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4.35 pm

The Secretary of State for Health (Mr. Alan Milburn): I beg to move, in line 3, to leave out from "illness" to end and insert:

When I became Secretary of State, I said that our top clinical priorities in the national health service should be threefold—to secure improvements in cancer and cardiac services and also in mental health services. These are the clinical priorities set out in the NHS plan. Why? Because all three had suffered from decades of neglect and, in all three cases, large numbers of patients were affected.

For years, mental health services were the Cinderella of the NHS, despite the fact that, as the hon. Member for Woodspring (Dr. Fox) said, millions of people—perhaps as many as one in four of the population—face a problem at some point in their lives. Each year, 600,000 adults with serious mental health problems are cared for by specialist mental health services. Thousands more young people and tens of thousands of elderly people also receive care. For every individual with a serious mental illness, many others such as families, carers, friends and, indeed, members of the wider public are affected, sometimes—sadly—with tragic consequences.

The hon. Gentleman was right to stress that mental illness takes many forms. It is worth saying at the outset that despite public perceptions to the contrary, the overwhelming majority of people with mental illness are a threat to no one. Indeed, many mentally ill patients are among the most vulnerable in our community. Reducing the stigma of mental illness should, in my view, be a priority for any caring, civilised society. That is why I was pleased last year that my Department launched the mind out for mental health campaign. It is the first time that the Government have backed a public information campaign specifically designed to tackle such discrimination.

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At the other end of the spectrum, however, there will always be some people with a serious mental disorder. Sometimes they do not recognise how ill they are; sometimes they are so disabled by their mental illness that they are not able to seek help, and sometimes they choose not to seek help. In a small minority of cases, people with a serious mental disorder will pose a significant risk to others but, more particularly, to themselves. In those circumstances, the Government's priority must be to protect patients, their families and the wider public both under the law and through the provision of appropriate services.

This much, then, is common ground between the Opposition and the Government and probably all parties. The difference lies in what various parties have been prepared to do about these problems and are now prepared to do about them. My right hon. and hon. Friends are more than happy to debate these issues with the Conservative party, because they know the difference between the warm words of the Conservatives in opposition and the grim reality of the Conservatives in power.

Mr. Michael Fallon (Sevenoaks) rose

Mr. Milburn: For a serious debate, the hon. Member for Woodspring skated pretty lightly over 18 years in office. I think that he was a Minister for at least part of that time. I know that the hon. Gentleman wants to forget what happened then, but what happened then informs what goes on now, and the standards of care and services that people with mental health problems receive.

Dr. Fox: Is the Secretary of State really suggesting that the whole concept of care in the community as it was initially rolled out was not part of a consensus? If he believes that, he is quite wrong.

Mr. Milburn: I will be coming to care in the community in a moment. I think that it was a spectacular failure, for reasons that I will give, and I think that the hon. Gentleman is gradually coming to that view too.

It is worth reminding the House about the state of mental health services that we found when we came to power in 1997. The view not only among carer and patient groups but in the wider health service is that mental health services had been allowed to become the poor relation in the NHS. There were no national standards of care—not a single one.

Mental health law had been allowed to be overtaken by both developments in services and in the wider society. Care in the community had been a failure, not least because the policy was both indiscriminate and underfunded. Years of under-investment had left dedicated, hard-working staff in our mental health services with more than their fair share of run-down buildings, continual cuts in the number of beds and, of course, shortages of staff. Indeed, in 1997, two-thirds of health authorities did not even provide round-the-clock access to community mental health services. The simple truth is that mental health was not a priority then—but it is now.

Mr. David Heath (Somerton and Frome): I do not for a moment doubt the right hon. Gentleman's commitment

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to this policy area, but the reality in my constituency is that we have seen the contraction of psycho-geriatric wards and acute mental wards into a centralised general hospital rather than the provision of such support across the community. That affects links between patients and their general practitioners and between patients and their own community and family. Is that part of the right hon. Gentleman's policy or is something still wrong with the funding arrangements for mental health trusts?

Mr. Milburn: On the provision of mental health services for older people—the point that the hon. Gentleman raised—as for provision elsewhere in the mental health service, the answer is not that one particular model of care is required. We need a spectrum of services to cope with the spectrum of needs; an elderly lady with severe dementia will have a different set of needs from those of a young child with depression. Our problem is that there are gaping loopholes and gaps in provision across the piece—whether in the acute sector, the community sector, crisis intervention or intermediate care. We need to plug all those gaps.

I do not advocate a single model of care as the answer to the problems in our mental health services—a range of provision is needed. The truth is that—as we set out in the national service framework that we published about three years ago—it will take some time to get there, so it is better to be straight and honest with people about that. We have started a 10-year programme and we are making progress, and I shall come to some of the details in a moment.

