House of Commons Hansard Debates for 4 Jun 1992

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because of unsatisfactory answers given by the Prime Minister on the Thursday before the recess, when he sought refuge by attempting to give them consolation over the way in which they would receive the guaranteed minimum pension? Is he further aware that for the pensioners in my constituency that will come to the "generous" sum of £6.76 a week, hardly enough to buy a pot of marmalade? Will the Leader of the House ensure that when the pensioners come to see us on Monday, and in the debate on Tuesday, assurances will be given not only about the review, which is important, but to the effect that they will not lose the money that is essential to keep their households together? That is the crunch in the matter.

Mr. Newton : I acknowledge the obvious intended thrust of the hon. Lady's question and shall draw that, too, to the attention of my right hon. Friend. I would observe, as a former social security Minister, that it is not possible to quote a figure for the guaranteed minimum pension--or, indeed, for the pension entitlement under Maxwell pension schemes--for any individual pensioner because it depends on the contribution record and period over which contributions were made.

Several Hon. Members rose --

Madam Speaker : Order. We must now move on.

Statutory Instruments, &c.

Madam Speaker : With the leave of the House, I shall put together the two Questions on the motions relating to statutory instruments. Motion made, and Question put forthwith pursuant to Standing Order No. 101(3) (Standing Committees on Statutory Instruments, &c.), That the Company and Business Names (Amendment) Regulations 1992 (S.I., 1992, No. 1196) be referred to a Standing Committee on Statutory Instruments, &c.

That the Food Protection (Emergency Prohibitions) (Dioxins) (England) (No. 2) Order 1992 (S.I., 1992, No. 1274) be referred to a Standing Committee on Statutory Instruments, &c.-- [Mr. Andrew MacKay.]

Question agreed to.

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Orders of the Day

Community Care (Residential Accommodation) Bill [Lords] Order for Second Reading read.

4.9 pm

The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo) : I beg to move, That the Bill be now read a Second time Hon. Members may recognise the Bill as being essentially the same as a private Member's Bill introduced in another place in the previous Session by my noble Friend the Baroness Brigstocke. That Bill gained all-party support but failed to complete all its stages here before dissolution. I acknowledge the work of my hon. Friend the Member for Suffolk, Central (Mr. Lord) to get the Bill through on that occasion. It is unfortunate that the Bill did not quite make it before dissolution, because the need for it remains.

Today's Bill, which successfully completed all its stages in another place after a wide-ranging and interesting debate, provides for a minor but vital technical amendment to section 42(2) of the National Health Service and Community Care Act 1990.

Hon. Members will be aware that Government policy on care in the community has recently been set out in the White Paper "Caring for People" and in part II of the National Health Service and Community Care Act 1990. The policy is based on two principles--first, that the majority of people want to remain in their own homes or in a homely environment for as long as possible and, secondly, that the needs of any two people can differ, so individual problems require individual solutions.

Our policy puts the emphasis of care where it should rightly be--on the proper assessment of the individual needs of the users of services and on the design of a package of care that meets those needs.

The White Paper's approach is based on giving local authorities the freedom and flexibility to develop effective individual solutions for the provision of services and support that frail, elderly, vulnerable or disabled people need. The aim is to enable those people to live as full and independent a life as possible.

That approach reflects the transformation of attitudes towards how that group of people should be looked after which has occurred during the last quarter of a century. Individuals, families, volunteers, professionals, campaigners and politicians from all sides have come to recognise the shortcomings of institutional environments and the greater potential and fulfilment which people enjoy when living in, contributing to and being supported by the community.

The White Paper is important, but it is merely one more step along a well- trodden road. It needs to be seen in that context, and its significance must be neither over nor under-estimated. Its objectives include, first, promoting the development of domiciliary, day and respite services to enable people to live in their own homes where that is practicable and desirable ; secondly, ensuring that practical support for carers is made a high priority ; thirdly, ensuring proper assessment of need and care management ; and,

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fourthly, promoting the development of a flourishing independent sector alongside good quality public provision.

Implementation of that policy is well under way. From April 1991 social services departments were required to introduce inspection units and complaints procedures and we introduced new specific grants to help particular groups. From April 1992, authorities were required to produce and publish community care plans. From April 1993, local authorities take on full responsibility for arranging all social care services.

That responsibility will include the provision of services such as home helps, home care assistants and day care to support people in their own homes, and making arrangements for residential and nursing home care for those who are no longer able nor wish to remain in their own homes. Individual needs will be assessed and a package of care designed and managed by the local authority.

