Vincent Cable speaks on St John's Hospital, Twickenham

11.10.00am UTC (GMT +0000) Wed 16th Jan 2008

[Debate on Elderly Mentally Ill People [Jan 15]] [Vincent Cable (Twickenham, Liberal Democrat): I am grateful to have the opportunity to open this Adjournment debate . . I sought it because of [a] particular local circumstance . . the St. John's hospital centre for the elderly mentally ill with particularly challenging conditions.

It is under threat, as are similar units in other parts of the country. As I have been fortunate enough to obtain a long debate, I shall also take the opportunity to make general arguments about how the NHS approaches elderly mental illness. I wish to express appreciation of the various charities involved-Age Concern, Help the Aged, the Alzheimer's Society, Mind and the Royal College of Psychiatrists-all of which have done admirable work in the field. That work all points to similar conclusions.

. . In terms of the burden on the NHS, about 40 per cent. of visits to GPs and 50 per cent. of all hospital beds are accounted for by elderly people who have some form of mental condition. Such people also account for 60 per cent. of all residential home places. So, about half of the health and social care economy is taken up by people who have some form of elderly mental illness. I have found it difficult to get my head around that.

. . St. John's hospital is a small facility in the middle of Twickenham. It was established in the mid-19th century by the Twining family. When Elizabeth Twining died, she said that it was "forever thereafter to be used as and for the purpose of a hospital or dispensary". It had a somewhat mixed existence and, in 1995, a purpose-built, new facility was established to cater for the needs of people who are what I call band 1 elderly mentally ill: people with severe dementia and challenging behaviour. There are two wings to the small hospital: Cole Park lodge, which provided respite facilities, and Marble lodge, which provides extended care and initially had 18 beds. I shall talk about Marble lodge. I stress that the facility was newly launched just over a decade ago. Indeed, a key player in its establishment was my Conservative predecessor, Toby Jessel. His sister, Lady Panufnik, was the chairman of the League of Friends. In a bipartisan spirit, I was invited to play a role in support of the League of Friends. It has been seen ever since, by many psychiatrists, as one of the great successes of the local health service.

The unit has a different philosophy from that of many centres for the treatment of the elderly mentally ill. Its underlying philosophy is quality of life without medication. The significance of that is that most elderly mentally ill are, to put it crudely, stuffed to the eyeballs with drugs in order to calm their behaviour. Those of us who visit residential homes will see elderly people sitting around in a dazed state, often full of drugs that are used, in essence, to sedate them.

The philosophy that underlies the unit is not simply that of finding the right medication but that in many cases medication is actually unnecessary, and that, with sophisticated treatment, patients can be managed in a much more humane way and without extensive medication. The unit at St. John's concentrates on two things: one is the built environment. That may sound rather fanciful, but enormous attention is paid to the design of the building, lighting and colours in order to introduce a calming environment. Also, the unit is an oasis of peace. Instead of the noise that is frequently oppressive in many residential homes and general hospitals, great attention is paid to trying to keep patients calm at all times. Because the environment is carefully managed, patients are more easily managed. Even extreme conditions can be handled in a much more civilised and dignified way than is often the case when people are simply pumped with drugs.

Susan Kramer (Richmond Park, Liberal Democrat): I thank my colleague for giving way-he is being generous with his time-but I just want to pick up on that issue of cost. In one of the meetings that he and I had with the PCT, it became evident that the cost differential between a service contracted out to traditional care homes versus one in the NHS is partly caused by including in the NHS cost an allocation of a great deal of central overhead costs. I believe that my colleague would agree with that. However, if the service were tendered out to the private sector, that core overhead would not disappear. It would merely be reallocated to other programmes. In fact, it might even be that the service provided by the care homes would be more expensive in total to the NHS-the overhead costs would still be part of NHS costs-than continuing the service in its current structure. The accounting mechanism makes that apparent.

Vincent Cable: I thank my hon. Friend, who anticipates some of the points that I want to make in my concluding remarks. She is absolutely right: we are dealing with complex and often misleading systems of cost accounting in the NHS market, and the problem in this case arises from the fact that the costs are not merely irrational but completely opaque, because the NHS providers will not share with us how they have arrived at their cost assumptions.

Before I return to that point in my concluding remarks, may I add to one section of the narrative? Not merely is Marble lodge recognised as an enlightened institution, it was recognised as such in the local strategy for mental health that was developed as recently as 18 months ago. The local PCT, the local mental health provider-the South West London and St. George's mental health NHS trust-and the local council embarked on a major strategic exercise involving a great deal of public consultation. It was an admirable, highly creditable NHS exercise designed to produce a strategy for mental health in the borough.

That was where we were until a few months ago, when it gradually emerged, not through any formal announcement but through rumours and leaks from members of staff who were being encouraged to go elsewhere, that the PCT and the supplier of services, the mental health trust, had agreed that the facility should close. MPs and the council were not told. The information emerged from the system following an elaborate and very public public consultation that reached the opposite conclusion. I am bringing this to the Minister's attention because of the unsatisfactory way in which that happened.

We became aware of the plans only because of the campaigning activities of an admirable individual, Mr. Paul Lamplugh, who is actually a constituent of my hon. Friend the Member for Richmond Park. The Minister may be aware of his name. His daughter, Suzy Lamplugh, disappeared 20 years ago, and, in their grief and distress, the family established a trust which later gave rise to the missing persons helpline. Its charitable work is acknowledged across the country. Unfortunately, Paul's wife, Diana, who was the driving force behind that charitable work, had a major stroke in 2003 and lost much of her mind. She was recommended for treatment at Marble lodge and has been a patient there ever since. Paul Lamplugh sought to mobilise help from the two MPs for the borough and from councillors and others when he began to see what was happening.

My colleague and I have tried to construct exactly the logic that led to the decision to pull the plug on this admirable institution. It appears that two factors were involved. The first was that, as the hon. Member for North-West Leicestershire (David Taylor) said a few moments ago, the PCT spotted that the unit cost of treating people in Marble lodge was twice that of the typical cost of a residential home for the elderly, which would normally cost £600 or £650 a week. Marble lodge was said to be costing twice that. I do not criticise the PCT for picking up on that. It is, after all, its job to obtain value for money for the health service, and it has a good reputation for purchasing good quality care for residents, and for maintaining financial balance. I do not criticise it for looking at the problem.

What has also contributed to the problem, as my hon. Friend the Member for Richmond Park said, is that the provider has included costs that bear absolutely no relation to the real cost of providing the service. We cannot get to the bottom of this because the provider will not disclose the figures, but it seems to have incorporated administrative overheads from the headquarters in the costs. It also seems, as is often the case with large providers, that it is dominated by consultants and big hospitals with little interest in peripheral, albeit high quality, ancillary operations. It seems to be quite indifferent to the unit's future. The problem is that the closure process is now well advanced. That is why I have brought the matter to a debate. The primary care trust has gone out to tender, despite protests from the council's overview and scrutiny committee and from the carers and Members of Parliament. [http://tinyurl.com/354fgo]