Health: Mental Health

Baroness Hollins Excerpts

Tuesday 28th October 2014 Lords Chamber

[Earl Howe]

If the noble Lord looks across the piece at the workforce statistics he will perhaps be more reassured than he is at the moment. The £400 million that we are putting into talking therapies, for example, will result in a workforce of 6,000 practitioners trained to deliver IAPT. Health Education England has increased the number of mental health nursing training places by 1.5%. In delivering a multidisciplinary workforce, the aim is to have skills that are transferable between different care settings. NICE will be publishing its authoritative guideline on safe staffing. We have already mandated NHS organisations to publish ward-level nursing with midwifery care staffing levels so that there is an incentive for them to make sure that they have their staffing levels right.

[Baroness Hollins (CB)]

The Government’s five-year plan to improve access to mental health services makes no mention of people with intellectual disabilities who have mental health problems. What steps will the Government take to improve access for this group of patients who have a higher prevalence of mental illness and treatable mental disorders?

[Earl Howe]

I hope that the noble Baroness will agree that the five-year plan is truly ground-breaking in many respects. We have identified £40 million to spend this year to support people in mental health crisis and end the practice of young people being admitted to mental health wards. Another £80 million has been freed up for next year to ensure that waiting time standards become a reality, not just for those with mild mental health conditions but across the piece. I will write to the noble Baroness if I can glean any further information about those with a specific disability.

Learning Disabilities: Premature Deaths

Baroness Hollins Excerpts

Wednesday 30th July 2014 Lords Chamber

Asked by

[Baroness Hollins]

To ask Her Majesty’s Government what progress has been made with regard to the recommendations of the Confidential Inquiry into the premature deaths of people with learning disabilities in the year since their response to the Confidential Inquiry.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, actions are under way with a range of national delivery partners and at local level in response to the inquiry’s recommendations, including improvements in the identification of people with a learning disability, the auditing of reasonable adjustments, and the provision of health checks. Progress is monitored through the Learning Disability Programme Board.

[Baroness Hollins (CB)]

My Lords, I welcome the commitment in the NHS business plan and the Department of Health mandate to try to reduce premature mortality in people with learning disabilities, and in particular to establish a national mortality review function, but until the necessary data linkages have been made, the review cannot begin. What action is being taken to ensure that the Health and Social Care Information Centre will prioritise the collection of the data required, such as identifying people with learning disabilities and their causes of death, so that the review can indeed begin?

[Earl Howe]

My Lords, the specification for the mortality review function is under development, and we all wish to see that work proceeded with rapidly. Data to support the function will be needed from both national and local sources. Work is under way with NHS England, the Health & Social Care Information Centre and Public Health England to derive data to underpin both the mortality review function and the NHS Outcomes Framework. However, it is important that this should take full account of wider developments in the collection and sharing of patient data, and this will inevitably impact on the pace of progress. As I am sure the noble Baroness recognises, it is vital that we get that right.

Mental Health: Beds

Baroness Hollins Excerpts

Tuesday 29th July 2014 Lords Chamber

[Earl Howe]

The noble Baroness referred to people with moderate health needs, which is departing slightly from the Question on the Order Paper. However, I can tell her that mental health policy and its delivery is now a major focus. We have a mental health system board to ensure that all the elements of the health and care system work as effectively as possible together. There is a ministerial advisory group in operation. Parity of esteem is reflected in the NHS constitution and in the Health and Social Care Act 2012. We have challenged NHS England through the mandate to make measurable progress this year towards achieving parity of esteem between mental and physical health.

[Baroness Hollins (CB)]

My Lords, in 2013 a census found that three-quarters of people with a learning disability admitted to a specialist in-patient facility were subject to the Mental Health Act. For a third of these, learning disability was the only reason given for their admission, without any of the additional requirements under the Act for detention being met. What action are the Government taking to ensure that the Act is being used correctly in the care and treatment of people with a learning disability?

[Earl Howe]

My Lords, if people with a learning disability are detained under the Act, this must be for assessment or treatment of mental illness. The person must satisfy the strict criteria laid down in the 1983 Act. When a learning disability is identified as well as a need for assessment or treatment of a mental disorder, the important thing is that alternatives to the use of the Mental Health Act are considered—for example, use of the provisions of the Mental Capacity Act and whether reasonable adjustments would assist the person with learning disabilities fully to access the assessment and treatment. This is an area we have explicitly covered in the draft code of practice, which is currently out for consultation.

