Select Committee on Health Memoranda


MEMORANDUM

Memorandum by the Department of Health

Table 2.4.10

ADMISSIONS TO PRIVATE FACILITIES UNDER THE MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL: 1997-98, ENGLAND (1)

Numbers

Admitted
to hospital
under Section
Subject to
Section after
admission (2)

Private facilities by RO and HA area
England
957
486
Northern and Yorkshire
37
4
   Bradford
1
   County Durham
4
3
   Newcastle & North Tyneside
1
   Tees
1
   North Yorkshire
30
1
Trent
17
   North Derbyshire
12
   South Derbyshire
1
   Lincolnshire
4
Anglia and Oxford
143
45
   Berkshire
49
   Buckinghamshire
6
   Cambridge & Huntingdon
16
   East Norfolk
10
   Northamptonshire
39
45
   Suffolk
23
North Thames
507
240
   Kensington, Chelsea & Westminster
267
69
   Enfield & Haringey
48
85
   Redbridge & Waltham Forest
27
7
   Barnet
2
   Brent & Harrow
96
4
   Ealing, Hammersmith & Hounslow
38
42
   North Essex
29
33
South Thames
130
112
   Bromley
11
22
   West Kent
31
30
   Lambeth, Southwark & Lewisham
5
3
   Merton, Sutton & Wandsworth
54
13
   East Surrey
8
2
   West Surrey
9
7
   East Sussex, Brighton & Hove
12
35
South and West
63
61
   Portsmouth & South East Hampshire
2
   Southampton & South West Hampshire
22
40
   South & West Devon
1
   Wiltshire
1
   Avon
23
7
   Cornwall & Isles of Scilly
4
3
   Dorset
7
11
   Gloucestershire
3
West Midlands
17
4
   Birmingham
6
4
   Dudley
1
   North Staffordshire
7
   South Staffordshire
3
North and West
43
20
   Manchester
5
3
   Salford & Trafford
4
3
   Stockport
28
7
   North Cheshire
3
2
   South Cheshire
4
   East Lancashire
2
1
   Wirral
1


Footnotes:

1. The table only includes health authorities in which there were private mental nursing homes that had detained patients during the year.

2. Includes all changes from informal status to detention under the Act, and detentions where the patient was initially brought to hospital under Section 136 (Place of Safety Order).

 APPEALS

8. The Mental Health Review Tribunal hears applications and references by and on behalf of patients detained under the Mental Health Act 1983. Applications are also heard from patients subject to Guardianship and Aftercare under Supervision. Most of the hearings are a result of the patient or the patient's legal representative making application.

9. The act also places a duty on the Hospital Managers to refer a case to the tribunal at the end of specified periods if no application is made in respect of the patient during that time. The Home Secretary is also obliged to refer restricted patients cases at the end of specified periods and has a discretion to refer cases at any time.

10 .In the year 1998 to 1999 there was a total of 17,544 applications and references and 8,694 hearings. These hearings resulted in the discharge (either absolute, conditional or delayed) of 962 patients from detention.

NEW SECTIONS 45A AND 45B

11. The provisions were introduced by section 46 of the Crime (Sentences) Act 1997 and came into effect on 1 October 1997. They make available to the higher courts the power to make hospital and limitation directions when imposing a prison sentence on an offender. The intention of these provisions is to give the courts greater flexibility in sentencing mentally disordered offenders. They were intended to ensure that:

    (I)  the courts retained an avenue to order hospital treatment when passing the mandatory life sentence (at section 2 of the 1997 Act),

    (ii)  that psychiatrists giving evidence to sentencing courts should not be inhibited from offering beds for the treatment of psychopaths by the risk of the offender proving untreatable, and

    (iii)  that the courts should be able to make a tariff in those cases where the offending behaviour was not directly linked to the offender's mental disorder.

12. The new power is only available initially where the offender is suffering from psychopathic disorder and can only be used for people who are convicted of offences which took place after 1 October 1997. To date it has been applied only once.

13. The effect of the power is that the sentenced offender remains detained for the duration of the tariff, and can remain in hospital for as long as he is benefiting from treatment. If treatment is completed, or the offender does not appear to be benefiting from treatment, the offender can be transferred back to prison to complete his sentence.

SPECIAL HOSPITALS, REGIONAL SECURE UNITS AND PRISONS

14. The attached table shows the total number of patients in the high security hospitals at 31 December in each of the last four years and the number of patients who were classified as having a learning disability. Patients with learning disabilities may also have mental health problems.

Table 2.4.11

TOTAL NUMBER OF PATIENTS RESIDENT IN HIGH SECURE HOSPITALS


As at
Ashworth
Broadmoor
Rampton
Total

31.12.94
522
441
483
1,446
31.12.95
504
454
432
1,390
31.12.96
473
444
453
1,370
31.12.97
456
440
454
1,350
31.12.98
426
426
457
1,309


TOTAL NUMBER OF PATIENTS WITH LEARNING DISABILITIES IN HIGH SECURE HOSPITALS


As atAshworth BroadmoorRampton Total

31.12.94481 93142
31.12.95360 107143
31.12.96250 108133
31.12.97180 111129
31.12.9890 104113


  15.  Table 2.4.12 shows the total number of medium and low secure places in Regional Secure Units for mental illness and learning disability as at September 1998. This data is not available in this form for previous years and was collated on the basis of the unit's own perception of what they regard as medium or low secure provision. It is the most up to date and accurate picture we have.

  16.  In asking for data in each of the last four years, the Committee might like to know that the development of the medium secure unit programme has had a number of features which has made it difficult to maintain a consistent picture over this period. The Department's central capital programme (1991 to 1995) of £47 million had as its central aim, the procurement of 1,250 medium secure places in the NHS but it is not unusual for a long term programme to be modified along its path and this has been the case here.

