§ Mr. Tom Brake (Carshalton and Wallington)I welcome the opportunity for this Adjournment debate and am grateful for the chance to speak about important issues surrounding mental health services in the London borough of Sutton and beyond. I shall keep my comments relatively short, to enable my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) to make some comments.
The timing of the debate is fitting, as it follows the "Saving Lives" debate at St. George's hospital on 25 February. That debate focused on the Government's target to reduce the rate of suicide in the mental health service and explored people's vulnerability when they feel unwell, raising many issues relevant to Sutton that are worthy of debate.
It may be helpful if I provide a brief history of developments in mental health services in Sutton over the past 12 months. In 1999, Sutton's services merged with Springfield university hospital to found the South-West London and St. George's Mental Health national health service trust. The trust's geographical boundaries encompass Wandsworth, Merton and Sutton.
The Minister will be aware of the cuts—euphemistically termed efficiency savings—that threaten many mental health services, and the pressure that they put on trusts to limit services. Our local trust needs to make efficiency savings of about £200,000. Since the merger, the trust has concerned itself with making savings in respect of day care in Sutton. Of the three boroughs covered by the trust, Sutton is at a disadvantage. That is ironic, given that it is thought to be rich in services. Services in Sutton could therefore be seen as an easy target for money-saving schemes. The trust has no deficit, so it will not benefit from the first tranche of new NHS money.
After a lengthy day care review, the closure of Chiltern day hospital was proposed. The hospital often provides out-patient care for people with acute mental health problems as an alternative to in-patient treatment, or following discharge from hospital. The therapeutic community treatment programme consists of sociotherapy, psychotherapy, occupational therapy and drug treatment. Many people, including professionals and clients, campaigned against the threat of closure because the hospital provides an invaluable service. Indeed, my hon. Friend the Member for Sutton and Cheam and I campaigned on that very issue.
I am pleased that the proposal to close the hospital has been withdrawn. The trust is taking a holistic view and reviewing mental health adult care services in Sutton as a whole. However, the need remains to identify savings of £200,000. It is clear that savings on that scale will leave mental health services in Sutton depleted, and cast doubt on the future of Chiltern day hospital and the Wallington and Cheam resource centres.
The "Saving Lives" debate to which I referred revealed sobering facts that highlight the importance of appropriate after-care. The 1999 report, by the national inquiry into suicide and homicide by people with mental illness, stated that 96WH
24 per cent. of suicides occurred within three months of discharge from in-patient care…These post-discharge suicides were at a peak in the first week after leaving hospital; within the first week, the highest number occurred on the day after discharge…41 per cent. of post-discharge suicides occurred before the first follow-up appointment.It will be clear to the Minister that those are worrying statistics. If we are to achieve the Government's targets for reducing suicide rates, we need services that provide community care for people at the vulnerable time immediately after discharge.On that issue, I want to raise the tragic case of 30-year-old Kevin Thadani, who was diagnosed as a paranoid schizophrenic. Mr. Thadani was found dead on Mitcham common six weeks after being discharged from the Jasper ward of Sutton hospital. He died from hypothermia, and the coroner recorded a verdict of misadventure. Mr. Thadani had a long medical history, and the Minister will note from the diagnosis that he was a vulnerable man.
After only a few weeks of in-patient care, Mr. Thadani was discharged into an unsupported bed-and-breakfast in Streatham, despite indications that he needed supported accommodation. Although Mr. Thadani had asked to be closer to London to increase his chances of getting a job, the bed-and-breakfast was unsuitable in other respects. Apparently, it is in a well-known red light district of Tooting Bec common. The Minister will agree that that is not the most suitable place for a person who is feeling unstable. As far as I am aware, no provisions were made for Mr. Thadani, apart from breakfast at the bed-and-breakfast, and presumably he spent considerable periods of time isolated in his room.
Mr. Thadani's absence was not reported immediately, and his appearance after death suggested that he had been living rough for several weeks. Clearly, he was a man who needed continuing care and support to maintain his mental health. Appointments with his community mental health team were not enough for him to sustain his health.
