Child and Adolescent Mental Health Services

(Limited Text - Ministerial Extracts only)

Monday 2nd February 2015 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the availability of child and adolescent mental health in-patient beds, and on child and adolescent mental health services more generally.

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

Since April 2013, NHS England has been responsible for commissioning in-patient child and adolescent mental health services—CAMHS—often referred to as tier 4 CAMHS. In 2014, NHS England reviewed in-patient tier 4 CAMHS and found that the number of NHS-funded beds had increased from 844 in 1999 to 1,128 in 2006. That has now risen to more than 1,400 beds, the highest this has ever been. These data are now being collected nationally for the first time, but despite the overall increase, NHS England also found relative shortages in the south-west and areas such as Yorkshire and Humber.

In response, the Government provided £7 million of additional funding, allowing NHS England to provide 50 additional CAMHS specialised tier 4 beds for young patients in the areas with the least provision—46 of these beds have now opened. NHS England has also introduced new processes for referring to and discharging from services, to make better use of existing capacity. A key objective of these actions is to help prevent children and young people from being referred for treatment long distances from home, except in the most specialised cases.

National availability of in-patient CAMHS beds is reviewed each week by NHS England specialised area commissioning teams and the national lead for commissioning, identifying any issues and taking proactive steps to address them. On 30 January, it emerged that the number of general CAMHS beds available was lower than in recent weeks. In response, NHS England implemented contingency plans, including contacting existing CAMHS providers to seek additional capacity and increasing the use of intensive home support packages to allow children and young people to be treated at home or on a non-specialised ward. NHS England has also contacted mental health providers to alert them to the immediate capacity issues in CAMHS and establish what capacity existed in adult in-patient and community services to take cases on a temporary basis, should that option be required.

The Government are committed to improving CAMHS as part of our commitment to achieving parity of esteem between mental and physical health—this is not just for in-patient services, but for services in the community, and for services that seek to intervene early and prevent problems arising. That, ultimately, is where the focus must be to ensure that, as far as possible, we spot issues early and prevent them from worsening, reducing the need for in-patient treatment.

In August 2014, the Department of Health set up the child and adolescent mental health and well-being taskforce. The taskforce brings together a range of experts from across health, social care and education. It will consider how we can provide more joined-up and accessible services built around the needs of children, young people and their families. A Government report on the taskforce’s findings will be published in the spring.

The Government have also invested £54 million in the children and young people’s improving access to psychological therapies programme and will invest £150 million over the next five years in improving services for those with eating disorders.

[Luciana Berger]

All over England, our child and adolescent mental health services are increasingly under pressure. Despite the best efforts of NHS staff, the system is now in crisis. Children are being sent hundreds of miles for treatment or detained in police cells because there is nowhere else for them to go. We are also hearing of young people getting no treatment at all. I was appalled to see the copy of the e-mail that NHS England commissioners sent on Friday night, warning mental health trusts of a national shortage of in-patient beds for children. It was almost one year ago that the chief executive of YoungMinds said that the increase in the number of children placed on adult wards was entirely predictable following cuts to mental health services. Why did the Minister not act on that warning and do something to prevent it from happening?

The e-mail from NHS England said that the shortage would make it likely that 16 to 18-year-olds would need to be admitted to adult wards. Senior inspectors at the Care Quality Commission say that under-18s should not be put on adult wards, so why is NHS England issuing guidance that contravenes that advice? Adult mental health wards are no place for young people, but how can the Minister be sure that even in emergencies adult wards can accommodate children and teenagers? Adult mental health wards are operating at well over their recommended capacity, and today the Royal College of Psychiatrists has warned that the lack of acute beds available to mental health patients has left the system at breaking point. If adult mental health wards are full, where will these children go? What assessment was used to determine how many beds were needed? Clearly, it is not working. Does the Minister now plan to reassess the situation?

Why are so many of our children and young people needing in-patient mental health care in the first place? Could it have anything to do with the £50 million of cuts to child and adolescent mental health services? The Minister talked about early intervention, but we have seen cuts to early intervention in psychosis services, cuts to crisis services in the community, and the decimation of the early intervention grant, putting a lot of pressure on in-patient services. Could the problem be the fragmentation of commissioning we have seen across the health service since the Government’s reorganisation of the NHS?

