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Mr. Cook : I remind the hon. Lady that the reason why she and several of her hon. Friends voted with the Opposition in March was precisely that they did not trust the language "annual review of the charges". She referred to the Price Waterhouse independent inquiry. If Conservative Members say that the inquiry will solve the problem of coming up with a new national recommended rate, and, to take the area represented by the Minister of State, if that rate is set at a level to solve the problem in Surrey, the inquiry will have to recommend a new national rate which will be wildly extravagant in other areas. It will cost the Treasury vastly more to solve the problem than it would if the Government implemented the changes in April next year and allowed their preferred method to be introduced The other people who will pay the price for the delay are elderly people who are in not residential but community care and the carers who cannot put off caring for those people for another two years and cannot wait until help is at hand. Already, some of their organisations have expressed their views on the prospect of delay. The director of the Carers National Association said :
"Our members feel angry, cheated and betrayed The Government has demonstrated that when it comes to us or the poll tax, we are not priority, because they know we cannot stop doing what we are doing." Rather extraordinarily, in replying to a question on the statement, the Secretary of State said that Mencap would welcome the phasing that he had announced. I have before
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me a letter of 11 July addressed to him. I do not know whether it has yet percolated through to his inner office. It says : "The promise of care in the community has been the lifeline for these parents and carers. Now this promise is not to be honoured because of Government fears that the estimated costs of implementing community care reforms would add 30p per week to poll tax bills And so for less than the price of a cup of tea a week, community care is to be sold down the river."It does not seem to me that Mencap welcomes the phasing that has been announced to the House today.
The language of both the organisations to which I referred may be more intemperate than the Secretary of State's. They may lack the cultivated urbanity of the Secretary of State. That is because they have to talk directly with their members, who wake every morning to the task of constant nursing care if, indeed, they slept through the night. Such people include a couple described by the Spastics Society in a circular which it sent to several hon. Members, but which appears to have missed the hon. Member for Suffolk, South (Mr. Yeo), who until the last election was director of the Spastics Society. In that letter the society described a couple in their 60s who care for their 40-year-old son who has cerebral palsy and very challenging behaviour. He cannot walk ; he needs constant care ; he cannot bathe himself ; he constantly soils himself. The father has recently undergone heart surgery, the mother is being treated for cancer. It is doubtful whether they will last the two years until the care in the community package is implemented. The letter says :
"Both parents are desperate for a break, but have not been able to obtain any respite care for their son for over 5 years. His mother says she has got to the point where she has contemplated drowning him because the situation seems so hopeless."
I believe that that couple deserve hope. They deserve it before 1993. The Opposition will vote tonight to restore that hope to them. 4.55 pm
The Secretary of State for Health (Mr. Kenneth Clarke) : I beg to move, to leave out from "House" to the end of the Question and to add instead thereof :
continues to support the Government's policy towards care in the community as set out in the White Paper, Caring for People, as an effective means of securing and delivering services on behalf of those people in need of social care ; and endorses the approach towards implementation which the Government has adopted.'
We all echo the sentiments expressed by the hon. Member for Livingston (Mr. Cook) towards the end of his speech about the need to give added support to all those who care for elderly, disabled, mentally ill or mentally handicapped people.
This is a most unusual debate. As I said in my answers on the statement, we are no longer debating the merits of the Government's policy proposals. The Opposition have decided to give them their wholehearted support. They press us to implement the proposals at the pace which we originally intended and which, indeed, was my intention when the Bill was taken through the House.
So the House accepts that the Government's policies for care in the community set us on a path which is likely to lead us to enhance the support that we give both to people who suffer a disability of some kind and to those who care for a member of their family or a friend who is
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in need. What divides us is that the Opposition have decided that it is right to go ahead in 1991 despite all the reasons that we have given of cost, difficulty of preparation and the impact of the community charge.The hon. Gentleman asked me when I was driven to the conclusion that we should examine the timetable on which we were proceeding. It was in the aftermath of the local authorities' announcements of their community charge levels. My constituents and those of most hon. Members were surprised and taken aback by the level of the community charge. That above all worried them. We all appreciate that, in the light of those community charge levels, we must take stock of the pace at which we can allow local government expenditure to continue to rise, the extent to which the pace of progress in many desirable policies must be matched with the ability of the local taxpayer to afford it, and the pace at which we continue to put new burdens and responsibilities on local authorities.
