§ Ms JowellTo ask the Secretary of State for Health when the review by the clinical standards advisory group of standards of care for people with schizophrenia will be published. [30191]
§ Ms JowellTo ask the Secretary of State for Health how many patients fell within the remit of the Mental Health Act Commission for each year since 1990. [30179]
§ Mr. BowisInformation is not available in the form requested. The number of formal admissions to national health service facilities, private mental nursing homes and the three special hospitals is published in the bulletin "In-Patients Formally Detained in Hospitals under The Mental Health Act 1983 and Other Legislation, England: 1987–88 to 1992–93", copies of which are available in the Library.
§ Ms JowellTo ask the Secretary of State for Health if she will list, for the last five years, the total numbers of medical practitioners in England currently approved under section 12(2) of the Mental Health Act 1983 as having special skill and experience in the diagnosis and treatment of mental disorder, listing them, in England, by regional health authority area and distinguishing between general medical practitioners who are approved and specialist medical practitioners who are approved. [30181]
§ Mr. BowisI refer the hon. Member to the reply that I gave to the hon. Member for Newcastle upon Tyne, East (Mr. Brown) on 19 June at column45.
§ Ms JowellTo ask the Secretary of State for Health if she will list the total number of patients admitted to hospital under sections 3, 37 and 37 to 41 of the Mental Health Act 1983, distinguishing between each of those sections and the classification of mental disorder from which the patient was judged to be suffering in each of the last five years. [30183]
§ Mr. BowisInformation on the number of patients is not available centrally. Information on the number of formal admissions under sections 3 and 37, with section 41 restrictions, and section 37 without section 41 restrictions, of the Mental Health Act 1983, distinguishing between each of those sections and the classification of mental disorder for the years 1990–91 to 1992–93 is shown in the table. Figures for the last two years are not yet available.
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Formal admissions to NHS facilities, private homes and special hospitals under the mental health act 1988 and other legislation by legal status, England 1990–91 to 1992–93 Mental Category1 MI PD MIMP SMIMP NS 1990–91 Section 3 4,074 32 41 15 39 Section 37 (with section 41 restriction) 228 23 24 0 6 Section 37 (without section 41 restriction) 612 17 26 5 13 1991–92 Section 3 5,505 35 51 18 44 Section 37 (with section 41 restriction) 270 26 23 1 1 Section 37 (without section 41 restriction) 574 13 46 3 6
Formal admissions to NHS facilities, private homes and special hospitals under the mental health act 1988 and other legislation by legal status, England 1990–91 to 1992–93 Mental Category1 MI PD MIMP MIMP NS 1992–93 Section 3 6,148 39 78 24 41 Section 37 (with section 41 restriction) 300 27 11 0 5 Section 37 (without section 41 restriction) 580 12 31 2 0 1 MI—Mental Illness MI—Mental Illness
PD—Psychopathic disorder
MIMP—Mental impairment
SMIMP—Severe mental impairment
NS—Not specified
§ Ms JowellTo ask the Secretary of State for Health what comments have been received by her Department on its draft "Guide to Arrangements for Inter-Agency Working for the Care and Protection of Severely Mentally Ill People" with particular reference to the after-care form contained in it; and when the guide will be published. [30185]
§ Mr. BowisWe have received a number of comments in response to our wide consultation on the draft "Guide to Arrangements for Inter-Agency Working for the Care and Protection of Severely Mentally Ill People". The guide will be published later this year.
We consulted separately on the after-care form before its introduction in February. More than 100 agencies and individuals responded and the form was broadly welcomed.
