House of Commons Hansard Debates for 1 Jul 1992

Column 889

"His eyes--we have got a TV for him--but can he see it and how much can he see?

Hearing--we know there is a problem with his hearing due to the fracture of his skull at the time of the train accident. But there has been no follow up on whether improvements can be made on his present hearing aid.

Teeth--only roots left which cause recurring infections--needs specialised dental treatment.

Speech--can say a couple of words--therapy may assist.

Muscle therapy--after all this time just laid like a vegetable his muscles must have wasted away--can't they be improved?"

I stress that the sisters are not knocking the home where their brother lives. However, in common with their late mother, they want him to be nearer to his home town. Unfortunately, that is not a practical possibility at the moment, but we are making every effort to do that.

Those sisters want an independent, objective and comprehensive review of their brother's case, which will cover all the various points about which they are concerned. That is precisely why we have tabled the amendment calling for such a review procedure. The current legislation does not impose on the Wakefield health authority or the Wakefield social services department any requirement to carry out a formal review of the case. Nor is there any requirement in the case of the Grimsby health authority or the Grimsby social services department to monitor this man's circumstances objectively. Yet, as his sisters say, that is urgently needed. We desperately need a system of the type to which the amendment refers. Jimmy Bull does not have a great deal to be thankful for, as must be fairly obvious from my description of his circumstances. However, he does have a family who love him, care for him, stand up for his rights, and are concerned about the fact that nobody is formally assessing his circumstances in the home--medically, socially or in any other way.

Many people in care are without mobility, hearing, sight or speech, and have no one like this man's two sisters to go to a Member of Parliament or kick up a fuss in the press. I hope that the Minister will take account of the circumstances of people like Jimmy Bull and do something about them. As someone who has worked with children, I can say that people like Jimmy have less of a voice than children do. There is a formal review system that gives children some voice and provides some check on the appropriateness of placement.

This amendment is vital if the well-being of people such as Jimmy Bull is to be secured. I therefore hope that we shall have a positive response from the Minister, even if that means his introducing, at a very early stage, legislation to provide the requirement that is envisaged in the amendment.

Mr. Gunnell : Following the very moving account of the case of the constituent of my hon. Friend the Member for Wakefield (Mr. Hinchliffe), which illustrates the points that we want to make, it is difficult to return to statistics. It is difficult to take a wider look at the issue and to make the case that the amendment would be extremely helpful to the Government in terms of financing the whole package of community care.

It is clear that there are many more people in residential care than there need be. The Firth committee, which was set up under the aegis of the Department of Health and Social Security, concluded that the increase in residential provision in the first half of the 1980s was not accounted for by the rise in the elderly population. That increase was

Column 890

twice what was suggested demographically. Similarly, William Laing, a research specialist in private health care, concluded in his review of private health care, which was published in 1990 -91, that there were 29 per cent. more elderly people in long-term residential care than might have been expected. There are in long-term residential care people for whom it is not the proper type of placement. A system of review and of advocacy, with a view to their possible removal from such care, is crucial to such people.

In this connection, I want to pay tribute to a group that operates in my constituency. I refer to the Belle Isle Winter Aid Group, which is in contact with about 500 elderly people in one of the major estates that I represent. In the last year or two, the group has been part funded by the Leeds social services department and the Leeds health authority. The reason for that is that it has contact with many elderly people in the area.

The social services department and the health authority were both very interested in the group's work. They wanted to ascertain how many of those 500 people wished to go into long-term residential care. I emphasise that this is a voluntary group and that, by and large, the people who did the visiting were volunteers. Their conclusion was that nobody they visited wanted to go into long-term residential care. Some people recognised that they might have to do so in the future, but they all emphasised that if services that would enable them to stay in their own homes were available, that is what they would want to do. This voluntary group does its best to see that services are in place for such people.

The case for advocacy and review in respect of those in residential care is very important indeed. As a social services chairman, I have seen to it that my authority has funded some advocacy work. Independent advocates have dealt with some clients of the social services department. It is also possible to have professional advocates, and I know that the city council has one or two such people who have taken up complaints, some of them against departments of the city council.

