§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Bates.]10.29 pm
§ Mr. Harold Elletson (Blackpool, North)
I am grateful for the opportunity to discuss the provision of social services in Lancashire. There has been much debate recently about the implementation of the community care reforms, and about the way in which local authorities have met their responsibilities for the management of social services.
There has been widespread support on both sides of the House for the concept of care in the community, and there is no doubt that it was the right policy, and that the Government were right to implement it. Like most hon. Members, I fully support the concept of offering choice to service users, to enable them to live in their own homes wherever possible and to allow them a greater say in how they live their lives.
It is now just over two years since implementation of the reforms began, and clearly it has been a much greater success in some parts of the country than in others. Tonight I shall concentrate on the local situation in Lancashire, and examine the extent to which the county council has met the challenge of care in the community and fulfilled its new responsibilities. I have to say that it is a far from happy story, and that Lancashire's experience has been a catalogue of incompetence, mismanagement and, in consequence, utterly avoidable misery.
§ Mr. Nick Hawkins (Blackpool, South)
Does my hon. Friend agree that it is probably owing to the total incompetence of the Lancashire county council Labour group that not only has no Lancashire Labour Member bothered to be here for the debate but that there is only one Labour Member in the Chamber at all—the hon. Member for Motherwell, North (Dr. Reid)—and even he is here by mistake?
§ Mr. Elletson
As usual, my hon. Friend makes an extremely good point, and I am sure that it was not lost on my other hon. Friends, or on the representatives of the press in the Gallery.
First, let me dispel the myth cynically propagated by the Labour leadership at county hall—that Lancashire's woes are the result of Government underfunding. As my hon. Friends, including the Minister, all know, Lancashire's Labour councillors are experts in black propaganda and in the techniques of twisting and manipulating statistics to distort the truth. They are also compulsive spenders, with a disgraceful record of wasting public money on bureaucracy.
§ Dame Elaine Kellett-Bowman (Lancaster)
Lancashire Labour councillors may be compulsive spenders on things other than education, but on education they are compulsive underspenders.
§ Mr. Elletson
I agree absolutely with my hon. Friend. Perhaps we could discuss education in another Adjournment debate on another day, because that is an equally important and urgent topic.
There is nothing that Lancashire county councillors would like more than to blame their misfortunes on the 770 Government—and, of course, in a local election year that is exactly what they have been trying to do. However, the truth is very different.
The total amount available to Lancashire county council to spend on social services has consistently increased since 1990–91, when total funding of social services was £92 million. In 1993–94, £147 million was available to the county council to spend on personal social services; in 1994–95, £169 million was available, and in 1995–96 there is £185 million available. The sum that Lancashire county council received last year to spend on social services represented an increase of £22.6 million on the previous year.
The truth is that there has been a continuous year-on-year increase in the resources available, yet Lancashire's mismanagement of the funding available has left it in an appalling predicament. In 1993–94 the county council recorded an underspend on the social services budget of £6.3 million and, despite the recommendation of the Conservative group on the council that the amount be carried forward, Labour refused to do that, and decided instead to build up the balances.
Last year, the council got itself into a position where it was faced with a possible overspend of £14 million, so it decided to threaten elderly and disabled people with the withdrawal of their home help services.
§ Mr. Elletson
I agree with my hon. Friend. I am sure that all my hon. Friends remember that letters were sent from county hall which terrified some of Lancashire's most vulnerable citizens. This year, the draconian cuts will be implemented because the county council cannot manage the available resources. It cannot balance the books, and it is spending above the level of its personal social services standard spending assessment. Once again, the Labour-controlled council blames a reduction in Government funding.
§ Mr. Nigel Evans (Ribble Valley)
Does my hon. Friend agree that the council's inept handling of its budget has meant that people who receive only one hour a week of home help have received letters from the county council to say that that one hour's help is to be removed? Does he agree that the county council has stated to the most vulnerable people in society that their money and help are to taken away from them, and does he further agree that those people will suffer because of that?
§ Mr. Elletson
I agree with my hon. Friend, and I know that his constituency postbag is as full as mine. My postbag is filled with letters from constituents who have to face reductions in social services such as respite care and home help. Many people, such as people with learning difficulties, now face an increase in their charges for non-residential services.
Many cases have been drawn to my attention by people who are at a complete loss as to what to do. It is difficult to single out one case among all those to draw to the Minister's attention tonight, but let me tell him about Geraldine Robinson. Geraldine's picture appeared on the front cover of a Lancashire county council leaflet advertising the care services that it proudly claims it provides to people in the community.
