HC Deb 03 July 1985 vol 82 cc499-506

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

4.27 am
Mr. Richard Needham (Wiltshire, North)

It is not very often, I suspect, Mr. Deputy Speaker, that you find two unrelated Pattens sitting on the same Bench at half past 4 in the morning. I welcome the arrival of my hon. Friend the Member for Oxford, West and Abingdon (Mr. Patten) to reply to this short debate. I am grateful to my hon. Friend the Member for Bath (Mr. Patten), who suggested over a year ago that I should instigate the debate. I owe much of the information and knowledge that I have gained about the problems of schizophrenia and the problems of parents who have to look after schizophrenic children to a constituent of my hon. Friend the Member for Bath, Mrs. Baker, who is the secretary of the Bath schizophrenia group.

I have been in correspondence with the Department of Health and Social Security on the issue on behalf of one of my constituents for a considerable time. In August 1983 Lord Glenarthur wrote to me, making the following points: In the light of comments received on that document"— he was referring to a document entitled "Care in the Community"— we are pressing ahead with a programme aimed at getting out of hospital and into community care as many as possible of those patients who do not specifically require hospital care … As you know, the needs of people who are, or have been mentally ill vary greatly. Both local health and social services authorities are obliged to provide care and after-care for these clients. A community psychiatric nursing service is an important component of health service provision in the community. This aims to provide help outside the hospital and so prevent unnecessary admission to hospital and to provide a nursing aftercare service following discharge from hospital. It is that paragraph that I want to bring to the Minister's attention in relation to a case in my constituency. I have an elderly couple in my constituency. The husband is 77 years old. His wife is half a year younger than he is and is bedridden. They are not badly off financially, but the last few years of their lives have in many ways been a living hell as they have struggled to look after their chronically schizophrenic daughter. Two and a half years ago she discharged herself from a mental institution. She then squatted in an abandoned farmhouse, but was finally persuaded to move to a MIND hostel, where she set fire to her bedclothes. It was then agreed mutually that she should return home. Since then she has been living at home. I should say that she had also been living at home on and off before that.

As I have explained, the parents are old and infirm, and what assistance do they get for her care? Once a fortnight they are visited by the community psychiatric nurse, who gives the daughter an injection. The nurse is extremely busy and does not have much time to talk to the parents. That is understandable, and I make no criticism of it. Once every three or so months the head social worker from the local mental hospital comes to visit them. The daughter receives invalidity benefit of £30 to £40 a week and the bedridden mother gets home help five days a week.

Therefore, the sum total of the assistance referred to in the noble Lord's letter is a visit once a fortnight from the CPN — the community psychiatric nurse — who, as I have said does not have much time, and who is changed quite regularly, and that is it. There has been no respite for the parents, according to them, to enable them to get away while their daughter is cared for.

The point that I want to bring to the attention of the House is that chronic schizophrenia is a young person's disease. It strikes between the ages of 15 and 30 and makes no distinction between rich and poor, clever and stupid. One third of those who suffer have a reasonable chance of total remission, one third do not recover, and one third continue to have attacks with varying degrees of intensity.

That most of the patients are better treated outside the confines of long-stay mental institutions is not in doubt. What is in doubt is whether in certain cases the policy of returning to the community is being properly and adequately organised and financed, or whether an increasing and intolerable burden is being placed on the very often aging parents.

What provisions are being made for cases such as the one that I have quoted? I see in his place my hon. Friend the Member for Norwich, North (Mr. Thompson), who also has a great understanding of these problems and whose views are similar to mine on this matter. When will there be individual care plans? When will there be places to which patients can go with their parents to have care dispensed and where the different organisations responsible for patient care can come together to discuss care, provision and future needs so that parent substitutes can be built up, so that general practitioners can feature much more in looking after the problems of the chronically disabled — general practitioners play a vital part in emergencies, but it is often felt by elderly parents that it would be much more useful to have them involved in a more permanent way—and also so that the chances of any likely increase in the suicide rate can be resisted? Parents may feel that without a place which is specifically set aside for them to discuss these matters, the care that their children get and that they can look for is disjointed.

