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Sir Geoffrey Pattie (Chertsey and Walton) : There was discussion earlier in the debate about the Griffiths report, about which I shall make some brief remarks. Sir Roy Griffiths, as the Prime Minister's health care adviser, has impeccable credentials. The problem has been that he has not come up with a convenient set of recommendations. It appears that the Government have taken longer to prepare their response than the Committee took to prepare the report in the first place.
Chapter 7 of the Griffiths report, paragraph 5, states : "There is a need for central government to make an early clear statement of the objectives and values underlining its community care policies, clarifying its view of the role of the public sector." The delay in responding to the report is profoundly unsatisfactory.
We could ask, "Does a delay matter?" It would not matter if there were no problem. We might then ask, "Is there a problem?" Everyone is agreed that certain aspects of the community care policy command widespread support, particularly the concept that health care can best be provided within the community--especially if that means that we can get away from the use of large mental hospitals which, all too often, are a legacy of the last century. It has always been recognised that a problem would arise if a mismatch occurred between the closure of mental hospitals and failure to provide adequate care for patients in the community. Unless community care is adequately in place before patients leave mental hospitals, adequate bridging finance must be made available. My
Column 419right hon. Friend the Member for Aylesbury (Mr. Raison), who made an excellent and cogent speech, used the term "bridging finance", which is the key to the current problem.
It is obvious from the evidence before our eyes that such a mismatch has occurred. Many people have been decanted out of mental hospitals and are now part of the so-called cardboard cities, which are an affront to any society that claims to be civilised. Market research on this need not be involved. Within a few hundred yards' walking distance--never mind driving distance--of the Palace of Westminster, one is likely to encounter such people. I am not suggesting that all those one encounters on these walks are former mental patients, but it is estimated that half of them are. Some people like the life on the road ; others have run away from home to try to find fame and fortune. However, if the usual estimate of 8,000 or 9,000 are sleeping rough in London tonight, about half that figure will be former mental patients. Therefore, a large number of people are clearly incapable of sustaining themselves in society without adequate support.
It is clear that voluntary groups are incapable of filling the gap. They carry out admirable work but cannot be expected to shoulder the entire load. Obviously, the Minister will hardly reveal the Government's response to the Griffiths report today, but it would be nice if he gave some sign of when that might come--other than the usual "soon"--or "in the spring". Sir Roy Griffiths reported on 12 February 1988, which was a long time ago. It would be constructive, and certainly helpful to me, if the Minister were prepared to recognise that the problem exists, and that people are living in such conditions, who are on the streets due to the inadequacy of the present system.
I imagine that, privately, the Minister must be unhappy about this aspect of what is otherwise an impressive health care system. Many of my hon. Friends have made reference in the debate to the large sums of extra money and additional facilities that have been provided. That is satisfactory and I support it. However, in this one matter, the evidence is there to be seen by all of us who are prepared, as it were, not to drive past on the other side. It shows that many of our fellow citizens face extreme difficulties tonight because the present policy is not working. What will the Government do about that? 9.17 pm
Mr. David Hinchliffe (Wakefield) : I hold no particular brief for the hon. Member for Stockport (Mr. Fearn) but, having listened to his opening speech, I feel that he deserved a more comprehensive response than he received from the Minister. Frankly, the Minister's response consisted of a series of insults and cheap jibes. Several Conservative Members have made serious points in the debate. I am sorry to have to make these remarks when the Minister has left the Chamber, but I was disappointed that he was not prepared to address the issues which have been raised by hon. Members from both sides of the Chamber.
The Minister's response to the opening speech made it clear that the Government do not have a policy on community care. In the brief time that I have tonight, I shall address myself to some of the implications of the Government's non-policy on this serious and worrying subject. If anyone needs convincing of the fact that the
Column 420Government's ideological blinkers have so often overridden any element of human concern, they need only look at community care. By allowing the policy on community care to be determined by the free movement of market forces, they have set back proper community care by decades.