The full implementation of all community care objectives involves a continuing process that goes on for many years. Not for nothing was the White Paper called "Caring for People--Community Care in the Next Decade and Beyond".

The Bill is concerned with the ability of local authorities to make arrangements for residential accommodation across a range of organisations and does not touch on domiciliary or nursing home care.

Hon. Members will be aware that there is a range of types of residential accommodation currently available, for example, residential care homes, group homes, and hostels of all types. They may be managed by local authorities, voluntary or commercial organisations, and they cater for varying types of need and degrees of dependency. Some provide only bed and board, others help with supportive or personal care. Those that offer personal care as well as board are required to register with the local authority under the Registered Homes Act 1984, unless they are specifically exempted from so doing.

At present, local authorities provide hostel accomodation and other forms of residential care either directly or through the independent sector-- voluntary or commercial--under the National Assistance Act 1948 and paragraph 2(1) (a) of schedule 8 to the National Health Service Act 1977.

The Government attached great importance to retaining and extending the flexibility that local authorities have to provide a range of residential accommodation to suit the varying needs of the individuals who go to them for care. In all the guidance that we put out, we stressed to local authorities the need to be flexible. Local circumstances will dictate the best balance between different types of arrangement, but we have emphasised that individuals should have genuine choice over the services that they receive.

That means choice not only of the type of service, but of its provider. The independent sector--both voluntary and private--plays an important part in residential care at the moment. We are determined that that will continue, and to encourage greater involvement of the independent sector in non- residential care.

A mixed economy of care is the way to ensure choice, stimulate quality, and secure the best value for money. Authorities should begin to move away from the role of sole provider to the role of enabler and facilitator. The independent sector is a resource that must not be allowed

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to lie unused. Most authorities know that, and are beginning to respond to their new challenges. The purchaser provider model, which is delivering great benefits within the national health service, may usefully be emulated in that respect by local authorities.

Mr. Peter Griffiths (Portsmouth, North) : Is my hon. Friend the Minister satisfied that the range and quality of care that will be offered by the voluntary and private sector will be such that a satisfactory environment will be provided for those who, at a time of poor health or increasing age, turn to local authorities to provide accommodation?

Mr. Yeo : Yes, I am more than satisfied. There is overwhelming evidence that the involvement of the voluntary sector and, more recently, of the private sector in residential and, to some extent, non-residential care--we want to encourage more of that--is a key influence in raising standards. The independent sector is only able to survive and prosper by offering local authorities and, through them, the individuals who need support a standard of provision that is not only as good as that provided by local authorities but better, in many cases.

It is a time-honoured tradition in this country for the voluntary sector in particular to pioneer standards of service with which the statutory agencies eventually catch up, so that they become available to all. I see the voluntary sector as a very benign influence in that whole process.

However, a problem has arisen that necessitates this Bill. From April 1993, when the National Health Service and Community Care Act 1990 is fully in force, paragraph 2(1) (a) of schedule 8 to the National Health Service Act 1977 will be repealed, and section 26 of the National Assistance Act 1948 will be amended by section 42(2) of the National Health Service and Community Care Act 1990. It was the Government's intention that the flexibility that local authorities currently have under the 1977 and 1948 Acts be retained.

Unfortunately, section 42(2) of the 1990 Act inadvertently curtailed that flexibility, particularly with respect to local authorities making arrangements with independent sector residential accommodation, which does not require to be registered under the Registered Homes Act 1984. It puts at risk the use by local authorities of a range of independent sector providers including hostels, and notably the Abbeyfield Society. That society has about 1,000 homes providing accommodation for elderly people who do not require personal care, as defined in the Registered Homes Act 1984, but domestic help and the provision of meals in a small and homely residential setting.

Most Abbeyfield homes are family-sized houses where seven to nine elderly people have their own bed-sitting rooms. Residents have normally moved from their own homes nearby. They furnish their own rooms with their treasured possessions ; they lead their own lives and come together for the main meals of the day, which are prepared by the resident housekeeper. That way of life provides a balance of privacy and companionship that can be ideal for many elderly people. People are individuals and have individual needs, and as I have said, the new community care arrangements are intended to allow local authorities to respond more effectively to those needs. I am sure that the House will agree that it would be most regrettable if their flexibility to

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do so were curtailed by the loss of powers to make arrangements with organisations like the Abbeyfield Society.

