Mental Health
Charles Walker Excerpts(11 years, 6 months ago)
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Mr Charles Walker (Broxbourne) (Con)
It is a pleasure to follow the hon. Member for Bridgend (Mrs Moon), who made an important speech on the mental health of military veterans who serve this country so bravely in many theatres.
I am in the Chamber because this debate is extraordinarily important. I could spend this Thursday knocking on doors in my constituency and pressing the flesh. If I was lucky, I might meet 100 people, but by being here, I can represent the interests of many thousands of people. That is why the Chamber of the House of Commons is so important. I hope that, this afternoon, I speak up for the interests of many thousands of my constituents who suffer directly from mental health problems and illness, and many thousands in their families who support them.
We have come a long way in the past year. In June 2012, we had a great debate in the Chamber. Many familiar faces who took part in that debate are in the Chamber this afternoon. In a sense, the lid has been lifted. People now feel much more confident speaking not only of their own mental health experiences, but of mental health in general, and the hopes, aspirations, fears and expectations of their constituents.
Although I have been involved in mental health for about seven years as vice-chairman and now chairman of the all-party group on mental health, I have met an enormous number of organisations in the past year. I have written a few of their names down on a piece of paper. I will not read them all out—that would not look too good in Hansard tomorrow—but I will focus on two or three special people I have met.
Daniel Macnamee from Changing Our Lives has suffered from psychosis and has been very unwell for significant periods. He is well at the moment and recognises the signs when he is about to become ill, so the process and his drug therapies can be managed. Daniel is doing extraordinary things. He is an advocate for people with mental health problems and who are ill, including within hospitals—people who have been either detained or who are there of their own volition.
Andy Sawford (Corby) (Lab/Co-op)
The hon. Gentleman mentions a constituent who becomes aware before he has a psychotic episode. In that situation, he would want acute and crisis services. Is the hon. Gentleman aware of Mind’s work on that? It recently surveyed all primary care trusts, which are now clinical commissioning groups, and mental health trusts about their acute and crisis care services. Does he agree that we ought to ensure that such services are available to people such as his constituent and my constituents?
Mr Walker
I thank the hon. Gentleman for that information. I have campaigned alongside Mind for many years to ensure that people have such services. We talk about support within the community, but it is variable and people’s experience of it is variable. If we are to get things right when people go into crisis or feel a crisis coming on, they need to be confident that the support they require will be there for them. That is why having a crisis plan is so important: people’s wishes can be respected. We too often talk over the heads of people with mental health problems, unwellness or illness—however we define it. We need to be aware of their wishes, because have an absolute obligation to their welfare and to respect their wishes.
Daniel, from Changing Our Lives, is not a constituent; he is just one of the most inspirational people I have met in the 45 years I have tottered along this mortal coil. He is a wonderful man and I am full of admiration for what he is doing.
A couple of days ago, I met Liz Johnson from UK Changes, who works in Staffordshire to ensure that people with mental health issues can remain and keep a foothold in the workplace. For those who are out of the workplace due to illness, her organisation provides mechanisms to help them get back in. The organisation has some reach and I strongly recommend that the Minister meets its representatives. I know there is a drive to ensure that people who have suffered from mental health problems have the opportunity to re-engage with the labour market. One great sadness is that the chance of being in work for those with a diagnosis of psychosis or schizophrenia is approximately 8%. A 92% unemployment rate is unacceptable.
Dame Anne Begg
Generally, people with mental health issues have been in work—they are not young and may be in middle age—but have fallen out of it. Does the hon. Gentleman agree that there needs to be a lot more work done with employers to ensure that an episode of mental ill health does not lead to people being sacked and becoming unemployed? Employers need to be much more sympathetic, helpful and understanding to keep people in the job they already have.
Mr Walker
The hon. Lady makes a fabulous point. Many organisations are doing that at the moment. The Work Foundation launched a report in the House of Commons a couple of months ago, and I was delighted to be able to speak at that event. Some people who had been excluded from the labour market for many years but are now in work spoke at the launch downstairs in the Churchill room. It was moving and uplifting. Good news stories tend to be uplifting and we need to have more of them. There is still a lot of disappointment and sadness in this area, and that is why we have such an obligation in this place to work with all Governments to improve outcomes and ensure we get things right.
Rehman Chishti
Like every other hon. Member here, I pay tribute to my hon. Friend for the work he has done on this issue over many years. Does he agree that the current NHS approaches are too focused on fighting fires, and that more investment in community and preventive care would improve quality and potentially reduce costs, a view shared by an expert from Imperial college?
Mr Walker
I agree with my hon. Friend. We need to ensure that the systems are in place in local communities to provide people with the support they require. Care in the community is a great concept if that care exists. It exists more in some places than in others.
I will not read out all the names on my list, but they show that civil society is alive and well. They are not statutory organisations; they are founded and run by people who wanted to reach out and do something about a problem that was relevant and prevalent in their community. I am full of admiration for them.
Ian Austin (Dudley North) (Lab)
I am grateful to the hon. Gentleman for giving way; he is being very generous. Like other Members, I pay tribute to him for his work on this issue. Before he moves on, I want to touch on the important point about employment. A constituent has written to me to say that employers need to be far more open to the idea of encouraging their employees to talk about these issues and support them in times of need. The loss to companies could be greatly reduced if they were able to support employees through times of mental fatigue and mental illness. Does he agree?
