In the House of Commons Tuesday 28th June, 2011 the Rt Hon Tony Lloyd MP, spoke in a Westminster Hall ‘Private Members’ debate (Edale Unit Manchester) of his frustration at not being able to obtain satisfactory answers to questions relating to the proposed closure of a hospital unit that deals with some of the most vulnerable people in the City of Manchester . Manchester Mental Health and Social Care Trust, runs the newly built Edale House Hospital Unit based in the grounds of Manchester Royal Infirmary, Manchester. The MP for Central Manchester, spoke at length and with passion about his concerns for people in Manchester who may have, or may have a family member who suffers a long-term mental health condition. More and more people are concerned that the Commissioners, who tasked with commissioning the correct mental health services for the City of Manchester are seemingly failing in their administration and duty of care towards its public. . In an atmosphere of bullying tactics, Manchester Users Network have received many past warnings of pending danger to patients care because of the problems that have arisen as a result of medical staff who are so scared of the repercussions of speaking out with their concerns for patients health that many have themselves become ill . A spokesperson for MUN said, “We welcome Parliaments involvement in all matters that may improve patients and staff member’s health and wellbeing, it is long overdue”.
In the Palace of Westminster, the Rt Hon Mr Lloyd MP, said, “It is a pleasure to have this debate under your chairmanship, Mr Walker, I am delighted to see the Minister here. However, I express regret on her behalf, as the debate would not have been necessary, had the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for care services, had the courtesy to meet me some weeks ago. I asked to meet him to discuss an important issue, not simply a local one, regarding how decisions are made in the NHS.
The subject of the debate is a mental health facility in Manchester. The Edale unit was a custom-built facility for in-patient mental health services, for people with acute mental health problems who need that type of dedicated care. It was built as part of the private finance initiative that totally transformed central Manchester hospital facilities in my constituency. The Edale unit opened only four or five years ago, and offers five wards and single rooms, many of which are en-suite. It has gyms, therapy rooms, quiet rooms and other facilities that, even now, are pretty much state of the art. It is therefore astonishing that some time last year—I do not know when because the mental health trust did not have the courtesy to inform me as the local MP—plans were made to close the unit and relocate it to a refurbished unit some miles away.
The first I knew about those plans was when the Manchester Users Network for those who use mental health services wrote to me, and to others, stating that it regarded the proposed relocation as deleterious. The group pointed out that it would be difficult for people to travel from central Manchester to the relocated site. That patient recovery is clearly helped by contact and support from networks, families and friends, and that it would be more difficult for some people to receive that support if the unit were located away from the centre at a site in north Manchester. The Manchester Users Network raised a number of other issues, and I am grateful to its chairman, Alan Hartman, and to others, for making me aware of what had been proposed. At that point, I was neutral about the proposals and wanted simply to be persuaded. I began to ask questions about the changes but, quite frankly, it is difficult because I have not received answers to the important questions.
One might think that a brand new facility, built to precise designs by the mental health trust, would be worth keeping. The trust said, however, that on cost grounds it made sense to close the facility. It claims that it will make savings of £1.7 million a year in running costs, which may be true, although it is not clear how such savings will be achieved. Nevertheless, even if we accept that figure as part of the basic argument, that does not justify the closure of a unit that the trust was so recently involved in designing.
The situation becomes even more bizarre when we learn that some £2.3 million of non-recoverable fixed costs will fall on the central Manchester health trust as a result of the closure of the Edale facility. In other words, there will be a loss of £600,000. That does not make accounting or economic sense, and even if it narrowly makes sense for the mental health trust, it does not make sense for the taxpayer.
I have never received answers as to whether the figures that I have cited on different occasions are right or wrong. If that imbalance exists and it will cost the NHS and the taxpayer more to close the facility than to keep it open, it will be a scandal to allow the relocation to go ahead. In any case, nearly £5 million worth of new capital costs will be needed to refurbish the old facility to which the mental health trust wants to move the present unit. A huge argument needs to be made to justify the cost equation, and Ministers, the strategic health authority, the mental health trust and the primary care trust have not yet provided answers to that.
