Mental Health: Children and Adolescents

Baroness Tyler of Enfield Excerpts

Wednesday 16th November 2016 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what is their response to the Report of the Values-Based Child and Adolescent Mental Health System Commission What Really Matters in Children and Young People’s Mental Health, published on 7 November.

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

My Lords, we welcome the noble Baroness’s report and its endorsement of the direction set out in Future in Mind, our own report which puts children, young people and their families at the centre of this Government’s ambitious transformation programme to improve children and young people’s mental health and well-being. This means listening to their views and enabling them to access the high-quality care they need. This report builds on and strengthens that approach.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for his response. Does he agree with one of the key recommendations of the commission’s report that schools, if properly funded and supported, have the potential to make a really big difference to improving children’s mental health, not least because children spend one-third of their time in school? Linked to this, does he also agree that the proposed Prime Minister’s challenge on children’s mental health should incorporate this strong focus on schools?

[Lord Prior of Brampton]

My Lords, when I read the noble Baroness’s paper over the last couple of days, I thought the part about schools was the most persuasive. School is clearly critical. The pilot project being done by the Department of Health and the Department for Education, trialling the single point of contact in schools, is very important, as is the PSHE guidance on teaching about mental health at the four key stages of education.

NHS: Health and Social Care Act 2012

Baroness Tyler of Enfield Excerpts

Thursday 8th September 2016 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I congratulate the noble Viscount, Lord Hanworth, on securing this vital debate. The starting point for our debate is the impact of the 2012 Act—legislation which is etched on the memory of many in this Chamber, and I suspect none more so than the noble Lord, Lord Lansley, who has just spoken. It was the first Bill I was actively involved in after joining this Chamber and, my goodness me, it felt like a baptism of fire. It is fair to say that it was a highly charged and contentious piece of legislation. However, rather than rehearse the heated arguments again, today I will focus primarily on how the system has responded to the changes and what it means for the future.

We probably all agree that there is no appetite for further structural reform, and I doubt whether there will be in the years ahead. Therefore, the current immense problems of sustainability will need to be resolved within the current architecture. This will require huge ingenuity, creativity, cultural and behavioural change, and transformed styles of leadership at both national and local level, along with very different financial incentives.

As we have heard, the 2012 Act introduced major structural changes—I am not going to run through them again—but how has the system responded to these changes in the face of huge financial and operational pressures? To answer that question it is important to highlight some key factors. First, whatever their rights and wrongs, the geography of clinical commissioning groups is not strategic. Simply put, there are considerably more CCGs—some 209—than there are hospitals, of which there are just over 150. That is not helpful. Such fragmentation militates against strategic planning and decision-making.

Secondly, the more market-based system that competition and the introduction of foundation trusts by successive Governments heralded may have been okay during times of plenty, but during a period of unprecedented austerity, coupled with a major growth in demand, it has proved much harder to sustain. Each trust fights hard to protect its own position, making collaborative working and the significant shifting of resources much harder.

Thirdly, in practice it has proved very hard for GPs to undertake the role envisaged for them of fundamentally reshaping the services provided by hospitals for the benefit of their patients. Too often they have been overwhelmed by rising demand, making effective collaboration between GPs and hospital consultants, which can be hard at the best of times, a distant dream.

The simple truth is that there is not enough money in the system to do all the things being asked of the health and social care system at a time of rapidly rising demand from a growing and ageing population—and that is before we come to the newest policy goal of seven-day working. We would all like to see that in an ideal world, but it must be properly resourced and planned if it is ever to become a reality. The current approach of trying to ram it through on resources that are not really adequate for five-day working, let alone seven, is clearly not viable.

There has been no shortage of recent reports demonstrating the parlous state of NHS finances. Reports from NHS Improvement, the King’s Fund, Nuffield Trust, the Public Accounts Committee and others have all shown rapidly declining financial performance and an alarming scale of deficits. In short, the NHS ended 2015-16 with an aggregate deficit of some £1.85 billion—a threefold increase on the previous year and the largest deficit in NHS history.

It is not at all clear how the £22 billion funding shortfall by 2020 will be achieved. When resources and demand are so out of kilter, what is urgently needed is a system-wide response, with system-wide thinking at its very core. This means putting far greater emphasis on geography—or place-shaping, as it is sometimes called—and, in essence, thinking in terms of local health economies rather than in terms of individual institutions or bricks and mortar. That system-wide thinking needs to be based on trust, collaboration, innovation and sophisticated networking—in short, the key ingredients of a joined-up response.

