§ The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo)I beg to move,
That the Special Grant Report (No. 7) (House of Commons Paper No. 504), which was laid before this House on 22nd February, be approved.Special Grant Report (No. 7) follows Special Grant Report (No. 6), approved by the House on 11 February. This completes the distribution of grants to local authorities for the financial year commencing on 1 April for expenditure on community care services as defined by section 46 of the National Health Service and Community Care Act 1990.I am always happy to debate the subject of community care, whatever the hour, but I very much regret the circumstances of this debate, which has been necessitated by a costly and ill-advised legal action, the effect of which has been only to cause delay for local authorities in setting their budgets and to create an unnecessary atmosphere of uncertainty.
This report confirms our commitment to the provision of adequate—indeed, generous—funding for our community care reforms. Not only have we transferred from the Department of Social Security to the local authorities the full £399 million that would have been spent if the policy had remained unchanged; we have added £140 million. That represents 35 per cent. on top of the existing expenditure to allow local authorities to develop their services. Then there is another £26 million relating to the arrangements for the successor to the independent living fund. The whole sum—£565 million—is now to be ring-fenced so that the local authorities can spend it only on community care services. Of course, local authorities will have complete discretion to meet the needs of the local community as they see them and to reflect their priorities. They will be able, for instance, to take account of the importance of providing services for people with drug and alcohol problems.
§ Mr. John Bowis (Battersea)It is good to hear of the global sum that my hon. Friend has announced and the release of the £20 million that was unfortunately held up by the legal processes. My hon. Friend will know that many of us have received letters from organisations, such as Turning Point and the Cranston projects, which deal with drug and alcohol problems. These letters express concern that, now that this money has been released, the allocation is perhaps weighted towards rural areas—as opposed to the inner cities where it is believed that many of the drug and alcohol problems are to be found. Can my hon. Friend reassure us that this is the fairest means of distribution?
§ Mr. YeoMy hon. Friend is one of the most vigorous advocates for the people of Battersea and Wandsworth. There is no issue affecting his constituency which is not promoted most energetically in this House and, behind the scenes, with Ministers. I can give my hon. Friend the assurance that he seeks in that 50 per cent. of the special grant is being distributed in accordance with the existing pattern of service providers. Of the transfer element of the grant, 50 per cent. is distributed in accordance with the standard spending assessment; the other half reflects where the existing treatment and other residential centres 402 for elderly or disabled people are located. We have indeed taken into account the concern that my hon. Friend has expressed.
The original suggestion—that the money for residential treatment of drug and alcohol abusers should itself be the subject of a ring-fence—was made at a time when the concept of a ring-fence for the totality of community care funding was not even contemplated. Now that we have this total of £565 million guaranteed for expenditure on community care services, it would be quite wrong if, within the total, we were to impose a sub-ring fence for the £20 million—
§ Mr. YeoIf the hon. Gentleman will contain himself for a moment, I shall explain. For a three-fold reason it would be wrong to provide a sub-ring-fence. First, that would completely destroy one of the fundamental principles on which the whole community care policy is based—the principle of individual assessment. We are not willing to undermine that principle. Why should an elderly or disabled person be entitled to an individual assessment before a decision is made about the services that he or she should receive but an alcohol or drug abuser be denied the same privilege?
§ Mr. David Hinchliffe (Wakefield)On the question of funding for treatment for drug and alcohol problems, is not the central point that most people who attend units are self-referred and do not arrive through the assessment process? Is not the central concern about the prospects for projects, particularly in areas such as inner London, the fact that the appropriateness of community care provisions in relation to assessment and care management is being seriously questioned?
§ Mr. YeoIf we were to allow the process of self-referral to continue without any assessment threshold at all, we should create two types of damage. First, people treated in these centres would not, after completion of treatment, be the responsibility of any local authority. There would be no statutory body with any continued interest in their welfare. [Interruption.] That would be the case after 1 April.
The second reason why it would be damaging to accept the existing arrangement whereby self-referral takes place is that the resourcing of services would continue to be based entirely on a pattern which was a historical accident and which did not reflect local needs. That is why we rest firmly on the principle that individual assessment should take place.
The third reason why it would be wrong to have a sub-ring fence is that to confine the expenditure to the purchase of residential services would perpetuate a bias in favour of residential services. Hon. Members on both sides of the House, especially Opposition Members, have expressed much concern about the matter and we debated it on 11 February.
§ Mr. Alun Michael (Cardiff, South and Penarth)Does the Minister accept that his proposal is a lot of theory whereas practical steps are needed to ensure that facilities are available to those who need them? Not only individuals but communities will lose out. I have seen the benefit of facilities such as Dyfrig House to my constituents, and others throughout England and Wales. They require this sort of assistance to be there when people 403 need it. If the Minister follows theory, he is ignoring the reality being urged on him from all sides, including those who have experience of such problems.
§ Mr. YeoIn the past five months, my right hon. Friend the Secretary of State, my hon. Friend the Minister of State and I have engaged in extensive discussions with the providers of residential treatment services and we have met a great many providers. In the light of those discussions, and reflecting our own concern about the importance of good services for drug and alcohol abusers, we have decided to do three things.
First, we have issued a circular to local authorities to make clear the high priority which the Government attach to seeing that appropriate services, in response to individually assessed needs, are provided for this important group of clients. Secondly, we have decided that it would be helpful if local authorities engaged in a direct debate with the providers of services about rapid assessment procedures and the way in which the process of identifying the responsible funding authority can be accelerated. Those discussions are already taking place with the help of the Local Government Drugs Forum.
Thirdly—and uniquely for this group of providers—we have decided to set up special monitoring arrangements so that we can have up-to-date quick information about the pattern of referrals by local authorities to drug and alcohol residential treatment centres during the first three months of the new policy.
Those are three responsible ways in which we have recognised the specific needs of the client group and the concerns of the providers of the treatment. I am confident that local authorities will share my view about the importance of the client group and that they will provide services in a responsible and effective way.
§ Ms. Glenda Jackson (Hampstead and Highgate)What concerns people in the voluntary sector who are providing these necessary services at present is that local authority social services simply do not have the resources to provide fast-track assessments. There seem to be no additional funds for them to increase staff and facilities to create the fast-track system.
§ Mr. YeoPart of the extra £140 million to which I referred, which has been made available over and above the money transferred from the Department of Social Security, is designed precisely to pay for the extra staff who will be needed to enable local authorities to carry out the additional assessment work that they will need to undertake in relation to community care as a whole.
§ Mr. Roger Sims (Chislehurst)My hon. Friend is right that the essence and philosophy behind the policy is not to perpetuate the present pattern of funding. Does he also accept that it is inevitable that as authorities take on completely new responsibilities in a completely new environment they will be more likely to pay attention to their local residents than those who come from outside the area? People with drug and alcohol problems who refer themselves for treatment tend to be from outside the local authority area and they are likely to be at the bottom of the list.
If my hon. Friend is not prepared to ring-fence the sums for drug and alcohol problems—I understand his argument—will he at least consider giving some guidance to authorities to emphasise that, at least for the first year, 404 they should continue the present pattern of funding so that the facilities currently available at least have some time to adjust to the new pattern of referral?
