Community Care (Hansard, 12 July 1989)

§ Mr. Peter Walker

The Government have laid the foundations in Wales over recent years for the effective development of community care for those who are not cared for appropriately in hospitals or residential care.

In the past, services for people with mental illness and mental handicaps have been imbalanced and poorly distributed across Wales. People have had to travel too far to receive care and the choice has too often been between care in isolated institutions, or of little or no support in people's own homes and communities.

The all-Wales mental handicap strategy has, over the past six years, made possible an unprecedented expansion of community services. For example, the number of people receiving support in their own homes has risen from just 41 in 1982–83 to 1,898 in 1987–88; the number of places in ordinary housing for adults from 66 to 614; the number of places in short-term care in domestic settings from 34 to 404; and the number of people receiving new community-based day-care services from 37 to 809. This has made possible a substantial reduction in the number inappropriately cared for in institutions, with a drop between 1983 and 1987 of almost 20 per cent. in the number of mental handicap hospital in-patients, and a fall of nearly 60 per cent. in the number of children in such hospitals. To build on this success, I have allocated £18,658 million towards the development of the new pattern of services in 1989–90, an increase of nearly £5 million over expenditure in 1988–89.

In June this year I published, following a highly successful public consultation, the all-Wales strategy for the development of mental illness services. This builds on the significant expansion of new patterns of services which has come about in recent years and which has been assisted by the recurrent additional investment of £13 million which the Welsh Office has made available. The strategy lays special emphasis on fully effective care and support for the most vulnerable, including those who require support in their own homes and communities after periods of care as hospital in-patients. I look forward to the joint plans from health and social services authorities and other agencies which the strategy calls for, and which will be the basis for development and investment by all concerned, including additional support from the Welsh Office, to secure the development throughout Wales of quality local services.

The greatest challenge in health and social care facing us in Wales, as elsewhere in the western world, is providing adequately for increasing numbers of very elderly people. Our massive investment in health care, including 560W community health services, with an increase in expenditure in real terms of almost 45 per cent. since 1978–79, has led to record levels of patient care from which the elderly in particular have benefited. There have also been significant developments in personal social services based on an increase in net expenditure in real terms since 1978–79 of 40 per cent. This has made possible, for example, a 65 per cent. increase in the provision of aids to people of 65 and over, and a 40 per cent. increase in the number of home helps. In addition, there has been an unprecedented expansion of sheltered housing; since 1984–85 more than 4,000 additional units have been provided by housing associations and local authorities.

To help health and social service authorities and other agencies to develop services further, in 1987 my Department launched an initiative on the care of the elderly. This aims to stimulate new developments by grant-aiding demonstration and innovative projects delivering services in a more flexible, co-ordinated and cost-effective way. Some 30 projects are now being funded for up to five years at a total cost of £6,261,000. We are appraising continuously the progress of the initiative and, in considering projects submitted next year, we will be placing more emphasis on encouraging the development of domiciliary care. My Department is undertaking surveys of services for disabled people provided by district health authorities, local authorities and voluntary organisations in Wales. Their needs will also be examined in the next round of health authorities' strategic planning. The results of those exercises will be available next year, but preliminary guidance for planning purposes will be issued shortly.

Last year I introduced a new grant scheme to support training for local authority staff and others who deal with child abuse. I have expanded the programme this year to provide grants totalling £483,000. I have also approved a new initiative to improve services to families with children under five. Under this, grant totalling up to £400,000 will be available to the voluntary sector over three years. I am considering carefully what might be done more generally to promote better child care and support for families.

These distinctive strategies and initiatives for Wales have been developed by taking advantage of my responsibility for a wide range of health and social services, housing and related programmes and the direct relationship between my Department and the key agencies. Nonetheless, those who need help with social care, over and above that which their families and friends provide, have had to look primarily to two separate sources: to the social services authorities for home care, day care and some residential care services, but to social security offices for payments towards the cost of places in private and voluntary residential care and nursing homes. In Wales, as elsewhere in the United Kingdom, this has led to a significant and unplanned expansion of residential and nursing home care which has not been subject to any assessment of individuals' need for such provision. This has not enabled the public agencies to secure the best packages of care for all individuals, although many have undoubtedly benefited from residential and nursing home care, and has worked against the generally accepted objective of securing, wherever appropriate, that people are supported in their own homes and communities.

The Government have been reviewing these arrangements following Sir Roy Griffiths's report "Community Care: Agenda for Action" which was published in March 561W 1988. My right hon. and learned Friend the Secretary of State for Health and my right hon. Friend the Secretary of State for Social Security have today announced the Government's conclusions. The main conclusions apply equally to Wales. In particular, I propose that in future there shall be a single budget for those seeking help from public funds for the cost of social care, whether in their own homes or in a residential or nursing home, which will enable decisions to be taken about the right package of care to meet an individual's particular needs at any point in time. The proposals will remove any perverse incentive for people to go into residential or nursing home care regardless of their needs.

The delivery of effective community care depends on close co-operation at all levels between personal social services and health authorities, family practitioner services, housing authorities and associations, and the voluntary and private sectors, and on all concerned having close regard to the views of those who benefit from services, including any informal carers. The experience of the existing strategies and initiatives in Wales shows that the right place for leadership in respect of the public funding of social care rests with the social services authorities. I propose, therefore, that they should have the responsibility and the budget for such care and other costs not met by the social security system. Community health and family practitioner services will continue to have responsibility and the budgets to ensure the provision of essential health care for those who need it.

In addition to the joint plans already required under the all-Wales mental illness and mental handicap strategies, I propose that social care plans for all groups should be produced by the social services authorities, in collaboration with other relevant agencies and interests. Detailed guidance on the arrangements for these plans will be issued in due course.

Local authorities are increasingly seeing the value of securing effective social care from whatever source can best provide it, rather than automatically providing it 562W directly themselves. There are good examples in Wales of the use of voluntary and private sector providers in this way. I shall expect local authorities to build on this experience. In this spirit, it is proposed that the local authorities should continue to meet the costs of people in their own residential homes, subject to their existing power to make charges according to residents' ability to pay. My right hon. Friend the Secretary of State for Social Security is not proposing any change to the benefit rules for the residents of such homes.

As in the rest of Great Britain, those already in registered residential and nursing home care before the new arrangements come into effect will remain eligible for financial help under the existing benefit arrangements.

With resources transferred from the social security programme, I shall make available additional resources to the local authorities commensurate with their new responsibilities. There will be detailed discussions with representatives of the local authorities and other key interests about the financial and wider implications of these proposals to ensure the successful introduction of the new arrangements, which I propose should take effect from April 1991.

The action which has already been taken in Wales to promote more effective community care has been widely commended. It has shown that it is possible for the Welsh Office, working in close co-operation with health and social services authorities and other agencies, to provide a favourable context for the provision of quality services which meet individual's needs in a sensitive way and which help and support, rather than undermine, informal networks of care provided by families and friends, which for most people will always constitute by far the greater part of the social care. The arrangements I have described in this statement will build on these achievements and enable all concerned to ensure that the people of Wales have every opportunity to preserve their independence for as long as possible as valued members of their communities.