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Ms. Hilary Armstrong (Durham, North-West) : The Government say that they have not yet responded to Griffiths because they are considering the whole range of responses and want to consider them all carefully. Why, therefore, have the Government not held a debate so that hon. Members could give their responses to Griffiths, which could also be considered by the Government?

Mr. Freeman : We are having a debate on Griffiths today.

Ms. Armstrong : But in our time.

Mr. Freeman : I have already said that when the Government respond to the Griffiths report there will, at a suitable time, be a debate in Government time.

Mr. Tim Devlin (Stockton, South) : Will my hon. Friend remind hon. Members how many debates we have had on the subject in the last two years?

Mr. Freeman : I have already said that this is the third debate within six months.

The hon. Member for Livingston implied that the Treasury was cutting the resources that are made available to local authorities. He should know that personal social services are provided through the local authority. Expenditure in real terms on personal social services increased by 25 per cent. between 1980 and 1989. The provision for personal social services in 1989-90 has increased by 10 per cent. in cash terms. National Health Service provision for community heath services, such as district nurses, health visitors, chiropody, occupational therapy and community psychiatric nurses increased by 27 per cent. in real terms between 1979-80 and 1986-87. There has been real growth in the amount of resources devoted to community health services. Income support for the elderly in residential and nursing homes has increased substantially, to approximately £1 billion of taxpayers' money.

Mr. Tony Worthington (Clydebank and Milngavie) : Unlike many of my colleagues, I think that the Government have responded to the Griffiths report. They have done so by setting up a structure in "Working for Patients" that makes community care very difficult indeed.

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The assumption is that most health care is of the "wheel them in horizontal and wheel them out vertical" kind, rather than of a continuing nature, which is what is required by many patients. Is the Minister able to say how many times mental health is mentioned in "Working for Patients"?

Mr. Freeman : I hope that I have made it plain that "Working for Patients" was directed at reforms in primary care and the hospital service and that we shall be responding shortly as to community care for the mentally ill, handicapped and elderly. The district health authorities will be responsible for ensuring that there is a complete range of provision for all those patients.

Turning to mental illness, the hon. Member for Livingston was perfectly fair on the House, and I agree with him, about the rundown in the number of beds in mental hospitals. Between 1977 and 1987, patient numbers have reduced from some 84,000 to some 60,000--a reduction of about 24,000. Over the same 10 years, local authorities and the Health Service have provided about 11,000 places. Day hospital places have increased by 5,000 to 18,000, residential places have increased by 4,000 to 9,000 and places at day centres have increased by 2,000 to 6,000. Between 1981 and 1986, the number of community psychiatric nurses doubled.

Hon. Members who contribute to the debate will share the hon. Gentleman's concern and mine that in the past there has not been adequate provision for those discharged from large psychiatric hospitals. There is no question about that. However, I must make two points. First, any discharge from a mental institution, in the past, or today, is a clinical decision and is not taken by administrators or politicians. Secondly, some of those patients go home where they are properly cared for. Nevertheless, the hon. Gentleman made a fair point. I agree with him that the provision of facilities in the community is not uniformly adequate and in the past some authorities have discharged patients from mental hospitals without ensuring that there was proper and adequate care. That is one issue that we shall address in our response to Griffiths.

I shall make one final point about hospital closures. At a recent Question Time, my hon. Friend the Member for Macclesfield (Mr. Winterton) asked me a question, and perhaps my answer was not as clear as it should have been. Let me make it quite plain that we have pursued the policy, and shall continue to pursue it with great vigour, of ensuring that a hospital closes only as a consequence of adequate facilities being available in the community and not for financial reasons. I give the House that very clear assurance.

Mr. Chris Mullin (Sunderland, South) : In my constituency there is a large psychiatric hospital from which large numbers of people have been discharged. As any hon. Member in that position will know, one receives a constant stream of complaints from neighbours, relatives, staff who work in the hospital or patients themselves that people are being discharged into the community for financial reasons. The most extreme case that has come to my notice involved three people who were discharged into the community, and two of them committed suicide.

