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Column 94During the summer recess I had a dialogue with the developers of a new home in the Wakefield area, which will provide 100 beds. When I was starting in social work 20 years ago, I remember that from Government level efforts were made to establish a policy that homes should be built with no more than 35 beds. It is unfortunate that we seem to be returning to the huge impersonal institution. The owner of the home in the Wakefield area told me by letter that a home that provided 100 beds provided economies of scale. In other words, the owners can make more money if they pack in more people. That worries me.
Leaving care to the market means insecurity in many instances for those who need to be in private homes. The inability to meet fees has been mentioned several times by hon. Members on both sides of the House, and we are all aware that many of our constituents are having to top up and subsidise within their families because income support is inadequate. I shall introduce tomorrow a ten-minute Bill designed to give people security when they are in homes. That form of security is not provided now.
With the development of the private sector, we talk about community care, and the Minister has talked about putting money into that form of care. He has spoken of a hundredfold increase in provision, but he was referring to institutional care. The community care that he is talking about often means that people have to move into communities that are many miles from where they have lived hitherto. That is not community care.
The Minister told us that he seeks the advice of the House on what should be included in the White Paper, but the Government have had more than 10 years to develop a policy. Instead of developing one, they have been content to sit back and allow to develop what can be described only as a shambles of a policy of community care. Any action that the Government have proposed has been anchored to a free market ideology that prevents rather than facilitates the development of a wide range of provision to meet the varying needs of the elderly.
I believe that the selfishness and greed engendered by 10 years of Conservative Government are rapidly coming to an end. We have on the horizon the likely election of a radically different Government with a radically different philosophy, who will be seeking to develop markedly different policies from those which are now available under a Government tied to the market.
Central to the strategy of a Labour Government will be a major policy commitment that those who wish to remain in their own homes should be enabled to do so, even if that means enormous expense to support them and to support the carers who give up so much of their lives to ensure that others can remain in their own homes. In taking that course, carers face great difficulties. With such a policy, there will have to be the development of radically new models of care that do not stem from the institutional framework. We have been stuck with the institution because of the hangover of the Poor Law. We still have the mentality that prevailed those many years ago. We must bring it to an end and move in the direction that has been taken by many other countries. It has been decided elsewhere that there should be a move away from the idea that people should end their lives in an institution.
I look forward to the development of elderly person support units, which makes intensive efforts to ensure that the elderly remain, with support, in the community. The Labour party is advocating flexible home-care provision. It should be possible, if necessary, to support someone
Column 95intensively 24 hours a day, seven days a week and 365 days a year. That is reasonable and the option should be available if people prefer it.
Housing provision has been neglected as a result of the market being left to determine care. Many elderly people do not have the resources to purchase. This means that they cannot enter the private market and the private market has not developed strategies to care for those who are highly dependent. We must develop sheltered housing that enables those who are extremely dependent to be looked after in their own homes. They should be able to remain in their own environment. They should not have to be moved into impersonal institutionalised care. That must be a central plank of the policy commitment of the next Labour Government.
Above all, we need vision and commitment, but we also need planning. Thought must be given to the future. We cannot leave issues as serious as those that we are discussing to the whims of the profit and loss account, the market, or the speculator, but that is precisely what the Government have done with the support of £1 billion of public money each year.
We have had 10 years of bankrupt Tory ideology. That is the only way to describe the experience. Members of this place are only too well aware of the tragic cases with which they are confronted in their surgeries. My colleagues and I meet people who are facing appalling consequences. I look forward to the next few years. I believe that we shall see the election of a different Government who have a different strategy and philosophy from those which we have seen pursued by the present Administration. The next Labour Government will alter radically the provision that is made for the elderly and many other groups who are currently grossly neglected by the present Government.
Mr. Michael Irvine (Ipswich) : Two months ago in Ipswich, reductions were implemented in the amount of home help available for the elderly and disabled people. It was not that overall expenditure on the home help services was being cut ; the problem was that the rapidly increasing demand for home help was putting severe pressure on even an increased budget. Part of the pressure was due to demographic reasons. We have seen an increase in the number of people living in Suffolk aged 75 years and over of nearly 60 per cent. during the past two years. That increase is set to continue. An even more significant source of pressure stemmed from the expansion of home help services to provide personal care for the seriously disabled and for those recovering following hospital operations. As the National Health Service has become more efficient, as more operations are performed, and as people are discharged at an earlier stage following operations, there follows a massive increase in the burden on the home help services.
Home help that consists of shopping and cleaning may involve no more than three or four hours a week, but home help that involves intensive personal care of someone who has returned at an early stage after a hospital operation often involves five or 10 times that number of hours. That is a significant factor to be considered in the face of the increasing burden that is being placed on home help services.
