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The theme on which I want to concentrate initially is in some ways a by-product of the legislation, but to me it is just as important: the way in which society regards those people who are unfortunate enough to suffer from mental illness, and the stigma and fear in society associated with those medical conditions. It was Enoch Powell, back in 1963, who introduced the concept of care in the community, rather than having people locked up in long-stay hospitals, out of mind and out of sight, where their conditions, quality of life and environment were horrendous. The basic ethos of the policy since then has been to integrate people into the community, where they can receive their treatment and
live as reasonable and normal a life as everyone else. That is absolutely the right philosophy and guidance to adopt in a civilised society.
There must of course be safeguards, as the Minister would be one of the first to accept. I, too, was a Minister for mental health many years ago and that duty was uppermost in our minds then. There are still flaws in the system, and they need to be addressed, but that does not mean that we must abandon and compromise the basic principle of care and decide that just because an individual suffers from mental illness, they must be isolated and treated differently from those suffering from appendicitis, flu or cancer. There must be equality, and there must also be protection for those individuals who are a threat to other citizens, but that is a different issue. We must ensure that we have in place a system that can recognise and identify those people who are safe and who should be treated in the community and those people who are a threat to themselves or others and who need a more secure form of residence and treatment. That requirement is not an overriding problem that invalidates the concept of appropriate mental health care.
If we accept that basic premise of a civilised society, we must consider how to change the publics perception. The publics attitude towards people with mental illness is radically different from their attitude to other acute illnesses. If one suffers, sadly, from cancer or one has flu, there is tremendous sympathy, concern and interest among family and friendswe have all have come across that throughout our livesbut if one suffers from mental illness, however mild, there is fear and a stigma attached, and that starts with the patients themselves. They are fearful of telling peoplesometimes, even members of their own familiesabout their illness because they are frightened of the reaction and the raw prejudice to which they may be exposed. Beyond ones family and friends, members of the public in general may be frightened. They always assume the worst, because they do not understand the complexities and conditions of mental illness.
Sufferers become the butt of jokes, prejudice and may be shunned and subject to associated ill treatment. Although that has gone on for generations, significant attempts have been made not only by the voluntary and charity sector, which does a fantastic job in providing help, support and practical assistance to the sufferers of mental illnesses, but by Governments to minimise such negative reaction. In the 1990s, my own Government started the process to try to reduce the stigma of mental illness and to break down the barriers. To their credit, this Government have done so, too. It would be stupid to suggest that, on 1 May 1997, all the good work that was being done before then stopped and that this Government have done nothing. It would be equally stupid to claim that everything that this Government have done in that respect from 1 May 1997 has been wonderful and that the previous Government did nothing. We may have started too latesociety may have started the process too latebut we made that start in the 1990s, and to their credit, this Government have carried on with that and built upon it.
We now see genuine attempts by the Government and in communities, through the mental health and community health trusts and the charitable and voluntary sectors and organisations, to work to break down the stigma, the fear and the prejudice; but by definition, that is a very time-consuming and slow process. Of course the Bill will concentrate on the nuts and bolts of mental health legislationthe treatments and all the other associated issuesbut I ask the Minister not to forget to carry on the work against fear, stigma and prejudice.
The Minister of State, Department of Health (Ms Rosie Winterton): I have been listening very carefully to the hon. Gentleman, who obviously brings to the debate his experience as a previous Mental Health Minister. I absolutely agree with him about stigma and discrimination. That is why I feel that one of the very important parts of the mental health Bill relates to the ability to undertake supervised treatment in the community. I am sure that, too often, he met the carers of people with mental health problems who felt that the stigma and discrimination was increased because, under the previous legislation, people always had to be detained in hospital. When people were no longer in hospital receiving treatment, they would deteriorate and carers had no ability to help them in the recovery process. That is why supervised community treatment is an important part of tackling stigma and discrimination, but there is also
Ms Winterton: I agree with the hon. Gentleman about the stigma and discrimination, but an important part of reducing peoples fear about those who have serious mental health problems is to give an assurance that robust legislation is in place to ensure that, if people need treatment, they can get it. If the public are reassured about that, a lot of the stigma and discrimination will disappear.
