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Angela Browning (Tiverton and Honiton) (Con): I am sure that my hon. Friend shares the concern of many of us that if the Park closed, there would be no children's in-patient service in a triangle bounded by London, Manchester and Dublin. The consequence would be that children admitted to hospital would have to travel huge distances, which would have a clinical impact on their treatment.
Mr. Vaizey: I absolutely share my hon. Friend's concern. It is incredibly important that families can visit their very young children when they are in unfamiliar surroundings. The more units that close—especially if we lose the Park—the longer the distances that families will have to travel and the more time that they will have to spend apart, which will have a further devastating impact.
It is said that low bed occupancy at the Park illustrates the point that fewer children are being admitted to hospital as part of clinical practice. However, I submit that low occupancy rates are a symptom not of a clinical decision but of contractual complexity. It is well known that many specialist services across the country would like to make use of the Park and Oxford's facilities, but—as I understand it—the trust has not pursued those case-by-case contracts.
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The dilemma faced by the Park is a clear example of how local commissioning falls down. The Park is a national as well as a local service, yet it is suffering the severe side-effects of the local financial crisis that affects Oxfordshire's health services across the board. For example, Oxfordshire's supporting people budget, which helps adults with learning difficulties lead independent lives, has been severely cut. The mental health trust faces cuts of £1 million this year and a further £5 million over the next five years. Nursing and psychiatric posts are being cut. The Barnes unit at the John Radcliffe hospital, which provides psychiatric services to those admitted to the accident and emergency department after a suicide attempt or self-harm, is also under threat of closure. Day services are being closed, including the Ridgeway day centre at Didcot in my constituency. Local financial pressures are leading to the potential closure of a national specialist service.
I have been in correspondence with the Department of Health about mental health and local health issues since July last year—they were some of the first issues that crossed my desk after I was elected—and I have been greeted throughout by the Department's mantra:
"It is for PCTs, with the support of the Strategic Health Authority if required, to plan and develop services in line with national priorities and in context of local need within the financial resources available to them".
With the best will in the world—
It being Six o'clock the motion for the Adjournment of the House lapsed, without Question put.
Motion made, and Question proposed, That this House do now adjourn.—[Mr. Heppell.]
Mr. Vaizey: What was just said was not meaningless verbiage—it was a very important procedural point of the House—but to return to the meaningless verbiage to which I was referring from the Department of Health, it is effectively passing the buck. Partly because I am currently a member of the armed forces parliamentary scheme and have recently been attached to the Royal Marines, the analogy occurred to me that allowing a local mental health trust to decide the fate of the Park would be a bit like asking Devon county council to decide the fate the Royal Marines.
Although I believe in local commissioning and local accountability, at some point the Government must recognise where they have a national resource that must have national backing. For example, a local primary care trust will admit a child to an in-patient unit less than once a year on average. So why on earth would a local mental health trust be charged solely with the responsibility for the Park? When the local mental health trust writes that the trust
"is not able to continue to host tier 4 in-patient services for children under 11 as the future withdrawal of local contracts leaves us without any secure income",
it is saying that it has been left holding the baby. Given that situation, it is further saying that it is going to sell the cot—the land on which the hospital stands.
Since it became more widely known that I would hold this Adjournment debate, things have moved somewhat. I was told this week by the mental health trust that
"for the foreseeable future, services will remain at the Park and we are in discussion with the PCTs about how the services will look in future and where in-patient facilities will be available".
Again, I am not at all sure what that means. Certainly, the people whom I have been speaking to do not believe that the Park has been saved from closure. Certainly, the mental health community believes that the Park will close. Has there been a failure of communication or a failure of consultation? How long is the foreseeable future? Where will in-patient services be available? Until the recent crisis, the intention had always been to close the Park, but to reopen a new in-patient facility.
The Government seem to be refusing to take responsibility for a national service. That is why I have chosen to raise this subject at a national level, in the House this evening. Managers, removed from the clinical chalk face, push through changes—or perhaps they are forced to push them through—that the professionals counsel against, whether in respect of special needs education or specialist clinical services, such as child psychiatry.
