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10.32 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): I thank the hon. Member for New Forest, East (Dr. Lewis) for giving me notice of some of the points that he has made. I congratulate him on raising such an important subject tonight. I know that he has a long-standing interest in it: indeed, I believe that he is one of only a few hon. Members to have displayed such a continuing interest. I am grateful to him for giving me the opportunity to set out the Government's intentions in relation to mixed-sex accommodation in psychiatric units.
We should see the issue in the wider context of the Government's plans to modernise mental health services, which we outlined at the end of last year in the strategy document "Modernising Mental Health Services". In that document, we tried to make it clear that we wanted services to be safe, sound and supportive--safe to protect the public, patients and staff, providing effective care for those with mental illness at the time when they need it; sound to ensure that patients are given the best and most appropriate care and treatment in the right settings, and have access to the full range of services; and supportive through work with patients, carers and local communities to help people to lead lives that are as independent as possible.
Effective responses to mental health problems require three elements to be in balance: resources and the systems to make the best use of them, legislative powers, and the processes of care. Deficiencies in one area cannot be compensated for by change in another. Increasing resources--which we are doing--will not be cost-effective unless the necessary care processes are in place; strengthening legislative powers cannot overcome the problems of inadequate resourcing. We recognise that reform in all three areas is needed to modernise mental health services.
Our plans for mental health services, taken with our proposals for modernising health and social care, add up to a comprehensive set of policies that will provide a new vision for mental health services. Our new vision is underpinned by new investment--the hon. Gentleman did not refer to it, but I am sure he will not mind if I do--of £700 million over the next three years. That sum represents the largest single increase in investment in mental health services since the NHS was established in 1948. It will be supported by the development of a new mental health national service framework, which will set new service models, and by a review of the current legislation.
In planning for high-quality mental health and social care, we do not, unfortunately, start with a blank sheet of paper. Instead, we inherit a complex legacy of problems
in policy, planning and the patterns of service delivery. All those need to be addressed. That will take time, but the plans set out in "Modernising Mental Health Services" make clear the direction that we intend to take, with a clear set of objectives and a focus on new investment. "Modernising Mental Health Services" marks a new beginning for mental health provision in England.
On the situation regarding mixed-sex accommodation that we inherited from the previous Administration, it is worth pointing out to the hon. Gentleman, as I know that he has a balanced and sensible approach to these matters, that many of the problems that he rightly identified did not date from 1 May 1997. He will probably want to join me in regretting the fact that the previous Administration, whom he strongly supported, made such poor progress in eliminating mixed-sex accommodation in the NHS.
I am acutely aware of the concerns that have been raised about the safety of patients in psychiatric units. Like the hon. Gentleman, I have had meetings with former patients. I recently met four women who have at various times been patients in the Maudsley hospital. They expressed to me their serious concerns about harassment and serious assaults on acute psychiatric wards. I was extremely concerned by what those women told me of their own experiences. As we have done on previous occasions, I made it clear to them, and I do so again today, that we are committed to getting rid of mixed-sex accommodation in the NHS.
The hon. Gentleman developed his arguments in his comments. It might be helpful to him, and to all the other hon. Members who are present and who are clearly interested in the subject, if we start to define some of our terms. By "single-sex accommodation" we mean clearly defined, separate sleeping areas, separate day rooms and social areas, and separate toilets and washing facilities. Guidance will be issued that will state clearly that male and female toilets and bathing facilities should be located in separate areas, close to respective male and female sleeping areas.
The word "accommodation", about which the hon. Gentleman was concerned, means the whole range of buildings and types of living space used by patients in the NHS. It would be wrong for the hon. Gentleman to suggest that using the word "accommodation" is in any way a narrowing of our manifesto commitment to ensure the safety of women patients who use the NHS. We made a clear promise in our manifesto and we will keep it. I cannot make myself any clearer than that.
I was intrigued by some of the hon. Gentleman's comments. I have read the speech that he made when he introduced his Bill. He might be interested to reflect on some of the words that he used in that debate. Introducing clause 2, he said that it dealt with mixed-sex areas, not wards. He said:
I repeat that we will not tolerate violence against women anywhere in the NHS. We are determined that all women in mental health units should be assured of conditions that are safe and free from harassment and abuse. However, we cannot overnight repair the damage of many years' neglect and under-resourcing. The previous Government spoke much about safety, but we are determined to take action to make improvements to protect patients. We inherited a national health service badly in need of modernising, and that is particularly true of mental health services. We also need to bring about a change in culture. Outdated attitudes and practices have no part in the revitalised services that we want to bring about.
