Motion made, and Question proposed, That the sitting be now adjourned.—(James Duddridge.)
Last November, I secured a short Adjournment debate entitled, “Woodhaven Hospital”, the subject matter of which ranged far more widely than the future of that state-of-the-art mental health unit, which was opened in New Forest East only eight years earlier. At issue was the vital question of how many acute beds should continue to be provided by the Southern Health NHS Foundation Trust, which covers most of Hampshire.
The trust was proposing a 35% reduction in acute mental health beds for adults, from 165 to only 107, 10 of which would go from Antelope House, Southampton, 24 from the Meadows in Fareham and 24 from Windsor ward at Woodhaven in my constituency, with this last unit being reused as a low secure unit for much longer-term detained patients. No one disputes that some beds will always be needed for people in crisis, and everyone welcomes the use of new mental health therapies to reduce the number of admissions and enable people to go home earlier. The argument is purely about how many beds are required and whether the trust has shown adequate statistical rigour.
The trust’s consultation document seemed to be designed to persuade the public that bed numbers were much higher and length of stay much longer in Hampshire than the national average, when that was not the case. Two other matters also caused particular concern. First, about half the acute in-patients at any one time had been detained or sectioned under mental heath legislation, so most detained patients would still need beds in the future. It seemed obvious therefore that the proportion of beds allocated to such patients would rise from about half to some two thirds or even three quarters if there were a 35% reduction. Yet, when I said on the BBC’s “South Today” programme that people’s best chance for future admission would be to get themselves sectioned, the chief executive of the trust, Katrina Percy, sent a letter to Ministers, councillors and Hampshire MPs denouncing such comments as “unfounded” and “scaremongering” and with
“no place in the 21st century”.
The trust feared the broadcast because it also demonstrated my second contention, which is that people were being misled about the number of unused acute beds out of the 165. As was explained in the previous debate, at 4 pm every day a bed states report is issued, showing the total number of beds available in each acute adult mental health unit. The figures are broken down into four important categories: male beds, female beds, vacant beds and leave beds. Male and female beds are obviously not interchangeable, except in the minority of cases where the configuration of a ward allows a bed to be used for either gender. Leave beds are those whose patients are away for a few nights, and beds empty for longer periods are rightly regarded as vacant and genuinely empty. Despite what the trust says, one cannot rely on admitting the same number of new patients as there are leave beds because people come back after two or three nights to reclaim such beds.
The trust hates my use of these 4 pm daily snapshots of bed occupancy, yet what is its alternative? It issues simplistic graphs, which plot three elementary tracks. The top line shows the number of beds in the system; the middle one shows the number currently in commission in case some have had to be closed; and the bottom one, which fluctuates widely, shows the number of patients in beds on each day. The picture presented by the graphs seems reassuring, because there is always a visible gap between the number of patients in beds and the number of beds in commission, but they do not distinguish between the different categories of unfilled beds. The graphs assume that all the beds are interchangeable regardless of gender and that they are all available for admitting new patients, when many are leave beds, which are, by definition, never empty for long.
In last November’s debate, I pointed out that between 21 September and 6 October 2011 the combined total of vacant and leave beds had varied from just three to just 11 out of the 165 in the system and that over the three months from August to October, even if all the leave beds had been counted as fully available for new admissions, bed occupancy was still at almost 92%. One must have huge confidence in the ability of the trust’s proposed alternative—virtual wards at home for acutely ill people—to think that a 35% reduction in beds will be safe and sustainable. In the previous debate, I said that it was
“distinctly probable that the overview and scrutiny committee of Hampshire county council may decide to refer this matter to the Secretary of State.”—[Official Report, 10 November 2011; Vol. 535, c. 552.]
That health overview and scrutiny committee—HOSC—can do that if it is sufficiently concerned about proposed changes in NHS arrangements.
I was a little perturbed to hear that HOSC’s relatively new chairman, Councillor Pat West, apparently said that I had my figures wrong. Before Christmas, I made contact with Mrs West, who took the trouble to meet me at the home of my caseworker, Councillor Diana Brooks, who is the health portfolio holder on the district council in the New Forest. The HOSC chairman went though some of my data, and forcefully explained her poor opinion of the Southern Health NHS Foundation Trust and one of its most senior administrators. She even hinted that there was a question mark over the suitability of the trust to continue with its contracts and said that the future of the acute mental health beds was just part of a bigger picture. She also added that the HOSC had considered referral to the Secretary of State but felt that that was premature at present and that matters would be considered further at the next HOSC meeting on 24 January. Encouraged, I put the date in my diary.
