David Lammy – 2016 Speech on Mental Health Services


Below is the text of the speech made by David Lammy in the House of Commons on 28 April 2016.

I am grateful to have the opportunity of this debate on this very serious subject. I am pleased to be joined by my hon. Friend the Member for Hornsey and Wood Green (Catherine West), who stands with me on this debate and also wants to speak about our mental health services in Haringey.

Let me state from the outset that I have the utmost respect for and gratitude towards all the staff working within Barnet, Enfield and Haringey Mental Health NHS Trust, who tirelessly care for some of the most vulnerable members of our community. Not least among those is the trust’s chief executive, Maria Kane, who has been recognised by the Health Service Journal as a top NHS chief executive who was shown to be doing a stellar job in the recent BBC “Panorama” film, “Britain’s Mental Health Crisis”. They have all been asked to do, frankly, an impossible job in the constituency and in the London borough of Haringey, which has 12 of the most deprived wards in the country where 2,284 people are receiving personal independence payments, over 270 different languages are spoken, 1,334 people have had their benefits sanctioned, and 826 households have found themselves homeless in the past year. 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 to the House today because it is unacceptable that, despite the fact that mental health problems cost the economy £100 billion per year, three out of every four people with mental health problems in England receive little or no help for their condition. I suspect that that figure is far higher in my constituency, given the high level of need. Today in this country mental health problems are not just some form of rare disease. The truth is that one in every four people will suffer from mental health problems during the course of this year.

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. 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 under 75 years of age. It is a sobering picture, then, that the average age of a male suffering from a severe mental health problem in my constituency may be under 55. 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 this year found that men of African and Caribbean heritage are up to 6.6 times more likely to be admitted as in-patients or detained under the Mental Health Act 1983, indicating a systemic failure to provide effective crisis care for these groups. The taskforce’s draft report also revealed that men from these groups are, on average, detained for five times longer.
As mental health problems affect so many lives, 23% of the UK’s burden of disease is mental health. That figure is higher than the burden of disease in cancer or in cardiovascular disease, which stands at 16.2%. Why then do mental health services receive only 11% of the NHS’s budget? It is clear that institutional bias against providing proper care for people suffering from mental health problems persists in 2016.

It was as far back as February 2011 that the coalition Government published their strategy for improving the nation’s mental health, which stated the now much-trumpeted concept of parity of esteem—an idea that began with a Lords amendment from Labour peers in the other place. Then, the very first section of the coalition Government’s infamous Health and Social Care Act 2012, which contained the central duty imposed on the Secretary of State in relation to our treasured national health service, was amended to put these services on an apparently equal footing. However, the reality already facing mental health patients across the country in 2014 was something different: mental health funding was cut for the first time in 10 years, and there were 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 the year and finally announced some funding. However, given that the budget had previously been cut, I find it difficult to see how it was a net increase, not least given the pressures of an ageing population. The Prime Minister announced that those particular funds would be targeted towards helping new and expectant mothers with poor mental health and towards liaison between mental health services, A&E departments and crisis teams, but that is not what I am seeing on the ground.

As demonstrated so vividly in BBC’s “Panorama”, 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 on them. The reality is that 3,000 mental health beds have been cut across the country in the past five to six years.

However bleak the national picture, it does not get anywhere close to the gaping holes in funding for mental health services that face the patients of Barnet, Enfield and Haringey Mental Health NHS Trust. Despite the obvious and ever-increasing need, that trust, on top of the vast inequality between physical and mental health services, receives a lower share of income proportionately than any other mental health provider in London. It is hard to understand how an area that includes Tottenham gets the lowest level of funding in London.

The trust has already done so much cost-cutting over the years that it is the most efficient NHS mental health provider in London. It already has the lowest number of acute mental health in-patient beds in London and higher productivity than other providers. It has also been proven to be underfunded over the course of not one or two, but three independent reports. The first of those reports was back in early 2014, the second in late 2014, and the third in October 2015. The independent evidence is that the trust needs £4 million a 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 that the trust now anticipates a deficit of £12.9 million in 2016-17.

The reality locally is that St Ann’s hospital in my constituency has lost a third of its beds in the past eight years alone, and this is a hospital that is obliged under section 136 of the Mental Health Act 1983 to find a bed for every patient detained under that section because they pose a risk to their own life or to the lives of others. We are not talking about varicose veins or wisdom teeth; losing beds in these circumstances has a dire impact.

