I beg to move,
That this House
notes that one in four people will suffer mental health problems;
is aware that mental health trusts are facing some of the largest cuts in planned budgets whilst already having to cope with worryingly high recruitment shortages;
further notes that patients with mental illness are often denied real choice in their treatments due to long waiting times for referrals and an acute shortage of non-drug therapies such as cognitive behavioural therapy;
is alarmed at the particular problems experienced by black and minority ethnic patients in accessing services;
is concerned at the continued absence of a Mental Health Bill almost four years after the first draft Bill was published;
and calls on the Government to raise the relative importance of mental health within the NHS, making early intervention a priority in order to enable access to a range of appropriate services and urgently to publish a revised Mental Health Bill which recognises the rights and dignity of people with mental illness.
May I say at the outset that I am sorry to hear that the Secretary of State is indisposed? We send her our best wishes. We are sure that it will be only a temporary indisposition and that she will be back performing her duties very soon. However, we are happy that the Minister of State, Ms Winterton, is here to speak for the Government on this subject, for which she is directly responsible in the Department.
The purpose of this debate is threefold. First, given that there has been no debate in Government time on the Floor of the House on mental health services since 1997, this debate will permit hon. Members not only to assess the future of those services, but to express their appreciation of the staff who work in them and their understanding of the needs of patients with mental health problems. Secondly, we want to express what I hope will be the view of the whole House, namely, that mental health services must not be the Cinderella services of the NHS that many people have often perceived them to be. The services deserve, and must have, priority, and that priority must be reflected in the delivery of the services. Furthermore, that delivery must not be compromised—and patients must not suffer—as a result of present or prospective NHS deficits. Thirdly, we want a reformed Mental Health Bill that people across the range of mental health interests can support to be brought before the House. Such a Bill was promised in the Gracious Speech, but there have been long delays. We want it to contain provisions that will provide dignity and a positive framework for those whom it is intended to serve.
Does my hon. Friend agree that this so-called reformed Mental Health Bill must address the considerations of the Scrutiny Committee—on which I sat—most of which were rejected by the Government? Does he also agree that any reformed Bill will need to have been really reformed?
My hon. Friend is absolutely right. My hon. Friend Tim Loughton also served on that Committee, and he and I are convinced that substantial changes to the proposed mental health legislation are required. The need for such changes could well be the reason for the delay in introducing the new Bill, but perhaps the Minister will tell us why the delay has been so great. There are things that we need from that legislation, and when we see the Bill in due course I hope that it will have been reformed in such a way as to command the support of the House. I also hope that my hon. Friend Angela Browning, with her experience, will contribute to those debates.
Will my hon. Friend confirm that there would be fewer people suffering from mental health problems in this country if the Government were to reclassify cannabis as a class B drug?
I am glad that my hon. Friend made that intervention. I had not intended to deal with that issue, but I think that he is right. Leaving aside the criminal justice issues, we should not underestimate the public health issues associated with drug use, and especially with the prolonged use of cannabis by teenagers. Some of the latest research by the Medical Research Council is pointing towards the existence of a common genetic mutation, occurring in about a quarter of the population, that could give rise to a substantial increase in the likelihood of psychotic episodes and schizophrenia as a result of prolonged cannabis use during the teenage years. That evidence should not be just put to one side—it should inform directly the calculation of potential harm that is supposed to underlie the advice given by the Advisory Council on the Misuse of Drugs. Sir Michael Rawlings, who leads that council and is chairman of the National Institute for Health and Clinical Excellence, ought to be rigorous in his examination of the medical evidence underlying those issues. If that has not been true up to now, I hope that it will be in future.
I happen to think that we should not have reclassified cannabis in the first place, and I did not vote for us to do so. In part, therefore, I agree with the hon. Gentleman. I must face the fact, however—and I hope that he will face it too—that since that reclassification, the number of young people using cannabis seems to have dropped. How will he deal with that issue?
I will not get into a debate about criminal justice issues. With respect to the hon. Gentleman, I will make my point about the health issue, which I have put on the record. Many Members want to speak and I do not want to take up too much of the limited time available.
No, I will carry on with my speech, if the hon. Gentleman will allow me.
Let us be clear that combating and overcoming the stigma attached to mental illness is at the heart of what we must do in relation to mental health services. My hon. Friend the Member for East Worthing and Shoreham and I visited the Brent Mind housing project this morning, where we talked to some of the tenants, most of whom have a dual diagnosis of schizophrenia and substance misuse of some kind. In relation to the impact of stigma, our discussion was very interesting. For example, they said that there is still a sense in which the public push the problem not just to the margins, but out of sight and out of mind. There seems to be an assumption that someone who has been mentally ill will not recover, and that the condition is permanent. That is not true. People do recover, medication is capable of assisting dramatically nowadays, and talking and other therapies can be very successful.
At any one time, 630,000 people might be receiving mental health treatment in this country, but that is only a fraction of the number who will at some time in their lives have mental illness—probably one in four of the population will have mental illness at some time. For many, it is a very traumatic but temporary condition. Therefore, we should not treat people who have mental illness and recover any differently from those who have had a broken leg. People recover and move on. Even if people are on medication, perhaps on a more or less permanent basis, we should not treat them differently. We do not say to diabetics that because they take insulin, their ability to work is necessarily compromised. We support such people, encourage them, help them into work and expect them to be integrated into society. The same should be true of people with mental health problems. Illnesses, whether physical, psychological or mental, should be treated in the same way.
As someone who represents a constituency with a high incidence of mental health problems, I find myself in the peculiar position of being in complete agreement with the hon. Gentleman's comments. Can he therefore explain why mental health was not mentioned once in his party's 2005 general election manifesto?
I am afraid that that is not true. The hon. Lady will find a mention of it, and we published substantial material on our approach to the mental health legislation, and the need for it, before the last election. I have a copy of our document with me.
My hon. Friend has talked about people recovering from mental illness. Does he agree that what he has said applies particularly to people in prison? Is he aware that 90 per cent. of prisoners have mental health needs, but are treated first and foremost as prisoners, which means that those needs are often neglected? If they are to leave prison, play a valuable role in society and be rehabilitated, should not their mental health needs come first?
I agree, and one of the measures that we have supported is the mainstreaming of health services for people in prison. If primary care trusts are to take over responsibility for that—and most have already done so—it does not bode well if they are trying to cut mental health services at the same time, as too many are. Given that a high proportion of those in prison have mental health problems, primary care trusts must ensure that mental health services are available.
By courtesy of my hon. Friend the Member for East Worthing and Shoreham, I now have the document relating to the Conservative party's reform of mental health legislation, "Compassion not Coercion", and also the mental health manifesto that we prepared before the last general election.
Not at this point.
We need to be clear about the current state of mental health services. The Government's amendment understandably emphasises the publication of the national service framework in 1999. As I have said, while it is to be applauded as a statement of priority, we need to ask what it does in terms of delivery. Let us examine some of the national standards contained in it.
First, there is the intention that there should be health promotion and that discrimination should be combated. Spending on promotion of mental health specifically has fallen to £2 million, a tiny fraction of the mental health budget, and is 60 per cent. lower than it was in 2001. As for discrimination, I am afraid that it is still unhappily true that black African and Caribbean patients are 44 per cent. more likely to be detained.
The second national standard emphasises access to diagnosis and effective treatment. Access to cognitive behavioural therapies is seriously lacking. In his recent report, Professor Layard said that we needed 5,000 more psychological therapists, and the Sainsbury Centre for Mental Health recently spoke of GPs with no access to CBT for their patients and a wait of up to six months for counselling. Responding to a survey by Mind, 47 per cent. of mental health service users said that their treatment was held back considerably by not being given the treatment that they needed. That standard, too, has not yet been met.
The third standard relates to round-the-clock contact. Crisis resolution and assertive outreach services are of course useful, and they have perhaps been the principal innovation of the national service framework. However, if core services are plundered so that crisis resolution and assertive outreach services can be fed, the net effect will be that although it may be possible to intervene at night and try to deal with a problem—and I know that many GPs' out-of-hours services value crisis resolution—the system will not work if the patient cannot be dealt with immediately the following morning.
The fourth standard recommends a care programme, but 50 per cent. of mental health service users are not offered a care plan. The fifth standard refers to timely access to hospital beds. Just over a fortnight ago, the Mental Health Act Commission said
"Over half of all wards are full or have more patients than beds."
As an indication of the way in which mental health services are viewed, what could be more compelling than the simple fact that when the Healthcare Commission's patient environment teams looked at hospitals, the only six that they found to be unacceptably dirty—they described those hospitals as "standard 4"—were mental health hospitals? As Members will know, given the definition of "unacceptably dirty", that was a pretty condemnatory conclusion for the teams to reach.
I am grateful to my hon. Friend. He leads me on to the area that I want to turn to next.
There have been improvements and extra resources, but the resources going into mental health services have not kept pace with the resources committed to the national health service as a whole. That is an indication of its relative lack of priority.
I will not give way for the moment.
Some of the progress that has been made is directly threatened because of the reductions in funding to meet deficits. It will not surprise hon. Members that I want to talk about Cambridgeshire. It is one of the areas where the cuts in mental health services are most profound. A letter was sent to me just a fortnight ago by psychologists and psychological therapists working for the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust. They say of the changes in Cambridgeshire:
"these are not minor trimmings or adjustments to services: they are cuts of essential, frontline services."
We are talking about the closure of in-patient beds. What most distresses me and many people in Cambridge is the closure of Douglas house, which provides a young people's service, and the cutting of access to services for young people.
I have raised that matter with the Secretary of State. We have had meetings. I have received correspondence. Everyone in Cambridge knows perfectly well that it all tracks back to the Government's failure to reflect adequately the genuine mental health needs in Cambridgeshire, and in Cambridge in particular. They should look not at their own demographic analysis, but at the actual demand and need in the community. All the Secretary of State keeps telling us is that it is not her responsibility but that of the local primary care trust. The trust keeps saying, "We just do not have the money to reflect the need that we have." When we go back to the Secretary of State, she says, "The statisticians have done their work and the work is as good as we can make it." So everyone is responsible except the Secretary of State—it is the statisticians and the primary care trust that are responsible. Never does she take responsibility for the impact of her changes and cuts.
The predicted deficits in mental health trusts are nothing like as serious as the cuts in services will be. The PCTs are shifting deficits into mental health trusts. That is affecting not just Cambridgeshire but Oxfordshire, which has lost seven consultants, and seven senior house officer and registrar posts. Mental health wards have closed in Westmorland. Supporting people budgets have been reduced in many parts of the country. In south-west London, particularly in the St. George's Mental Health NHS Trust, there have been widespread reductions and there is a major deficit. Psychiatric beds have closed in West Park hospital in Durham. In Lambeth, there is the potential closure of the Maudsley emergency clinic. There is also the possible closure of a mental health ward at Loughborough or Coalville hospitals. There are other examples.
Perhaps the hon. Gentleman is being a little unfair on the Government, who have increased resources in real terms by 25 per cent. There are now 8,000 psychiatric nurses, 1,200 consultants and 3,000 clinical psychologists. He seems to be drawing together examples from university towns—Cambridge, Oxford, Loughborough and elsewhere. Does he agree that we need to do much more in the FE and HE sectors to promote mental health? Ten per cent. of young people between the ages of 11 and 25 self-harm, suicide is the cause of 20 per cent. of the deaths of young people and the age group that commits suicide the most is young men aged between 15 and 24. Should not more be done in that regard?
At least the House is spared a speech from the hon. Gentleman by virtue of that intervention. I say two things to that. First, £30 million is now being spent on student counselling services. It is much increased. That is a measure of the need among students for mental health services. Secondly, in Cambridge, as David Howarth will know—
No. I will make the point because I know what the hon. Gentleman would say.
If the Government's statisticians treat students as affluent because they are not on benefit, and therefore as having much less mental health need, they are plain wrong. That is a good illustration of the absurdity of the way in which the mental health needs index is compiled.
No, because I have to finish. I beg my hon. Friend's pardon, but I have to conclude my speech.
We need to be vigilant about mental health service cuts because there is a major risk. Not only has there been less of a priority for mental health services than for other services, but with PCTs having to pay acute hospitals dramatically increased costs and having no choice but to pay for the GP contract, it is mental health services such as community hospitals that are bearing the brunt of the reductions in services.
