§ 2.54 p.m.
§ Baroness Ewart-BiggsMy Lords, I beg leave to ask the Question standing in my name on the Order Paper.
§ The Question was as follows:
§ To ask Her Majesty's Government whether there is a shortage of National Health Service nursing staff for patients requiring psychiatric treatment.
§ Lord SkelmersdaleMy Lords, there is a shortage of nursing staff caring for mentally ill people in some district health authorities, although nationally the total number of such staff increased by 9.2 per cent. to 59,480 man years between September 1981 and September 1986. This rise is made up of a 6.6 per cent. increase in hospital psychiatric nursing staff and compares with a fall of 15 per cent. in in-patients between years ending December 1981 and December 1986 and a rise of 134 per cent. in community psychiatric nursing staff. During this period the proportion of qualified staff has increased from 54 per cent. to 57 per cent.
§ Baroness Ewart-BiggsMy Lords, I am grateful to the Minister for his reply. In the light of it, what does he suggest should be done about the situation set out in the Guardian article where a registrar in psychiatry describes how shortage of nurses and pressure on beds in the acute admissions unit of her district hospital have meant that young and old people with mental disorders and young mothers with depression and suicidal tendencies have not been admitted because their condition is not considered critical enough? Does the Minister agree that funding is required to continue with preventive work whereby people would be taken in for a short stay and given treatment to get them through a critical period? If those funds cannot be found, there should be additional psychiatric community nurses to support those desperate people in their own homes.
§ Lord SkelmersdaleMy Lords. obviously, I accept that not all the staff were available in the places where the need arose. I have seen the article in the Guardian on the subject to which the noble Baroness refers. So far, I have been unable to discover to which hospital the article refers. However, as a result of better methods of treatment and modern psychiatric practice, far fewer people have entered in-patient care than was the traditional pattern 50 years ago. The answer to the main point raised by the noble Baroness is that there should be a gradual transfer of nurses from psychiatric hospitals to become community care psychiatric nurses.
§ Lord EnnalsMy Lords, I agree with the last point made by the Minister. Does he accept the disturbing figures recently presented by his department to the Public Accounts Committee which showed a 13 per cent. shortage of mental illness nurses and a 17 per cent. shortage of nurses for mental handicaps? Does he accept that the pay level is a vital factor which leads nurses to vote with their feet and to leave their jobs? Does he stand by the answer that he gave on Thursday to a supplementary question from the noble Baroness, Lady Cox, that there is no substance in the reports that the Government are contemplating increases in nurses pay?
§ Lord SkelmersdaleMy Lords, from what I can remember, that is a very free translation of what I 9 said on Thursday. I am sure that I said that the Sun article, upon which one of my noble friend's supplementary questions was based, was pure speculation. With regard to the number of staff, information about vacancies is not collected centrally. However, a sample survey of the Review Body for Nursing Staff, Midwives and Health Visitors showed that at 31st March 1986, 4.3 per cent. of whole-time funded posts in mental illness nursing had been vacant for at least three months compared with an average of 3.2 per cent. for all nursing staff. The House might be interested to know that whereas there were 60,000 patients in mental illness hospitals and units in England in December 1986, there were in fact 71,000 staffed beds.
§ Baroness SeearMy Lords, does the Minister agree that if mental patients are to be treated in the community, probably living in their own homes with their families looking after them, a great deal of support needs to be given to those families? It means for example, that far more resources will be needed for home helps and other support for people who have to look after patients in their own homes. I know that the Minister will agree that the strain of looking after people who would otherwise he in mental hospitals is considerable. A breakdown will occur unless there is adequate support.
§ Lord SkelmersdaleMy Lords, I certainly agree. That is why I said in answer to the noble Baroness, Lady Ewart-Biggs, that, first, I should like to see a considerable increase in community psychiatric nurses. Secondly, we are investigating the whole area of community care. We expect Sir Roy Griffiths, who is the Secretary of State's adviser on the health service, to report very early in the new year. We shall be able to take decisions based on that report.
§ Lord Harvey of PrestburyMy Lords, is my noble friend aware that one of the biggest problems facing the nurses, certainly in the South of England, is the cost of accommodation? Can something be done to alleviate that problem?
§ Lord SkelmersdaleMy Lords, yes. As I said in answer to a supplementary of my noble friend Lady Cox last week, the Government are indeed taking on board considerations for major moves in this area. I am afraid I have nothing to announce today.
§ Lord MolloyMy Lords, is the Minister not aware that the organisations that represent nurses in the National Health Service—the Royal College of Nursing, the Confederation of Health Service Employees and the Association of Home Visitors—have all expressed grave concern at what they term the vast number of nurses who are leaving the profession? Would it not be wise for the Government to consider having consultations with the Royal College, the Confederation of Health Service Employees and the health visitors' association, to see what can be done to stop this very dangerous drift of British nurses from the National Health Service?
§ Lord SkelmersdaleMy Lords, again, we are getting very wide of the Question on the Order Paper. However, I dealt fairly fully with this question last 10 week. If the noble Lord would like to refer to my answers then, I think he will find them helpful.
§ Lord KilmarnockMy Lords, is it the intention to make some special arrangements for nurses under the poll tax? Otherwise there will not only be a lack of nurses in this speciality but in all branches of nursing.
§ Lord SkelmersdaleMy Lords, again, I answered a supplementary question posed by my noble friend Lord Elton on this subject last week.
§ Lord Harmar-NichollsMy Lords, in view of the penultimate question, and several others, put to him this afternoon, is my noble friend aware that the furthest the Leader of the Opposition has been prepared to go is to say that there is an alleged deterioration? In the face of increased operations, additional improvements, and the money spent, is it not unnecessary to interfere with the morale of people? The Government have to consider whether the funding is right; and the people running hospitals have to ensure that they are spending wisely the money that they are receiving in the interest of the patient.
§ Lord SkelmersdaleMy Lords, yes. I certainly agree with that. But there is a world of difference between this Question on psychiatric treatment and the more general problems to which my noble friend has certainly some of the solutions and which we have discussed on numerous occasions in recent weeks in your Lordships' House.
§ The Countess of MarMy Lords, perhaps I may bring the issue back to the Question on the Order Paper. Has the Minister seen a statement by the consultant physician in mental health. in the Aylesbury Health Authority who said:
GPs were referring to hospital psychiatrists people who had social problems. The result is that specialised psychiatric units have become board and lodgings facilities for the socially deprived. The expertise available to provide adequate neuroleptics, and services such as family therapy is being wasted".Is the Minister aware that Buckinghamshire has now allocated community psychiatric nurses to 16 general practices? Is he prepared to extend this experiment to all GPs in the country and therefore to relieve the hospital psychiatric units of many cases?
§ Lord SkelmersdaleMy Lords, as I sought to explain earlier. I am as keen as anyone to extend the numbers of community psychiatric nurses. It sounds to me as though Buckinghamshire has been able to achieve it. Yes, I should like to see that duplicated widely.