Mental Health Care

Charles Walker Excerpts

Monday 21st November 2011 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

Thank you for calling me to initiate tonight’s Adjournment debate, Mr Speaker. May I alert the Minister who is responding this evening to an excellent report published today by Mind entitled, “Listening to Experience—An Independent Inquiry into Acute and Crisis Mental Healthcare”? That paper comprises more than 350 interviews with people who have experience of acute and crisis mental health care. I say to the Minister—although he probably knows this—that the report makes for very difficult reading. However, there is also room for huge optimism.

I am delighted to be joined tonight by the hon. Member for Ashfield (Gloria De Piero) and my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones), who will be making brief contributions. I have also given permission for a few of my chosen and near colleagues to make brief interventions because I know how much the issue matters to them.

We need a new approach to the provision of mental health care in this country. Provision should be based on compassion, understanding and respect. That is what comes out of the Mind report and the 350 voices it contains. It should not be a punishment to be mentally ill, but too often it is. People who suffer from mental illness feel hugely excluded from mainstream society, and we need to approach them in a compassionate way. We need to reach out to them and draw them near, not push them away.

[James Morris (Halesowen and Rowley Regis) (Con)]

My hon. Friend is making a powerful case. The report is shocking in many ways. Does he agree that, if we are to develop a compassionate model of mental health care, we should focus on providing talking therapies more extensively to those people who come into the acute and crisis environment, so that they can be seriously helped with the conditions they present?

[Mr Walker]

My hon. Friend makes a fantastic point and is a fantastic attendee of the all-party group on mental health. He has a great interest in this area and I will come on to answer his point directly in a few moments.

Over the past 30 years, we have made fabulous progress in moving away from the use of asylums, although we have had problems in doing that. We have talked about care in the community but, too often, the community has not been there to provide that care. We must continue to address that. In closing the asylums, we must remember that there is still a need for accommodation when people are in severe crisis. I do not like to talk about beds or hospital wards, but we do need accommodation. Sometimes, people are so ill that they need to be hospitalised and looked after, but in a caring environment.

I am concerned that, with the closure of small acute wards, we are moving towards having much larger hospital environments. Some of those are, without doubt, excellent. However, as the report identifies, some of them have too many of the characteristics of past asylums. As I said, being ill should not be a punishment. It concerns me greatly to read of people going to institutions where they fear for themselves and are frightened daily. How can someone start to recover from a mental health crisis when they are terrified every day in their environment? Many of the report’s respondents said that institutions were so terrifying that staff seemed to spend most of their time trying to stop nasty things from happening. We must get away from that. We have made progress, but we are not doing so at a fast enough pace.

Let me move away from discussing hospitals. Sometimes people need to leave their home. Therefore, we need settings that can take people out of their home, but that are not traditional mental health hospitals. In the report, I came across two fantastic initiatives. I knew about one because it is being pioneered in Hertfordshire, but another one I did not know about: crisis housing. That means that, when someone is at home and having a crisis, they do not have to go to hospital. They recognise that they are having a crisis, as do the people who work with them, and they can be sent to a home where they can go for just a few hours—four, five or six—to talk through their concerns with people who can understand what they are going through because, often, they have experienced mental illness problems themselves, so they are talking to their peers. Alternatively, they can spend up to three or four days there to get through the period of acute crisis, so that their equilibrium is coming back and they may be able to go back home and face the world again. Crisis housing sounds like a fantastic innovation, because we have to get away from the idea that when someone is terribly ill the only place for them to be is in a traditional mental health hospital. They may need a bed, but it does not have to be in a hospital.

The other thing that has caught my attention, and is being pioneered in Hertfordshire, is the idea of host families. This is a fantastic initiative that people have been developing in France and that Hertfordshire is leading the way on in this country. If someone is not really up to being at home with their family or looking after themselves, they need some extra support. There are families out there who will take them into their home and allow them to become part of their everyday life. Those people may well, and probably do, have experience of dealing with mental health illness themselves. They may be in recovery, they may have recovered, or they may have a child, a brother or sister who has been in these very dark places, so they understand and know what their house guest is going through. This is a fabulous way of providing support. It can last from three weeks to 12 weeks, and it is there to make these people feel part of a working, functioning family community. They have responsibilities and chores, but they are given the support and love that they need to make progress.

