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Miss Joan Lestor (Eccles) : The Minister will recall the commitment that was given about ring-fencing community care funds for mental health illness and for drug and alcohol abuse centres. That ring-fenced funding was later removed. What guarantee have we that the ring-fenced funding to which he has referred will be implemented?
Mr. Yeo : The specific grant for mental illness, now up to more than £31 million--raised by about 10 per cent. for 1993-94--has been an important element in the funding of local authority provision for people with mental illness. That is a specific grant for those services. There is a specific grant, of about £2.2 million, for alcohol and drug treatment. I appreciate that the hon. Lady is referring to the decision not to ring-fence the funding of residential treatment centres for alcohol and drug abusers. That decision is at present the subject of judicial review. The outcome of those proceedings will be known probably early next week, so it is difficult for me to say more on the subject now.
For that reason, I had intended later to point out--it may be convenient if I deal with the matter now--that the total figure in the special grant report is £20 million less than the £565 million that we are allocating in total to local authorities for the funding of community care. We shall make that £20 million available to local authorities and say how it will be distributed as soon as the present legal process has been completed.
The method of distributing the grant was discussed at length and attracted much interest from local authorities. I believe that we have arrived at the fairest possible method. We are not expecting too radical, too destabilising or too swift a change from the status quo but instead are making a smooth transition towards the achievement of our goal of reflecting in the distribution formula need, preserving individual choice and enabling care to be carried out at home. As I say, we have attached conditions to the payment of the grant, the first being the ring-fenced condition, and that has been widely welcomed. It will not apply in perpetuity. We believe that after three years the policy will be sufficiently integrated within the totality of social services provision, and by that stage it will be an erosion of local authority discretion to continue to apply ring fencing.
The second condition which we shall apply is the requirement that 85 per cent. of the money being transferred from social security should be spent by local authorities purchasing services from the independent sector. We attach the greatest possible importance to that condition. We believe that there is already a valuable history of independent sector residential care provision on
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which we can build. But the condition does not apply only to the purchase of residential services. Local authorities will also be able to satisfy it by purchasing from the independent sector domiciliary, day and respite care services.I hope that the whole independent sector will seize the opportunity offered to expand its activities in that area. The statutory sector cannot and should not work alone. I expect to see the independent sector taking on more of the work traditionally associated with local government.
Mr. Hinchliffe : My I press the Minister on the consistency of two of the factors that he has mentioned--the Government's apparent desire to ensure that people are not forced unnecessarily into care and to stimulate domiciliary alternatives to care, and the requirement to spend 85 per cent. of the DSS money in any one area on the independent sector? How do those factors square with the fact that, to my knowledge, many parts of the country have no independent domiciliary sector whatever? They do not seem to square.
Mr. Yeo : The reason why, I fear, some parts of the country have no independent domiciliary provision is the deep and enduring hostility of the local authorities to independent sector providers of all kinds, especially the private sector. In areas where there has been a more open-minded and rational approach to the provision of social services, there is no great difficulty in finding independent sector providers of all kinds of community care. The new condition was announced last October, although we have modified and slightly relaxed it after consultation. I hope that it will mean that, even in the past four and a half months, local authorities have been discussing with the independent sector how they can stimulate such provision. All that will help to make community care plans needs-led rather than service-led. We shall not tolerate the use of the money for some empire-building exercise by local authorities for their own service provision. I hope that we shall thereby reduce the scope for the incompetence, mismanagement and fraud which, sadly, has occurred in a few local authorities, and which besmirches the reputation of local government as a whole.
If the independent sector provision is to be fully realised, local authorities must collaborate. The study by KPMG which we commissioned last year, in support of the conclusions of our own monitoring exercise, showed significant shortcomings in local authority consultation with the independent sector. That is not an option ; it is essential. We have therefore issued two statutory directions to strengthen the requirement to consult.
Mr. Malcolm Wicks (Croydon, North-West) : I am still puzzled by the fact that 85 per cent. of the money is to go to the independent sector. Essentially, although not always, that means the private sector, so let us use proper vocabulary. Instead of 85 per cent. of the money going predominantly to the private sector, would a wise policy not be to ensure that 100 per cent. of it went to good services, whatever their source?
