Select Committee on Health Memoranda

MEMORANDUM BY THE DEPARTMENT OF HEALTH (CONT.)

  2.3  Expenditure on Community Care

Could the Department provide a table showing, by service, net expenditure in real terms by central and local government on community care, broken down by residential and non-residential care (taking into account relevant service pay and price increases), over the most recent five year period for which such data are available? Could this data include Social Security and Housing expenditures contributing to Community Care objectives? Could it also show this data in graphical form?

  1.  Table 2.3.1 provides details of central and local government net expenditure on services for community care in England, for 1994-95 to 1998-99, the latest year for which information is available. All figures have been adjusted to 1998-99 prices using the latest Gross Domestic Product (GDP) deflator. The reason for using the GDP deflator is that there is no single service pay and price index that would be appropriate for all sectors.

  2.  Community care expenditure is taken to mean expenditure on non-residential and residential care provided or arranged by local authorities for adults; community health services provided by the NHS for adults; certain social security benefits which support community care objectives; and certain expenditure on housing. Calculation of local authority expenditure by client group involves a degree of estimation.

  3. The data in the table are set out in graphical form in figure 2.3.1. The graph illustrates annual expenditure at constant prices since 1994-95, with the figures for 1994-95 indexed to 100. DSS payments in support of community care, local authority expenditure on non-residential care and expenditure on community health services have all grown significantly in real terms over the period. DSS expenditure in support of residential care has declined as a direct result of the April 1993 community care reforms. These reforms transferred care management and funding responsibilty for new admissions to independent sector care homes to local authorities and ended the former system of higher Income Support payments for people in such homes, unless they had preserved rights. The number of preserved rights cases has declined substantially over this period. For admissions since April 1993, Income Support has been payable to people in independent sector care homes in broadly the same way as it is payable to people in their own homes. Expenditure on housing associated with community care fluctuated over the five year period. On a comparable basis, expenditure on housing in 1998-99 is very slightly higher in real terms, than in 1994-95.

Table 2.3.1

NET EXPENDITURE ON SERVICES FOR COMMUNITY CARE (1998-99 PRICES) ENGLAND

£ million		1994-95	1995-96	1996-97	1997-98	1998-99
A.	Local Authority Non Residential Care (1) Home Care/ Home Helps	952	1,020	1,072	1,115	1,120
	Meals at Home	47	46	49	49	46
	Disability Equipment and Adaptations	62	77	76	75	65
	Day Centres for Older People	143	153	153	158	164
	Day Centres for Other Adults	439	446	454	454	473
	Care Assessment, Management and Administration (2)	1,078	1,168	1,179	1,187	1,229
	Total A	2,720	2,910	2,984	3,039	3,097
B.	Community Health (3)(4)(5)(6)(7)(8)(9) Chiropody	93	100	82	81	91
	Family Planning	60	65	53	52	60
	Immunisation and Surveillance	3	3	3	3	3
	Screening	59	65	52	53	61
	Professional Advice and Support	105	110	95	93	115
	General Patient Care	809	853	909	905	998
	Community Mental Illness	303	353	436	495	551
	Community Learning Disability Nursing	232	240	282	330	366
	Health Promotion	62	67	51	48	55
	Services to GPs Under Open Access	219	252	188	190	220
	Other Community Health Services	276	320	267	260	328
	Total B	2,221	2,428	2,418	2,510	2,848
	Total A plus B	4,941	5,338	5,402	5,549	5,945
C.	Local Authority Residential Care for (1) (2) Elderly People	1,352	1,564	1,775	1,832	1,869
	Younger Physically Disabled People	110	120	138	143	150
	People with Learning Disabilities	390	440	495	525	560
	People with Mental Health Problems	88	107	128	143	148
	Administration and Other	267	278	293	310	302
	Total C	2,207	2,510	2,829	2,952	3,029
D.	Income Support:—Residential Care, Nursing Homes and Residential Allowance Cases (10-13)	2,112	1,872	1,749	1,600	1,450
	Total C plus D	4,319	4,382	4,578	4,552	4,479
E.	Other Social Security Benefits Attendance Allowance (14) (15)	1,868	1,994	2,103	2,240	2,201
	Disability Living Allowance (14) (15)	2,824	3,337	3,717	4,146	4,272
	Invalid Care Allowance	481	549	662	636	636
	Independent Living Fund (16)	97	98	99	94	95
	Social Fund Community Care Grants	109	105	102	100	98
	Total E	5,380	6,083	6,683	7,217	7,302
F.	Housing LA Expenditure on Own Stock; New House building for the Elderly and Disabled (17)	n/a	7	3	3	3
	Housing Corporations; ADP Approvals (18)	149	80	120	63	71
	LA Grants; Disabled Facilities Grants (19)	103	107	106	103	108
	LA Expenditure on Own Stock; Adaptations to all LA Dwellings for Older People and Disabled Adults (20)	n/a	82	83	82	90
	LA Expenditure on Own Stock; Renovation of Specialised Dwellings for Older People and Disabled Adults (21)	34	n/a	n/a	n/a	n/a
	Total F	295	276	312	251	272
	Total E+F	5,676	6,359	6,995	7,468	7,574
	Grand Total A to F	14,936	16,079	16,975	17,568	17,998

Footnotes to table:

Parts A and C

  1.  Local Authority expenditure is obtained from the RO3 current expenditure return.

  2.  Care assessment, management and administration, although included under local authority non-residential care in Part A, also includes expenditure which is relevant to residential care (Part C).

Part B

  3.  As it is not possible to supply net expenditure figures from the HCHS programme budget, figures are gross expenditure and this may mean that they are slightly overstated.

  4.  Figures derived from HCHS programme budget analysis. It has been assumed that approximately 90 per cent of chiropody, 95 per cent of Family Planning, 1 per cent of Immunisation and Surveillance, 100 per cent of screening, 35 per cent of professional advice and support, 95 per cent of total general patient care, 95 per cent of community mental illness nursing, 80 per cent of community learning disability nursing, 70 per cent of Health Promotion and Services to GPs under open access and other community spending is on adults. It has also been assumed that 100 per cent of maternity care is spent on the delivery and no costs are associated with the mother, and 100 per cent of community dental is spent on children.

  5.  The above allocations have been taken from the Expenditure per head of population exercise.

  6.  Administration cost for community health services are not separately identifiable and are not included in the Community Health figures.

  7.  Prior to 1996-97 monies provided for GP fundholders to purchase HCHS was exclusively allocated to General and Acute care. A more realistic allocation of expenditure shows that community services comprised a part of this expenditure. Hence figures for 1996-97, 1997-98 and 1998-99 are not directly comparable with previous years.

  8.  In 1996-97 several categories of the programme budget were affected by the changes to accounting practice and the changing structure of the NHS. Included in these was the need to capitalise redundancy payments and recharges were no longer included.

  9.  Figures for 1998-99 are provisional. 1997-98 figures shown in last year's evidence have been replaced with final versions.

Parts D and E

  10.  Source: Income Support Statistics Quarterly Enquiries May 1998 to February 1999 inclusive. Based on a 1 per cent sample up to and including February 1994 and a 5 per cent sample thereafter. Estimated Annual Income Support expenditure is based on numbers and average weekly payments in the enquiry week, and is based on a four quarterly average.