We must look for a positive change in the future, in terms of priority and of the mental health legislation, which I hope we will have an opportunity to debate in substance when the new Bill is published. However, it must be a Bill that has neither a broad-ranging definition of mental disorder nor a broad-ranging definition of medical treatment, while giving an opportunity for community treatment orders to be imposed on a widespread basis. There are many people—particularly from the black and minority ethnic communities—who know that they are far more likely to be the subject of detention and who fear that the extension of such orders in the Bill will lead to widespread assumptions that they can have community treatment orders imposed upon them.
There is a major risk with the legislation that instead of achieving greater safety for the community, it will undermine compliance and support for patients in the community. Patients will not wish to present to mental health services and we will end up with patients untreated and the community less safe. That is the risk with the Government's legislation.
What do we need for the future of mental health services? We need the Bill to be published in a way that is geared to the positive treatment of patients, encourages compliance with treatment and supports clinicians in what they have to do, rather than taking the Home Office approach of coercion. Mental health services need greater priority and I want the Minister to tell the House that the increase in mental health resources will match the increase in NHS resources as a whole. We need to bring mental health more into the mainstream, so that GPs have greater access to mental health budgets for their patients and more responsibility for seeing the whole of the mental health patient pathway, rather than their being, as at present, more or less forced to abdicate responsibility and hand it over to mental health trusts.
Patients need more choice. At the moment there is no "choose and book" for mental health patients. Indeed, the Government have also virtually given up on direct payments for mental health patients. Mental health patients do not have control when, sometimes, their exercising greater control over the management of their care can in itself make a major contribution to the way in which they can make progress.
We must have dignity through the Bill, we must have no discrimination and we must have support for carers. At the moment, many carers who are supposed to have annual appraisals very often do not have an appraisal of their needs. We need them to be supported. We need all of that, and we need more. However, what we need most of all is to understand that the stigma of mental illness is completely misplaced. All of us are at some risk of mental illness at some time in our lives and we would not want that stigma to be applied to us. We would wish those services to be available for us if we needed them, so we should do no less for our constituents.
I beg to move, To leave out from 'House' to the end of the Question, and to add instead thereof:
"recognises that the Government has made mental health a key priority through the National Service Framework for Mental Health and the NHS plan;
welcomes the achievements set out in the National Director's progress report published in December 2004; further welcomes the record increases in investment and staffing;
notes that under this Government there are now over 700 specialised community mental health teams and that suicide rates are the lowest since records began, that there are 1,200 more consultant psychiatrists, over 3,000 more clinical psychologists, and 8,000 more mental health nurses than in 1997; further welcomes the Government's five year action plan to tackle inequalities in mental health services amongst black and ethnic minority communities and its action to tackle social exclusion in mental health;
acknowledges the Government's commitment to early intervention to support good mental health and improve preventative mental health services in the community, as set out in the recent White Paper "Our health, our care, our say: a new direction for community services", including by improving public understanding of mental health issues to counteract stigma and discrimination, expanding access to psychological therapies including cognitive behavioural therapy, promoting the use of information technology recently reviewed by the National Institute for Health and Clinical Excellence which supports people to take charge of their own treatment, and working with health professionals to improve standards in mental health services in the community;
and further welcomes the Government's commitment to reform mental health legislation as soon as parliamentary time permits."
As Mr. Lansley said, one person in four will suffer from mental ill health during their lives. Mental ill health can have a devastating effect, not just on individuals but on their families and society as a whole. Social exclusion, discrimination and stigma add to the suffering. Less than a quarter of adults with long-term mental health problems are in work. They are nearly three times more likely to be in debt, and can struggle with basic requirements such as transport or decent housing.
More than 1 million of the 2.7 million people claiming incapacity benefit list mental or behavioural conditions as their main disability. It has been estimated that mental illness costs the country up to £25 billion a year—in other words, 2 per cent. of gross domestic product. That is why this Government have recognised the importance of mental health to the well-being of the whole nation, not just of individuals. Along with cancer and coronary heart disease, mental health is one of our top three health priorities.
By 1999, within two years of taking office, we had published the national service framework for mental health—a ground-breaking and ambitious 10-year programme of reform and investment for mental health care in England.
I recognise that the Government have spent more money on mental health services. The Worcestershire Mental Health Partnership NHS Trust invested money in providing a home care service and we are very grateful for that, but the downside is that the Government are now saying that we must live within our original budget. The result is that mental health care in-patient beds are being cut to make the figures add up. Can the Minister explain why that is happening?
If the hon. Lady will allow me to make a little progress, I will come to some of the points that have been made about the financial situation in mental health and the effect on trusts themselves.
My hon. Friend will be aware that I worked as part of a primary care psychiatric team when the Conservatives were in power. They introduced a policy called care in the community, which was in a fact a con in the community, and led to many psychiatric patients wandering around city centres throughout the United Kingdom. Since then, have we not introduced a co-ordinated strategy consisting of investment not just from the health service, but from local government and the voluntary sector?
My hon. Friend describes very well the direction in which we are travelling, and it is important that we have such support in the community; we need input not just from the health service but from local government and the voluntary sector. I have seen some very good examples of the three working together to make an incredible difference not just to people with mental health problems, but, crucially, to those who support them—their carers, families and friends. Such support in the community is vital.
I am grateful to my namesake for giving way. Will the Minister not express some concern about the over-rapid closure of mental hospital beds, which has caused huge problems not only for the mentally ill who really should be accommodated in hospital, but for their families and the community? Community care has an important role to play, but have not too many hospital beds been closed? Will she consider that issue, and in particular the proposed closure of acute mental hospital beds in east Cheshire by the Cheshire and Wirral Partnership NHS Trust?
Perhaps I can combine my answers to the interventions that have just been made. Rapid closure under the previous Administration left people vulnerable in the community, and I hope to demonstrate that this Government have provided support in the community through crisis resolution teams and early intervention teams. The idea is that in-patient care should become very much the last resort. I hope that Members appreciate that removing people with mental health problems from their families and their home environment is not always the best road to recovery; if we can support them in their own homes, that is the way to go. I have visited a number of places where it has proved possible to switch resources from in-patient care to community home care teams, and we should not underestimate the importance of making that shift.
Such reshaping of services can help people to live for longer in the community and to avoid removal to hospital, which is sometimes inappropriate. That approach is ambitious, and that is why we have a 10-year programme. In many instances, it requires services to make switches that they may not be used to, but once the changes have been made, a big improvement has been seen. The plan followed widespread consultation and was warmly welcomed by the professions. I accept that professionals would like to see further changes, but in general the plan has been well received. In 2000 we followed it up with the NHS plan, which set some clear targets for mental health services.
I welcome what my hon. Friend says, but does she agree that if the strategy is to succeed, advocacy should be at the heart of Government policy? Will she confirm that it is still there?
Of course, and I hope that my right hon. Friend welcomed the announcement about the advocates for people with mental incapacity, which we discussed at some length during the proceedings on the Mental Capacity Act 2005. He is right to say that advocacy is an important part of ensuring that our mental health services are modernised.
I accept what the Minister says about the desirability of people being treated in the community if possible. Will she in turn accept that if someone suffers from an acute psychiatric breakdown there is no prospect of their being able to look after themselves in the community, and they will need to be an in-patient? It is important that such an in-patient should not be put in with people with different types of mental illness, who may be psychotic or even violent. What progress have the Government made to ensure that regard is had to the very different types of mental illness, so that people are treated separately where appropriate?
It is important to ensure that people who are dangerous or violent are held in more secure units than those suffering, for example, from a clinical breakdown. That is why we have increased the number of medium secure beds, why we have looked at changes for the high-security hospitals and why we have many more low secure beds. It is important that we make the distinction between people who need a secure environment and those who do not.
It is also important to recognise that people may reach a crisis point, and to ensure that if they need to spend some time in in-patient care, it is the minimum period necessary for that individual. We need to have the modernised services that I have mentioned in place—made possible through our increased investment, which I shall talk more about later—so that the time spent in hospital is minimised. That is because people often make a better recovery if they can have help in their own homes and communities.
It is good that the Government are giving community care a high priority, although perhaps not as high as some of us want. It is also good that the Opposition, by initiating this debate, are showing their commitment to improving mental health services.
On the subject of in-patient beds, is my hon. Friend not concerned about the huge increase in the number of patients who are in private facilities? The Mental Health Act Commission report cited by Mr. Lansley pointed out that the number had increased from 700 to 2,300 and although those institutions may have been cleaner, which is good, they had poor back-up facilities for emergency care. They are also expensive, so why is the NHS not improving its own in-patient provision?
Recently we announced investment of £130 million to improve in-patient facilities—but my hon. Friend is right, in that there has been a long tradition of using the independent sector in mental health care. We need to look closely at the commissioning that PCTs and others undertake in the private sector, to ensure that they carefully consider local needs so that people can remain as close to home as possible. There have been big advances in that commissioning, but we can certainly make improvements and I want to ensure both that we get good value for money, and that care takes place as close to the patient's home as possible, so that people can obtain the necessary back-up.
The national service framework was accompanied by record investment. According to the European Commission, the UK has one of the highest proportions of its overall health budget devoted to mental health of any EU member state. Those extra resources, which the Opposition voted against, have been put to good use. Compared with 1997, when we took office, we have 20 per cent. more psychiatric nurses, 50 per cent. more consultant psychiatrists and 75 per cent. more clinical psychologists. The suicide rate has fallen to its lowest recorded level and, again according to the European Commission, is one of the lowest in Europe. I hope that all Members welcome that.
The NSF proposed 170 new assertive outreach teams for people at risk of losing touch with conventional services—I think that was the point that Dr. Lewis raised. By March 2005, there were 262 such teams, providing badly needed support to about 20,000 people. In addition, the NHS plan envisaged 335 crisis resolution teams to give intensive support at home to people suffering a crisis in their mental health. By March 2005, there were 343 teams and they had been able to help nearly 50,000 people.
How can we help carers? They often carry a financial burden and are also under stress. How do their needs fit into the 10-year plan?
I agree that the needs of carers, especially those who look after people with mental health problems, are paramount. In the NSF, we have tried to provide extra support for carers, not least in the difficult situations that can occur. Sometimes it is difficult for a person to live close to someone with a mental health problem, and such situations need to be managed. In the White Paper, we set out a raft of measures in relation to carers, which, obviously, will apply to people caring for those with mental health problems. The best services that I have seen are those that have involved not only service users, but carers as well, in shaping them.
There is not much point in closing down purpose-built institutions for residential mental health care, such as the Brischam unit in Brixham, on the basis that people with dementia would prefer to be looked after by carers in their own homes, if the carers are driven to distraction by having nowhere to send their cared-for person with dementia, because all the purpose-built residential homes have been closed down.
The hon. Gentleman is referring to the need for good respite services. It is not necessarily perhaps a case of the constituents to whom he alludes wanting their loved ones to be elsewhere; they want a combination of care and support at home, with respite facilities as well. He is right to say that we all need to consider how we can increase those respite facilities, sometimes by turning inappropriate beds into respite care beds. That is an important approach to take, and it is sometimes important to consider what lies at the end of such proposals. For example, if a trust is talking about closing an institution, it should consider whether any such decision is backed up by a different type of service that better fits patients' needs, and respite care is very often involved.
Does my hon. Friend agree that having some form of mixed economy in mental health service provision is important? The residential rehabilitation service that may be appropriate for one person with a drug or alcohol problem may be wholly inappropriate for another, yet residential rehabilitation might be necessary for others—perhaps provided by the voluntary sector, which offers a very different style of service from that which is available from the state.
My hon. Friend makes an important point. We need to make better use of the voluntary sector, because in many senses it has been able to reach out to people who may not have been gaining access to services. We need to maximise the use of those skills. Last year, I launched some guidance with Victor Adebowale. It was all about how trusts needed to look closely at their relationship with the voluntary sector, and how they could operate services jointly. That approach fits in with our recent White Paper, and it applies particularly to mental health.
I need to make some progress.
In total, more than 700 new multi-disciplinary teams are now working for mental health in the community. The NHS plan proposed expanding by 150 the capacity for secure places for people with severe personality disorders. We now have 205 of those new places. The NHS plan set a target of 500 community gateway staff—experienced mental health professionals—to improve patients' access to specialised services. We now have more than 1,500 of them, compared with our target of 500. The NHS plan also set a target of 50 early intervention teams for younger people who experience the first onset of psychosis, and we now have more than 100 of those teams.
I should like to take this opportunity to pay tribute to the many thousands of people who work in mental health services. Too often they go unrecognised, but without them we would not have been able to make real improvements in services for some of the most vulnerable and often excluded members of our society.
