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EU Unemployment
Q4. Sir Teddy Taylor: To ask the Prime Minister if he will raise at the next meeting of the European Council the level of unemployment in the EU. [14384]
The Prime Minister: I shall take every opportunity to protect the United Kingdom's flexible labour market and falling unemployment against the damaging effects of the social chapter. No other significant European country has an unemployment rate lower than ours.
Sir Teddy Taylor: As high unemployment is becoming a tragic nightmare on the continent of Europe-- by comparison with the UK, where unemployment has been falling consistently--will the Prime Minister do all in his power to persuade his colleagues in Europe to abandon illogical policies such as fixed exchange rates, which are simply a recipe for job destruction?
The Prime Minister: My hon. Friend is quite right about the relative levels of unemployment. While unemployment fell here last week to a five-year low, in most similar large European countries it is either growing or remaining static at a much higher level than here in the United Kingdom. As the president of the European Monetary Institute said just the other day, other member states should use the United Kingdom as their economic model. I am delighted to have his support--that is what I have been saying to my colleagues on the European Council for several years now.
Mental Health Services
3.32 pm
The Secretary of State for Health (Mr. Stephen Dorrell): With permission Madam Speaker, I wish to make a statement about the future of mental health services.
On 24 August last year, my hon. Friend the Minister for Health wrote to health authority chairmen informing them that I had asked the regional directors of the national health service to review the progress being made in their regions towards the delivery of modern and effective mental health services. I am today publishing the conclusions of that process, and I am announcing the further steps that the Government intend to take to deliver their commitment to a comprehensive, high-quality mental health service.
The background to those developments is familiar to the House. In this and every other developed country during the past 40 years, health and social service authorities have been replacing asylum-based care with a broad spectrum of facilities that are better able to meet the needs of the individual person suffering from a mental illness. At its best, a modern mental health service represents a dramatic improvement in the quality of care available to its patients.
Too often, however, the reality has not matched up to that potential. That is why we decided last June to make the improvement of mental health services a key medium-term priority for the NHS, and it is why I initiated the review process last August.
Today's report of that review confirms that every health authority now has in place plans that commit it to deliver a comprehensive mental health service. Sixty-eight health authorities have demonstrated that that objective will be achieved during the next financial year; the remaining33 authorities have plans to deliver a comprehensive service, which will take longer to complete.
The review shows that health authorities are planning to increase the resources committed to mental health services next year by £53 million. Regional directors will continue to monitor the delivery of those plans at local level.
It is important to be clear about the objective. The phrase "care in the community" has too often been taken to mean the abandonment of residential care for mentally ill people. That is not, and never has been, our policy. That is why, today, I am publishing a document entitled "The Spectrum of Care", which sets out in clear language the range of services that constitute a modern mental health service. It restates our commitment to provide treatment at home for those patients for whom that is the right answer. For that group, a range of services needs to be provided by the NHS and local authority social services departments, very often in partnership with local authority housing departments.
The document also sets out the range of other facilities that are needed to complete the required spectrum of care. Those are: day hospitals and day centres, to provide for those who need care during the day; access to out-of-hours specialist services and crisis accommodation to meet short-term crisis need; acute hospital beds,to meet the needs of those with acute mental health problems; and 24-hour nursed residential places, to meet the long-term residential needs of those with severe and
enduring mental illness. All those facilities are needed, together with a range of secure units for those who need treatment in a secure environment.
Today's document makes clear the Government's commitment to deliver not simply care in the community, but the full spectrum of care required for a comprehensive modern mental health service.
Along with that overview of the full spectrum of care, I am publishing a report commissioned by my Department on 24-hour nursed care. The report states that there is accumulating evidence of a need for residential nursing care for a relatively small group of so-called new, long-stay clients. The Government accept that such facilities have a valuable role to play in the spectrum of care and will look to health authorities to ensure that their plans for the future provide for that need to be met.
Although it is understandable that much of the comment about the state of mental health services concentrates on the pattern of service provision, a crucial requirement is effective collaboration between the wide range of agencies that contribute to an individual's care. That is why the Government are committed to the full implementation from 1 April of the care programme approach. That requires the preparation for each patient under the specialist services of a plan of care based on an assessment of his needs, which names a key worker to be responsible for ensuring that that care is delivered.
From next year, the NHS is under an obligation to audit the successful delivery of that approach. Today, I am publishing an audit pack designed to assist with that process. It has been developed by the NHS executive with the Royal College of Psychiatrists and constitutes an important reinforcement of our commitment to quality in those services.
A further reinforcement of quality is provided by the Government's decision to introduce a patients charter on mental health. A charter does not, of course, by itself improve standards. It does, however, state clearly the standards that the individual patient can expect to receive from the statutory services and it therefore constitutes a benchmark by which the quality of the service can be judged.
Today, I am publishing a draft charter and I am asking for comments by 26 April. The draft charter proposes standards for timely access to specialist services. It sets out the entitlement of a mentally ill person to have his illness explained; to have the effects of medication explained; and to be given information about advocacy and support groups, together with information about what to do in an emergency. It also establishes that a patient who needs continuing care outside hospital will not be discharged from hospital until appropriate arrangements, including a care programme, have been put in place.
There has recently been disquiet about the arrangements that allow hospital managers to discharge patients from detention under the Mental Health Act 1983, possibly against the advice of their responsible medical officer. It is clearly essential that a detained patient must have the right to have his case reviewed, and the Mental Health Act 1983 provides for mental health review tribunals for that purpose. The powers of the managers operate in parallel with those of tribunals, to allow a more informal consideration of individual cases. The operation of the system is currently being considered by the Royal College of Psychiatrists and the National Association of
Health Authorities and Trusts, with the Mental Health Act Commission. We expect to receive their advice in the spring of this year, and the Government will reach and act on a conclusion on the basis of that advice.
Finally, I come to the question of money. The Government are firmly wedded to the provision of sufficient resources to allow the continued improvement of our mental health services. In December, I announced the creation of a mental health challenge fund within the NHS, and I am today publishing the detailed criteria for applications to that fund. The fund will deliver £20 million-worth of improvements and development in addition to the £53 million of growth money that health authorities already intend to spend on mental health next year.
In December, I also announced an increase of£11 million in the mental illness specific grant for 1996-97, and a further £9 million for 1997-98, subject to parliamentary approval. Of that £20 million, £4.5 million will provide for a 10 per cent. increase in the existing specific grant programme; £2 million will virtually double the provision for the homeless mentally ill initiative; and the remaining £13.5 million will be committed to a target fund to assist local authorities working in areas where the strains on the mental health services are greatest. I have written today to the local authority associations, inviting them to join us in drawing up the detailed criteria for those schemes.
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