Meanwhile, the trust’s chief executive, Katrina Percy, had responded to my November debate, and that led me to prepare a full analysis of the deficiencies so far discovered in the trust’s information. My memorandum, entitled “Unreliable Statistics”, was sent to my right hon. Friend the Minister, Miss Percy and the HOSC chairman on 11 January. My covering letter to Pat West stated:
“I hope the HOSC will consider the contents presently”.
With the HOSC meeting drawing near, I asked my parliamentary assistant, Colin Smith, to ring Councillor West to ask about my addressing her committee, perhaps with a delegation. She was adamant that there was no need for me to go to the 24 January meeting. She said that it would be “counter-productive” and that she would much rather keep me “in reserve” for later. Having no reason to doubt the advice, I followed it. My feelings can be imagined, therefore, when the day after the meeting I discovered that the HOSC had fully endorsed the bed closure plan and would not be considering it again until July, by which time all 58 beds would have closed.
I immediately telephoned the leader of Hampshire county council and expressed my incredulity that an elected councillor from my own party could have misled me so blatantly. Subsequently, the HOSC chairman spoke further with my office. She still insisted that my attendance would have been counter-productive. I am at a loss to know how the meeting could have been more counter-productive. Could her committee have voted to close all 58 beds twice over?
Suspecting that my paper on bed statistics had been suppressed rather than circulated, I sent it directly to all HOSC members and set out the circumstances in which their chairman had dissuaded me from attending. In case anyone thinks that I am relying on parliamentary privilege, this is what I wrote without it:
“She gave no inkling that there was the slightest chance of a decision to close the beds being taken at that meeting. I was, therefore, amazed and dismayed to learn (from a local press report) that that is precisely what happened. I feel totally misled and let down on behalf of some of my most vulnerable constituents... In almost 15 years as a Hampshire MP, I have never received treatment like this from an elected colleague in my own party, and I am deeply shocked by it.”
When the row broke in the local press, Councillor West refused to comment to the Southern Daily Echo, saying that she
“did not want to get into a slanging match with the MP in the media”.
However, on 3 February, she replied to my original letter of 11 January covering my memo to the HOSC and to my later letter to committee members:
“I am sorry that you could not attend the 24 January meeting”,
she wrote, without a trace of irony, adding that the agenda and papers for the meeting had been on the council’s website and would have shown me that the HOSC
“would be considering recommendations which related to the closure of beds”.
Apparently, I had only myself to blame for not distrusting her enough to ferret around on websites to check that I was not being misled.
The minutes of the meeting and the resulting press coverage revealed that two factors had featured prominently in the HOSC deliberations. The first was a statement by the trust’s clinical director, Dr Lesley Stevens:
“With regard to the data on bed demand, it was highlighted that between 20 and 30 beds had been vacant consistently over the past three months, and that this trend coincided with the introduction of new community services.”
That is precisely the sort of claim that I had intended to challenge.
On the very day of that meeting on 24 January, the trust’s own figures showed clearly that there were no vacant male or female beds, no leave male beds and just six leave female beds in the entire system, giving a grand total of six unoccupied beds. In November and December 2011, there had certainly been an unusual rise in the number of empty beds, in stark contrast to the previous month, October, when on 17 days the total number of male and female vacant and leave beds had been in the single figures, not 20 to 30.
Indeed, on 10 October, there had been no vacant male beds, no vacant female beds and just one male and one female leave bed in the entire directorate. Still, if overall totals of empty beds in January had continued at November and December’s high levels, I would have ended my campaign to prevent the closures. However, that did not happen. For example, on at least 14 days in January, there were no vacant male beds, and on at least 10 days, there were no vacant and no leave male beds, so no beds for men at all.
Later, I wrote to the local press about Dr Stevens’s claim to the HOSC that there had been 20 to 30 vacant beds consistently in the past three months. I pointed out in my letter that actually only a handful of beds had been empty when she claimed consistent totals of 20 to 30 unoccupied, and I noted:
“It is true that during November and possibly December”—
I did not have the full figures for December at that time—
“there was a sudden surge in available beds totals. Yet my continuing investigations have shown this to have slipped back since Christmas—and this would have been known to the trust’s representatives when they made their presentation to HOSC.”
Although my letter was published in at least three local papers, including the Southern Daily Echo, in which Dr Stevens had aired her views, as far as I can tell, she did not respond in any of them.
To deal with any suggestion that the trust’s new programme of intensive day therapies had been responsible for the temporary glut of beds in November and December, I asked senior trust members at a routine meeting on 3 February whether the new therapies and arrangements begun in 2011 were still in place. Dr Shanaya Rathod from the trust confirmed that they were. Therefore, the rapid decline in empty bed totals in January cannot be explained away by suggesting that the trust had stopped doing whatever it claimed was responsible for the temporary surge in beds during the last two months of 2011.
