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.

Oral Answers to Questions

Julian Lewis Excerpts

Tuesday 26th April 2011 Commons Chamber

[Mr Lansley]

The hon. Lady will know that the Health and Social Care Bill does make specific provision for NHS organisations to have regard to the needs for research. She will, I hope, also be very well aware that, by virtue of decisions made by this Government in the spending review, we have been able to sustain the level of research in the NHS. In particular, I was recently able to announce a new 30% increase in funding for translational research funded through the NHS.

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

When the consultation on the future of children’s heart surgery units is complete, will the Secretary of State bear it in mind that it would be a preposterous and perverse conclusion that the unit in Southampton, which is one of the two best in the country, should be threatened with closure?

[Mr Lansley]

I am, of course, aware of these issues, which have been raised by colleagues on both sides of the House. At this stage, may I simply reiterate that the consultation team should consider the points that I know my hon. Friend and others are making to it? After the consultation team has fully reflected on all the points, I hope Members will be able to see that it has fully taken them into account in whatever proposals it brings forward.

Patient Confidentiality (Mentally Ill)

Julian Lewis Excerpts

Thursday 9th December 2010 Commons Chamber

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

I am delighted to have secured this debate. This is the second time I have addressed the House today and I hope that the consensus that was lacking in the earlier debate will be restored for this one, because hon. Members in all parties have the welfare of the mentally ill very much at heart. We are all constituency Members and we all have to deal with sad cases. Sometimes, we can do something to help people and sometimes it is too late to do anything to help those whom we have lost, but we can still try to achieve something in their memory to help other sufferers in future.

By way of background, I want to make it clear that I have no expertise or practical qualifications in mental health and that my doctorate is not a medical degree. I do, however, have a certain amount of experience stemming from when I first set foot in the House, in 1997, and came second in the private Member’s Bill ballot. The individual who came first in the ballot promoted a Bill to ban hunting and the Chamber was packed on that Friday. I am sorry to say that when we came to debate my private Member’s Bill, which was on improving conditions for people who suffer catastrophic breakdowns and need in-patient treatment, the House was back to its normal sparse attendance. Nevertheless, despite that somewhat cockeyed sense of priorities, the issue of mental health is an enduring one that requires great sensitivity.

Since those days, I have from time to time raised issues that affect my constituency. Most recently, I have been concerned about the closure of the psychiatric intensive care unit at Woodhaven hospital, which was constructed on the site of a former mental institution. I was delighted when that great facility was opened in my constituency a few years ago, and I worry about its future now that it has lost the intensive care unit. I recently set up a small group of people from different parts of the spectrum of mental health concern in the New Forest area. I asked members of that group, which is called “Support our Mental Health Services”, to drop me a note about why they had joined it. One lady, Mary Stephenson, is particularly concerned about the loss of the PICU at Woodhaven, even though we are left with an acute ward. She wrote:

“On any acute psychiatric ward, there should be an opportunity to remove very disturbed, noisy and possibly violent patients, to have private peace and ‘cooling-off’ facilities.”

That is also for the benefit of other people on the acute ward who do not require intensive psychiatric care. Unfortunately, that facility has now been lost.

We are also concerned about the future of Crowlin House, which is a sort of halfway house. People have joined our group because they are concerned that if that residential facility were to close, those currently housed there might find themselves put into care homes for the elderly or for those with dementia. That would not be suitable for people who are, in a sense, halfway between being in-patients and being in the community.

Other people have joined us from Solent Mind, which supplies various important services. It has drawn to my attention the fact that the community mental health team is coming under pressure, as it faces losing 20% of its budget because of the introduction of improving access to psychological therapies—IAPT. In itself, IAPT is a good idea, but it is fairly low level and not a specialist service. It was supposed to be in addition to the services available to my constituents. As I have said before in this House, the danger can be seen in what happened to the specialist student service in Southampton—I cite that example in view of today’s earlier debate. That service is no more because its functions were supposedly moved in the direction of IAPT, but in fact IAPT was not able to take them up. In addition, one of the beneficiaries of a scheme called supported permitted work, David Hayward, has written to me expressing his worry that that is under threat, and I understand that there are concerns about the position of the vocational advice service—my constituent, Lorraine Miller, has written to me about that.

I have painted a general picture about the state of mental health services, which is mixed. We have lost some good services, but we retain quite a lot of valuable assets, although we are worried that they might go. That is why we are setting up a campaign group to try to ensure their future.

My specific concern tonight is the problem that arises when somebody is mentally ill and the people treating that person feel unable to share information about that person’s treatment with their carers or their next of kin. For once, I can say that some excellent work has been done on the theory, but I am a little worried about the practice.

I have with me a briefing paper prepared under the imprint of the Department of Health, King’s college London, the Institute of Psychiatry at the Maudsley, Rethink and the NHS service delivery and organisation research and development programme. The paper goes right to the heart of the issue. It is entitled “Sharing mental health information with carers: pointers to good practice for service providers”, and it seeks to tread a delicate line between preserving patient confidentiality and letting people who care about these patients have vital information about them when they are not in their right mind.

[Esther McVey (Wirral West) (Con)]

I congratulate my hon. Friend on securing this debate and beating me to it. I wish to raise the issues faced by a constituent who looked after her husband 24/7 until he passed away in 2006. He suffered from hallucinations, paranoia and depression. He also had falls, lost consciousness and regularly became violent towards her, all of which put a lot of pressure on their relationship and left her upset. Her health deteriorated and she felt that she could not look after him properly. It was not until he passed away that she learned that he had dementia. I have a question for the Minister: should the safety of the carer be put ahead of the patient’s right to confidentiality? Should we consider the severity of the patient’s mental health problem in determining whether they are fit to keep their condition a secret?

