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The Parliamentary Under-Secretary of State for Transport (Mr. Peter Bottomley) : One hundred years ago, William Morris, a Socialist Utopian, wrote these words :
"having said good night very amicably, took his way home by himself to a western suburb, using the means of travelling which civilisation has forced upon us like a habit. As he sat in that vapour-bath of hurried and discontented humanity, a carriage of the underground railway, he like others, stewed discontentedly".
The first thing that the comrade did when he woke up 115 years or more later was to cheer about the fact that the underground railway had been abolished. I am glad that the Labour party now supports it. It is important that we take London's transport opportunities--
Mr. Tony Banks (Newham North-West) : "News from Nowhere".
Mr. Bottomley : Yes, "News from Nowhere". I congratulate the hon. Gentleman. Instead of shouting out as if he were still on Capital radio, as he was earlier, it would be sensible if we tried to follow the hon. Member for Norwood (Mr. Fraser), who followed my hon. Friend the Member for Battersea (Mr. Bowis) in introducing this debate, on the serious sequence of movement in London.
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It is plain that transport in London is becoming more and more important and is becoming more popular among newspaper writers--I shall come back to Lynda Lee-Potter in a moment. If there had been a strategic planning authority in London in 1982 and if it had asked London's national newspapers, then congregated in Fleet street, what transport arrangements they wanted for their journalists and production staff to get to and from work and for delivering their newspapers, the answer would have been rail. In the past six years, however, every national newspaper has left Fleet street. Their staffs cannot use public transport and they are trying to drive to and from Wapping, the Isle of Dogs, Farringdon road and Barkers. They are now discovering that that is not possible. I welcome the fact that the newspapers are now facing up to the problems of London transport network, just as others have already done.I am grateful to my hon. Friend the Member for Battersea for the broad and serious way in which he introduced the debate. It is now common ground that movement in and out of London must take place predominantly by rail. My hon. Friend drew attention to the safety record of the railways.
The hon. Member for West Bromwich, East (Mr. Snape) asked about the terms of reference of the inquiry into the disaster at Clapham. The aim of the inquiry, as my right hon. Friend has said, is to establish the facts and to ensure that it never happens again. The terms of reference are similar to those for the Fennell inquiry and should be wide enough to cover all the relevant matters. If there is any addition to them, I shall write to the hon. Gentleman or make sure that his questions are followed up.
I am glad that the hon. Member for Newham, North-West (Mr. Banks) is present because what he said was very unfair. He knows perfectly well that the Parker report--I am grateful to him for lending me the booklet so that I can emphasise my point--said :
"The purpose of this discussion paper is to test public reaction and to establish the views of relevant authorities before deciding whether to undertake additional work."
I understand that the cross-rail study is being considered as part of the central London rail study.
Mr. Spearing rose --
Mr. Bottomley : No, I have only about four minutes to answer a long debate.
The point about safety is that 5,200 people a year die on our roads. The more movement we can transfer to the railways, while maintaining the safety on the Underground and overground, the better. [ Hon. Members :-- "Hear, hear."] The Labour party cheers, but that should not be a matter of dispute. If Labour Members are cheering because they believe that radial commuting, which needs to rely on the railways, is a new or controversial idea to be mooted by either side of the House, they have not listened to our debates.
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If the hon. Member for Islington, North (Mr. Corbyn) uses the word "motorway" as part of the assessment studies that are not purely road assessment studies, he is deliberately using a word that has been cast out by the Government. His only purpose in doing so must be to mislead, and I hope that he will not do it again. It probably was not intentional, but the word "motorway" does not work with the assessment studies. If the hon. Gentleman stopped chirping that word, his constituents would learn more from him and me.It is clear from the stage 1 reports that the Londoner's needs are taken into account. As hon. Members have said, perhaps it would be a good idea if we had more lanes going out of London than coming in. It is also important to recognise what was said about the rail links to the Channel tunnel and the rest of Europe. I was asked if I would oppose any new railway line going into a tunnel in my constituency. I said that I would not, and that it was impossible to work for railways and then to say that those lines should not come into London. As the hon. Member for Norwood has said, we must be bold and, although trying to ensure that the right choice is made and the compensation is correct, we must openly state that it is necessary at times to build railways and that that is not always convenient. We will not get extra movement on the railways in Europe or in Britain without paying a price for those lines.
