Baroness Cox: My Lords, I thank the noble Baroness for her reply, which contains some good news. Is the Minister aware of recent research published by the Joseph Rowntree Foundation which shows that the majority of mentally handicapped people or those with learning disabilities still live with their families and an increasing number are surviving to old age and therefore are being cared for by elderly relatives whom they may well survive? Does the noble Baroness accept that many of these elderly relatives find it hard to provide that care, often do not receive the support that they need from social services, and are also deeply worried about what will happen when the relatives for whom they are caring survive them? What can the Minister say to these people who have spent their lives looking after dependent mentally handicapped relatives, both to reassure them about the care that is needed now to look after them and what will happen to those relatives who survive them?
Baroness Hayman: My Lords, I am aware of the research to which the noble Baroness refers and also the immense contribution that is made by many carers who look after those who are mentally handicapped or
Lord Morris of Manchester: My Lords, is the Minister aware that some local authorities still seem unaware that provisions of the Chronically Sick and Disabled Persons Act apply as much to people who are mentally ill or handicapped as they do to the physically disabled? Is this a timely moment for a further circular about their statutory responsibilities?
Moreover, does my noble friend agree that one effective way of reducing the pressure on hospital beds is to increase the availability of adequate local services for chronically sick and disabled people generally?
Baroness Hayman: My Lords, my noble friend's longstanding commitment and contribution to the cause of the disabled is well known. He rightly points out the need for and advantages of sensitive and locally based services.
As regards provision for those with learning disabilities and the possibility of new guidance, we are currently funding an independent evaluation into the costs and outcomes of various forms of residential provision for people with learning disabilities. When we see the results of that, it will tell us whether we need to issue further guidance.
Lord Rix: My Lords, does the Minister agree that flexible short-term breaks and appropriate housing are essential elements in the long-term care of people with learning disabilities and their elderly carers? Can my noble friend inquire what has happened to the Disabled Persons and Carers (Short-Term Breaks) Bill which I introduced through your Lordships' House in 1996? It received all-party support, and since that time has lain alone and palely loitering in another place.
The issues raised in the noble Lord's Private Member's Bill are important. They are important contributors to the ability of relatives caring for people with learning disabilities to continue in that role.
Lord Clement-Jones: My Lords, on a related point, is the Minister aware of the problems and uncertainties that currently surround the commissioning of mental health services? I refer in particular to the provisions and responsibilities between commissioning by NHS regions, local authority social services and primary care groups. Will the noble Baroness's department issue clear guidance on the division of responsibilities in that area?
Baroness Hayman: My Lords, the guidance issued on national priorities was clearly focused on the responsibilities of both the health service and social services to work together, and to find mechanisms for working together whether through joint commissioning or pooled budgets, in order to provide the necessary cohesive services.
On the commissioning of mental health services, the mental health national service framework which is currently being drawn up will provide a template against which services can be commissioned and provided. It will be essential that health authorities, trusts and PCGs work together to manage that commissioning process.
With the introduction and establishment of primary care groups we have a unique opportunity for the key partners--they include social services and other branches of local authority services--to test new approaches to joint commissioning and more integrated provision.
Lord Pearson of Rannoch: My Lords, given the Government's official recognition that there is already a shortage of some 25,000 residential places for people with a mental handicap, is the Minister aware that the Government's excellent policy of encouraging a genuine range of provision is often thwarted at local level? In those circumstances, can the Government do anything directly to encourage new village communities for people with a mental handicap? They are in great demand and are cost-effective and care-effective.
Baroness Hayman: My Lords, the noble Lord points out the need for an increasing number of residential places. An additional 11 per cent. was provided between 1994-95 and 1996-97, but we need still more. He rightly says that the Government's policy is that a range of options should be available. We have recently written to all health and local authorities reminding them that they should continue to offer that range of residential provision and respect the rights of individuals to make informed choices, including placements in village communities, wherever the preferred choice is likely best to meet their needs within acceptable costs.
Lord Monro of Langholm: My Lords, is the Minister aware that throughout the countryside in the United Kingdom generally, but particularly in livestock areas, the rural economy is in crisis? Is he also aware that incomes have plummeted and that all the good work done by previous governments to enhance the countryside, the environment, wildlife and rural employment is gravely at risk? Does he appreciate that we cannot wait for the reform of the CAP? What action are the Government proposing to take in the next few weeks to stave off disaster?
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