Mr. Dave Nellist (Coventry, South-East) : Will the Secretary of State give way?
Mr. Clarke : I shall give way in a second.
In general, the first reaction of my hon. Friends was to accept, although with great disappointment in many cases, the common sense of what we propose. I feel sure that the common sense will be apparent to many in local government and to many community charge payers throughout the country when they put it in the context of all the other increases in local government spending and other new duties on local councils.
Mr. Nellist rose --
Mr. Tony Worthington (Clydebank and Milngavie) rose
Mr. Clarke : I give way to the hon. Member for Coventry, South-East (Mr. Nellist), because he sought to intervene earlier.
Mr. Nellist : The Secretary of State has just repeated a point that he made in his statement. He said that the local authorities are not ready for the new responsibilities. Is he aware that, on Monday, I received a letter from the director of social services in Coventry, saying that, if Coventry were given Government resources, it would be ready? Is he further aware of a survey by the Association of Directors of Social Services which showed that 95 out of 96 directors of social services said that, given the resources, they would be ready by April 1991? Is not the only problem not the local authorities but the fact that central Government funding is not available? That is what is needed to give carers and those who would benefit from care in the community the necessary support without adding to the intolerable burden of the poll tax.
Mr. Clarke : I accept that the overwhelming majority of directors of social services felt that they were ready to implement the new policies. I have no basis on which to challenge that. I accept that most of the voluntary organisations were ready to go ahead, and I correct what I said about Mencap earlier, when I was in error. I misunderstood the cue that I thought I was being given by the question. I now clearly recall that Mencap wanted to go ahead, and Sir Brian Rix, with whom I have had many conversations about this policy over the years, made some angry statements when he first heard of the speculation about delay.
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I understand the disappointment, because one fact on which both sides of the House agree is that we look forward to the day when we can move from the present income support arrangements to the transfer of resources and the development of steadily improved care in the community. We are improving it now, with ever-growing levels of local authority spending, but there is a need to phase the introduction of all the new duties and responsibilities for local authorities. Many people, including Select Committee members, feel that there is a good management and social policy reason for moving forward more steadily than either the directors of social services or Ministers were first inclined to accept.Mr. Frank Field (Birkenhead) rose --
Mr. Worthington rose --
Mr. Clarke : I want to give a short speech ; I cannot give way all the time. I have just answered one intervention and if I immediately give way again, I shall not get on. I shall give way but not too often, otherwise you, Mr. Deputy Speaker, will quite correctly pull me up.
Let us put in context the pace at which we are increasing spending and services. Total local government spending has gone up by 25 per cent. in the past two years alone. That is the background to the present problem in local authority financing. As I said, personal social services spending by local authorities tends to go up about twice as fast as the generality of their expenditure. Personal social services current spending in local authorities in real terms has gone up 21 per cent. between 1984-85 and 1989 -90--nearly double the increases for all local authority expenditure, which was 11 per cent.
During the Government's period of office, local authority personal social services expenditure on community care has risen 34 per cent. in real terms. That rise is flowing through into all kinds of increased provision of service, including 25 per cent. more home helps and meal services for the disabled up by 13 per cent. Such increases will presumably continue, and I have no doubt that there will be increased resources in future.
My announcement today is not an announcement of any reduction in resources. Tomorrow's statement by my right hon. Friend the Secretary of State for the Environment on the totality of aggregate Exchequer grant to local authorities will no doubt determine the pace of events for spending next year. It is wrong to say that it is the policy of any political party that all social services expenditure will be met out of central taxation, not local taxation.
Mr. Robert N. Wareing (Liverpool, West Derby) : No one has said that.
