House of Commons Hansard Debates for 17 Oct 1989

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worthwhile reports in recent times on this or any related topic. It is in that positive spirit that we have accepted his analysis and are inviting the House to debate and discuss it.

Mr. Tony Banks (Newham, North-West) : The Minister is making an interesting speech. He mentioned the increase in home help staff and in the number of meals served by meals-on-wheels, but he did not fully acknowledge that those are provided by the social service departments of local authorities. Many local authorities, especially Newham, then find themselves penalised for overspending. Is the Minister prepared to reconsider social service departments' budgets and the provisions for those budgets in central Government funding, so that there may be a continued growth rather than the restrictions now being faced by certain authorities?

Mr. Mellor : I am anxious to make as much common ground with the hon. Gentleman as possible, and I welcome his remarks. We should be failing in our duty if we turned this debate into a partisan matter. I know that he is not anxious to do so, and neither am I--nor, I hope, will any other hon. Gentleman. It is in recognition of the contribution that local authorities have made and can make that, after the most careful consideration, we have decided to follow the analysis of Roy Griffiths and give local authorities the leading role in arranging the provision of good quality community care. We recognise that a great deal has been achieved in that sector, although we are also aware that there have been some conspicuous failures.

That new role will obviously require an increase in resources. The year-on- year discussions about local authority expenditure have led to an increase of 39 per cent. in real terms in expenditure on personal social services during this decade. There is also the question of the transfer of resources from the Department of Social Security to local authorities to boost their domiciliary care arrangements.

There will obviously be room for debate--the hon. Gentleman has his view and I have mine--about whether a local authority seeking to make good quality social service provision would fall foul of the Government's arrangements. I come from a borough that has an excellent social services department and has never been threatened with rate capping or any of the other problems. I suspect that that is an issue on which we shall not agree, but one thing on which we are agreed is that it is at the heart of the achievement of good quality community care that local authorities should make good provision. That is the inescapable conclusion to which we have come, and it is in that spirit that we are moving ahead with our proposals.

Mr. John Bowis (Battersea) : Will my hon. Friend acknowledge that, where appropriate, we must also transfer best practice from the health authority to the local authority? For example, in domiciliary care there are cases where home helps and social workers are available only during the week, and district nurses and so on take over at the weekend. I hope that my hon. Friend will monitor the changeover carefully to ensure that full care is given to such people throughout the week.

Mr. Mellor : Given that there is a continuing role for the NHS community services, it is of the essence that there

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should be a better and much more effective liaison or interface--I try to avoid that dreadful word, but it is probably the best in the circumstances--between local authority social services departments and the NHS. There will plainly be people who require medical and social care and it is necessary for the two services to interlock. If we are honest, most of us will say that the provision of home help services in our localities is not necessarily the greatest ornament in the local authority's shop window. It is a service which needs to be developed. Even in the best local authorities it leaves something to be desired. It is one of those services that we wish to see developed in our aspiration for better and more comprehensive domiciliary care for those in need.

Mr. Michael Lord (Suffolk, Central) : Will my hon. and learned Friend give way?

Mr. Mellor : With respect to my hon. Friend, I must push on ; otherwise, there is a danger that I shall detain the House for longer than I would wish.

Mr. Lord : Will my hon. and learned Friend give way on that point?

Mr. Mellor : I hope that my hon. Friend will not criticise me if I overrun.

Mr. Lord : No, I shall not. I am grateful to my hon. and learned Friend for giving way on the point of Government funding to local authorities. Those responsible for the matter in Suffolk are anxious that the correct amount of money should go to pay for the changes for which it is designed. I believe that it is called ring fencing. My county is anxious that that money should not be part of some general grant that is then used for all sorts of different purposes. Will my hon. Friend assure the House today that such money will be specifically earmarked?

Mr. Mellor : My hon. Friend is vindicated in his decision to press me to give way. He has put his finger on one of the key issues, which we are still in the process of discussing. That is as it should be, when such new arrangements do not come into force until April 1991 and when tomorrow I shall be meeting the Association of Metropolitan Authorities and we are consulting widely outside as well as discussing the arrangements within Government.

