House of Commons Hansard Debates for 26 Jun 1989

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than they do. They find it very difficult to care for him. A growing problem is mental stress and granny bashing. We have not paid enough attention to that problem but it causes heartbreak on all sides.

Recently I visited a constituent who told me that she never goes out, because no one will sit with an incontinent granny, and that she spends her life washing and cleaning. She went on to say, "I love my mother dearly, but I am waiting for her to die." She was at the end of her tether. Then she said, "I haven't had a holiday for five years." She told me that she had given up a very good job and that she had not had a full night's sleep for a very long time. Finally she told me, "I don't like asking people to the house because it smells like a toilet." That woman had received very little help from the local authority or anyone else. The £10 billion that has been provided for the private sector could have given her a great deal of respite. Good hospitals and other kinds of good care have been closed down, purely on economic grounds, during the last 10 years. The Government say that they want to provide choice, but that woman has not been given any choice. She has had to sacrifice her own life to look after her elderly mother. The majority of the 1.25 million carers have not been given any choice, either. It is hell on earth for some of the carers who are trying to cope.

The Minister replied to my intervention about mentally ill people in prison by saying that the Home Office was carrying out a survey. That is too little and too late. Warnings have been flooding in to the Government about what is happening in the prison service and about what is happening to people sleeping under bridges and in cardboard boxes. The Government have been responsible for closing hospitals prematurely throughout the country without making sure that there is somewhere where those vulnerable people can go. The Government have taken 10 years to initiate a Home Office inquiry and they should be ashamed of themselves.

I very much welcome the debate, but I shall welcome even more a debate in Government time. I hope that they will come to the House with some humane and decent proposals for caring for the elderly, the mentally ill and the mentally handicapped.

6.20 pm

Mr. Tony Favell (Stockport) : I am an enthusiastic supporter of the mentally disabled, the mentally ill, the physically disabled and the elderly leading as full a life as possible in the community. I am very glad that, throughout the debate, hon. Members on both sides of the House have supported that view. That is what the disabled want. They do not want to be institutionalised ; they want to lead as full a life as possible in the community. From time to time that can be a disadvantage to them and possibly embarrassing to those of us who are not disadvantaged.

Dorothy Birch, a lady in my constituency who is disabled and who does an enormous amount for disabled people in Stockport, visited West Germany recently. When she came back she said, "You do not see any disabled people in West Germany." I said, "Is that a good thing or a bad thing?", and she replied, "It is a bad thing. If no disabled people are seen, that means they are kept out of sight and out of mind." It is to the credit of our community that disabled people are not kept out of sight and out of mind.

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However, from time to time we have to provide respite care for disabled people who require help. I strongly urge my hon. Friend to look very carefuly into the funding of sheltered accommodation instead of the more traditional caring accommodation. According to housing associations such as the Anchor housing association and the Collingwood housing association, it need be no more expensive to provide sheltered accommodation for elderly and handicapped people than to provide 24-hour care.

It is so much better for disabled people to have a little privacy--perhaps their own bedsit where they can invite friends--to be able to cook their breakfast and make their own bed, although it may take a long time, than to be got up, have their beds made for them and their breakfast provided and then to sit in a rectangle gazing at each other for the rest of the day. Many hon. Members will have had the awful experience of visiting such places and seeing people who in many cases have absolutely nothing to look forward to but death. That is disgraceful. It should be investigated, and the sooner something is done the better.

Many hon. Members have commented on the Griffiths report. I agree with paragraph 1.3.1 which states that local authorities should "assess the community care needs of their locality, set local priorities and service objectives, and develop local plans in consultation with health authorities "

Ultimately, the local authority will have to ensure that there is provision for disabled people within its boundaries. However, I disagree with paragraph 1.3.2 which states that local authorities should

"identify and assess individuals' needs, taking full account of personal preferences (and those of informal carers), and design packages of care best suited to enabling the consumer."

