§ 11 am
§ Mr. Andrew Mackay (Bracknell) (Con)
I commence by thanking Mr. Speaker for granting this extremely urgent debate. It is much appreciated by the people of Berkshire, who are deeply concerned about the financial position of the Berkshire Healthcare NHS trust. Secondly, I convey the apologies of my hon. Friend the Member for Maidenhead (Mrs. May), who is at the Children of Courage awards. She would have been here otherwise, because she takes a keen interest in the problem.
I will put a number of points to the Minister and I trust that she will answer them fully. First, which is the most vulnerable group of people in our society? I suggest that it is the mentally ill and those with mental health conditions and problems, closely followed by their carers, who do an outstanding job, and whom we should commend.
Vulnerable people in my constituency and throughout Berkshire are at their wits' end and are deeply distressed. The reason for that is very simple: it was revealed earlier this year that the new mental health trust that was set up for the county in April 2001 had overspent by £11.9 million and that the deficit had to be made good quickly. That means that there will be cuts of £8.1 million this year. My constituents cannot understand why Ministers are telling them every day on radio and television and in the newspapers that more taxpayers' money than ever before is going into the NHS, when there will be cuts of £8.1 million at the sharp end—where trusts are having to deal with mental health and mental illness in Berkshire. The Minister must tell us why we need the cuts if all that extra money is going in.
The trust has come up with one or two ideas as to where the cuts will fall. It has suggested the drugs budget. If it can make large cuts in the drugs budget, that will imply that it was wrongly prescribing over-expensive and unnecessary drugs, which would be a public scandal. However, I suspect that the drugs that people desperately need will no longer be available and will be replaced by cheaper, weaker and less effective substitutes.
We are told that patients who receive treatment out of area will be brought back into area. In principle, I am in favour of that. However, if patients can be brought back into area, will that, too, mean that there has been a scandalous waste of resources and that patients were unnecessarily going out of area? On the other hand, does it mean, as I suspect it does, that many of my constituents will get inferior treatment because it will be cheaper to look after them in area, even where specialties are not properly available? That would be a disgrace.
We are told that there will be a staff freeze. We all know what that means—when people leave, their positions will not be filled. That is fine if there has been unnecessary over-staffing. However, I suspect that the staff are as necessary as they were when the trust was set up and that reducing staffing levels will mean that certain services and care are no longer available in my constituency. That is deeply unsatisfactory.
96WH We need the Minister to say why the huge deficit and overspend occurred in such a short space of time—less than two years. Two reasons, or excuses, have been given. One is that the trust had no idea that the deficit and overspend were rising because accounting and auditing were done nationally, and the computer was not working. We have all heard the excuse about the computer being wrong rather than the people, so I have some doubts about that. However, I want the Minister's comments.
The second reason, or excuse, is more feasible. We are told that the trust was not funded properly when it was formed from entities taken from a lot of other organisations and trusts. We are told that, as a result of creative accounting, those other organisations and trusts kept more assets and income than they should have done and, therefore, that the trust never stood a chance. If that is true, whose fault is it? The answer is that it is the Secretary of State's fault. When the Government start changing trusts and creating new trusts, it is the Secretary of State's duty and responsibility to make sure that they are properly funded and set up and that deficits do not occur. So the Minister must tell us why we are in this situation. We need to know who was responsible and what will be done.
We also need to know what will happen next. It cannot be right that, through no fault of their own, vulnerable people and their carers will suffer for other people's mistakes and incompetence. I will not stand idly by and watch the cuts take place. Nor will the people of Berkshire, huge numbers of whom have signed petitions organised by the mental health voluntary action alliance and others. It is essential that the Minister tell us that the Government will intervene to ensure that the cuts do not take place. At a time when, as I said, more money is going into the NHS from taxpayers than ever before, it is inconceivable that vulnerable people should suffer such cuts in services.
Another concern that the Minister must address is accessibility. She will appreciate that access to mental health facilities, treatment and services is vital. Under strategic health authority proposals, most services will be concentrated at Prospect Park in Reading, which is a long way for my constituents and those who live in Windsor, Maidenhead and Slough to travel. That is most unsatisfactory.
There are also suggestions that vital wards—wards 12 and 14—at Ascot's Heatherwood hospital, which serves most of my constituency, will be reduced or abandoned altogether. Today, we want an undertaking not only that the cuts will be reversed, but that there will be good local access and that the very wrong plan to concentrate all resources at Prospect Park will be turned down. The Minister will have had reports of the huge meeting at the Madjeski stadium in Reading just a month ago. All sorts of stakeholders attended and they rejected the proposals virtually unanimously.
