§ Order for Second Reading read.9.34 am
§ Dr. Julian Lewis (New Forest, East)
I beg to move, That the Bill be now read a Second time.
In preparing for the debate, I thought long and hard about the best way to try to convey to hon. Members the gravity, the horror and the utter desperation of people who suffer mental breakdown. In the end, I decided that reference to medical books, case histories and academic studies would not convey what I wanted to put across, so I went back to literature and film.
Hon. Members who have read Orwell's futuristic nightmare novel "1984" will never forget the last two chapters. In the penultimate chapter, the central character, Winston Smith, is still unbroken. He has been tortured, imprisoned and abused, and has said anything, more or less, that his torturers wanted him to say. Finally, he is sent to room 101, where the torturer, O'Brien, tells him that the worst thing in the world awaits him. [Interruption.]
§ Mr. Deputy Speaker (Mr. Michael Lord)
Order. Will the hon. Member for Southampton, Test (Dr. Whitehead) leave the Chamber please? Electrical devices are not supposed to be brought in unless they are under control.
§ Dr. Lewis
To be interrupted in that way is perhaps another form of psychological torture.
The worst thing in the world for Winston Smith is a fear of rats. In the end, he cracks, even though no physical damage is done to him; that has already been done without breaking apart his mental stability. Finally, something that he fears more than anything else causes him, though the words are never used in the novel, to have an acute mental breakdown. In the final chapter, he has come out of it, but nothing will ever be the same again.
Moving from the written word to the visual image, one thinks of Alfred Hitchcock and the psychological films that he produced, which often dealt with the inner mysteries of the mind. To give an idea of what people go through when they have acute catastrophic mental breakdowns, I refer hon. Members to the film "Vertigo", where the central character is played by James Stewart. He has a fear of heights which leads him wrongly to believe that he has failed to save the life of the woman he loves, who he thinks has thrown herself from the top of a high building. Again, despite his courageous record as a policeman, it is that psychological pressure which causes 1264 him to break down and collapse. That is significant in relation to clause 1 of the Bill, which I hope will get a Second Reading.
In the film, James Stewart recovers from his breakdown. Having become thinner and thinner, woken time and again in the night, and having collapsed mentally, he is taken into a quiet, solitary, therapeutic environment with proper care so that he can come out of the trauma. A safe, separate and therapeutic environment is what people need to have any chance of recovering from catastrophic mental breakdown.
For someone who belongs to another category of person who goes through this ordeal—someone who has extra vulnerabilities due to her gender—protection and security are even more important. I refer of course to the situation in which a woman finds herself when admitted to an acute psychiatric unit. It may come as a surprise to hon. Members to know that, in all too many cases, women are on mixed-sex wards against their will.
I should like to refer to the report of the Mental Health Act Commission, which relates to clause 2 and provisions that I believe to be essential, long overdue and bound to come sooner or later. We need single-sex ward areas, and special security devices on doors so that patients and staff can let themselves in and out at will, but predators and intruders cannot get into rooms and assault female patients.
During my researches on this subject, I visited a number of units, including a national health service unit in which an experienced ward sister was on duty. She said that her constant nightmare was that in the evening hours, when perhaps three members of staff were on duty, a male would get from his sleeping area into a woman's room and assault her. Yet there are security devices to prevent that. Such devices are already installed in something less than half the existing units.
The Mental Health Act Commission's seventh report touches on those matters. On page 63, it says:The Commission recommends as a measure to secure privacy and safety that, wherever practicable, patients' single rooms should be lockable from the inside, but with staff having a master key.Sensible enough, one would have thought. On page 158, referring to women's issues, the report says:Only a minority of wards have policies dealing specifically with women's safety. Features of the physical environment of particular importance to women, such as lockable bedroom doors, self-contained washing and toilet facilities or a suitable place for visiting children, are too often lacking, although some units have made great efforts to improve.On sexual abuse, I will, with the permission of the House, read a slightly longer extract which is very telling. It is on page 175 of the report:Safety for women on psychiatric wards is a major issue, especially where staffing levels are low and violence considerable, as in the London area. A patient mix including men with a history of violence and young women with a history of abuse occurs on some wards. It has been reported to the Commission that Approved Social Workers are having to take such risk factors into account when considering applying for an admission.I break off from the quotation to refer to the question of beds in acute psychiatric units. This is not simply a debate about lack of beds. All too often, the problem is that beds are available in such units, but the mixture of patients is such that the general practitioner or consultant psychiatrist is reluctant to recommend that a patient suffering from a schizophrenic condition or mental breakdown be admitted.
1265 The principal author of the Bill, without whom I would never have been able to progress beyond the starting point, is Dr. Mike Harris, sub-dean of the Royal College of Psychiatrists. He has allowed me to point out, in the spirit with which I hope we all approach the matter, that he is a lifelong supporter of the Labour party. He has told me that in 1982, when he started to work as a consultant psychiatrist on an acute psychiatric voluntary ward of 20 people, an average of four were seriously disturbed; now, perhaps 15 are seriously disturbed. The admitting medical officer now has to decide whether such a ward is a suitable or therapeutic environment for someone who is already in the depths of clinical acute suicidal depression.
I return to the quotation from the report:Women are particularly vulnerable in Regional Secure Units where there may be very few other female patients, and a lack of female staff.Mother and baby units are sometimes unsuitably placed in a corner of an acute ward. Staff generally are not trained to care for babies and Health Visitors do not visit the wards.The Patients' Charter standard, offering a choice of single sex accommodation, is rarely met. This is a particular need for women from ethnic minorities whose cultural and religious practice forbids contact with men.Although many units have made considerable efforts to provide safe facilities for women and to preserve their privacy and dignity, there remains much room for improvement. The findings of the Commission's National Visit show that just over a third (35 per cent.) of women have access to women-only sleeping areas … a quarter (27 per cent.) have to pass male parts of the ward to reach women-only toilets, baths or showers; a third (32 per cent.) have access only to mixed sex toilets, bath or shower facilities. A small number (3 per cent.) use sleeping areas also used by men.Only a minority of units in the National Visit reported having policies dealing specifically with women's safety, although, when questioned, 58 per cent. of nurses thought there were issues of sexual harassment of women patients by male patients on the ward. One nurse saw 'no problem', but recalled two sexual assaults the previous year! There is a need for staff to be continually alert to women's sexual vulnerability.The aim of the Bill is to save the lives of potential suicides, aid the recovery of in-patients and protect them from assault, and, in short, to restore the role of the acute psychiatric unit to one of sanctuary, support, and asylum in the true sense of the word.
The Bill is designed on what might be called an a la carte basis. It has four provisions and is constructed in such a way that, if the Government felt that they could not in all conscience approve one of the provisions, there would be no need for them to knock out the entire Bill.
I have had a number of meetings with the Under-Secretary of State for Health, who has regaled me with his legendary charm and courtesy. I never knew that a brick wall could be so charming or courteous. I was fortunate enough to draw second place in the ballot for private Members' Bills. I have repeatedly offered to make my Bill available to the Government so that they can use it as a vehicle for any additional changes to the Mental Health Act 1983 that they might think beneficial, but unfortunately that offer has not been taken up.
1266 I have started by trying to create as much consensus as possible. The Bill's principles, which I shall explain in a moment, have been endorsed by a number of organisations. SANE has stated:The Bill is designed to ensure that some of the most vulnerable members of our society are given care and treatment in safe and therapeutic environments, where their privacy, dignity and security is protected. … People with mental illness are being neglected and lives lost. Dr Lewis's proposals may well prevent many unnecessary tragedies.Those are the words of Marjorie Wallace. I should make it clear that I am not a medical doctor; my doctorate relates to an entirely different subject.
The National Schizophrenia Federation has stated:NSF wholeheartedly supports the principles outlined in the Mental Health (Amendment) Bill and encourages all Members to support it.The Manic Depressive Fellowship has said of the proposal for single-sex wards:there is significant evidence amongst our members that this is the provision women want … In order to ensure that a hospital admission will benefit rather than add to the trauma … it is vital that the NHS provide single sex ward accommodation, particularly in emergencies.Although the mental health charity MIND has some reservations about clause 1, which refers to separate and therapeutic environments, and which I shall discuss later, it has said of the clause dealing with single-sex ward areas and security devices on doors:MIND welcomes Clause 2 of Dr. Lewis's Bill which imposes a duty on health authorities to provide single-sex ward areas in existing psychiatric units and to fit appropriate security devices to doors.The mental health and disability sub-committee of the Law Society has stated that it haslong been concerned about the needs and safety of vulnerable patients, particularly women patients, and would welcome a duty being placed on Health Authorities to provide single-sex ward areas and to make other security arrangements for the protection of patients.Perhaps it is time for me to pay tribute to all those people who have helped me and whom I have consulted at various stages. I have already singled out for particular thanks Dr. Mike Harris, the sub-dean of the Royal College of Psychiatrists. Dr. Adrian Yonace, who runs an NHS acute psychiatric unit at Poole, has also been fantastic in showing me at first hand the situation in such establishments. I have had many useful discussions with Dr. Charles Tannock and with Mr. Richard Jones, a specialist solicitor, who helped me with the technical details involved with drawing up key parts of the Bill. Mr. Steve Priestley, the Clerk in charge of private Members' Bills, and an employee of the House, was incredibly helpful in turning the ideas into the format necessary to bring it to the Floor of the House.
Others who have helped include Dr. Trevor Turner, Dr. Austin Tate, Dr. Pippa Brookes-White and all the parliamentary sponsors of the Bill—I hope that hon. Members have noticed that they come from both sides of the House. I have had useful meetings with Miss Marjorie Wallace and Miss Grainne McMorrow of SANE and Mrs. Margaret Pedler of MIND. As I have already said, I have also had a couple of useful meetings with the Minister.
1267 Before I submit my reasons for pressing for a Second Reading, let us look at the Bill's clauses in more detail. Clause 1 states:Each Health Authority shall be under a duty to … prepare a strategy for the provision of in-patientcare for people going through acute episodes of mental illnesswithin separate and therapeutic environments.Of course, that will be subject to the judgment of the medical officers in charge of the case. Where those officers are happy with the mix of people on a ward, there is no problem and no need for a separate environment.
I draw the House's attention to the introductory words of the clause, which state that a health authority should "prepare a strategy". The clause is written in those terms so that objections cannot be made on the ground that there are enormous financial implications behind it. To prepare a strategy does not cost a great deal of money. Indeed, it could be argued that it costs practically no money. I should have loved to lay a duty on local authorities to provide such separate therapeutic environments from the outset, but that would involve colossal expenditure.
The clause calls on each health authority to draw up a strategy so that, as and when resources become available, steps towards that ideal goal can be taken. If one does not plan ahead, one has no sense of direction, no target at which to aim and no goal to score in the battle to improve the conditions of people in such desperate circumstances.
I am not seeking to suggest in clause 1 that people suffering from certain types of schizophrenia or mental breakdown, which would result in their suicide if they were left out in society, should be treated separately because their conditions are more important and more deserving than, and superior to, those of disturbed violent patients. The latter are just as much in need of care and protection.
Those who support clause 2 may argue that they cannot support clause 1, because they do not recognise the special vulnerabilities of people who have suffered a breakdown or are at risk of committing suicide if they are treated as out-patients, and who will recover only if they are in a therapeutic and quiet environment. However, how can such people, in all conscience, support clause 2, which recognises that women are another group who have special vulnerabilities, which are just as serious in their own way? I believe that the principles underlying clauses 1 and 2 are identical.
Clause 2 calls on each health authority to provide single-sex ward areas. MIND and I would have liked the Bill to go further and refer to "single-sex wards", but the Bill could then have been shot down by the Government on grounds of unacceptable cost. Such areas can be provided at minimal cost. I am not talking about big open spaces with male patients at one end of the room and female patients at the other, but all wards should have an area reserved for women if they want that. It would be a refuge room not unlike the ladies waiting rooms provided at some railway stations for women who want to wait in a women-only environment. The difference between such areas and single-sex wards is that wards would require the duplication of all the necessary infrastructure and facilities.
New section 142B (b) in clause 2 refers to what are known in the trade as half-spindle locks, which are the devices fitted to the doors of rooms and wards. There is 1268 an ordinary handle on the inside, but one needs a key or a removable handle to operate the lock from the outside. Such devices are fitted in fewer than half the psychiatric units run by the NHS. Once again, I have tried to keep the cost implications to a minimum; but the Bill also refers to the need to plan for the future. Clause 3 lays a duty on health authorities to ensurethat all future psychiatric units are, so far as is practicable, designed and constructed in a manner which fulfils the requirementsof new sections 142A and 142B of the Mental Health Act 1983.
It has been suggested to me that I am going about this the wrong way and that a private Member's Bill may not be the appropriate vehicle to bring forward such proposals, but there is a long history of major measures that have reached the statute book through the medium of the private Member's Bill, not least the Abortion Act 1967.
It has also been suggested that the provisions of my Bill are a little too precise, pedantic and prescriptive to be included in the 1983 Act. I had a quick look at that Act and I wondered which of its quite prescriptive sections I should highlight. I wondered whether I should refer to sections 7 and 8, on appointing social workers or relatives as guardians; or sections 13, 14 and 15, about the duties and obligations of approved social workers; or section 117, about the duties of health authorities and social services to provide aftercare. In the end, I settled—for reasons that will soon become clear—for section 141:Members of Parliament suffering from mental illness.The section states:Where a member of the House of Commons is authorised to be detained on the ground (however formulated) that he is suffering from mental illness, it shall be the duty of the … person in charge of the hospital or other place in which the member is authorised to be detained, to notify the Speaker of the House of Commons that the detention has been authorised … Where the Speaker receives a notification under subsection (1) above, the Speaker shall cause the member to whom the notification relates to be visited and examined by two registered medical practitioners … The registered medical practitioners shall be appointed by the … Royal College of Psychiatrists and … shall report to the Speaker whether the member is suffering from mental illness and is authorised to be detained as such.And so on and so forth—[Interruption.]
I recognise from the sedentary comments that there are those on both sides of the House who feel that that provision will one day be applied to the speaker—not the Speaker of the House, but me.
§ Dr. Lewis
The hon. Gentleman was unsuccessful, to the great benefit of the whole country.
I have been drawing my remarks to a close—I hope on a lighter note, although a slightly more solemn note might be more appropriate. Unless one has either gone through the catastrophe of an acute mental breakdown or has seen it happen to someone close, one can have no concept of what it involves.
1269 Anecdotally, I can refer to a friend of mine from the opposite end of the political spectrum. That young lady had, in fairly rapid succession over two or three years, two bad accidents to her health. One was an acute breakdown from which, after a year or so, she eventually recovered; the other was a multiple fracture of her leg. She was crossing the road in the rain, laden with shopping, when her dog pulled on its leash and she slipped and fell. She was in hospital for months with that severe fracture. When we were discussing the Bill some months ago, she said, "Julian, if I had to choose between having another breakdown or another broken leg, break my leg again any time."
Breakdowns are so serious, so horrifying and so impossible to live with that it is no surprise that, if people cannot get a bed in a helpful, healthy and therapeutic environment, their will to live is extinguished.
I do not wish to be partisan, but I am disappointed that all the signs are that the Government intend to resist giving my Bill a Second Reading—even though it is drawn up in an infinitely flexible way, which would allow some measures to go through and others to be cast aside, and which could only benefit the cause of improving in-patient access and conditions by detailed scrutiny in Committee. It will be denied that if, as I fear, the Government have their way.
On Tuesday, the Government published the White Paper "The New NHS". Paragraph 1.5 on page 5 states:The Government has committed itself anew to the historic principle of the NHS: that if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone".If the Government's tactics are to talk out or vote down the Bill, that statement will, I am sorry to say, be no more than an empty boast.
§ 10.5 am
§ Helen Jones (Warrington, North)
The hon. Member for New Forest, East (Dr. Lewis) has given the House a timely opportunity to debate a much-neglected area of health care. It is sad that, for many years, mental health services have been the Cinderella services of the national health service. To put it bluntly, as politicians, we know that there are no votes in mental health. We also know that public debate is often characterised by fear and ignorance. The users of the service have been discriminated against and had their views ignored for many years. They have had little choice in the services on offer to them. Those are the points that I want to deal with.
I was privileged to work for some time in mental health. I pay tribute not only to the professionals who have struggled to maintain and develop those services over many years, but to the users of the services, many of whom have shown immense courage not only in tackling their problems, but in speaking out to raise public awareness and to try to improve the services for others. Their patience and persistence are an example to all of us. It was a privilege to work with them.
Although it is right to be having this debate, I regret to say that I cannot support the Bill as it stands. I accept that the hon. Member for New Forest, East has brought it to the House with the best of intentions. I have no doubt about his commitment to improving mental health services. However, the Bill is fundamentally flawed.
1270 The whole thrust of clause 1 is towards the provision of more hospital beds. From what the hon. Gentleman has said today and from articles that he has written, I know that he has spoken powerfully of the need to provide sanctuary for those in acute distress. No one would dissent from that, but I have seen some of the wards in our older mental hospitals and I have seen our acute hospitals. I have to say that, for many people suffering the sort of breakdown that he described, sanctuary is the last thing that those hospitals provide.
Of course, we know that for many people hospital is the right place—there is no doubt about that—but for others a hospital is a place where there is little privacy and an over-emphasis on treatment with drugs and electro-convulsive therapy. It can be a frightening place and it is the last place some of us would want to be in a crisis. Therefore, it is not necessarily what we should be providing for others.
Sanctuary does not have to provided in a hospital. Care and treatment can be given elsewhere. That does not mean that we care less; we care differently. To deal with the problems powerfully highlighted by the hon. Member for New Forest, East, we need not more hospital provision but a move towards community-based crisis services that can rapidly respond to people in distress and offer intensive support at their time of need, as well as linking into longer-term care and support as people need it.
As things stand, that service is often not available because 77 per cent. of the NHS mental health budget is spent on hospitals and medication. Acute psychiatric units are continuing to be built at vast expense without meeting the diversity of people's needs, and the pressure on hospital beds cannot be relieved because the alternative services are simply not there. If we want to break that vicious circle, we have to offer a range of services. That policy is morally right, because it allows people a choice of provision; it is economically right, because home treatment services are cost-effective—they are not cheap, at least not when done properly, but they are cost-effective.
§ Mr. Michael Colvin (Romsey)
I acknowledge the hon. Lady's knowledge of mental health services, in which she has worked. However, before she goes further, I have to say that I am not sure that she has really grasped the full intention of the Bill. Clause 1 does not call for more institutions, beds, and so on; it calls on the authorities concerned to draw up a strategy, which may well include the care in the community for which the hon. Lady is making such an eloquent case.
§ Helen Jones
I thank the hon. Gentleman for his intervention, but to me the whole thrust of the Bill is clearly in favour of provision for treatment as in-patients, and I believe that that strategy is wrong.
Let us look at what has happened elsewhere. In Birmingham, the provision of community and home treatment services in one scheme has managed to reduce hospital admissions by up to 50 per cent. A similar scheme operated in London showed budget savings of 25 per cent. That is money that can be used to improve mental health services elsewhere, and it should be used for that purpose. The system that I am arguing for can and should provide a whole range of care, such as helplines, counselling services and a place to go for intensive 1271 support when people are suffering extreme distress or an acute breakdown. It can also provide home treatment and crisis beds in the community, which is what we need more of.
Not only are such services extremely popular with users, but—despite being expensive because of high staff input and unit costs—they often result in people being helped much more quickly. In that connection, I draw the House's attention to a recent Audit Commission report, which said that high rates of readmission to psychiatric hospital often occurred where the hospital-based psychiatrists worked in isolation from community teams, and that £100 million could be saved for the development of services if hospital admissions were targeted at the most severely distressed, and hospital and community teams were better integrated. The Bill would not achieve that; it would further the cause of more hospital provision.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
I am listening carefully to the hon. Lady, but I think that she is confusing two separate issues. More crisis provision in the community is not incompatible with more in-patient psychiatric beds. By definition, they are in-patient and they are beds, and I hope that they would be in the community. She must not pretend that they are different, when they could properly be the same.