Mr Walker
Absolutely. A lot of good points are being made this afternoon and that is another one. BT and Legal & General are doing a huge amount of work on this. BT does it because it is a decent employer, but also because it wants to hold on to some of its top performers who make a difference to the business. It therefore makes sense to support people and ensure they can stay in work.
We have a fabulous civil society doing wonderful things. The great thing about the area of mental health—it is not all doom gloom; far from it—is the diversity of provision. There are a lot of people out there thinking about different ways of doing things, ways that work for the particular communities they serve. That is to be applauded and promoted. We need to support organisations that provide services that meet the needs of specific groups and their community.
Jason McCartney (Colne Valley) (Con)
I thank my hon. Friend for lifting the lid off the whole issue of mental health. The more times we talk about it in this Chamber, the more we can break down the stigma. It does not surprise me that he has such a long list of wonderful people and local organisations that are doing great things. I met representatives of the State of Mind campaign, which is running in rugby league. It is not a particularly well paid sport, but the campaign is helping young men who suffer from mental health issues. Will he continue, with me and other Members, to support those organisations and the wonderful people who are breaking down these stigmas?
Mr Walker
My hon. Friend makes a fine point. I want to touch, at the end of my speech, on resilience and the terrible tragedy of suicide among young men and women, so I will come back to that.
I remain terribly concerned about psychosis and schizophrenia. I mentioned a few minutes ago that anyone with a diagnosis of psychosis or schizophrenia is likely to be unemployed. If one is not unemployed at the time, one will end up unemployed. Life expectancy, which has already been mentioned today, can be up to 20 years shorter than for someone who does not have that diagnosis. That is not acceptable in a civilised society and should not be tolerated. I have spoken about this before in an Adjournment debate and I want to revisit it because it is so important.
My concern, having talked to people who care for loved ones with schizophrenia—sons, daughters, mothers or fathers—is that sometimes the NHS is more interested in managing the illness than with the overall health needs of the patient. Symptoms are managed down so that patients do not make a nuisance of themselves and take up time, but when one stands back and looks at them, one sees they are desperately unhappy. It does not matter if they are smoking 70 or 80 cigarettes a day, because they are not making a nuisance of themselves. It does not matter if they weigh 20 to 25 stone, because they are not making a nuisance of themselves. It does matter, however, because that patient is slowly killing himself or herself and we have to address that.
I know that the Minister and other colleagues share my concerns, but as a civilised society we just cannot allow this to continue. Yes, progress is being made in the advancement of drug therapies, but not fast enough in mental health. We still have treatments that were breakthroughs in the ’70s and ’80s, but we have not moved on to the 2010s and beyond. The hon. Member for Bridgend rightly said that we have to be very careful about the language we use today and not frighten people. I do not want to frighten people and I hope that she does not think I am, but I get terribly moved when a constituent, who is very ill and being cared for in hospital, writes to me and tells me that once every other week he is held down on the bed and has an eight inch needle injected into his backside. I just think that that must be terribly demeaning, distressing and awful—I am sorry, I am a bit upset about it. We need to get to a place where that does not happen anymore. It will take time, but we need to get there.
Norman Lamb
I pay tribute to the work my hon. Friend does on mental health, and the extent to which he argues the case for a fair share of resources and attention to be given to it. Does he agree that it is important for clinicians, who he was talking about earlier, to listen to loved ones and family members to hear their perspective? Of course there is the issue of confidentiality, but sometimes clinicians hide behind that and are not prepared to listen to those who know the patient best of all.
Mrs Moon
I wanted to follow up on the same issue as the Minister. In preparing for this debate, I received many e-mails from people who had to become experts in the condition in the hope of protecting a family member from exactly the sort of abuse that the hon. Gentleman is talking about. The fear that carers feel when a loved-one comes into contact with the health services, which should be there to protect them and aid them in their passage through their illness, should not exist. That fear should not add to the trauma of their treatment. That is something we have to address.
Gloria De Piero
I wanted to intervene because people were talking about family members. I have a close family member with a severe mental illness. It was a big part of my childhood and early adulthood, and remains a big part of my life to this day. It is so important that we have this conversation. It is not something that people share or talk about because of the stigma that surrounds it. Instead, people internalise it, deal with it and become their own expert, so I would like to thank the Backbench Business Committee for returning to this important issue. It is time to talk and time to change, and I thank the hon. Gentleman, along with Rethink and Mind, for their work in this area.
Mr Walker
I know that the hon. Lady is an expert on these matters. I was going to say in response to the hon. Member for Bridgend that there are experts in this place. I did not want to identify the hon. Member for Ashfield (Gloria De Piero), but, to her enormous credit, she has identified herself. She is a fantastic representative of her constituents, and it is a delight to have her here today.
We have to make progress on drug therapies. Lord Stevenson of Coddenham, who is known to me and the hon. Member for North Durham (Mr Jones) very well, is doing enormously good things in this area. He has established a charity with a significant budget to look into new treatments, pathways and the brain. The charity is called MQ, its chief executive is Cynthia Joyce and I commend its work to the Minister. I would also like to thank my hon. Friend the Member for Loughborough (Nicky Morgan), who cannot speak today because, according to some bizarre convention, Whips cannot speak in the Chamber, which is a great sadness, because I wish she could. I also thank my hon. Friend the Member for Halesowen and Rowley Regis (James Morris), who has done much in this area, and of course the hon. Member for North Durham, who has become a great friend over the past year and is a fellow musketeer in these areas.
