House of Commons Hansard Debates for 4 Jun 1992

Mr. Winterton : I shall give way in a moment to my hon. Friend, who was another distinguished member of the Select Committee on Health in the previous Parliament.

It may well be necessary in the course of the further stages of this legislation to tell the House that additional resources, both by way of public expenditure and in respect of public service manpower, may well be required

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to plug what is described in the explanatory memorandum as a lacuna created by the National Health Service and Community Care Act 1990.

Mr. Rowe : My hon. Friend's ingenious use of the explanatory memorandum seems to link with an earlier remark when he said that it is particularly sad that local authorities should be getting rid of their part III accommodation. The implication was that, in the private or non-profit- making sector, one might look for rather less effectiveness than in the public sector. I hope that is not what he means. He would be greatly mistaken if that was what he meant. I hope that he will correct any misapprehension on my part.

Mr. Winterton : I am delighted to respond to my hon. Friend. I look to community care to provide a wide range of facilities. I see developing a situation in which in many areas there will be few what I describe as statutory part III residential homes. Almost exclusively, the social service departments, acting as facilitators, as purchasers of services, not necessarily as providers, will not have the scope of choice that I believe is necessary. That is a point that has already been made in speeches today.

I am entirely in favour of partnership. I am entirely in favour of the private sector being an important part of that partnership. I am also in favour of the non-profit-making charitable organisations being part of the overall provision that is available to social service departments to choose from in respect of accommodation and care for the elderly and other vulnerable groups within the community. But I am deeply concerned that choice, which the Government have said should be an important part of the new system, will be limited. When elderly people are assessed about the accommodation and care they require, the assessment might well be affected by the availability of facilities.

Whether or not my hon. Friends are prepared to say it, clearly we are loading a heavy additional responsibility on to local authorities. I remain to be convinced that sufficient resources will be transferred to local authorities, in the main from health authorities, to enable local authorities as the lead authority in community care to provide the level of service and the range of accommodation that is required if community care in Britain really is to work.

Again, I make a plea for ring fencing, which has been suggested by Labour Members and Liberal Democrats and is also supported by Conservative Members. I am aware of many authorities, such as my own in Macclesfield, where the health authority and social service departments have now put forward a blueprint of what they hope to achieve. But the fruition, the true implementation, of what is contained in the excellent and well- researched proposal booklet that has been issued in my area will entirely depend on the level of resources that is made available.

The Bill is relatively tight, but the hon. Member for Bradford, South (Mr. Cryer) said that my hon. Friend the Under-Secretary of State had introduced the Bill widely, embracing the whole scope of community care. I suspect that he did, although I heard only tiny snippets of his contribution. However, I know from the experience that he has had that he will have put a good case.

Mr. Gareth Wardell (Gower) : Does the hon. Gentleman agree that it is fundamentally important that, when the Bill is implemented on 1 April 1993, money is made available so that disabled housing grants can be in

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place? It would be nonsense to have insufficient resources to provide the disabled with the aids they require in their homes--such as rails around the toilet and bath. In the Welsh context, a long waiting period for essential aids could make the Bill a nonsense.

Mr. Winterton : The hon. Gentleman makes an excellent point. His intervention, together with the excellent speech of the hon. Member for Monklands, West shows how effective this is as a Parliament of the United Kingdom. We do not need separate legislatures to highlight the particular problems of Wales, Scotland or--I say this to the hon. Member for Wakefield (Mr. Hinchliffe)--of the northern, north-western, or west midlands regions.

The hon. Member for Gower (Mr. Wardell) was right to highlight the need to provide resources to enable local authority social services departments to provide adaptations and modifications to homes so that the elderly and infirm can continue to live in the community. The hon. Gentleman's question perhaps implied that, if that cannot be done, community care cannot effectively be implemented in the United Kingdom. I share his concern to some extent. Those of my right hon. and hon. Friends who are deeply committed to an effective community care system and programme are aware that there are resource problems. There are rumours that the Government may seek further to postpone the programme. I hope that they do not. Although we are not utterly ready for it, a postponement would affect the morale of those who are desperately seeking to be ready by 1 April 1993 to an extent that would be counter-productive.

