MENTAL HEALTH UNIT CLOSURES – 20 October 2009
Dr Julian Lewis: Speaking in debates in the House of Commons is always a slightly tense occupation, but Westminster Hall is normally a more relaxed environment. Today, however, for the first time in Westminster Hall, I feel nervous. I know that on the outcome of this debate depends the future and fate of some of the most vulnerable members of my community.
I am pleased that my colleagues, my hon. Friends the Members for New Forest, West (Desmond Swayne) and for Broxbourne (Charles Walker), both of whom have an interest in the subject of mental health, have taken the unusual step of coming along to such a short debate. It is a measure of the concern felt in the community about the closure – allegedly a temporary one, for four months – of a psychiatric intensive care unit, or PICU, at Woodhaven Hospital in my constituency.
This is not the first time I have operated outside my comfort zone of defence and security concerns. Back in 1997, when I was a brand-new Member of the House, I came second in the Private Member’s Bill ballot. We all know what happened to the person who came first: he chose the important subject of banning fox-hunting, a decision with which I happen to disagree. On the Friday when that important Bill was debated, the Chamber was packed. A week or two later came my Bill, the Mental Health (Amendment) Bill, to improve conditions for people suffering catastrophic mental breakdown and needing a safe and secure in-patient environment in which to recover. Needless to say, because the debate concerned desperately ill people rather than foxes, attendance was down to the usual dozen or two hon. Members.
One person who gave me invaluable support in preparing for that debate, which involved an issue in which I have no specialist expertise, was Dr Adrian Yonace, an independent consultant psychiatrist and Fellow of the Royal College of Psychiatrists. Since then, he has become a personal friend. He is well acquainted with Woodhaven, the marvellous modern mental hospital built and opened in my constituency, much to my delight, only five years ago.
Woodhaven has two wards: a 24-bed acute ward, containing a mixture of people who have voluntarily admitted themselves and people who have been sectioned; and a six-bed PICU where the most seriously ill, difficult and challenging people are confined in a locked and regimented environment. Dr Yonace describes Woodhaven as an excellent local psychiatric service, with a PICU alongside the acute ward so there is always the potential for interchange between the two units. I will have more to say about that later if I have time.
Dr Yonace says that the closure of the psychiatric intensive care unit will put great pressure on other PICUs, which are already bulging at the seams. He describes the intensive care ward team under Dr Guy Powell as widely known for its excellence in the care of the most acutely mentally ill, particularly helping those who live in close proximity and their relatives.
Mr Desmond Swayne: My hon. Friend will know that mental illness is no respecter of Parliamentary divisions and that the unit serves my constituents as well as his. I hope that the NHS Trust does not underestimate the huge anxiety being caused to relatives who know the needs of the loved ones who habitually come and go from the units.
Dr Lewis: That point about the revolving-door nature of the service offered is crucial; I thank my hon. Friend for making it. I was about to say that Dr Yonace describes the closure of Ellingham Ward as a potentially catastrophic development if it becomes permanent and the great team that runs it is broken up. That is not some politician sounding off; that is an extremely senior professional who is intimately personally acquainted with the hospital concerned.
The people who run the Hampshire Partnership NHS Foundation Trust – these organisations are customarily honoured with such short and snappy titles – are not monsters. They are dedicated and civilised people. I have spent time with Mr Nick Yeo, the Chief Executive, and I find him an empathetic character. What he says relates not only to the Ellingham Ward closure but to the potential closure of a place called Crowlin House, again in my constituency. Indeed, I believe I was involved in the opening ceremony only eight years ago. It is another effectively brand-new establishment.
Crowlin House has had a reprieve for the moment, but Mr Yeo says that places such as Crowlin House were opened initially to process people from the old long-stay mental hospitals that closed in the 1960s and 1970s. I find that hard to understand, as there is rather a long gap between the closure of those hospitals and the opening of Crowlin House as a halfway house in the community in 2000, but the idea is that such units are meant to look after people who are, hopefully, in transition back to society but who have been institutionalised by having been too long in in-patient facilities.
Mr Yeo says that it is not the intention or the objective that people should stay in PICUs for very long. He says that the national guideline for the average stay is 26 days, and that people have been staying as long as 40 days, or even 90 in a couple of cases. Mr Yeo has considered the overall figures for the four PICUs in the Trust. The unit at Basingstoke has eight beds, the unit at Southampton has nine, ours at Woodhaven has six and one at Havant has eight. That makes 31 beds in all.
