HL Deb 29 November 1983 vol 445 cc658-80

10.32 p.m.

Lord Beswick rose to ask Her Majesty's Government to what extent they agree with the report of the Richmond Fellowship Inquiry on Mental Health and the Community and particularly with the plea for essential funds to ensure progress towards the mental health service proposed in the report.

The noble Lord said: My Lords, my Unstarred Question relates to the Report of the Richmond Fellowship Inquiry on Mental Health and the Community, copies of which report are available in the Printed Paper Office. The report asserts that today the mental health services in our country are in a situation of crisis. After a wide-ranging inquiry, and, excepting myself, involving persons of considerable experience and accepted authority in their respective fields, the report sets out the facts and makes reasonably detailed recommendations as to how the essential community care should be structured, supervised and financed. It also recommends that there should be a Minister with clear, and known, responsibility for this work.

The noble Lord and his department have been good enough to consider this report, and what I am now asking is the extent to which they agree with it, and what they have done, or propose to do, to further its objectives. Alternatively, if they find themselves in disagreement with parts of the report, I wonder if the noble Lord will say which parts and why the disagreement.

The noble Lord has said, in answer to a parliamentary Question, that he is the Minister with this clear responsibility and I should like to thank him warmly for making it possible to come to the House at this late hour and answer personally the questions which we put. It would be good to think that this discussion will help make his responsibilities even more widely known, and it will we hope serve to increase public support for his efforts and even increase his influence for good.

The idea that a known personal commitment of one Minister to the development of a special field in social activity is surely borne out by the example of Mr. Alf Morris, a Member of the other place, who, when designated as Minister with special responsibility for the physically handicapped, made an impact upon the country. We should like to think that example would be repeated.

It was my noble friend Lord Longford who, in the course of his quite exceptional—and I am tempted to say, saintly—concern for the less fortunate among us, raised in this House on 31st March 1981 the issue of the alternative care of men and women who had been or could beneficially be transferred from the larger mental hospitals. It was the Minister's reply on that occasion which seemed to me to expose the serious nature and extent of the present problem. The Minister then said that from 1954 to 1979 the number of hospital places had been reduced from 145,000 to 76,000, but he was quite unable to show that the necessary alternative services had been provided.

I think it is commonly agreed that an enlightened forward policy will entail the closure of many large hospitals, though I should like to add that no-one should appear to deprecate the devoted service in some hospitals like the Maudsley and the Royal Bethlem. Nor should we under-value the available professional skills or the new drugs and treatments which have been developed. But there could and should be a more rewarding deployment of those skills in the new stage of development of our care of the mentally ill. That is what the report calls for.

I think it is instructive—certainly to me—to see how the attitude towards the mentally ill has developed and changed in the past two centuries. I wonder whether the Minister will agree with me that the paragraphs in the report which give a concentrated account of past attitudes towards, and treatment of, the mentally ill are—for the non-professionals at any rate—absolutely fascinating and most moving. Those paragraphs, incidentally, were written by Professor Wing, to whose unsurpassed depth of experience I know others would wish me to pay the highest possible tribute.

That account tells how, at the beginning of the 19th century we would have been talking of pauper lunatics, not of the mentally ill; there would have been parish overseers, the local bride wells and the private madhouses. The fate for some in those days was being chained in a coal cellar or some other out-of-sight places. Then came the Lunacy Acts of 1890 and 1891, and the custodial era. After the First World War there was the Mental Treatment Act of 1930 to supplant the Lunacy Acts. After the Second World War we had that great period of social reform in which I can recall some of us singing "Bread of Heaven" as we marched through the Division Lobbies to vote for an improved pensions system, family allowances, supplementary benefits and a truly national health service.

We are now faced with a new challenge. Those old large mental hospitals, which in their day were a great advance, are to give way to more enlightened community care. But the reason why the report uses the term "crisis" is because hospital closures are taking place before alternative care is provided. Where there should be a progressive step forward, there is, in effect, a shrugging off of responsibility.

The figures given by the Minister in that 1981 discussion showed that there were 69,000 fewer beds than in 1954—fewer beds, I emphasise, not fewer people needing care. The report states that the 69,000 figure is now nearing 80,000, and the closure programme continues. The question to which this inquiry tried to find answers is: what happened to those human beings hitherto provided for in the hospitals? Some are fortunate to have a home environment in which they can, at any rate, secure shelter. Sadly, in too many of those cases, the resultant tensions lead to a break-up of the home. A number of others find assistance and, in some cases, supervised accommodation in those voluntary bodies whose contribution and potential for the future is dealt with in the report.

The efforts of some of those voluntary bodies are frustrated by inadequate financial support. The Richmond Fellowship, for example, could make more accommodation available, but it does need the funding. Of those referred to it by the hospitals, at least three-quarters are without financial support. Some evidence suggests that local authority social service support is available for those who would—if I may put it in this way—be a public nuisance, but not for those who, given proper professional care, could recover to be useful members of the communty.

Then there is evidence, some of it reinforced by a recent article in the Sunday Times, that many other former patients of those large hospitals end up in squalid lodging houses or sleeping even more rough. The ultimate fate of some of these discharged patients is suicide. For others, it is re-entry into hospital. What there should be in a truly civilised society is a properly organised and suitably qualified supervision, guidance and, in cases, accommodation.

The Guardian of 25th October reports a speech by the noble Lord in which he announced the further closure of some 20 or 30 large psychiatric hospitals. If I may say so, he made a good case for those closures. But what of the alternative positive provisions? According to that same report, the Minister promised £25,000 extra to MIND. I am sure that the money will be well spent by that fine voluntary organisation, but in the context of that closure announcement it seemed a pitiful gesture.

I now ask the Minister specifically: when the department assembled for him the facts about that additional closure programme, did he require to be worked out the number of patients who would be affected, and did he satisfy himself that there would be effective agencies through which alternative care would be provided for an equivalent number of patients?

This report outlines a suggested structure for the alternative services required. It proposes a district joint mental health development committee. This committee would bring together the resources of the regional and district health authorities, the voluntary organisations and the social services departments of the local authorities. I now ask the Minister: does he agree with this concept? Does he further agree that, to make a reality of such a committee, adequate—and that means increased—funding must be made available? This report calls for a development fund, because savings from closures will arise in the future, but the costs for the alternatives come now. So we do need this development fund.

I understand that the Government are now considering a new management structure for the health service. Could not the district joint committees recommended by the report be fitted into that new structure? Would it not be possible, with a sound management system, to ensure through the joint committee that monies intended for mental health care are in fact used for that purpose? Can the Minister assure us that these joint committees in each district will have an effective place in this new projected system?