However, those solutions may not be right for everyone, and many people will, on occasion, need to be hospitalised. The report identifies that many tens of thousands of people each year go into a hospital setting. I hope that we can reduce that overall number. Nevertheless, we need accommodation to look after them. As I said, too much of the small traditional accommodation has been shut down. That has been positioned as an unalloyed good thing: “Hooray, we’ve got rid of mental health beds; hooray, we don’t need them any more; hooray, the community can pick up all these people.” In fact, the community is not always in a position to pick them up. Crisis helplines that are meant to be running for 24 hours a day often run for only part of the day, and that is simply not good enough. A mental health crisis does not happen between 9 am and 5 pm; it is just as likely to happen between 9 pm and 5 am. We have to accept that the community is not always there for those people. Now that we have closed these beds, which were often in very small wards very close to people’s families, too often people who are committed into an acute environment can be sent up to 200 miles away from their home and from the people who care for them and can nurture them and provide them with support. To me, that is not progress.

We are now moving towards having larger mental health units. As I have said, some of those are very good but, as the report identifies, many are not. The threshold for being admitted to acute care is now so very high, because there are so few beds to accommodate people, that only the most ill people get into hospital. I have to say that, too often, their experience is pretty frightening and pretty unpleasant. I am not calling for less accommodation, but I am calling for us to do things differently, so that when we, as a society and as communities, are put in charge of people with a severe mental health problem, we go out and embrace them. We do not put them in a frightening environment where the doors are locked, where they are restrained, often face down, where they are terrified, and where they feel under pressure and in danger of being assaulted; we create environments where they can go and get well. With the mentally ill, we are not mending bones. I do not want to stick people in bed for 20 hours a day and put their leg in a brace. We are not doing that; we are not in that business. What we are in the business of doing is putting people in an environment where they can get well; where, as my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) said, they can talk through their problems; where they can come to terms with their problems; where they can speak to people who have been where they have been, then recovered and gone on. That is the kind of environment that we need to create in the acute setting.

That calls for a radical approach. Perhaps we have to stop talking about hospitals and beds, and instead start talking about accommodation and wellness centres, where people can go to get well and where they feel relaxed, comfortable and safe so that they can focus on themselves and their own mental health. When people have a mental health crisis, all too often they are simply terrified and feel that the world is against them. If somebody who is feeling like that is put in one of these institutions, I am sure that it does their mental health no good at all.

[Nigel Adams (Selby and Ainsty) (Con)]

What is my hon. Friend’s experience of youngsters who have to go to such hospitals and who find themselves in mixed-age wards?

[Mr Walker]

That is a very important area. Great strides are being made to end mixed-sex and mixed-age wards. How terrifying it must be for a young person to be in such an environment for the first time with people of all ages, with all types of experiences, illnesses and conditions. That is not acceptable, particularly if that young person is 200 miles or more from their family. That is not a way to treat people.

As I have said, being mentally ill is not a crime. We need to reach out and embrace these people, and we need to hold them close. We need to create environments where they can get better and focus on themselves. Talking therapies have a huge part to play in that. This is a fabulous report because it focuses on the areas of weakness in the current system. That provides the Government and Back Benchers with an opportunity to work together to get it right. I will now sit down and allow the hon. Member for Ashfield to join in.

Woodhaven Hospital

Charles Walker Excerpts

Thursday 10th November 2011 Commons Chamber

[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.

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 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”

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 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.

NHS Future Forum

Charles Walker Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

If I may, I will interpret the hon. Lady’s question in relation to the NHS Future Forum. I freely acknowledge that I wish that we had instituted the Future Forum after the publication of the White Paper last year. Although we had a full, formal consultation process at the time, to which 6,000 people replied, the character of the engagement that has been achieved over the past two months has been superlative. As we make further progress on the development of education and training proposals, for example, I want to ask the NHS Future Forum to continue that process of engagement in that and other areas across the service.

[Mr Charles Walker (Broxbourne) (Con)]

I have a great deal of time for most GPs—in particular for the one sitting in front of me, my hon. Friend the Member for Totnes (Dr Wollaston)—but what part of the Bill would allow communities to rid themselves of underperforming GP practices?

[Mr Lansley]

That would need to be initiated by the NHS commissioning board. Under the legislation, the board would respond to the health and wellbeing board in the local authority in question, or to the local clinical commissioning group. In my hon. Friend’s area of Hertfordshire, the health and wellbeing board will provide a new and powerful means by which the voice of the public can be expressed to challenge all the poor performance that occurs in the service.

Cannabis and Psychosis (Young People)

Charles Walker Excerpts

Thursday 9th June 2011 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

Thank you, Mr Deputy Speaker, for calling me to speak in this evening’s Adjournment debate. It is appropriate that my debate follows an informative debate on child protection.

Up and down the country, too many families are suffering the torture of watching their children squander their futures—bright children who have so much to live for ending up with so little. All too often, that is brought about by an addiction to skunk cannabis—a drug that is ruining young lives.