Mr. Clarke : In his intervention a moment ago, the hon. Member for Coventry, South-East implied that the expenditure would not affect the community charge payer, and the only problem was that central Government would not put in all the money. No party is offering to put all the money in. The way in which we are transferring responsibility to local authorities means that they will eventually decide how much is spent on the policy in the light of whatever grant they receive from central Government. The community charge will be determined by the difference between the standard spending assessment established by the Government of the day and the level of spending on which they choose to embark.
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I think that the hon. Member for Livingston said that the community charge would go up by only £15--but no one knows what the figure will be. That is his assessment, based on one set of local authority figures, of the amount by which the charge is likely to go up, in the first year alone, for care in the community policies. We all know that assessments of local authority spending are notoriously difficult to make. We also know that authorities such as Lancashire, Suffolk and Derbyshire are inclined to take no notice of such assessments, and are free to put the community charge level wherever they want.Given that we all share the same concern for disadvantaged people, I submit that it is impossible for us to turn a deaf ear to the concerns of charge payers, many of whom are not well off. It is not right for the hon. Member for Livingston to say that another £15 next year for one policy alone should blithely be assumed as acceptable. I am not sure whether it is an accurate figure for the hon. Gentleman to put forward--
Mr. Cook rose--
Mr. Clarke : I am about to refer to the hon. Gentleman, so I shall definitely give way when I have finished my point.
Earlier, I referred to the hon. Gentleman's reported comments about the likely level of expenditure next year if our proposals were implemented without phasing. I admit that the press cutting that I have is from the Morning Star, but the hon. Gentleman was also quoted in other newspapers. In the Morning Star he is quoted as saying :
"Local councils will need an extra £1.5 billion over the next three years if they are to take over responsibility for the elderly and mentally ill from next April."
The hon. Gentleman then quoted figures showing that the report was a little inconsistent. The figure to which he referred was for one year. He was solemnly suggesting that £1.5 billion should be added to personal social services expenditure--an increase of 40 per cent.--in one year. He has not explained--he did not do so to my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) when he intervened--how much of that would come from the taxpayer and by how much the community charge would go up in local authorities across the country if we followed his advice.
People caring for the disabled and elderly would find themselves at the receiving end of excessive community charge levels if we recklessly continued on the basis of the figures suggested by the hon. Gentleman.
Mr. Cook : I shall put two points to the Secretary of State. First, as he quotes those figures, may I point out that he does not need to read the Morning Star to obtain them ; he can merely summon his own officials, who have those figures in copious detail in the document submitted to them by the settlement working group which negotiates with the local authority associations. Those figures show that local authorities put the estimate of care in the community at £829 million in the coming year--£400 million of which would come from the transfer of DSS money.
I repeat the question that I put to the Secretary of State at the end of his statement, to which he did not reply in his supplementary, and which he has had a long time to think about. Will he confirm that at no stage since those figures were submitted almost two months ago have his officials
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queried a single one of the estimates? If he does not regard those estimates as acceptable, with which figure does he disagree and which one does he find excessive?Secondly, I shall correct the record before the figure of £15 enters history as my invention. The figure of £15 came from Mr. Thomason, chair of the Association of District Councils who, until the Secretary of State addressed the House, I had believed was a member of the Conservative party.
I shall repeat the other question that I posed to the Secretary of State : if the figure is £15 or more, why does he have to make the decision about how much should go on the poll tax of every authority in Britain? Why, on the principle of local accountability about which we have heard so much from the Government, cannot the Government leave that to be resolved by the local electorate?
Mr. Clarke : My officials in the Government have never accepted as bound to be paid out the estimates that the hon. Gentleman is defending. I know that they are the local authority estimates--that is why I know that they are for one year, not three years, as he was reported as having said in the newspaper. It is a one-year increase, which he, as a shadow Minister, is extraordinarily accepting at face value and endorsing. He is telling the House that we should go ahead, which will cost another £1.5 billion. The implication of what he said is clearly that that money should be found.
As I said, £1,500 million is presumably the local authorities' best estimate of the amount by which they intend to increase their spending on personal social services alone. It is a total guestimate. We do not know where it will be spent, but the history of local government spending leads most of us to suspect that the figure is as likely to be an underestimate as an overestimate. We have no idea where the local authorities, in current hands and under current control, intend the money to go.
