House of Commons Hansard Debates for 1 Feb 1995

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I thank my hon. Friend the Member for Canterbury for the courtesy with which he has dealt with the matter and kept us informed of his thinking. I listened carefully to what the hon. Member for Belfast, West (Dr. Hendron) said, although I am unable to agree with many of his comments. However, he presents his views with clarity and precision. The hon. Member for Bradford, South presented his constituent's interests clearly and boldly.

My hon. Friends the Members for Chingford and for Blaby bring to the House very real experience of the split-second decision making that is required while soldiering in Northern Ireland. Their experience is highly relevant and I am thankful that people who have served in difficult circumstances in our armed forces can bring a measure of authority to our debates. The hon. Member for Upper Bann (Mr. Trimble), in his excellent and admirable speech, outlined and dealt with many of the real difficulties that we face in this area. All hon. Members agree that keeping the peace is a crucial and critical task in which British soldiers have played a glorious and an heroic part. That is why we will always be prepared to examine any evidence that is brought before us by my hon. Friend the Member for Canterbury and by others to see how we can continue to refine the training and experience that we give to our soldiers before and upon deployment.

As my hon. Friend knows, we ask very young men who are armed with high- velocity weapons to make difficult decisions in a split second in the dark when it is raining, when their adrenalin is pumping and when they may be very frightened. Their discipline and training over the years have proved successful. They have given the British Army and services a record of which they can be proud in Northern Ireland--a fact for which our nation and the House are grateful. I congratulate the hon. Member for Carlisle (Mr. Martlew) on the tribute that he paid to his regiment. I am glad that he found its members in good heart. I am grateful to all who have taken part in this debate for the measured, clear way in which they expressed their views. The Government will take note of all of them. I assure the hon. Member for Bradford, South that his points about Private Clegg will be considered and referred to the proper quarters. Again, I thank all who have taken part--especially my hon. Friend the Member for Canterbury--for giving me the opportunity to respond to this important debate.

Mr. Deputy Speaker (Mr. Michael Morris): It may be convenient for the House to know that there is a fault in the Division Bell system. It is not a fire alarm.

We now move to--

Mr. Brazier: On a point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker: If it is for the Chair, yes.

Mr. Brazier: There was a reference in the debate that has just closed to an early-day motion on the Order Paper. May I put on record the fact that it includes the words

"recognising that soldiers must obey the law"?

Mr. Deputy Speaker: Order. That is an abuse of the Chair.

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Care in the Community

11.30 am

Mr. Archy Kirkwood (Roxburgh and Berwickshire): I am grateful for this opportunity to discuss community care and mental health, on which there has been quite a lot of activity in the House recently. Adjournment debates have been held, and several private Members' Bills of significance have been introduced--by the hon. Members for Dulwich (Ms Jowell) and for Croydon, North-West (Mr. Wicks), for instance--all dealing with various aspects of care in the community. It is therefore right, in the relatively calm atmosphere of this Adjournment debate on a Wednesday morning, that the House should have the chance to discuss these matters under the new Jopling procedures--

Mr. Don Dixon (Jarrow): I believe he is in America, and we were here late Monday night and Tuesday night.

Mr. Kirkwood: Possibly so; that might not be far enough away for some of us, but it is a matter for him.

This is a good chance to see how the community care changes are being implemented 18 months on. Community care is the right policy, and the Government have been right to implement it, although the way in which they have done so has caused some difficulties. I suspect, however, that those difficulties were inevitable given the radical nature of the changes. Any political Administration would have had problems getting from where we were to where we want to be. I think that hon. Members agree that community care is right in principle and that the Government are right to adopt and promote it. It has a great deal of potential; we must be careful not to throw out the baby with the bathwater when dealing with some of the criticisms that have rightly been levelled at the implementation of the policy. Moving from what was always a service-based policy to a much more flexibly managed, needs-led approach certainly is a radical change, which has had profound effects for users of the service and for their carers. The effects have also been profound for health care professionals and social work and social services professionals, and there have been consequences for the way in which voluntary groups operate too. All these people have had to respond dramatically to the changes implemented in the past 18 months.