Column 96The pressures are not set to diminish. Indeed, they are set to intensify. It is clear to me that significantly increased financial resources will be required to meet the pressures. I was glad to hear my hon. and learned Friend the Minister of State acknowledge that fact in his opening speech. I was glad also to hear that he has not closed his mind altogether to the ring fencing of the contribution from central Government. It is certainly the strongly held view of the Suffolk county council chairman of social services that ring fencing is a necessary and important safeguard.
However, increased resources and ring fencing by themselves will not be enough--every bit as important will be the effective and efficient administration of community care. Voluntary organisations make a magnificent contribution, but there is always the risk of lack of co- ordination with other groups and agencies. There is a need for permanent, specialist, high-quality administrative support to guide the voluntary groups and to make the maximum of their considerable efforts. We need co- ordination, accountability and clear lines of responsibility, and I am glad that the Government have accepted the recommendations of Sir Roy Griffiths.
It is important to recognise that a great deal more staff will be required to meet the additional demands and pressures of the next decade. I agree with paragraph 35 of Sir Roy's letter that accompanied his report, which said that there was a risk of over-elaboration, both of the professional input and of the amount of training required for such staff. As Sir Roy pointed out, many of the needs of the elderly and the disabled are for more practical help such as shopping, cooking, cleaning, and so on. It would be a waste of professional qualifications to overtrain people for that job. However, that does not mean that there should not be the most careful selection of those called upon to work as home helps.
The elderly, the disabled and the mentally infirm are vulnerable, and never more so than in respect of those who have access to their homes. The opportunities for theft, manipulation and the like are only too obvious, so those who help them in their homes must, above all, be honest, tactful, responsible and sympathetic. I am glad to say that, on the whole, standards are high, but there may be pressures on those standards in the coming decade because the very demography that is placing increasing strains on home help and other social services will be accompanied by trends in demography and social factors that will reduce the number of people available to carry out those services. There is a risk that the standards of honesty, tact, responsibility and sympathy might slip, and it is important that that is not allowed to happen.
I wish to touch on a theme mentioned by many hon. Members, which is the role of the carer at home. Family care and support is often the most effective and appreciated care of all. It is almost certainly the cheapest. In calling for improved and more plentiful community care, we must never forget the risk that when the state or a local authority takes responsibility, it might dull the sense of duty that every family should feel towards its elderly or less fortunate members. The state and the local authority can and should give support to those family carers, who bear a very heavy burden indeed and need respite and help. I agree with the wishes expressed by my hon. Friends the Members for Eastleigh (Sir D. Price) and for Macclesfield (Mr. Winterton) that, when the White Paper is published, proper account will be taken of that very important factor.
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Mr. Tony Worthington (Clydebank and Milngavie) : In the short time available, I shall restrict my remarks to the issue of the mentally ill. I wish to draw attention to a statement made by the Secretary of State for Scotland :
"I propose to maintain the current arrangements which have generally worked well for sharing responsibility for services to the mentally ill between health and social work authorities."--[ Official Report, 12 July 1989, Vol. 156, c. 534.]
I simply do not understand where the Secretary of State gets his information from or how he can reach such a conclusion. The relationship between the social work and the health authorities in Scotland is quite disgraceful. For a long time I was involved with Strathclyde regional council and the linking with several health boards. Everyone in the social work authority saw as one of the areas of shame the total failure to develop adequate relationships with the health boards.
Scotland has twice as many in-patients in mental hospitals as the remainder of the United Kingdom. Throughout the whole of Scotland during 1987 only one local authority had a day centre for the mentally ill. There is no comprehension of the numbers of old people who are sent to prison ; Scotland is only just beginning to count them. Scotland only received support financing in 1980, four years later than England and Wales. It was only in 1985 that support and joint financing were introduced to put Scotland on an equal footing with the remainder of the United Kingdom--10 wasted years after it had been introduced in England and Wales.
I regret to say that the Secretary of State for Scotland, unlike the Secretary of State for Wales, has failed to give any lead in that area. Once again, Scotland lags behind Wales, which has had a co-ordinated strategy for the mentally handicapped for the past 10 years and has now introduced a co-ordinated strategy for mental illness. Scotland has nothing like that. I do not know how the right hon. Gentleman can claim that the relationship between the social work and the health services is working well. In 1979-80, the very excellent report "Scottish Health Authorities Priorities for the Eighties"--SHAPE--identified as category A priorities care of the elderly, the mentally ill and handicapped, physically handicapped and prevention and community nursing--all issues in the community care area.
