§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I am grateful for this opportunity to discuss community care and mental health, on which there has been quite a lot of activity in the House recently. Adjournment debates have been held, and several private Members' Bills of significance have been introduced—by the hon. Members for Dulwich (Ms Jowell) and for Croydon, North-West (Mr. Wicks), for instance—all dealing with various aspects of care in the community.
It is therefore right, in the relatively calm atmosphere of this Adjournment debate on a Wednesday morning, that the House should have the chance to discuss these matters under the new Jopling procedures—
§ Mr. Don Dixon (Jarrow)
I believe he is in America, and we were here late Monday night and Tuesday night.
§ Mr. Kirkwood
Possibly so; that might not be far enough away for some of us, but it is a matter for him.
This is a good chance to see how the community care changes are being implemented 18 months on. Community care is the right policy, and the Government have been right to implement it, although the way in which they have done so has caused some difficulties. I suspect, however, that those difficulties were inevitable given the radical nature of the changes. Any political Administration would have had problems getting from where we were to where we want to be.
I think that hon. Members agree that community care is right in principle and that the Government are right to adopt and promote it. It has a great deal of potential; we must be careful not to throw out the baby with the bathwater when dealing with some of the criticisms that have rightly been levelled at the implementation of the policy. Moving from what was always a service-based policy to a much more flexibly managed, needs-led approach certainly is a radical change, which has had profound effects for users of the service and for their carers. The effects have also been profound for health care professionals and social work and social services professionals, and there have been consequences for the way in which voluntary groups operate too. All these people have had to respond dramatically to the changes implemented in the past 18 months.
I acknowledge the value of the work done by counsellors in social work and social services committees throughout the country, although I suspect that the Minister may not quite share my enthusiasm. They have done a great deal to make the policies work in the face of considerable troubles and difficulties. Immense challenges have faced them and many demands have been put on them. The House owes them a debt for the work that they have done and for the diligence with which they have discharged their duties.
§ Mr. Nick Hawkins (Blackpool, South)
Does the hon. Gentleman agree that some Labour-run authorities, of which Lancashire is perhaps the worst example, have 1016 badly mishandled the implementation of community care, and that it is not right to give blanket approval to the work done by social security committees on county councils—
§ Mr. Hawkins
Social services committees in some counties have done a good job, as the hon. Gentleman rightly said, but some county councils have misused the resources.
§ Mr. Kirkwood
I was desperately trying to avoid that kind of tone. Lancashire has lost £14 million. I do not know how it has husbanded its resources, but it would have been a clever trick for anyone to make a fist of the situation after losing £14 million. I am trying to stay above that sort of party political argument. Of course the hon. Gentleman's point was quite legitimate and I do not criticise him for making it, but I am trying to take a more philosophical approach to some of these problems. We owe that to the counsellors and to those who use the services—after all, it is the latter who suffer.
I was pleased to note that the Audit Commission's report, "Taking Stock"—I am sure that all hon. Members have read it—acknowledged that counsellors have shown themselves capable of responsible stewardship and of managing the process as well as might be expected. It is always easy to see things clearly with hindsight, but when Sir Roy Griffiths initiated the process he made it clear that he thought he was setting the agenda for a decade ahead. I think that the Government have been trying to travel too far too fast. The evidence in "Taking Stock", published in December, strongly suggests to me that some of the local authorities being asked to administer the new system do not possess the management information systems to enable them to cope with the uneven demand that they are facing in the first five or six years of the transition.
Local authorities are having to deal with existing protected clients under the old social security system—residential care—and with new clients who are coming on stream now. It is impossible to anticipate demand without sophisticated new techniques. The Audit Commission report makes it clear to my satisfaction that we expected local authorities to do too much without adequate tools. I should like the Minister to bear that thought in mind for the rest of the debate. Perhaps we should be thinking in terms of reaching our goals after 10 years instead of rushing in a manner that makes it difficult for people to cope.
Given all the evidence that we have it seems to me that there is an unanswerable case for setting up a standing working group that would involve local authority representatives, academics, departmental representatives and so on to oversee funding and many of the other issues which I expect to be covered in the next hour and a half. I hope to persuade the Minister of this idea. If he cannot respond to it today, perhaps he will respond to my suggestion later in writing. I am prepared to wait for the right answer. It is vital to get people to sit around a table in good faith to look at some of the problems of funding that are emerging and to deal with them as best they can.
The first issue that such a group would want to examine is the almost irresistible pressure that the 1990 legislation will place on health service professionals to cease providing long-term health care. The Department of 1017 Social Security transferred resources to local authorities to deal with residential care, and I understand the rationale behind that. As a consequence, the Government were able to control the budget, which was previously demand led.
Health care authorities are discharging long-term patients, including geriatric patients, into the community. I understand that care packages must be in place before such patients are allowed to be discharged, but when they are they become the responsibility of the local authority. At that stage, their needs are considered from a medical point of view, and their means are considered.
If the Government do not take a firm grip in the next few years, and if the process that I have described is allowed to develop unfettered, irresistible pressure will be placed on trusts, community health units and acute hospitals to divest themselves of long-term national health service patients, who hitherto have expected cradle-to-grave treatment. They have expected, rightly, because they have paid national insurance contributions, free long-term health care. That care will not be available to them in five or six years' time. I note that the Minister shakes his head in dissent. I shall be interested to hear him on this point. It will be a crucial part of and an influence on the funding that is available for community care in the hands of local authorities.
It is believed that funding is spiralling out of control, and the evidence suggests that the authorities are right. I spoke to the British Medical Association about the matter. I am sure that the Minister knows the figures. In 1990, 73,000 people were registered as national health service long-term care patients. In 1993, the total had fallen to 59,600. There must be a minimum level of national provision for long-term health care patients, but I see no evidence that the Government understand that. We cannot allow the number of long-term health care beds to fall indefinitely. I sense that the Minister wishes to intervene, and I am happy to give way to him.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
Has the hon. Gentleman seen the Government's continuing care guidance, which was drawn up as a result of the Leeds case? Has he submitted his views? Is he aware that there are NHS beds not only in hospitals but in nursing homes, which are not included in the figures that he has presented to the House?
§ Mr. Kirkwood
I understand the Minister's second point. I have been wrestling with some of the Government's guidance and positions on long-term health care. I am not alone in continuing to be slightly confused. Indeed, the BMA is slightly confused about exactly what the Government are saying about long-term health care.
