London's health service : minutes of evidence, Wednesday 2 March 1994 ... / Health Committee.
- Great Britain. Parliament. House of Commons. Health Committee.
- Date:
- 1994
Licence: Open Government Licence
Credit: London's health service : minutes of evidence, Wednesday 2 March 1994 ... / Health Committee. Source: Wellcome Collection.
16/24 (page 14)
![[Mr Sims Cont] achieve the legislation. We have the new guidance on the discharge of patients from hospital. I believe there is more to do, but we are now set fair to deliver the tightening up that is necessary. 61. And will the resources to meet these come from the community care funds we were just discussing, or from another source? (Mrs Bottomley) Over the last year there has been a 10 per cent cash, 6 per cent real terms, increase in spending on mental health in the London health area. We estimate that about £500 million is spent. It is quite difficult to identify the figures because, as Mr Sims rightly appreciates, it is interrelated with social services spending, some housing spending and other special initiatives. There is the safeguarded funding for the extra medium secure beds. There is the increase of money for community care about which John Bowis will be seeing the directors of social services in London to be sure that with that very substantial increase—as I say, up to £123 million now going to London—proper priority is given for mental health projects. Also the Mental Health Task Force, with David King as the chairman now to be joined by Dr Peter Kennedy who is a psychiatrist, will be visiting each of the purchasing authorities in London to discuss their plans, to see whether they are giving proper priority to mental health services and to see whether they have the balance right. At a time when there has been such an increase in psychiatric nurses, psychologists and psychiatrists, the concern is that they are not sufficiently focused on the group of patients who are most in need. Forgive me, Chairman, I also announced last week that of the £85 million for primary care, £10 million will be for mental health services. That is important, but I recognise that it is only one element in a great range of measures that are necessary. Tessa Jowell 62. Do you accept that until the people who need to be in medium secure provision are in medium secure provision, then their needs which are so great are likely to distort the pattern of use of other mental health services? (Mrs Bottomley) Yes. 63. Perhaps you will also accept this as a matter of fact. The South East London Health Authority knows that it needs 28 medium secure places for residents of south-east London. You are at present proposing that 75 per cent of the cost of these medium secure places should be derived from capitation funding. At something between £80,000 and £100,000 per annum per place, you will realise the scale of burden that providing that medium secure treatment imposes on a purchasing authority. Will you now accept the recommendation of the Ritchie report that there needs to be an urgent increase in the number of medium secure unit beds in south-east London? Will you undertake to underwrite the cost of those beds? (Mrs Bottomley) To repeat, there were 30 medium secure beds in 1980. The Glancey report said in 1975 that we needed 1,000 and nothing happened for that first five years. We are now up to about 635. There are 150 in the London area and we are on course to have a further 137 in the next two years. Obviously I want to make that happen as fast as possible. The overall capital cost of these places will be something like £100 million and that is being funded centrally. What Mrs Jowell is talking about is the revenue cost which I understand is more like £70,000 a year for a place. But that is rightly the responsibility of the purchasing authority. The purchasing authorities need to have in place a range of provision and where I agree with Mrs Jowell to begin with is that it is right that they must give these difficult patients the priority they deserve. What is so worrying about the Christopher Clunis case is that although there were any number of people who had been involved in his care, the fact that he was violent was either written out of the notes or resulted in him being ejected from a number of services. This was the story with Ben Silcock, that he attacked a worker at the day centre and therefore he was excluded from the centre. Whatever else mental health services provide, they must identify these often troublesome, difficult, challenging patients as one of their absolute priorities. When there is such an investment in a range of schemes, this must be an area that is given proper regard. Did Mrs Jowell make a point about capitation? 64. I made a point about capitation. I take it that you are not prepared to underwrite the cost of the places that south-east Thames needs? (Mrs Bottomley) The Government underwrite the capital for the places, but it is not right in a National Health Service constantly to take things to the centre. They must be devolved to the purchasers, those who are responsible for the ongoing care of the patients. I will explain why, Chairman, and I think Mrs Jowell may feel some sympathy with this. She is extremely knowledgeable on these matters, but when something is a free gift there is always a danger that it is a distortion of the market. One of the issues that Mrs Jowell may know concerns the use of the special hospitals. They are not funded by the local health authority purchasers and there is often a suspicion that there may be financial advantage in securing one of those places, for the same reason that people used to send children to detention centres. Be that as it may—and we can discuss it on another occasion perhaps—it will remain the responsibility for the health authority to fund the revenue cost. One aspect which I shall ensure we look at is whether or not the capitation figure should have more regard to psychiatric aspects. 65. And the need for medium secure places? (Mrs Bottomley) I have made that clear. We are on course to have our 1,000 and we want to achieve them as Soon as we can. 66. In south-east London? (Mrs Bottomley) The 137 over the next two years. 67. In south-east London? (Mrs Bottomley) I do not have the figure. But with £45 million going into this programme of medium secure places, this is a very large and necessary sum. Audrey Wise 68. As well as the shortage of beds in the medium secure units, the Ritchie report also identified a shortage of beds in general psychiatric wards for the](https://iiif.wellcomecollection.org/image/b32226433_0016.jp2/full/800%2C/0/default.jpg)
