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welcomes the extra £1.65 billion spent on mental health services since 2001; supports the record number of staff working in mental health since 1997 including almost 9,400 more psychiatric nurses and over 1,300 more consultant psychiatrists; further welcomes the lowest suicide rates since records began; recognises the work of the 700 new mental health teams in the community; notes the national patient survey, which shows that 77 per cent. of community patients rate their care as good, very good or excellent; recognises that between 2001 and 2005 £1.6 billion capital was spent by mental health trusts on improvements to mental health wards; further welcomes the Governments commitment to expanding access to psychological therapies; and further welcomes the Governments Mental Health Bill, which will update the legislation to reflect advances in knowledge and new ways of treating people, particularly in the community.
I notice that, unfortunately, lots of Liberal Democrat Members, including their leader, have flooded out of the Chamber. I was rather hoping that I might be able to say something that would cheer him up a little.
Despite this being an Opposition day debate, I think that there is a certain amount of consensus about the fact that, first, there has been considerable investment in the NHS over the past decade; secondly, mental health services have been modernised and reformed; and thirdly, a large part of the credit for making services better for patients is due to a willingness for staff working in mental health services to maximise the use of that extra investment by adopting new ways of working and using their skills to the full, whether that be by working in new community teams or by taking on more responsibilities.
Mr. Devine: Will my right hon. Friend confirm that the Mental Health Bill is about expanding the role and responsibilities of professionals, while the Oppositions policy is about contracting the role and responsibilities of professionals?
Ms Winterton: My hon. Friend is right. I shall come on to discuss the Mental Health Bill later. It is important that the Liberal Democrat spokesman should be aware of everything that his party is doing with regard to that Bill. Given his remarks, I would be surprised if he was in favour of some of the positions that are being taken.
Mental health services have changed considerably over the past decade. Of course, we are not saying that they are perfect, but we are making real progress, particularly in specialist mental health services, which are relied upon by more than 1 million people every year. That progress did not happen by accident, or just by putting the extra money in; it happened because this Government put mental health at the top of their list of priorities. In 1998 we set out our view of modern mental health services in a White Paper, and by the following year we published the national service framework for mental health, which defined for the first time a set of standards that mental health services are expected to attain.
In 2000 the NHS plan spelled out an ambitious modernisation agenda, with new community teams, secure beds and additional funding. We now have strong multidisciplinary networks for supporting people in the community. In total, more than 700 crisis resolution, assertive outreach and early intervention teams are in place in England. Those teams work to keep people out of hospital, supporting them in the community and providing care in the least restrictive environment consistent with their individual needs.
Tim Loughton: If that is the aim of the Ministers policy and she believes that she has achieved it, why, in more than 10 years of a Labour Government, has the number of people sectioned under the Mental Health Act 1983 doubled?
Ms Winterton: First, the number of in-patient stays has decreased. We are trying to ensure that we get treatment to people when they need it. The number of people sectioned under the Act every year has remained fairly stable; I do not know where the hon. Gentleman got the idea of its having doubled. However, we continue to want to make changes, and community teams are part of that process, to ensure that we can provide help early, as the hon. Member for North Norfolk (Norman Lamb) said, to prevent the deterioration that too often leads to sectioning.
Traditionally, a view developed that removing people with mental health problems from their families and their home environment was the best road to recovery. However, that is often not what people want. They have repeatedly told us to give them help and support in the community, often in their homes, and that is what we have done. In the past four years, II am sure that I speak for other hon. Members toohave visited many community-based teams and seen first-hand evidence of the difference that they make in transforming peoples lives. That applies not only to service users but to carers. The teams help maintain social networks, help people take control of their treatment and, crucially, provide timely support at times of crisis. In addition to the 700 new teams, we have 1,500 new community gateway staff to improve patients access to specialised services.
Norman Lamb: I agree with the Ministers point about the value of the outreach work. However, does she accept that one effect of the deficits is that some of that work has suffered? I have witnessed that in my county of Norfolk, where cuts have occurred.
Ms Winterton: I shall deal with deficits later. It is important to stress that we are not aware of redundancies, but I shall revert to that matter shortly because I want to cover the hon. Gentlemans point.
Chris Bryant: The Minister has outlined various things that the Government have done to increase the resources for mental health services. However, the proportion of health spending on mental health has fallen in the past 10 years. There are two ways of tackling that if one believes that the proportion is too low. First, other spending in the NHS could be cut. Secondly, the spending on mental health services could be increased faster than other health spending. Does the Minister hope that the proportion that we spend on mental health services will increase in the years ahead?
