§ 3.37 p.m.
§ Mr. Tom Boardman (Leicester, South-West)
I beg to move,That this House welcomes the recent White Paper, Better Services for the Mentally Handicapped, with the renewed emphasis on community care, the policy of providing community instead of hospital care for the mentally handicapped who do not need hospital treatment, and the additional £40 million made available by the present Government for accelerating over the next four years the increase and improvement of community services for the mentally handicapped and the improvement of conditions in the hospitals for the mentally handicapped.When it was my good fortune to have won a place in the Ballot, I was faced with something of that choice which is extended to the winner of other lotteries, namely, whether to expend this good fortune on a few exhilirating hours of party politics, attacking the follies of the former Labour Government and perhaps lacing it with the a few criticisms of the present Administration, or using the time constructively. I decided on the latter course.
My choice of subject was influenced by many factors. In the first place, like many hon. Members, I have come across a great number of matters in my constituency which flow directly or indirectly from the problems of the mentally handicapped. That must be the common experience of us all. Secondly, my visits to hospitals for the mentally handicapped have shown that some have a standard which is quite intolerable in the year 1971.
Thirdly, a great deal of time of this House and a great deal of publicity outside it has been devoted in recent months to what might be called by hon. Members opposite the harsher aspects of Government and I believe that it is time that the other aspects of Government which is equally powerful—the compassionate side of this Government—should have rather more time devoted to it. That can be illustrated by pointing to the amount of time that has been spent in debate, much of it at the request of the Opposition, on issues such as steel, while as far as I am aware the only reference made in the House to this very important White Paper "Better Services for the Mentally Handicapped" was contained in a Written Answer by my right hon. Friend.
36 My final reason for choosing this subject was that if the White Paper is to achieve the object and aims set out in it, it is essential that there should be a better understanding on the part of the public and a wider audience than that consisting of those who read only parliamentary papers, because to achieve the objective the public must both know and care.
I do not suggest for a moment that there is any greater compassion claimed by hon. Members on this side than on that : to do so would be quite wrong. On the other hand, I believe that hon. Members will concede that there is no less compassion on this side than on that. All parties recognise and sympathise with the problems. The White Paper, which is referred to in my Motion, acknowledges very freely and fairly that a great deal of its ground work that was done by the previous Government. It is right to say that both parties will the same end, but my right hon. Friend is entitled to claim the added virtue of providing the means to achieve that end.
The right hon. Gentleman the Member for Coventry, East (Mr. Crossman), when Secretary of State, recognised the need, which became very apparent in 1969. The House will recall that he then introduced what was known as the "interim" Measure in order to do something about the appalling conditions that had been starkly revealed in a number of cases. But a large part of the resources that were needed to fulfil the tasks set out in that interim Measure were dependent on the right hon. Gentleman's exhortations to hospital boards to reallocate money in 1970–71 which had already been allocated and no doubt used or planned to be used by those hospital boards for other essential hospital projects. He faced those boards with difficult problems of priorities, of robbing Peter to pay Paul. In 1971–72, which was as far ahead as he looked, I will not develop the reasons for this, the allocation of specific revenue expenditure under this head amounted to only £1½ million. My right hon. Friend increased the allocation of specific revenue to £3½ million, and also allotted further funds, so that the total sum available for hospital and local authority services for the mentally handicapped for the period 37 1974–75 will be increased by £40 million to £100 million in all.
I obviously must doubt whether that amount is enough. Many hon. Members, seeing the size of the problem, will feel that that is a very good start but that a great deal more is needed, and the White Paper recognises that it is only Stage I. But I must make some contrast between the policies of the parties on the financial aspects. I do not do so in order to provoke party controversy, because on this subject we can find a great deal of common ground, but the financial aspects illustrate the different approach and policies of this party and that.
There can be no disagreement that a great deal more money is needed; that a great deal more of the national resources must be put into both the hospital and the local authority services for the mentally handicapped. The former Administration, recognising that need, met it, or tried to meet it, in large measure by cutting back on the general hospital services and by transfer and reallocation. My right hon. Friend has approached the problem by giving very substantially more to the hospital services and the local authority services for the mentally handicapped, at the same time giving very substantially more to the other hospital services.
On the other hand—and this is, perhaps, an issue of party politics that I cannot avoid when talking about this aspect—the Government overall have financed a measure of these extra resources by requiring those who can afford to pay for certain services, whether they be prescription charges or school meals, to pay more than they did previously. This is the fundamentally different approach of the two parties, but it is a good illustration of how, when more money must be found, the present Government approach the matter. It is an approach which I believe has been supported by the public, and certainly by those who have seen the hospital conditions provided for many of these people.
I turn now to the needs, because it is needs to which my Motion primarily refers. The White Paper estimates that there are some 120,000 people mentally handicapped within the definition of the White Paper, of whom about half are children. A number of authoritative 38 sources believe that figure to be a substantial underestimate. There have been two censuses, the results of which are now being analysed. It will be interesting to see their outcome, but from the evidence of the large waiting lists for hospitals and certainly for homes for mentally handicapped, and of the number of mild mentally handicapped who may not have got on to any register, it seems that the White Paper, if it is out in its estimate of numbers, is out by being an underestimate.
I turn now to the question of the hospitals and the needs there. No doubt there are some very good hospitals, but a very large number—I fear they are the vast majority—are old and vastly overcrowded, and these conditions are intolerable, as I have said.
In the hospital group that serves my constituency in Leicester, there is an overcrowding to the extent of 46 per cent. I understand that this will be reduced to 15 per cent. in September. In paragraph 99, the White Paper acknowledges that, on the latest statistical evidence available, in 1969 60 per cent. of the hospitals had sleeping space of under 50 square feet per patient against a target of 70 square feet. I ask hon. Members to visualise what that means. I am sure that many will have seen those conditions. There are beds, side by side, with no room for such things as lockers, and very often no room for patients to pass between the beds, so that to get into bed they have to climb over the tailboard. Many of these patients are severely incontinent, and these are conditions which have become intolerable.
I welcome the White Paper's declaration of what is being done because, with the vast overcrowding, with incontinence, with lavatories very often well away from or inconvenient to the sleeping accommodation, and with limited recreational facilities, conditions for the staff are extremely hard. Morale must suffer and recruiting must be badly affected by that. I am sure that all hon. Members who have seen these sort of conditions, have the highest praise for the staff who do such tremendous work in these hospitals. But that is not enough. We must have conditions which allow us to obtain proper staff working under proper conditions, and not staff who can do no more 39 than look after the patients' basic physical needs.
I have some criticisms of the White Paper. It could have been rather more sharply drafted. I should like to have seen a clearer distinction made between the rôles of hospitals and residential homes. The dividing line between what will be in the hospital service and what will be in the local authority homes is not entirely clear. In a paper from the Campaign for the Mentally Handicapped, I have just seen that they have also made criticisms about that distinction.
In its intention and its clear message about laying the emphasis on domiciliary and community care, the White Paper is absolutely right. But the dividing line as to how that is to operate in practice sometimes gets a little blurred. It is essential that the strain on the hospitals be relieved so that they can achieve their proper rôle. There is a rôle for the hospitals, which is well set out in paragraph 181 of the White Paper, which talks about in-patient treatment and says :The aim is to help all patients, including the most severely handicapped, to develop to their full potential and to achieve as positive and independent a life as their handicaps allow.That must be right, but it can be put into practice only if the strains on the hospitals and the overcrowding are removed.
The provision of residential homes is critical, both in relieving strains on hospitals and, what is far more important, in providing the right community care for patients. In all too many areas there is no halfway house between the family home and the overcrowded hospitals. For the mentally handicapped person whose condition has deteriorated or whose family conditions no longer enable him to remain at his home, the only course is for him to go into one of these overcrowded hospitals. That applies in too many parts of the country. The White Paper rightly sets out the conditions for which we must aim in these homes. They must be homes in which people can live within the community, as far as possible, and not be segregated from it, and in which they can attend a special school or training centre and live as normal a life as possible.
40 I welcome particularly the requirement that they should provide for weekly boarders. Many mentally handicapped persons can be looked after in their homes at weekends, and many families want them back in their homes but find it almost impossible to look after them throughout the week as well. It may be that the only person capable of properly looking after the mentally handicapped person is himself having to go out to work. If it is possible for the mentally handicapped to go as weekly boarders during the week and to return home at weekends, there are great advantages to both sides, to the family and to the handicapped person. In many cases it will be essential that this be provided for if advantage is to be taken of the special schools and training centres, and the jobs which we hope can be made available close to these residential homes.
I welcome, too, the short stay boarders requirement, because the strain upon families is intolerable if it is for 365 days a year. Some mentally handicapped persons need a considerable amount of care. If it is possible to lift that strain and enable the family to have a holiday or a break, the strain is tremendously reduced. I regret that although the City of Leicester, in which my constituency lies, has made more progress than most in the way of training centres and the provision of residential homes for adults—though not nearly enough yet—it has no provision for residential care of children.
The load and the strain upon the family, which is so well put in the White Paper, is not recognised enough by the community as a whole. The constant attendance which is so often needed, the effects on other children in the family who have a mentally handicapped brother or sister, and the sense of shame which so many of them wrongly suffer from—which is unfortunate in this day and age, but I am glad that attitudes are changing—very often makes them conceal or try not to acknowledge the existence of the mentally handicapped or find the right treatment or cure for them.
The White Paper recognises the family problem and proposes positive action. It recognises the financial burden, which can be severe for a family who have to travel some distance to see a handicapped person. The daily attendance allowance will probably relieve the strain on many 41 of these families when it begins to operate in December. But the problems are more than that. There is a need for advice and practical help. The emphasis that the White Paper puts on the importance of the family and what is being done about it is very welcome.
On the question of research into prevention and cure, important as that is, J should be glad if my right hon. Friend would say what progress is being made into the problems of autistic children. There seems some conflict of views about their treatment. If my right hon. Friend has anything which he can add, I should very much welcome it.
The final category, if I may call it such, within the White Paper is the voluntary service element. First, I praise the organisations which are and have been doing so much, especially in recent years, both in education and the changing of people's attitudes and for the practical help which they have been giving. I welcome the encouragement the White Paper gives to this and particularly the emphasis it lays on the help that can be given to families.
I will quote two examples, one where help would be very welcome and one where a great deal is being done. The first example which I quote to illustrate the point which I hope I have made is a case in my constituency of a severely autistic boy living with his mother and three sisters in a small council house. The three sisters had considerable academic ability. They were taking various examinations at an exceptionally high level—and the greatest credit to them—but in conditions which were impossisble. The severely autistic son was disrupting the whole system in the household and destroying any books that they left around. If a neighbour had allowed the three girls to use her front room in the evenings to do their homework and perhaps watch television in her house, because they could not have a television set in their own house, it would have been a tremendous help to that family. I suppose people were inclined to think that the help that was required was help with looking after the mentally handicapped son, but that was only part of the answer.
The other case refers to a unique group called Menphys which has been formed in my constituency to provide recreation for mentally and physically handicapped 42 children. The group meets every Saturday, collects mentally and physically handicapped children together, and takes them out. The group sometimes organises outings during the week, but outings on Saturday mornings are a regular occurrence.
This achieves two purposes. It takes the strain off the mothers and the households on Saturday morning. The mother can go and do her shopping, get her hair done or just put her feet up. It provides the one certain break the mother can have during the week. It also stimulates an interest amongst the children. It has been said by many with considerable experience that the mixing of physically handicapped and mentally handicapped would not help. In this group, which has been running for only a year, it has been a great success. A bond of understanding has been created between the mentally handicapped and the physically handicapped which I am told is remarkable. The mentally handicapped helps the physically handicapped, and vice versa.
I ask my right hon. Friend to study this experiment. There may be other such experiments of which I am unaware, but I believe that this one is novel. It is not without interest that some of the young people who have helped the group are seriously considering taking up work with children as a career. They have seen the rewarding impact of their work.
I will not attempt to elaborate on the White Paper. Many hon. Members have great knowledge of the problems and the facilities which are available and what should be done. They can amplify on these aspects far better than I can.
If the debate does nothing else than encourage a growth of understanding on the part of the public and brings to their notice the rôle that they can play in helping to cope with the problems of the mentally handicapped and their families—I stress "and their families"—I hope that hon. Members will not consider that this use of private Members' time has been wasted.
§ 4.5 p.m.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I welcome the opportunity of speaking in this debate and I offer my warm congratulations to the hon. Member for Leicester, South-West (Mr. Tom Boardman), not only on choosing the 43 subject, which is highly commendable, but on his contribution to the debate.
Apart from the outburst of indignation one hears after occurrences such as Ely and Farleigh, the problems of the mentally handicapped tend to drift unheralded and unseen in the backwaters of public indifference and neglect. This is why I am appreciative of the choice of subject by the hon. Gentleman.
