§ 3.25 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, I beg to move that the House do now again resolve itself into Committee on this Bill.
Moved, That the House do now again resolve itself into Committee. —(Baroness Hooper.)
§ On Question, Motion agreed to.
§ House in Committee accordingly.
§ [The CHAIRMAN OF COMMITTEES in the Chair.]
Lord Carter moved Amendment No. 113AH:
Before Clause 44, insert the following new clause:
§ ("Assessment in the planning process of charges for accommodation
§ —(1) Each local authority shall, in taking steps to prepare its first plan of the provision of community care services in their area under section 44(1) below and annually thereafter specify acceptable standards of care and accommodation for placements for people in their area in residential care homes and nursing homes and shall specify those standards for each category of personal or nursing care required depending on an individual's level of dependency.
§ (2) Each local authority shall be required to supply the Secretary of State with a schedule setting out the range of charges which it considers reasonable and would be prepared to pay to meet the standards specified in subsection (1) above in respect of each of the categories of personal care set out in paragraphs 6 and 7 of Schedule 4 to the Income Support (General) Regulations 1987 in respect of the forthcoming financial year by such date as the Secretary of State may direct.
§ (3) Subject to subsection (4) below, the Secretary of State shall, after receipt of the information specified in subsection (2) above and following consultation with the local authority associations and other bodies he considers relevant, satisfy himself that the appropriate amount of income support (if it were in payment) would be adequate to meet such range of charges as has been specified for each of the categories of personal are as specified in subsection (2) above in relation to the forthcoming financial year.
§ (4) In respect of the first financial year for which community care services are provided under this Part, the Secretary of State shall certify that he is satisfied, after the consultation specified in subsection (3) above, that the equivalent resources have been made available to local authorities to meet the range of charge, notified to him under subsection (2) above.
§ (5) This section shall come into effect at Royal Assent.
§ (6) In this section, "appropriate amount of income support" has the same meaning as in paragraphs 5, 6 and 7 of Schedule 4 to the Income Support (General) Regulations 1987.").
§ The noble Lord said: In moving Amendment No. 113AH, with the leave of the Committee I shall speak to Amendments Nos. 113AJ and 113AL. The group of amendments deals with a real and urgent problem: namely, the current shortfall in income support levels in meeting the full weekly cost of residential and nursing care. We know that local authorities will inherit this shortfall next year. Residents at present in care and those who enter residential care between now and spring 1991 will be trapped in the shortfall.
I received a letter from the director of social services of Wiltshire County Council, who stated:
there is a shortfall between the level of benefits provided by Social Security and the cost of the fees. In Wiltshire the shortfall is approximately £30 per week for a residential care home, but substantially more for a nursing home".
§ Other surveys have shown a shortfall of £40 to £60 per week. All this is before we take into account the effects of higher interest rates on residential home costs in the private sector.
§ To their credit, the Government have decided to collect information on the level of costs and fees in residential care, but as we understand it this information will not be available when the social security budget is transferred to local authorities in April next year. Perhaps the Minister will confirm this when he comes to reply.
§ The pressure already affects the quality of care. As we all know, there is great pressure on relatives to make up the difference. In my own family, in attempting to find residential care for an elderly member of my wife's family, I experienced the subtle and insistent attempts by the social services departments to persuade the relatives to pick up the bill if they possibly could. We are told that in some areas of the country there are no homes with charges below income support levels. Obviously this raises tremendous problems for elderly, poor people and their relatives.
§ Those who will need residential care after the Bill comes into force will be able to claim from the local authority which will pay the full cost and recover a contribution from the resident towards the cost. However, anyone who is already resident in care now or goes into care before next year will have to rely on income support. There are approximately 150,000 residents on income support today and government figures confirm that over 40 per cent. are in homes where the charge is above the income support level.
§ I wish to ask the Minister to say in his reply what happens when people's savings run out. What happens when the relatives are no longer prepared to make up the difference? What happens if fees increase still further and the gap widens? I am sure he will emphasise in his reply the increase proposed in the levels of benefit for August. That is between £5 and £15 per week against a shortfall of £30 to £60 per week. All that the so-called preserved rights to income support achieve for those in residential or nursing care or entering before next spring is to preserve the right to uncertainty and deep concern.
§ I also wish to ask the Minister the Government's view about the comparison between residents in the same home after next spring. There will be some who have the preserved insecurity and others who will benefit from the Government's proposals if they enter after that date.
§ These amendments are designed to overcome this problem. Amendment No. 113AH places two new duties on local authorities to specify acceptable standards for residential placements and to incorporate these standards into the community care plan; and to supply the Secretary of State for Social Security with a schedule which sets out what it considers to be a reasonable range of weekly charges to provide an acceptable standard of care.
§ The schedule would correspond to the current categories of care used by the Secretary of State to set the national limits for income support. The first duty would require the authorities to list and publish 1475 the standards which must be met in homes which they will be using for residential care. The amendment seeks to avoid perpetuating the present two-tier system whereby residents who rely on public funds often receive poorer quality care. Adequate standards should include proper safeguards on privacy and should ensure that residents have their own clothing and appropriate diets. There should be adequate staffing and staff training and the care provided should encourage independence and include rehabilitation, where appropriate.
§ The second duty would provide a mechanism whereby the size of the income support shortfall in the area could be measured. At present there are 13 income support limits depending on the type of care needed; for example, ordinary residential care for the elderly, nursing care for someone under pension age, or treatment for alcohol or drug dependency. The schedule would allow comparison between the income support level and the rate which the local authority considered reasonable and was willing to pay. There would be an incentive for local authorities to set reasonable rates because these are the rates which they will have to pay from April next year when buying places in residential care.
§ Amendment No. 113AJ seeks to provide some limited protection for people who are in residential care homes or nursing homes now or who need to be in care but cannot find a home willing to accept them. There would also be continuing protection after April next year if income support limits failed to keep pace with homes' fees. The amendment gives the Secretary of State for Social Security the power to make a discretionary topping-up payment from the social security budget. An individual who needed care in a home with charges above the statutory limits would have the right to apply to the Secretary of State for an additional payment of income support. In considering the application and reaching a decision, the Secretary of State would have to take into account information supplied by local authorities and health authorities on the range of charges at homes registered in the area. There would also be a duty to take account of the rates which the local authority believed reasonable and was prepared to pay for an adequate standard of care.
§ The Independent Healthcare Association points out that the maximum levels of income support are inadequate to meet the average charges for nursing or residential care for the elderly. Most people are obliged to obtain top-ups either from relatives or from a charity. Fees for shared rooms are closest to the income support levels. Ironically, however, local authorities are insisting on a lower proportion of residents—often as few as 20 per cent.—occupying shared rooms. The association claims that a home which has a majority of patients receiving income support is only viable if the owner is able to provide 24-hour cover at a rate lower than the local authority would pay someone else, where capital costs have been paid and no reserves are kept in anticipation of future expenditure, where staff are paid significantly less than the rates proposed by the Whitley Council and where expenditure on repairs, maintenance, renewals, newspapers and other things is kept to a 1476 minimum level. However, that impinges on residents' quality of life.
§ We have all had massive briefing on this problem. We have heard from the Association of Metropolitan Authorities, the National Federation of Housing Associations, the NCVO, the Community Care Alliance, the Local Government Information Office, the Spastics Society, the National Association of Citizens Advice Bureaux and many others. Those organisations are in the front line of the problem. They cannot all be wrong. I urge the Government to deal most sympathetically with a situation where frail, elderly and frightened old people and their relatives are looking to the Government to provide a solution. I beg to move.
§ 3.30 p.m.
§ Baroness Cox
I support the amendment, moved so well by the noble Lord, Lord Carter, which contains many important provisions. The essence of the amendment has been expressed comprehensively and in general terms. Therefore, I do not wish to repeat the arguments. I wish simply to illustrate the need for the amendment. I shall do so by referring to a true case study which could be multiplied many hundreds of times over.
An elderly patient was discharged from hospital where he had been treated, having suffered from a cerebrovascular accident or stroke. By the time he left hospital he had recovered reasonably well but had some problems with mobility as a result of paralysis caused by the stroke and some problems with incontinence. He needed the support and advice of an incontinence adviser; he needed assistance to enable him to visit the lavatory regularly. However, he was sent to the kind of care home where that kind of specialist, skilled help was not available. Consequently, he suffered from incontinence, and that led to soreness and pressure areas. Those areas became infected and the patient's physical condition deteriorated. The patient naturally and understandably became depressed, demoralised and withdrawn.
A very unhappy syndrome of physical and psychological problems could so easily have been avoided if only there had been a proper assessment of the patient's needs and proper planning in terms of his social and health needs. The situation could further have been avoided if he had been sent to an appropriate place of care, and if he had received the care appropriate to his needs even if it was rather more expensive.
The noble Lord, Lord Carter, has highlighted the inadequacy of the provision of so much of the care that is currently available. We must ensure that all people in the community, particularly the frail elderly whose numbers will increase so dramatically over the coming years, are given the quality of care which they deserve and need. The example I have given illustrates the general purpose of the amendment. I shall reiterate the purpose: it is that such problems should not recur under the new dispensation.
The amendment would allow for the abolition of the suffering associated with the kind of situation I 1477 have described. It would also eliminate the fears that many people have that they will not be able to obtain or continue to have the high quality care which they need. That is an important point. The amendment is designed to meet in personal terms the needs of anyone entering community care and to meet in general terms the policy associated with planning provision and financial support for that care. I hope that the proposal will be accepted so that we avoid unnecessary suffering and provide for people according to their own unique, distinctive and individual needs. I support the amendment.
§ Baroness Seear
I, too, wish to support the amendment to which I have added my name. The noble Lord, Lord Carter, referred to the situation where, for financial or other reasons, patients are forced out of institutions where they receive proper care, or at least something approaching proper care. In some cases there is nowhere for them to go, but in many cases families will attempt to do something for thern out of a sense of family responsibility. However, in many cases those families are inadequately equipped to provide the kind of care that is required. As a result the patient suffers and the burden that falls on people trying to provide care becomes intolerable. I wish to underline that point in particular. We cannot overburden carers. We shall kill off carers in the attempt to maintain cheaply people who should be in institutions.
§ The Parliamentary Under-Secretary of State, Department of Social Security (Lord Henley)
If my noble friend will give way, it may be convenient if I intervene at this moment to put the Government's case. I hope to speak again at the end of the debate and reply to many of the points that Members of the Committee have made. Before I begin I should emphasise that Amendments Nos. 113AH and 113AJ are separate amendments and are grouped with Amendment No. 113AL. We are obviously speaking to the two together but it would not necessarily follow that if the first one were agreed to, the second one goes with it. They require separate decisions.
We have now come to one of the most important components of our proposals for care in the community—the drawing up of community care plans for the provision of services to local communities. These plans are a cornerstone of our policy. They are designed to enable local authorities to set out and publish the needs of the community they serve, their objectives for the arrangement of services to meet those needs within the resources available to them, and to set out targets which they are setting themselves to develop and improve the services available in their areas. We shall also require local authorities in drawing up their care plans to consult local statutory, voluntary and other agencies to ensure that the approach to community care becomes much more user driven rather than fitting clients into existing services.
I do not believe that the new clause proposed in Amendment No. 113AH will help in the planning of services in the way that I have just outlined. First, 1478 the clause appears to be designed to require local authorities to specify in their first plan, and annually thereafter, the standards of care and accommodation for placements for people in their areas in residential and nursing care for each category of personal or nursing care. Naturally the objective of all authorities will be to provide the best possible quality of care in residential settings for all clients whom they may assess as in need of such care.
It may well be that as authorities develop their plans over time they may wish publicly to state the standards and specifications which they may require from service providers, including their own directly-managed provision. I should certainly not wish to prevent authorities from doing so if they felt that it was the best way to secure the provision which they required locally. At the same time I do not wish to impose such a bureaucratic requirement upon them, particularly in the early rounds of planning when they will have a great deal of work to do in identifying all the resources which may be available locally and determining the way in which they wish to specify contracts and enter into agreements for that provision.
As I understand it, the second part of the clause is intended to require authorities to tell the Secretary of State what range of charges they consider reasonable and are willing to pay to meet the standards they have specified. It would also require the Secretary of State to satisfy himself that income support, were it paid, would have been inadequate to meet such charges and to certify what resources equivalent to the income support that would have been paid has been made available to local authorities.
That is a receipe for chaos and bureaucracy. It takes away all the local flexibility that we wish to give local authorities to enable them to enter into the contracts which are most beneficial in meeting the needs of those in their area requiring different forms of residential care. What is reasonable to one man can be outrageous or unrealistic to another man. Not least, there are clients with very differing needs, some of whom may be supported in residential care where fees can justly be comparatively low and made even more competitive through the purchasing power of the local authority. In other cases, people with very high and specialist dependency may require much more intensive and expensive support which the authority also feels is justified in the individual circumstances. Under our proposals local authorities have the flexibility to enter into either or both kinds of arrangements according to the priorities they determine. The clause before us does nothing to assist them in this; indeed, it could have precisely the opposite effect.
In turning to Amendment No. 113AJ I should like to commend the movers for their concern about this issue. I should like to emphasise at the outset that the Government recognise the importance of protecting the position of those who—for good and sound reasons—will not be covered by the new community care arrangements. We recognise the very real need to give as much reassurance as possible to those who are currently residents of homes and receiving benefit. I have to tell the Committee, however, that 1479 I believe that this new clause is both unnecessary and impractical.
In addressing the new clause and the concerns expressed by the movers of the amendment, I ought first to remind the Committee why the Government have decided to continue the income support system for people who are resident in homes at the point of change to the new arrangements next year. We recognise that the present system is not perfect and is something of a blunt instrument. However, we also consider that it is important to avoid any unnecessary disruption to the arrangements made for the many frail and elderly residents of these homes and their families. It is also extremely important to enable local authorities to concentrate on their primary task after April 1991; namely providing an effective service for those turning to them for help for the first time under the new arrangements.
The Committee will recall that the whole issue of the current income support system for people in homes was extensively debated in another place both during the passsage of this Bill and during the passage of the Social Security Bill. There are three separate themes in the Government's response and I believe that that response renders this new clause unnecessary.
The Government fully recognise the importance of the current levels of the income support limits. Last month we increased the weekly benefit for virtually all existing claimants in homes by £10 a week. I remind the Committee that that represents an additional cost of £100 million on top of existing expenditure of £1,100 million. Following representations made in another place we are also introducing a second stage to the increase in the limits in 1990-91. In addition to the changes already made, from 13th August there will be further targeted increases to all the income support limits of £5, £10 and £15 to help maintain their value during the coming year. More than 200,000 people will benefit. That amounts to £45 million more this year and £70 million in a full year.
My right honourable friend the Secretary of State has also been considering how he should carry out future upratings of the income support limits. He has undertaken to make a thorough assessment of the position and to look carefully at the levels and structure of the income support limits as they would apply from 1991. He also expects to approve the commissioning of the necessary research in the near future.
Thirdly—and this thought also lies at the heart of the new clause we are debating now —my right honourable friend wants to be able to use the information that will become available as a result of practical decisions and negotiations by local authorities after 1991. The Social Security Bill, which we shall debate in 11 or 12 days, already contains a new provision (Clause 9) which confirms his powers to do just that —to set local limits for income support taking into account evidence supplied to him by local authorities about the charges they will be negotiating and meeting for residents in homes under the new arrangements.
§ 3.45 p.m.
§ Lord Carter
Will the noble Lord allow me to intervene? Can he answer the question which I put to him and tell the Committee when the information which the Secretary of State proposes to collect in order to make those decisions will be available?
§ Lord Henley
Obviously it will take some time for that information to become available. It will not be available immediately the arrangements come into effect next April. We require information from the local authorities after they have negotiated fees for the homes. There is no point at the moment asking local authorities what fees are being charged in their areas because those are not necessarily the true fees. We need to know what the fees or charges will be after negotiation by the local authority. That is the evidence that we require. The information that the noble Lord seeks from local authorities at the moment has little value.
We shall not be able to use this new source of information immediately from April 1991 but we shall want to start to use it in reviewing and setting the limits as soon as enough robust information is available. Officials will be talking to the local authority associations about how local authorities can help in that process and how soon they can begin to help.
That brings me to the new clause in detail. The clause would require the Secretary of State to request from local authorities schedules of fees charged by homes in their area. It would also require him to deal with requests for review of the income support payable for an individual in a home where the amount paid is less than the fees charged and in doing so to take into account the schedules of fees supplied by local authorities, statements made by the local authority concerned about the range of charges in its area which it would be prepared itself to cover and any other information he wishes. The clause would come into effect on Royal Assent and hence be operative before April 1991. That is the point that I made to the noble Lord earlier. It is very different evidence from that which we would acquire after local authorities started negotiating their own fees.
