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Mrs. Browning: I am sorry about this—the Minister will not be surprised to hear this—but the experience of Devon Members is not what the hon. Gentleman is reading out from his brief. If the hon. Member for Exeter (Mr. Bradshaw) is seeing a senior Minister on this issue, I think I can speak for all Devon Members when I say that we would like to be at that meeting.

Dr. Ladyman: That is a matter for my hon. Friend the Member for Exeter and the Minister of State. Certainly my office door is always open to Members who want to discuss constituency issues of this seriousness.

I agree with the hon. Lady that the trust is facing a challenging agenda. She has asked the Department to step in and manage the problems that the trust is currently facing.
 
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As the local headquarters of the NHS, strategic health authorities are responsible for performance managing local NHS organisations and for ensuring that local organisations are of a high quality and performing well. Strategic health authorities are the link between the Department of Health and the NHS, with the Department's role being to provide strategic leadership and direction. It would be inappropriate, therefore, for the Department to become directly involved in specific local issues or manage local problems. That is what we set up SHAs to do on our behalf, and I am assured that the SHA is working with the trust to ensure that it has the support that it needs.

For example, the South West Peninsula SHA is working to strengthen the strategic direction of its mental health services. It is also supporting the trust in developing services, in line with the requirements of the national service framework, within a strong strategic framework. The SHA will also be providing close monitoring and advice on the trust's financial position, an issue to which I will return.

In addition—perhaps this will give the hon. Lady a bit more of the reassurance that she seeks—I can say tonight that mental health policy officials and officials from the Department's recovery and support unit will also be meeting the SHA on 25 November to discuss the future direction and performance of local mental health services throughout its area. Therefore, I hope that the hon. Lady will accept that we are providing from the centre the support and direction that the SHA needs so that it in turn can support the trust in these difficult times.

The recent departure of both the chief executive and the finance director have, of course, added to the challenges faced by the trust, and I am pleased that the South West Peninsula SHA has acted swiftly to put in place an acting chief executive. The acting chief executive of the trust has recruited an experienced NHS finance director to act as interim finance director until a permanent appointment can be made. He will take up his post at the beginning of November.

The hon. Lady should be reassured that both the chair and chief executive of the SHA have also liaised closely with the chair of the Devon Partnership trust on the appointment of a high calibre replacement for the chief executive. I understand that an interim chief executive has already been identified and subject to due process will be appointed shortly.

I am also aware of the real financial challenges ahead for the trust, but I am assured that it is putting in place a robust plan of action to address the problems that it is facing, and that the South West Peninsula SHA is providing the trust with the support to take this forward.

Mr. Adrian Sanders (Torbay) (LD): I warn the Minister that cuts are being proposed at the Riverside unit in Torbay. The hon. Member for Tiverton and Honiton (Mrs. Browning) mentioned the problems at the Cedars unit. Pre-dating that, there was a problem with the Edith Morgan unit in Torbay. The recommendations were essentially what was created, the Riverside unit, and it is that which is now to close. Organising and sorting matters out is a process that is being paid for by the most vulnerable in the community,
 
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and staff are extremely worried about the protections that they received as a result of some tragic cases that are now to be removed.

Dr. Ladyman: The hon. Gentleman is slightly misrepresenting the position in respect of the particular unit to which he is referring. The possibility of closing that unit is due not to financial pressures but the difficulty of recruiting staff, particularly agency staff, who are needed to maintain standards of clinical governance. I have been assured that if it is necessary to close the unit, it will be a temporary measure and the service would be reprovisioned in the local area. I will ensure that the hon. Gentleman's comments are looked into to see whether I have been misinformed in any way.

Richard Younger-Ross: If the Minister wants to examine the crisis in morale, he has only to look at the 100 staff whose salaries are being cut by the trust from £7 an hour to £5 an hour.

Dr. Ladyman: I cannot comment on that matter without exploring it, but I shall certainly look into it.

The trust has acted responsibly and is putting in place actions now to ensure that it reaches a year-end balance, which is a point to which the hon. Lady referred. It has developed a service improvement and financial recovery plan to identify how it can address the current financial problems and is engaged in ongoing discussions about the plan with its commissioning primary care trusts and other stakeholders. The strategic health authority is working with both the trust and the primary care trusts to ensure the successful resolution of those discussions.