The Minister will also agree, I am sure, that the necessary extent and standard of care should be maintained in each and every district, and we should like to have the Government's view of the report's recommendation that this essential standard of service should be monitored by inspectors appointed by the Government. The precedent for this is, of course, that of Her Majesty's Inspectors in the education service. On this point, we were advised especially by a quite superb authority. I vividly recall with not a little sadness Lord Redcliffe-Maud, not many days before his death, reaffirming his support for this recommendation.

There are others to speak more qualified than am I, but I must acknowledge the generous assistance of the Richmond Fellowship which made this inquiry and report possible, and also the special contribution of the director of the fellowship, Elly Jansen.

Finally, I emphasise the extent of the human problem with which we are dealing. One woman in five and one man in nine will require psychiatric treatment at some time in their lives. The pain and the sadness caused to those who are near and dear to them is probably deeper, and in a most hurtful and special way deeper, than with physical illness. We never see in the public press pictures of the mentally ill gallantly overcoming their affliction, as we do so often, so beautifully and so encouragingly, with the physically handicapped. There is a reluctance on the part of the public to face up to the problems of the mentally ill. The figures I have been shown indicate that voluntary financial assistance is less easily attracted for this cause of the mentally disturbed.

For all these reasons, we feel that a new effort, an extra effort, must be made to make a reality of this concept of community care for the mentally ill. I hope that the Minister tonight will be able to convince us that he is prepared to make that effort.

10.47 p.m.

Lord Vivian

My Lords, I am sure that all noble Lords are most grateful to the noble Lord, Lord Beswick, for putting his Unstarred Question as to what extent Her Majesty's Government agree with the report of the Richmond Fellowship Inquiry on Mental Health and the Community and particularly with the plea for essential funds to ensure progress towards the mental health service proposed in the report. The noble Lord has dealt with the wide-ranging report very fully, so perhaps your Lordships will allow me to state some of the reasons why I am particularly interested.

We learn from the report that since 1954 hospital places for the mentally ill have been reduced from 143,000 to 76,000 in 1979. Patients are in hospital for a shorter period of time and many of them are discharged still needing treatment which, it is agreed, is best managed outside hospital. Half of those in hospital with mental illness for more than one year are over 65 years of age. Many of these patients could leave hospital and live in hostels and attend day centres, thus becoming integrated again into the community, if local authorities and voluntary agencies had adequate funds to staff and develop such hostels and day centres. In the absence of these funds, local authorities are unable to accept this responsibility, so these people remain in hospital.

The report of the Richmond Fellowship inquiry points out on page 31 that when, as occasionally happens, services are available and working well, the social difficulties presented by severe mental illness are ameliorated and the individuals and their relatives are able to cope.

On page 31 of the report we are told, and here I start to quote: Many people do recover from severe mental illness and are pleased with the care they have received. However, it is clear to members of the Enquiry that services generally fall woefully short of achieving the quality of life for the mentally ill and their families that was envisaged when the run-down of the large hospitals began with such a fanfare. During the transition from care in large institutions to care distributed between many small local units, staffed by professionals with little training in common who need not be in close touch with each other, the problem of overall coordination has not received sufficient priority. Even within one administrative hierarchy such as a District Health Authority or a Social Services Department each small centre tends to develop its own traditions, select its own clients, guard its own autonomy and deny responsibility for what happens elsewhere". The report considers that for the mentally ill—excluding the elderly mentally infirm or mentally retarded—we need to provide as an absolute minimum to achieve a decent standard of care the following services per 100,000 of the population: district general hospital beds, 50; day hospital places, 25; hostel-wards for long-term illnesses, 17; short-term and rehabilitation hostels, 4 to 6; and long-stay accommodation in staffed and unstaffed homes, and in supervised lodging, 15 to 24; while for day centre places the number is 60.

Many districts do not attain even those minimal standards and progress towards those figures has been very slow. It is demonstrated by the fact that for every 100,000 population, only 12 people are supported by the local authorities; and the amount of suitable places in residential accommodation and for day care has scarcely risen since 1975 and has now reached 11 and 17 respectively, as opposed to a recommended 19 and 60. Even minimal levels will not be reached by the end of the century.

In addition to those basic needs, we should be providing work day centres for skills which fall between occupational therapy and sheltered workshops; some high-level sheltered factories; and rehabilitation units where people can be prepared for independent living in group homes and bedsitters. There will also be a need for hostels which provide refuge rather than treatment. Obviously, the present system of financing care for the mentally ill has failed and there is a need for proper service provision with good organisation and adequate staff training.

In view of the few facts I have mentioned, I would follow the noble Lord, Lord Beswick, and ask my noble friend Lord Glenarthur to what extent Her Majesty's Government agree with the Report of the Richmond Fellowship Inquiry on Mental Health and the Community and, in particular, with the plea for essential funds to ensure progress towards the mental health service proposed in the report.

Finally, before resuming my seat, I should like to offer my sincerest thanks to the many doctors (there is one in particular) and the physiotherapists (again, there is one in particular) who have helped me. I would also wish to thank the matrons and sisters and the nursing staff of several hospitals I have attended. It is the result of their collective work that has enabled me to speak very briefly to your Lordships tonight in this Chamber, the greatest club in the world.

10.56 p.m.

Lord Winstanley

My Lords, I must begin by thanking the noble Lord, Lord Beswick, on two separate counts: first, I obviously must thank him for drawing the attention of the Minister (and thereby the Government) to this report, which is on a desperately important subject which requires some urgent action. The noble Lord, by his Unstarred Question, has at least enabled the Minister to let us know the Government's thinking on this subject at this time. I must certainly thank the noble Lord for that. Secondly, I should like personally to thank him for having played a very important and crucial role in the business of the Richmond Fellowship inquiry, and in the preparation of its report.

I, too, had the honour to be a member of this inquiry. It is true that while I perhaps made some contribution and was able to put a fair amount of time and work into it in the early stages, I am afraid that my staying power was not as great as I might have wished, and other work made it necessary for me, not to withdraw from the inquiry but to take a less positive role in it after it had started. But, very fortunately, by that time we had recruited the support and assistance of the noble Lord, Lord Beswick. Without the assistance that he gave us in the terminal stages, this report would not have appeared in the very clear form in which it does, and I do not think would have had the degree of influence which it now has.

In a sense, I have already declared an oblique interest in this subject as a member of the inquiry, and as such I think I ought to exercise a certain discretion and self-discipline with regard to my contribution to this debate. I know other members of the inquiry are to speak: the noble Earl, Lord Longford, who did so much to set up this inquiry and put an enormous amount of work into it as chairman, and the noble Lord, Lord Richardson, who brought immense professional expertise and experience to bear on this subject and gave us invaluable advice. In general what we really want to do, even at this very late hour, is to allow sufficient time to enable the noble Lord the Minister to give us a full reply to the points raised and the recommendations put forward in the report. Therefore, I will try to limit my remarks merely to three separate points.

