Patient Safety

James Morris Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

That is absolutely true. A number of initiatives are taking place, and I welcome them. The involvement of universities can help us to understand some of these very difficult issues. This is uncharted territory for the NHS, because nowhere else in the world are we seeing the rigour with which we are going about our task. I think that we should be open about anyone who can contribute to the debate.

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

I welcome the Secretary of State’s focus on transparency and accountability. He is right to draw attention to the positive steps that the Government have taken in regard to mental health services in the last four years, but given our aspiration to secure parity of esteem between mental and physical health in the NHS, and our need to drive up mental health care standards throughout the country, should we not extend the transparency and accountability measures that he has announced to those services?

[Mr Hunt]

I pay tribute to my hon. Friend’s campaigning on mental health issues, which has done a huge amount to raise the profile of the subject. Let me reassure him that the information that we are publishing on the website today includes staffing data for all the mental health trusts. We completely recognise the parity issue, at least in what we are doing today.

NHS

James Morris Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

We on the Government Benches will take absolutely no lessons about transparency in the NHS from Labour after what it did for so many years. I think what we are introducing is a huge step forward, because for the first time every hospital in the country will, as a minimum, have to publish their ward-by-ward staffing ratios every single month. They can publish more—they can do what Salford does—but for every hospital in the country to do that every month is a huge step forward.

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

The Secretary of State talks about finding alternatives to people presenting at A and E. May I commend Rowley Regis hospital in my constituency, which has just opened a GP-led primary care assessment centre in order to deal with people in the community—in a community setting—rather than having to refer to A and E? That hospital used to have five in-patient wards, but they were closed by the Labour party and the right hon. Member for Leigh (Andy Burnham) when he was Secretary of State. However, three of them have been reopened in the past three years, which is a substantial new investment in a very important community hospital.

[Mr Hunt]

I commend what is happening; it is very important that locally driven solutions are providing good alternatives to going to A and E. One of the most important things we can do for my hon. Friend’s constituents is make sure we have proper continuity of care so that for our most vulnerable patients there is a doctor who knows what is up with them at any time, whether they are in or out of hospital, and who can give them joined-up care and make sure they have a proper care plan wrapped around them. That is the kind of care we need to see.

Psychological Therapies

James Morris Excerpts

Wednesday 16th October 2013 Westminster Hall

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

It is a pleasure to open this very important debate under your chairmanship, Sir Edward. First, I want to talk about why this debate is important. Mental illness is one of the biggest health challenges that we face over the next 20 or 30 years. The NHS spends approximately £14 billion on support for people with mental health conditions, which amounts to about 13% of total health spending. However, mental ill health accounts for about 28% of morbidity and 23% of all GP appointments, and recent estimates show that the overall economic cost of mental illness in Britain is about £105 billion a year.

Those are the raw statistics, but behind them is a story of broken lives, isolation and mental suffering. Every week in my constituency, I see people suffering from a range of difficult mental health conditions as a result of personal circumstances, family breakdown and all kinds of different issues. I am sure that other hon. Members here today have had similar experiences in their constituencies. As a compassionate society, we have a duty to address the growing crisis of mental health in Britain, not only by seeking to control its symptoms, but by tackling its underlying causes.

Our approach to mental health has been dominated for too long by what I characterise as a medicalised model. A psychiatric approach has been dominant. I am not arguing that psychiatry does not have a role to play in mental health, but it has been a dominant model for the way in which we approach mental health care in Britain, and the national health service is very focused on drug-based solutions to mental health problems. The number of prescriptions for drugs to try to solve mental health problems has gone up exponentially over the past decade, and as a result, I believe that our approach to mental health in the national health service is very much focused on control, rather than on tackling the profound underlying causes of the growth of mental health problems in Britain.

That is why I want to discuss talking therapies today. It seems to me that talking therapies are a human and compassionate response to mental suffering, as our constituents, our fellow citizens, and we all come to terms with the pressures of modern life, the increase in family breakdown, and the sheer stresses of dealing with information overload and the complexity of living in the modern world. This issue is not confined to any one part of the population; it crosses the whole age range, from children and young people through to older people.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on securing this very important debate. An alarming thing that I have discovered recently is that 80,000 young people across the United Kingdom suffer from severe depression, and 8,000 of those are under the age of 10. It is alarming, and it is running out of control. As the hon. Gentleman has said, personal counselling is an avenue that we can go down. An organisation in my area called Yellow Ribbon does exactly that, and it has had some fantastic results.

