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Mental Health Services (Lancashire)

Volume 520: debated on Wednesday 8 December 2010

Motion made, and Question proposed, That this House do now adjourn.—(Bill Wiggin.)

I rise to speak about acute mental health service provision in Lancashire. Since August it has become clear that the Lancashire Care NHS Foundation Trust has a clear strategy of closing adult in-patient care units for people with serious mental health conditions such as schizophrenia and bipolar disorder.

Initially, the plan was to be realised and carried out in secret, without the knowledge or consent of the democratically elected governors of the trust. However, once the staff at the Avondale unit of the Royal Preston hospital became aware of the fact that patients were being refused admission or sent for care at alternative facilities, they leaked the information to the local newspaper, the Lancashire Evening Post. Very quickly, campaigners and myself decided to take on the trust—if we can call it a “trust”—and fight the case. The people of Lancashire are enraged about closures across the county, such as that of the Pharos unit in Fleetwood earlier this year, and now the planned closure of the Avondale unit before the new year.

In order to fight the closures, the campaign organisation SAFE—Save Avondale For Everyone—was set up and is led by a courageous and determined set of activists: Andy Hanson, Alison Ball, Fiona Jones, Nadia Southworth, Steve Weyer and Lisa Daley. Along with many others, they have taken on the might of the autocratic managers with six-figure salaries who have no respect whatever for the democratically elected governors of the trust, or the people of Lancashire whom they are employed to serve.

Preston needs the Avondale unit, which has served and saved many lives over the decades: it has saved people from suicide and serious mental illness. Everyone in Preston knows somebody or has a relative who has needed treatment at the unit. As the coalition cuts begin to bite, more people will become unemployed, which will cause more mental illness. Preston is a military town, with Army and Territorial Army barracks. Many armed forces personnel will return to Preston from conflict zones around the world with different degrees of mental illness. Returning forces will need that facility. Preston also has many students, many of whom suffer from mental illness because of the stresses and strains of exams—and, of course, student debt, which is topical at the moment. I understand that the Minister will be absent tomorrow; he will be with the hon. Member for Torbay (Mr Sanders) in Torbay because he does not wish to vote for the coalition’s legislation—but that is by the way.

The closures mean that extremely vulnerable patients with mental illness from Preston will be forced to travel to Blackpool, Chorley or Ormskirk for treatment and care, despite the Government’s promise to ring-fence spending on the NHS. That promise is not worth the paper it is written on, because the trust is not only cutting spending this year, but will cut spending across Lancashire by £33 million next year.

The Lancashire Care NHS Foundation Trust has this mission statement:

“To improve the lives of the people we serve and ensure that mental health matters across the whole community”

and this strategic aim:

“To deliver high-quality, person-centred, compassionate services for mental health”.

It claims to have the following values:

“Teamwork…Compassion…Excellence…Accountability…Respect ...Integrity”.

Let us check the evidence on that. What do people want in Preston? We want local integrated in-patient and community care services; choice in accessing local services, and for that choice to be respected; and the continuation of local in-patient services in the city of Preston, which is the capital of Lancashire and its administrative centre. We have overwhelming local support: I have a petition with thousands of signatures that I will present to the Minister following the debate. The petition is very clear. Everybody in Preston and the surrounding areas wants the Avondale unit to be saved.

We accuse the funding bodies, the primary care trusts and the Lancashire Care NHS Foundation Trust of driving through hidden changes that will have profoundly detrimental psychological, economic and social effects on the people of Preston. There will be many other downsides. For example, the Lancashire Evening Post recently reported on the anger at the travel ordeal that patients will face in future. On 14 July it said:

“Mental health patients may have to travel from Preston to Chorley following the closure of…facilities in the city”.

The chairman of the Lancashire mental health and social care partnership board believes that the consultation process was inadequate. He said:

“It is unclear how the priorities identified at these events translate into a one option consultation—surely this means that there is no choice.”

Let me give a few examples of what patients will be faced with in future. If someone travels from Preston to Blackpool to get treatment, the cost implications for one adult visiting five days out of seven is £29 a day, with a minimum travel time of three hours a day. The average length of stay is 34 days, so the total cost would be around £145. For someone being treated in Ormskirk, the travel cost is £45 a day and minimum travel time is five to six hours. Again, if an average length of stay is 34 days, the total cost would be £225.

The authority clearly wants to adopt a strategy of having some provision at home. The claim is that

“when people are able to stay in their home environment they maintain contact with their family and friends, have less risk of losing their jobs, and can continue living their normal lives.”

That is a quotation from Steve Ward, the medical director of NHS Central Lancashire trust. The chief executive of the trust said:

“We know that community services such as crisis resolution, home treatment and assertive outreach teams enable more people to be treated safely and successfully in their own home or in the community, which is where they tell us they prefer to be treated”.