I acknowledge the value of the work done by counsellors in social work and social services committees throughout the country, although I suspect that the Minister may not quite share my enthusiasm. They have done a great deal to make the policies work in the face of considerable troubles and difficulties. Immense challenges have faced them and many demands have been put on them. The House owes them a debt for the work that they have done and for the diligence with which they have discharged their duties.

Mr. Nick Hawkins (Blackpool, South): Does the hon. Gentleman agree that some Labour-run authorities, of which Lancashire is perhaps the worst example, have

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badly mishandled the implementation of community care, and that it is not right to give blanket approval to the work done by social security committees on county councils--

Mr. David Hinchliffe (Wakefield): Social services committees.

Mr. Hawkins: Social services committees in some counties have done a good job, as the hon. Gentleman rightly said, but some county councils have misused the resources.

Mr. Kirkwood: I was desperately trying to avoid that kind of tone. Lancashire has lost £14 million. I do not know how it has husbanded its resources, but it would have been a clever trick for anyone to make a fist of the situation after losing £14 million. I am trying to stay above that sort of party political argument. Of course the hon. Gentleman's point was quite legitimate and I do not criticise him for making it, but I am trying to take a more philosophical approach to some of these problems. We owe that to the counsellors and to those who use the services--after all, it is the latter who suffer. I was pleased to note that the Audit Commission's report, "Taking Stock"--I am sure that all hon. Members have read it--acknowledged that counsellors have shown themselves capable of responsible stewardship and of managing the process as well as might be expected. It is always easy to see things clearly with hindsight, but when Sir Roy Griffiths initiated the process he made it clear that he thought he was setting the agenda for a decade ahead. I think that the Government have been trying to travel too far too fast. The evidence in "Taking Stock", published in December, strongly suggests to me that some of the local authorities being asked to administer the new system do not possess the management information systems to enable them to cope with the uneven demand that they are facing in the first five or six years of the transition.

Local authorities are having to deal with existing protected clients under the old social security system--residential care--and with new clients who are coming on stream now. It is impossible to anticipate demand without sophisticated new techniques. The Audit Commission report makes it clear to my satisfaction that we expected local authorities to do too much without adequate tools. I should like the Minister to bear that thought in mind for the rest of the debate. Perhaps we should be thinking in terms of reaching our goals after 10 years instead of rushing in a manner that makes it difficult for people to cope.

Given all the evidence that we have it seems to me that there is an unanswerable case for setting up a standing working group that would involve local authority representatives, academics, departmental representatives and so on to oversee funding and many of the other issues which I expect to be covered in the next hour and a half. I hope to persuade the Minister of this idea. If he cannot respond to it today, perhaps he will respond to my suggestion later in writing. I am prepared to wait for the right answer. It is vital to get people to sit around a table in good faith to look at some of the problems of funding that are emerging and to deal with them as best they can.

The first issue that such a group would want to examine is the almost irresistible pressure that the 1990 legislation will place on health service professionals to cease providing long-term health care. The Department of

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Social Security transferred resources to local authorities to deal with residential care, and I understand the rationale behind that. As a consequence, the Government were able to control the budget, which was previously demand led.

Health care authorities are discharging long-term patients, including geriatric patients, into the community. I understand that care packages must be in place before such patients are allowed to be discharged, but when they are they become the responsibility of the local authority. At that stage, their needs are considered from a medical point of view, and their means are considered.

If the Government do not take a firm grip in the next few years, and if the process that I have described is allowed to develop unfettered, irresistible pressure will be placed on trusts, community health units and acute hospitals to divest themselves of long-term national health service patients, who hitherto have expected cradle-to-grave treatment. They have expected, rightly, because they have paid national insurance contributions, free long-term health care. That care will not be available to them in five or six years' time. I note that the Minister shakes his head in dissent. I shall be interested to hear him on this point. It will be a crucial part of and an influence on the funding that is available for community care in the hands of local authorities.

It is believed that funding is spiralling out of control, and the evidence suggests that the authorities are right. I spoke to the British Medical Association about the matter. I am sure that the Minister knows the figures. In 1990, 73,000 people were registered as national health service long-term care patients. In 1993, the total had fallen to 59,600. There must be a minimum level of national provision for long-term health care patients, but I see no evidence that the Government understand that. We cannot allow the number of long-term health care beds to fall indefinitely. I sense that the Minister wishes to intervene, and I am happy to give way to him.

