Motion made, and Question proposed, That this House do now adjourn.—[Mr. Cawsey.]

I am delighted to have this opportunity to raise a matter of considerable concern to the people of Devon. I am concerned that the Devon Partnership NHS trust, with its budget of £85 million this year, may not place the care of patients as the priority. I am concerned about the total absence of day care facilities in Brixham for Alzheimer's and dementia sufferers since the unilateral closure of the Briseham unit on 20 December 2004. I am concerned about the lack of available NHS respite care, which is forcing those who look after very sick people to pay for their own respite provision out of their own pockets. I am concerned that we are not facing up to the reality that, as our population gets older, more people will need mental health care and that the NHS must be equipped to cope with the rapid increase in demand.

There are more than 750,000 people in the UK with dementia. The vast Majority are over 65 and the incidence of dementia increases with age—one in 20 people over 65 have dementia, which increases to one in five among people over 80. My Constituency has the 13th largest proportion of pensionable citizens and there are approximately 1,155 people with dementia in the area. They are among the most vulnerable people in our society. Dementia does not just leave sufferers with failing memories—as the condition worsens, many people cannot feed, bathe or dress themselves. Dementia is a forgotten disease. One carer said:

"This cruel disease does not just affect one person—it has affected everyone we come into contact with. It has forced an end to my husband's career; it has affected my career quite dramatically. It has changed our standard of living and our lifestyle. It has changed everything we have lived and worked for."

One carer, describing her father's condition, wrote:

"I found my father's frustration and anger terribly distressing. He cried in the world he didn't understand. He got lost in his own bungalow and was frightened of his own reflection in the mirror."

As medical advances lengthen our life expectancy, the proportion of our population with dementia and requiring the support of the mental health services will increase. The problems presented by an ageing population are much discussed in relation to pension provision, but we are yet properly to address what it means in terms of the changing demands placed on our health services, particularly our mental health services. It is estimated that, by 2010, there will be 870,000 people with dementia in the UK. That is the same as the population of Manchester and Liverpool put together. In five years' time, there will be that number of people with dementia or Alzheimer's. By 2050, nearly 2 million people will have dementia or Alzheimer's. That will require a significant expansion of mental health service provision and availability of day and residential care.

Since 2001, the care and treatment for those with dementia in my constituency has been the responsibility of the Devon Partnership NHS trust, which provides mental health and learning disability services to the population of Devon. There is a staff of 2,800 and in 2004–05, it spent approximately £80 million. One of its problems is the absurd position whereby it is funded by nine different sources. There are therefore nine paymasters—seven primary care trusts in Devon and Torbay, Torbay unitary authority and Devon county council. That makes for unnecessary problems with priorities and management. Will the Under-Secretary investigate how to simplify the funding arrangement?

In the 2005–06 financial year, the trust budget has been significantly increased, with Devon county council alone increasing its contribution to nearly £1 million, yet front-line service provision is often incoherent, unequal throughout the county and seemingly not patient-driven. More money has not meant better services for the Alzheimer's and dementia sufferer.

The Briseham unit in my constituency provided specialist treatment and assessment services to those over 65 with dementia. The building was specifically designed for the purpose of caring for the elderly mentally ill. That made it an especially suitable environment, more so than wards that had not been specifically built for the purpose. It had 16 beds, as well as offering day care seven days a week and a small respite facility, which was fully utilised. It was unilaterally closed on Monday 20 December 2004, although the trust remains insistent that it has not been closed but simply suspended. It remains suspended six months later. As a member of staff who was at Briseham recently said to me:

"I cannot believe that they have closed a purpose built, secure unit with access to an enclosed garden for patients to wander freely, and left open a ward on the first floor of a hospital where it is very difficult to observe patients, where they have no freedom to move, and the only view they have is the top of cars and buses."

The unit did not provide long-term residential care but day care and respite care. It provided the essential back-up to allow carers to continue looking after their loved ones at home. As the majority of carers are the spouses of the person for whom they are caring, they are likely to be elderly. Carers can cope and continue their role only with appropriate support. If they fall ill or cannot provide all the necessary care, sufficient respite and day care must be available. If it is lacking, everybody suffers, and people with dementia will need full-time residential care at the cost of millions to the taxpayer.