The second major factor that influenced the HOSC on 24 January was also set out in the minutes of the meeting:
“It was reported that the Centre for Mental Health had independently reviewed the evidence for the changes the trust was proposing and concluded they were necessary to meet the challenges the trust faced. The trust offered to provide the full report to HOSC members when available.”
On 27 January, I met the trust’s chief executive, Katrina Percy, and was given that document. In fact, it consisted of two separate reports. The first, from the Centre for Mental Health, supported what are termed recovery-oriented services, which the Government are rightly keen on, but did not analyse bed numbers. The second report was by Steve Appleton of Contact Consulting. Less than one page of his report dealt with Southern Health acute bed data, but every reference was footnoted to a single source, which was not attached—a third report called “Inpatient Capacity” drawn up by a third organisation, Consilium Strategy Consulting.
I recall the important debate secured by my hon. Friend the Member for Burton (Andrew Griffiths) on 19 December last year. With my hon. Friend the Member for South Derbyshire (Heather Wheeler), local consultants and the press, he had been battling similar techniques designed to justify closing acute beds at the Margaret Stanhope Centre in his constituency. Those techniques had also relied on an appeal to external authority and an “independent” report by Staffordshire university, which turned out to have been produced by someone on the payroll of the local trust.
Wondering whether something similar had happened in Hampshire, I contacted the Centre for Mental Health, formerly the Sainsbury Centre, which I knew enjoyed a deservedly high reputation. Its chief executive, Professor Sean Duggan, met me on 23 February, and later confirmed in a letter:
“The scope of the centre’s work did not include an examination of the number, type or location of beds that would be needed now or in future. A separate analysis, by Contact Consulting, looked at bed numbers...[The] Centre for Mental Health is an independent charity and as such we would not seek to endorse or condemn specific local decisions about reconfiguring inpatient mental health services.”
Yet, as we have already seen, the second report by Contact Consulting depended on a third report by Consilium Strategy Consulting that had not been made available.
I wrote to Katrina Percy on 28 February, pointing out that
“the so-called independent report that you handed me involved no examination primary source data whatsoever, but simply relied upon a third document—a report by Consilium—which it described as having been produced when the Trust ‘conducted its own benchmarking process’.”
I asked for a copy of the Consilium report; for a statement of the status of Consilium, in particular of how independent it is, if it all, from the trust; and for its contact details. Miss Percy replied on 9 March:
“I would just clarify that the content and status of the Consilium report, as mentioned in your letter to me, is commercially sensitive and is therefore not available to share publicly. However, should it be required, I would be pleased to provide you with the contact details of the consultant involved so that you may contact them directly.”
Despite two phone calls from my office to hers, and a further letter from me, the trust’s chief executive has yet to supply even the contact details of the Consilium consultant.
Although reluctant to reveal data that ought to be available, Southern Health resents criticism of its slippery methods. Yet how else can one describe the activities of an organisation that seeks to discredit, as it does, a public petition with more than 1,000 signatures against the closure of Woodhaven’s 24 acute beds by claiming that
“a number of people contacted the Trust and told us variously that they either did not know anything about the petition, could not recall signing the petition, suggested a friend or neighbour may have signed it on their behalf without their knowledge or consent… I am sure you would also acknowledge that the petition only has limited value in terms of a valid indicator of people’s views”?
If the trust had pointed out that I have some 70,000 adult constituents and that a petition, quickly compiled, represented only a fraction of them, that would have been fair enough. Sadly, it preferred to use a few anomalies to discount the views of 1,000 people and to cast doubt on the integrity of the petition’s organisers.
On Monday 5 March, the trust’s clinical director Lesley Stevens was interviewed for “South Today”, whose chief reporter—in fact, political editor—Peter Henley, challenged her claims about empty beds, given the figures in January’s bed status report. She insisted that there was no shortage of acute beds, yet the very next day the trust sent an e-mail to its consultants, stating:
“There are currently no unassigned acute beds in the Directorate. Can CRHT”—
the crisis resolution and home treatment teams—
“and the acute wards ensure that all clients are reviewed for leave or early discharge as a matter of urgency, please?”
I was also interviewed for the “South Today” report, which was broadcast on 13 March and said that that e-mail had given the game away completely. In-patients were already being reviewed for early discharge at a time when only 18 of the 58 beds scheduled for closure had actually gone. I said then, and I repeat now, that the trust’s policy of closing so many beds on the basis of bogus claims about surplus beds is inhumane.
As a result of the row over the January HOSC meeting, I was invited to take a deputation to the next one on 27 March. Although it was late in the day, a chance had been created to persuade the committee to at least pause the closure programme once the 34 beds at Antelope house and the Meadows had gone. We could then see whether the trust could cope with so many losses before starting to close the 24 Woodhaven beds as well. That had consistently been urged by Councillor Keith Mans, a governor of the trust and a former Member who was once a Parliamentary Private Secretary to a Secretary of State for Health. We believe that closures on this scale must be trialled properly and in stages before full implementation.
