House of Commons Hansard Debates for 3 Mar 1993

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According to Turning Point's research, Suffolk will receive three times as much cash as it needs while 10 out of the 13 London boroughs will receive an average of £1.18 million less than the residents require for their care to be sustained.

It is particularly important that the total found by Turning Point to be needed properly to support alcohol and drug abuse facilities--£21 million--is close to the £20 million that the Government announced that they had set aside during the judicial review. The issue is not that far more money is needed, but for that money to be directed to where the people are and where the services need support.

Ministers are in a small minority in believing that their policy is right. It is opposed by every organisation representing informed opinion--not just the providers of services to people with drug and alcohol problems, but the Association of Directors of Social Services, the British Association of Social Workers, the Institute of Health Services Management and the National Care Homes Association. I conclude with a simple question to the Minister which I hope he will answer when he replies to the debate. If he makes such play of the importance of stability and protection for the services of elderly people living in independent residential homes during the first year of community care reforms, why does not he accept that exactly the same need for stability and consistency applies to services for people who suffer from drug and alcohol misuse? 11.10 pm

Mr. Alan Milburn (Darlington) : Like the hon. Member for Battersea (Mr. Bowis), I think that we have had a good and well-informed debate. I hope that the Minister will take note of the fact that every hon. Member who has spoken so far has expressed grave concerns about the lack of operation of the ring fence.

The irony is that this debate need never have taken place. It would not have been necessary to be in our places this evening if the pledge that was given in 1990 by the then Secretary of State for Health, the right hon. and learned Member for Rushcliffe (Mr. Clarke), had been honoured. He guaranteed that ring fencing would be provided for drug and alcohol residential centres, in response to cross-party support in the House, from those in another place and from expert organisations, some of which have been referred to by my hon. Friends and Conservative Members. That support and pressure still exists and the decision to withdraw the 1990 ring- fencing promise has been universally condemned. I hope that the Minister will note that 123 hon. Members from both sides of the House have signed the early-day motion standing in my name which seeks a reversal of the Government's policy. I know from my work as the chair of the all-party alcohol misuse group and from the first-hand concerns that have been passed to me by both practitioners and clients of the impact that the Government's policy will have.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) has already referred to the Standing Conference on Drug Abuse and Alcohol Concern survey of 91 residential units. The Minister will know that half are threatened with closure by July. Some are already issuing redundancy notices to staff so that they might comply with the legal position that confronts them. Interestingly,

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hardly any of them believe that the Government's last-minute response to the furore caused by their broken promises will help to guarantee their future. A limp advice note from Ministers to local authorities together with a still undefined fast-track assessment procedure, whatever that means, is hardly an adequate replacement for guaranteed funding, which is what each centre needs.

The Minister will know that the imminence of closure is not a red herring or a false threat. It stems from the reliance of the centres on income support payments from their clients, payments that will disappear from 1 April, and from the special nature of their clients. The hon. Gentleman will be aware that the 140 drug and alcohol residential centres provide a national network of specialist help, support and rehabilitation services and offer short-term treatment. He will know also that there is a high turnover of residents. It was a recognition of the differences between alcohol and drug misusers and the groups that form the overwhelming majority of the recipients of community care--the elderly and the mentally ill, for example--that prompted the then Secretary of State for Health in 1990 to make the ring-fencing commitment in the first place. Unlike the elderly, alcohol and drug misusers do not enter residential care as a last resort or as a poor alternative to community-based services. They accept such care as a positive first step, or a short-term option, to allow them to regain control of their lives away from the environment of alcohol and drug misuse that has been the cause of their problems.

The decision to ring-fence drug and alcohol misuse services was made because even in 1990 it was clear that the competing priorities on the community care budget meant that the client groups which were more popular or acceptable, or which had a legal entitlement to service, would be prioritised and that is precisely the situation that we face now. The present Home Secretary described it in graphic language in June 1990 when he said that the elderly and disabled were popular and had a powerful lobby and he accepted that some local authorities were less inclined to give the correct priority to the mentally ill. He also accepted that drug and alcohol abuse were not always popular recipients of social services money. As ever, the right hon. and learned Gentleman was a master of understatement. The £20 million given in DSS payments for the direct use of those centres will now be lost in the general community care pool. My hon. Friend the Member for Wakefield referred to the press release and notice that accompanied the instrument that we are debating. It is clear that that money is not being ring-fenced.