§ Ms JowellTo ask the Secretary of State for Health what has been the cost of the Mental Health Act Commission for each of the last five financial years; and what is its projected cost for 1995–96 and 1996–97. [30187]
§ Mr. BowisPast and projected expenditure on commissioners' fees and expenses and staffing and administration is as follows:
Financial year £000 1990–91 1,264 1991–92 1,485 1992–93 1,546 1993–94 1,730 1994–95 11,728 1995–96 21,960 1996–97 21,988 1 Provisional. 2 Projected. Equivalent information about expenditure on fees, expenses, and training of those appointed by the commission under sections 57 and 58 of the Mental Health Act 1983 to give second opinions about treatment is as follows:
564W
Financial Year £000 1990–91 424 1991–92 490 1992–93 598 1993–94 587
Financial Year £000 1994–95 1724 1995–96 2725 1996–97 2749 1 Provisional. 2 Projected.
§ Ms JowellTo ask the Secretary of State for Health what steps she has taken to consider the contents and recommendations of the Law Commission's report No. 231 on mental incapacity; and if she will make a statement. [30189]
§ Mr. BowisThe Department is represented on the inter-departmental working group, chaired by the Lord Chancellor's Department, which is considering the Law Commission's report.
§ Ms JowellTo ask the Secretary of State for Health what arrangements her Department has made since August 1993 to provide better training for key workers under the care programme approach, including on the revised Mental Health Act code of practice and on new guidance on discharge from hospital, including what additional resources it has made available for such training, and an estimate of the numbers of staff trained as a result. [30193]
§ Mr. BowisTraining for key workers on all appropriate issues under the care programme approach is primarily a matter for national health service provider units and social services departments and a wide range of local training is under way or planned. To support this process we have arranged a number of national conferences to improve training with further national and regional conferences planned; commissioned the Open university to develop an open learning pack for social services staff; and commissioned a development pack for local health and social services authorities which incorporates the outcome of a national key worker training conference.
Information on the number of staff trained is not available centrally.
§ Ms JowellTo ask the Secretary of State for Health if she will list for the last five years the total number of patients who have been received into guardianship under sections 7 or 37 of the Mental Health Act 1983 listing them by social services authority and distinguishing between different classifications of mental disorder and between sections 7 and 37. [30190]
§ Mr. BowisThe centrally available information on the number of new cases by local authority, classification of mental disorder and section for the years 1989–90 to 1993–94 will be placed in the Library. An England summary of the data was published in "Guardianship under the Mental Health Act (1983) Year Ending 31 March 1994, England", copies of which are available in the Library.
§ Ms JowellTo ask the Secretary of State for Health what arrangements her Department has made to provide improved training to doctors approved under section 12(2) of the Mental Health Act 1983 including on the revised Mental Health code of practice, on the new guidance on discharge from hospital and on supervision registers, including the additional resources it has made available for such training; and what is her estimate of the numbers of doctors trained as a result. [30192]
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§ Mr. BowisRegional directors of public health are responsible, in association with professional and other bodies, for ensuring that suitable training is provided to doctors approved under section 12 of the Act. We have already recognised the potential value of a common core of training which would include the matters identified by the hon. Member and have been discussing with the Royal College of Psychiatrists the preparation of a training pack for this purpose. We expect to receive the college's detailed proposals shortly.
§ Ms JowellTo ask the Secretary of State for Health, what arrangements exist to monitor and evaluate strict compliance by district health authorities, NHS trusts and local social services authorities with the requirements of HC(90)23/LASSL(90)11; how many district health authority areas she has assessed being fully complied with this guidance; and what steps her Department is taking to ensure compliance with the necessary arrangements in those remaining. [30178]
§ Mr. BowisWe have been closely monitoring the introduction of the care programme approach in a survey of district health authorities earlier this year. From those responding it was clear that many districts were making rapid progress towards full implementation and over one third had already achieved this. We identified implementation of the care programme approach as a priority for the national health service in the priorities and planning guidance for 1995–96 and we have issued a revised "The Health of the Nation" mental illness key area handbook which contains further advice on implementing it. We have also commissioned an audit tool from the Royal College of Psychiatrists' research unit to enable district health authorities and trusts to monitor their performance. We are continuing to monitor the position closely to ensure that all districts achieve full implementation.