§ Mr. YeoI am aware of my hon. Friend's interest in the subject. He has spoken to me about it in the past. I cannot give him the assurance that he seeks because even what he suggests would to some extent run counter to the principle of tailoring services to meet individually assessed needs. To require or even issue guidance to local authorities to stick to an existing pattern of expenditure would run counter to our wish that individual needs should be the driving force behind the policy.
The Local Government Drugs Forum is currently promoting discussions between the local authorities a nd providers, in addition to dealing with the rapid assessment procedures. Its work also addresses how we identify which authority is responsible for the type of person who, as my hon. Friend suggested, might have moved around the country quite a lot as a result of their problems. It is clearly necessary for us to find a local authority which is responsible for that individual. The great advantage of that policy is that, once the authority has accepted responsibility for funding that individual's treatment, it has a continuing responsibility for that individual.
One of the weaknesses of the present policy was acknowledged even by the providers who expressed concern about our decision not to ring-fence the money. Many of the people who have been through the treatment drop out of the system. They lose touch with the people who have given them help, advice and treatment and fall back into their old habits. That happens not in every case but in a significant number of cases. It is less likely that it would happen if a local authority had a continuing relationship with an individual and took an interest in the arrangements for that person after treatment had been completed.
I conclude by saying that the court dismissed the application by an independent sector provider of an alcohol treatment centre for judicial review of the Government's decision not to ring-fence the money. The Government's position was entirely vindicated as a result of the court action. Against that background, I commend the report to the House.
§ Mr. David Hinchliffe (Wakefield)Tonight's debate is obviously a serious embarrassment to the Government. It is an embarrassing reminder that their implementation of the community care changes—which were originally due, let us remember, in April 1991—is not only delayed but discredited. Special Grant Report (No. 7) is before the House tonight because three weeks ago on I I February, when the original report on community care funding was before the House, the Government were being dragged through the courts on a judicial review of their about-turn on the clear commitment to ring-fence future funding of residential drug and alcohol projects. The Government were dragged through the courts because of their shabby disregard for the interests and concerns of those with drug and alcohol problems and for the future operation of many projects throughout the country which have a first-class track record in the care and rehabilitation of people facing such difficulties.
405 It is astonishing that the Government should try to hide their shame by claiming in local authority social services letter 93/5, issued on 22 February, that
the sums contained in Grant Report No. 7 are not attributable to services associated with any particular client group.We are asked to accept that the removal of £20 million from Special Grant Report (No. 6), approved on 11 February, during the Government's time in court was nothing to do with any client group. We are asked to accept that the funding contained in the report before us refers to no one in particular. We are also asked to believe that it is purely coincidental that the £20 million in Special Grant Report (No. 7) is so very similar to the amount arrived at in the Standing Conference on Drug Abuse and Alcohol Concern research document, which was used by the Department of Health's algebra group in its deliberations on the care funding formula. Updated to 1993 levels of income support, it was calculated that around £21.5 million would be needed to fund clients in residential care with drug and alcohol problems—what a coincidence.The Government might wish to say that the debate has nothing to do with drug and alcohol projects, but everyone else, including some Conservative Back Benchers, knows that that is precisely what we are talking about. We are discussing a most disgraceful about-turn on a clear political commitment, given by the previous Secretary of State for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), in response to widespread public concern—echoed by Conservative Members—that a failure to ring-fence drug and alcohol projects would lead to their rapid demise. In the debate on Lords amendments, the right hon. and learned Member said so. I was present and some Conservative Members may also be able to recall that he said:
some local authorities might be tempted to give a pretty low priority to the work of outside agencies for unattractive groups, such as drug abusers.He went on to announce that funding for such groups would receive specific protection:To use the jargon, that money will be ring-fenced and local authorities will be able to spend it only on grants to such bodies."—[Official Report, 27 June 1990; Vol. 175, c. 404.]When the Government deferred the implementation of the community care changes because of the poll tax shambles, the then Secretary of State made a clear commitment—in a statement to the House on 18 July 1990—to a specific grant for local authority funding of bodies that provide services for drug and alcohol abusers.Nearly three years later we are asked to believe that the change in the Government's policy on the ring fencing of community care funding has somehow rendered the commitment on drugs and alcohol obsolete, but it has not. The concern expressed by the then Secretary of State at the time is, if anything, even more relevant now in view of the financial climate facing local authorities and voluntary organisations and the fact that drug and alcohol problems are probably even worse in 1993 than they were when the commitment was given.
The Government's assumption that an overall ring fence will protect the projects ignores the reality accepted by the previous Secretary of State that, in practice, unattractive groups are likely to lose out.
406 Can the Minister say in all honesty that if his local authority had to choose between placing an elderly lady in a nursing home and funding a drug addict or alcoholic, it would go for the latter? Given the tight budgetary conditions of the new financial year, that is just the sort of decision that authorities will have to make.
I suspect that, regardless of political control or of which party is in control, most local authorities are likely to prioritise the elderly. We already have evidence that some drug and alcohol projects will become financially unviable within days of the introduction of the April changes. The SCODA and Alcohol Concern survey show that 71 per cent. of the 94 agencies responding said that they knew that they would be losing income in April. More than half the respondents predicted closure within the first four months of implementation of the community care changes — a loss of nearly 1,000 bed spaces. Those are not scare tactics, as we already have clear evidence of closures.
The North West London Housing Association, which provides a service for problem drinkers in Ealing and Haringey, has forwarded me a letter, which was sent to the North-East Thames regional health authority on 22 February and sets out the position and the difficulties:
the position is that we are now five weeks away from the introduction of the new arrangements, there is an enormous shortfall in the resources needed to continue present services in Registered Care Homes,…there is no sensible or reliable system to deal with homeless problem drinkers and there are other unresolved dilemmas.The DOH response to all this is to monitor the situation from next month and to continue to claim (as it did as recently as the week before last in the High Court) that removing ring-fencing was in our interests because it would allow local authorities to allocate even more resources than they would have been able to under ring-fencing.Mr. Levine, the director, continues:Against the background above my committee has had no option but to instruct me to close down the service by the end of June at the latest. Their duty as charity trustees requires them not to put the funds of the association at risk or operate when funds cannot be guaranteed.The financial consequences to the public purse of the collapse of that project are fairly obvious. It will increase pressure on the police, the prison system, hospitals, the probation service, the child care system and social services. For a Government facing a public sector borrowing crisis, the implications for spending on the other services are horrendous.More important are the human consequences for people such as the woman I met who had come from Essex and was in an alcohol recovery project house in Lambeth. My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett)—who is present for the debate—and I met her. She was working towards rehabilitation with her two children in care—she hoped to be back with them soon. What chance will there be of future referrals to that project for women outside London? What chance do the children of such women have of avoiding being permanently in care, as that woman's children are at present?
When the House debated the Special Grant Report (No. 6) on 11 February, I described the arrangements for distributing the funding after April as plain daft. This report is further evidence that the consequences of the formula used by the Government are, to say the least, bizarre. Turning Point, an organisation that is known and respected by hon. Members, has had the figures in the report analysed.
Recording the home local authority of residents during the financial year 1989–90, Turning Point calculated the 407 likely levels of money required by each authority to fund local residents who enter a project within that authority and those who attend a service in another local authority region. Just as the figures in report No. 6 show no correlation between need and funding, Turning Point's analysis demonstrated marked variations between the distribution in report No. 7 and knowledge of the funding needed.
