House of Commons Hansard Debates for 1 Jul 1992

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understand how they feel. Those individuals are on their own, and they need the protection of proper procedures to ensure that they are not abandoned.

My hon. Friend the Member for Dulwich (Ms. Jowell) rightly said that all that we are talking about in this amendment, and in many others with which we shall deal, is good practice and arrangements that maximise the quality of life. That is what the Opposition are pursuing in our amendments. The importance of this amendment is that key decisions are made at the point of discharge. If the arrangements are not made properly or if issues are overlooked, the arrangements can become dangerous and potentially disastrous for the individual. As has often been said, care in the community is in danger of becoming neglect in the community or neglect in a home unless these matters are addressed properly in procedures that must be taken into account of and followed at the time of discharge.

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There has been great concern about the closure of certain health service institutions, such as the William Nichol home in my constituency, because people are being moved from NHS institutions which have been their homes, often for many years. We should not treat lightly the arrangements made for those individuals at the time of discharge.

The pressure for arrangements for discharge to be made long before the date at which it has to happen and to be tailored to the individual has been accepted by the health authority and the Welsh Office after a lot of debate. We want such good practice and such important considerations to be written into the legislation and into the regulations that have to be observed. It is a personal matter ; we are dealing with individuals.

There have been occasions when hospitals have discharged patients, especially the elderly, into circumstances in which they were without the care and support they needed and the pressure of cash limits is always there. The hon. Member for Woodspring (Dr. Fox), who also intervened with a sound bite, may not share our view but this is now generally accepted as being bad practice. In recent years, efforts have been made to ensure that discharge is properly planned but the change to trusts, and indeed a financially driven regime for directly managed units too, will increase the risks of hasty discharge or discharge into inappropriate circumstances. We must take great care. I hope that the Minister will take on board the spirit of the amendment. We have made it clear that it is not the Labour party's intention to delay this limited and sensible Bill. We seek to persuade the Minister and his colleagues of the importance of the Government acting on their own and in their own right to respond to our concern, to recognise the strength of our case today and to ensure that proper procedures are put in place to protect the individuals concerned.

We believe that history will show the need for the arrangements proposed in the amendment, but because we do not want to delay the House or the Bill, I invite my hon. Friend the Member for Wakefield, who moved it so ably, to withdraw the amendment.

Mr. Hinchliffe : I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn.

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Mr. Tom Clarke (Monklands, West) : I beg to move amendment No. 2, in page 2, line 34, at end insert--

(IB) Arrangements shall only be made by virtue of this section where the voluntary organisation or other person providing the accommodation operates clear procedures providing opportunities for residents to review their own situation regularly with a friend or adviser and the care managers.'.

The amendment deals with opportunities for elderly people to review their situation with a friend or adviser and the care manager. We are debating community care yet again. I am pleased by the opportunities to do so in this Parliament, in contrast to the previous Parliament. One reason for the change was suggested by my hon. Friend the Member for Dulwich (Ms. Jowell) when she referred to a constituent who came to see her. She underlined what some of us said on Second Reading, which is that, although the House may be packed for debates on Maastricht, people come to our surgeries on community care issues far more than they do on the bigger issues. That will be reflected as our debates on these matters continue. The reason for tabling the amendment is that community care cannot be complete unless an essential ingredient is the recognition that the individuals whom we seek to serve in our communities and in residential homes have rights and views, and a desire to have an environment that is acceptable to them. We believe that the case for advocacy, which we debated in Committee, is overwhelming. Although the amendment does not go as far as we wish, it would give the opportunity, when vital decisions are being taken about community care, for the involvement of a friend or adviser, or for the presence of someone acting for and with the person. The person's needs are absolutely paramount when care managers make recommendations and take crucial decisions about the lifestyle of the individual.

As we debate community care, we recognise the growth of private residential homes, with which the Bill deals. One Scottish Tory newspaper refers irreverently to "granny farms". That term could apply if we denied the residents of such homes the rights that an advocate would insist that we recognise.