§ Helen Jones
The hon. Gentleman has missed the point. By spending most of our mental health budget on hospital beds, which the Bill would further, we are preventing the development of a range of care in the community. The Bill calls for a strategy of more hospital beds.
By building up our community services, we would tackle the problem the hon. Member for New Forest, East is trying to tackle with his Bill, by preventing more hospital admissions. We would give greater flexibility in the use of those hospital beds by preventing them from being gridlocked because of lack of provision elsewhere. The concentration of so many resources on the hospital model, which the Bill would further, prevents the development of more innovative and effective services.
§ Helen Jones
No—I have said that I will not give way again. I intend to draw my remarks to a close.
The concentration on hospital beds denies users proper choice and leads to further institutionalisation. Community care has been given a bad press. I have been immensely saddened by some of the things I have read in the papers that imply that all people with mental health problems are dangerous. The community suffers as a result.
§ Helen Jones
I know that the hon. Gentleman does not believe that, but that view is constantly being put forward.
1272 In fact, the figures from Birmingham and the experience in my own constituency show that community care can be successful. Warrington Community Health Care (NHS) trust has been excellent in providing care in the community and thereby reducing the provision of hospital beds. However, such a policy cannot be pursued on the cheap, which is what the Conservative Government tried to do—it is not a cheap option.
We have to ensure that that does not happen in future and that we provide a whole range of mental health care that gives real flexibility and choice to users of the service, but the Bill would not achieve that. It concentrates on greater hospital provision and would hinder the development of effective services. It does nothing to integrate people with mental health problems into the community, or to end the discrimination from which such people have suffered for far too long. That is why—regretfully, because I know that the Bill has been introduced with the best of intentions—I have to urge the House to reject it.
§ Mr. David Atkinson (Bournemouth, East)
I congratulate my hon. Friend the Member for New Forest, East (Dr. Lewis) on his good fortune in the ballot in his first Parliament and, in particular, on his choice of Bill. I also congratulate him on the eloquent and imaginative way in which he presented it to the House.
As my hon. Friend rightly stresses, mental health is no less important than physical health. Our mentally ill patients are entitled to the same help and treatment as other patients. The fact that our mental health service remains inadequate is demonstrated by the unacceptable rate of suicide among patients—10 per cent., compared with 1 per cent. among the general population—and by the appalling statistic that, over the past five years, an average of two people a month have been killed by mental patients or by people with schizophrenia who have been discharged from hospital under the care programme approach. I also suggest that demand for mental health services is growing and will continue to grow as a result of self-harm, stress and mental accidents.
I have taken a personal interest in mental health since before being elected to the House 20 years ago, shortly after a friend of mine, who I did not know was schizophrenic, committed suicide. I learned much about the issue as a member of the Standing Committee on what became the Mental Health Act 1983, which adopted the all too rarely used Special Standing Committee procedure so that we might benefit from expert opinion. More recently, I also benefited from being a member of the Standing Committee on what became the Mental Health (Patients in the Community) Act 1995. I have also experienced at first hand the agony of one sufferer, for whom I had arranged a month's work experience in my parliamentary office here; and I have monitored the experience of a constituent in Broadmoor hospital.
I readily acknowledge the achievements of the previous Government, who did more for mental health during their 18 years in office than had been done in the previous 180 years. I have always supported the principle of care in the community, but I have never been convinced that the provision of care kept pace with the closure of hospital beds, or that what was saved by the one was being spent on the other. Those fears have been borne out by the 1273 findings of successive inquiries into every homicide and tragedy involving the mentally ill. The fact is that the so-called safety net is not in place to support every patient, and there remains a failure to keep in contact with every discharge. That continues to lead to tragedy.
§ Mr. Nicholas Winterton (Macclesfield)
In respect of my hon. Friend's comment about the pace of removal of hospital facilities for mental illness, does he accept that that reflects entirely the views of the Select Committee on Social Services in the 1984–85 Session? Summary recommendation No. 2 of that Committee's second report states:The pace of removal of hospital facilities for mental illness has far outrun the provision of services in the community to replace them.That was the situation as seen by an all-party Committee chaired by a distinguished Labour Member, Mrs. Renee Short, and it remains the same today.
§ Mr. Atkinson
Well, the fact that my hon. Friend was a member of that Committee contributed to the warning that services were inadequate—were not keeping pace with changing needs. I pay tribute to him and the members of the Committee.
As my hon. Friend the Member for New Forest, East said, obviously much more needs to be done for the mentally ill, and I very much welcome his modest but practical Bill, which complements the revolving-door concept of the Mental Health (Patients in the Community) Act 1995.
§ Mr. Colvin
Is not planning the main problem? The main difficulty with care in the community comes when planning applications are made for a change of use of domestic property. As the previous Government ignored the matter, is it not incumbent on the present Government to issue new planning policy guidance regarding care in the community homes for the mentally ill?
§ Mr. Atkinson
My hon. Friend is right. Although I suggest that it is not the principal concern that the Bill seeks to address, there is a "not in my backyard" approach on the part of our constituents, which is detrimental to the needs of patients and must be tackled. It should be tackled much more positively by local authorities and in the way that my hon. Friend suggests.
§ Dr. Whitehead
Does the hon. Gentleman accept that a major component of the delay in implementing the care in the community provisions after the rundown of old-style mental hospitals resulted from the fact that many 1274 health authorities planned the provision of community care services on the proceeds of land sales of the hospitals that they were supposed to replace? It does not take a genius to realise that one must close and sell the hospital before one can realise the money to be spent on community services.
The previous Government presided over that mess, which sometimes led to a gap of four to six years between the closure or rundown of one of the old-style mental hospitals and the re-provision of effective services in the community.
§ Mr. Atkinson
Although I have applauded what the previous Conservative Government did for the mentally ill and in expanding the provision of mental health services, I have remained critical of the fact that there was no strategy to ensure that the proceeds of the closure of the old mental hospitals were transferred to the provision of care in the community.
I imagine that, like me, my hon. Friend the Member for New Forest, East and many hon. Members have heard horror stories from constituents of mentally ill patients causing problems for other patients in general wards. The Bill responds by enabling mental patients to be treated in the same compassionate and practical way as we treat other patients in hospital. The Bill provides for health authorities to meet the demand for in-patient beds now and in future, and for such a strategy to be monitored and reported on annually. It provides for single-sex wards in all psychiatric units—I welcome that—and for better security in those units.
I am pleased to tell my hon. Friend that the proposals in his Bill have the support of all those involved in mental health in my constituency whom I have consulted: Bournemouth social services, the East Dorset National Schizophrenia Fellowship Support Group, Dorset Healthcare NHS trust, the Dorset Association of Sheltered Homes, Bournemouth and Poole and District MIND and the local Richmond Fellowship.
As part of the consultation, I have also been asked to draw the attention of my hon. Friend, of the House and of the Government to what the Bill does not provide, in the hope that it might be amended, if allowed to go into Committee, to make more help available to the mentally ill, which would keep them out of hospital.
Liaison is needed between professionals and the carers of long-term sufferers who live at home. There remains widespread evidence that the needs and rights of long-term carers, as provided for under the Carers (Recognition and Services) Act 1995, are not yet being acknowledged.
More support is needed for the enduring mentally ill in the community, including services that are widely available for the elderly, such as warden-controlled housing, home helps and meals on wheels, which do much to keep patients out of hospital. More support is also needed for those who provide specialist sheltered housing in the community; they have been hit hard by the recent housing benefit changes.
§ Mr. Atkinson
No. I have given way three times, and that is enough.
1275 More provision is needed in the community for those known in the United States as "mentally ill chemical abusers"—usually young people with personality disorders, and drug, alcohol and substance problems who take up places in psychiatric hospitals meant for the mentally ill. Indeed, more places are needed in psychiatric hospitals, such as St. Ann's, which services my constituency and operates at about 90 per cent.—sometimes more than 100 per cent.—capacity.
I pay tribute to the Dorset Healthcare NHS trust, which, according to the president of the Royal College of Psychiatrists, provides the best mental health services in the country. The trust also serves the constituency of my hon. Friend the Member for New Forest, East.
The Bill seeks to lessen the variation that exists in such services throughout the country. For example, those arrested in our area under sections 135 and 136 of the Mental Health (Amendment) Act 1983 are taken to St. Ann's. In Hampshire, the same people would have to spend a night in a police cell and, in Devon, hospital staff would hold up their hands and say, "There is no room."
§ Mr. Spring
By highlighting mental health issues and the need for health authorities to devise a proper mental health strategy, the Bill will help to avoid the position that arises in some parts of the country, whereby individuals land up in the criminal justice system, where they should not be.
§ Mr. Atkinson
My hon. Friend is right to emphasise that point, which supports the need for the Bill. I hope that the Minister will endorse that later.
I conclude with a warning and an appeal to the Government. Like all previous legislation to provide better services for the mentally ill, the Bill will not be effective without sufficient staff—psychiatrists and nurses. Their numbers more than trebled under the previous Government, to whom I again pay tribute, but many of those people are retiring early or moving into the private sector, and health authorities are looking abroad to fill vacancies.
If one asks an overworked psychiatrist what needs to be done, he will urge the simplification of the bureaucracy of the care programme approach to enable him to spend more time with patients. Therefore, I hope that the new Government are including mental health services among their many reviews. I also hope that they will accept that, after 15 years, a review of the Mental Health (Amendment) Act 1983 is overdue.
§ Ann Keen (Brentford and Isleworth)
Mr. Deputy Speaker, thank you for giving me the opportunity to contribute to a debate that is unquestionably much needed and of great importance.
I have every reason to keep friends with the hon. Member for New Forest, East (Dr. Lewis). We have every reason to keep friends because, next year, we shall be together on the parliamentary armed forces scheme in the Royal Air Force, and when we are venturing off in our Tornadoes, we may remember what we said to each other in the Chamber this morning.
§ Ann Keen
The Bill has provided us with an opportunity to review activity and service in mental health 1276 provision. The Bill gives us an opportunity to share experiences and concerns, and may enable us to offer some solutions to the many problems faced by users, families, mental health professionals and support staff.
When we talk about solutions, we have to start with prevention; the new Government have started to do just that. When we think of mental health, we tend to think of social exclusion. This week's launch by the Prime Minister of the social exclusion unit is welcome news for all who care about mental illness. The purposes, aims and outcomes of the unit will inevitably address some of the causes of mental illness.
I am particularly impressed by the fact that the unit will report directly to the Prime Minister and the No. 10 policy unit. It will operate across Government Departments and will have a multi-agency approach, bringing public, private and voluntary sectors together. Most importantly, it will hear the views of the socially excluded themselves.
What is social exclusion? How does it relate to mental health? I ask the House to picture the following scene. Someone may be at a party or other social gathering, talking to friends and neighbours, at a bus stop or somewhere else in the company of people. After pleasantries have been exchanged about names, the weather and where people live, the conversation usually turns to asking people what work they do. Our picture of what kind of person someone is usually depends on the answer.
Before I was elected to the House, when I was asked what I did, I could say, "I am a nurse." People would usually smile, and say how marvellous they thought I was and what a wonderful contribution I was making to society. They always added that they could not possibly do my job, and that I definitely was not paid enough. All that was true.
Now, when I am asked what I do, and I reply, "I am a Member of Parliament", the response is very different. I am viewed with immediate suspicion. The kindest way in which to interpret the rest of the comments is that people are saying that I do not contribute very much to society. The situation is, however, quickly rectified when I inform people that I am a Labour Member of Parliament. Their trust is obvious and they are very reassured.
The position is very different when people say that they are unemployed or on the dole, and have no active place in society; they are then seen as being of no worth. Many people in that position whom I have met or nursed feel worthless. Many constituents tell me how they felt when they were made redundant. In the medical and nursing profession, we refer to the feeling as the psychology of loss.
Unemployment seriously affects mental health. The sudden loss of work causes deep shock, disbelief, anger, blame and jealousy—all very powerful emotions. The camera caught the look of hopelessness on men's and women's faces in the 1920s and 1930s, as they stood on street corners with nothing to do.
§ Dr. Julian Lewis
Like the hon. Lady, I am a new Member. I have heard about hon. Members talking out a Bill by introducing total irrelevancies. It is interesting to see that happening for the first time today.
§ Ann Keen
The hon. Gentleman is quite wrong. I am describing mental illness, which I thought the hon. Gentleman was interested in.
1277 Sadly, cameras can take similar pictures of the mentally ill today, whether young or old—in doorways, on estates or on our streets. Many long-term unemployed have received medication, when all they require is a home, a job and decent pay.
Young people suffer greatly from unemployment. They study at school and may go on to higher education, but then find that, instead of an exciting life ahead of them, their ambitions and dreams are shattered because they have no hope of a job. They aspire to be somebody, but start adult life being no one. That has a serious effect on health. Depression and social exclusion seem to be relieved by prescribed medication, alcohol abuse, drugs and other substances.
Young people can also feel excluded when they discover their sexuality. Society's desire to limit sex education to a small amount of advice on heterosexuality still causes great harm to many of our young people. We must consider the fact that suicide is the biggest cause of death for young men.
It is the duty of every hon. Member to work for the success of the social exclusion unit, and to support and develop existing legislation that will help to bring all into inclusion. That is one of the biggest contributions we can make to the prevention of mental illness.
§ Mr. Bercow
I am listening to the hon. Lady's speech with rapt attention. Would she, however, address herself to the provisions of the Bill? Specifically, does she support clause 2, which seeks to protect women through single-sex ward areas? If she does not support the clause, will she tell the House why?
§ Ann Keen
If the hon. Gentleman has patience and listens to my speech, he will find that I am coming to that point.
We must not be narrow-minded in our vision of dramatically improving mental health services. I am worried about clause 1. I have discussed the Bill with users, statutory and voluntary organisations, and, in particular, with Valerie Howell, the director of mental health services for the Hounslow and Spelthorne trust which covers my constituency. She advises me that many trusts would welcome a strategy for in-patient services, but that all agree that the strategy must be broader, and must cover the acute and community sectors.
I share the view of many others, including MIND—the National Association for Mental Health—that the proposed duty of preparing a strategy for the provision of in-patient care is neither a necessary nor an effective way in which to ensure that all patients are treated in an environment appropriate to their needs.
§ Mr. Patrick Nicholls (Teignbridge)
I, too, have been in contact with MIND; I dare say that we have received a similar briefing. Will the hon. Lady place on record the fact that, although MIND has reservations about clause 1, it is in favour of clauses 2 and 3? MIND hopes that the Bill will go into Committee, so that its concerns can be addressed.
§ Ann Keen
I have never experienced such eagerness to anticipate what I am about to say. If the hon. Gentleman is patient, he will find that I am coming to that point.
1278 MIND is also concerned that the proposal may divert more resources into one area of the service, and create unnecessary bureaucracy. The key phrase to keep in our minds during this debate is that patients should be treated in an environment appropriate to their needs. Community services are many and varied; sadly, support depends mainly on where one lives.
In my constituency, we have many hard-working and effective organisations; I should like to mention one in particular this morning. I recently had the pleasure of visiting a barge on the Thames at Isleworth which acts as an innovative workshop, providing support for people living in the community. The charity is called PSAW—the Psychiatric Support After-care Workshop.
PSAW was established in 1989 by its experienced director, Bob Cornell. The charity runs a variety of workshops and co-operative employment schemes, and will soon sail its renovated barge up the Thames to Westminster to meet me and the hon. Member for Spelthorne (Mr. Wilshire), who is a long-time supporter of the charity. The workers will demonstrate their skills to hon. Members, and, I hope, enjoy a good day out.
The director, Bob Cornell, has explained how medical intervention only partly solves the problem of mental health. Care in the community means being part of the community rather than being isolated in hospital units. Being distanced from the community only increases social exclusion. If people feel isolated, depressed, lonely, jobless and skill-less, they will feel worse in hospital. We need to develop more schemes and more means of intervention to create and develop dependency on a normal rather than a medical model. Users of PSAW have proved to have dramatically decreased the need for a medical model. Bob Cornell and his team should be congratulated on their work.
Clause 2 deals with single-sex accommodation, which can be a complex matter because different patients have different needs. All accommodation should be flexible. Single-sex rooms, particularly for women, provide privacy and dignity. Patients need to feel safe and secure, and security of their personal property is of high priority. Sadly, too many incidents of assault, abuse, sexual abuse and rape are reported. That culture must end, for we cannot tolerate such abuse in a care environment. Patients must have the right to security, which may mean the right to lock the door. I am aware that that can create safety dilemmas for carers, but the matter could be viewed individually, with sensible outcomes.
We must also be aware of the practice of locking patients into rooms. Only a small number of patients are detained under the Mental Health Act 1983; more than 70 per cent. are detained voluntarily. We must ensure that we provide patients with privacy and dignity, while having regard for the safety of patients, staff and society.
To do all that, we need highly trained staff across the spectrum of the mental health service and a supported voluntary sector. I hope that Minister will address the serious recruitment and retention problems when he replies to the debate. It is generally recognised that recruitment of staff in all parts of the mental health service is difficult. There is a recognised shortage of psychiatrists, and many choose to retire early and leave the service. Much of that is to do with the complexity and stress of dealing with many mentally ill patients, and with the "blame culture" that operates in society towards mental health staff.
1279 Nurse recruitment is difficult in all branches of care, but in mental health it is worse. Other more general branches of nursing have a high profile and a more popular image. Nurse educationists need to review the curriculum and training preparation. We must ensure that we prepare students adequately and have well developed support mechanisms in a practical setting. Leaders of nursing and medicine must continually retrain and be developed to be respected in their chosen field, and have an approachable open management style.
Will the Minister look at means of encouraging more mature students to train, and of providing part-time flexible courses so that they can contribute much needed life skills to the service? We must also expand and recognise the role of support workers, who often have positive outcomes with users.
Finally, will the Minister consider innovative ways of employing past users of the service, many of whom have much to offer present patients and their families? Could the welfare-to-work programme be an innovative way of ensuring that people who truly understand others' needs can contribute, while maintaining positive results for themselves as well?
We are nearing the end of the century. Let us all work to rid society of the stigma of mental illness. We must get rid of the institutions—I used to show my nursing students the film, "One Flew over the Cuckoo's Nest"—and we must stop looking at mental health in that way. The infamous Nurse Ratchett' s days are over, and her team has no place in our modern mental health service. This Government will ensure that people suffering from mental illness are cared for adequately, but our main aim will be to prevent mental illness.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
I welcome this debate. It is a paradox of this place that, two weeks ago, we had a packed Chamber on a Friday for a debate on whether to abolish fox hunting, which affects at most 60,000 people—that was the figure quoted by those opposed to the Bill. Today's Bill affects far more than 60,000 people—those who work in the service or who are affected currently or prospectively by mental illness—and we have a relatively small attendance.
§ Mr. Hughes
I shall not give way just yet.
I hope that this is the last time that we have to produce a private Member's Bill in order to have a debate on mental health. I hope that one of several undertakings which the Minister will give us is that we shall have an annual debate, in Government time, on mental health services. If we believe that, traditionally, mental health services are the Cinderella of the health service, we must recognise that in our procedures. I hope that that will be the spirit in which we proceed in today's debate, irrespective of the outcome of the Bill.
§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)
If Government business managers were to find time for such a debate, could the hon. Gentleman guarantee that more than one Liberal Democrat Member would attend?
§ Mr. Hughes
I do not know whether I could guarantee that, but I expect I could. I hope that the Minister will concentrate on the substance of today's debate rather than on attendance. I shall not lecture him about the seriousness of his actions, and I would respect it if he did not lecture others.
The last legislation on this subject was in 1983, in the middle of a period in which there was a dramatic loss of psychiatric beds. Two issues are at stake: first, whether we shall do something about the lack of inpatient provision; and secondly, whether the Government will allow the Bill to proceed further.
I say from the outset that I support the proposal that the Bill should have a Second Reading—there is no good reason why it should not. I hope that points of detail on the clauses can be dealt with in Committee, which is the right way to proceed with private Members' business. Given that the Government allowed a free vote on fox hunting, they should ensure that they do not prevent this Bill's passage into Committee.