Chronic schizophrenia is a dreadful disease. It is dreadful for the sufferer, as he or she withdraws from the family circle, suffers hallucinations and delusions, hears voices, loses the will to work and suffers acute stress and worry. Physically robust the sufferers may be, but they become mentally wrecked. It is dreadful for the parents as they see the love of their children wither and change. It is dreadful for the parents as their hopes for their children are dashed and as their responsibility for the care of their children increases and the prospect of a peaceful old age recedes.

When one parent was told that his child had chronic schizophrenia, he was advised, "React normally. Try to treat your child as normally as you can, and try to be as normal as you can." After years of care for his child, he said to me, "You have to become abnormal yourself if you are to survive." The point that I make follows on from the report of the Select Committee on Social Services. It does not seem to be right that in the care of chronic schizophrenics the parents should be other than a bonus in the provision of those services that patients require. They should not be the centre around which the various bodies which are responsible for patients hover uncertainly.

The report of the Select Committee, which was published in January, covers the ground very adequately and puts forward recommendations and solutions. When the Government respond to it, I hope that they will follow the recommendations of the Committee and do so with urgency. I trust that they will do nothing to close down existing provisions until adequate community provision is demonstrably in place. It cannot be right that very elderly people have their last years ruined by stress and worry because their children, whose love they find fading and withering away, cannot adequately look after themselves and they, the parents, cannot adequately look after them.

Mr. Patrick Thompson (Norwich, North)


Mr. Deputy Speaker (Sir Paul Dean)

Order. Does the hon. Gentleman have his hon. Friend's agreement to intervene?

Mr. Needham

Yes, Mr. Deputy Speaker.

4.39 am
Mr. Patrick Thompson (Norwich, North)

I am grateful for the opportunity to intervene briefly in this short debate in support of my hon. Friend the Member for Wiltshire, North (Mr. Needham). In my short time as a Member of Parliament, I have already come across cases in my constituency identical to those which my hon. Friend described. The matter has also come closely within my experience and knowledge. Therefore, I can reinforce my hon. Friend's description of the great distress and catastrophic effects of this disease on the families of sufferers.

It is right to emphasise that schizophrenia is remarkably common although, for obvious reasons, not widely publicised. The National Schizophrenia Fellowship was formed to support families who face this difficulty and who are not receiving the necessary support. It started with a letter in The Times by the founder, and the flood of response to it reflects how common the problem is, yet how little the general public know about it.

My hon. Friend referred to the effects of recent Mental Health Acts, the fact that treatment cannot always be completed and the fact, therefore, that the burden falls back on the family. Therefore, I do not need to deal with that.

Relatives cannot easily cope with the problem, especially elderly relatives. Families find it difficult to put up with the emotional stress and the violence. In supporting my hon. Friend, I encourage the Government to provide understanding and support, and to encourage society also to provide understanding and support for people facing this serious problem. I hope the that the Minister will respond in that spirit.

4.41 am
The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)

It is entirely characteritic of my hon. Friend the Member for Wiltshire, North (Mr. Needham) vigorously to pursue a general point arising from an individual constituency case. I am pleased to visit his constituency from time to time. It is a rare week when I do not reply to at least one Adjournment debate, a rare month when a thousand or more letters do not pass beneath my pen in reply to hon. Members' letters about their constituents' health, and an even rarer month when a substantial number of those letters do not come from my hon. Friend. If any Conservative Member could be described as ruthless in the pursuit of Ministers in the interests of his constituents, he can.

I welcome this chance to make four separate points. The first is about the nature of the illness and how disturbing it is; the second relates to developments in national provision; the third to available services in my hon. Friend's area; and the fourth to the invaluable cooperation we have from the voluntary sector. I welcome the attendance and speech of my hon. Friend the Member for Norwich, North (Mr. Thompson), and I shall try to pick up some of his points about the National Schizophrenia Fellowship, if I have time before the clock inexorably brings the debate to an end at 4.57 am.