You, Mr. Deputy Speaker, have been generous in allowing my speech to range wider than it ought to have done, but I followed my hon. Friend on the Government Front Bench in that--and I know that others of its members wish that I would do that rather more often. I promise them that I shall seek to do so, bearing in mind my own reputation and independence of mind. I say to my hon. Friend the Under-Secretary that my comments come not just from the heart but from the head. He knows that the Select Committee on Social Services made a long, deep and detailed study of community care. We produced some excellent reports, with fine conclusions and recommendations- -many of which received a positive response from the Department of Health. I ask my hon. Friend the Minister to give an assurance that the Bill will remove a lacuna created by the National Health Service and Community Care Act 1990, and that--despite the final sentence of the explanatory memorandum--the Government will give serious consideration to the provision of additonal resources, if they are needed before the legislation's implementation on 1 April 1993.

I am sure that my hon. Friend the Minister is aware that we are dealing with very vulnerable groups that cannot themselves promote a good case on their own behalf. They look to the House or to Parliament as a whole to ensure that their interests are safeguarded in the dramatic change of policy that is encapsulated in the 1990 Act.

6.15 pm

Ms. Tessa Jowell (Dulwich) : I join other hon. Members in congratulating you, Mr. Deputy Speaker, on your appointment, and in welcoming this legislation, which is little more than a technical tidying up to give local

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authorities the power to place people in and pay for facilities that are not registered under the Registered Homes Act 1984. Community care is at a watershed, and stability is of the essence. Certainty in the nature and range of provision is the only way in which the confidence of those who rely on that provision and their carers will be sustained. Concerns are emerging about the way in which the broader community care policy is being implemented. There is a danger that the legislation's excellent intentions and all the fine rhetoric from hon. and right hon. Members in all parts of the House will not be borne out by the daily experience of elderly and disabled people throughout the country. It is the job of the House to do everything in its power to ensure that the legislation's promises are honoured in the provision of better opportunities in the daily lives of the elderly and disabled.

Ministers have repeatedly given assurances that the new legislation will be adequately funded. The definition of adequacy will promote extensive debate among right hon. and hon. Members on both sides of the House. The importance of adequate funding cannot be overstated in terms of ensuring certainty and stability. Local authorities in particular must have the money to do properly the job that Parliament has willed them to do.

Negotiations are under way about the money to be made available. I suspect that it may create difficulties for local authorities that the sums will be announced not in July as originally intended but in October.

Reference has been made to the difficulties anticipated by local authorities because the money to be transferred to them to purchase care for people in their own homes or in residential accommodation will not be ring-fenced and specifically identified--and will therefore be susceptible. There are grave doubts also about the adequacy of the distribution formula, with evidence that the money may not be distributed by central Government to local government in accordance with local need.

Local authorities have been charged with the technically and managerially demanding job of implementing the legislation. Its complexity is extensively acknowledged--most recently, by the Audit Commission. In recent years, local authority infrastructure and the capacity to plan for these changes has been eroded as Government cuts have been forced on local authorities.

Other hon. Members have referred to the problem created by the "fee gap"-- the difference between the amount that residential and nursing home care costs, and the amount that is available from social security to pay for that care. It is terribly important for that problem to be rectified as part of the negotiations about the amount to be made available to local authorities. Current estimates suggest that there is an average discrepancy of some £30 a week between the cost of a residential care place and the amount made available through the social security system. In the case of nursing home places, the discrepancy is about £50 a week.

My constituency is fortunate to benefit from a small project--run under the auspices of Age Concern--that arranges placements for people who have been discharged from long-stay hospital care into private nursing care, searching the country for places where care can be provided at income support levels. Although, as a result, people are often placed a long way from home, the project also provides follow-up through visiting. I understand that

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it is a unique initiative, and that elderly people in other parts of the country cannot be guaranteed access to such valuable support.

