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29 Oct 2002 : Column 842—continued



29 Oct 2002 : Column 843

Motion made,

––[Mr. Woolas.]

Hon. Members: Object.



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Long-stay Patients

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Woolas.]

12.23 am

Mr. Bob Laxton (Derby, North) rose—

Mr. Deputy Speaker (Sir Michael Lord): Order. Will hon. Members please leave quickly and quietly so that we can proceed with the Adjournment debate?

Mr. Laxton: I am grateful for the opportunity to raise this important matter. Long-stay in-patient benefits affect a cross-section of society, from the youngest invalid to the oldest pensioner. Last year, 10,000 pensioners, 13,000 incapacity benefit and severe disablement allowance recipients and 3,000 income support recipients had their benefit reduced after being in hospital for more than 52 weeks. I shall focus on the effect of that reduction in benefit on just one group: those who suffer from mental illness. I do that partly in the interest of time; it is not to say that any other group suffers less. Indeed, many of the groups overlap. I need only to explain that some of the long-stay hospital patients with mental health problems are pensioners or on disability allowance benefit.

At Kingsway hospital, a mental health hospital in my constituency, 70 patients have been in hospital for more than 52 weeks. The trust is the appointee for the benefits of 46 of them, with 39 receiving in-patient benefit of #15.10 only. The remaining seven patients also receive disability living allowance low-rate mobility allowance of #14.10 a week.

I wish to pay tribute to the excellent and ongoing campaigning work by the Derbyshire patients council, which represents mental health patients in my constituency and across a wider area of Derbyshire. I should also like to thank it for its help with the preparation for this debate. I owe a debt of gratitude to Derbyshire mental health services staff, in particular its chief executive. They were obliging enough to dig into their records and gave me some very useful information.

The plight of mental health patients was brought to my attention by Derbyshire patients council. In May this year, the patients council and a huge busload of Derby mental health services users came down to the House of Commons and presented me with their petition bearing more than 3,700 signatures. They had the opportunity to meet a few MPs. I am grateful to the Minister for taking the time to meet them and to listen to the very valid case that they put to him. I should also like to thank my hon. Friend the Member for Birmingham, Selly Oak (Lynne Jones) who, in her role as chair of the all-party mental health group, tabled an early-day motion on the matter that received cross-party support and the signatures of just under 100 MPs.

It is clear from the draft mental health Bill that the Government are trying to change their thinking on mental health. Mental health organisations have already expressed many criticisms and I shall not dwell on them, but if the #15.10 of in-patient benefit reflects Government policy on mental health I question our commitment to help those with mental illness. At present, after six weeks in hospital a long-stay mental health patient with no dependants loses all of his or her

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premium paid with their benefits. The main benefit is reduced to a pocket-money rate of #18.90. After a year, that pocket money is further reduced to #15.10, formally known as the personal allowance benefit or personal requirements allowance. A similar situation applies to those who receive the basic state pension because after 52 weeks they, too, are on #15.10 a week. That works out to 20 per cent. of the standard rate of basic retirement pension or, to put it more plainly, #2.16 a day.

So what is the principle behind the downrating of in-patient benefit? A 1949 report on the rules by the national insurance advisory committee said:

In response to a written parliamentary question that I put to the Department for Work and Pensions, my right hon. Friend the Minister for Pensions reiterated that point. He wrote that the principle behind the hospital downrating rules is to prevent double provision from public funds, as well as from the publicly funded national health service, and that it is a Xkey cornerstone" of the system of national insurance introduced 50 years ago.

I doubt that we should be talking about double provision when single provision itself is called into question. In addition, it is worth bearing in mind the fact that the principle of downrating was introduced nearly half a century ago. Fifty years ago, or perhaps even 25 years ago, hospital patients could rely on their immediate and extended families for financial support. Sadly, that is not the case any more.

Patients nowadays, especially those with mental health problems, have less contact with their families, making them more reliant on the NHS to look after them and making this weekly allowance more important than before. Even for those mental health patients lucky enough to have contact with their family, there are still financial problems. For example, one patient, who has two grandchildren, would, like any other grandparent, like to treat them during their weekend visits together, but, unlike most grandparents, she cannot afford to do so.

At this point, I want to raise one particular point. I am puzzled as to how the weekly figure of #15.10 was reached. It is not enough to say that it is 20 per cent. of the basic pension. Why 20 per cent.? Why not 40 per cent. or more? On what basis is the sum calculated? My own estimate, which takes account of the barest of necessities and in their cheapest forms, is that a sum between #21 and #30 would be much more realistic.