I am pleased to see that hon. Members from both major parties who represent the London area are present. Once again, inner London has been particularly badly hit by the measure. Turning Point calculates that, of the 13 inner London boroughs, 10 will receive, on average, almost £120,000 less than the research suggested was needed to fund the treatment costs of people from each borough who receive care. Manchester has particular problems, with research suggesting a shortfall of about £500,000.
§ Mr. Tony Lloyd (Stretford)My hon. Friend will be aware that the services in Manchester are already massively overstretched and, as the drug addiction problem is still increasing, the human cost is high. Is my hon. Friend aware that the Greater Manchester police have calculated that the cost to the local community, in terms of criminality due to drug addiction, is already enormous and rising? The fact that the Government have acted as cheapskates over funding for Manchester means that that cost, both in human terms and financial terms, will be borne by the community in the Manchester region.
§ Mr. HinchliffeI am familiar with the constituency of my hon. Friend and well aware of the difficult problems that he and his constituents face every day. I agree that, in Manchester, there will simply be a transfer of the funding requirement from where it should be—in the hands of local authorities so that they can support projects on drug and alcohol problems—into the police budget, which is already very stretched. My hon. Friend may be interested to know that the bizarre nature of the finding arrangements contained in this report mean that, while Manchester will lose £500,000, Avon—which has a large number of private residential and nursing care beds—will, according to Turning Point, receive about £250,000 more than it needs.
Especially worrying is the fact that, as well as illustrating the consequences of the bizarre distribution formula, the research has unearthed clear errors in the calculation by the Department of Social Security of the location of income support payments upon which 50 per cent. of the formula is based. For example, in June 1992, the DSS calculated that 10 people across six care groups were in receipt of enhanced income support in homes within the London borough of Hammersmith and Fulham. It calculated that there were no claims for clients of residential drug and alcohol establishments.
But Turning Point operates a registered residential facility for drug users in the borough and it is known that income support payments were made to about 17 claimants in the project which was fully occupied during that month. Given that example and others, regardless of the distribution formula, the basis of the Government's calculation of funding is, to say the least, open to question.
I urge the Minister to recognise the inconsistency between the fine words in, for example, "The Health of the Nation", on drinking habits, mental disorder and suicide in particular, and the Government's position on this 408 question. I urge him to reconsider and to recognise the inconsistency between Richmond house media hype and the reality of Government policy.
A classic example has come my way. For some reason I always get two copies of each press release. I received one yesterday dated 1 March from the Department of Health. It is headed:
Government will tackle alcohol misuse head-on, says Dr. Mawhinney".I am sorry that the Minister for Health has left the Chamber. The press release goes on to quote the Minister as saying:We are not killjoys—a little bit of what you fancy, alcohol-wise, may do you good …But it does no harm to remind ourselves again of the scale of the problem.Hon. Members on both sides of the House are well aware of the scale of the problem and well aware that it is likely to become much worse as a direct result of Government policy.The Government talk, and the Minister referred to it tonight, of fast-track assessment. What we need is fast-track funding that is guaranteed and distributed in a way which reflects need. It should be recognised that with drug and alcohol projects the traditional means of referral do not tie in with the concept of assessment and care management.
What is needed is an understanding that drug and alcohol projects form a national network and require a funding system which recognises that fact. What is needed is a restoration of proper safeguards to protect the funding of those crucial projects. But, above all, what is needed is a recognition that tonight staring us in the face is a human tragedy which could and should be avoided.
§ Mr. Tim Rathbone (Lewes)I must comment first on the speech that has just been made by the hon. Member for Wakefield (Mr. Hinchliffe). It is a travesty to say that the principle of community care is discredited in the way that the hon. Gentleman described. It is a principle espoused by virtually everybody. The hon. Gentleman said that it was entirely discredited by the announcement this evening. It is a pity that we should start off in that tone of voice.
§ Mr. HinchliffeTalk about tone of voice!
§ Mr. RathboneThe hon. Gentleman can talk about how I speak, but I am talking about what has been said.
§ Mr. HinchliffeThe hon. Gentleman has completely misquoted me. I was not talking about the principles of community care. I believe in the principles of community care. I was referring to the manner in which the Government have implemented the changes that will take place with effect from 1 April.
§ Mr. RathboneThe hon. Gentleman did use the term "discredited", but Hansard will prove whether I am right or wrong.
Rather than talking about the principle of community care, which is accepted as an advance on both sides of the House, we should concentrate on the possible difficulties in the announcement this evening.
My hon. Friend the Minister explained the way in which funds had been allocated. In that context, I noticed that my own county of East Sussex has been given a large allocation, which I presume directly reflects the number of 409 elderly people in residential care and in nursing homes in that county, and the large number of treatment centres in East Sussex run by organisations such as Turning Point.
Although we are delighted that we can identify now how allocations to local authorities have been made, it concerns me—this will come as no surprise to my hon. Friend the Minister—that the formula used bears too little relation to the referrals made in the past and likely to be made in the future.
Of specific concern—this point was touched on by the hon. Member for Wakefield and in interventions by my hon. Friends—is the disproportionately large number of homeless drug and alcohol misusers in inner urban areas. They are unlikely to have an identifiable home local authority, yet they are in greater need of residential care, perhaps, than any other category.
As my hon. Friend the Minister pointed out, guidance was issued for consultation, which clearly stated that admission to residential care should not be delayed whilst the responsible authority is identified. However, with the larger number of homeless people in inner urban areas, less than adequate funding—even through a more appropriate allocation mechanism—will inevitably mean that many with the most urgent need for residential care will be unable to obtain it, because funds for a replacement will not be readily available or, in the worst cases, will not be available at all.
In that instance, fast track cannot work. Fast track must depend on the availability of funds to operate. If it does not work, it will be impossible to meet the individual needs to which my hon. Friend the Minister referred.
410 All that underscores the error of the transfer formula, which does not account for the geographical spread of referrals to drug and alcohol services. Research revealed that one in five referrals to a service originate from the local authority in which the project is based, so 80 per cent. of referrals originate in other areas. That is crucial not only to the funding material but to the scheme's operation. That was one factor that persuaded the Government to ring-fence funding for that vulnerable client group in the first place.
My hon. Friend's attempt to improve the mechanism for distributing funds still stands a horrible risk of backfiring. I may be wrong in that assessment, and I am sure that Opposition Members hope that their assessment is wrong too—because we care mainly that people should receive the care and services that they need. In case we are right in our assessment, I put a plea to my hon. Friend the Minister.
Instead of monitoring for three months, the monitoring period should be extended to at least six months, and preferably to the end of this year—in other words, over a nine-month period. The truth is that homes will taking steps now to get people into their homes and to keep them there, and that will put out of kilter the statistics that will be available during the first three months of the new scheme's operation. Although I appreciate the direction that the Government want to pursue in their application of funding, and hope that they will be proved correct, we owe it to the people who need the services in question to monitor the scheme longer than is presently envisaged.
