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Earl Russell: While the Minister considers that situation, perhaps I can make a brief intervention which

20 Apr 1995 : Column 632

may save the time of the Committee by my not needing to speak at all to Amendment No. 6, that also being concerned with the two stools issue.

I accept the justice of what the Minister says—that he has given us assurances on this matter twice. The noble Viscount, Lord Astor, at Second Reading of the incapacity Bill, gave us another. They were warm and full assurances. In terms of goodwill, I believe there is nothing between us. Yet the cases keep on coming. We need to work out why.

I am aware of a couple of cases which may help to illustrate what is going wrong. They are both CAB cases. One concerns someone who had been on invalidity benefit for five years and had it withdrawn. The unemployment office refused to allow her to sign on because she was not really fit. In the other case the claimant's invalidity benefit was withdrawn. On the unemployment benefit forms he said that he did not consider himself to be fit for work so his claim for unemployment benefit was refused. These are all people of limited capacity—I believe that is the crucial way to think of it—who are being sent along to the employment officers who are being asked to tackle the job of finding them work. That may be a thankless task because it may be extremely difficult.

I am reminded of what used to happen under the old Poor Law when the poor were meant to be sent back to their parishes. When they arrived there, the parish, finding a lot of destitute people who perhaps had not been seen for 20 years, were always apt to say, "She does not come from here, she comes from that parish over there". In the present situation we have employment officers with a great flood of business sent in to them reacting rather like Dame Partington by trying to push it out. It is a natural human reaction. It is no fault whatever of Ministers. But we need to think of how to stop it. Guidance may be part of it and, since this is an immense body of work, additional staffing may help also. I do not know if my contribution was helpful, but I hope so.

7 p.m.

Lord Mackay of Ardbrecknish: I hope that I can remember all the points which have just been wished on me at what I hope is the tail end of the debate on this series of amendments. In the hope that I can perhaps persuade the noble Earl to withdraw his next amendment, I have been able to find in this fairly complicated business what I might call the "legalistic answer" to the assurances that I have given about the question of "between two stools". Paragraph 2(1) of Schedule 1 to the Bill says,


    "The question whether a person is capable or incapable of work shall be determined, for the purposes of this Act, in accordance with the provisions of Part XIIA of the Benefits Act".

That is what links the two together. I hope that it will mean that nobody will get caught between the two stools. I hope that that answers the point made by the noble Earl. It is also what I would have said as regards his next amendment.

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I believe I was asked about appeals. I presume that I am being asked about someone who goes onto JSA and who is appealing against a JSA decision and is not appealing against being taken off incapacity benefit.

Baroness Hollis of Heigham: I thank the Minister for taking the trouble to answer this matter in some detail. I was putting to him the case of someone who has lost incapacity benefit and who is not contesting that. He has six to eight points or so, and he has come over to JSA. However, because he still carries with him that partial disability which originally rendered him eligible for invalidity benefit, he believes that he must restrict his availability for work to a greater degree than the Employment Service thinks reasonable. That service then regards him as failing to meet a JSA agreement or not actively seeking work. It therefore disqualifies him from benefit. He may then appeal against that on the grounds that he is acting reasonably, given the nature of his disability, and that his restrictions are reasonable. I am asking that while that is being contested, can that individual at least remain on benefit and not find him or herself both partially disabled and without income?

Lord Mackay of Ardbrecknish: In the light of an answer that I gave a few moments ago about the fact that the detail in the form of the medical evidence from the Benefits Agency medical service would come over to the Employment Service, and the fact that there are specialists available in the service to give advice in this particular field, I hope that the officer and the claimant will be able to come to an agreement. I have been asked about the situation if they do not so agree and I suppose I must go on to try to answer that. I am not sure that the noble Baroness will be satisfied with the answer, but I believe that it is the same as the answer that I gave earlier this afternoon; namely, that if they come into the vulnerable group then they continue with benefit until the matter is resolved. If they do not come into that group I believe that there is a two-week period before they receive —I have forgotten the name of the benefit—

Baroness Hollis of Heigham: It is partial benefit.

Lord Mackay of Ardbrecknish: I am grateful to the noble Baroness. I hope that that answers the question.

