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Mental Health Services (South-west London)
1 pm
Mr. Paul Burstow (Sutton and Cheam) (LD): I am grateful for that brief pause, Sir John. I am pleased to have secured this debate on mental health services in south-west London and to have the opportunity to draw the attention of the House to my concerns and those of several of my hon. Friends who represent south-west London constituencies about the development of services for people with mental health problems. I am also grateful to have this opportunity to ask several questions of the Minister responsible for these matters.
I question the way in which the South West London and St. George's Mental Health NHS Trust has gone about dealing with a series of service and financial difficulties in the past few years. My hon. Friend the Member for Carshalton and Wallington (Tom Brake), who cannot be in the Chamber today, shares my concerns, as do my hon. Friends the Members for Twickenham (Dr. Cable), for Richmond Park (Susan Kramer) and for Kingston and Surbiton (Mr. Davey).
The trust has let down both patients and staff. It has kept them in the dark and has lost their confidence as a result. In February 2004—that is 17 months ago—it was announced that the trust was to receive £30 million in a bail-out to help to cover its massive maintenance backlog. According to research that I carried out at the time, I discovered that the trust, which covers my constituency and five London boroughs, would still require another £43 million worth of repairs to bring it up to standard.
The costs simply to meet basic health and safety regulations stood at more than £500,000, while the cost for repairs to meet fire-safety compliance was almost £1 million. Those figures were known, and every taxpayer in the country has contributed to bailing out the trust from a long period of failure to invest in its building stock.
The maintenance backlog is only the tip of the iceberg. Earlier this year, the trust announced that it faced a deficit of £8.4 million. It also announced that it had agreed a change and recovery plan, which I sometimes believe is a euphemism for cuts, to bring expenditure within budget in the coming year.
The trust is currently consulting informally on its change and recovery plan, some of which has far-reaching implications. It has identified cuts to some services and changes to others in an attempt to balance its books. It would have us believe that the cuts are all part of its plans to modernise services and provide more locally-based care-in-the-community settings, but at the end of the day there is no hiding the fact that cuts are being made.
Mr. Edward Davey (Kingston and Surbiton) (LD): Tolworth hospital in my constituency is an example of that. Its acute day service and therapy team was introduced with much fanfare just over a year ago as an example of modernisation of the service, but it is the first service to be cut under the proposals.
Mr. Burstow : I presume that it was cut on a last-in, first-out basis, which is hardly a good model for
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developing services. My hon. Friend the Member for Twickenham and many of his constituents are concerned that the proposals to close the Maddison centre, which is a day hospital, will have an impact on many vulnerable patients who will be moved elsewhere as a consequence.
The mental health services in my constituency are in a dire state. The community mental health teams are understaffed and overstretched, and the Sutton teams have the highest referral rate and number of non-complex referrals in the trust area. The child and adolescent mental health teams have the equivalent of 11.3 full-time staff against a national service framework recommendation of 37.4. There is an acknowledged lack of talking therapies and advocacy services.
There is still a significant maintenance backlog, and the existing buildings do not meet the requirements of the national services framework or the mental health policy implementation guide. Day services are lacking, especially for younger people, and the services offered pay little attention to diverse ethnic, cultural and religious needs.
Overmedication is still taking place to placate immediate needs, and the lack of vocational support means that people are in fact becoming deskilled instead of receiving the assistance they require to hold on to their jobs or return to work.
Mr. Sadiq Khan (Tooting) (Lab): Does the hon. Gentleman not believe that, instead of investing in bricks and mortar and institutionalising people, there is something to be said for assertive community treatment schemes, early intervention services, home treatment schemes and 24-hour crisis lines? They help to meet the needs of our disparate communities. Some people have needs that being institutionalised, even in a day hospital, does not address.
Mr. Burstow : The hon. Gentleman makes a fair point. My purpose in raising these issues is not just to campaign in favour of bricks and mortar, but to campaign on behalf of those who need these services, regardless of whether they are provided at an institution or in a person's own home. I will return to the role of assertive outreach and similar teams soon.
There are small bands of dedicated staff—in the community and in hospital settings—that are battling on, but they are doing so in a climate of distrust and fear. I have received letters from some of them. Many are too afraid of losing their job to allow me to read out their names, but they are demoralised and they feel downtrodden by their excessive case loads. Members of staff of the acute services are particularly critical of poor health and safety measures. That was proved by the tragic incidents that took place at Springfield hospital, and for which the trust was officially criticised and fined.
