Whitsun Adjournment

May I begin by associating myself and my hon. Friends, many of whom will have known Lord Burlison and his work, with the comments of regret on his passing away, and pass on our condolences? I, too, wish to make a series of constituency points, rather than a Front-Bench speech. This Adjournment debate does not really warrant Front-Bench contributions, because it is about hon. Members putting to the Government the reasons why we should not adjourn for the Whitsun recess as we think there are issues that need to be debated and dealt with. I have three such issues which I wish to put to the Government. The first is the arrangements for commissioning tier 4 mental health services for people with moderate and severe personality disorder. The second is public sector housing finance. The third is the lack of a system for protecting vulnerable adults. The current system for securing the provision of specialist mental health services in England is not fit for purpose, and I shall give some evidence that supports that view. I have seen this flawed system at work in my constituency, but its impact goes much wider and should be a cause of concern for all hon. Members. My constituency is home to the Henderson hospital. To most people, it is a little-known, even obscure, small hospital tucked away in Belmont. Among those with any experience of the treatment of personality disorder, however—clinicians or patients—it is a nationally and even internationally renowned tier 4 residential service for the treatment of moderate to severe personality disorder. It offers a practical and challenging route to recovery through personal responsibility and social inclusion. I have met many ex-patients over the past few years, and especially in recent months during the trauma of threatened closure. For those who have received the service, it has been life-saving and transforming. It does not only offer patients a way to manage or contain their mental health problems, but provides treatment for those problems and a way for people to restart their lives. Many of them cannot understand why a service that they prize so highly and that has given them an opportunity to realise their potential could be taken away from the many others who might benefit from it. The service treats personality disorder, and it facilitates change in people's lives. Unlike many other mental health services, it is not simply about the management of the status quo or the containment of the threats that those with mental health problems can pose to themselves and in a few cases to others. Research on the Henderson has shown that its approach reduces acute admissions and interventions by the criminal justice system. The number of people in prison who have severe mental health problems is a blot on our criminal justice system and shows that provision does not adequately meet those people's needs. The service at the Henderson does offer a way to meet some of those needs. Despite the evidence that the Henderson therapeutic model works, the service has been earmarked for closure and indeed it has already been closed temporarily— as the euphemism has it—pending the outcome of consultation. The Henderson has a 60-year history. Over that time, it has taken from referrals from practically every part of the United Kingdom from Land's End to John O'Groats. However, in some circles, that history marks it out as old fashioned, out of date and ripe for closure. In truth, the model of care that it offers is a very modern one. It is run on democratic lines, with residents taking personal responsibility for much of the day-to-day running of the service. They make decisions about everything from menus to direct staff involvement in the provision of the service. That is very different from the typical model of mental health services that is still the norm in much of the country. A few years ago, the Henderson was even asked to replicate the service in two new units, at Webb house in Crewe—events there may be the reason why the Chamber is not especially well populated with Members seeking to contribute today—and at Main house in Birmingham. Webb house has since closed because of funding cuts, and Main house is struggling to keep its doors open. So why is such a successful service under threat? Until 2005, the Henderson was funded by the Department of Health through the national specialist commissioning advisory group. After 2005, funding passed to a consortium of 128 primary care trusts across London, East Anglia and south-east and central England, so many hon. Members will have constituents who have benefited from the service in the past. It has to be said that this was not a consortium of the willing. Within a year of the change in responsibility for the funding of the service, PCT after PCT took the opportunity to pull the plug on funding. As a result, the mental health trust that hosts the service, the South West London and St George's Mental Health NHS Trust, has been confronted with a growing funding crisis. The clinical need has not changed and clinicians still want to refer patients to the service, but the PCTs are refusing to fund referrals. So the closure is based not on clinical need, but on financial reasons. The NHS and the Minister responsible accept there is a need for tier 4 provision such as the Henderson. Everyone wills the ends, but no one will identify the means to deliver them. The Government's review of the commissioning of specialist mental health services, the Carter review, found that PCTs are ill equipped for the task of specialist commissioning of such complexity. In a system driven by tick boxes and targets, services such as the Henderson do not fit. So when Ministers say that this is a devolved matter for PCTs and that they cannot intervene, they miss the point. Closure is a direct result of the way in which devolution to PCTs was designed by the Department of Health. It is a consequence of policy, not of individual decisions of PCTs. There are no incentives for the complex regional collaborations necessary to commission specialist services. I hope that the Department of Health will wake up to that fatal flaw in the system before it is too late. Every day the service is closed, the risk is that the clinical expertise will be lost and, far worse, that the lives of those people who could have been helped will not be changed for the better. I hope that hon. Members on both sides of the House will sign early-day motion 1547 and, if they represent a constituency in the south of England, challenge their own PCT to support the service. The second issue I want to raise involves housing. In March, I joined a determined group of council tenants from the Sutton Federation of Tenants and Residents Associations and councillors of all parties from the London borough of Sutton to present a petition to the Prime Minister. The petition sought to highlight what my constituents and I regard as a stealth tax on tenants. The tenant tax is known in official Government circles as negative housing subsidy. It means that if the Department for Communities and Local Government determines that a council's rent account will be in surplus, the Government can cream off some of the money. This is money that tenants pay as rent in the belief that it will be used to pay for the management and maintenance of the local council housing stock, and even—dare I say it—of their own homes. In Sutton and Cheam, this year tenants will pay nearly £10 million in tenant tax or, to put it another way, tenants will be paying their rent to the Government until mid-August. Until then, not a penny piece of their rent will benefit them. The Government say that the system of housing subsidy and negative subsidy is there to support areas that need the money more, but it means