Mr. Freeman : I want to make it quite plain that discharge from psychiatric hospitals is a matter of clinical judgment. It is not for administrators, politicians or

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ministerial judgment. Hospitals will not close for financial reasons. In future, hospitals will close only when we are satisfied that there are adequate facilities in the community. That has been Government policy. I am not announcing or stating new policy, I am simply emphasising existing policy.

Mr. Nicholas Winterton (Macclesfield) : Is my hon. Friend aware that considerable pressure is being brought by managers on consultants to discharge patients because they want to empty the hospital to realise its capital value for development? I hope that my right hon. and learned Friend the Secretary of State for Health and my hon. Friend the Minister--I know that my hon. Friend is deeply committed to the problems of the mentally handicapped, mentally ill and elderly--are aware that great pressure is being brought on consultants which inevitably could affect their clinical decisions.

Mr. Freeman : I do not deny that that pressure exists. Intelligent ways to ensure the release now of the capital value of sites that are under -utilised are already being pursued in the Health Service. Before a hospital is closed, residential facilities must already be in place. I draw my hon. Friend's attention to the practice in the Oxford and East Anglian regions, which have excellent bridging finance schemes, and the practice in Yorkshire--

Ms. Harman : Not enough is done.

Mr. Freeman : The bridging schemes work well in the Oxford and East Anglian regions ; perhaps other regions should learn lessons from them. In Yorkshire, where only part of the mental hospital site which I have in mind is used, there has been an imaginative sale and lease-back of facilities, so that all the present patients are properly cared for in existing facilities but substantial capital is released now to construct new facilities. Other measures which the Government have under consideration must await the response to the Griffiths report.

Mr. Tom Clarke (Monklands, West) : We know of the importance of the timetable as we discussed these matters. I should like to ask the Minister, as we do not have the benefit of hearing from the Secretary of State for Health, about the press reports last week that the famous committee E, which is apparently considering this matter, received evidence. As the Secretary of State is here, perhaps he will take the opportunity to try to catch your eye, Mr. Speaker. I am sure that no one would object. Is it true that the Adam Smith Institute has submitted a paper to that committee and that it will submit a revised paper in two weeks' time?

Mr. Freeman : The newspaper reports are inaccurate.

Ms. Harman : In what respect?

Mr. Freeman : The hon. Member for Monklands, West (Mr. Clarke) asked me whether there was a moratorium on the closure of hospitals. I have told him that those newspaper reports are inaccurate. I have described the Government's policy on mental hospitals. When the hon. Gentleman has a chance to contribute in greater detail, I shall be happy to respond.

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Mrs. Alice Mahon (Halifax) : My hon. Friend the Member for Livingston (Mr. Cook) referred to mentally ill people who are languishing in prison and on remand. Does the hon. Gentleman have plans to monitor how many people who previously had serious psychiatric disorders are in prison? What does he intend to do to ensure that this tragic business stops once and for all?

Mr. Freeman : The Home Office has commissioned a study of all patients in remand centres and long-stay prisons to ascertain how many are suffering from a form of mental illness. As I am sure the hon. Lady knows, the estimates of prisoners who have some form of mental illness range from 3 per cent. to 30 per cent. Undoubtedly, a number of prisoners in the prison service should not be in prisons but should be either in special hospitals or in mental institutions with some form of security. We are working closely with the Home Office to ascertain the numbers and to work out how initially those people can avoid the criminal system and how those who go through it can be moved, with proper security, to mental institutions. We have already laid it down that by 1991 all district health authorities should have comprehensive care programmes for the mentally ill. We shall issue guidelines shortly to those health authorities to show how they should put those care programmes in place and what form they should take. The Royal College of Psychiatrists is drawing up guidelines on standards to assess patients before discharge and to ensure that there is proper follow-up thereafter. I assure the House that, when my right hon. and learned Friend the Secretary of State for Health and his Cabinet colleagues are reaching a conclusion on the Griffiths report, they will cover the important aspect of mental illness.

Mr. Nigel Griffiths : Does the hon. Gentleman realise that comprehensive care programmes and plans are not worth the paper they are written on if they are not backed up by comprehensive funding? Does he realise that the constituents who write to me are caught between the Scylla of seeing their relatives in mental hospitals with declining levels of care and others under increasing pressure as funding becomes tighter and the Charybdis of having their relatives in the community, with cuts in the number of home helps, meals-on-wheels services and in the general level of funding and provision in the community? We want to see some action on finance, not merely vague programmes.

