Charles Walker introduces a House of Commons debate on mental health services in Herts in which he praises the work of the Hertfordshire Partnership NHS Trust and condemns the severe levels of budget cuts being imposed on them. Full text of debate.

5.29 pm

Mr. Charles Walker (Broxbourne) (Con): I am grateful for being granted this opportunity to voice my concerns about the future of mental health services in Hertfordshire. As hon. Members on both sides of the House recognise, mental illness deserves our attention. For too long it has been overlooked and it has suffered in comparison with the more emotive and better understood diseases. However, mental health problems will afflict one in five of our constituents during their lifetime. For many, it will be a passing illness that can be treated and, thankfully, left behind. For others, however, it will be a life sentence both for themselves and their families.

In Hertfordshire, we are lucky to have an excellent mental health trust that does incredible work in supporting people with mental health problems. The Hertfordshire Partnership NHS Trust makes a real difference to the quality of people's lives. However, recent demands for budget cuts are casting a long shadow over the trust and its ability to deliver critical services to the community that it serves.

At the start of this year, the Hertfordshire Partnership NHS Trust was informed that it had to make a year-on-year saving of more than £5 million—a figure that equates to just over 5 per cent. of its annual budget. To put it another way, based on the figures that the Minister gave the House yesterday, it represents 30 per cent. of the total savings being demanded from mental health trusts across the country. The trust was told that the saving was required as part of its contribution to meeting an overspend in the wider Bedfordshire and Hertfordshire health economy. That overspend is estimated to be close to £100 million.

The Hertfordshire Partnership NHS Trust has played no part in creating that deficit. It has lived within its means since its inception in 2001. It has managed its budget efficiently and delivered value for money. Not unreasonably, one might be forgiven for thinking that that is the sort of financial performance that should be rewarded and held up as an example of best practice across the NHS. Instead, the trust is being penalised by a severe budget cut of more than £5 million. What message does that send out to other trusts struggling to balance their books? Penalising them for the debts incurred by their more profligate neighbours will certainly not encourage them to behave in a fiscally prudent fashion.

The scale of the cuts being asked of the Hertfordshire Partnership NHS Trust will have a severe impact on services across the county. In Hertfordshire, we face the following measures: closure of a 22-bed in-patient mental health ward; a reduction in direct-action psychology services; a reduction in day services; closure of the early-intervention psychosis service; reductions in the staffing for community mental health teams; the closure of an acute day treatment unit; staff reductions in mental health in-patient therapies; a reduction in services for people with alcohol and mental health problems; the closure of a day care unit that supports older people with mental health problems and their carers; a reduction in staff working in child and adolescent mental health services; and a reduction in support for people with learning difficulties. In total, those cuts could lead to more than 70 job losses and have an impact on more than 10,000 service users across the county. The services scheduled for cuts are not "nice-to-haves" on the periphery of the trust's offering; they are absolutely critical to many of their users.

In the words of the Hertfordshire Partnership NHS Trust:

"Considerable anxiety is already being expressed across the organisation regarding the impact of the proposed savings targets, particularly from the clinical staff, and the consultant psychiatrists especially. The focus of this anxiety is that there will be an inevitable increase in clinical risk and potential harm, and an overall deterioration in service provision that would reverse the considerable progress made in Mental Health over the years since the closure of large institutions".

Those concerns have been more forcefully raised by David Grayson, chair of the Hertfordshire Partnership Patient and Public Involvement Forum, who has gone on record as saying:

"The implementation of the proposed cuts will increase the suffering of service users and their carers, who will face increased risk of suicide and self-harm, longer recovery time, higher relapse rates and a greater reliance on carers who, due to their role, are already more susceptible to mental health problems."

Viewpoint, a charity dedicated to improving mental health services in Hertfordshire, states:

"The proposed cuts are financially inept. By reducing the provision of community services, psychological services and early interventions, more people will become acutely unwell. This is highly expensive and will actually increase the financial burden on the NHS."

Carers in Hertfordshire has written to say that

"the reduction in services will have an impact on care across the entire community. For unpaid family carers, the outcome will be devastating. With such drastic proposals, many carers could lose essential support and this could lead to a situation where carers reach breaking point."

