CLOSURE OF MENTAL HEALTH BEDS IN HAMPSHIRE – 18 April 2012
Dr Julian Lewis: Last November, I secured a short Adjournment debate entitled, “Woodhaven Hospital”, the subject-matter of which ranged far more widely than the future of that state-of-the-art mental health unit, which was opened in New Forest East only eight years earlier. At issue was the vital question of how many acute beds should continue to be provided by the Southern Health NHS Foundation Trust, which covers most of Hampshire.
The Trust was proposing a 35% reduction in acute mental health beds for adults, from 165 to only 107, 10 of which would go from Antelope House, Southampton, 24 from The Meadows in Fareham and 24 from Winsor Ward at Woodhaven in my constituency, with this last unit being reused as a low secure unit for much longer-term detained patients. No one disputes that some beds will always be needed for people in crisis, and everyone welcomes the use of new mental health therapies to reduce the number of admissions and enable people to go home earlier. The argument is purely about how many beds are required and whether the Trust has shown adequate statistical rigour.
The Trust’s consultation document seemed to be designed to persuade the public that bed numbers were much higher and length of stay much longer in Hampshire than the national average, when that was not the case. Two other matters also caused particular concern. First, about half the acute in-patients at any one time had been detained or sectioned under mental health legislation, and most detained patients would still need beds in the future. It seemed obvious, therefore, that the proportion of beds allocated to such patients would rise from about half to some two-thirds or even three-quarters if there were a 35% reduction. Yet, when I said on the BBC’s South Today programme that people’s best chance for future admission would be to get themselves sectioned, the chief executive of the Trust, Katrina Percy, sent a letter to Ministers, Councillors and Hampshire MPs denouncing such comments as “unfounded” and “scaremongering” and with “no place in the 21st century”.
The Trust feared the broadcast because it also demonstrated my second contention, which is that people were being misled about the number of unused acute beds out of the 165. As was explained in the previous debate, at 4 pm every day a bed states report is issued, showing the total number of beds available in each acute adult mental health unit. The figures are broken down into four important categories: male beds, female beds, vacant beds and leave beds. Male and female beds are obviously not interchangeable, except in the minority of cases where the configuration of a ward allows a bed to be used for either gender. Leave beds are those whose patients are away for a few nights, and beds empty for longer periods are rightly regarded as vacant and genuinely empty. Despite what the Trust says, one cannot rely on admitting the same number of new patients as there are leave beds, because people come back after two or three nights to reclaim such beds.
The Trust hates my use of these 4 pm daily snapshots of bed occupancy, yet what is its alternative? It issues simplistic graphs, which plot three elementary tracks. The top line shows the number of beds in the system; the middle one shows the number currently in commission, in case some have had to be closed; and the bottom one, which fluctuates widely, shows the number of patients in beds on each day. The picture presented by the graphs seems reassuring, because there is always a visible gap between the numbers of patients in beds and the number of beds in commission; but they do not distinguish between the different categories of unfilled beds. The graphs assume that all the beds are interchangeable regardless of gender and that they are all available for admitting new patients, when many are leave beds which are, by definition, never empty for long.
In last November’s debate, I pointed out that between 21 September and 6 October 2011 the combined total of vacant and leave beds had varied from just 3 to just 11 out of the 165 in the system and that over the three months from August to October, even if all the leave beds had been counted as fully available for new admissions, bed occupancy was still at almost 92%. One must have huge confidence in the ability of the Trust’s proposed alternative – ‘virtual wards’ at home for acutely ill people – to think that a 35% reduction in beds will be safe and sustainable. In the previous debate, I said that it was
“distinctly probable that the Overview and Scrutiny Committee of Hampshire County Council may decide to refer this matter to the Secretary of State”. [Official Report, 10 November 2011; Vol. 535, col. 552.]
The Health Overview and Scrutiny Committee – known as the HOSC – can do that if it is sufficiently concerned about proposed changes in NHS arrangements.
