HL Deb 17 February 1994 vol 552 cc285-7

3.8 p.m.

The Lord Bishop of Worcester asked Her Majesty's Government:

In view of the internal market in the health service, whether it is their policy to safeguard the future of long-term psychoanalytic therapy throughout the health service for those who need it.

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

My Lords, it is for health authorities and general practitioner fundholders to assess the needs of their populations and to contract with trusts, hospitals and community units for the services that they judge to be clinically effective. As the internal market develops, health authorities will increasingly commission a range of therapeutic interventions of proven effectiveness.

The Lord Bishop of Worcester

My Lords, I thank the Minister for that Answer. Is she aware that of the 200 health authorities, only 100 have that kind of therapy? Is she further aware that recent research by the Mental Health Foundation shows that one in 10 of the population of this country suffers from mental ill-health, and that research in the Low Countries and Germany shows that with psychoanalytical psychotherapy people can be saved from hospitalisation and expensive medication and can return to work? In view of that, does she agree that such therapy gives very good value for money?

Baroness Cumberlege

My Lords, this therapy has never been widely accessible to NHS patients because of the limited number of providers of the service and the differing views about its clinical effectiveness. I understand what the right reverend prelate is saying, and I know that some people find it extremely helpful. But the department feels that there is more work to be done in assessing and monitoring its effectiveness.

Lord Rea

My Lords, does the noble Baroness agree that psychotherapists who are properly trained and registered with the United Kingdom Council for Psychotherapy—I emphasise those points—have an important role to play, especially as their work does not require the use of drugs, as the right reverend prelate pointed out? Can the noble Baroness assure us that training institutions for psychotherapy, such as the Tavistock Clinic, will be enabled to continue when they are given trust status?

Baroness Cumberlege

My Lords, yes. A review is currently being undertaken by the department about training requirements. We encourage registers of all therapists so that we know who is available and at what standard. We have secured the future of both the Tavistock and Portman clinics. They have been granted trust status, and the NHS management executive issued a contract worth £3.7 million for 1994–95, which will support the transition to the internal market.

Lord Peyton of Yeovil

My Lords, taking up the point made by the noble Lord, Lord Rea, will my noble friend consult the Tavistock and Portman clinics? They are concerned in these matters and would welcome an opportunity to be helpful.

Baroness Cumberlege

My Lords, yes. Our relationship with those two clinics is extremely good. As I said, we have secured their future and value the work that they do in training, education and development.

Baroness Masham of Ilton

My Lords, is the Minister aware that the Tavistock and Portman clinics deal with the abused, the abusers and severe sexual deviants? Those people can be extremely dangerous not only to themselves but to the public. If those clinics do not survive in the internal market, serious problems may arise throughout the country in relation to training.

Baroness Cumberlege

My Lords, it is up to health authorities to assess the needs of their populations and to enter into contracts with those two institutions. As I said, the department values their work. We are giving every possible assistance to help them enter the internal market and to ensure that their teaching and research activities are safeguarded.

Lord Ennals

My Lords, is the Minister aware that there is a great deal of anxiety among voluntary organisations such as mine that there should be made available much more opportunity for what they call "talking treatments"? They are also concerned that over half the district health authorities have no service that they can offer. Can the Minister say a little more regarding the department's future progress on training as well as recruitment?

Baroness Cumberlege

My Lords, as I said, those therapies have a degree of ambivalence about them in relation to their effectiveness. There are those who find them extremely helpful and good value for money. They believe that they do a job that needs to be done. There are others who feel that it is actually quite damaging to people if the therapists are not properly trained, qualified, registered and recognised. Therefore the department has a review underway. The results will be available in the early summer. Once that review is completed, another review, which will involve specifically education and training, will start in the late summer.

Lord Carter

My Lords, is the fact that as many as half of the 200 or more health districts have no psychotherapy service a factor in the increasing problem of mentally ill people being discharged from hospital without a properly worked out individual care programme?

Baroness Cumberlege

No, my Lords. My honourable friend the Secretary of State made an announcement last December on the way forward for mental health services. She recognises that legislation will he needed in the near future to ensure that people who are discharged from hospital are followed up and monitored. However, that is rather divorced from the specific Question on the Order Paper.

Lord Monkswell

My Lords, bearing in mind that people in need of psychotherapy treatment are extremely vulnerable almost by definition, and bearing in mind that anybody can set themselves up completely untrained and irresponsibly as a psychotherapist, I should like to ask this question. What plans do the Government have to safeguard the future well-being of those vulnerable people by ensuring adequate training and oversight of the, workings of that profession?

Baroness Cumberlege

My Lords, that is the subject of the two reviews that I have mentioned. We are encouraging the Development of registration and training standards and codes of ethical and disciplinary practices. We want to create a responsible and accountable profession. The United Kingdom Council for Psychotherapy launched its register of psychotherapists in 1993, and the British Confederation of Psychotherapists is about to publish a register of its members.