Staff are also aware of the many well-paid managerial posts that have been created in the past few years. They are advertised in the specialist press, and some of them pay in excess of £70,000 a year. They cannot reconcile that with the cuts that are being proposed. My hon. Friend the Member for Twickenham has made that point in the House on several occasions in recent months.
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Change is always a difficult process to manage, but the South West London and St. George's Mental Health NHS Trust provides us with a textbook example of how not to manage change. There is lack of direction from the higher tiers of management, and an inability to understand the importance and timing of consultation with staff, the public and, perhaps, elected Members in this House and in local authorities.
That is exemplified by the closure in April of the Chiltern day hospital in Sutton. It almost seems that that was done on a whim; it was certainly done in a rush. One of the arguments put forward was, "Well, it does not matter too much, because we can manage the fact that there are only eight in-patients who will be directly affected by the closure." However, that is still a cut, and a cut to a service that is not easily provided elsewhere. Those eight patients, along with anyone else who may need the service in the future, have been farmed out to other, already stretched, facilities in the local area. There was no consultation about the closure; staff, patients and families were presented with a fait accompli, and the excuse that was given for not being able to consult was that there was so-called election purdah. That is downright disgraceful.
The Department of Health guidance on the general election was published on 5 April. It states:
"As at all other times, NHS staff should not be asked to engage in activities which could give rise to criticism that public resources are being used for party political purposes. In particular, you will want to ensure that there are no grounds for complaint against your organisation that it has behaved partially towards candidates or parties represented in the election during this period."
That is normal and good practice outside of election time as well.
"It would be advisable not to start a consultation now the election has been called unless it can be demonstrated that it would seriously impede NHS business to delay it a few weeks until the election period is complete."
There is nothing in the guidance about not being allowed to consult. It is simply stated that consultations should be delayed until after the election if that is possible. Why did the trust decide that it had to close down the day hospital so quickly? It was not falling down. There were no immediate health and safety issues. Why was not time allowed for proper consultation with patients, families, staff and the public? Why was this decision taken at the same time that the general election took place? It was not as if anyone with a passing interest in politics did not know when the election was likely to be called. It should not be beyond the wit of senior NHS managers to make a planning assumption about the date of a general election.
Mr. Khan : Will the hon. Gentleman give way?
Mr. Burstow : Let me finish the point and I will happily take one more intervention, but I want to ensure that the Minister has ample time to reply.
The general election has become a convenient excuse to hide incompetence and the failure to consult the public about proposals that would have a significant bearing on their quality of life.
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Mr. Khan : May I give the hon. Gentleman another example of plans to close a hospital without consultation, and without the excuse of the election? The trust of Springfield hospital in my constituency intended to close the Cottage day hospital without consultation. Thankfully, as a result of pressure from the hospital's overview and scrutiny committee, the trust will extend the consultation process. I agree with the hon. Gentleman that such closures lead to alarm and distress for hospital users and their families.
Mr. Burstow : I am grateful for that further example of how the trust conducts itself, the attitude that it takes and the value that it attaches to consultation. The trust will have to justify its decision on the Chiltern wing of Sutton hospital. Will the Minister confirm that the guidance issued by the Department just before the general election does not place a veto on consultation and that it does not prevent substantial variations being carried out during an election period? I am told that the local strategic health authority authorised the closure decision without consultation, and I ask the Minister to investigate whether proper advice was sought and whether the guidance was properly followed.
The national director for mental health published a report last December on the progress made since the national services framework for mental health was introduced in 1999. The report highlighted the lack of investment in mental health services throughout the NHS, saying that to a certain extent it was a result of the priority that primary care trusts give to mental health compared with other national targets such as access and waiting times. That is particularly so in my constituency.
The local primary care trust has a commissioning budget for my constituency and the adjacent constituency of my hon. Friend the Member for Carshalton and Wallington of £20 million, yet the newly appointed director for the PCT in Sutton has a budget of only £14.8 million for services to be provided locally. Why is 25 per cent. of the total figure being used to pay for out-of-borough services? It has not been explained, which is unsatisfactory, yet one person in three is likely to need some level of care from mental health services in their lifetime. That means that less than £500 is available to be spent on each person each year.