[Dr Lewis]

I am so grateful to my hon. Friend for staying after this somewhat trying and long day to make that important contribution, because it shows that I am not talking about some quirky, one-off situation. It is a very real dilemma, which requires great thoughtfulness and sensitivity.

I do not have time to go into the contents of that briefing paper in great detail, but I shall select just a couple of quotations that show how good it is. It says:

“Carers play an important role in many service users’ lives. Their knowledge and expertise represent an enormous resource for statutory and voluntary mental health services. These are reasons why it is so important to include them through sharing information. Providing carers with information to support them in their role can improve outcomes for both service users and carers…Carers fear being denied access to important information to help them in their role. They are also concerned that their own confidences may be broken.”

I came to the topic through the case of Mr and Mrs Edgell—my constituents David and Kay—whose lovely daughter Larissa, aged 34, hanged herself in 2006. They have obviously done everything that they can to come to terms with that, but I have a detailed file, which I have shared, because I knew they would want me to, with the Department and the Minister. I shall not go into the detail, because I do not have the time to do so, but it shows that from the earliest stages, back in about 2000, they warned of their fears that Larissa, or Lara as she was known, was seriously at risk.

Subsequently, in about 2004, Lara made a serious suicide attempt, but between then and 2006, when sadly—tragically—she succeeded, her parents were unable to know what was going on between her, the people who advised her in the NHS and, indeed, the people whom she saw privately, the private therapists.

I made it clear to Mr and Mrs Edgell that I felt that little could be done to improve on the excellent briefing document that I have only briefly quoted. It is an admirable piece of work and—unlike so much jargon produced in-house and, dare I say it, within the NHS—admirably clear. It is a first-class piece of work, and I would not alter a dot or comma in it.

When Mr and Mrs Edgell first came to see me in 2007, I wrote to the then Under-Secretary at the Department of Health—the hon. Member whose constituency I should have looked up. Is somebody going to tell me Ivan Lewis’s constituency? I am not the only who is stumped. That is the first time I have known Mr Speaker’s encyclopaedic memory to let him down. Sorry about that, Mr Speaker.

Anyway, I wrote to the hon. Gentleman and said that my main reason for doing so was to focus on two main issues relating to what had happened—[Interruption.] A voice off tells me that he is the hon. Member for Bury South (Mr Lewis). I am glad that we have sorted that out.

I said that I was writing on two main issues:

“The first is the frequent invocation by doctors who were seeing Larissa of the concept of ‘patient confidentiality’ when her desperate parents were trying to look after her interests at a time when she was too unwell to be the best judge of them herself.”

I went on to say that, after Larissa took her own life, Mr and Mrs Edgell investigated that matter and discovered that the Department of Health had an extremely good policy, set out in the paper that I have described, which it issued in January 2006. The paper seemed to show, as I said in my letter,

“a clear understanding of the importance of sharing vital information with those nearest to the mentally ill person”,

but, I pointed out,

“the best policy in the world is worthless if the doctors concerned fail to apply it either out of ignorance or obstinacy.”

Mr and Mrs Edgell discovered only when it was too late how many times—it said how many in the notes of their daughter’s various visits to medical professionals—she had had suicidal thoughts.

The response from the hon. Member for Bury South was rather disappointing. I see that I did write the name of his constituency on the reply, so I apologise for having embarrassed Mr Speaker for no good purpose.

In the reply, the then Minister states:

“As you state in your letter, the Department of Health had issued excellent guidance regarding confidentiality and people with mental illnesses. However, as you may be aware, the Government’s task is to set the national agenda, to put in place national standards and provide overall health service funding. The responsibility for deciding how the national agenda is delivered locally and determining how best to allocate these resources to meet the needs to their local populations rests with local health communities.”

I did not think that that was an adequate response. What is the point of producing excellent guidelines on highly sensitive, critically important, life and death matters, in that way and then relying on individual trusts to bestir themselves to the extent that they decide to apply or not to apply them? For once, it was the Conservative Opposition Member who was asking for a bit more central direction because, in this case, central direction was necessary.

The second main concern of Mr and Mrs Edgell was the lack of regulation of the private therapists whom Larissa had been seeing. Larissa was 34 when she died, and was well and truly an adult. However, it is a matter of concern that, even after her death, the people treating her outside the NHS have refused to give up any notes or information about what they were doing during the period she was desperately in need of help. Again, the reply basically said that Mr and Mrs Edgell might wish to contact the British Association for Counselling and Psychotherapy, which is a voluntary professional organisation that currently helps the psychotherapy and counselling profession to self-regulate. Frankly, that is no proper method of ensuring compliance when private therapists have been taking part in the treatment of someone who has ended their life under these circumstances.

My time is pretty much exhausted, so I will confine myself to saying that I hope I have done justice to my constituents and to the memory of their daughter. They have not failed to understand the delicacy of the issues involved and they hope that their daughter’s death will mean that, in the future, people recognise that the next of kin and/or the carer must be taken into confidence when people talk about doing away with themselves, even if those people are adults.

Adults do not have quite the same rights when they are not operating within their normal mental framework. We talk about people being “out of their mind,” which is perhaps an old way of saying something unpleasant about someone, but there is a literal truth in that phrase. I do not come from a Christian background, but I feel a particular sense of sadness when I hear people singing the famous hymn, “Dear Lord and Father of Mankind.” The third line states:

“Re-clothe us in our rightful mind”.

When people are not in their rightful mind, they need professional help. The professionals need to talk to each other and the mentally ill need the help of the people who have their interests most closely at heart. Those people are the next of kin and the carers. I would be most grateful if the Minister could give some reassurance for the future.