The Bill makes three simple proposals, all of which place duties on health authorities to do, in principle, sensible things, although we may argue about some of the detailed wording. The hon. Member for Warrington, North (Helen Jones) and the Minister misunderstand the Bill. I support all that the hon. Lady said about the need for community provision. I understand it well, from friends and constituents of mine. I understand absolutely the need for crisis response, and the need for people to go somewhere in the evening and at weekends, and when they need treatment; but that issue is separate from when people need to be admitted to hospital beds.
To explain to the hon. Lady why she failed to address the issue, I pray in aid the experience I had on Monday this week. I spent that morning discussing with the Barking and Havering health authority the community mental health provision. The Minister was due to go there on Tuesday but could not do so, probably because of the publication of the White Paper on the health service that day. I went there partly because my brother works as a psychologist for that health authority.
I talked to managers and professionals who run the community health care trust. They also run Warley hospital, a big old mental hospital that still has the most in-patient beds of any mental hospital in England. It was absolutely clear from our discussions that there was a significant need for in-patient facilities in a suitable and therapeutic setting.
Although those old hospitals are inappropriate in this day and age, they have not yet been replaced by equivalent places where people can be admitted as in-patients, in the way that the Bill identifies, when they are defined by registered medical practitioners as requiring admission to psychiatric units. Guaranteed places for those people are not available.
Warley hospital, for example, is due to be closed, but it is not being closed, because there is nowhere for the patients to be transferred. There are no in-patient facilities. No other trust wants to provide them. That is 1281 what the Bill is about. I share the views of the hon. Member for Warrington, North: it is not about crisis centres for the evening.
I was talking the other day to my constituents at what is called the Hearing Voices group in Rotherhithe. They are desperately in need of out-of-hours services, helplines and centres to go to. The treatment offered is poor, but that is a separate issue. It is not the issue addressed by the Bill.
§ Helen Jones
Does the hon. Gentleman accept that there is a need for the provision not only of crisis treatment and helplines, but of crisis beds in the community? If so, does he further accept that the spending of more and more money on increased hospital provision will not facilitate the development of those alternative services?
§ Mr. Hughes
There are two answers to that question, and the hon. Lady is still getting it wrong. One is that the Bill does not require the spending of money.
§ Mr. Hughes
The Minister, who is a solicitor—as are the hon. Gentleman on the Conservative Front Bench, the hon. Member for Teignbridge (Mr. Nicholls), and the hon. Member for Warrington, North—should know that the Bill does not require a great expenditure of money. That is the great joy of it. The Bill effectively requires the spending of no money. [Interruption.] No, the Bill states that three duties should be inserted in the Mental Health Act 1983, one of which is to prepare a strategy for the provision of facilities.
Once the strategy has been prepared, of course the Government must provide the money if the facilities do not exist. Let us get it right. Last year, an Energy Conservation Bill went through the House which set duties on local authorities to draw up strategies for warm homes. This Bill is comparable; it is not a money-spending Bill.
Let me quote a paragraph from the extremely well written brief for the Bill produced by Katherine Wright of the House of Commons Library. I hope that that will help the hon. Member for Warrington, North to get out of her head the idea that her argument is an answer to the proposal in the Bill. The brief states on page 15:One basic question posed when discussing the success or otherwise of the policy of care in the community is: are there enough in-patient beds left for those who need them? Two quite separate groups of patients needing access to beds can be identified: those who still need 24 hour care or supervision on a long-term basis; and those who are able to cope living in the community most of the time but who may periodically need 'acute' or 'respite' hospital care for a short period, for example if they are aware that they are in danger of suffering a relapse in their condition.The following sentence explicitly deals with the hon. Lady's point:It is worth highlighting that the distinctions between 'care in the community' and 'in-patient' care are not absolute: long-term 24-hour nursing care may be provided 'in the community' in non-institutional surroundings and different commentators may refer to these as community services or as in-patient services respectively.1282 Just because those services are in the community, it does not mean that they are not in-patient services. By definition, if a person must stay overnight, it is an in-patient service.
§ Mr. Hughes
I anticipate the hon. Lady's point. Let me deal with it. According to the Bill, those must be hospital services. We may want to consider that in Committee.
I visited High Wood hospital in Brentwood on Monday. It is a community hospital based in small buildings around the site in the middle of Brentwood. Just because those are hospital facilities, it does not mean that they are not in the community.
Our argument is that there should be hospital facilities in the community. There can perfectly well be in the community in-patient hospital facilities for psychiatric patients who are certified by doctors as needing them. Those could be of exactly the sort that the hon. Lady has argued for. They are not incompatible with other facilities that are not hospital facilities or are not specifically for continuing in-patients.
§ Mrs. Browning
The hon. Gentleman makes an extremely good point. Would not such facilities provide the flexibility that Labour Members have called for? For example, some hospitals in my constituency provide meals for people in their own homes under the meals on wheels service. Technically, one could say that those people are having hospital meals. Such integration and management from the hospital centre represent precisely the flexibility and the options that the strategy would embrace.
§ Mr. Hughes
I agree with the hon. Lady. For two decades, we thought that care in the community was almost always the answer for people with mental illness. The reality is that there is a range of needs, just as there are for people with physical illness.
Some people are severely mentally ill on a long-term basis. They must be in-patients, and hopefully may be able to be released. Some people are mentally ill varyingly. Some of the people who were at the lobby on behalf of the National Schizophrenia Fellowship the other day are sometimes perfectly well and want to do jobs, but have a relapse, which may be severe. A friend and constituent of mine, Pete Shaughnessy, is often very well and a great campaigner for mental illness services, but sometimes he is extremely ill and is admitted to hospital, possibly for three weeks at a time. When he gets better, he comes out.
A range of facilities must be available to meet the needs of all those people. That is why I appeal to the Minister to allow us to make some progress in getting a strategy in the health service. That is not incompatible with anything that he has said as a Minister, with Government policy or with the White Paper. Let us make sure that there is a duty on health authorities to think not just about care in the community and other health services, but about the provision of in-patient services for people with mental health needs.
§ Mr. Andrew Dismore (Hendon)
If that is what is needed, why does not the Bill say so? It states that the purpose is toprepare a strategy for the provision of in-patient facilities".It says nothing about the wider range of services that the hon. Gentleman is talking about.
§ Mr. Hughes
I specifically referred to in-patient facilities. The Bill would ensure that health authorities have a duty not only to provide care in the community, but to draw up a strategy for in-patient services.
Let me give an example. I represent Guy's hospital. In my constituency just over the bridge, there is a mental health trust, Lewisham and Guy's. We have mental health beds in Guy's hospital and in an old clinic, the Monro clinic. They are grim, and do not offer a therapeutic environment. There will be new beds in the new building, the new Guy's House, which will be mentioned in the Adjournment debate today.
Those beds will be less grim, by definition, because they will be in a more pleasant building, but it would be far better if some of the beds for mental health in-patients were on one of the more open sites elsewhere in my local health authority area. I want my local health authority to have a strategy for providing, somewhere in Lewisham, Southwark and Lambeth, appropriate in-patient beds in an appropriate therapeutic setting, but at present there is none. I want my local health authority to have a duty to provide one. That is as relevant in the inner city in the south of England as it is in rural areas or elsewhere.
§ Dr. Whitehead
The hon. Gentleman argues admirably that the health authority should have a strategy for provision, but he tells the House that the Bill will not cost any money. Clause 1(a) states that the health authority mustprepare a strategy for the provision of in-patient facilities",and clause 2(b) states that the health authority is under a duty to provide forthe fitting if appropriate security devices to all room and ward doors in all existing psychiatric units".We have already redefined what a hospital is, and we are now redefining expenditure. I do not see how one can propose a strategy for provision without providing; nor can an authority have a duty to provide locks without paying for them. The two notions are incompatible.
§ Mr. Hughes
No, the hon. Gentleman asks a proper question. I was dealing with the cost implications of the strategy under clause 1—there is none.
The hon. Gentleman is right; clauses 2 and 3 impose duties to do certain things and, inasmuch as those things are not done already, some costs will be involved. I have visited Broadmoor and other mental health hospitals, although Broadmoor is different because it is a special hospital for offenders, and I know that the provision of security devices such as locks does not represent megabucks in terms of Government spend.
I accept that clauses 2 and 3 will have some spending implications. As has been said, clauses 2 and 3 appear to have universal support from those who work in this 1284 sphere. They want the Bill to progress, so I hope that, if there are any costs as a result of the Bill, we will sign up to them.
§ Mr. Hughes
No, I will not give way. I am not trying to exclude the hon. Gentleman, who is a senior Member of the House, but I do not want it said that some of us spoke for so long that the Bill could not receive a Second Reading today.
When the Minister took office, he announced the establishment of an independent reference group to consider some of the matters before us. Before the election, shadow Health Ministers said that there would be a moratorium on the closure of psychiatric beds, and a locality-by-locality audit of gaps in provision. I would like him to tell us whether that is still the case. Will there be a moratorium on the closure of psychiatric beds until there has been an audit and we know that we have the provision suggested in the Bill?
It is important that the Bill goes into Committee and is debated properly. I agree with the hon. Member for Bournemouth, East (Mr. Atkinson), who has long had an interest in mental health issues, that this is just the sort of Bill that should go to a Special Standing Committee, where we can take evidence and not just debate among ourselves. It would enhance the Government's credibility if they adopted that procedure.
The hon. Member for Brentford and Isleworth (Ann Keen) has valuable nursing experience, and she and others will know that there is a catalogue of violence and abuse of patients in psychiatric hospitals, often by other patients. I will not elaborate, but the Library brief to which I have already referred quotes a report entitled "London's Mental Health" by the eminent King's Fund.
The fund states that the Royal College of Psychiatrists' survey on conditions in London's psychiatric units showed that, over a fortnight in January 1995, 131 assaults were committed by patients, four of which resulted in major physical injuries. The survey in May 1997 showed that there had been 126 assaults in a fortnight in psychiatric units London alone, of which 13 caused major physical injuries.
The hon. Member for Brentford and Isleworth knows as well as anyone that, if people who are mentally disordered, permanently or temporarily, are put together, there will be assaults by men on men and by women on women, but the main risk is of serious and further psychologically damaging assaults by men on women. When I visited Broadmoor earlier this year, it was clear that one of the biggest concerns of staff there was to protect patients from injury by other patients.
§ Ann Keen
That is why I said that I support the concept of single-sex rooms, and that accommodation must be flexible and secure. We must bear in mind the fact that only a small percentage of mental health patients are detained under the Mental Health Act, and that many are in hospital voluntarily. We need to take a wide view of how we accommodate in-patients.
§ Mr. Hughes
There is a debate to be had about that, which is why I want the Bill to go into Committee. The hon. Lady and I agree on the need to provide single-sex 1285 accommodation. Under the patients charter, everyone has a right to it if they want it, but hundreds of people are still in mixed-sex wards against their will. Some people might not want single-sex accommodation, but it should be available, and it might be a therapeutic and safer setting for some.
I went to the United States a couple of years ago to investigate health provision on the east coast. Very few hospitals there have wards, and most have separate rooms for all patients. Our thinking is out-dated, in that we are still discussing wards—the NHS is miles behind best practice elsewhere. [Interruption.] We could say, "Let's blame the Tories," or "Isn't Labour wonderful?", but I do not want to have that debate. We must recognise that the previous Government did some very good things for mental health provision, and that the present Government have some good intentions, but we can use the Bill as a starting point.
Clause 3 is a simple provision to make sure that a safety element is built into units. We can debate the practicalities, but let us at least deal with the proposal in Committee, as it is widely supported by people who work in mental health.
We have today had the opportunity to begin a debate on mental health provision. No other opportunity is generally available to hon. Members in this Session. The Select Committee may discuss the matter, and the Government are doing some, but not all, of the work internally, but that will take a long time. For heaven's sake, let the House be seen to be taking mental health and mental illness seriously. Let us bring in people who know what they are talking about, and show that we are serious about dealing with even a small part of the agenda that matters more than anything to many people outside.
§ Several hon. Members rose—
§ Mr. Deputy Speaker
Before I call the next hon. Member to speak, I must draw the House's attention to the fact that it has been necessary to reissue today's Order Paper, The House will wish to know that the Order Paper as originally printed omitted in error the Public House Names Bill promoted by the hon. Member for Macclesfield (Mr. Winterton). The Order Paper has therefore been reissued and now includes the Bill as item No. 9. Copies of the revised Order Paper are now available in the Vote Office.
§ 11.7 am
§ Dr. George Turner (North-West Norfolk)
As a new Member of Parliament, I might have some things to say to the hon. Member for New Forest, East (Dr. Lewis) and to Ministers which are distinctive because of experience outside the House. Lawyers believe that the world needs more law, and parliamentarians believe that the world needs more legislation. The hurdle that the hon. Member for New Forest, East needs to overcome is to convince me that legislation is required.
One of the great faults of those who would put the world to rights is that they believe we should do so by law. To put it bluntly, the House needs to produce less but better legislation and to spend more time ensuring that Ministers do their job more effectively. For Ministers, that means using existing legislation to good effect and using 1286 their powers of secondary legislation and of circular. It also means that they should encourage the spreading of best practice. That involves getting the professionals together and ensuring that their work is evaluated and known.
I do not know whether the Bill is required, and I will want to hear from the Minister a clear expression of the Government's attitude to what lies behind it.
The Bill deals with an important subject, but in some ways it was slightly unfortunately introduced. No doubt with the best of intentions—to add some colour to the debate—the hon. Member for New Forest, East referred to the horror that is associated with mental illness. He reminded us of the use in drama, including films, of the images of mental illness.
Over my lifetime in politics, including my early days as a party activist, I have visited some of the old mental health institutions. On re-reading a research paper, I recalled the horror of those visits. I was reminded of the horror of what happened in the 1950s and 1960s. I am talking of our attitude to and treatment of those suffering from mental illness.
Today, an employer is not likely to mutter to other members of an interview panel that a candidate had a broken leg four years ago. However, we still live in an environment where society is likely to remind itself that someone had a mental illness four years ago if the individual is applying for a job.
There is a fear of mental illness. In the public mind there is a fear of dangers that do not exist posed by those who are mentally ill. There is a stigma associated with mental illness. Most of us would far rather have a broken leg than be labelled as having a mental illness.
§ Dr. Julian Lewis
The hon. Gentleman completely misunderstood the point when he referred to a preference for a broken leg rather than mental illness. The person involved did not go into any institution during the mental illness, and stigma had nothing to do with it. The point is that the horror of the mental illness was far worse than the pain of the broken leg—no more and no less.
§ Dr. Turner
I said that it was probably with the best of intentions that the example was used to add colour to the debate. I believe that those outside the House will recognise the validity of my remarks in terms of society's attitude to mental illness.
Early in my new job I had the pleasure of visiting the Pamela North centre in Kings Lynn. It is an institution that deals with those who have had mental illness and occasionally suffer acute mental illness. The centre supports them in their normal life within the community. It is a million miles away from the treatment of mental illness that I saw in the 1960s. It was interesting when I sat down to lunch there. I was fascinated to find that I was unsure about who was being helped and who was helping.
It was an interesting visit and it brought to my mind the real need during my time in Parliament to do everything possible to change the public's image of mental illness. I believe that we should regard it in much the same way as we regard physical illness. We should recognise the real need to ensure that there is a broad range of provision, and encourage it.
It may be that we need to legislate, legislate, legislate. Or it may be that we need to educate, educate, educate, to use the mantra of my right hon. and hon. Friends.
1287 My concern about the legislative solution is that in so proceeding we may well be doing something that should instead be achieved by proper management. Are we seeking to manage by legislation when instead we should manage by good government? The House needs to think about things before it rushes to law.
I agree that the House needs to debate the subject that is before us and we need to have a Committee that can quiz Ministers and experts with a view to ensuring that there is a spread of good practice and good management techniques. To be blunt, it would usually be far better to finish there and to tell the managers to manage than to proceed to legislate.
Why should we not legislate? The answer is that legislation, especially primary legislation, is inflexible. We have a rapidly changing technological society and the House can barely keep up with the changes that it needs to make, whether they concern broadcasting or health, for example. The pace of change that is taking place with the advance of science and engineering is faster than that which legislators can understand in detail.
When my hon. Friend the Minister responds to the debate, I hope that he will make clear his attitude towards best practice. I thought that we had already recognised that within the national health service there must be security for the patient—whether he or she is suffering from physical or mental problems—and the employee. I thought that that was at the forefront of Ministers' minds. I thought that it had been recognised by the previous Government and the new Government that people should be allowed privacy and that, if they wish, they can sleep and live in a single-sex environment.
What is needed from the Minister, if I may say so, is not legislation and not good will but, to put it bluntly, cash. That is where the previous Government let us down. The need for good practice was recognised, but one of the prime responsibilities of this place is to ensure that we fund what we believe is necessary.
§ Mr. Bercow
I suggest that the hon. Gentleman has misread the terms of the Bill. If my hon. Friend the Member for New Forest, East (Dr. Lewis) is suggesting the provision of single-sex wards, there would be cost implications. Instead, my hon. Friend is suggesting the provision of single-sex ward areas, which does not carry anything like the same cost implications. Has the hon. Gentleman taken account of that and does he support clause 2—yes or no?
§ Dr. Turner
I am not arguing that the Bill has or does not have cash implications. I am asking whether we need to legislate or whether we need to ensure instead that Ministers are doing their job. If the Minister tells me later in the debate that he does not have sympathy with my views and that it is not the responsibility of his Department to ensure that such views are put into practice, possibly I can be persuaded to agree to legislate and to be rebellious for the first time since I joined new Labour. The Minister has yet to speak, of course.
I can tell the House that we have made a good start in providing cash in my constituency. I have been monitoring funding carefully because I have a responsibility to my constituents to ensure that we get a fair share of the extra money that is being made available. My hon. Friend can record my pleasure that health funding in my area will be 1288 twice what it would have been if I had not been elected on 1 May. I have noted also that almost £1 million will become available this winter.
However, if my hon. Friend is not to provide the means to make it possible for health authorities to deliver, I shall be critical and I shall perhaps have to consider joining ranks with the hon. Member for New Forest, East and insisting that proper provision is made. At least my hon. Friend should be given the opportunity to say where he stands.
I was elected on a platform of reducing bureaucracy. That is why I strongly support the view that we need less legislation but legislation that is properly delivered. Perhaps my hon. Friend will make it clear whether I have correctly identified the danger of duplicating bureaucracy. If area health authorities are not making strategic plans, for what reason do they exist? I would be upset if there were no revision of boundaries in my area so that we have less bureaucracy.
My part of the country, in which my hon. Friend, in his ministerial capacity, has a particular concern, could do with a bit less administration. If he can tell me that he will reduce the number of health authorities in my region, he will have my strong support. If he can ensure less bureaucracy through greater co-ordination of boundaries with social services in Norfolk, he will be applauded, and he will be ensuring that the people who are supposed to deliver health care are not simply party politicos doing a job. I recognise that area health authorities contain people from all parties who are genuinely interested in delivering health care. If we can let them get on with the job and give them the resources to do so, we will improve things far better than we could by legislating.
I referred earlier to what I saw at the beginning of my career in politics, as an amateur, and the changes that I have seen. It looks as though the world has come full circle. I left out one thing about my visit to that institution near Cambridge all those years ago: for goodness' sake, can we stop locking up the mentally ill? It is an interesting reflection on the way in which society has changed that we are thinking—probably correctly—of putting locks back in institutions after spending so many years arguing that we had to open them. Is it not good that we are putting them back because patients, not society, want them?
Please let us recognise that we need to spend more time talking to those with ministerial authority. We need to spend more time ensuring that best practice is achieved, and less time legislating. I look forward to hearing the Minister's response to the objectives in the Bill, which I hope will not be necessary.
§ Mrs. Angela Browning (Tiverton and Honiton)
I congratulate my hon. Friend hon. the Member for New Forest, East (Dr. Lewis) not only on drawing second place in the ballot but on the way in which he presented his Bill, which I am pleased to endorse.