First, and briefly, I think it would be right at this point to indicate that the recommendations contained in this report do have the broad support of all my noble friends on these Benches; I think it right that the Minister should know that. To move to my second point, I should like to underline as firmly as I can one particular recommendation which is contained in the report and which has been referred to already by Lord Beswick: the specific recommendation for the designation of a named Minister to have responsibility for mental health and all matters immediately connected therewith. That recommendation is found on page 92, Recommendation 1: The obligation placed on local health and social services under the Mental Health Act (1959) and the Health and Public Services Act (1968) should be reaffirmed by statute and the duty to see that it is implemented vested in a named Minister. It is utterly clear, and that is the recommendation I should like to underline.

Recommendation 2 is very much connected: A development fund should be set up under the control of a designated Minister working with a Departmental Planning Board. On that particular second elaboration of the functions of the named Minister, perhaps it is interesting to note that in this connection the Richmond Fellowship's inquiry is not the only fount of wisdom on this particular subject. The noble Lord will have noticed that the Scottish Association for Mental Health prepared a report on this very same subject back in August. It is interesting to note that in its report it clearly calls for the establishment of a development fund to pump prime initiatives. Indeed, many of its proposals are very much in line with the proposals in our own recommendations.

However, I leave those for the moment and come back to the specific recommendation for a designated named Minister responsible for mental health matters. As a doctor I am very well aware and conscious of the trend to end the separation of mental illness from illness in general. That trend has been going on for some years. The trend is gradually to close the old mental institutions and have the mentally ill treated in the normal way with other people in general hospitals. There has been a trend towards increasing acceptance in the community and by the community that mental illness is an illness and not a separate subject.

I have no wish to halt that trend but I believe that the existence of a named Minister with specific responsibility for mental health matters would be immensely heartening to all those who work in this field. That was most certainly the experience when a Minister was appointed with special responsibility for the disabled. That was not segregating the disabled in some special way. But if we are to make progress in this very important field of improving community care we are bound to be very dependent on the various voluntary bodies which work in this field. I refer to bodies such as MIND. the Richmond Fellowship, the Elizabeth Fitzroy Trust, and many others. I believe that the appointment of a Minister with specific responsibility would be immensely heartening to all those voluntary bodies. They would know that one Minister had responsibility and that there was one person to whom they could go with their appeals and anxieties.

I know that the noble Lord the Minister will recollect that in an earlier debate on another subject I referred to the need some day to break down this huge conglomerate, the Department of Health and Social Security, and perhaps hive off what are largely Treasury functions, such as dealing with pensions, and give us back a Minister of Health with Cabinet rank responsible for the National Health Service and for health, but for almost nothing else. I do not wish to re-open that subject now but this recommendation of a Minister being designated for a specific purpose is different and very much narrower. It would be encouraging to patients, to their relatives and to all the other people who feel that this part of the National Health Service has been a Cinderella, that it has been neglected and swept away. It would be an encouragement to them and to the voluntary sector upon which, I am sure, we shall be desperately dependent in the future. I should like to hear the Minister's reaction to that suggestion related, too, to the development fund, and I shall briefly return to the development fund in a moment.

My third and final point is that the whole purpose of the noble Lord's Question is to draw the Government's attention to this report and enable the Minister to give us his department's preliminary reactions, at least, to the important recommendations contained in it. I think it is right to say, as I have said before, that the Richmond Fellowship, and this inquiry, is not the only fount of wisdom on this subject. I have already referred to the Scottish Association for Mental Health, which has taken important initiatives.

My attention has also been drawn to a very interesting report which has been prepared by Mrs. Harrison-Gledhill, who is a professional counsellor and psychiatric therapist. She has prepared a report on the closure of the Camberwell Resettlement Unit. Some noble Lords will know the Camberwell Resettlement Unit. It was previously called the Camberwell Reception Centre but for some 25 years it has colloquially been known to those living in it and those dependent upon it as "The Spike". It is very much a home for the socially regressed and the incompetent and deals with single homeless people.

Almost by definition, single homeless people are very often mentally ill. That is often why they are homeless. Because they are single, they need accommodation. Many of these people found that accommodation in the Camberwell Resettlement Unit which is now being closed. Because it is being closed, the department, the department's officials and others have the responsibility of resettling these people. I know that the report by Mrs. Harrison-Gledhill has been discussed within the department. I gave the noble Lord the Minister notice of the fact that I should ask him whether it had been drawn to his attention.

I notice that the report refers particularly to the resettlement of these single homeless people and to the efforts which officials are making. It says: Only a small percentage of those considered suitable for resettlement have been and have stayed resettled for more than six months. The staff spend their lives doing what daily experience teaches them is virtually impossible". I am not in any way trying to depart from the main report we are discussing, but it is interesting that a specific report on a specific problem which arises at the same time perhaps gives further evidence in addition to our report, which is couched in much more general terms.

Later in the report of Mrs. Harrison-Gledhill she says that the staff in, I think, department SB3 within the Department of Health and Social Security, are confident that through their arrangements with private organisations they will find suitable accommodation by the time the unit finally closes". That means that there is already an understanding that there have to be some arrangements with private organisations and so on.

The essential point that the Richmond Fellowship inquiry underlines is that there has been a gradual reduction in the number of mentally ill people in hospital and a closure of hospital beds, but there has been no corresponding increase in the back-up services in the community to care for the increasing number who are having to be cared for at home. In simple economic terms, now that new methods of psychiatric treatment are so complex and sometimes so consumptive of resources of one kind or another, it is desperately wasteful to spend scarce resources on, for example, rendering a schizophrenic patient stable to the extent that he can return to the community and then finding that there is no back-up support in the community. Virtually all the money spent in the hospital will have been wasted. It is that kind of waste that the inquiry wishes to avoid, as no doubt do the Government.

The suggestion for a development fund—which has also been developed by the Scottish Association for Mental Health—relates to the possibility of a better integration of official or statutory provisions with the provisions of the voluntary sector. This Government have a record which is very good in certain areas. I have been involved in certain new initiatives which the Government have taken regarding the restoration of areas of decaying cities. Projects which were to be undertaken by a Government department in partnership with local authorities have now been privatised to the extent that they have been set up under trusts to enable the public sector (Government and local government) to unlock private funds from local industry, local voluntary bodies and others who can assist in various ways. I am the chairman of one such trust—the Operation Groundwork Trust.

