HC Deb 21 January 1992 vol 202 cc166-8
4. Mr. McFall

To ask the Secretary of State for Health what recent assessment he has made of the adequacy of community care provision for people with serious mental illness.

Mr. Dorrell

I am today publishing an assessment of the case for hospital hostels for people with serious mental illness. In recent years, we have established the capital loans fund and introduced the mental illness specific grant. My right hon. Friend recently announced that the mental illness specific grant is to be increased by 50 per cent. in the coming year, and he is today announcing that we are doubling the size of the homeless mentally ill programme in London. This programme together provides over £100 million of new money for mental illness services in this country.

Mr. McFall

There could be no more tragically eloquent testimony to the fact that the Government's community care policies have failed than the sight of mentally ill people spilling on to the streets every moment. Although it comes late, I welcome the comment by the Secretary of State for the Environment that that sight is an affront to society.

May I point out, however, that it is not only for the convenience of passing citizens that mentally ill people should be cleared from the streets? What is required is adequate special accommodation, along with the necessary health facilities. Will the Minister give a commitment that there will be no further discharges of patients from long-term hospitals until places have been found for mentally ill patients? Will he also give an assurance—

Mr. Speaker

Order. Briefly, please.

Mr. McFall

Will the Minister give an assurance that mentally ill patients who were ejected before the Government's U-turn will be given a rightful place in society?

Mr. Dorrell

The hon. Gentleman is wrong in almost every particular. First, he is wrong to assume that the policy to which he refers is espoused only by the Government: until now, there has been a bipartisan commitment to ensuring that mentally ill people receive care and facilities that are properly attuned to their needs.

Secondly, the hon. Gentleman asked for a change of policy that would ensure that, before people were discharged from long-stay hospitals, proper provision was made for them in the community. That does not require a change of policy; it is the Government's policy. It is our policy that no one should be discharged from long-stay hospitals without the existence of a care programme that defines that person's needs—and, furthermore, naming an individual key worker who will be responsible for ensuring that the person receives the care that he requires.

The fact is that the hon. Gentleman cannot support his assertions on the basis of the available evidence.

Several Hon. Members


Mr. Speaker

Order. I remind the House that multiple questions lead to multiple answers and take up time.

Mr. Nicholas Winterton

I warmly welcome my hon. Friend's announcement. Does he accept, however, that—sadly—many of those who are sleeping rough in our cities and elsewhere have indeed been discharged from psychiatric hospitals and have slipped through the care package net? Hundreds more are in our prisons, which are the wrong place for such people. Will my hon. Friend ensure that there is a proper care package, properly drawn up, for every mentally ill patient who is discharged from a psychiatric hospital before such patients are discharged? If that cannot be achieved, will he ensure that psychiatric hospitals do not close until the necessary arrangements can be made?

Mr. Dorrell

I am grateful to my hon. Friend for his support for the document that we are publishing today on hospital hostels. I agree with him that they have an important role to play in a fully integrated service for mentally ill people, but the House would mislead itself if it believed that those mentally ill people who find themselves on the streets are drawn from those patients who have been discharged from long-term care in hospitals. The great majority of homeless people who are mentally ill have never been in our hospitals. We need to ensure that the management of community care is improved to meet the needs of those who are discharged from hospitals and, more particularly, of those who have never been long-stay patients in our hospitals for the mentally ill.

Mr. Rooker

I welcome without qualification the Minister's statement and confirm that there is a bipartisan approach to this policy. However, we want that policy to be activated and managed. That is the difference between us. We do not want to stand idly by and do nothing. The Minister's announcement—which again I welcome without qualification—comes six years after the Audit Commission's report on care in the community, which in paragraph 28 highlighted the fact that then, six years ago, there were 37,000 fewer mentally ill and mentally handicapped patients than there were 10 years ago but that nobody knew where those who had been discharged were because nobody had done anything to find out what had happened to them. For six years, the Government have not taken a blind bit of notice of the Audit Commission's report. They have allowed their care in the community policy for ex-mental patients to amount to no more than people drifting within a community of hostels, in which one finds people who have fallen through the safety net and ended up homeless on the streets.

Mr. Dorrell

I find myself left wondering, if £100 million of new money is standing idly by, how much an action programme is going to cost the Labour party and when we shall see it properly costed.