It is apparent from the speeches of hon. Members on the Government Benches that, certainly on clauses 2 and 3, Labour Members support the principles of the Bill, particularly the need to provide areas within wards where women can feel safe and—as the hon. Member for North-West Norfolk (Dr. Turner) said—the need for an appropriate lock, not on the basis of the old concept of locking people in, but to provide privacy and protection 1289 for the patient. We all recognise the delicacies of the need for staff to have access, particularly when dealing with the most vulnerable patients who may be suicidal or prone to damaging themselves.
Given the comments so far about clauses 2 and 3, and with just a little questioning about clause 1, and given the consensus across the Floor of the House, it would be a great shame if the Bill did not go into Committee. Much could be done to overcome problems at the margins of a Bill whose substance clearly has support not only across the Floor of the House but outside it—particularly from the many charitable bodies that represent people with mental health problems.
Although we have heard support for the Bill, if it is the Government's intention to damage it in some way so that it does not have the oxygen of discussion in Committee, that would be an extremely backward move in terms of people's mental health needs. I listened carefully to what the hon. Member for North-West Norfolk said about the need to reduce the amount of legislation. We all appreciate that, but we have legislation, and it is quite right that, when old legislation is revisited, as it has to be, we should amend it in a way appropriate to the times.
As we have already heard—in terms of the public's perception of mental health; the need to educate people about some of the myths that surround mental health issues; the changing views about locks on doors, and the need to protect female patients in particular—things have moved on. Therefore it is quite appropriate that the legislation should be amended, as my hon. Friend suggests in his Bill. I know that he would be receptive in Committee to suggestions about the issues that have been discussed this morning—particularly those surrounding clause 1. It would be a great shame if the Bill, which has the support of a great many charitable bodies, were lost because we were not prepared to discuss specifics.
I do not want to repeat what has already been said, except to flag up a point that runs right through the Bill. As hon. Members have pointed out, there are different categories of mental illness. We know that some people suffer from lifelong mental illness. They cross a whole spectrum—from people who are a danger to themselves or who may be a danger to other people, to people who suffer—one hopes only once in their life—from a severe mental breakdown.
We know that someone with no previous history of mental illness suffering from a mental breakdown may require more than treatment at home—either medication from the GP or out-patient appointments at the local hospital. My hon. Friend mentioned a specific case of which he knows. We all know of such cases among our families, friends and constituents.
The hon. Member for Warrington, North (Helen Jones) talked about giving patients a choice. Sadly, for mentally ill patients—especially those living on their own, as many do—deprived of the sanctuary that my hon. Friend's Bill seeks for them, one very real choice is suicide, a choice that many of them take, becoming statistics on the coroner's register. In my personal life I know of someone who is just one of those statistics.
Some people—not just people involved in high-profile, dramatic instances of mentally disturbed behaviour but people in the privacy of their own home—do make a 1290 choice, and that choice is death. It is to prevent such cases that my hon. Friend seeks to help, through clause 1, to ensure that those with acute episodes of mental illness are treatedwithin separate and therapeutic environments.That particular need is not met at the moment, because GPs and other health officials consider that a bed in such a ward would not be appropriate for people with a severe mental breakdown, but there is nowhere else for them to go. If there is no strategy—whether, as the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) mentioned, it is to provide a hospital bed per se or whether provision is made on an outreach basis within the community—people will continue to fall through the net. They will continue to become statistics on the coroner's record. For that reason alone, clause 1 deserves more consideration than we have time to give it on Second Reading. Some Labour Members have expressed concerns. I would welcome the opportunity to explore a little more in Committee how the Bill will assist the people to whom I have referred.
§ Mr. Spring
I am sure that my hon. Friend recognises that, tragically, people who are suddenly overcome by some mental difficulty or tragic shock are not in a position to make judgments about the seriousness of their condition. Very often, the overwhelming and sudden impact of what has hit them causes their whole world to implode. That is precisely why there must be a strategy to cope with such people and provide the appropriate treatment in appropriate surroundings.
§ Mrs. Browning
Indeed. I agree. It is very hard to try to second-guess what is in the mind of somebody who is undergoing a severe mental breakdown. It is correct that medical professionals and people who are close to the person concerned—if there are such people—judge what is appropriate.
I would not dream of saying what a doctor should do in a given set of circumstances. The decision must rest with the doctor. From evidence that has arisen as a result of publicity for the Bill, doctors are clearly indicating that, when they have to make the choice for people with severe mental breakdowns, they do not choose a bed—even if it is available—because they do not believe that sending a person into such an environment is appropriate to the person's medical circumstances. The Bill seeks to resolve that problem, and address the needs of that group.
§ Mr. Clive Efford (Eltham)
The hon. Lady is falling into the trap into which some of her hon. Friends have fallen, of believing that the Bill is the only way to deal with the problem. Does she agree that there is no difference of opinion across the Floor of the House on the need to consider the appropriate provision for people with mental health needs, and the dignity with which they need to be treated in overnight institutions? The point is whether that can be dealt with by a Government commitment.
I suggest that the lack of commitment over the past 18 years is the reason why we are debating the issue today. [Interruption.] I am afraid that that is true; it is an undeniable fact. Do we need a cumbersome piece of legislation to implement provisions that could be 1291 implemented immediately? The White Paper that was published this week makes provision for transparency in the health service, and addresses the demands in the Bill.
§ Mrs. Browning
I am not under any illusion about the Bill; I am one of its sponsors. I see that it does not even fill two sides of an A4 sheet, so in nobody's estimation can it be called cumbersome. If the hon. Gentleman is suggesting that the Minister will say that there is no need for legislation because the Government will ensure that what is in the Bill is implemented, by directive, secondary legislation or whatever is required, I am sure that my hon. Friends and I would welcome that.
§ Mrs. Browning
I am answering the hon. Gentleman's first intervention before he makes his second.
I am nervous of the fact that, although Labour Members seem to recognise the need for such a Bill, they do not want to do anything about it. Unless the Minister can give us the categorical assurances that we seek, we ask very simply that the Bill be allowed go into Committee so that issues can be properly debated. Any reservations that hon. Members on either side of the House may have can then be properly discussed in a democratic way.
§ Mrs. Browning
The hon. Gentleman shakes his head. He is new to the House. He should read Hansard and discover my track record in this area. It is no good his shaking his head. I have a track record on subjects such as this that will bear investigation.
§ Mrs. Browning
I will, as long as the hon. Gentleman keeps his intervention short and does not make a speech.
§ Mr. Efford
The point is whether the Bill addresses the needs of people with mental health problems, not whether we debate clause 1. I think that there is a commitment on the Government Front Bench to accept and enact the provisions of clauses 2 and 3 without the need for the Bill to go into Committee and for us to talk among ourselves.
§ Mrs. Browning
If the hon. Gentleman is foreseeing what the Minister will say, we would certainly welcome such support for clauses 2 and 3. But I reiterate—[Interruption.] I am trying to reply to the hon. Gentleman. I was courteous enough to let him intervene twice. I hope that he is courteous enough to listen to the reply.
Clause 1 would help to deal with the problem of those who fall through the net. I have described who they are. Does the hon. Member for Eltham (Mr. Efford) not want that group, who are prone to suicide and who do not have access to appropriate therapy conditions, to have the treatment that their GPs and medical advisers would prescribe and which they are currently being denied? My hon. Friend the Member for New Forest, East has identified the problem and has proposals to overcome it. I ask the hon. Gentleman very politely to allow the clause 1292 that addresses the needs of those people to be debated further. I happen to think that the people whom I have described merit further discussion.
§ Mr. John Heppell (Nottingham, East)
I share the view of some of my hon. Friends that the Bill is well meaning. I am sure that it is the intention of the hon. Member for New Forest, East (Dr. Lewis) to try to improve provision for people who are mentally ill. However, the Bill's provisions are either unnecessary or, in the worst scenario, could make the situation for mentally ill people even worse.
I say that because it seems that we are wanting to step back to what we had before 1975. We almost seem to be putting the emphasis on in-patient care, when we should be moving in the opposite direction. We all lived through the period in which hospitals were closed. Almost half the hospitals that existed in 1970 have closed—and more hospitals will close. During those closures, many hon. Members protested—and rightly so. The sensible protests were not about about the closure of hospitals or the loss of beds but about the fact that, although the hospitals were closing, resources were not being put into the community to deal with the patients who were coming out of hospital. That is what has given care in the community such a bad name. That is why we have such a legacy.
Let us not forget the situation before 1975, before the previous Labour Government—it is going quite a long way back—introduced better services for mentally ill people. Let us remember what it was like when people were locked away from the rest of society, when many mentally ill people were treated as criminals, when mental health remained a low priority, when the prevalent thinking was, "out of sight, out of mind", when people were put away in institutions so that they would not be a nuisance to the rest of society. We have moved on since then, and we should not return to those times.
The hon. Member for Bournemouth, East (Mr. Atkinson) spoke of amending the Bill, which in itself would amend an Act. He listed all the things that the Bill would not do. That proves the point. We cannot consider the issue in isolation. We must consider mental health across the board and not only in terms of provision for in-patients.
The Bill accepts a number of things that should not be accepted. It accepts, or almost accepts, that entitlement to a hospital bed is the answer. It accepts the fact that beds are gridlocked, but, instead of figuring out why they are gridlocked—instead of considering the interface between the health service and social services, why people are not being shifted through the system more quickly, why people are in hospital beds when they should not be and how the system could be run more effectively—it simply proposes an increase in the number of beds. That is not the answer.
The Bill seems to assume that people will relapse when they are back in the community—that it is almost a foregone conclusion that they will get worse and worse until their problems become acute. That is not the way I see it. When I was a councillor, one of the first problems that I encountered involved a local man who rapidly became acutely ill and a problem to his neighbours. He removed fuses from a communal lighting system in a block of flats, and turned off the gas supply. He appeared to pose a danger.
That man would be taken into hospital for a fortnight, following which everything would be great for three or four weeks; then the incidents, and the complaints, 1293 would start again. The difficulty for me was not that it was impossible to find a bed for the man when the problem became acute, but the lack of support services. What was needed was intervention at the outset, rather than when the man had already started doing strange things, frightening people and making them feel that he was a threat to their lives. The problem continued not for a couple of weeks or a couple of months, but for many years. Every six weeks or so, it would recur and the man would be returned to hospital.
The Bill is not necessary, for all sorts of reasons. For one thing, the position relating to hospitals has changed. In September, the Government announced new plans for the closure of psychiatric hospitals. An independent reference group has been set up, which will not allow such hospitals to close unless the necessary resources and support are already available in the community.
Clause 2 is not necessary. The idea of single-sex wards, or areas in wards, is not just accepted by the Labour party; the Mental Health Act Commission published a report on it in November 1996, and the last Government—your Government—accepted it, saying that they were doing what they could to change things. The present Government have restated that policy, and Lady Jay, the Minister of State at the Department of Health, wants a report on progress to be published by Christmas. We have been in office for only seven months, and we have had fewer than 200 days—not 6,500—to act; but action is already being taken. That is the difference. You recognised the problem but did nothing about it, while the new Government also recognise it and are doing something about it.
The Bill asks for astrategy for the provision of in-patient facilities".Health authorities are already required to have a strategy for the provision of appropriate facilities for mentally ill people, and that includes in-patient facilities. In-patient facilities are a part of the whole. If we concentrate on that narrow area of policy, we shall return to where we were 20-odd years ago.
The Under-Secretary of State for Health made the point very well in a speech earlier this year. He said, "We must start to deal not just with the acute problems of mental illness, but with why people become mentally ill in the first place. We must prevent them from becoming ill."
§ Mr. Spring
I entirely accept that health authorities are required to have a mental health strategy, but strategies have to be updated. They must accord with what actually goes on in psychiatric wards. The point about the Bill is that it strengthens the strategy and puts flesh on its bones, so that the concerns about single-sex wards and the safety and security of those in them—concerns that have clearly arisen in the past few years—can be addressed.
§ Mr. Heppell
I will come to that point shortly. First, let me continue my quotation from the speech of my hon. Friend the Under-Secretary of State for Health, because it is so brilliant. He gave an analogy: he said that we should stop pulling people out of the river, when we should be ensuring that they did not jump into the river in the first place. That is what is wrong with the Bill. It deals only with the end result. My hon. Friends and I do 1294 not want to have to deal with acute mental health problems; we want to stop them from developing in the first place by ensuring that intervention in the community takes place much earlier.
The Bill is not necessary, because our care programme already accepts that what care is given, rather than where it is given, is important. You ask for monitoring of the strategy, but that is already done by the national health service executive's performance management framework. The Government are in the process of saving £1 billion by getting rid of bureaucracy in the NHS, and you want to put it back, and start duplicating. You ask for an annual report to the Secretary of State—
§ Mr. Deputy Speaker
Order. The hon. Gentleman keeps using the word "you". The Chair is not responsible for the matters to which he refers. Will the hon. Gentleman try to use the correct parliamentary language?
§ Mr. Heppell
I apologise, Mr. Deputy Speaker.
The Bill asks for an annual report to the Secretary of State, but such a report has been produced for the past three years, and the Secretary of State can always ask for a report when necessary. Again, there is duplication. What is the point?
In regard to single-sex wards, one of the components of the monitoring system that we have introduced is an audit checklist to evaluate the process for delivering acceptable single-sex accommodation. As for the security and design of psychiatric units, the NHS executive estate agency has already issued advice about such matters as locking bedroom doors, safeguarding personal property and en suite toilet facilities. We should be given a little time to see whether the action that we are taking works. You had 18 years of it; let us have 18 months.
§ Mr. Robert Syms (Poole)
I have listened carefully to the hon. Gentleman. He argues that we should give the Government a little more time. Does he acknowledge that the Bill should be given more time so that the issues can be explored in more detail in Standing Committee?
§ Mr. Heppell
I have no great objections to that, although I consider it a bit of a waste of the time of hon. Members. Conservative Members such as the hon. Member for Bournemouth, East have argued that the Bill is not adequate and mentioned what needed to be discussed. To treat in-patient beds as a separate issue is to do a great disservice to our current mental health services, which I hope will be improved.
§ Mr. Nicholas Winterton
Will not the hon. Gentleman go along with the suggestion of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) that the matter should ideally be sent to a Special Standing Committee for further evidence to be taken before the Bill came back for further consideration? It is an important matter.
§ Mr. Heppell
I do not think that that is necessary, because the independent reference group will do exactly that. It will advise the Government not only on hospital closures but on other issues such as long-term hospital stays, reducing the stigma of mental illness, ensuring that 1295 mentally ill people are cared for in safety in the community, and black and ethnic minority mental health issues.
I listened to the start of the speech of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) and realised early on that he did not understand the issue. He seemed to think that the real problem was the closure of the old bleak and horrible mental institutions and that we had not replaced them with new mental hospital beds. That is not my view of what it is all about. We all support the closure of old institutions, but we could not support the previous Government's no-bed strategy. In some cases, they reduced the number of beds to well below what was needed.
§ Mr. Bercow
If, as he claims, what the Bill seeks to do is already happening, why does the hon. Member think that two expert charities in the field, MIND and SANE, support the Bill?
§ Mr. Heppell
Before the hon. Gentleman asks me to comment, I would like to see what MIND said. Something was quoted earlier, but when I read on, I realised that MIND had said a bit more. It is easy to quote selectively from letters. I could pick out the comments of the Mental After Care Association against clause 1 and then say that it was for clause 2. MACA states:We fully support Dr. Lewis' aims in Clause 2 to protect vulnerable patients while they are in hospital, though believe these could be achieved without recourse to primary legislation.It is not total support.
§ Dr. Julian Lewis
Let me set this clearly on the record. I have been categorical in stating what clauses different organisations support. The National Schizophrenia Fellowship and SANE support the whole Bill. MIND supports clauses 2 and 3. The Mental After Care Association is the only organisation that has said that it does not think that primary legislation is necessary. All the other organisations have said that they wish the Bill, wholly or in part, to be passed. That is clear and unambiguous.
§ Mr. Heppell
I shall not repeat my hon. Friend's sedentary remark. He makes the point that some colleagues of the hon. Member for New Forest, East have said things that were in some respects out of context.
§ Mr. Nicholls
On a point of order, Mr. Deputy Speaker. I have shown considerable patience, as have my hon. Friends. For the past 20 minutes, the hon. Gentleman, whose name, I confess, I do not know, has been mouthing things and calling hon. Members silly little people. This debate has been in fairly good humour so far. It is about time that he picked up a feeling for the manners of this place.
§ Mr. Deputy Speaker
This debate has been conducted in a good mood so far and has been very constructive. I would be grateful if we could finish it in the same way.
§ Mr. Heppell
I want to make it clear for the record that the remarks of the hon. Member for Teignbridge (Mr. Nicholls) were not aimed at me.
1296 There are other reasons why we should be a bit happier about what is happening. The Government recognise the need to improve mental health services. An extra £5 million has been put into mental health services, specifically to reduce pressure on acute psychiatric services by helping with extra residential or 24-hour nurse staff places, and, more importantly, to develop more effective approaches to crises that will reduce the need for in-patient admissions. I welcome the extra money from the Government.
I welcome the £6 million increase in the mental illness specific grant from £67.3 million to £73.3 million in 1998–99. That is an increase of 9 per cent. That shows how serious the Government are about mental health. I welcome the fact that there will be an independent reference group. I also welcome the fact that my area will have more than £2.25 million extra to deal with problems this winter. The cash increase for 1998–99 will be more than £14 million, an increase of 5.2 per cent. We would not have got a comparable increase without a change of Government. Those figures show a cash increase above what the Tories were planning to spend of more than £6 million. That shows how the Government are trying to tackle mental health issues.
It is easy to cite the views of those who think something is a good idea. I got in touch with my local trust, Nottingham Healthcare NHS trust, to find what it thought about the proposals. It has been innovative about mental health. It did not reduce the number of in-patient beds when it closed the old Saxondale and Mapperley mental hospitals. People talk about stigma. No one can imagine any worse stigma than having been to Mapperley hospital. It was a form of insult. People used to tell each other, "Get to Mapperley." It was almost like referring to Bedlam.
So I welcome the closure of the old mental hospitals. I visited the empty premises of Mapperley last year. The trust wants to pull it down, but some people want it to be preserved as a listed building. My view is that it is an abomination and it should be pulled down. The trust has talked about changing it into student accommodation. But when one walks through the building and sees what amount to cells in which people were locked up in the old hospitals, one knows that people who think that there was a glorious age of mental health provision are wrong. I do not want to return to that.
§ Mr. Heppell
I shall not respond to that comment. I have quite a few students in my constituency, and I would not want to upset them.
The chief executive of Nottingham Healthcare NHS trust says:there has been growing pressure on acute psychiatric beds … To help address these pressure it is important for the Government to reform the Mental Health Act to support treatment in the community even when a patient is reluctant to receive it"—I know that there are difficulties with that, but that is his solution—and secondly to ensure that there are sufficient numbers of medical students being trained as well as nurses to ensure that there are sufficient clinical staff available to work in community mental health services.1297 He does not see extra beds as the solution. Nor do I.
We need to recognise that the debate is not simply about beds and in-patient care. It is about the whole mental health service. Unfortunately, the Bill does not deal with the issues across the board. For that reason, I am against it.
I want to see provision made for people with mental health problems, but I want to see some work done on altering the stigma of mental illness. I want to see work done not on how we exclude people by locking them away but on how we can include them. I want to see more 24-hour care not in hospitals but out in the community—in housing projects, for example. Let us use some imagination. Let us make sure that health authorities work with local authorities and other agencies so that we can meet the needs of all people with mental illness, not the needs of a few, who, I agree, require beds in hospitals. The way forward is not to increase the number of beds but to reduce the number of people who need care in hospital.
§ 12.1 pm
§ Mr. Nicholas Winterton (Macclesfield)
I am grateful to you, Mr. Deputy Speaker, for calling me in this short but important debate. The Minister knows that I have taken a great interest in this sector of health provision for many years. For 18 years, I was a member of the Social Services Select Committee and its predecessor, the sub-committee of the Expenditure Committee. Latterly, I chaired the Health Select Committee.
