§ Order for Second Reading read.
§ 4.9 pm
§ The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo)
I beg to move, That the Bill be now read a Second time.
Hon. Members may recognise the Bill as being essentially the same as a private Member's Bill introduced in another place in the previous Session by my noble Friend the Baroness Brigstocke. That Bill gained all-party support but failed to complete all its stages here before dissolution. I acknowledge the work of my hon. Friend the Member for Suffolk, Central (Mr. Lord) to get the Bill through on that occasion. It is unfortunate that the Bill did not quite make it before dissolution, because the need for it remains.
Today's Bill, which successfully completed all its stages in another place after a wide-ranging and interesting debate, provides for a minor but vital technical amendment to section 42(2) of the National Health Service and Community Care Act 1990.
Hon. Members will be aware that Government policy on care in the community has recently been set out in the White Paper "Caring for People" and in part II of the National Health Service and Community Care Act 1990. The policy is based on two principles—first, that the majority of people want to remain in their own homes or in a homely environment for as long as possible and, secondly, that the needs of any two people can differ, so individual problems require individual solutions.
Our policy puts the emphasis of care where it should rightly be—on the proper assessment of the individual needs of the users of services and on the design of a package of care that meets those needs.
The White Paper's approach is based on giving local authorities the freedom and flexibility to develop effective individual solutions for the provision of services and support that frail, elderly, vulnerable or disabled people need. The aim is to enable those people to live as full and independent a life as possible.
That approach reflects the transformation of attitudes towards how that group of people should be looked after which has occurred during the last quarter of a century. Individuals, families, volunteers, professionals, campaigners and politicians from all sides have come to recognise the shortcomings of institutional environments and the greater potential and fulfilment which people enjoy when living in, contributing to and being supported by the community.
The White Paper is important, but it is merely one more step along a well-trodden road. It needs to be seen in that context, and its significance must be neither over nor under-estimated. Its objectives include, first, promoting the development of domiciliary, day and respite services to enable people to live in their own homes where that is practicable and desirable; secondly, ensuring that practical support for carers is made a high priority; thirdly, ensuring proper assessment of need and care management; and, 960 fourthly, promoting the development of a flourishing independent sector alongside good quality public provision.
Implementation of that policy is well under way. From April 1991 social services departments were required to introduce inspection units and complaints procedures and we introduced new specific grants to help particular groups. From April 1992, authorities were required to produce and publish community care plans. From April 1993, local authorities take on full responsibility for arranging all social care services.
That responsibility will include the provision of services such as home helps, home care assistants and day care to support people in their own homes, and making arrangements for residential and nursing home care for those who are no longer able nor wish to remain in their own homes. Individual needs will be assessed and a package of care designed and managed by the local authority.
The full implementation of all community care objectives involves a continuing process that goes on for many years. Not for nothing was the White Paper called "Caring for People—Community Care in the Next Decade and Beyond".
The Bill is concerned with the ability of local authorities to make arrangements for residential accommodation across a range of organisations and does not touch on domiciliary or nursing home care.
Hon. Members will be aware that there is a range of types of residential accommodation currently available, for example, residential care homes, group homes, and hostels of all types. They may be managed by local authorities, voluntary or commercial organisations, and they cater for varying types of need and degrees of dependency. Some provide only bed and board, others help with supportive or personal care. Those that offer personal care as well as board are required to register with the local authority under the Registered Homes Act 1984, unless they are specifically exempted from so doing.
At present, local authorities provide hostel accomodation and other forms of residential care either directly or through the independent sector—voluntary or commercial —under the National Assistance Act 1948 and paragraph 2(1)(a) of schedule 8 to the National Health Service Act 1977.
The Government attached great importance to retaining and extending the flexibility that local authorities have to provide a range of residential accommodation to suit the varying needs of the individuals who go to them for care. In all the guidance that we put out, we stressed to local authorities the need to be flexible. Local circumstances will dictate the best balance between different types of arrangement, but we have emphasised that individuals should have genuine choice over the services that they receive.
That means choice not only of the type of service, but of its provider. The independent sector—both voluntary and private—plays an important part in residential care at the moment. We are determined that that will continue, and to encourage greater involvement of the independent sector in non-residential care.
A mixed economy of care is the way to ensure choice, stimulate quality, and secure the best value for money. Authorities should begin to move away from the role of sole provider to the role of enabler and facilitator. The independent sector is a resource that must not be allowed 961 to lie unused. Most authorities know that, and are beginning to respond to their new challenges. The purchaser provider model, which is delivering great benefits within the national health service, may usefully be emulated in that respect by local authorities.
§ Mr. Peter Griffiths (Portsmouth, North)
Is my hon. Friend the Minister satisfied that the range and quality of care that will be offered by the voluntary and private sector will be such that a satisfactory environment will be provided for those who, at a time of poor health or increasing age, turn to local authorities to provide accommodation?
§ Mr. Yeo
Yes, I am more than satisfied. There is overwhelming evidence that the involvement of the voluntary sector and, more recently, of the private sector in residential and, to some extent, non-residential care—we want to encourage more of that—is a key influence in raising standards. The independent sector is only able to survive and prosper by offering local authorities and, through them, the individuals who need support a standard of provision that is not only as good as that provided by local authorities but better, in many cases.
It is a time-honoured tradition in this country for the voluntary sector in particular to pioneer standards of service with which the statutory agencies eventually catch up, so that they become available to all. I see the voluntary sector as a very benign influence in that whole process.
However, a problem has arisen that necessitates this Bill. From April 1993, when the National Health Service and Community Care Act 1990 is fully in force, paragraph 2(1)(a) of schedule 8 to the National Health Service Act 1977 will be repealed, and section 26 of the National Assistance Act 1948 will be amended by section 42(2) of the National Health Service and Community Care Act 1990. It was the Government's intention that the flexibility that local authorities currently have under the 1977 and 1948 Acts be retained.
Unfortunately, section 42(2) of the 1990 Act inadvertently curtailed that flexibility, particularly with respect to local authorities making arrangements with independent sector residential accommodation, which does not require to be registered under the Registered Homes Act 1984. It puts at risk the use by local authorities of a range of independent sector providers including hostels, and notably the Abbeyfield Society. That society has about 1,000 homes providing accommodation for elderly people who do not require personal care, as defined in the Registered Homes Act 1984, but domestic help and the provision of meals in a small and homely residential setting.
Most Abbeyfield homes are family-sized houses where seven to nine elderly people have their own bed-sitting rooms. Residents have normally moved from their own homes nearby. They furnish their own rooms with their treasured possessions; they lead their own lives and come together for the main meals of the day, which are prepared by the resident housekeeper. That way of life provides a balance of privacy and companionship that can be ideal for many elderly people.
People are individuals and have individual needs, and as I have said, the new community care arrangements are intended to allow local authorities to respond more effectively to those needs. I am sure that the House will agree that it would be most regrettable if their flexibility to 962 do so were curtailed by the loss of powers to make arrangements with organisations like the Abbeyfield Society.
The Bill remedies the problem by replacing section 42(2) of the NHSCC Act 1990, thus restoring to local authorities the powers that they now have to make full use of the independent sector but would otherwise lose in April 1993 when the Act comes into force. The Bill makes a minor but vitally important technical change to the legislation, without making any policy changes; it simply maintains the status quo.
The substance of clause 1 restores to local authorities the ability to make arrangements for residential accommodation with the independent sector in premises neither registrable under the Registered Homes Act 1984 nor exempt from registration. It restores the flexibility to make arrangements with various independent-sector organisations for residential accommodation, as well as maintaining the rest of the arrangements found in section 42(2) of the National Health Service and Community Care Act 1990. Clause 2 provides for the short title, commencement and extent.
I hope that the House will agree that the Bill deals with a technical problem that arises from section 42(2) of the National Health Service and Community Care Act 1990, and remedies it so that hostels and societies like Abbeyfield are not put at risk.
§ Mr. Jeff Rooker (Birmingham, Perry Barr)
I welcome the Minister to his new post, and thank him for giving a fairly wide introduction to a fairly narrow Bill. In doing so, he has enabled the House to examine some of the wider community care issues. We are extremely grateful both for the example given by the Minister and for your acceptance of it, Mr. Deputy Speaker.
Given the wide-ranging remarks that the Minister made at the beginning of his speech, I hoped that he would take the opportunity to say a little more about what is in prospect for April 1993. It would have been useful to hear a clear, unambiguous reaffirmation that the community care reforms would indeed go ahead at that time. That is, in fact, a requirement, and I shall be happy to give way if the Secretary of State or any of the other Ministers wishes to intervene on the subject.
I feel that a Minister should clarify recent reports that Health Department officials have considered aborting the reforms. Those reports have not been contradicted so far, and they have sent shock waves through local authorities and the voluntary and private sectors, which need to know where they will stand next year. There can be no excuse for further delay or lack of readiness on the Department's part —unless, that is, the Government continue to refuse to talk about the financial arrangements. That in itself leads to doubt, which is only multiplied by the reports that I have mentioned. It would be helpful if this unexpected debate could be used to clear up that doubt; there is still plenty of time to do so.
The Government could at least say something about financial commitments to local authorities: for instance, a commitment that the financial arrangements will at least take account of the shortfall in income support between charges to residents and the benefits available. That shortfall is, after all, required to be made good by charity —by which I mean registered charities—and also by 963 relatives of people in care, some of whom are themselves receiving social security benefits. Such doubts and difficulties really must be cleared up. The implementation of the legislation has been delayed; following the general election, there can be no further excuse for Ministers not to make their position clear.
The difficulty of the shortfall led to what I consider an immoral two-tier charging system in some care-awayfrom-home establishments. Residents with assets—usually the proceeds of the former family home—who can therefore fund themselves for a few years until their assets run out are charged between £40 and £90 a week more than other residents so that the proprietors can balance the books. That is immoral, but Ministers never refer to that cross-subsidy.
Ministers cannot stay silent about the problem much longer. The Government must give a commitment—if not now then in Committee—that the community care funding arrangements for each local authority will be specific so that the authority can operate as an enabler and an organiser, and certainly only as a partial provider of services. Then we shall all know what the arrangements are. There will then be some accountability and a lessening of the risk that the money will be diverted to other, I have no doubt, useful purposes. There must be accountability at both central Government level and local authority level.
This Second Reading debate provides a welcome opportunity for the House to address these issues. This is a small Bill, though it is somewhat longer than the Maastricht Bill. We know, therefore, that there can be wide debates on small Bills. The House is trying to promote a policy of comprehensive community care which allows people to make informed choices regarding options about which they have been consulted. It is therefore necessary to have a flexible system which takes into account a variety of human networks and circumstances. A problem in one area has major ramifications elsewhere for services and choice. If we do not pass the Bill, people who cannot go into residential accommodation of this kind will be forced into unsuitable residential or nursing care. Some may even be forced to stay, unsuitably, in their own homes. Such a comprehensive system, based on variety and meeting people's needs at a personal level, means that the rest of the system must be examined, even when one is considering what appears to be a fairly narrow point.
However brief this debate on community care may be, the subject will be debated more today than it was ever debated during the general election campaign. Up to 6 million adults who are disabled or frail are affected, and anything up to 5 million or 6 million carers who have to undertake varying degrees of care are also affected, but their needs were completely passed by during the general election campaign. It may be argued that 80 or 90 per cent. of community care policy is common to all the parties, but that is no excuse for silence on a fundamental issue which affects people at a personal level. When it came to public debate during the general election campaign, community care was almost a no-go area. I have already said that there is a good deal of common ground between the parties, but that is no excuse for silence.
§ Mr. Rooker
I was about to mention the Secretary of State and I was probably about to mention the very point that she wishes to make. I am very pleased that the Secretary of State, whom I congratulate on her appointment, is in the Chamber.
I well remember Friday 28 February of this year when my hon. Friend the Member for Livingston (Mr. Cook) and I launched the Labour party's policy paper, "Better Community Care". Traffic in London was disrupted by bombs. I took part in a recorded interview with the Secretary of State in which we discussed community care policy. That recording for the BBC was made in the middle of that Friday morning. It was intended for "The World at One", but the recording was not broadcast because we did not argue with one another. That says more about how the BBC tries to manipulate political debate and the political process in this country than it does about my views, the Secretary of State's views, or the views of the Labour party and the Conservative party. If we do not argue, the BBC does not want to be involved, even though community care policy affects millions of our fellow citizens. I have waited quite a while to get that off my chest, and today's debate has provided me with a good opportunity to do so.
The Bill, to which I must refer from time to time, affects residential accommodation as opposed to residential care. It highlights the fact that the success of a comprehensive community care policy rests as much on housing and transport policies as on policies for health and social services. One cannot construct a comprehensive community care policy which meets the individual needs of our fellow citizens unless housing policy is an integral part of it.
The Bill touches on housing policy and the availability of housing of a specialist type. Whether we are talking about availability or choice in housing or aids and adaptations within the home, the aim must be for those who have to leave their home for a care-away-from-home establishment to succeed in restoring a degree of independence and be able to return to their own home. One should not have to end up in residential accommodation, even of the sort provided for in the Bill. There must be an aim to restore independent living. The thousands of stroke patients in this country will testify to that. They know the importance of the rehabilitation process to help them become as independent as possible. It should not be a one-way process; there must be the possibility of returning home. That is why housing policy is so crucial to the success of a comprehensive community care system.
The Bill is concerned essentially with residential accommodation provided by the voluntary and private sectors. The Labour party document to which I referred earlier makes it clear, without qualification, that we see a comprehensive community care policy as an ideology-free zone. Those who rely on community care services are not concerned about who provides that service so long as it is reliable and of good quality. The users are not over-preoccupied with the debate which has rightly gone on in the House about the split between purchasers and providers. One person may be the recipient of a service delivered by the local authority, the voluntary sector and elements of the private sector. Users do not need to know what sector it is that turns up at different times of the day. They want a seamless service. However, the argument about the split between purchaser and provider is a major 965 policy issue. It is a policy argument that we have had, and no doubt will continue to have, in the House. The users want to be treated as human beings.
