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Lord Morris of Manchester: My Lords, is my noble friend aware that many NHS mental health patients are now being sent from London up to 200 miles away to private hospitals, at a cost of more than £1,000 per patient a day, and that to take but one example, the South London and Maudsley NHS Trust in consequence is now facing an overspend of £1.5 million? Can anything be done to address this problem for the trusts affected?

Lord Hunt of Kings Heath: My Lords, my noble friend raises the very important issue of whether we have sufficient beds for this type of patient. I believe that trends in recent years undoubtedly have reduced the number of beds available. In 1987, 39,000 or so beds were available for adult patients. By 1997 that number had been reduced by 21,000. I recognise that a particularly acute problem exists in London. That is why 68 additional places were produced in 1999-2000, with a further 113 places being produced in the current financial year. I am, of course, happy to look into issues of particular financial difficulty which hospitals

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may be experiencing. I believe that the Maudsley Hospital to which my noble friend referred had an overspend of £700,000 last year which, in relation to its overall budget, is comparatively small. However, clearly the real answer is to ensure that we have enough beds.

Baroness Northover: My Lords, is the Minister satisfied that sufficient funds are being provided to local government for accommodation for psychiatric patients, including those with schizophrenia? How are the Government tackling the major shortage of community psychiatric nurses?

Lord Hunt of Kings Heath: My Lords, I fully recognise that local government has an important role to play in ensuring that there are sufficient facilities in the community to enable people suffering from mental illness to be appropriately supported. The purpose of the mental health grant is to help local authorities in their responsibilities in that respect. I am pleased to report that there has been an increase in the number of people in the workforce who provide direct care and support to people with mental health problems. For example, since 1998 the number of hospital consultants has increased from 2,360 to 2,710 and the number of community nurses increased from just under 9,500 to just over 10,000. I very much hope that we can continue to increase the numbers of staff in those areas.

Earl Howe: My Lords, is the Minister aware that in recent surveys, schizophrenic patients have expressed much greater satisfaction with the newer, atypical medicines than with the older ones? Does the National Institute for Clinical Excellence take into account the extent of patient satisfaction when determining the cost-effectiveness of a treatment?

Lord Hunt of Kings Heath: My Lords, it is not appropriate for me to describe how NICE will approach the work, as the noble Earl tempts me to do. At some stage in the process of NICE's considerations, the Government will have to take a view. If users find a particular set of drugs better to take than others and that increases the likelihood that they will take their medication, that must be taken into account when deciding which drugs are most appropriate to use. As the noble Lord, Lord Williamson, has already suggested, we have a real problem, in that many people suffering from schizophrenia are not following their medication regimes.

Baroness Pitkeathley: My Lords, does my noble friend agree that for schizophrenia, at least as much care is provided by patients' families as by the national health service or local authorities and that the support given to those families is therefore of great significance?

Lord Hunt of Kings Heath: My Lords, my understanding is that from estimates it is reckoned that about 125,000 people suffering from schizophrenia

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live with their family. That places a considerable burden on those family members as carers. We need to do all that we can to support them. The Government's strategy on carers will help, as will the Carers and Disabled Children Bill, which my noble friend is taking through the House, because, if passed, it will enable local authorities to give more support to carers.

US Nuclear Defence System Proposal

3.23 p.m.

Lord Wallace of Saltaire asked Her Majesty's Government:

    Whether they consider that upgrading early warning radar sites in the United Kingdom to support the proposed United States nuclear missile defence system would break the 1972 Anti-Ballistic Missile Treaty.

Baroness Ramsay of Cartvale: My Lords, the United States recognises that changes to the terms of the ABM Treaty would be required to enable it to deploy the sort of national missile defence system currently envisaged without breaching that treaty. That is why it is seeking to negotiate such changes with Russia. The Foreign Office and the Ministry of Defence recently submitted a memorandum on the subject to the House of Commons Foreign Affairs Committee, which has now put it in the public domain via the Internet. I shall therefore now be able to place a copy in the Library of the House.

Lord Wallace of Saltaire: My Lords, I thank the Minister for that encouraging reply. Does she recognise that at the present stage of debate in the United States, where people are much less determined to go ahead than they were some months ago, the views of America's allies will carry great weight? Will she assure us that Her Majesty's Government intend making their views known about a system that will require British co-operation if it is to go into service as designed?

Baroness Ramsay of Cartvale: My Lords, I assure the noble Lord and the House that our views on NMD have been conveyed clearly to the United States in bilateral exchanges and in discussions in NATO on many occasions. The debate involves important security concerns on all sides. We believe that they need to be considered and addressed seriously. Russia has now acknowledged that there is a growing threat from the proliferation of weapons of mass destruction and long-range missiles and that that threat must be addressed. It is essential that the issue is taken forward on the basis of dialogue and negotiation. Public confrontation will hinder, not help, the search for an agreed way forward.

Lord Archer of Sandwell: My Lords, safety from nuclear missiles is indivisible. Either the whole world is safe or no one is safe. If Russia is goaded into

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abandoning her arms control programme, it will make America a more dangerous place in which to live, not a safer one.

Baroness Ramsay of Cartvale: My Lords, it is in nobody's interests nor is it anyone's intention to goad Russia into anything of the sort. That is why the Americans are engaged in ongoing negotiations with the Russians, with our full support and encouragement, to try to find a way forward.

Lord Howell of Guildford: My Lords, does the Minister accept that, despite the failure of the booster rocket in the test at the weekend, if these exoatmospheric killer vehicles can be made to work, they will help to reinforce world safety by reducing people's readiness to resort to nuclear weapons? Will she reassure us that the British Government take a rather more positive view of the issue than, for example, the French Government? As the decision has to be made in two weeks in Washington on whether the programme will go ahead under the current President and as British participation is necessary for that decision, because of the high-resolution radar at Fylingdales and the infra-red tracking facility at Menwith Hill, will she reassure us that the British Government are also ready to take the necessary decision in the next few weeks? Will she ensure that we are fully informed when the Government take that decision?

Baroness Ramsay of Cartvale: My Lords, I assure the noble Lord that the House will be fully informed if any such decisions are taken. However, I caution against believing the reports, which I have also read, that decisions are about to be taken in the next week or two. I think that our information is accurate. Our understanding is that no decision on NMD will be taken in the United States until towards the end of this year. Many noble Lords will have seen the article in last Sunday's Observer stating that a decision would be taken at a meeting on Tuesday. That is not the case. There are many meetings taking place, as one would expect. The United States' decision on whether to proceed with NMD deployment will be taken by the President alone. I repeat that we do not expect any decision from him until later this year at the earliest.

Baroness Williams of Crosby: My Lords--

Lord Carver: My Lords--

The Lord Privy Seal (Baroness Jay of Paddington): My Lords, I think that we probably have time for two more questions. I believe that the House is inviting a contribution from the Cross Benches.

Lord Carver: My Lords, after the failure of the second trial the other day, will the Government try to persuade the United States Government to abandon this irrelevant project and switch their efforts to

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theatre missile defence, which would not be in breach of the ABM treaty and would be much more relevant to the needs of NATO?


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