I paint a very bleak picture indeed. The county's Members of Parliament, who represent all three political parties, are broadly united in their disgust at what has happened and they are demanding action. There are some very frightened, vulnerable people who do not know what Christmas and the new year will bring. We are all looking to the Minister for an appropriate response.
97WH In that respect, I should tell the Minister that her colleague, the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton), woefully failed at Health questions recently, when she told me that there was no problem in Berkshire. One can imagine how disgusted the people of Berkshire were when they read the Hansard report of those exchanges. I should also tell the Minister that the written response from the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), failed to address any of the questions that I put to him then or any of those that I am putting to her now. I therefore sought this debate out of desperation.
I intend to sit down two or three minutes early, so that, in the remaining 18 min utes, the Minister has every opportunity to reply in detail to the very serious questions that I have raised.
§ The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)
I congratulate the right hon. Member for Bracknell (Mr. Mackay) on securing this debate. I obviously listened carefully to his concerns about the financial position of the Berkshire Healthcare NHS trust. I should say at the outset that I agree that there are significant challenges ahead and that the local NHS needs to respond to them.
Before I deal with the specific issues raised by the right hon. Gentleman, I want to place in context the circumstances faced by the trust in delivering quality services. I am pleased that he did not criticise the quality of those services, but merely the financial position and the issues arising from it. As he will know, the trust provides secondary mental health care, learning disability and substance misuse services for Berkshire and it serves a population of 900,000.
The trust continues to perform well in meeting mental health targets, particularly in its development of crisis resolution teams, which are working across east and west Berkshire and making a real difference to people. The community services have also extended their working hours, including evenings and weekends, so that patients and their carers can access help and support when they need it.
The right hon. Gentleman opened his remarks by saying that vulnerable people were involved. Nobody would disagree with that, least of all me. He also said that carers were concerned about the situation. I understand that, faced with such financial difficulty, people—particularly such vulnerable people—receiving the services and their families will be concerned. The right hon. Gentleman asked why we are in this situation. He is right that record sums of money are going into the NHS, and the NHS in Berkshire is no exception. In the 2002 Budget, the Chancellor announced the largest sustained increase in funding in any five-year period in the history of the NHS. The plans mean that between 2003–04 and 2007–08 expenditure on the NHS in England will increase, on average, by 7.4 per cent. a year above inflation—a national increase of £34 billion. For the three-year period that I have mentioned, Bracknell Forest primary care trust will receive an increase in its revenue allocation of some £20.8 million-29.52 per cent. I am sure that the right 98WH hon. Gentleman will agree that substantial extra sums are going to the NHS in his area. The issue is not the amount of cash not going into the system. The right hon. Gentleman is right that what we say about money going into the NHS is borne out by the fact of the extra investment.
Our policy is to devolve much of the money to local trusts so that they can buy health care for their populations. Primary care trusts have specific local knowledge and expertise. They are the key drivers for improving health, securing the provision of all health services and integrating health and social care. To reflect that greater responsibility, they now also control 75 per cent. of the total NHS budget.
Before I talk about the general financial position of the trust and what has led to the present circumstances, let me respond to the right hon. Gentleman's comments on drugs budgets. We are not aware of any cuts to drugs budgets. That is not part of the financial recovery plan for the trust.
As to the current position of the trust and the concerns that have been raised, it has already had significant additional resources. Annual expenditure must remain within the resources that have been allocated by Parliament. I am sure that the right hon. Gentleman would not urge on the Government any less discipline than we wish to impose ourselves. It is now the responsibility of strategic health authorities both to deliver overall financial balance for their local health communities and to ensure that each body achieves financial balance. There is a degree of flexibility as to how that is managed locally. Where financial balance cannot be achieved in the current financial year, SHAs can agree to recovery plans that phase the recovery of deficits over a longer period.
Thames Valley SHA has been working closely with Berkshire Healthcare NHS trust since June, and they agreed an outline recovery plan in July. The SHA has also provided interim support for the trust, so that it has more than one year in which to return to financial balance. The trust has made significant efforts to bring its financial position under control, and it needs to continue to do so. I understand from the Thames Valley SHA that the trust is on course to bring down its deficit to around £5 million by the end of March 2004. That is a significant achievement, considering that an overspend of about £11.9 million was projected in June. I cannot disagree with the right hon. Gentleman: the task is challenging. However, I should make it clear that I expect the challenges to be met with a minimum impact on local people. Indeed, both Thames Valley SHA and the trust assure me that, despite the problems, the trust will maintain delivery of safe and secure mental health services and key service targets.
