Mental Health Care (Hampshire)

Julian Lewis Excerpts

Wednesday 18th April 2012 Westminster Hall

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

Last November, I secured a short Adjournment debate entitled, “Woodhaven Hospital”, the subject matter of which ranged far more widely than the future of that state-of-the-art mental health unit, which was opened in New Forest East only eight years earlier. At issue was the vital question of how many acute beds should continue to be provided by the Southern Health NHS Foundation Trust, which covers most of Hampshire.

The trust was proposing a 35% reduction in acute mental health beds for adults, from 165 to only 107, 10 of which would go from Antelope House, Southampton, 24 from the Meadows in Fareham and 24 from Windsor ward at Woodhaven in my constituency, with this last unit being reused as a low secure unit for much longer-term detained patients. No one disputes that some beds will always be needed for people in crisis, and everyone welcomes the use of new mental health therapies to reduce the number of admissions and enable people to go home earlier. The argument is purely about how many beds are required and whether the trust has shown adequate statistical rigour.

The trust’s consultation document seemed to be designed to persuade the public that bed numbers were much higher and length of stay much longer in Hampshire than the national average, when that was not the case. Two other matters also caused particular concern. First, about half the acute in-patients at any one time had been detained or sectioned under mental heath legislation, so most detained patients would still need beds in the future. It seemed obvious therefore that the proportion of beds allocated to such patients would rise from about half to some two thirds or even three quarters if there were a 35% reduction. Yet, when I said on the BBC’s “South Today” programme that people’s best chance for future admission would be to get themselves sectioned, the chief executive of the trust, Katrina Percy, sent a letter to Ministers, councillors and Hampshire MPs denouncing such comments as “unfounded” and “scaremongering” and with

“no place in the 21st century”.

The trust feared the broadcast because it also demonstrated my second contention, which is that people were being misled about the number of unused acute beds out of the 165. As was explained in the previous debate, at 4 pm every day a bed states report is issued, showing the total number of beds available in each acute adult mental health unit. The figures are broken down into four important categories: male beds, female beds, vacant beds and leave beds. Male and female beds are obviously not interchangeable, except in the minority of cases where the configuration of a ward allows a bed to be used for either gender. Leave beds are those whose patients are away for a few nights, and beds empty for longer periods are rightly regarded as vacant and genuinely empty. Despite what the trust says, one cannot rely on admitting the same number of new patients as there are leave beds because people come back after two or three nights to reclaim such beds.

The trust hates my use of these 4 pm daily snapshots of bed occupancy, yet what is its alternative? It issues simplistic graphs, which plot three elementary tracks. The top line shows the number of beds in the system; the middle one shows the number currently in commission in case some have had to be closed; and the bottom one, which fluctuates widely, shows the number of patients in beds on each day. The picture presented by the graphs seems reassuring, because there is always a visible gap between the number of patients in beds and the number of beds in commission, but they do not distinguish between the different categories of unfilled beds. The graphs assume that all the beds are interchangeable regardless of gender and that they are all available for admitting new patients, when many are leave beds, which are, by definition, never empty for long.

In last November’s debate, I pointed out that between 21 September and 6 October 2011 the combined total of vacant and leave beds had varied from just three to just 11 out of the 165 in the system and that over the three months from August to October, even if all the leave beds had been counted as fully available for new admissions, bed occupancy was still at almost 92%. One must have huge confidence in the ability of the trust’s proposed alternative—virtual wards at home for acutely ill people—to think that a 35% reduction in beds will be safe and sustainable. In the previous debate, I said that it was

“distinctly probable that the overview and scrutiny committee of Hampshire county council may decide to refer this matter to the Secretary of State.”—[Official Report, 10 November 2011; Vol. 535, c. 552.]

That health overview and scrutiny committee—HOSC—can do that if it is sufficiently concerned about proposed changes in NHS arrangements.

I was a little perturbed to hear that HOSC’s relatively new chairman, Councillor Pat West, apparently said that I had my figures wrong. Before Christmas, I made contact with Mrs West, who took the trouble to meet me at the home of my caseworker, Councillor Diana Brooks, who is the health portfolio holder on the district council in the New Forest. The HOSC chairman went though some of my data, and forcefully explained her poor opinion of the Southern Health NHS Foundation Trust and one of its most senior administrators. She even hinted that there was a question mark over the suitability of the trust to continue with its contracts and said that the future of the acute mental health beds was just part of a bigger picture. She also added that the HOSC had considered referral to the Secretary of State but felt that that was premature at present and that matters would be considered further at the next HOSC meeting on 24 January. Encouraged, I put the date in my diary.

Meanwhile, the trust’s chief executive, Katrina Percy, had responded to my November debate, and that led me to prepare a full analysis of the deficiencies so far discovered in the trust’s information. My memorandum, entitled “Unreliable Statistics”, was sent to my right hon. Friend the Minister, Miss Percy and the HOSC chairman on 11 January. My covering letter to Pat West stated:

“I hope the HOSC will consider the contents presently”.

With the HOSC meeting drawing near, I asked my parliamentary assistant, Colin Smith, to ring Councillor West to ask about my addressing her committee, perhaps with a delegation. She was adamant that there was no need for me to go to the 24 January meeting. She said that it would be “counter-productive” and that she would much rather keep me “in reserve” for later. Having no reason to doubt the advice, I followed it. My feelings can be imagined, therefore, when the day after the meeting I discovered that the HOSC had fully endorsed the bed closure plan and would not be considering it again until July, by which time all 58 beds would have closed.

I immediately telephoned the leader of Hampshire county council and expressed my incredulity that an elected councillor from my own party could have misled me so blatantly. Subsequently, the HOSC chairman spoke further with my office. She still insisted that my attendance would have been counter-productive. I am at a loss to know how the meeting could have been more counter-productive. Could her committee have voted to close all 58 beds twice over?

Suspecting that my paper on bed statistics had been suppressed rather than circulated, I sent it directly to all HOSC members and set out the circumstances in which their chairman had dissuaded me from attending. In case anyone thinks that I am relying on parliamentary privilege, this is what I wrote without it:

“She gave no inkling that there was the slightest chance of a decision to close the beds being taken at that meeting. I was, therefore, amazed and dismayed to learn (from a local press report) that that is precisely what happened. I feel totally misled and let down on behalf of some of my most vulnerable constituents... In almost 15 years as a Hampshire MP, I have never received treatment like this from an elected colleague in my own party, and I am deeply shocked by it.”

When the row broke in the local press, Councillor West refused to comment to the Southern Daily Echo, saying that she

“did not want to get into a slanging match with the MP in the media”.

However, on 3 February, she replied to my original letter of 11 January covering my memo to the HOSC and to my later letter to committee members:

“I am sorry that you could not attend the 24 January meeting”,

she wrote, without a trace of irony, adding that the agenda and papers for the meeting had been on the council’s website and would have shown me that the HOSC

“would be considering recommendations which related to the closure of beds”.

Apparently, I had only myself to blame for not distrusting her enough to ferret around on websites to check that I was not being misled.

The minutes of the meeting and the resulting press coverage revealed that two factors had featured prominently in the HOSC deliberations. The first was a statement by the trust’s clinical director, Dr Lesley Stevens:

“With regard to the data on bed demand, it was highlighted that between 20 and 30 beds had been vacant consistently over the past three months, and that this trend coincided with the introduction of new community services.”

That is precisely the sort of claim that I had intended to challenge.

On the very day of that meeting on 24 January, the trust’s own figures showed clearly that there were no vacant male or female beds, no leave male beds and just six leave female beds in the entire system, giving a grand total of six unoccupied beds. In November and December 2011, there had certainly been an unusual rise in the number of empty beds, in stark contrast to the previous month, October, when on 17 days the total number of male and female vacant and leave beds had been in the single figures, not 20 to 30.

Indeed, on 10 October, there had been no vacant male beds, no vacant female beds and just one male and one female leave bed in the entire directorate. Still, if overall totals of empty beds in January had continued at November and December’s high levels, I would have ended my campaign to prevent the closures. However, that did not happen. For example, on at least 14 days in January, there were no vacant male beds, and on at least 10 days, there were no vacant and no leave male beds, so no beds for men at all.

Later, I wrote to the local press about Dr Stevens’s claim to the HOSC that there had been 20 to 30 vacant beds consistently in the past three months. I pointed out in my letter that actually only a handful of beds had been empty when she claimed consistent totals of 20 to 30 unoccupied, and I noted:

“It is true that during November and possibly December”—

I did not have the full figures for December at that time—

“there was a sudden surge in available beds totals. Yet my continuing investigations have shown this to have slipped back since Christmas—and this would have been known to the trust’s representatives when they made their presentation to HOSC.”

Although my letter was published in at least three local papers, including the Southern Daily Echo, in which Dr Stevens had aired her views, as far as I can tell, she did not respond in any of them.

To deal with any suggestion that the trust’s new programme of intensive day therapies had been responsible for the temporary glut of beds in November and December, I asked senior trust members at a routine meeting on 3 February whether the new therapies and arrangements begun in 2011 were still in place. Dr Shanaya Rathod from the trust confirmed that they were. Therefore, the rapid decline in empty bed totals in January cannot be explained away by suggesting that the trust had stopped doing whatever it claimed was responsible for the temporary surge in beds during the last two months of 2011.

The second major factor that influenced the HOSC on 24 January was also set out in the minutes of the meeting:

“It was reported that the Centre for Mental Health had independently reviewed the evidence for the changes the trust was proposing and concluded they were necessary to meet the challenges the trust faced. The trust offered to provide the full report to HOSC members when available.”

On 27 January, I met the trust’s chief executive, Katrina Percy, and was given that document. In fact, it consisted of two separate reports. The first, from the Centre for Mental Health, supported what are termed recovery-oriented services, which the Government are rightly keen on, but did not analyse bed numbers. The second report was by Steve Appleton of Contact Consulting. Less than one page of his report dealt with Southern Health acute bed data, but every reference was footnoted to a single source, which was not attached—a third report called “Inpatient Capacity” drawn up by a third organisation, Consilium Strategy Consulting.

