Mr. John Hutton (Barrow and Furness) : I beg to ask leave to move the Adjournment of the House, under Standing Order No. 20 for the purpose of discussing a specific and important matter that should have urgent consideration.
Today my constituents have learnt that another 1,000 jobs are to be lost at the Vickers Shipbuilding and Engineering Ltd. shipyard. Those are on top of 5,500 jobs that have been lost in the shipyard since 1990, and brings the total of jobs lost there this year to 2,000. A particularly disturbing and worrying aspect of this round of redundancies is its impact on young people in my constituency, because 250 of the 1,000 jobs that are now to be lost are the jobs of young people who are completing their apprentice training this year. These young men and women are just starting on their careers, and this is a devastating blow to them and their families.
The situation facing my constituents is now so grave and serious that it merits an emergency debate. Many hon. Members will know that my constituency has an historic reliance on one employer VSEL. No other jobs are available for my constituents, and they and the south-west Cumbrian economy as a whole simply cannot sustain such job losses. I am fearful of the effect that the redundancies will have on the fabric of life in my community. After many decades of loyal service to the defence needs of the United Kingdom, my constituents deserve better treatment than this.
We need an immediate opportunity to hear the Government's response to this latest crisis affecting my constituents. Today marks a turning point in the life of my constituency and in the lives of many thousands of my constituents. I earnestly hope that you will accede to my request, Madam Speaker, and give my constituents the chance to let their voices and feelings on this matter be heard in the House.
Madam Speaker : I have listened carefully to what the hon. Gentleman has said. I have to give my decision on the matter without stating any reasons. I am afraid that I do not consider that the matter that he has raised is appropriate for discussion under Standing Order No. 20. Therefore, I cannot submit the application to the House.
Mr. Tony Marlow (Northampton, North) : On a point of order, Madam Speaker. I regret making points of order on two days in a row, but my point of order today is totally different. You will remember that up to a few years ago on Foreign and Commonwealth Office questions we had about 20 minutes for questions about the European Community. Things changed and there were reasons for that at that time. As you realise, the issue for debate in the House above all others and the issue for debate in the country is Europe. Is there any way in which a slot for European questions could be reintroduced?
Mr. Skinner : The hon. Member for Northampton (Mr. Marlow) is absolutely right. Time used to be allowed after half-past 3 for Common Market questions. One reason for the change was that the Tory Government at that time were very much in favour of everything that happened in the Common Market. That was when the previous Prime Minister, Baroness Thatcher, was pushing through the Single European Act with a guillotine. Everyone on the Government Benches seemed to think that everything in the Common Market garden was fine and lovely. They decided therefore to get rid of that question time. It is interesting that, now that the Tories are split down the middle, they want it restored. I am prepared to give them a chuck on.
Madam Speaker : I do not think that right hon. and hon. Members should delay the business of the House on points of order of which I am already very well seized. Both hon. Gentlemen know that their points of order concern a matter that is for the Government, not the Chair.
That leave be given to bring in a Bill to require that an occupant of, or candidate for appointment or election to, a public office or a post in a public service shall make a public declaration as to his membership or otherwise of any secret society ; and for connected purposes.
My Bill seeks to ensure that candidates either for appointment or election to public office should declare their membership or otherwise of any secret society. It will require also that the record of any such declarations is made available to the public. The Bill should appeal to democrats of all political persuasions. It does not seek to ban anything or to discriminate against anyone. It is based on the simple principle that membership by public servants of secret societies is incompatible with democracy and undermines public confidence in public institutions.
For those who fear that a declaration of membership of a particular organisation could result in discrimination, I shall include a clause that outlaws discrimination against anyone on the basis of any declaration that they have been obliged to make under the Bill. Although no particular organisation is mentioned and the scope of my Bill is not limited to any particular organisations, you, Madam Speaker, may not be surprised to learn that freemasons will be among those who fall within its scope. A number of speeches made recently by senior masons were designed to persuade the public that masons have entered an era of glasnost. I may add that this does not extend to masons being willing to appear with me on "The World at One" to discuss the issue. This afternoon, a request was made to the Grand Lodge to provide a spokesman, but the answer was no. I regret to say that the BBC, with characteristic gutlessness, therefore cancelled the interview.
