Backbench business

(Limited Text - Ministerial Extracts only)

Thursday 14th February 2013 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Walker. You are an appropriate Chair for this debate because of your interest in mental health and your willingness to speak out about your own experience, which meant an enormous amount to those who are fighting the stigma of mental health problems. Indeed, my hon. Friend the Member for Braintree (Mr Newmark) has done the same today. Such moments, when people are willing to speak out, are incredibly important in challenging and addressing the stigma of mental health problems in society.

I am deeply grateful to the members of the Backbench Business Committee for convening this important debate. It is good that Parliament has recently been willing to debate a number of different mental health issues in a way that perhaps has not happened in the past. Mr Walker, before Christmas you raised the issue of schizophrenia, on which we had a useful debate. The great value of such debates is that they force people to think about an issue, just as my hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe) has today. His experience of recognising the problem, perhaps for the first time, and talking about it with his children demonstrates the great value of such occasions, because they force all of us to think about an issue. Indeed, they force officials in my Department to think about the issue, too. I am grateful.

I do not want to detain everybody unnecessarily, but I will devote a little time to responding to the specific issues that hon. Members have raised. If the hon. Member for Romsey and Southampton North (Caroline Nokes) does not mind, I will refer first to the speech by my hon. Friend the Member for Braintree. I am so grateful that she persuaded him to come speak in this debate, because he made an incredibly valuable contribution. I was struck by his remarks about the huge stress experienced by teenagers. As the father of two boys who have been through the teenage years, I am acutely aware of the pressure on teenagers and the impact that it can have on their mental and physical health. He discussed huge stress, fear of failure and anger. I was struck by what he said: unless the mind is healed, the body cannot heal. We must look at the problem holistically.

One problem with health care is that we have institutionalised fragmentation. We have managed to separate mental health from physical health, which is ultimately not a good thing. We must consider the whole person. I know that the Opposition have been talking about that. It should not be an issue for political disagreement; it is such an obvious thing to recognise.

My hon. Friend the Member for Braintree discussed the need for education and raising awareness, including among parents. The strain, stress and anxiety that parents go through must not be underestimated. Improved awareness is needed in society of this range of conditions. He said that mental health care was the orphan within the NHS, which is absolutely true. There is an institutional bias against mental health. The way that money flows within the NHS disadvantages mental health. There is an 18-week target for physical health care and a tariff, meaning that every patient takes money with them into acute hospitals. Money is sucked through into acute hospitals, and there is great political pressure from every side to maintain the 18-week target. There is no equivalent in mental health. There is no right of access. Waiting nine months to access care and treatment is completely unacceptable. We must challenge that, and he was absolutely right to raise it. He ended on a positive note. There can be life after anorexia, however tough it is to get through it. Some, terribly sadly, do not. I will return to that point in a moment.

The hon. Member for Romsey and Southampton North made some incredibly important points. She mentioned her local organisation, April House in Southampton, and the fantastic work that it does, and she spoke about the absolute importance of raising awareness in primary care. Some people are lucky enough to find a GP who understands mental health and is passionate about it, but some are not. Families with a GP who just does not get it can be desperate; they have nowhere to turn. There is a need to raise awareness.

In the first mandate, a set of priorities published by the Government for the new NHS Commissioning Board, mental health has been given a higher priority than it has ever had in the NHS. The mandate makes it clear that the NHS is under a legal obligation to deliver demonstrable progress towards parity of esteem by 2015. That means treating mental health on a par with physical health. By placing the commissioning board under that obligation and disseminating the message to clinical commissioning groups, we will start to make progress on forcing the system to recognise the importance of treating mental health and physical health equally. It will not happen overnight, but it is a journey that we must take to improve the condition of many people. The hon. Lady discussed the impact on families and the unfair sense of guilt that many experience. She also mentioned waiting times, which in many cases are simply unacceptable.

I am grateful to the right hon. Member for Knowsley (Mr Howarth) for his contribution informing me and others about diabulimia. He discussed the rapid weight loss that can occur with diabetes, and how some people use the condition to lose weight in a dangerous way. He also said that in too many cases, a wrong diagnosis is made and the wrong treatment given as a result, and urged me to ensure that the condition was recognised better at a national level and the knowledge disseminated through the system. I urge him to engage with the commissioning board. I am happy to work with him on that, and for him to write to me on the issue.

[Mr George Howarth]

I am grateful to the Minister for the helpful way that he is addressing the problem. I have written to one of his ministerial colleagues on the matter. I arranged a meeting with her that she had to cancel owing to diary commitments, but I would be more than happy to meet him and anybody else he wants, including Diabetes UK and Diabetics with Eating Disorders. I am sure they would be happy to accompany me.

[Norman Lamb]

I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.

The hon. Member for South Derbyshire (Heather Wheeler) made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.

The hon. Member for North Tyneside (Mrs Glindon) mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.

I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.

