Westminster Hall Debate: Mental Health Services (South-west London)

Speech by Paul Burstow MP on Tue 19th Jul 2005

I am pleased to have secured this debate on mental health services in south-west London and to have the opportunity to draw the attention of the House to my concerns and those of several of my hon. Friends who represent south-west London constituencies about the development of services for people with mental health problems. I am also grateful to have this opportunity to ask several questions of the Minister responsible for these matters.

I question the way in which the South West London and St. George's Mental Health NHS trust has gone about dealing with a series of service and financial difficulties in the past few years. My hon. Friend the Member for Carshalton and Wallington (Tom Brake), who cannot be in the Chamber today, shares my concerns, as do my hon. Friends the Members for Twickenham (Dr. Cable), for Richmond Park (Susan Kramer) and for Kingston and Surbiton (Mr. Davey).

The trust has let down both patients and staff. It has kept them in the dark and has lost their confidence as a result. In February 2004—that is 17 months ago—it was announced that the trust was to receive £30 million in a bail-out to help to cover its massive maintenance backlog. According to research that I carried out at the time, I discovered that the trust, which covers my constituency and five London boroughs, would still require another £43 million worth of repairs to bring it up to standard.

The costs simply to meet basic health and safety regulations stood at more than £500,000, while the cost for repairs to meet fire-safety compliance was almost £1 million. Those figures were known, and every taxpayer in the country has contributed to bailing out the trust from a long period of failure to invest in its building stock.

The maintenance backlog is only the tip of the iceberg. Earlier this year, the trust announced that it faced a deficit of £8.4 million. It also announced that it had agreed a change and recovery plan, which I sometimes believe is a euphemism for cuts, to bring expenditure within budget in the coming year.

The trust is currently consulting informally on its change and recovery plan, some of which has far-reaching implications. It has identified cuts to some services and changes to others in an attempt to balance its books. It would have us believe that the cuts are all part of its plans to modernise services and provide more locally-based care-in-the-community settings, but at the end of the day there is no hiding the fact that cuts are being made.

Mr. Edward Davey (Kingston and Surbiton) (LD): Tolworth hospital in my constituency is an example of that. Its acute day service and therapy team was introduced with much fanfare just over a year ago as an example of modernisation of the service, but it is the first service to be cut under the proposals.

Mr. Burstow : I presume that it was cut on a last-in, first-out basis, which is hardly a good model for

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developing services. My hon. Friend the Member for Twickenham and many of his constituents are concerned that the proposals to close the Maddison centre, which is a day hospital, will have an impact on many vulnerable patients who will be moved elsewhere as a consequence.

The mental health services in my constituency are in a dire state. The community mental health teams are understaffed and overstretched, and the Sutton teams have the highest referral rate and number of non-complex referrals in the trust area. The child and adolescent mental health teams have the equivalent of 11.3 full-time staff against a national service framework recommendation of 37.4. There is an acknowledged lack of talking therapies and advocacy services.

There is still a significant maintenance backlog, and the existing buildings do not meet the requirements of the national services framework or the mental health policy implementation guide. Day services are lacking, especially for younger people, and the services offered pay little attention to diverse ethnic, cultural and religious needs.

Overmedication is still taking place to placate immediate needs, and the lack of vocational support means that people are in fact becoming deskilled instead of receiving the assistance they require to hold on to their jobs or return to work.

Mr. Sadiq Khan (Tooting) (Lab): Does the hon. Gentleman not believe that, instead of investing in bricks and mortar and institutionalising people, there is something to be said for assertive community treatment schemes, early intervention services, home treatment schemes and 24-hour crisis lines? They help to meet the needs of our disparate communities. Some people have needs that being institutionalised, even in a day hospital, does not address.

Mr. Burstow : The hon. Gentleman makes a fair point. My purpose in raising these issues is not just to campaign in favour of bricks and mortar, but also to campaign on behalf of those who need these services, regardless of whether they are provided at an institution or in a person's own home. I will return to the role of assertive outreach and similar teams soon.

