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Edinburgh University Dental School

3.32 pm

Mr. Alistair Darling (Edinburgh, Central) : I beg to ask leave to move the Adjournment of the House under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,

"the closure of Edinburgh university dental school."

The matter is urgent because the decision was leaked through a detailed press briefing last Thursday evening. The university was told of its fate when it saw the television cameras filming outside. The matter is important because three years ago, Edinburgh was promised a new dental hospital with teaching facilities. Last year, it was told that the dental school would expand. Now it is told that the school is to be shut, with its final admission of students only three months away. The Secretary of State for Scotland has recycled an old promise of a new hospital and he claims it as an achievement. The leak has all the hallmarks of a Scottish Office briefing. How typical it is of this Government that if there is dirty work afoot, they use a leak to carry it out. If a decision is bad or unpopular, they blame someone else. Edinburgh has been told that it will lose its school. It is told that it will have instead a post graduate institute, if you please. It is not told who will pay for the institute, where it will be or when the hospital will be built. Many believe that the car park that is on the site at present will remain there for a considerable time.

The university is entitled to make its case. It was never warned of the closure. It is no use the Secretary of State blaming the Universities Funding Council. The right hon. and learned Gentleman is an Edinburgh Member himself and he was also rightly quick to save the Glasgow veterinary school. The decision to close the Edinburgh dental school stands in stark contrast.

If we cannot have a debate today, we need a statement--not further press briefings. Edinburgh university and the public, who value their education and their dental health, are entitled to something better than this shabby treatment at the hands of the Secretary of State and the Government.

Mr. Speaker : The hon. Gentleman asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely, "the closure of Edinburgh university dental school."

I listened with concern to what the hon. Gentleman said but, as he knows, my sole duty in considering an application under Standing Order No. 20 is to decide whether it should be given precedence over the business already set down for today or for tomorrow. I regret that the matter he has raised does not meet the criteria of the Standing Order, and I cannot, therefore, submit his application to the House.

Mr. Nigel Griffiths (Edinburgh, South) : On a point of order, Mr. Speaker. I accept the ruling that you have just given, but can you use any influence on the Government to ensure that we have an early debate on university education, so that this matter, which has so incensed the Edinburgh community, can be fully aired and debated?

Mr. Speaker : That is not a matter for me, but no doubt there may be other opportunities.

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Mr. Jeremy Corbyn (Islington, North) : On a point of order, Mr. Speaker. Yesterday's edition of The Observer carried reports about the behaviour of the immigration service, on the instruction of the Home Office, in attempting to deny Kurdish refugees from Turkey the right to apply for political asylum.

Mr. Richard Holt (Langbaurgh) : What is the point of order?

Mr. Corbyn : My point of order is that this is a serious matter and serious allegations were made in that newspaper article, so I wonder whether you, Mr. Speaker, have had any application or request from Home Office Ministers to make a statement about that behaviour and what instructions they have given.

Mr. Speaker : I have not had such a request.

Several Hon. Members rose --

Mr. Speaker : Order. I remind the House that this is an Opposition Day.

Mr. D. N. Campbell-Savours : On a point of order, Mr. Speaker. I wish to raise with you the question of what is published on the Order Paper. You may be aware that I have been running a campaign to get Mr. Tiny Rowland to divest himself of his interest in The Observer. Over the past two months I have tabled 21 motions drawing attention to his conflict of interests and to the pressure that is being exerted on journalists of that newspaper in a number of ways. The motions relate to the tapping by Mr. Rowland of the Al-Fayed telephones, to allegations made by Donald Trelford against Mr. Mark Thatcher, which are untrue and which have been firmly denied, and to other allegations about the Tornado contract and the activities of Lonrho in the Bahamas.

Under our new procedures, these motions only surface on the Order Paper on Thursdays. Those of us who campaign on various matters rely on our motions being published, particularly if our campaigns involve a great deal of extra work. Last Thursday, I added signatures to 21 motions and briefed people to the effect that all the motions that I had tabled would be available for scrutiny. Thursday's Order Paper did not carry all the motions, however, and I am told that there is confusion in the system. Five of the motions did not end up on the Order Paper as a result.