It is important to consider in detail the consequences of a market-based policy of community care, because, if the Government have a community care policy, it is based on the movement of market forces. I shall pinpoint one or two matters relating to the private sector care of the elderly which worry my constituents, many hon. Members and me.
I listened to the observations of Conservative Members talking about the amount of money which has been put into community care by the Government. Huge amounts of public money are being mis-spent in the name of community care. There are people in institutions on income support who do not need to be there and would be far better cared for outside them, in their own communities, with proper community care.
The Minister mentioned the figure of £1 billion being spent on income support in the current financial year. That is the figure that was given by the Association of Directors of Social Services for the previous financial year. I suspect that it is a conservative estimate and that, if one attempted to find out what the figures were at local level, one would find that the DSS does not keep records of the amount of money paid in income support to private residential care. Therefore, we are talking about a guesstimate.
A year ago the Public Accounts Committee said that up to a quarter of income support claimants in residential care could have remained in their own homes if they had the proper community services and support. At least £250 million per annum is being spent on residential, institutional care for people who do not need it. That is the result of a free market policy in community care.
There is also a huge hidden cost to the public purse at local authority level. Problems arise time and again in local authorities' policing of private residential homes. The hidden cost is in the homes that have to be closed and the court cases which, according to the social work press, are happening virtually every week. There are disputes over deregistration and qualifications and conditions on registration. All that is costing public money.
In allowing such a free market policy to rule community care, the Government have developed enormous regional differences in the investment of public money. David Lane, the director of social services in my local authority, Wakefield, compared the amounts paid out in the south coast belt --Devon, Dorset, Hampshire and east and west Sussex--where the population is around 4.5 million and there are 26,000 beds in the private sector, with west and south Yorkshire, where the population is 3.25 million and there are fewer than 4,000 beds. Assuming that 50 per cent. of private beds are paid for through income support--a reasonable assumption--at an average cost of about £8,000 per annum, he calculated that the average authority in the south coast belt would have an annual income of £11.5 million per annum, while in west and south Yorkshire the amount would be £2.2 million. That is an enormous redistribution of public funding from the poorer areas to those with substantial resources.
We have also seen a huge distortion in the type of support services available to the elderly. It saddens me to say this. I entered social work, working with the elderly,
Column 421back in 1968, at a time when we were proud to boast that we were reducing institutional care and building small homes rather than huge, isolated institutions. Now we see the resurrection of care in such large institutions as society's central response to the needs of the dependent elderly.
I disagree profoundly with that policy. It is not in the interests of elderly people. The only people to gain from it have been the estate agents. It has given new life to rundown Victorian mansions, dilapidated country houses and struggling seaside bed-and-breakfast boarding houses and hotels, which are being used to care for people who, in many cases, have been shunted miles away from where they come from.
The larger the institution, moreover, the bigger the profits. I have asked parliamentary questions about the numbers of beds in such institutions, but I have not received answers because the figures are not kept. I can see with my own eyes, however, that large institutions are being used increasingly for the care of the elderly. They are once more being used as they were in the 1940s and 1950s and at the time of the Poor Laws.
Care Weekly, a social work journal which I read every week, reported on 7 April that Lodge Care plc, one of the increasing number of private companies involved in residential care, was selling off 12 of its 25 homes. The managing director, Graham Elliott, said that "it was the smaller homes which were least profitable and had to be disposed of".
I concede that there are some good, small private homes offering homely care : I have visited them. But those are the homes that are being disposed of, on the basis that they are the least profitable. There is, as yet, no profit to be made from preventive services. The profit-making sector--the market--has therefore moved into institutional care rather than preventing people from entering institutions. Strategies for care, having been left to the market by the Government, are now being determined by large business interests rather than by the needs of the elderly. Ladbrokes, for example, now owns about 1,000 residential and nursing care beds. Boddingtons brewery and the Vaux brewery group are also involved.