Demographic changes mean that there are more elderly people, so a strategy for care in the community must recognise that there will be some people in residential care. However, we strongly assert that support should be given within the community to ensure genuine independence for elderly people. We believe that the existence of advocacy would be a step in that direction. The Bill concerns the rights of many elderly people who may, at their age, become a little confused. If people are confused, the need to have a friend, an adviser or an advocate when decisions are being taken about individuals becomes all the greater.

Some of us received a report yesterday published by the Consumers Association. It was headed :

"Contracting for residential care : individual contracts for older people in residential care and nursing homes."

It dealt with contracts and specifically with confused residents. The House will recognise, as I quote from the report, that some of the points made are consistent with the wording of the amendment although the amendment was tabled before the report was published. The report says :

"The situation becomes less easy with people who are confused or suffering from dementia. The same principles apply--just because someone is mentally impaired, it does not mean that they do not have preferences which are worth

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formalising Also, it may be that more active participation would be needed on the part of a spouse, relative, friend or professional advocate drawing up the contract."

That is almost the wording we have chosen to use in the amendment. The amendment also refers to voluntary organisations, if only because so many voluntary groups are involved in the provision of care and in preparing care plans. It is important for us to acknowledge that the National Council for Voluntary Organisations Community Care Alliance has given support to the general principles in the amendment. In its manifesto prior to the election, the alliance said about user and carer participation :

"Community care envisages the active participation of service users and carers both in individual needs assessments and in the planning of services. Achieving this will involve challenging vested interests and shifting power to service users.

Training and support, in some cases advocacy support, are needed to give service users and carers the confidence to participate." I suggest that that applies to elderly people, too. Elderly, frail, vulnerable people in residential homes are in a difficult position. The decisions that are taken about them and the services that are or are not provided are of crucial interest to them. In that context, health provision becomes a very personal matter and is pivotal to the lifestyle and the quality of life of elderly people.

The amendment gained considerable support in the BMA's recently published document on this very issue--the tensions between care provision and what is happening in the health service and the health care problems of individuals. At risk of wearying the House, I should like to quote from that BMA report, which the all-party group on disability considered yesterday :

"The provision of residential and nursing care perhaps demonstrates most clearly the need for effective collaboration between health and local authorities, relevant professionals and voluntary organisations. The Caring for People' White Paper imposes a delineation between health and social care to explain the funding of the new arrangements. In reality, many dispute that this delineation actually exists. This is especially apparent when related to care for people with chronic, severe ill health, such as the frail elderly. As both health and local authorities will, understandably, be keen to limit expenditure, there is a danger that each will view the patients' needs as being the responsibility of the other authority." In the absence of the advocacy of a friend or companion who is willing to speak for the patient, and with two authorities tugging away at the provision of health care, what opportunity do frail or vulnerable people have to say anything about their needs and rights?

Ms. Lynne : Does the hon. Gentleman agree that the advocate must be an independent advocate and not tied to a local authority? If the advocate is not independent, there is a danger that he will decide what the individual needs by reference to what the local authority can provide.

Mr. Clarke : I entirely agree, and I hope to come to that point in due course.

Let me quote another section of the BMA report, remembering the crucial importance of health care for elderly people :

"The BMA has received several reports from hospital specialists who have been frustrated by the lack of information on the rapid changes taking place in the private home sector. The lack of consideration given to the provision of general medical services when private homes are set up is also of grave concern."

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If it is of grave concern to an organisation as professional and as well informed as the BMA, is it not also of considerable concern to elderly people who are placed in such difficult circumstances? Fundamentally, the amendment advocates good practice, because advocacy is good practice. It would also give value for money. All the reports that we have considered--the Griffiths report, the Wagner report, which I know is of great interest to my hon. Friend the Member for Morley and Leeds, South (Mr. Gunnell), and, indeed, the White Paper "Caring for People"--suggest that we may not be getting value for money even from the sums that are being made available for the services. If there is any doubt about an individual's needs, rights or desires--perhaps the word "desires" is more important than the others in terms of the individual's rights being paramount--we are not likely to get value for money.

