Southern Health NHS Foundation Trust

Mims Davies Excerpts

Wednesday 8th June 2016 Westminster Hall

[Suella Fernandes]

From speaking to families, relatives and patients, it is clear that they are struggling to have confidence in the services provided by Southern Health. The very reason that the debate it happening is so that we can air those concerns and, hopefully, find a pathway to restoring public trust. That is clearly the challenge facing the organisation.

[Mims Davies (Eastleigh) (Con)]

I thank my hon. Friend for securing this important debate. I also thank the Minister for the help that he is giving us across Hampshire and in the Southern Health area, and for taking the issue seriously.

Families feel concerned about their vulnerable loved ones. Despite changes in care plans and promises when things have gone wrong, families are not seeing changes. In fact, they feel that, in very vulnerable situations, it is sometimes better to be at home than in the so-called care of Southern Health. That has come up in constituency surgeries. I, like other hon. Members, feel that this debate and other investigations into Southern Health should get to the bottom of that.

[Suella Fernandes]

I thank my hon. Friend for highlighting the problems communicated to her by families, which echo and reflect the precise concerns about which the families sitting in the Public Gallery feel strongly. They emphasise that this is not an isolated issue. This is something that we all need to take seriously.

The Mazars report is the next chapter in this story. At the request of Connor’s family, NHS England commissioned an independent report into the deaths of people with learning disabilities or mental health problems while under Southern Health’s care. The report reviewed the deaths of people in receipt of care from mental health and learning disability services in the trust between April 2011 and March 2015. The report sought to establish the extent of unexpected deaths in those services and to identify issues that needed further investigation.

The report was published in December 2015, and its main findings included, first, that many investigations into deaths were of “poor quality” and took too long to complete. Secondly:

“There was a lack of leadership, focus and sufficient time spent in the Trust on carefully reporting and investigating…deaths”.

Thirdly, there was a lack of family involvement in investigations after a death and, fourthly, opportunities for the trust to learn and improve were missed.

Of the 1,454 deaths recorded at the trust during the period under investigation, 722 were categorised by the trust as unexpected. Of those, the review looked at 540 and found that only 272 unexpected deaths received a significant investigation. The report did not specify how many investigations there should have been, but it drew attention to the limited number of deaths that were investigated in different categories. The trust has questioned the use of some of those figures, but the picture painted overall was one of inconsistent standards for investigations, raising the worrying prospect that an unspecified number of deaths may not have been investigated properly. The question of whether there may have been other preventable deaths like that of Connor Sparrowhawk could not be definitively answered, which has led to a great deal of concern among the trust’s patients and something of a breakdown in confidence. Understandably, people want to know that they or their loved ones will be safe in the care of Southern Health. Those whose relatives have died while under the trust’s care need reassurance that the investigations were properly conducted and that the deaths were not also the result of avoidable errors.

My constituent Richard West is one of those relatives. His son, David, died in 2013, and he has been seeking answers from the trust ever since. At times, the handling of his case has been very poor indeed. Mr West, a former detective and policeman, says that he was ignored and was even told by a representative of the trust that the deaths of patients in its care were “like an airline losing baggage.” I know from speaking to other families that others have experienced similarly insensitive treatment.

The Mazars report contained serious and specific criticisms of the trust and its management. In particular, it levelled criticism at the board itself for the failures. It found that

“there has been a lack of leadership, focus and sufficient time spent on reporting and investigating unexpected deaths of Mental Health and Learning Disability service users at all levels of the Trust including at the Trust Board.”

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[Suella Fernandes]

I agree that there is a real risk, as my hon. Friend says so eloquently, of this issue falling into a bureaucratic abyss. It is absolutely vital that we have clear processes and that the identities of the responsible people and professionals are clear, so that there is a clear line of accountability for users and indeed for MPs.

Following the resignation of Mike Petter as chairman of Southern Health, NHS Improvement exercised its power to intervene to appoint his replacement, Tim Smart, who is now acting as interim chairman. The notice directing the trust to appoint him stated:

“These matters demonstrate that the Licensee”—

that is, Southern Health—

“does not have in place sufficient or effective board management and clinical leadership capacity and capability, as well as appropriate governance systems and processes as required by additional licence conditions. Monitor is therefore satisfied that the Licensee is breaching the additional licence condition.”

Time and again, in report after report, Southern Health has been criticised for its failures of management and leadership, and the effects that those failures have had on the care that it provides. That is why I called for this debate that focuses on the governance of the trust. We all accept that, sadly, tragic failures in care will inevitably occur from time to time, and those at the top of an organisation cannot be held responsible for every incident on the frontline.

Equally, we must pay tribute to the dedicated staff of Southern Health for the excellent care that they give day in, day out for the majority of the time. We cannot and should not tar all of them with the same brush because of the failures of others. However, when clear and systematic problems have been identified, we are entitled to ask that lessons be learned. For me, the most shocking part of the sequence of events that I have just recounted is that right up until this year—indeed, even in the last couple of months—inspectors have stated that necessary changes that have been flagged up as needing action have not been implemented.

