House of Commons Hansard Debates for 4 Jun 1992

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home owners to rehabilitate a resident and to work to get that resident back in the community if by doing so they put themselves into financial difficulties which may affect the viability of the homes? The Government's system works completely against rehabilitation and returning people to the community. People must address that point regardless of their politics. It is a human rights issue which we have overlooked and which needs to be addressed as a matter of urgency.

Another issue which ties in is the way in which the existing system actively encourages dependence in care--indeed, it actively rewards dependence. The Department's system of monitoring people who move from receiving income support payments for care to income support payments for nursing home care--a significantly increased amount which the Government have introduced--involves no monitoring of whether people need that additional form of care or whether they are receiving it. There is no system of checking whether that care is needed or is being given. That is a scandalous misuse of public resources.

I can give the Minister examples of individual cases. People have been shunted into nursing care when they do not need it. The system encourages dependence, and we must urgently address that problem. Other matters that we need to consider include the right to privacy. The Counsel and Care report last year pointed out that people cannot go to the toilet in private, cannot bathe in private, and cannot have their own bedrooms. I have been to a home in which elderly ladies were bathed alongside each other. The system was two baths side by side, with a lady sitting in each bath, and two members of staff between them. The argument was that that was a quicker way of dealing with all those who had to be bathed. Anyway, they said, it did not matter because those old people were confused, so they were not embarrassed by being bathed in front of each other. That is unacceptable. In case anyone thinks that I am anti-private sector, that happened in a local authority home. I accept that it was a few years ago, but it happened, certainly within the past five years. Before I was elected to this place, I went to a private care home in my constituency. Seven people were crammed into one bedroom. In this day and age that is completely unacceptable. The issues of privacy and rights within care must be addressed by the Government. We must consider security of tenure and also people's rights. There are few rights for people who are asked to pay because they cannot afford their fees. There is no system to ensure that they are properly looked after. Vulnerable elderly people worry about being out on the streets. I accept that there are care home owners--I know of some in west Yorkshire--who are subsidising people through their own charity and good will. However, we know of people in west Yorkshire who have been evicted and of people who have moved downmarket. That is unacceptable when people in their 80s and 90s are vulnerable, unhappy and unaware of what is happening.

The Government must put into statute some of the requirements in their "Home Life" document. It is nonsense to have recommendations in "Home Life" and not back them by statutory provision. It weakens the position of the inspectorate which is to monitor and register homes when there is no backbone to the desirable points in "Home Life". I hope that those issues will be addressed by amendments to the Bill. Opposition Members have no

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desire to block the Bill, but it is important to debate some of the human rights issues that are affected by such legislation. The Government should be ashamed of their record on community care. What we have seen over the past decade or more in the care of elderly people is wrong. It is about time we had a change of course. The Minister starts his job with a clean sheet. I hope that he will look at the matter afresh. The Bill provides the opportunity significantly to solve some of the problems to which I have referred and to which, no doubt, my hon. Friends will refer.

5.12 pm

Mr. Roger Sims (Chislehurst) : I always enjoy listening to the hon. Member for Wakefield (Mr. Hinchliffe), who speaks with vigour, enthusiasm and, of course, a knowledge born of his experience. His speech seemed to be a rather strong advocacy of the Government's legislation. He urged them to do exactly what the legislation is intended to do. He complained that too many people are in institutions and could be better looked after in their own homes. That is precisely the object of the National Health Service and Community Care Act 1990. He said that, in the past, we have not given sufficient help to carers. Again, that is very much the philosophy of the Act, the White Paper, and the way in which local authorities are endeavouring to implement the legislation. The hon. Gentleman pleaded for a redirection of resources. That is precisely what the legislation is all about, and it is exactly what we hope will happen.

I enjoyed the speech of the hon. Member for Birmingham, Perry Barr (Mr. Rooker), who complained that community care did not feature much in the election campaign. However, in his anecdote he demonstrated the reason for that. As has been and will be evident in the debate, this is not a matter of party political controversy. Even differences in the ways in which we reach the ends are a good deal fewer than they were a couple of years ago when we discussed such matters in Committee.