In fairness, the Five Year Forward View—widely regarded as an excellent document setting out a long-term vision—coupled with the planning guidance are both attempting to do just that. We have recently had the introduction of the five-year sustainability and transformation plan, which highlights the need for systemic leadership and a truly place-based plan, with local leaders, including from local government, coming together and developing a shared vision of what will work best for the local community.

This is a welcome shift in emphasis towards collaboration rather than competition in the way NHS services are planned, even if it is being done somewhat by stealth. It also provides a much-needed opportunity to plan for a health service focused far more on people living in the community with long-term conditions rather than on treating illness in hospitals.

The country is divided into 44 sustainability and transformation footprints, as they are being called. Getting the geography right is essential, and they should have the strategic scale to look at major reconfigurations of services, including shifting resources from the acute sector into primary care, community care and, critically, social care—something that the smaller CCGs clearly struggle to do.

The approach feels right if the focus can be on far greater integration, collaboration and system-wide thinking. It is a real concern that the general mood music around these plans, due to be published in October, is negative at the moment. We have had reports of excessive secrecy, lack of local engagement and a strong emphasis on preventing immediate financial collapse at the expense of proper long-term thinking and planning towards long-term sustainability.

A recent statement from the chief executive of the King’s Fund, commenting on the plans, was blunt. He said:

“Almost all the additional funding provided by the government this year is being used to reduce deficits in acute hospitals, leaving little if any to invest in services outside hospital. Sustainability and transformation plans will not be credible unless they demonstrate how money and staff for these services will be found”.

Similarly, a recent Nuffield Trust report concluded the same thing. It had in it the memorable phrase that we would have to “preserve the NHS in aspic”—meaning having to halt any further advancement in healthcare quality and new treatment.

The final sentence of that report reads:

“The political acceptability of that—following a Brexit campaign which highlighted a potential £350 million for the NHS a week—is highly questionable”.

That is putting it mildly. We must have an honest debate which recognises that the service transformation needed for a health service fit for the future will take much longer than one Parliament, must be properly resourced, even if that means raising extra taxation, and, critically, have the financial incentives which encourage and reward collaboration and system-wide thinking. Otherwise we will simply limp from one crisis to another, and that is to no one’s benefit.

NHS and Social Care: Impact of Brexit

Baroness Tyler of Enfield Excerpts

Thursday 21st July 2016 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I too thank the noble Baroness, Lady Watkins, for securing this very important debate. Indeed, I cannot think of a more pressing and urgent subject on which to finish our sitting.

As we have heard in the debate, the UK’s vote to leave the EU will without doubt have major implications for health and social care, not least because it has ushered in a period of major economic and political uncertainty at a time when the health and care system faces huge operational and financial pressures, as we have debated so many times in this Chamber. The NHS faces an extremely challenging set of circumstances. Demand, particularly from our ageing population, continues to grow faster than funding, putting further pressure on an already strained service. Fundamental change in how we provide care is urgently needed if the NHS is to be successful in meeting the twin challenges of providing high-quality services while balancing the books. To do this it is vital that we have the right numbers of staff with the right skills in the right place, and ensure that they feel valued, welcome and engaged in the work that they do—hence the debate we are having this afternoon.

The EU’s policy of freedom of movement coupled with mutual recognition of professional qualifications within the EU means that many health and social care professionals working in the UK come from other EU countries. I know we have already heard these figures but it is important to emphasise that these are big numbers. This is not something at the margins: it is 55,000 of the NHS’s 1.3 million workforce and some 80,000 of the 1.3 million workers in adult social care.

As we have heard this afternoon, the NHS is struggling to recruit and retain permanent staff. Indeed, there was a shortfall of some 6% in 2014 between the number of staff that providers of healthcare services said they needed and the number in post, with particular gaps in nursing, midwifery and health workers. As we heard very powerfully from the noble Baroness, Lady Howarth, similar problems exist in the social care sector. I will not repeat those numbers but I am particularly worried about the very high vacancy and turnover rates in domiciliary care services, which provide care to some of the most vulnerable people—the elderly and the disabled—in their homes. Given the current shortfalls in both health and social care that we have heard about, surely the Government must urgently clarify their intentions on the ability of EU nationals to work in health and social care roles in the UK, not least to avoid EU staff in the NHS deciding to leave to work in other countries where they may feel that they are made more welcome.