  11.  Expenditure is based on Preserved Rights Residential Care and Nursing Home cases, and Residential Allowance cases for England.

  12.  Excludes unemployed claimants who are now provided for by Jobseeker's Allowance.

  13.  Based on Government Office Region.

  14.  Estimated Attendance Allowance and Disability Living Allowance figures are produced by apportioning out-turn figure for England by average payment, in week ending February 1999.

  15.  Disability Living Allowance replaced Attendance Allowance (for people under 65) in 1992.

  16.  Expenditure for Independent Living Fund figures estimated as 85 per cent of Great Britain figures detailed in the DSS Departmental Report 2000.

Part F

  17.  The majority of new social housing (including for elderly or disabled people) is now provided by Housing Associations rather than Local Authorities. The figure quoted for 1998-99 is provisional.

  18.  Housing Corporation Approvals for capital expenditure, by Registered Social Landlords, through the Approved Development Programme (ADP), for homes for rent and sale to certain "special needs" groups (frail elderly people, people with mental health problems, people with learning difficulties, people with physical disabilities) and one "general needs" group, (elderly with warden support).

  19.  Disabled Facilities Grants are paid to the private sector and to Health Authority and Local Authority tenants. Figures shown are the total of mandatory and discretionary grants paid under the Local Government and Housing Act 1989 and Housing Grants, Construction and Regeneration Act 1996.

  20.  Collection of expenditure figures for Adaptations to all Local Authority Dwellings for Older People and Disabled Adults began in 1995-96. Figures for 1997-98 and 1998-99 are still subject to final validation, and should be regarded as provisional.

  21.  Collection of these figures ceased in 1995-96.

2.4  Care of Mental Health and Learning Disability Patients

(i)   Could the Department update the information given in Tables 2.4, on patients under the care of a learning disability or mental illness consultant, discharges by length of stay, ages and destination, and residential and other places available? Could the Department identify the number of individuals concerned, and hence the number of repeat discharges?

(ii)   Could the Department provide a table showing:

(a)   number of people sectioned, by trust and by type of section?

(b)   number of people sectioned in proportion to HA population? If the data are not available, will the Department consider obtaining it from the HES?

(c)   number of people sectioned in proportion to number of admissions?

(d)   proportion of people who appeal against being sectioned and the outcomes of the appeals?

(iii)   Could the Department provide a table showing, over the last four years, the numbers of people with mental health problems and with learning disabilities who have been in special hospitals, prisons and regional secure units?

(iv)   Could the Department provide any useful data and knowledge on the survey of the incidence of mental health problems in the prison population?

INTRODUCTION

  1.  Tables 2.4.1, 2.4.3 and 2.4.5 present information on in-patients under the care of a learning disabilities specialist. Similar information for patients under the care of a mental illness specialist is given in tables 2.4.2, 2.4.4 and 2.4.6.

  2.  Tables 2.4.7 and 2.4.8 present information on beds available in the NHS and private nursing facilities and places in residential care for people with learning disabilities.

  3.  Tables 2.4.1 to 2.4.6 are derived from the Hospital Episode Statistics (HES) system. The figures in tables 2.4.3 to 2.4.6 are estimates and provisional. In tables 2.4.1 and 2.4.2, figures for 1997 are not available.

CARE OF PATIENTS UNDER LEARNING DISABILITY AND MENTAL ILLNESS SPECIALTIES

  4.  The estimated number of in-patients under the care of the mental handicap specialty, at the end of each year, fell to 7,100 in 1999 from 34,200 in 1986—Table 2.4.1. This is mainly due to the fall in the number of very long stay patients, from 27,400 to 3,100 over the period. This fall in the number of very long stay patients resulted from the closure of long stay units and resettlement of patients in the community.

  5.  This is matched with a decrease in the number of in-patients under the care of mental illness specialists, at the end of the year, to 30,800 in 1999 from 60,300 in 1986. Again, this is due mainly to large falls in the number of long stay patients Table 2.4.2.

  6.  There has, however, been a substantial increase in the number of short stay episodes for learning disability. Provisional estimates show that 74 per cent of patients discharged in 1998-99 had been in hospital for less than a week. This compares to 58 per cent of those discharged in 1986—Table 2.4.3; this probably reflects the increased provision of respite care.

  7.  Table 2.4.4 shows an increase in the number of short stay episodes of mental illness in-patient care; there were an estimated 133,000 discharges in 1998-99 with a stay of under one month, compared to 116,000 discharges in 1986.

  8.  Table 2.4.5 shows that most learning disability patients under 65 discharged after a length of stay of less than a year return to their usual place of residence (98 per cent in 1998-99). This compares with an estimated 88 per cent for mental illness patients in the same year, Table 2.4.6.

  9.  In the case of learning disability patients aged 65 or over, 76 per cent return to their usual place of residence with a further 13 per cent transferred to other NHS trusts. This compares to 74 per cent and 10 per cent respectively for mental illness patients.

  10.  Of the learning disability patients under 65 discharged after a stay of a year or more (an estimated 1,250 in 1998-99), 23 per cent returned to their usual place of residence, 39 per cent transferred to another NHS trust and 29 per cent to local authority homes or other non-NHS institutions. In comparison, mental illness patients (as estimated 2,280 in 1998-99), 47 per cent returned to their usual place of residence, 30 per cent transferred to another NHS trust and only 12 per cent to local authority homes or other non-NHS institutions.

  11.  Only an estimated 200 learning disability patients aged 65 or over were discharged after a stay or a year or more in 1998-99, compared with 940 for mental illness patients; the estimates of destination on discharge are based on small numbers and are unlikely to be reliable.

  12.  Table 2.4.7 shows that, in NHS facilities, the average daily number of beds on wards for patients with learning disabilities has fallen to 11,500 in 1998-99 from 30,100 in 1988-89. There has been a fall in the average daily number of beds available for mentally ill patients in NHS facilities to 37,100 in 1998-99 from 63,000 in 1988-89—Table 2.4.8. The number of long stay adult beds in learning disability wards has fallen to 5,300 in 1998-99 from 28,400 in 1988-89 with little change in the number of short stay beds. Similarly the number of long stay beds in mental illness wards has fallen to around a third of the number in 1988-89 with only a slight drop in the number of short stay beds.

  13.  In private nursing homes the number of learning disabilities beds for adults has increased almost three fold over the ten year period to 3,740 beds in 1998-99. In staffed residential care (excluding small homes), the number of beds for adults has almost doubled in the 10-year period to 42,600 in 1998-99. Residential places for children decreased to 1,600 in March 1999 from 2,000 in March 1989.

  14.  The number of mental illness beds in private nursing homes and hospitals increased to 30,400 in 1998-99 from 5,900 in 1988-89. Most of the increase was in places for elderly patients. In addition, a change in the method of data collection in 1997-98 may also have had an effect on these figures.

NUMBER OF REPEAT DISCHARGES IN TABLES 2.4

  15.  The number of repeat discharges is not available. As a measure, it might anyway be regarded as ambiguous without a specification of the time interval between discharges.

  16.  The Department does, however, compile, as an indicator, the number of emergency psychiatric re-admissions. It is important to note that the exact definition and coverage of this indicator differs in some respects from that applied to psychiatric discharges in Tables 2.4.3 and 2.4.4.