Something must be done about this new rule, which undermines the position of campaigners. It has been done to save money, but there are other ways of saving money which have not been pursued. Will you, Mr. Speaker, personally review this matter and give a ruling on why my motions did not appear on the Order Paper, when I was assured that they would?

Mr. Speaker : I shall certainly look into that. The hon. Gentleman is correct in saying that motions appear in full on Thursdays. The matter has been confirmed by the Services Committee, and if the hon. Gentleman wishes to have a change made, he should make his representations to that Committee.

Mr. Dennis Skinner (Bolsover) : On a point of order, Mr. Speaker. Have you received any notice of a possible statement by the Prime Minister, who is proposing to use taxpayers' money to subsidise Ministers whom she sacks? Are you aware that it could involve yourself, Mr. Speaker?

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Mr. Speaker : I am not a Minister.

Mr. Skinner : Yes, Mr. Speaker, but let me finish. Will the new order extend as wide as the sacking of Mr. Speaker? I do not know, and I do not know whether you have been informed of that. There is also the question whether Ministers will in future wish to resign. What will be the point of Ministers sending resignation letters if they can be sacked and pick up 7,000 quid? What will happen before a general election when it looks as though the whole of the Cabinet will be cleaned out through a Labour victory? It is conceivable that some of them might use taxpayers' money to get out before the ship sinks. We should know all the facts.

Mr. Speaker : The hon. Gentleman will have to pursue that matter in a different way-- [Interruption.] Order. As far as I am concerned, I think that I can only be sacked by the House.

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Opposition Day

[15th allotted day]

Community Care

Mr. Speaker : I must announce to the House that I have selected the amendment in the name of the Prime Minister.

Mr. Tim Rathbone (Lewes) : On a point of order, Mr. Speaker. Have the Government given you notice of any intention to announce today what they intend to do to mark the United Nations designated International Day against Drug Abuse and Trafficking? If not, and as there is a full string of the Leader of the House, the Chief Whip and the Secretary of State for Health presently on the Front Bench, perhaps they could incorporate that information in the reply to the debate.

Mr. Speaker : That is a matter for the Front Bench. The hon. Member for Workington (Mr. Campbell-Savours) drew attention to matters contained in early-day motions, and that might be an admirable subject.

3.41 pm

Mr. Robin Cook (Livingston) : I beg to move,

That this House condemns the continuing failure of Her Majesty's Government to ensure that community services are expanded at a rate which matches the closure of mental health hospitals or the growth in the population of the very elderly ; expresses concern that the sole focus on the acute sector of the White Paper Working for Patients will further divert resources from chronic care ; regrets that, in the year since Ministers received the Griffiths Report on Community Care, they have failed to respond to a single recommendation ; accepts its central conclusion that social service authorities should be the lead agency for community care ; and rejects proposals that would confine local authorities to being purchasers rather than providers of services for the elderly and handicapped in their communities.

The whole House will know that, more than one year ago, Sir Roy Griffiths presented a blueprint to rationalise and develop care in the community. The Government's enthusiasm both for that problem and for Sir Roy's solution can be gauged by the fact that they chose to publish his report on the day after Budget day in 1988, which made sure that it never disturbed the conscience of a single sub-editor. Last week we passed another milestone in the history of the Griffiths report, because as of then, Ministers have spent longer ruminating over their response to Griffiths than it took Sir Roy to research, write and print the entire report. There is a stark contrast to that delay. In the same period that Ministers sat on Sir Roy's recommendations, the Secretary of State found the time to write a White Paper that turns upside down the entire acute sector of the National Health Service. It was published at the end of January, consultation on it finished four months later, and we are threatened with a Bill on that White Paper in five months' time.

The contrast between the breakneck pace of the Government's White Paper and the tardy progress in response to the Griffiths report is that no one wants the Secretary of State to force through his eccentric plans for our hospitals--even his Back Benchers are now praying that it will fade away and stop terrifying them in their

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constituencies--while everyone involved in delivering community care has pleaded with the Secretary of State to respond positively to the Griffiths report.

