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  • Dan Poulter – 2023 Speech on the Draft Mental Health Bill 2022

    Dan Poulter – 2023 Speech on the Draft Mental Health Bill 2022

    The speech made by Dan Poulter, the Conservative MP for Central Suffolk and North Ipswich, in the House of Commons on 26 January 2023.

    I first draw the House’s attention to my entry in the Register of Members’ Financial Interests as a practising NHS psychiatrist.

    The Joint Committee on the Draft Mental Health Bill was formed on 4 July 2022 to scrutinise this important and urgently needed reform of mental health legislation. Our Committee has been working hard since that date. We held 21 meetings in just over 12 sitting weeks, spoke with more than 50 witnesses, received more than 100 submissions of written evidence, and engaged with affected communities through surveys, roundtables and a visit to the mental health unit at Lambeth Hospital. We are grateful to everyone who took time to contribute to our inquiry, to the officials and Ministers at the Department of Health and Social Care for their engagement with our work, and to our specialist advisers and secretariat.

    Working on the Joint Committee was a collaborative process as we worked together through this complex topic and learned from each other’s expertise. There were differences of opinion, which may be reflected in later debates in this place. However, the fact that we felt it important to agree the report unanimously is testament to the Committee’s dedication to getting this once-in-a-generation piece of legislation on to the statute book. Our work was supported by an excellent team of officials and Clerks from both Houses. The Committee is grateful for their expertise and support in our work and in compiling the report.

    The Mental Health Bill has been much anticipated. Detention rates under the Mental Health Act are rising. A disproportionate number of people from black and ethnic minority communities are detained. Our attitude as a society towards mental health has changed and reform is needed. We welcome the principles contained in the draft Bill, which introduces important reforms to improve patient choice, bring down detentions and reduce racial inequality. In our inquiry we heard concerns about implementation, resourcing and possible unintended consequences of the proposed legislation. Our recommendations address those concerns and are intended to make this important Bill stronger and more workable.

    However, the process of mental health reform cannot stop or even pause with this Bill; there needs to be further consideration of fusion legislation of the mental health and mental capacity laws. During our evidence it became apparent that someone needs to drive mental health reform on behalf of patients, families and carers. We have recommended the creation of a mental health commissioner to oversee that process and to challenge the stigma that still exists around serious and enduring mental illness.

    Proper resourcing and implementation will be crucial for the changes to work. Mental health services are under enormous pressure, and significant changes and improvements are needed to provide high-quality community alternatives to in-patient care, particularly ensuring that there will be a sufficient workforce to deliver the proposed changes. We welcome commitments from the Government to increase spending on health and social care, but most people we spoke to, including mental health providers, were still unconvinced that current resourcing or workforce plans are adequate. The Government must publish a detailed plan for resourcing and implementation on introducing the Bill, including the implications for the workforce. They should report annually to Parliament on their progress against that plan.

    The independent review structured its work around four key principles that should shape care and treatment under the Mental Health Act. Those principles were: choice and autonomy, least restriction, therapeutic benefit and the person as an individual. These principles should be included in the Bill to ensure that they endure and become a driver of cultural change.

    Tackling racial inequalities in the use of the Mental Health Act must be at the core of the reform. Black people are four times more likely to be detained under the Mental Health Act than white people, and 11 times more likely to be given a community treatment order. Those figures are rising. There has been a collective failure to address this issue. We now feel that the time has come for that to be addressed. Understanding of racial inequality must be included in the Bill. There must be a responsible person in every health organisation to monitor data on inequalities and oversee policies for change. We heard evidence that community treatment orders are ineffective for most patients and disproportionately used for black patients. We have therefore recommended that they are abolished for civil patients and reviewed for use with forensic patients.

    On the important issue of the detention criteria, the draft Bill makes changes to the grounds on which someone can be detained for assessment and treatment, with the intention of moving away from a risk-based model and ensuring that detention will benefit the patient. Accountability is welcome, but we heard that it may lead to people being denied the help they need when they most need it, particularly patients with psychotic illnesses and those with chronic and enduring mental illness. We recommend some changes to the criteria and greater guidance in the code of practice to prevent that.

