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be a source of tremendous instability in a new system if such a large amount were not underwritten by the Government from the outset.Mr. Sims : It would be unreasonable to expect the Government to write a blank cheque for the sort of figure given by the hon. Lady, but it would be helpful to have some clarification about what the position would be given the circumstances that I have outlined. It would be reasonable for the local authority to have some discretion in the matter.
Mr. Ian McCartney (Makerfield) : In a debate on a statutory instrument in Committee yesterday, the Under-Secretary of State for Social Security, the hon. Member for Bury, North (Mr. Burt), said that he and his Department were seeking to draft amendments to section 43 of the National Health Service and Community Care Act 1990 to ensure that some categories of residence received top-up support from local authorities. He said that he could not say yet what those categories would be and that that was a matter for the Department of Health. The Minister could help today's debate, because yesterday it was placed on record that active consideration is being given to the issue by the Department.
Mr. Sims : I am grateful to the hon. Gentleman for bringing me up to date on the latest state of play on that issue and I look forward to hearing from my hon. Friend the Minister later.
Although I have voiced some reservations and some of the understandable concerns felt by those who will be implementing community care, I welcome the report--although I believe that it has come a little late. I hope that my hon. Friend's Department will watch carefully as the community care policy unfolds. I hope that the Minister will keep himself fully informed and, where action seems appropriate, will take it without delay.
5.48 pm
Mr. Nigel Jones (Cheltenham) : Liberal Democrats welcome many of the Government's ideas on community care, many of which are progressive. In the main, the philosophy that underlies their ideas is correct. Unfortunately, the report will not lead to enough money being provided properly to implement the Government's philosophy. I say that because social services departments of local authorities throughout the country are struggling to put together next year's budgets with inadequate finance. I declare an interest as an elected county councillor in Gloucestershire who serves on the social services committee of that authority.
More than 80 per cent. of directors of social services in England predict that their budgets will be reduced in April, which is the time when they are due to take on important new responsibilities for community care. According to a survey conducted by the Association of Directors of Social Services, 81.7 per cent. of local authorities which responded to the questionnaire seemed set to cut spending on social services when their budgets are finalised in April. A further 8.5 per cent. expect a standstill budget.
The consequences for the users of social services will be immense. For example, they may be subject to additional charges for services such as home helps and meals on wheels. Crucial inspection staff who are required to monitor standards in residential homes will not be appointed. Residential homes and day centres for elderly
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and mentally handicapped people could be closed. Additional staff required to implement the community care reforms and to respond to rising levels of social need will not be brought on to the social services payroll.According to the president of the ADSS, Peter Smallridge, the news for social services coming from the results of the survey carried out by the association is extremely gloomy. Members of the association warned last year of the danger that, despite ring-fenced money being made available for community care this April, the impact of Government policies towards local government expenditure as a whole would drive many councils--country as well as urban--to make cuts in other crucial areas of the social services budget. That seems to be what is taking place.
The great flaw in the report is that part of the calculation uses our old friend standard spending assessment. I shall not rehearse all the arguments about SSA because they were advanced in the debate last week. Even the Government seem to admit now, however, that SSA is not right. I welcome the Secretary of State's commitment to review the system, which seems to imply that even he thinks that it is not perfect. The Government say that SSA is not a statement of need but merely a method of distributing a predetermined amount of money. Gloucestershire county council, on which I serve, has carried out a detailed survey of existing residents in care who receive benefit. The director of social services, Deryk Mead, to whom I spoke yesterday and this morning, tells me that the survey shows that there is a shortfall of £1.4 million. I listened carefully to the Minister when he talked about rising standards. I would like to see rising standards, of course, but the financial arrangements seem to mean that local authorities will be obliged to try to force down fees. Many people believe that that will reduce standards and could lead to the financial collapse of some private care homes.
The proposed settlement does not reflect what has been happening in recent years. It seems that it allows for no increase in numbers. Nor does it allow for an increase in fees. When the Minister responds, I hope that he will tell the House how many people the Government estimate will enter care this year, bearing in mind the rapid increase in numbers over the past 10 years.
If local authorities have to find additional moneys for fees, there will be no funds to improve day care, respite care or home help. We have heard the views of the ADSS and the Association of Metropolitan Authorities about underfunding. I heard the Minister say that, if councils want to spend more on community care, they can draw on their own funds. Many local authorities, including Gloucestershire county council, wish to spend more on that form of care. That is why last night Gloucestershire's county councillors unanimously approved a budget--it was proposed by Conservative councillors--to exceed the capping limit by £10.3 million.
