Motion made, and Question proposed, That this House do now adjourn.—(George Hollingbery.)
I am grateful to have the opportunity of this debate on this very serious subject. I am pleased to be joined by my hon. Friend the Member for Hornsey and Wood Green (Catherine West), who stands with me on this debate and also wants to speak about our mental health services in Haringey.
Let me state from the outset that I have the utmost respect for and gratitude towards all the staff working within Barnet, Enfield and Haringey Mental Health NHS Trust, who tirelessly care for some of the most vulnerable members of our community. Not least among those is the trust’s chief executive, Maria Kane, who has been recognised by the Health Service Journal as a top NHS chief executive who was shown to be doing a stellar job in the recent BBC “Panorama” film, “Britain’s Mental Health Crisis”. They have all been asked to do, frankly, an impossible job in the constituency and in the London borough of Haringey, which has 12 of the most deprived wards in the country where 2,284 people are receiving personal independence payments, over 270 different languages are spoken, 1,334 people have had their benefits sanctioned, and 826 households have found themselves homeless in the past year. Social tensions are high, funds are tight, and there is an ever-increasing need for urgent help, from mental health services for children and young people to dementia services for the old.
I bring this debate to the House today because it is unacceptable that, despite the fact that mental health problems cost the economy £100 billion per year, three out of every four people with mental health problems in England receive little or no help for their condition. I suspect that that figure is far higher in my constituency, given the high level of need. Today in this country mental health problems are not just some form of rare disease. The truth is that one in every four people will suffer from mental health problems during the course of this year.
For the most greatly affected, mental health problems are fatal. It simply cannot be right that in our country in 2016 those who suffer from the most severe mental illnesses die, on average, 15 to 20 years earlier than the general population. I have already brought to the attention of this House the fact that, on average, an adult male in my constituency can expect to live to just under 75 years of age. It is a sobering picture, then, that the average age of a male suffering from a severe mental health problem in my constituency may be under 55. But premature death is not the only complication for my constituents suffering from mental health problems. The Mental Health Taskforce commissioned by NHS England in February this year found that men of African and Caribbean heritage are up to 6.6 times more likely to be admitted as in-patients or detained under the Mental Health Act 1983, indicating a systemic failure to provide effective crisis care for these groups. The taskforce’s draft report also revealed that men from these groups are, on average, detained for five times longer.
As mental health problems affect so many lives, 23% of the UK’s burden of disease is mental health. That figure is higher than the burden of disease in cancer or in cardiovascular disease, which stands at 16.2%. Why then do mental health services receive only 11% of the NHS’s budget? It is clear that institutional bias against providing proper care for people suffering from mental health problems persists in 2016.
It was as far back as February 2011 that the coalition Government published their strategy for improving the nation’s mental health, which stated the now much-trumpeted concept of parity of esteem—an idea that began with a Lords amendment from Labour peers in the other place. Then, the very first section of the coalition Government’s infamous Health and Social Care Act 2012, which contained the central duty imposed on the Secretary of State in relation to our treasured national health service, was amended to put these services on an apparently equal footing. However, the reality already facing mental health patients across the country in 2014 was something different: mental health funding was cut for the first time in 10 years, and there were fewer services for children and young people, fewer beds, and more people on acute psychiatric wards.
Many other strategies and documents were published, promising an improvement in services and repeating the mantra of parity of esteem, until the Prime Minister himself returned to the issue at the beginning of the year and finally announced some funding. However, given that the budget had previously been cut, I find it difficult to see how it was a net increase, not least given the pressures of an ageing population. The Prime Minister announced that those particular funds would be targeted towards helping new and expectant mothers with poor mental health and towards liaison between mental health services, A&E departments and crisis teams, but that is not what I am seeing on the ground.
As demonstrated so vividly in BBC’s “Panorama”, the truth on the ground could not be more different. Far from the level of funding being equal between physical and mental health services, or the gap decreasing, mental health hospitals have had far deeper cuts imposed on them. The reality is that 3,000 mental health beds have been cut across the country in the past five to six years.