In this field we have to find more resources. One way in which new resources could be found at the moment would be by the kind of pump-priming exercise to which our report refers, as does the Scottish report. It would enable the voluntary sector to do a great deal more than it now does. Let us make no mistake: it is doing an enormous amount at the moment. MIND, the Richmond Fellowship and all sorts of other bodies are making an enormous contribution. Without that contribution, things would be very much worse.

But if we are to put things to rights, the contribution must be much bigger. I believe that the recommendation for a development fund, coupled with one particular Minister with specific responsibility, could really change the whole atmosphere and feeling in this area, so that those working in it would move ahead with new confidence that at long last it was not to continue forever to be the Cinderella of the health service.

Mrs. Harrison-Gledhill's report also contains some ideas for new methods of treatment, and I believe that our report emphasises the fact that we must look for new initiatives. We must find funds with which to promote new initiatives. Mrs. Hamson-Gledhill's report includes a reference to a fresh initiative regarding new methods of dealing with the socially regressed and incompetent. That is the kind of thing which we should not neglect. If we neglect it, we could lose opportunities which could perhaps change in a very important way the situation for the mentally ill and all those who are responsible for them.

I have spoken for too long, and I am very anxious to hear what the noble Lord the Minister has to say. I look forward to receiving a little encouragement from him.

11.11 p.m.

The Earl of Longford

My Lords, it is a special pleasure to follow the noble Lord, Lord Winstanley, whose contribution to our work was much more valuable than his modesty allowed him to tell us. It was also very pleasant to find the noble Lord. Lord Vivian. emerging as the first Conservative spokesman in the debate. He was at school with me, as was his old friend, the noble Earl, Lord Halsbury, though they were of course much junior to me. But, in so far as he belongs to my period, I am very happy to find him beginning a political career at a time when the careers of some of us are drawing towards a gentle close.

Of course I am grateful, as we all must be, to the noble Lord, Lord Beswick, for the lucid, attractive, and always forceful way in which he initiated this discussion. As the noble Lord, Lord Winstanley, said, the noble Lord was all-important in our work. In fact in the later stages of drawing up the report he played a bigger part than I did. We are grateful to him for all he did in that regard, and for what he has said to us this evening. I echo many things that he has said, and perhaps in my own remarks I may repeat too many of them. However, in particular I want to join with him in paying tribute to two hospitals known very well to both of us, the Maudsley, and the Royal Bethlem.

I must mention one remark of the noble Lord's which I think I must have misheard. He made a reference to someone—I could hardly think that it was myself—being saintly. There must have been something wrong there. Of course all the Members of the House are saintly in their better moments. But the noble Lord, Lord Lyell, will forgive me for saying that my feelings were not saintly—they were more devilish than saintly—towards the end of the last debate, as it dragged along its weary course towards a close. I mention that point only to dispel any idea that anybody here, and least of all myself, would wish to claim any degree of saintliness. I think that the gesture of tying one's shoe lace, which the noble Lord is now doing, is particularly effective as a form of tacit rebuke.

I am sure that all members of the committee are very grateful to the noble Lord. Lord Beswick, for his speech this evening, and in turn I am sure that the noble Lord and myself are extremely grateful to the members of the committee for all their labours. In addition to leading psychiatrists and the noble Lord, Lord Beswick, and myself, the committee included four other Members of your Lordships' House. The noble Lord, Lord Winstanley, has already spoken, and we looked upon the noble Lord, Lord Richardson, as a father figure. No doubt he will give a kind of paternal blessing to these proceedings as soon as I sit down. The noble Baroness, Lady Trumpington, played a very useful part. It has apparently secured her promotion onto a higher level altogether, and so she is not able to take part in this debate. I know that the noble Baroness, Lady Faithfull, was anxious to participate. As we all know, she possesses as wide a knowledge—perhaps a wider one—of the social services as anybody in this House.

I also echo the tribute paid by the noble Lord, Lord Beswick, to the late Lord Redcliffe-Maud, who was much respected here. He worked as a member of our committee, coming up to London from Oxford almost to the day of his death. I can guess where he is at the present time, and I know he will be happy to look down on us and know that we are aware of what he underwent on our behalf.

We were indeed fortunate to be sustained, financially and otherwise, by the Richmond Fellowship, and, in that connection I would mention, as did the noble Lord, Lord Beswick, Miss Elly Jansen. She came to this country some years ago—although she is by no means an old woman, far from it—as a theological student and, as far as I know, she came without funds and built up this network of homes throughout this country and other parts of the world. I would also mention the help that we received from the Matthews Trust, whose founder. Peter Thompson, was also a valid member of our committee.

When I opened the debate on this subject—the debate which led to this inquiry and report—the Minister, who was here earlier this evening, was very sympathetic when speaking on behalf of the Government, and I would certainly like to acknowledge the goodwill shown throughout by the officials. I have no wish to reiterate what I said during that debate in March 1981. I would only say that the task is even harder than I thought and the need is even greater.

I am quite sure in my own mind—although the whole argument of the report does not rest upon this—that no considerable improvement of our mental aftercare provision is possible without a substantial injection of new money and new resources. I should be misleading the House if I gave any other impression. I am aware that the prospect of obtaining new resources at the present time from the present Government is not very encouraging. The outlook is bleak. Money is found for Fortress Falklands and money is found for prison building on a large scale. Large sums of money are involved. I am citing the facts. Indeed, as regards prison building, it would be far more profitable to spend the money on alternative means of treatment. I will not go into those matters now: they raise issues that obviously divide the country at present. I just wish to record the opinion that, until we are ready for a large allocation of resources to this and to the other social services, we must not expect very great improvement.

However, let us take the Government's policy as regards those matters. We are faced, whatever Government are in power, with the fact of mental illness. We have the fact stated by the noble Lord, Lord Beswick, that one woman in five, and one man in nine will receive psychiatric treatment at some time in their lives. In view of that, it might be thought that there would be a tremendous national demand for better treatment for the mentally sick. It would be an exaggeration to claim that such a demand shows itself at the present time. I would just linger on one reason for that which was touched on by the noble Lord, Lord Beswick, and which can be underlined to some advantage. No one, I hope, will underestimate my own concern for the physically disabled. Only yesterday I moved the First Reading of a new Bill to assist them, and that Bill will be taken fairly soon in this House. But the fact is that the physically disabled have wonderful champions in this House and elsewhere—people who are ready to stand up and share in the sufferings of the disabled and take pride, to use the biblical expression, "in their infirmity".

