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The timing of the debate is curious. As the Minister said, it curtailed the debate that we were having.—more rationally than she suggested in Committee on the Bill. Bill. It is good to raise the profile of mental health. The Mental Health Bill has attracted much publicity, much of it negative because of its controversial contents. I make no apology for my role in raising those objections, but it is important that we also raise the profile of the positive developments in the mental health world and the dedication of all the staff working in difficult circumstances, something that the Minister just managed to squeeze in in the 48th minute of her contribution. We should also mention the contribution of the excellent voluntary organisations and support groups such as Mind, Rethink, the Sainsbury Centre for Mental Health, YoungMinds and so on, as well as the carers of all those living with mental illness, on whom much of the responsibility for care falls, however good or not the legislation is. Not least among the carers are young carers, and the estimate is that some 20 per cent. of the 175,000 young carers are living with someone, usually a relative, who has a mental illness.
While the Liberal Democrat motion is right to flag up the problems and we can support those sentiments, the tenor of the Government amendment is far too complacent. That was borne out by the rather self-congratulatory tone of the Minister’s introductory remarks. The amendment paints a far too rosy picture of what most people still agree is the Cinderella service of the NHS, and CAMHS is the Cinderella service of that Cinderella service —[ Interruption. ] Well, I fear that my definition of a rosy picture is rather different from the Minister’s and perhaps we should put that into the lexicon of how this Government look at things differently from reality and from the experiences of our constituents.
I also query why, in a motion about mental health services, one of the co-signatories to the Government’s amendment—alongside the Secretary of State for Health and the Minister, the right hon. Member for Doncaster, Central (Ms Winterton), whom one would expect—is the Home Secretary. That says a lot about the way in which the Government view mental health and the pitch of the Mental Health Bill. It is about locking people up rather than providing therapeutic benefit for a health problem.
Meg Hillier: I would point out that the Prime Minister and the Chancellor of the Exchequer are also on the list of signatories. That is just joined-up government and perhaps the hon. Gentleman will withdraw that comment.
The hon. Gentleman raised an important point about mental health services often being seen as the Cinderella services, but he is being limited in his congratulations to the Government. I will raise later the many issues that still need to be tackled in mental health services, but he must acknowledge the huge improvements in investment and increases in psychiatric nurse and consultant numbers that are making a big difference on the ground, even though we could always do more.
Tim Loughton:
If the hon. Lady will forgive me, I am about to deal with that. If she will allow me to make my speech, there will be time for her to make her own.
Mr. Ivan Lewis: Will the hon. Gentleman give way?
Tim Loughton: I was not planning to speak for the 48 minutes that the Minister of State took, but I will give way to the Under-Secretary of State before he bashes the Dispatch Box to bits.
Mr. Lewis: I thank the hon. Gentleman, but does he stand by the proposition that separate, Home Office legislation should be used to deal with people with personality disorders? If so, that would be slightly inconsistent with what he said about the Home Secretary simply signing an order in this House.
Tim Loughton: No, because the proposition does not refer to people with a personality disorder—it refers only to people with a dangerous and severe personality disorder, which was the position adopted by the pre-legislative scrutiny committee. It is the position to which I signed up, and the one to which every Labour Member from the Lords and this place who formed the majority in that committee signed up. It remains relevant today, so it is up to the Minister to explain why Labour members of the Public Bill Committee—including those who were members of the pre-legislative scrutiny committee—now appear to have changed their minds.
The Minister of State was happy to trot out figures released by her mental health tsar last week in a report entitled “Mental Health Ten Years On: Progress on Mental Health Care Reform”. The tone was self-congratulatory, but in that litany of statistics there was a heavy dependence on head-count figures. I shall therefore give the right hon. Lady some more statistics.
The Government have admitted that, under the previous Conservative Government, the proportion of NHS spending devoted to mental health was in double figures. We could argue about the exact figure, but it was between 11 and 14 per cent. According to the document released by the Government’s mental health tsar, the proportion has been reduced over the past 10 years to just 8 to 9 per cent. That figure does not refer to in-patient spend, as the Minister claimed: that is total mental health spend, as the figures on page 4 of Lewis Appleby’s document show.
We need to be consistent about those figures. The proportion of funding that has gone to mental health in this country over the past 10 years is lower than it was in the previous 10 years under the last Conservative Government. By the Minister’s logic, therefore, the spending on mental health by the previous Conservative Government must have exceeded that of other European countries by an amount even greater than that achieved by this Government.
Ms Rosie Winterton: The figures can be a little confusing. When we talk about the proportion falling from 14 to 11 per cent., we are talking about the spend in secondary mental health services as a proportion of all secondary NHS spend. Therefore, that figure does not take account of the new services based in primary care trusts.
Tim Loughton:
I do not think that anyone is convinced. The Government can spin and fudge the figures as much as they like, and we may all agree that the spend has gone up by £1.5 billion since the national
service framework was established, but there is no doubt that spending has fallen in percentage terms. That is because mental health has been a lower priority under this Government than it used to be previously. There is no getting away from the fact that the absence of a level playing field can result only in promoting the stigma felt by people involved in mental health in this country.
