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Adam Afriyie (Windsor) (Con): Will the hon. Gentleman give way?
Steve Webb: Not at the moment, but I will endeavour to do so later.
The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned the situation in his county. I shall give an example from our website about Cambridgeshire mental health services. The lady concerned says that, as a result of the cuts in Cambridgeshire mental health services,
"Cambridgeshire used to be an example of outstanding care in this field . . . but now this is being broken up as too costly (for the NHS), pushing responsibility onto Social Services Departments which do not have a good record."
That is a vital point. The Minister says, in effect, "Well, it is only 16 million quid", but these individual human stories show that for every small cut in provision, there is real human misery. The Minister should not dismiss £16 million of cuts. She implied that it is nothing terribly significant because it is only a fraction of 1 per cent. That is not accurate.
My key point concerns the link with social services budgets. Until these are single budgets, we will get this absurd cost and deficit-shifting and lack of an holistic approach to people's overall care and health needs. If cutting health provision merely shunts the cost on to someone else, we will not get the decision that is in the best interests of the patient or member of the public but the decision that works best for the individual ring-fenced budget. That cannot be a rational way in which to proceed.
Mr. Vaizey: The snapshot of cuts that the Minister mentioned is literally that—a snapshot. In Oxfordshire, we will lose £5 million of our mental health budget, but that is over a period of three years. The hon. Gentleman is right to say that every cut has an effect. We have just lost the Ridgeway day centre in Didcot, which is a good example of a service that will not come back.
Steve Webb: I am grateful to the hon. Gentleman for highlighting the fact that whereas the Minister was talking about cuts in the current year's budget, some of them will go on, and accumulate, for much longer.
The hon. Gentleman mentioned Oxfordshire. Another person who visited our website commented that when they became ill in Oxfordshire some years ago, they received treatment that they described as being of a good standard, but that recently
"Oxfordshire Mental Healthcare has been severely affected, the psychiatrist that I saw has now left, and there is a chronic shortage of"
community psychiatric nurses. He goes on:
"People who now suffer as I once did are not receiving the treatment that I was so fortunate to have".
That is the main concern. Perhaps this is absurdly naive of me, but if Government amendments were more balanced in recognising that while they can cite statistics that show improvement, there are also worrying areas, one might almost think about voting for them. We cannot do so, however, while they remain so Panglossian in saying that everything in the garden is rosy.
I want to highlight a couple of other individual cases. We can trade statistics in such debates, but never get to the kernel of the issue. I was approached confidentially by a constituent who has given me permission to cite his case. His wife had suffered from suicidal tendencies. This was another instance of GPs wanting to help but being unable to cope. He said that
"it cannot be acceptable that somebody with suicidal tendencies (my wife has threatened suicide over 80 times since 1997) cannot get help until they actually take the step to kill themselves".
In a crisis, the urgent in-patient services step in but there is a huge gap in the middle, and a lack of support and training for GPs.
The GP may not always be the right person for someone with mental health problems to see. The GP may not respond appropriately and the person with mental health problems may not feel able to go to a GP. Has the Minister considered other routes for accessing the health service, for example, through access workers? Are the Government trying out those approaches?
Mr. Steen: Will the hon. Gentleman give way?
Steve Webb: No, I shall not. [Hon Members: "Go on."] No, not even briefly.
Before I consider broader policy matters, I want to examine emergency provision in circumstances in which a family member with mental health problems, who perhaps lives in a care setting, comes home, for example, for Christmas and things go wrong. I have recently come across two cases of people with mental health problems spending the night in a prison cell. Parts of the country have a protocol whereby that should not happen, but it has happened twice in my area relatively recently. At short notice, there was nowhere for those people to go and they ended up in a prison cell. That was traumatic for the family and the individuals, and the police knew that it was the wrong place for them. Will the Minister say something about short-notice crisis provision and alternatives to a prison cell?
As I said, we must consider whether GPs need substantially more training and whether there are alternative ways of accessing mental health services. However, we must take into account not only the mental but the physical health of those with mental health problems. When I recently attended an event that was organised by the charity Rethink, I was startled to discover that people with severe mental health problems can expect to live perhaps 15 or 20 years less than someone with similar physical problems.