Although I give the Government's White Paper a qualified welcome, I am bound to say that no Government have a proud record in the face of the continuing scandal of the imprisonment of thousands of mentally handicapped people in our asylums in conditions which would make any respectable prison reformer hysterical. I use the word "asylums" because I believe that the change to the term "mental hospitals" has begun to mislead the public about what these fortresses are. They are asylums which imprison mentally handicapped people.
I know that the Government do not like them and the Opposition do not like them and I think that the public are being misled into believing that, because they are called "mental hospitals", people within them are receiving medical treatment which will help. I believe that this euphemism should be dropped, even though I am still as anxious as anyone to ensure that the mentally handicapped should not be regarded by the public in the same way as they were in the past.
It is not only the Government who have no proud record about the mentally handicapped. It is also the medical profession, because neither royal colleges nor royal societies of medicine have done a great deal for the mentally handicapped. They are notably backward in helping backward children and backward adults. I believe that their silence in th face of the great scandals of the asylums has displayed either an incredible ignorance or an unforgivable neglect.
If mentally handicapped people were looking to the medical profession to expose these scandals, they have looked in vain, because they have been exposed by Members of the House, by members of the Government, or by forward-looking journalists. They have not been exposed by the medical profession.
44 It is beyond my comprehension how the medical profession can apparently condone a situation in a London hospital in which five senior consultants are attending in a hospital with 1,471 beds while at the same time in a general hospital with 1,471 beds there are 120 senior specialists. I know that mentally handicapped people do not all require medical specialists, but I refuse to believe that all the people in the mentally handicapped hospital need so little medical attention as can be given by only five specialists.
Although public opinion is changing, the public, too, like Governments and the medical profession, have no proud record when it comes to dealing with mentally handicapped people, because with up to 2,000 people in asylums, herded into domitories, deprived of clothes, possessions and self-respect, we should hear an outraged roar of public objection. But we do not. The public have been relatively quiet about scandals which have been exposed in the House, in the Press and on television. Although the Government and the Opposition are doing what they can about the problem—and I am critical of the Government, as I shall explain—only when the public are awakened will this problem be resolved. I hope that the Government will make a great effort to try to awaken public opinion. This is a chicken-and-egg situation. The stronger the public feels about this matter, the easier it is for the Government to take action. But until members of the public awaken to the problem, very little can be done by the Government.
It is a tiny minority of the medical profession who deserve our plaudits—those people who are dedicating themselves to helping the mentally handicapped. It is a small number of sociologists—people like Professor Peter Townsend and journalists like Ann Shearer and Sandra Franklin, the architect—who are campaigning in a greatly encouraging and highly stimulating way. They are in the vanguard with new thinking and new ideas. Although the Secretary of State will not accept all their ideas—I do not think that he can possibly do so with the limited financial resources at his disposal—these are the people who are becoming the new leaders of public opinion.
45 Some advances have been made, however, and the Government deserve credit for them, as do their predecessors. But, judged by the basic criterion—which is that the aim of any service for the mentally handicapped is to enable them to live as normal a life as possible—we still have a long way to go. That aim can be stated more clearly, perhaps with brutal clarity, by demanding that we should empty the asylums. We cannot do that overnight. I accept that it will take 15 years to do it. But if we set a deadline of 1985 to empty the asylums, this would be a noble goal at which to aim, because it has been estimated that if every population over 100,000 undertook to provide a living unit for eight people per year then the problem of our large mental hospitals could be solved. So the asylums could be emptied in this period and there can be no better aim for the Government or for the Opposition.
Although the Secretary of State is commendably committed in the White Paper to a significant reduction in the number of people in our mental hospitals, he says that he fears that it would be premature to try to empty the asylums. I can understand his difficulties and I recognise the practical problems of this objective. But I do not think it is seriously disputed that the great majority of the people in asylums are not in need of continuous medical care. They do not needassistance to feed, wash or dressand they even haveno physical handicap or severe behavioural difficulties".This is the picture which the House and the public must recognise.
We shall not have crazy madmen walking the streets if these people are released. They have a mental disability which does not need medical attention. Many of them are pleasant people who can live in an outside community without a great deal of difficulty. There might be some difficulty, but that could be provided for by extending community care, and the medical treatment which the minority of them require can be afforded in the ordinary general hospitals. The Government should commit themselves much more firmly to the priority of improving community care and community facilities.
46 I do not suggest that no improvements should be made to the hospitals. That is a necessary, temporary step. But I urge the Secretary of State to ensure that any improvements made to the mental hospitals do not lead to them becoming permanent institutions. The House will remember what happened with the old prefabricated houses. They were supposed to be temporary residences, and I now see "prefabs" from the First World War occasionally being renovated by well-intentioned councils and the renovation is used as an excuse for permanence. I hope that the Secretary of State will watch this situation very carefully.
One of the sections in the White Paper which really disturbs me is that in which the Secretary of State says that the Government will play their part but that the main responsibility lies with the local authorities. We all know the almost limitless range of competence and good will among the local authorities; and in the implementation of the Chronically Sick and Disabled Persons Act, which deals with mentally handicapped people, we have seen how a vast range of provision can be made. Some of them are doing a magnificent job. But some are greedy, lazy, selfish, arrogant, nasty and indifferent to the plight of the disabled, and the House might as well recognise that. Local authorities which ignore the mentally handicapped will have to be cajoled and bullied by the Secretary of State. While I commend those local authorities which are doing an admirable job for the mentally handicapped. I believe that the right hon. Gentleman should put great pressure on the bad local authorities.
I hope that what the local authorities will get from the Secretary of State is a kick in the two places where it hurts most : first, in the backside and, secondly, in their pockets. This is the only way in which he can ensure that positive action will be taken on behalf of mentally handicapped people by local authorities which are indifferent to their plight. If these local authorities want to dig in their heels, I am sure that the House will be prepared to fight. But I hope that they will co-operate with the Government and with the House in attempting to achieve the noble aim of enabling all mentally handicapped people to live their lives in as normal a way as possible.
§ 4.20 p.m.
§ Mr. Timothy Raison (Aylesbury)
I shall not take up in detail the speech of the hon. Member for Stoke-on-Trent, South (Mr. Ashley). I thought that he made some very fair points, though he was, for my taste, a little harsh on the medical profession as a whole, since I believe that we should not blame doctors quite so heavily for some of the things that have happened in this field over the years.
Broadly, I welcome the evidence of the Secretary of State's concern in this subject. So far as I can judge, the White Paper which we are discussing is a sensible document. It seems to me to take further the very well worth while developments which have come about in our approach to the training and education of mentally handicapped people in recent years, and it offers the prospect of a considerable better situation in the future.
I consider that the White Paper is right to lay the emphasis which it does on community care, and I do not think that anyone will be likely to dispute that this is the direction in which we should now be going. On the other hand, I think it right to reject the notion, even in principle at this stage, of the wholesale abolition of hospitals for the mentally handicapped. I recently visited one such hospital, as I shall explain in a moment, and the doctor in charge there pointed out to me one or two of the problems which would arise if we did adopt the notion that everything could be done in the community.
The first point to be brought out is simple. There are those, as this doctor told me, at his hospital "who have been with us for 20 or 30 years, who rightly regard the hospital as their home and the staff as parent surrogates". In other words, to have abolition and immediate dispersal of the patients at these hospitals could cause a great deal of unhappiness.
Second, and more important, the notion that there should be general dispersal rests so far, I believe, on a fairly limited research basis. The research of Dr. Kushlick is now rightly becoming well known, and anyone who has heard him speak or read about his work will acknowledge that it is in its way extremely impressive. But the fact 48 remains that we have not yet a substantial body of research. The experiments have been going on for only a year or two, and it would be a mistake, I believe, to rush into a policy which said that hospitals were necessarily wrong or hostels or family care necessarily right.
Community care and family care represent an ideal, but we must be sure of what we are doing before we have a headlong change in policy. In particular, we must be sure that, if people are transferred to the community, it will be possible effectively to provide the services which they so clearly need, and it must be seen that these services can be provided at least as effectively as they can in the best sort of hospital organisation.
We know that there are many facilities of which the mentally handicapped can make full use. They need, for example, physiotherapy units, they can use heated swimming pools to good effect, and they have need for such facilities as "rumpus rooms" and the like which are now being talked about. Perhaps the latter could be provided in a hostel or even in the ordinary home, but some of the other facilities will not be easily available if we have a sudden flowering of small hostels throughout the country. If we move towards hostels, we must be sure that the facilities are to hand.
We have heard—it is well known now—that this is an area of care presenting enormous problems. No one today can doubt the magnitude of what has to be done, and I shall not labour that. On the other hand, it is worth making the point that this is now an area of considerable hope, too.
In the first place, in the political world, Government and Opposition parties and public opinion generally have come to see that the mentally handicapped are people to whom we must now give far higher priority than we have ever given in the past. The battle is not won, but there has been an enormous advance in this respect. Also—this is of equal, or, possibly, even greater importance—we are beginning to absorb the lesson of just how much potential can be realised among mentally handicapped people. Over the last few years, people like Professor Tizard have shown that patients who, in the past, were regarded as totally ineducable are, in fact, capable of being educated, and as a result improved 49 facilities for training and education are coming into being. This is of great importance, and, again, it is very much part of the notion that, if we do disperse the mentally handicapped, we must not lose sight of them.
Third, and most important, there is greater public awareness, greater public sympathy and a greater understanding that the mentally handicapped should not be regarded as outcasts to be locked away.
I wish to tell the House now of my visit last Saturday to a fete held at the Manor House Hospital in Aylesbury. The first time I visited this hospital was some weeks ago, and I admit frankly that I went there with a considerable feeling of unease and some uncertainty about how I should react to what I might find there, for it is a hospital housing severely handicapped people. I broke the barrier, as it were, on that visit. After my visit there on Saturday, with my wife and two children, to open the fete, I came away with a feeling almost of exhilaration. This was due not to the fact that it is a highly advanced unit in terms of its facilities but to the real sense of revival which one feels there, a real sense that things are beginning to move.
The fete was given by the newly established League of Friends. I say "newly established" but I should say "revived", because it had been in existence some years ago but had fallen into abeyance. This fete marked the League's return to activity, and the Friends had put an enormous amount of work into it.
The environment and spirit of the hospital is affected also by the fact that, at long last, it is to have new buildings. For several years now, there have been plans on the drawing board for a new hospital, and last October these were given the go-ahead. I do not believe that the plans are perfect, partly because an essential feature of the new hospital is that it is to be built primarily as one big unit, and most of us know—certainly the staff know—that it would have been better to have it built as a series of smaller sections which might more easily be used to establish a family atmosphere. So the plans are not perfect, and the villain of the piece, as always, is cost. Nevertheless, there is a real feeling in the hospital now that it is moving forward to something very much better than people have had 50 in the past, and I believe that within the large new framework it will be possible, by careful organisation, to have quite a degree of family feeling and a breaking down into smaller units while at the same time providing the facilities which are of such importance. That is the second encouraging feature.
The third encouraging feature to me on my visit to the fete—I suspect that this is felt by most people who go to a function of this kind or who visit such places—is the unexpected degree of happiness which one can find in that sort of atmosphere. This is partly the result of the opening-up process which is taking place. Admittedly, it was, so to speak, a gala occasion on Saturday, with the feeling that everyone's parents and families were coming along, and a general atmosphere of cheerfulness which cannot but help to lift one's spirits. But it is most important and encouraging that one does find on visits to places of this kind that the patients themselves are capable of a degree of happiness which is infectious, infectious to the visitor and infectious, too, to the staff.
As I have said, I took my wife and two young children. Frankly, I was not sure whether to take my children, but come they did, and, even though they are very young, they were, I believe, able to share in the feeling that the place is a happy one. I am certain that the emphasis which we can now develop in community involvement will mean that this is more and more true in the future.
It is particularly important that the staff should be able to share in this feeling. We have heard criticisms of the staff at some of these places, and we know that there have been outrageous things done. But we know also—my hon. Friend the Member for Leicester, South-West (Mr. Tom Boardman) was right to stress this—that over the years the staffs at these hospitals have done a splendid and heroic job. They, also, need encouragement. The greater community participation which is developing and the increased coming and going are just as important from the point of view of staff welfare as they are from the point of view of the patients. I was rather touched when the doctor in charge of the institution told me that he had just been talking to a man who had been married to a woman who already 51 had three children, all of whom were subnormal. One or more of them were in that hospital. The mother had died a short time before, but the man had continued to visit the hospital. The doctor had said, "It is good of you to go on coming here although these are not your own children." The man replied, "It is my privilege." The doctor was clearly moved by that, by the way in which people are prepared to go on accepting that kind of responsibility in circumstances which may well be difficult.