Initially in the days after the referendum, it sometimes felt as if all EU nationals were being used as pawns in a negotiating game, and that was quite wrong. Since then, we have heard slightly more reassuring statements from Bruce Keogh, NHS England’s medical director, and Jeremy Hunt, the Secretary of State, who has sought to assure European staff working in the health service. We have also heard Simon Stevens call for more assurances, which are needed, and that is the right thing to do. However, we need to go a lot further. Providers of NHS and social care services must be able to retain the ability to recruit staff from the EU when there are not enough resident workers to fill vacancies. As others have suggested, this could be done by adding specific occupations to the Migration Advisory Committee’s shortage occupation list, which currently enables employers to recruit nurses and midwives from outside the European Economic Area. What steps will the Government take on this front?

I want to say a brief word about nursing staff. I am very conscious that I do not have anything like the expertise that we are so lucky to have in this Chamber in the noble Baroness, Lady Watkins, and, of course, the noble Baroness, Lady Emerton. However, I acknowledge the huge contribution that EU nurses make to the vital work of the NHS and, indeed, the health of the nation. Currently, some 33,000 EU nurses are registered to work in the UK. There has been a very large rise in this number since 2010. These numbers show that the UK has an ever-increasing reliance on nurses from the EU, who plug serious gaps in the nursing workforce. This is due to government cuts since 2010 to nurse education commissioning in the UK, which has drastically reduced the supply of nurses coming into the system. There will be serious consequences for patient care if EU health professionals are forced to leave the country or, indeed, are made to feel unwelcome and so decide to leave.

It is often the personal anecdote that brings this situation home. Yesterday, I had a very long day—about 15 hours—with my mother in a central London hospital. She is very elderly and frail and she needed an operation. But during that long day all her other complicated care needs had to be dealt with. The nurses in the hospital clearly came from all over the world. I cannot thank them enough for the care they gave my mother during that long and difficult day. It is absolutely clear to me that the NHS simply would not be able to function without staff from other countries; we just have not invested enough to grow our own. It takes four years to commission extra places and train nurses; it is not something that you can do overnight.

Where does all this leave us? I have to be honest and say that it leaves me feeling quite gloomy. I recently read a very good article in the Guardian, written by Richard Vize. He said that:

“The most insidious effect of the current anti-European climate will be to discourage EU talent from working in our health and care system”.

He went to say—and I think that this is the critical point—

“It is not just a question of the rules about who can work here, but the perception. With social and mainstream media in Europe already reporting incidents of racial abuse and a more general anti-immigrant feeling, and uncertainty about the future legal position of living and working in the UK, talented people from other EU nations have good reason to consider alternatives. There is a chronic global shortage of clinical staff, so the UK is part of a worldwide marketplace for talent. We have just made it more difficult to attract the best”.

It gives me no pleasure to say so but, frankly, I could not agree more.

I usually like to end on a fairly upbeat or positive note, as I know the noble Lord, Lord Crisp, does. He managed to do so extremely well, as always, but on this occasion I have failed. I end by raising an issue that the noble Lord, Lord Bilimoria, also mentioned. It is about that lie—that most flagrant and disgraceful lie—of the leave campaign. I have to say that there was very stiff competition for that particular accolade, but it is the lie where we were told that £350 million extra per week would be available for the NHS—it was plastered all over the campaign buses. Then of course it was retracted, even before the ink was dry on the results. But the public, quite understandably, now have an expectation that NHS spending will rise after the UK leaves the EU. I have never been very good at maths but I just made a little calculation. It is four weeks now—to the day, I think—since the referendum, so my calculation tells me that, four weeks on, £1.4 billion is now owed to the NHS. Can the Minister tell us whether that money has yet been received and, if not, how quickly he expects that money to be in the Department of Health coffers?

Mental Health: Ensuring Equal Access to Mental and Physical Healthcare

Baroness Tyler of Enfield Excerpts

Thursday 26th May 2016 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, in my contribution to the debate on the gracious Speech last week, I said that mental health had become one of the defining challenges of our age. I am delighted that today’s debate, secured by my noble friend Lady Brinton, provides an opportunity to expand on this. We have already heard today that one in four people experiences a mental health problem in any one year, so it really is an issue that touches each and every one of us at some point in our lives. The moral arguments are overwhelming, too. As Michael Marmot so powerfully reminded us in his recent book, The Health Gap: The Challenge of an Unequal World, people with mental ill health have a life expectancy between 10 and 20 years shorter than people with no mental illness. Doing something about this is a first-order issue for social justice.