Service provision may sometimes be very simple. It may sometimes be the provision of gadgets, aids and adaptations rather than a service. It is better to provide the kitchen aids and adaptations to enable people to cook their own food than for them to have to rely on meals on wheels. The former provides independence while the latter leads to dependence. If it is possible for people to cook their own food, that should be the priority because, by and large, that is what the user will want. Most people do not want care; they want a bit of help to enable them to exist and flower as independently as possible and to live as full a life as possible.
If we can aim to provide a seamless service, it will overcome many of the difficulties experienced by those who need the service, by hon. Members and by social workers. It is not easy to achieve that aim. There are good grounds for believing that if we do not get the planning and finances right, we shall not be able to achieve ii; from April next year, even with all the planning that has taken place.
§ Mr. Mark Wolfson (Sevenoaks)
Does the hon. Gentleman agree that one of the important issues in achieving independence for people living at home is that the bureaucracy involved in bringing about improvements and aid in the home must be kept to a minimum? Visits by white collar staff to ascertain what is needed and how it is to be done often occur on too many occasions and take too long when all that is needed is a workman who can do the job quickly.
§ Mr. Rooker
1 could not agree more, and 1 shall offer a solution which appears in policy documents published by the Labour party in February. I cannot understand why a qualified social worker or district nurse, who is at the sharp end of the problem, cannot order a second stair rail instead of the patient having to wait six months for a scarce occupational therapist to place an order. Why should not the social worker or district nurse order the minimum aids and adaptations which are required urgently to prevent further accidents, which in turn put further pressure on the NHS? I cannot understand that bureaucracy. We want trained occupational therapists for specialist work, but following, say, a stroke or the early diagnosis of Parkinson's disease, the simple aids—the handyman's aids—should be provided on the say-so of a qualified social worker or district nurse; they are at the sharp end because they are the first people to be involved.
The philosophy of providing a seamless service, not differentiating between the sectors, underpins the Labour party's desire to implement the original intentions of the Griffiths report. There is a good deal of policy agreement across the House, but there are some policy differences. I am not criticising any Minister as all are new to their tasks, but the Government still have not adopted the Griffiths recommendation that a Minister in the Department of Health should have key responsibility across other Departments because at least four Departments—Health, Environment, Transport and Social Security—are involved. We should enhance the role of the Department of Health in this aspect of policy. As Ministers settle to their 966 tasks, they may consider Labour policy and pick out some good ideas. We shall not criticise them for doing so—we shall just remind them of what they are doing.
I referred earlier to the ring-fencing of funds. It is crucial that local authorities are aware of funds in advance. A Minister should be responsible for a specific sum of money which can be traced. Those tax pounds should be traced from the House through the system to the user so that we can ensure value for money and that none of the money is diverted for repairing roads, roofs or our leaking and crumbling schools. Those are all worthy causes, but the House will have voted that money for community care.
The Griffiths report made it clear that it is necessary to ring-fence such money, and we believe that it should be ring-fenced for at least the lifetime of the Parliament. The quid pro quo is that local government must ring-fence its share as well. Too often the funds of social service committees have been raided by other local government committees.
We shall continue to press—we shall be able to do so better when the Government make their policy clearer—for a financial regime which is as fair as possible between the sectors so that the availability of finance in one sector and not in another does not force people into a choice of care which may not necessarily meet their needs. That is exactly what has happened in the past few years, when income support has been available for one sector but not for others. There must be fairness—level playing field is a term that we understand, but viewers may not—in multi-sector provision. A seamless service is distorted if the financial arrangements are not fair between the sectors.
The Bill covers the part of community care policy which the Labour party document referred to as care away from home. There are many aspects of care away from home, and I set out briefly some of the general principles which might be helpful for the providers as it is a matter for a bipartisan approach. Shadow Ministers shuffle off or shuffle around after elections, as do Government Ministers, but by and large our principles do not change. The Under-Secretary of State may smile at that, but it is an important point because the different sectors need to make investment plans beyond the lifetime of a Parliament. Finance is important for the voluntary sector, for local government and especially for the private sector; they need a fair degree of stability and to know the parties' positions. I shall make it clear what our principles were and are, and they will not change merely because faces may change. That fact has been recognised by the different sectors and they have found it helpful.
The Bill affects part of care away from home—residential accommodation as opposed even to residential care. Such forms of care should not be seen as a problem or failure of community care because, as the Minister said, they are an integral part of a comprehensive system of community care. They will include a variety of circumstances: housing with various degrees of independence, such as those covered in the Bill; group homes, also partly covered by the Bill; residential and nursing homes; and, in some parts of the country, village communities and elderly persons' foster schemes in individual homes such as those for young people.
The circumstances of people needing care away from home will vary from full-time nursing care to the minimalist provision involved in the care covered in the Bill. Making sure that the variety of human needs and 967 networks is covered requires a great deal of flexibility in housing and social policy—far more than has hitherto been shown by the Government.
The Labour party sees merit in a variety of organisational arrangements for care away from home. That variety not only assists in creating real choice and in meeting people's needs, which change in time, but avoids the trap of the monopoly provision of care. This is where I strike a note of discord with the Government, who sometimes appear to be actively working towards monopoly provision by the private sector while the Labour party is opposed to monopoly provision by any one sector. The public sector, the voluntary sector and the private sector all have a role to play and a contribution to make, either independently or in partnership on projects and packages. However, the choice should not be a maze for the consumer.
More attention must be given to information and guides to services in an easily accessible and understandable form. Information must be better than that offered by one London borough, which must remain nameless, which earlier this year advised a friend of mine desperately seeking information about respite care to "look in the Yellow Pages." Hearing that in 1992 from a social services authority shows clearly that a great deal of the modern thinking in the House has completely passed that authority by. However, there are also good model local authorities of all political persuasions which have gone out of their way to provide easily accessible guides and information on all services in their area and which are taking on board their enabling role.
Labour insists that all sectors providing care away from home are treated equally for quality assessment purposes because that is the ballpoint for the user. We are not prepared to allow any distinctions to be made with regard to quality measures and the rights to be enjoyed by residents, staff or carers based on the ownership, size or location of an establishment. It naturally follows that we shall not seek to play off one sector against another or to single out a whole sector for praise or blame on the basis of a few good or bad examples. That would send a wrong signal to the providers and, what is more, to the families of the people in care away from home. That is the problem which causes difficulty. It would also send the wrong signal to the staff employed in the establishments.
The consumers or users of the service must come first, whether or not they are the budget holders, and, by and large, the local authority will be the budget holder for most people. That is not a cliché or a new found policy. I was once taken to task for quoting Labour party policy which I was told was very old, but I said that it was still current. We said that we werecommitted to tip the scales back in favour of the individual and away from public and private concentrations of power.That suits community care policy and, indeed, any other aspect of policy. It has been our policy since 1976. I carry that cutting around constantly in my wallet and I am accused of abusing it in relation to different aspects of policy, but we meant what we said. It is time, in every aspect of policy, to tip the scales back in favour of the individual and away from concentrations of power, whether public or private, but it is especially important that that point is taken on board in community care policy.
968 I do not want to introduce a note of discord, but I did not have the opportunity to raise certain points during the general election campaign. One point of particular importance, bearing in mind the contents of the Bill, is that the requirement for care-away-from-home establishments will mushroom in the next decade. We have been through the very elderly persons explosion. We must enable people to remain in their own homes if that is their choice. We must not force them to stay in their homes, but if they choose to do so we must move heaven and earth and do all that is humanly possible to facilitate that. However, even with that as a policy objective and with the best will in the world, with imagination, initiative and enterprise, there will be increased demand for care-away-from-home establishments because, for example, of that great scourge of the late 20th century—loneliness.
Sometimes people want to leave their own homes after the loss of a partner or loved one. There may be no obvious medical or physical reason for them to leave, but they will have lost the companionship and perhaps cannot exist on their own. That has happened many thousands of times, and the problem will not go away, so there will be increased need for care-away-from-home establishments provided on a multi-sector basis.
We believe that the ownership of such establishments should be made absolutely clear in all brochures, explanatory details and contracts offered to local authorities or individuals. We also believe that if any employees, including general practitioners and consultants in the NHS or the local authority, have any financial interest in any care-away-from-home establishment in their employing authority or in any adjacent area, it should be transparent in a public register of interests. Attention should also be drawn to the register in material issued by the homes involved.
We do not say that such interests should not exist. If we are to have a comprehensive community care system with scope for choice and with a variety of multi-sector provision, we must encourage people to make the best use of their talent, expertise and training. We are not opposed to care professionals having such interests, provided that the interests are registered and transparent. Quality care demands nothing less from professional people, and such a move would be of help right through the system. The Government must deal with that issue, but it will not be made possible except by way of amendments which I have not yet fully considered.
We must return to the issue because it requires primary legislation. I hope that the Minister will take the point on board in the spirit in which it is made—not in any attacking, denigrating way, but as a means of avoiding problems in the future. If the policy is to be a success and meet the needs of our fellow citizens as users, we can do no less than examine that aspect of policy.
§ Mr. Peter Griffiths (Portsmouth, North)
I thank my hon. Friend the Under-Secretary of State for Health for his helpful response to my intervention. He satisfied my prime concern, which was that we were not looking simply at the range of accommodation that will be available for placements by local authorities but were attempting to ensure that accommodation of sufficient quality will be available so that placements can be the correct ones.
969 I found myself in almost full agreement with the hon. Member for Birmingham, Perry Barr (Mr. Rooker), who drew attention to the second point that I would like to make. Because we are discussing not long-term placements in nursing homes or registered care homes but people who may have relatively short-term problems, or problems—such as mental disabilities—which may eventually allow them to return to the community, it is essential that we note that the title of the Bill places community care before residential accommodation. The need for the accommodation arises out of a requirement for care. It is not somewhere to put people out of the way so that they can be conveniently forgotten. Rather they are placed there because that is the most suitable place in which the community can show its commitment to care for them. If in future they have the opportunity to return to some other form of accommodation—their own home, perhaps, or some other form of residential accommodation such as warden-assisted flats—that would be encouraged.
I was pleased that the Minister gave us an assurance that there would be accommodation of the quality required. That is a measure of the success of such accommodation. I have recently dealt with the case of a lady who, after undergoing heroic surgery for cancer, was placed first in a nursing home and then—after a remarkable recovery, considering the fact that she was elderly—she was able to move gradually back into other accommodation, so that she is now virtually independent, in a flat of her own. Surely that is the measure of the community care which everyone in the House would like to see.
I question what the hon. Member for Perry Barr said about differential charges. I was not sure whether, in suggesting that people who can pay are being made to pay more, he was criticising the proprietors of residential accommodation for having a range of charges within their establishments. If so, it was not a very fair criticism. After all, most homes offer a range of quality of accommodation—single rooms, or larger rooms, for example, for those who would prefer them.
§ Mr. Rooker
I made the point exactly as I intended to. In many areas, especially in nursing homes, a different charge is made for exactly the same level of service, depending on whether people are self-funded—that is, not in receipt of income support. That is immoral because it is a cross-subsidy from one resident to another, to make up a shortfall. The homes could not cope without it. If they did not have a mix including self-funded people, whom they charge more than they charge people on income support, they would close. That is the fault of the Government's refusal to organise their social security policy properly.
§ Mr. Griffiths
I thank the hon. Gentleman for that explanation. He may recall that in the previous Parliament I joined him and many of his hon. Friends in the Division Lobbies on that issue, so there is no great disagreement between us there—except that I still wish to defend owners and organisers who allow people whom they took on when they had private funds to stay in their highly expensive accommodation long after those funds have run out and they can obtain only the amount payable in income support. Credit should be given to such owners, who do not seek to remove people when their private funds have run out—but now I am sure that you, Mr. Deputy 970 Speaker, will draw my attention to the fact that we are not discussing registered accommodation or nursing homes this afternoon.
I believe that I shall have the support of Members on both sides of the House when I say that it is important that community care should contain the widest possible range and variety so as to be able to meet the needs of individuals. Social services departments should continue to be involved, as should other local authority bodies and agencies, after accommodation has been found. There should be a continuing commitment to the personal care and development of individuals. However slow that may be—in the case, for example, of people with serious handicaps—there should still be a continuing commitment to the development of the individual, not just to his or her placement.
The Bill, modest though it is, gives local authorities a wider choice, and I believe that they will seize the opportunity to ensure that they provide carefully selected and progressive accommodation to suit the requirements of each individual who turns to them for assistance.
§ Mr. David Hinchliffe (Wakefield)
I make it clear at the outset that I have no wish to obstruct the progress of the Bill. I certainly support its aims, and I am aware of the excellent work undertaken by some of the establishments whose functioning it will affect. There is an Abbeyfield Society establishment in my constituency, and the model that Abbeyfield offers should be actively encouraged. My comments will make it apparent that I wish us to have a detailed debate on the measure, as opposed to allowing it to go through on the nod, as yesterday's business statement led me to assume was the original intention. I was worried to see that the Bill was expected to go through all its stages today, and I welcome the fact that the Government have conceded the Standing Committee stage. That Committee stage may well be brief—there is no need to obstruct the Bill's progress—but I feel that there are issues which we should debate.
The Bill gives us the opportunity to discuss the current community care situation in the run-up to April next year, and the chance to pick up a range of issues which were missed when the National Health Service and Community Care Act 1990 was passed. I hope that the Government will listen to some of the suggestions made today, and perhaps add provisions to the Bill before the Committee stage.
I listened carefully to the Under-Secretary of State's opening speech—and, personally, I wish him well in his new role. I know that his background is relevant to the work that he is now undertaking. But I was worried because what he said made it appear that he and the Government were oblivious to what many people believe is a crisis in community care in the run-up to 1 April next year—a crisis that will not be resolved by the changes which it is proposed will take place on that date.
