Mental Health Act: CQC Report

Debate between James Heappey and Jackie Doyle-Price

Tuesday 27th February 2018 Commons Chamber

[James Heappey (Wells) (Con)]

Does the Minister agree that a better laydown of mental health services, involving crisis houses and step-down facilities, might end the need for people to be admitted to acute mental health facilities in the first place, or else support them immediately after their discharge? Will she join me in encouraging the Somerset CCG to ensure that such facilities are available in that county as well?

[Jackie Doyle-Price]

My hon. Friend reached the nub of the issue in that final point. Commissioning is a matter for local commissioning groups. However, through the CQC report, the work that we are doing through the mental health investment standard and the scrutiny applied by NHS England, we are trying to ensure that there is a consistent application of good-quality services around the country. We find some centres of excellence and some areas in which the service is less patchy, but when it is less good it obviously leads to worse outcomes. We are determined to do our best to promote the best possible services throughout the country.

Shepton Mallet Community Hospital

Debate between James Heappey and Jackie Doyle-Price

Tuesday 21st November 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Gray. It is also a pleasure to respond to my hon. Friend the Member for Wells (James Heappey), who has brought the required amount of passion to this argument. He is doing exactly what he should do to stand up for his constituents after the local health establishment made a very rapid decision regarding his hospital. It certainly came out of the blue for many people, but I would like to give some explanation as to why the decision was made and perhaps a message about where we may go in the future.

In the short term, we have the closure, but what happens beyond that is very much up for review. I commend my hon. Friend on the constructive way in which he has engaged with local health practitioners while still giving them a challenge. That is always the way to go with these debates. As we all know, the challenged situation we are facing is not only in terms of money. As he acknowledged, in this case the issue is not money; it is workforce across the trust. The challenged situation means that we will have to make some difficult decisions, and we should make them on the basis of constructive dialogue, not who shouts loudest. I certainly agree to his request to have more discussions on this matter in January. Although the decision-making process is independent, we as Ministers will want to satisfy ourselves that processes are being properly followed and representations are being properly heard.

The reality is that any decision of this kind has to be taken with full transparency and full accountability. Robust argument will withstand challenge. I look forward to taking the dialogue with my hon. Friend further. I also welcome the forward-looking points he made about the future campus and looking at future needs. All too often in such debates we look at the immediate short-term challenges without addressing the long-term ones. If we looked more at the long term, we might come to better decisions, rather than short-term ones.

I understand my hon. Friend’s concern about the impact that changes at Shepton Mallet Community Hospital will have on his constituents. I reassure him that changes will always be in the best interests of patients and the local community. Decisions must be driven by what is best clinically, what is best for the health service in the area and what is of most benefit to the greatest number of people in the area. He asked me to direct the trust to reverse the closure. We are very much of the opinion that it is right that such matters are addressed at the level where the local healthcare needs are best understood, rather than in Whitehall. I give him the assurance that I will join him in holding local decision makers to account to ensure that their decision making has been properly accountable and robust.

It is worth reiterating that all proposed service changes should meet the four tests for service change: they should have support from GP commissioners, be based on clinical evidence, demonstrate public and patient engagement, and consider patient choice. In addition, NHS England introduced a new test applicable from 1 April 2017 for the future use of beds. It requires commissioners to assure NHS England that the proposed reduction is sustainable over the longer term and that key risks, such as staff levels, have been addressed.

I will first outline what led Somerset Partnership NHS Foundation Trust to announce on 11 October the temporary closure of in-patient wards at two of its 13 community hospitals across the county. As my hon. Friend has pointed out, the decision was not financial; it was based on patient safety. Overall, Somerset Partnership provides 222 community hospital beds, spread out over 13 community hospitals. Plans drawn up for an expected increase in patients over this winter made it clear that although sufficient funding was in place to maintain services, the trust was facing vacancies in a quarter of its registered nursing posts, meaning that the trust nursing workforce was spread far too thinly at the time. Following a review, it was found not to be sustainable to continue to safely deliver in-patient services across all 13 sites.

To address safety concerns, the trust made the decision to move 10 beds at Shepton Mallet hospital and 14 beds at Chard hospital, along with their staff, to other community hospitals in Somerset. I fully appreciate the case that my hon. Friend has made about the services at Shepton Mallet being robust. I understand why the move feels particularly unfair, but we will have to address that in consultation as we take the matter forward.

The trust has said that the two in-patient wards are likely to be temporarily closed until at least the end of March 2018, but that the current total of 222 community beds and all current services across Somerset will be maintained. Somerset CCG has endorsed the move and is in the process of considering community hospital services and provision as part of a wider clinical services review across the county next year.

We talked earlier about criteria and how trusts should come to decisions: in full openness and consultation with staff and the public. I understand that the trust communicated with a wide range of staff and stakeholders on its plans to temporarily close the wards, including with the local county council, which supported the action taken by the trust on the grounds of patient safety. I am also pleased to say that the trust held all day face-to-face drop-in sessions with members of the public, as well as a public meeting organised by the League of Friends of Shepton Mallet Community Hospital, which was attended by 120 people, including my hon. Friend and local councillors.