§ Ms. Glenda Jackson (Hampstead and Highgate)I wish to draw the Minister's attention to the great concern that has been expressed—not only to me, I am sure—by the organisations that provide the care that we have been discussing. That applies not least to the Campaign for the Homeless and Rootless and the West London Mission, which has formed a group comprising 19 organisations that provide 22 centres—some residential and some providing day-care facilities—offering particular care and concern to those suffering from drug and alcohol abuse.
Those organisations make the specific point that, certainly in London, the removal of ring fencing for particularly vulnerable members of society is aggravated by certain factors. First, people move from one area of London to another, but at least 40 per cent. of the facilities are concentrated in three boroughs of the capital. The organisations also fear that there will be a desperate shortfall not only in basic funding but in the number of people prepared to accept responsibility for individual clients whose first residence is not in the borough to which they go to be housed or treated.
In my constituency, St. Mungo's Association has been running a registered residential home for single homeless men, all of whom have histories of varying degrees of grave mental problems—some exacerbated by drug and alcohol abuse. The care that is necessary for such people simply to make it possible for them to function in society again on the most basic, fundamental level is intensive, and takes up a great deal of time. The association's costs are currently covered by direct payments from the Department of Social Security, at a rate of £188.30 per head. It also has a grant of £30,000 from the local authority.
At present, of the 29 residents living in those houses, 10 could be deemed to be local; they are Camden residents. Between seven and eight come from the borough of Kensington and Chelsea, and the 11 other residents are referred to the registered residential home from the St. Mungo's central Endell street referral point.
The organisation is desperately worried about the possibility of an enormous shortfall, which it believes will amount to about £42,000. It is almost impossible for it to plan for any future provision. It fears that its own costs will inevitably increase if it has to pursue individual local authorities to provide for its residents; but its major concern is that relationships that have been built up—not only with its present residents, but with those for whom it has cared in the past and those for whom it wishes to care in the future—run a grave risk of being damaged. It feels that its residents will feel that the changes in the present system smack entirely of bureaucracy and officialdom, and that the necessary trust which is the basic step in rehabilitating such people will be destroyed at the first stroke.
I strongly urge the Minister to reconsider the present arrangements. I heartily endorse the remarks of the hon. Member for Lewes (Mr. Rathbone): I feel that the time scale that the Department is setting itself for monitoring is far too short. The idea of fast-track assessment is an absolute impossibility for most local authorities; they have not the staff, the funds or the time to be able to "fast-track" some of the most vulnerable members of society.
412 My hon. Friend the Member for Wakefield (Mr. Hinchliffe) spoke of the choice that many local authorities will have to make between an elderly, frail lady and someone suffering from the effects of drug and alcohol abuse. I entirely agree; but let me point out to the Minister that many frail, elderly ladies are also sufferers from drug and alcohol abuse. Surely it is in that regard that we should express what I believe should be our true concern: that "care in the community" should mean caring for everyone in the community.
§ Ms. Liz Lynne (Rochdale)I was saddened to hear of the Government's change of heart about the ring fencing of the drug and alcohol budget. I was a member of the drug and alcohol abuse committee in Rochdale when the news was first announced that the Government were to ring-fence that budget. Every member of the committee was delighted, because it meant that some of the services would be protected. I urge the Government to change their mind now.
Why have the Government plucked the figure of £20 million out of the air as the amount to be set aside for the judicial review? I have asked a number of people involved in drug and alcohol work how much money was needed for rehabilitation in England, but none of them came up with that figure. I should be grateful if the Minister could tell us where it came from.
I agree that three months for monitoring purposes is certainly not long enough. There should be a proper review of what will happen after 1 April to drug and alcohol services in the community.
The drug and alcohol service has always been the Cinderella service. It is often said that the mental health service is the Cinderella service, but the drug and alcohol service is even more so. We have heard that it will be believed that elderly people should benefit more from community care, whereas drug and alcohol misusers will be put at the end of the list.
There has been much talk recently about drugs and crime. Indeed, only yesterday we debated juvenile crime and juvenile offenders. We must accept the link between crime and drug and alcohol abuse. It is a great problem in Rochdale and the north-west. Greater Manchester was mentioned specifically in that connection.
Someone rang me today to tell me about the case of a 29-year-old man with three children. He has a heroin habit and steals to feed it. He has tried to get treatment at our local drug rehabilitation centre, but there is a waiting list. He is asking for treatment and help to get off the roller-coaster, but he cannot get it. After 1 April, it will be even more difficult. If the budget is not ring-fenced, more people will be sucked into crime.
Several surveys have been carried out on crime and its relationship with drug and alcohol abuse. The first to which I draw the House's attention was carried out in Nottingham. An audit in December 1990 found that alcohol was a factor in 88 per cent. of cases of criminal damage, 78 per cent. of assaults, 40 per cent. of instances of domestic abuse and 30 per cent. of child abuse cases. That is happening across the country, but we do not have enough statistics to know whether the true position is even worse.
Another report revealed:
young 'heavy drinkers' are more likely tban 'light drinkers' to report having committed minor violent offences, and more 413 likely to report that they have been the victim of crime…9 per cent. of adult males, 9 per cent. of young males and 4 per cent. of young females in the prison population are clinically diagnosed as dependent on alcohol, and perhaps as many as half drink more than the…recommended sensible limits.In the past few days, young offenders have been much discussed in the House and by the media. A report by the probation service states that probation officers have cited addiction or compulsion as a key factor in 34 per cent. of crime committed by young offenders. Among the 17-year-olds surveyed, the influence of alcohol was a factor in 41 per cent. of cases and the influence of drugs in 30 per cent. of cases. Among the same age group, 6 per cent. of offences were committed to pay for the habit.As I have already said, so many people are being sucked into crime to pay for and feed their habit. It is about time that the Government did something to stop that. I urge them to change their mind today about the ring fencing.
Talking about juvenile offending yesterday in the House, the Home Secretary said:
We are seeking to develop yet stronger policies to deal with the abuse of drugs. It is one of the causes of crime that society has the ability to control, as long as we back up the police, the voluntary agencies and every other agency to try to contain it."—[Official Report, 2 March 1993; Vol. 220, c. 149.] The Home Secretary said that yesterday. Today I ask theGovernment to change their minds, ring-fence the drug and alcohol budget again, and help the people in our society who are misusers of drugs and alcohol to have a decent standard of living.
§ 11 pm
§ Mr. John Bowis (Battersea)I welcome the global figure that the Minister has announced will be provided for community care. It is an excellent figure, and we should set our discussion against that background; that is where we start.
Secondly, I believe that history may record that it was as a result of a question from me to the Minister at the time that the ring fence for drug and alcohol projects was originally announced, so I have some personal interest in that success, and in the services that we are discussing. In my constituency, there is the Davies centre, which is part of Turning Point, and other projects such as the Cranston project, to which I have already referred in an intervention.
I am joining in what has been rather a good debate. Perhaps the Opposition Front Bench spokesman was a little belligerent, but that was nicely balanced by the quieter tones of my hon. Friend the Member for Lewes (Mr. Rathbone). We all share a genuine desire to help and support people who have the problems resulting from addiction to drugs or alcohol to which everyone who has spoken has referred.
Much is being done in the health service. There are many initiatives in hospitals, detoxification units and so on. Representing the inner-London area of Battersea, my concern is that people should not take the view that the problem should be passed out to the shires—that we somehow export our problems to be looked after. We should remember that Battersea is also a halfway home for people who have been in detoxification units and are on their way back home.
