(8 years, 8 months ago)
Westminster HallRead Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
James Morris (Halesowen and Rowley Regis) (Con)
I beg to move,
That this House has considered the report from the independent mental health taskforce to the NHS in England.
It is a pleasure to serve under your chairmanship, Mr Wilson. This is a very important debate on the “Five Year Forward View for Mental Health” report, published in February. I pay tribute to the chair of the taskforce, Paul Farmer, who is the chief executive of the mental health charity Mind, and the vice-chair, Jacqui Dyer, for all their work. I also thank all the other members of the taskforce and the people throughout the country who contributed to its work. It is an excellent study that contains more than 50 concrete recommendations about how we need to go about improving mental healthcare in our country.
The report represents an historic opportunity. There are three reasons why I believe it is pivotal to the whole history of our approach to mental healthcare in Britain. First, both the public debate in Britain about mental health and our social attitudes towards it have been transformed over the past 10 years. The quality of the debate in Parliament, the media and the public square is at a completely different level from where it was for many years. We are addressing issues of stigma and are open to discussing mental health problems in society.
Secondly, there is a general recognition in the Government and across parties that for too long, mental health care has been underfunded in the national health service. There is now a mature debate about how we should fund mental health services over the next decade.
Thirdly, I strongly believe that, as a result of the work of many people from all political parties over a long period of time, mental health is now at the top of the list of public policy priorities. We now have the political will, which is manifested in the Minister himself, who is absolutely committed to delivering on the plan formulated by the independent taskforce. Those are the reasons why I believe the report represents an historic opportunity.
The report provides a route map for change so that we can give hope to those throughout the country who are currently suffering from mental health problems and who may not be getting, or feel that they are getting, the level of service that they should from the NHS. I shall concentrate on the implementation issues highlighted in the report. There have been many reports over the past 20 years, and many strategies have been determined by Governments of both main political parties. I think we would all agree that over that period we have not made sufficient or fast enough progress, given that mental health issues are becoming more visible in society and given the prevalence of the mental health issues we are seeing across the age range and across the social and economic landscape of the country. There is a real urgency that we get this right, and now.
What do we need to do to drive the change that we all want to see in the quality and availability of mental health care in Britain today? The report focuses on four areas that are critical to implementation—commissioning; the importance of research and data; the incentives, levers and payments for services in today’s NHS; and leadership in the NHS and across Government. The truth is that, to achieve our goal of transforming mental health services in Britain, we need urgent action in all four areas.
The report is clear about the challenge we currently face on commissioning. It states:
“The quality of local mental health commissioning is variable. We found a twofold difference in apparent per-capita spend by CCGs, a more than threefold difference in excess premature mortality in people with mental health problems in England and a fourfold variation in mortality across local authorities.”
The reality is that we need better and more effective commissioning at a local level.
The report discusses the model of commissioning set out by the “Future in mind” taskforce, which looked into child and adolescent mental health services and came up with recommendations for improving commissioning. Those recommendations, which are picked up in the “Five Year Forward View” report, speak to the need to improve commissioning across mental health services and across the age range.
Rehman Chishti (Gillingham and Rainham) (Con)
I pay tribute to my hon. Friend for securing this debate and for all he has done for mental health in his time in Parliament. He has been an absolute champion of it. Does he share my concern, which is shared by the Royal College of Psychiatrists, that there is currently no proper accountability for local clinical commissioning groups? The Bill on accountability in commissioning that I presented to Parliament last year would have required every CCG in the country to report back to the Secretary of State every year on the resources and spend in the local area. That way we would know exactly what was going on and could ensure parity of esteem in resources and allocation.
James Morris
My hon. Friend makes a very important point. He is right, and I will come to the need for greater accountability later in my speech.
On commissioning, the “Five Year Forward View” report states:
“The transformation we envisage will take a number of years and without clear information about what the best care pathways look like and good data on current levels of spending, access, quality and outcomes, it will be hard to assess the impact of organisational change and ensure mental health services are not disadvantaged.”
Its very first recommendation is:
“NHS England should continue to work with Health Education England…Public Health England…Government and other key partners to resource and implement Future in Mind, building on the 2015/16 Local Transformation Plans”—
which I know are in the process of being implemented—
“and going further to drive system-wide transformation of the local offer to children and young people so that we secure measurable improvements in their mental health within the next four years.”
I dwell on those recommendations because—this speaks to my hon. Friend’s point—we need more transparency on what clinical commissioning groups are spending and where. The report is clear that there is currently simply too much variability across the country. I have long been an advocate of the importance of local, decentralised decision making. It is important that clinical commissioning groups have the freedom to commission services that they think are appropriate to their local population. The report is clear that we need a more consistent approach on mental health services that focuses on collaboration and more integrated commissioning across the spectrum.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
Will my hon. Friend reflect, in the context of the devolved settlement for services, on the importance of substance misuse services and on the impact that the fragmentation of those services away from other mental health services may have had on patient care?
James Morris
My hon. Friend makes a powerful point. We need to deal with some of the issues to do with fragmentation in the system—he refers to substance misuse. The thrust of the recommendations in the report is about making sure we have a more integrated approach to commissioning mental health services across the piece.
The second important facet of the implementation challenges that the report throws up is research into mental health services. It mentions the need to have a proper, coherent 10-year plan for research into mental health to fill what are, as many of us would agree, big gaps in the evidence base.
Norman Lamb (North Norfolk) (LD)
I congratulate the hon. Gentleman on securing the debate. Does he share my horror at the fact that the Medical Research Council spent 3% of its budget on mental health research in 2014-15? That bears no relation to the degree of disease burden in our country, yet it chose to spend just that much on research.
James Morris
I thank the right hon. Gentleman for that intervention and pay tribute to him for all the work that he has done, particularly when he was Minister with responsibility for this area. I agree that we need to spend much more on mental health research, and we need to know what we want to research. For example, there is much talk about the power of peer support in mental health. There is an assumption that it is a good thing and that it works, but we do not have a particularly rich evidence base about whether it does.
On the efficacy of certain psychotherapies, the evidence base shows that cognitive behavioural therapy can be effective for people with mild depression and anxiety, but we do not really know about the effectiveness of other psychotherapies that we may want to promote and develop in the national health service. We clearly do not know very much about a lot of emerging areas that have an impact on mental health. For example, using technology and mobile phone and other apps to help people with mental health problems is a big emerging area, but we do not know much about its effectiveness. We certainly do not know in any coherent sense about the implications of genomic medicine on mental health care. A coherent strategy on mental health research is required over the next decade so that we can extend and expand the evidence base, because the truth is that we are often flying blind.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
I congratulate my hon. Friend on securing the debate. It is a pleasure to serve under your chairmanship, Mr Wilson.