    Too many autistic people and those with learning disabilities are detained in inappropriate mental health facilities, and for too long. Change to the way the Mental Health Act works for patients with learning disabilities and autism is long overdue. The Government’s intention to address that, by removing learning disabilities and autism as conditions that can justify long-term detention under section 3 of the Mental Health Act, may lead to benefits in the longer term. However, we heard that without proper implementation, those changes could make the situation worse, and potential displacement of people with learning disabilities into the criminal justice system could occur. There must be improvements in community care before people with learning disabilities and autistic people can be supported to live in the community. It is vital that reforms are not implemented until that is achieved.

    Another pressing risk is that those communities may be detained, instead, under different legal powers, and possibly criminalised. That would be the opposite of what the change is intended to achieve. The Government must address that risk before the changes are implemented. We have therefore recommended the introduction of a tightly defined power to allow for longer detention periods in exceptional circumstances, with strong safeguards in place to prevent that happening unnecessarily.

    On patient choice, patients should be able to make choices about their care and treatment. The draft Bill makes welcome changes in this area but does not follow through on a White Paper commitment to give patients statutory rights to request an advance choice document. We heard almost unanimous evidence supporting an advance choices document, and made a recommendation that advance choices should be a statutory right.

    The number of children and young people experiencing mental distress has risen dramatically since the covid-19 pandemic. Children and young people continue to be placed in adult wards or in hospitals far from home due to the lack of appropriate care placements. The draft Bill misses a crucial opportunity to address that. We also believe that children should benefit from stronger protections in the draft Bill to support patient choice. This is a complex area and the Government need to carefully think through their proposals, consulting further where necessary about this Bill and how it will interact with the Children Act 2004.

    In conclusion, it is 40 years since the Mental Health Act 1983. This draft Bill is needed. If the Government are willing to address our concerns in the ways that we have suggested, the Bill can make an important contribution to the modernisation of mental health legislation. Given our suggested amendments, we hope that the Government act swiftly to introduce the Bill to Parliament in this Session, so that it can be further scrutinised and improved.

    Dr Rosena Allin-Khan (Tooting) (Lab)

    I thank all those patients, campaigners and experts who provided evidence to the Joint Committee. I give special thanks to Alexis Quinn, whose account of her own lived experience with autism touched many Committee members. I also thank the Committee members for what was an incredibly valuable experience and a true example of when cross-party working goes really well.

    I am honoured to have worked on a once-in-a-generation opportunity to improve the rights of patients experiencing a mental health crisis, and to tackle the health inequalities enshrined in current legislation. For years the Government kicked updating this legislation into the long grass, and now the draft Bill still does not go far enough to tackle the health inequalities and racial disparities of those detained under the Mental Health Act. I hope the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) will agree that the Government should put patient voices at the heart of this legislation and take the Joint Committee’s recommendations on board.

    Dr Poulter

    On behalf of the Committee, I thank the hon. Lady for all her work. We were lucky that we had her professional expertise as a frontline clinician, which added to our important scrutiny work. Given that it has been 40 years since there were any changes to the Mental Health Act, I certainly agree that the time has come to make those changes through a Bill. We urge the Government to take on board our well-intentioned recommendations and concerns to strengthen the Bill, and I hope we will continue to see a cross-party, collaborative process to improve mental health care for the patients who most need it.

    The Minister of State, Department of Health and Social Care (Will Quince)

    I sincerely thank my hon. Friend and the Committee for all the work that has been put into this constructive and important report, and I also thank all those who gave evidence to the Committee. The Government are now considering the Committee’s recommendations on how we can further improve the Bill and modernise the Mental Health Act. The Minister for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), gave evidence to the Committee in November, alongside the Minister for prisons, parole and probation, my right hon. Friend the Member for East Hampshire (Damian Hinds).

