15:56 - The House divided: - Ayes: 185 / Noes: 280 - Question accordingly negatived.
16:11 - The House divided: - Ayes: 278 / Noes: 0 - Question accordingly agreed to.
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes the increased burden on mental health following the pandemic, including on young people and those with severe mental illness; recognises the historic levels of investment being delivered by this Government into services, with an increase of £2.3 billion per year in front-line mental health funding over the past four years; notes that current NHS targets around access to talking therapies and intervention in psychosis are being met due to the efforts of NHS staff; and acknowledges the investment in mental health teams in schools, as well as the ongoing investment into open access mental health helplines in the 111 service and into the estate, including three new mental health hospitals to be opened in the next two years accompanied by a further £150 million in investment in new mental health ambulances and the development of better alternatives to accident and emergency services, including crisis houses, safe havens and step-down services.”
Improving mental health is a top priority for this Government. We can all agree that in the past it was not given the priority it deserves, and was seen as something to be ashamed of and not spoken about. Thankfully, we are changing that. We are working to achieve parity of esteem between physical health and mental health, with record amounts of investment going into NHS mental health services in England, and the stigma surrounding mental health is being reduced.
“The Five Year Forward View for Mental Health”, which was published in 2016, was a major step forward and secured an additional £1 billion in funding for mental health, so that an additional 1 million people could access high-quality services by 2020-21. It was followed by the NHS long-term plan in 2019, which committed an additional £2.3 billion a year for the expansion and transformation of mental health services in England by 2024, so that an additional 2 million people could get the NHS-funded mental health support that they need. It is also funding the increase in the frontline mental health workforce to meet the plan’s ambition for 27,000 additional mental health staff by 2023-24. There were 138,610 full-time equivalent mental health staff at the end of 2022, an increase of 8,900 on the previous year and of 20,700 on December 2010, so the mental health workforce in the NHS is radically bigger. In total, we spent around £3 billion more on mental health last year compared with four years ago. That is an increase of a quarter.
Backed by this huge investment, we are expanding access to NHS talking therapies for adults to meet the long-term plan’s ambition for an additional 1.9 million people to access National Institute for Health and Care Excellence-approved treatments for conditions such as anxiety and depression. From starting small in 2008, around 1.2 million people are now accessing NHS talking therapies every year, with 98% waiting less than 18 weeks for their treatment and 90% waiting less than six weeks. This means that we are delivering well over our national waiting time targets of 95% and 75% respectively.
Local mental health services are transforming community mental health care to give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and to support them to live well in their communities. We recognise that poor mental health is a major cause of sickness absence in the workplace and we are providing support to employees and employers on mental health in the workplace. We have announced additional measures to support workplace mental health, including a package to support the long-term sick and disabled to remain in or return to work. This includes £200 million for digital mental health to modernise NHS talking therapies, to provide free access to wellness and clinical mental health apps for the population, and to pilot cutting-edge digital therapeutics. There will be around £75 million to expand individual placement and support services to help more people with severe mental health illnesses into employment.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
Will the Minister give way?
Neil O’Brien
I will make a little progress first.
We know that the number of children and young people experiencing mental ill health is rising, and that many of them will continue to experience mental health problems later in life. Spending on children and young people’s mental health continues to grow, from £841 million in 2019-20 to £995 million a year later, and now to £1.1 billion in 2022-23. This means that we are helping more children and young people than ever before. In 2021-22, there were over 743,000 new referrals to children’s and young people’s mental health services, which is 41% higher than the year before.
Several hon. Members rose—
Neil O’Brien
I will make a bit of progress before I give way.
The long-term plan will ensure that 345,000 more children and young people can get the mental health support they need when they need it.
We are committed to ensuring that children and young people can access mental health support in school, so that they can access help with anxiety and depression and other common mental health services before problems become more serious. In that way, we can prevent—in exactly the way we all agree on—the problems from becoming more serious. That includes continuing to roll out mental health support teams to schools and colleges in England.
Fleur Anderson (Putney) (Lab)
The picture that the Minister is painting does not quite tally with the experience that I am seeing in families, many of whom are watching with a feeling of helplessness as their children’s mental health deteriorates while they are on long waiting lists. In the NHS South West London ICB area, there are over 10,000 young people on waiting lists, and many have their cases closed without even getting the support they need. That leaves them with deteriorating mental health and it leaves their families in despair. How is it that the money the Minister is talking about does not seem to get through to the young people who need help?
Neil O’Brien
I will come to the point about waiting lists in a moment.