I want to draw the Minister's attention to a report called "Elderly People- -Care, Participation and Satisfaction", which was based on interviews with more than 200 people, all of them over 75, some in community care, and some in residential homes. The carers, too, were interviewed. We have stressed how important it is that people should be able to make an informed choice. The report, which is reviewed in "Social Work Today" of 30 April, says :

"Only 6 per cent. of elderly people in residential care had been given alternatives, such as sheltered housing. Only half talked to anybody about moving to a home. For some the decision had been made so rapidly that they did not even know they were a permanent resident until after the move."

It is then recorded that when people were first seen they wanted services to take pressure off them. A quarter of those looking for help recorded gardening--their gardens were in a terrible state--as their highest priority, yet they ended up in residential care. In those circumstances, one must ask about the process.

This report is somewhat critical of the practice adopted by some social services departments, but it takes the view that social workers have been, and are, under enormous pressure because of lack of resources. For that reason, discussions with people often do not take place at the appropriate level. Leaflets tend to be left. One organiser of domiciliary care said, "We should give advice, but we

Column 891

don't. We are so busy that I just give a telephone number or a leaflet and don't get personally involved." Everybody knows that elderly people do not read those leaflets. They do not necessarily understand the choices that are available. It is evident from that report that people do not know how to complain if they are dissatisfied with what is happening to them. One woman who was interviewed was under the impression that she should write to the Foreign Secretary and one third of local authority home residents did not know where to start to make a complaint.

This report reveals the importance of having a case review for elderly people. It shows that many people have had very little say. In response to an earlier debate, the Minister emphasised the importance of choice. By way of the Bill, we are correcting omissions with a view to ensuring that people have a range of choices. At one level, we can ensure that there is choice, but we cannot ensure that it is made available to people going into residential care. The amendment would create that possibility. It seeks to provide for a review of people's cases and to ensure that someone is available to speak on their behalf.

The issue of advocacy is important. The Minister said that a great deal of money is being spent on residential care. If that money were spent on community services, it would help far more people. We should look seriously at the many people who are clearly misplaced in residential care, with no opportunity for a review and no knowledge about how to change their situation.

6.30 pm

Mr. Jeff Rooker (Birmingham, Perry Barr) : I should have thought that of all the amendments that the Opposition have proposed, No. 2, which makes fairly modest demands, would be by far the easiest for the Minister to accept. It does not cost much and requires no money from public funds. It is not exactly the same as implementing the legislation proposed by my hon. Friend the Member for Monklands, West (Mr. Clarke). I was reminded of that legislation earlier today when a Conservative Member intervened in my hon. Friend's speech and asked about advocacy and what he was doing about it. I expected my hon. Friend to refer to the proceedings on his legislation that has gone through the House.

Most of my hon. Friends have given examples of people in residential and nursing care who may not need to be there. I do not share the certainty of some of my hon. Friends, but it is clear that some people end up in care away from their own homes, for no other reason than that they lost the opportunity to have aids and adaptations in their homes. The lack of opportunity for changes in their homes forced them out of their homes and into care.

Mr. Tom Clarke : My hon. Friend referred earlier to some Conservative Members who are no longer present, but who intervened in my speech. I was far too modest to mention the Act that I introduced, but my hon. Friend will be pleased to know that, because the anniversary of its Royal Assent is 8 July, those two Conservative Members, in common with every other Member of the House, will receive strong representations from the Royal Association for Disability and Rehabilitation--RADAR--and many

Column 892

other voluntary organisations. Therefore, if those hon. Members do not know about the Act now, they will know about it then.

Mr. Rooker : I realise that my hon. Friend is much too modest to have mentioned the Act and that is why I mentioned it for him. Those absent Conservative Members should know that they challenged the one hon. Member who has done something about community care problems by putting an Act on the statute book.

The hon. Member for Tiverton (Mrs. Browning) mentioned Devon in an intervention. I visited Devon earlier this year--not the wider part of Devon which the hon. Lady represents, but your beautiful city, Madam Deputy Speaker. I visited two residential homes, both under threat of closure. One, Tory Brook, was purpose-built about 16 or 17 years ago. I do not think that it is in your constituency, Madam Deputy Speaker, although I saw your letter pinned on the notice board, supporting the demand of residents that the home be kept open. Let there be no misunderstanding about the reason given at the time for the home's closure. By and large, we were talking about all local authority homes.

The hon. Member for Tiverton intervened on my hon. Friend the Member for Monklands, West when he was specifically referring to the private sector. He was not talking about the local authority public sector.

Mrs. Browning : Will the hon. Gentleman give way?

