Southern Health NHS Foundation Trust

Julian Lewis Excerpts

Wednesday 8th June 2016 Westminster Hall

[Dr Julian Lewis (New Forest East) (Con)]

My hon. Friend the Member for Fareham (Suella Fernandes) has done the House a service by bringing this debate to the Floor. The measure of cross-party support that she has achieved is evidenced by the powerful speech of the right hon. Member for Oxford East (Mr Smith).

I hesitated to contribute to this debate because I have not been involved in the cause of the current crisis, which is about the deaths of patients being insufficiently explained. However, I have a history with Southern Health. I explained in the course of an urgent question, which the present Minister responded to on 6 May, that back in 2011 and 2012 my dealings with the trust were, in 19 years in Parliament, the only constituency issue that caused me genuinely to suffer sleepless nights. It was a question not about the way in which people were treated as inpatients in Southern Health establishments, but about a determination by the trust, in concert with a number of other trusts in other parts of the country using similarly questionable techniques, to follow what appeared to be a trend, if not a fashion, to close a significant proportion—35%—of the existing inpatient acute mental health beds.

My hon. Friend the Member for Eastleigh (Mims Davies) said in her intervention that she detected something of a “bunker mentality”. She is absolutely right. The mentality that I detected at that time was a culture of stubbornness and denial about whatever it was that Southern Health wanted to do, irrespective of what other people might wish it to do. The issue at the time hinged upon something that ought to have been straightforward: namely, what was the necessary number of acute inpatient beds to retain. I raised that subject in two debates. Although I have not yet had the chance to meet Tim Smart, the new chairman of the trust, of whom I hear good reports, I hope he will take the opportunity to look up the two debates. One was on 10 November 2011 and, most importantly, the second one was on 18 April 2012. I had information from within the trust that the bed occupancy rates were high. In fact, the bed occupancy rates on average were between 91.9% and 96.7% when I was surveying the data. So it made it rather hard to argue that one could safely close two out of the six acute inpatient units, thus reducing the number of available acute inpatient beds from a total of 165 to only 107.

Part of the reason for the reduction was given quite frankly as a cost saving. It was proposed to save £4.4 million; £2.9 million out of that total would be absolute savings and the remaining £1.5 million would be invested in something called “hospital at home”. The group that we set up in the New Forest, which continues to meet regularly—usually three or four times a year—is called Support our Mental Health Services. It has found no evidence whatever that there has been any significant increase in the amount of support or the quality or quantity of support that people get at home.

Given that, at the time, with 165 beds 53% of patients were detained and just under half the total were people who opted to go into an acute bed if they suffered some dreadful breakdown, I predicted that the figure for those detained would rise proportionately to about 82%. When I made these remarks in public, Katrina Percy took objection to them and sent a letter to Ministers, councillors and Hampshire MPs denouncing my comments as “unfounded”, “scaremongering” and with “no place in the 21st century” because I had pointed out that if someone suffered a severe breakdown, perhaps their best chance of getting a bed if they needed one under the Southern Health regime would be to cause as much mayhem as possible. But it remains a fact that today, as I understand it from sources within the trust, some 80% of the remaining beds are occupied by people who have been sectioned or detained, and that means that the opportunity for getting a bed if you need one, other than if you are sectioned, is correspondingly reduced.

The difficulty that I had at the time in trying to save the beds was that the trust’s clinical director, Dr Lesley Stevens, was determined to go on repeating figures over and over again that there were between 20 and 30 beds vacant at any one time. There were not. Exceptionally, in a short period—if I remember correctly around Christmas time—there was a figure of that sort, but even by the time she was continuing to put that bogus figure forward, that temporary departure from the norm of high bed occupancy had already been left behind and we were back to business as usual with pressure on bed numbers. Eventually, even a proposal that instead of closing both units at once the trust should close just one of the two units scheduled for closure, and see how that panned out, was rejected.

As you can imagine, Mr Hanson, the relationship between me and the trust was pretty much at rock bottom after all the controversy, but both sides decided we had better try to make the best of what was now a fait accompli. Katrina Percy, for her part, promised—and I believe she kept the promise—that no patient whom the trust judged to be really in need of a bed would be denied one, even if one had to be bought in from the private sector. In return I volunteered never to criticise the trust if it bought in such beds; and I never have, because it is most important that it should give beds to those who need them, and that it should not be deterred because of a politician saying “I told you so; look, you are now having to buy in private beds.”