The Government's strategy on community care has been clear for many years: leave it to the market. Now we are picking up the pieces. The market has organised what is in the interests of the market rather than those of the care consumer. There is now a huge explosion in one form of care—private institutional care—way above and beyond any reasonable estimate of the demand caused by the increasing number of elderly and very elderly people.
971 What concerns me is that, when the Government refer to "community care", they actually mean private institutional care. That is the central theme of their belief in community care. I do not believe that institutional care is community care. Community care is care in the community and not care away from the community. The Opposition have restated that point because it is a fundamental difference between the Government and the Opposition.
Let us consider what has happened in relation to funding the private institutional care sector since 1981. I find it interesting that the Government boast about the amount they have put into private institutional care through the income support system. In 1981, the amount invested in private care through supplementary benefit was about £10 million a year. In the past financial year, the amount invested was about £2 billion—a huge amount —which was paid through income support to people in private institutional care. The total figure invested by the Government through income support to people in private institutional care since 1981 comes to about £9 billion. Rather than boasting about that figure or being proud of it, the Government should be ashamed that so much money is being invested in institutionalising people in this day and age.
To make matters worse, alongside the investment of £9 billion through income support, one must consider the pattern of funding through the revenue support grant system to local authority social services. Figures available from the Library show that about £6 billion of RSG funding to local authority social services has been removed by reductions in RSG during the same period. The Government are clearly determined to move money away from preventive domiciliary services into institutional care. That is a nonsensical strategy which should be reversed as a matter of urgency. The Government have pulled the rug out from under the local authorities' ability to fund domiciliary care such as home helps, meals-on-wheels, respite care, day care and a range of other services which are geared to enabling people and their carers to remain in the community. That strategy should be exposed, and I urge the Minister to look afresh at the way in which the Government are acting.
We are debating an issue which is not only political but which involves basic human rights issues of how we treat elderly and disabled people. It is a basic human right to allow people to remain in independent or semi-independent living in the community if they and their carers so wish. The Government are determined to remove that right from people and they should be ashamed of their record in that respect. Compared with similar countries in Europe and elsewhere, in Britain far more elderly and disabled people are institutionalised than should be the case. We should consider that position very seriously and none of us should be proud of it.
As other hon. Members have said, we should consider afresh the issue of the financial difficulties facing vast numbers of elderly disabled people who cannot afford to pay for the private institutional care they receive at present —an issue that affects every hon. Member who has constituents in private care homes. It is scandalous that there are people in every constituency who have to use their personal allowances to pay for their care. Some 972 elderly people do not have a spare penny to spend on a hair-do, on new underwear or even on a bag of sweets. That is profoundly unacceptable in this day and age and the Government should be ashamed of it.
We are told that April 1993 will change everything—if April 1993 ever happens. As my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) said, there are strong rumours that April 1993 may not arrive and that there may be a second deferral of the implementation of the National Health Service and Community Care Act 1990. I should be grateful for further clarification from the Minister. I served in Committee on the National Health Service and Community Care Bill and I believe that April 1993 will be a false dawn. It is being held up as something that will suddenly cure all the ills in community care, but I do not believe that that will happen.
Assessment, care management and community care plans are all excellent and desirable provisions which were supported by the Opposition. However, assessment is nonsense when social workers cannot assess for alternatives to institutional care. With the huge explosion in private market care, the Government have established a bias towards institutional care. To ensure that we have an even playing field and a choice of services, we desperately need a massive redirection of funding away from the private institutional sector into alternatives to institutional care, whether public, private, voluntary or other, to enable people when they are assessed to have a genuine choice to remain independent and to stay out of care. Assessment may not have the impact that many people, including people in my own party, assume that it will have after April 1993.
There are huge gaps in the Bill and in the 1990 Act in relation to the rights of people in a care setting, whether private nursing homes, residential care homes, local authority homes or whatever. It is important for the Government, following important reports such as the Wagner report, the "Home Life" recommendations and reports from organisations such as Counsel and Care, which suggest that things are not well in relation to the rights of residents in many care homes, both in the private and public sectors, to address the issues, whether in the Bill or in separate legislation. The Government should bring into statute clear requirements protecting the rights of people in care.
We shall now have the opportunity to consider some of those requirements in Committee, but there are issues which we should consider as a matter of urgency and which could be addressed in the Bill. One issue is the right to rehabilitation. When we debated the 1990 Act in Committee—several of my hon. Friends served on that Committee—we discussed the assessment process which will come into operation after April 1993. However, once a person is placed in institutional care, there are no review procedures. Anyone who has worked with elderly people or who knows of cases of elderly people knows that a person's circumstances can change in a week, in a month or in six months, and that they may be completely different from when that person was initially assessed. It is essential that we introduce some form of reassessment and review for people who are in care homes to give them the opportunity of rehabilitation and actively to encourage rehabilitation.
People in the private sector are now worried that some of the homes may not be full and that they may not be able to run at a profit. What incentive is there for private care 973 home owners to rehabilitate a resident and to work to get that resident back in the community if by doing so they put themselves into financial difficulties which may affect the viability of the homes? The Government's system works completely against rehabilitation and returning people to the community. People must address that point regardless of their politics. It is a human rights issue which we have overlooked and which needs to be addressed as a matter of urgency.
Another issue which ties in is the way in which the existing system actively encourages dependence in care—indeed, it actively rewards dependence. The Department's system of monitoring people who move from receiving income support payments for care to income support payments for nursing home care—a significantly increased amount which the Government have introduced—involves no monitoring of whether people need that additional form of care or whether they are receiving it. There is no system of checking whether that care is needed or is being given. That is a scandalous misuse of public resources.
I can give the Minister examples of individual cases. People have been shunted into nursing care when they do not need it. The system encourages dependence, and we must urgently address that problem.
Other matters that we need to consider include the right to privacy. The Counsel and Care report last year pointed out that people cannot go to the toilet in private, cannot bathe in private, and cannot have their own bedrooms. I have been to a home in which elderly ladies were bathed alongside each other. The system was two baths side by side, with a lady sitting in each bath, and two members of staff between them. The argument was that that was a quicker way of dealing with all those who had to be bathed. Anyway, they said, it did not matter because those old people were confused, so they were not embarrassed by being bathed in front of each other. That is unacceptable. In case anyone thinks that I am anti-private sector, that happened in a local authority home. I accept that it was a few years ago, but it happened, certainly within the past five years.
Before I was elected to this place, I went to a private care home in my constituency. Seven people were crammed into one bedroom. In this day and age that is completely unacceptable. The issues of privacy and rights within care must be addressed by the Government. We must consider security of tenure and also people's rights. There are few rights for people who are asked to pay because they cannot afford their fees. There is no system to ensure that they are properly looked after. Vulnerable elderly people worry about being out on the streets. I accept that there are care home owners—I know of some in west Yorkshire—who are subsidising people through their own charity and good will. However, we know of people in west Yorkshire who have been evicted and of people who have moved downmarket. That is unacceptable when people in their 80s and 90s are vulnerable, unhappy and unaware of what is happening.
The Government must put into statute some of the requirements in their "Home Life" document. It is nonsense to have recommendations in "Home Life" and not back them by statutory provision. It weakens the position of the inspectorate which is to monitor and register homes when there is no backbone to the desirable points in "Home Life".
I hope that those issues will be addressed by amendments to the Bill. Opposition Members have no 974 desire to block the Bill, but it is important to debate some of the human rights issues that are affected by such legislation. The Government should be ashamed of their record on community care. What we have seen over the past decade or more in the care of elderly people is wrong. It is about time we had a change of course. The Minister starts his job with a clean sheet. I hope that he will look at the matter afresh. The Bill provides the opportunity significantly to solve some of the problems to which I have referred and to which, no doubt, my hon. Friends will refer.
§ Mr. Roger Sims (Chislehurst)
I always enjoy listening to the hon. Member for Wakefield (Mr. Hinchliffe), who speaks with vigour, enthusiasm and, of course, a knowledge born of his experience. His speech seemed to be a rather strong advocacy of the Government's legislation. He urged them to do exactly what the legislation is intended to do. He complained that too many people are in institutions and could be better looked after in their own homes. That is precisely the object of the National Health Service and Community Care Act 1990. He said that, in the past, we have not given sufficient help to carers. Again, that is very much the philosophy of the Act, the White Paper, and the way in which local authorities are endeavouring to implement the legislation. The hon. Gentleman pleaded for a redirection of resources. That is precisely what the legislation is all about, and it is exactly what we hope will happen.
I enjoyed the speech of the hon. Member for Birmingham, Perry Barr (Mr. Rooker), who complained that community care did not feature much in the election campaign. However, in his anecdote he demonstrated the reason for that. As has been and will be evident in the debate, this is not a matter of party political controversy. Even differences in the ways in which we reach the ends are a good deal fewer than they were a couple of years ago when we discussed such matters in Committee.
Like the hon. Gentleman, I have an Abbeyfield home in my constituency. If Abbeyfield had been left out of the legislation, we would have been astonished and would have endeavoured to put the matter right straight away. One accepts that, expert though parliamentary draftsmen are, errors and omissions sometimes occur, and steps must be taken to put matters right. That is exactly what the Bill is intended to do. I hope that it will have a rapid passage through the House.
Hon. Members tend to spend many hours in the mornings, afternoons and sometimes nights considering Bills in Committee until, finally, on Third Reading we consider that our job is done, as indeed may be the case. But that is when the work starts. Hon. Members who have followed the implementation of the Children Act 1989, for example, and now the community care part of the 1990 Act realise how much work has been going on within Government Departments and locally in implementing that Act.
There has been a steady stream of guidance from the Department to local authorities on a range of matters within the Act and on how it should be implemented. Local authorities have been doing much work in compiling their care plans, all of which were submitted to the Department by 1 April and are now being examined.
975 Authorities have been spurred on to increase their range of services. Of course, the philosophy behind the Act is that a range of services should be available and that it should be the responsibility of local authorities to ensure that they are provided, to make assessments and to make care packages. Whether care packages are available within local authority services, within the voluntary sector or within a mixture of sectors will depend on each case and on the local facilities available.
As the hon. Member for Perry Barr said, there has been a lack of guidance on finance. There has been virtually no guidance on the financing of community care. Hon. Members will recall that assurances on resources were requested time and again when the 1990 Act was being considered. The then Minister assured us time and again that resources would be available to ensure that the Act was fully implemented. That Minister is now the Secretary of State, and we can be sure that those promises will be fulfilled.
In attending local conferences on the implementation of community care, I have been struck by the enthusiasm to get on with the job and with the widespread concern about whether resources will be available, and in particular about what they will be. That depends not only on the Department of Health but on the Treasury and the DSS. It is important that, as soon as possible, we have clarification of the mechanics of shifting what, until now, has been the income support element under the DSS and how it will be made available to local authorities. In future, if, after assessment, an elderly or handicapped person—it may even be a child—is to go into a residential home, the cost is to be met by the local authority from funds that previously would have come from the Department of Social Security as part of income support. What is that figure to be? On what basis is it to be formulated? Surely discussions have been going on for a couple of years on that. It must be possible to give local authorities an idea what the figure will be.
Of course, one accepts that the normal local authority grant is still under discussion. Under the curious system that we have in Britain, it will be autumn before local authorities know the figure for the year starting next April. One wonders how businesses could operate on the same basis, but that is the way in which Governments operate. However, it should be possible to say now what will be the tranche which up to now was income support. It should further be clarified how the tranche will be applied.
For example, if a person is assessed as most suitably accommodated in an Abbeyfield home, will that cost be met in full by the local authority or will the local authority have only sufficient funds to pay what was up to now the income support level? As we know, that was often not sufficient to meet the full cost. Who will fill the gap?
If local authorities are obliged to make assessments, it is rather important that they have the resources to provide the services that they have decided are required. While I realise that my hon. Friend the Minister is unlikely to be able to give us a detailed reply in this Second Reading debate, there will be a useful opportunity in Committee to discuss how the important National Health Service and Community Care Act 1990 is being implemented.
Can my hon. Friend give us more information on resources and funding? What will be available and how 976 will it be applied? That information would be of enormous value to local authority officers who, with the assistance of many people in the private and voluntary sectors, are hard at work preparing for next April. They need assurances that they will have the means to carry out what Parliament has instructed them to do.
§ Ms. Liz Lynne (Rochdale)
I welcome this non-controversial Bill. It gives me an opportunity to ask some questions and raise several issues. The House is probably aware, as I am sure you are aware, Mr. Deputy Speaker, that at present income support levels often do not meet the cost of either residential or nursing homes. Elderly people often have to make up the shortfall or, if they are fortunate enough to have a relative around, a relative has to make up the shortfall. As has already been said, if there are no relatives, problems can arise.
What exactly does the Minister have in mind on funding? When local authorities take over the responsibility for paying for homes and residential accommodation, will the Minister give the same money as the income support level? Or is he thinking of paying the actual cost of the home? It is essential for us to know that. If local authorities do not receive the actual cost, many will say that they cannot provide as many places as perhaps they should.
People with learning difficulties are a good example. At present, such people are assessed and a statement is made. That statement is often made taking into account what facilities are available to the local authority. I am desperately afraid that the same thing could happen with this Bill and that local authorities will assess only on the strength of what they have available in residential accommodation. This is an important point to remember.
Another matter of concern is inspection. What does the Minister have in mind? Does he intend perhaps to set up an independent inspection unit? I should like far more inspections to take place in residential and, indeed, nursing homes. More inspections should be carried out unannounced. I know that that already happens to a certain extent, but I should like to see many more such inspections to ensure that standards are maintained in homes.
I am aware that the matter is not covered specifically by the Bill, but what are the Minister's views on the use of the Buxton chair, which I understand is still used in certain residential and nursing homes? It is sometimes referred to as the "naughty chair".
§ Mr. Deputy Speaker (Mr. Michael Morris)
Order. The Bill is fairly tightly drawn. I have been pretty generous in allowing a wide debate, but we cannot go way beyond the scope of the Bill.
