REGIONAL SECURE UNITS

HC Deb 16 June 1978 vol 951 cc1430-42

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

4.0 p.m.

Mr. Michael Spicer (Worcestershire, South)

One of the advantages and benefits of the last debate is that the Minister of State is to respond to my remarks. I have never experienced a Minister of State replying to an Adjournment debate, particularly on a Friday. I hope that his presence will mean that I shall receive some crisp, authoritative answers to the several questions which I wish to put to him.

In a debate on 22nd March in another place, the Minister of State, Home Office, Lord Harris, said: I think we can state this problem very simply so far as secure units are concerned. If we do not get them, a large number of mentally ill people are going to remain in prison. He went on: It does not seem to me that there is anything particularly liberal about not having enough secure accommodation; in fact the reverse is true."—[Official Report, House of Lords, 22nd March 1978; Vol. 389, c. 1886–7.] Those comments set the scene for my speech.

The shortage of time in an Adjournment debate does not permit one to go into the complexities of this extremely difficult and complex matter. The best approach I can make is to highlight what I am beginning to believe is a national scandal which, among other things, calls into question the accountability of regional health authorities for moneys allocated by central Government.

Let me highlight the whole issue by bringing to the attention of the House the case of a constituent of mine, Mr. Richard Tolley, who is 23 and who was sentenced to two years' imprisonment at Worcester Crown Court on 9th March this year after the psychiatric services had, in effect, given up on him. One of the ironies of his case is that the greater has been his will to overcome his mental illness, the less willing have been the psychiatric services to cope with him.

In the judgment on the case, the recorder said: Richard Martin Tolley…the medical evidence in your case is considerable, but may be summarised as follows: you suffer from severe mental illness, which is schizophrenia, or an illness akin to it, in the opinion of most of the doctors whose reports we have seen … You have in the past acted violently, using an axe, threatening members of your family, which has caused the police to come to your home on three occasions, and, of course, assaulting your mother, which led to your appearance before the justices… Suitable treatment is available to you in prison, and lastly and most importantly, there is no suitable place in any hospital whatever outside the prison service which is suitable to you. Now I say straight away that this is a very sad case and one which has caused us considerable anxiety… What we shall do is to pass sentence of two years' imprisonment… A prison sentence is, in the absence of a hospital order, justified in your particular case. I shall return to the question of whether it was justified.

After the sentence, the Minister of State wrote to me on 5th April in the following terms: The West Midlands Regional Health Authority arranged for Mr. Tolley to be examined by a consultant psychiatrist from Barnsley Hall Hospital. The report received supported the view of other psychiatrists (except Dr. Richards of Powick Hospital) that Mr. Tolley might benefit from psychiatric treatment, but that such treatment must be given in conditions of greater security than an ordinary psychiatric hospital. As Barnsley Hall has no secure facilities at present the consultant psychiatrist was not prepared to admit Mr. Tolley … At present no hospital in the Region has secure facilities suitable for Mr. Tolley, and it was felt most improbable that any psychiatrist would be prepared to admit him. The Department reconsidered the possibility of admitting Mr. Tolley to a special hospital but considered that there was insufficient evidence to justify this course of action. At the court hearing on 3rd March, Dr. Bickmore, the medical officer at Gloucester Prison, said that he was asking a consultant psychiatrist at Broadmoor Hospital" to see whether Mr. Tolley could be admitted. Mr. Tolley was examined at Broadmoor Hospital on 7th March and the opinion of the consultant psychiatrist there is that whilst having a personality disorder, he does not now suffer from mental illness of such a nature or degree as to warrant his detention in hospital. One there comes straight away across a perfect example of the subjective, not to say haphazard, process by which diagnosis as between personality and mental disorders.

