Community Care: Implementation (Hansard, 30 March 1993)

The Parliamentary Under-Secretary of State (Department of Health (Baroness Cumberlege)
My Lords, yes.

§ Earl Russell
My Lords, I thank the noble Baroness for that reply. I hope that it may prove correct.
The noble Baroness is doubtless aware of the letter of 1st March from Mr. David Lambert in her own department, directing directors of social services to record unmet choice and not unmet need. Does she agree that that has cast some doubt on what the Select Committee in another place called the transparency of the Government's funding arrangements? Does she agree that it makes it more urgent to ask whether the Government accept Recommendation 5 of the report of the Health Committee in another place? The report recommends that the Government should make sure: that there are no inhibitions on the ability of social services departments and health authorities to make a full assessment of unmet needs. It will be difficult to judge in future whether resources are adequate unless we have a clear indication of the level of need, both met and unmet". Do the Government accept that recommendation?

§ Baroness Cumberlege
My Lords, it is quite right and proper that assessments are made of individuals and that those assessments are shared with the individual concerned. That is laid down quite clearly in our guidance. However, asking social workers to produce a list of services that might be helpful without any thought for resources or priorities would be to ignore reality. Perhaps I may say to the noble Earl, Lord Russell, that the Health Committee also stated that the new funding arrangements provided the potential for a better and more efficient use of public money.

§ Baroness Faithfull
My Lords, perhaps I may ask the Minister, first, whether money from central Government to local government for community care has been ring-fenced? Secondly, will those projects which are now the responsibility of the local social services department but which are run by charities continue to receive the grant that they previously received from central Government now that those projects are non-statutory and the money is not stretching to them?

§ Baroness Cumberlege
My Lords, my noble friend is correct in her assumption that the money is ring-fenced—£565 million to local authorities. That includes an additional £140 million above the amount which the Department of Social Security would have spent had current arrangements continued.
With regard to charities, it is up to local authorities to decide which local charities they wish to support, but of course the Government support national charities under Section 64 funding.

§ Lord Molloy
My Lords, is the noble Baroness aware that the six main points of the Government's proposals appear to be most laudable, and are well overdue? They involve elderly people, the disabled and those suffering from drugs and AIDS. However, will the Government make sure that local authority assessment is fair and just? Will help also be given to 722 aged people who are in private nursing homes whose relatives are sometimes hard-pressed to afford the payment? Will some help be given in that area too?

§ Baroness Cumberlege
My Lords, I thank the noble Lord for his initial comments. Local authorities will take particular care with people who are in private and residential care. I forgot the noble Lord's second question.

§ Lord Molloy
My Lords, I referred to people in private homes and those unfortunate people who suffer from drug-taking and matters of that description. Some of those who contribute to payment for people in private nursing homes can no longer afford to do so. Perhaps the Government will take note of that situation.

§ Baroness Cumberlege
My Lords, I think that I answered that point.

§ The Countess of Mar
My Lords, is the noble Baroness aware of the considerable anxiety among the medical profession that the vulnerable, elderly, sick and disabled are at the mercy of the whim of a lottery, virtually, because some local authorities have more money available than others? Is it not now the time and place to publish a charter in which the basic needs which can be assumed for all local authorities are published? If that is so then those who have extra money or who are prepared to contribute extra money can provide the frills.

§ Baroness Cumberlege
My Lords, the money is ring-fenced. It is a considerable sum of money; it is new money to social services—£565 million. The calculations were based on the social security moneys which would have been spent in the next year, taking into account the anticipated increase in elderly people needing residential or nursing home care.
A further 30,000 additional cases were added, twice the number needed to keep pace with demography and people discharged from long stay hospitals. In addition, my right honourable friend the Secretary of State, in her negotiations with the Treasury, secured another £140 million.

§ Baroness Carnegy of Lour
My Lords, while accepting that these are serious and important questions, does my noble friend agree that the scope for meeting needs for care is endless? Therefore, by definition, there will never be enough money for community care.