I ask the Minister to reflect on the figures that are set out in the report. I ask him and his right hon. Friends to ensure that when local authority representatives speak to the Ministers who are responsible for their expenditure after they have exceeded their capping limit, Ministers will respond to the needs of the local community and to the councillors who have listened to the people whom they represent. I ask them to allow local authorities to spend what is needed to provide proper and decent high-level services in those areas.
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5.54 pmMr. Andrew Rowe (Mid-Kent) : This is a rather exciting day. I strongly approve of the policy that has been presented to us. As it is set out--in theory--it is excellent. Everything will depend, of course, on how it works out in practice. We all know that. If those who are in need of help from social services are assessed on the basis of their needs and the needs of their carers, we are taking a huge step forward.
It took a long time to complete the sterile debates in which we engaged during the health service reforms. We spent much time arguing about whether resources were adequate. I declare now that resources will never be adequate. There is no possibility of meeting all the needs that it would be so easy to define.
I spent an extraordinarily uncomfortable but profitable morning today as a participant in the Kilroy programme. I feel like a new form of graffiti-- "Kilroy, I was there." He had brought together a remarkable collection of people who were carers and some of those for whom they were caring. As I was the only representative of the governing party, it was predictable that any pretensions that I may have had in the past to be a supporter of carers in a wide variety of different ways vanished like snow off a dyke. I was instantly and continuously pilloried throughout the programme.
Nevertheless, the extraordinary courage, devotion and strength of purpose that carers of all ages and stages of life display in looking after others is remarkably clear. I feel that it is not within the scope of any Government to create at public expense the sort of total support system that is delivered for about 85 per cent. of people in receipt of care by individual carers. I feel, however, that they are entitled, and will increasingly expect and demand, the relatively minor support that makes it possible for them to continue. I was delighted to hear my hon. Friend the Minister say how much he valued the provision of respite care, to take but one example.
A recent report--it was the basis of the Kilroy programme this morning-- makes it clear that the preference of many carers is that support should be based on their own homes. They feel that the people for whom they are caring should not be sent away. I am sure that there are occasions, however, when the client, as it were, wants to be sent away. I have examples in my extended family where people have been going for several years on what they regard as a holiday. That works well, but we need to take tremendous note of the fact that carers look for respite within their own homes. I hope that the imaginative provision of the new community care legislation which states that the needs of the carer must be taken into account will prove to be a spur to imaginative and creative provision. I have a huge regard for the hon. Member for Wakefield (Mr. Hinchliffe). For a brief time only, before he was translated to higher things, he was chairman of the parliamentary panel for the personal social services, and his concern and devotion to the provision of social services is well known. However, I did not altogether recognise the scene that he painted, and in one respect in particular.
I may be wrong, but my understanding is that the Government intend to provide financial stability for those who are already in care and that gradually, as local authorities make new care plans, the automatic, or
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virtually automatic, sending of large numbers of people into residential care will stop, as it has already begun to cease in Kent.Mr. Hinchliffe : I am grateful for the hon. Gentleman's comments, although I expected something to follow on from them. Let me clarify my concern and that of the Labour party on the issue that he is addressing. The 85 per cent. requirement in respect of the independent sector will, because of the lack of independent alternatives to residential and nursing care, lead to people going into care, not on the basis of their assessed needs but because of the requirement to spend that money. If there are no domiciliary alternatives and their development is prevented, there is no choice but to continue placing people in care, often away from where they live.
Mr. Rowe : That is what I understood the hon. Gentleman to say, but it is nonsense. There is no reason why social services departments, through contracts with the independent sector, should not summon into being alternative provision. That is what is happening in my local authority.
My local authority is not typical because it has spent the past two years developing care and it is fair to say that it has been thinking about the development of community care for much longer than that. Much of the pre- thinking that went into the legislation was based on what was happening in Kent. One consequence is that it is busily engaged in inventing contracts of a sort which will summon into being different ways of delivering different kinds of care.
I take one example. I think that I am right in saying that Kent no longer has any long-term residential homes. They are now linked service centres which are used as a basis for a wide variety of provision including day and respite care. People go there for the management of their domicilliary services, and so on. Such a wide and imaginative variety of resources will grow, and so they should. That is the way forward.
It is true that at the moment Kent has some 835 homes providing 17, 000 places with a budget of £268 million and employing 20,000 people. Many of them are shaking in their shoes because they see that the emergence of community care will put a number of them at risk, and so it should. But instead of sitting back and going out of business because they cannot think what to do, the more imaginative home owners are already beginning to create other ways of delivering services.
