Child and Adolescent Mental Health Services

Andrew Percy Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Andrew Percy (Brigg and Goole) (Con)]

It is a pleasure to take part in this debate as a member of the Committee, and I associate myself with the kind words of our excellent chairperson, my hon. Friend the Member for Totnes (Dr Wollaston), about everyone who gave evidence, and about all the Clerks and House staff who supported the inquiry. It was one of the most important and far-reaching inquiries we have undertaken in the past few years, and I was proud to have been a part of it, because the issue is so important.

I wish to make a few general comments about this whole area and then to talk specifically about the role schools can play in mental health services for children and young people. I noted with interest the comments made by the hon. Member for Stoke-on-Trent South (Robert Flello). The comments today have generally been quite consensual, although something I will say a little later about funding may be less consensual. He pointed out that 10 years ago we were having many of these same conversations, but things have really moved on in the past 10 years, not least in this area; we heard in our inquiry about the increase in demand. Although many of the pressures young people faced 10 years ago are similar, a whole host of other pressures on young people now did not exist then, particularly those of a cyber nature, be it those arising from Facebook, Twitter or online bullying. When I started teaching in 2002 people did not have a great deal of understanding or expectation of any of those things, but they have now become so widespread that we have had a massive increase in demand in this area.

In addition, the way in which mental health services and care are delivered has changed beyond recognition during that period, and some would argue that it has not always been for the better. As we know, between 1998 and 2010 the number of mental health beds reduced from 35,000 to 25,000, and we have seen a continuing shift away from in-patient treatment units. What came out of this inquiry, and what I have seen in my constituency in mental health service provision for both young people and adults, is that although that more traditional unit-based, hospital-based, bed-based system of treatment has changed, what has replaced it has not necessarily always filled users with confidence or has even been consistent across the country. As our report makes clear, there is a lot more we need to do.

As I have said, I wish to focus on what we heard from young people. It was great that our inquiry had a session with young service users, including some from Hull, near my area, who came down to tell us about how they have engaged with local voluntary, local authority and, of course, school services. In our inquiry, we heard that the support schools offer young people is very patchy across the country, changing even within cities or within counties. Some young people we heard from, and some of the other evidence we took, made it clear that some of the best support they had received had come from dedicated teachers who understood mental health issues, really wanted to engage with those young people on them and help them access services. Having a teacher who was engaged and who understood what to look for in mental health really helped young people. Some pupils had different experiences. They felt that teachers either lacked the skills or were too uninterested to deal with the problem. Very often that can be because teachers are scared of mental health issues. In some cases, therefore, pupils experiencing mental health problems did not receive the support that they needed.

I started teaching in 2002. When I think back to some of the young people we had to deal with, I can see that many of them probably had mental health issues. At the time though, those pupils were dismissed as being badly behaved or as having background problems. As a practitioner, I was sometimes guilty of not understanding the signs that were being presented to me. However, teachers cannot be blamed for that; they work in a pressured environment. The pressures around school standards seem to get more intense every year and with every Government initiative.

What we did hear in our evidence was that 61% to 85% of schools are providing access to school-based counselling. Although that is a wide variation, it is a positive thing. We heard that some schools engage really proactively with the local authority and the NHS in this area. Unfortunately, though, we also heard of others that do not engage so well. Some schools seem to think that mental health issues are for health services and social services, but not for schools. When we talk about integration in all areas of health care, this area is one in which we need it the most and, potentially, it could have the biggest impact. My hon. Friend the Member for Totnes talked about early intervention. When we fail in that regard, the consequences are picked up by other services. That means that we have increased referrals and more behavioural difficulties in our schools, which leads to more exclusions. Those exclusions have consequences not just for the management of the school but for that young person’s life chances.

What can we do in schools to make a real difference? Increased collaboration among the services is vital. Although we talk about integration and greater collaboration, we need someone at some point to take responsibility for that and to be held accountable when that collaboration does not work. As we heard in our evidence sessions, some schools are keen to take the lead in that regard, and others less so. Clearly, this is an area where we need greater clarity.

The curriculum was raised by a number of young people, particularly around personal, social, health and economic education. They said, “We learn everything in PSHE. We learn about sexual activity, financial matters, career advice and career choices, but what we do not learn about is mental health and well-being.” Ofsted found that 40% of PSHE provision required improvements nationally and that one third of young people say that they want to know more about how to deal with stress and how to access help for eating disorders. Some 38% said that they wanted education around bereavement, which surprised me.