I was a little perturbed to hear that the HOSC’s relatively new chairman, Councillor Pat West, had apparently been saying that I had my figures wrong. Before Christmas, however, I made contact with Mrs West, who took the trouble to meet me at the home of my caseworker, Councillor Diana Brooks, who is the health portfolio holder on the District Council in the New Forest. The HOSC chairman went though some of my data, and forcefully expressed her poor opinion of Southern Health NHS Foundation Trust and of one of its most senior administrators. She even hinted that there was a question-mark over the suitability of the Trust to continue with its contracts, and said that the future of the acute mental health beds was just part of a bigger picture. She also added that the HOSC had considered referral to the Secretary of State but felt that that was premature at present, and that matters would be considered further at the next HOSC meeting on 24 January. Encouraged, I put the date in my diary.
Meanwhile, the Trust’s chief executive, Katrina Percy, had responded to my November debate, and that led me to prepare a full analysis of the deficiencies so far discovered in the Trust’s information. My memorandum, entitled “Unreliable Statistics”, was sent to my right hon. Friend the Minister, to Ms Percy and to the HOSC chairman on 11 January. My covering letter to Pat West stated:
“I hope the HOSC will consider the contents presently”.
With the HOSC meeting drawing near, I asked my parliamentary assistant, Colin Smith, to ring Councillor West to ask about my addressing her Committee, perhaps with a delegation. She was adamant that there was no need for me to go to the 24 January meeting. She said that it would be “counter-productive” and that she would much rather keep me “in reserve” for later. Having no reason to doubt her advice, I followed it. My feelings can be imagined, therefore, when the day after the meeting I discovered that the HOSC had fully endorsed the bed closure plan and would not be considering it again until July, by which time all 58 beds would have closed.
I immediately telephoned the leader of Hampshire County Council and expressed my incredulity that an elected Councillor from my own party could have misled me so blatantly. Subsequently, the HOSC chairman spoke further with my office. She still insisted that my attendance would have been counter-productive. I am at a loss to know how attending the meeting could have been more counter-productive. Could her Committee have voted to close all 58 beds twice over?
Suspecting that my paper on bed statistics had been suppressed rather than circulated, I sent it directly to all HOSC members and set out the circumstances in which their chairman had dissuaded me from attending. In case anyone thinks that I am relying on parliamentary privilege, this is what I wrote without it:
“She gave no inkling that there was the slightest chance of a decision to close the beds being taken at that meeting. I was, therefore, amazed and dismayed to learn (from a local press report) that that is precisely what happened. I feel totally misled and let down on behalf of some of my most vulnerable constituents ... In almost 15 years as a Hampshire MP, I have never received treatment like this from an elected colleague in my own party, and I am deeply shocked by it.”
When the row broke in the local press, Councillor West refused to comment to the Southern Daily Echo, saying that she
“did not want to get into a slanging match with the MP in the media”.
However, on 3 February, she replied to my original letter of 11 January covering my memo to the HOSC and to my later letter to Committee members.
“I am sorry that you could not attend the 24 January meeting”,
she wrote, without a trace of irony, adding that the agenda and papers for the meeting had been on the Council’s website and would have shown me that the HOSC
“would be considering recommendations which related to the closure of beds”.
Apparently, I had only myself to blame for not distrusting her enough to ferret around on websites to check that I was not being misled.
The minutes of the meeting and the resulting press coverage revealed that two factors had featured prominently in the HOSC's deliberations. The first was a statement by the Trust’s clinical director, Dr Lesley Stevens:
“With regard to the data on bed demand, it was highlighted that between 20 and 30 beds had been vacant consistently over the past three months, and that this trend coincided with the introduction of new community services.”