Does my hon. Friend recognise that one of the key issues in constituencies such as mine, which is a low-wage, low-skill economy, is tackling depression? That is helping us get everybody into work. If we want growth, it is important that we deal with people who suffer from depression, which is, of course, another mental health problem.
James Morris
My hon. Friend is absolutely right. We need to support people with depression back into work. The report makes a number of recommendations, which he may be aware of, on the use of strategies such as individual placement and support to get people with mental health problems back into work.
The report also talks a lot about data, which underpin our decisions about where we should focus our efforts on mental health. It refers to a “black hole” of data and calls for a “transparency revolution” in mental health. As I said earlier, for a long time—probably 20 years or more—we have not been collecting sufficiently robust data about what is actually going on in mental health services. We need better data on what is going on to have a firm basis on which to understand what is working, what is not working and what is going on at local and national level. Recommendation 50 in the report—this pertains to what my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) said about accountability—is at the heart of the implementation challenges that we face. It states:
“The Department of Health and NHS England should require CCGs to publish data on levels of mental health spend in their Annual Report and Accounts, by condition and per capita, including for children and Adolescent Mental Health Services, from 2017/18 onwards. They should require CCGs to report on investment in mental health to demonstrate the commitment that commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall allocation”
of funding. That goes to the heart of our data challenge.
For too long, mental health services have not been properly resourced because we do not have an effective data set on what is actually happening in the NHS or, as the report highlights, an effective model in the NHS for paying for mental health services. They tend to be commissioned on what is called a block contract basis, which often has the effect of focusing on the delivery of a low-cost service, rather than on quality outcomes. We certainly do not have a model of care that focuses on an individual care pathway or a cure for an individual patient.
We need a different model of payment for mental health services in the NHS that focuses on quality and outcomes and reflects our aspiration, which is written into the NHS’s operating mandate, for parity of esteem—the integration of physical and mental health. How can we express that aspiration? To give an example, if I suffer from diabetes and a serious mental health problem, my treatment in the national health service is effectively split in two: there is a physical health pathway, which is paid for in one way, and a mental health pathway, which is paid for in another way. I believe that we need to move towards a payment-by-activity model in the NHS that does not discriminate between physical and mental health. That will certainly not happen overnight, but the report goes some way towards arguing for it in recommendation 47, which states:
“NHS England and NHS Improvement should together lead on costing, developing and introducing a revised payment system by 2017/18 to drive the whole system to improve outcomes”.
Heidi Allen (South Cambridgeshire) (Con)
Does my hon. Friend think it is right that we have a separate payment model for mental health, or should physical and mental health be treated together? Separating them could cause the very division that we are trying to lose.
James Morris
That is precisely what I am arguing for. Over time, we need to move to a model that does not discriminate between mental and physical health, with integrated payment reflecting the fact that there are a lot of conditions and a lot of comorbidity. Getting the payment system right in the NHS is fundamental to everything about the aspiration for parity of esteem. “Parity of esteem” is an interesting set of words, which can be interpreted to mean that we want a culture change or a system change—all of which is right—but to achieve it we need to change the payment model for how services are commissioned and purchased in the NHS.
Rehman Chishti
I agree with the model that my hon. Friend is proposing. From my discussions with the Royal College of Psychiatrists, which has backed a Bill on accountability, I believe that such a model would achieve a more holistic approach for patients, which can only be a good thing for outcomes.
James Morris
Again, my hon. Friend is absolutely right. The model contained in recommendation 47 and discussed in the report should drive the achievement of parity by moving towards an integrated tariff or pricing model. A lot of detailed work needs to be done to achieve that—I am not saying it is something that the Minister will be able to implement in the next week—but it goes, fundamentally, to the transformation argument that is at the centre of the report.
Perhaps most importantly, the report talks about the importance of, and absolute need for, strong leadership in the NHS and across Government to drive the change and to make things happen. This is not only about the NHS, but about the whole of Government; it is about putting mental health at the heart of our thinking in many different areas. We need a cross-Government approach, with a strong grip at the centre. I say that despite being someone who believes in devolution, because in mental health policy we have reached the stage of consensus, with much agreement about what needs to be done, but we need political will and a grip at the centre of Government to make things happen. The truth is that the existing system needs to be challenged. We need a culture of challenge—if we say that we are allocating money to mental health, why is it not being spent? Why is it not delivering the outcomes that we need?
As the report highlights, successful implementation is about not only co-ordinating our healthcare response but what we need to do on mental health in education, criminal justice and, as my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) said, back to work programmes in the Home Office. Everything should be working together to achieve the goal of supporting the five-year transformation plan for mental health.
The last recommendation of the report, recommendation 58, might sound somewhat technical and bureaucratic, being a little obsessed with governance, but it is fundamental. It states:
“By no later than Summer 2016, NHS England, the Department of Health and the Cabinet Office should confirm what governance arrangements will be put in place to support the delivery of this strategy.”
That process of ensuring that the recommendations are followed through, that there is a performance and accountability framework, and that change is driven from the centre strikes me as fundamental.
The implementation challenges highlighted in the report are substantial and require action on multiple fronts. As I said earlier, the Minister has shown absolute commitment to addressing many of them. Will he give us an update on what progress has been made in the four areas that I have described today, namely commissioning, data and research, new payment mechanisms in the NHS and leadership in the NHS and across Government?
Getting this right is an historic opportunity. As I said at the beginning, to some degree the stars are aligned: we have a high-quality public debate; much more openness about mental health and its discussion; a mature debate on how we fund mental health; and political commitment at the highest level of Government, with the Prime Minister having made several speeches on and commitments about mental health in the past few months. We have the opportunity to drive forward what a 21st-century mental health care system should look like and make it deliver for all the people out there who need care and support. They are relying on the opportunity being realised and on us getting it right.
Several hon. Members rose—
Phil Wilson (in the Chair)
Order. Before I call the first speaker, I will impose an informal time limit on speeches of five minutes, because so many people want to get in. Please will the next speaker and others keep within the timeframe, so that I do not have to reduce the time limit any more?
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to serve under your chairmanship, Mr Wilson.
I thank the hon. Member for Halesowen and Rowley Regis (James Morris) for setting out the framework of this excellent report by Paul Farmer and his taskforce on addressing concerns about mental health. What stood out for me was that it was a very practical report—with time lines and specificity about how the debate should be taken forward, the resources required and the instruments we put in place to make the report a reality—but the hon. Gentleman was absolutely right: it is important that it should be accountable at every step of its journey. I will come to that later.
The report also sets out a clear action plan for some of the areas that need a focus, including the setting of key targets. I welcome the ambition in the report to improve access to services and reach a much wider community than they do now. It sets out a new chapter in this journey about how we build capacity for mental health services in future. I doubt that there will be disagreement in the Chamber about some of the emphasis in the report on funding and the requirement to put more resources into the service. What stood out for me was the startling figure that poor mental health costs us, economically and socially, £105 billion, a figure that compares with only £34 billion being spent on the service.
