§ Mr. Mark Wolfson (Sevenoaks)
I am pleased to have the opportunity to raise the issue of the work of the Broomhills psychotherapy unit at Bexley hospital with the House and with my hon. Friend the Under-Secretary of State for Health. I had experience of his competence, concern and judgment when I was a Parliamentary Private Secretary at the Ministry of Defence. I congratulate him on his new appointment and I wish him well in his key role.
The Broomhills unit is not in my constituency, nor is it within either of the health districts that cover the Sevenoaks constituency. My particular interest in its work arises because my wife, who has spent 30 years as a psychiatric social worker, is attached to Broomhills as the unit's social worker employed by Bexley council.
Having declared that interest, it should not, I hope, be held against my arguments, but rather viewed as one of the many ways in which hon. Members become interested, involved and knowledgeable about so many aspects of life in Britain.
Broomhills lies within the constituency of my hon. Friend the Member for Dartford (Mr. Dunn), and friend he is. We nursed our respective seats together and entered the House together. We continue to work together on much common ground. The future of Broomhill is one example. He has asked me to say that he fully supports the points that I shall make today and I confirm that he has already been active in pursuing the objectives that I shall outline.
Broomhills is a therapeutic community, managed by Bexley health authority in the grounds of Bexley hospital on the border of greater London and Kent. It is located in the old medical superintendent's house on the perimeter of the hospital's grounds and has its own entrance. It provides facilities for up to 18 patients who stay at the unit from Monday to Friday, returning home at weekends.
Broomhills aims to help severely disturbed people to understand their problems and find more healthy and adaptive ways of dealing with their lives and relationships. Treatment is primarily, but not exclusively, psychodynamic. It takes place daily in community meetings, group psychotherapy, art therapy and individual sessions facilitated by appropriate members of the multidisciplinary staff team.
As a therapeutic community, the treatment concentrates not only on work in groups but on the aspects of daily life which offer opportunities for social learning. That form of treatment avoids the use of medicinal drugs. All the domestic work—shopping, cooking and cleaning—is carried out by the patients. There are no domestic staff, which keeps costs down and prepares people for a full return to the community.
Broomhills' staff work with a broad range of patients, including those suffering from various neurotic disorders, personality disorders, and what may be termed borderline psychoses. Typically, most patients referred to Broomhills have a long-standing psychiatric history that may include contact with general acute services through episodes of overdosing and self-mutilation.
The key point I make is that the object of this therapeutic community is to break the revolving door 625 syndrome of more traditional interventions, so that readmission is rare and minimal psychiatric follow-up is needed. The success of that approach is shown by the fact that, over the past five years, eight out of 10 patients attending Broomhills have not required readmission or psychiatric aftercare.
I turn to the experiences and views of some of the patients themselves. I hope that my hon. Friend will find them interesting and worthwhile. All the Government's efforts at improving the Health Service are surely designed to improve delivery of services to the patients themselves. Therefore, I believe that the patients and their families should speak for themselves in the House today.