I do not want to be unduly sentimental about this, although sentiment keeps creeping in. We must recognise that there is a darker side to the picture. I refer to the familiar story of the backlog, the appalling overcrowding. Another side of the picture which is beginning to cause a good deal of concern to doctors is the deep ethical problem facing some of them. I approach this matter with some diffidence, because it is difficult to talk about. The doctors working in this field must face up to the question of how far to go in keeping alive some new-born children who might otherwise have died at birth and who may, in the doctors' expectation, not have a serious prospect of a happy life.
I would not dream of advocating euthanasia, nor do I dispute that the vast majority of handicapped children are capable of a real degree of happiness. They give out enough and take enough from life to justify their existence by any standards. The fact that they are capable of being loved and of loving is in a sense the real justification. But we must recognise that there are some people of whom that is not true. Doctors are beginning to be faced with a considerable problem. The classic instance is the condition known as spina bifida. Essentially the problem here is that if the child is not operated on at birth it is likely to die, but if it does survive it will almost certainly survive in a very poor condition, a much worse condition than if the doctors operated. If they operate they may achieve total success or simply prolong the life of someone whose life will, so far as can be judged, be at a very low level.
I would like to quote from an article written by Dr. Henry Miller, of Newcastle 52 University, which appeared in the Listener on 1st July. He wrote :Twelve years ago a group of dedicated and expert paediatricians in Sheffield deliberately decided to admit and treat all cases of meningomyelocele, or spinabifida where the spinal cord is present in the sac that protrudes at the site of the bony defect. Between 1959 and 1969 nearly 1,200 infants were treated, of whom more than 80 per cent. were admitted within 24 hours of birth.…The results of this massive surgical experiment are the most favourable that have ever been recorded. They are, however, profoundly disappointing, and support the critical and conservative approach to treatment rather than that of the enthusiastic interventionist.… Careful follow-up studies show that less than 10 per cent. of those originally admitted escaped severe crippling. Two out of five supporters are mentally retarded, and four have no bladder control. Many have required multiple operations, and have suffered distressing complications among which infections of the urinary tract and the brain itself are conspicuous.He gives other examples, and then says :The implications of these findings for the infants, for their families and for society are disturbing. Indeed, if all the cases in the country were treated in this way we would soon have 10,000 such crippled children alive and would ultimately have to support between 20,000 and 30,000 crippled adults in the community. Such socio-economic problems should not in themselves decide the issue, but it is also clear from this important experiment that the interests of the patient with a severe lesion are not served by operation which can mean only a life of surgical misery and severe residual handicap.This is a very difficult problem for the medical profession and for society as a whole to have to face, but there are some points I must stress. First, we are talking about a very small minority of the handicapped. Secondly, I do not think that we are talking about the allocation of resources but rather about an ethical problem. Thirdly, we must accept that is not a problem for the politicians to decide : it is one which the doctors must decide for themselves. They must make the decision whether it is right or wrong to try to prolong the life of someone who, at birth, faces a tremendous risk. It is right that the politicians should be prepared, as representatives of the public, to give a degree or backing to the doctors who are faced with this difficult ethical consideration, and that we should accept that doctors should be able to rely on the public to support them in the decisions they make.
§ Mr. Michael McNair-Wilson (Walthamstow, East)
Can my hon. Friend say how long such children are likely to live?
§ Mr. Raison
Increasingly the tendency is for them to live longer. Some of them have, I believe, symptoms associated with mongolism, and the life expectation of mongols is going up the whole time.
My point essentially is that we must trust the doctors. A distinguished American professor, Paul Beeson, has said that :If civilisation means anything you must trust people with a long cultural tradition to act in a humane way.Clearly, the principle that the doctor will work on is :Thou shalt not kill; but needst not strive Officiously to keep alive.Naturally not to keep patients alive goes against the grain of medical ethics and of the whole nursing profession. I must reiterate that I am talking about a very small number of cases where the need may be different. But we must give doctors our understanding and trust.
I have said enough, I hope, to give the feeling that I believe that we are now on the move; that we have reached the stage where we can expect a concentration of public interest and public sympathy in the whole of this area which has not existed in the past. I believe that my right hon. Friend's document is a reflection of this.
§ 4.38 p.m.
§ Mr. Christopher Mayhew (Woolwich, East)
I am glad to follow the hon. Member for Aylesbury (Mr. Raison) and hope to take up some of his thoughtful and positive remarks. He took the opposite view to that of my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) on a question that is becoming a rather tense dispute among those who are anxious to help the mentally-handicapped. I refer to the controversy as to whether we should now accept as a matter of principle, as my hon. Friend feels we should, the closing of all sub-normality hospitals within 15 years. The argument for this has been put forward very persuasively by a number of good friends of the mentally-handicapped. We think of Miss Ann Shearer, for example. The case was well argued by my hon. Friend on the ground that this was a challenging, precise target by which to 54 measure the progress we make in providing community care for the mentally-handicapped.
It can be argued as he did so well, that the idea of a hospital for the mentally-handicapped is in many ways anomalous and inappropriate. It is anomalous that, say, a mentally-handicapped adolescent who has gone successfully through a junior training centre and who has coped quite well should go into a residential institution called a hospital with a medical and staff nurses. It is not really appropriate to what he has experienced so far.
Even if it were medical care which he wanted and had gone to hospital to get, I am afraid that there would not be enough medical staff to give the care required. For those reasons, one has considerable sympathy for those who say that the whole concept of the hospital should give way and that for those mentally-handicapped persons who cannot be helped with community care the answer must be a general hospital and not a specialised subnormality hospital.
This has been admirably set out by those who support the concept and their case contains a number of important truths. On the other hand, the hon. Member for Aylesbury had some good points to make when he argued that it could not now be dogmatically said that there would never be a subnormality hospital of any kind. I think I have visited the hospital which he visited—I am almost certain which it is. If so, it is an example of a hospital which gives not only more expert, but possibly more personal care to mentally handicapped people than they might sometimes get in community institutions. That hospital may be instanced as a good way in which to look after those who need protective care.
However, my conclusion is that we should not tear ourselves to pieces trying to decide this question now. There is so much which is universally agreed in the way of urgent action needed to increase community care and to empty the hospitals that we ought not to start arguing about a decision which need not be taken now. I do not know why the Minister should be asked dogmatically to commit himself at this stage to saying that in 15 years there will not be one subnormality hospital left, however small, 55 however well staffed, however well appointed and however seriously handicapped the patients in them may be. Without prejudice to the argument that that may be the right thing to go for, I do not see why we should ask the Minister to decide it now. Let us go for what is practicable now over the next five or ten years in the basic things which urgently need to be done.
The hon. Member for Leicester, South-West (Mr. Tom Boardman), who introduced the Motion, ought not to be discouraged by the comparatively empty benches on either side of the House. It has been one of my observations over many years that there is no close correlation—when we are discussing social problems—between the number of Members present in the Chamber and the amount of human suffering caused by the problem under discussion. I do not know the reason. It is possible that it has something to do with the introduction of party politics—and the hon. Gentleman slightly lowered the tone in his admirable speech by introducing a partisan note. The truth is that if the social problem relates to some ideological factor, such as raising the cost of school meals in which the Government have been seriously at fault recently, even though in human suffering that does not measure up to mental handicap, more Members tend to be attracted to the Chamber.
I do not wish this to be a partisan issue. Throughout the years and throughout the decades every party has been equally to blame for neglecting this important problem, not only the problem of the mentally handicapped, but the whole problem of mental illness. It is extraordinary how disproportionately little attention is given by the political parties to the whole subject of mental health. Anybody who studies the matter with a clear mind will discover that the greatest obstacle to human well-being in this country is mental disorder in all its degrees and forms. The priorities of all the political parties, as shown in the election manifestos and in attendance in the Chamber at debates such as these, are astonishingly wrong, from top to bottom. It is high time that this situation was changed, and I congratulate the hon. Member on his choice of subject and I 56 hope that he will persevere in bringing it to the attention of the House.
None of us nowadays has any excuse for ignorance and nor has the public. Whatever excuse there may have been, there is none now. There is magnificent television coverage by the B.B.C., about the problems of mental handicap and mental sickness, and in the last five years it has had a pronounced effect on public attitudes. There have been several unofficial publications—the book "Put Away" by Dr. Pauline Morris—the campaign by the National Society for Mentally Handicapped Children, the excelent report published by the New Campaign for the Mentally Handicapped, the steady stream of publicity from the National Society for Menially Handicapped Children, the Spastics Society, the National Association for Mental Health, the Mind Campaign, which is just being launched by the National Association.
Finally, we have had one revealing and powerful official document after another. There was the admirable report of the Hospital Advisory Services, Dr. Baker's report, which was very important and which showed what a good committee that was. That report ended simply with a letter from a charge nurse in a mental hospital, and I am sure that the Minister has noted it. It was a letter to Dr. Baker saying that he might like to know in advance of his projected visit to the hospital that the following necessary and overdue reforms had been made : first, the toothbrushes had arrived for patients in the ward—and so on. This was splendid and it showed the importance and the strength of the Hospital Advisory Committee and it showed that this work had been properly handled by Dr. Baker and his colleagues, but it revealed an appalling situation in some of our worst hospitals.
We have had the Ely Hospital report and the Farleigh Hospital report and now the White Paper which is a frank and honest account of the problem. We now have no excuse. I shall not repeat what is often said in all the documents about the appalling conditions in some hospitals, for I take it for granted that hon. Members will know what they are.
When we talk about overcrowding, as the hon. Member for Leicester, Southwest did so convincingly, we ought to consider also the understaffing, which is 57 not quite the same thing. If anything, I am more horrified by understaffing than by overcrowding. It is true that the number of nurses has gone up in the last decade, as the White Paper says, and that is good, but we all know that the problem has increased, too, because the degree of handicap to be found in the hospitals is much more severe. Many more severely handicapped children are now living a long time and the nursing task in the hospitals is thus made much heavier, even though the number of patients per nurse is reduced. The result is that staffs may be discouraged and keenness and morale may suffer.
I am always immensely impressed by how well nursing staffs face their problems. I visited Farleigh Hospital a month or two ago. If one wants to know what the problem is and what caused the fearful tragedy at Farleigh when three nurses were convicted in the courts of persistent cruelty to patients, and if one wants to know how that kind of thing can happen, one should go to Farleigh and hang around the North Ward, where these things happened, try to imagine oneself with the job of a nurse there, dealing with young men severely mentally handicapped, mostly incontinent and many prone to violence and many epileptic, with only one other helper to look after 36 such patients for an 11½ hour shift without a break.
It is putting on someone more than any normal person can bear. What is more, I do not think that I exaggerate when I say that the reproduction of similar circumstances in other hospitals would be bound to lead to other Farleigh incidents. That is bound to be true.
At the heart of the trouble as much as anything is the understaffing, though admittedly Farleigh also revealed a shocking story of bad management. I shall not go into the details, since they are plainly on the record. Instead, I come back to the understaffing and perhaps I might ask the Secretary of State about it. He was kind enough to make a constructive reply to a Question which I put down about Farleigh in which he accepted almost all the recommendations of the Farleigh Commission. He said that he would ask boards to consider especially the needs of the most difficult patients. Has anything concrete come out of that? He also said that he was 58 pursuing the code of conduct laying down guide lines for handling difficult and sometimes violent patients which was drafted under the auspices of the National Association for Mental Health. I think that the right hon. Gentleman accepts it in principle. Has he carried it further in some way?
Before I leave Farleigh, of course there have been some improvements, including some to the North Ward. There is new hope under the fresh and positive medical leadership of Dr. Carter.
To return to the staffing point, will the extra money go to more staff? If it does, the result will be a better staff ratio, better working conditions, more staff recruited and more staff staying. And that in turn will mean that more staff are available to train the mentally handicapped and to modify their incontinence and their disturbed behaviour so that more of them can go out into the community. The result is a bigger turnover. The whole is self-perpetuating once one obtains a real push on the staffing question. I want to emphasise that most of all. But I am sure that everyone will agree that the quickest way to improve staff ratios is not to let people go into hospitals at the beginning. This is the major advantage of community care.
There is plenty of evidence that patients coming out of subnormality hospitals and mental hospitals and going into group homes, some kind of guardianship, and sheltered accommodation of one kind and another are a great deal happier. What is more, such a system costs less. Above all, it liberates hospital staffs and nursing talent for those who still have to remain in the hospitals. That is the justification for giving priority to it.
How are we to get it? Let me welcome the Secretary of State's £100 million. I said in his presence at a conference that we both attended that those who are interested in the mentally handicapped and mentally sick have watched streams of Ministers with good policies and good intentions go by and we have been disillusioned. The only test of a Minister of Health is whether he manages to blackmail his Cabinet colleagues into giving him the money necessary to carry out his policies. The Secretary of State has not made a bad start in that respect.