There is a chronic lack of funding for mental health services, and the mental health trust is to blame for failing to engage with the PCT and for failing to win the case for more resources. If we bear in mind that as many as 30,000 people may need some level of service in my constituency and my neighbouring constituency in the borough of Sutton, the resources are staggeringly low. I shall rehearse some figures to underline the fact.
There are 84 adult in-patient beds in the one specialised acute hospital ward in Sutton. There are only four adult community mental health teams to cope with a current caseload of 1,600 clients and 15 or 16 new referrals a week. There is one assertive outreach team with 150 clients, one crisis and home treatment team with 90 clients, and two resource centres with 180 clients. That just scratches the surface. People who receive a service rely on staff who are overstretched and buildings that do not meet the minimum standards.
The change and recovery plan drawn up by the trust is meant to deal with the emergency; but why should it have come to this? Why should it take a financial crisis
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to get the trust to acknowledge the need to start tackling the serious deficiencies in the service? The proposals are in line with current national thinking, and in many ways I support them. More services will be provided locally in the community, and there will be less reliance on hospital-based services. GPs with special interests and graduate workers will provide a broad range of services. That will be backed up by a network of social care specialists, counselling services and talking therapies, and there will be a stronger role for the voluntary sector, with self help and support groups.
It remains unclear, however, where that new army of specialised GPs, social workers and therapists will be found. Even less clear is where the funds will be found to train and employ them. What about the voluntary sector? Will it receive more funding to increase its capacity? Is anyone talking to the voluntary sector about the services that it provides now, and the role that it will be expected to play in future? The community mental health teams will be reduced from four to three, yet we need more of that sort of service, not less. How does that fit in with a transfer of care from inpatient to community-focused services?
The change plan states that there is a need to access a range of other services that form part of health promotion and ill-health avoidance, including advice on debt management, benefit availability and housing. Yet the plan is to close down the Springfield advice and law centre, which provides such advice to many hundreds of people, and which had over 200 new cases in 2004 alone. Does that really fit in with the promotion of well-being and the prevention of ill health? If people are not given the help that they need to manage their finances, keep their jobs or find new ones, pay for their housing and maintain their independence, the impact on their mental health will surely be considerable.
Providing care in the community and locally based services is far from a cheap option. It needs to be carefully thought through, properly costed and effectively managed. It requires expert training for general practitioners, social workers, therapists and the voluntary sector. It needs a thorough consultation strategy, so that the public, whether they are users of such services or not, understand the strengths of the new proposals and the advantages that they will offer, and have the chance to engage seriously with the development of the ideas at an early stage.
Care in the community and locally based services need to be properly financed, and need time and patience. The many hundreds of members of staff in my constituency who are dedicated to providing first-class mental health services deserve that, as do my constituents, although they are not getting it as a consequence of the process that we have embarked on, which has left them out in the cold. They should not be left in the cold; managers of our mental health services should engage with them fully, and they should be given the chance to shape those services for the future.
I hope that the Minister can respond positively and will take a much closer look at the issues that I have raised. I hope that he can make a careful examination of the role, calibre and quality of the management that has gotten the trust into the position that it is in today.
Mr. Khan rose—
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1.16 pm
The Parliamentary Under-Secretary of State for Health (Mr. Liam Byrne) : I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this Adjournment debate on mental health services in south-west London. I am aware that he takes a keen interest in health issues, both generally and in relation to his constituency; I have signed 30 parliamentary answers in response to his questions this Parliament. I listened closely this morning and appreciate the comments that he has made.
Before I come to a couple of the local issues that the hon. Gentleman mentioned, and particularly the engagement process, I hope that hon. Members will forgive me if I briefly paint a picture of mental health policy and say what the Government are doing to improve mental health services nationally. It is important to highlight that, last year, around 1 million people were unable to work due to mental health problems. Such problems are now the number one reason for claiming incapacity benefit and cost the British economy billions of pounds. Improving mental health services is therefore key in the hon. Gentleman's constituency, as well as nationally, if we are to reduce the number of people who cannot work because of stress.