I am not a clinician or a scientist, so I am not going to give a hugely exhaustive overview of the chemical content of skunk cannabis. All I would say is that the THC— Tetrahydrocannabinol—content of skunk cannabis is now six times higher than it was in the cannabis of the ’70s and ’80s: 18% compared to 3%. The CBD—Cannabidiol— content of skunk cannabis, which is the bit of the chemical that counteracted the psychotic effects of THC, has now been removed from the drug. What we see is young people suffering as a consequence.

It is believed that skunk cannabis works by releasing dopamine into the brain, which creates a sense of euphoria, but it also has many side-effects—hallucinations, delusions, paranoia, attention impairment and emotional impairment. The problem is that young brains do not properly form in adolescence; they do not do so until they are in their early 20s. What the drug does in its simplest form is to open up gates in the brain that may never close again, or, if they do close, only partially.

If a youngster smokes skunk cannabis, at best their academic performance will be retarded. So many teachers have told me about young, bright children getting to a certain age and then their academic performance just goes backwards—not slowly, but rapidly, as they go from being at the top of the class, to the middle, to the bottom and to not turning up in class at all. That is a tragedy; a young mind is a terrible thing to waste.

Too many young people suffer severe psychotic effects linked to skunk cannabis. One in four of us carry a faulty gene for dopamine transmission. If a youngster has that gene and smokes skunk cannabis, they are six times more likely to get a psychotic illness than the average youngster out there. If both parents give them two of these genes, they are 10 times more likely to suffer a psychotic incident and suffer long-term brain damage.

With your indulgence, Mr Deputy Speaker, I would like to read a few tragic stories. In a sense, I am a voice for all those parents who cannot be here tonight. Here is the first:

“Our son was a normal, bright, outgoing, sociable boy and good at sports. He started taking cannabis at about 15 years old. He experienced a dramatic change in personality at 23, which resulted in a major psychotic episode. In recent years, he has been under psychiatric care and on antipsychotic medication, and has not been able to keep down a steady job. He has been sectioned twice and remains under a community treatment order. His continuous use of cannabis has destroyed a fine young man who now has no ambition or awareness of responsibility. However, he is beginning to accept that the cannabis habit will lead to more severe mental health problems. It is hugely distressing to watch this lovely boy turn into a complete stranger.”

Another parent wrote:

“George was our only son to turn to drugs. His addictions began early—tobacco in junior school, cannabis in senior. At first we were in the dark but George’s hand was forced by events and we were informed. He was warned. However, nothing stopped him. His life and 2 marriages were ruined. The French wife aborted their 2 babies—she could not cope with George in tow—the dangers, the poverty, the filth, the dark, loving, violent, mesmeric personality he had become. George asked me to drive him to the clinic and wept all the way in the car. I tried to comfort him but I ached for my unborn grandchildren. He knocked me down a few times—he always apologised—George was such a gentleman. He spent 2 years in a mental hospital. He was very schizophrenic by now.”

Sadly, George is now dead.

Let me read just two more stories to the House. Here is the first:

“Michael became noticeably unwell aged 16 in February 2003 whilst on a family holiday. I found some cannabis in his room. This was a shock as Michael didn’t even drink alcohol as far as I was aware. His mood changes were almost immediate. Laughing one minute, crying the next. He spent all day in bed and had no energy, no motivation. By December 2003, Michael was sectioned under the Mental Health Act. It was the worst day of my life—he cried for his parents and had to be held down. He just screamed—it was heart-rending. After being there for 3 months, he was discharged. I thought this was the end, it was unfortunately the beginning of a road that I would not wish on my worst enemy. It is like Russian Roulette who becomes psychotic.”

Nine years later, the torture continues for that family.

Here is the final story:

“We were a normal, happy, busy family with four children until our second child, 16 ½ became involved with a new group of friends and started taking cannabis. Within a very short space of time, our happy, funny, healthy son turned into a screaming, paranoid, unhappy young man. He refused to go to college, worked only occasionally, and became a violent thug. When confronted, he would turn on us both physically and verbally, on one occasion breaking his father’s ribs because his father had intervened when he was threatening me. He would kick doors in, smash glass panels, destroy washing baskets, crockery, ornaments, etc. Our lives became a living hell. He has been clean from cannabis for a year now and is gradually rebuilding his life. He still has flashes of paranoia, has no qualifications and will always have to fight to overcome his criminal convictions.”

Those are harrowing stories, and they have been repeated thousands of times across the country. Child and adolescent mental health services across the country are dealing with thousands of youngsters and adolescents who are suffering from severe psychotic illnesses, and there is a causal link with skunk cannabis.

