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The Parliamentary Under-Secretary of State for Health (Caroline Flint): This has been an interesting and thoughtful debate. It shows that a wide-ranging discussion needs to be had not only by those in health but by those in education, local authorities, the voluntary sector, employers—whether in the public or private sector—and agencies such as jobcentres in order to tackle the variety of needs that people with mental health problems face in trying to live their lives. That is important given that much of the debate raised questions about the way in which people often work in silos in relation to mental health. We are trying—there is apparently consensus across the House on this—to challenge the importance that every organisation gives to how it meets the needs of those with mental health problems in their community, no matter what that organisation's core remit.

The debate has given the Government the opportunity to demonstrate our commitment to improving the lives of the one in four people who suffer from mental illness at some point in their lives. There has clearly been increased investment in, and modernisation of, mental health services since the publication of the national service framework in 1999.

Members made several accusations. To deal with one, I understand that the Tory-Liberal Democrat council in Birmingham recently cut £2 million from the Supporting People programme and moved it to another area.

David Howarth rose—

Caroline Flint: I am afraid that I am not going to give way because I do not have a great deal of time and the
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Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), took many interventions earlier.

In the seven years since the national service framework was introduced, ambitions have been surpassed in many areas, but I am the first to admit that a great deal more remains to be done. There is consensus across the House in congratulating and thanking all those who have worked so hard to make these reforms happen. I hope that we are moving towards a system of community care, supporting people in their own homes and working to increase inclusion and decrease stigma. It is equally important that a full range of high-quality in-patient services are there for those who need them. We have recently concentrated particularly on getting the balance right in that respect.

One of the ambitions of the White Paper that we launched last week is to engage with the issue of services that could be provided outside hospital. As the Minister responsible for public health, I fully take on board matters to do with prevention and public health for those with mental health problems, as I would with anybody in the community. That is at the heart of our desire to bear down on the health inequalities that still exist. We have made considerable strides towards high-quality mental health services, but we have an even more ambitious direction of travel. We are committed to supporting good mental health throughout the population and improving preventive mental health services in the community.

I turn to the points raised in the debate. I agree with the hon. Member for Northavon (Steve Webb) that it is important to integrate health and social care budgets. The White Paper sets that out very clearly. We can do plenty more work in that area, which creates opportunities for innovation and imagination.

The hon. Members for Northavon and for Banbury (Tony Baldry) talked about GPs. Practice-based commissioning will help GPs to manage more effective care pathways and allow primary care trusts to commission new services on behalf of GPs. Coupled with an enhanced role for GPs in managing mild to moderate depression in better monitoring mental health, we hope that this will create more flexibility and   incentives for GPs and PCTs to manage mental health.

The hon. Members for Northavon and for Tiverton and Honiton (Angela Browning) mentioned the new Bill. They are right to say that it will require a careful balance between a person's right to make decisions about themselves and society's duty to protect people with serious mental disorders from harming themselves, or occasionally others. We are confident that our Bill will achieve the right balance, but I am sure that my hon. Friend the Minister listened carefully to the points made in the debate.

Members asked about prisons as places of safety when there is a crisis situation. Last year, we announced £130 million to help trusts to create proper places of safety for those who need a settlement under the Mental Health Act 1983 instead of relying on police cells or accident and emergency departments. There has been considerable work within A and E departments to improve the relationship with social services on quick referrals. On prison health, 360 mental health in-reach
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staff are in post, exceeding the commitment to 300 in the NHS plan. NHS mental health in-reach teams now provide services in 102 prisons. Again, there is progress but more to be done.

My right hon. Friend the Member for Oxford, East (Mr. Smith) and the hon. Members for Banbury and for Cambridge (David Howarth) mentioned particular issues in Oxford and Cambridgeshire. I congratulate my right hon. Friend on the three-star trust rating; I am glad to hear about that progress. Last week, the Department issued a set of financial rules for the next financial year, requiring local health economies to develop an operating surplus to create a buffer against unplanned financial problems. We will work hard with NHS bodies to ensure that good finances are in place over the next few years. If we act now, we will help to protect mental health services better against the pressures that some have faced this year. That is an important challenge that we must face up to.

The hon. Members for Cambridge and for Banbury asked about payment-by-results work for mental health. We agree that that is an important issue, and we are working hard to tackle it. We have set out our intention to pilot a new currency in 2007–08, and the move to develop a tariff is being taken forward by the mental health team. We take the matter seriously, but we are not launching an untried system on mental health services.

The right hon. Member for Charnwood (Mr. Dorrell) made an interesting speech in which he talked about the integrated delivery of care. That is indeed vital to good services for patients. However, he failed to talk about how in 18 years he missed the opportunity to put some of his ideas into practice.

My hon. Friend the Member for Kingston upon Hull, North (Ms Johnson) made a good speech in which she acknowledged the investment and the changes in attitudes and culture when providing services. However, she was also challenging. We have asked Professor Louis Appleby to co-ordinate children, adult and elderly people's services. I believe that to be important. We have a national service framework for young people's mental health, which outlines standards for services and, indeed, sets world-class standards for their provision. Of course, we must ensure that they are delivered on the ground and we want the help of colleagues from all parties to hold agencies to account for that.

My hon. Friend also made good points about women. We have issued guidance on ensuring that in-patient services are safe for women—we take that seriously. My hon. Friend and the hon. Member for Northavon made points about mixed-sex wards. Ninety-nine per cent. of wards are not mixed sex—they have separate sleeping and bathroom facilities. However, we are working to improve matters. Sure Starts and refuges have an important role to play as first contacts for many women—and their children—who may suffer from mental health problems.

I stress to the hon. Member for Tiverton and Honiton that we are spending £60 million on pilots to protect older people's health and we are piloting new centres for older people's services, which will include work on tackling loneliness. She made a valid and interesting point.
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My hon. Friend the Member for Hackney, South and Shoreditch (Meg Hillier) was right to say that we must tackle the problems of stigma that prevent people from getting work. I hope that we can consider better methods of challenging those problems through the pathways to work programme. She also made points about ethnic differences. The issues are complicated but we have done some work on examining the reasons for problems that mean that some people from black and minority ethnic backgrounds are deterred from coming forward until their illnesses are more severe. I congratulate her area on tackling those problems, and my hon. Friend the Minister of State has promised to visit.

The hon. Member for Rugby and Kenilworth (Jeremy Wright) spoke about post-traumatic stress disorder. We acknowledge the importance of that work. We have evidence of what works from the National Institute for Health and Clinical Excellence and we have issued advice to all GPs in the NHS. That was invaluable in providing support for victims of recent tragedies such as the bombing on 7 July, when different agencies, including the voluntary sector, came together to help with the obvious need for counselling and support.

I shall not specifically answer the points of the hon. Member for East Worthing and Shoreham (Tim Loughton) because, if he reads my hon. Friend the Minister's opening speech, he will realise that she covered them. However, I stress that mental health has never been higher up any Government's agenda. The result has been record increases in investment and staffing. Thanks to the efforts of the staff, front-line services have become more responsive.

We remain some way from fulfilling all our ambitions but, based on what we have said today, I urge hon. Members to vote against the motion.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 215, Noes 283.

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