Mental Health Services: Leeds

Tuesday 23rd April 2019 Westminster Hall

18:00

[Fabian Hamilton (Leeds North East) (Lab)]

I beg to move,

That this House has considered mental health services in Leeds.

It is a pleasure to serve under your chairmanship, Mr Hosie.

I requested this debate with some reluctance, because I did not want to believe that mental health services in my city—a city that I have lived in for 40 years and which I have been privileged to represent for the past 22 years—were so appalling, especially when compared with other cities and regions in this country. Sadly, however, when I met my constituent Charley Downey two months ago at a routine advice surgery, the evidence that she presented to me on behalf of her husband was so damning and shocking that I felt that there was no other option than to bring their concerns to the attention of this House and hopefully to the attention of the Government, so that appropriate action could be taken to put right a gross injustice being done to so many of my constituents, as well as those of my seven fellow Leeds MPs from across the House, and those of MPs in the broader area, such as York MPs.

The Government have acknowledged on many occasions over the past few years that mental health services across the country are under-resourced and they have promised remedial action, but one of the biggest problems is the uneven distribution of funding, as I have mentioned. The waiting list for treatment in Leeds is approximately 48 to 52 weeks, once a patient is actually put on the waiting list. However, that requires a prior diagnosis by a qualified nurse, or a “formulation”—because nurses are not permitted to make diagnoses. If a patient is suicidal, then even a few hours on a waiting list may be too much, or in the worst cases possibly fatal, but to wait for a year is simply appalling. Compare that waiting-list time with, say, that of East Lancashire, which is 12 weeks, or that of the London Borough of Hillingdon, which is six weeks, or that of Cheshire, which is nine weeks, and I am sure that the Minister will understand my concern and the deep anxiety of my constituents.

Andy Downey first attended his GP’s surgery on 8 November 2016 with serious concerns about his depression. He was given a leaflet about a service called “Improving Access to Psychological Therapies”, or IAPT, and he had a blood test, which subsequently showed that he had a folate deficiency, for which vitamin D supplements were supplied.

Ten months later, in October 2017, with his symptoms worsening and the supplements failing to help, Mr Downey attended his GP’s surgery again. A week later, after suffering a full panic attack and breathing difficulties, he was referred back to his GP, who suggested that Mr Downey refer himself to the IAPT through a website called Mindwell. The problem was that Mindwell has no mental health content or referral option to the IAPT, apart from a phone number. Andy rang that number, which went straight through to voicemail. His GP had told him that Mindwell was the only way to get a referral to the IAPT, but when Mrs Downey phoned the mental health trust—the Leeds and York Partnership NHS Foundation Trust—she was told that the GP had given her husband the wrong advice, and the trust accepted Mrs Downey’s request for treatment as a referral. Therefore, Andy’s initial assessment meeting finally took place on 5 February 2018. Charley Downey has provided me with almost four pages of information about dates, times, meetings, appointments and lack of outcomes, all of which I can make available to the Minister, if she so wishes, or to the trust, which should already have this information.

When I first met Charley on 16 February, I was appalled not only at the way in which her husband had been treated but by the state of mental health services in Leeds, which this case seemed to typify. On 19 February, I wrote to Dr Sara Munro, chief executive of the Leeds and York Partnership NHS Foundation Trust, to express my concerns about the case of Andy Downey and to raise the issues of underfunding for mental health provision in general across the region.

I asked Dr Munro what her perspective was on the difficulty of accessing mental health care through the NHS at present and why the trust had decided to use online tools rather than face-to-face therapy, when it seemed to me—purely a layman—that mental illness is one area in which human interaction and sensitive expert clinical judgement might be essential.

[Andrea Jenkyns (Morley and Outwood) (Con)]

First, I congratulate the hon. Gentleman and my fellow Leeds MP for bringing this important issue to the House; we all have constituents who have suffered in a similar way to his constituent.