The letter continues: The consultant certainly did not consider Mr. Tolley suitable for placement in a special hospital. This report, and, of course, the earlier reports, were before the court when Mr. Tolley appeared before them on 9th March. He was sentenced to prison for two years, and although for the moment no further action can be taken certainly this is not the end of the matter if circumstances change. Whilst in prison"— this is the key issue— Mr. Tolley will be under observation and provided with all treatment that is considered necessary. In the light of that last sentence in the Minister's letter, I shall quote now from a letter to Mr. Tolley's father, dated 13th March this year, from Mr. A. H. Rayfield, the governor of Gloucester prison, where Mr. Tolley is serving his sentence. I have clearance from the governor giving permission to quote the letter: It is obvious that Richard has been sent to prison because there is nowhere else for him to go. He will be seen by a visiting psychotherapist whilst he is here, but you will appreciate that we cannot give him the specialised care he would expect to find in a hospital. That goes in flat contradiction to what the psychiatric services were saying and, indeed, what was said in the Minister's letter—on advice, I am sure. The chief inspector of police in Evesham summed up the position with the directness for which his profession is famed when he said: The whole situation is ridiculous. The lad needs treatment, not punishment. My principal reason for raising this matter is that Richard Tolley's case is one of hundreds of similar tragic cases of mentally ill or subnormal patients who are currently languishing in prisons throughout the country.

A series of Questions which I put to the appropriate Ministers earlier this week and last week revealed an appalling lack of information in the Government's possession, although the whole question was first highlighted soon after the passing of the Mental Health Act 1959, resulting in 1972 in a committee being set up under the chairmanship of Lord Butler to study the whole problem of mentally disturbed offenders. That committee reported in August 1975.

The figures available to the Government indicate that at the end of last year there were almost 700 inmates of prisons who were considered by the prison medical authorities to be suffering from mental disorder. I should add that there are other estimates—one was published in The Sunday Times at the end of last year—putting the figure considerably higher. But even the Government have set a target of 1,000 beds in regional secure units.

It seems that over the past two years, in order to meet the problem, the Government have allocated some £14 million to regional health authorities. I mention that figure with some trepidation because I received today an answer from the Minister of State which calls in question the amounts of money which have been allocated. At least, I may have misunderstood the figure in some way, and I should be grateful for clarification.

The answer which I have received today indicates that only £¼million was allocated last year—that is, in 1977–78. I suspect that that is a capital item and that other items are to come. I see that the Minister nods, but my question then is: for what other things, apart from capital items, can money be allocated when we do not even have the hospitals built?

There is some confusion, but, when the hon. Member for Basildon (Mr. Moon-man) put down a Question last week in which he mentioned the £14 million, the Government never denied that figure. Thus, one has to work on the assumption that £14 million has been allocated over the past two and a half years, yet, as far as I can see, this has resulted in not one penny being spent by the regional health authorities on regional secure units. Not one of them has any advanced plans for the building of regional secure units, and most of them are talking rather vaguely about constructing regional secure units in the 1980s.

One is entitled to ask what has gone wrong. The recommendations of the Butler Committee were quite clear—that Part V of the Mental Health Act 1959, which dealt with the whole question of the treatment of mental patients convicted of criminal offences, needed to be substantially revised and rethought. That was said in 1974. I understand that those recommendations of the Butler Committee, relating to the provision of regional medium secure units, have been accepted by the Government for the past two and a half years, and for that purpose £14 million was allocated.

I cannot see where the obstruction lies. The psychiatric profession is admittedly divided on the type of unit it requires, but it seems to be fairly united —that is a remarkable event in itself in that profession—on the need for some kind of semi-secure unit where potentially disruptive mentally ill patients can be placed.

It is true that psychiatrists and psychiatric hospital administrators have been very reluctant over the past decade to accept potentially disruptive patients. It is a sad probability that some psychiatrists are resorting to diagnosing psycopathic disorders specifically to ensure that potentially disruptive patients are transferred to prison and not to hospital.

It is said that regional health authorities are unwilling to override any local public opinion which is concerned about the placing of a regional unit in their area. If that is true, more publicity deserves to be given to the recent experience of the regional health authority in my region, which has made a start to build on to the Hatton Hospital, the central psychiatric hospital in Warwickshire, a small interim unit. Its experience in holding what I understand to be a highly successful public meeting, in which it involved the local community and was able to allay many of the local community's anxieties, bears looking at by other authorities. That approach should overcome local anxieties, certainly in the long term.

