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Speech on mental health services in Haringey

April 28, 2016

Today I led a debate on mental health services in Haringey in the House of Commons.

 

I brought this debate because it is unacceptable that three out of every four people with mental health problems in England receive little or no help for their condition.

 

I told the Minister Alistair Burt that it is clear that institutional bias against providing proper care for people suffering mental health problems persists in 2016.

 

I raised the fact that while the Government has promised to deliver "parity of esteem" between physical and mental healthcare services, the reality is that mental health funding has been cut, there are fewer beds for mental health patients in crisis and services for those that need them are stretched beyond breaking point.

 

I called on the Minister to ensure that the Barnet, Enfield and Haringey Mental Health Trust receives the funding it needs to ensure that services are safe and meet the needs of the patients and the communities the Trust serves. 

 

You can read the full speech below:

 

Introduction  

 

Mr Speaker, let me at the outset state that I have the utmost respect and gratitude towards all the staff working within Barnet, Enfield and Haringey Mental Health Trust who tirelessly care for some of the most vulnerable members of our community.

 

Not least amongst those is the mental health trust’s Chief Executive Maria Kane, who has been recognised by the Health Service Journal as a “top NHS Chief Executive” and who was shown to be doing a stellar job in BBC Panorama’s recent film “Britain’s Mental Health Crisis”[1].

 

Maria has been asked to do the impossible in my constituency within the borough of Haringey which has 12[2] of the most deprived wards in the country, where 2284 people receive PIP[3], where over 270 different languages are spoken, where 1334 people have had their benefits sanctioned and where 826 households have found themselves homeless in the last year[4].

 

Social tensions are high, funds are tight and there is an ever increasing need for urgent help – from mental health services for children and young people to dementia services for the old.

 

I bring this debate today, because it is unacceptable that three out of every four people with mental health problems in England receive little or no help for their condition, despite the fact that mental health problems cost the economy £100 billion per year.

 

And I suspect, Mr Speaker, that figure, given the high level of need, is far higher in my constituency.

 

Today, in this country, mental health problems are not some form of rare disease. The truth is that 1 in every 4 people will suffer from a mental health problem this year.

 

And, for the most greatly affected, mental health problems are fatal. It simply cannot be right that in our country, in 2016, those who suffer from the most severe mental illnesses die, on average, 15 to 20 years earlier than the general population[5].

 

I have already brought to the attention of this House the fact that on average an adult male in my constituency can expect to live to just 74.7 years.  It is sobering to picture then, Mr Speaker, that the average age of a male adult suffering from severe mental health problems within my constituency on these figures may be under 55 years.

 

But premature death is not the only complication for my constituents suffering from mental health problems. The mental health taskforce commissioned by NHS England in February of this year found that “men of African and Caribbean heritage are up to 6.6 times more likely to be admitted as inpatients or detained under the Mental Health Act, indicating a systemic failure to provide effective crisis care for these groups.”[6]

 

It was also revealed in the Taskforce’s draft report “that men from these groups are on average detained five times longer”[7]

 

And, Mr Speaker, as mental health problems affect so many lives, 23% of the UK’s burden of disease is in fact mental health.

That figure is higher the burden of disease of cancer at 22.8%, or cardiovascular disease at 16.2%.

 

Why then, I ask Mr Speaker, do mental health services only receive 11% of the NHS’ budget?

 

It is clear that institutional bias against providing proper care for people suffering mental health problems persists in 2016.

 

Parity of Esteem

 

Mr Speaker, I called this debate today, because for too long the Government’s promises about what the people of this country can expect from their mental health services do not match the reality in my constituency.

 

It was as far back as February 2011 that the Coalition Government published its strategy for improving the nation’s mental health[8] which first stated the now much trumpeted concept of “parity of esteem”.

 

Then, the very first section of the Coalition Government’s infamous Health and Social Care Act 2012, which contains the central duty imposed upon the Secretary of State in relation to our treasured national health service, was amended to put those services on an apparently equal footing.

