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Richard Younger-Ross (Teignbridge) (LD): Does the hon. Lady agree that the trust, the SHA and the other partners must be investigated to ascertain what has gone wrong not only with the trust but with the overseeing of it?
Mrs. Browning: I do not disagree with that proposal at all, but I also emphasise to the Minister that I do not want delays while investigations take place. We want action. If a school failed, someone would send in a team to deal with the immediate problems. We are talking about people's lives, and those problems need to be sorted out.
The Royal College of Nursing locally has regularly written to Members of Parliament for some months. Not only has it expressed concerns about staff morale, but it has written:
"The Trust management appears to believe that the financial overspend has been contributed to significantly by an inherited overspend . . . and underinvestment by the PCTs.
In the Trust document—
"the management is unequivocal: 'in the face of competing national and local priorities, many PCTs have not invested in the Trust to the level required to meet the full cost of inflation and cost pressures".
That is perhaps one of the things to which the hon. Gentleman was alluding.
"One might ask why the Strategic Health Authority allowed this situation to develop. One might think that the body which is responsible for the strategic planning for the health services . . . would monitor the functioning of a newly created Trust".
I mentioned that GPs have been to my surgery. I have but a very small selection with me of the quotes that doctors throughout not only my constituency but other parts of Devon have sent to me in advance of the debate tonight. One says:
"For nearly two years we have not been able to make a referral to the local community mental health team unless the patient is at serious risk of suicide. Although there is a psychological therapy service for primary care we have an allocation of 13 referrals a year for a population of 8250."
"We feel that there is a serious gap in the provision of mental health services for patients with mild to moderate depression or anxiety."
I shall come in a moment to the way in which the trust has made allocations for what it calls core and non-core patients. Another doctor says:
"GPs had been expressing doubts and worries about the management of the Trust for a considerable time before the managers were obliged to admit they couldn't do it".
"I am writing after much thought to express my concerns over the management of psychiatric services for the elderly in Tiverton."
There have been five different locum psychiatrists in two years, and as the doctor writes:
"Clearly this has made continuity of care a joke".
"To reduce the bed capacity of a severely overstretched service seems crazy. I have lost confidence in the management of Devon Partnership Trust."
"I am a working GP in Mid-Devon served by this trust. The service provided is very poor, the worst I have come across in 30 years of NHS work."
Another says that she carried out a small audit of repetitive suicidal behaviour, and states:
"The small study I conducted showed that 50 per cent. of patients were taking overdoses within three months of an initial self-harm attempt."
The reason for those doctors' concerns is that the trust has set up core and non-core services. A week ago, in answer to my written question the Minister said that those decisions were to be made locally, but I urge him to look at what is happening in this trust.
Mr. Hugo Swire (East Devon) (Con): On core and non-core issues, does my hon. Friend share my concern about the fact that beds put aside for those suffering from dementia or Alzheimer's, particularly those in our community or cottage hospitals, will not be staffed by specialist mental health nurses and may then be lost?
Mrs. Browning: My hon. Friend is right. That is one of the trust's proposals, and it is something that we are all concerned about. If people with Alzheimer's who are going into hospital for respite care are not treated by a qualified mental health nurse, the hospital will not be able to sustain its treatment of such patients, and the beds will revert to general ones.
The question of core and non-core services is a real problem because it means that there is virtually nothing for patients classified as non-core. When I say "virtually nothing", I am not exaggerating, and that is why GPs are coming to see me. They are not allowed to refer non-core cases to a consultant; they go to the community mental health team, who are there to assess patients and then decide on the level of care to be given and on whether further referrals are needed. At the moment, among the patients who have been to see me are people who have waited 12 weeks for a first appointment and some who are still waiting. We are talking about potential suicides here.
Only this weekend, I visited at home a young woman who has made no fewer than 10 suicide attempts since she was 15. I witnessed for myself the self-harm marks on her wrists. She has been turned down by the community mental health team as somebody for whom they are not prepared to provide support. [Hon. Members: "Disgraceful."] Hon. Members are right; it is a disgrace. In fact, it is quite wicked.
I mentioned in-patient care. The Cedars, part of Wonford House hospital, is a unit that takes patients from my constituency. In June 2002, we saw the most tragic event in which three patients, not all of whom were voluntary patients considered to be a low risk, left the unit together and collectively committed suicide by jumping from a cliff. As a result, the trust was meant to put in place at The Cedars certain safeguards to ensure patient safety.