For example, homes are becoming resource centres for carers and people use them on a daily basis for the provision of specialist teams to work in the community, whether to carry out simple carpentry tasks, which is often one of the things that people living on their own need
Ms Jowell : My hon. Friend the Member for Wakefield (Mr. Hinchliffe) was referring to the fact that, while there is nothing to stop the private sector developing domiciliary care--some have already developed what were loss leaders which have had to be closed because of the impact of the recession on residential care homes--many local authorities are having to cut their home care services to meet the Government's spending limits while having to maintain existing patterns of spend on the independent residential care sector for the next year.
Therefore, although there is no reason in theory why the private domiciliary sector should not grow and
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flourish, the Government have created specific obstacles to its development in the short term, while forcing many local authorities to cut their existing home care services. Domiciliary care is severely at risk, certainly in the short term.Mr. Rowe : I understand that local authorities vary greatly in the way in which they run their affairs and in the demographic and other distributions with which they have to cope. However, as my hon. Friend the Minister said at the beginning, the amount of money in real terms being spent on social services has rocketed in recent years. In some cases, the turnover--that is hardly the right word--in residential homes is rapid. People may die fairly swiftly or have to move into nursing homes or into other forms of disposition. When that happens, it will be the end of that perverse incentive which Griffiths was so anxious to remove and we shall see a new generation of forms of care and support. Certainly that is what I hope to see. An area that I believe to be of central significance to the satisfactory delivery of community care is the liaison between the health service and the social services. My hon. Friend the Member for Chislehurst (Mr. Sims) made an important contribution on that point which I wish to underline.
In that provision there are two elements, the first of which is general practice. It is fundamental that general practitioners should collaborate in every possible way with the social services. In Kent, the chances of that happening have been enormously improved by the development of a sophisticated computer package developed by the social services so that every care manager in Kent should have access to the database for his clients. What is more, a simplified version is being made available to every general practitioner in Kent so that they can summon up, using a carefully guarded confidential password, that part of the assessment and database which refers to their patients and to which they should have access.
Nothing ever works on machinery alone, but there is no doubt that equipment is enormously helpful. If that newly pioneered programme works as it is intended to work, it should enormously improve the liaison between the general practitioner and the social services manager. One of the most encouraging features of the NHS reforms has been the astonishing increase in the number of staff being deployed from doctors' surgeries. I do not have the figures for later than 1990, but they have gone up from 37,000 in 1980 to 78,000 in 1990. Many of those--
Mr. McCartney : Consultants and tax consultants.
Mr. Rowe : The hon. Gentleman, from a sedentary position, shouts, "Consultants and tax consultants." If he cares to look at the figures for nurses, for therapists and even, in a growing number of general practice surgeries, social workers, he will see that the general practice surgery is becoming a central point for the delivery of care based in the community.
I want not rivalry between services and GPs but collaboration on that basis. May I say to the Minister, in passing and in public, what I have said to him before in private : that when we can get away from the constriction of a one-year contract on which it is
extraordinarily difficult to plan, we should develop free-standing consortia of therapists, whether they be physiotherapists, occupational or speech therapists. Such consortia would be able to deliver services to the four purchasers which have now
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come into the market : schools, fund- holding practices, the health service and the social services. If they do not create a strong free-standing organisation of their own, therapists are liable to find themselves at the bottom of everybody's expenditure queue. For a whole range of people in the community, it is very often the services of therapists which are the most cost-effective way of helping them. The document makes no reference to volunteers, of course, but I believe passionately that we underestimate and under-use volunteers and the potential for them. It has to be remembered that one of the biggest single demographic changes in the country will result, in the next 10 years, in literally millions of people retiring from their principal occupations with 30 or more years of active life ahead of them. Someone who retires from his principal occupation between the ages of 55 and 60 will be active for another 30 years. What is he going to do? Unless those people are enabled and encouraged, in large numbers, to do things for other people, they will themselves become clients of the social services because they will be bored and will find themselves falling heir to a variety of different ills. The Prime Minister says that we need to release the tremendous resources in our people ; this is one area in which we need a serious, well-designed and effective way of organising volunteers. Volunteers are one of the best ways of monitoring the quality of services. Volunteers going in and out of homes, going in and out of individuals' homes, reading to people and doing their shopping, are as good a check on the way in which the statutory services are delivering community care as any other mechanism of which we can think. It is important that we should do that.I say to the Minister that community care will inevitably require some residential care. That residential care, which has so often been the scene of hideous scandals and which the Warner report has identified as extraordinarily under-trained, requires a substantial improvement in training, recruitment, monitoring and promotion of residential staff. There has to be a much greater interchange between residential and non- residential staff. There have to be ways for staff to be encouraged to move from one residential post to another so they do not get stale and dug into various Chinese or other practices.