The Minister argued tonight, as he argued in the Adjournment debate on the subject last December, that the ring-fencing commitment would merely have perpetuated the existing pattern of services. He must know that that is not so. The ring-fencing commitment was not merely a case of trying to preserve the old order. It was a case of trying to smooth the transition to a new order. I think I see the Minister looking astonished at that remark. He should read the speeches of his right hon. and learned Friend and other hon. Friends, who made it clear that the purpose of the ring-fencing commitment was not designed to set in stone a commitment for all time, but to ensure sufficient breathing space for a proper allocation of resources and development of services to occur so that the principles of community care could be properly met.

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All that has gone down the tubes and the Minister's decision has doomed dozens of centres, including those in my area, to closure. He has given them, and the local authorities involved, less than six months to introduce procedures that it was originally envisaged would take until 1996 to get right.

In the debate last December, we went into some of the issues and spoke of the incredible complexity of the referral arrangements to each centre. The centres know that the fast-track procedure about which the Minister spoke and which he lamentably failed to explain in detail will not work. The professionals and the clients know that it will not work. Why on earth will not the Minister recognise that it will not work?

By refusing to countenance ring-fencing, the Minister is not only arrogantly dismissing the advice of drug and alcohol centre professionals, but is dooming the 5,000 people who use their services to a life on the streets without treatment, without care and without any hope of rehabilitation back into a normal life in society--and that at a time when the problem of drug and alcohol misuse is not only growing but has finally been recognised by the Government. The annual cost to society of alcohol misuse is estimated at £2.5 billion. A few months ago, when the White Paper "The Health of the Nation" was launched, we heard of the Government's determination to tackle alcohol problems. How can that be squared with a policy that will close 140 drug and alcohol rehabilitation centres? In a week in which we have heard so much noise from Ministers about bearing down hard on crime, it is more than a little ironic to find the Government adding to the crime problems of the nation, bearing in mind that the majority of hardened drug users finance their habit by illegal means. They do so by theft, drug dealing and prostitution. With people having nowhere else to go and no prospect of help because the centres have been closed, the result will be more crime, not less. Society will end up picking up the tab for the Government's obstinate refusal to see sense on this issue.

My hon. Friends have already alluded to some of the anomalies in the report and have dealt with the detail. I make a last-minute heartfelt plea to the Minister not only to monitor what is going on--from 1 April, he will be monitoring redundancies and the closure of vital drug and alcohol centres-- but, more important, to reinstate the ring-fencing commitment. If he does not, not only the people who use the centres but society as a whole will face a bleak future. 11.20 pm

Mr. Jeremy Corbyn (Islington, North) : It is a pleasure to follow my hon. Friend the Member for Darlington (Mr. Milburn), who made an excellent speech. I only wish that someone of his character and calibre, and with his understanding of the issues and preparedness to protect the services and the people who use them, represented the Government at the Dispatch Box tonight.

I find the Minister's announcement extremely depressing. He seeks to hide behind the fact that the High Court found in his favour. I must tell him that the High Court has made many mistakes over many years. Besides, it is not really very important whether the High Court

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found in his favour on the ring-fencing argument. That is no justification. We want ring fencing to protect the projects and to protect the victims of drug and alcohol misuse.

I represent a depressed, deprived inner-city area. Our unemployment rate is shooting up. It is now well over 20 per cent. On some estates, it is over 40 per cent. The number of people who are suffering serious problems of alcohol abuse is very great and is increasing. Moreover, the figures are often understated in surveys because many people who suffer from alcohol abuse seek to hide it by various means. I do not necessarily blame them for hiding it ; I merely recognise that it happens. Likewise, the number of youngsters who are becoming involved in serious problems of drug abuse is increasing all the time.

I am glad to say that we live in a society in which there is universal condemnation of drug abuse. Unfortunately, there is little less concern about and research into the reasons why young people in particular become involved in drug abuse. We live in a dreadfully alcohol-related society, however. One has only to take any underground or bus journey in London or watch television to be fed a steady stream of advertisements encouraging one to drink. That advertising rubs off. Drinking is a form of escape and solace and it is also often the result of a great deal of peer-group pressure. I believe that the problems of unemployment, overcrowed and poor- quality housing, debt and depression lead people into drinking. We must recognise the many causes.

All that the Minister proposes is that, in effect, the overstretched and overworked projects that are doing their best to cope with the avalanche of requests for help should be cut and should lose money because they will be unable to compete in what has become the marketplace of social services demands in local authority decision making.

