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Mr. John Greenway (Ryedale): Will the Secretary of State tell us more about how the money will be distributed around the country? He knows that waiting lists grow for different reasons in different areas, and can increase because of lack of provision, or because one health trust is not as efficient as another. Rural North Yorkshire, with which he is familiar, has problems, although waiting lists are not as bad as in other parts of the country.
Does the right hon. Gentleman agree that people would be a little happier about the announcement if they were able to cheer because some of the money was coming to them? Can he assure people in North Yorkshire that the pattern of money going from rural areas to inner cities will not predominate in relation to this money?
Mr. Dobson:
Let me make two points. First, about 90 per cent. of the money will be allocated according to the usual formula, so that every area gets some; but a certain amount will be held back to deal with crises or to encourage those who need a bit of encouragement. Secondly, as one who represents an inner-city seat within about a quarter of a mile of the House, I can tell the hon. Gentleman that my health authority received one of the 20 smallest allocations in the country. The area that the hon. Gentleman represents received a good deal more in percentage terms--and I know that his hon. Friends like percentages.
Mr. Tom Levitt (High Peak):
I know that my right hon. Friend is a great believer in long-term planning, so I feel I must alert him to a problem that he may face before the end of the life of the current Parliament. What will happen to all the new doctors and nurses who will be recruited, when no significant waiting lists are left to be reduced?
Mr. Dobson:
If--as I hope--we hit the target, there will sadly still be more than 1 million people waiting for treatment. I hope that those doctors and nurses will remain in the employ of the national health service, reducing the figure much further.
People sometimes suggest that waiting lists are not important. Some of the academics who write about health care seem to think that, but we can usually assume that
they are not waiting for operations. Many people waiting for operations are in pain, and their lives and subsequent health may be endangered. I also think that long waiting lists damage the reputation of the health service in a way that practically nothing else does. They are dreary and apparently disorganised, and it looks as though our system--the most efficient in the developed world--is not doing its job properly. That is why it is important to reduce waiting lists.
Mr. Jenkin:
After all the irresponsible hype and propaganda that was conducted by the right hon. Gentleman's party in opposition, cannot the British people be forgiven for expecting increased resources for the health service under his party in government, to match, at the very least, what the Conservatives gave year on year on year?
Can I communicate to the right hon. Gentleman the real despair in Essex Rivers Healthcare MHS trust, which is having to close small hospitals around north Essex because it is experiencing the tightest financial circumstances in my memory, if not the tightest for the last 10 or 20 years? Will the right hon. Gentleman re-examine the formula for allocating resources across the health districts, which he has manipulated to favour the inner cities rather than the shires? The same has happened with local government.
Mr. Dobson:
Let me make it clear that we changed the formula to reflect need, and added an element to allow for the problems of ambulance services in rural areas. If there has been any fixing of the allocation since we came to office, it has been in favour of rural areas. That is why many people in inner cities are not very happy with the present position, and want it to be re-examined. I must tell the hon. Gentleman that we clearly do need to re-examine the system when areas as deprived as the east end are not getting their fair share.
Mr. Neil Gerrard (Walthamstow):
My right hon. Friend will know from his recent visit of the serious concern about the way in which Redbridge and Waltham
Mr. Dobson:
I can confirm that my hon. Friend's health authority will receive its normal allocation, and that money will go into mental health care. On occasion, people suffering from severe mental episodes turn up at hospitals and have to be admitted to wards where they not only occupy beds but make life intolerable for others, which is bad for them and bad for everyone else. We are trying to deal with that important problem.
Mr. Andrew Robathan (Blaby):
On a point of order, Madam Speaker. On 15 January, at Treasury questions, the Chief Secretary to the Treasury quoted some figures on pension returns, as reported in column 477 of the Official Report. The figures interested me, so I tabled a parliamentary question. On 20 January, I received a response saying that the question would be answered as soon as possible.
Those were figures quoted by the Chief Secretary. It is now nine weeks since he did so. I have re-asked the question, and have just been told that it will be answered as soon as possible. Is there anything that you can do to encourage Ministers to answer questions more quickly?
Madam Speaker:
There is nothing further I can do. I have answered points of order from the hon. Gentleman and other Back-Bench Members on this issue. The Government, I am sure, are very aware of it. No doubt, as he has raised a point of order yet again with me, they will look at it and respond as soon as possible.
Mr. Huw Edwards (Monmouth):
I beg to move,
That army of carers has increased in recent years, with the shift from institutional to community care, with the increase in the number of elderly people, and as a result of medical advances to sustain the lives of many people who would formerly not have survived. Those are the triumphs of our welfare state, but they have led to a disproportionate reliance on informal care, and care by women.