I have already quoted from the Social Services Select Committee report, "Community Care", which was produced in the 1984–85 Session. It referred specifically to the adult mentally ill and the mentally handicapped. Before I quote from the report again—it is extremely relevant to the matter that we are debating—I congratulate my hon. Friend the Member for New Forest, East (Dr. Lewis) on his success in the ballot for private Members' Bills and on the most detailed, reasoned and considered way in which he made his case.
The Bill is limited. I know that the Minister realises that. Clauses 2 and 3 are virtually unanimously supported by hon. Members on both sides of the House, who have admitted that the work that needs to be done is urgent and that the Bill fulfils those requirements very well. There is little or no controversy about it. There is controversy, or difference of view, about clause 1.
As someone who has taken a great deal of interest in mental health, I am worried about the rapid closure of in-patient care facilities for those suffering from mental illness. The wonderful Parkside hospital in Macclesfield did wonderful work over many decades. When I was first elected as the Member for the constituency, there were 1,500 patients in that hospital; today there are none. Under the previous Conservative Government, an acute mental illness unit was constructed on the district general hospital site. I regret that, because, as the Select Committee report stated more than once, an acute mental illness unit or hospital should be built separately from district general hospitals. As the hon. Member for Warrington, North (Helen Jones) has said, the environment of a district general hospital is not conducive to assisting the recovery, treatment and care of mental health patients.
1298 I therefore deeply regret that the wonderful site of Parkside hospital in Macclesfield is likely in due course to be covered by houses rather than providing therapeutic facilities for those suffering from certain categories of mental illness, not least schizophrenia, where tranquillity, quiet and calm are required for their treatment.
I have worked with the National Schizophrenia Fellowship, which has made a great study of that still relatively unknown disease, its causes and how it can be cured. People still do not know the answers. I only hope that, in due course, we can find a cure or a treatment for its sufferers.
My hon. Friend the Member for New Forest, East made many references to the work of SANE. I have the greatest affection, love, regard and respect for its director, Miss Marjorie Wallace, because she is such a sensitive and gentle person. Her outstanding role in trying to assist the mentally ill will go down in the history of mental health.
§ Dr. Whitehead
I have a great deal of sympathy for the hon. Gentleman's comments about the closure of long-stay hospitals, but it is necessary to be absolutely clear about the circumstances in which the majority of people in those hospitals were discharged. They were not acute cases, but, by and large, people who, these days, might not be admitted—most of us would say that they should never have been admitted.
The problem with the patients in many of those hospitals was that, because of the way they were treated, they became institutionalised, long-stay patients. They became inhabitants of the type of hospital that the hon. Gentleman has described. We need to be clear about the difference between acute intervention and long-stay hospital care. I would assume that we would support one option, but, these days, would be wary of the other.
§ Mr. Winterton
I entirely share the view expressed in so reasonable a manner by the hon. Gentleman. Of course, in the old days, a simple young man from a village outside Macclesfield might have been caught scrumping. Perhaps in those latter Victorian days he was taken to court and sent to the hospital on the hill, the asylum, the psychiatric institution—in Macclesfield, it might have been Parkside hospital. Perhaps a simple young girl got herself into trouble, and people wanted to put her pregnancy out of sight. She might have been sent to a psychiatric hospital—in Macclesfield, that would have been Parkside.
I agree with the hon. Member for Southampton, Test (Dr. Whitehead) that in years gone by many people were sent to the asylum or the psychiatric hospital—I repeat that, in Macclesfield it would have been Parkside—whereas today they would be treated within the community and in a more enlightened manner.
I return to my intervention in the speech of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson), when I quoted from the Select Committee report. It said:The pace of removal of hospital facilities for mental illness has far outrun the provision of services in the community to replace them.It also said:The Minister must ensure that mental illness or mental handicap provision is not reduced without demonstrably adequate alternative services being provided beforehand both for those discharged from hospital and for those who would otherwise seek admission.1299 That was a very sensible recommendation, which summed up the evidence taken by the Select Committee.
The second paragraph of a press release by SANE on the Bill states:The loss of psychiatric beds (50,000 since 1980) has led to seriously ill people being denied access to in-patient care when they need it. In our rush to close down institutions, we have replaced them with overcrowded wards where people with very different conditions have been thrown together. Hot-bedding is rife—14 people for every ten beds in inner cities—doctors are faced with impossible decisions to discharge someone who is still desperately ill to admit another at equal risk, making treatment at best ineffective and at worst damaging.While some people may not agree with everything that SANE says, I regard the organisation, and its director in particular, very highly.
The press release continues:This Bill recognises that in-patient care should be tailored to the individual needs, giving real choice to those currently denied `asylum'. Because of this crisis in in-patient care people with mental illness are being neglected and lives lost.I recall, with great sadness, three deaths in my constituency, two of them suicides. One was a young man and the other a young woman. I say to the Minister and Labour Members who oppose in-patient care for the mentally ill, that that young lady—whose name I will not mention as it may cause her family distress—craved and begged to be admitted to hospital for care, security and treatment. She was turned away.
§ Dr. Julian Lewis
My hon. Friend has said—with articulateness and passion which, sadly, I could not muster—exactly what I was trying to explain. He has identified the exact category of person and exactly the circumstance that first led me to take an interest in this matter, which is so far outside my usual areas of expertise.
§ Mr. Winterton
I am grateful to my hon. Friend for that comment. I am doing my best to support him. Although some may disagree with certain provisions in his limited Bill, there is no reason why it should not go into Committee for further consideration. If the Government do not like clause 1, it would be simple to amend it in Committee. I understand that the Government fully support the other proposals, which could be enshrined in legislation.
I want to refer to the Select Committee report again. I do not think that very much has changed since 1984–85, when the report was produced by an all-party group of Members of Parliament, under the chairmanship of Mrs. Renee Short, a very distinguished Labour Member who served the House well for many years. Among our conclusions and recommendations, No. 31 under the title "Asylum" states:We recommend that at least an equivalent proportion of those resources, services and amenities presently devoted to the most severely mentally disabled continue to be so devoted in the future.As one or two Labour Members have said, the money that has resulted from the sale of the sites of mental illness hospitals—some of which were very suitably located for redevelopment—has clearly not followed the mental health channel and been devoted to providing additional resources, facilities and amenities for the mentally ill.
Recommendation No. 32 states:The simple facts are that there is little prospect of major change for the better for many mentally disabled people. We must face the fact that some people need asylum.1300 That is the view, not of the National Schizophrenia Fellowship, but of an all-party group of Members who carried out a year-long in-depth inquiry into community care, with special reference to adult mentally ill and mentally handicapped people. The Committee added:We recommend that the Department draw on the experience of the existing hospital hostels with a view to producing practical guidance to authorities on the lessons to be drawn for future provision of asylum care.It was interesting to hear the hon. Member for Warrington, North talking about what an acute mental illness unit should be—how it should be designed and where it should be built. Under the heading "Mental Illness", recommendation No. 47 states:We recommend that hospital planning guidance from the DHSS"—as the Department then was—should emphasise the advantage of DGH"—district general hospital—psychiatric units being planned as physically separate entities, with space around them, with more attention being paid to off-ward facilities; and that it should also draw attention to the drawbacks of the standard design of medical wards.That is extremely revealing, because during our inquiry, we visited mental health hospitals throughout the country. We also went to local authorities whose social services departments were organising care in the community in a caring and positive way—but, as we all know, there are always resource implications of such policies.
It is worth noting that the Committee also recommended thatunder-provided areas should give urgent priority to creating adequate day care facilities for those recovering from mental illness.Those matters have frequently been raised by Labour Members during the debate. We recommended thatservice providers take the variety of needs into consideration when planning mental illness day care facilities and that encouragement be given to voluntary effort in the provision of informal day care.Finally, the report stated:We recommend that the DHSS and local agencies encourage schemes for voluntary work by those recovering from mental illness.All those recommendations are extremely pertinent to the Bill. However, under the heading "Admission policies", the Committee said:Great difficulties are being experienced in procuring emergency psychiatric care, putting a strain on the individuals concerned and their families. That is the present reality of community care as seen by many families. We recommend that catchment area boundaries for admission to mental illness hospitals should not be applied so inflexibly as to inhibit reasonable choice, and that admission policies should be established to reflect an individual's need for treatment or care rather than his prognosis.One of my deep worries is that people throughout the country, in pursuing policies to deal with mental illness, have sought always to be politically correct. It was thought at one time that all people, except perhaps a tiny hard core, could be dealt with in the community. In the light of experience—
§ Mr. Winterton
Even the Minister is nodding modestly.
1301 We have learnt that a number of people, especially those suffering from schizophrenia, need in-hospital care. I am not suggesting that such care should be provided in the huge wards typical of the Victorian institutions—the "hospitals on the hill" that I spoke about. However, many of the sites of such hospitals—such as Claybury hospital, Friern Barnet hospital, and Parkside hospital in my constituency—would have lent themselves to redevelopment, providing up-to-date facilities in cluster groups of bungalows and other forms of accommodation. It would not have cost the Government or local government a great deal, because the national health service already owned the sites.
I presume that the Minister will know what I mean when I refer to the village concept of dealing with mental illness and, in some cases, mental handicap. In Sweden, Denmark and Holland, I have seen some of these wonderful developments, which make it possible to deal with the worst cases of mental illness in a civilised and up-to-date way.
I make a heartfelt plea to the Minister to give some encouragement to my hon. Friend the Member for New Forest, East, whose speech was well reasoned and sensitive. I hope that, even at this stage, the Government will find a way of allowing the Bill to go into Committee. Unlike the hon. Member for Nottingham, East (Mr. Heppell), I do not believe that it would be a waste of time. His remark was unfortunate, because any discussion between hon. Members, in any forum, about those who suffer from mental illness—how we might help them, what facilities they need, what treatment we can give them and how we can give them the most meaningful of lives—is worth while, and appreciated by those who are mentally ill and by the dedicated, professional people who care for them.
The hon. Member for Brentford and Isleworth (Ann Keen) used to be a nurse. I respected much of what she said. She knows as well as I do that her understanding of such people has improved because she has treated them when they really needed care and treatment.
We should give the Bill the opportunity to make progress. Even if clause 1—on strategies for the provision of in-patient facilities in psychiatric units—which causes controversy, is substantially amended or changed, I want the House to have a chance to discuss this subject further, for the benefit of the people who are doing a wonderful job, such as those who work for MIND and Mencap, and Lord Rix, who was just Mr. Brian Rix when he gave evidence to the Select Committee. He became Sir Brian Rix and continues, as Lord Rix, to play a major role. I agree that that is to do with mental handicap, but, as the hon. Member for Brentford and Isleworth knows, mental handicap and mental illness often overlap.
My impression of a visit to a mental handicap hospital in Northern Ireland has stayed with me to this day. I know the commitment that is required from those who deal with people, young and old, who suffer from mental illness or mental handicap. They deserve the understanding and support of the House. I believe that they will misunderstand us if we do not allow the Bill to proceed to Committee.
I make a plea to the Minister. He and I occasionally have rather more in common on the health service than I have with some of my hon. Friends. He knows what 1302 happened to me in 1992. I had the honour of being Chairman of what I consider to be the most influential of all the Select Committees on Health that the House has ever had; it had members from the Labour, Conservative and Ulster Unionist parties. Because we were so influential, because we had the respect of people outside the House, because we tackled subjects and produced reports based on the evidence given to us, which meant that they were objective reports, and because we did the job that the House gives Select Committees to do—holding the Government of the day to account on behalf of the House—I was not reappointed as Chairman at the beginning of the 1992 Parliament.
§ Ann Keen
The hon. Gentleman has been kind enough to comment on my professional life. On behalf of health professionals, I should like to say that we praised the hon. Gentleman and believed that it was an absolute disgrace that he was removed from the Select Committee. We thank him for his work with the Committee.
§ Mr. Winterton
I am grateful for the hon. Lady's comment. Such remarks do not often come across the Chamber. It is very rewarding for me that a Labour Member is prepared to speak in those terms.
It is because of the position I held that I make a special plea to the Minister. I want him to understand what my hon. Friend the Member for New Forest, East seeks to do in his modest Bill, which I fully support and which, as the Minister knows, also has support from Labour Members. Sadly, the Labour Members who sponsored the Bill cannot be here today. The Bill has also received support from the Liberal Democrats. Mental health is an important subject. Let us allow further discussion.
§ Mr. Andrew Dismore (Hendon)
I congratulate the hon. Member for New Forest, East (Dr. Lewis) on securing second place in the ballot. His Bill deals with an interesting subject. I apologise to him and to you, Mr. Deputy Speaker, for not being able to remain for the whole debate, and I thank you for calling me at this stage.
I agree with much of what the hon. Member for Macclesfield (Mr. Winterton) said about the need to debate in the House the important issue of mental health. I also agree with the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) that it is important that we debate the issue on the Floor of the House. I am sorry that he is no longer in his place. I was also sorry to see so few Liberal Democrat Members earlier. When the hon. Gentleman made his speech, he was the only Liberal Democrat in the Chamber, although he has now been replaced by two colleagues. I hope that we shall hear from them later.
My hon. Friend the Member for North-West Norfolk (Dr. Turner) mentioned the stigma attached to mental health. Anyone who has been involved in public life, either in this House or, as in my own case previously, as a councillor, knows that there is a problem when we face the issue. I recall several such occasions when I was a councillor. When planning applications or licensing applications that related to mental health were made, there was vociferous opposition from residents which was born out of ignorance and fear.
I find it difficult to comprehend the attitude of such people, who often have no real idea what they are talking about. Whenever a planning application came up for 1303 discussion, fears were expressed that a mad axe man would run down the road dripping with blood. Few people with mental health problems fall into that category. We must recognise the stigma and the ignorance and fear that give rise to it, and we must do all we can to break down that ignorance. Part of the problem is that that ignorance is fostered by some of our institutions, which have developed in a certain way over the centuries.
Before I was elected to the House, I was a solicitor working in private practice. Unlike my hon. Friend the Member for Brentford and Isleworth (Ann Keen), when people at the bus stop asked me what I did, I said that I was a solicitor, and was met with as much approbation as if I had said that I were a Member of Parliament.
I pointed out that I was not an ordinary solicitor dealing with the buying and selling of houses or divorces, but that I specialised in personal injury law, acting for victims of accidents. I took on the big battalions of insurance companies and tried to secure compensation for those victims. On that basis, people still thought that I was overpaid, but were prepared to give me the benefit of the doubt.
My experience as a personal injury lawyer for almost 20 years revealed to me the prejudice that we see towards mental health issues within the law and in certain parts of the medical profession. I instructed doctors to prepare reports on my clients, some of whom had severe physical injuries from which mental problems had developed, and I often heard patients referred to as suffering from "compensation neurosis", "functional overlay", or, worst of all, "compensationitis", as though he or she were faking it all.
I regret to say that the same problems also arose within the psychiatric profession. The prejudice was not confined to those dealing with orthopaedics and similar conditions; it permeated throughout.
For example, 10 years ago, almost to the month, there was a serious fire at King's Cross underground station, and I had to represent a number of firefighters and railway workers who were injured in the course of that incident. They were suffering not just from burns or broken bones but from severe injuries to their minds.
I was horrified to see the extent to which London Underground would go to try to discredit the conditions from which those people were suffering. I spent hours with the victims, taking statements and listening to their account of events, and I have little doubt that they were wholly underestimated. The public simply do not realise how disabling some of those conditions can be.
One case went all the way to court. A firefighter called Mr. Hale was described by the judge at the end of the case as the bravest man he had ever met, and I agree. Mr. Hale had had a career in the fire service and had worked for many years effectively and efficiently. He was then called to the King's Cross fire. What he saw seriously affected him, to the extent that he could no longer work as a firefighter. He lost his self-confidence and bravery; indeed, he lost everything as a consequence of the mental illness that he suffered after that incident.
Mr. Hale thought that he might be able to cope with the job of postman. He had been a physically active man whose job required the full use of all his resources, but he now felt that he could only do a job with no great responsibilities. That brought home to me and to the judge—Mr. Hale won record damages—the extent to 1304 which the legal system underestimates the impact of psychiatric injury. That, however, was not the end of the story. Although we won record damages, they did not compare to the compensation that would have been awarded had it been physical injury that had to be compensated.
I am pleased to say that the Law Commission is looking generally at that aspect of the law, and not before time. It is a question not just of the amount of compensation but of the hurdles that people must jump in trying to claim compensation, which are much higher for people with a mental condition than they are for people suffering from a physical injury.
§ Mr. Spring
Is the hon. Gentleman planning in his discourse to give us the telephone number of the excellent firm of solicitors to which he is attached?
§ Mr. Dismore
As I no longer work for the firm, I have no intention of giving the telephone number, but if the hon. Gentleman would like the details, I can give them to him afterwards. I am even prepared to give him the telephone number of the law firm of which I remain a partner, although I am not taking cases, so he would not be able to rely on my services.
I was pleased to hear the statement made by the Parliamentary Secretary, Lord Chancellor's Department, earlier in the week, in which he dealt with issues of mental incapacity within the law, and proposed improvements in that regard.
We have heard from several hon. Members the responses of various charities to the Bill. I shall not repeat them, as they have been debated across the Chamber. In preparation for the debate, I consulted the senior management of Barnet health authority, which is responsible for health services in my constituency. I was told that senior management did not see the point of the Bill or how it would advance matters. The senior manager to whom I spoke also told me that at a meeting of the NHS confederation meeting last week, people were less than impressed with the thrust of the Bill.
The Bill represents a narrow approach to the issue of mental health. It does not address the wider and more fundamental concerns. By focusing on one narrow area, we run the risk of diverting resources, attention and effort from a broader strategy.
§ Dr. Julian Lewis
I appreciate that clause 1 refers to a relatively narrow issue, as does clause 2, which deals with women who are vulnerable to sexual attack. If, as I expect, the Minister will say something favourable to the principles of clause 2 for one narrow situation, I see nothing wrong with advancing the case of people who are at risk of suicide, whether they are suffering from acute breakdown or schizophrenia, as so eloquently described by my hon. Friend the Member for Tiverton and Honiton (Mrs. Browning). That is no more narrow a case than that of the women at risk. If the Government accept that something should be done for one group, they should accept that something should be done for the other.
§ Mr. Dismore
That does not answer my point. We must consider mental health services as a whole. The hon. Gentleman makes a valid point that there is a series 1305 of different issues. My answer is that the way to address them is not through legislation in the form of his Bill, but by the approach adopted in my local area.
The joint mental health strategy for Barnet report, which was prepared in October 1997, sets out the current position. The report was prepared jointly by the London borough of Barnet and Barnet health authority, adopting the partnership approach to the health service.
Through the partnership approach, we can begin to address not only the issues highlighted by the Bill, but the more general issues affecting mental health, and take the debate forward. The report illustrates the work that the Government are doing through the health authority and the Labour-controlled London borough of Barnet working in partnership.
We have set up a mental health strategy steering group, with task group strategies examining various aspects. That involves representatives of the major stakeholders in the area. There has been full participation by the voluntary sector, the community health council and, most important, people who use the mental health services. Eight implementation task groups have been set up, commissioned through the mental health strategy steering group, to work towards implementing the strategy.
That cross-agency membership involving the users has produced some successful ideas to take the provision of mental health services in my constituency further forward. I am pleased to say that the group has also identified weaknesses in the structure, and is considering how we can reconfigure around those weaknesses. The partnership approach, which is what is happening in my area and also in the general thrust of the White Paper published earlier in the week, is the way forward. I shall give some examples.
Let us examine out-patient provision through community mental health teams for the under-65s. We are setting up locally based multi-disciplinary teams which are being implemented progressively. They are operating 24 hours a day, 365 days a year, and are working closely with GPs and their teams to improve services across the borough.
Boundary issues will need to be resolved, but the White Paper on the overall health strategy will get to grips with what has been one of the main problems in the health service over the years—the peculiar boundaries that do not reflect people's needs or where people live. I may say a word or two about Edgware hospital in that context. Had there been a proper configuration of health service boundaries, some of the problems brought about by the previous Government might not have occurred.
The facility for the community mental health teams for the under-65s based in the west of the borough has been agreed, and is to be sited within the area of the Edgware community hospital. It is a new facility that we are creating out of the wreckage left us by the previous Government. The time scale for the permanent site is being determined as part of the Edgware hospital review, which we promised and which we have delivered, to sort out what community facilities we can now provide on that site.