Let us look at the big picture. Demand for mental health services is rising relentlessly and will continue to do so. It has been estimated that by 2030 there will be approximately 2 million more adults in the UK with mental health problems than there are today. Mental health services must be equipped to respond to increasing and changing demand and be able to tackle unmet need—that is a huge challenge. It is undeniable that mental health is getting much more attention from politicians and policymakers, and that is a good thing. But what actual difference is that making to those one in four people? That is what I want to focus my remarks on today, as well as offering a few concrete suggestions on how we start turning all these fine words into reality.

So, what is the overall strategy for addressing this issue? In a recent exchange in your Lordships’ House at Question Time, the noble Lord, Lord Prior, was asked when the Government would be producing their strategy on mental health. The Minister replied by saying that the Mental Health Taskforce report, along with the Future in Mind report and the report from the noble Lord, Lord Crisp, on acute psychiatric care, were the strategy. Although I am quite a fan of strategy documents myself, I thought that that was quite a good answer, and so reviewed them to see if they did add up to a comprehensive strategy.

First, Future in Mind, published just before the election, was a much-needed blueprint for modernising and improving children and young people’s mental health and well-being, backed up by £1.25 billion in funding. It highlighted the fact that 75% of mental health problems start before the age of 18 but that less than 25% of young people with a diagnosable condition were accessing support and treatment. Its almost 50 recommendations for transforming services for children and young people looked right across—from preventive work and early intervention through to crisis care. It was, in my view, a very good report.

Secondly, the excellent report by the noble Lord, Lord Crisp, Old Problems, New Solutions, on improving acute psychiatric care for adults, makes a compelling case for patients with mental health problems having the same rapid access to high-quality care as patients with physical health problems. As we have heard, the report recommended a new waiting time pledge for admissions to acute psychiatric wards and the phasing out by 2017 of the practice of sending acutely ill patients far from home for non-specialist treatment. I would like to add my voice to the other voices this afternoon saying that we should not have to wait until 2020 for that to happen, not least given the expert opinion that this practice is associated with an increased risk of suicide—as we have heard so powerfully and personally this afternoon from my noble friend Lord Oates.

Finally the Mental Health Taskforce report provided a comprehensive insight into the current state of mental health care. Its verdict was striking. It says that,

“too many people have received no help at all, leading to hundreds of thousands of lives put on hold or ruined, and thousands of tragic and unnecessary deaths”.

Those are strong words indeed. With 75% of people affected by mental health issues receiving no support at all, the report makes it clear that the current mental health care system is simply not coping as a result of years of chronic neglect and underfunding. The report also made more than 50 recommendations. Priority actions were: access to mental health care 24/7 as part of a seven-day NHS, new waiting time and access standards, and expanding access to psychological therapies to help more than 600,000 people. The report also had a lot to say on a more integrated approach to mental and physical health, recognising how interconnected the two are for many people.

In my assessment, these reports taken together do give us the overarching framework needed for transforming mental health care, so I am with the Minister on that point. So, “Job done?”, noble Lords may ask. Clearly not, because after all of this very good work and three excellent reports, we are simply at the starting line. The task of turning the rhetoric and good words into reality is Herculean, and all our attention should be focused on it. Central to this will be political will and sustained financial investment, along with far better data and much sharper accountability mechanisms.

I previously welcomed the government commitment to spend an extra £1 billion on mental health in 2020-21. I noted, however, that that extra money will come through only in 2020-21 and that in the years preceding, significantly less money will be available. Indeed, mental health services will be expected to make significant savings alongside the rest of the NHS. So when summing up, will the Minister spell out precisely how much money will be available in each of the financial years between now and then? We have already heard about the recent survey showing that most providers and commissioners do not feel confident that £1 billion will be sufficient to meet the challenges already outlined, given the historic underfunding of mental health services and the deficits that so many NHS trusts face. Of particular concern is whether this funding will be adequate to roll out the services needed to meet the first ever waiting standards for depression and anxiety and for early intervention in psychosis, introduced by the coalition Government, as my noble friend Lady Brinton told us. What reassurances can the Minister give me on that point?