I know that that is not an isolated case of a person with mental health difficulties being discharged into an unwelcoming and possibly frightening situation, which results in a relapse. That raises the question of why tragedies like Mr. Thadani's death occur. The Government are rightly keen to emphasise the importance of community care, but this case represents an example of the failure of community care.
Could the mental health services and the local authority have done more to support Mr. Thadani? The answer must be yes. An ideal, but not unrealistic, alternative to his follow-up care would have been supported accommodation and a referral to one of the day care services in Sutton or a neighbouring borough, if that was where he was resident. That would have ensured that someone had continuing responsibility for Kevin's care.
The Minister will remember the sobering statistics that I mentioned earlier about the high risk time for suicide, and therefore relapse, in the first 24 hours. The Chiltern day hospital, which was under threat of closure, provides an assessment within 24 hours of discharge from hospital, thereby acting as a safety net for many vulnerable people.
97WH Other valuable day care services in Sutton—Wallington resource centre and Cheam resource centre—provide continuing care for people with acute and long-term mental health problems. The centres' treatment is similar to that of the Chiltern day hospital. They integrate activities within the wider community and in educational and employment services, and treatment is provided in a non-clinical environment.
The majority of people with mental health problems receive little appropriate support from families and live isolated lives, thus increasing the risk to their health. Services such as the resource centres and Chiltern day hospital are invaluable in providing people with a regular routine and social interaction. As we have seen from the case of Kevin Thadani, the lack of effective and regular community support can result in tragedy. I therefore ask the Minister not only to support the concept of day care services in Sutton and elsewhere, but to invest nationally in preventive and containing community treatment.
It is worrying that neither Mr. Thadani's absence nor missed appointments were apparently followed up. I would be grateful if the Minister could comment on that. The case of Mr. Thadani also reflects the importance of appropriate housing for people with mental health problems. It raises the question of whether the council should be made more aware of the needs of people with mental health problems, which is necessary for better liaison between clinicians and the council. Bed-and-breakfast accommodation is rarely sufficient for a vulnerable person and is often an isolating and insecure experience. Many good supported housing associations operate in Sutton, such as Croydon Churches and Sutton Community Development Trust, which provide supported flats for people with mental health needs. Support includes practical help, monitoring of health, emotional support, social interaction and liaison with clinical services. Finding appropriate housing is extremely difficult, and is becoming more so, yet it is a fundamental necessity. If a person's housing is not right, their mental health often deteriorates.
A further concern is the emergency procedure that is available in respect of Sutton's local NHS trust. People in crisis or feeling unwell either have to contact their general practitioner or go to St. Helier accident and emergency unit for a referral to the on-call psychiatrist. Out of hours, it is extremely difficult to contact a GP, especially one who is familiar with the patient's case. A patient who chooses instead to go to the A and E unit may face a very long wait. A constituent of mine in a suicidal state had to wait six hours to see the casualty doctor before the psychiatrist was called. She said that psychiatric emergencies are often treated with a degree of ignorance or derision, which often deters people from asking for the help that they need. A and E procedure needs to be changed to make the mental health services more easily accessible to people who are at their most vulnerable.
I want to raise several further points to which I hope the Minister will respond either in this debate or in writing. Will he comment on the practice of placing in appropriate housing homeless people who have been discharged from hospital and who have a history of mental health difficulties? What action will be taken? I appreciate that supplying all types of housing is a major 98WH problem, but supplying affordable, supported or appropriate accommodation to people who have mental health problems is an even greater problem. What action will be taken?
What steps will the Minister take to prevent tragedies such as that involving Mr. Thadani's death, and to lower the risk of suicide in Sutton and elsewhere? The case to which I referred is just one among many. There is only one course of action that the local mental health services in my constituency could adopt to prevent tragedies such as that involving Mr. Thadani, and help to meet the targets for reducing the suicide rate—they should continue to invest in mental health services locally, and not attempt to make efficiency savings.
I ask for the Minister's support in raising the profile of mental health issues in the health service generally. The need for that was put to me forcefully when I discussed the matter with people on the trust. There may be a reluctance to talk about mental health issues, and Members of Parliament may be reluctant to support that valuable service. What action will the Minister take in that regard?
