§ Mr. Berminghamasked the Secretary of State for Social Services if he will accept approaches from regions 609W and district health authorities for bridging finance in the development of locally based mental health services in order that the facilities of the large mental hospital can be maintained and continue to provide an effective service while they are being replaced by the development of district-based services.
§ Mr. Kenneth ClarkeHealth authorities are required to plan their services within cash limits and within the resource assumptions issued to them for planning purposes. Where regional health authorities face particular peaks in capital expenditure in any one year, they may apply for a rephasing of their capital allocations or they may arrange a loan of capital from another region. Regions are similarly able to approve such arrangements between district health authorities.
The use of this facility to provide so-called "bridging finance" in the circumstances described by the hon. Member would be quite acceptable to me in principle, but proposals put to me are rarely based on any firm timetabled plans for the closure of the redundant large mental hospital. Applications for large increases now in spending on new community-based services against the possibility of savings later if a hospital eventually closes have to be judged for priority against other worthwhile bids for more resources.
§ Mr. Berminghamasked the Secretary of State for Social Services what is his Department's role in disseminating good practice deriving from the development of locally based mental health services.
§ Mr. John PattenThe Department's main function in this area is to develop and disseminate national policies and priorities to provide a broad framework within which health authorities and social service departments plan the development of local services. However, the dissemination of good practice is an important complementary activity which takes many different forms. For example, in the mental handicap field, a study has just been completed by a team of officials of the special needs of mentally handicapped people with additional disabilities and of the ways local services are meeting these needs. Their report, which draws together information on current ideas and practices for service planners and providers will be published shortly and will have a wide free distribution. In the mental illness field, the recent establishment of demonstration development districts for mental illness in old age is an effective method of encouraging and drawing attention to good practice. Details of all 27 winning schemes will be made available to all regions. More generally, the health advisory service and the development team for the mentally handicapped are available to advise authorities on the planning and development of their mental illness and mental handicap services respectively. In doing so, they draw on their extensive knowledge of good practice in different parts of the country. The Department provides a grant to the good practices in mental health project, which encourages and publicises local studies of good mental health schemes.
§ Mr. Berminghamasked the Secretary of State for Social Services if, in the light of the publication by MIND of "Common Concern", containing proposals for local mental health service development, a copy of which has been sent to him, he will recommend to district health authorities that they take action to implement these proposals; and if he will make a statement.
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§ Mr. John PattenThe publication "Common Concern" — MIND's manifesto for a comprehensive mental health service—was published on 24 October 1983. Most of its proposals can be immediately welcomed as tending to further the long-term aims of this and previous Governments. Others, however, concern means of achieving our objectives—for example, committee structures — and will require more careful thought. particularly in the light of the Griffiths recommendations.
My noble Friend has already told MIND of his interest in "Common Concern" and asked to be kept in touch with progress. I hope the publication will achieve its expressed purpose of adding further knowledge to the enthusiasm of those who are working towards comprehensive local mental health services, which remain a priority objective as district health authorities know.
§ Mr. Berminghamasked the Secretary of State for Social Services what assessment he has made of the effect of the recent imposition of cash limit reductions, coupled with efficiency savings and manpower reductions, on the development by district health authorities of district-based mental health services.
§ Mr. Kenneth ClarkeI refer the hon. Member to my reply to the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) on 15 November. —[Vol. 48, c.441.]
§ Mr. Berminghamasked the Secretary of State for Social Services (1) what are the major obstacles encountered by regional health authorities and district health authorities to the closure of large mental hospitals and the replacement of their facilities by district-based services; and if he will make a statement;
(2) in how many regions mental hospitals are currently scheduled for closure in the next 10 years; and if he will list the regions and the hospitals concerned.
§ Mr. Kenneth ClarkeIt is an important feature of our policy for the treatment and care of mentally-ill people to aim to develop community-based services and reduce unnecessary numbers of patients being treated as long-stay residents of hospitals. The development of strategies for the closure of large mental hospitals and a related expansion of district-based services is a difficult and complicated task and it is crucial that the interests of patients are safeguarded during as well as after the period of transition. However, where health and local authorities and voluntary bodies are committed to working together to meet the needs of people who are mentally ill or mentally handicapped, there should be no major obstacles to progress.
I know from my own discussions, and those of my ministerial colleagues, with chairmen of regional health authorities that most regions are now at last actively planning the closure of large badly-sited mental hospitals, together with the build-up of community-based services, although some are still looking at time scales of as long as 10 years. The nature and pace of these developments are of course a matter for individual health authorities in the light of local circumstances and priorities, but I hope that most will soon produce firm plans aiming at a reasonable rate of progress. The following table shows hospitals on which formal consultations have either recently been completed or are currently being undertaken on proposals to close. In addition, in the North East Thames region, the authorities concerned plan to go out 611W to consultation shortly with proposals to close Friern and Claybury hospitals within 10 years. Other regions are well advanced in developing their proposals.
Regional Health Authority Hospital Type Numbers of beds to be closed South Western Exe Vale MI 648 (Exminster Branch) Starcross MH 325 Moorhaven*† MI 240 West Midlands St Wulstan's MI 260 N E Thames Essex Hall† MH 205 Trent Lawn MI 125 Wessex Sandy Point MH 81 Tichborne Down MH 40 N W Thames All Saints MH 45 Banstead* MI 40 Houndswood MH 36 Annexe* (Harperbury Hospital) * Partial closures. † Closure formally approved, but not yet implemented.
§ Mr. Berminghamasked the Secretary of State for Social Services (1) how many local authorities have no day centres for mentally ill people; and if he will list them;
(2) how many local authorities in England make no direct residential provision, excluding voluntary facilities, for mentally ill people; and if he will list them;
(3) what was the number of local authority day-care places for mentally ill people provided in 1981, 1982, 1983 and projected by 1987;
(4) what was the number of residential places provided by local authorities in England and Wales in 1981, 1982, 1983 and projected by 1987 for mentally ill people.
§ Mr. John PattenThe number of residential places for mentally ill people provided by local authorities in England in 1981, 1982 and 1983 were as follows:
Number March 1981 3,981 March 1982 4,063 March 1983 *4,137 * Provisional estimate. No projections are available for 1987. Figures for Wales are a matter for my right hon. Friend the Secretary of State for Wales.
The number of local authority day care places for mentally ill people in England in 1981, 1982 and 1983 were as follows:
Day care places in: Day centres for the mentally ill "Mixed" day for centres† All places total March 1981 4,907 1,936 6,843 March 1982 5,025 2,064 7,089 March 1983* 5,157 2,165 7,322 * Provisional estimate. † Estimated figures. Mixed day centres may include elderly, younger physically handicapped, mentally ill and mentally handicapped people. No projections are available for 1987. Excludes day provision in residential homes because separate figures for mentally ill people are not available. Day care places are also provided in NHS mental illness day hospitals, and at the end of 1981 there were about 15,300 such places. None of the figures provided above 612W includes the places provided by voluntary and private organisations where the residents are supported financially by local authorities.
The following table shows the latest data available about individual authorities, some of which have not made returns in the last two years.
According to the last statistical return received from them, the following local authorities had no direct residential provision for mentally ill people:
- Tameside
- Warwickshire
- Dudley
- Lambeth
- Tower Hamlets
- City of London
- Bromley
- Kingston upon Thames
- Waltham Forest
- Isle of Wight
- Isles of Scilly
and the following did not provide directly either day centres for mentally ill people of mixed day centres:
- Tameside
- Trafford
- Shropside
- Solihull
- Walsall
- Suffolk
- City of London
- Gloucestershire
- Isles of Scilly