59 We are to have this money spent, we hope, on emptying hospitals rather than on improving them. We agree that they need improvement, and clearly some money must be spent on them. However, I do not get the impression from the White Paper that the financial priority is on emptying the hospitals rather than on capital expenditure on them, and I should like to be reassured on this obvious point. It may be that I have misunderstood some of the figures. However, paragraph 259 of the White Paper says :On the hospital side, it is hoped that capital expenditure in these four years will reach about £30 million.Can we assume that it is carefully calculated that these hospitals gain more from £30 million worth of capital expenditure than from reducing the number of patients by spending the money on the provision of community care and stopping people going to hospitals in the first place?
My hon. Friend referred to pressures on local authorities. What pressures are there on the bad authorities to pull up their socks? Will the Minister explain how he sees the point made so admirably by my hon. Friend that some local authorities are mean-minded, selfish, indifferent, insensitive and need to be brought into line. A number of them are very good. We should like the Minister to explain his views of them.
May we have published officially a league table of local authorities? I do not think that we have one yet. Christian Action has had a go at working out some kind of league table. Just as after the war we had a housing league table showing up the bad local authorities, let us have one for those providing community care for the mentally handicapped and the mentally sick, so that we know where our own local authorities stand and which are the backsliders.
All in all, I am not altogether satisfied with the priority of expenditure or with the speed of the timetable. But it is a move forward to have a target and to have £100 million. We must give the credit to the Minister.
As other hon. Members have said, public opinion needs to be persuaded, not only because members of the public are the ratepayers and the taxpayers, but 60 also because it will be our attitudes, either of kindness or aversion, towards those coming out of hospitals which make success or failure of the enterprise. Public opinion, therefore, is keyed to the whole problem.
There are still examples of sheer prejudice and bigotry preventing the establishment of community buildings to help the mentally handicapped. However, I agree that, in general, there has been a great improvement in the last 10 or 15 years in the public's understanding of the nature of mental handicap and mental sickness, though not perhaps in its appreciation of the scale of the problem or of the urgency with which matters need putting right, or of the possibility of alleviating suffering. There is still a slight feeling that it is all God-given and that there is nothing much that Governments, Members of Parliament or local authorities can do.
As for the nature of mental handicap and the anxiety and aversion towards mental handicap and mental sickness, there have undoubtedly been great advances in the last 10 or 15 years. I liked the reference by the hon. Member for Aylesbury to the subnormality hospital fete in his constituency to which he took his wife and two children. He reminded me of a programme which I saw on television a month or two ago with my own children. It was a very good programme about mentally handicapped children, and we saw on the screen in close-up the faces of severely handicapped children. That would never have been possible only 10 or 15 years ago. As a professional broadcaster at that time, I remember doing some programmes about mental sickness. We managed to achieve a great breakthrough. We took a camera into a mental hospital. However, we could not show the faces of the patients. That was much too strong meat for the public at that time. The hon. Gentleman said that when he was approaching this hospital he felt a certain apprehension. I recall that when I made those programmes the idea was mooted that I should spend a few days and nights as a patient in a mental hospital to convey better to viewers what it was about. I agreed to do this.
Like the hon. Gentleman, I felt a slight apprehension as I advanced upon the ward where I had been allocated a 61 bed. I hope that the House will not take me wrong, but, after being there a few hours, I felt completely at home. This is the solution to the whole problem—the solution to the public attitude to mental illness and handicap—to get closer to it and to see the mentally handicapped and the mentally sick not as a large rather forbidding army of people, but as individuals with their own problems, families, personalities, and so on. That is at the back of the reason for getting community care going. We shall then be bringing the public face to face with a great human problem instead of hiding it behind the castle walls of huge Victorian asylums. Once again, as was true centuries ago, the public will be getting into contact with a great human problem, and nothing but good can come of that.
§ 5.0 p.m.
§ Mr. Michael McNair-Wilson (Walthamstow, East)
I congratulate my hon. Friend the Member for Leicester, Southwest (Mr. Tom Boardman) on choosing this Motion for debate today. He has done us a great service. I also congratulate the hon. Member for Woolwich, East (Mr. Mayhew) on an excellent speech and on kindling my original interest in the subject by those television programmes to which he referred.
I had not visited any form of mental institution before becoming a Member of Parliament. I have subsequently visited training centres, schools for educationally subnormal children and mental hospitals. They are indeed most encouraging places to visit because of the sense not of hopelessness but of help, care and compassion which they give. Fortunately, the institutions serving my constituency must be somewhat model, because I could not put upon them the strictures which some hon. Members have expressed in the debate.
But I shall not forget the statement of one of the trained nurses at the Royal Eastern Counties Hospital in Colchester which serves my constituency, that by A.D. 2000 we would have a bed space shortage of 60,000. That figure must make us realise that we cannot wait forever to decide whether it is hostels or hospitals which we want. There is a pressing need for buildings of one kind or another, and we must do something about that problem rather quickly.
62 While I like the concept of community care, because it presents a rosy picture, there is an assumption underlying it that many of the mentally handicapped are not so severely handicapped as in fact they are. I do not believe that the severely mentally handicapped can ever live in community hostels with the assistance only of a warden and perhaps of one or two social workers. They will probably be institutionalised for the rest of their lives. Therefore, we must make sure that the buildings in which they live are adequate for their purpose.
We must be careful—I say this with some care—not to create more mentally handicapped people in our society. Some months ago I watched a "Panorama" programme about the problem of the homeless mentally sick in London. They were mainly schizophrenics who went to hospitals, were given crash treatment, and then pushed back into society because there was neither the bed space nor the stall available to give the long-term treatment which they required. Those people gradually deteriorate again when they return to society. They drift towards doss houses for their homes. As we know, those doss houses have no social or welfare workers attached to them. Therefore, these people get into more dire straits until ultimately they become the drifters in our society who either find their way back to hospital or end up on park benches as the flotsam of the world in which we live.
If we are not to create this category of mentally handicapped person, we must insist that all hospitals releasing such people into the community at least informs their local authority that they are doing so, so that they are not just pitched out with nowhere to go but come under the guidance and control of some local organisation.
I want to concentrate my remarks on the problems of the mentally handicapped child and his or her parents. This is primarily a problem for the community and for the family. If there is any single statement which is emphasised again and again in the White Paper, it is that love and affection is required by the mentally handicapped just as much as by the normal, and that there is an undoubted advantage in allowing such a child to stay, with its parents and to enjoy the benefits of home life.
63 Having said that, and before developing the point, I think we have to decide what level of mental handicap we are talking about. Here I take issue with the statement in the White Paper that we should continue to use the expression "mental handicap". If the World Health Organisation thinks that "mentally retarded" is the right expression and the Americans, the French and the Norwegians use that expression, why should we go out on a limb and use a phrase which in many ways is inaccurate? I think that the concept of "mentally retarded" is right. It allows us to have various levels. We can talk about severe or not so severe retardation of the patient. It is also more accurate when one is talking about somebody whose I.Q. is down at the bottom of the scale and therefore is clearly retarded compared with a normal person. But I am appealing for us not to use the expression "mental handicap" because, if we attend international conferences to discuss this kind of problem, we shall find that we are using an expression which others simply do not understand. However, I was glad to notice that even the White Paper used the expression "mentally retarded", and I shall try to continue to use that phrase during my speech.
The voluntary societies—and my constituency is blessed with a magnificent Society for the Care of the Mentally Handicapped Child—can do a great deal both to raise funds and to make families which have mentally retarded children realise that they are not the pariahs of society, but people who have had an extra burden laid upon their shoulders which, but for the grace of God, could be on any one of us.
But as the Appendix to the White Paper points out some mental handicap or retardation is genetic and can be carried as an hereditary disease. In this context, here I want to endorse the remarks made by my hon. Friend the Member for Aylesbury (Mr. Raison) to the extent that I think we must recognise the use of abortion, and of contraception initially, and even of sterilisation, to ensure that such births do not take place.
I recall a Catholic couple coming to see me. Their daughter, who was mentally retarded, was going to have a child. The trouble was that she had gont to a 64 hospital to have an abortion but, somehow or other, had been frightened about the whole business and the operation had not been carried out. She was then at a stage when she could not find a doctor who would perform the operation. I do not blame the doctor for ducking the moral issue involved, but the concern of those parents and, I understand, of their daughter as the moment drew nearer was very real.
The thought that someone is going to bear a child which, by the greatest likelihood, will be severely mentally handicapped is a daunting one for any young person. I am glad that the appendix to the report touches on this issue, because I think that we should consider how we can prevent the birth of children who are not likely to have much chance of having any quality of life as we appreciate that expression.
That brings me to the point raised by my hon. Friend about how we can help the family which has a severely mentally handicapped child, who wants to maintain that child at home, but who find the stress of doing so sometimes almost, if not completely, intolerable. The realisation that they never can have a normal life, certainly no social life, and the consciousness that the stress will be an everlasting burden may overcome any feelings of affection, and may presuade the parents that they must have their child institutionalised. Though they may believe that it is on a temporary basis, it sometimes lasts for the rest of the child's life.
My constituency is served by the Royal Eastern Counties Hospital, which is about 40 miles away. Any child severely mentally retarded finding its way into that institution is not going to be able to see much of its parents. Bit by bit the visits will become more intermittent and the child will become more and more an institutionalised patient.
That is inescapable, and when I asked my Society for the Mentally Handicapped Child what it would like me to say this afternoon, it said that I must emphasise the need for more short-stay hostels. I am glad that my hon. Friend touched on this, because I do not think there is any doubt that such hostels, possibly as an adjunct of a general hospital within the area, and thus drawing its funds both from the local authority and from the 65 National Health Service, could provide the breathing space that is so desperately needed by families faced with this sort of problem.
Sometimes such a hostel will become a home for these severely mentally retarded children, but at least it will allow for the possibility of their going home on occasion. More than that, it will maintain the continuing visiting which allows people to feel that they belong to somebody. I believe that such hostels should become part of the Government's policy because they are perhaps one of the most likely means of relieving the tremendous burden on the family that comes from someone in it being severely mentally handicapped.
I want to emphasise the new realisation that mentally handicapped people can be educated, can be trained, and can be made more able to stand on their own feet. The more a mentally handicapped person can do for himself, the easier he can live within the community, and at home. It follows from that that the more he lives at home, the less space is required in hospitals, and thus we gain all the way along the line.
But if the training is to be good, the quality of the teacher must also be good, and the desperate need, at least in the Greater London area, is to keep the teachers once they have been trained. I have in my constituency a school for the educationally subnormal, which is also a training establishment. The trouble is not that of finding people to train, but that of holding them once they are trained, particularly if they are married.
After 14 years, with all the additional allowances that are available in the Greater London area a teacher at that school earns £1,900 a year. That is not the sort of salary that will hold a man who is married and has children, when he can get a similar job in another area where the cost of living is very much lower. There is a need to offer these teachers a special allowance, otherwise this continual wastage of trained staff in the London area will pose considerable problems and stresses in teaching and training establishment for the mentally handicapped
As has been said before in this debate, and I shall repeat myself, I think that the stigma and the shadow of what is 66 mental handicap has passed to a great extent. The realisation that has come upon most of us that it could be our child has made us see this thing for what it is, an act of providence, not wanted, but not necessarily totally destructive of family life.
It is right that voluntary organisations should want to help, and I conclude by commenting on what I consider to be one of the most pleasant stories that I have heard. In my constituency the sixth formers from a number of schools have made it their task to visit the school for the educationally subnormal to help those children, to take them out for walks, and generally to try to improve the quality of their lives. I think that such compassion for young people from young people holds out a bright hope for the future.
§ 5.17 p.m.
§ Mrs. Doris Fisher (Birmingham, Ladywood)
I, too, should like to thank the hon. Member for Leicester, South-West (Mr. Tom Boardman) for raising this debate this afternoon. All those who have spoken this afternoon have emphasised that the service needs extra facilities and extra cash, but it also needs extra public sympathy.
One of the things which concerns me about the White Paper is the emphasis on domiciliary and community care. Too often that phrase sounds good but when put into practice means very little. One has only to work for the service for the mentally handicapped to see the heartache, the concern and the worry of parents about what is going to happen to their children. Many things can be done to help handicapped people to be cared for in their own homes, but hospitalisation will have to continue until a far greater range of services is performed by voluntary bodies and local authorities
One of the first things that has to be considered when thinking about severely mentally handicapped children is housing facilities. Many local authorities award what are called medical points to certain categories of people on their housing lists. Very often extra points go to those who have physical disabilities, while mental disabilities are lowly rated, but the fact remains that unless there are decent housing conditions for a mentally handicapped child the alternative is for him to be placed in an institution.
67 I have cases in my constituency of parents living in back-to-back houses, sharing toilets, and trying to bring up mentally handicapped children at home, but eventually having to give up and allow their children to go into an institution. The Minister should tell local authorities that they should give priority in respect of housing for the mentally disabled as they do for those with physical disabilities. When I refer to housing I am not referring to flats or maisonettes. A seriously mentally disabled child living in a block of flats in my constituency causes many problems because it is a constant rocker in a chair. The chair is continually banging on the wall and causing annoyance to the neighbours. The provision of housing for these people is important.