Inner cities themselves create much of the problem—they create many drug, alcohol and mental health 414 problems—but people who have suffered in the inner cities do not necessarily want to live outside London and the other big cities. They want eventually to come home. The wonderful support that the Davies centre and other such places can give enables them to come back to their homes within the city.
That is what I, working alongside, value so much, and that is why I hope that the Minister will monitor most carefully the effects of his decision to ensure that the money reaches the people who need it, that it is filtered through the new wider ring-fenced system and that, as my hon. Friend the Member for Lewes so wisely said, the fears that some of us have are proved groundless and the optimism built into the new system is justified. Should that prove not to be the case, we shall then be able to put matters right.
§ 11.4 pm
§ Ms. Tessa Jowell (Dulwich)I hope that the Minister will listen to the overwhelming cross-party support for a rethink of the Government position on ring fencing. I shall briefly refer again to the important conclusions of the Turning Point survey which have informed the debate and to which my hon. Friend the Member for Wakefield (Mr. Hinchliffe) referred.
I should like to provide some specific evidence from the London borough of Southwark. The Government's distribution formula suggests that Southwark needs about £116,000 to support its services for drug and alcohol misusers. The Turning Point survey, calculated on the basis of where the misusers are, suggests a figure of £244,000. Southwark will get £128,000 less than the current service providers deem necessary for drug and alcohol misusers living in Southwark. Let us contrast that with Kent. The Government believe that Kent needs £718,000. Turning Point, which deals with real clients rather than attributed figures, says that Kent needs £230,000, producing a potential surplus of nearly £500,000.
Why is there such a difference? The Turning Point study accurately reflects the unique nature of this particular group of community care service users. In many cases we are talking about people who have been in and out of drug clinics all over the country for many years. Typically, they become homeless and are without family support because of their substance abuse. They are not a settled group. Their use of services is therefore different from that of other community care service users.
Specialist clinics report that only 4 per cent. of drug and alcohol misusers are referred by social services–50 per cent. of them are self-referred. Their links with home or any local authority are slim. They may move around the country because they are trying to avoid their own local drugs scene or because the area where they originated does not have the facilities to treat their needs.
Because Southwark has among the lowest number of permanent residents who are known to have drug or alcohol problems, it gets less money under the Government's system of distributing the community care grant. However, the reality is that people who are homeless and have drug and alcohol dependencies will continue to come to inner city boroughs like Southwark. They will not stay in small leafy towns just because the Minister's bureaucratic formula tells them to do so.
415 According to Turning Point's research, Suffolk will receive three times as much cash as it needs while 10 out of the 13 London boroughs will receive an average of £1.18 million less than the residents require for their care to be sustained.
It is particularly important that the total found by Turning Point to be needed properly to support alcohol and drug abuse facilities—£21 million—is close to the £20 million that the Government announced that they had set aside during the judicial review. The issue is not that far more money is needed, but for that money to be directed to where the people are and where the services need support.
Ministers are in a small minority in believing that their policy is right. It is opposed by every organisation representing informed opinion—not just the providers of services to people with drug and alcohol problems, but the Association of Directors of Social Services, the British Association of Social Workers, the Institute of Health Services Management and the National Care Homes Association.
I conclude with a simple question to the Minister which I hope he will answer when he replies to the debate. If he makes such play of the importance of stability and protection for the services of elderly people living in independent residential homes during the first year of community care reforms, why does not he accept that exactly the same need for stability and consistency applies to services for people who suffer from drug and alcohol misuse?
§ Mr. Alan Milburn (Darlington)Like the hon. Member for Battersea (Mr. Bowis), I think that we have had a good and well-informed debate. I hope that the Minister will take note of the fact that every hon. Member who has spoken so far has expressed grave concerns about the lack of operation of the ring fence.
The irony is that this debate need never have taken place. It would not have been necessary to be in our places this evening if the pledge that was given in 1990 by the then Secretary of State for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), had been honoured. He guaranteed that ring fencing would be provided for drug and alcohol residential centres, in response to cross-party support in the House, from those in another place and from expert organisations, some of which have been referred to by my hon. Friends and Conservative Members. That support and pressure still exists and the decision to withdraw the 1990 ring-fencing promise has been universally condemned. I hope that the Minister will note that 123 hon. Members from both sides of the House have signed the early-day motion standing in my name which seeks a reversal of the Government's policy. I know from my work as the chair of the all-party alcohol misuse group and from the first-hand concerns that have been passed to me by both practitioners and clients of the impact that the Government's policy will have.
My hon. Friend the Member for Wakefield (Mr. Hinchliffe) has already referred to the Standing Conference on Drug Abuse and Alcohol Concern survey of 91 residential units. The Minister will know that half are threatened with closure by July. Some are already issuing redundancy notices to staff so that they might comply with the legal position that confronts them. Interestingly, 416 hardly any of them believe that the Government's last-minute response to the furore caused by their broken promises will help to guarantee their future. A limp advice note from Ministers to local authorities together with a still undefined fast-track assessment procedure, whatever that means, is hardly an adequate replacement for guaranteed funding, which is what each centre needs.
The Minister will know that the imminence of closure is not a red herring or a false threat. It stems from the reliance of the centres on income support payments from their clients, payments that will disappear from 1 April, and from the special nature of their clients. The hon. Gentleman will be aware that the 140 drug and alcohol residential centres provide a national network of specialist help, support and rehabilitation services and offer short-term treatment. He will know also that there is a high turnover of residents.
It was a recognition of the differences between alcohol and drug misusers and the groups that form the overwhelming majority of the recipients of community care—the elderly and the mentally ill, for example—that prompted the then Secretary of State for Health in 1990 to make the ring-fencing commitment in the first place. Unlike the elderly, alcohol and drug misusers do not enter residential care as a last resort or as a poor alternative to community-based services. They accept such care as a positive first step, or a short-term option, to allow them to regain control of their lives away from the environment of alcohol and drug misuse that has been the cause of their problems.
The decision to ring-fence drug and alcohol misuse services was made because even in 1990 it was clear that the competing priorities on the community care budget meant that the client groups which were more popular or acceptable, or which had a legal entitlement to service, would be prioritised and that is precisely the situation that we face now. The present Home Secretary described it in graphic language in June 1990 when he said that the elderly and disabled were popular and had a powerful lobby and he accepted that some local authorities were less inclined to give the correct priority to the mentally ill. He also accepted that drug and alcohol abuse were not always popular recipients of social services money. As ever, the right hon. and learned Gentleman was a master of understatement.
The £20 million given in DSS payments for the direct use of those centres will now be lost in the general community care pool. My hon. Friend the Member for Wakefield referred to the press release and notice that accompanied the instrument that we are debating. It is clear that that money is not being ring-fenced.
The Minister argued tonight, as he argued in the Adjournment debate on the subject last December, that the ring-fencing commitment would merely have perpetuated the existing pattern of services. He must know that that is not so. The ring-fencing commitment was not merely a case of trying to preserve the old order. It was a case of trying to smooth the transition to a new order. I think I see the Minister looking astonished at that remark. He should read the speeches of his right hon. and learned Friend and other hon. Friends, who made it clear that the purpose of the ring-fencing commitment was not designed to set in stone a commitment for all time, but to ensure sufficient breathing space for a proper allocation of resources and development of services to occur so that the principles of community care could be properly met.