How did the trust come to be in the position that it is in? I can outline some of the key issues for the right hon. Gentleman in that regard. The trust had not signalled any forthcoming financial difficulty, nor, I understand, did any of its papers before the end of the financial year in March 2003 indicate that there were any financial difficulties. It was therefore a surprise when the trust found itself in that position. We could speculate on whether that was appropriate—I would almost certainly share the right hon. Gentleman's view that it was not. I understand that the then director of finance has since left the post.
99WH The deficit appears to have been caused by a number of factors: the move of the learning disability homes to the independent sector, poor financial controls, investment in the modernisation of services such as the assertive outreach and crisis resolution services, the transfer of the management and provision of services for the people of south Oxfordshire to Oxford mental health trust, and the development of improved services through the transfer of services from Fair Mile hospital to Prospect Park hospital.
Faced with the deficit, the SHA has agreed a recovery plan and, broadly speaking, the trust is on target to deliver on it. Obviously the bulk of the deficit will be reclaimed—recovered, as it were—this financial year. The rest will have to be reclaimed in the next financial year. The right hon. Gentleman did not mention the report that PricewaterhouseCoopers issued and I do not know whether he has seen it.
§ Miss Johnson
The right hon. Gentleman shakes his head—I am told that the report is available and was part of the public papers of either the SHA or the trust. Berkshire Healthcare NHS trust commissioned the company to undertake a financial review of the process and procedures in the trust, following the emergence of the deficit. As a result, the recovery plan has been agreed. It is leading to the recovery of the substantial part of the deficit, which is expected by the end of March 2004. That should reassure the right hon. Gentleman that the matter is being taken in hand again.
§ Mr. Mackay
It is all very well to say that the deficit is being reduced. Fair enough, but that is not the problem. The problem is that services have been cut. The only way to make such huge reductions in the deficit is to cut services to the most vulnerable people.
§ Miss Johnson
I have already said that I expect the challenges to be met with the minimum impact on local people. I am afraid that the right hon. Gentleman has not supplied me with any details about the impact that the recovery of the deficit has had on local people, with which I could address the points. If he wishes to write to me or to the Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), we shall look at the points in more detail.
There has been a public consultation on the issue, involving a meeting in Reading on 6 November, to which the right hon. Gentleman referred. Around 120 people attended that meeting, where they looked at the options for the proposed new model of care for people with mental health problems in Berkshire. That was an all-day session; it brought together service users, carers, primary care trusts and local authorities. The work focused on a range of possibilities for a hub-and-spoke model, with local services supported by specialised hospital care. Twelve options, using five criteria, were 100WH considered. The Reading PCT and the Windsor, Ascot and Maidenhead PCTs together, as the lead commissioners for mental health services in the county, are considering the findings of the day to agree the best way forward. Due process of further consultation will be followed, and a full report will also be made to the Thames Valley SHA, which will discuss the options in early January. There is an ongoing process in respect of significant changes—or even more minor ones—to the service configuration.
I shall now discuss the local services in more detail. The main aim of the recovery plan is to bring mental health services even closer to where people live in the community—the hon. Gentleman made the point about the distance of some parts of the county from, for example, Reading. That includes bringing back to Berkshire patients who have been receiving treatment in other parts of the country so that they receive care closer to their families and friends. In response to the financial challenges, the trust is looking more radically at the provision of mental health services locally and how they can be improved.
The trust has developed a vision for local mental health services that will enable the provision of services locally, with a centre of excellence for those needing inpatient care. That model, which was discussed. involved, for example, the possibility of more community support in terms of day care, enhanced crisis services, expansion of community health schemes, closer liaison with accident and emergency, more community rehabilitation, extra support for older people and more day hospital services. That was the type of thing discussed at the meeting on 6 November. All the models were discussed and the comments made are being considered.
There is a lot more work to be done, but hon. Members, including the right hon. Gentleman and the hon. Member for Maidenhead (Mrs. May), can be reassured that work is in hand and that there will be an opportunity for them to express views on behalf of local people as part of that process.
In conclusion, I have taken serious note of the concerns raised by the right hon. Gentleman on this important subject. He and I agree that there are challenges ahead for the Berkshire Healthcare NHS trust. I hope I have reassured him that a lot of extra money has gone into the trust. I expect the health community to respond to the challenges and significant efforts to be made to achieve financial balance. I am sure the right hon. Gentleman will agree with me that that is necessary to achieve sustainable services and to deliver key targets. The Thames Valley SHA and the local health community must continue to support and guide Berkshire Healthcare NHS t rust during this period. I am sure they will welcome the interest, concern and support of their local Members.
§ Sitting suspended until Two o'clock.