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9.27 p.m.
Lord Acton: My Lords, it is a great pleasure to follow the noble Lord, Lord Mottistone, even when he criticises my noble friends Lord Hunt of Kings Heath and Lord Sainsbury. At least he was even-handed; as I understood it, he also criticised the noble Earl, Lord Howe, and the rest of his Front Bench.
At the outset I should say that I am a vice-patron of MIND. Between 1992 and 1994 that leading mental health charity's "Stress on Women Campaign" heard from women all over the country that they did not feel
safe in psychiatric hospitals. Accordingly, I welcome the principle in Clause 2 of the Bill introduced by the noble Lord, Lord Rowallan, which places a duty on health authorities to provide single sex ward areas in all existing psychiatric units. So much for Clause 2.I am firmly opposed to Clause 1 of the Bill. It is solely concerned with treatment for in-patients and will therefore increase the proportion of mental health spending allotted to hospital beds. This scheme immediately brings to mind the 1994 report of the Audit Commission, Finding a Place: A Review of Mental Health Services for Adults. At paragraph 27 the Audit Commission stated,
- "Where most of the resources are tied up in providing hospital beds it is difficult to break out of the vicious circle and to relieve the pressure on them".
Exhibit 9 graphically depicts the vicious circle: most resources are tied up in providing hospital beds; thus there is no spare capacity to develop community services; thus people are unsupported in the community and so are admitted to hospital; thus hospital beds are full, so most resources are tied up in providing hospital beds, and round and round and round the circle goes.
The Audit Commission called on all authorities to plan how to break the vicious circle and work out what mixture of services users and carers required. Applying that thinking to Clause 1 of the Bill, health authorities, as my noble friend Lord Hunt of Kings Heath said, preferably together with local authorities, should not only prepare a strategy for hospital provision but also for community services such as 24 hour crisis care, non-medical crisis houses and houses with flexible care and support for up to 24 hours a day. Other services users, requirements include home care to help them plan their day or week, employment advice, drop-in centres, support for self-help groups, counselling, befriending and various forms of therapy.
Alas, on all such community services Clause 1 is silent. Far from breaking the vicious circle, Clause 1 merely perpetuates it. I emphasise to the noble Earl, Lord Howe, that MIND opposes the clause and explains,
- "By creating a duty focusing only on in-patient facilities for acute patients it will distort the allocation of resources and in particular divert resources from community based provision".
On 12th December last year, a debate was held in another place on an equivalent Bill. The noble Lord, Lord Mottistone, mentioned it. Mr. Patrick Nicholls, the honourable friend of the noble Lord, Lord Rowallan, gave the impression from the Opposition Front Bench that Clause 1 could always be deleted in Committee. That is the course of action that I would advocate now. By all means proceed with the provision of single sex ward areas. But take heed of the Audit Commission and of MIND. Do not make the circle even more vicious. And, with a single clean stroke, sever Clause 1 from the Bill.
9.32 p.m.
Lord Lucas of Chilworth: My Lords, I am grateful to my noble friend Lord Rowallan for his limited Bill and the way he described it. I cannot agree with the noble Lord, Lord Acton, who wishes to delete Clause 1 from the Bill. My noble friend describes the Bill as one
step on. Let us not delete too much, nor at a later stage add too much to it because that will confuse the issue. Let us treat the Bill as one step along a long and tortuous path.Other noble Lords who have spoken have taken the advantage--it is an advantage that I shall take, perhaps to the ire of my noble friend Lord Mottistone--of not discussing the Bill any further but of discussing the somewhat narrow but immediate issue concerning mental illness. In that regard I beg the indulgence of your Lordships' House today.
Some noble Lords may ask why I am involved in matters of health. I am not well known in your Lordships' House for discussing these matters. It is simply because I have been approached over the past three or four months by a large number of people, some of whom are engaged in the health service and in the area of mental health and by patients who are frightened and concerned and who do not know what is happening.
I have a number of examples. However, it is late and perhaps I should give just two. One is from the professional side. A clinical services manager in a mental health resource unit tells of a patient who is very well-trained, about 40 years of age and has been in and out of employment over a number of years. The type of work that the patient does is stressful, and when the stress reaches certain levels he becomes disoriented and unstable and then has to fall back on the medical services available. Each time, his benefits are scrutinised; sometimes they are removed and sometimes they are replaced. I am given to understand that in circumstances such as that suicidal tendencies emerge. As noble Lords will know, there are very many cases of attempted suicide, probably more as a result of the stress associated with the illness--in trying to combat it and so on--than of the illness itself.
A "Panorama" programme on Monday night discussed these matters in relation to Merthyr Tydfil. An instance was given where both the GP and the wife were quite convinced that it was the stresses associated with the illness--the stresses of getting adequate support, including benefit--that drove the husband to suicide. It was a sad example. I fear that other, similar evidence may come to light unless we are extremely careful.
On the patient's side, the patient in my second example has been reassessed. I shall return to that point. Without being given a particular reason, that patient has had her benefit cut. She now has some six or eight weeks' rental arrears. There is nowhere to go and nobody to help. Perhaps that is why she came to me, believing that ignorance is bliss and that I could perhaps take up the point.
The point of course is, just at this moment in time, that the plight of the people to whom I have referred--and as I said earlier, there are many of them--rubs off onto others. So before very long, a whole number of people are infected with that fear.
