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I have been speaking for 13 minutes, so I will start to wind up my speech. Being mentally ill is not a punishment. If someone has cancer or heart disease, that is not a punishment, but too often being mentally ill becomes a punishment, and it should not. We should show the same warmth and compassion to people with mental illness as we show to people with any other disease.
It is not going to happen, but if I were Prime Minister this would be my manifesto. We want appropriate, well-resourced community services: the very best services possible, which meet the needs of our constituents, help them to get well, and give them the reassurance they need that the community is ready to embrace them. We need acute beds in modern buildings that promote wellness and recovery. My local trust, Hertfordshire mental health trust, makes no bones about the fact that its acute wards need to be made a lot better. I visited the PICU today, and it is fantastically modern. It aids recovery, and we must ensure that our hospital beds aid recovery.
We need wards that are safe and clean. The mentally ill do not deserve second best. There should be the same focus on cleanliness in mental health wards as there is in any other ward. We also need wards that are age and sex-appropriate. I know that the Minister has personally made enormous strides during his tenure in ensuring that children do not end up on adult mental health wards. Nevertheless, about 400 children a year do end up on adult mental health wards, and as we all know, that number is too high and must be reduced. We also need to ensure that we do not have mixed-sex mental health wards. Again, we need to ensure that patients feel safe and secure.
Finally, we need to ensure that mental health staff are properly rewarded and motivated. I want an NHS that is full of Sally Pegrums. I want an NHS full of people who have given 30-plus years to something that they love. Working with the mentally ill means working in a hugely difficult environment, and it is hugely demanding. Sally has been assaulted verbally and physically on a number of occasions, but she still cares passionately about her patients because she knows that they are ill. We need to reward such people, not just with gratitude but by ensuring that the job allows them to earn a living.
This is not a party political issue. Regardless of which party wins the next general election, mental health must be at the top of the list. It has been at the back of the queue for far too long. Successive Governments have brought it forward, and this Government have done very good things-I do not deny that-but we need to make sure that it remains at the top of the list and pushes to the head of the queue. We face difficult financial times in the years ahead. NHS budgets will come under pressure, but too often the first budget to come under pressure is the mental health budget. In future, it must be the last to come under pressure.
I would like to thank the Royal College of Psychiatrists. I would also like to thank Rethink and Mind for briefing me this evening, and Hertfordshire Viewpoint and the Hertfordshire mental health trust. I thank the Minister, too, with whom I have had a great relationship during his time as Minister with responsibility for mental health. I may not face him across this Chamber again, and in case he does not return to this place after the next election, I would like to say that he has made a fantastic
contribution to the cause of mental health, and I hope that if he leaves this place he will continue to give that area the benefit of his expertise. I thank him for everything he has done.
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The Minister of State, Department of Health (Phil Hope): I congratulate the hon. Member for Broxbourne (Mr. Walker) on securing the debate. I know that he has a very keen interest in this issue, stretching back to the work he did on the Mental Health Bill Committee two years ago. I also thank him very much for his extraordinarily generous remarks. If he were to sit on my side of the House, I would have no doubt he could be an excellent candidate for the highest ministerial office in the land, but we will see how things progress in the years to come; I shall watch his career with interest.
Mental health was once a forgotten service, which was poorly funded, highly reactive and focused on institutionalised care to support only those with the most severe illnesses. There were welcome, if rather flawed, attempts to transfer more mental health services into the community throughout the 1980s and 1990s, but it was the national service framework, established by the Government 10 years ago, that really moved mental health into a different place. It did this by expanding community services and developing a more proactive, preventive and personalised approach to treating people with severe mental illness.
As a result of the framework, and the £2 billion real-terms increase in mental health spending since 2002-there have been nine consecutive years of increased spending-we now have 67 per cent. more consultant psychiatrists, 79 per cent. more clinical psychologists and at least 23 per cent. more mental health nurses than in 1997. Crisis resolution and home treatment teams, and assertive outreach workers and early intervention teams are now helping more people with serious mental illness to manage their condition in the community.
I would also like to place on record my thanks to the carers, whom the hon. Gentleman mentioned in his remarks. The carers strategy, which we published last year, placed extra resources in primary care trust baseline budgets. I have recently met carers' organisations, which are keen to make sure that that money is spent in the community on services such as respite care for those people who are doing such an important and invaluable job in helping to deliver support and care in the community.
The improving access to psychological therapies programme has increased access to talking therapies to more people with lower level mental health needs, again helping to address problems before they escalate. I agree with the hon. Gentleman, and the nurse to whom he referred, that mental health services have changed beyond all recognition. That verdict of improvement has also been reached by the World Health Organisation. It has said that England now has some of the best mental health services in Europe. We want to maintain those high standards and keep mental health services at the forefront of a preventive NHS.
Even with stronger prevention, about one in 10 of those who receive specialist mental health care each year are admitted as in-patients, so the hon. Gentleman is right to say that in-patient facilities remain an important part of the jigsaw of services. He gave an excellent
description of the unit that he visited, and I join him in his comments. The hon. Member for New Forest, East (Dr. Lewis) also described excellent work by staff in these units, which are a key part of the mental health landscape. I am committed to continuing to raise standards and to improving the facilities available for in-patients into the future.
The hon. Member for Broxbourne will know that since 2006 the Government have put £130 million into improving those psychiatric in-patient facilities-these PICUs-and acute in-patient wards. He may be interested to learn-he made a specific reference to this-that about £30 million of that money is being used specifically to improve safety for women in-patients. That sits alongside our broader efforts to eliminate mixed-sex accommodation in these facilities and to ensure that every patient's dignity is fully respected.