In summary, the difference between this approach and that of the Government is that the proposers of the amendment wish individual local offices to reach individual judgments in individual cases and want the system to start now. The Government consider it crucial, on the grounds of simplicity and equity and on the grounds that there must be firm controls in that area to avoid a blank cheque being signed on the taxpayer, that there should continue to be a regulated system of limits applying, albeit one that is sharper than our current blunt instrument and as sensitive as we can make it. They also consider that it will be essential to reach a judgment, after consultation with the local authorities, about the precise information that would be most helpful and about how soon enough information would be available to provide the robust evidence that I mentioned earlier.
The proposed new clause imposes a completely unrealistic timescale and would place grave 1481 difficulties on Department of Social Security local offices as individual officers would be required to make extremely difficult judgments in individual cases. Even with the information from local authorities, they will have to reach judgments on what is a reasonable charge for the taxpayer to meet. That might be particularly difficult where no one in the home in question has been placed there by the local authority or no one receives the same level of care, or where there are several different levels of fee applying in the same home. Department of Social Security officers are not accountants. They simply do not have the expertise to sort that out. This is a recipe for delay, bad decision-making and unfair and unequal treatment.
As I said earlier, I clearly understand the motives behind the new clause. However, having said that, I hope that after some debate —and I shall answer as many points as possible at the end of the debate —the noble Lord will withdraw the amendment.
§ Lord Ennals
Before the noble Lord sits down, perhaps I may ask him two questions. First, in the studies that will be made by the Secretary of State, I presume that the different levels of cost of care homes in different parts of the country will be taken into consideration. I am aware that the cost of care homes in London is on average £66 per week higher than the income support level. I hope that the variations will be considered. Secondly, and perhaps more fundamentally, will the noble Lord give an assurance that none of those people now in care homes, without the resources to pay the fees required, will be evicted between now and the time when the legislation to which he referred comes into effect?
§ Lord Henley
I thought that I made it clear that my right honourable friend would look at local differences. That is the point of acquiring evidence from various local authorities. I should emphasise that that evidence should concern the cost rather than fees or charges. Those are two different things. That was why I stressed that our present arrangements are very much a blunt instrument. As the noble Lord knows full well, there is always the danger that if one puts up the limit many of the fees would go up.
The noble Lord also asked what will happen to those who are in homes at the moment and whether they might find themselves moved out. I cannot give him the assurance that he requires. He will know full well that the social security system, providing income support here, has never been the provider of last resort. Local authorities have a duty to help people who need residential care which is not otherwise available and health authorities have a duty to help people who need nursing care.
§ Baroness Seear
Perhaps I may press the noble Lord on that point. We are not trying to be difficult about it. As I see it, the crux of the matter is that it is a short-term problem. What will happen in the interim to those people who may be forced out? Unlike so many other problems, this problem will come to an end because, after 1991, the position will 1482 be different. However, what will happen to those people who, if they cannot meet the bills, will be out on their ear?
§ Lord Henley
I accept that there is a short-term problem here. That is why my right honourable friend made a mid-year announcement of an extra £5, £10 and £15, at a cost this year of £45 million and at a full-year cost of £70 million, in addition to the £100 million that he announced would come into effect this April. That is a large sum of money.
§ Lord Renton
As a past president of MENCAP and having a daughter aged 35 who has had to be in residential care pretty well all her life, I normally support the proposals put forward by the consortium to which the noble Lord referred, but I cannot in all conscience support this group of amendments.
I came to the debate without having thought about the matter very deeply, although I had read the amendments. However, having thought about the matter further—I shall burden the Committee briefly with some of my thoughts on it —and having heard my noble friend Lord Henley explain what the Government are doing and propose to do, I think it would not be reasonable for us to press the amendments. In any event, I hope that those who move them with their usual care and sincerity will consider the matter further in the light of the debate rather than put us into even temporary conflict with another place by pressing the amendments, even perhaps successfully, today.
Perhaps I may now give my reasons which are in addition to those which my noble friend mentioned, although I entirely support his reasons which I find very powerful. The first reason is that in Clause 44 the Government make an important new advance in the provisions—which after all have been on the statute book for many years —for the care of those who require it in various kinds of home, whether they are publicly or privately provided for or, as in the case of my daughter, a bit of each. Clause 44 makes a welcome and important new departure.
I find it strange that the first two amendments which we are discussing have been placed on the Marshalled List to precede Clause 44 because, quite frankly, they should be regarded as an elaboration and extension of it. By putting them first, we are putting the cart before the horse legislatively. In the circumstances, I do not think that it makes sense to do so.
In addition, the first amendment—Amendment No. 113AH —overlaps, as my noble friend said, with existing arrangements to be found in the Social Security Bill and, incidentally, overlaps with the broad power given by Clause 44. When legislating, even when we have to go into some detail, we should try to avoid overlapping if we can.
There is then the question of cost. I am glad to say that we are spending much more than used to be spent on care of the elderly and others with severe handicap of one kind or another. I tried to follow my noble friend, but I am not certain whether he gave any estimate of the cost of our requiring the Government to implement Amendment No. 113AJ. He said that we would give a blank cheque to those 1483 who were given power to spend. Although the Government have said that it will be a blank cheque, perhaps they have some idea, even at the back of their mind, as to how much might be incurred under that blank cheque.
We all know, and are worried about it, that the economy is not in such a healthy state as it has generally been under this Government in the past 11 years. I must confess to the Committee that the Chancellor of the Exchequer is a friend of mine. He represents my old constituency and achieves much bigger majorities than I ever did. He has not spoken to me about this, but I think that we are doing no service to those who are afflicted in any way by letting inflation run. We all have to be responsible enough to hold inflation. One way in which to do so is to avoid unnecessary expenditure—certainly to avoid blank cheques.
I therefore could not possibly vote in favour of either of these two amendments if they were pressed to a Division. I have much respect for the Members on the Front Benches. They are caring, as I hope that I am, about those who have special needs. However, if they press either amendment to a Division I could not support them.
My noble friend pointed out with some reason that, although we are imposing new administrative arrangements on the local authorities concerned and on the Secretary of State in Clause 44, we do not want the system —which is a good one and should be given a fair run —to be bogged down and perhaps delayed and impeded by over-elaborate administrative arrangements. One hesitates to use the word bureaucracy, but it would be a further extension of bureaucracy. For those reasons, expressed as briefly as I can, I very much hope that there will be second thoughts on the part of those who moved these two amendments.
§ 4 p.m.
§ Lord Kilmarnock
When the noble Lord, Lord Henley, replies to the debate perhaps he will clear up something for me. He mentioned that there were to be increases in income support in the three bands of £5, £10 and £15 respectively. I believe he said that that would affect 200,000 people and would cost about £45 million. But he also said that the Social Security Bill—which we have not yet discussed—will give the Secretary of State powers to take local conditions into account when setting levels of income support.
My question is simply this. When local authorities have reported, when the necessary information has been garnered, and if wide discrepancies are revealed, what will then be the Government's attitude? What will they do?
The noble Lord, Lord Ennals, has already mentioned that there is a discrepancy of £66 in the London area over and above the limits. I take the point that we need the information. It would be nice to hear what the Government plan to do if very large discrepancies are revealed.
§ Baroness Carnegy of Lour
This is a very complicated subject which is difficult for us to grasp.
1484 We have had some very short speeches which have not illuminated it. However, I am deeply disturbed by what some Members of the Committee are saying and what we in Parliament are doing.
The Bill follows the idea in the Education Reform Act that my noble friend Lady Cox supported enthusiastically in most of its parts. We made it possible for decisions to be made near the ground, by the people who will be most involved, who can be sensitive. We did so in the face of a good deal of opposition from a number of noble Lords opposite. There has not yet been time for that measure to be programmed.
In the community care section the Bill follows the same idea. It gives the decision making to local councillors who know the circumstances, and whose constituents are the people for whom care is needed and their relations. The councillors are answerable to them. Most people involved in local authority work are closely linked with somebody who will depend on community care. Anything that we do in this Chamber, or in another place, which militates against that idea will damage the ability of people at ground level to make decisions. Some Members of the Committee may not consider that people at ground level should do so. But if one does so consider it is very important not to damage such ability.
In putting the problem, the noble Lord, Lord Carter, very rightly talked about shortfalls in local authorities: the problems of meeting the costs of such provisions. My noble friend Lady Cox very rightly gave us one case study. I was reminded of discussions I had in my local government days about social services when our hearts went out to the people about whom we were talking. That is why I said the other day that there is not usually much problem in getting local authority voters to fund social services.
However, we must not mix up our concern that that should happen with the system by which it is proposed to bring it about. Of course a system must be found whereby people are not left in the lurch, and the charges must be met. The Bill may be incomplete. However, if we do what is suggested in these amendments, I believe that we take all the benefit away from the Bill as it is drafted. There may be Members on the Cross-Benches and very likely other noble Lords opposite who believe in the principle of the Bill and would not wish to undermine it. If one uses local government in this way, first, one ring fences its budget. That is what we have done as the Bill now stands. Local authorities are told the sum that they have; and that is the sum they they will spend. If one then allows them to say, "That is what we reckon we shall need; this is what we have," and if the Government have to assure them that they will give them the balance, one would remove from councillors their ability to do their job. It is the easisest thing in the world. The charges would be set accordingly. The councillors would not need to do all the negotiating that is at the heart of the Bill. The downward pressure would not be there. The taxpayer would have to stump up.
I am surprised that my noble friend did not say that it was not right for this committee to pass the amendment. It would cost an enormous amount of money because there is no pressure to do other than 1485 to spend. That worries me. We have not heard very much from Members opposite who have local government experience and I do not know whether they will agree with me. About 20 per cent. of local government expenditure will now be ring fenced. Local councillors can only make a decision within the budget. It will be ring fenced.
§ Lord Carter
We had this debate on Tuesday. The noble Baroness is wrong. In the case of ring-fenced funding. the local authorities will be perfectly free to spend over and above the ring-fenced funds. No one suggests that ring-fenced funds should be 100 per cent. of expenditure. The local authorities would be free to add to that money and then they will be held accountable to their voters for the poll tax.
§ Baroness Carnegy of Lour
It is true that they will be free to spend more than the amount that is being ring fenced. However, Members of the Committee who have local government experience will know that expenditure on the police, which takes another enormous portion of the budget, is virtually predetermined. Expenditure on the fire service is predetermined to the extent that standards are set and so forth. The one remaining large portion of local government expenditure is on education. At present that accounts for about 50 per cent., 25 per cent. of which is predetermined by salaries.
Parliament is saying that local government will be able to decide how to spend only 25 per cent. of its budget, plus 2 per cent. or 3 per cent. for other services such as rubbish. If in addition we say to local government, "Under an amendment such as this you can have as much as you want in addition because you have said that it is needed", we would wreck local government. I strongly believe in local government. At present it does not go my way in Scotland but I believe in it. It is doing Scotland a great service, although at the moment it is dominated by the Labour Party. It is doing Scotland a great service and we are ruining it—
§ Lord Ennals
The noble Baroness said that local government in Scotland is dominated by the Labour Party. It is not; is is dominated by the voters. Local government elections are the people expressing their view, whether it happens to be Conservative, Labour or Liberal. There is nothing wrong with that; that is what democracy is about.
§ Baroness Carnegy of Lour
I know that there is nothing wrong with it. I said that the people have elected councils which are dominated by Labour councillors. That was what they wanted. I believe that they are doing a great job for Scotland. The noble Lord must listen to what I say, although it may be surprising. If we take away that power—and the amendment enhances that —we shall be turning local government into an agent of central government—
§ Baroness Carnegy of Lour
The amendment turns it into an agent of central government. If the local authority associations are backing the amendment I 1486 wonder how closely in touch they are with councillors. They have not written to me about the matter, perhaps naturally. If they had I should know more about their views. I shall be very surprised if they are in close touch with the councillors.
The amendments are providing for local government to be able to ask for as much as they say they need for community care. The figure that must be spent on community care is the best that local government councillors can obtain. Of course there must be a mechanism whereby cases about which we know are not left in the lurch. However, I am most alarmed by the general principle. I am shaken by the fact that the Labour Party, which believes so much in local government, is going along with it. I do not like to talk about political parties in this Chamber but I find the matter quite extraordinary. I hope that its members will think hard before pursuing that principle, and I hope that the amendments will not be carried.
§ Lord Milverton
On previous occasions I have supported Members on the opposite side of the Committee. I have supported the noble Lord, Lord Carter, and my noble friend Lady Cox. I have given the matter some thought. I know a little about what it is like to have a disabled member of the family because my sister has a mongol child. That is minor compared with the disabilities with which many people must contend.
I have listened to the arguments and given the matter a great deal of thought. The remarks of my noble friend Lord Renton helped me to make my decision to vote against the amendment should it come to that. I have decided to support my Front Bench. As far as I am able to understand such complex issues my noble friend Lord Henley gave a satisfactory answer. Although I have supported the noble Lord, Lord Carter, on similar issues, on this occasion I shall support my Front Bench.
§ 4.15 p.m.
§ Lord Carter
The Minister has already spoken and therefore it may be helpful if I deal with some of the points which have been made since I moved the amendment. The Minister will have an opportunity to reply and we shall then decide what to do with the amendment.
Members of the Committee will have noticed that the Minister did not reply to my questions. I hope that in a moment he will take the opportunity to do so. What happens when those people now in residential care have a shortfall because their savings have run out?
§ Lord Carter
No, my noble friend asked what will happen if they face eviction. I ask what will happen if their savings run out. What are they to do if the relatives are no longer prepared to make up the difference? What will happen if the fees increase still further and the gap widens? None of those questions has been answered. The Minister did say what will happen to the residents who face eviction—that 1487 it will be up to the local authorities to solve the problem.
I could not hide a wry smile when I heard the remarks from the other side of the Committee about the bureacracy involved in our amendments. They come from members of a governing party which has introduced the poll tax, which is a bureaucratic nightmare. The Minister said that bureaucracy is involved because local authorities must discover the range of charges. Is not that exactly what the Government are trying to discover in their consultation process?
The Government believe in competition and the Minister used that word. It is intended to drive down the costs, thereby reducing the shortfall. However, the argument that today's fees should not be used as a regulator is spurious. The Department of Health assumes that local authorities will obtain cut-price care by negotiating the block contracts for care which the Minister mentioned. However, because of their nature, the block contracts will reduce choice. Therefore, the notion that we can have both choice and lower prices is illusory.
The noble Baroness, Lady Carnegy, must take the point that local authorities will have to make up the existing shortfall before they can begin to find the funds to solve the problems which the Minister said they will have to solve; for example, when the residents' savings run out, when the relatives will not make up the difference or when they face eviction. She referred with nostalgia to the old system of local government with which she is familiar. She described what used to happen in local government, but we now live in the age of the poll tax. Local authorities now have the overarching problem that the cost of everything they wish to do over and above the Government's requirements must fall on the poll tax. It must bear the cost of all extra local government expenditure.
Amendment No. 113AJ meets exactly the requirements which the noble Baroness mentioned. If there is a shortfall in individual cases it provides the power for a discretionary top-up to income support from the social security budget. We have been told endlessly that the amendments will wreck local government. Why then have we been briefed by all the associations representing local authorities which wish to see their provisions included in the Bill?
The Minister said that he recognises the importance of the cover required and that the Government wish to give a reassurance. But fine words of reassurance do not help to make up the many shortfalls. There are shortfalls after the recent April top-up. The further top-up in August of £5, £10 or £15 per week must be considered against the shortfalls which will then exist of between £30 and £60 per week.
Whenever we debate issues such as social security and health the Minister always quotes the big figures, and I understand that. We are told that is £45 million here and £100 million there, and that is important. However, that does not attempt to deal with the individual problems of people who now face a 1488 shortfall even after the expenditure which the Minister quoted. He said that the Secretary of State wishes to look at income support levels and therefore further research is required. We have been down that road before in respect of disability. We had the OPCS surveys but we have not received the comprehensive review of disability benefits which was promised as a result of the research.
The point was made in another place by a number of Members that the information which the Government require is available now. The point was made by my right honourable friend Mr. Merlyn Rees that one need only go to the voluntary organisations which run various homes around the country. They will be entirely prepared to reveal their costs, perhaps unlike the private sector, because, as the Minister said honestly and correctly, it is the costs about which the Government are anxious and not the fees which are charged. They want to know what are the costs which they will have to meet. That information can be obtained from the voluntary sector.