Like the hon. Gentleman, I have an Abbeyfield home in my constituency. If Abbeyfield had been left out of the legislation, we would have been astonished and would have endeavoured to put the matter right straight away. One accepts that, expert though parliamentary draftsmen are, errors and omissions sometimes occur, and steps must be taken to put matters right. That is exactly what the Bill is intended to do. I hope that it will have a rapid passage through the House.

Hon. Members tend to spend many hours in the mornings, afternoons and sometimes nights considering Bills in Committee until, finally, on Third Reading we consider that our job is done, as indeed may be the case. But that is when the work starts. Hon. Members who have followed the implementation of the Children Act 1989, for example, and now the community care part of the 1990 Act realise how much work has been going on within Government Departments and locally in implementing that Act.

There has been a steady stream of guidance from the Department to local authorities on a range of matters within the Act and on how it should be implemented. Local authorities have been doing much work in compiling their care plans, all of which were submitted to the Department by 1 April and are now being examined.

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Authorities have been spurred on to increase their range of services. Of course, the philosophy behind the Act is that a range of services should be available and that it should be the responsibility of local authorities to ensure that they are provided, to make assessments and to make care packages. Whether care packages are available within local authority services, within the voluntary sector or within a mixture of sectors will depend on each case and on the local facilities available.

As the hon. Member for Perry Barr said, there has been a lack of guidance on finance. There has been virtually no guidance on the financing of community care. Hon. Members will recall that assurances on resources were requested time and again when the 1990 Act was being considered. The then Minister assured us time and again that resources would be available to ensure that the Act was fully implemented. That Minister is now the Secretary of State, and we can be sure that those promises will be fulfilled.

In attending local conferences on the implementation of community care, I have been struck by the enthusiasm to get on with the job and with the widespread concern about whether resources will be available, and in particular about what they will be. That depends not only on the Department of Health but on the Treasury and the DSS. It is important that, as soon as possible, we have clarification of the mechanics of shifting what, until now, has been the income support element under the DSS and how it will be made available to local authorities. In future, if, after assessment, an elderly or handicapped person--it may even be a child--is to go into a residential home, the cost is to be met by the local authority from funds that previously would have come from the Department of Social Security as part of income support. What is that figure to be? On what basis is it to be formulated? Surely discussions have been going on for a couple of years on that. It must be possible to give local authorities an idea what the figure will be.

Of course, one accepts that the normal local authority grant is still under discussion. Under the curious system that we have in Britain, it will be autumn before local authorities know the figure for the year starting next April. One wonders how businesses could operate on the same basis, but that is the way in which Governments operate. However, it should be possible to say now what will be the tranche which up to now was income support. It should further be clarified how the tranche will be applied.

For example, if a person is assessed as most suitably accommodated in an Abbeyfield home, will that cost be met in full by the local authority or will the local authority have only sufficient funds to pay what was up to now the income support level? As we know, that was often not sufficient to meet the full cost. Who will fill the gap? If local authorities are obliged to make assessments, it is rather important that they have the resources to provide the services that they have decided are required. While I realise that my hon. Friend the Minister is unlikely to be able to give us a detailed reply in this Second Reading debate, there will be a useful opportunity in Committee to discuss how the important National Health Service and Community Care Act 1990 is being implemented.

Can my hon. Friend give us more information on resources and funding? What will be available and how

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will it be applied? That information would be of enormous value to local authority officers who, with the assistance of many people in the private and voluntary sectors, are hard at work preparing for next April. They need assurances that they will have the means to carry out what Parliament has instructed them to do.

5.22 pm

Ms. Liz Lynne (Rochdale) : I welcome this non-controversial Bill. It gives me an opportunity to ask some questions and raise several issues. The House is probably aware, as I am sure you are aware, Mr. Deputy Speaker, that at present income support levels often do not meet the cost of either residential or nursing homes. Elderly people often have to make up the shortfall or, if they are fortunate enough to have a relative around, a relative has to make up the shortfall. As has already been said, if there are no relatives, problems can arise.

