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Sexual and Mental Health Services (Yorkshire)

Volume 453: debated on Thursday 16 November 2006

Motion made, and Question proposed, That this House do now adjourn.—[Huw Irranca-Davies.]

I am pleased to be able to bring to the attention of the House the subject of sexual and mental heath services in the East Riding of Yorkshire. As hon. Members will be aware, the services are Cinderella services that are too easily ignored in the national health service. They do not carry the political clout of other matters. The Minister will be aware of my work on fighting for community hospitals, which has been backed by many hon. Members. When compared with the situation for sexual and mental health services, it is easier to organise public support for, and demonstrations on, institutions such as community hospitals so that local and national authorities can be persuaded of the need for change. Unfortunately, sexual and mental health services are easier targets for cuts.

On a business-as-usual basis, the new primary care trust for the East Riding of Yorkshire would have been heading for a £20 million deficit this year. A turnaround team had to go in to effect changes. Before that team arrived, Ministers were wont to tell us that any overspending or deficits were due to poor local financial management. When cuts took place, their typical response was, “It’s nothing to do with me, guv.” However, as the Minister will be aware, the accountants who came in to East Riding of Yorkshire PCT—or Yorkshire Wolds and Coast PCT, as it was—found that there had been no financial mismanagement. They found that the PCT had done a good job in trying to steward its resources, but that a combination of centralised targets and the funding that came with them put the PCT in the position in which it found itself.

As our ably managed primary care trust has tried to tackle its existing deficits, it has found—again, thanks to invention by central Government—that £8 million has been top-sliced and removed from the local area. That has had a further impact on the organisation’s financial balance. The situation might become worse in the future because funding often seems to be gerrymandered to Labour areas and taken away from Conservative areas. Given the meetings attended by the chairman of the Labour party involving the famous heat maps, we know that health funding is too often used to address political needs, rather than health needs. The most deprived people in the community that I represent are the ones who pay the price of that twisting away from recognition of real health needs.

Mental health services in the East Riding of Yorkshire are the 13th lowest funded in the country. The mental health trust is a three-star trust that does an excellent job with the resources that it receives, but there has been an historical failure of service provision because of the way in which the trust is funded. That position was worsened further this year by an additional £700,000 cut imposed on mental health services by the PCT because of its financial difficulties.

As the Minister may know, a few days ago The Independent reported that

“Patients in Yorkshire have to wait longer than anywhere else in the country for cognitive behaviour therapy, a treatment proven to help relieve low-level depression and anxiety. For example, Wakefield West PCT has a waiting list of 78 weeks and in East Yorkshire people with mental health problems are faced with a wait of up to 52 weeks.”

That is not acceptable. The work of Lord Layard, whose report helped to bring the need for counselling therapies to the Government’s attention, is being ignored, and people in my area are unable to access the services they need. Dr Foster, the health care information company, has conducted a survey of mental health charities and reports that cash-strapped trusts are diverting funds away from mental health services, and are instead using the money to plug gaps in other services. That story is heard all too frequently.

That brings me to sexual health services in my area. As the Minister will know, the Department for Health announced that £315 million would be allocated to improve sexual health services across the country. All too often, however, that money has not reached the providers of sexual health services. Because of the financial mismanagement occurring throughout Labour’s NHS, the money is being diverted away from sexual health services.

The impact of that is strongly felt, and it is worth acquainting the House and the Minister with the statistics on sexually transmitted infections in Yorkshire and the Humber region. Between 1996 and 2005, there was a 216 per cent. increase in cases of genital chlamydia. Chlamydia is easily cured, but if it is not found by screening, it can lead to infertility and additional expense later, and it creates great misery for those affected. The figures also show an increase of 128 per cent. in cases of gonorrhoea between 1996 and 2005. The incidence of syphilis has increased by 1,650 per cent., albeit from a low base: the number of cases increased from 6 in 1996 to 105 in 2005. To continue the sad recitation, the number of cases of genital herpes has increased from 457 in 1996 to 556 in 2005—a 22 per cent. increase in incidence—and there has been a 28 per cent. increase in the incidence of genital warts in the same period. We have a serious and growing problem of sexually transmitted infections in our local area, yet moneys that the Government have put aside to tackle that problem are failing to reach the front line, despite assurances from Ministers that they would try to ensure that that did not happen.