These are real concerns that are being expressed by organisations dedicated to the welfare of their community. There is already a deep understanding that the proposed cuts will have a significant impact on patients and their families. Furthermore, the consultation paper surrounding the proposals almost entirely fails to recognise the additional burden that the cuts will place on carers. It ignores the possibility that many carers will have to give up work in order to support patients losing day care services.

The cuts proposed for Hertfordshire's mental health services run contrary to the vision recently outlined in the Government consultation document entitled "Investing in Your Mental Health". That blueprint for the future delivery of mental health services makes many useful suggestions. In particular, it highlights the need for more local care and support to be provided through community-based services. Importantly, the White Paper makes it clear that any reduction in acute beds is possible only as a by-product of effective community services rather than as a precursor to their development.

In reality, what we have in Hertfordshire is the worst of both worlds. We are faced with the equivalent loss of 37 beds in St. Albans and Stevenage, with a corresponding cut in the very community-based services that were supposed to replace them. A briefing note circulated by the joint commissioning trusts to Hertfordshire primary care trusts said that

"it is likely that there will be some dismantling of those baseline services which were needed to be in place to achieve the objectives of Investing In Your Mental Health."

That point is picked up by Jonathan Freedman, chair of the Beds and Herts local medical committee, who states that

"the swathes of cuts through the predominantly community-based, mid-tier, support services for patients with mental health problems are completely contradictory to the proposals in the Government's White Paper."

He goes on to say:

"the LMC strongly rejects the degree of cuts listed because they will impact so severely on a particularly vulnerable group of patients who are often in no position to object. The impact on families, carers and children of patients suffering with mental health problems will be immeasurable".

What we face in Hertfordshire is the closure and scaling back of vital services. Inevitably, in cases in which services are retained in a reduced state, the threshold for acceptance will need to increase. As a result, many people will be denied access to hospital beds, and hundreds more service users will no longer be able to receive secondary care from community mental health and drug and alcohol teams. Inevitably, those people will fall back on already stretched GP surgeries.

In my constituency there is no spare capacity for the provision of counselling and support services. Completely separate from the cuts proposed for the Herts partnership trust, our PCT, South East Hertfordshire, is seeking to scale back counselling services provided in GP practices in the south of the borough.

When we look at what is being asked of the Herts partnership trust, it appears that the suggested cuts have been taken in isolation and not as a whole. There is little evidence that the knock-on effects attached to cutting middle-tier community-based support services have been adequately considered. It seems that at every turn these cuts are being driven by accountants not clinicians. In the words of Young Minds, a national charity that focuses on the mental health of children and also has operations in my constituency,

"the cuts proposed will materially affect the mental health and wellbeing of the most vulnerable children and young adults in the short, medium and long-term and will have a detrimental affect on their families and communities."

I fail to understand how the cuts can be justified. How is it possible for someone who is in need of hospital admittance one day to be no longer eligible the next? How can it be less important to help young people tackle psychosis this year than next year? Why has the importance of helping people manage and beat their alcohol addictions suddenly diminished at a time when alcoholism is a growing menace and we have 24-hour drinking in many of our communities?

I urge the Minister to look into the issue that I have raised. I accept that the NHS is not a bottomless financial pit and that tough decisions need to be taken. However, it is simply not right that a well-run and responsible mental health trust is being penalised for the financial difficulties of others. The iniquity of the situation demands attention. I know that the Minister has an extremely difficult job to do—a job that requires her to balance many competing demands. As this Government rightly recognise, however, mental health deserves special attention. Although things have got better, we still live in an age where mental illness is misunderstood and too often feared. The cuts that I have highlighted will further isolate those afflicted by terrible illnesses that can act as life sentences with no remission.

The cuts being put forward in Hertfordshire will penalise young and old alike. Children and adolescents will be denied access to services that can change their life prospects. Those trying to come to terms with catastrophic events in their lives will have nowhere to turn. Many carers will be left without support and hope. People in need of hospital treatment might find the door shut.

Hertfordshire Partnership NHS Trust has delivered above and beyond the call of duty. Its success deserves to be recognised and rewarded.

Mr. Oliver Heald (North-East Hertfordshire) (Con): I apologise to my hon. Friend for not being in the Chamber when he began his remarks, which was a little earlier than I had anticipated. Does he agree that cutting early intervention services, which are vital in tackling severe mental illness, would be a grave mistake and completely against the whole approach that the Government have been setting out in recent years? It is a denial of the modern approach that we want in mental health.