As my hon. Friend the Member for Wiltshire, North said, schizophrenia is a much misunderstood and maligned illness. The mention of the word creates a wholly unjustified picture of an underlying threat of malevolence and violence beneath some stereotype. Like all examples of stereotyping, which are based on ignorance, the picture is inaccurate, as anyone who has known a sufferer will he aware. In reality, people unfortunate enough to suffer from the illness, seldom present a threat to anyone. They need our sympathy and help, rather than our fear and pity.

It is a severe and potentially disabling mental illness which occurs most commonly in young adults and includes a number of grave, common and usually progressive mental conditions which are grouped together because they show similar disorders of thinking, emotional reaction and willpower. It is a confusing and difficult picture.

It would surprise many people to learn that about one person in 100 is said to suffer from the illness at some time in their lives. With modern treatment, many will improve and their symptoms will remit, but, alas, some will have residual symptoms which will affect them for the rest of their lives.

Hence, there is a long-term problem of the maintenance of schizophrenics in society, be they in establishments or in the community. Though no single theory of the cause has been established, it is possible that there is an inherited biochemical basis for it, possibly precipitated by environmental factors.

The symptoms of schizophrenia result from a disturbance in the normal processes of thinking. That can lead to false beliefs or delusions and false sensory experiences or hallucinations. This may show as the expression of strange ideas, mood swings, irritability, emotional and social withdrawal and disturbed speech and behaviour— a catalogue of great personal difficulties when all those aspects occur together.

How disturbing that must be not only for the individual, particularly during periods of remission, but for the person looking after that individual in the community, be it a parent, a daughter, a son or some other relative. In the way in which many members of our increasing elderly society suffer, for example, from Alzheimer's disease and dementia, so one must think of those who care for them and for people suffering from schizophrenia.

There is a brighter side, too. Research into the illness is proceeding here and abroad and I am certain that we can hope for real progress on that front. But, because at present we do not have the means to cure the illness, it is necessary that the practical needs of sufferers and carers are met and recognised by those who provide services.

Considerable research has shown that the needs of schizophrenic people in the community are not always appropriately met. At the same time, research has made it clear that the problem is not always one of inadequate services or resources. Sometimes it is a lack of coordination and planning for the individual.

It is easy when speaking of the National Health Service to say that if only there was more money, this or that problem would be solved. On many occasions, I dare say, more money might be the answer, or part of it, but all too often it is a case not of money but of planning and coordination between different parts of the NHS. For example, lack of money does not stop us from carrying out more kidney transplants; it is simply that we do not have the donor organs to carry them out. The surgeons, money and wards are there. We are waiting for the organs to be transplanted from those who are good enough to leave them so that others may live or have improved lives.

In the same way, sometimes in the area of mental disorder it is not a lack of resources but the fact that the people who need help are not brought easily enough into contact with the resources. In that connection, I was asked when there would be an individual plan for sufferers. We shall be expecting the NHS, the social services— and the probation service when it is involved—to know of every schizophrenia sufferer of whom we are aware, because we are dealing with individuals, and their needs must be met in relation to the services that are available.

The services exist, but sufferers and their carers are not always appropriately linked to them. Sometimes there is diffidence on the part of people who suffer from schizophrenia to use the services that are available, and sometimes there are problems with those who look after the individuals. That is not to say that the stresses caused within families by the failure to obtain services which are needed are anything other than immense. That is particularly so when the carers are elderly parents, and the prospect of the sufferer being left to cope alone is a constant and unwelcome theme. I recognise that my hon. Friend the Member for Wiltshire, North bases his more general remarks on one specific case where the parents are elderly and must greatly fear not only for their child of the moment but for their child of the future when they are no longer here.