The first point that needs to be made is that we did not accept Roy Griffiths's advice on the financing arrangements, largely because, having just changed the financing arrangements between central Government and local government, it did not seem opportune to change them yet again for social services spending. It is right that hon. Members on both sides of the House should speak up for local authorities and, since one of the principal burdens of complaint in the past decade has been an excessive determination of such issues by Whitehall, I should have thought that many would welcome the fact that we are accepting that local authorities should have sufficient discretion over the allocation of resources between the different services that they have to provide without too many of those decisions being pre-empted by Whitehall.

That is the argument in so far as it relates to the totality of Government support for local authorities. My hon. Friend the Member for Suffolk, Central (Mr. Lord) may have been referring to the funding that is transferred from the Department of Social Security to local authorities.

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There is an argument that, whatever the arrangements that relate to the general transfer of funds from national to local Government--that specifically Griffiths-related transfer from the DSS to local authorities--they should be ring-fenced. The Government have reached no conclusion on that argument. It is my genuine intention and that of my colleagues ranged here in extraordinary numbers to listen with care to what the House has to say. It is well worth advancing a case for ring- fencing that part of the transfer. However, it will be wrong for me to seek now to predict how that argument will shape up.

Mrs. Maureen Hicks (Wolverhampton, North-East) : Will my hon. and learned Friend give way?

Mr. Mellor : With great respect to my hon. Friend, I really must get on. I am between the devil and the deep blue sea. No doubt the flashing lights will exterminate me at the end of my speech if I go on for too long. [Interruption.] I am sure that that is an outcome devoutly to be wished by Opposition Members.

I hope that we can take the opportunity of exploring together these important avenues, some of which have already been raised in previous discussions. I hope that, as well as dealing with the broad thrust of the proposals, those who have expertise in dealing with some of the especially vulnerable groups will not hesitate to bring that to bear. My hon. Friend the Parliamentary Under-Secretary has taken a particular interest in the development of our policies on mental health. He will want to say a good deal about that when he winds up the debate. I shall not say too much about that now so as not to duplicate what he will be saying.

The overriding aim of our proposals is to make sense of the existing over- complicated and multi-faceted system for providing health and social care in the community. In particular, we want to promote independence and choice for the individual who needs community care. In the end, those people are the most important and their needs must lie at the heart of our proposals.

We are looking for a new partnership which, if it is to be effective, must be not only between central and local government but with the private sector, the voluntary sector and the National Health Service. If it is established in a spirit of constructive common sense and a businesslike responsibility, it will enable better and more appropriate care to be delivered to more people.

That brings me to the central pillar of our proposals. As I have already said, local authorities will be responsible for co-ordinating the appropriate care packages for those who need them. Our acceptance of Roy Griffiths's analysis is full-hearted on that point. We spent a long time thoroughly considering all the options and decided that this was the most practical way forward.

We want it to work out, and that is why the White Paper will have running through it a conscious awareness, 21 years after Lord Seebohm's famous report, that the Seebohm concept of the social services department remains highly relevant to our needs today. Lord Seebohm described an integrated social services department as "enabling the greatest possible number of individuals to act reciprocally, giving and receiving services for the well -being of the whole community".

We believe that the key components of community care must be services which respond flexibly and sensitively to individual needs, particularly those of the most highly dependent people, and which allow for real consumer

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choice. The Government have set the framework for those services with those objectives in mind. There are three objectives and I shall set them out.

Our first and foremost aim is to ensure that, wherever possible, domiciliary, day care and respite services are used to enable people to continue to live in their own homes for as long as possible. Existing funding structures have worked against that in the past ; but the unified social care budget that we propose, to be managed by local authorities, will provide a new incentive to give priority to those services for people at home, and to direct them towards those in greatest need of support. As I have said, many people will need long-stay accommodation, and we want them to have it. I am convinced that better domiciliary care will meet a real demand.

Secondly, we want to ensure that service providers make support for carers a high priority. We all recognise that carers make an enormous contribution, but we do not always do enough--indeed, sometimes we do not do anything--to help them. Pious acknowledgement of the role of carers is not enough ; we must develop practical ways of helping them, and I believe that the provision of respite care schemes must be a priority. Policy for carers is one of the most crucial aspects that we want to develop, and I look forward to receiving further advice from the House this afternoon.