Recently, I visited Morley Newlands Academy in my constituency during mental health week. I, for one, think we need to tackle mental health issues at a young age. Representatives of Place2Be, a charity, were there, having come into the school to offer a variety of services. I saw the value of raising the awareness of mental health at such a young age. Does the hon. Gentleman agree that we need to ensure that children in schools, even primary schools, receive the support they need, and that we also support the charities involved, to ensure that they get the funding to continue their good work?

[Fabian Hamilton]

I thank my hon. Friend—if I may call her that—and my colleague from Leeds for her intervention, because she makes a very important point, namely that we need to begin at the earliest possible age. It is tragic to me, and I am sure to every Member of this House, that an increasing number of young people are showing signs of depression and other mental health problems, and that is evident in our schools. The role of charities is very important, but so is the role of the national health service. Although we need to support those charities, as she rightly says, we also need to ensure that we have the resources within our NHS too.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am really grateful to my hon. Friend for securing this debate, because the Leeds and York Partnership NHS Foundation Trust lost the main contract with our clinical commissioning group as the result of a litany of failures in my constituency, including ignoring three Care Quality Commission reports, which put mental health patients in my constituency at serious risk. My question today is this: will the Minister review the licence of that trust to operate, or not, in light of the consequences of its actions and the harm it has caused?

[Fabian Hamilton]

I thank my hon. Friend for her intervention. York is a city that I know well, and of course York and Leeds are united together through the partnership trust. I will now go on to detail my own experience with the Leeds and York Partnership NHS Foundation Trust, because my experience is similar to the experience that many of her constituents have discussed. The points she makes are very valid and I would be very interested to hear what the Minister has to say in response, not only to her intervention but to what I am about to say.

The reply to my letter to Dr Sara Munro, the chief executive of the Leeds and York Partnership NHS Foundation Trust, was dated 1 March, and it was written by Samantha Marshall of the complaints team, who said she was

“sorry that you have reason to make a complaint and, as a trust, we have failed to meet your expectations.”

Bear in mind that I had written on behalf of my constituent and that I had raised other issues. Ms Marshall went on to say that the trust has had no contact with Mr Downey since he was referred to the IAPT, which is provided by Leeds Community Healthcare, and that she would forward my letter to LCH if I wished. However, no reference was made to any of the other more general questions that I had asked Dr Munro, questions that I believe are highly pertinent to the treatment that my constituent received, and to the treatment that many of my fellow Leeds MPs’ constituents have received as a result of the severe underfunding of mental health services in our area.

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend from Leeds North East is making an excellent speech. I had a similar case with one of my constituents, who visited her GP on 31 December 2018 to say that she felt suicidal. She was asked to go home and told that the crisis team would contact her. The crisis team did not contact her. Four hours later, she returned to her GP and then had to go by ambulance to Jimmy’s—St. James's University Hospital. She waited in accident and emergency for 20 hours. Eventually, the acute liaison team gave her a leaflet. That was the level of intervention that she experienced. It was not until my office intervened with the IAPT that she got a referral, and by then she had already made another suicide attempt. That is how the services in Leeds were delivered in the case of my constituent.

[Fabian Hamilton]

I thank my hon. Friend, whose constituency is next door to mine. As I suspected when I requested this debate, there are cases all over the city of Leeds—probably all over the country, but certainly in the Leeds and York area —that highlight the inadequacy of mental health services and the maze that people have to navigate if they need them. That is a source of huge concern.

[Andrea Jenkyns]

A couple of years ago, I had a memorable case of a gentleman who was suffering from horrific mental issues and had attempted suicide several times. On one occasion, after he had slit his wrists, he went to A&E. There was no joint communication; his GP, who was supporting him, did not even know about the incident. Does the hon. Gentleman think we need to ensure that the NHS systems talk to each other a lot better and that there is a much more joined-up approach?

