HC Deb 29 October 2002 vol 391 cc844-50

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

12.23 am
Mr. Bob Laxton (Derby, North)

rose—

Mr. Deputy Speaker (Sir Michael Lord)

Order. Will hon. Members please leave quickly and quietly so that we can proceed with the Adjournment debate?

Mr. Laxton

I am grateful for the opportunity to raise this important matter. Long-stay in-patient benefits affect a cross-section of society, from the youngest invalid to the oldest pensioner. Last year, 10,000 pensioners, 13,000 incapacity benefit and severe disablement allowance recipients and 3,000 income support recipients had their benefit reduced after being in hospital for more than 52 weeks. I shall focus on the effect of that reduction in benefit on just one group: those who suffer from mental illness. I do that partly in the interest of time; it is not to say that any other group suffers less. Indeed, many of the groups overlap. I need only to explain that some of the long-stay hospital patients with mental health problems are pensioners or on disability allowance benefit.

At Kingsway hospital, a mental health hospital in my constituency, 70 patients have been in hospital for more than 52 weeks. The trust is the appointee for the benefits of 46 of them, with 39 receiving in-patient benefit of £15.10 only. The remaining seven patients also receive disability living allowance low-rate mobility allowance of £14.10 a week.

I wish to pay tribute to the excellent and ongoing campaigning work by the Derbyshire patients council, which represents mental health patients in my constituency and across a wider area of Derbyshire. I should also like to thank it for its help with the preparation for this debate. I owe a debt of gratitude to Derbyshire mental health services staff, in particular its chief executive. They were obliging enough to dig into their records and gave me some very useful information.

The plight of mental health patients was brought to my attention by Derbyshire patients council. In May this year, the patients council and a huge busload of Derby mental health services users came down to the House of Commons and presented me with their petition bearing more than 3,700 signatures. They had the opportunity to meet a few MPs. I am grateful to the Minister for taking the time to meet them and to listen to the very valid case that they put to him. I should also like to thank my hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones) who, in her role as chair of the all-party mental health group, tabled an early-day motion on the matter that received cross-party support and the signatures of just under 100 MPs.

It is clear from the draft mental health Bill that the Government are trying to change their thinking on mental health. Mental health organisations have already expressed many criticisms and I shall not dwell on them, but if the £15.10 of in-patient benefit reflects Government policy on mental health I question our commitment to help those with mental illness. At present, after six weeks in hospital a long-stay mental health patient with no dependants loses all of his or her premium paid with their benefits. The main benefit is reduced to a pocket-money rate of £18.90. After a year, that pocket money is further reduced to £15.10, formally known as the personal allowance benefit or personal requirements allowance. A similar situation applies to those who receive the basic state pension because after 52 weeks they, too, are on £15.10 a week. That works out to 20 per cent. of the standard rate of basic retirement pension or, to put it more plainly, £2.16 a day.

So what is the principle behind the downrating of in-patient benefit? A 1949 report on the rules by the national insurance advisory committee said: The broad purpose of insurance benefits is to provide a basic contribution towards the ordinary needs, including maintenance, at times when earnings are interrupted or, as in the case of retirement pensions, cease. Where another public social service, the national health service, is at such times providing maintenance, in addition to treatment, we consider it right that the insurance benefits should be reduced on account of the maintenance of the beneficiary provided under the other service. In response to a written parliamentary question that I put to the Department for Work and Pensions, my right hon. Friend the Minister for Pensions reiterated that point. He wrote that the principle behind the hospital downrating rules is to prevent double provision from public funds, as well as from the publicly funded national health service, and that it is a "key cornerstone" of the system of national insurance introduced 50 years ago.

I doubt that we should be talking about double provision when single provision itself is called into question. In addition, it is worth bearing in mind the fact that the principle of downrating was introduced nearly half a century ago. Fifty years ago, or perhaps even 25 years ago, hospital patients could rely on their immediate and extended families for financial support. Sadly, that is not the case any more.

