Hilda Lewis House

HC Deb 27 February 1992 vol 204 cc1211-8

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

10.1 pm

Mr. Dennis Canavan (Falkirk, West)

I welcome the opportunity to raise the matter of Hilda Lewis house, which is on the verge of closure because of a decision taken by the Bethlem and Maudsley hospital special health authority.

Hilda Lewis house provides an intensive short-term in-patient assessment and intervention service for children who have severe learning difficulties and extreme behavioural problems, such as aggression to other people, or who injure themselves so severely that they can cause permanent damage. The aim of the staff at Hilda Lewis house is to help such children to lead as normal a life as possible. I am reliably informed by expert opinion that the treatment of such children needs to be carried out consistently on a 24 hours per day basis, which requires a high staff ratio.

Hilda Lewis house is a highly respected national resource offering residential treatment to children up to the age of 16 who have such severe problems that they cannot be adequately helped in a community setting. For most of those children, Hilda Lewis house is the last hope—the only answer. Without its help, they could end up under sedation in the wards of long-stay hospitals.

The excellent service provided by the staff was recognised by the previous Secretary of State for Health when he wrote to you, Mr. Speaker, in your constituency capacity, on 6 August 1990, stating: I am confident that Hilda Lewis House will continue to provide the unique service which it offers. I have no reason to believe that the changes proposed by the Special Health Authority will in any way detract from its international reputation as a centre of excellence for the treatment of all kinds of psychiatric disorders. In the same letter, he stated: There is absolutely no intention to close the unit. That was on 6 August 1990; yet only 17 months later, on 14 January this year, the special health authority decided to close in-patient services for children at Hilda Lewis house.

I understand that the remaining children at Hilda Lewis house were discharged last Friday without their treatment being completed. I should be grateful if the Minister would tell me exactly what has happened to those children. Are they merely being sent back to their families, or are any steps being taken to continue the treatment that they so evidently need?

Only a quarter of an hour or so ago, I met one of the children—a young lad called Simon, who was discharged last Friday and sent back to his parents. His mother and sisters have to look after him. I dare say that they will do their best, but they face an almost impossible situation without the essential back-up services that Simon had at Hilda Lewis house. It is a disgrace that in this day and age any child or young person such as Simon should be discharged without his therapy being completed. Will the Minister give me a case-by-case answer as to what has happened to all the children who were discharged last week without their treatment being completed?

In his recent letter to you, Mr. Speaker, which was dated 17 February, the Secretary of State, referring to Hilda Lewis house, said: The in-patient service is not unique, with similar services in units around the country. That seems to be a blatant contradiction of the statement made by the previous Secretary of State for Health when he referred to the "unique service" offered by Hilda Lewis house.

Mr. Eric Byers, the chief executive of the special health authority, agreed on the Radio 4 "Today" programme last month that there are no other similar national facilities. If there are similar services in units around the country—that now seems to be the view of the Department of Health —will the Minister name them? Where are those facilities? Is he absolutely confident that they offer the same type and quality of service as Hilda Lewis house? My information is that they do not, and that there is nowhere in the whole of the United Kingdom offering a similar service for such disturbed and deserving children and young people. I am assured that Hilda Lewis house is unique. Children are referred to it from all over Britain and from overseas, which is why it has such an excellent international reputation.

No justification has been given for its closure. In his recent letter to you, Mr. Speaker, the Secretary of State denied that Hilda Lewis house was being closed to provide a magnetic resonance imaging scanner. However, my information is that of the £250,000 that the authority hopes to save annually by the closure of Hilda Lewis house, £50,000 will go towards the purchase of a magnetic resonance imaging scanner although the cost-effectiveness of such a purchase has been questioned by several experts.

It seems that unless the closure decision is reversed, children from all over Britain will lose out. Irene Davis, whose son was receiving treatment at Hilda Lewis house, went so far as to say: If the special health authority are saying goodbye to Hilda Lewis house then they are saying goodbye to the rest of my son's life. In a letter to the hospital, Mrs. Davis wrote: My 12-year-old son is autistic, and over the years he has gradually regressed, he has become extremely aggressive to the point of being too dangerous to stay at home, and yet the one thing I want most is for him to be a part of our family, but because of my four and two-year-olds I've had to ask HLH"— that is, Hilda Lewis house— to help, otherwise he would be permanently sent away from home. I don't want that. He is my child, and not an aggressive stranger. HLH is really making headway with him, and he comes home to the family at weekends, and when they are finished with Paul, Paul will be part of our family with a future. You are taking that away from him, you are responsible for the fact that, due to this action, Paul and many children like him will be separated from their families indefinitely and probably locked away in so-called 'residential homes', which should be called 'institutions'. Well, I hope you can live with yourselves, knowing there are families and children going through incredible pain. I hope that the Minister will bear those words in mind.