  17.  Emergency psychiatric re-admissions are defined as patients aged 16-64 re-admitted as an emergency to the care of a psychiatric specialist within 90 days of discharge. These include patients under the care of a consultant with Mental Illness, Forensic Psychiatry and Psychotherapy specialties (ICD codes: 710, 712 and 713) excluding those with a primary diagnosis of drug dependency, alcohol dependency or eating disorder.

  18.  In 1998-99 the number of emergency re-admissions in England were 15,700 compared to 120,700 discharges in the same year (discharges are measured with the coverage described above for psychiatric re-admissions). This represents a re-admission rate of 13 per cent.

Table 2.4.1

PATIENTS UNDER THE CARE OF A LEARNING DISABILITIES CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1986, 1992 TO 1999 (2)

Estimated numbers and rates per 100,000 population

Duration of stay	1986	1992	1993	1994	1995	1996	1997 (1)	1998	1999
Number of patients
All Durations	34,200	19,600	16,000	13,900	11,400	10,500	-	8,400	7,100
Under 1 year	2,700	2,800	2,500	2,400	2,200	2,000	-	1,900	1,950
1 to 2 years	1,300	1,100	1,700	1,600	1,200	1,100	-	800	650
2 to 3 years	1,100	800	1,000	1,200	1,000	600	-	650	500
3 to 5 years	1,700	1,300	1,400	1,300	1,000	900	-	700	900
5 years and over	27,400	13,600	9,400	7,400	6,100	6,000	-	4,400	3,100
Rates per 100,000 population
All Durations	72	41	33	29	23	21	-	17	14
Under 1 year	6	6	5	5	5	4	-	4	4
1 to 2 years	3	2	4	3	2	2	-	2	1
2 to 3 years	2	2	2	2	2	1	-	1	1
3 to 5 years	4	3	3	3	2	2	-	1	2
5 years and over	58	28	28	15	13	12	-	9	6

  Source:   HES.

Footnotes:

  1. Figures for 1997 are not available. Required data not collected from Trusts.

  2. Figures for 1992 to 1999 have been estimated from the number of unfinished consultant episodes at 31st March. They are estimates based on returns to the Department from RHA's and Trusts and are not directly comparable with figures for earlier years. The 1986 estimate is a projection from a 1971 base year.

Table 2.4.2

PATIENTS UNDER THE CARE OF A MENTAL ILLNESS CONSULTANT AT 31 MARCH BY DURATION OF STAY, ENGLAND: 1986, 1992 TO 1999 (2)

Estimated numbers and rates per 100,000 population

Duration of stay	1986	1992	1993	1994	1995	1996	1997 (1)	1998	1999
Number of patients
All Durations	60,300	45,100	39,500	36,400	34,800	34,600	—	31,750	30,800
Under 1 year	26,000	25,500	22,200	22,400	20,800	22,500	—	23,500	22,900
1 to 2 years	6,600	4,200	4,600	4,200	4,300	3,000	—	2,700	2,750
2 to 3 years	3,600	2,900	2,800	2,100	2,500	2,500	—	1,450	1,500
3 to 5 years	4,600	4,400	3,500	2,400	2,400	2,400	—	1,750	1,600
5 years and over	19,700	8,200	6,400	5,400	4,700	4,100	—	2,350	2,050
Rates per 100,000 population
All Durations	128	94	82	75	71	71	—	64	62
Under 1 year	55	53	46	46	43	46	—	48	46
1 to 2 years	14	9	10	9	9	6	—	5	6
2 to 3 years	8	6	6	4	5	5	—	3	3
3 to 5 years	10	9	7	5	5	5	—	4	3
5 years and over	42	17	4	11	10	8	—	5	4

  Source:   HES.

Footnotes:

  1.  Figures for 1997 are not available. Required data not collected from Trusts.

  2.  Figures for 1992 to 1999 have been estimated from the number of unfinished consultant episodes at 31st March. They are estimates based on returns to the Department from RHA's and Trusts and are not directly comparable with figures for earlier years. The 1986 estimate is a projection from a 1971 base year.

Table 2.4.3

ESTIMATED DISCHARGES OF LEARNING DISABILITIES PATIENTS FROM NHS FACILITIES BY DURATION OF STAY 1986 AND 1992-93 TO 1998-99 (1)

England    Number and percentages

Duration of stay	1986	1992-93	1993-94	1994-95	1995-96	1996-97	1997-98 (2)	1998-99 (2)
All durations (3)	41,240	54,620	53,400	54,820	53,680	54,910	55,900	51,300
Under 1 week	23,890	37,240	38,730	40,520	39,940	40,800	41,790	37,750
1 week	12,270	11.230	10,600	10,780	10,190	9,820	10,430	9,920
1 month	1,180	1,220	1,080	1,110	1,010	1,190	1,150	1,000
3 months	970	1,040	870	800	760	940	830	830
1 year	310	480	370	320	340	310	400	310
2 years	430	530	380	370	440	430	400	390
5 years	460	480	210	160	140	230	170	180
10 years+	1,740	2,410	1,160	740	820	1,150	570	570
Duration unknown	0	0	0	10	60	40	170	350
Percentages (3)
All durations	100	100	100	100	100	100	100	100
Under 1 week	58	68	73	74	74	74	75	74
1 week	30	21	20	20	19	18	19	19
1 month	3	2	2	2	2	2	2	2
3 months	2	2	2	1	1	2	1	2
1 year	1	1	1	1	1	1	1	1
2 years	1	1	1	1	1	1	1	1
5 years	1	1	0	0	0	0	0	0
10 years+	4	4	2	1	2	2	1	1
Duration unknown	0	0	0	0	0	0	0	1

  Source: HES

Footnotes:

  1.  Data for 1986 relate to the calender year and are taken from the Mental Health Enquiry. The enquiry was replaced in April 1987 by the Hospital Episode Statistics (HES) system. Figures for 1991-92 on wards are derived from HES related to discharges from the care of individual providers (Trust or Directly Managed Unit); they include transfers to other NHS providers. All durations include age unknown data.

  2.  Estimates for 1997-98 and 1998-99 are provisional.

  3.  Percentages have been calculated using unrounded figures.

Table 2.4.4

ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS FACILITIES BY DURATION OF STAY: 1986 AND 1992-93 TO 1998-99 (1)

England    Numbers and percentages

Duration of stay	1986	1992-93	1993-94	1994-95	1995-96	1996-97	1997-98 (2)	1998-99 (2)
All Durations (3)	188,420	211,170	212,670	211,800	214,100	216,870	215,700	208,200
Under 1 week	33,660	43,700	46,030	46,520	46,350	48,300	46,900	46,980
1 week	82,210	95,060	95,700	93,760	93,970	93,740	90,790	86,260
1 month	50,250	51,990	51,860	52,020	51,820	52,890	53,660	50,960
3 months	16,790	16,040	16,120	16,590	17,050	18,920	19,990	19,970
1 year	2,340	1,670	1,430	1,330	1,560	1,590	1,770	1,780
2 years	1,330	1,170	760	800	960	900	810	980
5 years	640	490	270	240	290	220	210	240
10 years +	1,210	1,030	510	460	510	280	210	200
Duration Unknown	0	10	0	100	1,590	40	1,350	840
Percentages (3)
All Durations	100	100	100	100	100	100	100	100
Under 1 week	18	21	22	22	22	22	22	23
1 week	44	45	45	44	44	43	42	41
1 month	27	25	24	25	24	24	25	24
3 months	9	8	8	8	8	9	9	10
1 year	1	1	1	1	1	1	1	1
2 years	1	1	0	0	0	0	0	0
5 years	0	0	0	0	0	0	0	0
10 years +	1	0	0	0	0	0	0	0
Duration Unknown	0	0	0	0	1	0	1	0

Source: HES.