The task force’s very welcome commitment to introduce comprehensive waiting time standards is critical to bringing mental health in line with physical health and to fundamentally changing the culture. To turn the tanker around, these standards need to be accorded the same status as four-hour A&E targets, cancer waiting times and the 18-hour referral-to-treatment targets. However, the chief executive of NHS England, Simon Stevens, recently confirmed that the £1 billion by 2020 will not be sufficient to deliver comprehensive waiting time standards. Indeed, that assessment was backed up by a recent NAO report which found that achieving the standards would be “a very significant challenge”. In summing up, will the Minister please confirm whether the Government are still committed to fully funding these standards, which are at the very heart of parity of esteem?

Turning to funding for children and young people’s mental health, the additional and very welcome £1.25 billion secured in the April 2015 Budget to back up the Future in Mind report should amount to £250 million in each year of this Parliament. But as we have already heard, in reality, only £143 million was spent in the last financial year, with only £75 million of that going directly to CCGs to improve local services. That raises the question of why there was a delay in getting resources through to the front line of children’s mental health services. I know that capacity issues have been cited by the Government, so will the Minister please say what progress has been made on the workforce recommendations contained in Future in Mind, and when the roughly £100 million funding shortfall in 2015-16 will be forthcoming?

Along with adequate funding, we need far greater transparency about how money allocated at national level reaches the front line of mental health services and which mental health services are being prioritised. Frankly, it is worrying that it took a freedom of information request last year to find out that some 50 out of 130 CCGs were planning to reduce spending on mental health. The recent updated planning guidance from NHS England tells CCGs to increase in real terms their spending on mental health by at least as much as their overall allocation increases, and that is of course welcome. However, it is vital that proper tracking mechanisms are in place to ensure that CCGs are held to account on how much they spend and the impact that is having on their communities. In turn, that calls for far better data collection at local level on spending, including how much is being spent on different types of services and treatments. At present, we have what the Minister himself in this House has called a data black box. That is really holding back progress on the much-needed transparency and accountability.

One of the main ways of holding CCGs to account is the improvement assessment framework, which measures CCGs against specific targets. It was therefore very disappointing that the newly published framework does not include a specific assessment of how much CCGs spend on mental health provision in their areas. That was a real missed opportunity. I fully understand the severity of the overall pressures on CCGs, but they were exemplified most starkly in a rare move recently when the Mental Health Commissioners Network wrote to the Department of Health asking that money for young people’s mental health care be ring-fenced so that it is not siphoned off to pay for other services. I have to say that that is something I personally would support. I understand that the department has replied, saying that it does not have the legal powers to do that, so I turn to the legal position for a moment.

In the debate on the Speech I said that equal access to mental health care should be enshrined in legislation. At present, apart from a general reference to parity of esteem between mental and physical health in the Health and Social Care Act 2012, the only specific pieces of mental health legislation of which I am aware are the Mental Health Acts 1983 and 2007 and the Mental Capacity Act 2005, and they deal with completely different issues. So while I do not generally support the use of legislation to send policy signals, my sense, backed up by everything I have heard in the debate today, is that legislation in some form or legislative underpinning is needed to achieve the fundamental culture change we need.

One way of achieving this, in my view, would be for waiting times and access standards to be included in the NHS constitution and the handbook to it which the Secretary of State and all NHS bodies are required to take account of. Then people would know that it is an entitlement, not an aspiration or a discretionary matter subject to funding and other priorities. At present, waiting times and access standards are contained only in the NHS mandate, which does not have the same status.

I want to end on a slightly more upbeat note and acknowledge that critically important as money, data and accountability are, they are not the whole answer. There is a mindset issue and an issue about working collaboratively. I have the privilege of chairing the Values Based Children and Adolescent Mental Health System Commission, as declared in the register. The commission started its work earlier in the year and will report in September. In short, it is looking at how we can improve the commissioning and delivery of the children and young people’s mental health system to take better account of what really matters to all involved, most particularly the children and young people themselves. What sort of services, delivered in which way and where, would they like to see? We have received wide-ranging evidence from witnesses across the UK and I am particularly encouraged by some of the examples we have heard in different localities where services have been transformed by CAMHS, schools, local authorities and the voluntary sector coming together, collaborating and pooling budgets. The result is that some places have been completely redesigned around the needs of children and young people and their families. This redesign is generally based on a system-wide approach comprising early intervention and preventative services, often based in schools, with schools acting as hubs, working in tandem with target specialist and crisis services, the latter available on a 24/7 basis. Interesting features include a single point of access, no wrong door, open access and far fewer thresholds. Far more young people in these areas are getting the help they need and the money is being spent far more effectively. I look forward to bringing the findings of the commission to your Lordships’ House.