Does anyone honestly believe that those organisations are motivated by concern for what is in the best interests of dependent elderly people? Are they involved merely in acts of charity? Of course they are not. We all know that their involvement is based on hard-headed business decisions and profit motivation. They are diversifying into areas where they know that a quick killing can be made. Dependent elderly residents who have no one to stand up and vouch for them are the pawns in this increasingly big-business game.
The Government know that their community care policies are a shambles. That is why the Minister made no defence of them in response to the hon. Member for Southport. He did not even refer to issues raised by hon. Members on both sides of the House. My hon. Friend the Member for Monklands, West (Mr. Clarke) mentioned that the Audit Commission had said that community care was in disarray and that the Government were getting poor value for money, which I think is an understatement. The Government have been sitting on the Griffiths report for over a year. The report, in my view, is full of holes : its
Column 422vision of community care is very narrow, as my hon. Friend has made clear in a document produced by the Labour party. There have been many criticisms of it, but the important point is that it provides a basis for thought and debate on a matter that desperately needs both.
Urgent action is needed, rather than the complacency demonstrated by the Minister tonight. If I had more time, as I hope that I shall when we debate the Griffiths report, I should spell out what I think should be done. For the moment, however, let me make three brief points.
First, we need to reverse the present trend back to care in isolated institutions. Choice of care is a myth and a nonsense : the Minister conceded that. Of all the elderly people whom I have admitted to residential care in my time in social work, I cannot think of one who wanted to go into an institution. Sadly, however, the way in which the Government have allowed their policies to develop has resulted in that often being the only option. They have shunted investment into institutional care rather than into preventive community care.
In our debate before Christmas, the Minister virtually conceded his concern about the fact that any woman over 60 or man over 65 could obtain income support, fit as a fiddle, and then go into residential care. The system is nonsense. We must stop this open-ended income support for private care, and redirect public funding towards preventing institutionalisation rather than actively encouraging it. What could have been achieved in funding proper community care if the Government were not ideologically committed to the role of the free market? What could have been achieved with the amount of money that has been thrown into the explosion of private residential care? What could have been done with all that wasted money? The Public Accounts Committee suggests that £250 million is the sum spent on sending people to institutions who do not need to be there. What could have been done every year with that kind of money in providing proper community care, home helps, meals on wheels, support units, befriending services, day care, social clubs, community nursing, social support, sheltered housing, and numerous other elements of community care--all of which avoid the need for people to enter institutions and allow them to remain living in dignity in their own communities, surrounded by the people with whom they have lived all their lives?
Imagine what could have been done with that amount of money, had the Government not been tied to the vision of the free market and to the blind dogma that they apply to every area of their policy. To leave the care of vast numbers of the most vulnerable people in our society to the whims of the market, as the Government have done, is scandalous.
Mr. Michael Jack (Fylde) : I enjoyed the speech of the hon. Member for Wakefield (Mr. Hinchliffe) because it reminded me that we have something in common--we were both brought up in Yorkshire. The hon. Gentleman referred to the fact that there is a predisposition for elderly people to move to the south coast or to my own constituency of Fylde on the west coast of England. When I was selected to contest a seat in Lancashire, I apologised for the fact that I came from over the Pennines. However, one day I was told by one of my
Column 423supporters, "Don't worry that you come from Yorkshire. Half of Yorkshire is here already." Many people move to different parts of the country because that is where they want to retire and where they wish to be cared for.
The hon. Gentleman's narrow view of the source of care in the community must be criticised, because many of the people who have moved to the west coast of England are impressed by the diversity of care in the community, in both the public and the private sector, that is found there. The hon. Gentleman does not realise that a vast spectrum of resources is available to individuals. It ranges from income support, which the hon. Gentleman also criticised, to the provision of services to people who have adequate assets of their own--perhaps from the sale of their houses--and who currently benefit from the development of sheltered accommodation by the private sector and from the growing development of continuing care that is also to be found in the private sector. However, even those people, as they grow older, may require more institutionalised forms of community care.
