HC Deb 20 February 1996 vol 272 cc175-87 3.32 pm
The Secretary of State for Health (Mr. Stephen Dorrell)

With permission Madam Speaker, I wish to make a statement about the future of mental health services.

On 24 August last year, my hon. Friend the Minister for Health wrote to health authority chairmen informing them that I had asked the regional directors of the national health service to review the progress being made in their regions towards the delivery of modern and effective mental health services. I am today publishing the conclusions of that process, and I am announcing the further steps that the Government intend to take to deliver their commitment to a comprehensive, high-quality mental health service.

The background to those developments is familiar to the House. In this and every other developed country during the past 40 years, health and social service authorities have been replacing asylum-based care with a broad spectrum of facilities that are better able to meet the needs of the individual person suffering from a mental illness. At its best, a modern mental health service represents a dramatic improvement in the quality of care available to its patients.

Too often, however, the reality has not matched up to that potential. That is why we decided last June to make the improvement of mental health services a key medium-term priority for the NHS, and it is why I initiated the review process last August.

Today's report of that review confirms that every health authority now has in place plans that commit it to deliver a comprehensive mental health service. Sixty-eight health authorities have demonstrated that that objective will be achieved during the next financial year; the remaining 33 authorities have plans to deliver a comprehensive service, which will take longer to complete.

The review shows that health authorities are planning to increase the resources committed to mental health services next year by £53 million. Regional directors will continue to monitor the delivery of those plans at local level.

It is important to be clear about the objective. The phrase "care in the community" has too often been taken to mean the abandonment of residential care for mentally ill people. That is not, and never has been, our policy. That is why, today, I am publishing a document entitled "The Spectrum of Care", which sets out in clear language the range of services that constitute a modern mental health service. It restates our commitment to provide treatment at home for those patients for whom that is the right answer. For that group, a range of services needs to be provided by the NHS and local authority social services departments, very often in partnership with local authority housing departments.

The document also sets out the range of other facilities that are needed to complete the required spectrum of care. Those are: day hospitals and day centres, to provide for those who need care during the day; access to out-of-hours specialist services and crisis accommodation to meet short-term crisis need; acute hospital beds, to meet the needs of those with acute mental health problems; and 24-hour nursed residential places, to meet the long-term residential needs of those with severe and enduring mental illness. All those facilities are needed, together with a range of secure units for those who need treatment in a secure environment.

Today's document makes clear the Government's commitment to deliver not simply care in the community, but the full spectrum of care required for a comprehensive modern mental health service.

Along with that overview of the full spectrum of care, I am publishing a report commissioned by my Department on 24-hour nursed care. The report states that there is accumulating evidence of a need for residential nursing care for a relatively small group of so-called new, long-stay clients. The Government accept that such facilities have a valuable role to play in the spectrum of care and will look to health authorities to ensure that their plans for the future provide for that need to be met.

Although it is understandable that much of the comment about the state of mental health services concentrates on the pattern of service provision, a crucial requirement is effective collaboration between the wide range of agencies that contribute to an individual's care. That is why the Government are committed to the full implementation from 1 April of the care programme approach. That requires the preparation for each patient under the specialist services of a plan of care based on an assessment of his needs, which names a key worker to be responsible for ensuring that that care is delivered.

From next year, the NHS is under an obligation to audit the successful delivery of that approach. Today, I am publishing an audit pack designed to assist with that process. It has been developed by the NHS executive with the Royal College of Psychiatrists and constitutes an important reinforcement of our commitment to quality in those services.

A further reinforcement of quality is provided by the Government's decision to introduce a patients charter on mental health. A charter does not, of course, by itself improve standards. It does, however, state clearly the standards that the individual patient can expect to receive from the statutory services and it therefore constitutes a benchmark by which the quality of the service can be judged.

Today, I am publishing a draft charter and I am asking for comments by 26 April. The draft charter proposes standards for timely access to specialist services. It sets out the entitlement of a mentally ill person to have his illness explained; to have the effects of medication explained; and to be given information about advocacy and support groups, together with information about what to do in an emergency. It also establishes that a patient who needs continuing care outside hospital will not be discharged from hospital until appropriate arrangements, including a care programme, have been put in place.