My hon. Friend the Member for Hornsey and Wood Green will be aware of a recent case in the constituency. A young man whom I have known all his life attempted suicide and it has had a life-changing physical effect on his body. My hon. Friend might say a little more about that case, but it happened directly because there was no bed for him.

St Ann’s hospital is constantly running at over 100% capacity, while other mental health providers in London run at 85% to 90%. With each new admission, St Ann’s wards each have to nominate their “least ill patients” for discharge back into the community. Despite the efforts of staff, does that really present a safe outcome for those vulnerable patients and their families? Is that really a safe outcome for the community that requires the trust to serve it as best it can?

The shortfall in income is not the only problem 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 that was designed to meet the needs of 19th-century fever patients, long before the discovery of antibiotics, rather than the delivery of therapeutic interventions appropriate to current patients’ needs.

Indeed, the most recent Care Quality Commission inspection found that

“the physical environment of the three inpatient…wards”

on the St Ann’s site was

“not fit for purpose due to its age and layout. This impacts on the trusts ability to deliver safe services within this environment.”

That is a problem that the site has tried to resolve on the 28-acre St Ann’s site over the last decade.

Finally, the trust submitted plans to develop the site last year. It hopes to fund a new hospital and other health services on one third of the site by building homes on the remaining land. I have to say that I oppose those proposals, because they include only 14% affordable housing, even though London has a housing crisis. Despite my objections, the trust was granted planning permission in March last year.

There is an alternative proposal—it is a great proposal, which needs support—to build a community land trust. That is exactly what successive Mayors of London have said they want to see. It would result in affordable homes being built on the site, it would be holistic and it would fit with the mental health plan. I hope that the Minister might take an interest in it and that the next Mayor of London, whoever that is, will also take an interest.

The trust’s plan would not require any capital from NHS England. I have to ask why, on this site and in this constituency, and given the circumstances in which the trust finds itself, no capital is forthcoming from NHS England. It seems that the decision about whether to build a new hospital has, once again, been pushed by the Government into the long grass, and we have been given no date at all.

This debate about mental health comes on the back of a debate that I secured about the situation of primary care in the borough. I have raised both those subjects because I am seriously worried about health in the London Borough of Haringey and in my constituency. Despite myriad problems, only 16 months ago the independent Carnell Farrar review of the affordability of mental health services provided by the trust found that there was no compelling evidence to support merging the trust with any other organisation; that the trust is relatively efficient; and that there is a clear case for clinical commissioning groups to invest in it.

I had hoped that that would mark the end of the speculation about the trust’s future, but the CQC report, published in March this year, of the routine inspection conducted in December 2015 gave the trust an overall rating of “requires improvement”. It is no surprise to me that that is the case, despite the efforts of staff and leadership, when funding is so tight and the level of need is so high. The CQC report stated that out of 11 areas, five required improvement, five were good and one was outstanding.

The report concluded that mental health admission wards for adults required improvement, community-based mental health services required improvement, child and adolescent mental health required improvement, specialist community health services for children and young people required improvement and crisis mental health, 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 on the table to enable the trust to comply.

I am grateful to the Minister for last week agreeing to my November request for a cross-party delegation of local MPs to come and discuss our concerns about the trust. Let me put on record what I call on him to do to help the trust, to ensure that the services that it provides are safe and that work begins to ensure true equality between physical and mental health services in Haringey. The context is important, not just because of the suicide rate in England—the number of suicides recently soared to 4,881 in 2014—but, most disturbingly, because the draft version of that report stated that had just £10 million extra been spent on services for people who were suicidal, 400 extra lives would have been saved. For the sake of £25,000, which is less than the national average salary, each of those lives could have been saved.

I call on the Minister urgently to 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. I ask the Minister to visit the St Ann’s site to see the problems for himself, and I ask him to earmark appropriate funding for the crisis team and children’s mental health services.

I must warn the Minister that we have seen some terrible cases in my constituency. A young boy was injured and died outside his secondary school as he left with three friends. Police officers were assaulted with a machete. We have seen suicide and attempted suicide, with catastrophic consequences, in the recent past. I trust the Minister will ensure that the trust receives the funding it needs, and that he will recognise the CQC recommendations. By having this debate, I am putting him on notice of the real concerns about the development of the St Ann’s site and the real need to bear down on the pressures that the trust is under, in this pretty tough part of north London.