HC Deb 06 December 1966 vol 737 cc1313-24

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

11.26 p.m.

Mr. W. S. Hilton (Bethnal Green)

I am very glad to have the opportunity in this debate tonight of raising the question of the mental health problems of East London. Some of my colleagues have asked me, why such a broad and generic title? I have deliberately chosen the title because I want to raise in this debate the reasons why people become mentally ill; the way in which the illness is treated; the way in which the money is raised to pay for treatment and the way in which I believe money ought to be raised for local authority after-care services.

Although I am directing my remarks particularly to the Borough of Tower Hamlets, in which my constituency is situated, I think that the matter being raised tonight has implications for every city and town throughout the length of this country which has areas where there has been gross social under-privilege for many years. I want to make very clear what I mean when I say gross social under-privilege. I mean cities and towns which have areas of decaying houses and slums, schools which do not have a single blade of green grass, let alone a playing field, where there are low average incomes per family and where one finds a lower standard of general environmental conditions than one finds throughout the country as a whole.

In my constituency of Bethnal Green and South Hackney, in the East End of London, this is a reasonably accurate description of the conditions in some areas. I would not say, however, that it is an area full of slums and generally bad conditions, because local authorities in the area comprising many councillors with wisdom and foresight have done what they can, but the problem is very large and there is still much to be done. That is why I particularly wish to raise this question of the mental health aspect tonight.

People living in areas where there has been gross social under-privilege are more likely to be prone not only to physical illness, but to be subject to such social stress that it can lead to a mental breakdown. One may find that the local mental hospitals in such areas have a very high rate of admissions. This is exactly what is happening in the Borough of Tower Hamlets. The social conditions under which people live can, I believe, be measured by the rate of admissions to mental hospitals in the area. I know that this is a point which causes some dissent among those people who have researched into the problem, but let me state the facts.

The Psychiatric Rehabilitation Association, which deserves great tribute for the public service and work that it is doing, made a survey into the problems of the East End of London, specially related to the mental health aspect. The Association stated that the admissions to mental hospitals in the Borough of Tower Hamlets was 77 per cent. above the national average. When I raised this matter with my right hon. Friend the Minister of Health recently in the House, he questioned the figure of 77 per cent. and said that it was nearer 40 per cent. Whatever the actual figure may be, there is no doubt that the Minister, even on his own admission, has conceded the principle of the case that I am making that a grave problem exists in the East End.

The reason that I bring the Tower Hamlets position before the House is that a considerable proportion of the financial burden of looking after these unfortunate people falls squarely upon the local authority and is not borne out of national resources. The local authority has to pay for after-care—that is to say, the care of these people after they are discharged from hospital—out of the local rate funds. If anything has been grasped from what I have said tonight, it should be that those rate funds are already under a severe strain because of the demand upon them to alleviate the social conditions which contribute to sending people into mental hospitals.

At this point, I want to explode a fallacy which is commonly held about the National Health Service. There is no National Health Service in this country in the common concept: many people to whom one speaks think that there is a National Health Service which takes care of every aspect of physical and mental illness. This is not so.

What we have is a combined national and local health service, and the National Health Service, which has its funds raised reasonably equitably, deals only with part of the problem. But a local authority has to rely upon the rates it can raise to deal with local after-care problems, especially mental health. It does not take much reasoning to realise that some local authorities have a bigger burden of this work to carry out than others, and, therefore, the amount that has to be raised in rates, or the amount to be devoted from their rates funds to this work is very much greater than other local authorities, where the problem does not arise to the same extent.

Therefore, the National Health Service pays for and takes care of patients while they are in mental hospitals, but as soon as they are discharged, at a time when they require very great assistance to help them settle successfully back into a community atmosphere, the expense of that work has to be borne by the local authority. This is the point that I put to the Minister just over three weeks ago. I asked him whether he did not agree that, if there were these very high rates in the East End of admissions into mental hospitals, there was a proportionately higher rate of after-carework. I pointed out that this would mean a very much greater financial burden on the rate funds of the Tower Hamlets and many other local authorities.