§ Ms. Lynne
Thank you, Mr. Deputy Speaker. I move on to my last point about the funds that will be made available. I should like far more funds to be made available for community care generally. Come April 1993, when the National Health Service and Community Care Act 1990 must be implemented, local authorities throughout the country will have horrendous problems unless they have more funds and those funds are ring-fenced.
I make a plea to the Government again today seriously to consider ring-fencing the funds for community care, and specifically for residential homes. If the Government do 977 not ring-fence the funds or find some way of insisting that local authorities spend on those homes, the money allocated for residential homes they will hive off the money for pet projects. I should like some assurances on that.
§ Mr. Tom Clarke (Monklands, West)
I join my hon. Friends in congratulating the Minister on his appointment. With his former association with the Spastics Society, a great deal is expected of him. I am sure that he knows that. I also congratulate your good self, Mr. Deputy Speaker, on your appointment. It is a clear indication that being a rebel is no bar to respectability afterwards.
I find the Bill a little confusing in several respects. I am delighted that we are having this debate and that time will be found for reasonable discussion in Committee so that we can clarify some of the difficulties which emerge. My first difficulty with the Bill is why it does not apply to Scotland or, as the hon. Member for Antrim, East (Mr. Beggs) reminded me, Northern Ireland. Perhaps we can be told what the problem is.
In the explanatory memorandum there is a reference to a lacuna, which is presumably the reason for the Bill. I do not know whether there is a Scots word for "lacuna". Perhaps my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) can help me with that. I think that it means that there is a gap. I do not know whether there is a similar gap or lacuna in Scotland, but if there is, can we do something about it? If there is not, may we hear about it?
My hon. Friends, including my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker), rightly addressed the Bill in the context of our worries about community care in the 1990s. It is reasonable that we should have such a discussion at an early stage in this Parliament. We have heard some interesting speeches and I am sure that there will be other equally interesting speeches later. The Chamber is not so packed as it might be if this were a debate on Maastricht, but I humbly suggest that Members of Parliament will receive far more representations at their surgeries in the next four or five years about what is happening to community care for the elderly in our society than even about the important issue of Maastricht. The matter should therefore be viewed in that context.
Some of us received a document from the Royal College of Nursing this week entitled, "A Scandal Waiting to Happen". It tackles the problems of elderly people in nursing care in residential and nursing homes which are dealt with in the Bill. It makes a number of important points which are central to our approach to such matters —for example, the provision of proper funding after assessments take place. The booklet reflects a view which has been expressed in the debate when it says:Like many other organisations, the Royal College of Nursing has expressed concern that the money being allocated to local authorities to carry out their duties under the NHS and Community Care Act should be ringfenced.I am glad to see the hon. Member for Macclesfield (Mr. Winterton) in his place because the Select Committee which he chaired with some distinction, and the former Select Committee which dealt with such matters when there was a single joint Department, understood that there was a strong case for ring-fencing, as did so many other reports. The Griffiths report dealt with the matter and 978 complained that legislation in a difficult area, involving the elderly and their carers, is being passed in dribs and drabs —I fear that the Bill tends to suggest that the Griffiths report was right about that, if it was not necessarily right about everything else. The Bill represents dribs and drabs.
We spent a great deal of time in Committee dealing with the National Health Service and Community Care Act 1990. We have been told that the community care provisions will be introduced in 1993. However, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, there have been strong rumours from the Department of Health that that is not now the Government's intention and that they are under strong pressure to postpone their commitment. I hope that it may be within the rules of the debate for the Minister to deal with that—if he will listen to what I am saying. I am not sure what the Foreign Office has to do with these matters, but he might be better advised listening to hon. Members than to the Parliamentary Under-Secretary of State for Foreign and Commonwealth Affairs, who is sitting beside him. Will the Minister tell us whether the commitment to the community care sections of the 1990 Act is still as firm as the Government have suggested?
In common with my hon. Friends, I am greatly worried about our approach to this issue if the Royal College of Nursing takes the view that there is a scandal waiting to happen. When dealing with the enormous problems faced by elderly people, if we leave so much to market forces, without even providing for adequate inspection of public and private sector homes—although I accept that there should be no distinction between them—we do not seem to be making much progress.
Although we welcome the main thrust of the Bill's proposals, I am worried that yet again local authorities are being viewed as enablers rather than providers. In the absence of ring-fencing, enormous financial requirements are being made of local authorities, but it is not clear whether funding will be made available.
The Bill, and questions about it, are especially relevant at a time when we are considering the transfer of funding. Local authorities face great problems. The hon. Member for Chislehurst (Mr. Sims) mentioned their obligations under the Children Act 1989, and it is right that we should deal with the problems of children in need, but local authority budgets will have to cope with such important matters. I served on the Standing Committee on the Children Act, as did many hon. Members. We understood that such progress was being made. When we eventually hand all that legislation over to the local authority social services departments and the Scottish social work departments, they will have to decide their priorities. I do not think that they will welcome the job, given present financial constraints.
An additional problem in the 1990 Act, which the Government seek to amend by the Bill, is the transfer of funding from the Department of Social Security. The problem facing local authorities is clear. They will have to deal with the social security expenditure shortfall—with the fees deficit—and that will be made more difficult when the Bill is enacted. We are told that the present shortfall means £30 per week for a person in a care home and £50 per person for those in nursing homes.
If the Bill is enacted, a further responsibility will be passed to the local authorities, at the same time as the Government transfer an inbuilt deficit of £132 million to them. It is therefore reasonable for the Government to 979 explain their view of the priorities. What guidelines have they offered to local authorities? How do they view the central issue of assessment, for example, to which my hon. Friend the Member for Wakefield (Mr. Hinchliffe) referred?
It is not enough merely to produce a Bill of this sort, or even to say that the Government are going ahead with the 1990 Act, without considering the global problems of community care and without telling us whether they agree with the main thrust of the Griffiths report, which said that there should be genuine care within the community.
If we simply pile elderly people into institutions—to use a somewhat crude expression—that does not mean that we are providing care in the community. Happily, there is a growing number of elderly people. Surely we should demand that those men and women, who have brought up families and worked in their communities, are assessed properly to make certain that they are able to remain in the community. We should ask ourselves whether many of those people would be happier remaining in their communities, with the provision of more home helps and occupational therapists, and improvements in the meals on wheels and chiropody services.
With the emphasis being placed on providing residential care, mainly in the private sector, and on reducing resources for local authorities—including education, which ought not to be beyond the reach of the elderly, who are a part of our community and should be seen as such—I worry that we are not producing a real strategy for care in the community. We are pursuing the accountancy of the problems faced by the Treasury. A real strategy would mean that more elderly people would find independence but would be genuinely supported, when there is a need for such support, within the community.
I hope that we shall also be able to tackle the problem of advocacy in Committee. If we are dealing with proper assessments, with the role of carers, and trying to enrich the lives of the elderly, and especially the institutionalised, advocacy becomes profoundly important.
I was delighted that a group was established in Scotland this week to deal with dementia. Clearly, those people have rights. In the absence of advocacy, nobody in private or even public homes will be able to say they do not like a particular room, that they are unhappy because of social security problems, the food and clothing available, or that they have problems with incontinence. The elderly may feel that such important matters are not being dealt with.
Sadly, we all know from our constituency visits that, in some cases, the problem of incontinence is not being addressed. In the absence of advocacy, which I hope will be included in the Bill, I hope that elderly people will be assured that, at least, we are concerned about their lifestyle, health and welfare and that that is not inconsistent with the strategy for community care.
§ Mr. Nicholas Winterton (Macclesfield)
On the sad and sensitive matter of incontinence, is the hon. Gentleman, who has served as a distinguished member of the Select Committee on Health, concerned about the anomalies in the free provision of incontinence pads? I say without reservation that the hon. Member for Birmingham, Perry Barr (Mr. Rooker), who opened the debate for the Opposition, has done some wonderful work on that issue. It is crazy that elderly people in hospitals and in county 980 council part III statutory accommodation are in receipt of incontinence pads, but those in private nursing and residential homes have to pay for them separately. Is that not an issue to which the Government should give urgent attention?
§ Mr. Clarke
Apart from the importance of the issue which, as the hon. Member for Macclesfield rightly pointed out, my hon. Friend the Member for Perry Barr has promoted—[Interruption.]
§ Mr. Deputy Speaker
Order. If the hon. Member for Bradford, South (Mr. Cryer) wishes to speak, he can seek to intervene, but I prefer not to hear too many sedentary comments because they detract from the speech of the hon. Member for Monklands, West (Mr. Clarke).
§ Mr. Clarke
Thank you, Mr. Deputy Speaker.
The hon. Member for Macclesfield has made a valid point which helps to underscore my concluding remarks —I know that other hon. Members wish to speak. Advocacy—in the private sector especially, but I do not exclude it from the public sector—is important for elderly people.
At the beginning of my speech, I stressed that the vital issue of community care, including the problems of the elderly, are ones that we shall debate often in the course of the Parliament. It is right that we should do that. I regret to say that one reason for that is that, in the previous Parliament, we did not give the matter the priority that it deserved. We are all reminded by our elderly constituents that they are part of society and that their needs—and, above all, their rights—are matters that we should consider.
This small Bill follows on from the Government's major National Health Service and Community Care Act 1990. We have not seen much evidence to support the belief that the Government have broken away from the ideology of 1990. I do not see that those on the Government Front Bench are as committed to a mixed economy system in care as is my hon. Friend the Member for Perry Barr, with whom I agree. I hope that as our discussions develop the Government will accept that in the provision of community care we should have a commitment to a genuine provision of services to the elderly. There should be representations and consultations about their needs in the public and private sectors. We should ensure that there will be proper inspections at every level so that elderly people enjoy the fulfilled and enriched lives that the people of this country would expect the House to deliver.
§ Mr. Peter Thurnham (Bolton, North-East)
I congratulate you, Mr. Deputy Speaker, on your appointment, but I apologise for unavoidably missing the early part of this debate. However, I very much appreciate the opportunity to join in the discussion. I also apologise for missing my hon. Friend the Minister's opening speech. I shall look forward to reading it and I congratulate him on his appointment. He brings to it his long experience of 981 working with disabled people, and he has always shown great sensitivity to their needs. I am confident that he will fulfil his duties well.
I am pleased that the Government have introduced the Bill, because maximum flexibility is essential and local authorities should use the services of the private sector. I listened with care to the speech of the hon. Member for Monklands, West (Mr. Clarke), but I was confused by one of his points. I noted that he said that the resources available to local authorities had been reduced. I am sure that, in the provision of community care, we have increased resources to local authorities. If we consider the future for local authorities, an increasing proportion of local authority resources will go into community care. Perhaps fewer resources will go into education if more schools opt out, but more will go into community care.
§ Mr. Hinchliffe
At the end of his speech, will the hon. Gentleman accompany me to the House of Commons Library? There I shall introduce him to a researcher who will show him detailed figures—the hon. Gentleman was not present when I spoke—that show that the Government's reduction in rate support grant since 1979 has taken £6 billion out of local authority social service expenditure. They are not my figures or those of the Labour party: they are the figures of the House of Commons Library, and I look forward to taking the hon. Gentleman along the Corridor.
§ Mr. Thurnham
I am sorry that I was not present to hear the hon. Gentleman's speech, but I shall read Hansard with care. The figures that I have seen show an increase in resources, and there is no doubt that, in future, the proportion of local authority resources going into community care will increase, even if the proportion of resources going into education is reduced.
§ Mr. Tom Clarke
The hon. Gentleman will find that I was arguing that local authorities are being asked to undertake more and more responsibilities, and the hon. Member for Chislehurst (Mr. Sims) made the same point about the Children Act 1989. Does the hon. Gentleman agree that, whatever the argument about figures, my hon. Friend the Member for Wakefield (Mr. Hinchliffe) produced some important ones? If the case for ring-fencing is established, we will at least know how much funding is being made available.
§ Mr. Thurnham
I do not follow that argument, to which the hon. Member for Rochdale (Ms. Lynne) also referred. I do not believe that local authorities will divert resources from community care. The pressures and demands are for more resources in community care, so I do not believe that local authorities will divert such resources elsewhere.
I do not think that resources need to be ring-fenced because we cannot trust local authorities to spend their money where the needs are greatest. Local authorities are in the best position to make such judgments and, if anything, they will spend more than they possibly would if the expenditure was ring fenced. I do not follow the hon. Gentleman's argument: we need maximum flexibility.
I have seen an enormous community care plan produced by my authority in Bolton, and other Members will have seen similar plans produced by their authorities. Of course, it is the responsibility of local authorities to 982 produce such plans and to have them approved in order to start implementing the new services for which they will be responsible in 12 months' time.
Tomorrow I shall visit a centre which has been created for the provision of respite care and residential care, in a former children's home in my constituency at Moss Nook. I am delighted that it has been set up and is being arranged by a new charitable organisation that has been set up by the Bolton handicap action group. The work has been done in partnership with the health authority—in future I hope that the local authority will also be involved. Such partnership is the best way to provide services with the maximum flexibility.
The hon. Member for Monklands, West said that councils should act as enablers rather than as providers. I am glad that that message has got through, as it is the best way to provide community care services in the future. Some counties, such as Kent, have set a good example in providing services in the most efficient way by remembering that they are first and foremost enablers and not providers.
I look forward to the passage of the Bill. There should be the maximum flexibility. Local authorities should be trusted to use their discretion and there seems no need to ring-fence their funds, because they are in the best position to assess needs and decide how best to use their resources. I hope that local authorities will not try to make a political football out of all this, because the needs are real, the resources can be found and they must he used wisely. Those resources should not be distorted or manipulated to make political capital out of the needs of the people for whom they are intended.
§ Mr. Kevin Hughes (Doncaster, North)
It is desirable for everybody that local authorities are able to offer the widest possible choice to people seeking residential care. I welcome the Bill because, when enacted, it will provide a wider spread of provision available to local authority social service directorates.