Reference has been made to hostels and homes. I ask the Minister, whenever he intends to open a hostel or convert a building, to launch a publicity campaign of the kind that he launched recently to tell the public about the general services that are available, so that the local people are carried along with him. When local authorities and voluntary bodies attempt to convert large houses in residential areas I am worried at their being hindered by the outcry that arises when the local people realise that the work is being done for children or adolescent mentally handicapped people.
If the Minister could produce the same kind of public response as was produced in respect of the Government's financial measures this year we could go a long way to being able to provide these hostels or homes—call them what you like—in built-up areas and we could persuade the public to join in and help. As it is, more often than not, whatever good a local authority or voluntary body may feel about establishing a hostel or converting a house in a built-up area, its application is turned down because of the pressure brought to bear by local residents' associations.
Another possibility that we in Birmingham have used successfully—and I claim a little credit for it—is the establishment of residential schools belonging to the city. For two of the six weeks' holiday period now coming up we allow severely mentally handicapped children to use these schools so that they have a 68 fortnight's holiday, which at the same time gives the parents an opportunity of a fortnight's holiday away from their children. The parents thus get the same kind of rest and relaxation as is given to those sons and daughters who look after their elderly parents. The extension of facilities in this respect could readily be taken up in other parts of the country.
The White Paper refers to teachers in hospital. Under the new Act there will be a greater integration of what we used to call training centres under the education system, but I hope that the Secretary of State will seriously consider the question of teaching units inside hospitals for the handicapped. As many hon. Members have said, these hospitals will be with us for a long time, and if we can provide schools in hospitals for the physically disabled I hope that the Secretary of State will seriously consider extending this facility to children and adolescents who are mentally handicapped and cannot take their place in ordinary training centres.
The White Paper emphasises the serious problem arising from the shortage of adult training centres. Many local authorities—Birmingham is no exception—have provided purpose-built junior training centres. They have increased their numbers and enlarged them. They have spent a great deal of thought on how best to cater for these people, but a backlog has been formed, because when these children reach school leaving age they cannot be passed on anywhere else. It is unfortunate that although there has been a surge forward during the last eight to ten years in the provision of junior training centres the necessary impetus has not been developed to create the establishment of a sufficient number of adult training centres.
The White Paper rightly refers to this matter, and I hope that in the talks that are to take place with local authorities and regional hospital boards this situation will be emphasised—otherwise the good work that has been started in the junior training centres will be wasted.
We also need to extend the use of health centres. Many ante-natal care centres are not utilised to the full extent because mothers use the family doctor. In the Ladywood constituency we have a fine nursery group run by the health 69 centre, and its work is stimulated by the sixth formers in surrounding schools who, as part of their youth voluntary service, help to make a successful unit in a health centre, where the mentally handicapped children are clearly seen by the ordinary patients who use the centre. In that way the public see at first hand, and clearly, the way in which we are trying to overcome the disabilities of these children.
The White Paper mentioned many items of research. I draw the Secretary of State's attention to the research undertaken by the Children's Hospital in Birmingham, which is very concerned at the possibility that lead is causing mental retardation. It is looking into the intake of lead by children living in down-town areas, where peeling paint and all the other things that we find in decaying property may be leading to mental retardation. I mention this because it is an interesting thesis. That research work is also short of funds, and any help that the Secretary of State is able to give would be welcomed. It is working alongside the University of Aston in this research.
The mental health service has always been the Cinderella service—a service that we have tended to sweep under the carpet because the majority of hon. Members and the general public have found it somewhat distasteful. This afternoon we should pay tribute to all the voluntary bodies who, for many years, have worked to draw the attention of the public, hon. Members and Ministers to the serious problem of the mentally handicapped. It must hearten many voluntary societies who are working in this field to realise that one day in the life of Parliament is being devoted to this serious subject. It is still a Cinderella service, but the White Paper goes a long way towards extending some of the provisions that all hon. Members want to see.
The White Paper continues the work initiated by the previous Government. If we want the White Paper to be successful, we must recognise that local authorities—there are many good ones whose members are as concerned as hon. Members about the provision for the mentally handicapped—are thwarted by lack of finance. If we want more domiciliary care, we must give local authorities the necessary finance. The spirit is there, 70 but so often, because there are many calls upon a local authority's finances, the services cannot be provided.
§ 5.31 p.m.
§ Mr. Charles Simeons (Luton)
I have listened with great interest to the views about the future expressed by many hon. Members. I will not give the Secretary of State any advice. I will merely tell him that I want him to do something which will not cost money. I want him to see that the right people—that is, the violent people—are in hospitals and not left to become total burdens on their mothers, who are the ones who bear the brunt of the difficulties caused by any abnormal child.
When they are small, they are lovable creatures, but at the age of six or seven, they become quite violent and extremely strong, and even uncontrollable. I would instance the case of Nigel Uvanoviz, in my constituency. The eighth of eight children, he suffered from gargoylism. This made him unable to react in the way that normal children do. He was violent from time to time and incontinent, but the family loved him. When he reached the age of eight, he became so strong that no one could do anything with him. The Ministry and the local authority were aware of this problem, but on each occasion that they tried, there was no vacancy for him in a hospital.
The mother said to me, "I can stand it no more; I am leaving home". I went to see her and found that the boy had a capacity for moving around in the dark, so that, when they had gone to sleep, he would creep downstairs and wreak absolute havoc. He would take knives and cut his mother's legs. He burned the money; he put all the Christmas food in the sofa.
One of his older sisters had to be kept home from school to look after him. The local authority did not prosecute her, because that would have meant exposing the whole subject and it would have meant that something would have to be done. No one was prepared to do anything. I do not mean by that that they were not willing to do it.
I was faced with this problem—either the mother left home, in which case the boy would be taken into care with the 71 other children and would end up at Bromham Hospital that evening, or we took him there and the mother stayed at home. The hospital was sympathetic but said that it would have to consider the case. But I saw the mother's problem and her immense distress. She was right at the end of her tether. I realised that there was only one thing to do, so I took him to the hospital, and, after pointing out that I had every sympathy with their problems, I left him there and wished them a happy Christmas.
The mother was very sorry that he had gone, as were all the rest of the family, but it means that that family has stayed together and that that mother has remained sane and can look after the family, who are united and go to see the boy from time to time.
A little later, I went to a party for the mentally handicapped. The drummer in the band occasionally sang incredibly well. On asking, I was told that he came from Bromham Hospital. When I asked what he was doing playing in the band, I was told that he was very good but that he had nowhere to go, so he had to be kept in the hospital. The point that I hope my right hon. Friend will note is that, if people like that had somewhere to go, Nigel Uvanoviz could have got into the hospital much earlier.
But this poses a problem which has been recognised earlier. The problem is that, unless there is a group in the hospital—some "walking wounded" as well as "wounded"—the burden on the staff is so great that they cannot cope. If all the patients are violent, the burden becomes intolerable. Therefore, in these hospitals there may be only a limited time for the staff to go on one tour.
Until recently, I was chairman of the management committee of a home for the chronic sick—one of the Cheshire Homes. We found that there was a period for which the staff would work with the great devotion which they always show, but that then there needed to be a turnover of fresh people. There is a period of human endurance both for the mothers and for the hospital staff. I would ask my right hon. Friend not only to look into this but to tell these management committees to ensure that the names of those in the hospitals who could go out- 72 side are sent to him so that he can assess the vacancies which would result.
I was prompted to speak today also because of another case in my constituency which is becoming similar. I will not pretend that one can follow my caurse of action twice. One cannot dump boys at hospitals all the time, because that means that the system would break down.
This boy is 11 or 12. He was put in the local authority centre, but they would not keep him, because he was too violent, and they sent him home. I will give my right hon. Friend his name and I hope that he will make some inquiries. After we made some inquiries, the Dedisham School for Autistic Children interviewed the parents and sent them a letter saying :…we did not feel that Michael would fit in with the school as it is likely to develop … I cannot make the offer of a place here for him as a result of our meeting last monthThis is because he is too violent, so his mother must bear the burden.
According to the father, her problem is even greater than this, because he is becoming so violent that he throws things around and is always breaking windows, which are expensive to replace. The mother would like to go out to work to pay for the extra expense, but she cannot because someone must look after him.
We should look to the future, but we should also do something for mothers who, through no fault of their own, must bear the burden of children who are not only subnormal but violent.
§ 5.38 p.m.
§ Mr. A. W. Stallard (St. Pancras, North)
I too welcome this debate to which I have listened with great interest as someone interested in the problems of the mentally handicapped. I would dearly love to follow the hon. Member for Luton (Mr. Simeons) and relate details of some of the harrowing cases in my constituency. I am sure that the Secretary of State is well aware of some of them. We could go on for the rest of the evening giving these examples, but I will restrain myself.
I have been actively engaged in this field for some years as chairman of a fairly active mental health association in Camden. We do as much as is humanly 73 possible in this field. I pay tribute to all the voluntary workers engaged in the tremendous task of running these services. I would go further and pay tribute to all the dedicated, devoted staffs of hospitals. Bad as some of the hospitals are, the staff work in most difficult conditions and have to put up with a tremendous amount. They deserve the gratitude of all of us, as we certainly know who have been fortunate enough to visit the hospitals and see the problems that exist.
I, too, welcome this White Paper and many of the new approaches and the thoughts in it and much of the thinking behind it—for the development of community care in particular. I have some reservations, of course. Like other hon. Members, I have waited since 1959 for the implementation of many of the ideas and suggestions. They have been bandied around for a long time but they never seem to get further than a committee or a sub-committee or a working party or a local council group. Heaven knows, if ever there was a subject for which there were more committees, or which was so over-committeed, than that of mental health, I do not know of it. I suppose I have listened to millions of words spoken by thousands of experts on the subject of mental health or mental ill-health.
An aspect I particularly want to emphasise and concentrate on is practical application of ideas. This is where one gets a bit impatient. I should like to see something radical happening before it is too late. I am becoming impatient with the long overdue implementation of some of these ideas, many of which many of us welcomed as far back as 1959. I think there has been a major shift in public opinion in the last few years. I know of the work done in my own locality by voluntary workers through public meetings, film shows, bazaars, in trying to bring home the problem to the community, and they have had a tremendous impact. I welcome it and hope it will continue.
Having said that, we now must put more emphasis on community care. As others have said, this in itself raises many problems, and the biggest of them is finance. It is all very well to set up these committees and to say we need this or that, that we will do this or that, but 74 in the end we come up against the question of cash and we have to cut the suit according to the cloth. This inevitably means discussion of priorities in the allocation of the limited resources. We all understand that there must, unfortunately, be some limitation on them at this stage. So we must have priorities. If we were all of us to draw up our own separate lists of priorities, I doubt whether we would find any two the same. There would be similarities, but they would not be the same, if each one of us drew up his own individual list of priorities of what he would like to do in serving the mentally handicapped and for the treatment of mental illness.
What in this debate seems to have come high among the priorities is the question of day care and junior training centres, or places where adolescents can be trained. Indeed, that might well figure on anybody's list. I hope it will be on the Secretary of State's list when he advises local authorities on how they might be prepared to spend some of this money. Many of us, when we visit these hospitals, feel a bit worried—I certainly am every time I visit them, and I visit a good many—at the number of people who seem simply to sit on beds reading newspapers, or doodling with a pencil, or perhaps reading books, but with nothing more constructive to do. It seems that far too many of them wander aimlessly about the wards, or about the grounds if the weather is fine. It seems to me that there should be some kind of occupational therapy units and that they should have a priority; there is urgent need for activity which could be related to the patient's return to normal life—that is, to the community. I say this will all due respect to the kind of therapy which goes on, some of which is very good, but we must take it a stage further and link it with the patient's ultimate return to the community. The activity could be something different from weaving baskets or making the various gadgets which they make in the wards, and so on. We have to think further along these lines of developing that kind of service, both in and out of hospitals.
When we consider day care I hope we shall not hear somebody say, "That is the hospital's job; that can be done by the hospitals", or the hospitals say, 75 "It ought to be done by the local authority". That would mean that we would go on discussing for another 10 years whose responsibility it is.
I shall refrain from discussing now the question which I have taken up with the Secretary of State and his Department about younger people, adolescents, in geriatric wards when they should be in some other place, but an aspect of the matter which worries me is that there are people whose problems could have been studied a long way back—in childhood. There is need for diagnosis earlier in order to process the problems.
