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Care In The Community

Volume 75: debated on Tuesday 12 March 1985

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asked the Secretary of State for Social Services if he will make a statement about proposed developments in relation to care in the community.

We shall continue to encourage the development of services which enable people in need of care to live as normal a life as their condition allows.

I think that the overwhelming majority of people would acknowledge that as the correct policy in principle, but, will the Minister recognise the widespread anxiety among local authorities about the level of funding for community care? What guarantees can the Minister give that an appropriate and satisfactory level of funding will be made available to local authorities?

I am grateful to the hon. Gentleman for agreeing with the policy in principle. I can assure him that some very good things are now being achieved in practice by way of placing patients in more suitable care. Local authority social services spending has gone up by 18 per cent. on average ahead of inflation while the Government have been in office. As my hon. Friend was saying, as long as local authorities pay attention to getting the best value for that money, we believe that they can make perfectly adequate provision for this policy.

Are we not in danger of being overhasty over the closure of some hospitals, such as Balderton hospital in my constituency, and Saxondale hospital in his? Can he give the House an assurance that these hospitals will not be closed until firm placings are available for those who will be affected?

As my hon. Friend mentions Saxondale hospital in my constituency, I can tell him that I well remember that being mooted for closure by the right hon. Member for South Down (Mr. Powell) when he was Minister for Health. I am glad to say that we now have a definite date for closure. I agree with my hon. Friend that no closure of any hospital should take place unless and until there is proper provision for better care for the patients. The health authorities concerned are planning to provide just that.

Why should there be under-funded care in the community when there are perfectly good hospitals for the mentally handicapped available, such as the Dovenby hospital, in Cumbria, in my constituency? Is the Minister aware that the future of that hospital is being threatened only because of the backlog of repairs? Why does the Minister not cough up the money and make sure that the people in that hospital who wish to stay are not forced out into the community to save the Government money?

Many of our mentally handicapped patients would do better and have a better quality of life in good, smaller facilities than they will by being locked away in older hospitals. That is the aim of the policy. I understand the reluctance of many of the patients, which is shared by their families, to emerge from a hospital in which they have lived for a long time. However, only recently I met a man released from a hospital in which he had lived for 44 years, spending most of that time mute and violent, who is now enjoying a reasonable quality of life in a small home in Eastbourne.

Does my right hon. and learned Friend agree that there is a shortage of accommodation for the single homeless? In those circumstances, and in view of what the Minister of State said in answering an earlier question, will he reconsider the closure of resettlement units? The one in Newbury is a modern building, the costs of which compare favourably with private accommodation. As it has not been asked by the DHSS to trim its costs, why is it being closed?

I assure my hon. Friend that we shall ensure that our policy towards resettlement units does not conflict with our care in the community policy. As my hon. Friend the Minister for Social Security said, we are seeking to make better use of the resources and, in most cases, to make improved provision.

Is the Minister aware that many mentally disabled people are being pushed out of hospital, that health authorities then divest themselves of responsibility, that local authorities refuse to accept responsibility and that the mentally ill are thereby left in a no man's land, with appalling consequences for them? Is he aware that the only answer is for him to guarantee a community place for every mentally ill person who leaves hospital?

I agree that we must ensure that such incidents do not occur and that, when they occur, they do not happen again. It is essential to make a proper assessment of any provision for each patient. We have lifted many restrictions which applied to health authorities and which previously stopped them from providing funds to enable local authorities to make more provision. We are satisfied that, with good joint planning and the good planning of resources, the policy can go forward successfully.

Will my right hon. and learned Friend accept that many people are thoroughly in favour of the thrust of the new policy—

—but that there is a need to reassure some patients who are being moved out of old-fashioned hospitals and into the community that they will have the care in the community to which they have become used?

I am grateful to my hon. Friend for those remarks, though, as my hon. Friend the Member for Macclesfield (Mr. Winterton) pointed out, it is not a new policy in principle. It is, however, being handled with more care and pace than has been the case in the past, and we must reassure people with understandable fears that proper provision will be made for patients.

As the Government are prepared to give 100 per cent. disregard from rate capping for all council spending on civil defence, why cannot the right hon. and learned Gentleman persuade his fellow Ministers to give 100 per cent. disregard for all spending under joint finance for care in the community? Does he appreciate that the increased spending on the social services which he has praised is attributable largely to the actions of councils which are now being penalised by the Government by rate capping?

We have just eased the rules on the disregarding of joint finance expenditure and put joint finance in line with the urban programme. I assure the hon. Lady that some councils—such as authorities in Exeter and Devon, which are not remotely threatened by rate capping because they provide good services without breaching the Government's guidelines — are making spectacular progress.