There is a lot of opportunity to move the debate about funding and finances forward, as well as addressing issues to do with facilities. That has been a particular issue for us in York, as we have seen the closure of our acute service and the slow rebuilding of that service, with more emphasis on community delivery. It is important to ensure that we have the right number of beds as we put in a new facility for the people of our city. When we look at capacity issues, we should not look backwards at how a service was delivered, but look forward to the future needs and requirements of the service.
It is also important to reflect issues of workforce planning. We have seen a serious shortfall in people working across the mental health services. I welcome the recommended drive-up of, for example, 1,700 therapists. Will the Government be producing an action plan, as they did for health visiting, to ensure proper mentoring and support in the system to ensure that those therapists come online, while also ensuring a proper regulatory framework for the health professions across mental health? We do not have one currently, and I know that many of the professions are calling for proper regulation.
The other figure that really stood out for me concerned when people require support, with 50% of mental health problems established by age 14 and 75% by age 24. What stands out for me is the need to shift resources into early intervention and prevention services. I welcome the investment to be made into perinatal mental health, but we need to build up from those services, as we look at the provision that will be needed into the future.
In particular, if we are looking at that focus, I know from talking to teachers in my community that too much of the burden is being placed on them. We need to ensure that it shifts to the real professionals in the service, who are properly trained to provide support, diagnosis, signposting and screening for young people. There is urgent need to look across services for young people as they move out of school. We have also had specific issues with transition, and I still think there are cliff edges, as commissioning and service provision are done by different bodies. As a result, we get cliff edges—not smooth transition—based on a date of birth rather than clinical need. That really needs to be addressed.
In the short time remaining, I want to mention the raising of concerns in mental health services. The current system is quite inadequate—HealthWatch has contacted me today specifically about this issue. There are too many places where concerns can be raised. We have the Care Quality Commission and NHS Improvement; we also have regulators who look at the professions and other places, such as the healthcare safety investigation branch. There are so many different places. We need one place where concerns can be raised, so that service users and staff know where to go and can get a clear response. I hope the Minister will address that as well.
Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)
It is a pleasure to serve under your chairmanship, Mr Wilson, and to speak in the debate. I pay tribute to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for bringing the debate, for his continued advocacy of the needs of mental health patients and for pushing continually during his time in the House on an important issue in ensuring that we hold our Government and NHS providers to account, so that genuine parity of esteem is delivered for mental health patients.
In the brief time available, I want to talk about a few points raised in the mental health taskforce’s good report, focusing on the need for more holistic care and joining up physical and mental healthcare for people with mental illness. I want to talk about access to care, recognising that some people struggle to access physical healthcare owing to their ethnicity or because English is not their first language. Such problems are compounded for those who have mental illness. I will also focus on some of the challenges in joining up what is a very fragmented health and care system, particularly for people with complex and enduring mental illness.
On holistic care, we know that somebody who is mentally unwell and has a chronic and enduring or severe and enduring mental illness can live a life up to 20 years shorter than somebody without that mental illness. That fact alone makes the point that we need to join up physical and mental healthcare better. My hon. Friend talked about a patient with diabetes. Such a patient may well develop diabetes because they are mentally unwell and do not have the right physical healthcare and support, or they may develop it as a side effect of some of the medication they are taking. We know that antipsychotic medications, for example, are linked with high cholesterol and developing diabetes.
We need to do much more to join up physical and mental healthcare. It is quite frankly scandalous and wrong that someone who is mentally unwell has a 20-year shorter life expectancy than someone who does not have that condition. That is something we must focus on and get right. We need to improve the physical and mental healthcare services for those with chronic and enduring mental illness.
We talked a little about the commissioning opportunities in that, and we must recognise that, at a local level, despite the Government’s best intentions, commissioners do not often put additional money into mental health services. Certainly in Suffolk, which I represent, the NHS funding increases—small though they may be—went largely to physical health and local CCGs failed to increase the money going to mental health conditions adequately.
The question is: how do we improve holistic care and join up physical and mental healthcare for those with long-term mental illness? We can and must learn lessons from the care in the community programme in the 1980s. The purpose of the programme—to deliver more care in the community and move away from the old asylums—was right, but the programme was not properly resourced. We must face up to that. Also, a lot of the money freed up by that was swallowed up by the physical healthcare sector and did not go into mental healthcare in the community. If we are talking about putting all the money for physical and mental healthcare in one place, we have to be careful that, by doing what sounds like a good thing, we do not effectively end up propping up the acute provider sector, which already consumes 55% of the NHS budget—that figure has risen over the last five years, as the Minister will be aware—and inadvertently further disadvantage mental healthcare, which receives only around 10% of NHS funding.
It may be appropriate—the report touches upon the importance of this—to improve liaison services on both sides of the divide between physical and mental healthcare. We could improve psychiatric liaison services for people with complex physical healthcare problems or enduring physical illnesses and, for people with long-term and enduring mental illness, we could improve medical liaison services in hospitals and properly involve and support physical healthcare in the community through GPs. I will not expand on that, as I do not have very long, but I would be grateful if the Minister responded to that point.
On access to services, we have to recognise that there is a fragmented care environment, in particular for people with chronic and enduring mental illness. Addressing that is not just about providing money for the health service, but about having appropriate housing—we know there is a shortage of appropriate housing to look after people with mental ill health in areas such as London—and dealing with the challenges in delivering proper social services care for such people. We also have to recognise that the state is often the only mechanism of support for such people. The only people caring for some of the poorest and most disadvantaged people in our society—people with long-term mental illness—work for the state; they are NHS and council workers. Unless we properly value and recognise their roles and properly fund—and increase funding—in a holistic, meaningful and long-term way, we will be unable to deliver the care that we need. There needs to be more money, more key workers and joined-up physical and mental healthcare. I endorse a lot of what the report says and I look forward to hearing the Minister’s response.
Norman Lamb (North Norfolk) (LD)
I, too, congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) and thank him for all the work he has done in advocating for mental health. I also congratulate Paul Farmer, Jacqui Dyer and their whole team on their substantial piece of work.
This is a historic injustice. The disadvantage suffered by people with mental ill health in accessing treatment is not the responsibility of any particular Government; it has always been there, but the report gives us the opportunity to end that historic injustice, and we have an absolute responsibility to ensure that that happens. It is both morally wrong and economically stupid to ignore mental ill health. The case is made so well on page 5 of the report, where it says:
“Those with conduct disorder—persistent, disobedient, disruptive and aggressive behaviour—are twice as likely to leave school without any qualifications, three times more likely to become a teenage parent, four times more likely to become dependent on drugs and 20 times more likely to end up in prison. Yet most children and young people get no support. Even for those that do the average wait for routine appointments for psychological therapy was 32 weeks in 2015/16.”
