HC Deb 27 April 1978 vol 948 cc1811-22

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

11.42 p.m.

Mr. Tom Pendry (Stalybridge and Hyde)

I do not apologise for raising once again in this House problems experienced by my constituents. But on this occasion I should like to think that the fears which I express tonight are shared by all not only in my constituency but in the metropolitan district of Tameside itself. The problem is that of the treatment and care of the elderly and adult mentally ill.

It has been recognised generally that the area health authority and the social services departments within Tameside are among the poorest in the country, and this applies especially to the psychiatric services. The three consultants for adults and the elderly were appointed to the Tame-side General Hospital on the basic understanding that they would operate within a policy laid down by the North Western Regional Health Authority to develop a comprehensive service for all categories of mentally ill in Tameside. It was also understood by them that it was to be the policy to have full hospital facilities locally based as soon as possible and practicable so that patients and their relatives would not have to travel long distances out of the area. It was also hoped to develop the community services, such as community day centres, enabling, through the building-up of these facilities, a reduction in the need to admit all patients to hospital for in-patient treatment. I regret that none of this has happened. The actual situation presents a very different picture.

I intend to quote some national figures and Government recommended figures from either the White Paper "Better Services for the Mentally Ill" or the Command Paper "Priorities for Health and Social Services in England 1976" and others to back up my claims.

Let me first speak of the in-patient situation. The Department of Health and Social Security norm for a population the size of Tameside's—that is, about 250,000 people—is 125 beds for the type of patient of whom I am speaking. At the Tameside General Hospital there are 61 beds in operation. One ward has had to be closed for urgent repairs, and even when the four wards planned to deal with inpatients are opened by the end of this summer, there will still be only 78 beds avaliable—a shortfall of 47.

It is true that arrangements are in existence with two hospitals outside the region, but the beds there are also available to every other consultant in the North-West, and the maximum that Tameside is ever able to call on at any one time at Cheadle Royal is 12. The use of these beds can in itself create additional problems, as they come under the jurisdiction of another regional health authority. There is no clinical control by Tameside. The staff there are unaware of the local pressures on the patient. Family and friends have long distances to travel to the hospital, and in the case of Parkside, it is a 42-mile round trip from the centre of Tameside to that hospital.

Tameside, of course, has no say in the discharge arrangements, but has to provide the follow-up care, adding yet another burden to the overstretched facilities. The lack of local knowledge about the patient can clearly lead to errors of judgment in relation to discharge.

I hasten to add that in no way am I criticising the hospitals concerned, or their staff. I am merely pointing out an aspect of this arrangement—care outside the region—that is often not considered.

It has also been recognised that day places at hospitals can play a vital role in the care of the adult mentally ill and can also keep a patient out of long-stay hospital. In Tameside we have 50 such places. The DHSS norm is 160. At Hyde, in my constituency, there are 17 jointly financed day places. The DHSS norm is 32. There are an additional 17 local authority jointly financed day places. The DHSS recommended norm is 150. There are occasional social clubs, but overall this very important aspect of care is being sadly neglected.

This is also the case with hostels—both the medium-stay staffed hostels and the staffed short-stay hostels. The DHSS recommended that we should have 30 beds in the former category and 15 in the latter. It is sad to relate that Tameside has none in either category. We are at last getting some non-staffed local authority group homes and flats, where the newly discharged patient has to look after himself or herself. Both the day places at hospitals and the hostels play a vital role in the care and treatment of the adult mentally ill within the community, and so help patients to rehabilitate themselves as well as to alleviate the pressure on inpatient services at hospitals.

I call upon the Minister to think very carefully about extending or at least making available the means to provide the recommended number of places in these categories of care, so as to free the staff at the hospitals for patients who need not be inmates and who are there because of the lack of vital rehabilitation facilities.

It is recognised by the consultants in the area that they would just about be able to cope with the most acute cases provided that they were relieved of the new long-stay psychogeriatric patients who occupy 30 per cent. of the acute beds.

I would suggest that the answer does not lie in the recent suggestion of the Mersey Regional Health Authority, into whose area Parkside Hospital falls. The authority suggests that 50 per cent. of the full range of psychiatric services for adults within the Tameside health district should be provided from Parkside. I hope that the Minister will join with me in opposing this plan, as it would be a grave retrograde step, causing distress not only to the patients but to the relatives, and causing a great deal of discontent among patients and general practitioners.