The Government amendment spells out some of the progress that has been made, and several trends are encouraging. Does the Minister agree that among young people, levels of self-harm and indeed suicide, especially among young men between the ages of 15 and 24, are distressingly high? Is she planning any initiatives to target young people, especially those in higher and further education who are living away from home? There is still a problem to be resolved.
My hon. Friend is right, because obviously, any suicide is a suicide too many. However, the success of the suicide strategy has meant that the numbers have dropped considerably and we are leaders in the European Union. There are a range of things that we can do to support more people in the community, but I will come to that later.
I thank the Minister for giving way—she is being very generous. When I went to see her in July, I mentioned Shelton hospital, which is set to be the last working Victorian asylum unless it is rebuilt, which is the plan of Shropshire County primary care trust—the lead organisation—Telford and Wrekin PCT and Powys local heath board. Five years ago, the cost of the project would have been between £40 million and £50 million, but it has now grown to £85 million. The strategic health authority has put the project on hold because of the problems in Shropshire's health economy. If the delays carry on, there will be a bill of £400,000 each month. When does the Minister think that the last Victorian asylum will be replaced, thus saving taxpayers the £400,000 that is lost for every month that the delay continues?
The hon. Gentleman knows very well that it is for his local trust and strategic health authority to examine that matter closely. It is important to move services into the community as much as possible. Obviously we must preserve some in-patient care, but the more we can provide modern reformed services in the community, the better. We have announced extra investment to improve in-patient facilities, but that matter is for local discussion.
Much of the debate has been focused on adult mental health services and services for younger adults, especially in relation to suicide. Will my hon. Friend say a few words about mental heath services for children and adolescents, and the fantastic work that is done in that area?
My hon. Friend is right to say that excellent work is done in that area, too. There have been shortages in some of the professions involved in mental health services for children and young adults, so we are trying to address that problem. It is important to ensure that there is co-ordination between mental health services for younger adults and those for older ones. Too often people get caught in one area or another, which causes enormous difficulties. We have taken steps to ensure that there is better co-ordination, and our tsar, Professor Louis Appleby, has taken an overall strategic view on that.
At a suitable point, I will.
In 1999–2000, the NHS and social services spent £4.74 billion on mental health services. In 2003–04, the figure had risen to more than £6 billion, which was an increase of more than 27 per cent, or a £1.2 billion increase in real terms. As was shown in a recent independent survey of planned mental health investment, the increase has continued in subsequent years. There has been an increase every year since we published the national service framework. Such unprecedented investment has allowed us to make significant improvements to mental health services.
My hon. Friend will agree that early identification is paramount; often, people who are developing mental illness first come into contact with generalists rather than specialists. What conversations has she had with professional bodies representing different medical practitioners about making mental health a core component of their training?
We have been looking closely at specialist GPs, who can make an early diagnosis. We also want to facilitate the professional exchange of information, so that practitioners can look out for those early symptoms, and they can be followed up by intervention teams if people are obviously deteriorating.
I want to address some of the points that the hon. Member for South Cambridgeshire made about what he called cuts to mental health services, and it will be helpful if I set out some of the facts. In response to concerns expressed in the past few months, we recently asked for information from all 28 strategic health authorities. Twenty of them reported no reductions to planned expenditure on mental health services this year; the remaining eight reported that there would be reductions in planned expenditure affecting 11 trusts—11 trusts, of 84 trusts in England. Those trusts had planned to spend £894 million this year, and they are reducing their planned expenditure by a total of £16.5 million—2 per cent. of the total.
To summarise, 11 of 84 trusts are making expenditure reductions that amount to £16.5 million out of a total expenditure on mental health of more than £6 billion—0.3 per cent. of the total. Of course, in the light of the extra investment that we have made, we would prefer it if there were no planned reduction in expenditure. However, I hope that I can assure right hon. and hon. Members that strategic health authorities are working with those trusts to minimise any impact on patient services.
Does the Minister agree that despite the figures that she has quoted, many people working in mental health services, particularly in the community, still feel that they are part of a Cinderella service, that there are huge gaps in their opportunity to deliver services, and that those gaps are being filled week after week, day after day, by those working in the voluntary sector?
I believe that there has been a turnaround in the delivery of mental health services in this country, owing to the extra investment and the changed ways of working. It is important that we, as Members of Parliament, recognise those changes. There have in the past been difficulties in recruiting people to mental health services because they are constantly told that those are Cinderella services that are on their way out. We must recognise that mental health care is an exciting place to work, with new, modernised, reformed services that have received extra investment. We must recognise, too, that three out of four patients who use mental health services are very satisfied with the service that they receive.
I turn now to our plans for mental health services, as set out in our amendment.
I have taken a number of interventions, and I am afraid that if the hon. Gentleman's Front-Bench colleagues are complaining about the time that I have taken, I can take no more interventions.
We have introduced many new community services, but as I have said, it is also important to ensure that there is high-quality in-patient care, which is why we committed £130 million of capital investment to that. However, it is true that some people are still waiting too long for treatment and some are having difficulty in accessing the sort of treatment that they would choose for themselves, particularly psychological therapies such as cognitive therapy. For people with signs of mild depression or anxiety, psychological therapies can extend choice, reduce waiting times and help to keep them in work or support them in getting back into work earlier.
Earlier in my hon. Friend's speech she referred to 40 per cent. of the people on incapacity benefit, and I welcome her point about early intervention. Would she give encouragement to staff at my local Jobcentre Plus whom I met yesterday, who are keen to work with GPs and offer them support in that important area?
I am pleased to hear that my hon. Friend's visit to Jobcentre Plus had such productive results because, as the pathways to work project has shown, extra help and advice can make a real difference to getting people back to work.
We are committed to widening access to psychological therapies as a supplement to medication, as recommended by the National Institute for Health and Clinical Excellence, and we clearly set that out in the White Paper that we published last week. We will be looking to provide faster access to more specialised services for those who need them, and more choice for people in the kind of care that they receive, and in who provides that care. We will set up two demonstration sites that will focus on people of working age with mild to moderate health problems and aim to help them stay in, or return to, work. We also know that people with mental health problems suffer from serious inequalities in physical health, which is why our White Paper on public health set out a series of ways to tackle those inequalities.
The hon. Member for South Cambridgeshire spoke of access to, and experience of, mental health care for black and minority ethnic communities. For decades the problem went unrecognised and unchallenged. We have begun to change that. A year ago, following the report on the death of David Bennett, we published "Delivering Race Equality in Mental Health Care", a comprehensive five-year action plan to put right what was clearly unacceptable. One of the first steps along the way was last year's census of mental health in-patients. It confirmed the problems that we knew existed for people from black and minority ethnic communities. That is why, alongside the census, we have chosen 17 places throughout the country that are leading the implementation of the five-year action plan.
There is no such thing, I am sure, especially in the hon. Gentleman's case.
The hon. Member for South Cambridgeshire talked about the draft Mental Health Bill. We will introduce the Bill when parliamentary time allows. It is vital that we modernise mental health law and bring it into line with human rights legislation. Where compulsory treatment is necessary, we must reach a quality and level of service that gives people the treatment that they need and minimises the need for further periods of compulsion. These are not easy issues to deal with, but we are determined to do so.
Improving the mental well-being of individuals and our wider community, and tackling the stigma and discrimination suffered by those with mental health problems, will not be achieved simply by modernising mental health legislation and reforming mental health services. We need an approach that stretches across Government, which is why in 2004 we published the social exclusion unit report, which sets out a series of steps that need to be taken by the Government at all levels. For example, we need to examine access to housing, employment and a range of local services, which many of us take for granted. That is also why we published the health, work and well-being strategy at the end of last year, which looks at how to help people stay in work, and also how to help people back to work. That was part of the overall direction of travel set out in our recent Green Paper on welfare reform.
Let us recall the situation 10 years ago, and how mental health services looked then. We had thin community services, modern treatments were rationed, and the use of the Mental Health Act 1983 was rising year on year because of pressure on acute care. There was no clear policy direction, and there was no action in critical areas, such as the care of people from ethnic minorities. Anybody who was working in the service 10 years ago, and who looks at it again now, knows how much has changed. It is no longer a Cinderella service. It is a vital and thriving part of a modern national health service.
Our record on mental health is one of unprecedented progress and achievement. What I have described today is a serious, radical and long-term programme of change and modernisation. That is the future of mental health care under this Government. I urge hon. Members to vote against the Opposition motion and for our amendment.
I begin by reinforcing the Minister's words of praise for those in the national health service and the voluntary sector who work with people who have mental health problems. I am sure that all hon. Members who meet those who work on the front line admire their commitment and dedication. Many of them are doing jobs that I would find very difficult.
I welcome the fact that we are having the debate, and the selection of subject matter. It is a neglected topic of debate in the Chamber. In the eight months that I have been spokesman for our party, this is the first opportunity that I have had to debate it in the Chamber. I hope that the choice of subject represents a genuine change and a genuine commitment by the Conservatives to the NHS, and that it bears no relation to the recent letter from the Conservative leader to his colleagues, urging them to get active on the NHS and shed the party's negative image on the health service. I hope it is a lasting commitment.
The hon. Gentleman will recall that he entered the House in the same year as I did—1997—and that having come second in the ballot for private Member's Bills, I introduced a Bill on mental health services. I am grateful for the strong support that I received from the Liberal Democrats at that time, so the hon. Gentleman should be aware that there is a tradition among Conservatives of being concerned about these matters. I did not hear the Minister say anything about the abolition of mixed sex wards, which was an interest that the hon. Gentleman and I had in common. Is he aware of what progress has been made, and will he put that to the Minister?
I am happy to pay tribute to the hon. Gentleman's personal record on these matters. Mixed sex wards are an important issue. There was a Labour manifesto commitment to get rid of them entirely, yet one in four patients across the national health service, including all forms of health care, still experience a mixed sex ward at some point during an in-patient stay, which is a long way from the rhetoric. I hope that in winding up, the Minister will be able to address the up-to-date position on that.
Not at the moment. Those on the Conservative Front Bench are keen that as many as possible of the hon. Gentleman's colleagues get in.
When one reads Government amendments in debates such as this, one often wonders what world they are describing. We have just heard the Minister describe an unprecedented programme of achievement and progress. As an antidote, so to speak, to the Government rhetoric on the health service, the Liberal Democrats some months ago established a website designed to give members of the public around the country an opportunity to feed in both good and bad experiences of the health service. We have received many comments through libdemnhswatch.com about what is happening in mental health services around Britain. I shall refer to one or two examples, which put a different perspective on the Government amendment and the Government's spin.
One submission that came in a couple of months before Christmas was from a gentleman in the Bristol area, who wrote:
"I would comment on the provision of mental health care as little or none. I suffered from depression and was given tablets and a list of private practitioners who I could contact—this was not the GP's fault, and indeed she did all she could to listen, and take care of me to the extent that the NHS provides for."'
One of the themes of my remarks is that GPs are in the front line of mental health provision. The GPs to whom I talk say that perhaps three quarters or four fifths of mental health provision is done by GPs, many of whom are not trained to any great degree to do it, and that perhaps a third of GPs' time is taken up with mental health issues. There is a real gap—I do not mean this pejoratively—between the relatively superficial level of support and care that an untrained generalist can provide and the most acute in-patient care. There are some very big gaps in that spectrum and, as a result, problems arise from the lack of preventive work being done in the community.
The person who contacted us talked about raising £400 scraped together out of a student loan, which comes back to the point about young people with mental health problems. He says:
"I spent 8 months on some very pricy drugs, at around £150–£250 cost to the NHS every 2 weeks . . . Had I been treated with therapy,"— which is mentioned in the Conservative motion—
"one of the long term solutions, . . . the NHS would probably have saved money!"
If the NHS can deal with people effectively up front, it will potentially save money.
Not at the moment, but I will endeavour to do so later.
Mr. Lansley mentioned the situation in his county. I shall give an example from our website about Cambridgeshire mental health services. The lady concerned says that, as a result of the cuts in Cambridgeshire mental health services,
"my son . . . will lose his care nurse and contact with his consultant".
She goes on:
"Cambridgeshire used to be an example of outstanding care in this field . . . but now this is being broken up as too costly (for the NHS), pushing responsibility onto Social Services Departments which do not have a good record."
That is a vital point. The Minister says, in effect, "Well, it is only 16 million quid", but these individual human stories show that for every small cut in provision, there is real human misery. The Minister should not dismiss £16 million of cuts. She implied that it is nothing terribly significant because it is only a fraction of 1 per cent. That is not accurate.