However, with the mentally ill it is quite different. They lurk in the shadows. Anybody in this House or elsewhere who is mentally ill, or who has relatives who are mentally ill, will hesitate to mention the fact. Some years ago I was chairman of the National Society for the Mentally Handicapped and I can remember the tremendous wave of encouragement that was given to the mentally handicapped when, in this House, Lord Grenfell, at that time treasurer of the National Society for the Mentally Handicapped, rose up on the Benches opposite and mentioned his mongoloid daughter. It cost him an effort, and some of his friends at least two whiskies and sodas before he spoke and another two afterwards. It was a great spiritual strain, but that made a difference, and all the more because it is so rarely done.

However, those are the facts. The mentally ill will remain for some time a weak lobby, and that means that those who sympathise with them, whether or not they have any sort of personal connection with this subject, must redouble their efforts to be of assistance.

The noble Lord, Lord Beswick, and other speakers have explained the contents of this report so lucidly that I shall not try to go over the ground again. I shall just mention two points, both of which have already been touched on, but I am bound to mention them again. One is the implications of this strange phrase "community care", which has become a shibboleth, but which could mean many wonderful things or be meaningless. I do not need to repeat what has been said by the noble Lords, Lord Beswick and Lord Winstanley, in particular, but, in fact, up till now it has been something of a snare and a delusion. We have had the easy part of the Mental Health Act 1959 carried out; we are beginning to empty the hospitals, and good luck to that policy. But we have failed—if not totally, then very largely—to carry out the other part: to build up community care. I know that the Minister is well aware of the strong case for greatly expanding community care.

I shall just touch on one proposal in the report which has been mentioned by other speakers—the proposal for joint mental health development committees throughout the districts. The success or failure of the attempt to make community care a reality will depend on these rather clumsily labelled committees. I hope that the proposal for these joint committees in the districts, which in itself will be quite inexpensive, will at least obtain the support of the Minister. I know that, within the confines of Government policy, the Minister is genuinely anxious to help the mentally ill. So perhaps he will find it possible to say something about that particular proposal when he winds up.

I come finally to the question of a Minister with special responsibilities for mental health. Few will deny that the appointment of a Minister for the Arts has been a far-reaching benefit to the arts and, through the arts, to the country. The same was said of the appointment of a Minister for the Disabled—in that case Mr. Alf Morris—though lately his role seems to have been rather smudged. I shall state boldly my own conviction that the cause of mental health, so long neglected, and, for reasons which I touched on earlier, always likely to be underplayed, would benefit enormously from the appointment of a Minister recognised in official circles and by the general public as a designated champion in the way, for example, that the Minister for the Arts is recognised now as a designated champion.

I am not now concerned with the precise level of the proposed Minister. I know about these levels from experience. I have been a Lord-in-Waiting, an Under-Secretary, a Minister of State, a Minister of my own department but outside the Cabinet, and a Minister with a department inside the Cabinet. I know the way that one can move backwards and forwards between those various situations.

The most successful Minister for the Arts, by common consent, was Jennie Lee, who started ministerial life, if I remember correctly, as a Parliamentary Under-Secretary in the Ministry of Education. So while the level is important it is not everything. Mr. Alf Morris, coming to his task admittedly with the great achievement of the Bill behind him, was equally effective although no more than an Under-Secretary. May I say respectfully to the Minister who is to reply, and who is liked by everyone, that it is not enough for us to be told that he has a special responsibility within the department.

Any of us who has been an Under-Secretary, or had Under-Secretaries under him, will know that that in itself does not give the Minister any great influence. Many years ago I was an Under-Secretary in the War Office and given the responsibility of recruiting. But no one thought that I had very much power over recruiting. I do not know whether it did any better or any worse in my time than at any other time, but I was not the Minister of Recruiting in the same sense that a Minister with responsibility for the arts is Minister for the Arts.

I am certainly not concerned with personalities. So far as I am concerned, the noble Lord might well be the ideal Minister, so I hope he will not think I have in mind some suggestion that he should be replaced by somebody else. Not at all. I am happy to see him sitting there, but it is no good his telling us that he is already Minister for the mentally ill. That means nothing if it is simply something that leaks out in the course of Question Time.

If we go back to the Gospels we find that Jesus Christ placed physical and mental illness on the same footing. A high proportion, something like a third of the miraculous cures, were mental cures. Today the language is different. We do not talk about casting out devils, or at any rate that is not the phraseology used in official circles, but the issues are not really changed. Christian traditions and modern psychiatric advances combine to produce profound tenderness towards the mentally sick among so many dedicated people.

Your Lordships may remember that one of the multitude brought to Christ his son who had what is called a "dumb spirit". I am now quoting from the Gospel. 'Oft times' he said, 'it hath cast him into the fire, and into the waters, to destroy him: but if thou canst do any thing, have compassion on us, and help us'. Jesus said unto him, 'If thou canst believe, all things are possible to him that believeth.' And straightway the father of the child cried out, and said with tears, 'Lord, I believe; help thou mine unbelief'". The question today is whether we care enough, and whether we believe enough in our duty to the mentally ill. In this House at least I am hopeful that the answer is that we do.

11.28 p.m.

Lord Richardson

My Lords, the difference in the way that we should think about the mentally ill and the physically ill is very small; and the way in which we should attempt to relieve the mentally ill who have returned to the community is indeed compatible with the best medical principles as practised throughout medicine today. We believe—and in this of course the Government encourage us—that patients should not be in hospital longer than they need be, and that they should be cared for properly when they return to the community. This is widely accepted, and the periods in hospital for physical illness are always reducing.

What the Richmond inquiry has come up with, apart from their insistence, about which your Lordships have heard, is the importance of the organisation headed by a Minister, and funded in such a way that the funds cannot be diverted to other purposes, and it can be seen by all concerned that the funds are not so diverted, and that the Minister and those below him are profoundly dedicated and interested. This principle has been put to the House with great vigour by the speakers this evening. All I want to say is that the professional people, at a lower level, that of the patient, will have to implement the efforts that we so earnestly hope the Minister will tell us he is prepared to make, and they are able to do so; they are willing and know how to work as a team.

However, teams have to be trained. Although there is evidence of admirable training for the constituent parts of the team—namely, the doctors, the nurses and social workers; and. very important, the voluntary workers who do so much—there is, nevertheless, an important gap which needs to be dealt with. That is, to produce a common core of information and training which is common to all the professions concerned, so that they understand each other, and so that their disciplines will inter digitate and not be separate. A nurse should know the point of view of the social worker and not be solely concerned with the giving of her particular skills. The social worker should understand the place of the nurse. The doctor should be able to communicate, to explain and to understand the problems of the other professions and how best they can exercise their skills.