The Bill remedies the problem by replacing section 42(2) of the NHSCC Act 1990, thus restoring to local authorities the powers that they now have to make full use of the independent sector but would otherwise lose in April 1993 when the Act comes into force. The Bill makes a minor but vitally important technical change to the legislation, without making any policy changes ; it simply maintains the status quo.

The substance of clause 1 restores to local authorities the ability to make arrangements for residential accommodation with the independent sector in premises neither registrable under the Registered Homes Act 1984 nor exempt from registration. It restores the flexibility to make arrangements with various independent-sector organisations for residential accommodation, as well as maintaining the rest of the arrangements found in section 42(2) of the National Health Service and Community Care Act 1990. Clause 2 provides for the short title, commencement and extent.

I hope that the House will agree that the Bill deals with a technical problem that arises from section 42(2) of the National Health Service and Community Care Act 1990, and remedies it so that hostels and societies like Abbeyfield are not put at risk. 4.21 pm

Mr. Jeff Rooker (Birmingham, Perry Barr) : I welcome the Minister to his new post, and thank him for giving a fairly wide introduction to a fairly narrow Bill. In doing so, he has enabled the House to examine some of the wider community care issues. We are extremely grateful both for the example given by the Minister and for your acceptance of it, Mr. Deputy Speaker.

Given the wide-ranging remarks that the Minister made at the beginning of his speech, I hoped that he would take the opportunity to say a little more about what is in prospect for April 1993. It would have been useful to hear a clear, unambiguous reaffirmation that the community care reforms would indeed go ahead at that time. That is, in fact, a requirement, and I shall be happy to give way if the Secretary of State or any of the other Ministers wishes to intervene on the subject.

I feel that a Minister should clarify recent reports that Health Department officials have considered aborting the reforms. Those reports have not been contradicted so far, and they have sent shock waves through local authorities and the voluntary and private sectors, which need to know where they will stand next year. There can be no excuse for further delay or lack of readiness on the Department's part --unless, that is, the Government continue to refuse to talk about the financial arrangements. That in itself leads to doubt, which is only multiplied by the reports that I have mentioned. It would be helpful if this unexpected debate could be used to clear up that doubt ; there is still plenty of time to do so.

The Government could at least say something about financial commitments to local authorities : for instance, a commitment that the financial arrangements will at least take account of the shortfall in income support between charges to residents and the benefits available. That shortfall is, after all, required to be made good by charity--by which I mean registered charities--and also by

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relatives of people in care, some of whom are themselves receiving social security benefits. Such doubts and difficulties really must be cleared up. The implementation of the legislation has been delayed ; following the general election, there can be no further excuse for Ministers not to make their position clear.

The difficulty of the shortfall led to what I consider an immoral two-tier charging system in some care-away-from-home establishments. Residents with assets--usually the proceeds of the former family home--who can therefore fund themselves for a few years until their assets run out are charged between £40 and £90 a week more than other residents so that the proprietors can balance the books. That is immoral, but Ministers never refer to that cross-subsidy. Ministers cannot stay silent about the problem much longer. The Government must give a commitment--if not now then in Committee--that the community care funding arrangements for each local authority will be specific so that the authority can operate as an enabler and an organiser, and certainly only as a partial provider of services. Then we shall all know what the arrangements are. There will then be some accountability and a lessening of the risk that the money will be diverted to other, I have no doubt, useful purposes. There must be accountability at both central Government level and local authority level.

This Second Reading debate provides a welcome opportunity for the House to address these issues. This is a small Bill, though it is somewhat longer than the Maastricht Bill. We know, therefore, that there can be wide debates on small Bills. The House is trying to promote a policy of comprehensive community care which allows people to make informed choices regarding options about which they have been consulted. It is therefore necessary to have a flexible system which takes into account a variety of human networks and circumstances. A problem in one area has major ramifications elsewhere for services and choice. If we do not pass the Bill, people who cannot go into residential accommodation of this kind will be forced into unsuitable residential or nursing care. Some may even be forced to stay, unsuitably, in their own homes. Such a comprehensive system, based on variety and meeting people's needs at a personal level, means that the rest of the system must be examined, even when one is considering what appears to be a fairly narrow point.