I said that I would touch on suicide. We need to build mental health resilience in our schools. That should start at a very young age. It is a great tragedy that many young men and girls decide to end their lives in their teens and early 20s. It is a public health issue, and we need to address it.
Jeremy Corbyn
I compliment the hon. Gentleman on his speech and on his work on this subject. I am glad that he has raised the issue of suicide. Like me, he must be shocked by the number of suicides and attempted suicides within our prison service and by the number of prisoners clearly suffering mental health problems but not receiving the care and support they need. Does he agree that we need a much better regime of training and support on mental health issues for all prisoners?
Mr Walker
I absolutely agree with the hon. Gentleman. It is a great sadness that we shut down and cleared out the asylums only to put too many of those people in our prisons. They go in ill and they come out even more ill and more addicted. It is a disgrace and something we need to address.
I thank colleagues for being here today. I know that the call of their constituencies is hard to resist, but they will be congratulated by their constituents for taking part in this debate. I commend the work of the all-party group on mental health. We have done a lot of work on mental health, schizophrenia and ethnic minority mental health. I see that my hon. Friend for Taunton is here—no, it is not Taunton, but? [Hon. Members: “Totnes.”] Well, it begins with a T for crying out loud. What’s a T among friends? I thank my hon. Friend the Member for Totnes (Dr Wollaston) for her great work. I thank you, Madam Deputy Speaker, and the Backbench Business Committee for allowing the debate to take place, and I thank the Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), who was also a fabulous Minister, for giving the matter such attention and focus. They are to be lauded and applauded.
John Pugh
We are presumably talking about unintentional memory lapses—senior moments that may afflict any of us.
There is no absolute cut-off point between mildly obsessive behaviour and obsessive compulsive disorder, between mood swings and genuine bipolar conditions, or even between irrational fears of which everybody is sometimes a victim and some of the conditions we would call paranoia. There is a continuum; it is, to some extent, a matter of degree. It is even possible, apparently, to have hallucinations without having schizophrenia. Delusions are not unique to asylums; there are many victims in this place. There is nothing especially rational about clever, civilised people gathering here every Wednesday at 12 o’clock just to shout at one another.
There are two aspects to addressing the stigma of mental health. One of those is to persuade people that this can happen to anyone, including MPs. That is very important. The other job is to persuade the public that mental health is not an either/or, black/white distinction. I recognise that there are conditions such as serious neurological malfunctions, deterioration of the brain, and so on. Affective disorders can be evident in people classified as being well and also in people classified as being unwell with mental health issues. What determines the classification is not only the severity of the condition—the extent to which the person is down one continuum or another—but the capacity of society to deal with the condition and the ability of the person to cope within society with the condition. The cultural comparison made by the hon. Member for Bolton South East (Yasmin Qureshi) is useful in this context. The mental health of a society and the mental health of individuals are intertwined, and one is the index of the other. I wonder whether, when we talk in this place about producing a prosperous society or economic growth, or doing something about social mobility or social inequality, we ask ourselves sufficiently whether we are doing enough to make society a happy place for us all to live in.
Let me add one other point with which I think you, Madam Deputy Speaker, will be au fait. Community treatment orders were a bone of contention throughout the passage of the Mental Capacity Act 2005, when I served on the Bill Committee. We have to review that issue, and the Minister needs to make a response. I think that we made the right decision, but that depends on whether the Act is understood and implemented properly. There is a genuine case, particularly given some of the variations, for trying to see whether we have got it right.
Mr Charles Walker
On that point, it is very important to ensure that advocacy requirements are being met.
Jane Ellison
No; to the eternal shame of this country, in 25 years of this being an illegal act, there have been no prosecutions.
In recent times—I will return to the mental health aspects in a moment, Mr Deputy Speaker—we have had encouragement because Keir Starmer, the Director of Public Prosecutions, has been really good on this issue. He has a new action plan for the Crown Prosecution Service. It has reopened several old cases and is going through them with the police to see whether a prosecution is possible. It is also looking more imaginatively at prosecuting the aiders and the abetters, such as the people who set up the travel and those who supply the strong pain killers. If we wait for a seven-year-old girl to walk into a police station and report her parents, we will have a long wait. That is one reason why there have been no prosecutions. However, I am more optimistic now than ever that the police and the CPS are taking the matter seriously.
To return to the mental health aspects, a recent survey by the National Society for the Prevention of Cruelty to Children showed that 83% of teachers either do not know about FGM or have had no training on it. From memory, 16% of teachers thought that condemning FGM was culturally insensitive. That is extremely disturbing, given that it is an illegal act.
Mr Charles Walker
It is child abuse. There is no ambiguity. It is child abuse and it must be stopped.
Jane Ellison
I could not agree more.
My worry is about the 83% of teachers who just do not know about FGM or have not had the training. There are good guidelines, but they are not statutory. Not enough is filtering down. In my constituency, I have encountered people who say, “Don’t go there. It’s too difficult.” There is a role for Members of Parliament in pushing this matter at a constituency level. If teachers have no idea what FGM is or what the behavioural and psychological consequences might be, they will fail to understand why a young girl who has come back from being mutilated abroad is exhibiting naughty, disturbed or bad behaviour. It is therefore important to get more knowledge out there about the physical and psychological aspects of FGM so that we can understand and help children who present with signs of being disturbed.
In UK culture, women have an expectation that their sex life will be enjoyable and that they can have a normal expression of female sexuality. That is very much at odds with the mentality that leads to somebody being mutilated. Many of the women who are suffering the physical and mental complications of FGM do not speak English and live in socially isolated communities in which they are not encouraged to speak about it because it is entirely taboo. That is added to the taboo of speaking about mental health.