I recall the important debate secured by my hon. Friend the Member for Burton (Andrew Griffiths) on 19 December last year. With my hon. Friend the Member for South Derbyshire (Heather Wheeler), local consultants and the press, he had been battling similar techniques designed to justify closing acute beds at the Margaret Stanhope Centre in his constituency. Those techniques had also relied on an appeal to external authority and an “independent” report by Staffordshire university, which turned out to have been produced by someone on the payroll of the local trust.

Wondering whether something similar had happened in Hampshire, I contacted the Centre for Mental Health, formerly the Sainsbury Centre, which I knew enjoyed a deservedly high reputation. Its chief executive, Professor Sean Duggan, met me on 23 February, and later confirmed in a letter:

“The scope of the centre’s work did not include an examination of the number, type or location of beds that would be needed now or in future. A separate analysis, by Contact Consulting, looked at bed numbers...[The] Centre for Mental Health is an independent charity and as such we would not seek to endorse or condemn specific local decisions about reconfiguring inpatient mental health services.”

Yet, as we have already seen, the second report by Contact Consulting depended on a third report by Consilium Strategy Consulting that had not been made available.

I wrote to Katrina Percy on 28 February, pointing out that

“the so-called independent report that you handed me involved no examination primary source data whatsoever, but simply relied upon a third document—a report by Consilium—which it described as having been produced when the Trust ‘conducted its own benchmarking process’.”

I asked for a copy of the Consilium report; for a statement of the status of Consilium, in particular of how independent it is, if it all, from the trust; and for its contact details. Miss Percy replied on 9 March:

“I would just clarify that the content and status of the Consilium report, as mentioned in your letter to me, is commercially sensitive and is therefore not available to share publicly. However, should it be required, I would be pleased to provide you with the contact details of the consultant involved so that you may contact them directly.”

Despite two phone calls from my office to hers, and a further letter from me, the trust’s chief executive has yet to supply even the contact details of the Consilium consultant.

Although reluctant to reveal data that ought to be available, Southern Health resents criticism of its slippery methods. Yet how else can one describe the activities of an organisation that seeks to discredit, as it does, a public petition with more than 1,000 signatures against the closure of Woodhaven’s 24 acute beds by claiming that

“a number of people contacted the Trust and told us variously that they either did not know anything about the petition, could not recall signing the petition, suggested a friend or neighbour may have signed it on their behalf without their knowledge or consent… I am sure you would also acknowledge that the petition only has limited value in terms of a valid indicator of people’s views”?

If the trust had pointed out that I have some 70,000 adult constituents and that a petition, quickly compiled, represented only a fraction of them, that would have been fair enough. Sadly, it preferred to use a few anomalies to discount the views of 1,000 people and to cast doubt on the integrity of the petition’s organisers.

On Monday 5 March, the trust’s clinical director Lesley Stevens was interviewed for “South Today”, whose chief reporter—in fact, political editor—Peter Henley, challenged her claims about empty beds, given the figures in January’s bed status report. She insisted that there was no shortage of acute beds, yet the very next day the trust sent an e-mail to its consultants, stating:

“There are currently no unassigned acute beds in the Directorate. Can CRHT”—

the crisis resolution and home treatment teams—

“and the acute wards ensure that all clients are reviewed for leave or early discharge as a matter of urgency, please?”

I was also interviewed for the “South Today” report, which was broadcast on 13 March and said that that e-mail had given the game away completely. In-patients were already being reviewed for early discharge at a time when only 18 of the 58 beds scheduled for closure had actually gone. I said then, and I repeat now, that the trust’s policy of closing so many beds on the basis of bogus claims about surplus beds is inhumane.

As a result of the row over the January HOSC meeting, I was invited to take a deputation to the next one on 27 March. Although it was late in the day, a chance had been created to persuade the committee to at least pause the closure programme once the 34 beds at Antelope house and the Meadows had gone. We could then see whether the trust could cope with so many losses before starting to close the 24 Woodhaven beds as well. That had consistently been urged by Councillor Keith Mans, a governor of the trust and a former Member who was once a Parliamentary Private Secretary to a Secretary of State for Health. We believe that closures on this scale must be trialled properly and in stages before full implementation.

At the March meeting, I distributed tables showing how wrong it had been to claim that 20 to 30 beds were still empty when the January vote was held. I was given 10 minutes to state my case, which was a relief, because right up to the start of the meeting the chairman, Councillor Pat West, had told me that three out of the five of us would have to share 10 minutes between us. Mary Bryant, who was one of my deputations, spoke movingly of the burden on carers that the loss of the beds would impose; Councillor Sally Arnold gave the results of a survey of parish councils that had not been properly consulted; and Mrs Jane Barnicoat-Chongwe, a nurse practitioner on the acute ward at Woodhaven who had contacted me, expressed professional concern about the trust’s proposals. I put on the record now that at no time has she given me any data whatsoever or any documents from the trust.

Our fifth spokesman was Andrew Evans, a service user who for decades has relied on periodic admission to acute units. With extraordinary eloquence, Andrew explained not only the pressure on his parents, who are his carers, if he stays at home when in an acute crisis phase, but how the loss of the en-suite facilities at Woodhaven—remember that the unit is only eight years old—which are not available in some of the other units, will have a traumatic effect on in-patients’ dignity in future. The HOSC and the audience broke into spontaneous applause at the end of his presentation.

Thereafter, none of us could contribute further to the discussion, and I watched in frustration as Dr Stevens blandly maintained that the bed closures at Antelope house and the Meadows, which, of course, had only started after 24 January, had absorbed the 20 to 30 beds, which, in the face of all the evidence, she still claimed to have been empty up to that January meeting. She then mistook the e-mail of 6 March—which said that the system was full and that early discharges were needed, and which had been shown on the “South Today” programme—for another one, sent three days later. She explained how such communications were so normal and so routine that she would be concerned if she were not receiving them. I have since checked with sources at the trust, who have told me that no such e-mails had been sent for months before 6 March.

When questioned by HOSC member Councillor John Wall about the lumping together of male and female empty beds as if more than a fraction of them were interchangeable, Dr Stevens told the committee that a female could be allocated an empty male bed, for example, as long as “one-to-one observation” by a member of staff was maintained. So much for our long years of campaigning to eliminate mixed-sex wards in NHS hospitals.

Once the trust had finished its long presentation, the chairman put a motion to the vote that reflected the case made by Keith Mans and others, including me, that there should be a pause before the closure of the Woodhaven beds began, while an independent panel would seek to resolve the disputed figures about bed occupancy. To our delight, it was carried nem. con., at which point Dr Stevens interrupted the proceedings, which was out of order, because the trust’s presentation had ended. If there were any delays, she exclaimed, the Woodhaven staff would be so unsettled that many would leave, the unit would close and it would not reopen at all—even in its new role, I presume she meant. To my utter astonishment, the first vote was then ignored, as though it had never happened, and replaced by a much weaker proposal that a small panel of committee members and key stakeholders would examine the issues urgently and seek to resolve them without any delay to the closure of Woodhaven’s beds.

Given that the only reason any of this was happening was because of the data I had unearthed and my exclusion in January—remember that originally the matter was not supposed to have been considered again by the HOSC until July—hon. Members might think that I should be a part of the process if it is meant to be more than a charade. Not a bit of it. This little panel will go on its merry way looking at points previously raised in writing by me and others. If it cannot resolve any of those points, according to its terms of reference,

“this will be handled as a matter of urgency through the chairman communicating to the trust”

on behalf of the health overview and scrutiny committee. So our arguments and objections will be safe in the hands of Councillor Pat West and Katrina Percy, supported, no doubt, by the zealous Dr Stevens.

What then should Ministers do? At a meeting with Keith Mans and me on 26 March following an earlier exchange at Prime Minister’s questions, the Minister here today explained that Ministers cannot intervene to pause the process or have an audit carried out unless the HOSC refers the matter to the Secretary of State; but he did confirm that such a referral could still be made. Ministers’ hands are not completely tied, nor should they be given the deplorable tale I have set out today. If a Minister were to say that to restore a degree of public confidence he would welcome a referral to the Secretary of State, and if he were to invite and encourage such a referral to be made, it would be surprising if the committee rebuffed such an expression of concern. If he is unwilling to do so immediately—I quite understand if that is the case, although I would love it if he did—I expect Ministers to consider doing so later, when reflecting on my narrative.

It would be easy to summarise this story as that of a trust that could not be trusted with its own statistics and of a committee chairman who deceived an MP about a vital meeting. However, what it is really about is carers such as Mary Bryant, nurses such as Jane Barnicoat-Chongwe and, above all, service users such as Andrew Evans. It costs nothing to applaud such people, but applause will not help them. What they need is a Minister to grip this situation and send an unmistakable message to the scrutiny committee that he stands ready and willing to bring in the Independent Reconfiguration Panel on referral of the matter to the Secretary of State.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for New Forest East (Dr Lewis) for securing the debate. Health matters are devolved in Northern Ireland and I do not have a direct input into them, but I do have compassion for those who are less well off and that is why I am here as an MP. I want to try to change lives for the better. I recognise the issues that affect the hon. Gentleman’s constituency. He outlined clearly where the process works and where it has not worked, which is what we are debating today. As MPs, we look at the grand scheme of politics—we are all drawn to do that—but today I want to support the hon. Gentleman on the issue specific to his constituency and give an example from my area to illustrate the importance of acute mental bed provision.

As we all know, acute mental health bed provision is vital. Those who use it do so because they have to. The reason such provision is made is to ensure that they receive all the care they need in the best place for that care to be given. The hon. Gentleman outlined how and why the 56 acute mental health beds in his area were removed. That that should happen without full and open consultation with the MP who represents the area or with the many people who are affected greatly by the removal is nothing short of scandalous.

