HL Deb 12 July 1989 vol 510 cc287-301

4.40 p.m.

Lord Henley

My Lords, with the leave of the House I should like to repeat a Statement that is being made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:

"With permission, Mr. Speaker, I wish to make a Statement on the Government proposals for the future organisation and funding of community care.

"Community care is a policy to which successive governments have been committed for almost 30 years.

"The key aim of this policy is to enable people to live as full and independent a life as is possible for them in the community for so long as they wish to do so. For many people, this means providing the services and support they need to continue to live in reasonable comfort in their own homes for as long as possible. For others, who may have experienced long stays in hospital and have more intensive care needs, it means helping them to re-establish their lives away from large institutional settings. I am sure that the vast majority of people wish to live in or near their own homes until or unless age or disability make that impossible. It is the Government's purpose to help them and the people who care for them to achieve that aim. Success depends crucially on the availability of adequate services in the community.

"The background to the developments I am about to announce is one of tremendous growth in both resources and manpower for community care. To give the House some examples of the progress that has been made between 1979–80 and 1986–87, expenditure by the NHS on the community health services has risen by 40 per cent. in real terms, and local government spending on the personal social services has grown by almost 27 per cent. The number of day centre and day hospital places for mentally handicapped people rose by 10,000. The number of home helps grew by 20 per cent. and the number of day centre places for elderly people by 18 per cent. The number of residential places for mentally ill people rose by over a half, and places in day centres and day hospitals by a third. Between 1981–86 the number of community psychiatric nurses doubled. This growth in resources has been taking place alongside a dramatic change in the delivery of care and the movement of people out of hospitals and into community settings. Between 1980 and 1986 the number of children in mental handicap hospitals fell from 2,500 to less than 400 and the number of mentally handicapped adults in hospital fell by around 14,000, while the number in local authority, voluntary and private community based homes rose by 11,000. In addition we have, through the benefit system, put huge additional resources into supporting people in private residential care and nursing homes. The amounts spent on supporting these people have increased from £10 million in 1979 to £878 million in 1988.

"Nonetheless, I am sure that we all agree that progress has not been as even or as rapid as we should like. The rapid growth of residential and nursing home care has been unplanned and largely based on the availability of social security benefits. The Government recognised the need to see whether the arrangements for delivering community care could be improved when we asked Sir Roy Griffiths in December 1986 to report on ways by which the better use of public funds for community care might be achieved.

"We are indebted to Sir Roy for his report Community Care: Agenda for Action, which we published in March last year. The report has succeeded in stimulating valuable public debate. Over 280 organisations, professional bodies and members of the public, have sent us their views on it, many in support of the recommendations, but some favouring other options. We have taken full account of the wide range of views expressed, and considered a wide variety of options. Our conclusions are as follows.

"We accept the distinction Sir Roy Griffiths makes between health and social care. Our proposals do not alter the functions or responsibilities of health services. The community health services will continue to play an essential part in meeting the medical and nursing needs of people outside hospital.

"We are proposing to make important changes in the way in which non-health care is provided and, where necessary, funded at public expense. The great bulk of community care will continue to be provided by family, friends and neighbours. The majority of carers take on these responsibilities willingly, and I admire the dedicated and self-sacrificing way in which so many members of the public take on serious obligations to help care for elderly or disabled relatives and friends. Our proposals are aimed at strengthening support for those many unselfish people who care for people in need.

"At present, people who are unable to support themselves and need help with social care can look to two separate sources of statutory help: to social security offices for payments towards the cost of places in residential care and nursing homes; and to local authorities, for home care, day care and residential care services. We accept that the present arrangements are flawed because they cannot ensure that priority is given towards supporting people at home where that is possible and desirable. Social security payments for residential and nursing home care are subject to no assessment of individual needs for care. The public agencies have a financial incentive which no one ever intended to give to them, to rely as much as possible on the availability of social security for residential care. We do not believe that these present arrangements secure the best possible outcomes for people in need, or indeed the best possible use of taxpayers' money.

"We therefore accept Sir Roy's recommendation that those two sources of public funding should be brought together and allocated on the basis of a proper judgment of an individual's needs. By creating this unified source of funding for the full range of social care services, we can ensure that the objective of sustaining people in their own homes wherever possible be given the necessary priority.

