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David Taylor (North-West Leicestershire) (Lab/Co-op): Due to the actions of our Government since 1997, mental health care has recently ceased to be the Cinderella of the NHS, but it is still something of a poor relation. Can the Minister reassure the House that people and patients have not been put at risk by budget
reductions, about which Louis Appleby, the national director for mental health, is unhappy?
Ms Winterton: Given the extra investment in mental health services, we are anxious that primary care trusts and strategic health authorities should maintain a high quality of care. As I have said, when we looked at planned and actual expenditure last year, the difference was £16 million, but that does not mean that overall expenditure did not increase on mental health services. It did, and it has done so consistently in the years since the national service framework was introduced, along with new teams, modernised ways of working and increased investment. That has made a genuine difference to people who use our mental health services, and we certainly want to maintain those improvements.
Mr. Philip Dunne (Ludlow) (Con): Last week, Shropshire County PCT announced the closure of Whitcliffe mental health ward in Ludlow community hospital, not because of patient care needsthe patients will be transferred to the only remaining Victorian asylum operating in this countrybut entirely as a result of financial deficits. The mental health trust operated at surplus in 2005-06, and it is due to break even in 2006-07, but it has been forced to make cuts and close that ward purely because of the financial deficits that affect the rest of the NHS in Shropshire. Why?
Ms Winterton: It is difficult for me to comment. As the hon. Gentleman said, the trust will break even this year, so I am not certain why he said that that in-patient ward will be closed. In-patient wards are often closed because services are provided in the community, thus reducing the need for in-patient beds. That may be the case in his constituency, or some of the patients may be transferred elsewhere because that is more appropriate. However, he should accept that in some instancesI will, of course, look at the point that he madethose decisions are made for good reasons, as the fact that there are teams in the community may mean that there is less need for in-patient beds.
Steve Webb (Northavon) (LD): On Friday, the Department of Health produced a press release headed, End of the Prozac nationmore counselling, more therapy. It trumpeted a ground-breaking initiative, a major new programme. What we get is a couple of pilot schemes, while in Oxfordshire, Cambridgeshire and other places around the country that we have heard about, front-line mental health services are being cut. Is that not another case of the Department of Health being out of touch with what is happening on the ground?
Ms Winterton: I am disappointed by the sneering attitude that the hon. Gentleman is taking towards an initiative that has been welcomed by all the mental health charities and by mental health service users, who know the importance of psychological therapies. They know that we need to build up the case for saying that psychological therapies can be a very good alternative to drug therapies. We have always been clear in every White Paper and in our manifesto commitments that
we would start a gradual programme of introducing psychological therapies. We need to showwhich is why we have set up demonstration sitesthe benefits of the approach not just to the individual, but to the local community. The programme is a good way of doing that, and I am sorry that the hon. Gentlemans attitude goes against everything in which we have been supported by service users and mental health charities.
Tim Loughton (East Worthing and Shoreham) (Con): I presume the Minister was disappointed with Rethink when it published a damning catalogue of budget cuts to mental health services around the country: the closure of mental health day hospitals in Suffolk; mental health wards closed at St. Georges, Tooting or forced to become mixed sex wards; and 5 per cent. cuts in Hertfordshire mental health services. Was she disappointed with the Mind report yesterday, which highlighted the absence of appropriate services for the one in six women who suffer mental health problems around childbirth, with 25 per cent. of them waiting more than six months for any support? Will she be disappointed tomorrow, when Pulse magazine brings to Parliament general practitioners who are alarmed at its survey showing 93 per cent. of GPs prescribing antidepressants contrary to National Institute for Health and Clinical Excellence guidelines, because of a lack of available alternatives? Does she really think that our mental health services are having their best year ever?
Ms Winterton: Following the Rethink survey, we carried out a survey of all 84 NHS trusts whose full details we will publish tomorrow. I have been finalising everything that I want included in it. The figures show that, as I said, planned expenditure increased, but not by as muchby about £16 million less than was intended, out of a total expenditure by those trusts of £893 million. On psychological therapies and the Mind survey, the hon. Gentleman is right to say that, for post-natal depression, we need to increase the services available. That is why we have set up the demonstration sites that we announced last Friday. We know that much more can be donefor example, through health visitors to assist with post-natal
The Minister of State, Department of Health (Andy Burnham): Primary care trusts determine how best to use the funds allocated to them to plan, develop and improve health services for their local populations. No meetings are arranged with representatives from NHS trusts in East Anglia at present, but as Minister with
responsibility for the eastern region, I expect to have meetings with representatives and to visit the region in the course of my work.
Mr. Bellingham: Is the Minister aware that the Queen Elizabeth hospital in Kings Lynn is facing a £10 million deficit? The staff have my admiration for working tirelessly trying to sort out the crisis. Is it fair on the local community that the hospital is being forced to pay a usage charge of 10 per cent. on its borrowings? Is it fair that the PCT financial uplift for the next two years has been cancelled because of PCT reconfiguration? Does the Minister agreeif he puts his hand on his heart, I am sure he willthat my constituents deserve better from the Government?
