§ Motion made, and Question proposed, "That this House do now adjourn."— [Sir H. Butcher.]
§ 11.45 p.m.
§ Mr. H. Hynd (Accrington)
The lack of accommodation for mental defectives is a tragedy which can best be appreciated by the people immediately concerned and by their families, but I am certain that hon. Members have enough experience of this matter to acquit me of any charge of wasting their time in asking them once again to look at the present position. I say "look at it again" because, in November last year, the question was brought before us by the hon. Member for Billericay (Mr. Braine) and my hon. Friend the Member for Liverpool, Exchange (Mrs. Braddock).
It is a question that is brought frequently to the notice of every hon. Member of this House and I certainly have had some painful cases in my constituency. I had intended to open this evening by 736 quoting a specific case. I am happy to say that that case has now been settled to the extent of the boy concerned having been admitted to a hospital this week. I hope the hon. Lady the Parliamentary Secretary will not accuse me of any lack of gratitude if I make this comment about that case—that I believe we are finding too frequently in the House that when hon. Members use the big stick, as it were, about a particular case, something is done about it out of the ordinary course.
I say that because in the letter I received from the Minister of Health on 14th April it was admitted that the case of which I am speaking had been on the waiting list for admission to a mental deficiency hospital since June, 1951. The letter went on to tell me that there are seven other boys of similar age and type on the waiting list whose admission is of greater urgency than this one, and at least three others of equal urgency. It explained that until there is an improvement in the position, and it appears that there is little prospect of this at the present time, the board are unable to do anything for those cases.
As I say, I am grateful that this boy has been admitted, but it seems a little unsatisfactory and I have a slight twinge of conscience if he has been taken out of course and put ahead of what I am told are more urgent cases. However, I do not press that. I am more concerned with the general problem and the general shortage of this accommodation throughout the country.
As far as I can understand, the total number of mental defectives of all ages in England and Wales is 148,000. I take that figure from the current Annual Report of the Ministry of Health. The Minister told us in a written answer on 8th July, 1952, that over 48,000 of those are occupying beds in mental hospitals. He also said that there are 8,000 awaiting admission, and I gather that 664 of those are in the Manchester Regional Hospital Board area which covers my constituency.
The Parliamentary Secretary told us in the Adjournment debate to which I referred a moment ago that 15,000 more beds are needed for such cases, and I think that illustrates the magnitude of the problem. That is one side of the medal. The other side of it was also mentioned 737 by the Parliamentary Secretary in the same debate, when she told us that there are actually 2,693 beds not being used, for various reasons, mainly shortage of staff.
That is a very serious problem which, I know, is not confined to mental deficiency cases. Unfortunately, it is a general problem throughout our hospital services, and I understand that in the case of the Western Hospital, Fulham, London, there are no fewer than ten wards which are not in use. Surely, that is a very serious state of affairs, and I do not know what the Minister is doing about shortage of staff, or what is the reason for it.
I know that there has been a recent increase in wages; so perhaps it is not pay which is the cause, but, whatever it is, there is a remarkably large proportion of foreigners in our hospital service today, and not nearly enough domestic or nursing staff. Therefore, there is this two-fold problem of obtaining more accommodation, and finding ways and means of utilising to the full extent the beds which are already in existence.
Tonight, I am most concerned with the age group five to 15 of both sexes; because, while infants are more easily handled by their mothers, the children, when they get to school age, become something of a handful and mothers find they are unable to cope with them. This is a terribly serious problem in some homes; so much so, that there have been cases of suicide of one or other of the parents who has found the burden too much. Also, it is the five to 15 group which is in the formative stage when, if anything can be done by medical science and by those who specialise in this work, it must be done.
It is also the largest age group of the classes awaiting admission to hospitals. I make that last remark on the basis of a sample census in Middlesex, where the age group 0 to four was 75 awaiting admission, five to 15 was 189, and from 16 onwards, 139. That is a total of 403, and 189 is a large proportion; it shows that this is the class to which attention might be directed as a priority.
That is the problem. What are we to do? I admit at once that there has been great progress in the last few years in research into mental deficiency, and into the treatment of this 738 tragic disease. I should like to pay tribute to the hospitals and the staffs and the medical officers responsible, but the problem is such that nobody can be satisfied about what has been achieved. We have to ask continuously of the Minister what progress has been made, and what progress we can hope for in the near future. We have heard with great pleasure—and tribute has been paid in the Minister's annual report to it—of the work done by the voluntary bodies such as the National Association for Mental Health. I would draw attention to the fact that the President of the Association is the right hon. Gentleman the Chancellor of the Exchequer, and that may put a thought into the hon. Lady's head. Her right hon. Friend may not be unsympathetic if he is asked to provide some more cash for the work.
Then there is the Mental After Care Association and a newer body, the National Association of Parents of Backward Children and other organisations. As an example of the very excellent work which is being done, I mention the home provided at Rainhill, near Liverpool, by the Association of Parents of Backward Children, and run for them—very sensibly—by the National Association for Mental Health. That kind of place is badly needed at present. I should like to see many more places of this sort set up, either by voluntary associations— perhaps with Government assistance—or by local health authorities. They already have authority to set up such homes. That authority was given by the Minister of Health in Circular 5/52 in January last year, but there is a snag in it and that may be why some local authorities have not taken advantage of the permission given them in the circular.