[James Morris]

The hon. Gentleman makes a good point; there are major issues with children and young people’s mental health, and I will come on to that later in my speech.

I want to talk today about improving access to psychological therapies. That is a big area on which I have been focused on in my role as chairman of the all-party parliamentary group on mental health. The improving access to psychological therapies programme was established under the previous Government in 2006, following work by Lord Layard, who looked at the economic benefits of a widespread programme of access to psychological therapies across the country. IAPT was initially launched with small pilot areas and then was formally launched in 2008. I do not think anyone here would deny that the IAPT service has made progress. We have seen 1 million people entering treatment and 680,000 people completing treatment, and we have seen recovery rates of about 45%, with 65% significantly improved. The IAPT programme has led to 45,000 coming off sick pay and benefits, and we have seen 4,000 new practitioners trained in the national health service.

The programme was started by the previous Government, and in February 2011, the current Government published their “No health without mental health” strategy, which committed them to investing more than £400 million over four years into the IAPT programme. At the same time as the publication of that strategy, the Department of Health also published its “Talking therapies: A four-year plan of action”, which had the objective that by March 2015, 15% of the adult population would have access to evidence-based psychological therapies that are capable of delivering rates of recovery of 50% or more. Therefore, some progress has been made, but I want to raise serious questions today about how we should take the IAPT programme forward, about the scale of our ambition, and about the extent to which real choice is embedded in the system. I believe that those questions need to be addressed urgently.

The Department of Health, in its assessment of IAPT—its very comprehensive report was published in November 2012—was clear about challenges that the IAPT programme faced in the future. In particular, its report talked about the challenge of waiting times, stating that one of the challenges is

“building adequate service provision (including number of services, and size and efficiency of workforce) to ensure access for all who need treatment within 28 days of first contact.”

The report discusses the challenge of:

“Unmet need—addressing issues concerning equitable access to services where access is lower than expected among some population groups.”

It also refers to the challenge of “Patient choice”, which goes to the heart of the questions that I am raising today, and

“increasing information on treatment options and ensuring that treatment plans are agreed by both patient and therapist.”

Another challenge is the:

“Funding distribution process—ensuring that appropriate investments continue to be made in local IAPT services, to continue to expand capacity and assure quality in line with the overall financial expectations set out in the Spending Review.”

The Department of Health is clear, therefore, about the challenges faced by the further roll-out of the IAPT programme. In order to meet the challenges that come out of the Department’s assessment, we need radical thinking. We need to build on the strength of the existing IAPT programme, but we also need to address some of its fundamental weaknesses, which I believe are holding the programme back.

A central issue that we need to have an honest debate about is the fact that the IAPT programme is still dominated by the use of one therapy—cognitive behavioural therapy, or CBT. The National Institute for Health and Care Excellence guidelines that were drawn up in 2005 made the recommendation that CBT should be the default treatment option for the NHS, because it had the most random-controlled-trial supporting evidence for its effectiveness. In 2010, the guidelines were modified slightly to allow five other therapies into the NICE recommended mix. The reality, however, is that IAPT is still dominated by CBT. Again, I am not arguing that, in many circumstances, for patients with particular forms of anxiety and depression, CBT is not an appropriate form of treatment. However, it is a short-term, highly manualised approach to mental health treatment.

There is an interesting quote from NICE’s recommendations on psychological therapies:

“In using guidelines, it is important to remember that the absence of empirical evidence for the effectiveness of a particular intervention is not the same as evidence for ineffectiveness.”

That is a wonderful little quote from NICE.

One of the consequences of our approach to research into the efficacy of particular forms of mental health treatment, and of NICE’s approach to the formulation of its guidelines, is that long-term therapies such as psychotherapy and psychoanalysis, to name just two, which require long-term commitment from the patient and from the analyst, have effectively been locked out of IAPT. In Britain, we have a mature and highly professionalised cohort of therapists in psychotherapy and psychoanalysis. They have, over the past five years, found themselves unable to provide the sort of capacity that we need in IAPT. One of the consequences of that, and of the dominance of CBT, with a focus on training up therapists to concentrate on CBT, is that we have a monolithic model.

