Covid-19: Mental Health
Baroness Tyler of Enfield Excerpts(6 years, 1 month ago)
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Lord Bethell
The noble Baroness is entirely right to emphasise the importance of longitudinal studies. The UK household longitudinal study data, which analyses the GHQ-12 scores, has been upgraded. We will continue to invest in that, and Public Health England has been tasked with monitoring the development of mental health issues across the country.
Baroness Tyler of Enfield (LD) [V]
My Lords, research shows that the pandemic has had a disproportionate impact on some of the most disadvantaged, particularly those from BAME communities. During this period, many mental health and community services have moved online. While that is an appropriate first response, charities are now expressing concern that it is not an effective response for many, including the elderly, those with learning disabilities and those with severe mental illnesses. Can the Minister say what urgent steps the Government are taking to restore effective treatment and care for all, including face-to-face services, with all necessary PPE and testing in place?
Lord Bethell
My Lords, we are feeling our way in this area. There have been benefits from some of the moves online. People have been able to see more of their consultants, they have found that some of the content provided has been helpful, and the reach has gone up. However, I completely agree with the noble Baroness that it will not work for everyone. I pay tribute to mental health professionals who have maintained face-to-face contact during the epidemic, with all the threats associated, and we continue to look closely at how to fit appropriate technology and digital access to the right people and in the right format.
Covid-19 Update
Baroness Tyler of Enfield Excerpts(6 years, 1 month ago)
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Lord Bethell
My Lords, I remember the incident well and I intended no discourtesy whatever. I reassure the noble Lord that I left the Chamber and instructed my officials to draft that letter; on leaving today, I will chase it down and ensure that it goes to him speedily.
Baroness Tyler of Enfield (LD) [V]
My Lords, local lockdown plans in Leicester and elsewhere are vital to ensure that a proper place-based response takes full account of existing health inequalities. At an all-party group meeting yesterday, Sir Michael Marmot explained that Covid-19 has exposed existing inequalities in society and amplified them, with Covid-19 mortality rates closely linked to health inequalities and deprivation more widely. Does the Minister agree that, before the Summer Recess, your Lordships’ House must have a full debate on tackling inequality before a second wave hits us, with a sharp focus on the disproportionate impact on specific groups, particularly the BAME community?
Lord Bethell
My Lords, it is beyond my reach to instruct the House on its debates, but I would entirely agree with the noble Baroness that one of the saddest and most challenging aspects of Covid is that it hits society where it is weakest. It has undoubtedly hit those with health issues the hardest and has exacerbated health inequalities. It is my sincere hope that this Covid epidemic will be an inflection point, when this country embraces a strong public health agenda and addresses those health inequalities with energy.
Covid-19: Mental Health
Baroness Tyler of Enfield Excerpts(6 years, 1 month ago)
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Baroness Tyler of Enfield
To ask Her Majesty’s Government what assessment they have made of the report The mental health effects of the first two months of lockdown and social distancing during the Covid-19 pandemic in the UK, published by the Institute for Fiscal Studies on 10 June; and what steps they plan to take in response.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con) [V]
My Lords, the noble Baroness raises an important issue, and I am grateful to the IFS for this thoughtful report. It is too early to know for certain the mental health consequences of Covid, but we are deeply concerned about those who suffer from isolation, young people, those who have fears of economic uncertainty, and those with existing mental health vulnerabilities. I give thanks to mental health professionals, who have worked hard during the epidemic, despite difficult circumstances.
Baroness Tyler of Enfield (LD) [V]
My Lords, last week’s report by the IFS reveals how Covid-19 and the lockdown has had a major negative impact on mental health across the population, with women and young people particularly badly hit. Pre-existing inequalities in mental health have widened yet further. The report states that the scale of deterioration in mental health is of a magnitude unlike anything seen in recent years. What immediate steps are the Government taking to prevent this looming mental health crisis turning into an epidemic in its own right?
Lord Bethell [V]
My Lords, the report is extremely helpful and throws a spotlight on an issue that we are deeply concerned about. Immediate help includes a £4.2 million support fund for mental health charities, and a £5 million fund for Mind, specifically to support charities dealing with Covid-related mental health issues. We will continue to invest in mental health in the long term, to support this important area.
Health Protection (Coronavirus, Restrictions) (England) (Amendment) (No. 2) Regulations 2020
Baroness Tyler of Enfield Excerpts(6 years, 1 month ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, I have no issue with the minor lifting of restrictions contained in these regulations—apart from the bizarre timing of this debate—other than to say how odd it was to prioritise being able to visit an estate agent over being able to visit family members from whom we have been separated for months.
I will focus primarily on how as a country we move out of lockdown in a way that feels fair and does not discriminate. It has been more apparent in recent weeks that we were too slow to move into lockdown and that those lost weeks in March cost precious lives. The Government have also been far too slow in getting testing, tracing and isolating up and running, as well as in providing PPE and other crucial support for care homes.