"We propose to introduce a new funding structure for those seeking help from public funds for the cost of care. In future there should be a single budget to cover the costs of care whether in a person's own home or in a residential or nursing home. This will enable sensible decisions to be taken about the type of care that best meets an individual's needs and provides best use of public money. At the same time we will remove the perverse incentives in the present benefit system by making all claimants eligible for income support and housing benefit on a similar basis, whether they are living in their own homes or in independent residential or nursing homes.

"We have considered carefully which care authority should hold this new budget and take on the responsibility for the assessment of need and provision of care. Local authorities are already responsible for the full range of social care services and have a great deal of expertise in this area. We have concluded that the best way forward will be to build on local authorities' existing responsibilities. We accept Sir Roy Griffiths' proposal that local authorities should assume responsibility for the care element of public support for people in private and voluntary residential care and nursing homes, and for making the best use of those funds in relation to an assessment of people's needs and priorities. Collaboration between medical, nursing and social services agencies will be essential in assessing individual needs, and in designing suitable arrangements for care. We shall look to local authorities to ensure that suitable multi-disciplinary assessment procedures are in place, and to health authorities to make their contribution to those procedures.

"We attach great importance to securing a smooth transition to this new structure, avoiding uncertainty for people currently living in homes and for their relatives. We therefore propose that the new arrangements for social security benefit entitlement will apply only to people not already in residential or nursing home care after the date on which the new arrangements come into force.

"Residents of homes who are in receipt of income support when the new system is introduced will therefore retain their entitlement to help through the existing system. People who are self-financing residents of registered homes when the new system is introduced will also be able to apply for income support under the existing arrangements if their funds become exhausted subsequently. My right honourable friend the Secretary of State for Social Security is today announcing further details of these new arrangements.

"We accept that further efforts will be needed to improve co-ordination between health and social services in the arrangement and delivery of services to individuals. We believe that the clarification of roles in our proposals will make it easier to achieve this.

"The local authorities' responsibilities, in collaboration with others including doctors and other caring professions, will be to assess individuals' needs, design suitable care arrangements, and secure their delivery. It is not necessary for local authorities to provide all this service directly themselves and they should make maximum possible use of the voluntary, not-for-profit and commercial sectors so as to widen individuals' room for choice, increase the flexibility of services and stimulate innovation.

"The Government have long urged local authority social services departments to act in an enabling, and not just a providing capacity. Some authorities are already moving in that direction. To minimise disruption and to ensure that local authorities have every incentive to make use of the independent sector and offer people choice, we propose that they should continue to meet the full cost of accommodating people in local authorities' own homes, subject to their existing powers to make charges according to residents' ability to pay. My right honourable friend is not therefore proposing to change the benefit rules for residents of these homes.

"We believe that these new financial arrangements will give local authorities the necessary incentives to develop better services for people at home, and make greater use of independent providers. It will be important that local authorities should have clear plans for the development of community care services, worked out in collaboration with health authorities and the independent sector. I shall expect all authorities to have such plans, and shall ensure that they are open to inspection by my Social Services Inspectorate. I also propose to take powers to call for reports on local authorities' community care services.

"Local authorities will need adequate resources for their new responsibilities. That means that we shall transfer to the local authorities the resources which the Government would otherwise have provided to finance care through social security payments to people in residential and nursing homes. The aggregate amount of transferred resources will allow for the projected growth in the numbers of people needing support. Resources will be needed by the local authorities to carry out their new tasks of assessing individuals' needs, arranging appropriate care services for people at home, and buying private residential and nursing home care.

"We are confident that the proposed funding arrangements, by putting more emphasis on supporting people in their own homes, will provide both more appropriate services closer to individuals' wishes and needs, and better value for money from public spending than under the existing arrangements. We shall be discussing the detailed financial implications with local authority representatives. The necessary decisions on the resources to be transferred will be taken in the public expenditure survey next year.

"I have summarised our conclusions on the main proposals in Sir Roy Griffiths' report. They represent a major challenge for local authorities and social services departments. There are a number of associated issues on which the House will expect me to make the Government's position clear.

"First, we have been especially concerned to ensure that care for severely mentally ill people is properly managed. Here, as in other areas, we have concluded that the right course is to ensure that existing responsibilities are discharged effectively. On the health side, I will ensure that discharges of seriously mentally ill people from hospital will take place only when adequate medical and social care is available for them outside hospital. More details of the initiatives we are taking here will be announced shortly. On the social care side, we have decided to create a new specific grant directed at encouraging local authorities to make their necessary contribution to services, in line with health authority plans and objectives. To achieve that, we have decided that the grant should be payable by health authorities, acting as my agent, on the basis of plans and targets put to them by the relevant local authorities. The details of this proposal will be worked out in discussion with health and local authority representatives.

