§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lightbown.]9.35 am
§ Mr. Gareth Wardell (Gower)
I am most grateful for the opportunity today to bring to the Minister's attention one aspect of the problems associated with disabled people in Wales—the provision of disabled facilities grants.
My constituent Mrs. Rogers—I have deliberately altered the name—is 72 years old. She weighs about eight stone; she has always been a very active and busy lady. Her husband is also in his early 70s. He was admitted to hospital last year and had both his legs amputated at the knee. He weighs about 15 stone.
Mr. Rogers was discharged from hospital to his home, a comfortable three-bedroomed, semi-detached house. He was only too pleased to be going home, and his wife could not get him home soon enough—except that, when the ambulanceman left, the reality of community care came home to the family
Mr. Rogers cannot get up or down stairs, he cannot sit himself up in bed, or get on a bedpan or use a commode. He cannot get in and out of bed, or in and out of a wheelchair, or a bath or a shower. He cannot wash his hair. He cannot be taken in or out of the house in a wheelchair.
Mr. Rogers is a game individual. His wife is practical and a tower of strength, but she cannot lift him or safely steady him. It is just not physically possible for an eight-stone elderly lady to manhandle a disabled man almost twice her weight. He needs gadgets, such as pulleys and handrails, so that he can get up and down, and in and out of bed, and into or out of a wheelchair. He needs adaptations: perhaps not an extension to the house, but certainly a stair lift, wider doorways and ramps, instead of steep steps, so that he can move around his home and not be a prisoner in one room.
Mr. Rogers needs a different shower, unlike the one he has over the bath, so that, as he puts it, he can keep himself clean and enjoy some privacy and dignity.
Mr. and Mrs. Rogers need a disabled facilities grant for these adaptations if they are to cope. They have been told that they will have to wait three years for such a grant. They are just one of many couples who have approached me for help. Patients are being discharged from hospital to schemes of care in the community. They move from the boundaries of health care into social care. The keys to adequate and successful care for the disabled in the community are adaptations to their homes.
There are 300,000 carers in Wales. We rely on them as the backbone of care in the community. They look to us in the House to ensure that the basic facilities that will make their task possible will be available to them.
In Wales, according to the 1986 Welsh house condition survey, while only one in four owner-occupied households are pensioners, two out of every five pensioner households live in homes needing more than £3,000-worth of repairs. People aged over 75 are more likely to live in poor housing. Almost two thirds of households eligible and entitled to grant aid are elderly people.
As people get older, their need for a disabled facilities grant becomes more likely. With the introduction of care in the community, more pensioners will need grant help if they are to stay in suitable housing where they can be warm, safe and comfortable. The ability to meet that need 1053 at an average cost, based on Swansea city's experience, of £3,000 in disabled facilities grant per household is vital to the success of community care.
I have raised the issue during Welsh Questions on a number of occasions and have drawn both the Secretary of State's and the Minister's attention to the fact that, in my view, care in the community cannot work unless disabled facilities grants are available and adaptations are carried out before a patient is discharged home from hospital.
The Secretary of State's response resembled that of a petty schoolboy in the playground. "Don't blame me, blame the Labour councils," he told me, "Let the councils put their money where the hon. Member's mouth is."
If that really is the response of the right hon. Gentleman to a legitimate question about the funding of grants for the disabled and frail elderly, he should get himself back to basic courtesies, never mind constructing glib slogans. It is neither appropriate nor seemly to make such comments and push the frail elderly and disabled into that argument to avoid responsibility for implementing his own Government's policies.
The Under-Secretary of State who is to reply to the debate informed my hon. Friend the Member for Neath (Mr. Hain) on 10 January that £27.9 million is available to local authorities for disabled facilities grants in the financial year 1994–95. That is somewhat less than the Secretary of State led me to believe. He told me in a parliamentary answer on January 17 this year that local authorities had had £26 million in 1992–93, and that he was increasing that figure this year by £6.6 million. So in seven days the disabled in Wales seem to have lost £4.7 million.