What action are we taking? We are taking action on several fronts. We have set the national health service objectives to implement our commitment to the elimination of mixed-sex accommodation. We are monitoring its performance in achieving those objectives and we are to issue further guidance on mixed-sex accommodation. We are investing in staff training and we will ensure that variations across the country are reduced through the implementation of the mental health national service framework, which, in turn, will be monitored and enforced by the Commission for Health Improvement.
I want to say a little more about each of those areas to show that a substantial amount of work is taking place to deliver our commitment to getting rid of mixed-sex accommodation. First, the NHS has been given three key objectives: to ensure that appropriate organisational arrangements are in place to secure good standards of privacy and dignity for all hospital patients; to achieve fully the patients charter standard for segregated washing and toilet facilities across the NHS; and to provide safe facilities for patients in hospital who are mentally ill which safeguard their privacy and their dignity. [Interruption.]
We have made it clear--I say this in response to the sedentary intervention from the hon. Member for Rutland and Melton (Mr. Duncan)--that we expect 95 per cent. of health authorities to have met those objectives by the end of 2002.
Last August, we issued a monitoring tool to ascertain the progress of the NHS towards achieving those objectives. That contained a checklist to assist health authorities in monitoring the processes in place to deliver good physical segregation of the sexes in hospital. It also included additional arrangements for mental health in-patient facilities.
The NHS executive has monitored progress in achieving the objectives that have been laid down and the Government have already published two reports, which show health authorities' progress in this area. A further monitoring report will be published in the spring. We continue to keep this issue high on the NHS agenda, through the performance management systems that we are introducing, and to check hospitals' capital plans to ensure that the money that they have been given contributes towards the elimination of mixed-sex accommodation. As
a clear signal of our commitment in that area, £70 million has been earmarked specifically for that purpose from the NHS capital allocation for next year.
The monitoring checklist produced by the NHS executive included specific points to check that the safety of patients in mental health units is maintained, but we want to go beyond that by producing more detailed guidance that specifically addresses the issues for vulnerable, mentally ill people in hospital. Although there are constraints on the ability of NHS trusts to maintain the best standards in their existing stock of buildings, they must do what they can, within the constraints of the accommodation, to protect patients' privacy and dignity.
We have made it clear that new developments must achieve best practice standards in providing separate accommodation for the sexes. Each of the new schemes is being scrutinised by the regional offices to ensure that they eliminate problems and that they comply fully with the patients charter requirements.
When I addressed a conference of hospital designers and service providers last month, I announced that we would be issuing further guidance for mental health units in the late spring. That guidance will help to inform discussion locally about how to achieve the targets of privacy and dignity. It will also contain examples of good building design and solutions to varying ward layouts and requirements for operational policies that ensure the safety, privacy and dignity of all patients within the NHS.
We want to ensure that trusts have proper management policies in place and protocols to prevent assaults. The guidance will also give advice on what to do, both at trust management level and at individual ward level. It will cover such issues as the assessment of each individual's needs and the risks that they may present; speedy, robust arrangements to deal effectively with staff, or patients, who sexually abuse or harass patients; and monitoring of complaints to enable identification of problems over the care and treatment of women patients.
The guidance will also make it clear that each ward should have a written policy relating to the safety of women and that a designated officer at senior level in the trust should have overall responsibility for the safety of women. I could say more, but we will shortly run out of time.
All those requirements will be reflected in the mental health national service framework, which will specifically address unacceptable variations in services across England. It will set national standards for health and social care and establish performance indicators to measure the progress made by those services.
"I am not talking about big open spaces with male patients at one end of the room and female patients at the other, but all wards should have an area reserved for women if they want that. It would be a refuge room not unlike the ladies waiting rooms provided at some railway stations for women who want to wait in a women-only environment."--[Official Report, 12 December 1997; Vol. 302, c. 1267.]
I was rather surprised by the tone of some of the hon. Gentleman's remarks today expressing his concern about the use of the word "accommodation," which I do not think can be justified by what we have said.
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