HL Deb 25 January 1994 vol 551 cc880-2

2.57 p.m.

Lord Mottistone asked Her Majesty's Government:

What action they are taking in response to representations that there seem to be widely conflicting views within the professions concerned about appropriate care for mentally ill people.

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

My Lords, the Government are taking a range of actions to improve professional working within the mental health service through the task force launched on 1st January 1993, joint training schemes, support groups, Open University courses, working with the royal colleges and the King's Fund and through the production and use of the mental illness handbook.

Lord Mottistone

My Lords, I thank my noble friend for that reply which goes some of the way. Does she not agree that it is most unfortunate that psychiatrists are unhappy about the way in which the social workers interpret the code of practice for handling the mentally ill and that, vice versa, in many cases social workers are unhappy about the way the psychiatrists interpret the code? Arising from what my noble friend said, does she agree that it does not seem that the question of bringing the two together and making sure that both know what the rules really are is being pursued as actively as it should be?

Baroness Cumberlege

My Lords, I agree with my noble friend's first comment that it is essential that all the professions work together, not only nationally but at local level. But I do not agree with my noble friend's second comment. The Government are actively pursuing this matter through the measures which I outlined in my Answer.

The Earl of Longford

My Lords, I know that the noble Baroness is well versed in these matters. Does she agree that they cannot be fully considered without publication of the Reed Report concerning special hospitals? Can she explain why, after quite a few months, the report has not yet been published? Will she say when it is to be published?

Baroness Cumberlege

My Lords, I know that the noble Earl, Lord Longford, is very anxious that the report should be published, and so are we. But there is still more work to be done on it. Once that is completed we shall publish it.

Lady Kinloss

My Lords, can the Minister say whether the Government are satisfied that, before any mentally ill patient is discharged from hospital, there is an adequate community care programme arranged for them?

Baroness Cumberlege

My Lords, it is essential that that is the case. Indeed, my right honourable friend the Secretary of State introduced a number of measures in August and December of last year and again in January to ensure that the guidance given is followed.

Lord Dean of Beswick

My Lords, is the Minister aware that organisations and people dealing with this problem challenge what the Minister has said? Is she further aware that the people dealing with the problem and trying to operate the discharge of mentally ill people into the community are distressed at the increasing frequency of mentally ill people, having been discharged from hospital and sent out into the community, appearing very quickly on the list of homeless people?

Baroness Cumberlege

My Lords, that is why we intend to introduce legislation to ensure that the most difficult and vulnerable patients who have a history of repeated admission to hospital receive the aftercare that is needed. The Government recognise the need for a legal framework and we intend to introduce it as soon as the parliamentary timetable allows.

Baroness Fisher of Rednal

My Lords, is the Minister aware that the Housing Corporation and housing partnerships are becoming sceptical about helping mentally ill people discharged from hospital because they are failing to receive back-up from the Department of Health and the local authorities? Therefore, it ill behoves us to criticise if the housing associations cannot fulfil their part of the bargain struck when mentally ill people leave hospital.

Baroness Cumberlege

My Lords, we have involved the Housing Corporation in these schemes because we recognise the points that the noble Baroness makes. Housing is an integral part of discharge arrangements. We have also introduced short-stay hostels. Five are already open. Five multi-disciplinary psychiatric teams have been established in London to ensure that people who are discharged are well supported.

Baroness Jay of Paddington

My Lords, is the Minister aware that, as my noble friends' questions have demonstrated, there are a number of concerns about the operation of community care for people discharged from hospital? Is she certain that the legislative proposals of her right honourable friend will be tight enough? Is there not a need for resources to back the guidelines rather than just having guidelines on their own?

Baroness Cumberlege

My Lords, the resources that have gone into mental health have been considerable over the past 10 years or so. We have seen an increase in the number of community psychiatric nurses, consultant psychiatrists, mental illness day hospital places, local authority residential places, local authority day centre places and voluntary and private residential provision. All have increased substantially. I am convinced that there are sufficient resources. I am not convinced that the methods being used now are foolproof. Indeed, we are trying to introduce measures to ensure that, in most cases, we will be able to cover the situations mentioned by your Lordships today.

The Countess of Mar

My Lords, is the Minister satisfied that local social service departments have sufficient numbers of qualified social workers adequately to be able to cover the discharge of patients from mental hospitals?

Baroness Cumberlege

My Lords, that is under review. At the moment, we have no reason to suppose that there is a shortage.

The Lord Privy Seal (Lord Wakeham)

My Lords, perhaps we should move on now to Question No. 4.