My hon. Friend the Member for Battersea has spoken of the renewed use of the west London line. I have looked at some of the nice Christmas cards from Parkland walk, which says that it is opposed to road and rail schemes. But we must be prepared to accept that railways will cause some discomfort to people along the lines. We lead the world, certainly Europe, in road safety and we lead the world in the provision for the disabled, but there is more to be done. Let us remember our Airbus service, Taxicard, dial-a- ride and the availability of wheelchairs in our taxis--not to mention our minibuses.
I say to all in the Labour party : they should contact their friends in Europe to get across the point about the minibus driver licensing regulations--how a minor adaptation to move from an additional test to an assurance of safety, perhaps asking people to wait two years before they drive a minibus, will enable us to protect the 85,000 minibuses in this country, 11,000 of which have wheelchair adaptations on the back. Another 40,000 or so are used for the elderly, for children, for scout and Church groups and for common interest groups such as students. Then we shall be likely to preserve safe transport on the roads.
We want to protect safety on the roads, on the Underground and on the railways. We want to improve safety on the roads and to ensure that London prospers with greater movement, as well as environmental relief and road casualty reduction.
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Community Care
11.30 pm
Ms. Dawn Primarolo (Bristol, South) : This debate is about community care. Although the Government have continually promised reports and proposals on this subject, because of problems with the policy towards it, there were no proposals in the Queen's Speech to legislate on the problems in the community care scheme, despite the publication of the Griffiths report earlier this year.
I want to record some of the criticisms of the scheme made by some of the carers and organisations involved in the problems faced by people. I also want to discuss the Griffiths report's proposals and the fundamental problems of the community care scheme.
The Audit Commission review, published in December 1986, laid out the principles of community care, with which we would not disagree. It went on to describe the policies of successive Governments--but what has actually happened has been quite different. The Audit Commission made a series of proposals. The first concerned short-term funding to avoid the long-term waste of two systems that work inadequately and struggle to survive in parallel. The second related to how the social security system links with the community care policy. The review was concerned to ensure that there were no "perverse incentives" involved in encouraging residential, rather than community, care or provision for people to make a profit--I add, out of someone else's need. Thirdly, the Audit Commission recommended a more rational organisational structure for community care policy. I want to deal with the transition from long-stay hospitals of mentally or physically handicapped people, and with those who have remained in the community with their families. What services are provided for them?
In July 1987, I received representations from the Avon group of societies for the mentally handicapped. It expressed its worry about the development of a two-tier system of caring for people in the community. I contacted my county council, which explained--this seems to be a common pattern across the country--that the policy and plans are quite well developed for services for people who are leaving hospital. Finance is not always available, but the employment plans are beginning to be put in place. It went on to say that there is no Government money to provide comparable services for people who have always lived in the community. That includes the cost of respite care, residential care and day provision which runs into many millions of pounds.
In my constituency surgeries--many others will have experienced this--it is especially distressing to hear the stories of women, who tend to be the carers in our society, explaining the difficulties with their children who have reached the age of 19. There is no provision for their care in the community. The Down's Syndrome Association stressed that point. It said that the money available is directed to the transfer of patients from long- term hospitals and to speeding the closure of such hospitals. Yet 52 per cent. of the mentally handicapped already live at home in the community, and not enough services are being provided for them.
I do not say that people should stay in long-term hospitals. But if we are to have a community care policy, it must be exactly that. The Avon Mental Handicap Action Group wrote to me saying that the closure of
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long-stay hospitals was going well, but that the same could not be said of the integration of the former patients into the community. That was not to say that the community had rejected those people, but that the intensive support, care and encouragement which they need is not being provided.Another letter from the Down's Syndrome Association said : "More and more parents are discovering that there is nothing at all on offer for their mentally handicapped sons and daughters as they leave school, and no adequate respite-care to make life endurable. Also as the subnormality hospitals close, there is no long-term care to replace it for the severely handicapped already living at home. Such a crisis-orientated service adds to the already intolerable burden that these parents have to bear. The most severely handicapped and multiply handicapped people are the worst-served. As they grow into large adults, their parents are becoming older and less able to cope."