When NHS Improvement said in its enforcement notices that the trust was failing in its obligations under its licence and did not have effective border capacity and capability, it used the present tense. That was in April. Since then, Tim Smart has been installed as chairman, and I repeat my thanks to him for meeting my parliamentary colleagues and me yesterday in Westminster. He has been conducting an initial review of governance, and I was pleased to hear that he expects to make some announcements on his findings and proposals within the next month. I am sure I speak for many when I say that we will be looking for some far-reaching changes to recognise the gravity of the situation.

That brings me on to the issue of personnel. I have been asked repeatedly whether I am calling for the resignation of Southern’s executives, and in particular that of Katrina Percy, the chief executive. I have resisted doing so because, as the Minister has said in the House, politicians and Ministers demanding that heads must roll can often cause more problems than they solve. I repeat my thanks to Ms Percy and her team for coming to meet my colleagues and me on a number of occasions to answer our questions. However, I will now say publicly what I told her at our last meeting: I find it difficult to have confidence that she has properly acknowledged the scale of the problems under her leadership or how difficult it will be for patients and families to have their faith in the organisation restored without a visible sign of a fresh start.

Resignations are a matter for individuals, and Katrina Percy has said that she believes her responsibility is to provide stability by remaining in post. I understand that position, but the sheer weight of criticism of the trust’s leadership over a prolonged period while she has been chief executive would lead many to a different conclusion. The fact that NHS Improvement has now taken the power to direct changes at board level if it considers them necessary sends its own message.

[Mims Davies]

It has been my perception that there has been a sort of bunker mentality. Perhaps people are just burying their heads, going through the process and hoping it will go away. Does my hon. Friend agree that there is perhaps a little sense of that pervading Southern Health from the top?

[Suella Fernandes]

My hon. Friend is insightful in her observation, although I do not think it takes a genius to point it out. The catalogue of criticisms and failings is not new to anyone. I can understand the frustration and anger of families and patients when they feel that no substantive and material action is being taken.

A mechanism is now in place, and I hope the new chairman and the regulators from NHS Improvement will listen to what I and others say today and consider how they can best act to restore confidence in the trust. I thank my parliamentary colleagues for showing an interest, for speaking up for their constituents and for taking the time to voice their legitimate concerns, both directly to the professionals involved and in this debate.

Before I conclude, I again pay tribute to the families and campaigners who have pursued the issue and shared their experiences with us. In particular, the courage and resilience of Sara Ryan, Connor Sparrowhawk’s mother, has been an inspiration as she has continued to demand answers and ensure that the lessons of her son’s death are learned. Since the issue first began to attract significant coverage, more people have come forward with their own stories and added to the demands for action to be taken. They want to know that their concerns are being heard and that the Government and the NHS are serious about resolving the problems. I have heard them, and so has the Minister. I hope that he will be able to give them some of the reassurance they seek in his reply. I look forward to hearing from colleagues from all parts of the House.

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

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

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

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

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

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

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

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

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

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

[Mims Davies]

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

[Dr Lewis]

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

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[Alistair Burt]

I will address that a little later, if I may, but I will come to it.

I should also answer the right hon. Member for Oxford East (Mr Smith) on the chain of accountability for NHS Improvement, and on who makes the decisions there. The decisions are made by Jim Mackey, who leads NHS Improvement. He is a direct appointment of the Secretary of State, so the Secretary of State invests his confidence in Mr Mackey, who makes the decisions on the work of NHS Improvement.

I will now turn to some of the issues raised by my hon. Friend the Member for Fareham and others. First, on the position of Katrina Percy, I need to be clear: Ministers have no authority to intervene in such matters, and nor would it be right for them to do so. I have been assured by Jim Mackey, the chief executive of NHS Improvement, that agreed processes are in place to review the performance of the senior leadership team and to make any changes that are in the best interests of patients. A Minister has to leave that there, and is not able to express any further view. That there is confidence in decisions taken is clearly of huge importance to Members in the Chamber, as they have expressed, and to others. A process is in place to decide that, and it will be decided by the chair.

I share my hon. Friend’s concern that inspectors have pointed to repeated failure by the trust to close out necessary improvement actions until the beginning of the year. NHS Improvement has asked the improvement director to ensure that the trust does not treat actions as complete until sufficient robust evidence supports that claim. The repeated failure to complete actions is one of the things that I will come on to in answer to my hon. Friend’s questions. When people are told what to do by a serious regulator, why do they not just do it? Why do they not do it in Southern Health, but do it in other places? What is the point of accountability and what is the process whereby in other parts of public service something is demanded by a regulator—say, in the acute part of the NHS—and something therefore happens, but something does not happen if dealing with those with mental health or learning disability issues?

[Mims Davies]

Yesterday, Mr Smart told me that his initial view on exactly this point was that the senior executive team had a focus on dealing with Southern Health’s public relations issues, and not really on the care and quality in what was being delivered. That, simply, was why there was no change.