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“a large proportion of its resources”—
those of the skills for life strategy—
“are taken up by recent school leavers, many of whom might reasonably have been expected to gain their qualifications at school.”
Given all the debates that we have had this week about structure, funding, independence and involving other organisations, we must get on top of that issue. We must drive down the percentage of children who leave school at 16 without those basic skills. Unless we can do that, we will not have a hope of dealing with the problems of antisocial behaviour about which we have heard this afternoon, or of increasing our national productivity and competing effectively with other countries in Europe, and with India, China and other countries in the far east, as we need to do.
4.31 pm
Mr. Charles Walker (Broxbourne) (Con): Once again, I wish to raise the issue of the Hertfordshire Partnership NHS Trust, which provides mental health services. It is an important trust, which serves Hertfordshire and my constituency, and faces significant cuts this year and perhaps in coming years.
In case I sound churlish, let me say that the Government’s record in mental health is moving in the right direction. Everyone, across the political spectrum, wants the best service delivered to some of society’s most vulnerable people. Let me add the caveat, however, that the Government have probably slightly lost their way recently, especially in Hertfordshire.
As Members of the House and the wider public know, mental health problems come with a huge amount of stigma attached. One need only think of the headlines in The Sun when Frank Bruno underwent mental health problems—the headline “Frank Loono” was considered—and when Adam Ant had his problems. The behaviour of the media was disgraceful.
For that reason, I am glad that the Government are spending money on a campaign to raise awareness of mental health problems and to try to reduce the stigma—Shift. Unfortunately, that campaign receives funding of only £1 million across England, which is 2p per head. That pales into insignificance when compared with the 15p per head spent in Scotland, although that is not a huge sum of money either. I am afraid that those figures are not in the same ballpark as the money spent on smoking cessation programmes, important though those are.
The Hertfordshire Partnership NHS Trust was founded in 2001 and has operated since without going into deficit; it has balanced its books. This year, however, despite its good financial record, it was asked to make savings of £5.6 million—more than a 5 per cent. cut in its annual budget. I raised the issue in an Adjournment debate on 19 April, when I mentioned several of the services to be closed. I will not rehash those points today; the House is aware of them and they are recorded in Hansard. However, those closures are against the proposals in the Government’s White Paper “Investing in Your Mental Health”, which most Members of the House welcomed.
When I first raised the issue in that Adjournment debate, the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton) said:
“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.”—[ Official Report, 19 April 2006; Vol. 445, c. 204.]
That sounds good, until we remember that although the trust had an additional £4.2 million, the Government are now asking for £5.6 million back. What they gave with one hand they seem to be taking back with two.
When I raised that with the Minister, she said
:“I will come to some of the specific points that the hon. Gentleman has raised.”—[ Official Report, 19 April 2006; Vol. 445, c. 204.]
Unfortunately, she forgot to do so. Undeterred, I raised the same issue with the Secretary of State for Health—who, I may say, knows me by name, which is probably more than some of my own Front Benchers do, so I have a great deal of time for her. When I asked my question, she looked me straight in the eye and said:
“I shall come to that point in a little more detail in a moment.”—[ Official Report, 9 May 2006; Vol. 446, c. 193.]
I had absolutely no reason to disbelieve the Secretary of State. After all, she calls me Charles in the Division Lobbies and always makes time for me. Unfortunately, she too forgot to return to the point.
Mrs. May: What were you doing in the same Division Lobby?
Mr. Walker: Only yesterday evening I bumped into the Secretary of State during the vote on the Education and Inspections Bill as we supported the Government against their own Back Benchers. When I suggested to her that she might want to answer the question about what was happening to the money in a little more detail at a future date, she smiled very sweetly and moved on quickly.
I am extremely disappointed that my local mental health trust faces such huge cuts over the coming year. If we are to believe Government figures given during a debate on 7 February, they account for a third of all the money being clawed back from mental health trusts in the United Kingdom. In response to a question asked by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the Minister of State, Department of Health said:
“11 of 84 trusts are making expenditure reductions that amount to £16.5 million out of a total expenditure on mental health of more than £6 billion”.—[ Official Report, 7 February 2006;Vol. 442, c. 755.]
Well, £16.5 million across 11 trusts does not sound a lot of money—in fact, I am sure that it is a little more than that—but my trust accounts for a third of that amount, £5.6 million, with the other 10 trusts have to make cuts of £1.1 million each. I cannot believe that that is just or fair, particularly given that the Hertfordshire Partnership NHS Trust has never been in deficit in the five years for which it has been in operation. It has always balanced its books. What message do those cuts send to other trusts throughout the country that are struggling to balance their books? Not a very positive one.