Baroness Hollis of Heigham: That benefit is a 40 per cent. reduction even on the basic income support level.

Lord Mackay of Ardbrecknish: It is a reduction, but it is an indication in more general terms of the fact that we do not want people to appeal automatically in all cases. I said that I thought that the noble Baroness would not consider my answer to be very satisfactory, but I have answered her question.

Lord Swinfen: I would very much like to read the whole of this debate before deciding what to do. This evening I shall withdraw my amendment. However, I am delighted that my noble friend the Minister is himself beginning to question some of the legislation which is before us. He gave me the impression that he is beginning to ask questions on behalf of disabled people

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because he answered a question which I had not asked. I hope that he will encourage other Members of the Government to begin doing exactly the same thing. It will make the debates in this House a great deal less difficult and shorter if the needs of disabled people are considered at an earlier stage. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Amendment No. 6 not moved.]

Lord Inglewood: I beg to move that the House be now resumed. In moving this Motion, may I suggest that the Committee stage begin again not before five minutes past eight.

Moved accordingly, and, on Question, Motion agreed to.

House resumed.

Care of the Mentally Ill: Matthew Trust Report

7.6 p.m.

The Marquess of Reading rose to ask Her Majesty's Government what action they intend to take in respect of the findings of the Matthew Trust's report, Victims of Care.

The noble Marquess said: My Lords, the homeless beggars on the streets of every city in the land bear testimony to the creation of an underclass in our sophisticated society. Many of these people are alienated from the mainstream by virtue of their poverty and powerlessness.

I wish to speak today about one particularly troubled section of that underclass whose plight is eloquently described in the Matthew Trust's report, Victims of Care. These are people who suffer from severe mental illness. They feel themselves to be utterly cut adrift, not only from their fellow citizens, but also from the welfare services which have been established to care for them. As the most reverend Primate the Archbishop of Canterbury reminded us recently, the civilisation of a society can be judged by how well it treats its weakest members. I fear that we may be judged rather harshly on that score.

Only days before the Matthew Trust's report, Victims of Care, was launched here at the Palace of Westminster, the Department of Health acknowledged that people continue to fall through the safety net devised by the state to protect the most vulnerable in society. As a national charity concerned with mental health and penal reform, the Matthew Trust has a finger on this pulse. Its report describes how people fall through the net and considers the human consequences.

The purpose of my Question today is to discover how the Government intend to repair their safety net and to learn what procedures will be adopted to weave the knowledge and resources of the voluntary sector into a more comprehensive caring system. Almost every day we learn from the press and media of some fresh tragedy concerning the mentally ill. The shattered lives of the mentally distressed are made more difficult when

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insensitive coverage generates prejudice and fear among the public. That in turn makes provision of special care for the mentally ill a more problematic issue for the authorities.

Noble Lords may recall that I have the privilege to chair the advisory council of the Matthew Trust. When I addressed the House about the issue of patient confidentiality two years ago, I mentioned the trust's study of press coverage of mental illness. I am pleased to inform the House that the trust has continued its investigations and is planning a further report on the matter.

Every day the Matthew Trust receives appeals for help from social workers on behalf of clients whose urgent need cannot be met by the statutory services. Only last week the trust heard about a mentally ill young man whose home had been stripped by thieves while he was in hospital. The only financial help he can now obtain is a loan which has to be repaid from his meagre invalidity benefit. His benefit did not stretch to insurance cover, so he could not make a claim for his loss. The trust learnt from his social worker that, of the 441 clients for whom she was responsible, only 5 per cent. could afford contents insurance. That is a shocking statistic. That young man is not responsible for his mental condition, nor for his current predicament. Luckily, the Matthew Trust has been able to help him.

The report also details the work and the procedures of the trust, which has been championing the needs of the mentally ill for almost 20 years. It was commissioned by the trust's director, Mr. Peter Thompson, whose sterling work in this field and other areas has been acknowledged in this House on a number of occasions. He took the unusual step of opening the trust's files to independent scrutiny because calls upon the trust's limited resources had rocketed since the Government began to implement their plans for what is called "care in the community".

The Matthew Trust operates as a donor of last resort. It cannot provide help unless and until the resources of statutory and other agencies have been tapped. The vast majority of applications for help come via social workers, and applicants must supply evidence that all other routes have been exhausted.

