House of Commons Hansard Debates for 18 Jul 1990

Column 1036

process of setting up a community care package for all those people between now and April 1991, and it does not know what the dickens it can do now that the right hon. and learned Gentleman has delayed the care in the community policy. I am sure that the local authority will, in the end, make sensible and proper provision, but it will now have to be at the expense of existing services.

The key to community care is the importance of the individual assessment, which measures individual needs. We cannot have the real benefit of community care until the Government properly fund and support that part of the community care package. I accept that large sums of money are involved, but the way to unlock funds for community care is to give local authorities a single budget and the flexibility to provide the domiciliary support to take people out of institutions. That would generate money that is currently locked up in inappropriate care in institutions. The Secretary of State cannot say that no changes have been made to his plans because the crucial key that will open the door to the resources needed and to treatment in the community has been thrown away and lost for another two years. That is deeply worrying and the right hon. and learned Gentleman deserves all the criticism that he has received from hon. Members. I welcome the earmarked fund that the right hon. and learned Gentleman announced this afternoon. It is a positive step in dealing with mental illness. Can it be deployed in providing residential care for the demented elderly? I refer to not just the frail elderly, but to those who are demented and require a much higher and more consistent package of care. They need higher staff ratios and must be cared for in residential establishments. It would help if residential accommodation for the demented elderly could be paid for under the scheme.

Mr. Kenneth Clarke : I can confirm that psychiatric services would be included.

Mr. Kirkwood : I am grateful for that small mercy. I should also like to know when the Price Waterhouse report will be published, as that will be important.

Community care has been organised since the mid-1980s, and that is to be welcomed. However, I say with all the sincerity that I can muster that the right hon. and learned Gentleman's announcement today will simply shave off from existing services the money that local authorities need to provide community care now. That is not in anyone's interests and it will mean misery for a large number of our most vulnerable citizens. It is another direct consequence of the hated poll tax, which should have never reached the statute book and which, I hope, will be withdrawn at an early stage.

5.46 pm

Mr. Nicholas Winterton (Macclesfield) : I am always pleased to participate in any debate in which the right hon. Member for Stoke-on- Trent, South (Mr. Ashley) also participates. He and I have devoted many years and a great deal of time to the quality of life and the interests of the most vulnerable groups in society. However, on this occasion I have not reached the same conclusion as he did about my right hon. and learned Friend the Secretary of State's statement. In fact, in a quiet way I warmly endorse the phasing in of community care. My right hon. and

Column 1037

learned Friend knows that, over the years, I have warned that we have been proceeding at too fast a rate and that many people would suffer as a result.

I wish to pick up one or two points made by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). I refer him to the Select Committee's report on community care, "Planning and Co-operation". The report states :

"We call upon the Government to ensure that, in the event of a delay"--

or the phasing in that was announced this afternoon--

"sufficient money is allocated to local authorities to enable them to purchase services from those new community care projects which have been set up this year in the expectation that their costs would be met by local authorities in the coming year If there is to be a delay, we recommend"

that the Department of Health requires

"that local authorities use the intervening period to prepare joint health and social services community care plans for their area." That is still lacking, and I do not think that it could have been achieved if the policy had been implemented, as originally planned, on 1 April 1991.

The report also recommended that sufficient money be allocated "to train staff in assessment and case management."

My hon. Friend the Member for Eastleigh (Sir D. Price) and I know from our work on the Select Committee that there are inadequate numbers of people yet able to undertake that task. It also recommended that sufficient money be made available

"to put in place workable collaborative structures with health authorities and other local authority departments such as housing departments and with voluntary organisations ; and to draw up contractual agreements with statutory bodies and with voluntary organisations."

I have no doubt that my right hon. and learned Friend will study with great care not only that report but the other reports on community care recently published by the Select Committee. I do not think that all is doom, as has been prophesied by one or two hon. Members during the debate.

I wish briefly to mention the Select Committee's report, Session 1984-85, on community care for the adult mentally handicapped and mentally ill. The Committee pointed out that the policy of community care

"means more than reducing the number of hospital beds". The report went on that it means instead

"the creation of a whole variety of alternative facilities, supportive services for people and their families who have little contact with statutory services and the redeployment of thousands of staff and the switch of capital resources."