The hon. Member for Wakefield criticised the Government's response to the Griffiths report. We would all like to see an early response, but it was not the act of a reluctant Government to ask Sir Roy Griffiths to concern himself with community care. His report opens with the statement :
"Mr. Norman Fowler asked me to take an overview of community care policy."
The Government asked for that to be done and, in the nicest sense, they knew what they were letting themselves in for--a report from somebody who would seek an answer, and an answer of accountability. The Government were aware of the contribution that Sir Roy had made to earlier reforms of the Health Service when they sought the application of his intellect to the problem of community care and his ideas.
Sir Roy produced a brief but enormously thought-provoking response that sought to answer the questions, as my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard) pointed out, of bringing together the enormous diversity of community care. I suggest that rather than calling it community care, we should talk about the development of a community of carers. By that I mean the bringing together of all agencies--private and public, voluntary and individual--that make up the concept of community care.
Our country's capacity to care is enormous, and the good will felt towards the elderly is considerable. However, some education remains to be provided in terms of attitudes towards those who are mentally ill, mentally handicapped, or both. If they are to be properly received in their communities as they arrive there from long-stay institutions, we must educate ourselves on the need to receive them positively into our number and to provide them with the necessary care.
When considering recommendations such as those in the Griffiths report, we must decide whether we are looking for a top-down solution or a bottom-up solution. A top-down solution involves the kind of national institution that we would perhaps want to monitor. My hon. Friend the Member for Norfolk, South-West spoke in great detail about the various models that could be used. I am interested in a solution that grows from within the community. My hon. Friend identified the multiplicity of sources of community care. The essence of community care is the flexible response to the needs of the community.
Column 424In my constituency there is one of the finest community hospitals. It is so good that I was recently asked, "Mr. Jack, why is this new hospital opening in your constituency? Is it not a private hospital?" I had to say that it was not. It is a new community hospital opened under the auspices of the National Heath Service. It provides day care facilities, and a broad range of other services for the elderly, including physiotherapy and special wards dedicated to the rehabilitation and training of elderly people to help them re-enter the community.
I visit that hospital regularly for personal reasons, as my mother is there, recovering, we hope, from a stroke. I look around the hospital and I see the quality of the care that is available. It occurred to me that it is an ideal centre to base community care and to set up a buying and enabling agency to cater for the needs of the community as identified by the social services, general practioners and the private sector in rest homes or nursing homes. A buying or enabling agency centred in that hospital could draw resources from the community to provide care for elderly people. It could be broadened to serve the interests of mentally ill and physically handicapped people to provide a broadly based community service. How do we adapt that on a national level? I am attracted by the suggestion in the White Paper for hospital trusts. By definition, trusts seem to encompass all those who care about a particular matter. We have identified a broad range of sources for community care, so let us imagine a national care trust in which the interests of the Government, the social services and the private sector could be represented and where funds for the various budget heads catering for the needs of the community and the care of the elderly and the mentally ill could be accumulated and redistributed according to need to different parts of the United Kingdom. It is for the communities to ascertain their present needs and try to identify their resource needs to continue and develop existing services.
Community care has been prevented from working, in the way referred to by all hon. Members who have spoken, by the friction between health authority services and the social services. There have been differences of opinion. I used to hear them when I sat on the Mersey regional health authority, where we found it difficult to overcome the frustration at the lack of progress towards the right provision. The Griffiths report give us the opportunity to seek a solution in which the wheels of the relationship between the different agencies can mesh and run more smoothly. The smoothness with which care in the community can be delivered will mean a great deal. I applaud the comments made abut the need to allow elderly people to stay in their own homes. I pay tribute to my constituent, Mr. Stephen Hay, who runs a private rest home and has developed a private care in the community programme. His wife, who is a trained SRN makes domiciliary visits and supplies a broad range of services to elderly people in their own homes. His service is already over-subscribed, but how much better and how much more caring a service could be supplied if my hon. and learned Friend the Minister of State would appeal to his ministerial colleagues in the Department of Social Security to free the shackles on income support and use that money more creatively. Such creativity would allow communities to respond to the many and diverse needs of the elderly and mentally ill patients.