Mr. Walker: I agree totally with my hon. Friend, who is well known in his constituency for championing the plight of those with mental health problems. The cuts proposed in the consultation document are at odds with "Investing in Your Mental Health", and I am sure that the Minister will address that in her comments.

To conclude, I hope that the Minister will feel able to intervene at this late stage to help to ensure that common sense and compassion prevail in this case.

5.41 pm

Mr. Oliver Heald (North-East Hertfordshire) (Con): I apologise to my hon. Friend for not being in the Chamber when he began his remarks, which was a little earlier than I had anticipated. Does he agree that cutting early intervention services, which are vital in tackling severe mental illness, would be a grave mistake and completely against the whole approach that the Government have been setting out in recent years? It is a denial of the modern approach that we want in mental health.

Mr. Walker: I agree totally with my hon. Friend, who is well known in his constituency for championing the plight of those with mental health problems. The cuts proposed in the consultation document are at odds with "Investing in Your Mental Health", and I am sure that the Minister will address that in her comments.

To conclude, I hope that the Minister will feel able to intervene at this late stage to help to ensure that common sense and compassion prevail in this case.

5.41 pm

The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for Broxbourne (Mr. Walker) on securing this debate on the funding and provision of mental health services in Hertfordshire. At the beginning of his speech, he set out clearly the importance of having good mental health services and the wide effect on society, given the number of people who are likely to suffer from mental health problems. I thank him for acknowledging that the Government have recognised that mental health needs special attention. That is why we have made it one of the Department's top three priorities.

I also join the hon. Gentleman in paying tribute to all NHS staff in Hertfordshire, and especially those who have worked in mental health services. We have seen a real step change in the delivery of mental health services in recent years, which has required a real commitment from the NHS staff who deliver those services, many of whom I have met during my time as the Minister with responsibility for mental health services. This is an area in which we need staff to take an open view about some of the changes that have occurred. I have been incredibly impressed by the way in which those changes have taken place and the commitment and hard work of all those who work in our mental health services.

I hope that the hon. Gentleman will also acknowledge that there has been a massive increase in investment in the NHS overall in the past few years, including in his area. For example, his South East Hertfordshire primary care trust has received more than £155 million in the past financial year, which will rise to more than £209 million in 2007–08. Collectively, the eight primary care trusts in Hertfordshire received allocations in excess of £858 million in 2005–06, which will rise to £1.1 billion in 2007–08—an increase of about 28 per cent. 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.

Mr. Walker: I appreciate that the increase is £4.2 million over and above inflation, but Hertfordshire is being asked to save £5.2 million. What has been given with one hand over the past three years is now being taken away, with interest, by the other. That is where a great deal of the concern lies.

Ms Winterton: I will come to some of the specific points that the hon. Gentleman has raised. First, let me put what he has said in the context of some of the changes that have taken place.

There are now some six assertive outreach teams with about 50 staff, compared to 29 staff in 2001. Six crisis assessment and treatment teams operate across Hertfordshire, compared to none in 2001. Those teams saw nearly 2,000 people last year, some 300 of them from the hon. Gentleman's constituency, and 1,200 were new clients. In the past, the vast majority of those patients would have been admitted to an acute mental health unit, but now they can be seen in the community. That kind of approach has reduced the need for in-patient beds.

Members often tell the House that an in-patient ward or unit is closing. Sometimes our response should be "Congratulations", because the closure probably means that people are being served better in the community. I think that that is an important aspect of the changes that have taken place in the delivery of mental health services. I accept, however, that today we are also discussing changes in the way in which early outreach teams may be offered in the future.

Mr. Heald rose—

Ms Winterton: I give way to the hon. Gentleman.

Mr. Heald: I thank the Minister, and apologise again for being late.

It is the question of whether people are treated in the community or in in-patient facilities that is most upsetting to campaigners against the cuts. I received a letter today from all the numerous organisations in Hertfordshire that oppose the cuts. The second point in the letter is as follows:

"The proposed cuts are . . . inept. By reducing the provision of community services, psychological services and early intervention, more people will become acutely unwell."

How can the Minister justify that, given that it involves one of the three priority areas?

Why did the Prime Minister not mention mental health during Prime Minister's Question Time? He mentioned cardiac care. Is this not the problem—that mental health is always the subject that is left out?

