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Mental Health Services (Mid-Surrey)

1.29 pm

Chris Grayling (Epsom and Ewell): I shall start by expressing my gratitude to the Minister of State, Department of Health, the hon. Member for Redditch (Jacqui Smith), for allowing me to take some time out of her busy diary today. I want to raise a number of issues in relation to the provision of mental health services in my constituency and in mid-Surrey generally.

The Minister will be aware that mental health services have been a cornerstone of the community in Epsom for the best part of a century. Epsom has played host to five substantial mental hospitals, which were set up in the early years of the 20th century. At their peak they held approximately 10,000 residents; they were a dominating feature of that part of my constituency. Nearly 100 years later, with the advent of care in the community, the ethos of caring for those with learning disabilities and mental health problems has changed.

Over the past decade or so, we have seen a gradual move from institutional care to a more community-based provision. Step by step, those five hospitals have ceased to be used for their original purpose. Many arguments can be made for and against community-based services. The changes that have taken place have thrown up a large number of concerns in the Epsom area, which I suspect are invisible to the Government because that substantial and obvious block of care is no longer being provided in the area.

I want to raise three issues, the first of which concerns the debate that has been taking place over a number of years between the NHS and the parents and relatives of residents at St. Ebba's hospital, some of whom still live there. Secondly, I am concerned about how health service structures impact on mental health care in mid-Surrey. Thirdly—I am afraid that it often comes down to this—I draw the hon. Lady's attention to funding. I do not come here with a begging bowl, but when future NHS funding decisions are taken I want her to be aware of the particular circumstances of my constituency, and the fact that our problems could be overlooked when assessments for a broader funding formulae are made.

The Minister will be aware that a number of parents and relatives of patients at St. Ebba's have been arguing strongly for a long time for the creation of a village community on the site. Indeed, the Government have given much attention to the principle of village communities, because they deliver a high quality of mental health care in many parts of the county. St. Ebba's poses a conundrum because it is not always apparent from the exchange of letters between the Department for Health and the parents and relatives of the patients that two issues are involved, the first of which concerns what will happen to the residual services provided by Surrey Oaklands NHS trust on the St. Ebba's site.

The Minister may be aware that there has been some debate, and not a little controversy, about the trust's plans. A controversial planning application was recently lost on appeal for the provision of flats on the site. The trust is also putting a number of smaller units on the site to absorb some of the residents from St. Ebba's for whom care in the community may not be the right option.

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A final solution to the trust's future provision is not yet in place, but the goal of the parents and relatives group is rather different. Surrey Oaklands is considering its current operations and what still needs to be done, but the parents and relatives have been arguing for a long time that using part of the St. Ebba's site as a village community could offer much more than is offered to current residents. There has been much debate about whether a village community would be appropriate and feasible. Over the years, the parents and relatives have drawn carefully on the Government's policy on villages. Most recently, in a letter to my one of my constituents on 17 May, the Department made it clear that options for the care of people with learning disabilities and other mental health care problems

and stated:

That is right, and there is no dispute or debate about it. The parents and relatives group, with which my predecessor, Sir Archie Hamilton, worked actively, has argued for a number of years that St. Ebba's site should be used to provide such a community, to ensure that there is a proper mix of care in the area. There are pros and cons and planning issues to consider. Whether the borough council will permit the development of such a complex and whether the authorities are providing the resources and the people to populate such a community we cannot be certain. However, I think that the Government have an opportunity to clear up the issue. My belief is shared by senior people in Surrey Oaklands and in the NHS community locally.

One of my reasons for initiating the debate was to explain to the Minister why I think that that opportunity exists, and to ask her whether she will consider taking it. Two of the five hospitals, The Manor and Long Grove, have been fully developed: they have been completed and are fully populated. The Horton hospital site is up for sale to developers and the outline plans are clearly in place. I expect development to go ahead within the next year or two. The fourth hospital, West Park, is still partly used by Surrey Oaklands for a number of services—I shall touch on one of them later—and is just reaching the point at which outline planning permission is being sought. Detailed discussions are taking place about the development. I should tell the Minister that NHS Estates and the local authorities will find themselves under a lot of pressure over a controversial road scheme as part of that development, but I shall not be distracted on to that today.