Perhaps it is also appropriate to quote the 1986 Audit Commission report, to which the hon. Member for Livingston (Mr. Cook) referred. It pointed out that the reduction in NHS provision for the mentally ill had run ahead of the build-up of community services. The commission also highlighted geographical variations in standards, the need for bridging finance, the organisational confusion between statutory agencies, and inadequate service staffing.

For all those reasons--and many are still relevant today--I warmly support my right hon. and learned Friend's decision to phase in community care. That will produce a better community care policy, improved facilities, and more understanding.

The 1985-86 report of the Social Services Select Committee on the prison medical service expressed grave concern about the number of discharged mentally ill patients who ended up in prison because of the failure of community care and the lack of hospital beds for

Column 1038

psychiatric cases. Prison is not the place for individuals who have offended because of mental illness. Community care is not a panacea for all the evils that are with us today, and it should never be considered as such. It is the approach of management that can pay real dividends for the patient. In too many cases, it is based on a pecuniary policy introduced by health authorities to save on the cost of long-stay psychiatric and geriatric facilities.

In my own constituency, the people of Macclesfield have been raped and pillaged by the avaricious activities of Mersey regional health authority and its aggressive bulldog of a chairman, Sir Donald Wilson. The birthright of the people of Macclesfield has been stolen from under their very noses by a politically appointed, unelected manager who too often has appeared more interested in achieving capital receipts than in providing health care and services for my constituents.

The Macclesfield infirmary branch, which houses a geriatric ward, was closed down and sold for £3.5 million to Sainsbury to build a superstore. The Mary Dendy hospital has been sold off to Messrs. Barratt for houses, so that the mentally handicapped do not now have the same range of facilities that they did when that hospital existed. Part of Parkside hospital for the mentally ill in my constituency--a fantastic area of peace and tranquility in the heart of Macclesfield--has been sold off to McAlpine for houses against the wishes of an overwhelming majority of the people of my constituency. I say that with some regret, but I am concerned about what is happening to the facilities for vulnerable people in my constituency.

I have served for many years on the Social Services Select Committee, and my experience has been that in too many cases health authorities have discharged too many patients, too soon--and for the wrong reasons--into a community that is unprepared, unwilling, and, in some cases, unable to accept them.

Mr. Timothy Raison (Aylesbury) : Will my hon. Friend give way?

Mr. Winterton : No, I shall not give way, because I have a lot to say. I feel deeply on this subject, and I want to call on my experience and knowledge gained in recent years.

Why do not we follow the example of the Dutch? I recently led the Select Committee on a valuable visit to Denmark and to the Netherlands. We visited a large community for mentally handicapped people in Noordwijk, which is close to Amsterdam. That village community has 1,000 mentally handicapped residents--850 of whom live on the main site and 150 in group homes nearby. A small number of them are severely handicapped. Residents live not in the old conventional Victorian hospital which is so typical and which we say that we need to get rid of, but in about 30 houses around a large site, each containing about 25 residents. They live in proper apartments of between eight and nine people. The site is well landscaped and contains a swimming pool, horticultural plots, a supermarket where residents pay for their goods by Giro bank card, a hairdresser, a clothes store, and a new activity centre with impressive education and recreational facilities. It also includes hydrotherapy and--dare I use this word in the House--a "snoozlroom", which is amazing in aiding the rehabilitation and calm of some of the mentally handicapped who require that sort of treatment.

Column 1039

That village community has its own doctor, dentist and physiotherapy service. There are also nurses' homes on the site and a creche for the children of the staff. There are more than 1,000 staff. Not all are full time, but 650 are nursing staff. There is a nurse training school as well.

That village community is using the fantastic facilities that exist and is not selling them off for houses or other forms of development. It is using them for the progressive treatment of mentally handicapped people. My hon. Friend the Member for Harlow (Mr. Hayes) also visited that community, and he was as impressed as I was with the facilities. I am concerned for the future--

Mr. Kenneth Clarke : Will my hon. Friend give way?

Mr. Winterton : I shall give way to my right hon. and learned Friend uniquely.