771 Geraldine is a young woman who suffers from cerebral palsy. She was fully assessed by Lancashire county council social services in March 1994, and a care package designed specifically for her was finalised in June that year, which provided her with a cost-effective, 24-hour care service package. It enabled her to live an independent life in the community, and it had been based on an assessment of her clinical needs—just as the Government intended. Yet in June of this year, Lancashire county council, which was the author, the House may remember, of the leaflet showing Geraldine's picture and claiming to be able to cater for her needs, told her that her care package would be cut from £700 to £300 a week—not reduced, not trimmed, but cut by more than a half.
Despite several attempts by Geraldine and her carers to question why this decision had been taken, no answer has yet been forthcoming. I can only conclude—as any reasonable person would—that Geraldine is another casualty of the council's inability to manage its resources and keep within its budget.
§ Mr. Elletson
No, I will not give way to the hon. Gentleman, as I have given way three times already. Normally, there would have to be a reassessment before a care package was reduced, but that did not happen. The council said that its only alternative to reducing her care package would be to force Geraldine into residential care. Of course, she is extremely distressed about that. She has been trying to build a life for herself in the community, and she was encouraged by the county council to live independently, and even to move to a two-bedroomed property to allow more space for her carers.
Geraldine has overcome many personal tragedies, including the death of her fiancé in December 1993, but now the county council is turning on her the full pressure of its callous and insensitive bureaucracy. The social services department's actions in the past year have had a massive impact on Geraldine's life. She now has to undergo another comprehensive reassessment at a level the council is unwilling to identify, despite the fact that no significant major change in circumstances or Geraldine's needs or condition has occurred. That is not care in the community, or giving disabled and vulnerable people a greater say in their own lives. That is not enabling people to live in their own home. It is the incompetence of a county administration that has failed miserably to discharge its responsibilities to its most vulnerable citizens.
If the money is not to be spent on people such as Geraldine, where is it to go? I want to know what the priorities of Lancashire social services departments are. Let us look at the case of another young woman far less deserving and needy than Geraldine. She is a constituent of my right hon. Friend the Member for South Ribble (Mr. Atkins). Lancashire county council managed to find £2,000 a week for a course of remedial treatment so that she could go on a three-month riding course in Ireland and spend a considerable time in Australia—all, of course, in the company of social workers.
§ Mr. Robert Atkins (South Ribble)
Is my hon. Friend aware that, at the same time, the county council was prepared to close a home called Meadowcroft in my constituency which provided superb care for young 772 women who would not otherwise get the sort of care that they needed, in favour of keeping open a home in Liverpool—outside the county council area? The closure has caused great distress to many of my constituents and many of those associated with Meadowcroft, at the same time as wasting the sort of money that my hon. Friend has mentioned in the context of one case.
§ Mr. Elletson
I have heard of the case that my hon. Friend mentions. It is an equally disgraceful example of the misallocation of resources.
Perhaps the main priority of the social services department is to fund the ever-increasing numbers of administrators and bureaucrats in county hall. In the last financial year the social services department employed 203 extra members of staff. That was undoubtedly to deal with the appalling chaos that the department has created by its mismanagement of the assessment procedures. What is even more ironic—this whole sorry tale is a web of ironies—having taken on all the extra staff, the council now finds that it cannot pay them to do anything. I am sure that my hon. Friends will have noticed that today's Lancashire Evening Post tells us that social services workers are being told not to visit clients because the county council cannot afford their mileage.
The worst damage being done is to the people who could make a real success of care in the community—those in the private sector and the voluntary services. Lancashire county council has consistently favoured placement of clients in council-run residential homes over placement in independently run homes, even though the private sector can provide the same or a better quality of service at a lower price. Many of my colleagues have joined me in correspondence with the Lancashire Care Association, which represents more than 400 independent care providers across the county. Its members employ more than 15,000 staff and care for more than 10, 000 people.
The Lancashire Care Association tells me that the county council social services department has a written policy that all domiciliary services should be offered in-house before being offered to the private sector. If that is true, it is absolutely disgraceful. I hope that the Minister will ensure that the social services inspectorate fully investigates that claim as early as possible.
Let us take a moment to consider the financial implications of Lancashire county council's policy. The cost of placements in, for example, part III social services homes, is £100 per week more than placements in the private sector. The cost of council-run domiciliary services ranges between £11.20 and £17 an hour, but all private sector services are priced between £5.75 and £6 per hour, which is a massive saving on in-house costs.
§ Mr. Elletson
My hon. Friend has a good point. It is clear that substantial savings could be made if the council made better use of the private sector. Possibly as much as £10 million a year in the residential care sector and £4.5 million in the domiciliary care sector could be saved, yet the council appears to have no intention of using the private care sector. When the chairman of the social services committee, Councillor Mrs. Humble, took part in a programme on a local radio station and was asked by members of the Lancashire Care Association about the 773 possibility of buying more private non-residential care services, she told them—wait for it, my hon. Friends will not believe it—that she was not prepared to put local authority staff jobs in jeopardy.
