HC Deb 02 August 1961 vol 645 cc1607-16

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Hughes-Young.]

9.59 p.m.

Mr. W. A. Wilkins (Bristol, South)

I shall not talk tonight about the Common Market but about the need for a common community effort on behalf of an unfortunate section of our community. The House has always shown itself sympathetic in matters which concern the welfare of the mentally sick, and I am sure that it is always ready to aid and encourage every worth-while effort designed to assist them to regain their health and to help to reinstate or rehabilitate them in industry and society and normal industrial life.

It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Chichester-Clark.]

Mr. Wilkins

In these days of modern medical knowledge and techniques, this is by no means impossible in quite a substantial number of cases which, in days past, would have been written off as being incurable, and the story that I want to tell tonight to the House, and, I hope, to the country as well, is really a message of hope for these people.

It is also a story of a dedicated man, a consultant psychiatrist, who, with the sympathetic and practical support of industrialists, trade unions, trade unionists, the churches and social workers, and also of civic authorities, including doctors, ventured forth in faith upon a scheme for the industrial rehabilitation of mentally sick people. Very rich rewards for their courage and vision and enterprise are already being reaped, with tremendous financial advantages to the nation, which is one of the points I want emphatically to register.

Far transcending any consideration of this kind is the restoration of dignity and independence for the patients who have been restored to community life and to their immediate relatives and friends. The organisation I am referring to is known as Industrial Therapy Organisation (Bristol) Ltd., and its work provides a fascinating story of achievement. Here, interpose to say that I know that in at least two parts of the country similar but not parallel experiments are being undertaken, mainly. I understand, by local authorities.

This organisation has developed from an industrial therapy scheme which was pioneered in Glenside Hospital, Bristol. Some years ago the patients were encouraged under this scheme to assemble such things as ballpoint pens and small electrical components. Today, there is a thriving industrial unit in Glenside Hospital. In it nearly 400 longterm psychiatric patients are gainfully employed and are being helped to regain their confidence and self-assurance. But this has now become only stage 1 of a three-stage process of rehabilitation. Industrial Therapy Organisation (Bristol) Ltd. is stage two in this process.

This organisation a couple of years ago leased some old disused school premises which were literally derelict and equipped them as a factory through the great generosity with gifts of money by local people, but more especially with machinery which has been loaned to the organisation by a number of eminent local firms. These firms have gone even further, however. Some of them have seconded supervisory staffs to this work both at the hospital and the factory which enables them to ensure that the work which is produced for them by the patients is completed to their satisfaction.

A little more than six months ago a car-washing project was launched. It has proved a huge success. In the first four months, to 6th March this year, it had taken £1,314. The cars were washed at the rate of 6s. per vehicle and contract terms were also offered for the work. Contracts have now been secured to wash the whole of the G.P.O. fleet in the City of Bristol, and the fleets of some of the large industrialists in the city.

At the moment, the service is overstaffed, but as the organisation is nonprofit-making and as its major concern is the therapeutic value attached to it, the present staff will continue until and unless the organisation is forced to do otherwise. I believe that it will not be compelled to impose any restriction, because it is now proposed to instal a second car-washing branch.

I should now like briefly to quote from a paper which was reprinted from the British Medical Journal of 3rd June, this year. The paper is entitled, "Evolution in the Mental Hospital" and was written by Dr. A. B. Cooper, senior registrar, and Dr. D. F. Early, consultant psychiatrist of the Glenside Hospital, the man who I believe to be the inspiration behind this scheme. The paper says: There can be no doubt … of the improvement in morale of both patients and staff following directly on the establishment of the industrial units. For the first time a large proportion of the hospital population are fully and usefully occupied, and perhaps more important patients have been given the prospect of earning their living in the outside world. Not only are those patients formerly regarded as potentially capable of work now actually becoming self-supporting, but many others, once thought hopelessly deteriorated and unemployable, are now proving that they can make a useful contribution. Over the past three years patients' earnings have increased rapidly and continuously … and if the present trend continues the hospital population will soon contain a sizeable proportion of wage-earners who will need only suitable accommodation to become independent and self-supporting. I said that this was a fascinating achievement, and I will quote only a few figures. In 1957, none of this work was being undertaken and the total of hospital and basic workers' allowances in that year was £6,820. In 1960, the earnings in the unit in the hospital were £10,043. Earnings of the people employed by I.T.O. over a period of only ten months were £7,943. It is estimated that patients already placed in open employment have earned £3,750. The comparison is that between £6,820 in 1957 and the earnings £28,818 by these people in 1960. I have recited only the barest details concerning this great work of rehabilitation.

