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Madam Speaker: I am now seeking very brisk questions and answers.
Mr. Roger Sims (Chislehurst): As it happens, I met my local community health service trust at lunchtime and I know that its welcome for the prospect of increased resources will be reflected throughout the country. The important thing is how and where those resources are spent. My right hon. Friend listed a number of facilities that can be provided on a local trust basis, but others can be provided more effectively and efficiently over a wider area. Will he encourage trusts to co-operate with each other and co-ordinate their activities in providing those facilities, and ensure that resources are distributed accordingly?
Mr. Dorrell: I am happy to see such co-operation develop within the health service--and my hon. Friend knows that that is occurring. The key co-operation is between health authorities, to ensure that the needs of a particular locality are met. When those needs are best met by trusts in co-operation, I am strongly in favour of local partnerships developing.
Mr. Simon Hughes (Southwark and Bermondsey): I welcome the Secretary of State's statement as far as it goes. However, I should like him to inform the House
when he will be able to guarantee three things. When can he guarantee that there will be satisfactory co-ordination of health authorities and social services departments throughout the country? He is aware that that problem must be addressed. When can he guarantee that there will be 24-hour access to emergency admissions, to local support or to community care--the three options that a mentally ill person may need? Most importantly, when can he guarantee that urban areas--which have four times the incidence of mental illness compared with elsewhere--will be allocated the resources that they need statistically, as opposed to being dependent on the £13.5 million beauty competition that is the additional challenge funding that he announced today? It may mean that the places that are most in need will continue to go without.
Mr. Dorrell: Co-ordination between statutory authorities is part of the assessment for which regions are responsible when deciding whether comprehensive mental health services will be delivered. I agree with the hon. Gentleman: it is important to ensure that statutory agencies are co-ordinated properly. In the absence of that proper co-ordination, action will be taken to improve the situation. I agree with what the hon. Gentleman said about emergency access. In a supporting paper published today, the hon. Gentleman will find the statement:
- "We intend to include a standard in the final document on the mental health patients charter on access to out-of-hours services and views on that will be particularly welcome".
The hon. Gentleman is quite right when he says that out-of-hours access is important. We intend to include details of our proposal in the final version of the mental health patients charter.
As to the hon. Gentleman's proposal that we should revise the capitation formula that governs all health service financing, he will know that it is subject to regular review. With regard to the funding mechanisms that I announced today, I shall ensure that specific local issues are addressed. We must not wait until the generality of funding delivers that objective. It is important to target resources at that issue, reflecting the priority that health and social services managers now give to improving the quality of services.
Sir Gerard Vaughan (Reading, East):
My right hon. Friend's statement will be welcomed very widely. Will he confirm that today he has announced a new, high priority that will be on-going not only for mental patients in the community, but for mental patients across the board?
Mr. Dorrell:
Yes, I can give my hon. Friend exactly that assurance. My right hon. Friend and predecessor announced last June that the health service intended to make the maintenance of high-quality mental health services a key priority. That is not a passing fad. Mental health services are a key part of an integrated national health service, and the management of the health service and the political responsibility for it will continue to reflect that long-term priority.
Dr. Jeremy Bray (Motherwell, South):
The Secretary of State has accepted the difference between comprehensive plans and effective delivery. He has put forward specific proposals--such as the audit arrangements and the patients charter--to improve the
Mr. Dorrell:
The hon. Gentleman is right on all three counts. He takes a distinguished interest in this subject, as the chairman of the all-party group. He has placed emphasis on the importance of training all the professional staff responsible for delivering that service, which I echo. That is why my hon. Friend the Minister for Health announced the extra commitment to the psychiatric medical disciplines yesterday, and it is something that will also be followed up in the training plans for the nursing profession.
The hon. Gentleman raised three important issues, and I agree with all of them. The Government will carry them all forward. The distinction between plans and delivery is one that I take seriously. It is important that the commitment to the standards that I have announced today is monitored year by year by the health authorities and by the social services inspectorate--and that is what will happen.
Mrs. Edwina Currie (South Derbyshire):
Does my right hon. Friend realise that in his statement he has rendered a large chunk of my novel out of date? I am very pleased about that. In his efforts, will he also take into account the need to train general practitioners, to ensure that their services for mental illness are also improved?Is it not those people who will most likely first come into contact with someone who is depressed or suicidal, who will have to cope with their family and, in the long run, who will most likely be involved in their continuing care in the community?
Mr. Dorrell:
I am sorry to have rendered my hon. Friend's novel out of date, but I am not sure that I am ministerially responsible for that. I agree with what she said in relation to the development of the role of general practitioners in the mental health services. That is a specific aspect of the work that my hon. Friend the Minister for Health is doing, on the development of primary health care. It is important that the role of general practitioners in that service is not allowed to cut across or to undermine the important role played by the specialist services in meeting the requirements of those whose needs are genuinely specialist in nature.
Mrs. Gwyneth Dunwoody (Crewe and Nantwich):
Is the Secretary of State aware that the provision of extra registrars will be welcome, but without access to secure beds and to proper psychiatric staffing care, they are not as effective as they sound? Further, is he aware that the need is urgent for elderly constituents who are faced with the management of a psychotic and possibly dangerous member of their family? Those psychiatric services are falling apart now--not next week--and they need help now. What will he do to ensure that it is provided as rapidly as possible?
Mr. Dorrell:
The hon. Lady raised the subject of secure bed space, which is interesting because that is an aspect of the delivery of mental health services that has been developed substantially in recent years. In the early 1970s, the Glancy report target for medium secure beds was set at 1,000, but by 1979 nothing had happened. The figure is now 1,200 beds provided, with more to follow. We are providing the medium secure beds that the health service needs, and that is something that marks today's health service apart from the health service of a decade ago.
Mr. David Martin (Portsmouth, South):
Is my right hon. Friend aware that those providing mental health services in Portsmouth just would not recognise as an accurate picture of those services the catalogue ofslurs produced by the hon. Member for Peckham(Ms Harman)? He mentioned in his statement that a key worker would be available for every individual--and that he would be known as that individual's key worker. Will he ensure that the individual's neighbours and family know who that key worker is, so that those who are receiving mental health treatment in the community know that someone can be contacted immediately to sort out any problems?
Mr. Dorrell:
My hon. Friend makes an important point. The support of the carer working within the community is often critical in the delivery of a proper service to a mentally ill person. The support of neighbours who may not be formal carers can also be valuable. My hon. Friend will recognise that his proposal and the terms in which he makes it may raise concerns about confidentiality, but I agree with him that the name of the key worker is potentially important, not just to the mentally ill person but to that person's carer and community supporters.
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