Mental Illness: Psychiatric Care (Hansard, 9 July 1991)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, it is for district health authorities to ascertain the health needs of the population in their areas and to contract for appropriate services to meet those needs. National prevalence figures are not therefore collected.

§ Lord Mottistone
My Lords, is my noble friend aware that in February our noble friend Lord Cavendish said that there were 2.25 million people in that category? Is it not essential for the Government to know how many such cases there are in order to allocate the right resources for the care of those people in the community? Could not my noble friend give a slightly more encouraging reply regarding the efforts being made by the Government to do just that?

§ Baroness Hooper
My Lords, I do not disagree with the figures given earlier this year by my noble friend Lord Cavendish. However, if it is necessary to collect statistics centrally—it is possible to gather them together from the various districts —we will be the first to do so. As matters stand, the needs and requirements are best catered for at local level and the Government respond from the centre to that local demand.

§ Lord Dean of Beswick
My Lords, why are the Government continuing with the policy of discharging people into the community who should be in care? They are being discharged from hospitals and thrown onto the mercies of the housing market. Is the Minister not aware that there is evidence of handicapped and mentally ill people finding their way into the inner cities to join the queues of the homeless and being confined to living in cardboard cities in increasing numbers?

§ Baroness Hooper
My Lords, everybody is agreed that in terms of quality of life the community care approach is the correct one. Care is taken to ensure that good professional practices are followed in respect of patients about to be discharged. That involves systematic arrangements for assessment and aftercare to ensure that people with mental illness who are being treated in the community obtain both the health and social care that they need.

Lord Campbell of Croy
My Lords, while I understand the reasons for my noble friend's reply, she will be aware that the grant is a specific grant; it is the only one for the mentally ill. Therefore, can the Minister ensure that that grant will be related to the numbers? One needs to know something about the numbers in order to assess what the grant should be. Can the Minister confirm that the grant will be flexible if the Government do not know the total number involved?

§ Baroness Hooper
My Lords, the funding arrangements from central government are made on a regional basis. They respond to the figures collected by the regions from their districts. That is how central government respond to local needs.

Lord Winstanley
My Lords, I accept that the community care approach is the right one. However, does not the noble Baroness accept that unless the size of the problem of the mentally ill has been accurately measured and assessed in all parts of the country —a job which cannot be done effectively by the district health authorities alone—there is no hope of the community care arrangements actually working when they come into force next year?

§ Baroness Hooper
My Lords, the record speaks for itself. The results of the community care approach, which has been in effect for some years, are that the number of day hospital places for mentally ill people have risen substantially by 76 per cent.; local authority day places have risen by 51 per cent.; local authority residential places for the mentally ill have risen by 31 per cent., and so on. In addition, the number of consultant psychiatrists has substantially increased. The demand which is fed back to us from the districts is being met.

§ Lord Molloy
My Lords, does the Minister agree that the Question itself, and the following supplementary questions, are of intense interest not only to patients suffering from mental disorder but to their families as well? Does she also agree that some peace of mind could be achieved if many of the proposals suggested could be looked at with the object of putting them into practice?

§ Baroness Hooper
My Lords, I am delighted to agree that this is a very important subject and of paramount importance to patients and their families. The Government are committed to reviewing what is going on under the community care approach.

§ Lord Ennals
My Lords, does the Minister agree that any such study could have the effect of labelling patients in ways that may be disadvantageous to the 1311 patients themselves? Does she further agree that there are many people who have episodes of mental illness which require supervision by a consultant, but who are fully able to operate during most of their lifetime and need only to refer back to the consultant when in difficulties? Does the Minister accept that it would be very difficult to obtain the figures in any serious way?

§ Baroness Hooper
My Lords, that is the other side of the coin. It is important to remember that the effective contact for patients is with their own doctors and specialists. Therefore, it is not essential to collect these kinds of figures and statistics on a national basis.

§ Lord Hailsham of Saint Marylebone
My Lords, as a geriatric who has been arbitrarily excluded from this discussion, perhaps I may ask my noble friend whether she agrees that, like alcohol, statistics should be taken in moderation and not in excess?

§ Baroness Hooper
My Lords, yes. I too would be interested to know why my noble friend Lord Mottistone excluded geriatrics from the Question.

§ Lord Mayhew
My Lords, I agree with the noble Baroness that individuals should not be labelled. However, if it is practicable, though difficult, to get the figures should not that be done? The Minister read out details of the increased facilities, but we would like to be able to judge, against the increased facilities, whether or not the number of mentally sick people is increasing or decreasing. Does she agree that the figures should be gathered and that we should know them?

§ Baroness Hooper
My Lords, I believe that I said yesterday that if we are to make the National Health Service efficient it is essential that we do not unnecessarily gather statistics.

Baroness Faithful!
My Lords, does my noble friend agree that it is now good practice not to discharge anyone from a mental hospital without a plan being made for the patient?

§ Baroness Hooper
Yes, my Lords. I can reassure my noble friend on that point.

§ Lord Ritchie of Dundee
My Lords, can the Minister give the House any idea what proportion of the number of people sleeping rough on our streets are mentally ill?

§ Baroness Hooper
My Lords, I believe that is another Question.

§ Lord Mottistone
My Lords, can my noble friend say why it is that, having made the specific grant, it adds up to about only one-tenth of what we require in the Isle of Wight for caring for these people? Can she repeat why she does not think it necessary for the Government to have proper central figures so that they can make their own long-term forecasts?

§ Baroness Hooper
My Lords, to answer the last point first, it is because the Government believe that the health system is not best administered with a centralised policy. Therefore, we respond to local 1312 needs and estimates of those needs. As regards the specific grant, that is only a part of the funding that goes towards the care of the mentally ill. Even so, as a Government we are committed to reviewing the extent to which social care services are being improved or expanded as a result of the specific grant.