Community Care

HC Deb 11 February 1993 vol 218 cc1132-72 4.31 pm

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

I beg to move,

That the Special Grant Report (No. 6) (House of Commons Paper No. 404), which was laid before this House on 8th February, be approved. The report sets out the proposed allocation of special grants to local authorities for the financial year beginning 1 April for expenditure on community care services, as defined in section 46 of the National Health Service and Community Care Act 1990. It also describes the main features of the grant and the conditions that we intend to attach to it.

It may be helpful if I sketch the background to the report and say a word about our community care policy generally. The changes that are being introduced in April represent the achievement of a goal that was set out in the White Paper "Caring for People" in 1989. They follow two earlier stages of the implementation of our community care policy—the first in 1991, when we introduced arm's-length inspection units and greatly improved local authority complaints procedures; the second in April 1992, when, for the first time, we required the publication of community care plans by every local authority with responsibility for social services. The community care plans will be published annually from now on.

The significance of the changes that we shall make in April this year, however, lies in the fact that, perhaps for the first time, services will be tailored to meet need rather than, as, I am afraid, has tended to happen sometimes in the past, modifying needs to fit the services that happen to be available. The policy represents a coherent and properly funded approach to community care. It will guarantee for individuals who need services a choice between improved domiciliary and day care services at home and care in a homely setting for as long as possible, but where people are unable to stay at home they will be placed in appropriate residential accommodation. That will be achieved primarily through the process of individual assessment, which must by law not only examine the needs of every individual but take account of the person's wishes. Secondly and very importantly, it will take account of the needs and wishes of any carers who may be helping the individual to live at home.

We have four principal objectives in pursuing this policy. The first is that better consideration should be given to the alternatives to residential care. It has been common ground that one weakness of the present system, which allows people to obtain higher rates of income support to finance their entry into residential or nursing homes, is that sometimes people have been placed in those homes without full consideration of their individual needs and, in particular, without proper examination of whether, through the provision of additional domiciliary or day care services, they could be enabled to remain in their homes longer.

The second objective of the policy is the promotion of improved domiciliary, day and respite care services. I attach particular importance to the improvement of respite care. Anyone who has had personal knowledge of the burden which literally million of voluntary carers shoulder willingly will recognise that one way—perhaps the best way—of enabling them to continue shouldering that burden is through the greater availability of respite care. It may be for a week a month or only a week a year for someone who is not carrying such a big burden, but one of the best changes this April will be the removal of the perverse incentive which discourages local authorities from paying for respite care.

The third objective is the encouragement of the purchaser-provider split. That split, which has already shown its value in the health service reforms that were implemented two years ago, will bring forth even greater and faster benefits to community care. The marketplace—the mixed economy—is already better developed in social services. There is already healthy competition between providers of social services in the independent sector.

The fourth objective is to ensure that we create a flourishing independent sector. We want a variety of organisations—voluntary organisations and private for-profit organisations—to compete in the marketplace. One consequence is that standards will continue to rise, as they have done in the past 10 years, in the residential sector and elsewhere. It will also widen the choice available to individuals. Of course, through the statutory direction on choice we have built in a binding requirement on local authorities to honour, within certain practical limitations about cost levels, the preferences expressed by individuals. Not only will standards rise and choice widen, but we will see better value for money as a result of a flourishing independent sector.

The key to success in all this will be the greatest level of co-operation within the statutory sector between local authorities and health authorities. We will not accept any attempts by one agency or the other to pass the buck for responsibility for individual clients. It will also, however, require co-operation between the statutory agencies and the independent sector. I am glad that in many parts of the country there is evidence that such co-operation is building up, although I will have a little more to say in due course about the need for improved consultation with the independent sector by individual local authorities.

The whole policy is being introduced against the background of a two thirds real increase in social services spending since 1979. There has been a massive injection of resources all over the country, and the special grant report reflects that progress. The precondition of the payment of the grants to local authorities was that, by 31 December last year, every local authority should sign, jointly with the relevant health authorities covering the districts where they were both responsible, an agreement setting out the way in which, first, they will handle arrangements for the discharge of patients from hospital and, secondly, the way in which the purchase of long-term nursing home beds will be handled. I am glad to say that every local authority reached that deadline and satisfied the precondition.

The settlement with which the policy is being funded has demonstrated the Government's commitment, and the way in which we have honoured our pledge, to finance the policy in an adequate—I would say generous—fashion. The settlement comprises three elements. The first is the transfer of £399 million from the Department of Social Security. That figure, which was arrived at after detailed analysis and consultation, represents the money that the Department of Social Security would have spent in 1993–94 on higher rates of income support for people needing residential or nursing home care had there been no change to the policy.

In addition, we have allocated a further £140 million which is totally new money. It is additional to the resources that would have been spent if the policy had not changed. That £140 million will enable local authorities to improve the assessment procedures because, as I said, they are at the heart of the way in which we shall ensure that individual needs are assessed and met.

It will also enable local authorities to improve the day, domiciliary and respite care services which they make available to those who do not need any residential placement. It will also enable local authorities to meet any additional costs of fees for placements that they may make where those fee levels are higher than the higher rates of income support settled by the Department of Social Security.

Mr. David Hinchliffe (Wakefield)

I am grateful to the Minister for dealing with the funding issue. Has he received representations recently from the Conservative-controlled Association of County Councils on its view, shared with the Association of Metropolitan Authorities, that there is an overall funding shortfall of £135 million?

Mr. Yeo

I shall deal with the shortfall after I have sketched in the third element in the transfer, which is the £26 million being made available to local authorities to pay for clients who previously would have been handled under the independent living fund.

There have been suggestions from local authority associations about the adequacy of funding for the policy as a whole, in particular in relation to the costs which may arise where placements are made to homes whose charges are in excess of the higher rates of income support. The Association of County Councils and the Association of Metropolitan Authorities have commented on the matter. I regard the claims that they have made—that the policy is underfunded to the extent of £250 million—as totally bogus. Indeed, the AMA greeted my right hon. Friend's announcement in October last year with what can only be described as a wave of scaremongering.

It said that the cash shortfall would put 12,000 elderly and disabled people at risk of not receiving services. Unfounded claims such as that succeed only in frightening and worrying some of society's most vulnerable people. The AMA's figures do not add up. They assume that the numbers of elderly and disabled will grow exponentially. The curve of the AMA's graph goes through the roof, creating by September 1995 another 56,000 people—they do not actually exist—apparently needing residential care.

Mr. Hinchliffe

I was pressing the Minister to comment on the claim of his political colleagues in local government that there was a gap of £135 million.

Mr. Yeo

I am explaining why the claims are exaggerated. As I say, the numbers are unfounded. The figures are in sharp contrast to ours, which were based on a cautious assumption—perhaps I should put it the other way round and say they were based on the generous assumption—that by September 1995—[Interruption.] I am making a serious point.

We analysed carefully the numbers of people who would be likely to need services. We had regard to the rate of hospital discharge and demographic considerations. We then added to the figures produced by those two trends another 37,000 people, and we assumed that that number would be seeking services from local authorities. But even those figures are substantially lower than those used by the local authority associations, and it is there that a substantial part of the difference between our figures and theirs arises.

Next year, directors of social services will have at their disposal £565 million for reform, money that has been ring-fenced to ensure that it reaches its target. If councils want to spend even more on community care, they can draw on their own resources. The personal social services standard spending assessment now runs at more than £5 billion a year.

Miss Joan Lestor (Eccles)

The Minister will recall the commitment that was given about ring-fencing community care funds for mental health illness and for drug and alcohol abuse centres. That ring-fenced funding was later removed. What guarantee have we that the ring-fenced funding to which he has referred will be implemented?

Mr. Yeo

The specific grant for mental illness, now up to more than £31 million—raised by about 10 per cent. for 1993–94—has been an important element in the funding of local authority provision for people with mental illness. That is a specific grant for those services. There is a specific grant, of about £2.2 million, for alcohol and drug treatment. I appreciate that the hon. Lady is referring to the decision not to ring-fence the funding of residential treatment centres for alcohol and drug abusers. That decision is at present the subject of judicial review. The outcome of those proceedings will be known probably early next week, so it is difficult for me to say more on the subject now.

For that reason, I had intended later to point out—it may be convenient if I deal with the matter now—that the total figure in the special grant report is £20 million less than the £565 million that we are allocating in total to local authorities for the funding of community care. We shall make that £20 million available to local authorities and say how it will be distributed as soon as the present legal process has been completed.

The method of distributing the grant was discussed at length and attracted much interest from local authorities. I believe that we have arrived at the fairest possible method. We are not expecting too radical, too destabilising or too swift a change from the status quo but instead are making a smooth transition towards the achievement of our goal of reflecting in the distribution formula need, preserving individual choice and enabling care to be carried out at home.

As I say, we have attached conditions to the payment of the grant, the first being the ring-fenced condition, and that has been widely welcomed. It will not apply in perpetuity. We believe that after three years the policy will be sufficiently integrated within the totality of social services provision, and by that stage it will be an erosion of local authority discretion to continue to apply ring fencing.

The second condition which we shall apply is the requirement that 85 per cent. of the money being transferred from social security should be spent by local authorities purchasing services from the independent sector. We attach the greatest possible importance to that condition. We believe that there is already a valuable history of independent sector residential care provision on which we can build. But the condition does not apply only to the purchase of residential services. Local authorities will also be able to satisfy it by purchasing from the independent sector domiciliary, day and respite care services.

I hope that the whole independent sector will seize the opportunity offered to expand its activities in that area. The statutory sector cannot and should not work alone. I expect to see the independent sector taking on more of the work traditionally associated with local government.

Mr. Hinchliffe

My I press the Minister on the consistency of two of the factors that he has mentioned—the Government's apparent desire to ensure that people are not forced unnecessarily into care and to stimulate domiciliary alternatives to care, and the requirement to spend 85 per cent. of the DSS money in any one area on the independent sector? How do those factors square with the fact that, to my knowledge, many parts of the country have no independent domiciliary sector whatever? They do not seem to square.

Mr. Yeo

The reason why, I fear, some parts of the country have no independent domiciliary provision is the deep and enduring hostility of the local authorities to independent sector providers of all kinds, especially the private sector. In areas where there has been a more open-minded and rational approach to the provision of social services, there is no great difficulty in finding independent sector providers of all kinds of community care. The new condition was announced last October, although we have modified and slightly relaxed it after consultation. I hope that it will mean that, even in the past four and a half months, local authorities have been discussing with the independent sector how they can stimulate such provision.

All that will help to make community care plans needs-led rather than service-led. We shall not tolerate the use of the money for some empire-building exercise by local authorities for their own service provision. I hope that we shall thereby reduce the scope for the incompetence, mismanagement and fraud which, sadly, has occurred in a few local authorities, and which besmirches the reputation of local government as a whole.

If the independent sector provision is to be fully realised, local authorities must collaborate. The study by KPMG which we commissioned last year, in support of the conclusions of our own monitoring exercise, showed significant shortcomings in local authority consultation with the independent sector. That is not an option; it is essential. We have therefore issued two statutory directions to strengthen the requirement to consult.

Mr. Malcolm Wicks (Croydon, North-West)

I am still puzzled by the fact that 85 per cent. of the money is to go to the independent sector. Essentially, although not always, that means the private sector, so let us use proper vocabulary. Instead of 85 per cent. of the money going predominantly to the private sector, would a wise policy not be to ensure that 100 per cent. of it went to good services, whatever their source?

Mr. Yeo

I am surprised that the hon. Gentleman, who has some knowledge of such matters, claims that the independent sector is really the same as the private sector. It most certainly is not. Before entering the House I spent the latter years of my working life in what one might call the real world as a full-time employee of a large voluntary organisation supplying services extensively to local authorities. Many other voluntary organisations do the same.

It is absurd to suggest that we can use the term "private sector" to cover the work of Age Concern, Mencap, the Spastics Society and many other distinguished voluntary organisations, which are now increasingly substantial suppliers of services under contract to local authorities. Of course, it is because we want all the money to be spent on good services that we are determined to ensure that most of it is spent in the independent sector. As I said at the beginning of my speech, that is the best safeguard, that is what will deliver higher standards, value for money and wider choice.

