§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Knapman.]10.43 pm
§ Mr. George Walden (Buckingham)
I am grateful for the opportunity for an Adjournment debate because I fear that social services in Buckinghamshire are coming under severe strain and that a similar pattern may repeat itself across the country. What is emerging is not just a financial but a structural problem.
The Government are providing more money each year for social services and community care, but the demand created by the 1990 community care legislation in particular is ever-increasing. When that demand overtakes the supply of new money, local authorities have to ration services. We reach the crazy situation in which a steady increase in services and expenditure is perceived by the electorate as cuts. In Buckingham, for example, there is a day centre run by the Red Cross and funded by the social services department. The value of that kind of facility to elderly people forced to spend much of their time at home is clear, yet it is threatened with a reduced service to three days a week.
I have met representatives of Mencap, who are concerned about the effect of rationing on the elderly disabled. Like all hon. Members, I have seen evidence of the strain placed on local social services by increased family breakdown and have been appalled by the expense and complexity of caring for a single delinquent child or young adult, to keep him or her ending up an even more expensive guest in one of Her Majesty's prisons.
My hon. Friend the Minister will be familiar with the problem of explaining the paradox whereby we spend ever more and are accused of making cuts. I have the same difficulty explaining that paradox to my constituents—they are not very interested in the paradox. All they know is that the threat to their day centre, services and the mentally infirm are real.
Politically, a chain reaction follows. Again, the process will be familiar to my hon. Friend the Minister. Members of Parliament are asked to intervene and come under pressure in the local press. We ask the county council what is going on. The council says that it has run out of money and needs to make, in this case, 9 per cent. cuts. I take up the problem with the Minister, who tells me that £57 million has been made available for community services in Buckinghamshire next year—10 per cent. more than in 1995–96. I find it hard to explain to constituents that their day centre will deliver a reduced service because the Government have given the council an increase three times the rate of inflation, so back I go to the council. Of course things turn out to be more complex than they seem.
I will not go over the council's detailed finances. We have asked for and been given a breakdown of its expenditure, and we have had full and frank discussions. We have gone into matters raised in the Minister's reply to me—for which I am grateful—such as the need for efficiency savings. We have also looked at administration costs and why they appear to be rising. The reason seems to be investment in information technology in the pursuit of more efficiency. Above all, we have looked at rising demand.
515 I came away with the overriding impression that in the provision of social services and community care, we have embarked on an open-ended programme that will ultimately be unsustainable for any Government under any reasonable projection of the national income. Even if, for the sake of argument, Buckinghamshire county council could have managed things better, the consequent savings would have been a speck when seen against relentlessly growing demand. Friend as I am of efficiency savings, I am a friend also of logic. I fail to see how the council can be expected to produce money from such savings year by year until the trump of doom. There must come a point when the service in question is working efficiently and diminishing returns set in. It will not have escaped the Minister's notice that the American guru of downsizing in business has recently repented of his earlier enthusiasms.
I have noted in that connection the speeches by the hon. Member for Peckham (Ms Harman), which fail to promise more money for the national health service and pretend that new resources can materialise from administration cuts alone—a line echoed by my right hon. Friend the Member for Wokingham (Mr. Redwood). There are strange alliances in the House. I am all for cutting administration to the bone but I do not see how the future of the service can be guaranteed in the long run by offcuts from administration. Even if NHS administrative costs, for example, are halved that would yield less than £1 billion from a £34 billion budget—some of which, as a result, might be spent less efficiently. The point may be reached where the same is true of care in the community.
The easiest way out for me is to blame the Government and to ask for more money. That would get me the reputation of a caring person, but it would prove the opposite. I would be guilty of gesture politics—which is to say, of cynicism. Asking for more money from a Government in debt to the tune of £25 billion would be more than cynical, it would be a charade.
I would, of course, welcome more money for Buckinghamshire county council social services if there is any to spare in the Minister's budget. But the same goes for education, where some of our primary classes are too big, or for the NHS, where, despite improvements, there are still delays in operations. In all those areas, the Government are already spending more.
The central question is: how are we to deal with infinite demand? Two simple facts that I read in the local government management board report on community care for 1995 illustrate the point: the number of admissions to residential and nursing homes has increased by nearly a quarter since 1993 94—a mere two years ago. Even more striking, the average net cost to the local authority of an intensive package of non-residential services now exceeds the average net cost of a residential home for old people. In other words, whether they are in or out of residential care, there is no escape from the cost of caring for the elderly.
