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11.57 am
Dr. Julian Lewis (New Forest, East): As a new Member, it has been a privilege for me to hear for the first time the hon. Member for Wakefield (Mr. Hinchliffe) speaking on a subject on which he has a fine reputation in all parts of the House. If I understood his argument correctly, he said that we should move more in the direction of community care in the long-term treatment of the elderly, much as we have already done in the long-term treatment of the mentally ill.
As some hon. Members present will know, I was fortunate enough to introduce a Mental Health (Amendment) Bill when I was drawn second in the private Member's Bill ballot. I shall refer briefly to three categories of people who are affected by community care for the mentally ill: people who may kill; people who need what might be termed "a periodic MOT"; and people who need a place of refuge.
On his thoughtful speech, the hon. Member for Oxford, West and Abingdon (Dr. Harris) was a little too glib when he attributed to shortage of resources the problem of homicides committed by people released from psychiatric institutions into care in the community. I am sure that he does not mean that generally, because it is certainly not true.
It is a little strange that people are prepared to take chances with the lives of citizens by releasing people into the community, knowing that there is a significant risk that they may harm others--often members of their own families. By contrast, if one applies the same argument to the capital punishment debate, it is often said that one must not risk accidentally executing one innocent person, even if it means that 99 guilty people escape the gallows.
That shows a slightly different sense of values. There seems to be a complacency about taking the risk of releasing potentially lethal people into the community, but none about taking the risk of accidentally executing someone who is innocent. I am sure that the families of those who have been killed by people who were wrongly released into the community would have a lot more to say on that subject.
One must not throw the baby out with the bath water as one moves in the direction of community care for people who need a periodic MOT. There are people who suffer acute suicidal depression which cannot be coped with through care in the community alone.
There used to be a system which I understand--I am not an expert in this field--was known as "the revolving door." The idea was that people would be encouraged to live their lives normally in the community as far as possible; but, when they felt a crisis coming on, there would be an institutional facility available for them--to give them an MOT, to give them a service, to get them back on track. Then, perhaps, they would not require any more in-patient treatment for another three or four years. That process could continue steadily for the rest of their lives.
I am concerned that the shift towards community care and away from institutional treatment for people who are mentally ill, creditable though it is in general, has deprived such people of the facilities they need from time to time to keep themselves on the straight and narrow.
I refer now to the people about whom I was concerned when I introduced my private Member's Bill, which, sadly, was talked out in five and a half hours of precious parliamentary time, perhaps to little avail, on 12 December last year--people who need a place of refuge. It is often said that there are insufficient beds for people who suffer acute psychiatric breakdowns. That is not necessarily the case.
The problem is that, as a result of the mass closure of institutions, such beds as remain are not sufficiently compartmentalised between different people with different mental illnesses. Even where a bed is available in a psychiatric unit for someone who is suffering from an acute psychiatric, potentially suicidal, breakdown, the GP, or other medical officer in charge, will not want to recommend that that person takes it if he or she will thus be placed in an environment with seriously disturbed people, which could only harm rather than help his or her condition.
Mr. Patrick Nicholls (Teignbridge):
I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on his choice of subject for debate. He and I might have slight differences about solutions in given circumstances, but nobody could criticise him for having introduced the debate or the manner in which he did so.
The debate so far has been characterised by an understanding--I hope that it will continue in the time remaining--that, although we may disagree from time to time on how to achieve a given end, it is, as the hon. Member for Wakefield (Mr. Hinchliffe) said, ultimately about ensuring that our elderly people receive the care that we expect and hope for. That aspiration is shared by hon. Members on both sides of the House.
When I was preparing for the debate, I recalled having seen many years ago a rather dramatic advertising poster in the maternity unit of a hospital in Exeter. It struck me as rather apposite. It said, "The first seven days are the most dangerous in your life", and some wag had written underneath, "And the last seven are not devoid of hazard." In a sense, that is where I am coming from.
The hon. Gentleman made it clear that, although this is a wide-ranging debate, he wanted to talk about care of the elderly. I shall say a word or two about that as well. We are, after all, living in a greying population. The figures are dramatic. Between 1951 and 1996, the proportion of the population aged 65 or over increased by 66 per cent. The number who are 75 and over has increased by a dramatic 136 per cent.
At present, there are some 10 million pensioners in the UK. Eighteen per cent. of the general population are over pensionable age. Two thirds of those who are over 75 are women and more than three quarters of them are aged 85 and more. In 1993, a man of 60 could expect to live for another 17.8 years and, inevitably, a woman 21.9 years. Old people account for some £20 billion of spending in health and social services every year. Nobody need be in any doubt that we have a greying population, which imposes obligations and concerns on us that were not foreseeable in 1950.
I was particularly pleased to hear the hon. Member for Oxford, West and Abingdon (Dr. Harris) pinch one of my lines. One often hears about this, and it is often presented as a problem, but it is not. Not so long ago--certainly in our grandparents' generation--if someone was 50, their time was virtually up. These days that is not the case. If it were, several hon. Members in the House at the moment would feel more than nervous. It is good news that people are living so long. We are in the business of trying to ensure that they live for as long as possible and that they have a good quality of life for as long as possible--one that we would enjoy.
What people want when they consider care in their old age is affordable, quality health care. They do not want their hard-earned savings, for which they may have worked all their lives, to be gobbled up in their last two or three years. After a life in which they may feel that they have achieved some modest material success, they do not want to have nothing to leave to their children. There cannot be an hon. Member who has not had experience of difficult cases about where the money is going. Sometimes the concern is felt every bit as much by those who will not be able to leave something as it is
by those who think that it is not right that they will not inherit. Those are the two principal considerations that must be dealt with.
To some extent, community care for the elderly has grown like Topsy; we have not had a firm policy, it has just occurred. We have heard about the way in which community care has developed and about the changing role of local authorities. The Government are to be complimented--I say this quite straightforwardly--on having set up in December the royal commission to examine the short and long-term options for sustainable funding for long-term care for elderly people in the UK, both in their own homes and in other settings, and within 12 months to recommend how and in what circumstances the cost of care should be apportioned between public funds and individuals. That is a succinct statement of what the commission will examine.
The commission has yet to report, so it is early days, but has the Minister had any preliminary thoughts on the matter? He shakes his head slightly, but he must have had, because he has announced a number of other initiatives, for which I commend him. I hope that he will say something about the composition of the commission, under Sir Stewart Sutherland, which represents a roll call of the good and the great. The Minister will know that certain groups, such as care providers, charities and lobbying groups, are anxious because they are not represented on the commission.
Private sector providers of residential and nursing home care are worried that their voice may not be heard in the commission. Barry Hartley, chairman of the National Care Homes Association, said:
"We are extremely disappointed that there is no representation from the private care sector on the Commission or of care practitioners. The private care sector has a wide ranging knowledge of how the current system works and it also has experience and expertise of the funding of long term care which may well not be available elsewhere."
We must take that on board, because it addresses head on the worries of the hon. Member for Wakefield about trends under the previous Government.
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