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3 Dec 2002 : Column 747—continued
Prisoners (Mental Health)
9. Dr. Andrew Murrison (Westbury): What recent assessment he has made of the health of prisoners. [82625]
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): Since 2000, all prison service establishments and their NHS partners are expected to complete prison health needs assessments and prison health action plans. These identify, on a regular basis, the services required to meet prisoners' health needs.
Dr. Murrison : In a series of written answers, Home Office Ministers have shown themselves to have a lamentably low grip on the mental health of people in our penal institutions. I welcome Health Ministers' assumption of some of that role from April this year. What plans do they have for improving the mental health of people in prisons, particularly for increasing the rate of prescription of atypical antipsychotics? Can they assure the House that there will be the necessary transfer of funds from the Home Office to the NHS?
Mr. Lammy: The use of antipsychotic drugs is being considered by the National Institute for Clinical Excellence. However, our mental health strategy, published in December, makes it clear that all prisons and their NHS partners should review annually their mental health needs and develop action plans to deal with them. At the same time, the NHS has funded mental health inreach teams; the number will rise from the current 22 to 70 by April 2004. Of course, that takes money and investment, and I wish that the hon. Gentleman's party would match our investment in that regard.
Dr. Brian Iddon (Bolton, South-East): We heard on XNewsnight" last night from Mr. Hellawell's assistant, Mike Trace, that the £50 million allocated to the prison service for drug treatment is not getting through. Will my hon. Friend carry out an audit and ensure that that money gets through?
Mr. Lammy: It is getting through. Some 25,000 initial assessments have been undertaken and there are 60 intensive drug treatment programmes, plus additional funds, announced this morning in the drugs strategy.
Tim Loughton (East Worthing and Shoreham): The Minister should be aware that in the first six months of this year, the prison suicide rate increased by an alarming 40 per cent. Figures show that 70 per cent. of prisoners may be suffering from some form of personality disorder, yet the medical inspector of the inspectorate of prisons, John Reed, called care for mentally disordered offenders in prison a disgrace. Does
the Minister agree that a prison spell should be an opportunity to administer proper treatment for mental illness, not to make it worse? When the ill-fated mental health Bill re-emerges, will he make sure that it focuses on providing appropriate and early mental health treatment and care for prisoners and other citizens alike, rather than banging up yet more people, adding to the thousands with mental health problems banged up already?
Mr. Lammy: I will not seek to make a party political point on such a serious issue. The prison service is part way through a three-year programme of work designed to reduce the incidence of suicide and self-harm among our prisoners. Close watch is paid to the mental health of young offenders at Feltham and other institutions, and extra provision made to prevent suicide.
The hon. Gentleman referred to the prisons inspectorate. The former chief inspector of prisons has said that the partnerships between the NHS and the prison service are successful.
Dr. Phyllis Starkey (Milton Keynes, South-West): As part of its health improvement programme, Woodhill prison in my constituency has agreed an ambitious series of targets with our local primary care trust. Will the Minister clarify where the funding is coming from to make sure that those targets are met? Is it from the prison service or the PCT?
Mr. Lammy: Since 2000, there has been a close partnership between the NHS and the prison service. That means that by 2005–06, the NHS and the Department of Health will have increased funding by £46 million across the country, which will benefit my hon. Friend's local primary care trust.
Primary Care (Disabled People)
10. Mr. Tim Boswell (Daventry): If he will make a statement on access to primary care for disabled people. [82626]
The Minister of State, Department of Health (Jacqui Smith): We are committed to delivering primary care services that offer prompt and convenient access to all, including disabled people. The NHS plan sets a primary care access target that by 2004 all patients will be able to see a primary care professional within 24 hours and a general practitioner within 48 hours.
Mr. Boswell : But does the hon. Lady accept that in some parts of the country, including mine, it is difficult to get on a GP's list? It is even harder to do so for disabled people and it is exceptionally hard for people with a history of mental illness or with learning difficulties. What specific action does she plan to take to ensure that those very vulnerable people obtain the services they need and to which they are entitled?
Jacqui Smith: The hon. Gentleman makes an important point, especially about people with learning disabilities. If they have been in institutional care, or are still in such care, they are often not on GPs' lists. That is why the White Paper, XValuing People: A New Strategy for Learning Disability for the 21st Century",
made it clear that people with learning disabilities needed the same access to GPs and to primary care as everybody else. That is why, by summer 2003, we expect the local partnership boards to have put in place health facilitators, to help people with learning disabilities to access health services. That is why we have already issued for primary health care teams good practice guidance on meeting the needs of people with learning disabilities. In various parts of the country, there are already good and innovative training schemes, whereby staff and GPs in primary care receive training about and are made aware of the particular needs of people with learning disabilities.
Helen Jackson (Sheffield, Hillsborough): Is it not true that, more than anything, disabled people want to remain independent in their own home? Will my hon. Friend consider how the primary care sector of the health service can work with local authorities to bring down—almost to nothing—waiting times for people who want to adapt their homes or to put in bathroom conversions for level access showers to enable them to remain independent?
Jacqui Smith: My hon. Friend makes an important point about the role of adaptations and equipment in enabling disabled people to remain independent. Some of those issues are the responsibility of the Office of the Deputy Prime Minister. I have discussed the matter with ministerial colleagues there, and the Department of Health has made a contribution to the home improvement agencies in order to ensure that those types of adaptation are in place, especially for people who leave hospital. As my right hon. Friend the Secretary of State announced during the summer, we are also extending by 500,000 the number of pieces of community equipment available and that will benefit another 200,000 people over the next three years. Furthermore, I am sure that my hon. Friend is aware that the Community Care (Delayed Discharges etc.) Bill, if passed by the House, will also ensure that such community equipment is provided free to everybody who needs it.