No doubt the Minister will mention the announcement in the past few days of a new sexual health campaign. That campaign is to be welcomed—indeed, Nick Partridge, chief executive of the Terrence Higgins Trust, did welcome it as a belated effort to raise the profile of such issues. Following that announcement, he said that, of the £315 million,

“£50 million…was for new information campaigns, safer sex campaigns, condom promotion campaigns for young people, for all of those at risk of sexually transmitted infections.”

He went on to say:

“Sadly, only a small part of that £250 million has been spent by local health managers by improving sexual health services, and so far only £3.6 million of that £50 million has been spent on promotion campaigns.”

The Government have failed to deliver the money to the front-line treatment services, and they have failed to launch the promised full-scale campaign to tackle this strong, growing local problem.

Local services are currently being reconfigured, and between January and April next year, six sexual health clinics will close across the East Riding of Yorkshire, so that new, integrated clinics can be created. In its meeting of 12 September, East Riding of Yorkshire council’s overview and scrutiny committee expressed concern about the large distances that many service users would have to travel to integrated clinics. It recognised that some services would be provided in GP surgeries, but said that

“many people may not feel comfortable accessing those services from their GPs and may prefer the anonymity of obtaining service elsewhere. The Committee was also concerned about how the Trust would work with GPs to require them to provide enhanced services as part of their contract.”

As the Minister will be aware, when the GP contract was negotiated, sexual health services were given too low a priority under the points system that rewards GPs, so there is no incentive for them to take a continuing interest in this growing problem, which is a cause of real local concern.

The local primary care trust prepared a report for the board meeting of 28 September this year. Under the heading of finance, there is a short statement that goes to the heart of the failure to increase local sexual health services. It says that the proposals to reconfigure family planning clinics will result in £51,000 in part-year savings in 2006-07, and that £102,000 will be the full-year effect. Rates of sexually transmitted infections are exploding in the area, but the amount being spent by the local primary care trust is being cut, despite Government promises to the contrary. The Minister may hope that, when the director of public health spoke at that board meeting on 28 September, he suggested some reason why the services were not needed, but in fact, he said:

“If we were having a service based on need, and certainly on choice, the service would have to be considerably more extensive”.

The board concurred with that conclusion, but because of the Government’s financial mismanagement of the NHS, services are being cut, instead of increased.

One of the steps that the Government promised to take was to ensure that, by 2008, all patients could have access to a genito-urinary medicine clinic within 48 hours. In January this year, the hon. Member for Milton Keynes, South-West (Dr. Starkey) asked the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), about the likelihood of meeting the target, and the Minister said:

“The target is set for 2008 and we are heading for that.”——[Official Report, 31 January 2006; Vol. 442, c. 150.]

I suppose that that was meant to indicate that the target would be met, but on 13 September, the right hon. Member for Walsall, South (Mr. George) asked the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), about the same issue, and she answered that,

“Overall, the number of attendees at GUM clinics seen within 48 hours in England increased from 45 per cent. in May 2005 to 54 per cent. in May 2006”.—[Official Report, 13 September 2006; Vol. 449, c. 2305W.]

Is the 2008 target still expected to be met, and does the Minister have any idea whether it is likely to be met in east Yorkshire?

I have received many representations from both constituents and professionals, which I should like to share with the House. A young woman e-mailed me to say that she had attended a family planning clinic on a Monday morning at Hessle health centre. The doctor told her that the clinic was due to be cancelled because of a lack of money. She was informed that a clinic would only be open on Monday evening and would serve the surrounding area. She said:

“To me it is absolutely ludicrous that these clinics that are aimed at the young to prevent STDs, unwanted pregnancies and help with advice and free contraception are to be stopped.”

Local members of the British Association for Sexual Health and HIV—BASHH—said:

“If the clients have to travel long distances they may not attend the clinic at all or may access it late with a resultant risk of morbidity to the individual and a risk of onward transmission of sexually transmitted infection, which is a public health issue.”

Another clinician who contacted me said:

“The fact is, we are losing 11 genito-urinary sessions, mostly consultant-led and 5 family planning sessions, all doctor-led, to be replaced by 3 nurse-led…integrated clinics. There will be as yet undefined consultant GU services for complex cases…This is bound to have an impact on access, both geographically and levels of service.”