Many families who are incredibly devoted to their members must put up with inadequate services which lead to frustration, demoralisation and--in some people's lives--panic and fear about what will happen to their children.
The National Schizophrenia Fellowship was so worried that earlier this year it launched a nationwide campaign, making the point that the transfer of people into the community without sufficient support services was causing greater pain, more anguish, more suicides, more sick people, more people ending up in prison and more people sleeping rough on the streets.
I received a letter from a parent making representations on behalf of her 14-year-old son, who suffers from Down's syndrome. She said : "In March this year a group of parents of mentally handicapped young adults formed the Avon Mental Handicap Action Group. We are extremely worried about our adult' children's future. Avon County Council is in a desperate situation-- we are told by all three parties"--
Avon county council is run by a Tory-SLD administration "that there are no resources to provide the residential and respite care so desperately needed for mentally handicapped adults living in the community and no resources to provide the extra day-care facilities".
The distress that this situation is causing aged parents who are still caring for their children is beyond belief. That mother, as a younger parent, believes that her child has a right to a life of his own and she can see no hope for enriching his life in the future if those facilities are not provided.
After reviewing the services available, the Bristol community health council concluded in its 1987 annual report that, although it strongly supported--as I and the Labour party do--the principles that underpin community care, sadly, the reality is very different. I want to remind the House that 3.25 million women in Britain are unpaid carers. A carer is someone who looks after a friend or relative who has a physical or mental disability or is ill or impaired by infirmity. Most carers are women. Without their help, the health and social services simply could not cope, but what about the health needs of the carers themselves? Caring can sometimes be a lifelong responsibility and can take a tremendous toll of the carer's life. Carers are six times more likely to suffer a breakdown in mental health and many carers are themselves elderly with failing health. To leave them struggling in the community is simply unforgivable.
Shelter compiled an extensive report on Bristol outlining the problems that people who are discharged
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from hospital face in trying to find housing in the city. The problem cannot be shrugged off by saying that it is the fault of an inadequate housing authority. There is already a serious housing problem in Bristol and those people, who may have been in hospital for a long time, are tossed out into the world and are not receiving the support that they need.Let me quote two cases. The first is a couple who are both ex-patients from a mental hospital and have been brought out into the community. Their income dropped substantially as a result of the housing benefit changes and they find it difficult to cope financially even at the best of times--who does not find it difficult on social security?--but they now find themselves living in fear of building up debts.
Another couple said to me :
"We find it very difficult to manage our money having spent a lot of our lives in hospital. We have just about managed to pay off all our bills until this year and we simply do not know how we shall cope."
The income of another ex-patient, who lives in a house as a lodger, dropped from £49 a week to £41.70 a week as a result of housing benefit changes. He should pay £40 a week for board and lodging, but his landlady, out of the goodness of her heart, gave him back pocket money to help him get by. She has taken on the responsibility of a carer and is saving the state work, although such a demand should not be made of such a person.
Three people discharged from hospital in 1976 ran up enormous electricity bills in my constituency. I received details of the case from the Bristol Society of the Mentally Handicapped which pointed out how those people had been deserted by every agency simply because there was no clear line of responsibility as to who was the care manager.
In June, I wrote to the Under-Secretary of State asking him specific questions about proposals for improving care in the community. I was told that the Griffiths report had undertaken a review of community care policy and that when the proposals were available--they were actually published on 16 March--they would be considered jointly with the recommendations from the committee on residential care and proposals would be brought forward in due course.
How long is "due course"? We have had a Queen's Speech. Where are the proposals? The Griffiths report proposed that a Minister should be responsible for these matters. It also stressed the changes in the responsibilities of social services. It made recommendations about resources and about the role of the National Health Service. It recognised the carers, their unpaid role and their need to be supported. When all that information is available, why are there no proposals?
