5.45 pm
The Parliamentary Under-Secretary of State for Defence (Mr Andrew Robathan):
Let me add my condolences to those that have been expressed in relation to all our service personnel who have been killed in Afghanistan. It would have been strange if we had not all shed a tear
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at some stage for those who have come back from that country in coffins. Let me also mention, in particular, the Red Arrows pilot who was killed in a tragic accident earlier this week.
This is a fitting day for our debate, and, just in case anyone thought that the timing was a coincidence, let me make it clear that it was not. Over the next few days, ceremonies will take place and wreaths will be laid throughout the nation to commemorate local sacrifices and local heroes. I am sure that every Member in the Chamber will be taking part in them. In Afghanistan, services will be held to remember not only the many who have given their lives in past, but friends and colleagues whose memory is very fresh and very real.
Several Members, including my hon. Friend the Member for Colchester (Bob Russell), mentioned the appalling desecration of war memorials. One can hardly believe that it takes place, and it reflects very sadly on those responsible. I have my own views on what punishment they should receive, but all I ask is that an exemplary punishment be imposed when some of them are caught, for reasons that we all understand. That is not Government policy; it is only my own opinion.
I am sure the whole House agrees that the nation’s true feelings towards the armed forces, particularly the fallen, have been demonstrated spontaneously over the last few years by the people of Royal Wootton Bassett, and, now, outside Brize Norton. It is about honouring the debt to the fallen.
I believe that 25 Members spoke in the debate. I shall respond to some of them as quickly as I can, and I hope the House will forgive me if I do not take interventions.
I agree with the hon. Member for North Durham (Mr Jones) about a great many things, but I thought that the tone of his speech was churlish, if I may quote my hon. Friend the Member for Colchester. The record will show that it was depressingly partisan and carping, and self-congratulatory at the same time.
The hon. Gentleman mentioned pensions and the change from RPI to CPI. I declare an interest: I am in receipt of a military pension. The hon. Gentleman knows that public sector pensions must be sustainable. The public sector pension time bomb has featured in the newspapers and other media for well over a decade, and it is incumbent on Governments to make difficult decisions. The previous Government ignored the time bomb, but this Government are dealing with it. In Greece and elsewhere in the eurozone, untrammelled Government spending and debt are leading to huge problems. It is no good the hon. Gentleman’s shaking his head; I am afraid that that is what is happening.
Many Members raised the issue of the chief coroner, and I understand why people become concerned about it. It is incredibly important for coroners to be properly trained, and we are taking steps to ensure that they are. We are looking at ways in which we can improve the position still further. That is, of course, the responsibility of the Ministry of Justice. The question is, do we want box-ticking or do we want results? The answer is that we want results.
In my view, the campaign on this issue has been somewhat depressingly overstated. According to a document
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that I have here, recent ComRes polls clearly support the case for a chief coroner. Sixty-six per cent. of people questioned
“believe that a Chief Coroner is needed to ensure that coroners treat bereaved Armed Forces families sensitively.”
The poll was taken in September, before it really got going, and I suggest that 95% of people on the streets of our constituencies had never heard of the issue before that. What is important is the results of inquests and the good treatment of people at them, and we will get that right.
The hon. Gentleman told us a mere seven times that he had been a Minister, yet he took no responsibility for the dreadful state of affairs that we inherited in the MOD. There was a £38 billion black hole. [Interruption.] There most certainly was. Much as he may carp about the painful decisions taken in the strategic defence and security review, he must also answer for his responsibility as a member of the previous Government.
My right hon. Friend the Member for North East Hampshire (Mr Arbuthnot), the Chairman of the Select Committee, brought us back to a more balanced view of life. He made a very sensible and thoughtful contribution, and I especially agree with him about wearing poppies.
The hon. Member for Merthyr Tydfil and Rhymney (Mr Havard) also made a thoughtful speech, in which he rightly emphasised the legal and moral complexities of armed forces’ international work, as well as the practical issues of support and equipment. I thank him for that.
I thank my hon. Friend the Member for Canterbury (Mr Brazier) for his work on Future Reserves 2020, and I agree with him about young Territorial Army officers. I am looking into the security issues involving 7 Rifles officers, but I understand the people concerned had left several years earlier. We should be pragmatic and sensible on this issue, however. Since I first entered the House a depressingly long time ago, my hon. Friend has been a consistent champion of the reserves.