I pay tribute to the hon. Member for Enfield, Southgate (Mr Burrowes), who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend the Member for Wells (Tessa Munt) spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.

Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.

My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.

The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.

The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.

The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.

This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.

I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.

Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.

According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.

[Valerie Vaz (Walsall South) (Lab)]

I apologise for not attending earlier, Mr Walker; I was in another debate in the main Chamber. I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on securing this debate.

The Minister mentioned young people. Will he say what services are available for 17-year-olds in terms of continuity of care, as they move to adult services?

[Norman Lamb]

I will talk about that later. In so many respects, we have problems with people falling through the gap between children and adolescent mental health services and adult services, and that is matched in other areas, as well. There is a need to deal with this. The draft Care and Support Bill deals with the transition from teenage to adult services. I will return to that matter. I thank the hon. Lady for her intervention.

A generation of young people is growing up depressed and unhappy with their relationship with food. I want to tell hon. Members about a case in my constituency. Charlotte Robinson was a bright, outgoing young woman who was about to secure straight As at A-level and had dreams of going to Cambridge—between Duke of Edinburgh’s awards and learning to fly helicopters—but tragically, Charlotte was a victim of anorexia, stolen from her family in her prime, with her whole life ahead of her. That is what I meant when I said that for some, thankfully, there is life after anorexia—but not for everyone.

Charlotte’s parents, Christopher and Pauline, who are remarkable people, have campaigned tirelessly to help others. Pauline even ran the London marathon in pink wellies, such is her commitment. They are fantastic people and their attitude was that they did not want other families to experience the same horror that they have gone through, so they have been determined to change things in their county of Norfolk. They discovered that there was no specialist commissioned service at all in their own county. This is what we find. Hon. Members have talked about the enormous gaps in services around the country.

As a result of Christopher’s and Pauline’s fantastic determination, there is now a specialist commissioned service, but it took their efforts to achieve it. Their efforts have helped to fund local centres and a helpline in Norfolk, working with NHS Norfolk and the charity Beat, which I have mentioned. Their focus is on early intervention, helping people like Charlotte—helping children, young people and adults as soon as they need help. Charlotte’s decline was dramatic and rapid and the wait, although nothing like the nine months that we have heard about, still was too long for her.

Speedy access and early intervention are critical. That is why our mental health strategy prioritises early intervention and demonstrates how timely action can help.

In many cases, eating disorders stem from low self-esteem or are linked to stress and emotional problems. That is why our support for local organisations in improving mental health services locally is so important. Our mental health and suicide-prevention strategies both include actions that local organisations can take to improve mental health in their areas: ensuring that children and parents get mental health support from birth; that schools and colleges promote good mental health, alongside targeted support for those at risk of mental health problems; that public services recognise people, of all ages, at risk of mental health problems and take appropriate, timely action; and that health services step in early if there is psychosis or a crisis, to stop more serious problems occurring.

The right hon. Member for Knowsley and my hon. Friend the Member for Romsey and Southampton North raised the problem of transition—moving from being a young teenager at home to a young adult. Often the problem is exacerbated by moving to university, where people suddenly lose contact with services that might have been available to them at home. As my hon. Friend mentioned specifically, that is where things can break down. Away from friends and family, in a new and often stressful environment and, crucially, registering with a new GP, young people can often enter a spiral of decline. The problem must be addressed.

I will now outline some of our ambitions for services. From this April, the NHS Commissioning Board will commission specialist services for eating disorders for adults and children. Having one specialist group to ensure that specialist services are commissioned everywhere has the potential to improve the position in many parts of the country where such services are inadequate or missing. The Commissioning Board will develop a national service specification and encourage better planning, access and outcomes, helping to bridge the gap when someone moves and raising the level of care throughout the country.

We want clinical commissioning groups to commission services with early intervention in mind. We also expect adult social services to work alongside CCGs to focus existing support on early intervention, integration, personalisation and recovery. Social services have a role to play, involving service users as equal partners in commissioning and monitoring services, ensuring that services are designed for the people who use them.

Public health services can articulate the many benefits of good mental health and, because of their pivotal role in the new system, they can talk about mental health directly with members of the public. The transfer of public health to local government, alongside children’s services, social care and other services, with a seat on the health and wellbeing board, potentially gives it a prominence that it has not had in the past. The funding settlement for public health has also surprised many people, with significant real-terms increases this year and next. There is great potential for a focus on public mental health in a way that we have not had in the past, so I hope that we can take advantage in the best possible way of that opportunity.

Of course, the problem cannot be fixed by tweaking the system. A huge stigma remains around mental health, which means that in too many cases children and young people are not getting the support that they need. That is particularly the case with eating disorders, and people affected often feel marginalised and excluded, unable to talk about their suffering. The problems can be compounded if the sufferer is a man or suffering from a less stereotypical but no less serious eating disorder, such as atypical anorexia or a binge-eating disorder. Personal testimony and the courage of individuals in speaking out send a powerful message, and challenge that stigma.