To put things even more simply, I do not understand where the system is going. I can see how things can continue for a while longer as they are, but eventually the strains will show, under whatever Government. I have noted with interest the warnings of the shadow social security spokesman, who will not spend more than is 516 already being spent. We are in a vicious circle. I suspect that there is a great deal of self-deception involved on all sides and much postponing of the day of reckoning. That day, I believe, will involve more targeting of expenditure on those in the greatest need.
That brings me to the main question that I wish to put to the Minister, who will be relieved that, for once, I really will not ask him for more money. The Government have guided local authorities towards a policy of looking for a person-based approach to assess clients' needs. Buckinghamshire county council has been looking at the possibility of replacing an item-by-item flat-rate charge with a more streamlined approach—streamlined obviously being a euphemism for variable charges based, of course, on ability to pay.
Despite new home care charges introduced in 1995, individuals with the financial means to contribute a reasonable amount towards their care continue to be charged the same amount as those who are among the least well-off in the community. That means that well-off people are getting subsidised services and that that subsidy is financed, at least in part, through the taxes paid by people in work who may be less well-off than themselves. Where is the equity in that?
One inhibition to moving away from a flat-rate approach is the fear of legal challenge or recourse to the ombudsman. Would it not be of help to county councils such as Buckinghamshire if the Government recognised the facts about the costs of community care and introduced legislation to make ability to pay a criterion for the delivery of services. Unless the Government can promise that the spiral of spending will increase indefinitely—I doubt that they can—I see no other solution. Politically, I see very clearly that there would be a cost, but I ask my hon. Friend the Minister to imagine the political cost of headlines in the local newspapers, saying that day centres and services to the elderly disabled are under the axe.
§ Mr. Tim Smith (Beaconsfield)
I congratulate my hon. Friend the Member for Buckingham (Mr. Walden) on raising the important subject of funding for social services in Buckinghamshire, and I am grateful to him for allowing me this opportunity to make a short contribution.
Yesterday morning, I attended a meeting in Coleshill of adults with learning disabilities. It is no easy task to explain to people who have regularly attended day centres five days a week that, in future, depending on what assessment is made of their needs, they may be able to attend only three days a week, or even only one day. When I first examined the problem, I could not for the life of me understand why, if Buckinghamshire social services had, as my hon. Friend said, more money to spend on social services, services to individual clients would be cut in this way.
When I looked at it, I began to appreciate the huge increase in expectations brought about by the community care legislation, which have led to the massive increase in demand to which my hon. Friend referred. It is an increase in demand right across social services. In particular, demand from the elderly to stay in their own homes, which we all want to encourage, has increased substantially. In addition, fortunately, adults with learning disabilities have a greater life expectancy today than they had previously. That is also creating extra demand on social services.
517 By and large, Buckinghamshire county council is a well-run and well-managed authority. Having examined the matter, I believe that it has approached it in the only sensible way—which has been to say that whereas in the past it was possible to provide for all the demand at day centres, as and when young people with learning disabilities left schools, that can no longer be so and there will have to be some sort of rationing based on need. In fact, the only basis for rationing is to say that the greatest resources will go to those people who have the greatest need. That is what is now being proposed.
Difficult decisions will have to made, which will be hard to explain to parent carers—people who are often taken for granted by society; people who devote hours of their time to looking after their children. Sometimes, they get no recognition from society. They do not understand why these changes have to be made. As my hon. Friend said, we have to face the fact that, quite frankly, whatever resources are provided—and we would all like there to be more, although Buckinghamshire is already spending above its standard spending assessment on social services—will be inadequate to meet future demand. In fact, Buckinghamshire social services department has been commended by the Audit Commission for having adopted a rational approach to the matter.
As we look at the finances and at the number of people and as we talk about demand, we must remember that we are also talking about individuals, many of whom desperately need help from social services. Of all the groups that need help, those who most need it are those with some sort of disability. Perhaps the mark of a civilised society is the resources that we devote to those people.
Of course it is important—and Buckinghamshire social services attach great importance to this—that we meet the needs of children. In fact, the council has not been able to make any reductions in its budget for that because it is constrained by the law. It has had to make reductions in the help that it provides for old people and people with disabilities. I believe that it has approached the problem in a sensible way. However, as my hon. Friend said, it is important that we have a rational and intelligent debate about it. I congratulate him on raising the subject this evening.
§ Mr. David Lidington (Aylesbury)
I, too, congratulate my hon. Friend the Member for Buckingham (Mr. Walden) on securing this debate. I am grateful to him for allowing me to make a few brief remarks.
I wholly endorse the arguments of my hon. Friend and those of my hon. Friend the Member for Beaconsfield (Mr. Smith). I, too, have been pressed by the very real dilemmas that are faced by Buckinghamshire county council in making difficult judgments about how to allocate an increased budget, year on year, in the face of even greater increases in demand from people who look to its social services department for support.