From the autumn of this year, there will be 55 in-patient and 60 day places at Hyde for the elderly severely mentally infirm. The DHSS recommends 100 places for each. That is a shortfall of 45 and 40 respectively. At present Tameside General Hospital ward 21 has 32 beds. Additional beds are available outside the area, but even these have recently been reduced in number.

We fare no better with the staffed old people's homes. The national average is 18 beds per thousand elderly. Tameside has eight per thousand—in other words, 260 for 34,000 elderly, 300 places below the national average.

I call on my hon. Friend to pay special attention to these facts and to do whatever he can with the funds available to assist my area to build staffed old people's homes so that we in Tameside shall at least be able to provide the minimum care for the elderly.

In addition to requesting that priority be given to building old people's homes, I should like to hear from my hon. Friend when it is intended to have the psycho-geriatric ward fully opened at Hyde. Will he use his good offices with the regional health authority to ensure that ward 21 at the Tameside General Hospital is upgraded to supply 10 physiogeriatric assessment beds and 20 medium-stay beds to ensure that the present staffing complement is retained to cover the ward?

I have no time to talk about all the problems for the mentally handicapped or child psychiatry and the extremely limited facilities for psychotherapy, psychosexual counselling, adolescent treatment, and so on. I hope that on some other occasion I can return to these subjects, because their problems are as grave as those I am outlining.

I should like to stress that the service provided by the medical staff cannot be praised highly enough, but it must be extremely galling for highly qualified, dedicated people to see their efforts wasted by lack of facilities and the necessary ancillary provisions. The staff, patients and families in my area deserve much more.

So far I have spoken mainly about the frustrations, the shortages and the needs. Let me now speak of some success stories, though I am sure that my hon. Friend will be the first to appreciate that they will not continue if funds are not forthcoming to ensure that work can be carried out.

The Samaritans, MIND and the new Dial for Help service all play a vital role in the community and often do the work of the statutory authorities. Additionally, the National Council for Alcoholism has recently trained two volunteers to act as counsellors in Tameside. Within two weeks, and with practically no publicity, 24 people had come forward for help. More voluntary counsellors must be trained quickly to deal with this previously unmet need.

MIND has set up a group which will care for three people discharged from hospital. The money that this will save the National Health Service is significant. MIND hopes to set up more group homes. However, although the social services are involved in so far as they provide the furnishings for these homes, should MIND run out of funds the present home or any of the planned ones would become a burden on the local authority and probably remain unused. MIND has also set up structured relative support groups, psychiatric clubs and has made other small but significant contributions towards easing the burden on the NHS.

The secretary of MIND, Barry Barrett, who single-handedly organises the volunteer groups, speaks to small groups and school groups, deals with the administration and is often called out in the middle of the night to help and advise relatives and neighbours, was employed under the Manpower Services Commission job creation scheme. At present, however, he is working for no salary, because the urban aid grant, which it was hoped would provide the finance for this scheme in the future, terminated on 14th April and has not been renewed.

I ask for my hon. Friend's support in this matter. I have asked the Department of the Environment to renew the scheme, and my hon. Friend's support would be most valuable in this regard. Should Mr. Barrett have to terminate his work, not only will a valuable member of the community be out of work but an invaluable service to the Tameside area will cease to exist. This would not only be wrong but, to my mind, would be criminally negligent.

I have spoken at some length, and I am grateful for the opportunity to do so. The time is ripe for action. I am sure that my hon. Friend has been impressed with the case, as my right hon. Friend the Minister of State was when he came to Tameside with me and saw the problems at first hand. We want rather more than sympathy. We want some action. We want to see that the size of these problems is recognised and that the problems are dealt with.

I urge the Minister to do all in his power to hasten the day when the plans submitted by the area health authority to alleviate the problems that I have outlined will become reality, not in 1987—which is currently the thinking of the Department—but in 1980. The people whom I represent deserve action now.

11.55 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

I am glad that we have this opportunity to debate the care of the adult and the elderly mentally ill in Tameside. I pay tribute to the efforts of my hon. Friend the Member for Stalybridge and Hyde (Mr. Pendry) in focusing attention on this issue, and very much welcome the active local concern which he represents this evening.

It may be helpful if I begin by sketching in a little of the essential background. Tameside Area Health Authority came into being in 1974 under the National Health Service Reorganisation Act 1973 and is responsible for providing comprehensive health care services for a population of about 250,000. The authority inherited various hospital and community health services, but until recently the health care needs of the population had not been systematically identified and quantified.