That encapsulates the problem. It is scandalous that children with such needs do not get access to treatment. It destroys their life chances, and the cost to society of the outcomes described in the report is enormous.
I am conscious of the time available to me, so rather than highlight a number of issues from the report I will address some key points directly to the Minister. First, we know that there will be £1 billion of additional funding, but it is due to come late in this Parliament. Between now and then, the NHS Confederation believes that mental health will lose out on funding and that in 2016-17 the bulk of the front-loaded money will go to acute hospitals. I have a real concern that the ambition in this document will not be realised unless that investment is made. Will the Minister ensure that that investment is delivered?
Norman Lamb
I do not have time; I want to ensure that others can speak.
Secondly, there needs to be a clear implementation plan—others, including the Royal College of Psychiatrists and NHS Providers, have made this point. We need to understand exactly the practical mechanism for making these things happen. NHS providers say the plan should be delivered by August of this year. Can the Minister confirm that that will happen and that there will be reporting back on progress, so that we understand exactly what is happening? We need proper governance arrangements to make sure that these things happen.
Thirdly, the report endorses the approach that I took of implementing comprehensive maximum waiting times standards. That is an essential component of achieving equality—an equal right to treatment on time, whether someone has a physical or mental health problem. The Government have endorsed the report, yet there is no funding attached to ensuring we get comprehensive waiting times standards. How will the Government ensure that that happens? It is fundamental to ensuring that we end the historic injustice.
I am delighted that there is now a commitment to end the outrageous practice of out-of-area-placements. It is outdated, it treats people appallingly, and we know that there is a higher risk of suicide among people who end up being sent out of area. To do it by 2020 takes too long. The Royal College of Psychiatrists report—Lord Crisp’s report—says it could be done by October next year, so I urge the Minister to follow that timescale. Will he also commit to implementing all the recommendations in Lord Crisp’s report, which has been widely welcomed? Everyone recognises that it makes sense, so I hope he will confirm that.
There is a responsibility on all of us to ensure that we do everything we can to implement the recommendations. I chair a commission on mental health in the west midlands. Is the Minister interested in a briefing on the progress we are making? There is a real opportunity to implement early some of the recommendations in the report.
Finally, I will make the case for preventive healthcare. Relate, the organisation, has made a powerful case for the value of couple therapy and ensuring that every provider of IAPT—improving access to psychological therapies—provides that among the other evidence-based interventions.
Amanda Solloway (Derby North) (Con)
It is an honour to serve under your chairmanship, Mr Wilson. I, too, congratulate my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on securing this important debate and affording us the opportunity to look more closely at the excellent mental health taskforce report.
I want to highlight some issues from the report. First, I completely agree that more children and young people should benefit from an increase in high-quality mental health support when they need it. The pressures on young people in today’s climate have too often been ignored. Social media, education, home life and even peer pressure have an astounding effect on young people. Those are just a few everyday factors that are often overlooked and may result in young people suffering in silence.
The report’s recommendations would give individuals the support that they need to overcome their difficulties and continue to develop their talents throughout their education, and subsequently their employment. Crucial to tackling mental health illness across the UK is the need to tackle individuals’ problems at an early age, and certainly when the first warning signs are elicited.
The second point I want to touch on is the NHS’s approach to identifying what steps services should take to ensure that all deaths by suicide across NHS-funded mental health settings are learned from to prevent repeat events. The NHS would be wise to learn from previous events, and it must ensure that the right investment is provided to help prevent people from taking their own lives. I know what it feels like to lose someone to suicide, including for the family.
The figures in the report also strike a note with me. It states:
“A quarter of people who took their own life had been in contact with a health professional, usually their GP, in the last week before they died.”
Indeed, when my cousin took his life, he was in contact with a GP and awaiting counselling. Even if we could save only one life, that would be one less family who would have to experience the heartbreak of losing a loved one. I am therefore pleased to hear that the recommendations outline a system in which more will be done to help GPs further understand the issues surrounding mental health. That will hopefully help to reduce the number of people who take their own life even having seen a healthcare professional in the weeks leading up to their death.
I was recently appointed to the position of rapporteur on mental health to the Joint Committee on Human Rights, and the first area I will be reporting on is self-inflicted deaths in custody among 18 to 24-year-olds. The taskforce report touches on the issue of mental health in prisons and in the time following release from prison. There is no denying that prison should be a punishment. However, the criminal justice system is a difficult place for people with mental health issues, and I welcome the proposals to improve mental health provision both for those currently serving a prison sentence and those who have recently been released. We need to ensure that we provide the appropriate support to help ease people back into society and help them forge a life away from crime.
Nine years ago today, my mum died at the age of 67, having fought all her life against mental health issues—she was in and out of several institutions—and it strikes me that we could have had her for another 12 years had some recommendations in the report been adhered to.
The NHS taskforce report covers many aspects of mental health, which is an issue that is impossible to address overnight. We need a strong, detailed and considered plan of action to be implemented over the coming years. The Government have highlighted mental health as a key priority, and I hope that by working with the NHS and the organisations and charities at the heart of mental health, we can produce an effective plan to improve mental health provision across the UK.
Colleen Fletcher (Coventry North East) (Lab)
It is a pleasure to serve under your chairmanship, Mr Wilson. I congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing today’s debate on the excellent report from the independent mental health taskforce to the NHS in England. I reiterate many of the comments made so far, especially those about housing, jobs and the immediate environment in which someone lives. My constituency has shocking health inequalities, and improving all those things could lead to good mental health.
The report contains a series of recommendations that, if implemented in full, will lead to the introduction of essential reforms and the additional investment that our mental health services desperately need and people with mental health problems undoubtedly deserve. To understand why we need this fundamental step change in mental health provision in this country, we need look no further than the human and economic costs associated with the poor mental healthcare that has far too often been the norm.
The human costs are self-evident. They can be counted among the many vulnerable people with mental health problems who have been left to suffer in silence, with no help at all, stigmatised and shunted to the margins of society, their lives simply put on hold or irrevocably changed and ruined. I am talking about the many people for whom mental health provision has for too long been a second-rate, second-class service, and those who have been let down by the inadequacies of a system that is supposed to be there to support and care for them yet treats their body and their mind unequally. Regrettably, that has all too often been the reality for far too many people, simply because the way we think about and treat mental illness in this country has been woefully inadequate.
I reiterate that there are economic costs to such neglect, which are as unsustainable as the human costs are unacceptable. Failing to address mental illness through poor care has been a significant problem for decades in this country and costs the economy, the NHS and society dear. The taskforce’s report makes it clear that the economic cost is estimated to be £105 billion a year, as we have already heard. To address the challenges, we must, as the taskforce recommends, seek to transform services and support for people with mental health problems and ensure that everybody gets the right help at the right time, in the right place and from the right people.