Despite those category A priorities, at the end of that decade the proportion of expenditure on areas such as the mentally ill and handicapped had fallen--yet the Secretary of State says that it works well. The right hon. Gentleman played his part in producing the "Working for Patients" document, which achieved something quite remarkable--in its 100 pages it failed to mention mental illness. It takes a great deal of effort to write 100 pages on health and fail to mention mental illness. The numbers of the mentally ill are awesome--1 million people a year need some form of psychiatric care, and one person in eight will spend some time as an in- patient during his lifetime.
The White Paper is nothing but a cost-cutting exercise because it just deals with areas where a great deal of money is spent, such as acute care and drugs, and questions how that expenditure can be reduced. It does not address the Cinderella services such as mental illness and care of the elderly.
The White Paper is obsessed with increasing the number of a doctor's patients. I am reminded of a visit that I made during the recess to a hospital in my area and the
Column 98comments made there by mental health patients. One of them wrote to me saying that five years ago she found that getting a general practitioner to take her on to his list was a problem. That person said that she had since gathered information from other patients, one of whom was told, "I am not taking you. You will call me out at night." Another had to try three doctors, each of whom turned her down, before the fourth took her on his list. The letter went on : "My own case was dramatic as a local doctor's receptionist accepted me and made an appointment for the end of the week. My hospital registrar then wrote to the GP telling him my history and on the Thursday I had a recorded delivery letter stating that a mistake had been made and the GP could not take me on. The appointment was therefore cancelled."
That was before the "Working for Patients" document. I cannot see how we can have an adequate service that just needs smoothing. We should point out to the rest of the United Kingdom that we had a Minister who was responsible for community care. The responsibility for health and social work was shared by the hon. Member for Stirling (Mr. Forsyth). However, he has now been given other duties saving endangered species.
We must stop the crass target-setting that is going on. Gartnavel hospital has 165 patients in long-term care. The target is for that to reach 19 in five years and many have already been discharged. That leads to the sort of thing that happened to one of my constituents. She had a brother who had been in a mental hospital for 37 years and she had been approached by medical staff who asked what she intended to do to provide a home for him. Such a thought was horrifying to the brother and the sister.
We must also change many of our stingy attitudes to the voluntary organisations. It is offensive to expect voluntary organisations to raise money which is then matched pound for pound. The backbone of many of those voluntary organisations is exactly those carers about whom many golden words have been spoken today. Lord McCluskey says : "If the Navy needs three new frigates, we don't tell the Admiral of the fleet to run a charity bazaar in order to match pound for pound the monies to be made available from the taxpayer. In the field of community care those, particularly the volunteers, who seek to provide services are faced with just such requests. It is depressing for those who want to offer their skills to have to devote so much of their time to trying to raise money from charities and to jump through bureaucratic hoops."
Such an attitude must be dropped.
One point that has not yet received adequate attention relates to the need to set up patients councils for the mentally ill and to ask the patients what they think is needed. The professions say that they own people. Whether they are social workers or doctors, they say, "A bit of me is what these people need." Patients councils would put more emphasis on, for example, the need for asylum, for there to be some place to which they could escape ; on the need for work opportunities ; on the need for housing opportunities and on the need for crisis facilities and support, particularly at weekends. Such issues would loom much larger than they have so far, as would the need to support self-help groups.
We are glad to have had this debate. The test is now there for the Government. Hon. Members on both sides of the House have had 30 years of pious words. They must come to an end. As Griffiths said, the one thing that we cannot do is nothing. We have done nothing for far too long.
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Mr. Andrew Rowe (Mid-Kent) : I am delighted that the hon. Member for Livingston (Mr. Cook) has just re-entered the Chamber. I have attempted to educate him before but I will try to do so again because he is an hon. Member with much to offer if he learns a few lessons. The important thing for the hon. Gentleman to understand is that Kent may appear still lower in the league table of home helps over the coming year because it has changed the whole nature of the service that it offers. It has preferred to go for home care service which, as my hon. Friend the Member for Ipswich (Mr. Irvine) pointed out, is a different kind of service and includes such assessments as whether somebody needs help to get out of bed or to get back into bed and to be cared for in a variety of different ways. That intensification of service is proving a great deal more useful and valuable than simply an hour or two from a home help. Kent will remain unashamed of its appearance among the home help statistics. It is worth remembering that we should have a mixed economy in care. That is the other important element. I intervened earlier to say that it is a serious mistake for people who have been in the habit of choosing how to dispose of their resources throughout their lives and who have had the opportunity and good fortune to do so, suddenly to arrive at a stage in their development where they become the passive pawn of some institution, however well meaning. As my hon. Friend the Member for Gedling (Mr. Mitchell) said, the picture of community care and the discharging of people, particularly from hospitals for the mentally handicapped, is far too gloomy. When a mental handicap hospital in my constituency was half empty, its administrators kindly thought that it would be fun for those already discharged into the community to visit their friends who were still there. They took them in a bus to the hospital but only one patient was prepared to get out of the bus because they were so terrified that they would have to stay, despite that being a well-run mental handicap institution. Where community care works well, it is vastly to be preferred to big institutions.
