Mental Health Services (South-East Essex)

David Amess Excerpts

Wednesday 5th March 2014 Westminster Hall

[Mr David Amess (Southend West) (Con)]

I make this speech in sorrow and anger—in sorrow because as a result of the South Essex Partnership University NHS Foundation Trust, SEPT, my constituents are suffering, and in anger because I am a parliamentarian who takes his job extremely seriously and I have simply not been listened to.

In this very place on 1 March 2001—13 years ago—I made a speech outlining in graphic terms how disgracefully the mental health services that look after people with problems in Southend were run. I see no purpose in having Adjournment debates if when Members of Parliament raise an issue, Ministers say that they are glad it has been raised and then it gathers dust. Let me make it clear that I will not remain silent on this issue until something is done. The Minister is a Liberal, and will understand me well. Liberals like to dig themselves into their constituencies and have a high profile. That is what I did in Basildon and in Southend West. I know my area better than the Minister, the Care Quality Commission, Monitor, the civil servants and the trustees and directors of SEPT. I really do know what the service is like. I will be making a presentation to the House about the organisation. It will be horrified when it has a private meeting and reads what I have to say about it and how it will be reported. Let me use new Labour terms: the organisation is not fit for purpose. Let me then use terms that the Minister might respond to: there are lessons to be learnt.

Then there is the issue of governance. I can remember only too clearly the then Labour Minister listening to what I was sharing with the House, but absolutely nothing was done about it and people suffered. Under the Labour Government of 13 years, the organisation did extremely well under its previous chief executive. I will outline all sorts of honours that he received—he did extremely well.

Thinking about my old constituency of Basildon, when Sir John Major visited Basildon hospital, it was a first-class hospital. I am very proud to say that; it is where all my five children were born. We use local health services. I do not have private health care; I use the national health service. The previous Labour Prime Minister visited Basildon hospital just before the election on a public relations exercise, and the media reported how marvellous everything was. In the past three years, as the Minister knows, an inspection was done of the hospital. What went on with that fabulous hospital breaks my heart. Fortunately, new management is in there and it has been turned round in a remarkable fashion. It has perhaps the finest cardiac unit in the country, so I cannot speak highly enough of Basildon hospital now. I am only sharing that with the House because a public relations exercise can mislead in a graphic way.

What am I after in this debate, so we do not lose sight of what is happening? What went on is totally wrong; the previous chief executive was on his huge salary and all those personal things happened with the trust that we, the residents, had been paying for. It is absolutely outrageous that the governing body, whose duty is for governance of the organisation, then appointed the deputy, who has been with the organisation since 2005. What is so wrong about the organisation is the management. That is why they are not going to like what I shall say, but it is absolutely disgraceful.

Since I have been a Member of Parliament, I have observed how little power Ministers have these days. It was under Tony Blair’s Government that gradually powers seeped away, so I absolutely accept that the Minister is limited in what he can do. I have had meetings with Monitor and the Care Quality Commission—my hobby horse is that, for the life of me, I do not know why we have two organisations, one of which is in Wellington house, very close to the health service—and when I challenged them on these issues and on all the complaints, they were completely lost, so it is very frustrating.

When I first became a Member of Parliament, I could get things done. I saved Basildon A and E with just two days to go—there is a long list of things. Now we pass things to Ministers. It may take four weeks, eight weeks or 12 months for the civil service to produce a letter that is topped and tailed, and at the end of it all, it is a complete waste of time. I will not have that with this issue, because the mental health service is the Cinderella service of the country, as we all know. I applaud what the Government are doing with all their notices on the tube, as has been pointed out to me, and the way in which they are trying to turn round, in real terms, the way people see others who are suffering from mental health issues such as depression, so they are seen in a better light. However, I am not holding my breath that the Government will take action on this matter. Frankly, I think it has to be done through people power.

When I first became a Member of Parliament, I never saw as many people with mental health problems as I do now. They are growing in number. Whether it is depression or all sorts of matters, the numbers are definitely increasing. I really feel for my constituents who have a loved one with a mental health problem—not just through drug or alcohol abuse, but a real mental health problem—and then they have to go through the sectioning process, which is not easy. Of course, that process involves the police, and that is another subject as well, but what I want from the mental health service that looks after people in Southend is some honesty. Is it that they can no longer cope or that they do not know what they are doing? I am sick to death with my constituents’ endless list of complaints about mental health services. They are not part of the nanny state, wanting to dump their problem on to the state; they are in complete anguish about what it is like to get someone sectioned.