Learning Disabilities: Community-Based Support

Baroness Hollins Excerpts

Tuesday 22nd July 2014 Lords Chamber

[Earl Howe]

My Lords, the Government’s mandate for NHS England in the current year includes an objective which covers Winterbourne View concordat commitments. He is right that the deadline was missed. We are not satisfied with that and we are working very hard with NHS England to set out our expectations for progress and improved rates of discharge from in-patient settings. NHS England is going to produce an action plan this August but, in the mean time, it is doing three things. It is complying with the transforming care and Winterbourne View concordat commitments, which we have tasked it to do. It will set out what progress it expects to make and by when, with milestones, and it will provide real clarity on what success looks like—an important issue if we are trying to hold it to account—and how progress will be measured.

[Baroness Hollins (CB)]

My Lords, is the Minister aware that in the first six months of this year, 544 new people were admitted to assessment and treatment units and only 338 were transferred? Does he agree, therefore, that prevention is as important as discharge, and that in order to achieve both of these, skilled community support and skilled specialist support in the community are urgently needed and need to be funded?

[Earl Howe]

I do agree with the noble Baroness. For people who, with the right support, could and should be living in community-based settings, there is a variety of reasons why sometimes that does not happen. The lack of appropriate housing can be a barrier. For others, we know that clinical decisions are preventing discharge. NHS England is looking very carefully at how to strengthen second opinion to support people in in-patient settings to challenge the reasons for their placement as and when they need to. We are looking at making some capital funding available to support the transfer of people from in-patient care to community-based support.

People with Learning Disabilities

Baroness Hollins Excerpts

Thursday 12th June 2014 Lords Chamber

[Baroness Hollins]

Asked by

To ask Her Majesty’s Government what action they are taking to address the health inequalities found by the Confidential Inquiry into Premature Deaths of People with Learning Disabilities.

[Baroness Hollins (CB)]

My Lords, there are 1.5 million people with a learning disability in the United Kingdom. They are among our most vulnerable citizens and they experience shocking inequalities in healthcare. My interest is that I have been a learning disability psychiatrist for over 30 years—a clinician, teacher, researcher and policymaker—and my adult son has a learning disability.

In July last year we debated the recommendations made by CIPOLD, the Confidential Inquiry into the Premature Deaths of People with Learning Disabilities, and the Government’s formal response, which accepted most of CIPOLD’s recommendations. Before that debate I had tea with some families whose relatives have died due to inadequate healthcare in hospitals. Many of them stayed to watch the debate and many will be watching today.

How much progress has been made since then? We are still waiting for the Government’s One Year On report, promised by March this year. Why the delay? It seems that there are always delays. My own research 20 years ago found that adults with a learning disability were 58 times more likely to die before reaching the age of 50 than those in the general population. It took me a while to get that research published. Prestigious medical journals such as the British Medical Journal said that it was not of general medical interest. Eventually I published it in a small-circulation disability journal. Mencap then used my data to campaign.

In 2001, the Valuing People White Paper included my suggestion that a confidential inquiry into premature mortality should be established to investigate causes of death and contributory factors for this group of people. Nothing was done about it. Then, Mencap’s shocking Death by Indifference report in 2007 was followed by the Michael inquiry, which repeated the recommendation for a confidential inquiry. There was then yet another delay until 2010, when CIPOLD was finally established. In March 2013, it reported on the deaths of 247 people with learning disabilities over a three-year period in south-west England. It found that on average men with a learning disability died 13 years earlier and women 20 years earlier than a comparison group of non-disabled people. Of those deaths, 37% could probably have been avoided if these people had not been discriminated against. People had delayed access to diagnosis and treatment for the same conditions as the comparison group. This adds up to more than 1,200 avoidable deaths each year across England. The lack of public, professional and political outrage is unbelievable.

CIPOLD made several recommendations to address these health inequalities. In May 2014, the BMA’s Board of Science, which I chair, published a report on how to achieve parity of outcomes for people with learning disabilities. I will focus on the central recommendation from the confidential inquiry—also supported by the BMA—that a national learning disability mortality review body should be established.