It is also claimed that the unions, particularly the Confederation of Health Service Employees and the National Union of Public Employees, are against the building of regional secure units. My understanding is that they are taking a negotiating stance concerned with manning levels and conditions of service rather than one of outright opposition to the whole concept.

One suspects that there is a lingering anxiety about the construction of old-fashioned asylums and that this is the overwhelming reason why no action has been taken. If so, the position is tragic. In no conceivable circumstances can it be better to keep these unfortunate people in prison—where, as we have already seen from the letter I have received from the prison governor, they have no proper facilities, whatever the authorities say—than in purpose-built hospitals dedicated to their rehabilitation.

My guess is that the real reason behind the inertia is the low priority given to mental health in the Health Service. In this context, it would be extremely helpful if the Minister of State could give the Government's position on three specific questions. First, do the Government continue to accept the necessity for purpose-built hospitals housing around 100 mentally ill patients in conditions of some security?

Secondly, if the Government continue to believe in a policy which has been advanced by all responsible Ministers continually over the past two years, what sanctions do they intend to impose on regional health authorities which have misspent, and, as far as one can see, continue to misspend, the millions of pounds allocated to them?

Thirdly, what new initiatives do the Government propose to take in order to put right a situation in which those who are mentally ill and potentially disruptive to the routine of a conventional psychiatric hospital but who have no record of excessive violence are destined to serve fixed prison sentences, at the end of which neither they nor the society into which they return are any better off?

I should be very grateful if the Minister would be kind enough to answer some of those questions.

4.14 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

It is very useful that we have had an opportunity to discuss the question of regional secure units this afternoon.

The Government fully recognise the need—I think that this answers one of the three questions that the hon. Member for Worcestershire, South (Mr. Spicer) put at the end of his speech—to provide more facilities for the treatment of mentally disordered patients in secure settings. We regard this matter as one of urgent priority.

I take issue with the hon. Gentleman when he says that mental health is given low priority in the National Health Service. Mental health, mental illness and mental handicap are the top priorities of the health service and we wish to finance and develop facilities to deal with them.

I come to the background to this policy. It has always been part of the responsibility of the National Health Service to care for and treat all psychiatric patients and—except for the very small number of patients who require treatment in the specially secure conditions of the special hospitals such as Broadmoor—this includes providing suitable hospital places for those who need to be compulsorily detained.

There have been changing trends in the psychiatric services in recent years. There has been a trend away from custodial care towards treatment and therapy. There has been a trend towards open wards. These trends have made it more difficult to meet the responsibility which the NHS has for the persons whom we are discussing this afternoon. Staff are often reluctant to concentrate their valuable time upon patients who cannot easily be helped and who are likely to disrupt the normal life of the hospital as opposed to the vast majority who can be assisted by various therapy and care programmes.

Over the years this feature has meant some reduction in the ability of the NHS to help those few patients who need secure provision short of the very high level of security provided by the special hospitals. The Department set up a working party in 1971 to consider the present and future needs for security in psychiatric hospitals and units. The working party recommended the establishment of regional secure units and this was endorsed in 1974 by the interim report of Lord Butler's committee dealing with abnormal offenders.

We sent out a circular in July 1974 asking regional health authorities to establish regional secure units and, in the meantime, to set up some interim secure facilities. Authorities have been looking into the position in their regions and preparing plans for submission to the Department. We promised to meet the capital cost of approved schemes and have provided special allocations towards the running costs of secure facilities.

The hon. Member referred to a Question which he asked me. I cannot remember the exact wording of it but it had to do with how much money had been spent on secure units. I interpreted that to be asking for certain information about capital expenditure and answered it in those terms. I shall come to running costs, which are a different matter altogether, in a few moments.