If the hon. Gentleman were ever a member of a Government, he would know that this is the process that we have been going through in discussing the consequences of this year's community charge levels. He takes a blinkered view. We are talking about personal social services, and he cheerily says that, next year alone, an extra £1.5 billion must go on personal social services expenditure by local government. As I said in my response to questions, next year local authorities are taking on new duties under the Children Act 1989 and the Food Safety Act 1990, and they have important new duties in relation to education.
The totality of that expenditure and the community charge will be a crushing burden on taxpayers throughout the country. It is no good the hon. Member for Livingston talking about accountability. I certainly have been using the language of accountability when arguing about the level of community charge in my county, as have most of my right hon. and hon. Friends.
The Opposition refute any idea of local authority accountability for this. They are in favour of high spending and high taxation by local government. They face the difficulty that they have no idea in what form the bill should be presented to local taxpayers. They do not have
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a tax of their own, and they have no idea how this immense burden to the taxpayer--paying for burgeoning local government--will be parcelled up and shared out.The hon. Member for Livingston is one of those who refuses to pay his local tax : he is a refusenick on the community charge. For that reason, I can only describe his attitude as cavalier and irresponsible when he attacks us for a policy that he supports and cheerily says that we should underwrite a bill which is fairly uncertain but is perhaps of the order of an extra £1.5 billion. The combination of his support of our policy and his criticism of its pace and his belief that we should simply go ahead without regard for any of the other consequences is quite incredible to the electorate and totally irresponsible on the part of the Labour party.
Mr. Worthington : On the issue of accountability, whether rightly or wrongly, the Secretary of State for Scotland has said that, after one year of the poll tax, the local authorities in Scotland are now accountable. That is one excuse for not introducing the policy ; the lack of readiness of social work departments is said to be another, but they want to go ahead. As the Secretary of State believes that local authorities are now accountable, and as local authorities want to go ahead, why can we have the poll tax but not community care a year ahead?
Mr. Clarke : The hon. Member for Coventry, South-East made it clear that he wishes to go ahead. When he produces a hugely increased community charge bill for his electors, he will say that the reason is that not enough central Government money has been put in. The hon. Member for Livingston adopts the same approach, and appears to be promising vast amounts of central Government money next year for personal social services alone. We all know that the hon. Member for Livingston has no authority from his Front-Bench colleagues to promise that money. I do not believe for one moment that the Labour party would put that sum of money in, or anything like it.
The hon. Gentleman sees that there is a debate, sees a way to attack, his beard bristles in that engaging way, and up he gets to say that £1.5 billion is needed next year by local authorities for one small part of the policy area for which he has shadow responsibility. That is not a sensible way to proceed, and it is no way to demonstrate real care and concern for the client groups which are looking for continued development of policy along the lines that we have already seen, and for the evolution of that policy into a proper policy for care in the community.
I repeat what I said when I replied to questions on my statement : my announcement today did not contain any reductions in resources. There is no announcement of any cuts in social services provision. No one is withdrawing the entitlement to income support of those in residential care homes. My right hon. Friend the Secretary of State for Social Security is looking at the basis on which we must adjust income support in the next few years, until we are able to introduce the policy in full.
The hon. Member for Livingston talks about how my right hon. Friend might resolve some of the problems to do with a proper level of income support. My hon. Friend the Member for Maidstone (Miss Widdecombe) has been harrying the Government to improve the present arrangements and has succeeded in getting the level up. We have increased expenditure on that front by £145
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million, as a result of our defeat in the House, when we added £45 million. We also have the Price Waterhouse study on costs. We can also go in for local variations. Sections of the Social Security Act 1990 pave the way for local variations based on local authority policy in future, but we do not have to wait for section 9. My right hon. Friend can already consider what evidence exists to justify a local variation system, but, as he has often explained, it is extremely difficult to get an effective local variation system in place. We are proceeding with a pattern of services in which I expect to see continued development and growth of support for all these disadvantaged groups, better preparation for and advantage taken of the time for the introduction of the new policy, and then the change to care in the community in 1993.Mr. Frank Field : The Secretary of State is saying that nothing has changed as a result of the statement today. The point that I made about the statement was that a large number of organisations believed that the Government's word was their bond, and they have acted upon that. Perhaps the Secretary of State for Social Security has now told the right hon. and learned Gentleman that the answer that he gave was incorrect : people in day care facilities do not get help from income support.