I understand that the House will not hear the Secretary of State's response today--[ Hon. Members :-- "Why not?"] He has been kind enough to write to me to apologise because he will not be taking part in the debate. I understand that the Government will be represented in both the opening and closing of the debate by the Parliamentary Under-Secretary, whose name unfortunately does not even appear on the Government's amendment. Of course, I welcome the Under-Secretary to our debate. He is a gentleman of both courtesy and candour. I shall not try to get him into trouble with his superiors by arguing whether in those qualities he compares favourably or not with them. It is not a criticism of the Parliamentary Under-Secretary when I say that the House might have expected the Secretary of State to participate in this debate.

The Secretary of State for Health (Mr. Kenneth Clarke) : I am grateful to the hon. Gentleman for giving way, but I am surprised that he has raised this point. He shadows no fewer than two Departments of State and invariably participates in every debate on any subject arising from either Department. If he were a football player, he would be described as a greedy player. I believe that there are members of his team who are more than competent, but he often seems unwilling to give them an airing. My hon. friend the Parliamentary Under-Secretary of State is extremely competent to answer the hon. Gentleman's attacks on this or any other subject, particularly when the hon. Gentleman has chosen to raise a subject which he knows perfectly well will be addressed in a few weeks' time when there is to be a statement on the Griffiths report.

Mr. Cook : As I understand the Secretary of State's intervention, he is explaining why the Parliamentary Under-Secretary should be Secretary of State rather than himself. He chose to refer to my experience of Supply day debates. I have been to the House of Commons Library and checked on the 54 Supply day debates which have been held since the last general election. Of those 54 motions tabled by the Labour party, on only seven out of the 54 occasions, were the debates not replied to by a Cabinet member. Of those seven, there was only one occasion on which the speech from the Government Bench was made by a Parliamentary Under-Secretary rather than a Minister of State ; that was when, unfortunately, the Minister of State, Agriculture, Fisheries and Food was taken ill in Brussels and replaced by a Parliamentary Secretary. Although the House may not have fully appreciated his speech, we well understood why the Parliamentary Secretary made it.

The clear conclusion is that the only time when a healthy team of Ministers has left a Parliamentary Under-Secretary to reply to the debate is when the topic under discussion was care in the community. Those outside the House who are concerned about community care and try to make it work, will note that this demonstrates where community care comes in terms of this Government's priorities. Unfortunately, outsiders reading this debate will feel particularly aggrieved as they struggle to maintain services for community care which are in constant danger of being washed away by an ever -rising tide of need.

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Since the publication of the Griffiths report, another 40,000 elderly people have been added to the total number of those aged over 85. I recently received a parliamentary answer which showed how the provisions to support those people living at home have failed to keep pace with the increase in numbers. The number of those attending day hospitals per thousand of elderly over 75 has fallen from 552 in 1983 to 498 in 1987. That is a 10 per cent. drop, although such provision can be vital in enabling the elderly to be supported when living at home.

At least central Government can choose how many resources they put into the problem. Local authorities, when providing their services, find that they are ground between the lower millstone of ever-rising demand and the upper millstone of ever-decreasing resources. Sir Roy Griffiths states :

"many social services departments and voluntary groups grappling with the problems at local level certainly felt that the Israelites faced with the requirement to make bricks without straw had a comparatively routine task."

Those people left to take the strain are those officially designated informal carers, by which is normally meant the nearest available female relative. In reality, they provide the great bulk of care in the community. It is an outrage that we leave them to get on with it with minimal support. Nursing is a skilled job. Those in the profession receive three years' training and are then expected to work eight-hour shifts at a stretch. Time and again we ask informal carers to provide 24-hour constant nursing without training, respite or help, and often without sleep. It is hardly surprising that study after study shows that people left in constant attendance without a break are in poorer physical and mental health than the rest of the population.

One development since the Griffiths report clearly shows the Government's indifference to these carers. In April last year, people caring for a disabled relative were the only group on long-term supplementary benefit who received no premium on transfer to income support. As a result, 150,000 carers found that they were £5 a week worse off in entitlement. We owe this group an immense debt ; to reward that debt by cutting still further an income that is already pathetic beggars belief.