Leading masons have been at pains to emphasise that freemasonry is a bit of harmless fun and that its objectives are mainly sociable and charitable. It would be easier to convince non-masons of that were it not for the secrecy- - reinforced by blood-curdling oaths--to which all masons are sworn.
I want to stress that the Bill makes no objection to the practice of freemasonry. If grown men want to wear aprons, bare their breasts, and indulge in strange rituals, that is entirely a matter for them. I object to the secrecy, and to the corrosive effect that it has on public confidence in many of our most respected institutions. It is said that there are about 320,000 masons in England and Wales, 100,000 in Scotland and 55,000 in Northern Ireland. The nearest that we have to a definitive account of their activities is Martin Short's excellent book "Inside the Brotherhood". Its author suggests that freemasons are particularly well represented at all levels of the legal profession, in the police up to the highest level, in local government, places of higher education, and among hospital consultants. There is even a lodge in the House of Commons, membership of which, I understand, includes the hon. Members for Reading, East (Sir G. Vaughan) and for Banbury (Mr. Baldry), and a number of Officials of the House. There is also a lodge for the Press Gallery--about which considerably less is known than of the New Welcome lodge to which Members of Parliament and Officials of the House belong.
Column 854According to the 1991 masonic handbook for County Durham--which for masonic purposes includes Sunderland--Sunderland has 29 lodges with a total membership of 1,597. There are also various other masonic bodies, including eight royal arch chapters with a membership of 390, Master Masons with 24 members, Royal Ark Marines with 31, the Rose Croix with 59 and Proceptories--do not ask me what all this means, Madam Speaker--with 32. Several other masonic bodies do not list the total number of members. They include the Knights Templar Tabernacle, the Royal and Select Masters, the Order of the Secret Monitor, the Harte Conclave and Allied Masonic Degrees.
Lodge 5841 is the civic centre lodge. It has 62 members, and meets at a masonic temple conveniently situated less than 100 yards from the headquarters of the borough council. A number of other officials belong to lodges elsewhere. Some idea of the scale of masonic influence in County Durham may be gained from the handbook, a publication which, while not exactly secret, is not readily available to non-masons. It lists every lodge, in each case giving the number of members and the names of current officers and past masters. The names listed amount to about 10 per cent. of the total membership of each lodge. Altogether, they cover about 250 closely typed pages. As I look through the names of officers listed for the Sunderland lodges, my eye alights on a number of familiar names--names of people who are or were prominent in local public life. I see the name of a former chief executive of the borough council, and of the late Tyne and Wear county council. I see the name of a former leader of the council--a Tory, I should add. I see the names of former directors of housing and architecture. I see the names of policemen, magistrates and consultants-- including that of a consultant whose wife is a magistrate.
In an earlier handbook, I see the name of Mr. Ray Delaney, a former deputy director of engineering in the borough of Sunderland, who was obliged to resign two years ago after allegations of conflict between his professional duties and outside business interests. Mr. Delaney's name is preceded by the letters "IG" : I understand from those who know about such matters that they stand for "inner guard". I have no idea what the duties of an inner guard entail, but, if masons are worried about the sinister connotations that non-masons sometimes place on their activities, I put it to them that they have only themselves to blame.
As you know, Madam Speaker, for some years I have taken a particular interest in miscarriages of justice. That interest has brought me into contact with people at all levels of public life in the police and the legal profession, particularly in the west midlands. I make no allegations of impropriety, but one would have to be blind not to notice that many of those with whom I have dealt are freemasons.
In particular, those people include police officers up to and including the rank of chief constable. With the possible exception of the legal profession, there can be few professions in which freemasons are as well represented as they are in the police. That has been widely remarked on, and it is hard to think of anything more damaging to public confidence in the police. I know that it is deeply resented by police officers who are not freemasons.