This, though, is not, and should not be, a matter for party politics. It is genuinely an issue of national concern, and if we do not act, it will be a matter of national shame. The Park, and other units, shine as beacons of national excellence throughout the world. Moreover, they shine as beacons of hope for many vulnerable and disadvantaged children and their families. With little notice and even less justification, those beacons are being snuffed out one by one.
As my hon. Friend the Member for Tiverton and Honiton (Angela Browning) reminded the House, that will mean longer journey times for children and their families; more time spent apart; the inappropriate use of adolescent and even adult services for children; a greater cost to the community, because of the need to provide longer-term treatment; and the loss of a specialist service built up over many years.
As a House, we cannot sit idly by and let that happen. I am sure that the Minister, who has listened very carefully to what I have said this evening, will not let it happen. I know that, tonight, the Minister will say that the Park must be saved and that we must retain and enhance the national specialist child psychiatry services that we still have—just—in this country.
6.4 pm
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne): I congratulate the hon. Member for Wantage (Mr. Vaizey) on securing the debate. We have not had a chance to debate with each other before, but, through various channels, his reputation preceded him and this evening he has shown that that reputation is richly deserved.
The hon. Gentleman made a number of local points in the context of a broader national debate. This is a rare opportunity to debate child and adolescent mental health services, so I hope that the House will permit me to widen my remarks to the national picture before addressing the important local points. He singled out child psychiatric services, but we cannot consider that issue on its own; we must consider child and adolescent mental health services across the board. I pay tribute to the outstanding hard work of all staff who work in that area in the NHS and in other related services up and
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down the country. They provide important services, often under difficult conditions, to our children and young people.
The hon. Gentleman helpfully started with some facts and figures to set the context for the debate. He is right that last year the Office for National Statistics reported on the prevalence of mental disorders among five to 16-year-olds and found that one in 10 children had a clinically diagnosed mental disorder, 4 per cent. had an emotional disorder such as anxiety or depression, and 6 per cent. had a conduct disorder such as oppositional defiant disorder or hyperactivity. The prevalence in 2004 remained broadly unchanged from that found by the previous survey that was conducted in 1999.
To address those needs, we need to make sure that we improve the life outcomes of children with mental health problems by ensuring that all patients who need it have access to a comprehensive child and adolescent mental health service, and not just to child psychiatric services. We attach enormous importance to this matter and the hon. Gentleman was not correct to say that we do not regard it as a priority. The Government have set themselves a public service agreement target with the Treasury for the Department of Health. The way in which we achieve that vision is extremely important and our way of doing so was set out in the children's national service framework, which was published in September 2004. Quite rightly, it was recognised around the world as a leading example of how such services can be specified for children. Full implementation of the principles set out in the national service framework will not happen overnight, which is why it was given a 10-year timetable.
Quite rightly, there has been, and continues to be, significant additional investment to ensure that the important targets attached to our CAMHS work can be delivered. In the three years up to and including the current financial year, £300 million has been made available to the NHS and local authorities. Dedicated teams of CAMHS workers are advising commissioners up and down the country to help them to understand the best local strategies for improving services. The hon. Gentleman is right to say that aspects of those services have national significance and it is important that we recognise that.
All that activity is beginning to have an effect. We track our progress on CAMHS work through an annual mapping exercise. The latest results that we have relate to late 2004 and show encouraging signs of progress. The hon. Gentleman is right to say that there is an enormous amount still to do, but, between 2002 and 2004, the number of CAMHS staff—both professional and non-professional—increased by 20 per cent. The number of cases dealt with increased by 30 per cent. One of the biggest worries is the length of the wait before seeing a specialist, but, here too, the CAMHS mapping work shows that there is cause for optimism. In 2002, only 24 per cent. of new cases were seen in four weeks; by 2004, that figure had risen to 50 per cent. As the hon. Gentleman says, there is an enormous amount still to do, but the direction of travel is encouraging. Similarly, the number of cases waiting for more than 13 weeks has reduced from a little more than 50 per cent. and is now down to just over 30 per cent. Again, there is an enormous amount to do but there are some encouraging signs of progress.