Similarly, we must ensure that mental health is recognised as a priority for the NHS, Government, businesses, schools and society as a whole. That will enable us to promote good mental health, prevent poor mental health and respond effectively when mental health problems occur. If we are truly to achieve the ambition of parity of esteem for mental and physical health in the NHS we must, as a first step, ensure that the taskforce’s recommendations are delivered and funded in full. Transforming the way we deal with mental health is an enormous challenge, I know that, but one that we, as a country and a society, must tackle head-on for the future.
Huw Merriman (Bexhill and Battle) (Con)
It is a pleasure to speak under your chairmanship, Mr Wilson. I congratulate my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on securing the debate. It was a pleasure to listen to the right hon. Member for North Norfolk (Norman Lamb) and the Minister speaking at the launch of the mental health taskforce report last month.
Since I was elected, constituents’ concerns about mental health provision have caused me to immerse myself in the issue and further my education on this most harrowing of subjects. I want to focus on concerns about early-stage treatment for young people. At Prime Minister’s questions recently, I mentioned visiting three families in one day in my constituency, each of whom had a child who they felt had not been given the early-stage intervention that they expected by child and adolescent mental health services. I asked the Prime Minister for more focus on early-stage treatment, so that young people do not find their condition becoming more acute. I work closely with my local CAMHS team, and I have the highest regard for the many excellent specialists who do their best. However, it is of concern to me that constituents face lengthy waiting times and that some have been moved from pillar to post when receiving treatment.
Building up trust is a key ingredient in successful diagnosis and treatment. I hear stories about young people finding the courage and trust to open up about their condition only to find that there is a new practitioner at the subsequent session, and it disappoints me to find that the young person has then regressed because of the change in personnel. I would like a commitment to treatment being given on a fixed one-to-one basis. If we can do that for maternity provision, surely we can do it for mental health treatment.
At the mental health taskforce launch, I was buoyed by the commitment by the Minister and the chief executive of NHS England to implement the excellent report. I pay tribute to the chief executive of Mind, Paul Farmer, and his team for the review. An aspect of it that cheered me was the commitment to funds to ensure that our non-mental health NHS hospitals have adequate mental health expertise on site to deal with those who are hospitalised as a result of mental health issues or who have such a condition in addition to a physical illness. What drove my concern about that was the experience of a family in my constituency following a suicide attempt. The NHS staff did not have the ability to deal with the mental health condition and my constituent, a young man, was forced to wait until CAMHS staff could make their way over from another town miles away. I understand the need for specialist treatment, but it strikes me that there is a need for a culture change across the NHS, and that all staff should be trained to understand mental health and provide a basic level of treatment in the area. Specialisation in health is important, but if the NHS becomes overly specialised it can lead to a lack of general involvement in care for patients in such areas.
I welcome the news that the Government will fund 24/7 mental health provision in our hospitals, but I was somewhat alarmed at the suggestion by my local trust that the funding may not stretch far enough. I also want to ensure that that specific coverage will not mean that other NHS staff with the necessary levels of technical understanding and empathy feel that they are not empowered to help the many patients in hospital who need help with their mental health care in addition to their physical wellbeing.
Getting early-stage intervention right is a key part of getting proper diagnosis for people with a mental health condition and lessening the chances of acute difficulties. It is the most important investment not only for people’s welfare and wellbeing but to enable young people to fulfil their hopes and dreams in their careers and make something for themselves and their country. We should not misdiagnose young people who are suffering growing pains, and who need families’ and friends’ coaching and guidance to overcome the problems of adolescence. However, I have met too many young children who face a difficult future because their mental health condition was not treated at an early stage. I applaud the report and the Government’s response. They are leading the charge to ensure that we can support all who are affected by this terrible condition. I look forward to a better mental health service in the years to come.
Mrs Anne Main (St Albans) (Con)
It is a pleasure to serve under your chairmanship, Mr Wilson. Congratulations are due to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) on securing the debate.
The report is very important. In the short time available I want to touch on two problems that people with mental health issues have, which the report focuses on and which many of us will have encountered in our constituencies. If people are young their problems are with schooling, family disruption and access to services. If they are older they may struggle to get work. There is often a lack of support to enable people with mental health issues who are in work to keep their job, and a lack of employers who understand the often sporadic nature of mental illnesses.
I am a patron of Mind in mid-Hertfordshire and a supporter of its “Time to Talk” campaign, and I welcome the investment in talking therapies discussed in the report. However, the employment rate for people with mental health issues is still far too low. In 2012 I and, I am sure, many other Members of Parliament, supported the “Way to Work” campaign that Mind championed. I presented a little trophy to an employer that took on employees with mental health conditions, but sadly the take-up among employers in St Albans was very low, and nothing further happened.
It is worrying that too many companies find ways not to employ someone with mental health issues, particularly if an episode of ill health has resulted in absenteeism. I would like to know what more the Government can do to work with employers and show them how they can manage a workforce in which there may be mental health issues in much the same way as they would if there were people with disabilities. I do not think enough is done to bring people into the workforce and show how they can be supported in their periods of good health and ill health.
On the subject of young people, I have been told of people having trouble in dealing with CAMHS. A recurrent theme is having sporadic meetings with a lot of different people. I learned of the sad case of a very young lad who experienced extreme mental health problems. He had problems going to school, and in the end it became too difficult for him to get there. With regard to getting home schooling, he has almost dropped off the teaching rota. The lad is housebound because of his severe anxiety. There is not enough support for his parents, or for other families with young people living with mental health issues. The mother had to give up work, and the family could never go anywhere. They could not go on holiday. There was no real support for the family in their situation. We need a more holistic approach that deals with the family rather than just treating the young person with the mental health issues.
I have a few questions for the Minister. What will the Government do to improve access to talking therapies and specialist back to work support for older people who have mental health problems? What more is being done to help people find and stay in work? What more is the Department for Work and Pensions doing to integrate services for young people, to make sure that when they have problems with the education system and getting access to services, they get the right information in a timely fashion? If someone recovers from a mental illness that they had when young, whether that was self-harming or, as in the case I mentioned, agoraphobia, they may be set up for a life of failure because their education went out of the window during a formative period.
What more can be done to help people who had mental ill health when they were younger and did not have a good experience in the education system? What more can be done to support them to get their lives back on track when their mental health improves? I would like a co-ordinated approach. At whatever age a person presents with mental illness, they should be assessed holistically. If there have been gaps in their training to get into work or in their education, extra resources must be put in to ensure that when they are well, they can move on with their lives like the rest of us. That would be much like our approach to people in prisons, who often have mental health issues.
