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.

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.