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House of Commons

Tuesday 18 June 2002

The House met at half-past Two o'clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Mental Health

1. Mr. Edward Davey (Kingston and Surbiton): What plans he has to implement the proposals in the Wanless report to create a world-class mental health service; and if he will make a statement. [59118]

The Secretary of State for Health (Mr. Alan Milburn): The NHS plan and the national service framework for mental health will, when implemented, go a long way to creating a world-class mental health service, as proposed in the Wanless report. Targets set out in the NHS plan are on schedule to be reached by 2004. Details of our additional investment will be given in due course.

Mr. Davey: I thank the Secretary of State for that answer. In implementing the Wanless proposals for a world-class mental health service, will the right hon. Gentleman ensure that users and carers have a much greater role in setting local priorities and strategies? Has he shared my experience that in many aspects of mental health, including minor and moderate illnesses, users and carers can help to build cost-effective community self-help solutions, if they have resources and support? Will he ensure that the forthcoming mental health Bill places a new statutory duty on NHS trusts dealing with mental health services to involve users and carers far more extensively in the planning of local services?

Mr. Milburn: The general proposition that the hon. Gentleman advances is perfectly reasonable. If we want a service—including a mental health service—that is properly built around the needs of the people who use it, they should have a greater say in how the service is provided. That goes for their carers, too. People caring for those with a mental health problem do a sterling job: without them, the NHS could not do its work.

The hon. Gentleman will have to wait to see the provisions of the forthcoming mental health Bill, but I accept the proposition, which applies equally to mental health services and to the national health service in general.

Liz Blackman (Erewash): Wanless anticipated an increase in the prescribing of anti-psychotic atypicals for

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mental health patients with schizophrenia. May I take this opportunity to congratulate the National Institute for Clinical Excellence on its timely approval of the guidance? Not only will that decision make those drugs more available to patients with schizophrenia and lower the cost of in-patient care but, more important, it will drastically reduce the terrible long-term and irreversible side effects suffered by so many schizophrenia patients currently taking typicals.

Mr. Milburn: NICE's decision has been broadly welcomed, not only within the service but by users and carers. The atypical anti-psychotics are certainly a real step forward, not only for their safety and lack of side effects but for the good that they do. NICE is often in the news for—as it were—the wrong reasons. There is much criticism of NICE, which has a difficult job, but people should stand back and consider what it has done: it has made available more—or more cost-effective—services in the national health service. It has driven up the drugs bill in the health service, but I do not think that is a bad thing if it means that we are getting more cost-effective and more clinically effective treatments to more patients—and, in this case, that is certainly so.

Mr. Robert Key (Salisbury): But we are getting less effective treatment to fewer patients. On 29 April, I wrote to the Minister of State, the hon. Member for Redditch (Jacqui Smith), to point out that the brand new mental health service in Avon and Wiltshire has inherited a £500,000 deficit; that clinical judgment is that GPs cannot provide the necessary service; that the rehabilitation service is under threat; and that there is a six-month wait for an appointment with the alcohol and drug advisory service. The good lady who is the chairman of that trust—a very nice Labour councillor—came to see me in Salisbury to apologise, but why should she take the flak when the resources are not in the service?

Mr. Milburn: I am absolutely delighted to hear that there are such creatures as nice Labour councillors—I bet the hon. Gentleman was even more surprised.

On the overall position with mental health services, of course there are real problems and my hon. Friend the Minister and I are the first to acknowledge them. However, the national health service and mental health services are moving forward; there is more capacity than there was.

The issue for the hon. Gentleman is extremely straightforward, however: if he wants his local health service to expand, he needs to commit more resources to the national health service and agree to do what we have done—to put more money into the national health service over a longer period than has ever been done before. I bet my bottom dollar that the hon. Gentleman was one of those who voted against the extra money for the national health service.

Roger Casale (Wimbledon): As someone whose mother worked in the psychiatric unit at Kingston hospital, I can tell my right hon. Friend that mental health services have increased by leaps and bounds under the present Government. South West London and St. George's mental health NHS trust is a pioneer in the field of care for mentally ill people. It is a centre of excellence

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and an example of the best practice that, with the support, money, investment and reforms that the Government are putting in, can be spread around the country.

Mr. Milburn: I am grateful for my hon. Friend's comments. As I go around the country visiting mental health or other services, I am the first to acknowledge that there are considerable problems. Indeed, it is better to be straight about such things and to say that it will take some time for the problems to be put right. However, what is completely wrong is to say—as the Opposition do—that there is no progress in the national health service. We should be clear about why they say that: they want to run down the national health service. They want to see it fail, whereas we want it to succeed.

Mr. Oliver Heald (North-East Hertfordshire): Is not the task for the Secretary of State to match the rhetoric with action? How can the Government hope to create a world-class mental health service when the experience on the ground is one of service reductions, as my hon. Friend the Member for Salisbury (Mr. Key) says? Will the right hon. Gentleman comment on the fact that the Buckinghamshire Association for Mental Health wrote to me saying that

I received a letter from Manchester about cuts of £820,000 in mental health services. Cuts are planned in Shropshire. In north Cumbria—my Chief Whip gave this letter to me—there is talk of the patients counselling service being under threat. The British Association for Counselling and Psychotherapy said that that was

So why are there service reductions all over the country, despite Ministers talking about money going in and improvements being made? Is not that just another case of Labour not telling the truth about what is happening in this country?

Mr. Milburn: No, it is not; it is a case of the Conservatives running down the national health service. I point out to the hon. Gentleman that almost 500 extra secure beds have been created in the health service and that there are more than 320 extra 24-hour staffed beds and 180 extra assertive outreach teams because of the extra investment in the NHS. Finally, more than 50 crisis resolution teams are available in communities throughout the country, dealing with some of the most vulnerable people in the community, precisely because of the extra investment in the NHS. There is a simple choice for the country: either we continue to invest—as we promise to do not for one year, but for five or six years at record levels—or we do what the Conservatives now propose and cut investment in the NHS.