It is far better to divide the roles. It is fair enough that a local authority should ensure that there is overall provision for disabled people within their town, city or locality, but it is better for someone else to identify individual needs. I suggest that the best person to do that is the general practitioner, who has a full list of all his patients. The new contract, which contains many good things, as Conservative Members recognise, insists that every general practitioner sees each elderly person on his list at least once a year. General practitioners in my constituency do that more often. Many insist upon seeing elderly people at least once every six months. General practitioners are in touch with families and understand their needs over many years. They know whether a disability is transitory or permanent and they are the best people to assess what should be done, and of course the facilities exist already.

Mr. John Marshall (Hendon, South) : Does my hon. Friend accept that schizophrenics are mentally ill people who have not been helped by community care? They are frequently so aggressive that they lose their doctors and they often do not agree to carry out the treatment that has been prescribed for them. Does he agree that, if they are to be cared for within the community, they need far greater supervision than they have had until now?

Mr. Favell : I understand my hon. Friend's point, but most mental illness does arise from schizophrenia. As he will know, one in 10 people require some kind of mental treatment at some time in their lives. It has to be the general practitioner's responsibility as it would be impossible for the local authority to supervise one in 10 people living within its boundaries.

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I suggest that my hon. Friend the Minister looks very carefully into the possibility of general practitioners assessing individual needs while the town hall is responsible for ensuring that there is provision for people who require the help that general practitioners consider their patients need.

6.27 pm

Mr. John Marshall (Hendon, South) : I believe that one aspect of mental health policy has been a gigantic failure--the treatment of schizophrenics. I went to a meeting of my National Schizophrenia Fellowship branch, where one lady told me that her daughter had been released into the community. What did release into the community mean? It meant that that night, she was sleeping somewhere in one of the parks in London. Her mother did not know which park it was, only that she was sleeping rough and that she was not using the treatment that had been prescribed for her.

This morning I received a letter about a particular patient : "He returned to his flat on 5 June and since then he has been arrested by the local police a few times, they have called the crisis team who do nothing and next morning Hendon Magistrates court discharge him. The residents live in fear of his verbal abuse, loud music played day and night through his open windows and at times violent behaviour--then the police are called and arrest him and so the pattern repeats itself--I could write for hours. He has no doctor in Barnet Doctor struck him off for bad behaviour and no one else will accept him. What can you do to help us?"

Such individuals are not calling for care within the community. I suspect that we have to accept that, if certain schizophrenics are cared for within the community, they will refuse to accept the treatment prescribed for them. There is quite inadequate supervision of their lifestyles, and as a result they, their parents and the community suffer. I believe that we should do much more for them. Sometimes, the mentally ill are treated as the Cinderellas of the social services.

Mr. Rowe : My hon. Friend is making a very powerful point. Does he agree that it is part of a larger, extremely difficult problem--that of how far we should allow self-determination to people whom we are trying to treat in a much more mature and adult way? My hon. Friend is talking about one extreme, but the problem runs right through community care.

Mr. Marshall : I accept that the problem of self-determination has existed for a long time. I suspect that we may have moved from one extreme to the other.

I shall quote two examples of people who have come to my surgery for advice. One man came to me without an appointment saying that he had a terrible problem. He had received a telephone call from Marseilles. His son had walked out of the local mental hospital, emptied his account at the local building society and gone to Marseilles. The phone call was asking for money to enable him to come back home. That is an example of self- determination, someone walking out of treatment that he should have.

It is all very well talking about the philosophical advantages of self- determination, but I am talking about the practical disadvantages to the patient, the community and parents. I shall always remember a group of people

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who came to me in my constituency and said, "You must help us. Mr. X has been given a flat in our block and he plays music 16 hours a day. He starts at 8 pm and carries on through the night." That course of action is not benefiting him, his family or the community. I hope that the Government will do something about it.

6.30 pm

Mr. Tom Clarke (Monklands, West) : My hon. Friend the Member for Livingston (Mr. Cook) introduced this excellent debate, which reflects the importance of this crucial subject at a time when so many expect so much from the Government. Alas, they must have been disappointed by events this afternoon. In many ways, this has been a remarkable debate. The Secretary of State for Health appeared, albeit briefly, and made one short intervention. He accused my hon. Friend of being greedy in a team sense. When the right hon. and learned Gentleman occasionally looks at an egg and reflects on his hon. Friend the Member for Derbyshire, South (Mrs. Currie), he might regret not employing the tactics that he wrongly attributed to my hon. Friend.