Mr. Fallon: The right hon. Gentleman talked about warm words and he says that he is making progress, but surely he must admit that it has taken two years since the end of the consultation process to produce a Bill and even that is only a draft. What is the framework for putting his warm words into action?

Mr. Milburn: I shall come to that in a moment. Not even the most devout proponents of the Mental Health Act 1983 would claim that it was a radical overhaul of the 1950s provision. Fundamentally, mental health legislation in the 21st century is based on a model that dates back to the 1950s, so it would be just as well, as we have this once in a generation opportunity to get it right, that we do precisely that—through consultation, Green Papers, White Papers and a draft Bill. I should have thought that the hon. Gentleman would welcome that, because it provides a wider opportunity both in the House and outside to ensure that the provisions in the new Act are right and that we learn from some of the deficiencies in current mental health law.

Mrs. Joan Humble (Blackpool, North and Fleetwood): Does my right hon. Friend agree that the rapid closure of large mental institutions in the 1980s and the ejection of tens of thousands of people on to an unsuspecting community which was ill prepared to accept them has made his and the Government's job in building up new mental health services much more difficult? Does that not

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justify careful thought in order to ensure that the community is properly prepared for a genuine programme of care in the community?

Mr. Milburn: It is as true for mentally ill patients as for most patients that nobody actually likes being in hospital; nobody wants to be in hospital and people try to avoid it wherever possible. Sadly, for some people it will always be necessary, so we must get the range of provision right. Despite all the efforts in the 1980s and 1990s to make community care work, that one telling statistic, which I gave earlier, that in 1997 two-thirds of health authorities did not provide 24-hour access to community services, is a real indictment of the failure to implement what were undoubtedly good intentions. They were good intentions, but I am afraid that the world is paved with good intentions; deeds, rather than words, count in the end.

To get the range of services and provision right, three changes are necessary: first, changes in the law; secondly, reform to services, particularly with new national standards; and, thirdly, the right level of investment in mental health services. I should like to deal with each of those changes in turn.

First, on the changes to the law, I am publishing today a new draft mental health Bill and consultation paper, copies of which are available in the Vote Office. As I said in response to the hon. Member for Sevenoaks (Mr. Fallon), our proposals have already been subject to fairly detailed consultation during the past couple of years, but I hope that the publication of a draft Bill will allow further detailed scrutiny to take place. I would certainly urge all right hon. and hon. Members who have an interest in mental health issues to engage in that process and, more particularly, those outside the House, too.

The current mental health provisions date back to the 1950s. They are, quite simply, out of date. They have failed properly to protect the public, patients or, indeed, the staff who work in our mental health services. For example, under existing mental health law, the powers to treat patients compulsorily are available only if patients are in hospital. However, the majority of patients today are treated in the community. Public confidence in care in the community was undermined therefore by failures not just in the services, but in the law, too. The policy lost public confidence because, in too many cases, neither the services nor the law properly protected either patients or the public.

Services have too often worked in isolation from one another. Too often, severely ill patients have been allowed to drift out of contact with mental health services altogether. Many patients have failed to comply with treatment. That is, I am afraid, a recurring theme in all the inquiries into the tragic toll of homicides and suicides that have taken place in recent years. Doctors have often been in the absurd position of having to wait until patients in the community become ill enough to require admission to hospital. That prevents earlier intervention to reduce the risks to the patients and, of course, the wider public.

In particular, existing legislation has failed to provide adequate public protection from those whose propensity to be a risk to others stems from a severe personality disorder. As a result, patients and the public alike have been put at risk; they have been denied the protection that they need. Every year, there are more than 1,000 suicides

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and 50 homicides involving patients who have been in touch with mental health services in the previous 12 months. That graphically illustrates the failure of the old legal framework, which is in desperate need of reform. Our proposals, which are the most far-reaching for decades, are designed to enhance the safety of patients and the public.

It may be of benefit to the House if I briefly outline the proposals in the draft Bill and the accompanying consultation paper. At the heart of the draft Bill is the need to ensure that there is a new focus on the individual patient. Under the current law, patients are defined and treated not on the basis of their individual needs, but depending on which category of mental disorder they have. That has led to a loophole in the Mental Health Act 1983, so that a small minority of dangerous mentally disordered people have been able to argue that they will not personally benefit from treatment. In some cases, they argue that their illness makes them refuse to take part in appropriate therapy sessions or to co-operate with treatment that could be provided for them.

Under the 1983 Act, patients in those circumstances would be discharged from treatment and even detention, although people in official positions—whether prison officers or police officers—know full well that they could pose a risk to others as well as themselves.

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