"Secondly, both Sir Roy Griffiths and Lady Wagner made recommendations about the registration and inspection of residential care and nursing homes. Local authorities will be asked to establish inspection and registration units, at arm's length from the management of their own services, which should be responsible for checking on standards in their own homes, and to involve independent outsiders in these arrangements. We have concluded that, for the present, existing statutory functions should remain unaltered.

"Thirdly, we would expect general practitioners to ensure that social services departments are aware of their patients' needs for social care, as recommended by Sir Roy Griffiths in his report.

"I have outlined our conclusions on the main issues. My right honourable friends the Secretaries of State for Scotland and Wales are today announcing separately our conclusions of particular relevance to them. My right honourable friend the Secretary of State for Northern Ireland will be doing the same early next week. We propose to spell out our proposals in more detail in a White Paper which we aim to publish in the autumn. It will be necessary to ensure that the necessary legislative framework is in place before implementation, which we propose should be in 1991.

"Our proposals bring the policy of community care up to date and will improve the way in which it is put into practice on the ground. Community care is no longer primarily about providing an alternative to long-stay hospital care. The vast majority of people needing care have never been, nor expect to be, in such institutions. The policy aim now is to strike the right balance between home and day care on the one hand, and residential and nursing home care on the other, while reserving hospital care for those whose needs truly cannot be met elsewhere. The changes we propose will for the first time ensure that all public monies are devoted to the primary objective of supporting people at home wherever possible. They provide a solid basis for the future, and are founded upon the principles of preserving individual independence, freedom of choice and providing services in a sensitive and personal way. I believe they deserve wholehearted support, and I commend them to the House".

My Lords, that concludes the Statement.

4.57 p.m.

Lord Ennals

My Lords, I thank the noble Lord for repeating the Statement. It must be a great relief for him to be able to do so because, by my calculation, he himself, and his noble friends Lord Skelmersdale and Lord Hesketh, have on 21 occasions used variations of the word "soon" regarding when the reply would come.

The Statement was a very important one, and I must say that I welcome the general thrust of what has been said this afternoon. We welcome the Government's decision to rethink their attitude to Sir Roy Griffiths' proposals, and hope that this may also apply to the ill-considered proposals for the reform of the National Health Service. Hope springs eternal!

Is the noble Lord aware that our satisfaction and our broad acceptance of the Government's broad acceptance of Sir Roy Griffiths' proposals is somewhat clouded by irritation and, at times, anger at the incompetent manner in which this matter has been handled by the Government? Bearing in mind the urgency of the problem, the very great increase in the number of elderly, the increase in the number of patients being discharged into the community from long-stay hospitals and the rapid expansion in the number of homeless people, how can the Government justify a 17 month period of consideration of an issue as important and urgent as this? Everone else found time to reach their conclusions. During the period when Ministers sat on this report, the Secretary of State wrote a whole White Paper which has thrown the National Health Service into some chaos and confusion and, of course, into a massive rejection by the public.

What a contrast between the tortoise-like speed of the consideration of this important report and the kind of race track speed at which the Government have handled the White Paper. Even now, it seems to me that the Government show very little sense of urgency, despite the fact that the number of over-85s has exceeded by 10 times the proportion of people attending day hospitals for the elderly; and that over the past 10 years 25,800 long-stay patients were discharged from mental health hospitals, while only 2,230 extra day care places were provided for them in the community, and only 4,000 extra residential places. At a time of greatly increased need for community care provision, those places are at present grossly under-funded. Of course, there has been a great increase in expenditure, but this is largely based on the growing needs of the population which have required additional expenditure.

I wish to put a number of questions to the Minister for his response. First, I note what has been said about the discharge of severely ill people from hospital only when adequate measures of social and medical care are available. Great concern has been expressed in this House about discharges from psychiatric hospitals into the community when provision was not available. Broadly, we welcome the decision, but I hope that it will not mean simply imposing a brake on the closure of psychiatric hospitals when what is needed is a great increase in the availability of community care services in order that we may effectively transfer people into the community.