However bleak the national picture, it does not get anywhere close to the gaping holes in funding for mental health services that face the patients of Barnet, Enfield and Haringey Mental Health NHS Trust. Despite the obvious and ever-increasing need, that trust, on top of the vast inequality between physical and mental health services, receives a lower share of income proportionately than any other mental health provider in London. It is hard to understand how an area that includes Tottenham gets the lowest level of funding in London.
The trust has already done so much cost-cutting over the years that it is the most efficient NHS mental health provider in London. It already has the lowest number of acute mental health in-patient beds in London and higher productivity than other providers. It has also been proven to be underfunded over the course of not one or two, but three independent reports. The first of those reports was back in early 2014, the second in late 2014, and the third in October 2015. The independent evidence is that the trust needs £4 million a year, but it has not received a penny extra in funds, and no firm plan has been established to address the funding gap, which means that the trust now anticipates a deficit of £12.9 million in 2016-17.
The reality locally is that St Ann’s hospital in my constituency has lost a third of its beds in the past eight years alone, and this is a hospital that is obliged under section 136 of the Mental Health Act 1983 to find a bed for every patient detained under that section because they pose a risk to their own life or to the lives of others. We are not talking about varicose veins or wisdom teeth; losing beds in these circumstances has a dire impact.
My hon. Friend the Member for Hornsey and Wood Green will be aware of a recent case in the constituency. A young man whom I have known all his life attempted suicide and it has had a life-changing physical effect on his body. My hon. Friend might say a little more about that case, but it happened directly because there was no bed for him.
St Ann’s hospital is constantly running at over 100% capacity, while other mental health providers in London run at 85% to 90%. With each new admission, St Ann’s wards each have to nominate their “least ill patients” for discharge back into the community. Despite the efforts of staff, does that really present a safe outcome for those vulnerable patients and their families? Is that really a safe outcome for the community that requires the trust to serve it as best it can?
The shortfall in income is not the only problem the trust faces. Far from the Government’s rhetoric of parity of esteem, the truth in Haringey is that patients are condemned to treatment in a hospital that was designed to meet the needs of 19th-century fever patients, long before the discovery of antibiotics, rather than the delivery of therapeutic interventions appropriate to current patients’ needs.
Indeed, the most recent Care Quality Commission inspection found that
“the physical environment of the three inpatient…wards”
on the St Ann’s site was
“not fit for purpose due to its age and layout. This impacts on the trusts ability to deliver safe services within this environment.”
That is a problem that the site has tried to resolve on the 28-acre St Ann’s site over the last decade.
Finally, the trust submitted plans to develop the site last year. It hopes to fund a new hospital and other health services on one third of the site by building homes on the remaining land. I have to say that I oppose those proposals, because they include only 14% affordable housing, even though London has a housing crisis. Despite my objections, the trust was granted planning permission in March last year.
There is an alternative proposal—it is a great proposal, which needs support—to build a community land trust. That is exactly what successive Mayors of London have said they want to see. It would result in affordable homes being built on the site, it would be holistic and it would fit with the mental health plan. I hope that the Minister might take an interest in it and that the next Mayor of London, whoever that is, will also take an interest.
The trust’s plan would not require any capital from NHS England. I have to ask why, on this site and in this constituency, and given the circumstances in which the trust finds itself, no capital is forthcoming from NHS England. It seems that the decision about whether to build a new hospital has, once again, been pushed by the Government into the long grass, and we have been given no date at all.
This debate about mental health comes on the back of a debate that I secured about the situation of primary care in the borough. I have raised both those subjects because I am seriously worried about health in the London borough of Haringey and in my constituency. Despite myriad problems, only 16 months ago the independent Carnell Farrar review of the affordability of mental health services provided by the trust found that there was no compelling evidence to support merging the trust with any other organisation; that the trust is relatively efficient; and that there is a clear case for clinical commissioning groups to invest in it.
I had hoped that that would mark the end of the speculation about the trust’s future, but the CQC report, published in March this year, of the routine inspection conducted in December 2015 gave the trust an overall rating of “requires improvement”. It is no surprise to me that that is the case, despite the efforts of staff and leadership, when funding is so tight and the level of need is so high. The CQC report stated that out of 11 areas, five required improvement, five were good and one was outstanding.