Mr. Yeo : I am surprised that the hon. Gentleman, who has some knowledge of such matters, claims that the independent sector is really the same as the private sector. It most certainly is not. Before entering the House I spent the latter years of my working life in what one might call
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the real world as a full-time employee of a large voluntary organisation supplying services extensively to local authorities. Many other voluntary organisations do the same.It is absurd to suggest that we can use the term "private sector" to cover the work of Age Concern, Mencap, the Spastics Society and many other distinguished voluntary organisations, which are now increasingly substantial suppliers of services under contract to local authorities. Of course, it is because we want all the money to be spent on good services that we are determined to ensure that most of it is spent in the independent sector. As I said at the beginning of my speech, that is the best safeguard ; that is what will deliver higher standards, value for money and wider choice.
Mr. Yeo : Local authorities have been given the challenge of making the reforms work. They have been given the cash that they need. They have had the help of the community care support force. It is now up to them. The success of community care rests on the directors of social services. They are used to managing change, and the community care support force is issuing practical guidance to assist local authorities if unexpected eventualities arise.
The report brings those long-awaited reforms to the brink of implementation. That progress has been achieved in co-operation with most local authorities and health authorities. I pay tribute to their efforts. The benefits of the policy will be felt throughout the country by vulnerable and needy people and their families and friends. I commend the report to the House.
4.55 pm
Mr. David Hinchliffe (Wakefield) : Tonight the House has what will probably be the only opportunity--certainly the only opportunity in Government time--to debate before April the implementation of the changes due to take place in the arrangements for community care. The formula before us in Special Grant Report (No. 6) sets out the reality of community care in the next financial year--a reality in stark and marked contrast to the media hype about the likely impact of the changes which emanated from Richmond house until shortly after the general election.
Before 9 April 1992, the then Secretary of State and the junior Ministers were telling us in glowing terms how the delayed new arrangements would improve the lot of all and sundry. They talked about the avoidance of unnecessary institutional care--the Minister mentioned that again tonight-- about recognition of the needs of users and carers, and about choice. Those statements gave renewed hope to users and carers, pressure groups and voluntary organisations, and providers in the public, private and independent sectors. April 1993 would be a new dawn, an end to what had been for many people years of private personal struggle and uncertainty.
When the election was over, a new message began to emerge from Richmond house. I am sorry that the Minister for reduced expectations--otherwise known as the Minister for Health--is not here tonight. He was wheeled into action to tell us all to modify our vision of the future after April 1993, and his message was reinforced in writing to local authorities : "Play it down, folks, and don't be unrealistic."
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One or two Opposition Members have been criticised for not being realistic about what would happen after April, and for having said for some time that not only may April fail to herald much- needed long-overdue support for a vast number of people in desperate need, but that the circumstances of some users and carers could get worse. It take no pleasure in saying that the report before the House, detailing the manner in which the changes are to be implemented, substantiates and reinforces those concerns.It is important to remind ourselves of the reason for the changes due in April, of the real motivation behind the community care elements in the National Health Service and Community Care Act 1990. The central purpose of the whole exercise was to unravel the incredible mess that the Government had got themselves into over the ever-increasing cost of income support payments to residents in private care. They wanted to unravel the social and--more importantly, from the Government's point of view--financial consequences of an ill thought out free market experiment in welfare which began in 1981. That experiment took the DSS budget for supplementary benefit and income support from £11 million when the Government came to power to a staggering £2.4 billion in the current financial year, and reinstated institutional provision as the central plank of Government thinking on the care of old people. The number of places in care homes has shot way beyond any demographic increase in the number of elderly and very elderly people. That experiment shunted people into permanent care when, sometimes at half the cost to the public purse, many of them could have had what they really wanted--services geared to their remaining in their own homes.
The free market experiment encouraged dependence by rewarding moves towards more intensive nursing provision rather than rehabilitation. I have received representations from people whose relatives have moved from their care to the nursing sections of jointly registered homes for one reason only--that those honourable people in the private sector whom the Minister so crudely compared with corrupt local authorities had moved them to obtain more money for caring for them, although they did not need that nursing care.