Patients nowadays, especially those with mental health problems, have less contact with their families, making them more reliant on the NHS to look after them and making this weekly allowance more important than before. Even for those mental health patients lucky enough to have contact with their family, there are still financial problems. For example, one patient, who has two grandchildren, would, like any other grandparent, like to treat them during their weekend visits together, but, unlike most grandparents, she cannot afford to do so.

At this point, I want to raise one particular point. I am puzzled as to how the weekly figure of £15.10 was reached. It is not enough to say that it is 20 per cent. of the basic pension. Why 20 per cent.? Why not 40 per cent. or more? On what basis is the sum calculated? My own estimate, which takes account of the barest of necessities and in their cheapest forms, is that a sum between £21 and £30 would be much more realistic.

Yes, patients' accommodation and food are covered by the hospital, but the list of day-to-day items that are expected to come out of that money is still staggering. From that meagre sum, patients have to buy toothpaste, toothbrush and other toiletries, newspapers and magazines, stamps and stationery, the occasional haircut and paperback novel, and often cigarettes. I have to admit that as a notorious smoking fascist, I would on almost any other occasion urge someone to use this opportunity to give up the noxious and foul weed. However, the fact remains that even those who do not smoke have a problem meeting all other costs with £15.10 a week. It is grossly inadequate and demeaning for people whose home is a hospital.

Apart from the items that I have mentioned, patients are also expected to buy clothes and shoes out of their weekly allowance. In his response to a letter that I wrote on behalf of Michael Walsh, chairman of Derbyshire patients council, the Minister said: The Personal Requirements Allowance is regarded as a reasonable sum to cover small personal items not already provided by the hospital. However it is not expected to cover the more expensive items, such as clothing, which the Health Authority is expected to provide where necessary.' The reality is that such provision proves to be lacking. The patients council brought up that point with the Minister back in May, and he expressed sympathy. The fact remains that many mental health patients in Derby have resorted to scouring charity shops for second-hand clothing.

The mental health services trust in Derby did not allocate any finance specifically for clothing in the financial year 2001–02 and made a one-off payment of £250 to help patients with the purchase of clothing. The trust said that younger patients sometimes apply for a community care grant from the Department for Work and Pensions to provide additional funds for items such as clothing. If they receive a grant, they have an amount deducted from their weekly in-patient benefit to repay the loan over a period set by the social fund. The period is typically 18 months, and the average deduction from the weekly benefit is £3.16 per week, leaving the patient with just £11.94 to spend. To avoid losing a proportion of their benefit, a number of patients in Derby have recently applied for funds from various charities, which are held locally as they do not have to repay that amount and so can retain their weekly benefit.

There are, I suspect, differences across the country. In an early-day motion on the subject, my hon. Friend the Member for Birmingham, Selly Oak noted that the chief executive of South Birmingham mental health NHS trust commented that the trust regularly supplements the in-patient benefit allowance from care budgets to ensure that basic needs such as clothing, haircuts and other personal items are met, and furthermore that it is a drain on NHS resources.

The Derbyshire mental health services trust said that it allocated £11,000 to patients' therapeutic programmes during the financial year 2001–02. That money, which is intended to finance certain therapeutic activities such as yoga, becomes instead an essential top-up to patients' weekly benefit. Similarly, the trust provides money so that patients can treat themselves and go on occasional trips, but the money is limited and patients are unable to participate in social functions as much as they would like and as much as would benefit them.

Many mental health in-patients are not a danger to other people. At the meeting I had with them in May, many said that they would relish the opportunity to reintegrate into the ordinary community, to find some useful role to play in their local area. They said that there is always an unwarranted stigma surrounding mental illness.

However, what makes things more difficult and increases that stigma even more is when patients have to go about, slovenly dressed in tattered clothes—clothes that are often recycled from those who have died in the hospital. One of the people whom I spoke to said, "I don't want to talk about reintegrating into the community when my clothes immediately make me stand out for the wrong reasons, and when I can't even afford a cup of coffee in the local café"

If the amount of in-patient benefit increased, it would mean that patients had more and better opportunities to interact with the world outside the confines of a hospital, and money given to them by the mental health services trust that was intended for their therapeutic needs would actually be used towards that end. Perhaps, in the long run, it would mean getting a group of people who are currently reliant on benefits back into work—we would break the cycle of social and economic exclusion. The Government are rightly proud of their record in that respect, but there is still so much more to be done.

