§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Sainsbury.]
§ 10.6 pm
§ Sir John Wells (Maidstone)
In recent years there has been a great movement endeavouring to get people with mental disabilities out of the Victorian institutions in which they have been incarcerated back into the community. or, in the case of some older people, into the community for the first time. They may have been incarcerated in those large Victorian asylums for their entire lives. Those asylums are all over the country and are being closed. They seem ghastly and grim to ordinary people. Therefore, those closures are generally welcome. But we must remember that much good and dedicated work has been done in those places over the years and, in looking forward to their closure, we must not forget their past good work.
Tonight I want to talk about Leybourne Grange in Mid-Kent, whose position is completely different, as it is not a great Victorian monstrosity. The hospital is based in a house that was given in the 1930s by its owner for the welfare of those with mental disabilities. Some 27 houses and bungalows have been built since then in the extremely pleasant grounds of about 150 acres. It has farm, horticultural, workshop and other training facilities, including a school which is widely used by those with mentally disabled people from outside the hospital area.
Leybourne has been the happy home for many children, many of them well advanced in life. This excellent establishment was formerly run by the Kent county council and since reorganisation by the Department of Health and Social Security. It has a capacity for some 1,500 patients, of which only some 600 places are currently being used because of the rundown. Leybourne is now threatened with closure. I received a courteous and helpful letter from the chairman of the Tunbridge Wells health authority which administers it. It is curious that the hospital is not within the Tunbridge Wells health authority area. It is an offshore hospital, for want of a better description. Therefore, perhaps the health authority does not have quite the affection for it that we have in my part of Kent. It is not in my constituency but a few hundred yards outside. However, the whole of Mid-Kent is within its catchment area. It is important to my community in Maidstone and it is important to my hon. Friend the Member for Medway (Dame P. Fenner) who has spoken to me about this but is, unfortunately, unable to be with US.
With the threatened closure, parents and families of the patients—some of the parents are dead—are concerned for the future. Leybourne Grange has attracted great loyalty from the parents and many of them have urged me to sign early-day motions 424 and 425, which to date have 113 and 109 signatures respectively. I do not hold early-day motions in high esteem; they are a pretty useless part of our procedure. However, the fact that those two have achieved such a high number of signatures shows the genuine anxiety that there is on both sides of the House about the sweeping move to change the system without going into greater depth about the needs of the patients. I think that it is well worth my right hon. Friend the Minister considering those early-day motions.
957 My purpose in raising this with my right hon. Friend is to re-examine the working of the policy of care in the community. I have seen for myself some of the excellent work being done by the Maidstone district health authority in placing patients in the community. In general, I am a supporter of the principles outlined in Cmnd. 4683 about community care. However, its ideals are not suitable for each and every case.
We know that the system has worked well for many years in Holland, but there have been disastrous results when this sort of system has been applied in the United States and Italy. One must also remember the unhappy attitude of the property owners in properties adjacent to those where the health authority seeks to set up small homes. It is the awful "not near me" syndrome which is all too prevalent. That point is made strongly in the excellent notes that have been produced by the parents of the Leybourne Grange patients.
In one village in my constituency there are several residents clamouring about the fact that people from institutions should not be put near them. Yet, there are parents of a Leybourne child living a few houses away who are most anxious that their child should stay in Leybourne. Therefore, it seems that there is a great contradiction and muddle in the thinking of ordinary members in the community.
I want to urge my right hon. Friend to consider the fact that, if Leybourne is to be closed, the needs of each patient should be considered individually, carefully and fully. Those who can benefit from a return to the community should be so returned. However, let there be a modern pleasant alternative, a new Leybourne, for those patients for whom a caring, quality institution is still needed. I believe that that new village community might well be established at the very place where the present hospital is situated. There is no tradition of grimness. Indeed, it is a most excellent place.
I would now like to turn to the notes that have been produced by the parents of the Leybourne children. They make the point that the children are much happier in a stable community, and we all know that. If they are living in Leybourne or in a new Leybourne, rather than being shuffled from small hostel to small hostel, they will be happy. In small units, one is unlikely to achieve the continuity of care that is possible in Leybourne.
I am most concerned, too, that if the children are driven out into the community, the community will be unable to cope. I question whether the county councils' social services — I am talking on a broader national basis, because I believe that Kent county council runs a pretty tight ship and is pretty efficient and very caring—will be able to cope with the extra burden that will be placed upon them. I do not think that they are geared to it at all. I want to draw attention to this as a national problem and I urge my hon. Friend the Minister for Health to get better liaison going between county council social services and the Department of Health and Social Security. After all, if the sites are to be sold—Leybourne is a valuable site — the cash will flow into the Health Service regions rather than into the county councils, which will have to foot the bill for looking after the patients. I fear lest some less caring county council drive some of the patients into bed and breakfast or similar accommodation, which would be deplorable.