At the March meeting, I distributed tables showing how wrong it had been to claim that 20 to 30 beds were still empty when the January vote was held. I was given 10 minutes to state my case, which was a relief, because right up to the start of the meeting the chairman, Councillor Pat West, had told me that three out of the five of us would have to share 10 minutes between us. Mary Bryant, who was one of my deputations, spoke movingly of the burden on carers that the loss of the beds would impose; Councillor Sally Arnold gave the results of a survey of parish councils that had not been properly consulted; and Mrs Jane Barnicoat-Chongwe, a nurse practitioner on the acute ward at Woodhaven who had contacted me, expressed professional concern about the trust’s proposals. I put on the record now that at no time has she given me any data whatsoever or any documents from the trust.
Our fifth spokesman was Andrew Evans, a service user who for decades has relied on periodic admission to acute units. With extraordinary eloquence, Andrew explained not only the pressure on his parents, who are his carers, if he stays at home when in an acute crisis phase, but how the loss of the en-suite facilities at Woodhaven—remember that the unit is only eight years old—which are not available in some of the other units, will have a traumatic effect on in-patients’ dignity in future. The HOSC and the audience broke into spontaneous applause at the end of his presentation.
Thereafter, none of us could contribute further to the discussion, and I watched in frustration as Dr Stevens blandly maintained that the bed closures at Antelope house and the Meadows, which, of course, had only started after 24 January, had absorbed the 20 to 30 beds, which, in the face of all the evidence, she still claimed to have been empty up to that January meeting. She then mistook the e-mail of 6 March—which said that the system was full and that early discharges were needed, and which had been shown on the “South Today” programme—for another one, sent three days later. She explained how such communications were so normal and so routine that she would be concerned if she were not receiving them. I have since checked with sources at the trust, who have told me that no such e-mails had been sent for months before 6 March.
When questioned by HOSC member Councillor John Wall about the lumping together of male and female empty beds as if more than a fraction of them were interchangeable, Dr Stevens told the committee that a female could be allocated an empty male bed, for example, as long as “one-to-one observation” by a member of staff was maintained. So much for our long years of campaigning to eliminate mixed-sex wards in NHS hospitals.
Once the trust had finished its long presentation, the chairman put a motion to the vote that reflected the case made by Keith Mans and others, including me, that there should be a pause before the closure of the Woodhaven beds began, while an independent panel would seek to resolve the disputed figures about bed occupancy. To our delight, it was carried nem. con., at which point Dr Stevens interrupted the proceedings, which was out of order, because the trust’s presentation had ended. If there were any delays, she exclaimed, the Woodhaven staff would be so unsettled that many would leave, the unit would close and it would not reopen at all—even in its new role, I presume she meant. To my utter astonishment, the first vote was then ignored, as though it had never happened, and replaced by a much weaker proposal that a small panel of committee members and key stakeholders would examine the issues urgently and seek to resolve them without any delay to the closure of Woodhaven’s beds.
Given that the only reason any of this was happening was because of the data I had unearthed and my exclusion in January—remember that originally the matter was not supposed to have been considered again by the HOSC until July—hon. Members might think that I should be a part of the process if it is meant to be more than a charade. Not a bit of it. This little panel will go on its merry way looking at points previously raised in writing by me and others. If it cannot resolve any of those points, according to its terms of reference,
“this will be handled as a matter of urgency through the chairman communicating to the trust”
on behalf of the health overview and scrutiny committee. So our arguments and objections will be safe in the hands of Councillor Pat West and Katrina Percy, supported, no doubt, by the zealous Dr Stevens.
What then should Ministers do? At a meeting with Keith Mans and me on 26 March following an earlier exchange at Prime Minister’s questions, the Minister here today explained that Ministers cannot intervene to pause the process or have an audit carried out unless the HOSC refers the matter to the Secretary of State; but he did confirm that such a referral could still be made. Ministers’ hands are not completely tied, nor should they be given the deplorable tale I have set out today. If a Minister were to say that to restore a degree of public confidence he would welcome a referral to the Secretary of State, and if he were to invite and encourage such a referral to be made, it would be surprising if the committee rebuffed such an expression of concern. If he is unwilling to do so immediately—I quite understand if that is the case, although I would love it if he did—I expect Ministers to consider doing so later, when reflecting on my narrative.