The draft guidance that is supposed to be the subject of consultation states thatthe hospital will need to take account of the needs of other patients in determining how long the person can continue to occupy an NHS bed.That is to be contrasted with the guidance in 1989, accompanying circular HC(89)5, which stated:No NHS patient should be placed in a private nursing or residential care home against his/her wishes if it means that he/she or a relative will be personally responsible for the home's charges.1018 Over the past few years, various positions have been taken in guidance that has been issued by the Department of Health. The confusion continues to obtain. If the BMA is confused, I suspect that others are too. The Government have a duty to clarify exactly what is happening.
Some weasel words have been introduced into some of the guidance circulars on which consultation is now taking place. I refer to the NHS executive guidance, which for the first time says that the NHS remains responsible for care "within available resources". It says that every effort should be made to meet the preferences of the patientwithin the practical options and resources available.These words are incapable of precise meaning. When the Minister and I have to throw ourselves at the mercy of the NHS in 20 or 30 years' time, in our twilight years, will we be entitled to know the exact circumstances in which the NHS will provide and those in which it will not?
The shunting—a terrible piece of jargon—of health care resources into the local authority area for community care is a matter of singular and continuing concern. The same can be said of the circular and consultation process. The Minister and his Department should urgently try to resolve and clarify the issue. Similarly, it should be considered urgently within the review process that I have proposed.
§ Mr. Hawkins
Does the hon. Gentleman agree that one of the problems about the interface between health services and social services is that in many counties, including Lancashire, social workers have insisted on contradicting the advice of general practitioners and allowing elderly people who have not been in very good health to stay at home? When those people have had suddenly to be admitted to hospitals as emergency cases, an intolerable burden has been placed on hospitals and health services generally. That is one of the difficulties that the new system has thrown up in areas where social workers have insisted on countermanding GPs' advice on the best places for their patients.
§ Mr. Kirkwood
If that is true, it would cause me some concern. I have never heard of such circumstances, but I hear what the hon. Gentleman says. If that has happened, we should examine it carefully.
Funding is the crucial and core issue. I do not want to demand unlimited amounts of money. It is too easy for Opposition politicians to say that we need blank cheques. We know that blank cheques are not available and it is stupid to try to operate on that basis.
The 1994–95 local government settlement meant a difficult year for local authorities—I think that everyone would accept that in his or her quiet moments. It would seem that 1995–96 will be an even more difficult year. It is unfortunate that we are entering a crucial phase of the transition in community care at a time when local authority budgets are severely constrained.
§ Mr. Matthew Banks (Southport)
Does the hon. Gentleman agree that it is very important, in these days of public spending constraints, that local authorities spend the money allocated to them specifically for community care through the standard spending assessment? There are numerous examples of Liberal Democrat-controlled 1019 councils, or where the Liberal Democrats have a major hand in controlling policy within those local authorities, that show that they are not spending—
§ Mr. Deputy Speaker (Mr. Michael Morris)
Order. The hon. Gentleman did not have the Floor for a speech. A brief intervention was appropriate.
§ Mr. Kirkwood
I invite the hon. Gentleman to make an intervention in another debate. It is not a worthwhile use of the time of the House to debate individual councils. I stand by the statement that I made: the Audit Commission found that, by and large, councils were doing a good job in difficult circumstances. If the hon. Gentleman wants to hire a hall in Cornwall, I would be happy, on a day and place of his choosing, to appear on a public platform and argue with him long and hard about the individual circumstances of Cornwall. But I do not want to do that this morning. I am trying to keep the debate slightly above the tone of our usual debates, but I do not think that I am succeeding.
§ Mr. Gary Streeter (Plymouth, Sutton)
The hon. Gentleman is succeeding, because I am not going to attack him on a party political basis, as he is making a thoughtful and helpful speech. These are serious issues.
To what extent, none the less, does the hon. Gentleman place the responsibility on local authorities to use their money wisely? I give him one example—I shall not mention the political party, although he is a member of it. In Devon, the Liberal Democrats took control in 1993, reversed a decision to close local authority homes and is now placing residents in local authority homes at a cost of £400 a week, when in the private sector they can get better care at £200 a week. Is that not something for which local councils have a responsibility? It is not all the Government's fault.
§ Mr. Kirkwood
Again, if the hon. Gentleman wants to hire a hall in Devon, I will happily debate individual circumstances with him. From memory, I recall that Devon lost about £16 million. The hon. Gentleman makes a valid point. Of course I confirm that local authorities must act responsibly and spend money wisely. I have no evidence that the council in Devon has acted in anything other than the best interests of its users. The hon. Gentleman must understand that it is sustaining a loss. The rules changed, as he knows, unilaterally and unexpectedly. Losing £16 million is a pretty difficult row to hoe in terms of the provision of crucial services for people who are in a very vulnerable position.
§ Mr. Nick Harvey (North Devon)
Is my hon. Friend aware that Devon was the hardest hit of all the counties in the transfer of funds that resulted from the revision of the formula? Despite the attention that is rightly being given to Gloucester and the Isle of Wight, under the old arrangements Devon received 4.6 per cent. of national spend in this area, but under the new formula will receive only about 2 per cent. Whatever the merits of the 1020 argument of the hon. Member for Plymouth, Sutton (Mr. Streeter)—it is legitimate—he must appreciate that the total sum that he proposes is the merest skim of the sums about which we are talking. It is a blue herring.
§ Mr. Kirkwood
I am obviously failing miserably in my attempt to try to keep us out of a party political dog fight. There will, of course, be legitimate exchanges, but I am trying to concentrate on and accentuate the positive, because I am determined to try to get something out of the Government this morning, even if it is only a promise that they will reconsider my suggestion that a body should be created to consider these issues and that its advice should be made available to the Government.
The Government underestimate the impact on some counties of the unexpected change in the distribution of resources at the beginning of this financial year, and I hope that that will not be forgotten. It should be constantly kept under review, because of the impact—we have heard exchanges that reinforce the point—that it has had on the finances available to some local authorities.
More than anything else—the evidence appeared in the Audit Commission report, "Taking Stock", which was published in December—nobody correctly estimated the high demand that would be evident from the start of the new regime. Expectations, quite properly, have been raised. The Government cannot be held to account for every new demand or expectation encountered, but carers, users, voluntary groups and domiciliary services are experiencing quite unexpected interest and demand. The House and the Government must recognise that and take it into account, otherwise we will face severe examples of retrenchment, harsher eligibility criteria and withdrawal of services. In Gloucestershire, even the legal process is involved. We are heading rapidly towards a tangle of legal challenges in the courts. I do not believe that that is m anybody's interest.