The provision of modest financial assistance to mentally ill people in desperate need was once a relatively minor aspect of the trust's activities, but demand has increased by 400 per cent. since the publication in 1988 of the White Paper, Caring for People. Grant aid from the trust to individuals increased from less than £3,500 in the financial year 1989-90 to almost £14,000 in 1993-94. Indeed, the trust disbursed almost £25,000 to 312 individuals during the calendar year 1994. Some 2,000 others had to be turned away because the trust lacked the financial resources to be able to help them.

We are told that a healthy economy is built upon society's efforts to match demand with supply. By that measure our welfare services are sick indeed. One of the most salient observations made in the report is that the mentally ill are the least likely to be able to make appropriate demands upon the welfare services. That is precisely their special problem. Indeed, it would appear

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from the report that changes in the structure of care provision have bewildered even those who are responsible for providing it. The report documents the increased demand upon voluntary agencies such as the Matthew Trust since the new care in the community policy was introduced and draws attention to the lack of resources available to the voluntary sector.

I commend the report to your Lordships because it offers a rare glimpse of the humdrum and extreme crises faced by those who approach the trust for help. It also draws attention to an unfortunate practice which has grown up over the years in the face of mounting criticism of government health policies. I refer to the practice of calling in aid statistics to smother the voices of the poor and neglected, and the use of expensive consultants to supply apparently independent justification for policies that in the public eye seem to be failing. Public relations is no substitute for patient care.

The Department of Health has acknowledged that Victims of Care is a thought-provoking document, but that is all. That is not enough, because the well-being of hundreds of thousands of mentally ill people in the community, and the prospects for their families, will be determined by the adequacy of the Government's response to the report.

Only last November, in a letter to the noble Earl, Lord Longford, which is quoted in the report, the Parliamentary Under-Secretary of State at the Department of Health, the noble Baroness, Lady Cumberlege,


    "recognised the value of the work being done by the Trust in a difficult field of care, and appreciated the practical support it is able to give to individuals who are in crisis".

I am very grateful for that.

However, the Matthew Trust has been refused grant aid from the Government precisely because it gives financial help to those who are failed by the system. Indeed, the latest rejection came only last month and implied that the trust's work did not fit into,


    "the Ministers' current priorities within mental health services".

Perhaps the Minister can offer us some enlightenment about those priorities, especially since the Matthew Trust was asked by government officers for 30 copies of its report in advance of the debate—and was expected to supply them free of charge.

I have been critical of the Government because they carry the major responsibility for failings in the welfare system that they manage on our behalf. Because my overriding concern is for the mentally ill, I feel I must comment also upon an apparent lack of co-operation between the many organisations that now exist to protect their interests. It seems to me that a more efficient and effective supplementary care system would emerge if the various agencies pooled resources and skills rather than pursuing narrow vested interests. After all, if the mentally ill are their prime concern, nothing should stand in the way of promoting their best interests.

What is evident from the report is the need for a Standing Committee to encourage better liaison and co-operation between voluntary agencies of all sizes and specialisms in the field of mental health care. The combined experience of such a Standing Committee

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would provide the Government with unrivalled policy advice on how to improve support systems for the mentally ill.

These victims of care languish in a world known only to their broken minds. Those of us who, by the grace of God, live happier lives have much to be thankful for. We also have a duty to those less fortunate than ourselves.

I am sure the irony of the closing remarks in the Matthew Trust's Report will not be lost on your Lordships:


    "Many of the funds that find their way into the lives of people whom contemporary society has rejected come from Trusts established by past generations. Those who are forced to live on the margins of society must rely upon the generosity of long-dead patrons for the basic necessities of life".

We cannot leave it to those benefactors to contribute to the well-being of current generations. The problems of the mentally ill may seem intractable, but I am sure that your Lordships will agree that the Government of the day have a duty to make good any shortcomings that are identified in the services they provide in our name.

7.17 p.m.

