HC Deb 16 October 1975 vol 897 cc763-6W
Mr. Moonman

asked the Secretary of State for Social Services when she intends to publish the promised White Paper on services for the mentally ill.

Mrs. Castle

The White Paper "Better Services for the Mentally Ill", has been published today (Cmnd 6233).

Its purpose is to bring together into coherent whole existing policies on aspects which are inter-related, but which have tended to be looked at separately—on hospital services, personal social services, security, children and adolescents, alcoholism, drug addiction, and on education, housing and employment for the mentally ill. The general theme is the provision of networks of services which are locally based, with treatment in general hospital psychiatric units and day hospitals, and more emphasis on local authority day care, residential and field-work services. Most health and local authorities have been moving in this direction for some time.

The White Paper does not set out new policies but aims to provide a comprehensive restatement of existing policy and, among other matters, to put right various misunderstandings and misconceptions which have arisen in recent years. These relate particularly to the time scale within which it is practicable to achieve the necessary changes, and to the failure to appreciate the essential inter-dependence of health and local authority services. As a result, expectations have been aroused which can often not be fulfilled in the short term.

The White Paper confirms that it remains the Government's long-term objective to replace the present system of care for the mentally ill, based on large and often isolated mental hospitals, by a local district-based service. The new pattern of service is expected to be more flexible, and better able to respond to individual needs. It involves the provision not only of psychiatric units at general hospitals but also local hospital facilities for elderly severely mentally infirm patients, and a range of residential facilities and day care services. Some specialised services would need to be provided at regional and sub-regional level. The objective of community-orientated care is described, however, not simply in terms of new or different facilities but in terms of the patterns of staffing and professional teamwork, and the arrangements for co-operation between health and local authorities which are capable of being applied within the context of existing facilities to provide a better standard of care.

I wish to emphasise that the White Paper should be seen as a long-term strategic document presenting a comprehensive background picture of what should be our ultimate aim, enabling us to move more rationally towards this aim both within existing resources and as and when resources permit. It will also facilitate joint health and local authority planning for the time when development of services becomes possible.

The sections on resources in particular have been drafted to make it clear that the document is not setting out a specific programme of development but is a statement of objectives against which short-term and medium-term decisions can be taken. It stresses that very little material progress in the shape of new physical development is to be expected in the next few years, and that the time scale for further significant progress will depend on the totality of the resources available and on the degree of priority which can be given to services for the mentally ill in relation to other needs.

Since the new pattern of services is based on a reorganisation and build up of services within each district, it will not be possible to make equal progress in all parts of the country at the same time. In some cases the mental hospitals will have a continuing rôle for 20 years or more. Others will have a shorter life. It will be for local decision which replacement service should be provided first. The White Paper makes the point that more emphasis on day hospital treatment, day care, treatment and support in the home itself, and less on in-patient treatment, should mean that the increase in revenue requirement, taking health and social services together, need be only very modest, and, indeed, of much the same order as would be entailed if the present pattern of service were not to change. The White Paper also makes it clear, however, that the capital investment entailed means that even under relatively favourable economic circumstances a time scale of between 20 and 30 years would be required to introduce this pattern generally throughout the country. It is estimated that to provide all the new facilities required would require a capital programme of about £30 million per annum on health services and £8 million per annum on social services over a period of that order. In the current period of financial restraint, the scope for achieving progress in the next few years will inevitably be strictly limited, particularly as shifting the balance between hospital and community services presents particular problems, given the severe constraints on local authority spending. The possibility of achieving some modest growth in the resources available for the health and personal social services, and of increasing capital investment in the long term, must depend on the country's overall economic circumstances. I am investigating ways of joint financing schemes between health and local authorities.

A strategy which draws together overall objectives against a realistic resource background is essential if the best use is to be made at local level of the limited resources likely to be available in the next few years. At a time of general severe economic restraint it is all the more important to take short-term decisions against a comprehensive long-term perspective, and for health and local authorities to be able to take a shared perspective and joint decisions. I also hope that the White Paper will prove a valuable document in its own right in leading to a better understanding—both among the general public and in the National Health Service, central and local government—of the problems of mentally ill people and what can be done to help them.