  17.  Examples of this have been the additional local financial support by the NHS regions resulting in an alteration in the original number of places anticipated, a change or mix of specification of some units to include low secure provision taking account local assessment of need and "interim" secure places being put into place prior to or overlapping with the opening of a RSU, perhaps only for a short interval of time. One other "complication" in trying to compile figures has been the growth in the private sector provision.

  18.  Finally, as with many data collection systems, it is often the case that the sophistication improves over time so the earlier data we have does not show or match the accurate picture of what is currently in place as per Table 2.4.12. Examples of earlier gaps include little by way of low secure provision, some units either included or excluded what might be called "hostel" places which were located on the RSU site but were in effect, pre-discharge rehab units, some included or excluded the interim units and there was little or no data about places for people with learning disability.

Table 2.4.12

TOTAL NUMBER OF MEDIUM AND LOW SECURE PLACES IN REGIONAL SECURE UNITS


MENTAL ILLNESS
LEARNING DISABILITY

Medium Secure
Low Secure
Medium Secure
Low Secure

Units
Places
Units
Places
Units
Places
Units
Places

NHS
28
1,081
76
1,127
8
178
5
122
Private
6
426
4
95
1
19
Totals
34
1,507
80
1,222
9
197
5
122


  19.  The health of prisoners is the responsibility of the Directorate of Health Care of the Prison Service. We cannot state precisely how many people with mental health problems and learning disabilities have been in prison custody in each of the last four years. However, information on the incidence of mental health problems in prisons is available in the report of the 1997 survey of Psychiatric Morbidity among Prisoners in England and Wales carried out by the Office for National Statistics on behalf of the Department of Health, with the support of the Prison Service. (Copies of the full survey report and the summary are available should the Committee wish to see them).

  20.  The numbers of prisoners transferred to psychiatric hospitals for in-patient treatment as restricted patients by direction of the Home Secretary under section 47 and 48 of the Mental Health Act 1983 as follows:

    1997  745
    1996  745
    1995  723
    1994  785

  These are calendar years taken from the Home Office Statistical Bulletin 19/98 Statistics of Mentally Disordered Offenders in England and Wales 1997.

  2.5  How much has the Department allocated to voluntary organisations each year for the past five years?

  1.  The Department's expenditure is not recorded according to the status of the recipient and accounts records are not in a form which allows the reliable extraction of the information requested. Manual data extraction has identified payments for voluntary organisations in the last five years, which are shown in Table 2.5.1.

  2.  Table 2.5.2 provides a breakdown of the allocations to voluntary organisations from 1994-95 to 1998-99.

Table 2.5.1:
PAYMENTS TO VOLUNTARY ORGANISATIONS, 1994-95 to 1998-99


Summary
£ million

1994-95
52.6
1995-96
55.6
1996-97
63.3
1997-98
60.9
1998-99
53.8

Footnotes

  1.  These funds exclude amounts paid through other organisations (including the NHS).

Table 2.5.2 ALLOCATIONS TO VOLUNTARY ORGANISATIONS

£ million
(cash)

1994-95
1995-96
1996-97
1997-98
1998-99

VOTE 1
Hospital chaplains
0.158
0.163
0.162
0.162
0.162
NHS Retirement Fellowship
0.031
0.032
0.030
0.027
0.047
NHS Pensioners Trust
0.005
0.025
0.025
0.025
Kings Fund
0.665
0.697
0.687
0.618
0.366
   
VOTE 2
Family Support
0.500
Out of school
0.500
Child care circles
0.200
Parenting
0.100
0.200
Refocusing Initiative
0.800
0.300
0.482
Ethnic minority health issues
0.410
0.304
0.305
0.280
0.364
Contraceptive Education Services
1.056
0.994
0.903
Training medical staff
0.012
0.031
0.008
0.004
0.074
Haemophiliacs with HIV
2.500
3.000
Thalidomide Trust
7.000
Training in the care of people with learning difficulties
0.059
0.119
0.125
0.105
0.090
Opportunity for Volunteering
7.858
8.952
9.101
9.101
9.103
Community Care
0.120
0.058
0.004
0.012
0.186
Family Fund
17.183
17.955
16.885
18.196
16.991
British Council of Disabled People
0.008
0.008
0.008
0.008
0.008
Royal Association for Disability/Rehab
0.024
0.024
0.024
0.024
0.024
UK Disability Database
0.174
0.148
0.125
0.099
0.111
Social work training initiatives
1.295
1.230
1.229
1.312
0.982
Domestic violence
0.049
0.049
0.049
0.049
0.049
Drinkline and Alcohol Concern
1.176
0.763
1.263
1.313
0.659
Services for addicts
0.152
0.161
0.170
0.043
0.033
AIDS/Drugs Helpline
2.100
1.569
1.569
1.569
Targeted HIV prevention
0.800
1.100
1.514
Targeted HIV Prevention for African Communities
0.128
World AIDS Day
0.071
0.071
0.096
Funding for African Communities
0.140
0.075
Section 64 grants
19.863
20.262
21.317
21.785
20.532
Health promotion: Teenage sex projects
0.050
Health promotion: Black and ethnic minority groups
0.027
National Heart Forum
0.171
0.171
0.171
Pharmacy health care scheme
0.322
0.323
0.303
Health promotion: Drugs prevention
0.614
Health promotion: Accidents
0.105
   
TOTAL
52.637
55.552
63.307
60.939
53.843





 
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Prepared 18 October 1999