In my constituency, I am aware of the care that is needed for those with acute mental health problems. As you will know, Dr McCrea, the Bamford review raised awareness of mental health issues in Northern Ireland and the importance of having provision for them. It stated that nothing should happen until all the parts were in place, and that if something was to be removed there had to be something else there to take its place. The Bamford review was very important for Northern Ireland.

It has been suggested what the bed closures will mean. According to the background information, if someone is not in hospital, they will be at home. If so, has provision been made for them? The hon. Gentleman described how the system worked and how the consultation process did not involve everyone. Perhaps it did not look fully—it should have done—at how those at home, receiving care in the community, will be affected. Is that care of sufficient value and weight to fit the gap that has opened because of bed closures? I do not know whether it is or not, but back home, when there were changes, we also had to ensure that there was provision for care at home. That is important for those with acute mental health issues. I am not sure, from what I have heard so far, that that has been done in the case the hon. Gentleman has raised. I hope that the Minister can give us some idea of how that will work out.

The hon. Member for Romsey and Southampton North (Caroline Nokes) mentioned another problem. Sometimes, Members of Parliament think that they represent problems specific to their constituency, but they are not really, because all hon. Members represent people similarly and similar problems occur in Hampshire, Dorset, Scotland, Wales and in my constituency of Strangford in Northern Ireland. Last year, after changes were made, one of my constituents affected by mental health issues would have had to travel some 40 to 50 miles on a bus, because there was no car provision. To illustrate the point, we got on the bus and did the whole journey together, me and her, to the destination. There and back, the journey took seven hours and cost £39.40, not to mention the annoyance, hassle and problems that occurred. Whenever people talk about removing beds, they have to consider what happens outside that, including the effect on provision of care packages at home and on the families, and how they get from their home to the hospital whenever a person needs care. I am not sure that, when decisions are taken, people understand that families are also involved. It is not just about the person with the acute mental health problems, but about the families as well. When a stone is thrown into the water and it hits the centre, the ripples spread out: the centre is the person with the acute mental health needs, but the ripples spread out to the family, the community and everywhere else.

The hon. Member for New Forest East mentioned a petition with 1,000 names. I do not agree with Councillor Pat West, who commented that 1,000 names is only a small portion. A thousand names on a petition is a very great number and, I believe, represents a large part of the community.

[Dr Lewis]

For the sake of fairness, let me say that it was the chief executive of the NHS trust, Miss Percy, who sought to dismiss the petition in that way. The trust said that it had tried to validate it and said that a number of people professed not to know about having signed it. How big or small that number was, I have yet to discover.

[Jim Shannon]

I thank the hon. Gentleman. The name stands corrected in Hansard for us all, including me. I still say that 1,000 names can never be ignored. Ignore them at your peril, because those 1,000 people have families and so on, and the numbers are important.

The loss of beds puts pressure on a great many people. The hon. Member for Burton (Andrew Griffiths) spoke about the practicalities. It is important that we consider those, because before anything is done, people have to look at their effect further on. From what I have heard today, it is clear that this process has not been truthfully, honestly and fairly carried out.

To illustrate my point further and give examples, back home there has been pressure on mental health and acute mental health beds. I have pressed in this regard, as have other hon. Members—you have been involved as well, Dr McCrea, and the end result is a new 30-bed unit in Templepatrick, in your constituency. That is a £10 million to £15 million project undertaken in partnership with the health service, private enterprise and private monies as well. The unit is for acute mental health issues. I have become aware of some mental health issues over the years. People who have anorexia and bulimia have acute mental health issues to address; they feel that, no matter how thin they are, they are not thin enough. The 30-bed unit in your constituency, Dr McCrea, is there because of the vision of some of those in private enterprise, and individuals, who have worked with the Minister, Edwin Poots, to ensure provision.

I commend the hon. Member for New Forest East for bringing this matter to the House. Any closure or removal of mental health beds impacts not only on those who need them, but on families who have to live with their family members’ trauma and, wider afield, on the whole community, which also shoulders the burden. I look forward to the Minister’s response, which I am sure will be full and helpful. Again, I hope that we will get the answer that the hon. Member for New Forest East needs, confirming the retention of the beds, because that is the best way forward.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure, yet again, to attend a debate under your chairmanship, Dr McCrea.

The commitment of my hon. Friend the Member for New Forest East (Dr Lewis) is quite evident, because not only is this the second debate on the issue in the past five months but he has had ministerial meetings. He has championed the interests of his constituents, as expected of an assiduous Member of the House. I also congratulate my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on her speech and on how she represented the views and concerns of her constituents on a difficult and sensitive issue. My hon. Friend the Member for Burton (Andrew Griffiths) and the hon. Member for Strangford (Jim Shannon) managed, intriguingly, to merge Burton and Strangford into the southern county of Hampshire. To do so took political skill—debating skill—but they achieved it and made some interesting points that were a valuable contribution to the debate.

I have to say, however, that I am not quite sure what more I can say in response to my hon. Friend the Member for New Forest East following our meeting of 26 March, when we discussed the matter. My hon. Friend has campaigned vigorously since the autumn of last year against Southern Health NHS Foundation Trust’s proposed redesign of acute adult mental health services in Hampshire, and in particular against the withdrawal of the adult in-patient mental health ward at Woodhaven hospital in his constituency. Nevertheless, in the course of my remarks, I will seek to explain and to lay out the policy towards the provision of mental health care in Hampshire and the knock-on effects elsewhere.

The debate also gives me the opportunity to thank all the NHS staff who work in the field of mental health and, in particular, the staff at Southern Health NHS Foundation Trust, who do a fantastic job, day in, day out, looking after some of the most vulnerable and frail members of our society with complex medical problems. Locking into the valid point made by the hon. Member for Denton and Reddish (Andrew Gwynne), the staff must also combat the stigma associated with mental health issues. The hon. Gentleman is absolutely right to congratulate Stephen Fry, Mind, Rethink and others who work continuously to break down such barriers. I will be a little more generous politically, because the Major Government in the mid-1990s and the previous Labour Governments of Tony Blair and the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) did a tremendous amount of work to help bring down barriers and reduce stigma. The trouble is that there is still a long way to go and none of us can relax in fighting that battle.

If one suffers from an acute medical problem, people are all too willing to make hospital visits, to ring up and to inquire after someone’s general well-being, but it is a disgrace that if one’s mental health is suffering, people still too often do not want to find out or are frightened to ask. Even worse, the family and friends of people who suffer from mental illness want to ignore it or hush it up. The patients themselves are often too scared to allude to their medical problems because they are fearful of the response that they might get from family—less often—or friends and, generally, from people in the community. That is our challenge, and that is why I am so full of admiration for people in the NHS and elsewhere in the charitable and voluntary sector who do so much work, not only to look after people at a particularly vulnerable time in their lives but as ambassadors in seeking to break down the barriers and the stigma.

As I explained to my hon. Friend the Member for New Forest East when we met recently, the reconfiguration of local health services is exactly that—a matter for the local NHS. Although he is calling for a halt to the closure of beds at Woodhaven, Ministers cannot and should not be seen to interfere. My hon. Friend, who is generous and courteous, tried to tempt me —he slightly sugared the pill by suggesting that, if not today, perhaps upon reflection—to send out a message, almost like the white smoke that appears from the Vatican when a new Pope is elected, to the trust, and if not to the trust, certainly to the Hampshire HOSC, saying how much I would welcome a referral to my right hon. Friend the Secretary of State.

[Dr Lewis]

Do it.

[Mr Burns]

I know that nothing would give my hon. Friend greater pleasure, but I must warn him that I have been here too long to fall into that pit. It would completely compromise the independence of local government. I am sure he agrees that all too often, Governments of different political parties have been criticised for interfering too much in local government, and that local councillors are elected to local authorities to make decisions about matters that they, because of their representation of their constituents, are most familiar with. It would not be the way forward for a heavy-handed Minister at 79 Whitehall to issue messages of welcome for things. It would compromise the ethos and independence of local democracy, and the way in which local people elect local councillors to represent their views. Therefore, I must disappoint my hon. Friend.

[Mr Burns]

My hon. Friend makes a valid point, and I have total sympathy with it. It is precisely why we are abolishing PCTs on 1 April next year, and why we are creating the clinical commissioning groups under the Health and Social Care Act 2012. Those groups will consist of GPs, who are most familiar with their patients’ needs and requirements, and will commission care for their patients, and create the health and wellbeing boards which will, for the first time in a generation, have democratic accountability because they will include locally elected councillors and will have responsibility under the Act and the reforms to look out for and to ensure that the needs of the local health economy are being met in local communities. That is a positive and straightforward step in addressing the very problem that my hon. Friend raised.

In response to my hon. Friend the Member for New Forest East, decisions on reconfiguration of services will be made by the local health economy, not Ministers in Whitehall. He will be aware that planned changes to in-patient mental health beds in Hampshire have been the subject of local discussions since 2009-10. However, to reiterate the clinical case for change, it will allow investment in better alternatives to in-patient care by increasing home treatment, and developing other measures to support people outside hospital in Hampshire. The number of in-patient beds will decrease by 58, from the current total of 165, to 107. That addresses the question asked by my hon. Friend the Member for Romsey and Southampton North about how many beds were involved from the start to the finish of the process. The change will also enable growth in community reablement services in the New Forest to help and support people with longer-term mental health needs, allowing them to live a more independent and fulfilling life when that is clinically appropriate.

Doctors and other professionals, the public and service users have all been involved in this process in Hampshire from the outset, and their views have always been taken into account, even when they were not supportive of the proposals and the proposals were not radically changed or abandoned.

[Dr Lewis]

It is true that there has been public consultation. It is also true that soon afterwards an analysis of the responses listed concern about this, that and the other. If I remember correctly, the consultation ended in October last year, and it took me until March to get the trust to admit that the heavy majority of people who responded to the consultation were against the bed closures. It consults, and then carries on as though nothing has happened.

[Mr Burns]

I appreciate that point, and I will come to it.