The Earl of Longford: My Lords, it is a privilege to follow the powerful speech of the noble Marquess, Lord Reading. I think that his great-grandfather would have been very pleased with that speech. The question will be asked: did you know him? I did not, but within my lifetime he was an important man. After all, his great-grandfather had the extraordinary record of being Attorney-General, Lord Chief Justice, Viceroy of India and Foreign Secretary. I can think of only one person who can beat that record and that is the father of the noble Baroness, Lady Jay, who will wind up for my party. He was Home Secretary, Chancellor of the Exchequer, Foreign Secretary and Prime Minister. With that one exception, I believe that the record of the noble Marquess's great-grandfather is unique.

I know that this is a day of much pride for those who for quite a few years have supported the Matthew Trust in one way or another. I refer particularly to Mr. Peter Thompson, who has been mentioned and who emerged from Broadmoor—not a promising start for a new career—without influence, money or credit and who built up the Matthew Trust—and here we are in the House of Lords, a solid institution, devoting some time to discussing its report. I know that it will be a source of satisfaction to the trust that it is to be the noble Baroness, Lady Cumberlege, who will reply to the debate on behalf of the Government because her heart and soul engagement in these matters is recognised everywhere.

However, after those generally acceptable observations, some of the points made by the noble Marquess are thought-provoking—a phrase used by the department about the report—and they should worry those who rule our affairs in this area. We all know that community care is a fine ideal, and I am not disparaging it. It is much easier said than done, of course. People come out of institutions and it is said that the community can now look after them. What is the community? It

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may mean the local authorities; it may mean the general public, which does not have great concern and is not usually quick to help the mentally ill.

At any rate, community care is a great advance in embryo, but, as the Government now admit, people do fall, and will always fall, through the safety net. As the noble Marquess suggested, it may well be that better organisation of and co-operation by the authorities would minimise the number of those who fall through the safety net, and so would greater resources. But when all is said and done, some people will fall through the safety net because there is no obvious statutory criterion under which their cases can be brought by lawyers.

I could think of a number of cases. I have mentioned one or two in previous debates. There was a lady whom I was hoping to meet, but I could not meet her because I imagine that she was not well enough to see me. She needed a nebuliser. I do not know much about nebulisers. They are required if one is to breathe properly when suffering from certain forms of asthma. I had asthma for a time. It is about the only thing I have ever been cured of. I needed an inhaler. Luckily that has all passed, but it has not passed for this poor lady. She needs a nebuliser. What happens? No one will provide one until eventually her GP, out of the kindness of his heart, said that he would lend her one for three evenings a week for a short time.

This is where the Matthew Trust comes in. One might call it a refuge of last resort. It paid £280 for a nebuliser. One might say that that was very good of the trust. But one is bound to ask the Minister—I have given her short notice of it but I think she guessed that it was coming in view of earlier discussions—why the Matthew Trust should receive no help from the Government. The National Schizophrenia Fellowship and MIND receive government help. They are both fine, large and powerful bodies. But the Matthew Trust, which of course was started much more recently with much less backing, receives no help.

I always hate putting awkward questions to the Minister because I do not think she should be put in an awkward position as her intentions are so good. Nevertheless, she is a Minister and she is accustomed to awkward questions. Will she tell us why the Matthew Trust should not receive help? Patients are sent to the trust from the National Schizophrenia Fellowship and MIND. The Matthew Trust takes them on and pays for them. The larger organisations receive help, but the Matthew Trust does not.

It might be said that that is because the Matthew Trust gives financial help. Is that the reason? If so, it is a funny reason, because many voluntary bodies give a great deal of help of one kind or another, whether or not it is called financial. They render a great service. So I am bound to press the Minister on that point. Why should not the Matthew Trust receive help when the large organisations which send their patients to the Matthew Trust receive it?

Looking at the whole matter more broadly, it is a gratifying day not just for the Matthew Trust but for everyone who is concerned with the mentally ill that the House of Lords should devote even a short time to the

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subject. That will always be a great source of pride to the Matthew Trust and to all who take a genuine interest in the mentally ill.

7.25 p.m.

Lord Beaumont of Whitley: My Lords, I am depressed to hear that the Matthew Trust had to produce copies of the report free of charge. When Members of Parliament ask to discuss important reports I should have thought that they might well be paid for. The report makes depressing reading with its lists of people who have gone to the trust for help, in particular the list of those whom it had to turn away. In every example it appears that the solution to the immediate problem was simple: a new fridge, money for clothing—all very basic stuff. It is depressing that those people should slip through the net of the official channels, and even more depressing that the work of voluntary organisations such as the Matthew Trust cannot, despite their best efforts, meet the total demand for help.