There has recently been disquiet about the arrangements that allow hospital managers to discharge patients from detention under the Mental Health Act 1983, possibly against the advice of their responsible medical officer. It is clearly essential that a detained patient must have the right to have his case reviewed, and the Mental Health Act 1983 provides for mental health review tribunals for that purpose. The powers of the managers operate in parallel with those of tribunals, to allow a more informal consideration of individual cases. The operation of the system is currently being considered by the Royal College of Psychiatrists and the National Association of Health Authorities and Trusts, with the Mental Health Act Commission. We expect to receive their advice in the spring of this year, and the Government will reach and act on a conclusion on the basis of that advice.

Finally, I come to the question of money. The Government are firmly wedded to the provision of sufficient resources to allow the continued improvement of our mental health services. In December, I announced the creation of a mental health challenge fund within the NHS, and I am today publishing the detailed criteria for applications to that fund. The fund will deliver £20 million-worth of improvements and development in addition to the £53 million of growth money that health authorities already intend to spend on mental health next year.

In December, I also announced an increase of £11 million in the mental illness specific grant for 1996–97, and a further £9 million for 1997–98, subject to parliamentary approval. Of that £20 million, £4.5 million will provide for a 10 per cent. increase in the existing specific grant programme; £2 million will virtually double the provision for the homeless mentally ill initiative; and the remaining £13.5 million will be committed to a target fund to assist local authorities working in areas where the strains on the mental health services are greatest. I have written today to the local authority associations, inviting them to join us in drawing up the detailed criteria for those schemes.

The combination of an extra £20 million through the mental illness specific grant; an extra £20 million through the NHS challenge fund; £53 million from health authorities' own plans; and a contribution of at least £2 million from local authorities' own resources, will bring the growth money for the mental health services under this programme to more than £95 million.

Our national health service has made great strides in improving mental health care. I pay tribute to all those working in health and social services who have achieved so much for mentally ill people. We are committed to supporting them, to securing the best standards for users and carers and to providing a service of which the public can be proud. The measures that I have announced today constitute a substantial contribution to the progress that we need to make. I commend them to the House.

Ms Harriet Harman (Peckham)

Is it not the case that the Government have failed to ensure that mentally ill people get the care that they need when they need it, and that the price is paid by mentally ill people themselves and by the communities in which they live? Does not the Government's failure cause needless suffering to those who are unfortunate enough to have mental illness? Does not the failure cause despair to the relatives of mentally ill people, as they struggle to cope, and further demoralise the doctors, nurses and therapists—the mental health care team—who are stretched to breaking point as they run services that are stretched beyond breaking point?

Has not the Government's failure caused a breakdown of public confidence in our mental health services, as people hear report after report of assaults, murders and suicides committed by people who are desperately ill? Have not the Government created the worst of all worlds in relation to mental illness: too few beds for the mentally ill in hospital, inadequate and patchy services for the mentally ill in the community and staff shortages in hospitals and community services?

I join the Secretary of State in his tribute to the excellent work that has been done by the health care team. However, why does he not mention the chronic staff shortages in mental health services? Those services cannot run without the staff and, too often, they simply are not there.

The Royal College of Psychiatrists says that there are shortages of psychiatrists at all levels, consultants, registrars and junior doctors. So the risks increase, but no mention of that was made by the Secretary of State. Is he not aware that the Royal College of Nursing reports that there are now fewer community psychiatric nurses than there were five years ago, despite a huge increase in the number of mentally ill people in the community? Why was there no mention of that?

Is the Secretary of State not aware that in some areas whole wards are closed because sufficient staff nurses cannot be found to run them? Does not he realise that the huge turnover of very seriously ill patients in hospital means that doctors and nurses are providing only a custodial rather than a caring, quality service, with not enough time to talk to and get to know their own patients, let alone the patients' relatives? Will the Secretary of State admit and act on the problem of hospital bed shortages? Half of all acute beds for people with mental illness problems have been cut in the past 15 years.