417 All that has gone down the tubes and the Minister's decision has doomed dozens of centres, including those in my area, to closure. He has given them, and the local authorities involved, less than six months to introduce procedures that it was originally envisaged would take until 1996 to get right.
In the debate last December, we went into some of the issues and spoke of the incredible complexity of the referral arrangements to each centre. The centres know that the fast-track procedure about which the Minister spoke and which he lamentably failed to explain in detail will not work. The professionals and the clients know that it will not work. Why on earth will not the Minister recognise that it will not work?
By refusing to countenance ring-fencing, the Minister is not only arrogantly dismissing the advice of drug and alcohol centre professionals, but is dooming the 5,000 people who use their services to a life on the streets without treatment, without care and without any hope of rehabilitation back into a normal life in society—and that at a time when the problem of drug and alcohol misuse is not only growing but has finally been recognised by the Government.
The annual cost to society of alcohol misuse is estimated at £2.5 billion. A few months ago, when the White Paper "The Health of the Nation" was launched, we heard of the Government's determination to tackle alcohol problems. How can that be squared with a policy that will close 140 drug and alcohol rehabilitation centres? In a week in which we have heard so much noise from Ministers about bearing down hard on crime, it is more than a little ironic to find the Government adding to the crime problems of the nation, bearing in mind that the majority of hardened drug users finance their habit by illegal means. They do so by theft, drug dealing and prostitution. With people having nowhere else to go and no prospect of help because the centres have been closed, the result will be more crime, not less. Society will end up picking up the tab for the Government's obstinate refusal to see sense on this issue.
My hon. Friends have already alluded to some of the anomalies in the report and have dealt with the detail. I make a last-minute heartfelt plea to the Minister not only to monitor what is going on—from 1 April, he will be monitoring redundancies and the closure of vital drug and alcohol centres—but, more important, to reinstate the ring-fencing commitment. If he does not, not only the people who use the centres but society as a whole will face a bleak future.
§ Mr. Jeremy Corbyn (Islington, North)It is a pleasure to follow my hon. Friend the Member for Darlington (Mr. Milburn), who made an excellent speech. I only wish that someone of his character and calibre, and with his understanding of the issues and preparedness to protect the services and the people who use them, represented the Government at the Dispatch Box tonight.
I find the Minister's announcement extremely depressing. He seeks to hide behind the fact that the High Court found in his favour. I must tell him that the High Court has made many mistakes over many years. Besides, it is not really very important whether the High Court 418 found in his favour on the ring-fencing argument. That is no justification. We want ring fencing to protect the projects and to protect the victims of drug and alcohol misuse.
I represent a depressed, deprived inner-city area. Our unemployment rate is shooting up. It is now well over 20 per cent. On some estates, it is over 40 per cent. The number of people who are suffering serious problems of alcohol abuse is very great and is increasing. Moreover, the figures are often understated in surveys because many people who suffer from alcohol abuse seek to hide it by various means. I do not necessarily blame them for hiding it; I merely recognise that it happens. Likewise, the number of youngsters who are becoming involved in serious problems of drug abuse is increasing all the time.
I am glad to say that we live in a society in which there is universal condemnation of drug abuse. Unfortunately, there is little less concern about and research into the reasons why young people in particular become involved in drug abuse. We live in a dreadfully alcohol-related society, however. One has only to take any underground or bus journey in London or watch television to be fed a steady stream of advertisements encouraging one to drink. That advertising rubs off. Drinking is a form of escape and solace and it is also often the result of a great deal of peer-group pressure. I believe that the problems of unemployment, overcrowed and poor-quality housing, debt and depression lead people into drinking. We must recognise the many causes.
All that the Minister proposes is that, in effect, the overstretched and overworked projects that are doing their best to cope with the avalanche of requests for help should be cut and should lose money because they will be unable to compete in what has become the marketplace of social services demands in local authority decision making.
Many hon. Members have served on local authorities —in my case, I am glad to say, in slightly happier times. If I had thought that the 1970s were going to be the high point of local authority expenditure, I would have spent a bit more. Local councillors face an absolute nightmare in deciding between a whole variety of competing demands in every conceivable area. From my time at the London borough of Haringey in the 1970s and early 1980s I know that, even then, it was not a very popular move to go to a social services commmittee and ask for money for a drug or alcohol recovery project. The committee would say that it needed the money for pensioners' organisations, under-fives, people with disabilities, and so on—all perfectly sensible and worthy causes, which we wish to see supported. Anyone now going to a social services committee and saying that a certain amount of money was coming in would be confronted with a host of people trying to get their hands on funds for equally valuable and worthy causes. The purpose of the great campaign to have the community care budget ring fenced is to protect the principle of community care provision by local authorities. That is an added reason for having ring fencing of the budget for drug and alcohol recovery units.
I have visited a number of schemes in north London. One that comes to mind is the women's alcohol recovery project based at Drayton park in Highbury, which has a very dedicated staff and does an absolutely first-rate job. Most of the women are self-referred or have been brought in by friends. They are not necessarily local residents, or even identifiable as resident anywhere. Many are people of no fixed abode, having become homeless and friendless as 419 a result of the trauma of alcohol abuse and having been taken in by some good Samaritan. The people who provide such services face the future with a degree of horror. They know that the demand for their expertise and services is increasing steadily, but that their ability to meet it is reducing steadily. They recognise that this proposal does not help them at all—a point that they made very articulately in the Lobby this year.
§ Mrs. Audrey Wise (Preston)Does my hon. Friend know that his point about expertise is made also by the directors of social services? Leaving aside the other problems that my hon. Friend has has correctly identified, those people do not have the necessary expertise to deal with the difficulties created by alcoholism. This is especially true now that they have to cope with so many changes in care in the community. My hon. Friend may not know that when they expressed their feelings to the Select Committee on Health they were absolutely backed up by senior health service officials, who pointed out that failures in this area will result in our having more people in the care of the medical side of the service, at greatly increased cost.
§ Mr. CorbynMy hon. Friend makes an extremely valuable point as a distinguished member of the Select Committee on Health. Under-funding of any type of social or primary care service results in enormous demands on the acute health services, which are put at risk of being unable to cope. If the Minister has the time or the inclination, or even the interest, he should spend some time visiting general hospitals in London. It would be helpful if he were to listen to the debate. Perhaps he has so little interest in the subject that he cannot be bothered to listen to what hon. Members are saying about their experiences. When his mind was elsewhere I was about to suggest that he should get to know something of what hospitals experience in having to deal with the victims of these problems because of the lack of facilities elsewhere.
I hope that the hon. Gentleman will recognise the force of our argument about the need for ring fencing for these services and full support for the very dedicated people who are doing so much good work in this area. Why should they have to cope with cuts and closures and with increasing numbers of drug and alcohol abusers on the streets, causing more problems and more deprivation for themselves and others?
§ Mr. Ian McCartney (Makerfield)This debate is marked by the fact that the nine Members from both sides who have participated, excluding my hon. Friend the Member for Wakefield (Mr. Hinchliffe)—and I exclude him in a friendly fashion—have given eloquent testimony to the fact that what the Minister has announced tonight is wrong in principle, although Conservative Members may have said that some Labour Members put the view more passionately than they did.