It would be easy to summarise this story as that of a trust that could not be trusted with its own statistics and of a committee chairman who deceived an MP about a vital meeting. However, what it is really about is carers such as Mary Bryant, nurses such as Jane Barnicoat-Chongwe and, above all, service users such as Andrew Evans. It costs nothing to applaud such people, but applause will not help them. What they need is a Minister to grip this situation and send an unmistakable message to the scrutiny committee that he stands ready and willing to bring in the Independent Reconfiguration Panel on referral of the matter to the Secretary of State.
I pay tribute to my parliamentary neighbour and hon. Friend the Member for New Forest East (Dr Lewis), not only for the outstanding work he has done to highlight this important issue, which is of grave concern to his constituents and to many residents of southern Hampshire, but for his tireless work to analyse bed availability within the Southern Health trust area. From what he has told us this morning, there can be little doubt that the work done to analyse and challenge the statistics of bed usage, including the somewhat confusing question of what is an available bed and what is simply a leave bed, has taken a great deal of time.
What many of my constituents and other local residents want is to make sure that the outcome of the process is correct for local users of adult mental health services. As my hon. Friend has correctly indentified, this is not an argument about the philosophy of how best to care for those in need. There will always be a need for acute in-patient beds, although we certainly believe there is potential to improve arrangements and thus avoid in-patient admission for those who can be successfully and safely treated in the community. However, what has not been clarified throughout this process is the number of beds that there are in the system and the number of beds that are needed. My hon. Friend has certainly done sterling work over the past few months analysing bed usage, and I do not intend to repeat any of those statistics—we have heard in great detail what may or may not be available. Suffice it to say that, in the past six months, there have been many occasions when there have been no vacant beds across the service.
On top of that, there are many valid questions from service users in my constituency about the choices made about which beds should remain available in the locality. At the start of the year, I attended a meeting organised and hosted by my hon. Friend to learn more about the concerns of local service users and to hear at first hand how important the provision at Woodhaven is to local people, their families and their carers. Given the location of Woodhaven and the distribution of mental health beds across Hampshire, it is inevitable that this closure will impact on not only the constituents of my good Friend, but those of several Members across southern Hampshire. As my right hon. Friend the Member for New Forest West (Mr Swayne) has indicated, mental health problems are no respecter of, and trust boundaries are not contiguous with, constituency boundaries.
Of course, when discussing reconfiguration of health services, frequently the focus is on location, and service users will emphasise the distance of travel to get to a facility, the availability of public transport and how convenient it is for loved ones to come and visit. Interestingly, when discussing Woodhaven, that was not the message I received from service users or their families. Indeed, if we were to analyse the journey times and the ease of access, it is possible to argue that, for the vast majority of my constituents, Woodhaven is simply not as accessible as alternative provision at Melbury Lodge in Winchester. Woodhaven is a great deal further away for many people, and the public transport links are much poorer.
However, location has simply not been the focus for any of my constituents who have had experience of either Woodhaven or Melbury Lodge, or indeed both. Far from emphasising convenience, my constituents’ concern has been regarding the quality of provision. The questions they have posed have been eminently sensible. Why is it proposed to deprive acutely ill patients of the benefit of 24 modern en-suite beds that were opened only eight years ago? Why would the trust choose to keep the facility that is not as good, that does not afford the same level of privacy and dignity and that has no en-suite facilities at all? I would like to highlight the comments made to me by just two constituents who have contacted me. The first wrote:
“My wife has been an inpatient at both Woodhaven and Melbury Lodge. Melbury Lodge isn’t anywhere near the standard of Woodhaven. Woodhaven is very pleasant, with a lovely atmosphere. Melbury Lodge by comparison is very intimidating with a lock down high security approach. This may be appropriate for some of their patients but for the majority it’s just scary.”
The second constituent provided me with a very detailed account of his mental health issues, a suicide attempt in 2008, and his own stay at Woodhaven under section. He wrote:
“Having been an inpatient at Woodhaven I would emphasise the privacy. Having a breakdown surrounded by others who do not respect your privacy is very difficult. When I was in acute crisis I desperately needed short term care and support, it would be a disaster for local service users if those high quality short term beds were lost in favour of a less good facility, or worst case scenario, no bed at all.”
I pay tribute to one of my hon. Friend’s constituents, who made a lasting impression on me at the meeting mentioned earlier. He had been an in-patient under section at both Melbury Lodge and Woodhaven and, again, it was the privacy aspect he emphasised. While an in-patient at Woodhaven, he felt he had retained his dignity by being able to have his own bathroom. That clearly made an enormous difference to him personally, and I think we can safely draw the conclusion that a feeling of having some personal space and privacy can greatly improve the overall sense of well-being and aid the chances of a swifter recovery.
I have absolutely no doubt that the facility at Woodhaven is of an extremely high standard; we know that from the comments made by consultant psychiatrists. We know that the demand for short-term acute beds is high, and that one in four of the population suffers from some level of mental health problems at one time or other during their life. We also know that the NHS trust’s figures on bed usage and length of stay at the unit have been called into question. Is now the right time to press ahead with a closure, or is it timely to call a pause to the process until such time as the disputed statistics have been independently analysed?
