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Volume 281: debated on Wednesday 17 July 1996

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Education Vouchers

11.59 pm

I wish to present a petition from the Calderdale Schools Against Vouchers in Education. The petition contains 10,000 signatures from the people of Halifax and the Calder Valley. The petitioners urge the Prime Minister and the Secretary of State for Education and Employment to exempt them from nursery vouchers because, in their opinion, Calderdale is already a high provider of good quality nursery and reception education. They believe that it would be more appropriate to concentrate on supplying adequately provided state nursery and reception places for all children.

To lie upon the Table.

Rail Freight

12 midnight

The petition of the residents of the Beaconsfield constituency, particularly the residents of the village of Denham, declares that they totally oppose the proposed freight railway system planned by Central Railway plc. The objectors, who number almost 4,500 and who live in the vicinity, declare that the proposal is unacceptable because it will cause environmental damage far outweighing any claimed benefits. The fact that so many people in my constituency have signified their resolute opposition to the proposals is a clear sign to the House of Commons that it should reject them when they are debated and voted on next week. The petitioners therefore request that the House of Commons rejects Central Railway's application for an order under the Transport and Works Act 1992.

To lie upon the Table.

War Memorial (East End)

12.1 am

I present a petition signed by almost 4,000 Londoners, most of whom live in the east end, in support of the efforts of the group known as Civilians Remembered to obtain a suitable memorial for civilians who died during the last war and to commemorate the bravery of those who kept the London docks open throughout the blitz. The petition showeth that the most fitting and appropriate site to honour the suffering of east end civilians during the last war would be a memorial in a park setting, to provide a much-needed amenity for contemplation, education and recreation and access to the river for their surviving families and future generations. The petitioners pray that the House recognises that the bravery of east end civilians during the last war should be honoured by a memorial to be erected in a park setting on the last remaining open land fronting the Thames in Wapping, known as the Hermitage riverside close to Tower bridge, which was the entrance to the London docks.

To lie upon the Table.

Mentally Ill People (Blaenau Gwent)

Motion made, and Question proposed, That this House do now adjourn.—[ Mr. Bates.]

12.2 am

At a recent meeting to discuss the changed provisions for patients suffering from mental health problems in Abertillery and district, the wife of one of the patients said:

"You might be thinking that this does not affect you, well you are wrong. Mental illness can affect anyone, no matter how fit you are, or whatever age and it does it without warning. Anything can spark it off-a family death, birth of a baby, loss of your job, money worries, health problems, family problems. Your illness may be short term, or last for months, even years. As the Lottery says, it could be you."
She is right. The people who suffer from mental illness are among the most vulnerable in the community. Because of their mental state, they often find it difficult to stand up for their rights and they often require their family, friends and local community to provide support for them.

The Gwent community health trust obviously recognised that vulnerability, so the provisions for mental health care were changed without consultation and introduced without notice. The changes are opposed by me, the patients and their families, the local general practitioner, the county borough council, the community council, a representative of the community health council and by the non-executive director of Gwent area health authority, Peter Law. The senior employee of the health authority in the area admitted that the patients were "casualties of the reorganisation".

The chief executive officer of the community health trust, Bob Hudson, has admitted that there was no consultation. He said that, even with consultation, the conclusion would almost certainly be the same. That would not be consultation, but a cheap publicity gimmick—an insult to the consultation process. Page 2 of the patients charter issued by the Welsh Office in 1996 states that it is the duty of the authority to:
"Discuss and help to decide the care and treatment that's right for you."
Mr. Hudson has apologised for the lack of consultation and for the pain and trauma that the changes have caused the patients and their families. However, the patients are not interested in apologies or in sympathy: they want to revert to the first-class service that was provided until a few months ago. The chief executive officer of Gwent community health trust responded to that demand by saying:
"Well folks, you have lost out."
How callous and uncaring can a person be? What are the proposals? The changes to in-patient treatment involve transferring patients from the Dan-y-bryn hospital in Ebbw Vale to Talygam in another county borough. The Minister may wonder what the problem is. First, there is the difficulty of travelling from Blaenau Gwent to Talygam. Mr. Hudson argues that, as the crow flies, there is not much difference in the distance. However, Julie Pitcher, the wife of one patient, responded by saying, "Mr. Hudson, we are not crows". Mr. Hudson fails to realise—I assume because he is the equivalent of a member of the Flat Earth Society—that we live in valleys that are separated by mountains. Gordon Caldecott, a journalist with the Gwent Gazette, highlighted that fact when he calculated that a return journey would require six bus changes and take approximately four hours.

