Mental Health Taskforce

Baroness Royall of Blaisdon Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, it is very serious when someone going through a severe psychotic episode ends up in an A&E department, there is no local bed available in a mental health hospital, and they therefore spend time being specially guarded by two or three people, often in wholly inappropriate surroundings. This is the issue that the noble Lord, Lord Crisp, addressed in his report which came out a week earlier than the task force’s: people are moved, often many hundreds of miles away, out of their area, to find a bed. Sometimes they get there and the bed is full and they are a long way from their family. It is a highly unsatisfactory, often very dangerous, situation. The approach of the task force is to try to ensure that more money goes into the home treatment and home resolution area, to free up beds in the acute sector. By providing more care in the community, more beds are freed up in acute hospitals, increasing capacity and enabling people who are in A&E departments to be transferred more quickly to the right place. This is clearly a very serious issue.

[Baroness Royall of Blaisdon (Lab)]

My Lords, the response to the Urgent Question makes reference to the needs of mothers with new babies. Will any investment be made in additional mother and baby units, which are critical for mothers, children and families?

[Lord Prior of Brampton]

My Lords, of the £1 billion, £290 million has been earmarked for perinatal spending on pregnant women and mothers suffering from postnatal depression. I cannot tell the noble Baroness how many extra beds that might provide, or how much of that is being provided away from beds, but I will write to her on that matter.

Social Care

Baroness Royall of Blaisdon Excerpts

Thursday 15th October 2015 Lords Chamber

Asked by

[Baroness Royall of Blaisdon]

To ask Her Majesty’s Government what they are doing to ensure that quality social care is provided throughout the country and that the wages of care workers are increased.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Government have made the Care Quality Commission’s regulation and inspection regime much tougher to ensure that people receive safe, high-quality and compassionate care. The CQC’s report, The State of Health and Adult Social Care in England, published today, details how well adult social care is performing overall in respect of quality. The new care certificate is equipping staff to deliver high-quality services, while the national living wage will ensure that they are properly paid.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I am grateful to the Minister for that Answer. I declare my interest as a trustee of Crossroads Care in the Forest of Dean and Herefordshire. The Minister mentioned the new national living wage, which is coming in in April. At the same time, local councils up and down the country will have more and more cuts to their budgets. Notwithstanding what the Minister says, I believe that the sector is in crisis, and the sums simply do not add up. Some care organisations are already pulling out, especially in rural areas, where they do not wish to pay travel times. What are the Government going to do to ensure that there is quality care in isolated areas as well as in other parts of the country? Will the Minister agree to have a meeting with me to discuss this specific issue, which is a matter of deep concern?

[Lord Prior of Brampton]

First, I would be delighted to meet the noble Baroness any time—

Women: Postnatal Depression

Baroness Royall of Blaisdon Excerpts

Thursday 5th February 2015 Lords Chamber

Asked by

[Baroness Royall of Blaisdon]

To ask Her Majesty’s Government what steps they have taken to support women suffering from postnatal depression.

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

My Lords, the Government have prioritised improving mental health care and support for pregnant women and new mothers in their mandate to NHS England, with a clear objective to reduce the incidence and impact of postnatal depression. We have taken steps to improve the size and capability of the workforce—there are 2,000 more midwives and 3,200 more health visitors than in 2010. By 2017, specialist perinatal mental health staff will be available to every birthing unit.

[Baroness Royall of Blaisdon (Lab)]

My Lords, that is welcome news. Too many women who suffer from postnatal depression do not seek help because of the stigma attached to mental illness, together with the guilt and shame attached to feeling that they are not being the sort of mother that society expects. I hear what the noble Earl says about specialist care, but what are the Government doing to ensure that specialist mother and baby units can be accessed by these new mothers wherever they live in this country, so that they do not end up on acute psychiatric wards, separated from their babies or partners, or not receiving the requisite help? At the moment, I fear that parity of esteem for mental health is not a reality for these women.

[Earl Howe]

My Lords, we know there is more to be done. There are perhaps two key actions here. One is having a sufficient number of trained professionals in place—I have mentioned the increase in the number of health visitors and midwives—and the other is raising awareness of the risks and signs of postnatal depression with mothers-to-be. Extensive training is available and delivered to midwives, both during their initial training and afterwards. The programme of family nurse partnerships commenced by the previous Government is tremendously important in the follow-up stage after birth to ensure that new mothers are monitored closely.

Young People: Suicide

Baroness Royall of Blaisdon Excerpts

Thursday 27th February 2014 Grand Committee

[Baroness Royall of Blaisdon (Lab)]

My Lords, this has been an excellent, albeit painful, short debate, for which I, too, thank the noble and right reverend Lord, Lord Eames. We have heard the devastating facts and figures. Each and every young life lost through suicide is a tragedy, of course, to the young person, but also, as has been said, to the family and friends who love them.