 

But the reality already facing mental health patients across the country in 2014 was in fact:

 

  • That the mental health funding was cut for the first time in 10 years;

  • Fewer services for children and young people;

  • Fewer beds; and

  • More people on acute psychiatric wards

 

Many other strategies and documents were published promising an improvement in services and repeating the mantra of parity of esteem until the Prime Minister himself returned to the issue at the beginning of this year and finally announced some funding.  

 

However, Mr Speaker, I must comment that as the budget had previously been cut I find it difficult to see how this was a net increase, not least with the pressures of an aging population.

 

The Prime Minister announced that these particular funds would be targeted towards:

 

  • Helping new and expectant mothers with poor mental health,

  • “Liaison mental health services” within A&Es; and

  • Crisis teams.

 

Asked to do the impossible – the truth on the ground.

 

Mr Speaker, as demonstrated in BBC’s Panorama so vividly, the truth on the ground could not be more different.

 

Far from the level of funding being equal between physical and mental health services, or the gap decreasing, mental health hospitals have had far deeper cuts imposed.

 

The reality is that 3000 mental health beds have been cut across the country within the last 5-6 years.

 

However, bleak as that national picture is, it does not get anywhere close to the gaping holes in funding for mental health services which face the patients of Barnet, Haringey and Enfield Mental Health Trust.

 

Because despite the obvious and ever increasing need, this is a trust which on top of the vast inequality between physical and mental health services receives a lower share of income proportionally than any other mental health provider in London.

 

This is a trust which has already done so much cost cutting over the years that it is the most efficient NHS mental health provider in London.[9]  

 

This is a trust which already has the lowest number of acute mental health inpatient beds in London and higher productivity than other providers.

 

And, this is a trust which has been proven to be underfunded over the course of not one, not two but three independent reports.

 

The first of these reports was back in early 2014, the second in late 2014 and the third in October of last year.  The independent evidence is that the trust needs £4 million extra per year but it has not received a penny extra in funds, and no firm plan has been established to address the funding gap which means the trust now anticipates a deficit of £12.9 million in 2016/17.

 

The reality of this locally is that St Ann’s Hospital has lost 1/3 of its beds in the last 8 years alone.

 

And this is in a hospital which is obliged under section 136 of the Mental Health Act 1983 to find a bed for every patient detained under this section because they pose a risk to their own life or to the lives of others. This is not varicose veins or wisdom teeth that we are dealing with.

 

St Ann’s Hospital is constantly running at over 100% capacity when other mental health providers in London run at 85-90%. So with each new admission St Ann’s wards each have to nominate their “least ill patients” for discharge into the community.

 

Despite the efforts of the staff, does this really present as a safe outcome for these vulnerable patients and their families?

Is this really a safe outcome for the community the trust is obliged to serve?

 

St Ann’s Site

 

But Mr Speaker this shortfall in income is not the only problem which the trust faces.

 

Far from the Government’s rhetoric of parity of esteem, the truth, in Haringey, is that patients are condemned to treatment in a hospital which was designed to meet the needs of 19th  Century fever patients long before the discovery of antibiotics rather than deliver therapeutic interventions appropriate to current patient’s needs.

 

Indeed, the most recent CQC inspection found:

 

the physical environment of the three inpatient wards [at St Ann’ was] not fit for purpose due to its age and layout. This impacts on the trust’s ability to deliver safe services within the environment”.

 

This a problem which the Trust has tried to resolve at the 28 acre St Ann’s site for over a decade.

 

Finally the Trust submitted plans to develop the site last year.

They hoped to fund a new hospital and other health services on one third of the site by building homes on the remaining land.  

 

Mr Speaker I opposed those proposals because they included only 14% affordable housing in a constituency in the midst of a housing crisis.

 

Despite my objection, the Trust was granted planning permission in March of last year.

 

Alternatively a local community land trust has recently come up with a wonderful plan to redevelop the hospital on the St Ann’s site and build many truly affordable homes.

 

But, unfortunately, Mr Speaker, not even the Trust’s own plan which would not require any capital from NHS England or the Department of Health has been able to secure their approval.

It seems that a decision on whether a new hospital will be built has once again been pushed by the Government into the long grass to a date unknown.

 

Carnell and CQC Reports

 

Despite, these myriad problems just 6 months ago, the independent Carnell Farrer review into the affordability of mental health services provided by BEH-MHT found that there was:

  • No compelling evidence for the Trust to be a merged with any other organisation;

  • The Trust is relatively efficient; and

  • There was a clear case for CCGS to invest in the Trust.