Mr. Rooker : I invite the hon. Member for Tiverton to get up from her seat and make a speech to tell the House about social policy and community care policy in Devon. We should like nothing more than for her to make a speech rather than an intervention. We have not yet heard a speech from any Conservative Member on Report or in Committee about community care policies in their parts of the country. We want to share experiences with them. In the past few minutes, the Chamber has heard about the real-life experiences of ordinary people in the example given by my hon. Friend the Member for Wakefield (Mr. Hinchliffe). That is what community care policy is about. We must put legislation on the statute book to meet the needs of ordinary people, their life experiences and those of their carers.

The two homes that I visited in Plymouth were wonderful. I had lunch with and spoke to many of the residents who were in their 70s and 90s. They invited me to visit their rooms, explained their backgrounds and gave me letters to bring back to the Prime Minister, which I sent to him. They told me that people get a false impression when they visit such homes and see that the residents are well cared for and happy, with companionship. Visitors go away saying that the residents so look fit and healthy, can talk and are not stupid, that they should be living in the community.

However, the residents say that the quality of care that they receive in the home enables them to have a quality of life which they do not feel that they could get outside. That does not mean that some of those people could not be in sheltered housing if they had a choice. They may lose the companionship, and loneliness is a great scourge of the late 20th century. We underestimate it at our peril when forcing people to stay in their homes.

I came away from the two homes in Plymouth with mixed feelings. First, many of those people had not been consulted, which is the subject of the amendment. The

Column 893

proof of that is that one of the residents-- I think that her name was Annie--had got a judge to agree to a judicial review of the local authority's decision. That is positive proof that there has been no review of the residents' circumstances.

Mrs. Browning : Will the hon. Gentleman give way?

Mr. Rooker : I shall give way to the hon. Lady if she will undertake to make a speech at some time tonight.

Mrs. Browning : When I intervened on the hon. Member for Wakefield (Mr. Hinchliffe), he was saying--if I understood him correctly, and I asked him whether I had--that as circumstances, local area needs and the needs of the individual residents change, we should be much more open minded about considering the needs of residents who could go back into the community, having been in residential care. By the same definition, particularly with regard to local authority homes, if a review of immediate and future local needs is taking place, as happened in Devon--although I have not had the experience of visiting the two Plymouth homes, I know the situation in my constituency where local needs were deemed to be that more day care back up services, day care services for the elderly, and respite care for carers--

Madam Deputy Speaker (Dame Janet Fookes) : Order. I am sorry to interrupt the hon. Lady, but her intervention is now becoming too long.

Mrs. Browning : I apologise, Madam Deputy Speaker. Based on that--

Madam Deputy Speaker : Order. That means sit down, in polite language.

Mr. Rooker : I simply invite the hon. Lady to make a speech when I sit down and before the Minister winds up the debate. We are under no pressure and do not intend to filibuster. We just seek to make a point about community care policy and share our experiences in different parts of the country to send a signal to the Department so that matters can be put right from April. We are all concerned to ensure that the policy is right. We do not want a uniform policy across the country--it would be stupid for anyone to advocate that. However, we visit each other's constituencies and sometimes we have to share our experiences.

Mr. Hinchliffe : Does my hon. Friend agree that we should congratulate the hon. Member for Tiverton (Mrs. Browning) on her intervention, which was longer than the totality of contributions made by Tory Back Benchers in Committee and, so far, on Report? The point being made by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker), which we need to clarify, is that there are differences between the level of need catered for by local authority part III accommodation and by private care homes. I take a different view from the hon. Lady on the closing of part III accommodation. With the advent and growth of private sector accommodation, part III accommodation has to cope with people who are more dependent and are frequently rejected by private sector homes, whose officials say that they cannot cope with such residents. There is a big difference between private care homes and local authority accommodation described by the hon. Lady.

Column 894

Mr. Rooker : I agree with my hon. Friend. I came away from Plymouth believing that the decision had been taken on ideological grounds, and was not based on the residents' needs. I came to that conclusion because of what I heard in the two homes from the staff, carers and residents. It was that fact that we objected to ; no one objects to change based on needs.

I should have thought that the Government would accept the amendment. The examples given today are not random, but it is clear that it is much more complicated for a social worker to assemble a community care package for someone in the community, either in their own home or in some form of sheltered housing, than it is merely to place them in residential care, which is the easy option. It saves on the leg work, the telephoning, the case conferences and avoids a great deal of organisation if one can say, "You need to go into this nice little home where you will be well looked after," and that is the end of the problem. We are seeking to stop that.