I assure the hon. Gentleman that mental health is a key priority for the Government. That is demonstrated by the record investment that we have made. In the past five years, since the publication of the national service framework, we have invested over £1 billion more in mental health services. The provision of mental health services in the community is being strengthened. Mental health services have taken great strides to improve access to effective treatment and care; that is evinced by the fact that the suicide rate is at its lowest recorded figure. Current data suggest that we are on track to achieve our public service agreement target by 2010. Significant progress has also been made in reducing in-patient deaths, and in reducing the suicide rate for young men, which was particularly high.
That investment is also getting through to the front line, in the shape of a much-needed boost to the mental health work force. For example, more than 1,500 community gateway workers are working to improve the speed of access to specialised services. In England, some 343 teams are working on crisis resolution, 261 on assertive outreach and 109 on early intervention. Some 17,500 people are now being seen by assertive outreach teams each year.
Getting these specialist teams in place is an important step forward. Their work on the ground, in the community, means that more people will be supported and treated in their own homes rather than admitted to in-patient wards, as in the past. We are in the middle of a substantial reform of mental health services. The new Mental Health Bill is a key part of the plan to improve life for people with mental health problems and to make treatment more focused on their needs. The Bill is the biggest reform of mental health legislation since the 1950s.
It is important to say that mental health is no longer the Cinderella service of the national health service. In the five years since the national service framework was
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published, almost 30 per cent. extra has been invested in mental health. Today the mental health work force are stronger than ever.
I turn to some of the local service issues raised by the hon. Member for Sutton and Cheam. I understand from officials that secondary and specialist mental health care is provided to a population of just more than a million people across five of the six boroughs in south-west London by the South West London and St. George's Mental Health NHS Trust. The trust also provides several national services and employs about 3,000 staff. About 150 clinical teams work from service locations at 50 sites across the five boroughs, and there are some 800 in-patient beds, although 80 per cent. of the work is provided within community mental health teams.
The trust is pursuing an ambitious programme of improvement across all service areas. It is working with PCTs and local health partners. My hon. Friend the Member for Tooting (Mr. Khan) mentioned a different view of how services will be provided in the future, and the trust is now in the business of delivering that.
I was glad to hear that many of the benefits of the Government's policy nationally can now be seen in and around the hon. Gentleman's constituency. For example, three assertive outreach teams provide community care for people with serious and enduring mental health problems seven days a week. Secondly, three crisis and home improvement teams provide a 24-hour crisis telephone line for people with mental health problems and their relatives; that helped something like 500 people in 2004–05.
Thirdly, there are early intervention services to provide comprehensive health and social care for younger people in their first episode of serious mental health problems; that service covers the boroughs of Wandsworth, Merton and Sutton. In 2004–05, about 112 people received early-intervention help and the team has been very successful in promoting social inclusion. On top of that, the trust has recently successfully bid for more than £450,000 of funding from the Department to develop user-led services to provide support for people with personality disorders.
Much of what the hon. Gentleman said could be traced back to a couple of issues. One was engagement, to which I shall turn in a moment, and the other was resources. I know that he will welcome the fact that between 1999 and 2000 and 2003 and 2004 there was an increase in resources of £46 million, an increase in the order of 43 per cent. That has made and will continue to make a substantial difference to people in his constituency.
Mr. Davey : Will the Minister confirm that that increase has been mainly on the revenue side, and that the capital budget for South West London and St. George's Mental Health NHS Trust remains in a pretty parlous state? Although there are options for the trust to manage its estate better, given the financing rules imposed on trusts by the NHS and the trust's lack of capital resources, its managers have a major problem.
Mr. Byrne : I shall address that point during my remarks on the financial recovery plan. If I omit to address his concerns directly, I shall write to the hon. Gentleman on that point.
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I shall give examples of three more services that provide improvements on the ground. First, the £7 million Phoenix unit project at Springfield hospital, Tooting—in my hon. Friend's constituency—is due to open later this year. It is the first part of a major estate-modernisation programme being undertaken by the trust. It will be an 18-bed unit and replace services currently housed in a Victorian building that is more than 160 years old.
Secondly, Springboard is a relaunched and expanded service that opened in March 2005 in new premises at Tolworth hospital. It gives clients across five boroughs access to—
Mr. Davey : I do not want the House to think that that is a new service. It has been going for many years, but had four or five years of total instability as the trust failed to understand where it should be reconfigured and provided. I am afraid that the history of Springboard has been one of failure until very recently, when we went back to good practice from the past.
