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to carers and their clients so that those clients may live within the community as long as they wish, while recognising the rights and needs of their families and of other informal carers.There must also be created a genuine partnership between clients, carers, the state, and the voluntary and private sectors. Finally, there must be provided a network of services giving carers and the individual client a package of support best suited to his or her needs.
Government inaction is not the only cause for concern, because continual pressures on and incentives to health authority managers to close down mental health facilities have had awful consequences. Thousands of mentally ill people are discharged from hospital without alternative care arrangements being made for them. The past 10 years have seen the loss of 40,000 beds. Some of those people have been made homeless and are wandering the streets, while others find themselves under the jurisdiction of the courts and prison services. Many others are in bed-and-breakfast accommodation without any support from the medical or social arms of the public services. The neglect of the mentally ill is an appalling indictment for a country that claims to be civilised and increasingly prosperous. At what cost is our new-found affluence? Any community care legislation should embody Griffiths's statement :
"No person should be discharged without a clear package of care being devised and without being the responsibility of a named care worker."
Mr. Simon Hughes (Southwark and Bermondsey) : Does my hon. Friend accept that in the inner cities--which are meant to be the focus of Government policy, investment and attention--there is increasing pressure on right hon. and hon. Members in all parts of the House because of the large number of patients discharged from long-stay mental hospitals into what is allegedly care in the community?
Mr. David Steel (Tweeddale, Ettrick and Lauderdale) : It is not only in the inner cities that that happens.
Mr. Hughes : My right hon. Friend says that it happens not only in the inner cities, but in general that is where former long-stay mental patients are being discharged into the community in enormous numbers. It is a community in which no care is provided upon their arrival, and in which acute problems of mental illness and sickness afflict not only the patients themselves but their families and the immediate community, with no prospect of any help being provided.
Mr. Fearn : That occurs not only in the inner cities but in every town and city and in rural areas. The Schizophrenia Fellowship's drop-out centre in Southport is overflowing, and the staff have no idea where to send people who have nowhere to stay at night. We must accept that individual clients and carers have some right to chose the care that suits them. It may be that short-term or long-term residential care is required. Therefore, it should always remain an option and should be available through private, voluntary and public provision.
Community care debates often place emphasis on the elderly. We are an aging nation. We are also a nation that is not coping with the present needs of elderly people. How can we expect to cope in future unless those in authority recognise the problems and plan for them? Today, single
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elderly people and couples who can no longer fend for themselves, and some who are incontinent, unable to feed themselves or in need of non-urgent medical attention, receive very little support in the community because the social services are short of staff and resources due to Government cuts.Mr. Peter Thurnham (Bolton, North-East) : The hon. Gentleman mentioned Government cuts, and in his opening remarks he criticised the Government for failing to provide adequate resources. Will he cast his mind back to a document he wrote last July in which he called for annual increases of 2 per cent. in spending on the National Health Service and compare that with the Government's record of a 4.5 per cent. increase in real terms?
Mr. Fearn : I not only stand by my suggestion for a 2 per cent. increase in real terms, but stress that community care has received very little assistance. Health authorities are reluctant to take on elderly people in case they find themselves in a Catch-22 situation. Some hospitals will admit patients, but as soon as an assessment establishes that there is no medical need or that hospital treatment has been completed, the patient is discharged, regardless of the home situation and without continuity of care. The financial squeeze on health authorities has resulted in a reduction in the number of places in nursing homes they are willing to finance. The rigorous conditions of DSS regulations mean that one must impoverish oneself before any fees can be paid, and the recent ceiling on fees paid by the DSS, which makes no allowance for the wide variation in property prices, has made the availability of residential and nursing home care a matter of privilege, particularly in the south-east.
Mr. Matthew Taylor (Truro) : I represent an area where there are many residential nursing homes. Only recently I have received letters from the proprietors of those homes desperate about the increase in fees, and letters from residents desperate about the lack of an increase in their allowances. Those homes are becoming unable to continue to retain DSS claimants and they are being forced to make a choice between breaking even and continuing to care for those patients.
Mr. Fearn : My hon. Friend is quite right. In his constituency of Truro and certainly in other areas, nursing home proprietors fear that sooner or later the crunch will come and they will have to decide whether to discharge the people in their care. I know from their organisation that that is not what they want and that they will resist it for as long as possible.