[Fabian Hamilton]

Yes. I thank the hon. Lady for her point. That is one of the problems: it is a maze. If people are told to refer themselves through a website, which can then refer them to another organisation that is supposed to allow them to make an appointment, and they then leave a message on voicemail and it is never responded to, that is shocking in itself. The example my hon. Friend the Member for Leeds North West (Alex Sobel) gave of the ambulance and the waiting in A&E, and then the lack of credible resources and assistance from the mental health services, highlights the scale of the problem.

After the date for this debate was published, I was contacted by Healthwatch England, which told me that Healthwatch Leeds was about to publish a report on mental health in Leeds and that it would be happy for me to use some of the report’s data and conclusions in the debate. Unfortunately, owing to unforeseen circumstances, the publication of the report has been delayed, but to show that Andy Downey’s is not an isolated case, here is a quote from one of the 697 people in Leeds—I do not know his or her name—who gave evidence for the report during the first three months of 2019:

“I do not know what is wrong with the entire Trust. I had waited since February for a referral to the CMHT”—

the community mental health team—

“I was seen in August. I was discharged, told to talk to IAPT. IAPT has its own waiting lists. As a result of not being able to prove I accepted, I lost everything. I DID NOT REFUSE TREATMENT!! NONE WAS OFFERED!! Today I phoned the crisis team in tears, and they said ‘contact your GP in the morning’. I have no job, I have no money, I went through over 6 months waiting for a simple appointment. I am struggling, and the best the crisis team can do is say ‘contact your GP’. My GP referred me to the CMHT because I was suicidal. Can’t believe the crisis team said ‘tell your GP’. I have been telling my GP, who couldn’t handle it, so he sought help. Today I found out I lost my job, and I will soon be homeless, because my home is provided by my employer. I was suicidal and depressed before today... can’t the crisis team show some empathy and realise some things are a tipping point?”

[John Howell (Henley) (Con)]

I am not a Leeds Member, but what the hon. Gentleman has highlighted in that moving passage is the need for GP training in this area, right across the country. Is it not time that we got that training right?

[Fabian Hamilton]

I thank the hon. Gentleman for that important intervention. He is absolutely right. It is clear from what I, and all of us, have seen that all GPs need far better training in how to deal with mental health issues.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

It seems extraordinary that it is not compulsory for GPs to be trained in mental health. That is something that the Royal College of General Practitioners would like to change and something I hope the Minister will be able to pick up and work on. On the capacity in Yorkshire and the Humber, general and adult psychiatry at ST4 in 2017 had 20 places for trainee psychiatrists, only six of which were filled, and for dual general adult and older adult there were two places, none of which were filled. How much does the hon. Gentleman believe that a lack of staff resources contributes towards the poor care available to his constituent?

[Fabian Hamilton]

I thank the hon. Gentleman for that important point. I know that staff—competent and qualified staff—are needed to fulfil the expectations and the demands, but I do not know why that is. Is it under-funding or under-resourcing, or simply that there are not enough trained personnel available to fill the posts? Or is it that the level of training, competence and experience is not sufficient for the demands of the posts? That is something we will have to explore and I hope the Minister will also make it one of her priorities.

The quote I read out is a truly damning condemnation of the trust, not in my words, but in the words of someone crying out for help and cruelly being denied it, through, I believe, a mixture of incompetence, complacency, under-funding and—I am reluctant to say this—a bit of callousness too. Lives are being put at risk by the crisis and the question I would ask above every other is: why is Leeds so inadequate and so poorly funded compared with many other parts of England?

Let me come back to my constituent, Andy Downey. Andy was placed on the waiting list for mental health treatment in April 2018, with an estimated date for his first appointment in November or December of that year. That was subsequently extended to March 2019. However, in the meantime he experienced an unrelated physical health issue, in November 2018, and was sent to a private hospital—Spire Leeds Hospital in Roundhay —to see a surgeon, as they were contracting NHS services. That appointment was in December last year. He was told that he needed exploratory surgery to resolve the issue, which would be scheduled “after Christmas”. When no update had been received by January 2019, Charley chased the matter, only to be told that the hospital had tried to call but “hadn’t got through”. However, no calls or messages had been received by the Downeys. The surgery was subsequently scheduled for May 2019—next month. Because Andy will apparently not be able to attend mental health treatment while waiting for surgery—I am not sure why—his mental health treatment has been cancelled and he has been placed back on the bottom of the waiting list to start the whole process again. The current waiting list is 10 months.

