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12.14 am
The Parliamentary Under-Secretary of State for Wales (Mr. Gwilym Jones): As I said in Welsh Questions on Monday, I am pleased that the hon. Member for Blaenau Gwent (Mr. Smith) has managed to raise this important issue. I shall try to respond to all the important points that he made.
If the hon. Gentleman looks at the provision of mental health care for those living within the Gwent health authority region--including those living within Blaenau Gwent--he will, I hope, acknowledge the greatly improved level of care that is now provided. Over the past eight years, a comprehensive network of local facilities has been steadily built up to replace the outdated and relatively distant institution at Pen-y-Fal in Abergavenny. There are now eight multi-agency mental health teams based in the community. For adults, there is an ambitious range of purpose-built local in-patient, out-patient and day hospitals at Blackwood, Ebbw Vale and Pontypool, which are more convenient and in a homely environment. For the first time, a new liaison psychiatry facility has been established at Nevill Hall hospital. It provides special support when required for patients who are in the general hospital. That benefits Blaenau Gwent, and fills a significant gap.
There has also been considerable investment for elderly mentally ill patients. We now have a new purpose-built hospital, which is the first phase of Ebbw Vale community hospital. It provides continuing care, respite care and a day hospital for Blaenau Gwent.
Among the achievements in the Gwent health authority region is the fact that the specialist psychiatry facility for old age now includes five community mental health teams to meet the needs of older people as close as possible to their own homes. Each team is made up of a consultant psychiatrist, clinical psychologists, community psychiatric nurses and therapists who specialise in working with those with mental health problems. Each team also has active input from key social workers and voluntary organisations. A strong network of volunteers, including carer support groups for patients with dementia and their relatives, has also been developed. All those new provisions improve access and patients are treated more effectively, with an obvious improvement in the quality of care on offer.
As one would expect, as new developments are brought about catchment areas may need to change. In recent months, health and local authority boundaries and responsibilities have changed. That, and some acknowledged anomalies in catchment areas, prompted a view of existing configuration. The aim was to ensure that a greater consistency with local authorities, social services and general practices was achieved, thereby making liaison and continuity more effective.
Mr. Smith:
The Minister says that more continuity has been achieved in relation to local authorities. I am not talking about that, however, and nor are the patients. If there were such continuity, patients would continue to be treated in Dan-y-Bryn hospital in Ebbw Vale, but, as the Minister knows, they are forced to cross the valley to Torfaen. If we are to have the debate that we want, let us make sure that we get the facts right.
Mr. Jones:
I do not deny what the hon. Gentleman has said. I am trying to present all the facts.
I imagine that the hon. Gentleman is aware of the Audit Commission's report. It defined a framework for comprehensive, community-based mental health care. The lack of coterminous boundaries, and poor access to local in-patient provision, gave rise to specific criticism of Gwent health authority's abilities. Gwent Community NHS trust has attempted to reconcile the differences, and to respond positively to demands from local people and the agencies involved.
Mr. Smith:
Will the Minister give way?
Mr. Jones:
Will the hon. Gentleman pause for a while and listen? As I have said, I am trying to establish the facts.
Mr. Jones:
I do not wish to be discourteous.
Mr. Smith:
We must get the facts right. The Minister said that the trust was responding because of pressures
Mr. Jones:
As the hon. Gentleman will find, I am trying to establish what the position is.
Patients living in Pontllanfraith, Blackwood and Newbridge now have a local community mental health team and can go to a new in-patient unit, Ty Sirhowy, situated in Blackwood. Previously, they had to make a nine-mile journey to Pontypool. Residents in Abersychan and surrounding areas are now able to access new purpose-built, in-patient facilities at Pontypool and those from Tredegar and Sirhowy are now served by new in-patient facilities at Ebbw Vale.
In all cases, there is considerably less need to travel and improvements in liaison and quality, together with greater liaison and co-operation between community mental health teams and GP practices. The key to improving health care lies in enhancing the role of the primary sector. GPs and fundholders are and will continue to be central to this.
GP fundholders have a significant role to play in community-based arrangements, as they are responsible for commissioning mental health care for their patients. I expect the new health authorities to pay particular attention to the role of primary care so that we might achieve yet further improvements in the NHS.
Mr. Jones:
If the hon. Gentleman listens to what I am going to say, it will deal with his point.
People living in south Blaenau Gwent will also benefit as a result of these changes, although I accept that, for a small number, there appears to be a disadvantage. They will now have to travel to a different hospital for in-patient care and, for some, there will be a change of consultant.
That does not mean that the care that those people receive will be less good simply because the in-patient facility will be situated at Pontypool. The new unit offers a first-class environment for the treatment of the mentally ill. A wide range of health care will be available at Ebbw Vale and the unit is only marginally further away. It is certainly more convenient than the old institution in Abergavenny and, on past experience, it is expected that there will be less than one admission a week from the south Blaenau Gwent area.
Mr. Llew Smith:
I spent 15 years with the Workers Educational Association. A significant amount of that time was spent working in the mental health sector with mentally ill and mentally handicapped people, in all the hospitals and day centres that the Minister has mentioned and in many more, but one does not need to be an authority on mental health to know that a patient who has, say, a nervous background has gone through a traumatic experience. It often takes years. Indeed, one of the patients in the meeting that I mentioned referred to his severe mental state some 14 years ago, but he said, "As a result of the treatment and of developing relationships with the staff, I am here today." That is a major step forward.