I must reiterate that decisions on the reconfiguration of services are, as with all reconfiguration, for the local health economy to make, led by local people, local GPs and local clinicians. I have been assured that the proposed changes are supported by the majority of GPs, most but not all clinicians and the clinical commissioning group in the New Forest, as well as the Hampshire HOSC. I listened to the procedures and activities of the Hampshire HOSC and what happened at its meetings, but my hon. Friend will appreciate that those decisions do not come within Ministers’ responsibilities.

The Hampshire HOSC consists of elected county councillors who are responsible for and accountable to their local communities, and they made the decision not to refer the matter to my right hon. Friend the Secretary of State. I am sure that my hon. Friend accepts that I cannot dictate—I would not seek to, because it would be inappropriate—what an HOSC should do. It is an independent body with democratic accountability, and it will consider the sort of complaints that my hon. Friend and others have raised to see whether, on balance, it believes that they could lead to its deciding that the proposed reconfiguration is inappropriate and that it should be referred to my right hon. Friend with a request that it is then sent to the independent reconfiguration panel.

The problem for my hon. Friend and others who oppose the proposal is that that body, which has the power to seek a referral, has so far refused to do so. I am sure that my hon. Friend will accept that not only do I have no right or power to do that, but it would be totally inappropriate for me as a Minister to seek to interfere with the working of that local government committee and its decisions.

[Dr Lewis]

I fully respect and accept the Minister’s point. Will he reiterate the point that he made at our previous meeting that even now, if it chose to do so, the HOSC could make that referral to the Secretary of State?

[Mr Burns]

I can reiterate that if the HOSC decides—my hon. Friend said during his eloquent speech that there will be a further meeting in May—that there is new evidence, or whatever, and that it wants to reverse that decision, nothing in the rules and procedures prevents it from doing so. However, it has had two meetings and has heard the evidence and arguments, and the pros and cons, and has not decided so far to take that decision. It has decided not to make a referral to my right hon. Friend. I do not know whether it will change its mind at the meeting in May, and it is not for me to speculate, or to try to influence it. However, in theory, if it wished to make that referral, it could.

I understand that the trust is investing more than £1.3 million in community services and developing alternative patient care in Hampshire. For example, four new specialist liaison staff will help service users to move more easily from in-patient care to the community, and crisis funds will help service users who may struggle to pay things such as deposits on accommodation and household items, or electricity and gas charge cards. As my hon. Friend will accept, it is important to have plans and measures in place so that those people for whom treatment is more appropriate in the home or the community have the structures to help them ensure that that happens. Mental health services are no different from those for acute care, and no one wants to be in hospital for a day longer than they have to be. If it is more appropriate to care for someone in a home setting, with proper support and access to services, or in the community, that is better for the patient. However, such care must be based on a clinical decision about what is most appropriate.

More than 50 staff will form part of hospital-at-home teams, providing intensive support to people where they live and helping them to remain or return to their homes. They will also help to prevent readmission to hospital. In the west of Hampshire, three members of staff will work to support service users who have more complex mental health needs and to help them to gain emotional and vocational skills that will support their recovery and health.

The launch of those services, which are still in their early days, has shown that service users are able to re-establish links with their community and gain the confidence to adapt to home and family life. As a result of the investment, the trust has seen people staying in hospital for a shorter period of time because they receive more intensive support both before they leave hospital and afterwards in the community.

Independent service user and carer groups—for example, the west Hants area service user involvement project or the Princess Royal Trust for Carers—have worked closely with the trust to develop plans, and they have been supportive of the changes. The service user-led recovery philosophy for mental health services has underpinned many of those proposed changes.

As I said earlier, the proposed changes have had throughout the full support of GPs, most clinicians, service users and the HOSC, thereby demonstrating the importance of locally led change at the heart of our NHS. As my hon. Friend alluded to, the Hampshire HOSC last met on 27 March, and its chair wrote to Katrina Percy, the chief executive at the Southern Health NHS Foundation Trust, advising her that pausing the proposed changes would not be in the best interests of local people who were affected by them.

Of course, the HOSC recognises that local people are worried about the changes, and that is why it has agreed to set up a small task and finish group to discuss the concerns raised at the meeting on 27 March. The group will report its findings at the HOSC meeting scheduled for 22 May 2012. In the meantime, let me say that the changes proposed in Hampshire are not unusual—we got a flavour of that from my hon. Friend the Member for Burton, who I know has conducted a vigorous campaign about elements of the proposals in his county that he considers to be deeply flawed.

[Dr Lewis]

On a slightly lighter note, the Minister may be interested to know that the Southern Health NHS Foundation Trust appears to think that what it has been doing is a suitable model and template for the whole country. It has applied for NHS funding because it wants to design a

“comprehensive, independent service evaluation...to inform day-to-day operational business context”

and

“future modelling of service changes.”

Instead of giving the trust more NHS money, perhaps the Minister should provide it with a link to today’s debate, which will show everyone exactly how such trusts go about their reconfigurations.

[Mr Burns]

That is an interesting point that gives one side of the argument. I do not want to labour the point, but unfortunately the other side of the argument suggests that most GPs and clinicians, together with many service users and the HOSC, have so far not shared that view because in various ways they have been supportive of what the trust is doing. That is a serious problem for my hon. Friend, because the nub of the argument is that the democratically elected overview and scrutiny committee has so far refused, or felt it unnecessary, to decide that the trust’s proposals should be referred to the Secretary of State and then to the independent reconfiguration panel. That is the mountain that my hon. Friend has to climb, and as with most arguments there are two views about the effectiveness, efficiency and correctness of the proposals. So far, he is on the losing side within the rules and the way that things are done locally.

Hampshire is not unusual, but the important point is to achieve the best possible outcomes for people in mental health crisis. Significant changes have been made to community and hospital services, so that they become more responsive to people’s needs and more attentive to the physical environments in which care is received.

Other mental health trusts in England have already reduced the number of in-patient beds, so that more support can be given to people in familiar and appropriate surroundings, such as their own homes. Local changes are in line with the “no health without mental health” strategy that was launched on 2 February 2011. As my hon. Friend will know, that is a cross-governmental mental health outcomes strategy for people of all ages, with the twin aims of improving the population’s mental health and improving mental health services. The strategy takes a life course approach and sends the message that prevention and early intervention are key priorities. It also stresses the interdependence of mental and physical health—a point raised by the hon. Member for Denton and Reddish.

The bulk of the strategy will be delivered locally—as it should be—by experts on the ground working with service users and their families and carers. At national level, our early years policies, including health visitors and the pupil premium, are about helping children and young families to get the best start. We expect that investment to save the NHS £272 million, which will then be available to doctors and nurses for reinvestment in front-line services. That will save the public sector £704 million over the next six years—again, that money can be reinvested in front-line services, which I am sure all hon. Members would agree is where it should go.

As the Department of Health completes the nationwide roll-out of psychological therapy services for adults who suffer from depression or anxiety disorders, we will pay particular attention to ensuring appropriate access for people over 65 years of age. We have also committed an extra £7.2 million for mental health services for veterans—a key point given what is happening in that area of mental health.

Many patients who suffer from long-term conditions do not expect a long stay in hospital. They expect to be treated promptly and then discharged, so that they can go home and continue to recover with proper support and access to proper care and treatment. That is the most important thing. Patients in my hon. Friend’s constituency, those of all Hampshire MPs or, indeed, throughout the country who suffer from mental health problems must receive appropriate and swift care and be looked after to the highest standards and in the most appropriate setting. That lies at the heart of the problems highlighted by my hon. Friend.

In conclusion, my hon. Friend should continue his discussions not with a Minister with a heavy-handed approach who dictates things from Whitehall, but with democratically elected councillors and others on the ground in his constituency and in Hampshire.

Care of the Dying

Julian Lewis Excerpts

Tuesday 17th January 2012 Westminster Hall

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

If more hon. Members who support assisted suicide had participated in the debate, one word would have been heard above all others: safeguards. The only hon. Member who seemed to make the case for assisted suicide talked, in a brief intervention, about some people viewing these issues on a religious basis, by which I think he meant that we should judge them on a rational basis. I judge this issue entirely on the basis of rationality, rather than religion, and according to that rationality, it is impossible that the safeguards can be practical or reliable. Safeguards could not be applied to people choosing to end their lives, because the people who would try to apply them could not get into the minds of those people whose future was in question.

The case for assisted dying has been made by a small number of strong-minded and articulate people who have made up their minds that they want to die, but who cannot end their lives without help. If everyone relevant to the question were like that, there would be much less of a problem; but the real reason why safeguards are thought to be necessary is twofold. One is to prevent people from being subjected to subtle pressure, which no outside person could detect. However, as my hon. Friend the Member for South West Bedfordshire (Andrew Selous) said early in the debate, even without outside pressure, there would be a danger that people would feel they had to end their lives in a spirit of self-denial, so as not to be a burden on others. There is no way to erect safeguards to prevent subtle pressure from being applied undetectably; still less is there any way for such safeguards to prevent people from genuinely deciding, although they might want to continue with their lives, that they want still more to end them so that they will not be a burden to others. We cannot apply safeguards to those cases, and that is why the case for assisted dying based on the application of safeguards is fundamentally flawed.

Oral Answers to Questions

Julian Lewis Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Burns]

I am grateful to the hon. Gentleman for his suggestion, but I am afraid that I do not share his view. As he knows, there will be a review of adult services, but it has always been considered most appropriate to deal with paediatric cardiac services before adult care, and that is what we will continue to do.

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

Although the paediatric heart unit at Southampton general hospital is rated the best in the country outside London, it was included in only one of four options under the review. In the past, the Minister has helpfully hinted he might not be confined to considering only those four options. Can he expand on that?

[Mr Burns]

I can expand on it by saying that it will not be me who considers the options. As I have told my hon. Friend before, this is an independent review. However, as he suggests, the JCPCT may decide on four, six or seven possible sites. It all depends on what the consultation produces, and the clinical decision on what is the most appropriate number of sites, which will happen eventually.