Of course, there is then the nightmare that when someone is sectioned, people are told, “Well, we can’t talk to you directly because the person being sectioned has a number of rights,” yet when they are released, the families, who can often be aged, have to cope with these very difficult circumstances. Sadly, I say to the Minister that all the figures seem to show that the number of people with mental health problems is growing.

According to figures provided by SEPT, in 2004 there were 184 complaints. There was no record of any of the complaints being upheld. I would have thought that someone, somewhere in Government, when I complained about it, would have said “How on earth can that happen?” In 2012-13, under an enlarged organisation, which of course seems to be an excuse, 434 complaints were made against the service. Of those, 243 were upheld, so more than half the complaints were upheld. We do not have the time to go into the details of the stress caused by raising a complaint and the length of time it takes to deal with it. Those figures in themselves should have set alarm bells ringing in the Department of Health, but I do not think that has happened.

My question today is: why on earth has this service, which in the early 2000s was already in a shocking state of affairs, been allowed to continue in that fashion? Why did no one intervene when I raised it in this Chamber in 2001? It really is not good enough, frankly, that nothing has been done. What makes matters worse is that the organisation is rewarded for failure.

Many people in the organisation, and there will be lines to take on the matter, were not there on the journey I have been on. After 31 years, I have a real picture, but I go back to the appointment of the present chairman, who has been with the organisation since 2005. In 2010, 118 employees earned more than £60,000. That was up from 99 in 2009. More recently, in light of the numbers of complaints that I have just quoted, in March 2013, 161 staff earned more than £70,000, 49 of whom earned between £100,000 and £150,000. That is absolutely crazy—50 earning between £100,000 and £150,000.

It gets worse, however. Although complaints to the trust were increasing exponentially, SEPT staff were rewarded with higher salaries—rewarded being the norm. In 2009, while many ordinary people were suffering from the worst effects of the global recession, the salary of the chief executive of SEPT rose from £170,000 to £200,000, and then it became much higher than that. That is absolute madness, and it is all in Hansard. This is supposed to be the mother of Parliaments, which runs the country. I have complained about this time after time and yet nothing at all has happened. It is an absolute disgrace that my words of caution have been ignored about this matter. Apparently, the salaries were justified

“to recognise the trust’s exceptional performance”.

Well, that is a joke if ever there is a “Tick the box” exercise. The constituents and whistleblowers who have contacted me would certainly question it.

Following my Christmas pre-recess Adjournment debate, in which I raised this issue, I was informed by a Minister that the CQC currently has no concerns about SEPT’s services in Southend. Well, that is a laugh in itself, frankly. No concerns? What on earth has it been doing? It is absolutely ridiculous. I do not necessarily dispute whether the inspections of these services were carried out rigorously enough, but what I would dispute is that a recent inspection, in September 2013, when I started to make a fuss about this again, found no overarching concerns for any of the “four essential standards”, one of them being “complaints”. Surely the increased number of complaints in the past 10 years is evidence enough to suggest that we should question an inspection that declares that there is no cause for concern at all. Surely I should be listened to, as a local representative. I have been there longer than all these other people; I have 31 years’ experience.

Perhaps the CQC is not missing something, but in 2010 a whistleblower, who was a practising doctor for the service, claimed that the previous chief executive of the service would often circulate e-mails to encourage staff members to “talk up the service”. That actually happened when inspectors came to visit. Nothing at all was done about the people who were responsible for governance. In fact, according to the whistleblower, internal surveys that were meant to help the service to improve itself would often be loaded to ensure that a negative response could not be input into the questionnaire, so the service was either “excellent”, “very good” or “quite good”. And we, the mother of all Parliaments, have, as power has seeped away, allowed all this to happen. What is the good of elected Members of Parliament if we have become so impotent?

I recognise the motivation behind what the Care Quality Commission does to ensure that the health services across the country are serving the interests of patients, but I cannot help but feel that the inspectors are missing something or being misled by staff at SEPT, who have in the past been reported as ensuring that patients are on their “best behaviour” when an inspection takes place. I think that it is important to link that with the statistics that I referred to; the numbers of complaints have increased. How the CQC does not consider that to be not only incredibly concerning for patients and their relatives but very suspicious is alarming. That said, I welcome the recent report on Bedford hospital.

