Health and Social Security

Part of the debate – in the House of Commons at 4:14 pm on 22 November 1994.

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Photo of Kevin Barron Kevin Barron Shadow Spokesperson (Work and Pensions) 4:14, 22 November 1994

If we are to have the confidence that the right hon. Lady wants us to have in her and the health service, will the right hon. Lady tell the House what she thinks about a report on the front page of The Guardian, which states that a letter leaked from the Ian Greer Associates office names the principal Member of Parliament involved in lobbying Ministers and individuals of the House against the tightening of the voluntary code for tobacco advertising as her own Parliamentary Private Secretary?

Mrs. Bottomley: Certainly my Parliamentary Private Secretary has no recollection of such a matter at all. Much more to the point is the fact that any holder of my office who is not used to energetic lobbying by people from all persuasions and interests would be unable to do the job. If anybody wanted to take lessons in lobbying, for all the respect, indeed, affection that I have for them, there would few better advisors on the arts of lobbying than the British Medical Association and the Royal College of Nursing themselves.

Talking of the BMA and its colleagues, the recent meeting of the medical profession on core values in medicine was, I believe, a landmark. It showed that the Government and the profession share a commitment to the same objective—to a modern, dynamic health service based on knowledge, informed by research and focused on outcomes for patients, to a health service of the future and for the future.

In the same way, I am pleased to be working with the medical profession in taking forward our proposed Medical Act (Amendment) Bill. The public rightly have confidence in the vast majority of our doctors, but there is regrettably also a very small number of doctors whose performance is deficient. The General Medical Council, the doctors' regulatory body, wants to improve the procedures which they have for dealing with that minority. There may be some, for example, who need further training before they can be allowed to continue to practice. This Bill will provide those necessary powers, and the Government are glad to be able to support the GMC in that matter.

My hon. Friend the Under-Secretary of State and Opposition Members have long made that point, and I am pleased that we are able to take it forward at this stage. I also welcome the support of the right hon. Member for Derby, South and of the hon. and learned Member for Montgomery (Mr. Carlile) on behalf of his party. I hope that that support will translate into practical action which will facilitate the passage of the Bill through the House.

I want to speak now about the important Mental Health Bill also announced in the Gracious Speech. The principle of caring for mentally ill people, where proper and possible in the community, is long-standing and supported on both sides of the House. The national health service now spends more than £2 billion on services for mentally ill people. More and more of that money is being spent in the community. There are now better services for the vast majority of mentally ill people than ever before—four times as many psychiatric nurses, four times as much residential provision, twice the number of day centre places. However, the right hon. Lady and many of my hon. Friends know of areas in which we have not yet delivered the comprehensive standard of care that we want for all patients, and we are determined to take that work forward.

We have, for example, a £45 million capital programme to increase the number of medium-secure psychiatric beds. It has long been a concern of mine, as members of the Select Committee and others will be aware, that, while care in the community generally works well for the majority, a small group of the most vulnerable patients do not always get the support they need. There have been a number of well-publicised cases which have brought the issue into sharp perspective. The national health service needs to do more to make services for that group a greater priority. It is beginning to happen.

For years, in the cities in particular, the large acute hospitals commanded most of the money available. Our Bill introduces stronger powers for looking after the most severely mentally ill people in the community. The new power of supervised discharge will build on our programme of action to strengthen care in the community. We have already introduced tougher and clearer guidance on the discharge of patients from hospitals. Four out of five health authorities now have in place supervision registers.

Supervised discharge will apply to those patients who have been detained in hospital and who, on discharge, need special support in the community. A patient subject to supervised discharge will be required to abide by the terms of the care plan drawn up by the clinical team when he or she leaves hospital. Failure to comply would lead to an immediate review and the possibility of compulsory readmission to hospital under the Mental Health Act.

That, too, is a measure which I hope should command support on both sides of the House. It will significantly tighten care in the community. It will provide added protection for the public and for patients themselves, and it will reinforce confidence in the policy of care in the community itself.