My key point concerns the link with social services budgets. Until these are single budgets, we will get this absurd cost and deficit-shifting and lack of an holistic approach to people's overall care and health needs. If cutting health provision merely shunts the cost on to someone else, we will not get the decision that is in the best interests of the patient or member of the public but the decision that works best for the individual ring-fenced budget. That cannot be a rational way in which to proceed.
The snapshot of cuts that the Minister mentioned is literally that—a snapshot. In Oxfordshire, we will lose £5 million of our mental health budget, but that is over a period of three years. The hon. Gentleman is right to say that every cut has an effect. We have just lost the Ridgeway day centre in Didcot, which is a good example of a service that will not come back.
I am grateful to the hon. Gentleman for highlighting the fact that whereas the Minister was talking about cuts in the current year's budget, some of them will go on, and accumulate, for much longer.
The hon. Gentleman mentioned Oxfordshire. Another person who visited our website commented that when they became ill in Oxfordshire some years ago, they received treatment that they described as being of a good standard, but that recently
"Oxfordshire Mental Healthcare has been severely affected, the psychiatrist that I saw has now left, and there is a chronic shortage of" community psychiatric nurses. He goes on:
"People who now suffer as I once did are not receiving the treatment that I was so fortunate to have".
That is the main concern. Perhaps this is absurdly naive of me, but if Government amendments were more balanced in recognising that while they can cite statistics that show improvement, there are also worrying areas, one might almost think about voting for them. We cannot do so, however, while they remain so Panglossian in saying that everything in the garden is rosy.
I want to highlight a couple of other individual cases. We can trade statistics in such debates, but never get to the kernel of the issue. I was approached confidentially by a constituent who has given me permission to cite his case. His wife had suffered from suicidal tendencies. This was another instance of GPs wanting to help but being unable to cope. He said that
"it cannot be acceptable that somebody with suicidal tendencies (my wife has threatened suicide over 80 times since 1997) cannot get help until they actually take the step to kill themselves".
In a crisis, the urgent in-patient services step in but there is a huge gap in the middle, and a lack of support and training for GPs.
The GP may not always be the right person for someone with mental health problems to see. The GP may not respond appropriately and the person with mental health problems may not feel able to go to a GP. Has the Minister considered other routes for accessing the health service, for example, through access workers? Are the Government trying out those approaches?
No, I shall not. [Hon Members: "Go on."] No, not even briefly.
Before I consider broader policy matters, I want to examine emergency provision in circumstances in which a family member with mental health problems, who perhaps lives in a care setting, comes home, for example, for Christmas and things go wrong. I have recently come across two cases of people with mental health problems spending the night in a prison cell. Parts of the country have a protocol whereby that should not happen, but it has happened twice in my area relatively recently. At short notice, there was nowhere for those people to go and they ended up in a prison cell. That was traumatic for the family and the individuals, and the police knew that it was the wrong place for them. Will the Minister say something about short-notice crisis provision and alternatives to a prison cell?
As I said, we must consider whether GPs need substantially more training and whether there are alternative ways of accessing mental health services. However, we must take into account not only the mental but the physical health of those with mental health problems. When I recently attended an event that was organised by the charity Rethink, I was startled to discover that people with severe mental health problems can expect to live perhaps 15 or 20 years less than someone with similar physical problems.
For example, American evidence shows that people with severe mental health problems who develop cancer are 50 per cent. more likely to die of it than those without mental health problems. There are genuine worries about the ability of people with mental health problems to access care for their physical health. Looking after people's physical health helps their mental health. We need a much broader agenda that does not separate budgets for mental health and for physical health but perceives them as an integrated whole because one can beneficially feed into the other.
Mr. Flello mentioned mental health services for children and adolescents. He rightly said that much good work is being done. However, the charity YoungMinds suggests that the pressures on primary care trust budgets mean that those for community and adolescent mental health services are also under pressure. What reassurances can the Minister give that those groups are being properly looked after?
Let us consider the other end of the age scale. Many hon. Members will have attended a Mind event entitled "Access all ages" about mental health provision for older people. There is a danger that society assumes that those who are old become "a bit senile" and that mental health deterioration is simply part of getting old. We need to counter that assumption and ensure that we do not take it for granted that older people will have mental health problems.
This week, the Commission for Social Care Inspection published a report, with which the Minister will be familiar, which found that the management of many elderly people's medication in care homes is inadequate. That will undermine the mental health of many vulnerable older people and I am worried about that.
The motion mentions the position of those in black and minority ethnic communities, who are more likely to be in hospital with mental health problems, to be sectioned under the Mental Health Act 1983 and to be physically restrained. Do the Government understand the reasons for that and how far it is due to discrimination or different patterns of provisions? What is being done about that?
Let us consider positive action that can and should be taken. The Minister will have come across the Institute for Public Policy Research report that was published last year on "Mental Health in the Mainstream", which makes several specific recommendations. I shall touch on just a couple of those recommendations. First, the report talks about getting access workers into health services where GPs are inappropriate. What does the Minister think about that idea? How seriously has it been taken over the past few months? Secondly, it considers the use of "non-pharmacological" treatments, therapies and so on, and says that the key is prevention—getting in early, before things get out of hand.
Before concluding, I want to mention a couple of wider issues. The first has been mentioned already in the debate—the position of people with mental health problems in respect of the incapacity benefit system. It is worrying that the Government are proposing a carrot-and-stick approach: although it is possible that more money will be given to those people who jump through the right hoops when they apply for the benefit, the stick of sanctions might be applied to others. What discussions has the Minister had with the Department for Work and Pensions about the impact on mental health patients who fear that they will lose their benefit if they do not do certain things? What assessment has she asked that Department to make of the impact that changes to incapacity benefit will have on people with mental health problems?
There are three prisons in my constituency, so I was pleased that the problem of mental health in prisons has been raised. However, if we think that the mental health service as a whole is a Cinderella service, the mental health service in prisons is even lower down the scale. I am pleased that mental health in prisons is now the responsibility of the Department of Health and not the Home Office, but will the Minister say what progress is being made? There have been an alarming number of suicides over the past few years at the Eastwood Park women's prison in my constituency: how much of a priority is that for the Government?
Finally, mention has been made of the mental health Bill, which has yet to be published. So far in the debate, the Government have said some relatively enlightened things about the importance of mental health, and about prevention. However, that contrasts with the tabloid-driven, draconian, lock-'em-up mentality that seems to underlie the forthcoming Bill. I hope that the Department of Health will take ownership of the Bill and not allow the grubby hands of the Home Office to be all over it. We need a mental health approach to these matters, not the law-and-order approach driven by tabloid scare stories that is inappropriate in the vast majority of cases. Although there is agreement today that we should not stigmatise people with mental health problems, there is a real danger that that is precisely what the Bill will do.
This a vital and valuable debate. My concern is that the people in GPs' surgeries providing the front-line provision for those with mental health problems are not adequately trained or resourced. As we have heard, mental health services are being squeezed as deficits get shunted around. A key remedy would be to pool resources across different forms of health and social care, so that provision is made for the whole person and the totality of his or her needs. We must not see people only in terms of what is wrong with one part of their lives. That is the more enlightened approach that we in the Liberal Democrat party advocate.
I remind the House that Mr. Speaker has placed a 15-minute limit on Back-Bench speeches. Given the extra interest in the debate, hon. Members will be doing themselves a favour if they keep well within that limit in the time remaining.
I am very pleased to have this opportunity to debate mental health services. As has been noted already, they are enormously important to the lives of service users and their families. It is good to see a measure of agreement across the House that it is important to put the stigma associated with poor mental health behind us, and that the mental health services should get the attention and priority that they deserve.
Too often in the past, mental health care has been a poor relation, but there is no doubt that the extra money provided by this Labour Government has made a big difference. Although more needs to be done, it is no exaggeration to say that mental health care in Oxfordshire has been transformed over the past nine years. That is thanks to investment, the achievement of NHS staff at all levels and to the work of excellent local community groups such as Restore. The local trust has made great strides in providing better services and more facilities for patients. Tangible improvements are clear for all to see, and patients appreciate the improved standards of care that they receive. A recent survey of the Oxfordshire Mental Healthcare NHS Trust's service users showed that more than three quarters of the respondents rated the standard of their overall care as excellent, very good or good.
Smart new buildings, wards and facilities have been provided, and more are on the way. Wards at the Warneford hospital in my constituency are being upgraded, extended and refurbished, and the extension to the Highfield unit for young people with mental health problems will open up more places and allow the trust to provide separate areas for boys and girls. More services are being made available. In the past, people with a personality disorder had a choice between hospital and repeated GP appointments. Now, they have access to dedicated out-patient and day-care support.
My constituents can now receive in-patient care in Oxford for eating disorders, instead of having to be transferred to faraway hospitals. The new forensic pre-discharge service helps people who have been mentally ill and in secure hospital care to take the first steps towards living in their own community again. That is just the kind of gradual supported approach for people going back into the community that patients and the public want to see. Those and other developments, coupled with careful financial management, enabled the Oxfordshire Mental Healthcare NHS Trust to progress from one star in 2003 to three stars in 2005. No praise is high enough for the dedication of the staff at all levels who made that possible.
Despite all this outstanding work, however, local mental health services face the enormous challenges arising from cuts that are being made to tackle the financial deficit in the Oxfordshire health economy—a deficit, moreover, that was not of their making. My right hon. Friend the Minister quite reasonably gave the House the relevant figures earlier. However, what this means financially for Oxfordshire is that, whereas in 2004–05, Oxfordshire Mental Healthcare NHS Trust spent £51.2 million and budgeted £53.7 million to meet this year's expenditure, it is now being asked this year to cut £1.1 million from its spending, even after having received £1.5 million one-off help from the strategic health authority, which it may yet have to repay over the next two years. All in all, the trust has almost 10 per cent. less than it says that it needs to meet service and cost pressures. We can argue about these figures—and about what proportion of them represent legitimate efficiency gains, and so on—but however we measure them, the cuts are damaging to the trust and its services, and deeply worrying for patients, their families and staff, as the many letters that I have received from my constituents make clear.
What this means for services is that the trust is having to look at bringing forward the closure of in-patient beds, leading to a real rush to put in place the 24-hour crisis community cover that is needed. It would have been much better to plan and carry through such a change in a measured way. The trust is also having to consider the closure of the psychiatry liaison service at the John Radcliffe hospital, which provides support in the accident and emergency unit to people who have attempted suicide and which also supports people in acute beds who are suffering from chronic illnesses such as cancer. The trust is also considering the closure of an in-patient unit for older adults where patients are assessed for depression and Alzheimer's disease. It is also now unable to invest sufficiently in support for older people in the community or to ensure that early intervention is available to help young people at the first onset of mental illness.
The seriousness of the position is compounded by cuts in the Supporting People programme budget locally, as well as by the current state of NHS funding mechanisms, which is a more general problem for mental health care trusts. Whereas additional work for other acute hospital trusts is funded according to the national tariff, additional work at mental health care trusts has to be absorbed within the block allocation, which puts skewed pressure on their share of overall expenditure. This makes it more important that we all speak up for the needs of our mental health care services, both here and in our constituencies, so that they do not get squeezed out by competing demands.
All of that poses a real danger of damaging and obscuring the excellent progress that has been made in mental health care locally and nationally. However, it also puts a question mark over exciting developments planned for the future in preventive community provision in partnership with social services, round-the-clock community crisis support, the development of the complex needs service and the pre-discharge unit for mentally ill offenders, which addresses the issues raised by Steve Webb.
To build on what has been achieved rather than put it at risk, and to make the most of opportunities to improve mental health care in our community, I urge Ministers to consider again what can be done to ease the financial pressures in Oxfordshire, particularly in the mental health care trust, even now in the remaining weeks of the financial year. The mental health care trust is working with the rest of the local NHS to address the underlying financial problems that affect services in Oxfordshire. However, a more measured view needs to be taken of the trust's ability to bear the funding cuts, considering that it has a high proportion of vulnerable service users, many of whom are in no position to speak up for themselves.
In addition, given the body blow that services have suffered this year, Ministers need to assure us that they are taking action to avoid any repetition of this financial fiasco next year, and that budgets across PCTs and hospitals will be properly planned so that those in mental health and other services in the NHS can look ahead with confidence and work with patients and their families to make the most of the huge extra investment that this Labour Government have made and continue to make in the NHS. That has made a terrific difference to the quality of care available to patients and the wider community locally. Let us keep up that good work and carry it forward, not put it at risk as has sadly happened this year.
Like others who have spoken in this debate, I congratulate my right hon. and hon. Friends on the Front Bench on providing Opposition time to debate mental health services. Constant improvement in the services delivered to mentally ill people is a core responsibility of the national health service and my right hon. and hon. Friends on the Front Bench are entitled to credit for providing time for the House to debate those important issues.