Many hon. Members have served on local authorities--in my case, I am glad to say, in slightly happier times. If I had thought that the 1970s were going to be the high point of local authority expenditure, I would have spent a bit more. Local councillors face an absolute nightmare in deciding between a whole variety of competing demands in every conceivable area. From my time at the London borough of Haringey in the 1970s and early 1980s I know that, even then, it was not a very popular move to go to a social services commmittee and ask for money for a drug or alcohol recovery project. The committee would say that it needed the money for pensioners' organisations, under-fives, people with disabilities, and so on--all perfectly sensible and worthy causes, which we wish to see supported. Anyone now going to a social services committee and saying that a certain amount of money was coming in would be confronted with a host of people trying to get their hands on funds for equally valuable and worthy causes. The purpose of the great campaign to have the community care budget ring fenced is to protect the principle of community care provision by local authorities. That is an added reason for having ring fencing of the budget for drug and alcohol recovery units.

I have visited a number of schemes in north London. One that comes to mind is the women's alcohol recovery project based at Drayton park in Highbury, which has a very dedicated staff and does an absolutely first-rate job. Most of the women are self-referred or have been brought in by friends. They are not necessarily local residents, or even identifiable as resident anywhere. Many are people of no fixed abode, having become homeless and friendless as

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a result of the trauma of alcohol abuse and having been taken in by some good Samaritan. The people who provide such services face the future with a degree of horror. They know that the demand for their expertise and services is increasing steadily, but that their ability to meet it is reducing steadily. They recognise that this proposal does not help them at all--a point that they made very articulately in the Lobby this year.

Mrs. Audrey Wise (Preston) : Does my hon. Friend know that his point about expertise is made also by the directors of social services? Leaving aside the other problems that my hon. Friend has has correctly identified, those people do not have the necessary expertise to deal with the difficulties created by alcoholism. This is especially true now that they have to cope with so many changes in care in the community. My hon. Friend may not know that when they expressed their feelings to the Select Committee on Health they were absolutely backed up by senior health service officials, who pointed out that failures in this area will result in our having more people in the care of the medical side of the service, at greatly increased cost.

Mr. Corbyn : My hon. Friend makes an extremely valuable point as a distinguished member of the Select Committee on Health. Under-funding of any type of social or primary care service results in enormous demands on the acute health services, which are put at risk of being unable to cope. If the Minister has the time or the inclination, or even the interest, he should spend some time visiting general hospitals in London. It would be helpful if he were to listen to the debate. Perhaps he has so little interest in the subject that he cannot be bothered to listen to what hon. Members are saying about their experiences. When his mind was elsewhere I was about to suggest that he should get to know something of what hospitals experience in having to deal with the victims of these problems because of the lack of facilities elsewhere.

I hope that the hon. Gentleman will recognise the force of our argument about the need for ring fencing for these services and full support for the very dedicated people who are doing so much good work in this area. Why should they have to cope with cuts and closures and with increasing numbers of drug and alcohol abusers on the streets, causing more problems and more deprivation for themselves and others?

11.29 pm

Mr. Ian McCartney (Makerfield) : This debate is marked by the fact that the nine Members from both sides who have participated, excluding my hon. Friend the Member for Wakefield (Mr.

Hinchliffe)--and I exclude him in a friendly fashion--have given eloquent testimony to the fact that what the Minister has announced tonight is wrong in principle, although Conservative Members may have said that some Labour Members put the view more passionately than they did.

The underlying trend of what has been said is that the markets do not involve successful fast-tracking. The resources are not following projects, although the Government gave a commitment to that. The Government gave away the promise made in 1990 by the former Secretary of State to ring-fence resources. That has given greater impetus to the feeling in the community that the Government, first, do not have a real commitment to the

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principle of community care and, secondly, have a hidden agenda in terms of leaving local authorities holding the can for the serious problems which will arise because of underfunding in the care gap. In the debate on Special Grant Report No. 6, I said that the Minister was a Shylock. He proved tonight that he is not only a Shylock but a Pinocchio because, whenever he raises the issue of community care, one believes less of what he says about the Government's intentions in that regard.

To attack organisations for taking a case to court fundamentally undermines the real reasons why they went to court. They went to court out of total desperation at failing to convince the Minister that the Government's commitment should have been maintained. That commitment has not been maintained because the surveys and practical experience of the organisations show that 71 per cent. of projects have begun to lose income in the first nine months of the new scheme. By December 1993, 70 per cent. of all projects will have disappeared from most regions in the United Kingdom.

