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"On 24th August last year, my honourable friend the Minister for Health wrote to health authority chairmen informing them that I had asked the regional directors of the NHS to review the progress being made in their regions, towards the delivery of modern
"The background to these developments is familiar to the House. Over the last 40 years, in this and every other developed country, health and social service authorities have been replacing asylum based care with a broad spectrum of facilities which are better able to meet the needs of the individual person suffering from a mental illness. At its best, a modern mental health service represents a dramatic improvement in the quality of care available to its patients.
"Too often however the reality has not matched up to the potential. That is why we decided last June to make the improvement of mental health services a key medium-term priority for the NHS and it is why I initiated the review process last August.
"Today's report of that review confirms that every health authority now has in place plans which commit it to deliver a comprehensive mental health service. Sixty-eight health authorities have demonstrated that this objective will be achieved during the next financial year; the remaining 33 authorities have plans to deliver a comprehensive service which will take longer to complete. The review shows that health authorities are planning to increase the resources committed to mental health services next year by £53 million. Regional directors will continue to monitor the delivery of these plans at local level.
"It is important to be clear about the objective. The phrase "care in the community" has too often been taken to mean the abandonment of residential care for mentally ill people. That is not, and never has been, our policy. That is why I am today publishing a document entitled The Spectrum of Care which sets out in clear language the range of services which constitute a modern mental health service.
"It restates our commitment to provide treatment at home for those patients for whom that is the right answer. For this group there needs to be a range of services provided by the NHS and local authority social services departments, very often in partnership with local authority housing departments.
"The document also sets out the range of other facilities that are needed to complete the required spectrum of care: day hospitals and day centres: to provide for those who need care during the day; access to out of hours specialist services and crisis accommodation: to meet short-term crisis need; acute hospital beds: to meet the needs of those with acute mental health problems; 24-hour nursed residential places: to meet the long-term residential needs of those with severe and enduring mental illness.
"All of these facilities are needed together with a range of secure units for those who need treatment in a secure environment. Today's document makes clear the Government's commitment to deliver not simply
"Along with this overview of the full spectrum of care, I am also publishing a report commissioned by my department on 24-hour nursed care. The report states that there is accumulating evidence of a need for residential nursing care, for a relatively small group of so-called new long-stay clients. The Government accept that facilities of this kind do have a valuable role to play in the spectrum of care, and it will look to health authorities to ensure that their plans for the future provide for this need to be met.
"Although it is understandable that much of the comment about the state of mental health services concentrates on the pattern of service provision, a crucial requirement is that there is effective collaboration between the wide range of agencies that contribute to an individual's care. That is why the Government are committed to the full implementation from 1st April of this year of the Care Programme Approach. This requires the preparation for each patient under the specialist services of a plan of care based on an assessment of their needs, which names a key worker to be responsible for ensuring that this care is delivered.
"The NHS is under an obligation from next year to audit the successful delivery of this approach. I am today publishing an audit pack designed to assist with this process. It has been developed by the NHS Executive with the Royal College of Psychiatrists and constitutes an important reinforcement of our commitment to quality in these services.
"A further reinforcement of quality is provided by the Government's decision to introduce a patient's charter on mental health. A charter does not, of course, by itself improve standards. It does, however, state clearly the standards which the individual patient can expect to receive from the statutory services, and it therefore constitutes a bench-mark by which the quality of the service can be judged.
"I am today publishing a draft charter and I am asking for comments by 26th April. The draft charter proposes standards for timely access to specialist services. It sets out the entitlement of a mentally ill person to have their illness explained; to have the effects of medication explained to them; and to be given information about advocacy and support groups, together with information about what to do in an emergency. It also establishes that a patient who needs continuing care outside hospital will not be discharged from hospital until appropriate arrangements, including a care programme, have been put in place.
"There has recently been disquiet about the arrangements which allow hospital managers to discharge patients from detention under the Mental Health Act, possibly against the advice of their responsible medical officer. It is clearly essential that a detained patient must have the right to have their case reviewed. The Mental Health Act provides for
"Finally, I come to the question of money. This Government are firmly wedded to the provision of sufficient resources to allow the continued improvement of our mental health services. In December I announced the creation of a Mental Health Challenge Fund within the NHS, and I am today publishing the detailed criteria for applications to this fund. The fund will deliver £20 million worth of improvements and development in addition to the £53 million of growth money which health authorities already intend to spend on mental health next year.
"In December I also announced an increase of £11 million in the mental illness specific grant for 1996-97, and a further £9 million for 1997-98 subject to parliamentary approval. Of this £20 million, £4.5 million will provide for a 10 per cent. increase in the existing specific grant programme; £2 million will virtually double the provision for the homeless mentally ill initiative; and the remaining £13.5 million will be committed to a target fund to assist those local authorities working in areas where the strains on the mental health services are greatest. I have written today to the local authority associations inviting them to join us in drawing up the detailed criteria for the schemes.
