§ Mr. Cousins
To ask the Secretary of State for Social Services what financial arrangements are made in each health region when patients are transferred out of long-stay hospitals into community care; and how many patients were transferred out under these arrangements in each health region since 1984.
§ Mrs. Ann Winterton
To ask the Secretary of State for Social Services how many patients formerly resident in long-stay mental hospitals have so far been discharged into the community as part of the community care policy in each regional health authority; and what has been the total amount of cost savings accrued as a result.
§ Mrs. Currie
In response to local circumstances and needs, regions have a variety of financial arrangements for funding the transfer of mentally ill or handicapped patients from long-stay hospitals to more community orientated patterns of care. In some cases funds are transferred with individual patients ("dowries") according to regional guidelines or are directly negotiated by district health authorities; in others development monies are earmarked by the regional health authority to fund specific projects. General development funds are, of course, also used to meet the costs of community care. Dowries are often permanent revenue payments uprated for inflation each year. A number of regions have set aside specific sums to bridge the cost of continuing to run old long-stay institutions while developing new services, but such funds are not the only ways of meeting such costs. The broad details of regions' financing arrangements are as follows. The hon. Member may wish to contact the chairman of the regional health authority concerned for more detailed information.
Northern RHA. Health Service developments funded from regional priority service fund. Arrangements for patients transferred from NHS to local authority or voluntary care individually negotiated. Bridging arrangements but no specific fund.
Yorkshire RHA. Direct care costs transferred to patients "home" DHA. The balance of resources required to provide community care provided from general development funds. Arrangements for transfers to local authority and voluntary agencies separately negotiated at district level. Bridging fund.
Trent RHA. Regional guideline for dowries of £13,800 for patients transferred between health authorities and of £6,900 for transfer to local authority or voluntary care. Bridging fund. (Policy under review.)56W
North Western RHA. Dowry of £21,400 per patient for all patients transferred as part of district package of which £4,300 is non-recurrent. Dowry of f 13,400 for transfers agreed on an individual basis. Bridging fund.
Mersey RHA. Financial arrangements negotiatied by DHAs according to dependency level of individual patient. Bridging fund.
West Midlands RHA. Dowry of 50 per cent. of average cost of mentally handicapped patients and 100 per cent. of average cost of mentally ill patients. Targeted bridging fund.
East Anglian RHA. Funding arrangements negotiated individually by district health authorities. Bridging fund.
North West Thames RHA. Dowries ranging from £13,000 to £20,000 according to type of patient. Additionally, there are development fund moneys available from natural decline. Bridging fund.
North East Thames RHA. For health authorities, each DHA allocated funds either to pay for care in the existing long stay hospital or to provide its own service. Transfers to local authorities and voluntary agencies separately negotiated. Strategic reserve to top up costs of care in the community where necessary with ad hoc bridging finance provided by RHA to existing providing districts.
South East Thames RHA. Dowry of £13,000 (plus London weighting if necessary) for mental handicap patients. For mental illness patients costs of hospital care apportioned to districts on the basis of numbers to be transferred. Bridging fund.
South West Thames RHA. For health authorities dowries of £13,477 for mental illness and £11,334 for mental handicap patients admitted before December 1982. Separate negotiations for patients admitted after that date and for transfers to local authorities, voluntary agencies and across regional boundaries. Bridging fund.
Oxford RHA. Development funds earmarked for specific projects.
Wessex RHA. Dowry of £14,000 per patient for all agencies. Mental handicap bridging fund.
South Western RHA. Dowry of £13,700 for mental handicap patients available for community provision by health authorities. Separate negotiation for mental illness patients and for all transfers to other agencies.
Information is not available centrally on the numbers of patients discharged from long-stay care specifically under these arrangements. The tables show the number of discharges from NHS mental illness hospitals and units and mental handicap hospitals and units in England where the depth of stay was five or more years. Tranfers to other hospitals and special hospitals are excluded. 1986 is the latest year for which this information is available centrally.
Information on cost savings is not available centrally.
Discharges from Mental Illness hospitals and units where there was a stay of five or more years1 Regional health authority 1984 1985 1986 England2 981 987 1,082 Northern 48 48 54 Yorkshire 74 67 85 Trent 102 105 113 East Anglian 32 29 38 North West Thames 96 65 83 North East Thames 76 76 77 South East Thames 75 70 83 South West Thames 65 59 81 Wessex 53 67 99 Oxford 34 39 46 South Western 97 110 101 West Midlands 117 114 111 Mersey 65 81 50 North Western 46 56 61 Special health authority hospitals 1 1 0
1Excludes deaths, transfers to a special hospital, transfers to a 57W hospital psychiatric bed and transfer to a hospital non-psychiatric bed.
2Excludes special hospitals.
Discharges from Mental Handicap hospitals and units where there was a stay of five or more years1 Year Regional Health Authority 1984 1985 1986 England2 1,375 1,523 1,951 Northern 63 58 81 Yorkshire 71 148 175 Trent 129 150 300 East Anglian 58 66 60 North West Thames 50 65 58 North East Thames 72 83 53 South East Thames 148 201 275 South West Thames 119 171 277 Wessex 82 75 143 Oxford 38 57 74 South Western 304 155 133 West Midlands 70 100 104 Mersey 98 72 102 North Western 73 122 116 Special Health Authority hospitals 0 0 0
1Excludes deaths, transfers to a special hospital, transfers to a hospital psychiatric bed and transfer to a hospital non-psychiatric bed.
2Excludes Special Hospitals.
§ Mrs. Ann Winterton
To ask the Secretary of State for Social Services (1) if his Department currently issues any guidance to health authorities on the consultations which should be undertaken with patients, their parents and their relatives before individuals are discharged into the community from long-stay mental hospitals;
(2) if his Department currently issues any guidance to health authorities on the consultations which should he undertaken with patients, their parents and relatives, and local residents before long-stay mental hospitals are run down as part of the implementation of the policy of care in the community.
§ Mrs. Currie
The Government's response to the report of the House of Commons Social Services Committee on "Community Care with Special Reference to Adult Mentally Ill and Mentally Handicapped People", circulated to all health authorities, reminded them of the need to consult patients and their families about discharge from long-stay hospitals. We will be considering the question of consultation with local residents as we review reports from the Health Service Commissioner which bear on this issue.
§ Mr. Wareing
To ask the Secretary of State for Social Services what mechanisms his Department has established to oversee the transfer of residents of long-stay mental institutions to the community.
§ Mrs. Currie
The development of mental illness and mental handicap services, including the shift to community-based services, is a regular feature of the annual review meetings which Ministers and the NHS Management Board hold with each regional health authority. The Department's Social Services Inspectorate maintains liaison with local social services departments and monitors the development of personal social services, including those for patients discharged from mental institutions.
§ Mr. Hinchliffe
To ask the Secretary of State for Social Services what is his policy towards health authorities being58W required to consult neighbours before mentally handicapped people are moved into the community; what representations he has received in this respect for the Health Service Ombudsman, Mr. Anthony Barrowclough; and if he will make a statement.
§ Mrs. Currie
I refer the hon. Member to my reply to the hon. Member for Liverpool, West Derby (Mr. Wareing) on 10 June, at column727.
§ Mr. Hinchliffe
To ask the Secretary of State for Social Services what representations he has received regarding the cases of former long-stay hospital residents who are ineligible for community care grants on discharge because they do not qualify for income support; what was the nature of these representations; and if he will make a statement.