Mr. Michael Jack (Fylde) : If things are so bad, why do so many organisations wish to start nursing homes and rest homes?
Mr. Alex Carlile (Montgomery) : It is the get-rich-quick syndrome.
Mr. Fearn : I do not believe that it is the get-rich-quick syndrome, as my hon. and learned Friend suggested, because I believe that there is a great deal of care in the nursing homes and associations. Such institutions require help. Voluntary organisations are also finding it extremely difficult to operate within the DSS ceilings, and in some cases that leads to desperate situations.
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Mr. Carlile : Does my hon. Friend agree that, although there are some splendid private nursing homes, by and large the best quality nursing home care is provided by local authorities which can provide the most flexible nursing home services? Does he agree that the way in which private nursing homes are changing hands for massive sums of money suggests that an element of the get-rich-quick syndrome is at work?
Mr. Fearn : I certainly agree with my hon. and learned Friend's first point about local authority nursing homes. I have visited many homes throughout the country and they are run extremely well. If we cannot look after our elderly people now, what of the future as the number of people over 75 and over 85 increases substantially, as does their rate of dependency? The Royal College of Nursing estimates that an extra 10,000 places in residential nursing homes would need to be created every year for the foreseeable future to cope with those demographic changes. That figure is calculated from an assumption that only 4 per cent. of the elderly population will require such care. That percentage is below that for other developed countries. Currently, between 21 and 22 per cent. of people over 75 suffer from various forms of dementia and require 24-hour nursing care. If that rate continues--there is no reason to suppose that it will not-- there will be 80,000 to 100,000 more dependent people by the year 2000. Who will plan for their care?
In a society which is increasingly mobile and transient, in which moving to another part of the country to retire is becoming the norm, it should not be left to local government or health authorities. It is, and will be, a national problem. A Ministry for community care which has strong links with local bodies should be responsible for overall strategy planning and development of care for the elderly. In the past few years there has been a programme of closures of hospitals for the mentally handicapped, and the resettlement of mentally handicapped persons into community-based services. The care of those people often requires high levels of staffing and specially trained staff. As those skills are not always readily available in the community, some transfers have been unsuccessful. There will always be a hard core of people in every category who require special, specific and highly skilled care. We must ensure that, whatever the arrangements for community care, they are flexible enough to maintain the quality of life of those people.
Much of the debate on community care is concerned with cost, but it is a sector that may never be truly costed simply because of its very nature and the different levels of care and support required and provided. It is also clear, as Griffiths states, that most people do not consider that an effective system of care in the community can be conducted on the cheap. Whichever way community services are organised, there is already an apparent need for more social service staff and an increase in training. If local government is to be the lead agency, which I very much doubt, given the Prime Minister's fear of allocating too much to local authorities, an intensive training and retraining programme may be necessary. If community care is to be truly effective, it must be given the resources to match its needs. The availability and quality of care services should bear no relation to the individual's ability to pay. The proposals that I hope the Government will introduce very soon will
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be scrutinised very thoroughly to ensure that there is not a two-tier system of community care, as is the case in the NHS review. It is evident that many people who are in need of care would not be receiving attention if it were not for the informal carers. The majority of carers are women. There are more married women staying at home in Britain today to look after elderly relatives than there are staying at home to look after children. Not all those in need of care are elderly and there are many informal carers looking after people who are mentally ill, mentally handicapped or disabled.The stress of the continual dependence is often made more difficult by the added financial pressures. Many of the informal carers are elderly and some have already spent years bringing up a family. Thousands are now at breaking point. As a society we are in danger of creating more difficulties and increasing the number who may become dependent unless we begin to look after our carers.
The act of caring must be a positive choice, for that immediately relieves some of the tension and stress. In all areas we must provide more day centres, day and night sitting services, short and long-term respite care, transport and other support services. Above all, it is time we recognised the value to the community that is provided by informal carers. To relieve some of the burden and widen the area from which carers may be drawn, the Social and Liberal Democrats would like to see the Government introduce a carers benefit. Community care is a complex issue and there are many subjects I have not covered, including the plight of the disabled. Some of their difficulties and some of the problems facing the elderly could be relieved by the full implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986. I call upon the Government to implement that Act in full. Also, without further delay, they should bring their proposals for community care to the Floor of the House so that they can be debated and acted upon. A year ago Sir Roy Griffiths said :
"doing nothing is not an option."
