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We can all have much amusement at the Minister's expense as he stands before us to withdraw these three clauses, which were a necessary working requirement a short while ago and now do not fit with the different path that the Government are on. We can all poke fun and say that it shows a lack of strategy on the part of the Government. However, the reality for those of us who are here as Northern Ireland politicians and elected representatives is that there is genuine uncertainty and doubt about our capacity, competence and resolve to take and share responsibility together within the institutions to which we are elected.
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The Minister, in presenting the clauses a few weeks ago and now withdrawing them, is left as a victim of that uncertainty.
As Northern Ireland Members, we need to remember that the biggest questions are not about who wanted early elections a few weeks ago and who may not want them now, but about whether we want to take the powers and responsibilities that we can take within a Northern Ireland Assembly and Executive and within the north-south and east-west arrangements.
The hon. Member for East Antrim (Sammy Wilson) suggested that the SDLP had to show whether we would go into these interim arrangements, which are short of full-blown devolution. We do not want to go into anything half-baked, nor will we go into anything on a half-hearted basis. We do not believe that the Government have gone far enough in what they have proposed, but we will take things as far as we can. We will go in with a positive mind and try to make fast progress towards the agreement; we will not go into any diversions or cul-de-sacs that anybody else might want. We need to remember that it is for the parties from Northern Ireland to address and resolve the biggest questions around election dates for the Assembly and the restoration of the Assembly, and for the Government to be supportive as we try to do so.
Mr. Charles Walker (Broxbourne) (Con): I am grateful for being granted this opportunity to voice my concerns about the future of mental health services in Hertfordshire. As hon. Members on both sides of the House recognise, mental illness deserves our attention. For too long it has been overlooked and it has suffered in comparison with the more emotive and better understood diseases. However, mental health problems will afflict one in five of our constituents during their lifetime. For many, it will be a passing illness that can be treated and, thankfully, left behind. For others, however, it will be a life sentence both for themselves and their families.
In Hertfordshire, we are lucky to have an excellent mental health trust that does incredible work in supporting people with mental health problems. The Hertfordshire Partnership NHS Trust makes a real difference to the quality of people's lives. However, recent demands for budget cuts are casting a long shadow over the trust and its ability to deliver critical services to the community that it serves.
At the start of this year, the Hertfordshire Partnership NHS Trust was informed that it had to make a year-on-year saving of more than £5 milliona figure that equates to just over 5 per cent. of its annual budget. To put it another way, based on the figures that the Minister gave the House yesterday, it represents 30 per cent. of the total savings being demanded from mental health trusts across the country. The trust was told that the saving was required as part of its contribution to meeting an overspend in the wider Bedfordshire and Hertfordshire health economy. That overspend is estimated to be close to £100 million.
The Hertfordshire Partnership NHS Trust has played no part in creating that deficit. It has lived within its means since its inception in 2001. It has managed its budget efficiently and delivered value for money. Not unreasonably, one might be forgiven for thinking that that is the sort of financial performance that should be rewarded and held up as an example of best practice across the NHS. Instead, the trust is being penalised by a severe budget cut of more than £5 million. What message does that send out to other trusts struggling to balance their books? Penalising them for the debts incurred by their more profligate neighbours will certainly not encourage them to behave in a fiscally prudent fashion.
The scale of the cuts being asked of the Hertfordshire Partnership NHS Trust will have a severe impact on services across the county. In Hertfordshire, we face the following measures: closure of a 22-bed in-patient mental health ward; a reduction in direct-action psychology services; a reduction in day services; closure of the early-intervention psychosis service; reductions in the staffing for community mental health teams; the closure of an acute day treatment unit; staff reductions in mental health in-patient therapies; a reduction in services for people with alcohol and mental health problems; the closure of a day care unit that supports older people with mental health problems and their
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carers; a reduction in staff working in child and adolescent mental health services; and a reduction in support for people with learning difficulties. In total, those cuts could lead to more than 70 job losses and have an impact on more than 10,000 service users across the county. The services scheduled for cuts are not "nice-to-haves" on the periphery of the trust's offering; they are absolutely critical to many of their users.
"Considerable anxiety is already being expressed across the organisation regarding the impact of the proposed savings targets, particularly from the clinical staff, and the consultant psychiatrists especially. The focus of this anxiety is that there will be an inevitable increase in clinical risk and potential harm, and an overall deterioration in service provision that would reverse the considerable progress made in Mental Health over the years since the closure of large institutions".
