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Ms Harriet Harman (Peckham): Is it not the case that the Government have failed to ensure that mentally ill people get the care that they need when they need it, and that the price is paid by mentally ill people themselves and by the communities in which they live? Does not the Government's failure cause needless suffering to those who are unfortunate enough to have mental illness? Does not the failure cause despair to the relatives of mentally ill people, as they struggle to cope, and further demoralise the doctors, nurses and therapists--the mental health care team--who are stretched to breaking point as they run services that are stretched beyond breaking point?
Has not the Government's failure caused a breakdown of public confidence in our mental health services, as people hear report after report of assaults, murders and suicides committed by people who are desperately ill? Have not the Government created the worst of all worlds in relation to mental illness: too few beds for the mentally ill in hospital, inadequate and patchy services for the mentally ill in the community and staff shortages in hospitals and community services?
I join the Secretary of State in his tribute to the excellent work that has been done by the health care team. However, why does he not mention the chronic staff shortages in mental health services? Those services cannot run without the staff and, too often, they simply are not there.
The Royal College of Psychiatrists says that there are shortages of psychiatrists at all levels, consultants, registrars and junior doctors. So the risks increase, but no mention of that was made by the Secretary of State. Is he not aware that the Royal College of Nursing reports that there are now fewer community psychiatric nurses than there were five years ago, despite a huge increase in the number of mentally ill people in the community? Why was there no mention of that?
Is the Secretary of State not aware that in some areas whole wards are closed because sufficient staff nurses cannot be found to run them? Does not he realise that the huge turnover of very seriously ill patients in hospital means that doctors and nurses are providing only a custodial rather than a caring, quality service, with not enough time to talk to and get to know their own patients, let alone the patients' relatives? Will the Secretary of State admit and act on the problem of hospital bed shortages? Half of all acute beds for people with mental illness problems have been cut in the past 15 years.
Why does the Secretary of State announce £95 million of growth money when it is nothing of the sort? Why does he not admit to the House that it is existing money already allocated by health authorities? Does he not realise that people are fed up with hearing the Government announce new money or growth money and raising their hopes, only to have those hopes dashed when they discover that it is not growth money at all? Is not that yet another reason why this Secretary of State, like his predecessors, is not trusted by the public or by those who work in the national health service?
Does not the Secretary of State realise that his failed mental health policies mean patients committing offences and ending up in our police stations, courts and prisons? The number of mentally ill prisoners has increased by more than half in the past four years.
Is not the real story about Government failure on mental health revealed in a devastating secret report from North Thames regional health authority? The report shows that none of the health authorities in that region is providing a comprehensive adult mental health service and that two thirds of the health authorities will not be providing a comprehensive adult mental health service by 1997, even if they achieve all their existing plans and even if they take additional action.
The report, which the Government have kept secret, talks of organisational turbulence. It talks of a surfeit of first priority issues, pressures on staff and a range of attitudes, from anger to despair to desperation. It does not appear in the pack that comes with the Secretary of State's statement.
How can any hon. Member have confidence in what the Secretary of State tells the House when he has admitted that one in three health authorities will fail to deliver comprehensive adult mental health care services by the end of 1997? He says that 68 out of 110--he lists them in the pack--will provide a comprehensive adult mental health service by the end of 1997, but how can we believe him when we know that the list includes
authorities such as Brent and Harrow, and Camden and Islington, whose own region says that they will not achieve a comprehensive service by then even if they achieve all their existing plans and even if they take additional action?
Will the Secretary of State accept Labour's challenge and introduce a four-point action plan to begin to tackle the problems of mental health? Will he halt further psychiatric bed closures until community services are in place? Will he ensure not only the immediate implementation in all areas of the care programme approach, but greater consistency in its development? Will he take action to address staff shortages? Will he change the mental health funding allocation formula, so that over time cash ends up going where it is most needed?
Against the background of Government failure, the Health Secretary's statement offers no new money, no new rights and no new policy directions. What he has done is to identify needs. We know what the needs are;we have known them for years. He has identified the service provision that is needed; we have known about that for years. He has not taken action to tackle the problems. The Tories have failed for years on mental health and they have failed again today.
Mr. Dorrell:
I remind the House that my statement covered a range of subjects on which the Government have announced some proposals. We have announced proposals to redefine the spectrum of care; to heighten the commitment to nursed beds in the health service; and to strengthen our commitment to the care programme approach; and we have announced the publication of a draft charter for mental health patients. I talked about the changes that are being considered in managers' powers to release detained patients. I listened to what the hon. Lady had to say in her questions on my statement. I did not hear her mention a single one of those policy announcements. She picked on only one--that relating to money.
On money, the hon. Lady said that because today I announced the proposals that the health service was bringing forward for the use of next year's growth money, that somehow did not constitute new money. I am announcing how the health service will use the extra resources that have been voted to it, to improve the quality of health services during the next financial year. That is apparently not a subject in which she is interested.
The hon. Lady also spoke about staff shortages. I have good news for her on that. She said that the Government had nothing to say about increasing the staff commitment to mental health services.
Ms Harman:
The right hon. Gentleman did not say anything about it.
Mr. Dorrell:
The hon. Lady says that I did not say anything about that in my statement. That is true; my hon. Friend the Minister for Health announced some changes on that yesterday, when we announced the creation of114 specialist registrar posts in the psychiatric disciplines, specifically to address the concerns that she raised.I would have hoped that she might welcome that.
The hon. Lady also spoke about an alleged decline in the number of community psychiatric nurses working in the health service. I have the figures with me. In 1984--
I am not taking a date that is party politically convenient, but I will measure the numbers over a decade--there were 1,180; and in 1994, the most recent year for which figures are available, there were 4,760--an increase in community psychiatric nurses in post of 153 per cent.I would have hoped that she might welcome that.
Then there are the points that the hon. Lady made in her press release today, in which she said:
She did not anticipate that I would publish the list in the document that was published at 3.30 pm. I am sorry to have shot her fox.
The hon. Lady also challenged me to agree to her four-point plan. I have had the advantage of a few minutes in which to think about her four-point plan. [Interruption.] I did not need them, as she rightly says, because all the points are covered in the statement.
The hon. Lady called for a halt to further psychiatric bed closures until appropriate community services have been developed. That has been the policy of the Government for some years. Existing bed space is not closed until acceptable alternative provision is in place. In my statement, I announced immediate implementation of the care programme approach in all parts of the country. I would have hoped that she might welcome that.
"I am calling on the Secretary of State to publish the true information on the state of mental health services in every region of the country."
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