I am pleased to say that we know that patients think highly of the care that they receive in these units. Earlier this year, a Care Quality Commission survey of more than 7,000 recent in-patients found that nearly three quarters rated their care as good or better. That is a strong vote of confidence in the quality of acute services, but the question that the hon. Gentleman has really raised before the House tonight has been that of capacity: are there are enough in-patient beds to meet demand? I shall now address that key question.
The essential point is that not everyone needs care in a psychiatric bed, even in an emergency. Admitting someone to hospital when they are in crisis is a decision that nobody takes lightly. As the hon. Gentleman knows, a judgment has to be made on whether hospital admission is the only way to get a person the treatment they need at that moment to avoid the risk of harm to themselves or others. I have indicated, as he has done, that there are now strong alternatives to in-patient care, including community mental health teams, new models of practice, more robust care pathways, and supported accommodation or respite care in ordinary settings. I am pleased, as I am sure he is, that we are reducing demand for in-patient psychiatric care. For example, there were some 118,000 episodes of treatment last year for people who would otherwise have been admitted to hospital.
So although the national picture is one of falling mental health bed numbers, occupancy rates-I heard what the hon. Gentleman had to say about those and I understand the point he is making-have remained steady over several years, which indicates provision against demand is on an even keel. I understand, of course, that in a particular locality these decisions, which are a matter for the local primary care trust and health trust providers, are a matter for local balance and local decision making. The balance between in-patient services, intermediate settings and community services is a matter for local determination. That has to be based on those local health organisations' determinations, on the basis of their consideration of what is needed locally and what units are available locally. We have had a debate in Westminster Hall on the particular issues that the hon. Member for New Forest, East mentioned. I know that he has met his local trust representatives, and that the hon. Member for Broxbourne has done the same, to examine in detail the local situation.
Phil Hope: I am happy to give way, but I do not have that much time available.
Dr. Lewis: I just say to the Minister that Hampshire county council's health overview and scrutiny committee chairman is as alarmed as I am at the proposal to close the PICU and the intermediate beds in the rehabilitation centre. What can the Minister do if that committee, the local Member and the experts all say that the foundation trust is getting it wrong?
Phil Hope: I do not want to repeat the debate that we had in another Adjournment debate on another occasion. The truth is that these PICU beds are assessed on the local needs by the trust and the clinical leaders of that trust. It must be for local determination to achieve the balance between acute beds, community services and intermediate services. The important thing is that there needs to be spare capacity to cater for acute admissions, as and when they arise-that point was made by the hon. Member for Broxbourne.
The truth is that we are simply getting better at treating people effectively in the community. That is what people say they prefer, and what experts say provides better long-term outcomes for them. This is something to celebrate, not criticise-not that I believe that the hon. Gentleman was doing so.
There will always be people who need to be admitted, so we have to arrive at the right blend of community and in-patient services. I want to counter any impression that might be left that the decline in bed numbers, which we welcome, has meant that some patients were being forced out of in-patient units before they were ready. Let me say this straight off: just as admitting someone is subject to very careful scrutiny, so is discharging them back into the community.
Decisions about discharge are always made on clinical grounds, after full discussion with the patient and taking into account any community support that can be offered. So, decisions are not driven by bed numbers or targets; the safety of the patient is the only concern. However, as the hon. Gentleman has said, the debate is a little more complex than in-patient care versus community-based care. There is not such a clear divide. Community services frequently work hand-in-hand with in-patient units to give patients intensive support after their discharge. The introduction of supervised community treatment in the Mental Health Act 2007 gives clinicians added reassurance that if someone disengages from their treatment or from services, or if their condition deteriorates, they can immediately be recalled and treated as an in-patient.
I believe that the hon. Gentleman has not changed his view from what he said two years ago when we discussed the Mental Health Bill. He said that we needed to care about the welfare of people who are mentally ill-he has repeated that this evening- and about alleviating their troubles and ensuring that they are treated in ways that best meet their needs as ill people and as patients. That was an enlightened view two years ago; he has repeated it this evening and I know that he stands by it.
As community services improve and we can offer more support outside the hospital, then the need for in-patient provision will change. It is only right then to review the size and location of that provision and achieve the right balance between in-patient and community services to meet local needs. That is what is happening in many parts of the country. As we have heard, discussions are under way on what may seem on the surface to be difficult, perhaps controversial, decisions. We need to have a sensible debate, as we have had tonight. We do not want to go backwards or to scare people, but we need to talk openly about the issues.
On the question of mental health services in Hertfordshire, we know that the Hertfordshire Partnership NHS Foundation Trust has over the past six months reduced its average bed occupancy by improving its crisis resolution services. I listened carefully to what the hon. Gentleman said about staffing and the demand for such services, and the trust is now working with commissioners to look at other alternatives to in-patient care, including an acute day treatment unit, crisis beds and host family arrangements. It has assured the strategic health authority that pilots will take place before it reduces any bed numbers-in effect, it will "double run" community and in-patient services until it is confident that no patients will lose out from a reduction in bed numbers.
In conclusion, mental health services must continue to evolve and continue to improve if we want to give more people the best chance of recovery. The sun is setting on the national service framework but we can look forward to an even brighter future for mental health services through a new programme of work called "New Horizons". We are considering more than 1,000 consultation responses on our new mental health strategy, which will deepen our commitment to preventing mental illness and to treating people in the home and in the community as much as possible.
10.53 pm
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