§ Motion made, and Question proposed, That this House do now adjourn—[Dr. Liam Fox.]9.11 pm
§ Mr. Colin Shepherd (Hereford)
Usually at this time of night an hon. Member is on his or her feet complaining about something. Indeed, the Adjournment debate came about to enable grievances to be aired. I thank my hon. Friend the Minister for coming to the House to respond. My purpose in airing this subject tonight is not to gripe but to share with him and the House some good news. I am particularly grateful to Madam Speaker for selecting this topic from the many bids that are submitted for debate at this time of night.
The formal title tha[...] appears on the Order Paper, "Community care for physical disability in Herefordshire," conceals the real reason for the debate. A charitable organisation known as Herefordshire Lifestyles, which has been in existence for some nine years, is making a major impact on the lives of those disabled people in Herefordshire fortunate enough to have been referred to it or to have found it.
Herefordshire Lifestyles is about enabling disabled people to pioneer their own integration into the community. The organisation came about as a result of the fortuitous confluence of the ideas of five senior people in the caring services who realised that there was a missing dimension. That was back in 1985, when Ray Brown, the assistant general manager of the health authority in Hereford, Eric Beatty, the area director of social services for Hereford, Wendy Francis, the district physiotherapist, Micheline Robson-Ward, the occupational therapist, and Len Gale, the specialist careers officer, put their heads together and came up with that approach to the needs of the disabled. In effect, it turned how the services had been delivered in the past on its head. Their way recognises that disabled people want to be regarded as equal members of society. It enables disabled individuals to be in the driving seat of their destiny and to marshal the various agencies from there, which is precisely the opposite of what usually takes place.
Given the assistance of a volunteer, a disabled person is in a position to say, "OK, I have seven days in a week. What do I want to do with that time so as to meet my needs and personal objectives? What about work? What about going to college to obtain new skills? I lost mine when I became disabled. What about mobility? What about the need for company? What are my personal ambitions?" In that way, people come up with constructive proposals and plans for their future. The Lifestyles input and expertise helps disabled people to make things happen.
The developed package worked out with the client is reviewed every six months. In that way, disabled people make tremendous progress and develop in terms of both their work and their residence, with many of them able to continue living in their own homes, out of residential care or hospitals, in a variety of ways.
The outstanding feature of Lifestyles is the involvement of the disabled themselves in helping other disabled people. Indeed, the involvement of disabled people in all aspects of the organisation, work and structure, singles it out as being different from anything else that I have 521 experienced. The point that I want to emphasise as much as possible is that the work that these people are doing on behalf of their clients does not duplicate other agencies; it is complementary and helpful.
A wealth of information, in many forms, is available to the disabled, but if one does not speak or understand the jargon it is difficult to comprehend or to put in context. The help given by a Lifestyles volunteer is, as it was put to me, rather like having somebody to read the telephone directory when one is in a strange country and does not understand the language. Then, it all comes into place. The Lifestyles volunteers provide the necessary help for people to get around in the system. For Herefordshire Lifestyles, what started from very small beginnings is now an organisation with 55 volunteers who each give an average of 100 hours a year, which is a substantial voluntary input into the important work it does for its clients.
Of course, there is a financial dimension. I pay tribute to Mr. Len Gale, who abandoned what might be described as a safe haven within the careers service for the precarious position of executive director of Herefordshire Lifestyles. He has dedicated himself to the project. The financial future of Herefordshire Lifestyles is not secure; it is precarious. Until 1987, it had no budget at all. The Spastics Society—or Scope, as it is now called—gave it its first break with a commitment to cover a year on behalf of some of its clients. That enabled the provision of a small operating base.
It would be unkind to say that, since then, the project has staggered on, because it has in fact progressed very smoothly. However, financially it has staggered on on a month-to-month, hand-to-mouth basis with never more than a short-term view of its future. Over the years, it has been aided in its work by such eminent charities as the Nuffield Provincial Hospital Trust, Comic Relief, the Hereford and Worcester training and enterprise council—for which it has done valuable work—and social services, not to mention the Rowntree Trust and the King Edward VII Fund. I am pleased to say that the Eveson Trust has enabled the retention of a fundraiser for a year—an addition that is very much appreciated and needed in the light of its £100,000 budget for 1994–95.
At present, about 100 people are benefiting, but there are many, many more who could benefit, not only in Herefordshire but across the country. That is one reason why I wanted to raise the matter tonight. Herefordshire Lifestyles would like to be able to develop what it is already doing on behalf of a resident who is the responsibility of Suffolk county council—a referee of the Spastics Society for whom the county council has long-term responsibility. It provides the money necessary for the care of that individual and that money is ring fenced. Lifestyles then works out the appropriate package. In effect, it is working as a broker on behalf of its participants and procuring the best and most suitable package for each individual as an individual. The project is highly tailored to the needs of the recipients and a reflection of the Government's policy of community care. Lifestyles would like to be the recipient of finance, ring fenced on behalf of the client, so that it can work out a package that enables the community care objectives to be met.