What is the purpose of a national learning disability mortality review? It does not seek to blame individuals; its aims are to promote a culture of safety by collecting and analysing data on all deaths in this group. The review would monitor trends and identify specific actions and changes to practice that could be expected to reduce the number of avoidable deaths.

In May 2014, NHS England finally made a firm commitment to establishing a national learning disability mortality review by March 2015. It took 14 months for this commitment to be made, and it is deeply frustrating that another year’s delay is planned before the review body is established. By that time, an estimated 2,500 more people could have died needlessly since CIPOLD reported, but realistically no improvement can be expected in services until at least 2018. That would bring the number of avoidable deaths to 7,500 before any targeted action was likely. I will explain my rather pessimistic conclusion.

I was invited to join the cross-sector, multiagency mortality review oversight group. It had its initial meeting last week. To establish the review, the first step is to appoint a procurement partner to oversee the development of the service specification and tendering process. The mortality review then needs to gather data about trends and regional variations in excess mortality, and about contributory causes. Identifying people with a learning disability is fundamental to this. However, it is more difficult than it sounds.

The Government have previously agreed that better identification in the healthcare records of people with a learning disability is important. The 2012 power of information framework allows this information to be recorded electronically upon a person’s first contact with a healthcare professional. However, healthcare professionals seldom identify or record a person’s learning disability either in primary care or in hospital. Mencap says that of 900,000 people with a learning disability using services in England, only 200,000 have this recorded on their electronic GP records.

In their response to the confidential inquiry, the Government made a welcome decision to include excess under-60s mortality in adults with a learning disability as an indicator in the NHS outcomes framework. However, because of these and other data collection difficulties, they have not been able to provide the baseline figures. One problem is that the mortality review will need to link data from a number of registers, including GP registers, hospital episode statistics, and cancer, diabetes and mortality registries. The Department of Health says that it is working with NHS England, Public Health England and the Health and Social Care Information Centre to explore ways of linking cause of death with GP learning disability registers for this specific purpose.

Test work on obtaining mortality data through the General Practice Extraction Service was promised. A report on progress was to have been delivered by the end of 2013, but none of this has materialised. I understand that the Secretary of State could make a direction to the Health and Social Care Information Centre for this type of purpose. I am therefore seeking agreement from the noble Earl that he will ask the Secretary of State to issue a direction to ensure that this data linkage is made as a matter of urgency. Without it, the mortality review will stall and there will be further needless deaths. At the moment, the Health and Social Care Information Centre is not prioritising this work.

The mortality review has secured £1.5 million of funding for 2014-15 to set up the review function. Can the Minister confirm that this will be recurrent funding, clearly specified in the coming round of NHS business planning, so that we can begin to monitor deaths effectively to ensure that lessons are learnt and that improvements in practice are made?

Finally, the 2012 NHS mandate to NHS England sets out a requirement to provide joined-up care so that people,

“experience smooth transitions between care settings and organisations”.

The confidential inquiry provides many examples of where inadequate transitions have contributed to premature death. I commend the Government’s current emphasis on integrating health and social care, but I have found no reference to the deaths of people with learning disabilities in any of the documents or debates. Can the Minister advise us how the Government are sharing the learning from the confidential inquiry across all departmental programmes so that it becomes embedded as everyone’s responsibility and is at the forefront of everyone’s mind?

Taking action on the recommendations of the confidential inquiry, particularly to ensure that the mortality review is prioritised, is not simply a matter of fairness and equality. If we can get healthcare right for people with learning disabilities, we can probably get it right for everyone. People with learning disabilities and their families have waited a long time—too long—for change. This afternoon, Mencap delivered a petition signed by 2,700 people to the Department of Health asking for urgent action. I hope for a fast response.

I thank noble Lords for signing up for this debate. I am looking forward to their contributions and to the Minister’s response—and ultimately, I hope, with strong political leadership, to an end to the discrimination that people with learning disabilities have been facing for so long.

Abortion

Baroness Hollins Excerpts

Thursday 3rd April 2014 Grand Committee

[Baroness Hollins (CB)]

My Lords, as a mother with daughters and granddaughters, I find it unbelievable that aborting on grounds of female gender is not explicitly illegal; it certainly seems discriminatory.

