§ 5. Mr. Bowis
asked the Secretary of State for Social Services if he will give the figures for mental patients (a) living in National Health Service hospitals, (b) living in residential care accommodation and (c) living in the community; and if he will give these figures for those in England and Wales and for the Wandsworth health authority, respectively.
§ The Minister for Health (Mr. Tony Newton)
On 31 December 1986 there were 60,279 mentally ill in-patients in hospitals in England, including 807 under the care of the Wandsworth health authority. The number of places in residential care accommodation provided specifically for mentally ill people is 8,267 for England, including 133 provided by the London borough of Wandsworth. We have no comprehensive figures for people living in the community who could be described as in some degree mentally ill, many of whom are being treated by their general practitioners.
§ Mr. Bowis
Does my hon. Friend agree that there is an imbalance in the mental health budget whereby 90 per cent. of the funds go to the hospital service and only 10 per cent. to care in the community? Does he agree that the satisfactory transfer of patients to the community requires adequate housing, personal income and aftercare as well as adequate co-operation and co-ordination between the Health Service and social services departments? Does he agree that the programme of mental hospital closures should proceed extremely slowly until those prerequisites are met and the mental health budget rebalanced?
§ Mr. Newton
There are really three questions there. First, I think that the 90:10 statistic is oversimplified, hearing in mind how many mentally ill people are living in their ordinary homes.
On the second part of the question, I very much agree with the general thrust of my hon. Friend's remarks. That is one reason why we have asked Sir Roy Griffiths to conduct a review of many of these important matters.
On the third point, I entirely accept that closure proposals, where such exist, should be handled very carefully, because the aim is not to close hospitals but to ensure better care for the patients.
§ Mr. Loyden
Is the Minister aware of the serious concern of parents of mentally handicapped and mentally ill people with respect to two different needs, in that people in that situation might be better off in hospital until the 155 Secretary of State provides the funding to ensure that the necessary care in the community is available? Does the Minister agree that there is no excuse for closing hospitals before that provision is made?
§ Mr. Newton
I have already made my view clear. The aim of health authorities in this area is to improve the pattern of patient care. Hospital closures are incidental. If the hon. Gentleman studies the figures, he will see that there have been very substantial increases in resources for the care of mentally ill people in the community, including, for example a more than doubling of the number of community psychiatric nurses.
§ Dame Jill Knight
Will my hon. Friend take on board the fact that there is widespread concern that people are being let out of hospital when there is not always adequate care available for the community as well as for the patient? Is he aware that a great deal of trouble may be caused when neighbours suddenly find these poor people living next door? I beg my hon. Friend to bear that in mind.
§ Mr. Newton
I fully accept that there is concern, and in some cases I share it. That is one reason why at almost every meeting with district or regional health authorities I stress the point that I have emphasised to the House—that discharges need to be properly planned and based on proper provision of alternative facilities.
§ Mr. Wigley
If that is so, when do the Government intend to implement one of the essential first steps towards ensuring proper care in the community—the Disabled Persons (Services, Consultation and Representation) Act 1986, which has still not been implemented?
§ Mr. Newton
The hon. Gentleman knows full well that the primary focus of discussions between my hon. Friend the Minister and the local authority associations relate to sections 5 and 6 of that Act, which are concerned with disabled school leavers. We are very conscious of the importance of section 7, and one of my aims is to get that implemented as soon as possible.
§ Mr. Michael Morris
Is my hon. Friend aware that included in the statistics are the children of the Princess Marina hospital? I extend a personal "thank you" to our hon. Friend the Parliamentary Under-Secretary of State for visiting that hospital. Is my hon. Friend aware that those children are in tragic circumstances? May I press him for an early decision that they should remain in hospital?
§ Mr. Newton
I shall take careful note of what my hon. Friend said. As he mentioned, our hon. Friend the Parliamentary Under-Secretary of State recently visited that hospital. I wish to take this opportunity to make it clear to him and the House that in my judgment there are still many people who need hospital care. The policy of care in the community is not something to be pursued regardless of the needs of the individual concerned.
§ Mr. Tom Clarke
Does the Minister accept that his response to the hon. Member for Caernarfon (Mr. Wigley), in which he explained the delay in implementing one section of the Disabled Persons Act, does not excuse the delay in implementing another section? Does he further accept that there is a need for proper funding of bridging arrangements? The transitional period between hospital discharge and patients going into the community is of profound importance, if only because those who suffer from mental illness almost certainly have the 156 additional adversity of poverty, unemployment, homelessness and family break-ups. If the Government continue with their inadequately funded community care policy, will it not simply be seen as a euphemism for community neglect?
§ Mr. Newton
On the hon. Gentleman's first point, I did not in any way use my references to sections 5 and 6 as an excuse for not implementing section 7. I said that, quite rightly, a great deal of pressure in the House and elsewhere has been concerned with the provision for disabled school leavers. However, I also said that I attached high priority to implementing section 7. Regional health authorities have substantial resources available, and we look to them to use those resources sensibly to provide for the transitional period, as the hon. Gentleman rightly recommended.
§ Mr. Nicholas Winterton
Will my hon. Friend give a firm assurance that he will slow down the closure of psychiatric hospitals until there are sufficient trained and qualified staff to look after the patients when they are in the community, and also that suitable accommodation is available? We do not want them to end up in prisons, as the Select Committee on Social Services found in its inquiry into the prison medical service.
Will my hon. Friend also confirm—as I believe he has indicated already—that there will be a long-term need for hospital care for many of the mentally ill, especially the more acute and severe schizophrenics?
§ Mr. Newton
Certainly the answer to the latter part of my hon. Friend's question is yes. I think that, by implication, I have already answered the first part. The slowing down of the programme is not the issue; rather, it is that we will not approve hospital closures until we are satisfied that proper alternative provision is available.