The noble Lord, Lord Renton, referred interestingly in an aside to the fact that, were we to be successful on these amendments, that may result in a temporary conflict with another place. That assumes that another place would wish to overturn our decision. He referred at some length to Clause 44, but that does not help those in shortfall now. Amendment No. 113AJ is intended to deal with that problem.
The noble Lord also referred to the need for care as regards public expenditure. That is so. He mentioned too the state of the economy. To be fair, he might have referred to the 1 per cent. on the RPI which is a direct result of the Government's introduction of the poll tax. That has also affected the state of the economy. When one compares that sort of decision with the individual and human problems that we are now facing, I am surprised that the noble Lord is not able to see the importance of Amendment No. 113AJ in helping all those people who now face that problem. That must be dealt with before the new system is introduced next April.
§ Lord Boyd-Carpenter
Before the noble Lord sits down, in view of his reference to the possibility of a conflict with another place, has he thought about a major source of conflict which will arise if these amendments are carried and inserted into this Bill in the light of the amendment inserted into the Social Security Bill in another place on 26th March?
I shall quote a few words from the Secretary of State for Social Security in a few moments. But an amendment has been carried dealing with this topic which, whatever the noble Lord may say, is quite inconsistent with the amendments he is now proposing to insert into this Bill. I shall quote because I believe that it is only fair to do so. The Secretary of State for Social Security in introducing this amendment said:The power that I am taking in the new clause is designed to help me to set up a system of local limits, if need be. In setting such limits, I want to have regard to both the charges being met by local authorities in homes and also, perhaps, the charges being met by other bodies such as the voluntary sector".—[Official Report, Commons, 28/3/90; col. 590]1489 That amendment has gone into the Social Security Bill, which we shall shortly be considering in Committee. It is quite plain that that is not consistent with this amendment.
What will happen if these amendments are carried? Logically, the amendments to the Social Security Bill must be rejected or the law will be left in a state of chaos. That is unfair not only to the local authorities, which have to administer this, but even more so to the people whom it is supposed to benefit.
Perhaps the Committee will consider for a moment that, as some of my noble friends have said, we are dealing with a large volume of public expenditure. In those circumstances there must be a strong argument for adopting a solution of another place as to how that expenditure should be authorised and carried out. For this Chamber to carry a proposition such as we did the other day, which was rejected and which involved substantial expenditure, leaves the whole matter very uncertain. If we were, as in logic we should do as part of the same process, to throw out the amendments put in another place to the Social Security Bill, we should end up by doing no good to anybody.
I fully understand—and I have listened to this debate with great care—the strong feelings of Members on both sides of the Committee. I am sure that we were all very moved by what my noble friend Lord Renton said. However, if one wishes to be practical and to secure that as soon as possible the position of the very unfortunate people with whom we are concerned is rectified and put on a firm foundation, I suggest that the inevitable conclusion is that these amendments should be withdrawn. Thereafter, when we come, as we do in a few days' time, to consideration of the Social Security Bill in Committee, we should support the clause put in by another place, which is now safe from any alteration by that Chamber.
In that way we shall be able to go ahead knowing that, although we may not have achieved in exact detail what the Committee wants, we shall have secured that this important benefit is safe and secure for a great many people whose interests we have at heart. If we become involved in a conflict with another place by introducing clashing amendments, we risk throwing the whole matter into confusion and we shall inevitably incur delay.
§ Lord Ennals
I am not quite certain why the noble Lord is so worried. This Committee is entitled, as we did on Tuesday, to pass an amendment to a Bill which has come from another place. The other place must then decide what to do with it. When we come to consideration in Committee of the Social Security Bill, we are equally entitled to pass amendments if we believe that it is right to do so. Again, another place must then decide what is the best course to take.
The reason that the issue is before us today is that there is a conviction —and I believe it is shared by Members of the Committee on both sides—that some of those people who are in care accommodation today and who could conceivably be evicted are not 1490 covered by the steps taken by the Secretary of State for Social Security which we have welcomed. It is because we are worried about that particular group of people in the time until the new Act comes into operation that these amendments are before us.
§ Lord Boyd-Carpenter
The noble Lord is absolutely right in saying that we can amend and that another place can amend. However, I ask him to consider whether that makes good sense. We are trying to help a very unfortunate section of our population. With the full approval of another place there is a provision which will go a great way towards achieving that. Because some of us may prefer in certain detail our own ideas, it surely does not make good sense and certainly does not make good social sense to involve ourselves in a long and complicated conflict with another place which will delay the remedial measures that we all wish to see. If the noble Lord really wishes these people to be helped quickly, he will withdraw his amendments.
§ 4.30 p.m.
§ Lord Henley
The noble Lord, Lord Carter, spoke of shortfalls in the levels of income support and cited cases. There will always be shortfalls whatever may be the limit for the level for income support. The noble Lord knows full well that if we raised the limit to £300, there would still be shortfalls in some parts of the country. It is important to bear in mind that there are still homes below the limits as they are set although I appreciate that there are problems in some areas. However, I believe that we can find homes in all areas which are below the limits. The other point which the noble Lord should consider is that if we keep on increasing income support levels, as I said before, the fees are pushed up. That does not help those who are paying their own fees and who are not on income support.
The noble Lord asked about the position of those who are paying their own fees should their savings run out. It does not matter; they can still go on income support. They will still have their preserved rights. It is the residents who are in a residential or nursing home at April 1991 who are relevant, not whether they are in receipt of income support on that date.
The noble Lord quoted his right honourable friend in another place, Merlyn Rees, and said that there was already evidence of the costs. He quite rightly said that it was costs that we should look at and not fees and charges. He cited the evidence from voluntary organisations. It may be that voluntary organisations can provide some evidence, but merely because an organisation is voluntary does not necessarily mean that the fees it is charging are the cheapest or are the base line. An economist would probably be able to advise the noble Lord on this, but no doubt there are profit-making bodies providing a perfectly good service who charge lesser fees than some voluntary organisations.
My noble friend Lord Renton quite rightly asked about my estimate of the cost of Amendments Nos. 113AH and 113AJ. As my noble friend quite rightly said, I referred to a blank cheque. I do not think I can go beyond that. The amounts would be impossible to 1491 predict, and Amendment No. 113AH appears to be an open-ended cheque. Local authorities no longer need to negotiate; they simply set out what they consider the local charges to be and ask the Secretary of State to pay up. Amendment No. 113AJ is equally open ended. The Secretary of State has to respond to the fees charged and there will be no incentive for the local authority to negotiate the best fees. They would know that in the end my right honourable friend the Secretary of State would pay out.
As my other noble friends mentioned, Clause 9 in the new Social Security Bill deals with that problem. The noble Lord, Lord Kilmarnock, rightly asked what would be the attitude of my right honourable friend to local discrepancies under Clause 9 of the Bill. That will be debated in greater detail in 11 or 12 days' time; but perhaps I can read out part of the first section of Clause 9, which states:the Secretary of State shall take into account information provided by local authorities or other prescribed bodies or persons with respect to the amounts which they have agreed to pay for the provision of accommodation".I assure the noble Lord that my right honourable friend will take into account local variations, and we shall be very interested in the local variations that appear throughout the country.
The noble Lord, Lord Carter, in justifying Amendment No. 113AJ, said that it would help people who have a shortfall now. That may be the intention, but it cannot help people now. Reliable local authority information will not be available until after April 1991. Research is to be commissioned shortly by my right honourable friend, and that will help us in forming decisions on the next uprating of limits.
I shall repeat the upratings that we announced. There is an extra £100 million; that is, £10 a week on nearly all the income support levels this April; an extra £45 million on an interim uprating in August—a full year cost of £70 million. That is on top of the £1,100 million we already spend in a full year. Those upratings, together with the new clause in the Bill, constitute a substantial and proper response to the concerns expressed both here and in another place.
I remind the Committee that the Secretary of State for Social Security has given a commitment to review the level and structure of limits as they will apply to preserved cases. Finally, local authorities and health authorities will continue to retain their current ability to help individuals.
The Government's approach is the best way forward. The new clauses are unnecessary and impractical. If the noble Lord insists on pressing the amendment, I hope that the Committee will reject it.
§ Lord Carter
I do not intend to detain the Committee much longer. We received no reassurance from the Minister regarding the problems that we brought to the attention of the Committee. Perhaps I may deal briefly with the point made by the noble Lord, Lord Renton, regarding the conflict in the other place. It was intended to be a little tease about his use of the words "temporary 1492 conflict", which assumed that the amendment would be automatically overturned in another place.
§ Lord Renton
Perhaps the noble Lord will allow me. That is the right assumption, bearing in mind that this matter was twice debated in another place, and at Report stage the conclusion was reached that an amendment on the lines now proposed was not acceptable. The other place, to a far greater extent than this Chamber, has a responsibility under our constitution which we strictly do not have for having the last word in government expenditure.
§ Lord Carter
I understand that entirely. The advice that I received was that these amendments do not clash with the Social Security Bill. This is not the time to go into the constitution of debate. As I read the amendments, I do not think that they clash with the Social Security Bill, as the noble Lord, Lord Boyd-Carpenter, said.
§ Lord Boyd-Carpenter
If the noble Lord will allow me to intervene. Is the noble Lord saying that both the amendments to the Social Security Bill to which I referred and these amendments could co-exist in our law without utter confusion? Is he really saying that?
§ Lord Carter
As I am advised and understand the position, yes. Noble Lords may laugh out loud. They are entitled to their views. I am only repeating the advice that I received.
The Minister said that these provisions will push up the fees. Surely the plans of the Government's own research, the plans to impose local limits, will stop that. That information will all be made available to local authorities. If the Minister wants evidence regarding the costs in the voluntary sector, it is a pity that the noble Baroness, Lady Ryder of Warsaw, is not here because I am sure that she would be able to tell him about the substantial problems that are now faced in the homes with which she is involved.
We have had an excellent debate. I understand that it is a complicated matter. Noble Lords who support the amendment have not received the assurances required from the Minister, and I therefore feel I must ask the opinion of the Committee.
§ 4.37 p.m.
§ On Question, Whether the said amendment (No. 113AH) shall be agreed to?
§ Their Lordships divided: Contents, 90; Not-Contents, 112.1494
|Division No. 1|
|Acton, L.||Boston of Faversham, L.|
|Airedale, L.||Bottomley, L.|
|Allen of Abbeydale, L.||Broadbridge, L.|
|Aylestone, L.||Bruce of Donington, L.|
|Bancroft, L.||Campbell of Eskan, L.|
|Birk, B.||Carmichael of Kelvingrove L.|
|Bonham-Carter, L.||Carter, L.|
|Cledwyn of Penrhos, L.||Lockwood, B.|
|Clinton-Davis, L.||Longford, E.|
|Cocks of Hartcliffe, L.||Lovell-Davis, L.|
|Darcy (de Knayth), B.||Macaulay of Bragar, L.|
|David, B.||McIntosh of Haringey, L.|
|Dean of Beswick, L.||McNair, L.|
|Diamond, L.||Milner of Leeds, L.|
|Donaldson of Kingsbridge, L.||Morris of Castle Morris, L.|
|Dormand of Easington, L.||Mulley, L.|
|Ennals, L.||Nicol, B.|
|Ewart-Biggs, B.||Northfield, L.|
|Ezra, L.||Ogmore, L.|
|Falkland, V.||Oram, L.|
|Fisher of Rednal, B.||Peston, L.|
|Fitt, L.||Pitt of Hampstead, L.|
|Foot, L||Prys-Davies, L.|
|Gallacher, L.||Rea, L.|
|Gladwyn, L.||Ritchie of Dundee, L.|
|Graham of Edmonton, L. [Teller.]||Robson of Kiddington, B.|
|Hampton, L.||Russell, E.|
|Hatch of Lusby, L.||Sainsbury, L.|
|Hirshfield, L.||Seear, B. [Teller.]|
|Houghton of Sowerby, L.||Shackleton, L.|
|Hughes L.||Somers, L.|
|Hunt, L.||Stallard, L.|
|Jacques, L.||Stedman, B.|
|Jay, L.||Stoddart of Swindon, L.|
|Jeger, B.||Strabolgi, L.|
|Jenkins of Putney, L.||Thurso, V.|
|John-Mackie, L.||Tordoff, L.|
|Kilbracken, L.||Underhill, L.|
|Kilmarnock, L.||Wallace of Coslany, L.|
|Kirkhill, L.||Wedderburn of Charlton, L.|
|Leatherland, L.||White, B.|
|Listowel, E.||Williams of Elvel, L.|
|Llewelyn-Davies of Hastoe, B.||Winchilsea and Nottingham, E.|
|Lloyd of Kilgerran, L.||Winstanley, L.|
|Alexander of Tunis, E.||Faithfull, B.|
|Allenby of Megiddo, V.||Fraser of Kilmorack, L.|
|Arran, E.||Gisborough, L.|
|Auckland, L.||Hailsham of Saint Marylebone, L.|
|Balfour of Inchrye, L.||Henley, L.|
|Belhaven and Stenton, L.||Hesketh, L.|
|Beloff, L.||Hives, L.|
|Belstead, L.||Home of the Hirsel, L.|
|Bessborough, E.||Hood, V.|
|Blatch, B.||Hooper, B.|
|Blyth, L.||Hylton-Foster, B.|
|Boyd-Carpenter, L.||Joseph, L.|
|Bridgeman, V.||Killearn, L.|
|Brightman, L.||Kinnaird, L.|
|Brougham and Vaux, L.||Lauderdale, E.|
|Butterworth, L.||Layton, L.|
|Buxton of Alsa. L.||Limerick, E.|
|Caithness, E.||Lloyd of Hampstead, L.|
|Campbell of Alloway, L.||Long, V.|
|Campbell of Croy, L.||Luke, L.|
|Carnegy of Lour, B.||Lyell, L.|
|Carnock, L.||McColl of Dulwich, L.|
|Carr of Hadley, L.||Mackay of Clashfern, L.|
|Clanwilliam, E.||Macleod of Borve, B.|
|Coleraine, L.||Mancroft, L.|
|Constantine of Stanmore, L.||Massereene and Ferrard, V.|
|Cork and Orrery, E.||Merrivale, L.|
|Cornwallis, L.||Mersey, V.|
|Cottesloe, L.||Milverton, L.|
|Cranbrook, E.||Monk Bretton, L.|
|Dacre of Glanton, L.||Mottistone, L.|
|Davidson, V. [Teller.]||Mountevans, L.|
|De Freyne, L.||Mowbray and Stourton, L.|
|Denham, L. [Teller.]||Munster, E.|
|Dilhorne, V.||Murton of Lindisfarne, L.|
|Ellenborough, L.||Nelson, E.|
|Elles, B.||Nelson of Stafford, L.|
|Elliot of Harwood, B.||Nugent of Guildford, L.|
|Erroll, E||Orkney, E.|
|Oxfuird, V.||Shannon, E.|
|Peel, E.||Strathclyde, L.|
|Pender, L.||Strathmore and Kinghorne E.|
|Platt of Writtle, B.|
|Porritt, L.||Swansea, L.|
|Pym, L.||Swinfen, L.|
|Rankeillour, L.||Swinton, E.|
|Reay, L.||Terrington, L.|
|Rees, L.||Teviot, L.|
|Renton, L.||Thomas of Gwydir, L.|
|Roskill, L.||Thurlow, L.|
|St. Davids, V.||Trefgarne, L.|
|St. John of Bletso, L.||Trumpington, B.|
|Saltoun of Abernethy, Ly.||Ullswater, V.|
|Sanderson of Bowden, L.||Vaux of Harrowden, L.|
|Sandys, L.||Whitelaw, V.|
|Sempill, Ly.||Wolfson, L.|
§ Resolved in the negative, and amendment disagreed to accordingly.
§ 4.46 p.m.
§ [Amendment No. 113AJ not moved.]
§ Clause 44 [Local authority plans for community care services]:
§ Baroness Faithfull moved Amendment No. 113AK:
§ Page 50, line 4, after ("may") insert ("after taking into acount the views of the appropriate local authority associations").
The noble Baroness said: This is a simple amendment with no resource implications. I should point out that I speak as a vice-president of the County Councils Association. Clause 44(1)(a) states that each local authority,
shall, within such period after the day appointed for the coming into force of this section as the Secretary of State may direct, prepare and publish a plan for the provision of community care services in their area".