I have many criticisms of the Griffiths report. The philosophy behind community care was not properly investigated, and there are some errors. The balance between the public and private sectors must be examined. There is no place for the profit motive in the care and health of people in our community. That is not stated clearly in the Griffiths report.
People are being transferred from mental hospitals and long-stay hospitals without the necessary service developments in the area health authorities to support those people in the community. The whole emphasis of the strategy so far has been on the shift of responsibility from
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the National Health Service to local authorities. However, that strategy is cruelly undermined by the Government, who continue to batter local authority finance around the head so that the authorities do not have the money to make the necessary provision. The central problem is, who has the responsibility of the community care manager? That responsibility falls between two stools. For example, a constituent of mine was resident in a private residential home which closed because the owners decided that they did not want to run it any longer. My constituent was found a place in another residence and was transferred. However, none of his belongings were transferred and were left packed up in the other home. No arrangements were made to transfer his social security, so he had no money. His social worker was away on holiday. I am not decrying social workers for taking holidays and in this case I understand that the co-ordination failed.The problem in the private sector is that private sector residential provision comes and goes all the time. There are lots of reasons for that, but what happens to the residents in those circumstances? Who is responsible for ensuring that they are adequately provided for and transferred to new accommodation? We must also consider the training of staff in community care. There is no central personnel policy. We must not simply transfer people ; we must transfer the staff as well. As that has not been done, staff morale in hospitals has been undermined. Staff feel insecure and unhappy about their futures. There has been no central strategy about retraining or recognition of qualifications. The transfer of staff has been piecemeal and unco-ordinated in many respects. Managers are becoming reluctant to provide funds for building fabrics because they know that those buildings will not exist for long and there is also a real problem with the declining standards of care in long-term hospitals.
The Government have made no provision for those problems. They have done even worse : underpinning the whole community care policy is a social security system that is cruelly cutting people's income. Under that policy, the Government are automatically transferring people from hospitals to live in poverty on social security benefits without the support they need.
I conclude by quoting from "A better Life--A Charter for You to Sign and Support", produced by MIND. It sums up the state of the current community care policy admirably : "Mental health services in Britain are underfunded, inadequately staffed, dominated by huge, crumbling institutions, hamstrung by outmoded ideas with no consensus for the future. The state of decline which brings crisis to mental health care brings personal tragedy to many thousands of people with mental illness. Trapped in Victorian institutions, 40 to a ward, with no privacy, no choice, no power, and no way out. Or"--
the alternative as it exists now--
"living on the breadline in a dingy bedsit with no friends, no support, no job, and no home. The choice is stark."
That is not choice. We need to know when the Government will bring forward proposals for enhancing and supporting the community care policy. The tragedy is finding itself in the lives of hundreds of thousands of people all over the country. It is appalling that, while the Government claim to be targeting those in greatest need, they make no progress in community care.
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11.51 pmMr. Andrew Rowe (Mid-Kent) : The House owes a considerable debt to the hon. Member for Bristol, South (Ms. Primarolo) for raising this centrally important issue. I found myself sympathising with a number of her points, but she was less than charitable to a Government who have, among other things, overseen the largest single attempt to alleviate the extraordinary conditions suffered by the large number of people who have been institutionalised unnecessarily--and, by modernstandards, often wholly improperly--in hospitals for the mentally ill throughout the country.
It is often said in my constituency that the Government's programme of what is inelegantly called decanting the mentally handicapped from institutions into the community has been little thought through and leaves many of them uncared for. That may be the case in some authorities, but it is not in mine.
After one of the hospitals for the mentally handicapped in my constituency was half-emptied, it was thought that it would be nice if a number of its former patients, having lived in the community for some time, could return to visit friends remaining in the hospital. Thus, the former patients were gathered up from their foster homes, and so on, in the community and taken to their old hospital. When they arrived, only one of their number was prepared to leave the bus, because the others were terrified of being returned to what had in fact been an extremely well run, cheerful and hospitable institution. Nevertheless, so much did the former patients prefer being members of the community that they did not want to leave the bus.