That is code for cuts, and it is finance-driven, not care-driven.

When the Care Quality Commission looked at the provision of services in its community survey, only 5.5 out of 10 was scored on the question of whether

“those that had used the crisis number in the last 12 months…believe…they received the help they needed, the last time that they called this number.”

On trust performance review, a staggering 66% of patients have had to have a formal review of their care within 12 months, which clearly shows that the current system of providing care in the home is inadequate.

On the subject of suicides in Lancashire, the actual number of suicides in the Preston area in January to March this year was 12, and for April to June it was nine. The total number of suicides for people in contact with Lancashire Care NHS trust mental health services over the last two years is 80. The removal of local patient beds in Preston will increase the already unacceptably high number of suicides. All of these suicides were in the community. One headline reads “Suicidal patient told ‘no beds at Avondale’”.

There has been no consultation on the total closure of Avondale, and no working in partnership or public involvement. As I said earlier, the governors of the trust have been treated with contempt. There has been complete disregard of and disrespect for the wishes of the people of Preston, as the petition, which has thousands of signatories, makes clear. There has been a total lack of openness and transparency. Plans are only now being talked about in any detail, and are being presented as a fait accompli—by diktat, not by discussion with the governors or the people of Preston.

Preston community mental health services will be unable to manage crisis without local beds; they are struggling now. In order to close Avondale, they have had to refuse patients or move them elsewhere, in many cases to private units, which is privatisation by the back door. Patients in Preston face an unclear and constantly changing service plan. The governors have no power over the executive, which has become unaccountable and unrepresentative in its decision making.

The question is not whether Preston can manage without Avondale, but whether it should have to do so. The answer is clearly no. People manage to live through most disasters, but should we allow a publicly funded organisation to develop into a disaster for some of the most vulnerable people in Preston’s population? The evidence of the impending disaster is clear. In the review in 2006, Whyndyke Farm, Ribbleton hospital and Burnley were seen as sites that could have either new facilities or extensions to existing facilities. The plan was to close smaller units. No evidence exists that remote, large hospitals improve mental health care, but there is a lot of evidence that they do not. The deal on new facilities has now been reneged on. There is planning permission for Whyndyke Farm near Blackpool, but Ribbleton hospital will not receive an extension and Burnley will probably never get off the ground. Indeed, I would be very surprised if the extension at Whyndyke Farm sees the light of day. Questions remain over the capacity of local community health services to manage crisis without local in-patient beds in the long term.

A city the size of Preston needs its own in-patient beds and deserves to be consulted about what kind of care its citizens can expect to receive. A city the size of Preston should not be treated as if it were an afterthought, and it should not be forced to fit in with a corporate, financially-driven view of what Lancashire should look like. Lancashire Care NHS Foundation Trust does not care, and cannot be trusted.

As part of the campaign, there have been public meetings, demonstrations and a whopping petition that I shall serve the Government with at the end of the debate. I call upon the Minister and the Secretary of State to approach Lancashire Care NHS Foundation Trust and tell it that this plan does not serve the interests of the people of Lancashire or their mental well-being. The proposal is vandalism, and flies in the face of the Government’s promises to protect the NHS. It will result in more suicides and more vulnerable people coming to harm from others, as well as from themselves.

The former Prime Minister Margaret Thatcher claimed that the NHS was safe in Conservative hands. Well, we all know what happened. If this Government repeat her mistakes, they will pay for it with the lives of vulnerable people in Preston and across the country. Ultimately, they will pay for such actions by being turfed out of office again for those mistakes.

I am grateful to the hon. Member for Preston (Mark Hendrick) for allowing me to participate in this debate. The Avondale clinic is, of course, in my constituency. When the issue was raised by a constituent, I did my best to get to the bottom of the process before, first, forming a position and, secondly, tackling the Government and the NHS trust with some questions and requests.

I surveyed all the GPs in the north and south of Preston and in Chorley. I spoke to the professionals and visited the alternative in-patient centre in Chorley. I visited the Avondale site and spoke to many constituents to asses the key issues. The hon. Gentleman raised a number of sound concerns about the mental health trust, but I am afraid he also raised a number of partisan points. That is extraordinary—the evidence is not about that—given that much of the consultation on mental health reconfiguration started in 2006.

What I found from the surveys of GPs was absolutely clear. Although they were happy with the performance of the community mental health teams and the out-patient service that people were getting, and they were happy with settled and stable treatment in the community—many of them were very impressed by it—they were deeply worried by what was available for patients in crisis and for constituents who needed urgent referral. They found that, for people using the helpline or in serious mental difficulties, the service just was not there. There was a real gulf between what the mental health trust thought it was delivering and the experience of GPs and my constituents of what was delivered.