What is the purpose of these units, and what type of patient will they accommodate? There has been a lot of misunderstanding about this in some quarters. It is not intended that the units should take all patients who are violent from time to time but that they should provide relatively short-term—no more than 18 months to two years—intensive treatment in a secure setting. The units would be directed at those who present persistent problems of a degree which makes their local management impossible and who are likely to respond to the active therapeutic regime of the unit.

These are patients who are beyond the capacity of the ordinary open psychiatric hospital or unit to manage, even with a high level of staffing oversight. They will come from a variety of sources. Some will be transferred from other hospitals or units, while others may be admitted directly on court orders or transferred from prison under Section 72 of the Mental Health Act. On occasion, some may even be transferred from one of the special hospitals.

These regional secure units are not intended to be the sole provision for offender patients. We would expect the ordinary hospitals to continue to accept and make provision for a number of patients on court orders or on transfer from prisons or special hospitals. The special hospitals will continue to take those who need a high level of security.

The hon. Member was on firm ground when he spoke about the slow progress in setting up these units. I frankly admit that progress has been disappointingly slow. However, there has been some progress, although this has been faster in some parts of the country than in others. Ten of the 14 regional health authorities have now put definite proposals to the Department for regional secure units and we know that the other four are actively preparing their plans. In addition, four designated interim secure units are operational and a number of others are being urgently planned by health authorities.

My right hon. Friend the Secretary of State recently discussed the rate of progress with regional health authority chairmen to see what steps might be taken to speed things up. All the chairmen, without exception, confirmed their support for the policy, but pointed out the very real difficulties that they are facing. For example, there has been public opposition to the proposed location of the secure units in a number of cases—very often, in my view, based on a misunderstanding of the nature and purpose of the units, the kind of patient put into them, and the risk that the patients represent to the local public.

Staff attitudes are also a key factor. The hon. Gentleman was not inaccurate in the way in which he described the attitude of NUPE and COHSE, except that I would add that perhaps NUPE is a little more wary than COHSE of the developments. Some of the staff are reluctant to become involved in the care of patients who are unwilling to cooperate, are disruptive, and are at times violent, and I think that most of us can have some sympathy with such feelings. Many of the existing psychiatric hospitals are totally unsuitable for housing such violent patients.

I recall that at one of the first hospitals I visited on taking up my present post I saw one patient suffering from schizophrenia and epilepsy confined to a small box-like structure for most of the day, in a large open ward, because it was an ordinary psychiatric hospital which had not been constructed to take care of his problem. No one would say that his life in such an environment was ideal for him.

In order to help satisfy and solve the problem of staff interests, my right hon. Friend has set up a special working group comprising representatives from the TUC, the Royal College of Psychiatry, the Royal College of Nursing, regional health authorities and my Department, to help overcome local difficulties. The group has so far advised upon problems at Prestwich and Rainhill and how they may be overcome. The planning of these units is a considerable task, which involves a great deal of preliminary work and consultation with interested groups, including staff interests. It all inevitably takes a considerable amount of time.

As I have said, the Government are providing the capital money for particular regional secure unit schemes. We are also providing a substantial contribution towards the revenue costs. The first revenue allocation was made in 1976–77 and is being made on a recurrent basis.

Mr. Michael Spicer

What can this possibly be for if there is nothing to be run? We are talking about £250,000. What is the other £3¾million being used for each year?

Mr. Moyle

If the hon. Gentleman will be patient, I shall come to that point. The allocation was made from 1976–77 to enable regional health authorities to establish first of all interim facilities to try to close the gap in the service. We recognised then that this money would almost certainly not be effectively used for interim units in that year, and therefore authorities were authorised in that event to use allocations temporarily for other non-recurring revenue services. They were reminded last year that in 1977–78 they should be in a position to put the allocation to much fuller use than in the directions for which it had been allocated, and that in so far as they were unable to devote the whole of the special allocation for the purpose intended, they should give first consideration in using the surplus on other facilities for the mentally ill.

In other words, money is being allocated to the regional health authorities, but until such time as the iterim units, and eventually the secure units, come on stream, that money can be used for other psychiatric purposes.