Mr. Freeman : I shall deal with the elderly shortly. I commend the arrangements that Oxford region has put in place to transfer capital and revenue funding from large hospitals that are slowly being run down into proper provision, facilities and staffing in the community for mentally handicapped people. We should like such a model to be applied throughout the Health Service.

Between 1976 and 1986 there was a fall of 15,000 in the number of mentally handicapped patients being cared for in larger institutions. All those patients have returned to the community. Some have returned to their homes, but about 8,000 are using day and residential care facilities. Our closure policy for mental-handicap institutions is the same as that for mental- illness institutions.

Residental or village communities may be part of the new range of facilities that will be built in the future. As long as those village or residential communities for

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mentally handicapped people are not isolated or inward looking, they will have an important role to play. Hon. Members have a duty to explain to our local communities the importance of caring for mentally handicapped people in the community. Too often, we learn of community groups' opposition and of planning permission for the purchase and construction of small homes in the community for mentally handicapped people being contested.

Mr. Worthington : The Minister said that 15,000 fewer people are being catered for in hospitals for the mentally handicapped. The way in which he gave the figure was unintentionally deceptive. Those figures have fallen because, first, local authorities have prevented people from entering hospital, despite their lack of resources, and, secondly, because people are dying in those hospitals. Only a minority are being discharged into the community.

Mr. Freeman : By and large, local authorities have done an extremely good job caring for mentally handicapped people in the community.

Mr. Tony Favell (Stockport) : My hon. Friend said that the community has a responsibility to look after people who are less fortunate, especially mentally handicapped people. My hon. Friend will be interested to learn that recently a survey was held in Stockport of patients who had been discharged from Offerton House hospital. Every one of them said that they would prefer to be in the community rather than to return from whence they came. The local authority and the local community take their responsibility seriously. I am president of Stockport Mencap, and I accept that it has a responsibility to people who are less fortunate.

Mr. Freeman : I pay tribute to Stockport, which is renowned for its care of mentally ill and mentally handicapped people.

Between 1980 and 1986, the Government spent about £11 million on 40 schemes to move 340 children out of long-stay institutional care into the community. That represents a cost of £30,000 per place. I do not begrudge--neither, I am sure, does the hon. Member for Livingston--a penny of that money. They are immensely expensive but immensely valuable schemes. The Government do not want any mentally handicapped children to be looked after in the larger, isolated long-stay institutions. The number of children currently in such institutions is less than 400 and we want that figure to be reduced to nil. We are well aware of the demographic pressures and their effect on care of the elderly. The over-65 population has gone up by some 6.7 per cent. between 1980-87. The number of the very elderly will substantially increase. With regard to the National Health Service, it is important that we do not keep the elderly who are medically cured in hospital beds for longer than necessary. They consume a lot of medical and nursing care and, once medically cured, many of them prefer to be back in their homes or in the community under some form of rehabilitation care.

The elderly have benefited enormously from the NHS. Some 40,000 hip replacements are now performed each year compared with some 5,000 undertaken 20 years ago. Such operations bring great relief to a number of elderly people.

The hon. Member for Edinburgh, South asked me about assistance in the home. There has been a significant

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expansion in such assistance between 1980-87 and in real terms home help expenditure has gone up by 28 per cent., meals- on-wheels expenditure by--

Ms. Harman : What about resourcing?

Mr. Freeman : If the hon. Lady will permit, I will come to resourcing in a moment.

Expenditure on meals-on-wheels has gone up by 11 per cent., on nursing care by 14 per cent. and day centre expenditure is up by 16 per cent. In our review of Griffiths, we are tackling the issue of how to spend taxpayers' money wisely and efficiently. As I have already said, we spend £1 billion through income support on care for the elderly in residential and nursing homes. Clearly, it is right for the majority of those elderly people to be in such homes, but we are considering how care can also be given in the home to ensure that elderly people remain in their homes for as long as possible.