The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): Has the hon. Gentleman seen the Government's continuing carguidance, which was drawn up as a result of the Leeds case? Has he submitted his views? Is he aware that there are NHS beds not only in hospitals but in nursing homes, which are not included in the figures that he has presented to the House?

Mr. Kirkwood: I understand the Minister's second point. I have been wrestling with some of the Government's guidance and positions on long-term health care. I am not alone in continuing to be slightly confused. Indeed, the BMA is slightly confused about exactly what the Government are saying about long-term health care.

The draft guidance that is supposed to be the subject of consultation states that

"the hospital will need to take account of the needs of other patients in determining how long the person can continue to occupy an NHS bed."

That is to be contrasted with the guidance in 1989, accompanying circular HC(89)5, which stated:

"No NHS patient should be placed in a private nursing or residential care home against his/her wishes if it means that he/she or a relative will be personally responsible for the home's charges."

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Over the past few years, various positions have been taken in guidance that has been issued by the Department of Health. The confusion continues to obtain. If the BMA is confused, I suspect that others are too. The Government have a duty to clarify exactly what is happening.

Some weasel words have been introduced into some of the guidance circulars on which consultation is now taking place. I refer to the NHS executive guidance, which for the first time says that the NHS remains responsible for care "within available resources". It says that every effort should be made to meet the preferences of the patient

"within the practical options and resources available." These words are incapable of precise meaning. When the Minister and I have to throw ourselves at the mercy of the NHS in 20 or 30 years' time, in our twilight years, will we be entitled to know the exact circumstances in which the NHS will provide and those in which it will not?

The shunting--a terrible piece of jargon--of health care resources into the local authority area for community care is a matter of singular and continuing concern. The same can be said of the circular and consultation process. The Minister and his Department should urgently try to resolve and clarify the issue. Similarly, it should be considered urgently within the review process that I have proposed.

Mr. Hawkins: Does the hon. Gentleman agree that one of the problems about the interface between health services and social services is that in many counties, including Lancashire, social workers have insisted on contradicting the advice of general practitioners and allowing elderly people who have not been in very good health to stay at home? When those people have had suddenly to be admitted to hospitals as emergency cases, an intolerable burden has been placed on hospitals and health services generally. That is one of the difficulties that the new system has thrown up in areas where social workers have insisted on countermanding GPs' advice on the best places for their patients.

Mr. Kirkwood: If that is true, it would cause me some concern. I have never heard of such circumstances, but I hear what the hon. Gentleman says. If that has happened, we should examine it carefully.

Funding is the crucial and core issue. I do not want to demand unlimited amounts of money. It is too easy for Opposition politicians to say that we need blank cheques. We know that blank cheques are not available and it is stupid to try to operate on that basis. The 1994-95 local government settlement meant a difficult year for local authorities--I think that everyone would accept that in his or her quiet moments. It would seem that 1995-96 will be an even more difficult year. It is unfortunate that we are entering a crucial phase of the transition in community care at a time when local authority budgets are severely constrained.

Mr. Matthew Banks (Southport): Does the hon. Gentleman agree that it is very important, in these days of public spending constraints, that local authorities spend the money allocated to them specifically for community care through the standard spending assessment? There are numerous examples of Liberal Democrat-controlled

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councils, or where the Liberal Democrats have a major hand in controlling policy within those local authorities, that show that they are not spending--

Mr. Hinchliffe : It is ring-fenced.

Mr. Banks: I will deal with that point. Indeed, it is not, and the hon. Gentleman should know that.

The fact is that if one looks at Liberal Democrat-controlled authorities-- those in which the hon. Gentleman's party has a hand, and perhaps he will comment on this, in Cornwall--

Mr. Deputy Speaker (Mr. Michael Morris): Order. The hon. Gentleman did not have the Floor for a speech. A brief intervention was appropriate.

Mr. Kirkwood: I invite the hon. Gentleman to make an intervention in another debate. It is not a worthwhile use of the time of the House to debate individual councils. I stand by the statement that I made: the Audit Commission found that, by and large, councils were doing a good job in difficult circumstances. If the hon. Gentleman wants to hire a hall in Cornwall, I would be happy, on a day and place of his choosing, to appear on a public platform and argue with him long and hard about the individual circumstances of Cornwall. But I do not want to do that this morning. I am trying to keep the debate slightly above the tone of our usual debates, but I do not think that I am succeeding.