Mr. Byrne : Precisely. That is why the service has been relaunched and expanded on the back of the new investment that the Government have put in.
Thirdly, in December 2004 a new service, the Kingston and Richmond home treatment team, was launched to provide intensive home-based treatment on a 24-hour, seven-day-a-week basis for people in acute crisis.
In the remaining minutes, I shall try to address a couple of points before I come to financial recovery and engagement. I understand that the decision on the future of the Chiltern day hospital was dealt with in accordance with the procedures for local engagement, and that the trust had a meeting with the local council overview and scrutiny committee on 18 May, and with the primary care trust and the local authority. My officials advise that it was agreed that closure is not a substantial change, and that in a subsequent meeting the OSC formally noted the decision. In line with the NHS plan, the crisis and home treatment teams will now serve the functions recently provided by the facility.
Mr. Burstow : Will the Minister reconsider the chronology relating to the Chiltern wing decision, and confirm the position regarding the guidance given to the NHS during the election? That information is crucial to the decisions and lack of consultation.
Mr. Byrne : I shall certainly look at the guidance given around elections, because I know that many hon. Members are concerned about that.
I shall address the point about the financial recovery plan. I am pleased to note that, with the help of partners, the trust achieved financial balance in the past financial year. I understand that, in 2004–05, the board reviewed the underlying financial deficit, cost pressures and financial risks, and that the need for a programme to generate savings of £8.5 million was identified. Action has been taken to address that. The trust board has approved a financial savings plan structured around seven work streams; income, work force productivity,
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service reconfiguration, overheads and procurement, reduction of surplus estate, management restructuring and risk management.
The trust met the PCTs in April to discuss the financial situation and share views on the way forward as a health economy.
Mr. Burstow : Could I and several of my colleagues from south-west London meet the Minister after today's debate to explore the issue further? We are concerned not about the additional investment, but about how it is being spent and managed.
Mr. Byrne : I shall come to that point in a moment when I talk about the engagement process.
First, I shall conclude my comments on financial recovery. It is for local NHS bodies to work together in south-west London to ensure that they live within their means and plan for long-term financial stability. I know that the hon. Gentleman will recognise that. It is imperative that the current record investment is coupled with reforms to produce a better service.
I come now to the engagement process. The hon. Gentleman has raised several concerns, but I am assured that much is being done to ensure that patients, staff and other key stakeholders are fully engaged in the changes to mental health services locally. Formal consultation is being undertaken in relation to four specialist mental health services, and will run until the end of September. The principle driving the proposed changes to services is that they should be more easily accessible to patients. PCTs are committed to maintaining the same level of mental health funding throughout the process, which is important. The outcome of the consultation will be considered by the joint overview and scrutiny committee in October. If, after that, the hon. Gentleman is still not satisfied that things are being run sensibly, I will happily meet him and colleagues; once that process has been exhausted. I hope that that is of some comfort to him.
The trust must take account of its financial position, and must act to ensure that services are provided clinically and cost-effectively with the resources available. In November and December last year, 12 workshops were held, to which clinicians, managers, carers and service users were invited to consider how the trust might deliver services differently. The options from the workshops were put together in a paper, which culminated in the stakeholder event on 13 January at which the results were presented. Furthermore, a team briefing produced in May, which was circulated to the patient and public involvement forum and local user and carer groups, described the planned changes. The director of quality at the trust has met the chair of the PPIF and representatives of service users on a monthly basis, and has met carer representatives every two months.
Service directors from the trust have been talking formally and informally to commissioners, PCTs, local authorities and partnership boards about changes and progress. The next step is a formal briefing and discussion with partners and stakeholders. Two meetings with the Sutton Mental Health Action Group and the carers development worker have taken place to discuss how the trust can best develop robust structures to involve users and carers in the ongoing development
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and planning of their services. That discussion paper was drafted for consultation and a special meeting is planned for 25 July to progress matters.
Sir John Butterfill (in the Chair): Order. If the hon. Member for Tooting (Mr. Khan) wishes to take part in a short Adjournment debate in future he should first try to clear it with the sponsor, so he may give him some of his time.
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