I echo what the hon. Member for Darlington (Mr. Milburn) said about the quality of speeches from both sides of the House, including those from the hon. Members for Wakefield (Mr. Hinchliffe) and for Birmingham, Selly Oak (Dr. Jones) and from my hon. Friend the Member for Macclesfield (Mr. Winterton). In particular, I commend the speech of my hon. Friend the Member for Hendon, South (Mr. Marshall), who initiated this debate. As usual, he made a robust but thoughtful contribution. I always welcome his views on these matters.
I echo the points made about the need for a balance. We have a great national health service, which has made giant strides in mental health care. I pay tribute to all those working in health and social services, who have achieved so much for mentally ill people. They have transformed the approach to mental health.
Hon. Members were right to point to shortcomings and to the tragedies that occasionally occur. I agree that we need to continue looking for improvements while implementing the right policies. As my hon. Friend the Member for Macclesfield said, we need to close the gap.
My hon. Friend the Member for Hendon, South referred to the closure of Napsbury hospital. The decision was made some time ago and we are currently considering the consequences. As he knows, our policy is that no psychiatric hospital should close unless there are adequate replacement services. I understand that the chairman of Barnet health authority has given an undertaking that Napsbury will not close until replacement services based in Barnet are ready. Following the debate, I shall write to the chairman of that authority asking for evidence to satisfy me that that is indeed the case.
My hon. Friend the Member for Macclesfield made balanced and constructive points about the Lynn Fox case. I welcome what he is doing in bringing the agencies together. If, having done that, he would like to come to see me and tell me about what he has discovered, perhaps bringing the trust chairman with him, I would certainly welcome his visit.
My hon. Friend the Member for Hendon, South mentioned people who do not seem to have homes, which has been a problem in London. That is why we launched our initiative for homeless and mentally ill people. Indeed, immediately following the debate, I shall be going straight to Tower Hamlets to open another stage of that initiative: some move-on accommodation run by the Look Ahead housing association.
Five outreach teams are in place. They cover different parts of London, especially inner London. All 10 hostels that we promised are open. The last one opened in October. They provide 148 bed spaces. We are making progress with the move-on accommodation, to which I have just referred. We have an agreement with the Housing Corporation not only for the 150 supported places that it initially promised us, but for 181 places. Five schemes offering a total of 36 places were open by the end of last year and all the places should be available by the end of the financial year 1996–97. A valuation of that scheme has been generally favourable and I shall be looking to build on that scheme in future.
Reports often refer to the issue of beds. We know that there is a fairly constant provision of 80,000 beds and about 20,000 acute beds. However, important factors are the mix of available beds, where they are, whether they are effectively and efficiently managed and whether the right people are in the right beds. All those factors have come up in this debate and we shall continue to consider them.
We asked the mental health task force to consider the provision of beds, especially in London. I certainly noted the points made in the report by the Royal College of Psychiatrists. It drew up plans with all the inner-London authorities, which have in turn drawn up their own action plans. I hope that they will prove effective. I am not complacent about London. I am very conscious of the need for community work to be supported by the provision of beds.
Indeed, on one occasion, while meeting representatives of an authority, I heard talk of the ability to close beds once the community facilities were up and running. I said that that was not the case and that the authority would need beds to ensure the success, efficient running and well-being of patients in community service. That is very much the message that I bring to the House and to our mental health service.
Mention has been made of the high-security service. The range of Reed reports on that area of care has exercised our minds. From April, a new structure of three new special health authorities to run three special hospitals supported by new commissioning structures and boards will he introduced. Our purpose is to integrate more closely those hospitals with mainstream mental health services, which—I hope—will prove effective.
The hon. Member for Wakefield mentioned people who are in prison but perhaps should not be, and the need for mental health support. That support is sometimes provided in 'prisons and sometimes provided by transferring prisoners to mental health hospitals—often secure hospitals, for obvious reasons. That support has been a tremendous success. We are not often given credit for the way in which, since 1990, we have enabled more than 2,500 patients to move from prison to hospital. In 1994 alone, 784 people were transferred and found places in the health service under the provisions of the Mental Health Act 1983. That was more than double the number of transfers in 1990.