Mr. Gary Streeter (Plymouth, Sutton): The hon. Gentleman is succeeding, because I am not going to attack him on a party political basis, as he is making a thoughtful and helpful speech. These are serious issues.

To what extent, none the less, does the hon. Gentleman place the responsibility on local authorities to use their money wisely? I give him one example--I shall not mention the political party, although he is a member of it. In Devon, the Liberal Democrats took control in 1993, reversed a decision to close local authority homes and is now placing residents in local authority homes at a cost of £400 a week, when in the private sector they can get better care at £200 a week. Is that not something for which local councils have a responsibility? It is not all the Government's fault.

Mr. Kirkwood: Again, if the hon. Gentleman wants to hire a hall in Devon, I will happily debate individual circumstances with him. From memory, I recall that Devon lost about £16 million. The hon. Gentleman makes a valid point. Of course I confirm that local authorities must act responsibly and spend money wisely. I have no evidence that the council in Devon has acted in anything other than the best interests of its users. The hon. Gentleman must understand that it is sustaining a loss. The rules changed, as he knows, unilaterally and unexpectedly. Losing £16 million is a pretty difficult row to hoe in terms of the provision of crucial services for people who are in a very vulnerable position.

Mr. Nick Harvey (North Devon): Is my hon. Friend aware that Devon was the hardest hit of all the counties in the transfer of funds that resulted from the revision of the formula? Despite the attention that is rightly being given to Gloucester and the Isle of Wight, under the old arrangements Devon received 4.6 per cent. of national spend in this area, but under the new formula will receive only about 2 per cent. Whatever the merits of the

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argument of the hon. Member for Plymouth, Sutton (Mr. Streeter)--it is legitimate--he must appreciate that the total sum that he proposes is the merest skim of the sums about which we are talking. It is a blue herring.

Mr. Kirkwood: I am obviously failing miserably in my attempt to try to keep us out of a party political dog fight. There will, of course, be legitimate exchanges, but I am trying to concentrate on and accentuate the positive, because I am determined to try to get something out of the Government this morning, even if it is only a promise that they will reconsider my suggestion that a body should be created to consider these issues and that its advice should be made available to the Government.

The Government underestimate the impact on some counties of the unexpected change in the distribution of resources at the beginning of this financial year, and I hope that that will not be forgotten. It should be constantly kept under review, because of the impact--we have heard exchanges that reinforce the point--that it has had on the finances available to some local authorities.

More than anything else--the evidence appeared in the Audit Commission report, "Taking Stock", which was published in December--nobody correctly estimated the high demand that would be evident from the start of the new regime. Expectations, quite properly, have been raised. The Government cannot be held to account for every new demand or expectation encountered, but carers, users, voluntary groups and domiciliary services are experiencing quite unexpected interest and demand. The House and the Government must recognise that and take it into account, otherwise we will face severe examples of retrenchment, harsher eligibility criteria and withdrawal of services. In Gloucestershire, even the legal process is involved. We are heading rapidly towards a tangle of legal challenges in the courts. I do not believe that that is in anybody's interest. As I understand it, there is no spare money in local authority budgets. No other funds are available from charging or from efficiency savings. The bottom line is that front-line services are now at risk.

Mr. Hawkins rose --

Mr. Kirkwood: I shall not give way. I have been speaking for far too long already.

The Government must look at that. I suggest strongly that they should set up some review machinery, involving local authorities, to oversee the process for at least the next few years.

The ten-minute Bill of the hon. Member for Dulwich, Community Care (Rights to Mental Health Services) Bill, is a very important measure, which I hope the Government are considering seriously. Evidence produced by the National Association for Mental Health--MIND--shows the need for a crisis service and that extra resources are cost-effective in terms of moving away from acute units to a decent crisis and emergency service.