However brief this debate on community care may be, the subject will be debated more today than it was ever debated during the general election campaign. Up to 6million adults who are disabled or frail are affected, and anything up to 5 million or 6 million carers who have to undertake varying degrees of care are also affected, but their needs were completely passed by during the general election campaign. It may be argued that 80 or 90 per cent. of community care policy is common to all the parties, but that is no excuse for silence on a fundamental issue which affects people at a personal level. When it came to public debate during the general election campaign, community care was almost a no-go area. I have already said that there is a good deal of common ground between the parties, but that is no excuse for silence.

The Secretary of State for Health (Mrs. Virginia Bottomley) rose --

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Mr. Rooker : I was about to mention the Secretary of State and I was probably about to mention the very point that she wishes to make. I am very pleased that the Secretary of State, whom I congratulate on her appointment, is in the Chamber.

I well remember Friday 28 February of this year when my hon. Friend the Member for Livingston (Mr. Cook) and I launched the Labour party's policy paper, "Better Community Care". Traffic in London was disrupted by bombs. I took part in a recorded interview with the Secretary of State in which we discussed community care policy. That recording for the BBC was made in the middle of that Friday morning. It was intended for "The World at One", but the recording was not broadcast because we did not argue with one another. That says more about how the BBC tries to manipulate political debate and the political process in this country than it does about my views, the Secretary of State's views, or the views of the Labour party and the Conservative party. If we do not argue, the BBC does not want to be involved, even though community care policy affects millions of our fellow citizens. I have waited quite a while to get that off my chest, and today's debate has provided me with a good opportunity to do so.

The Bill, to which I must refer from time to time, affects residential accommodation as opposed to residential care. It highlights the fact that the success of a comprehensive community care policy rests as much on housing and transport policies as on policies for health and social services. One cannot construct a comprehensive community care policy which meets the individual needs of our fellow citizens unless housing policy is an integral part of it.

The Bill touches on housing policy and the availability of housing of a specialist type. Whether we are talking about availability or choice in housing or aids and adaptations within the home, the aim must be for those who have to leave their home for a

care-away-from-home establishment to succeed in restoring a degree of independence and be able to return to their own home. One should not have to end up in residential accommodation, even of the sort provided for in the Bill. There must be an aim to restore independent living. The thousands of stroke patients in this country will testify to that. They know the importance of the rehabilitation process to help them become as independent as possible. It should not be a one-way process ; there must be the possibility of returning home. That is why housing policy is so crucial to the success of a comprehensive community care system.

The Bill is concerned essentially with residential accommodation provided by the voluntary and private sectors. The Labour party document to which I referred earlier makes it clear, without qualification, that we see a comprehensive community care policy as an ideology-free zone. Those who rely on community care services are not concerned about who provides that service so long as it is reliable and of good quality. The users are not over-preoccupied with the debate which has rightly gone on in the House about the split between purchasers and providers. One person may be the recipient of a service delivered by the local authority, the voluntary sector and elements of the private sector. Users do not need to know what sector it is that turns up at different times of the day. They want a seamless service. However, the argument about the split between purchaser and provider is a major

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policy issue. It is a policy argument that we have had, and no doubt will continue to have, in the House. The users want to be treated as human beings.

Service provision may sometimes be very simple. It may sometimes be the provision of gadgets, aids and adaptations rather than a service. It is better to provide the kitchen aids and adaptations to enable people to cook their own food than for them to have to rely on meals on wheels. The former provides independence while the latter leads to dependence. If it is possible for people to cook their own food, that should be the priority because, by and large, that is what the user will want. Most people do not want care ; they want a bit of help to enable them to exist and flower as independently as possible and to live as full a life as possible.

If we can aim to provide a seamless service, it will overcome many of the difficulties experienced by those who need the service, by hon. Members and by social workers. It is not easy to achieve that aim. There are good grounds for believing that if we do not get the planning and finances right, we shall not be able to achieve it from April next year, even with all the planning that has taken place.

Mr. Mark Wolfson (Sevenoaks) : Does the hon. Gentleman agree that one of the important issues in achieving independence for people living at home is that the bureaucracy involved in bringing about improvements and aid in the home must be kept to a minimum? Visits by white collar staff to ascertain what is needed and how it is to be done often occur on too many occasions and take too long when all that is needed is a workman who can do the job quickly.