Mr. Ieuan Wyn Jones (Ynys Mo n) : Perhaps I could tempt the Minister into giving us some idea of the Government's thinking on this issue. Is he suggesting that the Government have shifted the emphasis away from ploughing money into providing care in residential and nursing homes back towards care in the community? Will the Government's response to Griffiths be the provision of resources for people in their own homes--the Minister has already said that 25 per cent. of such cases could be cared for in their own homes if they were provided with resources. Is the Minister saying that the inevitable additional resources will be given to a public body, either the local authority or the district health authority, or will they be given to the local authorities to buy in care from private or voluntary concerns?

Mr. Freeman : The hon. Gentleman is trying to tempt me into foreshadowing our response to Griffiths. I have noted what he has said and, if he can be patient, I am sure that he will be able to contribute to the debate on Griffiths that will come in Government time.

It is important to consider the role of the family and the private and voluntary sectors in giving support to those living in the community. We have no philosophical objections, unlike, I suspect, the hon. Member for Livingston (Mr. Cook) to the private sector providing care for the mentally ill and the mentally handicapped. Over the past few years, some local authorities have pioneered the private sector care of such people under the quality control of the NHS and themselves. So long as there is a proper contract and proper quality control, we want to see such care expanded.

Care in residential and nursing homes is provided largely by the private sector, although local authorities and the NHS play an important role. Lady Wagner made some important recommendations about residential care in her report. We have started a three-year programme to improve quality. We are looking at projects that encourage better contacts with the local community, better information about what is offered, training for care staff and a complaints procedure. We are taking Lady Wagner's other recommendations as part and parcel of our overall review of care in the community. I shall make a statement about some of her other recommendations shortly.

In 1988, we increased the fees for registration and inspection to help local authorities to inspect. We have laid down a minimum inspection rate of two a year. As I have

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said, we need to consider the other matters that fall to central Government, although many of the recommendations in the Wagner report were for local authorities and there is no reason for them to delay in implementing the recommendations that were addressed to them. This Government believe that the voluntary sector has a vital role to play. The Department of Health contributes £36 million a year to voluntary organisations, much of it to those involved in care. Districts and regions provide £25 million a year locally. I pay tribute to the work of the voluntary sector whch is so vital, especially for the carers. As the House will know, we launched the "Helping the Community to Care" initiative with about £10 million of funding and a separate initiative, "Care in the Community", which has evaluated about 28 pilot projects, including one in Bolton for the care of those coming out of institutions for the mentally handicapped, as my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) will know. We have funded the voluntary sector, which has a vital role to play.

I want to deal with the role of family and friends. It is important that we do not seek, as Members of Parliament or members of society, to shuffle off wholly to the state responsibility for caring for those in the community. Families, siblings and friends have an important role to play. They must be involved and we all have a responsibility. It is true that we are a more fragmented society. Children live much further from their parents than they did 20, 30 or 40 years ago. It is most important that family and friends retain and build on their responsibility to care for relatives when they come out of institutions.

Mr. Dennis Turner (Wolverhampton, South-East) : The Minister talked about fragmentation. The Government have it in their hands to resolve that and that is the essence of this debate. The Minister talked about the voluntary sector and the service it provides. Yet there is a crisis of resources in the voluntary sector at present. The Government are not facing up to that. How can the Minister tell us that he is responding positively to the needs of the voluntary sector when the Government are reducing the amount of income for the voluntary sector to meet the needs of the mentally handicapped, the mentally ill, the homeless and those in despair? We know that the Government are not doing that and that is why we are having this debate today.

Mr. Freeman : The hon. Gentleman is misinformed about the voluntary sector. The total income of voluntary organisations has risen substantially and the level of support provided by this Government has also increased.

Care in the community is a vitally important subject. It touches the lives of most of us through our relatives and friends. It is the mark of a civilised society that we provide high quality care in community. The Government take that seriously and we shall bring proposals forward shortly. I commend the amendment to the motion. 4.42 pm

Mr. Andrew Smith (Oxford, East) : I welcome the opportunity to take part in this debate, which addresses the most important social challenge facing us for the next 50 years. I do not envy the task of the Under- Secretary of State who has been put up this afternoon to defend the

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indefensible. Although one can agree with what he said generally about the need for humane treatment for mentally ill people and for support for elderly people who want to remain in their homes, it was all rhetoric. His lofty sentiments were not backed up by one jot of a concrete proposal for action to address the needs of people who are suffering now and who have been suffering during the long period during which the Government have scandalously not responded to the Griffiths report.