Within IAPT, we have access, but no effective choice for the patient—choice that is focused on the individual needs of the patients and on an assessment of the patient’s particular requirements. We have a professional cohort of highly trained therapists in long-term therapies who are unable to assist the NHS in extending capacity for the provision of psychological therapies and who are unable to become part of the conversation to address the programme challenges identified by the Department of Health’s assessment of the three-year IAPT programme in 2012.

We need to recognise those weaknesses in the existing IAPT programme, because there are still 50% of people who have been through the programme who have not responded well to CBT. Some 85% of people who are currently suffering from severe mental anguish cannot gain access to any appropriate psychological therapy on the NHS. We urgently need a review of the existing NICE guidelines, and I know that Professor David Haslam, the chair of NICE, has recognised the issue and has agreed to initiate a review.

We also need to look again at how we formulate evidence on the efficacy of mental health treatment. For certain long-term therapies, it might not be appropriate for research to be totally focused on randomised control trials, which are also costly to undertake. We therefore need to look at new types of evidence base. We also need to think about developing a new commissioning model for psychological services to create real choice. I will come on to talk about how that might work.

We also need to consider other groups who may benefit from greater choice and access to psychological therapies. The hon. Member for Upper Bann (David Simpson) talked about children and young people. He is right to be concerned about them; it is a major issue that we face in Britain today. Some 850,000 children between the ages of five and 16 are known to have mental health problems. There is a children and young people’s IAPT, which provides a broad range of interventions —parenting therapy, interpersonal psychotherapy and family therapy.

I think we all know and agree that early intervention for children and young people is crucial to prevent problems from becoming more serious. Lots of evidence shows that early intervention at the onset of psychosis in children and young people and suitable psychological therapy treatment can prevent that from blowing up into something much more serious later on. Perhaps we can learn some lessons from the children and young people’s IAPT for adult services, while recognising that the children and young people’s IAPT needs to be developed further.

Also, we must not exclude or not think about the needs of people aged over 65. As we all know, we have an ageing population, meaning that mental health in older people is an increasing problem. The Department’s “Talking Therapies” action plan committed the Department to address the underrepresentation of older people using IAPT. A quarter of people over the age of 65 have symptoms of depression that require intervention, but only one in six will consult their general practitioner. Therefore, IAPT needs to be tailored to meet the needs of older people. Those needs are not just one, single need; the needs of a 65-year-old may be different from those of a 90-year-old.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Gentleman on securing the debate. Earlier, he alluded, as my hon. Friend the Member for Upper Bann (David Simpson), did, to the problems in the younger age group, and now he is talking about the older age group. Given the significant increase of referrals in the past couple of years, does he agree that one of the overarching principles is that we will need significant additional resources to deal with the problem right across the age groups, from the young to the old?

--- Later in debate ---

[James Morris]

The hon. Gentleman makes an important point. The fundamental nature of my argument is that the current system, while it has made some progress, is not utilising the capacity that we should be able to develop in order to cope with the increasing problems that we face. IAPT needs to be tailored to older people and to be more flexible to meet their needs.

As I said, IAPT has made some progress, but we need to go further. Improving access is one thing; guaranteeing it is another. The NHS constitution provides a right to treatments recommended by NICE. The handbook to the constitution explains that that relates to any treatment that is

“recommended by a NICE technology appraisal.”

I am sorry to get a bit technical here, but I think the point is an important one. Technologies appraised by NICE include devices, medicines, diagnostic methodology, surgical procedures, health promotion activities and other therapeutic technologies. Regarding technologies, computerised CBT for depression and anxiety is the only NICE-approved psychological therapy, which, on the basis of the constitution, patients should have a right to. Psychological therapies have been excluded from the rights embedded in the NHS constitution, and we need to address that gap.