It is not simply a question of time and inconvenience. A patient explained at a recent meeting that travel can be a terrifying experience for some patients with particular mental health problems and the cause of great agitation. The Minister may ask: why not go by car? The same problems apply, but the statistics show—the Minister has access to them in the Welsh Office—that Blaenau Gwent has one of the lowest levels of car ownership of any valley community in south Wales. That is obviously a reflection of deprivation in the area.

The travel difficulties with bus changes will affect the patients, their families, friends and anyone else who cares to visit them. However, they are not the only problems confronting patients. When they arrive at the hospital, they will be faced with a new nursing staff and different consultants. If a patient has a fractured ankle, he can cope with a change of staff. However, we are discussing not fractured ankles, but people who suffer severe mental health problems. It often takes years for them to build up faith, trust and confidence in the nursing staff with whom they deal. It will take a long time to gain the trust and confidence of the new staff and consultants.

Secondly, we have the problems that relate to out-patient treatment. The original plans involved changes to many of the community nurses who make home visits. Thanks to the stand taken by the patients, their families and the local community, the number who would have experienced such changes has, thankfully, been reduced. Yet, if we are one of the minority forced to change nursing staff, for us the problem is just as big.

To placate the patients and the families, the trust decided to set up a clinic in Abertillery for four hours a month, which inevitably means a long waiting period before an appointment. That is a complete waste of time, considering that Blaenau Gwent has the highest level of mental illness of any part of Gwent. That being so, I should have though that the community health trust would have brought the service to the clients. But no. Because we are unable to fit into its grand plan for Gwent, patients must now go to the service, and damn the consequences.

Indeed, Mr. Hudson admitted that the problem has arisen because of the grand plan for Gwent. For this to happen anywhere is sad, but for it to happen in Blaenau Gwent, the birthplace of the national health service, is a tragedy. The patients and their families feel that they have been treated with much disdain and that the human element has not even been considered.

It is interesting to note that one of the two people who drew up the plans admitted, in a recent meeting, that he knew nothing about the area when contemplating the changes. At least he was honest, although his honesty has had tragic consequences for patients.

I have already quoted from the patients charter regarding consultation, but let me quote further from some of the passages that are relevant to these changes. On page 2, the charter commits itself to treatment
"with care, consideration and respect"
Further on, it states that we must have
"the right service at the right time and place".
These changes will mean that the service is neither at the right time nor in the right place.

Page 11 states:
"If you have a serious mental health problem, you will be encouraged to work with a carer of your choice and your local community health team, to agree a plan to help you get the care and support you need."
The trust, by not consulting, has taken away that choice. All this has been ignored, and patients are experiencing much pain as a result. That has been well illustrated in the meetings that we have had, where some patients break down and cry because they fear the consequences of isolation.

It seems to me that the Minister has two choices: first, to show that the promises in the patients charter are not just words on a page or some cheap gimmick and instruct Bob Hudson, chief executive officer of the community trust, to scrap the plans and return to the provision that had prevailed; or, secondly, to admit that it was a publicity stunt and, like the chief executive, say, "Well, folks, you have lost out".

I have argued that people with mental health problems are vulnerable and often unable to stand up for themselves. Yet the patients and their families have been magnificent. They have stood up to the bullies in the community health trust, and the message that they want me to pass on to the Minister is that they are standing firm and will not be shoved around any more. Everyone else recognises their courage, knowing what is best for them. That is why I—as is everyone else in the community—am giving them 100 per cent. support.

I finish by quoting from Julie Pitcher, the wife of one of the patients, who handed in a petition to the Under-Secretary of State, the hon. Member for Brecon and Radnor (Mr. Evans), on behalf of the patients. She wrote:
"Since the changes, patients' lives have become a jigsaw, always trying to fit the pieces together and we are worried that for some time the jigsaw is beginning to fall apart".
That is what it is all about. That is why we expect and demand of the Minister that he respond to the plight of these people.