Why does the Secretary of State announce £95 million of growth money when it is nothing of the sort? Why does he not admit to the House that it is existing money already allocated by health authorities? Does he not realise that people are fed up with hearing the Government announce new money or growth money and raising their hopes, only to have those hopes dashed when they discover that it is not growth money at all? Is not that yet another reason why this Secretary of State, like his predecessors, is not trusted by the public or by those who work in the national health service?

Does not the Secretary of State realise that his failed mental health policies mean patients committing offences and ending up in our police stations, courts and prisons? The number of mentally ill prisoners has increased by more than half in the past four years.

Is not the real story about Government failure on mental health revealed in a devastating secret report from North Thames regional health authority? The report shows that none of the health authorities in that region is providing a comprehensive adult mental health service and that two thirds of the health authorities will not be providing a comprehensive adult mental health service by 1997, even if they achieve all their existing plans and even if they take additional action.

The report, which the Government have kept secret, talks of organisational turbulence. It talks of a surfeit of first priority issues, pressures on staff and a range of attitudes, from anger to despair to desperation. It does not appear in the pack that comes with the Secretary of State's statement.

How can any hon. Member have confidence in what the Secretary of State tells the House when he has admitted that one in three health authorities will fail to deliver comprehensive adult mental health care services by the end of 1997? He says that 68 out of 110—he lists them in the pack—will provide a comprehensive adult mental health service by the end of 1997, but how can we believe him when we know that the list includes authorities such as Brent and Harrow, and Camden and Islington, whose own region says that they will not achieve a comprehensive service by then even if they achieve all their existing plans and even if they take additional action?

Will the Secretary of State accept Labour's challenge and introduce a four-point action plan to begin to tackle the problems of mental health? Will he halt further psychiatric bed closures until community services are in place? Will he ensure not only the immediate implementation in all areas of the care programme approach, but greater consistency in its development? Will he take action to address staff shortages? Will he change the mental health funding allocation formula, so that over time cash ends up going where it is most needed?

Against the background of Government failure, the Health Secretary's statement offers no new money, no new rights and no new policy directions. What he has done is to identify needs. We know what the needs are; we have known them for years. He has identified the service provision that is needed; we have known about that for years. He has not taken action to tackle the problems. The Tories have failed for years on mental health and they have failed again today.

Mr. Dorrell

I remind the House that my statement covered a range of subjects on which the Government have announced some proposals. We have announced proposals to redefine the spectrum of care; to heighten the commitment to nursed beds in the health service; and to strengthen our commitment to the care programme approach; and we have announced the publication of a draft charter for mental health patients. I talked about the changes that are being considered in managers' powers to release detained patients. I listened to what the hon. Lady had to say in her questions on my statement. I did not hear her mention a single one of those policy announcements. She picked on only one—that relating to money.

On money, the hon. Lady said that because today I announced the proposals that the health service was bringing forward for the use of next year's growth money, that somehow did not constitute new money. I am announcing how the health service will use the extra resources that have been voted to it, to improve the quality of health services during the next financial year. That is apparently not a subject in which she is interested.

The hon. Lady also spoke about staff shortages. I have good news for her on that. She said that the Government had nothing to say about increasing the staff commitment to mental health services.

Ms Harman

The right hon. Gentleman did not say anything about it.

Mr. Dorrell

The hon. Lady says that I did not say anything about that in my statement. That is true; my hon. Friend the Minister for Health announced some changes on that yesterday, when we announced the creation of 114 specialist registrar posts in the psychiatric disciplines, specifically to address the concerns that she raised. I would have hoped that she might welcome that.

The hon. Lady also spoke about an alleged decline in the number of community psychiatric nurses working in the health service. I have the figures with me. In 1984— I am not taking a date that is party politically convenient, but I will measure the numbers over a decade—there were 1,180; and in 1994, the most recent year for which figures are available, there were 4,760—an increase in community psychiatric nurses in post of 153 per cent. I would have hoped that she might welcome that.

Then there are the points that the hon. Lady made in her press release today, in which she said: I am calling on the Secretary of State to publish the true information on the state of mental health services in every region of the country. She did not anticipate that I would publish the list in the document that was published at 3.30 pm. I am sorry to have shot her fox.

