---

Column 1048

community care. It is an untapped resource. The Select Committee said that carers save the community £24 billion a year. We owe them a debt, and they will not be forgotten.

It is quite sensible and proper that local authorities do not implement the proposals with a big bang, because the Government would be held hostage by left-wing authorities-- [Laughter.] It is all very well for hon. Gentlemen to laugh, but left-wing authorities would not cut their women's units, their gay units, their police monitoring units or their civic newspapers ; they would cut care in the community. They would bring in the television cameras to show elderly people being thrown out of homes to gain some political advantage.

Mr. Allen McKay (Barnsley, West and Penistone) : What about ring fencing?

Mr. Hayes : I have always supported ring fencing, as has Sir Roy Griffiths.

I was pleased that my right hon. and learned Friend has met his road to Damascus today as he announced a new specific grant to support services for the mentally ill to ensure a higher priority for those services ; a new, specific grant for the funding of voluntary bodies providing services for drug and alcohol misusers who were given low priority in the past ; a new specific grant of £35.5 million for training social services staff ; more support for those working with the elderly, children, the mentally handicapped and the physically disabled ; and more support for post- qualification training courses.

It is a welcome change of policy, which could be called creeping ring fencing. The Government clearly appreciate that, as we are about to spend £800 million or £1 billion of taxpayers' and charge payers' money, we must ensure that it is properly spent.

The House has agreed to legislation suggesting that we should be kind to small, terrified, furry animals, so I shall be particularly kind to the hon. Member for Livingston. He suggested that disabled people would be severely disadvantaged. Has he forgotten my right hon. Friend the Secretary of State for Social Security's 20-point plan specifically to help the disabled? Has he forgotten the carers' premium? Admittedly it is only £10, but it is a start and recognition of the valuable work that they do. Are we totally to ignore the Government's record on the abolition of the invalidity trap and the increase in public expenditure on social services of something like 37 per cent. in real terms since 1979? We would be foolish to forget all that.

I regret the cynical manipulation by the Opposition of the elderly and those most at risk. I stress that the decision that had to be made will not be a cheap decision or a soft option. I refer my hon. Friend the Minister for Health to one of the most important parts of the Griffiths report--that which deals with residential care and nursing homes and the difficulties that many people face. A few weeks ago we had a debate about the many people on income support who are out of pocket by £40 a week in residential care and by up to £80 a week for nursing care. That is totally unsatisfactory, but between now and 1993 local authorities will gradually move people from voluntary homes to other homes, resulting in the Department of Social Security picking up an extremely large bill. Unless the Government set their mind to that problem, they will face an even larger bill.

---

Column 1049

I regret that that decision had to be made, but the justification shows that unfortunately it was absolutely necessary.

6.37 pm

Mr. David Hinchliffe (Wakefield) : In a couple of minutes, before the Front-Bench spokesmen wind up the debate, I should like to pick up one point which has not been mentioned in the debate. In addition to the Government's concern about the politics of the poll tax, there is a more sinister reason behind the Secretary of State's announcement that the proposals are being deferred.

The Government have caved in to extensive lobbying from the private care sector. Those involved in private care are deeply alarmed that the assessment of individual cases may well result in the redirection of individuals away from private institutional care. They realise that the legislation will well and truly put the brakes on the private care bonanza under the present Government, in which vast numbers of businesses have made a huge amount of money out of people's need for care. That has not been mentioned so far in the debate.

The Secretary of State spoke about new money for local authorities, but we should examine the gross misuse of existing resources through the income support system. We know that vast numbers of people unnecessarily end up in private institutional care without any assessment whatsoever. They are placed there to serve the interests of the private care business. The Government have announced that the legislation will be deferred for two or three years, but it should be stressed that a huge amount of public money will continue to be grossly misused and wasted on institutional care instead of preventive care.

It is important to note that the Association of County Councils' briefing paper states :

"It will cost at least as much to continue with the existing system as to move to the new community care regime."

Conservative-controlled councils have also said that. If we look at the matter from a financial point of view, deferral makes no sense. The continuation of open-ended income support payments for institutional care, whether or not people need it, is absolute nonsense and a gross misuse of public money.

Public resources are being misdirected towards private institutional care businesses at the expense of genuine community care which should be directed towards keeping people in their own homes. We should consider the human cost of deferral : by his statement today, the Secretary of State is imprisoning in institutional care people who do not need that care, and he is doing so at huge public cost. Vast numbers of people in institutional care are getting deeper into debt as a result of inadequate income support payments, and that will continue over the next few years. Has the Secretary of State discussed with the Secretary of State for Social Security what deferral means in terms of public expenditure on social security payments? The Government's actions make no sense. It is clear that there is a need for a Minister for community care--something that the Labour party proposes --who does not consider one narrow interest of one Department, but who considers the roles of all the Departments across the board and also considers the needs of people in the community rather than in institutional care.