I am conscious that I have asked rather a lot of questions and I am quite happy for the Minister to reply to me in writing on some of them.

Southern Health NHS Foundation Trust

Baroness Tyler of Enfield Excerpts

Tuesday 3rd May 2016 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for reading the response to the UQ on the CQC’s serious concerns about the safety of mental health and learning disability patients at Southern Health Trust. The whole House is deeply shocked by the inadequate and completely ineffective response to the Mazars review’s findings, following the tragic death of Connor Sparrowhawk over two years ago. The CQC’s stark assessment that serious risk to patients in ensuring their safety was still not driving the senior management or board agenda beggars belief in the light of the Mazars review and the CQC’s repeated concerns and warning notices. There are still no robust governance arrangements in place to investigate incidents and there is still a lack of effective arrangements to identify, record or respond to concerns about patient safety raised by patients, their carers, staff and the CQC. A particular concern is the continuing failure to act over important specific safety concerns about ligature risks in acute inpatient mental health and learning disabilities services and, given the terrible cause of Connor’s death, the board’s failure to give urgency to approval of the specific protocol for safe bathing and showering of people with epilepsy. Can the Minister assure the House that these will receive urgent attention by the new chair in his task of building new leadership and direction for the board and in an urgent programme of action for the trust?

Patients and their families need to see robust, urgent action and real accountability. When the Secretary of State responded to December’s UQ on Southern Health, he rightly said that, more than anything, people will,

“want to know that the NHS learns from … tragedies”,—[Official Report, Commons, 10/12/15; col. 1141.]

such as these. That clearly has not happened, so I ask the Minister what guarantees he can give to current patients and their families in the care of Southern Health that they are safe. Where is the accountability, culpability and responsibility? Can the Minister tell the House about the content and timescale of the review of the adequacies of the trust’s leadership that the new chair has been tasked with undertaking? Finally, will he listen to the heartfelt pleas of victims’ families, campaigners and all those who are demanding a full public inquiry into Southern Health and into the broader failure in adequately investigating preventable deaths?

[Baroness Tyler of Enfield (LD)]

My Lords, I, too, thank the Minister for repeating the Statement. The original Mazars report highlighted two profoundly shocking issues: the tragic and preventable death of Connor Sparrowhawk and the fact that too many unexpected deaths among those of learning disabilities and older people with mental health problems were even being investigated. Why did a full three months elapse after the Mazars report was published—and, indeed, only after a BBC investigation covered it—before Monitor finally appointed an improvement director to go in to work with the trust on urgently needed improvement? Why the delay?

Secondly, despite a series of national reports—we have just heard about the CQC report—warning notices, monitoring and progress meetings, all referred to in the Statement, nothing has been said about the precise changes that have happened or improvements that have taken place in Southern Health Trust. When can we hope to hear about specific and tangible improvements to the care provided by Southern Health Trust to some very vulnerable people?

Thirdly, it is crystal clear that new leadership needs to be in place if the trust is to retain any credibility, particularly among the people and families who use its services. Why have there been different responses to Mid Staffs and Southern Health? Both are about the neglect and death of vulnerable people in NHS care. There have been serious consequences for those in leadership positions in Mid Staffs, but not so at Southern Health. What does that say about the value placed on the lives of people with learning disabilities and older people with mental health problems?

[Lord Prior of Brampton]

My Lords, a number of serious questions have been asked. I shall make a personal observation. This trust is the result of the merger of three trusts: a mental health care trust, a community trust and a learning disabilities trust, three very complex businesses being brought together as one. They have 250 separate locations with over 1 million patient contacts every year. The risk inherent in that kind of business at this time is huge. In putting in a governance structure, we have to be very careful that we do not just draw up such structures in a boardroom or come up with strategies that cannot be implemented.

In the report, I was very struck by the fact that now there is almost a tick-box approach to the duty of candour; you tick the box to say that you have done it. Culture is usually important in this. What is the culture in the trust? That is one of the big issues that the CQC report is trying to get at. In response to the question of whether we can give guarantees about patient safety: this is inherently a very risky activity. Putting in strong governance structures is very important, but much will depend on the culture within the trust.