If this is done, as it can be, provided that there is confidence in the minds of these professionals that real support will be maintained and not diverted or amputated by cuts, then I have no doubt that great advances could be made in the care of people who should not be in hospital, but who should be, if not in their own homes, as near to their homes as they possibly can be.

A terrible burden lies on the families and on sufferers from mental illness; a burden that I am convinced is more than is felt by almost any form of physical illness. In the report the word "stigma" appears, and that appeared advisedly. I am trying to say that with co-ordination, proper appreciation of the skills of others and bringing them all together to bear on the patient, great things can be achieved. But they cannot be achieved at all—they can hardly be begun—unless there is the real confidence that those who are responsible for organising the service are profoundly prepared to see that it works. To put it in more practical terms: they must see that it works in accordance with the Griffiths' philosophy, and to see that it is properly financed. We all await the Minister. We have spent a great deal of time saying so and I will now sit down.

11.33 p.m.

Lord Wallace of Coslany

My Lords, we are dealing with a very important subject, unfortunately at a late hour, and in an Unstarred Question debate. The subject needs much wider discussion, although one should be very grateful indeed to all those noble Lords who have taken part in the debate so far.

It is not my intention to make a long speech. not as long as my speech in the debate of 31st March 1981. I reread the whole of that debate and congratulate the Richmond Fellowship on the way it used that debate to set up the inquiry which has resulted in such an excellent and positive report. It would be fair to say that in the last two years welcome changes have taken place in the mental health field, mainly as a result of the passing of the Mental Health (Amendment) Act, in the various stages of which this House played a very prominent part. But this Act, itself, asserting as it does patients' rights, adds to the problems that are fully faced in the Richmond Report.

Reference has been made by my noble friend Lord Beswick to press reports, particularly in the Sunday Times of 20th November, which featured an article by a lady called Margery Wallace; but she is certainly no relation. She dealt with the pitiable position of, thousands of mentally ill people being abandoned in squalid lodging houses or even decanted on to the streets". It is a sad story compared to the situation which exists in the 40 centres run by the Richmond Fellowship. We have been told that over the years the number of mental patients has been run down, so far as hospital treatment has been concerned, by about 70,000; and now a further 20,000 are expected to leave hospital as a result of closures. This will only add to present problems.

I agree that some of our old, outdated mental hospitals need to be demolished. There is one close to me, Darenth Park, which is going to be demolished. But the trouble is that, even so, patients will have to settle down in the transfer to the new units of accommodation within the hospitals and get used to their new surroundings. The nurses have admitted that. It will be difficult enough for these patients, but at least they will have skilled nursing staff available to assist them in the transition period. Release into the outside world, for many, unfortunately, does not mean the provision of care and reasonable accommodation. The release of many people from institutional care, some after a very long period, raises the problems of aftercare accommodation and employment.

Most of the people leaving a mental hospital after a lengthy stay face a very strange world and need care and guidance gradually to accustom themselves to a new and very strange environment. This is where the recommendation to set up a new organisation, particularly at district level, would go a long way to organise methods to provide that badly needed care.

In the debate on 31st March 1981, I referred to what happened in Norwich, where the local authority, the voluntary organisations and the health authority got together to produce transitional accommodation where female patients were able to settle down, to face the problem of buying things themselves and to do the little things which mean so much. And they were being helped by experienced nurses seconded for the job. That is an ideal scheme and such schemes are ideal. But unfortunately there is still a long way to go. The setting up of the suggested new organisation, as I have said, will go a long way to intensify efforts in the recommendation that has been advanced.

My Lords, there is a call for a designated Minister. It is a fact that the Minister responsible for the mental health services—and that by his own admission, probably at a very loose moment—is the noble Lord, Lord Glenarthur. It would be interesting and useful to the House if he could outline very briefly his present responsibilities in the mental health field. I ask this purely for information and no more. But, of course, what is needed is a Minister with complete responsibility for the mental health service and answerable to Parliament as such. In saying this, there is no personal reflection on the noble Lord, Lord Glenarthur, who himself, I know, is taking a very keen interest in this problem.

The mental health section, as the noble Lord, Lord Winstanley, and others have said, is still the Cinderella of the National Health Service. It is true that some of the stigma unnaturally attributed to mental illness has been gradually removed, but too much of it still remains and a majority of people just do not want to know.

Furthermore, in the present public concern over the effect of cuts in the National Health Service—or, to be fair, and putting the Government's view, the drive for efficiency and economic management—the plight of mental hospitals and their related services tends to be overlooked when they are suffering at least as much as or, in some cases, more than general hospitals. This attitude is mainly because the local general hospital is regarded as part of the community, while the mental hospital is normally not discussed by the majority. I say "the majority" deliberately because it gives me the opportunity to pay to the valuable and useful work put in by friends of various mental hospitals tribute for the efforts they make, the funds they raise and the visiting that they carry out. These are extremely enlightened people doing valuable voluntary work.

The inquiry report does cast light on the importance of mental health care in all its aspects in the community, and its title, Mental Health and the Community, is apt and underlines the outstanding need for such an approach. Of course, finance is needed—and here I must admit that I lack a degree of confidence that it will be provided in the very near future; but you never know, and the need must be stressed.

In conclusion, may I say this? Here is a report compiled with sympathy and understanding with sensible, progressive and logical recommendations. Like my noble friends, I look forward to the reply of the noble Lord, Lord Glenarthur, which, I am certain, will be made in a sympathetic manner and perhaps will raise a ray of hope, or even a slight degree of optimism. I hope it will.

11.42 p.m.

Lord Glenarthur

My Lords, I think we are all grateful to the noble Lord, Lord Beswick for asking this Question tonight. When he started his speech, the noble Lord referred to the history of mental health as fascinating and moving, and we have heard some fascinating and certainly some moving speeches tonight. He is quite right in what he says: that to the uninitiated in this field it often seems a sad and even distressing subject to become involved in, and I must confess that to some extent I found this myself when I took up my present responsibilities. But I have to say that I have also found a great deal to be encouraged about in the way that the mentally ill are looked after. While I would be the last to say that there are no problems at all, I do not think that the situation is quite as bleak as some noble Lords have made out tonight.

The report with which this Unstarred Question is concerned, as the noble Lord is aware, was received by my Department in July and, as I said in your Lordships' House on 2nd November, is still being considered. As the noble Lord, Lord Beswick, will no doubt recall, my officials recently met him, the noble Earl, Lord Longford, the noble Lord, Lord Winstanley, and the noble Lord, Lord Richardson, and representatives of the Richmond Fellowship to discuss the conclusions and recommendations of the report. As we said then, the Government's initial broad reaction is quite favourable. But I have to stress that consideration of the report has not yet finally been completed. Nevertheless, it is quite clear even now that it would be difficult to implement some of the recommendations it makes. In particular, those that involve additional expenditure or involve issues that we would normally expect health authorities to decide for themselves will require our particular concern. Our response will naturally also have to take account of the recommendations contained in the recent National Health Service Management Inquiry: the Griffiths report, to which the noble Lord, Lord Beswick, referred.