I congratulate my hon. Friend on his championing of Southampton general hospital as the local Member of Parliament.

Mental Health Unit (Burton)

Julian Lewis Excerpts

Monday 19th December 2011 Commons Chamber

[Andrew Griffiths]

The hon. Gentleman makes a valid point, which I hope to come to later in my speech. He has served his community well over many years and he properly understands the needs of families, particularly the most vulnerable in our society.

Removing those beds from the Margaret Stanhope centre will bring the median down to 11.5 per 100,000 people, compared with the median of 27.5 across the country. That is putting lives at risk, and we are not prepared to put up with it in east Staffordshire.

The Audit Commission report also talked about occupancy rates, saying that the median occupancy rate across those 46 trusts was 90%. I requested the occupancy rates from South Staffordshire PCT—I think it took five weeks to winkle, or drag them, out of the PCT. I was provided with the figures for April 2010 to August 2011. I examined them and found that, with the beds at the Margaret Stanhope centre still in place, the occupancy rate across the PCT was 87%.

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

This debate gives me such a sense of déjà vu, because a few weeks ago I initiated a debate about how Southern Health NHS Foundation Trust, which has a bed occupancy rate of over 90%, wants to close 35% of its acute beds. Like my hon. Friend, it took me a long time to get the statistics from the trust. When I asked for them to broken down in a different way, the breakdown showed twice as many beds being vacant as the first lot of calculations did. In other words, the trust has not got a clue what its own statistics add up to, yet it is intent on closing beds. Accurate statistics must be central to any consideration, and I think that my hon. Friend and I ought to go and see the Minister about this, if he would be willing to see us.

[Andrew Griffiths]

My hon. Friend makes an incredibly important point. He has been vociferous in campaigning on behalf of his local residents—as I am attempting to do—and I share his concerns. None of us is a backwoodsman, and none of us wants to ignore the facts, but the facts that are being presented to us by the PCTs are not the facts. When we dig down and look at the assertions that the PCTs are making, they simply do not add up. I shall give the House further evidence of that later.

For the six months during which we were able to examine the occupancy rate, we found that it was already more than 90%. In June 2010, it exceeded 100%, yet the PCT is telling us that it can safely remove those 18 beds from Margaret Stanhope with no impact on mental health provision in my community. I simply do not accept that.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for Burton (Andrew Griffiths) on securing the debate and on making his points so clearly on behalf of his constituents. I also congratulate him on demonstrating why Adjournment debates are so important: they give Members in all parts of the House an opportunity to bring issues to the attention of the public, and also to serve their constituents by bringing issues to the House in a way that requires Ministers to be accountable.

I am aware, from what my hon. Friend has said this evening also from my preparation for the debate, of the strength of feeling in my hon. Friend’s constituency. I noted his description of the contribution made by his local newspaper, the Burton Mail, in leading the campaign at local level. The 7,500 signatures to the petition that have been collected so far are an impressive indication of the extent of public support and concern.

Let me say a little about the national policy context, some of which I have said on other occasions. In February this year we published our mental health strategy, “No health without mental health”, which I commend to Members in all parts of the House and, indeed, to my hon. Friend’s constituents. Let me now make two specific points. First, we expect the treatment and care of patients to be provided in the environment that is most appropriate and therapeutic for the patient. Acute beds should of course be available for those who need them, and those in charge of services should always consult on the needs and wishes of patients when making decisions about community or hospital-based treatment. Indeed, 10,300 new patients with an early diagnosis of psychosis were engaged with early intervention in psychosis services this year, the largest number ever recorded.

A number of Adjournment debates in recent weeks have raised the issue of data on bed occupancy and the definitions on which they are based. I will not undertake to arrange a meeting, but I will undertake to ensure that work is done in the Department, which I will examine, to establish how well the data are collected and how clear they are.

[Dr Julian Lewis]

I am very satisfied with the Minister’s offer, but may I suggest that the Audit Commission—the only organisation that seems to produce reliable figures—has a chance to look at what we have discovered in our trusts? As I have said, the figures that are given to us are not reliable where I am, and, as I have heard tonight, they are not reliable where my hon. Friend the Member for Burton (Andrew Griffiths) is either.

[Paul Burstow]

I will certainly try to ensure that the data sets that we have are robust, although the future of the Audit Commission is perhaps a moot point in tonight’s debate.

Let me now deal with the local situation outlined by my hon. Friend the Member for Burton and, in particular, the proposals relating to the Margaret Stanhope centre. It is important to stress that the proposals are currently the subject of public consultation, notwithstanding some of the concerns about the process that have been outlined.

Oral Answers to Questions

Julian Lewis Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Burns]

As the hon. Gentleman will appreciate, it is imperative that Ministers continue to remain totally independent of this review, so that we cannot be accused of interfering. As he knows, the JCPCT has said that it plans to appeal against the decision, and we will have to await the outcome of that.

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

I fully appreciate the degree of independence that Ministers must preserve, but is there anything that this Minister can say on the methodology of the review to reassure the children’s heart unit at Southampton general hospital, which is rated the best in the country outside London, given that the review was, at one stage, excluding the entire population of the Isle of Wight in its calculations as to whether or not the unit should be in more than one of the four options being put forward?

[Mr Burns]

I am grateful to my hon. Friend for his question, although I will disappoint him by saying that I will not be led from my chosen path and start to voice an opinion. I will say, as I did say during the earlier debate that he attended, that of course it is not set in stone that there will be only four options chosen, as and when—the number could be more. That is dependent on the consultations and the decision of the JCPCT, but he will appreciate that I cannot seek to influence those decisions.

Mental Health Care

Julian Lewis Excerpts

Monday 21st November 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I start by congratulating my hon. Friend the Member for Broxbourne (Mr Walker) on securing the debate and on pursuing this issue through the all-party group on mental health and other channels for a considerable time. His good fortune in securing the debate tonight is particularly timely given the publication of Mind’s report this morning. I congratulate him doubly on that successful coalition of events that have led to the debate.

I, too, have had the opportunity to study the report, “Listening to Experience”, published by Mind, and I certainly share many of the sentiments that have been expressed in this brief debate. The report undoubtedly shines a spotlight on what is good about our acute and crisis mental health services, what is unacceptable, what is bad and what we can do to make them much better. It brings together the results of an independent inquiry, as we have heard, and it is fundamentally about ensuring that we listen to voices that are all too often overlooked and ignored.

I welcome the report. It is challenging, and some of the unacceptable practice that it describes is frankly harrowing. Many of its important conclusions reflect the aims and ambitions of our cross-Government mental health strategy, “No health without mental health”. More than that, it reinforces why it is right that our broader health and social care reform agenda focuses on patients being treated in a way that respects their dignity, protects their human rights and promotes flexible and creative commissioning solutions that are tailored to meet individual and local needs. The key is ensuring that services are genuinely personalised.

The provision of safe, modern, effective mental health services that offer patients real choice is, and remains, a Government priority. We expect the treatment and care of patients to be provided in the most appropriate therapeutic environment for them. My hon. Friend rightly referred to the concern expressed in the report that acute beds are not always available when needed. The hon. Member for Ashfield (Gloria De Piero) spoke about her own experience and her concerns about the journeys that some people have to make to find facilities, which is clearly unacceptable.

I want to make it absolutely clear that commissioners and providers have a responsibility to ensure that acute beds are available for those who need them. They should also ensure that the needs and wishes of patients, families and carers are not only sought but taken into account when decisions are made about community or hospital-based treatment. Distance and journey times are very serious issues that need to be properly taken into account in those commissioning decisions.

The quality, innovation, productivity and prevention programme, which is sometimes known as the Nicholson challenge, has targeted both reductions in bed days and—I stress—out-of-area admissions. Through a more effective acute care pathway, we can expect to achieve better patient experience of care, which means care that better reflects patient preferences, including being cared for at home if possible. That contributes to a more productive use of NHS resources to ensure that we drive up quality.

Specialised mental health community teams—crisis resolution home treatment, assertive outreach and early intervention in psychosis—provide care to service users and families in community settings. The crisis resolution home team performs a key role in supporting people at home, which often averts the need for an in-patient stay, acts as a gatekeeper for all those requiring access to in-patient services or other emergency care and supports early discharge, when appropriate.

The team is part of an integrated acute care system. It is affected by, and has an effect on, that system and beyond, especially the in-patient service and day hospital and community mental health teams. For example, patients with early onset psychosis benefit from early intervention services, and assertive outreach engages with severe and persistent mental disorder such as schizophrenia. That shared approach in system delivery is already beginning to show results, because 10,300 new patients with early diagnosis of psychosis were engaged with early intervention in psychosis services this year, which is the highest ever recorded figure. Overall investment in key mental health teams has also increased. In the last year, crisis resolution home treatment teams carried out 131,450 home treatment episodes for 106,790 patients who would otherwise have been admitted to hospital, an increase of 3.2% over the previous year.

I do not want my remarks in response to the important debate that my hon. Friend the Member for Broxbourne has secured to suggest that the Government are complacent. Mental health is a priority for us. The strategy that I mentioned earlier, and not least the spending review decisions that we made last year, make clear our commitment, especially as regards improving access to talking therapists for people with severe mental illness. However, there is always room to improve, and there is a need to listen to, understand and act on the experience of patients.

Mind’s report helpfully highlights four key areas: humanity, commissioning for people’s needs, choice and control, and reducing the medical emphasis in acute care, which is very much like the well-being concept that my hon. Friend has discussed. In mental health services, it is vital to balance patient autonomy with patient safety, which is often a source of debate in the Chamber. We need to ensure that that is done in an appropriate way, but it can be a challenging balance to strike. However, the solution to the problem does not lie with heavy-handed or coercive approaches. A wealth of research, guidance and good practice, much of which is cited in Mind’s report, offers practical strategies that can contribute much to ensuring that patient care is conducted in the humane, caring and respectful fashion described by my hon. Friend, envisaged in Mind’s report and espoused in the Government’s vision for mental health services.

