Mental Health Services (Norfolk and Suffolk)

Jim Shannon Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Dr Poulter]

Yes, that is absolutely the right way to provide integrated services and joined-up care, because we cannot necessarily have a one-size-fits-all approach across Suffolk or Norfolk. We need to look at the local healthcare need. That is partly about working not just with housing providers, social services providers, primary care and GPs, as I believe is happening in my hon. Friend’s constituency, but with the voluntary sector, other third sector providers and local charities, many of which have knowledge of the needs of patients, families and carers. When we are providing joined-up, holistic mental healthcare, it is just as important to make sure that the approach is joined up and holistic in that regard, and I believe that the project in my hon. Friend’s constituency will have a very good chance of improving services for patients.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Dr Poulter]

I will make a bit of progress first and give way in two or three minutes.

The challenge from a lack of bed capacity is acute; 36 beds have been closed in recent months, 28 of them temporarily to be reopened as soon as possible. One of the challenges, as my constituency neighbour, the hon. Member for Ipswich (Sandy Martin) said, comes from the lack of joined-up working and a failure of commissioners, to some extent, to work collaboratively with the trust to identify short-term solutions. None of us wants to see patients travelling outside Suffolk. The commissioners have not worked well with the trust, because beds are available. My neighbour, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is unable to speak because of her Government role, has rightly highlighted that bed capacity is available at the Chimneys in Bury St Edmunds—18 beds, including specialist eating disorder beds, which are available and could be commissioned if the commissioners worked more collaboratively and supported the leadership of the trust more effectively. I hope that will come out of the collaborative and pioneering work on which the trust’s partners are now supporting it.

None the less, there are some positive things to point towards. Building work is going on to deliver some new wards, and it is hoped that Lark ward in Ipswich, the psychiatric intensive care unit, will be able to reopen later this year. There are hopes that more can be done for child and adolescent mental health services, with continuing expansion in the number of beds.

--- Later in debate ---

[Jim Shannon]

I congratulate the hon. Gentleman on securing the debate. I sought his permission to intervene beforehand and told him why I wanted to. With the prevalence of mental health issues 25% higher in Northern Ireland than in the rest of the United Kingdom, and with our NHS unable to meet the demand on the service, does he not agree that mental health reform must be UK-wide and undertaken urgently, before people who simply need a bit of help to cope become people who need in-patient care and a strong drug regime to survive? Do it now and it can stop problems later.

[Dr Poulter]

I agree entirely with my hon. Friend. He is always a strong advocate for the needs of his Strangford constituents. He is right to highlight that early intervention and early support can be very effective. That is partly because it often prevents some of the other unwanted effects of having a mental illness. When people have been untreated for a long period, they may well lose their job and struggle with their relationships. A number of the supportive and protective factors that can help to support someone through mild and moderate ill health, such as being in work or in a supportive relationship, can be lost. If we can do more to help people in the early stages, that is a good thing—quite apart from it potentially reducing the number of acute admissions later on.

I want to make the important point that the staff shortages at the trust are one of the major challenges that need to be addressed. It is frankly, and I do not use this word lightly—I do not think I have ever used it before, even though we often hear it used by politicians—a scandal that there is such a shortage of staff at Norfolk and Suffolk mental health trust. I hope the Minister can think of better ways to fund and support the trust. Without enough staff, it cannot expand services or deliver safe services. The trust has struggled with CQC inspections because there are not enough staff on the ground to deliver the care it wants to deliver. That is not entirely the fault of the trust, however, as it is constrained by its funding.

I will outline some of the issues that the trust faces. It has had difficulty recruiting band 5 registered mental health nurses—there are approximately 125 full-time vacancies; there are 35 full-time equivalent vacancies for psychiatrists, partly owing to a national shortage, but also owing to particular challenges in the east of England; almost one in five medical posts at the trust are vacant—that means that doctors who should be there treating patients are not because of staff shortages; and 16.02% of qualified nursing posts are vacant. That is not acceptable or sustainable. If we are to improve patient care and help the trust to turn around, the fundamental issue of recruitment has to be addressed. There are fewer than 15 psychiatrists per 100,000 people in the region, which is much lower than the national average. In fact, the east of England has the fewest psychiatrists per head of population in the country.