The amendment merely inserts, after the word "may",
after taking into account the views of appropriate local authority associations".
§ As I said, I speak as a vice-president of the County Councils Association. All that we ask has nothing to do with policy or money; we seek merely to ensure that the local authority associations, which have an overall picture of the needs throughout the country, shall be consulted. I beg to move.
§ Lord Renton
I should have thought that the local authority associations are so well organised and so powerful that there is no chance whatever of their views being ignored. Therefore, my noble friend's amendment, essential though it may be considered, is unnecessary. That is because the local authority associations are doing their job so well.
§ Baroness Faithfull
Perhaps I may respond to my noble friend Lord Renton. The effect is the other way round —to enable the Government to have the views of the local authority associations that my noble friend thinks so good.
§ Lord Ennals
I certainly support the amendment. Consultation is absolutely essential. As the noble 1495 Baroness, Lady Faithfull, said, this is an important clause. It sets out not only that a compete plan must be published showing how a local authority fulfils its community care responsibilities but also that the plan must be reviewed. And there are powers to order it to bring forward a new plan. That will be an important, ongoing, operation if it is to be effectively carried out.
Of course, as the noble Lord, Lord Henley, said on an earlier amendment, there will be consultation with statutory bodies and voluntary organisations. However, sometimes it does not happen that the local authority associations are consulted. Whether we are referring to the AMA, the CCA, the ADC or even the ADSS makes no difference. All those organisations have an important contribution to make. And since this amendment cannot be considered controversial there is no way in which the Minister can reply that the Government do not believe in consulting the local authority associations. It seems to me that the amendment can be easily accepted.
§ Lord Renton
In fairness to my noble friend I should point out that I read her amendment as meaning that the local authority should take account of the views of local authority associations, and bearing in mind the comma after the word "direct" I am still of that view. But if she means that the Secretary of State should do so, perhaps a little further thought might be given to the drafting and then there would be no ambiguity. Whichever way it is, I still maintain that the local authority associations are so well organised that nobody has a chance of failing to take account of their views.
§ Lord Seebohm
I should like to support this amendment. I must confess that I am vice-president of the Association of County Councils, which is doing an enormous amount of work in co-ordinating the views of the various local authorities. It has a wealth of information which I think should be tapped.
§ Baroness Hooper
I believe that I can reassure the movers of this amendment, and the noble Lord, Lord Ennals, also, because there is, and has been, regular consultation with the local authority associations about the implementation of our community care policies. This consultation takes place at both ministerial and, regularly, official level. The views of the local authority associations are therefore well known and are being taken into account.
I am sure that the Committee will agree that the Secretary of State should be the person to determine the period and time by which all local authorities must prepare their plans, albeit that each authority does it individually. Since these plans are an important cornerstone of the new policy it is vital that they are produced at a time which coincides with the other changes that have to be made legislatively in order to implement our policies.
We expect to have them prepared by 1st April 1991, and I refer the Members of the Committee to 1496 paragraph 5.9 of the White Paper, which refers to this particular point. This is when benefit changes are made, and transfers of funds from social security resources are made to local authorities. This approach to timing has always been perfectly clear to the local authority associations and the many other interested statutory, voluntary and independent organisations, and has been accepted by them.
I believe that this amendment is therefore unnecessary, because consultation is an ongoing process. It is also even unhelpful because it is the proper role of the Secretary of State to determine the time at which implementation of the changes which effect our policy come into force. I believe that it could be a recipe for delay and again for further build-up of bureacratic procedures. I therefore urge the Committee to oppose this amendment.
§ Lord Ennals
The noble Baroness says that it is a recipe for delay. Does that mean that there is a possibility that they would not be consulted?
§ Baroness Hooper
I made it clear that they have been, and are being, consulted. Therefore, it is unnecessary to repeat the process and duplicate the procedure.
§ Lord Ennals
Here we are dealing with this quite new clause. It is a new responsibility placed on local authorities. It is not something about which they have been consulted up to now. It is about the plans and the nature of the plans presented to the Secretary of State and revisions of them as the years go by, and whether the Secretary of State should seek the advice of the local authority associations. The fact that they have been consulted up to now is not the point of the amendment.
§ Baroness Hooper
Perhaps I can help the noble Lord further by referring to the sort of timing that we have in mind. After all, we must await Royal Assent before we can move into the further detailed preparation of plans. Local authorities will then be directed to prepare plans, and quite probably that will be towards the end of September after we have had feedback on guidance, which is due to go out fairly soon.
However, many have already started making preparations for these plans. Furthermore, after the first year, which we all appreciate is likely to be the most difficult one, there will be opportunity for annual review based on the experience of previous years. There will be ample opportunity for adequate consultation with the local authority associations. My reference to what has been, and is, going on is simply to reassure Members of the Committee that it will be a continuing process.
§ Baroness Faithfull
I thank the Minister for her reply. I just say that the local authority associations often act as a bridge between the ministries and their plans and the people in the areas who put forth those plans. I recognise that there is consultation between the ministries and the local authority associations. I should like to read what the Minister has said, and 1497 if necessary bring it forward at the next stage of the Bill. Meanwhile, I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ [Amendment No. 113AL not moved.]
§ Baroness Seear moved Amendment No. 113AM:
§ Page 50, line 9, leave out ("and").
§ The noble Baroness said: With amendment No. 113AM, which is a paving amendment, I should like to take Amendment No. 113AN. There are two major concerns behind these amendments. It probably would not have been necessary to put down these amendments but for the fact that the Bill is extremely thin on any indication as to what the standards are to be in the application of community care. Of course standards are what it is all about. Community care not related to any idea of the level of care and what is involved in care is really a meaningless phrase.
§ In the Second Reading debate I asked the Minister what was the policy for quality of care; what researches had been done to find out how much resources were going to be needed in order to achieve minimum standards of quality of community care. Frankly, I got no reply. It is for this reason that we need to put down an amendment of this kind. The assurance of quality is essential if community care is to be anything other than a pious farce.
§ The second reason is that there is a grave danger that a local authority, hard pressed for resources, will skimp on community care in order to meet from its budget, its limited resources, the many other demands made on local authorities. I was delighted to learn that, in my reprehensible absence this week, the community care budget is to be ring fenced. If the Government would now give us a commitment that that decision taken earlier this week will not at any stage be reversed, to a large extent the need for this amendment would fall. I only keep it here because experience of what has happened to amendments of this kind in this Chamber does not give me the greatest encouragement to think that that amendment is necessarily absolutely safe. Although it would make a great deal of difference, I do not propose at this time to withdraw my amendment.
§ The point of these amendments is to make clear that every local authority should say what it thinks it needs to do, then what it thinks it is going to be able to do, and to explain the reasons for the difference. It is an attempt to establish standards of quality. I am sure that the Committee will be aware that we are here in a dangerous situation. We are bringing people out of institutions, putting them into the care of the community, and we have not any adequate estimate whatsoever as to what the costs are going to be. If we get it wrong, the price is going to be paid by those members of our community who are in the least strong position to pay it —the people coming out of the institutions, the people who, as the years go on, need special care, and above all the people on to whom that responsibility is going to be thrust if the organisations and the local authorities are inadequate in meeting those needs. It is the 1498 families of the people who will have to shoulder the burden. A great many of them will shoulder that burden as well as they can, but often it will be done inadequately at an enormous human cost. I beg to move.
§ 5 p.m.
§ Lord Carter
I am pleased to be able to add my name to the amendments and to support them from these Benches. When the noble Baroness, Lady Seear, referred to Amendment No. 113AM she said that it was a probing amendment. I think that she meant to say that it was a paving amendment. There is an important distinction. It is a paving amendment, and I was concerned when she said that it was a probing amendment.
§ Lord Carter
Amendments Nos. 113AM and 113AN seek to give local authorities the opportunity to demonstrate the scale of spending on a service which they would have wished to introduce had there been no constraints on their spending. They go a little further in that they require a community care plan report for the following financial year to specify the amount which will be spent, the amount which the authority would consider it desirable to be spent in that year and an explanation of the variance between the two figures.
Amendment No. 113AR places a duty on each local authority to prepare and publish a community care plan report after the adoption of its annual budget. That report will have to specify the amounts to be spent on different aspects of community care.
As the Committee will be aware, the removal of the local business rate from the control of the local authorities has meant that one half of the locally determined revenue of the local authority has been removed to central government. (We shall be looking at that point again and again in regard to different amendments.) To the extent that it is not financed by increased central grant or business rate, 1 per cent. local authority spending will amount to approximately a 4 per cent. increase on the community charge. The reality of the matter is that without significant support from central government, community care will be one of the most prejudiced areas of spending because it has to compete with existing responsibilities. The pressure on the community charge that is produced by local spending as a whole is such that local authorities have little room to manoeuvre. Indeed, that was the Government's intention when they introduced the poll tax.
As the noble Baroness stated when moving the amendment, it underlines the importance of the decision of your Lordships on Amendment No. 108E on the first day of Committee. The Committee agreed with the earmarking of the government grant element of community care spending with ring-fence funding. A timetable for the implementation of community care is now the responsibility of the Secretary of State, who must satisfy himself that adequate resources are available and help with 1499 start-up costs. Those points were agreed by the Committee on Tuesday.
This group of amendments is of crucial importance if the performance of community care is to be measured against expectations.
§ Baroness Carnegy of Lour
I share the anxiety of the noble Baroness, Lady Seear. As the matter progresses it is important that local authorities should have the means to ensure that the procedures work correctly for individuals. In the initial stages that will be difficult. There is no question about that matter. Change is difficult, and it is most difficult for vulnerable people.
I do not know whether the ring-fencing decision will stand. If local authorities' organisations want ring fencing (and I find that completely astonishing, as I have said before), the Government may let them have it, and they would have to live with the situation. I pity them; but that is their affair.
Given the fact that we look at this amendment not knowing whether there will be ring fencing, the way to ensure that individuals get the care they need and that the funding is there is not for local authorities to publish what they would like to spend, say what they think they will be able to spend and complain about the difference, which would be the effect of the report. There would be an annual row about the funding of community care. The whole matter then turns into politics and, as I am sure the noble Baroness agrees, that is not the way to ensure the best possible care of individuals.
I do not think that this is the right amendment. I am very anxious to hear what my noble friend has to say about standards and quality. I hope that the Government are thinking hard about the matter as the Bill goes through the House. The noble Baroness made an important point but I do not think that this amendment is the way to arrive at that situation.
§ Baroness Hooper
I cannot speak for or pre-empt another place in saying what will happen in regard to the ring-fencing amendment. I am somewhat surprised that the noble Baroness should ask me to attempt to do so.
The plans required by Clause 44 have to be kept under review. We have talked about them previously. In carrying out the obligations to produce a plan, we are providing that local authorities must consult with health authorities, family health service authorities, housing authorities, voluntary housing agencies and other relevant bodies.
There are two key features of that new responsibility which we are placing on local authorities to which I should like to draw particular attention. The first is the fact that plans have to be produced at all. A number of authorities already do so and seek to do so in conjunction with the other agencies with which they have to collaborate. We are now moving from a position where people tend to be fitted into services to a situation where the authority, in its enabler role, plans to meet the needs of the community it serves by clearly setting out its objectives and targets. The plans are therefore a tool 1500 to enable inter-agency collaboration towards meeting the needs of the local community.
The second feature is that the plans will be published. This is designed to heighten the local accountability of the authority and to enable statutory, voluntary and other organisations to participate in the planning process.
Our intention in preparing guidance for the planning approach is that they should be prepared on a three-year rolling basis which will involve annual review. Our approach meets the substance of Amendments Nos. 113AM, 113AN and 113AR. Therefore, to require local authorities further to produce reports in accordance with a particular format in the way that Amendments Nos. 113AN and 113 AR propose is asking them in many ways to duplicate what we are already expecting them to do.
The plans will in any case have to have full regard to the resources at the disposal of the local authority, and reviews will show progress according to overall objectives and particular targets and how resources have been applied to meet those targets. Our guidance, which we aim to produce in draft form for the widest possible consultation within the next few weeks, will indicate the main issues to be covered in the plans. That said, their purpose is primarily to facilitate the indentification of local needs and moves towards meeting them and to heighten the local accountability of the responsible authorities. Details of the way in which plans should be prepared are therefore something best left for local decision.
The noble Baronesses, Lady Seear and Lady Carnegy, raised the question of quality. There are several safeguards for quality in our proposals. Authorities will have to agree quality standards in drawing up contracts and arrange to monitor them. They will have to set up arm's length inspection units. We are introducing Amendment No. 115FC, which would require authorities to have a complaints procedure. Those matters would safeguard the important aspects of quality in which we all believe.
On that basis, I ask the proposers to these amendments to withdraw them.
§ Baroness Seear
Although the noble Baroness's answer shows that the Government have some awareness of the quality problem, there is little in the Bill itself to reassure us that it will be taken into account. We attach such great importance to quality that its failure to figure adequately in the Bill means that I must take the opinion of the Committee.
§ 5.10 p.m.
§ On Question, Whether the said amendment (No. 113AM) shall be agreed to?
§ Their Lordships divided: Contents, 81; Not-Contents, 105.1502
|Division No. 2|
|Airedale, L.||Blease, L.|
|Aylestone, L.||Bonham-Carter, L.|
|Bancroft, L.||Bottomley, L.|
|Birk, B.||Bruce of Donington, L.|
|Campbell of Eskan, L.||Lloyd of Kilgerran, L.|
|Carmichael of Kelvingrove, L.||Lockwood, B.|
|Carter, L.||Lovell-Davis, L.|
|Cledwyn of Penrhos, L.||Macaulay of Bragar, L.|
|Clinton-Davis, L.||McIntosh of Haringey, L.|
|Cocks of Hartcliffe, L.||McNair, L.|
|Darcy (de Knayth), B.||Masham of Ilton, B.|
|David, B.||Milner of Leeds, L.|
|Dean of Beswick, L.||Molloy, L.|
|Diamond, L.||Morris of Castle Morris, L.|
|Donaldson of Kingsbridge, L.||Mulley, L.|
|Dormand of Easington, L.||Nicol, B.|
|Ennals, L.||Northfield, L.|
|Ewart-Biggs, B.||Ogmore, L.|
|Falkland, V.||Oram, L.|
|Fisher of Rednal, B.||Peston, L.|
|Gallacher, L.||Pitt of Hampstead, L.|
|Gladwyn, L.||Prys-Davies, L.|
|Graham of Edmonton, L. [Teller.]||Rea, L.|
|Ritchie of Dundee, L.|
|Henderson of Brompton, L.||Robson of Kiddington, B.|
|Houghton of Sowerby, L.||Rochester, L.|
|Hughes, L.||Russell, E.|
|Hunt, L.||Seear, B. [Teller.]|
|Jacques, L.||Seebohm, L.|
|Jay, L.||Shackleton, L.|
|Jeger, B.||Stallard, L.|
|Jenkins of Hillhead, L.||Stedman, B.|
|Jenkins of Putney, L.||Stoddart of Swindon, L.|
|John-Mackie, L.||Strabolgi, L.|
|Kilbracken, L.||Swinfen, L.|
|Kilmarnock, L.||Thurlow, L.|
|Kirkhill, L.||Tordoff, L.|
|Leatherland, L.||Underhill, L.|
|Listowel, E.||Wallace of Coslany, L.|
|Llewelyn-Davies of Hastoe, B.||Williams of Elvel, L.|
|Alexander of Tunis, E.||Hailsham of Saint Marylebone, L.|
|Allenby of Megiddo, V.|
|Ampthill, L.||Halsbury, E.|
|Arran, E.||Hanson, L.|
|Auckland, L.||Henley, L.|
|Balfour, E.||Hesketh, L.|
|Belhaven and Stenton, L.||Hives, L.|
|Beloff, L.||Hood, V.|
|Belstead, L.||Hooper, B.|
|Blatch, B.||Howe, E.|
|Blyth, L.||Hylton-Foster, B.|
|Boardman, L.||Jenkin of Roding, L.|
|Boyd-Carpenter, L.||Lauderdale, E.|
|Bridgeman, V.||Limerick, E.|
|Broadbridge, L.||Lloyd of Hampstead, L.|
|Brougham and Vaux, L.||Long, V.|
|Butterworth, L.||Lyell, L.|
|Caithness, E.||McColl of Dulwich, L.|
|Campbell of Alloway, L.||Mackay of Clashfern, L.|
|Campbell of Croy, L.||Macleod of Borve, B.|
|Carnegy of Lour, B.||Mancroft, L.|
|Carnock, L.||Massereene and Ferrard, V.|
|Carr of Hadley, L.||Merrivale, L.|
|Clanwilliam, E.||Mersey, V.|
|Coleraine, L.||Milverton, L.|
|Constantine of Stanmore, L.||Monk Bretton, L.|
|Cork and Orrery, E.||Mottistone, L.|
|Cornwallis, L.||Mountevans, L.|
|Cox, B.||Munster, E.|
|Craigavon, V.||Murton of Lindisfarne, L.|
|Cullen of Ashbourne, L.||Nelson, E.|
|Dacre of Glanton, L.||Nelson of Stafford, L.|
|Davidson, V. [Teller.]||Nugent of Guildford, L.|
|Denham, L. [Teller.]||Orkney, E.|
|Dilhorne, V.||Oxfuird, V.|
|Elles, B.||Peel, E.|
|Elliot of Harwood, B.||Pender, L.|
|Erroll, E.||Platt of Writtle, B.|
|Faithfull, B.||Porritt, L.|
|Fraser of Kilmorack, L.||Pym, L.|
|Gisborough, L.||Rankeillour, L.|
|Glenarthur, L.||Reay, L.|
|Rees, L.||Swansea, L.|
|Renton, L.||Swinton, E.|
|St. Davids, V.||Thomas of Gwydir, L.|
|St. John of Bletso, L.||Thomas of Swynnerton, L.|
|Saltoun of Abernethy, Ly.||Trefgarne, L.|
|Sanderson of Bowden, L.||Trumpington, B.|
|Sandys, L.||Tryon, L.|
|Sempill, Ly.||Ullswater, V.|
|Somers, L.||Vaux of Harrowden, L.|
|Strathclyde, L.||Wise, L.|
|Strathmore and Kinghorne, E.||Wolfson, L.|
§ Resolved in the negative, and amendment disagreed to accordingly.