The problem for my constituents has therefore been recognised by people who work in the field. To emphasise the point, the 2005 report by the director of public health said that

“in less than 4 years the number of cases of HIV in the East Riding has almost doubled…2005 has also seen the first female identified as HIV positive in the East Riding”.

On chlamydia, the report said:

“Local clinics have seen a rise in incidence of more than 200 per cent. between 1995 and 2003.

Sexually transmitted diseases, including HIV, are the greatest infectious disease challenge for the East Riding.”

However, there have been cuts in services.

There is common thread between mental health and sexual health services. The Minister will be familiar with the Institute for Public Policy Research, a Labour-leaning organisation, which said:

“There are compelling reasons to act. Mental health problems have a high human cost in terms of lost opportunities, poorer health and lower life expectancy.”

In the summer, the Sainsbury Centre for Mental Health said:

“It is very worrying that mental health trusts are being squeezed to pay for the overspends of acute trusts using the new Payments by Results system. The NHS exists to bring greater fairness to health care funding and provision. It is essential to maintain that principle so that the needs of mental health service users”—

and, indeed, sexual health service users—

“and their families are not compromised by financial pressures elsewhere in the system.”

There is great concern across the East Riding and in my constituency of Beverley and Holderness, so I hope that the Minister can answer the points that I have put to him this evening and give local people hope that services that are too often regarded as Cinderella services will be subject to improvements, not cuts, and that the Government’s mismanagement of the NHS will not continue to affect some of the most vulnerable people in society.

I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart) on securing this debate on services that, all hon. Members accept, are regarded as Cinderella services. He made some important non-political points, but he must think that the British people are stupid if he expects them to accept his view—voiced by many other Opposition Members, too—of the development of the health service. The health service that we inherited in 1997 was a disgrace: it was underfunded, hospitals and services were crumbling, staff numbers were inadequate, and there was no obvious work force development strategy. Never mind Cinderella services being underfunded—mainstream core services were in a shambolic state.

The Government have invested record amounts in the national health service year on year, and we are close to achieving our aim of reaching the European average for health expenditure in 2008. The Opposition have not even made a commitment to match that funding for the health service in future.

No, I will not.

The economic test proposed by the Leader of the Opposition, which would share the benefits of growth between tax cuts and spending, would result in significant cuts in expenditure on the NHS and other public services. The document that was recently presented, which suggested the level of tax cuts that the Conservative party ought to be advocating, would lead to swingeing cuts in mainstream national health services.

It is no good Members like the hon. Member for Beverley and Holderness giving the impression to their local communities that they have supported the level of additional investment that the Government have put into the national health service so far, or that that level of funding would be continued under a Conservative Government. The hon. Gentleman does not tell his local people that the policy of the Conservative party on health is non-intervention, operational independence and local decision making, yet he and his colleagues suggest in such debates that Ministers like me should intervene on matters such as sexual health and mental health service configuration in his locality. If we adopted the policies of the hon. Gentleman and his party, there would be total operational independence, and decisions made locally would be locally determined.

What annoys me is not that the hon. Gentleman raises legitimate, valid and serious points in the House on behalf of his constituents, but the political disingenuousness, the posturing and the misleading presentation to his constituents of the policies of his party and the implications for the issues that he claims to care about.

I am grateful to the Minister for giving way. Perhaps he could pick up on one particular point. My constituents, and those of other hon. Members throughout the House, know that the investment by the Labour Government has been massive. The Government, to their credit, listened, and they put the money in—but our constituents want to know where it has gone. Under this Government, productivity has fallen. Will the Minister tell us this: has productivity gone up or down? We know where the money has gone: productivity has gone down, hospitals and services are closing.

Order. Perhaps I should remind both the hon. Member for Beverley and Holderness (Mr. Stuart) and the Minister that we are discussing the East Riding of Yorkshire. That is the purpose of this Adjournment debate.

In the East Riding of Yorkshire waiting lists are down, waiting times are down to record low levels and success in treating cancer and heart conditions is up to unprecedented levels. It is our ambition that by 2008 there will be the monumental achievement in the health service of a maximum 18-week wait from the moment a patient visits the GP to the door of the operating theatre. Without targets focusing on matters such as cancer and heart care—this applies to the community in Beverley and Holderness, as to other parts of the country—we would not have achieved much of the progress that has been achieved. The hon. Gentleman implies that the policy of the Opposition is to abolish all targets in the health service. In future, there would be no targets identifying priorities for the use of finite resources. Is it the policy of the Conservative party that there will be no targets in future? That would be a disaster.

