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Mental Health Services
Helen Jones: To ask the Secretary of State for Health how many NHS trusts have an advocacy scheme for users of mental health services; and what proportion of trusts this figure represents. [10011]
Jacqui Smith [holding answer 29 October 2001]: Very few national health service trusts actually provide advocacy services as it is widely recognised that advocacy services should be independent of provider services.
The Department has commissioned a mental health service mapping exercise from Durham University which will provide an up-to-date picture of where mental health service users have access to an advocacy service. This exercise is expected to report later this year.
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Mr. Heald: To ask the Secretary of State for Health by how much the NHS underspent on mental health in 2000–01. [12050]
Jacqui Smith: There are no expenditure targets relating to mental health, therefore there cannot be any underspend. The national health service does have service targets and in 2000–01 these were met.
Mr. Heald: To ask the Secretary of State for Health what assessment he has made of clinical outcomes in mental health in the UK in comparison to other EU countries. [13854]
Jacqui Smith [holding answer 12 November 2001]: Currently there is no assessment of clinical outcomes in mental health in the United Kingdom in comparison to other European Union countries. However, there are currently two important initiatives under way that involve the measurement of clinical outcomes for individuals in receipt of mental health services in the UK that will enable comparisons with other EU countries.
One is the outcome measurement implementation programme headed by the national director for mental health, Professor Louis Appleby, who has established an expert group of the leading experts in the field of outcome measurement in the UK. They are advising on and overseeing the selection and the pilot implementation of instrumentation for the routine measurement of outcomes for individuals in terms of mortality, morbidity, quality of life and user and carer satisfaction with services. The evidence base for this approach is substantial and drawn from extensive research conducted in the United States of America, Europe and Australia over many years.
The other initiative is the establishment of the new National Institute for Mental Health for England (NIMH(E)) which I announced in July. NIMH(E) will be the key vehicle, which supports implementation of national mental health policy in England. It will work with all agencies and interests to develop a co-ordinated programme of research, service development, workforce development and support. NIMH(E) will also generate links with organisations responsible for mental health services in other countries. This will offer the opportunity for comparison of services and clinical outcomes, and the promotion of best practice. A consultation document on NIMH(E) was launched on 6 November.
Mr. Heald: To ask the Secretary of State for Health whether he supports closer partnership working between statutory services and the Churches in the field of mental health; and if he will make a statement. [13847]
Jacqui Smith [holding answer 12 November 2001]: The National Service Framework for Mental Health encourages health and social services to work with individuals and communities to promote mental health. As an integral part of many communities, religious centres and leaders can assist in combating discrimination and social exclusion associated with mental health problems.
Mr. Heald: To ask the Secretary of State for Health what implications the EU working-time directive has for the staffing of acute mental health wards; and if he will make a statement. [13858]
Jacqui Smith [holding answer 12 November 2001]: The Working Time Regulations, which implement the European Community Directive into United Kingdom
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legislation, came into force on 1 October 1998. To implement this in the national health service, the Department made national agreements in the General Whitley Council for GWC staff and with the British Medical Association for Career Grade Doctors which secured maximum operational flexibility. Mental health staff have benefited by having protected rest periods which have reduced the risks of long working hours. Consequently patients have been better safeguarded.
Mr. Heald: To ask the Secretary of State for Health what his assessment is of the number of people with severe mental illness who could benefit from assertive outreach; and if he will make a statement. [13848]
Jacqui Smith [holding answer 12 November 2001]: It is estimated that some 20,000 people need assertive outreach and there is a NHS Plan commitment to have 220 assertive outreach teams established by 2004 to provide the necessary services.
Lung Cancer (Photodynamic Therapy)
Mr. Kevin Hughes: To ask the Secretary of State for Health what plans he has to make photodynamic therapy for lung cancer sufferers available throughout the NHS. [12669]
Jacqui Smith: There is currently not enough evidence to support the introduction of photodynamic therapy in the national health service. If photodynamic therapy is considered to be a potentially significant intervention, it can be referred to the National Institute for Clinical Excellence.
Drugs Budgets
Tim Loughton: To ask the Secretary of State for Health what estimate he has made of the level of spending against their drugs budget by (a) PCTs and (b) health authorities this year. [12598]
Ms Blears [holding answer 5 November 2001]: Health authorities and primary care trusts are responsible for setting primary care drugs budgets; decisions on the level of funding will depend on local priorities.
Forecasts of prescribing expenditure are provided to health authorities and PCTs and groups and it is for them to monitor this against their prescribing budgets. Prescribing budgets notified to the Department do not include any contingency reserves held locally.