It has been recognised for some time that the North Western Health Region, which includes the Tameside area, has not received its fair share of the resources available to the Health Service nationally. It follows that, despite the best efforts of the staff, to which I pay tribute, services in the area for many health care groups, including mentally ill, are less than the people of Tameside have the right to expect from a national health service.

Having said that, this Government are the first to have recognised fully the needs of the North Western Region and we have started the region on the road to getting its fair share of the NHS budget. Last year the region had a growth rate in its revenue allocation of 3.2 per cent., the highest of any region and more than twice the national average. This year, following the Budget Statement by my right hon. Friend the Chancellor of the Exchequer, we have done even better, and the region has had a growth rate of 4 per cent. in its revenue allocation. However, because the region has been so badly deprived of resources in the past, it will still take some time to meet all the needs that have now been identified.

A similar pattern of deprivation emerges, I regret to say, in relation to the local authority personal social services, which have a vitally important role in the care of the mentally ill and the elderly.

The social services have a considerable impact on health services, and vice versa, and this interdependence makes it essential to have effective arrangements for joint planning to secure the best balance of services and to make the most effective use of the resources available. Joint planning is vital to the Government's overall strategy of developing community-based services so that wherever possible people are kept out of hospitals and other institutions and are supported within the community.

A service which is jointly planned will generally fall to be financed by the responsible authority from its ordinary budget. However, the Government recognised that the different methods of financing health and local authorities could hinder effective joint planning and accordingly we introduced in 1976–77 arrangements to ease some of the short-term difficulties which might otherwise arise locally in jointly planned schemes.

In essence, joint financing is designed to allow the limited and controlled use of resources available to health authorities for the purpose of supporting selected social services spending by local authorities. In 1977–78 Tameside's joint finance allocation was £108,000, and £38,000 of this total was spent on supporting schemes for the mentally ill.

As my hon. Friend will know, Tame-side local authority district was created following local government reorganisation by the amalgamation of parts of Cheshire, Derbyshire, Lancashire and the West Riding of Yorkshire. The district, therefore inherited rather disparate and unco-ordinated social services provision from the former local authorities. At present there are six places for the mentally ill in sheltered accommodation. A further 10 places are currently being provided in three group houses and this scheme is being financed through the Government's urban programme. In addition, the local authority has in its capital programme a new 16–20 place home for the mentally ill, and work is scheduled to start on this next year.

I understand also that MIND is proposing to provide two group homes and that the local authority has already allocated to them one house for this purpose.

I am glad that my hon. Friend has paid tribute to the work of this and other voluntary organisations. In this connection the grant for a MIND worker is something that I shall look into, and I shall write to my hon. Friend about it.

As my hon. Friend will know, there is a community health centre in Hyde which provides about 35 day places for the mentally ill on a "walk in" basis, and the running costs of this centre are at present met partially by the area health authority through joint financing. There is currently no separate local authority provision for the elderly mentally infirm, who are accommodated in the general provision for the elderly, which consists of 340 places in 10 homes, together with a day centre.

I turn now to Health Service provision and planning. Last year the regional health authority published its strategic plan setting out a comprehensive programme for remedying identified deficiencies across the whole range of health services and my hon. Friend may know the regional health authority identified as priority services those for the mentally ill and the elderly, including those suffering from severe mental infirmity. It may be helpful if at this point I outline in turn the policies for the mentally ill and the elderly severely mentally infirm which authorities have been asked to pursue in providing and developing services for these health care groups.

The development of services for these groups is one of the Government's most urgent priorities in health and social services. The Government's White Paper "Better Services for the Mentally Ill" (Cmnd. 6233), issued in October 1975, set out the long-term strategy for meeting the various needs of mentally ill people for treatment, care and support. The view that we take is that mentally ill people who can live successfully in the community—either in their own homes, in homes or hostels provided by the local authority or by voluntary organisations, or in other types of sheltered accommodation—should be encouraged to do so. When hospital treatment is needed it should be available locally, near to the patient's home and family, and people should not have to remain in hospital if they do not need the specialised medical and nursing care provided there.

Past experience clearly shows that patients who spend long periods in mental hospitals isolated from family and friends have much more difficulty in returning to the community, and in some cases it has proved impossible. The psychiatric unit at the district general hospital is intended to be the centre of specialist psychiatric treatment of mental illness for all adults from its health district. It will act not simply as an in-patient department but as a centre providing facilities for treatment on both a day and in-patient basis, and as the base from which the specialist therapeutic teams provide advice and consultation outside the hospital.

