Mental Health: Out-of-Area Placements

Kevin Foster Excerpts

Thursday 3rd December 2015 Commons Chamber

[Norman Lamb]

That is a shocking practice. I applaud my hon. Friend for the work that he has done on it in his area. The idea of putting someone who is suffering an acute mental illness into a police cell, which is defined in the legislation, unbelievably, as “a place of safety”, is bizarre and ought not to be tolerated. I am pleased that the Government have indicated an intention to legislate, in effect to eradicate the problem completely for under-18s and to make it an exception for adults. We managed to reduce the numbers in England by 50% in the past two years, which was considerable progress, but we need to go much further and bring an end to an unacceptable practice.

It is interesting that where local passion and drive exist, amazing things are possible. In our capital city, London, last year around 20 people in total ended up in a police cell, whereas in Sussex the number was over 400. That demonstrates that with real drive from both police and mental health services, practices can be changed and people’s lives can be made better. My hon. Friend is right to persist with the issue in Wales, just as I have tried to do in England.

[Kevin Foster (Torbay) (Con)]

I congratulate the right hon. Gentleman on securing the debate and on the work that he has done to bring the issue to the fore. A police cell should be for someone charged with a crime, not for someone who is unwell. Does he agree that to some extent the problem could be overcome with better co-ordination? I had a case in my constituency where a local treatment unit was full so a person was placed in Maidenhead. We then discovered that there was someone from Maidenhead in the local treatment unit in Torbay and arranged a swap.

[Norman Lamb]

Such a story makes one weep and leaves one feeling that there is a degree of incompetence somewhere. I will come to that point. Much of what I want to see happen can be done by better organisation, rather than by providing more money. I strongly believe that we need more investment in mental health services, but a lot can be done just by organising things much better.

--- Later in debate ---

[Norman Lamb]

We do not have that information—the data are very basic—but that matter is crucial. I imagine that communications often fall down when urgent referrals to another location take place.

I would raise another issue about families. If they have to visit a loved one 50 km or 100 km from home, just imagine the cost involved. Members in the Chamber— any of us could be in this situation—can afford to visit a loved one, but many people cannot do so. That is another reason why the situation is intolerable.

[Kevin Foster]

It is very interesting to hear the right hon. Gentleman’s statistics on my own area of Devon. It is important to get to grips with the issue for the reasons he has mentioned. He raised the point about communications in the example of the expensive round trip from Devon to Maidenhead. In many cases, families may know where their loved one will go, but the reality is they are presented with a choice: “Your loved one needs treatment—this is where it’s going to be. There is not much you can do, other than trying to mitigate all the impacts in the best way you can.”

[Norman Lamb]

Such a situation leaves the family feeling desperate, guilty that they can do nothing to help their child or loved one, and powerless to do anything. That is similar to the case of Josh Wills, a little boy with autism, who lives in Cornwall. He was placed in a specialist unit in Birmingham, so we can imagine the journey his parents had to make every week. He was there for more than three years, and when I was the Minister, I had to intervene personally to get the commissioners to London to try to sort out the case. Josh is now back in Cornwall, but it took far too long for that to happen. Such cases must put families under intolerable pressure and strain.

I should mention the areas where the problem is at its worst. In the Lancashire Care NHS Foundation Trust, there were 30 cases in August. Again, that is one a day. In the Kent and Medway NHS and Social Care Partnership Trust the figure was 30, in West London Mental Health NHS Trust it was 25 and in Birmingham and Solihull Mental Health NHS Foundation Trust it was 25. Again, there is the caveat that we do not know where the responsibility lies, but we should all accept that the practice is not acceptable and has to be brought to an end.

The data focus on non-specialist beds. There will be cases, just as with physical health problems, where a patient needs specialist input and where a referral to a specialist hospital, such as Papworth in the case of a heart condition, is appropriate. However, non-specialist beds and services should surely be provided closer to home. So we got these data together and they now allow us to hold the system to account. As well as establishing the dataset, we got Monitor and the Trust Development Authority to do, to use the jargon, deep dives into a number of organisations, both good organisations and those with a bad record of out-of-area placements, to get a better understanding of what was going on. When they reported back to me, their conclusion was that this problem ought to be solvable.