It is unfortunate that there should have been such a long delay in implementing the community care legislation. It seemed to have fallen victim to the Government's poll tax folly. In other words, caring for people was sacrificed in an effort to prop up the doomed poll tax that continued the previous Government's policy of making the rich better off at the expense of the poor. Thatcherism will go down in history as a Robin Hood in reverse—robbing the poor to give to the rich.
Many elderly people, including the confused, the physically and mentally handicapped, those with autism and people with drug and alcohol problems, are eagerly awaiting the implementation of the community care legislation in April. I hope that the rumours about possible further delay in implementation are not true. The people concerned, and the carers, must not be let down. Certainly they should not be made to wait any longer for this legislation.
To ensure that their expectations, which are many and varied, are met, we must provide good-quality services. Most local authorities have been working hard to that end. They already have in place their registration and inspection units and are endeavouring to develop policies 983 encompassing all the elements of good-quality care, offering a wide range of choice. That will be made better by the Bill.
Many local authorities, working with area health authorities and the voluntary and commercial sectors, are operating genuine partnerships with the aim of providing professional and good quality care; but if community care is to be of the highest quality, giving real choice to users and carers, it must be provided by a highly trained and motivated work force in the local authority voluntary and commercial sectors.
That can be done only with proper funding by the Government. Real choice and quality cannot be offered on the cheap or set against a backdrop of a budget that cannot be altered. If we are to offer real choice and quality, people must be given it genuinely and be told that there is no budget backdrop to that choice.
We are now less than 12 months from implementation, yet local authorities still do not know how they will be funded and how much they will get. People must be trained and many new procedures developed and in place well before that date. If local authorities and others are to be ready, they must know as soon as possible the detailed information about the social security transfer of funds.
Why is it that we and local authorities still do not know the conclusions of the deliberations of the so-called algebra group that was set up to try to sort out the transfer of funds? Like my hon. Friends, I urge the Secretary of State to ring-fence the extra funding to ensure that the money is used on community care and not lost in wider local authority budgets. I have no doubt that it would be put to good use if they were allowed to use it for other causes, but we must make sure that the money is targeted directly into social service budgets so that it is used to implement this legislation.
Local authorities want to know how the Government expect them to fund the work force who will be needed to implement the final stages of the community care legislation. They need up-to-date information on the number of people currently in, and those projected to enter, independent care. Most local authorities are keen to undertake their new responsibilities for community care and have made considerable effort to meet required objectives. This measure will help them in that respect.
Recent reports from the social services inspectorate, regional health authorities and the Audit Commission suggest that local authorities are well on target. The final word on all the issues to which I have referred, and therefore responsibility for the effective implementation of the proposals, lies with the Government. I hope that the Secretary of State will promise the British people that the Government will make adequate funds available to ensure that, when they need care, they will get it when they need it, rather than being put on a waiting list for assessment.
Will the Secretary of State also promise them real choice and give an assurance that local authorities will not have to rob Peter to pay Paul in order to fund that choice? Will she also promise that people will not have to wait any longer for a high-quality community care programme, whatever their needs and wherever they live in Britain.
§ Mr. Nicholas Winterton (Macclesfield)
I am glad of this opportunity to contribute to the debate and, like my hon. Friend the Member for Bolton, North-East (Mr. Thurnham), I apologise for being absent for the early part of it. The studio in which I was located for a time was linked to the Chamber, so I was able to hear a major part of the speeches of those who spoke earlier.
I am pleased to support the views expressed by the hon. Member for Monklands, West (Mr. Clarke). He highlighted many problems that those of us who have taken a great interest in community care anticipate and believe will occur on 1 April of next year. I view that date with deep concern. It is not only my concern: it has been expressed to me by senior officials and others concerned with and appointed to help authorities and those who work in local authority social service departments.
The hon. Member for Doncaster, North (Mr. Hughes) thought—I share his view—that social service departments were unaware of the resources that they would have to spend on community care as from 1 April of next year. That state of affairs does not enable social service departments, which will be the lead authorities in community care, to make adequate plans.
I need not remind the House that we are talking of groups of people, particularly the elderly, who are among the most vulnerable in society. I view with concern the decisions being taken by county council social service departments to shed their part III residential homes and dispose of them, in the main, to non-profit-making charitable organisations which take over the management and running of the homes.
I am delighted to see in his place my right hon. Friend the Leader of the House, because nobody knows more than he about social security income support and all matters relating to assistance and benefit available to the needy and elderly. He knows that grave problems face elderly people in the funding of their residential care. The more people there are who depend on the private sector, the more difficult it will become. That is a matter to which the Government, and particularly the Department of Health, will have to give careful consideration.
We look to my hon. Friend the Under-Secretary of State to do a great deal between now and 1 April next year. He has a fine reputation for dealing with vulnerable groups in our society. He was a distinguished officer of the Spastics Society and he served on the Select Committee for Health and its predecessor Committees, and we look to him to achieve a great deal in the introduction of community care in Britain.
The one thing that causes me some concern is the last paragraph of the explanatory memorandum. My hon. Friend the Member for Chislehurst (Mr. Sims) will criticise me if I do not point it out, and perhaps will criticise me if I do, because it says:The Bill should not result in any increase in public expenditure, or have any effect on public service manpower.It should. We must oil the wheels of community care to ensure that it works and that those who deserve the support of hon. Members, on whatever side they sit—the elderly and other vulnerable groups—should be totally confident that, in the implementation of what is a dramatic change in policy, community care, brought into effect and 985 implemented by the National Health Service and Community Care Act 1990, has the resources to make it work.
Hon. Members would not expect me to sit down without saying that I too, like many who have spoken, wish expenditure in the specialist areas to be ring-fenced. Roy Griffiths said in his report that the money should be ring-fenced. My right hon. Friend the Leader of the House is nodding and smiling at me, and I am delighted that he is. I know, because of his own concern, just how much he is anxious about this and how much he wishes to see the community care policy working.
§ Mr. Newton
I apologise to my hon. Friend the Under-Secretary of State for intervening in a matter relating to my old pastures rather than my current one. I was nodding and smiling only because, as I think my hon. Friend the Member for Macclesfield (Mr. Winterton) knows perfectly well, the purpose of the Bill is modest—to correct an error in the original Bill affecting the Abbeyfield Society. I have to admire his ingenuity in ranging over the whole area of community care in the course of the debate.
§ Mr. Winterton
I can only pay tribute to the discretion and good sense of the Chair in enabling me to highlight a number of deep concerns felt on both sides of the House, which is helpful—
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)
Order. I hope that the hon. Gentleman does not rely too much on my discretion.
§ Mr. Winterton
I am grateful, Mr. Deputy Speaker, for that sound piece of advice, which, naturally, as a member of the Chairmen's Panel, I shall heed immediately.
§ Mr. Cryer
The hon. Gentleman probably missed some of the debate while he was in the television studio, so I should tell him that the Minister initiated a debate on the whole of community care, not just the narrow terms of the Bill. That was entirely endorsed by the then Deputy Speaker. Unfortunately, the Leader of the House did not hear the opening speech, so his remarks are slightly out of order.
§ Mr. Winterton
It would be completely inappropriate for me to comment on what the hon. Gentleman says. I always take the advice of the Chair, and as long as I serve in this place I shall continue to do so.
I am linking my remarks to the explanatory memorandum which, I repeat, says:The Bill should not result in any increase in public expenditure, or have any effect on public service manpower.
§ Mr. Winterton
I shall give way in a moment to my hon. Friend, who was another distinguished member of the Select Committee on Health in the previous Parliament.
It may well be necessary in the course of the further stages of this legislation to tell the House that additional resources, both by way of public expenditure and in respect of public service manpower, may well be required 986 to plug what is described in the explanatory memorandum as a lacuna created by the National Health Service and Community Care Act 1990.
§ Mr. Rowe
My hon. Friend's ingenious use of the explanatory memorandum seems to link with an earlier remark when he said that it is particularly sad that local authorities should be getting rid of their part III accommodation. The implication was that, in the private or non-profit-making sector, one might look for rather less effectiveness than in the public sector. I hope that is not what he means. He would be greatly mistaken if that was what he meant. I hope that he will correct any misapprehension on my part.
§ Mr. Winterton
I am delighted to respond to my hon. Friend. I look to community care to provide a wide range of facilities. I see developing a situation in which in many areas there will be few what I describe as statutory part III residential homes. Almost exclusively, the social service departments, acting as facilitators, as purchasers of services, not necessarily as providers, will not have the scope of choice that I believe is necessary. That is a point that has already been made in speeches today.
I am entirely in favour of partnership. I am entirely in favour of the private sector being an important part of that partnership. I am also in favour of the non-profit-making charitable organisations being part of the overall provision that is available to social service departments to choose from in respect of accommodation and care for the elderly and other vulnerable groups within the community. But I am deeply concerned that choice, which the Government have said should be an important part of the new system, will be limited. When elderly people are assessed about the accommodation and care they require, the assessment might well be affected by the availability of facilities.
Whether or not my hon. Friends are prepared to say it. clearly we are loading a heavy additional responsibility on to local authorities. I remain to be convinced that sufficient resources will be transferred to local authorities, in the main from health authorities, to enable local authorities as the lead authority in community care to provide the level of service and the range of accommodation that is required if community care in Britain really is to work.
Again, I make a plea for ring fencing, which has been suggested by Labour Members and Liberal Democrats and is also supported by Conservative Members. I am aware of many authorities, such as my own in Macclesfield, where the health authority and social service departments have now put forward a blueprint of what they hope to achieve. But the fruition, the true implementation, of what is contained in the excellent and well-researched proposal booklet that has been issued in my area will entirely depend on the level of resources that is made available.
The Bill is relatively tight, but the hon. Member for Bradford, South (Mr. Cryer) said that my hon. Friend the Under-Secretary of State had introduced the Bill widely, embracing the whole scope of community care. I suspect that he did, although I heard only tiny snippets of his contribution. However, I know from the experience that he has had that he will have put a good case.
§ Mr. Gareth Wardell (Gower)
Does the hon. Gentleman agree that it is fundamentally important that, when the Bill is implemented on 1 April 1993, money is made available so that disabled housing grants can be in 987 place? It would be nonsense to have insufficient resources to provide the disabled with the aids they require in their homes—such as rails around the toilet and bath. In the Welsh context, a long waiting period for essential aids could make the Bill a nonsense.
§ Mr. Winterton
The hon. Gentleman makes an excellent point. His intervention, together with the excellent speech of the hon. Member for Monklands, West shows how effective this is as a Parliament of the United Kingdom. We do not need separate legislatures to highlight the particular problems of Wales, Scotland or—I say this to the hon. Member for Wakefield (Mr. Hinchliffe)—of the northern, north-western, or west midlands regions.
The hon. Member for Gower (Mr. Wardell) was right to highlight the need to provide resources to enable local authority social services departments to provide adaptations and modifications to homes so that the elderly and infirm can continue to live in the community.
The hon. Gentleman's question perhaps implied that, if that cannot be done, community care cannot effectively be implemented in the United Kingdom. I share his concern to some extent. Those of my right hon. and hon. Friends who are deeply committed to an effective community care system and programme are aware that there are resource problems. There are rumours that the Government may seek further to postpone the programme. I hope that they do not. Although we are not utterly ready for it, a postponement would affect the morale of those who are desperately seeking to be ready by 1 April 1993 to an extent that would be counter-productive.
You, Mr. Deputy Speaker, have been generous in allowing my speech to range wider than it ought to have done, but I followed my hon. Friend on the Government Front Bench in that— and I know that others of its members wish that I would do that rather more often. I promise them that I shall seek to do so, bearing in mind my own reputation and independence of mind. I say to my hon. Friend the Under-Secretary that my comments come not just from the heart but from the head. He knows that the Select Committee on Social Services made a long, deep and detailed study of community care. We produced some excellent reports, with fine conclusions and recommendations—many of which received a positive response from the Department of Health.
I ask my hon. Friend the Minister to give an assurance that the Bill will remove a lacuna created by the National Health Service and Community Care Act 1990, and that —despite the final sentence of the explanatory memorandum—the Government will give serious consideration to the provision of additonal resources, if they are needed before the legislation's implementation on 1 April 1993.
I am sure that my hon. Friend the Minister is aware that we are dealing with very vulnerable groups that cannot themselves promote a good case on their own behalf. They look to the House or to Parliament as a whole to ensure that their interests are safeguarded in the dramatic change of policy that is encapsulated in the 1990 Act.
§ Ms. Tessa Jowell (Dulwich)
I join other hon. Members in congratulating you, Mr. Deputy Speaker, on your appointment. and in welcoming this legislation, which is little more than a technical tidying up to give local 988 authorities the power to place people in and pay for facilities that are not registered under the Registered Homes Act 1984.
Community care is at a watershed, and stability is of the essence. Certainty in the nature and range of provision is the only way in which the confidence of those who rely on that provision and their carers will be sustained. Concerns are emerging about the way in which the broader community care policy is being implemented.
There is a danger that the legislation's excellent intentions and all the fine rhetoric from hon. and right hon. Members in all parts of the House will not be borne out by the daily experience of elderly and disabled people throughout the country. It is the job of the House to do everything in its power to ensure that the legislation's promises are honoured in the provision of better opportunities in the daily lives of the elderly and disabled.
Ministers have repeatedly given assurances that the new legislation will be adequately funded. The definition of adequacy will promote extensive debate among right hon. and hon. Members on both sides of the House. The importance of adequate funding cannot be overstated in terms of ensuring certainty and stability. Local authorities in particular must have the money to do properly the job that Parliament has willed them to do.
Negotiations are under way about the money to be made available. I suspect that it may create difficulties for local authorities that the sums will be announced not in July as originally intended but in October.