The chief executive of the Devon Partnership NHS trust personally told me that he intended to wait until the Sainsbury centre for mental health published its report on "Future Development of Mental Health Services for Older People" in Devon before deciding about any change in the services that Briseham provided. Instead, he did the opposite. He closed the unit before the publication of the report, which came out in January, but to which the trust has still not responded. In a letter following the closure of Briseham, Mr. Tulley, the chief executive, stated:

"I think it is obvious that the day services were extremely valued and some form of day care in Brixham should continue."

So why has it not continued?

What happened after Briseham was closed reminds us that administrative decisions have a genuine and profound impact on people's lives. A few patients were offered care at the Harborne unit in Totnes, which is at least a 30-minute drive away. Such is the stress and strain of the journey that some patients have had to be medicated. However, the majority of people who previously received day and respite care at Briseham have been offered no alternative care by Devon Partnership NHS trust since it suspended the unit.

Mr. Gosling of Brixham is 85 this month. He devotedly cares for his wife who has Alzheimer's. When Briseham was open, he could count on it to provide day care when he needed time off, for example, to go to the dentist. In addition, the unit would care for his wife once every four weeks—the only respite Mr. Gosling got. Since Briseham was closed, Mr. and Mrs. Gosling have had to pay for respite care elsewhere. They have had to spend more than £1,000 of their hard-earned money for that purpose as the Devon Partnership NHS trust has offered them no alternative care. Mr. Gosling cannot understand how the powers that be could be so inhuman as to wipe out something that people need and rely upon, and that the NHS has a duty to provide.

Mr. Barber of Higher Furzeham road, Brixham is 77 and cares for his wife, who has been battling with Alzheimer's for 10 years. Before its closure, the Briseham unit provided day care on a four-day-a-week basis for him, as well as residential care for a couple of days when Mr. Barber was unwell or unable to care for his wife. Since it closed, no day care has been available for Mrs. Barber and, at a meeting of the Devon Partnership NHS trust, Mr. Barber was told that the other units that provided care for elderly people with mental health problems were unable to care for his wife, even if he could not do so through illness or for other reasons, as they were already seriously overloaded.

Mrs. Bovey of Golden close, Brixham cares for her husband, who has progressive supranuclear palsy. She cannot even pop out to get a pint of milk or loaf of bread unless someone can stay with him as he needs round-the-clock care. Prior to the closure of the Briseham unit, he had day care there two days a week and a week's respite care roughly every four weeks. Mrs. Bovey says that that was her "lifeline". She was never offered alternative care in any other unit. It is only in the past few weeks that social services, not the Devon Partnership NHS trust, have come forward with an offer of some respite care, yet Mr. Tulley, the chief executive, gave me a personal assurance that everyone who used Briseham is better off under the new arrangements.

The hon. Gentleman read out names of his constituents. There are constituents of mine who also depend on that unit. If we are in an age where people are living longer and getting older, will not demands be even greater than they are at present? Does he share my feeling that the plans that are being talked about for the future of mental health care services do not take into consideration the needs of those who require support at such a centre, or of those who need respite in order that their loved ones are cared for while they have some time out?

The hon. Gentleman could not have put it better. He and I share the bay—he has slightly more of it than me—and we are of one mind about the matter. Mental health services must be led not by what the administrators want but by what the patients and the carers need. I am grateful for that Intervention.

In a letter that Mr. Tulley wrote to me on 5 January, he said:

"I accept entirely that the current uncertainty is unhelpful to families of sufferers".

But he has done nothing about it. The chief executive also refers to the closure of Briseham as a "short-term decision." Six months later and we are no further forward.

In the letter of 5 January, the chief executive admitted:

"There has been no consultation in relation to the suspension of the service" at Briseham. It is not just the Member of Parliament who was not consulted but the staff, the patients, the carers, the Devon Partnership patient and public forum, Devon county council and the Torbay unitary authority, the later two having scrutinising responsibilities. How can the trust justify failing to consult the interested parties before taking such a monumental decision, which has devastated so many of my constituents' lives?

What is the point of the Government setting up a consultation and scrutiny mechanism if it is totally disregarded? Does not the Minister agree that the behaviour of the trust leaves much to be desired and that it must put its consultation process in order? The manner of Briseham's closure and the lack of consultation give weight to allegations that the trust behaves in an autocratic, cavalier and even bullying way, rather than as a responsible public body.

