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5.44 pm
Mr. David Hinchliffe (Wakefield): I welcome this debate, and I would like to say that there has been much in all the three previous speeches with which I genuinely agree. I welcome the fact that the Government have introduced their draft Bill, and I look forward to the debates on it. It will form the basis for important, long overdue changes in mental health legislation.
The background to today's debate is interesting. My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), the previous Secretary of State for Health, made the interesting comment, while he was still Secretary of State, that community care had failed, and today we have heard a possible confession from the Conservatives that their policies in the 1980s and 1990s on community care had failed.
In debates such as this, I find myself thinking about what went before. The hon. Member for Oxford, West and Abingdon (Dr. Harris) referred briefly to lunatic asylums—the system of long-stay institutions that was in place not long ago. Community care is not a recent development; I had the interesting experience of working in community care in the 1970s, when it was getting under way. Reference has been made to Enoch Powell, and moves towards community care were being made as long ago as the early part of the 20th century.
I have a vivid memory of what I saw in those long-stay institutions. The implication of debates such as this—that there was a golden age of lunacy, in which all such people were happily looked after in nice places—is absolute nonsense. Frankly, those places, some of which I knew well, were not nice. I was familiar with some of the highly questionable treatments that were used, and I witnessed the gross denigration of human rights. I remember training as a social worker in the early 1970s with former psychiatric nurses. They told me about a particular Yorkshire institution in which competitions were held to see who could throw patients furthest down a ward. My plea is that we do not forget that the previous situation was not positive but appalling for vast numbers of people.
I have personal experience of discharging from hospital people who were deemed moral defectives—women who had spent their lives locked up in institutional care for doing nothing other than, say, having a child out of wedlock. That was a disgraceful and scandalous situation, which we should never forget. I met many others who
were totally sane, even though they had spent their lives in institutional care. Indeed, other than the consequences of being institutionalised, they were no more mad than anybody in this place. Having said that, I have probably met more mad people in the Palace of Westminster than in all the years that I worked in various lunatic asylums and long-stay institutions.The hon. Member for Oxford, West and Abingdon mentioned the Health Committee's mental health inquiry of 2002. It was a cross-party report, in which we stated that it was "misleading and unhelpful" to argue that care in the community had failed, but that
- "it has failed for some individuals".
I commend the previous Conservative Government on the work that they did. Although I opposed many of their measures and had some practical concerns, the principle behind their policy was correct. They were going in the right direction and secured many achievements in community care. I congratulate the current Government, too, on many of their mental health policies, particularly the national service framework—a commendable initiative that is delivering genuine and long overdue improvements. However, I concede that several important problems remain, and in the brief time available I want to spell them out.
The resources question has been touched on. Money has been made available nationally, but it has not fed through to actual improvements in local mental health services. All of us—including, I suspect, Ministers—are concerned about that. I reiterate the point about funding discrepancies between health and social services. Commendably, through the Budget the Government have done something about that problem, which the Wanless report recognised. We now realise that such discrepancies have held back the development of alternatives for patients leaving hospital and returning to the community.
I also want to repeat my concern—I have expressed it on many previous occasions—about fragmentation of services and the lack of co-ordination between health and social care. I shall not reiterate the solutions that I have described many times before, but I hope that they come to fruition at some point during my time in this place. It is taking a long time to implement them, but I remain hopeful. The Government are gradually moving towards an integrated health and social care system. Such a system is necessary because problems such as mental illness do not slot neatly into a medical model or a social care model, but overlap both.
The lack of planning and co-ordination of services is obvious in my constituency, which contains male and female prisons. There is also a regional secure unit near my constituency. I visit each establishment and some of the special hospitals, and I see people who should be somewhere else, but nobody seems to ensure that such people move to where they should be. I welcome the steps that the Government have taken in linking special hospitals to local trusts. That is an important move forward, but I would welcome the Government being
more radical and acting on the many reports that have suggested that we need to leave behind the models of special hospitals that we have used for many years and have more localised regional secure units. That is a politically difficult step, because no one wants one in their backyard. I have one in my backyard and I understand the difficulties, but that is the way we must go. I welcome the steps that the Government have taken in that direction, but we must go even further.When the Health Committee considered mental health, the rights of patients concerned me greatly. We visited Broadmoor hospital, where we were told that 60 per cent. of the women detained did not need to be there and could be cared for in an appropriate environment within the community. That was very worrying, and we must ensure that our new mental health laws do something about that. At Ashworth hospital, we were told that a quarter of the male patients could be cared for more appropriately in the community. I commend The Independent on Sunday, which is running a series of articles that look in detail at the circumstances of some of those patients, because we need to be reminded that they are human beings. We should be concerned to ensure that our legislation will address their circumstances.
I am concerned that insufficient rigour is used when deciding where in the system patients would be most appropriately placed. That is why I intervened in the Secretary of State's speech to ask who will ensure that the decisions of mental health tribunals are properly policed. At the moment—and I mean no disrespect to the Mental Health Act Commission—I see far too many examples of people being left in completely unsuitable placements. I welcome the proposals for the inspectorate to examine that issue, and I hope that it will be able to join up provision in a way that does not happen now.
When the Minister winds up, I hope that he will address how we can square the principles of the national service framework—such as non-discrimination and combating stigma—with legislation that will primarily be focused on compulsion. That will present certain difficulties. On the matter of DSPD—dangerous and severe personality disorder—I would also welcome some clarification on what is a health issue and what is a criminal justice matter. Like the hon. Member for Oxford, West and Abingdon, I have some concerns about that difficult area, and we need to get it right. I am aware that the Government's position differs somewhat from that of the expert group that advised the Government on proposals for change in mental health law. I would also welcome comments on the consistency of the diagnosis of DSPD—we are talking about 2,400 patients—because I know many psychiatrists and they do not all agree on the diagnosis. We need to be careful when labelling people, or possibly locking them up for good, that we know what we are talking about.
Coincidentally, today I had a meeting with Young Minds, which was arranged many weeks ago. The young people I met made the point that we need to consider how we can prevent increasing numbers of children and young people from developing mental disorders. Their concern was that we do not make sufficient links between our health services and our education system. They see, as I do, children under immense pressure from league tables, examinations—I have a son who completed his GCSEs today, so I know full well the pressures on youngsters and schools—depression and parental break-up. Many factors
are forcing young people into mental illness and the current system does not sufficiently address the need for prevention.One of the issues that the Health Committee considered was the need to encourage far more user involvement in mental health services. We were impressed by some of the user initiatives that we saw in various places, which offered community-based alternatives to in-patient care. We felt that those initiatives should receive more support.
We have seen many positive developments in the past 25 years, for which successive Governments may claim credit. Although I accept that many challenges lie ahead, in my time in social work and working on policy development in this place, I have seen profound changes and it saddens me that we tend to forget how bad things were before the introduction of community care.
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