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Ms Lynne : It might have been before community care, but that does not make it-- [Interruption.] The lack of resources is still there-- [Interruption.] Will the hon. Gentleman allow me to continue with my speech? In response to that, the Secretary of State announced a further £10 million-- [Interruption.]
Mr. Deputy Speaker (Mr. Michael Morris) : Order. I should be most grateful if the hon. Member for Cardiff, West (Mr. Morgan) would either listen to the hon. Lady, who is making an important speech, or retire-- [Interruption.] Order. I do not know who the hon. Gentleman is pointing to, but I am not interested. He should either stay quiet and listen to the hon. Lady or go out of the Chamber.
Mr. Hinchliffe : I am grateful to the hon. Lady for giving way. The point that she is making is important. In response to her comments on the Clunis case, the Minister seems to imply that community care suddenly began on 1 April last year. Community care has existed for generations, before most if not all those in the Chamber tonight were born. She is right to say that of course community care existed when the Clunis tragedy happened. The Minister must address that fact.
The hon. Lady should address her remarks to the resources for community care that she would like to see, bearing in mind that over the four years we are raising them to £2.2 billion.
Ms Lynne : I am grateful to the Minister. I will reach that point in my speech, but we must take into account the Christopher Clunis report, because it was extremely damning of the Government. It is essential to remember that.
What was the response by the Secretary of State for Health? She announced a further £10 million for mental health care in the capital. That is a nice round figure, and appears to be generous, but do we have any idea whether that is enough? I do not think that we do, because there is no monitoring system. Will that money be new, or will it be diverted from another cash-starved programme? I would like the Minister to answer that when he replies.
Another illuminating comment arising from the Clunis inquiry was in section 52.0.1 of the report, which says :
"it has been noticeable how little routine attention appears to have been paid by anybody to the quality or outcome measurement of the community management of mentally ill people."
The report added, in section 52.0.2 :
"purchasers do not know what they are buying nor do providers know what they are selling. No one has a means of telling whether the community service provided is an effective or an efficient use of resources."
Essentially, no one knows what they are doing, how much it costs or whether they are meeting the needs of the people whom they are meant to serve.
How, then, did the Government reach the conclusion that £10 million was enough? How, for that matter, did they reach the conclusion that the money that we are debating tonight was adequate for the various needs that must be met by social services departments across the country? The Government need to set standards for community care, and then openly determine the resources that are needed to meet those standards. If that is more than they can currently afford to pay, let them at least have the decency to be honest with the electorate and say so. Perhaps they could also consider giving the electorate the freedom to decide whether they want more resources to be spent on community care.
If we cannot be convinced that the Government have provided enough resources for community care nationally, can we be convinced that the available resources have been distributed fairly? Again, I am not convinced. Last year, the DSS transfer was distributed in a way that took into account the historic income support expenditure. As I am sure hon. Members know, that was done to take account of the past costs to the DSS of supporting people in residential and nursing homes.
It had been suggested that the use of past income support data would continue for the next few years, although it would be tapered off. Instead, the Government have decided to rely entirely on the standard spending assessment as the means of calculating the amount required by each local authority. As my hon. Friend the Member for Cheltenham (Mr. Jones) pointed out in a debate on this issue last year, it has been admitted by many-- including the Government, or so it seemed at the time--that the SSA system was not right.
At that time, there was a commitment to review the system. Has that review taken place, and did it take community care responsibilities into account? Did the
Column 909Minister or his Department consult local councils? I am sure that such consultation must have taken place, but I should be delighted to hear that from the Minister. Did he and his Department ask local authority representative bodies for their views on the decision? It is possible that the decision to rely wholly on the SSA will not affect all regions, although a social services director in my region said that it was too early to say. There is particular concern, however, in areas with especially high numbers of older people. Many retired people have moved to one of our pleasant coastal towns, and social services departments in such areas fear that the SSA does not take into account the effect of that movement. In the south-west, for example, more that £35 million has been taken away ; not surprisingly, that is regarded as a devasting blow to the region.