Mr. Wicks

Why?

Mr. Yeo

Local authorities have been given the challenge of making the reforms work. They have been given the cash that they need. They have had the help of the community care support force. It is now up to them. The success of community care rests on the directors of social services. They are used to managing change, and the community care support force is issuing practical guidance to assist local authorities if unexpected eventualities arise.

The report brings those long-awaited reforms to the brink of implementation. That progress has been achieved in co-operation with most local authorities and health authorities. I pay tribute to their efforts. The benefits of the policy will be felt throughout the country by vulnerable and needy people and their families and friends. I commend the report to the House.

4.55 pm

Mr. David Hinchliffe (Wakefield)

Tonight the House has what will probably be the only opportunity—certainly the only opportunity in Government time—to debate before April the implementation of the changes due to take place in the arrangements for community care. The formula before us in Special Grant Report (No. 6) sets out the reality of community care in the next financial year—a reality in stark and marked contrast to the media hype about the likely impact of the changes which emanated from Richmond house until shortly after the general election.

Before 9 April 1992, the then Secretary of State and the junior Ministers were telling us in glowing terms how the delayed new arrangements would improve the lot of all and sundry. They talked about the avoidance of unnecessary institutional care—the Minister mentioned that again tonight—about recognition of the needs of users and carers, and about choice. Those statements gave renewed hope to users and carers, pressure groups and voluntary organisations, and providers in the public, private and independent sectors. April 1993 would be a new dawn, an end to what had been for many people years of private personal struggle and uncertainty.

When the election was over, a new message began to emerge from Richmond house. I am sorry that the Minister for reduced expectations—otherwise known as the Minister for Health—is not here tonight. He was wheeled into action to tell us all to modify our vision of the future after April 1993, and his message was reinforced in writing to local authorities: "Play it down, folks, and don't be unrealistic."

One or two Opposition Members have been criticised for not being realistic about what would happen after April, and for having said for some time that not only may April fail to herald much-needed long-overdue support for a vast number of people in desperate need, but that the circumstances of some users and carers could get worse. It take no pleasure in saying that the report before the House, detailing the manner in which the changes are to be implemented, substantiates and reinforces those concerns.

It is important to remind ourselves of the reason for the changes due in April, of the real motivation behind the community care elements in the National Health Service and Community Care Act 1990. The central purpose of the whole exercise was to unravel the incredible mess that the Government had got themselves into over the ever-increasing cost of income support payments to residents in private care. They wanted to unravel the social and—more importantly, from the Government's point of view—financial consequences of an ill thought out free market experiment in welfare which began in 1981.

That experiment took the DSS budget for supplementary benefit and income support from £11 million when the Government came to power to a staggering £2.4 billion in the current financial year, and reinstated institutional provision as the central plank of Government thinking on the care of old people. The number of places in care homes has shot way beyond any demographic increase in the number of elderly and very elderly people. That experiment shunted people into permanent care when, sometimes at half the cost to the public purse, many of them could have had what they really wanted—services geared to their remaining in their own homes.

The free market experiment encouraged dependence by rewarding moves towards more intensive nursing provision rather than rehabilitation. I have received representations from people whose relatives have moved from their care to the nursing sections of jointly registered homes for one reason only—that those honourable people in the private sector whom the Minister so crudely compared with corrupt local authorities had moved them to obtain more money for caring for them, although they did not need that nursing care.

Neither the DSS nor the Department of Health has addressed those issues. That free market experiment left thousands of old people without a penny to their names, using their own pocket money and begging subsidies from relatives and charities to meet the cost of their care. All right hon. and hon. Members have heard of similar cases, and every case is an individual tragedy. It was a free market experiment which led to the Government being defeated by their own Back Benchers because of the enormous public outcry about its human consequences.

We are here tonight to unravel the consequences of free market ideology being applied to the circumstances of some of our most vulnerable citizens—an unholy mess which has resulted in the gross misuse of millions of pounds of scarce public resources and, more importantly, has caused genuine distress and suffering to people who through no fault of their own are forced to look to the Government for their care and security.

It would be nice to say that the Government have learnt their lesson and that the community care changes will extract us once and for all from the results of the shambles, and that demented old people will no longer be shunted from the middle of London to questionable private placements in the Yorkshire dales. To use the parlance of the Select Committee on Health, old ladies in Dulwich will have the chance to stay in Dulwich rather than going to Clacton. The concept of choice should not be simply, "Which private home do you want to enter?" but, "Would you and your carer like to choose for you not to enter a home?" That is real and proper choice, and it is the choice that people want.

The report, however, tells us something different. It tells us quite clearly that, apart from shunting the funding problems on to local authorities, the Government are opting for the status quo. Having launched the free market experiment, in facing the consequences the Government are clearly more concerned with the interests of private providers of care than with the interests of users and carers.

The Special Grant Report (No. 6) says loud and clear that Government policy in the implementation of community care changes is completely provider-led—private provider-led.

Nowhere is that more graphically illustrated than in the calculation of the distribution of the special grant. Half the social security transfer element is being distributed to authorities in proportion to income support expenditure in respect of the numbers of individuals in private residential care and nursing homes in their areas.

Mr. Yeo

Is the hon. Gentleman aware that we offer local authority associations the opportunity for that part of the distribution calculation to be adjusted for migration from the area from which an individual came to the area where they were being cared for?

Mr. Hinchliffe

I was aware that discussions had taken place, but the Government have to answer the central accusation that the entire reform is geared to the status quo—to retaining the problems that we have had for the past decade as a result of the Government's commitment to floating the free market in care, and that those problems will continue after April.

When I expand on the point I was making, the Minister will understand my concerns about the formula. It takes no account whatever of the fact that, under the guise of what the Government have termed community care, older people and the disabled are frequently being placed in permanent settings many miles away from their own home areas. The Minister must recognise that.

Private care homes have developed where entrepreneurs have seen suitable properties, and not necessarily where the local population has presented a demand. Numerous private hotels and boarding houses in coastal resorts in the south-east, for example, have been converted for the care of older people and residents of psychiatric hospitals. In many instances, they have been filled with people from London who have been forced to move from their own homes and home areas due to lack of domiciliary support or suitable accommodation in their own communities.

The fact that the Government have chosen to concentrate future funding in the areas where those people have gone rather than where they have come from compounds the obvious mistakes arising from provision being determined almost entirely by the market. The new funding system clearly assumes that older people or the disabled will continue to be placed often 60 or 70 miles or more away from their home areas and their families. Rather than funding the changed system on the basis of known populations and needs, enabling the development of genuine care in the community, the Government have proved themselves to be concerned more with the continued commercial interests of the market.

The practical consequences will be obvious to those right hon. and hon. Members who have considered what the figures in the distribution of April's funding mean for their constituencies. For some inner-London boroughs, currently with minimal care beds, the opportunity to develop alternatives to sending people many miles from home are frankly non-existent. It is no real consolation for an older or disabled person in inner London to be told that they now have a choice of which home they wish to enter when, as a result of Government policy, the choice is Clacton, Brighton or 200 miles away in the Yorkshire dales.

It is not just in inner London that the nonsense of funding distribution arrangements occur. In my own area in west Yorkshire, we can compare the positions of two similar adjacent local authorities, Bradford and Leeds. I am not making a party political point because, fortunately, both councils are Labour-controlled.

Bradford has 80,000 people of pensionable age, 30,000 of whom are over 75; Leeds has 130,000 people of pensionable age, of whom 50,000 are over 75; yet the Government's funding system gives Bradford £60 for each pensioner and £158 for each one over 75, while Leeds gets £38 and £101 respectively. Any objective assessment would conclude that Leeds is likely to need greater community care resources, but the Government's formula rewards Bradford simply because that area has more properties suitable for conversion into care homes. It is as simple as that.

Conservative Members may be heavily into Victorian values, but is it right that the location of mill owners' mansions in the 1800s should provide the basis for community care funding more than a century later? Is it right that many of my constituents and those of many other hon. Members should continue to be placed away from their home areas because the Government's funding system is, frankly, plain daft?

Having dealt with the sublime, I will move on to the ridiculous. As the Special Grant Report (No. 6) indicates, in addition to basing their calculations of 50 per cent. of the special grant on the random location of existing private care beds, the Government are determined that 85 per cent. of the social security transfer element mentioned by the Minister must be spent on purchasing care within what they call the independent sector. The fact that the Government backed off their original intention for 75 per cent. of the overall funding to be committed in that way is evidence of the fact that there might just be someone left at the Department of Health with a grip, albeit limited, on reality.

No Opposition Member objects in any way to attempts to develop independent community care provision which has relevance to advancing the rights of users and carers and genuinely improves their choice, but does not the vast bulk of independent sector care, even after the Government have spent sizeable amounts trying to stimulate domiciliary provision, consist of private residential and nursing homes? Would it not have made more sense to be sure there were independent sector alternatives to institutional care in every area before requiring the expenditure of that proportion of the funding?

I appeal to right hon. and hon. Members in all parts of the House to examine the practicalities of the requirements for such expenditure in their constituencies. They will probably find, as I do, that it positively obstructs the ability of local people to address after April local priorities in terms of community care needs.

To be parochial for a moment, the principal agenda item in terms of community care needs in my constituency is a radical improvement in day care facilities for young adults with learning difficulties. I have had numerous meetings with desperate parents who, once full-time education ends, frequently find themselves left alone to cope. The local authority recognises that the excellent adult training centre at Lawefield lane in my constituency has insufficient resources to meet the demands. The local authority simply does not have the funding to expand the centre and employ more staff. April should have been about meeting the needs of such young people and their parents, but the funding formula prevents the local authority from tackling such urgent priorities in the most obvious way—by paying for the expansion of the existing centre and additional staff. Instead, it will have to buy from a frankly non-existent private sector because the Government put ideology before common sense.

The independent sector may eventually devise a scheme to help, but it could take years. In the meantime, parents and their sons and daughters are left to struggle. Frankly, I do not think that that is good enough, and how it all fits in with the concept of choice is beyond me. The choice of my constituents is improved public provision. What about the right to choose local authority care and good quality local authority public services? Where is the choice when people no longer have a local authority home in the area in which they live because it has been closed?

The other side of the Government's agenda is all too clear. While they positively discriminate towards so-called independent providers—to the obvious detriment, in some respects, of users and carers—they discriminate against public provision. It is right to apply the same standards to local authority residential care as we do to the private sector, hut the same Government who require those consistent standards then prevent local authorities from making the investment needed to upgrade their establishments.

What we have is a back-door method of closing council homes and reducing the choice about which the Government talk so much. The narrow application of the concept of choice means that people entering local authority care homes are excluded from receiving the new residential allowance. That is blatant dogmatic discrimination by a Government who are attempting to prop up and stimulate the private care market through the systematic destruction of public sector provision.

What choice will there be after April for those with drug and alcohol problems, in the light of the Government's decision to renege on the ring fencing of funding for drug and alcohol projects? As projects close, the choice for sufferers will be a police cell, prison or the streets; and for some, unfortunately, it will be the mortuary.

Mr. Yeo

Can the hon. Gentleman explain how any of the policies that we are debating will prevent local authorities from buying any services that they consider appropriate to the needs of the drug and alcohol abusers? Where is the obstacle?

Mr. Hinchliffe

If the hon. Gentleman lives in the real world, he will recognise that, when authorities are taking decisions on the expenditure of restricted sums of money and the choice is between, say, the placement of an elderly lady in a care home and the placing of an alcoholic or drug addict, it is a good bet that they will go for the elderly lady: in some people's eyes it is an issue of who is deserving and who is not. Is the Minister aware that a survey of 67 drug and alcohol agencies in the voluntary sector providing 1,300 bed spaces shows that 70 per cent. will start losing income in April and 46 per cent. will no longer be viable by the end of July 1993?

