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The Parliamentary Under-Secretary of State for Health (Caroline Flint): I congratulate the hon. Member for Totnes (Mr. Steen) on securing today's debate and I welcome other Members whose presence this evening shows that they have concerns about this matter.
The hon. Gentleman is right to say that we must ensure that the needs and choices of older peopleespecially those with mental health difficultiesand of their carers are central to the services that they receive. We must ensure that they are able to play as full a part as possible in society, that their dignity is respected and that their independence protected. That is the central theme of the Green Paper entitled "Independence, Wellbeing and Choice", which is currently out for consultation. We hope that that will be a key driver in ensuring that people at the greatest risk of losing their independence will receive the services and care that they need.
I know from his speech this evening that the hon. Gentleman cares passionately and deeply about facilities for sufferers from dementia and Alzheimer's. In his role as a constituency MP, he has clearly taken a very keen interest in those matters for a long time, and not just over recent months. I listened carefully to the concerns that he raised.
I want to pay tribute too to all the staff working in this field around the country. It is a highly specialised area, and the work can be very stressful, as it involves dealing with dementia and Alzheimer's sufferers and their
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families. The hon. Gentleman made it very clear that whole families are affected by the impact of those conditions on their loved ones.
I want to assure the hon. Gentleman that the Government are committed to improving the standard of care for those with dementia, and we have made available significant additional investment in order to achieve that. Indeed, more money than ever before is being invested in older people's services, but the hon. Gentleman is right to say that we must look to the future and take into consideration the fact that the additional investment in health care means that people will live longer, as well as the possibility that they may therefore develop dementia. We must keep our planning of services under constant review.
The hon. Gentleman drew a portrait of his area, and was right to say that needs are different in different communities, depending on the size of the elderly population. The Government can set priorities and frameworks beneath which standards of care should not fall, but we must also recognise that it would be ludicrous to plan every service in all communities. That would be an example of the dead hand of Government, so we must make sure that local servicesthe PCTs and strategic health authoritiesplay their part in the development of services, in consultation with service providers and, importantly, local communities and patients and their carers.
The Government recently announced the latest round of revenue allocations to PCTs, covering the period 200607 to 200708. Those allocations represent an investment of £135 billion investment in the NHS, with £64 billion going to PCTs in 200607 and £70 billion in 200708.
As the majority of users of the NHS are older peopletwo thirds of all those in hospital at any time are over the age of 65they will benefit in particular. In the hon. Gentleman's constituency, the South Hams and West Devon PCT will receive an increase of £19.7 million, or 17 per cent., for 200607 to 200708. Torbay PCT, which also serves some of his constituents, will receive an increase of £39.5 million for the same period.
In 2002, the Government announced an additional £1 billion for social services over three years from 200304 to 200506, to be invested in a range of initiatives to improve care for all older people. Overall, the Government have also announced total adult personal services funding of £11.5 billion for local authorities in 200506. That represents an overall increase in resources of around £850 million, or 5.6 per cent in real terms, when compared with 200405. That shows the steady progress being made by the Government in boosting the resources available in this sector.
The Government also recognise that older people with dementia need and deserve better services, and we have set in place a number of initiatives to ensure that they get them. We published a national service framework for older people in March 2001 to promote good mental health in older people, and higher-quality treatment and support for those with dementia and depression.
To build on the improvements we have already seen as a result of the national service framework for older people, the national clinical directors of older people's services and mental health services are helping to develop a vision of future mental health services for
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older people, together with a plan of action to help us realise that vision. That will help us nationally, but it should also help those planning local services. It will be launched in the near future.
Before I respond to the points that the hon. Gentleman made about the Briseham unit, it is important to note that all primary care trusts in Devon are reviewing how older people's mental health services are delivered and how they can be improved. As he will be aware, the Devon older people's strategic partnership, Torbay PCT and Torbay council commissioned the Sainsbury centre for mental health to look into the provision of mental health services for older people. The findings, which were published in December 2004, are being used to inform local planning.