Although any money for community care is welcome, it still concerns me that there is not enough, and that the Government are not open in how they determine what is needed and where it is needed. I also hope that the Minister will look again at the requirement to spend 85 per cent. in the independent sector ; I am sure that many social services directors have asked him to do so. I hope that some of my concerns can be remedied.
Mr. Andrew Rowe (Mid-Kent) : I shall be brief, but I think it important to contribute my view that community care is working a great deal better than the picture painted by Opposition Members suggests. Recently I met representatives of two of my local health trusts, along with the social services departments and local general practitioners. Morale was extraordinarily high ; tribute was paid to the work done by care managers and the way in which they work together to ensure that patients' transition from hospital into the community is as smooth as possible. That is very encouraging. Sod's law dictates that, as I speak, something is going badly wrong somewhere in a case in Kent. There are millions of relationships every day between social service staff, the private or public sector and individual clients and inevitably things will go wrong. One of the things that has been remarkable about the development of community care in Kent is the willingness of local staff of social services departments, the health department, the general practices, the caring organisations and the voluntary organisations to work together to achieve as good an outcome as possible for their clients.
Speaking as a Member of Parliament, I point out that we have had a dramatic decrease in the number of letters complaining about the way in which people are cared for and I believe that that reflects great credit on the development of community care in Kent. Of course, there are shortcomings. There always will be. We have a rapidly escalating number of people aged over 65 ; we have a growing number of young people coming from broken homes. Everyone knows that. We could spend twice or three times as much and still be asking for more. I have drawn the attention of my hon. Friend the Parliamentary Under-Secretary of State, the hon. Member for Battersea (Mr. Bowis), to the fact that my local social services people are a little anxious about the cost of some of the equipment that is required to enable people to stay in their own homes. I have no doubt that in the years to come we shall have to consider carefully the sophistication
Column 910and technological advances of equipment which makes it possible for people to stay in their own homes but which is very expensive. I believe that we shall also need to make rapid progress towards giving the public the assurance that social workers are properly qualified. Everyone knows that some staff in social services departments have had an exhaustive training whereas others have not. The introduction of national vocational qualifications has made, or will make, a dramatic difference to the self-confidence and competence of many staff, especially residential care staff and domiciliary staff. I welcome it enormously. I hope, however, that my hon. Friend the Parliamentary Under-Secretary of State is taking seriously the many occasions on which I and others have urged him to make progress with the social work council, because I think that it is not fair to attack social workers for a lack of professional self-confidence and competence while denying them the right to register as fully qualified professionals or, at any rate, giving them a level of competence that the public can recognise. They may not be fully qualified, but if at least there were a council which said what their qualifications were, the expectations of them would become more realistic.
I strongly believe that community care has been a tremendous improvement on what went before. A vast amount remains to be done, but I have to pay tribute to the remarkable way in which all the people concerned, as far as I can see, in my county, where they have been pioneers in the development of social services, are working together, and to their very clear perception that they are only at the beginning of the type of fruitful relationship that will result in ever-increasing improvements in the care delivered to clients in the community.
Ms Tessa Jowell (Dulwich) : There is nothing that divides the House about the desirability of community care. It is beyond dispute that elderly or disabled people are best, and indeed prefer to be, cared for in their own homes for as long as possible. What Opposition Members find so frustrating is the extent to which ideology has replaced a practical debate about what will deliver that objective for elderly and disabled people throughout the country.
I pressed the Minister to give the names of the authorities and people for whom community care was working so well and I recognised them all because of my previous work with the Labour-controlled authorities in Birmingham and Islington and with my present council, in Southwark. They are good news and we should celebrate them. They should not be the subject of ideological point scoring.
Opposition Members are concerned to persuade the Government to remove the obstacles that stand in the way of the community care that people want and need being delivered to people in their own homes. What users of community care and their carers tell us time and again is pretty consistent. It is of little importance who provides what they get. In many cases, people do not even know who provides the care that they receive. A recent study shows that about 40 per cent. of people thought that social security was provided by the local authority.
