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4.42 p.m.

Lord Mottistone: My Lords, I, too, should like to congratulate the noble Lord, Lord Ashley of Stoke, on his introduction of the debate. I am so sorry that he is unwell; I trust that he will get better soon. The timing of today's debate is especially apt for me as Governor of the Isle of Wight. Some noble Lords may have heard from the media recently that we have a real crisis in my island over the financing of our community care. Sadly, that sort of thing, though especially urgent, is not new to the Isle of Wight. It stems from a continuing lack of understanding by officials in all English government departments of the special peculiarities of islands in particular and also, it seems, of authorities with small communities.

I, and successive Members of Parliament for the Isle of Wight, have been grappling with that ignorance for over 20 years. The late Lord Ross of Newport nearly got an important understanding of the problem accepted by Mr. Peter Shore when he was Secretary of State for the Environment in 1979, but the Government fell before the understanding could be reached. I have had two or three similar near misses since with Conservative ministerial friends.

The particular problem is simple to describe. In October 1992 the Secretary of State for Health promulgated a plan for transferring the distribution of moneys for community care from social security to the local authority-run social services, with transitional grants over a four-year period and specified increases year by year over that period. All counties, including the Isle of Wight, made plans accordingly. In October 1993, the then Minister for Health, Dr. Mawhinney, made a statement which indicated that there would be no change in the plan.

However, on 2nd December 1993, almost exactly a year ago, for the Isle of Wight—and, as we now know, for other counties—a bomb was dropped. The Department of Health announced a revised method of calculating for the grant for 1994-95 (the current year) which slashed the Isle of Wight's expected grant by over half. The Isle of Wight County Council and its social services director reacted sharply. They wrote within a week to officials of the Department of Health saying that such a large, damaging, downward change could

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not be handled and repeated those letters in January. My honourable friend, Mr. Barry Field, the Isle of Wight MP, arranged a meeting with my honourable friend Mr. John Bowis, the responsible Minister, just before Christmas last year.

There was no response to the letters and no helpful outcome of the meeting until February when an official of the Department of Health wrote to say that, inevitably, a change in distribution mechanism involved both winners and losers. Some authorities, like the Isle of Wight, would be losers. Effectively, that letter said, "Bad luck old boy, better luck next time". Just how callous can you get? There was no thought for the effect on the old people of the Isle of Wight who were those principally affected.

The grumbles continued throughout the year; I shall not bore your Lordships with the details. But at no stage did the Government do anything to show that they recognised the acute problem of the Isle of Wight and propose some way of alleviating it. So, in mid-November, in exasperation, the Isle of Wight County Council announced to the press that it had only three weeks of community care money remaining as it had warned the Government a year before and throughout the year thereafter. I was gravely distressed by that publicity and told my county council friends so. Inevitably, the effect was to frighten seriously some of the old people of the island. I received letters from the clergy telling me that their parishioners were seriously worried about what might happen.

So what then to do? The Isle of Wight County Council has had a clean bill of health from the district auditor on the spending of its community care money to date. For the future up to March, it has arranged to transfer as much money from other resources as it dares—fewer road repairs for example. Let us hope that there is no snow this winter. It has asked the district auditor to report on all its expenditure during the past year so as to show the Government that it has acted as wisely as it knows how.

The problem is that small communities do not have so much money to reallocate when they get surprises. I expect several of the new unitary authorities—like, as I have discovered, the smaller London boroughs, which have populations not terribly dissimilar to the Isle of Wight—will discover that. Moreover, islands have their own special problems. For example, our fire brigade cannot expect support from adjacent authorities in dealing with major fires. My noble friend Lord Ferrers, when at the Home Office and responsible for fire brigades, had a long and enduring battle with the Department of the Environment to persuade those concerned that our arguments made sense. He was terribly frustrated and never finished the argument; for look where he is now.

What is needed is a quick, fresh look at the Isle of Wight's special problems by the Department of Health and action before Christmas to adjust the transitional grant for this financial year upwards by as much as is necessary. There is need also to ensure that next year's grant is enough. I suggest that anything less would be a grave dereliction of duty on the part of my noble friends responsible for that part of the world. I tried to get a

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warning through to my noble friend the Minister who is to reply to the debate that I intended to say such things. I hope that she will be able to give me some reassurance that something will happen between now and Christmas.

4.50 p.m.

Lady Kinloss: My Lords, I should like to thank the noble Lord, Lord Ashley of Stoke, for introducing this debate today. In 1988, a report to the then Secretary of State for social services by the late Sir Roy Griffiths was first published entitled, Community Care, Agenda for Action. Since then questions have been asked and the subject has been debated, and six years later we are still discussing the best means of ensuring that care in the community is working.

Age Concern fears that some local authorities appear to be defining the need to enter institutional care on the basis of the cost of the care package which would be required at home. They say they are unclear how this apparent move towards resource-led assessments fits in with the underlying theme of Caring for People: Community Care in the Next Decade and Beyond, published in 1989, which suggests that assessments should be needs-led and not resource-led.

The Association of Directors of Social Services welcomes the opportunity to comment on the draft guidance issued by the NHS Executive in August 1994 and welcomes the recognition that there is a need for guidance in clarifying responsibilities for long-term health care. Surely it is vital to decide which authority is responsible for which need, as this is necessarily a cause of financial concern and possibly a cause for confusion and worry for not only those trying to provide services but those on the receiving end. It would surely help those supplying different needs if it could be defined more precisely what constitutes continuing and specialist medical or nursing supervision and in what circumstances these definitions apply.

In the draft guidelines, Health Service Guidelines, the paragraphs dealing with hospital discharges of people with long-term health and social care needs worry families who are unsure of what they are entitled to in the way of help. Patients and their families need to be fully informed about how the procedure will work, and whom to ask about their needs. Can the Minister say whether any local authority or health authority has produced a small pamphlet explaining what is available for long-term care, whether in a nursing home or residential care home, which should also include information of the financial implications of each option? Perhaps the social services and health authorities should produce a small, easily understood pamphlet with guidance on what one can have and where to ask for the information.

The Alzheimer's Disease Society has found that there are about 17,000 younger people with Alzheimer's disease in Britain today. It is extremely rare for it to occur in young people under the age of 30. It is increasing, though, in people under pensionable age. The greatest worry seems to me to be those developing it in their 40s and 50s, who have young families, and who see their parent with this disease. It must frighten children when the parent gets progressively worse. A

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survey reckons there are 17,000 younger people under 60 out of 635,000 people who have the disease. There is only one consultant who has a special responsibility for younger people, and he resides in Liverpool.

The Alzheimer's Disease Society says there is a likelihood of between 50 and 100 younger people in every health district who have Alzheimer's disease. I ask the Minister to look into this apparent lack of focus on this most important aspect of care in the community, because of its knock-on effect on young families. Even those in their late teens will be affected by it. Will the Minister also ask health authorities to assess the needs in their districts of these younger sufferers from Alzheimer's disease? Does the Minister agree that there seems to be a need for more consultant specialists in this field, and not just one?

The noble Lord, Lord Ashley of Stoke, spoke of people being discharged from hospital and only living for a few weeks. Often they would wish to stay in hospital which represents a safe and caring place for them to stay, where they are looked after and may die in dignity. If a patient's wishes are to be considered, surely this is a small but very important consideration for the happiness of those who may not have long to live. I hope that one day community care will work as the late Sir Roy Griffiths hoped.

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