We are subjecting many young people to a life in prison if we do not allow them to be trained up and get the help they need. Otherwise, they will end up in a life of crime, because when they leave school or are at school leaving age they will have little to offer any employer. We need to ensure that those people’s lives are not snuffed out and wasted at an early age, and that they have the chance to form a life for themselves and their families.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
It is a pleasure to serve under your chairmanship, Mr Wilson. I congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on bringing this important and timely debate to Westminster Hall.
Although the report pertains to NHS England, the Scottish National party very much welcomes it. It is an opportunity to share best practice recommendations right across the UK. I would like to declare an interest: I worked in mental health as a psychologist for 20 years prior to coming to the House. I am particularly glad that the report has been produced. It is excellent, and I commend the work of those involved. The report is detailed, thorough and, importantly, based on inclusivity and service users’ views. It addresses key issues of prevention, access and parity.
In terms of prevention, we know that half of mental health issues are established by the age of 14, and three quarters by the age of 24. A new focus on young people and effective interventions designed for that age group via CAMHS are clearly required. More widely, we should look at mental health awareness training for teachers, so that we can pick up on early warning signs and refer on. Mental wellbeing could also be part of the curriculum, so that young people can develop positive, adaptive coping strategies, which are key to preventing the onset of mental illness.
We are dealing with the young generation, so the use of technology and modalities that young people like and use—for example, apps, which I am not particularly familiar with—will be really important. We have to get up to speed. Evidence-based interventions are required in particular for self-harm, eating and conduct disorders, depression and anxiety, which are common problems within the younger age group.
I welcome the fact that crisis teams will be locally based, 24/7, but I wonder if we could have some more detail. Will that involve specialist clinicians, nurses or doctors on call in each area who are trained in working with young people? More widely, in order that people present, should we have more public health awareness campaigns to reduce stigma?
Mental health care needs to be targeted across the lifespan, from younger people in CAMHS to adults and older adults. The report establishes that 40% of older adults in care homes are affected by depression, yet I read little information in the report about services provided or required for older adults, who may have co-morbid dementia, physical frailty or have suffered stroke, adjustment problems or loss. That area needs some more work and detail. Access to psychological therapies in the community, in hospital and in residential care appear to be key. Experts in psychological therapy for older adults are likely to be required, because people will be working with complex presentations.
I welcome the taskforce report’s recommendation of an integrated approach, looking at housing, employment, social needs and physical health. That suggests the need for integrated and holistic assessments in mental health, as well as in physical health settings. We need a formulation-driven approach, with an understanding of the precipitants, problems and exacerbating factors, but also of the protective factors. All those factors need to be targeted and integrated into treatment, in order to evidence improvement. Fundamentally, we are talking about a biopsychosocial approach, which means a change in assessment procedures across the system. We will have to evidence how that will happen and how it will be implemented across both mental and physical healthcare, but it links well to the integration agenda of health and social care.
I caution that although obtaining work is a very positive step in reducing depression for many people, pushing someone who is acutely unwell into work will invariably set them back, so this is about clinical judgment and timing. One of the major differences since I began working in the NHS more than 20 years ago is that there are now waiting time initiatives in Scotland and across the UK. That is significant. It challenges services to focus, and monitoring leads to an improvement in standards, but it must have ongoing underlying investment.
I welcome the recommendation that crisis care be provided 24/7. However, that will require specialists to be trained to work with individuals who have co-morbid substance abuse and mental illness problems. All too often, people are turned away because they are intoxicated at hospital when they present. I understand that it is difficult to properly assess people in that condition, but unfortunately research indicates that that may be when they are at highest risk of suicidal behaviour and at their most impulsive.
I particularly welcome access to psychological therapy for new mothers. One in five have depression, which impacts on the self, the family and the baby. I also suggest the extension of counselling to those who have suffered miscarriage or stillbirth, and who experience great trauma in that regard.
I am unsure of the fit of the recommendation on specialist GPs from my reading of the report. Does that mean treatment through minimal interventions or assessment by GPs? Does it mean specialist nursing staff in GP surgeries who could engage in treatment? My concern is about the cost-effectiveness of GPs engaging in therapeutic work, but training and assessment at a primary care level is a welcome idea.
The report highlights that nine out of 10 people in prison have mental health problems or drug or alcohol misuse issues, but it does not clarify how recommendations on criminal justice will be implemented. Cross-party and cross-Government agreement on how to implement the recommendations will be required across the country. Is it about access to psychologists in prisons? Again, more thought is needed on the detail of integration.
I will sum up, because I am running out of time and I want the Minister to be able to respond. I am pleased to see the inclusion of technology in the report, which I believe will be one of the key issues in transforming mental healthcare. The use of Skype, email and online treatment packages can increase access and links to therapists and improve access for rural communities.
Data collection is excellent. We need it, and we need to evidence outcomes and waiting times, but I appeal for balance. Drowning mental health staff in paperwork is not the answer. That reduces time for clinical work and time with patients, and we do not want this to become a tick-box exercise.
In conclusion, there is much to welcome. There is much to do. We need more strategy on integration plans. We need more detail on older adults and criminal justice. I was not able to touch on learning disability today, but that is another area to be considered. We do not want a postcode lottery, so it is important to look at local commissioning and share best practice, to ensure high-quality mental healthcare across the UK.
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
It is a real pleasure to serve under your chairmanship this afternoon, Mr Wilson. I congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) both on securing this vital debate on the final report of the independent taskforce on mental health and on his excellent contribution. I am pleased that we have the opportunity to examine this incredibly important piece of work and to hear a detailed response from the Government. I thank all Members who have spoken in the debate; the quality of the speeches we have heard is testimony of the strength of feeling on both sides of the House on the issue of mental health.
I echo previous contributions today in saying that the taskforce report is an extremely comprehensive piece of work. I pay tribute to all those who were involved in delivering it. The recommendations it makes are robust and wide-reaching and signal what the chair of the taskforce—Paul Farmer CBE from Mind—has rightly described as a
“landmark moment for mental health”.
I also thank vice-chair Jacqui Dyer for her commitment and passion.
If implemented in full, the changes could make a huge difference to a system that is under increasing and unsustainable pressure. The real challenge lying before us now is ensuring that the aspirations set out in the report are actually delivered. For too long the rhetoric on mental health has not matched the reality on the ground. Members today have reflected the concerns felt by the people whom we represent across the country—people who themselves suffer from mental health conditions, their families and the services and professionals that care for them—who are anxious to ensure that the opportunity we now have to transform mental health in our country is not wasted.
I will focus my remarks on implementation and three key areas where unanswered questions remain—funding, transparency and accountability. Turning first to the money, the taskforce identified a £1.2 billion funding gap in mental health services each year by 2020. The Government responded to the publication of the report with an announcement of an additional £1 billion of investment for mental health services up to 2020. That is, of course, very welcome but I understand that the £1 billion will be taken from the £8 billion set aside for the NHS up to 2020. If that is the case—perhaps the Minister can confirm that for us today—I struggle to see how it will meet what the taskforce says is required.