A sentence in the circular says that if additional grant-aided expenditure is involved it should be offset by savings on other parts of the service. It is very regrettable that such a sentence should have been inserted. I am sure many progressive local authorities would be glad to take advantage of this permissive power but when they are asked to do so by cutting off some of the other good work they do I can understand their hesitation in adopting this permissive power.
I should like to suggest one or two other ways in which this problem cannot be solved but may be ameliorated. One 739 is, again by using existing powers of local authorities, to provide guardians in suitable cases. Local authorities can spend money on guardianship and it is a very efficient way of dealing with the right type of case. Incidentally, it is cheaper than sending to an institution. There is the permissive power of setting up occupation centres for daily training and teaching to keep these people busy under proper supervision in suitable cases. That is one of the health powers delegated to county councils. I am told that there were 4,822 people attending such centres at the last count, but more than 7,000 ought to be in these centres. There is need for expansion of that work.
What I believe to be even more essential is the provision of hostels to which mental deficients can go as an alternative to an institution. Again, it would probably be cheaper to send them there where they could do useful work, perhaps gardening, or going out to work and coming back to the hostel where they can be supervised in their leisure time. I suggest something along the lines of the probation hostels which many of us know well. Or that type of hostel can be used for patients released from institution on licence, thereby giving space for people who need beds as more serious cases.
There is a suspicion, and I hope the Parliamentary Secretary can say something about this, that some of the high-grade patients in mental hospitals who are quite able to work and become very useful about the place, are not released as early as they might be because they are so useful. The staff concerned do not like to release them, and they are kept working when, for their own sake and for the sake of others, it might be better to let them go. Sometimes there is a sad case of a patient released on licence under the charge of a guardian who dies and, because he has nowhere else to go, the patient—who needs some kind of supervision—has to go back to the institution.
This kind of half-way house which can be called a place of social rehabilitation is one of the ways suggested for dealing with the problem outside the actual provision of hospital accommodation. I hope the Parliamentary Secretary will be able to provide some hope that that 740 remedy will receive serious consideration. One or two such places already exist as a wing of a hospital, but there seems to be some difference of opinion about whether the cost should properly be borne by the Health Service or the county council. I am not interested in who should bear the cost. That is a secondary consideration. The important thing is to find the best way to deal with the situation.
It was in 1929 that the last committee, the Wood Committee, dealt with the problem of the treatment of mental deficiency. I would ask whether the Parliamentary Secretary thinks that a sufficient time has elapsed, and when, following the developments in the study of this problem, we should consider setting up another committee to study the matter.
§ 12.2 a.m.
§ Mr. Ronald Bell(Bucks, South)
I intend to speak for only a few moments, because I am sure that the Parliamentary Secretary will wish to have as long as possible to reply. I wish to associate myself with what has been said by the right hon. Member for Accrington (Mr. H. Hynd). In broad outline the problem which seems to present itself is that the children who come under the responsibility of the Ministry of Health, because they have been medically certified as ineducable, cover a considerable range of mental defectives. There are. therefore, two problems involved.
First, there is the problem of the mental institution, the difficulty of getting them into the mental hospital in order to take the burden off their unfortunate parents. There the difficulties are the shortage of accommodation and the even worse shortage of nursing staff. There is also the separate problem which ought to be faced, that up to now the nation has not been doing enough for these children.
Once they are certified as ineducable there is no statutory duty to do anything about them at all. There are merely statutory powers for the local authorities to act if they feel so inclined. For those who are not hopeless cases there should be some separate provision so that whatever faculties they have can be developed to give them as much normal life as possible. Those who come under the Ministry of Education and those who are ineducable ought to be separated. My 741 view is that it will be necessary to organise this on a regional rather than. say, a county or a borough basis. Fortunately, the concentration of these children is not so high that any medical authority can separate them and provide institutions for the various different grades of ability. I think there is scope here for some Government initiative and I hope that my hon. Friend will say that something on these lines is being explored.
§ 12.5 a.m.
§ The Parliamentary Secretary to the Ministry of Health (Miss Patricia Hornsby-Smith)
As the hon. Member for Accrington (Mr. H. Hynd) has said, much of this ground was gone over in the debate initiated by the hon. Member for Billericay (Mr. Braine) and he will not expect me to go over the same details because he was so very familiar with them in his speech tonight. However. I can bring some of the figures up-to-date, but I would like to get two personal points out of the way beforehand.
First, with regard to the case he raised with the Minister of the nine year-old boy. I confirm that my right hon. Friend did write to him and say that there were seven children of the same age and type on the Manchester list and that three had equal urgency. I must state most emphatically that this boy was admitted at Calderstones this week not as the result of any queue-jumping, but because a further visit and inspection was paid to his home, where it was found that his father was going abroad. It was realised that the strain on the mother alone, without the second parent to help her with a very difficult case, accentuated the difficulties and this gave that case increased priority.