Another of my priorities would be some form of child guidance, some family unit, some family assessment clinic. With all the new reforms instituted piecemeal by hospitals or by local authorities, the service has become fragmented. It makes it very difficult for mothers of young children who are suspected of having a problem if there are half a dozen different places to which they should take them or to which they may be directed. As my hon. Friend the Member for Birmingham, Ladywood (Mrs. Doris Fisher) said, they start with the health committee, if one is fortunate enough to have a health committee in the area; but then the child may be referred to a school medical officer or to the welfare people, or even to a school teacher; or it may be referred somewhere else; a psychiatrist may visit the school and may eventually catch up with the problem. I would suggest that there should be a unit to assess the whole family at an early stage of a child's problem, because I have seldom found that such a problem comes in isolation; it is usually related to some wider problem affecting the whole family or arising from its environment. The family should be assessed at an early stage and steps taken to alleviate some of the more immediate problems.
I promised to be brief; I am grateful for having caught the eye of the Chair. I conclude by emphasising to the Minister that I hope that when he has discussions with the local authorities on priorities, or advises them, he will give some kind of guidance on how they will spend this extra money, that he will have a mind to family guidance clinics, and that he will help to avoid the difficulty of one service leaving the matter 76 to another so that nobody does anything in the end, and that he will have a mind to some practical application of these ideas. I think that we shall then be started on the right road.
§ 5.50 p.m.
§ Dame Patricia Hornsby-Smith (Chislehurst)
I join with other hon. Members in congratulating my hon. Friend the Member for Leicester, South-West (Mr. Tom Boardman) on raising a subject which has produced so constructive and so unusually non-controversial a debate. I agree strongly with the comments of the hon. Member for Woolwich, East (Mr. Mayhew): we have seen a very dramatic change in the last 20 years, and we are now getting on to the second phase. I remember that when I went to the Ministry of Health in 1951 there was not a mental hospital that did not have the majority of its doors locked. One went round preceded by someone with a key as though one were going into Wandsworth Prison. A pioneer in this progressive work was Dr. Rees, then superintendent of Warlingham Park who, in the face of the enormous fears of some of his contemporaries, opened every door.
As a public relations exercise, we had to get rid of the idea of asylums and or the belief that everyone who was in a mental hospital was dangerous. It was a very substantial job to educate the public, mainly because they never got behind those great gaunt walls, and never had the opportunity of seeing the patients within them, the overwhelming majority of whom were neither violent nor dangerous.
Having got the doors open, we had an opportunity to encourage more nursing staff in order to bring about a better standard, so that mental hospital nurses were recognised as being on a par with nurses in general hospitals, and it was recognised that because there is not the same dramatically quick turnover of patients, such nurses need a temperament of their own—that enormous patience, kindness and care which nurses in mental hospitals show, added to the increased skill needed now in the treatment. During this period there were the greatest advances in bringing about a more rapid turnover, and in encouraging people to accept mental hospital care instead of waiting until their condition became acute. We had this enormous advance in 77 medical science, when the new drugs made it possible to control, perhaps to aid, and in some cases to prevent people ever having to go into a mental hospital at all.
No one made a greater contribution to bringing these facts home to the general public than did the hon. Member for Woolwich, East in his outstanding television programmes on the subject, one of which I believe was done at Warlingham Park.
Alongside this faster turnover and increased knowledge we also had the Leagues of Friends. I hope that more and more of the mental hospitals will, as has practically every general hospital, have their Leagues of Friends. In this connection I have a story to tell of one of the first Leagues of Friends we were able to get in a mental hospital in the West Country. The hospital was large—about 3,000 patients—and we got the local W.V.S. to start things off. As a first exercise they asked, "How many of these people never have a visitor, or a letter or a birthday card?". They found that 700 of the patients had for years never had any communication from the outside world. They found "a friend" for everyone—friends who would take in a bunch of flowers from their garden or remember a birthday.
I remember attending an open day and fête at one local hospital and then going round the wards. One woman who had been there for 47 years had two very dog-eared birthday cards. When I asked, "Is it your birthday?" the sister whispered that the cards had been there for six weeks and that the patient would not part with them. Very simply, this woman replied, "Isn't it wonderful? My friends sent me birthday cards and brought me this birthday present", and from an equally grubby bit of tissue paper—it had been so handled—out came three handkerchiefs, from under her pillow.
As the hon. Lady the Member for Birmingham, Ladywood (Mrs. Doris Fisher) said, the general public could do far more in breaking down the sort of feeling of prejudice that is so prevalent. When the Kent County Council tried to set up a hostel for the mentally handicapped, it was opposed in 17 different localities by local residents who did not want these people within their community. 78 After seven years of negotiations, the council found this 17th site, and I am proud to say that it is in my constituency.
I hope that every mental hospital catering for mentally handicapped children will have Leagues of Friends because although the turnover among young people is greater, there is still an enormous problem.
I welcome my right hon. Friend's allocation of £100 million over four years for building. I know that most of this money will go to day patient and outpatient provision, to hostels and community care centres, but we will always have with us the very elderly patients.
I went on one occasion to Preston Park where in a ward of very elderly females I asked the average age. The ward was overcrowded : a 36 bed—but with 67 patients—this was some years ago. Three of the patients were in their sixties, about 20 were in their seventies, the majority were in their eighties, the eldest resident then was 97, and the staff apologised because their 103-year-old had died the Friday before! That type of patient may be in for 20, 30 or 40 years. We must not lose sight of the fact that in the care, comfort and warmth and discipline they enjoy, patients are far more likely to live for many more years than they would if prone to accidents, the colds and the chills outside.
My right hon. Friend's development proposals will command all-party support. We should have more outpatient and day-patient provision, together with the control and aid that drugs can give. I hope that particular attention will be given to the day centres and places to which patients of handicapped children, to whom they are prepared to sacrifice their time and devotion, can turn to get a break by putting the child in responsible care, if only that they may have a fortnight's holiday.
Can people realise what it means for a normal young couple with, perhaps, two or three normal children never to be able to take advantage of one of those nice package deals abroad, because the handicapped child's social behaviour is so unfortunate that no hotel or boarding house will accept the family? Instead, the parents have to camp, or hire a cottage, in which case the mother has still to cook for the family and look after 79 the handicapped child : there is no holiday for her.
I am proud to say that the Bromley Society for the Mentally Handicapped is aiming to build its own centre. It has had considerable support from Bromley Council. It seeks to raise £25,000, and in nine months has already raised well over half that amount. It intends to set up its own centre where not only can children go for the day, with parents themselves having a rota to look after one another's children, but where, if mum wants a day off to go to the shops, or do something that she is able to do with her normal children, when it is not possible to take the handicapped child with them, the centre will provide the opportunity. There are no parents who demand our sympathy more than those who make the enormous sacrifice, the sacrifice of their matrimonial companionship, often the sacrifice of never being able to go out together and leave the child, and the sacrifice of spending far more hours and doing more than one would normally expect to have to do with children of similar ages.
With the programme outlined by my right hon. Friend, these people can have a break. It will keep more people out of the hospitals and it will, with the younger people, do much to enable them to make their contributions, with the use of the present drugs and the use of the regular supervision which they can have at the day centres.
I hope that the Minister will be able to educate employers about epileptics. The new drugs have made epilepsy, for a very large number of sufferers, something which can be controlled. One of the saddest things is that when they have been controlled and been released, they have the greatest difficulty in getting a job, and immediately they are thrown back on themselves. Immediately they are inhibited that they are not like other people, they get depressed again, and within a few weeks or months they are back in hospital from the sheer frustration of being unable to get a job.
On the Bexley side of my constituency there is a very active association, and at its first meeting, which the hon. Member for Woolwich, East (Mr. Mayhew), the hon. Member for Woolwich, West (Mr. 80 Hamling) and myself attended, there was a surprisingly large turn out of about 150 people. They were all interested and anxious to help with epileptics, that being their particular speciality, all the parents there being parents of epileptic adolescents and younger children.
I support all that my right hon. Friend is doing. I am sure that he is right to get as many as possible to maintain contact with the hospitals. We should never forget that all too large a percentage of those who enter mental hospitals are forgotten, abandoned, or their families emigrate, and many of them never have the personal family contact so lavishly given to somebody in and out of general hospital in 12 days and whose place looks like Moyses Stevens during that period.
§ 6.3 p.m.
§ Mr. Michael Meacher (Oldham, West)
I, too, congratulate the hon. Member for Leicester, South-West (Mr. Tom Boardman) on introducing the Motion. But I make no apology for introducing a certain note of dissent and critical assessment since I believe that there are a number of inconsistencies and examples of lack of clarity in the White Paper which should be brought out.
It is remarkable that a White Paper in which the Government, having teetered on the edge of radicalism—now having come down firmly on the side of comprmise—should contain within the interstices of that White Paper a full and effective rebuttal of its own conservatism. But that is exactly how it is.
The crux of the debate, which is contained in paragraphs 190–1, is whether the hospital is the proper form of care for those who are not ill but whose intelligence is limited. Table 1 demonstrates very clearly that the great majority of people at present in subnormality hospitals do not have behaviour difficulties requiring constant medical supervision, do not need assistance in washing, dressing or bathing, are not room-bound, are not severely incontinent, and do not even have any physical handicap. This means that the services required by the mentally handicapped are basically social, occupational and educational.
Apart from the very handicapped people who are also mentally or physically ill and who might be cared for in units or annexes of general hospitals, specialist 81 hospitals for the mentally handicapped should be phased out. That is the clear implication. It is not a question of years, whether it be 15 or more, but the principle of the commitment. It also means that priorities should be decisively given to the development of community services over hospital services. All that the White Paper proposes, in its very interesting and extremely informative Table 5, is that the numbers of mentally handicapped cared for by hospital boards should be roughly halved while there is to be a corresponding increase in the number of local authority places to be substituted.
Most of the proposed rise in revenue and capital expenditure for the next few years is apparently intended for the hospitals, with money being spent on improving old hospitals, at least for a certain period, or, I regret to say, in erecting new smaller hospitals. Yet a 20-year period is being laid down for this process, even though local authorities are being asked to provide only an extra 55 places per 100,000 of the population, and even though the White Paper at paragraph 210, expects some areas to reach their target in only 10 years. But, if this is not faint-hearted enough, paragraph 210 caps the pusillanimity of the Government's plans with this sentence :So far as the resources available for capital projects allow, the Government will try to help authorities to complete their programmes within the time-span they set themselves …In other words, even by 1991, this far-from-radical set of polices may well not be complete.
Not only does the White Paper go only half way—and it does not get there fast also, because its central principles are confused and, perhaps, merely reflect a thinly disguised papering over of divergent Departmental views, it is unclear and inconsistent in its crucial exposition of the ostensibly complementary local authority and hospital rôles. One still wonders, after reading the White Paper, precisely what the rôle of the hospitals is to be. Paragraph 174 says that they should be used for treatment, though not for residential care. But paragraph 176 adds that they will not normally deal with physical or mental illness because general or psychiatric hospitals provide the necessary services. Paragraph 138 rightly asserts that the 82 assessment can be carried out as adequately in training schools, health centres, schools or residential homes as in a specialist hospital.
The White Paper's very ambivalent answer to the question of the rôle of hospitals is at paragraph 191:It is argued that only a hospital which brings together the mentally handicapped from a wide area can be large enough to classify patients with varying degrees or types of handicap, separate them in different wards and villas and provide the right tempo of life for each. It is also suggested that this type of hospital is necessary in order to allow staff to specialise in the care of the mentally handicapped and promote research into their problems and treatment.But since there are to be exactly the same principles for care in local authority and in hospital services, this argument is easily refuted. I am sure that the Secretary of State agrees that the services in no section of society should be organised specially to fit in with the research needs which are made upon them.
As I have said, it is remarkable that the White Paper should fail in its policy recommendations to follow through the logic of its own observations. It notes with a telling accuracy in paragraph 97:It is extremely hard, though creditable attempts have been made, to create a homely atmosphere in a barrack-like institutional building; or to care for severely handicapped, incontinent patients in multi-storey buildings without lifts, or with lavatories on one floor and the rooms used during the day on another.In that case if, on the Government's own admission, existing hospitals often defeat the principles of domestic simulation and community involvement, why is there no commitment in the White Paper for ending these unsuitable hospitals within a definite time-span?
In fact, although the Government indicate that the hospital population might be expected to reduce to 56 per cent. of its present size, the position is complicated by two factors. One is the recommendation to provide new units of up to 200 beds. Paragraph 245 states that200 in-patient beds would eventually be necessary only for a population well in excess of 250,000; a hospital serving more people than this would be too remote from many of them.Quite so. As the ever-useful Table 5 indicates that 68 in-patient hospital beds are required per 100,000 total population, 83 a hospital with 170 places on one site would therefore serve a population of 250,000. Hence one might expect that all hospitals with an excess over 170 places would be expected to be phased out within a definite period of time, but the relevant recommendation of paragraph 241 that hospitals with 500 places or more should not be enlarged certainly appears anomalous, to say the least. As 36 hospitals, each of them with more than 500 patients, account for 64 per cent. of the total subnormality hospital population, this is an issue of lack of clarity which is of fundamental importance.
