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Page 1, line 25, leave out ("not").

The noble Lord said: I should like to move Amendment No. 22 and speak also to Amendments Nos. 23, 24 and 31 which have been tabled together. I regret that my noble friend Lady Cox, who has put her name to this amendment, cannot be here this evening. She has been delayed on her return from a humanitarian visit to distant parts and will not be back in this country until much later tonight. I also regret that my noble friend Lord Renton has not been able to put his name to these amendments or speak to them. Unfortunately, he contracted viral pneumonia over the Christmas break. I am sure we all hope that he will be back with us as soon as possible. I believe that he is making reasonable progress.

I should declare an interest as the unpaid honorary president of RESCARE (the National Society for Mentally Handicapped People in Residential Care). These amendments follow on from what I said and the questions that I asked--not all of which have been answered--in the debate on the gracious Speech on 20th November last year, at cols. 200 to 203, and the Second Reading debate on this Bill on 7th December, at cols. 1,064 to 1,068. Those interventions are integral to a full understanding of these amendments. Although I shall not repeat all of them now, I shall need to touch upon aspects of them later.

Amendments Nos. 22 to 24 would vary the Bill to make it clear that local authorities could eventually give money to people to pay for places in long-term residential accommodation. Amendment No. 31 is aimed at allowing the families of mentally handicapped people, particularly the more severely handicapped, to purchase a place in a village community, or other forms of residential care. In referring to the more severely handicapped, I am talking particularly of those with a low mental age who cannot be expected to take the decision as to where they wish to live. Your Lordships will appreciate that I am concentrating on the mentally handicapped not only as honorary president of RESCARE but because of the other interest I should declare as the father of a mentally handicapped daughter.

I have promised not the weary your Lordships by repeating all of the points mentioned in my earlier contributions. Most of them can be found in the booklet Made to Care written largely by my noble friend Lady Cox, with a foreword by my noble friend Lord Renton,

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and published last April. Copies of that booklet are available in the Library or free from RESCARE via me. The booklet claims that village communities are care-effective, cost-effective and appear to be preferred by about half the families of mentally handicapped people. Yet they are being stifled by lack of support and negative ideology in the Department of Health, and in local authorities and social services. Choice between a village community and community care for one's relative very often simply does not exist. It has to be community care or nothing.

It is generally accepted, not always entirely fairly, that the old mental hospitals were bad news, but now the pendulum has swung too far in favour of integration at any price. These amendments will do something to alleviate that unsatisfactory state of affairs.

A number of questions have been put by me and my noble friends to the Government for a number of years. As yet, we have not received any satisfactory answers, or indeed any answers at all. Because these amendments are inspired by what we think the correct and obvious answers to our questions should be, I shall repeat some of them now in the hope of eliciting answers and sympathy from the Government for the amendments themselves. The first and most urgent question is whether the Government are absolutely confident that it is safe to continue their present policy of closing all the remaining long-stay mental hospitals and evicting all of their 16,000 more severely mentally handicapped residents into community care by the end of this year, 1996. In view of all the other difficulties surrounding community care at the moment, the Government cannot possibly have that confidence. Assuming that my noble friend cannot put her hand on her heart and assure us that these people will be properly looked after, can she explain why the Government do not order a stay of execution on the remaining long-stay hospitals, at least until the picture is clarified? Can she also explain why her department continues to refuse to put village communities back on the list of provision which the Government encourage local authorities to support? When answering the last question, with the greatest possible respect, can I ask her not to repeat that the Government believe that choice is working adequately at local level? It is absolutely clear that it is not. It is also clear that considerable suffering is being caused because local services and authorities are forcing into community care a growing number of people who cannot cope there and who cannot be coped with there.

I should like to repeat my request to my noble friend to explain why there is such a strong ideological bias in her department against village communities; and, indeed, against our most mentally handicapped people living in the countryside generally? Why is it all right for many of the landed aristocracy to avoid living in a town as though it were the plague, but not all right for my daughter to do the same? I fear that my noble friend Lady Cumberlege gave something of the game away as to her department's thinking on the question when, in reply to a Starred Question on 13th December, she

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described some of the aspects of normal living which the rest of us take for granted. She referred, for example, to such things as,

    "living in a normal house, in a normal street; going to the pub; going to the shops; and going to church".--[Official Report, 13/12/95; col. 1271.]

Why does normality have to include living within walking distance of a supermarket or shops or a pub or in a town at all? The answer is that of course it does not. If my noble friend agrees with the Government that choice should prevail in such matters, then she should look favourably upon my amendments.

I should just add that most people do not go to church, alas, and for mentally handicapped people it can be a far more spiritual experience to go to church in one of the excellent Camphill communities, for example, than in an almost empty inner-city church accompanied by social workers who may be well out of their depth.

I should also add that most village communities are not placed in deep country; they are near or even in towns, and all of them enjoy appropriate interaction with the local so-called "normal" community.

Once again, I should confirm that nothing I am saying should be taken as critical of community care when it works. Community care has enriched the lives of many handicapped people and, indeed, is often advanced and supported by RESCARE.

After our Second Reading debate on 7th December, I wrote to my noble friend Lady Cumberlege the next day to say that I could not accept what she said then in reply to the debate. She said that making direct payments for permanent or long-term residential care would simply add to the bureaucracy. Surely it would require less bureaucracy to pass funds direct to the family of a mentally handicapped person than it would to deal with some of the more mentally handicapped themselves and, indeed, with people suffering from other forms of more severe handicap. As I have not received an answer to that letter, I should be very grateful if my noble friend the Minister could answer it now.

In conclusion, the amendments, if accepted, would do nothing to compel local authorities to support village communities or other forms of residential care. They, like the Bill itself, are merely enabling measures. But they might encourage local authorities and others to start changing their attitudes a little more in favour of our communities. They might help the pendulum to swing back towards the centre. In that hope, I commend the amendments to the Committee. I beg to move.

6.30 p.m.

Lord Carter: The noble Lord made a persuasive and caring argument, but we believe that it is wrong because, in a sense, it is in the wrong place. We are discussing a direct payments Bill and the whole concept of those payments actually came from disabled people who were looking for an alternative to full-time residential care. That is what the Bill is about. Direct payments are all about helping people to remain in their own homes and to live independently. Residential care is not about independent living.

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We could have a very good debate about the weaknesses or strengths of community care and what has happened in the whole mental health field. However, for reasons which we can well understand, I believe that the noble Lord has introduced an argument which we would say--and I expect the Minister will say the same thing--is not in fact relevant to the Bill. We are discussing direct payments to disabled people to enable them to live independently in their own homes with the right level of care, and to give them the freedom to pay for the care package that they need.

The noble Lord has put forward an extremely good argument, but it is on a completely different subject. Indeed, what should happen to the mentally ill and mentally handicapped as regards how they should be accommodated--whether it be in the community or elsewhere--is a different debate. We have had such debates in the past and I should be happy to join in them again, but I do not believe that the Bill is intended to deal with the problem described by the noble Lord.

Baroness Flather: I now understand more clearly why my noble friend disagreed with me when I spoke against an amendment moved by the noble Baroness, Lady Hollis. Obviously my noble friend is keen to widen the scope of the Bill much further than even the noble Baroness wished to do. I was trying to stop her going in that direction at that stage. Clearly we have almost got a new addition to the Bill itself. It would be good if we lived in an ideal world and could look at everything in connection with a single Bill. However, that is not practical. I hope that we can now continue and get on with the job in hand.

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