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Lord Jenkin of Roding: My Lords, I will not detain the House more than a moment. However, one or two of the remarks made by the noble Baroness, Lady Jay, require some answer. The NHS trust which I have the honour to chair is in the process of closing one of the south's major mental hospitals, Claybury Hospital in north-east London, and providing those services elsewhere. I have not the slightest doubt that the provisions of this Bill will be extremely helpful to the professionals who are engaged in findingif I may use the words which I used as chairmana place and a plan for every single one of those patients who is to be moved into the community.
The Bill will provide the safeguard and the safety net to make sure that when patients are moved into the community there can be a provision whereby they can be properly supervised, and in particular whereby their medication can be properly supervised. If any single message came out of the cases to which my noble friend referred when she moved the Motion, it is the fact that people are lost sight of and as a result they cease taking the medication which keeps their condition under some kind of control and the result is disaster of the worst kind.
In the case of a major hospital closure such as I am engaged in, the question of adequate finance is, of course, crucial. We are close now, in our case, to being able to match the requirements with the resources that are available to meet them. The suggestion that somehow there is still an enormous amount of community care for mentally ill people which is not adequately resourced seems to me to be alarmist and untrue. Of course people always want more, but where one is engaged in a major operation of this kind, and where one is spending millions
Baroness Robson of Kiddington: My Lords, I am sorry to rise to speak at this stage of the Bill. I very much regret that I was unable to be present at the Committee and Report stages. I thank my noble friend Lord Russell for so staunchly standing in in my absence.
I read with great interest the proceedings of both the Committee and the Report stages. I am very conscious of the great assistance that both Ministers on the Front Bench have given in response to the anxieties expressed by Members of this House.
In her final remarks, the Minister referred to resources. That is one issue which still worries me deeply. How can one say that the Bill will not give rise to additional costs for health authorities while at the same time the Secretary of State states that those responsible for mental health services must ensure that this particular group of patients is afforded priority in terms of resources, staff time and active monitoring in the community? That cannot be done without increased expenditure. If it is done without increased expenditure, the services for other mentally ill patients who also need the services of the community will be diminished.
I know that the Government have injected another £10 million into mental health services. However, that money was injected, and was badly needed, before the Bill comes into effect. I am convinced that the Bill will be costly if it is implemented in the way that it is intended that it should be implemented. I am concerned that some other mental patients may suffer neglect in the community. Otherwise, I am grateful for and welcome the Government's attitude to the amendments that were introduced.
Lord Mottistone: My Lords, I should like to add my thanks to my noble friend the Minister for her acceptance of several of the amendments that I was, happily, able to put forward, so ably advised by the National Schizophrenia Fellowship.
I am concerned that people are worried as to whether this is the right kind of Bill for the subject in question. I believe it is a very good Bill, which fills a gap that needs to be filled. It provides additional resources in introducing the power to make supervision orders. It is now up to us to make use of the Bill, once it has been agreed by another place. If that turns out to be more expensive than suggested in the introduction to the Bill, as the noble Baroness, Lady Robson, expects, that is unfortunate from the Government's point of view. They have guessed wrong again.
The Bill provides a power that is needed for supervision of people in the community which is at present lacking. In my view, those people who feel that the Bill implies some form of restraint on civil liberties are wrong. As I see it, if and when this Bill is implemented, if the psychiatrists and
I believe that the concept of the Bill is most imaginative. Above all, I should like to thank my noble friend the Minister for being so ready to accept good arguments and to introduce amendments of her own to meet points which were made. That is something which, generally speaking, my noble friends on the Front Bench tend not to do. This is a jolly good Bill, and I hope that another place does not spoil it in any way and will hurry it through as quickly as possible.
Baroness Farrington of Ribbleton: My Lords, I too wish to add my support for the principles behind the Bill and the important issues which it seeks to tackle. I had not intended to speak, but, declaring an interest and drawing on my experience as a member of a social services authority in a county council, I feel that the issue of resources needs to be placed firmly on the record at this stage in the passage of the Bill through your Lordships' House.
Inexorably, additional demands for care in the community of a new range, quality and quantity are being added to the existing demands on local authorities providing those services. I say in passingnot as a member of a housing authoritythat with a reduced range of properties available for tenants it is increasingly difficult to find property for people who may, through no fault of their own, at times not be good neighbours and who may be difficult to place.
Within the community there are demands to meet the needs for the care of the elderly, chronically sick and mentally ill patients needing care in the community. As hospitals are closed and such people no longer become patients in hospitals, the demands grow. At every stage, every new demand is treated as being small or less than the total resources realistically required to meet those needs.
"Priority must be given" is a phrase the Minister will use. However, at the end of the day the community believes that priority must be given to other groups who are mentally ill: priority must be given to the young who need care within the community; priority must be given to the elderly within the community. When all those priorities are top priorities, priority must be given by the Government to the resources necessary to enact legislation which is basically good legislation, as this will be, but which will be better legislation if in another place the resources are appended to make it fully effective in all places at all times.
The Earl of Mar and Kellie: My Lords, I too wish to thank the noble Baroness and the noble Earl for the way they have presented the Bill and have been prepared to take on board some of the amendments which were moved in Committee and subsequently. I believe that the Bill has been improved as a result and will be more roadworthy for the 150 or so Scottish patients affected when the Bill becomes an Act. I should also like to thank
Finally, I should like to make a comment arising from the Report stage. There seems to be merit in not grouping amendments, for it is then clear to external readers of Hansard exactly what the Government's thinking is on any one aspect.
Earl Russell: My Lords, I shall not repeat what my noble friends have said. The noble Baroness knows that I agree with it in detail. But I shall say, on the basis that all that the noble Baroness was able to introduce was a Bill, that it is rather a good Bill. I can recognise a good government Bill when I see it. It gives me great pleasure to do so and to congratulate the noble Baroness and her team on producing it.
Baroness Cumberlege: My Lords, I am very grateful to noble Lords for their contributions to this final debate and for the, on the whole, warm welcome they have given to the Bill. I am particularly grateful for the words of the noble Earl, whose experience in your Lordships' House is long and distinguished. We believe that the Bill as a whole strikes the right balance. It provides the means of ensuring that mentally ill people who no longer need to be detained in hospital but who still represent a serious potential risk to themselves or other people receive the support they need in the community.
I understand the issues concerning resources, but the level of resources for the care of mentally ill people has increased and is continuing to increase, as the noble Baroness, Lady Jay, acknowledged. Gross expenditure on hospital and community health services for mentally ill people increased by 40 per cent. in real terms between 1979 and 1990 to £1.7 billion. Gross expenditure on local authority social services for the mentally ill increased by 209 per cent. in real terms between 1978 and 1992. So there has been a huge amount of increase. But I think that the new power will help to set priorities for the use of those increasing resources.