Lynne Featherstone

Here are the details of what I said in response to the proposals to close a ward at St Ann’s Hospital.

Following up the issue in my earlier post, I met with the Chief Exec and the Chair of Haringey Mental Health Trust this morning to discuss some of the issues raised from my advice surgeries, from my meetings with service users and organisations, from colleagues and from local people’s responses to my request for personal experiences of mental health services in Haringey.

The Trust closes its consultation next Monday on keeping permanently closed an acute ward that was flooded – permanently reducing inpatient bed capacity. The plan is to move people appropriately out of inpatient care into the community, supported by appropriate support to maintain patient safely in a stable and home setting.

An early question on the survey asks people whether they agree with the principle of looking after people in their own home as opposed to being kept in not the nicest of environments in an inpatient mental health ward. I would think that the majority of people will agree with this in principle – but it is the practicalities that are crucial and can sink the idea.

So of course we would all like to be fluffy, cuddly, let people live in their own homes – but there are a lot of buts. Buts such as …

But only if we never hear that someone couldn’t be admitted in an emergency or just prior to a crisis incident because there were no beds available. I can’t see how this can be the case if beds are reduced. The Chair and CEO said that Haringey had a high bed capacity compared to other boroughs. Users of the service tell me otherwise, talking of occasions where a patient would be sent home early because there was no capacity or where a crisis admission did not take place for between four days and four weeks because of shortage of space. Surely that does not suggest that capacity is adequate?

But only if we can be assured that care in the community is not just code for abandonment or poor support. Again, people who use the service have given me lots of instances where the home treatment team fell short. For example – the team will come once a day to ensure proper medication is taken. However, my service user describes the team as coming and when the door isn’t answered – going away without even contacting the housing manager to be let in and check what’s happened to the person. The Trust says that this is serious and shouldn’t happen – but the problem is the gap between what should happen and what does happen.

But what about the possible costs and fallout for neighbours, the police and the council if things go wrong? When the Trust says that it is cheaper to keep people in the community rather than the high costs of inpatient care – doubt whether they are counting in the cost to everyone else who is left to deal with the fall out when the care in the community fails. And the fallout isn’t just about finances when things go wrong.

There are many tales of gaps fallen through in the community care net as it is now. So how can the Trust guarantee that the care will be good enough to support even more people than before? The Chair says that the money not spent on inpatients will mean that the expenditure in the community will be enough to ensure good care. Easy promise to make, but will it stack up in reality?

There is also a belief gap in Haringey. In Haringey we do not have confidence in inspection regimes, tick-box procedures and management speak. We had all that only too recently with Baby P. How on earth can we get to a point of trust with the Trust?

There are loads more issues (lack of communication, lack of planning on transfer, 24 hour emergency line not working properly and on and on) and so will post my official response to the consultation when have finished it as it will contain more detail.

Both the Chair and the CEO wanted me to know that whilst some areas definitely need improving – they are very good at some things and have just won the commission for cognitive therapy for London. Indeed, I visited their Star Wards project when they won one of those. And given the dreadful years the Mental Health Trust had under the previous chair and management, these two have an awful lot to achieve and I am sure are trying very hard to bring about change in what is quite a stuck environment – not easy.

So – my consultation response will still focus heavily on the problems currently being experienced in terms of crisis admission with current bed capacity – and on the already stretched and reportedly unreliable care in the community. Without addressing these issues – I don’t see how the Trust can proceed.

Here’s my latest Ham & High column:

A woman came to see me recently to tell me of the appalling state of Haringey’s mental health services. Her husband is bi-polar and sometimes suicidal. From time to time he has to be admitted to the acute ward at St Ann’s – our local mental health facility.

She says the ward is enough to make you want to kill yourself. It is a ward with psychotic and highly disturbed patients. If you or I were placed in such a ward – we would be frightened – as was my constituent’s partner. He was so frightened he could not sleep at all due to the noise and disturbances from the other patients throughout the night – and of course these conditions hardly assist recovery or state of mind.

And when he’s at home and there are troubles – the theoretically 24-hour help is often on answerphone – and when not, she has even been advised just to give her husband warm milk! What a contrast with Camden, where – if you need help – a psychiatric nurse will come to your house to deal with the situation – and perhaps remove the need for admission to hospital.

To add insult to injury – with so many vulnerable people who need so much help – the Mental Health Trust is now proposing to reduce the number of acute beds at St Ann’s Hospital for those who do need admission. It may be unsuitable for some admissions – but it is all we have and we need a place of safety for those who are in acute crisis.

I am meeting with the Chair and Chief Executive and will point out how for many people, these beds are often the last resort. Acute wards are, even in St Ann’s, a place where a severely ill person is surrounded by professional nurses and doctors – even though the circumstances are clearly not ideal.

