Mental Handicap and Mental Illness Hospitals (Hansard, 21 July 1988)

§ Mr. Michael Forsyth

I congratulate health boards on making considerable improvements in recent years in the staffing of mental handicap and mental illness hospitals. Between 1979 and 1987 the number of nursing staff increased by 25 per cent. in both mental handicap and mental illness hospitals. Within those figures the number of qualified nurses increased even more—by 36 per cent. in mental handicap hospitals and 32 per cent. in mental illness hospitals. At the same time the number of patients being cared for in the hospitals decreased by 16 per cent.—some 3,400 people—in accordance with the Government's policy that, whenever possible and appropriate to the needs of the person concerned, support should be provided in the community in preference to admission to hospital or continued residence in hospital.

Despite these improvements in the ratio of nurses to patients, my right hon. and learned Friend has, however, been concerned to note some continued criticism of staffing standards, and has therefore considered available evidence on ways of assessing staffing requirements. Some work on this has been carried out in the mental handicap field. In 1985 the Scottish Home and Health Department recommended to health boards that, until such time as a more appropriate system had been devised for assessing nurse staffing requirements generally, they should use the Telford consultative approach to assess, for planning purposes, the nurse staffing requirements in mental handicap hospitals. I have placed in the Library of the House a report of the results of that exercise.

This shows that in 1986 there was a gap between the number of staff in posts and the estimated number of staff required following the application of the Telford approach. By February this year, however, the ratio of staff to patients had improved both because of the increase in the number of staff, and because of the decrease in the number of patients. It is not possible to judge what the estimated nursing requirement would now be, in terms of the Telford approach, because the results depend on a judgment on the nursing needs of individual patients which are of course likely to have changed since 1986, and because the estimated requirement may have been affected by other changes in staffing and working practices.

The Telford approach was used as a first step towards estimating nursing requirements. There is a need for further study of other methods, and for a review of all approaches currently available in the field of mental illness. In these two fields of mental handicap and mental illness it is also important to take account of the contribution of other professions such as occupational therapists, psychologists and social workers, and to consider multi-disciplinary ways of assessing staffing requirements. I have therefore asked the Scottish Home and Health Department to set further work in hand on other available methods, with a view to giving health boards further guidance in due course.

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Meantime I commend the report of the Telford exercise to health boards for use as an interim local planning tool in relation to their mental handicap hospitals. They will wish to look closely at the staffing levels in those hospitals where the 1986 exercise showed the largest gaps between staff in post and estimated requirement. They will also wish to inquire further where the reports shows major variation between one hospital and another. In many cases they will be able to point to improvements in the ratio of staff to patients since 1986 but they will wish to consider the extent to which they can make further improvements within the resources available to them.

Finally, I am concerned that the figures collected in February this year show that the funded establishment for qualified nurses in the 16 mental handicap hospitals studied was 7 per cent. higher than the number in post. This suggests that health boards are finding difficulty in recruiting sufficient numbers of qualified mental handicap nurses, although they are largely able to fill the vacancies with nursing assistants. The Scottish Home and Health Department has recently discussed with boards target figures for intakes to all branches of nurse training. I am glad to say that these discussions showed general recognition that increased recruitment to both mental illness and mental handicap training was required.