The report concluded that mental health admission wards for adults required improvement, community-based mental health services required improvement, child and adolescent mental health required improvement, specialist community health services for children and young people required improvement and crisis mental health, including home treatment teams, required improvement. Many detailed recommendations have been made by the CQC to improve services, but no extra money has been put on the table to enable the trust to comply.
I am grateful to the Minister for last week agreeing to my November request for a cross-party delegation of local MPs to come and discuss our concerns about the trust. Let me put on record what I call on him to do to help the trust, to ensure that the services that it provides are safe and that work begins to ensure true equality between physical and mental health services in Haringey. The context is important, not just because of the suicide rate in England—the number of suicides recently soared to 4,881 in 2014—but, most disturbingly, because the draft version of that report stated that had just £10 million extra been spent on services for people who were suicidal, 400 extra lives would have been saved. For the sake of £25,000, which is less than the national average salary, each of those lives could have been saved.
I call on the Minister urgently to look at the plans for the redevelopment of the St Ann’s site. I understand that the north London estates plan will be finalised by the end of June, and I seek an assurance that a decision, including consideration of the community land trust’s proposal, will now be made. I ask the Minister to visit the St Ann’s site to see the problems for himself, and I ask him to earmark appropriate funding for the crisis team and children’s mental health services.
I must warn the Minister that we have seen some terrible cases in my constituency. A young boy was injured and died outside his secondary school as he left with three friends. Police officers were assaulted with a machete. We have seen suicide and attempted suicide, with catastrophic consequences, in the recent past. I trust the Minister will ensure that the trust receives the funding it needs, and that he will recognise the CQC recommendations. By having this debate, I am putting him on notice of the real concerns about the development of the St Ann’s site and the real need to bear down on the pressures that the trust is under, in this pretty tough part of north London.
I want to thank the Minister, who has had a busy afternoon, for his excellent winding-up speech on autism. I congratulate my right hon. Friend the Member for Tottenham (Mr Lammy) on the long-term interest he has had in mental health and on the way in which he has championed the issue.
Since I was elected nearly 12 months ago—it will be 12 months next week—my office has seen more than 40 individuals whose mental health problems are so serious that I would say that they, and indeed others around them, are at serious risk. Since last May, the number of mental health cases coming in to my surgery has increased, which is a real concern of mine.
I have three questions for the Minister. First, are the Government monitoring the suicide risk of those facing homelessness? Secondly, is the number of housing related suicides being recorded and documented during the inquest process? Thirdly, what support are the Government giving to local councils to ensure that vulnerable adults with complex mental health difficulties do not face street homelessness?
I just want to mention two cases. The first is that of a soldier in the Army—he was in the light infantry—who did five tours in Northern Ireland and served in Bosnia. He suffered from post-traumatic stress disorder, but on the same day that he was issued with a section 21 notice he attempted to take his own life. Luckily, he was unsuccessful. He wrote to me that
“facing homelessness was the catalyst to me taking the action that I did”.
The second case concerns a young woman constituent who was victim of child sexual abuse. She suffers from a dissociative disorder, and has spent three years battling the CCG to get the therapy that she needs to handle her complex mental health problems. Her battle continues, and she is still without the support that she desperately needs to deal with the trauma of her past.
Mr Deputy Speaker, you will be very impressed to know that the community is working very hard on this problem. That involves not only me, my right hon. Friend and local councillors, but Mind in Haringey and an individual by the name of David Mosse, who leads on the suicide prevention plan for Haringey. As I am sure the Minister knows, not one borough in London yet has a comprehensive suicide prevention plan that challenges all the agencies to take responsibility for trying to prevent suicide. As we speak, David, as a concerned resident, is leading a session to try to secure best practice in Haringey by bringing all the agencies together to prevent suicide. That is a very exciting development. I just wish we could match at the statutory level what the community, Mind, the suicide prevention team, parents and carers are doing.