Does her concern for local authority bureaucrats justify such a prolific waste of taxpayer's money? Why does she not care about the jobs of workers in the private sector? What is wrong with them? Perhaps she should start thinking about the 15,000 employees of the various members of the Lancashire Care Association, who do a fantastic job, which day by day she makes more difficult.
§ Mr. Elletson
No, because I have given way a record five times in an Adjournment debate.
Lancashire social services department has issued its community care plan for 1997–97, which shows that costly in-house services will continue to be favoured. While that policy continues, the private sector struggles to remain solvent and service users' choices are severely restricted.
An integral part of the reforms was the requirement that a large percentage of the available funds would be spent on residential, day or domiciliary services, provided by the private and voluntary sector. That was to ensure that authorities could not build monopoly empires of their own and to encourage the growth of a healthy, energetic private sector, which was ready to meet the challenge of care in the community, with high-quality, cost-effective care packages.
The new system was designed to encourage local authorities to contract services out and to make more use of the independent sector. That clearly has not happened in Lancashire. Private carers are being forced out of business and service users are being driven into the clutches of Lancashire county council. That is the very opposite of everything for which we hoped from care in the community, and I hope that my hon. Friend will consider carefully the amounts that the county council is spending in the private sector and ask the social services inspectorate to consider whether that really meets the objectives of care in the community.
I am grateful to my hon. Friend the Under-Secretary for agreeing to reply to the debate. I know that he has been consistently bombarded with complaints about Lancashire county council and that he might feel that his hands are tied. Nevertheless, the situation in Lancashire is now so chaotic that it merits his special attention and a determined effort by the Government to intervene and protect service users and providers.
My hon. Friend the Under-Secretary and my hon. Friends may find some small amount of black humour in this final twist of irony. They may have heard that the leader of Lancashire county council, Councillor Louise Ellman, has been selected for a so-called safe Labour seat on Merseyside and hopes to join us here on these green Benches. I hear my hon. Friends asking who will replace her as the leader of the Labour group on Lancashire county council and I think I heard the hon. Member for Motherwell, North (Dr. Reid) mention a name.
Why, it is none other than the author of this great disaster. Step forward the woman who has presided over that colossal orgy of incompetence—none other than the 774 chairman of the social services committee, Councillor Mrs. Joan Humble. I just hope that the people of Lancashire understand what a nightmare of bureaucracy, sloppy management and cynicism they will face if she ever gets control of the rest of Lancashire's services.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
I thank my hon. Friend the Member for Blackpool, North (Mr. Elletson) for introducing this short debate on Lancashire's social services and congratulate him on bringing with him the Lancashire light infantry from Ribble Valley, Blackpool, South, Fylde, South Ribble, Wyre and, indeed, from Lancaster. They are light on their feet, as well as infantry in his support.
In most parts of the country, community care is a success story. We have been moving on with our plans, through our community care development programme. Our Community Care (Direct Payments) Bill was introduced in another place last week. In April, we will be moving through our community care charters and, from April, the Carers (Recognition and Services) Act 1995 will come into force, giving carers a legal right to have their views and circumstances taken into account when the person being cared for receives a community care assessment.
The common thread running through all those developments is that they are designed to increase user and carer choice and control. They are all examples of way in which the Government are pushing forward the implementation of the community care reforms to get us closer to achieving fully the aims of "Caring for People".
We are committed to providing people with increased choice in the type of service that they receive and in the way in which the services are delivered.
§ Mr. Keith Mans (Wyre)
I apologise for asking a question so early in my hon. Friend's speech. He well knows that, a couple of months after the start of care in the community, nearly three years ago, I told him about what was going on in Lancashire. I fully understand that, at the time, he felt that he had to wait a little longer to discover whether it was true. On the ground, we can now see the suffering of many constituents—my own and those of other hon. Members in Lancashire, as a result of three years of incompetent management. There must be a way for central Government to intervene. If there is not, it is a sad day for the people of Lancashire who, need the care to which they are entitled.
§ Mr. Bowis
I am grateful for that intervention. If my hon. Friend will bear with me, I will try to respond to the points that he and my other hon. Friends have made.
It is disturbing to hear of cases where the involvement of users and carers, and the possibility of choice, is being denied. It is right to involve user and carers, listen to what they say and take note of it, to give them choices wherever possible, and to ensure that they know what choices they have.