As I understand it, there is no spare money in local authority budgets. No other funds are available from charging or from efficiency savings. The bottom line is that front-line services are now at risk.
§ Mr. Kirkwood
I shall not give way. I have been speaking for far too long already.
The Government must look at that. I suggest strongly that they should set up some review machinery, involving local authorities, to oversee the process for at least the next few years.
The ten-minute Bill of the hon. Member for Dulwich, Community Care (Rights to Mental Health Services) Bill, is a very important measure, which I hope the Government are considering seriously. Evidence produced by the National Association for Mental Health—MIND—shows the need for a crisis service and that extra resources are cost-effective in terms of moving away from acute units to a decent crisis and emergency service.
As I said earlier, the private Member's Bill of the hon. Member for Croydon North-West, the Carers (Recognition and Services) Bill, is an important measure. I hope that the Government are considering that as well. I hope, too, that they will look at some of the constraints that local authorities are under, in terms of the 85 per cent. restriction—the limit on the amount that can be spent from what previously was paid to the private sector. The lack of privately provided domiciliary services in many 1021 areas is making it difficult to ensure that that money is most flexibly used. The Audit Commission said that flexibility, responsiveness and sensitivity were the three key issues in the successful promotion of community care in the future. I am sure that that is right, but I do not think that the Government have got the process right. The funding will create immense problems for the rest of this year and from next year.
One of the best ways in which the Government could cope with the situation today is to say that they understand that some factors need to be considered on an on-going basis, and that they will agree to enter into some arrangement, by way of a working group or some other body, with local authorities and other interested parties, to work these things out for the remainder of the transitional period. If they did that, local authorities throughout the length and breadth of the land would have more confidence that the Government were aware of the difficulties that they face.
§ Mr. Piers Merchant (Beckenham)
I am delighted that we are debating the important subject of community care, whose funding we should monitor to ensure that the objectives are adequately met. I must compliment the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on the restrained character of most of his remarks, and especially on his recognition of the value of this radical innovation.
Not only is community care delivering a better service, as it will continue to do; it represents an important devolution of power to local government. I particularly welcome that, and I am keen for it to work successfully. I pay tribute to people in my local authority of Bromley whom I know well: for instance, the director of social services, Mrs. Clare Marchant—I hasten to add that she is no relation—and other health professionals and administrators who have co-operated effectively in both setting up the system and making it work.
That is not to say that there have not been some transitional difficulties. Such difficulties were inevitable; indeed, I consider it miraculous that such a major change—such a huge innovation—has not involved more problems. In the borough of Bromley, certainly, most of those difficulties were overcome owing to the good will, flexibility and effort contributed by all who were keen for the system to work. I congratulate them on overcoming the problems at an early stage.
It is the easiest thing in the world to make a case for increasing spending on community care, as on any other programme. Again I pay tribute to the hon. Member for Roxburgh and Berwickshire, who made a point of saying that he was trying not to make such a case—although his attempts were not entirely successful towards the end of his speech. My wife is very good at suggesting that spending should be increased in various areas, but she is outdone by Opposition Front Benchers, who daily call for more expenditure.
The one thing that those Opposition Members are never prepared to do, however, is announce the grand total of the extra spending for which they are calling and explain to the House, and the outside world, where they will find the money. It is incumbent on anyone who wishes to behave responsibly to explain how the more generous 1022 funds required are to be secured, either through revenue raising or through reductions in certain services. The Labour party, however, becomes very coy when the question is put.
Although wonderful things can be done in community care, are already being done and, no doubt, will be done increasingly in future years, demand is open-ended. Eventually, no doubt, anyone who needed the slightest support could be given 24-hour backing, but the cost would be disproportionate. Balance is needed: we must ensure that adequate provision is made for community care, and that it is recognised as an important step forward, but the budget must not be open-ended.
I do not criticise social workers, who do a tremendous amount of good work, but I feel that they sometimes lose sight of reality and fail to appreciate that budgets must be controlled. All services, by their nature, must be cash limited; otherwise it is impossible to plan, make commitments or make room for other priorities.
§ Mr. Hawkins
My hon. Friend has mentioned the important role played by social workers. I agree that some social workers do an excellent job, but in my part of Lancashire—and perhaps in my hon. Friend's constituency as well—certain of them are so ideologically opposed to the idea of placing anyone in a private sector home that they refuse even to contemplate it. That is a vast waste of taxpayers' and charge payers' money.
§ Mr. Merchant
I must say that that is not a problem in my area—I have never encountered such a case—but I know that it has happened elsewhere. In certain parts of the country, care in the community has been impeded by those with tunnel vision who have not been prepared to exercise the flexibility that is required if the system is to work.
We should not overlook the generous funds provided by the Government, which stem from a belief in the system and a conviction that enhanced flexibility and better standards of care are necessary. It is so important to free those who have been trapped in grey institutions, and give them the care that they need, that the Government have rightly set aside large extra sums. In 1995–96, £1.8 billion has been provided in specific additional funds for care in the community-44 per cent. more than in the previous year—while £2.5 billion has been provided for 1997–98. No one could describe that as anything other than generous.
That is not the whole picture, however. The amount available for social services spending generally—the biggest growth area in local government—has doubled since 1990–91, rising from £3.6 billion in that year to £6.4 billion in 1994–95. In 1995–96 it amounts to £7 billion: that is an increase of 9 per cent. in a single year.
Local authorities are free to decide their exact social services budgets. It would be absurd if they were not, given that powers have been devolved to them, and I believe that that is what they want. But to make community care a success in the first years of its introduction they were given a special transitional grant, which was ring-fenced and separate from the revenue support grant settlement.
That grant, however, is not the only source of community care funding, although some people appear to have made the mistake of thinking that it is. It is additional to what authorities can take out of their social 1023 services budgets. Some local authorities, including some that have recently complained about underfunding, have not spent up to their standard spending assessment, which makes their claim that they are not given enough by central Government look rather hypocritical.
§ Mr. Hinchliffe
Does the hon. Gentleman recognise that the transitional grant was intended to finance new functions and increased responsibilities? He talks of the Government's generosity; will he tell us what they would have spent if the old system had remained? In 1979, £9 million was spent on social service departments' funding of private care; by 1993 the figure was £2.5 billion. What would the figure for the next two or three years have been?
§ Mr. Merchant
The hon. Gentleman is not comparing like with like. I assume that he is not suggesting that the old system should have been retained. Care in the community is a better system, and should not be compared with the old one. There is no doubt, however, that Government funding is excessively generous. It is more than adequate to cope with the extra demands placed on local government.