Perhaps the Hertfordshire trust has been a little naïve. Why did it even bother to balance its books over the past five years? Perhaps it should have just gone
into deficit, like so many other trusts. I am concerned about the fact that the trust is being asked to bail out other parts of the health service. That seems to contradict what the Secretary of State for Health believes. When I asked her about this—no, I did not ask her, actually; she just said it—she announced:
“we are reforming the way in which the NHS is run so that every hospital”
—I assume that she meant “trust”—
“takes responsibility for organising the best care within its budget. We will not expect others to bail them out.”—[ Official Report, 9 May 2006; Vol. 446, c. 196.]
That is simply not the case. As I have explained, my local mental health trust is being asked to bail out hospitals and trusts that are in deficit to the tune of £5.6 million. It is being penalised, and there seems to be no justice in the way in which it is being treated.
Of course, the Government will say that they have put local decision making in the hands of local health communities. That does not apply in this case. After all, it is the Government who fund the NHS, via the taxpayer. It is the Government who expect trusts to achieve financial balance, and demand that they do so. And it is the Government who, in this instance, are in essence asking for their money back.
I have raised my concerns with a number of charities, including Rethink, which as most Members know is a leading mental health charity. In its briefing, which was sent to Members of Parliament only a couple of weeks ago, it states:
“We believe that this is a national pattern in which wider health deficits are being addressed by shifting resources out of mental health.”
That is a fairly damning and worrying statement that should concern everyone in this Chamber and at the Department of Health, and all those outside this Chamber who would doubtless like to be here now. Mental health cuts are the deepest cuts. Mental health has traditionally been underfunded, so every pound taken from it can almost be multiplied by two or three when one contrasts that service with the better-funded areas of health care, such as cancer and heart disease.
I wrote to the Minister of State, Department of Health, the hon. Member for Doncaster, Central to ask her whether she was aware of the scale of the cuts and of the damage that they would do to local mental health services in Hertfordshire. She kindly responded on 5 May, saying:
“In deciding what proposals should be considered, the PCTs took account of...efficiency savings that could be made and that would avoid an adverse impact on front-line services”.
Well, the cuts in Hertfordshire will have an impact on front-line services—a very severe one. The hon. Lady also said that PCTs took account of
“proposals that were in accord with the principles and priorities set out in the recent consultation on mental health services”.
I assume that she was referring to “Investing In Your Mental Health”.
I have spoken to national charities and charities in the local health community, and they are absolutely convinced that the cuts will impact on people’s health
and increase the risk of suicide, and might lead to additional suicides. The hon. Lady went on to say that proposals were considered
“that did not worsen any inequality in the delivery of services across Hertfordshire.”
I am afraid to say that those proposals will lead to huge inequality in the delivery of services and have an enormous impact on many people’s lives.
I ask the Secretary of State to intervene in this matter. She is a decent woman, and if she took the time to look at what is going on and to consider the fact that a trust that has never been in deficit in five years is being penalised for the deficits of others, she might change her mind. As Rethink said, the Department of Health is complacent about these cuts and the impact that they will have on some of the sickest people in society—people who are ignored by, and who feel marginalised by, society. These are vital, critical services for local people, and central to their well-being.
4.43 pm
Norman Lamb (North Norfolk) (LD): I was pleased that the hon. Member for Broxbourne (Mr. Walker) focused on mental health, which has always been the Cinderella service. It self-evidently deals with some of the most vulnerable people, and many of us are extremely concerned about cuts to the service.
I want to take this opportunity to raise a number of issues that are of concern to Norfolk in particular, but all of which have some wider significance. First, I want to discuss the very sad closure of RAF Coltishall in my North Norfolk constituency and the question of age discrimination. A constituent of mine, Mr. Tony Thorpe, is a civilian employed by the RAF at Coltishall and has worked there for nearly 11 years. He is 60 and was amazed to discover that the cut-off point for entitlement to redundancy payment is 57. Such employees are exempt from the normal right to statutory redundancy payments, and he was initially told that he would get no redundancy payment at 60. We should bear it in mind that, at that age, it is particularly difficult to get other work. He was subsequently told, however, that he would receive a discretionary payment of £1,500—a figure based on allowing £150 a year for each of his 10 complete years of service. That is massively less than someone who had served the same number of years but was aged 40—an age at which it is much easier to get other work. That is not an appropriate way to treat someone who has worked loyally for the RAF for more than a decade.
The law will change on 1 October, when the Employment Equality (Age) Regulations 2006 come into force under the European employment directive. The explanatory notes state that, among other measures, they will remove the upper age limit for unfair dismissal and redundancy rights, giving older workers the same rights to claim unfair dismissal or to receive a redundancy payment as younger workers. The Government will introduce those rights in October, but they are denying the same rights to someone who is being made redundant before then.