I am ashamed that in the 21st century in a wealthy developed country with so many advantages and where we know the effects of bullying behaviour, too many young people contemplate or attempt suicide, too often successfully. I recognise the strains and stresses in our society, where there is great pressure to succeed and where much is expected of individuals, but who are not always able to live up to their own expectations, let alone those of their peers or society. Feelings of inadequacy, of being different, can be made acute by the media, including social media. The report, Alone with My Thoughts, produced last year, showed that nearly one-third of young people have contemplated or attempted suicide. This is a shocking statistic that I discussed with a friend in the forest who works in mental health. She suggested that there needed to be better training for staff in schools to identify the difference between perceived lack of motivation and depression and between anxiety and apathy, and that more support was needed around low confidence and self-esteem, especially in the world of social networking, where cyberbullying is rife.

I also know from talking to students that there is a similar problem in some colleges and universities. The Government have a suicide prevention strategy which includes the development of an e-portal for children, young people and those working with them. This is welcome, but will the Minister say how he will ensure that young people and their teachers will know about it? I also wonder what training, if any, teachers have to enable them to identify those children with mental health needs or those who are being bullied. Should not all staff working with children and young people receive training in mental health, including suicide prevention training? Some excellent charities are working in this area, including YoungMinds, but they rightly say that, despite the Government’s rhetoric or good intentions, we are a long way from seeing parity between physical and mental health.

Young people’s mental health is a vital issue that must be prioritised. It is not acceptable that in 51 of England’s 58 NHS mental health trusts there were 350 under-18s admitted to adult wards in the first nine months of 2013-14. This marks a 36% increase on the previous 12 months. Will the Minister say what action the Government are taking to ensure that under-18s are not admitted inappropriately to adult psychiatric wards and that, when they are sent to young people’s units, they are not hundreds of miles from home? Young people aged 16 to 25 are going through a number of transitions. If they are in contact with mental health services, there is the additional transition from child and adolescent services to adult services. I would be grateful for an assurance that steps are being taken to ensure that adequate care and support is given at this difficult time. A difficult transition can make young people disengage with services, with the risk that their mental health problems will become entrenched and harder to treat.

The Prince’s Trust has produced an excellent report, Youth Index 2014, the message of which is clear: long-term unemployed young people are in desperate need of support. Some 40% of jobless young people say that they have faced symptoms of mental illness, including suicidal thoughts, feelings of self-loathing and panic attacks as a direct result of unemployment. I pay tribute to the extraordinary work of the Prince’s Trust, which is helping these young people, many of whom grow up in poverty and face an increased risk of mental health problems as a result. The same is said in a recent report by the Samaritans, which reports that there are systematic socioeconomic inequalities in suicide risk defined by job, class, education, income or housing. Whatever indicator is used, people in the lower positions are at a higher risk of suicide.

Some recent reports suggest that the changes the Government are making to social security, including the bedroom tax, are exacerbating or creating problems for people who are already struggling, so clearly it is important that the Government rapidly monitor the effect of the changes and take the requisite action. My friends in mental healthcare tell me that, as a consequence of the changes, the pressure on their services grows by the day with a tidal wave of referrals each week, including from young people. These people working in mental health are themselves overstretched, and they feel that no one is listening to and addressing their concerns.

The Government have a suicide prevention strategy and a mental health strategy, both of which are welcome. I look forward to hearing that they are being implemented and, most importantly, that they are adequately resourced.

Health: Talking Therapy

Baroness Royall of Blaisdon Excerpts

Tuesday 3rd December 2013 Lords Chamber

Asked by

[Baroness Royall of Blaisdon]

To ask Her Majesty’s Government whether they have plans to create a legal right to talking therapy as part of their commitment to ensure parity of esteem between mental and physical health.

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

My Lords, the department has no plans to create a legal right to talking therapies. Mental health and parity of esteem are key priorities for NHS England. The Government’s mandate to NHS England makes it clear that everyone who needs it should have timely access to evidence-based services, which involves extending access to talking therapies. We are working with NHS England to develop standards on access and waiting times across mental health from 2015.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I am grateful to the noble Earl for his Answer, but I still have serious concerns about the services that mental health patients receive. I do not often quote the noble Lord, Lord Freud, but last month he said that,

“the association between poor mental health and poverty is clear”.—[Official Report, 7/11/13; col. 324.]