Ms Winterton: I challenge some of my hon. Friends points. The proportion of spending has not fallen. Some figures show that the proportion for in-patient care has fallen, but the overall spend has increased. However, I shall deal with that later.
We also recognised the need to modernise in-patient services, so that when people must go into hospital, they have access to more therapeutic opportunities and make a speedy recovery. That is why, on top of the capital allocations made available to trusts, we have provided an additional £190 million in the past five years.
The national service framework was accompanied by record investment. There has been an increase every year since we published the framework. According to the European Commission, the UK devotes one of the highest proportions of its overall health budget to mental health of any EU member state. We now spend £1 billion more in real terms on mental health services than we did six years ago; that is £1.65 billion in cash terms.
The motion states that the proportion of NHS spending on mental health has decreased over the past 10 years. In 1996-97, expenditure on specialist mental health services was 8.03 per cent. of the total net NHS spend. By 2005-06, that had risen to 8.41 per cent. It is important to see the overall picture. In 1996-97, we were spending 8.03 per cent. of a net budget of almost £33 billion on mental health services, whereas in 2005-06, the figure had risen to 8.41 per cent. of a net budget of well over £76 billion. The figures must therefore be viewed in the context of increased overall expenditure from £33 billion to £76 billion. The real-terms increase in investment is clear. That has not been disputed by any party for some time. The increase has happened, and made some genuine differences.
Such unprecedented investment has allowed us to make significant staff changes. Compared with 1997, we have almost 9,400 more psychiatric nurses, more than 1,300 more consultant psychiatrists and 2,700 clinical psychologists. The suicide rateagain, something against which to measure the success of our policieshas fallen to its lowest recorded level. According to the European Commission, it is one of the lowest in Europe, thanks to our national suicide prevention strategy.
Simon Hughes: I do not want to go into detail about statistics; the Minister and I have discussed those in other contexts. However, does she accept that short-term reductions in funds have occurred in some areas? My part of south London is one of those, because of the top-slicing of primary care trusts that are less able to give money to our South London and Maudsley NHS Foundation Trustwith adverse effects. However, if the Minister accepts that need is increasing, have she and her colleagues put in a bid to the Chancellor? In the comprehensive spending review announcement that we expect in the next couple of months, will there be an additional real-terms significant allocation of money for mental health services for the next three years?
It would not be appropriate to give all the details of our bid in the comprehensive spending review. However, let me consider deficits and their effect on mental health services. We have made it clear that we would not tolerate any mental health trust
being asked to contribute more in financial savings or cost improvement plans than any other service in the local health economy, unless that trust contributed to the deficit. My Department has investigated a small number of allegations in the past year, and found that in each case the savings required of mental health trusts were not disproportionate compared with the rest of the local health economy. I assure the hon. Gentleman that if any similar cases are brought to our attention, we will investigate them.
Mr. Rogerson: I am grateful for the Ministers reassurances. In my intervention on my hon. Friend the Member for North Norfolk (Norman Lamb), I was trying to emphasise the great change that is taking place. The Minister has already alluded to the refocusing from in-patient services to services in the community. At such times, services may be even more vulnerable to an overall re-examination of funding. If all trusts are being asked to examine where they spend their money, it may be especially important to examine closely those that offer mental health services to ensure that the impacts on them are not adverse.
Ms Winterton: As I said, we have made it very clear that we do not expect mental health trusts to have to make any disproportionate contribution. I recall an hon. Member coming to see me about the proposed withdrawal of an early intervention team. Because that related to one of the very clear targets that we had set, we pointed out that it would not be the right approach, and the health authority did things slightly differently. We were able to ensure that the early intervention team remained in place.
When I meet mental health staff, I always find that they want us to ensure that financial deficits are sorted; it is important to recognise that. Although mental health trusts have historically often kept their finances in good order, they have always felt slightly vulnerable in the event of financial problems. One thing that mental health staff often say to me is, We just want the overall situation sorted out. You are quite right to go down the road of doing that, because in mental health, we worry that if things are not right, people will come back to us and ask for more cuts in services. We are on the right track there, but with the proviso that we ensure that mental health services are not asked for disproportionate amounts of money.
The Opposition motion also calls for appropriate settings to be provided for young people who need to go into hospital for a mental health problem. My hon. Friend the Under-Secretary of State has made a commitment to eliminate within two years the use of adult psychiatric wards for children younger than 16. We are writing to strategic health authorities, informing them that if a child younger than 16 is placed on an adult psychiatric ward, it should be reported as a serious untoward incident. That is against a background of massively improved spending on child and adolescent mental health servicesCAMHSfrom £284 million in 2002 to something like £513 million in 2005, which is a rise of more than 80 per cent.