Andy Burnham: I am sure that an hon. Member of his long standing in the House and a member of his party would accept that the NHS must live within its means. The hon. Gentleman must accept that there is a combination of cost pressures on the system this year and that decisions must be taken locally. Before he rides off on his high horse and lectures the Government about NHS funding, no PCT in Norfolk will be more than 3.5 per cent. under target funding. The Norfolk PCTs have experienced a two-year increase of 22.5 per cent. against a national average of 19.5 per cent. He should look at the facts on the money going into his local health service before he dishes out criticism and says that it is all the Governments fault.
Mr. Blizzard: As my hon. Friend knows, one of the ways in which the NHS is using its money in East Anglia involves requiring the primary care trusts to allocate a certain amount of money to the private sector to provide services free at the point of delivery for patients, which will provide patients with greater capacity and greater choice. In order that that process should work successfully in my part of the region, will my hon. Friend agree to meet me and my hon. Friend the Member for Great Yarmouth (Mr. Wright) to discuss the way forward in our part of the region?
Andy Burnham: I am grateful to my hon. Friend for his constructive comments and agree to meet him and my hon. Friend the Member for Great Yarmouth. I am aware that the number of people waiting for an in-patient appointment for more than six months is down to almost nil within his region, and the number of people waiting for an out-patient appointment for more than 13 weeks is also down to a very low level. Huge improvements have been made, but I am ready to listen to him about how we can improve things further.
Mr. John Gummer (Suffolk, Coastal) (Con): Is the Minister aware that because of the underfunding of the PCTs in my constituencywe get 90 per cent. of average fundinghe is closing one hospital, halving the number of beds in a second, closing beds in a third and has cut to ribbons the money available for mental health? Will he meet me and my PCTs, all of which believe that the situation is a result of underfunding rather than overspending? The health service is now in its worst state for 30 years.
Andy Burnham: I find it hard to take lessons from a member of the Cabinet which slashed NHS funding. As I said to the hon. Member for North-West Norfolk (Mr. Bellingham), Norfolk PCTs have experienced a 22.5 per cent. increase, and similar increases have occurred across the region. I am ready to listen to the right hon. Gentleman and hear about the pressure on the ground, where difficult decisions are being made in NHS trusts. However, he would be the first to say, The NHS must live within its means and only spend what it has coming through the door. I am sure that he wants to support us in ensuring that his local NHS has a viable future.
The Minister of State, Department of Health (Caroline Flint): The SunSmart campaign, launched today, is the national skin cancer prevention campaign run on behalf of UK health Departments by Cancer Research UK. This year, it will focus on men, in whom the incidence of malignant melanoma has quadrupled in the past 30 years, and also on outdoor workers.
Mrs. James: I wonder whether my hon. Friend has read my early-day motion on unstaffed, coin-operated sun-tanning salons, which I tabled last week. She will be aware that under-16s should not use sunbeds and that children are gaining access to unstaffed centres. Will she consider using the SunSmart campaign to raise awareness among children about the dangers of sunbed use?
Caroline Flint: That is an important issue. More than 100 MPs have signed the early-day motion. I will do more than use the campaign to raise awarenessofficials from across the Departments will meet other interested parties to discuss regulation in that area, and in particular coin-operated tanning booths and under-16s.
Hywel Williams (Caernarfon) (PC): As part of the campaign, will the Minister ensure that awareness-raising information is targeted at men under 24 and over 64, who are particularly susceptible to not seeking medical advice when symptoms appear?
Caroline Flint: Part of the SunSmart campaign involves making sure that information goes to doctors and others, who can share it with other health professionals in their surgeries and make sure that leaflets are available. I am pleased that the campaign is focusing on men, because I am sorry to say gentlemen that you are not always very good at coming forward to look after your own healthtake advantage of the information and enjoy the sun, but keep it in proportion.
Dr. Ian Gibson (Norwich, North) (Lab): Would my hon. Friend agree that a little bit of sun is really good for you, because it helps to create vitamin D in the
body, which prevents a lot of stomach cancer, bowel cancer, osteoporosis and so on? Does she accept the international information that is available, and does she think that Cancer Research may have gone a wee bit too far?
Caroline Flint: I recently met my hon. Friend and Mr. Oliver Gillie to discuss this issue, and we have had discussions with Cancer Research. I think that my hon. Friend will find that the information does not advise not going out into the sun, but being proportionate. I have asked the Scientific Advisory Committee on Nutrition to consider some of the issues relating to adequate levels of vitamin D and prevention of other serious illnesses. My hon. Friend raises an important point.
The Minister of State, Department of Health (Andy Burnham): As at month six, the NHS is forecasting a net deficit of around £620 million for the financial year 2005-06. My right hon. Friend the Secretary of State intends to publish provisional out-turn figures for 2005-06 in early June.