However, despite people’s increasing stress due to poverty, the cost of living and zero-hours contracts, the Government have cut mental health spending in real terms in the past two years. Funding for therapies not included in IAPT has been cut by 5%, despite ministerial assurances that this would not happen. Last week, the We Need to Talk coalition released a report that revealed that more than half of mental health patients are waiting at least three months for treatment. Can the Minister commit to reducing those waiting times by March 2015, the date by which time the Government are committed to making progress towards that important parity of esteem?

[Earl Howe]

My Lords, I agree that waiting times for talking therapies are too long, and we are taking energetic steps to address that within the bounds of affordability. In the context of the noble Baroness’s main Question, what surely matters is the quality of outcomes, rather than just the extent of inputs. We set the outcomes that we expect the NHS to achieve in the NHS outcomes framework. There are a number of outcomes in there specifically for people with mental health problems, and others, about the quality of services. It is up to commissioners to prioritise their resources to meet those outcomes for the population based on assessments of need, and we will hold them to account for that.

NHS: Clinical Commissioning Groups’ Funding of Treatment

Baroness Royall of Blaisdon Excerpts

Tuesday 12th November 2013 Lords Chamber

[Baroness Wall of New Barnet (Lab)]

My Lords, as chair of one of the many trusts that are in financial difficulty—

[Baroness Royall of Blaisdon (Lab)]

I suggest that we hear from my noble friend Lord Harris.

[Lord Harris of Haringey]

My Lords, 55 years ago, I had my tonsils removed on the National Health Service. Had that not taken place and I now needed that procedure as an adult, according to figures from the Royal College of Surgeons I would be extremely unlikely to have them removed in the area in which I live—Haringey—but 22 times more likely to have the same procedure carried out in the Isle of Wight. Can the Minister explain why this Government’s arrangements facilitate that extraordinary postcode lottery, which means that there is no equity of treatment across the National Health Service?

Care Bill [HL]

Baroness Royall of Blaisdon Excerpts

Wednesday 3rd July 2013 Lords Chamber

I beg to move.

[Baroness Royall of Blaisdon]

My Lords, I shall speak to Amendment 79L tabled by the noble Lord, Lord Patel, who unfortunately cannot be in his place this evening. The purpose of the amendment to which I have added my name is to ensure that carers are identified and signposted to the enhanced support outlined in the Bill as early as possible and before they reach crisis point. I put my name to this amendment following a discussion with Macmillan, to which I am very grateful for its excellent briefing, about the situation of approximately 905,000 cancer carers in England, half of whom are not receiving any support despite the fact that cancer has a real impact on their lives. Of course, the impact is nowhere near as big as that on the person with cancer but nearly half of carers say that it affects their mental health and well-being; one in five says that it affects their relationships and working life; and 15% say that it affects their household finances. Almost half of cancer carers identify at least one type of support they are not currently receiving that would assist them with their caring duties. They are in real need of help but are not aware of who or where to turn for support.

As many noble Lords will know from personal experience, the real problem is that many cancer carers do not think of themselves as carers but they might well need information, advice or support. Indeed, my noble friend Lady Pitkeathley has just made the same point in general about all carers. They have no idea about things such as the local authority carers’ assessment, which is the gateway to statutory support. Consequently, the number of cancer carers who have had such an assessment is far lower than for those caring for people with other conditions and disabilities. Evidence shows that health professionals simply do not identify cancer carers as carers and do not signpost them to help or support.

Therefore, while I welcome the fact that the Care Bill enhances rights for carers, including placing a new duty on local authorities to undertake a carers’ assessment for all carers and to meet the eligible needs of carers, there is a gap which this amendment is designed to fill. Cancer carers have a lot of contact with the NHS but they seldom come into contact with local authorities. This amendment would help to ensure that all NHS bodies work with local authorities to improve the identification of all carers so that in turn they can be assessed and access appropriate support.

In the Care and Support White Paper the Government said that,

“there is still an unacceptable variation in access to tailored support for carers”.

It outlines its requirement for,

“NHS organisations to work with their local authority partners … to agree plans and budgets for identifying and supporting carers”.

This amendment would provide a vehicle for ensuring that this optimal practice of joint identification and partnership became a reality throughout England where, at the moment, the identification is at best patchy and at worst non-existent. Local authorities should take the lead but they could benefit greatly from the help of many relevant health bodies such as NHS England, CCGs, and primary care and hospital trusts which already have procedures and systems in place to identify carers. Clearly, that does not always happen.

The amendment would not lead to additional expenditure. In fact, if carers were identified as early as possible, when in most cases they just need signposting to information and advice, it could save money. Fewer carers would reach the sort of crisis point that requires NHS support for themselves and local authority support for the person for whom they are caring.