Mr. Rowe : I share the hon. Lady's anxiety for the amount available for community care to be sufficient. Is it not the case, however, that, when the purchaser of such care is the local authority and not, as at present, the Department of Social Security operating at one remove, it will be much easier to match what is available with what can be afforded?

Ms. Jowell : I shall come to that point. The Social Security Select Committee called for an urgent review of the fee gap, and I echo that call. If we do not sort out the problem now, local authorities will inherit an inherent deficit in the budget passed to them by Government via the revenue support grant, and that structural underfunding will limit the number of people in residential care whom authorities can support.

In setting up contracts with independent providers, local authorities will be required to underwrite the cost in full. At present, the shortfall is being met by means of a range of cobbled-together solutions. Organisations such as Counsel and Care for the Elderly and Age Concern can provide substantial anecdotal evidence of the pressure that is put on relatives to find what may be large amounts of money to make good that shortfall. My hon. Friend the Member for Monklands, West (Mr. Clarke) mentioned a figure of £142 million : that is a considerable sum, which must be taken into account in the calculation of local authority funding.

Another problem affects people who are currently in residential and nursing home care, who have what are described as "preserved rights" under the new arrangements. That often means that families or charities must make good the continued shortfall. If this important matter is not sorted out now--if money is not made available on the basis of the available evidence--the long-term success of the policy may be jeopardised.

A second problem that may sabotage the best efforts of local authorities relates to the current dispute between the Department of Health and local authority associations about the number of people currently admitted to residential and nursing home care each year. I understand that the discrepancy now stands at between 15,000 and 20, 000, and the costs associated with an underestimate of this scale in the number of people entering residential care is sufficient to jeopardise the policy's success further.

To a large extent, such problems arise through the inadequacy and unreliability of available information. We do not really know how many people are in residential care, from which local authorities they have come and who will be responsible once the legislation is fully implemented. Those factors do not merely jeopardise the capacity of local authorities to do the job that they want to do ; they have a direct and immediate impact on the well-being and confidence of disabled elderly people and their carers.

Adequate funding must be made available. It must be recognised that the new policy focuses particularly on support for elderly and disabled people to remain in their own homes, and that because of lack of alternatives, they may have to go into residential care. Estimates suggest that, at any time, about 10 per cent. of elderly people in

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almost any residential home in the country might have lived independently in their own homes if the necessary support had been available.

We need the capacity to maintain the stability of the residential sector, but local authorities also need the capacity to begin to build up and develop the new forms of domiciliary care that will be essential if the objectives of the policy are to be achieved in the years to come. We want more elderly and disabled people to live longer in the safety and security of their own homes.

None of us can have failed to be moved by the report published last week by the Carers National Association, which drew particular attention to the amount of illness suffered by carers. One of the great promises contained in the Bill is that the level, quality and sensitivity of support for carers will be much higher than it has been in the past, but local authorities will require money if they are to achieve that. [Interruption.]

Mr. Deputy Speaker : Order. If Conservative Front Benchers were quieter, I might be able to hear what the hon. Lady is saying.

Ms. Jowell : It is essential that the promises that have been made-- in the boldest terms--to improve the quality and level of support for friends and relatives who care for the elderly and disabled in their own homes are delivered in practice.

Let me end my speech by asking four questions, which I hope the Minister will answer. First, do the Government recognise the risks of failing to enter into early discussions with local authority associations about the shortfall that authorities are in danger of inheriting--a shortfall that may endanger their capacity to implement the policy properly?

Secondly, does the Minister recognise that additional difficulties have been caused because the money made available to support community care is not ring-fenced?

Thirdly, what provision is to be made for the inevitable contingencies that will arise as unforeseen problems are encountered? At the end of the last Parliament, the Government were prepared to bale out hospital trusts that had run into financial difficulties. I hope that the same effort will be put into ensuring stability in the care and support of elderly and disabled people.

Finally, recognising that one of the most important factors for elderly disabled people and their carers--the beneficiaries of the legislation--is certainty and clarity about what they are entitled to, will the Minister also consider introducing a community care, carers and users charter as an expression of general enthusiasm for citizens charters, about which we have heard so much from the Government? Codification of this entitlement-- setting it out clearly--would be one of the greatest benefits that we could extend to carers and disabled people, whose lives are often made more difficult and burdensome by the confusion, red tape and bureaucracy that they have to try to penetrate in pursuit of the care and support they need.

