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Tim Loughton (East Worthing and Shoreham) (Con): We have had a good debate. We are disappointed that the Secretary of State was not able to join us and we wish her a speedy recovery, but it is always a delight to have the Minister of State, Department of Health, the fragrant hon. Member for Doncaster, Central (Ms Winterton) giving her speeches, even if she did go on a bit.
The debate has been well informed, well mannered and civilised, although it has been dominated by Oxbridge—over half the speakers represented Oxfordshire or Cambridgeshire constituencies. Contributions ranged from that of my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright) on the important subject of post-traumatic stress syndrome to those of the hon. Member for Kingston upon Hull, North (Ms Johnson), with her expertise as a Mental Health Act commissioner, and my right hon. Friend the Member for Charnwood (Mr. Dorrell) with all the great expertise that he brings.
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It has been a good debate, but primarily it has been good to have a debate because we have not had one on the subject for more than eight and a half years, despite the fact, as everyone has acknowledged, that the subject is extremely important and affects so many of our constituents. We know that one in four people will suffer some form of mental illness in their lives—people from all backgrounds—and one in 10 school-age children will be affected by some form of mental illness. The hon. Member for Kingston upon Hull, North mentioned the importance of early intervention, for young people in particular, which is lacking in too many places.
Thirty per cent. of all GP consultations have a significant mental health component. Mental illness has enormous implications for social exclusion, is one of the biggest factors in the high level of disability benefit claims, and hits black and ethnic minority communities disproportionately, as many hon. Members mentioned. The Wanless report highlighted the fact that
I agree. The Healthcare Commission inspections last year found that standards in NHS mental hospitals were markedly poorer. Despite the apparent priority that the Government said they gave to mental health and the publication of the national service framework in 2000, we have not had a debate in all that time.
The World Health Organisation predicts that by 2020 depression will be the leading cause of disability and the second biggest contributor to illness in the developed world, after heart disease. Surely mental illness, particularly among young people, is one of the most worrying public health time bombs ticking away, with enormous implications for the health of future generations, employment and financial cost to the NHS.
Mr. Steen: Will the shadow Minister give way?
Tim Loughton: Will my hon. Friend forgive me? We have very little time.
Despite all the evidence, mental health merited just a passing reference amounting to two and a half pages in the 2004 White Paper on health and is virtually absent from last week's White Paper. The Government promised to update mental health legislation and bring the 1983 Act in line with new practices and treatments in the 21st century, but that Bill remains in doubt, despite the publication of the original draft Bill in June 2002 and a second draft in September 2004, and the scathing report of the pre-legislative scrutiny Committee last year. There are real doubts whether we will see the Bill this Session, as the Government promised.
Conservatives believe that mental health needs to be treated more seriously and more urgently than that. That is why we are holding this debate in our time today, and why we have held three mental health summits at Westminster in recent years and plan more. That is why we produced a separate, detailed mental health manifesto at the last election, contrary to the impression given by the hon. Member for Hackney, South and Shoreditch (Meg Hillier). That is why we set up an expert panel in 2004 to produce an alternative mental health Bill, and stand ready to introduce it as a private
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Member's Bill if the Government continue to fail to honour their promise to introduce a Bill of their own or refuse to adapt their Bill significantly in the light of the near-universal condemnation that it has received. We need to examine the issue of mental health holistically. Of all the areas in health care, mental health provision needs a joined-up approach, which has too often been missing.
Many hon. Members mentioned funding. Investment in mental health has risen, but not to the level needed to implement the NSF. It has not kept pace with rises in the NHS budget generally. There are serious worries that mental health trusts will bear the brunt of the current deficit crisis, just as the new mental health trusts inherited many of the worst overdrafts after the last restructuring of services—a point mentioned by the right hon. Member for Oxford, East (Mr. Smith). The near-zero figure suggested by the Minister turned into 10 per cent. in his county, Oxfordshire. That was reinforced by my hon. Friend the Member for Banbury (Tony Baldry) and the hon. Member for Cambridge (David Howarth). There have been significant cuts, leading to the diminution of services, and the cuts are not of the order of the very small snapshot amount contrived by the Minister. That is the reality of the services that our constituents are trying to access with increasing difficulty across the country.
Expenditure on day services for mental health patients has fallen from £176 million in 2001–02 to £149 million in 2003–04, despite more people in the community needing those services. We have had many other examples from across the country. It is a false economy not to continue the investment in such services. That is why Conservatives want a fairer share of the health funding cake to be spent on mental health services. That might start to address the problem of stigma mentioned by so many hon. Members.
