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Earl Russell moved Amendment No. 43:


Page 7, line 35, at end insert:
("( ) It shall be the duty of the Secretary of State to ensure that there are sufficient hospital places to allow the responsible after-care bodies to discharge the duty under subsection (4) (b) above.").

The noble Earl said: I remember the noble Baroness, when she was answering Questions from the Dispatch Box, once being asked whether the Treasury was involved in the matter. The noble Baroness replied that in her short time in office she had yet to find any matter in which the Treasury had not been involved. That answer drew a great deal of approval from long-standing Members of this Chamber. It is relevant to this amendment.

On the whole, the provisions of the Bill should work rather well, but the question is whether there are the resources for them to be made effective. It is a rule among historians in construing statutes that, if one finds the same provision repeated over and over again in a succession of statutes, one concludes that it was not effective the first time. That rule is also relevant to the amendment.

The amendment deals with the situation in which those responsible for a patient's aftercare recommend that the patient be committed to hospital. It places a duty on the Secretary of State to ensure that sufficient hospital beds are available. I do not believe that that is the case at present. The Royal College of Psychiatrists reports that in London there is 130 per cent. bed occupancy. That rather Irish statement does not mean that there is a system of box and cox. It means that large numbers of patients who ought to be in hospital are either at home, in prison, in inappropriate beds elsewhere or have been prematurely discharged.

The Royal College of Psychiatrists argues—and the point is important to the Government's response—that the present methods of collecting official data make it impossible to check how acute the shortage is. It has therefore undertaken a survey of its own from which it established that 204 patients were lodged elsewhere, 53 were in non-admissions psychiatric beds, five were in medical wards, 42 were in other NHS hospitals, 60 were in private psychiatric hospitals, 30 were at home or in the community and 14 were in prisons or in police cells.

Prisons and, even more, police cells are not appropriate places for treating mental illness. I understand that the prison authorities and the police agree. The noble and learned Lord, Lord Taylor of Gosforth, giving a seminar paper at Liverpool as recently as last Friday, quoted a figure given by Mr. Brendan O'Friel of 2,000 mental health sufferers in prison who should not be there. That is grossly ineffective for the treatment of mental illness, it may be cruel to the patients concerned, it is extremely expensive of public funds and it forces the prison staff to try to develop skills in which they are probably not trained and which perhaps they do not possess. In effect, it is a

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case of exporting problems into another Ministry. I should be tempted to use my regular phrase for such situations, "only connect", save that the title of the novel in which that appears might, in the context, be misinterpreted. I beg to move.

Lord Harris of Greenwich: Some years ago I visited Attica Prison, a high security prison in upper New York state. I was told by the director of the New York State Prison Department that there had been a long-running dispute between his department and the mental health authorities of the state of New York. Eventually, the situation became so serious that the governor of the state had to bring in an arbitrator to deal with the dispute. It concerned what happened with mentally ill inmates who should clearly have been transferred to a mental hospital.

My noble friend Lord Russell referred to the speech of the noble and learned Lord the Lord Chief Justice. I should be grateful if the noble Baroness would deal specifically with the point. It raises substantial matters of public policy. As she is aware, arguments have been going on between the Home Office and the Department of Health, to my mind for at least 15 years, and the noble Lord, Lord Carr, could arguably testify that they went on even longer than that. Grave disquiet has been expressed about the number of people who are mentally ill and who are held in prisons because there are not adequate places for them in mental hospitals.

My noble friend referred to the Lord Chief Justice quoting Mr. Brendan O'Friel, chairman of the Prison Governors' Association. We can all speculate as to how many people in prison suffer from mental illness. The figure may be 2,000; it may be less, it may be more. Nevertheless, there is a real issue of public policy here and I should be grateful if the noble Baroness could express her views on the matter. It is causing serious disquiet in the Prison Service and among many judges who have expressed their disquiet on the Bench. We wait with interest to hear what the noble Baroness says.

The Earl of Mar and Kellie: There has been some talk today about the patient being ill at the time when the supervision application is made. I put it that the patient will have been stabilised prior to the supervision application. He will appear to be well rather than ill. The problem is that he is liable to become ill again, usually if he stops taking his medication. Indeed, for the power to convey to be imposed on him is a substantial symptom of his deteriorating mental health.