Foundation Hospitals
11. Mr. Mark Prisk (Hertford and Stortford): If he will make a statement on the financial and legal relationship between the Department of Health and foundation hospital trusts. [82627]
The Secretary of State for Health (Mr. Alan Milburn): NHS foundation trusts will be part of the national health service but they will be owned and controlled by the local community, not by the Department of Health. This modern form of local public ownership will be spelled out in detail in a guide to NHS foundation trusts that I hope to publish before too long.
Mr. Prisk : Although we shall welcome that guidance note, the Secretary of State needs to be aware that many of my constituents are confused by the conflicting statements from Ministers on the issue. Will he provide a definitive answer today on financial matters in foundation hospitals—for example, borrowing—and
explain to the House who will have the final say? Will it be his Department, the Treasury or the regulator, or will it be locally elected governors?
Mr. Milburn: The hon. Gentleman will have to wait for the guide—[Hon. Members: XWhy?"] The hon. Gentleman would like a guide so I will give him a guide and a hint. He asked about local governance. As I told the House during the debate on the Queen's Speech, the membership of those organisations will be drawn from people in the local community served by the local hospital. Those members will be able to elect governors who will oversee the work of the hospital board. As a consequence, for the first time there will be a genuine form of local public ownership that will put the public at the heart of our key public service. It certainly will not be national state ownership. It will be a genuine form of local ownership.
NHS foundation trusts will be free to borrow; they may do so from the private markets and they will have access to public sector resources too. Decisions about their right to borrow will be based on an assessment of their ability to pay; that is not an assessment that I will be undertaking.
Mr. Andy Reed (Loughborough): Although the proposals are relatively controversial, as I am sure that the Minister would agree, does he accept that the co-operative and mutual role could play a really positive part in delivering those hospitals, if they go ahead?
Mr. Milburn: My hon. Friend has made an extremely important point. Certainly for those on the Labour Benches—perhaps not those on the Conservative Benches—there is a well-established tradition of co-operation and mutualism, which is at the heart of the founding of our party and the wider Labour movement. In terms of their governance, those organisations will be firmly grounded in those traditions. They will be owned and run by members of the local community. Therefore, for the first time since 1948, there will be clear national standards and NHS hospitals, serving NHS patients, according to NHS principles. They will provide care, according to NHS standards and inspected by an NHS inspectorate, that is free and which is offered on the basis of need, not the ability to pay. The difference is that members of the local community served by the local hospital will have some say over the decisions that are taken by that local hospital. That is not a form of privatisation, which the Conservative party advocates; it is a genuine form of local public ownership.
Dr. Liam Fox (Woodspring): On 7 August, the Secretary of State said:
- XFor some on the Centre Left the idea of transforming the public sector monopoly is heresy . . . In health, this means primary care trusts having control over budgets with explicit freedom to purchase care from the most appropriate provider—public, private or voluntary . . . And existing NHS hospitals should be able to become NHS foundation hospitals".
However, the Chancellor, in his Guardian tapes this week, said that
- Xthere will be problems in health if you try to introduce market forces. There is no way markets work in health care. If they did, you would have this extreme power of the producer over the consumer."
Mr. Milburn: It is the hon. Gentleman who is fixated on market forces. Indeed, I think that one year he managed tell his party conference that, as an unreconstructed Thatcherite, he was wedded to the market inside the national health service. As I have explained to the hon. Gentleman, foundation hospitals have nothing to do with market forces, still less to do with privatisation. It is about public ownership. It is about ensuring that the local public, who are served by the local hospital, are at the heart of the governance of that local hospital; so no longer will the hospital be owned by Secretaries of State of whatever political persuasion. It will be owned and controlled by the local community.
Dr. Fox: Instead of treating us to philosophical gobbledegook, the Secretary of State would be more honest if he said that his view was right and that the Chancellor—the psychologically flawed, downgraded Chancellor—was wrong. But since he cannot answer the ideological questions, perhaps he can answer a practical one. He has told the House that three-star hospitals alone will become foundation hospitals. What happens if a three-star trust becomes a two-star trust during the transition period? Will the process be stopped? And once a hospital has become a foundation hospital, what then? Will it still be subject to the star rating or, once it reaches foundation status, will that no longer apply?
The Secretary of State needs to understand that he must give clear answers to practical questions, because there is a distinct impression that not only is the Cabinet at loggerheads on this, but that Ministers are making up the proposal as they go along.
Mr. Milburn: As for the rating, yes, NHS foundation trusts will be subject to the star rating system, just as every other part of the national health service will be, whether it is a primary care trust or other NHS trust. As for what would happen in the event of a three-star NHS foundation trust losing its three-star status, when the hon. Gentleman reads the guide he will see that the independent regulator whom we will appoint will have various intervention powers to deal with precisely those circumstances.
On the issue that the hon. Gentleman raised about only three-star trusts being allowed to become NHS foundation trusts, I should point out to him that there would be no arbitrary cap on the number of NHS foundation trusts. The more performance improves throughout the national health service, the more NHS foundation trusts we can have. But we have to start somewhere. We should start with those that have a proven track record of success. The hon. Gentleman might like to know that 40 per cent. of the current three-star trusts in the national health service come from the
poorest parts of the country: places such as Doncaster, Sunderland, Hackney and Liverpool. So it will be a means not just of improving—
Hugh Bayley (City of York): If clinical outcomes and the quality of care in a foundation hospital decline markedly, will the guidance that the Secretary of State is issuing to the regulator include the possibility of the hospital losing its foundation status?
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