Finally, I express my gratitude to Kevin Thadani's brother, Joe, and his parents, for allowing me to refer to Kevin Thadani's case. That enabled me to highlight my concerns about mental health services. I am aware that this is a painful issue for Joe and his family, but if firm action is taken—it cannot guarantee that such a tragedy will never reoccur, but it could reduce the risk—Joe may feel that Kevin did not lose his life in vain.
§ Mr. Paul Burstow (Sutton and Cheam)I thank my hon. Friend the Member for Carshalton and Wallington (Mr. Brake) for initiating this debate.
My hon. Friend referred to the review that the South-West London and St. George's Mental Health NHS trust undertook last year in relation to day care—it proposed closing the Chiltern day hospital. Hon. Members will not be surprised to learn that that proposal went down like a lead balloon with service users, carers and staff, who felt that the trust failed to understand the hospital's role of assessing, containing and treating people with acute mental health problems. Users of the service and staff told me that the system works like a safety valve, because it prevents the need for in-patient admissions. Closing the hospital represents a false economy for service users and perhaps for the trust's budgets. Closure would have an impact on acute mental health patients and on the resource centres that provide day care services in Sutton. There are two centres in the borough—Wallington resource centre, which is in my hon. Friend's constituency, and Cheam resource centre, which is in mine. The closure of the day hospital would dilute their work and convert them into an integrated service. They would lose their client focus and client-centred approach to those who suffer from chronic mental health problems. Staff at the resource centres were worried that the case management systems that they had established would have been undermined by such changes. An audit of the work of resource centres was undertaken in Wallington and revealed their considerable value in reducing re-admission rates into the acute sector. There is great concern that service changes would have been to the detriment of many of 99WH the service users instead of for their benefit. One concern about the closure was that it would lead to a focus on acute mental health problems at the expense of chronic mental health patients.
The staff told me that they had a sense of déjà vu because, 10 years ago, the service was configured to integrate acute and chronic mental health service users under the same provision. A review found that service was not being delivered to the satisfaction of either group and was not providing the best outcome for either group. We are seeing the recycling of old ideas that have failed previously but are being brought back into service. That seems to be due, at least in part, to financial imperatives in the trust's budgets.
As part of the review, I visited Cheam resource centre and Chiltern day hospital. As a consequence of my discussions, I asked 14 questions in letters to the trust management. I have not yet received replies to those questions, but, as my hon. Friend rightly said, thanks to the campaigning of service users and others, the plans have been abandoned or put on the shelf. We hope that they will gather dust for many years.
We now have a review of the trust's services and the remit has been widened, which is welcome. The local authority is about to start a best value review of its mental health services. That provides an opportunity to consider the concerns of my hon. Friend by widening it to examine issues affecting housing and the integration of services. They work well together, but, as my hon. Friend's case demonstrates, they do not work well enough. More needs to be done to ensure that the national service framework is being properly implemented and that the new emerging mental health strategy in Sutton is fully implemented. Those should be the key criteria for developing services in Sutton, and I hope that the Minister will be able to give some assurance on that.
§ The Minister of State, Department of Health (Mr. John Hutton)First, I congratulate the hon. Member for Carshalton and Wallington (Mr. Brake) on securing this debate on mental health services. It is unusual for hon. Members to have the opportunity to discuss mental health services, which is a shame given their importance to millions of citizens. It is not often appreciated that mental health problems are as common as asthma in our society and at any one moment 6 million people in Britain may need support from the NHS or local authorities to help them to deal with mental health problems. Anything that we can do in this Chamber to raise the profile of mental health services would be welcome.
The hon. Gentleman asked me to take more steps to encourage the development of mental health services and to provide some leadership. We are trying to do that. We have made mental health services our top priority for the NHS and I shall say more about that shortly. It is important in this debate to be honest with each other. Mental health services have been neglected and undervalued for decades in the NHS and we must put that right because those services are crucial to many vulnerable people. The hon. Gentleman referred to the 100WH specific and tragic case of Mr. Thadani in his constituency. The history of mental health services is littered with such tragic cases in which things could be been done differently with a better outcome for patients and their families.