Each of the reports that I have mentioned supports the view that many elderly people are placed inappropriately, either in homes that are not suitable for them or in residential care rather than elsewhere in the community where they could benefit greatly. That is why advocacy is important.

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Dr. Liam Fox : I do not doubt the hon. Gentleman's sincerity, but can he give us some examples of who the advocates will be and who will appoint and regulate them so that they look after the interests of patients independently and are not in someone else's pocket?

Mr. Clarke : I hope to come to that point in due course. If he feels that, by the end of my short speech, he has not received an adequate reply, the hon. Gentleman would be well advised to read the report of my speech in Committee. He could have intervened or even made a speech on that occasion, and I am sorry that he did not take that opportunity. He may find that speech good reading, none the less.

We hear much about choice in relation to care in the community and care of the elderly, but we know that, in practice, it is, for the most part, mere waffle. How can an elderly person who has had a stroke, whose speech is impaired, who is blind--in some cases, deaf and blind--express his or her choice in the absence of advocacy? The community care provisions in the National Health Service and Community Care Act 1990 were introduced in response to the problems that we are discussing, and if that Act is to be given meaning, it is important that the amendment should be given a proper hearing. How can someone suffering from Alzheimer's be represented adequately when decisions are taken about him? In the absence of the kind of help that the amendment seeks to provide, how can the wishes of their carers be adequately represented when in some cases they are absolutely exhausted?

Hon. Members have mentioned social security--not just individual payments for income support which might give rise to individual problems, but the whole system which the Minister tells us is still to be introduced in April next year ; we wait with interest to see whether his words are prophetic-- whereby the money will be switched to the local authorities which will be seen as enablers rather than providers. With all those changes taking place, life may become extremely confusing, and not just for professional bodies such as the BMA or for local authorities--my hon.

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Friend the Member for Doncaster, North (Mr. Hughes) gave an excellent response suggesting that local authorities are aware of the problems and genuinely seeking to deal with them on a day-to- day basis.

Even when people are elderly, vulnerable and frail they have rights, such as the right to privacy and the right to make choices about clothing and food. That came to the fore in Committee, and we heard much disturbing evidence about those rights being challenged. People's privacy had been impinged upon and, although I do not say that it happens often, some elderly people have been locked up all night in circumstances that we regard as utterly unacceptable. We are entitled to ask who will protect those vulnerable people. In the absense of advocacy, do we really think that we can conceivably solve problems such as those discussed in Committee, which all of us found distressing.

In Committee, the views of directors of social services were related to us by my hon. Friend the Member for Dulwich. If we wantto get to grips with the problem, examine what happens in residential care homes and improve matters--I accept that the challenge is enormous--the views of such directors are important. My hon. Friend quoted one director as saying :

"It's not the children at risk who keep us awake at night, it's what might be happening to elderly people in residential care in the local authority's own homes and to the thousands of elderly residents who are cared for often a long way from home, in private residential and nursing homes."

When directors tell us that, it is time for us to worry about what is happening to our elderly folk.

How would any of us feel if such things were happening to any of our own parents or people in our families? We would be greatly worried and rightly so. When we have an opportunity such as that offered by the Bill to improve the position and introduce changes, we are right to take it. We must have some strategy for examining the system, the position of individuals and the quality of care. Those responsible for providing that care must know that that strategy exists.

In Committee several of my hon. Friends, in particular my hon. Friend the Member for Stockport (Ms. Coffey), expressed anxiety about examples of elderly people being evicted from private residential homes. When an elderly person has no family or anyone to defend him or her, the availability of advocacy becomes important.