Their attitude is something for which the Government can and should rightly take credit. However, I share the hon. Lady's anxiety that sometimes those who come with a dowry, as it were, from the National Health Service receive preferential treatment over the large number of others looked after at home by courageous people who are close to, or even beyond, breaking point, struggling with difficulties over which they have no control.
It is a complex issue, and I sympathise with the Government in not having yet made their proposals. However, I have less sympathy with them for having refused a formal debate on the Griffiths report before publication of the White Paper. I pressed for one but was rebuffed again and again. To me it is a sensible way of letting the House express its views before the White Paper is published. Nevertheless it is a complex issue, and I should like briefly to refer to one or two key issues within it.
The first is the question of choice. It is probable that scarcely a family in the country will, in the foreseeable future, have direct contact with at least one of its members who requires community care in one form or another. In that respect community care is unlike many other issues that we debate. Among that vast number is an increasing proportion who are accustomed to making choices because they have had the opportunity to do so all their lives.
I remember addressing a meeting of the British Association of Social Workers two years ago. The room divided neatly into two halves : one half vilified me for suggesting that people should be entitled to choose to go into private care if they wished, while the other half felt that it was a perfectly natural expression of the lifestyle that such people had enjoyed throughout their lives. I
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expect that if I addressed the same audience now the proportions would have changed dramatically, and that most social workers now accept that it is perfectly reasonable for someone who can afford it to choose private care.The fact remains, however, that either at the time of making their choice or soon afterwards, such people are extremely vulnerable. It is crucial that, whether they are in private or public care, they should be able to rely on standards being guaranteed. That means a common system of inspection of all kinds of residential and community provision, and I hope that the Government will bring forward clear proposals for a standardised system of inspection of community care, foster and residential homes.
I do not agree with the implication of the hon. Member for Bristol, South that private care is more haphazard, by its very nature, than public care. There are as many horror stories of haphazard and poor-quality care in the public as in the private sector. I strongly believe that part of the definition of choice is that it be informed choice. It is important for those in need of community care to have someone to speak for them if they feel uncertain or indeed incapable of speaking for themselves. I was proud to be one of the sponsors of the Disabled Persons (Services, Consultation and Representation) Act 1986, whose principal architect, the hon. Member for Monklands, West (Mr. Clarke), is sitting on the Opposition Front Bench tonight. I believe that the part of the Act that deals with advocacy is very important. I am not suggesting an army of people to second-guess the professionals. I am suggesting that those who are not able to speak for themselves are entitled to expect someone to speak for them who can be trusted to do it properly.
Then there is the question of prevention. One of the bizarre features--to use the words of the Audit Commission report, the "perverse incentives" which operate in the sphere of dependency--is the fact that for the lack of a couple of hours' respite care during a week people may be precipitated into enormously expensive and inappropriate care far earlier than they need be. I am sure that the Minister is aware of the large number of households in which carers are themselves in danger of breaking down completely. If they are allowed to break down through lack of respite, two people will be thrown into total dependency at colossal expense when a relatively small expenditure could have avoided it.
To return to a matter that I have raised here before and about which I feel passionately, may we please persuade those who design and build our houses to build in from the beginning a substantial proportion of those features that make it possible for people to remain independent for far longer than is possible today? It is absurd for builders to suggest that first-time buyers would be put off buying a house because the lintel on every door was 1 in wider than the lintel on standard doors or because there was a ramp instead of steps. A ramp is every bit as beneficial to the mother who has to cope with a push chair or the middle-aged woman who has to cope with a heavy shopping basket on wheels as it is to somebody in a wheelchair.