    I am grateful to see that the final report reflects the support that these reforms have on both sides of the House. The Committee has clearly engaged fully with the complexities involved in this work. It is the Government’s intention to take the next steps in getting this legislation right, so that people with severe mental health needs get the help and support when they need it, with their rights and dignity better respected. It is vital that we continue to progress the work we have started with NHS England and others to address the racial disparities that have for too long been associated with the use of the Act. Does my hon. Friend agree that the reforms proposed in the Mental Health Bill provide for an improved framework in which people experiencing the most serious mental health conditions will have far more choice and influence over their treatment?

    Dr Poulter

    I agree with the Minister. He is right to suggest that this is an important step forward and this piece of legislation will make a significant difference to patients, but it is part of a process, not the end of the journey. In particular, I draw the Government’s attention to the potential unintended consequences of some of the well-meaning changes being proposed in relation to patients with learning disabilities and autism and to changing the grounds for detention; for example, it might be harder to detain patients who are the most unwell, with chronic and enduring mental illness and psychotic conditions. I hope the Government will take on board those concerns and ensure that what comes back to this place is a stronger Bill that works in the best interests of patients.

    Fleur Anderson (Putney) (Lab)

    I welcome this report, and in particular the section on racial inequalities, which have been highlighted in my constituency by organisations such as the Wandsworth Community Empowerment Network for many years. Is the hon. Member optimistic after hearing all the evidence from organisations that the inequalities affecting black and minority ethnic groups, especially in terms of culture and policy, will be improved?

    Dr Poulter

    I am optimistic that if the Government adopt the recommendations we have made, we will have a much stronger Bill that recognises that we need to improve the care that is available to all patients and, in particular, that will deal with some of the racial disparities we currently see in the implementation of the Mental Health Act. We know that black people—particularly black men—are disproportionately detained under the Mental Health Act and are disproportionately likely to receive a community treatment order, or a CTO, as I would term it in professional jargon. There is also a disproportionate use of depot medication for black men. That has caused challenges in building therapeutic relationships and building trust with black communities across London and elsewhere, and it has to be put right.

    We have made several recommendations. For example, we believe that the evidence for CTOs is weak for all patients, and there is a disproportionate use of CTOs among the black community, so we have said that we think community treatment orders should not be applied in the civil part of the Bill. We have also recommended greater monitoring of how mental health legislation is used in each mental health provider, to ensure that providers, be they in London or elsewhere, have a proper understanding of how mental health legislation is used. Hopefully, that will start the process of rebuilding the trust of communities—particularly the black community—with mental health providers where it has been lost in the past.

    Dr Ben Spencer (Runnymede and Weybridge) (Con)

    I draw the House’s attention to my range of interests in this area, which were declared as part of the Committee’s report. I thank my hon. Friend for his statement and join him in thanking all those involved in the Committee, in particular the Clerks and the staff, who were fantastic in supporting us as we put this report together.

    Every 20 years or so, we go through a process of reviewing our mental health legislation. I am delighted at the work that has been done over the past few years through the Wessely review panel and driven by the Government, to make real changes in this very important area of law. Notwithstanding the huge step forward that the Bill will hopefully make in this area, does my hon. Friend agree that this is the beginning of a journey of continuous reform, rather than the end point?

    Dr Poulter

    The Committee was very lucky that we had the professional expertise of my hon. Friend, the hon. Member for Tooting (Dr Allin-Khan), a former president of the Royal College of Psychiatrists and some distinguished lawyers. I know that my hon. Friend has taken a great interest in this issue for many years, and he is right: this is the beginning of a process, not an end in itself. The Committee recognised that much needed to be done by a future Government to bring fusion between mental capacity law and mental health law, of which I know he was a great advocate throughout our work.

    Jim Shannon (Strangford) (DUP)

    I thank the Committee for its recommendations and the hon. Gentleman for his presentation of this report. Each and every one of us recognises the importance of these recommendations, which are for both patients and staff, and they should be commended to all the devolved Administrations—in particular the Northern Ireland Assembly, as health is devolved. Will that happen, and if not, could he make sure that it does?

