§ BARONESS SUMMERSKILLMy Lords, I beg leave to ask the Question which stands in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government, having regard to the rundown of the mental hospitals, what has happened to the patients who, between 1960 and 1969, occupied the 24,000 beds now lost to the Service.
§ THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ABERDARE)My Lords, a number of factors contribute to the continuing decline in the average number of occupied beds in hospitals for the mentally ill in England and Wales. The most important has been the development of new methods of treatment which have resulted in a decline in the number of beds for long-stay care, particularly in those required by younger age groups, and have made it possible for increasing numbers of patients to be treated on an out or day patient basis. The number of new day patients seen per year rose from less than 6,000 in 1961 to over 20,000 in 1969.
§ BARONESS SUMMERSKILLMy Lords, may I ask the noble Lord whether he has read the first article in the British Medical Journal of last week, which is highly condemnatory of the system, having regard to the fact that these patients have been discharged, that local authorities have provided only 2,000 beds and that these people are now being found in reception centres, in common lodging houses and on the heaths? Furthermore, is he aware that at least 10 per cent. of these people who have been 926 turned adrift are found to be mentally deranged?
§ LORD ABERDAREMy Lords, I have read the first article in the British Medical Journal, with which I do not agree. I find it wholly admirable that over 50 per cent. of patients now stay less than a month in our psychiatric hospitals, and I do not think there is any connection between the fact that day treatment is now much more possible in our hospitals and the fact that there are a number of people who, as the noble Baroness rightly says, are (as I think they are called in the article) "rootless wanderers." We are very concerned with these people, and we are looking to see what we can do to improve the situation; but I do not think the two problems are related.
§ LORD REIGATEMy Lords, can my noble friend say whether, as a result, there has been any reduction in the gross overcrowding that there was in the existing mental hospitals, which has been a scandal for many years?
§ LORD ABERDAREYes, my Lords. Indeed, this is the reason why there is this smaller number of beds required in our mental hospitals: that modern forms of treatment allow people to come out of hospital sooner and to be treated on an out patient or day patient basis.
§ LORD SLATERMy Lords, may I ask the Minister whether Section 79 still applies so far as the discharge of a patient from a mental hospital is concerned?
§ LORD ABERDAREMy Lords, the noble Lord has rather caught me on Section 79. What we are encouraging all hospitals to do is to make sure that there is the closest possible collaboration between the hospital and the social services before a patient is discharged.
§ BARONESS SUMMERSKILLMy Lords, is the noble Lord not aware that a very large percentage of prisoners are now remanded in order that a medical report should be obtained, and that it has been discovered that one of the reasons is that these unfortunate creatures, called "rootless wanderers", have been discharged from hospital and there is no alternative accommodation for them?
§ LORD ABERDAREMy Lords, it is also true that a number of them discharge themselves from hospital. We cannot keep them in hospital against their wishes unless they are certified.
§ LORD AUCKLANDMy Lords, while we are all very pleased that more and more patients are being discharged earlier through improved medical facilities, can my noble friend say whether he is really satisfied that enough is being done for the long-stay patients by way of both accommodation and facilities in these hospitals?
§ LORD ABERDAREMy Lords, we have made extra resources available to improve the situation in these hospitals. I am very appreciative of the problem that my noble friend brings up. We are determined not to run down the large hospitals until such time as there is other, adequate provision for them.
§ BARONESS BROOKE OF YSTRADFELLTEMy Lords, can my noble friend tell me how many cases are in sheltered hospitals, doing sheltered work? Are they counted in as part of the statistics in relation to the mental hospitals, or do they appear in a separate column?
§ LORD ABERDAREMy Lords, if they are in-patients in the hospitals they will be counted as hospital patients; but, as my noble friend knows, a lot of sheltered workshops have people coming from the community to work in them, and this is a development we are encouraging as much as we can.
§ LORD SHACKLETONMy Lords, could the noble Lord say how many of these people are in fact living under what might be called sheltered conditions—halfway houses, and elsewhere—and how far the responsibilities of local authorities may or may not be matching the need which existed previously when these patients were in hospital?
§ LORD ABERDAREMy Lords, I cannot give the noble Lord a figure, but it is certainly true that our provision in the community has not kept pace with the improvement in medical treatment in the hospitals. We are trying to remedy this, and certainly local authorities are trying to remedy it, but we still have a long way to go. The loan sanctions for 1972–73 for the provision of hostels, and so 928 forth, were double what they were for 1971–72 so far as local authorities are concerned, and we now have ten-year plans coming from local authorities which we hope will develop them still further.
§ LORD GARNSWORTHYMy Lords, I should like to ask the noble Lord whether the reply which he has given to my noble friend Lord Shackleton does not confirm what my noble friend Lady Summerskill said in regard to accommodation outside the hospitals.
§ LORD ABERDAREMy Lords, we are far from satisfied that there is enough of it; that is true. But that does not mean to say that the people whom the noble Baroness described as "rootless wanderers" are necessarily those who have been discharged from mental hospitals because of a lack of accommodation for them.
§ LORD GARNSWORTHYMy Lords, while accepting what the noble Lord has said, may I ask whether he does not agree that the noble Baroness was concerned with others as well as the particular category to which he is now referring?
§ LORD ABERDAREMy Lords, I expect so.
§ LORD SHINWELLMy Lords, could the noble Lord, Lord Aberdare, say whether his Department is from time to time made aware of conditions as regards accommodation and necessary provision for decent living of patients who are discharged from mental hospitals? Is his Department in touch with what happens?
§ LORD ABERDAREMy Lords, we have asked the local authorities to provide us with ten-year plans on their provision. We are in touch, through our social work service, with what is going on. One cannot stop a man from discharging himself from a mental hospital. He may tell a doctor that he had a job and somewhere to go. It may be that he has such arrangements but he may not keep them.
§ BARONESS SUMMERSKILLMy Lords, while agreeing with what the Minister has said, may I ask whether he does not agree that the real problem is that while in the past there was alternative accommodation (and we thought such accommodation would be provided now) 929 the Government have not made the supply of alternative accommodation compulsory, and the mean local authority is not providing any accommodation at all?
§ LORD ABERDAREMy Lords, we did not think it right to compel them; we left it to the local authorities good sense and discretion.
§ BARONESS LLEWELYN-DAVIES OF HASTOEMy Lords, is the noble Lord aware that if he had amended the National Health Service Reorganisation Bill in the way that we on this side tried to amend it, to provide the halfway houses with help, this kind of problem would be infinitely better solved?
§ LORD ABERDAREMy Lords, I do not agree. The fact is that both sides have tried to solve the problem in the best way they cans; and the National Health Service Reorganisation Act, by encouraging joint consultation between local authorities and hospitals, will, of itself, assist very greatly.
§ BARONESS BROOKE OF YSTRADFELLTEMy Lords, would my noble friend agree that part of the difficulty in finding accommodation for these cases when they come out of hospital is that the general public do not like hostels put in the area where they live; that they prefer them anywhere else but where they live?
§ LORD ABERDAREMy Lords, I agree with my noble friend. There are certain difficulties involved in getting planning permission for these hostels.
§ BARONESS LLEWELYN-DAVIES OF HASTOEMy Lords, is that not why the Department needs great courage in insisting on siting these hostels in places where they may not be popular at the beginning but where they are always accepted in the end?
§ LORD ABERDAREMy Lords, the Department is full of courage, but the fact is that it has to go through the planning procedures.