I mentioned my hon. Friend the Member for Medway because many of her constituents are patients in 958 Leybourne, and she takes a great interest in the well-being of the institution. My hon. Friend the Member for Exeter (Mr. Hannam)—who is unable to be here tonight, for obvious reasons — also shares my concern about the relationship between county councils and the DHSS. I hope that my hon. Friend the Minister will be able to do something at a national level to put our minds at rest.
As I have said, Leybourne is no Victorian monstrosity. It has always been a centre of caring excellence. The staff have always been superb, and it is not surprising that their morale is temporarily rather low because of the uncertainties that they face. I believe that if we could create a community village on the Leybourne site—if my hon. Friend could persuade the Tunbridge Wells health authority to take that path—we would have many much happier parents and the children in Leybourne and in our part of Kent would continue to be happy. Therefore, I ask my hon. Friend for his help tonight.
§ The Minister for Health (Mr. Tony Newton)
I congratulate—rather more than is the convention—my hon. Friend the Member for Maidstone (Sir J. Wells) on his success in securing the debate. I know from the correspondence that Health Ministers—not only me but many others before me—have received from him on this subject that it is very close to his heart. He has pursued it on many occasions as a Member of this House.
I join him in recognising the equally active concern of my hon. Friend the Member for Medway (Dame P. Fenner). Both my hon. Friends assiduously pursue the interests of their constituents. Having been Minister with responsibility for the disabled for some time, I also know of the long-standing interest shown by my hon. Friend the Member for Exeter (Mr. Hannam) which is well known to the House.
I shall address some of the anxieties expressed by my hon. Friend the Member for Maidstone about the implementation of community care policy throughout the country before dealing with Leybourne Grange. I should like to refer in particular to the co-ordination between health authorities and social services departments that is required.
I am grateful to my hon. Friend for his generally supportive expressions about the generality of community care policy and the objectives that are being pursued. That would put my hon. Friend very much in line with, perhaps not all opinion, but the overwhelming majority of opinion about the way in which these developments have been moving and the way in which the Government have encouraged them to move. I recognise that the coordination to which my hon. Friend referred is a vital part of a successful change from institutional care to care in the community and that it has not been achieved to perfection in every part of the country. I share my hon. Friend's view that the Kent health authorities and the Kent social services department generally have a good record in working together in these matters, and I am sure that they are grateful for what my hon. Friend said.
I hope that my hon. Friend recognises that those same flattering observations could be made of numbers of other health authorities and social services departments. I recognise that in some places this co-ordination does not yet work as well as we would like. We are giving it a good deal of attention and have sought to encourage it by 959 various changes, including the improvement in the so-called joint finance arrangements, which have been made over the past few years.
The deputy chairman of the NHS management board, Sir Roy Griffiths — my deputy — has been asked to undertake a 12-month review of community care and to advise on options that would contribute to making it more effective, to ensuring that we get value for money from the very large sums that are spent, and to ensuring that the policies are properly targeted and are as effective as they can be. I am sure that he will wish to take account of my hon. Friend's observations when carrying through that work.
The Tunbridge Wells health authority envisages the closure of Leybourne Grange by 1994–95 as local services in the community are fully developed. That was stated in the authority's strategic plan, and that plan is consistent with Government policy. I assure my hon. Friend that the needs of the residents of Leybourne Grange will dictate the time scale for reducing the number of patients and for the eventual planned closure of the hospital. The South East Thames regional health authority has set up a coordinating group of health and local authority officers who are drawing together all the district plans for the placement in the community of their residents at the hospital. That co-ordinating group is also establishing service development policies, personnel policies and resettlement policies relating to the hospital and drawing on the wealth of experience gained by a similar group which planned the community care of patients who were at the Darenth Park hospital, with which my hon. Friend will be familiar.
Administrative systems such as those to which I have referred are necessary to achieve effective co-ordination, but we fully recognise that, however much co-ordination there is, there can be legitimate concerns in the minds of the families of mentally handicapped people when the possibility arises of their son, daughter or relative transferring from a hospital, which may have been his or her home for many years, to the community. I am conscious that, because of some of those concerns, the Save Leybourne Grange Association has been campaigning against the planned closure of the hospital.
