That this House takes note of European Union Documents No. 11557/04, draft Regulation on the financing of the Common Agricultural Policy, and No. 11495/04 and Addenda 1 to 9, draft Regulation on support for rural development by the European Agricultural Fund for Rural Development; and supports the Government's objective of encouraging and sustaining development in rural areas through diverse, competitive and sustainable farming methods, in line with Common Agricultural Policy reform already agreed in June 2003 and consistent with the wider EU's shared rural development and environmental priorities.[Mr. Jim Murphy.]
That, at the sitting on Monday 7th March, notwithstanding the provisions of Standing Order No. 16 (Proceedings under an Act or on European Union documents), the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Mr Stephen Timms relating to Future European Union Finances not later than three hours after their commencement; and the proceedings may continue, though opposed, after the moment of interruption.[Mr. Jim Murphy.]
Mr. Malcolm Moss (North-East Cambridgeshire) (Con): I am most grateful to the House for this opportunity to raise this important issue in my constituency. At the heart of this debate is the proposed closure of an elderly mental health in-patient unit with 16 beds at a facility known as the Alan Conway Court at Doddington hospital near March.
I understand the situation in which the Minister finds himselfI am most grateful to him for replying to the debatein so far as I have been in his position. I was the Minister responsible for health in Northern Ireland for two and a half years before 1997, during which closures of hospitals and facilities came up fairly regularly, so I am fully aware of such situations and sympathise with all those from the Minister downwards who have to deal with often difficult decisions. I also recognise that the Minister's response would normally be, "That's all very well, but we devolve these decisions to the strategic health authorities and the primary care trusts, and the closure of a small hospital in someone's constituency doesn't really come within my ambit."
However, it is important that I raise the issue not just because it is very important to those in my constituency who are concerned, but because it reflects a more general situation in the health service, particularly in the provision of mental health services throughout the country. Lessons of a more general nature could be learned as a result of looking at and focusing on what has happened in this case, as there are mitigating circumstances surrounding the proposed closure. In microcosm it highlights some of the problems that are being faced and dealt with by many of those running mental health trusts throughout the country, and by those in the PCTs whose responsibility is on the one hand to deliver Government mental health policy and on the other to make extremely difficult decisions about their overall funding positions.
There are two key players in the scenario. First, there is the amalgamated Cambridgeshire and Peterborough Mental Health Partnership NHS Trust, which according to internal memorandums inherited a deficit of £2.5 million at inception. After a very short period in operation, the predicted deficit for the current financial year had risen to some £4.5 million. I have in front of me some notes from a board meeting held on 30 June 2004, which state:
"The Trust has an underlying deficit of over £4 million arising from an inherited deficit (£2.5 million) and cost pressures associated with national mental health strategy and technical and fiscal policy changes. Recent surveys show that most mental health Trusts throughout the country face the same problems . . . local funding proposals do not enable the Trust to meet its statutory obligation to achieve financial balance and to address nationally determined priority service developments without reducing some of its existing services."
So, there are two points from the board itself: cost pressures in meeting Government targets and policy changes, and the fact that it does not have the financial resources to meet them without reducing some of the existing services.
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The trust's financial position was complicated by its history. Its services were formerly provided by seven predecessor organisations, some of which had dissolved, such as Lifespan Healthcare NHS Trust and North West Anglia Healthcare NHS Trust, but most of which have continued to provide other servicesfor example, Addenbrooke's hospital and Hinchingbrooke Healthcare NHS Trust.
The process of identifying the direct and indirect costs of mental health services in those organisations was extremely complicated and it was accepted that some costs could not be released in the short term and that some might never be realisable. In January 2004, at a key meeting with the local PCTs and the SHA, it was agreed that the trust had inherited a deficit of £2.5 million and outline proposals were agreed for dealing with it.
In a written answer, I was surprised to learn that the Department of Health does not seem to realise that the amalgamation to form the new trust included not only Lifespan Healthcare NHS Trust and North West Anglia Healthcare NHS Trust, but five other hospital trusts within the county. This is the written answer that the Minister signed off:
With the best will in the world, my constituents might give a bit of fair wind to the local trusts in reaching certain conclusions, but when they see and read that the DOH does not know what is going on in Cambridgeshire, they are more inclined to think that the wrong decisions have been taken.
The second player in this scenario is East Cambridgeshire and Fenland Primary Care Trust. In the current year, it is £7.9 million below its formula funding level, which is about 6 per cent. below target, and it is been well below its funding formula target since its inception. Initially, it was funded by the area health authority, and in the past two years the DOH has funded it, but it has always had a funding shortfall. Both the two key players making the decision are stressed financially. One has got a fairly substantial deficit and the other has been trying to deliver Government policy with a 5 to 6 per cent. shortfall in its funding formula since it was formed.
I accept that the Government have recently addressed the problem of the underfunding of PCTs. It would be churlish for me not to welcome the substantial increase that the East Cambridgeshire and Fenland PCT will receive for the next two years, starting next yearour PCT has received one of the largest increases, which is welcome. At the end of those two years, however, the PCT will still be 3.5 per cent. below its funding level, which is better than 6 per cent. below, but I calculate that it will still be £7 million in deficit by 2007. That ongoing funding shortfall will not help to fund current service pressures from providers such as the mental health trust.
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The reconfiguration of the area health authorities and the PCTs in my constituency meant that the new PCT inherited two in-patient elderly mental health units, one in Wisbech at the Queen Elizabeth hospital, King's Lynn, which was in the North West Anglia Healthcare NHS Trust area, and the other at Alan Conway Court, Doddington hospital, near March. Some of the problems have arisen as a result of Government policy and tinkering with the organisation of health care delivery in places such as Cambridgeshire with the development of PCTs and the reconfiguration of the Cambridgeshire Mental Health Trust. That has meant that the current PCT inherited two elderly mental health in-bed units, perhaps in the wrong geographical locations.