I remind the House that the report is subtitled "Agenda for Action". For the Government, it has been nothing more than an agenda for prevarication. We are at last promised a statement and a debate on the matter before the recess. I ask the Minister whether that statement will set out in full and practical terms how care in the community is to be delivered in line with the Griffiths report, or whether it will be a holding statement which merely promises a White Paper later in the year after more months of delay and prevarication. I shall gladly give way to the Minister if he wants to answer the question. Shall we have a definitive statement before the recess, or will the White Paper come later? Evidently the Minister does not want to take this opportunity to answer that question. I strongly advise him to do so by the end of the debate, because millions of people cannot afford to wait any longer for the answer.

When the Government make their statement, I hope that they will take full account of the extensive consideration of the matter by voluntary associations, professional bodies, the trade unions, local authorities and the Select Committee on Social Services. Policy on this matter is far too important and too long-lasting in its implications and inevitably involves too many parties in delivery to be tackled successfully on a blinkered or partisan basis. The framework for community care must command sufficient general support to be administered and developed by Governments and local authorities of different political persuasions. The vulnerable people whose needs the policy must address deserve better than the political shuttlecock treatment. The overriding objective must be to place their needs and preferences at the centre of the system ; to that end, the key problems that must be addressed are clear.

First, the range of community care options and services is such that there is an enormous premium on effective co-ordination, which does not exist at present and which can clearly be delivered only by local authorities working under a comprehensive and coherent policy, organised centrally through Government, with people of sufficient standing in the Cabinet sufficiently committed to making of a success of it for us to know that resources will be available to enable the local authorities and other carers to do the job.

Secondly, this is an area of policy where services must be demand led. We must not have a system in which people's needs are perpetually bashed against cash ceilings which bear no relation to the real level of need and the cost of delivering services. Thirdly, we are considering people who, inevitably, are dependent to some degree or other. It is all the more important that they have a degree of choice open to them and a meaningful voice in the way in which services are delivered. Fourthly, that applies very much to the carers in families, as it does to those for whom they care. In the limited time available, I want to concentrate on the implications for local authorities and resourcing and

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the implications of that for choice. The present financing of community care is chaotic to the point of imminent breakdown. Oxfordshire illustrates that well. I was interested that the Under-Secretary of state should praise the Oxford region bridging scheme. If the situation in Oxfordshire is good, I dread to think what it is like in the rest of the country. If things are so marvellous in Oxfordshire and if there is bridging finance, why was Oxfordshire faced with the imminent closure of a hospital for the mentally handicapped, which had been known about for a year in advance?

Why was I in the district health authority manager's office, one week before the closure was due to take place, with tearful and angry parents, who still did not know where their mentally handicapped son was going to go? If it had not been for my intervention, what would have happened to that young man? That story of personal tragedy is repeated thousands of times throughout the country as a result of the inadequacy of the way in which the system works at present. The position on costs and the finance available for meeting them is no better in relation to residential care. A survey undertaken by Oxfordshire Welfare Rights of local residential care homes and nursing homes showed, on a 69 per cent. response rate, that more than 200 elderly residents in Oxfordshire had to contend with a gap between the cost of home care charges and what they received in income support, with an average shortfall being made up either by the elderly person, who was often exhausting his or her savings, or by relatives. I am sure that I am not the only hon. Member to have received heart-breaking letters from people who can no longer meet the difference and make up the shortfall in the cost of their relatives' care. Some of those letters come from people who are themselves elderly and who are trying to find the money out of their pension or inadequate income.

In the other half of cases in the survey, people could not make up the shortfall at all, and were being subsidised either by the homes or by the other residents. How did homes respond to that state of affairs? The survey quoted the remarks of representatives of two private residential and nursing homes. One said :

"We are not now accepting any DHSS funded residents unless the top-up is made. Existing residents we are still caring for, but as you can see at great cost. The private sector cannot continue to sustain these losses."

The second home said :

"Moved two back to hospital"--

that is not to say that the residents needed on medical grounds to go back to hospital ; they were merely moved back to hospital-- "rest are in the nursing home by our generosity but it is jeopardising the business."

I am sure that hon. Members--especially those who represent southern constituencies--will be no strangers to this alarming state of affairs.

