The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)
My Lords, I thank the noble Earl, Lord Listowel, for securing this important debate and for speaking to his Question so powerfully and with such authority.
Improving the mental health of children and young people is a key priority for the Government. It is part of our commitments to achieving parity of esteem between mental and physical health and to improving the lives of children and young people. Since 2010, we have raised the profile of mental health to unprecedented levels. We have produced the mental health and suicide prevention strategies and worked, through Time to Change, to reduce the stigma attached to mental health issues.
Although there has been much progress, the Government have been open about the scale of the challenge and acknowledge that there is still much to do. This includes action to improve outcomes for looked- after children and care leavers. Around 68,000 children are looked after by a local authority. For nearly two-thirds of these, the primary reason for being looked after is abuse or neglect. Although looked-after children have many of the same health risks and problems as their peers, they tend to have poorer outcomes. Almost half have a diagnosable mental health disorder and two-thirds have special educational needs. I can reassure my noble friend Lady Tyler, in particular, that it is the responsibility of the local authority, as corporate parent, to assess each looked-after child’s needs and draw up a care plan that sets out the services which will be provided to meet those needs. It must make arrangements to ensure that the child has his or her health needs fully assessed, and a health plan developed and reviewed.
At the end of last year, we consulted on revised statutory guidance on promoting the health and well-being of looked-after children. In that guidance, which will be published in its final form shortly, we emphasise the need for parity of esteem between mental and physical health. My noble friend Lady Stedman-Scott spoke about the social isolation felt by those leaving care. The guidance stresses the importance of ensuring continuing support for those leaving care, and that suitable transition arrangements are in place so that the young person’s health needs continue to be met.
That leads me to the concern expressed by the noble Earl about the problems that can arise during transition from children’s to adults’ services, a point touched on by the noble Lord, Lord Bradley. Indeed, ending the unacceptable cliff edge that some young people—not just those in or leaving care—face of support being lost as they reach the age of 18 is a key priority for action. I am delighted that NHS England has now published new service specifications for child and adolescent mental health that give guidance to local commissioners on how to improve transition practice. The Children and Young People’s Mental Health and Wellbeing Taskforce, to which I shall return in a moment, is also considering how to deliver more seamless transition built around the needs of young people. Our statutory guidance on promoting the health and well-being of looked-after children stresses the importance of ensuring continuing support for those leaving care and that suitable transition arrangements are in place, so that the young person’s health needs continue to be met.
The noble Earl asked how specialist mental health services for looked-after children, including psychotherapy, can be protected and, indeed, expanded. Rather than mandating mental health services targeted at specific groups such as care leavers, our aim is to ensure that everyone has timely access to evidence-based services when they need them. That is why—as mentioned by the right reverend Prelate—we have invested £54 million over the last five years in the Children and Young People’s Improving Access to Psychological Therapies Programme. This has transformed children’s mental health services throughout the country through the use of evidence-based therapies alongside session-by-session outcome monitoring, so that both therapist and patient know how well therapy is working toward a goal. We are strengthening the statutory guidance to make it clear that service commissioners must make sure that services provide targeted and dedicated mental health support to looked-after children, according to need. How they do that is for local determination, but it could include a dedicated team or seconding a CAMHS professional into a looked-after children multi-agency team.
The Government are clear that lack of investment in children and young people’s mental health services is not acceptable. Last November, we provided £7 million of additional funding to NHS England, allowing more in-patient tier 4 CAMHS beds to open. So far 53 new beds have been commissioned, taking the total to over 1,400 beds, more than ever before. We are well aware that there is variation across the country in investment in services provided by local authorities, schools and clinical commissioning groups. The noble Baroness, Lady Uddin, and other noble Lords have mentioned funding. We have legislated for mental health to get its fair share of local funding and this year’s NHS planning guidance is clear that spending on mental health services must increase. It is not enough simply to provide more and more beds. In order to ensure that improvements are sustainable, we need to focus on preventing issues arising, or taking action before hospital treatment is required. The task force is considering how best we strike this balance.
In addition, I can tell my noble friend Lord Addington that we have produced MindEd, which is an online platform designed to give those who work with children and young people every day the skills and knowledge to recognise the earliest signs of mental health problems. Health Education England is working with the Royal College of General Practitioners and others to improve training on CAMHS and the task force is also looking at the capacity and capability of the workforce. The Department of Health is commissioning a new prevalence survey of child and adolescent mental health, giving us something that we have needed for years: an accurate picture of mental ill health in youth.