---

Column 1050

6.40 pm

Mr. Tom Clarke (Monklands, West) : In this all too brief debate in Labour party time, a number of interesting and important points have been made. There were many disappointments, the most important of which was the statement which the Secretary of State made earlier and his defence of it during this debate. I also found it

disappointing--this is the first community care debate that I can recall in which I must say this--that every Conservative Member found it necessary to support everything that the Secretary of State did. One assumes that someone must have whispered the date of the general election in their ears because there can be little other justification for the Secretary of State's pathetic performance this afternoon.

The Secretary of State reduced the role of Minister into a spectator sport. I hope that Conservative Members will not regard "spectator" as too offensive a word. However, that is a clear description of his role. Instead of fighting for his Department and for the objectives that he set, he has surrendered completely and care in the community in Britain is all the poorer for that. The Secretary of State would not upset the Hush Puppies of the Chief Secretary to the Treasury. Indeed, we almost expect the Chief Secretary to enter the Chamber any minute to pat the Secretary of State on the head. He would be one of the few people who would do that. If it was the intention of Conservative Members to improve the Secretary of State's image, they should be aware that his relationship with carers is similar to that between the right hon. Member for Cirencester and Tewkesbury (Mr. Ridley) and the British-German friendship society.

As my colleagues have said, we are dealing with promises that were made clearly by the Government not just in the White Paper or in response to the Griffiths report, which the Secretary of State failed to mention, but as recently as 24 June. The Secretary of State quoted figures like confetti today, but he did not give us his figures, his thinking or his reasons for one of the most spectacular U-turns in the history of social services.

The Secretary of State lambasted the local authorities, but ignored the assistance that they have given to his Department time after time. He referred to the figure of £1.5 billion, but conveniently overlooked several things : the fact that the local authorities' quotation was £1.02 billion ; that they were bearing in mind that their estimate of £826 million for community care included £500 million in the social security budget which the Secretary of State had told us until today would be transferred to the local authorities in any case. No one would welcome the gross exaggeration about the local authority figures which the Secretary of State put before the House today.

In this retreat, it is clear that the real reason behind the Government's thinking is that they have created a monster in the shape of the poll tax. There should be no doubt, if the Government's previous rhetoric must be believed, that they have panicked in the face of an approaching general election and the vulnerable in our community, the physically disabled, the elderly, the mentally ill, the mentally handicapped and their carers will have to pay for that panic.

The Secretary of State said that he has thought about these matters and that he is worried about the community charge. Where did this sudden proposal for phasing-in come from? Why did not it appear in the White Paper or

---

Column 1051

in earlier statements to the House? Why did the Secretary of State not once in Committee tell my right hon. and hon. Friends that things would be phased in like this or that we would have a timetable? Why did he not once say that the Government were going to disown Sir Roy Griffiths's main recommendation? That is what the Secretary of State's statement today really means.

Conservative Members have said that they welcome the delay and postponement. The hon. Member for Bolton, North-East (Mr. Thurnham) could quote only one local voluntary organisation. I repeat the challenge of my right hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) : can the Secretary of State tell us of one voluntary organisation--the Royal Association for Disability and Rehabilitation, the Spastics Society, the Care in the Community Scottish group and many others--that would support the delay? The opposite is the case. Voluntary organisations have made their views known to hon. Members and they will be as shocked as Opposition Members at the Secretary of State's announcement this afternoon. The Secretary of State referred to the need for co-ordination between the national health service and local authorities. In the light of his statement this afternoon, the morale of GPs and that in local authorities, in the health service and social services and social work departments must be at a new low. None of that is good news for co-operation and nothing that we have heard from the Secretary of State this afternoon is good for the patient. The provisions relating to community care were the only part of the National Health Service and Community Care Bill that anyone wanted. The Government have rushed ahead with the parts that no one wants and now tell us that they are going to delay the implementation of the small features of the Bill that were practicable. The deputy Prime Minister told us that the implementation would take place according to the availability of resources. We have heard that before. We heard it in connection with the Disabled Persons (Services, Consultation and Representation) Act 1986, and if the Government really believe what they say about the consumer, choice and representation and if they are really listening to 6.5 million disabled people and their carers, they would have implemented all the provisions of that Act by now. Who can believe the Government's intentions when they refer to 1993 with regard to community care when the Disabled Persons (Services, Consultation and Representation) Act 1986 has been on the statute book for four years and not all its provisions have been implemented?