6.31 pm

Ms. Ann Coffey (Stockport) : I wish to refer specifically to the exclusion of small residential homes from inspection under the Bill, which I find difficult to understand. If someone goes into a home in which there are two other people, the monitoring of standards in that home should not be significantly different from those that apply to a

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home where there may be three other people. I cannot stress too strongly how important is the role of inspection in maintaining and monitoring standards, particularly where care and finance are closely linked.

Reference has already been made to the problems encountered over the financing of care in private residential homes. They are caused by high interest rates and low Department of Social Security grants. Financial problems of that nature affect the care that is given to residents. They also have an effect on the quality of staff employed in those homes.

Hon. Members have referred to the use of personal allowances and charging for extra items. Also, threatening residents with eviction because they cannot pay their fees is not the way to make them feel that they are being cared for. Sadly, though, that is a step that a residential home may have to take. It has a damaging effect on the people in that home.

Apart from the effect on the quality of nursing care, lack of finance also has an effect on local health authority provision. During the last year, my health authority has experienced an enormous increase in the number of acute admissions. That is ironic, since two wards were closed and nursing care was transferred to the private sector to release resources. Part of the reason for the increase in acute admissions may be that the quality of nursing care provided by private nursing homes was not good enough. That leads to an additional burden being placed on the health authority. Moreover, it means that beds for people who need operations cannot be made available.

The inspection process as a whole is inadequate, but particularly for nursing homes. The district health authority is responsible for inspection. If, however, a district health authority should deregister a home, it could lay itself open to a claim for compensation on appeal. Some district health authorities therefore might adopt an over-cautious approach.

The guidelines for inspection are insufficiently specific. They are fairly specific in terms of physical standards of care--the number of beds per room and toilet facilities--but they are not specific when it comes to the measurement of quality of care, which is, of course, very difficult. However difficult it may be, it should be attempted. Emotional support is important for residents ; the activities provided for residents are important. Their emotional support should be given the same attention as their physical needs, if the Government are serious about raising the standards of care in residential accommodation.

If we raise standards, the costs will rise. When the residential allowance is announced, I hope that it will take into account the higher costs of better care. If it does not do so, local authorities will have to make up the shortfall. If the cost of residential care becomes too expensive for local authorities, they will have insufficient money to spend on community care. The result, therefore, of the National Health Service and Community Care Act 1990 will be an increase in expensive private residential sector care which could have been provided much more cheaply by local authorities had the Government allowed local authorities to borrow capital in order to make the necessary adaptations to local authority homes.

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I urge the Minister to think carefully about a number of issues, but particularly about the inspection process and tightening up the guidelines. I hope that he will think carefully, too, about the provision of an independent inspection process for nursing homes. It should not be provided by the district health authority. That can lead to conflicts of interest. May I ask the Minister also to think carefully about providing the right amount of money for residential care? If he is determined to provide it through the private sector and to disadvantage the public sector, the residential allowance must enable good care to be provided, as well as profit. If the Minister does not make provision for the profit margin, the care provided to residents will inevitably suffer.

6.37 pm

Mr. Malcolm Wicks (Croydon, North-West) : May I start by telling you, Mr. Deputy Speaker, one story? I hope that it will bring the debate about community care down to earth. This happened to me during the election campaign. Hon. Members know that one of the curious habits of parliamentary candidates is to go up to perfect strangers in the street and ask them about their health. Sadly, one is really asking them about their vote.

On this occasion, the woman I spoke to turned on me in great anger and said that she was voting for no one, and why should she? She pointed to her husband, whom she was pushing in a wheelchair and who was seriously handicapped, and said, "I am his carer"--she used that word--"and I get virtually no help. Sometimes I have to care for him almost around the clock, such is the nature of his disability. I hear about community care. I know that that is a lie. I am not going to vote for anyone." I found that a difficult argument, because of the passion with which it was presented to me, to refute.