I understand that such items cost about £1,000 to install when a house is built but that they cost up to £20,000 if they have to be installed as adaptations. Consequently, those who need specially adapted homes are inevitably placed in a ghetto. No matter how humane the local
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authority or housing association may be, they become "ghettoised" and put together because that is the only way in which their needs can be met. That is an absurdity to which all of us ought to turn our attention.The key question, which was raised by the Griffiths report and the hon. Member for Bristol, South, is, who is responsible for the community care service as a whole? I believe that considerable advances have been made in many local authority social services departments, including the Kent social services department. Aided by some good district health authorities that have made it perfectly clear that they are not prepared to release patients until the social services department is willing to receive them, we are working out a partnership of which we can be proud. It seems to me perfectly sound to suggest that good local authority social services departments have been rightly nominated by Griffiths as those who should be responsible for community care.
If the Government believe that another body ought to be responsible for community care, it would be perfectly reasonable for hon. Members to debate that question, but I utter a word of warning. To a civil servant--I used to be one--sitting at a desk working out theoretical patterns of responsible administration, the idea of involving the family practitioner committee, because general practitioners have such an enormous part to play in the day -to-day care of many vulnerable people, seems to be enormously attractive, but I suggest that it may prove to be the ingredient that makes the responsibility for community care fall to pieces. Many general practitioners do not want to be directly responsible for the total care in the community of many vulnerable people. They do not believe that they have been trained for it and they do not necessarily feel that they are equipped to provide such care. The way in which they are remunerated means that, on the whole, there will always be an incentive to offload the most difficult and the most severely burdensome of their patients, for reasons that I fully understand and that are in no way deplorable.
There is a marked difference between the way in which medically trained personnel think about people's problems and the way in which people who have been trained as social workers think about people's problems.
Although I know that many general practitioners and hospital consultants will bite my head off for saying it, on the whole, medical care is more authoritative, and in many cases reinforces the sense that the patient is dependent upon the advice and authority of the doctor. Good social work makes a real attempt to preserve for as long as possible the equality of authority between the client and the social worker. That is a crude way of putting it, and I realise that it will read badly tomorrow, but we should be very wary of turning community care into too much of a medical model.
It is perfectly clear that, with their long history, their long training and their long habit of controlling the institutions and organisations in which they work, if members of the medical profession are given part of the responsibility it will not be long before they hold all the responsibility. I believe that they would be less willing to use social work techniques and rather too anxious to use nursing techniques, and that would not be to the long-term benefit of people needing community care.
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The issues are extremely difficult. They are issues of which I know my hon. and learned Friend the Minister is fully seized. There has seldom been a managerial report on such a sensitive subject that has been welcomed by such an enormous variety of professional organisations. In that welcome there is a clear message to the Government-- "For goodness' sake, let us make up our minds as soon as we can about how best to look after the most vulnerable people in the community." I believe that the programme which the Government have put into such courageous effect in so many parts of the country of unloading people from institutions into the community has called into being a wide variety of responses, many of which are of high quality and are functioning extremely well. More than anything else, the best examples which operate in Britain should be generalised as quickly as possible for the benefit of those vulnerable people.12.7 am
Mr. David Hinchliffe (Wakefield) : The Audit Commission's report in 1986 said that
"community care policy is in some disarray".
At that time that was an understatement, and the position has certainly worsened since 1986. The present shambles has been deliberately planned and constructed as part of the process of pushing Britain towards a private welfare system.
The crux of the matter is that, as my hon. Friend the Member for Bristol, South (Ms. Primarolo) pointed out, while local authority domiciliary care has been hammered by Government cuts, private residential care has been given open-ended public subsidy to the tune of £1 billion in the current year in income support to people in private care. That is the Association of Directors of Social Services figure, with which I am sure the Minister is familiar.
I wish to refer specifically to the care of the elderly about whom I am deeply concerned. Having worked in social work for more than 20 years, my general feeling as a social worker and as a politician on the local council was that institutional care for elderly people was the last resort, the final refuge or the final means of caring for an individual. Under the system introduced by the present Government, it is frequently the first port of call. The encouraging trend away from institutional care that has developed over many years has been completely reversed and the institution has been re-invented by the Government. The institutional care model offers the Government the easiest route towards the establishment of a free-market welfare system. So far, free marketeers have not really found a way of making domiciliary care pay. Care vouchers may enable that to come about. At present, the money is made in the residential sector.