In April 1985, Sir Kenneth Newman, the Commissioner of Police of the Metropolis, who did more than anyone else to clean up the Met, issued the following guidance to police officers who were freemasons. It appeared in an
Column 855official document entitled "The Principles of Policing and Guidance for Professional Behaviour", and was drafted by Assistant Commissioner Albert Laugharne. He wrote :
"The discerning officer will probably consider it wise to forgo the prospect of pleasure and social advantage in freemasonry so as to enjoy the unreserved regard of all those around him."
Those words might well apply to anyone in public life who is a freemason. My Bill, however, does not go as far as Sir Kenneth. It does not ask public servants to renounce freemasonry ; it merely asks them to renounce secrecy.
I believe that this simple measure will enjoy the widespread support of democrats of every political persuasion, and I am confidant that it will find support on both sides of the House. It is entirely consistent with the Government's stated ambition to create a classless society, and is essential to the stated intention of the Home Secretary and the Lord Chief Justice to restore public confidence in the police and the legal system.
My proposal has a good deal of support in high places. In 1986, the author Martin Short sent a questionnaire on freemasonry to every Member of Parliament. Questions 6 and 7 asked whether Members of Parliament and other public servants--including councillors, judges, policemen, civil servants and local government officers--ought to be obliged to declare their membership of masonic bodies. Among those who completed the questionnaire and agreed that public servants should declare was the right hon. Member for Huntingdon (Mr. Major), who is now the Prime Minister. I have a copy of the questionnaire that he signed, with his signature at the bottom, and it is available for inspection. I look forward in due course to the Prime Minister's support and help in ensuring that my Bill becomes law.
A great deal of paranoia surrounds freemasonry, much of it no doubt unjustified, and I have no wish to add to it. As I said at the outset, my Bill is based on the simple principle that membership of a secret society is incompatible with office in a modern democracy. Take away the secrecy, and the problem is resolved. I believe that my Bill will have the support of all those who believe, as I do, in greater openness in public life. I hope that it will also enjoy the support of honest freemasons--I am sure that they are the overwhelming majority--who are concerned at the poor public image that their organisation currently enjoys.
Question put and agreed to.
Bill ordered to be brought in by Mr. Chris Mullin, Mr. Andrew F. Bennett, Mr. Richard Shepherd, Mrs. Margaret Ewing, Mrs. Maria Fyfe, Mr. Simon Hughes, Mr. Nicholas Brown, Mr. Cyril D. Townsend and Mr. Bob Cryer.
Mr. Chris Mullin accordingly presented a Bill to require that an occupant of, or candidate for appointment or election to, a public office or a post in a public service shall make a public declaration as to his membership or otherwise of any secret society ; and for connected purposes : And the same was read the First time ; and ordered to be read a Second time upon Friday 13 November and to be printed. [Bill 51.]
(1A) No arrangements shall be made by virtue of this section with respect to a person being transferred into accommodation from an NHS hospital or trust unless the voluntary organisation or other person concerned has ensured that that person is provided with a care plan and the authority is satisfied that such arrangements will facilitate this plan.'.
The purpose of the amendment is to provide for a clear care plan when individuals are placed in an establishment under the Bill. I shall give the reasons behind the Opposition's concern, and will refer first to the White Paper "Caring for People--Community Care in the Next Decade and Beyond". It sets out clearly the national health service's role in providing continuous health care. I refer to the White Paper because my hon. Friends and I believe that the Government's actions do not follow the words of the White Paper. Paragraph 4.20 states :
"There will always be some people who cannot be supported in their own homes. Where such people require continuous care for reasons of ill-health, it will remain the responsibility of health authorities to provide for this."
In practice, that paragraph is meaningless. Continuous care is not occurring in hospitals and other places throughout the land. There have been huge reductions in the provision of care for the elderly. The national health service is clearly divesting itself of its responsibilities, with, I believe, the implicit blessing of the Government. Figures in the "THS Health Summary" of January 1992 show clearly what the position is. According to that journal, three quarters of health authorities had reported that in recent years they had cut the number of long-stay beds for the elderly. It also stated that closure plans would reduce NHS beds for the elderly mentally ill by 36 per cent. from 1990 levels. Everyone is aware that that number had been substantially reduced before 1990. The plans would reduce other geriatric beds by 25 per cent. and, even counting the private beds that have been bought for the NHS, the numbers would be down by 15 per cent. and 12 per cent. respectively.