§ 5.17 p.m.
§ [Amendment No. 113AN not moved.]
Baroness Cox moved Amendment No. 113ANA:
Page 50, line 12, at end insert: ("(d) shall, in consultation with relevant health authorities identify staff currently in the employment of any such health authority whose duties and responsibilities may be significantly affected by the local authority's proposed plan, and shall incorporate in the plan measures to secure the continued employment of such staff.").
§ The noble Baroness said: This is essentially a probing amendment designed to gain some assurances, we hope, on behalf of staff who will be affected by the transfer of responsibility from the health authority to the local authority in terms of providing care in the community, particularly for the elderly and the mentally handicapped.
In Community Care: Agenda for Action Sir Roy Griffiths noted:
It is important that the skills of staff formerly employed in long stay hospitals are not lost, as patients are discharged and responsibility for their care passes to another authority. Such staff are likely to have direct personal knowledge of individual former patients and their needs, as well as a wide range of skills which are equally valuable in a community care setting. There are legislative and other problems which inhibit the smooth transfer of staff between agencies at present, which can delay desirable changes".
Sir Roy went on to say:
There are a number of options for local action in regard to staff. They may be seconded to the local authority, which has the advantage of being a flexible approach. There can be locally arranged transfers to a local authority employment with no redundancy compensation and with the retention of NHS superannuation scheme membership, which can be an important consideration for the staff concerned. Finally the health authority can make the staff redundant followed by engagement of the same staff by the local authority. Each of these options has its own advantages and disadvantages".
However, he urged that central government should make,
a clear decision on the action to be taken".
§ He argued that, if this did not involve legislation, local management should at least have clear instructions and detailed guidance.
§ Perhaps I may shift my focus for a moment to deal specifically with nurses. They represent possibly the largest number of staff who will be involved. The Royal College of Nursing is concerned that the Government have not been more specific about how they envisage the transfer of nursing staff into the community to follow their clients and patients. It may be that local authorities will wish to take over the employment of nursing staff. Obviously, if that 1503 is to be the case, the college wish to see an acceptable transfer of terms and conditions of service for its members who will then be working in the community.
§ The college believes that such nurses should not be denied any benefits which accrue to nurses who remain in the employment of district health authorities. For example, mental handicap nurses have long valued their entitlement to retire at the age of 55, their special duty payments for working in a priority group and their mental health officer status. That is a consideration affecting not only mental handicap nurses; it also affects all district nurses.
§ The Royal College of Nursing is also concerned to ensure that the statutory accountability of nurses to the United Kingdom Central Council is also protected if they are transferred to local authority employment. That is a most important issue in terms of professional accountability and maintenance of professional standards of conduct. Respect for that accountability will, therefore, be a vital safeguard in ensuring high standards of nursing care. Additionally, it is important that nurses working in a local authority environment have access to their own professional peer review and that they have a professional chain of management to ensure that they have access to managers with nursing experience. The RCN is also anxious that any nurses employed by local authorities are allowed time to attend mandatory refreshment courses which are shortly to be required by the United Kingdom Central Council for Nursing Midwifery and Health Visiting.
§ In conclusion, perhaps I may make the point that the Royal College of Nursing believes that nursing staff will be of fundamental importance if community care is to become a reality, especially given the growing numbers of clients and patients who will be in the community and who will have health needs. It is therefore vital that the Government make clear how such staff and other staff currently working in institutions who will be moving into the community will be affected by the transfer to local authority employment. I beg to move.
§ Lord Ennals
I fully support the amendment. The noble Baroness presented the case on behalf of the Royal College of Nursing, and I support her in that respect. However, I should stress that the arguments do not apply only to nurses, as I am sure she recognises. We must consider, for example, occupational therapists. I have an interest through the College of Occupational Therapists.
There is more to the argument than simply picking out which professions must follow the patient. Mention has been made of the fact that funds must follow patients. I wish to ensure that staff follow patients. We are talking in many cases about people who may have been residents, occupants or patients of long-stay hospitals. Many establish a very close link with the staff looking after them. They will be moving into the community; in certain respects possibly moving into institutions in the community. We do not know the exact position.
1504 It is important to ensure, in the interests of staff and of patients, that those who might be called "key workers" can also be moved. Many patients who have to move from long-stay hospitals are not keen to do so. They have become institutionalised or have come to accept the hospital as their home. Accordingly, they are somewhat reluctant to move into the community.
I am not saying that there are no patients who need to stay in long-stay hospitals of one kind or another. However, every encouragement and assistance must be given to settlement into the community. Such encouragement could be enhanced by some staff—not necessarily those working in hospitals—moving into the community. We are dealing with both continuity of employment and continuity of treatment, friendship and understanding.
I hope that when the Minister replies to what, as the noble Baroness said, is a probing amendment, she will accept that aspect of the matter as well as the conditions of service argument put forward by the noble Baroness, Lady Cox, with which I agree.
§ Lord Swinfen
I too support the amendment. I especially agree with the remarks of the noble Lord, Lord Ennals. Members of the Committee will know that I work for the John Grooms Association for the Disabled. Over the past few years the association has taken very severely physically disabled people out of permanent long-stay hospital wards and has turned them from patients into residents, giving them a much greater degree of control over their own lives. The association has also taken staff from those hospitals, with local area health authorities' agreement, under various arrangements. It is essential not only to ensure continued employment but also to see that disabled people have the benefit of being looked after by people with whom they are familiar.
§ Baroness Blatch
This is an important issue. There is no doubt that the introduction of reforms can be unsettling not only for the staff but also for the recipients of the service; namely, the patients. Therefore, I hope that I can assure Members of the Committee about the Government's concern in the area.
In drawing up plans local authorities will most certainly need to consider the staffing implications and devise a personnel and training strategy to meet service requirements. District health authorities will need to go through a similar process in producing the plans. The two authorities will have to consult each other to decide who will be responsible for providing various services and how they will be staffed and funded.
If, in the event, it appears that the duties and responsibilities of employees of district health authorities are affected by the new arrangements, it will be for those health authorities to deal with the situation in accordance with arrangements which exist for this purpose. It may be that in some circumstances a transfer of staff to local authorities would be the best solution to maintain or provide services. But I do not think that it is sensible to 1505 pre-empt or to prejudge such issues. Indeed, amending the Bill as proposed could prevent local authorities and district health authorities from reaching agreements which would benefit their patients and clients.
I believe that local authority community care plans are not the right place in which to attempt to address the issue of the future of employees of district health authorities. Health authorities already have arrangements for dealing with changes in the duties and responsibilities of their staff. However, we accept that transfer of staff from health to local authorities may occur and the details of arrangements are already under discussion. But I do not believe that this amendment will assist authorities to reach the agreements which are essential for collaborative working.
My noble friend Lady Cox asked about the fate of community nurses moving from the health service into the community. I can assure her that they will continue to be employed by health authorities. The assumption is that conditions of service will remain unchanged.
I wish to emphasise that the Government appreciate the problems which can arise for members of staff as people previously cared for by the NHS move into the community to receive more appropriate care from local authorities. That theme was discussed at length in another place. In the light of that discussion the Government have tabled Amendment No. 115AEA which will be discussed in Committee on Monday. The amendment allows for regulations to be made dealing with issues such as continuity of employment which arise on transfer. My noble friend Lord Sanderson will be tabling a similar amendment for Scotland on Report.
I trust that this illustrates to the Committee that the Government are concerned and prepared to act on the important issue of continuity of employment.
§ Baroness Cox
I am most grateful to those who have contributed to this short and constructive debate. I thank the noble Lord, Lord Ennals, for helpfully broadening the points that I raised in my opening remarks to include, entirely appropriately, the other members of the health workforce. He also emphasised the importance of continuity of care and relationships which have been established during long-stay care.
I am also grateful to my noble friend Lord Swinfen. I strongly agree with the points he made concerning the continuity of friendship and personal support for people who have to face the challenges of moving out of long-stay care into what is often a frightening, strange and daunting community. I know from my own experience that many people making those adjustments need the continuity of care and support from the people with whom they have been familiar and who have formed part of their world for many years. I am grateful that those points have been made and an: on the record.
I thank my noble friend the Minister for her sympathetic reply. I was glad to hear that the details of arrangements for the transfer of staff are under discussion and to know that reassurances can be 1506 given concerning nursing staff. We shall look carefully at the other points which she made in her helpful reply. In the meantime, I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ 5.30 p.m.
Lord Peston moved Amendment No. 113AP:
Page 50, line 12, at end insert:
("(1A) A plan prepared under this section shall set out what steps the local authority intend to take to ensure that they are able to provide assessments of and community care services for persons with low incidence disabilities, and in particular how they intend to secure such expertise as is necessary for the performance of those functions.
(1B) If the Secretary of State is not satisfied that the steps set out under subsection (1A) above are adequate for the purpose of the proper assessment of and provision of services to persons with low incidence disabilities, he may by order provide for alternative steps to be included in the plan for that purpose and it shall be the duty of the local authority to take such steps.").
§ The noble Lord said: In moving this amendment which stands in the name of my noble friend Lord Carter, the noble Lord, Lord Hunter of Newington, and the noble Baroness, Lady Cox, I wish to make a few general points. I shall leave some of the detailed considerations that arise to the noble Lord, Lord Hunter, and the noble Baroness, Lady Cox.
§ In introducing the amendment I hope that I do not have to emphasise that we generally approve of the idea that local authorities should introduce plans for community care services. I believe that the noble Baroness, Lady Seear, was right with her amendment which, regrettably, was not accepted by the Government. It specified more clearly the nature of the planning process that would be desirable and in particular the importance of the distinction in the planning process between stating needs and objectives, on the one hand, and what can be afforded, on the other. It is a great pity that the Committee did not accept that we should place on the face of the Bill what the noble Baroness, Lady Seear, said at that time. So be it.
§ The amendment is a rather minor variant of the bigger amendment that we rejected. It concerns a particular aspect of the planning process. Again, it is one which I believe should commend itself to the Committee and it should be placed on the face of the Bill. I hope to receive a sympathetic response from the Government.
§ The amendment describes specific details about the plan that the local authorities should draw up; namely, that it should pay special attention to people with low incidence disabilities. In emphasising that, although I am a totally committed supporter of the National Health Service I do not pretend that it is perfect. I am not greatly sympathetic to the Bill but one of its advantages is that it enables us to put forward certain suggestions to improve the National Health Service.
§ The area we are discussing—that of low incidence disabilities—is one where we cannot be happy that the National Health Service has up to now done quite all that we should like. That is one good reason for introducing the amendment. Subsection (1B) goes further. It will enable the noble Baroness, in 1507 her reply, to say something more about the role of the Secretary of State. Subsection (1B) says that we cannot take it for granted that local authorities will do precisely what we want, even if they are instructed to do it under subsection (1A). Therefore the Secretary of State himself should be in a position to take the matter further. Those are the main points at issue and the principles involved.
§ The example to which I understand the noble Baroness will refer, concerns the deaf-blind. Here I wish to pay tribute to Deaf Accord, which, as the Committee knows, is a consortium of organisations concerned with the deaf. I pay tribute to it both for its work and for the excellent briefing it has given a number of us on this matter. The deaf-blind are not the only people to whom one refers when talking about low incidence disabilities. There are other more rare conditions which give rise to what are called low incidence disabilities.
§ I do not wish to pursue the matter any further in detail except to reiterate that although much good work is done here, it is an area where we are not doing enough. I am not convinced that the reason is solely to do with resources. It is not; nor is it obvious to me that this amendment is one on which an appropriate response on the part of the Government would be, "This is yet another of those blank cheque amendments". Certainly I shall not be happy with such an answer.
§ This concerns the perception of the role of the NHS, a perception of its priorities and the desire to emphasise that although this group of people is neither enormous in numbers nor trivially small, it is important for each person. The amendment seeks to ensure that they are not neglected. That is its purpose. I shall now give way to my collegues to allow them to make their remarks. I beg to move.
§ Baroness Cox
In supporting the amendment I believe that it may be helpful if I compliment —in both senses of the word—the noble Lord, Lord Peston, on his opening remarks. I do so by highlighting the seriousness of the needs of many people who suffer from low incidence disabilities. I highlight the complexity of their problems in order to show the need for the provisions of the amendment. These problems often represent some of the most acute, the most poignant and complex problems which can be confronted by people who live in the community.
Before I highlight two particular groups of such people, I join the noble Lord, Lord Peston, in paying tribute to those organisations that work with and for people who suffer from low incidence disabilities. I wish, without being invidious, to mention Headway, people who work with those suffering from brain damage and who have provided valuable information backing the need for the amendment; Deaf Accord, who do so much work with and for the deaf-blind; and also Combat, who do much work for people suffering from Huntington's chorea. I have the great honour to be associated with their work.
Perhaps I may illustrate, to assist the Committee, some of the problems that are confronted by people 1508 with low incidence disabilities, to show the need for the amendment. First, I take those who suffer from brain damage. They are inclined to fall, in terms of their problems, between the physically and mentally ill and the mentally handicapped classifications. They are not acknowledged as being in any of these categories. In addition, they may sometimes have behavioural or personality disorders as a result of their brain damage. They may therefore sometimes be discriminated against by those providing normal services, if I may put it that way. They often require care which involves a high staffing ratio.
Achievement of an adequate quality of life for people who suffer from brain damage is very difficult indeed. The assessment of the problems of this client group will be difficult because the range of deficits is often not widely understood. It is therefore j important that representatives of the relevant voluntary organisations are involved in these assessments and also in the subsequent decisions making, especially as in many cases the patients and clients themselves are unable to make a coherent or a coherently presented choice. Equally, appeal against assessment is an area in which those with normal cognitive powers have difficulty. Therefore people with such multiple disabilities will obviously have even greater difficulties. It will be particularly difficult for them to ensure that they obtain the quality of care that they need and for others to assure them on that front.
I wish to pass from the particular problems of those with brain damage to the problems of those who suffer from deaf-blindness. This is a low incidence disability which requires services specifically designed to meet the needs of people with a dual sensory impairment. The problems are highlighted by the fact that, again, they do not fall directly into any immediately predefined category. A deaf-blind person cannot just fit into a service designed for other needs. A service designed for mentally handicapped people will obviously not be good for those who are not intellectually impaired but who have communication, information and mobility problems as a result of sensory impairment. A service designed for hearing impaired people is probably no use for those with limited vision. A service designed for the visually impaired will probably depend on hearing. Therefore an alternative approach, based on tactile communication, will be required. That is a specialist approach but it is not necessarily widely available. It is important that deaf-blindness is diagnosed as early as possible and that the individual is supported through services that are designed to meet his specific needs.