Footnotes:

  1.  Data for 1986 relate to the calender year and are taken from the Mental Health Enquiry. The enquiry was replaced in April 1987 by the Hospital Episode Statistics (HES) system. Figures for 1991-92 on wards are derived from HES relate to discharges from the care of individual providers (Trust or Directly Managed Unit); they include transfers to other NHS providers.

  2.  Estimates for 1997-98 and 1998-99 are provisional.

  3.  Percentages have been calculated using unrounded figures.

Table 2.4.5

ESTIMATED DISCHARGES OF LEARNING DISABILITY PATIENTS FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION, 1992-93 AND 1998-99

England    number and percentages

	1992-93		1998-99 (1)
Intended discharge destination	length of stay less than one year	length of stay of one year or more	length of stay less than one year	length of stay of one year or more
Aged under 65
Number of Discharges (2)	50,110	3,000	48,950	1,250
Percentage (3)
Usual Residence (4)	98	29	98	23
Temporary Residence	0	6	0	2
Other NHS provider (5)	1	26	1	39
LA residential	0	14	0	8
Non NHS institution (6)	0	25	0	21
Other and not known (7)	0	0	0	7
Aged 65 or over
Number of Discharges (2)	460	600	360	200
Percentage (3)
Usual Residence (4)	68	23	76	20
Temporary Residence	2	6	1	1
Other NHS provider (5)	21	35	13	31
LA residential	3	11	0	8
Non NHS institution (6)	5	22	4	28
Other and not known (7)	0	4	5	11

  Source:   HES.

Footnotes :

  1.  Estimates for 1998-99 are provisional.

  2.  Age unknowns data are not included.

  3.  Percentages relate to intended discharge of patients as recorded inpatients' notes and are based on unrounded data.

  4.  Usual residence excludes the other categories listed in this table. It includes private dwellings whether owner occupied or rented and sheltered accommodation but not residential or nursing care. It includes patients with no fixed abode.

  5.  Other NHS Trust hospitals or NHS run nursing homes.

  6.  Independent residential or nursing care homes and private hospitals.

  7.  Prison, high special psychiatric hospital, not known.

Table 2.4.6

ESTIMATED DISCHARGES OF MENTAL ILLNESS PATIENTS FROM NHS FACILITIES BY AGE, LENGTH OF STAY AND DESTINATION, 1992-93 AND 1998-99

England    number and percentages

	1992-93		1998-99 (1)
Intended discharge destination	length of stay less than one year	length of stay of one year or more	length of stay less than one year	length of stay of one year or more
Aged under 65
Number of Discharges (2)	136,010	2,060	141,150	2,280
Percentage (3)
Usual Residence (4)	88	41	88	47
Temporary Residence	4	8	3	7
Other NHS provider (5)	6	25	6	30
LA residential	1	9	0	3
Non NHS institution (6)	2	16	1	9
Other and not known (7)	1	1	1	5
Aged 65 or over
Number of Discharges (2)	70,520	2,300	62,740	940
Percentage (3)
Usual Residence (4)	78	18	74	25
Temporary Residence	3	4	2	4
Other NHS provider (5)	7	35	10	44
LA residential	4	14	2	3
Non NHS institution (6)	8	27	10	14
Other and not known (7)	0	1	1	9

Footnotes :

  1.  Estimates for 1998-99 are provisional.

  2.  Age unknowns data are not included.

  3.  Percentages relate to intended discharge of patients as recorded inpatients' notes and are based on unrounded data.

  4.  Usual residence excludes the other categories listed in this table. It includes private dwellings whether owner occupied or rented and sheltered accommodation but not residential or nursing care. It includes patients with no fixed abode.

  5.  Other NHS Trust hospitals or NHS run nursing homes.

  6.  Independent residential or nursing care homes and private hospitals.

  7.  Prison, high security psychiatric hospitals, not known.

Table 2.4.7 HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE HOMES FOR PEOPLE WITH LEARNING DISABILITIES, ENGLAND: 1988-89, 1994-95 TO 1998-99

(numbers)

	1988-89	1994-95	1995-96	1996-97	1997-98	1998-99
Total Available Beds/Places (excluding unstaffed)	60,040	59,210	61,640	65,760	67,540	68,410
Average daily number of available beds in NHS facilities	30,050	13,210	12,680	13,040	12,280	11,530
For child short stay	180	240	220	290	280	270
long stay	260	160	150	110	100	100
For other secure units	.	330	330	420	440	420
short stay	1,210	1,410	1,630	1,350	1,440	1,420
long stay	28,400	11,060	10,350	7,440	5,940	5,280
Residential Facilities (1)	.	.	.	3,430	4,080	4,040
Beds in private nursing homes, hospitals and clinics (2)	1,390	3,200	3,320	3,360	3,580	3,840
Children	140	100	70	60	70	100
Other ages	1,260	3,100	3,250	3,300	3,510	3,740
Places in staffed residential homes for adults (2),(4)	26,580	36,290	38,180	40,500	41,580	42,610
Local authority	12,620	9,670	9,350	8,190	8,200	7,380
Voluntary	6,530	13,940	14,650	15,070	16,710	17,220
Private	7,420	12,680	14,190	17,230	16,670	18,010
Places in staffed residential homes for children (2)(5)	2,030	1,760	1,770	1,480	1,720	1,590
Local authority	1,590	1,260	1,240	950	1,070	1,040
Voluntary	310	340	430	310	290	260
Private	120	160	100	220	350	290
Places in small registered residential homes (<4 places) (2)	.	4,760	5,700	7,390	8,390	8,840
Voluntary	.	890	1,210	{	{	{
Private	.	3,870	4,490	{	{	{
Places in local authority unstaffed (group) homes (2)	2,700	2,650	2,650	2,990	{	{
Source: KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA(Form A).

Footnotes:

  1.  NHS residential facilities were recorded for the first time in 1996-97. Some of these beds may previously have been recorded under other headings.

  2.  Data relate to 31 March.

  3.  Excludes nursing care places in dual registered homes.

  4.  Registered residential care homes and local authority Part III homes.

. = not applicable, { = not available.