I am conscious of the fact that we are talking today without knowing what the outcome of the application for the judicial review will be at 10.30 on Monday morning. It is an absolute disgrace that the Government have been dragged into the courts on an issue which any human being can see is of great concern. I was in the Chamber when a former Secretary of State gave a clear commitment to ring fencing. I remember the hon. Gentleman's words well. He gave a commitment—I stress this point—on the back of huge pressure from his Back Benchers, including hon. Members who are here today. The Government's logic on this issue is frankly beyond me, and beyond belief.

Mr. Andrew Rowe (Mid-Kent)

I hear what the hon. Gentleman says and I understand it. Basically, he is saying that any human being would take the view which he takes. Surely, "any human being" includes local councillors, and therefore local councillors could well take that decision if they chose to do so. In Kent, the local authority has chosen to ring-fence for a year, and we shall see what happens at the end of that 12 months. To push the decision up from the local authority to central Government merely on the basis that somehow central Government are human beings and local authorities are not seems to fly in the face of much of what I have often heard the hon. Gentleman say.

Mr. Hinchliffe

In a sense, the hon. Member for Mid-Kent has missed the real problem with these projects. He will know that many of the projects in London and in areas such as Leeds, which I know well—the detoxification centre—and other similar excellent organisations in Bradford and elsewhere, take in people who are not residents of the local authority in the area involved. The key issue is getting those other local authorities, which may have no real knowledge of the work of organisations such as the alcohol recovery project in London, to take seriously the work that they do.

My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) and I spent some time visiting the projects and looking at some of the issues which people involved with them are worried about at present. I have seen one or two of the people who are benefiting from the present policy.

Ms. Tessa Jowell (Dulwich)

Does my hon. Friend accept that the dispute about the funding of services for drug addicts and alcoholics underlines the Government's inconsistency in the policy? The agencies which provide the care want precisely the same stability that the Government have undertaken with regard to private residential care for elderly people—that is, for the money to go where the people currently live. Does not that reveal that the Government are applying different standards to private residential care provided for elderly people and to voluntary organisations providing care and rehabilitation for drug and alcohol misusers?

Mr. Hinchliffe

My hon. Friend is absolutely right to point to the inconsistency between the Government's policy on this and their policy on the so-called independent sector providers to whom she referred. When I visited one of the projects recently, I met a woman who was receiving treatment for a drink problem. That woman has two children who are currently in care, and I know that the work that that project is doing will enable her to return home and be with her children.

If the Government's current illogical position is based on attempting to save money, it is completely the wrong way round. By failing to ring-fence those projects, resulting in the closure of a number of projects along the lines predicted in the survey, the Government are forcing up public expenditure on the prison service, the hospital service and young children in care, regardless of the human consequences.

Even at this late stage, I sincerely hope that the Minister will have a rethink during the debate. I am well aware that there is equal concern on the Conservative Back Benches about the way in which the Government have gone back on their previous commitments. I urge the Minister to consider why, over the past few years, the term "community care" has become in a sense a byword for neglect. In many people's eyes, it is an excuse for the Government to make savings and to release resources for the use of the Exchequer.

The Government should realise that, for many people, the Ben Silcock case raises questions other than those which were subsequently addressed by the Secretary of State. Such questions included the right to asylum facilities within the community, not locked away from the community; proper after-care for mentally ill people who leave hospital; joint funding for community care plans which does not taper down to nothing, as so much joint funding does; strategic planning involving everyone, including the user and his or her family.

The Minister used to work for the Spastics Society. I am sure that he will have seen the report which came out yesterday, produced jointly by the Royal College of Nursing and the Spastics Society. The report made it clear that the process of strategic planning had been made far more difficult by the deliberate erection of barriers and the creation of competition between arms of health and care services—for example, with the advent of trusts and the new health market.

When the 1990 Act was going through the House, some of us pointed out that its health and community care elements were contradictory. Millions of people are now looking to April, desperately hoping for answers to some of the problems that I have outlined and hoping for urgent change, but what hope is there for the new system when local authorities under both Labour and Conservative control point to a huge shortfall in the funding contained in the report before us today? I have talked to senior Conservative councillors who are deeply worried about what the changes will mean for people in their areas.

What are the prospects for the implementation of the new system when, as the Association of Directors of Social Services demonstrated recently, the vast majority of local authorities expect real cuts in their social services budgets in the new financial year? It became clear in the Health Select Committee recently that the Government had no plans to monitor the implementation of the reforms, so is it any wonder that users and carers—I meet people in various groups on a regular basis—are asking whether the Government really care? The impression is being given that, frankly, they do not.

What could have been achieved if, instead of the privatised welfare experiment in the 1980s and early 1990s the Government had been prepared to think out the use of the nearly £10 billion being spent on what Griffiths called perverse incentives to enter private institutional care? What could have been achieved if, instead of undermining the ability of local authorities and voluntary organisations to offer alternatives to institutional care, the Government had been prepared to invest in what people really want, which is help to remain independent rather than incentives to give up the ghost? What could have been achieved if concepts such as that underpinning the independent living fund had been developed and extended instead of being allowed to degenerate into the present shambles?

A few weeks away from April, severely disabled people, voluntary organisations, local authorities and, it seems, the Government have not the least idea how the new system will operate. The dogmatic obsession with the market means that the community care funding contained in the report will largely miss its real target. The Government have allowed the private institutional tail to wag the community care dog, and the real losers will be the users and carers who so urgently need a radically different agenda.

5.23 pm

Mr. Roger Sims (Chislehurst)

As we have been reminded, the report is another—and perhaps, before April, the last—step towards the implementation of an Act that was passed by the House more than two years ago. I recall sitting with several other hon. Members who are in the Chamber this evening on the Committee that considered the National Health Service and Community Care Bill. My recollection is that, while there was a good deal of controversy about the national health service part of the Bill, there was general support for the philosophy behind community care, as set out in the Bill. There might have been discussions about the detail, but there was general support in the Committee and the House for the idea of community care.

I am sorry that the hon. Member for Wakefield (Mr. Hinchliffe) spent so much time demonstrating the antipathy to the private sector for which he is well known. It was perhaps hardly surprising.

Mr. Hinchliffe

I am grateful to the hon. Gentleman, for whom I have a great deal of respect in terms of his commitment to social services issues, for giving way. My antipathy is not to the private sector: it is to a Government who distort the allocation of funding in social services in the direction of the private sector, at the expense of the public sector and care in the voluntary sector, which is often dependent on council support. I think that the hon. Gentleman will accept that point.

Mr. Sims

I will simply modify my remarks and say that the hon. Gentleman's prejudice clouds his assessment of Government policy.

When the Bill received its Third Reading, I was disappointed that we were told, and had not been told until then, that although the NHS part of the Bill would be implemented a few months later, implementation of the community care part of the Act would be deferred for a couple of years. Having said that, I am bound to say that the preparations for community care have proved extremely complex. A great deal of work needed to be done and has been done. Indeed, credit for the successful preparation for the Act is due in no small measure to the diligence of several officials in the Department of Health who have been extremely busy issuing guidance, holding seminars and so on about how the Act is to be carried into effect.

Perhaps I could also compliment the community care task force, which has done an effective job and was a useful idea. It sent people with knowledge of the detail of community care out to local authorities to assist them in making their preparations. Perhaps in his reply my hon. Friend the Minister will say a word about the future of the task force. There seems to be a question mark over whether it will continue after 1 April. I should have thought that, having shown its value in the preparatory stage, something akin to the task force, if not the same body, might continue, at least in a fire-fighting capacity. It would serve a useful purpose.

Special credit must go to all the people in local authorities and other organisations who have been responsible for putting the community care policy into practice. Any hon. Member who has had the opportunity to discuss the matter with local authority officers, officials in local voluntary organisations and so on will realise the enormous amount of work that has been done in preparation for 1 April, over and above people's normal duties, which, in the case of social services departments, are extensive. The success or otherwise of the community care provisions will depend on what happens locally. It will depend on organisations, local authorities, health authorities, the private sector, the voluntary sector and the individuals involved working together. We must wish them well as they progress towards what I suppose we might describe as C Day.

The report that we are discussing arrives not before time. It has been difficult for local authorities to make their detailed plans without knowing what central Government funding they will receive. They were told the global sum in October. They had some information about the funding, but only in this report do they know the final figures.

Indeed, I was with my own director of social services only this morning. He had not yet seen the report, so I was able to hand him a copy. He found that my borough was to receive £103,000 less than the earlier figures suggested. I suppose that, in budgets of millions, that is not significant, but it demonstrates the difficulties under which local authorities have had to work. I shall not go too far in comparing the relationship between local authorities and central Government with the way in which commerce and industry would work in similar circumstances.

Part of the grant recognises the extra costs that local authorities will incur in implementing community care: that is distinct from the transfer of the income support element. If the policy works out as we all hope that it will, the amount of social care in the community will increase and funds to cover that will be needed. The amount of health care in the community will also increase. If we are giving local authorities extra funds to meet their extra costs, may we know what extra funds the health authorities will receive to meet their share? Should we not expect, in due course, a report giving details of a special grant for them?

My hon. Friend the Minister will not be surprised if I draw attention to the basis on which the grant was calculated and to which the hon. Member for Wakefield has already referred. According to paragraph 3(a) of the report, 50 per cent. of the social security transfer element has been distributed between authorities in proportion to Income Support expenditure in respect of individuals in residential care and nursing homes in their area. I think that the hon. Member for Wakefield used the word "private", which does not appear in the report. Perhaps that is another illustration of his prejudice. Not all residential and nursing homes are private; some are run by voluntary organisations and others by local authorities—not necessarily in their own local authority area.

The point is, however, that the money is to be distributed according to where the recipients live, rather than where they come from. As the hon. Gentleman pointed out, that must disadvantage certain areas—for example, parts of both inner and outer London—from which a number of recipients of income support have moved to Kent, Sussex and Surrey, not necessarily as a result of compulsion. The authorities involved will receive a larger share of the income support tranche than they would have otherwise, while authorities in inner and outer London will lose.

My authority estimates that some 400,000 elderly people have moved out of the borough into homes in areas such as those that I have cited. A large amount of money has probably been lost because of the use of the formula that we are discussing.

Mr. Rowe

That important point should not be confined to community care. In the Medway health authority area, for instance, we had to struggle with an unsatisfactory funding arrangement which was weighted excessively towards older people moving into areas such as Brighton.

Mr. Sims

I was not suggesting that the problem was confined to inner and suburban London; the hon. Member for Wakefield mentioned other areas that are affected, and I appreciate that the same thing happens elsewhere.

In an intervention, my hon. Friend the Minister made an interesting reference to migration figures being considered. That was news to me and I hope that he will be able to expand on it, either during the debate or later. He knows of my interest. I wish to place on record my appreciation of the way in which he received a deputation from the London boroughs, which I led, and of the sympathetic hearing that he gave that deputation. I hope that he will be able to go some way towards improving the formula to remove the current sense of injustice—if not now, before this time next year.

Mr. Hinchliffe

It would be wrong to give the impression that every inner-London borough has suffered as a result of the funding system. Would the hon. Gentleman care to speculate, for instance, on why his authority, Bromley, receives £91 for each person over the age of 75, while for some reason Wandsworth receives £144.07 per person?

Mr. Sims

No, I would not. I shall merely say that that increases the sense of injustice and suggests that the formula is, to say the least, capable of improvement.

The question that inevitably arises, and will continue to arise, is whether the total grant, however it is distributed, will be enough to enable authorities to implement the policies set out in the community care legislation. The answer is, of course, that we simply do not know: we are entering unknown territory. As the implementation of the Act unfolds, cases will come to light, and will be assessed, with results on which we can only speculate. We do not really know the extent to which needs will be revealed, or what will be involved in trying to meet them.

That leads us to the problem encapsulated in the expression "unmet need". The dilemma, as I see it, is this: under the Act, a local authority will be required to assess each case, to specify the needs that the assessment reveals and then to meet those needs. It may not be able to do so, however. The chronically sick and disabled persons legislation, for instance, imposes an absolute obligation to meet the needs that are revealed.

Ideally, an assessment should be agreed with relatives—and, of course, with the user in particular. I am delighted to see that my right hon. Friend the Secretary of State for Health has arrived in the Chamber: she was good enough to commend my local authority's practice of securing the user's agreement to the assessment, along with his or her signature on the document. Nevertheless, the guidance now being given to local authorities is somewhat ambivalent, suggesting that it may not be wise to specify actual needs in an assessment because the authority concerned might then be open to legal challenge.

