To ask the Secretary of State for Social Services what financial arrangements are made in each health region when patients are transferred out of long-stay hospitals into community care; and how many patients were transferred out under these arrangements in each health region since 1984.
To ask the Secretary of State for Social Services how many patients formerly resident in long-stay mental hospitals have so far been discharged into the community as part of the community care policy in each regional health authority; and what has been the total amount of cost savings accrued as a result.
In response to local circumstances and needs, regions have a variety of financial arrangements for funding the transfer of mentally ill or handicapped patients from long-stay hospitals to more community orientated patterns of care. In some cases funds are transferred with individual patients ("dowries") according to regional guidelines or are directly negotiated by district health authorities; in others development monies are earmarked by the regional health authority to fund specific projects. General development funds are, of course, also used to meet the costs of community care. Dowries are often permanent revenue payments uprated for inflation each year. A number of regions have set aside specific sums to bridge the cost of continuing to run old long-stay institutions while developing new services, but such funds are not the only ways of meeting such costs. The broad details of regions' financing arrangements are as follows. The hon. Member may wish to contact the chairman of the regional health authority concerned for more detailed information.
Northern RHA. Health Service developments funded from regional priority service fund. Arrangements for patients transferred from NHS to local authority or voluntary care individually negotiated. Bridging arrangements but no specific fund.
Yorkshire RHA. Direct care costs transferred to patients "home" DHA. The balance of resources required to provide community care provided from general development funds. Arrangements for transfers to local authority and voluntary agencies separately negotiated at district level. Bridging fund.
Trent RHA. Regional guideline for dowries of £13,800 for patients transferred between health authorities and of £6,900 for transfer to local authority or voluntary care. Bridging fund. (Policy under review.)
North Western RHA. Dowry of £21,400 per patient for all patients transferred as part of district package of which £4,300 is non-recurrent. Dowry of f 13,400 for transfers agreed on an individual basis. Bridging fund.
Mersey RHA. Financial arrangements negotiatied by DHAs according to dependency level of individual patient. Bridging fund.
West Midlands RHA. Dowry of 50 per cent. of average cost of mentally handicapped patients and 100 per cent. of average cost of mentally ill patients. Targeted bridging fund.
East Anglian RHA. Funding arrangements negotiated individually by district health authorities. Bridging fund.
North West Thames RHA. Dowries ranging from £13,000 to £20,000 according to type of patient. Additionally, there are development fund moneys available from natural decline. Bridging fund.
North East Thames RHA. For health authorities, each DHA allocated funds either to pay for care in the existing long stay hospital or to provide its own service. Transfers to local authorities and voluntary agencies separately negotiated. Strategic reserve to top up costs of care in the community where necessary with ad hoc bridging finance provided by RHA to existing providing districts.
South East Thames RHA. Dowry of £13,000 (plus London weighting if necessary) for mental handicap patients. For mental illness patients costs of hospital care apportioned to districts on the basis of numbers to be transferred. Bridging fund.
South West Thames RHA. For health authorities dowries of £13,477 for mental illness and £11,334 for mental handicap patients admitted before December 1982. Separate negotiations for patients admitted after that date and for transfers to local authorities, voluntary agencies and across regional boundaries. Bridging fund.
Oxford RHA. Development funds earmarked for specific projects.
Wessex RHA. Dowry of £14,000 per patient for all agencies. Mental handicap bridging fund.
South Western RHA. Dowry of £13,700 for mental handicap patients available for community provision by health authorities. Separate negotiation for mental illness patients and for all transfers to other agencies.
Information is not available centrally on the numbers of patients discharged from long-stay care specifically under these arrangements. The tables show the number of discharges from NHS mental illness hospitals and units and mental handicap hospitals and units in England where the depth of stay was five or more years. Tranfers to other hospitals and special hospitals are excluded. 1986 is the latest year for which this information is available centrally.
Information on cost savings is not available centrally.