One former patient writes:Before arriving at Broomhills I had already been a patient in two hospitals. My treatment was ECT and tranquillisers. In the short term my treatment was successful. But as time passed on I was still unable to cope with my life. I feel that Broomhills worked because it was more of a common endeavour, therefore allowing patients to exhibit odd behaviour. I know by my experiences in an ordinary ward I would probably have received more pills for odd behaviour. But instead, with warmth and acceptance, I was able to release and work through difficult feelings. This was an extremely important part of my recovery. My quality of life is now far richer and I am able to live it less painfully. In fact, I can now move on to help others as a social work assistant. I know that if I had not had the chance to experience Broomhills, I would still be unable to cope with my life and still be dependent on the National Health Service. I feel privileged to have spent a year of my life in a place which holds so much warmth and commitment and in particular dedication from the staff. Broomhills is a valuable place.Another former patient's mother writes:I am Anne's mother and I am writing on her behalf because she no longer lives here—in fact, she married a steady, reliable young man in July last year and they are buying a house … something I would have thought impossible at the time she came to you. It would appear that your help at that troubled period of Anne's life has contributed greatly to this change in her attitude of life.Another former patient who is now a solicitor writes:I have personal knowledge of the value of the unit, having been a patient there for approximately 20 months two years ago. My stay at Broomhills provided me with, I believe, a very necessary respite … Since leaving Broomhills, I have started my own solicitors' practice, and also do some locum work. I have, amongst other things, learnt to drive. Quite to my surprise, I discovered an ability to design, make and sell … ceramic figurines. Having recommenced playing chess at Broomhills (after a gap of many years) … I have found that I am a fairly strong club player. Finally, I now do a significant amount of both paid and voluntary work for The Project for the Mentally Handicapped in Camberwell Road and at an ILEA youth club 'Fast Forward' in Peckham, both concerned with handicapped children and young adults. Broomhills was valuable to me in many ways. It provided me with a place where I could belong—it is not too strong to say it was, for me, a home in the best sense of the word—at a time when I felt desolate. That is not to say that it was easy to stay at Broomhills or that it was some sort of soft option—quite the reverse. Broomhills was for me a highly stressful place to be at, both because of the many, varied, and often conflicting personalities there, and because of the daily group and other work. On the other hand, since it was opened only during weekdays, and we patients went home from Friday afternoon until Monday morning, contact was not lost with life in 'the real world'. Indeed, such contact was encouraged … Broomhills is, after all, very much the sort of comunity orientated service that is apparently, as it should be, encouraged by the government.Those letters speak for themselves. They make our case for us.
Broomhills also provides a valued and well-used training resource. Student and pupil nurses are regularly 626 attached to the unit, and staff from other professional disciplines and agencies attend as part of their specialist training.
Hon. Members will have noted that the patient in my last example said that it was not easy to stay at Broomhills —that it was no soft option. Assuredly it is not. The assessment process is a very careful one, and is followed by a two-week trial period during which the patient stays at the unit. Commitment to use, to contribute to and abide by the rules of the community are absolute requirements for patients. Group pressure, guided and controlled by the staff with warmth and dedication, is the key factor in achieving long-term progress, and giving patients the ability to return to an active life in their communities is the end product.
What, then, is the present difficulty? Until now, Bexley has been the management organisation running Broomhills, and it continues to do so. Patients have been referred to it from Bexley, Greenwich and Lewisham, but Greenwich and Lewisham are now likely to withdraw their funding owing to financial constraints. For one district health authority to continue to fund a centre for 18 patients in such a specialist area would not continue to make sense. We now need to market the Broomhills unit. It is a very cost-effective service: a charge of £8,000 per patient for a treatment programme lasting approximately a year is astonishingly cheap compared with other similar units in other parts of the country, of which there are relatively few.
The staff of the unit, supported by Bexley health authority, have taken action to make the unit's work more widely known. My debate is part of that effort, and I hope that my hon. Friend the Minister will be able to set this type of work within the context of the Government's policy of care in the community for the mentally ill. Broomhills seems to me an ideally suited staging post; surely it must have an enlarging rather than a diminishing role.
So many times in recent months we have debated changes in arrangements—for tests on teeth and eyes, family allowances or social security benefits—and I have supported the Government. Those changes have been designed to ensure that those in the most need are given support and provided with effective treatment. Improved National Health Service structures and pressure to improve management effectiveness have all been designed as part of Government policy to target funds on those who need them most.
May I summarise the key factors that make the Broomhills unit unusual and say why it should become a facility that is supported by and made available to health authorities and their patients throughout the south-east region and other parts of London. A patient goes all the way from the midlands to Broomhills on a weekly basis. That is possible because a weekly residential system is used. It is a rare residential facility for emotionally damaged people. It falls outside the mainstream of the normal treatment for mental illness. These people suffer from severe depression, crippling anxiety states, suicide attempts, self-mutilation and neurosis. The five-day week discourages institutionalism, maintains contact with families and the community and is part of community care. Patients learn to understand their deep-seated problems through group work and through the rest of the programme. Drugs are not used—a great financial saving, as well as avoiding the problems of addiction that occur in 627 other people who are undergoing long-term drug therapy. I have already said that readmission is rare, either to Broomhills or to other psychiatric units. Patients learn to live together and run the unit completely for themselves. Surely that is good and sensible practice. It leads to their return to the community and, as I have been able to read out with some excitement today, to a return to valued work by many ex-patients. Again I emphasise that it is a very low-cost unit.