Flexibility, reliability and affordability are what matters. Research evidence about what residents of homes for the elderly value shows that it has little to do with
Column 911whether the home is run by the local authority or by an independent provider. However, elderly people view the sudden and often unannounced changes of management that are a feature of the private sector as one of the most disruptive influences. Homes change owners about every three years--that is a good run--and every change is profoundly disrupting for the elderly residents.
The Minister talked about local authorities giving preference to putting people into their homes, when the Government have erected every obstacle to local authorities continuing to act as providers of residential care. The role of local authorities in the provision of that care for the elderly has never been more important. Elderly people are being admitted, on average, to residential care when they are 10 years older than they were 10 years ago-- [Laughter.] Will hon. Members just listen to my point, because it is a serious matter?
Ten years ago people were admitted to residential care when they were in their early 70s, but the average age for admission now is the early 80s, when people are much more frail and dependent. Invariably, their care needs are beyond the resources of most independent, private care homes. It is relatively easy to find an independent care home for someone who is not dependent, incontinent or demented. It is much more difficult to find a place in the private sector for an elderly person who requires that level of care. The local authority, therefore, has to provide the essential backstop of reliable, available care. The Government have put every conceivable obstacle--financial and otherwise--in the way of local authorities trying to continue to offer that choice to the relatives of elderly people contemplating residential care.
My constituents have little access to nursing homes locally--I believe that there are about 12 nursing home beds in the whole of Southwark. If my constituents need to be admitted to a nursing home, they have to move many miles away to get the care that they need, which makes journeys difficult for families who wish to visit them. That leads me to another component of the complex web of factors which cannot be ignored in judging the success of community care. One reason why the independent or private nursing home sector has grown at such a rate is that it is an aspect of care which was previously provided free of charge by the national health service and which is now almost entirely in the private sector. If one is looking for an element of care which was previously provided free by the health service and which has now been effectively privatised, one needs look no further than nursing home care for elderly people. I refer now to some of the comments made in the wake of the thorough inquiry into the murder of Jonathan Zito by Christopher Clunis. I think that all hon. Members will accept that the Christopher Clunis case sets back the cause of community care by 20 years. One tragedy obscures the hundreds of thousands of success stories that have been part of community care for people with mental illness for the best part of 30 years.
It is important not to forget what a long haul mental illness is for many people who may suffer from it for most of their life. I was reminded of that recently when I opened the Ivydale centre in my constituency. It provides excellent community mental health support for people living in
Column 912south Southwark. I met again three or four regular users of the centre whom I knew from working as a psychiatric social worker at the Maudsley day hospital in the early 1970s. For them, mental illness and the certainty of a recurrence is a way of life.
I remember very well a man whom I will call Terry. He is in touch with people who use the Ivydale centre. When I worked at the Maudsley day hospital, he was being admitted for the 17th time. The consultant psychiatrist reminded everyone that it was a cause for celebration that he had stayed out for three weeks longer than ever before. It is no good regarding care for people who suffer from mental illness as a series of one -off, acute episodes. It is important to consider the type of care that will support people who become chronically ill for the rest of their life.
The conclusions of the Christopher Clunis inquiry make it important that the debate is conducted on the basis of fact, not muddied by some of the myths that are creeping in as a substitute for fact. How many Christopher Clunises are there likely to be? About 1 per cent. of the population suffers from schizophrenia and, of that 1 per cent., a further 1 per cent. is likely to become seriously mentally ill as Christopher Clunis became seriously mentally ill--a top estimate of no more than 4,000 at any one time.
We also need to remember that all those people who have committed serious offences while disturbed were known to their local services, all were young, and none had ever been long-stay patients in hospitals. So their circumstances had nothing to do with the closure of long-stay mental hospitals. However, what the Christopher Clunis inquiry has raised so sharply is need, and the desperate need in south-east London, for guaranteed funding for the number of medium secure places needed for people who suffer from serious mental illness so that the rest of the mental health services can function properly. I hope that the Minister will give a guarantee that such places will be provided.
Mr. Ian McCartney (Makerfield) : Will my hon. Friend highlight one more important aspect of the Clunis case--the fact that the introduction of the market system has made self-referral almost impossible in inner London and other inner city areas for people suffering from an acute illness? The introduction of the contract system has eradicated self-referral within the system, which in turn makes it almost impossible for the individual concerned to seek emergency services.