The lack of knowledge about FGM among teachers and medical professionals will increasingly be a problem as diaspora communities become scattered to places in the country where professionals do not see it as much. It is easier for a specialist in central London to know what they are looking for. Even if we stopped all FGM happening to young girls tomorrow—would that we could—we would still have to deal with the large number of women who are suffering the long-term consequences of it.
There is documentary evidence that some parents have second thoughts about having done this to their children. Some parents express regret. The Home Office had a good initiative last year, which we adopted from the Dutch, in which it provided girls and parents with a health passport to carry abroad with them to remind members of their extended family that the practice is illegal in the UK and that they must not do it, but must respect the rights of the child.
Mr Charles Walker
I apologise to the hon. Lady because I am about to leave the Chamber—I am chairing a debate in Westminster Hall in a moment. I agree entirely that Atos should not be a blunt instrument used to beat those who have mental illness. We need a system that empowers people with mental illness to re-enter the labour market, and not one that terrifies them.
I endorse the hon. Lady’s views on young men. Young men need to feel part of something and they need to feel wanted by their community. They need to have a job and a role. If they do not have those things, they join gangs. Her point about young men was beautifully and perfectly made.
Ms Abbott
I entirely agree with hon. Gentleman. Changes in society and economic changes such as the collapse of manufacturing and of de-industrialisation have left many young men unclear about their role, which puts tremendous pressure on their health and well-being.
Before concluding, I want to say a few words on black and minority ethnic persons and mental health. It has been known for at least 25 years that BME persons are disproportionately present in the mental health system. We are more likely to be diagnosed as schizophrenic, less likely to be offered talking therapy, and more likely to be offered drugs and electro-convulsive treatment—the hon. Member for Totnes touched on that important point. There is therefore a great deal of fear and anxiety about approaching the mental health system on the part of some of our BME communities. Very often, mothers will be trapped at home with sons who have serious mental challenges. I have dealt with cases in which they are assaulted in their own homes, but are so frightened of the system that they will stay trapped rather than take their sons for treatment. That is a real problem. We must monitor what is happening and use the voluntary sector. We need to ensure that minority groups do not hold back from presenting with mental health problems. The later people present, the more severe the problems.
Mental health is the biggest financial burden on the health service. It will affect the families of all hon. Members in the Chamber in our lifetimes. There is much to be concerned about in mental health trends. For instance, there is a rise in mental health issues among young people. Fully half of lesbian, gay, bisexual and transgender youngsters are self-harming.
As I have said, there is a relationship between an economic downturn and a rise in suicides of men under the age of 35. None the less, there is the possibility of progress. I believe that there is now less stigma about mental health than there was a generation ago, and the debate we had last year on the Floor of the House played its part in helping to lessen it. I think there is more understanding about some of the contributory issues than there was a generation ago, and I believe that public health going to local authorities opens up the possibility of innovation in mental health, working together with the voluntary sector.
I am grateful to the right hon. Member for Sutton and Cheam for securing the debate. I hope that it is part of a process of parity of esteem that will improve the outcomes for so many of our men, women, family members and communities.
Health and Social Care
Charles Walker Excerpts(11 years, 6 months ago)
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Mr Charles Walker (Broxbourne) (Con)
I pay warm tribute to the right hon. Member for Cynon Valley (Ann Clwyd). That was an incredibly moving speech—we could have heard a pin drop in the House of Commons throughout those eight minutes—and a fantastic contribution to the debate.
I had intended to make a statesman-like speech, but sitting next to me is possibly one of the greatest statesmen, my right hon. Friend the Member for Mid Sussex (Nicholas Soames). I do not want to go out and bat on a losing sticky wicket; I would rather have a general thrash around the field of play. I admit to the right hon. Member for Leigh (Andy Burnham) that I am a Eurosceptic. When I came to the House of Commons, I fell into bad company, including my hon. Friend the Member for Aldershot (Sir Gerald Howarth). Indeed, when I arrived here, I was nursed at the bosom of my hon. Friend the Member for Stone (Mr Cash), so I am a Eurosceptic—[Interruption.] Anyway, I want to crack on.
In 2011, I attended a public meeting in my constituency. We were discussing the future of an urgent care centre. Five hundred of my constituents were there for a lively debate, which ended at about 8.30 pm. I had arranged at 9 pm to travel northwards in my constituency to Hoddesdon to meet 12 or 14 Polish people. As I left the room of what I would regard as fairly natural Conservatives and got in my car to drive up the A10, I thought, “Why on earth am I heading up the A10 to meet 12 or 14 Polish people?”
I was pleased I did. They waited in a circle to see me. We were in a recession at the time, but their eyes were gleaming and glittering. They said, “Mr Walker, this is the land of opportunity. It is fantastic. You don’t just get one job here; you can have two jobs. If you do those jobs really well and do what you are asked to do, you get promoted. This is a fantastic country.” It was so refreshing to see such enthusiasm in the room.
We should have had transitional measures in place when the Poles came over to this country. It was not good enough to say, “There might be 15,000 or 30,000,” when 500,000 ended up coming here. That was a grave error. However, to say that the Poles are somehow responsible for the country’s problems is a gross simplification and a fairly disgraceful statement to make. As I have said, I wish fewer had come here, because we should have had transitional arrangements. The infrastructure was not ready to welcome 500,000 people to this country, but I cannot fault them for a second for wanting to come here.