Mr. Burns: I thank the Minister for that intervention, and she is absolutely right. It was quite evident to me 10 years ago that there were some glaring errors and problems with the Mental Health Act 1983 and with the states impotence, sometimes even when all the relevant authorities, such as the police, social workers, the health service and the voluntary sector, were concerned about an individual. Although everyone was convinced it was only a matter of time before that person committed a crime because of their mental state, nothing could be done because they had not yet done anything wrong.
I have considerable sympathy for the Minister and the Government in trying to wrestle with that problem and in coming up with a solution that both protects the public and is positive and helpful to the well-being of the individual involved. I do not want to come up with an opinion about what exactly should be done, because I am not qualified to do so. I will leave that to the Minister and to my Front-Bench colleagues when the relevant time comes. I am certainly not going to step into a quagmire now and talk on the hoof, because I understand that these are very difficult, complex issues. As the Minister rightly says, one way to try to break down the barriers is to establish or restore public confidence. The House must sort out how to do that during the legislative process, while balancing both sides of the argument and protecting the individual.
John Penrose (Weston-super-Mare) (Con): Does my hon. Friend agree that the problem goes much wider? Bad examples of stigma occur in the workplace. The Queens Speech also includes the Welfare Reform Bill, which is an attempt to reform incapacity benefit. One of the obstacles that people with mental illness particularly face in getting back into the workplace is discrimination and stigma among employers as well.
Mr. Burns: My hon. Friend picks up an extremely important point that is a crucial part of the equation. In fairness to the Secretary of State for Health, who is no longer present, I was heartened by her response to my intervention on the issue. According to her, such work is going on, rightly so, and I hope that it will be not only successful but applied throughout the work force and to all employers, as well as in the rest of society. That will be a crucial step forward. I will stop there on the issue of mental health, because I hope that there is a common ground on both sides of the House about tackling the problem.
I should like to raise another issue, which will probably not bring such happiness to the Minister, about the other part of the Queens Speech that relates to the national health service. It is, by and large, the catch-all phrase that the Government
will carry through the modernisation of healthcare based on the founding principles of the National Health Service.
As I said at the beginning of my speech, I wholeheartedly subscribe, as I have throughout my life, to the founding principles of the health service and I wish and am confident that, regardless of whether it is a Labour Government or a Conservative Government, those principles will be maintained, but what worries me is this inexorable drive towards modernisation.
I am not talking about modernisation where one embraces new and better drugs, more effective treatments and more effective equipment to treat peopleobviously, we all subscribe to that. What I worry about is the constant and inexorable desire of politicians to make changes to the system the whole time, so that we now have a national health service that is basically in a constant state of flux. Again, to be fair, it did not start on 1 May 1997. We, too, as a Government made changes. All Governments, regardless of their political colours, seem to have this desire to tinker, to change everything in the NHS the whole time and to reorganise. I think that the time has come to say enough is enough. It is time for us to allow
the changes in the structures to bed down and to allow people to get on with working in the health service, delivering the finest possible health care for our constituents, not wasting money on one reorganisation after another.
Funnily enough, I visited my national health service GP yesterday for a minor treatment. Knowing that it was the day of the Queen's Speech, he was talking to me about what he thought the Government would introduce in the next Session of Parliament. We got on to the health service. The one plea he made to me was, Can we please be left alone to get on with doing our job and treating patients, without constantly having reorganisation after reorganisation and change after change, micro-managed from Richmond house? I think there is considerable sympathy for and merit in that case. We must let the staff get on. A considerable amount of money has been wasted by the constant changes, which are not wanted by local communities.
The beauty of the PCTs when they first came in was that they were going to be local organisations based on local areas, with local people running them to determine local priorities for health care. I wholeheartedly accept that principle. When the legislation was going through Parliament, I wholeheartedly supported that concept, as a shadow health Minister, and wished the Government well. I thought, as I think in their heart of hearts the Government did at the time, that the size of the PCTs was too small and that that was never going to be a viable size. As I understand itthe Minister can correct me if I am wrong and I do not mean this in a derogatory waythe Government understood that prior to the last general election, but were not going to allow any true mergers until after that election.