I shall conclude by highlighting the fact that deaf-blind people are not an homogeneous group. Their degrees of hearing and sight loss influences their degrees of disability and their pattern of needs. Many have additional disabilities such as mental handicap. Their needs for education, habilitation or rehabilitation, help with communication for personal development and obtaining appropriate occupations and recreations and their needs for assistance with all the activities of daily living will depend to a significant extent upon all the related 1509 aspects of their particular unique disability and on the age at which they become afflicted with their disability and their personal circumstances.
Given the complex nature of this syndrome of disabilities, the need for specialist involvement in assessment, planning and provision of services and in the evaluation of the quality of those services is obvious. As the number of individuals involved is small, suitable services will not usually be available within any particular local area. A specialist service will often need to be provided from several local authorities, either by a voluntary organisation or by a consortium of authorities. At present there are hundreds of deaf-blind people in long stay mental handicap hospitals. They are often treated with drugs for their behaviour, which seems challenging or sometimes provocative. Many have not had their sensory impairment diagnosed and are receiving no specialist help. Their lives are often empty and confused. Without help and training they are unable to communicate as well as they could.
As the policy of community care begins increasingly to come into effect, many of these people will be considered for care in the community. Others are in the community but at the moment their handicap is not recognised, understood or given appropriate help. That is the position for many of them. They do not receive the support they need and they too often lead lonely confused, unhappy and sometimes isolated lives. With appropriate support and education they could maximise their potential and many could achieve a high level of independence and personal fulfilment.
People with such low incidence disabilities have profound needs. They are extremely vulnerable and they need specialist help. There must be provision for that specialist help to be available for them, wherever they live, in a systematic and comprehensive way and in a way that gives the best possible quality of life to people who often have agonising and acute problems.
§ 5.45 p.m.
§ Lord Hunter of Newington
Little remains to be said, but the challenge is there. How does a local authority that does not have specialist knowledge obtain an accurate assessment of a person who is suffering from a rare disability? That is the key to the matter. We are talking about a rare and difficult disability. When it occurs in children, the matter may become urgent as new treatments and new possibilities arise. I suggest to the Minister that what is required here for a quality service is a special contract between a local authority and a hospital or a specialised unit within the health service that knows about this disability.
We should not rely on the former arrangement, which was for patients to go to the local hospital. Local hospitals then acquire the ambition to obtain doctors with additional skills. They want to extend their field of interest. However, that is not the way to tackle this matter under the new conditions that will apply to the National Health Service.
In other fields the Government have promoted the drawing up of contracts. We should take the 1510 opportunity here to draw up a contract which sets up a specialised paediatric unit in a town perhaps some distance away. A paediatric nurse with specialised skills who belongs to that unit can then visit a child and make arrangements for what has to be done. An avenue is then open for a child or an adult in the community to have access to the best possible advice on how he can be best looked after in the community.
§ Lord Renton
One must be sympathetic to the broad case that has been made with regard to this matter. Extreme cases of disability have been mentioned as being intended to be covered. The deaf-blind are the most extreme and tragic of all. But we have also been told of Huntingdon's chorea. We have also heard the expression "mental handicap". There are various causes of mental handicap. However, if I may refer to the speech of the noble Lord, Lord Peston, there should be no doubt about the difference between mental handicap and mental illness. I do not think it is feasible to think of a half-way stage between them either, because the essence of mental handicap is that it is a form of brain damage or brain deformity which is incurable.
Having said that, I want to understand the meaning of the words "low incidence" in this amendment. I at first thought that the words "low incidence" meant that the person suffered from the disability only from time to time. As a simple student of the language, that was what I thought it meant. Now I understand from the speech of my noble friend Lady Cox that it means that there are not many people suffering from it, and that therefore these are very special cases which do not often arise. But let me tell the Committee that it is estimated that one person in 100 is born mentally handicapped. If they all lived to adulthood and had a normal length of life it would mean that there would be 500,000 of them in our society. In fact a great many of them die, although not as many as formerly because antibiotics have prevented that —
§ Baroness Cox
As I was one of the speakers who referred to mental handicap, I should like to clarify the situation. I did not intend to suggest that mental handicap was a low incidence disability. The conjunction of mental handicap with some of the low incidence disability problems was the context in which the words "mental handicap" came into the discussion. It is not that mental handicap itself is a low incidence disability, but sometimes it is an associated symptom or problem with some of the genuinely low incidence disability problems.
§ Lord Renton
I am most grateful to my noble friend for that clarifying amplification. Nevertheless, I must point out from my own knowledge that there are many handicapped people who also suffer from other disabilities. They are referred to as those with multiple handicaps. They are numerous. If the term "low incidence" is intended to point to their rarity, then the amendment should not have included that expression.
Having said that, I believe that those who have asked that the local authority should in some way 1511 be required to consider what is to happen to each type of disability have a good point. The question is whether the amendment is an appropriate way of doing that. It follows from what I have said that I would wish the wording of the amendment to be reconsidered.
I should be interested to hear from my noble friend on the Front Bench when she replies to the debate to what extent Clause 44 as it stands—which is pretty broad in its terms—would already require the local authority to do what the amendment asks should be done. Having said that, this is a serious matter and I shall be interested to hear what my noble friend has to say.
§ Baroness Masham of Ilton
I should like to comment at this point. The term "low incidence" adds yet another complication, as has been mentioned by the noble Lord, Lord Renton. The field of disability is so complicated and so wide that nobody understands it very well.
With reference to the White Papers, there is a great worry that there is almost no mention of handicap. Therefore it is very important that there is some provision, although perhaps the amendment is not the right one.
I have on my desk at home a letter setting out great anxiety about the pending closure of a school in Leeds which caters for children with multiple disabilities. They are assessed, looked after and helped at the school. The parents are also helped. The parents are now very worried. Those are the people who may fall between health and social services with no one to help them. Therefore, the Government should look very carefully at the matter. As has been said, a number of people are affected but their cases are complicated. However, we should not complicate legislation more, because the definition of disability is not easy.
§ Lord Butterfield
Perhaps I may make two points. The first concerns the word "incidence". Technically "low incidence" means that something occurs very few times each year. "Incidence" is the number of case or categories admitted to a certain diagnosis. "Prevalence" tells one the total of people with a particular condition at any time who have to be cared for. Therefore it may be that the amendment might benefit from a change from the word "incidence" to "prevalence". We are dealing here with chronic conditions and it is the chronicity which is reflected in the use of the word "prevalence". I make no apology for making this short intervention because it is a question which frequently appears in medical exams—"define the difference between incidence and prevalence".
I hope that my second point may be helpful when the Government reply to the amendment. There are people who may be able to help in the process in the course of their daily work. I am thinking particularly of regional rehabilitation consultants. All the people who need special limb apparatus or have special problems due to head injuries, for example, are brought to those consultants. I hope that the noble 1512 Baroness will reassure us that the Government will encourage local authorities to talk to those consultants—who have special lists and special experience —more than they have perhaps talked to them in the past, along the lines referred to by my noble friend Lord Hunter in his remarks.
§ Lord Swinfen
Surely the matter could be dealt with quite simply if the Government were to bring into operation Section 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986. That Act requests local authorities to make a proper assessment of each individual disabled person. Able-bodied people are like peas in a pod; disabled people, no matter what their disability, are all different. Although the disability may have the same clinical name the degree of handicap is different in each person, particularly when different disabilities occur in the same person. That makes matters very much more complicated.
§ Baroness Blatch
Perhaps I may begin by assuring the noble Lord, Lord Peston, that I do not intend to respond to the amendment as an issue of resources but more one of genuine concern that the needs of any client group or individual will be excluded from the planning process and thereby will be denied health or community care provision.
I hope that my noble friend Lord Renton will see from my response that the facility in the Bill as drafted provides what the amendment seeks.
I very much recognise the anxiety of the noble Lords who moved the amendment that people with low incidence disabilities should not be overlooked in our provisions. I accept what has been said about the confusion surrounding the term "low incidence". I believe that we now all understand what is meant by it even though there may be some argument about the word itself.
§ Lord Renton
Will my noble friend permit me to intervene? It has taken me 80 years to understand it. I had never seen the expression until I saw it in the amendment.
§ Baroness Blatch
I am greatly comforted by that intervention. When I saw the amendment I had to ask what it meant. I believe that it is accepted that we are talking about those illnesses from which few people suffer. We are also concerned with complex cases in which somebody may have a main illness, which may be a mental handicap, and also suffer from one of the illnesses which have been described or from multiple disabilities. We are anxious that people with substantial care needs should not be overlooked in our local authority provision. We have already, in connection with Clause 40, talked about which people are covered by the broad term community care services. We reassured noble Lords then, and I do so again now, that we include any person for whom it appears to a local authority that it may provide or arrange for the provision of community care services. That includes disabled people which, in the terms of the National Assistance Act 1948, covers people with communicative disorders—which would include blindness and 1513 deafness—mentally disordered or substantially handicapped by illness, injury or congenital deformity. I believe that there is a phrase which also refers to any other illness. That is genuinely intended to be a catch-all definition. Therefore, all the groups which have been mentioned by noble Lords in this and previous debates are covered by all of our provisions.
I can therefore assure noble Lords that community care plans will have to be comprehensive of the totality of need which the local authority has to address and the totality of the service provision it aims to provide within the resources available to it. I confirm that that also means working together with other agencies on the preparation of the care plan to ensure that all the resources at the disposal of the local community are brought to bear on both identifying the needs and then seeking out the most effective services to meet those needs, which will be further refined by the assessment process. The first part of the amendment is therefore unnecessary.
The second part of the amendment is also unnecessary because the Secretary of State may, in the terms in which the Bill is already drafted, direct local authorities to prepare and publish modifications to their current plans or, indeed, if the need arises, to direct that a new plan be produced. Therefore, the powers that the amendment seeks to give the Secretary of State already exist and no further words are required on the face of the Bill.
In their very effective interventions the noble Lords, Lord Butterfield and Lord Hunter, referred to how that would be done rather that what should be written on the face of the Bill in terms of providing powers to enable it to be done. The example given by the noble Lord, Lord Hunter, and the advice given by the noble Lord, Lord Butterfield, will be well worth thinking about in terms of the guidance offered to the authorities. I believe that those watching the debate will certainly take those comments on board.
Perhaps I may reaffirm what I said previously. Our guidance on community care plans will make clear that we are talking about the totality of potential provision for all client groups which the local authority serves. I hope that in the light of that reply, the noble Lords will feel able to withdraw their amendment.
§ 6 p.m.
§ Lord Peston
I thank noble Lords for that interesting debate. I am interested to learn that medical education has improved to such an extent that medical students now learn the difference between "incidence" and "prevalence" and will presumably learn about other aspects of epidemiology. That will stand them in good stead.
I am not entirely happy with the reply of the noble Baroness. As I said in my opening remarks, I would have been much more reassured if the Government had accepted the previous amendment of the noble Baroness, Lady Seear, which would have left in the Bill a much more specific provision about the planning process. Essentially, all we have is Clause 44. The guidance is not in the Bill. The guidance is 1514 simply the guidance. None of us doubts that it is possible for local authorities to do what we want them to do, but there is a world of difference between possibility, even with guidance, and making a specific provision in the Bill. That is the point. We do not suggest that those people with low-incidence disabilities will automatically be neglected. We simply say that, in order to ensure that they are not neglected, we would like to see a specific provision written into the legislation.
On the other hand, I am particularly glad that the noble Baroness has drawn our attention to Clause 44(1)(c) which states that
the Secretary of State may direct, prepare and publish modifications to the current plan, or if the case requires, a new plan".It is well worth bearing in mind that it looks, at least in theory, as if the second of the provisions in our amendment might be covered by the wording in the Bill. I say "might" because the wording in the amendment is more specific and places a greater obligation on the Secretary of State.
This is an important matter. Perhaps I may emphasise the point raised by the noble Lord, Lord Renton, in his more commonsense way; namely, the worry that an important but minor group will be neglected, to put matters in ordinary, every-day language. That is the worry. That is not to say that they will be neglected. We hope that they will not, but one must recognise that they have perhaps been neglected until now. That is an important piece of evidence.
The noble Lord, Lord Hunter of Newington, raised the point about expertise and the possibility that the local authority must look over a much wider range than within its own area to gain that expertise. The best step that those of us who tabled and spoke to the amendment—I hope that this includes the Government—can take is to reflect on the amendment and perhaps come back on Report with a measure that will commend itself to the Government and will produce the fail-safe state of affairs that we seek. I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ Lord Seebohm moved Amendment No. 113AQ:
Page 50, line 12, at end insert:
("( ) The plan for the provision of community care services referred to in subsection (1) above shall, in the case of those local authorities which are housing authorities, include details on how those authorities propose to meet the housing needs of the persons in their areas who are in need of community care services.").
§ The noble Lord said: This is an important amendment. The Committee will recollect that the importance of housing was made clear in the Griffiths Report, the White Paper and in Second Reading speeches. As far as I can make out, there is no specific reference to it in the Bill. The amendment seeks to ensure that, in drawing up community care plans, local authorities are obliged to provide information on how the housing needs of people who require community care services are to be met.
§ One tends to think perhaps too much that the community care provisions in the Bill refer solely to social services department and directors of social 1515 services, but local authorities have other services, such as housing, under their command. The Bill refers to local authorities, not to particular departments, so it is important that the Bill should make clear that those other departments are involved.
§ The special arrangements to be made with housing associations were discussed under a previous amendment on Tuesday and I not propose to take that matter further. However, the National Federation of Housing Associations has pointed out that there is as much need to consider and determine where and how people are to live as there is to provide other care services. This matter is as important as any other matter that we are to consider under Parts III and IV of the Bill. Not only is the welfare of the client vitally affected by his housing conditions, but the cost element of the provision, particularly in the early stages, could form the main cost of the bill.
§ Housing is the infrastructure of all welfare and it will require capital expenditure way beyond any possibility of financing it from the community charge. Perhaps we should have included arrangements in cases where the local authority is not the housing authority, but perhaps that point will be dealt with at another time. I shall be interested to know what the Government have in mind to deal with this matter. We are talking mainly about disabled people. It is no good providing a wheelchair or recommending the provision of one if there is no possibility of getting it in and out of the front door. Similarly, as people living in flats on the third or fourth floor grow older, there is no earthly way for them to get out and they need special separate accommodation arrangements. The strategy of housing provision with regard to community care must be looked at carefully. I have great pleasure in moving the amendment. I beg to move.
§ Lord Ennals
I am grateful to the noble Lord, Lord Seebohm, for raising the issue because housing is one of the most important provisions for those with social need. As he said, there is no acknowledgement in the legislation that many people with social care needs are either homeless or inappropriately housed. That fact should be recognised in the Bill.
The provision of appropriate housing is of fundamental importance in the promotion of community care policies. There is often a relationship between the presence of social care problems and housing problems. Clients with social care needs are frequently also either roofless or inappropriately housed. We see that especially when we consider the problems of people who have been in and out of psychiatric hospitals. We all know of cases involving people who have been in and out of psychiatric hospitals three, four or even five times. A person is discharged from hospital and may land up in a night shelter, on the floor of a friend's house or under a bridge. More than anything else they need adequate housing which is appropriate to meet their needs. That is the strength of the amendment. The wording may not be the best, but it must find its way into the Bill.
1516 As the noble Lord, Lord Seebohm, said, we are talking about disabled people. Some Members of the Committee may have seen a new report by Dr. Terry Morris, published by Shelter and entitled Our Homes, Our Rights. The survey reviews the extent to which independent living for disabled people is dependent on adequate housing provision together with effective social support. It paints a gloomy picture of recent trends which have been exacerbated by growing financial problems, both for local authorities and for housing associations.
The report states that the number of wheelchair and mobility properties built by housing associations has declined. The building of new wheelchair-accessible properties declined from 129 in 1979 to 63 in 1988. Even more startling is the drop in mobility standard properties from 2,316 in 1979 to only 207 in 1988. The new financial system for housing associations is putting on a squeeze that will threaten their existence.
There are very few local authorities with strategies for the provision of appropriate housing. There is little evidence of the needs of people with disabilities being taken into account in the increasing number of deals with the private sector.
We are not talking only about housing and the availability of a place to live. For disabled people we are talking about appropriate housing. It may often have to be housing that has been converted to meet the needs of disabled people. My name and that of my noble friend Lord Carter are synonymous; we are one and the same man or woman on the Bill. We do not pretend that the amendment solves the problems. But it will ensure that housing authorities have a duty to assess the need and make plans to meet it in line with the other aspects of the community care plans. Without that requirement the community care plans for individuals both in the community and in residential care will lack credibility or effectiveness.