If ever there were a debate involving Hamlet without the grave digger, this is it. There is no doubt that the Secretary of State should have been present throughout and should have told us the Government's thinking on these crucial matters. It is true that we have had three debates on community care recently--one was introduced by my hon. Friend the Member for Bristol, South (Ms. Primarolo) in a Consolidated Fund Bill debate ; one was introduced by the Social and Liberal Democrats through the hon. Member for Southport (Mr. Fearn), who spoke earlier ; and today we have this debate introduced by the Labour party in Opposition time. It is not enough, fifteen months after the report by Sir Roy Griffiths, for the Government to say again that they will make a statement, giving every sign that it will be a holding statement. If this trailer means that, after a long delay, a White Paper will be published during the recess and there will be inadequate debate before the Government rush through legislation, the Government can expect the utmost vigilance from the Opposition.

Now that the Minister has had time to consult the Secretary of State, I shall press him on one matter. In this crucial matter, the House has to depend for its information almost exclusively on rumour. What is happening with the famous E committee? Is a Cabinet committee considering the Griffiths report? If so, what have been the influences during its deliberations? We are told that the committee has been largely influenced by the Right-wing think tank, the Adam Smith Institute. We are told that the Secretary of State has been handbagged by the Prime Minister who, once again, finds herself at odds with one of her senior Ministers. If, as the Minister said in reply to me, these are mere rumours, why does he not take the opportunity to tell us the precise facts? This is a mature Chamber. There are many hon. Members on both sides whose input to our debate has been particularly helpful, who are well informed, who have tried to encourage mature input into the debate and who expect better than we have had from the Government so far.

We expect better because we were told that we should wait for the Government's White Paper on health, "Working for Patients". There was little in it about community care and what there was, as we have heard

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from virtually every general practitioner in our constituencies, was extremely unhelpful. As my hon. Friend the Member for Wakefield (Mr. Hinchliffe) rightly said, the problem remains. As hon. Members have insisted, within a few minutes' walk of the House of Commons there are people living in cardboard boxes. As the hon. Member for Macclesfield (Mr. Winterton) said in a thoughtful speech and as my hon. Friend the Member for Halifax (Mrs. Mahon) said in a telling speech, far too many people who are mentally ill or mentally handicapped are being sent to prison because the courts do not know where to put them.

This morning in The Times , in an article dealing with the problems of prisons, we read almost as an afterthought the comment : "The board of Canterbury Prison, Kent, says : The problem will become worse as mental hospitals devolve their inmates into the community without adequate support services and because changes in the rules governing housing benefit seem likely to lead to a reduction in hostel places'.".

All that is happening when, as my hon. Friends have said, public money is being spent, but as a contribution to the unplanned explosion of private residential homes. Sir Roy Griffiths has asked why that is happening, and we are entitled to know the Government's thinking. The Public Accounts Committee has said that the sum involved is about £250 million. With that money, we could do much in a planned way for the aspirations of community care that have been expressed in the debate.

The Government still offer no strategy for community care--worse, while we have been waiting all this time for a response to the Griffiths report, we have seen fragmentation in various Departments, including the Department of Health. We have seen Departments acting independently and Departments imposing policies that appear to be in conflict with the strategies in which, we are told, the Government believe, including the poll tax. If ever there was a perverse incentive for community care, that is it.

The Department of Health and Social Security has been split into two Departments, without an explanation of how that may influence our attitudes to community care. We have seen the impact of social security cuts. The hon. Member for Bolton, North-East (Mr. Thurnham) referred to Crossroads. The Labour party accepts that there is a role for voluntary organisations and that the private sector often fulfils a useful function. Why should a Government and their supporters who are so committed to voluntarism appear to ignore the views of the voluntary organisations? If ever there was a crisis, it was on the funding of Crossroads, as we know from our constituency correspondence. Again, as part of fragmentation, Lord Young interfered in these matters. We know that employment training schemes have an impact on what is happening in the community.