Given that mental health receives just under 10% of the total NHS budget, it is difficult to see how the funding announced could be considered as additional, particularly in the context of the £600 million cut that mental health trusts have experienced over the course of the last Parliament. I should have thought that the Minister would have allocated that proportion of the £8 billion to mental health anyway, so I am keen to hear his response on that point.
There are also real concerns about how this funding will be distributed and what systems will be in place to ensure that it reaches the front-line services for which it is intended and not siphoned off to plug the deficits of acute trusts. That point has already been made by the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Bexhill and Battle (Huw Merriman). The Minister is right to prescribe that CCGs must increase the amount of their budget that they allocate to mental health at a rate that is at least in line with the general growth in their budget. However, as that budget information is not published centrally, I have yet to see any evidence from the Government that they are able to guarantee that CCGs are fulfilling that commitment. In fact, I have had to make freedom of information requests, which have exposed the fact that more than one in three CCGs are not meeting that expectation.
Just before Christmas, the Health Secretary announced that from June there will be independently assured Ofsted-style ratings for mental health provision by CCG area that will expose the areas that are not making the commitment to mental health that they should. I asked then if he would clarify whether that commitment would include publishing a clear picture of mental health spending for every CCG. I am still awaiting a response to the follow-up letter I wrote seeking clarification on that very important point, and I would be pleased if the Minister were able to confirm that for us today. As he will know, the Opposition strongly believe that the annual survey of investment in mental health must be reinstated. It was stopped in 2011, and it is an absolutely crucial piece of information.
That is especially important given the concerns that have been raised not only by many hon. Members today, but by the Mental Health Network, which represents mental health trusts, who have said that providers of mental health services are yet to see the difference from the investment in child and adolescent mental health services that the Government announced last year. During this debate, many hon. Members have raised specific concerns about CAMHS and the imbalance in the amount that they are allocated from the overall mental health budget. It is less than 10%, and it is a significant challenge. I am interested to hear the Minister’s response both to those very serious concerns and to the proposal from many mental health leaders that the cash should be ring-fenced—I am very keen to hear what he thinks about that.
That brings me to the second key theme of the report—the startling lack of transparency and accountability in our mental health system, which was mentioned by my hon. Friend the Member for York Central (Rachael Maskell) and the hon. Member for Gillingham and Rainham (Rehman Chishti). The significant gaps in the information that the Government collect on mental health present a significant obstacle to their ability to deliver what they have promised on mental health. On Monday we saw further shocking evidence of that information gap during the BBC’s “Panorama” programme, which highlighted the discrepancy between the data that the Government hold on the number of children who have died in in-patient mental health trusts and units and the figures from the charity Inquest’s research. I raised that in the House yesterday.
Norman Lamb
I totally agree with the point that the hon. Lady is making. I always took the view that I was operating in a fog, without access to the proper data. The “Panorama” programme made reference to the fact that I gave a parliamentary answer saying there had been no deaths in children’s mental health services—an answer that was wrong, because I was given the wrong information. I have asked the Secretary of State for a full investigation into how that happened. We have to have absolutely accurate reporting of these things.
Luciana Berger
I thank the right hon. Gentleman for his intervention. I believe it is absolutely imperative that we are able to see how deaths in psychiatric care are not only treated and recorded, but investigated and learned from. We have heard from the Minister that there will be progress on that front.
The situation is particularly concerning given the ongoing case of Southern Health NHS Foundation Trust, which was found to have failed to investigate more than 1,000 unexpected deaths of mental health and learning disability patients since 2011. Only last week, more than two years since the very tragic death of Connor Sparrowhawk, Southern Health trust was found by the Care Quality Commission not to have addressed serious concerns that were raised about the safety of its patients and was issued with a warning notice. I would be grateful if the Minister shared with us what the Government are doing specifically to improve the mental health data that are being collected, published and made accessible to the public. When will we have a further update on avoidable deaths in the area of mental health and learning disability? Data are absolutely critical, not only to enable the Government to understand the realities of what is happening on the ground, but to allow us to check that the Government are delivering on what they have promised.
That brings me to the final point I wish to cover today—accountability for the implementation of the taskforce’s recommendations. The taskforce asked NHS England, the Department of Health and the Cabinet Office to announce what governance methods they intend to introduce for the delivery of the recommendations. That really is needed as a matter of urgency. We need greater transparency than before in the way that the recommendations are implemented. I note that one recommendation of the taskforce report is that the Government accept the recommendations from the previous taskforce on CAMHS—another issue raised by many Members during today’s debate—which reflects the fact that the delivery of these recommendations has been too slow. I should be grateful if the Minister would confirm what plans there are to publish and publicise updates on implementation of the taskforce’s recommendations.
The Centre for Mental Health has produced a fantastic report for NHS England, exploring what helps and what hinders the implementation of policies and strategies relating to mental health. I do not know whether the Minister has had a chance to read the report but, among other things, it calls for a robust implementation infrastructure to support local agencies in delivering the report’s recommendations. I should be grateful if the Minister would share with us today what plans there are to support local authorities, CCGs and mental health trusts to deliver on that strategy.
Many recommendations in the taskforce report also require Government Departments—such as the Ministry of Justice, the Department for Work and Pensions and the Department for Education—to deliver their own areas of work that relate to mental health. I was very pleased to see those recommendations, and as I have said and will continue to say, we will not address the challenges of our nation’s mental health just from the Department of Health. Prevention and early intervention are absolutely crucial, which was a point made by my hon. Friend the Member for Coventry North East (Colleen Fletcher).
Take the work of the Ministry of Justice, for example. The report calls for the completion of the roll-out of liaison and diversion services, as well as the increased uptake of mental health treatment requirements and improvements to prison mental health care. At a time when, as a country, we are seeing one person take their life every four days in our prisons, it is absolutely crucial that we address this very serious issue.
Another point made by the taskforce was about housing and the local housing allowance, which the Government seriously need to address. During today’s debate other Members have talked about the importance of employment and what more needs to be done to support employers to help people with mental health conditions into the workforce, and to support people who might be experiencing those issues. It was disappointing that the Government accepted only formally the taskforce’s recommendations relating to the Department of Health and its arm’s length bodies. I hope the Minister will confirm today whether other Departments will accept and implement the other recommendations.
In conclusion, for the many thousands of people who could benefit from these changes and the others set out in the taskforce’s final report, Ministers must keep their promise and deliver the vital reforms that are long overdue and desperately needed. We have heard a lot of rhetoric and warm words on mental health. Now is the time for real action and to translate parity of esteem into reality. I look forward to the Minister’s reply.
The Minister for Community and Social Care (Alistair Burt)
It is a pleasure to serve under your chairmanship, Mr Wilson. I thank my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for this debate.