Thirdly, we want to ensure that service delivery is based on a proper assessment of need. Social services departments will be familiar with the process, but the new financial arrangements will require the task to be undertaken in a different context. That will involve taking account of all the individuals' circumstances, including their health, and the several different ways of meeting needs within the broad objectives of community care policy. The basic aim is an individual assessment of need designed to offer the best possible outcome within the resources available. Clearly, the amount of time and effort required to make the assessment will vary considerably from case to case, as will the need to consult other agencies ; but we want to ensure that when consultation is needed it takes place, particularly when residential care is being considered. An input will plainly be necessary from the National Health Service as well as from local health authorities.

Although in some instances collective consideration will be necessary, it is vital for us to recognise that in many cases not collective but individual responsibility will be essential. We neither need nor can afford a case conference on every decision. We shall want to develop with the social services departments good practice in case management, with the aim of ensuring that named individuals are responsible for individual cases. That is the basis of the exercise of responsibility within a properly disciplined framework in social services departments. I hope that those will be seen as common-sense concepts with which we can all agree. Another key part of our proposals is the continued development of the independent sector, supplementing rather than replacing--I stress that--local and health authorities' provision, and therefore increasing the available range of options and widening consumer choice.

Mr. D. N. Campbell-Savours (Workington) : Will the Minister give way?

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Mr. Mellor : I will give way in a moment.

A steadily increasing number of authorities are already moving to become "enablers", and we wish that trend to continue. At a recent social services conference in Coventry, I was encouraged to note the number of authorities across the political spectrum that recognised that that was a proper role for them to be asked to fulfil. It makes a great deal of sense to look at what the independent sector can offer, in terms of both quality and cost- effectiveness.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich) : Is the Minister aware that his Government's policy of deliberately moving people out into the private sector, and then limiting the amount that they could receive in social security, is causing a real problem for many of my constituents? Having found themselves in private homes, they can no longer afford to stay there, and will soon be put in the intolerable position of having virtually nowhere to go. How does the Minister assess that idealised picture of a mix of private and public health care--which is not being provided under his command?

Mr. Mellor : I think that the hon. Lady is being less than fair. I have already pointed out that there has been a hundredfold increase in the provision of resources to enable people to enter long-term residential care. The number who have availed themselves of that opportunity has been far greater proportionately than the increase in the number of elderly people over the past decade.

I have acknowledged--and I am happy to repeat--that it is of the essence to look at the two variables. The first is what is right and proper to be charged by way of fees in these circumstances. One of the advantages of a mixed market is that there is competitive pressure to offer value for money. The second is the need to look at the amount of resources devoted to each individual.

My right hon. Friend the Minister of State for Social Security, who is present today, has said, notwithstanding the many other matters on his plate, that he appreciates that it is of the essence to keep under review the adequacy of these provisions. But I am a long way from being persuaded that the Dickensian picture that the hon. Lady paints is anything like an adequate or fair description of what is happening now.

Ms. Joan Walley (Stoke-on-Trent, North) rose --

Mr. Campbell-Savours rose --

Mr. Frank Field (Birkenhead) rose --

Mr. Mellor : I have an imploring trio, but I think the hon. Member for Birkenhead (Mr. Field) is the most irresistible

Mr. Field : The point that my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) made is vital. Many of our constituents, after a lifetime of contributing to the NHS, expected to be given a free service when they needed it. They now find, when they are put in what the Minister described as residential care, that they are in difficulty. In the first instance they may have found the situation satisfactory because the fees were covered in full. Increasingly, however, many of them are finding that the DHSS is not meeting nursing home fees in full. Many families are, fortunately, able to make additional

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contributions to ensure that the fees are paid, but gradually an increasing number are finding that they are unable to do so. The result is that, whereas many of our older constituents expected to be cared for free in hospitals, they are finding now that they are cared for initially free in residential care but are then faced with bills of £10, £20, £30 and even £40 a week. What does the Minister say to those constituents and families who cannot make up the difference by topping up the fees, who previously enjoyed a free service but who are now expected to make contributions?