As for my constituency, I shall merely tell the story of a man who was involved with Crossroads. His wife suffers from Alzheimer's disease. He was given some help, which he very much appreciated, in visits two or three days a week which were ordered by Crossroads. Because of the argument about funding, which has not been wholly resolved, he was told that that help would be taken away. He came in tears to see me. We should remember that his wife will not be exempt from the poll tax. If people are

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contributing to local authority services, it ill behoves those who impose their ideology to argue, as many do, that the role of local authorities should be reduced.

There are strong suspicions that, as the Government think these matters out, there are influences on their thinking that are not necessarily helpful and are almost wholly based on ideology. I note that the Secretary of State for Social Security is sitting on the Front Bench. His presence late in the debate confirms my point. We are told that the Under-Secretary of State for Scotland, the hon. Member for Stirling (Mr. Forsyth), had considerable influence on Government thinking, about which we shall hear when they have concluded their long deliberations.

Mr. Dick Douglas (Dunfermline, West) : Lord help us.

Mr. Clarke : My hon. Friend the Member for Dunfermline, West (Mr. Douglas) says, "Lord help us". The influence of the hon. Member for Stirling has caused many problems in Scotland. If he has as much influence on the United Kingdom, we are in trouble.

I mentioned the fragmentation of and contradictions in Government policy. I remind the House of what occurred with Lennox Castle hospital. I am sorry that a Minister from the Scottish Office is not present ; perhaps they have more important matters to deal with. The hon. Member for Stirling was aware of the many valid criticisms of conditions at Lennox Castle hospital. He was further aware of the television programme that told the world of some of the outrageous conditions there. What did he do? Did he involve himself in consultation? Did he say, "Yes, we are committed to community care, so let us consult"? Did he consult the Confederation of Health Service Employees or the consumers about whom we have heard so much? Did he consult those involved in joint planning, however inadequate it is in Scotland? No, he did not.

The hon. Member for Stirling, who is the most monetarist of monetarists, threw money at the problem by announcing £9 million of expenditure over the next two years without saying whether it was part of a strategy for community care--a policy which would be welcomed by the people of Scotland and, given the main stream of the debate, elsewhere. That proves that, if there is the will, the Government can find the necessary resources, which is why my hon. Friends were right to emphasise the importance of resources. The Disabled Persons (Services, Consultation and Representation) Act 1986--I make no apology for returning to it--offers the Government an opportunity, if only they would grab it, of a framework for community care. It deals with citizens who have special needs and their right of access to information and it makes agencies, social services, housing and health departments accessible. We shall never solve the problem of people being discharged from hospitals, about which we have heard much today, including from my hon. Friend the Member for Oxford, East (Mr. Smith), until we realise that there is a role for bridging, preparation and assessment. It is scandalous that many people are leaving the community to go into community care that does not exist.

Many hon. Members, including my hon. Friend the Member for Livingston, referred to carers. We owe much to carers, who do so much work 24 hours a day. That commitment should not be exploited. The social security changes, which have worked to the considerable

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disadvantage of carers of disabled people, should not be allowed to continue without review. The changes are false economy, because no one is helped, least of all the Treasury, if the relationship between the carer and the person they are caring for breaks down and both become institutionalised.

The Audit Commission has said that it is gravely worried about the way in which the Government have organised the changes. It mentioned a lack of planning, strategy and auditing of expenditure of public money, with drastic consequences for the people involved. The Salvation Army estimates that up to three quarters of its hostels' inmates may be suffering from mental illness. Such problems must be taken on board by the Government. They cannot ignore the appalling problem, which was brought to the notice of the Standing Committee considering the Children Bill, of older children, who have no parents or other family, leaving care and facing the difficulties of community life. In many cases, they are being trapped into crime, drugs and prostitution because the Government are not prepared to accept the responsibility that parents would accept for their children. That is the responsibility of a caring Government. The Government's delays and lack of commitment owe more to ideology than an appraisal of the problems. They are influenced by people who believe that we should consider only consumers, as explained by Mr. Norman Flynn, who in an article entitled "The New Right' and Social Policy" said :

"If possible, individuals should manage without help from institutions of any sort, except their own families."