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Since then, there have been further deaths among people who have left the unit. I mention in particular Daniel Heard, a constituent of mine who died last February. In July this year, after my many discussions with the then chief executive, she wrote, promising an external review of the circumstances surrounding Daniel's death. I spoke to his mother last week; neither she nor I has yet heard of any such review or inquiry being set up. That is symptomatic of the laissez-faire attitude towards situations in which people's lives have been at stake, yet the style and efficiency of the management throughout the trust, whether in dealing with an in-patient or with somebody who presents at a GP's surgery, show just how poor the services are.
I conclude by reading from the brochure of a GP practice in neighbouring Dorset that offers in-house counselling for adults, as well as a dedicated psychology service for children, families and teenagers. The brochure states:
"If your mental health needs cannot be met by our in-house service, we have access to the community based mental health team, a specialist psychotherapist and services for alcohol and drug addiction problems."
GPs in my constituency cannot refer heroin addicts aged under 18 to anybody—I tabled a written question about that last week. Across the piece, the service has disintegrated. I ask the Minister—I beg the Minister—do not just tell me tonight that the strategic health authority and others are trying to put things right. A lot more than that is needed to deal with the immediate problem that we face in Devon.
10.40 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate the hon. Member for Tiverton and Honiton (Mrs. Browning) on obtaining this debate and on her interest in local health services, both generally and in this important respect. She knows the difficulties that Ministers have when responding to debates such as this one. We do not have complete access to every single fact and figure needed to give a thorough and comprehensive response from the Dispatch Box, and I am sure that she does not expect me to give one tonight. Therefore let me begin by saying that, whatever else I say tonight, I shall ensure that all her comments are properly studied; I shall reflect on them and, if necessary, write to her after the debate about any other types of action that I consider appropriate. That applies also to the comments made by the hon. Members for East Devon (Mr. Swire) and for Teignbridge (Richard Younger-Ross). My hon. Friend the Member for Exeter (Mr. Bradshaw) has been raising the same issues: he has already met ministerial colleagues and is to meet the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), in the very near future. Clearly, all local MPs are very concerned.
Mental health services in every area of England are going through a radical programme of modernisation. Local delivery plans for the modernisation programme have now been agreed, and I assure the hon. Lady that in every area of the country, including her own, there is a clear commitment to deliver all the mental health targets in the NHS plan. Progress towards those targets is already being made: for example, a range of specialised teams and services to support people with
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mental illness are being established across the country and their impact is now starting to be felt by service users and carers: they are able to exercise more choice, to be treated at home instead of hospital when that is appropriate, and to access services more easily in an emergency. I am sorry that the hon. Lady feels that that sort of progress is not being made in her constituency. Clearly, we need to investigate that.
We are also making progress with strengthening the mental health work force. The number of consultants in the psychiatry group has increased by more than a third since 1997 and we have a comprehensive programme in place to ensure further development. In addition, we now have a quarter more psychiatric nurses working in the community and half as many more psychologists as there were in 1997. To support the focus on improving and modernising mental health services, significant extra national investment has been made—more than £300 million over the three years to the present. Between 2003–04 and 2005–06, Mid Devon primary care trust will receive an increase in its revenue allocation of £22.2 million, which represents a cash increase of just under 30 per cent.
I am pleased to say that—at least on the face of it, although she may not agree—progress has extended to the hon. Lady's constituency. The north and mid Devon assertive outreach team has been developed, as have crisis resolution teams in north and mid Devon that are open seven days a week, and an early intervention team, which was informed by a successful pilot project set up in north Devon. In addition, I understand that the trust wishes to develop a new mental health facility in her constituency in Tiverton, so that people who suffer a mental health problem in that area do not have to travel to Exeter for the care and help they need.
Notwithstanding the challenges faced by the local trust, which the hon. Lady outlined in her speech, I hope that she agrees that there have been a number of positive developments at both national and local level. I hope that she also agrees that the local trust has achieved well in the past. It has achieved two stars in the performance ratings for the past two years and it has returned a balanced financial position since its formation in 2001. That is a significant achievement, particularly given that four separate organisations were merged to create the trust. I think that we should pay tribute to all the staff who have contributed to those achievements.
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