Ms. Armstrong : It is the same everywhere.

Mr. Smith : My hon. Friend tells me that the problem is equally bad in other parts of the country. We cannot allow it to continue. The Minister rightly said that those who stay in their own homes need support if they are to remain as independent as possible. Clearly, they need a much better co-ordinated policy on domiciliary support services. At present, the rhetoric has it that independent elderly people are receiving support in their own homes, but in reality

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many of those people have been dumped and neglected. They are isolated and alone and do not receive the support they need. If they are to receive that support, and if local authorities are to be able to undertake the key co-ordinating role that Griffiths prescribed for them, we shall need nothing short of a revolution in the organisation of local authority finances.

In Oxfordshire, the cost of upgrading old people's homes to the standard that the authority requires the private sector to maintain and of providing effective community care services for elderly people alone would require an additional £7 million revenue over the next five years, while the capital costs would run up to £17 million gross. Those are not extravagant sums in relation to the needs to be met, but we have to remember that, in common with other authorities, Oxfordshire faces severe restrictions on its revenue budgets and the massacre of its capital programme as a result of reductions in capital receipts and the changes in the rules for capital financing under the Local Government Finance Act 1988.

While the Department of Health says that it is actively promoting care in the community and is attempting to push people out of long-stay institutions and hospitals--a fact to which the hon. Member for Macclesfield (Mr. Winterton) referred--we have an unco-ordinated, exploding but inadequate Department of Social Security budget and the cuts and restrictions imposed by the Department of the Environment make it quite impossible for local authorities to pick up the pieces.

That illustrates two great dangers of the Griffiths recommendations, especially in the hands of this Government. First, it would be disastrous if local authorities were given the prime responsibility for community care while at the same time being denied the powers or resources to meet those responsibilities. Secondly, if the Government specify that local authorities should not, in the main, be the deliverers of care but merely the planning and contracting agents for the voluntary and private sectors, those in need of care will be denied an important degree of choice, and those planning the provision will be denied the most direct means of ensuring that needs can be met at the quality standard that the community rightly expects. Everyone knows what a disaster the contracting out of hospital cleaning, for example, has been, and we do not want the same to happen to domiciliary services.

As many of us have said throughout, care in the community is not a cheap option. If it is to work at all satisfactorily, it requires a large injection of resources, as well as the very best and most efficient management of those resources. That cannot be achieved through any private insurance scheme proposed by the Adam Smith Institute, any more than such schemes can act as a substitute for the National Health Service.

We are talking about a common public obligation which must be met by all contributing to the cost in proportion to their means and receiving care in proportion to their needs. I believe that that is what the public wants.

As we bring such a system into operation, let us remember that we have a terrific commitment to caring for other people--in the local authorities, health authorities, social service departments, home help service, council housing departments, housing associations and voluntary associations and among private providers, as well as within families. People go into such jobs because they want to help other people and spread a bit of human happiness.

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Let us--and let the Government--harness that energy and commitment to caring so that people's eyes can be lifted from the demoralisation of knowing that they cannot give of their best because they do not have the wherewithal to do so. Let us set our sights on a civilised society in which carers have the resources and support necessary to do their job and in which all those in need of community care can help themselves to some of the dignity that should be everybody's right.

Planned provision, adequately funded and properly co-ordinated, with a variety of client choice in delivery, is the key to success in that endeavour. I hope that those aims will command the support of the whole House and that the Government will take notice. If they do not, millions in need of care will pay a terrible price in the years to come.

4.58 pm

Mr. Nicholas Winterton (Macclesfield) : I am pleased to be able to make a brief contribution to this very important debate. First, let me make it clear to my hon. Friend the Minister that I think that it is a great pity that the Government did not make a statement on the Griffiths report before they issued the White Paper "Working for Patients" because the two go so closely together. It is difficult to make a proper assessment and analysis of the many radical proposals in the White Paper without knowing precisely where the Government stand in relation to the Griffiths report.