I continued by asking whether he would not …consider whether a special grant should be made in these cases? My right hon. Friend replied: I have no powers to make a special grant." —[OFFICIAL REPORT, 14th November, 1966; Vol. 735, c. 32–3.] That was a reply from the Minister, but it was not a reply to the question asked, namely, whether he considered that something ought to be done. I did not want to be told simply that he did not have the power to do anything. I know that present legislation does not enable him to make special grants. But my point was that, in view of the undeniable circumstances existing, would he not consider the entire matter afresh, even to the extent of thinking about legislation to help areas with special problems, such as Tower Hamlets?

What are those undeniable circumstances, to which I have referred? The first is the simple fact, as the Minister has stated, that the Tower Hamlets Borough is already paying 10 per cent. more on health services, than the national average and 20 per cent. more than the average of the rest of the London boroughs. Surely this admission by the Minister completely substantiates the case that I am making?

I am asking, sincerely and seriously: is it right or just for a Minister to admit the existence of a problem but to refuse to consider ways in which to solve that problem? It is because I take a very serious view of this that I agree entirely with the report of the Psychiatric Rehabilitation Association, when it states that special responsibilities for providing residential accommodation, day centres and training centres, and general aftercare work was placed on local authorities in the Mental Health Act, 1959, but no special aid was made available for local authorities to fulfill adequately these functions. The Report goes on: Any additional expenditure on mental after-care has to be made at the expense of other local authority health services. Because Tower Hamlets is an area where there is a great demand for all services, one can appreciate the serious difficulties faced by councillors in trying to allocate scarce financial resources in a just and equitable manner. It can be said with some justification that they have an impossible task and I do not envy them in having to face this task.

I know that my right hon. Friend the Minister will not be replying tonight, but my hon. Friend, the Parliamentary Secretary will.

I wish to say to my hon. Friend that any constituency problem which I have raised with him has always met with sympathetic consideration. I could not have wished for greater co-operation from any Minister in the Government. That is why I appeal to him, with some hope of a favourable response, to consider how seriously placed Tower Hamlets is in trying to meet this problem out of the rate fund.

I have already said that some researchers differ as to why people go into mental institutions, and I think that my hon. Friend the Parliamentary Secretary has some differences with me on this matter. I can only give my own evidence, arising from case work in Bethnal Green and South Hackney, that a great deal of mental stress is caused through living in decaying houses and in a generally low standard environment.

I cite in support of that statement the Milner Holland Report on London's housing in general, which stated categorically: …applications for rehousing on medical grounds have shown the preponderance of two concomitants of multiple occupation—respiratory illness and psychological or psychomatic disorders. This is extremely valuable evidence supporting my contention that at living in an area which is decaying helps to accelerate mental breakdown.

Not only in Bethnal Green, Stepney and Poplar, within the area of Tower Hamlets, are we spending well above the average on mental health services, but we are also spending more on another service which gives me great concern, and some of this expenditure is due partly to the breakdown of parents. I refer to the children's service. Children are usually the first to suffer when anything happens to the parents, and the deprivation which they may experience in their early years makes them susceptible in adult life to the same pressures which put their parents in mental hospitals.

What is the present position in Tower Hamlets? The estimated rate poundage spent on children's services for this year is just over 1s. 2d. This is 57 per cent. above the average for all inner London boroughs of approximately 8¼d. The net effect is that Tower Hamlets, an area which should be receiving Government assistance, is having to rate itself at 11s. 6d. in the £, the highest rate of the 12 inner London boroughs, to try to cope with its problems. The people there have done a great deal to help themselves. East Enders have a resilient spirit. They have tried to cope with this problem. Voluntary organisations are also helping the local authority, otherwise the problem would be even greater.

I hope that the Ministry will consider this grave matter as it arises in my borough, and perhaps in other boroughs, with a view to doing something legislatively to help. I appeal to my hon. Friend to consider all of the facts which I have given him and to realise that if I am asking his Ministry to consider the possibility of giving assistance, it is for people who have already proved themselves worthy of any assistance which can be given to them.

I conclude by saying that I hope he takes a view of this problem not limited by narrow financial considerations, but based upon sympathetic understanding of what is a very human and real problem in the East End.

11.40 p.m.