As immediate past president of the BMA, I quote its guidance that,

“it is normally unethical to terminate a pregnancy on the basis of fetal sex alone, except in cases of severe x-linked disorders”,

which, of course, affect the male foetus.

The Minister recently stated that updated guidance is being prepared for abortion providers to make it,

“abundantly clear that gender selection is illegal”.—[Official Report, 12/2/14; col. 639.]

However, guidance alone is not legally binding. The Royal College of Obstetricians and Gynaecologists’ clinical guidance on induced abortion notes:

“Services should identify issues which make women particularly vulnerable”.

The RCOG includes domestic abuse and gender-based violence here and goes on to recommend that women should be referred to appropriate support services. Do we know whether this actually happens?

In January, the Independent attributed a reduction of between 1,400 and 4,700 expected live births of girls in the UK to sex-selective abortions. The Minister has in a previous response questioned the statistical analysis of the data, raising doubt about the Independent’s conclusion that sex-selective abortions are being performed. However women’s rights groups such as Jeena International and Karma Nirvana, which represent some of Britain’s minority women, are clear that gender abortions are happening here in the UK and that numbers are far from insignificant.

The reports available suggest that this is predominantly a cultural problem. Does the Minister agree that analysing the data regionally and by ethnicity could alert us to areas of concern? Will the Minister advise whether the Government would consider changing secondary legislation by amending regulations, thus providing clarity about the illegality of this apparently growing practice?

Health: Flour Fortification

Baroness Hollins Excerpts

Tuesday 21st January 2014 Lords Chamber

[Earl Howe]

My Lords, I can only repeat what I said before, which was that taking this step would be a major step by any standards. We must base it on a proper assessment of the risks and benefits. We have some excellent advice from SACN and we need to evaluate that advice fully before taking a decision.

[Baroness Hollins (CB)]

My Lords, does the Minister agree that the public education campaign has failed and that given that most pregnancies are unplanned and that the risk period for low folate levels is in the first 28 days, before a woman is aware that she is pregnant, there is actually some urgency to act?

[Earl Howe]

My Lords, I recognise the issues raised by the noble Baroness. We will of course take those into account.

World Innovation Summit for Health

Baroness Hollins Excerpts

Monday 16th December 2013 Lords Chamber

[Earl Howe]

I will write to my noble friend on the issue of political prisoners. On his main point of principle about parity of esteem, that principle—which essentially works to ensure that mental health has equal priority with physical health—is central to government-funded mental health programmes overseas; in particular, DfID funds programmes that promote the rights of people with mental health disorders to ensure that their needs are equally met. We recently invested £2 million for an additional three years’ support to the Disability Rights Fund, which makes disability, including mental health issues, a key international development priority.

[Baroness Hollins (CB)]

My Lords, people with learning disabilities are disproportionately affected by mental health problems, with three times as many people experiencing such issues. In this country we are very well aware of that, and despite our own problems, such as Winterbourne View, we actually lead the world in research and service development. This is not recognised in global initiatives such as the summit just referred to by my noble friend. What will the Government do to try to raise awareness of the mental health needs of this particularly vulnerable group of people?

[Earl Howe]

Often overseas we are working with very scant resources and the key is to build up the skills at primary care level in countries that are developing and may not have regarded those with learning disabilities as a priority for healthcare. It is a slow process but one that we are trying our best to support. Again, I would be happy to write to the noble Baroness with details.

Children and Families Bill

Baroness Hollins Excerpts

Wednesday 20th November 2013 Grand Committee

[Baroness Howe of Idlicote]

My Lords, very briefly, it was only about an hour ago that we had exactly the same situation having to be sorted out for kinship carers. For goodness’ sake, parent carers are about as kinship as you can get, and if they cannot be rolled into the same set up of proper analysis and proper attention to their needs, then what can happen? I hope the Minister is going to move this thing on as quickly as possible.