A number of organisations which the Government, given their rhetoric, ought to applaud--those which have got up and shown entrepreneurial skills-- believed that the Government were going to bring in the proposal by next year and have put their money where the Government's mouth is. They have got projects not merely on the drawing board but up and running, but they now face closure unless the Government come up with new money for them.
The Government believe in targeting. Will the Secretary of State give a commitment that he will go away and try to seek resources which can be targeted on the projects which are running because the Government said that the scheme would start next year?
Mr. Clarke : I agree that I said, first, that I did not know of the particular voluntary body in Birkenhead. Then I picked up on the hon. Gentleman's sedentary remark
Mr. Frank Field : They are all over the country.
Mr. Clarke : They are not all over the country. The hon. Gentleman must allow me to answer his intervention. If centres provide only day facilities and have no residents, they cannot obtain income support and cannot have been expecting to do so in future-- [Interruption.] The hon. Gentleman will not allow me to reply. He makes a case which frankly does not stand up, and he is trying to sustain it during my answer. We are not withdrawing any funds at the moment. If people are planning projects--
Mr. Field : The Government promised to pay.
Mr. Clarke : There was no such promise. That is total nonsense-- [Interruption.] The hon. Gentleman must allow me to reply. If a flow of funds is going to a voluntary body of any kind at the moment, I have not said anything that will end that. If a body was anticipating a flow of money next year, presumably it was anticipating a decision to be taken by the local authority, which it has not yet taken, which it cannot have yet taken and which was not backed by any
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promise made by the Government-- [Interruption.] The hon. Gentleman made a bad point and is trying to barrack me throughout the answer. There has been no withdrawal of funds and no promise of funds next year. The hon. Gentleman has merely described a body which, no doubt with worthy intentions, has anticipated a decision by the local authority next year to give it added support. It is ridiculous to suggest that the country is full of people banking on some promise that we made to pay, because no such promise was made--[Interruption.]
Mr. Deputy Speaker (Mr. Harold Walker) : Order. The hon. Member for Birkenhead (Mr. Field) must not sustain this constant barracking from a sedentary position.
Mr. Field : Some people believed the Government's word.
Mr. Clarke : It would be a ridiculous method of debating if both sides regarded themselves as entitled to speak at the same time throughout the debate.
No money has been withdrawn from any voluntary body. No plans have been drawn up for expenditure by any local authority next year. If the voluntary body was expecting expenditure by the local authority next year, it must look to the local authority to meet it. I do not accept the validity of the hon. Gentleman's point. Hon. Members say that nothing has changed-- [Interruption.] If hon. Members decide that it is as well to conduct this debate among themselves, it is because they are reduced to making a case against the phasing which they cannot sustain, and they are doing so in an absurd fashion. Various things have changed. We have announced additional resources for the care of the mentally ill, the beginnings of a specific grant for voluntary bodies giving help to people suffering from alcohol abuse and drug abuse, and greatly enhanced grants for training. Our announcement is a substantial advance for mentally ill people. The expenditure that we propose to support by the new specific grant is almost double existing expenditure by local authorities on residential care. We have given this specific grant because history shows that local authorities tend to give a low priority to mentally ill people compared with other groups that they are accustomed to supporting through social services.
We believe that there should be much closer collaboration between health authorities and local authorities providing for mentally ill people. We are therefore introducing, at a generous level, a specific grant which will oblige them to collaborate to unlock the resources which they will then spend on improving the community end of care for mentally ill people.
On alcohol and drug abuse, I acknowledge that the amount of spending that will be supported in the first year by the new specific grant is quite small--£2 million--but we were contemplating the new specific grant coming in to replace the income support income that voluntary bodies usually have. As there is no transfer of income support but also no ending of income support, income support revenue will still go to the voluntary bodies until the changeover in 1993. The £2 million which we now propose in support is in addition to existing expenditure. It will be new money. It is a benchmark for that specific grant, which will obviously have to be enlarged significantly in 1993 once the income support revenue for the voluntary bodies comes to an end.