Mr. Mellor : The hon. Gentleman, whose authority and good will on these issues I recognise, paints a less than fair picture. I cannot believe that he wanted to make one point in the way in which I heard it--the idea that those in residential care should have been better placed in hospital.

Mr. Field indicated dissent.

Mr. Mellor : I am glad that the hon. Gentleman was not implying that. It is of the essence of sensible provision under whatever Government may be in power that we do not use hospitals as places for the long-term care of those who do not require medical as against social care.

Mr. Field : There was no price tag.

Mr. Mellor : Some saw that as a clear advantage. In other situations, it meant that people who could reasonably have made some contribution towards their residential care did not do so. We must accept that we shall increasingly be living in a society in which, while it is true that many will require full protection--and they are getting it, because I have it on the authority of the Minister of State that the majority of people are receiving full cover in this connection--some will not be receiving full cover because they and their families can make up the difference without it being unreasonable for them to do so.

I know that the hon. Member for Birkenhead wants to be fair, and he will appreciate that while in any of these policy areas one can never have all gain and that there will always be problems, my right hon. Friend has acknowledged the need to keep these issues under review. It has been a major benefit this decade that there has become available good quality residential care for the elderly provided by the private sector largely financed by the public sector. No amount of quibbling at the margin can deny that that has been a major achievement of the Government.

Ms. Walley : In relation to fairness and placing people in the independent sector, perhaps the Minister will address a problem that was represented to me at my surgery on Friday. An elderly pensioner couple with a sister in a private residential home told me that she was in receipt of £10 a week less than was needed for her stay there. The elderly pensioner couple are having to find that £10 every week out of their pension of £74 to make up the shortfall between what is available from public funds to keep their sister in that home and what is being charged by the independent sector.

I assure the Minister that that is not an isolated case. People throughout the country are facing similar situations. We cannot rely on the independent sector when

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there are not sufficient funds available to cover that sector's charges. What answer does the Minister have for our constituents who are facing such problems?

Mr. Mellor : I appreciate the concern felt by the hon. Lady. I have already said that it is of the essence to assess the reasonableness of the fees charged and the reasonableness, in individual circumstances, of the amount of public assistance given. The hon. Lady will not expect me to give a substantive answer because, although I obviously know something about these matters, they are not my primary departmental responsibility and, secondly, it is difficult for me to comment on an individual case. I suggest that she writes about the facts of the case to my right hon. Friend the Minister so that the matter can be looked at.

Plainly, there are some problem cases that we must examine. I have already acknowledged that, and I do not mind doing so, but if we are to have a balanced and sensible debate, it would be helpful if all Opposition Members acknowledged that the reason that we are in this position is an unprecedented expansion in the availability of an area of care that was never available before the Government came into office.

In this mixed economy of care, it is clear that ensuring quality will be vital. Quality is at the heart of our concern. No agency has a monopoly of virtue on quality, but we will be looking to local authorities to ensure that the care provided is not simply the cheapest, the most convenient to supply or just a ratification of the way things have always been done, but the package that best meets the needs of the individual client.

To define good quality is not easy, but I hope that local authorities will begin by listening to their clients. Recently I was particularly glad to read an article in The Guardian by Tessa Jowell--a name rightly respected in this area--who made the point most graphically. She concluded a piece about local authority provision, which had food for thought for all of us and not just local authorities, by saying :

"Local authority provision is a badly directed mish-mash whose ineffectiveness frustrates or dispirits the provider and often demeans the beneficiary. The solution in local authorities is to listen to the customer."

I hope that that kind of straight talking will persuade local authorities to see the need for change and improvement not as a threat, or something to bridle at defensively, but as a shared endeavour which central and local government should work on together.

Mr. Tom Clarke (Monklands, West) : It is appropriate for the Minister to quote Tessa Jowell as she was a well-known supporter of the Disabled Persons (Services, Consultation and Representation) Act 1986. The Minister will note that I waited 37 minutes into his speech in order to hear what the Government plan to say to local authorities--and he has an opportunity to do just that, when he meets the Association of Metropolitan Authorities tomorrow. Where do the Government stand on this Act, or are we to assume that the off-the-cuff comment of the Secretary of State on 12 July now represents the Government's definitive position?