There have been many expressions of concern about the implications of that process. The Age Concern report entitled "Discontinuing Care" and published in 1991 shows great anxiety about the attitude of the NHS towards care of the elderly. At that time, the director, Sally Greengross, said :
"Long term hospitals may not have appropriate places for the care these people need, but this does not relieve them of the responsibility to provide and fund care for people who are defenceless and in need of total care."
The Age Concern report showed that some district health authorities now have no provision for elderly people needing continuing nursing care. That is worrying for many patients and their relatives and carers.
Column 857The Government say that provision is now in the private sector. The National Association of Citizens Advice Bureaux evidence produced not long ago shows that many patients and their families are never told that NHS funding is available for continuing nursing care. When they have to obtain such nursing care within the private sector, those patients and their relatives are often forced to meet the huge gap between what income support will provide and the weekly cost of the fees. I am aware of many people who have to spend their entire pocket money from their allowances on meeting the cost of care fees. This has been discussed many occasions.
I am concerned about the implications in my locality of the process that I have described. Since 1979, in the Wakefield health authority area, I have seen 1,000 beds removed from the NHS. Those beds were taken from hospitals catering for people within my constituency and were used mainly for elderly people. That shows why we feel that, especially in care for the elderly, there must be care plans for people discharged from hospitals and trusts. Some 200 of those beds in the Wakefield area were in the acute sector. The Government's figures show that about half the people catered for within the acute sector are elderly people.
In my constituency I have seen the closure of County hospital and Snapethorpe hospital in Wakefield, both of which catered primarily for the elderly on a long-stay or short-stay respite basis. The needs of those people are now met primarily, if they are met at all, by carers in their own homes or by the private sector. We know from the Carers National Organisation the struggles that many people have in caring for their relatives or loved ones. The recent report, "Speak Up, Speak Out", produced by the Carers National Organisation reveals the problems. Those who are not cared for within their own homes are placed in private homes. The process in my constituency--it is reflected in every constituency throughout the country--is that NHS provision has been run down or closed and people are shunted into the private sector. If that is not privatisation of the health service, I do not know what is.
At a national level, we are seeing the trend towards shifting the cost of long-term care from the health budget to social security. The National Institute for Social Work produced a commendable report in January 1992. It was entitled "Great Expectations". That report says that the transfer of elderly care from the NHS to the social security budget is feasible
"while the social security budget for such care remains open ended but will present a very different picture when that budget becomes cash-limited on transfer to local authorities in 1993."
There are serious questions being asked about whether the 1993 changes will go ahead as planned. That point may be picked up by my hon. Friends or by some Conservative Members. We are well aware that the options include a further deferment of these proposals or the transfer of the lead agency- purchaser role directly to health authorities either at local or regional purchasing level. That would avoid the local authorities having that lead agency function. That option has been talked about widely within the care community. Such uncertainties make the need for care plans related to the placement of people directly from hospitals or from trusts even more essential and back up our belief in the need for such plans to be prescribed in the Bill.
Column 858Amendment No. 1 refers specifically to trusts as well as to NHS hospitals. We have reasons for including the term "trust". We believe that there is clear evidence of trusts positively obstructing the processes of proper community care planning. I made the point in Committee on the National Health Service and Community Care Act 1990 that the NHS and community care elements of the Act were contradictory. We are now beginning to see in practice that those of us who made that point on many occasions were correct in our assessment of what was likely to happen.
I give one fairly well known example which explains our belief in the need for the amendment and ties in with the concern about trusts. The City and Hackney health authority, which was slimming down for trust status, shunted about 30 elderly demented patients to a private nursing home called the Pines near Skipton in Yorkshire. That private care home was run by an organisation called Burley Health Care. I asked the Minister where the care plans were in respect of the placement of those vulnerable demented people. The care plans did not exist. That case, along with many others that we could quote, evidences the need for amendment No.1.
