Mental Health Care (Hampshire)

Simon Burns Excerpts

Wednesday 18th April 2012 Westminster Hall

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

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

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

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

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

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

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

[Dr Lewis]

Do it.

[Mr Burns]

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

[Andrew Griffiths]

I am a fan of localism, and I completely support what the Minister says, but does he not recognise that there is a massive lack of democratic accountability in how PCTs operate? No one elects them. They make decisions, and they are accountable only to themselves and ultimately to the Minister.

[Mr Burns]

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

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

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

[Dr Lewis]

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

[Mr Burns]

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

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

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

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

[Dr Lewis]

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

[Mr Burns]

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

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

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

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

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

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

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

[Dr Lewis]

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

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

and

“future modelling of service changes.”

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

[Mr Burns]

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

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

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

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

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

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

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