Neither the DSS nor the Department of Health has addressed those issues. That free market experiment left thousands of old people without a penny to their names, using their own pocket money and begging subsidies from relatives and charities to meet the cost of their care. All right hon. and hon. Members have heard of similar cases, and every case is an individual tragedy. It was a free market experiment which led to the Government being defeated by their own Back Benchers because of the enormous public outcry about its human consequences.
We are here tonight to unravel the consequences of free market ideology being applied to the circumstances of some of our most vulnerable citizens- -an unholy mess which has resulted in the gross misuse of millions of pounds of scarce public resources and, more importantly, has caused genuine distress and suffering to people who through no fault of their own are forced to look to the Government for their care and security.
It would be nice to say that the Government have learnt their lesson and that the community care changes will extract us once and for all from the results of the shambles, and that demented old people will no longer be shunted from the middle of London to questionable private placements in the Yorkshire dales. To use the parlance of
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the Select Committee on Health, old ladies in Dulwich will have the chance to stay in Dulwich rather than going to Clacton. The concept of choice should not be simply, "Which private home do you want to enter?" but, "Would you and your carer like to choose for you not to enter a home?" That is real and proper choice, and it is the choice that people want.The report, however, tells us something different. It tells us quite clearly that, apart from shunting the funding problems on to local authorities, the Government are opting for the status quo. Having launched the free market experiment, in facing the consequences the Government are clearly more concerned with the interests of private providers of care than with the interests of users and carers.
The Special Grant Report (No. 6) says loud and clear that Government policy in the implementation of community care changes is completely provider-led- -private provider-led.
Nowhere is that more graphically illustrated than in the calculation of the distribution of the special grant. Half the social security transfer element is being distributed to authorities in proportion to income support expenditure in respect of the numbers of individuals in private residential care and nursing homes in their areas.
Mr. Yeo : Is the hon. Gentleman aware that we offer local authority associations the opportunity for that part of the distribution calculation to be adjusted for migration from the area from which an individual came to the area where they were being cared for?
Mr. Hinchliffe : I was aware that discussions had taken place, but the Government have to answer the central accusation that the entire reform is geared to the status quo--to retaining the problems that we have had for the past decade as a result of the Government's commitment to floating the free market in care, and that those problems will continue after April.
When I expand on the point I was making, the Minister will understand my concerns about the formula. It takes no account whatever of the fact that, under the guise of what the Government have termed community care, older people and the disabled are frequently being placed in permanent settings many miles away from their own home areas. The Minister must recognise that.
Private care homes have developed where entrepreneurs have seen suitable properties, and not necessarily where the local population has presented a demand. Numerous private hotels and boarding houses in coastal resorts in the south-east, for example, have been converted for the care of older people and residents of psychiatric hospitals. In many instances, they have been filled with people from London who have been forced to move from their own homes and home areas due to lack of domiciliary support or suitable accommodation in their own communities.
The fact that the Government have chosen to concentrate future funding in the areas where those people have gone rather than where they have come from compounds the obvious mistakes arising from provision being determined almost entirely by the market. The new funding system clearly assumes that older people or the disabled will continue to be placed often 60 or 70 miles or
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more away from their home areas and their families. Rather than funding the changed system on the basis of known populations and needs, enabling the development of genuine care in the community, the Government have proved themselves to be concerned more with the continued commercial interests of the market.The practical consequences will be obvious to those right hon. and hon. Members who have considered what the figures in the distribution of April's funding mean for their constituencies. For some inner-London boroughs, currently with minimal care beds, the opportunity to develop alternatives to sending people many miles from home are frankly non-existent. It is no real consolation for an older or disabled person in inner London to be told that they now have a choice of which home they wish to enter when, as a result of Government policy, the choice is Clacton, Brighton or 200 miles away in the Yorkshire dales.
It is not just in inner London that the nonsense of funding distribution arrangements occur. In my own area in west Yorkshire, we can compare the positions of two similar adjacent local authorities, Bradford and Leeds. I am not making a party political point because, fortunately, both councils are Labour-controlled.