In that fight, the national vocational qualification is a huge card to play. I am extremely pleased at the way in which forward-looking social services departments, like that of Kent, are making use of the national vocational qualification as a way of authenticating or accrediting the skills that many middle-aged people bring, perhaps from the experience of caring for their own people, to residential care. I hope that the Minister will give every possible boost to the expansion of that programme.
6.15 pm
Ms. Tessa Jowell (Dulwich) : I join other hon. Members who have talked about the popularity of a policy of community care. It makes sense-- and by and large it is what people want as they grow older or experience disability--to live at home and for those friends and relatives who provide most of our community care to be properly supported in the job that they do in caring for them. However, users of community care services and their carers also emphasise other aspects of community care beyond just social care and health services.
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They stress the importance of being properly housed. Too often, community care is seen only in terms of what the social services department or voluntary social care organisations can provide. The fact that a person has a home is taken for granted, yet housing is an integral part of proper community care. So, too, is an adequate income. Given that so many disabled people rely on social security benefits as their major source of income, proper information about their entitlement to benefits and maximising the take-up of benefits to which they are entitled is critical. So, too, is the issue of transport and mobility. Being able to get around and to make choices about what one does each day depends on being physically able to leave home. That is what community care means, as described by disabled people and their carers.In considering community care policy and its funding, it is also worth considering what makes good community care for disabled people and their carers. Often, it is not the volume of service, or who provides it. What matters is that the service is delivered with certainty, is flexible and takes account of the vast array of changing and different needs, that it is reliable and that people come when they say they will come.
Mr. Rowe : The hon. Lady is making a very powerful point, with which I wholly agree. Will she recall that there is at present before the House the Disabled Persons (Services) Bill, the purpose of which is to enable those who are particularly severely disabled but who wish to hire and fire some of their own staff to be able to have the cash to do that, rather than to have to get staff through some third party such as a local authority?
Ms. Jowell : Certainly disabled people and the organisations representing them will welcome the opportunity to have the cash to buy the care and support that they need. When I visited the centre for independent living in Boston some years ago, I was struck by the different approach to disability. That centre ran what was, essentially, a consultancy on the employment and management of teams of staff who supported disabled people, who then determined how the staff could be deployed so that they could go about their daily business in the way that they chose. That really represents freedom and freedom of choice for disabled people. The principles addressed by the hon. Gentleman are absolutely right and will be welcomed by disabled people.
This is also, perhaps, the moment at which to emphasise the great distress and anger among disabled people at the Government's decision to wind up the independent living fund, and their failure so far to provide any adequate explanation of how the alternative arrangements will be made. The independent living fund was probably the most popular benefit available to disabled people, precisely because it offered, on the basis of assessment, a degree of choice as to the nature of the care that people received and the support that they purchased for themselves, so that they could make their own choices about how they lived in their community.
It is very much to the Government's shame that they have chosen to wind up the fund in the context of the introduction of legislation which is about choice for disabled people, and it flies in the face of the choices which disabled people would themselves make. If disabled people
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were asked whether they wanted retention of the independent living fund or replacement along the lines that the Government propose, I guarantee that they would give the fund an overwhelming vote of confidence.Returning briefly to the hon. Gentleman's intervention, of course we want to see an end to the loophole whereby well-intentioned local authorities have cash available to disabled people but have had to use a voluntary organisation or a third party as a conduit. The essential tests against which we should be judging the provisions before the House today are that services are reliable--that the promised bus actually arrives--and that people have the opportunity to use services of high quality which they do not feel demean them as users. It is to our eternal shame as a country that so many disabled people and elderly people are being cared for in residential and other settings which none of us would choose for our families and which none of us who manage the services would choose. They are services for people who are unable to exercise any choice. If the implementation of this policy achieves the eradication of any stigma associated with using community care services, it will be a great tribute to those throughout the country who have worked to make the policy succeed. That is the important test.
