§ (1) The Minister of Health may, in accordance with arrangements made by him with the approval of the Treasury, make payments, at such rates as may be determined under those arrangements, to persons of such class or description as may be so determined in respect of travelling expenses necessarily incurred by them in making visits to patients for the time being detained under the Mental Health Act 1959 in special hospitals.
§ (2) The foregoing subsection shall have effect in Scotland, as if, for the references therein to the Minister of Health, the Mental Health Act 1959 and special hospitals, there were substituted references respectively to the Secretary of State, the Mental Health (Scotland) Act 1960 and State hospitals.—[Mr. K. Robinson.]
§ Brought up, and read the First time.
§ Mr. K. Robinson
I beg to move, That the Clause be read a Second time.
The new Clause empowers the Minister in England and Wales, and the Secretary of State in Scotland, to give financial assistance to visitors to patients in special hospitals or, in Scotland, the State hospital, respectively. Treasury approval 53 is required for the arrangements under which this assistance will be given.
The special hospitals and the State hospital are different from National Health Service hospitals in that they do not serve any local catchment area but admit patients from anywhere in England and Wales or Scotland, respectively. The consequence is that, in many cases, relatives and friends have to make long and expensive journeys to visit patients, and this can impose hardship.
The treatment and rehabilitation of patients in the special hospitals and the State hospital who normally have behind them histories of seriously anti-social conduct, is in a great many cases necessarily protracted. It is important that during long periods of compulsory detention, family and localities should not be broken, not only for reasons of simple humanity, but also because the preservation of those ties has a valuable part to play in the treatment of the patients and their rehabilitation to the point when they will be fit to return to the community.
In certain circumstances, help can be gig en by the Ministry of Social Security through the war pensions and supplementary benefits schemes, but the numbers to whom this form of assistance is available are limited. The usual form of assistance with the travel expenses of visitors is the issue of vouchers enabling recipients to purchase return railway tickets at a cost of one-and-a-half times the single fare. This assistance applies only to travel by rail and is not available for those who may prefer to travel by road in public transport. On the average, nearly 1,000 vouchers are issued annually for the three English special hospitals. If assistance with motor coach and bus fares were also available it is hoped that the amount of visiting would be increased.
In Scotland little use is made of the concession because the train services to Carstairs are inconvenient and so this concession with bus fares would be of great benefit to visitors.
It is a quite simple Clause which I am sure will commend itself to the House. We have found that the main difficulty of the existing arrangement is that we cannot give assistance for travel by public road services. We shall be making arrangements with the Treasury, and we hope to keep these as simple as 54 possible. The present cost by rail is small, something of the order of £1,000 a year. I do not expect that under this new arrangement the cost of assistance for travel will increase substantially, but I think this is a change worth making, and for that reason we seek to add this new Clause to the Bill.
§ Mr. Patrick Wolrige-Gordon (Aberdeenshire, East)
I myself would certainly agree with what the Minister has said, and I think that the House will probably want to welcome this new Clause, which will certainly be of great significance to people placed in this unfortunate position.
The point I want to make is really in the form of interrogation. Will this not open the door to great feeling on the part of people who have relatives in ordinary hospitals and who have to incur the normal expense involved in making visits to them? In my own part of the world some rural hospitals have been most unfortunately closed, and one of the main reasons for the feeling against this policy is the very considerable increase in time and expense involved in people going to visit their relatives in hospitals much farther away. Will there not be a loophole here, and the possibility of involving the Government in very much greater expenditure, if there is the feeling that there is a difference of treatment between patients of the one sort and the other?
§ Mr. Edward M. Taylor (Glasgow, Cathcart)
I should like to ask two questions. We have read with considerable interest the Report published just last week of the Estimates Committee in which the Committee dealt with the position of the special hospitals, and, having read it pretty carefully, I feel I must pay some tribute to the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renée Short) and her colleagues who revealed such interesting facts about the special hospitals and the travel arrangements.
One point which interested me was the reference to the possible withdrawal of the rail vouchers scheme, and I wonder if the Minister could tell us, in the event of the withdrawal of the rail vouchers, if it is his intention that some percentage of the amount will be made available to those who are visiting their relatives who are patients in these hospitals? Assistance 55 with travel was mentioned by the Estimates Committee as being vital to the patients, because, as the Report mentions, in one hospital there were no fewer than 76 patients who have not had one single visit for a period of over one year, and it is pointed out by the staffs of these hospitals that visits are a very important part of the treatment in the hospitals.
Certainly from the Scottish point of view it will be extremely helpful to have these facilities extended to forms of transport other than rail. As the Minister has said himself, Carstairs is not an ideal place for taking advantage of the facilities. In answer to a Question last week the Minister of Transport pointed out to me that of the figure of 1,000 only a small proportion relates to Scotland. I wonder if the Minister could give us an assurance, in the event of British Rail withdrawing this facility, will similar facilities be made available under this Clause? Secondly, will the amount of assistance to be given be of the same level?
§ Mr. James Dempsey (Coatbridge and Airdrie)
I should like to congratulate, however briefly, my right hon. Friend on introducing this new Clause. I live in the county where Carstairs is situated, and I have constituents who are resident in Carstairs State Institution, and I can confirm that it is a most inaccessible place indeed and to arrive at it requires a very circuitous route indeed. One of my constituents has a very dedicated wife who visits that place three times a week, and the number of hours involved in travelling to and fro is incredible, and the expense quite formidable. Very considerable inconvenience and cost are involved in maintaining links between the patients in the hospital and their relatives at home.