The Government have paid lip service to parity of esteem and brought cuts and crisis in reality. Our children deserve better, and that is why Labour is committed to working to reverse the damage done to child and adolescent mental health services by this Government and why we have pledged to end the scandal of the neglect of child mental health.

[Norman Lamb]

First, let me caution against sanctimony. This is not a new issue: under the previous Labour Government, children did at times end up in adult wards. That is highly undesirable—everyone recognises that—and we must do everything we can to prevent it, but please do not try to claim that this is an entirely new problem. It is not. The Government have significantly increased the number of beds available, so significantly more are available now than there were in the last decade. The hon. Lady says that she sees increasing numbers of children held in police cells, but let us have some honesty and accuracy in this debate. The number of children who end up in police cells is falling, not increasing. The crisis care concordat, published last February, set a commitment to end the practice of children going into police cells. Indeed, we intend to legislate to ban it, but the numbers are lower than they were so she should not suggest that it is a growing problem—[Interruption.] She did suggest that.

The hon. Lady asked about my acting on the warning. That is exactly what we did. NHS England carried out a review of clinical judgment on the capacity required to meet children’s needs. As a result, there was a proposal for an increase of 50 beds nationally, focusing on the areas of the country where there was a significant problem, and the Government provided £7 million of additional funding to ensure that those beds were opened. Forty-six beds have opened. There is a temporary problem in Woking, where beds that were available are no longer accepting new admissions. That is a CQC issue. One thing that we have been absolutely steadfast on is that if standards are not being met, we should not continue to admit children to those wards.

The hon. Lady mentioned psychosis services, but this Government, for the first time ever, introduced a waiting time standard for early intervention in psychosis, which was widely welcomed by everyone in the mental health world. From this April, we start the process of introducing a standard. To start with, 50% of all youngsters who suffer a first episode of psychosis will be seen within two weeks and start their treatment within two weeks. That is an incredibly important advance.

The hon. Lady lectures the Government on mental health services, but perhaps she will consider why the Labour Government left out mental health when they introduced access and waiting time standards for all other health services. That dictates where the money goes and means that mental health loses out. This Government are correcting that mistake.

[Dr Sarah Wollaston (Totnes) (Con)]

I welcome the extra beds committed to south Devon. The Minister will know that one of the most frequent points raised with the Health Committee in our recent CAMHS inquiry was the complete absence of accurate prevalence data on children and adolescents’ mental health needs and the services required to meet them. He will know that the prevalence data collection that used to happen every five years was cancelled in 2004. The Committee warmly welcomed the commitment to restart that survey. Will he update the House on exactly when that survey will start, whether the funds have been identified, and whether the scope of the prevalence data collection has been identified?

[Norman Lamb]

The hon. Lady is absolutely right. Unless we understand the prevalence of the problem, it is impossible to plan services effectively. I am delighted that we have secured the funding for an updated prevalence survey in 2015-16. It will be an expanded survey compared with the previous one. We want to cover as wide an age range as possible, to cover early years. That will give us the data, information and evidence we need, but I would then want us to do regular repeats to ensure that we maintain an understanding of prevalence.

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

The excellent in-patient facility in Hull and East Yorkshire closed under this Government in 2013 with no consultation whatever. Despite an excellent report by the Health Committee, despite criticism by the CQC and despite NHS England identifying a problem, we have waited two years. Does the Minister believe that the Health and Social Care Act 2012 has made him powerless to act in such cases? If not, why does he not do something?

[Norman Lamb]

Ultimately, it has to be down to clinical decisions. Indeed, the whole thrust of policy, which was very much started under the right hon. Gentleman’s Government and during the period that he was Secretary of State for Health, is to devolve decision making about the make-up of services to local areas. That approach has been maintained. Ultimately, he would probably agree that such issues cannot all be determined in a Whitehall office.

None the less, the right hon. Gentleman raises serious concerns. I have tried to engage with him on them and am happy to talk to him and meet him further. I share his concerns about the lack of sufficient response to the concerns he raises, but I will repeat one other point I have made: the emphasis of policy should be on building up crisis response services and better and stronger community support services to reduce the need for in-patient care as much as possible. It is not therapeutic to put children and young people on in-patient wards, and particularly not away from home.