Perhaps the cost will be balanced out if we have a much better facility for users of mental health facilities and their families in Manchester. The difficulty with that argument is that those groups who have been in touch with me feel as one that the proposed move will be a bad thing—I say as one, although in fairness one or two senior consultants from the mental health trust have told me that they are in favour of the move.
I have also received a letter which, although sadly anonymous, no one would dispute comes from clinicians. The letter is about the proposed changes, and warns that the transfer of the Edale unit to Park house in north Manchester would be a move to an
“Overcrowded, predominantly dormitory set up. This will predictably increase violence and morbidity on the ward.”
The letter goes on to say, among other things, that the move will
“Hinder the contact of the patient with their family—”
—again, a point made by the Manchester Users Network. The letter rails against the fact that there are already numerous transfers to Edale house from the facility in north Manchester for reasons of privacy and space, and states:
“Most senior clinicians of the Trust are very cynical and disillusioned with this plan and appalled that the Strategic Health Authority has not put a stop to this.”
That is quite strong language from the clinicians, although I admit that it is an anonymous letter, which makes it difficult to validate.
When the mental health trusts, and others, were scoping possible changes, they came up with a number of options. From all those available, the option that scored the lowest was that now adopted by the mental health trust. The weighted benefit score was a combination of inputs from clinical leaders, service users, carers and the wider community, and using those scores, the proposed relocation to Park house not only received the lowest mark but was deemed far worse than the “do nothing” option—in other words, to keep the Edale unit open. That assessment was not made by anonymous clinicians or users; it is the in-house weighted benefits score that was used to determine how to proceed. On that basis, I am at a loss to know the clinical justification behind the move. It is not necessarily that there is no case to be made, but the case has not been made to the wider public and it seems that for the mental health trust, cost is still the dominant issue.
More recently, a minute from the board meeting papers of the strategic health authority seemed to attempt to undermine the validity of the Edale unit. It stated:
“The Trust has indicated that any option to retain the Edale Unit is deemed to be unviable given their severe concerns regarding the design of the Edale Unit which include multiple ligature points, unsecured windows, dangerous balcony, and lack of access to outside space. The Trust does not feel the faults are rectifiable.”
That seems to be a damning critique of the unit. Catalyst, the PFI partner that developed the whole of the central Manchester site, was so concerned that it attempted to engage with the mental health trust. A letter sent to Mark Ogden, the chief executive of the strategic health authority, stated:
“Following our contact with the staff at Edale we had a telephone call from a Mr Paul Fitzpatrick who introduced himself as the lead for health & safety for the Manchester Mental Health and Social Care Trust. His manner was extremely abrupt; despite repeatedly requesting details of the alleged breaches to health and safety in order for us to address them, Mr Fitzpatrick hung up the telephone on us without divulging any details of the alleged breaches.”
That would be farcical if it were not so serious. A paid operative of the mental health trust refused to discuss with the developer the problems that were minuted in the strategic health authority’s board meeting. It gets slightly easier because Catalyst sensibly went out of its way to see whether there was any validity in the allegations. It commissioned a health and safety report and looked at whether anything needed rectifying. It replied to the strategic health authority:
“We are sure that you will be pleased to see that the allegations were groundless and we would like to agree a mutually acceptable amendment to the minutes of your meeting”.
I think that Catalyst has every right to ask for that retraction if the allegations cannot be made to stand up, not because I want to defend Catalyst—it is up to Catalyst to defend itself—but because it has been used as part of the polemic about the unit’s closure.
We are now in very serious territory, because the point that I am making to the Minister is this. On cost grounds, the closure does not add up. On quality-of-service grounds, it is a very uncertain case. I have had a reply from the chief executive of the mental health trust, who goes through a number of things that she says are improvements in the move from Edale to Park house. However, none of those supposed improvements is location-specific. They could be achieved—if they need to be achieved—either at the Edale unit or at Park house.