There are small bands of dedicated staff—in the community and in hospital settings—that are battling on, but they are doing so in a climate of distrust and fear. I have received letters from some of them. Many are too afraid of losing their job to allow me to read out their names, but they are demoralised and they feel downtrodden by their excessive case loads. Members of staff of the acute services are particularly critical of poor health and safety measures. That was proved by the tragic incidents that took place at Springfield hospital, and for which the trust was officially criticised and fined.

Staff are also aware of the many well-paid managerial posts that have been created in the past few years. They are advertised in the specialist press, and some of them pay in excess of £70,000 a year. They cannot reconcile that with the cuts that are being proposed. My hon. Friend the Member for Twickenham has made that point in the House on several occasions in recent months.

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Change is always a difficult process to manage, but the South West London and St. George's Mental Health NHS Trust provides us with a textbook example of how not to manage change. There is lack of direction from the higher tiers of management, and an inability to understand the importance and timing of consultation with staff, the public and, perhaps, elected Members in this House and in local authorities.

That is exemplified by the closure in April of the Chiltern day hospital in Sutton. It almost seems that that was done on a whim; it was certainly done in a rush. One of the arguments put forward was, "Well, it does not matter too much, because we can manage the fact that there are only eight in-patients who will be directly affected by the closure." However, that is still a cut, and a cut to a service that is not easily provided elsewhere. Those eight patients, along with anyone else who may need the service in the future, have been farmed out to other, already stretched, facilities in the local area. There was no consultation about the closure; staff, patients and families were presented with a fait accompli, and the excuse that was given for not being able to consult was that there was so-called election purdah. That is downright disgraceful.

The Department of Health guidance on the general election was published on 5 April. It states:

"As at all other times, NHS staff should not be asked to engage in activities which could give rise to criticism that public resources are being used for party political purposes. In particular, you will want to ensure that there are no grounds for complaint against your organisation that it has behaved partially towards candidates or parties represented in the election during this period."

That is normal and good practice outside of election time as well.

The guidance continues:

"It would be advisable not to start a consultation now the election has been called unless it can be demonstrated that it would seriously impede NHS business to delay it a few weeks until the election period is complete."

There is nothing in the guidance about not being allowed to consult. It is simply stated that consultations should be delayed until after the election if that is possible. Why did the trust decide that it had to close down the day hospital so quickly? It was not falling down. There were no immediate health and safety issues. Why was not time allowed for proper consultation with patients, families, staff and the public? Why was this decision taken at the same time that the general election took place? It was not as if anyone with a passing interest in politics did not know when the election was likely to be called. It should not be beyond the wit of senior NHS managers to make a planning assumption about the date of a general election.

Mr. Khan : Will the hon. Gentleman give way?

Mr. Burstow : Let me finish the point and I will happily take one more intervention, but I want to ensure that the Minister has ample time to reply.

The general election has become a convenient excuse to hide incompetence and the failure to consult the public about proposals that would have a significant bearing on their quality of life.

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Mr. Khan : May I give the hon. Gentleman another example of plans to close a hospital without consultation, and without the excuse of the election? The trust of Springfield hospital in my constituency intended to close the Cottage day hospital without consultation. Thankfully, as a result of pressure from the hospital's overview and scrutiny committee, the trust will extend the consultation process. I agree with the hon. Gentleman that such closures lead to alarm and distress for hospital users and their families.

Mr. Burstow : I am grateful for that further example of how the trust conducts itself, the attitude that it takes and the value that it attaches to consultation. The trust will have to justify its decision on the Chiltern wing of Sutton hospital. Will the Minister confirm that the guidance issued by the Department just before the general election does not place a veto on consultation and that it does not prevent substantial variations being carried out during an election period? I am told that the local strategic health authority authorised the closure decision without consultation, and I ask the Minister to investigate whether proper advice was sought and whether the guidance was properly followed.

