Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op):
My hon. Friend the Minister said that we need a response that stretches right across Government, and I want to address my brief comments in today's short debate to some of those issues. Last Thursday, I had the pleasure of opening an art exhibition by the Yao Yao groupa social group organised by the Chinese Mental Health Association, which is based in my
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constituencyand it was one demonstration of the fact that there are many ways to tackle mental health problems, not just through the health service.
I pay tribute to the many people and organisations in Hackney, South and Shoreditch and Hackney as a wholesuch as Mind and the Chinese Mental Health Association, which put time and effort into supporting people with mental health problemsas well as the people with mental health problems who also play a key role. My hon. Friend knows of the good work done at Homerton university hospital and by City and Hackney Mental Health Trust. It is important that all those organisations play a big role in a constituency with a high incidence of mental health problems.
I will not bombard the House with statistics in the short time that I have, but it is startling that admissions to hospital for schizophrenia are three times more common in Hackney than in England as a whole, for both men and women. I want to touch very briefly on three issues: employment, ethnicity and the impact on welfare benefits for people suffering from mental health problems. The hon. Member for Northavon (Steve Webb) rightly highlighted the need for preventive work. He said something about the Minister suggesting that everything in the garden was rosy. In some ways, I agree with him. Not everything in the garden is rosy, but it is a lot better than it was, which is a good step.
General practitioners in Hackney are very much at the sharp end of dealing with people with mental health problems. Other hon. Members, particularly the hon. Member for Tiverton and Honiton (Angela Browning), have highlighted some of the difficulties of dealing with mental health problems in the short time that many GPs have available. That is one of the reasons why I welcome those aspects of the health White Paper that will improve and promote community care provision at that initial presentation point.
We all know that people with mental health problems have much more difficulty finding employment than the general population. That is so even when compared with people who are physically disabled. About 16 per cent. of physically disabled people are more likely to be unemployed, compared with 50 per cent. of people with mental health problems. Some 86 per cent. of people with longer-term mental health problems are unemployed. The other side of the coin is how employers reactonly 37 per cent of them are prepared to consider employing people with such difficulties.
I am very proud that the two local mental health trustsEast London and the City, which covers Hackney, and North East Londonthe local strategic health authority and South Bank university have joined forces to fund a consultant occupational therapist for employment. I hope that my hon. Friend agrees that that is the sort of joined-up government to which she referred in her comments. The two mental health trusts have adopted a joint partnership approachthe roots to employment project, which is the first of its kind in the UK to help people with mental health problems into work, by working with employers to ensure that they address the issues and understand the need to help people with mental health problems back into the workplace.
Mr. David Drew (Stroud) (Lab/Co-op):
Does my hon. Friend agree that although people may expect this not
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to be the case, some problems exist in the public sector with regard to attitudes to mental health problems? I have taken up such cases, and it has always been more difficult to get someone who has had a breakdown back into public sector employment than into the private sector. Will my hon. Friend say something about that?
Meg Hillier: My hon. Friend may have a point. I cannot draw on enough experience of people bringing such issues to my surgeryI am only a new Member compared with himbut I am proud to see what happens when I go to forums in Hackney. For example, I opened a Jobcentre Plus office at the end of last week, and some of the employers there, including Hackney council and the local hospital, recognised the need to support people with mental health problems. They work positively with those people and take on board their problems. Perhaps that happens because we have the roots to employment project in Hackney, and perhaps my hon. Friend may wish to raise that with the primary care trust, the mental health trust and the other health and employment bodies in his constituency.
I said that I was going to touch on ethnicity. Hackney, South and Shoreditch is especially affected by the Eurocentric nature of much psychiatric training, which helps to contribute to the fact that Afro-Caribbean people are typically three to five times more likely than white people to be admitted to hospital with a first diagnosis of schizophrenia, and then 10 times more likely to be diagnosed as schizophrenic. The Chinese Mental Health Association has much of interest to say on the subject. The Chinese community in Britain is often isolated and many Chinese people do not wish to talk about mental health problems for cultural reasons. Problems due to language affect not only the Chinese, but other groups across the board.
I am delighted that north-east London is one of 17 nationally focused areas for delivering race equality in mental health. The Government have taken a major step forward by recognising the white Eurocentric approach to psychiatry. Such initiatives are sorely needed and much welcomed in Hackney. When I spoke to Hackney Mind, I found that many mental health service users were especially pleased that the scheme was moving forward, but we need to see results on the ground. We are only at the beginning with the scheme, but I am sure that my hon. Friend the Minister will keep a close eye on the situation from Whitehall. As other hon. Members have said, the crux of the matter is what happens locally, so local providers need to make changes.
When I said that I would be brief, I meant it in all sincerity, but I want to touch on incapacity benefit, as did the hon. Member for Northavon. Hackney, South and Shoreditch has the second highest number of incapacity benefit claimants of any London constituencyonly Regent's Park and Kensington, North, which is in west London, has more. My constituency, which nestles close by the City and runs right down to Liverpool Street station, is 31st equal nationally for the number of claimants. We have 7,400 claimants, 63 per cent. of whom are under 50. We are working locally to probe the matter more closely, but we know that there is a big overlap of people on incapacity benefit and those with mental health problems.