[Baroness Hollins (CB)]

My Lords, parents of disabled children often do not see themselves as carers, but they are. Their need for support has been argued and won over the past 20 years. They really are different from other parents. Their right to be able to have a life alongside caring for their disabled child has been fought for very successfully. Parent carers are often so focused on the needs of their child that they forget about their own health and well-being. It could be argued that failing to recognise the needs of the parent carer is against their right to a family life under the Human Rights Act. I was involved with a WHO/Europe declaration, Better Health, Better Lives, which was about the health and well-being of children and young people with intellectual disabilities across Europe and their families. It was signed by all the Health Ministers, including our own, in 2012. One of the 10 recommendations was about identifying the needs for support of parent carers. I join my voice to that of the noble Baroness in this amendment. What is the Government’s rationale for allowing that the carers of a disabled 13 year-old would effectively have rights inferior to those of the carers of an 18 year-old? I hope that the Minister will be able to respond.

[Baroness Howarth of Breckland]

My Lords, I wish to support the noble Baroness, Lady Pitkeathley, in this amendment. The Minister is right in saying that the framework is there in the present legislation or, at least, it should be there. The difficulty is that, because the focus among those who make assessments is split between adults and children and we do not have holistic family assessments, often the parents are lost. A family whom I met recently had just, after many years, been given a period of respite care, but the parent carers had not realised that that would make the difference in their being able to continue to care for their son, an extremely difficult young man. A series of workers had never suggested to them that their needs might be met in order to meet the needs of their child. That is the important message that front-line workers need to understand. This amendment would help them to understand that, unless you meet the needs of parents, you do not meet the needs of children.

I, too, had this query when I heard that it had been commented that to assess parents would undermine the rights of children. Assessing parents enhances the rights of children. Many of us who have worked in this field and continue to work with and meet families see it regularly. We also see when people fail to notice that parent carers are beginning to fail, simply because of their exhaustion and the fact that they have had no relief and no assessment for any kind of services, sometimes quite small ones that would make all the difference to their being able to continue.

I support this because we should have a family approach whereby children with disabilities will be maintained in their own homes rather than having to go into caring facilities because their parents are unable to look after them. I am losing my power of speech, like most of us at this time of night, so I leave it there. My only other point is that the noble Baroness, Lady Tyler, made a passionate speech about integration, which I think we all feel should happen.

Care Bill [HL]

Baroness Hollins Excerpts

Wednesday 16th October 2013 Lords Chamber

[Lord Patel of Bradford]

I thank the noble Baroness for her question. I would not like to associate mental health patients leaving hospital with the case that she has outlined, but clearly it is true that if we do not provide good quality aftercare services and encourage people to take them up but rather leave people in hospital anxious about whether they will have to pay for some of these services, then that is a potential result that we will have to live with, in circumstances where people do not have accommodation, health and social services provided or someone coming in and saying to them, “Deal with your accommodation and social care issues as well as your medication”. This is a real anxiety.

[Baroness Hollins (CB)]

My Lords, I commend the amendment of the noble Lord, Lord Patel of Bradford. I shall not say much more than that other than that he commented on the risk that the current situation could lead to more likelihood of a more medical approach to aftercare. Noble Lords might think that as a retired psychiatrist I would support that, but I do not; it is incredibly important that people who have a history of mental illness and need aftercare services receive the broadest possible support so that admission to hospital is not simply because there is inadequate support for them in the community. I commend his proposal.

[Baroness Barker (LD)]

My Lords, I wish to indicate my support for the continuance of Section 117, as I have done on many occasions before, not least during the passage of the most recent Mental Health Act—when various people, whom I shall not embarrass now by saying who they were, did indeed stand up to defend some of it—because it works.

When the Law Commission first made this proposal in its report, I had occasion to talk to that body. The noble Lord, Lord Patel, is right; the commission relies very heavily on the Mwanza case, and there is a great deal of dispute about the advisability of doing that. The question that I had when I first met the Law Commission still remains: when everything else in the legislation is geared towards enabling health and social care to work together to enable the transfer of people from acute health settings back into the community, why rip up the one piece of legislation that has been there doing that for 30 years? It is not just that some of us see Section 117 as being important with regard to the individuals whom we might know or come across; rather, we see it as an important means of bringing about the transfer that some of us have long hoped would happen in mental health services whereby, instead of having patients who revolve between acute and the community, we could have proper care planning in which people’s mental health needs were addressed by some of the same people, whichever setting they were in. It is not just about trying to preserve a pot of money; it is about trying to keep open a pathway to good and better practice. That is why the noble Lord, Lord Patel, as he always does in this area, has presented the House with a very persuasive argument. I have not yet fully understood why the department feels the need to make the changes that it is making.