Discharges from Mental Illness hospitals and units where there was a stay of five or more years1
| |||
Regional health authority
| 1984
| 1985
| 1986
|
| England2 | 981 | 987 | 1,082 |
| Northern | 48 | 48 | 54 |
| Yorkshire | 74 | 67 | 85 |
| Trent | 102 | 105 | 113 |
| East Anglian | 32 | 29 | 38 |
| North West Thames | 96 | 65 | 83 |
| North East Thames | 76 | 76 | 77 |
| South East Thames | 75 | 70 | 83 |
| South West Thames | 65 | 59 | 81 |
| Wessex | 53 | 67 | 99 |
| Oxford | 34 | 39 | 46 |
| South Western | 97 | 110 | 101 |
| West Midlands | 117 | 114 | 111 |
| Mersey | 65 | 81 | 50 |
| North Western | 46 | 56 | 61 |
| Special health authority hospitals | 1 | 1 | 0 |
Source: MHE.
1 Excludes deaths, transfers to a special hospital, transfers to a
hospital psychiatric bed and transfer to a hospital non-psychiatric bed.
2 Excludes special hospitals.
Discharges from Mental Handicap hospitals and units where there was a stay of five or more years1
| |||
Year
| |||
Regional Health Authority
| 1984
| 1985
| 1986
|
| England2 | 1,375 | 1,523 | 1,951 |
| Northern | 63 | 58 | 81 |
| Yorkshire | 71 | 148 | 175 |
| Trent | 129 | 150 | 300 |
| East Anglian | 58 | 66 | 60 |
| North West Thames | 50 | 65 | 58 |
| North East Thames | 72 | 83 | 53 |
| South East Thames | 148 | 201 | 275 |
| South West Thames | 119 | 171 | 277 |
| Wessex | 82 | 75 | 143 |
| Oxford | 38 | 57 | 74 |
| South Western | 304 | 155 | 133 |
| West Midlands | 70 | 100 | 104 |
| Mersey | 98 | 72 | 102 |
| North Western | 73 | 122 | 116 |
| Special Health Authority hospitals | 0 | 0 | 0 |
Source: MHE.
1 Excludes deaths, transfers to a special hospital, transfers to a hospital psychiatric bed and transfer to a hospital non-psychiatric bed.
2 Excludes Special Hospitals.
To ask the Secretary of State for Social Services (1) if his Department currently issues any guidance to health authorities on the consultations which should be undertaken with patients, their parents and their relatives before individuals are discharged into the community from long-stay mental hospitals;(2) if his Department currently issues any guidance to health authorities on the consultations which should he undertaken with patients, their parents and relatives, and local residents before long-stay mental hospitals are run down as part of the implementation of the policy of care in the community.
The Government's response to the report of the House of Commons Social Services Committee on "Community Care with Special Reference to Adult Mentally Ill and Mentally Handicapped People", circulated to all health authorities, reminded them of the need to consult patients and their families about discharge from long-stay hospitals. We will be considering the question of consultation with local residents as we review reports from the Health Service Commissioner which bear on this issue.
To ask the Secretary of State for Social Services what mechanisms his Department has established to oversee the transfer of residents of long-stay mental institutions to the community.
The development of mental illness and mental handicap services, including the shift to community-based services, is a regular feature of the annual review meetings which Ministers and the NHS Management Board hold with each regional health authority. The Department's Social Services Inspectorate maintains liaison with local social services departments and monitors the development of personal social services, including those for patients discharged from mental institutions.
To ask the Secretary of State for Social Services what is his policy towards health authorities being required to consult neighbours before mentally handicapped people are moved into the community; what representations he has received in this respect for the Health Service Ombudsman, Mr. Anthony Barrowclough; and if he will make a statement.
I refer the hon. Member to my reply to the hon. Member for Liverpool, West Derby (Mr. Wareing) on 10 June, at column 727.
To ask the Secretary of State for Social Services what representations he has received regarding the cases of former long-stay hospital residents who are ineligible for community care grants on discharge because they do not qualify for income support; what was the nature of these representations; and if he will make a statement.
This information could be obtained only at disproportionate cost.