The Mental Health Act 2007 code of practice is clear on the need to seek all alternative measures before adopting control and restraint or seclusion procedures. Restraint should be the last resort, never the practice of first choice. The code also emphasises the importance of providing support to patients after using control and restraint, seclusion or long-term segregation, and of reviewing such incidents to enable staff to learn from them.

The Mind report rightly draws attention to the importance of ensuring services meet the needs of black and minority ethnic communities. The Government’s mental health strategy acknowledges the lower well-being and higher rates of mental health problems that some BME groups suffer. The strategy is explicit on ensuring that health promotion and ill-health prevention approaches are targeted at high-risk groups, which means that programmes must be delivered in such a way that they are accessible to families from BME groups. Such approaches will lead to a narrowing of the health inequality gap.

There is no doubt that good data play a critical part in driving improvement—the report highlights that—which is why the mental health minimum dataset already has a good level of information on the ethnicity of patients, and why the annual mental health bulletin includes rates of access to services by ethnic groups and describes the ethnic profile of people spending time in hospital and being detained.

We will build on those measures. The mental health minimum dataset will go further, because for the first time it will be possible to analyse the full patient pathway, showing what happens to different groups of people before and after hospitalisation. This dataset has been identified as the single source for national statistics about the use of the Mental Health Act in the future, and the NHS information centre will launch a consultation next spring to determine exactly what information will be useful—I hope that hon. Members and others following the debate will take the opportunity to feed into that. The ability to compare and demonstrate differences between localities is an important way of driving improvement in services.

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

rose—

[Paul Burstow]

I can see my hon. Friend waving at me. I give way to him.

[Dr Lewis]

I am most grateful to the Minister. I want to put it on the record that since our last exchange on this subject on 10 November more data have come from the Hampshire trust, which intends to close more than one third of its acute in-patient beds, confirming that although only a minority of patients admitted to acute beds were detained patients, they stayed for longer, and that at any one time about half the beds, if not more, were occupied by detained patients. Does the Minister agree that if excessive numbers of beds are closed, the opportunity for a non-detained patient to find a bed will be disproportionately reduced?

[Paul Burstow]

I certainly agree that we need to look carefully at the data. My hon. Friend was right in his Adjournment debate on 10 November to highlight these issues and potential discrepancies, and I shall certainly take a close look at the data to which he has referred.

I am anxious to ensure that Mind and other key stakeholders play a part in identifying how the information that I have referred to can best be analysed and presented. As I have said, those data will be particularly useful in supporting commissioners in developing the kind of flexible and creative commissioning solutions that Mind and my hon. Friend the Member for Broxbourne have described so well.

The drive to improve the quality of services and reduce inequalities lies at the heart of our commissioning reforms. For the first time, the Secretary of State for Health, the NHS Commissioning Board and clinical commissioning groups will be under a legal duty to have regard to health inequalities in both access to and outcomes from health care. This legal duty will hardwire reducing health inequalities into the system. It not only obliges the Secretary of State to act, but obliges them to demonstrate that they did so and with what result. That is a powerful incentive for change.

Mind rightly emphasised the importance of choice, which I strongly endorse. That is already being demonstrated through several initiatives, including the improving access to psychological therapies programme for children and adolescents and for adults, the extension of the personal health budgets programme for people with mental health problems to increase choice and control and the development of adult and children mental health tariffs. We believe that choice of consultant or other professional-led teams should extend to mental health to achieve the parity of esteem expected by the mental health strategy, and we will work with key stakeholders to develop the proposals and look at ways of implementing our plans.

We recognise the benefits that mental health patients can receive from support and mentoring from peers, which was touched on in this debate, as well as the contribution from things such as crisis housing. To that end, I am working with colleagues on the ministerial working group on mental health to make these more widespread.

In conclusion, I thank my hon. Friend and others who have intervened and spoken briefly in this debate. I shall write to my hon. Friend the Member for Harrogate and Knaresborough (Andrew Jones) to pick up on his particular point. I very much welcome Mind’s report for its clarity and for the useful contribution that it makes to our shared aim of improving acute and crisis services, and I shall meet it to discuss its report and how we can take its recommendations forward in delivering the Government’s mental health strategy. The Government remain committed to achieving their overarching goal of better mental health outcomes for everyone. Our strategy sets out what everyone needs to do to realise that goal, and by working together we can make a long-lasting difference to the quality of life of people with mental health needs.

Question put and agreed to.

Woodhaven Hospital

Julian Lewis Excerpts

Thursday 10th November 2011 Commons Chamber

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

I am particularly pleased to see the Minister on the Front Bench tonight. I know of his care and compassion on the topic of mental health.

Woodhaven hospital is a state-of-the-art mental health unit set in a therapeutic, semi-rural but easily accessible location in my constituency. Its acute Winsor ward has, unusually, en suite facilities for all 24 in-patients and other top-of-the-range features. It was a proud and happy moment for me when I cut the ribbon to open the new hospital just eight short years ago. Now, to the immense distress of service users and their carers, Woodhaven is threatened with closure.

Currently, 165 acute in-patient mental health beds are available to the Southern Health NHS Foundation Trust. They are in six units throughout Hampshire, as follows: 50 beds at Antelope House in Southampton, 25 each for men and for women; 20 beds at Elmleigh in East Hampshire, 10 each for men and for women; 24 beds at The Meadows in Fareham, 10 each for men and for women and four more, known as flexible beds, which can be used for either; 23 beds at Melbury Lodge in Winchester, 13 for men and 10 for women; 24 beds at Parklands in Basingstoke, seven for men and 16 for women, plus one flexible bed; and finally, the 24 beds at Woodhaven in my New Forest East constituency, 10 each for men and for women, plus four flexible beds.

The foundation trust proposes to close Woodhaven, which is virtually brand new, and The Meadows, which is also quite modern. That would reduce the total available beds in the region from 165 to 117. However, of the 50 beds at Antelope House that have been available for acute cases up to the present, 10 are to be allocated to long-term, challenging in-patients, effectively reducing the total number of acute in-patient beds that will be available in future to only 107. The foundation trust has suggested that some of the future occupants of the 10 beds might come from other acute beds out of the 165 total, but it seems much more likely that the 10 beds at Antelope House will be allocated to residents from Abbotts Lodge, a different kind of unit that is not included in the 165-bed total and will be shut. For that reason, the real reduction in available acute in-patient beds will be from 165 to only 107.

Those 107 acute beds will contain two distinct categories of in-patient: those who are voluntary and those who have been detained. On what I believe to have been a typical day in mid-October, and on a similar day this month, when 153 beds were in use across the whole trust area, no fewer than 88 were occupied by in-patients detained under the Mental Health Act. That constitutes 53%—just over half—of the existing 165 available acute beds. With only 107 beds available in future, that 53% figure will rise to approximately 82%. Conversely, the proportion for voluntary in-patients who are acutely mentally ill will fall from about 47% to just 18%. In practice, there will be only about 19 beds left for the whole of the trust area in Hampshire for acutely mentally ill people who voluntarily go into hospital.

That will have a huge and negative effect on patient choice. There will be little chance of choosing or obtaining an acute in-patient bed, as four fifths of them will be occupied by people who have had to be detained because they will not voluntarily agree to admission. Indeed, someone who desperately wants an in-patient bed would be well advised to create sufficient mayhem in order to be sectioned, if they are to have a reasonable chance of gaining admission. Once admitted, the voluntary in-patients will find that the effect of the greatly increased preponderance of detained in-patients in each of the four remaining units in Hampshire will be to make their wards significantly less therapeutic. Should the trust be thinking of such a huge reduction in bed totals at all?

I should say at this point that there is no fundamental philosophical disagreement between me and the representatives of the district and county councils on the one hand, and the management of the trust on the other. The trust’s spokesmen consistently agree that some acute in-patient beds will always be needed. For our part, my colleagues and I have no doubt of the value of strong community, assertive outreach, crisis resolution and early intervention services at home.

The key question that must be resolved—I hope that it will be resolved as a result of this debate—is simply what is the correct number of acute in-patient beds in Hampshire. Naturally, the trust maintains that by investing in extra services at home some people will be prevented from deteriorating to the point where they need to occupy acute in-patient beds, but I believe that stripping out more than one third of the existing beds, as the trust proposes, cannot possibly be justified.

Of course, the trust ought to make efficiency savings. It states that closing two out of six acute in-patient units in the area will save £4.4 million, £1.5 million of which is intended to be invested in what was previously described as a “virtual ward” but is now more sensibly described as a “hospital-at-home” service. The remaining £2.9 million is, of course, an easy way to make a significant annual saving, but it is not an efficient way, especially when one considers that, according to an Audit Commission survey, Hampshire already has the highest number of staff per 1,000 of the population in community mental health teams out of 46 trusts examined. Cutting front-line services and making efficiency savings are two very different things.

Twenty-six acute beds per 100,000 people is the current average among the 46 mental health trusts surveyed. The Southern Health NHS Foundation Trust has 28 beds per 100,000 and expects that figure to go down to 21 if the two units, including Woodhaven hospital, are closed. I believe that the actual total would be just under 20 beds per 100,000 people. At the moment, with 28 beds, we are in the top 19 of the 46 trusts. Whether we go down to 21 acute beds per 100,000 or to just 20, we shall be in the bottom six, and that is an immense gamble to take with the welfare of people who, almost by definition, are at risk of losing their lives.