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I shall leave the issue of training to my hon. Friend the Minister for Health, who will speak at the end of the debate. The increased expenditure on the training of social workers which we have announced will mean a significant increase in the training activity of local authorities. That is an important part of how we must use the next three years. I expect local authorities to continue to expand and develop personal social services of all kinds over the next year or two, taking account of available resources and the ability of their local taxpayers to afford the pace of advance.I believe that the collaboration between health authorities, local authorities and voluntary bodies in preparing for the new policy will continue. We shall see them getting closer and taking advantage of the work that they have already done. If they follow the phased steps which I have announced, the momentum will be maintained in the policy, and in 1993 we will see a much improved policy of care in the community for all the disadvantaged groups whom the House wishes to help.
5.21 pm
Mr. Jack Ashley (Stoke-on-Trent, South) : I never thought that I would hear the Secretary of State make a disingenuous speech, but we have just heard a disingenuous speech and a disingenuous statement. I am surprised at his attempt to make out that the proposed changes will improve provision for disabled people and their carers. He must know that that will not happen. In fact, it will do the opposite. The Secretary of State had the brass nerve to say that he was annoyed at the response by my hon. Friend the Member for Livingston (Mr. Cook) and his policies. Disabled people and their carers feel more than annoyed. My hon. Friend used the words "angry, cheated and betrayed"--not his words or my words, but the words of the Carers National Association. That is how disabled people and their carers feel. They feel let down by the Government. The Secretary of State made out that there were wonderful improvements and craftily implied that there would be a small, marginal improvement because funds for the mentally ill were ring-fenced and the rest of it, conveniently omitting to say that all the other funds for which we asked will not be ring-fenced. This delay means putting back schemes that many local authorities have already drawn up.
The announcement by the Secretary of State is a serious setback for disabled people and their carers. He is a skilful debater, but no amount of rationalising can obscure the fact that the Government have let disabled people down badly. We all know that the poll tax has backfired on the Tory Government. Instead of blaming local authorities, the electorate is blaming the Government, rightly, for the poll tax. To win votes--which is what this manoeuvre is all about--the improvements put in hand by local authorities are being deferred. The poll tax--the Government's baby--is the real reason for deferring important schemes.
Disabled people have become the sacrificial victims of the poll tax. That is a simple equation. I do not know how the Secretary of State sees that political morality, but it is appalling to conduct the affairs of state in such a way that the rights and interests of severely disabled people and their carers are sacrificed. The Opposition would not do
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that, nor would some Conservative Back Benchers who are waiting to speak--their priorities would be to put disabled people and their carers first.Mr. Wareing : Will my right hon. Friend give way?
Mr. Ashley : I am sorry, but I have only 10 minutes to speak. Under this Government, disabled people have gone to the bottom of the queue. Community care reform means a higher poll tax because the Government plan to hand over responsibility without sufficient cash. Despite all the manoeuvring by the Secretary of State, that is the bottom line of the debate. There is inadequate central funding for community care. We cannot blame things on the poll tax or on town halls ; it is the Government's responsibility and their failure. That is what the debate is all about. The Secretary of State, seasoned debater though he is, cannot get round that basic fact, and that is why the public and disabled people will blame the Government. The Government cannot circumvent that reality. It is ironic that community care charges were introduced, not because of the plight of disabled people or of their carers but because of the rising costs of claims for income support for people in residential homes. I do not believe that anyone will dispute that. It is doubly ironic that cash considerations are forcing this decision. That is the reason for this damaging delay. We are coming full circle.