A curious British habit is to use the English language in imprecise ways-- sometimes in ways that are virtually a contradiction. While we all talk, as I do, about community care, the reality all too often is not care but neglect. The reality is community neglect in Britain. That is not just rhetoric. I recall data from the general household survey of carers which showed that the majority of carers receive no help at all.

What worries me about our debates--I refer not just to our debate in this Chamber but to the debates in the country--about community care, not least because of the jargon with which the professionals like to bemuse us, is that, while we hear about "packages of care" and the "seamless service", the reality for most people in this position is, very often, nothing.

Despite the expertise in the House, there is probably greater expertise elsewhere around Westminster, such as Victoria street late at night. It would be good for all of us, certainly Ministers, to leave the House occasionally, walk up Victoria street late at night and talk to those trying to sleep in shop doorways. Many of them are elderly or suffering from mental illness. They would be surprised to learn that they are examples of community care. It would be good for us all to experience that type of so-called community care. Therefore, we should be careful about our terminology.

Despite the poor attendance in the Chamber, and no doubt the lack of press interest in this debate, this must be one of the most important subjects that the House will debate. That point has already been made by many hon.

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Members. It is a subject that will grow in importance. The number of us who will reach a ripe old age is growing significantly year by year. As has already been pointed out, it is not just the aging of the population that is significant, but the aging of the elderly population itself. In the first census this century, in 1901, there were just 50,000 people over the age of 85--Wembley stadium half full. By the 1981 census the number had increased tenfold, to 500,000. Between 1981 and the year 2001, the number will double again, so that we will have over 1 million people aged 85 or over.

It would be agist and incorrect to say that all those poeople will need care in the community or elsewhere. Many are sprightly and will go on "Jim'll Fix It" and jump out of an aeroplane for the first time at the age of 85, hopefully with a parachute. However, we cannot be romantic about aging, because many of those people will suffer from Alzheimer's disease, be senile in other ways or incontinent and may need a great deal of care in our community. So the demography is against us. If this debate is important now, it will be even more important in five or 10 years. If we are to get it right, let us get it right sooner rather than later.

The debate is also important--this is a challenge to us all--because of the cost of so-called care in the community. Do we know enough about the cost of such care? When I say that, I am thinking about financial as well as social costs. We know from some estimates that the amount of care provided by family carers, let alone the Government, runs into billions of pounds. Because of the curious way in which we do our national arithmetic, none of those costs and contributions made by family carers will be found in our gross domestic product, which is the peculiar and narrow form of arithmetic that we sometimes take more seriously than we should.

I am interested in the cost of community care and who pays for it. At the moment, it is almost random. If a person becomes ill and is being treated in a national health service hospital, the costs are met by the NHS, with no direct payments from the patient. If the patient is cared for by a daughter or daughter-in-law, the costs will largely be met by the family, perhaps with some support from social security. If the person goes into a residential home and is below income support levels, the costs are largely met by the Department of Social Security. There is no consensus as to who should pay for the costs of aging. Should it be the elderly person if they can afford it, even if it means selling their main asset, their home, if they have one? Should the costs be paid for by the family, the state or the private sector? Those are important questions for the future that need to be grappled with.

The debate is also important because of the social and moral argument. Unless we can get this right and truly provide community care, we all suffer in a social and moral sense. I know that this is something of a cliche , but surely there can be no greater challenge than to enable our elders--that is how we should think of them--to live out their lives in comfort and with dignity. That is why the question of policy is so important.

Our Government and many others have waxed lyrical about community care over two decades. However, policy has been a slow train coming. It took reports from the Audit Commission and many other groups to embarrass the Government into setting up an inquiry under Sir Roy Griffiths. It then took some while for the Government to make up their mind what to do about that excellent report.

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Then, at last, 10 years late, we had an Act of Parliament addressing the issues, and its implementation was delayed. Therefore, it is not unreasonable for hon. Members on both sides of the House to be worried about the rumours that there could now be further delay. I want to ask three questions which echo some of the issues that have already been mentioned by hon. Members. I know that the Government will want to take the questions seriously. Given the rumours, I am sure that they will want to take this opportunity to put the record straight and to reassure those who are worried. I am sure that Ministers are worried by the rumours.

