HL Deb 22 November 1982 vol 436 cc736-9

4.11 p.m.

Second Reading debate resumed.

Baroness Robson of Kiddington

My Lords, you must excuse me for relaxing and leaning back. I was under the impression that the second Statement would be presented to us before it was my turn to continue the debate on the new proposed Bill. I should like to thank the noble Lord, Lord Trefgarne, for introducing the Bill so clearly and for pointing out to us what the Government are attempting to do. I shall turn to one or two aspects of the Bill, and not necessarily go through all its various clauses.

First, I should like to address myself to the question of care in the community—Part I of the Bill. I wish to say how greatly I welcome the extension of powers given to health authorities to make payments, as well as the extension of the period of time during which such payments may be made, as well as the fact that expenditure on housing and education is now to be included. I welcome the proposal because I think it is the right way in which to deal with joint financing if we are to achieve improvement in our care in the community programme. I welcome the proposal as a means of achieving the objective, but, until such time as there is more money in the fund, very little improvement will in fact take place. When we consider the problem that faces us, the announced £6 million increase next year in the funds available is only a drop in the ocean.

Some time ago, the Government themselves ascertained that there are in institutions at least 17,000 who could be living in the community if suitable conditions existed for them so to do. The amount of money available is nowhere near sufficient to move towards returning these people into the community. In view of the financial stringency and indeed the economic climate within which both local authorities and health authorities have to work, the danger in regard to the extension of time is that most of the money available to JCCs will be used to extend the time for payment in respect of projects already in existence. Personally, I should wish—and I think most people would wish—that the increased amount of money be used as pump-priming for new initiatives, and I am very concerned that that might not happen.

I believe that in society there are many misconceptions about the problems of getting people back into the community. First, it is not cheap. Many have assumed that it is a cheaper way and a better way of looking after people. I believe that it is a better way, but it is not a cheaper way. It is always assumed that, if this method relieves district health authorities of the responsibility of looking after people in institutions, there will be revenue savings to those authorities which can be transferred to the new accommodation created through joint financing. However, there would be very little revenue saving to the district health authorities, because, first, we should want to improve the staffing in the present institutions, and, secondly, a degree of high dependency would remain.

The other difficulty regarding the proposals in Part I of the Bill arises from the statement that money earmarked for joint financing can be used or controlled only by the JCC on which the district health authority is represented. That seems fair. But, if one considers the large psychiatric institutions in and around London, it would be necessary for joint financing money to be used in another district and in the area of another local authority. That is because one cannot expect the local authority in the area of which big psychiatric units are situated to take care of all the people who might be discharged. So, in my view, the DHAs would have to be represented on a large number of authorities, so as to enable people to go back into the community. The use of joint financing money is being somewhat restricted here.

While I was a regional chairman, I applied to the Department of Health and Social Security for permission to use some joint financing money in another region, because people who were to be released from a psychiatric unit were former residents of the region. There was a fairly noncommittal reply, but not a refusal, and my anxiety is that under the Bill it would not be possible for money to be used in that way, which could be beneficial to the authority that was proposing so to use it.

We on these Benches very much welcome the proposed legislation on the registration of private and voluntary homes. This has been long overdue, and can be only of great benefit. But I am a little concerned. First of all, I agree that inspection should be conducted on at least an annual basis, and I am grateful to the noble Lord for assuring us that that will be so. However, I should like to ask some questions on what kind of register will be kept. Personally, I should prefer a national register. This is a very important point because it is possible that, after a home has lost its registration through mismanagement and has been closed down, the perhaps undesirable people who had been running it might move to another part of the country where they would apply for, and be granted, a new registration. On the other hand, I believe that, if there were a national register of all registered homes, plus a register of the people who had had their registration withdrawn, that would be valuable. I shall be grateful for an answer as to whether a national register is envisaged under the Bill. So far as I can understand it, it does not seem that it is envisaged.

The other aspect of the Bill that we also welcome very much is the single system of adjudication. This seems to me the right way to move, that there should be only one body to which people would have to appeal. I also welcome the fact that the chairmen will be legally-qualified people; but it would be of great interest, I believe, to be told something of the Government's thinking on how many full-time chairmen there are going to be, because anyone at all aware of the problems that are going to face this appeal tribunal, with a mass of legislation which is constantly changing, will know how important it is that we have the maximum number of full-time chairmen, for I believe this is too complicated an issue for a large number of part-time chairmen, however eminent and however willing they are to work.

Another point I should like to make is that if there is any saving in the cost of administration coming from the amalgamation of these bodies, one would like to appeal to the Secretary of State to use that saving for training new members of the panel. The members of the panel are going to be part-time, and they will need an enormous amount of training, I believe, in order to deal with the very difficult questions that are going to be put in front of them.

I am also disturbed about the fact that the clerk to the tribunal should be provided by the DHSS, because it could appear to applicants in front of the tribunal that the clerk from the DHSS was really part of the system he was appealing against. Furthermore, if the clerk to a tribunal is going to be really useful to that tribunal, he will have to do more than just take notes. He should be a person similar to a clerk to a magistrates' court, who, on a point of law, could advise the panel. I do not think he will be able to do that if he is an employee of the DHSS, and I should prefer to see an independent person who is not connected with the DHSS itself. I hope that that point can be considered.

Then, this month the Social Security and Housing Benefits Act comes into force, under which there is no appeal, only a review. It seems to me that the new body, when it is set up, should be able to look at appeals under that Act as well. The last point on this issue about which I wanted to ask the noble Lord is whether he would explain why it is not possible for an appellant to appeal not only on a point of law but also on a question of fact.

I now want to come to the establishment of independent special health authorities for the family practitioner committees. I have always been in agreement with the Royal Commission's recommendation that FPCs should be properly integrated into the NHS. I always found when I was a regional chairman that there was a lack of communication and difficulties created in planning, in particular of primary care, because there was not a close enough relationship between the FPCs and the district health authorities. To me, it appears that planning is going to be even more difficult now, because it is going to mean willing co-operation between three different independent statutory bodies. There are going to be the FPCs, the DHAs and the Social Services Department; and the regional health authorities, who are responsible for the strategic long-term planning of their regions, are completely excluded, because the FPCs are directly responsible and have no obligation to report to the regional health authorities. I find this a tragedy, because I believe we made a mistake in 1974. We had the chance to put it right in the recent reorganisation, and I was hoping that this Bill would have put into effect what we all wish to see.

When it comes to the membership of the FPCs I have another great concern, and that is that on reading the schedule I see that there will be four DHA members on each FCP. I have no idea what the locality of the FPC is going to be, but one would assume that the Government are not going to go in for an enormous reorganisation of the size and shape of the FPCs, and that they are liable to be of the size of an area health authority. With four DHA members on them, there being some former area health authorities, localities which have many more than four districts within them, it means that if there are six or seven district health authorities only some of them will be able to be represented on the FPC. I find that upsetting.

Then, when it comes to planning, it is often forgotten that there are districts in this country which can be called deprived districts from the point of view of not having a sufficient number of general practitioners within their area. The influence that the DHAs will have to improve that position is going to be minimal under this new organisation; and when there is an insufficient coverage of general practitioners in a district, an enormous additional cost is handed over to the hospital services because the clinics in the hospitals have to take care of what should be done by the general practitioners. My Lords, I sincerely hope that some of these things can be put right at Committee stage. There are the beginnings of some very good things in this Bill, and I sincerely hope your Lordships will be able to make it an even better Bill at Committee stage.