Mental Health: Ensuring Equal Access to Mental and Physical Healthcare
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The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, I thank the noble Baroness, Lady Brinton, for tabling the debate. It is a pity that it is right at the fag end of this sitting because it is a hugely important issue. Whether it is once or twice a year, we ought to be held to account. It is so important. At a time when the health service is going through very difficult financial times, it will be easy to fudge some of the numbers. It is important that we are held to account for what we say will do. I thank the noble Baroness for bringing the debate here today.
The noble Baroness said that this was a funding issue and of course it is—up to a point. We have won a big argument over the last few years that preceded the funding issue. We should not underestimate how far we have come in this debate about mental health. It was very moving to hear the personal story of the noble Lord, Lord Oates. Society has come a heck of a long way since Section 28 of the Local Government Act, or whichever Act he referred to. The gender issues are largely behind us—but not fully so. The noble Lord, Lord Crisp, said that there was still prejudice around not just race but also homophobic issues. We should not be complacent about this but society has moved a heck of a long way over the last 20 or 30 years. We are slowly winning the argument that mental health care should be treated truly with parity with physical health care. Although I subscribe to the old saying that fine words butter no parsnips, fine words made a difference in this area of healthcare.
All speakers have shown just how important mental health is. As the noble Baroness, Lady Brinton, said, nearly all of us have someone very close to us—it may be as close as ourselves, as in the case of the noble Lord, Lord Oates, but it might be members of our families, children or friends—who have suffered the devastating consequences of poor mental health. The story of the 16 year-old girl kept in a police cell for 48 hours having committed no crime except that she was mentally ill is just one indication of that. But this is in part no longer a taboo subject because of the bravery of people such as Alastair Campbell and Stephen Fry. Some noble Lords will have read the obituaries of Sally Brampton in the papers last week; she took her own life after a lifetime of struggle with depression. I was particularly struck to read in one obituary that she had said that when you are depressed you do not know if it is your nature or your biology. That goes to the fundamental essence of depression. You do not know whether you are a bad person. Of course, it is often a question of biology and genetics, and of the environment you are in. The noble Lord, Lord Oates, talked about the strength of his family and friends that got him through a really difficult time.
I was struck by the comments of the noble Baroness, Lady Tyler, about health inequalities. She referred to Michael Marmot. Frankly, many of these issues go way beyond the NHS. We spend all our time talking about the NHS and so many of our health inequalities stem from poor housing, a lack of family support, unemployment, poverty and so on. It is interesting how much time we spend talking about the NHS when so much of what needs to be done in healthcare lies well outside the health system.
The noble Lord, Lord Crisp, made the fascinating point that globally mental health attracts 1% of funding but causes 25% of disability. He asked whether DfID could look at parity of esteem as well. That is a very interesting point and we should look at that. He made three other points, including on out-of-area treatment. That point was also mentioned by other noble Lords. When you have ill people being transferred not just for very specialist treatment but for general acute treatment—as he put it—that is a highly unsatisfactory situation. First, people may be admitted into an incredibly busy A&E department of an acute hospital. Often the situation in the A&E department is chaotic and people do not get the kind of one-on-one special support that they need. They then get put on a ward, where there is general chaos as well. They are just not kitted out to deal with people going through a psychotic interlude. The staff desperately ring round for beds in the county the patient happens to be in but they cannot find any. Then they find a bed somewhere else and by the time the patient gets there, that is taken and they end up in a bed somewhere else.
Meanwhile the patient’s family is at home, wherever that is, while the patient is transferred from one place to another. When he or she finally gets a bed, sometimes they are not assessed for days. Sometimes people can buy their way out of this. One noble Lord talked about CAMHS. Someone with money who has an eating disorder, for example, can sometimes buy their way out of reliance on state provision, but, of course, that is not available to many people. One of your children or friends may be being treated many miles away from where they live—that is, if they get a bed in an eating disorder unit.