Consultation has been prolific over whether to reopen the unit, which has so far taken six months without any conclusion. Why is it that the unit can be closed summarily and without consultation, abandoning patients and carers, but cannot be reopened without endless committee meetings? It seems that services can be suspended at speed but that reinstating them is a painstaking process.

The trust conveniently forgets that it cannot put on hold the debilitating effects of the disease while it debates the future. I believe the Torbay unitary authority's health scrutiny committee will produce a critical report later this month, which will quite rightly draw attention to the failures of the trust in a number of important areas, particularly in relation to the closure of Briseham.

One constituent of mine who received day care at Briseham before its closure was given no alternative care immediately following the closure of the unit, and his wife had to look after him unassisted for seven weeks until an alternative unit was able to provide some help. Sadly, he has since died. It is simply not acceptable that, in the last few months of a person's life, when they need care most—and the health trust knows that they need it most—care is unilaterally withdrawn, and their life is made worse, not to mention that of the carer. Their lives are callously turned upside down without any regard to the impact. The worst thing is that, too often, the administrators are not taken to task for that because the people hit hardest by their actions are those least able to speak up for themselves. Few believe the reasons given by Devon Partnership NHS trust as to why Briseham was closed and the trust has not been forthcoming with a detailed explanation that fits with the reality.

The whole area of mental health still suffers from public suspicion and distrust. A key step in overcoming it is for the mental health authorities to be more open about the way that they run their organisations. There needs to be transparency not just in the decision-making process, but in day-to-day operations. We should never forget that those who rely on mental health services are the most vulnerable and confused people who are the least able to say what they want for themselves. That is made even more unacceptable by virtue of the fact that those who rely on mental health services, for whom the partnership is supposed to provide, are sometimes extremely confused. They need their carers listened to and they need to be heard.

I ask the Secretary of State to review the running of the Devon Partnership NHS trust, its decision to close the Briseham unit, the manner in which the decision was made, current scrutiny procedures and the failure to provide day care facilities in Brixham—with 18,000 people, it is the largest town in my Constituency—for people with dementia.

I believe that the Government are planning a new approach to care for elderly people with mental health problems whereby responsibility will switch from health to social services. That will enable the providers of services to charge for whatever they offer, which could mean Alzheimer's patients and their carers being squeezed of every penny piece until the pips squeak. Everyone will be means-tested. If a carer needs respite care, he will have to pay for it, and the Minister will appreciate that many carers will not be able to afford it and will be forced to give up caring and put the patient back into the health service, along with the accompanying additional costs. Have the Government not realised that the consequence of their penny-pinching approach towards those least able to fend for themselves will be disastrous? Furthermore, it is rumoured that the Government's position that dementia and Alzheimer's are no longer to be treated as an illness, but as a condition, may result in health care for people with those diseases no longer being free at the point of delivery.

Carers save the state millions of pounds by providing care that the state would otherwise have to provide. That should be remembered when arguments about the cost of facilities for people with dementia are being bandied about. It is vital that the carer's desire to look after their loved ones is not exploited by the state as a way to avoid responsibility for looking after people with serious mental health problems.

Yesterday, I met the chairman, chief executive and chief nursing officer of the partnership trust. I have no doubt that their intentions are good and that they wish to do the best they can for those with mental illnesses in Devon, but they are going about it in a very strange way. If they are to win back the confidence of not just myself, but very many others, they will need to prove that they do provide people with the front-line services that the patients—not the administrators—need and deserve, with the £85 million budget that they have at their disposal.

The trust was at pains to point out that the type of support for people with dementia is increasingly focused on support in the home rather than in special units, but there is still a need for day respite services, as carers often want some time to themselves in their own home. Briseham provided that with its day-care facilities and the popularity of the service speaks for itself. People with Alzheimer's often benefit from mixing with other people in a different environment, particularly one where medical treatment for any ailments can be provided immediately. I am not entirely convinced that the evidence bears out the trust's suggestion that care in the home is preferable to care in a specialist unit. It is not an either or situation: both are needed.

We are the fourth richest economy in the world, so it is simply not acceptable that, with the resources and skills available, we treat those in desperate need of support so badly. How society treats its elderly and vulnerable is a most significant reflection of its values. There are too many public bodies in Britain whose employees feel unaccountable to anybody other than their immediate superiors—certainly not to the people whom they are meant to be serving. Some of those bodies behave like third-world dictatorships rather than publicly accountable and socially responsible organisations.