For the past decade we have talked about harm reduction, and we have an organisation called FRANK that leads the educational process on drugs, but harm reduction is not enough. There is no safe amount of skunk cannabis that a youngster can smoke. I do not condone drinking, but a youngster can have a glass of wine or a bottle of beer and suffer little ill effect, although I would not recommend that young people do it. Taking skunk cannabis is like holding a loaded revolver to your head and playing Russian roulette. You do not know whether you have the gene, and you do not know when the gun will fire the bullet. Some people who become addicted to skunk cannabis end up with such severe psychoses that they take their own lives. It would be interesting to know from coroners how many young people who have committed suicide recently were addicted to skunk cannabis.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for raising a matter that could well justify a full debate here or in Westminster Hall. In Northern Ireland, we have seen a rash of suicides as a result of this very drug. Does the hon. Gentleman believe that the laws on drugs should be tightened? I ask because what is happening in his constituency is happening in mine, and throughout the United Kingdom.

[Mr Walker]

I am very interested by what the hon. Gentleman says, but this evening’s debate is not about classification. A Health Minister will respond to it. However, classification might be a subject for another debate here, and if the hon. Gentleman tables a motion for such a debate I shall certainly support him.

For many young people, smoking skunk cannabis is like holding a loaded gun to their heads. It might not kill them—they may continue to have a life—but if they suffer from severe psychosis or schizophrenia, it will not be much of a life. It might be just an existence.

The Government need to get to grips with this, but the problem is that law makers and the clinicians who advise them view cannabis through the prism of their own experiences in the 1970s and 1980s, and, as I said earlier, things have moved on since then. The drug with which we are dealing now is highly toxic and highly dangerous. We must talk not about harm reduction, but about harm prevention.

We are responsible adults. I have had enough of the current trend of everyone trying to make adults children’s best friends. I am not my children’s best friend; I am their parent—I am their father and I must guide them and have their interests at heart. That is the duty of adults. We must not abrogate responsibility. We have to make young people aware of the risks they run if they smoke skunk cannabis.

I have an admission to make here tonight. I was the beneficiary of very good drugs education at the age of 14 and 15. I was educated in the mid-’80s. I have not lived a blameless life. There are things I have done in my past that I am ashamed of and I wish I had not done, but, as the Prime Minister said, everyone is entitled to a past. There were many drugs, but the one drug I really did not touch was LSD, because I was told that if we take LSD just once, we can have a bad trip and that can be the end; we may never return from that experience—the gate in our brain that opens up may never close. If we are lucky enough in our youth to survive using it intact as a whole person, we might in our mid-40s—as I am now—be driving our children back from football practice and suddenly start hallucinating again. That terrified me. The idea that I could lose my brain and my future terrified me, and ensured that at a time when LSD was rife in London I never—ever—touched it.

Drug education works, but we need to educate the educators. They need to be aware of the research that shows a strong causal link between skunk cannabis, psychosis and schizophrenia. As I have said, our health trusts are full of young people suffering the consequences. Families are being destroyed.

I will conclude by saying just a few more words. In an ideal world—let us have lofty ambition and strive for an ideal world—I do not want any youngster to take drugs. It is not a good thing to do; it is not good for their health, their future or their prospects. I will just say this, however: it is a lot easier to repair a septum in one’s nose than to repair a brain. Once our brain is gone, often the best pharmaceutical drugs in the world will not bring it back again—that is it. I have talked to dozens of parents across the country who are facing up to the fact that their children—the children they love, and brought into the world and nurtured—now have no future but simply an existence to look forward to. I do not think that is good enough, and I do not want to settle for it.

So here is my call to action for the Government: please take this matter seriously. Skunk cannabis has changed over the past 30 years. It is a major public health risk. It is robbing thousands of people of an opportunity to live fulfilled lives. I have worked with the Minister, and she has been fabulous up to this point, and I am sure she will continue her efforts to get this topic higher up the Department’s agenda.

Finally, I want to pay tribute to my enormously good friend Mary Brett, a former teacher who has worked for decades in the interests of young people and their welfare.

Cheshunt Urgent Care Centre

Charles Walker Excerpts

Wednesday 23rd March 2011 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

It is a great honour to speak on the Adjournment this evening—we have had the Budget today, so the eyes of the nation are upon this place.

Two years ago, I was involved in a fantastic community campaign to bring an urgent care centre to Cheshunt. I was joined by more than 3,000 constituents in a letter-writing campaign to the primary care trust. We had a number of public meetings, with the car parks overflowing and many hundreds of constituents making their views known. The campaign culminated when I, along with the chief executive and the leader of the council, visited the then Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), at the Department of Health. It was a true community campaign. If the big society means anything, that is its basis: people coming together from across a community and joining in one voice to bring a much-needed facility to the constituency.

