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8.37 p.m.
Lord Dahrendorf: My Lords, it remains for me to thank all those who have spoken in and contributed to what was a thoughtful debate. It has been one which augers well for the future of the voluntary sector. I should like to offer a special word of gratitude to the noble Baroness, Lady Byford, whose combination of personal experience and thoughtfulness was quite remarkable and perhaps characteristic of the best in this debate.
It is not for me, in this final minute or two, to go over the ground again. I am taking away three particular strands of general argument. One is that much of what happens in the voluntary sector is quite closely related to what happens in local communities. I am grateful that the noble Lord, Lord Dubs, mentioned the non-governmental organisations for voluntary activities in the international field. They, among several other important organisations, illustrate what can be done by voluntary activity.
The second important strand I noted is the one which the right reverend Prelate put so well when he talked about keeping society together. That will have to start where people form communities on the ground. It is not something which can be done by legislation or by government as such.
The third strand is the values which represent the work in the voluntary sector--values of service, values of civic responsibilities, values of altruism. However, make no mistake, those who work in the voluntary sector derive great satisfaction from so doing. Those in the voluntary sector are sometimes liable to complain that they do not receive enough recognition. I often feel that this is an area of activity and life where satisfaction lies in the activity itself. I know that many who are active in this world feel that way. Recognition does not need to be recognition by government.
What we have heard will give us many opportunities further to advance the case of the voluntary sector. It is crucial. When the noble Earl, Lord Longford, spoke about discussions nearly 50 years ago, I thought he was going to refer to Lord Beveridge, who, after his other reports and after inventing the welfare state, turned his attention very much to the voluntary sector and the need for the voluntary sector. That is as true today as it was then.
We need a thriving economy. We need a public sector which, as the noble Viscount, Lord Addison, said, does things which are properly within the realms of state activity. But, in the end, what keeps our society together is the activity of many millions of individuals which is based on their own motives, interests and sets of objectives, and the many little and larger associations formed around that. My Lords, I beg leave to withdraw the Motion.
Motion for Papers, by leave, withdrawn.
8.40 p.m.
Lord Graham of Edmonton: My Lords, perhaps the noble Baroness, Lady Cox, would allow me to intervene briefly because there is an inadvertent error to the list of speakers. That shows that my noble friend Lord Carter is to wind up for the Labour Benches in the following debate. Your Lordships will see that my noble friend Lady Hayman is not my noble friend Lord Carter and, equally, that my noble friend Lord Carter is not my noble friend Lady Hayman. The error is entirely mine and I should like to apologise to the House for it.
Community Care
8.41 p.m.
Baroness Cox rose to ask Her Majesty's Government whether they are satisfied that their policy of community care is providing satisfactory care for people suffering from mental handicap and learning disabilities.
The noble Baroness said: My Lords, I am grateful for this opportunity to raise issues concerning the care of people with learning disabilities or mental handicap. I am particularly grateful to all noble Lords who are to
contribute to the debate because their concern and expertise will be valued deeply by all who experience the problems we shall be addressing.I begin by declaring an interest and clarifying my terminology. My interest is that I am a patron of ResCare, an organisation set up and run by families caring for relatives with mental handicap. As regards my terminology, members of ResCare who have intimate experience of these issues prefer the term "mental handicap" to the term "learning disabilities" which they see as trivialising the multiple problems often experienced by their relatives. Therefore, at their request, I use the term "mental handicap" and hope that those who prefer the term "learning disabilities" will understand my terminology.
I wish to address three issues: the principles underlying the policy of community care; the quality of care currently provided for people with mental handicap, especially in what is termed the community; and the need for diversity of residential provision with particular reference to the option of village communities.
I begin by recognising that all was not ideal in the past. The shortcomings of the old long-stay hospitals for the mentally handicapped, however humanely they were run, were graphically exposed by a flood of studies from the 1950s onwards such as Goffman's classic book Asylums. That deluge of criticism led to a swing away from care in hospital type environments to care in the community, usually in small homes in urban or suburban areas.
That policy has been successful for many of the former patients of hospitals for the mentally handicapped. Many have found the opportunity to realise their potential in new ways. Many have enjoyed enhanced independence and the dignity associated with a more normal life within the wider community. I have received hospitality in such homes and rejoiced to see the fulfilment in the lives of their residents. For those people, the policy of community care has been a great success. I am sure that none of us would wish to put back the clock or be stinting in our appreciation of all that has been achieved.
But we should not be having this debate this evening if that were the whole story. The policy of community care has not been so happy for everyone, and it is incumbent on us to take seriously the plight of those who are suffering as a result of current policy. Many mentally handicapped people are not being provided for adequately in the community and many families of mentally handicapped people looking after relatives at home are deeply concerned about what will happen to their loved ones when they can no longer care for them.
The concept of community care implies that there is a community which cares. But the reality is that the community can be a very lonely place. Living in a small, three or four bedroomed house can make the person feel cabined, cribbed and confined compared with the more independent movement possible in the more spacious and sheltered grounds of a larger scale residential community.
