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Mental Health

12. James Brokenshire (Hornchurch) (Con): Whether she has made an assessment of the impact of financial deficits on the provision of mental health services; and if she will make a statement. [63698]

The Minister of State, Department of Health (Ms   Rosie Winterton): A recent assessment undertaken by the Department shows that, in 2005–06, 11 out of 84 mental health provider trusts made reductions to planned expenditure. The reduction of £16.5 million amounted to less than 0.3 per cent. of the total investment of more than £6 billion. In 2005–06, investment in mental health increased by £368 million.

James Brokenshire: There are still considerable concerns about funding mental health services. A day hospital that offered psychological services in my area closed in the past year. The re-provision of that service will take another three years. I am told that that is due to financial constraints in the health economy. Given that mental health is not listed as one of the national NHS priorities for the coming year, is there not a risk that funding to mental health services will be cut so that trusts can balance their books? At the start of national depression week, what assurances can the Under-Secretary give that funding for mental health facilities will not continue to be overlooked?

Ms Winterton: Since 1999, funding for mental health services has increased by about £1.5 billion. Mental health services have been made one of the Department of Health's top three priorities, and they have been transformed from a Cinderella service into a modernised and reformed service with a lot of new investment going into it. I understand the hon. Gentleman's concern about the day centre in his constituency, but the decision was made locally to put the money that was going into the day centre into new psychological therapies.

We have recently issued guidance on the use of day centres, and many local trusts are now considering providing more services on a social basis, for example, rather than always providing them in a centre. There was quite a lot of consultation with service users about the day centre in his constituency, and about the different types of service that they would prefer to be offered. Overall, expenditure on mental health services has increased, and we should all be very proud of the real changes that have taken place in the provision of those services.

John Hemming (Birmingham, Yardley) (LD): Given the £64 billion that is going into the primary care trusts, does the Minister accept that the difficulty in the health economy is that the inflexibility of the tariff is having a knock-on effect not only on children's hospitals, but on mental health services? Does she agree that, to avoid meltdown, we need some flexibility in the system so that the funding can be made available for mental health services as well?

Ms Winterton: The tariff does not apply to mental health services. The evidence is that there has been increased investment in those services, and we are now also providing many of those services within the
 
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community, outside the traditional hospital setting. The crisis resolution teams and early intervention teams have been very successful in removing the necessity for expensive in-patient treatment. Treating more people in the community—alongside the extra investment and the new ways of working involving new roles for mental health staff—has really turned the service round. I urge the hon. Gentleman to go and look at some of the new services that are being provided in his constituency. He will find that they are being warmly welcomed by service users and carers.

Tim Loughton (East Worthing and Shoreham) (Con): Why did the Minister claim in a written answer to me just three weeks ago that only three mental health trusts were forecasting a deficit when her own survey, published two months earlier, revealed that at least 25 per cent. of the trusts that responded were forecasting deficits? The Health Service Journal reports that 58 per cent. of mental health trusts' chief executives have had to close wards, and that four out of five have implemented recruitment freezes. Pulse magazine reveals that the average wait for an appointment with a child psychiatrist has gone up to 188 days, and that three of the country's specialist child psychiatric in-patient units have closed, with more closures threatened. Is it fair that the Cinderella service of the NHS now has to bear the brunt of the cuts resulting from the financial shambles brought about by the Minister's own Department?

Ms Winterton: It is quite astonishing that the hon. Gentleman can talk about mental health services as a Cinderella service under this Government, when he knows very well that they were in a shocking state under the previous Conservative Government. Under this Government, about £1.5 billion of extra investment has gone into mental health services, and about 25 per cent. extra for psychiatrists. That is not to say that we cannot go further, but we should all be proud of the massive changes that have been made to the way in which those services are delivered. The 11 trusts that are reported to be making planned reductions in expenditure were going to spend about £893 million. They have spent £16.5 million less than that. Overall, however, the increase in expenditure last year was £368 million. We have put in extra investment, changed the ways of working and made mental health services one of the top three priorities of the Department of Health. That has completely turned the service round since we inherited it from the Conservative Government.