The case of those elderly people was exposed by "Panorama", to its great credit. Those people were dumped by a trust applicant and sent up to Yorkshire, where there would be Department of Social Security funding away from the health service budget and away from the area in which they had been brought up and had lived all their lives. They were sent to a strange locality and to a different system of funding. As we know from "Panorama", conditions at the Pines were appalling. Serious questions need to be asked about the role of the City and Hackney health authority and about Airedale health authority. I am pleased to see the hon. Member for Macclesfield (Mr. Winterton) in his place today. He was Chairman of the Select Committee on Health, and I normally have a reasonable relationship with him, but on one occasion he ruled me out of order. When we were studying the issue of trusts, I asked a question about the role of Airedale health authority. The hon. Member for Macclesfield will recall that, on 4 March 1992, Mr. Edward Bishop, who was described as "director of healthcare contracting" in the Airedale health authority, gave evidence on trusts. I raised with him the way in which the 30 people from City and Hackney health authority had been treated and the role of Airedale health authority in that respect.
I am not sure that the hon. Member for Macclesfield, for whom I have some respect in his role as Chairman of the Select Committee, fully understood my point. What was clear from the evidence given by Mr. Bishop was that he washed his hands of any responsibility for those people's appalling situation. I quote from Mr. Bishop's response to a question of mine on 4 March 1992 in the Select Committee :
"I have to make it quite clear, there is no role for what might become the Health Authority of residence to play in that we are free as individuals in this country to move from one part of the country to another."
That was his response to the case of people who had been sent from London and dumped in a completely unsuitable, shabby private nursing home in the Yorkshire dales. There was no proper monitoring and no proper care plan.
When Mr. Bishop talks about freedom, he is talking about 30 seriously demented elderly patients who, I
Column 859suspect, had no choice about moving from London to Yorkshire. On care planning, the key issue is that Airedale health authority was responsible for the registration of the Pines nursing home. It had a clear responsibility, although that was obviously not accepted by the gentleman who gave evidence to the Select Committee. That is one example among many that we could cite to show that the need for clear care plans in the Bill is self-evident.
The need for care plans as a result of the creation of trusts is also evident from comments on behalf of other service users. I have spoken primarily of the elderly, but other groups such as the mentally ill benefit from care provision and will be affected by the Bill. In its evidence to the Select Committee, MIND made it quite clear that it saw no incentive for trusts to collaborate with agencies outside the health sector.
In respect of people with learning difficulties--some use the term "mentally handicapped"--with the advent of trusts, the Government have introduced a policy that contradicts the thrust of community care policy over the past 30 years. The Mental Health Act 1959, the 1971 Command Paper "Better Services for the Mentally Handicapped", the 1979 Jay report and numerous reports issued by the Department of Health and Social Security in the 1980s, including "Getting Mentally Handicapped Children Out of Hospitals", were all about the normalisation of care of people with learning difficulties, away from hospitals. They were all about the community. With the advent of trusts, the Government are thus running counter to the trend that has prevailed for the past 35 years. No one seems to have picked that up.
I note with interest the evidence given to the Select Committee by the organisation Values Into Action. The hon. Member for Macclesfield will recall that evidence, which was impressive. According to that organisation, the effect of granting trust status to health service learning difficulties units has been actively to promote the concept that they are the appropriate provider of care for people with learning difficulties, and that those people should be retained in long-stay hospitals. That contradicts the thrust of successive Government policies on community care over the past 30 years. The Values Into Action report "When the Eagles Fly" substantiates that argument in great detail and clearly shows that the Government's health changes are working against the wishes and best interests of people with learning difficulties. The report states :
"As far as learning difficulties are concerned, the 1990 National Health Service and Community Care Act introduces a direct conflict between ongoing health care, as perpetuated by the new trusts, and the development of community care as the responsibility of social services."
The organisation's worrying comments conclude :
"The overall picture emerging from the research is one of chaos and confusion in services for people with learning difficulties Anarchic is hardly too strong a description of a situation in which service models vary so widely and frequently display disregard for stated public policy."
The organisations that gave evidence to the Select Committee stated clearly that community care is in disarray. The term "anarchic" is used by an entirely responsible national organisation that knows what is happening at grass roots level. It is deeply concerned--as
Column 860are a vast number of organisations dealing with a whole range of client groups--about where we are heading on community care.
