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I was glad to hear the Government say that the care in the community policy, as it relates to mental health--that is all that we are discussing at the moment--never meant the abandonment of a residential care policy. I remind the Minister of some figures that we discussed during the passage of the Mental Health (Patients in the Community) Bill from the Royal College of Physicians on the shortage of mental health beds in London, and from the noble and learned Lord the Lord Chief Justice about the number of occasions on which people in need of mental health treatment have to be sent to prison. In the light of those, will the noble Baroness tell the House how many more mental health beds, either acute or long-stay, will be provided as a result of the Statement? In assessing the needs, I hope that she will take account of other pressures on mental health beds which may result from increasing homelessness in a wide number of contexts. That is one factor that exposes weaknesses in people's mental health make-up. In fact, it accounts for quite a large amount of the pressure on mental health beds.
Will the noble Baroness also consult, first, the National Association of Citizens' Advice Bureaux, and secondly, her noble and right honourable friends in the Department of Social Security about the plans to remove the mobility component of the disability living allowance for patients in hospital? That will fall particularly severely on mental health patients whose state is perhaps not particularly acute and who are able at present to maintain a contact with friends, relatives and neighbours. For them, such contact will be very much harder in future.
We hear about every health authority having plans. There are plenty of plans. I recall listening to Mr. William Waldegrave, when he was still an undergraduate, referring to Her Majesty's Stationery Office. I believe he described it as, "the large intestine of the body politic producing excreta of national plans". I do wonder whether very much has really changed. What matters is not whether we have plans, but whether those plans are capable of being delivered.
We hear of £53 million being devoted to plans. From where will that money be taken? Is it new money? Or is it at the expense of some other programme that the health authorities might otherwise have undertaken--and if so, what?
I am glad to hear that there is concern about the care programme approach. I am also glad to hear the Government say that a charter by itself does not raise standards. I can recall Mr. Roger Freeman, when he was a junior Minister, in 1991, saying that the Citizen's Charter, by definition, could not be used to solve major problems. At the time Mr. Freeman was speaking about the London-Tilbury and Southend line. How right he was.
I want to know not only whether there is a charter but what it covers and what means there are to make it effective. I should like to know whether the charter will cover the discharge of mental health patients from prison and what arrangements are to be made for them. I want the noble Baroness to understand, as I am sure
In this context, we need to bear in mind the remarks of my noble friend Lady Hamwee about the competing demands on local authority resources. Especially we must remember the tendency of mental health sufferers to gravitate to a few particular areas of the country. They go not just to large towns. It is more specific than that. They gravitate in particular to places where there are large concentrations of cheap, privately rented property and in fact to certain corners of London. Those areas often face quite special burdens. I should like to think that there have been discussions between the Department of Health and the Department of the Environment about adjusting local authority revenue support grants accordingly. If that is not done, I do not believe that the Statement will succeed in delivering the changes that we all wish.
A total sum of £95 million has been mentioned. Can the noble Baroness confirm or deny that, of that £95 million, only £20 million is new money now allocated for the first time? Is she aware of and does she accept the figure offered by MIND, which suggests--to me rather more realistically--that something of the order of £300 million is needed? If that amount cannot be raised, we must return to Sir Keith Thomas's definition of magic: if magic be defined as the use of ineffective techniques to allay anxiety when perhaps no effective ones are available, then perhaps no society will ever be free of it. I understand that, but I should like some effective ones sometime.
Baroness Cumberlege: My Lords, I should like to respond now to the two members of the opposite parties who have had a very quick opportunity to see the Statement and to comment on it. Let me start with the comments of the noble Baroness, Lady Jay, who came in strongly to say that community care is failing. The purpose of the Statement today is to put community care into context. In the past, community care has not considered the whole spectrum of care. There was concentration on moving long-stay patients out of huge mental institutions and into the community. Perhaps there has not been enough concentration on those who are severely mentally ill and need a different kind of provision of acute care in hospitals and also with 24-hour staff nursing beds. That is one of the main planks of the Statement today in our policy for the future.
It would be a pity if community care were totally rubbished. I used to be responsible for four of the largest mental institutions that served London. They were built in the last century. When I became regional
However, there is the other end of the spectrum. That is the end on which my right honourable friend is concentrating today. We are going to put huge resources into mental health services but they are targeted at the severe end. Although the number of beds has been increased, it has been done over a relatively short time. We want to ensure that that momentum is maintained.
The noble Baroness mentioned Christopher Clunis and those very severe cases where homicide has been committed. She described them as quite common. That is not true. They involve a tiny percentage of people. Indeed, there is no evidence at all--
Baroness Jay of Paddington: My Lords, with the Minister's permission, perhaps I may intervene at this point. Perhaps she slightly misheard what I said. I did not say that cases involving homicide were common. Indeed, I should always be at pains to say that people who are severely mentally ill, as Christopher Clunis was severely mentally ill, are more likely, as the statistics always show, to do damage to themselves than to other people. I said that it was common for people who were supposedly under community care not apparently to be properly supervised.
Baroness Cumberlege: I apologise to the noble Baroness if I misunderstood her. Certainly, she will appreciate that the new programme approach that we are adopting will try to address that problem. Indeed, where it works well, we know that it is extremely effective.
Concern has been expressed about the increased numbers of psychiatrists and psychiatric nurses that are necessary. Growth in the past has been considerable. But we recognise that in future there will be an even greater demand. That is why we have put so much resource into this initiative. If we consider just the past five years, over 14,000 nurses have received training as mental health nurses. Again, there has been an increase in the number of psychiatrists. Indeed, medical schools will take an initial 10 per cent. more medical students from now until the year 2000. It is not a matter of funding in this case; it is a matter of ensuring that people want to enter those particular occupations and specialties. We are aware of the vacancy rate that exists at the moment among psychiatrists. The posts are funded; they are there and they are allocated. It is a matter now of ensuring that they are filled. A working party has been set up by the department with the Royal College of Psychiatrists to look at those specific issues.
We are anxious--my right honourable friend has given an undertaking in the past--to ensure that beds are not closed until there is adequate alternative facility made. It will not always be beds. Sometimes it will
Perhaps I may now turn to the question of funding. The noble Earl, Lord Russell, asked whether this was new money. We are making available an extra £40 million over the next two years in addition to the £53 million from health authorities' own plans. They have already told us that that is the investment they want to make in mental health services next year. We know that every year the National Health Service receives an increase in funding. We expect the vast majority of that £53 million to come from the growth money that the National Health Service will be receiving through the PES round that was announced in November. We also expect local authorities to put in money from their allocations. They are also receiving additional money, but some of that money will be matched. We expect them to use the money they receive through the community care funds, the mental illness grant and other specific funds for this purpose.
The Patient's Charter in all its various forms--we now have a number of charters--has had an enormous impact, particularly on issues such as waiting times. We have seen waiting times plummet and we know that because we have set standards. Those standards are being met and they are being monitored. The noble Earl asked how we would ensure that the standards are met. There is specific monitoring of the care programme approach to ensure that the standards are met. We now have a system through the reformed National Health Service that enables that to happen through the regional offices.
I appreciate that noble Lords have not had a chance to look at the charter. I shall certainly place one in the Library if that is helpful. It takes into account the care programme approach so that relatives and carers can see whether that is being followed.
Lord Campbell of Croy: My Lords, I welcome in general the proposals in the Statement. On one part of it, while the large majority of schizophrenics are not violent or dangerous, there are a few who are. Will the Government do all they can to ensure that the community care system identifies those very few and keeps them away from the public and under supervision for their own safety? Will the Government also resist attempts by civil liberties organisations to let such people freely into the community?
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