Also, there is no 28-week or any other waiting time target for psychological therapies. If I have a serious physical illness, for example cancer, I will be seen and treated within a particular time frame, and I will know my pathway of care, if that is the right way of describing it. However, if I have a mental illness, there is neither a guarantee nor a waiting time target.

[Dame Angela Watkinson (Hornchurch and Upminster) (Con)]

Does my hon. Friend agree that that is similar to what happens during the perinatal period? If a woman has a premature baby, thousands of pounds—if not hundreds of thousands—will be spent on neonatal intensive care; whereas if she has a full-term baby, but has a psychotic episode and requires in-patient mental health care, it is a complete postcode lottery as to whether she receives any help at all?

[James Morris]

I thank my hon. Friend for that intervention. She has done a tremendous amount of work in that area. I totally agree with her point; we need to shift our emphasis towards much more early intervention and ensure that the issue she identifies is addressed.

[Dr William McCrea (South Antrim) (DUP)]

The burden of the hon. Gentleman’s address today concerns the therapies necessary to deal with mental health difficulties, but surely, as my hon. Friend the Member for Upper Bann (David Simpson) identified a few moments ago, the problem for the under-10s age group is that more research is needed into how a person under 10 is taken down the dark path of mental illness. We must find out what the problem is, as well as identify some of the treatment.

[James Morris]

The hon. Gentleman makes a good point. The chief medical officer is producing recommendations about children and young people’s mental health care, which will specifically look at evidence on why the prevalence of such difficulties is increasing. She is becoming concerned about the growing problem.

A consequence of no guaranteed or set waiting time is that thousands of people are awaiting referral while suffering severe anguish. A constituent of mine who is suffering from a relatively severe mental health problem has received a referral, but is still waiting for treatment. That wait has been going on for a long time and he is in a state of severe anxiety and anguish. That is the direct human consequence of the situation. We need to move towards a waiting time target. I know people are wary of talking about targets, but such targets speak to a parity issue in the health service. If we have waiting time targets for severe physical illness, it is surely right that we move towards waiting time targets for access to appropriate psychological therapies. Appropriate access builds in choice, meets the needs of individual patients and moves us away from the monolithic approach I described earlier.

When responding to the debate, I ask the Minister to consider the following points. We urgently need further research into the efficacy of long-term psychological treatments. We need more holistic research combined with a more flexible NICE regime; as I said, Professor Haslam recently acknowledged that work is needed on the way that NICE approaches recommendations in that area. We need to give serious thought to a new commissioning model assisted by some of the reforms that have been brought into the NHS, such as commissioning groups, and building on the any qualified provider model, which brings choice and capacity into the NHS by allowing the highly professional cohort operating in the private sector to provide therapy on the NHS through IAPT.

Would the Minister seriously consider making or at least working towards a commitment to a 28-week waiting time target for access to psychological therapies? Too many people are in a state of anxiety about when they will get treatment and what that treatment will be. We need urgent action, as other hon. Members have said, to ensure that the IAPT programme is further developed for younger people and children and we need to commit to further research into what is causing the disturbing trend in mental illness among our young people. We also need urgent action to ensure that older people are not locked out of the IAPT programme. The debate is about more than the right policies; it is important because we must address the anguish and suffering of our fellow citizens whose voices desperately need to be heard and whose stories are often the key to their cure.

[Several hon. Members]

rose—

Mental Health

James Morris Excerpts

Thursday 16th May 2013 Commons Chamber

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

The more fundamental point is that a significant proportion of the money that is spent on mental health services in the national health service—about £14 billion—is focused on acute services. If we were to shift, say, 4% of that budget into community-based solutions and early intervention, that might have a much more dramatic impact on our ability to tackle the underlying problem.

[Paul Burstow]

The hon. Gentleman makes a good point. Indeed, that has been part of the approach taken in the talking therapies strategy, which is about moving the resource to where it will make the most difference at an earlier stage, and helping to promote recovery in the first place.

The Minister said that the emergency service is a stark example of where parity of esteem has not been achieved, and I want to give another example. The Royal College of Psychiatrists and its president, Sue Bailey, have been looking, on behalf of the Department of Health, at the whole issue of parity of esteem and what practical steps could be taken to address it, and it has recently published work on that. How can it be right, for example, that a recommendation by the National Institute for Health and Clinical Excellence on the availability of a drug is a must-do for the NHS but a NICE recommendation on the availability of therapies is not? This means that evidence-based non-pharmacological treatments that are clinically effective and cost-effective are often left unimplemented. I hope that that bias will soon be brought to an end.

