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1.51 pm

Mr. Tom Clarke (Monklands, West): This has been an interesting debate; it would have been all the more interesting and informative if right hon. and hon. Members had adhered to our informal agreement. We might then have heard from my hon. Friend the Member for Glasgow, Rutherglen (Mr. McAvoy), who is now unlikely to catch your eye, Madam Deputy Speaker.

In a speech that lasted for one minute less than one hour, the Secretary of State for Health did not seem to give us a statement on the health service, his

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responsibilities and the Queen's Speech, but a screen test for a future role as Leader of the Opposition. I am sorry to have to say this to him, but I have some experience of the film industry and I do not think that he did very well. But he need not worry too much about that as I do not think that he has much competition.

The Secretary of State spoke about my right hon. Friend the Leader of the Opposition producing a mouse of a speech, which was particularly odd when considered in the light of the central issue of direct payments, which is, I understand, the flagship of the Government's care in the community policy. What we heard from the Secretary of State was a mere squeak--it was quite inadequate.

Care in the community is an extremely important issue. If we wish to separate rhetoric from reality we need look no further than the speeches of my hon. Friends the Members for Crewe and Nantwich (Mrs. Dunwoody), for Woolwich (Mr. Austin-Walker) and for Newham, South (Mr. Spearing). We heard nothing from the Government to confirm the crisis that exists in care in the community; Conservative Members sit back almost as though pretending that the crisis does not exist. It is not as though the Government were not warned: they were warned years ago by the National Audit Office. That warning led to the Griffiths report and, ultimately, to the National Health Service and Community Care Act 1990. Sir Roy Griffiths said then, and his view is just as applicable now, that given the chaos in community care, the one alternative not open to a responsive Government was to do nothing, which seems to be precisely what the Government have done.

The Secretary of State for Social Security need not listen to me. I occasionally see him and his right hon. and hon. Friends in sociable settings when we meet distinguished organisations and voluntary bodies. Those people know what is going on in the field and I refer the Secretary of State to some of their views about community care.

Scope recently produced a document entitled "Disabled in Britain: Counting on Community Care", in which it discussed the idea of charging for services. It said that local authorities have always been able to charge for domiciliary services but that, until recently, few did so. However, under community care, central Government allocates money to local authorities on the assumption that 9 per cent. of the revenue for the services will be raised through charges to service users. If the shortfall is not met through charges, the guidance advises local authorities to forgo that service provision. According to Scope, consequently many social services departments have either been forced to start charging for services they previously provided free or have increased existing charges.

A survey tells us that 17 per cent. of disabled respondents say that they have had to refuse a service because they could not afford to pay for it and that 18 per cent. have had to start paying for a service that they had previously received free of charge. If that is not lurching to the right, I do not know what is.

We can also refer to the views of distinguished bodies such as the Royal College of Psychiatrists. Its report revealed that, since the introduction of care in the community, there have been 34 killings by seriously mentally ill patients in contact with psychiatric services. The Zito trust--which was founded in the name of

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Jonathan Zito, the musician who was murdered on the London Underground--puts the figure at one killing a month. In other words, a murder is likely to be committed every month by a known patient who has been referred to doctors previously on the grounds of mental illness. We are invited to ignore that reality of community care in Britain.

Mr. Stephen: Will the hon. Gentleman give way?

Mr. Clarke: Yes, but the hon. Gentleman should bear in mind the fact that his speech cut into the Minister's time and he is about to do that again.

Mr. Lilley: That is my problem, not the hon. Gentleman's.

Mr. Stephen: How many of the patients to which the hon. Gentleman has referred were certified by psychiatrists as needing to be locked up for the protection of the public?

Mr. Clarke: I would be delighted to debate the matter if time allowed. I look forward to such a debate. As the Minister observed that the time considerations are his problem and not mine, he should not be too surprised if he finds that he can speak for only a few minutes.

The severely mentally ill are far more likely to do harm to themselves than to others. If that fact is not crucial to community care, what is? The National Schizophrenia Fellowship published a report last month highlighting the number of suicides among people suffering from schizophrenia. The report suggested that one in 10 schizophrenics commits suicide, and it admits that its methodology has probably underestimated the figure. There are about 250,000 schizophrenics in the United Kingdom.

They are not the views of a Labour party that is behaving irresponsibly--although we take them on board--they are the views of responsible organisations and responsible people. Bharat Mehta, the chief executive of the NSF, said:

In its 1992 paper "Health of the Nation", the Department of Health said that the Government had set a target of a 33 per cent. reduction in the suicide rate among people with severe mental illness. Two years later, in its follow-up paper entitled "Fit for the Future", the Department of Health admitted that it had been unable to report any findings because no definition of "severe mental illness" had been agreed.

There has also been an increase in violence, particularly towards social workers and GPs. Sadly, a doctor was murdered this year in Airdrie, the town next to my constituency. They are not isolated incidents. The Government do not seem to realise what is happening. They publish polished documents and spend money on advertising which is a world apart from the reality that I am now seeking to address. What is their view on the fact that 85 per cent. of people with learning difficulties live in the community and are provided with very little care?

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On disability, a few weeks ago we debated a quarter of a century of the important Act that my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris)--the Chronically Sick and Disabled Persons Act 1970--took through the House. That Act and the Disabled Persons (Services, Consultation and Representation) Act 1986 that I piloted through the House are not fully implemented. May I say to the hon. Member for Shoreham (Mr. Stephen) that if the section of the 1986 Act had been fully implemented and assessments made before people left psychiatric hospitals, the problem that he identified would not have occurred.

Mr. Lilley: What does the hon. Gentleman propose should be done to tackle the problem of violence that he identifies and I believe greatly exaggerates? As, on Second Reading, the Labour party opposed the measures that we introduced to provide supervised treatment of patients in the community, what does he now propose in addition to them?

Mr. Clarke: I am not surprised that the Secretary of State completely distorted what I said. He did not appear to realise that I was quoting the views of professional bodies, organisations and individuals working in community care. I did not submit those views, although I now endorse them. It would be an insensitive Secretary of State who rejected those views with such speed.

The right hon. Gentleman asked what we proposed to do. We shall not have to wait very long to be in government, but I shall tell him what he ought to do as we are debating his Government's Queen's Speech. He should tell us when the so-called Disability Discrimination Act 1995 will be implemented. He should tell us when the Government will implement the two earlier Acts to which I referred. Particularly in view of the problem of carers, which does not influence the Secretary of State one iota, he should tell us something about yesterday's excellent publication--he might challenge it until I tell him that the Department of Health made a considerable contribution to its production and I congratulate Mr. Roger Tyrell on that--"Stronger Links", which dealt with the need for caring for children who are disabled. I challenge the Secretary of State to tell us what he proposes to do about that document as the facts are known to his Department.

What about problems of children with disability? The health service management unit report published in March stated that up to 40,000 young carers in the United Kingdom are aged between 11 and 18. More than half of them live with a lone parent and almost half that number have mental problems. The Secretary of State should address those issues if he proposes to deal with the problem at all.

If the Government's care in the community policy is as successful as we are told, before we finish debating the Queen's Speech next week can the Secretary of State or the Home Secretary explain why there is still an enormous problem of mentally ill patients in prison? Last year we were told that the figure was 19.2 per cent. The Minister has not updated the figures today. I challenge him to do so and to produce the report that Professor John Gunn has already delivered to his Department which shows that one third of remand prisoners have a medically diagnosed mental disorder. I challenge him too to tell me whether in his speech or any other speech to the Conservative party conference, when Ministers crowed about law and order,

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they explained the real problems in Britain's prisons and the additional problems being created by their policy of care in the community.

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