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David Howarth (Cambridge) (LD): Mental health will certainly be one of the big issues of the 21st century. Placing greater emphasis on mental health is one way in which the Government can improve the well-being of individuals, but I have to say that the complete opposite is happening in my constituency. I hope that the House will forgive me if I confine my remarks to what is happening in Cambridge, because it is such an extreme example.
Despite what the Minister says, mental health services in Cambridge and south Cambridgeshire are in crisis. The overall budget has been cut by £2.75 million, which is 13 per cent. of the total. Two rehabilitation wards are being closed; an acute in-patient ward is being closed; three adult day care centres are being reduced to two; a ward for older acute patients is being closed; and arts therapies, physiotherapy and electroconvulsive therapy between them have to save £150,000. Other services are still under threat, including the young people's service, which the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned. We still hope to save that service; the decision has been deferred and we are trying to persuade the primary care trust and the mental health trust that it would be more expensive in the long term to make cuts now, because of the excellent preventive work that it does.
The PCT, echoing the Minister, claims that closure of acute wards will be offset by the reorganisation of community services and investment in assertive outreach work. The trouble is that the PCT is requiring £2 million of cuts not next year but in the current financial year. There is no lead-in time to get the community and crisis resolution teams fully in place. I fully accept that crisis resolution and community outreach are a good way to run mental health services, and preventing in-patient admission has to be a good idea. However, if there were no financial pressure, the change would have been brought in over a much longer period.
Tim Farron (Westmorland and Lonsdale) (LD): My hon. Friend may be aware that in my constituency the hospital trust is to lose £500,000 because the primary care trust is trying to save the same sum by closing two wards in Kendal. The pressure, of course, is on the PCT to balance its books; the reality is that the NHS overall loses out. If we look at those entities as separate organisations, not as a single national health service, we do not have sensible joined-up government. I wonder whether that experience is reflected in my hon. Friend's area.
David Howarth: That is a common pattern throughout the country where there are problems.
In normal circumstances, as I say, one would set up the new teams first, look to their effect on admissions and then perhaps reduce the number of beds. In some
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places, when an assertive outreach service is set up, the teams find unmet need, so the need for in-patient beds goes up, not down. In Cambridge, the change is happening all at once, and risks are being taken with patients' welfare. The whole thing resembles tightrope walking without a net.
The mental health trust is, of course, acting under duress from the PCT. The PCT has little choice because of the dire state of its budget. The Department of Health requires a £15 million reduction in spending, and even that does not cover the current deficit. Another £23 million deficit is on the way in subsequent years. Ministers keep saying that vast sums have gone into the NHS. In written answers to me the Minister has said that Cambridge PCT is receiving 29 per cent. extra, and that even after the cuts Cambridge's spending on mental health will still be above the national average.
We need to tackle those points directly. There has been an increase in funding, but as the hon. Member for Banbury (Tony Baldry) said, one of the problems is that if there is a foundation hospital, the PCT's cheque book is, in effect, handed over to that hospital, which writes itself cheques that deal with all of its previous financial problems. Effectively, the financial problems of the acute trusts have been transferred to the PCTs, and the PCTs have had to remove the budgets of what remains under their controlmental health and other services. When the mental health trust acquires the right to charge at tariff rates for the patients who cross its threshold, its problems may be solved in the same way as those of acute trusts, but what then will happen to PCT budgets and GP fundholder budgets?
On national averages, the point is not the average but the need. In October and in meetings with Ministers I raised several problems about the green bookthe index of mental health need. The measure of poverty that the green book uses is based on benefit take-up, not income. For Cambridge that is catastrophic, because successive Governments have taken away students' right to benefits. Students have serious mental health needs, as the hon. Members for North-West Leicestershire (David Taylor) and for Tiverton and Honiton (Angela Browning) said. Suicide rates are high and self-harm is a problem. I should add to thatI know this from experience as a university teacherthe problem of eating disorders, which I have seen blight the careers of several brilliant young women.
The second point about the green book is the measure of housing condition rather than housing tenure, despite the fact that all the academic work shows that the link with mental health problems is with housing tenure. The third and most important point for us is that the needs index reduces funding if one's area is near a good mental health institution, such as Fulbourn hospital. The reason for that is the cost of reaching the facility, but in reality being near a good facility increases the number of patients in the area, because of migration and because people stay in the area once they return to the community. The Secretary of State conceded that some work needs to be done on these matters, and I will be glad to hear what further work has been done.