That is precisely the sort of claim that I had intended to challenge. On the very day of that meeting on 24 January, the Trust’s own figures showed clearly that there were no vacant male or female beds, no leave male beds and just six leave female beds in the entire system, giving a grand total of six unoccupied beds. In November and December 2011, there had certainly been an unusual rise in the number of empty beds, in stark contrast to the previous month, October, when on 17 days the total number of male and female vacant and leave beds had been in single figures, not 20 to 30. Indeed, on 10 October, there had been no vacant male beds, no vacant female beds and just one male and one female leave bed in the entire directorate.
Still, if the overall totals of empty beds in January had continued at November and December’s high levels, I would have ended my campaign to prevent the closures. However, that did not happen. For example, on at least 14 days in January, there were no vacant male beds, and on at least 10 days, there were no vacant and no leave male beds, so no beds for men at all.
Later, I wrote to the local press about Dr Stevens’s claim to the HOSC that there had been 20 to 30 vacant beds consistently in the past three months. I pointed out in my letter that actually only a handful of beds had been empty when she claimed consistent totals of 20 to 30 unoccupied, and I noted:
“It is true that during November and possibly December” –
I did not have the full figures for December at that time –
“there was a sudden surge in available beds totals. Yet my continuing investigations have shown this to have slipped back since Christmas – and this would have been known to the Trust’s representatives when they made their presentation to HOSC.”
Although my letter was published in at least three local papers, including the Southern Daily Echo, in which Dr Stevens had previously aired her views, as far as I can tell she did not respond in any of them.
To deal with any suggestion that the Trust’s new programme of intensive day therapies had been responsible for the temporary glut of beds in November and December, I asked senior Trust members at a routine meeting on 3 February whether the new therapies and arrangements begun in 2011 were still in place. Dr Shanaya Rathod from the Trust confirmed that they were. Therefore, the rapid decline in empty bed totals in January cannot be explained away by suggesting that the Trust had stopped doing whatever it claimed was responsible for the temporary surge in beds during the last two months of 2011.
The second major factor that influenced the HOSC on 24 January was also set out in the minutes of the meeting:
“It was reported that the Centre for Mental Health had independently reviewed the evidence for the changes the Trust was proposing and concluded they were necessary to meet the challenges the Trust faced. The Trust offered to provide the full report to HOSC members when available.”
On 27 January, I met the Trust’s chief executive, Katrina Percy, and was given that document. In fact, it consisted of two separate reports. The first, from the Centre for Mental Health, supported what are termed recovery-oriented services, which the Government are rightly keen on, but did not analyse bed numbers. The second report was by Steve Appleton of Contact Consulting. Less than one page of his report dealt with Southern Health acute bed data, but every reference was footnoted to a single source, which was not attached – a third report called “Inpatient Capacity” drawn up by a third organisation, Consilium Strategy Consulting.
I recalled the important debate secured by my hon. Friend the Member for Burton (Andrew Griffiths) on 19 December last year. With my hon. Friend the Member for South Derbyshire (Heather Wheeler), local consultants and the press, he had been battling similar techniques designed to justify closing acute beds at the Margaret Stanhope Centre in his constituency. Those techniques had also relied on an appeal to external authority and an “independent” report by Staffordshire University, which turned out to have been produced by someone on the payroll of the local Trust.
Wondering whether something similar had happened in Hampshire, I contacted the Centre for Mental Health, formerly the Sainsbury Centre, which I knew enjoyed a deservedly high reputation. Its chief executive, Professor Sean Duggan, met me on 23 February, and later confirmed in a letter:
“The scope of the Centre’s work did not include an examination of the number, type or location of beds that would be needed now or in future. A separate analysis, by Contact Consulting, looked at bed numbers ... [The] Centre for Mental Health is an independent charity and as such we would not seek to endorse or condemn specific local decisions about reconfiguring inpatient mental health services.”
Yet, as we have already seen, the second report by Contact Consulting depended on a third report by Consilium Strategy Consulting that had not been made available.
I wrote to Katrina Percy on 28 February, pointing out that
“the so-called 'independent' report that you handed me involved no examination of primary source data whatsoever, but simply relied upon a third document – a report by Consilium – which it described as having been produced when the Trust 'conducted its own benchmarking process'.”