Mr. Clarke : I hope that my hon. Friend will allow me to put in a word for Sir Donald Wilson, whom he described as raping and pillaging Macclesfield. He must realise that the 19th century large mental hospitals are being sold to produce money for capital investment in a successful region. Mersey is developing its policies for the mentally ill and will do so with the aid of the new grant. It is one of the most successful regions in the country in reducing its waiting list for non-urgent operations, and it has recorded many other achievements. Will my hon. Friend moderate his language and his attacks on one of our most successful health authorities?

Mr. Winterton : I will not alter a single word of my comments about the actions of Mersey regional health authority in my constituency. I am fully supported by an overwhelming number of my constituents, including those who deal with the vulnerable groups of mentally handicapped people and others.

My concern for the future--and I am glad that my right hon. and learned Friend is still present to hear this--is heightened by his somewhat unfortunate action in refusing to ring-fence local authority funds for all community care, to prevent that provision being chipped away at, siphoned off or downright plundered to boost budgets to provide more high-profile and electorally advantageous services. Is it correct that my right hon. and learned Friend will be meeting only about 70 per cent. of the costs to local authorities of looking after mentally ill people who are discharged from hospital? If that is the case, it is a fraud. He owes it to these people to advance 100 per cent. of the cost. I am delighted that the resources for the mentally ill have been ring-fenced, but the amount given is important and should represent 100 per cent. of the cost.

We are gambling with the welfare and lives of the weakest and the most vulnerable people whose care is our responsibility. We cannot and must not turn a blind eye to the fact that we have failed so far to ensure that we have put in place the appropriate infrastructure and support that is necessary if that policy is even to stand a chance of working.

A group of people who include the right hon. Member for Stoke-on-Trent, South and my hon. Friend the Member for Eastleigh, and other members of the Select Committee, are deeply concerned about the carers. They are a vital part of the success of community care. Of the 6 million carers in Great Britain, 3.7 million carry the main

Column 1040

caring responsibility ; 1.4 million devote at least 20 hours a week to caring, with more than half of them spending at least 50 hours a week on their caring duties. That staggering resource should be nurtured and supported in a planned, proper and systematic manner. I may well rile my hon. Friend the Member for Maidstone (Miss Widdecombe) when I say that its continuation and extension cannot and must not in future be left to chance. If community care is to work, positive steps must be taken to ensure that local authority social services departments are obliged to make it a prime objective to bring together and disseminate information about the statutory and voluntary services in their areas that would be of assistance to carers and their dependants.

Furthermore, local authorities must consult carers and their representatives regularly about their community care plans ; high priority must be given to developing domiciliary support services for carers ; greater resources must be made available for training ; many more respite facilities must also be made available. Failing that, many of these carers will collapse. Those whom they look after will then automatically become the responsibility of the social services departments.

This is a critical debate. Sadly, party politics and political sparring have formed far too large a part of it. We are seeking to do our best for these most vulnerable groups. Through my work on the Select Committee and elsewhere, I shall continue to seek to represent their best interests and improve their quality of life, come hell or high water, come pressure from Government Whips, come pressure from any other source. I believe that the House has a duty to safeguard the future of these people.

6.1 pm

Ms. Mildred Gordon (Bow and Poplar) : Before the debate began I was extremely angry both about the community charge and about the lack of implementation of care in the community. I did not think that I could be angrier, but the laughter of the Secretary of State and of other Conservative Members when the hon. Member for Macclesfield (Mr. Winterton) described what was happening to the health service in his constituency has made me angrier than ever. So has the statement that the Secretary of State made today.

One thing that his statement has made clear to us is that one of the purposes of the so-called community charge is to destroy all sense of community and to turn the most vulnerable sections of society against one another. The Secretary of State said that people must be protected from having too great a burden of community charge laid upon them and that therefore the implementation of the provisions relating to care in the community must be delayed. However, it is the poorest and the most overcrowded families who suffer the most from this unfair tax. They have to pay far more than those who live in big, spacious properties.

It is these same poor people who have to pick up the pieces of the shattered welfare state that is under attack by the Government. They have to do the extra unpaid work of caring for people in the community. They have no assistance. The result of more and more cuts is that they receive less and less help. If he was really concerned about their problems, the Secretary of State could relieve their burden by abolishing the community charge.