The hon. Lady also challenged me to agree to her four-point plan. I have had the advantage of a few minutes in which to think about her four-point plan. [Interruption.] I did not need them, as she rightly says, because all the points are covered in the statement.

The hon. Lady called for a halt to further psychiatric bed closures until appropriate community services have been developed. That has been the policy of the Government for some years. Existing bed space is not closed until acceptable alternative provision is in place. In my statement, I announced immediate implementation of the care programme approach in all parts of the country. I would have hoped that she might welcome that.

I have already mentioned action to address staff shortages. The press release also refers to changing the mental health funding allocation formula so that over time cash ends up going where it is most needed". That is precisely the principle that underlies the funding changes that I announced today. The hon. Lady might have done better to listen and react to my statement rather than read out her press release.

Several hon. Members


Madam Speaker

I am now seeking very brisk questions and answers.

Mr. Roger Sims (Chislehurst)

As it happens, I met my local community health service trust at lunchtime and I know that its welcome for the prospect of increased resources will be reflected throughout the country. The important thing is how and where those resources are spent. My right hon. Friend listed a number of facilities that can be provided on a local trust basis, but others can be provided more effectively and efficiently over a wider area. Will he encourage trusts to co-operate with each other and co-ordinate their activities in providing those facilities, and ensure that resources are distributed accordingly?

Mr. Dorrell

I am happy to see such co-operation develop within the health service—and my hon. Friend knows that that is occurring. The key co-operation is between health authorities, to ensure that the needs of a particular locality are met. When those needs are best met by trusts in co-operation, I am strongly in favour of local partnerships developing.

Mr. Simon Hughes (Southwark and Bermondsey)

I welcome the Secretary of State's statement as far as it goes. However, I should like him to inform the House when he will be able to guarantee three things. When can he guarantee that there will be satisfactory co-ordination of health authorities and social services departments throughout the country? He is aware that that problem must be addressed. When can he guarantee that there will be 24-hour access to emergency admissions, to local support or to community care—the three options that a mentally ill person may need? Most importantly, when can he guarantee that urban areas—which have four times the incidence of mental illness compared with elsewhere—will be allocated the resources that they need statistically, as opposed to being dependent on the £13.5 million beauty competition that is the additional challenge funding that he announced today? It may mean that the places that are most in need will continue to go without.

Mr. Dorrell

Co-ordination between statutory authorities is part of the assessment for which regions are responsible when deciding whether comprehensive mental health services will be delivered. I agree with the hon. Gentleman: it is important to ensure that statutory agencies are co-ordinated properly. In the absence of that proper co-ordination, action will be taken to improve the situation. I agree with what the hon. Gentleman said about emergency access. In a supporting paper published today, the hon. Gentleman will find the statement: We intend to include a standard in the final document on the mental health patients charter on access to out-of-hours services and views on that will be particularly welcome". The hon. Gentleman is quite right when he says that out-of-hours access is important. We intend to include details of our proposal in the final version of the mental health patients charter.

As to the hon. Gentleman's proposal that we should revise the capitation formula that governs all health service financing, he will know that it is subject to regular review. With regard to the funding mechanisms that I announced today, I shall ensure that specific local issues are addressed. We must not wait until the generality of funding delivers that objective. It is important to target resources at that issue, reflecting the priority that health and social services managers now give to improving the quality of services.

Sir Gerard Vaughan (Reading, East)

My right hon. Friend's statement will be welcomed very widely. Will he confirm that today he has announced a new, high priority that will be on-going not only for mental patients in the community, but for mental patients across the board?

Mr. Dorrell

Yes, I can give my hon. Friend exactly that assurance. My right hon. Friend and predecessor announced last June that the health service intended to make the maintenance of high-quality mental health services a key priority. That is not a passing fad. Mental health services are a key part of an integrated national health service, and the management of the health service and the political responsibility for it will continue to reflect that long-term priority.