I will speak briefly in support of my hon. Friend the Member for New Forest East (Dr Lewis). We have joined together on many occasions to campaign on the provision of acute mental health facilities, and today I shall express my concerns about how these processes are being undertaken by primary care trusts across the country. If anybody wants to see why the health care reforms that the Minister has fought so valiantly to introduce are needed, PCTs’ actions and decisions to close mental health facilities are the perfect example and demonstrate how they are out of touch, need reform and need to change.
Sadly, three weeks ago South Staffordshire PCT took the decision to close Margaret Stanhope Centre, a unit of 18 acute mental health beds in my constituency. It took that decision not only in the face of huge opposition from local people—8,200 people signed a petition as part of a campaign run by my local newspaper the Burton Mail and the Friends of Margaret Stanhope campaign group—but in the face of the evidence. I am a new Member of Parliament, elected for the first time at the last general election, and I had always assumed that such decisions were based on fact and on evidence—that the PCTs that took such important and often life-threatening decisions would be able to stand up to defend their decisions by proving their case. However, in the closure of the Margaret Stanhope Centre the PCT acted irresponsibly, recklessly and had no factual evidence to back up its decisions.
We conducted some research and found an Audit Commission report: 46 PCTs across the country had taken part in a benchmarking exercise, and the report showed that the average provision of acute mental health beds in those 46 PCTs was 27.5 beds per 100,000. In my trust, however, provision was 14.5 beds—almost half that average. The PCT then prayed in aid the following report, produced during the consultation process. It claimed that, miraculously, its provision had shot up to 31 per 100,000, and that there was nothing to fear.
I tried to get the facts. I tried to get the information. I asked and I asked and I asked for independent data. When the data came, they showed that the PCT had got its figure wrong: provision was not 31 beds per 100,000, but 22. However, when analysing the raw data, the PCT had included such things as mother and baby post-natal depression beds, beds for eating disorders, and drug and alcohol rehabilitation, so actually the figure for provision came out at 13.2. The PCT then prayed in aid an independent report that it had commissioned from Staffordshire university. We asked for that report. When we received it—it took two and a half months to come—we found that the person who had conducted the independent report, Dr Eleanor Bradley, was being paid not only by Staffordshire university, but by the NHS trust. The independent report that it claimed demonstrated how safe it was to close the Margaret Stanhope Centre was actually conducted by somebody on its payroll.
One claim made in the report was that the PCT had been able, through a pilot scheme, to reduce the in-patient stay by a third, but when we managed to drag the report out from the PCT, we discovered a number of things. First, we discovered that for stays in Margaret Stanhope of more than 91 days, it had managed to reduce average stays beyond 91 days by more than a third, from 39 days to 23—a reduction of 41%. However, the vast majority of admissions—88%—were between two and 90 days, and there the reduction was just 1.1%. The PCT claimed to have reduced in-patient stay by a third, but had actually reduced it by just 1.1%. I could go on about how flawed was the evidence used by my PCT to justify the closing of a much loved and much valued unit that serves the most vulnerable in my community. The process began some four years ago, so this is not a party political point, but a point about the actions of the PCT.
We met three weeks ago to discuss the passionate campaign for the continued existence of the unit. The process used to make that decision—
Order. May I draw the hon. Member’s attention to the fact that we are having a debate on the closure of acute adult mental health beds in Hampshire? I am sure that he is building his case from his experience, but it must be linked directly with the situation in Hampshire.
Forgive me, Dr McCrea. I will do exactly that and draw my speech to a close.
What I have seen is that the processes are flawed. What I have seen is that PCTs cannot be trusted to make the decision in Staffordshire and they cannot be trusted to make the decision in Hampshire. It is essential that we reassure the most vulnerable in our communities and in society. It is essential that the Minister understands their concerns properly and reassures himself that the decisions being made in Hampshire, and the decisions made in Staffordshire, are correct and are based on fact and evidence. I urge the Minister to train his laser-like vision on this important issue and to reassure himself, so that he, we and our constituents can be confident that mental health provision in Hampshire and in the rest of the country is not being jeopardised by false decisions made by people who are unaccountable, unelected and are not making those decisions in the best interests of our constituents.
I commend the hon. Member for New Forest East (Dr Lewis) for securing the debate. Health matters are devolved in Northern Ireland and I do not have a direct input into them, but I do have compassion for those who are less well off and that is why I am here as an MP. I want to try to change lives for the better. I recognise the issues that affect the hon. Gentleman’s constituency. He outlined clearly where the process works and where it has not worked, which is what we are debating today. As MPs, we look at the grand scheme of politics—we are all drawn to do that—but today I want to support the hon. Gentleman on the issue specific to his constituency and give an example from my area to illustrate the importance of acute mental bed provision.