§ Mr. Merchant
The fact remains that some local authorities have complained about being insufficiently funded. We should, I think, examine their position more closely.
In the Audit Commission's recent second report on care in the community implementation, David Browning pointed to four areas of difficulty for local authorities. I shall refer to all four. He said that there were examples of poor local financial control and that there was increasing demand. That is undoubtedly true. He pointed to local decisions to allocate fewer funds to social services and, of course, he referred to changes in the Government formula.
I have mentioned all four lest someone suggests that I am selecting two that are particularly favourable to my case. However, I shall deal first with those two, the first of which is poor local control. There are undoubtedly examples of local authorities taking on the burden of care in the community, not managing it as efficiently as they should and slipping up on financial control. It is notable that it is those authorities which have screamed and complained most in the past few months. The complaints should be directed at their own internal systems rather than at their lack of grant. Of course, they attempt to find scapegoats for their own problems.
The second area causing difficulty is the decision to allocate fewer funds. As I said earlier, local authorities are free to choose how much they spend in different areas and there is no doubt that some local authorities—the one on the Isle of Wight is an example—have chosen not to spend up to their full SSA on personal social services. There again they have themselves to blame if they suddenly find that they are short of funds.
One of the two other areas is the growth in demand. That presents difficulties because no one can clearly predict demand. Pilot studies and predictions can be undertaken, but until people start knocking at the door requiring the support that local authorities are now duty 1024 bound to provide, one cannot know for sure what the pattern of demand will be. I hope that my hon. Friend the Minister will be flexible and will continue to monitor demand as it arises.
The fourth issue relates to changes in the Government formula. Those changes have benefited many authorities, but they have also resulted in some authorities not getting as much as they might have expected from the previous year's formula. But as, in the first year at least, the formula was biased in their favour and there has merely been rectification to a fairer overall system, they should be thankful for the extra support that they received, perhaps unexpectedly, in the first year of operation.
I do not want to go into specific examples in great detail, but I am sure that some of my hon. Friends intend to do that. However, I will mention that there is a clear contrast between local authorities which have managed the system well, are working within their budgets and delivering an excellent service—my local authority in Bromley is an example—and some others. Hon. Members will know whether a system in their area is working effectively because we are often the first people to receive complaints if it is not.
I have had so few complaints about care in the community that there is clearly no severe underlying problem in my area. That is clear even if I did not believe the evidence that has been provided to me by those who are administering the system. The few complaints that I have received have related to individuals; the system is bound to slip up occasionally in such cases. As soon as those problems have been drawn to the attention of those responsible the difficulties have been put right.
We can contrast that with the experience in counties such as Gloucestershire because despite large increases in funding—for example, Gloucestershire had a 10 per cent. increase in 1994–95 over the previous year—some counties have managed to get themselves into the most extraordinary mess. According to The Independent Gloucestershire council appears to be spending about £1,000 a day on computer consultants who scrapped a community care computer system at a cost of £250,000 and promptly spent £200,000 on replacing it.
§ Mr. Nigel Jones (Cheltenham)
The hon. Gentleman talks about increases. Does not he realise that there has been a cut of £3 million in the community care grant in Gloucestershire? That was totally unexpected and occurred after it had arranged all the contracts. The article in Computer Weekly last week entitled "Careless in the Community" bears absolutely no relation to the truth. If the hon. Gentleman would like to speak to Deryk Mead, the social services director in Gloucestershire, I can arrange it.
§ Mr. Merchant
As I have said, there was a 10 per cent. increase between 1993–94 and 1994–95 in Gloucestershire's social services budget. That is a particularly large percentage in view of the restraints in other areas of local government expenditure. I do not accept the hon. Gentleman's defence of poor financial control in that authority.
There are many other examples, but it will suffice to say that authorities that have managed the system well have not only coped but have produced a far better system than before. They have demonstrated that care in the community as a practice and not just as a theory is most 1025 effective. Authorities which have not managed the policy well need to look closely at their systems with a view to improving the standard of care for their people.
At the end of the day this is a major test for local government. As I said at the start of my speech, it represents a major devolution of power to local government, which I welcome. I should like to see local government having more responsibility and to see other functions that are currently carried out by central Government devolved to local government. That can be done only if we are confident that local government will be able to deliver those services at an adequate standard across the country.
This is a test for local government. If it is able—and I sincerely hope that it is—to ensure that the system works smoothly and effectively in the years to come, its case for handling other services will be greatly enhanced. However, if authorities drag their feet and are not able to deliver the efficiency that is expected of them in handling such a major area of policy, it will be difficult to support their understandable arguments that they should also handle other public services.
§ Mr. David Hinchliffe (Wakefield)
I welcome this opportunity to speak on community care, albeit in a brief debate. I shall stick to the issue of available funding, because care in the community is so wide ranging. I shall address in particular the difficulties that we recognise in many parts of the country. Some local authorities face serious problems in meeting their statutory responsibilities on community care changes. The Opposition are especially concerned about the impact of that on some of our most vulnerable citizens—the users and carers and people who depend on vital services.
I shall start by briefly recalling the warnings that were flagged up by local authorities when the changes were introduced in April 1993. Although the Minister was not in post at the time, he will recall that the Association of Metropolitan Authorities warned that the changes were underfunded. I remind him that the Association of County Councils, which was then Conservative controlled, also warned the Government about that. At that time, it was concerned with cuts in the counties. The situation has markedly worsened—to be fair, that has been conceded by Conservative Members who have contributed to the debate—as a result of the change in the formula which was introduced with effect from this financial year.
Many metropolitan authorities are finding their base budgets under pressure and cutting services. At least a dozen county authorities—there may be more, but 12 have told me this—have run out of special transitional grant. The Association of County Councils predicts a funding shortfall for the next financial year of at least £200 million. The Minister will know that because he has met the association at least once, and possibly twice, recently. In every way, demand for care services has been beyond all expectations.
One of our concerns is with the way in which the Government have not been willing to consider the issue of unmet need, and to make some sort of measurement of that need. They have discouraged local authorities from doing that. The most sensible way of planning for future care provision is to look at where the gaps are and how 1026 we can plug those gaps. I appreciate that resources are not infinite and that we must consider how funding is used. My concern is that the Government have not planned properly on a national basis to deal with serious unmet need in various parts of the country.