The national director for mental health published a report last December on the progress made since the national services framework for mental health was introduced in 1999. The report highlighted the lack of investment in mental health services throughout the NHS, saying that to a certain extent it was a result of the priority that primary care trusts give to mental health compared with other national targets such as access and waiting times. That is particularly so in my constituency.

The local primary care trust has a commissioning budget for my constituency and the adjacent constituency of my hon. Friend the Member for Carshalton and Wallington (Tom Brake) of £20 million, yet the newly appointed director for the PCT in Sutton has a budget of only £14.8 million for services to be provided locally. Why is 25 per cent. of the total figure being used to pay for out-of-borough services? It has not been explained, which is unsatisfactory, yet one person in three is likely to need some level of care from mental health services in their lifetime. That means that less than £500 is available to be spent on each person each year.

There is a chronic lack of funding for mental health services, and the mental health trust is to blame for failing to engage with the PCT and for failing to win the case for more resources. If we bear in mind that as many as 30,000 people may need some level of service in my constituency and my neighbouring constituency in the borough of Sutton, the resources are staggeringly low. I shall rehearse some figures to underline the fact.

There are 84 adult in-patient beds in the one specialised acute hospital ward in Sutton. There are only four adult community mental health teams to cope with a current caseload of 1,600 clients and 15 or 16 new referrals a week. There is one assertive outreach team with 150 clients, one crisis and home treatment team with 90 clients, and two resource centres with 180 clients. That just scratches the surface. People who receive a service rely on staff who are overstretched and buildings that do not meet the minimum standards.

The change and recovery plan drawn up by the trust is meant to deal with the emergency; but why should it have come to this? Why should it take a financial crisis

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to get the trust to acknowledge the need to start tackling the serious deficiencies in the service? The proposals are in line with current national thinking, and in many ways I support them. More services will be provided locally in the community, and there will be less reliance on hospital-based services. GPs with special interests and graduate workers will provide a broad range of services. That will be backed up by a network of social care specialists, counselling services and talking therapies, and there will be a stronger role for the voluntary sector, with self help and support groups.

It remains unclear, however, where that new army of specialised GPs, social workers and therapists will be found. Even less clear is where the funds will be found to train and employ them. What about the voluntary sector? Will it receive more funding to increase its capacity? Is anyone talking to the voluntary sector about the services that it provides now, and the role that it will be expected to play in future? The community mental health teams will be reduced from four to three, yet we need more of that sort of service, not less. How does that fit in with a transfer of care from inpatient to community-focused services?

The change plan states that there is a need to access a range of other services that form part of health promotion and ill-health avoidance, including advice on debt management, benefit availability and housing. Yet the plan is to close down the Springfield advice and law centre, which provides such advice to many hundreds of people, and which had over 200 new cases in 2004 alone. Does that really fit in with the promotion of well-being and the prevention of ill health? If people are not given the help that they need to manage their finances, keep their jobs or find new ones, pay for their housing and maintain their independence, the impact on their mental health will surely be considerable.

Providing care in the community and locally based services is far from a cheap option. It needs to be carefully thought through, properly costed and effectively managed. It requires expert training for general practitioners, social workers, therapists and the voluntary sector. It needs a thorough consultation strategy, so that the public, whether they are users of such services or not, understand the strengths of the new proposals and the advantages that they will offer, and have the chance to engage seriously with the development of the ideas at an early stage.

Care in the community and locally based services need to be properly financed, and need time and patience. The many hundreds of members of staff in my constituency who are dedicated to providing first-class mental health services deserve that, as do my constituents, although they are not getting it as a consequence of the process that we have embarked on, which has left them out in the cold. They should not be left in the cold; managers of our mental health services should engage with them fully, and they should be given the chance to shape those services for the future.

I hope that the Minister can respond positively and will take a much closer look at the issues that I have raised. I hope that he can make a careful examination of the role, calibre and quality of the management that has gotten the trust into the position that it is in today.