I congratulate the Government on the appointment of Sir Roy Griffiths. It is a fine example of the way in which private enterprise can assist the public sector. His contribution to the debate has been much valued on both sides of the House. He took a far more realistic view about the amount of resources available. I share with every other hon. Member who has spoken the belief that we need more resources for community care. We need them not only because of the demographic profile but to provide a better deal for carers, more respite care and for all the other reasons that have been given. However, if we were to add up the cost of all the demands that have been made in the Chamber, either explicitly or implicitly, we would arrive at a figure so unrealistically high that it would be a cruel deception to everyone to imagine that such a sum could be made available. When Sir Roy Griffiths said that he was concerned about the proper expenditure of whatever sum was available he was speaking realistically.
There is a clear need for a much better assessment of clients and potential clients. For example, clear evidence is mounting that a substantial number of confused elderly are confused because their bodies are in a state of
Column 100imbalance due to drugs. When people lose a spouse they can become very stressed and unable to sleep well. The doctor then gives them tranquilisers and they may then develop some sort of headache which the doctor treats with another drug, and so the spiral goes on. It has been shown that if a proper assessment of such confused elderly people is carried out and they are gradually restored to a proper balance, they are frequently able to live in their own homes without being a burden on the community care services.
It is vital that we build on the strengths of all the professions. People have professional pride and attachment and, just as some doctors are reluctant to see their patients handed over to social services departments, so teachers of children with special needs have a similar anxiety. A great deal of training and careful joint work will be needed to obtain an effective system of working together. Teachers, speech therapists and the professions allied to medicine must be brought into the system. One of the reasons why the parliamentary panel for personal and social services extended an invitation to the professions allied to medicine to meet it and the support group--the four professional social work associations--is that suddenly those professions find themselves with a third major purchaser of their skills. It is important for them to start making links.
It is vital that we give the client or patient a real choice. My hon. Friend the Minister should remember the demands that we made earlier for there to be opportunities for advocacy for those not able to choose for themselves from the varied or unvaried, menu, presented to them by the social services departments. I am cautious about having "professional" advocates because there is a danger that as they become more experienced they may start to hype up the demands of their client to what will eventually become a totally unrealistic proposition. We need to think about that.
One issue that is fundamentally important but which will not feature in the White Paper is housing design. How realistic is it to assume that we will be able to keep in their own homes the 6 million old-age pensioners whom we expect to have by the year 2000 if the homes in which they are expected to be kept are structurally unfit to shelter them? At a recent seminar that I ran with the Helen Hamlyn Foundation, which looks after frail elderly people, a shopping list of desirable features for a home for the frail elderly was put forward. If such requirements were included in a house that cost about £44,000 to build, the total cost of including them new would be about £8,000, or 16 per cent. of the total. If they were to be included later, the cost would rise to about 55 per cent. of the total. Every year we add to our housing stock more and more new build which cannot possibly accommodate a wheelchair or anybody not totally fit.
We have mentioned sheltered housing, which is valuable. There are about 44,000 units in the private sector and a similar number in the public sector. However, sheltered housing, no matter how desirable, often creates a ghetto ; an area in which people meet only others like themselves. What sort of choice is that? We have to reintroduce to our new building the requirements that will enable us to have flexibility in the housing stock. If we do not do that, community care will become a farce.
My hon. Friend the Minister should take the issue seriously. We may have to go back to considering some
Column 101sort of space requirements on new build housing and finding a way of paying for it that does not necessarily fall on the shoulders of the first-time buyer.
I support the idea of a national inspection. It is unrealistic to expect local authorities to inspect themselves and the private sector well enough without some central guidance. I hope that we can have a central inspection.
Mr. Tony Banks (Newham, North-West) : I must pick up a point that was made by the hon. Member for Bolton, North-East (Mr. Thurnham). If I do not, my wife will certainly not forgive me because she is a social worker and she will not be amused when I go home tonight and tell her that she works in a vast bureaucracy on a nine-to-five basis. I can assure the hon. Gentleman that that is not the case for many social workers, including my wife. They are often called out at unearthly hours in the early morning, in order to take children into care. The hon. Gentleman should revise what he said and thinks about social workers. He will not be on my wife's Christmas card list this year.