My hon. Friend the Member for Blackpool, North mentioned the case of Geraldine Robinson. I am grateful to him for letting me have information about her. He has explained that Geraldine Robinson and her parents are upset at the way in which Lancashire has carried out 775 assessments and reassessments and are concerned that her care package may be reduced. Local authorities have the responsibility for assessing people's needs and deciding what services are appropriate to meet those needs. We have advised local authorities to carry out reviews of assessment systematically and regularly. We have not said how often reviews should take place or exactly how they should be done because the appropriate frequency and level of review will vary from case to case, depending on individual circumstances.
I understand that Miss Robinson's father lodged a complaint with the social services department about the way that it was carrying out its reviews. As a result, it was agreed that an assessment interview should be carried out by someone who had had no previous contact with Miss Robinson. I am told that that interview took place on Tuesday of last week and that Lancashire has not to date made any proposal to alter her care package as a result of that assessment. Clearly, Lancashire should conduct its reviews in a way which not only meets its service requirements but which is sensitive to Miss Robinson's situation and views. I intend to ask my officials to look into the current position on this case, and I shall come back to my hon. Friend the Member for Blackpool, North on that.
§ Madam Deputy Speaker
This is an Adjournment debate. By tradition, it involves the Member who raises the subject and the Minister who answers. Any other speaker is by courtesy of both.
§ Mr. Bowis
It is not unreasonable to expect adults who are able to make contributions for non-residential services to do so, but local authorities have discretion to make charges for non-residential services. They decide whether to make them, what level they should be at and on any exemptions or discounts for different categories of users. Any charges must be reasonable and affordable.
If people with learning difficulties in Lancashire are being charged, that is absolutely and entirely at the discretion and decision of the elected leaders of Lancashire county council and it has nothing to do with the Government. Nothing from the Government requires that such charges must be made. I hope that that message will go back to those people.
Extending choice means extending the range of services and improving their cost-effectiveness so that more and better services can be delivered. There is a flourishing 776 independent sector for residential care and nursing homes and a growing range of day and domiciliary services provided by the independent sector. As my hon. Friend says, they offer the opportunity for local authorities to secure quality services at a competitive cost. All over the country, this opportunity is being seized but not, apparently, in Lancashire. I wonder why.
As my hon. Friend said, the Lancashire Homes Association has estimated that the county council could save £10.8 million a year if it made full use of the independent sector, such is the level of inefficiency in its own homes. Potential savings from the full use of the independent sector have been put at 14 million annually. That is money that could be invested in more care for more people. Some months ago, I went to the county council in Preston and put those figures to the leader of the council and the chairman of social services. To this day, they have not disputed or denied them. Instead of using all the means at its disposal to get more care for more people, the county council still, as we hear, gives first call to its in-house domiciliary and residential services.
Local authorities asked for and were given the responsibility for community care, for assessing the needs of individuals and for deciding on the appropriate services to meet those needs. They must now deliver, and local people will watch the way in which they are doing.
My hon. Friend has posed the question, reinforced by my hon. Friend the Member for Wyre, about what can be done. A lot can be done by publicising the decisions that are being taken—or not being taken. As a result of the concerns expressed in this debate today and generally, I intend to ask the chief inspector of social services to provide me with a full report on the position in Lancashire so that I can then decide whether further action by central Government is appropriate.
The primary responsibility for community care implementation lies with local authorities. They must answer to their local populations for their decisions and the results that those decisions have on the elderly and vulnerable people for whom they are supposed to care. The people of Lancashire will want to ask the elected leaders of their county council about the delivery of community care in their area. They will want to ask about choice, about value for money and about the way in which the authority is seeking to involve them, or not, to listen, or not, and to meet their needs, or not.
§ Mr. Hawkins
Will my hon. Friend ensure that in the inquiry, which all Conservative Members here are delighted he has announced tonight, evidence is taken from the senior and experienced general practitioners in our constituencies? They are aware of how often good, sensible decisions about the best place and the best way in which to care for the elderly and vulnerable are being contradicted by social workers who do not know what they are doing and who do not care.
§ Mr. Bowis
I shall look at that possibility. I hope that, in any case, my hon. Friend will ensure that the information that can come from the experience of general practitioners—I have heard some of it directly when I have been in Blackpool—is given to me so that it can be passed on to the chief inspector and his team.
The people of Lancashire will want to know why money is wasted on state provision when better and cheaper services are available from independent homes 777 and agencies. They will want to know why Lancashire's councillors prefer to support the state sector so that less money is available for home helps, respite care and other services to support vulnerable and needy people. They will want to know what Lancashire has done with the £92 million that the taxpayers have given it for social services 778 this year; the amount has been doubled since 1990–91. I, my hon. Friends here tonight and, much more importantly, the people of Lancashire want to know the answer to that question, and they have a right to be told.
§ Question put and agreed to.
§ Adjourned accordingly at two minutes to Eleven o'clock.