What makes the Government's meanness towards relatives who care for the elderly at home all the more unjust is the Government's willingness to tolerate dramatic rises in payments of social security to the proprietors of private homes. In 1980, the Government made social security payable to cover residential fees of private and voluntary homes, and presumably intended thereby to stimulate the private sector in residential care. That, certainly, was the dramatic effect.

Unfortunately, as happens so often when the Government are faced with the financial consequences of their own policies, they then rebelled at the bill. In 1985, they stopped paying the fees and imposed a national limit on each category. I have received figures in parliamentary answers which show that the limits on these categories have been lowered in real terms since their introduction in 1985. For elderly people in nursing homes, the money has fallen from £199 to £190 a week ; for the mentally ill, it has fallen from £211 to £195 ; for the mentally handicapped, it has fallen from £234 to £205. The cost of such homes, however, is not falling in real terms : it is rising. In between, a real gap is emerging between what they charge and what the social security system will pay, with the result that a

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growing number of elderly and handicapped people cannot meet their bills and face the real risk of being put out on the street. We condemn the Government's irresponsible policy of allowing this sector to grow unplanned and uncontrolled. Some, at least, of the payments that go to elderly people in residential care could have been used to sustain them in the community if local authorities had been given half the resources that the Government are willing to pay the proprietors of private homes. Having created this problem, Ministers cannot justify the cynical response of capping expenditure and leaving vulnerable and elderly patients to face the consequences of being unable to pay their bills.

From the elderly, I turn to services for those decanted from mental health hospitals, where we find the same picture of rising demand overwhelming inadequate provision. The Government have certainly pursued a vigorous programme of hospital closures, nowhere more markedly than in the case of mental health hospitals. The closure programme has been so rapid that Ministers seem to have difficulty keeping abreast of it. Last year I tabled a parliamentary Question inviting Ministers to list the mental health hospitals for which there were no closure plans. A subsequent survey of the list published in Hansard discovered that it included four mental health hospitals which had already closed at the time of the answer and two others which closed during the time that it took to carry out the survey. When I wrote to Ministers drawing their attention to this inaccuracy, I received a letter which had the breath to advise me : "the majority of the information in the reply was correct." Apparently it is sufficient for Ministers these days to aim at only a pass mark in a parliamentary answer.

Since then, I have received figures which confirm how badly the expansion of community care has failed to match the contraction of institutional care. Between 1979 and 1986, 28,500 long-stay patients were discharged from mental health hospitals into the community. In that same period, only 2,230 extra places were provided in day centres for the mentally ill. In other words, fewer than one in 10 of those discharged to the community had the opportunity of a place which could provide them with support and the opportunity of comfort. One can, of course, find excellent cases of an integrated range of community care facilities right across the country, from Dorset to Lambeth. It is all the more lamentable that, given those illustrations of what is possible, the majority of cases fall so far short.

A number of studies now confirm that, for most of those leaving care in an institution, care in the community is a myth. For starters, if the statutory authorities are going to deliver care in the community, they must know where to find the former patients who will receive that care. One study of 50 patients discharged from Claybury mental hospitals could trace only 26. Of those 26 who were traced, only six had a place at any day centure. A study of 150 patients discharged from mental hospitals in Essex could trace only 100. Two thirds of those traced had received no help since leaving hospital. That is not just a problem for the authorities : it is a source of distress for the relatives. A son--perhaps even a wife--may have a serious mental health condition, but his

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parents may not know where he is--whether he is in accommodation, whether he is being fed or whether he is going through an acute episode or is in a stable condition.

The reality is that, although we may not know where any one patient might be, we have an accurate idea of where they turn up. Hon. Members can find some of them under railway arches within strolling distance of the House. One medical study of the homeless who attended the Crisis at Christmas venue last year discovered that more than half of them had a history of psychotic disorder, and one third displayed psychotic symptoms that very night ; yet two thirds of them had no contact with any medical centre.