In the House a week ago, the Secretary of State introduced the document, "Making London Better", which contains two basic principles. I quote :

"The number and variety of community nursing services available have increased, for example, through walk-in and telephone advice, counselling, and support groups and help for those facing crisis and long term illness. In London some of these initiatives are already underway. The pace of change can be speeded up Important elements make up the process of modernising primary health care in London Devising accessible services for Londoners with special needs such as those who are mentally ill or who misuse drugs or other substances." A week ago, the Government gave a commitment to new services in London. Tonight, we are seeing the withdrawal of those services. The background to the withdrawal of services is that the number of addicts registered in London is 10 times the national average. In 1990, the age-adjusted rate in Greater London for chronic liver disease and cirrhosis was 60 per cent. higher for males and 31 per cent. higher for females than the average for England and Wales as a whole. Cirrhosis is a key indicator of the level of alcohol problems in the community.

Despite the Government's evidence and the introduction of the White Paper last week, the Minister intends to follow through with Special Grant Report No. 7 and withdraw the resources. It is an act of criminal irresponsibility by a Minister who never listens or learns. As a consequence, the most vulnerable people in the community suffer as a result of his decisions.

Mr. David Harris (St. Ives) : He is shaking.

Mr. McCartney : If the hon. Gentleman had any compassion, he would be not only shaking but apologising for this shabby report. The Minister should have further discussions about the ring fencing immediately. We need no back-chat from the hon. Member for St. Ives (Mr. Harris).

By December 1993, 69 projects and 1,521 beds will have been withdrawn and two thirds of the agencies will have given redundancy notices to skilled staff. It beggars belief that, within nine months of the projects coming under a new financial regime, skilled people working with drug and alcohol abusers in the community are being given redundancy notices. What a commitment to community care.

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It does not stop there. In every region in Britain there will be closure after closure month after month from1 April right through to 31 December. Projects throughout the country for men, for women, for men and women, for women and children, and for men, women and children will close. It is a league table of shame.

Last week the Government announced league tables for performance. How about introducing a league table for the Government's monitoring of the closure of alcohol abuse services? By the end of this year, 1, 533 beds will be lost from projects in the United Kingdom despite the Government's much- vaunted claim that the introduction of community care would bring an improvement in facilities in the community. Having listened to hon. Members on both sides of the House tonight, the Minister still has an opportunity to change his mind. If he does not want to listen to me and my honourable colleagues because of his party political bias and his commitment to Government policy, let him listen to his hon. Friends behind him. Let him listen to what they have said and bear in mind the areas from which they come. Let him listen to the problems that they have outlined. They did so because they know from their personal experience, from the organisations which have come to them and from the constituents who have submitted proposals to them, that the dogma does not work.

The practicalities are such that the Government's proposals will lead to the closure of projects, an increase in crime and a reduction in the ability of individuals in the community to self-refer to organisations in the community. That is the most damning effect of the proposal. By refusing to ring-fence the money, the Miniser will reduce the opportunity for self- referral. Fast-tracking interferes with that opportunity. The market will not recognise self-referrals. That will create winners and losers. The losers will always be the users of the two services. I beg the Minister to change his mind now.

11.36 pm

Mr. Yeo : This has been a valuable debate. I have listened carefully to the views expressed by hon. Members on both sides of the House. I had hoped that I might hear rather more speeches vigorously in support of the Government's decision, but never mind--I know that there is such a thing as a silent majority on such matters. The hon. Members who have spoken obviously attach a high priority to the needs of drug and alcohol abusers, and so do the Government, but hon. Members seem to assume for some reason that their views will not be shared by any of their local authority colleagues. No one has explained why that sudden divergence of opinion should arise, but that was the underlying assumption behind every request for ring fencing to be restored.

The Turning Point survey has been referred to by many hon. Members. It acknowledges that even in 1990, long before the local authorities assume responsibilities for community care in April this year, about half the applications for top-up funding for residential services for drug and alcohol abusers made to social service departments in the London boroughs and county areas

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surveyed were successful. The local authorities already recognised the needs even before they took on the duties that they are about to have.

Let me explain to the hon. Member for Makerfield (Mr. McCartney) that the Special Grant Report (No. 7), which we shall approve in a few minutes, does not remove resources. It adds £20 million to the special transitional grant, which is ring fenced for the purpose of expenditure on community care services--some of which will be for drug and alcohol abusers. The decision not to ring-fence the money for the residential treatment services does not mean that a single penny has been removed from the funds that the Government make available for drug and alcohol service providers.

The way in which the argument has been put this evening sometimes seemed a little over the top. Let us remind ourselves that since 1979 the real increase in expenditure on personal social services has been two thirds. In the past three years, the real increase in the personal social services standard spending assessment has been one fifth. If we take account of the special transitional grant of £565 million--I remind the House that that is not merely the money being transferred from social security, but an extra £140 million to help local authorities develop their services-- and the standard spending assessment, next year local authorities will have at their disposal 15 per cent. more resources for social services expenditure than they have this year. It will be up to local authorities to decide how much of that massive sum they allocate to the treatment of drug and alcohol abusers.