We do take account of prescribing trends and other influencing factors in primary care prescribing when considering the overall levels of allocations that are made to health authorities. The latest national forecast for 2001–02 prescribing expenditure represents a 9.2 per cent. growth on 2000–01 out-turn.
Tim Loughton: To ask the Secretary of State for Health what account he will be taking of the level of spending against their drugs budgets by (a) PCTs and (b) health authorities this year when determining budgets for next year. [12599]
Ms Blears [holding answer 5 November 2001]: Health authorities and primary care trust drugs budgets are not determined centrally. However, the Department issues guidance each year to the national health service with
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advice about factors that health authorities and primary care trusts should take into account in setting prescribing budgets. The latest guidance was issued in January 2001.
The latest guidance advises that
- "over the past five years the average growth in the drugs bill has been around 8 per cent.",
and that when setting prescribing budgets,
- "discussions should take into account local circumstances, including past trends and spending comparisons with similar areas."
Health authorities and PCTs and groups are also reminded to take account of additional costs from factors that influence prescribing costs, for example, national service frameworks, newly licenses drugs and National Institute for Clinical Excellence recommendations.
It is for health authorities in partnership with primary care groups/trusts and other local stakeholders to determine how best to use their funds.
We do take account of trends in primary care prescribing costs when considering the overall levels of allocations that are made to health authorities.
Electro-convulsive Therapy
Mr. Burstow: To ask the Secretary of State for Health how many (a) mental health and (b) other patients, broken down by reason for their admission to hospital received ECT (i) having given informed consent in advance, (ii) not having given consent but having the matter put to a second opinion and (iii) not having given consent and not having the matter referred to a second opinion- appointed doctor, in each quarter over the last nine years; and how many patients for each of the quarters where figures are available were (A) under 16, (B) 16 to 59, (C) 60 to 75 and (D) 75 years and over. [13111]
Jacqui Smith: The information requested is not available.
The most recent information available is contained in a one-off survey covering the period from January 1999 to March 1999, England only, that was undertaken to provide an up to date and accurate snapshot picture of the use of electro-convulsive therapy (ECT). Prior to this survey, the information previously recorded on ECT did not provide an accurate picture on the use of ECT treatment.
The results of the survey are contained in the Department of Health Statistical Bulletin "Electro- Convulsive Therapy: Survey covering the period from January 1999 to March 1999, England", a copy of which is in the Library.
Mr. Burstow: To ask the Secretary of State for Health when his Department last undertook an evidence review into the use and efficacy of ECT that drew on (a) UK and (b) international research. [13110]
Jacqui Smith: The Department has commissioned a systematic review of the effectiveness and safety of electro-convulsive therapy (ECT). This review which
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covers both United Kingdom and international research led by Dr. John Geddes at the University of Oxford and is expected to report by the end of this year.
The Department has commissioned the Institute of Psychiatry to conduct a review of studies and information on consumers' perspectives on ECT.
The Department's health technology assessment (HTA) programme has commissioned a review, on behalf of the National Institute for Clinical Excellence, on the clinical cost-effectiveness of ECT due to be completed in May 2002. The HTA programme has also commissioned a trial of the clinical effectiveness and cost of repetitive transcranial magnetic stimulation versus ECT in severe depression. This report is due to be published in May 2006.
The National Health Service Centre for Reviews and Dissemination has conducted systematic reviews relating to the effectiveness of ECT including:
- Electro-convulsive therapy for depression
- Electro-convulsive therapy for schizophrenia
- Half a century of ECT use in young people.
Mr. Burstow: To ask the Secretary of State for Health what guidance has been issued to doctors relating to who should (a) administer and (b) receive ECT in hospitals; and if he will make a statement. [13109]
Jacqui Smith: In 1995, the Royal College of Psychiatrists issued guidance on the use of electro- convulsive therapy (ECT) called "The ECT Handbook—The Second Report of the Royal College of Psychiatrists' Special Committee on ECT". This is an important source of guidance to patients and include sections on clinical guidelines; the administration of ECT; the law and consent. The college expects to issue an updated edition of this guidance in 2002.
In September 1998 the Chief Medical Officer and the president of the Royal College of Psychiatrists sent a joint letter to all consultant psychiatrists, health authorities and national health service trusts. Clinicians and mental health trust managers were expected to ensure ECT is administered to patients in accordance with the college's guidance.
Decisions on clinical interventions remain the prerogative of clinical staff. However, evidence and research tends to support the use of ECT treatment on patients with severe depressive illness and puerperal psychosis.
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