§ Mr. Berminghamasked the Secretary of State for Social Services how many local authorities have achieved the 1975 White Paper targets in the provision of long-stay hostel places, day centre places and community psychiatric nursing facilities, respectively.
§ Mr. Kenneth ClarkeThe 1975 White Paper, "Better Services for the Mentally Ill" (Cmnd. 6233) contained provisional planning guidelines on future levels of provision which were dependent on economic circumstances and developments in alternative ways of providing care. There are no targets as such. The White Paper indicated that completion of the new pattern of care was likely to take up to 20–30 years.
The Department's annual "Personal Social Services: Local Authorities Statistics" shows that local authorities' progress has varied greatly. As the White Paper says,
The level of local need can only be fully determined in the context of the individual locality.Some local authorities prefer to rely less on their own provision and more on accommodation and day care provided locally by voluntary bodies, which the local authority supports financially.
Despite problems, progress is being made, by local authorities and by health authorities (which are responsible for community psychiatric nursing services), towards a comprehensive district psychiatric service based in, the community. The allocation of extra funds for joint finance which I announced on 14 March 1983 — [Vol. 39, c. 54–55]— under our care in the community initiative should further assist progress.
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§ Mr. Berminghamasked the Secretary of State for Social Services whether he will make available additional financial resources in order to assist district health authorities and local authorities in the development of comprehensive local mental health services.
§ Mr. Kenneth ClarkeNo. Authorities must finance developments in all services within existing cash allocations and from resources released through greater efficiency.
§ Mr. Berminghamasked the Secretary of State for Social Services how many psychiatric beds are available based in district general hospitals; how far short of the Government's estimate of the numbers required this figure is; and what steps he intends to take to rectify this.
§ Mr. Kenneth ClarkeDistrict general hospitals are not explicitly identified in statistics collected centrally. During 1981, the latest year for which information is available, the average daily number of available beds in what are broadly classified as mental illness units in general hospitals was 14,236. No precise target has been set but I expect the number to continue to rise.
§ Mr. Berminghamasked the Secretary of State for Social Services (1) what criteria district health authorities are expected to observe in the development of their mental health services;
(2) what are the essential components of a district based psychiatric service, and how the cost of providing these district based facilities will compare with the average revenue cost of a large mental hospital;
(3) how many district health authorities have a full range of services for the treatment and care of mentally ill people within their district boundaries;
(4) what is Her Majesty's Government's policy on the future of large mental hospitals in excess of 200 beds; and what considerations district health authorities should take into account in planning for the future of these hospitals.
§ Mr. Kenneth ClarkeThe Government's long-term policy is for the development of comprehensive district-based mental health services, as set out broadly in the 1975 White Paper "Better Services for the Mentally Ill". I am sending the hon. Member a copy of a recent note for regional health authorities, which summarises our current thinking. The nature and size of the elements of an individual district's service must be determined locally, in the light of each district's particular circumstances, preferences and priorities, and after consultation with the social service departments, other statutory services, and voluntary organisations.
Assessment of whether a district has a reasonably full range of services for the district population within its boundaries is best done locally. We expect that in the long run the change in the pattern of services will not greatly change the overall revenue cost falling on a district, compared with the cost of mental hospital-based services for the same population, but this too will depend on local factors.
Health authorities which manage a large hospital need to decide whether that hospital can continue to provide a base for services reaching out into the community, or whether plans should now be made to redeploy the resources of people and money which are locked up in the hospital into a range of alternative facilities within the community. We are discussing with regional health 60W authorities the complex issues which must be faced in planning the hospital's future, to safeguard present and future patient care.
§ Mr. Berminghamasked the Secretary of State for Social Services which district health authorities are currently not providing psychiatric beds.
§ Mr. Kenneth ClarkeInformation is not available centrally in the form requested. The latest information available centrally relates to 1981, which is prior to the establishment of the new district health authorities.
§ Mr. Berminghamasked the Secretary of State for Social Services if he is satisfied with the current level of services provided for elderly mentally infirm people; and if he will make a statement.
§ Mr. Kenneth ClarkeWe remain concerned about both the quantity and the quality of services available for this group. But in the past year we have seen signs of improvement in both respects, partly linked to the £6 million initiative we took last year to provide an added incentive to the development of better services. We will continue to keep a close eye on progress.
§ Mr. Berminghamasked the Secretary of State for Social Services which local authorities are not currently providing any residential care places for elderly mentally ill people.
§ Mr. Kenneth ClarkeThis information is not available. Local authorities usually provide for elderly people suffering from dementia or other forms of mental illness in homes for the elderly, provided under Part III of the National Assistance Act 1948, and statistics do not separately identify those residents suffering from mental illness. All local authorities in England make some provision for the residential care of elderly people, and it is likely that some proportion of residents will suffer a form of mental illness.