§ Mr. PaiceTo ask the Secretary of State for Health if he will make a statement on the joint Department of Health and Home Office review of health and social services for mentally disordered offenders.
§ Mr. DorrellI announced the establishment of the joint review in my reply on 19 December 1990 to my hon. Friend the Member for Bury, North (Mr. Burt) at columns244–45. A steering committee was appointed under the chairmanship of Dr. John Reed, senior principal medical officer, Department of Health. It met first on 31 January 1991 and I am pleased to report that it has made substantial progress.
We are today publishing four consultation documents submitted by the steering committee. Copies are available in the Library. These are the reports of three advisory groups that have been examining services provided in the community, in hospitals and in prisons, and an overview by the steering committee itself. We are issuing them to a wide range of interested bodies with an invitation to comment by 31 January 1992.
Between them, the advisory groups have made 87 recommendations aimed at improving the delivery and co-ordination of care and treatment for mentally disordered offenders. They provide advice on the level and range of health and social services provision that may be needed, as well as the mechanisms required to identify and assess the needs of those who should be diverted from the criminal justice system to more suitable settings. A number of recommendations for the mental health care of prisoners are consistent with proposals in the White Paper on the prison service, "Custody, Care and Justice", Cm. 1647, and the current consultation paper on contracting for prison health services.
The steering committee has set up three further advisory groups which are now beginning work. These are concerned with finance, staffing and training, and research issues. They are due to report in the spring of next year. Work is also being undertaken on performance measurement and quality control, and services for patients with special needs.
The present reports reinforce the Government's policy that mentally disordered offenders who need care and treatment should receive it from the health and personal social services rather than being dealt with in the criminal justice system. They propose also a set of guiding principles for future service provision which we endorse. These are that patients should be cared for with regard to the quality of care and proper attention to the needs of individuals; as far as possible, in the community, rather than in institutional settings; under conditions of no
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NHS staff in post at 30 September 1990 England by regions1 2 Whole-time equivalents3 Regions Total Male Percentage male Female Percentage female Northern 53,000 13,300 25.1 39,700 74.9 Yorkshire 58,500 14,600 25.0 43,800 75.0 Trent 75,700 17,400 23.0 58,300 77.0 East Anglian 31,700 7,800 24.5 23,900 75.5 North West Thames 51,600 12,200 23.5 39,500 76.5 North East Thames 67,600 16,800 24.8 50,800 75.2 South East Thames 61,200 15,200 24.9 46,000 75.1 South West Thames 42,900 11,000 25.6 31,900 74.4 Wessex 44,500 9,900 22.2 34,600 77.8 greater security than is justified by the degree of danger they present to themselves or others; in such a way as to maximise their rehabilitation and chances of sustaining an independent life; as near as possible to their own homes or families, if they have them.
I have already indicated that we do not want necessary action to be delayed merely because the review is in progress. We are considering the present recommendations to identify those which could be implemented at an early date. The steering committee has proposed an initial action plan whose main elements are the improvement of inter-agency arrangements for joint working at both planning and operational level; local assessments of service need, including assessments in each NHS region before the end of the review of needs for local and medium secure hospital provision; the continued protection of existing NHS services for mentally disordered offenders, including those for people with certain special needs, pending consideration by the review of arrangements for purchasing services; to build on the positive response of agencies in the health, social and criminal justice services to Home Office circular 66/90 and to the review itself, and to review good practice guidance in the light of the advisory group reports.
We endorse the direction set by these proposals and will be taking action to follow them up so far as it lies within our direct responsibility. Final decisions will need to take account of the further work initiated by the steering committee and of responses to the present consultation exercise.
My right hon. and hon. Friends and I are committed to maintaining the close co-operation which has developed between our Departments through the review. We are very grateful to Dr. Reed and his colleagues, and others who have contributed to the advisory groups, for their work so far.
Existing NHS services for mentally disordered offenders are subject to NHS management executive letter (90) 190 which directs health authorities to maintain at least the present level of service until December 1991. This guidance is being extended until March 1993 in order to ensure that future planning of these services takes place against a reasonably stable background.