Let me complete my thoughts on prevention, which I think we all agree is important. There are 3.4 million pupils covered by mental health support teams in 2022-23, which equates to about 35% coverage of pupils in schools and learners in further education in England. We expect around 500 teams to be up and running by 2024, covering around 44% of pupils and learners, so it will be up from 35% to 44%. Over 10,000 schools and colleges now have a trained senior mental health lead, including more than six in 10 state-funded secondary schools in England. On prevention, the Government are also providing £150 million of capital investment in NHS mental health urgent and emergency care infrastructure over the next two years.
Andy McDonald (Middlesbrough) (Lab)
While the Minister is addressing the issue of young people, can I say that I have yet to hear any news from the Department as to whether there will be a public inquiry into the deaths of the three young women who died under the care of the Tees, Esk and Wear Valleys Foundation NHS Trust. Can he enlighten me on that?
Neil O’Brien
This is an extremely important issue that the hon. Gentleman is quite right to raise. We will be producing the results of the rapid review in the coming weeks, so he will not have to wait very long.
Munira Wilson
Like other colleagues, I see many children in my constituency waiting well over a year, sometimes two years, to access child and adolescent mental health services, so I was alarmed when NHS England recently told me that, on the latest modelling, the number of NHS-commissioned training posts in London for child and adolescent psychiatry will halve by 2031. I have no idea what is driving this modelling, but given that one in six seven to 16-year-olds have a probable mental health disorder, will the Minister at least look into these figures and undertake to write to me to explain why we are seeing such a drop in the number of training places?
Neil O’Brien
Those are not figures that I am familiar with or recognise, but I will certainly take this up with the London commissioners because it sounds like an important issue. I have talked about the dramatic increase we have already seen in the mental health workforce, and we are setting out further steps in our long-term workforce plan, but I will take that away and look at it closely with other Ministers.
Mr Toby Perkins
One of the issues here is that the demand for mental health services has gone through the roof, from 3.6 million in 2020-21 to 4.5 million in 2021-22. My hon. Friend the Member for Tooting (Dr Allin-Khan) was clear in her view, which I share, that the policies of this Government have been a factor in driving up the mental health demand. Does the Minister accept that? If not, what does he put it down to?
Neil O’Brien
I was just coming to that, but on the point about prevention and the social origins of these things, we are in agreement about tackling the origins of these things. In terms of financial security, that is why we are providing financial help worth £3,300 per household, one of the most dramatically generous packages anywhere in Europe. The question of good housing was raised earlier. We have the Social Housing (Regulation) Bill and we are taking action to extend the decent homes standard to the private rented sector.
Dr Luke Evans (Bosworth) (Con)
Is it not the case that we have to be really careful about what we are talking about? There is a difference between mental wellbeing and mental health. We all suffer with our mental wellbeing but we do not all suffer with our mental health, and we therefore need to have the support that is appropriate. Social prescribing, for example, has a fundamental ability to help people who suffer with their mental wellbeing. Are the Government doing anything more to drive up social prescribing, so that GPs and allied professions can get the support from the third sector and other voluntary organisations that people so desperately need for their mental wellbeing?
Neil O’Brien
My hon. Friend, as an experienced clinician, makes an important and thoughtful point. This is exactly why we have so dramatically increased the number of social prescribers in primary care. An example in Britain is the parkrun practices initiative, which is connecting people to sporting and cultural activities that can improve mental wellbeing as well as mental health. My hon. Friend is completely right, and that is why this is a priority for us.
Andrew Bridgen
The suicide rate in North West Leicestershire increased by more than 300% during the lockdown. Does the Minister know what the increase was in his constituency?
Neil O’Brien
It is just not true there was an increase in suicides because of the lockdowns. There have been a whole series of careful studies of this and that is just not the case. I am afraid that my hon. Friend is not correct about this.
Wera Hobhouse (Bath) (LD)
Eating disorders are a national scandal and have reached epidemic proportions. Anorexia nervosa has the highest mortality rate of any mental health disorder and a third of people with binge eating disorders are at suicide risk. With at least 125 million people suffering from eating disorders and with soaring waiting lists, is it not time that the Government appointed something like an eating disorder prevention champion to tackle this incredibly difficult but rising crisis?
Neil O’Brien
I completely agree about its tremendous importance, and I take this opportunity to mention the incredible work on this hugely important issue by brilliant charities such as Beat. I will outline some of the general things we are doing to increase capacity further.
Janet Daby
Only a few weeks ago, I met a constituent who endured an awful kidnapping and rape. She had some initial counselling and therapy from specialist services, but she has now been on the waiting list for more than a year and a half. What would the Minister say to my constituent, who desperately needs therapy?
