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Miss Ann Widdecombe (Maidstone and The Weald): I am grateful to the right hon. Gentleman for his courtesy in letting me have an advance copy of his statement and for ensuring that on this occasion, it reached me in good
time. I have questions about his proposals which I hope he will be able to answer today, but if he cannot, perhaps he will write to me.
First, will the Secretary of State confirm that the view of the profession is that care in the community has been an overwhelming success and that only a small number of inappropriate discharges have caused justifiable concern among the public?
Will the right hon. Gentleman confirm that a major factor in patients defaulting on medication is the rationing of the latest atypical anti-psychotics? Will he give an assurance that community treatment orders will not be invoked until the patient has been given access to all appropriate medication, even if that medication costs more than that currently being used? Will he ensure that guidance from NICE on the prescribing of medication for patients with mental illness does not assume that all patients should start on the older, less satisfactory medication? If NICE recognises a drug as effective, will he ensure that it is always available on the NHS?
Will the Secretary of State commission a study on the real costs to our health service of providing the latest anti-psychotic medication, compared with providing in-patient treatment? Will he state what consultation he has had with those involved with all aspects of mental health, and what are the results of that consultation?
Will the right hon. Gentleman clarify the position of personality-disordered patients in relation to the Mental Health Act 1983 and state what discussions he has had with the Royal College of Psychiatrists regarding the prospects for treatment of those individuals?
Will the Secretary of State clarify the role of the Under-Secretary of State for Health, the hon. Member for Barrow and Furness (Mr. Hutton), in consulting the mental health charities and what reception he has had from those discussions? Is it true that the hon. Gentleman greatly offended the charity MIND with ill-advised comments about enforced treatment?
Will the right hon. Gentleman confirm that care in the community has been in existence since the closure of Victorian-style asylums in the 1950s? Will he confirm that the policy of community treatment orders has caused concern among psychiatric nurses? What steps is he taking to ensure that their fears are not realised?
Will the right hon. Gentleman confirm that the number of dangerously mentally ill patients, from whom the public need protection, accounts for a small proportion of the total population of mentally ill people?
What estimate has the Secretary of State made of the number of new in-patient beds that will be necessary if community treatment orders are not to prove utterly unworkable? How many of those beds will be provided in mixed-sex wards? What is his policy on mixed-sex wards for the mentally ill?
When will the Mental Health Act 1983 be replaced? [Interruption.] I think that some Labour Members do not understand the workings of the Act. Is it not the case that to implement community treatment orders a new mental health Act will be required? Why, in that case, has the Secretary of State failed to win time for one in the Queen's Speech? If mental health is such a priority for him, why could not time have been found in this year's Queen's Speech for a new mental health Act? Can the
right hon. Gentleman confirm--I hope that he will--that there will be no enforced medication for patients outside NHS premises?
Mr. Dobson:
I cannot really thank the right hon. Lady for her welcome for what we are proposing. She asked me to confirm that the psychiatric profession's view is that care in the community was a success. It is my job to say what my views are. The right hon. Lady can find out from the profession what its views are. I think that it failed.
We are seeking the views of the various professionals involved in this matter, but some of the shortcomings in the present arrangements arise from the things that some of the professionals have got wrong in the past and, in my opinion, from their adherence to an over-optimistic view of the likely product of care in the community carried to extremes.
NICE will have the clear job of looking at new treatments and new pharmaceutical products, and advising on whether they are sound and should be widely used in the NHS. If they should, they will be funded.
I am afraid that I cannot read my notes. What was the right hon. Lady's fifth question? I am happy to take a hint.
Madam Speaker:
Perhaps the right hon. Gentleman will continue. I am sure that it will come to him eventually.
Mr. Dobson:
What we have been saying all along is that we want to consult the people who have been involved in these matters but, in view of the track record of some of them, we will have to look carefully at what they say and not necessarily directly accept their advice. Some of them have been responsible for some of the things that have gone wrong. There is a new arrangement in hand and they will have to become accustomed to it, as will the people at MIND who did not like theUnder-Secretary of State for Health, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), giving them an outline of what we intend to do.
I heard someone from MIND on the radio this morning and she apparently shares the right hon. Lady's view that there is really nothing wrong. I have seldom heard such a defence of the status quo as was apparent in the right hon. Lady's questions. She emphasised that the policy of care in the community has been in place for a long time. Indeed it has, and it has had time to show whether it works--it has shown that it has not worked. One cannot claim success for a policy that fails the most difficult cases, and that is certainly what has happened with care in the community.
We believe that the law needs to be changed to enable community treatment orders to be introduced; that is one of the reasons why we need to change the law. As I said in my statement, I recognise--it is fairly clear--that the dangerously mentally ill are a small minority. However, I have also emphasised that, until we sort out the crisis that they have created, proper attention will not be given to the other people who need help with their mental health.
We are not looking for national totals for beds. We are conducting a survey of all beds in the NHS to find out what is needed in each area so that we can identify what sort of beds are required. The fact that there is a surplus of beds in Norwich is of no consequence to those facing a shortage of beds in Bristol.
We want to eliminate mixed-sex wards. I have twice stepped in to prevent health trusts from following the policy of the previous Government and trying to create more mixed-sex wards. I will not tolerate such wards and they will be eliminated.
The right hon. Lady asked about the provision of legislative time in order to do these things. If she can sort out the Tory party's policy on the House of Lords so that we know whether it will obstruct the passage of our measures during this Session, perhaps we could introduce the legislation for which she apparently yearns.
Mr. David Hinchliffe (Wakefield):
I warmly welcome many of the points made by my right hon. Friend the Secretary of State. I welcome also the Government's recognition that serious problems are facing a minority within the community.
I find myself in some difficulty because I agreed with the first point made by the right hon. Member for Maidstone and The Weald (Miss Widdecombe) about community care being a success for many thousands of people. There are many thousands, who do not make news headlines, who are better off cared for in the community as a consequence of the community care policy. At the same time, I accept that there have been some very serious failures and tragedies that should be addressed, and my right hon. Friend is right to address them.
I say that in the context of regretting the view of some people that there was a golden age of the lunatic asylum; there was not. I am old enough to remember the Stanley Royd hospital in my constituency and other long-stay psychiatric hospitals, which left a great deal to be desired. I welcome my right hon. Friend's points in that context.
I press my right hon. Friend on two specific points. First--I am particularly concerned about this--does he recognise the urgency of the reform of mental health laws? As he has said, these laws reflect the old asylum system rather than the reality of today's care in the community. We desperately need laws that underpin the work of those who are doing a valiant job in helping people to be cared for in the community.
Secondly--it will not be a surprise to my right hon. Friend--bearing in mind the number of failures that have occurred through a lack of inter-agency working, is it not about time that we addressed seriously the issue of a single community care authority?
Mr. Dobson:
First, I shall answer my hon. Friend's final question. He has a great depth of professional and personal knowledge of these matters. I believe that there would still be boundaries wherever we drew the line. I am not in favour of having joint social services and national health service provision. I am sometimes told that such a system works brilliantly in Northern Ireland, while others tell me that it does not.
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