[Paul Burstow (Sutton and Cheam) (LD)]

I can recall many Labour Health Ministers telling us from the Dispatch Box that local decisions were made by primary care trusts and were not a matter for them. Will the Minister consider what he has told us about the CAMHS review? He has been frank about the fact that CAMHS are dysfunctional and broken. Surely the review is the opportunity to lay down a route map and set out how we can deliver the preventive early intervention services that prevent the crisis from occurring in the first place and the need for the admission. Do we not need that so that when there is a spending review after the general election, there is clarity about the investment needs for children’s mental health?

[Norman Lamb]

I think my right hon. Friend is referring to the children and young people’s taskforce that I established last summer. He is right that this provides us with an incredibly valuable opportunity to modernise the way in which we organise and commission children’s mental health services. There are many fantastic professionals working in children’s mental health services, but in my view they are let down by a dysfunctional system with horribly fragmented commissioning, which is a long-standing problem. Because we are involving experts and campaigners from outside and, critically, children and young people, we have a great opportunity to get services modernised and effective and focusing particularly on prevention.

[Glenda Jackson (Hampstead and Kilburn) (Lab)]

The Minister seems to be arguing that the solution to the problem is further evidence. For all the years that I have been in this House—almost 23 now—the issue of underfunding for mental health has been constant. The underfunding of services for children and adults who are suffering from mental health problems is an issue I raised in this House less than six weeks ago. It is unacceptable to claim that if there had been more information, measures would have been put in place to prevent children being sent hundreds of miles from their homes or being placed in adult wards. The Minister’s contribution has clarified the total lack of co-ordinated services for these young people. What kind of care would be afforded to someone in their home when, as in my constituency, their home may well be bed and breakfast, a hostel or some form of temporary accommodation? This is an urgent question; it requires urgent action. [Interruption.]

[Mr Speaker]

Somebody said that was very wrong. It was a Shakespearian performance. In fact, somebody once said to me, “That person could have been on the stage”!

[Norman Lamb]

I am delighted that the hon. Lady made the point not made by her Front-Bench spokesperson, which is that this is a long-standing problem. The disadvantage suffered by mental health has been there for a long time. Indeed, it was exacerbated, if I may say so, by the fact that access and waiting time standards were introduced for physical health, but the previous Government left out mental health. If that happens, it dictates where the money goes. That, combined with a funding system that sucks money into acute hospitals but which in mental health relies on a block contract, means that mental health always loses out. It is this Government who are determined to change that to ensure that mental health is finally treated equally.

[Tim Loughton (East Worthing and Shoreham) (Con)]

The Government can take credit for great progress in eliminating mixed-sex wards. The Home Secretary had some very encouraging things to say about children with mental health problems in police custody, and in the Department for Education great strides have been made in respect of kids in residential care homes not being placed well away from home. Many of us fought very hard during the passage of the Mental Health Act 2007 to get rid of the practice of children being placed in adult wards far from home. Will the Minister now, with the same urgency that led to those other successes, ensure that that is eliminated at last? In many cases it is not in the best interests of deeply troubled children.

[Norman Lamb]

I pay tribute to the hon. Gentleman for the work he did in his campaigning on the Mental Health Act and more recently as a Children’s Minister in the Department for Education. I know his passion for the subject and I share his view that it is intolerable that children and young people should go to adult wards. It has been a long-standing issue—it is not new—but it should not happen, just as it should not be the case that children are still placed in police cells. That is why I take the view that we need to ban it in law so that it cannot happen, and there are consequences if it ever does happen.

[Mr Kevan Jones (North Durham) (Lab)]

I do not question the Minister’s commitment to mental health. He is a great champion of parity of esteem, but he is part of a Government who are cutting money for mental health services. For young people in 2015 to be put in police cells is totally unacceptable. To pick up the point made by the right hon. Member for Sutton and Cheam (Paul Burstow) about CAMHS, is it not time not only for a fundamental review but for a new system, including the abolition of the present CAMHS system?