I turn to some of the particular points. I, too, was struck by the fact that there were still problems with ligature points in some of the facilities, as had been pointed out by the CQC some time ago. I was struck by the fact that the epilepsy protocol for those being bathed or showered had not yet been approved two and half years after Connor Sparrowhawk’s death. Clearly, there were very significant problems at the trust. On the question of where accountability and responsibility lie, the chairman has resigned. The principal job over the next three or so months will be assessing the capability of the executive management. That seems the right way to approach this.

It is always tempting to call for a public inquiry; I understand that temptation. We have an independent regulator, the CQC. The inspection team was led by mental health professionals and is fully transparent. We now have to give the trust the chance to respond to the CQC’s report and watch for serious improvements.

The noble Baroness asks if there have been any improvements. There are some illustrations and examples in the CQC report of where there have been some improvements, but putting in a new governance structure, changing the whole culture about raising concerns about those kinds of issues, will not happen overnight. Of course, I appreciate that for Connor Sparrowhawk’s family this happened two and a half years ago, and one must never lose sight of that.

A question was asked about NHS Improvement. It put in an improvement director. These people do not grow on trees. If we are honest about the NHS, we are very short of highly qualified and highly skilled senior management, and it sometimes takes time to find the right people.

Mental Health Services

Baroness Tyler of Enfield Excerpts

Thursday 28th April 2016 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what assessment has been undertaken of the likely impact on the quality of mental health care of removing mental health quality premium measures from NHS England’s Quality Premium Guidance for 2016-17.

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

My Lords, the quality premium for 2016-17 enables clinical commissioning groups to choose three local priorities, including from a menu of 17 mental health indicators. Given that mental health is still part of the scheme, NHS England has not assessed the effect of removing it. The Government have invested more than ever in mental health. Spending is estimated to have increased to £11.7 billion, and in January we announced almost £1 billion of extra investment.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his Answer, but I confess that I am left genuinely perplexed by the decision to drop the national level financial incentive for commissioners locally to improve mental health care. The four national measures account for 70% of the quality premium, which is worth up to £217 million. Relegating mental health to the very long list of 80 indicators from which local commissioners can choose only three seems no substitute. How does that downgrading of mental health in the quality premium scheme square with the Government’s oft-repeated commitment to ensure equality between physical and mental health?

[Lord Prior of Brampton]

My Lords, this year NHS England has chosen primary care, cancer and antibiotic prescribing to be the three key parts of the national quality scheme but, as the noble Baroness has said, 30% is determined locally, of which 17 indicators are related to mental health. NHS England proposes to include a mental health indicator in its national scheme in 2017-18. The point about the national schemes is to provide incentives and they will change from one year to another. If they are the same every year, they will cease to be incentives.

Psychiatric Units: Child and Adolescent Patients

Baroness Tyler of Enfield Excerpts

Wednesday 13th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there is no question but that early intervention is critical. There is a huge amount of unmet need. I expect that everyone in this House will know someone who has a child who has suffered from mental health problems, whether anorexia, self-harm or other aspects of mental ill health. It is a complete disaster, and for anyone who watched that “Panorama” programme it will have been brought very close to home. What the right reverend Prelate says is absolutely right. As I said in answer to the earlier question, we have a long way to go.

[Baroness Tyler of Enfield (LD)]

My Lords, the recent research highlighted on the “Panorama” programme also highlighted the deeply disturbing fact that there is no single body responsible for collecting, analysing and recording these data. What plans do the Government have to ensure that this information is centrally collected and publicised?

[Lord Prior of Brampton]

If I may, I will write to the noble Baroness on this matter. For me, the two profound issues in that “Panorama” were, first, that the parents of that poor girl, Sara Green, had to travel for over five hours to visit her in the in-patient setting that she was in; and, secondly, that she was found to be ready for discharge after three months in that setting but it was six months later when she took her life in the home, because there was no community resource in place closer to her home. The whole thing is a tragedy, but those two aspects in particular were very disturbing.

NHS: Mental Health Services

Baroness Tyler of Enfield Excerpts

Monday 14th March 2016 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what plans they have to publish data regularly on the availability and quality of NHS-funded mental health services across the country.