I am not surprised that it has taken so long for us to reach this point in consideration of the Griffiths report, for the simple reason that Griffiths had at the centre of his recommendations the role of the local authority. That must have been a major stumbling block for the Government. I would dearly love to have seen the Prime Minister's face when the report was thumped down on her desk by some quivering civil servant or Minister who said, "Do you know what he has done? He has said that we have to give a central role to local authorities." The Prime Minister's hatred of all local authorities is well known in the House. Griffiths showed good sense and I congratulate those Conservative Members who were able to convince the Prime Minister, despite her well-known and practised prejudices, that she and the Government should go along with a number of the recommendations made by Griffiths, particularly with regard to the role of the local authority.
In the few minutes that I have left I wish to mention the hidden needs of care in the community. Hon. Members know from experience in their surgeries that many needs are hidden because few services exist to meet them. The hon. Member for Bolton, North-East said that two thirds of live-in carers receive no help from any of the services that could bring them some relief. They may be caring on a 24 hour-a-day basis for dependent relatives. That becomes a form of house arrest if they receive no support. In areas such as the London borough of Newham in my constituency, elderly people from black and other ethnic minority communities find the existing statutory services inappropriate and inaccessible.
The trouble is that we have no estimates of the real levels of need for care in our communities. Last week I went to look at the Newham Crossroads care attendance scheme, which is based in Forest Gate in my constituency. We discussed some of the problems in the knowledge that today's debate was to take place. Just 10 care attendants were present. They are paid by the Crossroads charity and receive support from the local council, as do most of the Crossroads schemes ; payment, however, is limited to the rate for a 260-hour week. They told me that in the previous week they had already exceeded that, and were eating into the funds that they receive from jumble sales and other voluntary activities.
Column 102The care attendants relieve carers, sometimes for only a few hours a week, sometimes for a day a week. That is much appreciated, but they tell me that it is only the tip of the iceberg. The House, and the Government in particular, must address the problem of all the people who we know desperately need relief from caring for dependent relatives or friends. Most carers, I was told, are in the 55-to- 70 age range.
I asked each of the 10 care attendants to give instances of people whom they were currently looking after. Time will allow me to mention only three. A case that I found particularly pathetic was that of a mother who was looking after her daughter. That sounds perfectly reasonable ; however, the daughter is 45 and the mother 76, and in no fit state to look after her daughter. She has the additional worry of what will happen to her daughter on her death--which cannot be far off, given the amount of work that she must put in.
Others had different tales of personal tragedy to tell, concerning younger people. A 29-year-old single woman is looking after both parents. Where has her personal life gone? Where is her chance of a future? Her sense of responsibility prevents her from going out, meeting others of her own age and forming her own relationships. Her life has been blighted. There is also the male equivalent : a single man of 35 is looking after his mother, and has problems in trying to lead his own life outside. I was told that the budget allowed no money for training.
This is what I found most disgraceful of all--listening to what was said by people whose commitment was clear although many looked as if they needed a bit of care and attention themselves. It is not surprising that there is a great deal of poverty in that part of London ; but there is also a great deal of readiness to help out--and it is often those who can afford to give least who give most when asked to put their hands into their pockets or purses for charity. Those care attendants receive the magnificent sum of £3.75 an hour for bringing relief to carers throughout the London borough of Newham, and two weeks' money is kept in hand. They do not receive as much as home helps or district nurses, but that is all that the charity says that it can afford. One young care attendant has to pay £70 a week for a bedsit in Newham : that is the going rate in the private sector.
None of the matters that we are discussing can be entirely divorced from others over which the Government have influence. It is no good talking about having more care attendants, and about how much they should be paid, if a Bill going through Parliament will force up the cost of private accommodation in boroughs such as Newham and make it even more difficult for people to come forward to perform such vital functions.
Most people who have relations in need of care are compassionate and concerned, and what they do not want from the House are pious platitudes and expressions of hope for the future. They want resources. They want a commitment. They want the Government to say, "We believe in what you are doing, and we will back it up with hard resources." I hope that, when the White Paper is published, it will contain strong recommendations to back up the pious sentiments that we have heard from Conservative Members tonight.
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Mrs. Rosie Barnes (Greenwich) : Thank you, Mr. Speaker, for giving me the opportunity to participate in what has been a very constructive debate, with a remarkable degree of consensus from all corners of the House. I should like to dissociate myself from the remarks made a few moments ago about sheltered accommodation, which I found entirely contrary to my experience ; but I have no time to dwell on that.
Some steps proposed by the Government have broad acclaim-for example, the fact that there is to be an identifiable point of access, including a named person, that there is to be a unified budget and that some of the restrictions on financial planning have been removed-and there is general welcome for at least some move towards an assessment system.