The hon. Member for Stretford (Mr. Lloyd) intervened in the speech by the hon. Member for Wakefield (Mr. Hinchliffe) about the resourcing of Manchester.

Ms. Glenda Jackson : Will the hon. Gentleman give way?

Mr. Yeo : No, I have only four minutes to wind up.

This year, Manchester city council is spending £64 million on social services and it has a personal social services standard spending assessment of £76 million. Next year, the SSA will be £79 million and it will get a special transitional grant of £6 million, which is excluded from the rate-capping calculations. The only reason why there could be any shortfall in funding for social services in Manchester is because of the decisions of the Labour-controlled Manchester city council, which is exclusively responsible for denying the people of Manchester the services that they need.

A great deal has been made of the survey by Turning Point, which is scarcely a scientific study, as it is based on studies using 1989-90 prices and arbitrarily grossed them up by 68 per cent. over four years. I am not sure why costs should rise by that massive amount during that time, but I hope that when local authorities make referrals to drug and alcohol treatment centres they will at least ensure that they are getting value for money.

I recognise that the distribution decision is difficult. We went through detailed discussions with the local authority associations about how to distribute funds for community care. There is no obviously right answer. We are all concerned to try to achieve a smooth transition to the new policy, but 35 per cent. of the special transitional grant will be distributed on the basis of the present income support

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expenditure pattern and the other 65 per cent. is based on SSAs, which take into account socio-economic factors and tend to favour the inner cities.

I believe that that was the best judgment that we could arrive at to achieve the smooth transfer that we want. I stress again that our community care policy, the generous funding that we provide, and the way in which the money is being distributed are not intended to protect the position of every provider of treatment, but to ensure that services are designed to meet the needs of the individual. I must inform the hon. Member for Dulwich (Ms. Jowell) that we are giving the drug and alcohol service providers exactly the same protection that she says is being accorded to the providers of residential homes for the elderly. They are all being treated alike. On monitoring, I recognise the concerns of my hon. Friends, but I am not sure how they reconcile with the fact that Opposition Members have told us that some of the establishments will go out of business in three months. If that is the case, our three-month period will be long enough, especially bearing in mind that client turnover in the centres is rapid--the average stay is only 19 weeks. Monitoring by the social services inspectorate will continue, even after the end of three months, to see how the implementation of community care is going.

In conclusion, no providers of residential or other treatment for drug and alcohol abusers have anything to fear from our policy if the services that they offer are of a kind that are recognised as effective and valuable for that client group.

Question put : --

The House divided : Ayes 91, Noes 59.

Division No. 172] [11.43 pm

AYES

Amess, David

Ancram, Michael

Arbuthnot, James

Atkinson, Peter (Hexham)

Baker, Nicholas (Dorset North)

Bates, Michael

Beresford, Sir Paul

Biffen, Rt Hon John

Bottomley, Peter (Eltham)

Bowis, John

Brandreth, Gyles

Bright, Graham

Brooke, Rt Hon Peter

Browning, Mrs. Angela

Butcher, John

Carrington, Matthew

Carttiss, Michael

Chapman, Sydney

Clappison, James

Clifton-Brown, Geoffrey

Congdon, David

Coombs, Simon (Swindon)

Cran, James

Currie, Mrs Edwina (S D'by'ire)

Davis, David (Boothferry)

Day, Stephen

Deva, Nirj Joseph

Dover, Den

Duncan, Alan

Duncan-Smith, Iain

Dykes, Hugh

Elletson, Harold

Evans, Nigel (Ribble Valley)

Faber, David

Fabricant, Michael

Forman, Nigel

Forth, Eric

Fox, Dr Liam (Woodspring)

Freeman, Roger

Gallie, Phil

Gillan, Cheryl

Goodson-Wickes, Dr Charles

Griffiths, Peter (Portsmouth, N)

Hague, William

Harris, David

Hawksley, Warren

Heathcoat-Amory, David

Hendry, Charles

Horam, John

Hunter, Andrew

Jack, Michael

Kilfedder, Sir James

Kirkhope, Timothy

Knight, Mrs Angela (Erewash)

Knight, Greg (Derby N)

Kynoch, George (Kincardine)

Lidington, David

Lightbown, David

Lloyd, Peter (Fareham)

Luff, Peter

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