I talked in the Christmas Adjournment debate about the previous chief executive, Patrick Geoghegan, who left in September, and his history. I have mentioned in this debate the very large salary increase. I do not have time to go into how he described himself as a doctor. I have my own view as to what a doctor is. I will leave it to others to reflect on him. But I think that it is curious how that chief executive went from the modest role of a hospital porter when I was Member of Parliament for Basildon to become one of the highest paid chief executives in the whole country, and the mother of Parliaments has done absolutely nothing about this disgrace. We have just had heads down and a rule of silence: “This is the line to take, Minister, and let’s just get on with it.” Well, I am certainly not going to remain silent about it. For example, in 2009, under Labour, Mr Geoghegan received the NHS leader of the year award, beating 700 other candidates, and he was rewarded with a huge pay increase.

One of the most consistent complaints that I receive is with regard to the number of locum staff that the service employs. There is evidence to suggest that agency staff often work two jobs and, as a result, will turn up late for shifts.

In 2008, an independent inquiry criticised the staff turnaround rate after a murder was committed by the schizophrenic Gary Roberts. There was a report on that. I am rushing through this because I have so much to say. John Vesey, former chairman of SEPT for six years, has told me that there was a problem getting staff when he was there and he knew of extra money being offered to prospective psychiatrists on the side. He said that the directors—this is coming from the former chairman—

“lied through their teeth about this”

when it was brought up at a board meeting. In 2007, the trust was still facing staff shortages, and the board discussed the issue but concluded that the shortages had no detrimental effect on the quality of care. What an absolute joke. And the trust went on ignoring things.

In response to a freedom of information request that I put in to the trust in September 2013, I was told that £600,000 was spent on promoting this organisation. That was three times the salary that Mr Geoghegan was receiving at the time. We could have employed a number of hospital consultants for that. The uses of the public relations techniques are an absolute disgrace

Sharon Tattoo, a constituent of mine, became a whistleblower. I want briefly to talk about two issues now. John Vesey, while chairman of Thameside mental health service as it was then called, recalled how he was forced to dismiss a member of the board by the regional chairman after he was threatened with dismissal if he did not dismiss that individual from his post. That example of bullying is absolutely typical of SEPT, and the corruption does not end there. There was a particular incident in which Mr Vesey, in response to a large and elaborate party that had been held for his birthday, approached the director responsible for finance and inquired how the party had been paid for. The response unnerved Mr Vesey: the money had come from funds donated by what the then finance director called “grateful patients”.

Sharon Tattoo worked for SEPT. She became aware of what she saw to be the misuse of funds by the leadership. She told Mr Vesey, the chairman, about the funding being redirected. The chief executive then warned her that if she were to raise these issues with the chairman, his job would be at risk, and she was advised that she should refrain from making further complaints. I could go on and on about what happened.

Mr Geoghegan left in September, but what on earth was going on with the board when it replaced Mr Geoghegan with his deputy, Sally Morris, who had been there since 2005? I have looked at the present board members and where they come from. It is now a much larger organisation. But what on earth has Lorraine Cabel been doing, as the chairman of the trust, in overseeing all this? I think that what has been happening is an absolute disgrace; and all the time, my constituents have been suffering as a result of this poor care.

For instance, there is a young girl who is now in Rochford hospital as a result of having suicidal thoughts. She recently escaped, with another patient, from a ward, and the staff apparently allowed that escape to happen. I want to ask how the staff on duty at the time, bearing in mind that these patients have fragile minds, allowed two patients to escape from a secure unit. What has happened is absolutely disgraceful.

I want to end my speech by paying tribute to the work of one of my constituents, Cheryl Higgins, who in 1999 recognised how poor the health services were in my constituency and, supported by John Barber, set up Trust Links to address the gap in mental health services. That organisation is still flourishing today.

I say to the Minister that I am not going to let this matter drop—I am really not. I am very, very angry about the way I have been ignored on this issue. I have no doubt that there will be a line to take and that I will be told, “All is well.” It is not well. This is a very expensive service, and it seems to me that we want a complete clean sweep of the management. That is what I am asking the Minister to achieve. Mental health services have always been the Cinderella service. When the Government whom I support came to power, under one of our colleagues who was then a Minister, a pledge was given that it would no longer be the Cinderella service and it was going to be front line now. From what is happening in my own area, I am not at all satisfied that the organisation that is in charge is fit for purpose. I will not shut up until I get some real action on the matter.