 

I had hoped this would mark the end of speculation about the Trust’s future, but the CQC’s routine inspection report published in March of this year, which was conducted in December 2015, gave the Trust an overall rating of “requires improvement”. It is no surprise to me Mr Speaker, that this is the case despite the efforts of the staff and leadership, with funding so tight and the level of need so high.

 

The CQC’s report stated that out of 11 areas, 5 required improved, 5 were good and 1 was outstanding.

 

The Report concluded that:[10]

 

  1. Mental health admission wards for adults – required improvement

  2. Community based mental health services  – required improvement

  3. Child and adolescent mental health ward– required improvement

  4. Specialist community mental health services for children and young people – required improvement; and

  5. Crisis mental health services including home treatment teams – required improvement.

 

Many detailed recommendations have been made by the CQC to improve services but no extra money has been put in place to enable the Trust to comply.

 

Call to Action

 

I am grateful to the Minister for last week finally agreeing to my November 2015 request to meet a cross-party delegation of local MPs to discuss these concerns.

 

But let me put on record what I call on the Minister to do, to help the Trust ensure that the services they provide are now safe and that work begins to ensure true equality between physical and mental health services in Haringey.

 

The context of this is important Mr Speaker not just because the suicide rate in England recently soared to 4881 in 2014[11] but most disturbingly because the draft version of that report stated that if just £10m extra had been spent on services for people who are suicidal then 400 extra lives could have been saved[12].

 

That means, Mr Speaker that for the sake of £25,000, which is less than the national average salary, each of those lives could have been saved.[13]

 

So, I call on the minister to:

 

  • Urgently look at the plans for the redevelopment of the St Ann’s site. I understand that the North London Estates Plan will be finalised by the end of June and I seek an assurance that a decision including consideration of the Community Land Trust’s proposal will now be made[14]

  • Visit the St Ann’s Site to see the problems himself; and

  • Earmark appropriate funding for the crisis team and children’s mental health services.

 

Mr Speaker, I must warn the Minister that when things go wrong they can go horribly wrong. We’ve already had a young boy stabbed to death and his three friends injured outside a local secondary school[15].

 

I trust the Minister will now ensure that the Trust receives the funding it needs so it can comply with the CQC’s recommendations to ensure services are safe and meet the needs of the patients and the community we rely upon it to serve.

 

 

References

 

[1] First shown 30 October 2015

 

[2] 12 out of 19 wards bottom 20% of country. Northumberland Park is in bottom 2-3%

 

[3] 1433 (Tot) and 851 (Hornsey & WG)

 

[4] In 14/15 made up of 657 homeless, in priority need and not intentionally homeless, 92 homeless, in priority need but intentionally homeless and 92 homeless, not intentionally homeless but not in priority need

 

[5] NHS England’s own NHS Five Year Forward View, published October 2014

 

[6] https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf

 

[7] http://www.theguardian.com/society/2016/feb/13/mental-health-services-crisis-britain-revealed-leaked-report

 

[8] No Health without Mental Health: A cross-government mental health outcomes strategy for people all ages:

 

[9] And fourth nationally.

 

[10] Note CQC report refers to presentation Maria gave on the challenges the Trust faces and what they are proud of – try to get copy

 

[11] Government’s Mental Health Taskforce Report 2016.

 

[12] http://www.theguardian.com/society/2016/feb/13/mental-health-services-crisis-britain-revealed-leaked-report

 

[13] Average salary £27,600 - https://www.incometaxcalculator.org.uk/average_salary.php

http://www.theguardian.com/society/2016/feb/13/mental-health-services-crisis-britain-revealed-leaked-report

 

[14] Rather than pushed back until 2017/18 and introduction of NHS England’s Sustainability and Transform Fund

 

[15] Kasey Gordon stabbed to death age 15 in 2011 - http://www.dailymail.co.uk/news/article-1349023/Kasey-Gordon-15-stabbed-dead-mentally-ill-man-leering-schoolgirls.html

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David Lammy

From Tottenham. For Tottenham.