Secondly, yesterday was the third anniversary of the passing into law of the Disabled Persons (Services, Consultation and Representation) Act. Several provisions of that Act have not yet been implemented. Will the noble Lord say something about the timetable for the implementation of the remainder of that Act, some parts of which are very urgent?.

Thirdly, we welcome the appointment of the local authority as the lead agency for community care. Do the Government still propose to remove from the new health authorities representatives of local authorities? In view of the new confidence in and challenge to local authorities, should the Government not drop the very mean proposal that under the new reorganisation local authorities should no longer be represented on local health authorities? I hope that they will look at that matter very seriously.

Fourthly, why have the Government decided to discourage local authority social service departments from providing their own community services? I do not really understand the Secretary or State's motive. Is there any evidence that their standards are lower than those of privately provided services? My own impression is that it is the other way round. How can local authorities set high standards if they are not themselves to be responsible for providing their own services? Surely it is a matter of both enabling and providing, not one rather than the other.

Fifthly, what about the Griffiths proposal for a Minister for Community Care? That was one aspect of Sir Roy's recommendations which gained support from all sides. Not a word was said about it in the Statement. I hope that the noble Lord can comment on that proposal.

Sixthly, what is the Government's policy in respect of helping the carers at a time when growing responsibility, recognised by the Secretary of State in his Statement, is falling on families and their friends to care for the elderly and infirm, often involving, as he said, very great sacrifice? His thanks are welcome, but some of them need money. At present there are 150,000 carers of disabled people who now find themselves £5 a week worse off as a result of recent government action. There is an increasing number of elderly, frail arid handicapped people who are now unable to pay nursing home fees because of social security cutbacks. Some of them have already had to delve into their savings and some are frightened that they may have to leave. That is very bad for people in that position. Complaints were made by Age Concern only today on that score.

Seventhly, and most importantly, there is the question of the provision of funding for the community care programme. I noted that the Secretary of State said in his Statement that the two sources of funding—from social security offices and local authority budgets—are to be brought together. That is broadly to be welcomed. There is merit in a unified source of funding. It is difficult to comment until we have full details and until your Lordships have seen the Statement which was apparently also made today by the Secretary of State for Social Services. However, we on this side of the House must be satisfied that local authorities will receive funds which are adequate to meet the new responsibilities. It is no good putting a new pattern into place if the local authorities are to be starved of funds to enable them to fulfil the task. That is the situation at present and we must have assurances on that score. The discussions which are to take place with local authority associations are extremely important.

Eighthly, I welcome the announcement following the report of Sir Roy Griffiths and Lady Wagner on the registration and inspection of residential care in nursing homes and other accommodation. Will there be some national system of inspection and national standards, or will it simply by a system of local standards? It is important that private care provision must come up to the same standard as public and voluntary organisation provision. We must make a great effort to maintain high standards. At present I am very worried about some of the provision made in the private sector, although very substantial profits are made.

My final question concerns the timetable for the White Paper and for legislation. It is of crucial importance that as soon as the White Paper is published we should have the opportunity for a debate in your Lordships' House. As I have said, it is a very important Statement and there is a great deal of information which we want to absorb. I should like to know whether we will have a debate and whether the legislation to bring these proposals into effect will be introduced at the same time as the proposed legislation on the reform of the National Health Service. The two go together and I would expect that the legislation for both would come together.

Baroness Seear

My Lords, I should like to say from these Benches how much we also welcome the Statement given to us today. I can only say, better late than never. I shall not digress on the very large number of times that we have asked when the Statement was coming; I shall merely say that I am delighted that it has now arrived.

In the main the contents are very acceptable. We are very glad indeed that the Government have decided to place the responsibility with the local authorities. If ever there was a job which should appropriately be done by local authorities, with their local knowledge, ability to rally local support and to keep in touch with local voluntary organisations, it is in the area of community care. We have felt all along that that was where the responsibility should lie and we are very glad indeed that the Government have now made up their mind along those lines. Of course it is recognised that that job has to be done in full consultation with the health authorities.

We welcome the idea that there should be individual assessments of need by one authority so that there will be one department in the local authority ensuring that once the assessment is made the provision is available and the needs of individuals who have been assessed will be met. One can see from the proposals put forward, echoing as they do the proposals in the Griffiths Report, that the machinery can be brought in at last to ensure that a programme of care for the individual is mapped out, that care is provided, and, of the very greatest importance, that the services that are being provided for people who need care will be inspected.