Dr. Liam Fox (Woodspring) : If there is disarray in the implementation of the community care provisions, it is because left-wing social service units are refusing to take full account of the discussions that they were supposed to have with medical units and so on. Why is it that the Royal College of Nursing tells us that 75 per cent. of carers are not being asked by social services what they should do, that local management committees are not being asked, as the British Medical Association told us last week, and that private homes are having no discussions about how they can be involved in the plans? The failing lies not with Government plans but with implementation by social services.
Mr. Hinchliffe : The hon. Gentleman will get a chance to air his views as the debate continues. It is silly and naive to talk of left-wing councils because there are concerns about local authorities of a variety of political complexions. There are also concerns within local authorities that they have not been enabled to enact the provisions contained in the National Health Service and Community Care Act 1990.
If the hon. Member for Woodspring (Dr. Fox) wants to debate the position of local authorities, I am happy to refer him to information in the House of Commons Library which shows that the Government that he supports have taken £6 billion out of local authority personal social services, which is one reason why community care is in such a shambles at local level. I shall be happy to intervene on the hon. Gentleman when he is able to advance his argument in more detail. In Committee, the Minister responded that we were suggesting interference with the free play of market forces by proposing additional legislation for care plans and a range of other issues that we felt should be covered by statutory provisions in the Bill. The Government's philosophy is clear from their record on community care. It entails abandoning vulnerable people to the free play of market forces. We are not talking-- [Interruption.]
If Conservative Members do not agree, we can consider what has happened in detail. Frankly, the record of some care homes is abysmal ; care is being left to the market. We are not talking about distributing sacks of potatoes, but about human beings. Sacks of potatoes might well be usefully distributed by market forces, but that is not a mechanism to deal with the care of elderly, learning-disabled and handicapped people. It is not the correct model. That is apparent if one studies what has happened in the past decade.
The Bill deals with human beings and they deserve proper treatment--the best treatment, which should be secured by ensuring that appropriate plans are made. They are set out in amendment No. 1 and I hope that the Minister will see fit, just for once, to accept an amendment to the Bill.
Mr. Nicholas Winterton (Macclesfield) : I am pleased to follow the hon. Member for Wakefield (Mr. Hinchliffe), who has deployed his case in support of the amendment extremely well. He played a vital and informed role in the previous Parliament as a member of the Select Committee on Health. He drew our attention to an occasion when, as Chairman of that Committee, I was forced to rule him out
Column 861of order. He has not advanced all the detail of the incident to the House, but I am sure that he will admit in the mature light of day that I was not out of order in ruling him out of order in what he was seeking to do. Having done so, I was entirely confident that the hon. Gentleman was ingenious enough to secure an even larger audience for his remarks, and he has done so today. I commend him for doing so because, as a Conservative Member, I share his concern. We must ensure that proper, responsible and well-prepared care packages are available for every person discharged from a long-stay care institution into the community.
The hon. Member for Wakefield drew our attention to 30 demented and confused elderly people, who were discharged from a hospital in the City and Hackney health authority to an institution in Skipton, Yorkshire. That is thoroughly undesirable, and I was tempted to intervene when he discussed the matter to ask whether those involved with the 30 elderly people-- parents, relations and other close acquaintances--were consulted about whether the elderly people should be discharged to places almost at the other end of the country. Surely, part of any care package is visiting rights for the friends, next of kin and relations of the people in care. That is clearly important when caring for elderly people. I wonder whether any thought was given to how those who were involved with the 30 elderly people might keep in contact when the group was moved hundreds of miles away to Skipton in Yorkshire.
My hon. Friend the Minister has a splendid history of concern and, dare I say it, involvement in working for vulnerable and minority groups. His involvement with the Spastics Society was well known and respected. Is he worried that the national health service appears to be interested only in treatment and is decreasingly interested in the provision of care? That is a matter about which Conservative Members are gravely worried. I have expressed my anxiety to the Government for a long time, so my hon. Friend the Minister cannot find my position unexpected.
