HC Deb 11 December 1992 vol 215 cc1177-84

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

Mr. Andrew Miller (Ellesmere Port and Neston)

On a point of order, Mr. Deputy Speaker. I apologise for taking up the time of the House—[Interruption.]

Mr. Deputy Speaker (Mr. Michael Morris)

Order. I request all hon. Members to cease speaking. I point out that time spent now is taken out of the Adjournment debate.

Mr. Miller

As you will appreciate, Mr. Deputy Speaker, I believe that the Occupational Pensions Bill is a most important measure. I am confused and I should be grateful for your guidance. I have received correspondence from one Minister which expressed positive interest in the Bill, yet another Minister——

Mr. Deputy Speaker

Order. The Chair cannot give procedural advice. I ask the hon. Gentleman to talk to the Clerks. I am sure that they will give him proper advice on these matters.

2.40 pm
Mr. Alan Milburn (Darlington)

I am grateful for the opportunity to debate the important issue of the future of drug and alcohol rehabilitation centres, not least because the issue has some genuine cross-party support. I believe that there is a consensus of concern which I hope the Minister will be able to address. He will have seen the early-day motion that I tabled which was supported by more than 100 hon. Members of all parties.

Drug and alcohol centres face an immediate funding crisis. Discussions over the past few days suggest that a number of the 140 drug and alcohol rehabilitation centres in England and Wales face an immediate crisis in the new year when they will have to consider sending out redundancy notices to their staff. I know that other hon. Members want to contribute to the debate, so I shall use my short speech to make an 11th hour plea to the Minister to think again and to provide some breathing space for these vitally needed centres.

The Minister will know that there are 140 registered homes in England and Wales that provide expert help for people with severe drug and alcohol problems. He may know that there are two such centres in my own region of the north-east. Carousel is based in Middlesbrough and Turning Point is based in Whitley Bay. Between them, they see 450 clients each year. I am told that the number of clients knocking on their doors is increasing day by day. To confirm that, I recently spoke to the excellent drug and alcohol addiction service run by my health authority in Darlington. Workers there told me that the number of clients they had seen this year had increased by 50 per cent. compared with last year's figure.

Thankfully, the Government recognise the scale of the drug and alcohol problem. The commitments given in the White Paper, "The Health of the Nation", on tackling drug and alcohol problems achieved a great deal of support from hon. Members of all parties. I hope that, in the light of the need to tackle those problems, the Minister can give some assurances about the important and continuing role of drug and alcohol centres.

The Minister knows that those centres play a vital role not only in treating people with serious problems, but in ensuring that they are rehabilitated so that they can play a full role in their communities. He will also know that there is a national network which provides a variety of care and specialist services for all manner of people with drug and alcohol problems.

The Minister will also know that the centres operate an open-door policy. In the financial year 1989–90, the centres saw 5,000 clients. Unfortunately, a further 15,000 could not be admitted for treatment or for rehabilitation, because there was a shortage of beds. It is a national problem: quite simply, there are too few resources and we should seek to preserve what resources we have.

The bulk of the funding for the 140 centres comes, at present, from Department of Social Security payments. As part of the community care arrangements, from 1 April, that money will be transferred to local authorities, leaving the centres with a shortfall of between £100 and £200 per bed space per week. During the passage of the National Health Service and Community Care Act 1989, the Government recognised the special nature of the clientele with whom the centres deal and provided for a specific grant that would ring fence the £20 million paid out in DSS payments for the direct use of those centres.

The withdrawal of that commitment in October this year will force each of the centres to approach the home local authority of the client to obtain the funds required. Usually, that means dealing with betweeen 40 and 50 local authorities. I hope that the Minister will acknowledge that that will ensnare the centres in a mountain of red tape. He has created a bureaucratic nightmare with which those centres will be unable to cope because they lack the necessary resources. I suspect that administrative problems will divert the attention of the centres—if they survive—away from their essential role of looking after people with severe drug and alcohol problems.

The system that the Minister envisages is simply unmanageable because it does not recognise the nature of the client group. Often, the home local authority cannot be established because people with drug and alcohol problems form part of a dislocated population. Many of them are homeless and have no community base whatever. Nor is the local authority under any direct legal obligation to provide treatment or funding for people with drug or alcohol problems. Hon. Members will be aware that, because of that situation, each of the 140 centres now faces the very real threat of closure.