Bradford has 80,000 people of pensionable age, 30,000 of whom are over 75 ; Leeds has 130,000 people of pensionable age, of whom 50,000 are over 75 ; yet the Government's funding system gives Bradford £60 for each pensioner and £158 for each one over 75, while Leeds gets £38 and £101 respectively. Any objective assessment would conclude that Leeds is likely to need greater community care resources, but the Government's formula rewards Bradford simply because that area has more properties suitable for conversion into care homes. It is as simple as that.
Conservative Members may be heavily into Victorian values, but is it right that the location of mill owners' mansions in the 1800s should provide the basis for community care funding more than a century later? Is it right that many of my constituents and those of many other hon. Members should continue to be placed away from their home areas because the Government's funding system is, frankly, plain daft?
Having dealt with the sublime, I will move on to the ridiculous. As the Special Grant Report (No. 6) indicates, in addition to basing their calculations of 50 per cent. of the special grant on the random location of existing private care beds, the Government are determined that 85 per cent. of the social security transfer element mentioned by the Minister must be spent on purchasing care within what they call the independent sector. The fact that the Government backed off their original intention for 75 per cent. of the overall funding to be committed in that way is evidence of the fact that there might just be someone left at the Department of Health with a grip, albeit limited, on reality.
No Opposition Member objects in any way to attempts to develop independent community care provision which has relevance to advancing the rights of users and carers and genuinely improves their choice, but does not the vast bulk of independent sector care, even after the Government have spent sizeable amounts trying to stimulate domiciliary provision, consist of private residential and nursing homes? Would it not have made more sense to be sure there were independent sector
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alternatives to institutional care in every area before requiring the expenditure of that proportion of the funding?I appeal to right hon. and hon. Members in all parts of the House to examine the practicalities of the requirements for such expenditure in their constituencies. They will probably find, as I do, that it positively obstructs the ability of local people to address after April local priorities in terms of community care needs. To be parochial for a moment, the principal agenda item in terms of community care needs in my constituency is a radical improvement in day care facilities for young adults with learning difficulties. I have had numerous meetings with desperate parents who, once full-time education ends, frequently find themselves left alone to cope. The local authority recognises that the excellent adult training centre at Lawefield lane in my constituency has insufficient resources to meet the demands. The local authority simply does not have the funding to expand the centre and employ more staff. April should have been about meeting the needs of such young people and their parents, but the funding formula prevents the local authority from tackling such urgent priorities in the most obvious way--by paying for the expansion of the existing centre and additional staff. Instead, it will have to buy from a frankly non-existent private sector because the Government put ideology before common sense.
The independent sector may eventually devise a scheme to help, but it could take years. In the meantime, parents and their sons and daughters are left to struggle. Frankly, I do not think that that is good enough, and how it all fits in with the concept of choice is beyond me. The choice of my constituents is improved public provision. What about the right to choose local authority care and good quality local authority public services? Where is the choice when people no longer have a local authority home in the area in which they live because it has been closed?
The other side of the Government's agenda is all too clear. While they positively discriminate towards so-called independent providers--to the obvious detriment, in some respects, of users and carers--they discriminate against public provision. It is right to apply the same standards to local authority residential care as we do to the private sector, but the same Government who require those consistent standards then prevent local authorities from making the investment needed to upgrade their establishments.
What we have is a back-door method of closing council homes and reducing the choice about which the Government talk so much. The narrow application of the concept of choice means that people entering local authority care homes are excluded from receiving the new residential allowance. That is blatant dogmatic discrimination by a Government who are attempting to prop up and stimulate the private care market through the systematic destruction of public sector provision.
What choice will there be after April for those with drug and alcohol problems, in the light of the Government's decision to renege on the ring fencing of funding for drug and alcohol projects? As projects close, the choice for sufferers will be a police cell, prison or the streets ; and for some, unfortunately, it will be the mortuary.