Table 2.4.8

HOSPITAL BEDS AND PLACES IN RESIDENTIAL AND NURSING CARE HOMES FOR PEOPLE WITH MENTAL ILLNESS, ENGLAND 1988-89, 1994-95 TO 1998-99

(numbers)

	1988-89	1994-95	1995-96	1996-97	1997-98	1998-99
Total Available Beds/Places	85,010	89,810	92,800	104,190	104,910	105,660
(excluding unstaffed) (1)
Average daily number of available beds in NHS facilities	63,000	41,830	39,480	38,780	37,880	37,060
For child short stay	740	500	470	430	400	420
long stay	160	60	110	110	120	120
For elder short stay	4,960	6,390	6,390	7,370	7,380	7,290
long stay	20,320	10,760	9,330	8,230	7,410	6,990
For other secure units	810	1,080	1,370	1,580	1,920	1,750
short stay	16,800	15,210	15,080	14,500	14,460	14,420
long stay	19,210	7,830	6,730	5,410	4,910	4,710
Residential facilities (2)	.	.	.	1,160	1,280	1,360
Beds in private nursing homes, hospitals and clinics (3)(4)	5,860	24,190	27,450	28,510	28,280	30,370
Children	80	50	90	60	100	120
Elderly	3,260	19,330	22,140	21,450	19,130	21,100
Other ages	2,530	4,810	5,210	6,990	9,050	9,140
Places in staffed residential homes for adults (1),(3),(5)	16,150	22,180	23,970	34,190	36,160	35,780
Local authority	5,920	4,750	4,690	4,910	4,530	3,480
Voluntary	2,580	5,190	5,560	7,270	7,070	6,280
Private	7,650	12,250	13,710	22,010	24,560	26,030
Places in small registered residential homes (<4 places)	.	1,610	1,910	2,710	2,590	2,460
Voluntary	.	190	220	..	..	..
Private	.	1,420	1,700	..	..	..
Places in local authority unstaffed (group) homes (3)	1,990	1,680	1,660	1,840	..	..

Source:   KO36, RAC5, RAC5(S), RAU1, KH03, RHN(A) and RA(Form A).

Footnotes:

  1.  Discontinuity in data due to reclassification of some Elderly homes as homes for Elderly Mentally ill patients.

  2.  NHS residential facilities were recorded for the first time in 1996-97. Some of these beds may previously have been recorded under other headings.

  3.  Data relate to 31 March.

  4.  The method of data collection was changed in 1997-98 so the figures for 1997-98 are not strictly comparable with those for earlier years.

  5.  Excludes nursing care places in dual registered homes.

  . = not applicable,  .. = not available.

NUMBER OF PEOPLE SECTIONED BY TRUST AND THE TYPE OF SECTION

  19.  Table 2.4.9 presents information on the number of admissions to NHS facilities (trusts and high security hospitals) where the patient was detained under the Mental Health Act 1983 at admission and the number of occasions a patient already in hospital as an informal patient was placed under detention. Table 2.4.10 shows similar information for private mental nursing homes in each HA area (these data are collected by HAs for return to the Department). There were a total of 25,800 formal admissions to NHS facilities in 1998-99 with a further 1,300 formal admissions to private facilities. Another 21,100 changes from informal to formal detentions were recorded (20,500 in the NHS and 600 in private facilities). There may be double counting of patients where a patient has been detained more than once in the year.

NUMBER OF PEOPLE SECTIONED IN PROPORTION TO HA POPULATION

  20.  It is not possible to produce reliable figures on the numbers of people sectioned by HA area of residence. The data provided on the aggregate return does not collect geographic information on the area of residence. The Hospital Episode Statistics (HES) system does have some information on patients treated by area of residence, but the quality of data is poor on admissions of formally detained patients.

  21.  Some insight into the rates per 100,000 of the population of sectioned people is provided by the new study by the Royal College of Psychiatrists (Research into Mental Health Act 1983, Draft final report to DH from the Royal College of Psychiatrists Research Unit). This studied eight mental health trusts and looked at the use of Sections 2 and 3 across the geographic sectors covered by each trust in 1998-99. Although, the analyses suggest that there is a wide variation between trusts, it does not necessarily mean wide variations in the rate of sectioning across health authorities. This is because the sample of trusts is quite small and generally there is no simple relationship between each health authority and the areas covered by the local trusts.

  22.  It is possible to look at the variation in the rate of psychiatric activity by health authority area of residence. Table 2.4.11 shows 1998-99 rate of consultant episodes varied from less than one to more than nine per 1,000 with an average of around five per 1,000 population. Again this does not imply similar variations in the rates for those sectioned.

NUMBER OF PEOPLE SECTIONED IN PROPORTION TO ADMISSIONS

  23.  In England, in 1998-99, there were 27,100 formal admissions to hospital (including high security hospitals and private hospitals) under the Act and a further 21,100 changes from informal status to detention where patients were already in hospital. A patient subject to more than one period of detention under the Act during the year will be counted in these figures each time they are admitted to hospital under detention or have a change from informal status while in hospital so it is not possible to determine the number of people sectioned. Around 14 per cent of all admissions [estimated as 188,700] under psychiatric specialities in NHS hospitals in 1998-99 were formal admissions [25,800].

APPEALS

  24.  The Mental Health Review Tribunal is an independent body which hears applications and references by and on behalf of patients detained under the Mental Health Act 1983 as amended by the Mental Health (Patients in the Community) Act 1995. This includes patients admitted for assessment and/or treatment, hospital orders, guardianship, after-care under supervision and restricted patients which have come through the courts or transferred to hospital from prison. In some cases the nearest relative can also apply for the patient's detention to be reviewed. Most hearings are a result of applications by the patient or the patient's legal representative.

  25.  The act places a duty on Hospital Managers to refer a case to the tribunal at the end of specified periods where a patient has not had a hearing during that time. The Home Secretary in restricted cases is also obliged to refer cases to the Tribunal periodically and has a discretion to refer a patient's case at any time.

  26.  In the calendar year 1999 there were 18,806 applications and references. This is equivalent to about 40 per cent of the total number of formal detentions in 1998-99 (48,200). These included repeat applications made during the lifetime of an individual section. During the same period 7,628 cases were aborted mostly because the patient was discharged by the hospital or the application was withdrawn before the hearing. There were 10,502 decided cases resulting in the discharge (absolute, conditional or delayed) of 1,250 patients.

SPECIAL HOSPITALS, REGIONAL SECURE UNITS AND PRISONS

  27.  Table 2.4.12 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 also have mental health problems, but the figures are significantly lower for December 1999. This is because learning disabled patients are not considered to be appropriate for high security hospitals facilities.

Table 2.4.9

ADMISSIONS TO NHS FACILITIES UNDER THE MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL: ENGLAND: 1998-99 (1)

