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Mr. Oliver Heald (North-East Hertfordshire): Where is the money going?
Mr. Milburn: I did a bit of research before the debate. In the hon. Gentleman's area of North-East Hertfordshire, an assertive outreach team has recently been established to cover that region and a new rehabilitation project is providing high-level support to 12 people and lesser support to eight others. In addition, a new community mental health centre was established last year which offers day care and outreach facilities. A new assertive outreach team and a crisis resolution team are operating in area represented by the hon. Member for Woodspring.
I am sure that the hon. Member for West Chelmsford (Mr. Burns) is well aware of the opening of the Christopher unit in Chelmsford; it is a seven-bedded psychiatric intensive care unit. Older people's services in his area include a liaison nurse and a third consultant post. There is 24-hour access to those services for the first time. We have also provided drug and alcohol services and more appropriate premises.
The Conservatives ask where the money is going: it is going into front-line mental health services, which is precisely where we want it to go. Staff numbers are
growing, too. There are 450 more psychiatrists, 1,700 more psychologists and more than 2,000 extra nurses working in mental health services. Services for patients with the most severe mental illness have been the first priority for investment, and rightly so.The hon. Member for Woodspring rightly raised concerns about the standard of prison care, but as he heard from my hon. Friend the Member for Leeds, West (Mr. Battle), progress is also under way in that sector. We can make further progress in the years to come, provided that—this is the crucial consideration—we are prepared as a society, as a Government and in this House to commit the necessary resources to correct the historical underfunding that has been all too prevalent in our mental health services.
It is certainly true that there is a long way to go to secure the world-class mental health services that our country should aspire to provide, but progress is under way, and as the NHS plan set out, there is more to come. I was pleased that the hon. Member for Woodspring quoted approvingly from the Wanless review, which refers to mental health. I am pleased that the Conservatives now acknowledge the importance of Derek Wanless's work, especially as the hon. Gentleman dismissed the report when it was published by saying that it had "completely missed the point."
The hon. Gentleman may find the odd paragraph here and there in the Wanless review with which he can agree, but he cannot—perhaps he will not—make the single commitment for which it calls: a commitment to a growing NHS with rising levels of investment not just for one or two years, but over a period of years.
It was that commitment to a growing and improving NHS that we made at the time of the last Budget, and it was precisely that which the Conservatives voted against. We chose to make the necessary investment in the NHS; they chose otherwise. This week they will the ends, with today's demand for an improvement in mental health services; next week, no doubt, it will be something else; and almost daily, Conservative Back Benchers demand more health spending in their own constituencies. It is worth reminding the hon. Member for Woodspring—and the House—that only a few weeks ago he led those same Conservative Members into the No Lobby to vote against the Budget that provides the means to achieve the ends that they claim to want.
Unless and until the Conservatives have the courage to support the investment that the national health service needs, their claims of conversion to a new form of compassionate, caring conservatism will count for nothing. I say in all candour to the hon. Gentleman that until then they will be judged not on their rhetoric, but on their record—their record of underinvestment when in office, and of opposing investment when in opposition. They can talk about caring until they are blue in the face, but talk is cheap; making the necessary investment in public services is not.
It is the Labour Government who have begun the process of transforming our mental health services. Taken together with the reforms and investment that we are making in mental health services throughout the country, the proposals that I have outlined today for new mental health laws will enhance the safety of both patients and the wider public. I commend those proposals to the House and urge my right hon. and hon. Friends to back the amendment in the Lobby tonight.
5.16 pm
Dr. Evan Harris (Oxford, West and Abingdon): There is clearly much with which to agree in both the Front-Bench speeches that we have heard so far and in the Conservatives' motion. Indeed, it is tempting to support everything in the motion. The only point of disagreement might be what is lacking from the motion—an even more candid analysis of the record of many previous Governments. None the less, I think that the motion on the Order Paper is one that my party can support.
The Government have made things difficult by proposing to remove some of the words in the motion and replace them with other equally important statements. That puts those of us who did not table an amendment for fear that it might not be selected, in the difficult position of wanting to support some of the thoughts expressed both in the motion and in the Government amendment.
The debate has ranged wider than the words of the motion. The change to the title of the debate is interesting. The hon. Member for Colne Valley (Kali Mountford) claimed that it was illegitimate for the Conservatives to change the subject of their debate, but I think that it is legitimate for them to have done so. They clearly thought that mental health was an important issue this week, perhaps because they knew that the Government were about to publish a draft mental health Bill.
The change on the Order Paper makes it appear that the Government advanced the publication of the Bill to today to allow us to have a debate on the Bill as well as on the Conservatives' motion. There are good and bad aspects to that proposition. It seems to me that the House has witnessed a reverse statement: questions were asked by Conservative Front Benchers before the statement was made, and parts of the Secretary of State's speech resembled the sort of prepared statement that he would give on the publication of a draft Bill.
I hope that we will be able to return in good time to the draft Bill and its provisions. I welcome the fact that the Bill is in draft form, but not that the whole process has been somewhat delayed. None the less, the Government ought to be commended on the fact that the process has been deliberative—deliberation is a separate issue from delay. I am pleased that the Bill is in draft form because we have significant concerns about its current provisions, to some of which we take exception.
In his speech and in an article in The Independent today, the hon. Member for Woodspring (Dr. Fox) analysed care in the community, describing it as correct in principle. I agree with him. I would go further and say that care in the community was a good policy. For many people—not only those who were in institutions and were released as a result of that policy change, but those who would have become new patients facing life, or at least long-term, incarceration in institutions—the policy of care in the community introduced by the Conservatives was a boon.