The right targets are needed as incentives within the system, but if we had not had the heart and cancer targets, and the waiting list and waiting time targets, and if we did not have our present target of an 18-week wait, we would not have seen many of the performance improvements that have happened in the national health service since 1997.

The hon. Gentleman raised the issue of mental health. When one inherits as a baseline a service that is in such a dreadful state, it takes a significant amount of time to get that Cinderella service fit for purpose. Since 1997, we have 50 per cent. more consultant psychiatrists, 75 per cent. more clinical psychologists, and at least 20 per cent. more mental health nurses. We have more than 700 new mental health teams working in the community—assertive outreach, early intervention and crisis resolution teams. None of them are managers or bureaucrats. All are front-line staff providing mental health services.

The progress that has been made on sexual health is clear. The latest data shows that between 1998 and 2004 the under-18 conception rate fell by 11.1 per cent. and the under-16 rate by 15.2 per cent.—both record low levels since the mid-1980s. We have relatively low HIV prevalence compared with other EU countries—to a significant extent as a result of sustained public education and health promotion campaigns. There has been a large drop in the number of AIDS diagnoses and a 70 per cent. drop in AIDS deaths following the successful uptake of high active antiretroviral therapies since the late 1990s.

On a point of order, Mr. Deputy Speaker. The Minister is absolutely failing to address the situation in the East Riding of Yorkshire.

The content of a ministerial speech, particularly in an Adjournment debate, is not a matter for the Chair. The hon. Gentleman has initiated the debate and the Minister will find his own way of replying to it.

Thank you very much, Mr. Deputy Speaker.

In the East Riding of Yorkshire, the primary care trust is undertaking a significant review of family planning and sexual health services across the region, and it has an explicit and clear intention to replace family planning clinics with locally based sexual health services that it believes will better meet patients’ needs. Its aim is an integrated, locality-based sexual health service, following feedback received from patients that services are complex and sometimes confusing.

Another part of the distortion that goes on in these debates is that any change, reconfiguration or reorganisation of services is described as a cut. The Opposition have been clear about this. They will campaign against any change to services, even if that change is in the clinical best interests of their localities and local communities. If the judgment has been made in the locality that to provide a more integrated and effective service, reorganisation is necessary, the hon. Gentleman should engage in a constructive and positive way with his strategic health authority and the relevant PCT to consider what is genuinely in the best interests of his local community, not come to this House and engage in political posturing.

As I understand it, the hon. Gentleman has met the senior people at his SHA and had a sensible dialogue with them about their intentions. I assume that he would say that their intentions in terms of achieving more integrated and effective sexual health services are, from their perspective, in the interests of the local population, and they are not trying to undermine the services. Yet the hon. Gentleman comes to this House and implies in some way that that reorganisation or reconfiguration is essentially a cut, and that is disingenuous.

Is the hon. Gentleman or his party saying, in the context of this debate, that it is wrong that we are the first Government who have looked the health service in the eye and said that, as in any other organisation in the public or private sector, we will no longer tolerate a situation where budgets are allowed to be out of control, and that it has a duty and responsibility to bring those budgets back within reasonable control. We are the first Government to be brave enough to do that. Historically in the health service, the overspenders have been bailed out by the well-managed underspenders. It is in no one’s interests to allow such a situation to continue. For the first time the Secretary of State has looked the health service in the eye, has not blinked, and has said that it must put its house in order. The minority of health organisations that have not been managed properly and have a long history of overspending are now required to bring their budgets into balance. Surely a party that always claims to believe in good management, enhanced productivity and sensible financial controls should welcome the fact that we are the first Government to have done this.

If the hon. Gentleman is championing the importance of sexual and mental health services, I applaud that; more hon. Members should do so. They are Cinderella services that do not get enough attention or profile. If the hon. Gentleman is willing to engage in a debate about how to improve sexual and mental health services, he will find me a willing partner. But please do not come to the House and make dishonest—[Interruption.] I withdraw the word “dishonest”; he should not make disingenuous political speeches designed to give one impression to his constituents, while we get an entirely different impression if we look at the policies of the Conservative party, of which the hon. Gentleman is one of the most passionate supporters.

Question put and agreed to.

Adjourned accordingly at half-past Six o’clock.