1306 The strategy for the under-65s out-patient treatment has been agreed, and will work with the provision of GP link workers. That will enable communication between primary and secondary care. It will not act as a referral pathway for GPs, but it will provide a necessary service.
Another aspect of out-patient care covers the over-65s and the development of community health teams for them. Before the election and shortly afterwards, very little planning work had been carried out.
§ Mr. Spring
On the question of mental health facilities, is there a psychiatric ward at Edgware hospital? I should be very interested to know the answer to that question.
§ Mr. Dismore
I am coming to the provision of psychiatric facilities; it is a couple of pages further on. All will be revealed in time.
§ Mr. Bercow
I am especially pleased to listen to the hon. Gentleman's speech, because my mother is one of his constituents—although, sadly for him, not one of his supporters. In view of the importance of the findings of the Mental Health Act commissioners, following their visit to facilities in psychiatric units in November 1996, would the hon. Gentleman care to remind the House exactly what those findings were? Does he believe that they are valid, and might they cause him to support the Bill?
§ Mr. Dismore
I thank the hon. Gentleman for contributing" and for doing so at such length. I am pleased that his mother is one of my constituents. I hope that, by the end of my speech, I might have persuaded her to my way of thinking, and might have her vote at the next election. I shall come in a moment or two to the issue of in-patient treatment in the area, but I now return to what I was saying before I was interrupted.
I was talking about the community mental health teams for the over-65s, and saying that, before the election and, indeed, shortly afterwards, very little planning work had been done. However, I am pleased that a great deal more has been achieved in the past few months. The multi-disciplinary planning group meets regularly in that context. We are looking at one of the models based on local facilities and expect that the community-focused CMHT will be sited with other aspects of mental health care—in-patient care, day hospital services and others—on the Finchley Memorial hospital site.
I deal now with in-patient services, and I was glad to receive a prompt in this connection. There has been a substantial and vigorous debate in the local community about how and where such facilities should be provided. One particular issue was whether they should be concentrated on one site at Edgware community hospital or whether there should be provision both at Edgware, in the west of Barnet, with a spread of facilities in the east of the borough.
As I have said, there has been a vigorous debate within the local community. I am pleased to say that it has resulted in a sensible suggestion by the local health authority, which originally wanted to concentrate facilities at Edgware community hospital, in the west of the borough. It has now decided to ensure that we have provision on both sides of the borough. There will be facilities at Barnet hospital for those who need services from the east of the borough.
1307 The facilities that are being developed at Edgware community hospital will be second to none. This provision meets some of the points that stem from the second part of the Bill. At Edgware community hospital and at the rebuilt psychiatric unit at Barnet, on the Barnet general hospital site, patients will not have to worry about the issues which have been raised through the Bill. In the main, they will have individual rooms. There will be women-only areas. The design of the facilities will ensure that that happens.
There will be gardens that will reflect the multicultural nature of the Barnet community. That is the way forward. There are arguments about whether there is enough space left at Edgware community hospital to provide what is needed in the open area, but these are matters of detail that we are working through in the Edgware community hospital review process.
§ Dr. Julian Lewis
I know of a specific case involving someone who suffered an acute mental breakdown in recent times in the area covered by the acute psychiatric unit in Barnet. The person concerned was told by the general practitioner that, although a bed was available in the acute psychiatric unit at Barnet, she would not advise him to take it up, because he would be surrounded there by seriously disturbed people. It is that very case that first interested me in this issue.
§ Mr. Dismore
I thank the hon. Gentleman for that intervention. That is precisely why, in my area, we are reviewing facilities with a view to improving them. Day hospital services are being investigated so as to achieve the most effective way of meeting the needs of people with acute mental health problems who might otherwise need in-patient care, but who do not need the long-term support of day services. These are of a drop-in, therapeutic, community or employment-focused variety.
The Barnet day services are comprehensive, and include, for example, a work scheme. It is important, as we know from the Government's welfare-to-work programme, that we do not write off people who are disabled, whether their disabilities are physical or mental. We must try to ensure that these people are integrated by being brought back into society. They should be enabled to fulfil their full potential. One of the main failings of the previous Government was that they wrote them off. They left them on the scrap heap on benefit.
We must try to find ways of helping disabled people, both physically and mentally, and the welfare-to-work strategy will achieve that. We are helping with that process in Barnet through the work scheme and the job search service, which is run on a partnership basis with the Richmond fellowship.
I return to my point: that the way forward in mental health services is through partnership and not by placing the entire burden, as the Bill would do, on local health authorities. That is not the way forward for the provision of mental health services.
I take up the point made by the hon. Member for Macclesfield and others about the problems posed by the old Victorian hospitals. An issue that has been troubling those concerned in my constituency for some time is the re-provision from the Napsbury hospital, which is scheduled to close. Napsbury is an example of the large Victorian institutions. The facilities there are provided in 1308 huge wards. That is not the way to go into the next century caring for people who are especially in need of long-stay residential care. The assessment, planning, re-provision and support of people at Napsbury is much to the fore within the thinking of the health authority.
There was a real problem earlier in the year, before the election, when transfers began of people from Napsbury hospital to the alternative facility at Elmstead nursing home. The transfers were handled extremely badly when the previous Government were in office. Eight elderly people died because the transfer was extremely badly handled by the health authority and other agencies working under the previous Government.
It might be helpful if I lay before the House some of the conclusions of the very full review that was undertaken as a result of that very serious tragedy. We have to learn from the review, which concluded:The responsibility for ensuring the safe transfer of frail, elderly patients suffering from dementia … remains sharedbetween the health authority, the local health care trust and the private provider of the nursing home—again, the partnership approach. That is the way forward.
The report accepted that the patients who died were elderly, extremely frail and had severe dementia, and that their transferdid not adequately take into account all the risks associated with transfer.Although there was no evidence of malpractice at the home, there were serious shortcomings. The report says:The planning, implementation and monitoring of the transfer was not carried out to the level of detail necessary to protect individual frail, elderly patients suffering with dementia.The planning of primary care provision was not sufficiently addressed.Insufficient consideration was given to the specific risks involved in this transfer and how these could be reduced or managed.Inadequate time was given for new staff to become familiar with the frail, elderly patients who would be transferring from Napsbury … to Elmstead … and with their individual needs and care plans.
§ Mrs. Browning
I should be grateful if the hon. Gentleman would clarify something. Is he saying that he believes that the elderly frail are also mentally ill?
§ Mr. Dismore
I am referring to the elderly frail who are suffering from severe dementia, and who require mental health support. I said that. The detailed report, which I am sure the hon. Lady would like to read when she has time, gives examples of the problems.
I do not want to be accused of taking up too much time in the debate, because many of my hon. Friends wish to speak, and I want to ensure that they have time to say what they wish to say.
The review also concluded that theappointment of the GP to provide primary care service on 1 April 1997"—only a week or two before the transfer—gave insufficient time to allowthe GP service to be adequately involved in the planning process.Communications across the organisations did not fully address individual responsibilities, programming, monitoring of progress and decision making.1309Communications between clinicians was inadequate.The decision to alter at short notice the planned transfer timetable to Elmstead House was insupportable.The knowledge of the general risk of mortality following transfer had not been adequately disseminated to those involved in the resettlement of patients from Napsbury Hospital";and—this is where central Government have a role to play—There was a need for detailed central guidance from the Department of Health on the resettlement of patients from long stay settings.I am pleased to say that, when this extremely critical report was published, my hon. Friend the Parliamentary Under-Secretary agreed to meet me the day after. I had a very full and long discussion with him about the conclusions—
§ Mr. Dismore
The hon. Gentleman asks from a sedentary position whether I got a word in edgeways—[HON. MEMBERS: "Did he get a word in edgeways?"] Well, I certainly did a lot of talking at that meeting, because I wanted to get home to the Minister the seriousness with which my constituents view the tragedy that happened in the local community.
§ Dr. Julian Lewis
I thank the hon. Gentleman for his considerable courtesy in giving way yet again. Could the fact that the Minister has now left the Chamber have something to do with his experience in that earlier meeting with the hon. Gentleman?
§ Mr. Dismore
The hon. Gentleman makes an interesting point. I know that my hon. Friend the Minister has read the report and considered its recommendations extremely thoroughly, so, obviously, there is no need for him to hear me read them out again.
My hon. Friend the Minister was extremely concerned about what had happened. He expressed his view that there had beeninsupportable and unacceptable management failures. Decisions were taken in the course of the transfer that were driven by bureaucracy and the market rather than the requirements of patient care. The result was a completely inadequate response to the needs of elderly, frail people.In responding to the report on Elmstead nursing home, I am pleased to say that he gave the assurance:This new Labour Government is absolutely determined that lessons are learned across health and social services. We have already begun work on new guidance"—which, he promised me, will be published later in the year. The guidance will spell out safeguards for the transfer of elderly people from hospital—not only in my local area but nationally, for which the report called. I hope that he will be able to give me a progress report today on how far the guidance on national standards has developed.
We know from the experiences that we gained in that process the importance of ensuring that, yes, we consider closing down Victorian institutions, but that we do so in a properly co-ordinated way that recognises the need for national guidelines and continues to follow the partnership approach, which has been the theme of my speech.
Turning to other aspects of the re-provision from Napsbury, the Richmond Fellowship, in conjunction with Warden housing association and MIND, in partnership, 1310 working with the borough, successfully tendered for the provision of services for younger functionally mentally ill people resident in Barnet. The arrangement is that Warden housing association provides the accommodation, Richmond Fellowship provides the care services and MIND in Barnet provides the day services and other associated support, including advocacy. The scheme will be constructed from the start of the new year.
I return to the partnership approach, which is simply not recognised in the Bill. At the same time as the needs of the group of people who I have just identified have increased and the original service configuration has had to be re-examined, it is now agreed that very few of the group will be able to cope in any independent living arrangements. That is why such services are so important.
§ Mr. Nicholas Winterton
Will the hon. Gentleman comment on the views expressed a few years ago by Mrs. Major—not the wife of the previous Prime Minister—of the National Schizophrenia Fellowship? She said:As a magistrate, I am distressed to have to send somebody to prison from time to time because there is no secure accommodation elsewhere.Such situations persist today. In talking about partnership, how would the hon. Gentleman respond?
§ Mr. Dismore
There is more than the one remedy of locking people up in psychiatric institutions. In fact, I was about to make a point on the way in which we are looking at the problem of mentally disordered offenders in my health authority area.
Since the beginning of this year, we have had a fully functioning mentally disordered offenders team. Its operational policies have been accepted by all agencies. As is to be expected, the team is frequently expected to interpret guidelines in respect of referrals and so forth, because we still have the boundary problem which I identified earlier and which I am sure this week's White Paper will address in due course.
The team for mentally disordered offenders has an ambitious programme of development, including a new court diversion service, improved liaison and communications structures, and the development of effective performance indicators and evaluation methods. It is expected that those will include self-reports by service users.
I am pleased to say that the team is working on a partnership basis with the police and the local probation service. It is located with the probation service and is working closely with the police as a consequence. That is the way forward—or one of them—in dealing with the problem which the hon. Member for Macclesfield identified. I shall return to what I was saying about Napsbury re-provision, having diverted myself to answer the hon. Gentleman's intervention.
The MIND development at Bunns Lane in the west of the borough—the part in my constituency—has been agreed, and the service will, to a large extent, complement that provided in Finchley. That represents a net gain in day services for the borough, as well as providing support for people resettled from Napsbury. It will result in a more balanced day service across the borough for those who need drop-in support, as the number of places commissioned—50—will not be fully taken up by the 1311 resettled population. The development is due to open in October 1998, in new buildings that will be purpose-built. That takes us back to the Government's investment in mental health services. We must get rid of Victorian institutions, and provide the best possible buildings, as well as the best possible services, to ensure that people are looked after properly.
Communication is also important. As I said earlier, Members of Parliament and those outside need to bring home the problems of mental illness, and to try to improve public knowledge and understanding. We need to break down the hostility and fear. We are working hard locally to do that. At an early stage, the group recognised the need for a comprehensive and accessible guide to mental health services in Barnet, and subsequently supported a joint finance bid to enable MIND in Barnet to carry out research and publish such a guide.
I am pleased to say that the bid was successful: a guide was published recently, and has been praised as a clear and reasonable document making clear what facilities are available. That is a far more constructive approach than the Bill's narrow focusing on a small part of the whole. A further joint finance bid has been submitted for the employment of a short-term communications officer, whose post will be managed by the local trust. I hope that my hon. Friend the Minister will be able to give us some encouragement about that bid.
The trust is employing a training development manager to work in the context of the joint mental health strategy. A commissioning programme has been set up; trainees join the commission when that is appropriate and practical, and there is potential for inter-agency cross-fertilisation in the course of seminars.
Three areas have been highlighted for next year: team development for community mental health trusts, working with people with dual diagnosis—the need for a co-ordinated approach to the problem of alcohol and drug addiction in conjunction with mental illness, which an Opposition Member mentioned—and the mental health needs of members of Barnet's Jewish community and ethnic minorities. It is important that we recognise the special needs of certain groups.
§ Dr. Whitehead
Are the examples of good practice that my hon. Friend has given being disseminated on more widely? Are other health authorities taking stock of what is being done in his constituency, and will they be taking some of those ideas up?
§ Mr. Dismore
That is an important theme in the White Paper, which was also highlighted by my right hon. Friend the Secretary of State for Health when he presented the White Paper, and in subsequent press coverage. It is important for examples of good practice to be spread throughout the health service. I hope that, as the White Paper's policies develop, the examples that I have given will be disseminated more widely. The training programme in my local health authority involves a partnership approach, and a recognition of special needs in the community.
I am grateful to the hon. Member for New Forest, East for giving me the opportunity to raise the issues that I have raised, and to explain what the new Labour Government are doing, certainly in my area. I am glad to have been able to flag up the problems that can arise, and 1312 to tell the House how our Government are addressing them, vigorously, by producing new guidelines. I think that the partnership approach adopted by the Government, and a rounder view of mental health, represent the way forward; but they are not the way forward suggested in the Bill.
§ 1.3 pm
§ Mr. Patrick Nicholls (Teignbridge)
We have been treated to a tour d'horizon longer than the introductory speech of my hon. Friend the Member for New Forest, East (Dr. Lewis). The kindest thing I can say—I say it as one solicitor to another—is to remind the hon. Member for Hendon (Mr. Dismore) that Dr. Johnson said on a similar occasion that he would not speak ill of any man but he believed the gentleman was an attorney.
I shall curtail my remarks as much as I can to give the Minister the opportunity to say either that this Bill, like any private Member's Bill or any Government Bill, is not perfect but that it should go to Standing Committee to be improved, or to give Labour Members the opportunity to talk it out, which appears to be their intention.
Less contentiously, I echo Government and Opposition Members in complimenting my hon. Friend the Member for New Forest, East on the way in which he introduced the Bill. Introducing a Bill, whether as a Minister or private Member, is daunting. Those of us with experience of government, who have had help in assembling the material necessary for these occasions, can only marvel at what it must be like to do so without such assistance. The manner and style of his performance were remarkable.
One thing that has come across from the debate is that the people who get the worst deal as regards mental health treatment are often those whose background or propensities would give them no cause to think that they could ever get into such circumstances. Several instances have been cited of how the ordinary man in the street—the Minister or myself—could undergo an event so shattering that, perhaps for the first and only time in our lives, we need assistance.
The devastating effect that redundancy or job loss can have has already rightly been mentioned. I did matrimonial law almost exclusively when I was in private practice. Seeing the devastation that matrimonial breakdown can wreak on people who one would have thought were absolutely stable and capable of taking it makes one realise that we must ensure that such people, and everyone who needs the system, get appropriate treatment. The tragedy is that some 20 per cent. of those who suffer from acute reactive depression—I think that is the correct expression—take their own lives. The cruellest thing of all is that the statistics also show that such people, if they receive the right help, have the best prognosis.
Incredibly, one criticism of the Bill was that it is not ambitious enough. It is extraordinary for a legislature to say that, unless we can cure all the ills to which society is heir, we must not make any attempt at all. The point is at best naive and at worst bogus. If my hon. Friend the Member for New Forest, East had brought in a more ambitious Bill, he would have been criticised for trying to do things inappropriate for a private Member's Bill. We would have been told that it was far too difficult for a private Member to embark on such a radical piece of legislation, and that, if only he had come up with just one 1313 or two ideas that were capable of being handled, things would have been different. We can treat that idea with the contempt that it deserves.
We have already heard several times about the Bill's contents, so I shall be brief. The purpose of clause 1—the idea that a health authority should have a strategy and be required to report on it to the Secretary of State—strikes me as unexceptionable. The fact that the best may do it already is no argument for objecting to the requirement appearing in the Bill.
However, I freely concede that if, in due course, the House takes the view that that argument is not sustainable, the answer is simple: we either amend the provision in an acceptable way in Committee or delete it. It is the skill of my hon. Friend's Bill, as he said in a phrase that I felt I recognised, that the Bill enables the Government to dine a la carte. They can take the bits that they want and discard the ones that they do not want. Without making free with my hon. Friend's Bill, I think that it is possible to remove clause 1 and still have something eminently worth while.
I make it plain for the record that the Opposition believe that the Bill should be accepted and go into Committee, where it can be improved, as can any Bill. It is inconceivable that anyone could seriously argue that clauses 2 and 3 should not pass into law. The idea that there should be single-sex ward areas—not wards but areas—in all existing psychiatric units has to be right. The idea that there should be security devices to prevent unauthorised intrusion also strikes me as entirely right. To refer to the speech of the hon. Member for Warrington, North (Helen Jones), I find incredible the idea that, because one favours less hospitalisation, women should not be entitled to the protection that they need from indecent assault and rape in those hospitals that have to exist.
Some two weeks ago, of the 101 female Labour Members of Parliament—I compliment the Labour party on having so many female Members—92 turned up to vote against the Wild Mammals (Hunting with Dogs) Bill, yet today, of the tiny number of female Labour Members who have come to the House, none can bring herself enthusiastically to stand by her sisters and say that the two anti-rape provisions in the Bill deserve to be passed into the law of the country. I find that shameful.
§ Mr. Boateng
There is a touch of nauseating hypocrisy about the hon. Gentleman's approach. If the Bill is such as to commend itself with such obvious force and vehemence to Her Majesty's Opposition, why did they not introduce a similar measure when they were in government?
§ Mr. Nicholls
One always knows when the hon. Gentleman is on a losing wicket, because he leaves behind his usual genial persona. As brick walls go, one has never seen better. Outside the House and sometimes inside the House, he is most genial. But it is my experience that when he knows that he has no case, he resorts to gratuitous abuse. Let me remind him of the point that has clearly escaped him so far. He is now in government.
I will tell the House in a moment the steps that the previous Conservative Administration took, of which Conservatives can rightly be proud. For the time being, 1314 the hon. Gentleman should accept that he is now in government. He has the good grace to smile. What he should be doing, in ways that I shall explain in a moment, is building on the good steps that the previous Administration took.
My hon. Friend the Member for New Forest, East indicated the level of support that he had received. He has received the support of a consultant psychiatrist, Dr. Harris, the sub-dean of the Royal College of Psychiatrists. He referred to two other distinguished psychiatrists, Dr. Yonace and Dr. Tannock. Organisations up and down the land have said that they support the legislation.