The Sainsbury centre review outlined a number of key principles that it suggested needed to underpin services for older people in Devon, including more emphasis on community care and more support for service users and carers in their own home. However, I appreciate the point that the hon. Gentleman made. It is not a question of either/or, but of getting the balance right with a mixture of both sorts of care.
Work is now under way locally to draw up a pan-Devon commissioning strategy and drive forward the implementation of the report's recommendations. I understand that the strategic health authority is considering some of the issues that the hon. Gentleman raised in relation to funding and commissioning. I hope that he will engage in that process as it considers some of the complications caused by streams of funding to improve matters for the future. I understand that the group taking forward the pan-Devon commissioning strategy hopes to meet later this month, and it is anticipated that a strategy will be ready within the next two months. I urge hon. Members to make contact with their local area, if they have not done so already, to find out what is happening in that regard. In Torbay, the PCT has already developed a commissioning strategy that maps out the way forward for local mental health services, creating a service that is local, accessible and provides continuity of care for all.
I turn now to the specific issue of the Briseham unit. The hon. Gentleman is aware that the Devon partnership trust has decided that the services at Briseham unit will be decommissioned, and I understand that a public announcement will be made tomorrow. I know that the hon. Gentleman has had meetings this week that have informed him of that. I am assured that the trust has done all it can to ensure that the impact of the closure of the Briseham unit on service users, carers and their families has been kept to a minimum. I heard what the hon. Gentleman said this evening about individuals, and I will ensure that the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), who has responsibility for that matter, is aware of the issues that he has raised tonight.
When the trust suspended the service in December last year, it made sure that alternative arrangements were made for all users of the service. The unit offered a mixture of in-bed facilities, day care and respite care. Some 19 beds were available, but the usage of those beds had fallen considerably, which raised questions about sustainability and the quality of clinical care. I understand the local community mental health team has
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been working closely with social services to ensure that the transfer of patients has been as smooth as possible and I am advised that service users who previously received residential respite care at Briseham are now being cared for at the Harbourne unit in Totnes, as the hon. Gentleman said. I understand his point about the journey time, and that and other important issues will have to be considered when it comes to future arrangements.
As a temporary measure, patients who received day care at Briseham were initially transferred to the Chadwell centre in Paignton and the trust is now in the process of finding patients appropriate day care in social care facilities or the independent sector.
I assure hon. Members that the decision to close the Briseham unit is not about saving money. Currently, the Devon partnership trust is working up a model of care for services in south Devon that supports the principles and recommendations set out in the Sainsbury review. That model will help to ensure that more people have access to local services, and it will see that the £780,000 currently invested at Briseham is redirected into enhanced, integrated services at the community level. Those services will include the establishment of fully integrated, co-located community mental health teams, and a community matron. An in-patient service will continue to be provided at the Fernworthy unit on the Torbay hospital site, which offers 24-hour admission for individuals in need of in-patient care. The new model of care will also include a team of community support workers located with, and managed by, the community team.
One of the concerns raised by the hon. Gentleman was the provision of respite care. That is a key priority for the NHS locally, and I understand that the trust is actively exploring options to develop more provision in social services and independent residential and nursing care homes to boost the amount of respite care available in different communities.
I understand that one option for the future use of the Briseham unit might include the transfer of services currently provided at Brixham hospital. Although only a proposal at this stage, it demonstrates the commitment locally to look at ways in which the Briseham unit can be used in the future. I understand that Torbay PCT will be making an announcement about plans for the future use of Briseham at its next board meeting on 29 June.
The hon. Gentleman made several points about consultation. I am advised that the issues relating to the Briseham unit were discussed with patients, staff and carers before closure, but he has made his point this evening and I am sure that it will be heard by the trust and others locally. I hope that I have taken his remarks into consideration and I do not underestimate for a moment his sincere concerns about the future of older people's mental services in his area. Often, such issues are hidden; families often feel uncomfortable talking about them in public because of the impact of dementia and Alzheimer's on their loved ones. We have to find a way
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