As we all know, acute mental health bed provision is vital. Those who use it do so because they have to. The reason such provision is made is to ensure that they receive all the care they need in the best place for that care to be given. The hon. Gentleman outlined how and why the 56 acute mental health beds in his area were removed. That that should happen without full and open consultation with the MP who represents the area or with the many people who are affected greatly by the removal is nothing short of scandalous.
In my constituency, I am aware of the care that is needed for those with acute mental health problems. As you will know, Dr McCrea, the Bamford review raised awareness of mental health issues in Northern Ireland and the importance of having provision for them. It stated that nothing should happen until all the parts were in place, and that if something was to be removed there had to be something else there to take its place. The Bamford review was very important for Northern Ireland.
It has been suggested what the bed closures will mean. According to the background information, if someone is not in hospital, they will be at home. If so, has provision been made for them? The hon. Gentleman described how the system worked and how the consultation process did not involve everyone. Perhaps it did not look fully—it should have done—at how those at home, receiving care in the community, will be affected. Is that care of sufficient value and weight to fit the gap that has opened because of bed closures? I do not know whether it is or not, but back home, when there were changes, we also had to ensure that there was provision for care at home. That is important for those with acute mental health issues. I am not sure, from what I have heard so far, that that has been done in the case the hon. Gentleman has raised. I hope that the Minister can give us some idea of how that will work out.
The hon. Member for Romsey and Southampton North (Caroline Nokes) mentioned another problem. Sometimes, Members of Parliament think that they represent problems specific to their constituency, but they are not really, because all hon. Members represent people similarly and similar problems occur in Hampshire, Dorset, Scotland, Wales and in my constituency of Strangford in Northern Ireland. Last year, after changes were made, one of my constituents affected by mental health issues would have had to travel some 40 to 50 miles on a bus, because there was no car provision. To illustrate the point, we got on the bus and did the whole journey together, me and her, to the destination. There and back, the journey took seven hours and cost £39.40, not to mention the annoyance, hassle and problems that occurred. Whenever people talk about removing beds, they have to consider what happens outside that, including the effect on provision of care packages at home and on the families, and how they get from their home to the hospital whenever a person needs care. I am not sure that, when decisions are taken, people understand that families are also involved. It is not just about the person with the acute mental health problems, but about the families as well. When a stone is thrown into the water and it hits the centre, the ripples spread out: the centre is the person with the acute mental health needs, but the ripples spread out to the family, the community and everywhere else.
The hon. Member for New Forest East mentioned a petition with 1,000 names. I do not agree with Councillor Pat West, who commented that 1,000 names is only a small portion. A thousand names on a petition is a very great number and, I believe, represents a large part of the community.
For the sake of fairness, let me say that it was the chief executive of the NHS trust, Miss Percy, who sought to dismiss the petition in that way. The trust said that it had tried to validate it and said that a number of people professed not to know about having signed it. How big or small that number was, I have yet to discover.
I thank the hon. Gentleman. The name stands corrected in Hansard for us all, including me. I still say that 1,000 names can never be ignored. Ignore them at your peril, because those 1,000 people have families and so on, and the numbers are important.
The loss of beds puts pressure on a great many people. The hon. Member for Burton (Andrew Griffiths) spoke about the practicalities. It is important that we consider those, because before anything is done, people have to look at their effect further on. From what I have heard today, it is clear that this process has not been truthfully, honestly and fairly carried out.
To illustrate my point further and give examples, back home there has been pressure on mental health and acute mental health beds. I have pressed in this regard, as have other hon. Members—you have been involved as well, Dr McCrea, and the end result is a new 30-bed unit in Templepatrick, in your constituency. That is a £10 million to £15 million project undertaken in partnership with the health service, private enterprise and private monies as well. The unit is for acute mental health issues. I have become aware of some mental health issues over the years. People who have anorexia and bulimia have acute mental health issues to address; they feel that, no matter how thin they are, they are not thin enough. The 30-bed unit in your constituency, Dr McCrea, is there because of the vision of some of those in private enterprise, and individuals, who have worked with the Minister, Edwin Poots, to ensure provision.
I commend the hon. Member for New Forest East for bringing this matter to the House. Any closure or removal of mental health beds impacts not only on those who need them, but on families who have to live with their family members’ trauma and, wider afield, on the whole community, which also shoulders the burden. I look forward to the Minister’s response, which I am sure will be full and helpful. Again, I hope that we will get the answer that the hon. Member for New Forest East needs, confirming the retention of the beds, because that is the best way forward.