The report clearly demonstrates that the hard work, dedication and commitment of the Matthew Trust to the forgotten in our society has its limits. The system cannot be functioning well if even the longstop, last-resort organisations, which are there to pick up the pieces when all else fails, cannot cope.

Community care is the right policy. Whatever our misgivings about individual circumstances, about the level of funding, and the Government's organisation of the implementation of the community care programme, we support the concept. The mentally ill should not be treated uniformly, but as individuals with rights to determine their own future, and live and join with as wide a society as they possibly can. Community care is a laudable aim.

The report states that the trust's grant-making role has increased by 400 per cent. since the 1988 White Paper, Caring for People. What we have seen since that time is a radical change which has profound effects on the users of the services, on carers, on health, social work, social services professionals, and on the way in which voluntary groups operate.

The system as it stands, works, as far as it does, because of the dedication of the people involved, but the resources available are patchy and so the provision of help is patchy. What is needed is a comprehensive and systematic approach to the care of people. As my noble friend Lord Mar and Kellie, who has firsthand experience of working with the mentally ill, said on Second Reading of the Mental Health Bill:


    "Community care plans require the co-operation of social work departments, housing, health board staff, voluntary agencies and carers—and the use of their funds".—[Official Report, 16/3/95; col. 954.]

A comprehensive and systematic approach has to include the whole range of help from housing, education, and leisure facilities, as well as medical support. Included should be 24-hour crisis lines so that no distressed person is denied immediate help, and community mental health teams must be backed up by sufficient beds in local general hospitals. We must also give to carers adequate support such as respite care, training and a separate assessment of their needs.

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A fully comprehensive package would come with a price tag. We are not calling for unlimited money to be thrown at the system, but if the Government are serious about the issue of mental health, and if they are prepared to back up the community care initiative, resources will be needed. Restrictions on local authority budgets at the moment are such that, with the best of intentions, the system will never be fully functional unless there is more money.

On a different note, the campaign launched this week to counter ignorance among the general public about the nature of mental illness should be given every encouragement. There is no doubt that ignorance in fear of mental illness within society as a whole gravely hinders the effectiveness of care in the community. Moving people back into the community is a departure from the health service as it has existed for a long time. As regards such people, the health service provided a system of controlling them and preventing them from harming themselves and others rather than doing anything more positive.

The health service is dealing with acute cases and it is used to doing so. Now the community must care and we must ask whether communities are ready to care. Could there have been more preparation of the general public before the long-stay institutions began to be closed? Adequate care for the mentally ill is not an easy issue. Care in the community is the right policy but it needs to be properly resourced. The work of organisations such as the Matthew Trust are vital in the overall package of care and we should give them every support.

I am grateful to the noble Marquess, Lord Reading, for drawing our attention to this issue and for doing so in such an able and telling speech. I hope that the desperate examples of need found in the report will soon be a thing of the past because the Government have responded to the Question that is being asked of them tonight.

7.31 p.m.

Baroness Jay of Paddington: My Lords, I too am grateful to the noble Marquess, Lord Reading, for introducing the debate and drawing our attention to the important report of the Matthew Trust. It deals with those who are among the most vulnerable members of our society. The report describes them as having lives dominated by a struggle against poverty and illness, which happens daily.

It is especially opportune that we should have the debate when, in terms of the parliamentary timetable, we are simultaneously considering the Mental Health (Patients in the Community) Bill. Much of the report is relevant to the topics included in that Bill. Noble Lords will remember that the aims of the Bill include additional legal supervision of those who live in the community following discharge from institutions for the mentally ill.

Noble Lords who took part in the Second Reading debate, and those who read the Official Report, will remember that many speakers dealt with the need for extra practical support and help for people with severe

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mental illness living in the community. They saw that as a greater priority than more legal powers. That is confirmed by the personal stories and details that are included in the Victims of Care report. Indeed, on Second Reading of the Bill, my noble friend Lord Longford and I quoted from the report in order to demonstrate the burdens that agencies of this kind were having to assume.