We did see a type of merger, for example, in my own PCT, where we had the same chief executive as the Braintree and Halstead PCT next door, which was a form of merger in that it halved the salary bill for chief executives. However, it was inevitable that, once the election was over, PCTs were going to merge into more viable, realistically sized PCTs. We have probably reached that stage now. Certainly in Essex we have, where fortunately the Minister's Department listened to the lobbying of Members of Parliament and others and the number of PCTs went down from 13 to five, rather than the two that the health community proposed in Essex. That number is probably the right one to be able to be viable, to perform well and to meet the local needs of the community, which will identify with those PCTs.
Again, ambulance services in the east of England have been merged. The Essex ambulance service has been merged with those in the surrounding counties to form the East of England ambulance service. I do not think that that is a particularly clever idea. Earlier this year, the Home Office backed away from doing it with the police, which I welcomed. It is a mistake and a pity that the ambulance services were merged into one very large east of England regional service, but time will tell. The jury is out and we will have to wait and see.
The hon. Member for Denton and Reddish seems to think that everything is 100 per cent. wonderful in the health service and that there are no problems. Either he does not fully understand what is going on in his constituency, in mine and in my hon. Friends
constituencies, or some over-enthusiastic researcher in the equivalent of Central Office for the Labour party wrote the speech and he just read it out. Listening to some of it, I thought that it seemed to be totally divorced from reality. The only thing I can say to cheer him up is that I hope that the Whip on the Government Bench was listening carefully because such on-message loyalty to the regime can only help the hon. Gentleman at a future reshuffle.
Sadly, the wonderful impression that the hon. Gentleman gave is not the experience in Essex and West Chelmsford. We have suffered a double whammy. We have a fine nursing school at the local university, which trains nursesthe health service has been crying out for nurses for a number of years. We have invested in them both financially and in time and in training. They are now trained, have experience and are all ready to put something back into the health service, but a significant proportion of them cannot get any jobs in local hospitals; my local hospital announced six weeks ago that it is losing 245 jobs. We have invested in skills and in training people for an essential vocationnursingyet, ironically, they have the frustration of not being able to go into the health service to practise their skills, look after patients and earn a living. That is a callous waste and I am disappointed.
Because of the deficits both of the Chelmsford PCT and the Mid Essex Hospital Services NHS Trust, three intermediate care wards have been closed. I think that the Minister was in post when they were created. The Government, to their credit, provided funding to set up the wards, which were to relieve the problems of delayed discharges at Broomfield hospital and St. Johns hospital, so that we did not have beds being wasted by people remaining in them whose medical condition did not warrant that. The three intermediate care wards were established. We saw a significant drop in the problems of delayed discharges at the acute hospital and the wards were extremely good, but because of the £13 million deficit at Chelmsford PCT, now all three wards have closed, solely as a money-saving exercise, not because there was no clinical or medical need to keep them open. That is a waste. A good initiative by the Government has been stopped because of financial realities.
We will spend the next year of this Session discussing the further modernisation of the health service and the provision of the finest, highest-quality health care for our constituents. I ask the Government and Ministers to reflect and not to decide, as all politicians do, that they have to do something about a given problem, as doing something usually means reorganising or changing. It is not always necessary to change. Sometimes, it is better just to sit still and let the existing system bed down, so that it can deliver the services to the highest quality that we could hope for.
Dr. Doug Naysmith (Bristol, North-West) (Lab/Co-op):
It is a pleasure to follow the hon. Member for West Chelmsford (Mr. Burns) in this debate. We engaged in many stimulating discussions when we were colleagues on the Health Committee. As usual, he was trenchant this afternoon; but more unusually, I found myself
agreeing with much of what he said, at least in the earlier part of his remarks when he was speaking from his experience as a Minister with responsibility for mental health.
