HL Deb 09 February 1988 vol 493 cc97-100

2.58 pm.

The Lord Bishop of Carlisle

My 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 it is their policy that mentally handicapped patients should be moved out of National Health Service hospitals into the community.

The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skelmersdale)

My Lords, the Government's policy is that mentally handicapped people should reside in places suited to their individual needs. This should offer them and their families a genuine choice. Due to changes in assessment of needs this should in time mean less dependence on large National Health Service mental handicap hospitals. For people with special needs there will be a continuing need for some specialist residential health care.

The Lord Bishop of Carlisle

My Lords, I thank the Minister for that Answer. Is he aware that in some cases DHSS benefits previously paid to some ex-patients now living in community establishments have been stopped, thus jeopardising their chances of remaining in the community? If benefit payments are not restored, in some cases health authorities will have no option but to re-admit ex-patients to hospital. Does the Minister agree that that would be an unhappy retrogression?

Lord Skelmersdale

My Lords, I am grateful to the right reverend Prelate for bringing the matter to my attention. Before he sent me details of his Question I was unaware of this situation. I am advised that the current position is that all new projects are on hold. In the autumn my right honourable friend the Secretary of State met regional health authority chairmen and asked them to provide details of all their projects to establish homes and hostels for former patients. Once we have the information and are able to assess the position we can decide what steps to take.

I agree that in the long-term the right reverend Prelate's assertion would be correct and that it would be a great mistake. We also hope that Sir Roy Griffiths' over-view will be of help in providing pointers for the future.

Lady Kinloss

My Lords, can the Minister say whether the rate of discharge of such patients into the community has slowed down since the policy was established? Can he also say whether there is evidence that there is a sufficient number of nurses and social workers who are adequately trained to care for these patients in the community?

Lord Skelmersdale

My Lords, it is essential that proper provision is made in the community before patients are discharged, whether through nurses, doctors, health workers or anybody else.

Lord Renton

My Lords, is my noble friend aware that nearly eight years ago the then Secretary of State, my noble friend Lord Jenkin, announced the Government's policy of trying to remove many mentally handicapped people of all ages from long-stay hospitals so long as they could be cared for in the community? Towards that end the Government have given a great deal of help to voluntary societies, including the Royal Society for the Mentally Handicapped, and in recent years the process has been working satisfactorly.

Lord Skelmersdale

My Lords, I am extremely grateful to my noble friend Lord Renton for asking that supplementary question. When my noble friend Lord Jenkin made that statement he also made it clear that the primary aim of our policy is not the closure of hospitals but to provide better care. In concert with voluntary bodies such as MENCAP, I believe that we have achieved that aim.

Lord Ennals

My Lords, does the Minister accept the conclusion of the Audit Commission that many local authorities must transport employees a considerable distance before community care becomes a local reality for mentally handicapped people? Does he accept that much of that is due to the inadequate funding available to local authorities as a result of the Government's restrictions and penalties on the amount that local authorities are permitted to spend?

Lord Skelmersdale

My Lords, a considerable amount of money is allowed to local authorities to spend on community care and personal social services. We have studied the report of the Audit Commission with great care and, as part of the evidence, we referred it to Sir Roy Griffiths so that he can take it into account when presenting his report.

Lord Winstanley

My Lords, is the noble Lord aware that I was somewhat puzzled to hear him say that the information given to him by the right reverend Prelate took him by surprise, because I gave precisely the same information in correspondence to the noble Lord's predecessor some months ago? Would he care to look at that correspondence in the light of what has taken place?

Lord Skelmersdale

My Lords, I had not realised that my department's attention was drawn to this matter before. Certainly my attention has not been drawn to it.

Lord Harmar-Nicholls

My Lords, will the point raised in this Question be included in the general reappraisal as to the framework governing the National Health Service which we are told is now under consideration?

Lord Skelmersdale

My Lords, the general view is not likely to be as detailed as my noble friend suggests. However, the general points made in your Lordships' House as a result of this Question will indeed be taken into account in consideration of Sir Roy Griffiths' review.

Lord Allen of Abbeydale

My Lords, will the Minister accept that care in the community is not a cheap option? Although MENCAP and other voluntary organisations are grateful for any help, will the Minister accept that the main burden of providing necessary resources must fall on the public authorities?

Lord Skelmersdale

My Lords, yes. We have never made any secret of our feeling that care in the community is anything but cheap. Nonetheless, we believe it provides the right conditions for most mentally handicapped people, and of course the main burden of financing this care will continue to fall on public authorities.

Lord Elwyn-Jones

My Lords, can the Minister say what proportion of mentally handicapped patients have been moved? Is he aware of considerable concern in the Mental Health Foundation and other organisations about the arrangements?

Lord Skelmersdale

My Lords, I am indeed aware of that concern. I do not have the figures on the proportion that have been moved out into the community.

The Countess of Mar

My Lords, is the Minister aware that provision of accommodation for mentally handicapped people discharged from hospital varies very much from authority to authority? In some cases it is owned by the National Health Service; in some cases it is leased by the National Health Service; in some cases it is owned by the local authority. The methods for funding these ex-patients and funding the authorities are a real minefield. Can the Minister look at all the different means of funding and bring together some sort of co-ordinated policy for these people?

Lord Skelmersdale

My Lords, yes. It is certainly my intention to do that. I should point out that health authorities are not able to make a charge, and that is the crux of the problem.