    Dr Poulter

    I thank the hon. Member for his question. As part of our work, we looked at elements of reform that are being considered across the devolved Administrations. The fusion of mental health law and mental capacity law is already well under way in Northern Ireland, so it may be a question of the UK Parliament learning from the Northern Ireland Assembly, rather than the other way round. We in this place will continue to watch with interest how the proposed changes to legislation in Northern Ireland progress, as they may improve what we do when we look in the future, I hope, at a fusion of mental health law and mental capacity law.

  • Dan Poulter – 2022 Article on Increasing Pay for Nurses

    Dan Poulter – 2022 Article on Increasing Pay for Nurses

    A section of the article written by Dan Poulter, the Conservative MP for Central Suffolk and North Ipswich, with the full article in the Guardian on 16 December 2022.

    The government’s decision to squeeze nursing pay will push more nurses to vote with their feet, to leave the NHS and earn more money by either working for temporary NHS staffing agencies or to work for private healthcare providers. This could even result in the perverse situation where reductions in real-terms pay mean that the same nurse could leave their NHS job and return to work for the NHS, perhaps even in the same hospital department, as an agency nurse. The NHS will foot the bill for the agency costs and the increased salary paid to the nurse.

    This is poor healthcare economics. Pay needs to be set at a level that helps to recruit and retain the NHS workforce and the time has come for some joined-up thinking from government. Investing in better pay for nurses and other NHS staff would help improve staff retention and reduce the ever-growing temporary staff bill.

  • Dan Poulter – 2018 Speech on Mental Health Services in Norfolk and Suffolk

    Below is the text of the speech made by Dan Poulter, the Conservative MP for Central Suffolk and North Ipswich, in the House of Commons on 2 May 2018.

    I thank you, Madam Deputy Speaker, and Mr Speaker for granting this debate on mental health services in Norfolk and Suffolk and the challenges they face.

    Quite rightly, the Government have talked a lot over the last few years about parity of esteem between mental and physical health and about the need to invest more in mental health services. Indeed, there has been limited extra investment in Norfolk and Suffolk. None the less, the NHS trust has faced challenges that are affecting the quality of patient care. Tonight is a good opportunity to bring before the House some of those issues and, hopefully, to offer some solutions and appeal to the Government to do more to help the trust in very difficult times, because ultimately it is the patients who suffer when trusts are in difficult circumstances.

    First, I would like to pay tribute to Gary Page, who is the chair of the Norfolk and Suffolk mental health trust. Despite very challenging circumstances, difficult Care Quality Commission reports and the financial pressures that have faced services in Norfolk and Suffolk for many years, he has worked hard to make sure that there has been continuity. It is thanks to his leadership that the trust is now able to move forward and address some of the challenges that it faces with the quality of care.

    I want to talk briefly about some of the issues involved, focusing mainly on ward closures and the points raised in the CQC report. I want to outline to the House some of the fundamental issues with staff shortages, which are probably the worst in almost any mental health trust in the country. I want to talk a little further about the finances of the trust, and I also want to talk about some of the difficulties there have been in how the trust works with addiction services and how that is counterproductive to the effective care and treatment of patients.

    Although my medical work is not currently in the east of England, I want to draw attention to my declaration in the Register of Members’ Financial Interests. I am a practising NHS doctor working in mental health services, which of course gives me some insight into the challenges faced by the trust, although I do not think that interest is particularly applicable in this case, because my medical work is not done in the region.

    The quality of care challenges facing the trust are quite extensive. As the Minister will be aware, the trust was put into special measures in October 2017. There are significant pressures on beds within local services, resulting in higher numbers of out-of-area placements for patients. Many patients are now having to be transported out of area to be treated because of the closure of beds, which is not good medical practice. It is not good for patients either, because they will be a long way away from their support networks, and it interferes with the effective post-hospital care and rehabilitation that is so important in co-ordinating with community services.

