efforts of those who are trying to get builders to build new houses with level access and many other features which are beneficial to the elderly and the disabled?

Mrs. Bottomley

I appreciate, as ever, my hon. Friend's constructive remarks. We are now at the stage in the development of care in the community at which practical and innovative schemes must be arranged, often between departments of local government and between local government and health authorities, with the voluntary and private sectors. My hon. Friend will be aware that in Committee, our hon. Friend the Member for Ealing, Acton (Sir G. Young), the Minister for Housing and Planning, constantly referred to the need to collaborate with housing authorities. He joined me only the other day for a discussion about the way to carry forward collaboration between social services departments, health authorities and housing departments. We have met a number of local authorities to talk precisely through the practical ways in which they can ensure that schemes such as that to which my hon. Friend refers can make progress.