We must make a big change in the quality and consistency of mental health services and we are trying to do that. The hon. Gentleman may be interested to know that later this year I shall visit every part of the country to talk to chief executives and chairs of trusts and others about implementation of the national service framework. The hon. Member for Sutton and Cheam (Mr. Burstow) asked us to do more to implement the national service framework, but it came into operation on 1 April, so it is only a month old. We must be realistic. There is a lot of work to do to ensure that all the standards identified in the national service framework are translated into front-line services. Some health authorities are starting from a different position and are further advanced in developing the standards. There may be a significant need to do more in the hon. Gentleman's constituency and that of his hon. Friend the hon. Member for Sutton and Cheam and I shall not argue about that. The hon. Gentlemen have put forward strong arguments for change and improvement and we would certainly encourage that. However, I would like to pick up on the impression that they gave, perhaps inadvertently, that health services in Merton, Sutton and Wandsworth are experiencing a contraction of funding. That is not the case. The health authority in that area is receiving more than £30 million in additional funds in this financial year.
I believe that the hon. Member for Carshalton and Wallington has served on a local authority—the hon. Member for Sutton and Cheam certainly has—and I am sure that he would argue that there is always a justification for ensuring that money is being used efficiently and effectively. Best value for money should be a principle that unites everyone in the House, rather than causing divisions and arguments between us. There is a strong case for ensuring that services are provided efficiently and effectively, but it would be wrong for the hon. Gentlemen to give the impression, albeit inadvertently, that mental health services are having their money cut in Merton, Sutton and Wandsworth. That is most definitely not the case.
§ Mr. BrakeI checked my facts yesterday, and had a discussion with Duncan Selby, the chief executive of the trust. He thought that the trust would be required to make savings of £200,000—he used the euphemism "savings"—and he was worried about the impact that that would have.
§ Mr. HuttonI am grateful to the hon. Gentleman for making that point. However, what he and the hon. Member for Sutton and Cheam failed to point out was that the situation needs to be set in the context of £30 million of additional money going into the health authority of which his constituency forms a part. The NHS is growing in his constituency. Its capacity to provide better quality front-line services is increasing in Sutton, and I am sure that the hon. Gentleman will welcome that as everyone else does.
The hon. Gentleman made two more points to which I would like to respond briefly. He is right on these points, and I would not wish to take issue with him over 101WH them. He stressed the need for better partnership working between local authorities and the NHS in relation to mental health services. There is a strong need for closer, better integration of services between local authorities and health authorities and trusts in providing services for people with mental health problems.
I cannot think of a better example of the need for better partnership working, because the needs of people with mental health problems will not be met simply by the NHS. They will be met by a combination of services and different providers, not necessarily under the local authority umbrella, in relation to housing, social support and other services that are not the preserve of the national health service. If people with mental health problems are to recover as we want them to, and to lead normal, fulfilling, natural lives, they will need a range of other support services that the NHS cannot provide. We recognise the need for the networks of social support and proper housing that the hon. Gentleman mentioned and we are taking steps to improve them.
The hon. Gentleman also made the important point that in Sutton, as elsewhere, there is a strong need for round-the-clock access, especially to services for people with severe mental illness. He referred to his constituent Mr. Thadani in that context. We are making significant investments—I shall spell out in more detail in a moment the areas to which they will apply—to ensure that mental health services are available round the clock. People with mental health problems do not have them only from 9 to 5.
§ Mr. BurstowDoes the Minister agree that, in view of the fact that we are to have two reviews of mental health services—the best value review by the local authority and a review by the trust—it would be desirable to have either one review or two very closely integrated reviews?
§ Mr. HuttonYes, I agree with the hon. Gentleman on that point. As partnership working in mental health services becomes the norm, there is an obvious case—especially in relation to pooled budgets and integrated service provision—for the best value regime to be common to both parts of the services. We are not quite at that point yet in relation to services in Sutton, but I hope that we shall get there sooner rather than later.
Leaving aside those general points, I should like to return to some of the specific points raised by the hon. Member for Carshalton and Wallington. I was sorry to hear of the tragic case that he described, and I offer my sympathy to those who knew Mr. Thadani at what must be a sad and difficult time for his family. The hon. Gentleman will appreciate that it would be inappropriate for me to go into detail today about the circumstances of the case, or to draw any conclusions from it. South-West London and St. George's Mental Health NHS trust and the London borough of Sutton social services department are conducting an investigation into the circumstances leading to Mr. Thadani's death.
