House of Commons
Tuesday 16 January 1996
The House met at half-past Two o'clock
PRAYERS
[Madam Speaker in the Chair]
Oral Answers to Questions
HEALTH
Patient Care (Birmingham)
1. Mr. Rooker: To ask the Secretary of State for Health when he last visited an NHS hospital in Birmingham to discuss patient care. [7491]
The Minister for Health (Mr. Gerald Malone): My right hon. Friend visited Good Hope Hospital NHS trust Sutton Coldfield last Friday, when he met staff and patients.
Mr. Rooker: Does the Minister accept that people in hospital may get too much care because their discharge is delayed by a lack of adequate, immediately available community care facilities? Will he study carefully the plans and proposals of a qualified constituent of mine that I sent him before Christmas? They suggest a fast-track approach with perhaps a small part of the budget being given to health service discharge planners to help people move more quickly out of acute beds so that there would be no bed-blocking. That would save the NHS a fortune, help people to be discharged more quickly and release more beds for acute care.
Mr. Malone: I read with great care the letter that the hon. Gentleman's constituent sent him. It contained a number of very practical proposals, all of which, fortunately, need no change to national policy to be implemented. I, too, happened to be in the Birmingham area on Friday and travelled to Nuneaton, where I saw a hospital at which such a partnership was in action and social services had a halfway-home ward in which people were able to step down and get rehabilitation treatment before they went into the community. The NHS executive published a book in 1984 that gave guidance on discharge. Of course, we are always happy to learn where best practice tells us that we can do better, but with local action I believe that we can make a great impact on the problem. The hon. Gentleman's constituent made some very valid points on that.
Sir Norman Fowler: May I thank my hon. Friend the Minister for the action that he is taking to improve accident and emergency services at Good Hope hospital in Sutton Coldfield? However, I hope that he will also recognise that a new admission ward is needed and that, if one was introduced, it would make long waits on trolleys a thing of the past. I hope that he will consider that.
Mr. Malone: I am grateful to my right hon. Friend for acknowledging the progress that has been made at Good Hope hospital, as my right hon. Friend the Secretary of State was able on Friday to be at a press conference where it was announced that 65 beds were being brought back into service. That was a step in the right direction. I have listened carefully to what my right hon. Friend said about the proposals put forward by the trust. I understand that they are being evaluated by the regional health authority, which I expect to look rigorously at the proposals and do what it can constructively to help to alleviate the problem at Good Hope.
Mr. Burden: While I welcome the announcement on beds at Good Hope, when will the Minister recognise that Birmingham is being short-changed on national health service spending and the fact that the 1.1 per cent. increase on spending announced by the Minister before Christmas amounts to only 0.5 per cent. in Birmingham? That will result in cuts in the community facilities mentioned by my hon. Friend the Member for Birmingham, Perry Barr (Mr. Rooker) and could make the difference as to whether 75 community psychiatric nurses are in post. When will he do something about that?
Mr. Malone: I saw with some interest the proposal put forward by the local community health council, which seemed to suggest that there was underfunding in Birmingham of some 20 per cent. However, there is, of course, an equitable weighted capitation process in England that allocates funds. I should like to discover from the hon. Gentleman some time whether he is saying that he is committed to undoing the weighted capitation system. Can his Front Benchers commit his party to doing that in a way that would automatically bring more funds to bear in Birmingham? Unless he is undertaking to do so, his observation is entirely irrelevant. I would have hoped that what he might rather have done is to look at the forthcoming merger between the two Birmingham health authorities, which will immediately result in £1.2 million of savings, which will be available for added patient care.
Psychiatric Community Nurses
2. Mr. David Atkinson: To ask the Secretary of State for Health what has been the change in the number of psychiatric community nurses since 1979. [7492]
The Parliamentary Under-Secretary of State for Health (Mr. John Bowis): The number of whole-time equivalent nurses working in the community psychiatric area has increased from 1,080 in 1981, which is the earliest year for which figures are available, to 4,760 in 1994, an increase of 340 per cent.
Mr. Atkinson: While I think that my hon. Friend and his predecessor should be given full credit for that impressive increase, which clearly demonstrates the Government's commitment to the mentally ill, does he agree that his Department's report into homicides and suicides by mentally ill people provides even more evidence that there are still not enough psychiatric community nurses to go round to give that essential face-to-face contact with patients--especially schizophrenia patients--to make a success of our community care approach?
In the light of the patients charter for the mentally ill, which our right hon. Friend the Secretary of State has recently announced, can my hon. Friend now announce a further substantial increase in the number of psychiatric community nurses?
Mr. Bowis:
My hon. Friend has referred to the confidential inquiry report, which was set against the background of a decreasing proportion of homicides committed by mentally ill people.
Any homicide or act of violence against oneself or somebody else is a matter of concern to us, which is why we asked the inquiry to investigate whether there are common threads that run through such cases. The thread it highlighted is professionals' failure, in some cases, to communicate with each other. That observation ties in with the requirements that my right hon. Friend the Secretary of State has placed on every health authority in the country to report to us on the state of the care programme, the mix of beds and community services and the plans that they have in each case to correct any shortcomings.
We shall look carefully at all those programmes to ensure that the service in every district is up to the standard that we know exists in the best districts.
Dr. Wright:
How does the Minister's reply relate to the case of my constituent, Dylan Thomas Jones, a mentally ill patient about whom I wrote to every agency that was involved in his case? I told them that he was likely to kill either himself or someone else unless the most urgent action was taken. A few weeks ago, he killed himself. I wrote to the Department of Health to say that that might happen.
May I tell the Minister that, as far as the people of this country are concerned, including Mr. Jones' mother, community care for that category of patient has become a euphemism for the most monstrous neglect? Instead of waiting for another inquiry or another such death, will the Minister tell us what the Government are going to do about the problem?
Mr. Bowis:
That case is a tragedy, and we feel for the family or families concerned. After any such case, the Department of Health and the national health service order a full investigation into what has gone wrong. The lessons learnt are fed into the programming and planning of our mental health services. I can make that pledge, today and always, to the hon. Gentleman.
In return, I hope that the hon. Gentleman will have the goodness to acknowledge the real progress made in the care and treatment of mentally ill people, which is much more humane than it was some decades ago. Dedicated doctors, nurses and social workers are working with families and individuals to make that possible. When Professor Norman Sartorius, the distinguished president of the World Psychiatry Association, came to Britain,
he said:
Lady Olga Maitland:
I congratulate my hon. Friend on developing the community psychiatric nurse
Mr. Bowis:
My hon. Friend is right--the programme has developed since those days because the Government have made it a priority. My hon. Friend is also right to pay particular attention to psychiatric nurses working in the community and to others who act as the key workers in each case. Every patient who is discharged from hospital care or the mental health services should have a care programme around him or her, monitored and led by the key worker who is often a nurse and who is able to spot things when they are going wrong and alert the necessary professionals to help the individual get through the crisis that he or she may be suffering. If we work towards that end, we shall have a service that is in the best interests of both patients and the wider community.
"Our recent developments in improving mental health services will ensure that the UK continues to lead the world in this area". We should listen to that lesson, learn from it, and pay tribute to the work of our professionals, rather than downgrade them and abuse them every time we speak in the House on a particular case.
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