But that does not go far enough in terms of a national commitment to properly established national principles which are adequately funded. It does not go far enough in giving rights to people who need community care and in making the obligations statutory. Nor does it pay enough attention to the way in which what is proposed will bite. In that connection, I suggest that something along the lines of the statements that are given to children with special needs should be given to people in need of community care. The statement, which should be multidisciplinary, should enable resources to be commanded, for without resources no proposal is worth the paper on which it is written. There must be a national level and quality of service, not least to ensure that the public money that we devote to this sphere is properly used.
I welcome the commitment to the concept of compulsory assessment and treatment of patients suffering from mental disorder in hospital, but I, too, call for some compulsory treatment for those who are still in the community and, like other hon. Members, I am thinking particularly of schizophrenics.
Parents of schizophrenic young people in my constituency are desperate to know what to do, because once those concerned are out of hospital and have decided to stop taking the medication, their situation becomes intolerable. Those who most want to care for them find it impossible to do so. In other words, they are not controllable by those nearest and dearest.
In taking an overview of the policies and proposals that we are discussing, I feel that the lack of definition of needs and rights is accompanied by what amount to no more than vague promises about the funding of what is proposed.
Government figures suggest that as many as 35,000 previously institutionalised patients have been released into the community in the last decade. An optimistic estimate is that no more than 9,000 of them have been offered full-time residential places in their own communities. That leaves 26,000 vulnerable people dependent on domiciliary care or community support. Some of those have fallen through the net and are receiving no help whatever. Some of those undoubtedly contribute to the number with whom the s
We must know on what basis the transfer of resources to local authorities will be based. The levels transferred
must not perpetuate the existing shortfalls, and it is agreed that considerable shortfalls exist. We have little or no knowledge on a national basis about the adequacy of current resources. Indeed, it is generally believed that there is a major shortfall, particularly in relation to carers.
Much has been said about carers, and I endorse everything that has been said. Many of those carers are children, and that fact must be taken on board. I reiterate what has been said about the cost implications of caring for people at home rather than in a home. The National Care Homes Association estimates that to look after people in a residential home on a 24 hours a day basis cost 84p an hour, whereas to look after somebody in their own home, providing a service on the basis of only 14 hours a week, cos
The likely shortfall must be set in the context of what the Royal College of Nursing has described as
"the lack of a defined and exclusively dedicated budget for community care".
Today we have talked about ring fencing and I add my voice to the many who have asked for such ring fencing to ensure that the right amount of money is allocated to the right places.
The aging population suggests that we will be faced with an increasingly vulnerable group who will lean heavily on community care. That dependency will be coupled with a significant decline in the number of young people able to provide that care.
It is important to consider the bottom line regarding responsibility for the proposals. At the moment there is some input from the health authorities and, primarily, from the local authorities. The added dimension is the local hospitals, including mental care hospitals, which may be self- governing. When boundaries do not coincide and when it is unclear where funding will come from, it will be important to discover who will make the decisions. That must be resolved if the proposals are to be dovetailed into the National Health Service Bill, which we expect imminently. There could be an automatic temptation for a health authority to discharge someone from hospital and for the local authority to feel itself unable or unwilling to pick up the financial burden, which will then be in its court.
To make things work, we need national standards and national funding. Without that commitment, we shall, in common with so many before us, pay only lip service to community service.
Mr. Ian McCartney (Makerfield) : I want to discuss children and adults with learning difficulties. I have always found the term "mental handicap" a negative and ugly one. It describes many people who live in the community or who are subject to institutional care. The term does not adequately describe either the nature of their disability or the contribution that they can make to society. Because of the ugliness of the term, many people in the community switch off immediately when others discuss with them the concept of involving people with disabilities and learning difficulties in the wider community.
This morning I entered the House with a great deal of trepidation because as I went up the stairs of the
Column 105underground I was met by a phalanx of junior doctors and nurses wearing bandanas who were asking for a contribution towards the funding of the London hospitals. A few hours later, however, for the first time in 10 years, I sensed some hope because, from both sides of the House, there is a common approach and a recognition of the role of the public sector, the local authorities and the primary services in the development of care in the community.
It has taken 10 long, hard years for that lesson to sink in and perhaps that is why the Government have taken so long to publish a White Paper in response to the Griffiths report. It was never the Government's intention that the Griffiths report would be written in the fashion that it was. As the hon. Member for Macclesfield (Mr. Winterton) said--I am tempted to call him my hon. Friend, but that would get him into a great deal of trouble-- Griffiths was driven to his conclusions by the weight of evidence, which has been shown today. I hope that the Minister will appreciate the quality of the debate, the genuine compassion and, most important, the deep understanding felt by hon. Members about what must be done in relation to the development of community care policy through to the turn of the century and beyond.