Since then the problems have increased and the longer the Government delay, the more desolation, distress and degradation will be suffered by those in need of our services.
Primary care is not altogether a distinct and separate subject from community care. After all, the general practitioner is situated within the community and is responsible for the quality of health care available to the community. The proposals contained in the White Paper and associated documents will be damaging to the quality of primary care services. I am not talking about self-governing hospitals of general practice budgets. I believe that those are non-starters and that they will have little take-up. The damage will be done by the central plank of the proposals, which is the introduction of competition in the belief that it will lead to improvements overnight. To achieve competition, doctors' pay is to be increasingly linked to the number of patients on their list. To sustain income, doctors will compete with each other for patients with supposedly improved services and publicity. Yet it is strikingly obvious that an increase in the number of patients will result in less time being spent with the individual. Time is needed to discover the underlying cause of disease.
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The practice of preventive medicine and health promotion at individual patient level requires time for consultation and discussion. There will be no time to visit schools, factories or other sectors of the community to spread the health promotion message. The increase in list size will make home visits increasingly scarce and, once again, those most in need, such as the elderly, will suffer most. Doctors in rural areas and in some inner cities will find it impossible to increase their list size. That will make practice work untenable or, at least, unattractive. Patients will face a reduction in services and in some areas the loss of any general practice medical service. That is a heavy price to pay merely to satisfy the Prime Minister and the supporters of the free market philosophy.The Government have acknowledged the problem in Scotland and introduced separate proposals to safeguard rural practices. Perhaps the Minister will use this opportunity to explain to those who live in sparsely populated areas in England and Wales how their services will be protected. He does not seem to think that the problem ever warranted a mention in his recent letter to most hon. Members, which was dated 14 April and which I received today. Dr. Farrow, the chairman of the rural practices committee of the general medical services committee, has described the proposals as a "devious blow" which will
"probably result in the rape of the rural practice."
That quotation can be found in the British Medical Journal which quoted his speech at the British Medical Association council on 1 March.
The proposals contained in "Promoting Better Health" and "Working for Patients" are unacceptable and, in their present form, will diminish services rather than develop them. The future of rural communities and services is at risk. The Minister must address those concerns positively.
Our anxieties about the quality and range of services are further exacerbated by other Government proposals. The set requirement to spend 20 hours in the surgery at first seems innocuous. However, it will cut down the amount of time that some doctors can spend visiting their patients and in the community. In rural areas, the distance between split-site surgeries, the travelling time required to visit patients and patients' transport difficulties are real problems that the Government have failed to address.
Mr. Matthew Taylor : There is a particular concern about the hours requirement for doctors who also work in hospitals. The main district hospital in my area is located in the middle of my constituency and many of the doctors are involved in hospital work. They are faced with either withdrawing their services from the hospital or being penalised for not meeting the hours they are required to serve in the surgery. That is an immediate and real dilemma. Perhaps the Minister will be able to respond to it.
Mr. Fearn : That is a good point, and I hope that the Minister will respond.
Also unworkable and damaging are the terms that apply to the proposals on prevention and immunisation. Leaving aside the issue whether those should be the subject of incentive payments, the Government have set targets that are ideally correct but unrealistic in practice for many doctors. Parents are often unwilling to have their children immunised and, in inner-city areas where the population is
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transient, none of the screening or immunisation targets is ever likely to be met. Many doctors will stop providing the service altogether rather than experience the hassle.Each practice has a very different mix of patients and problems and each health care provider should, working to certain standards, have the flexibility to provide the service best suited to the area. The rigid guidelines that the Government are attempting to impose will be harmful to the development of good practice.
Medical audit and peer group review is welcome in theory, but unless it is accompanied by the necessary level of funding and support it will be a non- starter. Unless doctors have the staff and computer back-up required, they will become medical bureaucrats and accountants, tied to their desks shuffling endless bits of paper while their waiting rooms overflow. Will the Minister tell us how the figure of £250,000 for medical audit announced in the White Paper was arrived at? Will it be reviewed in the light of representations that have been made about its inadequacy?