Ms Jowell : I shall bring my remarks quickly to a close, but I must reiterate my concern that medium secure places in south-east London should receive the planned funding that is needed, and that the Government's current proposal to require 75 per cent. of funding for people who are mentally abnormal offenders to be met from capitation funding should be dropped.
Mr. Hinchliffe : With the leave of the House, Mr. Deputy Speaker, I shall make one or two concluding comments. I am pleased to follow the speech by my hon. Friend the Member for Dulwich (Ms Jowell), who speaks with such great knowledge and experience of the issues before us. I repeat what she said--that we want community care to be a success. Although there are significant
Column 913differences between us, which have been aired tonight, there is a consensus in the House that we all wish to aim in that direction. I shall reinforce some points that have been made by other hon. Members and make one or two points that have not yet been made. The position of carers is one of the issues that we have not touched on specifically, and there should have been more comment on it in the context of the report. Carers do not now have any statutory right to demand a service or even an assessment. Moreover, in the present arrangements for community care there is no provision for grievance procedures after assessment, for appeals on assessment or for reassessment or review, which would often be helpful.
The other question that worries many people in social services is the confusion that has arisen concerning the measurement of unmet need. Local authorities appear to have been discouraged from making a note of unmet need--yet surely the Minister must accept that measurement of a national care deficit would help any Government to address the problems that we face in developing a proper community care policy.
It would have been helpful if there had been some discussion on the problems arising from the rundown of the Independent Living Fund, which to my knowledge is having an impact on community care in many cases. The limit of £500 is pushing people into institutional care when that could have been avoided. According to parliamentary answers that I have received, that is happening in various parts of the country. Housing provision, too, should have been touched upon, because in anybody's book housing is one of the most fundamental elements of community care.
There have also been some important contributions on wider issues connected with social work. I commend the hon. Member for Mid-Kent (Mr. Rowe) for his reference to a general social services council. He made a point that Ministers should take up. It is no good people, especially Conservative Members, bashing social workers about lack of professionalism when social workers themselves are saying that they want a professional body that will regulate and ensure good standards. The Government cannot sit back and ignore the demands of the profession for such an important body.
The significant and profound difference in ideology between speeches by Opposition Members and most of those by Conservative Members has come across clearly. The differences really do come down to what my hon. Friend the Member for Dulwich called ideology. The Minister was obsessed with the need to use the independent and private sector, and his speech was riddled with comments on that theme.
The speech of the hon. Member for the Isle of Wight (Mr. Field) consisted of his desire to see beds filled in private homes. Conservative Members see care as a business. That is the fundamental difference between the Government and the Opposition. Community care is not a business. Community care is about addressing the real needs of vast numbers of people which will not be met by simply leaving the provision to the market.
Mr. Bowis : May I reply to some of the points which were raised? The hon. Member for Wakefield (Mr. Hinchliffe) raised a number of items which he said were not addressed. Let us concentrate on those that were. He
Column 914referred to the question of charging, which is, of course, one way in which to bring a contribution from users into the provision of social services. It is discretionary. It is always supposed to be according to ability to pay and not to exceed that and it is perfectly reasonable.
My hon. Friend the Member for the Isle of Wight (Mr. Field) raised an important point about the Mencap home. I hope that the Isle of Wight social services will listen to the points that he made and we shall certainly consider that further with him. He also referred to matters affecting the island's budget. He will know, as I know, that the island's budget for social services as a whole will rise by 12.4 per cent. in the current year. He will know as I know that the authorities there have had problems in the past because of their especial cost of fire prevention provision, being an island. He will also know, because we have discussed it before, that in social services we cannot take on board the other aspects of local government funding. The island's council has to use its resources efficiently and sensibly. I must say to him that his director of social services was the only one in the whole country who had not understood that the money from the first year's transitional grant was going to the standard spending assessment in the second year. We shall consider the points that my hon. Friend raised on the question of the underspent reallocation.