Neil O’Brien
I am terribly sorry to hear about the hon. Lady’s constituent’s case, which I will look at extremely closely. This is why we are putting in extra investment and tackling waiting lists.
Several hon. Members rose—
Neil O’Brien
I should make a little progress before taking further interventions.
The Government are providing £150 million of capital investment in the NHS’s urgent and emergency care infrastructure for mental health over the next two years. Those interventions include £7 million for 90 new mental health ambulances, with the remaining £143 million going to more than 160 capital projects with a preventive focus. These include new urgent assessment and care centres, crisis cafés and crisis houses, health-based places of safety for people detained by the police and improvements to the NHS 111 and urgent mental health helplines. The hon. Member for Tooting talked about creating such facilities in the community, and we are already doing that. We are also investing £400 million between 2020-21 and 2023-24 to eradicate mental health dormitory accommodation, improving safety and dignity for patients. Twenty-nine projects have already been completed since the programme commenced in 2020-21, eradicating over 500 dormitory beds.
Dr Ben Spencer
Will the Minister join me in welcoming the construction of the new Abraham Cowley unit, which will eradicate the dormitories that were in my constituency?
Neil O’Brien
I join my hon. Friend in celebrating that unit and his advocacy for people affected by mental health.
Florence Eshalomi (Vauxhall) (Lab/Co-op)
I thank the Minister for giving way, as I appreciate that he is trying to make progress. On the capital programme, one of the issues that my hon. Friend the Member for Tooting (Dr Allin-Khan) highlighted is Seni’s law, which will look at the treatment that patients receive in mental health units, where, sadly, restraint has led to deaths. The Minister talks about prevention, and we need to make sure that Seni’s law, which was enacted in November 2018, comes forward now. Does he agree?
Neil O’Brien
The remaining provisions will be commenced as soon as possible.
We are working with the NHS towards implementing new waiting time standards for people requiring urgent and emergency mental healthcare, in both A&E and the community, to ensure timely access to the most appropriate high-quality support. We also recognise that there is much more to be done to improve people’s experience in in-patient mental health facilities. The Minister with responsibility for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), has spoken to many Members following reports of abuse and care failings at a number of NHS and independent providers. We have been clear that anyone receiving treatment in an in-patient mental health facility deserves to receive safe, high-quality care and to be looked after with dignity and respect.
It is vital that, where care falls short, we learn from any mistakes to improve care across the NHS and to protect patients. That is why we have conducted a rapid review of mental health in-patient settings, with a specific focus on how we use data and evidence, including from complaints, feedback and whistleblowing reports, to identify risks to safety.
Marsha De Cordova (Battersea) (Lab)
The Minister wants to talk about data and evidence. We know that, within the mental health crisis, there are huge, long-established racial disparities, with young black men disproportionately being sectioned under the Mental Health Act 1983. The draft mental health Bill is still in train, and I would like to know exactly when the Government will table the Bill, which might stop these racial disparities and stop young black men dispro-portionately being sectioned.
Neil O’Brien
We are currently responding to pre-legislative scrutiny, so we are on the case. We are not just waiting, of course, and we are already doing things on these points, including through the culturally appropriate advocacy pilots for those at risk of detention and on the patient and carer race equality framework to avoid and prevent detention in the first place.
The rapid review’s report will be published very shortly. NHS England has also established a three-year quality transformation programme that seeks to tackle the root causes of unsafe, poor-quality in-patient care, including sexual safety, in mental health, learning disability and autism settings.
Our draft mental health Bill, which has been mentioned a few times in this debate, is intended to modernise the Mental Health Act so that it is fit for the 21st century and works better for people with serious mental illness. The draft Bill has completed its pre-legislative scrutiny, and we will respond to the Joint Committee’s recommendations very shortly.
In a world of increasing rates of multiple morbidity and diseases of increasing complexity, it is crucial that we continue our progress towards more person-centred, holistic care that considers a patient’s physical and mental health needs together. That is why we announced in January that we will be producing a major conditions strategy to tackle the conditions that contribute most to morbidity and mortality across the population of England, including mental health. The call for evidence is now open, and I encourage everyone to make their views known before it closes.
Liz Twist (Blaydon) (Lab)
The Minister is talking about the mental health strategy now being part of the major conditions strategy. Is he aware that many mental health organisations see it as a retrograde step that, having conducted an extensive consultation and invited views, the strategy will now be put back even further?