I have some real concerns that the closure plan trailed for Avondale unit is far too premature. At the very least, it does not take into account some of the changes to the primary care trusts and commissioning that might happen in the next few months or by next year, when the PCTs are abolished and GPs might want to use Preston capacity rather than that in Chorley. The mental health trust has not done anything like enough to answer constituents’ questions about what will be put in Avondale’s place, and how people will travel to it. The trust has talked about a shuttle but, frankly, that is not good enough.

Having visited both Chorley and Avondale, I can say that neither of them is fit for purpose. Chorley is not a great alternative to Avondale. It has had a new lick of paint, but there is nothing significantly better that would drive me to say, “Okay, on this occasion, the professionals are right. The facilities are better.” They are not; they are not outstanding. There is very little room for people to go out and walk and come to terms with some of the illnesses that they are suffering. That needs a lot more work.

In a submission to the latest consultation, I asked the trust to delay the proposal and to go back, fill that gap and ensure a seamless service for urgent referral, community care and in-patient care. Until it does that, the proposal should not be rushed through. It is very important that we ensure that the NHS reforms that the coalition Government are putting into place come to fruition and, at the same time, that patients are given the out-patient crisis support and referrals that the GPs are demanding. We also need to address GPs’ concerns. Once that is done, we will all be in a position to make a proper assessment of what is right.

However, we should not forget that Preston is a major city in Lancashire and the north-west, as the hon. Gentleman said, with a large hospital in my constituency. It would be wrong just to abandon in-patient capacity in that part of Lancashire without really thinking through the strategic impact on in-patient facilities throughout the county, and perhaps even in neighbouring counties. There are lots of black holes in Lancashire, so we must not let that happen. Let us proceed on the basis of evidence. We are not talking about a cuts-driven Government agenda. The trust has got a lot of things wrong, and it is the trust that must address them. That is what I am pressing for, and it is also why the closure of Avondale must not be proceeded with until those things at the very least have been sorted. I would like us to reconsider where the best place is in Lancashire for in-patient care.

I congratulate the hon. Member for Preston (Mark Hendrick) on securing this debate. On the many occasions during my 13 years in the House that I have secured these Adjournment debates, I have always taken the view that one should see them as an opportunity to present a case, not to try to score party political points. There are plenty of other opportunities to do that. Indeed, my hon. Friend the Member for Wyre and Preston North (Mr Wallace) perhaps demonstrated the way in which a case can be made without scoring cheap points.

There are also some points that I would like to spend some time making. In my view, the hon. Gentleman’s comments about students being under pressure and his suggestion that this causes them to rely on mental health services were deeply stigmatising and really unhelpful in trying to promote a sense of mental health and well-being. He does students a disservice by portraying them in that light. The suggestion has also been made that there is some sort of hidden agenda. Well, if there is a hidden agenda, let us be clear that this issue goes back to 2006. The work done then—which resulted in the plans that we are discussing, including the proposals for Avondale—came out of a set of principles in a national service framework for mental health that was drawn up by a Government of whom the hon. Gentleman was a member. That prompts some questions about quite where his attention ought to be focused now and where it ought to have been focused in the past.

I will indeed make reference to the 2006 consultation and the report that came afterwards. It recommended that new facilities be built, but as I said, those facilities are very unlikely to be built, because of the financial pressures created by the Government’s cuts. On the one site there is only planning permission, and on the other two sites there is no sign of any building or any commissioning of building yet to take place.

On the question of students, many are indeed suffering great deals of stress and worry about debt. There are cases up and down the country of students who have committed suicide or who are suffering from mental illness as a result of stresses associated with debt, worries about exams, and pressure from parents and society. It is glib of the Minister to dismiss that in the way that he has.

The hon. Gentleman’s contribution may well have been glib; my concern is about stigmatising people and creating even more concern about mental health problems.

The 2006 consultation looked at strengthening community-based services, in order to reduce reliance on acute hospital care, as well as phased closures of 15 facilities over a number of years, as demand reduces owing to other measures. They were to be replaced by a smaller number of purpose-built units, which I will talk about in a moment. Lancashire primary care trusts spend £23 million a year on community-based mental health services—an increase of 46% since the 2006 consultation, which has resulted in spending per head that is higher than the average for England. Just 4% of service users now need in-patient care in Lancashire, and many facilities are significantly underused as a result.

Many existing in-patient facilities are not fit for purpose—dormitories rather than single rooms; problems separating male and female sleeping areas; no outside space; privacy compromised. Indeed, my hon. Friend the Member for Wyre and Preston North made a case about some of those facilities in his speech. The PCT has plans for four new purpose-built units, the first of which, at Whyndyke farm, is due to open in 2013. The PCT assures me that plans to develop the Ribbleton hospital site are proceeding.