The foreword of Paul Farmer’s report states:
“For far too long, people of all ages with mental health problems have been stigmatised and marginalised, all too often experiencing an NHS that treats their minds and bodies separately. Mental health services have been underfunded for decades, and too many people have received no help at all, leading to hundreds of thousands of lives put on hold or ruined, and thousands of tragic and unnecessary deaths”.
That is the background to this issue. We have to recognise and be realistic about how long it will take us to get from where we are to where we need to be. It will not happen in a couple of years but over a longer period than this Parliament, I suspect.
I was very moved by the words of a patient, as cited by the noble Lord, Lord Crisp. So often it is the patient’s story that makes the argument. I also cite the words of a patient, as follows, “I returned to hospital from leave but there were no beds available so I had to sleep in a common room. There was little privacy, no lock on the door, no frosted glass. People often just wandered in, thinking it was a public room and I had to create my own makeshift curtains. The room stank of cigarettes. The floor was dirty and the only storage place I had was a small bedside table. Despite constant complaints from me regarding the room, I was expected to put up and shut up. I would have had better treatment in jail”. That is just one person’s experience of the mental health system.
So we are a long way away from parity of esteem, if we are honest, and it will take us a long time to get there. But that is no excuse for not trying as hard as we can and no excuse for not holding this Government to account for the promises they make. Before I come to the commitments that we have made, I will refer to the eight principles that Paul Farmer thought should underpin reform. Decisions must be locally led. Care must be based on the best available evidence. Services must be designed in partnership with people who have mental health problems and with carers. Inequalities must be reduced to ensure that all needs are met across all ages. Care must be integrated, spanning people’s physical, mental and social needs. Prevention and early intervention must be prioritised. Care must be safe, effective and personal and delivered in the least restrictive setting, and the right data must be collected and used to drive and evaluate progress.
Getting the data was referred to by the noble Baroness, Lady Tyler. She has made that point before. It is a black hole because without the data you do not know where you are. One thing that has absolutely come home to me over the past year is that if we are going to address the unwarranted variation that exists across the country, which is as true for physical health as it is for mental health, we have to have the data. If we are going to have waiting times enshrined in the constitution or legislation or anywhere else, we have to have the data —and, frankly, we do not have the data at the moment. So getting the data has to be an absolute priority.
Turning to the commitments we have made in support of parity of esteem, the 2015-16 planning guidance made it absolutely clear that CCG allocations must increase by at least the amount of the overall allocation, which was 3.74%. Half way through the year it looked as though that was growing by about 5.4%. The planning guidance for 2016-17 is that commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall expenditure increase. Your Lordships must hold us to account for that. That is what we have said we are going to do in 2016-17. If the money is not getting through to providers, as the noble Lords, Lord Crisp and Lord Tunnicliffe, said, then it should be getting through to providers and we have an obligation to make sure that it does.
I will write to noble Lords about the tangible commitments we have made. The noble Baroness, Lady Tyler, said before the debate that she would prefer me to write, and I do not think there is any point in me giving the figures now. I have got the annual figures but rather than read them I will write to everyone who has contributed to this debate, setting out the figures on a year-by-year basis. In summary, we are committed to spending £1.4 billion on children and young people’s mental health and eating disorders over five years. Of that £1.4 billion, £150 million is earmarked for eating disorders. In January this year the Prime Minister made a commitment to spend £1 billion over the period to improve perinatal mental health, mental health liaison services and 24/7 crisis care. In the Five-Year Forward View for Mental Health, Paul Farmer’s recommendations totalled £1 billion by the end of the period. I will write to noble Lords setting out clearly what those figures are. What they will show is that at the end of the period, we should be spending more than an additional £1 billion and another £300 million a year, I think, on children’s mental health.
In conclusion, we are absolutely committed to delivering better mental health care over the next five years, but your Lordships will have to have some patience with us: it will not happen overnight.