Moreover, many of the earlier groups of people discharged into the community were those best able to adjust to greater independence. As the more severely and often multiply handicapped are discharged, it is more difficult to cater for the greater complexity of their needs and there is a growing catalogue of tragic cases where the care provided has been so inappropriate that suffering has resulted.
I am not extrapolating from a few isolated examples to build a wholesale attack on community care. But we ignore the failures of policy at our peril or, more important, at the peril of those affected by the policy. The peril is very real. Some residents in community homes have died as a result of inadequate care or inappropriate implementation of the policy of so-called normalisation.
Three examples must suffice. Recently, in a home run by social services in Stockport, a man choked to death on food. He was the third man to die in such a way in Stockport in the past two years. It is reported that the coroner expressed criticism of the policy of having only one carer to look after six mentally handicapped people.
Secondly, a young man had been moved from a campus hospital to a small house. On the basis of freedom and risk taking, he was allowed freedom of movement, despite his known lack of traffic sense. He was killed within three weeks.
Thirdly, people with epilepsy have drowned in the bath in community homes, having been left alone by relatively untrained staff inappropriately trying to encourage normalisation of lifestyle.
The list is growing but the catalogue of concern is not limited to individual cases. A report in August by the Royal College of Psychiatrists reflects those concerns in its claim that there is a crisis in community care for people suffering from mental illness and mental handicap.
Research undertaken by Dr. Lorna Wing of the Medical Research Council documents events over a year during the closure of Darenth Park Hospital. She found that the experience of the move was positive for about one-third of the ex-residents but another third were deemed to have suffered a deterioration in the quality of life. One of her conclusions, widely ignored, was:
- "For many in this group with moderate or severe learning difficulties, sheltered communities would offer more opportunities for an interesting life than a small house in an ordinary street".
Therefore, it is not surprising that many families with mentally handicapped relatives are acutely anxious about current community care policy and are pleading for the development of a diversity of provision, including residential or village communities, in associated or satellite homes in the community.
It was against that background that last year my noble friend Lord Pearson and I brought out a publication with a foreword by my noble friend Lord Renton entitled Made to Care: The Case for Residential and Village Communities for People with a Mental Handicap. That stimulated the Department of Health to set up inquiries which have resulted in two interim reports--a mainly literature review by Professors Eric Emerson,
Chris Cullen and others and a study into the costs of village communities published by the Department of Health with the University of Kent's Personal Social Services Research Unit. Neither study has undermined our case for village communities. However, there is reinforcement of the concern which we have expressed as regards the shortfall of accommodation for people with mental handicaps.It is estimated that there is a current gap between supply and demand of between 20,000 and 25,000 places. To bridge that gap would require a 40 per cent. increase in accommodation. Those figures do not even begin to take into account increase in demand over the next two decades. Meanwhile the total number of residential places has been substantially reduced as hospital places are closed more quickly than alternatives are created.
Therefore, my first specific question for my noble friend is to ask what the Government are doing to bridge that gap to meet the current needs for accommodation and to anticipate the expansion of demand in the years ahead.
I move very briefly to my third theme; namely, the desirability of diversity of provision with reference to the case for village communities. I welcome the statement by the Department of Health in 1995 which reaffirms that services should take account of:
- "a variety of factors, including the views of individuals, families and professionals".
That commitment is fine but the reality is often at variance with commitment. The views of individual families are too frequently ignored. The views of professionals too often reflect an entrenched ideology bitterly opposed to the concept of residential or village communities. That opposition too often overrides the desires and requests of those most intimately involved--the families with profoundly handicapped relatives. A book published earlier this year called Bound to Care is an anthology of their experiences. A ResCare survey found that 50 per cent. of families with mentally handicapped relatives want village or residential communities as an option. But despite that, not one local authority has allowed a village community to evolve.
Therefore I ask, will the Government stop the closure of the remaining hospitals and encourage the establishment of village communities as pilot projects? I refer, for example, to a new development on the unsold site of Offerton House in Stockport, where day services are still in place, and to the evolution of the existing St. Ebba's Hospital in Epsom into a village, as wanted by many families.
I conclude by urging the case for village communities. It rests on the evidence of existing communities in the voluntary, independent sector, such as Ravenswood Village, the Camphill communities, and Brookvale in the UK, and comparable communities in the Netherlands. I ask my noble friend specifically if she will please give urgent priority to the development of village communities as one option in the care of mentally handicapped people, and if she will authorise at least some pilot projects on some existing hospital sites before it is too late? Can she reassure all concerned
that the Government will turn their principles into policies, their commitments into reality, and do everything to ensure that there is available the kind of care which is described so vividly and so poignantly in the brief poem by Beryl Drummond, quoted in the book Bound to Care which states:
- "For Rachel:
Build me a world, where I can be free
Free to be myself.
Biuld me a world, where I can be safe
Free from exploitation,
Build me a world, where I can work
I need my independence,
Build me a world, with specially trained people
Who understand my needs,
Build me a world, where I'll feel secure
I'm sure I have the right,
Build me a world
Don't force me into yours".
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