People say that people from eastern Europe want to come to this country to sponge off the NHS and our welfare system. The minority will, but the majority want to work hard and do the best for their families. There are rotten apples from European nations in this country, but there are quite a few rotten apples from this nation in foreign countries—hon. Members might have managed to see that a British fugitive was arrested by Spanish police yesterday on the Costa del Sol.
Immigration is not a uniformly good thing. It tends to work for the middle classes and the upper middle classes, whatever they are now. Basically, it works for people with money. Immigrants work very hard in our restaurants and cleaning our offices. However, immigration does not work so well if people are competing for scarce resources such as health, transport and education. I understand the concerns of people who now face additional pressures on scarce resources. We did not plan well. I do not want to sound overly partisan, but—dare I say—the previous Government did not plan well for the upsurge in immigration, which has created difficulties in our constituencies and a great deal of concern.
In my remaining three and a half minutes, I want to say a few more things about immigration. I am not a soft touch on that matter. I am extremely concerned about the continued underperformance of the UK Border Agency. About six years ago, I made the decision not to deal with immigration cases in my surgeries; I have enough problems from my own electorate to deal with, without having to take up UKBA’s case load as an unpaid officer.
Although our immigration system is improving, it still has a long way to go. It is simply not right that some people in this country should have to wait seven, eight or nine years for a decision on whether they can stay here. That is inhumane—it does not serve them or the taxpayer well. Unfortunately, those people are egged on by fairly ruthless and unpleasant lawyers, who keep lodging appeals and dragging out the process. However, it is we as politicians, of course, who provide the scope and room for those people to pursue those endless appeals processes. We must truncate the appeals process.
Mr Robin Walker (Worcester) (Con)
I congratulate my hon. Friend on his excellent speech. Does he agree that a system that does not work and leaves people in limbo is neither efficient nor compassionate?
Backbench business
Charles Walker Excerpts(11 years, 9 months ago)
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Caroline Nokes
I welcome the opportunity to summarise briefly. We have had a full and interesting debate. I pay particular tribute to my hon. Friend the Member for Basildon—I am sorry, I mean Braintree (Mr Newmark). I am trying to send him to a different part of the country. Everywhere in Essex begins with B! His contribution was fantastically personal and moving. I am convinced that many other hon. Members in the House have had personal experience of eating disorders in their families or personally, and we must, as the Minister said, take such disorders more seriously. I was delighted to hear his words this afternoon about his personal commitment while he remains in his job—long may that be so.
I thank all hon. Members who spoke. Many were unable to be here for the full time, but they came and went. Two important debates are taking place in the House this afternoon, which were also granted by the Backbench Business Committee, so I am conscious that we have been competing with others for parliamentary time and attention. I want to take this opportunity to reiterate some of the key points that we have made.
There must be continuity of care. We heard the important point about the transition from child services to adult services, and how some sufferers can fall through the gap. Equally, that transition, whether from school to college or college to university, may be a tipping point for those who suffer eating disorders when they need continuity of care. My strong argument to the Minister is that there must be flexibility in both specialist services and GP services so that if a young person moves away to university, there is joined-up thinking and treatment, and no moment of crisis when a young person does not get the care they need.
We have heard from hon. Members about the impact of eating disorders on male sufferers. They are the fastest-growing group, but that does not detract from the fact that clearly the majority of sufferers are women, and the vast majority are young women.
One stark statistic that I want to close on is that 20% of anorexia nervosa sufferers die from that condition. We must do more to ensure early intervention so that that number falls.
I thank the Minister for his time, and you, Mr Walker, for chairing the debate. I also thank all hon. Members who took part this afternoon.
Mr Charles Walker (in the Chair)
Thank you, colleagues, for such an informative debate, which was Parliament at its very best.
Question put and agreed to.
Accident and Emergency Departments
Charles Walker Excerpts(11 years, 9 months ago)
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Gavin Barwell
The honest answer to the hon. Lady’s question is that I do not know. I am simply relying on the report, which is suggesting that that analysis points to 500 as the number of deaths that are purely due to the timing of the week. We could argue about the figure, but I hope that she would agree on the point of principle that having fewer consultants on at the weekend must impose some level of risk.
The report also says:
“The Royal College of Surgeons state that a critical population mass is required in order to provide an efficient and effective emergency service. This is supported by literature that suggests that surgeons who perform a high volume of procedures tend to have better outcomes. The preferred catchment population size for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency surgical cases would be 450,000-500,000.”
We have a problem. We have a large number of hospitals in London with accident and emergency departments and they do not have the recommended level of full-time equivalent consultant cover to provide the best medical outcomes. Every single Member of this House will defend their local hospital, as that is where their constituents go for treatment. If I was in the same position as the hon. Member for Mitcham and Morden, I would be doing exactly the same.
Gavin Barwell
I shall give way to my hon. Friend, because I promised that I would.
Mr Charles Walker
The problem in north London—and in Broxbourne on the edge of north London—is that Chase Farm is serving a growing population. I do not want to keep Chase Farm A and E open because of any emotional attachment to it, but because we have a population that is due to grow by another 40,000 over the next few years.
Gavin Barwell
My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.
The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.
Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:
“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”
The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.
There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.
NHS Funding
Charles Walker Excerpts(11 years, 11 months ago)
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Mr Deputy Speaker
Order. I am sure that the hon. Member for Broxbourne (Mr Walker) is not going to walk out after his intervention and will stay a little longer.