Column 425There is much work to be done, but we have sufficient resources. My hon. and learned Friend referred to the money available through income support. Perhaps he did not have time to mention the £1 billion in attendance allowance. Such expenditure is not a sign that the Government do not care or are being mean with resources. It is a sign that the Government recognise the demographic issues and are trying to respond to them while creating a flexible response that will bring together the best of the private sector and the best of the public sector to provide care in the community. Sad to say, the problems of the mentally ill have not been referred to in the debate. I say sincerely to my hon. and learned Friend the Minister that the most difficult case with which I have had to deal since coming to the House involved the mother of a schizophrenic boy. She writes to me asking who will look after him when she dies. I have been to the district health authority, the regional health authority and even to my hon. and learned Friend's Department but all they say is, "tomorrow". That lady's tomorrow may come but she looks to me to provide an answer within the community for the problems of her son, Dennis. That is the challenge of mental illness and I feel certain that my hon. and learned Friend will respond to it.
Mr. Archy Kirkwood (Roxburgh and Berwickshire) : I have listened with interest to the discussion and I commend my hon. Friend the Member for Southport (Mr. Fearn) on the way in which he opened the debate. It is an important subject and that has been reflected in the speeches.
I listened with particular interest, as I always do, to the speech of the hon. Member for Monklands, West (Mr. Clarke). Interesting contributions were made by the right hon. Members for Aylesbury (Mr. Raison) and for Chertsey and Walton (Sir. G. Pattie). I should like to draw a line under the ministerial intervention in reply to my hon. Friend's opening speech by saying that we should leave past records behind us in the time remaining in the debate and look to the future. I recognise that a subject such as the provision of community care is difficult for the Government because it cuts across Government Departments. Also, I am not daft and I recognise that there are substantial funding implications if we are to get right the future provision of community care.
Having said that, and falling over backwards to be as amenable to the Government as I can, I must say that there is a blockage in the system. It is not right for the Minister to say that it does not matter if time passes while we get the provision right. It is wrong that two and a half years have passed since Sir Roy Griffiths was given his commission. It is a year since he produced his report, and people are suffering as a result of the delay. The lack of planning and the hiatus that has been created by the Government's unconscionable delay is not good enough. It is an indictment, and the speeches made by hon. Members, including Conservative Members, have shown that it is unacceptable.
The difficulties were well rehearsed two or three years ago, before Sir Roy Griffiths was given his commission, by the Select Committee on Social Services and by the Audit Commission. Hon. Members have referred to the points
Column 426made by those two bodies. I shall point out one or two of the important points that remain with us. The problem confronting the House is that community care is delivered by a vast array of organisations with different structures and different funding mechanisms. No one has overall responsibility for co-ordination. I had hoped that the debate would produce an indication of how the Government will resolve that confusion or, indeed, whether they intend to do so. That is the key question which has suffused all the arguments that have been deployed.
The funding mechanisms that the Government have been using--as I have said, there is a difficulty with different Departments being involved--have sent conflicting signals to the people responsible for the discharge and provision of the services. Health authorities have been cash limited, local authorities have been rate-capped and the DSS, particularly in relation to residential and nursing home provision, was demand-led and the provisions have been produced on a demand-led basis. The Minister is beating his chest and saying that the Government have increased expenditure from £10 million to £1 billion in that sector, but that was not planned. The Minister is making a virtue of something that took him and the Department by surprise. The Government must resolve the different funding mechanisms. That may be difficult, but they must grasp the nettle. Sir Roy Griffiths was asked to consider the geographical discrepancies between local authority and health board areas. It is extremely difficult to achieve coherent delivery of community care. The two-and-a-half-year delay has been quite unreasonable. Community care will inevitably become more important, given the increase in the number of elderly people and the demographic changes that will occur between now and the year 2000. The Government are also considering the OPCS report on disability, and I pay tribute to the work done by the hon. Member for Monklands, West on that. District health authorities have been closing hospitals and local authorities have been finding it increasingly difficult to train and obtain funds for social work departments.