I would not like it to be thought that hon. Members, by Questions or Adjournment debates, can, in any of these cases, jump the queue. Cases are decided by the medical authorities and by them alone, and not by our Department on the political side. I can assure the hon. Member that we have such a waiting list that we have no desire to hold anyone we can safely let out. Often cases are pressed by anxious mothers, who are always very relucant to think ill of their own children. One can sympathise with them, but very often we, who are able to give Members of Parliament information about cases which one cannot make 742 public, know very well that those patients, within the ordered discipline and regular routine of the institution are quite different from when they are out in the world at large. We have no desire to keep in any case. We are only too anxious, when our medical advisers can fairly release anyone with safety to themselves and the public, to provide a vacancy for someone else.
Steady progress although not as fast as we would like, is being made. The total number of in-patients at the end of 1952 had risen to 53,066 as against 51,194 a year previously. We have still, unhappily, a growing waiting list and a large proportion of them—about 4,000 out of 8,714—are children. That, again, reflects the same bulge in the age group which is the problem of education today, not that there is a vastly-increased proportion of children who are mentally deficient, but, in an increasing population, the proportion is about the same.
So we have an increased number for whom to try to find space. They are now in the age group four to seven years when it is impossible, or difficult, to keep them at home. Therefore, they are making claims upon accommodation. We have, then, this bulge of some 4,000 children on the waiting list.
There has been further progress in staffing the beds. The last figure I gave showed that at the beginning of January, 1952, there were 2,145 unstaffed beds. At the beginning of 1953, there were 1,587 unstaffed beds. But the problem is more nurses. The second problem is more buildings.
I do not want to go over the problems we inherited—I dealt with those fully before—but I should like to emphasise the efforts that have been made in accordance with my right hon. Friend's oft pronounced principle that we must give priority to the mental side in capital expenditure. Areas have been told that they must do this. In the Leeds area, for example, in the two-year programme, out of an expenditure of £190,000 the sum of £102,000 is going to mental deficiency. In East Anglia, £49,000 is being allocated to mental deficiency out of £181,000 for the 1953–54 programme.
743 Manchester and Liverpool for this purpose must be considered together, because when the line was drawn between the two regions nearly all the Liverpool institutions happened to come within the Manchester Region, and, therefore by an arrangement between the two regions, in which they co-operate firmly, Manchester Region takes a lot of cases from the Liverpool Region. Manchester took over 6,420 beds of which 560 were unstaffed in 1948; 170 beds have been added. There were 55 unstaffed beds at Brockhall, which was reopened last year, and another ward is being opened within a few weeks. A 40-bed unit for adolescent boys is to be built in the Mary Dendy hospital. All the time we are encouraging recruiting campaigns for mental nurses and quite a number of foreign nurses have been recruited to help out the situation in this and other regional board areas.
The top priority in our capital programme this year has been given to Greaves Hall, which is a very large project, for 1,040 beds. It is being built near Southport. The whole project will take five years and will cost £3 million. The largest single programme of capital expenditure has gone to that vast project for a mental institution there. The total cost, as I have said, will be just under £3 million. It will take five years to complete, but the first phase which is about to start will cost £676,000 and will provide for 170 new beds.
At the same time, at the Harpenbury Hospital, St. Albans, another scheme is now two-thirds complete, costing £131,800, and in the last two financial years there has been an expenditure of £899,000 on improvements in the purchase of buildings and adaptations entirely for mental deficiency work.
I hope that hon. Members will see that it was no empty promise when my Minister maintained that of the capital expenditure available to us we were determined to see that a very substantial proportion went to the mental deficiency side. We do not pretend that it is as much as we would like to have at our disposal for this very important and grave problem in the health service, but we 744 have seen that the allocation of priority has gone to that side of the National Health Service work.
As far as staff are concerned—and this is an all-important problem—the staff in 1948 were 6,000 full-time and 1,500 part-time, and at the end of 1952 it was 6,610 full-time and 2,128 part-time, a steady increase, but we still require many more. The Minister's National Advisory Council on the Recruitment of Nurses and Midwives is, as the hon. Member knows, discussing all these problems now, and he will have heard from an answer to a Parliamentary Question this afternoon that already some of the recommendations that they have made from their survey of the problems of recruiting mental nurses have been put to the Minister, and my right hon. Friend is in the process of sending out recommendations to the hospital management committees concerned.
The second part of their report still has to come, but the hon. Member will appreciate that we must await their full findings. The moment they are received they will certainly be acted upon. It is our greatest desire to see real progress made in this very grave problem, and I can assure the hon. Member that steady and increased progress has been made in the last 12 months. In the months to come the whole emphasis will be on trying to build up this neglected side of the National Health Service.
§ Miss Hornsby-Smith
On the local authority side, it is a dual responsibility. A part of it is provided by the local authorities and a part by us. There is certainly encouragement for them to help, though possibly the accent is on the educationally retarded side rather than on the mental side.
§ The Question having been proposed after Ten o'clock on Thursday evening, and the Debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.
§ Adjourned at sixteen minutes past Twelve o'Clock a.m.