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Simon Hughes (North Southwark and Bermondsey) (LD): I am particularly grateful that you have allowed me the opportunity to hold an Adjournment debate on this subject, Mr. Speaker. I am grateful to the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton), for being present. She has worked for the local authority in Southwark and for the Royal College of Nursing and I hope that I will not embarrass her by saying that she is still a Southwark resident when she is in London. I know that she will be concerned and will understand the concern about these issues. I am particularly grateful to the Secretary of State for Culture, Media and Sport for being present. She is one of five local MPs, of whom I am also one. The Minister of State, Department for Constitutional Affairs, the right hon. and learned Member for Camberwell and Peckham (Ms Harman) is another, as is the hon. Member for Vauxhall (Kate Hoey), who sends her apologies. She wished to be here, but cannot be for family reasons. The right hon. Member for Streatham (Keith Hill) is the other. All of us, across the party divide, are concerned about the issues that I have the privilege of raising and have raised them personally with the Secretary of State for Health and the Ministers of State. The Secretary of State for Culture, Media and Sport worked at the Maudsley hospital and therefore has direct experience, as well as constituency-relevant experience, as do we all.
I want to pay tribute to three other groups of people. The first is all the staff who work in mental health services in south London, who do an amazingly courageous and professional job. Without them, many people who are alive today would be neither alive nor as well as they are. The second is all the campaigners who have risen up to take part in the democratic process, perfectly properly and lawfully, wanting to be sure that their voice has been heard. One of them, a friend of mine for many years, is Stan Hardy. He is over 85 and, feeling that this is something that he wanted to do, he has been given a new lease of life. I pay tribute to such people, who could have been sitting in their armchairs but have decided that mental health services are important enough for them to stir themselves. Some are service users, some are families or friends of users and some have never used mental health services.
The third group, which is unusualI do not think that I have paid such a tribute recentlyis the staff of our local paper, the South London Press, which we share with other south London boroughs. Its editor clearly decided that this was an issue that she wanted to put on the agenda. As she told us tonight, at the meeting that we held before we came here, this is an issue that has had an unparalleled response from the public and on which the paper has continued to campaign strongly and determinedly.
I say to the Minister of State that we are here with all that support behind us. As I said to the Secretary of State for Culture, Media and Sport, whom I met just before the debate, I will not be able to do justice to the
case that those groups have made to us because it not only spans the NHS planning system, complicated statistics and a long history, but includes the personal experiences of people who have been very near the edge.
This is about people, not systems, and I want to share with the House two personal reflections that I hope will help. Like any MP who does their job properly I find that many people come to me with mental health issues. Somebody came to see me a few months ago because he had got into terrible debt, and despite all the advice he had received, he had not been able to get out of it and the debts were piling up. He suffered from bipolar dysfunction. In the end, somebody suggested that he came to see his MP. I was able, with the help of the companies concerned, effectively to get rid of his financial problem. Of course, people who suffer from mental illness do not necessarily put it behind them for ever or even for a long time; it can come back again and again. Not long ago, that person presented again, to a doctor in our borough. The doctor could not at that moment deal with him herself, so she sent him to the Maudsley emergency clinic where, she knew, he would get immediate and appropriate treatment. I am here because people such as that man, and people whom we know in our families, our circle of friends and our communities, have terrible struggles with mental illness and we have in our part of London the national flagship service for dealing with mental illness.
It is an odd coincidenceI did not know this until a few days agothat it was 100 years ago this year that Henry Maudsley gave the money to London county council for the land for the Maudsley hospital. The war intervened, and it was not built until after the war. The hospital and, on the adjacent site, the Institute of Psychiatry, are national flagshipsthat is the phrase that has been usedin the treatment of and research into mental illness. My brother worked there for a while and, as I say, the Secretary of State for Culture, Media and Sport worked there. Both institutions have fantastic reputations.
