Mr. Deputy Speaker (Sir Alan Haselhurst): I remind the House that Mr. Speaker has placed a 15-minute limit on Back-Bench speeches. Given the extra interest in the debate, hon. Members will be doing themselves a favour if they keep well within that limit in the time remaining.
Mr. Andrew Smith (Oxford, East) (Lab): I am very pleased to have this opportunity to debate mental health services. As has been noted already, they are enormously important to the lives of service users and their families. It is good to see a measure of agreement across the House that it is important to put the stigma associated with poor mental health behind us, and that the mental health services should get the attention and priority that they deserve.
Too often in the past, mental health care has been a poor relation, but there is no doubt that the extra money provided by this Labour Government has made a big difference. Although more needs to be done, it is no exaggeration to say that mental health care in Oxfordshire has been transformed over the past nine years. That is thanks to investment, the achievement of NHS staff at all levels and to the work of excellent local community groups such as Restore. The local trust has made great strides in providing better services and more facilities for patients. Tangible improvements are clear for all to see, and patients appreciate the improved standards of care that they receive. A recent survey of the Oxfordshire Mental Healthcare NHS Trust's service users showed that more than three quarters of the respondents rated the standard of their overall care as excellent, very good or good.
Smart new buildings, wards and facilities have been provided, and more are on the way. Wards at the Warneford hospital in my constituency are being upgraded, extended and refurbished, and the extension to the Highfield unit for young people with mental
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health problems will open up more places and allow the trust to provide separate areas for boys and girls. More services are being made available. In the past, people with a personality disorder had a choice between hospital and repeated GP appointments. Now, they have access to dedicated out-patient and day-care support.
My constituents can now receive in-patient care in Oxford for eating disorders, instead of having to be transferred to faraway hospitals. The new forensic pre-discharge service helps people who have been mentally ill and in secure hospital care to take the first steps towards living in their own community again. That is just the kind of gradual supported approach for people going back into the community that patients and the public want to see. Those and other developments, coupled with careful financial management, enabled the Oxfordshire Mental Healthcare NHS Trust to progress from one star in 2003 to three stars in 2005. No praise is high enough for the dedication of the staff at all levels who made that possible.
Despite all this outstanding work, however, local mental health services face the enormous challenges arising from cuts that are being made to tackle the financial deficit in the Oxfordshire health economya deficit, moreover, that was not of their making. My right hon. Friend the Minister quite reasonably gave the House the relevant figures earlier. However, what this means financially for Oxfordshire is that, whereas in 200405, Oxfordshire Mental Healthcare NHS Trust spent £51.2 million and budgeted £53.7 million to meet this year's expenditure, it is now being asked this year to cut £1.1 million from its spending, even after having received £1.5 million one-off help from the strategic health authority, which it may yet have to repay over the next two years. All in all, the trust has almost 10 per cent. less than it says that it needs to meet service and cost pressures. We can argue about these figuresand about what proportion of them represent legitimate efficiency gains, and so onbut however we measure them, the cuts are damaging to the trust and its services, and deeply worrying for patients, their families and staff, as the many letters that I have received from my constituents make clear.
What this means for services is that the trust is having to look at bringing forward the closure of in-patient beds, leading to a real rush to put in place the 24-hour crisis community cover that is needed. It would have been much better to plan and carry through such a change in a measured way. The trust is also having to consider the closure of the psychiatry liaison service at the John Radcliffe hospital, which provides support in the accident and emergency unit to people who have attempted suicide and which also supports people in acute beds who are suffering from chronic illnesses such as cancer. The trust is also considering the closure of an in-patient unit for older adults where patients are assessed for depression and Alzheimer's disease. It is also now unable to invest sufficiently in support for older people in the community or to ensure that early intervention is available to help young people at the first onset of mental illness.
The seriousness of the position is compounded by cuts in the Supporting People programme budget locally, as well as by the current state of NHS funding mechanisms, which is a more general problem for mental health care
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trusts. Whereas additional work for other acute hospital trusts is funded according to the national tariff, additional work at mental health care trusts has to be absorbed within the block allocation, which puts skewed pressure on their share of overall expenditure. This makes it more important that we all speak up for the needs of our mental health care services, both here and in our constituencies, so that they do not get squeezed out by competing demands.
All of that poses a real danger of damaging and obscuring the excellent progress that has been made in mental health care locally and nationally. However, it also puts a question mark over exciting developments planned for the future in preventive community provision in partnership with social services, round-the-clock community crisis support, the development of the complex needs service and the pre-discharge unit for mentally ill offenders, which addresses the issues raised by the hon. Member for Northavon (Steve Webb).
To build on what has been achieved rather than put it at risk, and to make the most of opportunities to improve mental health care in our community, I urge Ministers to consider again what can be done to ease the financial pressures in Oxfordshire, particularly in the mental health care trust, even now in the remaining weeks of the financial year. The mental health care trust is working with the rest of the local NHS to address the underlying financial problems that affect services in Oxfordshire. However, a more measured view needs to be taken of the trust's ability to bear the funding cuts, considering that it has a high proportion of vulnerable service users, many of whom are in no position to speak up for themselves.
In addition, given the body blow that services have suffered this year, Ministers need to assure us that they are taking action to avoid any repetition of this financial fiasco next year, and that budgets across PCTs and hospitals will be properly planned so that those in mental health and other services in the NHS can look ahead with confidence and work with patients and their families to make the most of the huge extra investment that this Labour Government have made and continue to make in the NHS. That has made a terrific difference to the quality of care available to patients and the wider community locally. Let us keep up that good work and carry it forward, not put it at risk as has sadly happened this year.