    The challenges appears to centre on patient flow into beds and delays to discharge. We know that there is a historical lack of community mental health services in ​Norfolk and Suffolk, and investment has not been available to increase them at the necessary speed and rate. There are challenges with housing providers in the area not necessarily working closely enough with the trust, and there are also the pressures on social services that we know too well exist across the country. Those pressures are very relevant in Norfolk and Suffolk, where we have a lot of older patients with dementia who are struggling to be discharged effectively into the community because of delays in receiving adequate social services. A lot of the blame for that has been attributed to the mental health trust, but many factors are beyond its control.

    The trust also faces significant challenges with the quality of its buildings infrastructure. Many of its buildings are old and not fit for purpose. The capital budget has not been available to improve the buildings, although there has been some new building work. I will come on to that in a moment.

    Sandy Martin (Ipswich) (Lab) My meetings over the past three weeks with the new chief executive and others have given me cause to hope that the structural problems are now being addressed. A new co-produced community services partnership, commissioned by the clinical commissioning groups and involving Norfolk and Suffolk NHS Foundation Trust, Ipswich and West Suffolk hospitals, the county council and the GP federation, is embarking on a level of integration that has never been tried before in the United Kingdom, working with district councils, schools and the voluntary sector to make mental health everyone’s business. Does the hon. Gentleman agree that the Government have a real interest in seeing whether that model can succeed? Will he support me in calling on the Minister to provide sufficient pilot funding for the project, so that Norfolk and Suffolk NHS Foundation Trust can recruit the staff it needs to make the new model capable of success?

    Dr Poulter I thank my constituency neighbour for that intervention. I entirely agree with everything he says, although I am not sure it is quite so pioneering—I think the hospitals in London would probably disagree with that. There is a lot of good work going on in London built around exactly that sort of model of more integrated care.

    One of the challenges faced by the trust in the past, and which mental health trusts in general face, is the failure of many partner organisations to properly engage on issues such as the provision of adequate social care for patients with chronic and long-term mental illness and dementia. There is also the failure of housing providers to be involved and of the police to be properly involved. There is a big overlap between some people with mental ill health and presentation to the police, when they would be better looked after by the NHS.

    This project is the right way forward, with more integration of services and better integration between mental and physical health. Many patients with chronic mental health needs have physical health problems. They are sometimes a side-effect of the drugs, but are often a result of a chaotic lifestyle. Better joined-up working with the local NHS undoubtedly has to be a good thing. For that to be effective, however, as we have seen in some pilot projects in London, there needs to be the funding to deliver it. The mental health trust is not in the best financial shape—I will come on to that ​later—and support from the Government through funding for this innovative way of working, which I think is certainly a first in a rural area, would be very welcome. I hope the Minister may be able to provide some reassurance on that this evening.

    Peter Aldous (Waveney) (Con) I congratulate my hon. Friend and constituency neighbour on securing the debate. Before he goes on to talk about the money, which is very important, does he agree that it is very important that the trust promotes and endorses local, tailor-made initiatives such as the trauma-informed approach currently being promoted in Lowestoft by mental health champions Tod Sullivan and Paul Hammond?

    Dr Poulter Yes, that is absolutely the right way to provide integrated services and joined-up care, because we cannot necessarily have a one-size-fits-all approach across Suffolk or Norfolk. We need to look at the local healthcare need. That is partly about working not just with housing providers, social services providers, primary care and GPs, as I believe is happening in my hon. Friend’s constituency, but with the voluntary sector, other third sector providers and local charities, many of which have knowledge of the needs of patients, families and carers. When we are providing joined-up, holistic mental healthcare, it is just as important to make sure that the approach is joined up and holistic in that regard, and I believe that the project in my hon. Friend’s constituency will have a very good chance of improving services for patients.

    Jim Shannon (Strangford) (DUP) Will the hon. Gentleman give way?

    Dr Poulter I will make a bit of progress first and give way in two or three minutes.