I turn now to service development. As regards the national picture, there is of course a long way to go, but the growth of community services is encouraging. For example, when the Government came into office in 1979, there were just over 1,000 community psychiatric nurses. Now there are about 2,000. That is a modest growth in a group of dedicated men and women who do an enormous amount of good, all too often unsung. On the social services side, people in the community now have the use of nearly 9,000 day centre places—an increase of about 2,000 places over the last five years.

At the same time, we are experimenting in places some way from Wiltshire, North—places such as Hackney, Salford and, a little closer to home, Southampton—in order to try to develop microcomputer systems to coordinate after-care services for schizophrenic people living in the community; in other words, trying to hit this planning nail on the head by the use of microcomputers. This is in direct response to the research evidence, and aims to remedy the defects of co-ordination and organisation which I mentioned earlier. We hope that these systems, when successfully developed, will be adopted by other authorities as a means of improving services. The projects are being funded under the "Helping the Community to Care" initiative, involving a considerable amount of expenditure.

That is the national picture of a continuing and sustained growth of psychiatric nurses, community psychiatric nurses, day centre provision and some interesting experiments involving microcomputers to try to plan better for the individual. As to the local picture in Wiltshire and nearby, with respect to psychiatric services in Bath, the Bath district health authority is to provide adequate support in suitable surroundings to patients discharged from the large psychiatric hospitals and to those who would previously have been admitted.

There are schemes jointly planned with local authorities funded from joint finance money in the area. For instance, in Wiltshire certain measures have been taken. A lodging scheme has been set up. This involves finding suitable homes for ex-psychiatric inpatients who are provided with the necessary community support. Day facilities for the mentally ill are being provided at Malmesbury hospital.

The health authority is also engaged in collaboration with the voluntary organisation MIND, which does such excellent work, in providing homes for former psychiatric inpatients in Chippenham. These will be available soon. For the future, it is planned that each small town within the Bath district will have its own day facilities for the mentally ill together with day services for the elderly and the elderly with psychiatric disorders. The health authority is also making more money available for the training of community psychiatric nurses, which is an important aspect, to meet the increased demand which will arise from the discharge of patients to community care.

Meanwhile, in nearby Avon joint moneys are being provided for additional community social workers and for training social workers in mental illness. A lodging service similar to the one in Wiltshire is also being provided.

In all this is the very important provision of respite care for those who look after schizophrenic sufferers. I was disturbed to hear that in one case cited by my hon. Friend respite care apparently had not been offered. I would not wish to enter into discussion of any individual case or any named person in the Chamber. None of us would like our case notes read out to the general public and recorded in Hansard. If my hon. Friend will get in touch with me about this, I should like to look into it. To be frank, I was surprised to hear that that was the case, having gone into the issues locally. I hope that my hon. Friend will correspond with me so that I can discuss the matter with my noble Friend Baroness Trumpington, who is responsible for these matters in my Department. It is a formidable task that she bears, characteristically formidably.

My hon. Friend referred to the Select Committee's report. It would be inappropriate for me to anticipate our response, but I should make it clear that the Government welcome the report. I would like the House — and especially my hon. Friend the Member for Norwich, North — to know that we value the role of the National Schizophrenia Fellowship very much indeed. We welcome its code of practice for discharging patients. The Royal College of Psychiatrists is helping to draw that to the attention of psychiatrists. We very much welcome and appreciate our partnership with the fellowship, and our recognition extends to the provision of grant currently at £80,000 a year over three years. It is a substantial sum of money. We have been happy to pay the grant every year since 1976. It is part of about £l million that we give each year to voluntary organisations dealing with the mentally ill.

Improving services for mentally disordered people is one of our priorities for the health and personal social services. My ministerial colleagues and I are keen to see all parties, statutory and voluntary, working together to plan and provide a full range of local services. I hope that during the next few years we can ensure that the difficult problems that my hon. Friend has raised this evening are dealt with in a way that means that they will no longer need to be brought to the House and the attention of Ministers.

Question put and agreed to.

Adjourned accordingly at four minutes to Five o'clock am.