As I said earlier, the private Member's Bill of the hon. Member for Croydon North-West, the Carers (Recognition and Services) Bill, is an important measure. I hope that the Government are considering that as well. I hope, too, that they will look at some of the constraints that local authorities are under, in terms of the 85 per cent. restriction--the limit on the amount that can be spent from what previously was paid to the private sector. The lack of privately provided domiciliary services in many

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areas is making it difficult to ensure that that money is most flexibly used. The Audit Commission said that flexibility, responsiveness and sensitivity were the three key issues in the successful promotion of community care in the future. I am sure that that is right, but I do not think that the Government have got the process right. The funding will create immense problems for the rest of this year and from next year.

One of the best ways in which the Government could cope with the situation today is to say that they understand that some factors need to be considered on an on-going basis, and that they will agree to enter into some arrangement, by way of a working group or some other body, with local authorities and other interested parties, to work these things out for the remainder of the transitional period. If they did that, local authorities throughout the length and breadth of the land would have more confidence that the Government were aware of the difficulties that they face.

11.58 am

Mr. Piers Merchant (Beckenham): I am delighted that we are debating the important subject of community care, whose funding we should monitor to ensure that the objectives are adequately met. I must compliment the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on the restrained character of most of his remarks, and especially on his recognition of the value of this radical innovation.

Not only is community care delivering a better service, as it will continue to do; it represents an important devolution of power to local government. I particularly welcome that, and I am keen for it to work successfully. I pay tribute to people in my local authority of Bromley whom I know well: for instance, the director of social services, Mrs. Clare Marchant--I hasten to add that she is no relation--and other health professionals and administrators who have co-operated effectively in both setting up the system and making it work.

That is not to say that there have not been some transitional difficulties. Such difficulties were inevitable; indeed, I consider it miraculous that such a major change--such a huge innovation--has not involved more problems. In the borough of Bromley, certainly, most of those difficulties were overcome owing to the good will, flexibility and effort contributed by all who were keen for the system to work. I congratulate them on overcoming the problems at an early stage. It is the easiest thing in the world to make a case for increasing spending on community care, as on any other programme. Again I pay tribute to the hon. Member for Roxburgh and Berwickshire, who made a point of saying that he was trying not to make such a case--although his attempts were not entirely successful towards the end of his speech. My wife is very good at suggesting that spending should be increased in various areas, but she is outdone by Opposition Front Benchers, who daily call for more expenditure.

The one thing that those Opposition Members are never prepared to do, however, is announce the grand total of the extra spending for which they are calling and explain to the House, and the outside world, where they will find the money. It is incumbent on anyone who wishes to behave responsibly to explain how the more generous

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funds required are to be secured, either through revenue raising or through reductions in certain services. The Labour party, however, becomes very coy when the question is put.

Although wonderful things can be done in community care, are already being done and, no doubt, will be done increasingly in future years, demand is open-ended. Eventually, no doubt, anyone who needed the slightest support could be given 24-hour backing, but the cost would be disproportionate. Balance is needed: we must ensure that adequate provision is made for community care, and that it is recognised as an important step forward, but the budget must not be open-ended.

I do not criticise social workers, who do a tremendous amount of good work, but I feel that they sometimes lose sight of reality and fail to appreciate that budgets must be controlled. All services, by their nature, must be cash limited; otherwise it is impossible to plan, make commitments or make room for other priorities.

Mr. Hawkins: My hon. Friend has mentioned the important role played by social workers. I agree that some social workers do an excellent job, but in my part of Lancashire--and perhaps in my hon. Friend's constituency as well--certain of them are so ideologically opposed to the idea of placing anyone in a private sector home that they refuse even to contemplate it. That is a vast waste of taxpayers' and charge payers' money.

Mr. Merchant: I must say that that is not a problem in my area--I have never encountered such a case--but I know that it has happened elsewhere. In certain parts of the country, care in the community has been impeded by those with tunnel vision who have not been prepared to exercise the flexibility that is required if the system is to work.

We should not overlook the generous funds provided by the Government, which stem from a belief in the system and a conviction that enhanced flexibility and better standards of care are necessary. It is so important to free those who have been trapped in grey institutions, and give them the care that they need, that the Government have rightly set aside large extra sums. In 1995-96, £1.8 billion has been provided in specific additional funds for care in the community--44 per cent. more than in the previous year--while £2.5 billion has been provided for 1997-98. No one could describe that as anything other than generous.

