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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Sir Robert. I am grateful to the hon. Member for Bootle (Peter Dowd) for securing this debate about mental health for those with long-term conditions, especially during Mental Health Awareness Week.
I thank everyone who contributed, including the hon. Member for Blaydon (Liz Twist) who does great work on mental health with her all-party parliamentary group on suicide and self-harm prevention. If other hon. Members do not mind me saying so, the standout speech was from the hon. Member for Birmingham, Perry Barr (Mr Mahmood), who talked about his own experience of going through a long-term condition and needing dialysis for renal disease. He highlighted not only the physical impact but the effect on his mental health, and the uncertainty that organ donation and transplant can bring.
I know that this is a debate on mental health for those with long-term conditions, but I will touch on what the hon. Member for Birmingham, Perry Barr said about the opt-out system for organ donations in England, which we brought in in May 2020. I recognise that even when someone has consented themselves, there are still issues with families refusing organ donation. In February 2023, we committed to implement the recommendations of the Organ Utilisation Group, which highlighted issues relating to opt-out and to the use of donated organs—we must ensure they go forward for donation—so I absolutely recognise the hon. Gentleman’s comments.
I want to reassure hon. Members about our commitment to improving mental health and wellbeing, particularly for those with longer-term conditions. Over the past 14 years, the stigma surrounding mental health problems and mental illness has been removed. People are much more willing to talk about their mental health and discuss issues that they face; we are breaking down those barriers.
We have also made progress on parity of esteem between physical and mental health, and the funding that we have made available to mental health in the past few years is the most significant ever in England. That is not to say that it has met all the challenges we face, but through funding, infrastructure and staff recruitment we are getting mental and physical health on the same level.
When I spoke at the Mental Health Foundation event in Parliament yesterday, I said that our challenge now was to ensure that we do not just silo people into having a mental health problem or a physical health problem. The hon. Member for Birmingham, Perry Barr expressed that so well. We cannot just treat people in isolation; we know that people who suffer with mental illness have significantly poorer health outcomes for major conditions including cancer and heart disease, and likewise people with long-term conditions struggle with their mental health. That is why we put mental health in our major conditions strategy. We got some criticism when we announced that we would not have a stand-alone mental health strategy, but it was because people’s conditions cannot be treated in isolation: their physical and mental health must be treated together. That is why, in the major conditions strategy, mental health is one of the major conditions that we will focus on.
That is also why, through the NHS long-term plan, we have provided record levels of funding to increase our mental health workforce across England. Our target is 27,000 mental health workers and we are on track to meet it. Our NHS forecast shows that since 2019 our spending on mental health services has increased by £4.7 billion in cash terms, compared with our original target of £3.4 billion. We invest almost £16 billion in mental health, enabling 3.6 million people to access mental health services.
Significant investment and resources are going in, but I recognise that there has been a tsunami of demand and we are struggling even to tread water. We have had a 46% increase in the number of referrals across the United Kingdom, not just in England. In Wales they have had a similar experience: child mental health waits were up 14% in July 2023, compared with December 2022. Overall, in Wales there are 30,000 people on the waiting list who have been waiting for more than two years. The challenges that we face in England are exactly the same as those in Wales, and I think it would be more appropriate to take the politics out of this and deal with the causes.
I am really pleased that the types of mental health services we are investing in are not just for people with a mental illness. It is really important that we not only provide bespoke services for people with specific mental illnesses, but improve the mental health of the country overall. One of our biggest successes is the flagship NHS talking therapies programme, which is for adults everywhere across the country. It is accessible on our NHS website. People can access the Every Mind Matters website, and can self-refer. Anyone can access those services, including people with diabetes, Parkinson’s, cancer, MS or renal conditions. So far, more than 1.2 million people have done so in the past year—an 11% increase since the start of the long-term plan in 2019.
We are expanding those services further to help people with mental ill health and long-term conditions. Colleagues in the Department for Work and Pensions are working with people who are struggling to find work because of a long-term condition and the mental health effects that that has had.
We do recognise that two thirds of people with common mental health problems also have a long-term physical health problem. One of the key issues we do need to overcome—which was not mentioned in this debate—is that if someone has a mental illness they may also have cancer, diabetes or renal problems, and sometimes there is diagnostic overshadowing that assumes that it is someone’s mental health problems when they are complaining about pain or describing other symptoms. They are not taken as seriously as someone who does not have a mental illness. That diagnostic overshadowing is sometimes responsible for the poorer clinical outcomes. There is a piece of work to do, across the board, that is not just about providing services. It is about changing that culture so that people with mental illness and long-term conditions get the help that they need.
On the talking therapies point, all integrated care boards are expected to expand their services locally by commissioning NHS talking therapies into physical healthcare pathways. I know the hon. Member for Bootle talked specifically about some of the work on renal disease. NHS England has published a series of service specifications covering renal services, developed by specialist clinicians and commissioners and patients with experience, to set out expected standards for specialised renal care. That does include clinical psychologists, although I recognise that is not happening everywhere. There are regular review meetings between regional commissioners; I am very happy to follow those up with the hon. Gentleman, to update him on where there may perhaps be gaps in service provision. However there is a service specification that should include those services for renal conditions as well.
I will move on to talk about suicide prevention. We released our strategy fairly recently and we have put in it that people with a physical illness or a long-term condition are more at risk of suicide. That is why physical illness is now included as a key national risk factor for action in our five-year suicide prevention strategy. I am very happy to update Members about the progress we are making. There are 130 actions that we believe will address some of those common risk factors and make swift progress.
In terms of the support we are giving to people with long-term conditions and the ability to live better with a long-term condition, we are providing support across the board here as well. It is important that teams that are looking after people, whether with cancer or diabetes, are aware of the emotional and psychological support needed. It has historically been the case that these patients are often referred to the mental health team. That is not always what is needed. Some basic support can do a huge amount to improve the psychological wellbeing of patients.
Children were raised in the debate and I want to update the House on that because children have long-term conditions too. We are putting in significant support. Only a few weeks ago, we put forward funding for 24 early support hubs—support hubs for children who want to get mental health support. No referral is required. They are local, with services provided to suit the needs of the local community, and £8 million has gone towards the funding of those 24 projects. We are evaluating them to see whether they are making the difference we need them to make. We are also rolling out mental health support teams in schools to over 4 million children via 400 mental health support teams which are providing support to just under 50% of our schools. I think that is making a significant difference. If a child has a long-term condition in school, they will have within their school a team able to provide emotional and psychological support to them as appropriate.
I hope I have given a bit of a whistle-stop tour—although perhaps not a Cook’s tour, as the hon. Member for Bootle did. I absolutely share some of the concerns that hon. Members have raised in this Chamber, and I hope that I have highlighted that there is some exciting, groundbreaking work happening in this space.
In Mental Health Awareness Week, it is really important that we talk about mental health problems for people with long-term conditions and recognise how being unwell over a long period—whatever the cause—affects a person and their family. That is why it is so important that we have whole-person treatment and support to improve both the physical and mental wellbeing of individuals.