I now want to say a word about the third stage and the important people in this fascinating experiment; the important people being, of course, the patients. No compulsion whatsoever is exerted on these patients to undertake any of this work, whether it is in the hospital or in the factory. They come to work if they wish, or they stay away and remain in the hospital if they so desire. If they come to work and at some period of the day they feel that they need a rest, they have one, because they are paid only for work they choose to do, and they are paid for that work at proper piecework rates for the job.

I do not know whether the Parliamentary Secretary has visited this factory. If she has not, I hope that when she is Bristol way she will take the opportunity to have a look at it. It is apparent to anyone who visits the factory that these people are really happy to be employed in this way, and that I think accounts for the tremendous success story which it is.

At the moment of my speaking in this House, 42 of those patients—it is a big figure—are back in normal civilian employment offered by sympathetic Bristol employers. I want to emphasise that they are able to do the work which has been offered. This is not philanthropy in any sense of the word. There is no philanthropy whatever about this aspect of the experiment.

Between them, those 42 patients have spent nearly 400 years in hospital. These are fantastic figures. Let us consider what that means in cost alone to this nation, to say nothing of what it means to the patient and his family in human terms. Surmising that the average cost of maintenance in hospital is about £8 per week—I believe that it is actually £7 19s. 8d.—that represents a sum of £166,400. We are therefore safe in saying that it is a figure of something over £150,000, but of course it is the human aspect which concerns me and the public spirited people who run this organisation.

May I give three examples of the kind of patient who has now been rehabilitated and reinstituted into normal industry and normal life? I have supplied the Parliamentary Secretary with two lists—male and female patients—which I think she will agree show pretty astonishing results. Mr. X is now 60 years of age. It is 35 years since he last worked. He was in hospital for 33 years. He is now a garage hand enjoying private life. He has held this job for eight months and is doing extremely well. Miss Y is 57 years of age, and she has never previously been employed. She has been in hospital for 37 years. She is now fully employed in a canteen. Mr. Z worked for ten years, and was then in hospital for nine. He is now working at the docks. He had worked previously at the docks, and his workmates approached the Transport and General Workers' Union and asked it if they could have him back working with them. He is now with them again, doing a useful job for the community. Those are only three of the 42 great achievements.

I bring this to the notice of the House tonight for three reasons. Incidentally, I wish to apologise for my voice; I have been getting this trouble for a week. First, I hope that what I have said here tonight will fire the imagination of colleagues on both sides of the House, so that they will endeavour to encourage or promote similar schemes of industrial therapy within their constituencies. Secondly, I hope that my words will reach the ears of industrialists, social workers, trade unionists, the Church and civic authorities, and inspire them to do likewise. Thirdly, my faith in the British people is such that I believe that a human problem such as this has only to be stated to ensure a warm and sympathetic response in their hearts. There is grand work to be done, and a very great reward for its doing.

Nothing that I have said tonight implies a criticism of the interested Government Departments; indeed, entirely the reverse is the case. I am able to tell the House that the local officials of the Ministry of Health, the Ministry of Pensions and National Insurance and the Ministry of Labour have given their assistance to the limits permitted by the regulations under which they administer such matters. The newly appointed Parliamentary Secretary to the Ministry of Labour recently visited this factory and opened what we call a sheltered workshop—a workshop for those people who may not be able to be completely rehabilitated in the way in which the patients to whom I have been referring have been. I am sure that the Minister was astonished at the progress and opportunities which he saw there.