The hon. Member for Bridgend (Mrs Moon) reminded us of the whole nation’s role and responsibilities in respect of the defence of the nation. She also reminded us of the excellent performance in Libya of the RAF, the Navy and, indeed, some soldiers. I thank my hon. and gallant Friend the Member for South West Wiltshire (Dr Murrison) for his excellent work on prosthetics and mental health, and I look forward to hearing more from him about world war one, and to working with him on plans for world war one commemorations.
The hon. and gallant Member for Barnsley Central (Dan Jarvis) is no longer present, but he drew our attention to remembrance and to our responsibility in this place to the armed forces, and especially to bereaved families. I agree with him on that.
My hon. and gallant Friend the Member for Beckenham (Bob Stewart) is also not present. He said there were 15 three-star generals, and I may not at the time have responded accurately; I said there were not that many, but I may have given the wrong number. There are, in fact, eight three-star generals in the Army at present. He made a valuable point about the fitness of reservists—and I know he will be leading by example on that.
The hon. Member for Clwyd South (Susan Elan Jones) paid tribute to James Eastwood and his parents, and I agree. Everyone who serves in Afghanistan deserves
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proper treatment, although I am not sure that a chief coroner would improve the service received by bereaved families. We are certainly concerned about anybody who is homeless, including ex-service personnel. It was said that 25% of homeless people are ex-service personnel. I think that would have been an exaggeration even 10 or 15 years ago. The proportion now is approximately 3% or 4%.
My hon. and gallant Friend the Member for Milton Keynes North (Mark Lancaster) made an important point about fragile states and concerns about Ministry of Defence and Department for International Development involvement. I will look into the issue of the 217 Field Squadron (EOD) reserve, and I will be happy to speak to him about it.
The hon. Member for Bethnal Green and Bow (Rushanara Ali) reminded us of the sacrifice east enders made in the second world war, and we agree entirely about vandalism to war memorials.
My hon. Friend the Member for Poole (Mr Syms) mentioned the constant need to maintain, refurbish and upgrade housing. All of us who own houses know about that, so I agree, but that is particularly difficult and the previous Government found it difficult and worked hard on it as well.
I am glad to see that the hon. Member for Walthamstow (Stella Creasy) has taken a break from tweeting or twittering—or whatever the Prime Minister called it. She raised an important point about debt. I had not heard of QuickQuid and the targeting of service personnel, but we are not complacent and I have asked questions about this already. This specific point has never been raised with me, however, and I will look into it further. She was talking in particular about those who have left the services being targeted. All personnel get financial planning as part of their phase 1 training. That will include advice on not taking on a loan at ridiculous interest rates—I agree with her about that. Furthermore, we put particular emphasis on resettlement training, including for those early service leavers. I have never heard of payday loans, but I will look into the matter.
My hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile), who is a champion for his constituency and for the Royal Marines, concentrated on mental health issues, raising very real problems. I walk on eggshells when discussing mental health issues, because the subject is very difficult, but we and the armed forces are very concerned about it. Again, I refer him to the “Fighting Fit” report produced by my hon. Friend the Member for South West Wiltshire and to the work we do with Combat Stress.
I was interested to hear from the hon. Member for Islwyn (Chris Evans) about the standard in St Mary’s church in Risca, because I believe that the reredos behind the altar is in fact a memorial to my great grandfather, but I will check it out. He referred to some lawyers as “bloodsuckers”—his term, not mine. All I would say is that those who served in the 1950s, when of course there was national service, deserve our respect. They were doing their duty when they were at the nuclear tests. We do study these things and, in fact, if someone was in the forces, including in that cohort who witnessed the nuclear tests, they are less likely to be dead by now—their mortality rate is lower—than those who were civilians at the time. So we need always to work on the basis of facts rather than emotion on this.
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Those people who have suffered or think that they have suffered as a result of their service watching the nuclear tests have been given war pensions, because the balance of probability means that it is very much on the Ministry of Defence to prove that we were not responsible.
My hon. Friend the Member for Colchester stood up for the armed forces, as always, and I would like to thank him for his great contributions to the debates on the armed forces and on the Armed Forces Bill. I say to him that mouldy carpets are absolutely not acceptable and I thought he was a very brave Liberal Democrat to quote from the Daily Mail.
