HL Deb 24 March 1993 vol 544 cc328-31

2.54 p.m.

Lord Mottistone asked Her Majesty's Government:

What evaluation of the care programme approach for mentally ill people has been received from regional health authorities and what judgment has been made of the effectiveness of the new arrangements.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

My Lords, each regional health authority has supplied information about the implementation of the care programme approach to the Department of Health. From that it is clear that some authorities are more advanced than others. Regional health authorities are undertaking further work to ensure that the care programme approach is fully applied to all patients for whom it is intended. The department's NHS management executive will continue to monitor progress.

Lord Mottistone

My Lords, I thank my noble friend for that reply. It is, of course, early days to obtain a full picture on the matter. However, is there sufficient information to indicate whether there will be enough care in the community facility in all the regions? Further, can my noble friend say whether it might be a good plan to slow down any closing of beds in mental hospitals until such reassurance has been obtained?

Baroness Cumberlege

My Lords, regional and district health authorities are well aware that they must not close hospital beds until there is adequate provision in the community for those people who are in institutional care. That is a very clear directive to those authorities. The Government expect them to fulfil that aspiration.

Lord Marsh

My Lords, does the Minister agree that while most people accept the complexity of the problem—which is a very real one—they are becoming increasingly concerned about the very large number of people on our streets, especially in London, who are clearly, and by any standards, incapable of looking after themselves?

Baroness Cumberlege

My Lords, I am sure that every Member of the House shares that concern. But research shows that those people who are on the streets are not people who have been discharged from mental hospitals. It shows that they have a form of mental illness. They need care; but they have not been discharged from long-stay mental institutions.

Lord Ennals

My Lords, from the studies that she has made—

Baroness Robson of Kiddington

My Lords, can the Minister assure the House that when a mentally ill person is returned to the community the agreement of the carer (which is usually the family) has been obtained before he or she is returned home?

Baroness Cumberlege

My Lords, the care programme approach is very specific: the carers must be consulted and their views considered when the programme is drawn up.

Baroness Fisher of Rednal

My Lords, can the Minister give any evaluation of what the hospitals that are closing down are doing? Are they making any of the land upon which the hospitals are situated available to housing associations so that such people may be rehoused in the areas where they have been resident for a very long time?

Baroness Cumberlege

My Lords, once a hospital is closed, an assessment is made to see whether other health care is required on the site. The health authority has to make that decision. But, on the whole, the value of the site is assessed and the income from it is then redeployed in community services.

Baroness Seear

My Lords, the noble Baroness said that carers have to be consulted. But does that include the right of the carer to refuse?

Baroness Cumberlege

My Lords, I am not quite sure what the noble Baroness means. Perhaps she would be kind enough to explain.

Baroness Seear

My Lords, does such consultation include the right for the carer to refuse to take the person coming out of the institution back into the family home?

Baroness Cumberlege

My Lords, that would be very much part of the care programme approach. It would be up to the professionals involved in the assessment to take into account the views of the carer.

Noble Lords

Order! Lord Ennals!

Baroness Seear

My Lords, does that mean that, having said they do not want the person in the home, the carer can be forced to take that person back? That is the point I should like clarified.

Baroness Cumberlege

My Lords, I think that it would be impossible to ensure that someone discharged from a mental institution would be looked after at home without adequate care and support.

Noble Lords

This side!

Baroness Faithfull

My Lords, can my noble friend the Minister tell me whether in her research or that of her department figures from the Salvation Army have been sought? I ask that question because the Salvation Army, together with Guildford University, carried out research on the subject.

Baroness Cumberlege

My Lords, I am sure that the mental health task force which is led by David King will have consulted a number of voluntary organisations which have expertise in the field, including the Salvation Army.

Noble Lords

Lord Ennals!

Lord Wakeham

My Lords, I think that the noble Lord, Lord Ennals, has been trying very hard to put his question and has been very gentlemanly in his behaviour by giving way.

Lord Ennals

My Lords, up to now I have given way, but always to noble Baronesses!

From the studies that she has made of the regional reports and the knowledge that she has of local authorities, is the Minister satisfied that local authorities will have their services in place on 1st April when they take on the new responsibilities? Further, has she yet reached a different conclusion as regards the matter which was debated in the House; namely, that local authorities are very dissatisfied with the amount of money that has been transferred to them to carry out their new responsibilities?

Baroness Cumberlege

My Lords, we are entering a very new world and I can understand that local authorities have misgivings about the amount of resources that are being made available. That is a natural apprehension. We are monitoring very closely what local authorities are doing at the moment. Quarterly reports are being produced by the social services inspectorate. It is my aspiration and that of the Government that these schemes will be put in place. I refer particularly to the pilot scheme being run by Kent County Council which shows what can be achieved.

Lord Peyton of Yeovil

My Lords, will my noble friend bear in mind that one of the tests by which the new arrangements will be judged is the length of time it takes for effective action to be taken to look after any particular case of need?

Baroness Cumberlege

My Lords, I agree very much with my noble friend. I remind your Lordships of the words of H. L. Mencken: For every difficult and complicated question there is an answer which is simple, easily understood and wrong".

Lord Carter

My Lords, are health and local authorities obliged to purchase the services that they assess to be necessary? If that is the case, there is no incentive to alter the patchiness of the care programme to which the Minister has referred.

Baroness Cumiberlege

My Lords, the care programme assesses the needs of individuals and decides whether they require care in the community or in institutions. But local authorities will have to take into account the resources that are available. Clearly aspirations that go beyond those resources cannot be met.

Lord Pearson of Rannoch

My Lords, in view of the growing doubts about the way our well intentioned care programmes are actually working, does my noble friend agree that it might be sensible for the Government to look again at their recent decision to remove sheltered and village communities from the list of provision which local authorities are encouraged to support? Might not sheltered and village communities come to be a welcome haven for the mentally ill as well as for the mentally handicapped?

Baroness Cumberlege

My Lords, I understand that my noble friend is discussing this issue with my right honourable friend the Secretary of State and I am sure that she will have views on this.