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

My Lords, data on mental health have been a bit like a black hole. We are working with the Mental Health Data and Information Board to improve the data, as recommended by the Mental Health Taskforce. A new mental health dataset will be online by April this year. Starting with early intervention in psychosis, it will comprise data on waiting times, availability and outcomes. We will expand the dataset to other pathways once data become more robust.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his Answer. The Mental Health Taskforce which he alluded to called for a data and transparency revolution in mental health services, specifically in their availability and the spending on mental health. Its actual words were “absolute transparency on spending”. What steps are the Government taking to ensure that the data on spending come into the public domain and how quickly will that happen? Specifically, how does the department intend to respond to the call last week from the Mental Health Commissioners Network for money for children and young people’s services to be ring-fenced so that it is not siphoned off elsewhere?

[Lord Prior of Brampton]

We agree entirely with the recommendations in the task force report regarding the need for a revolution in transparency of information about mental health, and that will include spending. Even when adjusted for need, I think that there is almost a twofold variation in the spending on mental health from one CCG to another, so we entirely accept the recommendations.

Mental Health Taskforce

Baroness Tyler of Enfield Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we have strayed somewhat from the subject. On the money, the Prime Minister announced an extra £1 billion in January. It is the same £1 billion and is within the £8 billion—or £10 billion—that was in the settlement in November. The Government asked Paul Farmer to set out in his report where the priorities are and where the money should be spent, and that is exactly what has happened. Interestingly, I saw Don Berwick last week. He is a very distinguished American with a lot of experience in patient safety and health improvement. There is no question: it is going to be tough. It will be very difficult to do on around 7% of GNP, but there is absolutely no doubt, from the work of the noble Lord, Lord Carter, and others, that there is a lot to go at. If it was not tough, we would not be going at it. We must take advantage of the fact that it is going to be tough by addressing some of the difficult issues which we should perhaps have addressed in the past but did not.

[Baroness Tyler of Enfield (LD)]

My Lords, the task force report, which I greatly welcome, points out that, while mental health activity accounts for some 23% of what the NHS does, it accounts for roughly half of that in NHS spending. Worse still, years of low prioritisation within the NHS have meant that clinical commissioning groups have often diverted money earmarked for mental health spending to areas of physical health, and that is harder to quantify because of obscure methods of data collection. Could the Minister say what steps the Government propose to take to ensure that the extra £1 billion announced, whether entirely new or not, is actually spent on improving mental health services. How will that be monitored in practice?

[Lord Prior of Brampton]

My Lords, that is clearly a very good question. At our level, we will monitor this through the mandate given to NHS England. Within that mandate, it has told all CCGs that they must increase their spending on mental health services by, I think, at least 3.7%. The noble Baroness will be interested to know that in the first six months of this year the increase in spending on mental health has been 5.4%, so it is higher than the stipulated 3.7%. Over the next five years I think we will see a trend towards more money going into mental health and primary care and away from acute care. We should not underestimate the very difficult impact that will have on many of our acute hospital services. The transformation will be very difficult. We may not agree on how much money it will take but I think we all agree in this House on the direction of travel—that it must be right for money to be spent in those areas. I hope that answers the noble Baroness’s question.

Health: Adult Psychiatric Care

Baroness Tyler of Enfield Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I reiterate my thanks to the noble Lord for his excellent report: it is 134 pages and reads very well and very quickly. It is obviously highly unsatisfactory that so many people have to travel long distances to get in-patient care. The noble Lord’s report shows that, in one month—in September, I think—500 people had to travel more than 50 kilometres to get to in-patient care. It is a priority for the Government and we are considering the noble Lord’s recommendations. I cannot give a commitment that we can reduce the four years to 18 months now. I can only repeat that we fully understand the importance of addressing this issue.

[Baroness Tyler of Enfield (LD)]

My Lords, the noble Lord’s report rightly points to the need to improve both in-patient care and alternative treatment in the community. Given that, as the report says, the cost of one adult acute bed is the same as that of treating 44 people at home, will the Government say what plans they have at this early stage to increase financial incentives to encourage commissioners to get the right balance of provision?

[Lord Prior of Brampton]

My Lords, if we can improve home treatment and crisis resolution at home it will free up in-patient beds and solve the other problem as well, as people will have to travel less far. That is absolutely critical. I cannot tell the noble Baroness today what NHS England is proposing to do with financial incentives, but I can reiterate that treating more people outside hospital, at home, is a priority for the Government.