Haringey residents come to my advice surgeries to tell me how they have not been able to get their loved partner / child / parent admitted into an acute ward – despite obvious need. Of course each case has its own particular circumstances, but from questions I have asked in Parliament, it is clear that there are more people to each bed in Haringey than for almost any other area in London – and that’s before the proposed closures.

The Trust claims that people in acute need can be dealt with adequately in the community. I do welcome more support in the community, but in moments of crisis there must be the option for a higher degree of care and supervision.

And unless the care in the community is exemplary, then reducing beds in the in-patient facility we have seems mad. We should be investing in making the acute wards better – not reducing beds. My own angst is that the Trust is in such a state it is making these reductions for cost purposes rather than meeting the needs of those with mental health issues in Haringey.

The Trust is currently consulting on the issue – so now is the time for us to have our say. I am keen to hear your views, particularly if you have any direct experience of our local mental health services, so I can feed them into the consultation. You can write to me at lynne or House of Commons, London, SW1A 0AA. Please indicate whether you wish for your views to be treated confidentially or if you are happy for me to share them with the Trust.

The consultation deadline is the 23rd March, so please make sure that I get your views before then. If you want to find out a bit more about the consultation, have a look at the Trust’s website.

Also, my Liberal Democrat colleague Councillor Ron Aitken is chairing a scrutiny review at Haringey Council on the proposals – two public meetings are planned . The first was on Monday 2nd March but the next is on Wednesday 25th March at 6pm at Haringey Civic Centre. Please do come along and share your views.

All too often mental health is treated as the Cinderella service of the NHS and rarely gets the prominence or the resources it needs and deserves. I am determined that this should not be the case in our Borough.

I have set up an urgent meeting with the mental health trust following the publication of an independent investigation into the dreadful case of a paranoid schizophrenic who killed one and seriously injured four others in 2004.

The report by NHS London into the care provided to Ismail Dogan shows gross failings – both in community mental health care and an inability on the part of the Trust to make sure lessons were learnt.

It is another appalling tale of inadequacy and incompetence and worse in Haringey. Baby P was failed by Haringey Council and Haringey Primary Care Trust (PCT), and here we have the third of the trilogy – the Mental Health Trust.

In fact, in this case it looks like the cover-up, the secrecy and the closing ranks were even worse. The internal investigation into the tragedy was not even circulated to staff and middle managers across the Barnet, Enfield & Haringey Mental Health Trust, or Haringey PCT, so that pepole could learn from the incident and avoid it happening again.

The report also shows that Mr Dogan’s Psychiatric Nurse amended his notes after the incident to make out his care to be more comprehensive than it actually was. The community mental health team, who managed Mr Dogan’s care in the community, was also shown to have failed providing ongoing care, which was a direct contributor to the 2004 incident.

On top of hiding the internal investigation report it is equally worrying that the Trust’s community health team was not up to scratch in 2004. Particularly so as we are currently being asked in a consultation at the moment our views on the proposed closure of an acute mental health ward at St Ann’s in favour of care in the community. This would be an absolute disaster in my view – given the state of the care currently

A woman came to my surgery last week (obviously cannot go into detail) but I wanted to place in public the utter poverty of treatment and support for those suffering from mental health issues and their families in Haringey.

Services just seem to diminish and diminish endlessly. The ward at St Ann’s where you can be admitted as an emergency is not suitable for many of those admitted due to an episode of one sort or another – for example an episode for someone with a long-term bipolar condition.

Such a person needs to be taken in – but where they are placed is so important. Currently it is a ward with psychotic and highly disturbed patients.

If you or I were placed in such a ward – we would be frightened – as was my constituent’s partner. He was so frightened he could not sleep at all due to the noise and disturbances from the other patients throughout the night – and of course these conditions hardly assist recovery or state of mind.

There is virtually no continuity in mental health care. Senior managers were not in the slightest bit interested in helping him move elsewhere where there was a doctor who had been dealing with him and with whom he felt comfortable. They just kept passing him on – and on – and on – from one to another. There was virtually no patient engagement.

And there is no support for his wife – the woman who came to me for help. Nobody helped her when her husband was threatening suicide. And there has been a complete lack of care for him outside of the hospital. Where they have now moved to – psychiatric nurses come to the house. In Haringey, when the threats of suicide were at there worst – all my constituent got was advice from social workers who suggested that he drink some warm milk before bed.

They have moved and now get much better care and the husband is vastly improved. You should not have to move out of Haringey to get proper mental health care. Yes – I will be raising this with the new Chair of the Mental Health Trust and the PCT when I meet with them shortly.