Mr. Spicer

Does not the right hon. Gentleman find it rather unsatisfactory that this money—£14 million—should ostensibly be allocated, but in the clear knowledge, as I understand it, that only about £1 million can possibly go to the purposes for which it was allocated? As far as I can see, the Government have connived in this process. I think that the situation is more serious than I had imagined. Have I misinterpreted it in any way? Why could it not be used to speed up the rate of construction?

Mr. Moyle

I think I have explained some of the difficulties which have arisen in the planning and construction of these regional secure units. The policy was initiated only four years ago, and a large part of that has been a planning period. It is one that I have described as being rather more fraught with difficulties than the planning of many other types of health facilities. Indeed, "conniving" is not the word, but because our general mental illness services have been neglected over the years, there is a fruitful field for the redeployment of such money to other aspects of the psychiatric service if it cannot be used immediately for the regional secure units.

Mr. Spicer

Why not say so?

Mr. Moyle

I am saying so, with all due respect. I want to tell the hon. Member what is happening in the West Midlands, and time is drawing on.

Even when the secure units are in being, the ordinary National Health Service mental illness and mental handicap hospitals and units will need to continue to provide for many patients who, either continuously or from time to time, need a fairly high degree of supervision and control because of their anti-social behaviour—including verbal and even physical violence—and this calls for some wards to have higher than average levels of staffing. Such wards may need to be locked, at least on certain occasions.

The question of patients needing longer-stay security is an extremely important one, particularly in the context of the likely closure of a number of mental hospitals in the years to come. Another important point—we must watch this in our planning—is the risk of isolation of secure units and regional forensic services in general from other parts of the psychiatric service. We should be making a great mistake if we thought that a secure unit must be a place that is completely isolated. This again is a bone of contention.

At the other end of the spectrum of secure accommodation for mentally ill and mentally handicapped persons requiring treatment under conditions of special security, Broadmoor, Rampton and Moss Side provide accommodation for 2,000 patients. In the further special hospital under construction at Park Lane, Liverpool, 70 beds have already been provided in the first stage of development.

I now turn to the position in the West Midlands. This region has no secure psychiatric facilities at the moment, but a 100-place secure unit on the site of Rubery Hill Hospital, Birmingham, is being planned. As the hon. Member will know from our recent correspondence, it will be several years before the unit is operational, but I hope that the construction work will start in the financial year 1980–81.

In the meantime, two interim secure units are being established and a third is planned. Work is in progress on an eight-bed unit for the mentally handicapped at Coleshill Hall Hospital in Warwickshire, and there is a 15-bed unit for the mentally ill at the Central Hospital, Hatton, Birmingham, to which the hon. Member has already drawn attention. The Coleshill Hall unit should be ready in about three months' time, and it is hoped to open the Central Hospital unit late in the summer of 1979. A third unit, primarily for the mentally ill, which will have 12 beds, is being planned at Barnsley Hall Hospital in the Hereford and Worcester area. The region recognises that additional interim secure facilities are needed and is in discussion with other area health authorities in the region.

The revenue costs are being met from a special allocation to the region for secure facilities. Where the allocation is not fully taken up, authorities have been asked to use the money for other psychiatric purposes. Birmingham has spent £40,000 of its allocation on the recruitment of additional psychiatric nurses. I hope that what I have said clarifies the position for the hon Member and emphasises our continual concern to make progress in dealing with this very difficult issue.

Mr. Spicer

I must confess that it has not really fully clarified the position and has rather confused it from my point of view. Is it the Government's position that they can allocate money to the tune of, say, £14 million and say to the authorities, in effect, "You can spend £1 million of the £14 million but spend the rest on what you like"? Is that the Government's position? That is what it sounded like from what the Minister said.

Mr. Moyle

I have been trying to explain the position, which is that the Government allocate money primarily for regional secure units to the various authorities, in the hope that they may be able to make use of it. But if they cannot spend the money on that particular purpose within that particular year, they have the authority of the Department to spend money on other psychiatric—

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

Adjourned at half-past Four o'clock.