§ Sir Fergus Montgomeryasked the Secretary of State for Social Services what progress has been made so far with regard to the care-in-the-community policy in-so-far as it concerns the mentally handicapped; and if he will make a statement on the short and long term financial implications of this policy.
§ Mrs. CurrieSubstantial progress has been made. The majority of mentally handicapped people continue to live with their families or independently, usually supported by local authority, health and voluntary services. The number of mentally handicapped people living in hospitals has been falling steadily for many years while numbers living elsewhere, including local authority and local authority sponsored accommodation, and small NHS units in the community, have risen. The provision of local authority day services has increased. Relevant figures are available530W in my Department's various publications on health and personal social services statistics, copies of which are available in the Library.
Estimated gross current expenditure on mental handicap in-patient services amounted to £461 million in 1984–85, an increase in real terms of around 13 per cent. over 1978–79, reflecting an increase in staff-patient ratio. Personal Social Services gross current expenditure (including joint finance) on residential and day care services for mentally handicapped people has also increased steadily in real terms and stood at some £241 million in 1984–85, an increase in real terms of around 54 per cent. over 1978–79. 1984–85 figures are provisional.
Community care is not a cheap option and is not intended to be. These figures illustrate both the improvements which have been achieved and the money invested in making them happen. Health authorities' strategic plans envisage continued growth in overall expenditure on mentally handicapped people. Social security costs will inevitably rise as normal benefits replace the personal allowances paid in hospital.
The provisional figure for personal social services provision in the rate support grant settlement for 1987–88 includes an extra £27 million for the development of community care generally. Decisions on priorities for local government spending are the responsibility of individual local authorities.
§ Sir Fergus Montgomeryasked the Secretary of State for Social Services what is his policy with regard to the degree of local authority involvement in care-in-the-community developments in so far as they affect the mentally handicapped; what financial provision he expects local authorities to make in the realisation of this project; and if he will make a statement.
§ Mrs. CurrieSocial services departments have been encouraged to play an increasingly important role with regard to care in the community developments. The long-standing policy is to develop a comprehensive range of co-ordinated health and social services for mentally handicapped people and their families, including assessment, day services and long-term and respite residential care in each locality, and to achieve a major shift from institutional care for mentally handicapped people to a range of community care provided by the statutory, voluntary and private sectors according to individual needs, with a corresponding shift of resources.
At the same time the continued run-down of large mental handicap hospitals will proceed, but specialised residential health provision, which may be in small units in the community, will continue to be needed for people with special medical or nursing needs, as well as specialist health support for those in other settings.
The business of recognising the changing needs of mentally handicapped people is a multi-disciplinary and multi-authority one. The balance between authorities may shift, from time to time and from individual to individual, but the basic point of contingent responsibilities remains. Authorities should listen to mentally handicapped people and their families and, as far as possible, offer them choices which are genuine and explicit.
The priority for mental handicap services has been emphasised in successive policy documents and regional review letters to Chairmen of Regional Health Authorities, available in the Library, and is explained with fuller 531W comment on policies in the Government's response to the report of the House of Commons Social Services Committee on Community Care (Cmnd. 9674).
Under the care in the community arrangements health authorities can transfer funds for as long as necessary to pay local authorities or, with the agreement of local authorities, voluntary organisations, for community care for people moving out of hospital. In addition, NHS joint finance enables health authorities and local authorities to launch jointly planned schemes for mentally handicapped people.
Priorities for increased spending by local authorities are for local decision but we would hope the additional provision for care in the community developments included in the 1987–88 Rate Support Grant Settlement and the potential availability of resources from NHS authorities will enable local authorities to continue to give priority to the development of community services for mentally handicapped people.