One way to place a check and balance on such a policy is to have regular reviews involving the residents, their advocates, friends, advisers and care managers. Like the hon. Member for Rochdale (Ms. Lynne), I distinguish between care managers and care providers. It is crucial that those undertaking the reviews do so with open minds and place the users' needs first.

Earlier, one of my hon. Friends quoted the views of the British Medical Association. While the BMA wants the assessments to be separate from the service provision and general practitioners to be involved in the assessment process--which is essential for the patients--it believes that the patients' GPs should not be involved, but someone more removed so that an independent overview is given. There are many examples throughout the country of people who have entered residential care when they need not have done. How can we, as legislators, draft legislation to help them in future? One way to do so would be to introduce a systematic review. I think that the period of six months, which was mentioned in the debate, is too long. I think that the review needs to be carried out more frequently--perhaps every three months. I would not be too rigid about that, but there must be a review ; people must know about it and must be able to share their experiences. Carers, care managers and individual users must know that whatever is wrong or whatever progress is being made can be reported to the review. The residents may well become more independent.

6.45 pm

Private sector home owners have told me that the demographic changes in the country--the increase in the number of elderly people that has occurred this decade--mean that they will have no difficulty in filling residential places, despite the various adaptations and community care plans. Therefore, home owners are not reluctant to encourage residents to become independent or semi-independent. They know that allegations have been made- -sometimes with

justification--that they want their beds filled.

The financial policy suggests that home owners may have an incentive to keep residents in their homes--they may have, but they need not be the same residents. One test of whether private sector home owners are interested in quality care is whether they have regular, systematic reviews of their residents. If they are not having them now,

Column 895

one task for Opposition Members next April will be to ensure that local authorities require such reviews to take place. If that policy is carried out, there is a good chance that some residents will regain independence or semi-independence.

Ms. Jowell : Given that the average age of elderly people admitted to residential care has increased in the past decade--those of us who have visited homes know that the average age is now about 85--and if the assessment has been properly carried out, it is unlikely that residents will leave residential care. The review process should identify ways in which the regime of the home should bend and adapt to accommodate residents' changing needs.

Mr. Rooker : I agree entirely with my hon. Friend. The thrust of the speeches of some of my hon. Friends has been that people are misplaced. I gave an example in Committee of homes in my constituency that had closed or changed, making it necessary to reassess residents. Assessments had not been regular events in the past. In one case, papers were studied and assessments carried out, and it was found that a resident was admitted to part III accommodation 10 years ago, who should not have been. That resident is now happily re-established in the community, but that was an exceptional case. As my hon. Friend the Member for Dulwich (Ms. Jowell) said, of necessity, regular reviews involving friends and advocates, users and care managers, will be directed more towards improving the quality of care and the life style in the home than moving people around. Many people who are admitted to residential care today are at an age where they do not want to be moved around. They are looking for peace, tranquillity, companionship and care. They may have left behind the chores of looking after a property. They may have been carers who, worn out by caring for a loved one who has died, now need to be cared for themselves. They are not looking to return to the community or to move around, but they do not deserve to be forgotten. That can be achieved only by a regular review.

I cannot for the life of me understand why the amendment cannot be accepted. It will cost nothing--it contains no requirements for further public sector manpower and calls for no resources over and above those that will be needed if the community care policy operates as Ministers have said it will from next April. The Minister assured us that there would be no change in that policy.

Accepting the amendment would send the signal to the public, voluntary and independent sectors that the House of Commons is serious about community care and that we seriously intend to ensure that these policies, which are by and large bipartisan, operate successfuly from next April in the interests of our constituents. We must advocate a better system that will ensure improved quality. We all know of enough examples to prove that, without giving this idea a statutory basis in the Bill, it will not come about. That is the reason for the amendment.

Mr. Yeo : The amendment was moved by the hon. Member for Monklands, West (Mr. Clarke), who made another powerful speech in favour of advocacy. He is an expert on that subject, so his views will always be heard with respect. I shall return to the question of advocacy shortly.