If I may paraphrase the speech of Mr. Smith, it is fair to say that he argued that the Government have provided substantial extra money to the national health service, which is true, and that that has made possible significant improvements in services to mentally ill people, which is also true. However, difficult issues remain for those responsible for managing those services locally. Whatever level of resources is likely to be provided to the national health service, difficult choices remain to be made about the pattern of delivery of local services. That relates directly to the point made by Steve Webb.
The Minister does neither herself nor her Government any credit when she seeks to persuade us that, before 1997, there was a dark age in which no progress was made on any of those issues, and that there was suddenly a new dawn on
We all know that the story of the changes in mental health service delivery over the intervening 40 years has been one of individual local successes and failures, but it is surely true to say that, throughout those 40 years, Ministers of all political complexions have been committed to broadly the same vision of the future of mental health services. If we acknowledge that, we shall be able to engage in a much more mature and adult debate on the issues that we face in delivering what is a broadly shared agenda.
Various speakers have rightly sought to avoid the phrase "Cinderella service", which is generally applied, almost by default, to mental health services. I believe that it emanates from the wrong train of thought, because it implies that mental health service delivery in the NHS is somehow different from, or separate from, all other NHS health care delivery. In my view, the similarities between the priorities involved in mental health care delivery and those involved in physical health care delivery are more important than the differences.
As the hon. Member for Northavon pointed out, the great majority of mental health service delivery through the NHS takes place via community and primary health care services. Exactly the same applies to the rest of health care delivery in the NHS. Mental health services are an integral part of the delivery of health care to elderly people. He was right to say that we should not imagine that all elderly people need mental health services, but we cannot think of mental health service delivery without thinking of it in the context of delivery to individual patients, many of whom are elderly and many of whom suffer from physical illnesses that are complicated by the presence of mental health problems.
The hon. Gentleman was also right to stress the importance of the interface between social care and health care delivery. If we are to deliver high-quality, successful mental health services, we must bear that in mind. Any multidisciplinary team responsible for delivering mental health care in the community must include both a health care and a social care element. Throughout those 40 years, too many failures could be traced to their roots in the breakdown of communication between health care and social care delivery. As he said, that remains an institutional issue that Ministers—those responsible for policy development—have not yet cracked.
Mental health services are sometimes represented as being driven by a mysterious political orthodoxy under the title "care in the community". That was mentioned earlier in the debate. It surely cannot be stated too often that caring for people in the community, whether they are mentally ill or physically ill, is not a manifestation of political correctness, nor is it the manifestation of a Treasury-driven desire to close hospitals and get people into the community, although it is sometimes represented as such. In fact, it represents the central purpose of all health care. Why do we have health care in our society? Surely its purpose is to enable people, as far as is humanly possible, to live their lives normally. That is why community health care, whether it is delivered to the physically ill or to the mentally ill, must be at the heart of the development of health care delivery generally.
The priorities in the development of mental health services are thus very similar to the priorities in the delivery of the rest of health care. For instance, they relate to the development of primary and community-based care. I welcome the Government's White Paper on the subject, published at the beginning of last week. There is almost nothing in the White Paper that I could not have envisaged writing as the Secretary of State for Health 10 years ago. I observe without rancour that it is a pity that we have gone on such a long detour to get back to some of the ideas that we were developing 10 years ago, most notably and obviously what we used to call GP fundholding and what the Government now call practice-based commissioning. There is no difference of principle between the two and it is a pity that we have lost 10 years in the development of that important idea.
I ask Ministers to reflect, in the context of the delivery of mental health services, on the implications of the recent changes in the GP contract for access to primary care services at evenings and weekends. All studies of mental health service delivery emphasise the importance of people at short notice being able to secure access to services, particularly young people in the acute phase of mental illness and elderly people who have a short-term requirement for respite care. Now in our communities, Tesco and Sainsbury's are open all through the weekend, but our primary health care delivery facilities are more difficult to access than they used to be. That is an issue for health care across the field but it is a particular issue in the delivery of mental health services.
I ask Ministers, too, to reflect on the need to ensure that there are properly integrated community-based health care services, including not only social care, but residential care for those who are in an acute phase of schizophrenia and psychotic illness and residential care for those requiring respite care. We all know that, if we are going to deliver successful integrated care in the community, there will have to be proper patient plans—pathways of care—that integrate the different elements of the service.
What we look for from Ministers is a clear commitment that the Government recognise that there is no difference of view in any part of the House about the type of service that we want to see delivered. Nor is there any difference about our commitment to see resources grow year by year, as they have for 50 years in the NHS, to support the growth and improvement of the delivery of those services. What we have to see is detailed planning locally to avoid the ups and downs in the delivery of service, which were described by the right hon. Member for Oxford, East, and integrated delivery of care, so that, from the perspective of the patient, the service is more reliable, and of better and more consistent quality than we have seen in the past under Governments of all political persuasions.
For three years, I was a member of the Mental Health Act Commission. I visited patients not only to check that they were legally detained under the Mental Health Act 1983 but to talk to them about their concerns. With that experience, I am pleased to be able to say a few words this afternoon.
Although as a Mental Health Act commissioner I was working at the acute end of mental health, dealing with people who were detained, it was interesting to talk to them about their pathways and how they ended up being sectioned. I visited not only NHS psychiatric facilities but private sector facilities. That was an interesting experience because, in some instances, the private sector can provide good facilities and meet needs where the NHS cannot.
Mr. Dorrell mentioned that the view seemed to be that, prior to 1997, things were terrible and that, from 1997, suddenly things got a lot better. The focus on mental health services has increased since 1997. The investment has gone in since 1997. When we talk to the community and voluntary sector, it says that the joined-up thinking and the investment in mental health services in local communities has been staggering in some instances. From my right hon. Friend the Minister, we heard that there are 8,000 more psychiatric nurses, 1,200 more psychiatric consultants and 3,000 more psychologists. Those are real people providing a real service to our constituents with mental health problems.
The most important thing that Labour has done is the 1999 national service framework on mental health services, which set the gold standard for what we should be looking to achieve in all our mental health services. I want to talk about child and adolescent mental health services, women patients in mental health services and the NHS estate in terms of psychiatric units.
On children and young people, on Friday I went to a meeting of the Humber mental health trust, a three-star mental health trust that does excellent work. It said that, although the national service framework for adult mental health services—it includes sections involving children—was a good start, we needed an NSF for young people. The chief executive said that the split between children and adolescent mental health services that goes up to 16 or 18 years of age was not providing the kind of care we should be providing for young people. We need a service that spans the age group from, say, 15 to 30.
We need to make sure that, for younger children who may come into contact with mental health services, their contact is community-based. We must keep young people away from the acute sector because it is not an environment where we want children and young people to enter unless there are extreme circumstances. The facilities are not suitable for them. There are some disturbed people in our facilities and we need to keep our focus on the community setting.
Getting in early is important. I was pleased to see that Sure Starts were putting emphasis on developing emotional well being in the support that they are providing to parents and carers of our youngest children. Such guidance to those who look after children uses creative activity to improve children's self-esteem, social skills and emotional well being. That is absolutely right. It is a stark fact that a child living in a low-income, lone-parent household is twice as likely to have emotional disorder as a child in a two-parent family on a reasonable income. There is a clear link with poverty and it is right that Sure Starts, which were based on the most disadvantaged areas, are putting the focus on emotional well being.
I want to talk about Mind, which provides excellent services across the country for people with mental health problems. In my constituency, the Linx project provides help with housing and independent living for young people who have shown the first signs of psychosis. Getting in early and investing early in our young people means, we hope, that they can go on living independent lives and putting their problems behind them.
We have heard about the massive investment in PCTs for mental health services and it is worth putting on record that £300 million has gone into PCTs and local authorities to improve child and adolescent mental health between 2003 and 2006. However, there are still some gaps. I visited Hull domestic violence refuge and was told by some teenagers that there were counselling facilities available to younger children to help them deal with the trauma they had experienced, but that there was nobody to provide teenagers with counselling. I hope that we put some work into that area. It may be that we invest now to save later on.
I want to pay tribute to the work done in Scotland in the one in four campaign, which is trying to remove the stigma from mental health. Hon. Members will agree that that is a good campaign. In Australia, the National Youth Mental Health Foundation has been set up and is looking to make sure that money is put towards young people suffering mental health problems. We need to ensure that particular resources are attached to making sure that those in the 12 to 25 age group get the help they need. Of course, the recently published Health White Paper will work to counteract the stigma of mental health.
I turn briefly to safety, which is a real issue for women in-patients in mental health facilities. As was pointed out earlier, there can often be a mixture of people with various mental illnesses and disorders on a given ward. It is important that women, who can often be very vulnerable, are provided with separate facilities. We have a commitment to providing gender-specific facilities and I hope that more resources will be put into providing them throughout the country.
We also need to consider the estate. Statistics show that only 35 per cent. of psychiatric intensive care units have en suite facilities, that 25 per cent. have no enclosed garden space and that 35 per cent. have no gender- specific facilities. We need to get these issues right. A decent standard of accommodation can have a very positive effect on the recovery of those suffering from mental illness or disorder. I am pleased to note the massive investment that has already gone into improving in-patient facilities, but there is still more to do.
I am pleased that we have made a positive start and it is indeed since 1997 that we have really focused on this issue. We need to keep working on provision for children and young people, because there is more to do in that regard. As part of our wider public health agenda, we need also to deal with the issue of emotional well-being throughout an individual's life.
During this debate, which I very much welcome, we need to reflect on the scale of mental ill health. We are told that one in five adults will experience mental health problems at some point in their life, which means that, of the 20 Members currently in this Chamber, four of us could well experience such problems. It is very unlikely that the same ratio of Members will experience any other type of health problem.
As with many other conditions, mental ill health does not affect just the patient. The impact on families, particularly the prime carer, is enormous; indeed, it is so great that, ultimately, it can affect both their mental and physical health, particularly if that patient has a long-term condition. Many of us—certainly me—have experienced at first hand in our families the agonising condition of mental ill health and its impact on people's lives. It is one of the most distressing conditions.
In discussing mental health, I want to focus on the two age extremes. Many Members have mentioned young people, and at that age suicide is an issue. The Mental Health Foundation and Mind have pointed out that the highest rate of suicide is among young men between the ages of 15 and 24, that 20 per cent. of all deaths among young people are through suicide, and that one in 10 of 11 to 25-year-olds self-harm. Given the scale of the problem, we have to find the answers and the policies to alleviate it. Behind those bare statistics are very real tragedies for the families concerned.
It would be remiss of me not to add one more statistic on behalf of a group of people whom I mention probably far too often in this House. However, I make no apology for doing so. A recent report by the National Autistic Society pointed out that the attempted suicide rate among adult sufferers of Asperger's syndrome is 8 per cent., which is very high indeed. When we consider, in managing such patients, how they reached the point of attempting suicide, there is usually—not always, but usually—an identifiable pathway in their relationship with the statutory services.
In the recent past, I have had more than one Adjournment debate on in-patient deaths within the Devon Partnership NHS Trust. I wish to put on the record that since I have raised the issue and some of the concerns have been addressed, we have seen—under the management of Mr. Iain Tully and his team—a real rethink on why those tragic deaths occurred in our area. The mother of one of the young men who died showed me a plan of his relationships with statutory services during his long history of mental ill health. The relationship usually started well, but eventually failed. We euphemistically call that falling through the net, but too many young people do so—especially in their relationships with community services.
I wish to pick up a point made by Steve Webb. Often, the first professional a patient sees is their GP. I sympathise with GPs because they have an eight-minute slot in which to listen, assess and decide what to do. There are GPs in my constituency—and I am sure they are not unique—who ask how they can do anything other than pick up the prescription pad at the end of the eight minutes. A prescription may solve a short-term problem, but—and I mean no disrespect to GPs—it does not address the underlying cause. Many of the young people who end up as suicide statistics do so because not enough time has been spent with them, there has not been enough continuity in their care and the people who could help are not out there in the community.
My hon. Friend Mr. Lansley pointed out that when people break their legs, they recover. Well, people do make full recoveries from certain types of mental illness, but mental health problems make people fragile. Such problems are often recurring. Also, when people present to GPs and other professionals, their instinct is often to conceal the underlying problem. It often takes many hours of discussion and counselling before even the best trained psychiatrist can start to identify the right approach for an individual. It is time-consuming, painstaking work that is very different from other areas of medicine. Therefore, while I understand the Minister's wish to put the statistics in the best light possible, we still have a huge way to go. The suicide statistics prove that.