The present system is geared towards pushing elderly people into residential care, whether they need it or not. A 60-year-old woman or 65- year-old man may retire and qualify for a pension but they may be as fit or fitter than many hon. Members in the Chamber. However, they could go to the Department of Social Security, having obtained admission to a private home, and ask for income support to cover the fees. I challenge the Minister to deny that the DSS may pay that money. It is in the interests of the institution's proprietors to have a fit person of 60 or 65 in their care because they can make more money by having independent people in their home.
I am concerned that that system exists. I can give as an example a neighbour of mine. A lady in her early 80s lived
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with her sister until her sister died. The family wanted to ensure that the house in which they were living was sold. The old lady, who could have coped on her own, was shunted off into private care 15 or 20 miles from where she had lived all her life. That is wrong. There was an incentive to put her into institutional care. She could have remained independent in the community. The system did not pay for the care she could have had in the home environment but paid to put her into an institution.I know of a recent case involving--I am sure that the woman will not mind me mentioning her name--a Mrs. Palmer. I served on the local council with her husband many moons ago. In her old age she became dependent on her family. Unfortunately, her only daughter lived in the midlands. She had to travel to Yorkshire virtually every weekend to care for her mother. They could not obtain any support from the system for the work involved in caring for her in the community. When she went into hospital she was told that she required permanent institutional care. The lady's daughter came to see me. She had struggled without the benefits that she should have had when she was helping her mother to be independent, but she found that once institutional care was mentioned the benefits flowed. Therefore, that woman can go into institutional care without any problem. The system works the wrong way round. There are huge inbuilt incentives to persuade individuals to give up their independence and move into institutions. The Government have attacked local authorities' ability to offer services geared to keeping elderly people in their own homes.
The Audit Commission said that the current system of redistribution of rate support grant acts as a deterrent to the expansion of community-based services. The current funding policies clearly discriminate in favour of private residential care at the expense of crucial areas of public domiciliary services.
The present system constitutes an irresponsible misuse of public resources. In the Wakefield district council area the number of people over 85 years of age will increase by 41 per cent. between 1981 and 1991. However, there will be no commensurate increase in the funding of the National Health Service or the social services to cover that huge change of demand on the local services. David Lane, the director of Wakefield social services, told me today that if Wakefield received its share of the £1 billion worth of subsidies being pumped into the private sector this year, it would have, by a simple division of population, an additional £6.6 million to keep people in the community and not shunt them into institutional care, frequently against their wishes.
The system results in an uneven and unfair distribution of public funds. About £20 million or £30 million is given to the east Sussex area to subsidise private residential care. It must be borne in mind that subsidies ease the housing and social services burdens of local authorities and reduce their expenditure. That £20 million or £30 million should be compared with the £2 million that Wakefield gains under this exercise. There is clearly a discrepancy in the way in which various amounts are pumped into local economies. There are also differences in the numbers of people in private care. Over a year ago, New Society stated that as many as seven times as many private nursing beds existed in the south- west as in the northern region. The most worrying aspect is what is happening to elderly people. Domiciliary care is not only a cheaper
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option but in most cases infinitely better for the individual. I know from my experience as a social worker that elderly people live longer when they are supported in their communities by friends and neighbours rather than being moved 20, 30 or 40 miles into a private institution.The system rewards those in the private sector who pursue the worst policies, have the largest institutions and use economies of scale by packing in more and more residents. I visited a home, which fortunately was threatened with closure, where there were seven people in one room, including somebody sleeping under the fireplace. The system rewards those who skimp on staffing and pay the lowest wages. In that regard, the private sector should be considered in detail. I know of a 17-year-old girl who is receiving £1 an hour but is left in complete charge of a private home, which is irresponsible. We must consider these facts when comparing the two sectors. I am not so ideologically blind as to say that there is no such thing as a good private residential home, but I agree with my hon. Friend the Member for Bristol, South that profit should not be made out of care. Small private homes offer good homely care, but are penalised by the funding system. As a matter of urgency, the Government must consider that problem.