On Saturday, I was in Torbay and I talked with some people about their excellent system of integrated healthcare in which they understand that a whole-system approach is needed to support carers and that proactive identification is needed by the NHS. I was therefore interested to read a quote from Mr James Drummond, lead officer for integrated services at the Torbay and Southern Devon Health and Care NHS Trust, in which he says:

“If we wait for carers to approach us we may not engage until there is a crisis. Proactive identification is good practice, but national support is needed to spread this across the country. It should be made clear that identifying carers and signposting them to support is the responsibility of all health and social care professionals, not just local authorities”.

That says it all. I know that the Government recognise the need for the NHS and local authorities to work together on this important issue so I very much hope that the noble Earl will use this amendment and agree to look at ways of formally involving the NHS in the local authority duty to identify carers.

[Lord Hunt of Kings Heath]

My Lords, this is a very important group of amendments, and I very much support my noble friend Lady Pitkeathley in her Amendments 78F, 79E, 79H, 88C, 88E and 88F. I also support my noble friend the Leader of the Opposition in her Amendment 79L, emphasising the importance of working with the National Health Service.

My Amendments 79F, 79J and 79M to Clause 2 concern the position of young carers. They aim essentially to ensure that local authorities provide or arrange services to prevent young carers from developing needs for care and support, as well as preventing and reducing needs for adults and adult carers. The 2011 census identified 178,000 young carers who have to care for a relative in England and Wales alone. It is good that the Government have now acknowledged that, given the changes being introduced by the Care Bill for adult carers, the law must also be reviewed for young carers. However, we need a much clearer indication of what these changes will look like and particularly of how the Care Bill will ensure that adults receive sufficient care and support so that children are protected from excessive and inappropriate caring roles. We cannot have a situation where people have unmet care and support needs, which results in children and young people having to meet these needs.

I recently met a young man who had been caring for someone in his family for most of his life. He told me that it would have made a huge difference to him if his family had received support earlier. If this had happened, his caring responsibilities might not have had such a clear and serious impact on his education. He is doing well now and hopes to go to university, but it has clearly been extremely challenging for him to stay in education, and there are many thousands of other young people who have been similarly affected. That is why my amendments to Clause 2 are so important. They make clear that local authorities must take steps to prevent children from carrying out caring duties that have a detrimental effect on their health and well-being. Can the noble Earl assure me that the Care Bill will be amended to ensure that this is the case? If he can, I would welcome an indication of which parts of the Bill will be amended so that young carers are protected.

My other amendments on this issue are to Clause 12, which provides for regulations on whole-family assessment. Again, the Government have indicated that they will look at how the law might be changed for young carers in the Bill, but it is not clear how that might be done. We know that currently adult social care services and health services routinely fail to identify children who may be caring for an adult, even where the adult is assessed. That also applies to educational establishments. That means that often children can continue to undertake harmful caring roles and end up developing needs for care and support themselves.

It is very important that adult needs assessments relate to any child in the household, so that inappropriate caring by children is prevented and children's needs for support are prevented or reduced. The law must be clear that adult services need to help to identify young carers. The presence of a young carer should always constitute an appearance of need for the family and should automatically trigger an assessment of the person for whom they care. Can the noble Earl confirm that this is indeed the Government’s view? Will it be made clear, through primary care or regulations, that there should be consideration of whether a joint child and adult assessment would be appropriate and that children’s services should work together; consideration of whether any child should be assessed for support in their own right under children’s law; and consideration of whether lower-level support may be needed for the whole family, including the child?

It is a pity that we are taking this important debate at so late an hour, and no doubt we will return to this matter on Report, but I look forward to the noble Earl’s response.

Abortion

Baroness Royall of Blaisdon Excerpts

Thursday 6th June 2013 Lords Chamber

[Earl Howe]

My noble friend is right. The abortion rate across England and Wales has been static since 2009. The good news is that the abortion rate for women under 18 has gone down. There was a 9.6% decrease in the rate between 2010 and 2011. On repeat abortions, the news is not so good. The proportion of repeat abortions for women who had abortions in 2011 was 36%. The figure was higher than it had been the previous year, which is a matter for concern.

[Baroness Royall of Blaisdon]

My Lords, I very much welcome the figures that the Minister gave on the number of abortions going down for younger women, and regret the figure for repeat abortions. Naturally, we must do everything possible to stop illegal abortions. However, will the Minister confirm that it is important that women who need abortions should not be impeded in any way, and that sex education and education about relationships are terribly important? I hope that the Government will be open to accepting amendments to the forthcoming education Bill on that issue.