At the other end of the age spectrum are the elderly. The mental health of many elderly people breaks down from a simple cause—social isolation. To put it more simply, the cause is loneliness. Many elderly people who are unable to get out and about, or whose family and friends have started to die off or have moved away, spend far too many hours on their own, and that inevitably leads to depression. As we know, depression is a spectrum. It can be intermittent and addressed by medication, but all too often it leads to more serious mental health problems. Depression is also a common side effect of other physical conditions, such as Parkinson's disease. It is extremely difficult to disaggregate the depression and the underlying mental health problems from the physical conditions in elderly people who are often not able to be very good self-advocates. I can think of some of my elderly relatives who always put on their best face when the doctor came to call—a natural response for that generation—even though they had problems that the doctor needed to know about. It is a complex and grey area, which is not easy for professionals, let alone politicians, to enter.
More than 13 per cent. of the NHS budget is devoted to mental health services and I am concerned about care in the community. We have heard much about the packages to deal with people's physical needs, but if we are to move towards more people being cared for at home for longer—as we certainly are in Devon— especially when they are extremely dependent physically, their emotional and psychological needs must also be met; otherwise, many elderly people will develop serious mental health problems. All too often when serious problems occur, whether with younger people in suicide cases or with elderly people with mental illness—the health service has to respond to a person in crisis. The statutory services have to respond suddenly to situations where, to put things in crude financial terms, much more money will have to be spent than if there had been regular, lower-level interventions at an earlier stage.
There is a dilemma. Health authorities and social services departments work on annualised budgets and the system mitigates against such regular interventions. It has to deal with people who are in crisis, so it is easier to pare off services and facilities that may be regarded as low level, even though they might have ensured that many people who appear in the crisis statistics had a better quality of life and did not succumb to mental illness. The fact that more people have been admitted to mental hospital since the implementation of the Mental Health Act 1983 is an indication that intervention takes place only when there is a crisis. We must address that issue. Crisis management is never the most effective outcome, for either the patient or the system.
As I said earlier, I served on the scrutiny Committee on the Mental Health Bill, so it would be remiss of me not to mention my grave concern about two aspects of the Bill; indeed, the Minister would expect me to do so. I still believe that the Government's broader definition of mental disorder is wrong and if the Bill is introduced I hope to put my case to the Minister even more robustly than in the past. I urge her to reconsider that aspect of the Bill.
My second concern relates to compulsion. We received evidence from the Royal College of Psychiatrists that, under the provisions, we should need to detain one in 2,000 people with no previous indication that they would cause severe harm. I realise that the proposal came from the Home Office rather than the Department of Health, but if we broaden the definition of mental disorder so that it is based not on clinical diagnosis but merely on behaviour, and if that is accompanied by wider provisions in civil legislation for indefinite detention, the infringements of civil liberties that we have discussed in this place in the past will be as nothing by comparison. If the Minister does not address that aspect of the Bill, the rebellion will not be merely in this and another place; people will march in the streets.
I urge the Minister to reconsider those two fundamental rights, on both of which the scrutiny Committee made firm recommendations. Together, those two aspects of the Bill will be a huge infringement of civil liberties.
My hon. Friend the Minister said that we need a response that stretches right across Government, and I want to address my brief comments in today's short debate to some of those issues. Last Thursday, I had the pleasure of opening an art exhibition by the Yao Yao group—a social group organised by the Chinese Mental Health Association, which is based in my constituency—and it was one demonstration of the fact that there are many ways to tackle mental health problems, not just through the health service.
I pay tribute to the many people and organisations in Hackney, South and Shoreditch and Hackney as a whole—such as Mind and the Chinese Mental Health Association, which put time and effort into supporting people with mental health problems—as well as the people with mental health problems who also play a key role. My hon. Friend knows of the good work done at Homerton university hospital and by City and Hackney Mental Health Trust. It is important that all those organisations play a big role in a constituency with a high incidence of mental health problems.
I will not bombard the House with statistics in the short time that I have, but it is startling that admissions to hospital for schizophrenia are three times more common in Hackney than in England as a whole, for both men and women. I want to touch very briefly on three issues: employment, ethnicity and the impact on welfare benefits for people suffering from mental health problems. Steve Webb rightly highlighted the need for preventive work. He said something about the Minister suggesting that everything in the garden was rosy. In some ways, I agree with him. Not everything in the garden is rosy, but it is a lot better than it was, which is a good step.
General practitioners in Hackney are very much at the sharp end of dealing with people with mental health problems. Other hon. Members, particularly Angela Browning, have highlighted some of the difficulties of dealing with mental health problems in the short time that many GPs have available. That is one of the reasons why I welcome those aspects of the health White Paper that will improve and promote community care provision at that initial presentation point.
We all know that people with mental health problems have much more difficulty finding employment than the general population. That is so even when compared with people who are physically disabled. About 16 per cent. of physically disabled people are more likely to be unemployed, compared with 50 per cent. of people with mental health problems. Some 86 per cent. of people with longer-term mental health problems are unemployed. The other side of the coin is how employers react—only 37 per cent of them are prepared to consider employing people with such difficulties.
I am very proud that the two local mental health trusts—East London and the City, which covers Hackney, and North East London—the local strategic health authority and South Bank university have joined forces to fund a consultant occupational therapist for employment. I hope that my hon. Friend agrees that that is the sort of joined-up government to which she referred in her comments. The two mental health trusts have adopted a joint partnership approach—the roots to employment project, which is the first of its kind in the UK to help people with mental health problems into work, by working with employers to ensure that they address the issues and understand the need to help people with mental health problems back into the workplace.
Does my hon. Friend agree that although people may expect this not to be the case, some problems exist in the public sector with regard to attitudes to mental health problems? I have taken up such cases, and it has always been more difficult to get someone who has had a breakdown back into public sector employment than into the private sector. Will my hon. Friend say something about that?
My hon. Friend may have a point. I cannot draw on enough experience of people bringing such issues to my surgery—I am only a new Member compared with him—but I am proud to see what happens when I go to forums in Hackney. For example, I opened a Jobcentre Plus office at the end of last week, and some of the employers there, including Hackney council and the local hospital, recognised the need to support people with mental health problems. They work positively with those people and take on board their problems. Perhaps that happens because we have the roots to employment project in Hackney, and perhaps my hon. Friend may wish to raise that with the primary care trust, the mental health trust and the other health and employment bodies in his constituency.
I said that I was going to touch on ethnicity. Hackney, South and Shoreditch is especially affected by the Eurocentric nature of much psychiatric training, which helps to contribute to the fact that Afro-Caribbean people are typically three to five times more likely than white people to be admitted to hospital with a first diagnosis of schizophrenia, and then 10 times more likely to be diagnosed as schizophrenic. The Chinese Mental Health Association has much of interest to say on the subject. The Chinese community in Britain is often isolated and many Chinese people do not wish to talk about mental health problems for cultural reasons. Problems due to language affect not only the Chinese, but other groups across the board.
I am delighted that north-east London is one of 17 nationally focused areas for delivering race equality in mental health. The Government have taken a major step forward by recognising the white Eurocentric approach to psychiatry. Such initiatives are sorely needed and much welcomed in Hackney. When I spoke to Hackney Mind, I found that many mental health service users were especially pleased that the scheme was moving forward, but we need to see results on the ground. We are only at the beginning with the scheme, but I am sure that my hon. Friend the Minister will keep a close eye on the situation from Whitehall. As other hon. Members have said, the crux of the matter is what happens locally, so local providers need to make changes.
When I said that I would be brief, I meant it in all sincerity, but I want to touch on incapacity benefit, as did the hon. Member for Northavon. Hackney, South and Shoreditch has the second highest number of incapacity benefit claimants of any London constituency—only Regent's Park and Kensington, North, which is in west London, has more. My constituency, which nestles close by the City and runs right down to Liverpool Street station, is 31st equal nationally for the number of claimants. We have 7,400 claimants, 63 per cent. of whom are under 50. We are working locally to probe the matter more closely, but we know that there is a big overlap of people on incapacity benefit and those with mental health problems.
I echo the hon. Member for Northavon in hoping that my hon. Friend the Minister is talking to her colleagues in the Department for Work and Pensions to ensure that my concerns, which are shared by Hackney Mind and local health providers, are being tackled. As we make important and welcome changes to incapacity benefit, we should not lose sight of such a difficult issue. I hope that my hon. Friend is joining up with her colleagues in the DWP as part of the joined-up Government that she mentioned.
I was sorry to hear about the Secretary of State's illness, not least because all six Oxfordshire Members are due to meet her at 12.30 pm tomorrow to discuss the freefall of the NHS in Oxfordshire. My right hon. Friend the Leader of the Opposition, my hon. Friends the Members for Wantage (Mr. Vaizey) and for Henley (Mr. Johnson), Mr. Smith and Dr. Harris will all be extremely disappointed if the meeting does not go ahead, so we wish the Secretary of State Godspeed for a quick recovery.
The Minister said that mental health was one of the Government's top three priorities, but I hope that the House will not consider me churlish when I say that I increasingly think—perhaps I have one of the problems to which my hon. Friend Angela Browning referred—that I am living in a parallel universe, because there is a world occupied by Ministers and many others, and the world in Oxfordshire. As the right hon. Member for Oxford, East indicated, Oxfordshire's mental health services are confronted by a series of interrelated problems.
The primary care trust wants the Oxfordshire Mental Healthcare NHS Trust to save £1 million. Additionally, the strategic health authority is requiring the trust to save a further £5.3 million over the next three years to break even and has imposed a cut of £1.7 million on top of that, not because the trust is in any way overspent, but because the rest of the NHS in Oxfordshire is overdrawn. The SHA thus imposed an implied deficit of £1.7 million on the trust to make up for overspends in other parts of the NHS.
In addition to all that, there has been a reduction of at least £400,000 in the Supporting People budget, which I have raised in the House on a number of occasions. The sum of all those interactions is that the cuts represent about 10 per cent. of the mental health care trust's budget for patient care and at least 15 per cent. of the money for supported housing, which is likely to have a devastating impact on the lives of people affected by mental illness and the people who care for them.
To put that in context, I can tell the House that Dr. Fergusson of the Banbury branch of the Alzheimer's Society has written to everyone he can write to, because he feels, quite rightly, that the closures
"are scandalous on a number of counts".
People involved in mental health care in Oxfordshire feel desperate about this. As the right hon. Member for Oxford, East said, over the last few years the mental health care trust has gone from having one star to having three stars. We started to feel that people were getting a grip on the service. It has now gone into freefall again, and we are seeing the closure of older adult psychiatric day hospitals, which, in the words of Dr. Fergusson,
"directly targets health service provision for one of the most vulnerable groups in society, who are unable to protest".
The Fiennes day hospital in Banbury is a centre of excellence where, Dr. Fergusson says,
"a very competent and committed staff team have, over recent years, transformed local perceptions of Older Adult Psychiatric Services. This team should be held up as an example, not destroyed."
He is also concerned that a number of the closure decisions were taken—I can confirm this—in the mental health care trust before public consultation had even begun. In one or two cases, such as that of the Fiennes adult day hospital, the staff heard of the closure in briefings, not in a consultation document, and before any member of the statutory services, myself or anyone else. That is not acceptable.
There are three issues that I want to mention to Ministers. First, in the overall context of NHS spending, if there is a squeeze on spending, mental health seems to take a disproportionate share of it. I see no reason why the strategic health authority has arbitrarily imposed a £1.7 million implied deficit on the mental health care trust.
Secondly, we are moving into a world of payment by results. There has been no real discussion about that this afternoon. I do not see how payment by results will work with NHS mental health care funding. There has to be an alternative system to ensure that mental health work is properly funded in future; otherwise, there will be real tension. I am not confident that GP practice-based commissioning will ensure that mental health trusts in Oxfordshire and elsewhere are properly funded.
I turn to my last point about the squeeze on mental health care work. In the acute sector there is a reasonably clear divide between work done by the NHS which is free at the point of use in the NHS and funded by the NHS, and work done as part of social care, which is means-tested and provided by social services. Often there is a black hole, and there is a debate about where the line should be drawn, but there is a reasonably clear line. When it comes to mental health care services, that line is much more blurred, so the mental health care trust ends up carrying up many more services, such as those under the Supporting People budget. There is a much greater tension there, and people expect the trust to deliver those services.