The hon. Member for Rochdale (Ms Lynne) referred to the allocation for her borough. That represents an increase in the current year of 12.7 per cent. for Rochdale. She also referred to the south-west and, in the case of Devon, there has been a 13.5 per cent. increase in total resources in the current year and an increase of 17.7 per cent. for Cornwall. I hope that she will tell her political friends in that part of the world that that settlement is generous. It requires in return the efficient use of resources.
My hon. Friend the Member for Mid-Kent (Mr. Rowe) was correct in his assessment of what has been achieved. He talked of good progress and that is the message which has come from all the monitoring that we have conducted in the first 11 months of community care. The right assessment is that good progress has been made and that there is more progress to be made. It is a programme for a decade, not for one year, and we shall build on that. My hon. Friend referred to the general social services council. I have discussed that with him before and I know how closely he is associated with the arguments on that issue. It is certainly an issue which we are considering and we shall have to see the sort of social work level of qualification which one may consider in such a council. Other hon. Members referred to a council which would cover everybody working in social work. There are different arguments, but we welcome the debate.
The hon. Members for Rochdale, for Wakefield, for Dulwich (Ms Jowell) and others referred to the tragic Clunis case. It is not directly relevant to the debate because it pre-dates the way in which we fund community care and goes beyond it. Nevertheless, I accept the points that have been raised about the need to take on board the lessons of that and other comparable cases if we are to reassure the public, people who have mental health problems, their families and the professionals as a whole. Let nobody suggest that we are not doing just that. It is not only a question of £10 million in response to that inquiry. That was an important £10 million towards resources in London, but it is by no means the whole answer. The whole answer begins with the £2 billion that we are putting into mental health provision in the current year and it continues
Column 915through the code of practice, which I am sure that the hon. Member for Dulwich recalls was laid before Parliament in the past year and is now revised and in current usage. The whole answer also refers to the £45 million programme for the medium secure unit building programme. It refers to the key workers training, which is so important and on which I shall be addressing a conference later in the week. It refers to the supervision register which we are requiring should be in the programme by 1 April for contracts from from that time.
It applies to the discharge guidelines on which we are consulting at present. It applies to the supervised discharge and extended leave proposals for which we are awaiting legislation. It applies to the £20 million homeless mentally ill initiative, which supports 2,000 people in the community. It applies to the £35 million supporting £50 million of specific grant--800 schemes supporting 64,000 people. We are talking about the cost of community care doubling from £565 million to £1.2 billion this year. We are talking about £6.4 billion for social services, which is an increase of 48 per cent. in real terms since 1990-91. I have no hesitation in asking the House to support the generous settlement for this year which is provided in the report for the benefit of people in community care.
Question put :--
The House divided : Ayes 185, Noes 52.
Division No. 152] [11.54 pm Ainsworth, Peter (East Surrey)
Arnold, Jacques (Gravesham)
Arnold, Sir Thomas (Hazel Grv)
Atkinson, Peter (Hexham)
Baker, Rt Hon K. (Mole Valley)
Baker, Nicholas (Dorset North)
Blackburn, Dr John G.
Bonsor, Sir Nicholas
Bottomley, Peter (Eltham)
Brown, M. (Brigg & Cl'thorpes)
Browning, Mrs. Angela
Bruce, Malcolm (Gordon)
Carlile, Alexander (Montgomry)
Coombs, Simon (Swindon)
Cope, Rt Hon Sir John
Davies, Quentin (Stamford)
Douglas-Hamilton, Lord James
Durant, Sir Anthony
Emery, Rt Hon Sir Peter
Evans, Jonathan (Brecon)
Evans, Nigel (Ribble Valley)
Evans, Roger (Monmouth)
Fairbairn, Sir Nicholas
Forsyth, Michael (Stirling)
Foster, Don (Bath)
Fox, Dr Liam (Woodspring)
Freeman, Rt Hon Roger
Gardiner, Sir George
Goodson-Wickes, Dr Charles
Greenway, Harry (Ealing N)
Griffiths, Peter (Portsmouth, N)
Hamilton, Rt Hon Sir Archie
Hamilton, Neil (Tatton)
Hampson, Dr Keith
Hannam, Sir John