The staffing levels, because of the involvement of patients and because treatment does not have to be provided on a one-to-one basis, are low and help to keep costs down. The training facility, too, is important. It is used for training nurses and social workers and for training art therapists, psychologists and psychotherapists.
After leaving Broomhills, patients often return to their old jobs, or find new ones. Some seek retraining through disablement resettlement officers and the resettlement training schemes. Others return to interrupted university or college studies, while others have started GCSE courses as adult entrants so that they may qualify for places later in polytechnics. There are a few similar facilities in the London area—at Henderson hospital, the Cassel hospital, the Ingham centre and to some extent the Maudsley hospital, but Broomhills has its own contribution to make. It is a uniquely useful contribution that should be made more widely available and that should not run the risk of closure.
§ The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)
I thank my hon. Friend the Member for Sevenoaks (Mr. Wolfson) for his kind words on my new appointment. I look forward to being closely involved with the challenges facing the Health Service at the national level, but I am also well aware that, locally, plans for the delivery of services can be very sensitive. That is shown by, among other things, the large number of debates on local health issues. I think that I shall be a frequent visitor to the Dispatch Box. I think that this week I have already appeared at the Dispatch Box more often than I did during the months that I spent as a Ministry of Defence Minister.
I congratulate my hon. Friend the Member for Sevenoaks on securing this Adjournment debate. I know that he is very assiduous in pursuing the interests of his constituents in local health matters in debates and in correspondence with my ministerial colleagues. I quite understand that he is raising not simply a constituency matter, but a much wider regional issue. They are very important matters and I am pleased that he has had the opportunity to raise them. It must surely be a mark of a civilised society, with all the pressures and strains on our citizens, that we are able properly to deal with those with mental illness and to return them to the community to play an active role, if that is possible. The National Health Service has a very important part to play in that process.
The work of the Broomhills unit and its future have been brought to Ministers' attention not only by my hon. Friend, but during the past few months by correspondence from my hon. Friend the Member for Dartford (Mr. Dunn) in whose constituency the unit lies, my right hon. 628 Friend the Member for Old Bexley and Sidcup (Mr. Heath), my hon. Friend the Member for Erith and Crayford (Mr. Evennett) and the hon. Member for Greenwich (Mrs. Barnes). I have received correspondence from those right hon. and hon. Members recently, and following this Adjournment debate I shall be writing to them more fully.
It might be helpful if I first say something about policy on the planning of psychotherapy services. Psychotherapy services can range from any form of psychological treatment without drugs to very specialised treatment such as that being provided at Broomhills. Most psychotherapy treatment is provided not by designated psychotherapists but by various mental health professionals as part of their general work. In those circumstances, it would not be appropriate for the Department of Health to prescribe a particular organisation of psychotherapy services. I know that my hon. Friend agrees with that. It is a matter for clinical judgment, not ministerial directive, as to how mentally ill patients should be treated. It is up to individual district health authorities to develop their own models of how patients should be treated and make available the necessary resources. I strongly agree with my hon. Friend about emphasising the importance of the patient. The patient must come first. In this case we are dealing with mentally ill patients, a very important part of the wide spectrum of patients treated by the National Health Service which should always be orientated towards patient care. The patient is first and last on our list of priorities.
I repeat that it must be for individual health authorities to develop their own model of service, taking into account the local demand and the resources available. The major need for psychotherapy comes from those who are best treated on a day case or out-patient basis, although a very small number need in-patient psychotherapy treatment. The trend in local provision of services therefore appears to be away from in-patient treatment to community provision on a district basis. I understand that the Royal College of Psychiatrists has been developing a document recommending a full district-based psychotherapy service.
