Select Committee on Health Minutes of Evidence


Memorandum by the Department of Health

PROVISION OF NHS MENTAL HEALTH SERVICES (MH 1)

EXECUTIVE SUMMARY

  1.  Mental health services are a priority for this Government, confirmed in the most recent National Priorities Guidance (2000-03). Developments in mental health services are being carried out in the context of the Government's White Paper: The new NHS, Modernising Social Services and Saving Lives: Our Healthier Nation.

  2.  The Government's strategy for mental health is set out in Modernising Mental Health Services (published in December 1998) and is designed to improve mental health services as part of the overall programme to modernise the health and social care system. It proposed action in three areas:

    —  New investment and systems to manage resources more effectively;

    —  Revised legislative powers, taken forward through the review of the 1983 Mental Health Act and consultation on the management of dangerous people with severe personality disorder;

    —  Properly integrated care processes, which cross professional and organisational boundaries, taken forward through the implementation of the National Service Framework.

Mental Health National Service Framework

  3.  The National Service Framework addresses the mental health needs of working age adults, and sets out seven standards of care which cover health promotion, assessment and diagnosis, treatment, rehabilitation and care, and encompasses primary and specialist care and the roles of partner agencies.

  4.  Implementation of the National Service Framework will begin in April 2000 and will represent a long term programme requiring sustained, concerted and systematic action to combat long-standing and complex problems. The initial focus will be on providing safe services.

  5.  The National Service Framework contains a clear set of timetables, national milestones with high-level performance indicators covering inputs, processes and outcomes.

  6.  As well as ensuring continuing financial support for the National Service Framework, local delivery of the Framework is being supported by four other underpinning national programmes:

    —  Workforce development.

    —  Research and development.

    —  Clinical decision support systems.

    —  Information strategy.

Additional Investment

  7.  Additional investment of £700 million has been provided for health and social services over the three years 1999-2002 to modernise mental health services. In 1999-2000 £128 million extra has been invested in mental health services for adults of working age, and £20 million for children and adolescents.

Secure Mental Health Services

  8.  The Government believes that partnerships and integrated service development within the wider NHS and other statutory and voluntary agencies are priorities for modern secure psychiatric services, and will end the isolation of the high security service. The provisions in section 41 of the Health Act 1999 are designed to help address the current problems of isolation by allowing the high security hospitals to join with other mental health NHS Trusts.

  9.  Following the publication of Judge Fallon's report into the personality disorder unit at Ashworth Hospital, the three high security hospitals have been working closely with the NHS Executive Regional Offices to implement the recommendations of the inquiry and improve service delivery and security at the hospitals.

  10.  To ensure the continued development of appropriate low and medium security mental health services, £14 million was specifically made available from the Modernisation Fund for Mental Health in 1999-2000 for new additional secure places, and a further £15 million has been allocated for 2000-01.

Prison Health Care Services

  11.  A report on The Future Organisation of Prison Health Care undertaken by a joint Prison Service and NHS Executive Working Group (March 1999) recommended that prisoners should have access to the same quality and range of health care services as the general public receives from the National Health Service. The Working Group made several recommendations regarding the provision of mental health services to prisoners, in particular that the care of mentally ill prisoners should develop in line with NHS mental health policy and the National Service Framework, including new arrangements for referral and admission to high and medium secure psychiatric services.

  12.  The Government has accepted the Working Group's recommendations and two new joint units have been created, located within the NHS Executive, to lead and manage the process of change. The Prison Health Policy Unit is working to ensure that the right policies are in place to give a clear strategic direction and guidance, and the Prison Health Care Task Force supports the delivery of change in the field.

Dangerous People with Severe Personality Disorder

  13.  A consultation paper, Managing Dangerous People with Severe Personality Disorder: proposals for policy development, was published in July 1999 by the Department of Health and the Home Office. The paper set out options which include both legislative and organisational changes. The consultation period ended on 31 December 1999 and the responses will be considered alongside those from the Reform of the Mental Health Act 1983. The Government recognises that, whatever option is chosen for longer-term policy development, there is a need to develop capacity within existing prison and health service structures to manage dangerous people with severe personality disorder more effectively. As a first step a number of pilot projects will be set up to test the procedures that might be used to assess risk and symptoms of personality disorder.

Child and Adolescent Mental Health Services

  14.  Since 1997, when the Government published its response to the Health Select Committee's report on Child and Adolescent Mental Health Services, the focus of the Department's work in this field has been to address acknowledged deficiencies in the range, quality and distribution of services. In particular this has involved up-dating the information base and setting specific development objectives underpinned by additional resources.

Reform of the 1983 Mental Health Act

  15.  The Government published proposals for a modern legislative framework for mental health in a Green Paper, Reform of the Mental Health Act 1983, on 16 November 1999. These proposals are out to consultation until 31 March 2000. The Green Paper is broadly based on the framework suggested by the expert committee chaired by Professor Genevra Richardson, although not all of their proposals are accepted. The focus is on managing risk and providing better health outcomes for patients in a way that strikes the right balance between public safety and the rights of individuals.

Conclusions

  16.  This represents an ambitious agenda, developing modern mental health services which are culturally appropriate and which reflect the needs and wishes of service users and their carers.

Annexes

  18.  Four annexes to this memorandum cover the specific issues raised by the Committee in their terms of reference:

    Annex A:  Current Government Definitions and Categorisation of Mental Illness.

    Annex B:  The ability of "Care in the Community" to cater for people with acute mental illness.

    Annex C:  The transition between acute and secure mental health sectors.

    Annex D:  The transition between adolescent and adult mental health services.


 
previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2000
Prepared 9 May 2000