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Mr. Richard Bacon (South Norfolk) (Con): I congratulate the hon. Member for North Norfolk (Norman Lamb) on securing this debate, and I pass on to him the thanks of Mr. Iain Dale for having done so; I know that Mr. Dale secured a meeting at Rebecca house on a cross-party basis to express the widespread concerns of residents and relatives about the position being taken by the trust.

I want to highlight for the Minister a fact to which the hon. Gentleman alluded—this is not an isolated case, and the same situation is widespread across Norfolk. Indeed, there are five such units, including Cygnet house in Long Stratton in my constituency, which I understand the Minister visited today. I also understand that some friendly local fox hunters were present to greet him, although I had nothing to do with that. I hope that he found the visit congenial, notwithstanding some of the people by whom he was greeted.

Cygnet house is one of the five units for the elderly across Norfolk. It has units catering for long-term residential care for the elderly mentally ill, and it also offers respite care. The number of units can vary from day to day. On 25 October, it had 11 residents, compared with 14 in Rebecca house. Adding Ellacombe, Yew Tree and Laburnam, which are located in Norwich, produces a total of 49 places on that date—a number that will fall to some 28, as the hon. Gentleman said, under the proposals.

That raises a number of concerns. First, some facilities, especially at Cygnet house, are very local to people in South Norfolk, for whom it is not always easy to get into Norwich, especially when they are elderly people. The Minister will have seen today how large my constituency is; it covers some 350 sq miles. At the moment, Cygnet house provides easy access for relatives, and there is no doubt that Norwich is more difficult to visit.

In addition to the question of access, there is the quality of care that is provided. The father of a councillor in my constituency, Councillor Martin Wilby, has been at Cygnet house for two and a half years, and has received excellent care, both physically and mentally. Mr. Wilby senior has been in homes of various kinds for some 10 years, but his time at Cygnet house has been the best, according to Councillor Wilby. Mr. Wilby senior spent some time at Hellesdon hospital in Norwich, but there was a high staff turnover and the care could be patchy. Cygnet house, which has a low staff turnover and a higher and more consistent quality of care, is in my view and that of many local people better for residents.
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The hon. Member for North Norfolk also alluded to cost, which is the other issue that I want to raise. I have a copy of the report to the board of the Norfolk and Waveney Mental Health Partnership NHS trust, which refers to potential options for Cygnet house, including the refurbishment of the facility and its use as a care unit for the whole of central Norfolk. However, the report states that if that option were pursued, clinical and out-of-hours cover, as well as the high revenue costs, would raise concerns. On the face of it, it seems that the change is a cost-cutting exercise, with not enough thought being given to the needs of elderly people with mental health problems who need specialist care, and it does not seem right to make relatives pick up the tab, again.

I strongly endorse the point made by the hon. Member for North Norfolk that Norfolk's demographic profile is old and that in many cases it is getting older—people move to many parts of my constituency in order to retire—so dementia services will grow, not decline, in importance. There are serious concerns about whether the trust's proposal is the right way forward. I have asked Pat Holman, the chief executive of the partnership, to reconsider the closure of Cygnet house, and I look forward to the Minister's reply.

7.41 pm

The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I appreciate the interest that the hon. Member for North Norfolk (Norman Lamb) takes in his local health service and congratulate him on securing the debate. I thank my hon. Friend the Member for Norwich, North (Dr. Gibson) and the hon. Member for South Norfolk (Mr. Bacon) for their interest.

I also thank the hon. Member for South Norfolk for his concern for my welfare. The fox hunters in his constituency were friendly and took their democratic opportunity to express their views in a reasonable manner.

Dr. Gibson: They are wrong.

Dr. Ladyman: As my hon. Friend says, they are simply wrong, but we will leave that matter to another day.

I would also like to take this opportunity to pay tribute to all the staff in the local health economy, who are committed to the improvement of local services and who are doing a fine job. I agree that older people with dementia deserve better services, which is why the Government have set in place a number of initiatives to try to ensure that that happens. More money than ever before is being invested in older people's services, and if I have one message for hon. Members on both sides of the House tonight it is that if we want better services for older people, and especially older people with dementia, we must modernise those services and be prepared to engage constructively and with open minds.

As part of the ongoing process of "Shifting the Balance of Power" to a local level, it is for local NHS organisations to assess the needs of the local population and meet them from general allocation funds. They are in the best position to do that because of their specialist knowledge of their local communities. By devolving
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funding to the front line, we have given the NHS in every local area the freedom and the resources to develop a strategy for the future that will deliver financial balance and sustainable services.

The latest round of allocations has been made for three years. That certainty of funding will enable health communities to plan their finances and will provide a surer foundation for PCTs to commission services in a way that will deliver improvements in performance. Older people will benefit from those record allocations to primary care trusts, as a considerable portion of those allocations will go to services for older people, including the care and treatment of those with dementia.