I have already asked the Minister about how the weekly sum of £15.10 is reached, but is it not simply the amount of money that a patient receives after 52 weeks that I question. I also question whether it is actually worth lowering it. Someone receiving income support gets £18.90 in week 52, then £15.10 in week 53 of their stay in hospital. Getting £3.80 a week less than before might not make much difference to many people, but to a person who is on £18.90 every last penny counts. I note that the Benefits Agency estimates that administering the 52-week rule costs £500,000 million, and that £58 million is saved from the 52-week downrating rule. Can that saving can be balanced against the impossibility and misery of trying to get by on £2.16 a day?

I hope that my hon. Friend the Minister will heed these concerns, which are very real but often overlooked, and that he will act accordingly.

12.36 am
The Parliamentary Under-Secretary of State for Work and Pensions (Malcolm Wicks)

The House of Commons has just voted for substantial parliamentary reform and modernisation to make the House fit for its purpose in the 21st century, so although I stand, and others sit, here at just past half-past midnight, we do so knowing that our nocturnal manoeuvrings will shortly be placed in the dustbin of our nation's parliamentary history, the lid shut tight.

I congratulate my hon. Friend the Member for Derby, North (Mr. Laxton) on bringing this important issue to the House's attention, and on the way in which he introduced a subject that is especially significant to those of our citizens who suffer mental illness, often over a long period. The contention that the level of benefit is insufficient to meet the needs of long-term hospital inpatients is not new—indeed, my hon. Friend and others have been pursuing a substantial increase in the rate of the allowance for some time, and I commend them for doing so. As he said, last May he brought representatives of Derbyshire patients council to meet me. I promised at that meeting that my officials would discuss these matters with officials from the Department of Health. Such discussions have now been undertaken, and I hope that they have resolved some of the issues of concern to him.

We are dealing with two distinct issues: first, the rules on benefits paid by my Department and, secondly, the maintenance support that long-term patients require. The personal allowance for long-term in-patients must be seen in the context of the overall benefit rules for people going into hospital. The principle behind the reduction in benefit is, as my hon. Friend acknowledges, not a new one—indeed, it has been a basic feature of the benefits system since the introduction of the national insurance scheme in 1949. The principle is a simple one: while the national health service provides free maintenance as well as free treatment, maintenance benefits, which are also paid out of state funds, should not be paid in full indefinitely. To do otherwise would be to provide twice for the same items. The rules have been applied, albeit with minor modifications, for more than 50 years.

Adjustments for periods spent in hospital are applied to most social security benefits. Currently, there is no reduction during the first six weeks in hospital, then an initial reduction is made—for example, a benefit such as the basic state pension would be reduced to £46.80 for a person without a dependant. After 52 weeks in hospital, benefit is further reduced to 20 per cent. of the prevailing rate of the basic state pension. As my hon. Friend says, that is currently £15.10 a week. In addition, the rules also protect a person's housing costs. It is important to acknowledge that.

Provided that the absence from home is expected to be less than a year, people in hospital who have low incomes and who retain a liability to pay rent for their homes can get housing benefit as long as they intend to return home and their home has not been let or sub-let.

We believe that these rules strike a fair balance between what the state should provide financially and the provision that individuals should make for themselves. However, we recognise that the rules are not immutable, and we have already committed ourselves to modernising them. To coincide with the introduction of the state pension credit next October, we plan to extend the period before the initial reduction in benefit from six weeks to 13 weeks. This change is a recognition of the fact that in today's society—my hon. Friend was urging us not to look back 50 years but to consider today's circumstances—people have more ongoing fixed commitments, such as housing costs and utility bills while they are in hospital. So people will be able to keep their full benefit for a full quarter before any downrating takes place. This will give them more time to plan their budget for when downrating does take place.