I am sure that the Minister genuinely believes that this is one of the Government's three priorities. She and her colleagues are very welcome to come to Oxfordshire, because I am not being flippant or frivolous—I increasingly believe it—when I say that we are living in a parallel universe there. It may well be something to do with its being a comparatively small county with a large teaching hospital and a major centre of research. Something is causing a problem when we have an NHS in freefall, but the effects are being felt particularly by those with mental health problems. That is not fair and it is not reasonable. It is not good news for the Minister, because for every success story that she can trumpet, "G2", the New Statesman and the rest of the media can focus on a failure. Although NHS mental health care in Oxfordshire is not a failure, the situation is in freefall; it should not be, and it needs to be addressed.
Mental health will certainly be one of the big issues of the 21st century. Placing greater emphasis on mental health is one way in which the Government can improve the well-being of individuals, but I have to say that the complete opposite is happening in my constituency. I hope that the House will forgive me if I confine my remarks to what is happening in Cambridge, because it is such an extreme example.
Despite what the Minister says, mental health services in Cambridge and south Cambridgeshire are in crisis. The overall budget has been cut by £2.75 million, which is 13 per cent. of the total. Two rehabilitation wards are being closed; an acute in-patient ward is being closed; three adult day care centres are being reduced to two; a ward for older acute patients is being closed; and arts therapies, physiotherapy and electroconvulsive therapy between them have to save £150,000. Other services are still under threat, including the young people's service, which Mr. Lansley mentioned. We still hope to save that service; the decision has been deferred and we are trying to persuade the primary care trust and the mental health trust that it would be more expensive in the long term to make cuts now, because of the excellent preventive work that it does.
The PCT, echoing the Minister, claims that closure of acute wards will be offset by the reorganisation of community services and investment in assertive outreach work. The trouble is that the PCT is requiring £2 million of cuts not next year but in the current financial year. There is no lead-in time to get the community and crisis resolution teams fully in place. I fully accept that crisis resolution and community outreach are a good way to run mental health services, and preventing in-patient admission has to be a good idea. However, if there were no financial pressure, the change would have been brought in over a much longer period.
My hon. Friend may be aware that in my constituency the hospital trust is to lose £500,000 because the primary care trust is trying to save the same sum by closing two wards in Kendal. The pressure, of course, is on the PCT to balance its books; the reality is that the NHS overall loses out. If we look at those entities as separate organisations, not as a single national health service, we do not have sensible joined-up government. I wonder whether that experience is reflected in my hon. Friend's area.
That is a common pattern throughout the country where there are problems.
In normal circumstances, as I say, one would set up the new teams first, look to their effect on admissions and then perhaps reduce the number of beds. In some places, when an assertive outreach service is set up, the teams find unmet need, so the need for in-patient beds goes up, not down. In Cambridge, the change is happening all at once, and risks are being taken with patients' welfare. The whole thing resembles tightrope walking without a net.
The mental health trust is, of course, acting under duress from the PCT. The PCT has little choice because of the dire state of its budget. The Department of Health requires a £15 million reduction in spending, and even that does not cover the current deficit. Another £23 million deficit is on the way in subsequent years. Ministers keep saying that vast sums have gone into the NHS. In written answers to me the Minister has said that Cambridge PCT is receiving 29 per cent. extra, and that even after the cuts Cambridge's spending on mental health will still be above the national average.
We need to tackle those points directly. There has been an increase in funding, but as Tony Baldry said, one of the problems is that if there is a foundation hospital, the PCT's cheque book is, in effect, handed over to that hospital, which writes itself cheques that deal with all of its previous financial problems. Effectively, the financial problems of the acute trusts have been transferred to the PCTs, and the PCTs have had to remove the budgets of what remains under their control—mental health and other services. When the mental health trust acquires the right to charge at tariff rates for the patients who cross its threshold, its problems may be solved in the same way as those of acute trusts, but what then will happen to PCT budgets and GP fundholder budgets?
On national averages, the point is not the average but the need. In October and in meetings with Ministers I raised several problems about the green book—the index of mental health need. The measure of poverty that the green book uses is based on benefit take-up, not income. For Cambridge that is catastrophic, because successive Governments have taken away students' right to benefits. Students have serious mental health needs, as the hon. Members for North-West Leicestershire (David Taylor) and for Tiverton and Honiton (Angela Browning) said. Suicide rates are high and self-harm is a problem. I should add to that—I know this from experience as a university teacher—the problem of eating disorders, which I have seen blight the careers of several brilliant young women.
The second point about the green book is the measure of housing condition rather than housing tenure, despite the fact that all the academic work shows that the link with mental health problems is with housing tenure. The third and most important point for us is that the needs index reduces funding if one's area is near a good mental health institution, such as Fulbourn hospital. The reason for that is the cost of reaching the facility, but in reality being near a good facility increases the number of patients in the area, because of migration and because people stay in the area once they return to the community. The Secretary of State conceded that some work needs to be done on these matters, and I will be glad to hear what further work has been done.
The cuts in mental health services in Cambridge have had at least one good effect: they have brought the community together in opposition to them. Thousands of people joined the public protests, attending meetings and vigils against the cuts. That in itself has helped to reduce the stigma attached to mental illness, which several hon. Members have mentioned. Despite all the brave and good things that people have done—including, in a live BBC radio interview, the interviewer mentioning to me that he had suffered from mental illness and had recovered—the campaign that we are waging is not just to change public attitudes but to get more funding. That is the problem that we face. I gather that today the county council's health scrutiny committee is meeting, and it has the power to refer the issue to the Minister. I very much hope that it does so. Then we shall see the strength of the Minister's commitment to mental health.
I agree with comments by Members on both sides of the House that the primary difficulty with the mental health debate is that various types of mental illnesses are minimised and often ignored. Within that broad category of mental illnesses, there are some that are disregarded even more than others. I want to focus my remarks in the brief time available on one of those: post-traumatic stress disorder.
Post-traumatic stress disorder is a mental illness that is often dismissed, not simply by the rest of us but by those who suffer from it. It therefore presents its own specific difficulties in terms of the work that the Government and the NHS must do to support those who suffer from it. People have always suffered from it, but it has only relatively recently been recognised—from first world war shell-shock to the illness that is diagnosed today.
Post-traumatic stress disorder can affect us all. Whether we are holidaymakers or commuters, we are potential victims of post-traumatic stress disorder as a result of natural disasters of almost biblical proportions or terrorist atrocities on our daily commute to or from work. It particularly affects—this is the group of people to whom I particularly want to draw the attention of the House—those who feel that they ought to be most able to deal with it, and are therefore least likely to seek help. I refer to those in the armed services and the emergency services. Those who serve this country bravely, and sometimes at great cost to themselves not only physically but mentally, suffer from anything ranging from flashbacks to serious mental breakdowns, and do so often in what might be an unsympathetic environment.
There is no doubt that post-traumatic stress disorder, like other mental illnesses, wrecks lives—not just the lives of those who suffer from it but those of their families and friends. It often leads to alcoholism, violence, homelessness and family breakdown, and all those problems need addressing in the context of the illness that the person is suffering from. The illness is costly not only in human terms but in financial terms.
I recently met an experienced firefighter who, as a result of a collision with a car in which the driver of the other vehicle was killed—an incident that was not the firefighter's fault—suffered a series of flashbacks leading to a more serious breakdown, after which he spent six years away from work. That cost the taxpayer a total of £118,000 in pension, incapacity benefit and other benefits. On that basis it must be right that in framing their Mental Health Bill, the Government give clear and full consideration to the ways in which we can assist those individuals and ensure early intervention, so that they can receive the care and treatment that they need as soon as it can be given to them.
I hope that the Minister accepts that although one option for those individuals when their illness becomes very serious is in-patient care—I am sorry to say that in-patient facilities for military personnel have closed progressively over the past few years, both at Catterick and Ty Gwyn in north Wales—other options include counselling and therapy, which should be available through the NHS but so rarely are. As I understand it, there are only 14 locations where counselling can be given to those who suffer from post-traumatic stress disorder. The gap must be bridged by the voluntary sector. In fact, it is bridged very successfully by such groups as Assist, in my constituency, which does a fantastic job in trauma management. I invite the Minister and all those involved in drafting the mental health Bill to consider what can be done to weight the services available to those who suffer from post-traumatic stress disorder in favour of therapy and access to counselling, either in person or by telephone, in order to ensure that people have early access to support, which they, and we, will find valuable.
The firefighter to whom I referred calculated the costs to the taxpayer of his six years' absence from work. He has recently felt able to return to work, and has done so, as a result of counselling provided by Assist which cost £1,000. The Government could profitably consider such approaches to looking after those who have served us so well and ensure that they receive the care and support to which they are fully entitled. All Members will rightly express outrage when members of the armed services and the emergency services who have suffered serious physical injury do not receive the care to which we and they believe that they are entitled. It is surely right that those who suffer mental injury as a result of the same activities on our behalf should receive similar consideration.
We have had a good debate. We are disappointed that the Secretary of State was not able to join us and we wish her a speedy recovery, but it is always a delight to have the Minister of State, Department of Health, Ms Winterton giving her speeches, even if she did go on a bit.
The debate has been well informed, well mannered and civilised, although it has been dominated by Oxbridge—over half the speakers represented Oxfordshire or Cambridgeshire constituencies. Contributions ranged from that of my hon. Friend Jeremy Wright on the important subject of post-traumatic stress syndrome to those of Ms Johnson, with her expertise as a Mental Health Act commissioner, and my right hon. Friend Mr. Dorrell with all the great expertise that he brings.
It has been a good debate, but primarily it has been good to have a debate because we have not had one on the subject for more than eight and a half years, despite the fact, as everyone has acknowledged, that the subject is extremely important and affects so many of our constituents. We know that one in four people will suffer some form of mental illness in their lives—people from all backgrounds—and one in 10 school-age children will be affected by some form of mental illness. The hon. Member for Kingston upon Hull, North mentioned the importance of early intervention, for young people in particular, which is lacking in too many places.
Thirty per cent. of all GP consultations have a significant mental health component. Mental illness has enormous implications for social exclusion, is one of the biggest factors in the high level of disability benefit claims, and hits black and ethnic minority communities disproportionately, as many hon. Members mentioned. The Wanless report highlighted the fact that
"For too long mental health has been stigmatised and starved of resources and national attention."
I agree. The Healthcare Commission inspections last year found that standards in NHS mental hospitals were markedly poorer. Despite the apparent priority that the Government said they gave to mental health and the publication of the national service framework in 2000, we have not had a debate in all that time.
The World Health Organisation predicts that by 2020 depression will be the leading cause of disability and the second biggest contributor to illness in the developed world, after heart disease. Surely mental illness, particularly among young people, is one of the most worrying public health time bombs ticking away, with enormous implications for the health of future generations, employment and financial cost to the NHS.
Will my hon. Friend forgive me? We have very little time.
Despite all the evidence, mental health merited just a passing reference amounting to two and a half pages in the 2004 White Paper on health and is virtually absent from last week's White Paper. The Government promised to update mental health legislation and bring the 1983 Act in line with new practices and treatments in the 21st century, but that Bill remains in doubt, despite the publication of the original draft Bill in June 2002 and a second draft in September 2004, and the scathing report of the pre-legislative scrutiny Committee last year. There are real doubts whether we will see the Bill this Session, as the Government promised.
Conservatives believe that mental health needs to be treated more seriously and more urgently than that. That is why we are holding this debate in our time today, and why we have held three mental health summits at Westminster in recent years and plan more. That is why we produced a separate, detailed mental health manifesto at the last election, contrary to the impression given by Meg Hillier. That is why we set up an expert panel in 2004 to produce an alternative mental health Bill, and stand ready to introduce it as a private Member's Bill if the Government continue to fail to honour their promise to introduce a Bill of their own or refuse to adapt their Bill significantly in the light of the near-universal condemnation that it has received. We need to examine the issue of mental health holistically. Of all the areas in health care, mental health provision needs a joined-up approach, which has too often been missing.
Many hon. Members mentioned funding. Investment in mental health has risen, but not to the level needed to implement the NSF. It has not kept pace with rises in the NHS budget generally. There are serious worries that mental health trusts will bear the brunt of the current deficit crisis, just as the new mental health trusts inherited many of the worst overdrafts after the last restructuring of services—a point mentioned by Mr. Smith. The near-zero figure suggested by the Minister turned into 10 per cent. in his county, Oxfordshire. That was reinforced by my hon. Friend Tony Baldry and David Howarth. There have been significant cuts, leading to the diminution of services, and the cuts are not of the order of the very small snapshot amount contrived by the Minister. That is the reality of the services that our constituents are trying to access with increasing difficulty across the country.