That brings me to a point raised by the hon. Member for North Norfolk and challenged by the hon. Member for South Norfolk: if the reconfiguration frees up any resources, the intention is to reinvest those resources in further and better support for older people—the reconfiguration is in no way a cost-cutting exercise. The hon. Member for South Norfolk may be interested to learn that North Norfolk PCT has been allocated £97.6 million for 2004–05, which is an increase in cash terms of about 9.5 per cent.

Just because we have given power and resources to the front line, it does not mean that the front line can duck difficult decisions. All hon. Members have a duty to help their local NHS face those challenges, which is what I ask the hon. Members for North Norfolk and for South Norfolk to be prepared to do.

Before I deal with local issues, the hon. Member for North Norfolk raised some national issues about progress with continuing care. I have made two written statements that detail progress on that. The last one reported on progress up to the end of July. I have no plans to make a further statement on that, but when I have sufficient data I shall do so.

The hon. Gentleman referred to criteria. The legal judgment to which he referred did not suggest that the criteria were too strict. It stated that there is an upper limit beyond which it is ultra vires for councils to provide support. It did not distinguish between social care and health care. The ombudsman, when investigating cases, subsequently said that errors were being made and that there was too much variation in the criteria. Consequently, we asked all strategic health authorities to produce new criteria based on central guidance and to ensure that they were legally compliant. They have all done that. The review is retrospective and covers people who may have been unfairly treated in the past. In addition, we are introducing new procedures to ensure that people are properly assessed in future. I believe that the new procedures are working well.

Reassessment is necessary because people's conditions change from time to time. When their condition changes, the care package that they need changes. We must reassess to ensure that people are getting the care that they need.

Norman Lamb: I fully appreciate that care package needs will change, but does the Under-Secretary
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concede that that results in a change in the financial package? It means that people move from free NHS care to means-tested care.

Dr. Ladyman: That is possible. National health service continuing care applies not only to people with dementia, but to people with all conditions. Some conditions are curable and it is therefore necessary to remove the continuing care package when someone is cured. That is not the case for people with dementia. However, their care package will need to be changed and, in the very unlikely event that they are cured, it is theoretically possible that they would revert to means-tested support. That would happen only if their predominant needs were no longer health needs and they no longer fulfilled the eligibility criteria. The primary reason for reassessment is to ensure that the care package always matches people's needs.

The hon. Gentleman mentioned personal care and the fact that it is not free in England. I do not know who controls the social services of his local council, but it is entirely in their power to make home care free if they wish to do that because the matter is devolved to local councils. Not one Liberal Democrat council in the country has chosen to do that and I doubt whether any councils will do it because it is not financially viable. It would cost £1.5 billion a year, not the £1 billion that Liberal Democrat Front-Bench Members claim. The Rowntree Foundation has suggested that the cost will increase to approximately £10 billion by 2050. That would be entirely unaffordable.

I have listened to the hon. Gentleman's comments. The changes that he discussed locally in Norfolk, and especially in Rebecca house, are part of a set of proposals that Norfolk and Waveney mental health partnership trust developed in partnership with the PCT, social services and other stakeholders in a wider programme of service improvement and modernisation. There has been a robust and inclusive local process to develop the proposals, including a full needs assessment and options appraisal.

Those proposals are a work in progress and it is for all hon. Members to engage in it and try to influence it. I can assure hon. Members that no final decisions have been made by the local NHS and its partners pending a formal public consultation process, which will commence later this year.

The hon. Gentleman is a member of a party that says that it believes in power to the people, local decision making and devolution. Yet one could interpret his comments this evening as following none of those principles. He seems to have made up his mind before he has listened to the consultation and the views of his constituents—[Interruption.] Well, the formal consultation has not yet begun, and he did not sound to me as though he was keeping an open mind. He sounded as though he had made up his mind. If the services in his constituency are not properly modernised, he will be doing his constituents no favours because they will not be getting the level of service that they deserve.

The hon. Gentleman has talked about local services. There are several thousand older people with dementia in central Norfolk at any one time. Thankfully, only a few require specialist mental health in-patient treatment, yet there are five separate units providing
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elderly mentally illness—EMI—in-patient continuing care services in central Norfolk. These are Laburnum, Yew Tree, Ellacombe, Rebecca house and Cygnet house. They provide a total of 101 beds. However, only 65 of the 101 beds are occupied, and only 22 of those 65 patients meet the criteria for NHS-funded and provided continuing care and, more importantly, require a specialist mental health in-patient service. The total cost of the services that I have just described is £3.8 million per year. That is an awful lot of money to be spending on empty beds and services that do not best suit some of the people in those places.

Clearly, the demand for these services has changed since they were established. New therapies are now available, and there is a greater recognition that it is important to identify and intervene in the onset of dementia early. That is why the proposal to reshape the services currently provided from these units is being put forward. It will ensure that the resources available to mental health services meet the needs of more people with dementia and their carers, and better fit the needs of the hon. Gentleman's constituents. If we close our eyes to the need to reshape these services, we are ducking our responsibilities. If the hon. Gentleman's first instinct is to say that there should be no change, or even—heaven forefend—to climb on the bandwagon of sentiment that is often associated with establishments, rather than with the people in them, he will not be doing his constituents any favours.

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