The underlying trend of what has been said is that the markets do not involve successful fast-tracking. The resources are not following projects, although the Government gave a commitment to that. The Government gave away the promise made in 1990 by the former Secretary of State to ring-fence resources. That has given greater impetus to the feeling in the community that the Government, first, do not have a real commitment to the 420 principle of community care and, secondly, have a hidden agenda in terms of leaving local authorities holding the can for the serious problems which will arise because of underfunding in the care gap.
In the debate on Special Grant Report No. 6, I said that the Minister was a Shylock. He proved tonight that he is not only a Shylock but a Pinocchio because, whenever he raises the issue of community care, one believes less of what he says about the Government's intentions in that regard.
To attack organisations for taking a case to court fundamentally undermines the real reasons why they went to court. They went to court out of total desperation at failing to convince the Minister that the Government's commitment should have been maintained. That commitment has not been maintained because the surveys and practical experience of the organisations show that 71 per cent. of projects have begun to lose income in the first nine months of the new scheme. By December 1993, 70 per cent. of all projects will have disappeared from most regions in the United Kingdom.
In the House a week ago, the Secretary of State introduced the document, "Making London Better", which contains two basic principles. I quote:
The number and variety of community nursing services available have increased, for example, through walk-in and telephone advice, counselling, and support groups and help for those facing crisis and long term illness. In London some of these initiatives are already underway. The pace of change can be speeded up…Important elements make up the process of modernising primary health care in London …Devising accessible services for Londoners with special needs such as those who are mentally ill or who misuse drugs or other substances.A week ago, the Government gave a commitment to new services in London. Tonight, we are seeing the withdrawal of those services. The background to the withdrawal of services is that the number of addicts registered in London is 10 times the national average. In 1990, the age-adjusted rate in Greater London for chronic liver disease and cirrhosis was 60 per cent. higher for males and 31 per cent. higher for females than the average for England and Wales as a whole. Cirrhosis is a key indicator of the level of alcohol problems in the community.Despite the Government's evidence and the introduction of the White Paper last week, the Minister intends to follow through with Special Grant Report No. 7 and withdraw the resources. It is an act of criminal irresponsibility by a Minister who never listens or learns. As a consequence, the most vulnerable people in the community suffer as a result of his decisions.
§ Mr. David Harris (St. Ives)He is shaking.
§ Mr. McCartneyIf the hon. Gentleman had any compassion, he would be not only shaking but apologising for this shabby report. The Minister should have further discussions about the ring fencing immediately. We need no back-chat from the hon. Member for St. Ives (Mr. Harris).
By December 1993, 69 projects and 1,521 beds will have been withdrawn and two thirds of the agencies will have given redundancy notices to skilled staff. It beggars belief that, within nine months of the projects coming under a new financial regime, skilled people working with drug and alcohol abusers in the community are being given redundancy notices. What a commitment to community care.
421 It does not stop there. In every region in Britain there will be closure after closure month after month from 1 April right through to 31 December. Projects throughout the country for men, for women, for men and women, for women and children, and for men, women and children will close. It is a league table of shame.
Last week the Government announced league tables for performance. How about introducing a league table for the Government's monitoring of the closure of alcohol abuse services? By the end of this year, 1,533 beds will be lost from projects in the United Kingdom despite the Government's much-vaunted claim that the introduction of community care would bring an improvement in facilities in the community.
Having listened to hon. Members on both sides of the House tonight, the Minister still has an opportunity to change his mind. If he does not want to listen to me and my honourable colleagues because of his party political bias and his commitment to Government policy, let him listen to his hon. Friends behind him. Let him listen to what they have said and bear in mind the areas from which they come. Let him listen to the problems that they have outlined. They did so because they know from their personal experience, from the organisations which have come to them and from the constituents who have submitted proposals to them, that the dogma does not work.
The practicalities are such that the Government's proposals will lead to the closure of projects, an increase in crime and a reduction in the ability of individuals in the community to self-refer to organisations in the community. That is the most damning effect of the proposal. By refusing to ring-fence the money, the Miniser will reduce the opportunity for self-referral. Fast-tracking interferes with that opportunity. The market will not recognise self-referrals. That will create winners and losers. The losers will always be the users of the two services. I beg the Minister to change his mind now.
§ Mr. YeoThis has been a valuable debate. I have listened carefully to the views expressed by hon. Members on both sides of the House. I had hoped that I might hear rather more speeches vigorously in support of the Government's decision, but never mind—I know that there is such a thing as a silent majority on such matters.
The hon. Members who have spoken obviously attach a high priority to the needs of drug and alcohol abusers, and so do the Government, but hon. Members seem to assume for some reason that their views will not be shared by any of their local authority colleagues. No one has explained why that sudden divergence of opinion should arise, but that was the underlying assumption behind every request for ring fencing to be restored.
The Turning Point survey has been referred to by many hon. Members. It acknowledges that even in 1990, long before the local authorities assume responsibilities for community care in April this year, about half the applications for top-up funding for residential services for drug and alcohol abusers made to social service departments in the London boroughs and county areas 422 surveyed were successful. The local authorities already recognised the needs even before they took on the duties that they are about to have.
Let me explain to the hon. Member for Makerfield (Mr. McCartney) that the Special Grant Report (No. 7), which we shall approve in a few minutes, does not remove resources. It adds £20 million to the special transitional grant, which is ring fenced for the purpose of expenditure on community care services—some of which will be for drug and alcohol abusers'. The decision not to ring-fence the money for the residential treatment services does not mean that a single penny has been removed from the funds that the Government make available for drug and alcohol service providers.
The way in which the argument has been put this evening sometimes seemed a little over the top. Let us remind ourselves that since 1979 the real increase in expenditure on personal social services has been two thirds. In the past three years, the real increase in the personal social services standard spending assessment has been one fifth. If we take account of the special transitional grant of £565 million—I remind the House that that is not merely the money being transferred from social security, but an extra £140 million to help local authorities develop their services—and the standard spending assessment, next year local authorities will have at their disposal 15 per cent. more resources for social services expenditure than they have this year. It will be up to local authorities to decide how much of that massive sum they allocate to the treatment of drug and alcohol abusers.
The hon. Member for Stretford (Mr. Lloyd) intervened in the speech by the hon. Member for Wakefield (Mr. Hinchliffe) about the resourcing of Manchester.
§ Ms. Glenda JacksonWill the hon. Gentleman give way?
§ Mr. YeoNo, I have only four minutes to wind up.
This year, Manchester city council is spending £64 million on social services and it has a personal social services standard spending assessment of £76 million. Next year, the SSA will be £79 million and it will get a special transitional grant of £6 million, which is excluded from the rate-capping calculations. The only reason why there could be any shortfall in funding for social services in Manchester is because of the decisions of the Labour-controlled Manchester city council, which is exclusively responsible for denying the people of Manchester the services that they need.
A great deal has been made of the survey by Turning Point, which is scarcely a scientific study, as it is based on studies using 1989–90 prices and arbitrarily grossed them up by 68 per cent. over four years. I am not sure why costs should rise by that massive amount during that time, but I hope that when local authorities make referrals to drug and alcohol treatment centres they will at least ensure that they are getting value for money.