Conservative Members accused my hon. Friend the Member for Livingston (Mr. Cook) and others of exaggerating the problems of the elderly and of income support and the care gap in private residential homes. If they do not think that there is a problem now, they should listen carefully to the directors of social services. I cannot understand why they think that there is no problem now. We saw on television just the other night some of the problems that already exist. The directors of social services are warning hon. Members that people will increasingly go to their surgeries because of the demographic time bomb

---

Column 1052

and because of the problem of income support. We know that the elderly are already suffering because of the lack of planning. Conservative Members ignore that at their peril.

This all too brief debate has failed to consider in the detail that we would wish the Government's real strategy for community care. The Prime Minister seems to believe in seminars to study characteristics. Why does not she call a seminar to study the real characteristics of the elderly, the disabled, people suffering from Alzheimer's disease and their carers? Why does not she consider how they can be properly supported in their own homes? The Prime Minister lectures us, today of all days, when we have had such a pathetic response to the problems of community care within our society. Nothing could be more devastating to millions of families than the Government's proposals for community care.

In that spirit, I invite hon. Members to support the motion. I invite the British public in due course not just to dismiss a Secretary of State who can produce such lethargic proposals but to throw out with him the Government who have made such lethargy possible.

6.51 pm

The Minister for Health (Mrs. Virginia Bottomley) : Let me make it quite clear that we are not discussing abandoning the policy of community care or of cancelling the policy of community care ; we are discussing carrying forward our policies in a practical, sensible and responsible manner. My right hon. and learned Friend the Secretary of State has made it only too clear that next April we shall begin with the new provision for the mentally ill. Many hon. Members have referred to the importance of proper community care provision for the mentally ill.

My hon. Friends the Members for Macclesfield (Mr. Winterton) and for Leeds, North-East (Mr. Kirkhope) and the hon. Member for Bow and Poplar (Ms. Gordon) referred to the need for the mentally ill to have proper provision made for them when they are established in the community. We are not satisfied that sufficient work on that matter has already been undertaken by local authorities. Local authority expenditure on the mentally ill amounts to about 3 per cent. Nor are we satisfied that the proper provision that the public need to satisfy them as well as those who need care has been arranged. That is why the specific grant allowing spending of £30 million will be established from next April, thus ensuring--this should satisfy my hon. Friend the Member for Macclesfield--that no individual will leave a long-term mental hospital without a proper care package and without a named individual being responsible for his or her care as he or she goes out into the community.

Again, my right hon. and learned Friend announced that we intend to make headway with particular assistance for those who suffer from drug or alcohol misuse, thus ensuring that resources are provided for the voluntary sector. My hon. Friend the Member for Bolton, North-East (Mr. Thurnham) referred to the importance of the voluntary sector. It has done excellent pioneering work, and headway will most certainly be made.

Many hon. Members have referred to the importance of carers, and the White Paper and the National Health Service and Community Care Act 1990 particularly refer to the importance of carers. We are funding caring organisations to the tune of about £100,000 this year. They are deeply involved in our consultation on guidance and

---

Column 1053

the implementation of their important work. The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) asked when the guidance will be made available. I give him the clear assurance that the guidance will be available in the autumn. As he will know, we have already issued draft guidance on plans, assessment, inspection and several other matters. We have been consulting widely with local authorities, and that guidance will further inform our plans as we take forward the important work.

Many hon. Members have rightly and properly drawn attention to the very great change that we are seeking to create. We know full well that health authorities and family health service authorities are busy taking on their new responsibilities, thereby putting them in a good position to provide for the health care of their resident populations. District health authorities, family health services authorities and general practitioners, through the new contract, can be active partners in the provision of care in the community. The Select Committee, in its most recent report, suggested, perhaps with some justification, that the tight timetable means that it will be difficult for local authorities to implement care in the community policies to the standards that we all would want. That allows a further period for local authorities, voluntary organisations and the private sector to implement, to carry forward, to consult and to co- ordinate, so that in April 1993, when they take on the full responsibility- -when the social security money is transferred to local authorities, when there is no longer the safety valve of social security payments to provide for those who need residential care--they will be able properly and effectively to undertake their responsibilities.