Dr. Jeremy Bray (Motherwell, South)

The Secretary of State has accepted the difference between comprehensive plans and effective delivery. He has put forward specific proposals—such as the audit arrangements and the patients charter—to improve the quality of service. Does he agree that, with the best will in the world, long-term developments are needed in the care of the mentally ill, which cannot possibly be completed within two years? For example, first, I refer to the training of staff in the mental health services, from a basically institutionally based system to a community-based system. Secondly, I refer to the reabsorption of those who have been mentally ill into the normal life of the community. Finally, I refer to the effectiveness of mental health services being very much conditioned by public understanding of the nature of mental illness.

Mr. Dorrell

The hon. Gentleman is right on all three counts. He takes a distinguished interest in this subject, as the chairman of the all-party group. He has placed emphasis on the importance of training all the professional staff responsible for delivering that service, which I echo. That is why my hon. Friend the Minister for Health announced the extra commitment to the psychiatric medical disciplines yesterday, and it is something that will also be followed up in the training plans for the nursing profession.

The hon. Gentleman raised three important issues, and I agree with all of them. The Government will carry them all forward. The distinction between plans and delivery is one that I take seriously. It is important that the commitment to the standards that I have announced today is monitored year by year by the health authorities and by the social services inspectorate—and that is what will happen.

Mrs. Edwina Currie (South Derbyshire)

Does my right hon. Friend realise that in his statement he has rendered a large chunk of my novel out of date? I am very pleased about that. In his efforts, will he also take into account the need to train general practitioners, to ensure that their services for mental illness are also improved? Is it not those people who will most likely first come into contact with someone who is depressed or suicidal, who will have to cope with their family and, in the long run, who will most likely be involved in their continuing care in the community?

Mr. Dorrell

I am sorry to have rendered my hon. Friend's novel out of date, but I am not sure that I am ministerially responsible for that. I agree with what she said in relation to the development of the role of general practitioners in the mental health services. That is a specific aspect of the work that my hon. Friend the Minister for Health is doing, on the development of primary health care. It is important that the role of general practitioners in that service is not allowed to cut across or to undermine the important role played by the specialist services in meeting the requirements of those whose needs are genuinely specialist in nature.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

Is the Secretary of State aware that the provision of extra registrars will be welcome, but without access to secure beds and to proper psychiatric staffing care, they are not as effective as they sound? Further, is he aware that the need is urgent for elderly constituents who are faced with the management of a psychotic and possibly dangerous member of their family? Those psychiatric services are falling apart now—not next week—and they need help now. What will he do to ensure that it is provided as rapidly as possible?

Mr. Dorrell

The hon. Lady raised the subject of secure bed space, which is interesting because that is an aspect of the delivery of mental health services that has been developed substantially in recent years. In the early 1970s, the Glancy report target for medium secure beds was set at 1,000, but by 1979 nothing had happened. The figure is now 1,200 beds provided, with more to follow. We are providing the medium secure beds that the health service needs, and that is something that marks today's health service apart from the health service of a decade ago.

Mr. David Martin (Portsmouth, South)

Is my right hon. Friend aware that those providing mental health services in Portsmouth just would not recognise as an accurate picture of those services the catalogue of slurs produced by the hon. Member for Peckham (Ms Harman)? He mentioned in his statement that a key worker would be available for every individual—and that he would be known as that individual's key worker. Will he ensure that the individual's neighbours and family know who that key worker is, so that those who are receiving mental health treatment in the community know that someone can be contacted immediately to sort out any problems?

Mr. Dorrell

My hon. Friend makes an important point. The support of the carer working within the community is often critical in the delivery of a proper service to a mentally ill person. The support of neighbours who may not be formal carers can also be valuable. My hon. Friend will recognise that his proposal and the terms in which he makes it may raise concerns about confidentiality, but I agree with him that the name of the key worker is potentially important, not just to the mentally ill person but to that person's carer and community supporters.

Mrs. Alice Mahon (Halifax)

If the Minister really believes that every bed that has been closed in the psychiatric sector has been replaced with a good community care place, why are so many mentally ill people in prison and homeless? Does he recall my sending him a letter about the closure of the psychiatric unit at Northowram hospital, from GPs who said that they already faced frequent difficulties in admitting psychiatric patients to Halifax general hospital? Has he any idea how much worse it will be when the psychiatric unit closes? Will he please put a moratorium on all bed closures until decent places are provided in the community?

