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Ms Rosie Winterton: Perhaps I can combine my answers to the interventions that have just been made. Rapid closure under the previous Administration left people vulnerable in the community, and I hope to demonstrate that this Government have provided support in the community through crisis resolution teams and early intervention teams. The idea is that in-patient care should become very much the last resort. I hope that Members appreciate that removing people with mental health problems from their families and their home environment is not always the best road to recovery; if we can support them in their own homes, that is the way to go. I have visited a number of places where it has proved possible to switch resources from in-patient care to community home care teams, and we should not underestimate the importance of making that shift.

Such reshaping of services can help people to live for longer in the community and to avoid removal to hospital, which is sometimes inappropriate. That approach is ambitious, and that is why we have a 10-year programme. In many instances, it requires services to make switches that they may not be used to, but once the changes have been made, a big improvement has been seen. The plan followed widespread consultation and was warmly welcomed by the professions. I accept that professionals would like to see further changes, but in general the plan has been well received. In 2000 we followed it up with the NHS plan, which set some clear targets for mental health services.
 
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Mr. Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab): I welcome what my hon. Friend says, but does she agree that if the strategy is to succeed, advocacy should be at the heart of Government policy? Will she confirm that it is still there?

Ms Winterton: Of course, and I hope that my right hon. Friend welcomed the announcement about the advocates for people with mental incapacity, which we discussed at some length during the proceedings on the Mental Capacity Act 2005. He is right to say that advocacy is an important part of ensuring that our mental health services are modernised.

Dr. Julian Lewis (New Forest, East) (Con): I accept what the Minister says about the desirability of people being treated in the community if possible. Will she in turn accept that if someone suffers from an acute psychiatric breakdown there is no prospect of their being able to look after themselves in the community, and they will need to be an in-patient? It is important that such an in-patient should not be put in with people with different types of mental illness, who may be psychotic or even violent. What progress have the Government made to ensure that regard is had to the very different types of mental illness, so that people are treated separately where appropriate?

Ms Winterton: It is important to ensure that people who are dangerous or violent are held in more secure units than those suffering, for example, from a clinical breakdown. That is why we have increased the number of medium secure beds, why we have looked at changes for the high-security hospitals and why we have many more low secure beds. It is important that we make the distinction between people who need a secure environment and those who do not.

It is also important to recognise that people may reach a crisis point, and to ensure that if they need to spend some time in in-patient care, it is the minimum period necessary for that individual. We need to have the modernised services that I have mentioned in place—made possible through our increased investment, which I shall talk more about later—so that the time spent in hospital is minimised. That is because people often make a better recovery if they can have help in their own homes and communities.

Lynne Jones (Birmingham, Selly Oak) (Lab): It is good that the Government are giving community care a high priority, although perhaps not as high as some of us want. It is also good that the Opposition, by initiating this debate, are showing their commitment to improving mental health services.

On the subject of in-patient beds, is my hon. Friend not concerned about the huge increase in the number of patients who are in private facilities? The Mental Health Act Commission report cited by the hon. Member for South Cambridgeshire (Mr. Lansley) pointed out that the number had increased from 700 to 2,300 and although those institutions may have been cleaner, which is good, they had poor back-up facilities for emergency care. They are also expensive, so why is the NHS not improving its own in-patient provision?
 
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Ms Winterton: Recently we announced investment of £130 million to improve in-patient facilities—but my hon. Friend is right, in that there has been a long tradition of using the independent sector in mental health care. We need to look closely at the commissioning that PCTs and others undertake in the private sector, to ensure that they carefully consider local needs so that people can remain as close to home as possible. There have been big advances in that commissioning, but we can certainly make improvements and I want to ensure both that we get good value for money, and that care takes place as close to the patient's home as possible, so that people can obtain the necessary back-up.

The national service framework was accompanied by record investment. According to the European Commission, the UK has one of the highest proportions of its overall health budget devoted to mental health of any EU member state. Those extra resources, which the Opposition voted against, have been put to good use. Compared with 1997, when we took office, we have 20 per cent. more psychiatric nurses, 50 per cent. more consultant psychiatrists and 75 per cent. more clinical psychologists. The suicide rate has fallen to its lowest recorded level and, again according to the European Commission, is one of the lowest in Europe. I hope that all Members welcome that.

The NSF proposed 170 new assertive outreach teams for people at risk of losing touch with conventional services—I think that was the point that the hon. Member for New Forest, East (Dr. Lewis) raised. By March 2005, there were 262 such teams, providing badly needed support to about 20,000 people. In addition, the NHS plan envisaged 335 crisis resolution teams to give intensive support at home to people suffering a crisis in their mental health. By March 2005, there were 343 teams and they had been able to help nearly 50,000 people.

Mr. Jim Cunningham (Coventry, South) (Lab): How can we help carers? They often carry a financial burden and are also under stress. How do their needs fit into the 10-year plan?

Ms Winterton: I agree that the needs of carers, especially those who look after people with mental health problems, are paramount. In the NSF, we have tried to provide extra support for carers, not least in the difficult situations that can occur. Sometimes it is difficult for a person to live close to someone with a mental health problem, and such situations need to be managed. In the White Paper, we set out a raft of measures in relation to carers, which, obviously, will apply to people caring for those with mental health problems. The best services that I have seen are those that have involved not only service users, but carers as well, in shaping them.

Mr. Anthony Steen (Totnes) (Con): There is not much point in closing down purpose-built institutions for residential mental health care, such as the Brischam unit in Brixham, on the basis that people with dementia would prefer to be looked after by carers in their own homes, if the carers are driven to distraction by having nowhere to send their cared-for person with dementia, because all the purpose-built residential homes have been closed down.
 
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Ms Winterton: The hon. Gentleman is referring to the need for good respite services. It is not necessarily perhaps a case of the constituents to whom he alludes wanting their loved ones to be elsewhere; they want a combination of care and support at home, with respite facilities as well. He is right to say that we all need to consider how we can increase those respite facilities, sometimes by turning inappropriate beds into respite care beds. That is an important approach to take, and it is sometimes important to consider what lies at the end of such proposals. For example, if a trust is talking about closing an institution, it should consider whether any such decision is backed up by a different type of service that better fits patients' needs, and respite care is very often involved.

Chris Bryant: Does my hon. Friend agree that having some form of mixed economy in mental health service provision is important? The residential rehabilitation service that may be appropriate for one person with a drug or alcohol problem may be wholly inappropriate for another, yet residential rehabilitation might be necessary for others—perhaps provided by the voluntary sector, which offers a very different style of service from that which is available from the state.

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