The Secretary of State says one thing about his projects, plans and policies ; but clear, eloquent statements are being made by not only my hon. Friend the Member for Livingston, whose speech I admired, but organisations representing disabled people that are working at the coal face as it were, and know at first hand how people are suffering. I think that I can claim that all of them--I am open to challenge--are appalled at the Government's actions. I do not see how any responsible Minister can find a hint of evidence to support the Government. I should not say to the people who are working with crippled, blind, deaf, spastic or mentally handicapped people that they are wrong. They unanimously condemn the Government. [Interruption.] It does not matter what the Government Whip says to the Secretary of State. All organisations representing disabled people are saying that. I shall sit down if I am challenged on that point and the Minister or the Whip can name one organisation that backs the Government, but I see that I need not give way. If the changes are delayed, will the guidance still be published in September and will health authorities still be required to commit funds for community care projects? Delay is bound to mean that people in hard-pressed local authorities and the national health service will simply turn their attention to other matters. Like Ministers, they are busy people and delay means that they will carry out bypass operations and other projects that are dear to the hearts of voters. As a result of the Secretary of State's announcement, thousands of disabled people will be pushed aside. I regret that.
The care problems of disabled people cannot be solved overnight. As my hon. Friend the Member for Livingston said, we have waited six years for changes and now they have been put further back. The Government's failure is politically embarrassing for the Secretary of State, but to many disabled people and their carers the proposals are not simply an embarrassment, but a disaster. Ministers should be ashamed of themselves.
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5.30 pmMr. Timothy Kirkhope (Leeds, North-East) : I have not spoken in the House before about community care but I have a special interest in it. For the first three years of its life I was a legal commissioner with the Mental Health Act Commission and during that time I played a small part in the drafting of those parts of the biennial report and the code of practice dealing specifically with community care for the mentally ill.
I support the Secretary of State's proposals. Even if he had not spoken about the community charge, I should have urged a transitional introduction of community care in the way that he suggested. One of my reasons is that during my time with the commission we were concerned, especially in the early days, about demands from the progressive wing--the psychiatrists, psychologists and some Opposition Members who are active in these matters-- to put pressure on the authorities to empty the mental hospitals and return freedoms and rights to the patients. They thought that that could be done only by emptying our hospitals and making people go back into the community, whether ready or not. In the first year or two it was part of our task to bring quite clearly to the minds of those concerned that that was not necessarily always appropriate and that the proper provisions were not available on the ground to deal with the problem. The community, in the sense of us all and not just those concerned with mental health or disabled people, is not ready to accept many people into the community and to treat them with the sympathy and understanding that they deserve. I regret to say that then and even now there are clear signs that the education of the public in such matters is not sufficiently developed.
During our discussions we met many people from the social services departments of local authorities. I pay tribute to many of them, especially directors, who were keen to play a much greater role in community care, not only for the mentally ill but more generally for other groups. Their keenness to do so did not hide the fact that they were often ill-equipped to provide the necessary facilities. Opposition Members may think that I am about to mention resources, which of course play a part. We did not conclude that the majority of the problems stemmed from lack of resources. Many of them stemmed from the fact that organisations, the number of people who had been trained to the right level in mental health care, and the number of approved social workers in place were quite inadequate. Sometimes in their keenness to be of help, social services directors ran away with the idea that they could manage when they could not. That is why I welcome in our proposals the assistance with greater training of those who in due course will carry out community care.
The people whom I have mentioned were in a great hurry and were not well equipped. As a result of the work carried out by the commission and other interested people, the progress towards community care for the mentally ill was slowed--I do not use the word delayed--so that we could take account of the needs. It is right to apply the same concept to other areas of community care. That is why I welcome the proposals.
Little has been said about the great work that is being carried out by other people who are interested and work in community care. Not only district health authorities, local authorities and the Government are concerned, because voluntary and charitable organisations are keen to accept
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responsibility in an area in which they have a great deal of expertise. I should be sorry to see that expertise lost. I have already mentioned the community as a whole. Of course, we need more education and more help. People in families with someone who is disabled in some way will appreciate the extra resources which, whether the Opposition like it or not, have been provided by the Government for greater community care.Mr. David Hinchliffe (Wakefield) : They are provided by local authorities.
Mr. Kirkhope : No, by the Government.
My mother-in-law recently broke her hip and has just left hospital. I can speak highly of the assistance that she received from the voluntary sector and from the local authority social services department. She is grateful for that assistance and many other elderly and disabled people have good reason to be grateful for what they receive. However, it is a matter not just of gratitude but of our responsibility to such people. Plainly, the Government accept that responsibility in the implementation of the community care proposals and they are ready and willing to discharge it.
