Charles Walker leads a debate on mental health services and raises concerns about the disproportionate closure of mental health beds and the need to ensure that bed closures are matched by sufficient new provision of facilities in the community.

Mr. Charles Walker (Broxbourne) (Con): Thank you for calling me this evening for the Adjournment debate, Mr. Speaker. It is a great honour for me to speak tonight on mental health.

Earlier today, I visited a unit delivering mental health services to my constituents in Hertfordshire. It was a fantastic and enlightening visit. I met a wonderful lady called Sally Pegrum, a nurse who has been in the NHS for 34 years delivering services to mental health sufferers. She trained at 17 and became a mental health nurse at 18. She is still only in her early 50s, so I hope that we will have another eight years of her excellent service.

I asked Sally what changes she had seen in her 34 years of service, and she said that the delivery of mental health services to the most ill in our society has changed out of all recognition. That is a credit to previous Governments and to this Government. When she started 34 years ago, she worked in an institution—and in those days, they were institutions—where she discovered a woman in her 70s who had been there for 60 years for committing the crime of having a child out of wedlock in her early teens. This is recent history—it was not the turn of the century but 34 years ago. Let me start by saying, then, that things have moved a long way in the past 34 years.

I fully support the idea behind keeping ill people in the community and in intermediate care wherever possible. We have crisis resolution teams working towards that aim. The truth is, however, that the reality of crisis resolution teams does not always match the ambition we have set for them. Such teams are often overworked. They have very large case loads, which makes it difficult for the professionals comprising them to give mental health patients the attention they deserve.

There is often a shortage of intermediate and crisis housing, so even if we want to keep mental health patients in the community or near their homes, there are not the facilities to do so. I fully appreciate that efforts are being made to bring this up to speed, but at the moment, those facilities do not exist in many places.

More worryingly or as worryingly, emergency telephone numbers that are meant to operate 24 hours a day are often not manned in the evenings and at the weekend. If someone is having a mental health crisis, it does not always happen in business hours or during weekdays. We need these telephone lines to be staffed 24 hours a day to meet the cries for help. It is also the case that before being admitted to an acute unit with beds, mental health patients are expected to get assessed by these crisis teams, but in 50 per cent. of cases that is not happening. Again, we need to address this flaw in the system.

My final plea is on behalf of carers of people who are mentally ill. I have met many carers who look after people who are extremely ill, and without their help the full burden would fall on the NHS and the taxpayer. We, as a civilised society, need to look after the mental and physical health of these carers, and we need to ensure that they get excellent respite care, so that they can continue their excellent work on behalf of those whom they love.

I also accept that we are closing beds for the best of reasons, but the truth is that for every three beds that close in hospital wards that do not deal with mental health, six close in mental health wards. I am not going to stand here tonight and argue that mental health wards are particularly nice places to be. In truth, many are not and in fact I have never met anyone who looks forward to going into hospital. Mental health wards are important, however, and they do fulfil a need.

There are problems with existing mental health wards, as I have touched on. About 20 per cent. of patients feel physically threatened in them, while a further 50 per cent. feel threatened at times. A mental health ward is three times more likely to be assessed as being unsatisfactory than a ward treating people with heart disease or cancer, for example. Unfortunately, as my hon. Friend the Member for New Forest, East (Dr. Lewis) knows, such wards are too often located a long way from people’s homes.

Dr. Julian Lewis (New Forest, East) (Con): I know a cue when I hear one. Not for the first time, my hon. Friend makes a remarkably eloquent case on the plight of the mentally ill. I was delighted that the brand-new Woodhaven hospital was built and opened in the past few years in my constituency. One reason why its acute ward is not a threatening place to be is that it has alongside it a psychiatric intensive care unit, so that if people get into a threatening state, they can be looked after there—except for the fact that that unit has been temporarily closed and might never reopen. Does my hon. Friend agree that to lose a psychiatric intensive care unit, which functions as a complement to an acute ward, is to make things worse not only for the people in need of the intensive care beds, but for those who need to go from the acute ward, at short notice, into intensive care, and who will now be sent, as he says, a long way away?

Mr. Walker: My hon. Friend makes a valuable point. It is no coincidence that today I visited a PICU—as they are called—an outstanding facility that aids the recovery of some of the illest in our society. I wish my hon. Friend the best of luck in his campaign, and I hope that the primary care trust reconsiders its position. Hertfordshire has an excellent, brand-new facility, which aids recovery.

I am not in favour of keeping acute wards open for the sake of it. However, we must accept that there is a danger of closing wards before the facilities are available in the community to pick up the slack and the patient load. The truth is that in most acute wards, occupancy rarely stands at 85 per cent. In most cases, it is far nearer 100 per cent., averaging 98 to 99 per cent., and can go as high as 125 per cent. when one counts people on leave who are trying to rehabilitate themselves into the community at an intermediate stage, but with the option of a bed remaining open if they have a crisis during that process.

As I am sure the Minister is aware, the pressure on such beds creates problems. When a higher threshold for admittance applies, such acute beds have a higher concentration of seriously ill patients. Staff numbers do not always reflect that situation. The overall number of patients might be the same, but their health needs are far greater because the admittance threshold is raised. Therefore, more staff need to be in place, because too often they feel that they are managing patients, as opposed to treating and making them better, which is what mental health staff want to do.