We have seen some good things happen with the curriculum. We heard in our inquiry that the ICT curriculum now contains a section on cyber-bullying. Clearly, some improvements have been highlighted but an awful lot more still needs to be done. The focus should be on young people as much as it is on teacher training. In our evidence sessions, we heard from the Secretary of State about how a great deal of effort has gone into providing teachers with the tools to deal with mental health issues and to improve training, and that is really important.

When I did my postgraduate certificate in education, I do not remember receiving a great deal of education about mental health and young people’s emotional well-being. Clearly, that needs to change, but the focus should be not only on equipping teachers better, but on ensuring through the curriculum that young people are able to understand mental health issues. The stigma needs to be removed through both teacher training and the curriculum, and young people who have had experience of mental health issues should be involved in developing that curriculum.

I wanted to say a little more about youth services, but I do not have a great deal of time. We have heard a lot about council spending reductions and the impact that that can have. The truth is that whoever was in power, we would be in this position, with council budgets having been reduced. In my area, I am very pleased that North Lincolnshire council has made a concerted effort to reverse the cuts to youth services instituted by the previous administration of a different party, which cut the services by £194,000. Even in these tough times the council has been able to put in an extra £100,000 of funding and over the next three years will add to that a further £300,000.

Local authorities can do that if they have the necessary vision. In the case of North Lincolnshire, the driver for that is a very good portfolio holder in the cabinet who understands that we have to get it right early. That means that we need proper investment in positive activities for young people, because that allows savings elsewhere down the line. Despite all the difficulties that we have faced in local government funding, where there is leadership and vision, people who understand the value of these services can find the money to invest in them. With that, I will end as I am conscious of time and I know that one of my colleagues wishes to speak.

--- Later in debate ---

[Grahame M. Morris]

That is true. Some of the organisations that submitted evidence to the Health Committee and subsequently provided briefings made that point.

Another issue of concern is the complex commissioning landscape for CAMHS, which can result in poorly co-ordinated services and a lack of clarity about roles and responsibilities, leading to gaps in provision and poor transitions from child to adolescent and from adolescent to adult. The service is certainly underfunded. We often talk in this place about parity of esteem. As other Members have reported, CAMHS nationally is receiving about £1.8 billion of the £14 billion that is spent on mental health. Local authority-provided services, which are often having to bridge the gap, are facing huge financial challenges. My local authority, which I share with my hon. Friend the Member for North Durham (Mr Jones), has had to cope with cuts of £250 million over the lifetime of this Parliament. That is forcing councils to make extremely difficult decisions about which services are funded.

I fully understand the point made by the hon. Member for Brigg and Goole, but I also fully understand the difficult decisions faced particularly by authorities in the north that seem to be suffering disproportionate cuts. Councils are embracing their new public health responsibilities—

[Andrew Percy]

I hope the hon. Gentleman understands that both my local authorities are in the north of England; I would not want him to get his geography wrong.

[Grahame M. Morris]

I am certainly aware that some authorities are facing higher cuts than others. My area is one of relatively high deprivation, but we seem to be in a far worse position than some in the south that are more affluent and do not have the same kinds of pressures.

In rural areas, in particular, people face problems with travelling long distances, a lack of accessibility to specialist services, and long waits. One issue is the 12-week target for referral to CAMHS in cases where children and adolescents are referred out of their local areas. Transition between services varies from one area to another. In some areas it happens at 16, in some at 18, and in some at a point in between. These issues all need to be addressed.

Fundamentally, this issue comes down to funding. I welcome the establishment of the taskforce and the provision of £30 million over the next five years to improve services for young people with mental health problems. However, we must recognise that councils play a vital role in working with health services to target support and co-ordinate services, and they should play a key role in directing the funding.

Francis Report: Update and Response

Andrew Percy Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I will look into the issue that the hon. Gentleman raises, but let me deal now with the issue of nurse training places. The cuts began under the Labour Government, and we have been gradually reversing them. The main point, however, is that, in all parts of the House, there was a lack of understanding of the importance of safe staffing in wards before the Francis report, which is why successive Secretaries of State made mistakes in their projections of what was needed.

We have 8,000 more nurses in our hospital wards, including those at Stoke, and I hope the hon. Gentleman welcomes that.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State will want to congratulate North Lincolnshire and Goole NHS Foundation Trust on getting out of special measures and employing more nurses and doctors. On the issue of “freedom to speak up” guardians, will he ensure there is one in every hospital, because in my trust staff in the smaller hospital sometimes feel their voice is not heard by the two big district general hospitals, which are up to 60 miles away?