Mr Charles Walker: My hon. Friend makes a good point. We do not want to lock people away in institutions. However, there will always be a need for acute beds. The problem is that if we get rid of acute beds, the threshold for admission rises, and all too often very sick people are left out in the community, which is not in a position to support them.
Dr Lewis: Indeed. It is supposed to be the case that people from PICUs are not discharged except to another ward. After intensive care, they should be discharged to an acute ward and then, hopefully, back into society, perhaps via some sort of halfway house. If they do not get better, they should go to a low or medium-secure unit for a long-term stay.
The problem is that although there is a guideline of 26 days and the Trust therefore proposes to get by with 25 PICU beds rather than 31 by losing the six at Woodhaven, the fact is that there is a long waiting list for the low-secure unit at Southfield, in my constituency, which has 18 beds, and people cannot be shifted in the way that theory dictates. That is why Dr Yonace said that the system is bulging at the seams.
I have been contacted by Rethink, which used to be called the National Schizophrenia Fellowship. It is concerned that during the recession, mental health services will come under much greater strain:
“Rethink expects that different elements of the current crisis – home repossession, debt and unemployment – will all take their toll.”
It is concerned because:
“Users of Rethink services appear to be experiencing greater financial difficulties and associated stress, which can trigger relapses”.
Another concern is that:
“Mental health services in general face increased caseloads as a result of individuals experiencing mental health problems triggered or worsened by straitened economic circumstances”.
I have spoken to professionals from Ellingham Ward and Crowlin House, and to the relatives of people who have used those services. Crowlin House, which has had a temporary reprieve, is a unit in my constituency where people with long-term problems are held in a kind of halfway house in the community with round-the-clock support. I have been told that such places are not just for a transitory group, but are vital in caring for people at different points on a spectrum that extends from the most grievously and dangerously ill, through those who can go to acute wards, to those who are not ready to go back home but who need an environment that will help them to reintegrate into the community.
As my hon. Friend the Member for Broxbourne said, no matter how far care in the community is taken, there will always be some people who need in-patient care or at least to be surrounded constantly by specialised support. Outreach teams usually visit somebody at home twice a week for 30 minutes. When a person at home is seriously ill, the teams visit them once a day for 30 minutes. That means that the person has 23½ hours of every day in which to cope by themselves.
When Ellingham Ward was closed temporarily, there were five people for the six beds. One of the patients went straight home. He was ready for an acute ward but a bed could not be found, so, reluctantly, he was allowed to go home. Winsor Ward, the 24-bed acute ward in Woodhaven, was chock-a-block. The second patient went to another PICU in Basingstoke. His parents live locally and are worried about the distance and disruption. The third patient, who also went to Basingstoke, was so distressed that he had to be manhandled to the car. His normal home is in the west of the New Forest and his elderly mother now has no way of seeing him unless the Trust arranges it. The fourth patient went to Havant and the fifth to Southampton. There are lulls in the occupation of beds, but it is not true that there are always several empty beds among the 31 PICU beds in the area.
This jewelled operation in our community is being smashed.
The PICU in Woodhaven was closed to new admissions on Tuesday, 6 October, although some patients were still there. By Friday, 9 October, the PICU network in the Trust was completely full. All acute beds in the Trust were taken up and the system was in crisis. At 6 pm on the Friday, a patient on Winsor Ward – the acute ward – became very disturbed and had to be found a PICU bed. None was free, so Ellingham Ward’s admissions policy had to be reversed so that the patient could be admitted. If that had happened a week later, the situation would have been impossible.
Any bed that is freed up by somebody going to the PICU enables somebody in the community who is in serious need of a bed on the acute ward to have it. I said earlier that I would refer to such interchange. When a crisis emerged in the acute ward, the staff and capacity of the PICU were available to meet it. The reverse is true: when someone was ready to come out of the PICU, but not ready to go home, they could go straight into the adjacent acute ward. However, even the future of the acute ward is under threat, because who can say what will happen to it when it is a stand-alone hospital, albeit a brand new one?
On the night when the Ellingham Ward PICU was closed and everyone was shifted out, there was only one free acute bed and one free PICU bed in the Trust’s institutions, hospitals and organisations. That was at the start of the weekend, when admissions are usually higher. A small, windowless meeting room on Winsor Ward has been used recently to accommodate patients on a put-you-up bed. In the two weeks since Ellingham Ward was closed, that box-room with no toilet or wash basin has been in constant use.