None of that need happen if the Minister gives an assurance today that the transitional provisions agreed during the passage of the National Health Service and Community Care Act will be enacted. Under the present proposals, the money will be lost in the general community care pool. The buck has been passed to local authorities with centres in their areas, which will be asked to fund those centres. I am told that 87.5 per cent. of the clientele of Turning Point, one of the centres in the north-east, comes from outside the North Tyneside local authority area. It is surely unfair to ask North Tyneside council to pay for a service that is not even serving the population of its area.

People with drug and alcohol problems often deliberately go to other local authority areas for help, to escape the environment that has nurtured their addiction in the first place. Local authorities with centres in their area will not subsidise the costs of treatment for clients from other areas, especially as local authorities across the political spectrum claim that the overall community care budget is underfunded to the tune of between £150 million and £200 million. Nor is it particularly likely that any local authority will pay for any client allocated to it by a centre without a thorough assessment. Any assessment will be costly and time consuming and will require expertise that many local authorities do not have.

As the Minister must recognise, under the community care budget, local authorities will increasingly be forced to choose between providing services for the elderly, for people with disabilities or for those with drug and alcohol problems. Most hon. Members recognise that a pecking order has been established. I am afraid that people with drug and alcohol problems will be at the bottom of that order. They will be de-prioritised and, as a result, services will go down the tube.

The special nature of the services provided by the 140 centres has been partially recognised by the Minister. In a recent announcement, he provided for a new fast-track assessment procedure and he said that further guidance would be sent to local authorities and that a monitoring system would be established to assess how the system will work after 1 April.

However, I am afraid that that announcement is too little, too late.

Monitoring after April 1993 will occur after many centres have issued redundancy notices to staff in order to comply with the Charities Act 1992 and their legal obligations under the Companies Act 1989. The costs of closure will be incalculable. Each year, 5,000 people will be denied the opportunity to put behind them their alcohol and drug misuse. Immediately, they will face the prospect of being thrown out on to the streets because, quite simply, there will be nowhare else for them to go in the short term.

Closure of the 140 centres will also undermine the Government's health and social policies. It is well known that the majority of hardened drug users finance their habit by illegal means. They do that by theft, dealing in drugs and, in some cases, by prostitution. Society will end up paying a very hefty price if those centres go under. I am not alone in believing that that is not a price worth paying.

In 1990, the Government came up with a solution that satisfied service providers and purchasers. The ring-fencing solution would have worked. It would have given centres a three-year breathing space to develop more appropriate, long-term funding arrangments. I ask the Minister for some breathing space to allow those centres to adapt to the new community care arrangments that will apply from 1 April.

It is not good enough to replace a positive commitment given two years ago with a limp advice note to local authorities which the Minister must know will be ignored by them. I know that the Minister does not want the centres to close. However, they need more than ministerial assurances if they are to survive. They need protection and support. The best way to achieve that is to provide guaranteed, ring-fenced funding for the next three years.

2.52 pm
Mr. Tim Rathbone (Lewes)

I am grateful to the hon. Member for Darlington (Mr. Milburn) and to the Parliamentary Under-Secretary of State for Health, my hon. Friend the Member for Suffolk, South (Mr. Yeo) for allowing me to add a few words to this important debate speaking, as I do, with the entire support of the all-party drugs misuse group.

The hon. Member for Darlington expressed genuine concerns. They are not scaremongering as my hon. Friend the Minister for Health suggested in recent correspondence in The Guardian. Those concerns have been raised from the inception of the plan by every agency and individual concerned with the problems of alcohol and drugs misuse.

The concerns stem from the fact that alcohol and drug services are different, in respect of the kind of recipient, the needs of the recipient and the mobility of the recipient, from the services provided under other aspects of care in the community. Because of that difference we must plead for more time for the agencies that do such good work to readjust under the new rules of care in the community, which are welcome changes.

Drug and alcohol misuse is a tragically expanding problem. It must receive from the Government firmer attention, increased worry and a greater contribution in terms of direct funding than, unfortunately, the plans indicate. I hope that, at her meeting with the various agencies next Tuesday, my right hon. Friend the Secretary of State will take the opportunity to consider the points that have been raised this afternoon, to listen to the agencies' opinions and concerns, and to readjust the Government's plans. Perhaps my hon. Friend the Minister could give an inkling of such thinking right now.

2.55 pm
The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo)

I congratulate the hon. Member for Darlington (Mr. Milburn) on gaining the opportunity to raise this important subject and on giving me the chance to explain just how much importance the Government attach to tackling the problems associated with alcohol and drug misuse.