Mr. Dorrell

The reason why I do not agree with those who say that we should have a moratorium on all bed closures is that it would create the implication that the existing pattern of provision in some of the old asylums should be sustained. I want to ensure that we provide an improved, modern mental health service that more accurately meets the needs of patients.

Mrs. Mahon

What is the Secretary of State doing about that?

Mr. Dorrell

The hon. Lady asks what I am doing about that. I announced in my statement the publication of a document on nursing home beds for those suffering from severe and enduring mental illness. All the professional opinion now suggests that it is a better way of meeting the residential care needs of those with such illnesses. Surely to goodness we should be able to agree across the Floor of the House that those needs are better met in that way than by keeping open a model of care which was a great breakthrough in the 19th century, but which is no longer regarded as a proper way of caring for people with a mental illness.

Mr. David Congdon (Croydon, North-East)

Does my right hon. Friend agree that when mentally ill people are discharged into the community, it is crucial not only that are they provided with suitable housing by housing authorities, but that there is good liaison between housing and social services to ensure that social services provide proper support? Will the measures that he has announced today improve liaison and co-ordination not only between health authorities and social services, but with housing departments?

Mr. Dorrell

My hon. Friend is quite right to remind the House of the importance of the relationship with local authority housing departments. I specifically referred to that in my statement. In regard to people being discharged from hospital with continuing needs from the mental health services, I set out the proposition contained within the mental health patients charter, that people in those circumstances should not be discharged from hospital until proper arrangements have been made with the relevant authorities, so that those continuing mental health needs will be met.

Mr. Dennis Skinner (Bolsover)

Does the Minister agree that, for a comprehensive care in the community policy to succeed, much attention and assistance must be given to individual carers who look after a great number of people in the community? Is he aware of the plight of some of those people? One of my constituents informed me that she was on incapacity benefit, but the moment she became an individual carer, the Department of Social Security took the book away and she lost not only her incapacity benefit, but her entitlement to rent and all other benefits. The net result is that she is worse off as a result of taking on an onerous task. She has saved the state £300 a week and she is getting absolutely nothing.

Mr. Dorrell

I prepared for a number of different questions for this session, but I confess that I did not include mastering the rules governing the social security system. I shall take the hon. Gentleman's question away and write to him with an answer.

Mr. John Marshall (Hendon, South)

As one who has instigated a number of Adjournment debates on the care of the mentally ill, I welcome my right hon. Friend's statement and the fact that he has listened to the concerns expressed in those debates and outside the House. I also welcome the commitment to new long-term clients, because there has been an inadequate number of beds, especially in London, for the mentally ill. Can my right hon. Friend tell the House how Barnet health authority will be affected by his proposals?

Mr. Dorrell

I am grateful to my hon. Friend for his support for the announcements that I have been able to make, and I agree with him about the need to ensure that there is a proper understanding of the case for a full spectrum of care. Community care should be seen as part of that spectrum and not as the totality. I hope that my hon. Friend will accept that his emphasis on the need to ensure the provision of residential places was covered in my statement.

Barnet health authority has a clear commitment and a plan to deliver—as the hon. Member for Peckham (Ms Harman) will see—a comprehensive mental health service. As my hon. Friend knows, Barnet health authority has to come from further behind than some, so it would be unrealistic, as the hon. Member for Motherwell, South (Dr. Bray) pointed out, to suggest that all the problems can be resolved overnight. The commitment is there to ensure that those services will deliver our objectives, and my hon. Friend's constituency will be able to benefit from the spending programmes that I announced this afternoon.

Mr. Jim Callaghan (Heywood and Middleton)

I listened carefully to the order of priorities that the Secretary of State has just given to the House. Is he aware that one of my constituents, Mrs. Worsley, while on her way to work at the University of Manchester Institute of Science and Technology at 7 o'clock in the morning a fortnight ago, was savagely attacked by a man with a mental illness? As a result of the attack, she had nine stab wounds in her back, one stab wound in the back of her head and a gash in her face that required nine stitches. In the light of that and other savage and unprovoked attacks, what assurances can the Secretary of State give to Mrs. Worsley and other victims that that will not happen again?