Mr. Stephen Dorrell (Charnwood) (Con): Like others who have spoken in this debate, I congratulate my right hon. and hon. Friends on the Front Bench on providing Opposition time to debate mental health services. Constant improvement in the services delivered to mentally ill people is a core responsibility of the national health service and my right hon. and hon. Friends on the Front Bench are entitled to credit for providing time for the House to debate those important issues.
If I may paraphrase the speech of the right hon. Member for Oxford, East (Mr. Smith), it is fair to say that he argued that the Government have provided substantial extra money to the national health service, which is true, and that that has made possible significant improvements in services to mentally ill people, which is also true. However, difficult issues remain for those
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responsible for managing those services locally. Whatever level of resources is likely to be provided to the national health service, difficult choices remain to be made about the pattern of delivery of local services. That relates directly to the point made by the hon. Member for Northavon (Steve Webb).
The Minister does neither herself nor her Government any credit when she seeks to persuade us that, before 1997, there was a dark age in which no progress was made on any of those issues, and that there was suddenly a new dawn on 1 May 1997 when all requirement for choices was removed. That is not a vision of events that will be recognised by those who work in the mental health services of the national health service. It seems much more accurate to say that the direction of mental health services has been consistent under Governments of all political complexions since the days when Enoch Powell was Health Minister and first committed the national health service to the policy of taking mental health services out of the Victorian institutions and providing proper, high-quality, community-based care for mentally ill people.
We all know that the story of the changes in mental health service delivery over the intervening 40 years has been one of individual local successes and failures, but it is surely true to say that, throughout those 40 years, Ministers of all political complexions have been committed to broadly the same vision of the future of mental health services. If we acknowledge that, we shall be able to engage in a much more mature and adult debate on the issues that we face in delivering what is a broadly shared agenda.
Various speakers have rightly sought to avoid the phrase "Cinderella service", which is generally applied, almost by default, to mental health services. I believe that it emanates from the wrong train of thought, because it implies that mental health service delivery in the NHS is somehow different from, or separate from, all other NHS health care delivery. In my view, the similarities between the priorities involved in mental health care delivery and those involved in physical health care delivery are more important than the differences.
As the hon. Member for Northavon pointed out, the great majority of mental health service delivery through the NHS takes place via community and primary health care services. Exactly the same applies to the rest of health care delivery in the NHS. Mental health services are an integral part of the delivery of health care to elderly people. He was right to say that we should not imagine that all elderly people need mental health services, but we cannot think of mental health service delivery without thinking of it in the context of delivery to individual patients, many of whom are elderly and many of whom suffer from physical illnesses that are complicated by the presence of mental health problems.
The hon. Gentleman was also right to stress the importance of the interface between social care and health care delivery. If we are to deliver high-quality, successful mental health services, we must bear that in mind. Any multidisciplinary team responsible for delivering mental health care in the community must include both a health care and a social care element. Throughout those 40 years, too many failures could be traced to their roots in the breakdown of communication between health care and social care
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delivery. As he said, that remains an institutional issue that Ministersthose responsible for policy developmenthave not yet cracked.
Mental health services are sometimes represented as being driven by a mysterious political orthodoxy under the title "care in the community". That was mentioned earlier in the debate. It surely cannot be stated too often that caring for people in the community, whether they are mentally ill or physically ill, is not a manifestation of political correctness, nor is it the manifestation of a Treasury-driven desire to close hospitals and get people into the community, although it is sometimes represented as such. In fact, it represents the central purpose of all health care. Why do we have health care in our society? Surely its purpose is to enable people, as far as is humanly possible, to live their lives normally. That is why community health care, whether it is delivered to the physically ill or to the mentally ill, must be at the heart of the development of health care delivery generally.
The priorities in the development of mental health services are thus very similar to the priorities in the delivery of the rest of health care. For instance, they relate to the development of primary and community-based care. I welcome the Government's White Paper on the subject, published at the beginning of last week. There is almost nothing in the White Paper that I could not have envisaged writing as the Secretary of State for Health 10 years ago. I observe without rancour that it is a pity that we have gone on such a long detour to get back to some of the ideas that we were developing 10 years ago, most notably and obviously what we used to call GP fundholding and what the Government now call practice-based commissioning. There is no difference of principle between the two and it is a pity that we have lost 10 years in the development of that important idea.
I ask Ministers to reflect, in the context of the delivery of mental health services, on the implications of the recent changes in the GP contract for access to primary care services at evenings and weekends. All studies of mental health service delivery emphasise the importance of people at short notice being able to secure access to services, particularly young people in the acute phase of mental illness and elderly people who have a short-term requirement for respite care. Now in our communities, Tesco and Sainsbury's are open all through the weekend, but our primary health care delivery facilities are more difficult to access than they used to be. That is an issue for health care across the field but it is a particular issue in the delivery of mental health services.
I ask Ministers, too, to reflect on the need to ensure that there are properly integrated community-based health care services, including not only social care, but residential care for those who are in an acute phase of schizophrenia and psychotic illness and residential care for those requiring respite care. We all know that, if we are going to deliver successful integrated care in the community, there will have to be proper patient planspathways of carethat integrate the different elements of the service.
What we look for from Ministers is a clear commitment that the Government recognise that there is no difference of view in any part of the House about
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the type of service that we want to see delivered. Nor is there any difference about our commitment to see resources grow year by year, as they have for 50 years in the NHS, to support the growth and improvement of the delivery of those services. What we have to see is detailed planning locally to avoid the ups and downs in the delivery of service, which were described by the right hon. Member for Oxford, East, and integrated delivery of care, so that, from the perspective of the patient, the service is more reliable, and of better and more consistent quality than we have seen in the past under Governments of all political persuasions.