The physical environment that the mental health trust proposes to move to is certainly inferior. The facility has been refurbished, but not, I am told, to an amazingly high standard, although that has to be proved. It is certainly the case that, instead of offering the single rooms that the Edale unit offers, that facility will have dormitory accommodation. One of the concerns that people involved with the treatment of mental illness have put to me is that, with that type of dormitory accommodation, when more than one person in the dormitory is in a very distressed condition that is a combination that is simply not acceptable in terms of the best possible type of treatment. There are real doubts even about the capacity of the proposed alternative if it is brought to fruition.
I cannot quote Greater Manchester police officially on this matter, but I have talked to individual police officers. It will perhaps be difficult for the Minister to know the physical geography of Manchester—why should she?—but the Edale unit is very close to the city centre. Crumpsall hospital in north Manchester is a considerable way from the city centre. One of the realities of policing in a city such as Manchester is that there are times when people who are severely distressed during bouts of mental illness and mental health breakdown are taken to the accident and emergency unit at the Manchester Royal infirmary, which is close to the city centre and part of the central Manchester site. When the clinicians recognise that the people brought in need mental health treatment—mental illness treatment—they can be transferred across the hospital site to the Edale unit.
I know from talking to police officers that exactly that happens regularly. Their concern has been expressed to me in this way—again, I point out that this is not GMP force policy. If they take people to the A and E unit at the central Manchester site and are told that the people need treatment in a mental health unit. They will have to transfer them physically, with all the use of police time at busy times of the week—on a Friday night or Saturday night—from the centre of Manchester up to the new unit in north Manchester. I say to the Minister that I fail to understand why the police were not a formal consultee in this process, because that seems a fairly obvious thing to have asked about.
The location matters in its own right. This is not a location-free decision. There are better locations in central Manchester than the north Manchester site. That is not to say that there should be nothing in north Manchester. I represent constituents across the north and the centre of the city. What I am asking the Minister for is some sense that the decisions really have been thought through and that there are proper answers to the very serious doubts that have been raised. As yet, I have not heard those answers.
I come finally to what may be the most important issue of all. I have been very concerned for a long time about the governance of the mental health trust in Manchester. I have met representatives of the strategic health authority. I have had many meetings over the years about the situation there. Most recently, there was an inquest into the death of Peter Thompson, a man who was certainly an alcoholic. Who died outside the Edale unit. The coroner and the jury involved made quite hard-hitting reports on his death. The coroner issued a report under rule 43 of the Coroners Rules 1984. He says in his letter to the mental health trust:
“This rule provides that where the evidence at an inquest gives rise to a concern that circumstances creating a risk of other deaths will occur or will continue to exist in the future. In the coroner’s opinion, action should be taken to prevent the occurrence or continuation of such circumstances, or to eliminate or reduce the risk of death created by such circumstances. The coroner may report the circumstances to a person who may have power to take such action.”
This is quite a strong thing for the coroner to have done: he has reported to the mental health trust that it needs to take action.
Section 8 of the conclusions of the report of the inquest said:
“The court received independent expert evidence from a Professor of mental health nursing, who identified and confirmed several failures in management and planning.”
In relation to the actions that the coroner urged should be taken, he said:
“It was noted that there seemed to be a general lack of appropriate management and control of the ward staff…The court was concerned about the general competence and professionalism of the staff and their actual ability to do the job…What is required is effective leadership and management. This appeared to be absent.”
This matter is not sub-judice, Mr Walker—I must make that point in case it is of concern to you. It is already in the public domain. The coroner sent the rule 43 letter to the mental health trust and to other interested parties. I will not argue about the nature of cuts in modern Britain—that is a fallacious argument. I believe that the mental health trust in the city of Manchester has been underfunded for many years. I believe that, in the desperate need to find cost savings, the mental health trust has come up with a scheme that will save the mental health trust money. However, it
does not deal with the real issues of a mental health trust that is not managing its affairs properly, which is putting—in this case, literally—the life of someone at risk.