Helen Barnett, whose brother was one of the five patients who were forced to leave Ellingham Ward, has met me and written to me. She has given me permission to mention the case. She wrote that her brother was
“a patient on Ellingham Ward at Woodhaven Hospital until … he was suddenly transferred to … Royal South Hants Hospital.”
“horrified to read of the proposed closure of Ellingham Ward due to the under-utilisation of the beds.”
I do not accept that and nor do the professional medical staff.
She went on:
“He regularly requires the specific secure environment and treatment that Ellingham provides. When he is acutely unwell in a heightened elated presentation he can and has previously required several months of a strict monitored regime that can only be offered on an intensive care ward.”
She says that it is now more likely that he and other service users
“will be admitted to units that are not local to their existing care team and where the nursing team will not have the personal knowledge of the patient that currently exists and which is invaluable in the treatment of those with mental health conditions.”
It is not as though extra resources are being found for the active outreach teams. We have the strange situation in which figures are being presented that are supposed to show that there is spare capacity in the PICUs. That is the basis on which these half-a-dozen beds can go. In fact, over the last two months, if those half-a-dozen beds had not existed, there would not have been enough PICU beds in the Trust area for 80 per cent. of the time and we would have been struggling and in great difficulty.
Mr Walker: For any system to work, there must be spare capacity.
Dr Lewis: My hon. Friend is right. In this case, an inadequate capacity is being built in. I am concerned that the system we are so fortunate to have in the New Forest area is being dismantled on the same basis as the mass closures of the ’60s and ’70s, even though the units we are discussing were designed for the people who were not catered for by those mass closures. As for the highly specialist prize-winning team at Ellingham, it is being sent off to an adolescent unit, to a forensic unit and to other places where its skills will not be properly used. Those staff are just being used to replace other staff who will now not have to be recruited.
I will conclude by saying that this is not a cheap shot, but it is worrying to have been presented with a long list of non-clinical posts that have been advertised by the Trust. In terms of annual salaries, the posts total more than £1.25 million a year and include jobs such as: head of consumer experience at £42,000, chief operating officer at £90,000, project manager at £39,000, interim deputy director of operations at £59,000, graphic designer at £28,000, associate director of contracting and commercial development at £59,000, assistant communications manager at £28,000, human resources principal workforce information data analyst at £34,000, and so on. It has also been reported – this has been taken badly by the community and I give credit to the Southern Daily Echo for exposing it – that, while all these closures have been going on, part-time health chiefs in the Trust have had some very nice pay rises indeed.
I think it obvious from my remarks that I have had information from people who are directly involved in working for the Trust on the clinical side – not the administrative side. I hope that there will be no question of any form of recrimination, victimisation or career disadvantage against those people who have spoken out. I was absolutely thrilled when Woodhaven opened in my constituency. The problem is being driven by cuts, but it is being dressed up as the dogma of being the means of coming into the modern world and bringing people into the community more. We have done all that and we were right to do it; but even then, it was recognised that the pendulum could have swung too far. The wonderful system we have, of which we are so proud in the New Forest, must not be dismantled. I look to the Minister to reassure me; but, more importantly, to reassure my severely ill constituents and their extremely worried families.
[The Minister of State, Department of Health (Phil Hope): I congratulate the hon. Member for New Forest, East (Dr Lewis) on securing the debate on a matter that is clearly of great concern to him and his constituents. Indeed, as he remarked at the beginning of his contribution, he has had a long and active interest in these matters. Clearly the contribution and presence of two of his parliamentary colleagues and neighbours, the hon. Members for New Forest, West (Mr Swayne) and for Broxbourne (Mr Walker), shows the wider interest in the issues he is raising.
I am sure that the hon. Member for New Forest, East will join me in paying tribute to the NHS staff in Hampshire for showing outstanding energy and commitment to providing high-quality care for all patients, including those with acute mental health needs. His concerns are clearly fundamentally based on the current action being taken by the Hampshire Partnership NHS Foundation Trust, which has decided to close the Ellingham psychiatric intensive care ward and the Rivendale rehabilitation unit, to which he did not refer –
Dr Lewis: It is not in my constituency.