The hon. Member for Strangford (Jim Shannon) said that people in Northern Ireland have every right to be proud of their contribution to the UK’s armed forces, and I agree entirely. I was discussing that contribution only yesterday with Edwin Poots, the Health Minister in the Northern Ireland Executive, and we also talked about the Camp Bastion medical facilities, to which the hon. Gentleman referred. I look forward to hearing his next contribution in Welsh.
I will need to come back to my hon. Friend the Member for South East Cornwall (Sheryll Murray) on search and rescue, but she did ask an interesting question about manning discrepancies between RAF and Royal Navy helicopters. I am told that they are not that large, but we can see. I have been to the Naval Families Federation in Portsmouth, and she is absolutely right to say that the harmony arrangements in the Royal Navy are extremely difficult. I am sorry about the redundancy announcements. They are actually chosen not by Ministers, but by the armed forces and single services. However, she made a very good point about timings. All redundancies are painful, and that is certainly the case when they are compulsory.
The hon. Member for Halton (Derek Twigg), to whom I pay tribute for his work as veterans Minister, was right about the situation in 1919. We have moved on, for a number of reasons, but I am old enough to remember the stories about ex-servicemen with one leg selling matchsticks on the corner. We have gone a long way beyond that, and rightly so, but we must go further still. He referred to the bravery and sacrifice of our armed forces in Afghanistan and the need for success there, and I am entirely with him on that.
I wish to thank my hon. Friend the Member for Bournemouth East (Mr Ellwood) for his work as a Parliamentary Private Secretary in the MOD and I am delighted to see that he has a new job in the Foreign and Commonwealth Office. [Interruption.] He has got another job, so the hon. Member for North Durham should not worry. My hon. Friend made my speech for me on both our policies and the early failings of the Afghanistan campaign.
I wish to thank my hon. Friend the Member for Tamworth (Christopher Pincher) for his work on the Armed Forces Bill. I agree with him about the serious housing issues, on which we will continue our work. We have a group, involving the Housing Minister, that discusses the difficulties that service personnel face in buying houses.
My hon. Friend the Member for Salisbury (John Glen) raised the important issue of wills. I recently met a young lady who made some sensible suggestions on this subject. Her fiancé was killed in Afghanistan and
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she has had the most terrible time. We are looking at this, but we cannot compel people to make wills. We are including a software check-box that people must tick if they have not completed a will. I will certainly talk to my hon. Friend further about this issue; I am very happy to meet him to discuss it.
My hon. Friend the Member for Portsmouth North (Penny Mordaunt) talked about naval redundancies, which are painful. Community covenants, which we introduced, allow local government organisations to take proper note of service families. I agree that reservists want to deploy and about the need for education. That is why I commend the armed forces parliamentary scheme for the work it has done for so many people.
Our soldiers, sailors and airmen are good people and they deserve our respect. We have had to take some very difficult decisions in the light of the dreadful state of the defence programme that we inherited. That is a matter of regret, but I am proud of what we have achieved in the past 18 months. Tomorrow—
6 pm
Motion lapsed (Standing Order No. 9(3)).
Alison Seabeck (Plymouth, Moor View) (Lab): On a point of order, Mr Deputy Speaker. The Government statement today on Project Avanti, which is about Army restructuring, is very interesting, and is made all the more so because it appeared in an American defence magazine on 7 November. It is important that we understand why the American defence community knew about the statement in quite a lot of detail, including naming names, three days before the House did. Will the Secretary of State for Defence, when he is available, come to the House to give an explanation or, at the very least, instigate an investigation within the Department into how that happened?
The Parliamentary Under-Secretary of State for Defence (Mr Andrew Robathan):
Further to that point of order,
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Mr Deputy Speaker. I was not aware of that. I will most certainly ensure that it is looked into very closely and I will let the hon. Lady know.
Mr Deputy Speaker (Mr Nigel Evans): I hope that has clarified the point of order. The Speaker has let it be known on several occasions that when Government announcements are made, they should be made to the House first.
petition
Dartford Crossing
6.1 pm
Jackie Doyle-Price (Thurrock) (Con): I am pleased to present a petition on the subject of the Dartford crossing on behalf of my constituents in Thurrock. The petition has been prompted by the Government’s announcement that they intend to increase tolls at the Dartford crossing and to make proposals for an additional crossing in the lower Thames, the three options under consideration all passing through the constituency of Thurrock. Some 2,000 signatures have been collected on this petition and similar ones run by the Thurrock Gazette and by the community forums in Bulphan, Orsett and Chadwell St Mary.
