HL Deb 05 February 1992 vol 535 cc257-9

Lord Mottistone asked Her Majesty's Government:

Whether regional health authorities have been given detailed advice on monitoring arrangements since 1st April 1991 of the care programme approach for patients considered for discharge from psychiatric hospitals and for new patients accepted by specialist psychiatric services.

Baroness Denton of Wakefield

My Lords, the health authorities were given very well defined instructions in setting up the care programmes. In July 1991 the chief executive of the National Health Service Management Executive wrote to regional general managers saying that he would be asking them for evaluations of the care programme approach for 1992–93. A copy of the executive letter, EL(91)103, is available in the Library. Regions will be notified in due course of the form those evaluations should take.

Lord Mottistone

My Lords, I thank my noble friend for her very full Answer. May I understand from that reply that the assessment of what is being done is already well under way and that there will be no delay in April this year in obtaining a composite picture of what is being achieved in the way of care?

Baroness Denton of Wakefield

My Lords, submissions received by the RHAs and the National Health Service Executive indicate that districts are making progress with the implementation of the programme. The monitoring will be followed up, as the noble Lord would wish. I should add that a social science research organisation has been commissioned to examine the implementation of the care programme on a qualitative basis. That research will also be available.

Lord Thurlow

My Lords, we warmly welcome what the Minister has told us, but is she aware that as recently as November a body which I believe to be authoritative, the Reed Committee, reported that many NHS agencies still believed that the Government's intention was to go ahead with reductions in the number of beds available in hospitals without regard to the availability of alternative services in the community? Can the Minister assure the House that as a result of the monitoring procedure the Department of Health will at long last have a comprehensive and complete picture?

Baroness Denton of Wakefield

My Lords, I can assure the House that the issue was well seen. The executive letter states very clearly that the health authorities will need to ensure that any reduction in the number of hospital beds does not outpace the development of alternative community services. The people responsible for managing the care programme will have the information with which to measure it.

Lord Winstanley

My Lords, does the noble Baroness yet know whether the evaluation carried out thus far has revealed shortcomings in the care programme approach? Do we know, for example, whether the net has been drawn too widely and whether any patients ought to come within the care programme approach are not doing so because they do not qualify? That ought to be revealed early in the monitoring which is being carried out. Do we yet know?

Baroness Denton of Wakefield

My Lords, these are very early days in the programme. The authorities have been asked to set up the programme. There are no indications that people are slipping outside the guidelines, which were very closely drawn up.

Baroness Faithful

My Lords, will the social service departments throughout the country which are involved in the implementation of the Mental Health Acts also be monitored, because I am assured that there are insufficient resources and social workers to carry out the community work under the Acts?

Baroness Denton of Wakefield

My Lords, as my noble friend indicated, it is important to the success of the programme that the integrated part of it involving the social services and health authorities works. Monitoring will be undertaken by the Social Services Inspectorate and those anxieties will be borne in mind.

Baroness Hilton of Eggardon

My Lords, in some parts of London, in Harrow for example, 30 per cent. of patients are discharged without community care programmes. Therefore, does it surprise the Minister that half of those sleeping on the streets of London and 20 per cent. of people in our prisons have a history of severe mental illness?

Baroness Denton of Wakefield

My Lords, we are all very concerned that even one person with a history of mental illness should be on the streets. However, there is no evidence that there are large numbers of homeless mentally ill people on the streets. The closure of mental hospitals has not led to those large numbers. Such evidence as exists suggests that they are mainly people who have never had any contact with psychiatric services or who were offered treatment in the community following discharge from hospital but arrangements have broken down despite the valiant efforts of the people involved.

The Earl of Halsbury

My Lords, may I remind your Lordships that we on these Cross-Benches have no collective opinion? My noble friend used the first person plural. We have no collective opinion.

Earl Haig

My Lords, as the care programme is needed throughout the United Kingdom, will my noble friend the Minister give an assurance that it will be extended to cover Scotland as well?

Baroness Denton of Wakefield

My Lords, I am sure that the concern is such that the care programme where needed will be examined and implemented as fast as possible.

Lord Carter

My Lords, is the Minister aware that full implementation of all parts of the 1986 Disabled Persons (Services, Consultation and Representation) Act gives mentally ill people the right to an assessment of their needs and the right to an advocate to speak on their behalf? Does she agree that the Government's refusal to implement the relevant parts of that Act means that mentally ill people are denied the representation and advocacy which would be of enormous help in identifying their problems and helping to plan the care programme that they need?

Baroness Denton of Wakefield

My Lords, the great value of the care programme is that it extends care to one-to-one. There is a key worker for every individual coming out and there is one person responsible for another person. It is also important that the programme should involve the families of the people concerned.

Back to