Since the centre arrived in October 2009, it has been fabulously well received. It is estimated that 400 people a week would use it at most, but in some weeks we have had 700 people voting with their feet by coming to that GP-led urgent care centre. It really is at the heart of the community. The reason so many people choose to use the facility is that it is open 12 hours a day, seven days a week, from 8 in the morning to 8 at night. Unlike many GP surgeries, it does not close for lunch and is open on Saturdays and Sundays, when people can use a medical facility because they are not at work in London.

Despite that enormous success, I was horrified to learn a few months ago that the PCT was not happy with the centre’s performance. I do not need to tell you, Madam Deputy Speaker, that being a Member of Parliament over the past three years has been fairly challenging, but one of the bright spots of my career has been walking around my constituency and being stopped by people saying, “Charles, we are so pleased we have the urgent care centre. It was so much needed in this part of the borough. Thank you so much for the campaign you led.” It has been enormously gratifying and satisfying to get that level of feedback.

The PCT came to the House to meet Hertfordshire Members and I had my turn to chat with them about the issues relevant to Broxbourne. After 10 minutes of pleasantries I asked, almost off the cuff, “Of course, you’re not thinking of closing the urgent care centre, are you?” The reply was, “I’m afraid, Charles, that that is one of the options on the table.” I am normally a mild-mannered Member, but I am afraid that on that occasion I blew up. I think that I swore. Indeed, I know that I swore. I am ashamed of my behaviour, but it demonstrates how passionately I feel about the centre.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I pay tribute to my hon. Friend for his passion and commitment to the urgent care centre and for the joint campaign run in Cheshunt and Enfield for the retention of a fully functioning accident and emergency department at Chase Farm hospital. Does what has happened to the urgent care centre not highlight the importance of the Secretary of State’s decision to encourage us all to think again about options other than the Barnet, Enfield and Haringey strategy, which would lead to the downgrading of not only Chase Farm hospital in Enfield, but, as predicated, an urgent care centre there?

[Mr Walker]

My hon. Friend makes an excellent point. He is at the forefront, along with my hon. Friend the Member for Enfield North (Nick de Bois), of the campaign to save Chase Farm hospital’s A and E, and I am always proud to join him outside those gates, making the argument for a fully functioning A and E service there.

The PCT has told me that it believes that the GP-led urgent care centre is treating inappropriate cases—whatever those are—and that people going there should be going to their GPs. It asks why it should have to pay for that treatment twice. Of course, they should not pay for it twice, but I always believed that the money should follow the patient, not the GP who does not deliver the service. My constituents use the urgent care centre so fully, because many—not all, but many—GP practices in my constituency do not deliver on their promise, or live up to their end of the deal, to provide a full GP service to them. So my constituents vote with their feet.

GP surgeries close for lunch, early in the evening and at weekends. If people want an appointment, they have to call up on the morning that they want it, only to be told, “We haven’t got any today, but if you want to come and see us tomorrow try calling us tomorrow.” That is not acceptable, and my constituents are not going to sit at home and wait to be treated like that day after day; they are going to walk to the urgent care centre and get treated there. What really upsets me is that the beacon of success in our constituency—the one that sees up to 700 people a week—now faces closure, while the GPs are not facing the necessary censure for some of their practices in delivering services to my constituents.

I discovered in a PCT board paper that many GP practices in my constituency are in the NHS version of special measures, meaning that they are in the bottom 10% of GP practices in the country. That leads me to ask again, “Why does the urgent care centre, which delivers a high level of service, face closure?” while GPs, as I said earlier, are not delivering the service that they are paid to deliver.

The PCT says that there was a unanimous decision on behalf of a steering committee to change the use of the urgent care centre—at best to make it a minor injuries unit, or perhaps even to close it. It says that the decision came about as a result of a meeting with various stakeholders and some research—independent research, I was told—by an organisation called Opinion Research Services. Of course, it was not independent research, because it was commissioned by the PCT: it paid the bills of Opinion Research Service. I do not know what went on at that meeting, but I am fairly sure of what did not, which is that those there did not get a full picture of how successfully the urgent care centre meets the needs of local constituents.

What I did learn is that the GP services in the area leave a lot to be desired. On page 8, the board report states:

“A quarterly patient access survey carried out nationally has highlighted perceived problems with access and satisfaction with primary care in the area served by Cheshunt UCC.”

On page 8, it goes on to state:

“In addition, perceived poor access to primary care in and around the area served by Cheshunt must be addressed.”

