§ Mr. Parkinsonasked the Secretary of State for Social Services what action she has taken in respect of regional hospital boards which have not taken steps to provide small, community-based units for mentally handicapped people since the publication of the White Paper "Better Services for the Mentally Handicapped".
552Wc. 625–34.]—was in error. The corrected information is as follows:
§ Dr. OwenWe have been carefully considering what action may be taken centrally to improve the services provided for mentally handicapped people. My right hon. Friend the Secretary of State hopes to make a public statement shortly.
§ Mr. Parkinsonasked the Secretary of State for Social Services whether local authority social workers are automatically informed when patients are discharged from a mental hospital to continue their lives under community care.
§ Dr. OwenThere are no automatic arrangements. It is good practice wherever possible to ensure the closest co-operation between hospitals and those involved with providing community care for discharged patients.
§ Mr. Parkinsonasked the Secretary of State for Social Services what is the latest estimate of the total number of patients in hospitals used wholly for mentally handicapped adults and children in England and Wales, or in units set aside for them in other hospitals; and how this compares with the totals for the previous three years.
§ Dr. OwenThe latest information available refers to 1973. In that year and in the three previous years, figures at year end were as follows:
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1970 57,924 1971 56,892 1972 55,397 1973 54,199 Figures for England only were as follows:
1970 55,434 1971 54,409 1972 52,950 1973 51,797
§ Mr. Parkinsonasked the Secretary of State for Social Services whether she is satisfied with the progress made towards providing a co-ordinating organisation to prevent and detect mental handicap as suggested in the White Paper "Better Services for the Mentally Handicapped".
§ Dr. OwenGuidance on these matters has been given to health authorities in the White Paper "Better Services for the Mentally Handicapped" and in a circular on children's health services issued last year. It is now for the individual authorities to build up and co-ordinate the services required. We are, however, watching developments with close interest, and a study of comprehensive assessment services in particular is in progress.
§ Mr. Parkinsonasked the Secretary of State for Social Services whether any new mental hospitals containing over 250 beds for in-patients have been completed in England and Wales since the publication of the White Paper "Better Services for the Mentally Handicapped"; and whether regional hospital boards have any plans for building any hospitals of similar size in the future.
§ Dr. OwenI assume that the hon. Member is referring to hospitals for the mentally handicapped. Four such hospitals, all of which were in progress when the White Paper "Better Services for the Mentally Handicapped" was published, have since been completed in England. None has been completed in Wales. None is now in progress, nor would I approve of any such schemes which I would consider to be contrary to the policies set out in the White Paper and to which I attach considerable importance.
§ Mr. Parkinsonasked the Secretary of State for Social Services how many local authority homes for mentally handicapped children and how many for mentally handicapped adults in England and Wales have been built since the publication of the White Paper "Better Services for the Mentally Handicapped".
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§ Dr. OwenThirty-one homes for mentally handicapped children have been opened since January 1971. They include 13 in adapted buildings. Corresponding figures for homes for mentally handicapped adults are 119, including 44 in adapted buildings.
§ Mr. Parkinsonasked the Secretary of State for Social Services whether any regional hospital boards in England and Wales have closed a mental hospital since the publication of the White Paper, "Better Services for the Mentally Handicapped"; and whether any regional hospital boards have plans to do so during the next five years.
§ Dr. OwenYes. A number of mental handicap hospitals have been closed after full local consultation. Information on these and on possible further closures is not readily available. As part of the planning system for the reorganised National Health Service, health authorities will review existing, and prepare strategic, plans for a period of 10 years.
§ Mrs. Wiseasked the Secretary of State for Social Services whether she has any estimate of the number of voluntary patients in mental hospitals who are no longer in a disturbed mental state but cannot be discharged because they no longer have homes to go to.
§ Dr. OwenAlthough reliable estimates are not available there is little doubt that significant numbers of patients now in mental hospitals no longer require hospital care in any strict sense. In general, however, they would need alternative forms of care or professional support were they to live outside hospital.