It is worth quoting MIND. I do so not just because its views, of all views, ought to be taken seriously, but to make the point, as my hon. Friend was fair enough to do, that the organisation does not support every provision in the Bill. It says of the proposals in clauses 2 and 3:Mind's Stress on Women campaign which ran between 1992 and 1994 heard from women all over the country that they did not feel safe in services. Some talked of constant fear. Others chose not to use services because of the abuse that they, or women they knew, had experienced.MIND gives two examples. A woman who wishes to remain anonymous—one can see why—said:I and a number of other women I know have had very bad experiences on mixed wards. A friend of mine was raped and I was harassed to death by men and the staff never intervened … The situation in the hospital was so awful I'd never go back there—you can't be ill in peace.Another woman, whom MIND called "Carol"was raped while in a psychiatric hospital. The man had simply walked through the adjoining mixed ward into Carol's unattended dormitory and into her cubicle.The Mental Health Act commissioners' national visit in 1996 has already been referred to, so I will not go into it at great length. It found thatsexual harassment of female patients in psychiatric hospitals is rife. In just over half the wards visited it was discovered that women patients were being harassed by male patients. Problems includedindecent exposure,physical assaults and verbal harassment.As the seventh biennial report of the Mental Health Act Commission identified:Safety for women on psychiatric wards is a major issue.During the course of its visit it found thatjust over … (35 per cent.) of women have access to women-only sleeping areas … a quarter (27 per cent.) have to pass male parts of the ward to reach women-only toilets, baths or showers … a third (32 per cent.) have access only to mixed sex toilets, bath or shower facilities. A small number (3 per cent.) use sleeping areas also used by men.As a result of those findings, in January 1997—the date will be significant because it was before the election—the NHS chief executive, Alan Langlands, set health authorities in England the objective of providing safe facilities for mentally ill patients in hospital that preserved their privacy and dignity. As I understand it—doubtless the Minister will say something about it in due course—the report that he produced in August 1997 showed that that objective had been met by less than half the health authorities—some 43 per cent.
The answer to the Minister's intervention about what the previous Government did is that we drew attention to the problems in the patients charter. It was that charter 1315 that told the public out there, not those of us who know about such things because of our particular interests, what was going on. It was drawn up in January 1995 and the progress made since then has meant that the agenda has been taken forward to protect some of the most frail and vulnerable women in society. The idea that we did nothing is absolutely wrong. Today, we are entitled to tell the Minister that the previous Government followed a creditable agenda, and we are asking him to build on it.
It would be accepted by those hon. Members who have heard me before that I never indulge unnecessarily in party political exchanges—[Interruption.] That only goes to show that not everyone knows me. I did not expect or intend to point out the track record of the previous Conservative Government. On matters such as this the public expect us to be able to debate without bringing in such political points. I was provoked into referring to our record by the Minister, who felt, unwisely, that he should draw attention to it. Our record was wholly creditable and the Bill presented by my hon. Friend the Member for New Forest, East modestly invites the Government to draw upon it.
Before I was provoked by the Minister, I mentioned the organisations that support the purposes of the Bill. As has already been said, SANE supports it, as does the National Schizophrenia Fellowship, which has stated that itagrees with the principle of providing security within psychiatric units but would again encourage active consultation with those using the facility … to ensure a therapeutic environment which might be lessened by over-zealous security measures.As I have said, SANE welcomes the Bill in similar terms and the British Medical Association generally supports it.
MIND has its reservations about clause 1. Yesterday, I had a long session with Margaret Pedler, the policy director of MIND, and I am extremely grateful to her for the time that she spent talking me through the implications of the Bill. She believes that the drawback with clause 1 is that it might have the effect in due course of distracting attention from other people—if I may use shorthand, less fashionable people—who might need to be cared for. She is concerned that the clause might be interpreted in such a way that resources are taken from one group of patients and concentrated on another.
If I thought that that was likely to happen, I would agree with Margaret Pedler's fears about the clause posing a great risk, but I do not believe that that would be a consequence of it, as drafted. I have discussed it with my hon. Friend the Member for New Forest, East, and it is not his intention that the clause should be seen to operate in that way. If Labour Members are seriously concerned that the problem identified by Margaret Pedler might arise, let them discuss it in Standing Committee. They could get rid of that clause if they wanted, because it is not essential to the Bill.
As for the contributions from Labour Members, I will not go through the litany of shame because I am sure that the press will be capable of doing so, but I was saddened when I listened to the hon. Member for Brentford and Isleworth (Ann Keen), who used to be a nurse. In the past, she has been able to say what she does when asked by someone at the bus stop and—unlike the hon. Member for Hendon (Mr. Dismore) and me—get a reasonable hearing. When I said to her that, whatever her other reservations, surely as a nurse she would want at least the sexual harassment provision to go forward, she replied, "I will deal with that later in my speech." I listened carefully to her speech, but she did not do so.
1316 We are all busy on Fridays. No hon. Member should be criticised for not showing up for a Friday debate. However, when a Member does turn up and when the Whips say, "We don't want the Minister to have to talk out the Bill: we want you to earn your spurs by doing it for him," that Member puts himself on record. I would not want to be a former nurse who had played a part in talking out this Bill—although perhaps that will not be what happens to it.
I was minded to speak for longer, but I shall not do so. The Minister and I have been in politics long enough to know that gratuitous abuse across the Dispatch Box will not deal with the concerns of people who back the Bill. He should remember that the person who has most helped my hon. Friend the Member for New Forest, East in framing the provisions is a long-standing member of the Labour party. That should be sufficient to make him realise that his response should not be to indulge in the sort of language and tactics he tried a few moments ago. There is a time for that sort of behaviour, but not on this sort of Bill.
The issues are as plain as they could possibly be—this Bill would protect some of the most frail and vulnerable people in society. It does not involve massive expenditure. Labour Members presumably feel that expenditure is all right sometimes, but they actually draw the line at putting locks on areas in wards to make sure that people cannot be raped and abused.
This is a modest Bill with modest proposals, which could go forward to Committee. If, ultimately, the Government were not satisfied in Committee, they could kill the Bill. We want to hear from the Minister today that either he will let the Bill go to Standing Committee, while reserving the right to kill it off in due course, or he will come up today with specific measures to implement clauses 2 and 3. If he does not do that, it will be a disgrace.
§ Dr. Alan Whitehead (Southampton, Test)
Thank you, Mr. Deputy Speaker, for allowing me to take part in this debate. I congratulate the hon. Member for New Forest, East (Dr. Lewis) on bringing the subject to the House for debate. I agree with the hon. Member for Macclesfield (Mr. Winterton) that it is almost forgotten in parliamentary debate and, indeed, in public debate.
Whatever we may think about the detail of the Bill, this is an invaluable opportunity to talk about the various issues surrounding mental illness and how we have historically provided and currently provide for people who are mentally ill—those who deserve our support either in recovering or through their illness. This debate is worth while in its own right, whether or not the Bill proceeds.
At first sight, the Bill is tantalisingly laudable. It enshrines a number of principles and aspirations which no one in the Chamber would seriously dispute. The difficulty to which Labour Members have drawn attention is not the principle of how to provide for the treatment and recovery of those suffering from mental illness, but whether the Bill makes a good job of doing that.
In my short time as a Member of Parliament, my approach to legislation has been to consider whether a measure improves what was there before; whether it is possible to achieve the aims of the legislation by other means, because we do not want to overburden those who 1317 provide services in this country with new legislation every other day; and, finally, whether—however well-intentioned the legislation—the net consequence of what is to be enacted will cause side effects that will eventually do more harm than the good that was intended. My view of this Bill is that it falls foul of at least two of those criteria. That is I why I am unable to support the Second Reading. Although its underlying principles may be laudable, I cannot support it in detail; I cannot support what the Bill would end up as, or the consequences that would arise were it to be enacted.
I shall make a case for my stance by looking at where we have come from and where we now stand in respect of the provision of services for people with mental illness. We have heard a lot this morning about the so-called water-tower mental hospitals. That phrase entered public parlance in 1959, when Enoch Powell MP, making a speech to the National Association for Mental Health, described the Victorian-style asylums asisolated, majestic, imperious, brooded over by the gigantic water-tower and chimney combined, rising unmistakable and daunting out of the countryside—the asylums which our forefathers built with such immense solidity.As one who, at an earlier stage of his life, spent a long time advising health authorities and other agencies on how to provide and reprovide work rehabilitation, both within long-stay mental hospitals and in the community, when those hospitals had closed down, I can vouch for the accuracy of Enoch Powell's description. I have visited long-stay hospitals throughout the country and can tell the House that, when visiting one for the first time, if someone has been given confusing directions, they can soon orientate themselves by scanning the countryside looking for the water tower. By so doing, they find their way to the hospital, and also see the relative isolation it suffers from the rest of the town.
I want to correct one misconception, voiced by hon. Members on both sides of the House, about the background to those long-stay hospitals. It is relevant to our debate because, interestingly enough, the purpose of our Victorian forefathers in building those asylums was to provide the sanctuary described by the hon. Member for New Forest, East. Some of the foremost social reformers of the day were behind the move to build what we now call the water-tower hospitals. They did so because of the appalling conditions of treatment for people with mental illness that existed before those hospitals were built.
Those of us with an historical bent will know the history of the original Bedlam and what certain members of the upper classes regarded as the sport of going to Bedlam at the weekend to look at the lunatics raving there. The idea motivating the reformers of the Victorian age was that that was not the way in which we should treat people in a civilised society. They therefore developed hospitals in leafy surroundings and with clean air and nice grounds—indeed, several had hospital farms. They provided a secure environment—a therapeutic environment, I dare say—and sanctuary for those who, the reformers realised, needed such treatment in order to recover from their illnesses.
Sadly, that movement effectively came to an end toward the end of the Victorian era, and a substantial change in attitude came over the people who were subsequently responsible for provision. They regarded 1318 those hospitals not as sanctuaries, but as places of containment. They believed that those people should be placed away from society's view, away from towns; that they should be shuffled away into those hospitals, which became not sanctuaries, but prisons for very many people.
The hon. Member for Macclesfield (Mr. Winterton) said succinctly that many people who had committed no other crime than to be slightly on the wrong end of what society believed to be the right thing to do found themselves incarcerated in long-stay mental hospitals as a result of having a baby out of wedlock or acting oddly in a public place. Eventually, they became institutionalised.
The main criticism to be made of those facilities as they were envisaged in Edwardian times and at other times early in the 20th century is that, by placing a person in such an institution, one often condemned them to life imprisonment because they found it impossible to get out of the system once they were in it. To a large extent, people became institutionalised after 20, 30 or 40 years in such an institution and were incapable of making a new life in the outside world if they were discharged—which often they were not.
The change came with the discovery and introduction of psychotropic drugs in the 1960s. It became possible to use medication and newly developed rehabilitative facilities to rehabilitate many people who had been placed in a back ward, away from public view. Some of the Victorian pioneers' original ideas concerning sanctuary were reintroduced. In a secure environment, work rehabilitation facilities, occupational therapy, community farms and art therapy were developed, with a view to re-establishing long-stay patients in the community.
The origin of the change in thinking about the reprovision of facilities in the community was the move to close the long-stay asylums—the water-tower hospitals. It was thought that people should not be incarcerated, that even people who had been in a mental hospital for a long time had a future, like anyone else, and that that future should be in society if possible.
I shall quote briefly the words of a consultant psychiatrist at the then Herrison hospital in Dorchester, who rejoices in the name of Dr. Donald Dick. He gives an apt description of the thinking behind such reprovision.
§ Mr. Spring
This is a fascinating insight into the history of mental institutions and the development of drugs. However, I suggest that the hon. Gentleman now focuses on the serious issues of current importance in the Bill, affecting the security of women patients especially, and that he addresses clause 2. If he does not, he will demean the whole process of our serious consideration of mental health in this country.
§ Dr. Whitehead
I thank the hon. Gentleman for his suggestion. However, in order to comment seriously on the issues that we are discussing, it is necessary to lay the groundwork so that people can understand what lies o behind them. The hon. Gentleman mentioned security for women in hospital. That relates to the whole history of people being locked up in psychiatric institutions, as I have described.
§ Dr. Whitehead
If hon. Members will stop intervening, I shall explain. However, I will give way to the hon. Gentleman.
§ Dr. Lewis
I thank the hon. Gentleman for giving way, albeit reluctantly. I do not see how the history of people being locked up in establishments has anything to do with the proposal that people who go into establishments, usually voluntarily, should be able to lock out people who intend to attack them.
§ Dr. Whitehead
I am happy to explain my views. I would have come to clause 2 later, but I will explain my views now. Important points have been raised. I share the hon. Gentleman's view that, if people are taken out of the community, either voluntarily or involuntarily—as the hon. Gentleman says, it is voluntarily in most cases—they must have a strong expectation that they are going to an environment that is safe and "therapeutic", as the Bill says—[Interruption.] The hon. Gentleman is not listening to my reply.
My comments on clause 2 relate to the history of people's incarceration in long-stay mental hospitals. I accept that the clause is honourably framed and well intentioned, and is intended to deal with an issue that has been raised in the debate. I ask hon. Members, however, to look at the detailed wording of the clause.
§ Mr. Nicholls
If the hon. Gentleman is concerned only about the detailed wording, I can give him some assurance. The matter can be dealt with in Committee. The public will want to know whether the hon. Gentleman is or is not in favour of women being protected from indecent assault and rape by proper security devices being placed on doors. Even the hon. Gentleman should be able to get his mind around that prospect in the time available.
§ Dr. Whitehead
I regret the aggressive tone of that intervention. The answer to the question is, of course, yes—there's a surprise. It is facile to assume that, because I agree that women should be safe in the hospitals to which they have been committed, either voluntarily or involuntarily, I have nothing further to say on the subject. The care, including treatment and rehabilitation, of people who suffer from mental illness is complex nowadays.
Proposed section 142B(b) refers tothe fitting of appropriate security devices to all room and ward doors in all existing psychiatric units to prevent unauthorised intrusion.That wording is unambiguous. By law, health authorities will have to fit such devices in all institutions where people who suffer from mental illness are being looked after.
I speak now from direct experience of looking at the way in which people lived in long-stay mental hospitals in the late 1970s and early 1980s. I looked at their daily lives, at what hope they had of resettlement in the community and at what facilities they enjoyed, whether work rehabilitation, occupational therapy or other activities. A balance must be struck—I understand that it is a complex and difficult issue—between security and ensuring that people in those institutions feel that they are in a genuinely therapeutic environment and will benefit from their stay. That issue has properly been raised today.
1320 The reason why I answered yes to the question put by the hon. Member for Teignbridge (Mr. Nicholls) is that of course I believe that security is important for women in long-stay mental hospitals, just as it is for everyone else. [Interruption.] The hon. Gentleman asked me a question, but I am afraid that he does not want to listen to my reasoned answer.
My concern—I hope that Opposition Members will accept it—arises from my knowledge and understanding of such environments: it is important to ensure that people within hospital grounds have the maximum opportunity to feel as free as possible within the hospital environment.
§ Dr. Julian Lewis
If the hon. Gentleman went to stay in a five-star hotel, there would be a lock on the bedroom door, which he could open from the inside but which no unauthorised person could open from the outside. That would not add to a sense of oppression or over-security. If the hon. Gentleman thinks that it would, I suggest that he take the lock off the front door of his home. I am sure that he has no intention of doing so.
§ Dr. Whitehead
The hon. Gentleman misunderstands the clause, which refers tothe fitting of appropriate security devices to all room and ward doors"—not just to bedroom doors. That requires local health authorities to fit a lock on every single door in long-stay mental institutions.
§ Dr. Whitehead
With respect, the clause says that appropriate security devices should be fittedto all room and ward doors".The hon. Gentleman will agree, because this is his Bill, that every single room and ward door must have an appropriate security device, which means, unless my command of English is seriously amiss, some form of lock or method of securing the door.
The result is that in areas of long-stay mental health hospitals where people undertake precisely the sort of therapeutic activity that the Bill advocates, the doors will have locks. In my extensive visits to many mental hospitals, the only place where I have seen that regime carried out is Rampton.
§ Mr. Nicholls
The hon. Gentleman puts himself at odds with every mental health organisation, so he needs to know what he is doing. If we are to take him at face value as a genuine and sincere person who is trying to ensure that good legislation gets on the statute book, why does he not tell the Minister that he wants the Bill to go to Standing Committee so that the wording can be considered?
§ Dr. Whitehead
My hon. Friend the Minister has already asked the NHS executive estates agency to issue advice, which I believe it has, on the security and design of psychiatric units. That advice concerns locking bedroom doors and safeguarding personal property, en suite toilet facilities and observation arrangements. The advice that has been issued does precisely what I have 1321 suggested: it ensures that areas of long-stay psychiatric hospitals that require proper security, for the reasons that have been expressed in the debate, are given that security.
I am attempting to distinguish between the blanket provision contained in the Bill—it is not easily amendable because it is at the heart of the principle of the Bill—
§ Dr. Whitehead
I recall, Mr. Deputy Speaker, hearing the hon. Member for Teignbridge state that party animus or personal unpleasantness rarely enter such debates. I am sorry that that has occurred only a few minutes after he made that remark. It reflects poorly on how I understood the debate should be conducted and on how the hon. Gentleman said that it should be conducted.
I hope that the Opposition will carefully consider the wording, if the Bill proceeds. If we place a blanket requirement on a health authority to provide security everywhere, the health authority will be subject to legal action if, for any reason, it fails to do so. The side effect of ensuring such security could conceivably be immensely detrimental to the therapeutic environment that the health authority is attempting to provide.
My visits to numerous long-stay mental hospitals have taught me that the health authority and the hospital managers should be allowed some discretion to provide security in appropriate places, and to provide relative freedom and a therapeutic environment, also in appropriate places, subject to the security that the staff of the hospital can provide.
I accept that that is a difficult strategy, and that a careful interpretation of security is necessary. On various occasions in long-stay hospitals, I observed that tools were available in the therapeutic workshop. People who were severely mentally disturbed were encouraged to take on board the possibility that, if they were discharged, they might be able to go to work again—not necessarily waged work, but perhaps therapeutic work in the community.
While those people are in hospital, it is necessary for them to undertake such therapeutic work and to be trained to use a lathe, an adze or a hammer. However, if so many security devices are put in their way in, around, to and from the workshop that it bears no resemblance to anything that they might experience in the outside world, that will do little to promote the object of the exercise, which is to resettle people in the community, if that is possible.
The only place in which I saw provisions such as those that would be the logical outcome of the clause was in a high security mental hospital for the criminally insane, not in units that provide acute intervention and therapeutic recuperation prior to rehabilitation in the outside world. I hope that I have responded adequately to the question posed by Opposition Members.
1322 As a result of the changes in attitude to mental health in Britain that I have outlined, we embarked on the care in the community programme, whereby we have reduced the number of people in long-stay mental hospitals from a population of 150,000 in the early 1950s to the 32,000 beds currently provided—an enormous and welcome decrease.
I intervened in the speech of the hon. Member for Macclesfield (Mr. Winterton) in the context of the continued provision of places in such long-stay mental hospitals, because we must distinguish between people who in previous generations were incarcerated for no good reason, against their will, in contravention of their human rights and in contravention of everything that we now believe is right in mental health provision, and people who require a brief respite—brief sanctuary—and the possibility of rehabilitation and re-establishment in the community once that episode has passed. We need to distinguish between the core provision—the 32,000 places—and the numbers originally in long-stay hospitals.
What we do not need to do is ask health authorities to plan for a number of beds as if we were re-creating the old long-stay mental hospitals. I understand that the Government have already asked health authorities to plan a service that will ensure that acute beds are available and will deal properly with the range of problems that it faces. The range of problems has widened in recent years.
I have already mentioned a particular hospital consultant. I shall now quote what he said about work in the outside world and what problems he saw facing the people who had been long-stay patients in his psychiatric hospital:The patients that I see are not usually so bothered by the loss or lack of income that comes from unemployment as they are by other feelings. Shortage of money is a difficult enemy but at least it is visible and there are some choices to be made in the combat. The real pain comes from the sense of uselessness, of not contributing, of not being able to describe oneself as part of the common endeavour … Unemployment is a strong predisposing factor in attempted suicide, the modern epidemic. Fifty per cent. of men of working age who attempt suicide are unemployed. The number of men in the age range of 20–35 is rising, as is the incidence of alcohol and drug related disorders. Surveys of patients in psychiatric admission units during Health Advisory Service. visits in early 1983 showed that as few as 5 per cent. of patients of working age have a job. Absence of paid employment is therefore a frequent accompaniment of mental illness or psychological distress. It may not be the sole cause, but it certainly makes the situation and treatment much more difficult.As I said in an intervention, the care in the community policy was skewed by five years. While the old long-stay mental hospitals were being closed and before new provision was made in the community, many people were simply dumped in the community and left bereft of any services. That happened under the previous Government—whether or not it was their intention, it is what happened.