    The challenge from a lack of bed capacity is acute; 36 beds have been closed in recent months, 28 of them temporarily to be reopened as soon as possible. One of the challenges, as my constituency neighbour, the hon. Member for Ipswich (Sandy Martin) said, comes from the lack of joined-up working and a failure of commissioners, to some extent, to work collaboratively with the trust to identify short-term solutions. None of us wants to see patients travelling outside Suffolk. The commissioners have not worked well with the trust, because beds are available. My neighbour, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who is unable to speak because of her Government role, has rightly highlighted that bed capacity is available at the Chimneys in Bury St Edmunds—18 beds, including specialist eating disorder beds, which are available and could be commissioned if the commissioners worked more collaboratively and supported the leadership of the trust more effectively. I hope that will come out of the collaborative and pioneering work on which the trust’s partners are now supporting it.

    None the less, there are some positive things to point towards. Building work is going on to deliver some new wards, and it is hoped that Lark ward in Ipswich, the psychiatric intensive care unit, will be able to reopen later this year. There are hopes that more can be done for child and adolescent mental health services, with continuing expansion in the number of beds.

    ​Jim Shannon I congratulate the hon. Gentleman on securing the debate. I sought his permission to intervene beforehand and told him why I wanted to. With the prevalence of mental health issues at 25% higher in Northern Ireland than in the rest of the United Kingdom, and with our NHS unable to meet the demand on the service, does he not agree that mental health reform must be UK-wide and undertaken urgently, before people who simply need a bit of help to cope become people who need in-patient care and a strong drug regime to survive? Do it now and it can stop problems later.

    Dr Poulter I agree entirely with my hon. Friend. He is always a strong advocate for the needs of his Strangford constituents. He is right to highlight that early intervention and early support can be very effective. That is partly because it often prevents some of the other unwanted effects of having a mental illness. When people have been untreated for a long period, they may well lose their job and struggle with their relationships. A number of the supportive and protective factors that can help to support someone through mild and moderate ill health, such as being in work or in a supportive relationship, can be lost. If we can do more to help people in the early stages, that is a good thing—quite apart from it potentially reducing the number of acute admissions later on.

    I want to make the important point that the staff shortages at the trust are one of the major challenges that need to be addressed. It is frankly, and I do not use this word lightly—I do not think I have ever used it before, even though we often hear it used by politicians—a scandal that there is such a shortage of staff at Norfolk and Suffolk mental health trust. I hope the Minister can think of better ways to fund and support the trust. Without enough staff, it cannot expand services or deliver safe services. The trust has struggled with CQC inspections because there are not enough staff on the ground to deliver the care it wants to deliver. That is not entirely the fault of the trust, however, as it is constrained by its funding.

    I will outline some of the issues that the trust faces. It has had difficulty recruiting band 5 registered mental health nurses—there are approximately 125 full-time vacancies; there are 35 full-time equivalent vacancies for psychiatrists, partly owing to a national shortage, but also owing to particular challenges in the east of England; almost one in five medical posts at the trust are vacant—that means that doctors who should be there treating patients are not because of staff shortages; and 16.02% of qualified nursing posts are vacant. That is not acceptable or sustainable. If we are to improve patient care and help the trust turn around, the fundamental issue of recruitment has to be addressed. There are fewer than 15 psychiatrists per 100,000 people in the region, which is much lower than the national average. In fact, the east of England has the fewest psychiatrists per head of population in the country.

    Doctor recruitment is not a good story either. Issues with the junior doctor contract might not have helped, but we are where we are. Recruitment for CT1 junior doctors in 2017 saw only 16 of 45 vacancies filled—that is 36%—so only one third of the number of doctors who should have started training at CT1 level are working in the trust. That is a big rota gap to fill and will of course affect patient care. In 2015-16, about one third of ST4 vacancies in child and adolescent psychiatry ​were filled. In general adult psychiatry, which is the bread and butter of psychiatry, only nine of 18 posts were filled in 2015. In 2017, only five of 22 posts were filled, which means that less than a quarter of posts for registrar trainees in general adult psychiatry are filled. The story goes on and is equally bad in older-age psychiatry—and we have a lot of older people with dementia to look after in the east of England.