Mr. Mellor : I was asked this question at Coventry and I understand why, but all I can give is the same answer. I have no further announcements to make of further

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progress in implementing other parts of that Act, but I have plenty of other plans and schemes and everything must fit in to a sensible order of priorities.

Service specifications and monitoring have a vital role in local authorities' own services. Contrary to what some have said, we are not stopping local authorities providing their own old people's homes and so on. What is clear, however, is that local authorities will need to prove better than they have ever been able to do that they are properly monitoring the standards within their own homes as well as having an arm's- length agency capable of dealing fairly with residential homes that lie within their areas. In the years to come, their ability to be fair will be one of the key tests of whether we were right to charge local authorities with those responsibilities under Griffiths.

I should like to commend those local authorities that are already developing quality assurance work within their social services departments. It is not enough that social services departments should believe in what they are doing : they should be capable of demonstrating that what they are doing is of good quality. That is essential.

Turning briefly to planning and monitoring, while quality will be an essential element in the new planning and monitoring system, there are other issues that we need to grasp. Accountability will be a central plank of an effective, high-quality public service, and we shall be looking to satisfy ourselves that authorities have plans which are in line with national policy objectives. We shall be taking new powers to call for reports from authorities where we have reason to think they may be needed. We shall want the social services inspectorate--which is well respected by local authorities of all political colours--to have access to plans and to offer advice on them. We have no desire to establish an over-bureaucratic or heavy-handed system, but it is important that future community care arrangements are subject to that additional form of public accountability.

Let me say a word or two about resources. I have already made it clear, and I am happy to do so again, that the Government have an important role in ensuring that local authorities have the financial resources they need to tackle these new tasks of assessing need, arranging care packages and buying residential and nursing home places. Our proposals are aimed at making sure the best possible use is made of all available resources, whatever their source. They represent a challenge to local authorities in terms of developing their role as enablers encouraging quality control, giving value for money, improving community involvement and enhancing consumer choice.

We have not under-estimated these demands, and recognise that local authorities will need the means to meet their new responsibilities. That is why we shall be transferring to them the money that the Government would otherwise have provided to finance care through social security payments to people in residential and nursing homes. Decisions on the amounts to be transferred, which will allow for projected growth in the numbers of people needing support, will be taken in next year's public expenditure survey. I am well aware of the importance of those discussions proceeding well. That is why we are having intensive discussions with local authority associations and others in trying to ensure that we reach some balanced judgment as to what that figure should be.

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Mr. Campbell-Savours : Can the Minister explain what is happening in Brighton, as in many ways that is at the beginning of the route we are on? We understand that in Brighton a health authority has in effect handed over to a housing association responsibility for the care of 16 to 20 people with learning difficulties. The housing association has told the people who currently look after those people that they cannot have jobs if they seek to remain in the same union. Clearly, the housing association has done that because it considers that there are economies to be made and money to be saved if the people working for the housing association who take over that care are not members of the trade union they belong to in the Health Service. Is that the community care arrangement one wants for people with learning difficulties, whereby one hires people without skills, who have not been involved in that care in the Health Service from outside in the market, simply to save on wages and conditions? Is that what we are to expect?

Mr. Mellor : The hon. Gentleman has not made the best possible use of the time he took for his intervention. Obviously, he cannot expect me to comment on a case about which I know nothing. My principal curiosity is why the hon. Gentleman who represents Workington should be so fascinated by what happens in Brighton, which, so far as I am aware, is extremely capably represented by two of my hon. Friends who probably get on perfectly well without him on that aspect. Let me say a word or two about training. We recognise that there is a significant training agenda here for local authorities, who must now be starting to consider how to meet the training needs of their staff and to plan new training programmes. At last month's social services conference in Coventry, I was glad to announce the continuation in 1990-91, at present levels, of the training support of an additional central grant of £2 million next year to support post- qualifying training in management which will be at the heart of all this. Authorities should be able to take advantage of these in preparing their training plans for the new community care arrangements.