The Government's proposals take no account of the need to increase preventive medicine and ignore the costs of smoking, bad diet, alcohol abuse and poor housing. They do nothing for those most in need of help-- those with disabilities or handicaps, the elderly, the frail, the deprived, the isolated and the homeless.
The Government's failure to respond to the Griffiths report and their proposals in "Promoting Better Health" and "Working for Patients" highlight Ministers' complete lack of understanding and ignorance about health, personal social services and the needs of the people who use, and want to continue to use, primary care and community care services.
The next decade will see greater demands placed on medical and community services from an increasingly elderly population and by diseases such as AIDS. This year could have been the year in which the Government met the challenge and laid out their plans for the future. Instead there is silence on community care and cuts in primary care.
While the Government play political games with our health care services, millions of people will remain trapped in their homes in poverty, deprivation, illness and hardship. The Government neither see them or care for them. It will be left to a future Government to release them, and I hope that that will be sooner rather than later. 7.40 pm
The Minister of State, Department of Health (Mr. David Mellor) : I beg to move, to leave out from House' to the end of the Question and to add instead thereof :
expresses full support for the Government's policy of community care and for the proposals set out in the White Paper, Working for Patients ; commends the Government's record on the funding and development of primary health care and community care ; and believes that the White Paper, together with the Government's earlier White Paper, Promoting Better Health, will help family doctors to develop the services which they provide for their patients, strengthen the provision of primary care in general and complement the development of policies for community care, improve the quality of care for all patients, and ensure that all those concerned with delivering health care make the best use of resources available to them.'.
The debate, which I was glad to see on the Order Paper, should have provided the hon. Member for Southport
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(Mr. Fearn), given his background in local government, with an opportunity to make a thoughtful speech about the problems of community care. I am sorry that he did not take the opportunity to do so, but instead resorted to a melange of lowest-common-denominator party politics. He seemed to be reading large chunks of a British Medical Association brief. I do not expect high standards from Opposition Members, but is a Social and Liberal Democratic party health policy to be written by the BMA and parroted by its spokesman in the House without recognition of the opinions of people who are concerned about a consumerist Health Service and want it to have consistency of standards? We did not have an especially distinguished performance from the Social Democratic party yesterday, but at least there was admission of concepts such as internal markets, which are necessary for a developing Health Service.The hon. Member for Southport appeared to be nothing more than a mouthpiece for a trade union, which I always thought was the traditional role of the Labour party.
Mr. Robert Maclennan (Caithness and Sutherland) rose
Mr. Mellor : I shall give way in a moment.
I can at least say that I listened to all the speech of the hon. Member for Southport, which is more than can be said for the leader of the SLD, the right hon. Member for Yeovil (Mr. Ashdown). The right hon. Gentleman disappeared about two thirds of the way through his hon. Friend's speech. I do not know whether that was caused by the quality of the hon. Gentleman's speech, but no doubt we shall be told.
Mr. Mellor : Hon. Members who say that they represent a different sort of politics shout and jeer as though the hon. Member for Bolsover (Mr. Skinner) has been giving them lessons. It is perfectly legitimate to inquire--it is much more edifying than the words that tripped from the lips of the hon. Member for Southport--why the leader of the SLD felt compelled to leave halfway through his hon. Friend's speech.
Mr. Carlile rose --
Mr. Mellor : I shall give way in a moment.
There were some interesting deficiencies in the remarks of the hon. Member for Southport on community care. He spoke of it as though it was exclusively the preserve of other people. It is interesting that, as we run up to county council elections, not a word or sentence was wasted on the community care policies of the various Liberal county councils. It may be that when it comes to putting these great ideas into practice there is not much about which those who have held office for the SLD can boast.
I shall enjoy showing how the hon. Member for Southport was wrong about cuts. It was interesting to hear his remarks about cuts in primary care, because expenditure on it has increased by 50 per cent. in real terms.
Mr. Carlile : Will the hon. and learned Gentleman give way?