The trust has also organised a workshop event in the town for key local stakeholders on 30 November to seek the views of patients and carers while the ward is temporarily closed, and has developed a wider consultation document to inform its next board meeting on 6 February. I urge my hon. Friend and his constituents to engage in that process and make their voices heard. I want to reassure him that Somerset CCG has not put the trust under any financial pressure to temporarily close the wards at Shepton Mallet Hospital.

As my hon. Friend has pointed out, the issue is not about money. It is solely down to the issues around nurse recruitment, and the trust is working hard to improve on that. It has recruited two specialists who have extensive experience of specialised nursing recruitment. It is also offering more intensive support for potential recruits to increase the rate at which they take up posts. It is also working with Yeovil District Hospital to recruit nurses from the Philippines. I am pleased to learn that already there is a large number of interested nursing staff, which the trust hopes will be recruited and in post from April 2018. Furthermore, the trust is revisiting its current golden hello bonus of £1,000 to see how it can be better tailored to individual needs and it is looking at how else it can attract nurses to the trust.

Owing to staffing issues, the CCG supports the closure on the basis that, as my hon. Friend has pointed out, it is temporary and has been made on patient safety grounds, not on financial ones. It has been made clear that there can be no permanent closure of the wards at the community hospitals without prior patient and public engagement and formal public consultation. The CCG fully expects the beds to be reopened after the winter.

By taking planned measures now, the CCG is reassured that that represents the safest way of avoiding the potential risk of disruption to patient care should we see severe winter weather or the predicted higher than average levels of sickness from flu.

[James Heappey]

There is some concern locally about what the consultations look like. The Minister, briefed by local health authorities, has relayed that a “consultation” was conducted in the last few weeks of November ahead of the temporary closure. The reality is that that, including the agreement of Somerset County Council, was done after the solution was presented as a fait accompli. Can the Minister reassure me that the health authorities will be explicit with the community and all other stakeholders when having such a consultation about permanent closure and that the discussions going on right now about the temporary closure will not in due course be dressed up as the consultation leading to permanent closure?

[Jackie Doyle-Price]

My hon. Friend has the nub of the issue completely. To inspire confidence among his constituents, we as decision makers need to be very clear about the basis on which the decision was made and how future decisions will be made. The short-term consultation was about a decision made purely to get us through winter for patient safety reasons. For any long-term closure there would have to be a full consultation, fully transparent and fully accountable. I know he will hold me as well as his local trust to that. I do not think I can be firmer. We inspire confidence in the public and in patients who use the services only if we are fully transparent in making decisions. It is unfortunate that the speed with which this particular decision had to be made in order to get us through the winter will have undermined confidence. Of that there is no doubt, but rest assured I will continue to engage with him to make sure we can restore public confidence among his constituents in future.

As I have mentioned, the decision taken has allowed the trust to consolidate beds and staff into fewer hospitals, but larger wards. Closing the wards has reduced the number of unfilled shifts by 60 shifts a week: the equivalent of 13 nurses. Regrettably, since the closure, three Shepton Mallet patients have been admitted to surrounding community hospitals—one patient is in West Mendip and two are in Wincanton. I am advised that, as a result of the temporary closures, the trust has provided support budgets to enable carers and relatives who need financial assistance to visit patients. I should also add that all of Somerset CCG community hospitals have free car parks, so if people are visiting their loved ones, they will not have to pay. I should point out that that is not a privilege enjoyed by many other areas.

My hon. Friend talked about the long-term plans for a health campus. Both Chard and Shepton Mallet have been assessed as requiring significant redevelopment. Chard Community Hospital infrastructure was assessed as not fit for purpose by a 2015 Care Quality Commission inspection. As he pointed out, Somerset CCG is developing a clinical services review that will take into consideration the views of patients before developing a series of service proposals, which will ensure that family doctors, community hospital and district hospital services are joined up with social care services and provide financially sustainable and high quality care. It expects to engage with the public on those proposals in the new year. I know he will engage in that process.

The decision to temporarily close wards at the hospital is an important issue and the decision was not taken lightly. However, the decisions made by the trust have not been made because of financial concerns, but because of nurse recruitment issues. I know that the decision will cause concern to the residents of Chard and Shepton Mallet and the surrounding villages, but I urge my hon. Friend to encourage his constituents to attend the trust’s local public meetings and listen to what is said about addressing the issues that have caused the temporary ward closures, as well as making sure their voice is heard. We will all understand each other better with that dialogue. The people affected by the changes need to be involved in expressing their views and making key decisions.

Our starting point for discussing service change is that no permanent changes to the services that people currently receive will be made without formal public consultation. I reiterate that strongly to my hon. Friend. I conclude by encouraging him to continue to engage with Somerset Partnership Trust, Somerset CCG and me in the new year as the proposals are brought forward.

Question put and agreed to.