In 1999, the Government introduced a voluntary code of practice on age diversity in employment that
was supposed to set out best practice principles. The Government have failed to follow their own code and are discriminating against loyal staff only months before they legislate to outlaw that unacceptable discrimination. Today, the Government accepted the argument that we will all have to work longer, so why should they discriminate against someone aged 60? I urge the Minister to pass on my concerns to his colleagues in the Department for Trade and Industry, because that injustice needs to be addressed immediately.
The next issue is a case study of what has been dubbed the “Tescoisation” of Britain. In Norfolk, Tesco already has 44 stores, but in a long-running saga it has attempted to secure a supermarket site in Sheringham, a thriving coastal town with an impressive town centre and shopping area. Last September, in the latest stage of the saga, the local authority planning committee emphatically rejected Tesco’s latest proposal, voting 20 to nil against it. However, in April, councillors were forced into an extraordinary volte face. They decided no longer to resist Tesco’s appeal against an earlier refusal after receiving legal advice on an agreement that had come to light on the sale of land by the council to Tesco. It had been signed by officers immediately after the 2003 district elections, when a new council had been elected but before members took their seats. The new councillors were not informed and a confidentiality clause was included that appears to have prevented them from explaining to an amazed public why they had changed their minds so completely compared with just a few months earlier. It appears that that legal agreement effectively prevented the council from pursuing any alternative proposal on council-owned land. Tesco managed to secure an exclusive right, without the public knowing, to pursue a supermarket application.
The public were amazed by the apparently inexplicable change of approach and it is untenable for local people to be left in the dark about a process that has been characterised by secrecy. I pay tribute to the council for being determined to get the full facts into the public domain, but I am concerned that years of secret negotiations between council officers and a major supermarket chain appear to have resulted in a legal agreement with a secrecy clause, leading to a volte face by the council without the public having any idea why that has happened. That is not an example of open and transparent decision-making. The whole planning process needs to be looked at to ensure that the public can have confidence in it.
Norfolk and Norwich university hospital is one of the Government’s flagship private finance initiative projects. It was built immediately after the 1997 general election, and it pioneered, on behalf of the whole NHS, the new form of financing that the Government said was the way forward. The hospital now faces a financial black hole of about £15 million.
We have heard already in this debate about health service redundancies. My hon. Friend the Member for Chesterfield (Paul Holmes) told the House that his local hospital is to lose a number of nursing sisters. The flagship Norfolk and Norwich hospital faces the prospect of up to 450 redundancies—nearly 10 per cent. of its work force. That is obviously a massive
concern to the people involved, but we must also be worried about the impact on patient care.
“We do not believe that we can achieve the required level of cost savings to break even in 06-07 without the risk of severely compromising the ability of the hospital to deliver safe, high-quality patient care.”
That is an extremely serious matter, so what caused the financial crisis? Was it chaotic management? Clearly not: we heard earlier from the hon. Member for Broxbourne that his hospital trust had met its financial targets every year, and the same is true of the Norfolk and Norwich. It has broken even every year, at the same time as implementing the sort of major change that the Government have encouraged. It is well run, but it was told about its budget settlement only two weeks before the start of the new financial year. That is a ridiculous way to plan the finances of a major hospital.
I want to highlight two issues, the first of which is the PFI contract. I referred the contract to the National Audit Office a couple of years ago, as it seemed to be very expensive and a poor deal for the NHS. Ultimately, the NAO agreed, finding that the Norfolk and Norwich hospital trust was paying an additional sum, or premium, for being one of the first PFI hospitals. When it was built, it was very difficult to secure private sector engagement, and the hospital had to pay extra.
The private partner in the project was the Octagon consortium. Two years after the hospital opened, Octagon refinanced and secured a windfall gain of £116 million, £82 million of which it retained. In its recent report on what is an extraordinary scandal, the Public Accounts Committee said that
“the benefits to Octagon’s investors have soared on refinancing to levels which are unacceptable even for an early PFI deal”.
The report went further, adding:
“We do not expect to see another Accounting Officer appearing before this Committee defending what we believe to be the unacceptable face of capitalism...in the consortium’s dealings with the public sector.”
Those are the words of the PAC’s Conservative Chairman, and they are a pretty strong condemnation of what happened.
Octagon’s chairman is the well respected Lord Lieutenant of Norfolk, Richard Jewson. He and his colleagues should reflect on the PAC’s findings very carefully. It is a major Committee of this House, and its findings must be taken very seriously by the Government and their private-sector partners. Both the Government and Octagon should reflect on the findings, and consider whether it is in their long-term interests to assist the Norfolk and Norwich hospital trust further in dealing with its severe financial difficulties. The public of Norfolk will expect nothing less than a further contribution from Octagon.
I call on the Secretary of State to intervene. Norfolk’s patients should not pay the price of pioneering a new form of financing on behalf of the Government and the health service. The premiumfor this expensive PFI contract amounts to about£6.8 million a year—a significant amount.
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