§ 9. Mr. Tom ClarkeTo ask the Secretary of State for Health when he expects to announce Her Majesty's Government's policies for introducing assessment for patients leaving long-stay psychiatric hospitals and going into the community.
§ Mr. DorrellGuidance on the introduction of assessment for patients leaving long-stay psychiatric hospitals was issued to health and local authorities on 10 September.
§ Mr. ClarkeIn view of the great distress that has been caused to many patients who are leaving long-stay psychiatric hospitals supposedly to go into community care, which simply does not exist, when precisely will the Government implement section 7 of the Disabled Persons (Services, Consultation and Representation) Act 1986? Does the Minister recall that the former Secretary of State for Health announced, after over three years of negotiations with local councils, that the Government's National Health Service and Community Care Act 1990 and their provisions for community care transcended section 7, and that once that had been monitored, the Government would decide what they were going to do? Now that the Government have abandoned their proposals for community care until 1993, what will happen to the patients? Is that community care in the 1990s, or is it saying to those patients, "Look forward to cardboard homes and cardboard hopes"?
§ Mr. DorrellThe hon. Gentleman is completely wrong. We have not abandoned community care; we are committed to implementing it. Furthermore, we are committed to implementing community care for mentally ill people on an accelerated timetable. The mental illness specific grant will make available £30 million of expenditure from next April. Capital approvals to local authorities will make available a further £10 million from next April. The capital loans fund has provided £10 million this year to invest in reprovision for mentally ill and mentally handicapped people. The initiative that I announced in July for homeless mentally ill people provides £5 million for that client group. Approximately £55 million has been made available by the Government in the current year to invest in improving the facilities available to treat mentally ill people in the community.
§ Mr. Anthony CoombsI warmly welcome the Government's proposals for improved assessment of people leaving long-term psychiatric hospitals and, more important, the provision of a key worker for each patient to co-ordinate the services available to him, but will the Government support and promote the additional voluntary service of Citizens Advocacy, a branch of which is in my constituency, which provides a friend—not a professional—to help formerly mentally ill or mentally handicapped people reintegrate into the community?
§ Mr. DorrellMy hon. Friend rightly draws attention to an interesting and useful contribution to care for mentally ill people. I welcome the initiative that he referred to and the opportunities that it represents. The care programme approach that I announced on 10 September provides, for the first time, an ordered framework to assess the needs of 146 each mentally ill individual and to ensure that they are met in the community. My hon. Friend referred to advocacy schemes, which have a part to play in that process.
§ Mr. RookerDoes not the Minister appreciate that it is the belief of millions of carers and the cared-for that. the Government have abandoned their community care programme? Sticking to the narrow confines of the question, does the Minister accept that the guidance for the assessment must be much wider than that which is published? How does it meet, for example, the criticism of the MIND survey, which mentioned the lack of choice and dignity, the lack of keys and the lack of the chance to keep pets? The survey in the west midlands found that virtually no social activity is offered in the private residential sector. How can it meet the problems that are caused by the lack of co-ordination between health authorities, social service departments and the planning authorities? In our large cities, hostels for mentally ill and mentally handicapped people are located next to another hostel, across the road from another hostel or round the corner from another hostel. Care in a community of hostels is not what patients or their families want.
§ Mr. DorrellIt may be true that there is a belief in the field that community care has been abandoned, but it is quite simply wrong. When it has repeatedly been stated to be wrong, it does no one any good for the hon. Gentleman to repeat it from the Dispatch Box. As regards the suggestion that the care programme approach is too narrow, that was out to consultation throughout most of the summer, which offered an opportunity for those in the field to argue for the widening that the hon. Gentleman advocated. He did not do so and most of the people in the field did not do so at that time. The guidance that we published on 10 September represents the first structured attempt to ensure that the needs of an individual mentally ill person are assessed and that effective machinery is put in place to support that individual in the community.
§ Mr. HindWill my hon. Friend carefully consider respite care for the relatives or friends of psychiatric patients who return home? As well as the carers of psychiatric patients, many other carers need a break and we must cater for their needs in future programmes.
§ Mr. DorrellMy hon. Friend is absolutely right. We recognise that respite care is an important part of a proper programme for community care for psychiatric patients and we shall ensure that provision is made.