[The Minister of State, Department of Health (Norman Lamb)]

It is clear from the contribution of my hon. Friend the Member for Southend West (Mr Amess) how strongly he feels about the matter, and I absolutely respect that. I am not interested in any line to take from the Government. I have a speech here, but I want to address directly what my hon. Friend has had to say. I share his passion for trying to improve mental health services. That is something that I feel strongly about. I never like the idea of sweeping failures of service under the carpet. He has raised some serious concerns, although he did not have time today to go into the detail of all the things that he wanted to raise, and I would be keen to meet him to discuss those issues further.

I want to say a word about what I am trying to do in mental health. I agree that it has always been the Cinderella service, and there is what I would describe as an institutional bias against mental health in the NHS, which manifests itself in all sorts of ways. The spotlight is not on standards in mental health as it is in other areas of the health service. When the Government responded to the Francis report on Mid Staffordshire, we made it clear that addressing the concerns he raised about culture in the NHS was just as important in mental health as it was in any other part of the health service. If my hon. Friend reads the Government response to Francis, he will see that that is the case.

One of the ways in which we have responded to Francis is substantially to change how the Care Quality Commission goes about its work. My hon. Friend sought to make the case—by putting it in such a way, I do not suggest that he is wrong; I am not in a position to judge —that there is a massive gap between what he knows about a local service and what the regulators say about it. I know from my own part of the world, Norfolk, that when one raises acute concerns about, for example, the ambulance service, the response is often that everything is fine even though we know that it is not. We must try to ensure that inspectors and regulators reach a clear and accurate view of the quality of services.

The inspection regime that we are introducing, first in acute hospitals but soon in mental health trusts as well, is much more rigorous than anything that has gone before. One of the things that the previous Government did in 2008 was to remove specialist teams of inspectors, so that everyone in the CQC became a generalist. They might one week inspect a dental practice, a GP practice, an acute hospital and perhaps a mental health trust. That is no good; we must have people who know what they are looking for. It is also critical to involve clinicians and service users, who may well have an insight that others will never achieve. The CQC has appointed a deputy chief inspector who is in charge of the inspection regime for mental health, and I urge my hon. Friend to contact him directly to raise the concerns that he has expressed. At the end of the inspection process, mental health trusts will be rated so that the public has a much better view of the quality of a service in their local area.

Regulation on its own does not change culture; I absolutely get that. There must be carrot and stick. We must do things to change the culture within organisations as well as seeking to secure good standards through regulation. Regulation and inspection are a critical part of the overall picture, however, and we must have confidence in the inspection regime.

Everything that has emerged from the CQC’s work under the new leadership of David Behan and David Prior—a former colleague of my hon. Friend’s whom I happened to beat in North Norfolk to give him the opportunity to become the chair of the CQC—shows that they understand about compassionate care and high standards of care. We will shine a spotlight on mental health services and other parts of the health service in a way that has not happened before. I think that that will be of some value.

[Mr Amess]

Does the Minister understand how frustrating the whole thing is for me? The previous chief executive, Patrick Geoghegan, was in an unusual relationship, which I will not enlarge on, with someone who was first installed in a property in my constituency—there was a dispute about that—and later became a top-earning member of the board. With all this due diligence and inspection, how on earth was that allowed? What has happened is absolutely crazy, and I will need quite a bit of convincing, whoever the Minister introduces me to. It seems to be only when we air things publicly in Parliament that there is any interest—“Yes, Minister. Let’s get a brief ready.” I am not going to let the matter drop because my constituents deserve better than they are getting at the moment.

[Norman Lamb]

I hope that my hon. Friend recognises that I have sought to address his concerns directly, rather than reading from a pre-prepared speech. I share his concern about levels of pay in the upper echelons of the NHS, and I believe that that must be addressed.

On a more positive note, in the short time that I have available let me mention some of the positive things that we are doing. In January, we launched a document called “Closing the gap”, which directly addresses the fact that mental health services always fall behind physical health services. We have stated publicly, and we have put into legislation, that there should be parity of esteem and equality between mental and physical health services. The document identifies 25 areas in mental health services in which essential change is needed. One example is the widespread use of face-down restraint. Such restraint is not acceptable or necessary in a modern mental health service, and many areas have demonstrated how to create positive regimes without the use of such a barbaric approach.