First, will the National Health Service and Community Care Act 1990 be implemented fully, and as originally stated, on 1 April 1993 ? If the answer is yes, as I hope it is, it is easy for Ministers to tell us that tonight. That would reassure the elderly, their families, the professions and social service departments.

Secondly, are the Government satisfied with the quality and nature of the community care plans now coming forward ? They will now have had an opportunity to study them. I have had an opportunity of studying several dozen, and many could not be regarded as plans as such. They contain broad statements of intent, sometimes repeating the broad statements in the White Paper and many good statements of philosophy, saying broadly what they would like to happen. However, I do not regard them as plans. Are the Government satisfied with that process ?

Thirdly, those plans may not be real business plans, because of the question of resources. How can one draw up a proper plan if one does not know what money can be spent ? A Conservative Member made a sound point when he said that a company would not try to draw up a plan without an idea of the resources available. I am sure that this will be taken seriously by the Government, because the Conservative party is the party of private enterprise, and no doubt wants to run the Government as efficiently as the best companies. If it is not sensible for ICI or Glaxo to draw up business plans without an idea of how much can be spent in the forthcoming financial year, why does the Department of Health expect major organisations such as social services departments to draw up such plans ?

I invite Ministers to state clearly the financial arrangements that the Department of Health wishes to make. Will Ministers also confirm the existence of the working party on financial arrangements, known as the algebra group ? Will they further confirm that the working party's officials are having some difficulty with the algebra ? In the new spirit enunciated by the Prime Minister, will they state whether the working party's report will be published ? There can be no state secrets.

I was grateful for the broad way in which the Minister introduced the debate, because we cannot sensibly discuss this important Bill, which we all support, without considering its context. We have perhaps a few months left to get the policy right. All too often, it has been the sad experience of our social history that it takes some tragedy or case of abuse, and sometimes death, before

institutions--including, with respect, the House and Government--act. The sad history of child care since the last world war is that it has taken tragic, sad and well-known cases of children being murdered before Government and the rest of society took the issue seriously. We already know of cases of abuse, which can occur in publicly and privately owned residential accommodation and, perhaps most

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sadly, in the home where carers are caring for the cared for. We would all stand condemned if we provided resources for the important subject of community care only when public opinion was galvanised and shocked by cases of abuse and tragedies, which perhaps occurred because carers could stand it no more, such were the pressures and the lack of support that they were receiving, often because resources were not available.

It will be a real test of our judgment and collective wisdom to see whether we can rationally analyse the situation and bring passion to bear on it. We have the evidence and experience to force Government--I mean that in a most decent way--to find the resources, to help the Department of Health to get those resources from the Treasury. We all have an interest in ensuring that.

Perhaps we are at a turning point and soon will truly be able to say that this is the first chapter in which we start to turn the story of community neglect into a decent story of true community care.

6.52 pm

Mr. Bob Cryer (Bradford, South) : We should all be grateful to the Danish people for giving us an opportunity to speak about this important subject. We hope that the Government will bear that in mind and will not try to resurrect the discredited Maastricht Bill. That will give us more opportunity to debate important issues such as community care.

I join my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) in thanking the Minister for the way in which he introduced the Bill, which has a narrow base but wider applications, as it amends a number of community care issues. The House is grateful for his introducing it with that in mind, as it has enabled hon. Members to speak in general terms about this important subject.

Labour Members agree that expenditure on community care should be ring- fenced. Why do we say that? We do not share the startling view of the hon. Member for Bolton, North-East (Mr. Thurnham), who said that he had faith in local authorities spending the money allocated to community care according to that definition. That view is not shared by the Government on a wide range of local government activities, and I dare say that the hon. Member for Bolton, North-East would share the Government's view of, for instance, schools opting out of local authority control to avoid local authority expenditure allocation.

