HC Deb 23 February 1993 vol 219 cc753-4
5. Mr. Jacques Arnold

To ask the Secretary of State for Health what plans she has to ensure that the clients of community care services have a wide degree of choice over services which they are to receive.

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

New assessment arrangements will ensure that individual users and carers are fully involved in deciding how their needs can best be met. Public funding will be available for a wider range of services from an increasing range of suppliers. Those requiring residential or nursing home care at public expense will have the right to choose their own home, subject to certain practical limitations on cost and suitability.

Mr. Arnold

Are not competition and choice the best way to achieve standards and services both in the national health service and in community care? Is it a coincidence that Conservative authorities such as Kent county council are already well under way with that, to the benefit of the clients that they will be serving?

Mr. Yeo

My hon. Friend is right. The Government are promoting competition and choice both through the requirement that local authorities spend 85 per cent. of the money transferred from the Department of Social Security purchasing services in the independent sector and through the binding direction requiring local authorities to honour individual preferences in the choice of residential home. The real way to promote competition, choice and higher standards will be to vote Conservative in the county council elections on 6 May so that there will be more excellent county councils such as Tory-controlled Kent county council.

Mr. Alfred Morris

Does the Minister accept that severely disabled people should have choice and freedom to make their own arrangements for personal care? For that to happen, local authorities must be empowered and adequately resourced to make direct payments which relate to individual need.

Mr. Yeo

The right hon. Gentleman makes a point which has been canvassed before in the House. The cornerstone of our community care changes in April is placing the wishes and needs of individual users of services at the heart of the decision-making progress when the assessment is made. That will ensure that far greater attention than can be paid under the present system will be devoted to the personal needs of each individual who approaches his or her social services department. Further, it is our intention that individual needs should include much better consideration of alternatives to residential care. In future, it is far more likely that people approaching social services departments will be given a package of domiciliary, day or respite care services to keep them in their own homes for longer than was previously possible.

Mr. Sims

Does my hon. Friend agree that in the provision of sheltered housing, special needs housing such as that for the disabled, and what is often referred to as part 2½ accommodation, housing associations have an important role to play in community care policies? Will my hon. Friend ensure that housing associations are fully involved in the preparation and implementation of community care plans?

Mr. Yeo

My hon. Friend raises an important point. We certainly want to see all local authority social services departments in close consultation with housing associations and with many other bodies. One of the biggest difficulties that we have encountered in making the necessary preparations for the changes is that too many Labour-controlled authorities refuse to engage even in a proper dialogue with independent sector providers of all kinds of care and services. That is why we had to issue a further direction, requiring consultation to take place and authorities to state in their community care plans in future how they will consult independent sector bodies.

Mr. Hinchliffe

How does the concept of choice square with denying the right to advocacy by not fully implementing the Disabled Persons (Services, Consultation and Representation) Act 1986? How does it square with denying the right to choose good quality public services, and with telling local authorities not to record unmet need during the assessment process? The Minister talks about giving people the right to choose which home they will enter—what about giving them the right to choose not to enter a home in the first place? Is that not the real issue which the Government ought to be addressing?

Mr. Yeo

It is indeed the real issue, and the Government are addressing it. For that reason, every local authority will be required in future to make an assessment of the individual's needs before he or she enters residential care. The exact weakness of the present system is that it is possible to obtain an automatic social security payment to finance a person's entry into residential care. In future, there will be much more detailed consideration of individual needs, so that there will be a good chance that a person who might otherwise have entered a residential nursing home will receive a package of individually tailored domiciliary, day and respite care services. I only hope that Labour-controlled authorities will address that issue rather more successfully than Sheffield city council, which is currently diverting resources from social services into payment for the provision of offices for Labour Members of Parliament.