It is not alway convenient to get to Carstairs even by bus. Travelling by rail is difficult, because the distance from the railway station to the institution is quite considerable. We find in education circles that it is sometimes necessary to use taxis part of the way to supplement the existing public bus services in that part of the county of Lanark. What I would ask my right hon. Friend, without interpreting this Clause too widely or too liberally or too generously, is whether 56 taxis would be considered as part of the transport services.
With all due respect to the hon. Member for Aberdeenshire, East (Mr. Wolrige-Gordon), I do not think one can, in considering travel facilities, compare the specialised hospitals with such State hospitals as this. A patient in a State institution may be domiciled there for years and years, whereas, in another hospital, he may be there for weeks or at the very longest possibly under one year. The situation in the State institution I believe is entirely different, because some of those unfortunates may find themselves domiciled for life in such an institution, necessitating regular weekly travel by their relatives and friends between their homes and the hospital. I have visited Carstairs State Institution and spent a whole day in it and I really appreciate the wonderful work the staff do in institutions of that nature. They maintain that one of the finest tonics for their patients is regular visitation by the patients' close relatives.
If my right hon. Friend's new Clause means that reasonable expenses will be paid to enable them to maintain those visitations, to maintain the link between home and the unfortunate person in the institution, even, if necessary, partly by means of taxi services, he will, in my view, be doing excellent service, not only to the individual patients concerned and their families, but to the Health Service as a whole.
§ Mr. Paul Dean (Somerset, North)
We on this side of the House welcome this new Clause and the emphasis which the Minister and others who have spoken have given to maintaining contact as far as possible between patients in the hospitals and their relatives.
I am sorry that the Minister did not see fit to pay tribute to the Estimates Committee on which I have the privilege to serve and which has looked at special hospitals in very recent months and has just produced its Report. I should like, if I may, to pay tribute to the wonderful work which the staff do in these special hospitals in caring for and treating the patients there.
We found that owing to the remoteness of many of these hospitals, and to the difficulty, which is the result of this, 57 of people visiting them, and getting over-night accommodation, a very large number of the patients are literally never visited. We found that no fewer than one in eight in Broadmoor received no visitors. At Rampton, the number is even higher, with three in ten, and only one 20 patients receives a visit more than once a month. We found at the State hospital at Carstairs that about 70 patients are never visited at all. The lack of visits to quite a large proportion of patients in the special hospitals proves the value of the new Clause.
I hope that the Minister will be able to answer the point raised by my hon. Friend the Member for Glasgow, Cathcart (Mr. Edward M. Taylor), which was also raised in the Report of the Estimates Committee, about rail vouchers. If the concession is removed, I hope that the Minister will be able to give an assurance that he will see that it is made up under the arrangements which he proposes.
In making the suggestions, I hope, too, that the Minister will be able to assure the House that he intends to supplement and not supplant the valuable arrangements already made on a voluntary basis by, for example, the friends of hospitals. We on the Estimates Committee were very impressed by the efforts made by local communities and friends of hospitals to provide funds so that relatives can be helped to visit the special hospitals. I am sure that the Minister will agree that the work of the friends of these hospitals and those who help in other ways is of the very greatest importance to them and that the provisions in the new Clause should be regarded as a supplement to those arrangements rather than an intention to supplant them.
§ Mr. K. Robinson
I am grateful to the House for the reception that it has given to the new Clause.
In reply to the point raised by the hon. Member for Aberdeenshire, East (Mr. Wolrige-Gordon), I think that he was answered by my hon. Friend the Member for Coatbridge and Airdrie (Mr. Dempsey), who pointed out what I may not have stressed sufficiently in my opening remarks. The special hospitals really are in a special position in two respects. The 58 first is that, inevitably, they contain a very high proportion of long-term patients. The second and perhaps more important is that there are so few of them—one for the whole of Scotland and three for the whole of England and Wales—that the difficulties of travel for visitors and relatives is of a quite different order from that for relatives and visitors to ordinary hospitals. That is why we found it necessary to limit the scope of the new Clause to the special hospitals.
Turning to the points made by the hon. Member for Glasgow, Cathcart (Mr. Edward M. Taylor) and the hon. Member for Somerset, North (Mr. Dean), I might well have mentioned the Estimates Committee. I did not dare because, strictly, I do not think that it is in order. However, as it has been mentioned, may I say how much I welcome its Report, which is very thorough and constructive? I welcome it because of the warm tribute that it pays to the health departments and staff for the general administration of special hospitals. After three and a half years in this office, it comes as no surprise to me that the only aspect of the Report which received any publicity in the Press was the one major criticism about the inevitable overcrowding at Broadmoor. Nevertheless, the general tone of the Report was most gratifying to my Department.
In reply to the particular question raised by the hon. Member for Glasgow, Cathcart, I do not normally answer hypothetical questions, and this is hypothetical. However, I can tell the hon. Gentleman that, in the event of these railway concessions being withdrawn, there is power under the Clause, by agreement with the Treasury, to replace these facilities at the same rate as they exist now.
That is partly an answer to my hon. Friend the Member for Coatbridge and Airdrie. The precise arrangements to be made will have to be discussed with the Treasury and promulgated in due course. I will take note of his point, but, at the moment, we are thinking in terms of public transport. However, consideration will be given to his point.
§ Question put and agreed to.
§ Clause read a Second time, and added to the Bill.