I add my voice to that of my hon. Friend the Member for Beaconsfield in asking for particular weight to be given, by both central and local government decision makers, to the challenges faced by the parents of mentally handicapped children. Unlike, for example, the adult children of very elderly and frail people, the parents of a mentally handicapped child face a lifetime's responsibility 518 and commitment. We need to think carefully about how to ensure that our policies reflect the obligations that those people undertake on behalf of their children and of society as a whole. When we debate in an intelligent and rational manner such issues as changes to the charging regime or means testing, we need to take account of the fact that families face what might be termed a life sentence, not merely a commitment that will last only a small number of years.
I should like to draw my hon. Friend the Minister's attention to two other points. I hope that he will reply, if not at the end of the debate, then possibly in writing thereafter. The first was alluded to by my hon. Friend the Member for Beaconsfield. Buckinghamshire county council has told local Members of Parliament that, by law, it is unable to apply the same rationing criteria to services for children that it can to other social services, so it argues that the matter has not yet been tested in a leading case before the courts. I do not know whether my hon. Friend the Minister can provide further enlightenment on that issue.
Secondly, I draw my hon. Friend the Minister's attention to the possible implications of the impending split between Milton Keynes, which will become a unitary authority, and the residuary Buckinghamshire county council. Early indications are that the division of resources and SSAs will be weighted towards Milton Keynes in a way that is disproportionate to the populations of the two successor local authorities. If those early indications are followed through, the residuary Buckinghamshire county council might face great budgetary difficulties as a result of a large reduction in its SSA for 1997–98. I hope that my hon. Friend the Minister, with his social services responsibilities, will discuss that problem with his colleagues at the Department of the Environment.
§ 11 pm
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
If my hon. Friend the Member for Buckingham (Mr. Walden) can bear it, may I be the third hon. Member to congratulate him on raising this subject and on his contribution? I do so with all sincerity because he has not asked me for any extra money, so it is a delight to answer the debate. He has, however, raised some important issues and points, as have my hon. Friends the Members for Beaconsfield (Mr. Smith) and for Aylesbury (Mr. Lidington).
The debate is about the quandary of considerably more resources going into a service, yet the service being managed in such a way in some parts of the country that services for people who need them have been reduced. My hon. Friend the Member for Buckingham asks where the system is going. The answer is that it is going in the direction of a partnership between taxpayers, rate payers, families and individuals, supported by private and voluntary sectors. In the years ahead, how one creates the mix of that partnership will be fundamental.
My hon. Friend rightly refers to the Labour party's commitment for no extra resources, which is a bold statement for the Labour party, but it needs to be heard and understood throughout the country. He has suggested that more people could contribute and he will, no doubt, have read with interest the consultation paper on partnership schemes, which goes some way towards that, so that people can plan ahead, contribute and, as a result, protect some of their assets for their families.
519 My hon. Friend talked about the ability-to-pay criterion. That is there; it is in the system. It is a question of how it is used. Once the assessment has been made of an individual's need, the assessment of that individual's ability to contribute is relevant. It is required, of course, in relation to residential care. In relation to domiciliary day care, it is discretionary, but it is there and it is a question of how it might be developed. He rightly says that it is good that, through our community care policies, more people have been able to stay at home. Following that, there was a but and the dot dots of the argument as to how that can be afforded in future, taking into account demographic changes and other factors.
May I refer to my hon. Friends' points about disability needs? They rightly highlighted the need to consider especially carefully the needs of people with disabilities, whether they be physical, learning or mental health disabilities. Mentally handicapped children were referred to. Of course, a mentally handicapped child is not necessarily a child in the sense of being under age—he can be the child of someone who concludes that he is not going to outlive that child, which causes additional worries. What is planned for such children as they grow older and whether there are any cost implications are important matters.
Not so long ago, Mencap and others lobbied Parliament to highlight the issue of charging. My hon. Friend the Member for Buckingham has concentrated on the other side of the coin this evening. The lobby was genuinely concerned that charging might be unfair, but, because we have a discretionary system, every single local authority has the absolute discretion to exempt mentally handicapped people from any charge or to reduce the charge. That should be borne in mind.
My hon. Friends queried whether the rationing of services to children was legal. It is a question not of legality but of looking after children's interests as best one can. Clearly, if a child is in need, the local authority has a duty to protect that child. Yes, there are requirements relating to taking a child into care. Beyond that, there are the same restraints on authorities looking after children as there on them looking after elderly people, and authorities have to manage their child care services within a budget just as they do any other services.