		Numbers
	Admitted to	Subject to	Total
	hospital	Section after	detentions
	under Section	admission (2)	in hospital
England	25,826 [24,108]	20,526 [18,836]	46,352 [42,944]
Northern and Yorkshire	3,117 [2,888]	2,720 [2,548]	5,837 [5,436]
Airedale	89	100	189
Bradford Community Health	372	333	705
Calderdale Healthcare	63	60	123
Dewsbury Health Care	45	62	107
Durham County Priority Services	237	183	420
East Yorkshire Community Health Care	80	40	120
Gateshead Health	79	85	164
Harrogate Health Care	61	77	138
Hartlepool & East Durham	51	74	125
Huddersfield Healthcare Services	131	94	225
Hull and Holderness Community Health	164	63	227
Leeds Community & Mental Health Services	477	260	737
Leeds Teaching Hospitals	—	8	8
Newcastle City Health	224	242	466
Newcastle Upon Tyne Hospitals	9	10	19
North Lakeland Healthcare	93	95	188
North Tees Health	57	58	115
Northallerton Health Services	47	37	84
Northgate and Prudhoe	45	22	67
Northumberland Mental Health	80	87	167
Northumbria Healthcare	26	51	77
South Tees Community & Mental Health	208	162	370
South Tyneside Health Care	39	60	99
Wakefield & Pontefract Health	180	119	299
Wearside Priority Health Care	136	134	270
West Cumbria Health Care	45	41	86
York Health Services	79	163	242
Trent	1,943 [1,897]	1,933 [1,739]	3,876 [3,636]
Barnsley Community & Priority Services	51	97	148
Bassetlaw Hospital & Community Health Services	25	31	56
Central Nottinghamshire Healthcare	85	76	161
Central Sheffield University Hospitals	1	—	1
Chesterfield & North Derbyshire Royal Hospital	87	85	172
Community Health Services, Southern Derbyshire	1	—	1
Doncaster Healthcare	126	168	294
Fosse Health, Leicestershire Community	5	6	11
Grimsby Health	38	64	102
Leicestershire Mental Health Service	446	370	816
Lincoln District Healthcare	137	113	250
Mulberry	4	—	4
North Derbyshire Community Health Care Service	13	21	34
Nottingham Healthcare	295	214	509
Rotherham Priority Health Service	93	161	254
Scunthorpe Community Health	45	63	108
Sheffield Community Health	229	161	390
South Lincolnshire Community and Mental Health Services	75	93	168
Southern Derbyshire Mental Health	180	210	390
West Lindsey	7	—	7
Anglia and Oxford	2,232 [2,260]	1,721 [1,604]	3,953 [3,864]
Addenbrookes	156	112	268
Allington	14	8	22
Aylesbury Vale Community Health Care	44	48	92
Bedford & Shires Health Care	67	59	126
East Berkshire	2	—	2
East Suffolk Health	92	150	242
Heatherwood & Wexham Park Hospitals	175	93	268
Hinchingbrooke Healthcare	22	25	47
Kings Lynn & Wisbech Hospitals	52	72	124
Lifespan Healthcare Cambridge	8	5	13
Mid Anglia Community Health	61	70	131
Milton Keynes Community Health	73	56	129
Norfolk and Norwich Health Care	—	11	11
Norfolk Mental Health Care Unit	362	256	618
North West Anglia Healthcare	40	124	164
Northampton Community Healthcare	121	103	224
Norwich Community Health Partnership	7	26	33
Oxford Radcliffe Hospitals	2	30	32
Oxfordshire Learning Disabilities	11	—	11
Oxfordshire Mental Healthcare	326	218	544
Rockingham Forest	104	62	166
South Bedfordshire Community Healthcare	216	56	272
South Buckinghamshire	98	55	153
Stoke Mandeville Hospital	1	1	2
West Berkshire Priority Care Services	178	81	259
North Thames	5,632 [5,248]	3,612 [3,256]	9,244 [8,504]
Barking, Havering & Brentwood Community Health	142	108	250
Barnet Community Healthcare	166	103	269
Camden & Islington Community Health Service	831	284	1,115
City & Hackney Community Services	354	219	573
East Hertfordshire Health	46	65	111
Enfield Community Care	145	58	203
Essex & Herts Community	134	57	191
Forest Healthcare	184	133	317
Haringey Health Care	234	203	437
Harrow and Hillingdon Healthcare	116	62	178
Hillingdon Hospital	110	97	207
Horizon	9	18	27
Hounslow & Spelthorne Community & Mental Health	102	103	205
Mid Essex Community and Mental Health	92	77	169
New Possibilities	7	18	25
Newham Community Health Services	122	85	207
North East Essex Mental Health	181	114	295
North Hertfordshire	65	74	139
North West London Mental Health	470	283	753
Parkside Health	132	87	219
Redbridge Health Care	285	141	426
Riverside Mental Health	461	292	753
Royal Free	109	178	287
Royal Hospitals	3	21	24
Royal Marsden Hospital	—	2	2
Southend Community Care	192	112	304
Thameside Community Health Care	142	86	228
Tower Hamlets Healthcare	216	188	404
University College London Hospitals	1	8	9
West Hertfordshire Community	282	124	406
West London Healthcare	299	212	511
South Thames	3,823 [3,806]	3,193 [2,908]	7,016 [6,714]
Bethlem & Maudsley	196	427	623
Bexley Community Health	276	283	559
Bournewood Community & Mental Health Services	56	113	169
Chichester Priority Care Services	164	188	352
East Kent Community	264	294	558
Eastbourne & County Healthcare	170	122	292
Hastings and Rother	116	64	180
Invicta Community Care	145	70	215
Kingston and District Community	259	64	323
Lewisham and Guys Mental Health	564	284	848
Lifecare	4	1	5
Merton & Sutton Community Healthcare	5	—	5
Mid-Sussex	61	38	99
Pathfinder	489	307	796
Royal Surrey County & St Lukes Hospital	—	1	1
South Downs Health	181	182	363
St Helier	51	83	134
Surrey Hampshire Borders	171	84	255
Surrey Oaklands	159	131	290
Thames Gateway	166	191	357
West Lambeth Community Care	234	190	424
Worthing Priority Care Services	92	76	168
South and West	3,137 [2,785]	2,098 [2,010]	5,235 [4,795]
Avalon, Somerset	191	166	357
Bath Mental Health Care	222	92	314
Cornwall & Isles of Scilly Mental Health	2	3	5
Cornwall Health Care	214	178	392
Dorset Community	98	57	155
Dorset Healthcare	252	204	456
East Gloucestershire	85	87	172
East Wiltshire Health Care	65	85	150
Exeter Community Services	211	223	434
Frenchay Healthcare	80	48	128
Isle of Wight Healthcare	90	43	133
North Devon Healthcare	55	36	91
North Hampshire Loddon Community	75	106	181
Phoenix	12	3	15
Plymouth Community Services	177	55	232
Portsmouth Healthcare	235	153	388
Royal Cornwall Hospitals & West Cornwall Hospital	—	7	7
Royal National Hospital for Rheumatic Disorders	—	2	2
Salisbury Health Care	94	65	159
Severn	176	80	256
South Devon Healthcare	154	79	233
Southampton Community Health Service	173	92	265
Southmead Health Services	109	58	167
United Bristol Healthcare	224	69	293
Weston Area	71	38	109
Winchester and Eastleigh Healthcare	72	69	141
West Midlands	2,474 [2,272]	2,007 [1,736]	4,481 [4,008]
Birmingham Heartlands & Solihull	—	3	3
Black Country Mental Health	117	77	194
Coventry Healthcare	152	126	278
Dudley Priority Health	78	136	214
Herefordshire Community Health	68	58	126
Kidderminster Healthcare	39	59	98
Mental Health Foundation	109	56	165
North Staffordshire Combined Healthcare	208	183	391
North Warwickshire	153	89	242
Northern Birmingham Mental Health	373	157	530
Premier Health	123	56	179
Royal Shrewsbury Hospitals	—	5	5
Shropshire's Communaity & Mental Health Services	302	159	461
Solihull Healthcare	109	85	194
South Birmingham Mental Health	135	445	580
South Warwickshire Combined Healthcare	84	70	154
Walsall Community Health	137	69	206
Walsall Hospitals	6	10	16
Wolverhampton Health Care	119	75	194
Worcestershire Community Healthcare	162	89	251
North West	3,347 [2,849]	3,241 [3,035]	6,588 [5,884]
Aintree Hospitals	140	159	299
Bay Community	235	190	425
Blackburn, Hyndburn and Ribble Valley Health Care	272	137	409
Blackpool Wyre and Fylde Community Health Services	134	94	228
Bolton Hospitals	153	164	317
Burnley Healthcare	135	121	256
Bury Health Care	41	69	110
Calderstones Hospital	15	6	24
Central Manchester Healthcare	117	29	146
Cheshire Community Health Care	1	4	5
Chorley & South Ribble	127	96	223
East Cheshire	60	110	170
Guild Community Healthcare	98	53	151
Halton General Hospital	42	33	75
Mental Health Services of Salford	170	145	315
Mid Cheshire Hospital	23	80	103
North Manchester Healthcare	79	115	194
North Mersey Community	125	320	445
Oldham	99	85	184
Rochdale Health Care	141	113	254
South Manchester University Hospitals	194	105	299
Southport & Formby Community Health Service	56	57	113
Southport and Formby	—	1	1
St Helens & Knowsley Community Health	1	—	1
St Helens & Knowsley Hospital	127	101	228
Stockport Healthcare	117	86	203
Tameside and Glossop Community & Priority Services	64	129	193
Trafford Healthcare	74	93	167
Warrington Community	99	76	175
West Lancashire	50	62	112
Wigan & Leigh Health	117	148	265
Wirral & West Cheshire Community	241	257	498
High Security Hospitals	121 [103]	1[—]	122 [103]
Ashworth Hospital Authority	33	1	34
Broadmoor Hospital Authority	48	—	48
Rampton Hospital Authority	40	—	40