I am here because there is a real concern that at least one, if not two, of the elements of that set of services, the Maudsley emergency clinic and the Felix Post service for the elderly, which includes day care, could be lost when they need not be and when there is not an adequate alternative. I want to make the case for them. I hope that the Minister of State will be able to say to us that they will not, as is planned, close in a matter of weeks but that there will be a reappraisal to take into account the huge number of serious arguments that I, among others, keep hearing from the users, the doctors, the consultants, the nurses, the staff, the unions and many others with an interest. People have been willing to speak out, even though they risked their jobs by doing so, because they feel so strongly about the subject. I hope that the Minister will recognise the importance of what they are saying.
I want to add two or three points to put the matter in context, but I am conscious that this is a short debate. The Minister will know the background figures, but the most recent parliamentary answers show that, in the last year for which we have figures, there were just short
of 200,000 admissions to national health service hospitals in England under mental illness specialties. I asked the Library for the figures, and according to the best estimate that it could give, 250,000a quarter of a millionpeople a year in England and Wales are admitted to hospital because of mental illness. One in four people suffer from mental health problems at some stage in their life, but in Southwark the rates are higher than average, as the Minister knows. The London-wide suicide rate is about five people in 100,000, but the Southwark rate is nearly eight in 100,000.
The Minister may not know this, but I have discovered that, according to all the expert evidence, Southwark and Lambeth have the highest level of psychosis in the country, and probably the world. I am no expert on such mattersI am a laypersonbut people have shown me the evidence and the statistics, and the evidence is not just based on presentation and anecdote. A combination of factors is responsible. They have to do with the urban community, deprivation and poverty, and the introduction of large groups of immigrants over the decades and centuries, some of whom are from communities in which there is a particularly high prevalence of mental illness. It is the combination of those factors in communities such as ours that is responsible. We are here to argue for a service that caters not just for those people, but for people outside Lambeth and Southwark too.
It is not usual to find a 24-hour mental health emergency clinic in this country; in fact, it is unusualit is the exception, not the rule. It is like those other unusual things, the beacons of excellence. The emergency clinic has been here for 50 years, and people from other parts of London and beyond are sometimes pointed in its direction by the police or friends. Homeless people who have heard of it are sent there, by doctors who cannot cope, or by family. The service is a bit like the Samaritans, but with a face. One of my parents has worked for the Samaritans for many years, and they did and do a fantastic job. The Maudsley has a telephone hotline, too, but it also has a dedicated space, open 24 hours a day and 365 days a year, where a person can be seen by doctors and nurses immediately, and where they are safe. It is a refuge. It has a waiting area, but it also has separate rooms, all of which are private and confidential, where people can be seen.
Budget cuts have been forced on the South London and Maudsley NHS Foundation Trust, which is a four-borough trust, including Lambeth, Southwark, Lewisham and Croydon. Some £8 million is to be taken out of the trusts budget by Southwark and Lambeth, and as a result, the financial pressure is on, so the trust has to look for other services to cut. If it were not for that pressure, we might not be holding this debate today. It did not have to decide to cut the mental health service, but as a result of that pressure and other factors, it decided that the service should be cut.
Mr. Andrew Pelling (Croydon, Central) (Con):
I am grateful to the hon. Gentleman for giving way, and will be very brief. I am pleased to support him in this debate because, after all, the Maudsley is a place not only of professional excellence, but of financial excellence, and it is a great shame that we had to turn to the Maudsley
to make reductions. I am keen to support him, because as a result of the financial pressures, there have been the first rumblings about service reductions in Croydon. I applaud him for bringing the issues to the Houses attention.
I will not lecture the Minister on the finances of the health service because although the Govt have greatly improved many parts of the health service, this is not about costs and budgets but about retaining the service. It is not even about the site as much as it is about the service. It is about making sure that there is somewhere to go when one needs it.
I have watched the huge improvement in the home treatment services and I understand that lots of people need someone who gives support during the four, five or six weeks of a crisis. Those involved do a brilliant job. However, there are some people who, in the middle of the night, at the weekend or on a bank holidaywhen at present there is no home treatment servicecannot be dealt with at home. They do not want to stay at home and they need to leave; home is where they are imprisoned and they need to escape.