§ Mr. Parkinsonasked the Secretary of State for Social Services what was the revenue expenditure, at 1970 prices, on hospitals for the mentally handicapped in the years 1969–70, 1970–71, 1971–72, 1972–73 and 1973–74, respectively.
§ Dr. OwenRevenue expenditure in hospitals for the mentally handicapped in England, at 1970 Public Expenditure Survey prices, was:
£ million 1969–70 40.73 1970–71 43.85 1971–72 48.42 1972–73 52.16 1973–74 (provisional) 55.87
§ Mr. Parkinsonasked the Secretary of State for Social Services how much will have been spent, at 1970 prices, on capital 555W expenditure on hospitals for mentally handicapped children and adults in England and Wales in the four years 1971–72 to 1974–75, respectively.
§ Dr. OwenThe information requested is as follows:
Hospital capital expenditure on mental handicap services £ million at 1970 Survey prices 1971–72 8.0 1972–73 7.9 1973–74 (Estimated) 7.1 1974–75 (Estimated) 5.7
£ million 1971–72 1972–73 1973–74 1974–75 Hospital capital … 8.0 7.9 7.1* 5.7* Hospital revenue … 51.0 54.8 58.8* No figures available Local authority capital … 6.0* 8.0* 9.0* Local authority revenue … 14.7 16.3 19.4 * Estimated figures.
§ Mr. Parkinsonasked the Secretary of State for Social Services what was the capital investment at 1970 prices on the development of residential homes and adult training centres for mentally handicapped children and adults in England and Wales in the financial years 1970–71, 1971–72, 1972–73 and 1973–74, respectively.
§ Dr. OwenTotal capital expenditure at Public Expenditure Survey 1970 prices is estimated to have been:
£ million 1970–71 5 1971–72 6 1972–73 8 1973–74 9 It is not possible to provide an accurate breakdown of expenditure between the different types of homes and for training centres.
§ Mr. Freudasked the Secretary of State for Social Services what is the annual cost of maintaining a mentally handicapped adult in a hospital unit.
§ Dr. OwenThe average annual cost of maintaining a mentally handicapped patient in 1972–73, the last year for which figures are available, was £1,665. Separate figures are not available for adults.
§ Mr. Parkinsonasked the Secretary of State for Social Services how much will have been spent, at 1970 prices, on improving hospital and local authority services for mentally handicapped children and adults in England and Wales in the four years 1971–72 to 1974–75.
§ Dr. OwenThe following table provides figures at 1970 Public Expenditure Survey prices. Revenue expenditure attributable solely to improved services cannot be established. Figures are, therefore, for total revenue expenditure.
of maintaining a mentally handicapped adult in sheltered accommodation.
§ Dr. OwenInformation is available only for local authority residential accommodation. In 1973–74 the average cost was about £850, excluding debt charges.
§ Mr. Freudasked the Secretary of State for Social Services how many adult training centres are catering for mentally handicapped adults; what is the number of places available; and what expansion of this service will take place in 1975–76.
§ Dr. OwenOn 31st March 1974 there were 371 adult training centres with 31,600 places. It is estimated that by 31st March 1976 a further 50 centres with an additional 4,800 places will have been opened.
§ Mr. Freudasked the Secretary of State for Social Services what provision is made to enable nursing staff in hospital units catering for the mentally handicapped to cope with the educational needs of their patients.
§ Dr. OwenIn May 1974 a circular about the education of mentally handicapped children and young people in hospital was issued jointly by my Department and the Department of Education and Science. This includes advice on the rôles of nurses and teachers, and I am sending a copy to the hon. Member. The 557W greater involvement of nurses in education and training is also recognised in the revised RNMS nurse training syllabus.
§ Mr. Freudasked the Secretary of State for Social Services what statistics are available relating to the numbers of mentally handicapped adults over 16 years of age.