Unlike the noble Lord, Lord Ennals, I very much welcome the fact that use is to be made of voluntary organisations and the private sector, provided always that inspection standards are suitably high. As I read the Statement, it does not rule out the provision of care by local authorities. It merely says that in addition to local authorities making their own provision, care can also be provided by the commercial and voluntary sectors.

While welcoming that fact, perhaps I may add that from the point of view of the voluntary organisations, if care is to be provided by voluntary organisations there must be adequate funding. To take the approach—welcomed on these Benches—of using a variety of resources to meet the needs could be a disaster unless money is provided to ensure that it is done properly. From experience in other areas in which voluntary bodies are asked to collaborate and provide services, it is clear that they must have an assurance that money will be available over a reasonable period of time and that there will not be frequent changes in the way in which it is made available.

Nothing is more devastating from the point of view of the voluntary organisations—we have had so much of this over recent years—than for them to be encouraged to provide services and to put resources, effort and enthusiasm into them only to find, six months, nine months or a year later, that the financial arrangements have altered. There must not be continuous chopping and changing about provision. Voluntary organisations must be given confidence to know that there will be adequate money and that that will be sustained over a proper period of time.

There are one or two points upon which I should like further clarification, although I think that, from the wording of the Statement, the Government are not absolutely clear as to how they intend to handle the matter themselves. The Statement says that the new provisions will not apply to people at present in residential care. I am looking for the appropriate page of the Statement.

Lord Henley

My Lords, will the noble Baroness give me the paragraph number?

Baroness Seear

My Lords, that is what I am looking for. If I could find it, I should be only too delighted to give it to the noble Lord. I have read the passage three times so I am absolutely certain that it is there. Perhaps the noble Lord, Lord Ennals, can find it. It is a rather important point. I shall come back to it in a moment.

Another point on which we seek clarification is the provision for the mentally ill. The Statement says: Here, as in other areas, we have concluded that the right course is to ensure that existing responsibilities are discharged effectively … discharges of seriously mentally ill people from hospital will take place …". That is fine, but the responsibility is to be through the health authorities. The Statement goes on to say: the grant should be payable by health authorities, acting as my agent, on the basis of plans and targets put to them by the relevant local authorities. Will the Minister explain the relationship between the health authorities and the local authorities in the area of people discharged from mental hospitals? There is a clear distinction between that and the way in which one handles other cases. The funding will be different in that it is payable to the health authorities, yet the local authorities still come into the matter. I do not know whether the Minister is in a position to make clear how that mechanism will work. I do not think that it is clear in the Statement. Perhaps it has not yet been fully worked out. Again, providing care for mentally ill people is an expensive business. Will the funding be on the same scale or greater? May we be assured that it will be adequate when people move out of mental hospitals? That is an important point.

Lord Ennals

My Lords, the passage to which the noble Baroness referred previously is in paragraph 13.

Baroness Seear

My Lords, I thank the noble Lord, Lord Ennals. That is what one calls comradeship.

Paragraph 13 states: We attach great importance to securing a smooth transition … We therefore propose that the new arrangements for social security benefit entitlement will apply only to people not already in residential or nursing home care". What does that mean? If those people come out, who will provide for them? Presumably, if they are already in a home, some of them will come out. Are they excluded from the new provisions even when they come out? That does not appear to be clear from Paragraph 13. Perhaps the Government have not fully worked it out; but we shall need to know about that because it is an important point. It seems to me that, as the provision is worded at the moment, such people are excluded from the provisions. The new arrangements will apply only to people not already in residential or nursing home care. Will the Minister clarify that point?

However, having said that—in a somewhat confused way, I fear—I should say that we welcome the proposals. We are glad that they have at long last come forward. We hope that they can be brought into force with great speed. I should like to echo the point raised by the noble Lord, Lord Ennals; namely, is the question of a Minister for community care to be considered? Finally, surely this is a subject on which we need to have a debate, rather than having a quarter of a debate now.

5.15 p.m.

Lord Henley

My Lords, I thank both the noble Lord, Lord Ennals, and the noble Baroness, Lady Seear, for their generous remarks in generally welcoming the Statement. I am pleased not to have to use the words "soon" or "shortly" for the moment. I imagine that the same would apply to my noble friends who have also used those words. There has been a delay, but the noble Lord knows that community care is a complex and sensitive area in which a number of departments have a keen interest. We need to take a broad and considered view of government policy.