Neil O’Brien
I assure the hon. Lady that all contributions were fed into the major conditions strategy process. The reason why we are making the mental health strategy part of the major conditions strategy, and why we are looking at co-morbidities, is because, as the hon. Member for Tooting mentioned, people with mental health conditions have a shorter lifespan and, in general, the cause is typically a physical co-morbidity. It is essential that we look at these things together if we are to make progress on tackling disparities.
We have committed to publishing a new national suicide prevention strategy later this year, and we are engaging widely across the sector to understand what further action we can take to reduce cases of suicide. The new strategy will reflect new evidence and the national priority for preventing suicide across England, including action to tackle known risk factors and targeted action for groups of concern. We are also providing an extra £10 million over the next two years for a suicide prevention voluntary, community and social enterprise grant fund. This competitive grant fund will help to support the sector to deliver activity that can help to sustain services to help meet increased demand for support and to embed preventive activity that can help to prevent suicide and stem the flow into crisis services.
Liz Twist
Of course it is good that we will have a refreshed national suicide prevention strategy, and of course £10 million is welcome, but it is not out there yet. In the meantime, the £57 million that was earmarked for local work on suicide prevention has run out. Will the Minister consider making urgent interim arrangements to ensure that this vital work can continue until the strategy is published?
Neil O’Brien
I am conscious that we need to help the sector to maintain and grow its levels of service.
I finish by paying tribute to all those who do so much to support people’s mental health: frontline NHS staff, those working in the voluntary community and social enterprises, and all those who are quietly supporting a family member or loved one.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
Thank you, Madam Deputy Speaker.
What a shame it is that the Opposition have chosen to play politics with mental health, as we heard from my right hon. Friend the Member for Chelmsford (Vicky Ford) and my hon. Friends the Members for Watford (Dean Russell), for Runnymede and Weybridge (Dr Spencer) and for Penrith and The Border (Dr Hudson), because these are important issues. All countries are facing challenges with rising cases of mental ill health and capacity issues, but we have made progress in the last 10 years. It was in 2016 that David Cameron first talked about changing the stigma on mental health and, as my right hon. Friend the Member for Chelmsford put it so well, we want more people to come forward. The problem in the past was that people did not come forward, instead waiting until they became so acutely unwell that it was more difficult to support them.
Dr Hudson
A recurrent theme in today’s debate, on both sides of the House, has been the importance of prevention and breaking down stigma. Does my hon. Friend agree that the message should go out from Members on both sides of the House that it is okay not to be okay, that people should reach out and that more people in all walks of life should be first aid-trained to help when people do reach out?
Maria Caulfield
My hon. Friend is absolutely correct. As my hon. Friend the Member for Bosworth (Dr Evans) said, we had an event with the NFU yesterday, and that is exactly the point we wanted to make. It was my right hon. Friend the Member for Maidenhead (Mrs May) who set about changing the status of mental health, putting it on a level playing field with physical health, not just in the services we provide but in funding and staffing, with parity of esteem across the board.
Let us look at some of the progress that has been made over the last 10 years. The shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), said in her opening remarks that she is bored of this figure, but it is true that £2.3 billion of additional funding is being put into frontline mental health services, supporting another 2 million people to access NHS-funded mental health services.
We are already doing much of what shadow Ministers have set out this afternoon. We are already recruiting 27,000 additional staff into mental health services, with 20,000 of them already in place. My right hon. Friend the Member for Chelmsford highlighted the difference that is making in her local area. We are removing dormitory accommodation across the country through a £400 million capital programme, and 29 schemes have already gone through—that is 500 beds that are no longer in dormitory-style accommodation.
My hon. Friend the Member for Runnymede and Weybridge highlighted the difference that funding is making in his constituency. We are moving to a system of community crisis support and early intervention so that people do not get to a point where they need to be admitted. Our £190 million of capital funding is being used to build community crisis facilities up and down the country. We are investing in mental health ambulances: 20 are already in place, 40 will be in place by the end of the year, and 47 will be in place next year. The shadow Minister laughs about this, but when somebody is going into crisis, it is more appropriate that a mental health specialist team visits them in a mental health ambulance than an ordinary paramedic, who will inevitably take them to A&E.
Suicide is the leading cause of death in new mums, which is completely unacceptable. That is why we are investing in perinatal mental health services in every part of England—these services saw 31,500 women last year.
