HL Deb 17 January 1991 vol 524 cc1252-4

3.19 p.m.

Lord Mottistone asked Her Majesty's Government:

Whether they have consulted local authorities and directors of social services about the practical implementation from April 1991 of the care programme for all patients discharged from psychiatric hospitals.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)

My Lords, yes. We consulted social service directors, local authority associations, health authority managers and NHS professionals.

Lord Mottistone

My Lords, in view of the fact that more than 180,000 such patients were discharged in 1987–88, the vast majority of whom were discharged within one month of admission, can the Minister give the House the results of those consultations and say how the Government intend to deal with a vast number of people?

Baroness Hooper

My Lords, the care programme proposals were broadly welcomed by the local authorities. Their views were taken into account when drawing up the care programme guidance which was issued last September. Clearly they must have been aware of the figures quoted by my noble friend at that point and no specific obstacles to their implementation were raised in the course of the consultation.

Lord Ennals

My Lords, bearing in mind the Government's £20.2 million specific grant for mental illness and the local authorities' estimate that in order to provide residential and day care facilities, they need about £75 million per annum, how is the programme to be funded by local authorities? Is the department to make a specific grant to local authorities or will funds be transferred from health authorities to local authorities? Did the noble Baroness discuss funding when she had consultations with the local authorities associations?

Baroness Hooper

My Lords, the care programme approach has been reinforced by the new specific mental illness revenue grant and the authorisation of increased capital expenditure. That was certainly designed to meet the needs of discharged patients.

Lord Ennals

My Lords, where are the funds to come from for local authorities, bearing in mind the restraints on their public expenditure programmes, charge capping, and so on?

Baroness Hooper

My Lords, the funds will come from the normal source—the taxpayer.

Lord Thurlow

My Lords, does the Minister agree with the widespread public perception that in any circumstances there will be a critical shortfall in the number of community psychiatric nurses or social workers required for effective aftercare? Will the Government consider consulting with local authorities on the options for a crash programme of recruitment and training of such workers?

Baroness Hooper

My Lords, the key elements of the care programme approach are, as the noble Lord well knows, as follows; systematic arrangements for assessing the health and social care needs of patients to be discharged and the appointment of a key worker to ensure that the appropriate services are provided. Clearly the numbers of people necessary to implement that approach have been taken into account.

Lord Winstanley

My Lords, can the noble Baroness tell the House whether the necessary and proper number of hospital social workers will be in post by the date stated in the Question? Does she not agree that the advice and help of hospital social workers is essential before those patients are discharged? If there are no hospital social workers, then that help will not be available.

Baroness Hooper

My Lords, it is important; and care has been taken to ensure that adequate arrangements have been made after assessment for the discharge of patients.

Baroness Masham of Ilton

My Lords, does not one of the practical problems arise when the placement in the community breaks down and the psychiatric patients drift into homelessness and perhaps prison? Is the Minister content that the lines of communication between prison, social services and health departments are adequate?

Baroness Hooper

My Lords, every care has and is being taken to ensure that the community care programme approach works because it is important that it should do so. If the noble Baroness wishes to have a specific answer on the problem of homelessness, I should be delighted to reply to questions which she may table.

Lord Murray of Epping Forest

My Lords, when the Minister speaks of every care being taken, will she ensure that care is taken to discharge such persons from psychiatric hospitals at the rate at which they can be cared for in the community? As the noble Baroness, Lady Masham, said, too many patients are ending up in prison and on the streets. Surely there is a case for reviewing the speed of discharge of those patients from hospitals.

Baroness Hooper

My Lords, behind the whole policy is the need to have adequate arrangements, whether they be housing arrangements, the catering for social care needs and so on, before patients are discharged.

Lord Hankey

My Lords, will the Government accept that the release of all these people into the community without adequate arrangements being previously made is becoming a major matter for concern to the electorate?

Baroness Hooper

My Lords, the programme which we are discussing is to be implemented from April 1991. Therefore, we have held consultations and have made whatever arrangements may be necessary for the implementation in April 1991. We hope very much that the arrangements will mean that that approach to community care for discharged mentally ill patients is quite adequate.