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Mr. Oliver Heald (North-East Hertfordshire) (Con): I apologise to my hon. Friend for not being in the Chamber when he began his remarks, which was a little earlier than I had anticipated. Does he agree that cutting early intervention services, which are vital in tackling severe mental illness, would be a grave mistake and completely against the whole approach that the Government have been setting out in recent years? It is a denial of the modern approach that we want in mental health.

Mr. Walker: I agree totally with my hon. Friend, who is well known in his constituency for championing the plight of those with mental health problems. The cuts proposed in the consultation document are at odds with "Investing in Your Mental Health", and I am sure that the Minister will address that in her comments.

To conclude, I hope that the Minister will feel able to intervene at this late stage to help to ensure that common sense and compassion prevail in this case.

5.41 pm

The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for Broxbourne (Mr. Walker) on securing this debate on the funding and provision of mental health services in Hertfordshire. At the beginning of his speech, he set out clearly the importance of having good mental health services and the wide effect on society, given the number of people who are likely to suffer from mental health problems. I thank him for acknowledging that the Government have recognised that mental health needs special attention. That is why we have made it one of the Department's top three priorities.

I also join the hon. Gentleman in paying tribute to all NHS staff in Hertfordshire, and especially those who have worked in mental health services. We have seen a real step change in the delivery of mental health services in recent years, which has required a real commitment from the NHS staff who deliver those services, many of whom I have met during my time as the Minister with responsibility for mental health services. This is an area in which we need staff to take an open view about some
 
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of the changes that have occurred. I have been incredibly impressed by the way in which those changes have taken place and the commitment and hard work of all those who work in our mental health services.

I hope that the hon. Gentleman will also acknowledge that there has been a massive increase in investment in the NHS overall in the past few years, including in his area. For example, his South East Hertfordshire primary care trust has received more than £155 million in the past financial year, which will rise to more than £209 million in 2007–08. Collectively, the eight primary care trusts in Hertfordshire received allocations in excess of £858 million in 2005–06, which will rise to £1.1 billion in 2007–08—an increase of about 28 per cent. The Hertfordshire Partnership NHS Trust's total increased investment in its mental health services is £4.2 million over and above inflation for the three-year period from 2003 to 2006.

Mr. Walker: I appreciate that the increase is £4.2 million over and above inflation, but Hertfordshire is being asked to save £5.2 million. What has been given with one hand over the past three years is now being taken away, with interest, by the other. That is where a great deal of the concern lies.

Ms Winterton: I will come to some of the specific points that the hon. Gentleman has raised. First, let me put what he has said in the context of some of the changes that have taken place.

There are now some six assertive outreach teams with about 50 staff, compared to 29 staff in 2001. Six crisis assessment and treatment teams operate across Hertfordshire, compared to none in 2001. Those teams saw nearly 2,000 people last year, some 300 of them from the hon. Gentleman's constituency, and 1,200 were new clients. In the past, the vast majority of those patients would have been admitted to an acute mental health unit, but now they can be seen in the community. That kind of approach has reduced the need for in-patient beds.

Members often tell the House that an in-patient ward or unit is closing. Sometimes our response should be "Congratulations", because the closure probably means that people are being served better in the community. I think that that is an important aspect of the changes that have taken place in the delivery of mental health services. I accept, however, that today we are also discussing changes in the way in which early outreach teams may be offered in the future.

Mr. Heald rose—

Ms Winterton: I give way to the hon. Gentleman.

Mr. Heald: I thank the Minister, and apologise again for being late.

It is the question of whether people are treated in the community or in in-patient facilities that is most upsetting to campaigners against the cuts. I received a letter today from all the numerous organisations in Hertfordshire that oppose the cuts. The second point in the letter is as follows:


 
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How can the Minister justify that, given that it involves one of the three priority areas?

Why did the Prime Minister not mention mental health during Prime Minister's Question Time? He mentioned cardiac care. Is this not the problem—that mental health is always the subject that is left out?

Ms Winterton: I believe that our action in putting mental health up there as one of the three priorities is the reason for many of the changes that have taken place. I accept some of what the hon. Gentleman has said—for instance, what he said about the early intervention team—and I shall say more about it later, but I would vigorously defend the record in terms of changes in mental health services, and the increased investment in those services over the past two years.

When I met the chief executive of the trust yesterday, we discussed some of the changes. There have been significant reductions in spending on agency staff, and the trust should be congratulated on that. I believe that in 2003 some £3.1 million was spent per year on agency staff; that was reduced to £524,000 last year, owing to a successful policy of recruitment to vacancies. Over the same period, spending on agency nursing staff was reduced from £2.2 million to £1.1 million. The trust now employs 506 psychiatric nurses—62 per cent. more than in 2001—and 75 consultant psychiatrists, 78 per cent. more than in 2001.

It is also proposed that some £350,000 be invested in a primary care counselling service model—the hon. Gentleman referred to the need for more counselling services. That will offer a range of therapeutic interventions for those with mild to moderate mental health problems. If this model, which is currently out for public consultation, is supported, it is anticipated that it will reduce demands on community mental health teams and referrals to psychiatrists. In addition, the trust has improved work force efficiency by cutting staff turnover.

As I said, there have been some very impressive improvements in the delivery of local services, along with increased investment. But it is true that the health economy in Hertfordshire as a whole faces financial challenges, and that some tough decisions have to be made to address the situation. As the hon. Gentleman said, it is important that organisations get a grip on of the problems that have built up. The task of commissioning mental health services in Hertfordshire falls to the joint commissioning partnership board, which includes representatives from Hertfordshire PCTs and Hertfordshire county council. Each organisation contributes to a pooled budget.

Hertfordshire PCTs have asked all providers in the area to make expenditure savings, and as the hon. Gentleman said, Hertfordshire Partnership NHS Trust has been asked to make a 5 per cent. saving, which is the same as that being asked of all local providers. Decisions on where to ask the trust to make these savings were not taken lightly. At a special meeting of the joint commissioning partnership board on 16 February, it was faced with the very difficult task of considering where such savings could be made. It took a strategic overview of service provision, to ensure that the impact
 
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on patient services was kept to a minimum. Having considered the various options, it agreed a proposed list of savings totalling some £3.2millon, in addition to the £1.7 million-worth of internal efficiency savings already being made. Formal consultation on the proposed changes started on 20 March and will run until 3 May. It is important that Members encourage their constituents—as they doubtless will—to engage as fully as possible in the consultation, to ensure that their views are taken into consideration.

The hon. Gentleman set out some of the issues being considered during the consultation period that cause particular difficulties for those affected. However, it is important to recognise that strategic health authorities, trusts and PCTs need to work together to ensure that the whole health economy in a given area gets back on to a stable footing. I know from my conversations with them that NHS staff need to be reassured that the deficits that have built up over years will be sorted out. Uncertainty can affect both patients and staff, and decisions about how to proceed must be made jointly.

The local NHS trust is currently discussing the proposed service changes with staff, and I know that every effort will be made to avoid redundancies. If necessary, and where possible, staff will be redeployed to different teams. Although it is proposed that the St. Julian ward should close—as I understand it achieving savings of some £1.4 million, of which £400,000 will be reinvested in community services—I emphasise that the changes already introduced mean that more people are treated in the community, with the result that they receive attention earlier and do not have to go into patient care.


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