Column 1041

There is a hospital for the mentally ill in my constituency. Proposals are afoot to close St. Clement's hospital and sell the land and buildings. The Secretary of State says that he never allows such a hospital to be sold off without ensuring that even better provision is made for the mentally ill patients in the community. I hope that he will do that when the closure of St. Clement's is considered. There is no provision for severely mentally ill and severely disabled people in the community. If the Secretary of State's Department always makes sure that there is good provision for these people in the community when hospitals are closed, how does he explain the fact that people are living on the streets in cardboard boxes? Mentally ill patients are being discharged from hospitals every day, their possessions in a plastic bag, and given a list of hostels where they can look for accommodation, even though everybody knows that those hostels are already full. They therefore end up on the streets, and their condition gets worse and worse.

If the community charge is cut, due to cuts in public expenditure, that will lead to more money in the pockets of the rich, but public expenditure cuts will lead to misery, uncertainty and suffering for the most disadvantaged people. After a lifetime of work, when they become old, frail, sick or disabled, having been squeezed dry in order to profit others, little provision is to be made for them. They are thrown on the scrap heap. They are told, "Wait a few years ; you can go swing your hook in the meantime."

I have tried to discover the scale of the problem in Tower Hamlets. In particular, I have tried to find out how many young severely disabled people need care in the community, and what it will cost. I have received no answers during the last three months, although I know personally of six cases. Two of them are severely disabled young men, paralysed from the neck down as a result of injuries in rugby matches.

I digress in order to say that something ought to be done about the rules of that dangerous game. Protective clothing should be worn, similar to that which is worn by those who play American football. That might prevent terrible accidents, leading to total paralysis and the ruin of young men's lives. Those injuries are not uncommon. When my son was a young boy, I spent endless time in the accident and emergency department of my local hospital because of injuries that he and his friends suffered in rugby games.

There are four young disabled people in Charles Key lodge who would like to live in the community with support. There is a frail elderly lady whose husband can no longer look after her on his own, and other people who suffer from multiple sclerosis. All those people, as well as mentally ill and handicapped patients, will be very expensive to look after. Rehabilitation programmes in national health service hospitals need to be funded to enable them to prepare for life in the community. However, money for that purpose has not been provided. We need central funding that is ring-fenced so that they can be properly looked after in the community.

From the cases that I have examined, it seems that one of the problems is the demarcation line between the national health service and social services. That applies to both funding and the work that is done. If someone is paralysed and needs a catheter and help for bowel functions, the question is whether that is to be regarded as medical help or dealt with by a carer who has been trained

Column 1042

just for that purpose. That question has not been answered. It has resulted in help for individuals who are waiting for release from hospital being delayed.

I have referred before to the case of Corporal Bill Blackburn, but I have been unable to talk about him for more than a few seconds. His case graphically illustrates what is happening but what should not be happening. Corporal Bill Blackburn was injured three years ago in a rugby accident. He is tetraplegic and paralysed from the neck down. That young man, who is not yet 30, was admitted to the Odstock spinal injuries unit near Salisbury three years ago. Two years ago, he was admitted to the Queen Elizabeth military hospital on the premise that he would soon be able to live in a specially adapted flat that we had obtained for him in the area where his mother lives, on the Isle of Dogs. We used pressure to obtain that flat for him.

A dispute arose over who would be responsible for funding his care in the community. The health authority offered a district nurse, but the service could not guarantee that he would be taken out of bed before 11 am. He was also told that he would have to be put back in bed before 7 pm. That is no life for a young man. He rejected that proposal and asked whether alternative arrangements could be made, with three carers taking it in turns to look after him. While a number of case conferences took place, Corporal Blackburn got on with his rehabilitation programme. In April 1989 he went to New York, where he won medals in sports for the disabled.

He says that he does not want or need sympathy--that all he wants to do is to get on with his life. He has waited for three years to get into his flat so that he can again live a full life. However, the conflict between the NHS and the local authority social services continues.

He was given a discharge date of November 1989, but it was not kept because of the disputes over money and who should do which job. After pressure from me, the director of social services went to the military hospital to see Bill Blackburn and promised him that he would definitely be discharged by the end of January 1990. Because it was the director of social services who made that promise, Bill spent money on a washing machine and fitting his flat with blinds. He really believed that this time he would be discharged. It was not to be. I have a letter from the social services department which says that, if the Government cannot be made to understand the problems for local authorities of funding these cases, which cost perhaps upwards of £30,000 a year, some even double that, the legislation will be meaningless.