Other figures counter some of the claims made by Lewis Appleby. Last year’s report from the Sainsbury Centre for Mental Health found that nearly two thirds of mental health trusts had been asked to cut their budgets to cover overspending in other areas of the NHS. Since 1997, the number of NHS beds in the mental illness sector has declined by 6,799—almost one fifth of capacity—yet, as I said earlier, twice as many people have been sectioned in the same period. More people are requiring mental health services. The King’s Fund report showed that vacancy rates for psychiatrists were over 10 per cent., compared with 4 per cent. across other disciplines. It also showed that vacancy rate for mental health nurses was double that for all nurses.
The Rethink reports “A Cut Too Far” and “A Cut Too Far: Six Months On” gave a catalogue of cuts, both planned and potential, worth £67 million. They included proposed cuts of £5 million to older people’s mental health day hospitals and other services in Suffolk. In Westmorland, proposed cuts involve the closure of two mental health wards at Westmorland general hospital. In the South West London and St. George’s mental health trust, which the hon. Member for North Southwark and Bermondsey (Simon Hughes) mentioned, Yew ward has been closed and Bluebell ward, previously women only, is now mixed. The drug addiction ward has been closed and in-patient provision for eating disorders has been closed.
The list goes on and on. Most recently, in Milton Keynes the PCT is to cut £1.4 million from mental health services, including drug and alcohol treatment and a memory screening clinic. Those are rather different figures from the rosy picture that the Minister’s mental health tsar has trotted out. I am sure that she will agree that the National Institute of Mental Health is not partisan. Its report, published in 2005, found that the bed occupancy rate was 100 per cent. on average and in London the average was 107 per cent.; that staff in a quarter of wards had to work unpaid overtime; and that half of wards lack a lead consultant, 13 per cent. have no ward manager, 12 per cent. have no administrative support and three quarters have no housekeeper.
The Mind ward watch survey of 2004 found that 53 per cent. of in-patients said that the ward environment did not help their recovery; 27 per cent. of patients felt unsafe in hospital and 51 per cent. had been verbally or physically abused. The “Count me in” survey, which did not see the light of day for some while, was produced earlier this year. Far from repeating the Government’s assertion—repeated even by the Minister in Committee this morning, remarkably—that 99 per cent. of hospitals were complying with the requirement for no mixed-sex wards, the survey showed that this year 55 per cent. of patients were not in single-sex accommodation.
The situation is getting worse and it is worst of all in mental health hospitals. That is particularly frightening for young people, inappropriately placed in adult wards, in mixed-sex wards. It is a frightening prospect
for a 15 or 16-year-old girl who has undergone a psychotic incident; many have given evidence to people interested in the Mental Health Bill.
The Commission for Healthcare Audit and Inspection and the Department of Health use the same criteria to classify exactly what a mixed-sex ward is, so the Department really must explain how it has come up with such extraordinary figures that are completely out of touch with reality. I could go into detail about the situation for children and young people, which we debated at length in Committee this morning, and the alarming report by the Mental Health Act Commission, relayed by its chairman, Lord Patel, in the House of Lords. The report revealed that between April 2003 and October 2006, no fewer than 1,308 under-18s were detained in adult psychiatric units with no special safeguards—that is one a day. When the commissioners asked ward staff whether there were any plans to transfer the young person or child to more appropriate surroundings within the next seven days, they were told that there were no such plans for nearly three quarters of the children. Those are not short-term emergency measures; such things are happening day in, day out and the situation is getting worse. It is getting worse under the Labour Government, on the Minister’s watch.
Angela Browning (Tiverton and Honiton) (Con): We had a long discussion in Committee about that situation. It is an indictment of any part of the health system, but particularly in the mental health sector, that children and young people are not kept safe.
Tim Loughton: My hon. Friend is entirely right. Such provision is a stipulation of the UN convention on the rights of the child, to which the Minister—I thought—adhered.
When the Minister was giving her figures, she did not mention that the Government have failed to meet their target for a public service agreement for CAMH services in every authority area by December 2006—nor was it mentioned in the mental health tsar’s report. The scandal of age-inappropriate treatment for our vulnerable children and young people should be a source of shame to the Government, not a source of self-congratulation as they trot out headline figures that bear no reality to the alarming and deeply harrowing experiences that many of our young people continue to suffer. Today, the Government, the Minister and her 11 colleagues voted out of the Mental Health Bill assurances that would give some succour, security and hope to those vulnerable young people.
Meg Hillier: Will the hon. Gentleman give way?
Tim Loughton: If the hon. Lady will forgive me, I will not, because I want to allow her and others time to speak later in the debate.