NHS Estates now has two big developments to deal with: the Horton site and West Park. It is also beginning to turn its attention to St. Ebba's. However, I would argue that it cannot do everything at once. These are five substantial sites, and if there is to be substantial construction work at Horton and West Park, work at St. Ebba's should be further down the track.

The Government should tell the parents and relatives of the residents of St. Ebba's that they do not know whether they are right, but they are prepared to give them an 18-month window and an option on the 12 acres at the St. Ebba's site that they are considering

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taking on. They should be told to put forward a commercial, viable proposition, backed by the private sector and the local authorities, if they believe that it is right to do so. If they can show the Government that there is a business case and a care case for what they want to do, and that people could valuably take advantage of a village community in the area, let them do so, because it would not damage NHS Estates' ambitions to develop the other sites in the area one jot.

Therefore my first request to the Minister is to give those parents and relatives an 18-month window, so that they can come back with a solution. If they cannot do that, we know where we stand. If they can, there is an exciting option for the future that would do credit to everyone involved if it were given serious consideration.

My second concern relates to NHS structures. It is particularly associated with a seemingly growing commitment in the NHS to focus services on London, where it is delivering services to London. Whereas, in the past, a number of services have crossed boundaries, there is an increasing tendency within the NHS in London to do things itself. That has most recently manifested itself in one of the remaining units on the West Park site, the Woodside adolescent unit. Over a number of years, that has provided a service across a wide range of authority areas for young people with particular mental health problems. Discussions are taking place within the Surrey Oaklands NHS trust about the future model of care that would be required for that service, and such a debate has been taking place for some time. Surrey Oaklands is now being forced into a decision to close that unit because the principal buying source in London—Merton, Sutton and Wandsworth—has decided that it will no longer buy that service from Surrey but will establish its own unit two miles up the road in Tolworth.

Clearly, there are clinical and health considerations to be taken into account in determining the rights and wrongs of the matter, but I am concerned that that decision has been taken as a result of the desire of the NHS in London to deliver its own services. I am sure that the Minister would agree that it makes no sense to break up a team in north Surrey only to recreate a team in London. Will she ensure that no curtain is drawn across the London boundary that prevents services from being provided across that boundary? If London purchasing power is removed—it was London purchasing power that built up the services in Epsom in the first place—the community in Surrey will not have the services that it needs.

I am also concerned about proposals to establish a mental health trust for the whole of Surrey, because the last thing that Surrey Oaklands needs is another reorganisation. I ask the Minister to think carefully before pressing ahead with that option.

I now turn to finance and resources. There were 10,000 residents in Surrey hospitals, many of whom are now of pensionable age. Their families can no longer support them, although their relatives have done a wonderful job in trying to provide support in difficult situations. As a result, there is now an older community of people in the area who are more dispersed than before, and because Epsom was a magnet for people with learning disabilities and mental health problems,

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that community is disproportionately large. My concern is that the Government will take a decision on resourcing for Surrey based on many other factors. It would be easy for the Government to decide that the prosperous area of Surrey does not need the same resourcing as other areas, and for that mental health community to be forgotten.

That approach manifests itself to me most clearly in the fate of the mental health citizens advice bureau in Epsom. That service has been run by the local CAB for several years and provides valuable support. The chairman of the CAB told me that he no longer receives NHS or Government funding. He has been able to secure interim finance from a charitable source, but the service risks disappearing in 12 months' time. There is a need to provide a disproportionately high level of support services to that community, but I fear that services may be eroded because funding decisions will be taken according to much broader formulae. I ask the Minister to bear that in mind when making future service and funding decisions.

My concern is shared by others. Mid-Surrey Mencap has expressed its concern about insufficient funding being available for Surrey social services to meet the needs of the mental health community. I have received letters and e-mails from other people involved in mental health who say that funding decisions are eroding their ability to provide the necessary support for people with learning disabilities and mental health problems in the Epsom area.

Can we lay the issue of St. Ebba's to rest once and for all? Will the Government please take extreme care over what the NHS does as regards providing services across the London border? Will they please also ensure that future funding decisions do not remove core services from a relatively substantial community of people who have a special need? These are wonderful people. I visited a home the other day and met a gentleman in his 60s who had had mental health problems all his life, but who was the most wonderful pianist. I have visited and spoken to many of the devoted staff who care for such people. They deserve my support as their Member of Parliament and the support of the Government, and I hope that they continue to get it. I hope, too, that the Minister will take steps to make their jobs easier.