Your Lordships will be aware that the purposes of this inquiry were to review the initiatives that had been taken by the Government to improve health service efficiency and to advise on further action. The team has produced recommendations designed to improve accountability and to strengthen management in the National Health Service. Their aims—and ours—are to secure the best deal for patients and the community within available resources; the best value for the taxpayer and the best possible motivation of staff.

While none of the recommendations relates specifically to psychiatric services, most will have some implications for their future delivery. The report has been welcomed by the Government and its general thrust has been accepted. Consultations are now proceeding with health authorities and professional and other interests. At this early stage, it seems likely that such things as the extension of the accountability review process through to unit level, the initiation of cost improvement programmes, which will certainly help mental health, the taking of all day-to-day decisions at hospital or unit level, the greater involvement of clinicians in the management process and other items which I could list, could all impinge beneficially on the mental health services in this period of transition.

A number of your Lordships raised the matter of a Minister with special responsibility for mental health. As was stated, it is something which was raised on 2nd November when I answered a Question. I am sorry that some of your Lordships feel that more needs to be done on this account. I understand the motives behind their argument, but I think they will accept that there are obvious pitfalls in attaching a variety of specific labels to Ministers. They will undoubtedly multiply and, in doing so, may become devalued and therefore meaningless.

I was surprised to hear from the noble Earl, Lord Longford, that the country at large did not know that I have my particular responsibility until, as he put it, it leaked out at Question Time. I can assure him that it was only a very few hours after I reached my desk at the Elephant and Castle when both the voluntary and the statutory sectors got in touch with me. They have not ceased to do so since, and I enjoy meeting them, hearing from them and talking to them, and I learn a very great deal from what they have to say. So I hope I can reassure both them, and those of your Lordships who are concerned on this point, that my responsibilities for mental health take up a very large proportion of my time.

Perhaps I may come back to that in a moment, but the noble Lord. Lord Wallace, asked me exactly what my responsibilities are so far as mental health is concerned. I could elaborate at some length on what I am going to say, but I do not think I shall do so now. What I ought to say is that I provide something of a focal point within the department for the development and review of mental health services. This involves co-ordinating the contributions of the voluntary sector, the health service and local personal social services.

I have already made a number of visits around the country to form a first-hand impression of the problems faced in this field and, in doing so, I have met representatives of organisations such as MIND, the Mental Health Foundation and MENCAP. The noble Lord, Lord Winstanley, drew attention to the importance of these voluntary agencies. He is quite right. We really could not do without them, though I do not think I could agree fully with the noble Earl, Lord Longford, that with powerful bodies such as these the mentally ill do not have champions. They most certainly do.

The noble Earl, Lord Longford, and the noble Lord, Lord Winstanley, also referred to the financial position generally. I think it would probably be worth my while pointing out at this juncture that the department's grants to the voluntary bodies—taking them as a separate issue in the mental health field—will amount to about £800,000 this year. So I hope that that indicates that we attach a very great deal of importance to all the work that they do, and do what we can to encourage them.

However, to come back to the point made by the noble Earl about labelling a Minister with special responsibilities, I am sure that that is a point which my right honourable friend the Secretary of State and my right honourable friend the Prime Minister will take into account. I do not think I can go further on this point than to say what I said earlier.

Perhaps I can list now those aspects of the report which the Government can commend. They are: the accent on comprehensive mental health services in every district; the emphasis on training of staff; the need for co-ordinated planning between health and local authorities; the involvement and greater recognition of the role of the voluntary sector; and the monitoring of service provision and standards.

May I now turn to some of the more specific recommendations contained in the report. On the question of a new development fund, the report considers that the present joint funding arrangements are unsatisfactory because local authorities and voluntary organisations have to take over revenue costs from health authorities after a "tapering" period. I am aware that there are difficulties at the local level over joint finance, and the point the report makes will be fully considered. Nevertheless, the Government introduced improvements to the system earlier this year. These should ease some of the problems that have arisen.

The report envisages the establishment of a new development fund, as described by the noble Lord, Lord Beswick. This would involve a substantial annual investment of additional funds made available by central Government over a considerable period of time. The money would be disbursed through joint funding arrangements so that revenue costs could be continued indefinitely.

I must point out that such a fund could only be financed from existing resources and would thus have to come from monies at present allocated to health and local authorities. There are two major obstacles to this proposal. First, it would have the effect of transferring responsibility for decisions on service needs and provision from the local level to central authority. This flies in the face of the long-standing policy of local decision-making being an essential part of community care. Secondly, it would single out mental illness for special treatment, even though there are of course other priorities—for example, mentally handicapped people, whom I also look after, elderly people and physically handicapped people. I really do not believe, despite what has been said in the debate tonight, that the Government could necessarily agree to set any one priority group ahead of the others, although the points which noble Lords have made will be taken into account.

Lord Beswick

My Lords, is it really proper to proceed with the closure programme if the alternative services are not to be financed because the money is not available?

Lord Glenarthur

My Lords, the closure of some of these hospitals will lead to the repositioning—if that is the right word to use—of a great deal of cash which is tied up in hospitals which do not necessarily meet the requirements of the people who are in them. To give an example of the kind of funds which will be made available from revenue, a couple of weeks ago I visited one of the hospitals in Surrey which is due to close in due course. I believe I am right in saying that the figure I was quoted for heating alone was £500 per patient per year. That is a fairly staggering figure. If it is possible to divert revenue which is being wasted in some respects in this way and to put it into the community, it may be one way in which we can meet the noble Lord's requests.

The report also recommends a departmental planning board specially for mental illness to assist the Minister with special responsibility for mental health in the task of allocating money from the development fund to improve mental health services generally. This recommendation goes hand in hand with that for a new development fund and also raises similar difficulties. On the positive side, my honourable friend the Minister for Health recently agreed to set up a joint working party with the local authority associations to consider improvements to the joint planning arrangements. This development holds out the promise of more effective and better co-ordinated planning for the future.

One of the other recommendations in the report—to which the noble Earl, Lord Longford, referred—is the setting up the joint mental health development committees. They would have the responsibility for achieving minimal standards for district services. The report envisages that they be given statutory force.

The Government endorse the need for joint planning between health and local authorities, as I made plain just now, and recently passed legislation to give voluntary organisations places on joint consultative committees. It is a matter for a joint consultative committee itself to decide what committee structure it needs—so that if it does consider a mental health development committee to be more effective than a joint care planning team, it can no doubt act on the inquiry's recommendation.

