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Mrs. Alice Mahon (Halifax): If the Minister really believes that every bed that has been closed in the psychiatric sector has been replaced with a good community care place, why are so many mentally ill people in prison and homeless? Does he recall my sending him a letter about the closure of the psychiatric unit at Northowram hospital, from GPs who said that they already faced frequent difficulties in admitting psychiatric patients to Halifax general hospital? Has he any idea how much worse it will be when the psychiatric unit closes? Will he please put a moratorium on all bed closures until decent places are provided in the community?
Mr. Dorrell: The reason why I do not agree with those who say that we should have a moratorium on all bed closures is that it would create the implication that the existing pattern of provision in some of the old asylums should be sustained. I want to ensure that we provide an improved, modern mental health service that more accurately meets the needs of patients.
Mrs. Mahon: What is the Secretary of State doing about that?
Mr. Dorrell: The hon. Lady asks what I am doing about that. I announced in my statement the publication of a document on nursing home beds for those suffering from severe and enduring mental illness. All the professional opinion now suggests that it is a better way of meeting the residential care needs of those with such
illnesses. Surely to goodness we should be able to agree across the Floor of the House that those needs are better met in that way than by keeping open a model of care which was a great breakthrough in the 19th century, but which is no longer regarded as a proper way of caring for people with a mental illness.
Mr. David Congdon (Croydon, North-East): Does my right hon. Friend agree that when mentally ill people are discharged into the community, it is crucial not only that are they provided with suitable housing by housing authorities, but that there is good liaison between housing and social services to ensure that social services provide proper support? Will the measures that he has announced today improve liaison and co-ordination not only between health authorities and social services, but with housing departments?
Mr. Dorrell: My hon. Friend is quite right to remind the House of the importance of the relationship with local authority housing departments. I specifically referred to that in my statement. In regard to people being discharged from hospital with continuing needs from the mental health services, I set out the proposition contained within the mental health patients charter, that people in those circumstances should not be discharged from hospital until proper arrangements have been made with the relevant authorities, so that those continuing mental health needs will be met.
Mr. Dennis Skinner (Bolsover): Does the Minister agree that, for a comprehensive care in the community policy to succeed, much attention and assistance must be given to individual carers who look after a great number of people in the community? Is he aware of the plight of some of those people? One of my constituents informed me that she was on incapacity benefit, but the moment she became an individual carer, the Department of Social Security took the book away and she lost not only her incapacity benefit, but her entitlement to rent and all other benefits. The net result is that she is worse off as a result of taking on an onerous task. She has saved the state£300 a week and she is getting absolutely nothing.
Mr. Dorrell: I prepared for a number of different questions for this session, but I confess that I did not include mastering the rules governing the social security system. I shall take the hon. Gentleman's question away and write to him with an answer.
Mr. John Marshall (Hendon, South): As one who has instigated a number of Adjournment debates on the care of the mentally ill, I welcome my right hon. Friend's statement and the fact that he has listened to the concerns expressed in those debates and outside the House. I also welcome the commitment to new long-term clients, because there has been an inadequate number of beds, especially in London, for the mentally ill. Can my right hon. Friend tell the House how Barnet health authority will be affected by his proposals?
Mr. Dorrell: I am grateful to my hon. Friend for his support for the announcements that I have been able to make, and I agree with him about the need to ensure that there is a proper understanding of the case for a full spectrum of care. Community care should be seen as part
of that spectrum and not as the totality. I hope that my hon. Friend will accept that his emphasis on the need to ensure the provision of residential places was covered in my statement.
Barnet health authority has a clear commitment and a plan to deliver--as the hon. Member for Peckham(Ms Harman) will see--a comprehensive mental health service. As my hon. Friend knows, Barnet health authority has to come from further behind than some, so it would be unrealistic, as the hon. Member for Motherwell, South (Dr. Bray) pointed out, to suggest that all the problems can be resolved overnight. The commitment is there to ensure that those services will deliver our objectives, and my hon. Friend's constituency will be able to benefit from the spending programmes that I announced this afternoon.
Mr. Jim Callaghan (Heywood and Middleton):
I listened carefully to the order of priorities that the Secretary of State has just given to the House. Is he aware that one of my constituents, Mrs. Worsley, while on her way to work at the University of Manchester Institute of Science and Technology at 7 o'clock in the morning a fortnight ago, was savagely attacked by a man with a mental illness? As a result of the attack, she had nine stab wounds in her back, one stab wound in the back of her head and a gash in her face that required nine stitches.In the light of that and other savage and unprovoked attacks, what assurances can the Secretary of State give to Mrs. Worsley and other victims that that will not happen again?
Mr. Dorrell:
Of course, no Secretary of State can give to any citizen the assurance that there will never be an attack in the street again, whether perpetrated by somebody suffering from mental illness or not. I can assure the House that we are specifically considering the discharge arrangements provided by hospital managers to ensure that there are adequate safeguards to command public confidence. In the context of the services that I mentioned today, that is the right assurance to give to the hon. Gentleman.
Mr. David Atkinson (Bournemouth, East):
Is my right hon. Friend aware that the initiatives and extra resources that he has announced today will be warmly welcomed by the voluntary organisations involved with the mentally ill--MIND, the National Schizophrenia Fellowship and the Schizophrenia Association of Great Britain? Will my right hon. Friend ensure that the views of those voluntary organisations will be specifically sought by the Department of Health when it consults on the draft patients charter and on the management of the release of detained patients, which he has announced today?
Mr. Dorrell:
The answer to my hon. Friend's question is yes. I will ensure that they are consulted and that their views are heard and noted.
Dr. Lynne Jones (Birmingham, Selly Oak):
If everything is to be as the Secretary of State has explained, there will indeed be a dramatic improvement in mental health services. I wish the Secretary of State well, because I think that he believes in what he said. I hope that he will forgive some of us who are a little cynical about whether he has put the means to achieve his aims in place.
In Birmingham, there is 0.5 per cent. growth in the health budget and most of that will be spent on the waiting list initiative. The mental health trust in south Birmingham has been asked to make 3 per cent. efficiency savings and it has been reported that a project, which linked mental health services and the police, so that they could try to intervene when mentally ill people were arrested, will have to fold.
Will the Secretary of State give an assurance that when projects are funded through the challenge initiative and are successful, funding will continue and resources will be made available to ensure that the good practice that has been learnt can be disseminated throughout the country?
Mr. Dorrell:
I entirely agree with what the hon. Lady said about the importance of disseminating good practice.
If the health authority in the hon. Lady's constituency is above target and, therefore, saw only half a per cent. growth in last year's settlement, it is precisely to that health authority that the challenge fund is addressed. The fund will provide resources that will allow the service to continue. The money will not be withdrawn after one year.
Mr. Nicholas Winterton (Macclesfield):
I congratulate my right hon. Friend on his statement and on the direction that he is giving to mental health provision. Does he agree, however, that long-term care for the more severely and permanently mentally disabled needs to be provided not on a district general hospital site but on a site that is more conducive to therapy and the provision of long-term care? I am sure that my hon. Friend the Member for Hendon, South (Mr. Marshall) agrees with me on that.It is important that hospital sites that are ideal for what my right hon. Friend has in mind are not sold off prior to the new initiative being fully considered by him, with perhaps the new provision being provided on such sites. If he does not put his foot down, those sites may be sold.
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