Mr. Yeo : Can the hon. Gentleman explain how any of the policies that we are debating will prevent local
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authorities from buying any services that they consider appropriate to the needs of the drug and alcohol abusers? Where is the obstacle?Mr. Hinchliffe : If the hon. Gentleman lives in the real world, he will recognise that, when authorities are taking decisions on the expenditure of restricted sums of money and the choice is between, say, the placement of an elderly lady in a care home and the placing of an alcoholic or drug addict, it is a good bet that they will go for the elderly lady : in some people's eyes it is an issue of who is deserving and who is not. Is the Minister aware that a survey of 67 drug and alcohol agencies in the voluntary sector providing 1,300 bed spaces shows that 70 per cent. will start losing income in April and 46 per cent. will no longer be viable by the end of July 1993? I am conscious of the fact that we are talking today without knowing what the outcome of the application for the judicial review will be at 10.30 on Monday morning. It is an absolute disgrace that the Government have been dragged into the courts on an issue which any human being can see is of great concern. I was in the Chamber when a former Secretary of State gave a clear commitment to ring fencing. I remember the hon. Gentleman's words well. He gave a commitment--I stress this point--on the back of huge pressure from his Back Benchers, including hon. Members who are here today. The Government's logic on this issue is frankly beyond me, and beyond belief.
Mr. Andrew Rowe (Mid-Kent) : I hear what the hon. Gentleman says and I understand it. Basically, he is saying that any human being would take the view which he takes. Surely, "any human being" includes local councillors, and therefore local councillors could well take that decision if they chose to do so. In Kent, the local authority has chosen to ring- fence for a year, and we shall see what happens at the end of that 12 months. To push the decision up from the local authority to central Government merely on the basis that somehow central Government are human beings and local authorities are not seems to fly in the face of much of what I have often heard the hon. Gentleman say.
Mr. Hinchliffe : In a sense, the hon. Member for Mid-Kent has missed the real problem with these projects. He will know that many of the projects in London and in areas such as Leeds, which I know well--the detoxification centre--and other similar excellent organisations in Bradford and elsewhere, take in people who are not residents of the local authority in the area involved. The key issue is getting those other local authorities, which may have no real knowledge of the work of organisations such as the alcohol recovery project in London, to take seriously the work that they do. My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) and I spent some time visiting the projects and looking at some of the issues which people involved with them are worried about at present. I have seen one or two of the people who are benefiting from the present policy.
Ms. Tessa Jowell (Dulwich) : Does my hon. Friend accept that the dispute about the funding of services for drug addicts and alcoholics underlines the Government's inconsistency in the policy? The agencies which provide the care want precisely the same stability that the Government have undertaken with regard to private residential care for elderly people--that is, for the money
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to go where the people currently live. Does not that reveal that the Government are applying different standards to private residential care provided for elderly people and to voluntary organisations providing care and rehabilitation for drug and alcohol misusers?Mr. Hinchliffe : My hon. Friend is absolutely right to point to the inconsistency between the Government's policy on this and their policy on the so-called independent sector providers to whom she referred. When I visited one of the projects recently, I met a woman who was receiving treatment for a drink problem. That woman has two children who are currently in care, and I know that the work that that project is doing will enable her to return home and be with her children.
If the Government's current illogical position is based on attempting to save money, it is completely the wrong way round. By failing to ring-fence those projects, resulting in the closure of a number of projects along the lines predicted in the survey, the Government are forcing up public expenditure on the prison service, the hospital service and young children in care, regardless of the human consequences.
Even at this late stage, I sincerely hope that the Minister will have a rethink during the debate. I am well aware that there is equal concern on the Conservative Back Benches about the way in which the Government have gone back on their previous commitments. I urge the Minister to consider why, over the past few years, the term "community care" has become in a sense a byword for neglect. In many people's eyes, it is an excuse for the Government to make savings and to release resources for the use of the Exchequer.
The Government should realise that, for many people, the Ben Silcock case raises questions other than those which were subsequently addressed by the Secretary of State. Such questions included the right to asylum facilities within the community, not locked away from the community ; proper after- care for mentally ill people who leave hospital ; joint funding for community care plans which does not taper down to nothing, as so much joint funding does ; strategic planning involving everyone, including the user and his or her family.
The Minister used to work for the Spastics Society. I am sure that he will have seen the report which came out yesterday, produced jointly by the Royal College of Nursing and the Spastics Society. The report made it clear that the process of strategic planning had been made far more difficult by the deliberate erection of barriers and the creation of competition between arms of health and care services--for example, with the advent of trusts and the new health market.
