The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)
I sincerely thank my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton), who is vice-chair of the Health and Social Care Committee, for securing this debate. I pay tribute to her for her work on that Committee, on which she has consistently championed the voices of the unheard, and for her 30 years’ service in the NHS as a district nurse. As she was speaking, I recalled that, as a medical student at the University of Glasgow, I had the pleasure of spending a lot of time shadowing district nurses. I always found them to have the perfect mixture of clinical acumen and a sixth sense of something being not quite right. She displays those attributes in abundance.
My hon. Friend has been true to form in raising the issue of hoarding. This disorder is, by definition, kept from public view. Although it is often overlooked, it has a profound impact on the lives of the affected, their families and their carers, and, of course, on local services. Too many suffer in silence. I thank Hoarding UK, Clouds End and Clutterers Anonymous, to name just a few of the charities that do so much to support people up and down the country.
For too long, hoarding has been seen as something quirky, or perhaps even comical, but the disorder is neither a joke nor a rarity; it is a complex and often misunderstood condition that can have devastating consequences for people’s mental and physical health. Often, it is a portent to investigating further mental wellbeing and illness.
Estimates vary, but research suggests that between 2% and 3% of the UK population, as my hon. Friend adumbrated, may be affected by hoarding behaviours. These are often associated with traumatic life experiences such as bereavement, divorce or eviction. People who hoard can experience deep emotional distress, guilt and anxiety. The clutter in their homes often represents emotional pain, memories or attempts to regain control.
Dr Ahmed
The impact of hoarding can be severe. The clutter can compromise hygiene, strain relationships and pose safety risks, so let me be clear: these people deserve compassion and support from this Government and from every corner of society.
My hon. Friend asks whether the Government will introduce a national hoarding strategy. There are no plans for a specific strategy, but we absolutely recognise that people who hoard must have access to the right support. At the moment, that requires more co-ordination than is currently in place. As she knows better than anyone as a district nurse and an independent lay manager, mental health services have been decimated over the last 14 years. This Government are doing the hard yards of rebuilding those services while transforming our mental health system, so people can access the right support at the right time and indeed the right place. Through our 10-year health plan, we have set long-term reforms to make mental health a core priority of the NHS and to move from crisis care to prevention and early intervention.
This transformation will include: investing up to £120 million to expand the number of mental health emergency departments to 85 across England; a modern service framework for severe mental illness to support consistent high-quality and high-value care; and, as my hon. Friend mentioned, recruiting 8,500 new mental health workers across the NHS to increase capacity and make sure help is available where and when needed.
We are already piloting six 24/7 neighbourhood mental health centres, which will bring together a range of professionals and imbibe that holistic concept—professionals such as psychologists, peer support workers, housing specialists and employment advisers. The pilots are testing out mechanisms that will enable that whole-team approach to capture people who otherwise remain hidden, including collaborative planning of care and treatment, communication and engagement, single patient records and shared outcome measures. This joined-up approach presents an opportunity for people, including those with hoarding disorder, to be identified and to get holistic support and treatment, and then to better join up between social services and mental health support.
We know, too, that there are people in contact with social care right now who have a suspected hoarding disorder. Digital social care records, which have been implemented by 80% of Care Quality Commission providers, are already improving that quality and safety, and that personalisation of care. We are also investing in the development of a national infrastructure for social care, which will lay the foundations for ensuring greater interoperability and integration between care and health services, so that, again, fewer people slip through the net, as is often the case with hoarding disorders.
People who hoard may be isolated, may not recognise their behaviour as a problem and may be reluctant to engage with services. That is why safeguarding plays such an important role. The Care Act 2014 and its statutory guidance make clear that self-neglect, which explicitly includes hoarding, is a safeguarding concern. Where a local authority has cause to suspect that an adult appears to be at risk of self-neglect and is unable to protect themselves as a result, that authority must carry out a safeguarding inquiry. The purpose of that inquiry is to establish what action is required and by whom, and to keep that person safe and ultimately get them the support they need. The guidance also advises that each case of self-neglect should be assessed on an individualised case-by-case basis. Professionals, whether social workers, carers, housing officers, emergency services or clinicians, have a responsibility to spot the signs, raise concerns, and support people and direct them towards help.
One of the most effective treatments of hoarding disorder is cognitive behavioural therapy, otherwise known as CBT. CBT is a form of talking therapy that helps individuals to understand the thoughts and feelings that influence their behaviour and supports them gradually to make practical changes to their living environment. Through NHS talking therapies, people with a hoarding disorder can access evidence-based psychological interventions such as CBT.
This Government are expanding access to talking therapies this year and have committed to continuing this expansion over the coming years. We aim to increase the number of people completing a course of talking therapy by 384,000 by the end of this Parliament and to increase the number of sessions someone can access, meaning that more people will be able to access timely and high-quality mental health support in their local area, and that these services can be accessed not only through their GP, but through self-referral.
We know, however, that accessing these services can be difficult for those who feel isolated or who feel shame about their condition. As advised by national charities, therefore, during National Hoarding Awareness Week, we encourage friends and family members of people suspected of having a hoarding disorder to gently encourage them to speak to their GP, who can help to assess their needs and refer them to the appropriate mental health and community support. No one should face this condition alone.
Of course, hoarding can also be associated with serious mental illnesses, including severe depression and obsessive compulsive disorder, which can require more specialist or intensive forms of support. That is why the Government are transforming services for people living with severe mental illnesses by investing in new models of integrated community care, expanding priceless support and increasing access to physical health checks and tailored interventions.
At its heart, this debate is about dignity and compassion. We are talking about members of our own communities who deserve the same compassion, care and support as anyone else with any other illness. The Vice-Chair of the Health and Social Care Committee, my hon. Friend the Member for Birmingham Erdington, deserves real credit for her work on this issue. We will continue to work with her, mental health professionals, voluntary organisations and people with lived experience to smash the stigma while improving access to care.
Rachael Maskell
I am grateful to the Minister for giving way. From listening to, meeting and engaging with those from York Community Bees, I know that their big cry is for funding. These people are specialists in the work that they do to support my residents, but they need funding. Will the Minister send a message to commissioners to ensure that they commission these support services?
Dr Ahmed
My hon. Friend brings a great deal of experience in these matters to this House. I can certainly give her an assurance that as part of this Government’s 10-year health agenda, we encourage all commissioners to commission strategically on the basis of what will prevent ill health in the long term. I believe this issue is an exemplar of where we could think about commissioning mental health services differently to try to pick up the signs earlier.
For too long, people with mental health conditions, including those who hoard, have not received the understanding or support that they deserve. I want to end, however, on a note of optimism. With love from families, patience from friends and the ongoing support of charities and third sector organisations, countless people with hoarding disorder have managed to live safe, healthy and fulfilling lives. We will continue to work closely with these partners, local authorities and charities to ensure that this Government are also playing our full part.
Question put and agreed to.