I have been particularly concerned about the impact of lockdown on the well-being of those living by themselves, for whom lockdown has been especially tough. For some living alone, there has been a limited easing of restrictions in recent weeks; they can now form a social bubble with another household. These are clearly steps in the right direction, but I am concerned about the mental health impact of long periods of isolation on both the over-70s and those of any age living alone.
Back in April, the Mental Health Foundation voiced concerns over the long-term impact of the pandemic on mental health after a quarter of adults surveyed admitted to experiencing loneliness during lockdown. Perhaps surprisingly, the most affected group was found to be young people aged 18 to 24, 44% of whom admitted to experiencing loneliness. Research has shown that loneliness has the same impact on mortality as smoking 15 cigarettes a day, making it more dangerous than obesity. More recent research from Age UK has shown that over two-fifths of people aged 70 and over say that their mental health has been affected, with those locked down alone having a particularly anxious time.
Many people over 70 who are still fit and active, contributing to the economy and society and with no underlying health conditions, are increasingly finding these blanket policies ageist and discriminatory. A growing number of over-70s are also annoyed at the implication that all their age group are equally vulnerable and have called on the Government to take a more nuanced approach. Indeed, some are starting to say that the proposed cure of a lengthy extended lockdown for older people is as bad as or worse than the disease itself.
To finish on care homes, which are never far from my mind, at the end of May social care leaders began calling on Ministers to prioritise unlocking care homes amid growing concerns that mental health problems were contributing to the deaths of residents, a call echoed by the Relatives & Residents Association. The executive director of the National Care Forum said:
“We need to put the same energy and imagination into opening up care homes as we’re putting into opening up the great British pub.”
I for one agree.
National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) Regulations 2020
Baroness Tyler of Enfield Excerpts(6 years, 2 months ago)
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Baroness Tyler of Enfield (LD) [V]
My Lords, I too support the long-overdue pay increase for nurses working in the social care sector. I also strongly support the regret Motion tabled by the noble Lord, Lord Hunt, who is right to draw attention to the financial instability of this deeply fragmented sector.
There are approximately 15,000 care homes in the UK, with more than 400,000 beds, run by approximately 8,000 providers. Some are very small; others provide a large network of homes. It is a mixed economy: 84% of homes are owned by the private sector, including some that are owned by private equity firms, both British and offshore; 13% are owned by not-for-profit organisations; and 3% are owned by local authorities. Funding comes from a mix of private funders, local authorities and the NHS. Despite this funding mix, care homes have been hit by a decade of cuts in social care funding. An FT investigation last summer revealed:
“Britain’s four largest privately owned care home operators have racked up debts of £40,000 a bed, meaning their annual interest charges alone absorb eight weeks of average fees paid by local authorities on behalf of residents.”
Many have argued that this debt-laden model is completely inappropriate for social care, as is one that involves paying large dividends to investors.
Many homes are already running close to bankruptcy and have expressed grave concerns about the spiralling costs of PPE and extra agency staff, as well as lost income from empty beds. It has been estimated that when bed occupancy rates slip below 87%—as many have now—operating surpluses are such that many smaller care homes quickly become unviable, particularly those with greater reliance on state-funded residents.
This virus has brutally exposed systemic weaknesses in our social care sector. The latest official figures show more than 12,000 Covid-related deaths of care home residents in England and Wales, but it has been estimated that the true figure, calculated by looking at excess deaths of care home residents in the period, could be double that. According to a recent poll, one-third of people say that they are less likely to seek residential social care for their relatives or as a future option for themselves. This brings into very sharp relief the respective responsibilities of central and local government if care home owners go under financially or simply decide to shut up shop and hand back the keys. Simply put, who is the provider of last resort?
Tellingly, that poll also revealed that the vast majority of respondents want care workers to be paid above the minimum wage. If this pandemic has revealed one thing, it is that we can no longer kick the can down the road but must take advantage of the growing public and political consensus that social care should be free at the point of need, funded largely out of taxation. There are, of course, a number of ways of doing this: general taxation, hypothecated tax, or some form of social insurance. This needs to be at the nub of both the political debate and a grown-up national conversation.
Covid-19: Obese and Overweight People
Baroness Tyler of Enfield Excerpts(6 years, 2 months ago)
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Lord Bethell
The noble Baroness is entirely right that chapter 2 outlines an extremely thoughtful roadmap for how to address this issue. It is currently being reconsidered. I cannot make the guarantees she asked for from the Dispatch Box, but I can assure her that we are working hard to see how we can use the example of Covid to make progress on this important agenda.