that families on modest incomes living in my constituency and in many others bear the brunt of that redistribution. What is worse is that the current subsidy regime is headed for a national surplus. In 2001-02, the Government made a net contribution of £351 million. That fell to £252 million in 2002-03, and to £191 million in 2003-04. It is widely believed that the system is reaching a tipping point at which the Treasury will pay out less in subsidy than it receives in negative subsidy from local authorities. At that point, any argument that the negative subsidy is anything other than a stealth tax will fall to pieces. Indeed, reports in Public Finance magazine suggest that this year the Treasury could be skimming as much as £194 million off rent payments across the country, and that figure will perhaps rise to £500 million within a decade. Tenants have every right to demand to know what the Government intend to do with that money. They have every right to call it a tenant tax and every justification in calling for it to be scrapped. At a time when the Government are reeling from the consequences of their decision to double the 10p rate of tax, it seems remarkable that they would continue to defend a stealth tax of some of the poorest in our country—that is, many of our council tenants. In March, the Government formally launched a much-delayed review of the housing revenue accounts subsidy system. I have been talking to the chair of the Sutton Federation of Tenants and Residents Associations, Jean Crossby, about the subject. She is working very hard with tenants in the borough and with tenants organisations around the country to challenge this iniquitous tax. She has pointed out that the Government are failing to engage seriously with tenants as part of the review. For example, I understand that here in London a handful of tenants will be involved in the review process. Surely more must be done to ensure that tenants can have a real say about the future financing of public housing. I hope that the Deputy Leader of the House will be able to give the House some assurances about the extent to which the tenant's voice will truly be heard in this process and, at the very least, will pass on those concerns to the Minister for Housing. Finally, I want to raise my continuing concern about the arrangements we have in this country for the protection of vulnerable adults and older people. Over the past 10 years, I have drawn to the attention of the Government and the House the mounting evidence of the abusive and inappropriate prescribing of anti-psychotic drugs to older people with dementia in care homes. In doing so, I have often outraged some care home owners, but I think that it is right to raise these concerns because it is right to draw attention to the academic research evidence, which is becoming compelling. At any one time, about 100,000 older people in care homes are on those drugs, which are not licensed for the treatment of dementia, have adverse side effects, increase the risk of strokes and even bring on premature death. The prolonged use of those drugs on some of the most vulnerable people in our society is nothing less than restraint by chemical straitjacket. Change is long overdue. The Department of Health, medicine licensing authorities, the care regulator, the General Medical Council and care providers all have a part to play in rooting out bad practice and protecting the vulnerable. Elder abuse is a serious matter in this country. Government-funded research found that 342,000 people over the age of 66 are victims of one form of abuse or another, including fraud, theft, psychological or emotional abuse, and assault, including the use of restraint. High hurdles had to be clambered over in order to register as a victim of abuse in the study, and many people were excluded altogether, such as those in care homes or those with dementia who live in the community. They were not approached or included in any way in the result. It must be likely that the study's figures are a conservative estimate of the scale of the problem and the challenge that we still have to confront. It is a challenge that the Law Commission asked us to confront in 1995. It said that it had no confidence in the adult protection procedures that existed at that time, but although there have been a number of welcome piecemeal adaptations to the system since then, they are not sufficient to meet the concerns that the Law Commission flagged up so long ago. The Law Commission proposed that social services departments should be given powers to protect vulnerable adults similar to those that exist for child protection and a duty to investigate; that powers should be granted for magistrates to issue entry warrants, temporary protection orders and removal orders; and that an offence should be created of obstructing officers acting on behalf of the courts. Rather than acting on those recommendations, the Government chose to go down the guidance route. In 2000, they issued guidance called ““No Secrets””. The evidence is that ““No Secrets”” has failed to gain the necessary traction and acceptance in local authorities and other agencies, and as a result its implementation has been piecemeal and patchy. In 2006, Action on Elder Abuse completed a two-year study funded by the Department of Health on adult protection systems. The report stated:"““Protection of Vulnerable Adults work is currently supported by the No Secrets guidance which has Section 7 status but no ring-fenced finances. This has hampered efforts to develop Protection of Vulnerable Adults policies, procedures and systems consistently and coherently. Many of the inconsistencies in practice and procedure highlighted throughout this report can be attributed directly or indirectly to its perceived lack of status, and the lack of priority in the NHS.””" The report went on to recommend that the protection of vulnerable adults be placed on an statutory basis equivalent to that for child protection and domestic violence. The report and its recommendations were produced in March 2006. The fact that the Government funded the research in the first place was welcome, but it took two years for them to come back and announce, as they did in March, that they will have a review of ““No Secrets”” that will consider the case for legislation. I suppose that that should be welcomed, but it has taken 13 years—and that is not good enough. When the circumstances surrounding the death of Victoria Climbié emerged, they convulsed the child protection system and galvanised the Government to legislate and to work with others to drive change in the child protection system. Although no system in which humans are involved will ever be perfect, there has been significant improvement in this country's child protection system. It should not take a similar shock to the adult protection system to achieve long overdue reform and action. I hope that legislative time will be found to enact the Law Commission's proposals or similar ones. Thirteen years is far too long to wait. In conclusion, the future of the Henderson hospital is in limbo as a result of a dysfunctional funding system. Council tenants in my constituency are paying 37p of every pound of rent as a tenant tax to the Treasury. The frail and the vulnerable are protected by a system found to be unfit for purpose more than a decade ago. The message from my constituents to the Government is that it is time for dither and delay to end. It is time that the Government put those things right. Although I enter into the spirit of things by wishing all colleagues a good Whitsun recess, I hope that the Government will take advantage of the fact that they do not have business in the House next week to reflect on the concerns held by me and my constituents.