What exactly does the Minister have in mind on funding? When local authorities take over the responsibility for paying for homes and residential accommodation, will the Minister give the same money as the income support level? Or is he thinking of paying the actual cost of the home? It is essential for us to know that. If local authorities do not receive the actual cost, many will say that they cannot provide as many places as perhaps they should.

People with learning difficulties are a good example. At present, such people are assessed and a statement is made. That statement is often made taking into account what facilities are available to the local authority. I am desperately afraid that the same thing could happen with this Bill and that local authorities will assess only on the strength of what they have available in residential accommodation. This is an important point to remember.

Another matter of concern is inspection. What does the Minister have in mind? Does he intend perhaps to set up an independent inspection unit? I should like far more inspections to take place in residential and, indeed, nursing homes. More inspections should be carried out unannounced. I know that that already happens to a certain extent, but I should like to see many more such inspections to ensure that standards are maintained in homes.

I am aware that the matter is not covered specifically by the Bill, but what are the Minister's views on the use of the Buxton chair, which I understand is still used in certain residential and nursing homes? It is sometimes referred to as the "naughty chair".

Mr. Deputy Speaker (Mr. Michael Morris) : Order. The Bill is fairly tightly drawn. I have been pretty generous in allowing a wide debate, but we cannot go way beyond the scope of the Bill.

Ms. Lynne : Thank you, Mr. Deputy Speaker. I move on to my last point about the funds that will be made available. I should like far more funds to be made available for community care generally. Come April 1993, when the National Health Service and Community Care Act 1990 must be implemented, local authorities throughout the country will have horrendous problems unless they have more funds and those funds are ring-fenced.

I make a plea to the Government again today seriously to consider ring- fencing the funds for community care, and specifically for residential homes. If the Government do

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not ring-fence the funds or find some way of insisting that local authorities spend on those homes, the money allocated for residential homes they will hive off the money for pet projects. I should like some assurances on that.

5.26 pm

Mr. Tom Clarke (Monklands, West) : I join my hon. Friends in congratulating the Minister on his appointment. With his former association with the Spastics Society, a great deal is expected of him. I am sure that he knows that. I also congratulate your good self, Mr. Deputy Speaker, on your appointment. It is a clear indication that being a rebel is no bar to respectability afterwards. I find the Bill a little confusing in several respects. I am delighted that we are having this debate and that time will be found for reasonable discussion in Committee so that we can clarify some of the difficulties which emerge. My first difficulty with the Bill is why it does not apply to Scotland or, as the hon. Member for Antrim, East (Mr. Beggs) reminded me, Northern Ireland. Perhaps we can be told what the problem is.

In the explanatory memorandum there is a reference to a lacuna, which is presumably the reason for the Bill. I do not know whether there is a Scots word for "lacuna". Perhaps my hon. Friend the Member for Greenock and Port Glasgow (Dr. Godman) can help me with that. I think that it means that there is a gap. I do not know whether there is a similar gap or lacuna in Scotland, but if there is, can we do something about it? If there is not, may we hear about it? My hon. Friends, including my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker), rightly addressed the Bill in the context of our worries about community care in the 1990s. It is reasonable that we should have such a discussion at an early stage in this Parliament. We have heard some interesting speeches and I am sure that there will be other equally interesting speeches later. The Chamber is not so packed as it might be if this were a debate on Maastricht, but I humbly suggest that Members of Parliament will receive far more representations at their surgeries in the next four or five years about what is happening to community care for the elderly in our society than even about the important issue of Maastricht. The matter should therefore be viewed in that context. Some of us received a document from the Royal College of Nursing this week entitled, "A Scandal Waiting to Happen". It tackles the problems of elderly people in nursing care in residential and nursing homes which are dealt with in the Bill. It makes a number of important points which are central to our approach to such matters--for example, the provision of proper funding after assessments take place. The booklet reflects a view which has been expressed in the debate when it says :

"Like many other organisations, the Royal College of Nursing has expressed concern that the money being allocated to local authorities to carry out their duties under the NHS and Community Care Act should be ringfenced."