Baroness Tyler of Enfield (LD)
My Lords, given the Prime Minister’s welcome recent statement that a more interventionist stance is needed to tackle obesity, is the Minister aware of a recent poll by the Obesity Health Alliance showing that 72% of those surveyed supported restrictions on shops promoting unhealthy foods in prominent areas, including checkout areas, and 63% wanted the sugar tax on soft drinks extended to other sugary foods? What plans do the Government have to introduce these measures, working collaboratively with supermarkets and other food retailers?
Lord Bethell
The noble Baroness is entirely right to suggest that Covid might be the infection point—the intervention necessary to wake up the nation to the dangers of obesity. We are keen to use that moment to make progress on this important issue.
Mental Health Services
Baroness Tyler of Enfield Excerpts(6 years, 2 months ago)
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Baroness Tyler of Enfield
To ask Her Majesty’s Government what steps they are taking (1) to protect, and (2) to support, mental health services (a) during, and (b) after, the COVID-19 pandemic.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)
My Lords, the NHS has issued guidance to services to support them in managing demand and capacity across in-patient and community mental health services. Services have remained open for business as usual as a result. We remain committed to the additional investment in mental health services set out in the NHS long-term plan. We have provided an additional £5 million to mental health charities to support their work during the pandemic.
Baroness Tyler of Enfield (LD)
My Lords, the Royal College of Psychiatrists warned last week that the nation faces a mental illness “tsunami”. Those on the front lines of our health and social care services have gone above and beyond to tackle this dreadful virus, but now may themselves face significant mental health problems. Thousands have lost colleagues, endured serious illness or experienced major trauma. Will the Government commit to investing in a world-class mental health response to Covid-19, including by setting up specialist support services for those on the front line of our NHS and care services, mirroring the services available to our armed services personnel?
Lord Bethell
I join the noble Baroness in paying tribute to those working in mental health in the NHS. They have kept services running in extremely difficult circumstances and their impact has been extremely powerful. Although we are aware of the deep threat of a mental health tsunami, as was warned, the evidence to date is that these people have done an amazing job of addressing the concerns of those who are suffering under coronavirus and the lockdown.
Covid-19: Vulnerable Populations
Baroness Tyler of Enfield Excerpts(6 years, 3 months ago)
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Lord Bethell
I share the noble Baroness’s celebration of Florence Nightingale Day, which is an important day for the nursing profession and for all of us. We have made huge progress on testing in care homes in the last three weeks. The new portal was made live on Monday and care homes are now massively supported by satellite care home facilities manned by the Army. I am not sure about the 6 June date of which she speaks, but I reassure the House that care home testing is the number one priority of our testing facilities and is benefiting from the large increase in capacity.
Baroness Tyler of Enfield (LD)
My Lords, over the course of this crisis we have seen substance misuse and mental health services adapt their provision to better support homeless people facing multiple problems. Could the Minister say what the Government, in particular the new homelessness task force, will do to ensure that these flexibilities remain in place?
Lord Bethell
The noble Baroness is right to raise concern for the homeless—surely one of the groups suffering the most in the current epidemic. We are putting in place facilities for testing, housing and mental health support for the homeless. We envisage that these will continue for the length of the epidemic.
Covid-19: Social Care Services
Baroness Tyler of Enfield Excerpts(6 years, 3 months ago)
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Baroness Tyler of Enfield (LD)
I thank the noble Baroness, Lady Wheeler, for securing this important debate. As the terrible and ever-rising death toll in care homes has so visibly shown, the social care sector, so long underfunded and neglected by politicians and policymakers, finds itself at the front line of this cruel pandemic. The severity of the challenge faced in care homes and other community settings is impossible to overstate. In short, care homes providing personal and close contact care need urgent access to reliable and ongoing supplies of protective equipment to protect residents and staff, rapid and accessible testing, and far greater support, with funding and equipment on an equal footing with the NHS.
If this pandemic has proved one thing, it is that health and social care are inextricably linked and cannot be treated differently. The National Care Forum has called on the Government to form a ring of steel around care homes, but what is it like at the moment? I have spent the past couple of days talking to various social care leaders running front-line social care services. It has been a humbling experience to hear what is going on.
Their stark messages include: how the rhetoric from government is hard to hear when the reality is so different; the confusing, contradictory and constantly changing nature of guidance issued by government and other bodies; the daily struggle to secure protective equipment, with government supplies sometimes being diverted to NHS facilities and homes having to source their own supplies at extortionate prices; staff shortages running at 25% alongside existing high vacancy levels that require the hiring of agency staff, which raises the risk of transmission; a serious shortage of nurses in homes and great difficulty recruiting, as nurses are deployed into the acute sector; testing arrangements which show little understanding of how the sector works, with care workers who have no car being asked to drive to centres many miles away, at times that do not fit with their shift patterns; patients being sent from hospitals into care homes without testing; much-needed financial resources from government not reaching the front line; GPs no longer coming into care homes to verify deaths, leaving such tasks to some of the lowest-paid staff; and care workers left feeling insecure and anxious when left in charge of clinical details.