I shall now try to cover as many points as I can that have been raised in the debate. I will of course write to noble Lords whose questions I have not been able to address in the time available. The noble Earl spoke very eloquently about the need for proper supervision of staff. All staff working in a children’s home should receive supervision of their practice from an appropriately qualified and experienced professional. In the majority of homes the supervisor will have experience or qualifications in the mental health field. The national minimum standards for fostering services expect them to ensure that foster carers receive the support and supervision they need. Programmes such as Multidimensional Treatment Foster Care can provide support, both to the child and to its foster carers. We expect to lay before Parliament next week new quality standards regulations for children’s homes in England, to come into force on 1 April. The regulations will require all staff in a home to receive practice-related supervision by a person with appropriate experience.
The noble Earl also referred to the qualifications of managers and staff. The Department for Education introduced new mandatory qualifications for children’s home managers and staff from this January. These include requirements to be able to support the well-being and resilience of children and young people.
The noble Baroness, Lady Warwick, referred to the reported drop in investment in CAMHS. As she knows, we have taken difficult economic decisions to protect the NHS budget and there have been no central government funding cuts to children and young people’s mental health services. We have been clear that a lack of investment in mental health services for children and young people is not acceptable, as I have said, and the child and adolescent mental health task force was commissioned to identify how to improve the quality of and access to children and young people’s mental health services.
My noble friend Lady Tyler asked what practical steps the Government are taking to ensure access to school counselling. The Department for Education is producing new guidance on good school counselling. We anticipate that this will be published in March. She also asked what we are doing to promote PSHE in schools. The Department for Education has funded the PSHE Association to produce new guidance for schools on teaching about mental health.
The right reverend Prelate the Bishop of St Albans spoke very powerfully about young people who self-harm and who commit suicide. Indeed, in January this year we issued a call to every part of the NHS to commit to a zero suicide ambition. In addition, the Government announced £150 million over the next five years to improve services for eating disorders and self-harm. He will know, I am sure, that preventing suicide in children and young people is a central part of the cross-government suicide prevention strategy published in 2012. That is backed by £1.5 billion of funding for research on suicide and self-harm.
As regards Mind’s call for talking therapies to be available within 28 days, the five-year plan for mental health sets out the ambition to have new waiting time standards across all mental health services by 2020. The Department of Health and NHS England are working to do this, and I think that introducing those waiting time standards is a landmark for mental health services that we have not seen hitherto.
The noble Baroness, Lady Uddin, spoke about the need for CAMHS for autistic children in particular. The new statutory framework for children and young people with special educational needs and disability is designed to greatly improve integrated working across health, education and social care, to deliver improved outcomes for the child and their family. CCGs and local authorities have joint arrangements for assessing, planning and commissioning services for children and young people with special educational needs.
The noble Lord, Lord Ramsbotham, asked how best we should address the lack of co-ordination across CAMHS. On 11 December last year, eight pilot projects were announced that will look to accelerate new collaborative commissioning approaches for children and young people’s mental health. These new pilots will be in various parts of the country—I will not read them out—and have each been awarded up to £75,000 to develop their plans. They have until April to get their new approaches up and running.
Time prevents me from covering the questions posed by the noble Lord, Lord Bradley, in particular. I undertake to write to him and other noble Lords, as I said. But I would just like to touch on the subject of parenting, which the noble Earl, Lord Listowel, mentioned, as did the noble Baroness, Lady Warwick, and the noble Lord, Lord Bradley. The CYP IAPT programme includes a focus on parenting for three to 10 year-olds with conduct disorder. It currently works with services covering 68% of the population and the ambition is for nationwide coverage in 2018.
The task force is a crucial element of our plans. It brings together experts from across health, social care and education to look at how to improve the way children and young people’s mental health services are organised. It has a particular focus on the needs of the most vulnerable children and young people, including looked-after children. We will publish the Government’s report of the task force’s findings shortly. I hope that noble Lords will be reassured that there is much going on in this area. The Government are very focused on the subjects that we have heard about this evening. I very much hope that the progress we have seen over recent years will be continued under the next Government.