Notice the emphasis on “perceived”. It is not perceived poor access, however; it is real poor access. If it was perceived, hundreds of my constituents would not go to the urgent care centre.

On pages 11 and 12, the report states:

“The need to improve access to primary care in the Cheshunt area has been recognised and steps are being taken in conjunction with the Clinical Executive Committee (CEC) to support and performance manage those practices”—

not a practice, but those practices—

“in the bottom 10% nationally in terms of patient’s perceived access.”

Quite frankly, that is not good enough.

I became even more concerned about the situation when I went on to read that it is local GP commissioners who are putting pressure on the PCT to close our successful GP-led urgent care centre.

On page 9, the report states:

“Local GP commissioners do not support the configuration and have confirmed that they would not wish to commission UCCs as currently configured at...Cheshunt in the future."

On page 12, it states:

“The view of the GP Practice-Based Commissioning leads in the localities is that these needs are best addressed directly with the practices rather than by way of additional services.”

But why are the practices not addressing those needs now?

The PCT has said, with great fanfare, that it is providing additional services and support to GPs to help them to improve. Of course, that is very welcome. However, given that it is providing new telephone systems, automated self-check-in screens, waiting room plasma screens, web-based online appointments systems and electronic document management systems, my constituents and I want to know what on earth has been going on in these practices for the past 10 years. One thing that GPs have not been short of is money, so how have they not placed these absolutely critical tools for managing patient load in their surgeries, with the PCT now having to fund them?

If services in my constituency are to improve, we need competition. We need the urgent care centre to set new standards of treatment. If the urgent care centre, which is driving ever-higher levels of patient care, is shut, what incentive will there be for GPs to improve their service levels? It is incumbent on my local GPs, who are falling behind, either to deliver or surpass that level of care, or perhaps to make way and allow practices to come into the borough that are willing to take up the challenge of opening 12 hours a day and providing weekend services. Until we reach that stage, the PCT has absolutely no excuse for closing down this urgent care centre.

Earlier today, the PCT had a meeting where it decided to downgrade the urgent care centre to a minor injuries unit; it thinks it will get away with that. However, that is not good enough and it will not satisfy my constituents, because closing down the urgent care centre and removing the GPs from it removes the incentive for practices in and around the centre that are not delivering to their patients to improve their services.

As you can see, Madam Deputy Speaker, I am really very annoyed about this. I thought that I would come here and manage to smile my way through it and be magnanimous, but I simply cannot. For my whole life, I have believed that good practice and success should be rewarded. I thought that that was just the way things were—that an organisation that saw an urgent care centre that was delivering not 400 patient outcomes a week, as envisaged, but 600 or 700, would feel that it was a success story that deserved to be built on. By accident or design, our PCT has stumbled on a formula that works and meets the needs of the local community, but instead of building on that, it is pulling the rug from underneath it, and I believe that it is being pressured by some GP practices in my constituency and future GP commissioners to do so.

I will conclude, after my 15 minutes, by saying that there is only one set of vested interests that I represent in this place. It is not the PCT’s interests or the GPs’ interests—it is the interests of my constituents, more than 520 of whom turned up, at about nine days’ notice, at a public meeting that I held last Thursday to say to the PCT: “No, we want to keep our urgent care centre.” The PCT has got it wrong, it needs to listen, and we need that urgent care centre in Cheshunt.

[The Minister of State, Department of Health (Mr Simon Burns)]

I begin by congratulating my hon. Friend the Member for Broxbourne (Mr Walker) on securing what is a very important debate for him and his constituents. I commend him for the commitment that he has shown, as illustrated during his high-powered speech, in campaigning on health issues for his constituents to ensure that they get first-class, quality care. I also take this opportunity to recognise the hard work and dedication shown by NHS staff in his constituency. Their dedication, expertise and drive do so much to improve the health and well-being of his and other hon. Members’ constituents on a daily basis. This Government will support and empower them to provide his constituents with health outcomes that are consistently among the very best in the world.

As part of the Government’s commitment to the NHS, we are consistently increasing the amount of money we provide to local organisations. Total revenue investment in the NHS in 2011-12 will grow to more than £102 billion. The allocations announced on 15 December will provide primary care trusts with £89 billion to spend on the local front-line services that matter most. That is an overall increase of £2.6 billion, or 3%. Of that, Hertfordshire PCT will receive £1.7 billion—a cash increase of £47.7 million, or 2.9%.