Mr. Dorrell

Of course, no Secretary of State can give to any citizen the assurance that there will never be an attack in the street again, whether perpetrated by somebody suffering from mental illness or not. I can assure the House that we are specifically considering the discharge arrangements provided by hospital managers to ensure that there are adequate safeguards to command public confidence. In the context of the services that I mentioned today, that is the right assurance to give to the hon. Gentleman.

Mr. David Atkinson (Bournemouth, East)

Is my right hon. Friend aware that the initiatives and extra resources that he has announced today will be warmly welcomed by the voluntary organisations involved with the mentally ill—MIND, the National Schizophrenia Fellowship and the Schizophrenia Association of Great Britain? Will my right hon. Friend ensure that the views of those voluntary organisations will be specifically sought by the Department of Health when it consults on the draft patients charter and on the management of the release of detained patients, which he has announced today?

Mr. Dorrell

The answer to my hon. Friend's question is yes. I will ensure that they are consulted and that their views are heard and noted.

Dr. Lynne Jones (Birmingham, Selly Oak)

If everything is to be as the Secretary of State has explained, there will indeed be a dramatic improvement in mental health services. I wish the Secretary of State well, because I think that he believes in what he said. I hope that he will forgive some of us who are a little cynical about whether he has put the means to achieve his aims in place.

In Birmingham, there is 0.5 per cent. growth in the health budget and most of that will be spent on the waiting list initiative. The mental health trust in south Birmingham has been asked to make 3 per cent. efficiency savings and it has been reported that a project, which linked mental health services and the police, so that they could try to intervene when mentally ill people were arrested, will have to fold.

Will the Secretary of State give an assurance that when projects are funded through the challenge initiative and are successful, funding will continue and resources will be made available to ensure that the good practice that has been learnt can be disseminated throughout the country?

Mr. Dorrell

I entirely agree with what the hon. Lady said about the importance of disseminating good practice.

If the health authority in the hon. Lady's constituency is above target and, therefore, saw only half a per cent. growth in last year's settlement, it is precisely to that health authority that the challenge fund is addressed. The fund will provide resources that will allow the service to continue. The money will not be withdrawn after one year.

Mr. Nicholas Winterton (Macclesfield)

I congratulate my right hon. Friend on his statement and on the direction that he is giving to mental health provision. Does he agree, however, that long-term care for the more severely and permanently mentally disabled needs to be provided not on a district general hospital site but on a site that is more conducive to therapy and the provision of long-term care? I am sure that my hon. Friend the Member for Hendon, South (Mr. Marshall) agrees with me on that. It is important that hospital sites that are ideal for what my right hon. Friend has in mind are not sold off prior to the new initiative being fully considered by him, with perhaps the new provision being provided on such sites. If he does not put his foot down, those sites may be sold.

Mr. Dorrell

I agree with my hon. Friend that it is important that any new provision that is planned within a health authority area is planned, so far as is possible, at a location that suits the type of service that is to be delivered. That will often not be on the district general hospital site, and my hon. Friend is right about that. It will not necessarily follow from that conclusion that the right place is on what was traditionally the mental health site of the asylum. It may be that a third site is more appropriate. My hon. Friend is right in his principle that new facilities should be located in the place that is judged to meet the needs for which the facilities are designed.

Ms Mildred Gordon (Bow and Poplar)

Members of my local community health council tell me that they are worried about the increasing trend to treat all mental illness in elderly patients, especially those over the age of 75, as dementia, even when it might be a different form of mental illness. Will the Secretary of State assure us that steps will be taken to ensure that elderly patients who have mental or physical illness receive the specialist treatment that they need, rather than being dumped into a geriatric unit?

Mr. Dorrell

I entirely agree with the principle that the condition of any patient, whether young or old, should be accurately diagnosed and that the clinical care given should be appropriate for the clinical condition. I am sure that the House will not wish me to be drawn into questions of clinical judgment between one condition and another, something on which I am entirely unqualified to offer a comment.

Several hon. Members


Madam Speaker

Order. We shall now move on. No doubt we shall be returning to this subject in due course.