Therefore, I suggest that there is a need for a guarantee that a bed will be available if the patient's mental health deteriorates to the point of requiring readmission. I insist that the provision of a hospital bed must be part of the community care plan. A health authority will need to keep a quota of beds free proportionate to the number of supervision orders operating in its area. The beds must be available when needed, otherwise the idea of aftercare with supervision in the community will become worthless.

Baroness Farrington of Ribbleton: I support the points raised on the amendment. I refer particularly to the experience which some of us have of seeing people whose mental health has deteriorated to the point where

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they behave in a bizarre way and in the end are drawn to the attention of the police. There is not only a problem in prisons; there is sometimes a problem in police cells which are the only place of safety to which people can be taken in advance of hospital beds being made available. Such people may have committed a crime or appear to be about to commit a crime. It is critically important to ensure that we do not close beds as patients move out as a book balancing exercise, a financial transaction, only to discover that inevitably there will be occasions when, not necessarily for permanent return but for respite care, in the best interests of the patient a hospital bed is the best place.

Baroness Cumberlege: Health authorities are responsible for assessing the needs of their populations for the full range of mental health services and for contracting with NHS trusts and other providers to ensure that sufficient services are available. To make that the subject of a specific statutory provision would, we believe, undermine the essential principle that the details of local arrangements and priorities are a matter for decision at local level.

However, we are aware of the resource situation. Large increases in the number of medium-secure psychiatric hospital places are planned in our current building programme. There will be an increase from 700 in 1992 to nearly 1,200 in 1996, next year. The number of mentally ill people who have transferred from prison to hospital increased from 325 in 1990 to 755 in 1993. I agree with Members of the Committee who have spoken about the need to prevent people from getting into the prison system in the first place. The Committee will be aware of the number of court diversionary schemes which we have also introduced.

Different forms of care can be provided with beds for mentally ill people. When I was chairman of the South West Thames Regional Health Authority, we were responsible for the huge institutions commonly known as the "Epsom Cluster". They were enormous Victorian institutions which used to house 2,000 people. Sometimes I had sleepless nights thinking about their care and the nature of those places. I am pleased that the situation has radically changed and that some have closed.

Members of the Committee may know the work of Virginia Beardshaw who wrote an interesting book, Conscientious Objectors. There is an appendix at the back of the book showing the 22 major inquiries which took place between 1968 and 1981, and the Committee will be horrified by some of the results. One must get into perspective the type of care that has been provided over the years.

As to the long-stay hospital beds, in the past 10 years the number of places in the large hospitals has continued to fall. However, that has been matched by an increasing provision of alternative places in smaller NHS hospitals, local authority places and private and voluntary nursing homes. We welcome the growing number and diversity

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of places for mentally ill people in the community. In 1988-89 the number of short-stay beds was 22,505; in 1991-92, it was 22,159.

Baroness Farrington of Ribbleton: Perhaps the Minister will give way for a moment. I agree that there are major areas where there has been a transfer of resources into the community. But equally in almost every major town and city individuals are known to fall between the available resources. That is because they are unable to accept the requirements of living in a community setting, which makes more demands on their ability to behave in a socially acceptable way to other residents than they are able to live with. Those difficult cases are known in almost every small town throughout the country. People sleep in doorways, they sleep rough and they are incapable of fitting into the models that we are discussing and which are essential in terms of development.

As regards the amendment, my fear is that we are dealing with the very people for whom there is no alternative if the residential part of their care package breaks down and they become impossible. That is because the demands they will make on the people with whom they share the accommodation are far too great. Therefore, they must have a bed and it must be available for so long as that person needs it.

7 p.m.

Baroness Cumberlege: The noble Baroness interrupted and perhaps I could finish what I was about to say. Going back to the long-stay institutions, studies carried out in central London have shown that all those who are roofless and who are homeless are not people who have been discharged from long-stay institutions. But, a great many of them have a mental illness. We accept that. That is why we set up a mental health task force to look at the needs of London in particular. It produced a recent report Priorities for Action, which found that some of the problems could be alleviated by increasing community provision or improved bed management strategies. But the task force also identified a need for more acute beds in a few inner London districts. The district health authorities involved have agreed action plans to bring about the required increase in provision.

So we accept some of the arguments and are taking action on them. But we resist this amendment.


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