Mental Patients: Community Care (Hansard, 18 November 1991)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, the care programme approach was implemented in April this year and all regional health authorities have confirmed they have complied. We have asked regional health authorities to provide thorough evaluations of the implementation after the first full year of operation. It is at this point that it will be possible to judge the full effectiveness of the new arrangements.

§ Baroness Fisher of Rednal
My Lords, is the noble Baroness aware that the Government have failed to implement the Mental Health Act 1983 in which they promised support and accommodation for people leaving mental hospitals, and that as a result many ex-mental patients are now homeless, living in squats, enduring squalor and not receiving proper medication.

§ Baroness Hooper
My Lords, the essential elements of the care programme approach are the systematic assessment of patients' health and social care needs and the identification of a key worker to monitor that the agreed care package is delivered. There has been a substantial increase in community care services; for instance, an increase of some 76 per cent. in day hospital places and a 51 per cent. increase in local authority day places over the past 10 years. There have also been increases in local authority residential places and in voluntary and private residential provision. The number of consultant psychiatrists has increased by 32 per cent. and the number of community 700 psychiatric nurses by 212 per cent. We may not be quite where we should like to be, but we are certainly moving in the right direction.

§ Lord Dean of Beswick
My Lords, those figures are welcome. However, is the noble Baroness not aware that people dealing with the situation believe that firm evidence shows that an increasing number of people in the category we are discussing are to be found among the homeless in London and other inner cities? It is obvious that those people are not being catered for. The problem is urgent. Can the Minister say when something will be done for that group, who are the people most in need?

§ Baroness Hooper
My Lords, there are certainly some homeless mentally ill people sleeping rough in every significant town and city. However, by the very nature of the groups, there is little or no hard information about numbers. We are all sadly aware that there is a particular and visible concentration of such people in central London. That is why the department has implemented a special initiative to assist them.

§ Lord Stallard
My Lords, is not the accurate answer to my noble friend's Question, no? Is the Minister aware that more and more mentally ill people are appearing in court having committed petty crimes, mostly in their search for food or shelter? Unfortunately, some of those people end up in prison because there is nowhere else for them to go. That cannot be satisfactory. Surely the answer to the Question is, no.

§ Baroness Hooper
My Lords, that is not so. The answer to the Question is that we are implementing a new policy. We are half way through the process of implementation. If the noble Lord has read the consultative document The Health of the Nation, he will know that it identifies mental health as one of the targeted areas. Of the £1.5 billion which has been spent by the health service on the specialist mental services, over half still supports the 40,000 beds in the old traditional hospitals. Clearly we must push ahead. The targeting intended as a result of the consultative document will ensure a planned approach to phasing out those traditional hospitals which are gobbling up so much of the resources.

§ Lord Carter
My Lords, is the Minister aware that full implementation of the 1986 disabled persons Act would give mentally ill people the right to an assessment of their needs and the right to an advocate to speak on their behalf. Why have the Government consistently refused to implement all the sections of the 1986 Act?

§ Baroness Hooper
My Lords, as the noble Lord knows, the reason is that we believe that our community care plans, which have been incorporated in the National Health Service and Community Care Act passed last year, take over the responsibilities for many of those issues.

§ Lord Carter
My Lords, does the Minister agree that those provisions do not give mentally ill people the right to have an advocate to speak on their behalf?

§ Baroness Hooper
My Lords, The Citizen's Charter indicates the need to help all members of the community including people with special needs. The Patient's Charter points to the special needs category as a matter on which to concentrate. A number of our initiatives, including the funding of many voluntary organisations which provide advocacy services, are directed at helping people and their carers to find the services they require.

§ Baroness Fisher of Rednal
My Lords, does the noble Baroness not agree that the quality of service should be monitored? We do not need lots of percentages; we want actual figures of numbers of people and information on what is happening to them. The quality of service should be monitored and good practice developed and fully resourced. Has the noble Baroness noted the comments of her right honourable friend the Prime Minister who, in a reference to the charter, said last week that to ask for higher standards of service should need no justification?

§ Baroness Hooper
My Lords, the noble Baroness is asking for exactly what will be achieved by our care programme approach. As I said at the outset, we have asked regions to monitor and evaluate the effect of the new policy. The mental illness specific grant, which has been substantially increased this year, is also being monitored by the SSI. The worries of the noble Baroness are therefore being met.