At that moment, such people will in future be asked to go across the road to Kings College hospitals accident and emergency service. Kings has improved; it is a great hospital. The A & E unit is greatly improved; I was there the other day. But it has already outgrown what it was planned to cater for, and I promise that it could not cope physically with both the physical ailments that come through the door and the mental health ailments.
If someone is coming in on the edge of suicide, terribly deranged, very violent and psychotic, will they be helped by being next to a person coming in from a car smash or a fireman with an axe in his head? Will that help to calm that person? There are only two rooms in Kings A & E with doors, not curtains. Is it appropriate for those people to be looked after literally under the same roof, however brilliant the staff are? If so, is it appropriate for the person to be shown to a corner for mental health patients? Is that not reinforcing the stereotypes that people have about mental health?
The Secretary of State for Culture, Media and Sport, her hon. Friends and mine are arguing that we need a dedicated space and refuge that is always available and that is, as it were, supported by the experts. All the evidence from nurses and doctors is that we cannot assume that we can bring in people who are not on site at the last minute, or that we can contain the violent people and then take them over the road, with security people, to the Maudsley. There are some inappropriate outcomes; on some occasions, people who cannot be treated when they need to be go off and either risk taking their own lives or, equally badly, risk taking the lives of others by their uncontrollable behaviour.
Mr. Brooks Newmark (Braintree) (Con):
I congratulate the hon. Gentleman on securing this very important debate. Having lived in south London for 18 years, I know that this is an issue that he and his constituents are passionate about. However, this is not an isolated instance. North Essex mental health care
trust has lost £4 million, which has been top-sliced. Does he share my concern that the problem with the Government is one of reverse engineering: not putting the patients needs first, but putting finances before the patient?
Simon Hughes: Politicians such as myself, the hon. Gentleman and the Minister are involved, but a lot of the people involved in the issue are not politicians, and people said at the meeting tonight that they had never been involved in party politics before but had been involved in community issues for 50 years. There is no party issue here; it is about how we can come together to take things forward.
The letter from the Secretary of State on 12 January followed the decision by both Lambeth and Southwark councils that this was the wrong road to go down. The scrutiny committees of both councils and the joint council scrutiny committee looked into the matter and said that they wanted the service to be kept. The Members of Parliament have all made that view clear.
The proposal is that there should be a transfer over a matter of weeks, with the Maudsley emergency clinic probably closing by the end of April. The poor manager and his staff who are running it are in a terrible position because they have to do the bidding of their NHS masters, but they know the pressure from the community. The idea is that their work will be picked up by the service over the road, which is not ready and will not be ready for at least a year. Even if the rebuilding took place, it still would not have the facilities.
The Minister may have been in the House last Wednesday when the hon. Member for Vauxhall put a question to the Prime Minister, who said that he would speak to the Secretary of State for Health about the matter. The Secretary of State for Health was in Southwark at another place the other day, and was asked by campaigners in support of the Maudsley whether she would review the issue, and she said she would be happy to reconsider the matter. After the debate I will be happy to let the Minister and the Department have all the representations that I have received from nurses and doctors, the Royal College of Nursing and so on.
I ask the Minister to take back to the Secretary of State a request to stop the clock, so to speak. It is fair to say that the Secretary of State for Culture, Media and Sport, the other Members of Parliament and I ask for a moratoriuma pause while we work out an acceptable way forward with the community, the users, their families, the clinicians and the practitioners.
I end with this proposition: if a mental health service exists to stop people going over the edge, it must have the confidence of the public. If it has the confidence of the public, they will use it. Yes, numbers may go up, but that will be a sign of success because people are using the service. I have been in the House 24 years this month. I have been told that there is no more important subject than this. It is potentially a life and death issue. I know the Minister understands that, and I do not say it as blackmail or to be over-heavy.
I heard on Saturday that I had lost another friend to suicide. I have lost friends in the past, and I have seen family and friends nearly go down that road or suffer badly from depression. We all have that experience.
This is about saving lives, and it cannot be the best politics to press ahead with a decision that does not have the confidence of the community or any of their representatives, when we could have a better solution if we just sought to agree it in a way that gave confidence. I hope the Minister will respond positively, and I hope we can save a 24-hour clinic service on the Maudsley site or nearby to do the fantastic work in the future that it has done for the past 50 years, which has literally been the salvation of hundreds, if not thousands, of people.
