HL Deb 09 July 1991 vol 530 cc1312-4

2.58 p.m.

Lord Mottistone asked Her Majesty's Government:

What steps are being taken by the Secretary of State for Health to establish national estimates of the number of mentally ill people (excluding geriatrics) needing long-term hospital care, or its equivalent, in terms of medical supervision and staffing.

Baroness Hooper

My Lords, again it is for district health authorities to ascertain the health needs of their populations and to contract for appropriate services, which include adequate medical supervision and staffing to meet those needs.

Lord Mottistone

My Lords, is my noble friend confident that hospital beds are not still being shut down much faster than the needs of the people who are the subject of my Question are being met? Is she sure that there is not a need to tell local health authorities to stop the practice until the assessment has been made?

Baroness Hooper

My Lords, it is government recommended practice to assess carefully and to ensure that all social and health needs are being catered for in the community before the discharge of any particular patient.

Lord Allen of Abbeydale

My Lords, is the Minister satisfied that in calculating estimates sufficient attention is paid to the likelihood that, with the progress of time and as social conditions change, there will be fewer parents and relatives able to look after the mentally ill at home and that some other form of care will have to be provided for many of these people?

Baroness Hooper

My Lords, we have always intended that there should be a variety of facilities available for the care of the mentally ill while directing our efforts to ensure that community care is adequate. Obviously, in keeping the whole subject under review we may have to change to meet changing needs.

Lord Renton

My Lords, is my noble friend aware that many mentally handicapped people have been very properly discharged from long-stay hospitals in recent years? Does this not make it much easier to find places for those who are mentally ill and who need to stay in long-stay hospitals?

Baroness Hooper

My Lords, that must be so. However, I would point out that in the recently published Green Paper The Health of the Nation the Government propose to realign the resources spent on special psychiatric services into district-based care, thereby allowing many of the remaining 90 large psychiatric hospitals to be closed before the year 2000.

Lord Ennals

My Lords, is it not extremely important that the Secretary of State for Health should make a careful assessment of the amount of money that will be required by local authorities over the next 10 years to enable adequate care to be provided in the community and to minimise the need for people to be long-stay patients if they could be cared for in the community? Perhaps I may ask a second question. On what estimate is the Secretary of State basing the community care programme for the year beginning 1st April 1993, which is getting very close?

Baroness Hooper

My Lords, perhaps I may take the noble Lord's second point first. The arrangements for 1993 are still under consideration; therefore I am not able to give an answer. I agree that we have to make long-term plans. However, I suspect that the noble Lord himself, from his own experience, will be the first to realise that government sources of finance are dealt with on an annual basis.

Lord Winstanley

My Lords, while it was wise and necessary to close down some of the long-stay hospitals, particularly long-stay mental hospitals, nevertheless, is it not a fact that a considerable number of patients will necessarily need long-stay hospital accommodation? We need to know how many. It is not a figure which can be computed and calculated by each individual district health authority. The work has to be done centrally: it cannot be done locally over and over again and then added up afterwards.

Baroness Hooper

My Lords, with the systematic closure of the large institutions, clearly it may become necessary to look at national figures in that respect.

Baroness Masham of Ilton

My Lords, what liaison is there with the Home Office on the discharge of psychiatric patients who are to be released from prison and whose care in the community will require planning?

Baroness Hooper

My Lords, the Home Office and the Department of Health seek to ensure that mentally disordered offenders receive the most appropriate and timely placement. Our common aim is to ensure that in suit able cases they are dealt with without resort to the courts, or failing that, the penal system. The Government recognise that there is scope to increase the level of provision in this area.

Lord Taylor of Gryfe

My Lords, does the Minister agree that the discharge of mentally ill people from hospital frequently creates a considerable burden in their domestic lives? A good deal of the responsibility of the state is undertaken by carers who have to give up employment in order to take care of ageing parents. Can the Minister indicate what encouragement and financial support for carers will be provided in order that they may undertake this very burdensome duty?

Baroness Hooper

My Lords, the Government recognise the role of carers in this as in all community-placed health care. The figures that I quoted earlier about day hospital places, residential short-stay hospitals and other facilities offering respite to carers is a very important help to those in that situation.

Lord Hunter of Newington

My Lords, will the Minister answer the question of the noble Lord, Lord Winstanley? It is very important. It could be embraced within my question. What is the department's estimate of long-term beds for the mentally ill in 1992?

Baroness Hooper

My Lords, if I have those figures with me, I cannot find them. Therefore, I shall write to the noble Lord.

Lord Skelmersdale

My Lords, will my noble friend accept that there is a close correlation between the two questions being asked today by my noble friend Lord Mottistone, namely, the care inside and outside hospital of mentally ill people? In keeping the subject under review, as the Minister has undertaken to do, will she consider transferring the responsibility for social services from local authorities to health authorities?

Baroness Hooper

My Lords, decisions have already been made in that respect. Clearly, while keeping the whole subject under review, that will come into consideration. The Government plan to move ahead with the arrangements which are due to be finally and fully implemented in 1993.