Source:   KP90.

Footnotes:

  1.  The table only includes trusts 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).

  3.  The figures in brackets are the totals for 1997-98.

Table 2.4.10

ADMISSIONS TO PRIVATE FACILITIES UNDER THE MHA 1983 AND CHANGES FROM INFORMAL TO DETAINED STATUS WHILE IN HOSPITAL, ENGLAND: 1998-99 (1)

Numbers

	Admitted to hospital under Section	Subject to Section after admission (2)	Total detentions in hospital
Private facilities by RO and HA area
England	1,253  [957]	585  [486]	1,838  [1,443]
Northern and Yorkshire	58  [37]	30  [4]	88  [41]
County Durham	12	3	15
Newcastle & North Tyneside	5	—	5
North Yorkshire	38	25	63
Northumberland	2	2	4
Tees	1	—	1
Trent	35  [17]	—  [—]	35  [17]
Lincolnshire	7	—	7
North Derbyshire	21	—	21
North Nottinghamshire	4	—	4
South Derbyshire	3	—	3
Anglia and Oxford	226  [143]	39  [45]	265  [188]
Berkshire	83	2	85
Buckinghamshire	37	—	37
Cambridge & Huntingdon	6	2	8
East Norfolk	17	—	17
Northamptonshire	43	34	77
Suffolk	40	1	41
North Thames	466  [507]	268  [240]	734  [747]
Barnet	5	—	5
Brent & Harrow	125	11	136
Ealing, Hammersmith & Hounslow	58	52	110
Enfield & Haringey	24	63	87
Kensington, Chelsea & Westminster	148	96	244
North Essex	42	21	63
Redbridge & Waltham Forest	63	24	87
West Hertfordshire	1	1	2
South Thames	234  [130]	126  [112]	360  [242]
Bromley	12	24	36
East Surrey	21	7	28
East Sussex, Brighton & Hove	19	33	52
Lambeth, Southwark & Lewisham	97	19	116
Merton, Sutton & Wandsworth	61	31	92
West Kent	15	7	22
West Surrey	9	5	14
South and West	62  [63]	64  [61]	126  [124]
Avon	18	7	25
Cornwall & Isles of Scilly	3	4	7
Dorset	—	1	1
Gloucestershire	2	1	3
North & East Devon	4	1	5
Portsmouth & South East Hampshire	2	—	2
South & West Devon	5	—	5
Southampton & South West Hampshire	27	50	77
Wiltshire	1	—	1
West Midlands	30  [17]	20  [4]	50  [21]
Birmingham	13	19	32
Dudley	—	1	1
North Staffordshire	15	—	15
South Staffordshire	1	—	1
Wolverhampton	1	—	1
North West	142  [43]	38  [20]	180  [63]
East Lancashire	—	2	2
Manchester	14	1	15
North Cheshire	4	—	4
Salford & Trafford	5	9	14
South Cheshire	4	—	4
Stockport	59	22	81
Wigan & Bolton	56	4	60
Source: KP90.

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).