The second complication is the vagueness of the local authority commitment to residential care. Will the new homes of 25 persons per home resemble private housing in urban localities or will they be a pale copy of the larger Victorian institutions at present run by the hospital boards with or without a cordon sanitaire of isolation? This is a crucial question and one on which the White Paper, is, unhappily, entirely silent.
Nobody can fail to welcome the White Paper as a step in the right direction, but it is a faint and faltering step, two steps forward for every one step back. In view of the ground swell of reform, and in view of the mounting expectation over what I am sure the right hon. Gentleman will agree was a rather longish gestation period, it is a disappointingly timid offspring with more than a tinge of the Janus complex of two heads pointing in opposite directions.
§ 6.12 p.m.
§ Mr. Alfred Morris (Manchester, Wythenshawe)
This is a most timely and deeply important debate. I warmly congratulate the hon. Member for Leicester, South-West (Mr. Tom Boardman). He has done a great service in allowing us to debate what right hon. and hon. Members on both sides regard as one of the main challenges facing us in the whole field of the social services.
There have been many outstanding speeches from both sides. We on this side believe that we may even have helped the right hon. Gentleman in his battle with the Treasury Ministers. While he has had some success in his exchanges with them so far, this debate may serve to fortify him in the further discussions there 84 must be for a much greater allocation of resources to help those who are mentally handicapped and mentally ill.
I am reminded of a speech made on the last occasion when the House discussed mental hospitals. It was a debate in February, 1970, in which the hon. Member for Farnham (Mr. Maurice Macmillan) referred to the mentally handicapped and the mentally ill as the Cinderellas of the National Health Service. In that debate the hon. Member for Farnham said there had been so little dissension because the House had avoided the one topic on which differences arise most easily, that of funds and resources. The hon. Gentleman then used these words :… we in this House are fooling ourselves … if we seriously believe that we can deal with these problems … by any other method but by finding a way of getting more money for people to spend on the Health Service in general and the care of the mentally sick and abnormal in particular."—[OFFICIAL REPORT, 11th February, 1970; Vol. 795, c. 1393–4.]Plus ça change, plus c'est la même chose. The hon. Member for Farnham is now the Chief Secretary to the Treasury. I greatly hope that the Secretary of State will remind the hon. Member of the great wisdom of the approach he adopted in the debate of 11th February, 1970, and that this debate will serve to strengthen the right hon. Gentleman's hand in seeking from the Treasury more resources to help those who are mentally handicapped and mentally ill.
What we are debating is a shameful and unreasonable gap in our social scheme. The Mind Manifesto of the National Association for Mental Health, with the support of many other organisations, has reminded all of us of the size of the problem. I quote from The Times of 25th February, 1971 :Yet the size of the problem may be even greater than the formidable statistics compiled earlier this year by the N.A.M.H. What complex human misery lies behind the figure that at least 6,000 young people between the ages of 10 and 20 enter hospitals for the mentally ill each year? Or that 22,000 mentally confused people over 65 are taken every year from their homes and cared for in hospital? It is estimated that several million people in this country take tranquillising or anti-depressant drugs regularly to relieve mental or emotional strain. Millions take drugs to help them sleep.Each year 4,500 people kill themselves and 14,000 make an unsuccessful attempt at suicide. 85 Over 72,000 children of school age are emotionally disturbed and attend child guidance clinics, special schools or psychiatric hospitals. About one-third of the estimated 30,000 tramps in Britain are mentally ill. There are probably about three million people whose lives are shadowed by mental disorder. In 1967–68, over 30 million working days were lost because of mental illness and the sickness benefit cost nearly £30 million.We ought to reflect on the problems created by the bigger and bigger organisations in which most people now have to live and work. They are often extremely impersonal and soulless organisations. It is perhaps not surprising that so many personality defects should manifest themselves in organisations that are themselves so impersonal and soulless.
Like all of my hon. Friends who have spoken in this debate, I am deeply grateful to the Rt. Hon. David Ennals, whose great energies have been enlisted in the service of those whose problems we are debating, for the way in which he has delineated the size of our task. It is the wish of all of us that David will return to the House at a very early date.
He has done for the mentally handicapped and mentally sick what Oxfam has done for the very poor and Shelter for the homeless. I am sure that the Secretary of State will agree with me that the former Minister of Slate has done great service in this field.
Big hospitals, like other big organisations, can also be very soulless. Of one such hospital—one of the biggest psychiatric hospitals in the country—it was reported in The Times of 30th June this year that its inmates werewaiting to die in neat straight rows.Quoting from an official report, The Times said thatIn the unreconstructed wards, patients mill around in a kind of primeval gloom. Beds are jammed tightly together like pack ice with narrow passages running between them. In the lounges, patients sit cheek by jowl. Others shuffle about aimlessly among a nightmarish clutter of limbs and geriatric chairs.".This sounds like a report, not from a hospital, but from an anti-hospital
The battle against such conditions as those reported in The Times is a grim struggle with squalor. The recent New Stateman series by Donald Gould and Ann Shearer shed a great deal of light on living conditions—I should perhaps 86 have said the conditions of existence—in many of our subnormality hospitals. Their series of articles should be made compulsory reading for everyone with responsibility in any part of this field. They say in their recent concluding article that most of the huge institutions are much of an age, that is, about a century old. They say that before the onset of industrialism… was a good time for mental invalids. A system we tend to think we have just invented—community care—was working well.".Then came the asylums, with their high walls and sombre interiors. But if Victorian England was a harsh and inhuman place for mental invalids, at least our ancestors had the excuse of ignorance. Paragraph 43 of the White Paper states :Less was known then than now about the extent to which the mentally handicapped may respond to the stimulus of education, training and social activity".There is no longer any excuse for preventable suffering. We can now so easily improve the conditions of those who lie behind the walls of these ancient institutions. All of us must see to it that the Secretary of State is supported in any and every attempt to end the squalor of many of our so-called mental hospitals.
As the right hon. Gentleman knows, there are those who passionately believe that the existing sub-normality hospitals are not the answer to the problem of mental invalidity. The Campaign for the Mentally Handicapped wants these hospitals to be phased out within 15 years and to be replaced with a system of community-based residential units. Ann Shearer, Sandra Francklin and Pat Taylor, who have distinguished themselves by their work in this field, believe that this can be done without any increase in the totality of expenditure. The Secretary of State recently had a meeting with representatives of the Campaign for the Mentally Handicapped. I hope that he will keep in the closest possible touch with the Campaign, because it has a very important viewpoint to which he should pay careful attention.
As he knows, there are some other very strong critics of his White Paper. I agree with Peter Townsend that as we replace the existing sub-normality hospitals we do not want a system of minor isolated barracks put up by local authorities in pale imitation of the larger Victorian barracks which are at present run 87 by the hospital authorities. Professor Townsend has said :Yet the White Paper makes this an all-too-likely possibility".In the Sunday Times of 27th June, 1971, he also said :The Government has taken a whole year to ruminate over its predecessor's unpublished proposals and the decisions that have been eventually reached are tragically disappointing in nature and scale. The Government proposes a reduction of hospital numbers and a shift to a more balanced division of services between community care and hospitals; but does so in a half-hearted and confused fashion which may result in a pattern of services little better than they are now".I am sure that in his reply the Secretary of State will want to address himself to those criticisms.
I wish also to refer to a letter which I have received from Miss Mary Applebey, General Secretary of the National Association for Mental Health, who has made some very important points to me which should be considered by the Secretary of State in this debate. She says :I see no reason to suppose that the local authorities will now allocate more of their scarce resources to meet the targets which the Government now sets unless there is a statutory obligation placed upon them to provide services to the standard required".She goes on to say :The role of the hospitals in the future is insufficiently definedThe White Paper is rather defensive on this point. Paragraph 192, having discussed the conflicting viewpoints about the future of mental hospitals, says:The Government considers it premature to form a final view on these questions".Many of us feel that the time is long overdue for reaching conclusions on this matter.
§ Mr. Raisonrose—
§ Mr. Morris
I must be brief, because I have given an undertaking to give the Secretary of State sufficient time to answer the points raised in the debate.
Another very important point made by Miss Mary Applebey is thatThe junior training centres which have now become part of the Education Service have over the past 20 years developed from nothing to a first class service, well housed and with a professional training for teachers. Similar provision for adults lags far behind and hostel 88 provision is practically non-existent. This is where the pressure has to be put on and unless there is urgency in the Government's plans for adults, the hospitals will continue to be choked by patients who ought not to be in hospital at allI have also been asked to emphasise again to the House and the country that the Chronically Sick and Disabled Persons Act, 1970, affects the mentally handicapped and the mentally ill just as much as it affects the physically handi-happed. Miss Applebey has put it to me that the more this can be rubbed in the better. We do, however, accept that there is no point in attacking local authorities unless we ensure that they have the resources to do what we want them to do.
I have only one other point to raise with the Secretary of State. It concerns the Education (Handicapped Children) Act, 1970. The Under-Secretary of State for Education and Science pointed out that the Financial Memorandum which was considered on 13th July, 1970,has no relevance … to any future increased expenditure."—[OFFICIAL REPORT, 13th July, 1970; Vol. 803, c. 1319.]The reference there was to future increased expenditure under the provisions of that Act. I should like to be certain that the local education authorities, whose responsibilities are much increased by that Act, will themselves not be short of the resources to implement it properly.
What we all want, on both sides of the House, is that those who are mentally handicapped and mentally ill should at least be allowed to live in circumstances of decency and dignity.
§ 6.30 p.m.
§ The Secretary of State for Social Services (Sir Keith Joseph)
Like all other hon. Members, I pay a tribute to my hon. Friend the Member for Leicester, South-West (Mr. Tom Boardman) for choosing this subject and for opening the debate in such a wide-ranging and constructive speech. His choice has been vindicated. If I may say so, I do not remember a debate containing more excellent speeches. I do not believe that a debate of this sort on this subject would have been possible 10 years ago. It might conceivably have been possible five years ago.
Although I shall refer to the main points made by all hon. Members who 89 have taken part, I wish to pick out, in particular, if I may, the speeches of the right hon. Member for Woolwich, East (Mr. Mayhew) of the hon. Member for Stoke-on-Trent, South (Mr. Ashley) and of my hon. Friend the Member for Aylesbury (Mr. Raison) for their combination of factual knowledge and deep feeling.
There is no doubt that the occasional scandal does an enormous amount for a social service. The Mental Health Act, 1959, carried through proudly, and rightly so, by my right hon. and learned Friend the Member for Hertfordshire, East (Sir D. Walker-Smith), which followed a Royal Commission, laid out the framework of what the country needed to do for the mentally ill and mentally handicapped. I recall that my right hon. Friend the Member for Chislehurst (Dame Patricia Hornsby-Smith) was in the Ministry just before that Act was passed. But the resources just did not become available in ample enough supply during the 1960s to make a very great difference.
There has been a difference for the mentally ill, thanks to the chemo-therapeutic revolution. There has begun to be a difference for mentally handicapped children, thanks to local authority expenditure on junior training centres. But there has not been enough change, and that is why we who are interested are now impatient to get on with the job. It was the series of incidents in the late 1960s which gave my predecessor an opportunity to begin a new impetus in care for the mentally handicapped, an impetus which I am glad to have the opportunity to acelerate.
I wish to pay tribute to four groups. First, I join with all those who have paid a tribute to the parents and families who cope, often under incredible strain, with mentally handicapped relatives. Second, I pay a tribute to the voluntary societies, which have pioneered a more humane attitude to the mentally handicapped. Third—I know that the whole House will endorse it—I pay a tribute to those astonishing people, the nurses. Occasionally, those of us who go to these hospitals—I expect that I am by no means the only one to have done it—will say to a nurse, "I am so glad that you choose to do this work. Why do you do it?", only to receive the answer, "I would not do anything else". It is a miracle of nature 90 for which one thanks God. Of course, there are criticisms. When one comes to analyse the pressures under which these nurses have to work, it is not surprising that there are episodes of which all concerned, and particularly the nursing profession, are ashamed. But, in general, the country owes a deep debt of gratitude to the nurses who care for the mentally handicapped.
The fourth tribute I pay is to my right hon. Friend the Chancellor of the Exchequer. It is a fortunate Minister, and, I believe, a rare one in my office, who has as his right hon. Friend at the Exchequer someone who has previously been Minister of Health. My right hon. Friend has made available more resources for the Cinderella sectors of the Health Service, and because of that extra money it has been possible for the White Paper to be published and to offer more resources than some people feared would be available.
Undoubtedly there is a changing attitude in the country, and the changing attitude in the country coincides with a changing prospect for the mentally handicapped themselves. Over the years, doctors, teachers and research workers have uncovered a latent potentiality in most handicapped people, though not in all, which responds to training and to loving care. It is now agreed, I think, that, given individual and loving care, almost all mentally handicapped children and adults—not all, but nearly all, can develop to a greater or lesser extent.