NHS Funding

14. Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): If she will ensure that health trusts which balance their budgets are not disadvantaged under NHS funding criteria. [63700]

The Secretary of State for Health (Ms Patricia Hewitt): We use a fair funding formula to direct funding for the NHS towards areas of greatest need. Over the next two years, in line with that formula, we will ensure that no area is more than 3.5 per cent. below its fair funding target—most will be far closer than that. We will not change that funding formula.
 
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Meg Hillier: It is good to see you back, Mr. Speaker. Both the Homerton hospital trust and the primary care trust in Hackney have had balanced books since their inception, except for a small deficit for the Homerton hospital for the first time this year. Will my right hon. Friend assure me and Hackney residents that money loaned to other areas of the NHS will be paid back on the date agreed and with the interest agreed, so that continuing services develop? Will she also consider how the good management in Hackney can be extended to other parts of the NHS? If the books can be balanced in Hackney, which has severe health needs, they can be balanced elsewhere.

Ms Hewitt: My hon. Friend is right. It is wrong that, in the old monolithic NHS, underspending areas such as Hackney, and the east end of London more broadly, were compensating for overspending in, for instance, the west end of London, which generally has a much better-off population and less pressing health needs. I guarantee that money lent from the Hackney health community and other parts of London to manage the financial problems of the current year will be returned to them, that they will be able to satisfy themselves that recovery plans are not only in place in the overspending areas but implemented and that the NHS in London will be restored to financial balance.

Alistair Burt (North-East Bedfordshire) (Con): Will the Secretary of State also ensure fair treatment for hospitals such as Bedford hospital, which worked hard to obey the Government's instructions before the last election to clear their waiting lists regardless of costs and which now face financial disadvantage because the goalposts have been moved? Why should my local hospital not be in a position to afford to replace consultants because the tactics have suddenly changed post the election?

Ms Hewitt: The majority of hospitals across the NHS are not only meeting their waiting time targets, treating the vast majority of patients in accident and emergency within four hours and improving patient care in many other ways, but are doing so within their substantially increased budgets. We expect Bedfordshire and Hertfordshire to do exactly the same. I hope very much that the hon. Gentleman will support decisions being made by the NHS in Bedfordshire, some of which are difficult, to ensure that it delivers the best possible patient care, and does so within its budget instead of expecting to be bailed out by other poorer parts of the country.

Jim Dobbin (Heywood and Middleton) (Lab/Co-op): Does my right hon. Friend agree that those hospital trusts that repeatedly balance their books should not make staff redundant?

Ms Hewitt: The important test is whether a hospital, even one that is in financial balance, is delivering the best possible patient care with the best possible value for money. Some hospitals that are in financial balance can none the less do more to improve services, whether through day case surgery, reducing the average length of stay or ensuring that more patients are treated in the community rather than having to be admitted to hospital in the first place. The guiding light for all these
 
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changes is to provide the best possible care for patients within the enormously increased budgets that we are giving the NHS.

Steve Webb (Northavon) (LD): One important group of trusts that will struggle to balance budgets this year is specialist children's trusts, which, under the new tariff system, will not get the cost of their specialist work refunded to them. Will the Secretary of State investigate the concerns of those trusts? Surely people who want to send their children to Great Ormond Street, Alder Hey and other excellent trusts should not face front-line cuts because of an over-hasty implementation of reform simply to give the Prime Minister a legacy before he goes.

Ms Hewitt: Contrary to what the hon. Gentleman has just said and has been saying to the media, we are taking four years to introduce payment by results, which I think he and, indeed, most people in the NHS strongly support. Not only does it underpin patient choice, it gives every hospital proper transparency in relation to costs and a proper reward for its activity.

In the case of specialist trusts, it is true that the tariff needs further work and development to reflect the costs properly. We are discussing those issues with children's specialist hospitals in particular. They are part of the pride and joy of the NHS, and we will ensure in our discussions with them that they can continue their excellent work for some of the sickest children in our country.

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