Mr Walker
The meeting is in thirteen minutes.
My right hon. Friend knows that it is not just about funding but about good management. He cannot be responsible for management across the NHS, but in the East of England ambulance service there are question marks over the quality of its senior management. Will he find time to cast his eye over those senior managers?
Mr Hunt
I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.
Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[Interruption.] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.
Schizophrenia Care
Charles Walker Excerpts(11 years, 11 months ago)
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Mr Charles Walker (Broxbourne) (Con)
Let me start by saying that I am a great enthusiast and a great optimist. I enthusiastically believe that in the area of schizophrenia we need to do more of what we do well and less of what we do badly—more of the good stuff and less of the bad stuff. I pay tribute to the fantastic men and women who work in the NHS in mental health; they are the unsung heroes. It is not the glamorous end of the NHS but it is, perhaps, the most important.
I want this to be an upbeat speech—I really do—but I think that at the beginning we must focus on what we do badly. First, I am very concerned at the fact that the life expectancy of someone who has a diagnosis of schizophrenia or psychosis is up to 20 years less than that of someone who does not have that illness or disease. I do not believe that that is acceptable in a first-world civilised society; we cannot tolerate it any longer. I am concerned that young and middle-aged men and women around the country who have a diagnosis of psychosis and who live with schizophrenia might well end up smoking 60 or 70 cigarettes a day, gaining huge amounts of weight and living pretty desperate lives. Their drug therapies cause them to feel pretty miserable and disconnected, and that is why we end up in this terrible and desperate situation of such a lowered life expectancy.
Secondly, we need a system in which people are not frightened. Being ill is not a pleasant experience. People are naturally fearful, but too many people suffering from psychosis or schizophrenia are very scared and very frightened far too much of the time. That is very upsetting for many people. It is upsetting for them and for their friends and families, and I am afraid it is upsetting for those of us who observe this going on and want to change things. Again I say, we are a first-world society and we cannot have people feeling frightened and separate.
Thirdly, we lock up far too many people who are ill. There are 7,000 people in secure units, many of whom should not be there, but we do not know how to get them out. We do not know how to take them out of a secure unit and reintegrate them into society. Those processes are not in place, so we remove people’s liberty, sometimes for their own good to stop them harming themselves, and in the most extreme cases to stop them harming others. But we must ensure that when they are in these places they feel safe and secure and that the systems are in place to enable them to return, as far as possible, to mainstream society.
Finally on the bad things that we must stop doing, only one in 10 people who are diagnosed with psychosis or schizophrenia are in work. We have an unemployment rate of 92% and we all know in this place that employment is the route to fulfilment: being in a career with friends and colleagues, having a sense of purpose, being able to get up in the morning to go to a place that is welcoming and to which we want to go.
Let us now be upbeat. What we need is a manifesto of good things. We need more and earlier interventions, because the quicker we can deal with a problem the more chance there is that it will remain manageable and the less likely it is to escalate to something far more serious. That is why we need early interventions.
Mr Brooks Newmark (Braintree) (Con)
I appreciate that I did not speak to my hon. Friend about his debate, but I have been listening to him and I congratulate him on holding the debate. Does he agree that another bad thing that happens with schizophrenia is that people are left to roam the streets and end up homeless, and that a huge number of people are afflicted by schizophrenia and other mental illnesses with whom we need to deal?
Mr Walker
My hon. Friend makes a very good point. I have had an extremely good paper from St Mungo’s dealing with that very issue.
We also need to do more listening. We must stop talking over people who suffer with psychosis or schizophrenia. They are warm, live human beings. They exist. We tend too often to talk over them and about them, not to them. Certainly there will be times when they are in crisis, but when they are we need a crisis plan so that they can tell us how they want to be treated, looked after and cared for—how we can help to secure their dignity. Then we need to ensure that they have advocates who can sit alongside them and be their voice—someone they trust at a time of crisis, illness and distress.
We need more support for carers—the people who love them, the people who stand by them day in and day out, trying to do the right thing, trying to get them the care that they deserve and require—their champions. Let us not forget in this place the important role that carers play in being the champions. We need much more talking and listening to carers, involving them in the process. They will know so much more about the individual being cared for than probably anyone else.
Then we need to provide more training for people working in the mental health arena. It is a demanding environment. In the acute settings people tend to be admitted who are very ill. The threshold for admittance is so much higher now. The staff need to be trained to deal with and to care for these people. It is no reflection on the staff that I am asking for this. I want to stand shoulder to shoulder with the staff. We want to stand alongside them and help them to deliver the care that they want to deliver, and that their professional pride demands that they deliver.
Robert Halfon (Harlow) (Con)
I congratulate my hon. Friend on securing the debate and on his knowledge of the subject. He talks about early intervention. I recently visited the North Essex Partnership NHS Trust, which works on mental health. It puts people into schools to identify children and young people who are developing such problems, which has a huge impact and manages to stop more serious problems developing later.
Mr Walker
My hon. Friend makes an excellent point on early intervention. It is about getting there before the crisis occurs and making sure that people who are at risk have the support they need to manage their illness so that they end up in a good place, not a frightening place.
We need more peer support. When someone goes through a mental health crisis, many people tell them that it will get better, but they might not be believed, as things can look pretty dark and desperate at the time. There are many professionals around, but perhaps that person wants to talk with someone who has been there, travelled through the fire they are going through and come out the other side, someone who can sit with them and say, “We’re going to work through this together. I’m not just saying this; I’ve actually done it. I’ve been where you are and I’ve come out the other side. I’m going to take you by the hand and we’re going to walk through this together.” That is peer support, and we need to encourage it and see more of it.
