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Mentally Ill People

Volume 75: debated on Tuesday 12 March 1985

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6.

asked the Secretary of State for Social Services if he has received any representations concerning the level of local authority support for the mentally ill.

Yes, Sir, I have received representations from several hon. Members and others since my right hon. Friend answered a similar question from the hon. Gentleman last October. The Social Services Committee has also produced its report on community care which bears on this matter.

Does the Minister agree that, at the very time when it is his policy to discharge people from mental illness hospitals into the community, there is an additional obligation on local authorities to provide adequate care? Will he condemn the decision by Wandsworth council to cease funding the Bolingbroke day centre for the mentally ill, which means that some of the most vulnerable people in our community will be thrown onto the streets?

Local authorities are the junior partners in the movement of the mentally ill into the community, because money can be moved with patients into the community. Year on year we are providing better standards of community care, with increased numbers of day hospital places, increased numbers of day centres and, perhaps best of all, a substantial increase in — nay, doubling of — the number of psychiatric community nurses.

I am grateful for my hon. Friend's assurance that provision in the community for the mentally ill is not entirely a matter for the local authorities, and that health authorities also have a very major role to play. Will my hon. Friend take steps to ensure that mental illness hospitals are not closed before adequate provision is made in the community for those displaced, and that a flexible system of bridging finance is introduced, on the ground that the receipts from the sale of hospitals can be several years delayed from the initial capital provision required for the community facilities?

These closures of large hospitals are proceeding rather more slowly than many of us might like, because careful discussions have to take place between local authorities and local health authorities. Sometimes the root of the problem has been found to be not lack of finance, but lack of really good joint planning.

Will the Minister promise to investigate the special difficulties faced by the Salford health authority and the Salford city council regarding the discharge of patients from Prestwich hospital?

My right hon. and learned Friend the Minister for Health recently considered the problems of the Salford health authority.

Will my hon. Friend accept that if a policy of caring for the mentally ill in the community is to work, the mentally ill must be absorbed into the community at a rate with which the community can cope? Bearing that in mind, will he stress to local authorities that they must consider the extent to which people can be absorbed into their particular community, instead of, in some cases, issuing planning permission at random for a particular area because the houses there happen to be acceptable?

Planning permission is obviously an important part of the matter, and I know that there can be emotive issues, as there are in my hon. Friend's constituency. At the root of getting the relatively small number of the remaining mentally ill into the community, whom we judge can go into the community—there are about 5,000 — is not only money, but good joint planning between the health and local authorities to ensure that those people are well and properly placed.

Although I appreciate what the Minister said about the transfer of resources with patients from health authorities to the local government sector and voluntary bodies, will he accept that local authorities are anxious about the continuation of funds for places after the deaths of the patients with whom those funds come? I noted the comments from both sides of the House about the need to be sensible about the problem. Will he take them on board and examine ways to encourage local authorities to accept their responsibilities in that regard?

There are long-term issues to be considered. For the life of a patient, funds are transferred on a named basis with a particular patient.

Is my hon. Friend aware that the Select Committee on Social Services, which recently reported on community care, expressed deep anxiety about the ready availability of rhetoric and principle and in some cases the considerable lack of action and practice? Will he comment on its recommendation that the Department's social work service has an important role to play in the setting and maintenance of standards throughout the country, possibly through an inspectorate?

My hon. Friend talks about the readiness of rhetoric, and I listened carefully to what she said about that point. We welcome the report of the Select Committee on Social Services, on which my hon. Friend gives such distinguished and painstaking service. The report has 101 recommendations, and we shall respond in detail to each recommendation, including the reference to rhetoric which my hon. Friend mentioned.

Is the Minister aware that many of the local authorities which want to do more to provide community care for the mentally ill now say that they are in a Catch-22 situation? In seeking to observe the Government's rate laws, they find it increasingly difficult to discharge their mandatory duty to the mentally ill and others under the Chronically Sick and Disabled Persons Act 1970. What are DHSS Ministers doing to persuade Treasury and Environment Ministers of the need to ensure that adequate funds are available for the full implementation of that Act?

Bad authorities which cannot run good social services departments should look at the best practice of good social services departments, which are run predominantly by Conservative-controlled local authorities.