I asked for a copy of the Consilium report; for a statement of the status of Consilium, in particular of how independent it is, if it all, from the Trust; and for its contact details. Ms Percy replied on 9 March:
“I would just clarify that the content and status of the Consilium report, as mentioned in your letter to me, is commercially sensitive and is therefore not available to share publicly. However, should it be required, I would be pleased to provide you with the contact details of the consultant involved so that you may contact them directly.”
Despite two phone calls from my office to hers, and a further letter from me, the Trust’s chief executive has yet to supply even the contact details of the Consilium consultant.
Although reluctant to reveal data that ought to be available, Southern Health resents criticism of its slippery methods. Yet, how else can one describe the activities of an organisation that seeks to discredit, as it does, a public petition with more than 1,000 signatures against the closure of Woodhaven’s 24 acute beds by claiming that
“a number of people contacted the Trust and told us variously that they either did not know anything about the petition, could not recall signing the petition, suggested a friend or neighbour may have signed it on their behalf without their knowledge or consent … I am sure you would also acknowledge that the petition only has limited value in terms of a valid indicator of people’s views”?
If the Trust had pointed out that I have some 70,000 adult constituents and that a petition, quickly compiled, represented only a fraction of them, then that would have been fair enough. Sadly, it preferred to use a few anomalies to discount the views of 1,000 people and to cast doubt on the integrity of the petition’s organisers.
On Monday, 5 March, the Trust’s clinical director, Lesley Stevens, was interviewed for South Today, whose chief reporter – in fact, political editor – Peter Henley, challenged her claims about empty beds, given the figures in January’s bed states reports. She insisted that there was no shortage of acute beds, yet the very next day the Trust sent an e-mail to its consultants, stating:
“There are currently no unassigned acute beds in the Directorate. Can CRHTs” –
the Crisis Resolution and Home Treatment teams –
“and the acute wards ensure that all clients are reviewed for leave or early discharge as a matter of urgency, please?”
I was also interviewed for the South Today report, which was broadcast on 13 March, and said that that e-mail had given the game away completely. In-patients were already being reviewed for early discharge at a time when only 18 of the 58 beds scheduled for closure had actually gone. I said then, and I repeat now, that the Trust’s policy of closing so many beds on the basis of bogus claims about surplus beds is inhumane.
As a result of the row over the January HOSC meeting, I was invited to take a deputation to the next one on 27 March. Although it was late in the day, a chance had been created to persuade the Committee to at least pause the closure programme once the 34 beds at Antelope House and The Meadows had gone. We could then see whether the Trust could cope with so many losses before starting to close the 24 Woodhaven beds as well. That had consistently been urged by Councillor Keith Mans, a governor of the Trust and a former Member who was once a Parliamentary Private Secretary to a Secretary of State for Health. We believe that closures on this scale must be trialled properly and in stages before full implementation.
At the March meeting, I distributed tables showing how wrong it had been to claim that 20 to 30 beds were still empty when the January vote was held. I was given 10 minutes to state my case – which was a relief, because right up to the start of the meeting the chairman, Councillor Pat West, had told me that three out of the five of us would have to share 10 minutes between us. Mary Bryant, who was one of my deputation, spoke movingly of the burden on carers that the loss of the beds would impose; Councillor Sally Arnold gave the results of a survey of Parish Councils which had not been properly consulted; and Mrs Jane Barnicoat-Chongwe, a nurse practitioner on the acute ward at Woodhaven who had contacted me, expressed professional concern about the Trust’s proposals. I put on the record now that at no time has she given me any data whatsoever or any documents from the Trust.
Our fifth spokesman was Andrew Evans, a service user who for decades has relied on periodic admission to acute units. With extraordinary eloquence, Andrew explained not only the pressure on his parents, who are his carers, if he stays at home when in an acute crisis phase, but also how the loss of the en-suite facilities at Woodhaven – remember that the unit is only eight years old – which are not available in some of the other units, will have a traumatic effect on in-patients’ dignity in future. The HOSC and the audience broke into spontaneous applause at the end of his presentation.
