Tuesday, 16 May 2006
Oral Answers to Questions Health
Mental Health Services
Planned expenditure for mental health services in 2006-07 is still being negotiated as strategic health authorities finalise their local delivery plans. In 2005-06, 11 out of 84 mental health trusts reduced planned expenditure by £16 million overall, while the complete expenditure increased by £368 million.
I thank the Minister for her response. At the last Health questions, she assured me that mental health services were one of her Department's top three priorities, notwithstanding existing NHS deficits. If that is the case, why is mental health not included on the list of the six key national NHS priorities specified in the Department's operational framework and setting out the key principles for financial management for health trusts for this current year? Does she appreciate that the effect of that is that spending on mental health services by health trusts is likely to be frozen or cut this year as a consequence?
We should be clear about the improvements that have taken place in spending on mental health servicesan increase of something like £1.6 billion over the past five years. Also, if we consider what happened last year, again, 11 out of 84 trusts reduced planned expenditure. They were going to spend £384 million more than they spent the year before, but in fact they spent £368 million. That means that overall expenditure on mental health has increased. It is clear, through the targets that have been set and the local delivery plans, that the actions we have adopted contributed towards that increase in mental health spending. Mental health under the previous Administration was a Cinderella service, suffering from years of underinvestment, unlike the situation under this Government.
Berkshire Healthcare Trust faces cuts of £10.2 million in mental health care provision. One area particularly affected by those cuts is early intervention services which, as the Minister knows, are a key Government target in the national strategic framework for mental health. Will she carry out an assessment of the human costs of such cuts?
The hon. Gentleman is right that early intervention teams are important, which is why we introduced them. One of the many changes made under the Government to the delivery of mental health care is the greatly increased emphasis on care in the community. In Berkshire, I believe that the spending figure is about £200,000 less than was going to be spent, so it is not quite the same as what he suggested. I will look into his point, but I understand that the figure is about 0.1 per cent., because the overall budget is £77 million. There have been improvements in his area, and I hope that he welcomes them. I accept the point that he made about early intervention, and I will look at what cuts are proposed for early intervention teams, as I would be concerned about them.
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?
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.
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?
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.
On Friday, the Department of Health produced a press release headed, "End of the 'Prozac nation'more 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?
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. Gentleman's attitude goes against everything in which we have been supported by service users and mental health charities.
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. George's, 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?
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