I hope that the Parliamentary Secretary has received the further information that I sent her today, relating to one or two remaining snags- One of them would require a very lengthy recital, which the time limit imposed by the Adjournment debate prevents me from stating. I am sure that she will examine it with great care. I ask her to do two things. First, I hope that she will agree that when we return after the Recess she or her Minister will provide an opportunity for a talk about the matters to which I have referred in my communication and which I cannot mention tonight, with a view to seeing whether something can be done.

Secondly, I invite her, through her Department, to take all the steps that are open to her to publicise the possibilities of schemes of this character, through the Federation of British Industries or the various chambers of commerce and the trade unions, so that we may hope that this kind of scheme will be sponsored in all the great cities—the Leeds, Bradfords, Birminghams and Newcastles—with a view to bringing about a national rather than a local effort in matters of this kind and offering opportunities to those less fortunate people in our community for whom the House still recognises some responsibility.

10.20 p.m.

The Parliamentary Secretary to the Ministry of Health (Miss Edith Pitt)

I welcome the opportunity afforded me by the hon. Member for Bristol, South (Mr. Wilkins) by choosing this subject for an Adjournment debate to pay my tribute to the energy and enterprise which has been shown in this project at Bristol. It is a particularly good example of what I would call joint voluntary community effort. I think also that it is a good example of something about which we feel keenly in my Department, the acceptance by the community of the mentally ill as part of the community; the acceptance of a responsibility towards them.

The results of the first year's operation of the Industrial Therapy Organisation includes, according to the report I read, the successful placing in employment of thirty long-stay patients. The hon. Gentleman said that the figure was forty-two.

Mr. Wilkins

The figure in the report was up to March. My figures are up-to-date.

Miss Pitt

I am happy that the figure has increased and I think it extremely encouraging. It suggests that the scheme is making an important contribution to the problem of bridging the gap between hospital and life in the community.

The hon. Gentleman referred to some difficulties which have arisen and I know that to be the case. It is true that initially arrangements for patients to contribute to their maintenance in hospital and the rules governing National Insurance contributions and benefits and National Assistance gave rise to difficulties. In some cases patients were worse off working far I.T.O. I think it inevitable that schemes such as the National Insurance Scheme and the National Assistance Scheme should be administered according to regulations. The Departments concerned have made every effort within the limits of the regulations to meet the special circumstances of I.T.O. The Ministry of Pensions and National Insurance was able to accept I.T.O. patients as undergoing training which meant that they were exempt from the liability for National Insurance contributions. In so far as the Board arranged to meet the essential needs of patients' dependants when National Insurance benefit ceased, the local officer of the Board visits the training factory regularly and takes any new applications for assistance and discusses any difficulties. In addition my right hon. Friend uses his discretion to vary the maintenance charge payable by patients under Section 28 of the National Health Service (Amendment) Act, 1949.

Some problems however remain. I appreciate that I.T.O. would like patients to be progressively better off continuously until they are independent. As he said, the hon. Member handed to me a letter from the managing director of I.T.O. making suggestions as to how this might be achieved and I am asking my right hon. Friend the Minister of Pensions and National Insurance to examine these. I think it fair to say that the main difficulties have been resolved and the Departments concerned have shown clearly their anxiety to co-operate fully with I.T.O.

I would add, in no spirit of criticism, that I feel that some of the earlier difficulties might have been avoided had the organisers of I.T.O. approached the Departments concerned fairly well in advance of arranging the scheme. I put that on record now in the hope that when similar schemes may be launched the organisers will profit from that experience. I am glad of the opportunity to make clear that there are other areas where progress has been made in rehabilitation of long-stay patients and where there has been fruitful co-operation between the hospital, industry and the trade unions.