I hope that the arguments that have been used and those to come will convince the Minister that this amendment, or words to its effect, is needed to show the importance of housing within the provision of social care.
§ 6.15 p.m.
§ Baroness Llewelyn-Davies of Hastoe
I am very glad to follow the noble Lord, Lord Seebohm, and my noble friend Lord Ennals in their emphasis on the housing problems, which are absolutely central to the situation. Members of the Committee who are active in this field know that it is often impossible to implement the social care services until the housing problem is solved. Just imagine the difficulties of social workers who have to contact families in bed and breakfast accommodation, with all its attendant horrors. They often have to follow families from relatives to relatives. When the situation becomes desperate many relatives have to take these families in. It becomes very difficult for social workers to produce the social care services that they know the client needs.
Social services will have to work very closely with housing departments, housing associations, charities 1517 and, as my noble friend Lord Ennals said, the private sector in particular. If they do not do so we shall not be able to develop a full and flexible range of housing.
I am sure that all Members of the Committee have been inundated with letters and briefing about the Bill. I was impressed, but sadly, by the citizens advice bureaux, which made a report that it found, and I quote,very poor liaison between social services departments and housing departments and a reluctance by the latter to accept their statutory responsibility for homeless clients".Frail and elderly people cannot live independently, comfortably and safely at home unless their home is well repaired and properly adapted. The Committee knows that housing associations have over the years acquired the experience and expertise that is needed to provide appropriate accommodation, as the noble Lord, Lord Ennals, said. But it is essential that they should be in at the very beginning of the local authorities' planning. If the community care plans ignore the necessity for available housing, the community care services may well fail. That would be a very serious matter. It is essential that the local authorities co-ordinate with the relevant departments and organisations and, above all, with the users of the services. It gives me great pleasure to support the amendment.
§ Baroness Masham of Ilton
I should like to add a few points that have not yet been mentioned. I speak now as president and founder of the Spinal Injuries Association. I assure the Committee that in every single spinal unit in the country there are acute beds being blocked by patients who cannot go home.
I have had numerous letters from a surgeon in Newcastle, many of which I have sent on to the department. He is a surgeon of vascular surgery. Many of his patients cannot go home because the local housing authorities will not help with rehousing them. Some of their homes are completely and utterly inadequate. Many of his patients are elderly. They will have only a few years of life left. It is very important that the quality of that life should be good. He has had to keep patients for more than one further year in an acute hospital bed. That is not very good for the operating waiting lists. I am sorry that the noble Lord, Lord McColl, is not present. It is a very serious problem.
There are also many people who go home to very inadequate housing. Some time ago I dealt with a young man who had to evacuate his bowels in the kitchen. That was not very hygienic and not very pleasant for the remainder of his family. But is was the only room that he could get into with his wheelchair. The bathroom was totally inaccessible and he had to use a commode. I could tell the Committee many horror stories about paraplegics.
A young women with a child and husband cannot get out of her house. She becomes very seriously depressed. Depression is a problem. If people cannot get in and out of their homes to go shopping—they have a family to provide for—the situation is bad. Some measure ought to be provided to make local authorities do something about this very serious issue. But it is expensive to their health service.
1518 At the Second Reading of the Bill I asked a question to which I have not yet had the answer. With the new system, if someone remains in hospital after he has completed his hospital treatment and rehabilitation, who pays the bill? It is quite unfair that the hospital, the health authority or the GP should have to pay it. That patient is ready to go home but cannot because he has no suitable house. Is it therefore the housing authority, the local authority, which will pay that bill? I am still waiting for a reply.
Baroness Darcy (de Knayth)
I too should like to support the amendment. My noble friend has said much of what I should have liked to have said in relation to people with spinal cord injury, the problem of blocking hospital beds and of trying to rehabilitate people in unsuitable housing.
I refer briefly to one letter from the Spinal Injuries Association to a director of housing about a paraplegic woman. She was moved into unsuitable housing on the understanding that it would be for just six months. That was five years ago. She now has a baby. She cannot take the baby out unless her husband is home to help her up the step back into the house. They have one bedroom. She can hardly move around the room in her wheelchair to look after her baby. She has injured herself on numerous occasions trying to reach for things which were difficult to reach. She injured herself and required stitches at one point after trying to leap onto a work surface to reach items in a cupboard in the kitchen. That has continued for five years. It is not acceptable. In terms of human happiness, independence, ability to contribute to the community, medical fitness and, as my noble friend said, leaving valuable hospital beds free for those who need them, the amendment is necessary.
§ Lord Swinfen
I also support the amendment. It is absolutely essential that we should be able to move people out of hospital to give them a much better quality of life. I have said in the Chamber on a number of occasions that an alteration to the building regulations would make very many more houses accessible to people in wheelchairs.
The ordinary house built by private developers in particular has doors, passages and rooms which are too small for anyone in a wheelchair. For the most part, the housing associations and local housing authorities are now building dwellings with sufficient space. However, the problem needs to be taken into account when considering such building. It is interesting to note that in the past financial year the Housing Corporation gave a great deal less funding to housing associations catering for physically disabled people. I understand that this year there is virtually no funding for residential accommodation for physically disabled people. That, coupled with the new financial arrangements for the housing associations whereby they must raise some 30 per cent. of their funds from voluntary or other sources, makes it extremely difficult to provide sufficient accommodation.
The population as a whole is becoming older and therefore many more people are becoming disabled 1519 as a result of infirmity and disease. The doctors do a good job and can keep people alive when they are merely becoming older or when they have a medical condition. However, that is resulting in a problem because we are running out of properly designed accommodation. That problem must be considered fully.
§ Lord Wise
I too support the amendment. The citizens advice bureaux have reported a number of cases where there is a relationship between the presence of social care and housing problems. People with social care needs are often homeless or in entirely inappropriate housing conditions. Not only do those conditions exacerbate the problems, but they make it impossible to deliver the necessary social care services. That cannot be done until the housing problem has been resolved.
If the intentions of the community care legislation are achieved there will be a significant increase in the demand for an inadequate supply of housing for the disabled. It is crucial that legislation provides a mechanism for that expansion to take place. I shall support the amendment because it provides a starting point for such a process. It proposes that the community care planners shall determine how any additional accommodation shall be provided.
§ Baroness Hooper
This is a difficult area and it was beneficial for the Committee to be made aware of those examples. In reply to my noble friend Lady Masham, I point out that while anyone remains in hospital, the health authority must foot the bill. Therefore, the problem of bed blocking is best solved by co-operation between health and local authorities. The problem cannot be solved by elaborate cross-charging systems between the authorities. Later today the Committee will consider a Government amendment, No. 114ZA, which will require the social services departments to bring apparent housing needs to the attention of the housing authorities. Although that applies only where the authorities are separate we agree that a similar situation should apply when the same local authority is involved.
The effect of the amendment will be to require local authorities which are both social service and housing authorities—they are the metropolitan district councils and London boroughs—to include in their community care plans details of the way in which housing needs are to be met for everyone, whether they are disabled or merely have housing needs. I was surprised that no mention was made of the fact that the Government have already amended Clause 44 to include a provision for consultation with housing interests, including housing authorities, where they are different from the social services authority. The changes that were introduced by the amendment agreed in another place are contained in Clause 44(2) to which Members of the Committee may wish to refer.
I take the point behind the amendment which is designed to cover the situation where there will be no requirement to consult. I suggest that we should 1520 consider further the best way of addressing that situation. It may be that we shall decide that guidance should be given to authorities; but if legislation appears to be necessary, that could be introduced at a later stage of the Bill.
I must hide behind the fact that the points raised by my noble friend Lord Swinfen about building regulations are a matter for a different department. Therefore, I must research the subject a little further and write to him.
§ Lord Swinfen
I realise that it is the responsibility of a different department. However, perhaps my noble friend can bring pressure to bear on that department because the situation would be made easier for elderly and disabled people.
§ Baroness Masham of Ilton
A point raised by the noble Lord, Lord Winstanley, has been forgotten; it is the serious lack of hospital social workers and occupational therapists working in local authorities as a link. There must be that important link between the hospital and the community particularly in respect of housing.
§ Baroness Hooper
I fully agree that it will be important to have proper and appropriate co-operation. Whether that can be achieved as a result of the provisions in the amendment is another matter.
§ Lord Hylton
The Committee will be grateful to the Minister for the sympathetic views she expressed, particularly about the possibility of a tighter or better-drawn Government amendment. Nevertheless, further remarks must be made because the impression should not be given that the problem affects only people in wheelchairs, for example.
The recent survey of homeless people in London carried out by the Salvation Army and Surrey University showed that approximately one third of ex-mental patients discharged from hospital become homeless within a matter of months. That is a serious matter. Other groups are affected such as drug addicts and alcoholics who have been rehabilitated in hospital or elsewhere. There are also people suffering from AIDS or who are HIV positive. There is the generality of single homeless people many of whom suffered from a lack of medical attention and primary care in the first instance. That may mean that later they must be admitted to hospital. We know that there is a lack of liaison between the Department of Health and the Housing Corporation. They are additional reasons showing why the Government need to reconsider the position and bring forward a suitable amendment.
§ 6.30 p.m.
§ Lord Seebohm
Before I decide what action to take on this amendment, perhaps the noble Baroness will give an assurance that there will be something like this written on the face of the Bill, whether that is by an amendment brought in by the Government or by acceptance of a similar amendment at a later stage. Without that, I do not believe that the Committee will be satisfied.
§ Baroness Hooper
I am sorry, but I feel that it is very important to recognise that as valuable as is the co-operation about which we have been speaking, that will not be achieved by writing something on the face of the Bill. That will be achieved by effective co-operation and methods of co-operation being developed at local level. There are other ways of achieving that. Therefore, in agreeing to consider the amendment, I make that offer without commitment.
§ Baroness Masham of Ilton
Before the noble Lord decides what to do, I should point out that if something is written on the face of the Bill, it places emphasis on it and it is not then forgotten. Sometimes people forget matters which are not written on to the face of the Bill.
§ Baroness Hooper
As I pointed out, in Clause 44 there is already reference to this matter. That is the amendment which was introduced in another place.
§ 6.31 p.m.
§ On Question, Whether the said amendment (No. 113AQ) shall be agreed to?
§ Their Lordships divided: Contents, 67; Not-Contents, 66.1522
|DIVISION NO. 3|
|Airedale, L.||Jenkins of Putney, L.|
|Allen of Abbeydale, L.||Kilbracken, L.|
|Ampthill, L.||Kilmarnock, L.|
|Aylestone, L.||Kirkhill, L.|
|Bancroft. L.||Llewelyn-Davies of Hastoe, B.|
|Bonham-Carter, L.||Longford, E.|
|Bruce of Donington, L.||Lovell-Davis, L.|
|Butterfield, L.||Macaulay of Bragar, L.|
|Carmichael of Kelvingrove, L.||McIntosh of Haringey, L.|
|Masham of Ilton, B.|
|Carter, L.||Milner of Leeds, L.|
|Cledwyn of Penrhos, L.||Molloy, L.|
|Clinton-Davis, L.||Morris of Castle Morris, L.|
|Cocks of Hartcliffe, L.||Nicol, B.|
|Craigavon, V.||Ogmore, L.|
|Darcy (de Knayth), B||Peston, L.|
|David, B.||Prys-Davies, L.|
|Dormand of Easington, L.||Robson of Kiddington, B.|
|Ennals, L.||Rochester, L.|
|Ewart-Biggs, B.||Russell, E.|
|Faithfull, B.||Saltoun of Abernethy, Ly.|
|Gallacher, L.||Seear, B.|
|Graham of Edmonton, L. [Teller.]||Seebohm, L. [Teller.]|
|Grimond, L.||Stoddart of Swindon, L.|
|Hacking, L.||Swinfen, L.|
|Henderson of Brompton, L.||Thurlow, L.|
|Houghton of Sowerby, L.||Underhill, L.|
|Hunter of Newington, L.||Wallace of Coslany, L.|
|Hylton, L.||Williams of Elvel, L.|
|Hylton-Foster, B.||Winchilsea and Nottingham, E.|
|Irvine of Lairg, L.|
|Jay, L.||Winterbottom, L.|
|Jeger, B.||Wise, L.|
|Jenkins cf Hillhead, L.|
|Ailesbury, M.||Layton, L.|
|Alexander of Tunis, E.||Long, V. [Teller.]|
|Allenby of Megiddo, V.||Lyell, L.|
|Arran, E.||McColl of Dulwich, L.|
|Balfour, E.||Mackay of Clashfern, L.|
|Belstead, L.||Macleod of Borve, B.|
|Birdwood, L.||Massereene and Ferrard, V.|
|Blatch, B.||Merrivale, L.|
|Blyth, L.||Mersey, V.|
|Boardman, L.||Monk Bretton, L.|
|Boyd-Carpenter, L.||Mottistone, L.|
|Bridgeman, V.||Mountevans, L.|
|Brougham and Vaux, L.||Munster, E.|
|Caithness, E.||Murton of Lindisfarne, L.|
|Campbell of Alloway, L.||Nelson, E.|
|Campbell of Croy, L.||Nugent of Guildford, L.|
|Carnegy of Lour, B.||O'Hagan, L.|
|Carnock, L.||Orkney, E.|
|Carr of Hadley, L.||Peel, E.|
|Colwyn, L.||Pender, L.|
|Constantine of Stanmore, L.||Rankeillour, L.|
|Cork and Orrery, E.||Reay, L.|
|Dacre of Glanton, L.||St. John of Fawsley, L.|
|Davidson, V. [Teller.]||Sanderson of Bowden, L.|
|Eden of Winton, L.||Strathclyde, L.|
|Elles, B.||Strathmore and Kinghorne, E.|
|Hailsham of Saint Marylebone, L.||Swinton, E.|
|Henley, L.||Thomas of Gwydir, L.|
|Hesketh, L.||Thomas of Swynnerton, L.|
|Hives, L.||Trefgarne, L.|
|Hooper, B.||Trumpington, B.|
|Kinnoull, E.||Ullswater, V.|
|Lauderdale, E.||Vinson, L.|
§ Resolved in the affirmative, and amendment agreed to accordingly.
§ 6.39 p.m.
§ [Amendment No. 113AR not moved.]
§ Lord Carter moved Amendment No. 113ZAS:
Page 50, line 12, at end insert:
("(1A) Any plan as defined by subsection (1) above shall include the local authority's proposals for ensuring that community care services are provided in a manner consistent with its powers and duties under the Children Act 1989.").
§ The noble Lord said: In moving Amendment No. 113ZAS, with the leave of the Committee I shall speak also to Amendment No. 115ZCA. These are probing amendments whose purpose is to clarify the relationship between the National Health Service and Community Care Bill and the Children Act 1989. These are two major and overlapping pieces of legislation which will come into force within the same parliamentary Session. However, there seems to be an absence of a clear government or departmental rationale for the relationship between the two pieces of legislation. There is an urgent need for clarification of the relationship and, if a relationship between the two is intended, what the nature of that relationship might be. These amendments are intended to probe that relationship.
§ The government and departmental statements which deal with the overlapping of the two pieces of legislation are somewhat confused and apparently in conflict with each other. Both the Children Act and the National Health Service and Community Care Bill require the assessement of the need for services. Each allows the assessment to be carried out under the relevant sections of the Disabled Persons (Services Consultation and Representation) Act 1986. As that Act requires the ability of carers to 1523 continue to provide care to be taken into consideration, some clarification is required of the position of parents as carers under the provisions of these related pieces of legislation.
§ Under Clause 44(3)(c) of this Bill, local authorities may provide or arrange services under Section 21 of and Schedule 8 to the National Health Service Act 1977. They relate to certain social services for mothers and children. Under the Children Act 1989 those relevant sections are removed. That means that for an interim period between the Children Act and the implementation of this Bill there is a direct recognition of the provision of some community care services for children and their families. However, it appears to be inconsistent to allow that relationship for a few months but not to ensure that it continues in the longer term.
§ The need for clarification is exemplified by the experience of organisations which are trying to provide services for children in such a way that they can be encouraged to move towards independence and the acceptance of adult responsibilities in the most constructive manner achievable. Those points have been put to us by Dr. Barnardo's, the Children's Society and the National Council of Voluntary Childcare Organisations.
§ The two amendments emphasise the need to ensure consistency between the two pieces of legislation which affect child care and community care. That is the intention of both amendments. Amendment No. 113ZAS attempts to ensure that in elaborating their plans local authorities take account in practice of the inevitable relationship between the two pieces of legislation, particularly at the point when young people with special needs move from childhood to adulthood. As we all know, there are some very real problems when special educational provision ceases because there is a major gap in disability care at that point.