That is not the whole picture, however. The amount available for social services spending generally--the biggest growth area in local government-- has doubled since 1990-91, rising from £3.6 billion in that year to £6.4 billion in 1994-95. In 1995-96 it amounts to £7 billion: that is an increase of 9 per cent. in a single year. Local authorities are free to decide their exact social services budgets. It would be absurd if they were not, given that powers have been devolved to them, and I believe that that is what they want. But to make community care a success in the first years of its introduction they were given a special transitional grant, which was ring-fenced and separate from the revenue support grant settlement. That grant, however, is not the only source of community care funding, although some people appear to have made the mistake of thinking that it is. It is additional to what authorities can take out of their social

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services budgets. Some local authorities, including some that have recently complained about underfunding, have not spent up to their standard spending assessment, which makes their claim that they are not given enough by central Government look rather hypocritical.

Mr. Hinchliffe: Does the hon. Gentleman recognise that the transitional grant was intended to finance new functions and increased responsibilities? He talks of the Government's generosity; will he tell us what they would have spent if the old system had remained? In 1979, £9 million was spent on social service departments' funding of private care; by 1993 the figure was £2.5 billion. What would the figure for the next two or three years have been?

Mr. Merchant: The hon. Gentleman is not comparing like with like. I assume that he is not suggesting that the old system should have been retained. Care in the community is a better system, and should not be compared with the old one. There is no doubt, however, that Government funding is excessively generous. It is more than adequate to cope with the extra demands placed on local government.

Mr. Bowis: The straight and simple answer to the question posed by the hon. Member for Wakefield (Mr. Hinchliffe) is that under the old system £160 million less would have been spent.

Mr. Merchant: The fact remains that some local authorities have complained about being insufficiently funded. We should, I think, examine their position more closely.

In the Audit Commission's recent second report on care in the community implementation, David Browning pointed to four areas of difficulty for local authorities. I shall refer to all four. He said that there were examples of poor local financial control and that there was increasing demand. That is undoubtedly true. He pointed to local decisions to allocate fewer funds to social services and, of course, he referred to changes in the Government formula. I have mentioned all four lest someone suggests that I am selecting two that are particularly favourable to my case. However, I shall deal first with those two, the first of which is poor local control. There are undoubtedly examples of local authorities taking on the burden of care in the community, not managing it as efficiently as they should and slipping up on financial control. It is notable that it is those authorities which have screamed and complained most in the past few months. The complaints should be directed at their own internal systems rather than at their lack of grant. Of course, they attempt to find scapegoats for their own problems.

The second area causing difficulty is the decision to allocate fewer funds. As I said earlier, local authorities are free to choose how much they spend in different areas and there is no doubt that some local authorities--the one on the Isle of Wight is an example--have chosen not to spend up to their full SSA on personal social services. There again they have themselves to blame if they suddenly find that they are short of funds.

One of the two other areas is the growth in demand. That presents difficulties because no one can clearly predict demand. Pilot studies and predictions can be undertaken, but until people start knocking at the door requiring the support that local authorities are now duty

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bound to provide, one cannot know for sure what the pattern of demand will be. I hope that my hon. Friend the Minister will be flexible and will continue to monitor demand as it arises. The fourth issue relates to changes in the Government formula. Those changes have benefited many authorities, but they have also resulted in some authorities not getting as much as they might have expected from the previous year's formula. But as, in the first year at least, the formula was biased in their favour and there has merely been rectification to a fairer overall system, they should be thankful for the extra support that they received, perhaps unexpectedly, in the first year of operation.

I do not want to go into specific examples in great detail, but I am sure that some of my hon. Friends intend to do that. However, I will mention that there is a clear contrast between local authorities which have managed the system well, are working within their budgets and delivering an excellent service--my local authority in Bromley is an example--and some others. Hon. Members will know whether a system in their area is working effectively because we are often the first people to receive complaints if it is not.

I have had so few complaints about care in the community that there is clearly no severe underlying problem in my area. That is clear even if I did not believe the evidence that has been provided to me by those who are administering the system. The few complaints that I have received have related to individuals; the system is bound to slip up occasionally in such cases. As soon as those problems have been drawn to the attention of those responsible the difficulties have been put right.