Mention was made of the new unitary authority of Milton Keynes. We are watching the new authorities carefully to see how they establish themselves and how the transfer of responsibilities, resources and facilities is carried out. We have already seen the first wave of such authorities, such as Avon, Cleveland and others. The Department of Health, through its social services inspectorate, is working hard and even humble Ministers are attending conferences to try to ensure that the new generations—whether they be reduced generations such as in Buckinghamshire, or new generations taking on unitary authority status as in Milton Keynes—understand the social service needs of their areas.
I deal now with one of the main points behind the comments of my hon. Friend the Member for Buckingham. He is right to say that personal social services is one of the largest elements of public spending. Such spending in England this year amounts to some £7.5 billion. That excludes the resources for Scotland, 520 Wales, Northern Ireland and, indeed, those spent by the Department of Social Security on preserved rights cases. That is up from £3.6 billion in 1990–91 and represents a real-terms increase of 68 per cent. For Buckinghamshire, total personal social services resources were up from £32 million to £74 million in that period which, in real terms, is an increase of not 68 per cent. but 87 per cent. Spending on community care in Buckinghamshire rose from £22 million to £58 million—my hon. Friend mentioned a figure of some £57 million or £58 million-which is a real-terms increase of 112 per cent.
Buckinghamshire has also been fortunate in the two changes made in 1994–95—one to the special transitional grant distribution formula, which gave Buckinghamshire an extra £1.76 million, and one to the standard spending assessment, which gave it an additional £3.4 million, neither of which sums it would necessarily have planned to receive had the changes not been made. Buckinghamshire has been dealt with fairly, and there has been a substantial commitment to put the Government's, or taxpayer's, money where our policy is.
My hon. Friend is right to say that there is an ancient British custom according to which all would be well if only the Government would give us more money. That is the cry that we so often hear, but we have not heard it tonight, which is good.
We must remember that social services asked to have responsibility for community care, and most of them have responded well. Tributes have been paid in this debate to much of the work of Buckinghamshire social services. That was a 10-year implementation programme, and it needs to be managed effectively. The challenge is to manage the programme effectively, to obtain value for money, to identify priorities, to assess need and to listen to the views and preferences of local communities, individuals and carers.
Buckinghamshire has reviewed its services and decided as a policy for the county to switch £1.2 million into children's services. That is its prerogative, and I have absolutely no quarrel with the decision if that is what was assessed as the best use of resources. If resources are going to be switched into something, they will of course have to be switched out of something, and Buckinghamshire has decided that adult and elderly services should be reduced to provide money for children's services.
Buckinghamshire has also conducted a public consultation on priorities, which I certainly commend. It is always a good idea to consult the public on priorities, but we must remember that if we consult we will hear quite loudly from those who stand to lose out. Their voices will certainly be heard.
The lessons that all social services authorities must learn are the lessons that we have heard from the Audit Commission about better management of resources, better use of the independent sector and better manpower planning. The Audit Commission said that, across the country, it could see £500 million being saved with better staffing policies, without any threat to front-line service. That is not a bad figure to be putting into the pot if one is looking for ways of managing a tight demand for services in a substantially increased budget—which must nevertheless be managed very carefully if we are not to lose services that are deemed locally to be essential.
521 Public information is important. I believe that the community care charters that started to come into force on 1 April this year will enable local people to see for themselves what each social services authority is setting out as the range and standard of service that they have a right to expect—anything from the time that people should have to wait for an assessment through to local and national rights, such as the statutory direction and right on choice of home. We need to ensure that that is better understood by the public, and the public need to understand the eligibility criteria to discover whether they should qualify for services.
I believe that we do not want or need national standards. We want local priorities to set local standards, after consultation with local people, and then to publish those standards in local community care charters.
My hon. Friend the Member for Buckingham has dwelt particularly on the question of charging. We agreed that it is reasonable to make a charge to seek a contribution from a service user. Local authorities have absolute discretion whether to make charges for any non-residential adult personal social services. It is a matter 522 for each local authority to decide whether to make such charges, what level they should be set at and what exemptions or discounts there should be for various categories of people.
The legislation of course requires that any charges levied must be reasonable and that if a person has difficulty meeting charges, he or she can make representations to have the charges reduced or waived. The charges must be reduced or waived if the authority considers it reasonable to do so. Once someone has been assessed as requiring a care service, that service should not be withdrawn because of an inability to pay for it.
The question of contributions is important. It is central to the thrust of the comments made in this debate by my hon. Friend the Member for Buckingham. If people make a fair contribution—remembering that the figure across the country is only 10 per cent., which could certainly be increased without causing hardship to people—that contribution can help to pay for more services.
§ Question put and agreed to.
§ Adjourned accordingly at thirteen minutes past Eleven o'clock.