    Recruitment, then, is vital. We have to do more to recruit psychiatrists. The current strategies are not working, so I ask the Minister to look at what has been successful overseas—in Queensland, Australia, and other places—and to put financial incentives in place to support nurses and doctors to come and work in the east of England, because at the moment patients are paying the price for a lack of doctors on the ground. The trust is doing its best to recruit, but it needs extra financial support through Health Education England, and it needs to be given support and the go-ahead from the Department. We know from elsewhere in the world that financial incentives work in rural and coastal areas, as long as doctors and nurses are helped with a relocation package. The Department’s successful health visitor programme is a good example of how financial incentives can work. I hope she will look at that.

    The pressures on the trust’s finances have been there for many years—since the merger of Norfolk and Suffolk mental health trusts—and we know that mental health has been underfunded nationally for decades. The trust needs £9.2 million to meet CQC recommendations for improvement. Some £4 million can be funded from the capital budget, but given that the CQC has criticised the building’s infrastructure, it seems ironic to raid the capital budget for buildings and infrastructure and put it into the revenue budget to deal with immediate quality of care issues.

    Even with that £4 million, however, there is still a shortfall of £5.2 million, and that was the subject of a recent funding bid to NHS England. The bid will be resubmitted fairly soon, and I hope the Minister will encourage NHS England to look favourably on it. It is important that the trust be given the financial wherewithal to deal with the quality issues raised by the CQC, to reinvest in vital community services and to undertake the vital work on integration that my constituency neighbour, the hon. Member for Ipswich, mentioned in his intervention.

    There is some positive news. The ligature reduction project is proceeding successfully, and some good work is being done in the rebuilding programme at Chatterton House. The Norfolk and Waveney perinatal mental health service was launched in September. I pioneered support for the expansion of perinatal mental health services when I was a Minister, and I am pleased to see that it is now happening on the ground. In February a specialist perinatal mental health service was launched in Suffolk, which is a very good development. However, severe challenges remain and need to be addressed.

    Finally, let me say something about services for patients with addictions. I will be brutally honest: I think that we created a problem with effective addiction treatment through the Health and Social Care Act 2012. The commissioning of addiction services has been transferred to local authorities, although the bulk of mental health services and physical health care for patients with addictions is still run by the NHS.​

    In the east of England, the amount invested in drug misuse services has been reduced by about £6 million over the last four years. Drug misuse is a serious challenge in areas such as Lowestoft, Ipswich and Norwich, not just as a result of underfunding but because those services are not working in a joined-up way with mainstream physical and mental health services. That must be addressed as a matter of urgency, because patients are falling through the net and not receiving the holistic care that they need. Many end up in the criminal justice system as a result, and the police and, in some cases, communities are picking up the pieces because of the failure to provide joined-up care for those patients. The lack of substance misuse services as part of any NHS system affects the dynamics and practicalities of good care, such as the sharing of information. Barriers are created, and the good intentions of staff on the front line are undermined. That has an adverse effect, and I am sure that we will continue to see a rise in the number of drug-related deaths as a consequence.

    Let me ask the Minister some questions. What additional support can be offered to the trust to help it to deal with its historical and current financial challenges and transform its services in the wake of the CQC’s report? There is a shortfall in funding; the trust has submitted a funding bid, and I hope that the Minister will support it. What additional resources can be made available to improve the recruitment and retention of psychiatrists and nurses, and what can be done to attract junior doctors to the east of England? One in five doctors who should be at work are not there because of staff vacancies. What steps are being taken to stop the transfer of patients out of area for treatment? Finally, what can be done to ensure that there is proper integration of addiction services with mental health services in our region, to ensure that patients are given a better deal?

    It is time for the rhetoric about mental health to join up with the reality, and for patient care to improve. It is time for Norfolk and Suffolk mental health trust to be given the support that it needs, so that it can do the best for its patients.