In an intervention the hon. Member for Woodspring (Dr. Fox) asked me to define the role of the advocate. The hon. Member for Rochdale (Ms. Lynne) raised the issue of the independence of the advocate. Those were both fair points, all the more so because we must recognise that there are times when the interest of the elderly individual and the interest of the family conflict. That can often happen. It is right that at the end of the assessment and the decision-making process, the elderly person is given greater priority. Therefore, I accept the case for independence in advocacy. Of course, advocacy may vary. It does not always have to be on a professional basis. There are some excellent examples of voluntary advocates. For example, I commend the Sheffield advocacy alliance to the hon. Members for Woodspring and for Aylesbury (Mr. Lidington). I am sure that they wish to pursue the matter more fully and to see advocacy in practice, and I encourage them to do so.

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We seek to discourage the idea that elderly people merely go into homes to receive services passively. They do not enter a home simply to be "helped". They want to feel that they are individuals who are encouraged to enjoy the best possible quality of life and to participate in their care. It is not always possible for elderly residents to participate if their views, needs and rights cannot be expressed.

I also commend to the hon. Members for Woodspring and for Aylesbury the views of Citizen Advocacy and Age Concern. Those organisations have spent a great deal of time on the matter. They understand that the quality of care provision for elderly people can be improved by making provision for advocacy. Sometimes even close members of the elderly person's family cannot get near to the right solution to particular problems. The very independence of the advocate can be helpful in reaching a solution.

We recognise the dedication of nursing staff, but we must accept that, despite their dedication, they are not always the right persons exclusively to take decisions on behalf of their elderly residents or clients. We dealt with that point in Committee. The independence of the type of advocate that we suggest in amendment No. 2 is extremely important. We accept that philosophy.

I finish by dealing a little more specifically with the definition of the advocate's role. If my hon. Friend the Member for Dulwich will forgive me for quoting her again, she did a service to the Bill and the debate about advocacy and representation when she gave the definition of advocacy drawn up by John O'Brien, one of the American pioneers of citizen advocacy. He described it as

"the process whereby one individual represents the interests of another as if they were his or her own."

That is the process which the amendment seeks to make available. The amendment is clear. It is consistent with the commitment to care in the community of my hon. Friends and the voluntary organisations the views of which we embraced in the amendment. As the amendment is both realistic and attainable, I hope that the Minister and the House will respond positively.

Mr. Hinchliffe : It is a great privilege to follow my hon. Friend the Member for Monklands, West (Mr. Clarke), who feels passionately about the issue and has spent much of his time in the House arguing the case for advocacy. I commend his continuing efforts to persuade the Government to take seriously the issue with which he dealt in his speech to amendment No. 2.

I also welcome you to the Chair, Mr. Deputy Speaker. It is the first opportunity that I have had to speak in a debate when you have been in the Chair. Those of us from the west riding of Yorkshire are proud to see you in the Chair. We all wish you well. It is a great privilege to have a Deputy Speaker who understands the important things in life like rugby league football and, of course, community care. I hope that you will see fit to call me on many future occasions.

Amendment No. 2 attempts to include in the legislation the Government's own policy. I simply refer to two documents published by the Government on the requirement to review cases where people are placed in some form of care setting. First, the Minister will be familiar with the document "Home Life". It is the

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guidance issued by the Government on the implementation of the Registered Homes Act 1984. In paragraph 2.1.5, entitled "Review of Placement" it states :

"After the trial period the proprietor should discuss fully with the prospective resident and key supporter (relative, friend, social worker) the suitability of the placement and the prospective resident's feelings about it. The possibility of transfer if the placement is unsuitable and eventual discharge, should also be raised if appropriate. Review decisions should be recorded and implemented."

Paragraph 2.1.6, entitled "General Reviews", states :

"On admission a programme of general reviews should be established and the purpose and process of the reviews explained. These reviews will include general health and social needs, and should always be regarded as an opportunity to extend methods of rehabilitation and prepare residents for leaving when this is appropriate. The resident and key supporter should normally be amongst those involved in such reviews."

