NHS: Standards of Care and Commissioning

Baroness Tyler of Enfield Excerpts

Thursday 31st March 2011 Lords Chamber

[Baroness Tyler of Enfield]

My Lords, that is a hard act to follow. I congratulate the noble Lord, Lord Turnberg, on securing such an important debate at a time of far reaching reforms to our National Health Service. These reforms should be judged by the extent to which they lead, first, to better health outcomes for adults and children; secondly, to consistently higher standards of care for all; and, thirdly, to a more responsive and personalised service. Given the scale and pace of reforms, the most radical in a generation and beyond, it will be crucial to give close attention to the quality of care during this period of immense change.

I would like to illustrate this by talking about the standards of care and commissioning practices within mental health services, still seen in some quarters as a Cinderella service. I am indebted to the briefing and support that I have received from the charity Mind.

One in four people is likely to experience a mental health problem every year and the cost of poor mental health to the economy is estimated to stand at £105 billion. As will be well known in your Lordships' House, mental health problems are inextricably linked to social factors such as debt, unemployment, poverty and poor housing.

The Government’s recent No Health without Mental Health strategy sets out a clear vision for the future of our mental health services. This is to be welcomed. The strategy also makes it clear that the provision of high-quality services is dependent on high-quality commissioning.

To make a reality of that strategy, it will be important to ensure four things: first, that commissioning bodies have a proper understanding of mental health services and service users; secondly, that mental health services are fully integrated both within the health service and across social care, public health and areas such as housing and policing; thirdly, that every opportunity is taken to increase patient and public involvement and that those who need extra support to get involved in decision-making are given it; and, finally, that there is parity of esteem between mental and physical health services.

In response to a recent survey by the charity Rethink, 42 per cent of GPs said that they lacked knowledge about services for people with mental illness and lacked confidence in commissioning those services. The abolition of the National Mental Health Development Unit this very day will create a real gap in mental health advice for commissioners and providers. What plans do the Government have to fill that gap in expertise?

The Government have recently announced plans to invest around £400 million over four years to ensure that adults with depression and anxiety across England have access to a wider range of effective psychological therapies. This investment will also enable the expansion of much needed psychological therapies for young people, older people, people with severe mental health problems and people with long-term physical health conditions. All this is greatly to be welcomed but it is vital that this funding is not seen in these tough financial times as an opportunity to cut existing mental health services.

As already referred to, only this week the Care Quality Commission released its latest report on the state of health and adult social care. I was concerned to see that, despite the welcome advances across the board, care standards for people experiencing mental health problems are being left behind, particularly in acute and crisis mental health care.

I would have liked to have finished by saying a few more words about the commissioning of children's mental health services—an area that I know something about. I am chief executive of the charity Relate, a declared interest of mine, which has experience of providing what is called early intervention counselling services. Time will elude me, but the one thing that I will say is that far too often the voluntary sector finds itself left to pick up the pieces because statutory services such as children and adolescent mental health services, which try to do a good job in very difficult circumstances, are vastly oversubscribed with very long waiting lists. More needs to be done to give this area higher priority.