§ Dr. OwenIt is not possible to give any accurate figure for the number of such persons living at home with their families. "Better Services for the Mentally Handicapped" estimated that, for severely mentally handicapped per sons over the age of 15, the incidence was 71.65 per 100,000 total population. This would give a current total of around 33,000.
At 31st March 1973 there were 6,322 adults resident in homes and hostels and 558W 974 adults boarded out in private households by local authorities. On 31st December 1972 there were 46,999 mentally handicapped patients aged 16 and over in mental handicap hospitals. All figures relate to England only.
§ Mr. Freudasked the Secretary of State for Social Services what are the staff-patient ratios per 100 mentally handicapped adults in hospital care in each of the regions.
§ Dr. OwenIt is not possible to provide figures for staff ratios relating to adults alone. The following table provides data relating to overall ratios in 1973, the latest year for which information is available. This information is published annually in the Statistical Research Report series.
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HOSPITALS AND UNITS FOR THE MENTALLY HANDICAPPED, 1973: MEDICAL, NURSING, OTHER PROFESSIONAL, WARD AND DOMESTIC STAFF Region Staff per 100 resident patients England and Wales England Newcastle Leeds Sheffield East Anglian North-West Metropolitan North-East Metropolitan South-East Metropolitan Consultants in psychiatry* … 0.29 0.28 0.26 0.28 0.25 0.58 0.29 0.38 0.30 Other psychiatric medical staff … 0.38 0.37 0.27 0.22 0.29 0.55 0.41 0.34 0.50 Qualified nurses† … 18.0 18.0 18.4 17.0 19.4 20.0 17.8 20.0 16.4 Other nurses … 20.9 20.7 23.6 21.6 21.4 23.3 22.5 20.9 20.9 Total nurses … 38.9 38.8 41.9 38.7 40.9 43.2 40.4 40.8 37.2 Social workers: (a) Employed by hospital … 0.17 0.16 0.27 0.13 0.18 0.16 0.12 0.24 0.12 (b) Employed by local authority … 0.02 0.01 — — — — — — 0.02 Therapists (physio, speech, chiropodists, etc.) … 0.26 0.26 0.16 0.28 0.27 0.39 0.25 0.23 0.71 Therapists, rehabilitative (occupational, industrial, work therapy, handicrafts, etc.) … 2.18 2.17 1.09 2.74 2.15 2.12 1.40 3.31 4.21 Ward orderlies and domestics … 9.8 9.7 10.8 12.0 10.3 12.2 14.3 10.8 10.1 Region Staff per 100 resident patients South-West Metropolitan Combined Metropolitan Oxford South Western Birmingham Manchester Liverpool Wessex Wales Consultants in psychiatry* … 0.26 0.30 0.56 0.17 0.33 0.14 0.35 0.24 0.45 Other psychiatric medical staff … 0.41 0.42 0.47 0.33 0.50 0.31 0.11 0.45 0.66 Qualified nurses† … 17.0 17.6 20.7 16.7 16.6 19.3 21.6 16.6 17.2 Other nurses … 15.2 19.4 28.5 19.3 20.9 18.6 28.3 18.6 24.5 Total nurses … 32.2 37.0 49.2 36.0 37.5 37.9 49.9 35.1 41.7 Psychologists … 0.27 0.22 0.10 0.06 0.19 0.06 0.14 0.04 0.26 Social workers: (a) Employed by hospital … 0.21 0.17 0.28 0.07 0.28 0.11 0.02 0.06 0.40 (b) Employed by local authority … — ‡ — 0.10 — 0.01 — 0.06 0.04 Therapists (physio, speech, chiropodists, etc.) … 0.23 0.33 0.26 0.24 0.16 0.09 0.43 0.24 0.24 Therapists, rehabilitative (occupational, industrial, work therapy, handicrafts, etc.) … 2.02 2.52 1.61 2.61 2.50 0.80 1.82 2.79 2.37 Ward orderlies and domestics … 6.8 10.2 8.3 7.0 8.5 8.5 10.9 8.9 11.8 Source: SBH 112. * Consultants in mental illness, mental illness children and adolescent and mental handicap. † Registered and enrolled nurses. ‡ Indicates a value greater than zero which is not large enough to register the accuracy quoted.