Phil Hope: Indeed. The Trust has decided to close that ward and unit for four months. Given the brief time I have left to reply and the local responsibility for the decisions, I should say that I hope the hon. Gentleman’s concerns will be read and heard by the Trust, which will want to respond to the specific points he has made. I understand that he met the chief executive of the Trust just last Friday, when he raised some of his concerns about access to psychiatric intensive care units. I think he was assured by the Trust that there are no plans to change the clinical thresholds for access to the units and that, indeed, the Trust’s clinicians were confident that they would continue to ensure high-quality care. I know he has been invited to meet those senior clinicians and tour some of the Trust’s services to see for himself how things are run. I hope that he will take further opportunities, apart from the one he had last Friday, to meet the Trust and present the points he is making.
Let me make it clear, and in so doing reassure all hon. Members who have contributed to this short debate, that these temporary closures will not jeopardise the recovery of existing patients and will not lead to a bed crisis or a drop in the quality of care, as the hon. Gentleman fears. The temporary closure of the two units is in line with wider plans to transform mental health care in Hampshire.
In keeping with many Trusts across the country, Hampshire has been on a journey in relation to mental health services and the Trust deserves credit, not criticism, for thinking progressively about how mental health can be improved across the region. In particular, it has recognised that some patients in Hampshire have spent more time in in-patient rehabilitation units and psychiatric intensive care beds than is recommended. For example, an audit taken this September found that the average length of stay in psychiatric intensive care units in the Trust was 40 days, compared with a national average of just 26 days.
The temporary closure also reflects the wider successes of Hampshire NHS in re-evaluating the way mental health services are delivered locally, and shifting away from a ward-centred, in-patient-focused model of mental health care. Opposition Members know that that is the right direction of travel. We must get it right, but such a model of mental health care is the right direction of travel as it means reassessing how services are used.
On the specifics of the PICU on the Ellingham Ward, from April to June 2009 the average bed occupancy was 94 per cent., and from July to September occupancy dropped to just 74 per cent. The need for a level of flexibility in the system was mentioned, and if we consider Rivendale, from April to June 2009 its occupancy was 70 per cent., after which occupancy dropped to just 54 per cent. Those are the realities of the pattern of usage of these services.
Dr. Lewis: I am sorry to cut into the short time I have allowed the Minister, but I have heard those statistics before and I am assured that there will always be lulls at some point. This was an atypical couple of weeks and for 80 per cent. of the time, if there had not been those six beds, the system would have been in crisis. He must not rely on those figures.
Phil Hope: Those are the figures I have but as I said, the hon. Gentleman has the opportunity to challenge the Trust in more detail in due course.
On the reduction in demand for beds, there may be fluctuations because of changes that have nothing to do with how the health service is managed. However, such fluctuations are partly due to changes in the way acute and community services manage patients. For example, changes in clinical practice mean that people spend less time in psychiatric intensive care units before being discharged into more appropriate clinical settings. In line with the principles of the national service framework for mental health, the Trust and the primary care Trust have been looking carefully at how they can move care out of in-patient wards while crucially ensuring patient, staff and public safety. And they have been successful. The growth in community-based services is helping to reduce the number of patients needing to be admitted and maintained as in-patients for extended periods. As a result, demand is falling for in-patient services and increasing for community services such as assertive outreach, crisis resolution and home treatment. That is in line with the Government’s vision for mental health.
However, the Trust did not take the decision to close the beds lightly and it will review the situation in January 2010. The closures were necessary to maintain the quality and safety of services for patients and to ensure sustainable working conditions for staff. I would like to take this opportunity to assure the hon. Gentleman that these moves are part of the patients’ care plans, which are developed and agreed with patients and/or their carers. The decision was taken on the basis of patient and staff safety and was supported by senior clinicians and service directors across the Trust, including medical and nurse directors. There has been no suggestion that patient, staff or public safety will be compromised.
Hon. Members have talked about the pressure on other psychiatric intensive care units, but there are local PICUs that have enough capacity, and there has been a growing number of PICU bed vacancies across the Trust. However, I appreciate the hon. Gentleman’s concerns about these matters, which he and his colleagues have had a good opportunity to articulate. I hope that he takes future opportunities to address these issues with the Trust directly, so that he and his colleagues, his constituents who use these services, their families, carers and the wider community can be assured that patient and community safety and patient care always come first.]