The Petition of residents of Thurrock and others,
Declares that the Petitioners are opposed to any increase in the tolls charged for the Dartford Crossing and any option for a new Thames crossing in the south Thames area, which the Petitioners believe would involve the building of new roads in Thurrock and increased congestion on Thurrock’s already crowded road network.
The Petitioners therefore request that the House of Commons urges the Department for Transport to reduce tolls on the Dartford Crossing and to reconsider proposals for a new Thames crossing in the lower Thames area.
And the Petitioners remain, etc.
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Woodhaven Hospital
Motion made, and Question proposed, That this House do now adjourn.—(James Duddridge.)
6.2 pm
Dr Julian Lewis (New Forest East) (Con): I am particularly pleased to see the Minister on the Front Bench tonight. I know of his care and compassion on the topic of mental health.
Woodhaven hospital is a state-of-the-art mental health unit set in a therapeutic, semi-rural but easily accessible location in my constituency. Its acute Winsor ward has, unusually, en suite facilities for all 24 in-patients and other top-of-the-range features. It was a proud and happy moment for me when I cut the ribbon to open the new hospital just eight short years ago. Now, to the immense distress of service users and their carers, Woodhaven is threatened with closure.
Currently, 165 acute in-patient mental health beds are available to the Southern Health NHS Foundation Trust. They are in six units throughout Hampshire, as follows: 50 beds at Antelope House in Southampton, 25 each for men and for women; 20 beds at Elmleigh in East Hampshire, 10 each for men and for women; 24 beds at The Meadows in Fareham, 10 each for men and for women and four more, known as flexible beds, which can be used for either; 23 beds at Melbury Lodge in Winchester, 13 for men and 10 for women; 24 beds at Parklands in Basingstoke, seven for men and 16 for women, plus one flexible bed; and finally, the 24 beds at Woodhaven in my New Forest East constituency, 10 each for men and for women, plus four flexible beds.
The foundation trust proposes to close Woodhaven, which is virtually brand new, and The Meadows, which is also quite modern. That would reduce the total available beds in the region from 165 to 117. However, of the 50 beds at Antelope House that have been available for acute cases up to the present, 10 are to be allocated to long-term, challenging in-patients, effectively reducing the total number of acute in-patient beds that will be available in future to only 107. The foundation trust has suggested that some of the future occupants of the 10 beds might come from other acute beds out of the 165 total, but it seems much more likely that the 10 beds at Antelope House will be allocated to residents from Abbotts Lodge, a different kind of unit that is not included in the 165-bed total and will be shut. For that reason, the real reduction in available acute in-patient beds will be from 165 to only 107.
Those 107 acute beds will contain two distinct categories of in-patient: those who are voluntary and those who have been detained. On what I believe to have been a typical day in mid-October, and on a similar day this month, when 153 beds were in use across the whole trust area, no fewer than 88 were occupied by in-patients detained under the Mental Health Act. That constitutes 53%—just over half—of the existing 165 available acute beds. With only 107 beds available in future, that 53% figure will rise to approximately 82%. Conversely, the proportion for voluntary in-patients who are acutely mentally ill will fall from about 47% to just 18%. In practice, there will be only about 19 beds left for the whole of the trust area in Hampshire for acutely mentally ill people who voluntarily go into hospital.
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That will have a huge and negative effect on patient choice. There will be little chance of choosing or obtaining an acute in-patient bed, as four fifths of them will be occupied by people who have had to be detained because they will not voluntarily agree to admission. Indeed, someone who desperately wants an in-patient bed would be well advised to create sufficient mayhem in order to be sectioned, if they are to have a reasonable chance of gaining admission. Once admitted, the voluntary in-patients will find that the effect of the greatly increased preponderance of detained in-patients in each of the four remaining units in Hampshire will be to make their wards significantly less therapeutic. Should the trust be thinking of such a huge reduction in bed totals at all?
I should say at this point that there is no fundamental philosophical disagreement between me and the representatives of the district and county councils on the one hand, and the management of the trust on the other. The trust’s spokesmen consistently agree that some acute in-patient beds will always be needed. For our part, my colleagues and I have no doubt of the value of strong community, assertive outreach, crisis resolution and early intervention services at home.
The key question that must be resolved—I hope that it will be resolved as a result of this debate—is simply what is the correct number of acute in-patient beds in Hampshire. Naturally, the trust maintains that by investing in extra services at home some people will be prevented from deteriorating to the point where they need to occupy acute in-patient beds, but I believe that stripping out more than one third of the existing beds, as the trust proposes, cannot possibly be justified.