They also turn up in our remand centres, because it is more convenient for our society to label their behaviour as criminal than to respond to their medical or social needs. At the time of the Rampton disorders, I tabled a parliamentary Question to the Government, from the answer to which I discovered that one in six of those who were inmates at the Rampton remand centre at the time were formerly in-patients at psychiatric hospitals. As Dr. Kilgour, the director of medical services of Her Majesty's prisons, has said : "My colleagues and I find ourselves having to handle people who are inappropriately committed to custodial sentence due, to put it bluntly, to the failure of the community to provide suitable facilities for them."

I read in The Daily Telegraph last week that this problem has now surfaced in the consciousness of the Prime Minister. Confronted with the closure of Friern Barnet hospital in her constituency, the Prime Minister has ordered plans for further hospital closures to be frozen. I am glad that someone in the Government has recognised the problem, but that emphatically cannot be a permanent solution. Many of our present stock of mental health hospitals were built by the Victorians. Some of them were built as the local poorhouses--places of punishment and detention rather than of medical treatment. The solution is not to perpetuate those conditions indefinitely, but to make a reality of community care by providing the services that are needed to support the patients who leave the hospitals--to provide them with small-scale residential communities, with day hospitals and drop-in centres, and with sheltered employment opportunities, because many of those leaving hospital want to work.

This morning, West Lothian Poverty Action Forum in my constituency published an excellent report that allows claimants to speak in their own voices. I was much struck by the observation of one disabled claimant about the trap in which he found himself. He had no experience ; therefore he could get no job. He could get no job ; therefore, he could obtain no experience. Only community provision can help him to break out of that trap.

That brings me back to the Government's failure to respond to Sir Roy's recommendations to improve care in the community. There are plenty of reasons why we should treat the report with caution. Indeed, if I suspected that that was why the Government were taking so long to respond to the report, I would treat the delay with more understanding and tolerance. Sir Roy's report contains no commitment to extra resources to make community care work. There is nothing about enabling users to participate in the planning of services or to contribute to the management of those services when they are up and running. For all the rhetoric about consumerism in the

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report, Sir Roy has produced a design intended to improve lines of managerial accountability, not to make the services accountable to the users.

Mr. Peter Thurnham (Bolton, North-East) : The hon. Gentleman has criticised the Government for the length of time in responding to the Griffiths report. As I understand it, the Labour party policy review did not agree with Griffiths, in so far as Griffiths calls for local authorities to be more the organisers and purchasers of services instead of the providers. Why is the Labour party so keen on the local authority being the provider? Is that because of the continued obeisance of the Labour party to the trade unions?

Mr. Cook : It is true that one reason why the Labour party remains committed to public provision is that public provision overwhelmingly provides better working conditions for those who provide the service. We do not believe that a caring and compassionate service can be provided for those in need if it is based on the exploitation of the workers in the service.

It is certainly not the case that we have failed to respond to Griffiths. We have produced major documents in response to the Griffiths report. We have differences with Griffiths. We believe that in many respects he was in error partly because of the remit that he was given by Treasury Ministers and that that explains why he was unable to recommend extra resources. We believe that it is inexcusable that the Government will not tell us whether they agree with Griffiths and, if they fail to agree with him, what they will put in place of Griffiths.

The hon. Member for Bolton, North-East (Mr. Thurnham) has put his finger on the major reason why Ministers have been delaying a response to Griffiths. That has not happened because Griffiths failed to recommend extra resources --that must commend the report, rather than be a handicap in the Government's eyes. Ministers have behaved like paralysed rabbits for the past year as a result of the sheer horror that they must feel at Griffiths's central recommendation. As the hon. Member for Bolton, North- East said, the central recommendation is that if we are serious about care in the community, more responsibility and control of resources will have to be given to local authorities which provide the services in the community. That message is as welcome to No. 10 as telling the Prime Minister that Labour has a 14-point lead in the opinion polls.

The Prime Minister has presided over a sustained strategy of undermining local government, which has abolished the local authorities which she liked least, which has cribbed and confined with restrictions the right to express political opinions of those local authorities which remain, and which is currently compelling the authorities to hand over many of their services to private contractors.