The same can be said for access standards. There has rightly been uproar when even small changes occur in the amount of time people wait to attend accident and emergency departments. NICE has said that a person experiencing a mental health crisis should be assessed within four hours, yet only one in three people is so assessed. I am puzzled by the decision not to set a 28-day access standard for therapy, because the NHS constitution should embody parity of esteem, and that is a tangible way it could do so. Having said that, I take heart from the revised NHS constitution handbook, which said albeit it in a footnote:

“The Mandate indicates that we will consider new access standards, including waiting times, for mental health, once we have a better understanding of the current position. We need to do this work and consider carefully the implications of introducing any new standards, before we can make any firm commitments in this area.”

Why on earth is this problem still not being understood? Why do we need yet more reviews? Will the Minister give an indication of the time scale?

Community Hospitals

James Morris Excerpts

Thursday 6th September 2012 Commons Chamber

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

I join in congratulating the hon. Member for Totnes (Dr Wollaston) on securing the debate and the Minister on her much deserved elevation to the Front Bench.

Shortly before I was elected, I was contacted by some nurses from Rowley Regis community hospital in my constituency who had just been told that the hospital’s in-patient wards would be closing. Rowley hospital was one of the last community hospitals to be built under the last Conservative Government using central funds rather than through a private finance initiative project. It had always offered a mix of in-patient and out-patient care, and with about 100 beds it was considerably smaller than nearby hospitals such as Dudley’s Russells Hall, West Bromwich’s Sandwell general or Birmingham’s City hospital.

The last Government’s preference for large super-hospitals meant that the local NHS trust, like others around the country, felt under pressure to move in-patient services from small community hospitals such as Rowley. Staff at the hospital and members of the local community feared that the closure of the hospital’s two remaining wards was part of an agenda to turn it into a polyclinic, which the Government were pushing heavily. There is no question but that without in-patient care, Rowley would be more like a walk-in centre and clinic than what most people think of as being a hospital.

The campaign to keep in-patient care at Rowley brought the whole community together. Working with local residents, staff and patient groups, we gathered petitions against the loss of in-patient care, manned town centre stalls, delivered leaflets and wrote letters. The independent Facebook group alone attracted well over 1,000 supporters. Local people wanted to keep services at their local community hospital.

I know that, as other Members have mentioned, Members of all parties will have run similar campaigns in their constituencies. The campaign was a great success. My right hon. Friend the Leader of the House, who was then the shadow Health Secretary, joined me for meetings at the hospital with the NHS trust and hospital staff. He promised that under a Conservative Government services would be maintained where the local population, as service users, and local GPs as commissioners, demanded them. I was therefore proud when, last year, the trust invited me to open the Henderson reablement unit, a new in-patient ward that cares for patients recovering from serious illness. The Henderson unit is now a busy and successful part of the hospital, and I know that the trust is exploring ways to bring further in-patient services to Rowley hospital.

Community hospitals such as Rowley are an essential part of the national health service. They are important because the NHS is not just about drugs and operations; it is about care and about helping people make a full recovery in a supportive environment. Rowley Regis hospital cares for patients who are recovering from life-changing illnesses and injuries while they are unable to care for themselves. The care goes beyond medical treatment and physical therapy, helping patients to regain the ability and confidence to carry out necessary everyday tasks in a safe and supportive environment.

The staff at the hospital are fantastic examples of the very best of our national health service, showcasing the blend of professionalism and compassion on which the NHS at its best relies. Patients feel that they are given more individual and personalised care than would be possible at a large district general hospital.

The hospital itself is a pleasant place to be, which is particularly important for elderly patients whose lives, after a lifetime of independence and living at home, have been turned upside down by a serious fall—such as the one mentioned by my hon. Friend the Member for Penrith and The Border (Rory Stewart)—or a stroke. Patients can enjoy the beautiful gardens, and socialise in the well-designed communal areas, and when I talk to in-patients at Rowley I find that they are overwhelmingly positive about their environment and the care they are receiving. Being at the heart of the local community, rather than in a larger town a long bus journey away, helps to soften the anxiety of being away from families and friends, and it is easier for families to visit and help relatives through their recovery.