Is it correct to say that because there have been problems with care in the community, it has failed? I would argue that that is an unfair statement, because care in the community was never properly tried and it never had the required funding and resources. Clearly, in mental health more than any other area, the therapeutic environment is staff-rich. Many other conditions can be treated at arm's length from professional staff, with drugs alone or with surgery and little follow-up, but mental
health needs a high ratio of professional staff to patients, not only to monitor drug therapy, but to offer the talking treatments and counselling that are becoming popular with patients and whose effectiveness is increasingly becoming evident.That is why care in the community, which loses the economies of scale achieved by gathering people in institutions, should not be seen simply as a cash-releasing exercise allowing old hospitals to be closed and sold off and the overheads saved, and why it required not just existing funding, but additional investment, which was never made available. Despite progress in their thinking, the Conservatives have not accepted that analysis of care in the community.
In his article in The Independent and in his speech, the hon. Member for Woodspring said that he thought care in the community
- "was implemented too quickly, often with inappropriate patient selection, and in too many places there was too little investment".
- "too little investment in training, finance and related areas."
I would not say that care in the community failed because of poor implementation. That appears to blame the staff or civil servants for what was a political decision to underfund the sector. I say that it was in large part due to a failure of funding and—these arguments have been well rehearsed before—the difficulty of communication between social services and health departments, particularly when both are short of money. I have made the point before that to describe the barrier between them as a Berlin wall is wrong—it would be more accurate to say a Berlin trench, with both digging for the resources. That applies not only to the Conservative Government, but to the previous Parliament.
I pay tribute to the work of the Zito Trust in drawing attention to the needs of patients in the community and the dangers that they pose to themselves and the public. Mike Howlett of the Zito Trust was quoted as complaining that part of the problem with the way in which some patients in the community have been managed is that dangers were not spotted. That is no excuse for detention of those with personality disorder, or for compulsory treatment, but it is an argument for better follow-up, more support for those patients and ensuring that they remain in touch.
I had a homicide in my constituency which occurred nine years after the patient was last in touch with mental health services of either kind, so it was not a problem of poor follow-up of a treated patient who was in the system. The patient was not in the system at all. There is not enough evidence to suggest that we need to go further than improving support. We should not be considering indefinite detention and other such policies.
The hon. Member for Woodspring also spoke—and I believe that others will speak—about the stigma attaching to people with mental health problems. We must recognise that, and regret stigma where we see it—in films and on television—in the portrayal of people with
mental illness in stereotypical or caricatured forms. We must regret irresponsible newspaper coverage of events in the community and seek to persuade newspapers to look at the problem from both points of view, and not just to represent, as they see it, the views of the outraged public.We in the House have a responsibility for the language that we use. I have often been embarrassed by language used in the House—including, no doubt, some of the language used by my hon. Friends. The hon. Member for Woodspring was provoked into describing, without justification, an intervention from a Labour Member as "imbecilic". The use of such words is part of the problem. The Secretary of State's predecessor sometimes became carried away and used heightened language about which I have expressed concerns to him. He did so, for example, in describing Opposition politicians as loony. That may have been worth a laugh at the time, and such language might sometimes have been merited—I am not speaking about those on my Benches—in terms of what he was trying to say. None the less, the use of such terms is part of the problem of increasing stigma. I hope that the Government guide themselves in line with their campaign to ensure that we are responsible in our use of language.
Mental health services have been described in this debate as Cinderella services. We need to analyse in a little more detail the reasons why they can be so described. It has always been difficult to argue for more funding for mental health at local and indeed national level, because it is not glamorous and the latest technologies are not found in this specialty. The status of professionals working in mental health has not traditionally equalled that of those working in acute medicine, emergency medicine and elective surgery, and in what is seen as life-saving surgery in general. That makes it is almost more important for Governments and more incumbent upon them to redress the balance and ensure that adequate funds are made available. We start from a position of gross underfunding of the mental health specialty. It was most prevalent in the Conservative years, but also existed in the first two—if not four or five—years of the current Administration.
We have a further problem in that there are no easy outcome measures. When the Government link funding or prioritisation to the measurement of outcomes, as they do in elective surgery and accident and emergency medicine in terms of trolley waits or general waiting times, the danger is that specialties such as mental health and care of the elderly, which are not easily outcome-measured, suffer because of a lack of political prioritisation, despite the words of the Secretary of State and despite the national service framework. If targets are based on those outcomes and health service managers know that their jobs are dependent on their meeting Government targets that have been raised to a level of political risk, such as those for waiting times and, even worse, waiting lists, there is a danger of diversion of resources from mental health to those other fields.
That is why I have argued—and I have done so consistently, in contrast with the Conservatives—against such central priority setting. I believe that funding should generally not be earmarked; that priorities should be set locally; and that when politicians, even under pressure from the Opposition or the newspapers, seek to set targets
in certain areas, they must recognise that there will be a tyranny over the outcome measured in terms of time and resource allocation and prioritisation.That is a problem. The Secretary of State will recognise that some of the resources that he meant to go into his priority of mental health were diverted into dealing with the here and now of deficits and waiting list targets, and that that funding was, and still is, being poached from mental health. It would be better to ensure that local priorities are set with input on public health and guidance from the Government, but not strict targets. There is a need to allow the bottom-up approach to ensure that resources are provided.
Within this particular Cinderella specialty—there are two such specialties: elderly care and mental illness—the elderly mentally ill are the Cinderella of Cinderellas.
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