The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for North Southwark and Bermondsey (Simon Hughes) on securing the debate. It is clearly a matter of great concern to him and his constituents, as I know it is to my right hon. Friend the Secretary of State for Culture, Media and Sport. I know that both Members have had meetings with the Secretary of State for Health about the matter.
I join the hon. Gentleman in paying tribute to the many people who have worked so hard to make improvements to mental health services. Some have dedicated their lives to that work. I recognise the importance of the community wanting to improve those services, which is clearly an issue in the present case. Too often, mental health services are not considered part of the mainstream. The community is sending an important message that they want to see real improvements and to ensure that the best services are available.
The hon. Gentleman was right to highlight the importance of early intervention services for people who are starting to experience the first symptoms of psychosis. Many such teams have been established across south London. They reduce the risk of people reaching crisis point and having to be admitted to hospital at a later stage. They can often help people to get back into work more quickly, if that is appropriate, and they can generally improve the quality of peoples lives.
A network of home treatment teams has also been established across London. An important part of the reform and modernisation of mental health services is that, if possible, we try to treat people at home who might otherwise be admitted, or who have been admitted but might have had to stay in hospital longer if the home treatment service were not available. We are trying to stop the revolving door syndrome, in which people are discharged from hospital, become unwell and have to be readmitted. That is the general direction of travel, and I am pleased that extra investment has gone into those services, which, together with the dedication and commitment of the staff, have made a real difference.
I would now like to turn to the issue of the closure of the emergency clinic at the Maudsley hospital. As the hon. Gentleman and the Secretary of State for Culture, Media and Sportmy right hon. Friend the Member for Dulwich and West Norwood (Tessa Jowell)know, the Secretary of State for Health made a number of
statements in her reply to the Lambeth and Southwark joint health scrutiny committee about how she wanted the proposals to go forward. She tried to respond to the concerns set out by the committee in its referral letter.
The Secretary of State obviously took views from the local NHS, from Department of Health officials and from the national clinical director for mental health, while acknowledging that the views of stakeholders and others had been put forward by the joint committee. She concluded that the closure of the emergency clinic would be in line with the mental health national service framework and other departmental policy, because it focused on meeting the needs of service users primarily through strengthened community provision and accident and emergency provision. The hon. Gentleman will know that that provision involves 24-hour access to emergency assessment and treatment, and that, as far as possible, there should be proper crisis teams in place.
I should also stress that the Secretary of State agreed with the committee that the other elements of the local mental health crisis system need to be sufficient to meet the needs of mental health service users in the absence of the emergency clinic. Local stakeholders need to be confident that this is the case, particularly in relation to local A and E services, which the committee and other local stakeholders highlighted as a specific concern. It has become absolutely clear that there is a commitment that, when the clinic closes, there will be 24/7 cover across Lambeth and Southwark.
The Secretary of State has welcomed the fact that the local NHS has strengthened its proposals, after the referral by the joint scrutiny committee, to create a designated space at Kings College hospital, adjacent to the A and E unit, which is across the road from the emergency clinic, to provide a safe and segregated area for mental health service users requiring assessment. I also understand that NHS London has agreed to provide capital funding of £6 million to enable the proposed changes to be put in place. In addition, I am informed that the Southwark and Lambeth primary care trusts are going to commission a wide range of mental health and 24-hour crisis mental health services of a high standard. The Secretary of State wants those proposals to be tested and agreed locally through a robust implementation plan, as the hon. Gentleman said, with input from key stakeholders, to ensure a smooth transition following the closure of the emergency clinic.
Simon Hughes: The Minister of State must know, and the Secretary of State must be told, that the plan at the moment is that the emergency clinic will close in a matter of weeks. There cannot be the people, the capital, the revenue or the arrangements over the road to replicateor anything like replicatewhat the emergency clinic currently provides. At the moment, we have a closure planned but absolutely no guarantee of an emergency clinic facility continuing after that, which is simply not acceptable.
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