People are extremely proud of Rowley Regis hospital, and I would be pleased to welcome the Minister to Rowley so that she can see it for herself. I know, however, that Rowley is not unique, and other hon. Members have mentioned their experiences of local community hospitals. Community hospitals around the country are important to the patients they care for and treat—the kind of care that is extremely difficult to replicate in a larger hospital. I hope the new Minister will ensure that community hospitals remain a key part of a national health service that, at its heart, recognises that one size really does not fit all.

Mental Health

James Morris Excerpts

Thursday 14th June 2012 Commons Chamber

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

I welcome this important and timely debate. As other hon. Members have said, mental health issues are often marginalised in debates about health in general. Mental health must take centre stage, because mental health problems are widespread across the social system and affect people of all ages.

As Members have pointed out, there has often been a stigma attached to mental illness, but we are beginning to tackle that stigma head-on both here and, increasingly, through other public figures talking about their mental health problems.

As we attack that stigma, we must also examine whether our approach to tackling the problem is fit and appropriate for the 21st century. Our approach to mental illness over a number of decades has been based on what I would call the psychiatric model. The model has medicalised mental illness and treated it as something to be dealt with using drug-based therapies. It is dominated by a concern for short-term relief rather than long-term cure. That approach has dominated our thinking about mental illness in mainstream health. In my view, it needs to change, which is why I broadly welcomed the recommendations in the Government’s “No Health without Mental Health” strategy, particularly its emphasis on improving access to psychological therapies. The Government are investing £400 million over the spending review period, which is a welcome development.

People who suffer from a range of mental health problems need clear access to a range of talking therapies, but it has become fashionable to be sceptical about the effectiveness of long-term approaches such as psychoanalysis and psychotherapy, and we must not fall into the trap, as we do in many aspects of modern life, in focusing on therapies that have a short-term effect. I believe strongly that psychoanalytical and psychotherapeutic approaches can help to treat a range of mental health problems, from anorexia and psychosis to schizophrenia. We should not be embarrassed to advocate the use of such therapies.

At the same time, we need an integrated approach at a local level. I am impressed by the approach taken in Sandwell, part of which I represent. A GP-led approach to mental health care in Sandwell has borne results. The area has high levels of mental ill health, and high social deprivation and unemployment. Local GPs, led by Dr Ian Walton, agreed that depression should be a top priority. They developed an integrated mental health care approach emphasising greater choice, and helping to build emotional resilience and independence. The approach shifts the focus to mental well-being rather than mental illness.

As other hon. Members have pointed out, GPs are an important first gateway into NHS mental health services and the early identification of treatment for mental health problems. Big steps have been taken in Sandwell to improve GP training to deal with patients presenting complex mental health problems, and Dr Walton and his team have invested time in GP training to improve the efficacy of early diagnosis.

Improving early diagnosis of mental health problems is a fundamental part of the integrated model that has been successful in Sandwell. It frees resources in secondary care and allows people to deal with their mental health problems in community and family settings. The Sandwell model emphasises positive self-help, access to appropriate talking therapies and a focus on specialist programmes tailored to the needs of patients, which other hon. Members have mentioned. It also emphasises the importance of partnership working with schools, health, employment and other social providers.

Dr Walton and other local GPs have helped to transform mental health care in Sandwell, with consistently high recovery rates using IAPT of 63%, compared with a national average of just 44%. As we seek to tackle the major problem of mental health across our country, we need that greater emphasis on talking therapies. We need to challenge the psychiatric model of mental health treatment that has dominated thinking in our health system for far too long. We need an integrated approach at a local level that takes the best talking therapies and gives people access to the treatment they need. As the debate has illustrated, we also need a commitment from the Government to place mental health as a top priority within our health service as we seek to tackle the problem.