We in the Department, the social services inspectorate and local authorities have a great deal of work to undertake in the two years. We shall be continuing our training and seminars. We shall be issuing a newsletter on implementation to make sure that we can continue to develop and promote further the momentum of an important policy. My right hon. and learned Friend the Secretary of State made it clear that the amount of money to be available for training local authorities will increase to about 25 per cent. next year. Training money will be available not only for the elderly and for children but for the mentally ill, the physically disabled and the mentally handicapped. I hope that my hon. Friends will believe that this is not a cancellation or an end to the policy. This is a moment so that we can spend more time actually preparing and ensuring that we make the headway that we should properly and rightly make. It will be hard work. We need to ensure that all the necessary steps are taken. Several hon. Members referred to the provision of social security payments. As was well said by my right hon. and learned Friend, our right hon. Friend the Secretary of State for Social Security has set up a study. There have already been extra resources to the degree of £145 million to provide additional assistance to the likes of Florence Smith and others about whom we heard during the detailed debate earlier in the year.

Care in the community policy will take time to implement fully and effectively. Over the past 10 years-- [Interruption.] Over the past 11 years we have seen dramatic advances. We have seen a phenomenal increase in provision in terms of adult training centres for the mentally handicapped--11,000 more places, which is a 25 per cent. increase. We have seen a great increase in the

---

Column 1054

number of day centre places for the mentally ill--30 per cent. more ; another 1,500 places. We have seen a tremendous increase in the number of social workers--I may need to declare a vested interest. There are 5,000 more social workers--an extra 23 per cent. There are an extra 12,000 more home helps--25 per cent. more and, again, many more community psychiatric nurses. We have seen a dramatic increase in personal social services spending to the degree of 47 per cent. That is the record of a Government who have been investing in the community and developing community care services. We believe in the policy. We now have the legislation on the statute book. We believe that there are urgent tasks to be undertaken. We believe in quality. We believe in safeguarding the interests of the frail and the vulnerable. That is why the complaints procedures and the inspection units will go ahead from next April, together with the other specific grants in areas of special and important need, to which my right hon. and learned Friend referred.

It is essential that nobody should for a moment forget the challenge that is ahead of us--to ensure that over the next decade we can achieve these community care policies. I urge hon. Members most sincerely and strongly to reject the motion.

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

The House divided : Ayes 224, Noes 335.

Division No. 301] [7 pm

AYES

Adams, Allen (Paisley N)

Allen, Graham

Alton, David

Anderson, Donald

Archer, Rt Hon Peter

Ashdown, Rt Hon Paddy

Ashley, Rt Hon Jack

Ashton, Joe

Banks, Tony (Newham NW)

Barnes, Harry (Derbyshire NE)

Barnes, Mrs Rosie (Greenwich)

Barron, Kevin

Beckett, Margaret

Beggs, Roy

Beith, A. J.

Bell, Stuart

Benn, Rt Hon Tony

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

Bermingham, Gerald

Bidwell, Sydney

Blair, Tony

Blunkett, David

Boateng, Paul

Boyes, Roland

Bradley, Keith

Bray, Dr Jeremy

Brown, Nicholas (Newcastle E)

Brown, Ron (Edinburgh Leith)

Bruce, Malcolm (Gordon)

Buckley, George J.

Caborn, Richard

Callaghan, Jim

Campbell, Menzies (Fife NE)

Campbell, Ron (Blyth Valley)

Campbell-Savours, D. N.

Canavan, Dennis

Carlile, Alex (Mont'g)

Carr, Michael

Cartwright, John

Clark, Dr David (S Shields)

Clarke, Tom (Monklands W)

Clay, Bob

Clelland, David

Clwyd, Mrs Ann

Coleman, Donald

Cook, Robin (Livingston)

Corbett, Robin

Corbyn, Jeremy

Cousins, Jim

Crowther, Stan

Cryer, Bob

Cummings, John

Cunliffe, Lawrence

Cunningham, Dr John

Dalyell, Tam

Darling, Alistair

Davies, Rt Hon Denzil (Llanelli)

Davies, Ron (Caerphilly)

Davis, Terry (B'ham Hodge H'l)

Dewar, Donald

Dixon, Don

Dobson, Frank

Doran, Frank

Douglas, Dick

Duffy, A. E. P.

Dunnachie, Jimmy

Dunwoody, Hon Mrs Gwyneth

Eadie, Alexander

Evans, John (St Helens N)

Ewing, Harry (Falkirk E)

Ewing, Mrs Margaret (Moray)

Faulds, Andrew

Field, Frank (Birkenhead)

Fisher, Mark

Flannery, Martin

Flynn, Paul

Foot, Rt Hon Michael

Forsythe, Clifford (Antrim S)

Foster, Derek

Foulkes, George

Fraser, John

Fyfe, Maria

Galbraith, Sam

Galloway, George

Garrett, John (Norwich South)

Garrett, Ted (Wallsend)

---