A charter for better mental health services has been developed locally with some wonderful family carers and service users. Their demands are very clear, and I will send the Minister a copy of their charter. They want community mental health teams to be less overstretched, and they want effective early intervention. They recognise the desperate shortage of acute psychiatric beds—capacity is frequently 128%, which is overcapacity—and they basically want enough hospital beds to be available locally. As my right hon. Friend has said, we believe in community approaches to sorting out mental health problems, but we all accept that there are times when, even with the best will in the world, people need to be hospitalised for certain treatments. The idea of switching things into the community is laudable, but we need beds for the moments when acute care is necessary.
Another demand is for the crisis response service to be more fit for purpose, with an effective and accountable emergency crisis response. In the case mentioned by my right hon. Friend, the young man attempted to take his own life because of the domino effect: it was the emergency crisis response not being adequate, the ambulance service not being adequate and the fact that no bed was available that led to his attempt on his life.
Finally, the last three issues on the charter are that the route into admissions needs to be clearer for patients and carers, that there is a lack of suitable housing for vulnerable people after they have been in hospital and that carers feel that they are not listened to.
Will the Minister touch on preventing suicide through better homelessness options? Unfortunately, the moment when certain individuals receive their section 21 notice from a housing provider, meaning that they are going to be made homeless, often coincides with an attempt at suicide. I have quoted the cases of a man and a women from my constituency who have each been affected, but we know that, sadly, suicide is the biggest killer of men under the age of 45, across the country. That is a very sad note to end on, but I look forward to the Minister’s response.
I begin by congratulating the right hon. Member for Tottenham (Mr Lammy) on securing this debate on an issue that I know is important to him and his constituents. I thank him for his courtesy in letting us see a copy of his speech; that was much appreciated. I also thank the hon. Member for Hornsey and Wood Green (Catherine West) for raising the issues that she did.
I have to say that I have a soft spot for Haringey. Shortly before I first came to Parliament, 33 years ago, I was in the Hornsey and Wood Green Young Conservatives, and was a councillor in the London borough of Haringey, which taught me a great deal about the issues faced by an outer London borough with inner London problems. I still very much remember that time and the work that was done by very good councillors who were trying to do their best in that area.
My speech will necessarily be short, but I say right at the beginning that I share the concerns expressed by both colleagues. I will ensure that the meeting that the right hon. Gentleman was looking for takes place. He raised a number of detailed current issues in Haringey, which really need the specialist advice of those involved in the NHS and the clinical commissioning group. Unfortunately, it has not been possible for them to find time to speak to me in the last couple of days before this debate—I appreciate that it has been a very busy time in the NHS—but I know that they will find time, at the senior level, to meet him, me and others at Richmond House, at a time that we will put together as soon as we can. That will enable us to go into rather more detail on some of the issues that I simply will not be able to touch on today.
I share the right hon. Gentleman’s passion, which he illustrated very well in his speech, about these important issues. Some raise national issues; I will touch on those briefly, as they are important. I can understand his frustration about hearing comments made from a Dispatch Box about national amounts of money and then seeing what happens locally. I have got used to going round the country, talking about what successive Governments—in particular, the coalition Government and ourselves—have done and how there has been an increase in investment, and hearing people say, “Well, not round here, there hasn’t.” That is a very real issue: we must make sure that what we commit to flows through to the local NHS and CCGs. We are on to that in terms of monitoring and transparency, and can discuss it further when we meet.
I am very proud of what we are currently doing on mental health. We are investing unprecedented amounts, with spending expected to increase to £11.7 billion. CCGs are required to continue increasing their spend on mental health each year, and we are watching them. We have committed to investing £1.4 billion on children and young people’s mental health, and eating disorders. That will be spent by the end of this Parliament. The Prime Minister has said that an additional £1 billion will be spent to improve perinatal health, mental health liaison and 24/7 crisis care; I am grateful for the welcome that the right hon. Gentleman gave to that. Mental health really is a priority for all of us.
We have had the conclusions of the Mental Health Taskforce. The Department has accepted the recommendations directed at ourselves, as has the NHS. I am making sure that there is transparent delivery, and there will be constant reference back to the recommendations, so that people will be able to see what is actually being done, in order to counter the scepticism.