I recognise that the distribution decision is difficult. We went through detailed discussions with the local authority associations about how to distribute funds for community care. There is no obviously right answer. We are all concerned to try to achieve a smooth transition to the new policy, but 35 per cent. of the special transitional grant will be distributed on the basis of the present income support 423 expenditure pattern and the other 65 per cent. is based on SSAs, which take into account socio-economic factors and tend to favour the inner cities.
I believe that that was the best judgment that we could arrive at to achieve the smooth transfer that we want. I stress again that our community care policy, the generous funding that we provide, and the way in which the money is being distributed are not intended to protect the position of every provider of treatment, but to ensure that services are designed to meet the needs of the individual.
I must inform the hon. Member for Dulwich (Ms. Jowell) that we are giving the drug and alcohol service providers exactly the same protection that she says is being accorded to the providers of residential homes for the elderly. They are all being treated alike.
On monitoring, I recognise the concerns of my hon. Friends, but I am not sure how they reconcile with the fact that Opposition Members have told us that some of the establishments will go out of business in three months. If that is the case, our three-month period will be long enough, especially bearing in mind that client turnover in the centres is rapid-the average stay is only 19 weeks. Monitoring by the social services inspectorate will continue, even after the end of three months, to see how the implementation of community care is going.
In conclusion, no providers of residential or other treatment for drug and alcohol abusers have anything to fear from our policy if the services that they offer are of a kind that are recognised as effective and valuable for that client group.
§ Question put:
§ The House divided: Ayes 91, Noes 59.
424| Division No. 172] | [11.43 pm |
| AYES | |
| Amess, David | Dykes, Hugh |
| Ancram, Michael | Elletson, Harold |
| Arbuthnot, James | Evans, Nigel (Ribble Valley) |
| Atkinson, Peter (Hexham) | Faber, David |
| Baker, Nicholas (Dorset North) | Fabricant, Michael |
| Bates, Michael | Forman, Nigel |
| Beresford, Sir Paul | Forth, Eric |
| Biffen, Rt Hon John | Fox, Dr Liam (Woodspring) |
| Bottomley, Peter (Eltham) | Freeman, Roger |
| Bowis, John | Gallie, Phil |
| Brandreth, Gyles | Gillan, Cheryl |
| Bright, Graham | Goodson-Wickes, Dr Charles |
| Brooke, Rt Hon Peter | Griffiths, Peter (Portsmouth, N) |
| Browning, Mrs. Angela | Hague, William |
| Butcher, John | Harris, David |
| Carrington, Matthew | Hawksley, Warren |
| Carttiss, Michael | Heathcoat-Amory, David |
| Chapman, Sydney | Hendry, Charles |
| Clappison, James | Horam, John |
| Clifton-Brown, Geoffrey | Hunter, Andrew |
| Congdon, David | Jack, Michael |
| Coombs, Simon (Swindon) | Kilfedder, Sir James |
| Cran, James | Kirkhope, Timothy |
| Currie, Mrs Edwina (S D'by'ire) | Knight, Mrs Angela (Erewash) |
| Davis, David (Boothferry) | Knight, Greg (Derby N) |
| Day, Stephen | Kynoch, George (Kincardine) |
| Deva, Nirj Joseph | Lidington, David |
| Dover, Den | Lightbown, David |
| Duncan, Alan | Lloyd, Peter (Fareham) |
| Duncan-Smith, Iain | Luff, Peter |
| Lyell, Rt Hon Sir Nicholas | Sweeney, Walter |
| MacGregor, Rt Hon John | Sykes, John |
| Maitland, Lady Olga | Taylor, Ian (Esher) |
| Malone, Gerald | Thomason, Roy |
| Merchant, Piers | Thompson, Patrick (Norwich N) |
| Mitchell, Andrew (Gedling) | Thurnham, Peter |
| Neubert, Sir Michael | Townend, John (Bridlington) |
| Nicholls, Patrick | Trend, Michael |
| Patnick, Irvine | Twinn, Dr Ian |
| Pattie, Rt Hon Sir Geoffrey | Waller, Gary |
| Porter, David (Waveney) | Wardle, Charles (Bexhill) |
| Rathbone, Tim | Wells, Bowen |
| Richards, Rod | Wheeler, Rt Hon Sir John |
| Robertson, Raymond (Ab'd'n S) | Whittingdale, John |
| Robinson, Mark (Somerton) | Widdecombe, Ann |
| Shaw, David (Dover) | WiHerts, David |
| Soames, Nicholas | Wood, Timothy |
| Spencer, Sir Derek | Yeo, Tim |
| Spicer, Michael (S Worcs) | |
| Spink, Dr Robert | Tellers for the Ayes: |
| Sproat, Iain | Mr. Andrew MacKay and |
| Steen, Anthony | Mr. Robert Hughes. |
| Stephen, Michael | |
| NOES | |
| Abbott, Ms Diane | Jackson, Glenda (H'stead) |
| Adams, Mrs Irene | Jackson, Helen (Shefld, H) |
| Barnes, Harry | Jones, Lynne (B 'ham S O) |
| Bayley, Hugh | Jowell, Tessa |
| Bermingham, Gerald | Kennedy, Charles (Ross, C&S) |
| Blunkett, David | Kennedy, Jane (Lpool Brdgn) |
| Boyce, Jimmy | Kilfoyle, Peter |
| Clapham, Michael | Lewis, Terry |
| Clarke, Eric (Midlothian) | Lloyd, Tony (Stretford) |
| Clelland, David | Lynne, Ms Liz |
| Coffey, Ann | McCartney, Ian |
| Connarty, Michael | McMaster, Gordon |
| Cryer, Bob | Mahon, Alice |
| Cunliffe, Lawrence | Meale, Alan |
| Davidson, Ian | Michie, Bill (Sheffield Heeley) |
| Dixon, Don | Milburn, Alan |
| Dowd, Jim | Pope, Greg |
| Etherington, Bill | Prescott, John |
| Foster, Rt Hon Derek | Primarolo, Dawn |
| Gerrard, Neil | Roche, Mrs. Barbara |
| Godman, Dr Norman A. | Simpson, Alan |
| Gordon, Mildred | Skinner, Dennis |
| Grant, Bernie (Tottenham) | Stott, Roger |
| Hall, Mike | Taylor, Mrs Ann (Dewsbury) |
| Harvey, Nick | Turner, Dennis |
| Heppell, John | Wilson, Brian |
| Hill, Keith (Streatham) | Wise, Audrey |
| Hinchliffe, David | |
| Hood, Jimmy | Tellers for the Noes: |
| Howarth, George (Knowsley N) | Mr. Jeremy Corbyn and |
| Hughes, Kevin (Doncaster N) | Mr. Malcolm Chisholm. |
| Illsley, Eric |
§ Question accordingly agreed to.
§
Resolved,
That the Special Grant Report (No. 7) (House of Commons Paper No. 504), which was laid before this House on 22nd February, be approved.
§ Mr. CorbynOn a point of order, Mr. Deputy Speaker. As fewer than 100 voted in favour of the report it can hardly be said to have the full-hearted consent of the House, so is it now legal?
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)The answer to that is yes.