The Mentally Ill: Facilities for Acute Cases (Hansard, 29 June 1994)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, the number of short-stay psychiatric beds has remained at around 22,000 for the past five years, while at the same time services in the community have increased. From 1991 to 1995, £45 million has been made available from central funds for an additional 600 medium secure places.

§ Lord Thurlow
My Lords, I thank the Minister for that, to some extent, reassuring reply. However, I cannot say that my disquiet is entirely allayed. Over the past 10 to 12 years almost half the beds in mental hospitals have been closed. As I understand it, closures are continuing at the rate of about 4,000 beds a year.
We welcome the fact that the department is at last monitoring the situation. Will the Government review the situation regionally and freeze further closures when the situation requires it?

§ Baroness Cumberlege
My Lords, perhaps I may explain the discrepancies regarding the number of beds that have closed over the years. Those were not acute beds, or those used for the urgent cases which were the subject of the Question put to me. They were long-stay beds. We know that the majority of those beds have been replaced by places in the community—over the years about 80,000 in total.
The noble Lord is absolutely right. I think that the situation needs very close monitoring. That is why we set up the mental health task force. We want to keep the issue under close review.

Lord Campbell of Croy
My Lords, did my noble friend's initial reply include Scotland and Wales? If not, is the situation much the same in those areas? Is my noble friend satisfied that enough is being done to ensure that beds in hospitals are available for the mental illness relapses which are to be expected, as recommended by the Ritchie Inquiry after the distressing Clunis case?

§ Baroness Cumberlege
My Lords, I am probably remiss in not including Scotland and Wales. I shall certainly look into that and write to my noble friend. With regard to the situation where people relapse and need hospital care, that is a clinical decision. It is 770 important that the facilities are available and it is the duty of health authorities to assess the needs of their populations and purchase the services that are needed.

§ Lord Stallard
My Lords, the Minister referred to support services. Is she aware that almost everyone who is familiar with the issues agrees that some support services for the severely mentally ill do not exist in London or in many parts of the country? Nor can such services be set up overnight. Does the Minister recall that in March of this year she assured noble Lords that the Secretary of State had accepted all the; recommenda-tions of the Ritchie report? They included a recommendation that an increased number of beds in general psychiatric wards in London was urgently needed. In May of this year the Minister for Health, Dr. Brian Mawhinney, MP, seemed to say that the Government are not convinced that the main answer to pressure on mental health services is more beds.
There is a contradiction in those statements. There seems to be some confusion in government thinking, with the Secretary of State accepting the Ritchie report and the Minister for Health saying that that recommendation is not all that important. The Minister in this Chamber has told us that there are sufficient support services. However, that is not the real situation on the ground. Can she reconcile those views and tell us the Government's position?

§ Baroness Cumberlege
My Lords, the Government take the issue very seriously indeed. My right honourable friend the Secretary of State for Health launched a 10-point plan in August last year. Responding to the health Select Committee which conducted an inquiry into health services, we set out all the different things we were doing: greater provision of medium secure beds; supervision registers; discharge guidance; supervised discharge; and the care pro-gramme approach. A great deal is going on. I accept that there is a particular problem in London where we have enormous pressures in regard to mental illness, and that is why the task force is looking specifically at the situation and reporting to my right honourable friend in the autumn of this year.

§ Baroness Jay of Paddington
My Lords, is the Minister aware that in the district health authority which deals with the greatest number of mentally ill patients in the country—that is London, as the noble Baroness said —there is at present a consistent demand of more than 100 per cent. for all the acute beds? I had the opportunity to discuss that with the chief executive of the authority this morning, who assured me that the authority was committed to the long-term plan of dealing with the problem by community care methods. However, surely in the short term we need some national programme to increase hospital beds for the acutely mentally ill; otherwise, as we have discussed many times in your Lordships' House, we shall have people wandering the streets with acute mental illness, sometimes with tragic results.

§ Baroness Cumberlege
Yes, my Lords. 1 should like to make it absolutely clear that research has been carried out by the team for the assessment of psychiatric 771 services in the rundown of long-stay hospitals, particularly Friern and Claybury, which shows that the people who are discharged from those hospitals are not those on the streets. I accept that many of the people who are homeless are mentally ill, but they are not people who have been discharged from long-stay institutions.
To supply and provide back-up support we have invested £36 million this year in mental illness-specific grants to help local authorities fulfil their commitments. We also have the homeless mentally ill initiative, which ensures that more resources are going into hostels and short-stay places. The noble Baroness is right, London has a specific problem and those problems are being addressed.

§ Lord Monkswell
My Lords, is the Minister aware that the problems that appear to beset London which are flagged up in the national press are not only apparent in London? Every major urban conurbation, every major city in the country, is beset by the same problems. The people living in those cities have to put up with the same difficulties as Londoners, solely because people live in the community with mental illness or mental handicap but there is a lack of adequate support services in the community. What will the Minister or the Government do about the problems of people living outside London?

§ Baroness Cumberlege
My Lords, the vast majority of people who have a mental illness live very satisfactory lives in the community. With the new drugs that are now available it is possible for people who were previously in locked wards to hold down jobs and to contribute usefully to society. I think that it is totally wrong to put over the impression that we have severe problems in every city in the country. That is not the case. We know that in many places the issue is being dealt with very efficiently by health authorities which are purchasing the right services and by those hospitals and community units that supply the services.