When the 1990 Act was going through the House, some of us pointed out that its health and community care elements were contradictory. Millions of people are now looking to April, desperately hoping for answers to some of the problems that I have outlined and hoping for urgent change, but what hope is there for the new system when local authorities under both Labour and Conservative control point to a huge shortfall in the funding contained in the report before us today? I have talked to senior Conservative councillors who are deeply worried about what the changes will mean for people in their areas.
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What are the prospects for the implementation of the new system when, as the Association of Directors of Social Services demonstrated recently, the vast majority of local authorities expect real cuts in their social services budgets in the new financial year? It became clear in the Health Select Committee recently that the Government had no plans to monitor the implementation of the reforms, so is it any wonder that users and carers--I meet people in various groups on a regular basis--are asking whether the Government really care? The impression is being given that, frankly, they do not.What could have been achieved if, instead of the privatised welfare experiment in the 1980s and early 1990s the Government had been prepared to think out the use of the nearly £10 billion being spent on what Griffiths called perverse incentives to enter private institutional care? What could have been achieved if, instead of undermining the ability of local authorities and voluntary organisations to offer alternatives to institutional care, the Government had been prepared to invest in what people really want, which is help to remain independent rather than incentives to give up the ghost? What could have been achieved if concepts such as that underpinning the independent living fund had been developed and extended instead of being allowed to degenerate into the present shambles?
A few weeks away from April, severely disabled people, voluntary organisations, local authorities and, it seems, the Government have not the least idea how the new system will operate. The dogmatic obsession with the market means that the community care funding contained in the report will largely miss its real target. The Government have allowed the private institutional tail to wag the community care dog, and the real losers will be the users and carers who so urgently need a radically different agenda.
5.23 pm
Mr. Roger Sims (Chislehurst) : As we have been reminded, the report is another--and perhaps, before April, the last--step towards the implementation of an Act that was passed by the House more than two years ago. I recall sitting with several other hon. Members who are in the Chamber this evening on the Committee that considered the National Health Service and Community Care Bill. My recollection is that, while there was a good deal of controversy about the national health service part of the Bill, there was general support for the philosophy behind community care, as set out in the Bill. There might have been discussions about the detail, but there was general support in the Committee and the House for the idea of community care. I am sorry that the hon. Member for Wakefield (Mr. Hinchliffe) spent so much time demonstrating the antipathy to the private sector for which he is well known. It was perhaps hardly surprising.
Mr. Hinchliffe : I am grateful to the hon. Gentleman, for whom I have a great deal of respect in terms of his commitment to social services issues, for giving way. My antipathy is not to the private sector : it is to a Government who distort the allocation of funding in social services in the direction of the private sector, at the expense of the public sector and care in the voluntary sector, which is often dependent on council support. I think that the hon. Gentleman will accept that point.
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Mr. Sims : I will simply modify my remarks and say that the hon. Gentleman's prejudice clouds his assessment of Government policy. When the Bill received its Third Reading, I was disappointed that we were told, and had not been told until then, that although the NHS part of the Bill would be implemented a few months later, implementation of the community care part of the Act would be deferred for a couple of years. Having said that, I am bound to say that the preparations for community care have proved extremely complex. A great deal of work needed to be done and has been done. Indeed, credit for the successful preparation for the Act is due in no small measure to the diligence of several officials in the Department of Health who have been extremely busy issuing guidance, holding seminars and so on about how the Act is to be carried into effect.
Perhaps I could also compliment the community care task force, which has done an effective job and was a useful idea. It sent people with knowledge of the detail of community care out to local authorities to assist them in making their preparations. Perhaps in his reply my hon. Friend the Minister will say a word about the future of the task force. There seems to be a question mark over whether it will continue after 1 April. I should have thought that, having shown its value in the preparatory stage, something akin to the task force, if not the same body, might continue, at least in a fire-fighting capacity. It would serve a useful purpose.
Special credit must go to all the people in local authorities and other organisations who have been responsible for putting the community care policy into practice. Any hon. Member who has had the opportunity to discuss the matter with local authority officers, officials in local voluntary organisations and so on will realise the enormous amount of work that has been done in preparation for 1 April, over and above people's normal duties, which, in the case of social services departments, are extensive. The success or otherwise of the community care provisions will depend on what happens locally. It will depend on organisations, local authorities, health authorities, the private sector, the voluntary sector and the individuals involved working together. We must wish them well as they progress towards what I suppose we might describe as C Day.