Obviously, however, the partnership goes wider than between Government and local authorities during the implementation period. It stretches out to embrace all those involved in community care--health and social services, independent and statutory sectors, providers and consumers, advisers and assessors, care managers and carers--and it will persist as working together in a real sense after the new mechanisms are in place. Our ability to devise systems whereby those various parts of the system can work together will be a test of whether we have succeeded.

I am to be involved in this area of activity at a time when there is a real chance of making a decisive move forward towards better community care. There is, I realise, a wealth of difference between stating policy and putting it into practice. Nevertheless, I believe firmly that, given strong management and a businesslike approach, there is much that can be achieved. We can get better at meeting the needs of the public to whom we are all of us accountable. The focus should be on the needs of the individual, whether a child with a mental handicap, and elderly person who, despite disabilities, wants to remain at home, or a person with mental illness who needs help facing the problems of living with dignity with his disease.

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I conclude with another passage from Tessa Jowell's article : "It takes time, patience and a commitment to change, rather than a lot of money, to translate the vast range of individual experiences into service changes that are recognisable to the people who use them."

I add to that that of course money will be needed. I gladly concede that, but people need also to find the time, the patience, the commitment to change and the effective organisation and management of these services. If that is absent, no amount of money will give us the community care that we all want to see.

Those people who are cared for and those who do the caring deserve a better deal from community care. That is the spirit in which we have announced our proposals. I hold firm to my belief that central Government, local authorities and all the other major players in the community care world will be better able under these arrangements to forge the new partnership needed to give that better deal to the increasing number of people who need it.

4.47 pm

Mr. Robin Cook (Livingston) : This is our third debate on community care in the past six months. It is the first such debate in Government time, and it was widely expected on both sides of the Chamber when the debate was announced in July that this would be the occasion when the House would debate the White Paper we were promised on 12 July in the Secretary of State's holding statement. In reply to a question from my hon. Friend the Member for Monklands, West (Mr. Clarke) the Secretary of State said, on the timing of the White Paper :

"It will probably be in the recess."--[ Official Report, 12 July 1989, vol. 156, c. 998.]

I believed him. I certainly believed him when I discovered that we would be debating this matter on the first day back after the recess because I could not believe that anyone would be so foolish as to expose himself to a debate on this issue unless he was confident that the White Paper would be published in advance. I now know not to believe him next time.

Like the rest of the House, I tuned in to the Secretary of State's address to the Conservative party conference. I was flattered to note that the Secretary of State found time to make two references to me, but they were two more than the references he made to the Government's plans on community care which have fallen back down to the depths of his mind. It is perplexing that the delay is not just a matter of three months since the holding statement in July. It is now a delay of 19 months since the Griffiths report was published. The Government have taken close on two years to get themselves together to publish their response to a report which was written in just over one year. When one considers that laid-back timetable--

The Secretary of State for Health (Mr. Kenneth Clarke) : That is what the hon. Gentleman was going on about last time.

Mr. Cook : The Secretary of State says that this is what I went on about last time, but if the case against the Government's delay was strong in June, how much stronger it is when we meet again in October.

It is perfectly clear what is getting priority under the Secretary of State at Richmond house--his plans to

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convert the NHS to market medicine. That means focusing on conditions that can be cured quickly and therefore can be priced and delivered on price. That means marginalising infirmities, disabilities that cannot be cured, that require long-term, low-technology care and nursing, that are expensive without ending, and cannot be made a commercial proposition.

One consequence of this further, unanticipated, delay--about which I think we are entitled to press Ministers, particularly the Secretary of State, since he is with us today--is the problem of the vanishing interval available for consultation on the White Paper when it is published. I grant that this is not a ministerial team noted for lending a patient ear to consultation. They have not paid a blind bit of notice of the storm that the last White Paper produced, but there it is--for form's sake, presumably they intend to have some sort of consultation when they produce the White Paper.

We understand that, if there is to be legislation arising from the White Paper, it will be included in the Government's Bill on the National Health Service proposals which, although unloved, unpopular and consistently rejected by four to one by public opinion, they intend to whip through the House.