Expenditure on day services for mental health patients has fallen from £176 million in 2001–02 to £149 million in 2003–04, despite more people in the community needing those services. We have had many other examples from across the country. It is a false economy not to continue the investment in such services. That is why Conservatives want a fairer share of the health funding cake to be spent on mental health services. That might start to address the problem of stigma mentioned by so many hon. Members.
On choice and access, the Secretary of State has spoken much about the choice agenda in health, yet what choice is there, realistically, for mental health patients? The Government are bringing in the "choose and book" system, giving patients with physical health needs the opportunity to choose their hospital and treatment times, yet mental health is one of the few areas where that will not be introduced across the country. Too often, the only treatment available to patients is the GP's prescription, as my hon. Friend Angela Browning described so well.
Can it be right that 40,000 children—some as young as six—and adolescents are prescribed anti-depressants each year? Those drugs are effective, and in many cases they may be appropriate, but are they not prescribed because alternative therapies are not available and doctors do not have time to tease out the more complicated symptoms that accompany mental health problems? It is not like presenting with a broken leg. More time is needed.As the Sainsbury centre and our own surveys report, many GPs complain that they have had no access to cognitive behavioural therapy. Elsewhere, patients can wait six months for basic counselling, and all the while their conditions deteriorate, yet we know that early intervention is key.
In his hard-hitting report last year on the economics of mental health, Lord Layard proposed a dramatic overhaul of our priorities, the setting up of a network of 250 therapy centres and a new cohort of 5,000 cognitive behavioural therapy specialists. We need radical thinking backed up by long-term investment if we are to diffuse the ticking time bomb.
We need also not to treat people with mental illness in silos. Mental health patients suffer physical conditions like the rest of us, such as heart disease, obesity and diabetes. Worse, they have pronounced medical conditions. A schizophrenic is likely to have a life expectancy 10 years shorter than the average one of us. They are twice as likely to die from respiratory infections. Like everyone else, they suffer those diseases, but they frequently complain that they are labelled primarily as mental health patients when they visit their GP and are treated differently.
Spending on mental health promotion is crucial, but it is a scandal that at £3 million it represents just 0.04 per cent. of the total expenditure on mental health services, at a time when many experts say we should educate the population better on mental health issues, not least through the curriculum in schools. It is a false economy not to do so, yet it does not feature in the "healthy schools" programme.
We need to be bolder and more imaginative in the places where people can access mental health services, often anonymously, not least for the 14 to 16-year-old boys, who experience some of the highest levels of stress and depression but see their GPs least frequently of all. Similarly, we need to do much more to encourage more people from black and ethnic minority communities to present with mental problems earlier. We have heard all the figures showing that they are much more susceptible to mental illness.
It is a scandal that 90 per cent. of prisoners have some kind of mental health or substance abuse problems, yet some of the worst mental health services available. Too little imagination and flexibility are available to divert people with severe mental health problems away from prison entirely. It is no coincidence that the prison population has increased tangentially to the decrease in acute mental health beds in the NHS. Perhaps if we start to address those problems, we can start to remove the stigma that still attaches to mental health issues.
Finally, on the mental health work force, we hear all the time about doctors and nurses, hospital waiting lists and numbers of operations. We hear little about the one in six consultant psychiatrists' posts currently unfilled or the 5 per cent. vacancy rates for mental health nurses in hospitals.
We need to do more to commit to a serious recruitment campaign among mental health professionals and to bring back the morale of a demoralised profession. We need to do more to encourage employers to look dispassionately at taking on the 80 per cent. of potential workers with a mental illness on disability benefits who want to work, only 20 per cent. of whom get the opportunity to do so. The Supporting People programme is being cut at a time when it is doing good work, as we saw this morning in Brent in a project supported by that budget.
If we can do something urgently and seriously to tackle these problems, perhaps at long last we can go some way to turning the tide against the stigma that still pervades the whole subject of mental illness. That is in sharp contrast to the way in which it is handled in many other European countries, and it succeeds only in fuelling the ignorance and prejudices displayed too often by some elements in the tabloid press.
We cannot hope to tackle the stigma of mental illness when we still have a wholly unacceptable draft Mental Health Bill hanging over the heads of everyone with a mental illness or anyone who needs to be encouraged to present themselves for such a diagnosis. It is a Bill that is more about locking people up than giving them the support and treatment that they need for what is first and foremost an illness. It contains fundamental flaws and, according to the British Medical Association, would quickly bring mental health services to a standstill. The Bill, in its current form, could prove to be counterproductive and yet another example of the attacks on civil liberties that are becoming the hallmark of this Government. It can only harm the prospects of reducing the stigma attached to mental illness. I urge the Government to clarify their intentions now and to listen to the mental health community, who are up in arms.
Above all, the Government need to live up to their bold words about making tackling the inequalities in mental health a Government priority. To continue to fail to do so is a false economy and a serious threat to one of the most serious public health challenges facing our nation today.
This has been an interesting and thoughtful debate. It shows that a wide-ranging discussion needs to be had not only by those in health but by those in education, local authorities, the voluntary sector, employers—whether in the public or private sector—and agencies such as jobcentres in order to tackle the variety of needs that people with mental health problems face in trying to live their lives. That is important given that much of the debate raised questions about the way in which people often work in silos in relation to mental health. We are trying—there is apparently consensus across the House on this—to challenge the importance that every organisation gives to how it meets the needs of those with mental health problems in their community, no matter what that organisation's core remit.
The debate has given the Government the opportunity to demonstrate our commitment to improving the lives of the one in four people who suffer from mental illness at some point in their lives. There has clearly been increased investment in, and modernisation of, mental health services since the publication of the national service framework in 1999.
Members made several accusations. To deal with one, I understand that the Tory-Liberal Democrat council in Birmingham recently cut £2 million from the Supporting People programme and moved it to another area.
In the seven years since the national service framework was introduced, ambitions have been surpassed in many areas, but I am the first to admit that a great deal more remains to be done. There is consensus across the House in congratulating and thanking all those who have worked so hard to make these reforms happen. I hope that we are moving towards a system of community care, supporting people in their own homes and working to increase inclusion and decrease stigma. It is equally important that a full range of high-quality in-patient services are there for those who need them. We have recently concentrated particularly on getting the balance right in that respect.
One of the ambitions of the White Paper that we launched last week is to engage with the issue of services that could be provided outside hospital. As the Minister responsible for public health, I fully take on board matters to do with prevention and public health for those with mental health problems, as I would with anybody in the community. That is at the heart of our desire to bear down on the health inequalities that still exist. We have made considerable strides towards high-quality mental health services, but we have an even more ambitious direction of travel. We are committed to supporting good mental health throughout the population and improving preventive mental health services in the community.
I turn to the points raised in the debate. I agree with Steve Webb that it is important to integrate health and social care budgets. The White Paper sets that out very clearly. We can do plenty more work in that area, which creates opportunities for innovation and imagination.
The hon. Members for Northavon and for Banbury (Tony Baldry) talked about GPs. Practice-based commissioning will help GPs to manage more effective care pathways and allow primary care trusts to commission new services on behalf of GPs. Coupled with an enhanced role for GPs in managing mild to moderate depression in better monitoring mental health, we hope that this will create more flexibility and incentives for GPs and PCTs to manage mental health.
The hon. Members for Northavon and for Tiverton and Honiton (Angela Browning) mentioned the new Bill. They are right to say that it will require a careful balance between a person's right to make decisions about themselves and society's duty to protect people with serious mental disorders from harming themselves, or occasionally others. We are confident that our Bill will achieve the right balance, but I am sure that my hon. Friend the Minister listened carefully to the points made in the debate.
Members asked about prisons as places of safety when there is a crisis situation. Last year, we announced £130 million to help trusts to create proper places of safety for those who need a settlement under the Mental Health Act 1983 instead of relying on police cells or accident and emergency departments. There has been considerable work within A and E departments to improve the relationship with social services on quick referrals. On prison health, 360 mental health in-reach staff are in post, exceeding the commitment to 300 in the NHS plan. NHS mental health in-reach teams now provide services in 102 prisons. Again, there is progress but more to be done.
My right hon. Friend Mr. Smith and the hon. Members for Banbury and for Cambridge (David Howarth) mentioned particular issues in Oxford and Cambridgeshire. I congratulate my right hon. Friend on the three-star trust rating; I am glad to hear about that progress. Last week, the Department issued a set of financial rules for the next financial year, requiring local health economies to develop an operating surplus to create a buffer against unplanned financial problems. We will work hard with NHS bodies to ensure that good finances are in place over the next few years. If we act now, we will help to protect mental health services better against the pressures that some have faced this year. That is an important challenge that we must face up to.
The hon. Members for Cambridge and for Banbury asked about payment-by-results work for mental health. We agree that that is an important issue, and we are working hard to tackle it. We have set out our intention to pilot a new currency in 2007–08, and the move to develop a tariff is being taken forward by the mental health team. We take the matter seriously, but we are not launching an untried system on mental health services.
Mr. Dorrell made an interesting speech in which he talked about the integrated delivery of care. That is indeed vital to good services for patients. However, he failed to talk about how in 18 years he missed the opportunity to put some of his ideas into practice.
My hon. Friend Ms Johnson made a good speech in which she acknowledged the investment and the changes in attitudes and culture when providing services. However, she was also challenging. We have asked Professor Louis Appleby to co-ordinate children, adult and elderly people's services. I believe that to be important. We have a national service framework for young people's mental health, which outlines standards for services and, indeed, sets world-class standards for their provision. Of course, we must ensure that they are delivered on the ground and we want the help of colleagues from all parties to hold agencies to account for that.
My hon. Friend also made good points about women. We have issued guidance on ensuring that in-patient services are safe for women—we take that seriously. My hon. Friend and the hon. Member for Northavon made points about mixed-sex wards. Ninety-nine per cent. of wards are not mixed sex—they have separate sleeping and bathroom facilities. However, we are working to improve matters. Sure Starts and refuges have an important role to play as first contacts for many women—and their children—who may suffer from mental health problems.
I stress to the hon. Member for Tiverton and Honiton that we are spending £60 million on pilots to protect older people's health and we are piloting new centres for older people's services, which will include work on tackling loneliness. She made a valid and interesting point.
My hon. Friend Meg Hillier was right to say that we must tackle the problems of stigma that prevent people from getting work. I hope that we can consider better methods of challenging those problems through the pathways to work programme. She also made points about ethnic differences. The issues are complicated but we have done some work on examining the reasons for problems that mean that some people from black and minority ethnic backgrounds are deterred from coming forward until their illnesses are more severe. I congratulate her area on tackling those problems, and my hon. Friend the Minister of State has promised to visit.
Jeremy Wright spoke about post-traumatic stress disorder. We acknowledge the importance of that work. We have evidence of what works from the National Institute for Health and Clinical Excellence and we have issued advice to all GPs in the NHS. That was invaluable in providing support for victims of recent tragedies such as the bombing on
I shall not specifically answer the points of Tim Loughton because, if he reads my hon. Friend the Minister's opening speech, he will realise that she covered them. However, I stress that mental health has never been higher up any Government's agenda. The result has been record increases in investment and staffing. Thanks to the efforts of the staff, front-line services have become more responsive.
We remain some way from fulfilling all our ambitions but, based on what we have said today, I urge hon. Members to vote against the motion.
Question accordingly negatived.
Question, That the proposed words be there added, put forthwith, pursuant to
Madam Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House recognises that the Government has made mental health a key priority through the National Service Framework for Mental Health and the NHS plan; welcomes the achievements set out in the National Director's progress report published in December 2004; further welcomes the record increases in investment and staffing; notes that under this Government there are now over 700 specialised community mental health teams and that suicide rates are the lowest since records began, that there are 1,200 more consultant psychiatrists, over 3,000 more clinical psychologists, and 8,000 more mental health nurses than in 1997; further welcomes the Government's five year action plan to tackle inequalities in mental health services amongst black and ethnic minority communities and its action to tackle social exclusion in mental health; acknowledges the Government's commitment to early intervention to support good mental health and improve preventative mental health services in the community, as set out in the recent White Paper "Our health, our care, our say: a new direction for community services", including by improving public understanding of mental health issues to counteract stigma and discrimination, expanding access to psychological therapies including cognitive behavioural therapy, promoting the use of information technology recently reviewed by the National Institute for Health and Clinical Excellence which supports people to take charge of their own treatment, and working with health professionals to improve standards in mental health services in the community; and further welcomes the Government's commitment to reform mental health legislation as soon as parliamentary time permits.