It is a pleasure to serve under your chairmanship as always, Dr McCrea, and to contribute to this important debate. I commend the hon. Member for New Forest East (Dr Lewis) for ensuring that this issue is raised in Parliament and for the comprehensive, forceful and eloquent case that he and his colleague, the hon. Member for Romsey and Southampton North (Caroline Nokes), made for protecting services in Hampshire. After contributions from his colleague from the not-quite-neighbouring county of Staffordshire, the hon. Member for Burton (Andrew Griffiths), and from Northern Ireland—the hon. Member for Strangford (Jim Shannon)—we are indeed a United Kingdom in making the case for adult acute mental health care beds.
Given the huge changes that are going on in the NHS, it is important that we do not forget those who are genuinely most in need. Mental health services and mental health provision have often been referred to as the Cinderella service. It is crucial that the provisions for those with mental health needs do not slip down the gaps in health care provision.
The hon. Member for New Forest East forcefully raised local concerns about the plans of the Southern Health NHS Foundation Trust, and he is right to do so. This debate is important, because statistically one in four of us will experience a mental health problem in our lifetime—an example of how we live our lives in the 21st century. Mental ill health will soon be the biggest burden on society, both economically and sociologically, costing some £105 billion a year. The World Health Organisation predicts that, by 2030, more people will be affected by depression than any other health problem.
The previous Labour Government made important progress on mental health, with the national service framework early on and the improving access to psychological therapies programme towards the end. But we must also look to the wider challenges of modern life. People are living longer, less stable, more stressful and isolated lives. It is clear that there is still a tendency not to talk openly about mental health. The stiff-upper-lip culture is ingrained in our society, at home, in our work places and, yes, even in Government and Parliament.
The challenges of 21st century living demand a rethink in our approach to mental health. We need to consider a number of issues. For people to get the support that they need from the NHS to live full and economically active lives, and if it is to be sustainable in the 21st century, mental health must move from the edges to the centre of the NHS. Also, we can no longer look at people’s physical health, social care and mental health as three separate systems. They must be part of one vision for a modern health care system. Changes in our public services will be successful only if matched by a wider change in attitudes towards mental health.
We need to pay attention to and look at the stigma surrounding mental health, because not only must people face the direct effects of depression but their problems can be compounded by the reactions of others. People do not feel able to admit to having a problem that could change their employment and prospects or lose them their friends. With most illnesses, people get a sympathetic shoulder to cry on, but with mental illness, they may get the cold shoulder. Even if people admit a problem, family and friends might not know how to advise them adequately. The public debate that has been so powerfully led by Stephen Fry, Frank Bruno and others is therefore tremendously important. It is essential that the excellent “Time to Change” campaign, led by Mind and Rethink and funded by the Department of Health, ultimately prevails.
The specific issue of today’s debate was put so eloquently by the hon. Member for New Forest East. I do not wish to stray into the politics of Hampshire’s health overview and scrutiny committee, nor into the internal politics of the local Conservative party—fun though that might be—but he made some important points. It would be helpful if the Minister clarified whether he has seen any meaningful assessment of how many mental health beds there should be in Hampshire. Of course, trusts all over the country have to make efficiency savings, but cutting front-line services and making efficiency savings are two very different things. So although I understand the need for referral from the health overview and scrutiny committee to the Minister, has he been able to analyse whether there is an adequate supply of beds for mental health patients throughout the county of Hampshire, particularly if required in an emergency admission? Is there adequate capacity? If so, has there been an assessment of future operations with the reduced beds available?
I ask those questions not least because the hon. Member for New Forest East made it clear that the statistics that he had obtained contradict the statistics that have been put forward by his local NHS trust and that are being used by the health overview and scrutiny committee. To move forward, we need certainty, clarity and confidence in those statistics, so that decisions made locally are based on sound statistics. We will see more instances of trusts forced to make difficult decisions. Indeed, we have heard what is happening in other parts of the country today. Such decisions will undoubtedly have real consequences for the care received by patients, not least because of the combined effect of the Nicholson challenge, set in train by the previous Government, and the huge top-down reorganisation pushed through by this Government under the Health and Social Care Act 2012.
Finally, mental health is an equality issue, and social progress in the 21st century depends on us waking up to that fact. Children from the poorest 20% of households are at a threefold greater risk of mental health problems than children from the most affluent 20% of households. We will only have a fairer and more equal society in this century if we work to change attitudes to mental health and to look at a whole-person approach to health care, so that the problems that we might all face at some point in our lives do not stop us from reaching our potential. Again, I commend the hon. Gentleman for putting his case for mental health in Hampshire so forcefully. I, too, look forward to the Minister’s response.
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.
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.
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.
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.
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.
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.
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.
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”
“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.
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.