Mr. Rooker : I could not agree more, and I shall offer a solution which appears in policy documents published by the Labour party in February. I cannot understand why a qualified social worker or district nurse, who is at the sharp end of the problem, cannot order a second stair rail instead of the patient having to wait six months for a scarce occupational therapist to place an order. Why should not the social worker or district nurse order the minimum aids and adaptations which are required urgently to prevent further accidents, which in turn put further pressure on the NHS? I cannot understand that bureaucracy. We want trained occupational therapists for specialist work, but following, say, a stroke or the early diagnosis of Parkinson's disease, the simple aids--the handyman's aids should be provided on the say-so of a qualified social worker or district nurse ; they are at the sharp end because they are the first people to be involved.

The philosophy of providing a seamless service, not differentiating between the sectors, underpins the Labour party's desire to implement the original intentions of the Griffiths report. There is a good deal of policy agreement across the House, but there are some policy differences. I am not criticising any Minister as all are new to their tasks, but the Government still have not adopted the Griffiths recommendation that a Minister in the Department of Health should have key responsibility across other Departments because at least four Departments--Health, Environment, Transport and Social Security--are involved. We should enhance the role of the Department of Health in this aspect of policy. As Ministers settle to their

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tasks, they may consider Labour policy and pick out some good ideas. We shall not criticise them for doing so--we shall just remind them of what they are doing.

I referred earlier to the ring-fencing of funds. It is crucial that local authorities are aware of funds in advance. A Minister should be responsible for a specific sum of money which can be traced. Those tax pounds should be traced from the House through the system to the user so that we can ensure value for money and that none of the money is diverted for repairing roads, roofs or our leaking and crumbling schools. Those are all worthy causes, but the House will have voted that money for community care.

The Griffiths report made it clear that it is necessary to ring-fence such money, and we believe that it should be ring-fenced for at least the lifetime of the Parliament. The quid pro quo is that local government must ring-fence its share as well. Too often the funds of social service committees have been raided by other local government committees.

We shall continue to press--we shall be able to do so better when the Government make their policy clearer--for a financial regime which is as fair as possible between the sectors so that the availability of finance in one sector and not in another does not force people into a choice of care which may not necessarily meet their needs. That is exactly what has happened in the past few years, when income support has been available for one sector but not for others. There must be fairness--level playing field is a term that we understand, but viewers may not--in multi-sector provision. A seamless service is distorted if the financial arrangements are not fair between the sectors.

The Bill covers the part of community care policy which the Labour party document referred to as care away from home. There are many aspects of care away from home, and I set out briefly some of the general principles which might be helpful for the providers as it is a matter for a bipartisan approach. Shadow Ministers shuffle off or shuffle around after elections, as do Government Ministers, but by and large our principles do not change. The Under-Secretary of State may smile at that, but it is an important point because the different sectors need to make investment plans beyond the lifetime of a Parliament. Finance is important for the voluntary sector, for local government and especially for the private sector ; they need a fair degree of stability and to know the parties' positions. I shall make it clear what our principles were and are, and they will not change merely because faces may change. That fact has been recognised by the different sectors and they have found it helpful.

The Bill affects part of care away from home--residential accommodation as opposed even to residential care. Such forms of care should not be seen as a problem or failure of community care because, as the Minister said, they are an integral part of a comprehensive system of community care. They will include a variety of circumstances : housing with various degrees of independence, such as those covered in the Bill ; group homes, also partly covered by the Bill ; residential and nursing homes ; and, in some parts of the country, village communities and elderly persons' foster schemes in individual homes such as those for young people.

The circumstances of people needing care away from home will vary from full -time nursing care to the minimalist provision involved in the care covered in the Bill. Making sure that the variety of human needs and

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networks is covered requires a great deal of flexibility in housing and social policy--far more than has hitherto been shown by the Government.

The Labour party sees merit in a variety of organisational arrangements for care away from home. That variety not only assists in creating real choice and in meeting people's needs, which change in time, but avoids the trap of the monopoly provision of care. This is where I strike a note of discord with the Government, who sometimes appear to be actively working towards monopoly provision by the private sector while the Labour party is opposed to monopoly provision by any one sector. The public sector, the voluntary sector and the private sector all have a role to play and a contribution to make, either independently or in partnership on projects and packages. However, the choice should not be a maze for the consumer. More attention must be given to information and guides to services in an easily accessible and understandable form. Information must be better than that offered by one London borough, which must remain nameless, which earlier this year advised a friend of mine desperately seeking information about respite care to "look in the Yellow Pages." Hearing that in 1992 from a social services authority shows clearly that a great deal of the modern thinking in the House has completely passed that authority by. However, there are also good model local authorities of all political persuasions which have gone out of their way to provide easily accessible guides and information on all services in their area and which are taking on board their enabling role.