Will the Minister ensure that she takes a very close look at the Devon Partnership NHS trust and makes a clear and unequivocal statement as to the future of the Briseham unit in Brixham, what facilities will be available in Brixham for people with Alzheimer's, what respite facilities will be available for carers and what domiciliary care and home facilities will be on call? The testimonies of carers of people who were cared for at the Briseham unit show that it was a hugely valued and vital resource for people coping with incredibly difficult situations. The way the Devon Partnership NHS trust has behaved cries out for an explanation. Perhaps the Minister can make some suggestions as to how it can move forward with the support of the entire community.

I congratulate Mr. Steen on securing today's debate and I welcome other Members whose presence this evening shows that they have concerns about this matter.

The hon. Gentleman is right to say that we must ensure that the needs and choices of older people—especially those with mental health difficulties—and of their carers are central to the services that they receive. We must ensure that they are able to play as full a part as possible in society, that their dignity is respected and that their independence protected. That is the central theme of the green paper entitled "Independence, Wellbeing and Choice", which is currently out for consultation. We hope that that will be a key driver in ensuring that people at the greatest risk of losing their independence will receive the services and care that they need.

I know from his speech this evening that the hon. Gentleman cares passionately and deeply about facilities for sufferers from dementia and Alzheimer's. In his role as a Constituency MP, he has clearly taken a very keen interest in those matters for a long time, and not just over recent months. I listened carefully to the concerns that he raised.

I want to pay tribute too to all the staff working in this field around the country. It is a highly specialised area, and the work can be very stressful, as it involves dealing with dementia and Alzheimer's sufferers and their families. The hon. Gentleman made it very clear that whole families are affected by the impact of those conditions on their loved ones.

I want to assure the hon. Gentleman that the Government are committed to improving the standard of care for those with dementia, and we have made available significant additional investment in order to achieve that. Indeed, more money than ever before is being invested in older people's services, but the hon. Gentleman is right to say that we must look to the future and take into consideration the fact that the additional investment in health care means that people will live longer, as well as the possibility that they may therefore develop dementia. We must keep our planning of services under constant review.

The hon. Gentleman drew a portrait of his area, and was right to say that needs are different in different communities, depending on the size of the elderly population. The Government can set priorities and frameworks beneath which standards of care should not fall, but we must also recognise that it would be ludicrous to plan every service in all communities. That would be an example of the dead hand of Government, so we must make sure that local services—the PCTs and strategic health authorities—play their part in the development of services, in consultation with service providers and, importantly, local communities and patients and their carers.

The Government recently announced the latest round of revenue allocations to PCTs, covering the period 2006–07 to 2007–08. Those allocations represent an investment of £135 billion investment in the NHS, with £64 billion going to PCTs in 2006–07 and £70 billion in 2007–08.

As the Majority of users of the NHS are older people—two thirds of all those in hospital at any time are over the age of 65—they will benefit in particular. In the hon. Gentleman's constituency, the South Hams and West Devon PCT will receive an increase of £19.7 million, or 17 per cent., for 2006–07 to 2007–08. Torbay PCT, which also serves some of his constituents, will receive an increase of £39.5 million for the same period.

In 2002, the Government announced an additional £1 billion for social services over three years from 2003–04 to 2005–06, to be invested in a range of initiatives to improve care for all older people. Overall, the Government have also announced total adult personal services funding of £11.5 billion for local authorities in 2005–06. That represents an overall increase in resources of around £850 million, or 5.6 per cent in real terms, when compared with 2004–05. That shows the steady progress being made by the Government in boosting the resources available in this sector.

The Government also recognise that older people with dementia need and deserve better services, and we have set in place a number of initiatives to ensure that they get them. We published a national service framework for older people in March 2001 to promote good mental health in older people, and higher-quality treatment and support for those with dementia and depression.

To build on the improvements we have already seen as a result of the national service framework for older people, the national clinical directors of older people's services and mental health services are helping to develop a vision of future mental health services for older people, together with a plan of action to help us realise that vision. That will help us nationally, but it should also help those planning local services. It will be launched in the near future.