The local authority says that it cannot find the money to look after Bill Blackburn without a financial contribution from the health authority. The health authority said that the health service contribution has to be in relation to the provision of health care skills and that it does not accept that it is a district health authority responsibility to contribute directly towards Mr. Blackburn's social care needs.

It requires the judgment of Solomon to decide which are social care needs and which are health care needs. It gives the local authority an opportunity to yo-yo backwards and forwards and continue arguing, while Bill Blackburn is still in the military hospital. The Secretary of State's statement today just adds to that yo-yo effect. Bill told me recently that he hides his head when the consultant goes around the hospital because he knows that he will be asked whether there is any news from Tower

Column 1043

Hamlets council. There is no news. He knows that the bed has been needed for years to help the rehabilitation of others who have had accidents or who are severely disabled. He does not want to settle for life in an institution, and why should he have to do so when he is a young man? It would not be right and proper for him. Surely the proposals for care in the community should be able to be used to help someone like Bill live a full life, yet they are not working. The Secretary of State and his team must suffer either from a lack of imagination or from a lack of conscience when they can come here and blandly make proposals which will postpone help for all such people. Perhaps they do not realise the heartbreak involved. I challenge the Secretary of State to go down to the Queen Elizabeth military hospital to see Bill Blackburn and explain his policies and tell Bill when he will be able to use his flat on the Isle of Dogs. 6.12 pm

Mr. Peter Thurnham (Bolton, North-East) : The hon. Member for Bow and Popular (Ms. Gordon) is calling for extra spending but she seems to forget how relatively low the level of spending was when the Labour party was last in power. In 1979 spending on community care services was just over £1 billion. The latest figure is well over £3 billion--an increase of 68 per cent. in real terms over eight years. She should bear that in mind.

Ms. Gordon : The hon. Gentleman must realise that many hospital wards and beds have been closed since then and there is far more need for care in the community than there was when the hospital service was more full and efficient.

Mr. Thurnham : More hospitals closed under the previous Labour Government than under this Government.

The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) said that he thought that people with disabilities would be disappointed with the Government. I think that they will be disappointed with the Opposition. I would have thought that we could have had a full-day's debate on something as important as care in the community and I am disappointed that it is only a half-day debate. The Opposition's motion calls upon Her Majesty's Government to "ensure adequate funding". When I asked the hon. Member for Livingston (Mr. Cook)--I am grateful that he gave way to me--about what level of funding the Labour party would provide if it were in power, he was not able to give me an answer. I should like to take him to the kiosk at the side of the Chamber and buy him a tin of humbugs because that is what it is. The motion calls on the Government to provide funding, but the Opposition cannot provide an answer when asked about their proposals.

People with disabilities will be disappointed that the Opposition have not come forward with proper policies. However, we can see their difficulty. The Leader of the Opposition has gone on record as saying that 15 out of 16 working taxpayers would not pay anything extra if his party were in power. I understand that the hon. Member for Livingston will not pay his community charge. Therefore, there would be no resources to put into extra

Column 1044

community care. That is why the hon. Member for Livingston cannot provide an answer and why he has to talk in vague terms about adequate funding. All he could say was that he would want to provide a reasonable amount. The Government have increased spending on community care substantially. We have done more than the Labour party is offering to do.

The Government are right to phase in community care because it would be wrong to go for a big-bang approach. The chief executive of Bolton local authority has sent me a fax saying that Bolton is willing and ready to take on implementation of the Act, provided there is the necessary financial support. However, it has overspent on the budget for Network homes by about £500,000. The cost of providing for those in Network homes is far too high. The figures I have show an average cost per resident of about £22,000 a year. In a voluntary home a few miles away with what I believe to be a higher standard of care, the cost is £12,000 a year. The existing resources are not being used efficiently. Before calling for extra resources we must see that existing resources are used more efficiently. I call on the Government to issue strict guidelines to local authorities to use the phasing-in period to involve voluntary groups much more fully. I received a letter today from Fidelity Simpson, the parliamentary adviser to the Spinal Injuries Association. She said :

"The delay gives local authorities ample opportunity to fully consult with organisations of disabled people in their area and we urge the Government to stress this in their guidance on planning. The Social Services Inspectorate Report on the Disabled Persons Act issued in January 1990 highlights how service developments for physically disabled people are often given a lower priority than service developments for other groups of service users.' It goes on to recommend that social services authorities should progress the direct involvement of disabled people in the strategic and operational planning of services at elected member and officer levels'."