It is extraordinarily difficult to achieve the complex objectives of the policy in practice. Described simply as the desirability of looking after elderly people in their own homes, providing support to carers, and responding to need rather than just delivering services, it all sounds incredibly straightforward. However, the hon. Member for Chislehurst (Mr. Sims) and other hon. Members have sat with me on the Select Committee during recent deliberations, and we have heard from local authority associations, regional health authorities and the social services inspectorate about the complexity of turning local authorities inside out and getting them to change course from being providers of services to developing the capacity to respond to people's needs.
I well remember a recent conversation with an elderly lady who was being assessed for community care services and whose needs were therefore being judged. She said, "I know that I am coping if my windows are clean." It is being able to meet sensitively that kind of very personal test of competence which is so terribly important to so many elderly people. The capacity to do that is one proof of how far local authorities can shift from being Henry Ford-like providers of services--on any terms so long as it is meals on wheels or a bit of residential care--to addressing the complex task of meeting the multiplicity of individual needs, which may include a preference for having clean windows.
Behind the general consensus on the desirability of community care, there are enormous tensions and the fault lines are beginning to open. It is around the opening of these fault lines that the consensus which saw this policy, which is now being implemented, through the last Session of Parliament is breaking down. It is very hard to reconcile the Government's protestations about the importance of choice and their determination to meet people's needs rather than simply deliver services with the increasing debate about the adequacy of the money being made available, and the glaring discrepancies which have been revealed between the estimates of the local authority associations representing both political persuasions and the calculations made by the Government.
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We must ensure not necessarily that agreement is reached at this stage on the precise figures, but that the Government's mind and, perhaps more importantly, their cheque book remains open, so that they can come to the rescue not just of local authorities, but of those elderly people who may be caught towards the end of this financial year with a local authority which cannot buy any more residential care for them, regardless of their need. We want an assurance from the Minister today that the Government's mind is open and that they will accept the evidence of underfunding as the first, very tricky year of implementation proceeds.The second area of great concern, to which I have already referred briefly, is that of the loss of the independent living fund. Again, we look forward to hearing from the Minister just how the promise of choice is reconciled with the decision to withdraw a fund which for so many disabled people has represented what might be the only, rather limited, opportunity to exercise choice.
We must also address the real risk that an imperfect and inadequate system, led by social security, within which people's entitlement was clear, is being replaced by a system which relies very heavily on discretion and in relation to which individual service users and carers will have no redress and no right of appeal. I am terribly concerned that elderly and disabled people throughout the country may become prey to the discretionary judgments of social workers rather than having an explicit statement of their entitlement.
We also have to take account of the other pressures that local authorities are facing and which will impact on their ability to deliver properly what this policy promises. The Association of Directors of Social Services has provided compelling evidence of the cuts in social services which are likely to be implemented as a result of the requirement to meet Government spending targets over the next year. We know that the consequences of cuts in those services will be a betrayal of the promise to carers of improved and increased care and support. Ultimately, the one source of support that is always there is the carer--the friend or relative who provides most of the care and support for a disabled person.
On the basis of what we have heard and seen, local authorities are taking on the new lead responsibility for community care with great enthusiasm. In so doing, we and they want to ensure that they are not being set up to fail. There are grave risks of fragmentation in their critical lead role. As Sir Roy Griffiths rightly said in his report some years ago, it is through that lead role that the fragmentation which has so bedevilled the proper and seamless development of community care in the past will end.
Fragmentation remains a danger in two ways. The first is the lack of definition between social and health care to which other hon. Members have referred. It is still possible that an elderly person can leave hospital and, on the grounds of his continuing need for nursing care, be referred directly to a nursing home with which the health authority has a contract. That person will receive the nursing care free of charge. However, another elderly person who is placed in the same nursing home through the local authority assessment route may be required to top up or make a personal contribution to the cost of his care because his social rather than nursing needs were deemed to be paramount. Studies which have tried to establish the distinction between nursing care need and
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social care need have proved what a difficult boundary that is, but it is terribly important that it does not become a source of fragmentation and inequity in the new system.The second risk is that general practitioners will not be sufficiently co- operative with the lead role of local authorities and, especially, that after 1 April this year GP fund holders may use their enhanced ability to purchase community health services on behalf of their patients so as to circumvent the local authority assessment procedure. Even before 1 April, we must anticipate some of the problems which may arise and which could defeat the policy. We must be assured of the Government's open-mindedness and their willingness to take action to avoid fragmentation.
As I represent the constituency of Dulwich in London, I wish to deal specifically with some of the problems facing London. A major problem was identified in the mid-year population estimates published by the Office of Population Censuses and Surveys. It showed a substantial loss of population in London, especially among elderly people aged 85 and over. My borough of Southwark shows a staggering loss of 32 per cent. in its population of those elderly people. Clearly, that has severe knock-on consequences for the grant that Southwark will receive.