Until the new pattern of locally-based psychiatric health services is fuly established—and we see this as being a 20-year to 30-year programme—the large mental hospitals will continue to have an important and valuable contribution to make in the specialist treatment of the mentally ill. The role of the mental hospitals and ther problems during this transitional period are currently being studied by a working group set up by the Secretary of State and due to report at the end of this year.

The new pattern of services also calls for a considerable range of facilities outside hospital for the care and support of the mentally ill. The support facilities must include more than a place to stay. As well as residential accommodation, domiciliary services, day care, employment rehabilitation services, sheltered employment, social work support, and appropriate health care in the community all need to be developed.

The Government's consultative document on priorities for the health and social services, issued in 1976, endorsed the aims of the White Paper and put particular emphasis on the need for more residential accommodation and day care for the mentally ill to be provided even at a time when resources were limited and when such developments might therefore have to be at the expense of other services. This priority was confirmed in "The Way Forward", published in September 1977 and in the national "Guidelines" that we published last month.

As for the elderly mentally infirm, it must be remembered that the vast majority of elderly people suffering from some degree of mental infirmity—currently thought to number, in England, at least 500,000—are cared for in their own homes with the support of the primary health care and the social services. Some are accommodated in residential homes, either alongside other residents, in discrete wings or in completely separate homes, depending on the local authority's policy. However, about 17,000 such persons—mainly those suffering from severe mental infirmity or dementia—are currently in hospital, and many will no doubt continue to need this degree of care.

Others will come to need it, and an overall long-term in-patient provision for 3 per cent. to 4 per cent. of the elderly suffering from mental infirmity will probably continue to be desirable for the future. It is planned to replace the old mental illness long-stay hospital beds as quickly as possible with beds in small, discrete units within local community hospitals at a general level of between two and a half and three beds per 1,000 elderly population. A similar percentage of the elderly with mental infirmity may benefit from attendance at a day hospital, and provision for these facilities is recommended at a rate of between two and three places per 1.000 elderly population. For some time to come these facilities will no doubt have to be provided in adapted existing small local hospitals, but health authorities are being encouraged to allocate over the next four to five years about 30 per cent. of their capital earmarked for mental illness development towards replacing their unsatisfactory long-stay mental illness hospital provision—at current price levels an annual programme of some £8 million.

Day hospital provision and out-patient services will be funded separately. An overall development programme for these facilities of about 30 years is currently envisaged in order to achieve the recommended levels of provision.

The North-Western Region was a pioneer in moving towards the new pattern of locally-based mental illness services, and already two-thirds of admissions are made to district general hospital units.

Provision for the mentally ill and elderly severely mentally infirm in Tame-side is not ideal, as my hon. Friend has said. Current facilities in the area are inadequate. At present there are at Tame-side General Hospital 80 mental illness beds, 50 day places and a further 46 beds for the elderly severely mentally infirm. The existing number of adult mental illness beds represents only about two-thirds of the provision indicated for that specialty by the region's norms of provision based on my Department's planning guidelines.

Similarly, Tameside has a little less than half the number of beds it requires for the elderly severely mentally infirm. The existing provision is at present supplemented by patients from Tameside being treated at other hospitals outside the area, notably Parkside Hospital, at Macclesfield.

It is recognised by the area and the regional health authority that this situation, where patients are treated some distance from their homes—is undesirable from the point of view of both the patients and their relatives, and the authorities recognise the need to provide more psychiatric facilities within the area.

As my hon. Friend will know, there is currently under construction at Hyde Hospital, in his constituency, a new unit for the elderly severely mentally infirm which will provide 56 beds and 50 day places at a capital cost of £1.3 million. This unit is due to open before the end of the year and will be a very significant addition to the psychiatric facilities in the area. In addition, the regional health authority has decided very recently to include in its capital programme a new mental illness unit, at Tameside General Hospital, of 120 beds and 160 day places, and work on this is scheduled to start in the mid-1980s.

The completion of these schemes will mean that the residents of Tameside will no longer have to rely for psychiatric treatment on hospitals outside the area. I recognise that the starting date for the unit at Tameside General is not as early as we would all wish, but this is something that has to be seen in the context of the other heavy pressures facing the North Western Region, which has inherited some of the oldest hospital buildings in the country.

I hope that my hon. Friend will agree that while the facilities in the area for the adult mentally ill and the elderly severely mentally infirm are not adequate, this is recognised by the authorities concerned, and that they do have a continuing programme for meeting, the needs that undoubtedly exist and which my hon. Friend has so graphically described.

Question put and agreed to.

Adjourned accordingly at eight minutes past Twelve o'clock.