Radical plans to bring health care and social services for the mentally ill together under one roof were outlined by the Government today. The proposals, which would cost about 2 billion, are intended to prevent communication breakdowns which have led to tragedy.
A number of options are put forward for consultation in a Green Paper launched by Health Secretary Stephen Dorrell. The most far-reaching involves setting up an entirely new statutory authority, accountable to the Health Secretary, responsible for mental health and social services. A second option would designate either health or local authorities as the single agency with the job of planning and purchasing psychiatric and social care. Other suggestions are for health and local authorities to establish new joint bodies between them, or to delegate particular functions or responsibilities to each other.
All the proposals would need primary legislation. Initially they would be aimed at people of working age with severe mental illness. But Mr Dorrell said they could be extended later to include children and the elderly. He stressed that the present flawed system could not continue. "The status quo is not an option. We either have to demonstrate that we can improve co-ordination by a number of administrative means within the statutory framework, or we have to change the statutory framework. The status quo has failed too often," he declared. Reports into mental health failures had repeatedly exposed a lack of co-ordination between different care agencies, and he was "unambiguously committed" to addressing this problem. The proposals were given a mixed reception by mental health charities.
The charity SANE backed plans for a single unitary authority responsible directly to the Government, believing it would prove the most effective and economic way of providing beds, 24-hour care and properly-trained staff. Marjorie Wallace, chief executive of SANE, said: "We believe that help for mentally ill people has become so fragmented that rather than being the `Cinderella' of health care it has become the `Humpty Dumpty'. There is no way of putting the pieces together again -- we have to start afresh." But the charity MIND said setting up new unitary mental health authorities would only result in "further upheaval and disruption". National Director Judi (correct) Clements said: "The last thing we need is yet another reorganisation. It is far more important that the most effective services are provided and the money is available to do the job. "We hope this debate is more than pre-election window-dressing, because this will represent one of the most important challenges facing the incoming government." Shadow Health Secretary Chris Smith was also critical. "This paper will do nothing to restore public confidence in care in the community.
"This was an opportunity for the Government to show real leadership and to address the problems which have been clearly identified by inquiry after inquiry. "Instead it has produced yet another consultation paper only three months before a General Election," he declared. Mr Smith said there was an urgent need to improve the poor joint working and communication between social services and health services and the lack of accountability. He said there was evidence that good housing and support were the key to a successful community care system - but the Government had done nothing to ensure that housing authorities were involved in the process.
The Mental After Care Association welcomed the Green Paper. Chief executive Gil Hitchon said: "Our over-riding concern is that whichever option is taken it delivers real improvements in care for people with mental health needs, and that change does not take place for change's sake." Both the National Association of Health Authorities and Trusts and the Sainsbury Centre for Mental Health rejected the idea of new authorities, saying this would involve "tremendous structural upheaval" and could take years to achieve.
They called for a mental health agency headed by a single manager while health and social services departments retained their existing responsibilities. NAHAT director Philip Hunt said: "The model we prefer would result in one set of commissioning plans in each district. It would remove current inefficiencies caused by conflicting priorities and the bewildering diversity of funding arrangements. "Whereas creating mental health authorities would just cause tremendous upheaval and might prevent benefits to patients being realised for some years." The British Medical Association said it was concerned by the emphasis placed on severely mentally ill adults. Dr Brian Goss, the BMA's GP negotiator, said: "People with learning disabilities, children with mental illness, the huge numbers of elderly mentally infirm, and those who suffer with lesser degrees of mental illness such as depression and anxiety stand to lose out. "In a climate of severe NHS resource limitation, there is a danger that these patients will be denied access to the best care if resources are devoted to the, albeit important, group to which the Green Paper's proposals are addressed."
The Mental Health Foundation warned that most of the proposals would take too long to implement to make a real impact on current problems. Director June McKerrow said: "We do not believe that a radical restructuring is needed - mental health provision in many parts of the country has been demonstrated to work, but the Government needs to remove the obstacles in the system which prevent it from working elsewhere." The charity Turning Point welcomed the proposals but said developing new ways of working was not the only issue that needed addressing. A spokesman said: "The lack of resources at service level continue to hamper the provision of good quality care. "Increasing numbers of people with mental health problems are now living on the streets because there just aren't the appropriate places to care for them." Directors of social services warned against setting up a new unitary authority reporting directly to the Government and transferring responsibility for services either to local or health authorities.
But the Association of Directors of Social Services argued for the removal of all blocks to joint commissioning of mental health by local authorities and health authorities. It also called for adequate resources. Roy Taylor, chairman of the ADSS Disabilities Committee, said: "Legislation to allow health and social services authorities to collaborate and pool mental health budgets seems the most effective approach among the Government's options." Shadow Health Secretary Chris Smith said the proposals would do nothing to restore public confidence in care in the community. He said: "This was an opportunity for the Government to show real leadership and to address the problems which have been clearly identified by inquiry after inquiry. Instead it has produced yet another consultation paper only three months before a General Election. "People need to be reassured that the Government is taking this crisis seriously.
The problems in the present system need to be addressed now." Mr Smith listed mentally ill individuals at the centre of the worst incidents caused by failures in the community care system. :: Christopher Clunis, who stabbed Jonathan Zito to death in December 1992. :: Ben Silcock, who was seriously mauled by a lion at London Zoo in December 1992. :: John Rous, who killed hostel volunteer Jonathan Newby in 1993. :: Stephen Laudat, who stabbed Brian Bennet 82 times in July 1994. There was an urgent need to address the poor joint working and communication between social services and health services and the lack of accountability that were "key factors in the present crisis", said Mr Smith. There was also a need for a new statutory framework for joint commissioning and joint working. "The last thing that is needed is a major structural reorganisation, with the consequent upheaval in the lives of patients, relatives and staff," said Mr Smith. "The Government needs to take immediate action to ensure joint working is implemented without delay." The Government had done nothing to involve housing authorities, despite clear evidence that good housing and support were vital to successful community care, he added.
The King's Fund, which promotes better health care, welcomed better partnerships between health and social services, but urged the Government to take account of "the financial cost and the disruption of even more structural changes". King's Fund chief executive Robert Maxwell said: "We believe there is an urgent need for the Government to provide leadership for a medium term programme of local service development, informed by the views of users and carers."
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