I mentioned the issue of leave: many patients leave acute mental hospitals to have a couple of days in an intermediate setting to help them to integrate back into their community. However, many patients are frightened to go on leave because they fear that if they have a crisis they will never get back into hospital, as the demand for their bed becomes so pressing while they are on leave that it is given up. Psychiatrists report anecdotally a greater pressure to discharge patients early, which results in far higher rates of readmission. Also—I hope the Minister does not think that I am arguing against myself—bed blocking can occur, because the patient is at a stage at which they can be moved on, but the intermediate services between them and the community are not in place to take them on board. I notice my hon. Friend the Member for New Forest, East getting restless, and I will allow him to intervene again.

Dr. Lewis: I promise that this will be my last intervention. I had not intended to make it, but as my hon. Friend has referred to rehabilitation in intermediate stages, I must draw attention to the fact that Crowlin house—a state-of-the-art rehabilitation centre in Totton, in my constituency—is threatened with closure. It has been reprieved for the moment because no places have been found for residents to be sent in the meantime, but once again, exactly the scenario that my hon. Friend is describing in theory is developing in practice in my Hampshire constituency.

Mr. Walker: As the Minister knows, such intermediate services are critical. The closure of wards works only when there are good intermediate services that ease patients’ return to the community.

One of my concerns about the additional pressure being placed on acute wards relates to staff turnover. If staff no longer feel that they are in control of the situation—if they feel under intolerable pressure—they are tempted to move on, and many staff who are experienced in hospital settings are now moving to crisis management teams. That is no bad thing, because they bring their experience with them, but we need equality of service. We need excellent people in the community, but we need excellent people in our hospitals as well.

I never thought that in my parliamentary career, I would talk about a balanced score card—it sounds very exciting and new—but I think we need one in this instance. When we are, rightly, closing hospital beds and reducing a hospital ward’s capacity from 22 to 16, as is suggested by best practice, we should have that balanced score card. We should ensure, before the closures happen, that there are community facilities to take the increased load that will be moved back into the community. We should ensure that we have the intermediate beds, the safe houses and the respite care for carers that will make the transition work. We in this place want to be confident that the system works. We want to be confident that our constituents are being given the very best care, and that applies across the House this evening.

I have been speaking for 13 minutes, so I will start to wind up my speech. Being mentally ill is not a punishment. If someone has cancer or heart disease, that is not a punishment, but too often being mentally ill becomes a punishment, and it should not. We should show the same warmth and compassion to people with mental illness as we show to people with any other disease.

It is not going to happen, but if I were Prime Minister this would be my manifesto. We want appropriate, well-resourced community services: the very best services possible, which meet the needs of our constituents, help them to get well, and give them the reassurance they need that the community is ready to embrace them. We need acute beds in modern buildings that promote wellness and recovery. My local trust, Hertfordshire mental health trust, makes no bones about the fact that its acute wards need to be made a lot better. I visited the PICU today, and it is fantastically modern. It aids recovery, and we must ensure that our hospital beds aid recovery.

We need wards that are safe and clean. The mentally ill do not deserve second best. There should be the same focus on cleanliness in mental health wards as there is in any other ward. We also need wards that are age and sex-appropriate. I know that the Minister has personally made enormous strides during his tenure in ensuring that children do not end up on adult mental health wards. Nevertheless, about 400 children a year do end up on adult mental health wards, and as we all know, that number is too high and must be reduced. We also need to ensure that we do not have mixed-sex mental health wards. Again, we need to ensure that patients feel safe and secure.

Finally, we need to ensure that mental health staff are properly rewarded and motivated. I want an NHS that is full of Sally Pegrums. I want an NHS full of people who have given 30-plus years to something that they love. Working with the mentally ill means working in is a hugely difficult environment, and it is hugely demanding. Sally has been assaulted verbally and physically on a number of occasions, but she still cares passionately about her patients because she knows that they are ill. We need to reward such people, not just with gratitude but by ensuring that the job allows them to earn a living.

This is not a party political issue. Regardless of which party wins the next general election, mental health must be at the top of the list. It has been at the back of the queue for far too long. Successive Governments have brought it forward, and this Government have done very good things—I do not deny that—but we need to make sure that it remains at the top of the list and pushes to the head of the queue. We face difficult financial times in the years ahead. NHS budgets will come under pressure, but too often the first budget to come under pressure is the mental health budget. In future, it must be the last to come under pressure.

I would like to thank the Royal College of Psychiatrists. I would also like to thank Rethink and Mind for briefing me this evening, and Hertfordshire Viewpoint and the Hertfordshire mental health trust. I thank the Minister, too, with whom I have had a great relationship during his time as Minister with responsibility for mental health. I may not face him across this Chamber again, and in case he does not return to this place after the next election, I would like to say that he has made a fantastic contribution to the cause of mental health, and I hope that if he leaves this place he will continue to give that area the benefit of his expertise. I thank him for everything he has done.

10.41 pm

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