Jay Committee (Report) (Hansard, 8 March 1979)

§ Mr. Ennals

My right hon. Friend the Secretary of State for Scotland, my right hon. and learned Friend the Secretary of Sate for Wales and I, have today published the report of the committee of inquiry into mental handicap nursing and care—Cmnd 7648, vols. I and II. We extend our warm thanks to Mrs. Peggy Jay and her committee for all the hard work and thought they have put into producing this far-reaching report on an important and difficult subject.

The report is being widely circulated and comments are being sought. A shortened version, prepared by the Jay committee is also being distributed to staff working with mentally handicapped people in hospitals and local authority accommodation.

We welcome the attention given by the Jay committee to the principles of residential provision for mentally handicapped people, and the stress it lays throughout on the fullest possible integration of mentally handicapped people into the life of the community as a whole—an aim which the Government strongly support.

The Committee makes detailed and radical proposals for the manpower required for the residential care of mentally handicapped people in hospitals and in local authority accommodation, including a new form of training for the staff who provide that care. The report thus raises issues of major importance for the development of mental handicap services 815W which local authorities are providing on an increasing scale, as well as for services provided by the National Health Service. Consultations on the specific training proposals in the report, in particular the concept of a single training body for all staff in this field, will be an important part of the discussions which will now start on the report.

Any major change in the patterns of training would clearly take some years to bring about. But the Government will, in the meantime, seek to discuss urgently with the bodies now responsible for training how far they might adapt their present training arrangements to provide—as soon as possible—greater emphasis on the social aspects of care with particular reference to the special needs of mentally handicapped people on the lines envisaged in the Jay report.

Whether or not the Jay proposals are accepted, the Government recognise that many mentally handicapped people will still require an NHS service for the foreseeable future and that staff who have received training in nursing will continue to have a key role in delivering this service.

The committee makes some bold and imaginative suggestions for changes in the pattern of residential care. Many of these are based on pioneering work already undertaken by field authorities and voluntary bodies. We shall be studying closely the desirability and feasibility of what is suggested in the light of the public debate on the report. In Scotland, the committee's recommendations will be considered in the context of a recent review of services for the mentally handicapped carried out by the Scottish Health Services Planning Council and the Advisory Council on Social Work.

In England and Wales the basic principles set out in the 1971 White Paper "Better Services for the Mentally Handicapped"—in particular the emphasis on community care—remain valid. But questions about the pace and direction of change are being raised not just by the Jay report but by the National Development Group, field staff and others. As I briefly indicated last year, I have decided that may Department should review, in consultation with the National Development Group, the present progress on the policies set out in the White Paper and the way these need to be developed. 816W The pattern and progress of services for the mentally handicapped in Wales will be reviewed separately by the Welsh Office.

As the review in England proceeds, it is intended to publish a series of discussion documents on the findings. The response to these documents, together with the results of the consultations on the manpower and training proposals in the Jay report, will be taken into account in deciding the guidelines needed by health and local authorities for their future care of mentally handicapped people.

Some of the questions we shall be looking at in this review are:

How is the incidence and prevalence of mental handicap and associated handicaps changing—for example because of better preventive measures and improved life expectancy?

What kinds of services should we be providing to meet the varied needs of mentally handicapped individuals and their families—for example the best balance between day care and support in the home?

How can these varied services best be provided in each locality? What are the implications for the organisation and staffing of services? What buildings will be needed?

Did the White Paper get the balance between health and local authority services right? If not, what changes are required? What part can the voluntary movement play?

What are the stages by which it will be practicable to move from the patterns of provision we have now to those desired in the future, taking into account resources and other constraints?

How best can progress in improving the quality and level of services be assessed and encouraged?

The Government's plans for developments in the mental handicap field—including their response to the Jay Committee's proposals—which the Committee acknowledge would have substantial resource implications—will necessarily be constrained by the availability of resources and other needs within the health and personal social services. But mentally handicapped people will continue to be a priority for additional resources and the 817W coming public debate will help to determine the most effective way of providing them with better services.