On choice and access, the Secretary of State has spoken much about the choice agenda in health, yet what choice is there, realistically, for mental health patients? The Government are bringing in the "choose and book" system, giving patients with physical health needs the opportunity to choose their hospital and treatment times, yet mental health is one of the few areas where that will not be introduced across the country. Too often, the only treatment available to patients is the GP's prescription, as my hon. Friend the Member for Tiverton and Honiton (Angela Browning) described so well.
Can it be right that 40,000 children—some as young as six—and adolescents are prescribed anti-depressants each year? Those drugs are effective, and in many cases they may be appropriate, but are they not prescribed because alternative therapies are not available and doctors do not have time to tease out the more complicated symptoms that accompany mental health problems? It is not like presenting with a broken leg. More time is needed.As the Sainsbury centre and our own surveys report, many GPs complain that they have had no access to cognitive behavioural therapy. Elsewhere, patients can wait six months for basic counselling, and all the while their conditions deteriorate, yet we know that early intervention is key.
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In his hard-hitting report last year on the economics of mental health, Lord Layard proposed a dramatic overhaul of our priorities, the setting up of a network of 250 therapy centres and a new cohort of 5,000 cognitive behavioural therapy specialists. We need radical thinking backed up by long-term investment if we are to diffuse the ticking time bomb.
We need also not to treat people with mental illness in silos. Mental health patients suffer physical conditions like the rest of us, such as heart disease, obesity and diabetes. Worse, they have pronounced medical conditions. A schizophrenic is likely to have a life expectancy 10 years shorter than the average one of us. They are twice as likely to die from respiratory infections. Like everyone else, they suffer those diseases, but they frequently complain that they are labelled primarily as mental health patients when they visit their GP and are treated differently.
Spending on mental health promotion is crucial, but it is a scandal that at £3 million it represents just 0.04 per cent. of the total expenditure on mental health services, at a time when many experts say we should educate the population better on mental health issues, not least through the curriculum in schools. It is a false economy not to do so, yet it does not feature in the "healthy schools" programme.
We need to be bolder and more imaginative in the places where people can access mental health services, often anonymously, not least for the 14 to 16-year-old boys, who experience some of the highest levels of stress and depression but see their GPs least frequently of all. Similarly, we need to do much more to encourage more people from black and ethnic minority communities to present with mental problems earlier. We have heard all the figures showing that they are much more susceptible to mental illness.
It is a scandal that 90 per cent. of prisoners have some kind of mental health or substance abuse problems, yet some of the worst mental health services available. Too little imagination and flexibility are available to divert people with severe mental health problems away from prison entirely. It is no coincidence that the prison population has increased tangentially to the decrease in acute mental health beds in the NHS. Perhaps if we start to address those problems, we can start to remove the stigma that still attaches to mental health issues.
Finally, on the mental health work force, we hear all the time about doctors and nurses, hospital waiting lists and numbers of operations. We hear little about the one in six consultant psychiatrists' posts currently unfilled or the 5 per cent. vacancy rates for mental health nurses in hospitals.
We need to do more to commit to a serious recruitment campaign among mental health professionals and to bring back the morale of a demoralised profession. We need to do more to encourage employers to look dispassionately at taking on the 80 per cent. of potential workers with a mental illness on disability benefits who want to work, only 20 per cent. of whom get the opportunity to do so. The Supporting People programme is being cut at a time when it is doing good work, as we saw this morning in Brent in a project supported by that budget.
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If we can do something urgently and seriously to tackle these problems, perhaps at long last we can go some way to turning the tide against the stigma that still pervades the whole subject of mental illness. That is in sharp contrast to the way in which it is handled in many other European countries, and it succeeds only in fuelling the ignorance and prejudices displayed too often by some elements in the tabloid press.
We cannot hope to tackle the stigma of mental illness when we still have a wholly unacceptable draft Mental Health Bill hanging over the heads of everyone with a mental illness or anyone who needs to be encouraged to present themselves for such a diagnosis. It is a Bill that is more about locking people up than giving them the support and treatment that they need for what is first and foremost an illness. It contains fundamental flaws and, according to the British Medical Association, would quickly bring mental health services to a standstill. The Bill, in its current form, could prove to be counterproductive and yet another example of the attacks on civil liberties that are becoming the hallmark of this Government. It can only harm the prospects of reducing the stigma attached to mental illness. I urge the Government to clarify their intentions now and to listen to the mental health community, who are up in arms.
Above all, the Government need to live up to their bold words about making tackling the inequalities in mental health a Government priority. To continue to fail to do so is a false economy and a serious threat to one of the most serious public health challenges facing our nation today.
6.21 pm
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