§ 4.8 p.m.
§ THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)My Lords, I much regret interrupting this most interesting debate again, and for the moment preventing my noble friend Lord Barnby from making what I know will be a first-class contribution. However, with the permission of the House, I should like now to repeat a Statement which is being made in another place by my right honourable friend the Secretary of State for Social Services about how the Government propose to spend the English share of the extra £110 million which they have planned to make available to the National Health Service over the next four years. The Statement is as follows:
"For the next year (1971–72) the resources available for the hospital and local health and welfare services will now be about £75 million more (at constant prices) than during the present financial year, an increase of 6 per cent. overall, compared with 4.7 per cent. envisaged in the plans of the previous Administration; and with an increase of 4.3 per cent. during 1969–70. This means that it will be possible not only to continue the normal development of the services—building programmes, improved treatment and diagnostic services, more staff, in hospitals and the community—but also to speed progress in vulnerable sectors such as the care of the mentally handicapped, mentally ill and the elderly.
"Hospital and local authorities are expected to spend at least £100 million over the next four years on improved services for the mentally handicapped over and above present running expenditure. Of this about £40 million will come from the £110 million.
"Another area for expansion is the improvement of hospital and local authority services for old people and for the mentally ill. Nearly £300 million additional to present running expenditure will be spent over the next four years on improved services, of which about £40 million will be new money from the £110 million.
762 "I hope to make a statement soon of the Government's intentions in respect of family planning.
"We need to improve the accident and emergency services. A review of what should be done is under way, and when it is complete I shall be issuing further guidance. Meanwhile boards will be expected to aim at faster progress out of the increased allocations. I am setting aside an extra £3 million over the next four years for special units for the young chronic sick, and an extra £2 million to improve facilities and counsel for alcoholics. The whole problem of alcoholism is to be reviewed.
"The Government will encourage high quality national voluntary services. About half a million pounds will be available next year in support of voluntary effort—roughly twice as much as this year.
"Further anouncements will be made from time to time about developments in other special areas of the Service."
My Lords, that concludes the Statement.
§ 4.12 p.m.
§ BARONESS LLEWELYN-DAVIES OF HASTOEMy Lords, I should like to thank the noble Lord very much for repeating that Statement, the more so as we have awaited with great anxiety further information about how the Government proposals are going to work out. I should like, if I may, to put to him three questions. In the first place, I wonder whether he could explain the arithmetic a little more clearly. Are we right, for instance, in assuming that the so-called extra £110 million comes from the savings made on welfare food and school meals and prescription charges? If so, of course, we shall have to consider the priorities of the question. Could he equally make a little more clear the arithmetic about having saved about £40 million for the mentally handicapped? Where is the further £60 million coming from; and on the mentally ill and old people, £40 million again comes from the original £110 million. Where is the rest of the £260 million (I think it is) coming from?
Secondly, while of course we warmly welcome the Government's intention to carry out the previous Administration's 763 plans for the handicapped and the old people, may I ask whether the noble Lord is convinced that £3 million is enough to take the young chronically sick out of Part III accommodation? And over all these estimable plans we should like to know how the Government propose to increase the nursing staff, without whom none of these proposals can really be put into action.
There is one more slightly smaller question that I should like to ask the noble Lord. We see from the Statement that the boards—I imagine they are the hospital boards and so on:
will be expected to aim at faster progress out of the increased allocations".Well, I hope that they are increased allocations, but we should like to know whether the money will be actually there when the boards arrange to spend it. If they plan immediately to spend it, will the money be immediately there? And may we be assured that, if they can only spend it later than the period for which they have made their plans, they will not lose the money at the end of that particular financial year but will be able to use it later on?
§ LORD AMULREEMy Lords, I should like to join with the noble Baroness in thanking the noble Lord for repeating the Statement. I do not want to follow the noble Baroness in her questions—although I think they were most cogent—but I am pleased to say that the plans proposed seem really to deal with those people who need them most—the mentally handicapped, the mentally ill and the elderly. I very much hope that the services provided by local authorities for the elderly will work in the way the Minister has said, because it has long been one of the real difficulties about getting proper services going for the elderly that the local authority services, apart from some of the domiciliary services, have been far behind what has been done on the hospital side. We trust now that something may be done to encourage local authorities to keep up.
I am pleased to see, too, that the young chronic sick are to get some special care for themselves. I am interested to see what the proposals are and whether the sum of money allocated will go as far as we hope it will. The number 764 of young chronic sick is not very large. One wonders what provision will be made for their care, whether it is going to be in large homes or little homes. I am pleased to see that something at last has been done for the care and treatment of alcoholics, which is a much bigger problem than people think, and has been neglected by the Health Service for a very long time. I am also pleased that the Government are to encourage voluntary service. That will take some of the burden off the non-voluntary services in getting the job done. I shall be very interested to see how it works, and I hope that the Government will do as much as it would appear from the Statement of the noble Lord they will.
§ BARONESS SUMMERSKILLMy Lords, may I ask a question? In view of the shortage of staff and the time it takes to build new hospitals, I attach great importance to the domiciliary service, and I would ask the noble Lord to elaborate that a little. He has referred to the chronic sick and to the old people, and all of these could receive attention if there were an enlarged domiciliary service. I would ask him how much of this money is going to be devoted to that.