I keep reading in the press that that Bill will be in Committee before Christmas. That is using the universal law of the guilty--if it is to be done, it is best that it is done quickly. Where does that leave the proposals for community care?

Mr. Mellor : The hon. Gentleman's debating points seem always to move further and further away from any anchorage in reality. He has chosen to make complaints about consultation and delay. Would he care to tell us which group, whose interests he claims to represent today, has briefed him to say that there has been inadequate consultation? He knows that, as I have already said, there has been the closest consultation with all local authority associations and the Association of Directors of Social Services. If it is taking a week or two longer to complete the White Paper, it is because of the thorough examination that is now going on.

Is the hon. Gentleman just making debating points or will he settle down and debate the topic seriously?

Mr. Cook : Since the hon. and learned Gentleman asks me, I am happy to say what groups I consulted when preparing this speech. They are the Spastics Society, MIND, Mencap, Age Concern and the Association of Metropolitan Authorities, all of whom remain quite mystified as to the financial arrangements that will flow from the holding statement last July and are anxious to obtain the White Paper.

Mr. Mellor rose --

Mr. Cook : I shall give way again, but I want to ask one question. One of those organisations told me that it has heard a rumour that, because of the narrow interval that will now exist between publication of the White Paper in late November and publication of the National Health Service Bill in early December, the Minister intends to put necessary clauses arising from the White Paper on community care before the Committee that considers that Bill. That would be only too typical of the contempt with which the Government have treated parliamentary procedure.

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Since the hon. and learned Gentleman is so anxious to intervene, I shall ask a specific question. Will he give us assurances that the House will have those clauses on Second Reading of the Bill so that it may be afforded the courtesy of debating them on Second Reading?

Mr. Mellor : The hon. Gentleman--[ Hon. Members :-- "Answer!"] The hon. Gentleman wants to wriggle off a hook of his own making by posing another question. He mentioned four organisations, one of which I am meeting tomorrow. He made the accusation about lack of consultation. Will he tell us which of the four organisations complained to him about lack of consultation by the Government during the preparation of the White Paper on community care?

The hon. Gentleman can wriggle and jiggle. That was the point he was making and it is a bad point, as he well knows.

Mr. Cook : I can answer that point fairly and squarely. All of them said they did not have the July statement and that they needed clarification.

The Minister cannot escape the fact that the Government produced a statement in July and that all the organisations in this field remain ignorant of its meaning.

The Minister said that I produced another question. I have asked only one question of the Minister so far, and it is one that he has singularly failed to address.

I am grateful for the Minister's intervention--interventions at the Dispatch Box usually are enlightening. He has not ruled out the possibility of these clauses being produced in Committee. That is typical of how the Government proceed once a Bill is before the House. No doubt they will already have guillotined it. Nothing illustrates more clearly the low priority that the Government attach to community care for the disabled, the elderly and the mentally handicapped than their reducing clauses relating to them to a Committee point.

I shall now consider what we know about the White Paper, which comes from an essay, "Plan for a White Paper", published by my hon. Friend the Member for Peckham (Ms. Harman), which is more enlightening about the likely contents of the White Paper than was the Minister's speech.

As the Minister knows, concern about the draft synopsis for his White Paper focused on the passage about non-residential services. In that passage, the draft says :

"Local Authorities : To encourage the further development of mixed economy of care, to encourage diversification of private providers' entry into domiciliary care market."

I have asked only one question so far and I think I am entitled to a second. What does that mean? I am sure that it does not mean a greater partnership with voluntary agencies because there is already a flourishing partnership between local authorities and voluntary agencies. Most lunch clubs are funded by local authorities but administered by voluntary groups. The only thing that holds up expansion plans is lack of local authority resources. Nor can it mean that commercial companies will be allowed to enter the market to sell services to the consumer, because commercial companies can do that already and they have not shown the slightest interest in entering what is an unprofitable market. What I presume it means is that local authorities will be forced to hand over chunks of their provision to the commercial sector. That brings me to my second question. Does this bode putting home helps out to competitive tender at some future date?

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