People who suffered the sense of uselessness and hopelessness to which the consultant referred find that they could not engage. All too often, they experienced what is known as the revolving door syndrome. They were readmitted to hospital because they could not cope. The facilities were not available, and they had to return to hospital, despite their best endeavours to stay out.
§ Mr. Simon Hughes
The hon. Gentleman and the hon. Member for Hendon (Mr. Dismore) have spoken for more than an hour in total. Is it the hon. Gentleman who wants the Bill to be talked out, or the Government?
§ Dr. Whitehead
This hon. Gentleman has made it clear that he does not agree with the Bill. I believe that I need to make a case for not agreeing with it, which I hope I have done in some detail.
§ Dr. Julian Lewis
I confirm that the hon. Gentleman has made his case in some detail. Like the hon. Member for Hendon (Mr. Dismore), he has spoken for longer than I did when I introduced the Bill. He has served his purpose, and his Whips will have noticed; his duty has been discharged, if not honourably. Why does he not now draw his remarks to a conclusion so that my hon. Friend the Member for West Suffolk (Mr. Spring) can make his speech and so that the Minister can talk out the Bill in person?
§ Dr. Whitehead
The reason why I wish to continue until the end of my speech is that it makes a coherent case. As far as I am aware, the House wishes to listen to coherent cases. If I sit down, halfway through making my case—
§ Dr. Whitehead
One does not have to be halfway through a speech to make half a case. I am attempting to make an entire case that is based on a coherent train of logic, during which I shall attempt to introduce various facts relating to it. Those two approaches are not necessarily conterminous in time.
The result of the community care policy introduced by the previous Government and the sad dissonance between the emptying of long-stay hospitals and the reprovision of facilities have meant that people suffering from mental illness, often severe, have suffered a severe diaspora. They are found in many different manifestations, not only in the old long-stay hospitals.
For example, it is estimated that about 60 per cent. of those who are long-term rootless have mental health problems, some of them severe. It is estimated that thousands of people who are suffering from severe mental health problems, or potential problems, are on remand for crime. They need not punishment for crimes, but support and treatment to allow them to live a life that they want to live that does not involve committing crimes.
It is estimated that about 40 per cent. of acute admissions involve people who have multiple problems relating to mental health. They have the problems that stem from having a severe and debilitating mental illness. At the same time, they are suffering from related problems associated with drugs and alcohol, which also need to be appreciated.
Against that background, we should say to health authorities, "We shall expect you to ensure that your services for people with mental health problems are the best that you can achieve. You should provide acute beds, rehabilitative services and support for people living in the community. Overwhelmingly, if you possibly can as a 1324 health authority, you should ensure that people are not admitted to hospitals in the first place so that they remain in and are supported in the community, and can return fully to the community when their particular episode of mental illness has passed." We should say all those things to health authorities.
We should also say to health authorities, "We shall ensure that you do all these things by allowing you to take seriously the complexity of the problem with which you are faced." There is the nub of the problem that is presented by the Bill. The Bill prescribes certain actions as a trump on all other actions so that the health authority has to do certain things, possibly to the detriment of other things.
Let us take, for example, people who are suffering from mental illness and a multitude of other problems. There is a need for new teams that can deal with multiple problems. We tend to have mental health teams that understand mental health and alcohol, and drug abuse teams that understand alcoholism and drug abuse. The idea of having teams that understand all those problems and the often complex actions that need to be taken to rehabilitate and return life chances to someone who has a multiplicity of problems is often not taken on board.
If the Bill were to be given a Second Reading—I return to the criteria that I mentioned when I first rose—the criteria that we have to bear in mind, one of the criterion is, or one of the criteria is—I am sorry. A criterion that we should be concerned about—one of the criteria is—[Interruption.] Conservative Members will make me continue for even longer.
§ Dr. Julian Lewis
I believe that, in a former life, the hon. Gentleman was a professor. May I take it for granted that he was not a professor of English grammar?
§ Dr. Whitehead
I cannot say that I was a professor in English grammar. Were I to be a professor of English grammar, I can assure the hon. Gentleman that I would continue in a much more tortuous way than I have.
One of the criteria that were at the heart of my checklist of how we should judge any legislation is whether there are any other unintended consequences of the proposed legislation that would outweigh the benefits.
My conclusion is that, first, there will be an unintended consequence in requiring health authorities to take action that they often know in their hearts will not be the best combination to deal with the very real issues that they face. Secondly, they will be required to implement a regime in their long-stay acute admission hospitals which they know is not conducive to the outcome that they wish to achieve.
That is why I oppose the Bill. I applaud its sentiments, but I am afraid that I cannot support it. I trust that Opposition Members will accept my sincerity in so doing, and that they will also trust my sincerity in my hope that the Government will take the difficult and complex action that is necessary to deal with the real issues that I have raised.
§ 2 pm
§ Mr. Richard Spring (West Suffolk)
I congratulate my hon. Friend the Member for New Forest, East (Dr. Lewis). Rarely has anybody introduced a debate about something 1325 of such importance with such clarity and sincerity. I know of the extraordinary amount of work that he has undertaken in consulting individuals and organisations to bring coherence to the Bill and to present it to the House this morning. I unreservedly support him, and congratulate him on what he has done.
I do not propose to speak for very long, because we are all anxious to hear the Minister's reaction to the Bill. I am pleased to say that, on many issues, there appears to have been something of a consensus across the Chamber today, although we had a rather wild walk in the woods from two hon. Members on the Government Benches. At one point I felt that, rather like in a 747, an oxygen mask might just appear in order to give the hon. Member for Hendon (Mr. Dismore) some sustenance, but that did not happen. From the hon. Member for Southampton, Test (Dr. Whitehead) we had an interesting long diversion into the history of psychiatric ailments and the incarceration of people in the past.
It is true that in the past 20 years there has been a huge change in people's understanding and perception of mental illness. I entirely welcome it. There is not a family in the land who has not directly or indirectly been impacted in different ways by mental illness. Anybody who has seen it at first hand, or, indeed, as a Member of Parliament, knows the anguish and agony that it can cause.
There is no doubt that there has been a rise in psychiatric disorders in the past generation—much of it appears to be stress-related—schizophrenia, phobias, anxieties, addictive ailments, chronic depression and compulsive eating disorders. Twenty years ago, nobody had ever heard of chronic bulimia—it was not even defined as a word. The whole point about the Bill is that, in essence, it is beginning to address the very different mental disorders that have arisen and that will undoubtedly continue to arise as the way of life changes in our country.
In providing separate therapeutic environments, the Bill addresses a real and sensitive need in the way in which people who, tragically, suffer from mental disabilities or mental illness can be treated in proper and appropriate surroundings. The Bill addresses widely different needs and widely different acute mental illnesses.
Although it is true that the Department of Health requires health authorities to prepare a strategy for the provision of a comprehensive range of mental health services, in practice we know that that does not happen adequately. The key area of in-patientcare facilities needs to be specifically addressed, and the Bill does precisely that.
I pay tribute to Suffolk Health and Mid Anglia community health trust, with which I have worked on mental health issues since becoming a Member of Parliament. I have frequently visited ward G8 of West Suffolk hospital in Bury St. Edmunds, in the constituency of my hon. Friend the Member for Bury St. Edmunds (Mr. Ruffley), to see for myself the conditions there and discuss with psychiatrists mental illness and the treatment of those who tragically suffer from it. I have often brought such issues to the attention of the House.
I should like to mention one aspect of the problem, which I ask the Minister to think about. It is described in a letter sent to me by somebody with whom I have 1326 considerable contact, and for whom I have considerable professional respect. Dr. Webb, the consultant psychiatrist at West Suffolk hospital, wrote:In the past month for a period of two weeks ending just over a week ago it was virtually impossible to admit either male or female adults of working age … to an acute psychiatric bed within reasonable reach of West Suffolk.Male and female admission beds on Ward G8 of West Suffolk Hospital were filled immediately they became available but it was necessary for ward staff to check on a daily basis where the next available bed was, in the event that admission was unavoidable. Over the weekend of 23rd/24th November we confirmed that there was no available bed in the counties of Suffolk, Norfolk, Cambridgeshire or Essex. Female beds were located in Boston, South Lincolnshire and in Leicester … The situation reached its most extreme on 1st December when the nearest female bed we could locate was in Hereford, a full day's journey by emergency ambulance had we needed to take advantage of it.I ask the Minister to listen carefully to such comments. Undoubtedly, there is considerable pressure on psychiatric wards, due to the rise in the incidence—it would appear—of people who are suffering from mental illness for one reason or another, whether temporary or not.
Making that point and urging that the provision of beds be kept firmly in mind does not detract from the importance of care in the community for those who have mental problems. From talking to professionals in Suffolk, the feeling is that, certainly in that county, care in the community has worked reasonably well. There are now only nine beds for medium and long-stay patients under the age of 65 in west Suffolk. It is important to realise that the spectrum of provision needs to be built on as we address the problem in years to come.
The important thing about the Bill is simply this: as our understanding of the needs of people who have suffered or suffer from mental illness changes and progresses—there have certainly been significant changes of attitude over the years—we have come to appreciate that issues of single-sex psychiatric accommodation and ward provision need to be properly addressed. Although, in practice, such accommodation is provided in some parts of the country, it is not universal. The Bill seeks best practice across the country.
A balance must be achieved. There must be areas in certain psychiatric wards—I have seen them in my local hospital—where both genders can mix freely in certain circumstances, but it is absolutely right, for all the reasons suggested by hon. Members, that there are also areas where women particularly can feel secure and safe if they feel threatened in any way. As the Mental Health Act Commission pointed out, and as a number of hon. Members have mentioned, it is absolutely unacceptable that, in this day and age, there is inadequate access for women to lavatories and areas where they can be private and isolated from men. The Bill seeks to address that problem, at least in part.
It is true that, over the past generation, there have been considerable improvements in the treatment of diseases or ailments such as schizophrenia and psychotic behaviour, and in our ability to prevent relapses; but individuals can deteriorate very quickly. It is important for us to take care of people, and to deal with their specific therapeutic needs in in-patient facilities, as long as it is done in an appropriate way. All that is part of a spectrum of provision that I believe to be crucial.
The Bill merely amends an existing Act. It is narrow and relatively costless, and I feel that every hon. Member should be able to support it. If hon. Members feel 1327 uncomfortable with some aspects of it, that is no reason to reject it outright. Given the importance of the issue, it is only right for a Standing Committee—perhaps a Special Standing Committee—to be set up to examine it properly.
An Opposition Member described mental health as the Cinderella of the NHS. I agree with that description, but, as our understanding of mental illness continues to improve, we must try to deal with it in a way that is appropriate to the needs of the age in which we live.
The Bill addresses key aspects of the protection and security of, in particular, female patients, and demands that health authorities draw up an appropriate strategy to deal with some of the main problems of mental illness. It is a Bill whose time has come. If the Government damage it irreparably, they will do a disservice to all who take a genuine interest in mental illness, all the organisations that lobby for the mentally ill, and, indeed, our constituents and their families.
§ Mr. Tony McNulty (Harrow, East)
Because of the time, I will be brief.
The hon. Member for Tiverton and Honiton (Mrs. Browning) took umbrage earlier, but I was attacking her Government's lack of activity rather than her own record, which is commendable. If she felt that I was attacking her, I humbly apologise.
On the whole, the debate has been productive, but I was less than happy about two key elements. The first is the arrogance of Conservative Members, who seem to assume that, if we do not take the route outlined in the Bill, nothing will happen. Things are already happening; Conservative Members should catch up with what is happening in this and other areas of the health service, and help us.
I do not doubt the sincerity of the hon. Friend the Member for New Forest, East (Dr. Lewis). I congratulate him both on his success in the ballot, and on his splendid speech. If I were being nasty—like the hon. Member for Teignbridge (Mr. Nicholls), who is rather intemperate this morning—I would welcome him in his new, more genteel manifestation: he is no longer the muck-raker that he was in the 1980s. But that is by the by.
§ Dr. Julian Lewis
I thank the hon. Gentleman for showing us that, while he seems on the face of it to be being polite, he is really reverting to the true style that lies beneath the surface of his gentility.
§ Mr. McNulty
Many thanks. To use the words of a stimulating intellectual sedentary intervention from the hon. Member for Teignbridge, "You started it."
I am mindful of the time. I took notice of what the hon. Member for New Forest, East said. I found the comparison between a broken leg and a breakdown useful. I have some personal knowledge of friends who have gone through such terrible periods. Anyone would take a broken leg over a breakdown. He was right to identify the problems and to focus on the vulnerable, but the Bill does not offer solutions. It does not offer the sanctuary and asylum that is sought. For us to dine a la carte, there needs to be something on the menu; in this case, there is nothing but what the Government are already doing.
§ Mr. McNulty
No, I have only a minute.
1328 To those who argued that a Standing Committee should have the chance to improve the Bill, I say, let the independent review group discuss the matter. With the best will in the world, any Standing Committee that we can offer will be as nothing compared with the expertise of the group's membership or that of bodies such as the National Schizophrenia Fellowship, SANE and MIND.
Let them discuss the serious issues raised in the Bill. Let the group work with the Government to develop some of the points made by the hon. Member for West Suffolk (Mr. Spring). If we are to make progress, hon. Members should work with what is finally, after 18 years, on the table. I again congratulate the hon. Member for New Forest, East on raising the matter. In that spirit, I hope that, after today, all hon. Members, if they are serious, will work with the Government on this.
It was disgraceful for the hon. Member for Teignbridge to suggest that the absence of female Labour Members meant that they do not care about the vulnerability of women in mental health institutions to rape and assault. Anyone, including jumped-up lawyers sitting on the Front Bench—[Interruption.] I meant the Conservative Front Bench, I hasten to add—can play the silly game of how many Members are sitting on each side of the House.
We could have said the same last week about the special educational needs debate. I do not suggest that the absence of the hon. Member for Teignbridge meant that he does not care about children with such needs. He should withdraw the remark and apologise, or at least give it serious thought in his taxi home.
§ The Parliamentary Under-Secretary of State for Health (Mr. Paul Boateng)
The House owes the hon. Member for New Forest, East (Dr. Lewis) a debt of gratitude for bringing this subject before the House. He did so with great feeling and intellectual force. Almost without exception, the other contributions were of the highest quality. Hon. Members brought to the debate experience of their constituencies, and of the concerns and problems of their constituents and friends. Their previous experience of the matter qualified them to speak.
The House's concern about mental health is rooted in the anxiety about community care that exists in the public we seek to serve. That is the concern which the hon. Gentleman, in introducing the Bill, seeks rightly to reflect.
One of the most powerful speeches today came, not surprisingly, from the hon. Member for Macclesfield (Mr. Winterton). He draws on an unparalleled experience in the House on Social Services and Health Select Committees. He draws on that experience in a way that always commands respect. It did today.
I have had the advantage of considering the report of the Social Services Select Committee to which the hon. Gentleman referred. I commend it to the House. The lessons it sought to teach the House and the then Government apply as much today as they did then. Most powerfully, the Committee of which the hon. Gentleman was a member said in the 1984–85 Session:The stage has now been reached where the rhetoric of community care has to be matched by action, and where the public are understandably anxious about the consequences.That was some 13 years ago. Today we might say exactly the same thing.
1329 It must be said—I do not say it in a spirit of party political acrimony, but nevertheless I say it—that not enough has been done in the past 13 years. It is as a result of inadequate action on the problem over the 18 years of Conservative government that we have reached the pass we are in today, when the hon. Member for New Forest, East finds it necessary to introduce this measure. I owe it to the House—I intend to discharge this function in full—to explain fully what action the Government intend to take.
We shall begin by making sure that the NHS is put on a sounder footing. That is why a number of my hon. Friends have made reference to the NHS White Paper. The internal market has not helped the situation. I do not put it any higher than that for the purposes of today's debate, because there are other matters that we must deal with, but the reform of the internal market is essential to create the context in which it will be possible to deliver a comprehensive mental health service. With the announcement by my right hon. Friend the Secretary of State in that regard, that process has begun.
However, we need to go on from there. The same Social Services Select Committee rightly made the point that it was necessary to understand that community care would never be resource-neutral. I owe it to the House to make it clear that we accept that community care is not resource-neutral. I only wish that, when the Conservative party was in government, it had backed community care with the resources which at that time were made available by the sale and disposal of the sites of the old watchtower hospitals. Nevertheless, it did not happen. So we have to begin where we are.
I want to announce today that we shall make available some £5 million to mental health services to ease the pressure on acute beds this winter by buying extra residential or 24-hour nursing home places. That is important because those places of security, whether within the context of a hospital or without, make a valuable contribution to the crisis we face.
I want to draw the House's attention to another part of the report by the Select Committee on Social Services, which urged the House then, some 13 years ago, to face the fact that some people need asylum. I accept that, and the Government accept it. I also accept, however, as it said:Asylum can be provided in a physical and psychological sense in the middle of a normal residential community: traditionally indeed, in the midst of a busy church.It is right to recognise that, when we talk about places of tranquillity, to which the hon. Member for New Forest, East rightly referred, we have a duty to ensure not only that such places of tranquillity exist within district hospital and other hospital provision, but that community provision offers places of tranquillity. That is why we need the flexibility which is at the core of the Government's approach. The Bill presents some difficulties for me, because I fear that it would reduce an element of flexibility that must be present.
I want to make it clear that we will underpin our strategy with resources. We will increase next year's mental illness 1330 specific grant by £6 million to £73.3 million, an increase of 9 per cent. That is occurring in circumstances according to which there was no intention on the part of the Conservative party to make any such increase. It is money that we are making available for that purpose.
We will use the grant in two ways. It is intended that £2 million will be spent to extend the grant for services for children and adolescents with mental health problems. Local authorities will be eligible to bid for that money. That is vital when one considers the increase in the number of young men who are taking their own lives in circumstances about which, quite frankly, we as a nation should be extremely concerned. I know that the hon. Member for New Forest, East believes that his Bill would address such circumstances.
We will also be making £4 million available to the local authority mental health partnership fund to promote partnership working with the NHS and other agencies. We must take on board the vital contribution that is made not only by local authorities but by voluntary and charitable organisations. Hon. Members have drawn on such organisations' expertise and commitment in their constituency work and in their previous contributions to debate in the House. We know how much good work is being done out there, and new money will back it up.
We have gone beyond that, because we are concerned to make sure that the NHS responds. Both the funds I have mentioned will be used to foster local innovative projects and to develop best practice. That is of key importance.
We will go beyond that, however, because we take the view that it is necessary to find additional moneys, and we will do so. Some £4 million will be available in 1998–99 for the development of NHS mental health services, matching the local authority partnership fund. That is what we have to do to make a reality of the improvement in provision that we are concerned to bring about.
§ Dr. Julian Lewis
I thank the Minister for his generosity in giving way, and for the money that he is making available. Will he tell us, however, whether any of that money will be used to address the specific concerns in my Bill: that people cannot get into acute beds; that locks need to be fitted on doors; and that single-sex ward areas should be provided?
§ Mr. Boateng
We certainly intend that the money should be applied in such a way as to do just that.
I should now like to consider the specific concerns highlighted in the Bill. We have made it clear to the NHS that we expect the policy that is already in place to be carried forward. As for the NHS approach to mixed-sex wards, we expect it to take seriously the commitment that the Government have made, and will implement, on safety and security on wards.
Let us be very clear about what we are doing. We have been told by a substantial number of health authorities that they will not be able to deliver the objectives that have been set until after April 1999. That is not acceptable. We expect them to ensure that appropriate operational arrangements are in place to secure good standards of privacy and dignity for hospital patients. 1331 We expect them to meet the requirements of the patients charter. We expect them to provide safe facilities for patients who are mentally ill, in order to safeguard their privacy and dignity.
That is why we have set in place a review, with health authorities, of any target that has been set after April 1999, and to consider what scope there is to bring that forward. A central monitoring system is being developed which will provide further regular information on authorities' performance against those objectives—
§ It being half-past Two o'clock, the debate stood adjourned.
§ Debate to be resumed upon Friday 16 January.