Mr. Mellor : The hon. and learned Member for Montgomery (Mr. Carlile) knows that I am halfway
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through a point. If he contains himself a little longer I shall give way, but if he wants me to carry on and prevent other hon. Members speaking I shall happily do so because that is the only effect of sedentary observations. If he allows me to go on, I shall give way in my own good time and allow him to make a substantive speech.If hon. Members want a sensible debate, they should start sensibly. I cannot allow talk of cuts in primary health care when expenditure on it has increased 50 per cent. in real terms over the past 10 years. The number of GPs has increased 20 per cent. ; the number of dentists has increased by almost 20 per cent. ; the number of GP support staff has increased by 50 per cent. ; and the number of practice nurses has almost doubled.
Expenditure on community care has increased sharply in real terms. There is much room for sensible discussion on the issue, which fitfully appeared in the speech of the hon. Member for Southport. The Government are working hard to consider the implications of the Griffiths report. It is not a matter for sneering, second-rate, lowest-common-denominator politics. The quality of care that we should be offering an increasingly aging population and who is best placed to provide it are serious issues.
There were one or two refreshing aspects in the speech made by the hon. Member for Southport. He acknowledged that, in considering the proper provider market, we should not, as do the official Opposition, consider only local authorities. We must consider the role of health authorities and the private and voluntary sectors. Interestingly, in the Janus-faced way in which the SLD deal with these matters, the hon. Gentleman's remarks seemed to stimulate a lively debate among his right hon. and hon. Friends. The hon. and learned Member for Montgomery appeared unable to agree about the quality of private nursing homes. The crucial factual background that provides the basis for sensible debate was again lacking.
The hon. Member for Truro (Mr. Taylor) would have us believe that private nursing is all doom and gloom. When we took office in 1979, the amount of social security paid to elderly people in private residential nursing homes was £10 million. By one of those massive cuts inflicted on the nation by this Government, we expect the amount paid this year to be £1 billion. That not only shows the Government's contribution to the care of the elderly but raises some difficult questions about the proper gatekeeper role.
The hon. Member for Southport--I could not help feeling that a good speech was trying to get out--raised a matter about which we are all concerned : what we do in the community through integrated care services to prevent elderly people from going into long-term residential care. I do not often meet elderly people whose ambition is to go into long-term residential care ; most of them wish to avoid it for as long as possible. It is sad that "it -says-here-BMA rhetoric", lowest-common-denominator politics and inaccurate party charges disfigured what could have been an interesting debate about an issue that will not go away and, sooner or later, will have to be considered in depth.
Mr. Matthew Taylor : The Minister has rather let his bile run away with him. He accused my hon. Friend the Member for Southport (Mr. Fearn) of parroting the views of the British Medical Association. Why has he felt reduced to writing to Conservative Back Benchers, asking
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them to ask members of the Conservative party throughout the country to write to their local media to parrot his views? Is it acceptable to parrot the views of the Minister, but not those of doctors who care for patients?Mr. Mellor : I do not think that we should have a one-sided debate and I believe that there will come a time when people think about these matters a little more rationally. The cynical exploitation of patients by the BMA's tendentious leaflet will seem shocking to people other than the Government. Each of us must determine what role we play in these debates. It is sad and regrettable that hon. Gentlemen from the Social and Liberal Democratic party seem to think that their policy on primary health care can be devised for them by the BMA. I would have thought that they would want to stand up for the patients and not just articulate the opinions of doctors. Mr. Tom Clarke (Monklands, West) rose--
Mr. Mellor : I shall not give way yet. Many of the doctors' opinions are based not on fact, but on tendentious assertions.
Mr. Clarke : May I gently remind the Minister that this debate is about community care? So that we are not unfair to him at a later stage, I ask him firmly to use this opportunity to give us the Government's views on the Griffiths report.
Mr. Mellor : I will not use this opportunity to give the Government's view on the Griffiths report. If the hon. Gentleman penetrates further into the motion, he will see that it deals with primary care as well as community care. The hon. Member for Southport said specifically that he was now turning to primary care, and I did him the service of turning to primary care a little earlier in my speech than he did in his.