I suspect that I share much of the anxiety expressed by the hon. Member for Wakefield about establishing almost a private sector monopoly in the provision of care for the elderly. Many of us believe that the health service has a role in not only treating but caring for people. We fear that the role is increasingly being discharged to the private, independent or charitable sectors.
I do not suggest that the independent, private or charitable sectors do not have a vital role to play. I believe that they have and that in many instances they can make provision that is supplementary and complementary to NHS provision. I should hate however, to see the provision of care for the elderly, the mentally ill and the mentally handicapped fall entirely into private and independent hands. I hope that when my hon. Friend the Minister replies to the debate he will give us some assurances. Those of us who have taken a deep interest in these matters for many years are worried that some of the accommodation provided by the independent sector leaves much to be desired.
We also place in some difficulty the families of people who are discharged from the NHS into the independent and charitable sectors. As the hon. Member for Wakefield said at the beginning of his speech, when people are cared for by the health service all the facilities are provided free. The total cost of the care, the accommodation and so on
Column 862is covered. When people are discharged from the NHS, however, charges are levied. Whether those charges are picked up by the social security system through income support or in other ways, or whether they are picked up in part by the families, charges are made. I and many hon. Members on both sides of the House have had traumatic experiences in dealing with families who have come to us about their difficulty in meeting the additional cost, which cannot be met through social security, of care for relatives who have been discharged into accommodation in the independent, private or charitable sectors.
I hope that in this short debate my hon. Friend the Minister will give some assurances, especially to Conservative Members who understand the concept of what the Government seek to achieve. We believe in the concept of community care, which draws considerable additional private resources into the provision of care for the elderly and other vulnerable groups, such as those with learning difficulties. Those additional resources were not available previously. We believe that our policy will provide choice. The hon. Member for Wakefield always speaks with great clarity, knowledge and experience, but he did not refer to the element of choice. One of the key concepts of community care is the provision of genuine choice for the individual. I wonder whether the system that will operate after 1 April 1993 will provide such genuine choice, which is the essence of a successful community care policy. I hope that, on this occasion, my hon. Friend the Under-Secretary will be a little more generous and perhaps a little kinder in his response to a very humble Back-Bench Member who feels things deeply. 4.15 pm
Ms. Liz Lynne (Rochdale) : I support the amendment because it is essential that we have a care plan for those who leave NHS hospitals and trusts. Without such a plan, tremendous difficulties could arise. That plan must be the result of full consultation with everyone concerned. The user, the client, must be consulted or, if that is not possible, that person's relative or advocate should be consulted. Without a care plan, problems could arise as a result of people being transferred into inappropriate residential accommodation. I accept that large organisations, such as Age Concern, have been consulted and I know that carers in some local authorities have also been consulted. However, smaller voluntary organisations have not had access toomuch of that consultation process.
In Rochdale, I formed the alliance for community care with another person to ensure that smaller voluntary groups were consulted and were able to discuss the care plans for people coming out of NHS hospitals. It is essential that the Bill is amended to ensure that all voluntary organisations are consulted.
Adequate resources must be made available to assist transfers. The other day, I met the Rochdale social services director to discuss the problems that might arise when people are transferred to private or residential nursing accommodation without the necessary resources being made available. In the past, I have drawn attention to the problems caused by the income support levels, which do not meet the costs of residential or nursing home care. Invariably, a patient's relatives have to top up the patient's share of those costs. It is essential that the actual cost of
Column 863residential or nursing home care is met by the Government rather than through income support. The problem is particularly severe in the north-west where more people are in residential accommodation than the population figures would suggest. For that reason, I make a plea for the real costs of such accommodation to be met.
Local authorities of different complexions--Labour, Conservative and Liberal Democrat--have had problems in attempting to implement all the community care provisions by 1 April 1993. We therefore need a national plan so that each local authority knows what is expected of it. I know that the Bill provides for some planning, but a true care plan for those coming out of NHS hospitals is essential. For that reason, I support the amendment.