To bring the story up to date, and conclude: there was a double tragedy. The individual tragedy was the death of a young man called James Barton. He was taken on by the trust and became the director of mental health and learning disabilities. That was in about 2014, and in my opinion James was a total breath of fresh air. He reached out to us, and said, “I know we have had all these troubles in the past; I want to build a new relationship”—and he did. In the course of a number of times when James came to liaise with and participate in our group he confided to me that he believed that the bed cutting had gone too far, and he was experimenting with different configurations, in the hope that bringing perhaps about 15 or 18 beds back into the system—approaching approximately half of what had been lost—might get things back into balance. Tragically, in February 2015 James was suddenly found dead at the age of 36, from an unexplained medical condition. That was a huge personal loss to people such as myself, who knew him only slightly. I can only imagine the catastrophic loss it was to his nearest and dearest.

It was also a tragedy from the point of view of people who need acute beds, in my opinion. Although James’s successor, Mark Morgan, has maintained the contact and is a very pleasant person to deal with, the message that I am getting back from Southern Health now is exactly what it was: “Well, we were having to buy in these beds, but we are not having to do it now, and we seem to be back in balance. We don’t need any extra beds.” Incidentally, one of the two units that were closed was at Woodhaven hospital and was only eight years old. I had performed the opening ceremony. The Winsor ward in Woodhaven hospital remains empty to this day.

[Mims Davies]

I have had families coming to see me—particularly the families of people aged 19 or in their early 20s—for whom beds and in-patient availability are the biggest issue. The treatment at home is working, but they need more sustained treatment, and the closure of bed spaces is having a profound effect on the development of those young people.

[Dr Lewis]

Furthermore, the beds at Woodhaven were state of the art, with en suite facilities—which is terribly important if someone has to be an in-patient in such circumstances. Many of the remaining beds do not have those facilities. That ward has been standing empty for several years now. I believe a change of culture is needed in the trust. Certainly there is no difference of opinion between us on the point that it is desirable if possible for people to avoid going into a mental health unit as an in-patient. However, to have the confidence to be treated in the community they must know that there will be in-patient beds for the occasions when they need extra support. I hope that that lesson from the past will be borne in mind in future restructuring of the trust. I called the trust’s culture one of stubborness and denial. That may lie in the minds of individuals, rather than in its structure, but that is a matter for people other than me to decide.

--- Later in debate ---

[Alistair Burt]

Genuinely, I am unaware of that. The police may review evidence at any time. If CQC has certain evidence that it wishes to take to the police for prosecution, that is a matter for it. I understand the processes that people would want to go through. It is important for me to offer reassurance that those processes are in place, and that things that for too long have been swept under the carpet are open for examination, which I understand to be the case.

Let me deal with the question of a public inquiry. Ministers face many calls for inquiries, and it is important for public inquiries to be considered only where other available investigatory mechanisms would not be sufficient. Public inquiries are rare events. I argue that the processes now being followed by NHS Improvement and CQC are the best way to put right the safety and governance issues at Southern Health. That does not rule out the dissemination of wider learning from this case through NHS Improvement or, where appropriate, the holding to account of individuals via professional regulation or normal performance management routes.

It is right and proper that we should ask such questions. We can perhaps examine whether the system would have responded in the same way had the trust been an acute trust, as I mentioned earlier. I am passionate about improving the care and outcomes for people with mental illness or learning disabilities by ensuring that all aspects of healthcare for people, whatever the issue that has brought them into the care of the NHS and others, are given equal priority with physical health. That must include regulation.

Let me now deal with the point made by my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood). As I have indicated, what I have observed over the past year has worried me. That is to say, there seems to be greater tolerance of when things go wrong in mental health than in acute services. We need to ask ourselves why it has taken so long to resolve those difficulties and to reach the regulatory decisions that are now starting to take effect.

I will therefore be looking at the matter with NHS Improvement, to consider both the effectiveness and the timeliness of regulatory interventions in mental health and learning disability services. I am keen to bring independent leadership into that work, alongside NHS Improvement. A task-and-report group will do a piece of work specifically on that.

Let me name the other places that have upset me during the course of the year. In Hull, there has been a problem with in-patient beds and an inability on the part of the NHS to make decisions about it for more than three years. There was the case of Matthew Garnett, the young man with autism in the wrong place; I could not get information on him for weeks, because of the failure of the NHS to provide what I needed. There are the problems in Tottenham with new mental health facilities, similar to what happened in York, at Bootham Park—how that was closed, and the inability of people to handle it correctly. That is a whole series of cases in which I think things could have been done better. The response has not been good enough. An inquiry into one thing is not sufficient, and the processes are in place to deal with that. Looking at the whole range of why such things happen is really important, and that work is now underway.

[Dr Julian Lewis]

Will the Minister give way?

[Alistair Burt]

No, I cannot, because my hon. Friend the Member for Fareham has to have her two minutes.

A further review of the investigation of deaths is being done. It was announced by my right hon. Friend the Secretary of State for Health, but it will not be completed until the end of the year, when the Department will give its response. This has been a hugely important debate, but it is not the end of the matter. It is a staging post, and people will be able to see things following it. I commend my hon. Friend for raising it.