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Ms Coffey: I shall not give way, because the right hon. Gentleman has taken up an inordinate amount of time in the debate. It is sad that our debate on community care is characterised by confrontation, conflict and confusion. That arises from the obsession of the Government and the Minister with what competition can deliver. We need to make changes that reward co-operation.
We support the objective of the 1990 Act: to give people genuine choice, particularly the choice to remain in their own homes. For that objective to become reality, there must be co-operation between the purchasing authorities and the range of providers. We believe that the private, voluntary and public sectors should be able to
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A local council cannot deliver the objectives of the Act by itself and nor can private providers or the health authority. Those objectives can be achieved only through partnership, particularly with carers, on whom we depend. They are the ones delivering community care. There are some excellent examples of good practice, showing what can be achieved by local authorities in spite of the obstacles that are put in their way.
The Minister should congratulate Lancashire county council and give it credit for some of the excellent things that it has done: for negotiating care agreements with four health authorities; for establishing joint planning with 12 NHS trusts; for establishing an intensive home care scheme, which facilitates early discharge from hospital and helps people to stay at home; for the provision of respite and short-term care; for the development of care homes to provide day care and outreach services; for the development of day care among independent sector providers; and for the joint development of dispersed housing schemes in the community.
Such initiatives are important for improving services and should be followed up across the country. There should be clearer guidance from the Department of Health on the approach to community care. Community care plans should be properly monitored by the social services inspectorate and by the NHS management executive. There should be better dissemination of information on cost-effective practices that deliver services in the most helpful way for those receiving them.
The research on social care outcomes recently commissioned by the Minister should have started in 1993. The present system of funding is obviously based on best bidders rather than best bids. I understand why. Without research on what the best bids are, it is difficult to decide which of the schemes put forward is best.
Mr. Mans:
The hon. Lady has listed several ways in which matters could be improved. Does she agree that inspections for homes in the public sector should be the same as for those in the private sector?
Ms Coffey:
Yes. The hon. Gentleman should have been aware that that is part of our policy.
People are sick and tired of the present situation. They are sick and tired of the chaos and failure of the community care scheme. They know that things will get better only when there is a Government prepared to lead. No amount of debates will convince the people of Lancashire that the Government are acting responsibly on community care. There is failure in services to children and in services to families. Resources are being wasted because they are not being used in the best possible way. The elderly, the sick and children are suffering. That is a reflection of a Government who do not care. If they cared, they would have got their act together on community care a long time ago.
The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns):
First, I must congratulate my hon. Friend the Member for Blackpool, South (Mr. Hawkins) on securing this important debate. I am delighted also to see my right hon. Friend the Member for South Ribble (Mr. Atkins) and my hon. Friends the Members for Blackpool, North (Mr. Elletson), for Wyre (Mr. Mans), for Chorley (Mr. Dover) and for Morecambe and Lunesdale (Sir M. Lennox-Boyd) present, as this is an important and sensitive subject.
The provision of community care is a vital function of local authorities. It offers help and an independent lifestyle, where possible, for the most frail and vulnerable members of society. Due to the vigilance and concerns of my hon. Friends in Lancashire, it seems that we now have to have an annual debate in the House on the failings of politically motivated county councillors in Lancashire and the provision of care in the county. It is a sad fact of life that old Labour is alive and well and running Lancashire county council--not new Labour for Lancashire, but neanderthal Labour.
At a time when all local authorities should be calmly and responsibly providing community care for the enhancement and improvement of the lives of those most in need, in Lancashire a highly politically motivated group of county councillors has hijacked all that is good about community care and turned it into a party-political football for the basest of motives. I remind those county councillors that the Government's policies for community care have helped many people in Lancashire--and throughout the country--to maintain an independent life and to receive better support in their own homes when faced with the problems brought about by disability or frailty in old age. Local authorities welcomed that policy and wanted the extra responsibility that it gave them. They must now accept responsibility for the decisions that they are making as they implement the policy. That includes Lancashire.