I hestitate to use of the word "deception", but it seems that assessments could be misleading. My anxiety is increased by the evidence given to the Select Committee by officials from the Department—this relates to what was said by the hon. Member for Wakefield. The officials seemed to suggest that, although the progress of community care would be monitored and some statistics would be collected, statistics relating to unmet need would not be collected. That rather negates the whole principle that community care should be driven by needs rather than resources.

During the passage of the legislation, many of us said, time and again, "This is all very fine, but will the resources be there to meet the needs?" We were assured that the resources would be there, and we have been assured again today that the report is part of that provision; but how can the Department know that the resources are adequate without having information about unmet need?

I understand the difficulty. It is desirable to specify the need, and it is also realistic to accept that it may not always be possible to meet that need. We all know that budgets—even if they are twice the figure that we are discussing—are finite. There could be circumstances in which it would be impossible to meet every need. Will my hon. Friend the Minister consider ways to resolve that difficulty? Is it practicable to have a genuine and open assessment of need and the extent to which it can be met? We should be straightforward about the matter and say to the users, "This is our assessment of your need and this is what, ideally, you should have—A, B, C, D and E—but we can currently offer you only, A, B, C and D. We accept that, in time, we should be able to help you in other ways."

I think that the users and relatives will accept that funds are not unlimited, but we should all know where we stand. The local authority should have it on record and know the exact position. It should know not only the needs that it is meeting, but the needs that it has been unable to meet. Those statistics could then be collected at Richmond house and my right hon. and hon. Friends the Ministers will be able to see whether community care is working.

Perhaps in a few years' time we shall hear that everything is going smoothly and the resources have proved adequate—I hope so. The resources may be adequate in some sectors, but inadequate in others. There may be room for adjustment or increase, but at least that would be a fairer and more realistic system than the present apparent fudging and uncertainty.

Of course, there are still worries—there are bound to be—about exactly how community care will work, particularly the interface between health authorities and local authorities, notwithstanding any agreements that may have been made. There is a distinction between social care and health care, how each one is defined and where they overlap. Given good will and common sense, I am sure that those difficulties can be overcome.

There are uncertainties—with only a few weeks to go, some are inevitable—but some of them could be clarified. For example, what happens when someone is in a home where the fees are higher than his income support and he receives a top-up, which then ceases? What is the local authority's responsibility? I have a letter from my local assistant care director which refers to that dilemma:

The verbal advice from the Department of Health is that a resident in receipt of Income Support and who therefore has preserved rights after the community care changes, whose top up from whatever source is withdrawn after that time, must seek a cheaper placement. If no such placement is available they may apply to the local authority to supplement their Income Support allowance. The Department of Health is however stating that the resident must move placement in order that local authorities are not just used as an automatic source of funding. The problem is that people left, right and centre could withdraw their top-up knowing that the local authority will automatically take over. Clearly, we must guard against that, but it seems that there could be cases where the withdrawal of the top-up could be due to unavoidable circumstances such as a relative dying. It would be harsh if someone who had been in a residential or nursing home for many years were then required to move for the reasons that I have described. I do not necessarily expect my hon. Friend the Minister to give a straightforward answer today, but I hope that he will clarify the position, certainly before 1 April.

Ms. Jowell

The issue of the shortfall between income support limits and the actual cost of residential care is, rightly, a source of enormous worry. It is one sector of expenditure where the local authorities and local authority associations feel that the Government have failed to heed the evidence of the scale of the difficulty nationally. Local authorities calculate that the national shortfall is £73 million. That shortfall is currently made up by relatives, charities and a range of top-up sources, but could, after 1 April, become the responsibility of the local authority. I am sure that the hon. Gentleman will agree that it would be a source of tremendous instability in a new system if such a large amount were not underwritten by the Government from the outset.

Mr. Sims

It would be unreasonable to expect the Government to write a blank cheque for the sort of figure given by the hon. Lady, but it would be helpful to have some clarification about what the position would be given the circumstances that I have outlined. It would be reasonable for the local authority to have some discretion in the matter.

Mr. Ian McCartney (Makerfield)

In a debate on a statutory instrument in Committee yesterday, the Under-Secretary of State for Social Security, the hon. Member for Bury, North (Mr. Burt), said that he and his Department were seeking to draft amendments to section 43 of the National Health Service and Community Care Act 1990 to ensure that some categories of residence received top-up support from local authorities. He said that he could not say yet what those categories would be and that that was a matter for the Department of Health. The Minister could help today's debate, because yesterday it was placed on record that active consideration is being given to the issue by the Department.

Mr. Sims

I am grateful to the hon. Gentleman for bringing me up to date on the latest state of play on that issue and I look forward to hearing from my hon. Friend the Minister later.

Although I have voiced some reservations and some of the understandable concerns felt by those who will be implementing community care, I welcome the report—although I believe that it has come a little late. I hope that my hon. Friend's Department will watch carefully as the community care policy unfolds. I hope that the Minister will keep himself fully informed and, where action seems appropriate, will take it without delay.

5.48 pm

Mr. Nigel Jones (Cheltenham)

Liberal Democrats welcome many of the Government's ideas on community care, many of which are progressive. In the main, the philosophy that underlies their ideas is correct. Unfortunately, the report will not lead to enough money being provided properly to implement the Government's philosophy. I say that because social services departments of local authorities throughout the country are struggling to put together next year's budgets with inadequate finance. I declare an interest as an elected county councillor in Gloucestershire who serves on the social services committee of that authority.

More than 80 per cent. of directors of social services in England predict that their budgets will be reduced in April, which is the time when they are due to take on important new responsibilities for community care. According to a survey conducted by the Association of Directors of Social Services, 81.7 per cent. of local authorities which responded to the questionnaire seemed set to cut spending on social services when their budgets are finalised in April. A further 8.5 per cent. expect a standstill budget.

The consequences for the users of social services will be immense. For example, they may be subject to additional charges for services such as home helps and meals on wheels. Crucial inspection staff who are required to monitor standards in residential homes will not be appointed. Residential homes and day centres for elderly and mentally handicapped people could be closed. Additional staff required to implement the community care reforms and to respond to rising levels of social need will not be brought on to the social services payroll.

According to the president of the ADSS, Peter Smallridge, the news for social services coming from the results of the survey carried out by the association is extremely gloomy. Members of the association warned last year of the danger that, despite ring-fenced money being made available for community care this April, the impact of Government policies towards local government expenditure as a whole would drive many councils—country as well as urban—to make cuts in other crucial areas of the social services budget. That seems to be what is taking place.

The great flaw in the report is that part of the calculation uses our old friend standard spending assessment. I shall not rehearse all the arguments about SSA because they were advanced in the debate last week. Even the Government seem to admit now, however, that SSA is not right. I welcome the Secretary of State's commitment to review the system, which seems to imply that even he thinks that it is not perfect. The Government say that SSA is not a statement of need but merely a method of distributing a predetermined amount of money.

Gloucestershire county council, on which I serve, has carried out a detailed survey of existing residents in care who receive benefit. The director of social services, Deryk Mead, to whom I spoke yesterday and this morning, tells me that the survey shows that there is a shortfall of £1.4 million. I listened carefully to the Minister when he talked about rising standards. I would like to see rising standards, of course, but the financial arrangements seem to mean that local authorities will be obliged to try to force down fees. Many people believe that that will reduce standards and could lead to the financial collapse of some private care homes.

The proposed settlement does not reflect what has been happening in recent years. It seems that it allows for no increase in numbers. Nor does it allow for an increase in fees. When the Minister responds, I hope that he will tell the House how many people the Government estimate will enter care this year, bearing in mind the rapid increase in numbers over the past 10 years.

If local authorities have to find additional moneys for fees, there will be no funds to improve day care, respite care or home help. We have heard the views of the ADSS and the Association of Metropolitan Authorities about underfunding. I heard the Minister say that, if councils want to spend more on community care, they can draw on their own funds. Many local authorities, including Gloucestershire county council, wish to spend more on that form of care. That is why last night Gloucestershire's county councillors unanimously approved a budget—it was proposed by Conservative councillors—to exceed the capping limit by £10.3 million.

I ask the Minister to reflect on the figures that are set out in the report. I ask him and his right hon. Friends to ensure that when local authority representatives speak to the Ministers who are responsible for their expenditure after they have exceeded their capping limit, Ministers will respond to the needs of the local community and to the councillors who have listened to the people whom they represent. I ask them to allow local authorities to spend what is needed to provide proper and decent high-level services in those areas.

5.54 pm

Mr. Andrew Rowe (Mid-Kent)

This is a rather exciting day. I strongly approve of the policy that has been presented to us. As it is set out—in theory—it is excellent. Everything will depend, of course, on how it works out in practice. We all know that. If those who are in need of help from social services are assessed on the basis of their needs and the needs of their carers, we are taking a huge step forward.

It took a long time to complete the sterile debates in which we engaged during the health service reforms. We spent much time arguing about whether resources were adequate. I declare now that resources will never be adequate. There is no possibility of meeting all the needs that it would be so easy to define.

I spent an extraordinarily uncomfortable but profitable morning today as a participant in the Kilroy programme. I feel like a new form of graffiti—"Kilroy, I was there." He had brought together a remarkable collection of people who were carers and some of those for whom they were caring. As I was the only representative of the governing party, it was predictable that any pretensions that I may have had in the past to be a supporter of carers in a wide variety of different ways vanished like snow off a dyke. I was instantly and continuously pilloried throughout the programme.

Nevertheless, the extraordinary courage, devotion and strength of purpose that carers of all ages and stages of life display in looking after others is remarkably clear. I feel that it is not within the scope of any Government to create at public expense the sort of total support system that is delivered for about 85 per cent. of people in receipt of care by individual carers. I feel, however, that they are entitled, and will increasingly expect and demand, the relatively minor support that makes it possible for them to continue. I was delighted to hear my hon. Friend the Minister say how much he valued the provision of respite care, to take but one example.

A recent report—it was the basis of the Kilroy programme this morning—makes it clear that the preference of many carers is that support should be based on their own homes. They feel that the people for whom they are caring should not be sent away. I am sure that there are occasions, however, when the client, as it were, wants to be sent away. I have examples in my extended family where people have been going for several years on what they regard as a holiday. That works well, but we need to take tremendous note of the fact that carers look for respite within their own homes. I hope that the imaginative provision of the new community care legislation which states that the needs of the carer must be taken into account will prove to be a spur to imaginative and creative provision.

I have a huge regard for the hon. Member for Wakefield (Mr. Hinchliffe). For a brief time only, before he was translated to higher things, he was chairman of the parliamentary panel for the personal social services, and his concern and devotion to the provision of social services is well known. However, I did not altogether recognise the scene that he painted, and in one respect in particular.

I may be wrong, but my understanding is that the Government intend to provide financial stability for those who are already in care and that gradually, as local authorities make new care plans, the automatic, or virtually automatic, sending of large numbers of people into residential care will stop, as it has already begun to cease in Kent.

Mr. Hinchliffe

I am grateful for the hon. Gentleman's comments, although I expected something to follow on from them. Let me clarify my concern and that of the Labour party on the issue that he is addressing. The 85 per cent. requirement in respect of the independent sector will, because of the lack of independent alternatives to residential and nursing care, lead to people going into care, not on the basis of their assessed needs but because of the requirement to spend that money. If there are no domiciliary alternatives and their development is prevented, there is no choice but to continue placing people in care, often away from where they live.

Mr. Rowe

That is what I understood the hon. Gentleman to say, but it is nonsense. There is no reason why social services departments, through contracts with the independent sector, should not summon into being alternative provision. That is what is happening in my local authority.

My local authority is not typical because it has spent the past two years developing care and it is fair to say that it has been thinking about the development of community care for much longer than that. Much of the pre-thinking that went into the legislation was based on what was happening in Kent. One consequence is that it is busily engaged in inventing contracts of a sort which will summon into being different ways of delivering different kinds of care.