The facts that we have been discussing illustrate the scale of the issue before us. We know that one in four of us is estimated to suffer from mental illness at some point in our lives. We know that mental illness is three times more common than cancer and as common as heart disease, and that few of us will pass through life without being touched by it—whether personally or, as the hon. Member for Selly Oak rather movingly told us, through the suffering of a friend or family member.
The cost of mental illness to society is heavy—not only in terms of human misery but economically. In 1991, for example, some 91 million working days were lost to mental illness even without taking into account days lost by carers who were looking after somebody who was mentally ill. A degree of stigma is still attached to the topic. That is damaging because it makes life more difficult and distressing for mentally ill people and prevents others from seeking help when they need it. Removing stigma is part of our policy and must be part of the onus placed on all of us.
In Health questions yesterday, I referred to Professor Norman Sartorius, the president of the World Psychiatric Association and the former head of the mental health division of the World Health Organisation. Overnight, we have received a further message from him stating:
England has taken the lead in work to prevent mental illness and to tackle stigma.
Although that is good news—I welcome the tribute—we must strive ever more. We sponsor surveys of public attitudes, we have produced leaflets which discuss in jargon-free terms the policies in different areas, and of course we support World Mental Health Day, which focuses especially on young people.
The debate has concentrated on the sort of support needed to avoid problems. That is why one of the keys to successful policy is the care programme approach, which aims to ensure that care is provided on the basis of properly assessed individual need, with a coherent care plan and a facility for regular review. The vast majority of health authorities have already implemented it. Perhaps, as the hon. Member for Darlington said, some progress is still to be made. On the whole, that relates to those who are not severely mentally ill, in ensuring that such care is available for everybody.
It is our firmly expressed policy that hospitals should not close unless and until alternative provision is available. Indeed, many are not closing but being converted to more modern and appropriate facilities We must have a range of facilities, including residential care, varying degrees of support, hospital facilities, crisis beds and medium-term hospital beds. The whole concept of asylum is essential as part of the package of measures to help people who are mentally ill. Some people will have to spend long periods of time in 24-hour nursed beds—in some cases the whole of their lives—and we should not duck that responsibility.
We also attach great importance to the development of primary care in mental health. We are continuing to part-fund a senior GP fellow who takes national leads in the education of GPs in that area. A senior primary care nurse facilitator does likewise. Our work on defeating depression is also part of that development.
I make no apologies for reminding the House of our programme to increase the number of medium-secure psychiatric beds. They are essential. Despite the fact that a gap in provision was identified by the Glancy committee in 1974, there was not one such bed by 1979. The Government have responded to that, and by the end of this year, there will be more than 1,200 such beds through our £47 million investment. With an additional 300 regional beds, and the provision of about 500 beds in the independent sector, the figure just about totals the 2,000 beds to which my hon. Friend the Member for Macclesfield referred.
Mental health services are at the top of our agenda. I am grateful that hon. Members of all parties recognise the priority and emphasis given to that area of our health service by my right hon. Friend the Secretary of State. That is why, last August, we wrote to health authorities requiring them to let us have details of their plans for service development. The results of that exercise are now being analysed and we hope to make an announcement on the conclusions shortly. I shall be surprised if those conclusions do not show that there are widespread plans for increased investment in mental health services. That underlines our commitment to the mental health service. It is one of the five key areas in "The Health of the Nation" strategy and one of the six medium-term priorities for the 1996–97 priorities and planning guidance for the NHS.
Mentally ill people, like everyone else who receives care, have a right to expect standards of care, and that is why we shall launch for consultation our draft booklet in the patients charter series specifically for users of mental health services. We can improve the system and we can improve the service. We shall do so if we all work together for the benefit of patients.