The publicity currently given by both the Government and the media to the Benefit Integrity Project and the use of "adjudicating officers"--I do not know what an adjudicating officer is in relation to health matters, and
particularly mental health matters--has given further cause for concern. What is happening? What is going on?In a Written Answer in another place on 9th February, the Minister responding said that,
- "This Project is operating under the normal assessment and adjudication rules that are applied to all DLA cases"--[Official Report, Commons, 9/2/98; col. WA 76.]
She states that the matter can go to an appeal tribunal and so on.
But, surprise, surprise, on the very day that that entry appeared in Hansard, in Middlesbrough at a party meeting, as reported on Tuesday 10th February in the Daily Telegraph, Ms. Harman insisted that information about the care and mobility needs of DLA beneficiaries was essential, but acknowledged that she was,
- "unhappy with the quality of the decisions made so far".
Apparently Ms Harman has now banned officials from automatically withdrawing or reducing benefits. Against the background of a White Paper on welfare reform, it seems rather odd to me that a new or enhanced project should be set in place. The Minister said that she was unhappy at some of the decisions that had been made. What about the feelings of those disabled by mental illness who have been affected? What about the case that I quoted? Will there be compensation for that person with the rent arrears? Will someone have a further look at some of the recent decisions and, where they have borne harshly on people, will some immediate remedial action take place?
I do not believe that those of us who enjoy full health can understand what an unending struggle it is to be disabled through any cause and what a great desire there is among disabled people to make a contribution--limited though it may be--to the society in which they live. They should be helped to do that rather than being harassed by officials, many of whom I am given to understand have no medical experience whatever.
9.41 p.m.
Baroness Young of Old Scone: My Lords, I shall keep the noble Lord, Lord Mottistone, happy because I shall discuss the Bill. I also hope to make him slightly happier about the people he faces across the Chamber by talking about my credentials as a newcomer to the debate.
I was responsible for the management of mental health services in North London for about 10 years, working in some of the most deprived inner-city districts such as Lambeth, Haringey, Brent, north Kensington and parts of north Westminster. That included arrangements for the appropriate care of people with mental illness in connection with the run-down and closure of some large mental hospitals.
This is a serious and important subject that we are addressing tonight because mental illness is a personal catastrophe for individuals and families. It is a drain on society's resources and, alas, it is an increasing phenomenon. We are seeing mental health problems connected with a range of subjects arising through unemployment, racial tensions, homelessness and
refugee status. There is a whole variety of reasons why mental health is becoming a more and more pressing issue for society these days. It is most pressing in terms of its personal load on individuals when they are unable to take a normal role in society.I shall be brief tonight. It is in the interests of the mental health of us all that we get home and get some sleep. I do not think anyone could argue with Clause 2 of the Bill in terms of content. Quality of care is vitally concerned with issues of single sex areas and appropriate security devices. But there is already guidance available in the provision of those facilities. It is inappropriate for them to be the subject of legislation.
Clause 1 is more difficult. It asks for a strategy for in-patient facilities. One could say that drawing up a strategy is a fairly harmless activity, but there are three reasons why it is inappropriate to legislate for that strategy. First, as we heard from other Members of the House, in-patient facilities and services are only part of a wider picture. What we need is not strategies for in-patient resources but a strategy for comprehensive and integrated mental health services and a balanced service system. The ability to give support to the damaged people who suffer with problems of mental health depends on a range of services. We have heard some of them outlined tonight. Crisis in-patient services are only one part; community crisis services are vital as well. Also, there is 24-hour staffed nursing homes, the kind of outreach services to which my noble friend Lord Sainsbury referred in terms of the ability to prevent mental health breakdown, issues of employment, long-term care, intensive home support. A whole range of services needs to be provided. In-patient care is only one of them and to plan piecemeal is inappropriate.
A second reason why the Bill is inappropriate is that services cannot be planned by health authorities alone. Many aspects of care that are required are not delivered by health authorities; they are delivered in conjunction with social services and housing authorities. Strategies therefore need to be planned with all three of those authorities working in conjunction. We want to see the same professionals providing care across the divides of different authorities. We need a care programme approach which focuses on individuals, and it would therefore be inappropriate for a Bill to require health authorities alone to prepare the strategies.
The third issue has already been touched on; that is, the question of distortion of priorities if in-patient care is given inappropriate high priority as a result of being the subject of legislation. I believe that the provision of in-patient beds in many settings, particularly in inner cities, is one of the most inappropriate forms of care. I do not know whether any other noble Lords have spent a night in an acute psychiatric ward anywhere in this country but particularly in some of the inner city units. As we see the rising tide of mental illness and fewer and fewer resources available for mental health care, we see in some of the in-patient wards the most inappropriate people, who are in a severe mental health crisis. I may be accused of being flippant, but nobody in their right mind would want to go into one of those facilities on occasions. They are quite often full of extremely disturbed people, often in an inner-city area.
They arrive there as a result of being collected by the police, possibly under section, and often with extreme racial tension on some of the wards. It is highly inappropriate for many people to be admitted to such facilities. We need a range of appropriate facilities as part of an integrated care service.My last point is that there is already a requirement laid on health authorities by the NHS Executive for strategies for a comprehensive range of mental health services. We do not need more strategies or more legislation. We need more sharing of good practice, more evaluation and monitoring and perhaps particularly we need sufficient resources in the highly deprived inner-city areas to provide an adequate standard of mental health care for everyone.
I congratulate the noble Lord, Lord Rowallan, on bringing these issues to our attention, but I urge your Lordships not even to consider these issues as being appropriate for legislation.
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