Psychiatric Patients: Care in the Community (Hansard, 16 June 1992)

§ Baroness Trumpington
My Lords, as my noble friend Lady Cumberlege said on 8th June, our primary aim is not the closure of mental hospitals but the provision of better care for people with mental health problems. Ministers will not approve the closure of any mental hospital unless it can be demonstrated that adequate alternatives have been developed in the community; hence the care programme approach.

§ Lord Mottistone
My Lords, I thank my noble friend for that reply. But is she aware that in the 1980s the numbers of day centre places for the mentally ill increased from 5,000 to 7,000, an increase of 2,000? Is she further aware that in that same period some 25,000 beds were shut down in hospitals? Does she agree that, bearing in mind the great discrepancy, if 43 hospitals are closed in the next five years, it is extremely unlikely that the aims she mentioned in her Answer will be achieved?

§ Baroness Trumpington
My Lords, the figures quoted by my noble friend tell only part of the story. They relate only to long-stay beds. Approximately 40 per cent. of long-stay patients do not move out of National Health Service care. Total day care provision rose by 116 per cent. to 15,100 places in 1991.

§ Lord Ennals
My Lords, can the noble Baroness tell the House the procedure by which the Department of Health will decide whether the accommodation in the community is adequate? Bearing in mind the Statement made by her fellow Minister yesterday that local authorities will not know what funds are available until November, and bearing in mind also the great reluctance of private sector providers of accommodation to take the severely mentally ill, how will the department determine whether a hospital should be closed and whether it is satisfied with the accommodation that is provisionally made available by the local authorities?

§ Baroness Trumpington
My Lords, I believe I gave the answer to the last part of the noble Lord's question when I said that nobody will leave. Hospitals will not close until we are sure that adequate care is provided for those who come into the community. As well as retaining in-patient facilities in district general hospitals, small hospitals or psychiatric units as part of the care programme approach, there will be systematic arrangements for assessing the health care needs of patients who could potentially be treated in the community.

Lord Campbell of Croy
My Lords, the Government's intention underlying the full introduction next April of the new community care system is widely accepted. However, is my noble friend aware that there is considerable doubt whether the preparations and arrangements that are necessary will be completed in time in all the local authority areas?

§ Baroness Trumpington
My Lords, we do what we can to help. It is up to local authorities to do some of the work themselves.

Lord Winstanley
My Lords, does the noble Baroness agree that there will always be some mentally ill patients who will require long-stay hospital accommodation? Is she in a position to tell the House how many long-stay beds for the mentally ill will be retained and where they will be?

§ Baroness Trumpington
My Lords, I cannot answer the last part of the question because it depends on my original Answer concerning when the community day care or other care is provided. But the Government recognise that there will always be some mentally ill people who require long-term in-patient care and supervision. Facilities for them, usually in the form of small hostels or psychiatric units, will continue to be available as part of the range of mental health services in districts.

§ Baroness Masham of Ilton
My Lords, if the placements in the community break down some of those patients may end up in prison. What facilities are there for them in prison?

§ Baroness Trumpington
My Lords, if, for instance, police constables find someone who is mentally ill on the streets, under Section 136 of the Mental Health Act 1983 they have the power to remove that person to a place of safety. If they find a person in a public place who appears to be suffering from mental disorder and in immediate need of care and control, in his own interests and for the protection of others they would call in medical help.

§ Baroness Fisher of Rednal
My Lords, will the noble Baroness explain government policy for those severely ill mental patients whom we know will need constant hospital care? We would have more satisfaction if the Government would declare their policy for those people who will have difficulty with the care in the community proposal.

§ Baroness Trumpington
My Lords, with the greatest respect to the noble Baroness, I have just answered that question.

§ Lord Elton
My Lords, does my noble friend accept that the great majority of those who have long or medium term in-patient treatment become rapidly institutionalised and cannot be released successfully into any accommodation in the community without rehabilitation for the everyday mechanics of living in society? Are the Government prepared to give assistance to voluntary bodies providing such training?

§ Baroness Trumpington
My Lords, we already support, for instance, the National Schizophrenia Fellowship. A long time ago I had an opportunity to meet members of that body and appreciate the work that it does. The Government give it £91,000 per annum. I am well aware of the number of projects undertaken by the National Schizophrenia Fellowship. Other organisations also receive support from the Government.

§ Baroness Seear
My Lords, will the noble Baroness tell the House how many patients can be supported for a year on £91,000?

§ Baroness Trumpington
My Lords, I cannot do so without a pocket calculator.

§ Lord Carter
My Lords, is the Minister aware that the Government have consistently refused to implement Section 1 and other sections of the Disabled Persons (Services, Consultation and Representation) Act 1986? Section 1 gives the mentally ill patient the right to authorise a representative or an advocate when he is discharged from hospital. Mentally ill patients having been given such a right, does the Minister agree that its implementation would do a great deal to resolve the problem?

§ Baroness Trumpington
My Lords, the question goes a little away from the original Question on the Order Paper. However, with a little luck I have managed to find an answer for the noble Lord. Local authorities can ensure that there is access to advocacy schemes. The Government encourage them to do so and have issued guidelines.

§ Lord Mayhew
My Lords, does not the Minister believe that before a decision is taken on the number of hospitals to be closed, a careful estimate should be made of the number of seriously mentally ill people requiring long-term treatment?

§ Baroness Trumpington
My Lords, although the number of long-term mental illness beds is falling steadily at an average rate of 2,500 per year, that reduction is offset by a substantial increase in community services. I can say no more except that hospitals will not close unless there is adequate community care for patients.

§ Lord Skelmersdale
My Lords, my noble friend stated that a grant of £91,000 is given by the Government to the National Schizophrenia Fellowship. Is it not a fact that a great deal more money is given to MIND every year?

§ Baroness Trumpington
My Lords, that is indeed a fact.

§ Lord Thurlow
My Lords, has any mental hospital not been closed as a result of evidence that there are insufficient facilities in the community?

§ Baroness Trumpington
My Lords, no. However, if the noble Lord knows of any such case perhaps he will let me know and the department will be delighted to consider it.