Let me summarise Andy Downey’s case, for the Minister’s benefit—I am sorry, I am eating into her time: it took longer than a year, and multiple GP appointments, just to get a mental health referral, and then only after an ambulance attended. Referral for assessment took four months. From assessment to recommending prescription for antidepressants to receiving a prescription took an additional two months. The waiting list from decision on treatment to first treatment session took 49 weeks. It took 18 months from first contact to get an antidepressant prescription. It took 29 months from first contact to initial treatment appointment. It then took another 10 to 11 months to restart treatment because of the failure of a private company to schedule unrelated surgery. I am sure that the Minister will agree that that is totally unacceptable. Mental health services are often as urgent and necessary as physical health treatment, yet they are treated almost as a Cinderella service. The fragmentation and under-resourcing of mental health services, especially in Leeds, means that lives are often at risk.

We have had several debates in the House over the past few years about depression and the effect that it can have on the individual and everyone who cares about that person, with a few brave MPs telling the House and the public what they have suffered, but unless we make our mental health a priority, we will have more and more cases like that of Andy Downey and his wife Charley —who is present here today, and has had to carry the burden of incompetent and inadequate public services on her shoulders. Although we live in one of the richest societies in the world, we cannot, it seems, organise and fund the very services that will help to bring so many people afflicted with mental illness and depression back into mainstream society. It is a condemnation of us all that couples such as the Downeys have had to bring their shocking experience into the public domain through their Member of Parliament. I salute their courage, but feel angry on their behalf.

Finally, will the Minister answer these questions or, if she is unable to do so, will she write to me after the debate? First, what mechanism do the Government have to ensure that mental health services are delivered equally across the country? Secondly, does the Minister really believe that the private sector has a beneficial role in delivering mental health services? Thirdly, will she intervene by raising with the Leeds and York Partnership NHS Foundation Trust the issues that I have drawn to her attention in this debate? I hope, for the benefit of the Downeys and on behalf of the many thousands like them across our city, that mental health services can be given the priority and the resources they need in order to ensure a healthier and better society for us all.

18:20

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I thank the hon. Member for Leeds North East (Fabian Hamilton) for the passionate and articulate speech he has made on behalf of his constituents.

I often get frustrated by debates about the NHS, which are all about inputs—how much money is being spent, or what the size of the workforce is—and not enough about the direct patient experience and whether what we have is delivering the right outcomes. The story that the hon. Gentleman has shared illustrates that, for a lot of people experiencing mental ill health, their journey towards getting care is not always optimal. That is for a whole host of reasons, including historical issues regarding process and how people interact with their services. I will go away and take a deeper look at what he has highlighted, because it is a very good example of how things can go wrong.

As I say, the issue is not just about money, because we have made money available to all clinical commissioning groups. The hon. Gentleman has asked why, when we are making money available at an increased rate across the board, mental health services are so much worse in Leeds than elsewhere. As is so often the case with these things, a lot of it is about leadership. One issue that has been specifically raised with me is that often, the person responsible for commissioning mental health services within a CCG is not as senior as others. They are not as experienced, and that can cause weaknesses in commissioning.

It is important that we take action centrally to make sure that we deliver services more consistently, and I expect that to be achieved through the Care Quality Commission. The hon. Member for York Central (Rachael Maskell) raised specific concerns about her local trust. The CQC’s inspection report last year said that the trust requires improvement, so I fully expect it to work collaboratively with the CQC to take the steps that it is advised to take, in order to improve its performance when providing care. That CQC scrutiny will continue until the relevant improvement in performance is delivered.