12.14 am

As I said in Welsh Questions on Monday, I am pleased that the hon. Member for Blaenau Gwent (Mr. Smith) has managed to raise this important issue. I shall try to respond to all the important points that he made.

If the hon. Gentleman looks at the provision of mental health care for those living within the Gwent health authority region—including those living within Blaenau Gwent—he will, I hope, acknowledge the greatly improved level of care that is now provided. Over the past eight years, a comprehensive network of local facilities has been steadily built up to replace the outdated and relatively distant institution at Pen-y-Fal in Abergavenny. There are now eight multi-agency mental health teams based in the community. For adults, there is an ambitious range of purpose-built local in-patient, out-patient and day hospitals at Blackwood, Ebbw Vale and Pontypool, which are more convenient and in a homely environment. For the first time, a new liaison psychiatry facility has been established at Nevill Hall hospital. It provides special support when required for patients who are in the general hospital. That benefits Blaenau Gwent, and fills a significant gap.

There has also been considerable investment for elderly mentally ill patients. We now have a new purpose-built hospital, which is the first phase of Ebbw Vale community hospital. It provides continuing care, respite care and a day hospital for Blaenau Gwent.

Among the achievements in the Gwent health authority region is the fact that the specialist psychiatry facility for old age now includes five community mental health teams to meet the needs of older people as close as possible to their own homes. Each team is made up of a consultant psychiatrist, clinical psychologists, community psychiatric nurses and therapists who specialise in working with those with mental health problems. Each team also has active input from key social workers and voluntary organisations. A strong network of volunteers, including carer support groups for patients with dementia and their relatives, has also been developed. All those new provisions improve access and patients are treated more effectively, with an obvious improvement in the quality of care on offer.

As one would expect, as new developments are brought about catchment areas may need to change. In recent months, health and local authority boundaries and responsibilities have changed. That, and some acknowledged anomalies in catchment areas, prompted a view of existing configuration. The aim was to ensure that a greater consistency with local authorities, social services and general practices was achieved, thereby making liaison and continuity more effective.

The Minister says that more continuity has been achieved in relation to local authorities. I am not talking about that, however, and nor are the patients. If there were such continuity, patients would continue to be treated in Dan-y-Bryn hospital in Ebbw Vale, but, as the Minister knows, they are forced to cross the valley to Torfaen. If we are to have the debate that we want, let us make sure that we get the facts right.

I do not deny what the hon. Gentleman has said. I am trying to present all the facts.

I imagine that the hon. Gentleman is aware of the Audit Commission's report. It defined a framework for comprehensive, community-based mental health care. The lack of coterminous boundaries, and poor access to local in-patient provision, gave rise to specific criticism of Gwent health authority's abilities. Gwent Community NHS trust has attempted to reconcile the differences, and to respond positively to demands from local people and the agencies involved.

Will the hon. Gentleman pause for a while and listen? As I have said, I am trying to establish the facts.

We must get the facts right. The Minister said that the trust was responding because of pressures from local agencies and people. I challenge him to name one individual, organisation or local agency that has not only pushed for the changes but supported them. The Minister made his point; now he must explain it.

As the hon. Gentleman will find, I am trying to establish what the position is.

Patients living in Pontllanfraith, Blackwood and Newbridge now have a local community mental health team and can go to a new in-patient unit, Ty Sirhowy, situated in Blackwood. Previously, they had to make a nine-mile journey to Pontypool. Residents in Abersychan and surrounding areas are now able to access new purpose-built, in-patient facilities at Pontypool and those from Tredegar and Sirhowy are now served by new in-patient facilities at Ebbw Vale.

In all cases, there is considerably less need to travel and improvements in liaison and quality, together with greater liaison and co-operation between community mental health teams and GP practices. The key to improving health care lies in enhancing the role of the primary sector. GPs and fundholders are and will continue to be central to this.

GP fundholders have a significant role to play in community-based arrangements, as they are responsible for commissioning mental health care for their patients. I expect the new health authorities to pay particular attention to the role of primary care so that we might achieve yet further improvements in the NHS.

If the hon. Gentleman listens to what I am going to say, it will deal with his point.

People living in south Blaenau Gwent will also benefit as a result of these changes, although I accept that, for a small number, there appears to be a disadvantage. They will now have to travel to a different hospital for in-patient care and, for some, there will be a change of consultant.