Before turning to the specific issue of the Cheshunt urgent care centre, I will set out the context of our plans to modernise the NHS and bring considerable improvements to the health care experienced by my hon. Friend’s constituents. We believe that local NHS services should be centred around the patient, led by local clinicians and free from political interference, either from this House or from the various levels of NHS bureaucracy. To this purpose, we have set out our proposals to liberate the NHS from central control. We will set front-line professionals free to innovate and to make decisions based on their clinical judgment and the needs of their patients, with the sole aim of improving the quality of care given and the outcomes achieved.

Responsibility for budgets and commissioning care will transfer from managers within the PCTs to clinicians in general practice-led consortia. Patients will receive health care that is tailored to their community and their personal circumstances. Our plans will radically simplify the NHS. Two layers of management—strategic health authorities and PCTs—will no longer be necessary. We anticipate a one-third reduction in administration costs, saving the NHS £5 billion by the next election and £1.7 billion in every year after that. Every single penny of those billions of pounds will be reinvested in front-line services.

There are now 177 pathfinder consortia across England, covering 35 million people—more than two thirds of the population. Those consortia are taking a lead in rejuvenating local services, cutting out waste and putting the needs of patients before the needs of the system. There are now three pathfinder consortia in Hertfordshire. The East and North Hertfordshire GP commissioning consortium covers part of my hon. Friend’s constituency.

Clinical leadership will go hand in hand with greater local democratic accountability. Under “any willing provider”, an increasing number of independent sector and social enterprise organisations will deliver NHS services. Unlike now, local authorities will have the power to scrutinise all providers of NHS-funded services. Local authorities will be able to require the provider to present information and to appear at scrutiny meetings to hold them to account.

Already, 143 local authorities—almost 90% of those in England—have signed up to be health and wellbeing board early implementers, including Hertfordshire county council. The make-up of health and wellbeing boards will be left to their own discretion, but will include representatives of GP consortia, directors of public health, adult and children’s services, representatives of HealthWatch, representatives of the NHS commissioning board and locally elected councillors. As well as preparing a joint strategic needs assessment, they will have to draw up a strategy to deliver the requirements set out in that assessment. In short, health and wellbeing boards will promote integrated working across the NHS, public health and social care, and will hold NHS services to account. That will lead to better, more accountable services for local people.

The Government are clear that in a patient-led NHS, any changes to services must begin and end with what patients and local communities want and need. Until the new system is in place, we expect PCTs to follow best practice in ensuring that local communities are fully engaged in such decisions. When it comes to urgent care, it is vital that local services are coherent and easily accessible around the clock. However, we have again been clear that decisions on the form that they should take are best made locally, in the light of local needs.

In the Broxbourne area, there are 12 GP surgeries, four of which are in Cheshunt. The area also has an out-of-hours GP service provided by Herts Urgent Care, based at the Cheshunt community hospital. The community hospital also provides out-patient clinics and a range of community services. There are 22 pharmacies in the borough, nine of which are in Cheshunt and one of which opens for extended hours.

On the specific matters that my hon. Friend raised regarding the Cheshunt urgent care centre, I understand that in 2007, the former two Hertfordshire PCTs, in partnership with the two Hertfordshire acute trusts, held public consultations on a health strategy, “Delivering quality healthcare for Hertfordshire”. The strategy was intended to improve access to urgent care services in Hertfordshire, so that people with urgent but not life-threatening conditions could be redirected from hospital accident and emergency departments to receive more appropriate treatment more quickly and closer to home.

In response to the public consultation, the PCTs agreed to piloting urgent care centres at both Cheshunt and Hertford, on the basis that they would be evaluated before longer-term decisions were made about their future. It is crucial to remember that they were pilot schemes, and it was always understood that after a period of time had passed, so that experience could be gained, they would be evaluated before those longer-term decisions were taken.

The urgent care centres were established as part of a 12-month pilot project between January and December 2010, with the specific objective of relieving pressure on local accident and emergency services. The primary purpose and objective was to reduce the number of patients seen at A and E by 20,000 a year, by providing local people with direct access to urgent care centres. The purpose of those centres is to see and treat people with urgent, but not life-threatening, illnesses such as sprains, strains, broken bones, and minor burns and scalds in a local community setting, allowing A and E departments to concentrate on life-threatening emergencies.

Hertfordshire PCT commissioned an independent research organisation, Opinion Research Services, to evaluate the success of the pilot centres at Cheshunt and Hertford, the latter in the constituency of my hon. Friend the Member for Hertford and Stortford (Mr Prisk). I understand that during the evaluation process, the views of the general public, NHS staff and local GPs were taken into account. Evidence was then submitted to an evaluation panel consisting of local GPs, local councillors, staff from local authorities and representatives of the PCT.