The hon. Member for Preston mentioned concerns about beds. I am assured by the PCT that the closure of facilities has been carefully phased to ensure sufficient capacity. I have looked at the figures, and I have been told that there is an average of 35 spare beds across Lancashire. I shall take no lectures from the hon. Gentleman on the use of taxpayers’ money to get the best possible results for patients, but it hardly makes sense to have an excess of supply of beds such as we are seeing in Lancashire. Indeed, only last week, the King’s Fund demonstrated that better outcomes could be achieved through effective use of resources.

I will in a moment.

That is why we believe that the proposals make sense, and simply to talk about a potential mental health beds crisis is unnecessary scaremongering.

This is far from scaremongering. People are committing suicide in Lancashire, and people are being turned away because of a lack of beds. People come to my surgeries who are suffering from stress and mental illness, or who are caring for someone who is trying to get into the Avondale unit. The Minister mentioned the 36 spare beds, but that is the figure across the whole of Lancashire. The occupancy rates across Lancashire range from 85% to 90%, which are rates that any hotel would be proud of.

It is important that the changes that are resulting from the consultation in 2006 are properly implemented, that they are led by clinical evidence, that they take account of legitimate public concerns, and that they involve appropriate scrutiny. That is why I have asked questions about the nature of the consultation that took place in 2006. More than 115,000 consultation documents were sent out, 74 public meetings and events took place, and independent evaluation by Salford university found that the engagement process was robust and comprehensive. All Members of Parliament, including the hon. Gentleman, were sent the consultation documents and offered briefings by the chair of the primary care trust’s joint committee. However, the only MPs to respond were the hon. Member for West Lancashire (Rosie Cooper) and the former Member for Fylde. I am surprised that the hon. Gentleman appears to have come late to this issue. I understand that he started to get interested in it only earlier this year. I must question why he did not pursue it when it was being consulted on in 2006, when he might have had an opportunity to shape the proposals a little more than he has so far.

In a moment.

When the proposals went to the Lancashire joint overview and scrutiny committee, which was formed in 2006 to consider the proposals, it was committed to ensuring that there was proper engagement. It took the view that there had been significant engagement around these proposals.

I want to address two of the points that the Minister has made. First, we were happy with the consultation that took place in 2006, and with the report. Now, however, the NHS trust is reneging on that report, because it will not have the necessary resources—and, in my view, it does not have the determination—to complete the new units that were promised. On the Minister’s point about not contributing to the consultation or making any objections, we were perfectly happy to see the Ribbleton Hall site extended and improved to accommodate extra beds, but at the moment there is no sign that the extra beds will go there. Until the new facilities are built, I see no logic in closing the Avondale unit, or any other facilities.

I have just given an indication of the PCT’s position in respect of Ribbleton Hall. The PCT is in the process of conducting a further review of the proposals and has produced a revised case for change. That explores the overall clinical model, but does not alter any plans for specific site closures. It does revise the case, which is supported by GP commissioners. I will, however, make sure that the points that both hon. Members have raised in the debate are passed to the PCT, so that it is aware of their ongoing concerns.

The hon. Member for Preston also talked about a city the size of Preston having the right to be consulted. It is worth bearing in mind that, while the city council raised its concerns in August this year, and objected to the closure of Avondale ward, Preston councillors who were sent the original consultation—just like everyone else in Lancashire—and invited to offer feedback and comments about the proposals, did not offer a response, yet the proposals in 2006 included the proposal about Avondale.

I am of course aware of the petition that the hon. Gentleman has mentioned, but I do not think that his presentation of the case has helped his constituents advance this matter at all. He has been stigmatising in some of his remarks about mental health, and I think it is important to value community-based care. It is essential that we see continuing developments in that regard. There is clear evidence that it leads to better clinical outcomes for patients, and the NHS in Lancashire should be congratulated on its strong record of investing in community services.

Changes to acute mental health services, including the closure of outdated facilities, are a necessary part of the local NHS’s strategy for mental health and are necessary to deliver better results and better value for money as well. It is the right approach, delivered in the right way with proper engagement and careful management of available beds, to deliver better results for people in this area of health care.

I have listened carefully and I will make sure that the hon. Gentleman’s representations are fed back to the primary care trust and other NHS organisations concerned. I am sure that he will continue to make these points, and we will continue to improve mental health services, as this Government are determined to do. We entirely reject the notion that there is in any way an agenda of cuts and closures driven by this Government. These initiatives started under the previous Government. They were about improving services then, and they are about improving services now. That is what this Government will deliver.

Question put and agreed to.

House adjourned.