The hon. Member for Wakefield (Mr. Hinchliffe), supporting the hon. Member for Monklands, West,

Column 896

concentrated on the need for regular reviews of people's situations. Of course people should be able to have their circumstances reviewed and to take part in reviews themselves. As time moves on, so their needs will change. Some people may find that their health has deteriorated, so they have become more dependent ; others move in the opposite direction--their health improves so the nursing that they needed at one stage becomes unnecessary. It is also true that a person whose social needs were met by a particular type of establishment--a large home, say--might change his preferences and attitude and require a smaller, quieter, more family-like setting. All sorts of changes can take place, which is why our community care policies are based on the principle that just as the needs of any two individuals may differ, so the needs of one individual can change from time to time. Each individual situation requires an individual solution.

The policy puts the emphasis of care where it should be : on meeting the needs of the users of the services and, in certain circumstances, on meeting the needs of their carers, too. The White Paper is based on the idea of giving local authorities the freedom and flexibility that they need to develop individual solutions which will provide services and support, especially for frail, elderly, vulnerable or disabled people--always with the aim of enabling them to lead as full and independent a life as possible.

The hon. Member for Wakefield underestimated the effectiveness of the code of practice "Home Life", which, as I said in Committee, we are about to update in any case. I believe that there are many advantages in a code of practice which is more flexible than law and which can therefore reflect more quickly the latest attitudes and methods of providing services.

The assessment process and the third stage of our community care policies which come into force next year will eliminate the kind of problem to which the hon. Member for Wakefield referred. He deplored unsuitable placements-- an issue about which the hon. Member for Morley and Leeds, South (Mr. Gunnell) was also worried. The solution to the problem of inappropriate placements is therefore at hand. My hon. Friend the Member for Tiverton (Mrs. Browning) made an important intervention, which I welcomed, although I was not sure how much it was welcomed by Labour Members. They seemed inclined to tease her a little about it, but what she said about the delivery of domiciliary services in Devon was significant. The Government expect one of the consequences of the third stage of our community care policies to be an acceleration in the delivery and provision of services. We also expect the independent sector to play an increasing role in their delivery.

I must take issue with the argument of the hon. Member for Wakefield that the existence of the independent sector actually works against the process of rehabilitation. I share his concern to encourage rehabilitation--

Mr. Hinchliffe : The Minister distorts my point. I said that the financial arrangements for the private sector reward increased dependence-- the Minister must accept that. If someone with a jointly registered home moves a person from residential care to nursing home care, thereby receiving more money, that is a financial incentive to making the person in question dependent. The Minister knows that I can give him examples of that.

Column 897

Mr. Yeo : I do not accept that, for two reasons. The first reason is that the cost of providing nursing home care will be greater, so even if the fee charged is higher, the margin earned on the delivery of the service may be no greater. More importantly, there is a threshold which someone who moves from residential care into a nursing home must cross ; the health authority will act as a policeman of that threshold and no one will be able to move from residential care into a private nursing home, even within the same establishment, without the approval of the local health authority. As it will be the local authority contracting with the providers, the authority will buy a certain number of places. Someone whose condition has improved and who benefits from rehabilitation may leave an independent sector establishment and his place may be taken-- the local authority may have contracted to take the place--by someone newly discharged from hospital who needs the services more. It could therefore be argued that the independent sector favours rehabilitation more than the statutory sector does, as in the latter the local authority may feel that for its own financial needs it must keep its establishments full, and it may be reluctant to move people out even though their condition justifies that.

Mr. Gunnell : As the Minister knows, I was a member of a health authority for two years before coming to this place, as well as chairing a social services committee. I was worried because people discharged from hospitals almost always went into private residential care ; very few went into local authority residential care. It is not true that local authorities seek to maximise the numbers in residential care. As I explained fully in Committee, my local authority outdid that of the hon. Member for Tiverton in respect of the number of residential homes that it closed, because we did not need the places. We did not try to keep places going for the sake of it. Nevertheless, I was worried about the disparity, so I looked into the health authority's procedures--

Madam Deputy Speaker : Order. I am sorry, but this intervention is getting rather long--although on this occasion the Opposition Whip does not seem to have made any comment.

Mr. Gunnell : I shall bring it to a conclusion, then.

Madam Deputy Speaker : Rapidly.

Mr. Gunnell : Certainly, Madam Deputy Speaker. The health authority said that when it wanted to place people, it had to place them rapidly ; it could not wait for the local authority's assessment procedures because it wanted a rapid move from hospital to residential care.

Mr. Yeo : I have tried to give way generously but it is not an incentive to generosity when interventions are prolonged. In any event, the hon. Gentleman has had a good opportunity to make his point.

