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Community Care

Volume 173: debated on Tuesday 5 June 1990

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To ask the Secretary of State for Health if he will make a statement on earmarked grants to local authorities for the purpose of community care.


To ask the Secretary of State for Health if he will make a statement on earmarked grants to local authorities for the purpose of community care.

Local authorities are responsible for determining the use of the resources on matters for which they have policy responsibility and for which they are accountable. The House welcomed the Government's decision to make community care the prime responsibility of local government, and earmarked grants would be inconsistent with that decision.

I am sorry to hear the Secretary of State's response, although I am not surprised by it. Is he aware of the anxiety throughout social services departments that there will not be sufficient grant to meet the demand for community care? Is he further aware of the London Research Centre report, published in April, which suggested that there would be a shortfall of £100 million rising to £500 million by 1994? Will he consider specific grants to meet such shortfalls, should they arise?

We have always made it clear that local authorities need, and will receive, adequate resources to carry out their new responsibilities. Those resources will be decided during the public expenditure round. It is rather premature to produce reports, from any source, about the inadequacy of resources before we have even decided what those resources will be.

One difficulty with earmarked grants is that it is impossible to separate that area of expenditure from what is already being spent on care in the community, which in large part is already a local authority responsibility. remind the hon. Gentleman that while the Government have been in power total spending on care in the community has risen by 68 per cent. in real terms—that is more than half as much again as was being spent when we took office and before we introduced our popular arrangements.

On 6 December the former junior Minister made a speech of glowing support for community care when he addressed the annual general meeting of the National Schizophrenia Fellowship. Is not it a cruel deception of such bodies that there is a distinction between the Government's aims and the methods that they use? Does the right hon. and learned Gentleman accept that earmarked grants should be available to areas such as north Derbyshire so that they can meet the provisions referred to in Government statements?

My junior Ministers move on to greater things so rapidly that I am not sure whether the hon. Gentleman is referring to a speech made by my hon. and learned Friend the Minister of State, Home Office or my hon. Friend the Minister for Public Transport, but if he was addressing the National Schizophrenia Fellowship I have no doubt that the reference was, above all, to the specific grant that we have made it clear that we shall be introducing to encourage community care for mentally ill people. A specific grant for that area is important because in the past it has not been given high enough priority by local authorities. Therefore, money aimed specifically at mental illness will be allocated to local authorities when they produce plans that are satisfactory to the health authorities.

Will my right hon. and learned Friend comfirm that, whether earmarked or not, grants given to local authorities from next April will represent the sums that hitherto would have been paid in social security benefits? Is he yet able to give the formula by which the figures will be calculated or an estimate of the sum involved? I am sure that he appreciates the difficulties of local authorities in making their plans from next April without knowing what resources will be available to them.

We are firmly committed to transferring from the Department of Social Security vote to our vote and to local government the sum of money that would have been spent by the Department of Social Security under the old policy of making provision through income support for people in residential care. We also have to make a calculation for growth and a calculation of what is available for this year, and we shall do that when we make the decision on the revenue support grant for local government. I appreciate the difficulties for local government in having to make plans when final decisions have not been reached on exactly how much will be available next year, but that is inescapable in the system of annual financial planning that we have always had. It is true of the whole range of government, under this Government or any other, that we have to wait for the autumn spending round before we know exactly how much we have for the next year. Neither the Treasury and Civil Service Committee nor anybody else has yet come up with a better way of doing it.

Has my right hon. and learned Friend had a chance to consider the sad and moving story that appeared in the Nottingham Evening Post last Friday about Colin Jago, a schizophrenia sufferer, who slipped so tragically through the community care net? Will he have a look at that story to see whether any lessons can be learnt for our policy on care in the community?

I agree that the story of Colin Jago is tragic. It shows what a dreadful way of life he led as a result of suffering from schizophrenia. I shall ask the chairman of the district health authority to let me have a report on his case to see whether there are any lessons to be learnt.

That is sheer hypocrisy. The Secretary of State is allowing the mental illness unit for adolescents to close.

Before the hon. Gentleman stoops any further to try to make party political points out of a tragic individual case—

People must make their own judgment about where hypocrisy lies in the matter, and loud-mouthed barracking does not help.

I should point out to my hon. Friend the Member for Gedling (Mr. Mitchell) that Colin Jago was examined and interviewed by a doctor at Mapperley hospital, who decided that it was not necessary to admit him to hospital for treatment. However, we must discover the full facts to see whether there are any lessons to be learnt from Mr. Jago's sad death.

Will the Secretary of State acknowledge that Sir Roy Griffiths recommended an earmarked grant, that the local authorities, including the Conservative ones, want an earmarked grant, and that now the other place has voted for it? Even flagship Wandsworth has made representations to the Secretary of State supporting the case for a ring-fenced grant. Why does he disagree with everybody else if it is not that he is afraid that an earmarked grant will make it only too plain that he cannot come up with the cash that the councils need to make care in the community work?

Because good government depends on clear responsibility and accountability, and I have not been persuaded that it is right to give responsibility for this matter to local government and then for the House or any Government to try to keep to themselves part of the responsibility for determining the level of resources. No one in Wandsworth or anywhere else would want the Government to determine the total level of resources available. There is also a practical problem with an earmarked grant. I do not understand how it is proposed to distinguish the earmarked grant, made with whatever new money we might make available, from all the moneys already being spent on care in the community by local government, which already provides home helps, meals on wheels, and so on. I do not believe that it is practicable and nor, for the reasons that I have given, am I persuaded that it is desirable.