"The combination of an extra £20 million through the mental illness specific grant; and extra £20 million through the NHS Challenge Fund; £53 million from health authorities' own plans; and a contribution of at least £2 million from local authorities' own resources will bring the total of growth money for the mental health services under this programme to over £95 million. Our National Health Service has made great strides in improving mental healthcare. I pay tribute to all those working in health and social services who have achieved so much for mentally ill people. We are committed to supporting them, to securing the best standards for users and carers, and to providing a service of which the public can be proud. The measures I have announced today constitute a substantial contribution to the progress we need to make. I commend them to the House".
Baroness Jay of Paddington: My Lords, I thank the Minister warmly for repeating the Statement made in another place. It is an important Statement, not least because the Government are acknowledging that community care for the mentally ill is failing, as we on these Benches have been saying for some time. There
Today it is sadly all too common to see mentally ill people apparently aimlessly wandering our streets. Their present plight arises from a failure to develop proper community care services to substitute for old-fashioned long-stay residential institutions. As the Statement rightly says, too often the reality has not matched up to the potential. Too many psychiatric beds in hospitals have been closed too quickly. Nearly half have been cut since 1980, and patients have been discharged to fend for themselves without adequate support. The modest package of proposals announced in the Statement does little to redress that central crisis--a crisis that has been often demonstrated by many reports that this House has considered. I remind the House of the tragic cases of people such as Christopher Clunis, Alan Boland and Andrew Robinson.
The Government's review of health authority performance has found the mental health services wanting. Will the Government now call a halt to further closures of psychiatric beds at least until these new measures have been given a chance to develop? Will appropriate residential care play an important part in the new spectrum of care programme to which the Secretary of State now lends his support? At the same time, and very importantly, will the Government insist as part of their apparently new, tough line with health authorities, that all those authorities have in place proper care programme policies? The Statement says that they expect full implementation from 1st April. The care programme approach, which is supposed to ensure that all mentally ill patients have a care programme in place before they are discharged into the community, was originally intended to be implemented by 1991. In 1996, it is still not universal. That is disgraceful. Perhaps the care programme approach should be included in the new Patient's Charter when the draft is finalised--which, as the Minister explained, will also be in April.
We welcome the new Patient's Charter, which, as the Minister said, sets out what services patients will have a right to expect. However, I add a note of caution about the value of such a charter in this special area of care. Many mentally ill people are confused, isolated and without personal support. Some will undoubtedly have willing families and friends who will be able to act as their advocates. But others will be literally unable to understand or to pursue their care entitlements. Many noble Lords will remember the evidence of Christopher Clunis, the schizophrenic who murdered Jonathan Zito on the London Underground. Clunis, although he realised he was in trouble, simply had no idea where he should look for help or what help was available. He continued to walk the streets. A new Patient's Charter will not solve that kind of situation, which I fear is very common. I hope that the Government will not have too much confidence in it as an instrument of policy.
Even in ideal circumstances, a Patient's Charter will work only if sufficient financial and staff resources are in place to deliver the services promised. Will the Minister explain whether any of the financial arrangements announced in the Statement today represent new money? Will she also tell the House how the Challenge Fund money and the mental illness grant can be used specifically to improve the numbers of healthcare professionals working in this very difficult area of care? The Royal College of Psychiatrists has complained that there are staff shortages at consultant, registrar and junior doctor levels. The Royal College of Nursing reported in January that there are fewer community psychiatric nurses working in England today than there were in 1990--although the past six years has been the time when more and more mental health patients have been discharged into the community. Today, only one in five people diagnosed as schizophrenic and living in the community has access to a community psychiatric nurse.
Staff shortages and low morale among those who are working under great stress make it very difficult indeed to deliver successful care. Perhaps the Minister will explain how the new measures will ease shortages and raise moral.
On these Benches, we welcome the Government's overall review of mental health services. However, we find it extremely disturbing. Despite the confidence expressed in the Statement about future plans and performance, it is disgraceful that, for example, the North Thames region reported that none of its health authorities presently has in place a comprehensive set of services for mentally ill adults. Two-thirds did not expect to be able to offer comprehensive services by the end of this next year, even with extra help. Community care is failing very badly, and this package of proposals is inadequate to deal with that failure.
Unless we have a far-reaching, much broader strategy than is represented by the Statement, one designed to address acute bed shortages and staff shortages as well as overall care and supervision in the community, it seems very likely that the alarming picture painted by the Mental Health Task Force will continue.
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