§ Mr. Hawkins
I know of the hon. Gentleman's expertise in this matter, which he gained before coming to the House. Does he agree that immense responsibility is placed on all local authorities to manage their funding sensibly? Is not one of the most serious criticisms made of local authorities that so badly mishandle funding—Lancashire is a classic example—that they have allowed unlimited, incredibly expensive domiciliary care packages? They have not limited those packages to exceptional cases, as the guidelines from 1992–93 onwards clearly state they should. Purely for ideological reasons, they have not used much less expensive, much better residential care in the private sector.
§ Mr. Hinchliffe
I hope that people will note the hon. Gentleman's comments carefully. He said that people who have basic human rights should have the opportunity to be placed in institutional care when, as an alternative, his council is clearly and rightly attempting to ensure that they are given the right to remain in the community, which is the aim of the community care changes. He cannot honestly say that authorities have allowed unlimited packages. I have met his colleagues in Lancashire and many local authorities.
I worry about the message that the hon. Gentleman has got across. If he found himself in those circumstances and had certain needs, would he prefer to have services and support supplied to him in his home, and carers in the community to visit him at home, where he has lived all his life? Or would he prefer to be shunted into a private institutional care home, miles from where he lived, as is happening in many instances? It is a human rights issue. The hon. Gentleman said on the record that he would deny human rights. I hope that his constituents will note that.
§ Mr. Hinchliffe
I must continue because my time is limited. I shall cover a number of points that the hon. Gentleman has made, if he will listen.
I recognise that, in many parts of Britain, a serious problem exists in relation to community care and it needs an urgent response. I listened carefully to the suggestions of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), who opened the debate. I want to make some constructive suggestions. I hope that the Minister will listen to them in a non-partisan and constructive way and that he will respond in some detail to my points.
It is important to remember that the difficulties arise directly from the implementation of the care elements of the National Health Service and Community Care Act 1990. Those elements were clearly Treasury driven. I want to go back a bit further than the Liberal spokesman and to consider why we are in this position with these changes. The 1990 legislation attempted to unravel the mess that the Government had got into during the 1980s and 1990s in relation to the wholesale privatisation of the care of old people. That is why we have the problems.
Earlier in an intervention, I mentioned that private care in residential and nursing homes cost £9 million per annum when the Government came to power, but when 1027 the changes were introduced, it cost the Department of Health and Social Security some £2.5 billion, an enormous increase, which was caused by a deliberate policy of privatisation.
§ Mr. Hinchliffe
No. I am sorry. I must continue with my speech. I shall probably give way later if we get to an appropriate point.
The problems arise because of the deliberate policy of the privatisation of the care of elderly people. The hon. Member for Blackpool, South (Mr. Hawkins) said that we should push people into institutional care in the private sector, but they should have the opportunity to remain in their own homes in the community where they have lived all their lives. In 1979, there were 24,000 private care home places. That had grown to 135,000 by 1993. The comparable increase in the population of elderly, very elderly and vulnerable people is nowhere near that increase.
We are talking about choice. I was interested in the attack on local authority accommodation. That accommodation is part of an individual's choice. He can choose to go to whatever accommodation is appropriate to his particular needs. Many people positively want to choose local authority accommodation. During that period of massive increase in the private sector, the number of local authority home places fell from 102,000 to 63,000. To my knowledge, that figure has decreased even more.
The private institutional sector was deliberately expanded, with massive subsidies from the taxpayer, but national health service provision was deliberately reduced. The figures are on record. Following the implementation of the 1990 Act's care changes, the Government's formula for allocating the special transitional grant to individual local authorities caused immense difficulties, as everyone knows, whatever his or her politics. In the first year of the changes, it pushed money into regions with the most private care home places, despite the fact that, after the changes, residents in those homes had preserved entitlements to Department of Social Security benefits. The Government must have known that many people in homes came from different local authority areas, which were penalised by the formula.
The formula reflected the Government's care priorities: it propped up the business interests of the providers of private nursing and care homes. That is at the heart of many of the problems with which we are dealing this morning.
§ Mr. Hawkins
The hon. Gentleman does not recognise that, in areas like mine, the shunting is being done by ideologically driven social workers, who are denying choice and who are not even telling the elderly and vulnerable that they have the choice to go into a private nursing home, which is often located just around the corner from where they live and which has high standards. They are told to enter, at double the cost, local authority homes, which are further away. That is a vast waste of taxpayers' money. That is the shunting that is going on and that is the cost.
§ Mr. Hinchliffe
I think that the Industry and Parliament Trust should extend its scheme to include the placement of Tory Members of Parliament in social services departments, so that they will come to the Chamber 1028 knowing what they are talking about. I did more than 20 years in front-line social work before I came to this place. I know that what the hon. Gentleman has just said is nonsense. He does not deserve an intelligent response to some of the points that he has raised. Frankly, he is speaking through ignorance and I suspect that some of his briefing material is based on The Daily Telegraph rather than on any reasoned analysis of what is happening in social services. [Interruption.]
§ Mr. Deputy Speaker
Order. I would be most grateful if the hon. Member for Blackpool, South (Mr. Hawkins) would contain himself.
§ Mr. Harvey
Is the hon. Member for Wakefield (Mr. Hinchliffe) aware that social services authorities have shunted people out of local authority homes, where they have lived happily for many years, and into other provision, which is often further away from their home and less satisfactory? People at an advanced age who feel frail are very much at home in places where they have lived for many years. At that stage of their lives, they find the shift into private care, which is made for ideological reasons, traumatic.
§ Mr. Hinchliffe
The hon. Gentleman makes a valid point. I have come across examples of that in various parts of the country. People have died by being moved in that way. It is a denial of choice and the Government insist that choice is at the root of the care changes. The choice, unfortunately, does not include that positive choice that many people make to enter local authority accommodation and to receive local authority services. There is a denial of choice, which is at the root of many elements of the Government's care policies.
I want a response on those points from the Minister in his winding-up speech. The changed formula that was introduced in the current financial year was geared more closely, as the Minister will tell us, to standard spending assessment calculations, but its introduction, without any form of phasing, has completely undermined the planning and assumptions of local authorities that were better off under the original formula—mainly the county areas, many of which changed political control last year. That is the reason why one or two Tory Members, who would not normally be in the Chamber to discuss something as important as community care, are showing an interest in the subject. [Interruption.] The hon. Member for Beckenham (Mr. Merchant) is waving at the Benches behind me. He may not be aware that a meeting of the parliamentary Labour party is taking place. This is one of the unfortunate problems with meeting on a Wednesday morning. As he knows, my colleagues would be here in force but for that meeting upstairs, which is packed to the rafters.