Labour insists that all sectors providing care away from home are treated equally for quality assessment purposes because that is the ballpoint for the user. We are not prepared to allow any distinctions to be made with regard to quality measures and the rights to be enjoyed by residents, staff or carers based on the ownership, size or location of an establishment. It naturally follows that we shall not seek to play off one sector against another or to single out a whole sector for praise or blame on the basis of a few good or bad examples. That would send a wrong signal to the providers and, what is more, to the families of the people in care away from home. That is the problem which causes difficulty. It would also send the wrong signal to the staff employed in the establishments.

The consumers or users of the service must come first, whether or not they are the budget holders, and, by and large, the local authority will be the budget holder for most people. That is not a cliche or a new found policy. I was once taken to task for quoting Labour party policy which I was told was very old, but I said that it was still current. We said that we were

"committed to tip the scales back in favour of the individual and away from public and private concentrations of power."

That suits community care policy and, indeed, any other aspect of policy. It has been our policy since 1976. I carry that cutting around constantly in my wallet and I am accused of abusing it in relation to different aspects of policy, but we meant what we said. It is time, in every aspect of policy, to tip the scales back in favour of the individual and away from concentrations of power, whether public or private, but it is especially important that that point is taken on board in community care policy.

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I do not want to introduce a note of discord, but I did not have the opportunity to raise certain points during the general election campaign. One point of particular importance, bearing in mind the contents of the Bill, is that the requirement for care-away- from-home establishments will mushroom in the next decade. We have been through the very elderly persons explosion. We must enable people to remain in their own homes if that is their choice. We must not force them to stay in their homes, but if they choose to do so we must move heaven and earth and do all that is humanly possible to facilitate that. However, even with that as a policy objective and with the best will in the world, with imagination, initiative and enterprise, there will be increased demand for care-away-from-home establishments because, for example, of that great scourge of the late 20th

century--loneliness.

Sometimes people want to leave their own homes after the loss of a partner or loved one. There may be no obvious medical or physical reason for them to leave, but they will have lost the companionship and perhaps cannot exist on their own. That has happened many thousands of times, and the problem will not go away, so there will be increased need for care-away- from-home establishments provided on a multi-sector basis.

We believe that the ownership of such establishments should be made absolutely clear in all brochures, explanatory details and contracts offered to local authorities or individuals. We also believe that if any employees, including general practitioners and consultants in the NHS or the local authority, have any financial interest in any care-away-from-home establishment in their employing authority or in any adjacent area, it should be transparent in a public register of interests. Attention should also be drawn to the register in material issued by the homes involved.

We do not say that such interests should not exist. If we are to have a comprehensive community care system with scope for choice and with a variety of multi-sector provision, we must encourage people to make the best use of their talent, expertise and training. We are not opposed to care professionals having such interests, provided that the interests are registered and transparent. Quality care demands nothing less from professional people, and such a move would be of help right through the system. The Government must deal with that issue, but it will not be made possible except by way of amendments which I have not yet fully considered.

We must return to the issue because it requires primary legislation. I hope that the Minister will take the point on board in the spirit in which it is made--not in any attacking, denigrating way, but as a means of avoiding problems in the future. If the policy is to be a success and meet the needs of our fellow citizens as users, we can do no less than examine that aspect of policy.

4.49 pm

Mr. Peter Griffiths (Portsmouth, North) : I thank my hon. Friend the Under-Secretary of State for Health for his helpful response to my intervention. He satisfied my prime concern, which was that we were not looking simply at the range of accommodation that will be available for placements by local authorities but were attempting to ensure that accommodation of sufficient quality will be available so that placements can be the correct ones.

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I found myself in almost full agreement with the hon. Member for Birmingham, Perry Barr (Mr. Rooker), who drew attention to the second point that I would like to make. Because we are discussing not long-term placements in nursing homes or registered care homes but people who may have relatively short-term problems, or problems--such as mental disabilities--which may eventually allow them to return to the community, it is essential that we note that the title of the Bill places community care before residential accommodation. The need for the accommodation arises out of a requirement for care. It is not somewhere to put people out of the way so that they can be conveniently forgotten. Rather they are placed there because that is the most suitable place in which the community can show its commitment to care for them. If in future they have the opportunity to return to some other form of accommodation-- their own home, perhaps, or some other form of residential accommodation such as warden-assisted flats--that would be encouraged.