The Department of Health is therefore funding Time to Change, a brilliant campaign that was started under the previous Government but continues now. We are providing £16 million between 2011-12 and 2014-15, the first time that Time to Change has had central Government funding. It will also get a further £4 million from Comic Relief, the second time that that charity has awarded its largest UK grant to Time to Change. Run by the charities Mind and Rethink Mental Illness, Time to Change is England’s most ambitious programme to end the stigma and the discrimination against mental health through activities ranging from education to publicity. It aims to reach 29 million members of the public, explaining mental health and helping them to understand conditions, including eating disorders, that might at first seem alien or scary.

I was delighted that two young women from Time to Change came into the Department of Health recently to speak about their own experiences of mental health. They spoke about how talking about their own mental health had empowered them. One said that it had, “given me my life back”. Their stories were both moving and inspiring and I pay tribute to all those who find the courage to open up and to talk to others. Time to Change aims to increase the confidence of 100,000 people with mental health problems, helping to give them the self-belief that they need to recover.

The Time to Change campaign also works with schools to support children and young people facing problems of integration and bullying that can be caused by mental health issues. I have not only signed up to committing the Department of Health to be an exemplar employer on mental health, but made the commitment to try to get every other Department to sign up as well. We cannot encourage others to behave in the right way unless we practise what we preach. That is a challenge for Government, and I have not yet achieved that aim, but I am determined to pursue it.

The reasons for eating disorders are complex, as has been made clear in the debate this afternoon. Biology and genetics play their part, but so too does the pressure from our celebrity culture and the media. A recent controversy ignited by stick-thin La Perla lingerie models erupted only last week, and it is important to send out the message that organisations that do this sort of advertising have a responsibility; they cannot opt out. Government cannot do everything on its own. Everyone in society has a responsibility to get the right messages out. I was pleased to hear the shadow Minister’s reference to Vogue, which has made a good commitment to avoid getting out the wrong images.

[Caroline Nokes]

This is an important point. Last week, we had a controversy about La Perla using stick-thin models for its lingerie but, before Christmas, Marks & Spencer used some “larger ladies” in lingerie advertising. Some of them were almost a size 12. What would the Minister say to those in the health care professions who cited that advert as Marks & Spencer promoting and celebrating obesity?

[Norman Lamb]

I take the point and I am grateful for that intervention. We have to think before we speak on these things, to ensure that we do not send out confusing messages. There is a problem of obesity in our society and it is causing serious concerns about a drift towards type 2 diabetes and a whole series of health consequences, but let us be balanced in what we say and not confuse youngsters in such an unhelpful way. In the compelling words of Marya Hornbacher, in her memoir of anorexia and bulimia, we are “turning skeletons into goddesses” and teaching our children and impressionable young people to hate their own bodies. That is why I am so grateful to the hon. Member for Romsey and Southampton North and members of the all-party group on body image for their tireless work in addressing the causes and consequences of body image anxiety. Through the Government Equalities Office, the coalition Government are conducting our own body confidence campaign, with three main aims: to raise awareness about body image and encourage a more open and public conversation; to promote a world where all healthy body shapesare represented, and people recognise that their value is far more than merely their physical appearance; and to widen the definition of beauty to include all ages, ethnicities and healthy sizes.

Pro-anorexia and pro-bulimia websites, which were mentioned by the shadow Minister, the hon. Member for Romsey and Southampton North and others, have grown significantly in recent years and are represented on sites such as Facebook. They do not cause eating disorders, but they play a significant role in exacerbating and reinforcing illness. Limited research is available, but what there is shows us that a significant number of teenage girls in particular visit such sites, including a substantial proportion of young people who already have an eating disorder. Disturbingly, nearly all of them report learning new weight-loss techniques from the sites. I am extremely concerned about those sites but cannot take legal action against them as they are not in themselves illegal and might also be hosted overseas, but we continue to explore other, non-legislative courses of action. For example, we recently worked with a media agency to run advertisements directing youngsters to more appropriate sites, because there is much good information out there on the internet, as well as dangerous sites.

A couple of weeks ago, I met security companies such as McAfee and Symantec, and urged them to work with groups such as the Samaritans, Beat and BeatBullying, as well as internet service providers, and to sign up to a concordat, speeding up the reporting of harmful content and blocking harmful websites. They told me they would explore such a concordat. In turn, the Government would be willing to facilitate and support such an initiative in any way we can.

We cannot place all the blame at the feet of the media. That would dramatically underestimate the scale and nature of the problem, but it is something we must challenge. Education and early intervention, keeping an eye out for symptoms, and providing relevant support are simple things that can dramatically increase the chances of recovery.

Sufferers have asked us to listen. My message to them is that we are listening. As I said, I have had personal experience from my work in Norfolk of the horror of this condition and its impact on families. While I am in this job, I want to do everything I can to help others to address this very serious problem and to improve the lives of those who are affected by it.