[Mr Hunt]

That is a very good point. I had a great visit to my hon. Friend’s local hospital and saw a knee operation which was quite gory but looked to me to be a very good example of safe care. He makes a good point and I will certainly feed into the consultation the idea that it should be easy to contact somebody who works in the same hospital or building, rather than someone who is a long way away.

Oral Answers to Questions

Andrew Percy Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I do recognise the pressures on the ambulance service and the hon. Lady’s local area has had £1.6 million extra to help to deal with winter pressures. We have 1,700 more paramedics in the ambulance service and they are doing 2,000 more emergency journeys every day, but none of that is any consolation to the family whom she talks about, and that is why we must always ensure that every lesson is learned.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State, the Department of Health and my local hospital trust inform me that there are more doctors and nurses in the local NHS and the NHS nationally than there were in 2010. This weekend, residents in north Lincolnshire received a leaflet from the Labour party saying that there were fewer doctors and nurses and less care. Who is telling the truth?

[Mr Hunt]

It is not the Labour party, because all it wants to do is to turn the NHS into a political weapon. It might just think about the impact on NHS patients and staff when it does this. It does not help anyone and it is bad for the NHS.

A and E (Major Incidents)

Andrew Percy Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

Of course I regret any individual incidents where people do not get the care they need promptly. The hon. Lady will know that the solutions to such problems are not always things that can be done overnight. If she looks at the record of joined-up care over the past few years, she will see that this is the first Government to encourage 150 local authority areas to sit down with their local NHS and jointly plan care for the most vulnerable people in the social care system. That is a very big step forward. We are also doing nearly 1 million more operations every year across the NHS. In accident and emergency, the number of people being seen within four hours has gone up by nearly three quarters of a million since the start of this Parliament. That is real progress, but of course there are long-term issues, and we will focus on those as well.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate Goole hospital on hitting its target 99.7% of time, and the trust as a whole on hitting its target 93% of the time. I spent my Christmas volunteering in the NHS at A and E and with the ambulance service. Staff repeatedly told me that as first responders what they see are more old and frail people needing to be admitted to hospital. That situation was not helped by 50,000 hospital beds being cut by the previous Government. One way of dealing with the problems would be to move to a community paramedicine model and to use the skills of our ambulance services more. I encourage the Secretary of State to ensure that NHS England is seriously looking at that option.

[Mr Hunt]

May I congratulate my hon. Friend on the shining example he gives to everyone in this House by being a first responder? I do agree that one thing that we could do in the next year is to integrate better what happens in the ambulance services, out-of-hours GP services and 111. Individually, they are all doing a good job, but they could do a much better job if what they did was integrated.

A and E and Ambulance Services

Andrew Percy Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for championing care for his constituents. Let me reassure him: I had a meeting on that very issue on Monday. It is important that the NHS community care sector plays its role alongside the social care sector in making effective discharge possible.

[Andrew Percy (Brigg and Goole) (Con)]

I thank the Secretary of State for his kind words about first responders. I will be on duty tonight, as will thousands of first responders in Yorkshire ambulance service, Lincolnshire ambulance service and throughout the country, responding to cardiac arrest, respiratory disease and so on. On the matter of community service, what are the Government doing in the light of the Royal College of Nursing saying to us at a Health Committee a few weeks ago that a failure to invest properly in community services 10 to 15 years ago is having a major impact now on our hospitals?

[Mr Hunt]

My hon. Friend is right about that. Just as this Government have taken a very robust attitude towards poor care in hospitals—we now have 6,000 more nurses on our hospital wards following the Francis report—we need to take an equally robust attitude towards what is provided in people’s homes, to make sure that we have proper care. It is a false economy to cut back on out-of-hospital care to pay for hospital care, as we need both.

Oral Answers to Questions

Andrew Percy Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

We are, on the NHS, the most transparent Government in history, and I can see no reason why we would not publish that. We are very proud of what the CDF has achieved. We are very proud that the level of cancer diagnoses has increased by more than 50% compared with what it was under the previous Labour Government, and so we are finally starting to win the battle against cancer.