Reference has been made to the difficulties anticipated by local authorities because the money to be transferred to them to purchase care for people in their own homes or in residential accommodation will not be ring-fenced and specifically identified—and will therefore be susceptible. There are grave doubts also about the adequacy of the distribution formula, with evidence that the money may not be distributed by central Government to local government in accordance with local need.
Local authorities have been charged with the technically and managerially demanding job of implementing the legislation. Its complexity is extensively acknowledged—most recently, by the Audit Commission. In recent years, local authority infrastructure and the capacity to plan for these changes has been eroded as Government cuts have been forced on local authorities.
Other hon. Members have referred to the problem created by the "fee gap"—the difference between the amount that residential and nursing home care costs, and the amount that is available from social security to pay for that care. It is terribly important for that problem to be rectified as part of the negotiations about the amount to be made available to local authorities. Current estimates suggest that there is an average discrepancy of some £30 a week between the cost of a residential care place and the amount made available through the social security system. In the case of nursing home places, the discrepancy is about £50 a week.
My constituency is fortunate to benefit from a small project—run under the auspices of Age Concern—that arranges placements for people who have been discharged from long-stay hospital care into private nursing care, searching the country for places where care can be provided at income support levels. Although, as a result, people are often placed a long way from home, the project also provides follow-up through visiting. I understand that 989 it is a unique initiative, and that elderly people in other parts of the country cannot be guaranteed access to such valuable support.
§ Mr. Rowe
I share the hon. Lady's anxiety for the amount available for community care to be sufficient. Is it not the case, however, that, when the purchaser of such care is the local authority and not, as at present, the Department of Social Security operating at one remove, it will be much easier to match what is available with what can be afforded?
§ Ms. Jowell
I shall come to that point. The Social Security Select Committee called for an urgent review of the fee gap, and I echo that call. If we do not sort out the problem now, local authorities will inherit an inherent deficit in the budget passed to them by Government via the revenue support grant, and that structural underfunding will limit the number of people in residential care whom authorities can support.
In setting up contracts with independent providers, local authorities will be required to underwrite the cost in full. At present, the shortfall is being met by means of a range of cobbled-together solutions. Organisations such as Counsel and Care for the Elderly and Age Concern can provide substantial anecdotal evidence of the pressure that is put on relatives to find what may be large amounts of money to make good that shortfall. My hon. Friend the Member for Monklands, West (Mr. Clarke) mentioned a figure of £142 million: that is a considerable sum, which must be taken into account in the calculation of local authority funding.
Another problem affects people who are currently in residential and nursing home care, who have what are described as "preserved rights" under the new arrangements. That often means that families or charities must make good the continued shortfall. If this important matter is not sorted out now—if money is not made available on the basis of the available evidence—the long-term success of the policy may be jeopardised.
A second problem that may sabotage the best efforts of local authorities relates to the current dispute between the Department of Health and local authority associations" about the number of people currently admitted to residential and nursing home care each year. I understand that the discrepancy now stands at between 15,000 and 20,000, and the costs associated with an underestimate of this scale in the number of people entering residential care is sufficient to jeopardise the policy's success further.
To a large extent, such problems arise through the inadequacy and unreliability of available information. We do not really know how many people are in residential care, from which local authorities they have come and who will be responsible once the legislation is fully implemented. Those factors do not merely jeopardise the capacity of local authorities to do the job that they want to do; they have a direct and immediate impact on the well-being and confidence of disabled elderly people and their carers.
Adequate funding must be made available. It must be recognised that the new policy focuses particularly on support for elderly and disabled people to remain in their own homes, and that because of lack of alternatives, they may have to go into residential care. Estimates suggest that, at any time, about 10 per cent. of elderly people in 990 almost any residential home in the country might have lived independently in their own homes if the necessary support had been available.
We need the capacity to maintain the stability of the residential sector, but local authorities also need the capacity to begin to build up and develop the new forms of domiciliary care that will be essential if the objectives of the policy are to be achieved in the years to come. We want more elderly and disabled people to live longer in the safety and security of their own homes.
None of us can have failed to be moved by the report published last week by the Carers National Association, which drew particular attention to the amount of illness suffered by carers. One of the great promises contained in the Bill is that the level, quality and sensitivity of support for carers will be much higher than it has been in the past, but local authorities will require money if they are to achieve that. [Interruption.]
§ Mr. Deputy Speaker
Order. If Conservative Front Benchers were quieter, I might be able to hear what the hon. Lady is saying.
§ Ms. Jowell
It is essential that the promises that have been made—in the boldest terms—to improve the quality and level of support for friends and relatives who care for the elderly and disabled in their own homes are delivered in practice.
Let me end my speech by asking four questions, which I hope the Minister will answer. First, do the Government recognise the risks of failing to enter into early discussions with local authority associations about the shortfall that authorities are in danger of inheriting—a shortfall that may endanger their capacity to implement the policy properly?
Secondly, does the Minister recognise that additional difficulties have been caused because the money made available to support community care is not ring-fenced?
Thirdly, what provision is to be made for the inevitable contingencies that will arise as unforeseen problems are encountered? At the end of the last Parliament, the Government were prepared to bale out hospital trusts that had run into financial difficulties. I hope that the same effort will be put into ensuring stability in the care and support of elderly and disabled people.
Finally, recognising that one of the most important factors for elderly disabled people and their carers—the beneficiaries of the legislation—is certainty and clarity about what they are entitled to, will the Minister also consider introducing a community care, carers and users charter as an expression of general enthusiasm for citizens charters, about which we have heard so much from the Government? Codification of this entitlement—setting it out clearly—would be one of the greatest benefits that we could extend to carers and disabled people, whose lives are often made more difficult and burdensome by the confusion, red tape and bureaucracy that they have to try to penetrate in pursuit of the care and support they need.
§ Ms. Ann Coffey (Stockport)
I wish to refer specifically to the exclusion of small residential homes from inspection under the Bill, which I find difficult to understand. If someone goes into a home in which there are two other people, the monitoring of standards in that home should not be significantly different from those that apply to a 991 home where there may be three other people. I cannot stress too strongly how important is the role of inspection in maintaining and monitoring standards, particularly where care and finance are closely linked.
Reference has already been made to the problems encountered over the financing of care in private residential homes. They are caused by high interest rates and low Department of Social Security grants. Financial problems of that nature affect the care that is given to residents. They also have an effect on the quality of staff employed in those homes.
Hon. Members have referred to the use of personal allowances and charging for extra items. Also, threatening residents with eviction because they cannot pay their fees is not the way to make them feel that they are being cared for. Sadly, though, that is a step that a residential home may have to take. It has a damaging effect on the people in that home.
Apart from the effect on the quality of nursing care, lack of finance also has an effect on local health authority provision. During the last year, my health authority has experienced an enormous increase in the number of acute admissions. That is ironic, since two wards were closed and nursing care was transferred to the private sector to release resources. Part of the reason for the increase in acute admissions may be that the quality of nursing care provided by private nursing homes was not good enough. That leads to an additional burden being placed on the health authority. Moreover, it means that beds for people who need operations cannot be made available.
The inspection process as a whole is inadequate, but particularly for nursing homes. The district health authority is responsible for inspection. If, however, a district health authority should deregister a home, it could lay itself open to a claim for compensation on appeal. Some district health authorities therefore might adopt an over-cautious approach.
The guidelines for inspection are insufficiently specific. They are fairly specific in terms of physical standards of care—the number of beds per room and toilet facilities —but they are not specific when it comes to the measurement of quality of care, which is, of course, very difficult. However difficult it may be, it should be attempted. Emotional support is important for residents; the activities provided for residents are important. Their emotional support should be given the same attention as their physical needs, if the Government are serious about raising the standards of care in residential accommodation.
If we raise standards, the costs will rise. When the residential allowance is announced, I hope that it will take into account the higher costs of better care. If it does not do so, local authorities will have to make up the shortfall. If the cost of residential care becomes too expensive for local authorities, they will have insufficient money to spend on community care. The result, therefore, of the National Health Service and Community Care Act 1990 will be an increase in expensive private residential sector care which could have been provided much more cheaply by local authorities had the Government allowed local authorities to borrow capital in order to make the necessary adaptations to local authority homes.
992 I urge the Minister to think carefully about a number of issues, but particularly about the inspection process and tightening up the guidelines. I hope that he will think carefully, too, about the provision of an independent inspection process for nursing homes. It should not be provided by the district health authority. That can lead to conflicts of interest. May I ask the Minister also to think carefully about providing the right amount of money for residential care? If he is determined to provide it through the private sector and to disadvantage the public sector, the residential allowance must enable good care to be provided, as well as profit. If the Minister does not make provision for the profit margin, the care provided to residents will inevitably suffer.
§ Mr. Malcolm Wicks (Croydon, North-West)
May I start by telling you, Mr. Deputy Speaker, one story? I hope that it will bring the debate about community care down to earth. This happened to me during the election campaign. Hon. Members know that one of the curious habits of parliamentary candidates is to go up to perfect strangers in the street and ask them about their health. Sadly, one is really asking them about their vote.
On this occasion, the woman I spoke to turned on me in great anger and said that she was voting for no one, and why should she? She pointed to her husband, whom she was pushing in a wheelchair and who was seriously handicapped, and said, "I am his carer"—she used that word—"and I get virtually no help. Sometimes I have to care for him almost around the clock, such is the nature of his disability. I hear about community care. I know that that is a lie. I am not going to vote for anyone." I found that a difficult argument, because of the passion with which it was presented to me, to refute.
A curious British habit is to use the English language in imprecise ways—sometimes in ways that are virtually a contradiction. While we all talk, as I do, about community care, the reality all too often is not care but neglect. The reality is community neglect in Britain. That is not just rhetoric. I recall data from the general household survey of carers which showed that the majority of carers receive no help at all.
What worries me about our debates—I refer not just to our debate in this Chamber but to the debates in the country—about community care, not least because of the jargon with which the professionals like to bemuse us, is that, while we hear about "packages of care" and the "seamless service", the reality for most people in this position is, very often, nothing.
Despite the expertise in the House, there is probably greater expertise elsewhere around Westminster, such as Victoria street late at night. It would be good for all of us, certainly Ministers, to leave the House occasionally, walk up Victoria street late at night and talk to those trying to sleep in shop doorways. Many of them are elderly or suffering from mental illness. They would be surprised to learn that they are examples of community care. It would be good for us all to experience that type of so-called community care. Therefore, we should be careful about our terminology.
Despite the poor attendance in the Chamber, and no doubt the lack of press interest in this debate, this must be one of the most important subjects that the House will debate. That point has already been made by many hon. 993 Members. It is a subject that will grow in importance. The number of us who will reach a ripe old age is growing significantly year by year. As has already been pointed out, it is not just the aging of the population that is significant, but the aging of the elderly population itself. In the first census this century, in 1901, there were just 50,000 people over the age of 85—Wembley stadium half full. By the 1981 census the number had increased tenfold, to 500,000. Between 1981 and the year 2001, the number will double again, so that we will have over 1 million people aged 85 or over.
It would be agist and incorrect to say that all those poeople will need care in the community or elsewhere. Many are sprightly and will go on "Jim'll Fix It" and jump out of an aeroplane for the first time at the age of 85, hopefully with a parachute. However, we cannot be romantic about aging, because many of those people will suffer from Alzheimer's disease, be senile in other ways or incontinent and may need a great deal of care in our community. So the demography is against us. If this debate is important now, it will be even more important in five or 10 years. If we are to get it right, let us get it right sooner rather than later.
The debate is also important—this is a challenge to us all—because of the cost of so-called care in the community. Do we know enough about the cost of such care? When I say that, I am thinking about financial as well as social costs. We know from some estimates that the amount of care provided by family carers, let alone the Government, runs into billions of pounds. Because of the curious way in which we do our national arithmetic, none of those costs and contributions made by family carers will be found in our gross domestic product, which is the peculiar and narrow form of arithmetic that we sometimes take more seriously than we should.
I am interested in the cost of community care and who pays for it. At the moment, it is almost random. If a person becomes ill and is being treated in a national health service hospital, the costs are met by the NHS, with no direct payments from the patient. If the patient is cared for by a daughter or daughter-in-law, the costs will largely be met by the family, perhaps with some support from social security. If the person goes into a residential home and is below income support levels, the costs are largely met by the Department of Social Security. There is no consensus as to who should pay for the costs of aging. Should it be the elderly person if they can afford it, even if it means selling their main asset, their home, if they have one? Should the costs be paid for by the family, the state or the private sector? Those are important questions for the future that need to be grappled with.
The debate is also important because of the social and moral argument. Unless we can get this right and truly provide community care, we all suffer in a social and moral sense. I know that this is something of a cliché, but surely there can be no greater challenge than to enable our elders —that is how we should think of them—to live out their lives in comfort and with dignity. That is why the question of policy is so important.
Our Government and many others have waxed lyrical about community care over two decades. However, policy has been a slow train coming. It took reports from the Audit Commission and many other groups to embarrass the Government into setting up an inquiry under Sir Roy Griffiths. It then took some while for the Government to make up their mind what to do about that excellent report. 994 Then, at last, 10 years late, we had an Act of Parliament addressing the issues, and its implementation was delayed. Therefore, it is not unreasonable for hon. Members on both sides of the House to be worried about the rumours that there could now be further delay.
I want to ask three questions which echo some of the issues that have already been mentioned by hon. Members. I know that the Government will want to take the questions seriously. Given the rumours, I am sure that they will want to take this opportunity to put the record straight and to reassure those who are worried. I am sure that Ministers are worried by the rumours.
First, will the National Health Service and Community Care Act 1990 be implemented fully, and as originally stated, on 1 April 1993? If the answer is yes, as I hope it is, it is easy for Ministers to tell us that tonight. That would reassure the elderly, their families, the professions and social service departments.
Secondly, are the Government satisfied with the quality and nature of the community care plans now coming forward? They will now have had an opportunity to study them. I have had an opportunity of studying several dozen, and many could not be regarded as plans as such. They contain broad statements of intent, sometimes repeating the broad statements in the White Paper and many good statements of philosophy, saying broadly what they would like to happen. However, I do not regard them as plans. Are the Government satisfied with that process?