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The debate is about the future rather than the past. There are important elements that we need to get right if we are to make serious progress on this agenda, and I want to highlight them. The first is our ability in every part of the country to provide access to 24-hour services to meet urgent needs. I am pleased to say that emergency coverage of this sort is now available in 80 per cent. of primary care trusts. It has increased from about 57 per cent. in 2003.
The second area is the provision of CAMH services to people who have a learning disability. It has been of some interest to many right hon. and hon. Members. The availability of this type of service has increased from about a third in 2003 to more than 50 per cent. of PCTs now. The third area is the provision of CAMH services to 16 and 17-year-olds. I know that the hon. Gentleman centred the debate not on adolescents but on children, but that is an important area because as young people reach maturity and independence at different ages, CAMH services should be structured to take account of that.
Young people may wish to decide whether their care is managed within CAMHS or within adult mental health services. We think that it is important that CAMHS should be available for young people up to and including the age of 17. In 2003, half of local services were able so to deliver. The figure has now increased to three quarters. There are signs of progress although there are a number of important hurdles that we still need to leap over, as it were.
The first issue is that of staffing. It is an important part of the set of challenges that the hon. Gentleman has outlined. There is some good news to report in that the number of consultant child psychiatrists working in hospitals has increased from about 390 in 1997 by nearly 25 per cent. to nearly 500 in 2004. That is the last year for which figures are available. The rate of progress on staffing appears to be accelerating not only in the case of child psychiatrists but in other staff sectors as well. For example, in England the total number of staff employed in CAMHS teams in 2004 was nearly 9,000. That is up by 15 per cent. compared with the previous year. That is quite a rate of growth in the space of a year, given how long many of these professionals need to spend in training.
Over the same year, the number of clinical child psychologists increased from nearly 1,000 by nearly a third to 1,320. Over the same period, the number of CAMHS nurses increased from 2,000 to nearly 2,500. That is quite a rate of growth in such a short period.
The second big hurdle that we need to confront lies with the criminal justice system. We are tackling the mental health provision that is available to young people in contact with the CJS. That is a considerable issue for children in the CJS. Services that are now available include mental health screening for young people in court. There are joint appointments between CAMHS and youth offending teams—dedicated teams—that are providing in-reach to secure units and young offender institutions.
Our basic principle on this aspect of CAMHS is that a child or young person who is in contact with the CJS, whether they are in custody or in the community, should have the same sort of access to the comprehensive service as any other child or young person within the general population.
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The third issue is that of adult psychiatric wards, a subject that has been of some interest to right hon. and hon. Members. The national service framework recognised that, for the majority of 16 and 17-year-olds for whom admission becomes necessary, admission to a young people's unit is the appropriate and preferred option. For some young people who are living away from the family home, or those with certain types of clinical need, an adult facility may be more appropriate. Our plans to increase CAMHS provision will reduce the incidence of placing children and young people inappropriately. As a contingency measure, NHS trusts should identify wards or settings in adult units that would be appropriate.
The issues raised by the hon. Gentleman related to his local facility of the Park hospital. I know that there have been provisional plans to close in-patient facilities there. I am advised by officials that the Park building has been deemed inappropriate for in-patient over-night care of young children. There has always been, and continues to be, an intention to develop new facilities to provide appropriate modern community and extended day services for children with a mental health problem to help the hon. Gentleman's local health community to achieve the ambitions set out in the national service framework. It is worth underlining the fact that that framework is not optional for the national health service—it is mandatory. It is spread over an extended time horizon, because of the scale of the ambition that it expresses. I understand that, because of concerns that have been voiced locally, not least by the hon. Gentleman, the plans are being further considered. I do not have a precise update on those considerations but, once I do, I would be more than happy to write to him with full information.
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