All noble Lords who have spoken have agreed that we want community care to succeed. We see it as the way forward and of dealing with the mentally ill. We have all supported the closure of the long-stay institutions but the vision of how we cope with such vulnerable people must be properly resourced. In my opinion, it must be supported largely by public money.

One of the most sad facts in the report is that applications to the Matthew Trust have increased in an extraordinary fashion since the community care arrangements were changed. That was mentioned by the noble Marquess, Lord Reading. The Matthew Trust describes its role as being as a last-stop voluntary agency. At the same time as we have this extraordinary increase in applications to organisations in the voluntary sector such as the Matthew Trust, we are told by the Mental Health Foundation that statutory sector funding across the country for community care for the mentally ill is stable and in some places it may be falling.

We know that the number of people who need such care in the community is increasing. In large cities such as London they may be discharged prematurely from institutions as a result of bed shortages. Noble Lords will remember the information that has been given in answer to various Questions tabled in this House. Indeed, it emerged again at the Second Reading of the Mental Health (Patients in the Community) Bill. The evidence shows that, for example, in London some of the acute sector mental health hospitals have what is called a 120 per cent. or 130 per cent. bed occupancy. I found that concept difficult to understand until it was explained to me that doctors who run those units could admit 20 per cent. or 30 per cent. more patients if they had the beds. The demand exists but they simply do not have the resources to meet it. Therefore, one often has the suspicion that people are living in the community in circumstances that their health does not appropriately allow for.

The noble Marquess, Lord Reading, asked for a government response. All noble Lords—in particular my noble friend Lord Longford—would be more optimistic than normal to expect a response from the Minister tonight suggesting that a large new injection of resources would be made available either for the acute-sector care of the mentally ill or for community care. It is worth reminding your Lordships that the Government have said that the new Bill which we are now discussing will need no further financial provision and that the new form of care that the Bill will provide should be encompassed by the resources which local authorities and local health authorities already have.

Would it be possible for the Department of Health to offer guidance or a code of practice—in other contexts the Minister has told us that these have great force

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within the health service—to establish some of the provisions that would make the work of organisations such as the Matthew Trust more successful not in terms of their aims but in dealing with the large number of people who go to them for help? Perhaps I may suggest three practical ways in which that could be addressed. Perhaps it would be possible, for example, for the Department of Health to issue guidance to establish limited caseloads for community psychiatric nurses so that they were not battling with huge numbers of people to the detriment of each individual. I appreciate that it would be more expensive to start on a general basis but it should be possible to establish crisis homes or hostels where very ill people could be looked after perhaps on a temporary basis while some clinical or practical crisis was dealt with.

Another solution, which would be relatively inexpensive, is that people who fall into the category of being severely mentally ill, but who are nonetheless struggling to survive and are struggling against the daily problems of mental illness and poverty, could be given crisis cards so that they had ready access to the types of service that we are discussing. As was mentioned by the noble Marquess, Lord Reading, the report contains the notorious comment, made last November by those in the Department of Health, that:


    "Facilities for care of the mentally ill in the community exist. But many of these people don't come to see the agencies responsible for their care".

As the report commented, that is a staggering remark which encapsulates the problem that the report seeks to highlight, because the mentally ill are those least able and least likely to seek appropriate help when it is most needed.

The strength of the report is that, in addition to giving powerful and saddening individual personal anecdotes about people's experiences, it has drawn together a number of authoritative sources and commentaries on the present state of community care for the mentally ill.

Perhaps I may conclude my brief remarks by quoting from two of the reports that are cited in Victims of Care. The first is from the Health Committee in another place, whose report was entitled Better Off in the Community? It is right to emphasise that there was a question mark at the end of its title. The noble Lord, Lord Beaumont of Whitley, has referred already to the question of the new funding arrangements for that type of care in the community. As is mentioned in the Matthew Trust report, the Health Committee concluded that the current funding formula:


    "very substantially under-estimates the extra need for mental health services within the more socially deprived inner-city areas".