Every day, the trust files a record of how many beds were vacant out of the total of 165, and at my request it has provided a print-out for the past three months. This shows, beyond any doubt, that bed occupancy levels are consistently high. Let us remember that we are considering 165 beds, spread over almost all of Hampshire and serving hundreds of thousands of people. The trust’s tables give a breakdown of the numbers of male and female beds vacant each day, and the numbers of so-called “leave” beds temporarily empty. Leave beds are those that have already been allocated to in-patients, but that are not being used for short periods, because their occupants are spending typically one, two or three nights at home. Even when leave beds are counted together with genuinely vacant beds, the total number of empty beds throughout the area is low—often, indeed, in single figures. Thus, from 21 September to 6 October this year, the overall daily totals were respectively nine, seven, five, five, seven, three, three, three, four, 11, nine, nine, eight, nine, seven and six empty beds out of 165. When one excludes the leave beds, however, as one should because they have not been genuinely vacated, one is left with numerous instances of 100% acute bed occupancy for the whole region. For example, there were no vacant male beds at all on 2, 7, 10, 11, 17, 18, 20 to 24 and 26 September; in the same month, there were no vacant female beds on 7, 10, 11, 16 to 18, 20, 23, 24, and 26 to 29; and on September 3, 4 and 25, gender information not being available for those three dates, there was either only one male and no female acute beds available, or only one female and no male beds available in the entire trust area in Hampshire.

Of course, one can debate how much use can safely and regularly be made of at least some of the leave beds that are temporarily vacant.

[Mr Charles Walker (Broxbourne) (Con)]

My hon. Friend will know from previous debates that one can have occupancy rates above 100% because sometimes, in emergencies, leave beds are drafted into use.

[Dr Lewis]

I am extremely grateful to my hon. Friend for making that important point, as I am for him being here to support me tonight. I know of his great interest in the subject.

Using the trust’s own figures, I have calculated the average acute in-patient bed occupancy over the three months from August to October. Even if all the leave beds are counted as available, which they are not, bed occupancy was 91.9%, and the figure would be higher if weekends were excluded, given the number of people who go home for short periods at those times. When only the genuinely vacant beds are considered, the average occupancy rate is seen to have been a remarkable 96.7%.

One of the most extraordinary assertions in the consultation document on the proposed changes is to be found on page 11, where it declares:

“The time that people are spending in our…hospitals is longer than the national average (our average length of stay is 51 days (including leave) compared to below 30 days (excluding leave) in other Trusts).”

That is an extraordinary manipulation of the data, as it contrasts the total of days spent on and off the wards in our trust area with the total of days spent only on the wards in other trust areas. A glimpse of the true situation is again to be found in the tables drawn up by the Audit Commission. In referring to all mental health admissions in the Hampshire PCT area, which is not quite the same as the foundation trust area but is a reasonable general guide, the Audit Commission states:

“Hampshire PCT is below the national average”

for length of stay. I do not know whether the trust’s blatant and gross failure to compare like with like was deliberate, but the public, their local representatives and Ministers are surely entitled to ask what the average length of stay excluding leave is in Hampshire’s acute beds, and what the average length of stay including leave is in the acute beds of other trusts, so that real rather than bogus comparisons can be made.

Time prevents a more detailed dissection of other dubious claims made by the trust. Its spokesmen refer to the acutely mentally ill suffering “disempowerment” as a result of spending what is usually a relatively short time on an in-patient ward. Most frequently, it insists that

“people have consistently told us they want to be at home”.

Such claims fly in the face of what we hear from service users and especially from carers, who want the assurance that an acute bed will be available when it is needed. I have yet to discover what, if any, systematic survey was undertaken to arrive at that conclusion. Who carried it out? How many people were surveyed? What questions were asked? The trust says that its soundings showed a desire for:

“Care within a community setting where possible, and avoiding going into hospital unless it is necessary.”

Well amen to that; we can all sign up to that, but that is a very different proposition from wishing to see a more than one-third cut in available beds that have an average occupancy rate of between at least 91.9% and 96.7%.

Only five out of the 46 trusts listed by the Audit Commission have 20 beds or fewer per 100,000 of the population. Southern Health NHS Foundation Trust wishes us to follow that example. Its consultation says that that small minority of trusts

“deliver good or excellent standards of care”,

and it recently identified four of those five trusts in a presentation to me and others. Although the overall ratings for those four trusts are, indeed, good or excellent, the picture is different where in-patient services are concerned: none of the four is rated as excellent, two are rated as good, a third is rated only as fair, and the fourth is rated as weak.

At meetings with the trust, I and my colleague, County Councillor Keith Mans—a former and distinguished Member of this House—have stressed the need for the new hospital-at-home model to be piloted before any of the six in-patient units is closed. If this exercise is really about “Improving Outcomes for Hampshire’s Adult Mental Health Services”—as the consultation document is entitled—rather than about saving £2.9 million a year, then acute in-patient beds should not be discarded until pilot projects clearly show significant reductions in the current very high levels of acute bed occupancy.

We need a step-by-step approach that clearly rules out the present plan to remove not just one but two modern mental health units, including Woodhaven hospital, right at the start. It is distinctly probable that the overview and scrutiny committee of Hampshire county council may decide to refer this matter to the Secretary of State. This evening, I look to the Minister for two assurances.

First, I want an assurance that Woodhaven hospital, which is so valued by our community, will not be closed until objective and independent surveys have been carried out assessing whether there really are dozens of people in beds for the acutely ill in Hampshire who do not need to be there. Secondly, I want an assurance that Woodhaven will remain open until a pilot scheme has demonstrated that the proposed hospital-at-home scheme is starting to reduce the current high levels of acute bed occupancy. It cannot be right that in-patient beds should be cut to 107 for the whole trust area in Hampshire, so that we are left with a woefully inadequate total of about 19 for voluntary in-patients once all those detained under the Mental Health Act have been accommodated. People’s lives are at stake.

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for New Forest East (Dr Lewis) on securing the debate and on being, as ever, so thorough and detailed in his exposition of the case that he puts before the House. I take this opportunity to pay tribute to the hard work of the staff who work within the NHS in his constituency.

I want to set out the current position, as I understand it from the briefings that I have had over the past few days, and to respond to several of my hon. Friend’s specific points. I assure him that under the proposals for adult mental health redesign set out by Southern Health NHS Foundation Trust, Woodhaven hospital will not close but will change the nature of what is provided. I want to make it clear that there is a continuing NHS future for the facility, albeit not the one that he believes to be appropriate.

While the trust recommends that the acute adult mental health ward is withdrawn from Woodhaven, the excellent hospital which my hon. Friend opened eight years ago and which the community should rightly be proud of will continue to offer specialist adult mental health services. The aim of these changes is to provide the right mix of community and bed-based care—this debate centres on what that balance is—and ultimately the best possible support for people in his constituency who use these services.

My hon. Friend will be aware that during the 18-month engagement with the public that took place prior to the statutory consultation, the majority of patients consulted said—this is one of the areas that he challenges—that they wanted to be treated in the community. As a general principle in any field of health care, the more we can focus on prevention and on supporting people in their homes so that they retain their independence and stay connected with their communities, the better the outcomes we can achieve. The principles behind the trust’s proposed redesign can therefore be pinned squarely to the views of local people, and this is where I want to reassure my hon. Friend a little further. I understand that, through the consultation, the trust has been told this on repeated occasions. I have a quote from one service user:

“I was unfortunate enough to need the services of the home treatment team over Christmas 2008 and New Year 2009, but due to the care I received from the team I didn’t need to be admitted to hospital and I was able to stay at home with my husband and son.”

Clearly, my hon. Friend disputes the evidence that the trust is putting forward about whether patients want to be treated at home, but it is for this reason that it is recommending the integrated model for mental health services in Hampshire and the reinvestment of savings from acute services into community services. However, I will ensure that he is supplied with further evidence on these points so that he can satisfy himself and his constituents that the trust is basing its decisions on reasonable evidence.

Additional community services will ensure that patients receive flexible and bespoke care packages in their home wherever possible, even when acutely unwell. The intention of the proposals will mean that people are admitted to hospital only if it is clear that hospital is the best place for them to receive their treatment. The trust tells me that treatment and care for patients will be provided in the most appropriate and therapeutic environment for the patient and that acute beds should be available for those who need them. However, when local trusts propose changes to existing services, the public should be closely consulted. Again, my hon. Friend obviously feels that that is not what has happened. In the case of Southern Health NHS Foundation Trust, service user involvement projects and carers’ groups from across the county have worked closely with the trust to develop the proposals for the redesign.

I want to deal with a couple of the specific statistical points that my hon. Friend set out so clearly. He has demonstrated something that does not always happen in these debates, in that someone has done a lot of detailed research to try to nail the issue that he is most concerned about. First, I want to deal with the proportion of people detained versus those in voluntary admission. He referred to two days’ worth of data that he had collected and his conclusion that 53% of people were detained in those circumstances. However, I understand that over the past six months, on average, 22% of people admitted to the trust’s adult acute beds have been detained under the Mental Health Act. I have asked the trust to write to my hon. Friend with those figures so that he can see more data.

[Dr Julian Lewis]

The trust did fax me some figures of that sort. However, they did not make sense because when they were added up, the total was way below the number of beds that had been occupied. I honestly think that the trust is wrong on these proportions.

[Paul Burstow]

That is why I think it is right for the trust, having read this debate, to follow it up by writing to my hon. Friend. I know that he has been engaging with it face-to-face as well, and I am sure that he will continue to do so.

My hon. Friend made a point about the trust anticipating the effectiveness of the whole clinical pathway and about the focus on the most unwell reducing the number of people admitted under the Mental Health Act, in addition to reducing voluntary admissions.

My hon. Friend mentioned the issue of whether one counts leave beds. It is common for people who have been detained in hospital to have a period of leave from the ward before they are discharged. That can vary from a few days to several months. The beds for leave patients are not kept empty, but are made available for other acute admissions, as my hon. Friend the Member for Broxbourne (Mr Walker) said. It is therefore important to count leave beds when considering capacity. My hon. Friend the Member for New Forest East set out clearly his concern about bed occupancy and the impact of leave beds. I will make sure that the trust considers this issue carefully as it draws together the feedback from the consultation before its forthcoming discussion with the Hampshire overview and scrutiny committee. I will ensure that his concerns about length of stay, which he set out so clearly, are put to it.