Since 1 April 1992, however, the allocation of moneys for disabled facilities grants is a notional inclusion into the basic credit allowance of local councils. It has therefore become easy for any Minister in Wales to claim that there has been no cut by central Government, even though local councils are having to make up progressive year-on-year reductions in funding for all housing needs.
It is unfortunate that, because of the switch to care in the community, the increased demand for disabled facilities grants has coincided with the Government ceasing to make a distinct and separate allocation of disabled facilities grant moneys, shifting such grants into the basic credit allocation and away from the supplementary credit allowance. That means that grants for the disabled now have to compete with other demands on the council's capital programme.
In Swansea, for instance, the city's ability to switch money to disabled grants is limited by the city's commitment to long-standing projects such as the PRC housing refurbishment programme. Disabled facilities grants now have to compete with other grants for council house repairs and improvements. Those competing demands jostle for priority within a reduced budget.
A recent survey of local authorities in Wales undertaken by Swansea city council shows that the proportion of basic credit allocation used for disabled facilities grant purposes varies from a mere 7 per cent. to an enormous 83 per cent. The question seems to be by how much one can rob Peter to pay Paul. Of the councils that took part in the survey, 62 per cent. experienced a shortfall of finance for disabled facilities grants, with increases required ranging from 10 per cent. to 150 per cent. The average increase in capital required to deal with demand was 33 per cent.
1054 The experience of Swansea city council is that the number of applications for grant has increased. In April 1991, 204 applications were approved, out of a total of 555 applications. In 1992, 491 applications were approved, from 706 original applications. From April 1993 to June 1993, when disabled facilities grants were stopped for lack of funds, 66 applications were approved, from 162 original applications. The city now has 250 applications awaiting approval, and 470 inquiries on hold. To meet that need, the city will need an extra £2 million.
It has been a source of satisfaction that in Swansea there has not been an excessive wait for disabled facilities grant.—until this year, when it became apparent that the amount the city had allocated for disabled facilities grant, along the lines the Government had suggested would be the city's needs, no longer met increased need for adaptations. There is now a backlog of 263 full applications awaiting approval. Acceptance of new applications has been frozen. Approximately £500,000 of next year's disabled facilities grant allocation has been spent, and the system is breaking down.
It is not just that the vulnerable and their carers are having to cope with special problems and difficulties in totally unsatisfactory circumstances, as in the case of Mr. and Mrs. Rogers; it is grossly inefficient that a system of care which depends on three agencies—the health authority, county social services and the district councils grant system—should be jeopardised in this way.
Hospitals do not want elderly patients commandeering scarce acute long-term beds, but the health authority is not prepared to pay for nursing care in private nursing homes.
The Under-Secretary and I served together on the Select Committee on Welsh Affairs that in 1992 examined community care in Wales, especially in respect of the needs of the elderly. One aspect we explored was the discharge of patients from hospital. I am extremely perturbed that, as far as I know, there remains in force a Welsh Office circular dated 5 January 1990, which was included in the annexe of the fourth report of that Committee, published on 11 March 1992. It states:No NHS patient should be placed in a private nursing home against his/her wishes if it means that he/she or a relative will be personally responsible for the home's charges.Among the witnesses from county council social services departments who appeared before the Committee on 5 February 1992 was Mr. Byron Williams, assistant director of community care for Gwynedd. At column 159 of the minutes, I suggested that there was a hidden conspiracy between consultant geriatricians and hospital social workers in discharging elderly people from hospital into private nursing homes, without explaining the meaning of the relevant paragraph in the Welsh Office circular. Mr. Williams replied:I quite agree with the sentiments you are expressing. What we have to look at is the pressures on those people in those circumstances, and they are quite appalling. Sometimes it is a kind of social conspiracy, almost, involving a number of people, quite unconsciously, to achieve certain tidy outcomes, which is residential nursing home care.It concerns me that the Welsh Office circular remains in force and that patients are still discharged into private nursing homes without a proper explanation of the financial implications. I am certain that still goes on, but it is complicated by the fact that the patients return home first before entering a private nursing home, which avoids the provisions of the Welsh Office circular.