Three clear messages came from the Griffiths report. First, Griffiths gave local authorities a clear vote of confidence on the way in which they currently discharge their duties and the way in which they will do so in the future. That may cause the Prime Minister and the Cabinet some ideological difficulties, but only a planning role would be involved. Griffiths was suggesting an essential co-ordinating role, so Conservative Members should not put about scare stories of local authorities being given tremendous extra powers, which the Government do not want. Griffiths's recommendation was broadly right, and if local authorities are not involved in co-ordination, another agency should be.
Secondly, the funding recommendation is fundamental. The idea of a community care grant paid for from a local authority's agreed overall plan is extremely attractive. A Minister for community care, whoever he or she may be, would have some input into agreeing such overall plans, so, again, the Government need not divest themselves of control of these important funding systems.
Thirdly, the delivery of tailored services to meet individual client needs is an important improvement that which the Government should embrace.
Column 427There are only three, or perhaps four, options open to the Government. They could fully implement the Griffiths report, but people would accept phasing if the Government made it clear that they accepted the broad tenet and thrust of the recommendations. Alternatively, they could opt for limited acceptance of the report and engage in consultation on the need for joint planning, setting up community care managers and funding for training and pump priming. We believe that that would be a second-best alternative which would result in a lack of overall planning and co-ordination, which, more than anything else, is needed.
I should be worried if the Government placed responsibility for community care with another body jointly funded by health authorities and local authorities. Perhaps more worrying are scare stories that the Government may be considering entirely privatising community care and handing it over lock, stock and barrel to the private sector. Mr. Mellor indicated dissent.
Mr. Kirkwood : I see the Minister shake his head. He seems to be ruling that out of court. If he is prepared to say that in his response to the debate, he would allay some of the fears that have been expressed to me recently.
The Minister must accept that there is overwhelming support for the Griffiths solution. If the Government set their face against the report, they will do so at their peril. They must bear in mind important issues such as the fact that there is no correct way of providing care in the community. It is right that there should be plurality of provision, diversity and local initiatives. The Griffiths report made a virtue of that and drew it to the fore of the argument when it said :
"The aim must be to provide structure and resources to support the initiatives the innovation and the commitment at local level and to allow them to flourish ; to encourage the success stories in one area to become the commonplace of achievement everywhere else. To prescribe from the centre will be to shrivel the varied pattern of local activity."
That is the essence of the Griffiths report.
I implore the Minister to give us some idea when we shall receive a statement about what is happening in the Cabinet committee carrying out the review. Is it going over all the ground again? Is it commissioning its own evidence? Will that evidence be published? There are a host of questions. This debate was designed to elicit the answers from the Government. I implore the Minister to use the short time available to him to try to open the doors of Whitehall on this important subject and to tell us what is going on.
Mr. Mellor : I spent last evening discussing the vexed question of AIDS with a group which included the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood), and he knows how much I agree with his insights on that matter. It is a pleasure to follow him in this debate. I am sorry that I cannot satisfy his curiosity on all his points, although I found his speech interesting and valuable. As the debate has progressed, it has proved possible for hon. Members of all parties to come to grips with the complexity of the issue. I assure the hon. Gentleman that there is no question of privatising community care, but the clear analysis given in the Griffiths report needs to be tested against certain other
Column 428competing possibilities. That is done purely in the context of provision within the public sector, while allowing proper access to provision made by the voluntary services and by private providers, which the hon. Member for Southport (Mr. Fearn), as he made clear in his opening speech, saw as a part of his party's policy.