§ Mr. Parkinsonasked the Secretary of State for Social Services whether there are any plans to build new specialist hospitals for mentally handicapped people in England and Wales; and, if so, when will these be built.
§ Dr. OwenI am at present considering the proposals of regional health authorities to start building schemes costing more than £350,000 in England in the financial year 1975–76 and I understand that my right hon. and learned Friend the Secretary of State for Wales is similarly engaged.
§ Mr. Parkinsonasked the Secretary of State for Social Services whether she has any plans to carry out a census of all mentally handicapped patients in hospitals in England and Wales, and a census of all mentally handicapped people in local authority and voluntary homes in England and Wales.
§ Dr. OwenNo. A census of hospital patients in England and Wales was carried out in 1970. Information regarding admissions and discharges of hospital patients and of residents in local authority homes is returned annually to my Department. The report of a census covering residential accommodation for mentally handicapped people, including that provided by voluntary bodies, will be available shortly.
§ Mr. Parkinsonasked the Secretary of State for Social Services whether she has any plans to devote more attention to the use of children's homes and foster homes—both local authority and voluntary—as an alternative to both hospital care and a separate system of hostels for mentally handicapped children.
§ Dr. OwenI recognise the need to provide more residential places in the community relevant to the particular needs of mentally handicapped children. A few such children may be properly accommodated in some community (children's) homes. Local authorities are aware of this, and also of the desirability of fostering where that is appropriate.
§ Mr. Parkinsonasked the Secretary of State for Social Services what was the average ratio of nursing staff, both qualified and unqualified, to patients in hospitals and hospital units for the mentally 562W handicapped in England and Wales in the years 1969, 1970, 1971, 1972, 1973 and 1974, respectively.
§ Dr. OwenThe following table provides the figures:
Nurses per 100 residents Qualified* Other Total 1969 14.9 11.0 25.9 1970 16.2 12.6 28.8 1971 16.7 15.6 32.2 1972 17.4 19.6 37.0 1973 18.0 20.9 38.9 1974 Not yet available * Registered and enrolled nurses.
§ Mr. Parkinsonasked the Secretary of State for Social Services what percentage of children and adults diagnosed as severely mentally handicapped live at home in England and Wales.
§ Dr. OwenSurveys conducted some years ago broadly indicated that of the people classified as severely mentally handicapped about 70 per cent. of those aged under 15 and about 40 per cent. of those aged 15 and over lived at home. Further details of the surveys are given in Chapter 2 of the White Paper "Better Services for the Mentally Handicapped".
§ Mr. Freudasked the Secretary of State for Social Services if she now has more up-to-date figures for the total number of adult patients in hospital for the mentally handicapped and subnormal hospitals than those indicated in her answer of 8th November 1974 to the hon. Member for Ormskirk (Mr. Kilroy-Silk).—[Vol. 880, c. 280.]
§ Mr. Parkinsonasked the Secretary of State for Social Services if she will report on the progress of the training of the staff of residential homes for the mentally handicapped developed by the Central Council for Education and Training in Social Work.
§ Dr. OwenThe Central Council has now adopted wide-ranging proposals for the development of training for all areas of residential social work. These provide for the integration of such training with training for social work in the field, and for a major expansion in the number of training places available. The timing and 563W scale of developments must, however, depend on the availability of resources and are among the matters being considered by the Working Party on Manpower and Training for the Social Services, chaired by my Department, on which are represented the Central Council, the other Government Departments concerned, the local authority associations, the Personal Social Services Council and the professional organisations.
§ Mr. Parkinsonasked the Secretary of State for Social Services whether an estimate has been made of the number of mentally handicapped adolescents in England and Wales who have to remain at home or at school until a place in an adult training centre can be found.