We have talked about people spending money wrongly, and I hope that Tory Members will listen to this point. The continued preoccupation with the so-called independent sector has forced the councils to spend more money than should have been necessary in many instances. The requirement to spend the bulk of the special transitional grant in this sector is resulting in people being placed in expensive permanent care because, often, councils cannot use the special transitional grant on their own home care services and there is frequently none available in the local independent sector. The hon. Member for Roxburgh and Berwickshire made that point.
1029 Last year, I undertook a survey of directors of social services in England. The responses showed that a third of local authorities found that what was then the 85 per cent. requirement was preventing them from developing alternatives to residential care. Half of them had not spent as much as they wanted on domiciliary care because of the 85 per cent. rule and a fifth stated that they had placed people unnecessarily in residential care because of a shortage of home care services.
§ Mr. Hawkins
What does the hon. Gentleman have to say about the authorities—Lancashire is an example—that have never made any attempt to get anywhere near the 85 per cent. requirement and are continuing to ensure that all their local authority homes are full, at the expense of all the good private sector homes, many of which are going bankrupt? That will cause even more social problems of the kind that the hon. Gentleman claims to be trying to avoid.
§ Mr. Hinchliffe
The private sector would concede that in some areas there is an overprovision of private care places. I have met people in the private sector who have said that. There are reservations about the use of the independent sector. One of the problems that we should address is the lack of regulation in certain parts of that sector. The Minister will tell us in a moment how the Government are attempting to increase the provision of domiciliary care in the independent sector, but he will not tell me why the Government are not prepared to regulate and register people in that sector. We see people from private cleaning companies going into those homes to care for some vulnerable old people without any sort of check or inspection. That is one of the reasons why caring councils such as Lancashire are worried about using the independent sector.
§ Mr. Hinchliffe
I shall not give way again. I have been reasonable with the hon. Gentleman.
The Government's dogmatic approach to the implementation of the care changes is actively preventing innovation within the community and the development of community alternatives to institutional care. It is also wasting scarce public resources. The Government should respond on that point. It is a valid point which has been made by directors of social services and by local authorities of various political persuasions.
Alongside those constraints, local authorities have had to face up to the impact of the introduction of the health market. The Labour party's most recent survey, "Passing the Buck", was published in December and found clear evidence that in 54 per cent. of the 80 councils that responded, shunting from health to local authorities was a major factor in the current financial difficulties. A third of the councils described the way in which the cost of palliative care was pushed on to them. There were examples of nursing cases being passed on to local authorities. Shorter hospital stays for acute treatment mean early discharges. How far are we going?
Last night, my local evening paper, Yorkshire Evening Post, told the story of an 86-year-old man who, last week, was shunted home from Leeds general infirmary in a taxi in a snowstorm dressed in only his pyjamas and slippers 1030 and wrapped in a towel. His family are, rightly, angry. That is happening not just in Leeds but all over the country. People want to know what is going on. It means that cases such as that have to be wrongly picked up by local authority social services departments. They are having to deal with an increased number of requests for support packages for dependent people who used to recuperate within the NHS.
Anyone here who does not believe that the NHS is being privatised should try to obtain recuperative or respite nursing care for an elderly relative. In my constituency of Wakefield and elsewhere, after a local authority means test, people now have to buy that care from the private sector. I have piles of letters from pensioners in Wakefield and other parts of the country asking why they now have to pay again for the care for which they have paid all their lives, through national insurance and taxation, since the inception of the NHS and, in some instances, even before that. The generation who are responsible for the introduction of the welfare state—people such as Cyril Turner, the 86-year-old I have mentioned—have found that it has deserted them when they are most in need. The privatisation of the health service and community care and the Government's obsession with the market are leaving thousands of people without access to the basic welfare services that they expected to be freely available when they needed them.
The answer to the present problems requires a marked change in direction by the Government. They must recognise that their health changes have led to enormous new demands on local authorities which were never anticipated when the funding arrangements for the care changes were considered. Funding must take account of the effect of the NHS changes on local authority budgets. It is crucial that when the new guidance on continuing care is completed by the Government, it should be made to stick. We should no longer hear of health authorities passing on their funding responsibilities to councils.
The Government must recognise the real difficulties arising in the current year in areas such as Lancashire and Essex—county areas in particular—which have arisen as a result of the sudden switch from one allocation formula to another. Spending plans have had to be scrapped and, in many areas, service cuts made. The Government must abandon the blanket requirement to spend set sums in the so-called independent sector and ensure that local authorities make the most cost-effective use of resources in a way that encourages the development of new services in all sectors.
I began my involvement in social work in the 1960s. I continued to be involved in social work in the 1970s and I placed people in private care homes although I was a member of the Labour party. There is nothing unusual about placing people in private care homes. Sadly, the Government seem to believe that the only care available is private institutional care. That is why many social workers are damned angry about remarks such as those made by the hon. Member for Blackpool, South (Mr. Hawkins). Those remarks are inaccurate and do not reflect what has taken place in local social services arrangements for many years.
The Government's handling of community care suffers from the same constraints as their handling of the health service. They are obsessed with a private market model and, as a direct consequence, we are prevented from realising the enormous potential of community care. That 1031 type of care has immense potential for many people with a variety of needs. Community care could enhance the basic human rights of millions of people.
§ Mr. Nick Harvey (North Devon)
I will not detain the House for long, because I am interested to hear what the Minister has to say.
Care in the community was introduced with all-party support and with the support of professionals and voluntary and private sector providers. In the county of Devon, it has been a success story in its first year. It was embraced with enthusiasm by the county council, whose efforts have been given plaudits and whose work has been commended by the district auditor. In that first year, I believed that it would be a success story.
However, the revision of the funding formula for the second year has been an absolute disaster for Devon. It has taken no less than 20 per cent. of the overall transfer brought about by the change in formula. It is impossible to meet the demands in that county when all the plans, all the contracts and all the work being undertaken can be interrupted by such an extraordinarily huge loss of budget.
Many of those involved outside the county council have been hit. Some carers started up new operations, in some cases putting their life savings on the line to get a new facility up and running. They are finding that they are having to cut the level of client service that they had expected to be able to provide and, in some instances, the enterprise upon which they have embarked has been put in peril.
The county of Devon has a very large elderly population which is not only indigenous but comprises many people who choose to retire there. Since the introduction of care in the community, the demand for new residential places has risen by no less than 85 per cent. It is impossible for the social services department to meet its obligations under the care in the community legislation while suffering such a cut in its resources.
