HL Deb 13 July 2000 vol 615 cc367-70

3.14 p.m.

Lord Williamson of Horton asked Her Majesty's Government:

Whether National Health Service arrangements for the care and treatment of patients with schizophrenia are adequate.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)

My Lords, there have been unacceptable variations in the standards of care available to people with mental health problems, including those with schizophrenia. The Government are rectifying that by investing significant new resources, by introducing national standards and by bringing forward proposals to modernise the mental health legislative framework.

Lord Williamson of Horton

My Lords, I declare my interest as a patron of the National Schizophrenia Fellowship, and I thank the Minister for that encouraging Answer. However, will he join my crusade to reduce the number of cases where patients abandon their medication with serious consequences for hospital admissions and, of course, for cost? As it is well established by current surveys that one of the main reasons why patients abandon their medication is their aversion to side effects, does the Minister agree that it is important that the whole range of drugs, including those which may cause fewer side effects, should be available under the NHS and that drug rationing is a false economy?

Lord Hunt of Kings Heath

My Lords, I certainly agree that we must do everything that we can to encourage people who suffer from schizophrenia to take the drugs that they have been prescribed. I believe that some of the care programmes and assertive outreach programmes are well geared to encouraging users to do so.

I accept the noble Lord's point that many of the traditional drugs have adverse side effects, although even the new or atypical drugs which are better tolerated by many users also have a range of side effects. However, in relation to policy on the prescribing of such drugs, the National Institute for Clinical Excellence has been asked to manage the production of guidelines which, I believe, will help to ensure consistency of approach throughout the NHS.

Lord Jenkin of Roding

My Lords, is full use currently being made of the supervised treatment orders introduced in legislation a few years ago?

Lord Hunt of Kings Heath

My Lords, I believe that many problems have arisen in relation to patients who are not prepared to accept the treatments prescribed for them. That is why, in the Government's papers reviewing the current use of mental health legislation, the proposal has been put forward for compulsory treatment orders. We have received many comments on that proposal and are currently considering how to take the matter forward in relation to proposed new legislation.

Lord Morris of Manchester

My Lords, is my noble friend aware that many NHS mental health patients are now being sent from London up to 200 miles away to private hospitals, at a cost of more than £1,000 per patient a day, and that to take but one example, the South London and Maudsley NHS Trust in consequence is now facing an overspend of £1.5 million? Can anything be done to address this problem for the trusts affected?

Lord Hunt of Kings Heath

My Lords, my noble friend raises the very important issue of whether we have sufficient beds for this type of patient. I believe that trends in recent years undoubtedly have reduced the number of beds available. In 1987, 39,000 or so beds were available for adult patients. By 1997 that number had been reduced by 21,000. I recognise that a particularly acute problem exists in London. That is why 68 additional places were produced in 1999–2000, with a further 113 places being produced in the current financial year. I am, of course, happy to look into issues of particular financial difficulty which hospitals may be experiencing. I believe that the Maudsley Hospital to which my noble friend referred had an overspend of £700,000 last year which, in relation to its overall budget, is comparatively small. However, clearly the real answer is to ensure that we have enough beds.

Baroness Northover

My Lords, is the Minister satisfied that sufficient funds are being provided to local government for accommodation for psychiatric patients, including those with schizophrenia? How are the Government tackling the major shortage of community psychiatric nurses?

Lord Hunt of Kings Heath

My Lords, I fully recognise that local government has an important role to play in ensuring that there are sufficient facilities in the community to enable people suffering from mental illness to be appropriately supported. The purpose of the mental health grant is to help local authorities in their responsibilities in that respect. I am pleased to report that there has been an increase in the number of people in the workforce who provide direct care and support to people with mental health problems. For example, since 1998 the number of hospital consultants has increased from 2,360 to 2,710 and the number of community nurses increased from just under 9,500 to just over 10,000. I very much hope that we can continue to increase the numbers of staff in those areas.

Earl Howe

My Lords, is the Minister aware that in recent surveys, schizophrenic patients have expressed much greater satisfaction with the newer, atypical medicines than with the older ones? Does the National Institute for Clinical Excellence take into account the extent of patient satisfaction when determining the cost-effectiveness of a treatment?

Lord Hunt of Kings Heath

My Lords, it is not appropriate for me to describe how NICE will approach the work, as the noble Earl tempts me to do. At some stage in the process of NICE's considerations, the Government will have to take a view. If users find a particular set of drugs better to take than others and that increases the likelihood that they will take their medication, that must be taken into account when deciding which drugs are most appropriate to use. As the noble Lord, Lord Williamson, has already suggested, we have a real problem, in that many people suffering from schizophrenia are not following their medication regimes.

Baroness Pitkeathley

My Lords, does my noble friend agree that for schizophrenia, at least as much care is provided by patients' families as by the national health service or local authorities and that the support given to those families is therefore of great significance?

Lord Hunt of Kings Heath

My Lords, my understanding is that from estimates it is reckoned that about 125,000 people suffering from schizophrenia live with their family. That places a considerable burden on those family members as carers. We need to do all that we can to support them. The Government's strategy on carers will help, as will the Carers and Disabled Children Bill, which my noble friend is taking through the House, because, if passed, it will enable local authorities to give more support to carers.