§ Ms JowellTo ask the Secretary of State for Health what research her Department is undertaking or funding into the impact and effectiveness of the Mental Health Act code of practice on decision making by those with powers under the Mental Health Act 1983, with particular reference to the effect of the revisions made to the code in November 1993 on the use of those powers to admit and detain patients in hospital for assessment or for treatment. [30180]
§ Mr. BowisNone at present. We have given wide publicity to the 1993 revisions to the code clarifying the grounds on which a patient may be admitted to hospital under the Act, and have no reason to believe that they are not properly understood.
§ Ms JowellTo ask the Secretary of State for Health on how many occasions she has been requested by the Mental Health Act Commission in accordance with section 121(4) of the Mental Health Act 1983 to direct it to keep under review the care and treatment of any patients other than those detained under the Act to which patients the requests related; and how she responded. [30182]
§ Mr. BowisThe Commission made a request in 1986 for its remit to be extended to hospital patients other than those detained under the Mental Health Act 1983. Similar requests have been made with regard to patients subject to guardianship and those who would be receiving after-care under supervision. We have told the commission that we566W consider its overriding priority to be the protection of patients detained under the 1983 Act. This remains our view and we do not consider that an extension of its remit would be justified at this stage. We shall however keep this matter under review.
§ Ms JowellTo ask the Secretary of State for Health what plans she has to amend the Mental Health Act code of practice; and when draft revisions will be published for consultation. [30184]
§ Mr. BowisWe shall be proposing amendments to the code to cover the provisions of the Mental Health (Patients in the Community) Bill, if this receives parliamentary approval. They will be published for consultation after Royal Assent and when the necessary regulations have been laid.
§ Ms JowellTo ask the Secretary of State for Health what theoretical and practical training is received by general medical practitioners as part of their general syllabus in assessing the risk of harm which a person's mental disorder may pose to that person's health or safety or to the safety of others. [30186]
§ Mr. MaloneTraining in psychiatry is an important part of the basic medical education common to all doctors. The body responsible for general practice vocational training—the joint committee on postgraduate training for general practice—expects general practitioners to be knowledgeable about the impact of psychological factors upon illness and of illness upon patients and their families and skilled in recognising and making appropriate decisions about all problems presented by their patients. The specific curricular arrangements are the responsibility of regional postgraduate organisations. Further training and experience are provided as part of the continuing education of practitioners.
§ Ms JowellTo ask the Secretary of State for Health if she will list the organisations and individuals which have made representations to her Department during the last two years requesting her to establish a review of the Mental Health Act 1983. [30188]
§ Mr. BowisThe Mental Health Act Commission submitted proposals for a review of the Mental Health Act 1983 to my right hon. Friend in September 1993. This was followed by a joint representation by the commission, the Law Society and the Institute of Psychiatry. In her response, my right hon. Friend said that while the Act as a whole would need to be reviewed at some stage this would have to take account of the impact of the Government's proposals for supervised discharge and related initiatives in the field of mental health.
Arguments for a review of the Act have been put forward by a number of other organisations and individuals including some of those who responded to our consultation on legal powers on the care of mentally ill people in the community and on Mental Health Act guardianship.
§ Ms JowellTo ask the Secretary of State for Health, what arrangements exist to monitor and evaluate compliance by district health authorities and NHS trusts with the requirements of HSG(94)5; how many district health authority areas she has assessed as having fully and sufficiently implemented this guidance; and what steps her Department is taking to ensure that those remaining introduce the necessary arrangements. [30194]
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§ Mr. BowisThe introduction of supervision registers has been closely monitored by the national health service executive. Registers have been established in all districts. We are continuing to monitor the position to ensure that the registers are operating effectively.
§ Mr. Nicholas BrownTo ask the Secretary of State for Health how many general practitioners there are in each region approved under section 12 of the Mental Health Act 1983; and what steps are taken to ensure that a section 12 approved doctor can be contacted in an emergency. [31050]
§ Mr. BowisRegional directors of public health are responsible for ensuring that there are sufficient suitably trained and experienced doctors approved under the Act, and that the necessary out-of-hours cover is available. We are satisfied that these requirements are being properly met.