That does not mean that the care that those people receive will be less good simply because the in-patient facility will be situated at Pontypool. The new unit offers a first-class environment for the treatment of the mentally ill. A wide range of health care will be available at Ebbw Vale and the unit is only marginally further away. It is certainly more convenient than the old institution in Abergavenny and, on past experience, it is expected that there will be less than one admission a week from the south Blaenau Gwent area.

I spent 15 years with the Workers Educational Association. A significant amount of that time was spent working in the mental health sector with mentally ill and mentally handicapped people, in all the hospitals and day centres that the Minister has mentioned and in many more, but one does not need to be an authority on mental health to know that a patient who has, say, a nervous background has gone through a traumatic experience. It often takes years. Indeed, one of the patients in the meeting that I mentioned referred to his severe mental state some 14 years ago, but he said, "As a result of the treatment and of developing relationships with the staff, I am here today." That is a major step forward.

I am not criticising people in Talygarn hospital. I am sure that the nurses and consultants there are first class. I am not criticising the building. I know the region well, but patients will have to start from the word go. They will have to go through all the traumatic experiences that resulted in their mental illness. Those will inevitably be dug up again and discussed with the staff and consultants. One does not need to be an authority on mental illness to know that that will happen.

Order. The hon. Gentleman has already made a speech.

I acknowledge that there is agreement between us, but the hon. Gentleman is, in part at least, exaggerating the position.

I want to explain two points. First, the changes were motivated by clinical considerations and were developed by clinicians and patients before they were carried into full effect. Secondly, when it became clear—I think that this is what the hon. Gentleman was referring to—that a small number of people would be inconvenienced, the trust sought to discuss the issue openly and publicly and to make improvements to meet the most pressing concerns.

Increased out-patient and day hospital places have been provided locally and the Gwent Community Health trust has considered assisting relatives and friends to visit patients in hospitals. This is not the action of an uninterested and unresponsive organisation.

I do not know who wrote that speech, but his or her knowledge of the community is equivalent to that of the people who drew up the plans for the Abertillery and district area.

The Minister stated that the patients were involved and consulted. The chief executive officer, Mr. Bob Hudson, has apologised and admitted that there was no consultation, not only with the patients and families, but general practitioners, the local council, Uncle Tom Cobbleigh and all. So let us stick to the facts.

Naturally, my officials have been in touch with the Gwent Community Health trust and obtained information. As I said, when it became clear that there were problems, consultations were opened. I think that I know what the hon Gentleman means and I hope that he knows what I mean.

Considerable thought has been given to the effect on an average patient in the south Blaenau Gwent area. Previously, patients travelled to Ebbw Vale or Blaina for out-patient sessions. They now travel shorter distances to new, more convenient out-patient sessions closer to Abertillery.

Gwent Community Health tells me that by the end of the summer, only those who need first appointments will be required to travel outside the south-east of Blaenau Gwent. Furthermore, Gwent Community Health aims to provide complete local provision in due course. That is no mean target for what are, after all, very specialised functions.

Some 1,000 out-patient appointments a year are involved and that represents a considerable improvement in access for those living in the surrounding areas, as well as in the quality of health care.

Furthermore, patients travelling to Ebbw Vale quite often saw not their consultant but an associate. The new arrangements will result in an increased number of out-patients being seen by their own consultant.

Continuity of care is essential and even more so for individuals with a mental health problem. In recognition of that, the community psychiatric nurses involved with those living in the south of Blaenau Gwent are to remain with their patients, thus retaining their links.

In addition, parallel clinical sessions by community psychiatric nurses will supplement out-patient consultant sessions at Abertillery. All community psychiatric nurses will now be linked to GP practices and liaison between the two should be greatly simplified and enhanced.

I am not aware of any change or proposed change that is not firmly based on the intention to improve patient care. I stress that the changes have not been driven by a management agenda to reduce costs or make savings at the expense of mental health patients.

The changes represent a genuine attempt by the trust to improve health care in the south-east of the hon. Gentleman's constituency and they seek to demonstrate that the process is continuing. I want to see a determination to listen to the views of those whom they seek to serve.