§ Baroness Cumberlege
My Lords, my noble friend is correct in saying that the money will, of course, be tight. We brought in the new assessment procedure because we believe that local people will have a better idea of what is needed in their local areas. That assessment will be sensitive. Whereas before there was an incentive for people to go into residential care, the new scheme is intended to help people to stay at home, where the vast majority want to be.

§ Baroness Robson of Kiddington
My Lords, in view of the uncertainty over the true costs of implementing community care on 1st April, are the Government 723 prepared to set up a contingency reserve as recommended in the House of Commons Select Committee report, paragraphs 88–91?

§ Baroness Cumberlege
My Lords, I think, as I have explained, that the amounts of money are enormous—they are huge. We anticipate them being enough. If we were to keep contingency sums, it would mean that perhaps some people would be denied care in the coming year. I think it is preferable that social services departments should have that money in order to make their assessments and in order to help people who are very much in need.

§ Lord Ashley of Stoke
My Lords, is the Minister aware that the rosy picture which she paints is not shared by the vast majority of organisations for disabled people? Is she aware that the Select Committee for Health in another place said that there would be a 20 per cent. underfunding, mainly in London and inner city areas? Is she also aware that the survey by the Association of Directors of Social Services said that no less than 87 per cent. of local authorities plan cuts in their provision? If that is true, it means that many disabled and elderly people will suffer very great hardship unless the Government think again.

§ Baroness Cumberlege
My Lords, this money, this special transitional grant, is not going to be cut. It is ring-fenced. And it is not capped.

§ Lord Skelmersdale
My Lords, irrespective of the detailed supplementary questions and answers that we have had on this Starred Question, may I ask my noble friend the Leader of the House whether Starred Questions are still intended to elicit information from the Government and whether he considers that this question falls into that category?

§ Lord Ennals
My Lords, apart from the underfunding to which my noble friend Lord Ashley referred, is the noble Baroness aware that her department is already slashing grants to excellent voluntary organisations, particularly the organisation Extend? It does wonderful work for elderly and disabled people and I have been its president for 15 years. The organisation was not just told that its grant would be reduced; it was told that for the first time in 15 years the grant would be cut altogether. Is that not totally irresponsible and unfair to noble voluntary organisations?

§ Baroness Cumberlege
My Lords, the total amount of money that the Government are giving in their grants to national organisations is not being cut. I think it is quite right, though, that the Government should sometimes re-order their priorities and make an assessment of the individual organisations to which they are giving. Very often, it is important to re-order that money in order to pump-prime new organisations that are trying to get off the ground.

§ Lord Carter
My Lords, is the Minister aware that there is still considerable confusion regarding the rights of the individual to receive community care and the duty of the local authority to provide that care? If, 724 after an appeal, an individual is assessed for community care and the local authority says that it lacks the resources to provide that care, what will happen?

§ Baroness Cumberlege
My Lords, it is absolutely right that social services departments, in doing those assessments, have to take into account the resources that are available. I am very optimistic on the subject. In my experience a little money goes a very long way in terms of supporting people in their own homes. I have spoken to a number of carers who have very small requirements. Sometimes I think that those working in the field—social workers—try to produce a list of services which is more of a wish list than the actuality of what is required.

§ Lord Mancroft
My Lords, is my noble friend aware that too often this is an issue not of funding but of control? Whereas local authorities will always spend up to their budget, regardless of what it is, many voluntary sector organisations spend with a great deal more care and skill, which up until the changes the Government had recognised. By giving all the money back to the local authorities, the Government are condoning a greater level of inefficient spending.

§ Baroness Cumberlege
My Lords, it is quite right that the responsibility for this should be with the social services departments. I agree, though, with my noble friend that voluntary organisations on the whole spend their money very well and very wisely. That is why the Government give them so much support.

§ Earl Russell
My Lords, does the noble Baroness accept Recommendation 11 of the Select Committee? If I may paraphrase it, the recommendation states: if it turns out that there is not enough money, will the Government please notice and do something about it?

§ Baroness Cumberlege
My Lords, I note the noble Earl's comments.