I take one example. I think that I am right in saying that Kent no longer has any long-term residential homes. They are now linked service centres which are used as a basis for a wide variety of provision including day and respite care. People go there for the management of their domicilliary services, and so on. Such a wide and imaginative variety of resources will grow, and so they should. That is the way forward.

It is true that at the moment Kent has some 835 homes providing 17,000 places with a budget of £268 million and employing 20,000 people. Many of them are shaking in their shoes because they see that the emergence of community care will put a number of them at risk, and so it should. But instead of sitting back and going out of business because they cannot think what to do, the more imaginative home owners are already beginning to create other ways of delivering services.

For example, homes are becoming resource centres for carers and people use them on a daily basis for the provision of specialist teams to work in the community, whether to carry out simple carpentry tasks, which is often one of the things that people living on their own need—

Ms Jowell

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) was referring to the fact that, while there is nothing to stop the private sector developing domiciliary care—some have already developed what were loss leaders which have had to be closed because of the impact of the recession on residential care homes—many local authorities are having to cut their home care services to meet the Government's spending limits while having to maintain existing patterns of spend on the independent residential care sector for the next year.

Therefore, although there is no reason in theory why the private domiciliary sector should not grow and flourish, the Government have created specific obstacles to its development in the short term, while forcing many local authorities to cut their existing home care services. Domiciliary care is severely at risk, certainly in the short term.

Mr. Rowe

I understand that local authorities vary greatly in the way in which they run their affairs and in the demographic and other distributions with which they have to cope. However, as my hon. Friend the Minister said at the beginning, the amount of money in real terms being spent on social services has rocketed in recent years. In some cases, the turnover—that is hardly the right word—in residential homes is rapid. People may die fairly swiftly or have to move into nursing homes or into other forms of disposition. When that happens, it will be the end of that perverse incentive which Griffiths was so anxious to remove and we shall see a new generation of forms of care and support. Certainly that is what I hope to see.

An area that I believe to be of central significance to the satisfactory delivery of community care is the liaison between the health service and the social services. My hon. Friend the Member for Chislehurst (Mr. Sims) made an important contribution on that point which I wish to underline.

In that provision there are two elements, the first of which is general practice. It is fundamental that general practitioners should collaborate in every possible way with the social services. In Kent, the chances of that happening have been enormously improved by the development of a sophisticated computer package developed by the social services so that every care manager in Kent should have access to the database for his clients. What is more, a simplified version is being made available to every general practitioner in Kent so that they can summon up, using a carefully guarded confidential password, that part of the assessment and database which refers to their patients and to which they should have access.

Nothing ever works on machinery alone, but there is no doubt that equipment is enormously helpful. If that newly pioneered programme works as it is intended to work, it should enormously improve the liaison between the general practitioner and the social services manager. One of the most encouraging features of the NHS reforms has been the astonishing increase in the number of staff being deployed from doctors' surgeries. I do not have the figures for later than 1990, but they have gone up from 37,000 in 1980 to 78,000 in 1990. Many of those—

Mr. McCartney

Consultants and tax consultants.

Mr. Rowe

The hon. Gentleman, from a sedentary position, shouts, "Consultants and tax consultants." If he cares to look at the figures for nurses, for therapists and even, in a growing number of general practice surgeries, social workers, he will see that the general practice surgery is becoming a central point for the delivery of care based in the community.

I want not rivalry between services and GPs but collaboration on that basis. May I say to the Minister, in passing and in public, what I have said to him before in private: that when we can get away from the constriction of a one-year contract on which it is extraordinarily difficult to plan, we should develop free-standing consortia of therapists, whether they be physiotherapists, occupational or speech therapists. Such consortia would be able to deliver services to the four purchasers which have now come into the market: schools, fund-holding practices, the health service and the social services. If they do not create a strong free-standing organisation of their own, therapists are liable to find themselves at the bottom of everybody's expenditure queue. For a whole range of people in the community, it is very often the services of therapists which are the most cost-effective way of helping them.

The document makes no reference to volunteers, of course, but I believe passionately that we underestimate and under-use volunteers and the potential for them. It has to be remembered that one of the biggest single demographic changes in the country will result, in the next 10 years, in literally millions of people retiring from their principal occupations with 30 or more years of active life ahead of them. Someone who retires from his principal occupation between the ages of 55 and 60 will be active for another 30 years. What is he going to do? Unless those people are enabled and encouraged, in large numbers, to do things for other people, they will themselves become clients of the social services because they will be bored and will find themselves falling heir to a variety of different ills.

The Prime Minister says that we need to release the tremendous resources in our people; this is one area in which we need a serious, well-designed and effective way of organising volunteers. Volunteers are one of the best ways of monitoring the quality of services. Volunteers going in and out of homes, going in and out of individuals' homes, reading to people and doing their shopping, are as good a check on the way in which the statutory services are delivering community care as any other mechanism of which we can think. It is important that we should do that.

I say to the Minister that community care will inevitably require some residential care. That residential care, which has so often been the scene of hideous scandals and which the Warner report has identified as extraordinarily under-trained, requires a substantial improvement in training, recruitment, monitoring and promotion of residential staff. There has to be a much greater interchange between residential and nonresidential staff. There have to be ways for staff to be encouraged to move from one residential post to another so they do not get stale and dug into various Chinese or other practices.

In that fight, the national vocational qualification is a huge card to play. I am extremely pleased at the way in which forward-looking social services departments, like that of Kent, are making use of the national vocational qualification as a way of authenticating or accrediting the skills that many middle-aged people bring, perhaps from the experience of caring for their own people, to residential care. I hope that the Minister will give every possible boost to the expansion of that programme.

6.15 pm

Ms. Tessa Jowell (Dulwich)

I join other hon. Members who have talked about the popularity of a policy of community care. It makes sense—and by and large it is what people want as they grow older or experience disability—to live at home and for those friends and relatives who provide most of our community care to be properly supported in the job that they do in caring for them. However, users of community care services and their carers also emphasise other aspects of community care beyond just social care and health services.

They stress the importance of being properly housed. Too often, community care is seen only in terms of what the social services department or voluntary social care organisations can provide. The fact that a person has a home is taken for granted, yet housing is an integral part of proper community care. So, too, is an adequate income. Given that so many disabled people rely on social security benefits as their major source of income, proper information about their entitlement to benefits and maximising the take-up of benefits to which they are entitled is critical. So, too, is the issue of transport and mobility. Being able to get around and to make choices about what one does each day depends on being physically able to leave home. That is what community care means, as described by disabled people and their carers.

In considering community care policy and its funding, it is also worth considering what makes good community care for disabled people and their carers. Often, it is not the volume of service, or who provides it. What matters is that the service is delivered with certainty, is flexible and takes account of the vast array of changing and different needs, that it is reliable and that people come when they say they will come.

Mr. Rowe

The hon. Lady is making a very powerful point, with which I wholly agree. Will she recall that there is at present before the House the Disabled Persons (Services) Bill, the purpose of which is to enable those who are particularly severely disabled but who wish to hire and fire some of their own staff to be able to have the cash to do that, rather than to have to get staff through some third party such as a local authority?

Ms. Jowell

Certainly disabled people and the organisations representing them will welcome the opportunity to have the cash to buy the care and support that they need. When I visited the centre for independent living in Boston some years ago, I was struck by the different approach to disability. That centre ran what was, essentially, a consultancy on the employment and management of teams of staff who supported disabled people, who then determined how the staff could be deployed so that they could go about their daily business in the way that they chose. That really represents freedom and freedom of choice for disabled people. The principles addressed by the hon. Gentleman are absolutely right and will be welcomed by disabled people.

This is also, perhaps, the moment at which to emphasise the great distress and anger among disabled people at the Government's decision to wind up the independent living fund, and their failure so far to provide any adequate explanation of how the alternative arrangements will be made. The independent living fund was probably the most popular benefit available to disabled people, precisely because it offered, on the basis of assessment, a degree of choice as to the nature of the care that people received and the support that they purchased for themselves, so that they could make their own choices about how they lived in their community.

It is very much to the Government's shame that they have chosen to wind up the fund in the context of the introduction of legislation which is about choice for disabled people, and it flies in the face of the choices which disabled people would themselves make. If disabled people were asked whether they wanted retention of the independent living fund or replacement along the lines that the Government propose, I guarantee that they would give the fund an overwhelming vote of confidence.

Returning briefly to the hon. Gentleman's intervention, of course we want to see an end to the loophole whereby well-intentioned local authorities have cash available to disabled people but have had to use a voluntary organisation or a third party as a conduit.

The essential tests against which we should be judging the provisions before the House today are that services are reliable—that the promised bus actually arrives—and that people have the opportunity to use services of high quality which they do not feel demean them as users. It is to our eternal shame as a country that so many disabled people and elderly people are being cared for in residential and other settings which none of us would choose for our families and which none of us who manage the services would choose. They are services for people who are unable to exercise any choice. If the implementation of this policy achieves the eradication of any stigma associated with using community care services, it will be a great tribute to those throughout the country who have worked to make the policy succeed. That is the important test.

It is extraordinarily difficult to achieve the complex objectives of the policy in practice. Described simply as the desirability of looking after elderly people in their own homes, providing support to carers, and responding to need rather than just delivering services, it all sounds incredibly straightforward. However, the hon. Member for Chislehurst (Mr. Sims) and other hon. Members have sat with me on the Select Committee during recent deliberations, and we have heard from local authority associations, regional health authorities and the social services inspectorate about the complexity of turning local authorities inside out and getting them to change course from being providers of services to developing the capacity to respond to people's needs.

I well remember a recent conversation with an elderly lady who was being assessed for community care services and whose needs were therefore being judged. She said, "I know that I am coping if my windows are clean." It is being able to meet sensitively that kind of very personal test of competence which is so terribly important to so many elderly people. The capacity to do that is one proof of how far local authorities can shift from being Henry Ford-like providers of services—on any terms so long as it is meals on wheels or a bit of residential care—to addressing the complex task of meeting the multiplicity of individual needs, which may include a preference for having clean windows.

Behind the general consensus on the desirability of community care, there are enormous tensions and the fault lines are beginning to open. It is around the opening of these fault lines that the consensus which saw this policy, which is now being implemented, through the last Session of Parliament is breaking down. It is very hard to reconcile the Government's protestations about the importance of choice and their determination to meet people's needs rather than simply deliver services with the increasing debate about the adequacy of the money being made available, and the glaring discrepancies which have been revealed between the estimates of the local authority associations representing both political persuasions and the calculations made by the Government.

We must ensure not necessarily that agreement is reached at this stage on the precise figures, but that the Government's mind and, perhaps more importantly, their cheque book remains open, so that they can come to the rescue not just of local authorities, but of those elderly people who may be caught towards the end of this financial year with a local authority which cannot buy any more residential care for them, regardless of their need. We want an assurance from the Minister today that the Government's mind is open and that they will accept the evidence of underfunding as the first, very tricky year of implementation proceeds.

The second area of great concern, to which I have already referred briefly, is that of the loss of the independent living fund. Again, we look forward to hearing from the Minister just how the promise of choice is reconciled with the decision to withdraw a fund which for so many disabled people has represented what might be the only, rather limited, opportunity to exercise choice.

We must also address the real risk that an imperfect and inadequate system, led by social security, within which people's entitlement was clear, is being replaced by a system which relies very heavily on discretion and in relation to which individual service users and carers will have no redress and no right of appeal. I am terribly concerned that elderly and disabled people throughout the country may become prey to the discretionary judgments of social workers rather than having an explicit statement of their entitlement.

We also have to take account of the other pressures that local authorities are facing and which will impact on their ability to deliver properly what this policy promises. The Association of Directors of Social Services has provided compelling evidence of the cuts in social services which are likely to be implemented as a result of the requirement to meet Government spending targets over the next year. We know that the consequences of cuts in those services will be a betrayal of the promise to carers of improved and increased care and support. Ultimately, the one source of support that is always there is the carer—the friend or relative who provides most of the care and support for a disabled person.