I can assure the House that we do not want to take a moment longer than necessary in considering the report, and I hope that it will not be long before a full statement can be made. During the debate, there was no shortage of points on which we could all agree.
I am sorry that I missed the first half of the speech by the hon. Member for Wakefield (Mr. Hinchliffe). He was right to remind me of the debate we had before Christmas, when we shared some of the insights he mentioned. He mentioned factors that are very much at the heart of our consideration of the Griffiths report. But I am sorry that he felt compelled to say that we have no community care policy. We have a community care policy that meets the points that he emphasised ; hence the care we are taking in analysing the Griffiths report.
It is the key to our policy that people should be able to live their own lives for as long as possible and that we should respect people's independence, and work to protect it. It is our policy to ensure that it is only in the final analysis, when other community-based options are no longer viable, that people move into long-term residential care. That is why I am dissatisfied with the absence of a gatekeeper role. As those are our basic beliefs, there has to be a range of community services, from domestic assistance to home helps and nursing care, going on to residential care. We want to ensure that those services can be provided by a range of different providers but although, as my hon. Friend the Member for Norfolk, South-West (Mrs. Shephard) made clear, that is not an easy thing to achieve, we must achieve it and it is a priority for us to do so. The hon. and learned Member for Montgomery (Mr. Carlile) made his points with his customary vigour and clarity. I well understand why he and some other hon. Members representing rural areas are concerned about the contract and that nothing should be done to damage the expansion of rural practices, to which, as the hon. and learned Gentleman acknowledged, we have committed so many resources. Indeed, we have played a full part in revolutionising today's primary care, when compared with what it was when the hon. and learned Gentleman first became conscious of it. Rural doctors have nothing to fear from the changes that we propose. The various arrangements for the contract will make it easier, not more difficult, to take on practice nurses. Those are matters of hard practicality, not of principle and certainly not of dogma.
We are concerned to try to ensure that we achieve greater consistency in primary care not only by putting within the contract a basis for rewarding general practitioners for the efforts that they have made, but by creating incentives for them to do more. That is a practical business. I assure the hon. and learned Member for Montgomery that we are looking at the various points that have been raised, not only by Members of Parliament following the extensive discussions that we know are taking place with doctors, but also from our own discussions. I have been having at least one meeting and often two meetings with GPs every day for the past
Column 429fortnight, and I shall have another large one in the west country tomorrow. That is not being done as a public relations exercise. We are listening, and we are taking note.
The draft contract that my right hon. Friend the Secretary of State has submitted is not necessarily the last word. Attention has been drawn to the Scottish contract, which was issued following discussions here in England. We shall not hesitate to make changes to the contract if we are persuaded that the present arrangements do not achieve what we have set out to achieve. I hope that the hon. and learned Gentleman finds that helpful. I shall certainly take careful note of what he has said.
Mr. right hon. Friends the Members for Aylesbury (Mr. Raison) and for Chertsey and Walton (Sir G. Pattie) raised a question with which I chose not to deal in my opening speech in this short debate because, although ministerial contributions could expand endlessly, I wanted the opportunity to hear the anxieties of the House. I left out the important points about mental handicap. I accept that it is essential for us to justify not only the necessary policy of closing the large Victorian institutions for which nobody would want to make a strong case, but to emphasise that we have managed to build up in the community facilities which mean that people are not left to wander abroad, but have facilities in the community that enable them to lead, we hope, an altogether more satisfactory life.
It is worth noting that between 1976 and 1986--we must remember that there has been continuity of policy on this subject--the hospital population of people suffering from mental handicap fell by about 15, 000 places while the number of day care and residential places in the community rose by 50 per cent. over and above that to a total of 26, 000. Expenditure on services for mentally handicapped people increased by 62 per cent. over the period 1978-79 to 1986-87. We aim to ensure that no institution is closed if there is not the proper provision in the community to ensure that continuity of care is provided. I am well aware that hon. Members of all parties have expressed concern about whether that has been achieved in every instance. Indeed, we have under active consideration the question whether there needs to be some fine tuning of our policy in this respect. That matter is being considered, as well as the proposals of Griffiths, and I hope that we shall be able to announce our conclusions shortly.