The 1994 report of the Mental Health Foundation, when talking about resources, pointed out that:


    "A lack of resources is such a common complaint from every quarter that it can easily be ignored as just further professional pleading. But the mental health arena is crying out for more resources, stretched beyond reasonable measure in far too many areas. This is serving as a constraint on what can be done for any one person but, much more importantly, is hindering the proper planning and investment services that would bring greater savings in the long run".

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It is very helpful that we should have this extremely authoritative report before us from the Matthew Trust, which is an important organisation. I should like to thank the trust for its extraordinarily good work within the community. The report draws together the very sad stories of individual victims of care but it also gives us an authoritative commentary from many sources about what is happening in the community. When the Minister responds, I hope that she will be able to make some practical suggestions as to how the Government could take action to meet the points that have been raised, because this problem is demonstrably becoming a crisis.

7.41 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, I am extremely grateful to my noble friend Lord Reading for introducing this important debate on the care of mentally ill people in the community with such perception and insight. I refer in particular to the Matthew Trust. The subject is one of great concern but, equally, it is one of great complexity. Your Lordships' debate has not only done justice to that complexity but has also taken the matter further with customary perception.

Mental illness has received much attention over the last few months and has at times been a source of controversy in the media. The Government recognise their responsibilities to people with mental illness, who have for many years been a priority group. We are committed to providing safe and effective care, whether it is in the community, in hospitals or elsewhere. We are also committed to removing the stigma which is sometimes attached to that condition and to enabling the millions of people who experience mental illness to fulfil their potential and have easy access to the services that they need. The Government fully support the public awareness campaigns referred to by the noble Lord, Lord Beaumont of Whitley, being run this week by the Daily Express and the Royal College of Psychiatrists and in respect of Radio 4 and BBC2 we are giving financial help and advice.

However, the difficulty of turning caring intentions into effective services is not to be underestimated. There is no single blue-print for psychiatry. The Government believe that those working in the field are best placed to develop effective local services which are responsive to local needs. Those services will make full use of the range of facilities available and the high quality care which the different agencies and professions can offer.

Effective partnerships between the statutory and voluntary sectors are essential for that. Each agency has its own unique expertise and by working with others can provide a complementary and comprehensive range of services, a point made by my noble friend in his far-ranging speech. The Government recognise the importance of those partnerships and our Guide to Inter-Agency Working for the Care and Protection of Severely Mentally Ill People refers to the important role of the voluntary sector. The draft guide has been warmly welcomed and we hope to issue the final version shortly.

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I hope that that will go a little way towards meeting some of the points raised by the noble Earl, Lord Longford.

The Matthew Trust is widely respected for its work, giving financial assistance to those who are in need, as well as offering counselling and other services. The Government share that respect for the trust's professionalism and its commitment.

Its report Victims of Care is a useful contribution to our understanding of mental illness. We shall certainly consider its findings carefully. But as the report itself acknowledges, the anecdotal experiences it records often raise more questions than they offer solutions to. One example of that is that the increased demand on the trust's services referred to by the noble Baroness, Lady Jay, may not simply be a result of more unmet need. It may show a greater awareness of the trust's work. That is a likely explanation of the doubling in applications received between 1993 and 1994.

The report makes a number of recommendations for the income support and Social Fund systems and I shall make sure that these are brought to the attention of my right honourable friend the Secretary of State for Social Security. One does not wish to diminish the cases of genuine need which the report highlights, but the 2,300 applications for financial help received by the trust last year should be set against the overall prevalence of schizophrenia, which is between 250,000 and 300,000 in the UK.

The noble Earl, Lord Longford, asked why the Government have not given financial support to the trust by way of a Section 64 grant. The noble Earl has been extremely generous in his personal remarks about my intentions and I shall answer his questions to the best of my ability, but I sense that he will be disappointed. We have considered the trust's applications for a core grant very carefully but, as I am sure your Lordships will understand, decisions about grants are never easy. The amounts applied for always exceed the resources available, despite the fact that in the field of mental illness this year alone we allocated some £2.3 million for the voluntary section. But we have a clear policy to give priority to organisations which need pump-priming to help them become established or to develop new initiatives. The Matthew Trust is a well-established organisation. It has been carrying out its work for nearly 20 years. Over that time it has frequently shown its ability to raise funds elsewhere and it has a good record in containing administrative overheads and in fund-raising. But however deserving an organisation is, I am sure that your Lordships will appreciate that our resources are finite.

