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9.57 am
Mr. David Hinchliffe (Wakefield): I commend the hon. Member for Hendon, South (Mr. Marshall) for introducing the debate and once again obtaining time to discuss a serious issue. He has previously been successful in doing exactly that. I genuinely respect his strength of feeling about the problems that have arisen in many respects although I differ to some extent with the solutions that he has put forward. On his own admission, he has concentrated primarily on failures rather than successes. He accepted at the beginning of the speech that there have been successes. It is important to recognise that the successes do not hit the headlines. They are not reported widely in news bulletins and accordingly do not come to the attention of Members. That should be borne in mind. Indeed, it should underpin our thoughts this morning.
I have probably been involved in most, if not all, of the debates on community care since the introduction of the National Health Service and Community Care Act 1990, and on the White Paper that preceded it. I have listened with interest to the opinions of Conservative Members. There is the irony that there is probably more support for the principle behind the Government's policy on the Opposition Benches than on the Conservative Benches. There is a scarcely concealed romantic vision-- it underpinned the speech of the hon. Member for Hendon, South--of the past in psychiatry, where there were no problems on the streets and the lunatic asylums were full. I do not share that romantic notion because, as the hon. Gentleman is aware, I spent much of my working life before becoming a Member of Parliament discharging from psychiatric institutions--the former lunatic asylums--people who had been wrongly incarcerated, in many instances before I was born.
I feel strongly that although it is nice to go back to that romantic, idealistic past, we should not forget what happened to vast numbers of people in our society who were incarcerated in a way that nobody should defend. Nobody should want to go back to that. I do not suggest that the hon. Gentleman wants to go back to that, but I remind him that I was involved in discharging people from hospital who were incarcerated as moral defectives. They were not in any way mad or ill. They were simply people who had a different way of life from the majority of people at that time. All were women. I had never met a male moral defective until I came to this place. "Back to basics" exposed one or two, but I shall not go into detail on that.
I respect the fact that the Minister believes in the policy. I have worked closely with him over a number of years, so I exempt him from my accusation. The difficulty that the Government have is that they believe in institutional incarceration, whether in psychiatry or the penal system, but they are not prepared to pay for it. That difficulty has caused many of the problems that we now have in community care. Community care is nothing new. In a sense, what is new is institutional provision. If one goes back in history, one will see that community care was the norm. People lived in the community. There was the village idiot. Such people were accepted more than they are nowadays.
The institution was, for a variety of reasons, invented. Enoch Powell, who was the Minister responsible for the hospital plan in 1962, was advised that there had been changes in the drug regimes and that we could treat people in the community. There was vast evidence--from Goffman and others--of the effects of institutionalisation, but the key issue that persuaded Enoch Powell, who was a monetarist before Lady Thatcher, was that it was far cheaper to keep people in the community. What concerns me, and in a sense the hon. Gentleman referred to this, was that the Treasury attraction to the policy in the 1980s, and the rapid--perhaps too rapid--move towards closing and disposing of establishments and moving patients into the community, was driven primarily by monetarist policies aimed at realising the assets of the institutions rather than looking at the principles behind community care and the human rights that we would all agree should be accorded to people with mental health problems.
I was a member of a health authority when the process was going ahead and I recall the pressures that the authority in Wakefield was placed under to get rid of its psychiatric beds. I remember vividly one meeting at which we had a letter from the Yorkshire regional health authority, expressing concern that the people in Stanley Royd hospital in Wakefield were not dying as quickly as expected and that the number of beds was therefore not being reduced. Concern was expressed to the health authority about the impact of the policy.
We should look at what happened in the 1980s, because that is the key to unravelling some of the problems that we now have. One of the most insidious elements of what was happening with the care in the community programme in the 1980s was the introduction of performance-related pay for senior health officials on the basis of achieving bed reductions, ward closures and the closure of hospitals. They were personally paid bonuses-- not to ensure that people were properly rehabilitated in the community, but to achieve the disposal of psychiatric facilities. That is why we have the problems now. There was a rapid, ill-thought-out move to care in the community--care which, frankly, did not and in many respects still does not exist.
Perhaps the hon. Gentleman agrees with many of the points that I am making. We are now picking up the pieces as a result of that ill-thought-out, Treasury-driven policy in many of the tragedies that we face. I in no way underestimate the difficulties facing many people as a result of some of the tragedies. Like the Minister, I have met people who have been directly affected. Jane Zito is an extremely courageous woman for whom I have the greatest respect. After suffering the most appalling
personal tragedy, she has gone out and fought. As she knows, I do not always agree with what she says, but I admire her courage, and the courage of others who came recently to the House of Commons when the supervised discharge order was being debated, to lobby Members of Parliament about their concerns. I appreciate their concerns and their courage in attempting to say to Members of Parliament, "Do something so that others do not have to face similar tragedies."
The real weakness of Government policy is that community care seems to be in a narrow policy box, divorced from a range of wider issues that impact on the lives of people in the community who face various mental health problems. We had an example of that this week. I understand that the Government are to slash 3,000 prison officers from the Prison Service. In my constituency, I have two prisons, one of which is a top security prison, and I know for a fact that a significant number of people in both those prisons suffer from mental illness. In slashing the number of prison officers and addressing the prison budgets, there has been no evaluation of the impact that that will have on the mentally ill. There has been no consideration of the knock-on effects that that will have or of the way in which the prison system is dealing--in my view, completely wrongly--with many people who should be helped by other means within society. The Government's housing policies have a clear impact on the ability of people from psychiatric hospitals to obtain and respond to care in the community.
What about employment prospects? The mass unemployment policy impacts on the most vulnerable. Clearly, people who want to be rehabilitated need employment opportunities, which are often denied them due to the policy of mass unemployment.
The key area that I wish to emphasise is the wider organisational aspects of community care. We have never really addressed the way in which, in terms of its framework, the current organisation of community care is a shambles. What we have as an organisational framework to assist people in the community is simply not working. I felt that that was so when the National Health Service and Community Care Act 1990 went through Parliament. I am on record as saying that I felt that we were not offering a way forward, although I did not differ with the Government on moving to assessments by the local authority and on community care planning. Everybody knows that the central motive for the community care changes was Treasury driven--the desire to reduce the social security budget. That was the real reason why we moved to the current system.
I found it amazing that on the one hand the Government introduced community planning within local authorities, and on the other introduced an internal market in health. The two simply do not square up. When there has been an inquiry into what has gone wrong when a person has come out of hospital and caused problems, and when sometimes there have been fatalities, the finger often points at the organisational structure of what is on offer to such people when they are being rehabilitated into the community. I appeal to the Minister to look at the division between local authorities and the NHS, because so long as there is a split responsibility on issues such as community care and continuing care there will be problems. There will be disputes and people will blame one another. That is at the heart of our present organisational difficulties.
Government policy has become reactive. It changes from day to day in response to various tragedies. As the Minister knows, I understood his dilemma in relation to supervised discharge orders, but the Government have ignored representations from virtually everyone who will have to administer the new arrangements. It has been pointed out that those arrangements are unworkable, and do not deal with the real problems of care in the community.
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