  3.  The figures in brackets are the totals for 1997-98.

Table 2.4.11

ALL CONSULTANT EPISODES (1) OF PATIENTS WITH A MENTAL ILLNESS BY HEALTH AUTHORITY OF RESIDENCE, 1998-99

Health Authority Code	Health Authority Names (2)	Episodes (3)	Rate per 1,000population (4)
England		241,760	4.88
QD8	Avon HA	4,051	4.05
QAP	Barking & Havering	1,429	3.72
QAQ	Barnet HA	983	2.96
QCG	Barnsley HA	1,784	7.82
QA6	Bedfordshire HA	2,428	4.36
QA7	Berkshire HA	3,091	3.86
QAA	Bexley & Greenwich HA	2,113	4.88
QD9	Birmingham HA	4,450	4.39
QDD	Bradford HA	3,062	6.34
QAR	Brent & Harrow HA	2,854	6.14
QAC	Bromley HA	2,026	6.82
QA8	Buckinghamshire HA	2,557	3.75
QCT	Bury & Rochdale HA	1,998	5.11
QDT	Calderdale & Kirklees HA	4,580	7.85
QA9	Cambridge & Huntingdon HA	3,143	6.72
QAT	Camden & Islington HA	3,355	9.13
QDV	Cornwall & Isles of Scilly HA	2,252	4.59
QDE	County Durham HA	2,135	3.51
QEA	Coventry HA	1,363	4.48
QAD	Croydon HA	2,287	6.76
QCK	Doncaster HA	1,622	5.58
QDW	Dorset HA	4,529	6.55
QEC	Dudley HA	1,308	4.20
QAV	Ealing, Hammersmith & Hounslow HA	3,709	5.53
QEP	East & North Hertfordshire HA	2,447	4.90
QAE	East Kent HA	982	1.63
QCX	East Lancashire HA	2,583	5.05
QAW	East London & The City HA	4,517	7.38
QCA	East Norfolk HA	3,340	5.32
QDF	East Riding HA	709	1.23
QAK	East Surrey HA	2,173	5.17
QAM	East Sussex, Brighton & Hove HA	3,544	4.74
QA4	Enfield & Haringey HA	2,301	4.73
QDG	Gateshead & South Tyneside HA	2,539	7.18
QDY	Gloucestershire HA	2,812	5.05
QED	Herefordshire HA	909	5.41
QA2	Hillingdon HA	1,181	4.70
QD4	Isle of Wight HA	984	7.75
QA3	Kensington, Chelsea & Westminster HA	2,892	7.40
QAG	Kingston & Richmond HA	1,569	4.70
QAH	Lambeth, Southwark & Lewisham HA	6,795	9.12
QDH	Leeds HA	3,593	4.94
QCL	Leicestershire HA	404	0.44
QCM	Lincolnshire HA	2,983	4.79
QC2	Liverpool HA	3,342	7.24
QC3	Manchester HA	2,403	5.59
QAJ	Merton, Sutton & Wandsworth HA	3,062	4.88
QC4	Morecambe Bay HA	2,699	8.70
QDJ	Newcastle & North Tyneside HA	2,284	4.86
QDX	North & East Devon HA	2,852	5.95
QD1	North & Mid Hampshire HA	2,247	4.03
QCV	North Cheshire HA	1,733	5.56
QDK	North Cumbria HA	1,859	5.82
QCH	North Derbyshire HA	1,727	4.67
QAX	North Essex HA	3,291	3.67
QCN	North Nottinghamshire HA	2,162	5.56
QEH	North Staffordshire HA	2,740	5.84
QCD	North West Anglia HA	1,341	3.24
QCY	North West Lancashire HA	2,900	6.22
QDR	North Yorkshire HA	3,938	5.30
QCC	Northamptonshire HA	3,104	5.04
QDM	Northumberland HA	1,233	3.98
QCP	Nottingham HA	1,889	2.94
QCE	Oxfordshire HA	2,034	3.30
QD2	Portsmouth & South East Hampshire HA	4,461	8.19
QA5	Redbridge & Waltham Forest HA	2,472	5.45
QCQ	Rotherham HA	883	3.47
QC6	Salford & Trafford HA	2,248	5.04
QEE	Sandwell HA	1,044	3.59
QC7	Sefton HA	1,554	5.40
QCR	Sheffield HA	3,768	7.09
QEF	Shropshire HA	2,029	4.72
QEG	Solihull HA	714	3.47
QD5	Somerset HA	2,929	5.99
QD6	South & West Devon HA	2,617	4.44
QCW	South Cheshire HA	3,208	4.77
QAY	South Essex HA	3,589	5.07
QDL	South Humber HA	910	2.95
QC1	South Lancashire HA	1,410	4.51
QEJ	South Staffordshire HA	2,343	3.96
QD3	Southampton & South West Hampshire HA	3,659	6.75
QCJ	Southern Derbyshire HA	2,585	4.56
QC5	St. Helens & Knowsley HA	1,719	5.16
QC8	Stockport HA	974	3.33
QCF	Suffolk HA	2,995	4.46
QDN	Sunderland HA	1,283	4.39
QDP	Tees HA	2,589	4.65
QDQ	Wakefield HA	2,235	7.01
QEK	Walsall HA	1,108	4.24
QEL	Warwickshire HA	2,076	4.10
QEQ	West Hertfordshire HA	3,861	7.23
QAF	West Kent HA	2,509	2.58
QC9	West Pennine HA	2,445	5.18
QAL	West Surrey HA	2,760	4.31
QAN	West Sussex HA	1,584	2.11
QDA	Wigan & Bolton HA	2,861	4.95
QD7	Wiltshire HA	2,358	3.89
QDC	Wirral HA	1,606	4.91
QEM	Wolverhampton HA	885	3.66
QEN	Worcestershsire HA	2,283	4.24

Source:   HES.

Footnotes:

  1.  Hospital in-patients are assigned to a Consultant who is responsible for their treatment, and their period of care under a Consultant is termed a "Consultant Episode".

  2.  Health Authority of residence is the Health Authority in which the patient lived in before admission. This however may not be the same area where treatment took place. The Health Authority codes were introduced in 1996-97, previously the District Health Authority codes were used.

  3.  The figures are provisional as no adjustments have het been made for shortfalls in data.

  4.  The population rates have been rounded to the nearest 2 decimal places.

Table 2.4.12

TOTAL NUMBER OF PATIENTS RESIDENT IN HIGH SECURE HOSPITALS

As at	Ashworth	Broadmoor	Rampton	Total
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
31.12.99	416	429	447	1,292

TOTAL NUMBER OF PATIENTS WITH LEARNING DISABILITIES IN HIGH SECURE HOSPITALS

As at	Ashworth	Broadmoor	Rampton	Total
31.12.95	36	0	107	143
31.12.96	25	0	108	133
31.12.97	18	0	111	129
31.12.98	9	0	104	113
31.12.99	0	0	95	95

Source:   HSPSCT.

NUMBER OF PEOPLE WITH MENTAL HEALTH PROBLEMS IN REGIONAL SECURE UNITS

  28.  Last year we explained why it has not been possible to supply data over the last four years. This remains the position. Nevertheless, we were able to produce Table 2.4.13 (below), which gave a snapshot picture as at August 1998 based upon the units' own perception of which category they fell into.

  29.  What is clear, however, is that the area of secure services has been one of continuing development since 1998 which has also been subject to a number of changes which overlay the change process. These include the re-organisation of NHS Regional Office structure in April 1999 and the movement and mergers of NHS Trusts for example. These structural (and managerial) changes naturally lead to a re-appraisal of the delivery of local services to meet perceived needs to which have also been set against the subsequent policy changes introduced by the National Service Framework for Mental Health in 1999. We therefore anticipate the data we will be able to supply may have a different structure and content to that shown previously.

Table 2.4.13

TOTAL NUMBER OF MEDIUM AND LOW SECURE PLACES IN REGIONAL SECURE UNITS AS AT AUGUST 1998

	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

INCIDENCE OF MENTAL HEALTH PROBLEMS IN THE PRISON POPULATION

  30.  The health of prisoners is the responsibility of the Joint Prison Health Policy Unit and Joint Prison Healthcare Taskforce, both of which report to the Prison Service and the NHS located within the NHS Executive. 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).

  31.  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 is as follows:

  1998, 737

  1997, 745

  1996, 745

  1995, 745

  1994, 723

32.  These are calendar year figures taken from the Home Office Statistical Bulletin 7/2000 Statistics of Mentally Disordered Offenders in England and Wales 1998.

2.5  Modernisation Fund

(i)   Could the Department list the monies set aside in the Modernisation Fund for the NHS (including expenditure on NHS Direct), the gains expected from each element of the fund, and the means by which results and achievements will be monitored and assessed? Could the allocations be broken down by year and include a reconciliation between the expenditure projected in table 1.2.2 and actual spending in 1999-2000?

(ii)   How many successful Modernisation Fund bids went to health authorities which were already over their target allocation? How will these Modernisation Fund allocations impact on future funding formulas and capitation position?

(i)   Could the Department list the monies set aside in the Modernisation Fund for the NHS (including expenditure on NHS Direct), the gains expected from each element of the fund, and the means by which results and achievements will be monitored and assessed? Could the allocations be broken down by year and include a reconciliation between the expenditure projected in table 1.2.2 and actual spending in 1999-2000?

  1.  The NHS Modernisation Fund has been earmarked for modernising and developing the NHS. It consists of some £5 billion from 1999-2000 to 2001-02. The Fund makes up part of the three-year cash allocation to the NHS following the outcome of the Government's Comprehensive Spending Review.

  2.  The Modernisation Fund demonstrates the Government's commitment to a new way of funding improvements in the NHS.

  3.  The purpose of the fund is to help ensure the delivery of the new, modern and dependable NHS. Monies have been strictly targeted across the most important development programmes. Mechanisms are in place to ensure that all elements of the fund are carefully managed and that the NHS delivers its objectives for upgrading and improving service for patients.

  4.  Table 2.5.1 shows a summary of the information requested. This is based on detailed project plans for each of the main programmes.

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Prepared 27 October 2000