The trust approached all the PCTs in Cambridgeshire to help fund its deficit. Without spare fundsas I pointed out, the East Cambridgeshire and Fenland PCT was well below its funding targetit was forced to consider service reductions to help balance the books of the mental health trust. That was confirmed to me in a letter from the chief executive of the Cambridgeshire Mental Health Trust in June 2004. The proposal was to close the Alan Conway Court facility, thus saving some £500,000 in operational costs for the trust. The PCT would save some £350,000 because it would reinvest £150,000 of that £500,000 to boost the community mental health service which, as the report pointed out, was under-developed in that part of Cambridgeshire.
The report from the Cambridgeshire Mental Health Trust suggested that the decision to close the unit was predicated not solely on the requirement to save money, but on the assessment that the East Cambridgeshire and Fenland PCT area was over-provided with in-patient beds and under-provided with community mental health services. That is somewhat surprising, because a recent National Institute for Mental Health in England survey demonstrated that the trust as a wholethat is, the Cambridgeshire Mental Health Trusthas fewer acute beds than the average for the strategic health authority, and that the authority has fewer beds than the average for England. Even so, the number of people who need to be sent to expensive out-of-county placements, often outside the NHS, is comparatively low. Community staffing levels are also significantly below average.So the report from the National Institute for Mental Health in England states that although there might be more beds in one PCT area, the county as a whole is rather low on acute beds. I am puzzled why the conclusion has been reached that we could close a 16-bed unit when the evidence points in an entirely different direction.
Another important consideration is the population profile, which in the case of East Cambridgeshire and Fenland is skewed towards an elderly population. After Greater Peterborough, the PCT area had the second highest population over 65 in the whole county. It also had the highest proportion of over-65s to total population of any PCT and was also the fastest-growing group of over-65s. Perhaps the decision was based on short-termism rather than looking at the future, even the immediate future. There is a fear that the facility may be closed this year or next year, and a few years down the line we will say, "Pity we did that because we need such a facility for our growing population."
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"The Department of Health has now included a Growth Areas Adjustment in determining 2006/07 and 2007/08 target allocations to Primary Care Trusts in the Growth Areas that will shortly experience additional burdens from high levels of growth . . . The Growth Area Adjustment is of course one element in working out the final resource allocation for each PCT, but it is important that we give proper recognition to the needs of growing communities."
In population terms, Cambridgeshire is probably one of the fastest-growing counties in the country, with a disproportionately fast-growing elderly population. It is a very attractive area in which to settle. One can sell one's house in London or the south-east, buy a much cheaper house in the fenland area, and put the rest in the bank. Large numbers of people are retiring to the area, and they will eventually feed through into putting greater pressure on resources of this kind.
Another ingredient in the equation is the fact that when East Cambridgeshire PCT amalgamated with Fenland PCTthere are so many amalgamations going on that one sometimes gets rather confusedan arrangement was made whereby elderly, mentally infirm patients, some with dementia or Alzheimer's, would go to Fulbourn hospital on the edge of Cambridge. It is felt in my constituency that were that arrangement not in place, the facility at Alan Conway Court at Doddington could just as easily meet the requirements of some of the people who live in east Cambridgeshire. In some respects, we seem to be robbing Peter to pay Paul. The Alan Conway Court facility is to close, while the Fulbourn unit in Cambridge is sustained by the purchasing of services from the amalgamated trust.
Local people are very disillusioned with the so-called consultation process, because once it had begun they were told that they were not being consulted on whether the unit at Alan Conway Court should close, but on the implications and ramifications of such a closure. In other words, the closure seemed to be a done deal. It will therefore come as no surprise that this has left a very bitter taste.
More recently, over the past year the county council's health and social care scrutiny committee and the four former area health and social care scrutiny panels have considered in detail the mental health services in the county. The scrutiny committee said:
"The Government's National Service Framework . . . for mental health requires the development of a range of specialist community services: early intervention, crisis resolution and assertive outreach . . . There are two key challenges associated with the development of these services in Cambridgeshire."
The health and social care scrutiny committee recognised that all health partners in Cambridgeshirethe strategic health authority, the mental health trust and the four primary care trustsoperate in a context of deficit budgets for 200405 and severe financial constraints in 200506. The committee will discuss the most effective ways of lobbying nationally and at strategic health authority level for the Government to give greater priority to mental health in their guidance to primary care trusts on the allocation of funding and more national health service resources for mental health in Cambridgeshire.
A decision was made to close a relatively small in-patient unit, which is only a decade old, for dementia and Alzheimer's sufferers in the village of Doddington outside the town of March in a rural area. It was built partly with subscriptions from local people and was much respected and valued by them. More than that, it was loved by those people, who care deeply about the facility. Out of the decision to close it, partly to save money and perhaps partly to reconfigure the service with a greater emphasis on community mental health provision, we realise that there are problems nationally with mental health service provision, funding for mental health and setting centralised targets by the Government, which are not adequately funded through the system. That all creates the sort of difficulties that I outlined.
I do not expect the Under-Secretary to leap up and say that he will intervene to stop the closure. I hope that he does but I do not expect it. However, I should like him to consider some of my points. After all, when the mental health trust amalgamated, the area health authority promised that any deficits would be made good. That has not happened. We no longer have an area health authority but somebodyhopefully, the strategic health authorityshould honour the commitment. With an extra £2.5 million, the closure need not go ahead.