1.45 pm

The Minister of State, Department of Health (Jacqui Smith) : I congratulate the hon. Member for Epsom and Ewell (Chris Grayling) on securing this debate. He took a very measured approach to describing his constituents' concerns and the operation of the system in Surrey. I hope to be able to give his constituents some assurances, although I may not be able to give them all the assurances that they are hoping for. I can, however, promise him that the needs of service users will remain the primary concern throughout the many changes that are taking place in the provision of mental health services and of services for those with learning disabilities. I think that we share that objective.

The Government have proved that they attach significant importance to mental health. It was not only the focus of the first national service framework, which was issued in March 1999, but one of our clinical priorities in terms of investment. The national service

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framework put in place a 10-year programme with new, high standards for mental health care services. It clearly stated what services should aim to achieve, how they should be developed and delivered, and how to measure performance in every part of the country. Standards were set in five crucial areas: mental health promotion; primary care and access to services; effective services for people with severe mental illness; carers; and the action necessary to reduce suicides.

Although the framework concentrated on the mental health needs of people of working age, we are also dealing with the needs of children, adolescents and the elderly through other national service frameworks. The framework for older people was published in March 2001, and contains a dedicated standard on mental health for older people, which requires the NHS and social services to put in place by April 2004 plans for integrated mental health services for older people. My Department is also working on the children's national service framework, and one module will be dedicated to the mental health and psychological well-being of children and young people, which clearly relates to the issues that the hon. Gentleman raised about the Woodside unit.

In July 2000, the NHS plan built on the first national service framework, and provided for extra investment in mental health of more than £300 million by 2004. The purpose of that extra investment is to fast forward the implementation of the framework and to ensure that NHS commitments are delivered. It has already provided almost 500 extra secure beds; more than 320 24-hour staffed beds; 170 assertive outreach teams to provide intensive support and follow-up to patients who were being lost to services, often with tragic results; and access to services 24 hours a day, 7 days a week for all those with complex mental health needs. In addition, we have provided investment to improve the physical environment in psychiatric wards, and issued guidance to ensure the safety, privacy and dignity of mental health patients.

The hon. Gentleman touched on the long-term care of people with learning disabilities, which is an important service that is often linked with mental health provision. There is no doubt that improvements were desperately needed in that area of care. People often spent a great part of their lives in large hospitals, often living in conditions that would not be tolerated now, because it was widely assumed that they had no expectancy of a normal life and would have little chance of making any contribution to the wider community.

Times and attitudes started to change, and it began to be recognised that many residents would do better in smaller, community-based care homes. However, when the old institutions closed, the comprehensive local health services needed to care for people too often failed to materialise. The Government recognised that it was vital that people with learning disabilities were properly supported in a variety of settings and given access to appropriate resources such as housing, education and work, to ensure that they had the quality of life to which they were entitled. Such concerns culminated in the publication in March 2001 of the White Paper "Valuing People", which was the first White Paper for 30 years on the care of people with learning disabilities.

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The Government initiatives outlined in the White Paper and the changed attitudes that I mentioned have resulted in real benefits for a large and previously neglected group of people. We welcome that, but we must not ignore the fact that change is often stressful. It takes no imagination to understand how frightening such change must be to patients who have lived for many years in the institutional system and to their families, although many mental health professionals have stories about how the most unlikely people have thrived when given the opportunity to live in the community with the support necessary to make that a reality. We must ensure that the option to do so is open to all, but there will still be people whose needs are best served by care in the more traditional setting, and appropriate provision must be made for them.

The hon. Gentleman clearly highlighted the St. Ebba's issue. He will know that that redevelopment came about because of concerns that the residents' quality of life was not what it should have been. They lived in dormitory accommodation in turn-of-the-century buildings. They had little privacy, personal space or ability to choose how and with whom they spent their day.

I am sure that the hon. Gentleman appreciates that the future configuration of the St. Ebba's site, including the development of a village community, is a matter that must be determined locally. It is not a matter in which Ministers can intervene. However, I can assure his constituents that health and social services authorities will continue to work with parents, relatives, carers and, most importantly, the residents themselves to ensure that people with learning disabilities are placed in the care environment that is right for their individual needs.