On the basis of what we have heard and seen, local authorities are taking on the new lead responsibility for community care with great enthusiasm. In so doing, we and they want to ensure that they are not being set up to fail. There are grave risks of fragmentation in their critical lead role. As Sir Roy Griffiths rightly said in his report some years ago, it is through that lead role that the fragmentation which has so bedevilled the proper and seamless development of community care in the past will end.

Fragmentation remains a danger in two ways. The first is the lack of definition between social and health care to which other hon. Members have referred. It is still possible that an elderly person can leave hospital and, on the grounds of his continuing need for nursing care, be referred directly to a nursing home with which the health authority has a contract. That person will receive the nursing care free of charge. However, another elderly person who is placed in the same nursing home through the local authority assessment route may be required to top up or make a personal contribution to the cost of his care because his social rather than nursing needs were deemed to be paramount. Studies which have tried to establish the distinction between nursing care need and social care need have proved what a difficult boundary that is, but it is terribly important that it does not become a source of fragmentation and inequity in the new system.

The second risk is that general practitioners will not be sufficiently co-operative with the lead role of local authorities and, especially, that after 1 April this year GP fund holders may use their enhanced ability to purchase community health services on behalf of their patients so as to circumvent the local authority assessment procedure. Even before 1 April, we must anticipate some of the problems which may arise and which could defeat the policy. We must be assured of the Government's open-mindedness and their willingness to take action to avoid fragmentation.

As I represent the constituency of Dulwich in London, I wish to deal specifically with some of the problems facing London. A major problem was identified in the mid-year population estimates published by the Office of Population Censuses and Surveys. It showed a substantial loss of population in London, especially among elderly people aged 85 and over. My borough of Southwark shows a staggering loss of 32 per cent. in its population of those elderly people. Clearly, that has severe knock-on consequences for the grant that Southwark will receive.

At a recent meeting which I, the hon. Member for Chislehurst and the London local authority associations attended, the Minister accepted that such a loss of population could not be accounted for merely by the fact that elderly people from London boroughs who need residential care have to be referred to private homes on the Essex or south coast. He said that we had to look for other reasons. We are grateful to the Minister for the undertakings that he made in that respect.

I hope that the Minister will also keep an open mind about the inequity of the distribution formula and its impact on London authorities. My own authority of Southwark stands to lose about £800,000 as a result of that formula.

Those problems must be dealt with as a matter of urgency. If not, the old lady from Dulwich to whom ray hon. Friend the Member for Wakefield (Mr. Hinchliffe) referred will not have the choice of living in her own home in my constituency but will surely be shipped off to the Essex coast or the south coast, perhaps against her will. She will have to go because she has no choice and it is the only place where the residential care is provided. We want the Government to deal with those problems with an open mind as the policy unfolds, so that the good principles behind the policy will be safeguarded in practice.

6.36 pm

Mr. David Congdon (Croydon, North-East)

This has been an interesting debate on an important subject. Most hon. Members are fully committed to care in the community and what it involves, although, as the date of implementation comes closer, some concerns are inevitably raised.

However, community care is nothing new. It has been practised by many social services departments for many years. I do not believe that there will be a dramatic change on 1 April except in the critical aspect of the assessment process to which the hon. Member for Dulwich (Ms. Jowell) referred.

I agree with the hon. Lady about care in the community and the sensitivity with which services should be delivered. In some ways, residential care is very easy to provide: it is usually provided in one building and, regrettably, people can be put into residential homes and forgotten because one knows that, broadly speaking, they will be cared for reasonably well.

However, under care in the community there is a much greater risk of services not being delivered sensitively and, certainly, not always being delivered at the right time, especially when a large number of agencies are involved. It will be a challenge for all the agencies to ensure that they deliver care in the way that it needs to be delivered to the people who need it, when they need it.

Reference has been made to the residents of Dulwich, a constituency that I have the privilege of knowing very well. As some hon. Members will know, in a former incarnation I was chairman of the Young Conservatives in Dulwich. I suspect that, far from being shipped off to the south coast, many elderly residents of Dulwich come to the many excellent independent homes in the borough of Croydon. Croydon has many such homes, which is why it is the only London borough that appears to benefit from the distribution of grant that we are debating.

I deal now with the independent sector in general. I thought that the hon. Member for Wakefield (Mr. Hinchliffe) was rather unfair when he referred to the growth in the private sector as a free market experiment. We should not forget that many elderly people up and down the country have received excellent care as a result of the growth in the independent sector. We are very well aware of the fact that many of those people could have benefited from care in the community. Equally, however, there is a strong case for the independent sector.

Mr. Hinchliffe

Hon. Members who are present have heard me describe cases involving constituents who have ended up in private institutional care many miles from my constituency, at a cost to the state twice as high as would have been the cost of supplying the services needed to enable those people to remain at home. That is my objection to what the Government have done to encourage the explosive expansion of private sector care.

Mr. Congdon

I understand and appreciate that objection. The important point that I am making is that people with money can afford to buy residential care, wherever they want it, without any assessment, whereas people without money cannot afford to do so. The provision of income support has enabled the latter to secure residential care. However, there is a downside. If community care had been properly provided by the social services departments to which the hon. Member for Wakefield referred, people could have benefited from it. I readily concede that point. In fact, many social services departments have properly expanded their services to meet that very demand.

Equally, however, many local authorities have used their planning powers responsibly and sensibly to ensure that obstacles are not placed in the path of those wishing to set up independent homes. I make that point as someone from a borough which has an enormous number of independent homes and which came in for much criticism for giving planning permission for them. But the result is that many residents of my borough have been able to secure the required residential provision within their localities.

I take issue with the remark of the hon. Member for Wakefield that community care has become a byword for neglect. I certainly concede that in some areas there has been a shortfall in the provision of services for the mentally ill. In general, however, it is something of a disservice to those involved in community care to use such terms.

In this context, we must bear in mind the enormous growth in funding for health and personal social services. I was intrigued by the comment of the hon. Member for Wakefield about funds going back to the Exchequer. If funds have gone back to the Exchequer, I do not know where they have ended up. Over the past 13 years, there has been a growth of 60 per cent., in real terms, in NHS expenditure and an increase of two thirds in real terms in social services expenditure. I do not think that there has been a bonanza in this respect.

I understand the concern about the ability of social services departments to cope, given the amounts of money being allocated to them. Reference has been made to the fact that many social services departments are saying that, following the rate support grant settlement, they will have to cut their budgets in the forthcoming year. That point was made by the hon. Member for Cheltenham (Mr. Jones). I regard that argument as a little odd. Everyone says that community care is very important. Certainly, those involved in local government say so. However, when it comes to the crunch, some authorities do not seem to be prepared to put their money where their mouths are. They should look at all their services and decide their priorities.

I am pleased to say that the council of which I was a member for 16 years was able continually to put growth money into social services. In the year beginning 1 April 1993, excluding the money for care in the community, there will be an extra £500,000 for the social services budget. If local authorities regard community care as a priority, they should do likewise in respect of their social services budget and should look to other services with a view to cutting out waste. Thus they could protect a valuable personal social service.

There are two issues before us: the scale of the funds being made available by the Government and their distribution. It is always possible to argue, as my hon. Friend the Member for Mid-Kent (Mr. Rowe) did, that there will never be sufficient funds to meet all needs. However, we have a responsibility continually to put extra resources into health and social services. That has indeed been done.

I had a particular interest in the discussion in the Select Committee on Health on the question of the appropriate level of funds to be allocated to social services. In broad terms, I was satisfied that the level and the basis of the calculation were reasonable. One can always argue for more, but one is dealing with a projection of the number of people who, under the previous rules, would present themselves as being in need of, and would secure, care in residential homes, and of what will happen after 1 April. That is an important point.

Also important is the fact that the Department of Health and its Ministers must review at the strategic level the numbers being provided for in the coming year, to determine whether the amount of money transferred is at the right level for future years. It seems to me that that must be done. No one can guarantee that the right amount of money is being transferred. The proof of the pudding will be in the eating.

An equally important issue is that of distribution. It is not surprising that a fair number of local authorities are protesting about the amount of money that they are receiving. In fact, I should have been very surprised if they had not done so. I should probably have wondered whether the Government. in their allocations, had been too generous.

It is difficult to make a fair allocation. I fully understand the arguments about basing allocation on standard spending assessments. I equally understand the argument about the need to avoid decimating the existing independent sector and pattern of provision. It is not for any ideological reason, for the purpose of protecting the private sector, that I say so; it is because many of those homes are providing good care.

At a time of great change—and there will indeed be great change over the next few years—it is important to avoid being too disruptive on day one. We do not know in detail how what is being introduced will work in practice. That is why I am very much in favour of an evolutionary approach. I might draw a comparison with the NHS reforms, in which case, although the purchasers enter into contracts with providers, the contracts, in general, have been in a steady state in year one.

That approach is rightly being adopted, in broad terms, in the case of care in the community. I say so with some caution, as we all wish to see resources switched, over a period, from residential care to community care. I realise how difficult it is to achieve that. Even when one sets out with such an aim, one has to be very careful to ensure that, over a period, resources are switched.

On allocations, there is concern that some London boroughs are losing—many would argue that that is the case. However, it is important to bear in mind the fact that the split between SSAs and income support is being treated in such a way as to ensure that an increasing proportion of the money allocated will be based on SSAs. That is an important point.

If we take the other money in the revenue support grant, these proposals should be seen in the context of representing an increase of 15 per cent. in SSAs for social services for local authorities. That is a significant increase. I hope that that will give local authorities the opportunity to get to grips with the job and successfully implement community care.

It is ironic that for many years local authorities have criticised the Government for taking responsibilities from them. Much play has been made of that. Local authorities put in a very strong bid to be given responsibility for care in the community. Many did not think that the Government would have the courage to give them that responsibility. The Government have had the courage to do so, and it is now up to the local authorities to get on with the job and do the best they can to implement the community care proposals sensibly and sensitively. Over the next year they should have a lively dialogue with Government about reviewing the amounts of money if they believe they have not got the necessary funding to implement their policies. At least they should get on with implementing the proposals for the benefit of the people in their communities.

6.50 pm

Mr. Malcolm Wicks (Croydon, North-West)

It is a great pleasure to speak in the debate because it concerns one of the most important issues facing the country. The timing is good, because it is a pleasure for me to follow the hon. Member for Croydon, North-East (Mr. Congdon). It means that at least the north of Croydon has been well represented in the debate. I thank you for that, Mr. Deputy Speaker.

My colleague talked about Croydon. I too should like to start my speech by talking about Croydon, but rather differently. In my judgment, formed from talking to many people in Croydon, the dawn of the new community care age is opening darkly. The social services authority, Croydon council, is already making cuts in preparation for the new regime.

Yesterday I visited Bensham lodge, an old people's home in my constituency, which is facing the axe. Another home in the constituency of the hon. Member for Croydon, South (Mr. Ottaway) is also facing the axe. Why? I remember experts telling us that old people's homes were not institutions but the homes of the old people; we were told that they were places where the old people lived and that the residents should be treated like other people who were living in their own homes.

What did Croydon council do? The council marched in one day and said to the residents, many of whom are frail, "The home will be closed. Here is the timetable." Many people were distressed. To that they were tearful is an understatement. The carers and relatives were concerned. They telephoned and asked me to go to the home to find out what was happening.

I visited the home yesterday and I was appalled. I tried not to raise the issue of closure with the old people because I knew how upset they were. I wanted to find out about the atmosphere, but the old folk themselves said to me, "Look at what is going on. The home is going to close, is it not? Why do we have to go?" It is a splendid home in very good grounds in the heart of Croydon and it is much loved by the residents and their relatives.

Now the council has had to think again briefly because properly a court elsewhere has said recently that councils cannot treat people in that way. The court decided that the councils could not close homes without consultation. Croydon council is now going through a consultation process. Cynically, people on the committee are saying that it is a process which they have to go through because the court has said so. As I understand it, it is not a proper process of consultation whereby old people will be listened to.

If there was proper consultation, there might be a change of heart and the home might be safeguarded. Instead, I fear that the residents will be shunted out to the private sector, not the independent sector. The provision of accommodation will be put out to tender and people who have lived in the same home as friends for many years will be split up. I take this public opportunity to urge the director of social services in Croydon and the chairman of the social services committee to visit the home, as I did, not to talk but to listen to what the old people in Bensham lodge have to say.