When the evaluation panel met on 17 January this year, it came to the unanimous view that urgent care centres were not achieving their aim of diverting significant numbers of patients from A and E. I remind the House that that, of course, was the primary purpose of the pilot scheme when it was started at the beginning of January 2010. Instead, considerable numbers of those using the urgent care service were seeking advice and treatment usually provided by GPs, for conditions such as raised temperatures, sore throats and headaches. It was never the intention that the urgent care centres would have a primary care focus. They were established to relieve pressure on local A and E services and to treat people with urgent but not life-threatening illnesses.

The evaluation panel recommended that the pilot centres should not continue in their current format. Instead, it recommended that the PCT should consider recommissioning activity through one or two minor injuries units. It also recommended that the PCT consider how it could improve access to high-quality primary care, to compensate for the loss of the urgent care centre.

As my hon. Friend the Member for Broxbourne is aware, Hertfordshire PCT published its board papers on the issue on 18 March. I understand that the PCT met earlier today to consider the recommendations and has decided to uphold them and not recommission the urgent care centres in their current form. Instead, it will consider recommissioning a minor injuries unit at Cheshunt.

I accept, as my hon. Friend made clear, that the Cheshunt urgent care centre is well regarded by local people. However, the provision of services is a matter for the local NHS. As he understands, it is not for Ministers to interfere and micromanage the day-to-day business of the NHS.

My hon. Friend mentioned access to general practitioners in the Cheshunt area. To reiterate what he said, the evaluation panel recommends that the PCT considers how it can improve access to high-quality primary care to compensate for the loss of the Cheshunt urgent care centre. The PCT has upheld that recommendation. I understand that the PCT has a programme of measures to improve access to general practice, to which he referred. I am sure he will agree that it is important to pursue and achieve that.

[Mr Walker]

I would argue that the PCT ought to have been improving the performance of GPs in my constituency for the past decade. It has arrived a little late at the party.

[Mr Burns]

My hon. Friend makes an extremely valid point. It is sad that only in the last few months have this Government been able to come to grips with some of the previous Government’s failings in making the local health service more accountable to the needs, wishes and requirements of local people. He and I will be totally in agreement on that. That is why I believe that the core of our health service modernisation programme— putting patients at the heart of the delivery of care—is so important. I am sure that he and I agree that that is an appealing principle from which to work.

As my hon. Friend said, the PCT has established a funding initiative for GP practices to support the Improving Access programme, which includes funding for new telephone systems, improved appointments and check-in systems, and medical equipment. The programme continues to be a key area of work for PCT staff, who will work closely with GPs to ensure that it is implemented, and that local people see improvements.

I have been advised—I hope this reassures my hon. Friend—that the latest GP patient survey results show that four GP surgeries in his constituency scored 91% or above in terms of satisfaction with care. Two of those practices—the Cromwell medical centre, which achieved a 92% rating, and the Warden Lodge medical practice, which achieved 93%—are in the Cheshunt area.

I am assured that the PCT will hold discussions with East and North Hertfordshire GP consortium and involve it fully as it conducts that further investigation. I am also assured that the PCT will have conversations with the public and other stakeholders, including my hon. Friend if he wishes, to gain further understanding of the needs of the local population, and to explain to potential users of the services what a minor injuries unit can provide. In addition, I am advised that the PCT will strengthen its performance management of GP practices to address the problems that some local people have experienced. I fully understand my hon. Friend’s concerns, but the board has decided that the PCT needs to explore further the possibilities of setting up a minor injuries unit. I understand that the PCT will test the feasibility of the new unit with providers.

Question put and agreed to.

Public Health White Paper

Charles Walker Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

I agree with the hon. Gentleman. Almost 22,000 people with HIV are unaware of their condition. We need to ensure, through the sexual health services, that people have consistent access to HIV testing and are encouraged opportunistically to ensure that they are HIV tested so that we can deliver the services they need. What he describes is one of the opportunities that we can examine when considering how the outcomes framework will measure the performance of local health improvement plans.

[Mr Charles Walker (Broxbourne) (Con)]

I have just learned that for the past year Hertfordshire primary care trust has been plotting to close the enormously successful urgent care centre in Cheshunt. If that happens, can the local authority step in, if its finances allow, to run the urgent care centre?

[Mr Lansley]

I was not aware of what my hon. Friend describes, and strictly speaking it does not relate to the White Paper. None the less, it will remain the case that local authorities, through current overview and scrutiny arrangements or future scrutiny arrangements, have the ability to ensure that major service changes of that kind are subject to scrutiny. If such changes are not justified in the interests of local people, they can be referred to me and I can seek the independent reconfiguration panel’s advice.