It might be helpful if I remind Labour county councillors in Lancashire of the words of Stanley Baldwin during the St. George's by-election in March 1931. He said:
The funding arrangements that we have put in place have also resulted in substantial growth of independent sector providers, real progress towards a mixed economy of care, and better value for taxpayers' money. Those are considerable achievements, both in Lancashire and elsewhere, but I have been concerned that the
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Several of my hon. Friends have today raised matters of serious concern about what has been going on in Lancashire. They also did so last year in a debate initiated by my hon. Friend the Member for Blackpool, North. Those concerns were reiterated today by my right hon. Friend the Member for South Ribble and by my hon. Friends the Members for Blackpool, South and for Wyre. They expressed concern about financial mismanagement and bureaucracy resulting in sudden cuts in services and other problems that Lancashire has not been able to deal with as it should.
Mr. Mans:
Will my hon. Friend give way?
Mr. Burns:
I am sorry, but I do not have time.
My hon. Friend the Member for Blackpool, South mentioned the sad case of David Gardner. I am concerned about that case. I understand that Mr. and Mrs. Gardner's complaint about lack of continuity of care has been upheld, but that Lancashire county council has not yet said what it intends to do as a result. I hope that it will learn from the lessons, problems and stress that the Gardner family had to go through to get to this point. I shall ask my officials to obtain further information about the case and respond in writing to my hon. Friend once we know more from the social services inspectorate about what has been going on.
As a result of the problems highlighted in the debate last year, my predecessor was sufficiently concerned to ask the chief inspector of the SSI to provide a full report on Lancashire. That document confirmed that there was cause for concern about how Lancashire was implementing policy in several respects. Subsequently, the chairman of the social services committee, Mrs. Joan Humble, received our analysis of the problems and was asked to respond with an action plan. Our analysis raised serious issues, which required a considered and constructive response. Mrs. Humble's initial reply did not demonstrate such a response. After time for further and, thankfully, more mature reflection, however, a plan was duly received from Lancashire in September. I have asked the chief inspector of the SSI to monitor and report back to me on the implementation of that plan.
I am concerned to emphasise to Lancashire county council that decisions about the allocation of services should be taken and applied consistently, and with sensitivity to the needs and feelings of service users. The council has responded with assurances that disruptions in the continuity of care, which occurred in earlier years, have now been dealt with and that more effective monitoring arrangements are in place. I hope that that is indeed the case, and I shall be looking for evidence of that when Lancashire's action plan is reviewed.
I am also concerned that changes to the balance of services should avoid unnecessary disruption to service providers. The council has responded with an intention to publish its purchasing policies in a form that will be more readily accessible to service users and providers. Good communication among commissioners, providers and users of services is essential to effective management of
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The funding of community care has featured heavily in this debate, particularly in the comments of the hon. Member for Burnley (Mr. Pike). Total personal social services funding by the Government is a massive £9 billion including the social security contribution. That is a phenomenal amount of money compared with what was being spent in 1990.
I have also heard a great deal of protest from the county council about its inability to manage community care without even more money. When I look at the figures, however, I see an interesting picture. Within the total amount that the Government consider the county council needs to spend this year to provide a reasonable level of service is an element of £156 million for community care, which includes £61 million for its new responsibilities and the community care reforms. That represents an increase in total resources for community care since 1990-91 of 104 per cent. in real terms--over and above the rate of inflation. That means that Lancashire has done even better than the national average, which was a doubling of resources in real terms during that period.
It is for each local authority to set its budget, but given the accusations made by Lancashire, I find it surprising that it underspent in two financial years. It was clear that the hon. Member for Burnley was unable to explain that and the so-called justification offered by the hon. Member for West Lancashire (Mr. Pickthall) made me remain deeply sceptical of the line that he was trying to push.
"Power without responsibility--the prerogative of the harlot throughout the ages."
It is time that councillors lived up to their responsibilities rather than parroted meaningless platitudes and slogans that do nothing to improve or enhance the quality or provision of community care. I shall explain some basic facts of life to them. The transfer of social security funding through the special transitional grant has resulted in substantial increases in the level of care to people in their own homes, in day services and in the use of care homes to provide the short breaks that are essential for many families. People entering residential or nursing care homes have benefited from the assessment process to identify their needs and match them to a care home of their choice.
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