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Mr. Lansley:
I agree, and one of the measures that we have supported is the mainstreaming of health services
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for people in prison. If primary care trusts are to take over responsibility for that—and most have already done so—it does not bode well if they are trying to cut mental health services at the same time, as too many are. Given that a high proportion of those in prison have mental health problems, primary care trusts must ensure that mental health services are available.
By courtesy of my hon. Friend the Member for East Worthing and Shoreham, I now have the document relating to the Conservative party's reform of mental health legislation, "Compassion not Coercion", and also the mental health manifesto that we prepared before the last general election.
David Taylor: Will the hon. Gentleman give way?
Mr. Lansley: Not at this point.
We need to be clear about the current state of mental health services. The Government's amendment understandably emphasises the publication of the national service framework in 1999. As I have said, while it is to be applauded as a statement of priority, we need to ask what it does in terms of delivery. Let us examine some of the national standards contained in it.
First, there is the intention that there should be health promotion and that discrimination should be combated. Spending on promotion of mental health specifically has fallen to £2 million, a tiny fraction of the mental health budget, and is 60 per cent. lower than it was in 2001. As for discrimination, I am afraid that it is still unhappily true that black African and Caribbean patients are 44 per cent. more likely to be detained.
The second national standard emphasises access to diagnosis and effective treatment. Access to cognitive behavioural therapies is seriously lacking. In his recent report, Professor Layard said that we needed 5,000 more psychological therapists, and the Sainsbury Centre for Mental Health recently spoke of GPs with no access to CBT for their patients and a wait of up to six months for counselling. Responding to a survey by Mind, 47 per cent. of mental health service users said that their treatment was held back considerably by not being given the treatment that they needed. That standard, too, has not yet been met.
The third standard relates to round-the-clock contact. Crisis resolution and assertive outreach services are of course useful, and they have perhaps been the principal innovation of the national service framework. However, if core services are plundered so that crisis resolution and assertive outreach services can be fed, the net effect will be that although it may be possible to intervene at night and try to deal with a problem—and I know that many GPs' out-of-hours services value crisis resolution—the system will not work if the patient cannot be dealt with immediately the following morning.
The fourth standard recommends a care programme, but 50 per cent. of mental health service users are not offered a care plan. The fifth standard refers to timely access to hospital beds. Just over a fortnight ago, the Mental Health Act Commission said
As an indication of the way in which mental health services are viewed, what could be more compelling than the simple fact that when the Healthcare Commission's
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patient environment teams looked at hospitals, the only six that they found to be unacceptably dirty—they described those hospitals as "standard 4"—were mental health hospitals? As Members will know, given the definition of "unacceptably dirty", that was a pretty condemnatory conclusion for the teams to reach.
Mr. Philip Hollobone (Kettering) (Con): Does my hon. Friend share my concern that a recent Health Service Journal report highlighted that over half of hospital chief executives have had to consider closing some of their mental health facilities, including at Kettering general hospital in my constituency?
Mr. Lansley: I am grateful to my hon. Friend. He leads me on to the area that I want to turn to next.
There have been improvements and extra resources, but the resources going into mental health services have not kept pace with the resources committed to the national health service as a whole. That is an indication of its relative lack of priority.
Mr. Jim Devine (Livingston) (Lab) rose—
Mr. Lansley: I will not give way for the moment.
Some of the progress that has been made is directly threatened because of the reductions in funding to meet deficits. It will not surprise hon. Members that I want to talk about Cambridgeshire. It is one of the areas where the cuts in mental health services are most profound. A letter was sent to me just a fortnight ago by psychologists and psychological therapists working for the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust. They say of the changes in Cambridgeshire:
"these are not minor trimmings or adjustments to services: they are cuts of essential, frontline services."
We are talking about the closure of in-patient beds. What most distresses me and many people in Cambridge is the closure of Douglas house, which provides a young people's service, and the cutting of access to services for young people.
I have raised that matter with the Secretary of State. We have had meetings. I have received correspondence. Everyone in Cambridge knows perfectly well that it all tracks back to the Government's failure to reflect adequately the genuine mental health needs in Cambridgeshire, and in Cambridge in particular. They should look not at their own demographic analysis, but at the actual demand and need in the community. All the Secretary of State keeps telling us is that it is not her responsibility but that of the local primary care trust. The trust keeps saying, "We just do not have the money to reflect the need that we have." When we go back to the Secretary of State, she says, "The statisticians have done their work and the work is as good as we can make it." So everyone is responsible except the Secretary of State—it is the statisticians and the primary care trust that are responsible. Never does she take responsibility for the impact of her changes and cuts.
The predicted deficits in mental health trusts are nothing like as serious as the cuts in services will be. The PCTs are shifting deficits into mental health trusts.
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That is affecting not just Cambridgeshire but Oxfordshire, which has lost seven consultants, and seven senior house officer and registrar posts. Mental health wards have closed in Westmorland. Supporting people budgets have been reduced in many parts of the country. In south-west London, particularly in the St. George's Mental Health NHS Trust, there have been widespread reductions and there is a major deficit. Psychiatric beds have closed in West Park hospital in Durham. In Lambeth, there is the potential closure of the Maudsley emergency clinic. There is also the possible closure of a mental health ward at Loughborough or Coalville hospitals. There are other examples.
David Taylor: Perhaps the hon. Gentleman is being a little unfair on the Government, who have increased resources in real terms by 25 per cent. There are now 8,000 psychiatric nurses, 1,200 consultants and 3,000 clinical psychologists. He seems to be drawing together examples from university towns—Cambridge, Oxford, Loughborough and elsewhere. Does he agree that we need to do much more in the FE and HE sectors to promote mental health? Ten per cent. of young people between the ages of 11 and 25 self-harm, suicide is the cause of 20 per cent. of the deaths of young people and the age group that commits suicide the most is young men aged between 15 and 24. Should not more be done in that regard?
Mr. Lansley: At least the House is spared a speech from the hon. Gentleman by virtue of that intervention. I say two things to that. First, £30 million is now being spent on student counselling services. It is much increased. That is a measure of the need among students for mental health services. Secondly, in Cambridge, as the hon. Member for Cambridge (David Howarth) will know—
David Howarth (Cambridge) (LD): Will the hon. Gentleman give way?
Mr. Lansley: No. I will make the point because I know what the hon. Gentleman would say.
If the Government's statisticians treat students as affluent because they are not on benefit, and therefore as having much less mental health need, they are plain wrong. That is a good illustration of the absurdity of the way in which the mental health needs index is compiled.
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