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Mr. Nicholas Winterton: Does the hon. Gentleman believe, from a professional point of view, that there was an adequate transfer of resources from the national health service to social services? The hon. Member for Wakefield (Mr. Hinchliffe) made the point that social services had to assume huge additional responsibilities for functions that were previously provided by the NHS. Does the hon. Gentleman believe that there was an adequate transfer of resources to enable local authority social services departments to undertake those important responsibilities?
Dr. Harris: No, I do not think so. We are now entering the sixth year of the special transitional grant. However, the scale of funding is not enough. I had intended to address that point later, but I shall tackle it now, as the hon. Member for Macclesfield (Mr. Winterton) has helpfully introduced it.
It is not acceptable for the Secretary of State, in an article in The Daily Telegraph, or for anyone else, to claim that community care has failed when many hon. Members feel that it has never been tried--because it was never funded adequately by the previous Government. It was unfair to expect social services to cope, particularly with elderly people leaving NHS care and long-stay hospitals and the mentally ill leaving asylums.
Mr. Hinchliffe:
It is important to clarify the Secretary of State's comments in the article, which I read. He was talking specifically about the perception, in relation to mental health, that there were people within the community who were a danger to themselves and to others. The Secretary of State said not that community care had failed but that serious questions remained as to whether, in order to secure the safety, health and well-being of those people and the community, they should have the option of acute psychiatric provision locally.
Dr. Harris:
I am grateful to the hon. Gentleman for explaining the Secretary of State's comments. The Department of Health also issued clarification following the publication of the interview, explaining that the emphasis should be on those few tragic cases--which I fear may always occur--involving assaults and occasionally murders in the community.
Since my election, a community care patient has murdered a family in Abingdon in my constituency by burning down a house. There was also the well-known
Newby case in Oxford. I have read the reports at length. Although they raise questions about adequate communication between the multiple agencies involved--particularly with regard to housing in the Abingdon case--there was a clear problem of underfunding, including in the acute sector. People are pushed out of care extremely quickly in order to free up beds because occupancy levels in the acute sector are well over 100 per cent. in many mental health wards. Hon. Members will recognise that figure.
There are also inadequate resources in the community to keep an eye on people and give them support. The Government will soon have to decide whether community enforcement orders, under which people are supervised and forced to take medication, are the only way out of the problem. I express no view on that, as this is not the appropriate time at which to do so. But no one wants to go back to the days of asylums. Where the changes have worked and have been adequately funded, they have been welcomed.
In the case of Oxfordshire and many other counties, the root cause of the funding pressures facing the county council this year and next has been an inadequate settlement and an inadequate standard spending assessment for social services, which increased nationally by only £91 million, even before inflation and demographic changes were taken into account.
The blame for that does not lie entirely with the Government, because they were wedded--wrongly, the Liberal Democrats believe--to Conservative spending plans, which were a catastrophe for social services. The Government suggested that things would get better after the election, but in Oxfordshire we shall have to wait until the year after next--if then--for things to start being turned round.
That, sadly, will be too late for many people, who will suffer now. When we speak about cuts in care for elderly and vulnerable people, we ought to remember that those people may well die, and will certainly have a reduced quality of life, if they do not get adequate care.
It is difficult for people in my constituency to understand why, in order to fund the commitment not to increase taxes on the wealthy, the most vulnerable--the users of social services--must pay. The two pledges--to improve services and save the NHS, and not to raise taxes--are incompatible. It cannot be done.
I shall deal now with the interaction between care in the community and the health service. There are two problems. The first is the media's concentration on the acute sector in hospital care. Politicians of all parties may be to blame, as the best proxy that we have for measuring how the health service is performing are waiting list figures.
Those figures are flawed, because they do not take account of the time spent waiting for the initial out-patient appointment, the time taken for investigations and then the time taken to see a surgeon, perhaps, to get on the waiting list. They are also flawed because, for many operations that used to be offered, such as those on uncomplicated varicose veins, which used to have a long waiting list, the waiting time is now infinite because the operation is not available. The result is a fiddling of the figures, not necessarily deliberately, by health services that are reducing the number of operations offered.
Waiting list figures are nevertheless a useful proxy for measuring the health service. Because of that, we tend to concentrate on them--certainly, the media do--at the expense of everything else. Extra effort is put into reducing waiting lists--I understand that there is to be a statement this afternoon expanding on that, as we heard on the radio this morning--but we must ask whether additional resources might be better spent in community care, perhaps to free up beds in the acute sector so that waiting lists can be tackled.
The second problem is the concentration on crisis management in the health service. Money announced in July last year is allocated in November last year to be spent by April this year on avoiding a winter crisis. As any business person or any good public service budget manager knows, money can be spent far more efficiently and to far greater good if notice is given that it is coming and the time constraints are not so tight.
However, we recognise that many innovative schemes were produced by the winter pressures money. Anglia and Oxford health region got a good share of that funding and, by working with the social services departments of all the local authorities in the area, put in place some excellent schemes, such as the hospital at home, step-down care and increased support to stop people being admitted in the first place.
The question is what will happen next winter. Will that funding be continued? I should be grateful if the Minister could tell us whether it will be recurrent or whether there will be a similar exercise next winter, which will not be as efficient as allowing social services some extra funding to pick up the costs of people who have been moved into their budgets in the residential care sector with the winter pressures money.
The pressure on emergency admissions is no longer just a winter phenomenon; it exists all year round, because social services are failing to cope all year round. When we do not offer support for carers, there is an increase in emergency admissions. In hospital parlance those are called social admissions. That is a poor term. In my experience as a hospital doctor, those are people who desperately need to be seen and desperately need treatment, but they are there because they cannot cope with their home circumstances.
Delayed discharge is another aspect of the problem. The figures show increases in delayed discharges, despite the extra money for winter crises.
Liberal Democrats propose a lifting of the cap in local authorities to allow local people democratically to elect authorities to spend money on social services and care for the most vulnerable. We also propose that some health service money should be spent directly on community care, to relieve the pressure on the health service and improve community care.
In a spirit of co-operation, I offer the Minister some ideas about how the welcome extra money allocated in the Budget might be devoted to community care, not only to improve services there, but to save money and create space in the acute sector by tackling the waiting list problems that were inherited from the previous Conservative Government and exacerbated by the adoption of that party's spending plans.
Unlike other Opposition parties, the Liberal Democrats always present an alternative Budget. Over and above the sum that the Government have allocated this year, we allocated additional money from cyclical surpluses to the NHS, so that an extra £250 million would be spent on three areas.
The money should be used to save community hospitals that are currently under threat in Oxfordshire, Essex, Cornwall and other parts of the country, as the Minister knows from previous Adjournment debates. Those community hospitals can work with social services to provide good community care through the three Rs of community care: recuperation, rehabilitation and respite care.
People who have had their operation can be moved out of busy, noisy, intensively nursed acute wards into more appropriate local care near their families to recuperate before going home. If they need rehabilitation, they can receive physiotherapy or occupational therapy and their houses can be modified while they are in a cheaper bed in a community hospital. Respite care can be given for one in four, six or 10 weeks, according to need, to enable carers to cope more easily and to reduce emergency admissions.
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