Just as private health care ignores the chronically sick, the private care sector does not want to know those who are incontinent, confused or multiply handicapped. If those people get into a private home, they will rapidly find themselves being moved into local authority part III accommodation. I am aware of this only too well because over a year ago my mother ended up in local authority part III accommodation. I felt sorry for her and the staff because of the day-to-day problems that they faced. As a consequence of the development of private care, local authority part III accommodation is being used as a dumping ground for those who the private sector does not want to know.
The Government want to break the dominant position of local authorities on community care, which has been clear since they took office. In their first Budget they slashed 9 per cent. from personal social services at the same time as they started shunting money into private residential care. When they wanted to break the dominant position of local authorities, the Griffiths report came along and presented them with some difficulties. That is why the Government have difficulty in responding to what Griffiths said. That gentleman, who is a great friend of the Prime Minister and has done everything so well in the National Health Service and caused all the problems that many of us have to face at local level, has come up with a solution that simply is not acceptable to the Government. It means that local authorities have a fundamental role to play in the future monitoring and provision of care.
Local authorities now face many problems. They find it impossible to develop long-term plans when they are faced with the completely uncontrolled expansion of the private sector. They cannot plan for future services when they do not know how many private homes will be in the independent sector. The Government want the complete privatisation of social care. They want to see an end to the collective, public sector provision of social care.
Mr. Bob Cryer (Bradford, South) : Does my hon. Friend accept that a clique of Right-wing extremists are in control in Bradford? Bradford is being used as a test bed by the Tory central office. The Tory party--the law and
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order party--is in the process of selling 15 old people's homes. Although the decision is subject to judicial review and Mr. Speaker has said that we should approach a debate on the matter with caution, the Bradford Tories have shown no such respect for the law courts and have gone ahead and discussed the matter in detail in committees. That bears out my hon. Friend's point.Mr. Hinchliffe : My hon. Friend has made a valid point. Of all the things that have happened in Bradford, the most unacceptable, lowest point that has been reached by the new group in control is in respect of its proposals relating to the elderly. The Bradford Tories are not the first to make that proposal. Other Tory authorities have done so, but they have not gone as far as the Bradford Tories appear to be going.
The Government are actively encouraging an increasing number of large business concerns to move into the private sector. I hope that the Minister is listening, because I shall refer to an official of whom he is probably aware. An organisation called Premier Care was launched a couple of weeks ago. It is funded by--this is an example of the extent to which businesses get involved in private sector caring--Fulton Prebon Sterling Ltd., reputed to be the third largest money broking firm in the world. It is interesting that one of the directors is a Mr. Maurice Phillips, who, until earlier this year, was the deputy chief inspector of the DHSS's social services inspectorate.
The purpose of Premier Care is to set up a privatised system of registration and inspection. I cannot envisage someone who has been at such a senior level within the DHSS putting his money into a company such as that without knowing that the Government are thinking of having a privatised system not just of care but of registering, monitoring and inspecting. I should like to hear the Minister's response to that point. I can see him shuffling in his seat. I have probably spoken for too long, so I shall finish with one or two points.
I remind the Minister, who is new to his job, that about 20 years ago-- around the time when I started in welfare work--the Seebohm report addressed the problem of divided responsibility for policy, resources and co-ordination in social services, and came up with the existing provision of local authority service, the generic departments that we have grown to know and, some of us, to love. The Seebohm report said :
"The more fragmented the responsibility for the provision of personal social services, the more pronounced these problems become."
The Government have deliberately fragmented the provision of services for the elderly to pave the way for private welfare ; it is not accidental. In consequence, they are presiding over a scandalous misuse of huge amounts of public resources which could be directed to people who need to be supported in the community, rather than being used to support those who do not need to be in residential care. It all comes down to the fact that the Government are sacrificing the interests of elderly people on the altar of their free market ideology. It is a disgrace that there was nothing in the Queen's Speech on Griffiths or community care, and it is appalling that it has taken so long to produce any response. I want to hear some answers tonight.
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