Care in the Community (Hansard, 19 July 1989)

§ Mr. Needham

My right hon. and learned Friend the Secretary of State for Health last week announced the Government's conclusions on the recommendations in the Griffiths report. On the same day, my right hon. Friend the Secretary of State for Social Security announced corresponding changes in the benefit system. Full details of the new arrangements, as they will apply to Great Britain, will be published in a White Paper later this year.

The Griffiths report did not extend to Northern Ireland, where we already have an integrated administration structure for the health and personal social services. I have asked the health and social services boards in carrying out the current review of their management structures to ensure that their proposals meet the management needs of the personal social services as well as those of the health services, and facilitate the co-ordinated provision of health and social care. I have also kept in close touch with the Government's detailed consideration of the Griffiths recommendations, whose emphasis on the development of care in the community is very much in keeping with our own regional strategy for the health and personal social services.

In particular, we are already committed to enabling people who need care to stay in or return to their own homes and neighbourhoods and live there with as much dignity and independence as their disabilities allow. This means making available improved and better co-ordinated services in the community. It means ensuring that 185W members of the public have access to the information and objective professional advice they need to make sensible choices about the way they run their lives. It means ensuring that an extensive range of services is available, including support for the dedicated relatives, friends, neighbours and volunteers who will continue to provide so much care so unselfishly. And it means ensuring that public money is used as effectively and efficiently as possible to meet the needs of clients of the health and personal social services and their informal carers.

Substantial resources have been devoted in recent years to improving community care services in Northern Ireland. I will give some concrete examples of the progress that has been made between 1979–80 and 1986–87. Expenditure on community health services rose by 32 per cent. in real terms, and on personal social services by 29 per cent. Attendances by mentally ill people at day hospitals arose by 26 per cent. and at out-patient clinics by 40 per cent. Training centre places for mentally handicapped adults have almost doubled. Day care places for various groups rose by 28 per cent. The number of community psychiatric nurses more than trebled. In addition, Northern Ireland has shared in the rising national expenditure on social security benefits to support individuals in residential and nursing homes and other accommodation.

Earlier this month I announced an additional injection of resources amounting to £6 million over the next three years, to be used as bridging finance to support patients discharged from long-stay hospitals. This brought the total bridging funds available to health and social services boards over the five-year period from 1987 to £18 million, all of it specifically targeted towards enabling mentally ill and mentally handicapped people to move out of long-stay institutions and into the community. There remains much more to be done, and I am confident that our health and social services boards will rise to the challenge.

At present people who are unable to support themselves and need social care can look to two separate sources of help: to social security offices for payments towards the cost of places in residential and nursing homes and to health and social services boards for home care, day care and residential care services. This arrangement is not consistent with the priority which we wish to give to supporting people at home where that is otherwise possible and desirable. Social security payments for residential and nursing home care are not subject to any assessment of individual need for care.

The same changes to the social security system will be introduced in Northern Ireland as in the rest of the United Kingdom, and funds will be transferred on the same basis to the boards. In the longer term, they will become fully responsible for funding the care element of public support for people in private and voluntary residential and nursing homes and for ensuring that services are developed and funds allocated in accordance with their assessment of individuals' care needs.

As in Great Britain, residents of private or voluntary residential and nursing homes will from April 1991 be given access to help from the normal income support system and from housing benefit on a similar basis to the help they would receive in their own home.

Existing residents of private or voluntary homes who are already in receipt of income support or who may 186W become eligible for such support at any point after that date will continue to be covered by the present arrangements.

To derive maximum benefit from establishing boards as a unified source of public funding for community care, priority will be given to the development of assessment procedures so that services can be planned on the basis of full and accurate information about each individual's need and a better balance achieved between residential care and support for people living in their own homes. Close attention will be paid to devising arrangements which will provide members of the public with easily understood access to information about services and help suited to their individual needs. People who are thinking of entering a residential or nursing home, whether on a private basis or with public funding, are particularly likely to benefit from objective advice about any other options available to them.

Boards will continue to meet the full cost of accommodating people in statutory homes, subject to their existing powers to charge according to resident's ability to pay. There will be no change in the benefit rules applying to residents in these homes.

The new arrangements will clearly have expenditure implications for boards and my Department will take these into account when determining their financial allocations.

I will be giving careful consideration to the development of suitable planning and monitoring arrangements to allow me to assess the implementation of the new policy.

My Department issued a consultative document last November on the registration and inspection of private and voluntary residential and nursing homes, and is now considering the responses, totalling over 100, which have been received. Proposals for a Registered Homes Order will be brought forward later this year, to consolidate and update existing legislation.

In Northern Ireland, the current strategy for the health and personal social services is to reduce the number of occupied beds in mental illness and mental handicap hospitals rather than to promote a programme of hospital closures. The substantial bridging funds to which I have already referred are being allocated against specific schemes identified by the four boards to develop and expand community facilities and services in advance of patients being discharged from hospital. Discharges of long-stay patients, who will have the greatest adjustments to make to life in the community, are already the subject of careful planning. They take place only after the patients concerned have taken part in a programme of rehabilitation and proper services and facilities are in place to support them in the community. Earlier this year, my Department invited tenders for a monitoring and evaluation project which will track all long stay patients discharged into the community over a three-year period; evaluate the care they receive; and focus on their quality of life and that of their informal carers. A paper will be published in the autumn which will spell out in greater detail the implications of these changes for Northern Ireland, and explain how they will fit in with the new arrangements to be introduced on foot of the current review of boards' management structures.

I am confident that the Government's proposals, and in particular the establishment of a single source of funding for community care, will enable a higher priority than ever before to be given to the co-ordinated development of 187W services aimed at supporting people in their own homes, at providing more help for families and other informal carers and at developing the part played by voluntary and other interests in achieving these objectives.