Local authorities, having experienced cuts in rate support grant and revenue support grant since 1979, are faced with invidious and difficult priorities. Will they be forced to spend money on housing homeless persons, or will they improve community care by housing homeless persons who have been thrown out of hospitals for the mentally handicapped which have been closed on the pretext of community care? Will they incur expenditure under the Education Act 1981 by statementing children with special needs who will be required to have those needs provided?

Those are the priorities that local authorities face. The Government cannot therefore apply the usual formula against ring fencing, which is that the priorities are determined by the local authority and it is its responsibility

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entirely, thus evading the real point--that the Government, by making cuts, have stretched the services that local authorities provide while local authorities have taken the blame for their allocation of priorities. It is an invidious position for local councillors.

One of the great advantages of a local authority making decisions is that it is accountable through the democratic process with which we are all familiar. Hon. Members who have been active in local authorities and who have taken part in local authority elections will be aware of that accountability. There is no such accountability in the private sector, to which the Minister paid lip service in his opening remarks in a quite extraordinary way. He said that it was, as it were, the pacemaker of community care. That simply is not true. Where community care is operated for private profit, the tendency will be to cut expenditure and maximise income in order to maximise profit. Private sector carers will so operate unless they are subject to strict inspections, but local authorities must, of course, bear the cost of ensuring that such inspections are made. That further cost is not recognised by the Government.

Under the National Health Service and Community Care Act 1990, local authorities are having to bring their own homes up to a standard higher than in the private sector so that they can examine old people's homes objectively and so that home owners cannot say, "The local authority homes are in an inferior condition, so how can they judge us?"

The Government have not recognised that cost, which local authorities are having to bear. The Labour-controlled local authority in Bradford took over from the Conservative council, which was trying to sell homes and people lock, stock and barrel. It failed to do so, but the Labour-controlled local authority embarked on a programme of updating and improving local authority homes. It has been able to do so only by selling its properties--very reluctantly--which were declared as surplus. That revenue is being used for modernisation and improvement. The Government are not providing enough resources. They should face up to their responsibilities and allocate money for community care.

It is important that the Bill is passed, to allow local authorities more flexibility. Schedule 8 of the National Health Service Act 1977 must not be narrowed, because in certain circumstances local authorities could be required to pick up the pieces for the private sector. We have not examined that very closely today, but we should do so, especially in view of the Minister's rabid obsession with supporting the private sector at the expense of the public sector. We should point out to him that the legislation contains the seed of rescue patterns which may be necessary because of the difficulties that the private sector might face.

I cite a specific example for which the Bill is tailored. It involves Westwood hospital in my constituency--a hospital for the mentally handicapped, now called people with learning difficulties. I must say that parents and people who work in the hospital do not like the new nomenclature, because they think that it is an attempt to cover the problem with words and to make it seem that things are not so difficult as they are.

Westwood hospital has been subject to a programme of putting people into the community for many years. In the first instance, the local authority was involved but the programme was more or less a disaster. It was called

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"Operation Springboard", and it did not work. I recall that two people who were released into the community from Westwood hospital came to see me. They had been trying to get grants from the Department of Social Security for more than 12 months. They had had a difficult experience and received form after form which bemused them. They came to me to get things sorted out and I managed to do so. I am in contact with many of the people who work at Westwood hospital and many of the parents, so it occurred to me to ask the two people whether they could read or write. They could not. They had been going to a DSS office for 12 months, but nobody had asked them whether they could read or complete the forms being poured out to them. They were subject to care in the community, but clearly there was no care in the community for them. Incidentally, the arrangement ended in violence, and both went back to Westwood hospital. One problem with care in the community that the Government must face is that their cutbacks to local authorities and to district health authorities are forcing district health authorities to sell hospital sites. When the sites are gone and a difficulty arises with the care in the community programme because of a difficulty with or a wholly mistaken assessment, where are people to go if there are no havens such as Westwood hospital? The Minister should answer that question, but I do not think that he, his civil servants or anybody else in the Department of Health or the Department of Social Security have troubled about it.