1055 Whatever happens, when the elderly patient is discharged home, the social services department eventually makes an assessment of need, based on the requirement for adaptations. My experience is that social workers take no account of the length of time that work will take to complete. In any case, is it efficient to pay for a nursing home place for any length of time when a relatively small amount of money spent on aids and adaptations can often enable a patient to live happily, competently and decently at home, with ancillary care support services?
Disabled facilities grants are extremely cost-effective if they allow the individual to remain in his own home, if that is where he wants to be, compared with admission to a nursing home at a cost of up to £16,000 a year. If community care is to be a meaningful alternative, it must be paid for in terms of not only social workers, health visitors, district nurses arid care assistants but adapting homes where necessary—and quickly, so that the health, morale and well-being of patients and their carers are not worn down by the strain of barely coping.
I hope that the Minister will re-examine that issue and amend the Welsh Office circular, so that the financial burden of means testing is clearly explained to patients. They are given a so-called choice, but in reality there is no choice in terms of being discharged from hospital into a nursing home. I hope that he will also consider the needs of patients receiving care in the community and will increase funding of disabled facilities grants.
That allocation should be ring-fenced and specific, as part of community care funding. Local councils need to be on top of the demand for care, so that they may take their crucial place in the community care chain. For patients such as Mr. Rogers, returning home should be a continuum of suitable care, not a sentence of house arrest.
I hope that the Minister will reconsider that important issue. The fundamental error in April 1992 was to transfer the only mandatory housing grant—the disabled facilities grant—out of the supplementary credit allowance and into the basic credit allowance. If the Minister examines the issue carefully, I am sure that the lives of many people who experience tremendous anguish in trying to cope at home without necessary adaptations will be made much more pleasant.
§ The Parliamentary Under-Secretary of State for Wales (Mr. Gwilym Jones)
I am glad of the opportunity to respond to the hon. Member for Gower (Mr. Wardell) on this important matter. I listened carefully to his comments, and various points that he raised deserve replies.
The hon. Gentleman described the take-up of moneys allocated to Swansea city council. The figures I have for the latest available year substantially bear out the hon. Gentleman's comments about better take-up by that council. In the previous year, it used less than half the moneys allocated for disabled facilities grants.
I appreciate the difficulties experienced by the hon. Gentleman's constituent, Mr. Rogers. That is exactly the sort of case to which we all want to see local authorities responding sympathetically and speedily.
I must correct an apparent confusion in the hon. Gentleman's mind. The sum for disabled facilities grant in the coming year will be £27.9 million, which is £1.5 million more than the current year. In turn, my right hon. 1056 Friend the Secretary of State is bringing forward an additional package of a variety of measures to try to help disabled people, totalling £6.6 million, so there is no question of a reduction of £4.7 million in seven days.
I agree with the hon. Gentleman that housing has a crucial role to play in the success of community care. If we are to encourage people to continue to lead independent lives in their own homes or non-institutional settings for as long as possible, we need to ensure that their accommodation and the arrangements for their care are appropriate for their individual requirements.
There are impressively high levels of home ownership in Wales, emphasising the importance that the vast majority of people in Wales attach to owning their own homes. Similarly significant is the community spirit, which we are anxious to maintain and enhance and which gives us tremendous opportunities to develop community care in a way that is sensitive to, and takes advantage of the strength of, those communities.
As many homes were built during periods of rapid industrial expansion around the turn of the century, proper maintenance, repair and improvement of those homes plays a vital part in securing their future. It must first be for owners to take responsibility for looking after their homes, but it is important that we provide help for those in need. That is where our home renovation grant arrangements have provided invaluable assistance, not only in renovating and improving property, but also by providing essential adaptations for disabled people in Wales, through disabled facilities grants and minor works assistance.