The fact that Crossfields, an excellent sheltered workshop in Croydon, for people with disabilities also faces the axe is another cause for concern. That workshop showed how employment can be a key factor in community care. The people were doing good work making windows and other things. Because of the recession, and because Croydon council wishes to withdraw a grant, the workshop faces closure. The people may be offered a day centre, but they do not want that. They want to work, like the rest of us: it gives some meaning to their lives. Work is an important aspect of community care for those with learning difficulties or severe mental handicap.

Because of the proposed closure of the old people's home and the sheltered workshop, I am not as confident as the hon. Member for Croydon, North-East about the prospects for community care in our borough.

The trends are clear, and I think we all agree on them. We see a reduction in public sector residential provision for old people. That is happening in the national health service and the public sector too. By contrast, there is a huge increase in the private sector. When he kindly let me intervene in his speech earlier, the Minister quarrelled with me and said that the independent sector was not the private sector but included the voluntary sector as well. I conceded that in my intervention, but I said that it was essentially the private sector.

Since the Minister finished his speech, I have looked at the figures to see what has happened to residential places in the public sector, the private sector and the voluntary sector between 1980 and 1990. I quote the data from Laing and Buisson, consultants of whom the Minister will know. That shows that, between 1980 and 1990, the local authority residential sector has declined by 3 per cent.; the voluntary sector has declined, not increased, by 7 per cent.; only the private sector has increased, by 416 per cent., if my calculator has not let me down; the private nursing home sector has increased by 457 per cent. Therefore, the growth in the so-called independent sector has been in the private, commercial sector, so let us have no nonsense on that score.

I do not know about the domiciliary sector in Croydon, but if the Minister thinks that there is a huge difference which makes his statement valid, no doubt he will remind me of that in his reply to the debate. I am talking about the private commercial sector, some of it good, some of it excellent, some of it shabby and awful where none of us would want to live or want our elders to live.

I focus briefly on an issue not referred to much on the Government Benches—the carers. The distortion of the community care policy into a residential care policy is extraordinary. The whole philosophy of community care was, strangely enough, about community care and not residential care. Because of the expenditure fix and the ideological concern of Government, regardless of need, to boost the private commercial, for-profit sector, we are now talking about residential care.

Sadly, when we should be talking about community care and the needs of carers, we are discussing the finances of residential care. We are doing it narrowly. We are not talking about employment, housing and the other dimensions of community care. What should have been a wide debate has become remarkably narrow. I think I know why the Government do not talk about carers any more. Of course, in speeches, they pat them on the back and say how wonderful and important they are, but we do not hear so much now about a brave new era after 1 April for the carer and those being cared for genuinely in the community. I wonder why.

I am struck by the evidence from the new Office of Population Censuses and Surveys general household survey. In 1990, it updated a survey of carers first done in 1985. The data were published a few months ago. The information has not received the attention is deserved. It showed that 15 per cent. of the people are carers, looking after elderly relatives or people with handicaps or disabilities; 13 per cent. of men and 17 per cent. of women are carers. That adds up to a huge army of carers, 6.8 million—an army of health and social service carers far greater than we find in social services departments of the formal national health service. It is the most important army, but the forgotten army of the welfare state. Some are under enormous burdens; one in 10 provide care for 50 hours or more a week. Without that enormous exertion of care, community care would totally collapse.

A problem with the House is that we are unrepresentative. Given the numbers of carers in the community, we would, if we were truly representative, number among us about 90 carers. I am sure that there are some who are doing excellent work, but if 90 Members were carers our debates would contain a greater sense of experience, expertise and passion. That would certainly be so if we were more representative in terms of gender and therefore in terms of care.

Imagine the difference if 90 Members were carers. The President of the Board of Trade, if a carer, would have to phone the Prime Minister and say, "I regret that I cannot close down the coal mines today because an elderly relative needs my care. I must take her to hospital. The home help has not turned up, so I cannot come to work today. Please look after the mines until I return." The Minister of Agriculture, Fisheries and Food might have to phone to say that he could not attend an official lunch or dinner. Or the Secretary of State for Transport would have to phone the office to say, " I regret that I cannot come in this week because there is a crisis of care in my family. I fear that I cannot play with my railway trains this week."

If a representative number of hon. Members were carers, the whole debate would be changed. I am not being frivolous. I give those examples to show how serious I am. If we had a better understanding of what is going on, we would have genuine community care in Britain, especially if more men and politicians were involved in caring.

The general household survey review of carers for 1990 makes interesting reading, especially when the figures are compared with the situation in 1985. For example, during those five years, there was a greater recognition by Ministers of the needs of carers. That recognition manifested itself in speeches and rhetoric, although it did not appear in reality and resources.

Carers were asked, in effect, "How often does the person for whom you are caring receive regular visits from the health and social services—the doctor, district nurse, home help, social worker and so on?" In 1985, 22 per cent. of those being cared for by carers had a regular visit from the doctor. By 1990, the number had declined to 16 per cent. For district nurses, the position was steady—only 15 per cent. received regular visits from a district nurse in both 1985 and 1990. For health visitors, there was a slight decline, from 6 to 4 per cent.

Ministers may say that community care, domiciliary care and support for carers is moving in the right direction, but they should accept that, while my hon. Friends and I say that that is nonsense and Conservative Members say it is true, the facts do not support their claim. I appreciate that in this place some people do not like the facts to get in the way of a good argument, but in this matter the facts speak more loudly than our speeches, and the facts show that we were providing less care for carers at the end of the 1980s than we were five years previously. In other words, all the talk about supporting carers is only talk. It is not happening in reality because we are providing less care.

If the Minister has evidence to prove that what I say is wrong, I shall be delighted to listen to him. I fear that I am right. Indeed, my fear about our neglect for the carer goes further. Because we are now emphasising residential care, hard-pressed social service authorities will have to use the domiciliary care that is available to them for those in the most acute need. Those authorities will say, "If you have a carer, you are not in acute need, so we will not provide more support for you and your carer." That will result in even more neglect of the carer.

When I spoke on the subject of community care shortly after coming to this place, I noted how often, in the sphere of child care or community care, a case of abuse or a tragedy had to occur to arouse public and parliamentary concern and, thank goodness, sometimes governmental concern. I asked then whether we had to continue along that road for ever, with a tragedy having to happen before action was taken.

Some months later, we began to take mental illness seriously, but only after an unfortunate citizen with schizophrenia jumped into a lion's den. What a sad commentary on society that was. It was also a sad commentary on the Government, because only after that incident did they start to bustle. I can imagine the meetings that took place behind closed doors as Ministers thought about the statements they would make. Ministers should walk around Westminster, go into the underground station or stroll up Victoria street and see what is happening. Why did somebody have to jump into a lion's den before action was taken?

There is already documentary evidence—there have been some excellent television programmes on the subject—to show that there is a danger that, out of frustration, after caring day after day, year after year, carers may sometimes hit out at those for whom they are caring. We must understand that situation. I appeal to the Government not to wait for tragedies and cases of abuse to occur in the sphere of true community care affecting the overstressed carer before a Minister appears before us and says, "I did not know it was happening. It is remarkable. I am setting up a committee of inquiry and we intend to take action."

I hope that, when replying to the debate, the Minister will talk about community care and not just about residential care. I urge him to spell out not just his ambitions for the carer but the reality of what is being provided. If he thinks that the evidence I have given about a lack of support for carers is wrong, I hope that he will say enough to prove me wrong. Let us hear about community care in this debate. After all, it is meant to be on the subject of community care.

7.5 pm

Mr. Ian McCartney (Makerfield)

This has been an excellent debate, with considered and constructive contributions from hon. Members in all parts of the House. It has reflected, particularly for hon. Members such as the hon. Member for Chislehurst (Mr. Sims), a long-term commitment to community care. I congratulate him on taking the opportunity to plunge a dagger between the Under-Secretary's shoulderblades in relation to the Minister's advocacy and assessment procedures.

The hon. Gentleman's remarks have also saved me having to make about half the speech that I had intended to make, because much of what he said represents Labour party policy. I invite him to sit on these Benches when we next debate the subject: that particularly applies to his remarks about advocacy and assessment.

The Minister introduced the debate in a rather blasé fashion. He appeared self-congratulatory as he set out his view of community care. He set himself up as a sort of Father Christmas, when in reality he is a bit of a Shylock. It is clear from the way in which the funding regimes have been constructed that a pound of flesh has been removed from virtually every social services sector. A dagger has been plunged into the heart of the concept of community care and, as my hon. Friend the Member for Croydon, North-West (Mr. Wickes) said, we are left with institutional and residential care as the way in which the Government are driving forward the concept of the market provision of care in the community.

The Minister also abdicated responsibility for the mental health services. Indeed, he neglected to refer to the subject, apart from a brief comment in answer to an intervention. He failed to identify any ring-fencing mechanism for resources for mental health services. He rejected the idea of the provision of financial regimes to achieve flexibility in providing employment projects, advocacy and assessment, permanent housing, non-clinical crisis houses and resources for residential care in appropriate settings, along with respite and crisis care for those with mental illnesses or learning disabilities.

It is tragic that, in a debate such as this, the Government should have abdicated responsibility in many other spheres. For example, they look to the Department of the Environment to set financial criteria, with the result that, from 1 April, about 80 per cent. of social services departments will cut their core services, even though those services are vital to assessing the level of facilities in the community, the standard of those facilities, and access to them by those with a mental illness or mental disability.

The Minister behaved disgracefully as he skated over the need to accept responsibility for the preparation of care strategies for offering choice and quality to clients and carers. He offered no protection for failed contractual arrangements, for protection for clients' rights and for standards of care in bankruptcy situations. He knows that such situations will arise because, in the privacy of discussions in the Department with various organisations, he has admitted to expecting a failure rate of between 30 and 40 per cent. in the next financial year in the private care sector.

That represents a phenomenal number of businesses in that sector likely to go out of business. Even so, only weeks before the introduction of community care, we do not know what protection arrangements have been made when contractual arrangements are broken. Local authorities will be left with the responsibility of clearing up the mess when, for various reasons, homes are unable to continue trading. Nor did the Minister show any sense of the need for a mental health service with a strategy, objectives, minimum requirements and some clarity of purpose to be developed.

I believe that the Minister should pay attention to six basic requirements for mental health services in connection with community care. They must be effective and challenging, created and fashioned by the experience of people involved in the system. They must be non-paternalistic and user-led, enabling and assessing choices and providing a real right of advocacy on behalf of client groups. They must be locally based and accountable and linked to a core of service providers, involving appropriate housing and primary care resources. Strategies must allow the full potential of people with a mental illness of disability to be realised. They must be well resourced and highly motivated and staff must be trained to the highest possible level.

That all requires resources at local authority level, yet, when the Government announced a £34 million fund for fighting mental illness last November, they operated a lock and key principle. Everybody welcomed the statement that additional resources were to be provided for mental illness services—but when we read the small print we realised that there were two major flaws in the proposed expenditure. First, local authorities would have to match payments on the grants pound for pound, at a time when the Department of the Environment is forcing local authorities to make real cuts in their budgets for social services and housing, and across the whole care spectrum. Authorities are also having to make real cuts in capital expenditure, as Environment Ministers told us in the debate on the revenue support grant settlement last week.

Furthermore, only 70 per cent. of the project funds will come from the Government; the remaining 30 per cent. will have to be met from local authorities' own resources. That was a simple and devious financial device which will mean that many local authorities will find it impossible to take up the resources and develop the strategies and objectives that I have outlined. It means that, after 1 April, there will be no real opportunity to develop core services for people with a mental illness.

It is not only Labour and Liberal party members in local government who complain about the way in which the Government have skewed the financial settlement towards the private sector, thus locking out choices and opportunities for other methods of community care. All those involved in community care who advocate on behalf of people suffering from a mental illness have expressed extreme concern because the transitional grant will not be spent on mental health services and because distribution and access to the grant will be arranged so that resources will be insufficient to provide the quality of care demanded in the White Paper.