I shall now turn to community care. The Griffiths report raises interesting issues. It raises the issue of how we deliver community care to an increasingly significant number of people requiring it. It requires difficult decisions to be made about the manner in which the provision is delivered, by whom it is delivered and whether distinctions are made between those who provide the services and those who provide the resources, as well as the framework in which the service is resourced and the quality tests that are put in place. To those of us who have to consider such matters seriously for implementation, they are difficult matters. For those outside, it can become merely a party game. Until the Government announce their decision, people ask where the decision is and jibe about why it has not come forward. The moment the decision comes forward, people shout the odds about what a terrible decision it is and ask why such a rushed hotch- potch has been inflicted on the public.
Mr. Maclennan rose--
Mr. Mellor : I shall give way in a minute. I am giving way too often and I do not want to be long.
We intend to bring forward our response to the Griffiths report as soon as the various Ministers have considered it. The hon. Member for Southport was at least accurate in saying that a committee was considering the response. We want to bring forward our response to the report as soon as our deliberations are complete.
I find it disappointing that the hon. Member for Southport, who was an experienced local councillor, could
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fall so readily for the idea that everything is suffering some sort of blight while awaiting the Griffiths report. Local authorities do not generally wait for the Government to make the decision. They generally--and rightly--assert that they have the powers to carry on doing the job. As we make clear, there is plenty of scope for the further development of community care. The more some local authorities project good community care, the more they can make us forget some of the glaring examples of the inner-London boroughs, which bring the idea of local authority social service departments into disrepute.The hon. Member for Southport said that there were no resources. He could not be wider of the mark. Between the financial year 1980-81 and the financial year 1988-89, expenditure on personal social services increased by 25 per cent. in real terms. Local authorities propose to spend £3.3 billion in 1988-89 on personal social services. We hear some feeble excuses for inaction, but £3.3 billion is a formidable sum if properly deployed.
It is interesting that, although the hon. Member for Southport spoke for almost half an hour, there was not a word of commendation for any step in community care taken by councils controlled by the Liberals, SLD or whatever we are meant to call them. That silence speaks volumes for the record of achievement that the voters will have the opportunity to consider. I give way to the hon. and learned Gentleman.
Mr. Alex Carlile : I am grateful to the Minister. Will the hon. and learned Gentleman tell the House what specific criticisms he is implying against Liberal-controlled or Liberal-led councils?
Mr. Mellor : I was simply pointing out that if it was as easy to transform the situation as is suggested-- [Interruption.] The hon. and learned Gentleman should not bandy charges around without carefully considering the opening speech. I can respond only to the debate to which I have been invited to reply. I would sooner have replied to a more substantial debate than the one on which we seem to have embarked.
Mr. Maclennan : The Minister is trying to treat the points made by my hon. Friends as peculiar party points, yet in the space of 15 minutes, he has not given us any idea of the Government's policy in this area. If we draw attention to the vacuity of the Government's case after 10 years of office and the formidable criticisms made of it by the doctors, we are not alone. The Minister should, at least in this debate, answer the trenchant criticisms of the Financial Times which, last week, devoted its second leader to drawing attention to the fact that the Government had nothing to say on community care.
Mr. Mellor : I am glad that the hon. Gentleman has recovered his vigour after his difficult period of leadership. I have already made it clear that in relation to community care, which is primarily a local authority responsibility, the increase in resourcing has been formidable. From the centre, a host of initiatives have been taken by the Government to improve quality and training. We have now embarked on a thorough look at the manner in which community care is delivered, which the Griffiths report stimulated and on which the Government will give their opinion in due course. It is a sign of the significance of this
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issue that the Government are taking time for consideration. The Opposition are trying to have it both ways. They criticise the fact that no decision has been reached, just as they will criticise the decision, whatever it is, when it is reached.I shall now deal with the area in which we have direct responsibility for primary care through the National Health Service. These have been years of conspicuous achievement, and I gave the hon. Member for Southport the figures. Never has there been greater expansion in primary care than under this Government. Never has more been achieved in broadening the base of the NHS and extending out into a range of necessary preventive services than in the 1980s. That was impossible in the years in which the hon. Member for Caithness and Sutherland (Mr. Maclennan) held ministerial office because of the slashing cuts that were made then in NHS provision, as is well known.