I welcome my hon. Friend the Member for Lewes (Mr. Rathbone), the chairman of the all-party group, to the debate. As he said, next week my right hon. Friend the Secretary of State and I will meet a number of others who are concerned mainly as providers of treatment services to discuss proposals and to explain the Government's up-to-date thinking. I have already had several meetings in the past two months on that subject. I hope to explain just why the hon. Gentleman's rather alarmist scenario is without foundation.

The inclusion of targets for alcohol and drug misuse in the Government's White Paper, "The Health of the Nation", is just one reflection of the importance that we attach to this important issue. The White Paper also emphasised that the Government, local authorities and health authorities all have a role to play in ensuring that the needs of alcohol and drug misusers are properly met.

Health authorities provide resources from their general allocations to support alcohol treatment services, and since 1986 they have received additional allocations for the expansion of treatment and rehabilitation services for drug misusers. Since 1987, they have also received further sums from the AIDS allocations. The total sums earmarked specifically for drug misuse services amounted to nearly £19 million in 1992–93.

I am delighted to be able to announce that there will be a 23 per cent. increase in part of the drugs budget which provides for the expansion of treatment and rehabilitation services for drug misusers. In 1993–94 the amount will increase from £6.8 million to £8.2 million. There will also be additional moneys available from the AIDS allocation.

Mr. Milburn

Given that the Department has set out the targets in "The Health of the Nation", would the Minister he prepared to accord the same statutory rights to drug and alcohol abusers as are accorded to other groups in society who are provided for under community care—I am thinking of people with disabilities and of the elderly, for example—to enable local authorities to have a direct statutory obligation to provide services to people with alcohol and drug problems?

Mr. Yeo

That the targets have been set in "The Health of the Nation" is an indication of the importance that we attach to those groups and of our wish that local authorities and health authorities should reflect the same priorities in their purchasing strategies. Under the community care arrangements, local authorities have a duty to assess the needs, regardless of age or disability, of people who might need social services. Once that assessment has been carried out, they must decide how needs will be met.

Alcohol and drug rehabilitation centres are an important component of service provision. As the hon. Gentleman said, there are about 2,000 bed spaces in residential centres. Rehabilitation programmes vary, but the average length of stay is about 19 weeks. Nearly all the services are provided by the voluntary sector, and the Government recognise and value that sector's contribution to service provision.

The arrangements for funding residential care change in April next year—from then, local authorities will be responsible for assessing people who may be in need of care and, where appropriate, for making placements and funding the social care costs of residential care. Residents will be able to claim basic income support and a residential allowance, and from that and any other resources that they have they will pay a charge to the local authority.

The community care special transitional grant, announced on 2 October, will be available for local authorities in 1993–94 for implementation of the community care policies. That money—£539 million for England—will be ring-fenced for use by local authorities for that purpose, including the purchase of services for alcohol and drug misusers.

The £539 million is made up of a £399 million transfer from the Department of Social Security, which reflects what would have been available if the existing income support arrangements had continued. We have increased that figure by a further 35 per cent.—an extra £140 million—over and above the social security transfer for additional services, administrative work and assessments. Therefore, there should be no additional administrative burden on individual establishments. On top of the £539 million, there will be a further £26 million for the independent living fund arrangements.

All those funds are in addition to the 20 per cent. increase in real terms in the personal social services standard spending assessments during the past three years. If one adds to that the special transitional grant, it means that resources made available by the Government to local authorities for social services have increased by a massive 34 per cent. in real terms over the past three years.

In the county of the hon. Member for DarlingtonDurham—the special transitional grant will be £7.125 million next year, and a small addition will soon be made to that figure in respect of the independent living fund. The social services standard spending assessment for Durham has risen during the past three years by £12.5 million to £54 million—an increase of 13.6 per cent. in real terms. The policy is incredibly generously resourced. If the special transitional grant for Durham is added to its standard spending assessment, the increase in real terms of resources available in Durham is more than one third.

Mr. Milburn

I cannot let the Minister get away with that—at least he had the good grace to smile as he was telling me how well off county Durham social services are. He will also be aware that in Durham the local authority has been forced to close a succession of homes for the elderly precisely because of the inadequacies of its SSA assessment. More generally, given all the complaints coming from all local authority associations and individual local councils, regardless of their political make-up, will the Minister today agree to review the basis of the statistics for SSA settlements? He should do so because of the frequency and depth of the complaints.

Mr. Yeo

I do not want to get drawn into the wider subject of the system of local government finance. The SSAs are ultimately a matter for my right hon. and learned Friend the Secretary of State for the Environment. Not all the local authority associations have expressed dismay over the finding of community care. The Association of County Councils is extremely satisfied with the generous resourcing basis.