I am glad to see the hon. Member for Macclesfield (Mr. Winterton) in his place because the Select Committee which he chaired with some distinction, and the former Select Committee which dealt with such matters when there was a single joint Department, understood that there was a strong case for ring-fencing, as did so many other reports. The Griffiths report dealt with the matter and

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complained that legislation in a difficult area, involving the elderly and their carers, is being passed in dribs and drabs--I fear that the Bill tends to suggest that the Griffiths report was right about that, if it was not necessarily right about everything else. The Bill represents dribs and drabs.

We spent a great deal of time in Committee dealing with the National Health Service and Community Care Act 1990. We have been told that the community care provisions will be introduced in 1993. However, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, there have been strong rumours from the Department of Health that that is not now the Government's intention and that they are under strong pressure to postpone their commitment. I hope that it may be within the rules of the debate for the Minister to deal with that--if he will listen to what I am saying. I am not sure what the Foreign Office has to do with these matters, but he might be better advised listening to hon. Members than to the Parliamentary Under- Secretary of State for Foreign and Commonwealth Affairs, who is sitting beside him. Will the Minister tell us whether the commitment to the community care sections of the 1990 Act is still as firm as the Government have suggested?

In common with my hon. Friends, I am greatly worried about our approach to this issue if the Royal College of Nursing takes the view that there is a scandal waiting to happen. When dealing with the enormous problems faced by elderly people, if we leave so much to market forces, without even providing for adequate inspection of public and private sector homes-- although I accept that there should be no distinction between them--we do not seem to be making much progress.

Although we welcome the main thrust of the Bill's proposals, I am worried that yet again local authorities are being viewed as enablers rather than providers. In the absence of ring-fencing, enormous financial requirements are being made of local authorities, but it is not clear whether funding will be made available.

The Bill, and questions about it, are especially relevant at a time when we are considering the transfer of funding. Local authorities face great problems. The hon. Member for Chislehurst (Mr. Sims) mentioned their obligations under the Children Act 1989, and it is right that we should deal with the problems of children in need, but local authority budgets will have to cope with such important matters. I served on the Standing Committee on the Children Act, as did many hon. Members. We understood that such progress was being made. When we eventually hand all that legislation over to the local authority social services departments and the Scottish social work departments, they will have to decide their priorities. I do not think that they will welcome the job, given present financial constraints.

An additional problem in the 1990 Act, which the Government seek to amend by the Bill, is the transfer of funding from the Department of Social Security. The problem facing local authorities is clear. They will have to deal with the social security expenditure shortfall--with the fees deficit- -and that will be made more difficult when the Bill is enacted. We are told that the present shortfall means £30 per week for a person in a care home and £50 per person for those in nursing homes.

If the Bill is enacted, a further responsibility will be passed to the local authorities, at the same time as the Government transfer an inbuilt deficit of £132 million to them. It is therefore reasonable for the Government to

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explain their view of the priorities. What guidelines have they offered to local authorities? How do they view the central issue of assessment, for example, to which my hon. Friend the Member for Wakefield (Mr. Hinchliffe) referred?

It is not enough merely to produce a Bill of this sort, or even to say that the Government are going ahead with the 1990 Act, without considering the global problems of community care and without telling us whether they agree with the main thrust of the Griffiths report, which said that there should be genuine care within the community. If we simply pile elderly people into institutions--to use a somewhat crude expression--that does not mean that we are providing care in the community. Happily, there is a growing number of elderly people. Surely we should demand that those men and women, who have brought up families and worked in their communities, are assessed properly to make certain that they are able to remain in the community. We should ask ourselves whether many of those people would be happier remaining in their communities, with the provision of more home helps and occupational therapists, and improvements in the meals on wheels and chiropody services.