[Norman Lamb]

I am grateful to the hon. Gentleman for his generous remarks—perhaps he ought to talk to his Front-Bench colleagues about my commitment. He is absolutely right to highlight the fact that although there is quite a mixed picture across the country, in many areas there has been disinvestment in children’s mental health services. They are local decisions, and they are not decisions that I accept. That is why I made the serious point about the absolute importance of introducing waiting time and access standards, including in children’s mental health services. We need data so that we can monitor performance against those standards, and we need a payments system that does not disadvantage mental health. I also share his view that we need to change the way services are organised and commissioned so that we focus much more on prevention.

[Dr Julian Lewis (New Forest East) (Con)]

Does the Minister accept that this is a matter not only of funding but of philosophy? Does he agree that part of the problem is that certain primary care trusts have adopted a philosophy of cutting in-patient beds generally? For example, adult beds have been cut by 35% in areas as far apart as my constituency and that of my hon. Friend the Member for Burton (Andrew Griffiths). Does he detect any rowing back from that rather extreme philosophy in the near future?

[Norman Lamb]

We want to try to ensure that when there is a crisis, a bed is available locally. With regard to the philosophy of seeking to reduce the tendency to have long periods of in-patient care—institutionalising people—it is absolutely right that we move away from that and focus far more on early intervention, community support and recovery. That is the general trend in progressive views within mental health. However, there must be a bed available when a crisis occurs.

[Mrs Madeleine Moon (Bridgend) (Lab)]

The Minister generously attended the launch of the report by the all-party group on suicide and self-harm prevention, which showed that one third of local authorities have no suicide prevention plan. Has he found any correlation between the lack of such a plan, poor CAMHS provision and a high incidence of suicide, particularly among young men?

[Norman Lamb]

May I first pay tribute to the hon. Lady for her inspiring work on suicide? Not many people in the House focus on issues that are talked about so seldom, so I pay tribute to her for the brilliant leadership she has shown. The all-party group’s report provides some really interesting and important questions of the sort that she has put to me today. These are questions that we need to ask. We have not yet established that link, but I think that it enables us to start asking local areas those questions. The Deputy Prime Minister has talked about the ambition of avoiding every suicide. We can improve services across the board by focusing much more on preventing conditions deteriorating to the point where someone becomes so desperate that they choose to take their own life.

[Mr Adrian Sanders (Torbay) (LD)]

I welcome the Government’s announcement of an extra £7 million, although I do not know whether it will be enough. I am very pleased, on behalf of constituents in Devon and Cornwall, that we have a new facility opening in Torquay—it is not yet fully open—and hope that the Minister can visit it. I also welcome the fact that he is reviewing the place of safety designation, although I question whether that actually requires legislation. The case that occurred in my constituency raised something that he has not yet mentioned: the problem that a person trying to find an appropriate place has no central register to look at. If we want a hotel room, we can go online and find a vacancy, but finding a vacancy in an appropriate setting seems to take an enormous amount of time.

[Norman Lamb]

The case in my hon. Friend’s constituency highlighted an incredibly important issue. The lessons that are being learned as a result of that incident will result in improved co-ordination and reducing the risk of that sort of thing happening. It was completely intolerable that that young girl ended up in a police cell for that length of time, and we should all be completely clear about that. The crisis care concordat makes the objective clear. We asked every area to sign up—and every area did so by December—to committing to implement the standards in the concordat, one of which is to end the practice of under-18s going into police cells. I think we need to go further and ban it in law.

[Mark Reckless (Rochester and Strood) (UKIP)]

It is just over a year since 35 mental health beds at Medway Maritime hospital were closed. As those closures and the associated changes in Kent were referred to the Health Secretary, will the Minister review whether the changes promised to community care, particularly for some degree of residential provision in Medway, have taken place? Is he satisfied with current provision?

[Norman Lamb]

I am happy to look into that for the hon. Gentleman. Indeed, he can come along to one of my Monday evening advice sessions and we can discuss it further. It is clearly important that the right provision is available in his area.

[Mark Pritchard (The Wrekin) (Con)]

I welcome the new funding announced by the Minister. Surely one way of reducing pressure on in-patient beds is to expand mental health assessments within youth custody facilities and expand treatment within those facilities. What co-ordination is there between his Department and the Ministry of Justice on that issue?

