§ Mr. McCrindleasked the Secretary of State for Social Services (1) if the Government remain satisfied that care in the community for those needing special care and attention remains cost effective; and if he will make a statement;
(2) what is the latest estimate of the cost of caring for those with physical or behavioural difficulties and those who suffer mental handicap in the community; and if he will make a statement.
§ Mr. Kenneth ClarkeThe cost of providing community care depends on the particular needs of individuals and the range of services required to meet those needs. For people with a low level of dependency community care may well cost less than institutional care: for those of higher dependency, it may well cost more. The comparative cost will also depend upon local circumstances such as the services already available and the opportunities for development.
I do not think that in the present state of knowledge I could offer any useful generalisations about the cost of community care. The programme of pilot projects which we are centrally funding under the care in the community initiative should in due course provide useful insights into the cost of providing community care for people with a wide range of needs moving out of hospital into the community in a variety of situations.
We are not promoting community care as a cost-neutral policy. We expect health and local authorities to give priority to services, both hospital and community, for vulnerable people, such as mentally handicapped, mentally ill, elderly and disabled people. There has been a very significant increase on the level of spending on all services for these patients over the last six years.
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§ Mr. McCrindleasked the Secretary of State for Social Services if he will make a statement on the progress of the community care programme.
§ Mr. Kenneth ClarkeSome progress has been made in recent years in the development of community care. For example, over the last decade or so places for mentally handicapped people in local authority homes and hostels have more than doubled to reach over 14,000, and adult training centre places have increased by almost one third to 47,000. Places funded by local authorities in residential accomodation for mentally ill people have increased from about 3,000 to over 5,000. Day hospital places for mentally ill people more than doubled to over 15,000 and day centre places increased from about 5,000 to over 8,000. The number of psychiatric nurses working in the community has tripled to over 2,000 in the period. A study in 1981 showed that over 1,000 supported housing schemes for mentally ill and mentally handicapped people had been developed in the preceding 10 to 15 years, providing over 5,000 places. Many more people will have moved through these schemes into ordinary accommodation over the period.
Spending by local social services authorities has increased by over 20 per cent. in real terms since 1978–79. We have supported the development of community care by the injection of over £600 million of National Health Service funds through the joint finance arrangements up to and including this year's allocation.
Progress in developing community care will depend to a large extent on the further development of joint planning between health authorities, local authorities and voluntary organisations. We will continue to encourage health authorities to promote the care in the community initiative and to develop community care working with local authorities and voluntary bodies. The new social fund, proposed as part of the Government's reform of social security, will, among other things, help to promote community care.