We can contrast that with the experience in counties such as Gloucestershire because despite large increases in funding--for example, Gloucestershire had a 10 per cent. increase in 1994-95 over the previous year--some counties have managed to get themselves into the most extraordinary mess. According to The Independent Gloucestershire council appears to be spending about £1,000 a day on computer consultants who scrapped a community care computer system at a cost of £250,000 and promptly spent £200,000 on replacing it.

Mr. Nigel Jones (Cheltenham): The hon. Gentleman talks about increases. Does not he realise that there has been a cut of £3 million in the community care grant in Gloucestershire? That was totally unexpected and occurred after it had arranged all the contracts. The article in Computer Weekly last week entitled "Careless in the Community" bears absolutely no relation to the truth. If the hon. Gentleman would like to speak to Deryk Mead, the social services director in Gloucestershire, I can arrange it.

Mr. Merchant: As I have said, there was a 10 per cent. increase between 1993-94 and 1994-95 in Gloucestershire's social services budget. That is a particularly large percentage in view of the restraints in other areas of local government expenditure. I do not accept the hon. Gentleman's defence of poor financial control in that authority.

There are many other examples, but it will suffice to say that authorities that have managed the system well have not only coped but have produced a far better system than before. They have demonstrated that care in the community as a practice and not just as a theory is most

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effective. Authorities which have not managed the policy well need to look closely at their systems with a view to improving the standard of care for their people.

At the end of the day this is a major test for local government. As I said at the start of my speech, it represents a major devolution of power to local government, which I welcome. I should like to see local government having more responsibility and to see other functions that are currently carried out by central Government devolved to local government. That can be done only if we are confident that local government will be able to deliver those services at an adequate standard across the country.

This is a test for local government. If it is able--and I sincerely hope that it is--to ensure that the system works smoothly and effectively in the years to come, its case for handling other services will be greatly enhanced. However, if authorities drag their feet and are not able to deliver the efficiency that is expected of them in handling such a major area of policy, it will be difficult to support their understandable arguments that they should also handle other public services.

12.17 pm

Mr. David Hinchliffe (Wakefield): I welcome this opportunity to speak on community care, albeit in a brief debate. I shall stick to the issue of available funding, because care in the community is so wide ranging. I shall address in particular the difficulties that we recognise in many parts of the country. Some local authorities face serious problems in meeting their statutory responsibilities on community care changes. The Opposition are especially concerned about the impact of that on some of our most vulnerable citizens--the users and carers and people who depend on vital services.

I shall start by briefly recalling the warnings that were flagged up by local authorities when the changes were introduced in April 1993. Although the Minister was not in post at the time, he will recall that the Association of Metropolitan Authorities warned that the changes were underfunded. I remind him that the Association of County Councils, which was then Conservative controlled, also warned the Government about that. At that time, it was concerned with cuts in the counties. The situation has markedly worsened--to be fair, that has been conceded by Conservative Members who have contributed to the debate--as a result of the change in the formula which was introduced with effect from this financial year.

Many metropolitan authorities are finding their base budgets under pressure and cutting services. At least a dozen county

authorities--there may be more, but 12 have told me this--have run out of special transitional grant. The Association of County Councils predicts a funding shortfall for the next financial year of at least £200 million. The Minister will know that because he has met the association at least once, and possibly twice, recently. In every way, demand for care services has been beyond all expectations. One of our concerns is with the way in which the Government have not been willing to consider the issue of unmet need, and to make some sort of measurement of that need. They have discouraged local authorities from doing that. The most sensible way of planning for future care provision is to look at where the gaps are and how

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we can plug those gaps. I appreciate that resources are not infinite and that we must consider how funding is used. My concern is that the Government have not planned properly on a national basis to deal with serious unmet need in various parts of the country.

Mr. Hawkins: I know of the hon. Gentleman's expertise in this matter, which he gained before coming to the House. Does he agree that immense responsibility is placed on all local authorities to manage their funding sensibly? Is not one of the most serious criticisms made of local authorities that so badly mishandle funding--Lancashire is a classic example--that they have allowed unlimited, incredibly expensive domiciliary care packages? They have not limited those packages to exceptional cases, as the guidelines from 1992-93 onwards clearly state they should. Purely for ideological reasons, they have not used much less expensive, much better residential care in the private sector.

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