Many of us who have spent a lifetime working with people with learning difficulties have attempted to provide care patterns as a result of discussions with the families of those involved and with local authorities. We have attempted to produce a care pattern that provides choice for disabled people, whether they suffer from a physical disability or from severe learning difficulties. That pattern of care and the development of choice must underpin the Government's commitment to providing resources. We cannot have a national framework recognising the role of local authorities if, in the final analysis, we do not provide the resources to develop that expectation. I wish to discuss that expectation.
In the pattern of institutional care and care in the community, there are some essential choices that must not be made by us. We must provide the resources for disabled people to make those choices. In all our debates in the past decade we have failed to recognise that those individuals have the right to choice, the right to family life, the right to develop friendships inside institutions and to maintain those friendships when they leave the institutions, the right to proper housing and to care within housing in the community, and the right to education, training and employment.
Local authorities have a central and pivotal role to play. Since its inception in 1972, my local authority, Wigan metropolitan borough council, has developed four training centres and a factory and has developed within that factory the employment of disabled people to the point at which almost all the factory, including the management, is run exclusively by disabled people for disabled people, operating and selling its services in the market place, to other local authorities and to private industry. Wigan also provides sheltered working arrangements for severely disabled people with learning difficulties and physical difficulties. It has transformed their lives in the community, allowing individuals to make choices and their families to be involved in those choices.
At the very point at which we are discussing developing a national framework, all those schemes are put at risk by leaked reports and suggestions that local authorities will have to put these provisions out to tender. That flies in the
Column 106face of evidence and in the face of all that we were hoping to do to develop within the community choices for people with physical and learning difficulties.
We also have to provide choice in health care. My hon. Friend the Member for Leigh (Mr. Cunliffe) and I know all too well about cuts and the lack of resources in the development of health care facilities in our community for those with physical handicaps. We are currently fighting off proposals to close five units in the metropolitan borough of Wigan, all with a co- responsibility for care facilities within the community, linking them with the National Health Service and selling them off in an asset-stripping exercise to a property developer who will develop the sites for housing in the green belt where most of the sites are located. That does not ring true with what we are debating today and the attitudes that have been struck by hon. Members on both sides of the House. I ask the Minister to intervene at this early stage and put down the nonsense of asset-stripping large parts of the National Health Service and its resources. Those resources are needed as part of the core services for care in the community.
We must also develop within our care plan choices for personal expression. Many of the most profoundly disabled people can still express themselves through art, music and other cultural activities. We have to challenge the ethos that in this country the arts will be provided mainly through private donations and sponsorship. For many profoundly disabled people, the arts are the only form of expression that they have been able to develop, and much of that is at risk with the cuts in expenditure in local authorities and the development of alternative arts and crafts within local authority social service departments.
During this debate, hon. Members on both sides of the House have set out clearly the priorities for the Government. They are about the nature of the care to be provided, the types of framework necessary to ensure that that care is provided and the nature of the funding that is required.
If the Minister is serious about listening, this debate will have laid to rest the 10 years of mismanagement of community care and the ethos of the private sector and market forces delivering care. Let us hope it has been buried here and that we can have a fresh start, because out there millions of people, carers and the disabled, look to this House for salvation.
Mr. Tom Clarke (Monklands, West) : I think that the House will agree with my hon. Friend the Member for Makerfield (Mr. McCartney) that this has been an excellent debate. The cameras that have witnessed our proceedings would have done a great service to Parliament had it been possible to project the debate to a wider audience. The public would not have been disappointed.
The Minister of State said that he sought a non-partisan debate. In many ways, he has been given his wish. Whether speeches were robust or coded, it has to be said that there was precious little support for the Government's priorities for community care and for their failure to respond in any tangible way to the Griffiths report in the 19 months that have elasped since it was published.
My hon. Friend the Member for Kilmarnock and Loudoun (Mr. McKelvey) said that he attempted to obtain
Column 107the White Paper before he came to the Chamber. I am not surprised. After all, as my hon. Friend the Member for Livingston (Mr. Cook) reminded us, the Secretary of State told the House on 12 July that the White Paper would be available during the recess. That has not happened.
We are getting used to broken promises from this Government and this Secretary of State. It is not surprising to me that yet another pledge has gone, to coin a phrase, "just like that." The great pity is that so many of the Government's other pledges have gone with it. We have not seen the challenge for community care policies being matched by resources. It was clear from speech after speech from hon. Members on both sides of the House, that, whatever reservations we might have about some of Sir Roy's recommendations, we agree that we have had far too much rhetoric that has not been matched with resources.