My hon. Friend made a request for a pilot. Although I will not go quite as far as he would like tonight, it might help if I provide him with some information about the process that the trust has put in place to evaluate and assess the proposed changes. I understand that it has invited the Centre for Mental Health to do an independent review of the proposals, which is expected to be complete within a month. The trust’s research and development department is also completing a thorough evaluation of proposals, comparing a range of quality measures at baseline and after implementation.

On the next steps, the trust has been in discussions with the Hampshire health overview and scrutiny committee, and it has been agreed that the trust will hold a number of stakeholder meetings. It is expected that the trust will return to the health overview and scrutiny committee at the end of this month and present a written report that describes the themes from the consultation feedback and the progress that has been made in those meetings. The trust will then make suggestions on the next steps, which it will agree with the health overview and scrutiny committee, with a view to reaching final decisions in early 2012. As I understand it, any changes will be implemented by the trust in a phased, transitional approach over a period of time, not as a big bang.

The trust will, of course, keep my hon. Friend fully informed. I know that he has been diligent in pursuing the trust with his concerns. I encourage him to carry on that dialogue. I again congratulate him on securing this debate and for clearly articulating his concerns on behalf of his constituents. I hope that I have been able to articulate some of the points that the trust has put to me and I look forward to a conclusion of this matter in the new year.

Question put and agreed to.

Patient Security (Mental Health System)

Julian Lewis Excerpts

Monday 7th November 2011 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

I am extremely pleased to have the opportunity to raise this important topic in the Chamber tonight. I should declare at the outset my position as a vice-chairman of the all-party parliamentary group on mental health.

The Government’s recent mental health strategy stated that mental ill health represented up to 23% of the total burden of ill health in the UK, and that it was the largest single cause of disability. At least one in four adults will, at some point in their life, experience a period of mental ill health. For some, it may be a relatively mild, one-off episode. For others, the first episode will herald the start of a long-term relationship with the mental health services in all their guises. Such episodes, whether short term or long term, have a profound effect not only on the person suffering with a mental health condition but on their families and friends, many of whom will never have come into contact with these conditions or this part of the NHS before.

In the most serious cases, a patient might spend a period of time in an acute care setting, either voluntarily or while being detained under the Mental Health Act for their own welfare and the welfare of those around them. At such times, the patient and their families and loved ones will expect the patient to be kept safe and secure while they are given the appropriate therapy and treatment to enable them to resume their place in our communities. That expectation, and the fact that it is sometimes not fulfilled, are the focus of this short debate tonight.

In June 2010, shortly after I was elected as the Member of Parliament for Loughborough, I was approached by a constituent, Glyn Brookes, who told me about the tragic death of his daughter, Kirsty. I appreciate that the Minister is unlikely to be able to respond to this particular case, although I have sent his office a copy of the coroner’s report into Kirsty’s death. However, it is because of this case that I have ended up leading this debate tonight.

Kirsty was a patient at the Bradgate unit at University Hospitals of Leicester. She was able to escape from the unit using the frame of an external door to help her. Her escape was not dealt with as it should have been, and she was able to commit suicide before either the hospital authorities or the police found her. This has clearly been devastating for the Brookes family, and I would like to pay tribute to them, and particularly to Mr Brookes who contacted me to tell me their story. I would also like to pay tribute to the excellent coroner whose report helped, I think, to answer the Brookes family’s questions about the tragedy. I should say that I have spoken to the former and current chairmen of Leicestershire Partnership NHS Trust, which administers the unit, and I understand that work is ongoing to learn and act on the lessons of this case.

As a result of the case being raised with me, I began to wonder how many other patients absconded each year from units run by our mental health trusts. I submitted Freedom of Information Act requests to all 58 of the mental health trusts in England, 57 of which have replied. The figures make grim reading. Before I go into them, however, I should say that this exercise has shown me that there is a real variety in the quality of record keeping at the trusts. There also seems to be a real difference in the way in which the term “abscond” is used by the trusts as a basis for recording the relevant information. I hope that the Minister and the Department will be able to help with this matter.

The Mental Health Act 1983 defines “abscond” as when a patient who is liable to be detained under the Act

(a) absents himself from the hospital without leave granted under section 17 above; or

(b) fails to return to the hospital on any occasion on which, or at the expiration of any period for which, leave of absence was granted to him…; or

(c) absents himself without permission from any place where he is required to reside in accordance with conditions imposed on the grant of leave of absence”.

In responding to my request for information, some trusts used this definition, while others made the distinction between a patient who was “absent without leave”, “absent without explanation”, “missing” or escaped. In addition, some trusts use the terms “AWOL” and “abscond” interchangeably without definition or explanation. Other trusts used only “abscond”, but did not define what they meant by the term. Finally, some trusts provided the number of “incidents” of absconding, rather than the number of patients. Others did not make that distinction. For simplicity, however, the figures that I will now mention refer to the total number given for the five-year period that I asked about, and therefore do not differentiate the different types of absconding incident.

My research showed that in the past five years about 40,500 incidents of absconding occurred, ranging from a total of three reported incidents for Barnet, Enfield and Haringey Mental Health Partnership Trust to 3,891 for Lancashire Care NHS Foundation Trust. There is significant variation across the country, so clearly some trusts are doing things very differently from others. In the case of Leicestershire Partnership NHS Trust, the total figure for the past five years is 386. I must stress caution in comparing those numbers. We could, in many cases, be comparing different things—although the overall effect of patients absconding is the same—simply because the trusts use their own definitions, despite the fact that the Department of Health has published its definitions of absconding and escaping.

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

I do not know where on my hon. Friend's list the Hampshire Partnership NHS Trust figures, but did she find any correlation between the quality of the infrastructure of the units and the numbers of people absconding? Did she find, for example, that a brand-new unit, such as Woodhaven in my constituency, tended to have a lower rate of such problems? This is of particular interest to me, as that eight-year-old hospital is threatened with closure, and I have a debate on it later this week.

[Nicky Morgan]

I am grateful to my hon. Friend. I have seen the subject of his Adjournment debate later this week. Unfortunately, I did not have the opportunity to go into that level of detail, but I shall come to the quality of care and to demonstrate that it has a huge impact on the absconding rate for patients. As I shall come on to mention, this is an issue on which the Department of Health and the trusts could work together. Interested Members or other interested parties should see the link between absconding and the quality of care given. There is no doubt that there are innovative ways of ensuring that patients do not feel the need to abscond, and that if they are outside the environment, of ensuring that they will come back because they know that they will receive therapeutic treatment.

As I was saying, despite all the caveats, the numbers are simply too high for organisations that owe their patients a duty of care. The fifth agreed objective in the Government’s mental health strategy launched earlier this year stated:

“Fewer people will suffer avoidable harm—people receiving care and support should have confidence that the services they use are of the highest quality and at least as safe as any other public service.”

This is, of course, an objective that anyone who has an interest in any health service, but particularly mental health services, would want to see met. The fact is that guidance is already in place for mental health trusts and for those working within them to follow, although it would be fair to say that a lot of that guidance deals with how to react to an incident of absconding rather than offering concrete guidance on prevention. In the case of my constituent, the coroner expressly found that

“it would appear that the hospital had a system and policies in place to protect and supervise Kirsty from harm but at all material times those caring for her did not follow those policies.”

That is just not acceptable.

The Minister will remember the long sessions earlier this year discussing the Health and Social Care Bill in Committee Room 10 upstairs—how could we forget them? One of the recurring themes was not just that we all want to see high-quality services but how we ensure our health and social care services are of high quality and that everyone is focused on the primary objectives of the health system. Do we do so through inspections? Do we hope that everyone working within the health system works to their own high standards, as many thousands of employees surely do? Do we ensure that guidance is not only available but followed? And do we ensure that when things go wrong, as in the case of my constituent, thorough investigations follow and lessons are learned? Surely it must be a combination of all those things.

As I mentioned, hospital wards are meant to be places of therapy, but too often, especially in the case of mental health wards, they are anything but. In a recent report, the Centre for Social Justice said:

“Hospitals tend to be untherapeutic and dangerous places”.

In helping me to prepare for this debate, Mind sent me a note saying:

“The quality of care quite clearly has an impact on a patient’s decision to abscond. Unfortunately, as Mind’s forthcoming acute and crisis care campaign will show, people in inpatient settings often experience substandard quality, with no meaningful activities, little or no interaction with staff or each other, and at worst, lack of safety, abuse and coercive treatment.”

Oral Answers to Questions

Julian Lewis Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

The hon. Lady will know, I hope, that the deputy chief executive wrote to primary care trusts a few weeks ago further to remind them of the need to respond to NICE clinical guidelines. It was the hon. Lady’s Secretary of State, John Reid who, when NICE published its guidelines, told PCTs in 2004 that they should not follow them.

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

The news that the Woodhaven hospital in my constituency is threatened with closure only eight years after it was opened as a state-of-the-art mental health facility is causing great concern. Will my right hon. Friend endeavour to look into what is proposed for the closure of acute in-patient beds because the “hospital at home” alternative is simply not good enough?

[Paul Burstow]

I am grateful for the hon. Gentleman’s question and I would certainly be happy to look further into the matter and write to him accordingly.

Oral Answers to Questions

Julian Lewis Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Simon Burns]

I appreciate that question, because I understand how important the issue is to the hon. Gentleman. We have had considerable discussions on this matter, which is currently being further discussed by the Department of Health and the Treasury. We hope to reach some decisions shortly, and he will be one of the first to know.

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

How can a consultation process on children’s heart units that includes the best unit in the country outside London, at Southampton general hospital, in only one out of four options and disregards the population of the Isle of Wight completely be anything other than fundamentally flawed?

[Mr Burns]

As my hon. Friend will know from the debate that we had in the House a few weeks ago, it would be inappropriate for me to comment, because I must in no way be seen to be prejudging the issue. The inquiry and consultation is independent. However, I can say to him that the inquiry is not fixed on determining only four sites if the results of its consultation suggest that there should be more. The decision rests with the inquiry.