Another question that I did not have time to deal with is that of carers. Of course, through the invalid care allowance, through our £10 million policy of innovation throughout the country, under the "Helping the Community to Care" banner, we are committed to assisting carers. These are all revolving policies, which I look forward to having future opportunities to debate in the House.
Question put, That the original words stand part of the Question :--
The House divided : Ayes 41, Noes 159.
Division No. 167] [10 pm
Ashdown, Rt Hon Paddy
Barnes, Harry (Derbyshire NE)
Barnes, Mrs Rosie (Greenwich)
Beith, A. J.
Bruce, Malcolm (Gordon)
Buckley, George J.
Column 430Carlile, Alex (Mont'g)
Clarke, Tom (Monklands W)
Ewing, Mrs Margaret (Moray)
Forsythe, Clifford (Antrim S)
Golding, Mrs Llin
Hughes, Simon (Southwark)
Johnston, Sir Russell
McKay, Allen (Barnsley West)
Mahon, Mrs Alice
Michie, Mrs Ray (Arg'l & Bute)
Pike, Peter L.
Powell, Ray (Ogmore)
Steel, Rt Hon David
Taylor, Matthew (Truro)
Wareing, Robert N.
Tellers for the Ayes :
Mr. James Wallace and
Mr. Archy Kirkwood.
Alison, Rt Hon Michael
Arnold, Jacques (Gravesham)
Arnold, Tom (Hazel Grove)
Baker, Nicholas (Dorset N)
Bennett, Nicholas (Pembroke)
Bevan, David Gilroy
Blackburn, Dr John G.
Braine, Rt Hon Sir Bernard
Brooke, Rt Hon Peter
Brown, Michael (Brigg & Cl't's)
Buchanan-Smith, Rt Hon Alick
Carlisle, John, (Luton N)
Carlisle, Kenneth (Lincoln)
Clark, Dr Michael (Rochford)
Clarke, Rt Hon K. (Rushcliffe)
Coombs, Simon (Swindon)
Cope, Rt Hon John
Davies, Q. (Stamf'd & Spald'g)
Douglas-Hamilton, Lord James
Field, Barry (Isle of Wight)
Fishburn, John Dudley
Fookes, Dame Janet
Forsyth, Michael (Stirling)
Fowler, Rt Hon Norman
Gilmour, Rt Hon Sir Ian
Goodhart, Sir Philip
Goodson-Wickes, Dr Charles
Greenway, Harry (Ealing N)
Greenway, John (Ryedale)
Griffiths, Sir Eldon (Bury St E')
Griffiths, Peter (Portsmouth N)
Hamilton, Neil (Tatton)
Hargreaves, Ken (Hyndburn)
Hicks, Robert (Cornwall SE)
Hordern, Sir Peter
Howarth, Alan (Strat'd-on-A)
Howarth, G. (Cannock & B'wd)
Hughes, Robert G. (Harrow W)
Hunt, David (Wirral W)
Knight, Greg (Derby North)
Lee, John (Pendle)
Lennox-Boyd, Hon Mark
Lester, Jim (Broxtowe)
Lloyd, Peter (Fareham)
Lyell, Sir Nicholas
Macfarlane, Sir Neil
Major, Rt Hon John
Marshall, John (Hendon S)
Marshall, Michael (Arundel)
Martin, David (Portsmouth S)
Maude, Hon Francis
Mayhew, Rt Hon Sir Patrick
Meyer, Sir Anthony
Miller, Sir Hal
Morris, M (N'hampton S)
Moynihan, Hon Colin
Peacock, Mrs Elizabeth