I dare say, Mr. Speaker, that in your time as a Member of Parliament and as Speaker you have often heard accusations, some justified and some perhaps not, of Government commitments having been broken. I have certainly heard many such accusations in my time as a Back Bencher, but I have never before come across a case in which a Minister has clearly broken a written commitment to the Speaker of the House of Commons. What is worse, no justification has been given for breaking that commitment, and no adequate alternative provision has been made for the children who will suffer the consequences of an inhumane and deplorable decision.

I demand that the Minister intervene now, even at this late stage, and reverse the closure decision, for the sake of people such as Mrs. Davis and her son Paul, the young lad Simon, and all the other children who could benefit from the excellent service provided at Hilda Lewis house.

10.13 pm

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

The hon. Member for Falkirk, West (Mr. Canavan) is raising this matter for the second time in the House. He tabled a health question for oral answer last week, but it was not reached. I made a brief statement to him about the background to the decision to close Hilda Lewis house. My answer was necessarily brief, as it was an initial answer to what was intended to be an oral question, so I am grateful for the opportunity to explain to the House in more detail the background to that difficult decision.

Hilda Lewis house was created by, and was the responsibility of, the Bethlem and Maudsley special health authority which, as its name implies, plays a special role in the national health service. It has a special responsibility for the care of especially difficult cases involving psychiatric illness.

In London there are a number of such special health authorities within the health service. They have a particular responsibility for providing a research and development capability, postgraduate teaching and training, and a tertiary referral centre for difficult cases. In addition, the special health authority provides a range of local mental illness services. The case that the hon. Gentleman has made for the maintenance of the facility at Hilda Lewis house is based on its role as a tertiary referral centre for particularly difficult cases of young people suffering from a combination of psychiatric disorders and behavioural problems coupled with learning disabilities. That was the specialty for which Hilda Lewis house was designed. The facility provided five in-patient places and 10 day patient places. No one disputes that while it was open it performed valuable work providing care for patients and leading to better understanding within the profession and the health service of the treatment and care of such difficult cases.

Partly as a result of the experience and work at Hilda Lewis house, but more generally as well, thinking in the service about the best way of caring for and treating difficult psychiatric cases of people with learning disabilities has developed during the time when Hilda Lewis house was open. When, in June last year, the health advisory service and the social services inspectorate visited Hilda Lewis house to examine the facility, they said that the SHA should consider the future of the facility to see whether it still represented the best use of available resources. I take particularly seriously the opinion of the health advisory service, which has a monitoring responsibility for mental illness services throughout the NHS.

Those bodies pointed out that the emphasis on in-patient care at Hilda Lewis house was somewhat at variance with developing ideas about the proper way of caring for difficult people—with the stress now placed on providing a wide range of support in the community, where possible, and at the very least—and however difficult the cases involved—on providing care for them as close as possible to the places where they live.

I do not claim—it is not true—that the HAS and the SSI said that there was no place for Hilda Lewis house, but they did say that the future of the facility should be considered. They recommended that the SHA consider whether it still represented as valuable a resource as it undoubtedly did the day it was opened and during the early part of its life.

Mr. Canavan

Saving money.

Mr. Dorrell

I shall come to that. I have looked in some detail into the background of this case, and I am totally confident that saving money does not constitute the background to it.

Following the report from the HAS and the SSI, the director of the facility left in the second half of last year. I am sure that we can all agree that when the specialist body responsible for monitoring mental illness services within the NHS had suggested that a review was necessary, it would have been a dereliction of duty if the SHA had not taken the opportunity provided by the director's leaving to conduct a review, as suggested by the SSI and the HAS, into the efficacy of the services provided at Hilda Lewis house.

When the director left, therefore, the SHA launched a review led not by managers and certainly not by politicians but by a joint committee of the special health authority—representing the centre of excellence for difficult psychiatric cases and the development of the psychiatric discipline in the health service—and the Institute of Psychiatry. The committee was to examine the use of resources at Hilda Lewis house. From a professional and not a managerial standpoint, the committee concluded that the SHA would use the resources better and provide a better quality of care for the people for whom, as the hon. Gentleman was right to stress, the NHS has an important responsibility to care. That committee decided that the resources could be better used.

Against that background, the hon. Gentleman asked me to intervene in the case. If I receive first from the HAS, then from a joint committee comprising the Institute of Psychiatry and the SHA and then ultimately from the SHA board—which is the properly constituted body for managing that centre of excellence within the health service—advice arguing that the resources would be better used on a different model and that the care needs of the client group for which the facility was established would be better met by different means, it would not be my place as a Minister with two years standing in the health service and a background in business—not psychiatry—to intervene and overrule a decision made by bodies with a pedigree in the psychiatric discipline which I cannot hope to match.

However, I can try to answer one or two of the specific points raised by the hon. Gentleman about the last in-patients who were discharged from Hilda Lewis house and some of the points made in the earlier letter from my right hon. and learned Friend the Secretary of State for Education and Science when he was Secretary of State for Health.