We are now clear that the proposals outlined in the Statement offer the best way forward. I shall try to deal with quite a number of the points made by the noble Lord. I believe that there was a total of nine.

Lord Ennals

My Lords, I believe that there were 10.

Lord Henley

My Lords, I suspect that I might have missed some—I counted nine—but I shall try to cover them all.

The noble Lord spoke about the discharge of the severely ill. Perhaps I may say in passing that there will be an announcement about further initiatives very soon. For once, I can tell the noble Lord what the word "soon" means. My honourable friend the Parliamentary Under-Secretary of State, Mr. Freeman, will make a speech tomorrow to the National Schizophrenia Fellowship in which he will outline the Government's new initiatives for the care of the mentally ill. There is at present no intention to change policy or rein back on the closure of psychiatric hospitals. We intend to encourage local authorities to play their part in that process.

The noble Lord, Lord Ennals, raised the question of residents who cannot meet the fees in nursing homes because of cuts in social security. The level of social security benefit is a matter for my right honourable friend the Secretary of State for Social Security. I know that the rates are sufficient in the majority of residential care and nursing homes. My right honourable friend looks at them each year and I am sure that he will review them in the course of events.

The noble Lord was also worried about the question of local authorities' own homes. I was pleased to have some support on that matter from the noble Baroness, Lady Seear, who, I took it, understood that we still accept the fact that local authorities should run their own homes if they so wish. However, they should be encouraged to make use of the private and voluntary sector. We are not making any change to the existing arrangements for people in local authority homes. We are simply encouraging local authorities to beef up their community care domiciliary services in the other sector.

Both the noble Lord and the noble Baroness asked about the recommendation in the Griffiths Report that there should be a Minister of State with special responsibility for community care. We feel that that is unnecessary at the moment. Clearly, the Minister of State for Health already has that responsibility and we feel that there is no need to create a new ministerial post.

The noble Lord also said that carers were badly off as a result of social security. Aain, that is a matter for my right honourable friend. I am sure that he will take note of the noble Lord's comments. The idea behind the social services departments presenting a package is that they can obviously take into account the needs of the carers as well as those of the clients in setting up that package. Obviously, that is a relevant matter.

The noble Baroness mentioned voluntary organisations. I was pleased that she gave credit to the important contribution that they make. We are in a new and exciting climate in which we hope that they will collaborate with county councils and other social services departments in a meaningful way.

The noble Baroness also asked about the specific grant. The intention is to encourage Focal authorities to build up their mental illness services from a low basis and to ensure that the development of their services will be consistent with health authority plans. Health authorities will administer the grant. The grant is not intended to cover all costs—"pump priming" I think would be a better word. The level has not yet been decided and will be discussed in the White Paper.

Both the noble Lord and the noble Baroness asked about the timetable of the White Paper which will be published in the autumn. As noble Lords will understand, whether or not we have a debate on that White Paper is a matter for the usual channels. However, I am sure that the usual channels will take note of the extensive interest on this matter in the House.

With regard to the matter of legislation, noble Lords will appreciate that I cannot pre-empt the Queen's Speech.

No doubt I have missed out some points but perhaps I could now say a brief word on funding, although I cannot be very specific. There will be a transfer of funds from central to local government to ensure that the local authorities have adequate resources to carry out their new responsibilities. That means that we shall transfer to the local authorities the resources that the Government would otherwise have provided to finance care for those receiving social security payments in residential care and nursing homes. The transfer of resources will allow for the projected growth in the number of people needing support. Detailed financial implications will be discussed with the local authority associations.

Perhaps I may turn now to paragraph 13, which was causing the noble Baroness some confusion; I thought that it was self-explanatory. Those who are in residential homes at the moment will not lose out because of the new arrangements. Also, those who are there and paying for themselves but who later need support will be protected. It only affects people who go in after the scheme has been set up.

I hope that I have answered Most of the points that have been raised. If not, I shall write to the noble Lords covering any points that I have missed.

Lord Renton

My Lords, perhaps I may first say that the Statement is very welcome, although one will need time to consider the details of it because as Statements go it was very long. I wonder whether my noble friend can give some broad idea as to whether the proposals will lead to a reduction in the number of mentally handicapped people—I am not talking of the mentally ill, but the mentally handcapped—in long-stay hospitals of whom there are still several thousand.

Lord Henley

My Lords, I can only say that we shall continue our existing policy. Where possible we should like to see people coming out of long-stay hospitals. Obviously if mentally handicapped people had been in a long-stay hospital for such a length of time that it would not be a satisfactory care solution to allow them back into the community, then they would stay in the hospital.

