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Mr. Gary Streeter (Plymouth, Sutton): Labour reforms?
Mr. Milburn: Four Labour reforms are needed, as the Government Whip says from a sedentary position.
First, there is a need to offer more choice for community care service users. The stark lack of choice in the community care market, polarised between fairly low levels of domiciliary provision and fairly high levels of expensive residential provision, often means that intermediate forms of care are unavailable to those who can best benefit from them.
The current gaps in provision deny choice to the individual who needs care, and load unnecessary additional costs on the taxpayer. A range of services is needed, including home-based care, respite care, convalescent care and residential care. We want the Government to remove perverse financial incentives towards more institutional forms of care. Institutionalisation is the very reverse of what community care is supposed to be all about.
In that context, it is disappointing that, through the report, the Minister has decided to retain the requirement that local authorities must spend the bulk of their STG budgets in the independent sector. Surely the requirement for them to do so has long since gone. By and large, there is a well-developed mixed economy of care that is thriving in most parts of the country.
Secondly, there is a need to end the lottery in the provision of community care services. The Government could begin by introducing, after consultation with users, carers, providers and statutory bodies, a national framework for local charging policies. We, the Opposition, support the call that has been made by the Select Committee on Health for a nationally set framework that specifies eligibility criteria for long-term care so as to define what the health service, a national service, should provide. We support that approach. Do the Government support it?
We think that the Select Committee's call for a national long-term care charter so that people may know what they can expect from health, housing and social services is absolutely right. We support that; do the Government?
Thirdly, there is a need to improve standards in community care services. Standards will rise, however, only if there are appropriate safeguards. We, the
Opposition, recognise the benefits that can flow from a mixed economy of social care that involves public and independent providers. We are in favour of diversity. We are in favour also of consistency. Our concern is to ensure that there is a level playing field of high standards in all forms of care in the private sector, in the public sector, in residential provision and in domiciliary provision. I hope that the Minister's response to the moving forward of the consultation process will concur with the Opposition's.
Fourthly, there is a need to end the waste of time and money that now bedevils the planning and supply of community care services. That means finding ways of overcoming differences in values and structures between local government and the NHS that can frustrate joint working. When local authorities and health authorities tussle over responsibilities and resources, it is the elderly person and the disabled person who loses out. We want new, nationally agreed mechanisms--if necessary, enforced--to speed co-operation among the three principal organisations that are charged with the planning and delivery of community care services; health, housing and social services.
The four-point plan that I have outlined would broaden choice, raise standards and provide better value for money. Instead, the Government seem content to pour money into a black hole. Our reforms would be the basis on which to provide long-term care for the elderly in future.
Mr. Ieuan Wyn Jones (Ynys Mon):
I am pleased to have the opportunity to make a short contribution to the debate. I shall speak to the Special Grant Report (Wales). Before doing so, however, I take up the Minister's opening statement.
In general terms, the Minister claimed that the Government had introduced a substantial cash increase over a number of years. The Minister may recall that when we were debating the principle of community care in the late 1980s, especially in response to Sir Roy Griffiths's report, he suggested that if community care were introduced a proportion of those who claimed to be inappropriately placed in residential homes and nursing homes might wish to be cared for in their own homes.
The policy was introduced on the basis that a proportion of those claiming to be inappropriately placed would be cared for in their own homes. We now find that the number of people making that choice is much greater than anyone anticipated. The proportion of those who are choosing to stay at home as against going into residential nursing homes is substantially greater than hitherto, and I accept that it is greater than anyone on either side of the House expected. The cost of providing care at home is greater than providing care in a residential home. Local authorities in Wales are saying that the Government have
not gone far enough to meet the demand for care at home. Some local authorities in Wales are saying that the financial shortfall this year is quite substantial.
The Minister said that local authorities should be seeking ways in which to become more cost-effective, by becoming enablers rather than providers. However, it is difficult for local authorities to do that, especially in extremely rural areas such as the one that I represent--the former county of Gwynedd, which is now the two counties of new Gwynedd and Ynys Mon--because there is no private sector to develop. It is therefore difficult for local authorities to consider moving along that line. There is a highly developed voluntary sector, but not an independent sector.
Local authorities in areas of Wales such as the one that I represent therefore do not have a choice, even if they agree with the Government's ideology and accept that that represents the direction in which they should be going. These are important considerations in the context of the debate.
I endorse the comments of the hon. Member for Darlington (Mr. Milburn) about local authorities in England. Similarly, local authorities in Wales believe that the Government have underestimated the amount that authorities require to meet some of the changes introduced by the Chancellor of the Exchequer's Budget--changes that we all welcome, although they do not go so far as some would have liked. The Government had to make up the funding shortfall for local authorities this year in order to meet those changed circumstances.
I have asked three local authorities in Wales--Ceredigion, Gwynedd and Ynys Mon--about their feelings regarding the provisions made under the order that we are discussing today. As set out in the Government's order, Ceredigion receives about £100,000, Gwynedd receives £191,000 and Ynys Mon receives £96,000. The local authorities tell me that the shortfall for the three counties totals £164,500--in addition to the cut that each local authority says that it will have to make in its general budget, including cuts in community care. I then asked the local authorities to tell me the reasons for that shortfall and the way in which the sums were calculated.
I am told that the Welsh Office estimates were based on figures arrived at after consulting the old counties and using a historical formula. The figures were also based on the current number of people in residential and nursing homes. The local authorities believe that it is also important to take into account those for whom the option of residential or nursing home care is now more attractive as a result of the Budget changes. The local authorities face the added burden of having to assess people for contributions who were previously outside the system. Therefore, there will be additional expenditure.
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