Rightly, those grants form a very important part of care in the community. By providing substantial assistance to adapt homes for disabled people, they help to ensure that disabled people need not move away from their existing homes, but can remain in familiar surroundings, living in dignity and comfort with the support of families, friends, neighbours and carers. That makes best use of strong, existing communities, which are essential in underpinning the principle of care in the community.
Since the new system was introduced in 1990, disabled facilities grants worth more than £30 million have been made available to disabled people in Wales. We should not underestimate the impact that that has had, not only in providing the facilities to enable people to remain in their own homes, but in easing the difficulties that many of those people who help or care for them may have experienced.
Obviously, disabled facilities grants form part of the wider home renovation grant arrangements. That is especially important as many of the homes in which disabled people live will not only require adaptation but may also need works of repair or improvement.
From the outset, the Government realised that the new grant system would have tremendous value in Wales. The special financial arrangements that applied in the first two years of the new system have ensured that Welsh authorities were well placed, and the system was off to a good start. The substantial sums of the taxpayers' money that we have since made available have helped authorities to tackle the repair, improvement and adaptation of the homes of those who are least able to help themselves. Those have often been the elderly, the disabled, or people who were simply unable to make any contribution towards the cost of repairs under the earlier grant arrangements.
Following the introduction of the current system in 1990, almost £650 million has been provided for home renovation in Wales. Next year, a further £149 million is 1057 allocated for mandatory renovation grants alone—£3.5 million more than in 1993–94. A further £27.9 million, as I have mentioned, is available specifically for disabled facilities and discretionary grants. That is £1.5 million more than this year, and that total of almost £28 million will enable local authorities to give about 6,300 grants for disabled people in Wales at the average grant rate if that money is used for disabled facilities grants alone. Those are substantial sums.
From 1992–93, we have ensured that funding arrangements for disabled facilities grants are such that local authorities can respond more flexibly, in liaison with social services departments, to the needs of people with disabilities in the context of care in the community. With disabled facilities grants being of help in enabling many disabled people to continue to live in their own homes, there will be occasions when alternative approaches may be more suitable and are felt to be more appropriate by the disabled person. The current funding arrangements are designed to enable councils to consider all housing options, including transfer to more suitable accommodation, in responding to the needs of disabled people.
Local authorities have greater operational flexibility in the way in which the moneys are used, so that they may determine their own spending priorities and make the best judgments of how they should respond to the needs of disabled people, alongside other priorities, within the significant total sums from the taxpayer that we have made available.
During the three years since 1992–93, more than £80 million will have been made available in Wales specifically for disabled facilities grants and discretionary renovation grants. In 1992–93, less than half of those sums available for adaptations was spent on such grants. We estimate that, for the current year, the figures will again be no more than half of the available moneys.
There is obviously scope for councils to direct more money to disabled facilities grants. I hope that Welsh local authorities will take full advantage next year of the increase that we have made available to ensure that disabled people can obtain the assistance they need to adapt their homes in the community.
Given the moneys that have been, and are being, made available, there is no reason why any disabled person who is entitled to a grant should not receive the help that he or she needs, where the housing authority and social services department agree that the package of care should include adaptations. There can be no foundation for any suggestion that the absence of a grant can stem from lack of financial provision.
It is essential that there is a partnership between housing and social services authorities in agreeing with the disabled person the package of care that is most suitable for his or her needs. Indeed, there is a statutory duty for housing authorities to consult the social services departments. I know that, in many areas of Wales, effective working relationships and liaison have been developed, and that can only be to the benefit of those seeking assistance.
I urge all Welsh local authorities to consider carefully their current liaison arrangements, to ensure that there is no blockage which may cause difficulties or delays in the 1058 provision of assistance for adaptation, making full and best use of the substantial sums of money that we have made available.