To put matters into perspective, I shall cite a few figures. Under the previous arrangements, 4.65 per cent. of the Department of Social Security's spending on residential care was spent in Devon. Under the new arrangements, Devon county council is being provided with only 2 per cent. of the national spend, which means that its share of the national spend has been more than halved.
I implore the Minister to review the situation. If the quotas are not to be reversed, could the Government at least reconsider the capping limits so that the elected authority can take its case to the people of the county so that they can decide whether they want such appalling cuts in the provision of care?
§ Dr. Robert Spink (Castle Point)
Essex did rather well in terms of Government funding, which was increased this year by 22 per cent., or £32 million, for which we are grateful. In 1991, the amount spent on social services in Essex was £82.54 million; this year it is £174.89 million; and next year, it will be £192.35 million. Those represent generous real terms and cash increases.
I entirely accept that the social services department has had to take on new functions. By and large, it is doing its best to carry them out, although there have recently been 1032 some hiccups, with which I shall deal in a moment. Essex's proportion of the total national resource has been very generous, and I thank the Minister for that.
The hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) made a thoughtful and helpful contribution, and its tone was excellent. I do not think that he accused the Government directly of underfunding the system, but he said that they had gone too far, too fast. He suggested that the changes could be slowed down and introduced over a 10-year period. If that is Liberal policy, what would he do about the current generation of elderly people who would be betrayed by such a time scale? They require help now, and might not be here to benefit from Liberal policy in 10 years' time.
Essex did very well under the new arrangements, but what did the Liberal and Labour parties in Essex do with all the extra money? They lost it though inadequate and incompetent budgeting, by following profligate socialist policies, by bad management and having too many managers, and by taking disastrous decisions. I hope to raise one instance in particular in an Adjournment debate very soon.
Budgeting in Essex gave rise to particular problems. Those involved in social services management there did not realise that there are 12 months in a year. The Audit Commission warned in its report of the lack of proper and sensible financial controls and budgeting in a few county councils, including Essex. It called for better budgeting to manage fluctuations in demand and to ensure that the financial consequences of past commitments were properly anticipated and allowed for.
The Audit Commission also called for county councils to make better use of independent sector provision, which is often more cost-effective, as my hon. Friend the Member for Blackpool, South (Mr. Hawkins) pointed out. Independent sector provision is often of a higher quality, but not necessarily so; there is some excellent state provision in my constituency, which I welcome.
The commission called for increasing flexibility and more prudent policies. Its report, entitled "Paying the Piper", identified potential savings of £500 million which could be made through better management control of local government pay bills, and would involve no cuts in front-line services.
Essex got its budgeting wrong, but that is not the whole story. Liberal and Labour control in the county meant a procession of eccentric, politically correct, madcap and profligate policies, which were followed not by mistake but on purpose, out of socialist dogma. I reviewed some of these incompetent and dogmatic socialist schemes in my Adjournment debate of 11 January. I do not have time to repeat them, but they are on the record.
Essex social services lost a total of £8.5 million. It would perhaps be more accurate to say that the money was thrown away on mad ideas. To its great and permanent shame, the county council took some cruel and insensitive action to cover its loony left incompetence. It cut care in the community provision and front-line service delivery to the old, the frail, the disabled and even children—the most vulnerable people in society whom the council should be protecting.
Those whose need was greatest had their services cruelly cut, while incompetent social services managers, who cannot even count the number of months in a year, have increased their already very high salaries this year. 1033 Socialist and Liberal Democrat councillors are reinforcing their wasteful, profligate and dogmatic policies unchecked, and are not in the least humbled by their disasters.
To solve the problem, the council should use its £28 million reserves this year to reinstate the services that it so cruelly cut. It must also drop its madcap, profligate policies, and reduce management levels. It should also reduce management salaries by 6 per cent. in order to save money to protect vulnerable people in future, as I pointed out in my Adjournment debate. There should be no cuts in staff levels or staff wages in the front-line services in Essex, because those people are the deliverers of care such as home helps. They are good people.
One consequence of socialist dogma and incompetence in community care in Essex has been hospital bed blocking. Again, I alluded to it in my Adjournment debate on 11 January, as did my hon. Friends the Members for Colchester, South and Maldon (Mr. Whittingdale), for Rochford (Dr. Clark) and for Basildon (Mr. Amess) and many others.
I conclude at this point, because I know that the Minister is anxious to deal with the points that have been raised. However, I call on Essex county council to change its madcap policies, and to use its reserves of £28 million to make good the cruel cuts that it has imposed.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
I am grateful to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) for providing the opportunity for this debate, not least because, on this morning of Back Benchers' debates, he has abandoned his constituents and come south, referring to the constituents of hon. Members in the English counties and metropolitan areas. The hon. Gentleman entitled the debate "Care in the Community", a phrase that applies specifically to mental health. However, he dealt also with community care, and I shall respond on both counts.
The hon. Gentleman asked specifically about the financing of mental health care, which is the domain of the health service and social services. This year, we have invested £2.5 billion in mental health care. Since 1979, there has been a 40 per cent. real terms increase in national health spending and a 171 per cent. real terms increase in social service spending.
I agree that we need to do more and ensure that mental health is moved up the list of priorities. Indeed, the White Paper "The Health of the Nation" made it one of five key areas of activity. That is why we introduced the mental illness specific grant, which is widely recognised as having initiated good practice locally.
There are more than a thousand new projects, and more than 100,000 people being helped by this scheme already. This year, £36 million of Government money is supporting spending of £50 million. Next year, we shall announce Government spending of £47.3 million supporting £66 million. That is a 30 per cent. increase, which is good news for spending on mental health. In addition, this year the Government are spending some £2.4 million through section 64 grants to voluntary organisations.
1034 We are putting the money into medium secure beds, which are perceived to be the gap in provision. The Glancy report, which was mentioned last night, reported that there were no such beds by 1979. There are now 1,300 secure and interim secure beds available, and we are building on that achievement this year and next year. In addition, we are putting an extra £10 million into London services, as a result of our task forces and London Implementation Group surveys of the health service, which will be helpful.
It is a question of joint commissioning between health and social services, and working with the independent sector. No one in the House would disagree with the need to involve the independent sector as well. MIND has been mentioned, which is a provider as well as a lobbyist. Many others help us in this area, and it is an important area for those who are severely mentally ill and, of course, for those who suffer from dementia. As the population ages, more people will be frail of mind as well as of body, and will need social care as well as medical care. We need to ensure that there is provision in the community as well as provision in hospitals.