Thirdly, those plans may not be real business plans, because of the question of resources. How can one draw up a proper plan if one does not know what money can be spent? A Conservative Member made a sound point when he said that a company would not try to draw up a plan without an idea of the resources available. I am sure that this will be taken seriously by the Government, because the Conservative party is the party of private enterprise, and no doubt wants to run the Government as efficiently as the best companies. If it is not sensible for ICI or Glaxo to draw up business plans without an idea of how much can be spent in the forthcoming financial year, why does the Department of Health expect major organisations such as social services departments to draw up such plans?
I invite Ministers to state clearly the financial arrangements that the Department of Health wishes to make. Will Ministers also confirm the existence of the working party on financial arrangements, known as the algebra group? Will they further confirm that the working party's officials are having some difficulty with the algebra? In the new spirit enunciated by the Prime Minister, will they state whether the working party's report will be published? There can be no state secrets.
I was grateful for the broad way in which the Minister introduced the debate, because we cannot sensibly discuss this important Bill, which we all support, without considering its context. We have perhaps a few months left to get the policy right. All too often, it has been the sad experience of our social history that it takes some tragedy or case of abuse, and sometimes death, before institutions —including, with respect, the House and Government—act.
The sad history of child care since the last world war is that it has taken tragic, sad and well-known cases of children being murdered before Government and the rest of society took the issue seriously. We already know of cases of abuse, which can occur in publicly and privately owned residential accommodation and, perhaps most 995 sadly, in the home where carers are caring for the cared for. We would all stand condemned if we provided resources for the important subject of community care only when public opinion was galvanised and shocked by cases of abuse and tragedies, which perhaps occurred because carers could stand it no more, such were the pressures and the lack of support that they were receiving, often because resources were not available.
It will be a real test of our judgment and collective wisdom to see whether we can rationally analyse the situation and bring passion to bear on it. We have the evidence and experience to force Government—I mean that in a most decent way—to find the resources, to help the Department of Health to get those resources from the Treasury. We all have an interest in ensuring that.
Perhaps we are at a turning point and soon will truly be able to say that this is the first chapter in which we start to turn the story of community neglect into a decent story of true community care.
§ Mr. Bob Cryer (Bradford, South)
We should all be grateful to the Danish people for giving us an opportunity to speak about this important subject. We hope that the Government will bear that in mind and will not try to resurrect the discredited Maastricht Bill. That will give us more opportunity to debate important issues such as community care.
I join my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) in thanking the Minister for the way in which he introduced the Bill, which has a narrow base but wider applications, as it amends a number of community care issues. The House is grateful for his introducing it with that in mind, as it has enabled hon. Members to speak in general terms about this important subject.
Labour Members agree that expenditure on community care should be ring-fenced. Why do we say that? We do not share the startling view of the hon. Member for Bolton, North-East (Mr. Thurnham), who said that he had faith in local authorities spending the money allocated to community care according to that definition. That view is not shared by the Government on a wide range of local government activities, and I dare say that the hon. Member for Bolton, North-East would share the Government's view of, for instance, schools opting out of local authority control to avoid local authority expenditure allocation.
Local authorities, having experienced cuts in rate support grant and revenue support grant since 1979, are faced with invidious and difficult priorities. Will they be forced to spend money on housing homeless persons, or will they improve community care by housing homeless persons who have been thrown out of hospitals for the mentally handicapped which have been closed on the pretext of community care? Will they incur expenditure under the Education Act 1981 by statementing children with special needs who will be required to have those needs provided?
Those are the priorities that local authorities face. The Government cannot therefore apply the usual formula against ring fencing, which is that the priorities are determined by the local authority and it is its responsibility 996 entirely, thus evading the real point—that the Government, by making cuts, have stretched the services that local authorities provide while local authorities have taken the blame for their allocation of priorities. It is an invidious position for local councillors.
One of the great advantages of a local authority making decisions is that it is accountable through the democratic process with which we are all familiar. Hon. Members who have been active in local authorities and who have taken part in local authority elections will be aware of that accountability. There is no such accountability in the private sector, to which the Minister paid lip service in his opening remarks in a quite extraordinary way. He said that it was, as it were, the pacemaker of community care. That simply is not true.
Where community care is operated for private profit, the tendency will be to cut expenditure and maximise income in order to maximise profit. Private sector carers will so operate unless they are subject to strict inspections, but local authorities must, of course, bear the cost of ensuring that such inspections are made. That further cost is not recognised by the Government.
Under the National Health Service and Community Care Act 1990, local authorities are having to bring their own homes up to a standard higher than in the private sector so that they can examine old people's homes objectively and so that home owners cannot say, "The local authority homes are in an inferior condition, so how can they judge us?"
The Government have not recognised that cost, which local authorities are having to bear. The Labour-controlled local authority in Bradford took over from the Conservative council, which was trying to sell homes and people lock, stock and barrel. It failed to do so, but the Labour-controlled local authority embarked on a programme of updating and improving local authority homes. It has been able to do so only by selling its properties—very reluctantly—which were declared as surplus. That revenue is being used for modernisation and improvement. The Government are not providing enough resources. They should face up to their responsibilities and allocate money for community care.
It is important that the Bill is passed, to allow local authorities more flexibility. Schedule 8 of the National Health Service Act 1977 must not be narrowed, because in certain circumstances local authorities could be required to pick up the pieces for the private sector. We have not examined that very closely today, but we should do so, especially in view of the Minister's rabid obsession with supporting the private sector at the expense of the public sector. We should point out to him that the legislation contains the seed of rescue patterns which may be necessary because of the difficulties that the private sector might face.
I cite a specific example for which the Bill is tailored. It involves Westwood hospital in my constituency—a hospital for the mentally handicapped, now called people with learning difficulties. I must say that parents and people who work in the hospital do not like the new nomenclature, because they think that it is an attempt to cover the problem with words and to make it seem that things are not so difficult as they are.
Westwood hospital has been subject to a programme of putting people into the community for many years. In the first instance, the local authority was involved but the programme was more or less a disaster. It was called 997 "Operation Springboard", and it did not work. I recall that two people who were released into the community from Westwood hospital came to see me. They had been trying to get grants from the Department of Social Security for more than 12 months. They had had a difficult experience and received form after form which bemused them. They came to me to get things sorted out and I managed to do so.
I am in contact with many of the people who work at Westwood hospital and many of the parents, so it occurred to me to ask the two people whether they could read or write. They could not. They had been going to a DSS office for 12 months, but nobody had asked them whether they could read or complete the forms being poured out to them. They were subject to care in the community, but clearly there was no care in the community for them. Incidentally, the arrangement ended in violence, and both went back to Westwood hospital.
One problem with care in the community that the Government must face is that their cutbacks to local authorities and to district health authorities are forcing district health authorities to sell hospital sites. When the sites are gone and a difficulty arises with the care in the community programme because of a difficulty with or a wholly mistaken assessment, where are people to go if there are no havens such as Westwood hospital? The Minister should answer that question, but I do not think that he, his civil servants or anybody else in the Department of Health or the Department of Social Security have troubled about it.
I revert to the example in greater detail because it is relevant to the legislation. Westwood hospital has been subject to a care in the community programme for many years. In 1988, it was agreed that the Westwood hospital site would become the site of a mixed community development. It is a green site of 30 acres or more in which people can walk around. It is like a college site in that it has security—I do not mean fixed gates or doors, but security from traffic. There are speed humps so that cars cannot speed around. It offers a tranquil existence which people who are mentally handicapped frequently need. Indeed, it offers the sort of tranquil existence that most of us need from time to time, especially when we have been in this place a few years.
In 1988, in evidence to a planning inquiry about the Westwood site, the district health authority said:In the event, the proposed phased movement of patients into the community in accordance with the "Springboard Project" did not prove successful. The Health Authority is nevertheless still firmly committed to the essential policy of care in the community. At Westwood, this will now be achieved by the creation of sites for housing whereby certain numbers of the houses will be reserved for use by the Health Authority by agreement with the developers.It was clear that it was to be a mixed site. It continued:In this way, normal cross sectional communities will he created in which people with a mental handicap presently in the hospital, will be allocated domestic living units. The environment so produced will encourage the return of residents to the pattern of daily life. These proposals will have the effect of bringing the community to Westwood Hospital, in the form of a mixed housing development plan. The funds released from the sale of housing land will he allocated to capital works within the Yorkshire region although benefits will generally accrue to the Bradford area wherever possible.It is fully anticipated that there will be continued health care facilities and stair support. For example, certain of the more modern buildings within the hospital complex will be retained as community units such as a day care centre providing for 24 to 40 people.998 That policy, presented to obtain planning consent, secured the consent but was then reneged on in a disgraceful and despicable way. The whole site is to be sold and only the nurses' home is to be converted to a 20-bed unit. That is absolutely disgraceful, and it is one of the reasons why my hon. Friend the Member for Croydon, North-West (Mr. Wicks) finds that people are cynical and have become disillusioned and disenchanted with administrative institutions which make fine promises but then renege on them and spurn the carers, many of whom are aging people growing weary of looking after their mentally handicapped children, often with great devotion. The plans that they supported are torn up virtually in their faces.
§ Mr. Hinchliffe
I think that my hon. Friend is aware that I have had correspondence with a number of people about Westwood hospital. I am personally familiar with one or two parents who have long fought for a proper resolution to the problem. The information provided by my hon. Friend shows what a kick in the teeth there has been for people who have struggled for a long time with handicapped members of their family who were involved with Westwood hospital. However, the experience that he described is not happening only at Westwood.
I commend to my hon. Friend a press conference to be held in the House next Wednesday morning in the Jubilee Room. It is organised by Values into Action, an organisation concerned with exactly the type of experience that he outlined. Such events are happening not only in Bradford but across the country, and my hon. Friend is right to point them out to the Minister who must deal with them.
§ Mr. Cryer
My hon. Friend is right. RESCARE is a national organisation devoted to retaining the high standard of residential care in the public sector at sites such as Westwood which are decent and potentially marvellous sites.
I have a letter from Bradcap—Bradford and District Care and Protection for Mentally Handicapped People—a group battling for parents and for people living at Westwood hospital. The organisation is very worried about the lack of development of Westwood's potential and about Westwood being abandoned and discarded. The letter states:At a recent meeting organised at Westwood by the Community Health Council over 100 people attended and we were overwhelmingly in favour of Bradcap's plan, i.e. Retention of some land at Westwood including the excellent Recreation Hall, Occupational Therapy Unit, Hydrotherapy Pool, etc.The replacement of wards with more home-like bungalows. A sheltered environment for some of the mentally handicapped who need it for reasons of behavioural problems or vulnerability.Parents do not want their children at risk or as a stock in trade for ambitious businesses.That last sentence is a fair comment about the privatisation of provision for people who, whether they are mentally handicapped or elderly, are among the most vulnerable in our community.
§ Mr. Tom Clarke
Does my hon. Friend agree that it would help to solve some of the important problems that he has mentioned if the Government, even before introducing the Bill, fully implemented the representation sections of the Disabled Persons (Services, Consultation and Representation) Act 1986, so that the people he 999 mentioned would be properly represented when decisions affecting them were taken? Does he recall that that course of action was firmly supported by the Spastics Society?
§ Mr. Cryer
My hon. Friend is absolutely right. One of the key areas about which my local organisation is concerned is the representation which should be invoked by legislation, but which has not been invoked so far.
At the meeting at Westwood hospital mentioned in the letter, when about 100 people were present to discuss the proposed closure of the hospital and the disgraceful selling of land, because nobody else thought of doing so I asked for a vote. Out of more than 100 people present, only two voted against the proposals which I have outlined, in which some sort of mixed use of the land would be retained.
I shall deal directly with the Bill now, Mr. Deputy Speaker, and the greater flexibility for local authorities which it will retain—except for what is termed a lacuna. That means that a draftsman got it wrong and made a mess of things—but calling it a lacuna makes it sound so much better. If a plumber or an engineer had done that, he probably would have been sent down the road, sacked for having made a mess of the job, but that does not happen when the result is a lacuna rather than broken equipment.
The Bill rectifies the lacuna by providing local authorities with more flexibility. The district health authority is now decanting patients from Westwood in pursuit of an utterly unscrupulous policy, so great dangers arise. I have been finding out where the patients will be allocated. About 120 of them will go to a company called AHP Rehabilitation Ltd.
That firm made clear in its latest company returns that it is dependent on continued finance from the banks to stay in business. That is true for that private company. In fact, it is true for all private companies, as the case of Olympia and York—which was in a bigger way of business than AHP Rehabilitation Ltd.—demonstrates. With Olympia and York, all that happens is that the building stays empty—
§ Mr. Deputy Speaker
Order. The hon. Gentleman is straying. I hope that he will confine himself as closely as possible to the Bill. I appreciate that the Minister's remarks may have extended the scope of the debate on the Bill, but talking about Olympia and York is taking things too far.
§ Mr. Cryer
Perhaps I could draw your attention, Mr. Deputy Speaker, to the flexibility which the Bill restores. I am trying to explain that, if AHP Rehabilitation Ltd. gets into financial difficulties because the bank pulls the rug, the question will arise: who will pick up the pieces? Without the Bill, local authorities would not be an alternative choice. That is the problem. I asked the so-called chief executive of the district health authority exactly what provision the authority would make. Would there be a guarantee? Have funds been put to one side? I am still waiting for the answers. The Bill provides important background information, so that we can say that the local authority, with the backing of the legislation, will be an alternative organisation if the district health authority—that authority is going down a funny road, as I shall illustrate with two further examples—simply has not obtained guarantees and cannot provide the facilities.
1000 That opportunity is important. Without it, I am afraid that, if AHP Rehabilitation Ltd. goes into liquidation, it is not known what will happen to the 30 or 40 patients involved. We are trying to provide some certainty about that.