Yes, patients' accommodation and food are covered by the hospital, but the list of day-to-day items that are expected to come out of that money is still staggering. From that meagre sum, patients have to buy toothpaste, toothbrush and other toiletries, newspapers and magazines, stamps and stationery, the occasional haircut and paperback novel, and often cigarettes. I have to admit that as a notorious smoking fascist,

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I would on almost any other occasion urge someone to use this opportunity to give up the noxious and foul weed. However, the fact remains that even those who do not smoke have a problem meeting all other costs with #15.10 a week. It is grossly inadequate and demeaning for people whose home is a hospital.

Apart from the items that I have mentioned, patients are also expected to buy clothes and shoes out of their weekly allowance. In his response to a letter that I wrote on behalf of Michael Walsh, chairman of Derbyshire patients council, the Minister said:

The reality is that such provision proves to be lacking. The patients council brought up that point with the Minister back in May, and he expressed sympathy. The fact remains that many mental health patients in Derby have resorted to scouring charity shops for second-hand clothing.

The mental health services trust in Derby did not allocate any finance specifically for clothing in the financial year 2001-02 and made a one-off payment of #250 to help patients with the purchase of clothing. The trust said that younger patients sometimes apply for a community care grant from the Department for Work and Pensions to provide additional funds for items such as clothing. If they receive a grant, they have an amount deducted from their weekly in-patient benefit to repay the loan over a period set by the social fund. The period is typically 18 months, and the average deduction from the weekly benefit is #3.16 per week, leaving the patient with just #11.94 to spend. To avoid losing a proportion of their benefit, a number of patients in Derby have recently applied for funds from various charities, which are held locally as they do not have to repay that amount and so can retain their weekly benefit.

There are, I suspect, differences across the country. In an early-day motion on the subject, my hon. Friend the Member for Birmingham, Selly Oak noted that the chief executive of South Birmingham mental health NHS trust commented that the trust regularly supplements the in-patient benefit allowance from care budgets to ensure that basic needs such as clothing, haircuts and other personal items are met, and furthermore that it is a drain on NHS resources.

The Derbyshire mental health services trust said that it allocated #11,000 to patients' therapeutic programmes during the financial year 2001–02. That money, which is intended to finance certain therapeutic activities such as yoga, becomes instead an essential top-up to patients' weekly benefit. Similarly, the trust provides money so that patients can treat themselves and go on occasional trips, but the money is limited and patients are unable to participate in social functions as much as they would like and as much as would benefit them.

Many mental health in-patients are not a danger to other people. At the meeting I had with them in May, many said that they would relish the opportunity to reintegrate into the ordinary community, to find some useful role to play in their local area. They said that there is always an unwarranted stigma surrounding mental illness.

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However, what makes things more difficult and increases that stigma even more is when patients have to go about, slovenly dressed in tattered clothes—clothes that are often recycled from those who have died in the hospital. One of the people whom I spoke to said, XI don't want to talk about reintegrating into the community when my clothes immediately make me stand out for the wrong reasons, and when I can't even afford a cup of coffee in the local café."

If the amount of in-patient benefit increased, it would mean that patients had more and better opportunities to interact with the world outside the confines of a hospital, and money given to them by the mental health services trust that was intended for their therapeutic needs would actually be used towards that end. Perhaps, in the long run, it would mean getting a group of people who are currently reliant on benefits back into work—we would break the cycle of social and economic exclusion. The Government are rightly proud of their record in that respect, but there is still so much more to be done.

I have already asked the Minister about how the weekly sum of #15.10 is reached, but is it not simply the amount of money that a patient receives after 52 weeks that I question. I also question whether it is actually worth lowering it. Someone receiving income support gets #18.90 in week 52, then #15.10 in week 53 of their stay in hospital. Getting #3.80 a week less than before might not make much difference to many people, but to a person who is on #18.90 every last penny counts. I note that the Benefits Agency estimates that administering the 52-week rule costs #500,000 million, and that #58 million is saved from the 52-week downrating rule. Can that saving can be balanced against the impossibility and misery of trying to get by on #2.16 a day?

I hope that my hon. Friend the Minister will heed these concerns, which are very real but often overlooked, and that he will act accordingly.

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