We must do better. Frankly, it is not good enough for the Minister responsible for care services to refuse a meeting with me to talk about these issues. I would not have been raising them today in this public forum had I had a private meeting with him. May I invite this Minister to say that there will now be a proper investigation of the way in which the decision was made, to satisfy not just me but the public that on cost grounds and on care grounds, the decision is optimal. Most importantly, we must now begin to get to grips with the management malaise that the coroner identified and that other people have raised as a concern. If we do not do that, we not only let down those who are mentally ill; we may put them at the most serious risk.
The Parliamentary Under-Secretary of State for Health (Anne Milton): Still we are here, Mr Walker—how lovely!
I congratulate the hon. Member for Manchester Central (Tony Lloyd) on securing the debate. I would join him; I am sure, in paying tribute to the skills and dedication of mental health professionals not just in Manchester, but also throughout the country. They do a fine job, often in very difficult circumstances. However, he was right to say at the end of his speech that we must do better. Mental health services have often been the Cinderella services. It has been extremely difficult to get them the priority that they deserve. From my perspective as a Minister responsible for public health, I see the prevention of poor mental health as being as much a priority as the prevention of poor physical health. I know that the hon. Gentleman has campaigned locally on health issues in his constituency and is a very strong supporter of all that goes on. Unfortunately, my hon. Friend the Minister of State, Department of Health, who has responsibility for care services, is tied up with the Health and Social Care Bill today. However, I am sure that he will read the record of this debate with interest.
I cannot unravel this story in the time available to me, so I hope that the hon. Gentleman will bear with me when I raise a number of issues that are pertinent. I shall come in my conclusion to what I feel is the best way forward. There is no doubt that any change brings uncertainty. I can well understand how plans to transfer
local mental health in-patient beds naturally provoke concern. I understand the hon. Gentleman’s surprise at the relocation of beds from a newly built facility. He particularly mentioned the central location of Edale as important, and the views of the police not having been sought. I cannot comment on that, but his point is well made.
Let me give a little background on where we are with mental health services. We have launched “No health without mental health: a cross-Government mental health outcomes strategy for people of all ages”, which has two aims: improving the population’s mental health and improving services. The mental health strategy takes a life-course approach and sends a clear message that prevention, early diagnosis, and early intervention are key priorities.
We would expect the bulk of the strategy to be delivered locally by experts on the ground working with services users, their families and carers, and, in some circumstances, the local police. Through the Cabinet Sub-Committee on Public Health and the ministerial advisory group, Ministers will continue to pay close attention to the delivery of the improvements set out in the strategy. There is no doubt that services in the community and closer to patients’ homes are better for recovery and encourage independence, although in-patient beds are needed at times.
The ministerial advisory group will bring together the new NHS commissioning board, Public Health England and a range of stakeholders, including clinical commissioning groups, the voluntary, community sectors, and local authorities—one cannot underestimate the role that local authorities have to play in providing services for people with mental illness. Once the proposed NHS commissioning board and Public Health England are fully operational, we anticipate that they will become the focus for all stakeholders to lead the implementation of the mental health strategy and to review its progress.
The NHS in Manchester is working to strengthen its community-based services and to reduce reliance on acute care for those with a mental illness. That should be about improving quality, not introducing cost-saving measures. That follows the strategy set out in the national service framework for mental health services, which the Labour party introduced when it was in government. Indeed, there is cross-party consensus that investing more in community-based support benefits patients, and there is a growing body of evidence to support that. What people are fearful of is that such support is a cost-cutting measure.
I am told that Manchester Mental Health and Social Care Trust has worked closely with staff, service users, carers and other stakeholders, including the Manchester local involvement network and the Manchester carers forum, to develop proposals for rationalising its in-patient services for adults and older adults with mental health problems. The hon. Gentleman might not feel that that work has been sufficient, but it is important to put on the record what the local NHS feels it has done, which, as he rightly said, involves reducing the number of in-patient sites
The proposals will maintain the same number of beds, and I am told that only one in 17 mental health service users requiring in-patient services in Manchester will be affected. Service users who are in receipt of community support from adult and later life community teams at the nearby Rawnsley building and those who attend out-patient appointments will not notice any changes to services as a result of the relocation of beds. Alternative accommodation for the non-in-patient services based at Edale house is being sought in more appropriate community settings. I do not know Manchester well, but I am sure that there are other community settings in which such services can be provided.