Chris Grayling : It is true that the part of St. Ebba's that is being dealt with by the Surrey Oaklands NHS trust remains very much a local service but, at present, the remainder of the site is under the auspices of NHS Estates, which is one reason for diverting the matter to Ministers.

Jacqui Smith : I think the hon. Gentleman would agree that it is vital that we release resources that are tied up in surplus NHS properties owned by the Secretary of State and plough the funds back into the NHS for the benefit of all. For that reason, surplus NHS land, including that at St. Ebba's, is sold. I have some sympathy with those who are concerned about the future of their relatives following the changes at St. Ebba's, but I do not believe that we can put off the business case that has been made for selling the land on the basis of what the hon. Gentleman agreed was an uncertain prospect.

I am willing to consider the timetable for the sale of the land, but I would not want the hon. Gentleman to go away with the feeling that it would be sensible or efficient to lose the significant financial benefits from the sale of the land because of some of the plans that he discussed. He stated the Government's position on housing for those with learning disabilities, and I am aware of the need to carry out properly a full assessment of the care

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needs of those at St. Ebba's, for example, and to ensure that appropriate care arrangements are put in place. I have been assured by the local commissioner that the proposals that have been developed fulfil that duty, but housing is key to the lives of those with learning disabilities. That is why we made it clear in the White Paper that there is no veto on any option, including village communities, and that where there is limited demand for a particular option, councils and housing authorities may need to consider joining neighbouring authorities to encourage development of a greater range of provision.

Turning to Woodside, the Government recognise the importance of ensuring that a full range of child and adolescent mental health services is available to those who need them. Our ongoing commitment included extra investment of £35 million last year to assist health and local authorities to meet the requirement to improve provision of appropriate high-quality care and treatment for children and young people by building up locally based services. I have a problem with the hon. Gentleman's contention that we should protect a service in one part of the country by preventing another part of the country from developing precisely those locally based services.

It is probably good for young people with mental health problems if the services they need are developed near to them or in London so that they can be easily accessed. It is precisely that demand for the sort of services currently offered at Woodside that is the basis of the need to change and of the considerations of closure. Of course it is important that health commissioners work with other key agencies and providers—I understand that they are doing so—to plan and develop provision to ensure that there is better integration and joint work between tier 3, which covers specialist outreach and out-patient services, and tier 4, which covers in-patient services, to improve the links and provide a 24-hour crisis response team, better outreach and respite services and early intervention in psychosis. All will require some change—change is difficult for users and clinicians—and careful planning and involvement of users and professionals.

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Although a decision has been made by Surrey Oaklands NHS trust to close the Woodside unit, I assure the hon. Gentleman that the views of those most directly affected will be key to the development of the new services. A steering group consisting of staff, clinicians, commissioners, carers and users has been established to conduct a review of the services currently supplied by Woodside and to recommend how the model of care delivery given to adolescents and children could be modernised in line with national policy. The group's proposals will be presented for consideration by Surrey Oaklands NHS trust later this month and will then be open to wide consultation involving all stakeholders. Their views will be taken into account before a final decision is made.

In conclusion, the hon. Gentleman referred bravely to funding and finance. I recognise his point that there are ways in the standard spending assessment distribution for local authority funding and health allocations. We must work on the formula to ensure that it delivers the necessary resources in those areas where needs are greatest and work is being done with the SSA formula and the health formula. I am sure that the hon. Gentleman agrees that the issue for Surrey may not be solely distribution but the amount of money, so I have no doubt that he welcomes the Chancellor's ongoing, extra investment into health and social services and the effect of that on his constituents.

I recognise the hon. Gentleman's concern about the particular nature of the population of those with learning difficulties. It is because we recognise the needs of those with learning disabilities, particularly with older carers, that we made that a key area for investment of the learning disability development fund.

Last year, Surrey received through local funding a 12.6 per cent. increase in its mental health grant. A further increase this year will be important to maintain the sort of services that we want for the hon. Gentleman's constituents with mental health problems and learning disabilities. Regardless of whether we are changing the system, we shall continue to place users' needs at the centre of improvements.

Question put and agreed to.

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