Ms Winterton: I believe that our action in putting mental health up there as one of the three priorities is the reason for many of the changes that have taken place. I accept some of what the hon. Gentleman has said—for instance, what he said about the early intervention team—and I shall say more about it later, but I would vigorously defend the record in terms of changes in mental health services, and the increased investment in those services over the past two years.

When I met the chief executive of the trust yesterday, we discussed some of the changes. There have been significant reductions in spending on agency staff, and the trust should be congratulated on that. I believe that in 2003 some £3.1 million was spent per year on agency staff; that was reduced to £524,000 last year, owing to a successful policy of recruitment to vacancies. Over the same period, spending on agency nursing staff was reduced from £2.2 million to £1.1 million. The trust now employs 506 psychiatric nurses—62 per cent. more than in 2001—and 75 consultant psychiatrists, 78 per cent. more than in 2001.

It is also proposed that some £350,000 be invested in a primary care counselling service model—the hon. Gentleman referred to the need for more counselling services. That will offer a range of therapeutic interventions for those with mild to moderate mental health problems. If this model, which is currently out for public consultation, is supported, it is anticipated that it will reduce demands on community mental health teams and referrals to psychiatrists. In addition, the trust has improved work force efficiency by cutting staff turnover.

As I said, there have been some very impressive improvements in the delivery of local services, along with increased investment. But it is true that the health economy in Hertfordshire as a whole faces financial challenges, and that some tough decisions have to be made to address the situation. As the hon. Gentleman said, it is important that organisations get a grip on of the problems that have built up. The task of commissioning mental health services in Hertfordshire falls to the joint commissioning partnership board, which includes representatives from Hertfordshire PCTs and Hertfordshire county council. Each organisation contributes to a pooled budget.

Hertfordshire PCTs have asked all providers in the area to make expenditure savings, and as the hon. Gentleman said, Hertfordshire Partnership NHS Trust has been asked to make a 5 per cent. saving, which is the same as that being asked of all local providers. Decisions on where to ask the trust to make these savings were not taken lightly. At a special meeting of the joint commissioning partnership board on 16 February, it was faced with the very difficult task of considering where such savings could be made. It took a strategic overview of service provision, to ensure that the impact on patient services was kept to a minimum. Having considered the various options, it agreed a proposed list of savings totalling some £3.2millon, in addition to the £1.7 million-worth of internal efficiency savings already being made. Formal consultation on the proposed changes started on 20 March and will run until 3 May. It is important that Members encourage their constituents—as they doubtless will—to engage as fully as possible in the consultation, to ensure that their views are taken into consideration.

The hon. Gentleman set out some of the issues being considered during the consultation period that cause particular difficulties for those affected. However, it is important to recognise that strategic health authorities, trusts and PCTs need to work together to ensure that the whole health economy in a given area gets back on to a stable footing. I know from my conversations with them that NHS staff need to be reassured that the deficits that have built up over years will be sorted out. Uncertainty can affect both patients and staff, and decisions about how to proceed must be made jointly.

The local NHS trust is currently discussing the proposed service changes with staff, and I know that every effort will be made to avoid redundancies. If necessary, and where possible, staff will be redeployed to different teams. Although it is proposed that the St. Julian ward should close—as I understand it achieving savings of some £1.4 million, of which £400,000 will be reinvested in community services—I emphasise that the changes already introduced mean that more people are treated in the community, with the result that they receive attention earlier and do not have to go into patient care.

Mike Penning (Hemel Hempstead) (Con): The St. Julian ward is the only one in that part of Hertfordshire offering respite to carers whose loved ones are desperately ill. Will the Minister therefore ensure that the consultation process considers its proposed closure very carefully?

Ms Winterton: I assure the hon. Gentleman that the trust will be made aware of this debate, but I hope that he, and the other Opposition Members present, will agree that it is right for the local NHS to get back on an even keel. The proposed changes are subject to consultation: although difficult decisions will have to be taken, I assure the House that every effort is being made to ensure that there is only minimum disruption to services and to jobs.

As I have said, the work of the local NHS trust has been extremely impressive. These are difficult decisions, but I repeat that I have been assured that any disruption to services will be kept to a minimum, and that some of the savings will be reinvested in alternative provision.I understand how strongly some hon. Members feel about this matter, and hope that my remarks have helped to reassure them.

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