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[Norman Lamb]

My hon. Friend raises an incredibly important point. There is a lot of co-ordination between the two Departments. Indeed, he may be aware of a new taskforce set up by the Deputy Prime Minister to co-ordinate Departments’ work on mental health. There is a plan to roll out the liaison and diversion service nationally by 2017. No other country in the world is doing this on such an industrial scale, in order to ensure that someone who turns up at a police station or a court with an identifiable mental health problem gets referred for treatment. That is really exciting.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

The Minister is right about this. In the 10 years for which I chaired the Education Committee, I knew that child mental health services were not as good as they could have been. We now have a crisis. In the past, we patched things together with a partnership among children’s services, the local authority, mental health services in hospitals, and GPs. That partnership has been broken, mainly by the reforms that the coalition Government have introduced in commissioning and the fragmentation of so much else. The earlier a child is diagnosed and treated with therapeutic help, the better. At the moment, that is not happening. This is not just about beds; it is also about early intervention.

[Norman Lamb]

I totally agree. However, I caution the Opposition about going around declaring a crisis every second day, because the picture is very varied around the country. I agree with the hon. Gentleman about any unacceptable things that are happening. He makes a very good point about co-ordinating services much better. Indeed, a central focus of the children’s mental health taskforce is to try to ensure that we get much better, co-ordinated commissioning of care.

[James Morris (Halesowen and Rowley Regis) (Con)]

In my capacity as chair of the all-party group on mental health, I recently visited the Elms centre in Dudley, which is providing an excellent CAMHS service for the people of the borough. It is important to recognise that there are very high-quality CAMHS services in certain areas of the country, although we accept that there is variability. Does the Minister agree that the challenge is not just about the order of magnitude of resources but about ensuring that commissioners are prioritising CAMHS at a local level so that they make the right decisions about the sort of provision that is required in their area?

[Norman Lamb]

I pay tribute to my hon. Friend for the work that he does on mental health. He is another champion of mental health in this House. I also pay tribute to the people in the service in Dudley that he mentioned. I have visited a fantastic children and young people’s mental health service in Accrington in Lancashire—one of the six pilots on using psychological therapies for people with severe and enduring mental ill-health. He makes a very good point. We need to celebrate great care where we find it, and also ensure that commissioners, in local authorities and in clinical commissioning groups, take this seriously. The trouble is that when there are no standards at all in mental health, it is very easy for people quietly to cut back, thinking that they can get away with it. That is why I want to ensure that people suffering mental ill-health have exactly the same right to access treatment as anyone else.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It was interesting to hear the Minister say that he has learned lessons from the incident in Torbay, because there was exactly the same incident over a year ago in my constituency. A young person who had committed a violent offence found themselves in a police cell for 36 hours. I spent the best part of the day working with officers involved with mental health from the local authority and the health service, desperately trying to find an appropriate place for that person’s particular behavioural issue. They had not got a list. We looked at a place in Somerset that had closed, probably thanks to the 6% cuts. Will the Minister help Members of the House by placing in the Library a list of where the beds are and what the specialisms are? It would be enormously helpful to us, and certainly to those working in that field.

[Norman Lamb]

I would be happy to provide as much information as possible—I have no need to keep anything secret and I would like to assist as much as I can. Again, I caution that children and young people turning up in police cells has been happening, quietly and unnoticed, for a very long time, but the truth is that the numbers are coming down. That is good, but I want it to stop altogether.

[Sarah Newton (Truro and Falmouth) (Con)]

The Minister has been supportive of my work to secure specialist adolescent mental health services in Cornwall. When he next comes to Cornwall, will he meet me and local commissioners to see how we can benefit from new money and plans that have been communicated today?

[Norman Lamb]

If the diary allows I am certainly up for that, and I pay tribute to the hon. Lady for the work she has done in her county in trying to improve children’s mental health services. We must do that across the country, and there are many examples of real and significant improvements.

[Diana Johnson (Kingston upon Hull North) (Lab)]

We are discussing young people, and Natalie Carmichael has e-mailed me. She is 17, lives in Hull and suffers from anorexia nervosa, yet she had to go to Manchester—more than two and a half hours away—to access 24-hour care. She states:

“The illness itself is distressing enough…but I feel it made it ten times more traumatic the fact that I was hundreds of miles away from home and I couldn’t reach to my family for comfort and support in the tough experience I was battling.”