The report that we are discussing arrives not before time. It has been difficult for local authorities to make their detailed plans without knowing what central Government funding they will receive. They were told the global sum in October. They had some information about the funding, but only in this report do they know the final figures.
Indeed, I was with my own director of social services only this morning. He had not yet seen the report, so I was able to hand him a copy. He found that my borough was to receive £103,000 less than the earlier figures suggested. I suppose that, in budgets of millions, that is not significant, but it demonstrates the difficulties under which local authorities have had to work. I shall not go too far in comparing the relationship between local authorities and central Government with the way in which commerce and industry would work in similar circumstances.
Part of the grant recognises the extra costs that local authorities will incur in implementing community care : that is distinct from the transfer of the income support element. If the policy works out as we all hope that it will, the amount of social care in the community will increase
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and funds to cover that will be needed. The amount of health care in the community will also increase. If we are giving local authorities extra funds to meet their extra costs, may we know what extra funds the health authorities will receive to meet their share? Should we not expect, in due course, a report giving details of a special grant for them?My hon. Friend the Minister will not be surprised if I draw attention to the basis on which the grant was calculated and to which the hon. Member for Wakefield has already referred. According to paragraph 3(a) of the report,
"50 per cent. of the social security transfer element has been distributed between authorities in proportion to Income Support expenditure in respect of individuals in residential care and nursing homes in their area."
I think that the hon. Member for Wakefield used the word "private", which does not appear in the report. Perhaps that is another illustration of his prejudice. Not all residential and nursing homes are private ; some are run by voluntary organisations and others by local authorities--not necessarily in their own local authority area. The point is, however, that the money is to be distributed according to where the recipients live, rather than where they come from. As the hon. Gentleman pointed out, that must disadvantage certain areas--for example, parts of both inner and outer London--from which a number of recipients of income support have moved to Kent, Sussex and Surrey, not necessarily as a result of compulsion. The authorities involved will receive a larger share of the income support tranche than they would have otherwise, while authorities in inner and outer London will lose.
My authority estimates that some 400,000 elderly people have moved out of the borough into homes in areas such as those that I have cited. A large amount of money has probably been lost because of the use of the formula that we are discussing.
Mr. Rowe : That important point should not be confined to community care. In the Medway health authority area, for instance, we had to struggle with an unsatisfactory funding arrangement which was weighted excessively towards older people moving into areas such as Brighton.
Mr. Sims : I was not suggesting that the problem was confined to inner and suburban London ; the hon. Member for Wakefield mentioned other areas that are affected, and I appreciate that the same thing happens elsewhere.
In an intervention, my hon. Friend the Minister made an interesting reference to migration figures being considered. That was news to me and I hope that he will be able to expand on it, either during the debate or later. He knows of my interest. I wish to place on record my appreciation of the way in which he received a deputation from the London boroughs, which I led, and of the sympathetic hearing that he gave that deputation. I hope that he will be able to go some way towards improving the formula to remove the current sense of injustice--if not now, before this time next year.
Mr. Hinchliffe : It would be wrong to give the impression that every inner-London borough has suffered as a result of the funding system. Would the hon. Gentleman care to speculate, for instance, on why his
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authority, Bromley, receives £91 for each person over the age of 75, while for some reason Wandsworth receives £144.07 per person?Mr. Sims : No, I would not. I shall merely say that that increases the sense of injustice and suggests that the formula is, to say the least, capable of improvement.
The question that inevitably arises, and will continue to arise, is whether the total grant, however it is distributed, will be enough to enable authorities to implement the policies set out in the community care legislation. The answer is, of course, that we simply do not know : we are entering unknown territory. As the implementation of the Act unfolds, cases will come to light, and will be assessed, with results on which we can only speculate. We do not really know the extent to which needs will be revealed, or what will be involved in trying to meet them.
That leads us to the problem encapsulated in the expression "unmet need". The dilemma, as I see it, is this : under the Act, a local authority will be required to assess each case, to specify the needs that the assessment reveals and then to meet those needs. It may not be able to do so, however. The chronically sick and disabled persons legislation, for instance, imposes an absolute obligation to meet the needs that are revealed.