"The implementation of the proposed cuts will increase the suffering of service users and their carers, who will face increased risk of suicide and self-harm, longer recovery time, higher relapse rates and a greater reliance on carers who, due to their role, are already more susceptible to mental health problems."
"The proposed cuts are financially inept. By reducing the provision of community services, psychological services and early interventions, more people will become acutely unwell. This is highly expensive and will actually increase the financial burden on the NHS."
"the reduction in services will have an impact on care across the entire community. For unpaid family carers, the outcome will be devastating. With such drastic proposals, many carers could lose essential support and this could lead to a situation where carers reach breaking point."
These are real concerns that are being expressed by organisations dedicated to the welfare of their community. There is already a deep understanding that the proposed cuts will have a significant impact on patients and their families. Furthermore, the consultation paper surrounding the proposals almost entirely fails to recognise the additional burden that the cuts will place on carers. It ignores the possibility that many carers will have to give up work in order to support patients losing day care services.
The cuts proposed for Hertfordshire's mental health services run contrary to the vision recently outlined in the Government consultation document entitled "Investing in Your Mental Health". That blueprint for the future delivery of mental health services makes many useful suggestions. In particular, it highlights the need for more local care and support to be provided through community-based services. Importantly, the White Paper makes it clear that any reduction in acute beds is possible only as a by-product of effective community services rather than as a precursor to their development.
In reality, what we have in Hertfordshire is the worst of both worlds. We are faced with the equivalent loss of 37 beds in St. Albans and Stevenage, with a corresponding cut in the very community-based services
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that were supposed to replace them. A briefing note circulated by the joint commissioning trusts to Hertfordshire primary care trusts said that
"the swathes of cuts through the predominantly community-based, mid-tier, support services for patients with mental health problems are completely contradictory to the proposals in the Government's White Paper."
"the LMC strongly rejects the degree of cuts listed because they will impact so severely on a particularly vulnerable group of patients who are often in no position to object. The impact on families, carers and children of patients suffering with mental health problems will be immeasurable".
What we face in Hertfordshire is the closure and scaling back of vital services. Inevitably, in cases in which services are retained in a reduced state, the threshold for acceptance will need to increase. As a result, many people will be denied access to hospital beds, and hundreds more service users will no longer be able to receive secondary care from community mental health and drug and alcohol teams. Inevitably, those people will fall back on already stretched GP surgeries.
In my constituency there is no spare capacity for the provision of counselling and support services. Completely separate from the cuts proposed for the Herts partnership trust, our PCT, South East Hertfordshire, is seeking to scale back counselling services provided in GP practices in the south of the borough.
When we look at what is being asked of the Herts partnership trust, it appears that the suggested cuts have been taken in isolation and not as a whole. There is little evidence that the knock-on effects attached to cutting middle-tier community-based support services have been adequately considered. It seems that at every turn these cuts are being driven by accountants not clinicians. In the words of Young Minds, a national charity that focuses on the mental health of children and also has operations in my constituency,
"the cuts proposed will materially affect the mental health and wellbeing of the most vulnerable children and young adults in the short, medium and long-term and will have a detrimental affect on their families and communities."
I fail to understand how the cuts can be justified. How is it possible for someone who is in need of hospital admittance one day to be no longer eligible the next? How can it be less important to help young people tackle psychosis this year than next year? Why has the importance of helping people manage and beat their alcohol addictions suddenly diminished at a time when alcoholism is a growing menace and we have 24-hour drinking in many of our communities?
I urge the Minister to look into the issue that I have raised. I accept that the NHS is not a bottomless financial pit and that tough decisions need to be taken. However, it is simply not right that a well-run and responsible mental health trust is being penalised for the financial difficulties of others. The iniquity of the situation demands attention. I know that the Minister has an extremely difficult job to doa job that requires
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her to balance many competing demands. As this Government rightly recognise, however, mental health deserves special attention. Although things have got better, we still live in an age where mental illness is misunderstood and too often feared. The cuts that I have highlighted will further isolate those afflicted by terrible illnesses that can act as life sentences with no remission.
The cuts being put forward in Hertfordshire will penalise young and old alike. Children and adolescents will be denied access to services that can change their life prospects. Those trying to come to terms with catastrophic events in their lives will have nowhere to turn. Many carers will be left without support and hope. People in need of hospital treatment might find the door shut.
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