As your Lordships know, care in the community is not simply about money, but, as the noble Lord, Lord Beaumont of Whitley, said in his very comprehensive speech, money is important. I assure your Lordships that the Government are committed to funding mental health services where they are needed and to promoting comprehensive services to meet individuals' differing needs. Mental health spending is currently £2.5 billion per year—higher than it has ever been in any previous year. Hospital and community health funding has increased by 40 per cent. in real terms since 1978-79

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and social services funding for mentally ill people has risen by 171 per cent. in real terms over the same period. We will continue to give priority to mental health funding. This year the mental illness specific grant gave local authorities an extra £36 million to supplement £14 million which they invested in new initiatives. This year we will increase that grant by approximately 10 times the rate of inflation to £47.3 million.

The noble Baroness, Lady Jay, raised the question of premature discharge from hospitals because of the shortage of beds. We recognise that there are severe pressures on beds, in particular in London. That is why we have asked the Mental Health Task Force to look specifically at that whole question. It may not be that more beds are needed, but better management of beds may improve services, and certainly we know that services within the community make a dramatic impact on the use of hospital beds. The task force report shows that progress is being made by health authorities to improve the level of services.

The noble Baroness also mentioned the question of crisis cards. A number of local psychiatric services have pioneered the system of crisis cards which give essential information about people to contact should a crisis arise in a patient's care. We welcome those initiatives and would like to see them tried more widely. However, we are not convinced at this time that more central guidance would be valuable.

The noble Lord, Lord Beaumont of Whitley, talked a little about moving people into the community. Our policy is to provide a comprehensive range of services to include in-patient care where appropriate, as well as services in the community. When my right honourable friend the Secretary of State for Health launched the Ten Point Plan, which I shall discuss in a moment, she gave an undertaking that no permission for closures of hospitals would be agreed to unless there were better alternatives provided in the community.

While making funding available, the Government are also taking steps to develop the quality of mental health care. We are working closely with the professional organisations, the NHS and other agencies to disseminate good practice and continue setting high standards. We are promoting alliances between health, social services, housing and criminal justice departments. At the centre of that approach is a coherent, sharply focused strategy known as the Ten Point Plan.

The plan includes proposals to strengthen the powers of supervision for patients detained under the Mental Health Act when they leave hospital. The Mental Health Bill referred to by the noble Baroness, Lady Jay, returns, as your Lordships will be aware, to this House next month. If it is passed, it will introduce a new power of supervised discharge so that patients who are most at risk comply with the terms of their care plan. I believe that those measures are designed precisely to meet the very sad—indeed, tragic—case of the young man referred to by my noble friend. I believe that his name was Martin Lloyd. It is very much those sort of cases that our new legislation will prevent.

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As part of the Ten Point Plan we have also issued an improved version of the Mental Health Act Code of Practice. New guidance has been given which prevents patients being discharged from hospital inappropriately and promoting easier access to care from different agencies. The supervision registers introduced last year have clearly identified patients with highest priority needs. We are confident that that can help prevent suicides, self-neglect and violence.

The Government have consistently supported the care programme approach and through the Ten Point Plan we have made training for key workers a priority. A national conference was held in March 1994 on the care programme approach, followed by a further three which the Government supported. We are currently discussing with the Open University and others how to take that further by developing training materials for professionals in all aspects of mental illness.

The noble Earl, Lord Longford, spoke of the difficulties of implementing community care. I believe that the Ten Point Plan goes a long way towards helping us do so successfully. However, we have not stopped there. Much work is continuing, both nationally and locally, as part of The Health of the Nation strategy. We are continuing to issue up-to-date guidance as good practice is identified and developed.

My noble friend Lord Reading is absolutely right to call attention to the area and to the important work of voluntary organisations such as the Matthew Trust. The Government believe that mental health will continue to be a priority for the future as one of the five key areas in The Health of the Nation initiative. We hope that there will be further advances in understanding and further developments in good practice. The Government will continue to listen to patients and to professionals and we will encourage the National Council for Voluntary Organisations to co-ordinate the activities of the voluntary sector. We will also promote and continue to fund high quality services and research.


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