The Minister made that point, as though, collectively, the state had no responsibility. What does that attitude mean in reality? What did the National Council for Voluntary Organisations--volunteers expressing their views and pleading to the Government--say about the family and its input? It said :

"One woman, aged 73, who suffered from a stroke in 1986, is currently in hospital following a further stroke. The sheltered housing scheme where she now lives have said that her care needs are now too great for her to remain a resident there. Nursing home fees in the area--Berkshire--are around £300 per week and the woman concerned would be reliant on income support of £185. As the widow of a milk roundsman who died in 1959 this woman has only a small amount of capital which would soon be eroded by the need to top up' her own fees ; her children both have financial family commitments of their own and would not be able to assist."

I fear that that problem is reflected throughout many parts of the country.

We cannot dismiss such problems by saying that they must be dealt with by distant families or friends and that the Government have no responsibility. However, that would be the view of the Adam Smith Institute. I have had the benefit of reading the paper that we understand has been before Cabinet committee E. It shows the conflict in philosophy between the Government and the Opposition. The paper says :

"Government can, by providing very modest encouragement to the private sector, help it to grow with that rising demand. It can, by means of incentives to personal saving and personal provision, make it easier for most people to provide for their own care needs in retirement."

In other words, the choice is artificial, because without good planning and services there is no option.

If local authorities are to be underfunded and denied essential resources, where is the choice? According to the

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mentality displayed in the paper of the Adam Smith institute, we shall have to rely on people who can afford to pay for services. What will happen to the rest? Are they not entitled to advocacy and consultation on what happens to services? Of course they are, but the overwhelming evidence before the House confirms the view of the Audit Commission that community care is in disarray and Sir Roy Griffiths's view that it remains in chaos.

For that reason, Opposition Members have a responsibility to promote the needs, demands and requirements for services of millions of elderly, vulnerable and disabled people and their carers. We do not believe that the Government have placed on such matters the priority which the British people would rightly demand. That is why the Government offer a proper suspicion of any scrutiny from Europe. They know that, if Europe is looking for best practice from central Government, it will not find it in Great Britain. For that reason we believe that the Government have failed the nation. We shall reflect our repugnance and our despair at their policies by voting in the Lobby tonight.

6.50 pm

Mr. Freeman : The hon. Members for Monklands, West (Mr. Clarke) and for Oxford, East (Mr. Smith) asked again about our response to Griffiths. As I made plain at the outset of the debate, we shall make a statement before the summer recess on our response to it, and there will be a debate in Government time at the appropriate time thereafter.

The hon. Member for Monklands, West is tilting at windmills that he has created in his own mind when he refers to the Adam Smith Institute.

Mr. George Foulkes (Carrick, Cumnock and Doon Valley) : Let us hear from the Secretary of State.

Madam Deputy Speaker (Miss Betty Boothroyd) : Order. The Minister is at the Dispatch Box, and he must be heard.

Mr. Freeman : We are carefully considering all the evidence and the results of our review of Griffiths. We shall make our announcement before the summer recess.

Mr. Andrew Smith rose--

Mr. Freeman : I am about to answer the hon. Gentleman's point, if he will listen to me.

The hon. Member of Oxford, East asked me about the cost of upgrading local authority residential care homes to home life standard. Since 1978 local authority personal social services capital outturn expenditure has gone up by 22 per cent. in real terms under this Government. It was cut by two thirds by the previous Labour Administration.

My hon. Friend the Member for Macclesfield (Mr. Winterton) made a thoughtful, wide-ranging speech in which he raised a number of points about mental illness with which I shall try to deal. There is no moratorium on the closure of hospitals for those suffering from mental illness or a mental handicap, but no hospital will close until or unless there are adequate facilities in the community. I hope that I made that clear earlier.

My hon. Friend talked about the need for long-stay care and asylum care. My hon. Friend is right that there is a need for long-term facilities for those suffering from mental illness or a mental handicap. Certainly existing buildings can and should be re-used. At the beginning of

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this debate, I said that we were well aware that such institutions should not be isolated or too large, but should be part of the community. I accept that some of the institutions that are being run down currently are physically in the community and I am sure that some of those facilities can be re-used.