§ The second amendment addresses the need for local authorities to work jointly with other organisations. It is a slightly modified version of Section 27 of the Children Act 1989 and attempts to incorporate the principle of co-operation between authorities equally in both pieces of legislation. Again, that is essential. Perhaps that requirement should be more forceful, as is set out later in Amendment No. 113E. We shall consider that point later.
§ It cannot be emphasised too much that there is an urgent need to ensure consistency between these two pieces of major legislation —the Children Act and this Bill—affecting the delivery of social services. For that reason I hope that the principles incorporated will be widely recognised and will gain general support. I beg to move.
§ Baroness Blatch
I listened with care to what the noble Lord, Lord Carter, had to say about the interrelation of services for children and community care services. The Government share his concern that the two sectors should be managed as effectively as possible and that the boundary between the two does not cause any problems. It is a well-established fact that territorial disputes are most unproductive.
1524 There are three possible areas where this type of provision might apply. First, in what may be termed philosophy of care, a local authority may wish to apply similar principles and practices in its children and community care work. The needs of different client groups will of course be distinct, but there may be lessons from one that can be applied to another. That is essentially a matter for professional and local judgment, however, not one for legislation.
Secondly, at the level of planning a local authority will have to have regard to its commitments and duties in relation to child care when it frames its community care plan. That is simply part and parcel of good management. Given that we have integrated social services departments, I see no reason why that should cause difficulty to any director of social services or to a social services committee. Even if it did, I am bound to say that a statutory duty would sow further confusion rather than clarify matters.
Finally and perhaps most importantly, the amendment could relate to the circumstances in which somebody needs to move from a service designed for children or teenagers to one designed for adults. That is always a challenge to professional social workers and can be unsettling for the young person concerned. The key is surely good communication and co-operation within the social services department and with any other agencies that may be involved. Again, I am not clear what a statutory duty would add in practical terms for the individual client.
I am also reluctant to endorse any amendment that seems to merge the statutory base for the provision of adult and children's services. As noble Lords will be aware, the base legislation we are discussing in this part of the Bill is quite separate from that which underpinned the Children Act 1989. That separation has borne the test of time remarkably well and has given social services departments clear statements of their responsibilities in each field. We lose that distinction at our peril.
In the light of what I have said about the need to recognise and manage carefully the problems which can arise for individual clients and for local authorities at the boundary of their two areas of responsibility, I hope that some of the noble Lord's concerns have been allayed.
Turning to Amendment No. 115ZCA, this new clause would empower a local authority to seek the help of any other local authority, education authority, housing authority, health authority, or person authorised by the Secretary of State—for example, a social services inspector—who they consider could help them with their community care functions. The noble Lord has underlined, quite rightly, the importance for community care of collaboration between authorities. The guidance on these functions which we are in the process of preparing will also stress that point. We plan to issue this guidance to other authorities concerned as well as to local authorities. But we do not see any need to add to existing statutory provision. Section 22 of the National Health Service Act 1977 already requires local authorities of all types to collaborate in the exercise of their respective functions.
1525 In the spirit of this provision collaboration is something which must be worked out locally by the authorities concerned. I do not feel new legislative provisions which give wide-ranging powers to local authorities and lay such an open-ended duty on those receiving requests will prove helpful in improving collaboration. I can assure the Committee that the social services inspectorate and other staff of the department stand ready at all times to respond to requests from local authorities with advice and assistance with their community care functions. I hope that the noble Lord will accept that we shall cover that aspect fully in our guidance.
§ Baroness Faithfull
I apologise for not giving notice of this question, but perhaps I may ask my noble friend the Minister how many handicapped children are still being cared for in hospitals in this country. I am sure that the noble Lord, Lord Carter, will feel that his amendment is applicable to that point, because there are a number of hospitals and therefore there are children who are not in the care of the local authority. They are not children in care, but they are children in mental hospitals.
§ Baroness Blatch
I hope that my noble friend will accept that I am unable to give a specific reply to that question at this time. In view of the promise that these amendments will not be pressed this afternoon we shall all have time to consider that point. I shall write to my noble friend and make the reply available to the noble Lord, Lord Carter.
§ Lord Hylton
I am sorry that the Government do not feel able to be a little more forthcoming on these two amendments. We must bear in mind that an increasing number of children in need of care or support of one kind or another are either adopted or fostered.
Secondly, in regard to the second amendment spoken to by the noble Lord, Lord Carter, the wording, should be helpful to the noble Baroness, Lady Hooper, in relation to the problem she was seeking to address on the previous amendment. I say that because Amendment No. 115ZCA states,may request the help of that other authority or person, specifying the action in question".That, I submit, is much more helpful than the existing wording of Clause 44 which, as I have already pointed out, simply says "shall consult". The amendment continues in subsection (2) to use the words,
shall comply with the request [provided it] does not unduly prejudice the discharge of any of their functions".That also seems to be highly relevant.
§ Baroness Blatch
I think that my response addressed the issue of properly serving the needs of both children and adults, and also the transitional point where children become adults. We are all concerned about effective working relationships that transcend both the provisions for children and for adults.
I believe I clearly made the point that separation of provision for children has worked very well. I have also promised that I will take into account the 1526 question posed by my noble friend to see whether there is room for modification. I hope that for the moment that will suffice.
§ Lord Carter
I think it is only for the moment. As I said, these are probing amendments and although I am grateful to the noble Baroness for her reply, I have to say that I am a little disappointed. We shall need to read carefully what she said. In addition to the point raised by the noble Baroness, Lady Faithfull, there are other examples which I shall not take up the time of the Committee by relating. There are a number of areas of overlap and confusion. If there is an opportunity for discussions before the next stage of the Bill perhaps we could usefully have them. However, in the meantime I reserve the right to come back later. I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ Baroness Seear moved Amendment No. 113AS:
Page 50, line 27, after ("area") insert:
("(dd) organisations of or for service users, their families or carers").
§ The noble Baroness said: The Government claim, sometimes with justification, that they stand for the interests of the consumer. We seem to have heard that rather often. They also preach the doctrine, with which many of us agree, of collaboration between the statutory, voluntary and private sectors. That is not always an easy doctrine to apply but it is one of which we on these Benches certainly approve.
§ The amendment is aimed at inviting the Government to apply the doctrine to which they pay so much lip service. In the drawing up of a local authority plan the Committee will notice that the local authority is told that it must consult the district health authority (a statutory body), the family health services authority (another statutory body), the local authority, the local housing authority and the voluntary housing agencies—the voluntary sector gets a look in there—to provide housing or community care services in its area.
§ The people at the receiving end or the people who speak to the people at the receiving end do not feature in that consultation. We believe that it is of the greatest importance that in drawing up the plan there should be consultation with the beneficiaries of the plan, who may not think that all these bureaucratic bodies necessarily fully understand exactly what they would like.
§ I remind the Government that partly in response to and, I have to say, partly as a result of the encouragement given by the Government, there are now many organisations who are well placed to speak for the beneficiaries, the clients or whatever one wishes to call them, of these services. All that we ask in this amendment is that after the word "area" in Clause 44(2)(d) there should be explicitly included, "organisations of or for service users, their families or carers".
§ It is extremely important that at the stage of the drawing up of the plan these people are consulted and are able to put their contribution into the consideration of the plan. It is not good enough for them to come along to make comments on it after 1527 the plan has been formulated and when thinking has been crystallised.
§ I suppose that I should declare an interest, in a sense, in that I am president of the Carers' National Association. That body has branches throughout the country as well as a national organisation. It is steeped in knowledge of the problems of people who are doing the caring and, together with other organisations, it should be given the opportunity when the plans are formulated to put a point of view on what the plan should include. I beg to move.
§ Baroness Cox
I support the amendment, for three brief reasons. First, it would allow people to be consulted who can make a most important contribution to planning. For example, they may be aware of a range or, if I may use the word, prevalence of need which is not perhaps known to those who are charged with planning the arrangements for care.
Many potential recipients of care who could benefit from it may not be known to the local authorities or social service departments and therefore might never come within the orbit of being included. It is important that organisations representing carers' families and receivers have the opportunity to be involved in the planning process. Equally, it is important for an effective contribution to the appropriateness of the care provided that there is the best possible match between needs and services.
Finally—an important point which will arise in later amendments but which is met in this one—the amendment is one way of ensuring that the interests of the carers themselves are taken into account in the formulation and planning of care. For those three general reasons I strongly support the amendment.
§ Lord Hylton
Perhaps I may be permitted to say a few words in support of the amendment. If accepted it may well be the first time that carers will appear on the face of the Bill. If so, it is high time that they did. From personal experience within my family I know how extremely wearing it can be to support people who, for example, have lost their memory or are suffering from a depressive illness. There is a great need for respite help for carers and their views should be very much taken into consideration.
§ Lord Kilmarnock
I find it hard to imagine that the Government could actually refuse this amendment, for the reasons which have already been well stated. One consideration that we must take into account—I hope this is in the Government's mind—is the sheer volume of the number of people affected. According to a reputable article in The Times of 10th May, more than 2.5 million elderly people are looking after someone older, more ill, more disabled or more frail than themselves. Of the estimated 6 million carers nationally who provide a regular unpaid service to friends or relatives, 42 per cent. are over the age of retirement.
That is an enormous volume of effort, but the Bill as drafted does not appear to be prepared to take that into account. After all, these people perform a 24-hour-a-day job, seven days a week, with little or 1528 no assistance from either the statutory or voluntary services. I know that there has been a slight improvement in the invalid care allowance but it does not affect a large number of people. It has been estimated that 90 per cent. of the mentally ill and 80 per cent. of the mentally handicapped are cared for full time by their families. The number of long-stay hospital beds has been reduced but the necessary places in the community—for example, in NHS and local authority day-care centres—have not increased correspondingly. The result has been an increased burden on carers.
Families are now expected to cope on an unprecedented scale. I do not want to give too many statistics, but beds in the geriatric, mental illness and mentally handicapped sectors have declined in the period 1979 to 1989 from 55,000 to 51,000, from 89,000 to 63,000 and from 50,000 to 30,000 respectively. That is a total reduction of 50,000 beds in all those sectors, whereas the residential places in local authority homes for the equivalent groups over the same period have risen by only 17,000. There is a loss of 50,000 beds being replaced by only 17,000 places in the community. The gap is obviously being coped with by the growing army of informal carers. They are the people who make up the difference. These are figures on a large scale. It seems inconceivable that the Bill can be written in such a way that those carers are not consulted at all at the point of drawing up the local authority's community care plan. My party has advocated all sorts of things for carers. We have advocated a carers' benefit and various other rights that we shall come to in subsequent amendments. The amendment before us simply requires that carers, or their organisation, should be consulted in the preparation of the local authority community care plan. I would have thought the case absolutely unanswerable and I should be totally amazed if the noble Baroness did not accept the amendment.
§ 7 p.m.
§ Lord Swinfen
The statutory authorities, as will be apparent from the face of the Bill, have a large number of functions to perform. They are probably understaffed and will tend from year to year to come up with the same ideas and plans. There will be a tendency to become fossilised. The carers and disabled people themselves are facing, and dealing with, problems on a daily basis. They know the changing needs not only of themselves but also of society in general. They will have a much clearer idea of what is needed and will produce far more accurate advice in the way of consultation than will the statutory bodies.
§ Lord Carmichael of Kelvingrove
The Government will realise that they have grouped this amendment with Amendments Nos. 113AW and 113AX. We were quite happy about that. The amendments refer specifically to Scotland. The Minister will see that Amendment No. 113AW proposes to omit in line 9 the words,as appear to the authority to".so that the Bill reads,such voluntary housing agencies and other bodies which provide housing or community care services".1529 I do not think that there is any necessity for examination by an authority. Once it was discovered whether such bodies did or did not provide housing, no question would arise of appearing to provide housing. The amendment tidies up the Bill.
Amendment No. 113AX deals with a matter on which much has already been said. I shall be brief. The Bill lists a number of bodies to be consulted in the preparation of community care plans. It fails however to list the most important group—the consumers of community care. After all, if there were no consumers of community care we should not be discussing this matter now. If there were none we would not be discussing them.
The Bill says that voluntary organisations providing services rather than those which represent service users need to be consulted. The omission is surprising when paragraph 5.7 of the White Paper clearly states that the views of the service users and carers should be taken into account. It is not sufficient to argue that this will be achieved by another method. The views of consumers should be afforded the same status in the legislation as those of service providers.
In Committee in another place the Minister for Health, on 13th February at col. 940, recognised the strength of feeling on this issue and undertook to reconsider the position. Clearly, if the omission is being rectified it should be recognised in those clauses referring to Scotland.
§ Lord Mottistone
I am advised, as I believe the Committee knows, by the National Schizophrenia Fellowship. Our view is that the amendment should be supported. It is really a question of whether the reference to "community care" in paragraph (d) is good enough. Those who work in the field do not think it is.. I would not go to the stake on the wording of the amendment that we are discussing, and I do not suppose that anyone else would. But there is need for something more than the existing paragraph (d). I hope that the Government will be able to consider some sort of change even if they do not accept the amendment as it stands.
§ Baroness Carnegy of Lour
The noble Baroness, Lady Seear, spoke powerfully at Second Reading about the position of the carers and the fact that she did not feel that they had sufficient mention in the Bill. I looked afterwards at the White Paper. At the beginning in Chapter II, paragraph 3, the Government point out—and I must remind them of this—that,the reality is that most care is provided by family, friends and neighbours. The majority of carers take on these responsibilities willingly, but the Government recognises that many need help to be able to manage what can become a heavy burden".I take it therefore that the Government see the involvement of carers in the planning as important. This must be the case. Whether their inclusion as a category, along with users, in the list of people to consult is right I do not know. However, the point made by the noble Baroness is important. I hope that having heard the barrage of approval for the amendment my noble friend will take it on board. I do not think that we shall be very pleased if she does not.
The Earl of Balfour
As we are discussing this group of amendments I should like to refer to the last amendment, Amendment No. 113AX, put forward by the noble Lord, Lord Carmichael. I feel that at line 12, on page 54. the words,such other persons as the Secretary of State may directachieve a great deal of what we need. I had hoped that perhaps my noble friend Lord Sanderson could add a few words.
This is the sort of case where the new organisation, Scottish Homes, could provide accommodation where required for those people who require wheelchair facilities or special facilities in a home. I feel that this is one of its functions and something it should do.
§ Baroness Masham of Ilton
The noble Baroness, Lady Carnegy of Lour, may not be sure, or may not quite know, but I certainly know. I consider it most extraordinary for consumers and carers to be left out of a decision. It looks to me like the age of Dickens and forgetting to involve those people who are the most important.
§ Baroness Carnegy of Lour
May I remind the noble Baroness that we are talking about local government which represents all those people and is in close touch with them. My only query was whether putting them in a list and looking for organisations was the right way to proceed. Much sympathy exists in Scotland and I think that people there feel that there are sufficient organisations, so I back the amendment.
§ Baroness Masham of Ilton
I thought that the Government's whole emphasis was that people should be as responsible for themselves as possible. I should be very surprised if the amendment were not accepted.
§ Baroness Hooper
I would hate to cause so much surprise. I am sorry that I have not been able to intervene sooner in this interesting discussion. I have been keen to comply with the invitation made by the noble Baroness, Lady Seear, and to underline the Government's commitment to the involvement of users and carers in the whole process of planning through to service delivery, and in achieving the best possible outcomes for the clients of the services.
As the noble Baroness, Lady Carnegy of Lour, stated—a fact which the noble Baroness, Lady Masham, chose to ignore—that is something which is both implicit and explicit in the White Paper and in the guidance that we are preparing.
I am entirely sympathetic to the reasons behind the amendment, although we may wish to make some modification to its wording. If we may consider this matter further, I undertake to come back at a later stage to introduce a government amendment. I understand from my noble friend Lord Sanderson that this commitment applies equally to the Scottish amendments. I hope that in the light of that assurance, the movers of the amendment will feel able to withdraw it.
§ Baroness Seear
In the light of that near promise and on the strict understanding that if the provision is not to our liking we shall move our amendment at the next stage, I beg leave to withdraw the amendment.
§ Amendment, by leave, withdrawn.
§ Baroness Blatch
I beg to move that the House do now resume. In so doing, perhaps I may suggest that the Committee resumes not before ten minutes past eight.
Moved accordingly, and, on Question, Motion agreed to.
§ House resumed.