§ 4.17 p.m.
§ LORD ABERDAREMy Lords, I am grateful indeed to all noble Lords and Ladies who have welcomed this Statement. If I may take the points in the order in which they were raised, I would congratulate the noble Baroness, Lady Llewelyn-Davies of Hastoe, on having mastered the arithmetic, which I found quite complicated. She is quite correct in saying that we have been enabled to find this extra money for the services as a result of the other reductions in public expenditure which were recently announced. I have no doubt we shall be going into this subject next week, and so she will not wish me to comment further on it to-day.
So far as the arithmetic on the extra money for the mentally handicapped and the mentally ill and the elderly is concerned—both of which will receive £40 million extra over the four years—the additional £60 million for the mentally handicapped and the £260 million for the mentally ill and the elderly are increases which were already planned 765 by the previous Administration. We are continuing the development of the services that were planned previously, and are adding the further £40 million over and above that.
The noble Baroness asked about the allocation of £3 million for the young chronic sick. We believe it will enable us to make a start on the help which is very much needed for the young chronic sick, and, if I may answer the noble Lord, Lord Amulree, at the same time, it is particularly for providing special hospital units for them. This is a start, and if it is not enough we hope we may find more. Not all the £110 million has yet been allocated.
As to nursing staff, I fully appreciate that it is not only a matter of money. We are looking into this question very carefully and will do our utmost to recruit more nurses. Finally, the noble Baroness asked about Regional Hospital Boards. Their allocation will be phased over the years and they will spend the full amount over the four years.
The noble Lord, Lord Amulree, who takes such an interest in the provision for elderly people, raised a number of points. I can assure him that one of our major concerns is to see that there are better services for the elderly in the community and especially (in relation to what the noble Baroness, Lady Summer-skill, said) domiciliary services. We attach extreme importance to providing home service, health visitors, home nurses and so forth, because, as I am sure the noble Baroness would agree, the more we can keep people in their homes, the better for them and the more economic for the community.
§ BARONESS LLEWELYN-DAVIES OF HASTOEMy Lords, while thanking the noble Lord for answering my questions so carefully and in such detail, may I ask whether we are not right in thinking that there is no increased allocation beyond what the previous Administration proposed, except for the money taken from the increased charges and welfare foods and school-children's meals?
§ LORD ABERDAREMy Lords, I thought I answered that point. The fact is that by cutting public expenditure we have been able to provide more money where we think it is better used.
§ BARONESS SUMMERSKILLMy Lords, could the noble Lord explain to the House how he can reconcile this policy? He is prepared to undermine the health of the school-children for the sake of the elderly. It is a little difficult to understand this thinking.
§ LORD ABERDAREMy Lords, I would not agree that we are undermining the health of the school-children. We believe we are providing all that is necessary at the right ages for those who require it, and we are not in fact expecting any cut in the total resources. There will be an increase in the resources devoted to health and welfare. But I think we had better go into this next week.
LORD GRENFELLMy Lords, I know that I speak for all interested in the hospital services, and especially the mentally handicapped, in thanking Her Majesty's Government and my noble friend for this Statement. Would my noble friend look with favour on the expenditure of some of this money on hostels, in hospital grounds where applicable, so that a great number of high-grade patients could be discharged from mental hospitals and beds thus be released for more urgent cases, relieving many families of great distress?
§ LORD ABERDAREMy Lords, I am grateful to my noble friend, Lord Grenfell. My right honourable friend the Secretary of State is hoping to give some guidance very shortly about how we intend to spend the extra money allocated for the mentally handicapped, and I know that the sort of project my noble friend has in mind is one with which he will have great sympathy.
§ BARONESS BIRKMy Lords, I should like to ask the Minister a question on the rather tantalising little trailer he gave us about the Government's making a statement soon on family planning. As chairman of the Health Education Council I may say that that is of great interest to us. Could we have an indication as to how soon is "soon"? In view of the fact that out of about 200 local authorities only one third provide a full service, less than a half partial facilities and the others very little at all, is the idea being contemplated of giving money locally, or of integrating contraception into the National Health Service? May I put to 767 the Government the cost benefit of a scheme of this sort? Are they also thinking in terms of increased expenditure on health education if facilities are to be increased?
§ LORD ABERDAREMy Lords, I am well aware of the interest of the noble Baroness in this subject. I can only say that "soon" is soon, and I am afraid I cannot anticipate what my right honourable friend is hoping to say.
§ LORD AUCKLANDMy Lords, can my noble friend say whether within this new scheme, which we all very much welcome, new accident hospitals will be given top priority? Is my noble friend aware that there are quite a large number of fairly large hospitals where, at weekends particularly, accident services are most inadequate owing to shortage of staff, and will he do all he can to see that this is improved?
§ LORD ABERDAREMy Lords, I am well aware of the difficulties of accident and emergency departments. My noble friend mentioned new accident hospitals, but these services are departments in hospitals and are often in need of help, especially at weekends. We are going into this subject very thoroughly now and will see whether there is a chance of improvement by use of some of this additional money.