After a decade of running down local government, the Prime Minister and her Ministers have received a report which advises them that, in this matter at least, they cannot do without local government. It tells them that, if they are serious about caring for the elderly and providing for the mentally ill and mentally handicapped, they need local government. Rumours are surfacing in the press that a compromise has been worked out in the Cabinet and that local authorities will be designated as the lead agencies in community care, but that they are to be denied any

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opportunity to demonstrate leadership because they will be stripped of all responsibility for direct provision of services.

The Adam Smith Institute recently threw a party to celebrate its 100th proposal to be accepted by the Government. It has produced a document along the lines that I have just described. It justifies preventing local authorities from making direct provision on the following grounds :

"Government's priority should be to encourage the growth of the private sector. No initiative by Government should undermine that independent sector or attempt to compete with it."

There is a remarkable double standard there. Local authorities are to be obliged to put all their services out to competitive tendering, but the private sector is protected from competition by the local authority. Given the Adam Smith solution to the Hong Kong problem, we should all be grateful that it is not proposing that we should sweep up the mentally ill and put them down on the Mull of Kintyre. It cannot be emphasised too strongly that local authorities are the largest single providers of residential and domicillary care ; they understand the needs of people requiring community care ; that they have acquired unrivalled experience and professional skills in running community care ; and that it would be pure ideological vandalism to break up that service--and we shall fight any proposals to do so.

In the meantime, scandalous examples of the failure of community care continue to accumulate. I mentioned that former patients can be found in hostels for the homeless and in remand centres. Tragically, they also turn up as the subjects of inquests, such as that currently being held into the death of Beverley Lewis. Deaf, blind and handicapped from rubella, and unable to demand help herself, she starved to death in the community in the year since Griffiths. Tragic though her case is, it does not compare with the much greater scandal of the delay and indifference with which Ministers treated Griffiths over that same year. We have already lost a whole year. It is because we believe that there is no more time to lose that we shall vote tonight for an urgent response from the Government.

4.5 pm

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : I beg to move, to leave out from "House" to the end of thQuestion and add instead thereof :

"commends the Government's record on the development and funding of community services for all people in need of care ; reaffirms its support for the policy of community care ; believes that it will be complemented and strengthened by the proposals contained in the Government's White Paper, Working for Patients' ; and looks forward to an announcement of the Government's conclusions on Sir Roy Griffiths' report, Community Care : Agenda for Action', in the near future."

I am grateful to the hon. Member for Livingston (Mr. Cook) for making out an excellent case for my early preferment. However, I do not believe that his recommendation will be entirely productive. I apologise for the absence of my hon. Friend the Minister of State, Department of Health, who is chairing a conference of the Council of Europe in Strasbourg, which is an important and long-standing engagement. My response will be as brief as possible, because I know that many right hon. and hon. Members wish to speak. If I

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catch your eye later, Mr. Speaker, and with the leave of the House, I shall seek to answer some of the questions that will arise. What do we mean by care in the community? For the mentally ill and the mentally handicapped, we mean providing care away from the large, isolated and inhumane Victorian institutions that for so long have been the hallmark of institutional care. That policy has existed for 20 years, shared with differential rates of fervour by right hon. and hon. Members on both sides of the House. We want to move away from a regime that involves long-stay facilities, hostels, houses-- [Interruption.] Perhaps the hon. Member for Peckham (Ms. Harman) will pay me the courtesy, as she usually does, of listening to my arguments

Mr. Nigel Griffiths (Edinburgh, South) : It is not worth it.

Mr. Freeman : The hon. Gentleman's remark is a little premature. If he will listen to what I have to say, I shall do him the courtesy of listening to his contribution.

We want to move away from a regime of institutional care in isolated, Victorian institutions to a system whereby we provide a range of facilities much closer to the community.

We want to enable more elderly people to stay in their own homes for as long as possible before institutional care becomes necessary and unavoidable. I quote from the report of the Public Accounts Committee laid on 25 April 1988, which I am sure the hon. Member for Livingston read :

"We draw attention to the fact that up to 23 per cent. of claimants"--

that is claimants of income support--

"entering residential homes could have stayed in their own homes for longer periods had appropriate community support services been made available."

Although not all right hon. and hon. Members may agree with that figure, I am sure that they accept the broad thrust of the Committee's argument.