There will be disarray in decision-making between what the Department of Health says will be the resource levels for local authorities and the reality. There will be a gap between the assessment and the requirement that local authorities provide services for individuals and collections of individuals suffering from a mental illness. There is a real conflict between assessment and advocacy.

There is plain dishonesty when the Department of Health tells local authorities that they must give the client an open and fair assessment that clearly shows his or her needs, and that the client must have an opportunity to advocate for himself or herself—or that others should have the opportunity to do so on their behalf—while in the background the same Department sends local authorities a notorious circular saying that that might not be quite the way in which they should proceed and that they should not provide the client or the advocate with the full assessment arrangements or allow clients access to information in their computer data banks which could determine whether the assessment was appropriate and whether the level of needs revealed by the assessment was to be met.

That is disgraceful. The Government are putting clients, professionals and carers into potential conflict. People should be working together in the community, yet the Government are introducing mistrust of the assessment procedures from the outset. That mistrust will provide opportunities for legal challenges and resources will be spent in the courts instead of delivering professional services and access to those services.

The circular is a cowardly attack by the Government on those least able to defend themselves. The Government have hidden behind the responsibility that they have given to councillors and staff, hoping that, when legal challenges are made, the blame will be pushed on to local authorities rather than on to the circular. At the last minute of the debate, they have introduced confusion, leaving local authorities unable to assess at this stage whether to follow the circular or the original Government advice.

Things are even worse than that. Many local authorities are already involved in assessment procedures and have had advice from their district auditors. For example, in Gloucestershire the district auditor has already met members and officers of the county council and issued the authority with written guidance on assessment. A letter describing the meeting says:

When we met the District Auditor she was very explicit about her advice that Members should make decisions and not leave it to officers and … that we should be open to and honest about the assessment of need. The district auditor has submitted a letter to the authority setting out the requirements. What are the councillors and officers to do now? Do they follow the written advice of the district auditor? Do they follow the circular? Do they leave it to the courts? Or do they leave it to the Under-Secretary of State for Health?

The position is intolerable. Only a few weeks before taking up their community care responsibilities, local authorities have been given one lot of advice by the district auditor and two different sets of advice by the Department of Health. The Minister must sort that out quickly and assist local authorities or provide them with the management letter sent by the district auditor to Gloucester county councillors.

Will the Minister give us some insight about contingency funds in the event of contractual obligations not being undertaken? In the transfer of resources from local authorities for the provision of individual care packages, it is vital that, when those packages cannot be delivered, there is financial provision for alternative facilities of at least the same quality, and in the same area, within days or hours of the breakdown of the contractual arrangements.

If a care home goes bankrupt, we cannot have local authorities scrabbling round at the last moment trying to find alternative placements for the elderly confused—people who, by the very fact that they have been committed to such institutions, must be frail and must suffer from a mental illness or from mental confusion. That cannot be countenanced in any circumstances. The Government should say now what contingency funds will be available if contractual arrangements are broken, as happens when a care home goes into liquidation. If they are not prepared to tell us now, they should prepare a circular at an early stage.

The Minister should also tell us the position on discharge plans. The Government made great play of discharge plans and talked of the need for discussions between local authorities, health authorities and trusts, but there should now be public honesty about the nature of the plans. Discharge plans should be public documents, so that not only the local authority and those involved in the delivery of the service, but the client groups and the clients themselves have access to the plans and information about them. Then they would know from the outset whether their interests were being met by the discharge plans and whether the assessments concerned allowed them the opportunity to object or to appeal.

The plans should not be excluded from the client's right to knowledge—both as an individual and because plans would be public documents. The community in the area concerned would know what the discharge plan was and what effect it would have. Perhaps the Minister can explain the effect of section 43 of the National Health Service and Community Care Act which deals with interventions.

Mr. Yeo

I shall not have enough time.

Mr. McCartney

The Minister says that he shall not have enough time, but he had plenty of time earlier. I hope that he is not making excuses, as we are all limited by time. He has had months to come to the House and has waited until there were only weeks to go before the implementation of his proposals to sneak in a three-hour debate on a Thursday night, whereas the House should have been allowed proper consideration of them. He should not object to Opposition Members asking for information. If he does not have time, perhaps he can give a commitment to offer me and my colleagues at the earliest opportunity a meeting at the Department or a debate in Government time about the consequences or the proposals.

Finally, perhaps the Minister can explain why yesterday the Under-Secretary of State for Social Security could give no commitment to the Select Committee on Statutory Instruments on which groups would be able to claim from their local authorities a top-up on income support from 1 April. It seems incredible that the Minister did not know the consequences of the proposals. There appears to be a bit of a shambles between his Department and the Department of Social Security. Will he state clearly, within seven days if possible, the categories affected, so that local authorities, client groups and those who advocate them, can reach reasonable conclusions on the level and quality of care in the community for those who require services under the National Health Service and Community Care Act 1990.

7.21 pm

Mr. Yeo

We have had a most useful debate, characterised by the high quality of the speeches of hon. Members who have spoken often with professional or local government expertise. I am sorry that as the hon. Member for Makerfield (Mr. McCartney) has used 16 of the available 26 minutes, it may not be possible for me to respond as fully as I would wish to all the points that have been raised, but I shall do my best in the time available.

I am glad to see the return to the Chamber of the hon. Member for Dulwich (Ms. Jowell) whose attendance during the debate has been somewhat spasmodic. I advise her in good faith that, if she wishes her contributions to be taken seriously, it helps if she attends the bulk of the debate—[Interruption.] The hon. Member for Brent, South (Mr. Boateng) has just walked in during the past minute or two and is not aware of the fact that the hon. Lady was not even here when the debate started.

Several hon. Members referred to cuts. We are talking about a policy which has experienced a two-thirds real increase in expenditure since 1979. The standard spending assessments for personal social services have risen by more than one fifth in real terms in the past three years. The increase in standard spending assessments for this particular local government function has been higher than for any other except the police. If one includes the special grant that we are now about to approve, the resources available for personal social services in 1993–94 are more than one third higher in real terms than they were only three years ago.

The record of commitment that the Government have shown in allocating resources seems to be unmatched. The transfer money from the Department of Social Security was calculated on the basis of an assumption that income support limits would rise by 4.25 per cent. In fact, they have risen by 3.6 per cent., so even the transfer money has been inflated by assumptions which were calculated to be as generous as possible to the authorities receiving them.

The president of the Association of Directors of Social Services said after the announcement last October: In the context of the present economic climate", my right hon. Friend the Secretary of State for Health

has done well to get this money and to give us specific funds for the second and third year of implementation". I began with some sympathy for the hon. Member for Wakefield (Mr. Hinchliffe), as he had a difficult task this afternoon. He had to try to find grounds on which to attack or criticise the policy or its implementation. I am only sorry that in doing so he seems to have turned to his sponsors, the National Union of Public Employees, for advice. That is the only explanation that I can think of for his hostility to the independent sector.

Mr. Hinchliffe

Will the Minister give way?

Mr. Yeo

I am sorry, but the hon. Member for Makerfield has taken up so much time, so I will not give way. The hon. Member for Wakefield has had a good chance to speak today.

The statutory direction on choice that we have issued, and which binds local authorities to recognise the preferences of individuals in terms of where they go to receive residential care, does not seem remotely consistent with the hon. Gentleman's allegation that the policy is provider-led. It is clearly user-led. What did seem to be provider-led was the hon. Gentleman's assertion that choice for local authorities on how to treat drug and alcohol abusers was somehow constrained by the decision not to ring fence funds for that purpose.

Ring fencing would restrict the freedom of local authorities. It would perpetuate exactly the emphasis on residential provision for that group that the hon. Gentleman quite rightly is keen to see ended for other groups. Nothing whatever prevents local authorities from purchasing the services that are needed.

The hon. Member for Wakefield, in a moment which must have been intended as humorous, suggested that we should wait for independent sector provision to emerge before imposing our 85 per cent. condition—[Interruption.] If he consults Hansard he will find it. I am not quite sure how long we would have to wait in the London boroughs of Lambeth and Hackney for such independent sector provision. I wonder whether independent sector providers would even be able to talk to such authorities if we had not required them to do so.

My hon. Friend the Member for Chislehurst (Mr. Sims) paid tribute, for which I am grateful, to the community care support force. Its future is under consideration and it certainly will not continue in its existing form. There will, of course, be other monitoring of the policy after April through the regional health authorities and the social services inspectorate. My hon. Friend referred to the lateness of the figures, but in terms of individual authorities they are very little changed since the publication at the end of November of the split by function of next year's revenue support grant. However, I recognise that local authorities are now drawing up their budgets.

The £100,000 change in Bromley to which the director of social services drew attention is the result of the withholding from the report of the £20 million pending the outcome of the judicial review, so I am confident that my hon. Friend will find the final figure closer to what was originally expected.

He made an interesting and important point about unmet need. It is my view that the local authorities themselves are best placed to assess the need in their areas. That is far better than someone sitting in Whitehall trying to second-guess at a distance what will be needed in each authority. It may save time if I write to my hon. Friend about migration adjustment as it is a rather technical point. I shall be happy to copy in the hon. Member for Wakefield if he wishes.

Local authority topping up is another important point. We cannot sensibly require local authorities automatically to top up the costs of residential accommodation for someone whose placement in that accommodation was not the decision of that local authority, or where there was no opportunity to carry out an assessment. However, we are about to clarify what the local authorities should be doing.

The hon. Member for Cheltenham (Mr. Jones) referred to the Association of Directors of Social Services survey. In my judgment, that was largely an exercise in defending personal social services against the encroachments of other local authority expenditure areas. In Gloucestershire it is much needed. Social services spending there is substantially below the level set in the personal social services standard spending assessment. It is precisely for that reason that we felt it necessary to introduce ring fencing so that Gloucestershire county council could not remove for other purposes the funds that we wanted to go into community care.

As for the numbers that we are assuming for transfer, we have assumed, based on past trends, a growth of 30,000 a year in Great Britain. Of course, that does not take account of the fact that we believe that in the medium term the policy will result in some diversion from residential into more domiciliary care and improved day and respite care services. The hon. Member for Cheltenham may find that my hon. Friend the Member for Croydon, North-East (Mr. Congdon) can provide some helpful advice about how priorities should be reflected locally.

My hon. Friend the Member for Mid-Kent (Mr. Rowe) apologised in advance for the fact that he could not stay until the end of the debate, so I shall deal with his points separately. My hon. Friend the Member for Croydon, North-East made a constructive speech. I do not know whether funds for this policy will be adequate. As I said, they are certainly much more substantial than anything ever envisaged before and much more substantial than would have been available for this client group if we had not changed the policy.

The hon. Member for Croydon, North-West (Mr. Wicks) seems upset about the growth of the private sector. I can only imagine that he wants to return to the local authority monopoly, inspired perhaps by the example of neighbouring boroughs such as Lambeth, where large-scale fraud is now under investigation, and Sheffield, where charge payers' money is being diverted from providing services to provide accommodation for the local Labour Members of Parliament.

The hon. Gentleman wanted facts, and I have just mentioned one. Another fact which I mention is that there has been a substantial shift in local authority expenditure away from residential care and towards domiciliary care. In 1978–79, just over £1 billion was spent on residential care and domiciliary care.

Mr. McCartney

Will the hon. Gentleman give way?

Mr. Yeo

I am sorry, I will not give way. On the same basis—

Mr. McCartney

Will the hon. Gentleman give way?

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)

Order. The Minister is not giving way.

Mr. Yeo

On the same basis, in real terms the increase in domiciliary expenditure has been 80 per cent. and in residential care it has been 40 per cent. I am sorry that time will not permit me to answer all of the points raised by the hon. Member for Makerfield, but that is due to something outside my control. I say simply that the Government's commitment to the success of the policy has been demonstrated by our role in the preparations to which local authorities and health authorities have also contributed—

It being three hours after the motion was entered upon, MR. DEPUTY SPEAKER put the Question, pursuant to Order [5 February].

Question agreed to.

Resolved,

That the Special Grant Report (No. 6) (House of Commons Paper No. 404), which was laid before this House on 8th February, be approved.