As we remove the stigma, it is important that we have the services to deal with the rising number of people who come forward and ask for help, as we want them to do. We have introduced three targets, the first of which is on access to talking therapies, where 75% of people should begin treatment within six weeks. Currently, 90% of people are doing so and we are meeting that target. When children and young people are referred for eating disorders, the target is that 95% should be seen within one week. We are currently at 77%, whereas last year’s figure was 61%, so despite the rising numbers we are seeing more children with eating disorders—
Vicky Ford
I was incredibly upset by the shadow Minister’s suggestion that I do not care about mental health. As someone who has suffered with mental ill health in the past and spoken in the Chamber about how hard it is to speak about that, I found that very upsetting. Mental health suffered greatly during the pandemic, especially that of children and young people—I was the children’s Minister at the time. We all know that we need to do better, which is why it is important that we learn about what is working now and about new innovations. On eating disorders, I particularly thank the Minister for getting the waiting list time down.
Maria Caulfield
I thank my right hon. Friend for that. It is important that we take the politics out of this argument, because no one in this Chamber, on either side, does not care about mental health.
The psychosis target we have introduced is that 60% of people should start treatment within six weeks, and we are currently at 72%. We are overperforming on many of those targets. NHS England has five new targets that we hope to introduce soon—
Maria Caulfield
Unfortunately, given the time I have left, I will not give way any more.
As for the challenges we face, we are seeing rising numbers, but we are seeing that in all parts of the country. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about not judging Labour on its track record on health in Wales, where Labour has produced smaller funding increases for its health service; its 7.8% increase compares with the 8.6% increase that we have given in England. Mind Cymru has said that hundreds of people across Wales are currently waiting more than a year to access psychological therapies. The target is supposed to be that 80% of people in Wales access therapies within six months, but that target has never been met. It gets worse, because since 2020 the number of people waiting longer than a year in Wales for mental health support has increased by 17%. Labour talks a good game, but its actions speak louder than its words. I urge shadow Ministers to acknowledge that these problems exist in all countries and that we all face these pressures. A grown-up conversation would be about sharing best practice and working together to make that happen.
Many Members talked about preventive and early intervention therapies. My hon. Friends the Members for Bosworth and for Devizes (Danny Kruger) talked about that and about moving away from the medicalisation of mental health. That is why we are investing in talking therapies. For anyone who has not been on the Every Mind Matters website, let me say that it provides practical support for people who are anxious, distressed or not sleeping. It also provides for self-referrals to talking therapies. Since we introduced that, more than 1.2 million patients have accessed NHS talking therapies in the last year, helping them to overcome anxiety and depression. More than 90% of those people have had their treatment completed within six weeks.
Many Members talked about schools, and we are introducing mental health support teams in schools. We have almost 400 now, covering more than 3 million children, and about 35% of schools and colleges. More than 10,000 schools and colleges have trained a senior mental health specialist, including more than six in 10 state schools. That work is happening already and it is making a difference right now. My hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) highlighted how we need to move that into universities, and I would be happy to talk to him about how we can do that further.
On in-patient services and the quality of care, we have recently conducted a rapid review of mental health in-patient settings. The Secretary of State will announce the results of that soon. We have also introduced a three-year quality transformation programme, which seeks to tackle the root cause of unsafe, poor-quality in-patient care, particularly for those with learning disabilities and autism.
On suicide prevention, our forthcoming strategy will target high-risk groups and locations of concern. We will also provide £10 million of funding for charities that do so much good work in this space. I say to my hon. Friend the Member for Penrith and The Border that I would be very happy to meet the 3 Dads Walking, Andy, Mike and Tim. I know that they have met the Prime Minister.
Maria Caulfield
I am just answering a question on suicide. I would be very happy to meet the 3 Dads Walking to learn the lessons for our suicide prevention strategy.
Maria Caulfield
I will not give way. I only have a few minutes left.
It is disappointing that Labour Members cannot understand the progress that has been made and are determined to make political points, damaging the work that our NHS staff up and down the country do day in, day out, backed by record levels of investment that have never been seen before in mental health services.
It is true that we have tabled an amendment this afternoon, in which the Prime Minister acknowledges how much work we have done in this space. With a rising number of people accessing mental health support, which is a good thing and not something to be criticised, we are investing in those services and in 27,000 extra staff.
Maria Caulfield
Madam Deputy Speaker, I will continue if I may.
Despite the disingenuous motion proposed by the Labour party, it is my privilege to hear about the valuable contributions being made up and down the country. It is so easy to talk down our services, but if Labour Members are serious about improving mental health services, perhaps they should talk to their Welsh counterparts. Action speaks louder than words. Mental health services in England are performing better than those in Wales. We all know that this is not really about improving mental health services; it is about using mental health as a political football, but we on the Government Benches will not play that game.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.