The Government want to ensure that a greater proportion of the elderly can stay in their own homes for as long as possible, and we fully appreciate that that requires proper domiciliary support. If the elderly are allowed to remain in their own homes they retain their dignity and independence, and are closer to their friends and families. It is a more effective use of taxpayers' money to care for the elderly in their own homes, which is where they want to receive care, rather than in institutions.

Dame Elaine Kellett-Bowman (Lancaster) : Is my hon. Friend aware that the Lancaster health authority was the first in the country to provide round-the-clock nursing care for those who stay in their own homes? We have two large institutions, and we pioneered the kind of service to which my hon. Friend has referred.

Mr. Freeman : My hon. Friend is right, and I pay tribute to Lancaster. There are many examples of excellent community care facilities, although I regret to say that there are also many areas where they are not excellent. I shall deal with that a little later.

Ms. Harriet Harman (Peckham) : I support what the Minister has said about the importance of people being able to stay independent in their own homes. Does he not

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recognise, however, that one of the recruiting sergeants for residential care--both public and, increasingly, private--is the present difficulty of obtaining home helps and meals on wheels, compared with 10 years ago? Local authority social service and voluntary sector provision have not kept pace with the growing number of people who need such services.

Mr. Freeman : One of the challenges in any review of community care provision is the need to look carefully at how taxpayers' money is spent. I agree that there is a strong case for using taxpayers' money for the care of the elderly in their own homes--and the hon. Lady listed a range of services--rather than in hospital, if they are cured, or in nursing or residential homes. There must be a case for providing proper support for those who wish to stay in their own homes.

What was Sir Roy asked to do in his report? He was not asked, as the hon. Member for Livingston (Mr. Cook) said, to consider the level of resources ; he was asked to consider how we should decide which elderly and handicapped people should be cared for in the community, what help should be provided and who should make the necessary judgment. What did he suggest? As we all know, he suggested that the social services authorities should have prime responsibility for assessing and arranging, although they should not necessarily have monopoly in the provision of services. As my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) said in an intervention, Sir Roy recommended a range of provision.

The Government will be making a statement about our response to the Griffiths report before the summer recess, but there will also be a debate in Government time at a suitable point thereafter. A substantial amount of time has been devoted to considering the implications of the report, and I remind the House that different Departments are involved : the Department of the Environment, the Department of Social Security, the Treasury and, of course, the Department of Health. It is very complicated to work through all the implications, and it would be much better to get the analysis right than to rush it.

The hon. Member for Livingston said that this was the third debate on community care in seven months. It will probably be the last occasion for the Government to listen to comments and advice from the House before we announce our conclusions.

Mr. John Battle (Leeds, West) : The Minister has given the impression that existing facilities and services were being supported. Is not the Treasury at this very moment discussing with the Department of the Environment reductions in local authority provision, which means that next year authorities will not be able to spend as much on home and meals at home for the elderly? While we are discussing the matter, the service is being reduced. Is that not the reality?

Mr. Freeman : No, it is not the reality. If the hon. Gentleman will be patient, I shall deal shortly with social services provision and the resources devoted to local authorities.

I am puzzled by the Opposition motion. It

"expresses concern that the sole focus on the acute sector of the White Paper Working for Patients will further divert resources from chronic care".

The hon. Member for Livingston has obviously given some careful thought to the wording of the motion.

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Provision for care in the community was deliberately omitted from the White Paper. We wanted sufficient time in which to prepare a proper response. That will come shortly. There are two reasons why the hon. Member for Livingston needs further time in which to reflect on the phrasing of an appropriate motion. He knows that the White Paper "Working for Patients" does not have as its sole focus acute care. Many of the proposals concern primary care.

The responsibility for providing a comprehensive range of health services for all people, including those in the community--the elderly, the mentally handicapped and the mentally ill--will rest firmly under our proposals with the district health authority. It will be the purchaser of care. Who that care is provided for will depend on a variety of circumstances. The district health authority will be responsible for the balance and range of services that are required and for the care of everyone, including those in the community. By definition, a community health service must be provided locally. The district health authority will have the primary responsibility for ensuring that it is provided.

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