I have mentioned the "people benefit", but there is also a cost benefit. In practical terms, the benefit is very much in the form of a stitch in time that saves nine. Lifestyles' 522 contacts mean that social services can be alerted before a crisis happens, such as a carer collapsing under the strain or a major problem developing. Action can be taken in a measured way before matters develop into an emergency.
For many other people, the project offers an alternative to using social services departments and provides a useful tool for social services to achieve goals that they would otherwise be stretched to achieve, given their own financial limitations, as obliged by law. In addition, it becomes possible for disabled people to use the ordinary facilities of the community rather than special ones. I am told by those involved in the Herefordshire Lifestyles project that that is an important objective for a disabled person. The scheme meets both society's objectives and those of disabled people. It is possible to see Lifestyles as the missing component of the community care model, acting at the interface between purchasers and providers, and enabling the clien[...] to obtain the best and most effective value from the system.
The project provides a good gearing mechanism. The concept needs to be developed on a far wider basis than that of Herefordshire. The efforts of Len Gale and others have resulted in 10 nascent Lifestyles organisations in other parts of the country— north Dorset, Salisbury, Swindon, Trowbridge, Cirencester, Stroud, Worcester, Sandwell and Exeter. But Herefordshire is the most advanced and developed; it is the pioneer. All the projects are staggering from one financial uncertainty to another and existing from hand to mouth.
My hon. Friend the Minister will know that sections 1 and 2 of the Disabled Persons (Services, Consultation and Representation) Act 1986 have not yet been implemented. The development of the concept that underlines Herefordshire Lifestyles provides a value-for-money way forward as it can put in place those two important elements of that legislation. For my hon. Friend the Minister, who has to deal with realities, there is a distinct cost benefit involved in developing the concept.
I should like my hon. Friend to work out how the Lifestyles concept can be spread nationwide to the benefit of all physically disabled people. I want disabled people throughout the country to have what some of the disabled people in Herefordshire have. Herefordshire Lifestyles has put much effort into spreading the word, and not without success. But effort spent in that direction is effort not spent on Herefordshire Lifestyles' intended objective, which is to work to the benefit of Herefordshire's disabled.
Perhaps my hon. Friend the Minister can set up what might loosely be described as a task force or working party or study group which can look at the Herefordshire Lifestyles experience, see how it can be extended and report to my hon. Friend with its recommendations. Perhaps he can use his good offices to promulgate awareness of the concept and can give specific advice to social services departments on how they can help the project along. I am sure that a push from him could enable an enormous number of disabled persons to benefit as so many of those in Herefordshire have done. For my part, I want to preserve and develop something good that is already up and running.
I give the last word to some participants in Herefordshire Lifestyles. One said:Lifestyles has made me think that there is more to life than just my disability.523 Another said:Lifestyles has got me up and doing things",while yet another said:They help disabled people get a grip on their life and make something of it.Finally, one participant said:Lifestyles has given my life a real rocket.Herefordshire Lifestyles has started something good; I want it to expand and I look to my hon. Friend the Minister for help in that.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
I was going to say that it was a double pleasure to reply to my hon. Friend the Member for Hereford (Mr. Shepherd), but I think that it may be a triple pleasure. It is indéed a pleasure to respond to my hon. Friend; it is a pleasure to hear what he describes as a good news story; and it is also a pleasure to both of us, and perhaps to you, Mr. Deputy Speaker, and to ray hon. Friend the Member for Woodspring (Dr. Fox), that this debate is taking place at a reasonable hour, and earlier than some had expected.
I was delighted to hear of the work being done by Herefordshire Lifestyles, and I greatly welcome initiatives that seek to enable disabled people to achieve greater independence and choice in their daily lives. I certainly recognise the important role of advocacy in helping people who, for whatever reason, may have difficulty in making known their views and wishes. The local availability of advocacy and self-advocacy services is an essential part of community care, and Lifestyles seems to be a prime example of the type of scheme that we are actively encouraging local authorities to use and support.
My hon. Friend's success in securing this Adjournment debate means that I have had the opportunity to read some of Herefordshire Lifestyles annual reports and the case studies contained in the 1993 report. They bear witness to the practical help that Lifestyles workers and volunteers have been giving disabled people, giving them the confidence to maximise their opportunities for education, employment and training and trying out new social activities.
My hon. Friend referred to the experience of one participant and I have seen the testimony of another beneficiary of Lifestyles—Jonathan Wood—from a different part of the country, who said:My experience of the Lifestyles project has given me a state of mind which I have not had the opportunity to experience before. Also, a sense of control, and essentially, direction of mine and subsequently others' thoughts and actions. Unlike the majority of forms of provision for disabled people, the advantage with Lifestyles projects is that the client, i.e. the disabled man or woman, is accepted for themselves … Lifestyles should continue and thrive. The freedom of choice must not be taken in the form of charity, but a disabled person's fundamental human right … they must be given the ability to choose".I can respond immediately to my hon. Friend's request by saying that I intend to examine more closely the work done in Herefordshire. I shall ask the social services inspectorate to provide me with a detailed report on Lifestyles activities.