I am not criticising people in Talygarn hospital. I am sure that the nurses and consultants there are first class. I am not criticising the building. I know the region well, but patients will have to start from the word go. They will have to go through all the traumatic experiences that resulted in their mental illness. Those will inevitably be dug up again and discussed with the staff and consultants. One does not need to be an authority on mental illness to know that that will happen.
Mr. Deputy Speaker (Mr. Michael Morris):
Order. The hon. Gentleman has already made a speech.
Mr. Jones:
I acknowledge that there is agreement between us, but the hon. Gentleman is, in part at least, exaggerating the position.
I want to explain two points. First, the changes were motivated by clinical considerations and were developed by clinicians and patients before they were carried into full effect. Secondly, when it became clear--I think that this is what the hon. Gentleman was referring to--that a small number of people would be inconvenienced, the trust sought to discuss the issue openly and publicly and to make improvements to meet the most pressing concerns.
Increased out-patient and day hospital places have been provided locally and the Gwent Community Health trust has considered assisting relatives and friends to visit patients in hospitals. This is not the action of an uninterested and unresponsive organisation.
Mr. Smith:
I do not know who wrote that speech, but his or her knowledge of the community is equivalent to that of the people who drew up the plans for the Abertillery and district area.
The Minister stated that the patients were involved and consulted. The chief executive officer, Mr. Bob Hudson, has apologised and admitted that there was no consultation, not only with the patients and families, but general practitioners, the local council, Uncle Tom Cobbleigh and all. So let us stick to the facts.
Mr. Jones:
Naturally, my officials have been in touch with the Gwent Community Health trust and obtained information. As I said, when it became clear that there were problems, consultations were opened. I think that I know what the hon Gentleman means and I hope that he knows what I mean.
Considerable thought has been given to the effect on an average patient in the south Blaenau Gwent area. Previously, patients travelled to Ebbw Vale or Blaina for out-patient sessions. They now travel shorter distances to new, more convenient out-patient sessions closer to Abertillery.
Gwent Community Health tells me that by the end of the summer, only those who need first appointments will be required to travel outside the south-east of Blaenau Gwent. Furthermore, Gwent Community Health aims to provide complete local provision in due course. That is no mean target for what are, after all, very specialised functions.
Some 1,000 out-patient appointments a year are involved and that represents a considerable improvement in access for those living in the surrounding areas, as well as in the quality of health care.
Furthermore, patients travelling to Ebbw Vale quite often saw not their consultant but an associate. The new arrangements will result in an increased number of out-patients being seen by their own consultant.
Continuity of care is essential and even more so for individuals with a mental health problem. In recognition of that, the community psychiatric nurses involved with those living in the south of Blaenau Gwent are to remain with their patients, thus retaining their links.
In addition, parallel clinical sessions by community psychiatric nurses will supplement out-patient consultant sessions at Abertillery. All community psychiatric nurses will now be linked to GP practices and liaison between the two should be greatly simplified and enhanced.
I am not aware of any change or proposed change that is not firmly based on the intention to improve patient care. I stress that the changes have not been driven by a management agenda to reduce costs or make savings at the expense of mental health patients.
The changes represent a genuine attempt by the trust to improve health care in the south-east of the hon. Gentleman's constituency and they seek to demonstrate that the process is continuing. I want to see a determination to listen to the views of those whom they seek to serve.
I hope that I might have the hon. Gentleman's agreement that, in general, we have a good track record in Wales for developing health care that responds to individuals' needs and preferences. I very much want to ensure that the essential partnerships between health and local authorities will be strengthened as a result of the changes.
I am aware of the concerns locally about the transfer of some provision from Ebbw Vale to Torfaen. A decision to consult on that issue is a matter for the health authority and the national health service trust in discussion with local interests. At the end of the day, the determination of the precise pattern and level of health care provision for mental illness must be a matter for those involved locally and will always need to be considered within the context of available resources and competing priorities.
Health care will change from time to time and, in looking at the needs of one locality, the needs of the health authority's region as a whole must be taken into account if maximum benefits are to be achieved.
I regret any inconvenience that some people might face as the changes take place. Even if clinical standards are improved, as in this case, have no wish to see vulnerable people, their families and friends put to avoidable inconvenience. I give the hon. Gentleman my assurance that I will be watching the situation as it develops.
In acknowledging that the hon. Gentleman has raised a number of important issues relating to the south of his constituency, I think it fair to try to put them in the context of the considerable advances made under this Government for those suffering with a mental illness. Those advances can be seen both nationally and locally, throughout Wales and in the hon. Gentleman's constituency.
We should not forget that, for the past 100 years, mental health care throughout Wales has been primarily provided within isolated, large psychiatric institutions, typically the old Victorian institutions, and there is the widest agreement that those are no longer suitable for the
mentally ill. Often, they meant for many people that they were removed from their local communities and that links with their families and friends were destroyed.
We remain firmly committed to our policy. We want to see that those who suffer from a mental illness have the right care and the support that they need. It is a continuing challenge. Individuals cannot be slotted into a standard model of care.
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