Mr. Ian Mikardo (Poplar)

I desire to take less than one minute of the time of the House to make two points. The first and more important one is to pay my tribute and express my thanks to my hon. Friend the Member for Bethnal Green (Mr. Hilton) not only for raising this matter, but for the deep thought, considerable research and hard work that he has put into the question, as will be evident to everyone who has heard what he said. By his action in bringing the matter to public notice and the trouble that he has taken to do so in the most informed way, he has put in his debt not only his own constituents, but my constituents and those of the third constituency which goes to make up the Borough of Tower Hamlets.

The second and lighter point which I want to make is that during the nearly 20 years that I have been in this House, this is the first occasion on which I have been present at a debate at which not one hon. Member of the Opposition has been present. I am sorry to say that that seems to be an indication of the fact that hon. Members who should be opposite are totally indifferent to grave social problems of the sort that my hon. Friend has raised.

11.41 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Charles Loughlin)

I congratulate my hon. Friend the Member for Bethnal Green (Mr. Hilton) on calling the attention of the House tonight to services needed for the mentally ill. This is a subject of importance to every one of us and, therefore, I welcome this opportunity to discuss what is being done, with particular reference to East London.

Our object is that a fully comprehensive service should be developed in every part of the country by co-operation between the three branches of the National Health Service. I shall, however, refer mainly to the hospital and the local health authority services and the interaction between them.

My hon. Friend has said that the admission rate to mental hospitals among the population of Tower Hamlets is 77 per cent. above the national average, and that that throws a burden on the local health authority in connection with the after-care service quite out of proportion to its financial resources.

To take, first, the figure of an admission rate 77 per cent. higher than normal, I understand that that figure was based on a study of records at St. Clement's Hospital, Bow, and Long Grove Hospital, Epsom—the main hospitals serving the area—as compared with national figures obtained from my Department; these figures were for adults aged 21 or over. The Department's statistics are not normally collected on that basis, but relate to the population of all ages.

Our statistics suggest that my right hon. Friend the Minister of Health was quite correct when he said that the admission rate from Tower Hamlets is about 43 per cent. above the national average. The way in which this figure has been calculated is as follows. The admissions so far this year from Tower Hamlets to Long Grove and St. Clement's indicate an annual rate of 4.8 per thousand of the population. The 1965 national figure was 3.36 per 1,000 of the population. Thus, the figure for Tower Hamlets is 42.8 per cent. above last year's national figure. However, I do not think that it is really profitable to spend too much time discussing these figures.

The hospital in-patient admission rate is not always indicative of the incidence of mental illness, nor even of the demand for the services of care and aftercare in the community for which local health authorities are responsible. A great many patients receive psychiatric treatment as out-patients. Local health authority services will be needed for some, but not for all, of those who have had or are having in-patient or out-patient treatment, and possibly for some who have not needed specialist psychiatric treatment at all. In-patient figures, therefore, should not be used in isolation, and even the total number receiving hospital services, including out-patients, cannot be regarded as more than a very approximate guide to the demands for local authority services.

Moreover, the number of patients receiving hospital treatment rises as treatment facilities improve. In-patient admissions to St. Clement's have shown a marked increase since a 30-bed intensive treatment unit came into use in 1965. The high turnover rate achieved at this unit is not necessarily an indication of a high incidence of mental illness, but reflects the fact that treatment is more readily available. Out-patient and day-patient attendances at St. Clement's have also risen fairly substantially. Outpatient attendances rose from 4,616 in 1964 to 7,800 in 1965, and day-patient attendances from 6,083 to 8,114. I am sure that my hon. Friend will agree that increases of this order reflect improved facilities for treatment, rather than a dramatic rise in incidence.

Nevertheless, I agree with my hon. Friend that the supporting services which many patients need after discharge from hospital, or for that matter while receiving treatment as out-patients and living at home, need to be greatly expanded. It is only since 1959, following the report of the Royal Commission on Mental Health, that this has been regarded as a major responsibility of the local health authorities. Before that, social work for discharged patients, in so far as it was provided at all, was provided mainly by the hospitals, and this was especially difficult in areas such as inner London for which the mental hospitals were sited on the outskirts of the London area.