I was asked to look again at the Mental Health Bill with particular regard to age-appropriate accommodation. I said in Committee this morning that I would look at whether it was possible to amend the Mental Health
Bill along the lines put forward by YoungMinds about age-appropriate settings. Bearing in mind what was said about political point scoring, I have to say that I was disappointed to find that the Conservative Opposition put out a press release saying that all Labour Members had voted against this, when I specifically said that I would take the amendments away. We discussed why they were not appropriate at the time and I undertook to keep the Opposition informed about any decisions in order to involve them in the issues. I am therefore very disappointed that they have decided to act in this way.
David Taylor: The decision announced by the Under-Secretary is certainly a step forward, but does not the national service framework for children and young people referin standard 9, I believeto the need for the broader group, not just under-16s, to receive care and attention appropriate to their age? What progress can we look forward to for the wider group? That is fine for under-16s, but there are still far too many adolescents older than 16 in adult wards. That cannot be tolerated much longer.
Ms Winterton: That is absolutely rightbut it is all about ensuring that the correct assessment is made. We have to recognise that sometimes circumstances will be difficult, as in the case of emergencies, and we need to be clear that we can deliver treatment where it is necessary rather than turn a child away. However, we have made particular commitments about how best to handle that situation. I want to ensure that we get the services right, and that any legislation that we introduce does not create a perverse incentive for children not to get treatment because a clinician feels that what he wants to do is unlawful. It is a delicate balance and, as I said, we are looking further into the position. We were all agreed in Committee along the lines that I have outlinedthat we want to see the change happen, but we want to ensure that we get it right.
Tim Loughton: Far from apologising, I want to challenge the Ministers sanctimonious claptrap. She knows full well that all 12 of her colleagues in Committee voted against a provision in the Mental Health Bill, added in the other place, that would have given guarantees for age-appropriate treatment to some of our most vulnerable children. She knows that that is what they did. Furthermore shealong with her mental health tsar and colleagues in the Lordshas been talking for months and months and months about looking into the problem and doing something about it, but at no point has she promised to come back with a new amendment that will specifically address those concerns. She has said only that she will have a look at the problem, which is far removed from promising to do something about it.
The hon. Gentleman knows very well that the debate in Committee this morning was quite reasonable and sensible. We agreed that there were
some real issues that needed to be looked at. Particular points were raised under one of the amendments to the amendment, which again put the doctor in charge by referring to registered medical practitioners. That was different from what we wanted, which is to give more powers to people such as psychologists and nurse consultants. The hon. Gentleman knows that that is why we said that we would take the amendment away. His comments are purely for political point scoring: he well knows that, and he is being slightly disingenuous if he fails to admit it.
I am glad that the Opposition motion mentions our work on improving access to talking therapies. As the hon. Member for North Norfolk said, the Government will expand its programme to gather more evidence to support the hypothesis put forward by Lord Layard and his colleagues at the London School of Economics. We are also working very closely with colleagues in the Department for Work and Pensions and the Health and Safety Executive, particularly looking at the connections between the pathways to work condition management programme and our work on improving access to psychological therapies. It is important for the various strands to work closely together to ensure that we can provide holistic support for those who really need it. I think that the Treasury recognises the importance of the work that we are doing, particularly in the two pilot sites. That has been a major part of the Governments cross-cutting review of mental health and employment.
It is right to talk about the importance of getting employers to take responsibility and help employees who are having mental health problems. Some of that is also about the Government and others providing the right kind of information and support, of which our action on stigma programme forms an important part. Organisations such as Royal Mail and BT have put forward some good policies and we should ensure that others are made aware of them. We should gradually get people to sign up to that kind of approach. My hon. Friend the Member for Kingston upon Hull, North (Ms Johnson) said that there were good examples around the country, and my hon. Friend the Member for North-West Leicestershire (David Taylor), who is no longer in his place, pointed out that the media also have an important part to play.
Barbara Keeley (Worsley) (Lab): My hon. Friend mentioned holistic working. Bolton, Salford and Trafford have a single mental health trust, and I recently attended a meeting with GPs in Salford and Trafford at which they raised the significant differences in access to psychological services in the different areas. Their conclusion was that services were better in Salford precisely because of the things that my hon. Friend has described, such as improved counsellingthe service is keen to shift resources around the city to improve accessand the fact that people are prepared to work outside silos and to prepare maps of counselling services to try to provide access. They highlighted projects such as Salford womens centre, which has very good counselling services that can be made available. Apart, possibly, from certain bigger factors, the difference seemed to be made entirely by those things. People in Salford are getting right those holistic approaches and different ways of working. Waiting times and access to psychological services are considerably better in Salford than in Trafford.
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