With the emphasis being placed on providing residential care, mainly in the private sector, and on reducing resources for local authorities--including education, which ought not to be beyond the reach of the elderly, who are a part of our community and should be seen as such--I worry that we are not producing a real strategy for care in the community. We are pursuing the accountancy of the problems faced by the Treasury. A real strategy would mean that more elderly people would find independence but would be genuinely supported, when there is a need for such support, within the community.

I hope that we shall also be able to tackle the problem of advocacy in Committee. If we are dealing with proper assessments, with the role of carers, and trying to enrich the lives of the elderly, and especially the institutionalised, advocacy becomes profoundly important.

I was delighted that a group was established in Scotland this week to deal with dementia. Clearly, those people have rights. In the absence of advocacy, nobody in private or even public homes will be able to say they do not like a particular room, that they are unhappy because of social security problems, the food and clothing available, or that they have problems with incontinence. The elderly may feel that such important matters are not being dealt with.

Sadly, we all know from our constituency visits that, in some cases, the problem of incontinence is not being addressed. In the absence of advocacy, which I hope will be included in the Bill, I hope that elderly people will be assured that, at least, we are concerned about their lifestyle, health and welfare and that that is not inconsistent with the strategy for community care.

Mr. Nicholas Winterton (Macclesfield) : On the sad and sensitive matter of incontinence, is the hon. Gentleman, who has served as a distinguished member of the Select Committee on Health, concerned about the anomalies in the free provision of incontinence pads? I say without reservation that the hon. Member for Birmingham, Perry Barr (Mr. Rooker), who opened the debate for the Opposition, has done some wonderful work on that issue. It is crazy that elderly people in hospitals and in county

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council part III statutory accommodation are in receipt of incontinence pads, but those in private nursing and residential homes have to pay for them separately. Is that not an issue to which the Government should give urgent attention?

Mr. Clarke : The hon. Gentleman makes an excellent and valid point.

Mr. Bob Cryer (Bradford, South) : The Minister thinks that it is all wonderful.

Mr. Clarke : Apart from the importance of the issue which, as the hon. Member for Macclesfield rightly pointed out, my hon. Friend the Member for Perry Barr has promoted-- [Interruption.]

Mr. Deputy Speaker : Order. If the hon. Member for Bradford, South (Mr. Cryer) wishes to speak, he can seek to intervene, but I prefer not to hear too many sedentary comments because they detract from the speech of the hon. Member for Monklands, West (Mr. Clarke).

Mr. Clarke : Thank you, Mr. Deputy Speaker.

The hon. Member for Macclesfield has made a valid point which helps to underscore my concluding remarks--I know that other hon. Members wish to speak. Advocacy--in the private sector especially, but I do not exclude it from the public sector--is important for elderly people.

At the beginning of my speech, I stressed that the vital issue of community care, including the problems of the elderly, are ones that we shall debate often in the course of the Parliament. It is right that we should do that. I regret to say that one reason for that is that, in the previous Parliament, we did not give the matter the priority that it deserved. We are all reminded by our elderly constituents that they are part of society and that their needs--and, above all, their rights--are matters that we should consider. This small Bill follows on from the Government's major National Health Service and Community Care Act 1990. We have not seen much evidence to support the belief that the Government have broken away from the ideology of 1990. I do not see that those on the Government Front Bench are as committed to a mixed economy system in care as is my hon. Friend the Member for Perry Barr, with whom I agree. I hope that as our discussions develop the Government will accept that in the provision of community care we should have a commitment to a genuine provision of services to the elderly. There should be representations and consultations about their needs in the public and private sectors. We should ensure that there will be proper inspections at every level so that elderly people enjoy the fulfilled and enriched lives that the people of this country would expect the House to deliver.