That is the Government's guidance. That is what they say should happen in our care homes.

The Government went on to commission a report which came out in 1988. The Wagner report was endorsed by the Government. Chapter 3, entitled "Enlarging and Safeguarding Choice", states :

"We wish to ensure that people who begin to need assistance in order to care for themselves are able to exercise a positive choice over the combination of accommodation and personal services which they require."

Paragraph (v) says :

"The chosen service should be reviewed at appropriate intervals." On page 31, the same report states :

"As and when needs change, either users or carers should be able to call a review. We are particularly concerned with those residents who are unable to exercise effective choice or give effective consent." That point was made by my hon. Friend the Member for Monklands, West.

The report continues :

"where a general practitioner judges this to be the case, we recommend that it be a statutory requirement that a review be held at least every six months."

In practice, reviews are virtually non-existent in care homes. Those reports, which supposedly form the backbone of the present Government's procedures for the management of care--whether in the public or in the private sector--are absolutely meaningless. Although they sound nice and have been endorsed by the Minister, his colleagues and his predecessors, in practice they mean nothing. 6 pm

The reason why the Government are reluctant to give detailed consideration to the introduction of a formal review system is not purely and simply because of their laissez-faire, laid-back and "let market forces run the system" attitude. If they introduced a review system, it would prove that a vast number of placements, especially those in the private sector, are utterly inappropriate, as many Opposition Members have feared. People who do not need to be in private care and nursing homes are placed in them and it is totally wrong. If the Minister were honest, he would admit that he knows that to be the truth. Any hon. Member who has looked into care homes in their constituency, or has talked to people in the private care sector or in social services departments, will accept that that is true in many areas.

The main purpose of reviews is to check on the appropriateness of a placement. I recall a discussion with a gentleman for whom I have a good deal of respect--

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Tony Pitacio--who was the chairman of the British Federation of Care Home Proprietors. Prior to that organisation having some internal difficulties, which I shall not go into, I attended a conference which I believe he chaired. The hon. Member for Shipley (Sir M. Fox) also spoke at the conference, which was held in Yorkshire. We gave different perspectives on our attitudes to private care and the care of the elderly. Mr. Pitacio told me that about one quarter of the people in his care home should not have been there. A substantial number of them would have been supported by finance from the Department of Social Security.

Evidence to the Select Committee on Health, when it considered the wider issues relating to the operation of local authority social services was clear. The evidence was also clear when the Health Select Committee joined the Select Committee on Social Security to consider the financing of private care homes. For example, we heard clear evidence from the Association of Directors of Social Services. My hon. Friend the Member for Monklands, West was present in March 1991, when directors and deputy directirs from various London boroughs, controlled by different political parties, gave evidence. The consensus among them was recorded in the minutes of that meeting. They said that 50 per cent. of people in private care homes in London could and should have been living independently or semi-independently in the community.

Mrs. Angela Browning (Tiverton) : If I have understood the hon. Gentleman correctly, he is saying that many residents in care homes are capable of independently living or living with some protection in the community. In Devon, his party has had the most to say when the social services department has rightly analysed the needs of people in care homes and has proposed the closure of residential homes. At the last Labour party conference, great political capital was made of the proposals by Devon county council social services to close some homes. Yet now, as I understand it, the hon. Gentleman is saying that many authorities should be doing what Devon county council social services have been doing--providing more day care places and more care in the community for residents in care homes, having analysed their needs. Have I understood the hon. Gentleman correctly?

Mr. Hinchliffe : I have spoken in virtually every community care debate in this place since 1987. As I said on Second Reading and in Committee, the main error of the Government's ways is that they have allowed an open-ended investment of income support in institutional care. Therefore, in many localities, including my own and possibly in the hon. Lady's constituency, although I do not know Devon well, many people end up in care because resources have not been invested in alternatives to institutional care.