The report goes on to propose—as the noble Lord, Lord Beswick, said—the setting up of an inspectorate to monitor services along the lines of Her Majesty's Inspectors of Schools system. Its function would be to extend the valuable work of the health advisory service and social work services. The report also mentions the strengthened inspectoral role that the Government have announced for social work service.

We shall carefully consider that proposal because it echoes the Government's desire to obtain effective and efficient services. However, we may well conclude that it will be better to rely on strengthening the existing mechanisms for monitoring service provision rather than creating new mechanisms; and the health advisory service already has an excellent reputation.

Another of the report's recommendations for which I have some sympathy is that the basic elements required in a comprehensive community service should be made mandatory. It is already our long-term aim that comprehensive mental health services should be provided in every district. But as the 1975 White Paper, Better Services for the Mentally Ill, made clear, progress towards them will take 20 to 30 years to reach fruition and will depend on the ability of the nation's economy to provide the necessary financial resources. It is in the long-term interests of all mentally ill people, therefore, that the economic progress this Government have made is maintained and built upon.

In order to improve accountability and clarify objectives, a system of annual performance reviews was introduced into the National Health Service in January last year. Mental illness provision is one of the subjects studied in preparation for the reviews and indeed it features in most of the review meetings themselves. Those are just the sort of meetings which discuss the kind of closure programmes to which the noble Lord, Lord Beswick, referred in his speech. I can certainly assure the noble Lord that I take a particular interest in the programmes which regional health authorities put forward when I undertake such reviews, which I do fairly regularly. Those reviews are also continued between the region and the district concerned. There is great merit in the review procedure.

I note that the report further urges that the obligation placed on local health and social services under the Mental Health Act 1983 and the Health Services and Public Health Act 1968 should be reaffirmed by statute. The report is almost certainly referring to the statutory obligation to provide aftercare services. The 1983 Act does partly reaffirm the statutory obligation to provide after-care, but there has been a duty placed on local authorities to make appropriate arrangements for mentally ill people for many years. It can be traced back to powers in the National Health Service Act 1946, which directions—issued in 1950—converted to a duty.

Those directions were renewed in a circular issued to local authorities in 1974 advising them of their responsibilities. We have consistently taken the view that Section 117 of the Mental Health Act 1983 does no more than re-state an existing responsibility and we therefore see no need to reaffirm that obligation yet again.

Several noble Lords are concerned at the need to promote good mental health positively. On this front the department are involved in such matters are improving the position for those people who care for relatives and friends suffering from mental illness. It may not have been a point brought out tonight but I believe it is one worth stating now.

We are discussing with the Health Education Council ways of promoting and increasing public awareness of mental health. We fund organisations active in the field of bereavement counselling such as CRUSE and the Widows' Advisory Trust, and we are looking into the special problems raised by disturbed adolescents—all areas, we think, where investment of time and money can have quite wide-ranging benefits.

Several of your Lordships have said some—I do not know if discouraging is the right word, but I think it almost amounted to that—things about the reality of the care in the community. I should like to respond to some of the points raised. First, it needs to be clearly understood that this is not a new policy: successive Governments for many years have embraced the policy that most people who need continuing care should be looked after in the community. Mentally ill people are but one of the groups that this policy involves. Most of our psychiatric patients who had been in hospital a long time and who could benefit from living outside hospital have already been discharged.

It also needs to be clearly borne in mind that the great majority of people who suffer from a mental illness either never go into hospital for treatment or, if they do, are discharged to home and family within weeks. Thus, most mentally ill people already receive the most natural form of care in the community—that is, of course, care.

The noble Lord, Lord Wallace, mentioned the figure of 20,000 who might be transferred from mental hospitals. He is not quite correct in that figure, I am afraid; I ought to tell him that of the approximately 70,000 patients at present in mental hospitals it is estimated that up to about 5,000 may benefit from living outside and it is on this comparatively small proportion that the "care in the community" policy focuses. That figure puts in perspective what I think was really a fairly misleading statement in the article in the Sunday Times that was referred to earlier, which more or less implied that hospitals were being closed willy-nilly, and the patients were being turned out into the streets. That is not the case.

The noble Lord, Lord Winstanley, asked about residential accommodation and the number of places there were. It might interest him to know that residential accommodation has increased by over 30 per cent. between 1975 and 1982, and day centres by about 50 per cent. over the same period. Day hospital places increased by about 150 per cent. between 1970 and 1981. The noble Lord also asked about the provision of psychiatric nurses in the community. I can tell him that staff numbers more than doubled between 1976 and 1981.

Because we were aware that the financial arrangements between health and local authorities designed to assist the move to community care were not working as well as they might, we introduced more flexibility into the system earlier this year. Health authorities can now guarantee continued funding to local authorities and voluntary organisations for people moving out of hospital, and this ought to assist progress considerably. We shall also shortly be issuing a circular to extend the joint finance arrangements to cover the costs of providing accommodation, for instance, through housing associations, and this too should help.

The noble Lord, Lord Richardson, spoke of the need for professional training on a multi-disciplinary basis. Perhaps I may say to him that the Government fully recognise the desirability of effective training for all staff involved in the provision of mental health service. I have read with interest the report's suggestions for improvement of professional training, and I am particularly impressed by what the noble Lord, Lord Richardson, said in calling for a common core of information to be available for the different professions. I am grateful to him for his contribution.

The noble Lord, Lord Winstanley, asked about Mrs. Harrison-Gledhill's report. May I briefly tell him that in 1981 the Government announced plans, as he knows, for the replacement of the Camberwell Resettlement Unit by small hostels run by voluntary organisations to be funded jointly by the DHSS and Department of the Environment. Work is well advanced towards completing the objective of closing the resettlement unit by the end of1985. Mrs. Harrison-Gledhill's report on the problems likely to be experienced during the closing down period and her suggestions for the future treatment of the socially regressed and incompetent have been studied in the various branches of the department with considerable interest. When officials met her in August last they made a number of comments which she agreed to consider. I have to tell the noble Lord, Lord Winstanley, that we have not heard from her since. She has not come back to us so I cannot go much further on that tonight.

I close by stating my very real appreciation for the enormous contribution made and the effort that has gone into the production of the Richmond Fellowship Report. I and my ministerial colleagues will continue to give the report's recommendations our close consideration. We certainly do not profess to hold a monopoly on the fount of wisdom on this matter. However, I hope that I have demonstrated this evening the genuine efforts we are making to improve mental health services and that we are only too keenly aware of the issues raised in the report.

House adjourned at seven minutes past midnight.