The hon. Member for Monklands, West referred to the recent BMA report and spoke of health authorities and local authorities each trying to pass on to the other responsibility for meeting the needs of certain people. Health and local authorities co-operate properly in many parts of the country--I have visited a number of them in the past three months.

Column 898

At member level, management level and at the sharp end there is good co-operation. The Government would take a serious view of authorities that could not reach local agreement about the responsibility for meeting a person's needs. That is a serious matter and local authorities must not try to shift responsibility. The hon. Member for Monklands, West used that as an argument in favour of the provision of advocates.

7 pm

The hon. Member for Wakefield, in support of the need for advocacy, described the tragic case of a constituent. The family to which he referred has the sympathy of all hon. Members. In that context, the implementation of the third stage of our community care policy next year is important. If those policies are properly implemented and agencies co-operate in the right way, such tragic cases as that mentioned by the hon. Gentleman can be minimised.

Mr. Hinchliffe : What difference will the policy to be implemented in April make to Jimmy Bull's case ? No one in a placement of that kind will find any difference. Jimmy Bull is more dependent than many children in care, but he does not have the same legal rights to independent objective monitoring of his circumstances in care.

Mr. Yeo : That case will not be affected by the changes in April because they will apply only to people who are coming forward for the first time. The change is incremental and will not affect people whose situation has already been determined.

It is difficult to define who should be the advocate in a particular case, and there is some difficulty about deciding accountability. The hon. Member for Monklands, West acknowledged that conflicts of interest can arise even within a family. As the hon. Member for Birmingham, Perry Barr (Mr. Rooker) said, sometimes residential care is an easy option not just for the authority but for the relations as well. The hon. Member for Perry Barr spoke seductively at the start of his speech when he said that the amendment contained few cost implications. The Government's approach, not just to the amendment but to the whole matter, is driven by the needs of individuals and community care policies. It is not driven exclusively by financial considerations, although of course they cannot be entirely ignored.

As the House is aware, one of the key objectives of our policy is to ensure that service delivery is based on an assessment of need and that clients are involved in that assessment and in the choices made about care provision. The basic aim is an individually tailored care package, not an off-the-peg version that may not fit a person's needs and circumstances or the needs of his carer. I agree with the hon. Member for Perry Barr that that will involve regular reviews, although, because of the diversity of individual need, I do not think that it is possible to prescribe a time scale.

The review of care needs is an integral part of the assessment process. It is right that responsibility for that should rest with local authorities because it lies better with them than with the operators of a residential or nursing home. Many people who will need regular reviews of their care needs are not in residential or nursing homes at all. Our policy guidance "Community Care in the Next Decade and Beyond" states :

"Care needs for which services are being provided should be reviewed at regular intervals The purpose of the review

Column 899

is to establish whether the objectives set in the original care plan are being, or have been, met and to increase, revise or withdraw services accordingly The other purposes of reviews are to monitor the quality of services provided and, in particular, to note the views of service users and carers and any changes in their wishes or preferences'.

The Registered Homes Act 1984 also states that residents' wishes should be taken into account where possible and "Home Life" recommends that residents should, where possible, have access to external advice, representation or advocacy.

We recognise the importance of advocacy schemes but, as I said in Committee, we would prefer to see them develop flexibly according to local circumstances rather than under a uniform scheme imposed from the centre. The hon. Member for Morley and Leeds, South confirmed that local schemes exist and flourish. It is undesirable to enshrine every detail in legislation in order to achieve the desired results. We want good practice to develop in line with local circumstances, and we have asked authorities to develop local advocacy schemes or to use those that are already available locally for clients who need that kind of help. We have ensured that material on the subject is included in our guidance on complaints procedures and in care management and assessment guidance. A regular review of care needs and the care plan are fundamental elements of the assessment and care management process. That underpins the whole of our new community care arrangements.

Mr. Rooker : We have heard about a northern local authority suggesting to someone with a problem that he should look in Yellow Pages. I could give the name of a London authority which gave exactly the same information. I accept the thrust of the Minister's argument. Will he make it clear that the signal going from the House must be that no local authority should tell advocates, carers or anybody else to look in Yellow Pages?