My authority in Wakefield had major problems with the standard spending assessment because it could not spend the money that it needed to provide statutory facilities and services for people outside care, because the Government prevented it from doing so by threatening it with rate capping ; yet a huge amount of money has been invested in the private care sector.

I know of many people who have gone into care when they did not need to do so. Their relatives have told me that they could not get the services to maintain them

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independently in the community because the local authority and the health authority did not have the resources to provide them. Once people enter the private care sector, the money flows in --£288 per week. If that money were available to purchase facilities in the community, those people could have remained independent.

If the change takes place in April next year, assessment will be meaningless unless we positively invest in developing alternatives to care of the sort that the hon. Member for Tiverton (Mrs. Browning) described. In some respects, I go along with the trend in Devon, but I suspect that my political colleagues there were telling the hon. Lady and her party that the alternatives to care were not sufficient for the authority to take the action that it was proposing. I undertand her argument, and she may expand it if she wishes to contribute to the debate.

Reviews allow us to check on the appropriateness of placements in whatever sector--whether in what the Government call the independent sector and what I would call the private sector, or in the local authority sector.

It is only right that each person's case should be looked into. Whatever type of home they are in, we should be aware of whether they are being placed appropriately. A review would also afford the opportunity to make an informal, objective check on the well-being of residents. At least every six months, there is a statutory check on whether a child is being properly looked after in the environment in which it has been placed, whether at home on trial, in a foster home, a children's home or a community home. That should also happen with elderly people.

My hon. Friend the Member for Monklands, West said that a person's medical position may change. I know of people who have entered care homes in an appalling state, but have made a marked improvement within a couple of weeks or months because they have been properly fed and looked after. They have changed fundamentally, put on weight, regained strength and sometimes been capable of returning to independent or semi-independent living in the community.

People's social circumstances may also change. Relatives, friends or carers who could not look after or support a person at the time of admission to a home, may now be able to offer additional support. My hon. Friend also said that a review would offer a formal opportunity for residents to voice their opinions about what should happen to them. The Minister will recall that we discussed that in Committee, when I said that, for many elderly people, the idea of freedom of choice is nonsense. They are placed by hospitals or relatives in homes and often they do not want to go. I know of many people who have been placed away from their home area. They have had no choice. A review would allow them to have some say in what is happening in their lives and in what is often intimate care, in the establishment in which they have been placed.

A review would also offer an opportunity to consider

rehabilitation--an opportunity which is not allowed under the present system. I also said in Committee that there is an assumption that once an elderly person is in care, that is the end of it. That is nonsense. We should work towards rehabilitation for each elderly person, if it is at all possible and if they desire it.

The assumption is that, once an old person is admitted to care, it will be downhill and decline until the end comes.

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That is wrong. We should offer people a positive choice, should they leave care, between perhaps some sheltered accommodation and return to some form of semi-independent living. Such choice is not on the agenda now, and that is why we need a formal review system. It is worth repeating what was said in Committee about the central weakness of the Government's funding system for private nursing and residential care homes. That system rewards those private home owners who increase a resident's dependency. If one owns a jointly registered care home, one can make more money if one gets more of one's patients to transfer from just residential care to nursing care.

What incentive is there for that owner to get someone back into the community? The private care sector is under pressure at the moment and there are vacancies in many homes, so what incentive is there for the private care home owner to rehabilitate a patient? If he does so, he will lose profits by virtue of the fact that he has one fewer resident. The Government's system of funding works against the idea of rehabilitating the elderly, disabled and handicapped people or persons with learning difficulties or mental illness. Rehabilitation means lost income--such is the inherent nonsense of the private care market.

The Minister believes that our objections to the private care market rest solely on ideology, but I have sound practical concerns that make me argue that that market is the wrong one for the care of the elderly and other similarly vulnerable people. For that reason, the review system is urgently needed.