What does the Minister say to Natalie?

[Norman Lamb]

I find it as intolerable as she does, and that is why we are investing to improve access to beds in the locality. Indeed, we identified the hon. Lady’s region as an area where there were shortages of beds for children and young people’s mental health, and we have taken action to increase that number.

[Mr Philip Hollobone (Kettering) (Con)]

Which is the best CAMHS service in the country, why can it do it when others cannot, and what is stopping its best practice from being copied?

[Norman Lamb]

My hon. Friend makes an important point, and there are many excellent mental health services, as the hon. Member for somewhere in Birmingham—[Interruption.]—for Halesowen and Rowley Regis (James Morris), said earlier. If some areas can do things well with the available resources, then other areas can too. It is also true that some areas have chosen to cut funding for children’s mental health, in my view inappropriately.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Birmingham is one of the fastest growing younger cities in Europe—40% of its population is under 25, and 30% under 15. Combined with local authority cuts of £281 per head in the next financial year, and a totally dysfunctional commissioning system, does the Minister seriously think that even the good intentions of the children and young person’s taskforce will address the problems we already have, as well as those that we can see coming but have no means of remedying?

[Norman Lamb]

Again, I gently make the point that we all, on both sides of the House, have to recognise the need over the next five years to make better use of the resources available. The hon. Lady’s own party does not propose ring-fencing local authority funding for the provision of mental health services at the lower tier level. We all have to work on making more effective use of the money, and I genuinely think that the taskforce is an opportunity to modernise how we organise services, particularly commissioning—having four different commissioners does not create the best chance of co-ordinating services.

[David Rutley (Macclesfield) (Con)]

Like many in the House, I recognise the Minister’s commitment to this important issue. I speak to young people and teachers, and there is a growing recognition of the importance of mental health services for adolescent children. What research has the Minister undertaken to better understand the root courses of the mental health challenges facing young people today, particularly the impact of social media?

[Norman Lamb]

My hon. Friend is right to highlight an emerging and growing phenomenon causing increased distress for some young people. The prevalence survey, for which we now have the funding for 2015-16, is a massive opportunity to understand much better the scale of the problem we are seeking to deal with.

[Pat Glass (North West Durham) (Lab)]

In 2012, the Education Select Committee called CAMHS in this country a “national disgrace” and urged that the Department for Education and the Department of Health urgently get together to avoid the crisis we are seeing today. In the meantime, we have seen cuts in services, provision and funding, leading to the chaos today. I am incredibly unhappy with the complacency of the Minister’s answers. It is almost as if he is a spectator. He is the Minister with responsibility, and the answer is not a taskforce two years down the line or a prevalence survey five years down the line; it is to take action now.

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[Norman Lamb]

I am left totally confused. The hon. Lady has just referred to my complacency, whereas the person who was just sitting next to her, the hon. Member for North Durham (Mr Jones), paid tribute to my passion in fighting for mental health services. So which is it?

If there was any substance to the hon. Lady’s question, it concerned the importance of mental health services and education working more effectively together and, as was said earlier, the role of schools. As a result of the taskforce, I think we can achieve much better collaboration among schools and mental health services. I also point out, as have hon. Members on her own side, that this is a long-standing problem that goes back far beyond 2010.

[Andy Sawford (Corby) (Lab/Co-op)]

The Minister might remember that I wrote to him about a local family who went through a living hell when a young girl was sent from East Northamptonshire to a hospital in Bury, where she was left for weeks; where there was conflicting advice about whether she should be there at all; and where the family felt she was getting worse not better. Will he look specifically at provision in Northamptonshire, particularly the provision of beds for teenagers, and reflect that, to be fair to CAMHS in Northamptonshire, ours is one of the worst-funded areas for health care in the whole country—way off the NHS England target?

[Norman Lamb]

I know that the hon. Gentleman is campaigning on this matter—he is right to do so—and I would be very happy to talk to him further about this case. The circumstances he describes are intolerable. As my hon. Friend the Member for Kettering (Mr Hollobone) said, the frustration is that, if some services and commissioners can avoid that, why does it happen in other areas of the country? However, I would be happy to discuss the matter with him.