That is the important point for the Minister. It is not that this problem is something we would all love to solve but find it impossible to do. It is achievable, but it requires drive, ambition and determination to see it through. If I may, as an ex-Minister, I will offer a bit of advice to the incumbent. It is no good saying that we need to make incremental progress to reduce the numbers. We need to establish the principle that this practice is not acceptable. Someone in a mental health crisis who does not require specialist care should not be sent away from home, full stop. This is not a difficult issue. It should become what in the NHS is known as a “never event”—it should never happen. If we know that there is a link between this practice and an increased risk of suicide, how can we tolerate it?

The Minister has to set the objective of ending this practice. I understand that it will take time. Back in March, I wanted to see it end by the end of this calendar year. I recognise that that is now not achievable, but I set the objective of ending it within 12 months. That is achievable, provided that there is drive, ambition and purpose to make it happen.

A related issue is that of money. I have made it clear that I totally sign up to the importance of doing things differently and making better use of resources to achieve good results for people. However, investment is needed in mental health. In the negotiations in the run-up to the March Budget, my right hon. Friend the Member for Sheffield, Hallam (Mr Clegg) secured £1.25 billion of extra investment in children and young people’s mental health services for the five-year period of this Parliament. In year 1, the amount that ought to have arrived on an equitable division of that £1.25 billion was £250 million. The amount that was made available was £143 million, which means there is a shortfall.

We were told that that was because we were part way through the year, we had had the general election and we needed to make sure that the money was spent effectively. I sort of accepted that explanation, but I have since heard from reliable sources that there was a land grab going on and that money was taken away from children and young people’s mental health services to prop up the finances of acute hospitals, for example. I urge the Government to make good the shortfall in future years.

On 13 October, the Minister helpfully reconfirmed that the full £1.25 billion would be spent in this Parliament. I call on him to repeat that commitment today. It is critical that the extra investment that was confirmed in the Budget in March is stuck to. It is a matter of good faith by the Government and I would like to hear that confirmation. I also think, incidentally, that we should make good the shortfall in year 2 because, just as with the rest of the NHS, frontloading the money to invest in change is the best way to use the resources that are available.

I will move towards the end of my contribution, which has been rather elongated owing to the additional time that is available. I will end by asking specific questions of the Minister. I would be grateful if he addressed each of them directly this afternoon. If he is unable answer any of those questions directly, I would be grateful if he wrote to me as soon as possible and responded to them directly.

First is the issue of principle. Does the Minister accept that this practice is intolerable? I am not talking about specialist beds; I am talking about non-specialist beds where someone at a moment of mental health crisis, or in other circumstances, is shunted around the country—a practice that would never be tolerated in physical health. Secondly, will he commit to ending that practice completely within 12 months, and effectively to make it a “never event”? Thirdly, will he personally drive that change, because I know from experience that that is necessary? He needs to be on the case constantly to ensure that the system responds to that moral imperative.

Fourthly, will he ensure that all providers provide the data that their contracts oblige them to provide to the information centre? Anything short of that is completely unacceptable. The data are still in experimental form, and information centre notes state that they provide a “reference point” for a more accurate measurement in the future. There must therefore be an evolution to get to a point where data around the country are completely accurate, so that providers and commissioners can be held to account. Will the Minister commit to ensuring that the experimental data are turned into final-form data that we can all rely on?

Finally, will the Minister reconfirm his total and absolute commitment to ensuring that £1.25 billion of additional investment is spent on children and young people’s mental health services this Parliament? Will he commit to sticking with the vision that we published in October last year and to introduce comprehensive maximum waiting time standards? I did that work—which led to the publication of that document—in collaboration with the Secretary of State, and he was incredibly helpful in supporting me to get that published. The vision was clear, and it recognised that until we have comprehensive waiting time standards for mental health, just as exist for physical health, we will not get equality of access to treatment. An essential principle in a publicly funded service is that all people must have the same right to receive evidence-based treatment on a timely basis. As I have said, will the Minister write to confirm any specific point that he feels unable to deal with this afternoon?

--- Later in debate ---

[Norman Lamb]

One of the recommendations from the taskforce that NHS England established to look at tier 4 services, at the number of beds required across the system and at the variability of the services was that treatment should always be contained within a region —in other words, that no child who lives in the south-west should ever go out of the south-west for treatment. I cannot remember where the child from Torbay had to go—

[Kevin Foster]

Berkshire.

[Norman Lamb]

Indeed. Is the Minister going to stick to that? Is he going to ensure that that is the objective, and will he monitor it to ensure that he meets it?