Another group of patients will go to a firm called Care Solutions Ltd., which was formed as recently as October 1991. It has no background of care in the community, or of financial success to give the certainty that we should like to provide. Indeed, the company was formed so recently that there are no company returns. If the parents of mentally handicapped people who went into that company's care wanted to get hold of the directors to raise issues with them, they might have a problem. Three of the directors live in London, which may not be too convenient, but the fourth—a Mr. Pietro Fascioni—is an Italian national living in Lugano in Switzerland. It would he fairly difficult for a parent to get hold of that director and say, "There is trouble down at the home."
The director lists his occupation on the company returns—as he is bound to do. His occupation is not that of a doctor, a consultant or anyone experienced in care in the community. That director lists his occupation—in the way which the Minister considers so wonderful—as "entrepreneur". People are being handed over to the care of an entrepreneur called Pietro Fascioni who lives in Lugano in Switzerland. The company may get into financial difficulties. We hope that it does not, but if it does, no capital background has been given and it has no records. So is it not reasonable that the local authority should be given the means, through ring fencing expenditure, to pick up the pieces so as to help protect some of the most vulnerable people in our society?
§ Mr. Cryer
I shall finish my illustration first, and give way to my hon. Friend in a moment.
The district health authority is even going back to mediaeval times; it is handing over more patients to an order of monks called St. John of God. Those people may have a perfectly decent record, but I wonder what is happening in our society when we are handing people over to a religious order to look after. If we are handing people over from the district health authority and its tender mercy, we should do so to someone with some degree of democratic accountability, such as a local authority. The Bill will help to bring that about.
§ Mr. Hinchliffe
My hon. Friend should be clear that the Bill as it stands needs amending to allay his worries about people such as the gentleman who he mentioned who lives in Switzerland. I am concerned about the limitations on the requirement to check out the owners and managers of homes in the private sector. I have come across several examples where people with what I can only describe as semi-criminal backgrounds are now directly involved in the private care business. Does my hon. Friend agree that, when the Bill is in Committee, it would be useful to amend it to block the loopholes which allow such persons to be involved in caring for vulnerable people?
§ Mr. Cryer
My hon. Friend is wise to point that out, and I have taken the matter up. I do not want local authorities to have to use the measures that we are considering—to ask the Government for money to pick up the pieces. The local authority should be concerned with 1001 other things, but we know full well that, when things go wrong in the private sector, it is always the community at large which picks up the pieces. Whether it involves a factory closing and people going on the dole, or anything else, we all pay. For example, in the case of Olympia and York, 2,000 civil service jobs are to be moved—but I had better not go down that path, Mr. Deputy Speaker, except by way of illustration. People from the Department of the Environment may have to pick up the pieces.
It is important, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, that if we are to have legislation, we might as well tag on to it additional advantages which will enable us to try to prevent the circumstances in which pieces occur and in which the whole thing breaks up.
I have been on to the so-called "chief executive" of the district health authority to ask him what guarantees there are and how Mr. Pietro Fascioni fits into the picture—whether he is approved and whether he is more than an entrepreneur—but I am still not getting any answers. I believe that the health authority has been inefficient, careless and far too precipitate in decanting patients from Westwood hospital because it wants to sell it off.
§ Mr. Cryer
One hesitates to make a judgment, but with a name like Fascioni, it sounds a bit like it.
With all the difficulties, the Government should be prepared to allocate more resources to local authorities so that they do not face difficult competing priorities such as I have mentioned. Local authorities must have the opportunity to take over, if necessary, the care of people who are in private rest homes for the elderly or in homes in the community for the mentally handicapped.
The Minister's predecessor was not especially helpful. He agreed with the idea of village communities for the mentally handicapped on hospital sites, but he gave no support to the objectors to the closure of Westwood hospital. The best solution would be to revert to the policy that the district health authority advocated at a planning inquiry in April 1988. The proposal was for a mixed development on the site which would keep tranquillity for people who are mentally handicapped. Some part of the site could be developed, but we should ensure that we do not put people into the community without adequate resources and without an adequate reserve if the community resources are faulty or the assessment mistaken.
The people who work at Westwood hospital, and the parents of the patients there, feel that they have been badly betrayed by the move to so-called care in the community. They feel badly betrayed by the district health authority and by the Government because the Government have not allocated the necessary resources. It is about time that these bankrupt policies were changed.
§ Mr. Rooker
With the leave of the House, Mr. Deputy Speaker. My hon. Friend the Member for Bradford, South (Mr. Cryer) made the point that we in the House owe a great debt to the people of Denmark for allowing us to have a short debate on community care in prime time. I say that in all seriousness. This is the first debate in the House on community care since April 1991. If nothing else, I hope that it will send signals to the Minister, to his colleagues 1002 and to his advisers that there is an unmet need and a pent-up desire in hon. Members of all parties who are concerned about what will happen before April next year and who want to raise many issues. We must respond to the points raised, although I accept that we cannot respond to all of them in Committee, which will probably be the week after next.
The Government will make a rod for their own backs if they do not introduce their own proposals from time to time rather than leaving the task to the Opposition on Supply days, because there dare not enough of those days. The Government could then give reports to the House about the preparations, the decisions being made and the planning for the implementation of the community care reforms next year.
It is no good simply waiting until April 1993—waiting for problems to arise and then having loads of requests for emergency debates under Standing Order No. 20. I hope that the Government will meet the demand for information and the demand to share the experiences of the planning of the implementation of community care which have been expressed in the debate.
I look forward to listening to the Minister and I hope that he will answer some of the questions. The one question that he must address is the first question that I raised, which has been raised by other hon. Members subsequently. We asked for an unequivocal and unqualified reaffirmation that the community care reforms will be implemented on 1 April next year.
§ Mr. Yeo
With the leave of the House, Mr. Deputy Speaker, I will briefly respond to some of the points raised in an excellent and wide-ranging debate. There were moments when I regretted having opened the debate with such a wide-ranging speech, because it appeared to bring everyone else into order almost regardless of what he or she said.
In answer to the last point raised by the hon. Member for Birmingham, Perry Barr (Mr. Rooker), may I say that I noticed that, during the six days of debate on the Queen's Speech, the Opposition did not choose to address health or community care issues.
§ Mr. Rooker
Let us not waste time on this. The Queen's Speech did not refer to health or to community care. That was the Government's decision. The Queen's Speech did not refer to unemployment. We chose subjects that were mentioned in the Queen's Speech, so let us have no more time-wasting on this nonsense.
§ Mr. Yeo
It is not a question of time-wasting. I am responding to a point raised by the Opposition. If the hon. Member for Perry Barr reads through the Queen's Speech, he will see that there were references to health. It appears that they were not of sufficient concern to justify the Opposition choosing that subject for any of the considerable amount of debating time.
I welcome the chance to debate matters with the hon. Member for Perry Barr and I hope that he will not be reshuffled too soon. I start with the point about which he is so concerned. Many other hon. Members have raised it today and some have even referred to rumours that our community care policies will not be implemented. I am not aware of those rumours, which is why I did not refer to them in my speech.
1003 It may occur to hon. Members that the whole purpose of introducing the Bill is to put in place the last legislative brick in the framework that is needed to bring about the third and final step in implementing our White Paper "Caring for People". What other purpose would we have in introducing the Bill if we did not wish to go ahead with the policy? It is the third step and, as I said, there were two other important steps in 1991 and 1992, and the White Paper itself is only a small step in a substantial shift of policy which has been—
§ Mr. Yeo
I will not give way in winding up the debate. My opening speech was very much shorter than the majority of speeches in the debate. I will try to deal with as many points as I can, and I will not be able to do so if I keep giving way.
The White Paper is but one component in a continuum of policy which is designed to achieve higher standards—
§ Mr. Clarke
On a point of order, Mr. Deputy Speaker. Can you help with a misunderstanding? The Minister referred to policies. He was specifically asked about the National Health Service and Community Care Act 1990. How can we persuade the Minister to respond to that specific point?
§ Mr. Hinchliffe
Further to that point of order, Mr. Deputy Speaker—a different point of order. The Minister has said that he does not intend to give way in his wind-up speech, thus implying that there is a restriction on time for this debate. Will you confirm that there is no restriction on time for this debate?
§ Mr. Yeo
I make it clear that I will try to deal with the points raised in the debate which relate to the Bill. Unless I am to keep the House here for another hour or so, I cannot allow every hon. Member to intervene on points, most of which have no direct relevance to the Bill. I will try to deal with the points raised which relate to the Bill.
Several hon. Members, including the hon. Member for Perry Barr, my hon. Friend the Member for Chislehurst (Mr. Sims) and the hon. Member for Rochdale (Ms. Lynne), concentrated on the question of finance. Of course I appreciate how central financial considerations are to the successful implementation of the policy.
I will make three things clear. First, the policy will be fairly resourced. Secondly, the transfer of funds from the Department of Social Security will be made in a transparent fashion and the basis of the calculation for that transfer of funds will be made clear. Thirdly, we will use the Government's powers to the full to ensure that when the money is transferred from the Department of Social Security no authority can misuse those resources.
I very much welcome the acknowledgement by the hon. Member for Perry Barr of the role of the independent sector and of the value of the mixed economy. That was refreshing to hear, and I hope that those views are shared by his colleagues. They did not seem to be shared by the hon. Member for Bradford, South (Mr. Cryer), whose 1004 hostility to the private sector came through very strongly. We are grateful to the hon. Member for Bradford, South for continuing to articulate the old-fashioned socialist attitudes which ensure that Opposition Members stay in opposition.
The hon. Member for Perry Barr rightly mentioned the importance of other policies, including housing, social security and so on. I am glad to tell him that my hon. Friend the Minister of State already chairs an informal group of Ministers from other Departments dealing with the implementation of our policy. The hon. Gentleman also made an important point about the disclosure of interests. Under the Registered Homes Act 1984, local authorities are required to keep a register of all homes. The register includes full details of home owners and of any company or other organisation which is involved and which has a financial interest in those establishments.
The hon. Member for Perry Barr, together with the hon. Member for Wakefield (Mr. Hinchliffe), made a point about the availability of domiciliary services. I would not want to give the impression that we have not been making progress in improving domiciliary services. That remains a key objective. It is just as important as anything that we are doing in residential care. It is partly in order to encourage the development and diversity of domiciliary services that my right hon. Friend the Secretary of State announced an initiative for local authorities to work with the voluntary and private sectors to develop new and innovative forms of service in the domiciliary sector. As I have said, I am particularly keen to see private sector involvement in domiciliary care.
My hon. Friend the Member for Portsmouth, North (Mr. Griffiths) made an important point about the possibility of people moving either way in the spectrum. We certainly recognise that point. There can be a process of assessment followed by reassessment if people's needs change, and they can lessen as well as increase.
The hon. Member for Wakefield made some vigorous points. It is certainly a novel criticism that we are spending too much money on income support to provide better care for old people. The hon. Gentleman did not mention the substantial increase in social services expenditure, which is up by a third in the past two years and up by almost two thirds in real terms since 1979. If the quality of care which is provided by independent sector homes is inadequate, local authorities need not and will not contract with them; but of course those same standards can reasonably be demanded of local authority homes as well.
The hon. Member for Wakefield overlooked the role of assessment in the system. I do not share his view that voluntary codes are inadequate. I certainly am not convinced that a statutory framework is the right answer for specifying standards for what goes on inside homes. He also made a point about privacy. This is the first time that I have replied to a Second Reading debate with the benefit of having seen some of the amendments that will be tabled in Committee. There is an amendment on the subject that the hon. Gentleman mentioned, so I dare say that we shall pursue it in more detail in Committee.
I am grateful to my hon. Friend the Member for Chislehurst for his support. I have tried to respond to his concerns about finance.
The hon. Member for Rochdale (Ms. Lynne) made a point about independent inspections. We already have 1005 independent inspections in place, and we shall monitor them to see that they cover the points about which the hon. Lady is concerned.
The hon. Member for Monklands, West (Mr. Clarke) was kind in his tribute to me. I should not wish him to think that any of my past connections should lead to high expectations of what I shall deliver in my present job, but the hon. Gentleman has a great interest in the subject. On the Bill being confined to England, the position in Scotland and Northern Ireland is that the provisions on residential accommodation in Scotland and Northern Ireland were not affected by the lacuna which has caused amusement during the debate.
Let me assure the hon. Gentleman, however, that the process of assessment is at the heart of our policy. Our policy is designed to ensure that those who can remain at home will do so wherever possible, with the benefit of better domiciliary and day care services. I have noted his point about advocacy, and I hope that we have a chance to debate that subect in Committee also.
The hon. Member for Doncaster, North (Mr. Hughes) fell into the popular misconception that community care is to be implemented next April. As I have said, implementation is a long process, and next April is just one more step, although it is important.
My hon. Friend the Member for Macclesfield (Mr. Winterton), who missed the first hour of the debate, made a lengthy and characteristically wide-ranging speech, most of which had nothing to do with the Bill, and has nothing to do with the Bill, and he has left without hearing the replies. I must refer to his speech, however. Nothing gives me more confidence in the Success of our policies than to hear him express such great concern about 1 April 1993. He used similar phrases two years ago about the national health service reforms which are now proving to be the kind of success which I know this—
§ Mr. Deputy Speaker
Order. It is for the Chair, not the Minister, to decide whether an hon. Member is in order.
§ Mr. Yeo
I apologise, Mr. Deputy Speaker.
I have no doubt that my hon. Friend the Member for Macclesfield will read my remarks. I hope that, by that time, he will have had time to read and understand the Bill. If so, he will realise that it would not be appropriate for the Bill to increase public expenditure.
I assure the hon. Member for Dulwich (Ms. Jowell) that we are already in discussion with local authority associations on a wide range of funding issues.
Other points can be picked up in Committee. The debate has illustrated the wide support for the Bill, and I invite the House to give it a Second Reading.
§ Question put and agreed to.
§ Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).