We are dealing with three main categories of people--the mentally ill, the mentally handicapped and the elderly and infirm who require some form of special care or accommodation. I intend to direct my remarks mainly to the care of the mentally ill. I know that my hon. Friend the Minister is aware of my deep concern for and interest in that matter. It is appropriate to look after most of those who suffer from mental handicap through care in the community--that is desirable, humane and compassionate. There is one caveat, however, and it is that when people with mental handicap also suffer from mental illness, some of them should be looked after in long- stay hospitals because of the complexity of their condition.

In respect of the elderly, the infirm, and those requiring special accommodation or care in the community, and not in an institution or a hospital, it would be wrong to put all our eggs into the one basket of private provision. I served on a county council which had responsibility for social services and the provision of part III accommodation. Since I entered Parliament 18 years ago, I have taken a great interest in that subject and have regularly visited all the part III homes in my constituency and virtually all the private and independent homes--some of which I opened with great pleasure. It would be wrong and very damaging to put all our eggs into one basket and hand over the care of the elderly to the private sector. Indeed, from the representations from people operating wonderful caring homes in the independent sector, I do not think that even the private sector wants that.

My main concern is for the mentally ill. I generally support the policy of care in the community. However, unlike a number of people in my hon. Friend's Department, and unlike organisations such as MIND, my long interest and service in this area make me believe that there is a permanent need for long-stay hospital places for

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many mentally ill people, especially those suffering from schizophrenia. It is a tragedy that for purely commercial reasons some magnificent hospitals are being closed and their sites redeveloped. Part of the treatment of the mentally ill is the environment in which they live--the refuge and the asylum aspects of hospital care. Again, speaking from some knowledge, I know that although some of the hospitals for the mentally ill may be the Victorian institutions that some have described, built when buildings were intended to last virtually for ever, many can be altered, upgraded, rehabilitated and turned into the most attractive accommodation for the modern care of the mentally ill. Those hospitals are often sited in wonderful parkland, woodland and gardens.

I was a member of the Select Committee on Social Services which carried out an in-depth and very lengthy inquiry into care in the community for the mentally ill and mentally handicapped. Many of those who treat them believe that their environment--that refuge, asylum, quiet and tranquility--is part of the treatment and care that they require. I view with deep concern the rapid closure of those hospitals, with the patients being discharged into the community and often inadequately catered for in accommodation or in the number of skilled and qualified personnel available to look after them. As the hon. Member for Livingston (Mr. Cook) said, it is tragic that hundreds of mentally ill people frequently end up in prisons. Some hon. Members may ask how I know that. It is because as a member of the Select Committee, having completed and reported on our inquiry into care in the community for the mentally ill and mentally handicapped, we carried out an inquiry into the prison medical service. We visited at least 20 prisons in Scotland, England and Northern Ireland, where we came across many dozens of prisoners who should never have been there ; more appropriately, they should have been receiving treatment and care in a mental hospital. When discharged into the community they had committed minor offences, although some were, perhaps, a little more serious. They had not done so intentionally, but because of their mental condition. When they appeared before the courts either the hospitals were not prepared to take them back or there was no hospital place available, so they were put into prisons. That is a tragedy not only because they are not receiving the care and treatment that they need either to contain their condition or, as one would hope, to make them better, but because their condition is being exacerbated and they are receiving no meaningful treatment.

I am pleased that my hon. Friend the Minister said that his Department was carrying out some form of survey. He was kind enough to allow me to bring a delegation from the National Schizophrenia Fellowship to see him a few weeks ago. I wonder whether he has now had time to consider whether his Department can financially assist Professor Kathleen Jones of York university, who is an expert in that area and is embarking on an inquiry into the whereabouts of a specific number of people who have been discharged from mental illness hospitals.

One of the tragedies of what has happened since we put the policy of care in the community into practice is that those who have been discharged have not been followed up and monitored. I hate to quote yet again the hon. Member for Livingston, but I accept what he said about many of

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those sad people now sleeping in cardboard boxes, on streets not many yards from this Palace of Westminster or under the arches at Waterloo.

Mr. James Couchman (Gillingham) : My hon. Friend and I shared the Select Committee investigation into care in the community. Does he agree that although we saw some appalling examples of

deinstitutionalisation from here to the west coast of America, we also saw some extremely good examples of people who had been discharged into the community being supported in very good circumstances?

I agree with my hon. Friend that there are a number of patients for whom the asylum offers by far the best remedy. Does he agree that we should be seeking a continuum of care from informal accommodation within the community right through to something similar to the existing mental hospitals?