As for what the hon. Lady said, first, the issue of suicide is extremely important. I have asked for local suicide prevention plans to be revamped. We have a national suicide prevention strategy, but we do not have local suicide prevention plans in every area. That will change. She is right to talk about the link with homelessness. We need to do much more, and I am grateful to Samaritans, Cruse and all those in our national health service and other agencies who work hard on this issue. Crisis care concordats are in place everywhere—that was one success from the time of the right hon. Member for North Norfolk (Norman Lamb)—and they have placed a renewed focus on crisis and suicide prevention. I am glad that the hon. Lady mentioned carers because they are also important. Indeed, she could hold an entirely separate debate on those three issues, and I urge her to secure one so that we can discuss them.
In Haringey we introduced the first waiting time standards for mental health, starting with psychological therapies this year. Barnet, Enfield and Haringey Mental Health NHS Trust exceeded the standards for improving access to psychological therapies, with 90% of patients treated within six weeks of referral, and 99% within 18 weeks. In February 57% of patients referred for early intervention psychosis received treatment within two weeks, which exceeded the minimum standard set at 50%. This is not as simple as pulling a lever because capacity must be built up over time—that is something we should discuss. I, too, watched the “Panorama” programme, and the Haringey example well illustrated the national pressures.
One of the three priorities in Haringey clinical commissioning group’s health and wellbeing strategy 2015 to 2018 is improving mental health and wellbeing. In Haringey an estimated 3,000 children and young people have some kind of mental health problem at any time, and more than 34,500 adults have a common mental disorder such as anxiety or depression. About 4,000 adults with a severe mental illness live in Haringey.
Over the next three years the CCG aims to ensure that people living with mental illness experience a more seamless service from hospital to GP. It intends to strengthen support for people to manage their mental ill health in primary and community care settings. Just over £34 million funding has been awarded to mental health services in Haringey—an increase of 9% since 2013-14. Of that, £31 million is for Barnet Enfield and Haringey Mental Health NHS Trust. In 2013 to 2014, compared with 11 other CCGs in north and central London, Haringey spent the fifth highest proportion of its budget on mental health.
The right hon. Gentleman mentioned St Ann’s and in-patient mental health beds have reduced there, as they have over the whole country in line with national policy. That has taken place as more appropriate alternatives have been developed in the community, and the trust has used a number of private bed placements owing to capacity constraints. The trust is also operating at extremely high levels of bed occupancy, and it is working with the CCG to reduce that. There will be a new development at St Ann’s hospital, for which an outline planning application was given in March 2015. NHS Improvement is working with the trust and its partners to develop a strategy for mental health estates across the sector, and we can discuss that in more detail.
I do not wish to conclude without mentioning equality and diversity. We know that different ethnic groups have different rates and experiences of mental health problems. Black people across Barnet, Enfield and Haringey were the subject of four times as many applications to be detained under section 2 of the Mental Health Act in 2014-15 as they constituted a proportion of the population at the 2011 census. The trust’s rate is broadly in line with national data and reflects a wider challenge that is the subject of extensive national research and action.
Our commitment to tackling inequalities in access to mental health services is set out in the mental health action plan “Closing the Gap”, published in January 2014, and the mental health taskforce made that a central issue in its recommendations. This week I met a group to discuss issues of equality and diversity in mental health. It was the first meeting that I have had on the back of the mental health taskforce, illustrating the priority that I attach to the issue, and we are working up some proposals for that. Along with our commitment to the other recommendations, the right hon. Gentleman will not find us lacking in commitment to deal with this issue, and I know how important it is. We also want to ensure that BME communities have access to more important psychological therapies, and we are working with the sector to find out why they have had less access to them, and what we can do to change that.
We have heard about the challenges facing mental health services in Haringey. The Government are committed to transforming mental health, and ensuring that patients receive the best treatment. I mentioned our initiatives at local level, and it is clear that Haringey is working hard to address those challenges, but there are many. Therefore, when we get together with a group of MPs and senior representatives of the NHS and trusts, we will discuss this matter with a little more time and detail. I look forward to that meeting, and will do my best to help the right hon. Gentleman and the hon. Lady in their quest to support their constituents still further.
Question put and agreed to.