The Minister of State, Department of Health (Norman Lamb)
I congratulate my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on securing this debate on this incredibly important and difficult issue. He asked some specific questions. First, he talked about the failure of organisations to share information, and I will develop my thoughts on that in due course. He made a particular point about the role of the Care Quality Commission. Under the new inspection regime, the CQC will undertake much more detailed inspections of providers than has been the case in the past, and it will be able to take into account issues such as the importance of sharing information to ensure good care. I will make sure it receives the Hansard report of this debate, so it can take on board the specific points he makes.
My hon. Friend talked about the importance of a more systematic and standardised assessment of risk. That is one of the points the Government need to respond to in terms of the report. At the end of his speech he asked about the status of the report. It is clear that the report raises issues of both local and national significance. It is incredibly important that the Government recognise that and seek to address and respond to the concerns identified. I am happy to write to him to pursue that further, but I am intent on ensuring that we respond as soon as possible where it is clear that there are national lessons to be learned. This tragic case raises issues that have been raised before—they are not new. It is imperative for all of us to seek to address the issues identified in the report.
My hon. Friend raised a concern about individuals who do not hit the threshold for admission to secondary care. He also asked whether I would be prepared to review child and adolescent mental health services. I am pleased to say that in the summer I announced a taskforce to review the way in which CAMHS operate. I do not think that the way we commission or organise CAMHS is fit for purpose. There is a need for a fundamental review of how the services are organised and commissioned. The findings of the report can absolutely feed into that taskforce.
I would just like to dwell on some of the issues we need to look at in the taskforce process. At the moment, four organisations are involved in the commissioning of services for children and young people: local authorities, schools, clinical commissioning groups and NHS England. The fragmented arrangement for commissioning care does not lead to the best chance of joined-up services and that fundamentally needs to change. We recognise that it is very clear that only a minority of youngsters who have mental health problems receive access to any service at all. That has been the case for a very long time, but it does not make it right.
It is clear that many interventions deployed with youngsters have a very strong evidence base. For example, early intervention in psychosis—after the first episode of psychosis—can stop deterioration occurring. However, around the country the position is variable. In some areas there is access to good services, but in other areas there is either no service at all or people have to wait a very long time. I am therefore very pleased that the Prime Minister announced in October the introduction, for the first time, of an access waiting time standard of two weeks for early intervention in psychosis. We start with 50% of everyone who experiences an episode of psychosis. In future years, the aim would be to raise that percentage so that as many people as possible have access to support as fast as possible, and access to a service that is evidence-based, NICE-based and approved.
That is a breakthrough and a watershed moment for mental health services, but another area that the CAMHS taskforce wants to look at is how to improve access more generally. In Australia there is something called Headspace, which involves non-stigmatised access to services often provided by third sector consortia. There are local Headspace centres around the country, and a telephone service and an online service. That means that far more youngsters can receive access to some support at a much earlier stage than is the case in this country—and was the case in Australia before it introduced Headspace. We can learn lessons from the way services are commissioned and provided, and there is a lot we can do to improve access to support in those earlier years.
Moving on from the specific points my hon. Friend raised, I should put on the record my horror at Christina’s murder. I share his sentiments and wish to extend my personal sympathies to the family. What they must have been through is unimaginable, and my heart goes out to them. Christina Edkins was a happy, well-loved teenager with a bright future ahead of her. She was doing well academically, she played netball for the school team and enjoyed writing. She had ambitions to become a midwife and was already working with young children in a nursery school. Her death was tragic. We should all be able to go about our daily lives without fear of violence.
As Dr Reed’s report says, the attack was random and unprovoked. The question is whether it was preventable. As my hon. Friend made clear, Phillip Simelane’s mother tried for many years to get him the help she knew he needed. The system has let down that family as well as the victim’s family, and one’s heart goes out to his mother for what she must have gone through, having tried so hard to get help over many years. She herself suffered a number of attacks by Phillip, and she knew that his mental state was deteriorating and tried to get help. We cannot say what would have happened had she been successful, but it could hardly have been worse than what took place in March 2013. I am sure I speak for everyone here when I say that my heartfelt sympathies go out to the families of both Christina Edkins and Phillip Simelane.