It is an utter disgrace – and if this was your or my loved one – we would be up in arms. I hope this new Chair wants to hear what I have to say – because this is not acceptable. And if the Government say – it’s the local PCT and Mental Health Trust who are responsible – and if the PCT and local mental Health Trust say it is the Government – I think that will demonstrate pretty conclusively that the system we have to protect us and provide our local health services stinks!

Go to St Ann’s Hospital to celebrate its Lordship Ward becoming the 300th ward of the national ‘Star Wards’ project. David Lammy (MP for Tottenham) is on the visit too.

We start by meeting Marion Janner. Marion is a service user from Haringey and is a vocal campaigner and mover on the Star Wards project. This is a national project started to begin to address one of the great challenges of mental health care – that on an inpatient ward the boredom is enough to drive you to madness. It is totally counterproductive to a therapeutic outcome – and so Star Wards begins to address some of those challenges.

St Ann’s is only at the beginning of its program to generate and implement Star Wards – but judging by the enthusiasm of both staff and patients that I met this will deliver real improvement. I also visited the ‘healthy living’ part of the equation and met patient and trainer in the gym.

St Ann’s has had a difficult recent history in terms of administration at higher echelons – but as they move towards their application for ‘foundation status’ with their new Chair, Michael Fox (who I met later in the day at Parliament – coincidentally) they have hopefully moved onward and upward. And there certainly was a very positive attitude around the wards and the patients and the potential.

Two notes of discord did surface. The first was a desperate plea for me to tell the Government that they don’t want, and can’t cope with, endless new initiatives. They feel that they are barely given time to get a new directive in place and begin to embed it – before it is changed and the next headline initiative rolls in – and it’s all change, thereby never reaching a point of proper implementation and smooth running.

The second was about the service provided by the crisis centre – which deals with emergencies. The problems ranged from being answered by an answerphone (not great if you are suicidal) to being told to ‘pull yourself together’.

As I said, later in the day, I met with the new Chair of the Mental Health Trust who seems very determined to turn St Ann’s into a modern and exemplar service deliverer. There will be a need to sell around half the site to fund the new building etc. My criteria – as I told him – was about what would be provided post development, how real and thorough the consultation would be (we are sick of faux consultations) and so on. St Ann’s is not a great layout for a hospital – but it is friendly and human scale. So – we will see how all this develops over the next period.

Met with Carl Lammy – Chair of Haringey Mental Health Trust. The promised development of St Ann’s (and much needed and vital development – have you seen the antiquated mess of buildings that form St Ann’s?) has run into a storm of objections from local people concerned that what this really means is a sell-off of public land. Well – yes probably.

In this, yet again, we see this Labour government’s steam-roller approach to their avowed intent – which is to remodel the health service into specialist centres with local super health hubs within which 15% of the budget will be spent on private providers.

We didn’t ever get to vote on that. If such a switch to private providers had been from a Tory government it would have brought forth a howl of protest from Labour supporters – but this is from Labour itself. Put this together with the sell-off of public land assets to finance new builds – and you get protests.

Hence the problems St Ann’s renewal is encountering: they suffer the rage of those of us who never agreed to this program – but they have no real choice or voice in this. Local campaigners together with local politicians including my Liberal Democrat colleague Wayne Hoban and others campaigned against the closure of the X-ray service on the St Ann’s site – and that bit has had a reprieve, but it is only a reprieve. We need an X-ray department at St Ann’s. The very important eating disorder services that are there – and many others – that need frequent x-rays.

Anyway – the point is that the facilities at St Ann’s are ancient and failing. To change them to modern day standards and comfort needs money – and Labour will only make funds available on its own terms, making people jump through the hoops that it wants, regardless of local opinion. And that will see land sold, I am sure.

We have seen this happen in education and in housing and now it is health’s turn. Labour’s modernisation program means – do what we say, sell-off land and involve private companies. Now – selling off land and involving private companies can have their place on occasion – who would want to die the in ditch to say that every single last square millimetre of land owned by the NHS anywhere in the UK must be kept for all time? – but the problem with Labour is that they impose, top-down, a one-size fits all solution rather than taking individual cases on their merits and listening to what local people really want.

Selling assets and involving private firms through PFI, PPP, LIFT etc is a live now, pay later philosophy – where we getting new buildings for our aging hospitals and schools but then the pain comes down the line when we are still paying high costs year after year and all the family silver has gone.

Off to the Three Compasses (my HQ) for a council of war on what is happening to health in this borough. The cuts are cutting now deeply. Five family planning units gone or going for example. The X-ray unit at St Ann’s saved – but many, many other front line services disappearing. And why? Because of this Labour government’s lack of understanding about how best to run the health service. They have flung a fortune at the health service – most of which has gone into poorly negotiated doctor and consultant contracts. Their budgeting regime has meant that if a Trust balances its budget (much of which is achieved by cuts) then the following year it must make more ‘efficiency savings’ so that it can give its ‘surplus’ to a Trust that has failed to keep to budget. It is theatre of the absurd. It demotivates the good Trusts and rewards the ‘bad’. Except that the ‘bad’ are those Trusts that ‘overspend’ – but overspending means that they are trying to meet need in the community where elsewhere they are cutting front line services – as here.