My hon. Friend also asked about discharged patients in prisons. Part of the problem is that the courts do not in all cases use their present powers to send potential prisoners to hospital for mental illness care. We would encourage the courts so to do. It is also important that consultants should visit prisoners and especially those on remand awaiting trial as promptly as possible. We are in close liaison with the Home Office to ensure that that happens. My hon. Friend also asked about the inquiry undertaken by Professor Kathleen Jones and I shall respond to that shortly.

My hon. Friend, in common with several other hon. Members, also spoke about those living under the arches at Waterloo. I have also visited those who are living in cardboard homes, not only under the arches of Waterloo but elsewhere. Those poor unfortunate people and their existence are a blot on society, but I must tell the House that those people have access to medical care ; general practitioners visit those people. One cannot simply shovel all those who are living rough into institutions against their will.

Mr. Battle rose --

Mr. Freeman : No, I shall not give way.

My hon. Friend the Member for Macclesfield also asked me about visiting Parkside hospital. I assure my hon. Friend that I shall visit that hospital with him and I plan to do so as quickly as possible--in September, I hope.

The hon. Member for Southport (Mr. Fearn) properly reminded us about the importance of the voluntary sector. He was also right to emphasise the importance of long-term funding for voluntary organisations. It can be counter-productive for those organising voluntary societies to spend too much of their time chasing for money, whether it comes from the public purse or from other sources. It is important that those societies should be given some form of funding security, perhaps over three to five years. The Department of Health is carefully reviewing how it provides assistance through statutory means--we provide about £15 million a year. I am sympathetic to the hon. Gentleman's suggestion of extending the guarantee of funding, so long as that does not hamper our ability to provide new finance to new organisations when submissions are made.

My hon. Friend the Member for Norfolk, South-West (Mrs. Shephard), with all her experience in such matters, made a number of relevant points. She was right to talk about the multiplicity of ways in which to make community care work. There are a multiplicity of facilities, professions and authorities that provide such care, which represents a partnership between the NHS, the local authorities, the private sector and voluntary organisations. My hon. Friend asked about the evaluation of the pilot projects on care in the community. The university of Kent is evaluating the 28 pilot projects and the results should be available at the end of the year. The interim results suggest that the initiative has been successful. I will write to my

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hon. Friend--if I forget, I am sure that I shall be prodded--at the end of the year, and I shall send her a copy of the final report. My hon. Friend also spoke about money being locked up in mental illness and mental handicap hospital sites. My hon. Friend is absolutely right that we need the necessary facilities now, in advance of those hospitals' closure. I repeat that they shall be closed only when there are adequate facilities in the community. We are looking at a number of imaginative ways in which existing capital and revenue can be released. When we respond to Griffiths shortly, I hope that my hon. Friend will be satisfied that we are pursuing a number of initiatives in that connection.

The hon. Member for Wakefield (Mr. Hinchliffe), in common with me, drew attention to the Public Accounts Committee report. He rightly reminded us that some 23 per cent. of those in residential care wanted to be at home. I believe that that is relevant ; I would not necessarily agree with the percentage quoted by the hon. Gentleman, but the thrust of his remarks was correct. Our review of the Griffiths report has meant that we have carefully considered how resources should be devoted to help the elderly frail stay in their own homes.

My hon. Friend the Member for Bolton, North-East (Mr. Thurnham) again stressed the crucial role of the voluntary sector. Since 1978, we have increased funding to the voluntary sector by 130 per cent. in real terms. I share my hon. Friend's views about the importance of that sector. My hon. Friend also spoke about adoption, and I draw his attention and that of the House to the family placement scheme for the mentally ill. Under that scheme, mentally ill people are placed with families, outside institutions, and adequate financial resources are made available either from the social services as appropriate or from the Health Service. That scheme is in its infancy, but it is working well and I commend it to the House.