The trust expects to achieve a number of clinical benefits, although the hon. Gentleman is perhaps somewhat cynical about that. It feels that those benefits will include a greater concentration of staffing expertise, an improved level of support on wards, a reduction in delays for treatment and the development of specialist services. We probably need to concentrate specialist services ever more to get the expertise we need.
Tony Lloyd: I am genuinely sympathetic to the Minister, who has been given her briefing. I mean no disrespect to her or her speech, but the problem is that such claims are easy to make; indeed, the 100-bed Edale unit could deliver concentration in exactly the same way. It is just not obvious that the mental health trust is doing anything more than providing words as a façade for its decision. It has given no explanation of why the change is better, or why the present situation is worse, other than this fallacious nonsense about the Edale unit not being up to standard.
Anne Milton: I thank the hon. Gentleman for his intervention. I should probably have started with the end of my speech, but I will come to the direction I feel he should move in.
The Government have pledged that all service changes must in future be led by clinicians and patients, and not driven from the top. The Department has outlined and strengthened the criteria that any decisions on NHS service changes are expected to meet. Decisions must focus on improving patient outcomes, and the hon. Gentleman mentioned quality, although the issue is obviously open to debate locally. Decisions must also consider patient choice, have support from GP commissioners and be based on sound evidence.
I must stress that the NHS is not run from Whitehall, and a lot of local issues need to be looked at locally. The overview and scrutiny committee has confirmed that it is satisfied that appropriate involvement has taken place. The mental health trust is exploring the feasibility of introducing a defined transport system at the committee’s request to ensure that service users and their families have suitable access.
The hon. Gentleman mentioned the tragic case of Peter Thompson, and my sympathies are always with the friends and families involved in such situations. The case has clearly raised significant issues, not least that of good leadership, which is critical to ensuring that good services are available. I would expect the local NHS to learn from this tragic incident and to ensure that it does not happen again.
The chief executive of the mental health trust has written to the hon. Gentleman and offered him a meeting on three occasions—28 February, 25 May and more recently. I urge the hon. Gentleman to have that meeting, because he is clearly unhappy about a lot of issues. He mentioned the anonymous letter he had received, and if its authors get sight of this debate, I hope they will come to see him in confidence—like all Members, I know that he would keep their identities confidential. The letter has raised some concern, but it is difficult to do anything about it while it is anonymous. I am sure that the hon. Gentleman’s assurance that it is from clinicians would hold up.
I urge the hon. Gentleman to meet the chief executive. He clearly remains open-minded, but he is anxious to be convinced. He describes a complex story, in the middle of which we have a tragic death and the coroner highlighting some important issues. I am sorry that I cannot give the hon. Gentleman more in the debate, but the best way forward would be for him to meet the chief executive.
Tony Lloyd: I would, of course, be happy to meet the chief executive, but what I have really been offered is a meeting to tell me why the trust is going ahead with the decision that it has already made. I want explanations, and that is what the public and the taxpayer are entitled to. If I do not get that explanation, can I come back to the Minister and her colleagues and at least get some sense that they are engaged in dealing with what could be a scandal?
Anne Milton: I thank the hon. Gentleman for that intervention. That is right: he should see the chief executive and ask for an explanation. As he rightly says, he is open-minded and wants to be convinced. If he still does not get an explanation that satisfies him that things are being done to improve patients’ quality of care, I am sure that my hon. Friend the Minister of State would meet him. He would be welcome to come back to us with any issues, but I urge him to have a meeting with the chief executive first.
Watch The Debate from the Westminster Hall : Visit: http://www.parliamentlive.tv/Main/Player.aspx?meetingId=8637&st=12:59:00