I should like to deal with the specific issues raised by the hon. Member for Darlington, about which my hon. Friend the Member for Lewes was also concerned. The proposal to ring-fence the community care transfer was made subsequently to the consultation document issued in January. In the light of the new conditions, we concluded that it would not be right to have a separate ring fence for alcohol and drug misusers as that would have perpetuated the existing pattern of services based on an historical pattern, rather than on an assessment of the needs of local people. It would also have tended to produce a bias against domiciliary services by guaranteeing automatic funding for residential provision and, most importantly, it would have undermined the principle that all those who may be in need of community care should be individually assessed by local authorities to determine the appropriate services. The specific grants might also have been seen as a ceiling rather than a floor for expenditure. Therefore, we decided against having a separate ring fence within the overall ring fence.

However, the Government do not believe that what is now proposed will be any less beneficial for people needing access to residential services for treatment of alcohol and drug misuse. Indeed, the new arrangements will give alcohol and drug misusers the wider benefits of all the community care policies. They will ensure that when people come forward for help—whether to a local authority, or to a voluntary agency—they will receive a comprehensive assessment of their needs. Local authority responsibilities will not necessarily end when the period of rehabilitation ends. Indeed, people can expect that they will continue to be able to obtain support in the community from the local authority, if their needs are assessed in that way.

Mr. Milburn

I understand the background, but the Minister will also understand that the decision to withdraw the ring-fencing commitment came with only six months to go before the time when all the agencies had assumed that their funding would indeed be ring-fenced. By the time the advice notes are sent out from the Department the agencies will have only three months left in which to plan how to cope with the new state of affairs. Will the Minister put on hold the arrangements that he is putting in place, so as to allow for a planned and steady provision of continuing services? If he will not, it is not scaremongering to say that some of these centres face closure.

Mr. Yeo

The decision not to ring-fence the money for alcohol and drug misusers was taken after we had ring-fenced the much larger sum of money. Guidance is being issued in draft form. We are consulting local authorities and voluntary providers. I hope to issue the final guidance shortly to all local authorities, advising them of the importance that they should attach in their purchasing to the needs of this client group.

Having decided on this larger ring-fencing of around £539 million it would have been difficult for us to produce an inner ring-fence. That would have given rise to demands from other groups—severely handicapped adults, frail and mentally ill elderly people, perhaps—for similar arrangements. I recognise that there are some special characteristics among drug misusers, and we intend to deal with those in a variety of ways.

We have announced that we will promote a dialogue between the local authorities and the independent providers to deal with the problem that the hon. Gentleman identified of deciding which local authority will be responsible for financing a person's treatment. The lifestyles of many of the people who need this kind of treatment can sometimes make it difficult to identify which authority should be responsible, but the advantage of having one responsible authority is that it has a continuing duty to assess the needs of a person even after a successful rehabilitation programme. By looking at some specific cases coming up before 31 March for this sort of treatment with the voluntary organisations, it should be possible to determine how we can identify which authority is responsible by tracing a person's history.

Mr. Rathbone

The new guidelines have been produced in a great rush. They were distributed on 8 December, comments were required by 14 December and the Minister has said that he hopes to issue the guidance shortly—by 18 December, I believe. That is not the way to tap wisdom out there in the working world.

Mr. Yeo

We have proceeded with such speed and urgency because of the representations that we have received. I have had meetings during the past few weeks with local authority associations and with representatives of the voluntary sector providers of this sort of treatment. I have had about five meetings on the subject; my right hon. Friend the Secretary of State has also had some; and we are both holding another one next week.

The issues are so familiar to everyone who has debated the subject that the compressed time should not give rise to worry. We are trying to find the right sort of solution so that the valuable treatment provided by these centres can be preserved. I have had no time to mention our wish to achieve a fast-track assessment procedure, but we also attach importance to that because we realise that it will he necessary to assess the needs of alcohol and drug misusers who may be willing to have treatment the day after tomorrow, as it were. Elderly people coming out of hospital may perhaps be subject to a more leisurely process of assessment.

We have initiated discussions of how to identify which authority is responsible. I believe that any residential treatment centre offering good services for this client group has nothing to fear, given that we are telling all local authorities that we expect them to continue sponsoring clients to obtain this treatment.

Mr. Milburn

Would the Minister——

The motion having been made after hall-past Two o'clock, and the debate having continueds for half an hour, MR. DEPUTY SPEAKER adjourned the House without question put, pursuant to the Standing Order.

Adjourned at nine minutes past Three o'clock.