I remember the startling impression which I had when I first came to my present job on reading an anecdote in one of the books published by, I think, Dr. and Mrs. Clarke about two girls, both with the same I.Q. when they started and both with loving parents. One of them lived all day and night in bed, nursed by her parents, and the other, of the same age and starting with the same I.Q., kept house for her parents. In the second case, the child had been stretched by the loving care of her parents instead of merely being cherished and cared for.
There is, therefore, a prospect for many of the mentally handicapped, and, as my hon. Friend the Member for Leicester, South-West emphasised, most of them are loving and loved. Most of them are capable of giving and arousing affection. But, of course, as other hon. Members 91 have emphasised—I shall come to the points which they made—there are some mentally handicapped who are very disturbed, withdrawn or intractable and a few who are violent.
I have been asked to report on the position regarding autism. I fear that I have nothing new to say. There have been a number of debates on the subject recently, one answered by my hon. Friend the Under-Secretary of State, the Member for Barkston Ash (Mr. Alison). It is a subject which spans my Department and the Department of Education and Science. There is a lot of work going on. No breakthrough has been achieved, and I should be wrong to suggest that any progress has been made which should be reported since the last debate only a few months ago.
§ Mr. Alfred Morris
And the dyslectic child? There has been a great deal of work done, has there not?
§ Sir K. Joseph
Research is going on, but I have no change to report.
Against these more promising features, as my hon. Friend the Member for Aylesbury was right to remind us, there is a greater number of frail mentally handicapped children whose lives are being preserved. The capacity of doctors to preserve life is increasing the number of severely mentally handicapped who may live often for decades. I for one very much welcome the growth of discussion among doctors about where their ethical duty lies, a discussion which was focused by the broadcast by Dr. Henry Miller to which my hon. Friend referred.
The first matter which, I think, I should pick out of the mass of interconnected subjects with which we are dealing is, perhaps, the most important of all for the future, that is, the question of prevention. The House will have noticed that we have an appendix in the White Paper on prevention and early detection. There is no dramatic break-through at hand. There is a possibility, which is being deeply studied at the instigation of the M.R.C., of identifying Down's syndrome among older mothers early enough to offer them abortion where mental handicap is diagnosed. It may be that this could be a practical possibility within a few years. The House will know that mongolism, Down's syn- 92 drome, is a cause of a substantial proportion of severe mental handicap.
The White Paper does not seek to conceal the bad conditions of our services for the mentally handicapped. We have all paid tribute to the burden lovingly borne by the families at home, where most of the severely mentally-handicapped children are, as are nearly half the severely mentally-handicapped adults. But often the families go on bearing the burden long past the tolerable point and cannot pass it on to a suitable caring institution when the time comes. I am glad to say that the kind of case identified by my hon. Friend the Member for Luton (Mr. Simeons) is comparatively rare. As we decongest the hospitals by the growth of community services there will be places for those who become too great a burden for their families. It will not happen overnight, but I hope that such cases will become rarer and rarer until none is recorded.
In the hospitals, to borrow a phrase from the hon. Member for Stoke-on-Trent, South, patients are herded together. I will add a word to his phrase by saying that they are herded in conditions which are barbaric both for them and for those who have to care for them. We must try to understand the pressures upon the nurses in over-crowded, old-fashioned wards with minimum domestic staff, where because of the growth of local authority services patients tend to be far more severely subnormal than they were 10, 20 and 30 years ago.
The hon. Member for Woolwich, East asked me two questions. The letter of advice following the Farleigh Report has gone out from my Ministry to all hospital management committees concerned. The guidelines which the National Association for Mental Health initiated for the care of potentially violent patients are being discussed by the Royal College of Nursing and the Royal College of Psychiatrists preparatory to something appropriately professional being sent out.
Added to the burdens of which we are all aware, the hospitals for mentally handicapped tend to be very isolated physically, so that there is a danger of the patients quickly becoming cut off from their families, and the difficulty in recruiting staff, both professional and domestic, is made the greater.
93 In the local authority world, although there has been not nearly enough growth of homes—the homes recommended by the Mental Health Act—we should pay tribute to the remarkable surge of provision of junior training centres, what are now called special schools. Local authorities did remarkably well during the 1960s. About 10,000 extra places for mentally-handicapped children have been provided. But the local authorities have not begun yet to provide equivalent provision for the adults.
Against that background, the objective of the country is common ground. There should be a first-class service for the detection and assessment of mental handicap; a full range of services to support, educate and train the mentally-handicapped, wherever they are living; residential accommodation of a homely kind for those who cannot stay in their own homes; and hospitals for those who need services which only a hospital can be expected to provide. Towards the achieving of those objectives a considerable amount of research is in hand and will be needed. There is a report in Chapter 8 of the White Paper on research in progress.
I think that it was the hon. Member for Woolwich, East who emphasised the important part that incontinence plays in the life of the mentally handicapped. Yet we know that, given enough attention to habit training, the mentally handicapped need not generally suffer from incontinence. Of course, there are cases where physical disabilities are associated with mental handicap. The methods of communicating with and training the mentally handicapped are still in their infancy. An important group of research studies connected with special educational and treatment methods is reported on page 65.
The hon. Member for Birmingham, Ladywood (Mrs. Doris Fisher) asked me about research into the influence of lead in creating mental handicap. Research into the subject is going on at the Hospital for Sick Children, Great Ormond Street. I have not had an application from Aston University, but obviously any application will be studied on its merts.
I come to what we want to see provided. First, for the majority of the mentally-handicapped, living in their own homes, there must be much better sup- 94 port—more home helps, more social workers, better laundry facilities, more holiday or emergency relief, and, above all, alternatives available if the strain is too severe. The whole House will agree about that. I am sure that under the impetus of their new social service committees, local authorities will be embarking enthusiastically upon strengthening such services. We all agree, too, that in the community there should be homely homes, not called hostels, homes with ordinary homely addresses, of a homely size—20 or 25 at the maximum. I would prefer to see them even smaller for children, anyway. The hon. Member for Ladywood made a number of good points in connection with local authority provision, but I do not have time to go into them individually.
In the hospitals, we want to give the doctors, the nurses and all the other professions concerned a chance to do what they could do if they were not coping with such desperate overcrowding. We want to enable them to assess and reassess, to train, to provide day services and out-patient services. We want them to have a catchment area, to decongest, to improve. There may well have to be smaller units, perhaps much smaller units of the Kushlik, Wessex type in the community, associated with district general hospitals where those professional services can be provided.
That combination of support in the home, community services and hospital services will all depend upon educational provision. My hon. Friend the Member for Walthamstow, East (Mr. Michael McNair-Wilson) and the hon. Member for Ladywood both made a number of valid points that are primarily for my right hon. Friend the Secretary of State for Education and Science. All those services depend upon sheltered employment and training, in the hospitals, through industrial therapy, training schemes or in special schools. All depend upon multi-disciplinary assessment, reassessment and advice. I particularly emphasise my agreement with the hon. Member for St. Pancras, North (Mr. Stallard) who stressed the importance of multi-disciplinary advice being available through one door for the bewildered family. That is an objective at the heart of the White Paper, but it cannot be achieved overnight, as he knows.
95 Serving all those different places where the mentally-handicapped will be there must be the volunteer, as my right hon. Friend the Member for Chislehurst emphasised. No community can afford the money to provide all those services by the paid method alone. To support the family and the paid worker there must be the enthusiastic volunteer. Thank God there is a surge of volunteers coming forward.
That is a very tidy picture, but it does not correspond with reality. People are in the wrong place. People who should be in hospital are at home, and people who should be in homes are in hospitals. We have somehow to sort out the misplacements and stop more occurring. Therefore there is at the heart of the White Paper the simple principle of a stop—that is, the local, regional and, one day, the national stop. As a result of the discussions that will be taking place on the initiative of the regional hospital boards later this year, each area and region will assess the date by which local provision should be enough to enable hospitals no longer to accept cases that do not need hospital treatment. That date may be fairly soon—within two or three years in some areas where the local authority provision has already begun to approximate to what is needed. In other regions it will be more remote.
I hope—I shall come to what I shall do in connection with local authorities—that we may reach that stop before too long. As we begin to decongest the hospitals, the virtuous cycle to which hon Members have referred will begin. The less-crowded hospital will have a higher staff ratio per patient, the staff will be able to begin to train patients, more patients will become suitable for discharge to local authority homes and this, again, will improve the staff-patient ratio.
Against this background, what is the area of disagreement? The hon. Member for Oldham, West (Mr. Meacher) made, I thought, an unnecessarily strident speech. There is an area of disagreement here. Some doctors would like us to place more emphasis on hospitals where, they say, they can guarantee—once we end the crowding and provide the money—loving, graded, sheltered care and training and a happy life for their patients. There are others 96 who say that the hospital will have no purpose to play in 15 years' time.
We do not, however, have to make this decision now. There is so much that we have to do before that date can possibly come. The local authority provision is nowhere near enough yet. We have years of slog to get local authority homes in sufficient quantity to absorb those occupants of hospitals who, everyone agrees, should not be there. The time may come when these isolated hospitals will find it hard to play a purpose.
§ Mr. Meacherrose—
§ Sir K. Joseph
I am sorry, I cannot give way. I am not disagreeing with the desire of the hon. Member to make as great a success as possible of community care, but we do not have to take this dreadful decision now whether the mental hospitals will survive after 15 years. We have to make life tolerable in them now. The hon. Member would agree upon that. The staff and the inmates cannot be left, while local authority provision is building up, to continue in these barbarous conditions of today. We have to look after the morale of the menial hospital staffs. In future, hospitals may need to be much smaller and much more local, but meanwhile we have a great amount to do that all agree should be done.
The White Paper tries to set out the whole spectrum of overlapping considerations. I inherited a draft from my predecessor. I have acknowledged my debt to him. Local authorities now know their targets; hospitals know the prospect ahead of them. This I can guarantee : that within a few years' time, there will be no mental handicap hospitals, such as there are today, so overcrowded, so ill-founded and so inadequately staffed.
I must, however, report to the House that there is a big job to be done in improving the management in the hospitals for the mentally handicapped. I have already paid tribute to my predecessor for initiating and creating the Hospital Advisory Service. I would like once again to pay public tribute to Dr. Baker and his teams, who are doing an astonishing job of friendly analysis and advice in the mental handicap, mental illness and geriatric hospitals.
A new generation of consultants is growing up. These doctors will replace 97 the traditional—and often worthy and respected—rôle of the medical superintendent by working closely with their senior nursing and administrative colleagues as members of a multi-disciplinary team. These doctors are increasing the services of the hospitals by providing for day patients, running out-patient clinics and joining paediatricians in assessing handicapped children. It is, however, exasperating that even with existing resources in existing hospitals, some teams do so much more for patients than others. The question of multi-disciplinary management can transform life for the patients in these hospitals.
We have provided more money—never enough, but more. About half is going to the hospital service and about half through the rate support grant to local authorities. The House will have noticed that on page 42 of the White Paper there is a table of the gap which has to be filled in adult training centres and, above all, the childrens' and adults' homes. I am glad to say that even before the White Paper was published, local authorities had bid to me enough adult training centre provision to fill over one-quarter of the gap over the next four years and a substantial proportion—about the same—of the gap for adults' homes and children's homes.
I hope that as a result of the White Paper and what will follow it, local authorities will increase their bids. There are many competing pressures upon them, but they are enjoying a 12 per cent. increase in real terms this year over last year and will have a further 12 per cent. increase in real terms next year over this year in the rate support grant for health and welfare services.
It is my intention to ask the regional hospital boards to initiate this autumn talks with local authorities to discuss local plans for providing homes, training centres, day centres and supporting services. It is my intention—this has already been announced—early next year to invite local authorities to prepare, preparatory to submission to the Government for publication, a 10-year programme for all health and welfare services. As a result of the regional hospital board area discussions which will start at the end of the year, and of the pressure that, I 98 promise, I shall bring to bear by persuasion on local authorities, I hope that we can improve upon the figures I have already given.
It will take five years to make a real difference to the present position but I believe that in 10 years' time the position for the mentally handicapped and their families will have been transformed. I believe that in 15 years' time we shall nearly have finished the job of making this country a civilised place for the family of a mentally-handicapped child. No one thinks that it can be solved by a wave of a magic wand. We have decades and generations of relative neglect to repair, but the Government are determined to achieve and maintain a momentum.
I conclude by thanking again my hon. Friend for initiating what has been a most constructive debate.
§ Question put and agreed to.
That this House welcomes the recent White Paper, Better Services for the Mentally Handicapped, with the renewed emphasis on community care, the policy of providing community instead of hospital care for the mentally handicapped who do not need hospital treatment, and the additional £40 million made available by the present Government for accelerating over the next four years the increase and improvement of community services for the mentally handicapped and the improvement of conditions in the hospitals for the mentally handicapped.