Ideally, an assessment should be agreed with relatives--and, of course, with the user in particular. I am delighted to see that my right hon. Friend the Secretary of State for Health has arrived in the Chamber : she was good enough to commend my local authority's practice of securing the user's agreement to the assessment, along with his or her signature on the document. Nevertheless, the guidance now being given to local authorities is somewhat ambivalent, suggesting that it may not be wise to specify actual needs in an assessment because the authority concerned might then be open to legal challenge.
I hestitate to use of the word "deception", but it seems that assessments could be misleading. My anxiety is increased by the evidence given to the Select Committee by officials from the Department--this relates to what was said by the hon. Member for Wakefield. The officials seemed to suggest that, although the progress of community care would be monitored and some statistics would be collected, statistics relating to unmet need would not be collected. That rather negates the whole principle that community care should be driven by needs rather than resources.
During the passage of the legislation, many of us said, time and again, "This is all very fine, but will the resources be there to meet the needs?" We were assured that the resources would be there, and we have been assured again today that the report is part of that provision ; but how can the Department know that the resources are adequate without having information about unmet need?
I understand the difficulty. It is desirable to specify the need, and it is also realistic to accept that it may not always be possible to meet that need. We all know that budgets--even if they are twice the figure that we are discussing--are finite. There could be circumstances in which it would be impossible to meet every need. Will my hon. Friend the Minister consider ways to resolve that difficulty? Is it practicable to have a genuine and open assessment of need and the extent to which it can be met? We should be straightforward about the matter and say to
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the users, "This is our assessment of your need and this is what, ideally, you should have--A, B, C, D and E--but we can currently offer you only, A, B, C and D. We accept that, in time, we should be able to help you in other ways."I think that the users and relatives will accept that funds are not unlimited, but we should all know where we stand. The local authority should have it on record and know the exact position. It should know not only the needs that it is meeting, but the needs that it has been unable to meet. Those statistics could then be collected at Richmond house and my right hon. and hon. Friends the Ministers will be able to see whether community care is working.
Perhaps in a few years' time we shall hear that everything is going smoothly and the resources have proved adequate--I hope so. The resources may be adequate in some sectors, but inadequate in others. There may be room for adjustment or increase, but at least that would be a fairer and more realistic system than the present apparent fudging and uncertainty.
Of course, there are still worries--there are bound to be--about exactly how community care will work, particularly the interface between health authorities and local authorities, notwithstanding any agreements that may have been made. There is a distinction between social care and health care, how each one is defined and where they overlap. Given good will and common sense, I am sure that those difficulties can be overcome.
There are uncertainties--with only a few weeks to go, some are inevitable-- but some of them could be clarified. For example, what happens when someone is in a home where the fees are higher than his income support and he receives a top-up, which then ceases? What is the local authority's responsibility? I have a letter from my local assistant care director which refers to that dilemma:
"The verbal advice from the Department of Health is that a resident in receipt of Income Support and who therefore has preserved rights after the community care changes, whose top up from whatever source is withdrawn after that time, must seek a cheaper placement. If no such placement is available they may apply to the local authority to supplement their Income Support allowance. The Department of Health is however stating that the resident must move placement in order that local authorities are not just used as an automatic source of funding."
The problem is that people left, right and centre could withdraw their top- up knowing that the local authority will automatically take over. Clearly, we must guard against that, but it seems that there could be cases where the withdrawal of the top-up could be due to unavoidable circumstances such as a relative dying. It would be harsh if someone who had been in a residential or nursing home for many years were then required to move for the reasons that I have described. I do not necessarily expect my hon. Friend the Minister to give a straightforward answer today, but I hope that he will clarify the position, certainly before 1 April.
Ms. Jowell : The issue of the shortfall between income support limits and the actual cost of residential care is, rightly, a source of enormous worry. It is one sector of expenditure where the local authorities and local authority associations feel that the Government have failed to heed the evidence of the scale of the difficulty nationally. Local authorities calculate that the national shortfall is £73 million. That shortfall is currently made up by relatives, charities and a range of top- up sources, but could, after 1 April, become the responsibility of the local authority. I am sure that the hon. Gentleman will agree that it would
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