For example, American evidence shows that people with severe mental health problems who develop cancer are 50 per cent. more likely to die of it than those without mental health problems. There are genuine worries about the ability of people with mental health problems to access care for their physical health. Looking after people's physical health helps their mental health. We need a much broader agenda that does not separate budgets for mental health and for physical health but perceives them as an integrated whole because one can beneficially feed into the other.
The hon. Member for Stoke-on-Trent, South (Mr. Flello) mentioned mental health services for children and adolescents. He rightly said that much good work is being done. However, the charity YoungMinds suggests that the pressures on primary care trust budgets mean that those for community and adolescent mental health services are also under pressure. What reassurances can the Minister give that those groups are being properly looked after?
Let us consider the other end of the age scale. Many hon. Members will have attended a Mind event entitled "Access all ages" about mental health provision for older people. There is a danger that society assumes that those who are old become "a bit senile" and that mental
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health deterioration is simply part of getting old. We need to counter that assumption and ensure that we do not take it for granted that older people will have mental health problems.
This week, the Commission for Social Care Inspection published a report, with which the Minister will be familiar, which found that the management of many elderly people's medication in care homes is inadequate. That will undermine the mental health of many vulnerable older people and I am worried about that.
The motion mentions the position of those in black and minority ethnic communities, who are more likely to be in hospital with mental health problems, to be sectioned under the Mental Health Act 1983 and to be physically restrained. Do the Government understand the reasons for that and how far it is due to discrimination or different patterns of provisions? What is being done about that?
Let us consider positive action that can and should be taken. The Minister will have come across the Institute for Public Policy Research report that was published last year on "Mental Health in the Mainstream", which makes several specific recommendations. I shall touch on just a couple of those recommendations. First, the report talks about getting access workers into health services where GPs are inappropriate. What does the Minister think about that idea? How seriously has it been taken over the past few months? Secondly, it considers the use of "non-pharmacological" treatments, therapies and so on, and says that the key is prevention—getting in early, before things get out of hand.
Before concluding, I want to mention a couple of wider issues. The first has been mentioned already in the debate—the position of people with mental health problems in respect of the incapacity benefit system. It is worrying that the Government are proposing a carrot-and-stick approach: although it is possible that more money will be given to those people who jump through the right hoops when they apply for the benefit, the stick of sanctions might be applied to others. What discussions has the Minister had with the Department for Work and Pensions about the impact on mental health patients who fear that they will lose their benefit if they do not do certain things? What assessment has she asked that Department to make of the impact that changes to incapacity benefit will have on people with mental health problems?
There are three prisons in my constituency, so I was pleased that the problem of mental health in prisons has been raised. However, if we think that the mental health service as a whole is a Cinderella service, the mental health service in prisons is even lower down the scale. I am pleased that mental health in prisons is now the responsibility of the Department of Health and not the Home Office, but will the Minister say what progress is being made? There have been an alarming number of suicides over the past few years at the Eastwood Park women's prison in my constituency: how much of a priority is that for the Government?
Finally, mention has been made of the mental health Bill, which has yet to be published. So far in the debate, the Government have said some relatively enlightened things about the importance of mental health, and
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about prevention. However, that contrasts with the tabloid-driven, draconian, lock-'em-up mentality that seems to underlie the forthcoming Bill. I hope that the Department of Health will take ownership of the Bill and not allow the grubby hands of the Home Office to be all over it. We need a mental health approach to these matters, not the law-and-order approach driven by tabloid scare stories that is inappropriate in the vast majority of cases. Although there is agreement today that we should not stigmatise people with mental health problems, there is a real danger that that is precisely what the Bill will do.
This a vital and valuable debate. My concern is that the people in GPs' surgeries providing the front-line provision for those with mental health problems are not adequately trained or resourced. As we have heard, mental health services are being squeezed as deficits get shunted around. A key remedy would be to pool resources across different forms of health and social care, so that provision is made for the whole person and the totality of his or her needs. We must not see people only in terms of what is wrong with one part of their lives. That is the more enlightened approach that we in the Liberal Democrat party advocate.
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