The hon. Member for North Norfolk (Norman Lamb) repeated the figures for the number of people on benefits by reason of a mental health disorder. The number has risen from 732,100 in 1997 to 1,092,910 last year. There has been a 194 per cent. increase in severe stress and an 82 per cent. increase in depressive episodes. Of course Lord Layard’s proposals make sense. They make economic sense, but they also make sense in relation to the health of people who suffer
from depression, who would be able to get back to being viable members of a community and of society, contributing through jobs and taxes.
The Pulse report last year revealed that 93 per cent. of GPs had been forced to prescribe anti-depressants because of long waiting times, against their better medical judgment and against best clinical practice. Three quarters of those GPs were dissatisfied or strongly dissatisfied with their local services for depression. Patients were waiting on average 94 days for assessment and treatment in primary care and 249 days in secondary care, with the worst waiting times, again, for children. At least 50,000 children—some as young as six—are on anti-depressants. What a start in life for those vulnerable individuals. They are being fed powerful chemicals that, in many cases, are not the most appropriate way of treating them. There has been an enormous explosion in drug prescriptions for attention deficit hyperactivity disorder.
When it comes to taking Lord Layard’s experiments and proposals seriously, there is not only a clear economic payback, but there is a clear social and personal health payback. We have had two pilots, in Newham and in the Minister’s city of Doncaster. Perhaps her colleague, the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), can enlighten us as to what will happen to the findings of those pilots and whether there is going to be a full roll-out. My visit to Newham to speak to the staff who are running that excellent project certainly suggested that it had been a great success.
There is also the issue of the disproportionate effect of the lack of mental health care on the black and minority ethnic community. That is another area that we have discussed at length in the Mental Health Bill Committee. It is no surprise that the BME community is perhaps most alarmed of all at the disproportionate effect the Bill’s provisions will have on its members. There is a fear that, given the disproportionate number of people with a mental illness in the BME community, the proposals in the Mental Health Bill and particularly community treatment orders—which I will not prejudge because we have not debated them yet—will drive people away from presenting for services in the first place, and that their condition will therefore fester under the clinical radar, which is the worst of all worlds.
I will not go into great detail about the importance of dealing with mental health problems in the workplace. We have a lot more to do in that respect. Certain examples of good practice among certain companies were mentioned, but the Government have to do a lot more to get the work-life balance right and to achieve an approach to the work force that considers their general well-being, so that people work in partnership with their companies, companies benefit from a healthy work force and the work force benefit from good mental health.
At the last election, my party produced a mental health manifesto. We talked about making mental health a national priority in our health policy and about public health being a key feature of our future Government’s health policy. Mental health is one of the most worrying ticking time bombs when it comes to
the health of our nation, and, not least, the health of our children. We want greater choice for service users in mental health. That choice does not exist in mental health services at the moment. We want urgently to tackle the recruitment crisis, which the Government seem to be in denial over. The figures do not back them up. We want to see an increase in CAMHS beds and we want to place duties on health providers to admit children and young people to age-appropriate facilities. We voted for that in the Mental Health Bill Committee today. We want to see better help for black and ethnic minorities, who face particular difficulties, and we want to have more appropriate services targeted at getting them to present to mental health services in the first place. We want help for carers dealing with mental health issues and we need to address the mental health crisis in our prisons. The Conservative party signed up to all those things at the last election and we will continue to put them at the forefront of our health policy because not doing so would be a false economy.
Conservatives will continue to move mental health up the political agenda. It is important that the Mental Health Bill is not used as a substitute for inadequate mental health services, as the Minister seems to wish to do all too often. There are no grounds for the sort of complacency about which we heard from her in ranting form. I fear that professionals throughout the country, the 80 members of the Mental Health Alliance, service users and voluntary organisations do not agree with the rosy picture that the Minister and the Government paint.
The most vulnerable in our society deserve better. They deserve a better response to this important debate than that given by the Minister. We need a level playing field for mental health, at least to prevent the mental health time bomb from getting worse. We need to do something at last to shift the stigma attached to people with a mental illness. Addressing that fate is still one of the biggest challenges that we face, but I fear that the Government’s complacency has only served to make it bigger.
9.6 pm
Meg Hillier (Hackney, South and Shoreditch) (Lab/Co-op): First, I must tackle some of the comments made by the hon. Member for East Worthing and Shoreham (Tim Loughton). It is frankly an insult for him to suggest that Labour Members are complacent. I, like others, represent a constituency in which there are severe mental health needs. I remind him that under the watch of the previous Conservative Government, it was the first time that more young black men were in prison than in university. Such inequality and the inequalities that we still see in the mental health service started under that Conservative Government. It is disingenuous for the hon. Gentleman to suggest that there are problems that are down to this Government alone. Such an approach does not help to solve the problems that affect many of my constituents and others. Even if there is nit-picking and the issuing of petty press releases as part of the shilly-shallying on the important matter of the Mental Health Bill, I had hoped for an acknowledgment that we have a joint responsibility to tackle some of the problems. We do the people who use mental health services no favours by caricaturing things in such a way.
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