We need more intermediate services, because many people are terrified of going into acute care and too often the experience is not a good one. Being hospitalised is frightening. They do not want to go into acute care because they are terrified by that prospect. Let us think more about intermediate care. When things are getting on top of someone and they are feeling stressed out, that perhaps the ground is going from underneath them and that things are getting out of control, there should be a place they can go in the community, a crisis house, where they can say, “I need help, because I feel that I’m going to have some troubled times ahead.” There they can be told, “Come on in. We’re going to work together for the next couple of weeks. We’re not going to be a crutch and you aren’t going to be here indefinitely, but we will work together for the next five or 10 days or two weeks to get you back on your feet and out there again.”
We also need uniform reporting. I want diversity of provision, because out of diversity comes innovation, but I also want to know what is going on. I want to know when we are successfully meeting the needs of those with psychosis and schizophrenia, but I also want to know when we are not, because that is when we can start doing something about it. With heart disease, cancer or stroke, we can check the league tables and know exactly what is going on, but it is much more difficult with mental health problems, particularly psychosis and schizophrenia, so we need uniform reporting. I am concerned that the Care Quality Commission is stopping its in-patient surveys in mental health wards, which I think is a mistake. I think that it is regressive and that it needs to be revisited. I hope that I can bring the focus of the House to bear on that issue.
Patients need a voice. They need to be able to tell us what is and is not working. Most of all, we need to ensure that people have a chance of living fulfilled and complete lives and that a diagnosis of psychosis or schizophrenia is not the end of the road. They should not hear, “That’s it. Society will now turn its back on you. You’re in real trouble and you’re going to be removed.” We must have absolutely no more of that. We have an obligation to work together on mental health problems in this place and with the NHS and to say to people, “We’re going to work together to get you through this. You have a right to have a chance for a fulfilled, happy and productive life. What has gone before is not good enough, but what will come will be better.”
I have said that I am an enthusiast and an optimist, and I am optimistic. We have the bit between our teeth, we are moving ahead and mental health is being talked about, but schizophrenia and psychosis is a difficult area for politicians and for the public, because so much misinformation and nonsense has been talked about it for so many years. It is going to be the hardest mountain to climb, but climb it we must, because we have an obligation and a duty in this country to take everyone with us. We must not leave people behind because they are ill but take them with us on a journey together—a journey towards wellness.
I have spoken for far too long and I am now much more interested to hear what the Minister has to say. I conclude by saying this: I speak a lot about mental health, but I am fully aware that an army of people out there, professionals and charities, do mental health and do it extremely well. Mind and Rethink are fantastic organisations that campaign daily, hourly, by the minute to ensure that people with mental illness get a voice. As a result of their hard work, those people are getting a voice in here, and that is a good and positive thing.
Mental Health Act 1983
Charles Walker Excerpts(12 years ago)
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Mr Hunt
As a result of the technical irregularities that we have identified and put right, I do not believe that what the hon. Gentleman describes has happened. Let me explain that when I say “we believe”, it reflects the advice we have had that there are good arguments on why the detentions were and are lawful, but that is not to say that those arguments cannot be challenged or that a court would necessarily agree with us. That is why it is necessary to take this unusual step of introducing emergency legislation.
Mr Charles Walker (Broxbourne) (Con)
Removing the liberty of ill people is serious business, and deserves to be taken seriously. That has not been the case for the past decade, or perhaps even longer. I hope that, as we go forward, we can ensure that people who are ill get the representation and advocacy they deserve and that they—and, most importantly, their rights—are taken seriously.
Mr Hunt
My hon. Friend is absolutely right. As a result of the new structures in the NHS, responsibility for ensuring that all patients who are threatened with detention receive the advocacy to which they are entitled under the Mental Health Act will be transferred from primary care trusts to local authorities. We will use this opportunity to review the arrangements, talk to local authorities, and do all that we can to ensure that those functions are discharged in the way my hon. Friend seeks.
Mental Health
Charles Walker Excerpts(12 years, 5 months ago)
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Mr Charles Walker (Broxbourne) (Con)
It is absolutely fantastic to follow the hon. Member for North Durham (Mr Jones). I was a researcher here in the early 1990s and a few Members present were here at that time. They will remember the debates about homosexuality. There were some discriminations, as there still are, in relation to homosexuality, and people were beginning to feel very uncomfortable about that. Many colleagues came to this place to take part in those debates, and they would say, “These discriminations against homosexuals are disgraceful, but I am not gay myself.” They did not want to be perceived as gay because they had an interest in those matters.
I am delighted to say that I have been a practising fruitcake for 31 years. It was 31 years ago at St John’s Wood tube station—I remember it vividly—that I was visited by obsessive compulsive disorder. Over the past 31 years, it has played a fairly significant part in my life. On occasions it is manageable and on occasions it becomes quite difficult. It takes one to some quite dark places. I operate to the rule of four, so I have to do everything in evens. I have to wash my hands four times and I have to go in and out of a room four times. My wife and children often say I resemble an extra from “Riverdance” as I bounce in and out of a room, switching lights off four times. Woe betide me if I switch off a light five times because then I have to do it another three times. Counting becomes very important.
I leave crisp and biscuit packets around the house because if I go near a bin, my word, I have to wash my hands on numerous occasions. There has to be an upside to a mental health problem. I thought that the upside would be that I would not get colds, because apparently if you wash your hands a lot, you don’t get colds, but I wash my hands hundreds of times a day and I get extremely cheesed off when I end up with a heavy cold.
