"Care in the Community" (Hansard, 12 July 1989)

§ Mr. Rifkind

The report by Sir Roy Griffiths on "Care in the Community" made far-reaching recommendations about the funding and delivery of community care services for the elderly, people with mental and physical disabilities and people with mental health problems. The report did not formally apply to Scotland, but I have been fully involved in the Government's detailed consideration of the report.

Our objectives for the development of community care in Scotland are the same as those set out in the statement made today by my right hon. and learned Friend the Secretary of State for Health. We wish to enable people to live as full and independent a life as is possible for them in the community for as long as they wish to do so.

I have given detailed consideration to the policy implications for Scotland and have had regard to the many comments and representations that I received about Sir Roy Griffith's report. My proposals are as follows.

I have decided that local authorities in Scotland should be responsible for meeting the contribution from public funds towards the cost of the care of people in private and voluntary residential care and in nursing homes. They will, in collaboration with health boards, assess the care needs of individuals applying for such support and will reach a view on whether residential care is required or whether, in view of the primary objective of sustaining people in their own homes, a better outcome is possible by devising suitable individual packages of care. In future, therefore, the special income support system for those in homes will be ended, and local authorities will be responsible for providing any help required towards the costs of residential care in the cases where they decide that a residential home would be appropriate.

Local authorities will 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. These new arrangements will apply from April 1991 to all new claimants for income support. Existing residents of registered residential care or nursing homes at this date will remain eligible for income support under the present rules.

My right hon. Friend the Secretary of State for Social Security is today announcing further details of these new arrangements.

Local authorities must have adequate resources for their new responsibilities. This will mean transferring to them an appropriate share of what the Government would otherwise have provided to support social security payments to people in residential and nursing home care. I shall be discussing the detailed financial implications with the Convention of Scottish Local Authorities and the necessary decisions will be taken in the public expenditure survey next year.

The new role of local authorities cannot be fully discharged without renewed emphasis on the importance of joint planning between local authorities and health 536W boards, with the full involvement of the private and voluntary sectors. The health and social needs of individuals with mental and physical disabilities are inseparable and the assessment procedures which local authorities will establish must reflect this fact. Joint planning is already an established feature of health and social work policy in Scotland and we look to local authorities, working with health boards and other agencies, to ensure that it is effective. The community health services will continue to play an essential part in meeting the medical and nursing needs of people outside hospital.

Local authorities have traditionally been the biggest single provider of residential and community services in Scotland. More recently there has been growth in both the private and voluntary sectors and local authorities will want to make full use of these facilities in the interests of widening consumer choice. Local authorities should increasingly see themselves not just as providers but as enablers making full use of the range of provision available in the private and voluntary sector.

Because of the importance of the new responsibility placed on local authorities I will be giving careful consideration to suitable planning and monitoring arrangements to allow the implementation of the new policy in Scotland to be evaluated. It will be important that local authorities should have clear plans for the development of community care services, worked out in collaboration with health boards and the independent sector. I will expect authorities to have such plans and propose to take powers to call for reports on community care services. The arrangements already in operation through the joint consultative group comprising representatives of the social work services group and the Convention of Scottish Local Authorities will continue to have an important part to play.

I have decided to make no change to the existing statutory functions of local authority and health boards for the registration and inspection of residential care and nursing homes.

I am considering carefully the question of improving liaison between general practitioners and social work departments to ensure that the latter are aware of patients' needs for social care. This could be achieved by informal day-to-day contact as well as more formal procedures. I will be discussing with local authorities, the representative medical bodies and health boards how this could be best achieved.

Finally, I propose to maintain the current arrangements which have generally worked well for sharing responsibility for services to the mentally ill between health and social work authorities, while improving further the arrangements for co-operation and co-ordination.

A White Paper will be published in the near future about the Government's overall proposals in response to the Griffiths report, including implications for community care in Scotland. It will contain more detail about legislative requirements, planning and monitoring systems and the basis of the new funding arrangements.