Veterans (Mental Health)

James Morris Excerpts

Wednesday 7th March 2012 Westminster Hall

[Julian Sturdy]

I agree. As I said, there is a real problem about the joined-up thinking that needs to be done. A tremendous amount of work and services are out there, but we need to bring that all together, under one roof. I will come on to that later if I can.

There remains a real danger that too many veterans will slip through the net because they fail to be registered for initial support on leaving the service and get lost in the system thereafter. The best way to ensure that support gets through to veterans is to keep up to date with veterans, as has been said.

Having touched on the increase in mental health nurses across the strategic health authorities covered by an armed forces network, I ask the Minister to outline the initial effect that the Government believe those nurses are having. Is there sufficient demand for the increased services? Do we need to consider increasing the numbers further? Ensuring that Government provision is frequently reviewed in such a manner will help to keep the ball rolling on this very important subject.

Without wishing to ask too many questions, I should be grateful to the Minister if he confirmed how many of the 10 health networks have now developed integrated services for veterans with specific mental health problems. As I said, ensuring that our provision is targeted correctly and effectively in supporting veterans is key.

I should now like to deal with the online package of interventions for veterans. In response to a recent written question tabled by my hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips), the Minister, who I am delighted to see will respond to this debate, stated that the uptake of membership of the Big White Wall among the armed forces family is exceeding expectations. It would be interesting to know whether uptake among veterans is also high. Although I am a great supporter of online interventions, my slight fear is that information, assistance and forms of community engagement are all present and accessible online, but only if someone actively searches for them. With respect to veterans who suffer from mental health problems, we cannot expect all of them to be able or even willing to carry out such research. Are those leaving the service provided with the relevant links and information before they leave?

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

I, too, commend my hon. Friend for initiating the debate. Does he agree that there is a key role to be played by local authorities in providing the information for veterans that he is describing? David Herbert, a constituent of mine in Halesowen, was instrumental in bringing together a veterans charter in the Dudley borough, precisely to signpost veterans towards key information in the local area, including information on provision of mental health services.

[Julian Sturdy]

I thank my hon. Friend for that timely intervention. I agree that local authorities have a key role to play, and I agree with the point about the veterans charter, which could go a long way towards delivering what we need, because ultimately we must signpost services correctly. That is the real point. As I said, there are great services out there, but I fear that if we do not signpost them to veterans effectively, we might be missing a trick.

Mental Health Care

James Morris Excerpts

Monday 21st November 2011 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

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

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

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

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

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

[Mr Walker]

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

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

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

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

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

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

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

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

Southern Cross Care Homes

James Morris Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I thank the hon. Gentleman for his comments. He should just reflect on the fact that this company and this business model were established during the 13 years when his party was in office, and on the fact that his party did not put in place the necessary regulatory measures that would have allowed anything other than the very measured approach that this Government are taking— working with the lenders and the landlords to ensure a consensual restructuring of this business. That is what the residents of these homes want, and this is what we are doing to make it happen.

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

I recently visited Roxburgh House in Cradley Heath in my constituency, where a number of vulnerable elderly residents are concerned about their future. Does the Minister agree that we need not only to address the continuity of care in those homes now, as he has described, but seriously to review the situation, once this crisis has been managed, to make sure that it does not happen again? Will he outline the steps he will take to ensure that that happens?

[Paul Burstow]

I am grateful to my hon. Friend. That is exactly what we also need to work on, which is why we are providing in the Health and Social Care Bill the necessary powers for regulations to be made that would allow such a regulatory approach to be developed. During consideration of those ideas in Committee, it was far from clear whether the Opposition believed that this was a worthwhile approach to adopt.

Southern Cross Healthcare

James Morris Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

It is important to put on record that something that the hon. Gentleman said is not, and never has been, the case. Social care in this country is not free. That is one of the big inequities of our current system and one of the big challenges that the Government are determined to address through the review that Andrew Dilnot is undertaking.

On the hon. Gentleman’s question about the good old days, I have to say that many people did not see those days as good, because the care was not personalised and individualised, and it was not always of good quality, either.

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

Will the Minister say something more about the specific steps he is taking to see that the Care Quality Commission ensures that standards of care are maintained during the transition period in homes in my constituency owned by Southern Cross? What steps will he take to ensure that the CQC takes its responsibilities seriously?