At a recent meeting which I, the hon. Member for Chislehurst and the London local authority associations attended, the Minister accepted that such a loss of population could not be accounted for merely by the fact that elderly people from London boroughs who need residential care have to be referred to private homes on the Essex or south coast. He said that we had to look for other reasons. We are grateful to the Minister for the undertakings that he made in that respect.
I hope that the Minister will also keep an open mind about the inequity of the distribution formula and its impact on London authorities. My own authority of Southwark stands to lose about £800, 000 as a result of that formula.
Those problems must be dealt with as a matter of urgency. If not, the old lady from Dulwich to whom my hon. Friend the Member for Wakefield (Mr. Hinchliffe) referred will not have the choice of living in her own home in my constituency but will surely be shipped off to the Essex coast or the south coast, perhaps against her will. She will have to go because she has no choice and it is the only place where the residential care is provided. We want the Government to deal with those problems with an open mind as the policy unfolds, so that the good principles behind the policy will be safeguarded in practice.
6.36 pm
Mr. David Congdon (Croydon, North-East) : This has been an interesting debate on an important subject. Most hon. Members are fully committed to care in the community and what it involves, although, as the date of implementation comes closer, some concerns are inevitably raised.
However, community care is nothing new. It has been practised by many social services departments for many years. I do not believe that there will be a dramatic change on 1 April except in the critical aspect of the assessment process to which the hon. Member for Dulwich (Ms. Jowell) referred.
I agree with the hon. Lady about care in the community and the sensitivity with which services should be delivered.
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In some ways, residential care is very easy to provide : it is usually provided in one building and, regrettably, people can be put into residential homes and forgotten because one knows that, broadly speaking, they will be cared for reasonably well.However, under care in the community there is a much greater risk of services not being delivered sensitively and, certainly, not always being delivered at the right time, especially when a large number of agencies are involved. It will be a challenge for all the agencies to ensure that they deliver care in the way that it needs to be delivered to the people who need it, when they need it. Reference has been made to the residents of Dulwich, a constituency that I have the privilege of knowing very well. As some hon. Members will know, in a former incarnation I was chairman of the Young Conservatives in Dulwich. I suspect that, far from being shipped off to the south coast, many elderly residents of Dulwich come to the many excellent independent homes in the borough of Croydon. Croydon has many such homes, which is why it is the only London borough that appears to benefit from the distribution of grant that we are debating.
I deal now with the independent sector in general. I thought that the hon. Member for Wakefield (Mr. Hinchliffe) was rather unfair when he referred to the growth in the private sector as a free market experiment. We should not forget that many elderly people up and down the country have received excellent care as a result of the growth in the independent sector. We are very well aware of the fact that many of those people could have benefited from care in the community. Equally, however, there is a strong case for the independent sector.
Mr. Hinchliffe : Hon. Members who are present have heard me describe cases involving constituents who have ended up in private institutional care many miles from my constituency, at a cost to the state twice as high as would have been the cost of supplying the services needed to enable those people to remain at home. That is my objection to what the Government have done to encourage the explosive expansion of private sector care.
Mr. Congdon : I understand and appreciate that objection. The important point that I am making is that people with money can afford to buy residential care, wherever they want it, without any assessment, whereas people without money cannot afford to do so. The provision of income support has enabled the latter to secure residential care. However, there is a downside. If community care had been properly provided by the social services departments to which the hon. Member for Wakefield referred, people could have benefited from it. I readily concede that point. In fact, many social services departments have properly expanded their services to meet that very demand.
Equally, however, many local authorities have used their planning powers responsibly and sensibly to ensure that obstacles are not placed in the path of those wishing to set up independent homes. I make that point as someone from a borough which has an enormous number of independent homes and which came in for much criticism for giving planning permission for them. But the
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result is that many residents of my borough have been able to secure the required residential provision within their localities. I take issue with the remark of the hon. Member for Wakefield that community care has become a byword for neglect. I certainly concede that in some areas there has been a shortfall in the provision of services for the mentally ill. In general, however, it is something of a disservice to those involved in community care to use such terms.In this context, we must bear in mind the enormous growth in funding for health and personal social services. I was intrigued by the comment of the hon. Member for Wakefield about funds going back to the Exchequer. If funds have gone back to the Exchequer, I do not know where they have ended up. Over the past 13 years, there has been a growth of 60 per cent., in real terms, in NHS expenditure and an increase of two thirds in real terms in social services expenditure. I do not think that there has been a bonanza in this respect. I understand the concern about the ability of social services departments to cope, given the amounts of money being allocated to them. Reference has been made to the fact that many social services departments are saying that, following the rate support grant settlement, they will have to cut their budgets in the forthcoming year. That point was made by the hon. Member for Cheltenham (Mr. Jones). I regard that argument as a little odd. Everyone says that community care is very important. Certainly, those involved in local government say so. However, when it comes to the crunch, some authorities do not seem to be prepared to put their money where their mouths are. They should look at all their services and decide their priorities.