My hon. Friend also spoke about the services provided for those who are mentally handicapped or who display challenging behaviour. My hon. Friend may not know that, this week, we published a new report, the short title of which is "Needs and Responses". I hope that he will find it helpful. I also hope that local authorities and NHS district authorities will find it helpful in outlining the best practice to deal with those with challenging behaviour.

The hon. Member for Halifax (Mrs. Mahon) spoke of the resources available for local authorities and local authority homes. I must correct a statement that I made earlier about the increase in the resources available to the personal social services sector. I understated that expenditure increase, which represents 25 per cent. in real terms between 1980-88. The numbers of those who have been helped by nursing care during that time is up by 14 per cent. The number of day centres has increased by 16 per cent., the number of home helps by 28 per cent. and the number of meals on wheels by 11 per cent. The hon. Lady also asked me about consultants going round wards with lists of private accommodation. We have made it clear several times that elderly people should not be moved to private homes against their will if it means that they have to take responsibility for the fees.

My hon. Friend the Member for Stockport (Mr. Favell) talked about sheltered accommodation, which is extremely important, and I commend local authorities that have concentrated on the provision of sheltered accommodation for elderly people. It provides dignity and security in old age. He also suggested that the general practitioner

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should have a greater role in assessing care for the elderly. I am glad that he supports the new contracts that my right hon. and learned Friend the Secretary of State negotiated with the General Medical Services Committee. Under the new contract, every doctor is encouraged--indeed urged--to visit every elderly person in the practice each year, and higher capitation fees are paid for those over 75. We are ensuring that general practitioners care especially for the very elderly.

My hon. Friend the Member for Hendon, South (Mr. Marshall) talked about schizophrenics in the community. It is important to keep track of those discharged from hospital, or those who never reached hospital in the first place, who are suffering from schizophrenia. The Royal College of Psychiatrists is introducing an initiative on that, which I mentioned at the beginning of the debate. I hope that we shall make a further statement on that in due course.

The Labour party has talked tonight about the need for extra resources for care in the community, yet if one studies its proposals for the reform of the NHS and for care in the community, one sees at least three that are counter-productive for resources. The Labour party has said that it is utterly opposed to private practice in the Health Service. That will mean £60 million less, because of the loss of private beds. The Labour party has said that it will end compulsory tendering, which will mean the loss of £100 million a year. It has said that it will put local councillors and union representatives on health authorities. Nothing could be more calculated to make the management of resources in the Health Service more inefficient.

This has been a constructive debate on a vital matter. As Conservatives, we care deeply about care in the community for the mentally ill, the mentally handicapped and the elderly. The Government have increased resources over the past 10 years. We are in partnership with local government, the private sector and the voluntary sector. We will bring forward our proposals shortly. I invite the House to support the amendment in the name of my right hon. Friend the Prime Minister.

Question put, That the original words stand part of the Question :--

The House divided : Ayes 197, Noes 281.

Division No. 260] [7.02 pm

AYES

Abbott, Ms Diane

Adams, Allen (Paisley N)

Allen, Graham

Alton, David

Anderson, Donald

Archer, Rt Hon Peter

Armstrong, Hilary

Ashdown, Rt Hon Paddy

Banks, Tony (Newham NW)

Barnes, Harry (Derbyshire NE)

Barnes, Mrs Rosie (Greenwich)

Barron, Kevin

Battle, John

Beckett, Margaret

Bennett, A. F. (D'nt'n & R'dish)

Bermingham, Gerald

Bidwell, Sydney

Blair, Tony

Blunkett, David

Boateng, Paul

Bradley, Keith

Brown, Gordon (D'mline E)

Brown, Nicholas (Newcastle E)

Brown, Ron (Edinburgh Leith)

Buckley, George J.

Caborn, Richard

Callaghan, Jim

Campbell, Menzies (Fife NE)

Campbell-Savours, D. N.

Canavan, Dennis

Carlile, Alex (Mont'g)

Cartwright, John

Clarke, Tom (Monklands W)

Clay, Bob

Clwyd, Mrs Ann

Cohen, Harry

Coleman, Donald

Cook, Robin (Livingston)

Corbett, Robin

Corbyn, Jeremy

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