National Alcohol Strategy

2. Nick Harvey (North Devon): When he expects to publish a national alcohol strategy. [59119]

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The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): The NHS plan makes clear our commitment to implement a strategy to address alcohol misuse by 2004, and we remain on target.

Nick Harvey: I thank the Minister for her reply, but during the four years in which the alcohol strategy has been imminent, the Government have pursued a number of other priorities. Does she accept that, during that time alcohol services on the ground have been visibly disintegrating? Is she aware that, in my constituency, we have one long-term counsellor and two suppliers of specialist accommodation to cover a population of more than 150,000? Does she share my concern that 39,000 admissions annually to accident and emergency departments result from alcohol misuse, that it is causing untold misery in the home through jobs lost and that the Treasury is losing revenue because of those lost jobs? Will she now commit herself to a timetable for the strategy and make absolutely certain that there is no slippage on it? Does she accept that alcohol misuse has been wrongly falling down the list of priorities?

Ms Blears: I think that I made it clear to the hon. Gentleman that we have set out a timetable in the NHS plan to implement the strategy by 2004, and that we are on target to meet that timetable. I certainly do not accept that services are falling apart. Primary care trusts spend about £95 million a year on commissioning alcohol treatment services, but this is not just a matter of treatment services; it is crucially also about prevention, and therefore we have been investing an extra £23 million on substance misuse education in our schools—drugs, alcohol and tobacco—to try to send out the message that it is better to prevent those problems from occurring in the first place. We have also sent out a very effective sensible drinking message to try to prevent some of the binge drinking, which is clearly a problem.

I recognise the fact that accident and emergency departments are caused tremendous problems by people who turn up drunk. That is why we have a zero tolerance policy towards any kind of violence against anyone in the NHS. We encourage prosecutions against people who turn up drunk and assault people in accident and emergency departments. Prison sentences have been imposed recently on people who have behaved in that unacceptable way. Clearly, there is a problem with alcohol misuse in this country, but it is not simply a matter of having strategies; it is about tackling the problem on the ground.

Mr. Kelvin Hopkins (Luton, North): Does my hon. Friend agree that alcohol causes far more damage to people's lives and the economy than illicit drugs and that it is implicated in a wide range of crimes? Will she contact our right hon. Friend the Home Secretary about the impact of alcohol on crime? Does she also agree that a more urgent strategy than she suggests is desirable?

Ms Blears: My hon. Friend is right: it is not a matter of action against drugs or action on alcohol; it is a matter of tackling both issues in our communities and in our society. The Home Office has issued an action plan on alcohol-related crime, and the Department of Health is fully engaged in those issues, too. It is also a question of treatment. About 500 treatment centres in this country concentrate not just on drug treatment but on alcohol

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treatment. A strong case exists for bringing together some of our policies on substance misuse. My hon. Friend makes some extremely constructive points, and I reassure him that the Department of Health takes these issues extremely seriously. That is why we want prevention and treatment, especially in respect of the misuse of alcohol and binge drinking by young people, for whom it has been shown that brief interventions by health professionals can have an impact. We are currently training general practitioners and nurses in those brief interventions to get people out of the cycle of binge drinking—

Mr. Speaker: Order. I think the hon. Gentleman gets the point.

Mr. David Tredinnick (Bosworth): The hon. Lady spoke of the importance of strategies on the ground and gave a long list of policies, but she excluded complementary and alternative medicine, which must surprise the House given the effectiveness of complementary therapies in reducing the problems of those who suffer from alcohol abuse and drugs problems in particular. No doubt she will have received reports of how therapeutic touch and the use of herbal remedies can reduce the time that it takes a heroin addict to come off heroin by about 50 per cent. Many clinics up and down the country now use these different treatments. When will the Government put their weight behind the range of therapies that are available and make sure that they are available not just for middle-class people but for those who are very badly off and who are addicted?

Ms Blears: Question Time would not be the same without an intervention from the hon. Gentleman. I shall not be taking up what was perhaps an offer of therapeutic touch, but I shall consider it in due course.

The hon. Gentleman makes an important point: complementary therapies can be useful for a whole range of conditions, and he has raised these issues on many occasions. He will be aware that work is ongoing in the Department to consider the effectiveness of complementary and alternative therapies to see whether we can provide a wider choice for people, in relation not just to drug and alcohol problems but to a whole range of conditions. It is important that the research is ongoing, and we will have an opportunity later this afternoon to discuss further issues in this area.

Glenda Jackson (Hampstead and Highgate): Despite what the Government have done and are doing through the national alcohol strategy, there is a perceptible belief among those who have to deal with the victims of alcohol abuse, day in and day out, that such abuse is not as high up the list of Government priorities as they would wish. Is more than one Department still engaged in the strategy? Special attention must be given to the increasing problem of teenage alcohol abusers.

Ms Blears: My hon. Friend is absolutely right that the strategy must engage many Departments, because it is not simply about picking up the pieces through long-term health treatment: crucially, it also involves education and the Home Office. I assure her that consultation on the strategy is already under way across the relevant

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Departments. We hope to come up with a strategy that does not simply consider one aspect of the problem but considers it across the community.

There is a particular problem with young people—my hon. Friend will be aware of the chief medical officer's recent report on the increase in liver cirrhosis, especially among young women. We therefore need to direct our education policies in a much more targeted and focused way to make sure that we reach the young people who are increasingly the victims of binge drinking, which, in some cases, is out of control.

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