I am pleased to say that the council of which I was a member for 16 years was able continually to put growth money into social services. In the year beginning 1 April 1993, excluding the money for care in the community, there will be an extra £500,000 for the social services budget. If local authorities regard community care as a priority, they should do likewise in respect of their social services budget and should look to other services with a view to cutting out waste. Thus they could protect a valuable personal social service. There are two issues before us : the scale of the funds being made available by the Government and their distribution. It is always possible to argue, as my hon. Friend the Member for Mid-Kent (Mr. Rowe) did, that there will never be sufficient funds to meet all needs. However, we have a responsibility continually to put extra resources into health and social services. That has indeed been done.
I had a particular interest in the discussion in the Select Committee on Health on the question of the appropriate level of funds to be allocated to social services. In broad terms, I was satisfied that the level and the basis of the calculation were reasonable. One can always argue for more, but one is dealing with a projection of the number of people who, under the previous rules, would present themselves as being in need of, and would secure, care in residential homes, and of what will happen after 1 April. That is an important point.
Also important is the fact that the Department of Health and its Ministers must review at the strategic level the numbers being provided for in the coming year, to determine whether the amount of money transferred is at the right level for future years. It seems to me that that
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must be done. No one can guarantee that the right amount of money is being transferred. The proof of the pudding will be in the eating.An equally important issue is that of distribution. It is not surprising that a fair number of local authorities are protesting about the amount of money that they are receiving. In fact, I should have been very surprised if they had not done so. I should probably have wondered whether the Government, in their allocations, had been too generous.
It is difficult to make a fair allocation. I fully understand the arguments about basing allocation on standard spending assessments. I equally understand the argument about the need to avoid decimating the existing independent sector and pattern of provision. It is not for any ideological reason, for the purpose of protecting the private sector, that I say so ; it is because many of those homes are providing good care.
At a time of great change--and there will indeed be great change over the next few years--it is important to avoid being too disruptive on day one. We do not know in detail how what is being introduced will work in practice. That is why I am very much in favour of an evolutionary approach. I might draw a comparison with the NHS reforms, in which case, although the purchasers enter into contracts with providers, the contracts, in general, have been in a steady state in year one.
That approach is rightly being adopted, in broad terms, in the case of care in the community. I say so with some caution, as we all wish to see resources switched, over a period, from residential care to community care. I realise how difficult it is to achieve that. Even when one sets out with such an aim, one has to be very careful to ensure that, over a period, resources are switched.
On allocations, there is concern that some London boroughs are losing--many would argue that that is the case. However, it is important to bear in mind the fact that the split between SSAs and income support is being treated in such a way as to ensure that an increasing proportion of the money allocated will be based on SSAs. That is an important point.
If we take the other money in the revenue support grant, these proposals should be seen in the context of representing an increase of 15 per cent. in SSAs for social services for local authorities. That is a significant increase. I hope that that will give local authorities the opportunity to get to grips with the job and successfully implement community care.
It is ironic that for many years local authorities have criticised the Government for taking responsibilities from them. Much play has been made of that. Local authorities put in a very strong bid to be given responsibility for care in the community. Many did not think that the Government would have the courage to give them that responsibility. The Government have had the courage to do so, and it is now up to the local authorities to get on with the job and do the best they can to implement the community care proposals sensibly and sensitively. Over the next year they should have a lively dialogue with Government about reviewing the amounts of money if they believe they have not got the necessary funding to implement their policies. At least they should get on with implementing the proposals for the benefit of the people in their communities.
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6.50 pmMr. Malcolm Wicks (Croydon, North-West) : It is a great pleasure to speak in the debate because it concerns one of the most important issues facing the country. The timing is good, because it is a pleasure for me to follow the hon. Member for Croydon, North-East (Mr. Congdon). It means that at least the north of Croydon has been well represented in the debate. I thank you for that, Mr. Deputy Speaker.