Mr. Amess: I, too, welcome the Minister to his post and remember him as a well-respected colleague on the Health Committee, but that is where the pleasantries end. As he will know, the Royal College of Midwives, for instance, will be particularly concerned about this announcement. Is he aware that the decision to merge the three strategic health authorities in the east of England has concerned Southend hospital, which is not running a deficit and has actually saved money? The health professionals there are very worried that they will now be asked to bail out other health authorities that are running a deficit. Will the Minister confirm that that will not happen?
Andy Burnham: I thank the hon. Gentleman for his generous welcome. I remember our time on the Health Committee. He always had a pleasant word for me then, so I hope that that will continue in this job.
I entirely understand the point that the hon. Gentleman is making on merging strategic health authorities. We made a commitment at the general election to take money out of NHS bureaucracy by slimming the number of NHS organisations and taking £250 million out of the system. I remind him that his party made a much deeper proposal of cuts up to£600 million. One of the systems that we are taking forward is to ensure that those who do run a good ship do not get penalised as they did in the past and that organisations that are helping to recover the position can rightly expect that money to come back into their local health area. That is true for my constituency, too, and for many more represented on the Labour Benches of the House.
Mr. Kevin Barron (Rother Valley) (Lab): May I also welcome my hon. Friend to his new position on the Front Bench? Does he agree that it is vital not only to know what the out-turn deficit is for this particular year and how we are going to deal with that in this financial year and in years to come, but to understand why we have this overspending minority of trusts when we have a Government who have doubled expenditure on the NHS in the past seven years?
I entirely agree that once we have got through the immediate difficulties, the important thing is to understand how these problems arose and to ensure that there is the strongest possible financial control at trust level. Boards must be given the information that they need in order to make decisions to ensure that the trust lives within its means, balances its books and remains in a strong position. I take on board my right hon. Friends commentshe is right to make thembut I think that he would join me in saying that despite the problems, there is no trade-off against NHS standards. Within the current difficulties, the NHS continues to improve and is producing record waiting times for patients.
Dr. Richard Taylor (Wyre Forest) (Ind): Last week, it was reported in the British Medical Journal that adverse drug reactions are estimated to cost the NHS nearly £500 million a year. In view of the current NHS deficits, is it wise for the Department of Health to terminate the contract for supplying the Drug and Therapeutics Bulletin to prescribers? I, too, welcome the new Minister. I do not think that he was on the Health Committee when we carried out our inquiry into the pharmaceutical industry. The Government response to that recognised the importance of the Drug and Therapeutics Bulletin as one of the very few sources of independent advice to prescribers. Will he therefore reconsider that decision?
Andy Burnham: I am grateful to the hon. Gentleman for his welcome, and that another of my comrades from the Health Committee is giving me the benefit of his advice at my first Health questions. I always have the highest regard for what he says, and I have listened carefully to the point that he has made. These issues have to be considered in the round against the background of NHS deficits, and there are continual pressures on the national health service. However, I have listened to the hon. Gentleman today, and I will continue to listen carefully to his views.
My hon. Friend the Minister referred a moment ago to primary care trusts and health authorities running a good ship. That has been exactly the case in Barnsley, Doncaster and Rotherham in South Yorkshire.
Sheffield, however, despite brokerage and borrowings of £20 million, is still £16 million in deficit. Consequently, every health authority in South Yorkshire is now being asked to pay a 2.5 per cent. levy. For Barnsley, that means £6 million being taken out of the PCTs budget before the financial year even begins. Does my hon. Friend think that it is fair that the people who have been running a good ship are being penalised for their success?
Andy Burnham: My hon. Friend makes an extremely fair point. His PCT is similar to mine in many respects, being in a former mining area. I agree that the money to which he has referred is vital in an area such as Barnsley, just as such funding is needed in my constituency to improve public health and preventive care, so I understand entirely what he is saying. This is about putting in place a fair regime in the NHS, so that those organisations that bail[Hon. Members: Bail?] Those organisations that help those that are having problems should not suffer the consequence of not seeing the money come back into the system. My hon. Friend is right to raise that point. It is not right that organisations that manage their affairs well should compensate those that do not. The incentives in the system must reward those who run a good organisation.
Mr. Stephen Dorrell (Charnwood) (Con): Although we recognise that there has been a huge increase in funding to the national health service, which we welcome, does the Minister recognise that a depressingly familiar pattern is reasserting itself? This afternoon, we have seen the Minister with responsibility for mental health services standing at the Dispatch Box telling the House how important those priority services are, yet PCTs all round the country are cutting the growth budgets available for those services, regarding them as a soft touch for available resources. This is a familiar pattern. What steps is the Department taking to ensure that that is not allowed to continue?
Andy Burnham: It would be deeply irresponsible, when financial pressures have arisen, not to take steps to get the local health economy back into balance. However, I understand the serious point that the right hon. Gentleman is making about the position of mental health in the overall health economy, and about ensuring that it is not the specialty in which cuts are made and from which funds are taken first. I respect that point. Overall, however, it is up to the local health economies to make a proper judgment on their priorities for mental health services. But, as the right hon. Gentleman says, mental health services are not optional, and it is vital that they are adequately resourced.
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