When we look at community care, we see a great increase in services throughout, which has been made possible by the increased economic strength of this country. Expenditure on health services for elderly people rose between 1980 and 1987 by 29 per cent., although the growth in the elderly population over that period was only 6.7 per cent. The number of elderly people treated by district nurses increased by 14 per cent., the number of meals on wheels by 11 per cent., the number of day centre places by 16 per cent. and the number of home helps by 28 per cent. This has been a time of growth. We now need to consider the manner in which those services are delivered, their efficiency and quality. I do not resent listening to the contributions of others on this important topic. We shall be glad if, having got rid of all the necessary party politics, we can settle down to have a debate that assists with the difficult issues of coming to terms with the Griffiths future.
It is clear that those who have been innovative in community care, as have several local authorities, can continue with that. We believe that the future of community care lies with the creation of, in effect, a level playing field which would allow all the various agencies to play their part and which would allow the voluntary and private sectors to play an increasing role.
All those decisions will soon be heard by the House when the Government announce their response to the Griffiths report--
Mr. Thurnham : My hon. and learned Friend has mentioned increased provision in the public sector. Does he agree that one difference between the Conservative and Labour parties is the much greater value that we place on the contribution made by voluntary groups? Is he aware of the excellent work done by the Crossroads care attendance scheme in over 130 areas? Will he provide Crossroads with support in other areas, including Bolton?
Mr. Mellor : What my hon. Friend has said about the voluntary sector is entirely right. As he well knows, we have made considerable use of our ability to grant-aid voluntary organisations, both larger ones with a traditional role such as the Red Cross, and smaller ones, such as Crossroads, that have recently come on the scene. It is clear that we now have a much more comprehensive approach to community care than was possible before. We can look forward to shaping with some confidence the framework within which that can be set in the future.
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I trust that the House will have no difficulty in rejecting the motion and I urge it, in due course, to vote for the Government amendment.8 pm
Mr. Tom Clarke (Monklands, West) : I congratulate the hon. Member for Southport (Mr. Fearn) and his colleagues on choosing the vital subject of community care for this debate. I also congratulate the hon. Gentleman on his comprehensive and informed speech, which clearly was not matched by the Minister's response.
If the Minister's comments are the extent of the Government's thinking on the Griffiths report and on community care, the rumours that we have been hearing about a statement being made fairly soon do not appear to be well based. The Minister gave the impression that he had hardly read the Griffiths report. He certainly gave the impression that he does not understand the immense problems of community care.
When the Minister says that the Opposition criticise the Government for not responding to Griffiths, he is right ; and when he says again that we may criticise the Government for their response when it comes, he is right again, because we have that right. What we cannot accept is that the Government will do nothing, if only because Sir Roy Griffiths himself said that to do nothing is simply not an option. Indeed, why should we do nothing?
The Government appear to take the view that when, after his intensive examination of the problems, Sir Roy suggested that there was a lead role for local government, he was inviting the Government to produce their prejudices because they do not accept that local government should have a major role. The Government ignore the problems that have been identified and which invite an immediate response.
We are led to believe that in this area, as in others, we should depend on market forces. Indeed, the Minister used the phrase, "the internal market". However, if market forces had been so productive and so appealing, there would not be 30,000 former psychiatric patients on the streets of New York, which has exactly that system, with all their problems unresolved.
The Minister and some of his hon. Friends who intervened referred to resources. I stress that we are entitled to complain bitterly about the unplanned growth in private residential homes, which has been unrelated to any real assessment. It is not as though we said, as a society, on the basis of consultation, that that was the best thing to do. It is not as though Lady Wagner, whose report has also been ignored, suggested that that was the best thing to do ; we have drifted towards it. No responsible Government can invest that amount of resources in private accommodation unchecked--the accommodation is not in any sense adequately inspected--and nobody should pretend that that this is the way towards making a major contribution to community care in the 1980s, and as we approach the 1990s.
Strangely, the Minister devoted most of his speech almost exclusively to the subject of primary care. I say "strangely" because all the evidence suggests that the Government's proposals for the National Health Service in their review will add to the problems rather than taking away from them. I am sorry that the Scottish Office is not represented on the Government Front Bench, but I make the point that our experience of the response of general
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