NHS England also demands that CCGs achieve the mental health investment standard. Under that criterion, CCGs are bound to spend more of the additional money they receive on mental health services than their overall increase in budget. We expect NHS England to take direct action to secure that. However, that is not the whole story, because it depends on what CCGs are commissioning.

One of the messages that I have been keen to give CCGs is that delivering good outcomes for people suffering from mental ill health is not just about clinical services; the voluntary sector can play a big role. I have challenged CCGs to use some of their budgets to commission services directly from the voluntary sector. When someone is suffering a mental health crisis, they need help to navigate the system. In the example that the hon. Member for Leeds North East shared, that help was clearly not forthcoming from the GP.

Having someone with an understanding of mental health who can help a person suffering a crisis navigate through the system is clearly beneficial and, frankly, is good value for money. We should not spend all our NHS budgets on clinical staff when that additional support can deliver so much. In the case that the hon. Gentleman outlined, the GP did not do as much as he could have done, so we perhaps need to consider what else we can do to make sure that GPs understand that system. Again, the voluntary sector has a role to play.

My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) mentioned having more mental health education in schools, which is an issue that we are taking forward. She specifically mentioned Place2Be, which is a good example of how a third-sector organisation can work with the NHS to deliver the right outcomes. We are in the process of rolling out a whole new workforce in our schools to do exactly as my hon. Friend has challenged us to do.

On people who have attempted suicide, I readily concede that patients in such circumstances have not had a joined-up service between their GPs and their primary care providers. However, through the liaison psychiatry teams that we are rolling out in A&E, we intend to make sure that that wrap-around care is provided more readily.

[Dr Poulter]

Will the Minister give way?

[Jackie Doyle-Price]

I will, although I was just about to come to my hon. Friend’s point.

[Dr Poulter]

Suicides are very unpredictable, and a lot of people who attempt to take their own life were not previously known to services—whether their GP or psychiatric services. The problem with mental health services in Leeds and elsewhere is that community services have been completely hollowed out by funding cuts over many years. Unless we invest in community services to stop people ending up in crisis in the first place, we are not going to solve the problem of suicide or deliberate self-harm, or provide help to those who really need it. I hope that the Government are going to get a grip on that problem and push it through NHS England and CCGs.

[Jackie Doyle-Price]

My hon. Friend is absolutely right. When we try to deliver a transformational step change in the level of service, one of the problems is that we end up raising expectations quicker than we can deliver on them, because we need a whole workforce that is able to deliver. I note my hon. Friend’s points about the number of people applying for psychiatric posts; we need to do much more to encourage people. We have spent a lot of time raising awareness of mental health and put a huge amount of investment into psychological therapies. However, at the heart of the forward plan for the next 10 years is a recognition that we need much more service available in the community, and much more help for people with severe mental ill health. I hope that my hon. Friend is reassured by that.

As I have limited time, I will follow up in writing on the other points made by the hon. Member for Leeds North East. As I said, we have made money available in Leeds, but when we look through the prism of someone who needs help and whose journey in getting that care is less than optimal, we clearly need to consider what is going wrong with that care pathway. If someone is vulnerable and needs help, and perhaps does not have a good understanding of mental health or has no experience of it, the whole process is very confusing and distressing.

How we navigate people through the NHS can often feel very inhuman—it is very reliant on process. The hon. Gentleman gave an example of how people are sent online to register, which feels a bit uncomfortable. We need to make sure that we take every opportunity to ensure that the patient is at the heart of this process and that their experience is pleasant, at a time when they are going through great distress. To say, “Here you are: go to this website—you’re on your own, so see you later,” is not a good start for anyone looking for help.

I am grateful to the hon. Member for Leeds North East for having brought this case to my attention, and I pay tribute to Mr and Mrs Downey for sharing their story, because doing so is incredibly difficult. I will look at the specific points that the hon. Gentleman has raised and come back to him.

18:29

Question put and agreed to.