My colleague talked about Croydon. I too should like to start my speech by talking about Croydon, but rather differently. In my judgment, formed from talking to many people in Croydon, the dawn of the new community care age is opening darkly. The social services authority, Croydon council, is already making cuts in preparation for the new regime.
Yesterday I visited Bensham lodge, an old people's home in my constituency, which is facing the axe. Another home in the constituency of the hon. Member for Croydon, South (Mr. Ottaway) is also facing the axe. Why? I remember experts telling us that old people's homes were not institutions but the homes of the old people ; we were told that they were places where the old people lived and that the residents should be treated like other people who were living in their own homes.
What did Croydon council do? The council marched in one day and said to the residents, many of whom are frail, "The home will be closed. Here is the timetable." Many people were distressed. To that they were tearful is an understatement. The carers and relatives were concerned. They telephoned and asked me to go to the home to find out what was happening.
I visited the home yesterday and I was appalled. I tried not to raise the issue of closure with the old people because I knew how upset they were. I wanted to find out about the atmosphere, but the old folk themselves said to me, "Look at what is going on. The home is going to close, is it not? Why do we have to go?" It is a splendid home in very good grounds in the heart of Croydon and it is much loved by the residents and their relatives.
Now the council has had to think again briefly because properly a court elsewhere has said recently that councils cannot treat people in that way. The court decided that the councils could not close homes without consultation. Croydon council is now going through a consultation process. Cynically, people on the committee are saying that it is a process which they have to go through because the court has said so. As I understand it, it is not a proper process of consultation whereby old people will be listened to.
If there was proper consultation, there might be a change of heart and the home might be safeguarded. Instead, I fear that the residents will be shunted out to the private sector, not the independent sector. The provision of accommodation will be put out to tender and people who have lived in the same home as friends for many years will be split up. I take this public opportunity to urge the director of social services in Croydon and the chairman of the social services committee to visit the home, as I did, not to talk but to listen to what the old people in Bensham lodge have to say.
The fact that Crossfields, an excellent sheltered workshop in Croydon, for people with disabilities also faces the axe is another cause for concern. That workshop showed how employment can be a key factor in
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community care. The people were doing good work making windows and other things. Because of the recession, and because Croydon council wishes to withdraw a grant, the workshop faces closure. The people may be offered a day centre, but they do not want that. They want to work, like the rest of us : it gives some meaning to their lives. Work is an important aspect of community care for those with learning difficulties or severe mental handicap.Because of the proposed closure of the old people's home and the sheltered workshop, I am not as confident as the hon. Member for Croydon, North-East about the prospects for community care in our borough.
The trends are clear, and I think we all agree on them. We see a reduction in public sector residential provision for old people. That is happening in the national health service and the public sector too. By contrast, there is a huge increase in the private sector. When he kindly let me intervene in his speech earlier, the Minister quarrelled with me and said that the independent sector was not the private sector but included the voluntary sector as well. I conceded that in my intervention, but I said that it was essentially the private sector.
Since the Minister finished his speech, I have looked at the figures to see what has happened to residential places in the public sector, the private sector and the voluntary sector between 1980 and 1990. I quote the data from Laing and Buisson, consultants of whom the Minister will know. That shows that, between 1980 and 1990, the local authority residential sector has declined by 3 per cent. ; the voluntary sector has declined, not increased, by 7 per cent. ; only the private sector has increased, by 416 per cent., if my calculator has not let me down ; the private nursing home sector has increased by 457 per cent. Therefore, the growth in the so- called independent sector has been in the private, commercial sector, so let us have no nonsense on that score.
I do not know about the domiciliary sector in Croydon, but if the Minister thinks that there is a huge difference which makes his statement valid, no doubt he will remind me of that in his reply to the debate. I am talking about the private commercial sector, some of it good, some of it excellent, some of it shabby and awful where none of us would want to live or want our elders to live.
I focus briefly on an issue not referred to much on the Government Benches- -the carers. The distortion of the community care policy into a residential care policy is extraordinary. The whole philosophy of community care was, strangely enough, about community care and not residential care. Because of the expenditure fix and the ideological concern of Government, regardless of need, to boost the private commercial, for-profit sector, we are now talking about residential care.
Sadly, when we should be talking about community care and the needs of carers, we are discussing the finances of residential care. We are doing it narrowly. We are not talking about employment, housing and the other dimensions of community care. What should have been a wide debate has become remarkably narrow. I think I know why the Government do not talk about carers any more. Of course, in speeches, they pat them on the back and say how wonderful and important they are, but we do
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