12.44 pm

The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): First, I congratulate the hon. Member for South Cambridgeshire (Mr. Lansley) on securing a debate on this important subject, and thank him for his generous words of welcome at the beginning of his speech.

The hon. Gentleman has raised a number of issues around residential care. In doing so, he has emphasised the links with the national health service. He is right to do so. In Cambridge, as elsewhere, the NHS is an integral part of community care. He also raised the issue of the closure of the Meadowcroft home in Trumpington, to which I shall refer later.

It may help if I begin by talking about the aim of community care, which is to provide the support that frail or vulnerable people need to live in their own homes or homely settings, retaining the independence, dignity and quality of life that come from being a part of the community. Social services, to which the hon. Gentleman referred, have a central role here, but as one of several partners, along with housing authorities and the NHS. Each partner needs to understand the others and to draw effectively on their contribution to overall care provision.

Social services have the lead in community care planning. In Cambridgeshire, as elsewhere, that is about planning and commissioning a balanced range of services--including residential care--to enable authorities locally to meet the assessed care needs of individual service users.

People's needs do not recognise organisational boundaries. That was one of the themes of the hon. Gentleman's speech. In the case of older people particularly, they are often complex. They also change both in the short term and over a longer period. Following a period in hospital, people may need additional support, perhaps from the community health

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In planning residential care, in Cambridgeshire as elsewhere, what is important is joined-up thinking in the wider community care and health context. Residential and nursing home care provision is closely linked with hospital discharge arrangements, rehabilitation services, domiciliary support and current work on prevention.

The interdependence of health and social care make it essential that the provider agencies collaborate effectively in service planning and commissioning, assessment and delivery, and not least, funding. Section 28A of the National Health Service Act 1977 has long been a key funding mechanism enabling health authorities to support social services. I am sure that the hon. Gentleman would not want to give the impression that the new Government are approaching the issue any differently from their predecessor. That mechanism includes supporting residential and nursing home placements through "dowries" and similar payments in respect of people transferring out of long-stay hospitals, and supporting innovative cross-agency service.

We are providing a positive agenda of change. Joined-up thinking and partnership between health and local government run through our agenda. We have an ambitious programme of review and reform including the royal commission on long-term care, the forthcoming social services White Paper and our charter on long-term care. Other examples include the better services for vulnerable people initiative and "Partnership in Action: New Opportunities for Joint Working Between Health and Social Services", the recent discussion document trailed in last year's "The New NHS" White Paper. It might be helpful to say a little about that context before returning specifically to residential care, to social services funding and to arrangements in South Cambridgeshire.

Collaboration between local authorities and the NHS is considered in detail in the recent discussion paper "Partnership in Action", which sets out plans for a new statutory duty of partnership. Much of the paper is about collaborative funding mechanisms, such as proposals for the new NHS Bill to provide for health and social services to pool budgets, delegate functions and resources to each other in lead commissioning arrangements or develop integrated provision of services. It also envisages a significant widening of health authority powers under section 28A of the 1977 Act, with funding going to local authorities in support of objectives set out in health improvement programmes.

Last December, following our manifesto commitment, we established a royal commission on the funding of long-term care for elderly people. The commission is looking at demographics and future levels of need, different models of provision and how it should be funded. The commission is due to report around the end of the year.

Last year, in an executive letter, "Better Services for Vulnerable People", we set out the medium-term agenda for people with continuing health and social care needs. The circular asked local and health authorities to take forward work in three areas: first, drawing up joint

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Further guidance on the better services initiative was issued in August by the NHS executive and the Department's social care regions. Joint investment plans are a distillation of the health improvement plan and community care planning information. They bring together in a single document the joint information needed for health and social services to deliver on their respective responsibilities. The recent guidance requires health and local authorities to have JIPs in place by April 1999, as a minimum, for older people, including those with mental health problems.

Multi-disciplinary assessments by health and social services have always been a joint responsibility in community care. More effective multi-disciplinary assessment means better co-ordination of care services. In the community, it may avoid unnecessary hospital admission and allow older people to remain in their own homes for longer; within the hospital setting, good multi-disciplinary assessments may avoid an unnecessary admission subsequently to institutional care. Similarly, developing recuperation and rehabilitation services will enable people to return to the community sooner and to remain in their own homes. I am sure that the hon. Gentleman agrees that that is common sense.

Those are also key themes in the forthcoming social services White Paper, giving the context within which services such as residential care must be seen and developed. We should be aiming to maximise independence rather than supporting dependency. We need a new emphasis on rehabilitation, recuperation and prevention services. Crucially, the White Paper programme is underpinned by the personal social services settlement--an additional £2.8 billion over three years secured in the comprehensive spending review.

Last winter, an additional £269 million was allocated for tackling winter pressures. While that money was non-recurrent, it was not just elastoplast for the winter. It provided an opportunity for longer-term improvements in services, relationships and systems. Among the priorities applied in allocating the funds were plans that would reduce delays in discharging patients and reduce the need for people to be admitted to hospital in the first place, for example by strengthening primary, community and social services.

Winter pressures were well managed by social services departments, health authorities, trusts and other agencies working in partnership. Cambridge and Huntingdon health authority received £1.4 million of the £15.174 million available to the Anglia and Oxford region. Nearly £1 million of that went to social services to enable the discharge of delayed patients at Addenbrooke's, Hinchingbrooke and Lifespan into nursing and residential homes.

Let us look ahead to the coming winter. Last week, the Chancellor of the Exchequer announced that we would find a further £250 million to help the national health service and social services to cope with 1998-99 winter pressures. The English share of that total is £209 million. On Monday, my right hon. Friend the Secretary of State

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Once again, health authorities will be encouraged to use section 28A to transfer resources for joint schemes to social service departments when appropriate. In some pressure spots, that will mean purchasing extra long-term placements in residential and nursing homes. We would also expect social services to be supported to invest in community-based rehabilitative and recuperative care.

Mr. Lansley: I am sorry to interrupt the Minister. Will he clarify that the £14.7 million to which he refers is an increase in the overall allocation to Cambridge and Huntingdon health authority? Is he yet able to say what winter pressures money is available for the year ahead and whether there will be continuing support to follow up that money?