Of course, the trust ought to make efficiency savings. It states that closing two out of six acute in-patient units in the area will save £4.4 million, £1.5 million of which is intended to be invested in what was previously described as a “virtual ward” but is now more sensibly described as a “hospital-at-home” service. The remaining £2.9 million is, of course, an easy way to make a significant annual saving, but it is not an efficient way, especially when one considers that, according to an Audit Commission survey, Hampshire already has the highest number of staff per 1,000 of the population in community mental health teams out of 46 trusts examined. Cutting front-line services and making efficiency savings are two very different things.
Twenty-six acute beds per 100,000 people is the current average among the 46 mental health trusts surveyed. The Southern Health NHS Foundation Trust has 28 beds per 100,000 and expects that figure to go down to 21 if the two units, including Woodhaven hospital, are closed. I believe that the actual total would be just under 20 beds per 100,000 people. At the moment, with 28 beds, we are in the top 19 of the 46 trusts. Whether we go down to 21 acute beds per 100,000 or to just 20, we shall be in the bottom six, and that is an immense gamble to take with the welfare of people who, almost by definition, are at risk of losing their lives.
Every day, the trust files a record of how many beds were vacant out of the total of 165, and at my request it has provided a print-out for the past three months. This shows, beyond any doubt, that bed occupancy levels are consistently high. Let us remember that we are considering 165 beds, spread over almost all of Hampshire and serving hundreds of thousands of people. The trust’s tables give a breakdown of the numbers of male and
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female beds vacant each day, and the numbers of so-called “leave” beds temporarily empty. Leave beds are those that have already been allocated to in-patients, but that are not being used for short periods, because their occupants are spending typically one, two or three nights at home. Even when leave beds are counted together with genuinely vacant beds, the total number of empty beds throughout the area is low—often, indeed, in single figures. Thus, from 21 September to 6 October this year, the overall daily totals were respectively nine, seven, five, five, seven, three, three, three, four, 11, nine, nine, eight, nine, seven and six empty beds out of 165. When one excludes the leave beds, however, as one should because they have not been genuinely vacated, one is left with numerous instances of 100% acute bed occupancy for the whole region. For example, there were no vacant male beds at all on 2, 7, 10, 11, 17, 18, 20 to 24 and 26 September; in the same month, there were no vacant female beds on 7, 10, 11, 16 to 18, 20, 23, 24, and 26 to 29; and on September 3, 4 and 25, gender information not being available for those three dates, there was either only one male and no female acute beds available, or only one female and no male beds available in the entire trust area in Hampshire.
Of course, one can debate how much use can safely and regularly be made of at least some of the leave beds that are temporarily vacant.
Mr Charles Walker (Broxbourne) (Con): My hon. Friend will know from previous debates that one can have occupancy rates above 100% because sometimes, in emergencies, leave beds are drafted into use.
Dr Lewis: I am extremely grateful to my hon. Friend for making that important point, as I am for him being here to support me tonight. I know of his great interest in the subject.
Using the trust’s own figures, I have calculated the average acute in-patient bed occupancy over the three months from August to October. Even if all the leave beds are counted as available, which they are not, bed occupancy was 91.9%, and the figure would be higher if weekends were excluded, given the number of people who go home for short periods at those times. When only the genuinely vacant beds are considered, the average occupancy rate is seen to have been a remarkable 96.7%.
One of the most extraordinary assertions in the consultation document on the proposed changes is to be found on page 11, where it declares:
“The time that people are spending in our…hospitals is longer than the national average (our average length of stay is 51 days (including leave) compared to below 30 days (excluding leave) in other Trusts).”
That is an extraordinary manipulation of the data, as it contrasts the total of days spent on and off the wards in our trust area with the total of days spent only on the wards in other trust areas. A glimpse of the true situation is again to be found in the tables drawn up by the Audit Commission. In referring to all mental health admissions in the Hampshire PCT area, which is not quite the same as the foundation trust area but is a reasonable general guide, the Audit Commission states:
“Hampshire PCT is below the national average”
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for length of stay. I do not know whether the trust’s blatant and gross failure to compare like with like was deliberate, but the public, their local representatives and Ministers are surely entitled to ask what the average length of stay excluding leave is in Hampshire’s acute beds, and what the average length of stay including leave is in the acute beds of other trusts, so that real rather than bogus comparisons can be made.