I need hardly say what value my Department attaches to this work of occupational therapy in the treatment of mental patients and that it has long been recognised. Mental hospitals have traditionally provided for patients a variety of occupations in farms and gardens, wards, kitchens and laundries and in hospital workshops. Some of these occupations, however, tended to encourage the institutionalisation of patients and emphasis was on the occupation rather than on the rehabilitation of patients who had to be accepted as chronic. In recent years the prospects for rehabilitation have been transformed by advances in treatment and changes in the régime and approach of mental hospitals.

As part of these changes, hospitals have in recent years provided a greatly increased range of occupations through which patients can progress to the point whore many even of the long-stay patients are able to return to the community. Industrial work carried out under contract with outside firms has been of great importance. This makes it possible far patients to carry out the kind of work they might expect to do outside hospital in conditions which resemble as far as possible those of outside employment. Patients can thus be trained to meat the stresses of competitive employment and to secure the work habits necessary to enable them to hold a jab.

There remain many long-stay patients who developed their illness before modern treatments were available and who cannot now be rehabilitated to the paint of discharge. There are many long-stay patients Who are elderly—around one-third are over 65—and there is no question of their being able to return to normal employment but for these patients also industrial work has a part to play in providing stimulating occupation and helping to redeem them from the vegetative existence which would, at one time, have been their lot.

My Ministry has done all it can to encourage this industrial rehabilitation work. The Standing Mental Health Advisory Committee reported in 1957 and we followed that up with a general memorandum on rehabilitation commending to the hospital authorities the advice of that Committee and of the Piercy Committee. Since then the Ministry, in its Annual Report, has drawn attention to the value of industrial work and has given examples of particular schemes whose experience was likely to be of value to other hospitals proposing to enter this field. We have shown what has been done so that others can profit by it and since 1958 there has been a great expansion of industrial units in hospitals for the mentally ill.

The hon. Member may like to know that we recently sent out a questionnaire from the Ministry and fifty-seven hospital management committees reported that they had one or more industrial units at mental hospitals within their groups. The reports received indicated that hundreds of different processes are now being carried out by the mental patients the main types of work being assembly, packaging and salvage work for a variety of industries. At Netherne Hospital, for example, eleven different kinds of work are undertaken which include electric blanket wire threading, varnishing children's toys, machining of coat hangers, contract typing, subassembly and soldering of radio and television parts, the latter entailing fourteen different jobs.

At Banstead Hospital, which has a long standing industrial unit establishment in association with the social psychiatry unit of the Medical Research Council, work includes packing clutch plates, folding and packing serviettes and filling and sewing up various types of dolls. There are many other examples. Hon. Members may see from the notes I have how long I could have gone on had time permitted. There have been other forms of rehabilitation and extension of the occupational work and diversity of occupational work within hospitals.

Important though industrial and occupational therapy is, it is not the only factor which is contributing to the improved prospects of rehabilitation for the long-stay mentally sick. In recent years a number of developments have interacted and combined so that it is impossible to say what has made the greatest contribution to the discharge rate. These developments include the advances in physical treatment and drug therapy, the removal of unnecessary restriction on patients, the increased range of recreation as well as occupation, improved physical surroundings, new methods of group therapy and rehabilitation and the development within the hospital of a community life in which patients are given great responsibility.

Following on from industrial therapy, and in a few cases as an alternative to it, hospitals arrange for suitable patients to go out to work with local firms while living in hospital and remaining under general psychiatric supervision. Services provided by the Ministry of Labour, in particular the work of resettlement officers, have made an important contribution to placing patients in employment. It is only by a planned programme of rehabilitation involving a combination of these developments that it has been possible gradually to bring chronic sick patients to a point where they can take their place in outside employment.

The Question having been proposed at Ten o'clock and the debate having continued for half an hour, Mr DEPUTY-SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Ten o'clock.