5.44 pm

Mr. Peter Thurnham (Bolton, North-East) : I congratulate you, Mr. Deputy Speaker, on your appointment, but I apologise for unavoidably missing the early part of this debate. However, I very much appreciate the opportunity to join in the discussion. I also apologise for missing my hon. Friend the Minister's opening speech. I shall look forward to reading it and I congratulate him on his appointment. He brings to it his long experience of

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working with disabled people, and he has always shown great sensitivity to their needs. I am confident that he will fulfil his duties well.

I am pleased that the Government have introduced the Bill, because maximum flexibility is essential and local authorities should use the services of the private sector. I listened with care to the speech of the hon. Member for Monklands, West (Mr. Clarke), but I was confused by one of his points. I noted that he said that the resources available to local authorities had been reduced. I am sure that, in the provision of community care, we have increased resources to local authorities. If we consider the future for local authorities, an increasing proportion of local authority resources will go into community care. Perhaps fewer resources will go into education if more schools opt out, but more will go into community care.

Mr. Hinchliffe : At the end of his speech, will the hon. Gentleman accompany me to the House of Commons Library? There I shall introduce him to a researcher who will show him detailed figures--the hon. Gentleman was not present when I spoke--that show that the Government's reduction in rate support grant since 1979 has taken £6 billion out of local authority social service expenditure. They are not my figures or those of the Labour party : they are the figures of the House of Commons Library, and I look forward to taking the hon. Gentleman along the Corridor.

Mr. Thurnham : I am sorry that I was not present to hear the hon. Gentleman's speech, but I shall read Hansard with care. The figures that I have seen show an increase in resources, and there is no doubt that, in future, the proportion of local authority resources going into community care will increase, even if the proportion of resources going into education is reduced.

Mr. Tom Clarke : The hon. Gentleman will find that I was arguing that local authorities are being asked to undertake more and more responsibilities, and the hon. Member for Chislehurst (Mr. Sims) made the same point about the Children Act 1989. Does the hon. Gentleman agree that, whatever the argument about figures, my hon. Friend the Member for Wakefield (Mr. Hinchliffe) produced some important ones? If the case for ring-fencing is established, we will at least know how much funding is being made available.

Mr. Thurnham : I do not follow that argument, to which the hon. Member for Rochdale (Ms. Lynne) also referred. I do not believe that local authorities will divert resources from community care. The pressures and demands are for more resources in community care, so I do not believe that local authorities will divert such resources elsewhere.

I do not think that resources need to be ring-fenced because we cannot trust local authorities to spend their money where the needs are greatest. Local authorities are in the best position to make such judgments and, if anything, they will spend more than they possibly would if the expenditure was ring fenced. I do not follow the hon. Gentleman's argument : we need maximum flexibility.

I have seen an enormous community care plan produced by my authority in Bolton, and other Members will have seen similar plans produced by their authorities. Of course, it is the responsibility of local authorities to

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produce such plans and to have them approved in order to start implementing the new services for which they will be responsible in 12 months' time.

Tomorrow I shall visit a centre which has been created for the provision of respite care and residential care, in a former children's home in my constituency at Moss Nook. I am delighted that it has been set up and is being arranged by a new charitable organisation that has been set up by the Bolton handicap action group. The work has been done in partnership with the health authority--in future I hope that the local authority will also be involved. Such partnership is the best way to provide services with the maximum flexibility.

The hon. Member for Monklands, West said that councils should act as enablers rather than as providers. I am glad that that message has got through, as it is the best way to provide community care services in the future. Some counties, such as Kent, have set a good example in providing services in the most efficient way by remembering that they are first and foremost enablers and not providers.

I look forward to the passage of the Bill. There should be the maximum flexibility. Local authorities should be trusted to use their discretion and there seems no need to ring-fence their funds, because they are in the best position to assess needs and decide how best to use their resources. I hope that local authorities will not try to make a political football out of all this, because the needs are real, the resources can be found and they must be used wisely. Those resources should not be distorted or manipulated to make political capital out of the needs of the people for whom they are intended. 5.50 pm

Mr. Kevin Hughes (Doncaster, North) : It is desirable for everybody that local authorities are able to offer the widest possible choice to people seeking residential care. I welcome the Bill because, when enacted, it will provide a wider spread of provision available to local authority social service directorates.