Amongst other things, we are meeting to kick off the arrangements for the campaign to force the pace on the progress (or lack of it) on Hornsey Hospital. After the meeting we go off to Hornsey Hospital to set up the campaign shots. It looks so forlorn these days with its closure notices. It is six years since we were promised that if we (residents and Lib Dem politicians) stopped our campaign to save the hospital – then the Trust would together with us to a create new health facility for the community. So we worked with the PCT. There were public meetings and plans and public meetings and working meetings and lots of commitment – even complete planning permission at one stage. But after six years – we are nowhere.

… and on a technical note (highlight of my week this!) I’ve added links to each post so you can easily post them on del.icio.us / digit. Thanks to Technology Wrap for the tip on how to do it easily.

Flashed over to St Ann’s for a road show and meeting on the “restructuring” of mental health services in Haringey. If this is more care in the community then it had better be better resourced – given that so many people with mental health challenges come to my surgery as the support for them in the community is not adequate. The police, doctors, CAB, politicians who hold surgeries – and ultimately prisons – are all paying the price for inadequate care in the community. Don’t get me wrong – the more someone can stay in the community the better – but the services and the support just is not there in enough quantity to support the number of people who need it.

In fact – and interestingly – Haringey is the one of the ‘worst’ health authorities because they have mental health inpatients for longer than most anywhere else. However, their return rate is one of the lowest. Methinks someone should be looking at that as perhaps an indicator that shoving people out too early (much like in general health) can mean lots of return visits.

I asked for a comparative figure for the budget for drug therapies used versus budget for talking therapies. It wasn’t a question the Chair and Chief Exec could answer on the spot – but they acknowledged it was a good question and that they had no means of collecting such data. Behind my questions lies the fear that the Government is willing – as are health trusts – to fund drug therapies but not talking therapies to the same extent. I suspect this is partly because of cost – though drugs can be very expensive – but mostly because they can’t measure outcomes so easily in this target driven world we live in. Patients like talking therapies – they find it therapeutic – and possibly therein lies the point.

The other question – even better than mine – was from a user who was asking what choice the patient had in their treatment. If the patient feels better and more secure with a particular method of treatment their recovery would be better. So why should the patient have no say at all? The Chair and Chief Exec agreed that there was no choice!

The scooted over to a public meeting on the proposed expansion of Coleridge Primary School in Crouch End. Lord knows – residents, colleagues and I all campaigned and worked to get Haringey Council to buy the old TUC building to provide desperately needed school places. Crouch End parents, not surprisingly, have been going mad over the last few years over the shortage of places for their little ones.

Anyway – the building was purchased. The issue now is that the site is directly opposite an existing school – Coleridge – with a busy road between the two. So, should Coleridge be expanded, using the new site, to be a four-form entry? This would make it one of only twelve schools in the country to be that big at primary level.

The Head, the Council and the architects had obviously done a huge amount of work on designing a structure and form that would make the children still feel like it was a small family atmosphere school. However, all the work in the world could not offset the anxieties of the existing parents that their children would be ‘swamped’ in such a vastly expanded school.

The argument from the panel against creating a second school across the road, rather than expanding the existing one, was that it would split the community. But they really didn’t seem to have spent much time on an alternative – and the proposal to expand was clearly what they all regarded as the only viable option. I suppose there is some truth in that if there was a second school parents who put Coleridge as their first preference but ended up at the second school might feel that they got second best.

When asked if this was a genuine consultation and that if enough people were against the expansion would that change the outcome, Ian Bailey (Deputy Director of Education) said yes. But it did feel like the only game in town from the way it was presented.

It is now vital that they consult even better – as many people at the meeting had only just about heard about the plans. The main thing, however, whichever way this goes forward is that there will be more school places available in the area for local children – which is brilliant.

Today’s surgery was full of really difficult people. “Care in the community” often just means that the care isn’t adequate and people can’t cope in the community.

Often what is considered anti-social behaviour is then ASBO’d, which is then broken, which then means a custodial sentence when really this is just a vulnerable person with mental health challenges – not someone who the police or prison is left to deal with.

I am extremely worried about the restructuring of Haringey’s mental health services which are being launched on Monday – because I bet you my bottom dollar it will be all about getting them out of residential care back into the community. And it will be sold as better for the individual – but it won’t be. It will just mean that they can downsize the residential care, save money, and parcel of the land round St Ann’s for development. You watch!