Let me first say that I welcome the central thrust of yesterdays legislative package, which is to tackle the big issues of todaythe changing nature of crime, the causes and effects of climate change and the need for pension reform. Each of those issues is of great concern to my constituents, and I look forward to helping to progress the new legislation through this House, andpossibly more important, and as has been remarked on more than one occasion todayto ensuring that it is put into effect once it is enacted.
I wish however mainly to confine my brief remarks to the mental health Bill. It is interestingand perhaps a little regrettablethat the mental health Bill has been introduced in an atmosphere that emphasises the need for security. It might have been better to have reassured the many peoplesome estimate the figure to be as high as one in four of the populationwho at some time in their lives will suffer from a mental illness. Incidentally, the great majority of them pose no threat to anyonesave, on occasion, to themselves. It would have been better to have reassured such people that the outdated lawsthey date back to 1983will be replaced by modern legislation that will uphold the human rights of patients, provide easy access to care for people with mental illnesses and allow the use of compulsory treatment only as a last resort. The words used by Her Majesty yesterday reflect that:
A Bill will be introduced to provide a better framework for treating people with mental disorders.
I spent much of the parliamentary Session of 2004-05 as a member of the Joint Committee on the then draft Mental Health Bill. That was an interesting and rewarding experience. We took a great deal of evidence, deliberated long and hard, and eventually produced a fairly lengthy, but well targeted, report. It was well received by most of those best placed to understand the issues. But unfortunately, not long after it was published, the Government thanked us for our work and told us that they had decided that they would not proceed with a draft Bill in that form.
primary purpose...must be to improve services and safeguards for patients and to reduce the stigma of mental disorder.
Naturally, my colleagues in this House and the other place were disappointed that there was to be further delay in replacing the outdated legislation. So the new proposals for a mental health Bill that were put forward yesterday are most welcome, and it is pleasing that some of them clearly reflect a number of the points highlighted in our report: in particular, the increase in availability and appropriateness of treatment, which the Minister has emphasised; the emphasis on patients human rights; the introduction of limited supervised treatment in the community, but only after a period of treatment and assessment in hospital; the attempt to agree a single definition of mental disorder; and expanding the skill base of
professionals who are responsible for the treatment of patients treated without consent. All that has been recognised.
Our report also made some other important recommendations which have not so far been addressed in the information provided about the proposed Bill. They include conditions to ensure that legislation cannot be used inappropriately. There is also no mention of the recommendation that the threshold of risk for harm to others should be raised, or that compulsion should be used only where a treatment is available which would be of therapeutic benefit to the patient.
A number of other questions will be asked of the new Bill. Where a persons decision-making is unimpaired, will they be allowed to refuse treatment, as recommended in the report? Could there be separate criteria, or different legislation, for dangerous people with severe personality disorder, also as recommended in the report? Will the Bill introduce new national training standards and monitoring, as recommended in the report?
Our report also expressed serious concern in respect of the resources needed to implement the proposals in the previous draft Bill, particularly in relation to adequate staffing and funding for mental health tribunals. Some of the evidence we took clearly demonstrated that, even under current legislation, there are frequently difficulties in this area. If there is to be expansion in the role of tribunalsand even if there is notit is essential that this matter be addressed.
There have been great improvements in mental health services over the past nine years. There has been record spending on the service, and there are thousands more nurses, psychiatrists and clinical psychologists, as well as new early intervention services for young people, new outreach teams improving access to mental health services, and crisis teams providing care in patients homes. Against this background of improving services, it is crucial that we have updated legislation, not only to address concerns about public safety, but to keep pace with the growth of modern community-based patient services and to be compatible with the European convention on human rights, as well as to provide properly for the Bournewood judgment, which will have a big influence.
Before I finish, I wish to refer to sperm donation, which was mentioned by my constituency neighbour, the hon. Member for Northavon (Steve Webb). I suspect that we have been briefed by the same consultant at the same hospital in the Bristol area. Something of a crisis seems to have developed since the recent legislation outlawing anonymity. There are now apparently only two centres operating fully in terms of sperm donation for the whole of the United Kingdom, as opposed to certainly more than a dozen, and probably almost 20, before the new legislation began to take effect. That must be addressed, and I trust that the Minister will make sure that that message is relayed back to headquarters.
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