Getting clinical discharge right is important. That is why we issued the new guidance on that. The care programme approach is central to management in the community. We are putting a lot of emphasis on key work and key worker training. We shall be bringing forward the supervised discharge proposal, which has now been endorsed by the report of Sir Louis Blom-Cooper, to the House in the very near future, together with other measures in that area.
I shall move on to the bulk of the debate, which in many ways has summed up the reality of community care. I acknowledge the opening words of the hon. Member for Roxburgh and Berwickshire. Tributes have been paid to the start of community care, and that is right. The hon. Gentleman welcomed the policy, and that is right. I know of nobody who disagrees with the policy. There is perhaps some disagreement on emphasis in the practice and implementation of it, but the policy is right, and progress has been made.
Of course, some concerns about that progress have been rightly identified across the House, and we shall look at them. Hon. Members from all parties have also mentioned some poor performances. My hon. Friends who have raised those matters are fair in raising some of the motives behind some of the problems. There has been an element of dogma in some of the decision making in community care, which my hon. Friends have raised in speeches and interventions. It would be absurd to suggest that that problem does not exist. We must try to nail the dogma when it emerges and ensure that decisions are taken through good financial and care management throughout the country.
The hon. Member for Roxburgh and Berwickshire also paid tribute to counsellors, and I echo that tribute. I would start by paying tribute to the directors of social services around the country and their teams, who have put care in the community into practice. Many councillors around the country of all parties are sincerely trying to make it work.
Again, my hon. Friends were right to point out those councillors who are trying to put obstacles in the way and use community care as an excuse to blame the 1035 Government for all the ills of the nation and all the funding ills, which those councillors choose to highlight for any local newspaper headline of the day.
§ Mr. Bowis
I welcome the fact that the hon. Gentleman clearly recognises that.
I shall pin down one or two funding issues that the hon. Gentleman mentioned. He said that Lancashire and Devon had lost £14 million and £16 million respectively, the latter of which was also mentioned by his hon. Friend the Member for North Devon (Mr. Harvey). I do not know where those figures come from. Those counties have not lost any money at all. They have gained money. What the hon. Gentlemen are trying to say is that the counties have not gained as much as they would have liked, or, indeed, gained as much, in some cases, as they perhaps led themselves to expect.
Far from Lancashire losing £14 million, wherever that came from, it in fact, with the special transitional grant changes, received a reduction of £8 million. But, in the standard spending assessment change, implemented in the same year, it got £7 million more than it could have expected. We need to take that into account. Overall. from having £62 million to spend in 1991, it had £108 million in 1993–94 and that figure has risen to £126 million this year, which is a 15.4 per cent. increase on the previous year. It is due to have £142 million in the coming year. That represents a 66 per cent. increase compared with the national increase in England as a whole, and that is good news.
§ Mr. Bowis
I am sorry, but I want to answer the points that have been made.
The same goes for Devon, although it involves bigger figures. Essentially, it lost £9 million in the STG and gained £6 million in the SSA. That needs to be put into context. I know that there are one or two problems in Devon, not least because of the pressures of the elderly and mentally ill coming into the county. But in Devon, the figures have risen from £63 million to £108 million—the same pattern as in Lancashire—to £122 million, which is a 13.5 per cent. increase this year, and up to £136 million next year, representing a 77 per cent. increase over those five years.
I suggest that the hon. Member for North Devon goes back to Devon and says to the council that it receives generous funding, and asks it why it is planning to underspend. If it is under such pressure, why is it planning to spend 5 per cent. less than the SSA indicates it needs to spend, which is provided for in central and local funding? That does not make sense.
The hon. Member for Roxburgh and Berwickshire requested something that I can easily fulfil, because it has already been announced. He rightly asked for careful consideration of community care, and he wanted everybody to take part in those discussions. I agree with that. As hon. Members from all parties have said, we are talking about a policy which was originally intended to be implemented over a decade. Of course, through all our monitoring, we have identified areas which need strengthening, such as housing, information, the involvement of users and carers, and better involvement of the independent sector.
1036 We need to plan ahead. That is why, at the social services conference, my right hon. Friend the Secretary of State announced that we would be taking that issue forward and arranging a forum to look at how we should proceed. Indeed, when I met the local associations, the Association of County Councils and the Association of Metropolitan Authorities, to which the hon. Gentleman referred, including Councillor Ann Peniket, who is one of the hon. Gentleman's party colleagues in local government, I said that the local authority associations would be involved with our officials in that forum. They were made that offer, and I know that they will take part, because they accepted it on the spot. We will be able to plan future development together.
§ Mr. Kirkwood
I want to push the Minister on that point. Is the forum a standing mechanism, which, over a period, will address common problems raised by Government, local authorities and other interested parties?
§ Mr. Bowis
It is a forum that we have set up. It does not matter whether it is standing or sitting. It will enable co-operation and co-ordination.
It is right to draw attention to long-term health care, as we are doing, not least with the Leeds case. We have issued the draft discharge guidance. The Department has listened very carefully to the points made by the hon. Member for Roxburgh and Berwickshire, my hon. Friends and many others. We shall be refining that guidance, with which I think that the hon. Gentleman will be pleased.
Let me make it very clear that cradle-to-grave health care will remain. Most people's health care is carried out by GPs and primary health care. When that is necessary, it applies wherever one lives, in one's own home or in residential care. That will stay, and the same goes for the need for health care which involves hospitalisation or national health service cover in the residential sector. We must get the area between health and social services right, and we are working on it through the guidance and good practice of the work of the NHS executive.
I cannot answer all the points made by the hon. Member for Roxburgh and Berwickshire. He made many good points and one or two contentious points, which were answered by my hon. Friends.
My hon. Friend the Member for Beckenham (Mr. Merchant) also raised a number of important points. He exemplified Bromley as showing a good record of implementation, overcoming problems and managing with the funds available. Funding is generous. Funding for community care is not only special transitional grants. That element represented what had previously gone from the Department of Social Security through income support to residents in the independent sector. It was important to give stability to that sector and to the residents in it. That is why there was an 85 per cent. requirement for the opening years, and why we have the same requirement for next year alongside the hospital discharge agreement between health and social services.
The Audit Commission has produced two reports, one of which emphasises the £500 million to be saved through better staff cost management. The other report considers 1037 better financial control to improve community care, better use of the independent sector and ensuring that the available money is spent on social services.
The policy is popular, and it is well resourced. It is not Treasury driven; it is user driven. It is run by local authorities, because they asked to run it. They must show that they can deliver and most of them are doing just that. A few are having difficulties—