It is unfortunate that there should have been such a long delay in implementing the community care legislation. It seemed to have fallen victim to the Government's poll tax folly. In other words, caring for people was sacrificed in an effort to prop up the doomed poll tax that continued the previous Government's policy of making the rich better off at the expense of the poor. Thatcherism will go down in history as a Robin Hood in reverse--robbing the poor to give to the rich.

Many elderly people, including the confused, the physically and mentally handicapped, those with autism and people with drug and alcohol problems, are eagerly awaiting the implementation of the community care legislation in April. I hope that the rumours about possible further delay in implementation are not true. The people concerned, and the carers, must not be let down. Certainly they should not be made to wait any longer for this legislation. To ensure that their expectations, which are many and varied, are met, we must provide good-quality services. Most local authorities have been working hard to that end. They already have in place their registration and inspection units and are endeavouring to develop policies

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encompassing all the elements of good- quality care, offering a wide range of choice. That will be made better by the Bill.

Many local authorities, working with area health authorities and the voluntary and commercial sectors, are operating genuine partnerships with the aim of providing professional and good quality care ; but if community care is to be of the highest quality, giving real choice to users and carers, it must be provided by a highly trained and motivated work force in the local authority voluntary and commercial sectors.

That can be done only with proper funding by the Government. Real choice and quality cannot be offered on the cheap or set against a backdrop of a budget that cannot be altered. If we are to offer real choice and quality, people must be given it genuinely and be told that there is no budget backdrop to that choice.

We are now less than 12 months from implementation, yet local authorities still do not know how they will be funded and how much they will get. People must be trained and many new procedures developed and in place well before that date. If local authorities and others are to be ready, they must know as soon as possible the detailed information about the social security transfer of funds. Why is it that we and local authorities still do not know the conclusions of the deliberations of the so-called algebra group that was set up to try to sort out the transfer of funds? Like my hon. Friends, I urge the Secretary of State to ring-fence the extra funding to ensure that the money is used on community care and not lost in wider local authority budgets. I have no doubt that it would be put to good use if they were allowed to use it for other causes, but we must make sure that the money is targeted directly into social service budgets so that it is used to implement this legislation. Local authorities want to know how the Government expect them to fund the work force who will be needed to implement the final stages of the community care legislation. They need up- to-date information on the number of people currently in, and those projected to enter, independent care. Most local authorities are keen to undertake their new responsibilities for community care and have made considerable effort to meet required objectives. This measure will help them in that respect.

Recent reports from the social services inspectorate, regional health authorities and the Audit Commission suggest that local authorities are well on target. The final word on all the issues to which I have referred, and therefore responsibility for the effective implementation of the proposals, lies with the Government. I hope that the Secretary of State will promise the British people that the Government will make adequate funds available to ensure that, when they need care, they will get it when they need it, rather than being put on a waiting list for assessment.

Will the Secretary of State also promise them real choice and give an assurance that local authorities will not have to rob Peter to pay Paul in order to fund that choice? Will she also promise that people will not have to wait any longer for a high-quality community care programme, whatever their needs and wherever they live in Britain.

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5.56 pm

Mr. Nicholas Winterton (Macclesfield) : I am glad of this opportunity to contribute to the debate and, like my hon. Friend the Member for Bolton, North-East (Mr. Thurnham), I apologise for being absent for the early part of it. The studio in which I was located for a time was linked to the Chamber, so I was able to hear a major part of the speeches of those who spoke earlier.

I am pleased to support the views expressed by the hon. Member for Monklands, West (Mr. Clarke). He highlighted many problems that those of us who have taken a great interest in community care anticipate and believe will occur on 1 April of next year. I view that date with deep concern. It is not only my concern : it has been expressed to me by senior officials and others concerned with and appointed to help authorities and those who work in local authority social service departments.