I am glad to say that the chairman of the Tunbridge Wells health authority and its general manager have met the association's chairman to discuss its concerns. I emphasise that, in the Government's policy and in my personal view, no one should be discharged without the prior development of community-based services and careful consideration of the future needs of each individual. In general in mid-Kent the health authorities and Kent social services department have been working together closely and effectively to develop a range of community provision for mentally handicapped people. I shall give one or two instances.
The Medway health authority and local social services operate a community living project using premises at Leybourne Grange to prepare individual residents to make the transition between an institutionalised model of care and the community model of care that the project provides in its staffed houses. So far that project has resettled 32 residents from Leybourne Grange into the community and it plans to resettle a further 20 people each year.
960 Maidstone health authority, to which my hon. Friend the Member for Maidstone paid tribute, in which I would wish to join, and the local social services run the Maidstone community care project. That has resettled into the community 39 residents from Lenham hospital which, as my hon. Friend will be aware, is another hospital for mentally handicapped people in Mid-Kent, and the authority plans to resettle a further 36 people. It hopes to resettle successfully into the community 75 residents of Leybourne Grange between 1987 and 1991. I am glad to say that the build-up of community services also involves, and it is important that it should, the voluntary organisations. In Maidstone, for example, MENCAP is actively involved in consultation and joint development plans for setting up a health authority project for mentally handicapped people.
My hon. Friend the Member for Maidstone and I have mentioned the need to give careful consideration to the future of each resident. That should involve not only the professionals who are responsible for the individual's care but also the parents and the mentally handicapped person wherever possible. Individual assessments are essential—I want to underline this again — because of the individual's specific needs, the wide range and type of community provision, the experience of professional staff and the views and needs of close relatives. All those matters need to be taken into account. I am glad to say that we have been assured that that careful and individual consideration will continue to take place before any resident is discharged from Leybourne Grange hospital.
I understand that the Save Leybourne Grange Association has recently suggested to the South-East Thames health authority that the hospital should be retained to provide a more local service to mentally handicapped people from Maidstone and the Medway towns only, rather than as at present to all health districts in Kent. My hon. Friend the Member for Maidstone made a suggestion which I understand is associated quite closely with that thought. That is primarily something to be considered by the health authorities concerned, since they have the statutory responsibility for the provision of services. I understand that the association can expect a reply on its suggestions shortly. I will undertake to ask that the health authorities' attention should be drawn to the remarks that my hon. Friend has made so that they can be taken into account in its considerations.
My hon. Friend mentioned staff. I would wish to echo what he said about the tremendous work that we can all too easily forget has been done by the staff of these large residential institutions over the years in caring for the people in their charge. The change of policy is no criticism of the efforts that so many of them have made to providing care, but rather a change in the perception of how the care should be provided in the long-term interests of the patients.
It is important that we should have in mind the needs and interests of the staff when we are making these changes. I know that, with regard to Leybourne Grange, a co-ordinated personnel policy is being worked out which will give staff full opportunities for employment in those districts which are receiving patients. That will include the early interview of staff and, in some cases, protection of salary and conditions of service. The personnel policies will be based on those that were introduced and are successively operating for staff at Darenth Park hospital.
961 I hope that in some of what I have said tonight I have been able to reflect, if not allay, the concerns that my hon. Friend expressed and to show that I agree with him on the essential need for individual assessment and the importance of improving co-ordination between the different authorities involved in those areas where it does not work as well as I am glad to say it does in Kent.
I hope that I have said enough to make it clear that the move to community care is not, in any sense, a careless or thoughtless policy. It is a policy that needs the careful planning that has been mentioned time and again in the course of this short debate; and it needs the individual assessment that I have emphasised.
When concerns of this kind are expressed, I never tire of saying to people that we do not regard community care as a cheap option. We do not want to hear it described —let alone describe it ourselves—in terms of decanting people from old institutions into some new environment.
962 In the long run, it is a better way of providing individual care for people who need the care of the community, because we believe that that can best be provided in the community. I am certain that the policy, if properly implemented as we want it to be, will be better for many of what is becoming an earlier generation, who have spent too long in the older institutions. It is certain that it could, should and will provide in due course a much better future for new generations of people who may need our help than could have been provided in the past.
The task is a difficult one, not yet always achieved with perfection, but I hope that, through my hon. Friend's speech and his dedicated work for this cause, we have the opportunity to contribute to ensuring that in future progress is even better than ii has been in the past.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-nine minutes to Eleven o'clock.