Mr. Winterton : I am happy to agree strongly with my hon. Friend's remarks. When my hon. Friend the Minister responded to the hon. Member for Livingston, he said that he felt that at least two health authorities provided excellent facilities within the community and that those examples should be followed elsewhere. I agree with my hon. Friend the Member for Gillingham (Mr. Couchman) that in America we saw the extremes of absolutely superb facilities in some areas and absolutely grotesque, horrible facilities, of the sort we just would not want to think about, in other areas. We need to strike a balance and achieve a continuum of care.

I hope that my hon. Friend the Under-Secretary will confirm when he winds up that, in the immediate future, the Government will recommend to health authorities not to close or dispose of any additional psychiatric, mental illness hospitals. It is vital that we review the position to see exactly where we stand before we dispose of any more valuable sites.

I know that my hon. Friend would not expect me to sit down without mentioning Parkside hospital in my own constituency. Sad to say, some of the Mersey and Macclesfield regional and district health authorities' senior management appears more interested in realising capital assets than in caring and treating people with mental illness and mental handicap. Parkside hospital, Macclesfield which is renowned for its care of the mentally ill, is not isolated in the middle of some bleak moor. It is in the community, in the heart of Macclesfield and situated in magnificent parkland and gardens which, as I have said, constitute part of the therapy of caring and treating the mentally ill.

The Mersey regional health authority and the Macclesfield district health authority are seeking to dispose of more than 80 per cent. of the site for housing and other development. That would be a rich capital harvest for the health authority, but what of the environment for those still requiring treatment and care for their mental illness? Will any of the gardens, parkland, ayslum or refuge, which are such a valuable part of the treatment and care of the mentally ill, remain? No. All that will go under bricks, concrete, pipes and road. That should not happen.

On behalf of the community I am fighting what is almost a last ditch battle to try to persuade the health authority to rethink. As my hon. Friend the Under-Secretary knows, I invited him to visit Parkside hospital

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and the nearby young persons' unit and am pleased to say that, in principle, he has accepted. I urge him to come before too long if he does not want to see a hospital that has been closed and facilities that are no longer available.

It is vital that the Government realise what is being done in their name up and down the country. I know from the work which I do on the Select Committee on Social Services that Parkside hospital is not an isolated case, and the Under-Secretary should come to Macclesfield as soon as possible. The future welfare of those suffering from mental illness and mental handicap, as well as the elderly requiring specialist accommodation, is at stake and these groups should be able to look to a Government of any political view for the care, humanity and compassion which I believe all hon. Members would wish to give them.

As many of my hon. Friends are aware, I feel deeply about this matter. The lengthy inquiry that we had into care in the community just a few years ago opened my eyes. I went into it with an open mind and I came out realising that we have to do a lot for the elderly and particularly for the mentally ill and handicapped and that we would not serve their future welfare and well-being if, for the wrong reasons, we disposed of valuable hospital sites. Why not bring the community into those hospitals, where necessary? Why not build care and cluster group dwellings for the mentally ill on those sites? One aspect which I am afraid my hon. Friend and, dare I say it, Sir Roy Griffiths do not fully appreciate is that the facilities that exist for the mentally ill and handicapped within their respective hospitals are such that it would be difficult to replicate them within the community. Such facilities include sheltered workshops, hydrotherapy pools and all the specialist facilities that are so important to the well-being and meaningful life of these people. Is it not stupid and crazy that dozens of people from Parkside hospital in Macclesfield have been discharged into the community and are now being collected every day in buses and minivans to be brought back to the hospital? Facilities should have been built within the wonderful grounds and areas surrounding the hospital which are so treasured by the people of Macclesfield. The hospital is a valuable community facility which, by the way, in essence cost the Health Service next to nothing because it was vested in the Health Service when it was formed so superbly in 1948.

I believe that I heard my right hon. and learned Friend the Secretary of State for Health say in an earlier intervention that the Government's pronouncement on the Griffiths report would come within two weeks. Perhaps my hon. Friend the Under-Secretary will tell me whether I am right when he winds up the debate. The Government's statement on that report is urgently awaited and it is so important that the Government should get it right.

5.16 pm

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