Thereafter, none of us could contribute further to the discussion, and I watched in frustration as Dr Stevens blandly maintained that the bed closures at Antelope House and The Meadows, which, of course, had started only after 24 January, had absorbed the 20 to 30 beds which, in the face of all the evidence, she still claimed to have been empty up to that January meeting. She then mistook the e-mail of 6 March – which said that the system was full and that early discharges were needed, and which had been shown on the South Today programme – for another one, sent three days later. She explained how such communications were so normal and so routine that she would be concerned if she were not receiving them. I have since checked with sources at the Trust, who have told me that no such e-mails had been sent for months before 6 March.
When questioned by HOSC member Councillor John Wall about the lumping together of male and female empty beds as if more than a fraction of them were interchangeable, Dr Stevens told the Committee that a female could be allocated an empty male bed, for example, as long as “one-to-one observation” by a member of staff was maintained. So much for our long years of campaigning to eliminate mixed-sex wards in NHS hospitals.
Once the Trust had finished its long presentation, the chairman put a motion to the vote that reflected the case made by Keith Mans and others, including me, that there should be a pause before the closure of the Woodhaven beds began, while an independent panel would seek to resolve the disputed figures about bed occupancy. To our delight, it was carried nem. con. – at which point Dr Stevens interrupted the proceedings, which was out of order because the Trust’s presentation had ended. If there were any delays, she exclaimed, the Woodhaven staff would be so unsettled that many would leave, the unit would close and it would not reopen at all – even in its new role, I presume she meant. To my utter astonishment, the first vote was then ignored, as though it had never happened, and replaced by a much weaker proposal that a small panel of Committee members and “key stakeholders” would examine the issues urgently and seek to resolve them without any delay to the closure of Woodhaven’s beds.
Given that the only reason any of this was happening was because of the data I had unearthed and my exclusion in January – remember that originally the matter was not supposed to have been considered again by the HOSC until July – hon. Members might think that I should be a part of the process, if it is meant to be more than a charade. Not a bit of it. This little panel will go on its merry way looking at points previously raised in writing by me and others. If it cannot resolve any of those points, according to its terms of reference,
“this will be handled as a matter of urgency … through the chairman communicating to the Trust”
on behalf of the Health Overview and Scrutiny Committee. So our arguments and objections will be safe in the hands of Councillor Pat West and Ms Katrina Percy, supported, no doubt, by the zealous Dr Stevens.
What then should Ministers do? At a meeting with Keith Mans and me on 26 March, following an earlier exchange at Prime Minister’s questions, the Minister here today explained that Ministers cannot intervene to pause the process or have an audit carried out unless the HOSC refers the matter to the Secretary of State; but he did confirm that such a referral could still be made. Ministers’ hands are not completely tied – nor should they be given the deplorable tale I have set out today. If a Minister were to say that, to restore a degree of public confidence, he would welcome a referral to the Secretary of State, and if he were to invite and encourage such a referral to be made, it would be surprising if the Committee rebuffed such an expression of concern. If he is unwilling to do so immediately – I quite understand if that is the case, although I would love it if he did – I expect Ministers to consider doing so later, when reflecting on my narrative.
If would be easy to summarise this story as that of a Trust which could not be trusted with its own statistics and of a Committee chairman who deceived an MP about a vital meeting. However, what it is really about are carers such as Mary Bryant, nurses such as Jane Barnicoat-Chongwe and, above all, service users such as Andrew Evans. It costs nothing to applaud such people, but applause will not help them. What they need is a Minister to grip this situation and send an unmistakable message to the Scrutiny Committee that he stands ready and willing to bring in the Independent Reconfiguration Panel on referral of the matter to the Secretary of State.
[For later developments, click here.]
[For the similar experience of Andrew Griffiths, MP for Burton, click here.]