5.36 pm
Mr. Archy Kirkwood (Roxburgh and Berwickshire) : I listened with some interest to the speech of the hon. Member for Leeds, North-East (Mr. Kirkhope). I do not know how he can justify his conclusion because, although large sums of money are involved--we should not treat large sums lightly--those sums demonstrate beyond peradventure that out in the community there is an existing unmeasured and unmet need. The Government propose to postpone the resources required to meet that need which inevitably will mean that they will be ignoring the need during the period of postponement. None of us should ever forget that.
The Secretary of State's statement was deeply disappointing. The Government's decision and the reason for it have obvious political overtones and implications. However, I wish to concentrate on the implications of the delay for the management of the implementation of community care, which already has a sorry history. The original Griffiths study commenced more than 10 years ago. Community care was marched to the top of the agenda and the professions geared themselves to face the consequences of fundamental change in the new approach to community care. That was welcome then and continues to be welcome now on all sides.
A long time afterwards, in spring 1988, the Griffiths consultation paper was published. Community care was again marched up and then down the hill. Then there was a long and worrying hiatus between 1988 and 1989, and finally in the winter of 1989 the White Paper was published. Expectations were again raised and people were led to believe that that was the final version of the scheme that the Government would implement. Like the proverbial grand old Duke of York, the Secretary of State has once again marched everyone back down the hill with today's announcement.
Whether the Secretary of State thinks that community care is good, bad or indifferent, his approach is a totally stupid way to govern. Local authorities and care professionals do not know whether they are coming or going. It is quite disingenuous for the Secretary of State to
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say that his announcement will change nothing. Whether he likes it or not, people have sensibly been making professional arrangements to take advantage of the scheme in April 1991. Now, all those plans have crumbled into dust in their hands. The Secretary of State may say that it is merely phasing-in, but in fact it is a two-year or more delay. That is significant in the time scale that we are discussing, especially bearing in mind the few years that some elderly people live in residential homes before they die. The right hon. and learned Gentleman is making a severe and fundamental change.The Government have not taken into account the real costs of such a sudden change of direction. My local authority has, quite properly, made painful sacrifices in an attempt to use its present resources to anticipate the changes and so meet the previous target date of April 1991. That work has now been wasted ; it will have to be set aside and begun again in two years. The delay will mean that a great deal of work, such as case management pilot projects and assessment procedures, in which my local authority has engaged diligently and thoroughly, has now gone out of the window. That is a shame because the results of that work and what could have been achieved by April 1991, had the Government allowed the policy to proceed, were encouraging.
Irrespective of what we think of "Working for Patients", "Providing Better Health" and "Caring for People", which embrace the health board changes, and whatever we think of the general practitioner contract changes, which embrace a systematic survey of the health needs of the elderly, they could have been introduced and administered much better as an integrated package. My local social work authority has found that general practitioners in rural areas are now referring greater numbers of elderly people who require occupational therapy. It could cope with that much more easily if it had the advantage of the care in the community package that was due to be implemented next April. It now has to go back to the drawing board to find a way to meet that additional demand on resources, without the initial assistance that was expected from the implementation of the package. If I had longer, I could illustrate the confusion and the disruption that will be caused, and I am sure that other hon. Members could do the same.
There is another problem to which the Government have paid no attention. Although the changes are not so fundamental in Scotland, the changes to the child care services law in England and Wales will be imposed on local authorities in Scotland not, as the Secretary of State said, in April, but in two or three years' time. The social work department in my constituency will have to cope with the fundamental changes in community care at the same time as trying to cope with the changes in child care services. That works against the Government's argument in favour of delaying the policy.
I can cite a case similar to that cited by the hon. Member for Birkenhead (Mr. Field). It is a Borders region authority problem. It has inherited a home that was recently closed by a religious order. It is situated in the constituency of my right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel), and it was closed for valid reasons. However, the local authority now has to cater for another 54 people. It was in the
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