Time prevents a more detailed dissection of other dubious claims made by the trust. Its spokesmen refer to the acutely mentally ill suffering “disempowerment” as a result of spending what is usually a relatively short time on an in-patient ward. Most frequently, it insists that
“people have consistently told us they want to be at home”.
Such claims fly in the face of what we hear from service users and especially from carers, who want the assurance that an acute bed will be available when it is needed. I have yet to discover what, if any, systematic survey was undertaken to arrive at that conclusion. Who carried it out? How many people were surveyed? What questions were asked? The trust says that its soundings showed a desire for:
“Care within a community setting where possible, and avoiding going into hospital unless it is necessary.”
Well amen to that; we can all sign up to that, but that is a very different proposition from wishing to see a more than one-third cut in available beds that have an average occupancy rate of between at least 91.9% and 96.7%.
Only five out of the 46 trusts listed by the Audit Commission have 20 beds or fewer per 100,000 of the population. Southern Health NHS Foundation Trust wishes us to follow that example. Its consultation says that that small minority of trusts
“deliver good or excellent standards of care”,
and it recently identified four of those five trusts in a presentation to me and others. Although the overall ratings for those four trusts are, indeed, good or excellent, the picture is different where in-patient services are concerned: none of the four is rated as excellent, two are rated as good, a third is rated only as fair, and the fourth is rated as weak.
At meetings with the trust, I and my colleague, County Councillor Keith Mans—a former and distinguished Member of this House—have stressed the need for the new hospital-at-home model to be piloted before any of the six in-patient units is closed. If this exercise is really about “Improving Outcomes for Hampshire’s Adult Mental Health Services”—as the consultation document is entitled—rather than about saving £2.9 million a year, then acute in-patient beds should not be discarded until pilot projects clearly show significant reductions in the current very high levels of acute bed occupancy.
We need a step-by-step approach that clearly rules out the present plan to remove not just one but two modern mental health units, including Woodhaven hospital, right at the start. It is distinctly probable that the overview and scrutiny committee of Hampshire county council may decide to refer this matter to the Secretary of State. This evening, I look to the Minister for two assurances.
First, I want an assurance that Woodhaven hospital, which is so valued by our community, will not be closed until objective and independent surveys have been carried out assessing whether there really are dozens of people
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in beds for the acutely ill in Hampshire who do not need to be there. Secondly, I want an assurance that Woodhaven will remain open until a pilot scheme has demonstrated that the proposed hospital-at-home scheme is starting to reduce the current high levels of acute bed occupancy. It cannot be right that in-patient beds should be cut to 107 for the whole trust area in Hampshire, so that we are left with a woefully inadequate total of about 19 for voluntary in-patients once all those detained under the Mental Health Act have been accommodated. People’s lives are at stake.
6.20 pm
The Minister of State, Department of Health (Paul Burstow): I congratulate my hon. Friend the Member for New Forest East (Dr Lewis) on securing the debate and on being, as ever, so thorough and detailed in his exposition of the case that he puts before the House. I take this opportunity to pay tribute to the hard work of the staff who work within the NHS in his constituency.
I want to set out the current position, as I understand it from the briefings that I have had over the past few days, and to respond to several of my hon. Friend’s specific points. I assure him that under the proposals for adult mental health redesign set out by Southern Health NHS Foundation Trust, Woodhaven hospital will not close but will change the nature of what is provided. I want to make it clear that there is a continuing NHS future for the facility, albeit not the one that he believes to be appropriate.
While the trust recommends that the acute adult mental health ward is withdrawn from Woodhaven, the excellent hospital which my hon. Friend opened eight years ago and which the community should rightly be proud of will continue to offer specialist adult mental health services. The aim of these changes is to provide the right mix of community and bed-based care—this debate centres on what that balance is—and ultimately the best possible support for people in his constituency who use these services.
My hon. Friend will be aware that during the 18-month engagement with the public that took place prior to the statutory consultation, the majority of patients consulted said—this is one of the areas that he challenges—that they wanted to be treated in the community. As a general principle in any field of health care, the more we can focus on prevention and on supporting people in their homes so that they retain their independence and stay connected with their communities, the better the outcomes we can achieve. The principles behind the trust’s proposed redesign can therefore be pinned squarely to the views of local people, and this is where I want to reassure my hon. Friend a little further. I understand that, through the consultation, the trust has been told this on repeated occasions. I have a quote from one service user:
“I was unfortunate enough to need the services of the home treatment team over Christmas 2008 and New Year 2009, but due to the care I received from the team I didn’t need to be admitted to hospital and I was able to stay at home with my husband and son.”