The cuts in mental health services in Cambridge have had at least one good effect: they have brought the community together in opposition to them. Thousands of people joined the public protests, attending meetings
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and vigils against the cuts. That in itself has helped to reduce the stigma attached to mental illness, which several hon. Members have mentioned. Despite all the brave and good things that people have doneincluding, in a live BBC radio interview, the interviewer mentioning to me that he had suffered from mental illness and had recoveredthe campaign that we are waging is not just to change public attitudes but to get more funding. That is the problem that we face. I gather that today the county council's health scrutiny committee is meeting, and it has the power to refer the issue to the Minister. I very much hope that it does so. Then we shall see the strength of the Minister's commitment to mental health.
Jeremy Wright (Rugby and Kenilworth) (Con): I agree with comments by Members on both sides of the House that the primary difficulty with the mental health debate is that various types of mental illnesses are minimised and often ignored. Within that broad category of mental illnesses, there are some that are disregarded even more than others. I want to focus my remarks in the brief time available on one of those: post-traumatic stress disorder.
Post-traumatic stress disorder is a mental illness that is often dismissed, not simply by the rest of us but by those who suffer from it. It therefore presents its own specific difficulties in terms of the work that the Government and the NHS must do to support those who suffer from it. People have always suffered from it, but it has only relatively recently been recognisedfrom first world war shell-shock to the illness that is diagnosed today.
Post-traumatic stress disorder can affect us all. Whether we are holidaymakers or commuters, we are potential victims of post-traumatic stress disorder as a result of natural disasters of almost biblical proportions or terrorist atrocities on our daily commute to or from work. It particularly affectsthis is the group of people to whom I particularly want to draw the attention of the Housethose who feel that they ought to be most able to deal with it, and are therefore least likely to seek help. I refer to those in the armed services and the emergency services. Those who serve this country bravely, and sometimes at great cost to themselves not only physically but mentally, suffer from anything ranging from flashbacks to serious mental breakdowns, and do so often in what might be an unsympathetic environment.
There is no doubt that post-traumatic stress disorder, like other mental illnesses, wrecks livesnot just the lives of those who suffer from it but those of their families and friends. It often leads to alcoholism, violence, homelessness and family breakdown, and all those problems need addressing in the context of the illness that the person is suffering from. The illness is costly not only in human terms but in financial terms.
I recently met an experienced firefighter who, as a result of a collision with a car in which the driver of the other vehicle was killedan incident that was not the firefighter's faultsuffered a series of flashbacks leading to a more serious breakdown, after which he spent six
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years away from work. That cost the taxpayer a total of £118,000 in pension, incapacity benefit and other benefits. On that basis it must be right that in framing their Mental Health Bill, the Government give clear and full consideration to the ways in which we can assist those individuals and ensure early intervention, so that they can receive the care and treatment that they need as soon as it can be given to them.
I hope that the Minister accepts that although one option for those individuals when their illness becomes very serious is in-patient careI am sorry to say that in-patient facilities for military personnel have closed progressively over the past few years, both at Catterick and Ty Gwyn in north Walesother options include counselling and therapy, which should be available through the NHS but so rarely are. As I understand it, there are only 14 locations where counselling can be given to those who suffer from post-traumatic stress disorder. The gap must be bridged by the voluntary sector. In fact, it is bridged very successfully by such groups as Assist, in my constituency, which does a fantastic job in trauma management. I invite the Minister and all those involved in drafting the mental health Bill to consider what can be done to weight the services available to those who suffer from post-traumatic stress disorder in favour of therapy and access to counselling, either in person or by telephone, in order to ensure that people have early access to support, which they, and we, will find valuable.
The firefighter to whom I referred calculated the costs to the taxpayer of his six years' absence from work. He has recently felt able to return to work, and has done so, as a result of counselling provided by Assist which cost £1,000. The Government could profitably consider such approaches to looking after those who have served us so well and ensure that they receive the care and support to which they are fully entitled. All Members will rightly express outrage when members of the armed services and the emergency services who have suffered serious physical injury do not receive the care to which we and they believe that they are entitled. It is surely right that those who suffer mental injury as a result of the same activities on our behalf should receive similar consideration.
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