Lady Saltoun of Abernethy

My Lords, I too am delighted that after 16 months' brooding the Government have at last hatched this egg. In view of the enormous increase in the cost of residential care and nursing homes and the Government's declared aim of keeping people in their own homes so far as is possible, will they make sure of providing local authorities with adequate and if necessary earmarked funds for paying for personal alarms for the elderly and disabled in their own homes in cases where alarms cannot be afforded now that they can no longer be charged to housing benefit?

Incidentally, can the noble Lord say whether in fact the additional funding that the Government will supply to local authorities for implementing the Griffiths Report will be earmarked? Finally, could he possibly say how the hospices will fit into this scheme?

Lord Henley

My Lords, the noble Lady asks about personal alarms. Obviously this will be a matter for the social services departments to consider in relation to all their other home care services. It is the home care services that we wish to see expand. If it is felt that they would make it easier for people to stay in the community, then obviously personal alarms could be of great benefit.

The noble Lady also asked about hospices. Currently the position of hospices is the subject of separate consideration and they will not be affected by the proposals announced today.

Lord Mottistone

My Lords, I too should like to thank my noble friend very much for this Statement which I think is good so far as it goes. I should also like to congratulate him and his right honourable and honourable friends on producing the Statement before the Summer Recess. At one moment it seemed that we might not have it and I like to think that perhaps my Schizophrenia After-Care Bill had some effect in hurrying it up.

I am also most grateful to hear that his honourable friend Mr. Freeman will be addressing the National Schizophrenia Fellowship; he will make a Statement on the detail as regards the severely mentally ill which is still awaited. I hope that the not so severely mentally ill will also be included. The term covers a wide range of people and I hope that he will not be as restrictive as that. In general I welcome what we have heard today.

Lord Henley

My Lords, I thank my noble friend for those remarks. I do not know what my honourable friend Mr. Freeman will be saying. However, knowing the noble Lord's interest and having listened carefully to the discussions on his Schizophrenia After-Care Bill when it was going through this House, I think it very likely that tomorrow he will be there to listen to my honourable friend's speech and take note of what he says.

The Lord Privy Seal (Lord Belstead)

My Lords, this has been a very long Statement and it is quite understandable that the House has wanted to take the length of time that it did to discuss it. Nevertheless, we have been discussing it for half an hour. Perhaps I may suggest that we now take the next intervention, that of the noble Lord, Lord Seebohm, and then pass on to the next business.

Lord Seebohm

My Lords, I shall be brief. I speak in my capacity as president of Age Concern. The announcement that we have heard today comes as a very great relief to me and, I am sure, to all my colleagues in Age Concern. My main worry is whether we shall have sufficient funds to undertake all the training and retraining that will be necessary as well as the other facilities that will be required in setting up this new system. I think that that will be very important.

It may be of some small interest to the House to learn that after nearly 20 years on the 24th of this month I shall be handing over the presidency of Age Concern to Sir Roy Griffiths.

Lord Henley

My Lords, I thank the noble Lord for his comments. As regards funding, I cannot add to what I have already said. We spend a great deal on community care, and funding has been rising steadily throughout the past decade. Of course, Her Majesty's Government will ensure that adequate funding is made available.

Lord Winstanley

My Lords, I should like to put two brief and specific questions to the noble Lord before we proceed to other business. First, since local authorities will be given the resources to provide community care rather than merely the opportunity to take the blame for community care not being provided, does he think that it would be helpful if a named and known local government officer were to be made responsible for this work? If so, does that mean that there is now a case for restoring the old and much respected office of medical officer of health in local government? The medical officer of health carried out many of the new functions which the noble Lord has just described, saying that local authorities will have to undertake them.

Secondly, can the noble Lord confirm the new arrangements for ensuring that mentally ill patients are not discharged from hospital until the community care arrangements are in place? Will those new arrangements come into force tomorrow, after the Minister speaks, or will they have to wait until 1991?

Lord Henley

My Lords, with regard to the noble Lord's first question, I should have thought that what they call the officer is a matter for the local authorities. In my view the title director of social services is just as good as chief medical officer but I leave that matter to the local authorities.

So far as concerns discharges from hospitals, I can only repeat that the position remains the same. No one should be discharged from hospital until adequate care arrangements are available. That has always been the case.