I shall put the matter in context numerically. More than 97 per cent of people are discharged from hospital within 13 weeks. The vast majority will not have their benefits, which are designed with the cost of everyday living in mind, touched during their stay in hospital. Those whose stay is longer than 13 weeks will also gain, I believe, from having a longer period where their benefits remain unchanged, as they too will have time to plan for their future circumstances. I hope that that shows our commitment to improve benefits for people who go into hospital, and perhaps puts the numbers in context. I hope that it shows also that we have been listening to my hon. Friend, his colleagues and his constituents.

Nevertheless, I recognise that my hon. Friend is predominantly concerned with a specific group of patients—those long-stay patients who are in hospital for longer than a year, and sometimes years, such as those suffering from long-term psychiatric conditions. As I have already explained, such people receive the lowest rate of benefit entitlement, which is £15.10 a week. That is because the national health service has assumed the responsibility for maintaining those patients who have spent more than 52 weeks in hospital.

This rate is, in effect, a personal allowance—it is just that. It is designed to meet a patient's personal day-to-day requirements such as newspapers, magazines and toiletry items, and other things of their choosing. The allowance has historically increased year on year in line with prices and so has maintained its relative value.

The Social Security Advisory Committee considered the level of the hospital personal allowance rate in 1987. To quote from the committee's conclusions, some patients, particularly those who are more active, may find the allowance is not sufficient for their needs, but we have no research to convince us the level … should be raised". Nevertheless, in the past two years we have increased the allowance by more than prices in line with the above-inflation increases in the basic state pension.

It is important to recognise that the allowance does not, and was never designed to, cover the purchase of more expensive items, such as clothing. These are the statutory responsibility of the local NHS trust to provide where necessary. Where there are abnormal needs because of a patient's condition or illness, and the patient or relatives are unable to afford the extra cost, the hospital also has discretion to top up the allowance to meet such needs.

I know that each individual's financial circumstances vary, particularly in cases where in-patients are more physically active. However, it has been broadly accepted that it is impracticable to require the benefit system to have regard to the detailed circumstances of each individual before the appropriate reduction of benefit can be assessed. That is why general rules have been adopted and common rates of benefit are payable.

I know that my hon. Friend, and other hon. Members and organisations such as MIND and his local organisations, have campaigned for the dignity of long- term patients in hospital, particularly those suffering from mental health problems. His points about clothing and the dignity of having new clothes rather than second-hand ones would have a resonance in any century, as they certainly do in the 21st century. I listened very carefully to what he said in that regard.

We consider that the current rates of benefit for people in hospital are fair and that the allowance is adequate to meet the day-to-day requirements of a person in hospital. Obviously, where there are local issues, they should be dealt with at a local level through contact with the chairman or chief executive of the national health service trust concerned. Nevertheless, we recognise that, for the system to work properly, we need to ensure that the highest standards of care, including the provision of items such as clothing, is maintained for patients requiring long-term care in hospital. That is why the Department of Health intends to ensure that best practice is shared throughout our national health service. Its officials will be happy to discuss the best way forward with relevant stakeholders at both national and local levels, including in my hon. Friend's constituency.

To sum up, the current arrangements for hospital downrating have been in place for many years and are designed to give the appropriate level of help, depending on the length of time spent in hospital. We are committed to improving those rules by allowing inpatients to keep their full benefit for 13 weeks rather than six weeks, as at present. For long-term patients, social security meets a limited range of needs in a personal allowance and the national health service has a statutory duty to meet other maintenance costs. As I said, the Department of Health will ensure that best practice in the care of long-term patients is shared throughout the national health service.

I trust that that deals at least in part with the proper concerns of my hon. Friend. We are considering the issue seriously and work is in progress to improve the arrangements for long-term patients, and not least those with often debilitating psychiatric conditions. I am grateful to him for bringing this vital matter to the attention of the House. It is an important matter to discuss at any hour of the day, although we will perhaps discuss it one day at a more civilised hour.

Question put and agreed to.

Adjourned accordingly at thirteen minutes to One o'clock.