Among several impossible jobs I have, responding to a debate of this quality in 10 minutes simply cannot be done, so in accordance with my normal practice, if I do not answer any question, I will write to the hon. Member and, with colleagues’ permission, I will link the questions so that everyone gets the same letter, so that virtually everyone who has spoken will get a letter. I will put a copy in the Library so that other colleagues can see it.
There are many things on which there is no disagreement. To give some one-liners, My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said that we now deal with mental and physical illness in an holistic way; that is absolutely right and ensures that money goes to the right place. I will cover that later, but no one disagrees.
On psychiatric liaison, we are on to that. The importance of housing and so on is now understood as part of dealing with mental illness.
My hon. Friend the Member for Halesowen and Rowley Regis spoke about valuing the public sector; yes, that is not said often enough and it is vital to do. The right hon. Member for North Norfolk (Norman Lamb) spoke of the economic case for dealing with mental illness. No one now disagrees with that. The priority that the hon. Member for Coventry North East (Colleen Fletcher) mentioned is absolutely right, and when it comes to waiting times, we are on to those. We are funding waiting times differently from when the right hon. Gentleman set them up, but they are being funded and I am happy to write to him separately on that. His worry is not shared in the Department and I can clear that up.
We are accepting the taskforce’s recommendation that we act on out-of-area placements by 2021. I would like to do it sooner if possible. I am determined to do it, but it takes time and the attitude to tier 4 will need to change. My recent experience in Hull showed me how inept current NHS processes are in deciding where new tier 4 beds should be. The situation is unacceptable and they have got themselves into a complete mess. That must change and be done properly, and I am determined it will be.
My hon. Friend the Member for Bexhill and Battle (Huw Merriman) rightly spoke about the importance of early intervention, as did the hon. Member for York Central (Rachael Maskell). I pay tribute to the knowledge and work of the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) in this area. Perinatal care is very much on everyone’s agenda.
My hon. Friend the Member for St Albans (Mrs Main) talked about the importance of work. There is now a joint unit between the Department of Health and the Department for Work and Pensions to do more of that. A White Paper or Green Paper is expected later this year and will show its importance.
On the importance of young people, the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned our work with the Department for Education on new technology, apps and earlier intervention. She is absolutely right.
I do not want to dwell on any of those matters, although I could spend 10 minutes on each, but we have all grasped how important they are. I would like to respond to the key issues raised by my hon. Friend the Member for Halesowen and Rowley Regis and the hon. Member for Liverpool, Wavertree (Luciana Berger). I can cover transparency and implementation right up front.
I thank Paul Farmer, Jacqui Dyer and colleagues for their very important report. I am determined that it will not gather dust and as a way forward I have suggested—and we will do it—that an implementation plan is published by the end of the summer. I am not sure whether that will be in August, but it will be by the end of the summer. It will detail how we intend to implement the recommendation. There will not be one response; there will be a series of responses, and there will be a website where people can see what is being done and monitor what is planned. It will be transparent. There will be monitoring by all those who have been engaged but there will be constant reference back to the taskforce’s work, so that people can see that what is being done is related to that. The Department is putting in place a robust process with people to monitor it. That is how we will do it.
I want to cover the cross-Government issues not by interministerial committee, but by way of bilaterals with colleagues to drive things forward. I think that is the right way to do that.
My hon. Friend the Member for Halesowen and Rowley Regis mentioned data, particularly in the context in which the hon. Member for Liverpool, Wavertree mentioned them. I think there is recognition that the way in which data have been collected in the past has not been good enough, and there is also recognition that we are trying to lever up standards in all places. The “Panorama” programme and the hon. Lady’s questions over a period exposed the difficulty of getting all the data in the right place. This needs a separate debate and a separate set of answers. I have put in place an investigation into where the deficiencies in the data are, and how data that are collected elsewhere but centrally can be brought together. That will not be necessary in some cases and a written question may not provide all the answers.
In relation to the matters raised in “Panorama” on Monday and the difficulty for the right hon. Member for North Norfolk, it should be possible to answer the question. The problem is in terminology and deciding at what point a young person might be in the mental health system. I have agreed to meet Deborah Coles of INQUEST to talk about the information they have gathered. Plainly, it cannot be right that one Minister says “none”, I say “one”, the NHS says “four” and INQUEST says “nine”. That cannot be fair to the people involved.
A lot of attention is paid to the death of any young person with mental health problems. My hon. Friend the Member for Derby North (Amanda Solloway) raised this in a personal context. I can reassure colleagues. There are serious incident reviews, a child death overview panel, and the Care Quality Commission is involved.
Alistair Burt
If my hon. Friend will forgive me on this occasion, there is just too much to cover in a short period.
There is a national confidential inquiry into suicide and homicide by people with mental illness and the Office for National Statistics is involved. Unfortunately, there is a gap in the data between national and local sources due to commission arrangements changing. That is an explanation; it is not an excuse or an answer, so my officials are looking urgently into how we can make sure our data collection is more unified and that we are working collaboratively with INQUEST to make sure we get an accurate number and resolve any discrepancies. Most importantly, as my hon. Friend the Member for Halesowen and Rowley Regis said, we must make sure we learn from every tragedy so that we can apply the learning to make things better. We are on to that. I promise the hon. Member for Liverpool, Wavertree that I will find a way of responding to the House to put that right. I will be in touch with her further.
I thank my hon. Friend for his work with the all-party mental health group. He and other colleagues have been responsible for raising these issues over a period.
A figure from the National Institute of Health Research indicates that it spent £72.6 million on mental health research programmes in 2014-15, which in terms of particular research is £27.7 million higher than in any other disease area, including cancer. We are determined to do more research, but I am not convinced the figures are quite as bad as people say None the less, we need data and we need research. Again, the taskforce is right. The Department has accepted all the taskforce’s recommendations.
I agree with my hon. Friend that there is a need for better commissioning. We are changing the tariff terms. He said it could not be done from tomorrow, but it is being done from April 2017. To end the block payments, there will be two new payment approaches with two different tariffs. I agree with him on leadership.
The funding will be there, but it must build up over time. The money is being delivered through the spending review and how we intend to fund the national health service generally. The commitment for the £1 billion of extra funding the taskforce asked for is very important and I believe it will make a significant difference.
Commitment, money and determination from the whole of Parliament will be of huge importance in this area and I thank colleagues for their engagement.
James Morris
I thank all right hon. and hon. Members for taking part in this debate. We have got to the stage of knowing where the problem is and what the solutions are. We need the will in Government and across Parliament to make them happen. We owe that to all the people out there who are relying on us to get this right and I think the stars are aligned to make it happen. Let us get it right.
Question put and agreed to.
Resolved,
That this House has considered the report from the independent mental health taskforce ta the NHS in England.