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11.16 am
Mr. David Hinchliffe (Wakefield): First, I pay tribute to the hon. Member for Sutton and Cheam (Mr. Burstow) for obtaining this debate. In general, I agree broadly with
virtually everything that he said. It is a great pity that we have precious few debates on such a fundamentally important area as community care. During my time in the House, with the exception of the 1993 legislation, every debate on community care has been initiated by Back-Bench Members, which is a great pity when one considers the crucial impact that such provisions have on our constituents.
I must inform the House that I spoke to the hon. Member for Sutton and Cheam yesterday to establish what area of community care he intended to approach. I did so for a particular reason. In 1995, I was surprised to receive from the Minister's predecessor a parliamentary answer indicating that the Department of Health had established a difference between the formal definitions of community care and care in the community. Having been around community care for a long time because of my work background, I regarded the two terms as meaning the same, but under the previous Government, a new definition arose. Care in the community came to refer to mental health and provision for people who had been in psychiatric hospitals. Community care meant the areas to which the hon. Gentleman referred--elderly and disabled people.
This morning, I will stick to the same area as the hon. Gentleman, but I must place on record my belief that it is important in the near future to debate mental health and provisions for the elderly and the learning disabled. I am conscious that both areas require much attention, and I am aware that the Minister may want to discuss policy initiatives with the House.
The Government face a series of key challenges on community care as a direct consequence of the way in which the previous Government, over 18 years, effectively privatised community care provision in a manner that has directly affected service levels and the nature of provision. The hon. Member for Sutton and Cheam mentioned that in describing the inappropriate care models into which people may be pushed. I want to consider the history of why we are where we are now and why the Government face tough challenges in re-establishing some coherence in community care instead of leaving the job lot to the private market, which was the essence of the previous Government's policy.
I await with interest the shadow Minister's contribution, because he normally gives a robust performance in such debates, and especially his defence of the previous Government's record on care of the elderly. They were responsible for some fundamental changes that were very much for the worse. The policy change over their 18 years stemmed largely from a little-publicised decision in 1981 to allow the use of supplementary benefit to supplement the costs of home provision of private or voluntary care. That later became income support. The decision profoundly affected the nature of community care provision, especially for elderly people. That point was picked up by the hon. Member for Sutton and Cheam.
The direct consequence of the previous Government's decision--I believe that this was deliberate--was, from 1981 onwards, a huge explosion in the provision of private nursing home and residential care in a way that distorted the nature of community care provision, especially for the elderly and disabled. The matter has still to be addressed by the new Government. It will take many
years to skew provision away from the emphasis on institutional care that was mentioned by the hon. Member for Sutton and Cheam.
I have established from the Library that £3 billion was used for the scheme between 1981 and 1993, when the community care changes occurred. Anyone considering that logically would realise that the money would have been far better invested in the community services that the hon. Member for Sutton and Cheam mentioned rather than in a huge expansion of institutional care, which was on the way out even in the 1970s. We have gone in the opposite direction to most other European countries because of the dogma of the Conservative party, which believes in private medicine, private medical care and private provision. That has been detrimental to properly planned community care which enables people to remain in their own homes. I shall expand later on what we should do about that.
I take issue with one point made by the hon. Member for Sutton and Cheam. He said community care was introduced on 1 April 1993. He understands the point that I am going to make. Community care was not introduced then; there was a change in its administration. It existed in a variety of ways long before institutional care, or even the workhouse, was invented. It has generally been the province of a carer in a family, usually a female relative. He will accept that all that happened in 1993 was an attempt to unravel the shambles that followed the 1981 decision. The National Health Service and Community Care Act 1990 was Treasury-driven because of alarm about how the income support budget had shot through the roof as a result of the 1981 decision.
The 1981 decision had several policy consequences that the Minister understands and will no doubt address later. An outdated model of provision that was on the way out, in cross-party policy terms, as far back as the 1970s has been resurrected by the privatisation of community care. Institutional provision for elderly people is now everywhere. I am not knocking such provision because there are some very good care and nursing homes in the private and voluntary sector. Some are less good, as the Minister will accept. His current review and the White Paper may tackle that in due course.
What concerns me about the privatisation of community care and the development of institutional models is the way in which public perceptions of what elderly people need were narrowed down to focus on such provision. That was unhelpful. For people of a certain age--we all hope that we shall reach such an age--there is now a perception that the appropriate care may be institutional. We should ask serious questions about that, as other countries are doing, and consider how we can use available resources to develop alternatives to give people a proper choice so that they do not have to go into institutional care. I accept the point of the hon. Member for Sutton and Cheam that some resources invested in institutional care could be better used to ensure that people have the choice of remaining in their own homes.
I fear that a consequence of privatisation has been the development of a huge market in private care, both residential and nursing, and in private insurance to encourage the view that we all need to insure ourselves privately so that, when we are gaga, we can be looked after through some institutional provision. It worries me that that perception has been allowed to float around this place without being challenged.
The hon. Member for Sutton and Cheam mentioned the third report of the Health Select Committee in the 1995-96 Session. Interestingly, his predecessor was a member of the Committee. She was usually--in fact, always--totally uncritical of the Conservative party's performance in government. However, this report exposed a good deal of what that Government did, and stated:
The report also made some profound comments about the idea that there is a great demographic crisis. The first paragraph of its of summary of conclusions said that that belief was based on "unsound evidence" and was "downright alarmist". That alarm has been whipped up by private business interests who want to create the view that we must build more and more institutions for the elderly and pay more and more to insurance companies to ensure that we are looked after in old age. I accept that the royal commission on long-term care for the elderly will examine those issues, but I make a plea for us to move away from such narrow thinking and to broaden our views of care of the elderly in the way, in many respects, in which the hon. Member for Sutton and Cheam mentioned.
The second direct consequence of the changes of the 18 years of Conservative rule was a double whammy for the elderly in that people in their 60s, 70s, 80s and 90s in my constituency have endlessly raised with me their anxiety that, throughout their working lives, they have paid national insurance and taxation on the assumption that, on reaching old age, free care would be available. They were paying for a national health service that offered them free care.
When they reached that stage, the NHS gradually, with a nod and a wink from the Department of Health, withdrew from free care. Such people were means-tested and found that they had to pay for the care they had already paid for. People are deeply unhappy about that, because they have been misled. People who fought in the second world war and who are still around deserve our consideration. That is a grievance affecting thousands or even millions of people who feel that they have been badly let down.
Mr. Nicholas Winterton (Macclesfield):
I apologise for not having been here for the whole of the debate. The hon. Member for Wakefield (Mr. Hinchliffe), who is currently Chairman of the Select Committee on Health and whom I hold in high regard, has drawn attention to the fundamental injustice of what has happened. Does he agree that at no stage has the House voted for the change that took place by deceit, which is that services that had hitherto been provided within the health service were ultimately taken out of the health service, so that people who believed that they would be looked after in their retirement now have to pay for their care and perhaps utilise all the savings that they have accumulated during their working life?
"We are very disappointed with the Government's response, which attempts to shuffle off responsibility and does nothing to meet the needs of some of the most vulnerable members of society."
His predecessor said that, or at least subscribed to it in the report. That shows the extent to which people were concerned about what had happened.
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