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I echo the hon. Member for Northavon in hoping that my hon. Friend the Minister is talking to her colleagues in the Department for Work and Pensions to ensure that my concerns, which are shared by Hackney Mind and local health providers, are being tackled. As we make important and welcome changes to incapacity benefit, we should not lose sight of such a difficult issue. I hope that my hon. Friend is joining up with her colleagues in the DWP as part of the joined-up Government that she mentioned.
Tony Baldry (Banbury) (Con): I was sorry to hear about the Secretary of State's illness, not least because all six Oxfordshire Members are due to meet her at 12.30 pm tomorrow to discuss the freefall of the NHS in Oxfordshire. My right hon. Friend the Leader of the Opposition, my hon. Friends the Members for Wantage (Mr. Vaizey) and for Henley (Mr. Johnson), the right hon. Member for Oxford, East (Mr. Smith) and the hon. Member for Oxford, West and Abingdon (Dr. Harris) will all be extremely disappointed if the meeting does not go ahead, so we wish the Secretary of State Godspeed for a quick recovery.
The Minister said that mental health was one of the Government's top three priorities, but I hope that the House will not consider me churlish when I say that I increasingly thinkperhaps I have one of the problems to which my hon. Friend the Member for Tiverton and Honiton (Angela Browning) referredthat I am living in a parallel universe, because there is a world occupied by Ministers and many others, and the world in Oxfordshire. As the right hon. Member for Oxford, East indicated, Oxfordshire's mental health services are confronted by a series of interrelated problems.
The primary care trust wants the Oxfordshire Mental Healthcare NHS Trust to save £1 million. Additionally, the strategic health authority is requiring the trust to save a further £5.3 million over the next three years to break even and has imposed a cut of £1.7 million on top of that, not because the trust is in any way overspent, but because the rest of the NHS in Oxfordshire is overdrawn. The SHA thus imposed an implied deficit of £1.7 million on the trust to make up for overspends in other parts of the NHS.
In addition to all that, there has been a reduction of at least £400,000 in the Supporting People budget, which I have raised in the House on a number of occasions. The sum of all those interactions is that the cuts represent about 10 per cent. of the mental health care trust's budget for patient care and at least 15 per cent. of the money for supported housing, which is likely to have a devastating impact on the lives of people affected by mental illness and the people who care for them.
To put that in context, I can tell the House that Dr. Fergusson of the Banbury branch of the Alzheimer's Society has written to everyone he can write to, because he feels, quite rightly, that the closures
People involved in mental health care in Oxfordshire feel desperate about this. As the right hon. Member for Oxford, East said, over the last few years the mental health care trust has gone from having one star to
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having three stars. We started to feel that people were getting a grip on the service. It has now gone into freefall again, and we are seeing the closure of older adult psychiatric day hospitals, which, in the words of Dr. Fergusson,
He is also concerned that a number of the closure decisions were takenI can confirm thisin the mental health care trust before public consultation had even begun. In one or two cases, such as that of the Fiennes adult day hospital, the staff heard of the closure in briefings, not in a consultation document, and before any member of the statutory services, myself or anyone else. That is not acceptable.
There are three issues that I want to mention to Ministers. First, in the overall context of NHS spending, if there is a squeeze on spending, mental health seems to take a disproportionate share of it. I see no reason why the strategic health authority has arbitrarily imposed a £1.7 million implied deficit on the mental health care trust.
Secondly, we are moving into a world of payment by results. There has been no real discussion about that this afternoon. I do not see how payment by results will work with NHS mental health care funding. There has to be an alternative system to ensure that mental health work is properly funded in future; otherwise, there will be real tension. I am not confident that GP practice-based commissioning will ensure that mental health trusts in Oxfordshire and elsewhere are properly funded.
I turn to my last point about the squeeze on mental health care work. In the acute sector there is a reasonably clear divide between work done by the NHS which is free at the point of use in the NHS and funded by the NHS, and work done as part of social care, which is means-tested and provided by social services. Often there is a black hole, and there is a debate about where the line should be drawn, but there is a reasonably clear line. When it comes to mental health care services, that line is much more blurred, so the mental health care trust ends up carrying up many more services, such as those under the Supporting People budget. There is a much greater tension there, and people expect the trust to deliver those services.
I am sure that the Minister genuinely believes that this is one of the Government's three priorities. She and her colleagues are very welcome to come to Oxfordshire, because I am not being flippant or frivolousI increasingly believe itwhen I say that we are living in a parallel universe there. It may well be something to do with its being a comparatively small county with a large teaching hospital and a major centre of research. Something is causing a problem when we have an NHS in freefall, but the effects are being felt particularly by those with mental health problems. That is not fair and
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it is not reasonable. It is not good news for the Minister, because for every success story that she can trumpet, "G2", the New Statesman and the rest of the media can focus on a failure. Although NHS mental health care in Oxfordshire is not a failure, the situation is in freefall; it should not be, and it needs to be addressed.