Nothing we can do can return Christina to her family, but as my hon. Friend said, we can ensure that lessons are learned and that appropriate action is taken to prevent, as far as is humanly possible, any similar event from happening again. This afternoon, I met Dr Reed, who wrote the homicide report into Christina’s death, and discussed with her at length both her report and the importance of responding to the recommendations raised in it. Lessons can be learned from this tragic incident, both locally and nationally, and we are considering the national recommendations in the report. As well as explaining some of the actions today, I would be happy to write to my hon. Friend setting out in more detail what action the Government are taking to address the recommendations. I want us to be clear about the time scale for responding more fully and about what actions might follow a formal written response.
Before I turn to the specifics of the report, I would first like to touch on the importance of parity of esteem for mental health, which has long been a personal priority of mine and of my hon. Friend. The Government are clear that mental health care is as important as physical health care. It is unacceptable that in this time of modern medicine three out of four people with common mental health problems receive no treatment. If three out of four people with diabetes, for example, received no treatment, we would all be completely outraged. Mental health problems can have a huge impact on the quality of life of individuals and their families and friends and should be taken as seriously as physical health problems. I think that this simple principle of equality is starting to be accepted, but there remains a big and frustrating time lag when it comes to translating it into practice in terms of the responsiveness of services on the ground.
It is clear from the homicide investigation report that Phillip Simelane did not receive the treatment he needed for his mental health conditions. His mother repeatedly attempted to get appropriate treatment for her son from the time he was 14. The report found that there were multiple opportunities for Mr Simelane to be given access to mental health interventions or treatment, but many opportunities were missed. In some cases, Mr Simelane did not meet the provider’s criteria for specific services—a point made by my hon. Friend—such as admission to a psychiatric intensive care unit. In others, he was not able or willing to engage with services. During this time, his behaviour deteriorated and his mother became increasingly concerned and at risk. One can only begin to imagine how hard it must have been for her to see the deterioration happening before her eyes, to be at risk herself yet to have no proper response from the authorities, who ought to have been safeguarding her and ensuring that others were safeguarded from the actions of someone whose condition was deteriorating.
In total, Mr Simelane was reviewed or formally assessed for mental health conditions 17 times by four different organisations between April 2009 and December 2012. Quite a lot of effort and time were put into assessing him, but there was precious little action or support. None of this resulted in him getting the help he actually needed.
The 2014-15 mandate to the NHS sets out an explicit target for NHS England to make measurable progress to ensure that
“everyone who needs it has timely access to evidence-based services”,
whether it be for mental health or physical health. We have identified £40 million of additional spending to kick-start change in mental health services in the current year, and a further £80 million for 2015-16. As I said, this will for the first time enable the setting of access and waiting time standards in mental health services. This will include 75% of people referred to the improving access to psychological therapies programme being treated within six weeks of referral, and 95% being treated within 18 weeks of referral as a backstop. At last, people with a mental health condition—depression, anxiety or a condition such as obsessive-compulsive disorder—will have an entitlement, just like those with a physical health problem, to access treatment on a timely basis. Furthermore, at least 50% of patients experiencing a first episode of psychosis will be treated with a NICE-approved care package within two weeks of referral, while £30 million-worth of targeted investment from within the total £80 million envelope will be spent on effective models of liaison psychiatry in more acute hospitals.
Crisis care is one area where the gap between the experience of those with physical and mental health problems is at its greatest. If someone suffers a physical health crisis, they will know what will happen—an ambulance will arrive and they will be taken to A and E. The system may be under pressure, but access will be granted to a specialist who can help with the particular condition. If someone suffers a mental health crisis, however, God knows what will happen. They may have a good service, but too often it falls short. Too often still, people end up in police cells when they are in the middle of a mental health crisis.
James Morris
One crucial aspect of this particular report is the interaction between crisis care services and the Prison Service. One of the big gaps revealed by the report relates to what happens when someone is released from prison with known mental health problems. In this case, nothing happened and the individual was lost to services. Will the Minister reflect a little on how we might be able to join the Prison Service and health services more closely?