Mrs. Helen Jackson (Sheffield, Hillsborough) : I support the amendment. I was not a member of the Committee that considered the Bill, but I know that the majority of its discussions centred on the transfer of patients out of local authority care into that of the independent sector. I am concerned about the future role of health authority care and the transfer, or non-transfer, of patients who currently receive chronic, long- term residential accommodation and nursing care in the NHS.
I was struck when, in October 1991, I saw the concerns that were expressed in the fourth report of the Select Committee on Social Security. One of these was
"that the obligation on health authorities to provide nursing care for those who cannot or do not wish to pay for it should be strictly enforced and that health authorities should not evade what are properly their responsibilities."
That is an important recommendation, and it is well understood by patients in my constituency who live in one of the few
community-based residential nursing homes run by the health authority. It is a small establishment in which there are 30 elderly patients. The staff are most experienced and very well established. The home has close links with the community and the local general practice. I have some personal experience of private and independent sector private nursing homes, having been involved in casework, and I know that the home is a model of what residential nursing homes should be.
When it was proposed that these elderly patients should be transferred from health authority care into the independent sector, it was clear that they understood exactly that the central feature--with which I agree--of the NHS is that it is not free and that they had paid all their working lives for what they were to receive. They were of the view that, having reached the stage of requiring nursing care day and night, they should be entitled to receive it through the health service.
This point must be made strongly. Like Sheffield community health council, I am extremely concerned about some of the implications of the report of Sheffield health authority on the future strategy for services for elderly people in our area. In the report it is argued :
"There are no clinical reasons why an individual in a chronic, stable condition should be cared for in an NHS setting rather than in a nursing home outside the NHS, or"
and this is fine-- "in his or her home".
The authority tries to draw a distinction between elderly people with dementia and elderly people who simply require nursing. It is quite impossible and entirely inappropriate to draw such a distinction.
Column 864The authority goes on to argue that the NHS should therefore work towards supporting provision in the independent sector and should seek to withdraw its own capacity to provide long-term care for such individuals. It then argues, entirely illogically, that that is especially important because there is an increasing need for elderly people to receive such long-term care, that the cost is too high for the NHS to bear and that there must therefore be faster work to transfer the duty from the NHS to the independent sector. It is my view, and the view of Sheffield community health council, that the important thing is need and not the resources of the health service in any particular areas and that, until it is absolutely clear that there is adequate provision in some other context for elderly people in need of long-term nursing care, no more beds in the health service in the Sheffield area should be withdrawn. The debate is an opportunity for the Minister to make it clear to health authorities that they have a duty to provide a service for chronically sick or disabled people in need of day and night nursing, whether it is provided in their own homes through community nursing services, by a combination of home, day or short-stay residential care, or in long-term accommodation. The Government will accept that the most appropriate residential care is delivered in community-based nursing homes with easy access to family, friends and local general practitioner services. We have heard about the appalling example of the transfer to Skipton, where people were moved a long distance from where they were content and felt comfortable.
Patients in the model nursing home in my constituency kept saying, "This is our home." They meant that they were familiar with the rooms, the staff, the locality where they had lived all their lives and the costing system. It was helpful when the Minister said a few weeks ago that it was Government policy that no NHS patient should be transferred into private or independent care without his or her consent. That is an important principle, but we need to go further and recognise the significant difference between long-stay patients in the NHS and residents in nursing homes for the elderly, run by private or charitable institutions. In the first instance, payment has been duly made during a lifetime of work. In the second, payments must be requested from the social security system after full disclosure of the household's income and means. If top-up moneys are required, the family pays a second time for a service that it has already financed.
Will the Minister make it crystal clear to health authorities throughout the country that whenever a transfer is proposed, whether patients are to be physically transferred to another place or not, it amounts to a substantial change for the patient and his or her family. It must therefore be the subject of full consultation with the patient and his family, as well as the community health council in the case of an institution such as the one in Sheffield. It needs to be made clear that the financial change is so substantial that it must be subject to the full consultation procedure.
I make these points not only on behalf of my constituents and my relatives, with whom I have a personal and close relationship, but for ourselves, too. We are paying into the NHS, week in, week out, and so are our families. Where do we want to receive nursing care when we reach an age at which we may require it?