Doctor recruitment is not a good story either. Issues with the junior doctor contract might not have helped, but we are where we are. Recruitment for CT1 junior doctors in 2017 saw only 16 of 45 vacancies filled—that is 36%—so only one third of the number of doctors who should have started training at CT1 level are working in the trust. That is a big rota gap to fill and will of course affect patient care. In 2015-16, about one third of ST4 vacancies in child and adolescent psychiatry were filled. In general adult psychiatry, which is the bread and butter of psychiatry, only nine of 18 posts were filled in 2015. In 2017, only five of 22 posts were filled, which means that less than a quarter of posts for registrar trainees in general adult psychiatry are filled. The story goes on and is equally bad in older-age psychiatry—and we have a lot of older people with dementia to look after in the east of England.

Recruitment, then, is vital. We have to do more to recruit psychiatrists. The current strategies are not working, so I ask the Minister to look at what has been successful overseas—in Queensland, Australia, and other places—and to put financial incentives in place to support nurses and doctors to come and work in the east of England, because at the moment patients are paying the price for a lack of doctors on the ground. The trust is doing its best to recruit, but it needs extra financial support through Health Education England, and it needs to be given support and the go-ahead from the Department. We know from elsewhere in the world that financial incentives work in rural and coastal areas, as long as doctors and nurses are helped with a relocation package. The Department’s successful health visitor programme is a good example of how financial incentives can work. I hope she will look at that.

The pressures on the trust’s finances have been there for many years—since the merger of Norfolk and Suffolk mental health trusts—and we know that mental health has been underfunded nationally for decades. The trust needs £9.2 million to meet CQC recommendations for improvement. Some £4 million can be funded from the capital budget, but given that the CQC has criticised the building’s infrastructure, it seems ironic to raid the capital budget for buildings and infrastructure and put it into the revenue budget to deal with immediate quality of care issues.

Even with that £4 million, however, there is still a shortfall of £5.2 million, and that was the subject of a recent funding bid to NHS England. The bid will be resubmitted fairly soon, and I hope the Minister will encourage NHS England to look favourably on it. It is important that the trust is given the financial wherewithal to deal with the quality issues raised by the CQC, to reinvest in vital community services and to undertake the vital work on integration that my constituency neighbour, the hon. Member for Ipswich, mentioned in his intervention.

There is some positive news. The ligature reduction project is proceeding successfully, and some good work is being done in the rebuilding programme at Chatterton House. The Norfolk and Waveney perinatal mental health service was launched in September. I pioneered support for the expansion of perinatal mental health services when I was a Minister, and I am pleased to see that it is now happening on the ground. In February a specialist perinatal mental health service was launched in Suffolk, which is a very good development. However, severe challenges remain and need to be addressed.

Finally, let me say something about services for patients with addictions. I will be brutally honest: I think that we created a problem with effective addiction treatment through the Health and Social Care Act 2012. The commissioning of addiction services has been transferred to local authorities, although the bulk of mental health services and physical health care for patients with addictions is still run by the NHS.

In the east of England, the amount invested in drug misuse services has been reduced by about £6 million over the last four years. Drug misuse is a serious challenge in areas such as Lowestoft, Ipswich and Norwich, not just as a result of underfunding but because those services are not working in a joined-up way with mainstream physical and mental health services. That must be addressed as a matter of urgency, because patients are falling through the net and not receiving the holistic care that they need. Many end up in the criminal justice system as a result, and the police and, in some cases, communities are picking up the pieces because of the failure to provide joined-up care for those patients. The lack of substance misuse services as part of any NHS system affects the dynamics and practicalities of good care, such as the sharing of information. Barriers are created, and the good intentions of staff on the frontline are undermined. That has an adverse effect, and I am sure that we will continue to see a rise in the number of drug-related deaths as a consequence.

Let me ask the Minister some questions. What additional support can be offered to the trust to help it to deal with its historical and current financial challenges and transform its services in the wake of the CQC’s report? There is a shortfall in funding; the trust has submitted a funding bid, and I hope that the Minister will support it. What additional resources can be made available to improve the recruitment and retention of psychiatrists and nurses, and what can be done to attract junior doctors to the east of England? One in five doctors who should be at work are not there because of staff vacancies. What steps are being taken to stop the transfer of patients out of area for treatment? Finally, what can be done to ensure that there is proper integration of addiction services with mental health services in our region, to ensure that patients are given a better deal?

It is time for the rhetoric about mental health to join up with the reality, and for patient care to improve. It is time for Norfolk and Suffolk mental health trust to be given the support that it needs, so that it can do the best for its patients.