Norman Lamb
I completely agree with my hon. Friend on that point. The first incredibly positive thing to say is that we have embarked on the national roll-out of a liaison and diversion service, the purpose of which is to ensure that when a person first appears in the criminal justice system—whether at a court or a police station—someone will be able to assess their mental health. If they have an identifiable mental health problem, they will be referred straight away for treatment and support. They may still go through the criminal justice system and may still end up in prison, but their condition will have been identified and they will have been referred for the treatment that may help them to address their offending behaviour.
So far we have spent £25 million in the current financial year. We have covered about 25% of the country, and next year we will cover more than 50%. Our aim is a national roll-out by 2017, subject to the making of a business case to the Treasury, and that in itself will make a dramatic difference. No other country in the world is pursuing this on such an industrial scale. Moreover, what we are doing is evidence-based, and as we build on the programme, we will develop the evidence and ensure that we apply it. There is also the issue of what happens to someone who is in the system and what happens when the person leaves prison, and I shall deal with that in a moment.
The Department has funded nine street triage pilots this year, in which police and mental health professionals have worked together to support people who are experiencing mental health crises. Perhaps most relevant to cases such as that of Mr Simelane is the £25 million to which I referred earlier, which constitutes the first stage of the roll-out of a national liaison and diversion service.
Before my hon. Friend intervened, I was talking about the unacceptable practice of allowing people who are in the middle of mental health crises to end up in police cells. It is good news that between the 2012-13 and 2013-14 financial years there was a 24% reduction in the use of police cells, and evidence suggests that that trend is continuing in the current year. Earlier this year we published the mental health crisis care concordat, in which more than 20 national organisations committed themselves to standards of care in mental health crisis for the first time. Our objectives were a 50% reduction in the use of police cells in the current financial year compared with two years ago, and a complete ending of the use of police cells for children. My right hon. Friend the Minister for Policing, Criminal Justice and Victims and I are currently writing to local authorities asking them to take seriously their responsibility to end that unacceptable practice. I think everyone would agree that the practice of allowing a child under the age of 18 to end up behind bars in a police station must be brought to an end.
A key finding of the homicide report was that information sharing within and between organisations involved in Mr Simelane’s case was not effective. The sharing of information between organisations that are responsible for the care of vulnerable people has many benefits, and all organisations of that kind should strive to communicate and share information effectively. Indeed, I believe that they have a duty to do so. At the heart of most of the scandals over the years when something dreadful has happened has been a failure to share information effectively, and that certainly includes the case of Mr Simelane.
I realise that, in practice, such information sharing is difficult to achieve, but it must be an absolute priority, and the organisations involved must actively seek solutions. We recently issued a simple one-page guide for practitioners working in the health system, which emphasised the importance of sharing information. We are right to focus on the importance of confidentiality, but, in doing so, we sometimes forget that need to share information to ensure that good care is provided.
Electronic patient records are becoming more prevalent and are making information sharing easier, but they are not foolproof, and there are still security and confidentiality issues that limit the sharing of some information. For the time being, such systems should be seen as adding an additional layer of patient safety, and it is important for all clinicians receiving a referred patient to satisfy themselves that they have a thorough understanding of the patient’s history. Clinicians also have the ability to request additional information from other clinicians or relevant professionals if they feel that such information would be beneficial in making an accurate assessment of the patient.
The Ministry of Justice is responsible for the management of offenders in the community. Care and supervision may be delivered by a number of agencies working together to share information, including health, social care, probation and other authorities. This enables appropriate action to be taken if an offender’s behaviour escalates to present a risk to the public, and that may include intervention by professionals or even recall to prison or to another appropriate facility.
We come back to the need for appropriate sharing of information among organisations. As I have said, this can in practice be complex and difficult to implement. However, organisations with a responsibility to care for vulnerable people and to protect the public must be able to work effectively together. Dr Reed’s report was only published in September and there will be no quick fixes for the organisations involved in this case. We expect NHS England to work with all the NHS providers involved to ensure that they address the recommendations in the report. This will require NHS providers to work with non-NHS organisations, including the Prison Service, to ensure that the lessons that need to be learned from this report are implemented across the board.
