HC Deb 26 February 1975 vol 887 cc158-61W
Mr. Kilroy-Silk

asked the Secretary of State for Social Services if she is now in a position to make a statement on services for the mentally handicapped.

Mrs. Castle

We have considered whether it would speed progress in the mental handicap services to make radical changes in their organisation. In particular, careful consideration has been given to the possibility of a national service for the mentally handicapped which would bring together present hospital services with those of local authorities, including their educational activities, which would be financed by central Government and would operate with a social service and not a sickness service emphasis. We are in no doubt that a social and educational emphasis is right. However, we are also satisfied that at present further reorganisation would create more problems than it would solve. We have also considered whether overall progress could be speeded up by transferring existing mental handicap hospitals, or at least their residential and training facilities, to local authority social services departments. But again this would throw up great problems of strain on social services departments, new—and undoubtedly unpopular—burdens on the ratepayers, and probably a serious effect on the morale on the very large numbers of existing hospital staff who would be affected by the transfer.

We have concluded, therefore, that the right course for the present is to reaffirm the philosophy and general approach of the 1971 White Paper "Better Services for the Mentally Handicapped", with health and local authorities continuing to share responsibility for mental handicap services. Now that reorganisation has been carried through both sets of authorities can and should use to the full the new machinery for co-ordination which has been established between them.

We have, however, also decided to take a series of measures designed to stimulate changes in attitudes, to put us in a strong position to pursue the objectives of the White Paper and also to work out solutions to the outstanding problems to which the White Paper provided only interim answer, for example, on the balance between hospital and community care.

First, I propose to establish a National Development Group for the Mentally Handicapped [...] advise me as Secretary of State and to [...]lay an active rôle in the development [...] departmental policy and the strategy for its implementation. For example, the group will give advice on the targets and minimum standards to be adopted, important questions about the priority for services for children outside hospital, the reparation of guidance on good practice and advice on ways of introducing changes. Professor Peter Mittler of the Hester Adrian Research Centre at Manchester University has agreed to become chairman of this group. He will have lirect access to Miinsters. The group will be compact and will have members from the main disciplines involved, including medicine, nursing, social services and administration. It will have links with the Central Health Services and Personal Social Services Councils and both councils will be invited to nominate a representative to serve on it.

I also propose to establish a small development team—possibly, in due course, more than one—which will work closely with the group, and will advise Ministers, where necessary, through the group. This team will also be multidisciplinary and will include people with specialised knowledge, experience and a record of innovation who are at present working in the mental handicap services or closely related fields. It will be able to provide specialist information about the current state of development of mental handicap services within the NHS and personal social services. It is my hope that it will establish a close working relationship with authorities, their staff and the joint consultative committees and that it will help them in developing and implementing a comprehensive policy for the mentally handicapped in their areas. Since it will cover local authority services I shall be consulting the local authority associations as well as the professions and health authorities about this proposal and shall discuss with them the team's detailed methods of working, including relationships with my Department, NHS and local authorities. I envisage that members of the team will work part-time, probably on secondment and importantly will continue their links with their own professions. They will work under the guidance of the Development Group in close association with the Department's Regional and Service Development Divisions and Social Work Service. The establishment of this development team will, at least for the time being, mean that the Hospital Advisory Service will not reconstitute a mental handicap advisory team.

Thirdly, I propose to establish an inquiry into mental handicap nursing and care to follow up in greater detail the ideas which were tentatively mentioned in the Briggs Report on Nursing. Mrs. Peggy Jay, who is a member of the Central Health Services Council and who has wide experience in the National Health Service and in local government, has agreed to be the chairman of this committee. The other members will be announced in due course.

Fourthly, I intend to press ahead with the detailed consultations already in progress about the future rôle of the medical specialist in mental handicap. In doing this I have two particular objects in mind. One will be to shift the emphasis of the specialist's rôle from hospital in-patient services to the needs of mentally handicapped people in the whole community, and to the specialist advice required by families, local authorities and other organisations. The other object will be to identify the fields in which medical skills can make their greatest contribution, to free doctors from extraneous responsibilities and to give them a rôle which meets the need of their patients and is challenging and clinically satisfying. This redeployment of medical time must, of course, take account of the very real and continuing need to give a medical lead on the therapeutic needs within the hospital.

As an interim measure and to emphasise the doctors' wider and changing rôle, I propose to ask health authorities, in consultation with the regional manpower committees, to consider in future making new consultant appointments in mental handicap to the health area or districts rather than to a particular hospital.