524 This project for the physically disabled in Herefordshire sits well with our overall community care philosophy of putting the needs of users and their carers first and involving them in decisions about the care that they receive. Community care is a complex and long-term undertaking, involving partnerships between public, private and voluntary agencies. None the less, the new arrangements have already brought us the beginnings of care which is better tailored to individual users' needs, for day, domiciliary, residential and nursing care.
We are listening carefully to users and their carers, and increasing numbers of them are beginning to benefit from the improved choices in care options available. People now have a better chance of being offered the help and support that they need to remain in their own homes—as my hon. Friend said, they should have the option of doing that. It is, after all, what most people want.
My hon. Friend mentioned the Disabled Persons (Services, Consultation and Representation) Act 1986, and suggested that what he described could be one way of fulfilling the intentio[...]s of that Act. He may well be right. In some ways, the community care reforms have overtaken the remaining provisions of the Act, and the reforms demonstrate our commitment to high-quality community care, responsive to the needs and wishes of service users and carers.
The whole thrust of that policy is towards enablement. We are supporting advocacy projects that aim to help those with particular needs. So, as my hon. Friend said, schemes such as the one that he has highlighted may be the way to develop that aspect of the intentions behind the 1986 Act.
We have made sure that the new community care arrangements have been properly funded, and we shall continue to do so. This year, a further special transitional grant of £736 million is being made available to English local authorities solely for community care. That takes the total over two years to more than £1.2 billion. The grant this year includes an extra £20 million to encourage further development of respite care and other services that give carers a well earned break.
Joint working between local authorities and the NHS is generally good. The agreements that we required to be made on hospital discharge arrangements have had a positive effect in furthering the co-operative working that is so essential if users and their carers are to receive care that is both comprehensive and seamless.
The independent sector has played an important part in community care to date, and I am sure that it will have an important role to play in the future. There is a challenge here for local authorities, the independent sector, and users and carers to work together to shape the future.
I believe that there is still much greater potential for the independent sector to move into day and domiciliary care provision. We have a great opportunity to cultivate and nurture it now—one which I am not prepared to see wasted. Users and carers would not forgive us if we were to miss the opportunity to extend the range of services available to them. They can play a full part in helping us to design the pattern of future provision. 525 So often, the independent sector brings a freshness of ideas, and a willingness to innovate and be flexible. Built on the solid foundations of their experience and quality, that gives new opportunities for users and carers—and, indeed, for social services and health planners.
We have a continuing commitment to the mixed economy of care. That is how we can secure a full range of services to meet the many diverse needs of vulnerable people all over the country. There is no question of preferring one sector at the expense of others; we simply want good care to be favoured over poor, the cost-effective over the wasteful, the imaginative over the dull, and the best over the adequate, so as to bring about effective, efficient provision for all users, whatever the sector.
From the beginning of our new arrangements, we have had a full monitoring programme so that we can keep a check on progress, and, also so that we can see and disseminate best practic[...] and innovation—ideas such as Lifestyles. This year, we shall want local authorities to report on, for example, how assessment is working, how users and carers are being involved and what new services are being bought to extend the range available. That, too, is relevant to Lifestyles.
Earlier this year, we announced our plans to extend the benefits of the citizens charter to community care. That will help us to ensure that users and carers are in a position to make informed choices about the kind of care that they receive. Again, schemes such as Lifestyles can have an increasing role to play.
The Government fully recognise the important role played by carers, and the dedicated and often arduous work involved in caring for a loved one. That is why the 526 community care reforms aim to promote the development of domiciliary, day and respite services for those receiving community care in their own homes.
Our community care reforms make it clear that the voices of users and carers must be heard and listened to by those responsible for purchasing and providing services. To ensure that I as the Minister responsible was also hearing and listening, we set up the National User and Carer Group to give us its experience of community care and to help us monitor its implementation.
However, as my hon. Friend has said, it is locally that advocacy comes into its own. That is true, whether it is advocacy or self-advo[...]acy. It is perhaps the former that we have had the chance to consider tonight—the helping hand and the helping voice enabling people with disabilities to achieve and to enjoy the fullest and highest possible quality of life. In the example given by my hon. Friend this evening, he has shown how there can be the added dimension of disabled people themselves providing the hand and the voice to help others with disabilities. That is real added value.
§ Mr. Colin Shepherd
I am most grateful for what my hon. Friend has said, and for his commitment. It would be a matter of enormous pleasure if, in his busy schedule, he could find time to come to Hereford and to see what we are doing as part of that visit.
§ Mr. Bowis
I close by thanking my hon. Friend for taking the opportunity to bring to the attention of the House the work of Herefordshire Lifestyles. Yes, I should very much like to visit the scheme and to see it in action when I am next in his area. Meanwhile, I join him in wishing success to all working in the area of Lifestyles and advocacy, and to all who need their services.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-five minutes to Ten o'clock.