Clearly, my hon. Friend disputes the evidence that the trust is putting forward about whether patients want to be treated at home, but it is for this reason that it is recommending the integrated model for mental health services in Hampshire and the reinvestment of savings
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from acute services into community services. However, I will ensure that he is supplied with further evidence on these points so that he can satisfy himself and his constituents that the trust is basing its decisions on reasonable evidence.
Additional community services will ensure that patients receive flexible and bespoke care packages in their home wherever possible, even when acutely unwell. The intention of the proposals will mean that people are admitted to hospital only if it is clear that hospital is the best place for them to receive their treatment. The trust tells me that treatment and care for patients will be provided in the most appropriate and therapeutic environment for the patient and that acute beds should be available for those who need them. However, when local trusts propose changes to existing services, the public should be closely consulted. Again, my hon. Friend obviously feels that that is not what has happened. In the case of Southern Health NHS Foundation Trust, service user involvement projects and carers’ groups from across the county have worked closely with the trust to develop the proposals for the redesign.
I want to deal with a couple of the specific statistical points that my hon. Friend set out so clearly. He has demonstrated something that does not always happen in these debates, in that someone has done a lot of detailed research to try to nail the issue that he is most concerned about. First, I want to deal with the proportion of people detained versus those in voluntary admission. He referred to two days’ worth of data that he had collected and his conclusion that 53% of people were detained in those circumstances. However, I understand that over the past six months, on average, 22% of people admitted to the trust’s adult acute beds have been detained under the Mental Health Act. I have asked the trust to write to my hon. Friend with those figures so that he can see more data.
Dr Julian Lewis: The trust did fax me some figures of that sort. However, they did not make sense because when they were added up, the total was way below the number of beds that had been occupied. I honestly think that the trust is wrong on these proportions.
Paul Burstow: That is why I think it is right for the trust, having read this debate, to follow it up by writing to my hon. Friend. I know that he has been engaging with it face-to-face as well, and I am sure that he will continue to do so.
My hon. Friend made a point about the trust anticipating the effectiveness of the whole clinical pathway and about the focus on the most unwell reducing the number of people admitted under the Mental Health Act, in addition to reducing voluntary admissions.
My hon. Friend mentioned the issue of whether one counts leave beds. It is common for people who have been detained in hospital to have a period of leave from the ward before they are discharged. That can vary from a few days to several months. The beds for leave patients are not kept empty, but are made available for other acute admissions, as my hon. Friend the Member for Broxbourne (Mr Walker) said. It is therefore important to count leave beds when considering capacity. My hon. Friend the Member for New Forest East set out clearly his concern about bed occupancy and the impact of leave beds. I will make sure that the trust considers this
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issue carefully as it draws together the feedback from the consultation before its forthcoming discussion with the Hampshire overview and scrutiny committee. I will ensure that his concerns about length of stay, which he set out so clearly, are put to it.
My hon. Friend made a request for a pilot. Although I will not go quite as far as he would like tonight, it might help if I provide him with some information about the process that the trust has put in place to evaluate and assess the proposed changes. I understand that it has invited the Centre for Mental Health to do an independent review of the proposals, which is expected to be complete within a month. The trust’s research and development department is also completing a thorough evaluation of proposals, comparing a range of quality measures at baseline and after implementation.
On the next steps, the trust has been in discussions with the Hampshire health overview and scrutiny committee, and it has been agreed that the trust will hold a number of stakeholder meetings. It is expected that the trust will return to the health overview and
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scrutiny committee at the end of this month and present a written report that describes the themes from the consultation feedback and the progress that has been made in those meetings. The trust will then make suggestions on the next steps, which it will agree with the health overview and scrutiny committee, with a view to reaching final decisions in early 2012. As I understand it, any changes will be implemented by the trust in a phased, transitional approach over a period of time, not as a big bang.
The trust will, of course, keep my hon. Friend fully informed. I know that he has been diligent in pursuing the trust with his concerns. I encourage him to carry on that dialogue. I again congratulate him on securing this debate and for clearly articulating his concerns on behalf of his constituents. I hope that I have been able to articulate some of the points that the trust has put to me and I look forward to a conclusion of this matter in the new year.