Based on these conversations, I ask the Minister: why are care homes having to pay VAT on protective equipment when the NHS does not, and what urgent steps will the Government take to put them on an equal footing? What measures are they taking to ensure that some registered nurses in the newly returning workforce are deployed to care homes, which desperately need them? When will the newly established volunteer scheme be used to help care homes? Finally, when will the Government’s visa exemptions for NHS nurses be extended to those working in the social care sector?
When this terrible tragedy subsides, a long-overdue and fundamental reform of social care must be a top priority. A national health and social care system means just that: a fully integrated service, properly funded and run on an equal basis so that we are no longer, as one social care professional put it to me, simply an afterthought at the back of the queue.
Queen’s Speech
Baroness Tyler of Enfield Excerpts(6 years, 9 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, I start by remarking on what very strange times we live in and the frankly rather surreal context to the debate. I was particularly struck yesterday by the remark of my noble friend Lord Beith, who I am delighted is in his place next to me, who called this the “fantasy gracious Speech”—and that was before the vote to reject the timetable for the withdrawal agreement Bill and the Prime Minister’s recent announcement that it will now be “paused”.
With that preamble aside, I will start with one aspect of the gracious Speech that I welcome: the commitment to reform the Mental Health Act to,
“improve respect for, and care of, those receiving treatment”.
That is based on the independent review of the Mental Health Act, chaired by Sir Simon Wessely, which reported in December 2018 with 154 recommendations aimed at improving and updating the Mental Health Act 1983. That is critical, given the growing number of detentions, of which we know that there was a 40% increase over a 10-year period, and grave concerns about the disproportionate numbers of people from black and minority ethnic communities being detained.
Unless my hearing failed me, at the start of the debate I was pleased to hear the Minister confirm that it is the Government’s intention to publish the White Paper outlining their response to the independent review by the end of the year. I welcome that, but is the Minister able to say anything more about the timetable for bringing forward a new mental health Bill and whether the Government will be able to accept the Wessely review’s recommendations in their entirety? We should not lose sight of the fact that the best way to reduce the need to detain patients under the Act is to prevent their health deteriorating and reaching a mental health crisis in the first place. That is best done through expanding and improving mental health services.
So it is to be hoped that delivering the improvements contained in the NHS long-term plan will bring real benefits to people with mental illness. However, as we have heard before this afternoon, these all rest on having enough staff with the right skills to deliver care to patients—so could the Minister also say when the Government will publish their legislative proposals to implement the long-term plan? While I welcome plans for a new piece of mental health legislation, as I have said, it is also important that the forthcoming White Paper considers the non-legislative steps needed to improve patient care.
The noble Lord, Lord Ribeiro, made the really important point that the review of the Mental Health Act found that mental health facilities where patients are admitted are often some of the most out of date. Indeed, they were described as the “worst estate” in the NHS, at times with more in common with prisons than hospitals. Badly designed, dilapidated buildings and poor facilities contribute to a sense of containment and make it difficult for patients to effectively engage in therapeutic activities. This capital investment to improve the in-patient physical environment, which was recommended by the review and supported by the long-term plan, is critical, so could the Minister set out what action is being taken to fund these infrastructure improvements?
Ensuring that patients are not detained any more than is absolutely necessary—something I am sure we would all agree with—requires expanding mental health services and having the medical workforce to deliver and sustain the commitments in the long-term plan. That will require the Government both to sort out the short-term recruitment and retention crisis in the mental health workforce and to prepare for the longer term by doubling the number of medical school places by 2029, as was discussed in Questions yesterday.
One group who would benefit from proposals for greater integration of mental and physical healthcare are those who have mental illness and alcohol and substance abuse issues. They are often seen by various services but do not get the holistic care that they need. I think that we all know that patients being seen for mental health conditions often do not get the physical healthcare they need and vice versa, with those with physical health conditions often having their mental health needs ignored. I was therefore interested in the proposals put forward by NHS England and NHS Improvement for an NHS integrated care Bill to assist the delivery of the NHS long-term plan and allow services to work together more easily. Can the Minister say what is happening in this area?
A common misunderstanding is that the Mental Health Act applies only to adults rather than to young people, but we should note that, in total, almost 3,500 children and young people were admitted to inpatient mental health hospitals in 2017-18, with more than 1,000 formally detained under the Mental Health Act and more than two-thirds of those children aged 16 and 17. Therefore, as the review makes clear, detention should only ever be a last resort. Consequently, it is vital that reforms to the Mental Health Act are accompanied by greater investment in early intervention for children and young people, so that more young people receive support in their communities before they reach crisis point. Again, I would be grateful for anything that the Minister might be able to say, either now or later, about the specific steps being taken by the Government to make early support a real priority.