The work of the Broomhills unit, which my hon. Friend has described so well, has to be considered within that context. As my hon. Friend has explained, the future of the unit is jeopardised by the fact that Greenwich health authority and Lewisham and North Southwark health authority have decided to develop their own psychotherapy services. I do not criticise those health authorities for doing that. They are following the trend which I have explained. Greenwich, which has been the main user of the unit, referring about seven to 10 patients per year, is developing community-based services for mentally ill people based on new mental health centres, which will provide psychotherapy. Lewisham and North Southwark has referred only six patients to Broomhills in the last five years. It has its own 12-bed psychotherapy community ward at Guy's hospital. It is planning to increase psychotherapy consultant services by four more in February 1989 and is very much advocating community psychotherapy in the future.
Only last month Bexley health authority, which manages the Broomhills unit, published a consultative document on the future organisation of mental illness services in the district. In that document it saw the development of psychotherapy as being integrated into the mainstream of community services. The document also details a service in which hospital-based care will be part 629 of a wider range of community and residential facilities, leading to an accessible and flexible service. The plan recognises that most individuals with mental health problems are already managed in the community by general practitioners, families and other carers and it is proposed that their contribution should be fully recognised and supported.
I stress that the psychotherapy services in general in those districts are not being lost. Rather they are being developed in an alternative way on a more local basis. I am sure that my hon. Friend will welcome that, as he and I believe that there are many different ways of treating patients in this area. That is not to belittle what the Broomhills unit does—perhaps it underlines its contribution.
It is recognised that the Broomhills unit provides a service that is not widely available. I recognise that it is committed to the multi-disciplinary team approach to treating disturbed people. The unit bears the imprint of Dr. Edward Herst, the consultant psychiatrist, and I pay tribute to him and all members of his staff for their expertise and the valuable service that they provide.
For those reasons, Bexley health authority wishes the unit to continue if there is a demand for its services. I hope that my hon. Friend will agree that it would be unreasonable for Bexley to continue to run the unit for only a few patients. That would not be cost-effective. I join my hon. Friend in congratulating the health authority on its positive action in marketing the unit to the four Thames regional health authorities to see whether there is a wider demand for its services. That is a sensible, positive and constructive step. I have seen the authority's information leaflet and am very impressed with it. The authority's actions have the full support of staff at the unit. I, too, hope that there is a favourable response from other health authorities to this vigorous marketing. It is a good example of the entrepreneurial approach that we wish in the NHS.
630 I understand that responses have been requested by 20 January next year. If those efforts are unsuccessful, I have been told that Bexley will consider approaching authorities outside the Thames regions. I am convinced that Bexley health authority is doing its utmost to ensure the continuation of the unit.
§ Mr. Wolfson
I am glad that my hon. Friend mentioned the timetable involved and Bexley's readiness to be flexible in looking for a wider market than the one it initially circulated. But there may be a problem with the timing. There was some administrative delay in producing the brochure—one can understand how that happens—and 30 days may not be long enough to obtain a response. We may need a little longer.
§ Mr. Freeman
I fully understand that.
If the district is not as successful in its marketing strategy as we would all hope, it will be for the district to decide what level and type of psychotherapy service it should provide, and it would be wrong for me to anticipate any such decision now. However, it is clear that Bexley health authority, the South East Thames regional health authority and fellow hon. Members all want the unit to continue, and Bexley health authority has been active in trying to secure the support necessary from other health authorities. I hope that it is successful and that it takes the time necessary to do that. My hon. Friend the Member for Sevenoaks fully and comprehensively described the unit. He will appreciate the many pressures on my time, but I shall arrange soon to visit Bexley health authority and the Broomhills unit.
I take this opportunity to wish you, Madam Deputy Speaker, a happy Christmas. I also wish my hon. Friend the Member for Sevenoaks, his constituents and those at the Broomhill unit a happy Christmas and prosperous and healthy new year.