In the past few months, I have also spoken to two Ministers at the Department of Social Security about the need for a review system to check the appropriate or inappropriate use of public funding through the payment of income support to care home owners. A worrying case that has arisen in the constituency of the hon. Member for Batley and Spen (Mrs. Peacock) illustrates my concern. I shall pass on the details of that case to the Under-Secretary if the hon. Lady is happy about that, but I believe that it is the prime responsibility of the Department of Social Security.

That case involves a woman who was moved from the care section to the nursing section of a jointly registered home without any need and without her consent. That lady is not even receiving any nursing care, but that transfer means that the home is getting more money a week because of the cost differential between the two types of care. Those who own that home may receive more income, but such nursing care is inappropriate for that woman. A review system would introduce a formal check on the appropriate use of public funding in such circumstances. It would also act as a check on the standard of care in any particular establishment.

The amendment tabled by my hon. Friend the Member for Monklands, West reflects our practical concerns about the way in which the community care legislation is operating and will operate after 1 April 1993. Let us be honest about this : we are talking about the lives of individuals. The National Health Service and Community Care Act 1990 is about individual human beings--our constituents. The case of one of my constituents--I have his family's permission to raise it--illustrates precisely the need for the

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amendment. I hope the Minister will take careful note of the circumstances of the gentleman's case, which is worrying, but not that unusual. His name is Mr. James Edward Bull, and he is 39. His two sisters, Mrs. Mary Banham and Mrs. Susan Turton, saw me on Monday to express their concern about their brother's circumstances and the way in which his case has been handled under the current community care system.

Jimmy comes from Wakefield. In July 1986, this young man--39 is still young --lost his feet and fractured his skull when he was run over by a train. Unfortunately, he took a short cut across a railway line and was knocked down and seriously injured. In fact, his life was threatened as a result of the injuries he received. Sadly, while he was in hospital, he became ill with meningitis, and he is now severely brain-damaged, he has no sight, no hearing and little speech and he must take food intravenously. In a letter from his sisters, which I received yesterday, they describe him as a cabbage. That man was transferred from Pinderfields hospital in Wakefield in September 1991 to a private nursing home in Dewsbury. The hospital could not offer continuing care, and it was felt that he should be cared for permanently in a nursing home. That nursing home cared for him for a fortnight and subsequently returned him to Pinderfields. His family were very concerned at the marked deterioration in his general condition and weight in those two weeks.

6.15 pm

The family maintain that Pinderfields hospital exerted great pressure to discharge Jimmy. They maintain that the hospital felt that he did not require hospital care. In the letter that I received, one sister notes :

"I was given a book of private nursing homes and told to get on with it myself, even mentioning the Yellow Pages."

Unfortunately, that is the reality behind the care plans of the NHS. I am not singling out my authority for criticism, such practice is common across the country. All our constituencies are facing similar problems.

Eventually, after various developments in Jimmy's case, he was placed at Stallingborough nursing home at Grimsby, 80 miles from his home town of Wakefield. He has been at that nursing home since last October. I had a meeting with his elderly mother, Mrs. Brett, about the problems caused to her because of his distance from Wakefield. She loved and cared for him very much, but a round trip of 160 miles meant that it was virtually impossible for that elderly lady to see her son regularly.

I saw Mrs. Brett about that problem only recently, but I am sorry to report that she died a couple of weeks ago in hospital. I will not go into the circumstances of her death, but I am pursuing that matter with the health authority. Jimmy's sisters maintain that the fact that he was so far from home broke their mother's heart. I can accept that, given what I know about the case.

I want to make it clear that the sisters are not in any way attacking the private care home. They have spoken highly of the care provided, and say in their letter :

"He is loved and cared for as a person".

However, they add :

"but there is no follow up regarding his quality of life." Jimmy's case vividly illustrates the problems faced by many in care who have no voice and who cannot stand up for themselves. In their letter, his sisters list the problems caused by that lack of follow-up :

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