That is excellent. It shows that one voluntary group sees this time as an opportunity to become more involved. I call on both Bolton local authority and other local authorities to involve voluntary groups to a much greater extent.

The Bolton Handicap Action Group has set up a charitable trust and wants to play a part. It should be helped to do so. If voluntary groups have not had enough help in the past, they should be given more help to organise themselves to provide a service which can be done much more efficiently and effectively than by local authorities which are riddled with high overheads and restrictive practices and are concerned far more with bureaucracy than providing care for individuals.

In my constituency there is a severely disabled young man by the name of Paul Hargreaves. He desperately wants more care. His mother has told me repeatedly that she cannot go on any longer. However, the local authority has failed to provide care for him. It has to reconsider its priorities and provide help where it is needed. If necessary, we should look carefully at the proposals to allow local authorities to give cash for care. We were not able to secure an amendment on that the other day, but we should devolve packages of care whereby people in need can have money to buy in care services far more efficiently than they could be provided by local authorities. I call on local authorities to use this phasing-in time to improve the standard of care and the way in which they organise it.

Column 1045

6.18 pm

Mr. John McAllion (Dundee, East) : The idea of care in the community is one to which all hon. Members subscribe. People who need not remain hospitalised in long-term institutions must be given the opportunity to live independently in the community.

We can all agree at least on that point, but what separates the Opposition from the Government is the context in which we place the idea of care in the community. For us, it must be pursued for its own sake. It represents a substantial and qualitative leap forward for thousands of citizens who do not receive the quality of care that should be theirs of right. The Opposition regard care in the community as an end in itself, albeit one with massive resource implications for the Government and the taxpayer. The Government regard it not as an end but as a means to an end that has little to do with improving the quality of services for people in need, as a means of cutting the cost of the national health service and as a cheaper alternative to other options.

The Government further regard care in the community as a means by which the private sector can be allowed inside the national health service to pick off, one by one, the nice little earners that they have identified. I do not doubt for a minute that the Government's friends in the private sector will be able to provide private care under the new community care proposals, but in the main they will put profit first and patients second. Despite the rhetoric of Conservative Members, that is a fundamental reality which they will not be able to overcome. They cannot deny that the Government are promoting the private sector through their care in the community policies.

I consulted the excellent magazine Labour Research for 1987, which showed that there were 100,000 elderly and mentally and physically handicapped people in private nursing and residential homes in the United Kingdom. Yesterday, I telephoned the Library to ask how the statistics had changed in the intervening period. It told me that in March 1989, according to the review of private health care, there were not 100,000 but 231,800 elderly, chronically sick and physically disabled people in private nursing and residential homes. That figure does not include mentally handicapped people, so it is actually even higher. Hon. Members know from constituency experience that since March 1989 the number of private residential and nursing homes has mushroomed further. The intention of the Government is to encourage the private sector to provide for mentally and physically handicapped and elderly people.

The reality is that thousands of the most vulnerable people in our community are being shipped out of the national health service, which has looked after them for most of their lives, and handed to private providers, the motivation of most of whom is to make money from their predicament. Does not the realisation that that is happening send a shiver of apprehension down the spines of those Conservative Members who still have a conscience? If it does not, it should be doing precisely that.

Mr. Raison rose --

Mr. McAllion : The right hon. Gentleman will have to forgive me--I do not have time to give way.

A report was recently issued by the director of social work on Tayside regional council. It questions the ethics of the Government's encouragement of health boards to use

Column 1046

private contractors and to make an alternative provision for the chronically sick and elderly in their hospitals. He writes : "Given the vulnerability of the client groups affected by these arrangements, the question of whether they can give informed consent to these changes must be in doubt, and questions have been raised about whether the quality of care they will receive will be equal to that available in a hospital environment. This latter issue was raised recently when general practitioners in one Scottish Region objected to providing services free of charge to the many nursing home residents who previously had received medical and nursing care in Health Service hospitals."