The hon. Gentleman accurately quoted the letter from my right hon. and learned Friend in which he said that there were then no plans to close Hilda Lewis house. That was perfectly true: there were no such plans. However, I have explained in some detail why the position of the SHA changed during the nine months beginning with the investigation by the HAS and the SSI, the findings of which were published last June. No hon. Member would argue that a commitment, albeit in an august letter from a Secretary of State to you, Mr. Speaker, that there was, as accurately stated then, no intention to close Hilda Lewis house, should bind the managers of the health service for ever, particularly if the managers receive advice from the psychiatrists and specialists in the field with the pedigree that I have described to the House.

Even though the undertaking was made in a letter to you, Mr. Speaker, I feel perfectly comfortable that the advice available—not to the Government, because this is not directly a Government decision—to the special health authority charged with managing that important national resource, and the circumstances have changed sufficiently for a decision to be reached that clearly contradicts the statement made by my right hon. and learned Friend when he was Secretary of State for Health some time ago.

The hon. Gentleman also asked whether we and the SHA recognised that the service provided at Hilda Lewis house was a national service. It is true that the services provided by any SHA are available to the whole NHS. It is part of the purpose of the SHA system that those authorities should develop the delivery of health care and that the results of their experience should be available widely through the health service. To that extent, the service provided at Hilda Lewis house was a national service. However, when we consider the pattern of where the patients came from, it is difficult to argue that Hilda Lewis house was a national service that was used throughout the country.

Between 1985 and 1991, 70 in-patients were cared for at Hilda Lewis house of whom 63 per cent.—very nearly two thirds—came from the South East Thames region in which Hilda Lewis house was located. Of the remainder, 16 per cent. came from South West Thames, which is the next nearest region, and only 21 per cent. of the total—15 cases—came from outside one of the two south Thames regions.

Against that background, I do not think that the case is made that that was a service of extensive value to the Trent region, for example, which covers my constituency, still less to the Scottish Home and Health Department, which covers the hon. Gentleman's constituency. However, that service undoubtedly performed valuable work for the people who went there, and it developed a better understanding of the care of those conditions, but I do not think that it was a resource that met a national need.

Mr. Canavan

The previous Secretary of State described it as a unique service. Is the Minister reneging on that statement? He has only five minutes in which to answer. What provision has been made for the children who were discharged last Friday? If it was a unique service, there is literally nowhere else for those children to go.

Mr. Dorrell

Those were to be my final two points to the hon. Gentleman. One was whether an alternative service of a similar type is available to meet that need elsewhere in the country. I am advised that two institutions offer similar treatment for children who suffer from the combination of acute psychiatric conditions and learning difficulties. They are Harper house, which is in North West Thames region, and the Haven, which is in Paignton, in South Western region. Those facilities offer, I am advised, care that is comparable with that which was previously available at Hilda Lewis house.

I repeat that, bearing in mind the geographical home territory of the people who were treated at Hilda Lewis house, there is simply no support for the assertion that it was a national service. Certainly, there was learning which may be useful on a national scale—I do not dispute that—but I dispute that the service was uniformly available and used through the national health service.

Mr. Canavan

Do any of the places that the Minister has named offer 24-hour treatment combined with the assessment that was given at Hilda Lewis house?

Mr. Dorrell

Again, I am advised that the North West Thames, Northern and South-Western RHAs have a range of services that provide multi-disciplinary in-patient, out-patient community assessment and specialised consultancy for such patients. "In-patient" means residential care for those for whom it is most appropriate. I stress to the hon. Gentleman, as I have stressed to many audiences, both friendly and hostile, the health service's commitment to ensuring that, where possible, all people who suffer from a learning disability, and most particularly young people who suffer from a learning disability, are cared for in a domestic context and, where humanly possible, with their families. That is simply because the overwhelming weight of evidence is that, when that risk is taken and when that attempt is made, the outcome in terms of the lifestyle of the individual is dramatically better than is possible in an in-patient context. There are repeated examples of patients surprising themselves, their families and professional staff by what they are able to do when supported in that context.

I now refer to the hon. Gentleman's question about the three patients who were discharged last Friday. I remind the House that the closure of that facility did not involve a massive dislocation; it involved the relocation of three patients—all of them individuals with the right to expect that we discharge a proper responsibility of care for them. I am advised that two of the existing patients, one from Waltham Forest and one from Worthing, were already in local authority care and have returned to respite care in their home areas. The third has returned to his home in the Oxford area while a suitable placement nearer home is found. The SHA continues, because we are talking about the closure of only a tiny part of its activity. It will use some of the money that is released by the closure of Hilda Lewis house to ensure that there is proper follow-up of not only those three cases but all the cases that stand to benefit from the type of services offered through that important centre of excellence.

The centre of excellence is the SHA. It has a deep and continuing commitment to continue to improve the quality of care available in the health service for this type of patient. It is its professional judgment that such care is best delivered by following the route that it has set out.

Mr. Canavan

Why were the children discharged before the treatment was completed?

Mr. Dorrell

As I have said, the treatment of such conditions by its nature is never completed. We seek to ensure that for all discharged patients there is follow-up and that continuing care which meets their needs is available. That is the commitment which I have given and repeat and which the health authority has given.

Question put and agreed to.

Adjourned accordingly at half-past Ten o'clock.