[Andrew Percy (Brigg and Goole) (Con)]

We all remember the horror stories before the CDF existed locally, and all Government Members certainly support its continued use. Before any drugs are delisted from the CDF, will the Secretary of State make available the scoring of those drugs? Will he also outline what the provisions will be for consultation with patients and their families?

Special Measures Regime

Andrew Percy Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

I absolutely recognise that issue, which is something we will have to think about in terms of the long-term sustainability of the trust. Let me reassure my hon. Friend and the hon. Member for Barrow and Furness that the CQC chief inspector will not say that a trust can come out of special measures unless he can see a long-term sustainable future for that trust, so part of the purpose of the regime is to force everyone in the system to confront those issues so that we bite the bullet quickly.

[Andrew Percy (Brigg and Goole) (Con)]

The positive progress of the Northern Lincolnshire and Goole NHS Foundation Trust is to be welcomed and is a direct result of the work of health care assistants, nurses and doctors. On the issue of social care, may I commend North Lincolnshire to the Secretary of State and ask him perhaps to visit again? The local council has not only refused the request by the Labour opposition on the council to cut social care in the budget, but has actually increased funding for elderly and disabled people by £1 million in this year’s budget and is opening up a network of well-being centres to support older people in their own homes, as well as constructing a £3.2 million intermediate care facility, so that a lot of our residents do not have to go into hospital in the first place.

[Mr Hunt]

I thank my hon. Friend for the warm welcome he gave me when I visited the trust—including the visit to a not particularly healthy, but delicious bakery as part of the trip. I welcome what is happening in social care, and I think it is something on which we can agree at the national level across the House—that cuts in social care can be very counter-productive, leading to more pressure on the social care system and more pressure on the NHS.

Patient Safety

Andrew Percy Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I do not know the answer to that question, so I will look further into the matter and get back to the hon. Lady.

[Andrew Percy (Brigg and Goole) (Con)]

As the hon. Member for Scunthorpe (Nic Dakin) mentioned, local GPs raised concerns last week about a cluster of cases at Scunthorpe and Grimsby hospitals—not at Goole hospital, which was also revealed last week never to have breached its four-hour waiting target. There is still a lot more to be done, so does the Secretary of State share my concern at the evidence received by the Health Select Committee last week from the Care Quality Commission, which stated that all too often, members of staff who raise concerns are dealt with by the human resources department rather than in a proper way that allows their complaints to be properly aired?

[Mr Hunt]

That is a very good point, and I thank my hon. Friend for welcoming me to Goole hospital; I had a very good visit. That hospital is in special measures but it is making real progress. It was interesting to talk to staff at the front line. I do not know when the hospital will be ready to leave special measures, but the staff on the front line felt that things were changing, and they welcomed that. My hon. Friend is absolutely right that if someone raises a safety concern, it should not be viewed as an HR issue; it is a patient safety issue, and trusts need to treat it as such.

Care Homes

Andrew Percy Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

The hon. Lady is absolutely right, and that is why we are introducing the fit and proper person test for every director of every care or health care provider. If they have been complicit in unacceptable standards or prosecuted for unacceptable care, the CQC can require them to be removed from the board of a care provider. The new standards should help considerably.

[Andrew Percy (Brigg and Goole) (Con)]

Nobody who uses schools is unaware of Ofsted and its job. Should we not look for a similar situation with regard to the CQC, and is there not a big public information job to be done to ensure that people know better what the CQC is there for and how to access it?

[Norman Lamb]

My hon. Friend is absolutely right. The CQC needs to build a reputation so that everyone has confidence in its ability always to represent the patient’s interests. I believe that the CQC’s leadership understand that mission and are well on the way to achieving it, but it will not happen overnight.

Oral Answers to Questions

Andrew Percy Excerpts

Tuesday 1st April 2014 Commons Chamber

[Andrew Percy (Brigg and Goole) (Con)]

Every weekend, as a first responder volunteer in the NHS, I see too many people taken off to hospital unnecessarily. One way of addressing that is to have a proper strategy for community paramedicine. We have had a trial running in Goole, which the Secretary of State has seen, where an emergency care practitioner delivers care in people’s homes, thereby reducing visits to hospital. Do we not need a national strategy on community paramedicine?

[Jane Ellison]

I know of my hon. Friend’s extraordinary work as a first responder, and we all greatly admire it. He makes another great point about how we tackle this long-term challenge of the sustainability of our acute services. I am happy to draw his comments to the attention of NHS England. I am sure that it is one part of all the things it is looking at as it addresses this issue.