In recent years, our statutory agencies have put increasing responsibility on informal carers as a result of community care legislation. The National Health Service and Community Care Act 1990 gave local authorities a duty to undertake individual care assessments. The need for respite care, or short-term breaks, has increasingly been recognised as a major unmet need, but it is not specified in community care assessments. The Bill's aim is to give people with disabilities and carers the right to be assessed for respite care and to have that care provided, if they are so assessed.
It is important to establish appropriate respite care--to involve carers in decisions about their need for respite care. The Bill therefore extends the Carers (Recognition and Services) Act 1995, which was introduced by my hon. Friend the Member for Croydon, North (Mr. Wicks).
That Act gave statutory recognition for the first time to the role of carers and their right to have their needs assessed, but it gave no right to the provision of services. That is why Lord Rix, chairman of Mencap, introduced a private Member's Bill similar to this Bill in the House of Lords in 1996. I am privileged to have been asked by Mencap to reintroduce that Bill into the House, and I thank it for the help that it has given me in promoting the Bill.
According to Mencap, 100,000 people with severe learning difficulties and their carers are not receiving much-needed respite care. Only 32 per cent. knew about respite care. Almost one in five carers who applied for respite care were refused it by a local authority or health authority.
In recent weeks, I have met groups of carers in my constituency. Those I have met have stressed the value they place on respite care for the person for whom they are caring. Respite care offers an opportunity to meet new people, for personal development, to be more independent, and to enjoy a new environment. In effect, short-term breaks for people with disabilities have the same attractions as they have for all of us.
Carers I have met say that they need short-term breaks too, to allow them to lead more ordinary lives, to recharge their batteries by going away for a couple of weeks, a few days or even a few hours--to spend time with their partners, their families and friends, to spend more time with their other children, to catch up with the housework, to go shopping, or simply to catch up on their sleep.
However, Mencap's research showed that four out of 10 carers had not been out for an evening in the past six months, and one in five not for the past five years. One mother wrote to me:
Respite care can be cost-effective, as has been shown by research carried out at the university of Brighton, where I worked before entering the House. The needs of carers were studied, and it was found that supporting carers can maintain their health, thus reducing the cost of hospitalisation and breakdowns among carers.
Respite care enables carers to return to work, which reduces the cost of benefits and increases tax and national insurance revenues. If carers could not or would not care, the responsibility would fall on the state. Official carers would be paid and receive time off and annual leave, whereas informal carers get next to nothing.
There are many forms of short-term break--holiday breaks, emergency breaks, family-based care and sitting services. In many areas, there are good examples of respite care provided through local authority social services and voluntary organisations. The all-Wales mental handicap strategy was a progressive strategy that established good collaboration between voluntary and statutory agencies. It was a progressive programme, with ring-fenced resources, but it lacked the statutory framework of rights that carers, and the people for whom they care, need.
However, respite care is scarce in many areas. Too much depends on where the carer happens to live. The aim of the Bill is to make respite care universally available, to raise standards nationally and to enshrine a right to a specific form of care, thereby imposing a duty on local authorities.
I am grateful for the support that many organisations have given me for the measure--organisations such as Mencap, the Carers National Association, Sense, the National Aids Trust, Age Concern, the British Medical Association and many other voluntary organisations. I am grateful, too, to the hon. Members on both sides of the House who have signed early-day motion 1090. However, it is the carers, more than others, that the House should thank--and society should thank them, too.
The Chronically Sick and Disabled Persons Act 1972 was piloted through the House by Alf Morris, who then represented Manchester, Wythenshawe. That Act was rightly seen as a charter for the disabled. Arguably, it was the most significant piece of legislation on disability in the post-war period, and it was passed by a Labour Government and implemented by a Conservative Government. The present Government have established a royal commission on long-term care, and we intend to make specific representations to it about the need for respite care.
My Bill will reinforce the work that the Government are doing to enhance the rights of people with disabilities. We need to establish a charter for carers, and the Bill will establish the right of carers to respite care and short-term breaks. It has cross-party support, and I commend it to the House.
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That leave be given to bring in a Bill to provide for assessments of health and social needs of disabled persons to include assessments of the needs for short-term breaks for the disabled persons and any carer.
Every right hon. and hon. Member will have in their constituency a silent army of dedicated, selfless carers. They care for people with a wide variety of needs: people with physical disabilities, learning disabilities, mental health problems, chronic sickness and degenerative conditions. Carers can be of any age, and from all walks of life. One in seven of the adult population are estimated to be carers, the great majority of whom are women. Any of us could become a carer at any time.
"I am very grateful for the 3 hours per week respite that we have through our Mencap Family Carer, but I am conscious of how fortunate we are compared to most others."
A short-term break may be covered in the carer's own home by a sitting service; it can be inexpensive, a small investment, but its value can be immense.
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