As we have waited for the Government's response, the problems that have been identified have grown. The problems of the elderly have been mentioned and carers have been an important aspect of the debate. Only yesterday we had a compelling report from the National Association of Citizens Advice Bureaux which underlined the appalling problems of young people leaving care and facing, in many cases, crime and even prostitution. Opposition Members hope that that matter will finally be tackled in the Children Bill, when we debate it in the House next week.
The Government have said that the purpose of this debate is to give them the opportunity to listen. Have they been listening? Although I am pleased to welcome the hon. Member for Galloway and Upper Nithsdale (Mr. Lang), it seems to me that the capacity of the hon. Member for Stirling (Mr. Forsyth) showed a measure of listening fatigue. I am sorry if that is the case. If time allows, I hope to refer to some of the hon. Gentleman's comments later.
If the Government are truly listening to the House and to the voluntary bodies to which my hon. Friend the Member for Livingston referred, there are two things which must concern them above all others. First, the House has made it clear that there is an overwhelming case for ring fencing as we identify priorities. The hon. Members for Eastleigh (Sir D. Price) and for Caernarfon (Mr. Wigley) underlined that theme and it has been widely echoed. My hon. Friend the Member for Birkenhead (Mr. Field) spoke for the House when he made a plea for a full national insurance record for carers. Yesterday, I had the privilege of meeting Maureen Oswin, who spent five years of her life looking after her sister who was dying of cancer. I was impressed that she displayed no bitterness. She made a genuine plea from the heart, based on her experience, for the House and the Government to accept their responsibilities to carers. My right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) and my hon. Friends the Members for Crewe and Nantwich (Mrs. Dunwoody) and for St. Helens, South (Mr. Bermingham) underlined that important plea based on their constituency experience.
I welcomed some contributions from Conservative Members. I hope that I do not embarrass the hon. Member for Gillingham (Mr. Couchman) when I say that his remarks on training were appropriate. We will not achieve
Column 108the objectives that we all share, which represent the major recommendations of the Griffiths report about cost- effectiveness, if proper funding for training is withheld.
The hon. Members for Belfast, South (Rev. Martin Smyth) and for Bolton, North-East (Mr. Thurnham) mentioned the Disabled Persons (Services, Consultation and Representation) Act 1986. I had a little to do with that Act, which received tremendous support from all hon. Members. Nevertheless, there was a time when I felt a little embarrassed about raising it. My embarrassment is a fraction of the embarrassment that the Secretary of State and his Ministers should feel when they attempt to defend the Government's squalid position on that vital legislation.
I want to examine in detail the relevance of the Act to the Griffiths report and to any debate on community care. Section 7 is crucial to every point that has been made, including the important points made by the hon. Member for Eastleigh, about people being discharged from long-stay psychiatric hospitals. There is talk about listening and consultation, but there was immense consultation throughout the passage of that Act, which was endorsed by both Houses without a vote. On 12 July the Secretary of State said :
"On the health side, I will ensure that discharges of seriously mentally ill people from hospital will take place only when adequate medical and social care is available for them outside hospital."--[ Official Report, 12 July 1989, Vol. 156, c. 978.]
How does he plan to do that without proper assessment under section 3? Practical measures must be introduced or the Secretary of State's words become mere rhetoric of the type that Sir Roy identified. The Act says that assessment should be carried out prior to discharge. In the best spirit of everything that has been said today about the consumer, the Act says that the consumer should be consulted about assessment by the health authority and by social services. For many people who would not be able to be involved in the process, section 1 deals with advocacy and representation and ensures that their needs are not ignored.
If we are talking about consumerism, we are also talking, especially in terms of discharge from hospital, about national standards. The message from hon. Members, which we have heard clearly from constituency after constituency, is that people are sick and tired of hearing about the accidents of geography and patchy planning.
Hon. Members have told us about the National Schizophrenia Fellowship and the 90 per cent. of admissions of schizophrenics that are re-admissions after relapse. Where is the economy in that? How can the Treasury take a hard line with any justification, given that it is not even financially viable, apart from being socially unacceptable?
Again, on 12 July, in an off-the-cuff remark in reply to the hon. Member for Exeter (Mr. Hannam), the Secretary of State said : "We do not think that, on this occasion, it is right to use the 1986 Act to implement any part of what we are doing today."--[ Official Report, 12 July 1989 ; Vol. 156, c. 192.]
Many hon. Members found that comment staggering. If that statement represented a change of policy, the House was entitled to hear about it long before it did and in a more formal way.
If this is a change of policy, I invite the Minister to tell us why the Department of Health issued the booklet "Discharge of Patients from Hospitals", which clearly