There have been comments about the delays in disabled people receiving the assistance which they deserve, and to which they are entitled. Timing and handling of applications must be a matter for individual councils. Councils must already make decisions on all renovation grants, including disabled facilities grants, within six months of receipt of the application. Councils must, rightly, consult social services colleagues and the disabled person in deciding the most suitable forms of assistance to meet the needs of that individual.
While it remains for the councils to administer the system and determine the priority which they give to applications locally, in so doing they should account for their actions in helping to meet local needs sensitively and sympathetically.
It is essential that the substantial sums of the taxpayers' money available for disabled facilities and mainstream renovation grants are targeted on those people who are in greatest need. The test of resources that currently applies to all grants ensures that those in most need receive the greatest help—up to 100 per cent. of the cost of works. Correspondingly, it is right that those who are able to make a contribution towards the cost of renovation or adaptation to their home should do so. That is essential if those who are not in such a fortunate position are to receive the help they need from the taxpayer.
The Government have recently undertaken a review of the renovation grant system to ensure that it will continue to be effective in tackling housing condition issues over the remainder of the decade. That review also covered disabled facilities grants, and we are grateful for the comments that have been provided by local authorities and others with experience of operating the system.
We are currently looking carefully at the comments that have been made, including those on some aspects of the disabled facilities grant arrangements. Clearly, it would be premature at this stage for me to pre-empt any decision that may emerge from that review, but I can assure the House that the continued provision of help to adapt disabled people's homes, where that is the most suitable approach, will continue to be uppermost in our minds.
Although I have concentrated on adaptations to homes which are owned by disabled people, we must not lose sight of the importance of providing facilities for those tenants of local authorities who may also suffer from disabilities. The principle of community care applies here equally, and it is essential that they too should be given the facilities to remain in their own homes and within their existing communities where that is appropriate.
Councils can, of course, adapt their own housing to the benefit of their tenants. The extent of adaptations carried out, or the possibility of transfer to more suitable council accommodation, must be for the council to consider, in liaison with social services departments and tenants.
Funding for the adaptations will come from the councils' budgets for repair and maintenance of their housing. Again, considerable financial resources have been made available for that in Wales. For the current financial year, some £52 million has been provided. Disabled facilities grants are also available to council tenants if they would prefer that route to secure adaptations to their 1059 homes. Whatever route is chosen, the end result must be the same for council tenants and home owners who may suffer from disabilities.
It is clear that we have recognised the importance of caring for people in their communities by providing substantial support for disabled facilities grants and renovation more generally. Judged by the proportion of the money spent where it is intended, adequate funding is already available, and there is scope for councils to direct more of those moneys to disabled facilities grants. It is essential that the various local authorities and agencies work together in assessing and providing the most suitable package of care for disabled people.
Suitable housing is a vital component of any care package, either through the adaptation of existing homes or the provision of alternative housing. It is important that the accommodation best meets the need of the individual. We have the mechanisms in place to achieve that and we have provided substantial funding to support it. The key issue is that those councils and agencies in the front line provide the packages of care that disabled people deserve and need and to which they are entitled.
The White Paper "Caring for People" placed emphasis on the necessity for effective arrangements for assessing the care needs of people with a wide variety of dependencies. It was recommended that local social service authorities should identify and assess people's needs, taking full account of personal preferences and those of their carers, and design packages of care best suited to enabling people to live as normal a life as possible.
The key objectives remain. The first is to promote the development of domiciliary, day and respite care to enable people to live in their own homes wherever feasible and sensible, and to encourage the targeting of home-based care on those who need it most. The second is to ensure that practical support for carers is a high priority. Assessment of care needs should always take account of the needs of family, friends and neighbours. The third is to make proper assessment of need and good care management the cornerstone of high quality care. Care arrangements should be in line with individual needs and preferences. The fourth is to clarify the responsibilities of agencies and hold them to account for their performance.
That is the basis on which we continue to move forward. I fully share the regard that the hon. Member for Gower has for the importance of disabled facilities grants in Wales. We have made substantial sums available. The basis is right, and we will continue to keep it under review. I look forward to continuing progress.