Mr. Yeo : I agree that such a clear message must be sent. We are engaged in monitoring the preparations being made by local and health authorities for the implementation of the policy in April. We are satisfied that the bulk of the 108 social services authorities will have the right mechanisms in place, if they work hard, but some give rise to concern. We have a list of authorities--I shall not describe it as a hit list--to which Ministers will pay close attention. The authorities on the list are not confined to any specific part of the country or type of authority. Given the emphasis that we all place on meeting individual needs, it is quite unacceptable for anyone to be told to look in Yellow Pages. For all those reasons, I invite the House to reject the amendment.

Mr. Tom Clarke : This has been an interesting debate and the Minister's speech seems to show that he knows what advocacy is about. He did not go much further than that, but in one sense his recognition is progress. We are debating advocacy and the role of the elderly in a changing and traumatic situation.

The Minister conceded that there was some merit in the argument advanced by the British Medical Association. It is deeply worried, as it said in its document, that, following the changes in April, some health authorities will dispense with their responsibilities by saying that they are matters for local authorities. Some local authorities will say that

Column 900

they cannot cope. In the middle will be the elderly people who expect community care and who will find that it is not there. In response to that, the Minister said that if such a situation arises the Government will step in because it would imply that joint planning was breaking down. That is exactly what it would imply. In many parts of the United Kingdom, especially in Scotland, joint planning has never operated. There have been no agreements, discussions or policy formulation involving the health authorities and the local authorities, with input from voluntary organisations and users. That is essential if community care is to have any meaning. Hundreds of thousands of elderly people are not receiving the democratic support embracing their rights that any approach to the provision of proper social services seems to suggest. The hon. Members for Woodspring (Dr. Fox) and for Aylesbury (Mr. Lidington) were anxious to know more about advocacy, and I am anxious to encourage them in their search for knowledge. They missed the speech of my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker), who suggested some further reading for them. It would do them no harm to study the Disabled Persons (Services, Consultation and Representation) Act 1986, which clearly defines advocacy, assessment and representation. Perhaps they have the imagination to extend that Act's provisions to the elderly.

The hon. Member for Tiverton (Mrs. Browning) made a constructive intervention, and she should be encouraged to make a speech. She seemed to invite the House to become involved in an argument about Devon. I would not pretend to know much about Devon, but what if one multiplied her example and applied the argument elsewhere in Great Britain?

The one element missing from our arguments is the view that elderly people take of the services that are or are not provided for them. The elderly and their advocates ought to contribute to any debate leading to decisions that are of enormous importance, for good or for ill, to elderly people.

The Bill's origins are to be found in a report published by the Public Accounts Committee five or six years ago--which is recent history in terms of community care--saying that community care was in chaos. As a consequence of that and other strong representations, the former Prime Minister, Baroness Thatcher, invited Sir Roy Griffiths to prepare a report. Given his previous report on the health service and the then Prime Minister's belief in market forces, she did so with some confidence. However, after close examination, Sir Roy found that allegations made by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and others of my right hon. and hon. Friends were staring him in the face in reality.

My hon. Friend spoke of people being discharged from institutions and channelled into some other form of health care without proper assessment or any evidence of advocacy. Sir Roy was confronted with instances of that happening on a day-to-day basis, in a domestic sense.

Sir Roy's report stated that there had been decades of rhetoric but no action, and that Government declarations had not been matched by resources. He said that there ought to be a community care strategy so that if elderly people, for example, were discharged from long-stay psychiatric hospitals into the community, proper assessments and arrangements could be made and genuine care in the community delivered.

Column 901

Sir Roy said also that the problem of the boom in the number of elderly people was not being addressed. Even if the Bill is enacted, many elderly people will remain in the community. There is a strong case still for supporting local authorities in delivering services such as home help, so that the elderly can live independently and enjoy an improved quality of life.

Madam Deputy Speaker : Order. Although I have no objection to passing references to matters of general and wider import, I hope that the hon. Member does not intend to go into great detail. He should bear in mind that the House is considering an amendment to one clause, not the genesis of the whole Bill.

Mr. Clarke : Your perspicacity, Madam Deputy Speaker, never ceases to amaze me. You called me to order at exactly the point at which I intended to turn to the relevance of advocacy. Our objectives cannot be achieved unless more progress is made with advocacy.

I will conclude in the generous terms with which the Opposition have approached the Bill. Although the Minister has not delivered, at least he acknowledges the problem. Because we have made at least that progress with him, if not with certain Conservative Back Benchers, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Next Section

Home Page