I was pleased that the Minister gave us an assurance that there would be accommodation of the quality required. That is a measure of the success of such accommodation. I have recently dealt with the case of a lady who, after undergoing heroic surgery for cancer, was placed first in a nursing home and then--after a remarkable recovery, considering the fact that she was elderly--she was able to move gradually back into other accommodation, so that she is now virtually independent, in a flat of her own. Surely that is the measure of the community care which everyone in the House would like to see. I question what the hon. Member for Perry Barr said about differential charges. I was not sure whether, in suggesting that people who can pay are being made to pay more, he was criticising the proprietors of residential accommodation for having a range of charges within their establishments. If so, it was not a very fair criticism. After all, most homes offer a range of quality of accommodation--single rooms, or larger rooms, for example, for those who would prefer them.

Mr. Rooker : I made the point exactly as I intended to. In many areas, especially in nursing homes, a different charge is made for exactly the same level of service, depending on whether people are self-funded-- that is, not in receipt of income support. That is immoral because it is a cross-subsidy from one resident to another, to make up a shortfall. The homes could not cope without it. If they did not have a mix including self- funded people, whom they charge more than they charge people on income support, they would close. That is the fault of the Government's refusal to organise their social security policy properly.

Mr. Griffiths : I thank the hon. Gentleman for that explanation. He may recall that in the previous Parliament I joined him and many of his hon. Friends in the Division Lobbies on that issue, so there is no great disagreement between us there--except that I still wish to defend owners and organisers who allow people whom they took on when they had private funds to stay in their highly expensive accommodation long after those funds have run out and they can obtain only the amount payable in income support. Credit should be given to such owners, who do not seek to remove people when their private funds have run out--but now I am sure that you, Mr. Deputy

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Speaker, will draw my attention to the fact that we are not discussing registered accommodation or nursing homes this afternoon. I believe that I shall have the support of Members on both sides of the House when I say that it is important that community care should contain the widest possible range and variety so as to be able to meet the needs of individuals. Social services departments should continue to be involved, as should other local authority bodies and agencies, after accommodation has been found. There should be a continuing commitment to the personal care and development of individuals. However slow that may be- -in the case, for example, of people with serious handicaps--there should still be a continuing commitment to the development of the individual, not just to his or her placement.

The Bill, modest though it is, gives local authorities a wider choice, and I believe that they will seize the opportunity to ensure that they provide carefully selected and progressive accommodation to suit the requirements of each individual who turns to them for assistance.

4.56 pm

Mr. David Hinchliffe (Wakefield) : I make it clear at the outset that I have no wish to obstruct the progress of the Bill. I certainly support its aims, and I am aware of the excellent work undertaken by some of the establishments whose functioning it will affect. There is an Abbeyfield Society establishment in my constituency, and the model that Abbeyfield offers should be actively encouraged. My comments will make it apparent that I wish us to have a detailed debate on the measure, as opposed to allowing it to go through on the nod, as yesterday's business statement led me to assume was the original intention. I was worried to see that the Bill was expected to go through all its stages today, and I welcome the fact that the Government have conceded the Standing Committee stage. That Committee stage may well be brief--there is no need to obstruct the Bill's progress--but I feel that there are issues which we should debate. The Bill gives us the opportunity to discuss the current community care situation in the run-up to April next year, and the chance to pick up a range of issues which were missed when the National Health Service and Community Care Act 1990 was passed. I hope that the Government will listen to some of the suggestions made today, and perhaps add provisions to the Bill before the Committee stage. I listened carefully to the Under- Secretary of State's opening speech--and, personally, I wish him well in his new role. I know that his background is relevant to the work that he is now undertaking. But I was worried because what he said made it appear that he and the Government were oblivious to what many people believe is a crisis in community care in the run-up to 1 April next year--a crisis that will not be resolved by the changes which it is proposed will take place on that date.

The Government's strategy on community care has been clear for many years : leave it to the market. Now we are picking up the pieces. The market has organised what is in the interests of the market rather than those of the care consumer. There is now a huge explosion in one form of care--private institutional care--way above and beyond any reasonable estimate of the demand caused by the increasing number of elderly and very elderly people.

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What concerns me is that, when the Government refer to "community care", they actually mean private institutional care. That is the central theme of their belief in community care. I do not believe that institutional care is community care. Community care is care in the community and not care away from the community. The Opposition have restated that point because it is a fundamental difference between the Government and the Opposition.