Before I respond to the points that the hon. Gentleman made about the Briseham unit, it is important to note that all primary care trusts in Devon are reviewing how older people's mental health services are delivered and how they can be improved. As he will be aware, the Devon older people's strategic partnership, Torbay PCT and Torbay council commissioned the Sainsbury centre for mental health to look into the provision of mental health services for older people. The findings, which were published in December 2004, are being used to inform local planning.

The Sainsbury centre review outlined a number of key principles that it suggested needed to underpin services for older people in Devon, including more emphasis on community care and more support for service users and carers in their own home. However, I appreciate the point that the hon. Gentleman made. It is not a question of either/or, but of getting the balance right with a mixture of both sorts of care.

Work is now under way locally to draw up a pan-Devon commissioning strategy and drive forward the implementation of the report's recommendations. I understand that the strategic health authority is considering some of the issues that the hon. Gentleman raised in relation to funding and commissioning. I hope that he will engage in that process as it considers some of the complications caused by streams of funding to improve matters for the future. I understand that the group taking forward the pan-Devon commissioning strategy hopes to meet later this month, and it is anticipated that a strategy will be ready within the next two months. I urge hon. Members to make contact with their local area, if they have not done so already, to find out what is happening in that regard. In Torbay, the PCT has already developed a commissioning strategy that maps out the way forward for local mental health services, creating a service that is local, accessible and provides continuity of care for all.

I turn now to the specific issue of the Briseham unit. The hon. Gentleman is aware that the Devon partnership trust has decided that the services at Briseham unit will be decommissioned, and I understand that a public announcement will be made tomorrow. I know that the hon. Gentleman has had meetings this week that have informed him of that. I am assured that the trust has done all it can to ensure that the impact of the closure of the Briseham unit on service users, carers and their families has been kept to a minimum. I heard what the hon. Gentleman said this evening about individuals, and I will ensure that the Minister of State, my hon. Friend Ms Winterton, who has responsibility for that matter, is aware of the issues that he has raised tonight.

When the trust suspended the service in December last year, it made sure that alternative arrangements were made for all users of the service. The unit offered a mixture of in-bed facilities, day care and respite care. Some 19 beds were available, but the usage of those beds had fallen considerably, which raised questions about sustainability and the quality of clinical care. I understand the local community mental health team has been working closely with social services to ensure that the transfer of patients has been as smooth as possible and I am advised that service users who previously received residential respite care at Briseham are now being cared for at the Harbourne unit in Totnes, as the hon. Gentleman said. I understand his point about the journey time, and that and other important issues will have to be considered when it comes to future arrangements.

As a temporary measure, patients who received day care at Briseham were initially transferred to the Chadwell centre in Paignton and the trust is now in the process of finding patients appropriate day care in social care facilities or the independent sector.

I assure hon. Members that the decision to close the Briseham unit is not about saving money. Currently, the Devon partnership trust is working up a model of care for services in south Devon that supports the principles and recommendations set out in the Sainsbury review. That model will help to ensure that more people have access to local services, and it will see that the £780,000 currently invested at Briseham is redirected into enhanced, integrated services at the community level. Those services will include the establishment of fully integrated, co-located community mental health teams, and a community matron. An in-patient service will continue to be provided at the Fernworthy unit on the Torbay hospital site, which offers 24-hour admission for individuals in need of in-patient care. The new model of care will also include a team of community support workers located with, and managed by, the community team.

One of the concerns raised by the hon. Gentleman was the provision of respite care. That is a key priority for the NHS locally, and I understand that the trust is actively exploring options to develop more provision in social services and independent residential and nursing care homes to boost the amount of respite care available in different communities.

I understand that one option for the future use of the Briseham unit might include the transfer of services currently provided at Brixham hospital. Although only a proposal at this stage, it demonstrates the commitment locally to look at ways in which the Briseham unit can be used in the future. I understand that Torbay PCT will be making an announcement about plans for the future use of Briseham at its next board meeting on 29 June.

The hon. Gentleman made several points about consultation. I am advised that the issues relating to the Briseham unit were discussed with patients, staff and carers before closure, but he has made his point this evening and I am sure that it will be heard by the trust and others locally. I hope that I have taken his remarks into consideration and I do not underestimate for a moment his sincere concerns about the future of older people's mental services in his area. Often, such issues are hidden; families often feel uncomfortable talking about them in public because of the impact of dementia and Alzheimer's on their loved ones. We have to find a way—

The motion having been made after Seven o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.

Adjourned accordingly at one minute past Eight o'clock.