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.