[Earl Howe]

I am sure that those issues should be discussed very thoroughly. I agree that young people should be taught about relationships. However, I also believe that access to contraception is very important. Our data show that there has been no decrease in the number of women using contraception, and that more women are turning to extremely effective measures such as long-acting contraception. It is encouraging that the abortion rate for the under-18s is coming down.

Suicide

Baroness Royall of Blaisdon Excerpts

Tuesday 23rd April 2013 Grand Committee

[Baroness Royall of Blaisdon]

My Lords, I thank the noble Baroness, Lady Buscombe, for this important and timely debate. I am not a member of the Samaritans board. However, I fully support the calls for a free-to-caller number. I hope that Ofcom and the telephone companies are listening. I wonder whether we should all pen a joint letter to Ofcom and the telephone companies after this debate.

Like other noble Lords, I thank the organisations that have been mentioned, including faith groups, and especially the Samaritans in their important anniversary year. All these organisations, with their thousands of volunteers, work with, care for and support people who are troubled or have a mental illness. For too long, mental illness was shrouded by stigma and deprived of adequate resources. People with a mental illness, including those at risk of suicide, have always depended on what the Government might call the big society. The Samaritans have a shining record on this very tough subject. Thankfully, the stigma in society relating to mental health is increasingly being lifted, and all parties recognise the need for mental health to have parity with physical health. We would all agree on there being no mental health without physical health—and, I would add, without appropriate social care.

As Call to Action informs us, more lives in England are lost to suicide than to road traffic accidents, and every life lost to suicide is a tragedy. I welcome the cross-government strategy on preventing suicide. However, like Sarah Yiannoullou, the manager of the National Survivor User Network, I am concerned that self-help groups, survivor groups and small voluntary and community organisations that have helped with a preventive support have had increased burdens put on them and are having to close because of funding problems. There appears to be a conflict between what is said in the strategy and people believing that this can be delivered in the current climate. The right reverend Prelate made very important points about systemic and short-term funding.

Mental health services are clearly critical in providing the timely help and emotional support that can reduce the risk of people committing suicide. Having spoken to people working in mental health in my county of Gloucestershire, I know that they fear that recent changes in the NHS and the fracturing of services will have a negative impact on the delivery of mental health services in the community, especially in rural areas. There appears to be less co-ordination and less support for joint efforts between health services, charities, churches and other organisations that are working with people who have mental health problems. I would be grateful for the noble Earl’s views on whether there is appropriate integration where necessary. It feels as if the postcode lottery is being extended.

A briefing by the excellent organisation YoungMinds provides disturbing information about cuts by local authorities. Some have slashed 27% of their services, which has had an impact on people with mental health problems. Like the noble Baroness, Lady Buscombe, I am deeply concerned about the lack of local suicide prevention plans. The Government must not only provide requirements for such plans but must ensure that the funding is there in order for local authorities to implement the plans.

Society has changed profoundly in the past 50 years. We now live in a physically safer society, but emotionally people are far less secure. As many noble Lords said, many people live alone, and even when they do not live alone, they feel alone. We are all living longer, we have more stressful and isolated lives and we have to cope with huge and constant change. As the noble Lord, Lord Roberts, said, the increase in young people’s mental health problems is very disturbing. The factors that contribute to mental health problems, and indeed to suicide, such as drug and alcohol misuse, unemployment, social isolation, poverty and poor social conditions, appear at the moment to be increasing, and there are so many stresses and strains in society with little help available. There is a lack of hope, and it is incumbent on us all to give people more hope and vision for the future.

I look forward to the answers from the noble Earl about the support that the Government are providing to the voluntary and statutory sectors. Perhaps one of the greatest supports would be for the Government to change some of their current policies so that factors such as poverty, which increase the risk of suicide, are reduced. The risk of suicide in the whole population increases when we experience times of financial difficulty—this is not only my view but a widely held one—so I urge the Government to maintain their support for suicide prevention over the coming years.

NHS: Private Companies

Baroness Royall of Blaisdon Excerpts

Monday 11th February 2013 Lords Chamber

[Earl Howe]

I am aware that the board of the CQC is looking at that very question at the moment in the light of the Mid Staffordshire review. The noble Baroness is absolutely right. I think the essence of the answer to her question is that a risk-based approach must be adopted so that areas that are deserving of more attention from the CQC receive it and areas that are of lesser concern are allowed to act accordingly without interference.

[Baroness Royall of Blaisdon]

My Lords, the Minister spoke of the possibility of local tariffs. How does that translate into regional pay? Is the Minister in favour of regional pay for people working in health service?

[Earl Howe]

My Lords, regional pay is already allowed for under Agenda for Change, and has been for a number of years. The Government do not intend to change that.