Surely the report is right to question the ethics of a deal struck between the Government, health boards and private contractors--a deal that is essentially about money--the consequence of which is to transfer vulnerable patients into potentially exposed circumstances in which the quality of care that they receive can be significantly reduced. Does not it give hon. Members pause for thought that we have just passed legislation that makes it much more likely that many more vulnerable people will be transferred into such potentially exposed circumstances?

One of the most revealing documents on the Government's attitude to care in the community is the recent Scottish Office consultation paper on specific grants for mental illness. The basic concept behind it is good : first, that the current level of community-based services for people with mental illnesses is far too low ; and, secondly, that something must be done to improve those services. No one would argue with that, but on reading into the document a different picture emerges. Page 1 states :

"The policy aim is twofold : to reduce the numbers of mentally ill people requiring admission to hospital and to enable mentally ill people to leave hospital."

Page 2, under the heading,

"types of project eligible for assistance",

states that the

"main criterion for judging applications"

is the

"extent to which the proposed project could assist in providing for, or supporting community living and in so doing help to reduce the need for hospital admissions or facilitate the discharge of persons from hospital."

It would appear that the true purpose behind the provision of specific grants on mentall illness is simply to empty hospitals. The director of social work in Tayside region described it as placing "excessive emphasis on hospital discharge programmes."

I can understand the Government's reasons for introducing care in the community. It reduces costs in the health service, transfers the financial burden from the Government to local authorities and, possibly more important, reduces the requirement for beds in psychiatric hospitals, particularly those located in prime development sites, thereby making it easier for the Government to sell them and to acquire a capital receipt.

Has that anything to do with helping mentally ill people? Are they a priority in the Government's policies? The answer to those questions must be a resounding no. If they had been a priority, the Government would have adopted a different approach. First, they would have assessed the need for community-based services. Secondly, they would have targeted resources to increase annually the level of such services that could be provided. Thirdly, they would have geared hospital discharge programmes to the community-based services that are available for those leaving hospitals.

Column 1047

The fact that the Government have made a priority of the hospital discharge programmes and geared funding to maximise the emptying of those hospitals reveals the true nature of their commitment to care in the community. They put buildings, costs, revenue and profits before people who depend on services.

This afternoon, the Secretary of State made the absurd suggestion that local authorities had not prepared plans to implement the care in the community proposals, which excused the delays that he announced. That is sheer nonsense. The plans that have been made by councils are ready for implementation. I have three lengthy reports from Tayside regional council on the plans that it has developed to implement it. Its convenor of social work, Councillor Jim Mudie, who is the convenor of the social work committee of the Convention of Scottish Local Authorities, was quoted this morning in the Scottish press as saying that councils in Scotland are ready and willing to meet the Government's original deadline of 1 April next year. What is lacking is the Government's resolution to make available the resources that would make it possible to keep to their timetable. They realise that if they do not provide the resources to proceed in April 1991 it will have an impact on poll tax levels in a general election year.

Ultimately, that means that the Government have decided their priorities. They had to choose between implementing their care in the community policies and backing off and trying to save their political skins in an election year. The fact that they chose the latter speaks much of the Government's attitude over the past three or four years and explains why they will not be the Government after the next general election.

6.29 pm

Mr. Jerry Hayes (Harlow) : As a wholehearted supporter of the Government's policy on community care, I was disappointed to learn that we cannot go ahead on 1 April 1991 in the way intended. I found most offensive the rather unpleasant way in which the hon. Member for Livingston (Mr. Cook) was suggesting that elderly, frail and disabled people will be decanted into the streets. That is simply not true ; it will not happen. I find it deeply offensive that the old and the frail should be cynically manipulated and used as a political football.

Sir Roy Griffiths, the author of the splendid report which led to the legislation, said a few weeks ago :

"There is a serious situation out there which needs tackling." He said that if there was a delay, he

"would like to see a lot of justification".

I agree wholeheartedly.

I was pleased to learn that my right hon. and learned Friend the Secretary of State and his ministerial team will not be postponing their excellent proposals, but will be phasing them in sensibly. I and many professionals in the caring community were concerned that the proposals would be put on ice. There were worrying reports in the newspapers that the delay would save the community charge payer £15 a year, or 30p a week. If that had been the reason for the decision, it would have been immoral nonsense.

Sir Roy Griffiths stressed the need for justification and said that there will never be precisely enough money for

Next Section

Home Page