I revert to the example in greater detail because it is relevant to the legislation. Westwood hospital has been subject to a care in the community programme for many years. In 1988, it was agreed that the Westwood hospital site would become the site of a mixed community development. It is a green site of 30 acres or more in which people can walk around. It is like a college site in that it has security--I do not mean fixed gates or doors, but security from traffic. There are speed humps so that cars cannot speed around. It offers a tranquil existence which people who are mentally handicapped frequently need. Indeed, it offers the sort of tranquil existence that most of us need from time to time, especially when we have been in this place a few years.

In 1988, in evidence to a planning inquiry about the Westwood site, the district health authority said :

"In the event, the proposed phased movement of patients into the community in accordance with the "Springboard Project" did not prove successful. The Health Authority is nevertheless still firmly committed to the essential policy of care in the community. At Westwood, this will now be achieved by the creation of sites for housing whereby certain numbers of the houses will be reserved for use by the Health Authority by agreement with the developers." It was clear that it was to be a mixed site. It continued : "In this way, normal cross sectional communities will be created in which people with a mental handicap presently in the hospital, will be allocated domestic living units. The environment so produced will encourage the return of residents to the pattern of daily life. These proposals will have the effect of bringing the community to Westwood Hospital, in the form of a mixed housing development plan. The funds released from the sale of housing land will be allocated to capital works within the Yorkshire region although benefits will generally accrue to the Bradford area wherever possible.

It is fully anticipated that there will be continued health care facilities and staff support. For example, certain of the more modern buildings within the hospital complex will be retained as community units such as a day care centre providing for 24 to 40 people."

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That policy, presented to obtain planning consent, secured the consent but was then reneged on in a disgraceful and despicable way. The whole site is to be sold and only the nurses' home is to be converted to a 20-bed unit. That is absolutely disgraceful, and it is one of the reasons why my hon. Friend the Member for Croydon, North-West (Mr. Wicks) finds that people are cynical and have become disillusioned and disenchanted with administrative institutions which make fine promises but then renege on them and spurn the carers, many of whom are aging people growing weary of looking after their mentally handicapped children, often with great devotion. The plans that they supported are torn up virtually in their faces.

Mr. Hinchliffe : I think that my hon. Friend is aware that I have had correspondence with a number of people about Westwood hospital. I am personally familiar with one or two parents who have long fought for a proper resolution to the problem. The information provided by my hon. Friend shows what a kick in the teeth there has been for people who have struggled for a long time with handicapped members of their family who were involved with Westwood hospital. However, the experience that he described is not happening only at Westwood. I commend to my hon. Friend a press conference to be held in the House next Wednesday morning in the Jubilee Room. It is organised by Values into Action, an organisation concerned with exactly the type of experience that he outlined. Such events are happening not only in Bradford but across the country, and my hon. Friend is right to point them out to the Minister who must deal with them.

Mr. Cryer : My hon. Friend is right. RESCARE is a national organisation devoted to retaining the high standard of residential care in the public sector at sites such as Westwood which are decent and potentially marvellous sites.

I have a letter from Bradcap--Bradford and District Care and Protection for Mentally Handicapped People a group battling for parents and for people living at Westwood hospital. The organisation is very worried about the lack of development of Westwood's potential and about Westwood being abandoned and discarded. The letter states :

"At a recent meeting organised at Westwood by the Community Health Council over 100 people attended and we were overwhelmingly in favour of Bradcap's plan, i.e. Retention of some land at Westwood including the excellent Recreation Hall, Occupational Therapy Unit, Hydrotherapy Pool, etc.

The replacement of wards with more home-like bungalows. A sheltered environment for some of the mentally handicapped who need it for reasons of behavioural problems or vulnerability.

Parents do not want their children at risk or as a stock in trade for ambitious businesses."

That last sentence is a fair comment about the privatisation of provision for people who, whether they are mentally handicapped or elderly, are among the most vulnerable in our community.

Mr. Tom Clarke : Does my hon. Friend agree that it would help to solve some of the important problems that he has mentioned if the Government, even before introducing the Bill, fully implemented the representation sections of the Disabled Persons (Services, Consultation and Representation) Act 1986, so that the people he

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