Disabled Patients: Community Rehabilitation (Hansard, 14 June 1988)

§ The Parliamentary Under-Secretary of State, Department of Health and Social Security (Lord Skelmersdale)
My Lords, it is for health and local authorities to co-operate in the planning and provision of appropriate services for disabled people returning from hospital to the community. While the range of services provided will vary in the light of individual needs and local circumstances and there is always likely to be room for improvement, we are pleased to see the many examples of progress being made in this field.

§ Baroness Masham of Ilton
My Lords, I thank the Minister for that reply. is he aware that many of the beds that are being blocked are in regional special units or super regional units? Is he further aware that this is most frustrating for the surgeons who are trying to clear their waiting lists? Will he look into this matter very quickly?

§ Lord Skelmersdale
My Lords, I am well aware that the noble Baroness has a special interest in this field. She has written to me about it and I am following up the cases which she quoted. I can advise her that the department has recently completed consultations on a draft circular on the discharge of patients from hospital in which health authorities were reminded to make suitable plans for the discharge of patients, including arrangements for transfer to other facilities at an early stage of the patient's stay in hospital. It points out the need to involve patients and their relatives or carers in such plans. I said that consultations had recently been completed. The results are now being considered and the circular should be issued quite shortly.

§ Lord Carter
My Lords, will the Minister give the Government's response to the excellent report recently produced by Shelter entitled Freedom to Lose, which reveals the worrying position regarding the transfer to adapted housing for physically handicapped people? Will he agree that the possibility of transfer of local authority housing into the private sector and to housing associations as a result of the new Housing Bill will mean a considerable reduction in the availability of housing adapted for the physically handicapped?

§ Lord Skelmersdale
My Lords, I cannot comment on the report because I have not seen it. I can advise 149 the noble Lord that in 1986, the latest year for which statistics are available, 17,201 owner-occupied or rented dwellings were adapted for disabled people at a cost of more than £36 million. Therefore I do not think that the arrangements in the new Housing Bill will make any difference to that figure.

§ Lord Carter
My Lords, in the late 1970s the Department of the Environment revealed that there was a need for 46,000 houses to be adapted for the physically handicapped. Since that time less than 10 per cent. of the total housing stock has been adapted. Are not the Government being complacent about this?

§ Lord Skelmersdale
No, my Lords, I do not think that we are. If I may go back to the original Question, I was asked about those patients with permanent disabilities who are being discharged from hospital. There are a comparatively small number. We are talking about 1,450 patients a year. In the latest year for which statistics are available a fair number of buildings were adapted. Further, I can say that 2,036 dwellings now provide standard amenities suitable for disabled people where the existing amenities were not accessible by reason of their disability. Quite a lot is going on in that area.

§ Baroness Elliot of Harwood
My Lords, will my noble friend investigate areas such as Birmingham which are doing a very good job? That area provides accommodation for people leaving hospital while other areas do not do anything. Some of the new techniques are extremely valuable. Will the Minister make inquiries about the areas where this is not being done?

§ Lord Skelmersdale
Yes, my Lords, most certainly. It may help my noble friend to know that the Department of the Environment recently published a helpful handbook entitled House Adaptation for People with Physical Disabilities which should do a good deal to stimulate good practice in this area. I have arranged for a copy to be placed in the Library.

§ Lord Mellish
My Lords, the Minister will know that some local authorities—I can name at least two—are bad at providing the kind of facilities referred to in the Question. The housing and community facilities for people with disabilities discharged from hospital are grim. What are the Government doing about those local authorities that are not doing what they are supposed to do?

§ Lord Skelmersdale
My Lords, as in other areas, I accept that performance is patchy. The Government's objective is to bring the worst up to the level of the best. The Government are encouraging local authorities along those lines.

Lord Winstanley
My Lords, does the noble Lord recall that in the past often acute hospital beds were blocked by patients ready for discharge merely because their relatives were unwilling to receive them? Is it not even worse that acute beds in hospitals like Stoke Mandeville should be occupied by 150 permanently disabled people who are ready for discharge and whose relatives are entirely willing to receive them home but are unable to do so because adaptations to their houses to make them fit to accommodate those people have not been carried out? Is it not time that we looked again at the implementation of those sections of the Chronically Sick and Disabled Persons Act which provide for access and home adaptations for chronically disabled people?

§ Lord Skelmersdale
Yes, my Lords, to both supplementary questions. In answer to the first, that is exactly why we are preparing this circular advising early consultation between the patient, the relative, the clinical team and the local authorities. That is important. The noble Lord referred to the Chronically Sick and Disabled Persons Act. Discussions are going on and I hope to be able to make an announcement on Section 7 in due course.

§ Lord Ennals
My Lords, does the Minister accept that in the fields of mental illness and physical and mental handicap there is a serious inadequacy both of housing and community services which leads to great hardship? Does he further accept that the failure of the Government to respond to the recommendations of the Griffiths Report is leading to uncertainty in local authorities and great difficulty in planning for services in the future?

§ Lord Skelmersdale
My Lords, the noble Lord, Lord Ennals, makes an interesting point but I rather believe that it is wide of the subject on the Order Paper.

§ Lord Stallard
My Lords, the Minister was asked whether he was satisfied that the provisions are adequate. Is he aware that some people have been in hospital for more than 12 months after they could be discharged? That cannot be satisfactory. Is he aware that the supply of houses that should be available to these people has almost dried up because of government policy on rates and the Government's refusal to release money to local authorities from the houses that they have sold? The authorities could adapt or replace houses in order to rehouse these people, who could then leave hospital. He cannot be satisfied, can he?

§ Lord Skelmersdale
My Lords, the noble Lord will need to read the Official Report in the morning, as will I, because to the best of my knowledge I did not express myself satisfied. Indeed I could never be satisfied in this area. I said that there is always likely to be room for improvement, which is hardly satisfaction.

§ Lord Ennals
My Lords, can the Minister explain why he said that my question was wide of the mark? Surely it was absolutely directed to the Question on the Order Paper.

§ Lord Skelmersdale
My Lords, people with mental illness are not regarded as having permanent disabilities. I would accept that people with mental handicaps might well fit—

§ Lord Ennals
And physical handicaps.

§ Lord Skelmersdale
Yes, indeed, my Lords, but the noble Lord asked me about mental illness and mentally handicapped patients.

§ Lord Ennals
My Lords, I said physical handicap, mental illness and mental handicap.

§ Lord Skelmersdale
My Lords, I apologise because I misheard. Certainly mental illness does fall outside this Question. I have announced what the Government are doing in the area of mentally handicapped and physically handicapped patients. If the noble Lord has a more specific supplementary question I shall do my best to answer it.

Baroness Darcy (de Knayth)
My Lords, perhaps my noble friend can enlighten me, because I am slightly confused. Under Section 7 of the 1986 Act, upon which I think he said that he hoped to make an announcement shortly, do physically handicapped people in hospital have the same right to pre-assessment as those with mental and physical handicap? If not, why not?

§ Lord Skelmersdale
My Lords, I am afraid that the noble Baroness has caught me on the hop. I shall have to write to her on the matter.

§ Baroness Masham of Ilton
My Lords, does the Minister agree that the problem has been made worse with the closure of many small hospitals, situated near people's homes, which could have acted as a halfway house? Can he perhaps encourage a halfway-house system to be attached to some of the large technical hospitals for this purpose?

§ Lord Skelmersdale
My Lords, yes. Indeed there are halfway houses which are already in use in connection with some hospitals. However, I agree that a great deal more could be done.