Since 1959, however, local health authorities have had a duty to provide services for the prevention of mental illness, and for the care and after-care of those who are, or have been, ill. The main components of these services are social workers to support patients and their families in dealing with many prolems associated with mental illness; residential accommodation for short or long periods if patients cannot suitably remain in their own homes; and suitable occupations for any who cannot do their normal work. Provision for industrial rehabilitation may, of course, be made by the Ministry of Labour. All these services need to be planned and operated in close collaboration with the hospitals which provide the psychiatric treatment.

Local health authorities have been called on to develop these services at a time when they have also had to meet many other demands for improvements in other social services to which, in some respects, my hon. Friend referred. In spite of this, local authority services for the mentally ill have developed fast throughout the country, not least in the part of London with which we are concerned tonight.

The number of people receiving local health authority services for mental illness in England and Wales rose from 31,943 at the end of 1960 to 71,379 at the end of 1965, an increase of nearly 125 per cent. In the last two years alone they rose by more than 15,500, an increase of 28 per cent. In these last two years the number of social workers employed has risen by 15 per cent., the number of mentally ill people provided with residential accommodation by 70 per cent., and the number of places in day centres has nearly doubled.

I should have liked to have been able to give my hon. Friend similar comparisons to illustrate the rate of development in Tower Hamlets, but, as he knows, this authority was created under the London reorganisation in 1965, so there are no statistics available for this precise area for past years. In Inner London as a whole, which corresponds with the area of the former London County Council, the number of mentally ill persons receiving local authority services has risen in these two years by 52 per cent. compared with 28 per cent. in England and Wales as a whole, and the number of social workers employed has risen by 39 per cent. compared, again, with 15 per cent. for England and Wales as a whole.

It can also be shown how the services now provided by the Council of Tower Hamlets compare with those provided by local health authorities in England and Wales as a whole. In 1965–66, this London borough spent on its mental health services approximately £320 per 1,000 population; this compares with a national figure of £290, so Tower Ham- lets spent approximately 10 per cent. more than the national average. These figures refer to local authority mental health services as a whole, that is, those provided for the mentally ill and for the mentally subnormal, as the financial statistics are not sub-divided; I appreciate, however, that my hon. Friend's main concern this evening is with the mentally ill.

At the end of last year there were 482 mentally ill persons receiving mental health services from the Tower Hamlets authority. This represents 2.36 persons per 1,000 population compared with a national figure of 1.49. Twenty-seven were provided with residential accommodation, which is 0.13 per 1,000 population compared with the national figure of 0.04. Sixty-eight people were attending day centres for the mentally ill, representing 0.33 per 1,000 population compared with a national figure of 0.03. At the same date, this authority was employing 13 social workers—that is, whole—time equivalents—equal to 0.06 per 1,000 population as compared with the national figure of 0.03. This authority's 10-year plans forecast further development.

I must stress that it would be misleading to conclude from the figures that I have quoted that the need for services of this type are greater here than in the country as a whole. Local authorities generally are still at a very early stage in the development of their mental health services, and the conclusion to be drawn is that in this part of London more progress has already been made than in the country as a whole.

My hon. Friend has suggested that poor housing and social conditions lead to a higher incidence of mental illness, and that these same conditions give the boroughs a low rateable value and thus less financial resources to support the services needed. There is, in fact, no evidence that poor housing and social conditions are a cause of mental illness, though they exacerbate the associated social difficulties and may make it more difficult to provide a suitable environment for a convalescent patient.

I now turn to the arrangements for financing the local authority mental health services, which my hon. Friend has mentioned. The Minister of Health has no power to make a grant to local authorities generally or individually, in aid of their local health services, which include their mental health services. As I understand the procedures of this House it is extremely difficult to talk about legislation in an Adjournment debate, and I think it would be wrong for me to go into the question whether legislation would or would not be possible.

Exchequer assistance towards the cost of these services, as well as others such as education, child care—to which my hon. Friend referred—and services for the elderly is given through the general grant, which leaves each authority free to decide its own policy and priorities in the raising and spending of its money without the detailed control from Whitehall which specific grants to individual authorities for particular services would inevitably entail. I think that we are right in saying that this is the correct way.

I want to mention the question of the financial resources of this local authority. I have looked at the financial resources——

The Question having been proposed after 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 six minutes to Twelve o'clock.