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The Minister of State, Department of Health (Jane Kennedy): I am grateful for the opportunity to share this debate with the hon. Member for Hornchurch (James Brokenshire), and I congratulate him on securing it. This is clearly a matter of great concern to him and to his constituents. I am grateful to him for advertising the detail of his speech on his website; that was a great help in preparing my response. I also compliment him on the depth of knowledge that he has displayed, and on the coherent and cogent way in which he has advanced his case. I am sure that that will not have been lost on his Whips, and that they will draw it to the attention of whoever wins the Conservative leadership contest. I am sure that he has a bright future here. It particularly gives pause to a Minister to hear someone who clearly understands the nature of the challenges that the health service faces in their area.

I give credit to the hon. Gentleman for—and join him in—paying tribute to all the staff in the local health service in Havering, whose hard work and commitment are delivering improvements to the local health service, notwithstanding the challenges that the hon. Gentleman has described. It is because we believe that local people are best placed to take decisions on the shape of local health services that we have now devolved more than 80 per cent. of the health service budget to the front line, for decisions to be taken at primary care trust level. As a direct result of that, the hon. Gentleman's local primary care trust will benefit.

The hon. Gentleman is right. It is incumbent on me to remind the House and the public of the investment that the health service has received. His PCT will receive £303 million in 2006–07 and £331 million in 2007–08. That represents a cash increase of £52.6 million, or 18.9 per cent., over the next two years. Those resources should deliver significant benefits to the local population.

Only last week we announced a further £2.6 million for choice and control pilot projects, of which there will be 13 in England. One will be run by the London borough of Barking and Dagenham council, and another by Essex county council. Those pilot schemes will enable older and disabled people across England to receive, as part of an innovative programme, a virtual money box, which will allow them to take control of their own social care budgets to manage their support and to choose the services that suit them best. It will help them to lead the lives that they want.

I am particularly grateful to the hon. Gentleman for giving me the opportunity to discuss certain subjects, such as mental health services. I take a close interest in mental health, although it is not part of my portfolio. Let me deal, however, with the local issues that the hon. Gentleman raised, particularly mental health services but also podiatry services and antenatal classes for expectant mums and dads in his constituency.

Havering PCT's planned investment in mental health services delivered by the North East London Mental Health trust has increased from £14.9 million in 2002–03 to just over £16.5 million in 2004–05. The trust now has—is to be applauded for it—six crisis resolution teams with 55 staff, compared with the single team that it had in September 2001 with only 12 staff. It also has four assertive outreach teams with 41 staff. I should add
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that since 1997, North East London strategic health authority has been given over 3,267 more nurses, 445 more consultants, 385 more doctors in training, 121 more GPs, 1,882 more health care assistants and 174 more qualified midwives.

The hon. Gentleman was careful not to say that nothing was going well, although he rightly highlighted areas of concern. He mentioned the £245 million new hospital. I am sorry that I could not attend the celebration earlier in the month, but I hope to rearrange that. An extra £410,000 has been invested in primary care mental health services in the 2004–05 financial year. Much good work is being done, and a great deal of real, serious financial investment is leading to real improvements in local services.

Before I talk about podiatry, I should deal with the hon. Gentleman's questions about the Duchess of Kent day hospital, which relate specifically to the mental health problems he described. I was interested to hear his description of the break in service that he believes some of his constituents will experience. Havering PCT decided to close the unit following the expansion of primary care-based services, which resulted in an increasingly limited range of services being offered at the day hospital. Before the closure, a formal meeting was hosted by the borough director and the therapy service manager in June 2005. Approximately 20 service users attended, so there was prior consultation. I will look into the hon. Gentleman's points about the lack of formal consultation, but care was clearly taken to ensure that service users were advised of the changes that would take place. They were given an opportunity to discuss their concerns and raise questions with clinical staff and others, who were also given the chance to discuss their concerns although they could not attend the meeting. When the unit closed, the majority of service users had completed their therapy. A very small number of service users—only six, I understand—were referred for additional therapeutic work elsewhere. I will examine all the issues that he has raised, but I wanted to reassure myself about that point.

With regard to podiatry services, I want to reassure the hon. Gentleman that the rationale for changes to those services was based on clinical need—I accept that he does not quarrel with that—to ensure that those patients who had medical conditions that placed their lower limbs at risk, such as diabetes mellitus, peripheral vascular disease, and rheumatoid arthritis, and who were in the greatest need had access to services to improve their quality of life. I listened carefully to his representations with regard to his constituent, and he might want to write to me following the debate with the details of the case that he has in mind, and I will look into it further. He is right, however, that the PCT has sought to prioritise the way in which it uses its resources and has made those decisions. I will not offer to second-guess the decisions that the PCT has made. It is rightly charged with the responsibility of making those decisions.

On the issue of parentcraft classes, he is right that it is a scary time for parents-to-be. The London strategic health authority cabinet has commissioned a review of maternity services across the whole of London, in direct response to the increase in births in the capital in recent years. That rise is expected to continue, which is the reverse of the national and international trend. Barking,
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Havering and Redbridge Hospitals NHS Trust maternity services, the main provider of maternity care for women living in the three boroughs, has developed initiatives to improve midwifery services. Those initiatives include the home birth support team, which has seen home births increase from 1 to 3 per cent. in the past year, and the small team of midwives focusing on the special needs of teenagers in Barking and Dagenham, which has the highest level of teenage pregnancies. I was delighted to learn that the trust won "Nurse of the Year" for that innovative service, which is in fact being driven by young mothers in the area. Midwifery-led care has been introduced for a proportion of low-risk women who are cared for solely by midwives and not consultants, who are obviously carefully selected in line with the national service framework. That is an innovative development in delivering maternity services locally. In line with the reshaping of maternity services, we expect the report from strategic health authorities in London early in the new year.

A final new initiative was the realigning of the current skill mix for support workers in maternity services and training them to support women, both at home and in hospital, in relation to breastfeeding. Barking, Havering and Redbridge hospital is part of the Department of Health pilot for that. That does not address his specific concern about the loss of parentcraft classes, but it demonstrates the way in which the PCT has been realigning the resources that it has available in line with the priorities that it has determined locally.

James Brokenshire: I hear what the Minister has said, but will she accept the importance of parentcraft and antenatal classes in preparing parents for the birth of their children? To return to podiatry services, does she acknowledge that some users will clearly no longer be able to access the service and the fact that that might have an impact on them?

Jane Kennedy: I am happy to acknowledge that when local decisions of that nature are taken, clearly, some patients will not be able to access services that would previously have been available to them. The hon. Gentleman is right about that. Parentcraft classes are an important way, particularly for new parents and those who have not gone through the process—when people have done it once, they are old hands—to reassure parents-to-be, who can be very anxious. Those decisions have been weighed in the balance by the local PCT.

The hon. Gentleman raised concerns that Suttons House is to be closed, and referred to discussion about St. George's hospital. I want to assure him and his constituents that I am advised that there are no current plans to close the older people's day hospital at Suttons House. I can tell him categorically that there are no secret plans in the Department of Health. I am not advised that there are any secret plans anywhere. Clearly there will be a consultation process.
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I also note the hon. Gentleman's optimism following the North East London strategic health authority and Havering PCT's recent decision that further work was required on the re-provision of services currently being provided from St George's. The press release said that the PCT and the SHA believed that there was a need to further develop the overall strategic context within the local health economy.

The SHA and the PCT also wish to see what impact the anticipated White Paper on care outside hospital and changes arising from "Commissioning a Patient-Led NHS" will have for their local health service and therefore they feel now is not the time to make such a major decision on the way services are provided for this vulnerable group.

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