I offer my sympathy to those who knew Mr. Thadani at what must be a sad and difficult time for his family. As the hon. Gentleman will appreciate, it would not be appropriate for me to talk in detail today about the circumstances of the case or to draw any conclusions 102WH from it. As he will be aware, an investigation by the South-West London and St. George's Mental Health NHS trust and the London borough of Sutton housing and social services department is being carried out into the circumstances that led to the death of Mr. Thadani. Both organisations have agreed to an independent membership of the joint investigation team. The investigation's objective is to establish the circumstances and the reasons for the tragedy. I hope that the hon. Gentleman agrees that that is the best way to ascertain the facts and, by learning from the problems of individual cases, to avoid repetition in the future. We are determined to ensure that service failures are not followed by tragedies in individual cases. We want to ensure that services are comprehensive and effective and to learn any lessons that need to be learned from this terrible case.
I shall refer to the points made by the hon. Members for Carshalton and Wallington and for Sutton and Cheam on mental health services generally before I consider the specific circumstances relating to Sutton. A number of problems have been identified in mental health services: not enough joint working between health and social care; inadequate investment; problems with professional demarcations; problems brought about by a lack of effective, integrated services. Those problems mean that despite the strong commitment and invaluable hard work of those delivering the care services, we have not always managed to deliver the seamless, accessible and effective services that people want, need and deserve. Yes, there are continuing problems; there is much room for significant improvement. Things are not entirely as we and the hon. Member for Carshalton and Wallington and his hon. Friend would wish. It would be foolish to pretend that things are perfect and I shall not do so.
I can say with confidence, however, that although there is a long way to go, the Government, the national health service, social services and the other stakeholders are rising to the challenge. In the national service framework, we produced one of the most widely welcomed statements on the development of mental health services in many years. Mental health services will no longer be the Cinderella service of the national health service; improving mental health services is one of the Government's top priorities for the NHS. The national service framework provides us with a unique opportunity to build on examples of good and innovative practice throughout the country. That will benefit the hon. Gentleman's constituents in Sutton as it will people in other parts of the country.
Every health authority is developing its local implementation plans for ensuring that the national service framework becomes operative and effective locally. Significant amounts of additional investment are going to improve mental health services. We have identified £700 million in the existing comprehensive spending review period to invest for that purpose. A significant amount of that investment will go into the areas to which the hon. Gentlemen referred: improving access to round-the-clock services, more assertive outreach teams, greater access to 24-hour staff care, a different mix of beds and secure accommodation for people with mental health problems and, most importantly, we are investing significantly to ensure that 103WH there is greater use of the atypical anti-psychotic drugs, a matter that I know interests the hon. Gentleman and the hon. Member for Sutton and Cheam.
I have stated some of the priorities in terms of investment in mental health services nationally. Although he did not refer to it, the hon. Member for Sutton and Cheam will be aware of the new mental health strategy document for London, "Health Services in London—A Strategic Review". It is an important context in which to discuss mental health services in Sutton.
This is the first time that a Government have attempted a comprehensive mental health strategy for any of the regional offices in the United Kingdom and the first one that we have been able to prepare, develop and launch covers London. It is a strategic blueprint; it is not about individual boroughs and their health plans, but it provides us with a context in which future mental health services in Sutton can be expanded, developed and enhanced.
There are some good news stories in Sutton mental health services; for example, there is better access for Sutton residents to specialist drug and alcohol services and a dedicated in-patient unit on the Springfield site. I hope that there will be better use of mental health beds in Sutton, which will mean that residents will have access to services locally and do not have to travel to other parts of London for treatment. Clients on an enhanced care programme approach—the seriously mentally ill—will have better access to services 24 hours a day all year round and to a duty psychiatry system which can be addressed at either Springfield university hospital in Tooting, or at Sutton hospital. Significant additional investment of hundreds of thousands of pounds has gone into improving mental health services at Sutton. These include funds to develop Derby ward at Sutton hospital and turn it into a secure unit. There is now a single team for children's services in Sutton which has received more than £100,000 in funding. An additional £175,000—
§ Mr. Deputy Speaker (Mr. John McWilliam)Order. Time is up.