I appreciate that the plan's contents have caused some concern among local people, but its aim is to examine how the trust can make best use of its available resources and modernise services in order to deliver the national service framework for mental health. The Department has made it clear that where financial recovery plans are developed, they should not be at the expense of proper service provision. I am assured that the trust is making every effort to ensure that the impact on patient care is kept to a minimum, but we must examine that point in the light of hon. Members' comments.

The hon. Lady also highlighted concerns about bullying in the workplace. The Government have made it clear that no form of bullying or harassment will be tolerated in the NHS. Staff should be fairly treated, properly rewarded and able to use their skills to the full. In the course of its recent clinical governance review, the Healthcare Commission received reports of harassment and bullying from members of staff. The final report, published in September, recommended that an independent review be carried out into these allegations.

The Devon partnership trust has fully accepted the Commission's recommendation and a review is being established. The SHA is currently working in collaboration with the Healthcare Commission and the trust on the terms of reference for the review and on the appointment of personnel to undertake it. The review is expected to commence in January 2005, and I am assured that it will be robust, thorough and transparent.

I also appreciate the serious concerns about the numbers of suicides at the Cedars unit and agree that there are important lessons to be learned. I want to
 
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reassure the House that I have looked carefully at the steps taken by the trust and the SHA to investigate the events that took place at the Cedars unit. I understand that a full internal review, an external review and an inquest into the triple suicide in 2002 have taken place, and the trust has fully taken on board the recommendations from those inquiries.

The trust has acted on the findings of the reviews and has introduced changes to its key policies as well as improvements to the day-to-day running of the unit. For example, environmental changes have been made such as placing observation windows in all bedrooms, relocating the nursing station and replacing CCTV cameras. Policy changes have also been made, and 63 new policies have been put in place. Those policies include a revised engagement and supportive observation policy, a clinical risk policy, an incident reporting policy, a policy on alcohol and substance misuse and an absent without leave policy.

Improvements have been made to staffing levels. Minimum staffing levels have been implemented, and those are increased to meet the clinical needs of patients. The trust has been working with Mid Devon primary care trust to increase the medical establishment by two additional consultant posts over the next two years. Improvements have been made to clinical record keeping. For example, detailed care plans that include leave arrangements are now used as a basis of communications at handover and with families and carers. New management and leadership arrangements are in place, and a senior H-grade nurse was appointed in September 2003 and leads the unit. The team is managed through the north and mid locality team and the senior nurse acts as a co-ordinator for the team, attending ward rounds and handovers.

Before I conclude, I shall deal briefly with waiting and referral times. I understand that the Devon partnership trust operates a single point of entry system to mental health services. Under that system, GPs can still refer patients directly to a consultant, but the referral is handled in conjunction within the multi-disciplinary team, which means that all cases are handled in the same way. Urgent referrals are always looked at the same day, and less urgent cases are discussed and reviewed at weekly referral meetings.

The community mental health teams in the hon. Lady's constituency have been working over the past 12 months to reduce waiting times by offering service users the opportunity to arrange first and follow-up appointments at times to suit them, which has had a significant impact on waiting times. If the hon. Lady and the GPs whom she mentioned believe that that is not an accurate representation of the situation, I would very much appreciate it if she wrote to me with their views, and if she made the Healthcare Commission, which has a role in inspecting these services, similarly aware.

I am sure that I will not have reassured the hon. Lady completely, but I hope that she is at least partly reassured by the fact that there are to be further meetings with the strategic health authority and that we are going to give it support.
 
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Through "Shifting the Balance of Power" and devolving funding to the front line, we gave health services in every local area the freedom and resources to develop a strategy for the future that will deliver financial balance and sustainable services. However, when things go wrong there is always a call for us to step in from the centre and take over. That is not the way in which it should work if we are to give people the freedom they need. Mechanisms are in place for us to provide support to the strategic health authority and, through that, to trusts themselves. Other mechanisms enable us, with the help of the Healthcare Commission, to inspect services and ensure that we are picking up on these issues.

I encourage the hon. Lady and other hon. Members in the Chamber to ensure that they are feeding all this information into the SHA and the Healthcare Commission. I will refer the impressions that I have gained from the debate to the SHA and engage with it to see whether we can come together to find a way of
 
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supporting the very important mental health services that Members highlighted. We can make progress on this—

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