OCD is like internal Tourette’s: sometimes it is benign and often it can be malevolent. It is like someone inside one’s head just banging away. One is constantly striking deals with oneself. Sometimes these are quite ridiculous and on some occasions they can be rather depressing and serious. I have been pretty healthy for five years but just when you let your guard down this aggressive friend comes and smacks you right in the face. I was on holiday recently and I took a beautiful photograph of my son carrying a fishing rod—hon. Members may know that I love fishing. There was my beautiful son carrying a fishing rod, I was glowing with pride and then the voice started, “If you don’t get rid of that photograph, your child will die.” You fight those voices for a couple or three hours and you know that you really should not give into them because they should not be there and it ain’t going to happen, but in the end, you ain’t going to risk your child, so you give into the voices and then feels pretty miserable about life.
But hey, there are amusing times as well. I do not feel particularly sorry for myself, because my skirmish with mental health is minor. There are people who live with appalling mental health problems day in, day out, which is why I when I became an MP, I regarded it as a wonderful opportunity to try to help them. I hope that I have an insight into some of their pain and agony and the battles that they go through on a daily basis. Many people are frightened and feel excluded.
My first year and a half in Parliament was absolutely appalling. It was very, very difficult. My constituents thought that I was a jolly fellow—that is how I came across—but I remember sitting in my office going through my post. A book arrived with a letter saying, “Managing your Tourette’s”. I thought, “Oh my word, someone has spotted me on television. I’m done for. They’ve sent me a book and I’ll be outed in the newspapers: ‘Walker’s a loony’”. My constituents will turn their backs on me, my association will throw its hands in the air, and my children will be chased through the playground.” I sat in cold terror for 10 minutes, wondering how I would navigate my way through this. I then picked up the letter and realised that it was a circular that had gone to all 650 MPs, so I took great comfort from the fact that probably 50 others were having the same emotions as me.
We can talk about medical solutions to mental health problems, and of course medicine has a part to play. In reality, however, society has the biggest part to play. This is society’s problem, and we need to step back from our own prejudices, park them and embrace people with mental health problems. You only get one chance at life. You get about 80 years-ish. If you have severe mental health problems, you get about 65. Can you imagine going through your whole life feeling miserable, excluded, discriminated against, with little hope? I cannot. I have a wonderful vocation, I have a loving family, and I have a comfortable lifestyle, so I know, even when things are bad, they will get better, but a lot of people are not in that position, and we need to reach out to them.
I am really excited about the speech by the hon. Member for North Durham—I am very excited about that—and I am excited about the fact that my hon. Friend the Member for Loughborough (Nicky Morgan) secured this debate. We are making progress and moving in the right direction. We will hear from my hon. Friend the Member for Croydon Central (Gavin Barwell) in a few moments—or hours—about his private Member’s Bill. Many colleagues in the House are taking part in the debate. I think that some colleagues would like to be here but, again, if they are here discussing mental health, some people might feel that they have a problem. Look, it is a not a problem, it really is not: let’s get over it guys, and move on.
Media reporting has improved and we do not often see headlines such as “Frank Luno”, which was totally indefensible. The media are beginning to get on board, because there are many people in the media who suffer from mental health problems. As the hon. Member for North Durham alluded to at the beginning of his speech, who are these people out there? They are doctors, nurses, teachers and soldiers; they are all around us. Why would the hon. Gentleman’s constituents think any differently of him now than they did 20 minutes ago? In fact, they will respect him a great deal more. Why would my constituents think any differently of me now than they did 10 minutes ago? Those who disliked me will continue to dislike me; those who like me will continue to like me; and those who were slightly agonistic could go either way.
Here we are, having a great, great debate. The all-party group on mental health is going from strength to strength and, for the first time, I am feeling really positive and very happy. I am not going to speak for much longer, but I want to say two things. We need to sort out independent mental health advocacy for people who face incarceration or are on community treatment orders. Access to representation is patchy across the country, and we need to sort that out, because we cannot lock up people who do not receive proper advocacy or constrain their liberties without proper advocacy.
We also need to address Criminal Records Bureau checks under the heading “Any other relevant information” that are entirely at the discretion of the chief constable. I am aware of a number of people who have had mental health problems and have been detained for a short while. The police became involved, because they took those individuals into detention or to hospital. They go for a job perhaps as a counsellor or working in the charitable sector. They have a clean record but under “Any other relevant information” the chief constable can say, “We are aware that this person was detained for a mental health problem at this institution. We are not aware that they are a threat to adults or children.” That is that. That is the end of the matter, because we recognise that there is stigma and discrimination. I am afraid that in our ultra risk-averse world, that is a career death sentence for those people. We need to sort that out.
I join the hon. Member for North Durham in saying that I am not frightened any more. Like him, I am pretty middle-aged, and I do not care what people think of me any more. When people come up to me and say, “Mr Walker, we think you an absolute rotter and so-and-so”, with OCD, I would probably have said a lot worse to myself 20 minutes earlier. It is not such a big deal. I am not frightened any more. It is a really good place to be, and we need to ensure that many hundreds of thousands can be in that place as well. Not being frightened is a really good thing. Hon. Gentlemen, hon. Ladies and friends: rock and roll, as they say. Thank you.
Mental Health Care
Charles Walker Excerpts(13 years ago)
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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(13 years ago)
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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.