The issues identified in the report as essentially local will probably be common to many other organisations around the country, and we owe it to the families who have been devastated by this tragedy to ensure that those local lessons with wider applications and the issues identified as of national importance are all properly addressed, and I am happy to work with my hon. Friend to try to achieve that.
James Morris
On the specific point about the status of this report, I know that the Edkins family have written to NHS England expressing concerns about some of the findings in the report and asking whether there needs to be a further independent review. I think NHS England has promised to get back to them. Could the Minister use his good offices to communicate with NHS England to get back to the family?
Norman Lamb
I absolutely will communicate with NHS England and seek to ensure that the family get a response to that request.
As I said earlier, I shall write to my hon. Friend on all the issues that emanate from the report, and in doing so I will summarise the work being undertaken by the Government in response to this report. Work on this has already begun. The health care providers at HMP Hewell and HMP Birmingham have developed action plans in response to the recommendations in the report. NHS England’s Shropshire and Staffordshire area team is monitoring progress closely to make sure that all recommendations are met. The report also contained national recommendations for NHS England, and the Department of Health and the Ministry of Justice will work with partner organisation to address these recommendations.
Black Country Partnership NHS Foundation Trust has already implemented some changes in response to Christina’s death. It has phased out the use of “opt-in” letters, which my hon. Friend specifically referred to. Their use was an extraordinary practice when one thinks about it, given the nature of the condition that individuals such as Mr Simelane suffer from. Opt-in letters were previously used to invite patients to make an appointment, but they allowed someone to be discharged from secondary care if they did not respond. This practice has to end. The trust now proactively assesses all patients referred to it. That issue has wide application across the country.
The trust is working to improve the way its services join up with others, particularly those provided by external agencies, in the care of someone with severe mental illness. The trust will shortly be introducing electronic patient records which will enable teams across different parts of the service to access relevant patient information more quickly.
Birmingham and Solihull Mental Health NHS Foundation Trust has also implemented changes, including putting in place a robust escalation process for all cases in which disputes or concerns are raised about the outcome of a prison assessment, and ensuring that a full check is made on the HMP health care patient information recording system to identify any previous significant physical and/or mental health history.
The trust also has work under way. This includes changing psychiatric intensive care unit induction and training for doctors and nurses to include training on how to undertake prison assessments; introducing a review of all new prisoners by a nurse specialist within 24 hours when mental health concerns have been raised and, if recommended, by a psychiatrist within a maximum of five working days; and including in health screening on discharge cross-checking and reference between the health and prison records systems. The trust aims to have these and other changes in place by March 2015.
The investigation makes national recommendations, including the implementation of new supervision requirements for offenders who have served sentences of under 12 months, as was the case for Mr Simelane at the time of the incident. As part of the Transforming Rehabilitation programme, the National Offender Management Service is working with the NHS on through-the-prison-gate support for offenders serving sentences of under 12 months, including those offenders who are known to have mental health problems.
The Ministry of Justice is putting in place an unprecedented nationwide resettlement service, which will mean that most offenders are given continuous support by one provider from custody into the community. The Ministry will ensure that most offenders are held in a prison designated to their area for at least three months before release. This will mean better continuity of supervision and rehabilitation services, as well as better family links for those offenders and a network of prisons more specifically catering for the needs of short-term offenders. As my hon. Friend has pointed out, continuity of care and support when an individual leaves prison is of fundamental importance.
None of the changes made in response to Dr Reed’s report can bring Christina Edkins back, but we can all do our very best to ensure that no other family suffers in the way that Christina’s has done. None of the recommendations in the report is unachievable. They will require hard work on the part of many organisations, but the result will be better care, supervision and support for some of our society’s most vulnerable people.
I close by once again offering my heartfelt condolences to Christina’s family and assuring them that we will ensure that everything that can be done to prevent similar tragic events in future will be done. I shall be happy to work with my hon. Friend and to continue a dialogue with him to ensure that we maintain momentum in addressing the recommendations in the report and the concerns of the family.
Question put and agreed to.