I hope that I might have the hon. Gentleman's agreement that, in general, we have a good track record in Wales for developing health care that responds to individuals' needs and preferences. I very much want to ensure that the essential partnerships between health and local authorities will be strengthened as a result of the changes.

I am aware of the concerns locally about the transfer of some provision from Ebbw Vale to Torfaen. A decision to consult on that issue is a matter for the health authority and the national health service trust in discussion with local interests. At the end of the day, the determination of the precise pattern and level of health care provision for mental illness must be a matter for those involved locally and will always need to be considered within the context of available resources and competing priorities.

Health care will change from time to time and, in looking at the needs of one locality, the needs of the health authority's region as a whole must be taken into account if maximum benefits are to be achieved.

I regret any inconvenience that some people might face as the changes take place. Even if clinical standards are improved, as in this case, have no wish to see vulnerable people, their families and friends put to avoidable inconvenience. I give the hon. Gentleman my assurance that I will be watching the situation as it develops.

In acknowledging that the hon. Gentleman has raised a number of important issues relating to the south of his constituency, I think it fair to try to put them in the context of the considerable advances made under this Government for those suffering with a mental illness. Those advances can be seen both nationally and locally, throughout Wales and in the hon. Gentleman's constituency.

We should not forget that, for the past 100 years, mental health care throughout Wales has been primarily provided within isolated, large psychiatric institutions, typically the old Victorian institutions, and there is the widest agreement that those are no longer suitable for the mentally ill. Often, they meant for many people that they were removed from their local communities and that links with their families and friends were destroyed.

We remain firmly committed to our policy. We want to see that those who suffer from a mental illness have the right care and the support that they need. It is a continuing challenge. Individuals cannot be slotted into a standard model of care.

In Wales, we have been at pains to ensure that appropriate community care is provided before hospital beds are withdrawn. Our aim is to have a range of facilities to meet all the varied clinical needs. We must strive to meet reasonable needs and to keep individuals in contact with their families, friends and colleagues. Helping them remain in their own homes and surroundings remains the cornerstone of our policy.

Clearly there has been significant progress in Wales. We now have some 50 community mental health teams across Wales. They work in partnership with a host of other agencies, sharing dedicated bases and aiming to provide local and accessible care to those with severe mental illness.

On a point of order, Mr. Deputy Speaker. Will you confirm that this debate is about mental health provision in Blaenau Gwent as opposed to Wales? The Minister said, in his own words, "From now on, I shall discuss provisions for the rest of Wales."

As far as I am aware, Blaenau Gwent is in Wales. Therefore, the Minister's remarks are in context.

I have sought to describe the situation in Gwent because I thought that I had agreed with the hon. Member for Blaenau Gwent that it was important to put the facts on the record. I specifically discussed the situation surrounding the problems to which he has drawn attention, and I acknowledge that there are some problems. I have sought to assure him that, as he has drawn the problems to my attention, I mean to continue to watch the position.

This is essentially a local matter. I should hope that the hon. Member for Blaenau Gwent will use his best offices in continuing to represent this matter with the Gwent Community Health trust and with the Gwent community health authority. I should tell him, however, that I do not think that he is doing the greatest service for his constituents with the manner in which he is behaving in this debate. I think that a more considered and constructive approach towards a matter of this nature would secure a much greater gain and response from those who need to listen to him. I, for one, am listening to him, and I shall continue to listen to him.

It is arrogant and condescending to say that I should involve myself in discussions with the health authority and with the trust, and that I should be a part of the consultation process. The point that we are trying to make is that there has been no consultation in recent weeks because of pressures from the families and friends of those involved. There have been meetings. I am not the only one making this argument, because GPs, local authorities, social services and everyone else is opposed to the plans. That should lead the Minister and the health trust to arrive at the conclusion that, perhaps, they have it wrong.

Of course there must be discussions at every possible level. As a constituency Member of Parliament, I know that I participate in such discussions, and I am sure that the hon. Member for Blaenau Gwent participates in such discussions. However, I think that I am entitled to tell him that the manner in which he has behaved today does not endear his case to me—although, from what I have heard and from my investigations, I understand that there is substance in the points that he has made. But when he goes overboard—in a particular manner—in making those points, he undermines the importance of his case. I must tell him that there is constructive discussion and there is destructive discussion.

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned accordingly at twenty-eight minutes to One o'clock.