Mental Handicap Services (Report) (Hansard, 29 July 1982)

§ Mr. Nicholas Edwards

I appointed this working party under the chairmanship of my Department last December. It comprised representatives of county and district councils, health authorities, professional advisory bodies, the voluntary sector and my Department. The working party's unanimous report was submitted to me earlier this month and I have today placed copies in the Library.

I am grateful to the working party for its despatch in producing such a comprehensive study of the needs of mentally handicapped people in Wales, and for its far-reaching but realistic proposals for the development, over the next 10 years, of community based services. I should like to record my special thanks to those who joined with my officials in the working party and to the many individuals who contributed so freely to its studies.

Substantial progress towards achievement of the working party's proposals would successfully transform the quality of life of mentally handicapped people and their families in Wales. I propose now to issue the report for public consultation and, as part of the process, to table it for discussion by the All-Wales Health Forum, the establishment of which I announced in the Welsh Grand Committee on 15 April 1981, c. 8.

I have considered carefully the crucial question of resources. The working party, in an evaluation of need, calculated that the requirement for completely comprehensive services throughout Wales might ultimately be of the order of £100 million per annum. It recognised that this figure, being based on potential needs, extensive public provision and substantial support of existing family efforts rather than forecast demand, and on the unit cost of existing patterns of service, should be regarded as an ultimate objective rather than as an immediate programme of action. I commend the working party's proposal that authorities should concentrate on development over the next ten years.

When I announced my proposals in Cardiff last November, I said: 646W I envisage that, once an agreed strategy has been formulated initially some £1 million of extra cash should be provided from Health Service resources on a recurring basis each year, beginning in the financial year 1983–84 for an initial period of five years, with a stock-taking after three years".

The strategy recommended by the working party would involve the commitment by my Department of a higher level of resources throughout the proposed 10-year period. Annual expenditure would build up to £8 million by the end of the first five years, and by a further £15 million per annum in the following five years, making in all £23 million per annum additional expenditure after 10 years.

This recurring expenditure would represent a more than fourfold increase in the present level of spending by social services authorities in Wales on services for mentally handicapped people. There is no doubt that resources on this scale would enable very substantial progress to be made throughout Wales as well as intensive development towards self-sufficient community services in two vanguard localities to test the viability of the new patterns, as recommended by the working party.

If the local authorities in their response to consultation endorse the broad thrust of the strategy proposed by the working party, and in particular the rapid development of services in chosen vanguard localities, I will undertake to see that the necessary resources to launch a 10-year programme of development on the lines recommended by the working party are provided. In making this commitment I have regard to the working party's words: In an environment where overall levels of public expenditure are severely constrained, extra money for services for mentally handicapped people can only be found at the expense of growth—or indeed, in some circumstances, of existing levels of provision—in other services. However, the need to improve services for this client group is such as fully to justify its being given this priority.

We have to face the fact that the services we wish to develop are not free. We can pay for them only by foregoing developments elsewhere in the Health Service. But it is right that mentally handicapped people should be given their chance and that the health authorities should look to greater efficiency to finance improvements in their acute services.

Resources must be looked at again as part of the formal review of the strategy which I propose should be undertaken after three years of development. Meanwhile close control of expenditure will be essential.

As I announced yesterday in a written answer to my hon. Friend the Member for Brecon and Radnor (Mr. Hooson), I propose to seek an early opportunity to introduce legislation which would enable me to grant-aid direct the development of community services by local authorities and voluntary organisations and I intend to use this power as the means by which to channel my Department's contribution to the development of community services for mentally handicapped people. Once the new services are substantially established, I propose to transfer the sums involved permanently to the local authorities through the rate support grant.

In accordance with the timetable I had in mind when I set up the working party, I hope that the first developments under the strategy will be launched in April 1983. While the consultation is going on, to the end of October, my Department will be in touch with the bodies which provide services, in order to work up proposals for these initial developments.

The success of this initiative will depend on the willingness of all those involved in the lives of mentally 647W handicapped people to work together towards the common aims of developing community care and promoting integration. The working party's unanimous report gives cause for confidence in our ability to do just this. I look forward to a positive response to the recommendations of the report and a firm declaration of a common resolve to translate its proposals into the reality of new services over the next 10 years.