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Mr. Simon Hughes (Southwark, North and Bermondsey): First, will the Government accept our welcome for their intention to make mental health a greater priority for the national health service? In particular, we welcome the commitment to assertive outreach, early intervention and 24-hour services, whether they are drop-in services or admission into hospital beds for those who need that provision--and at present, often cannot have it. We join the Secretary of State in his tribute to those who care for the mentally ill, especially psychiatric nurses, community psychiatric nurses and psychiatric social workers, who are often in the front line undertaking extraordinarily difficult jobs.
Will the Government reflect, however, and consider whether it would be better as a policy not to be tough on care in the community, but tough in providing the resources for that care? Is it not the case that many of the problems that have made the front pages of the tabloid newspapers have been caused by overstretched teams not being able to provide such care, rather by people being out in the community and being cared for?
Is the Secretary of State able to tell us the number of beds that he estimates we need to open? More importantly, does not he accept that we are desperately short of psychiatric nurses, community psychiatric nurses and psychiatrists? How many more of these people will be engaged as a result of the resources that he is announcing today?
In the past eight years, there has been a cut of about one sixth in the share of the NHS budget spent on mental health. Will the funds that have been cut be restored? Will the £700 million be £113 million a year for the next three years, or £233 million for the next three years? There are two ways of calculating £700 million, and one total is only half of the other.
Does the Secretary of State accept that--to protect the public and the mentally ill from homicides and, much more often, suicides involving the mentally ill--we need to have better ways of controlling the moment of discharge, often by including a lay element? Does he accept also that--rather than telling people that they will be taken back into hospital if they do not take their drugs, taking away their civil liberties--the test should simply be whether people are well enough to be in the community?
Mr. Dobson:
That was a set of weasel words at the end of the hon. Gentleman's questions. It is not simply a matter of people taking their drugs. Day in and day out--
Mr. Dobson:
If the hon. Gentleman will listen for a moment, I shall answer his question. Day in and day out,
I am sorry that I did not follow the hon. Gentleman's arithmetical gymnastics, in which he seemed to disappear halfway up the sum that he originally mentioned.
There are more specialist psychiatric nurses in training, and we want to ensure that there are sufficient nurses and other staff available to do the job that needs to be done. It is certainly true that, across the United Kingdom, there are overstretched teams. To help them, we plan to change the law, to provide extra resources and to change the way in which they go about things. We believe that those three actions combined will lead to a very substantial improvement in the service for all those who are mentally ill.
Mr. John Gunnell (Morley and Rothwell):
Will my right hon. Friend ensure that, when it is recommended that a patient has electro-convulsive therapy, it will be certain that the hospital providing the therapy has up-to-date equipment and a technician or doctor trained in the use of that equipment, and that, if the patient has any uncertainty about accepting the treatment, the opinion of an independent second appointed doctor will be available before the treatment is provided?
Mr. Dobson:
Anyone who is being treated in the national health service should be entitled to treatment using equipment that is sufficiently up to date to be safe and to do the job that it is intended to do, whether it is to treat patients for something that is physically or mentally wrong with them. It is certainly intended that all treatments should be administered by properly trained staff. There is royal college guidance on the matter, and it should be followed. If my hon. Friend feels that we have to follow up and augment the guidance with arrangements in the national health service, I should be happy to contemplate doing so. One of the reasons why we are giving responsibility for quality to the national health service is that we feel that current arrangements are not satisfactory.
Mr. Nicholas Winterton (Macclesfield):
I served on the Social Services Committee when it undertook a lengthy inquiry into adult mental illness and mental handicap. I warmly support the Secretary of State's statement. The recognition of the failings of care in the community for the more severely mentally ill is long overdue. In-patient hospital beds are required for that small minority. My constituency has experienced two or three tragic deaths as a result of the failure of the system. The Secretary of State made a statement some time ago that no further hospital beds would be closed in the mental health sector. Will he repeat that assurance and promise
Mr. Dobson:
I thank the hon. Gentleman for his kind welcome for what I have said and for all the work that he did on the Select Committee, which he chaired with great distinction. On these issues, he sometimes appears to be more supportive of the present Government than he was of the previous one. I do not want to ruin his reputation with his colleagues. He developed a reputation for saying what he believed to be true, which is a good reputation to have anywhere, particularly in the House of Commons. I share his view that unless those who are in favour of care in the community are willing to recognise its failings, we shall not be able to address those failings and get on with the rest of the task.
We do not want any loss of psychiatric beds that does not make sense. We have slowed the process of closure and have instituted an independent review, which is new. There may still be some cases in which moving people out of some of the remaining large hospitals is an appropriate response, but, as the hon. Gentleman says, if that is going to happen, the people must be moved to somewhere that is suited to their needs. I remember drawing the analogy when I was a shadow health spokesman a dozen or more years ago of looking at the old institutions as broken down motor coaches. What is needed is something approaching a custom-built vehicle for everyone who moves out. Sadly, a lot of them have been left to walk.
Audrey Wise (Preston):
I particularly welcome my right hon. Friend's reference to child and adolescent mental health services. I recommend that he ensures that his Department continues to keep an eye on that theme. When the Health Committee investigated the issue, it was concerned that neglect in childhood was worsening the situation for adult mental health. We were distressed to find that many of those engaged in child and adolescent mental health services felt that their service was a Cinderella of a Cinderella. I urge my right hon. Friend to keep his eye firmly on the issue for economic reasons as well as to ensure a good service.
Mr. Dobson:
I thank my hon. Friend for what she has said and for her contribution to thinking on the issue. The strategy document refers to the views of the Select Committee on that. The services for children and adolescents are a neglected part of an already neglected service. We want to put that right.
Mr. Peter Brooke (Cities of London and Westminster):
I thank the Secretary of State for his statement. Will he accept it from me that I have heard the president of the Royal College of Psychiatry say within the Palace that although the present policy constitutes major problems for those on the streets of the Secretary of State's constituency and mine, it has worked a good deal better in rural and suburban areas? Does the Secretary of State further agree that it is important that we achieve, if possible, as much of a bipartisan policy as
Mr. Dobson:
I accept most of what the right hon. Gentleman, who represents the neighbouring constituency to mine, says, but nobody could accuse me of bringing politics into this afternoon's statement.
Dr. Lynne Jones (Birmingham, Selly Oak):
I commend my right hon. Friend on the sensitivity of his statement. One of my earliest recollections is visiting my father in what was known locally as the loony bin, and having my clothes prodded by elderly ladies who were dressed in clothes from the communal store and who looked like children. God forbid that we should ever return to those days of dehumanising institutionalisation. However, the principle of care in the community is not a failure; it is the inadequacy of its resourcing. Will my right hon. Friend assure the House that there will be sufficient well-trained staff with manageable case loads to provide care and support for the majority of mentally ill people who are not a threat to the community, and who for too long have suffered in silence either alone or, if they are lucky, with their families who are equally in despair? Will he ensure that sufferers and their carers are involved in the development of new services? Perhaps he could also consider establishing a mental health ombudsman to look at complaints across the boundaries of social services and health services which so often failed in the past?
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