Let us consider what has happened in relation to funding the private institutional care sector since 1981. I find it interesting that the Government boast about the amount they have put into private institutional care through the income support system. In 1981, the amount invested in private care through supplementary benefit was about £10 million a year. In the past financial year, the amount invested was about £2 billion--a huge amount--which was paid through income support to people in private institutional care. The total figure invested by the Government through income support to people in private institutional care since 1981 comes to about £9 billion. Rather than boasting about that figure or being proud of it, the Government should be ashamed that so much money is being invested in institutionalising people in this day and age.

To make matters worse, alongside the investment of £9 billion through income support, one must consider the pattern of funding through the revenue support grant system to local authority social services. Figures available from the Library show that about £6 billion of RSG funding to local authority social services has been removed by reductions in RSG during the same period. The Government are clearly determined to move money away from preventive domiciliary services into institutional care. That is a nonsensical strategy which should be reversed as a matter of urgency. The Government have pulled the rug out from under the local authorities' ability to fund domiciliary care such as home helps, meals-on-wheels, respite care, day care and a range of other services which are geared to enabling people and their carers to remain in the community. That strategy should be exposed, and I urge the Minister to look afresh at the way in which the Government are acting.

We are debating an issue which is not only political but which involves basic human rights issues of how we treat elderly and disabled people. It is a basic human right to allow people to remain in independent or semi- independent living in the community if they and their carers so wish. The Government are determined to remove that right from people and they should be ashamed of their record in that respect. Compared with similar countries in Europe and elsewhere, in Britain far more elderly and disabled people are

institutionalised than should be the case. We should consider that position very seriously and none of us should be proud of it. As other hon. Members have said, we should consider afresh the issue of the financial difficulties facing vast numbers of elderly disabled people who cannot afford to pay for the private institutional care they receive at present-- an issue that affects every hon. Member who has constituents in private care homes. It is scandalous that there are people in every constituency who have to use their personal allowances to pay for their care. Some

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elderly people do not have a spare penny to spend on a hair-do, on new underwear or even on a bag of sweets. That is profoundly unacceptable in this day and age and the Government should be ashamed of it.

We are told that April 1993 will change everything--if April 1993 ever happens. As my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) said, there are strong rumours that April 1993 may not arrive and that there may be a second deferral of the implementation of the National Health Service and Community Care Act 1990. I should be grateful for further clarification from the Minister. I served in Committee on the National Health Service and Community Care Bill and I believe that April 1993 will be a false dawn. It is being held up as something that will suddenly cure all the ills in community care, but I do not believe that that will happen.

Assessment, care management and community care plans are all excellent and desirable provisions which were supported by the Opposition. However, assessment is nonsense when social workers cannot assess for alternatives to institutional care. With the huge explosion in private market care, the Government have established a bias towards institutional care. To ensure that we have an even playing field and a choice of services, we desperately need a massive redirection of funding away from the private institutional sector into alternatives to institutional care, whether public, private, voluntary or other, to enable people when they are assessed to have a genuine choice to remain independent and to stay out of care. Assessment may not have the impact that many people, including people in my own party, assume that it will have after April 1993. There are huge gaps in the Bill and in the 1990 Act in relation to the rights of people in a care setting, whether private nursing homes, residential care homes, local authority homes or whatever. It is important for the Government, following important reports such as the Wagner report, the "Home Life" recommendations and reports from organisations such as Counsel and Care, which suggest that things are not well in relation to the rights of residents in many care homes, both in the private and public sectors, to address the issues, whether in the Bill or in separate legislation. The Government should bring into statute clear requirements protecting the rights of people in care.

We shall now have the opportunity to consider some of those requirements in Committee, but there are issues which we should consider as a matter of urgency and which could be addressed in the Bill. One issue is the right to rehabilitation. When we debated the 1990 Act in Committee--several of my hon. Friends served on that Committee--we discussed the assessment process which will come into operation after April 1993. However, once a person is placed in institutional care, there are no review procedures. Anyone who has worked with elderly people or who knows of cases of elderly people knows that a person's circumstances can change in a week, in a month or in six months, and that they may be completely different from when that person was initially assessed. It is essential that we introduce some form of reassessment and review for people who are in care homes to give them the opportunity of rehabilitation and actively to encourage rehabilitation.

People in the private sector are now worried that some of the homes may not be full and that they may not be able to run at a profit. What incentive is there for private care

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