The hon. Member for Doncaster, North (Mr. Hughes) thought--I share his view --that social service departments were unaware of the resources that they would have to spend on community care as from 1 April of next year. That state of affairs does not enable social service departments, which will be the lead authorities in community care, to make adequate plans.

I need not remind the House that we are talking of groups of people, particularly the elderly, who are among the most vulnerable in society. I view with concern the decisions being taken by county council social service departments to shed their part III residential homes and dispose of them, in the main, to non-profit-making charitable organisations which take over the management and running of the homes.

I am delighted to see in his place my right hon. Friend the Leader of the House, because nobody knows more than he about social security income support and all matters relating to assistance and benefit available to the needy and elderly. He knows that grave problems face elderly people in the funding of their residential care. The more people there are who depend on the private sector, the more difficult it will become. That is a matter to which the Government, and particularly the Department of Health, will have to give careful consideration.

We look to my hon. Friend the Under-Secretary of State to do a great deal between now and 1 April next year. He has a fine reputation for dealing with vulnerable groups in our society. He was a distinguished officer of the Spastics Society and he served on the Select Committee for Health and its predecessor Committees, and we look to him to achieve a great deal in the introduction of community care in Britain.

The one thing that causes me some concern is the last paragraph of the explanatory memorandum. My hon. Friend the Member for Chislehurst (Mr. Sims) will criticise me if I do not point it out, and perhaps will criticise me if I do, because it says :

"The Bill should not result in any increase in public expenditure, or have any effect on public service manpower."

It should. We must oil the wheels of community care to ensure that it works and that those who deserve the support of hon. Members, on whatever side they sit--the elderly and other vulnerable groups--should be totally confident that, in the implementation of what is a dramatic change in policy, community care, brought into effect and

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implemented by the National Health Service and Community Care Act 1990, has the resources to make it work.

Hon. Members would not expect me to sit down without saying that I too, like many who have spoken, wish expenditure in the specialist areas to be ring-fenced. Roy Griffiths said in his report that the money should be ring -fenced. My right hon. Friend the Leader of the House is nodding and smiling at me, and I am delighted that he is. I know, because of his own concern, just how much he is anxious about this and how much he wishes to see the community care policy working.

The Lord President of the Council and Leader of the House of Commons (Mr. Tony Newton) rose --

Mr. Winterton : I am delighted to give way to such a senior Minister.

Mr. Newton : I apologise to my hon. Friend the Under-Secretary of State for intervening in a matter relating to my old pastures rather than my current one. I was nodding and smiling only because, as I think my hon. Friend the Member for Macclesfield (Mr. Winterton) knows perfectly well, the purpose of the Bill is modest--to correct an error in the original Bill affecting the Abbeyfield Society. I have to admire his ingenuity in ranging over the whole area of community care in the course of the debate.

Mr. Winterton : I can only pay tribute to the discretion and good sense of the Chair in enabling me to highlight a number of deep concerns felt on both sides of the House, which is helpful--

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse) : Order. I hope that the hon. Gentleman does not rely too much on my discretion.

Mr. Winterton : I am grateful, Mr. Deputy Speaker, for that sound piece of advice, which, naturally, as a member of the Chairmen's Panel, I shall heed immediately.

Mr. Cryer : The hon. Gentleman probably missed some of the debate while he was in the television studio, so I should tell him that the Minister initiated a debate on the whole of community care, not just the narrow terms of the Bill. That was entirely endorsed by the then Deputy Speaker. Unfortunately, the Leader of the House did not hear the opening speech, so his remarks are slightly out of order.

Mr. Winterton : It would be completely inappropriate for me to comment on what the hon. Gentleman says. I always take the advice of the Chair, and as long as I serve in this place I shall continue to do so.

I am linking my remarks to the explanatory memorandum which, I repeat, says :

"The Bill should not result in any increase in public expenditure, or have any effect on public service manpower."

Mr. Andrew Rowe (Mid-Kent) rose--

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