NHS: Reform
Baroness Tyler of Enfield Excerpts(9 years, 5 months ago)
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Lord Prior of Brampton
There is no doubt that, looking forward over the next five years, the resource to be put into primary care will be greater, relatively, than it has been in the past. We wish to deliver more care outside hospital. That is why we are committed to training and having in place 5,000 more doctors in general practice by the end of this Parliament—not just GPs, but others who will support GPs.
The model of primary care will change significantly over the next five years, and it is fundamental to the five-year forward view that we reduce the number of people going into acute hospitals and that we discharge people at the other end of their journey through an acute hospital much quicker.
Baroness Tyler of Enfield (LD)
My Lords, I welcome the principle of working towards a weekend service—indeed, I think it is hard not to—but I certainly do not underestimate the difficulty of achieving it, particularly in a fully joined-up way. This morning, I attended a meeting with many children and young people who had experienced a serious mental health crisis at the weekend and had real difficulty accessing the treatment they needed. Indeed, some of them had turned up at A&E but there had simply been no mental health services available for them. In the light of that, will the Minister reassure me that the principle of seven-day working will apply to consultants from mental health disciplines, particularly those treating children and young people whose access to those services seems to be even harder to secure than it is for adults? Secondly, the Statement talked about CQC quality ratings as well as waiting times being made accessible to patients. Will he confirm that these will include waiting times for mental health services?
Lord Prior of Brampton
The Government are committed to parity of esteem, and if we are truly committed to parity of esteem the answer to both the noble Baroness’s questions must be yes. We must have the same standards for physical health as we have for mental health. If someone has a psychotic crisis on a Friday afternoon and they cannot get access to any help until the following Monday, that is clearly extremely poor care. If they end up in an A&E department being looked after by people who have no experience of dealing with mental health problems, it is a very poor environment to be in, so I agree entirely with the noble Baroness.
Mental Health: Young People
Baroness Tyler of Enfield Excerpts(9 years, 5 months ago)
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Baroness Tyler of Enfield
To ask Her Majesty’s Government what plans they have to respond to the recommendations of the Children and Young People’s Mental Health Task Force Report Future in Mind.
Baroness Tyler of Enfield (LD)
My Lords, following hot on the heels of our excellent debate last week on young people’s experience of mental health crisis care, I am delighted that today we are able to debate the Government’s response to the children and young people’s mental health task force’s report Future in Mind. Perhaps the focus we now have in your Lordships’ House on mental health—and, recently, on children and young people’s mental health in particular—shows that the tag “The Cinderella of Cinderella services”, which is often used in debates in this House, is starting to become a thing of the past. Let us hope that is indeed the case, but let us also remain vigilant so we can feel confident that the good intentions of the task force’s report will turn into a reality for the alarmingly high number of children and young people in this country experiencing mental health problems.
I start by thanking all the members of the children and young people’s mental health task force for producing an excellent report. Since its publication in March this year, it has clearly had a major impact on mental health policy. In his March Budget, the Chancellor announced that mental health services for children and young people would receive an additional £1.25 billion in funding over the next five years. This amounts to £250 million annually, £l5 million of which is for perinatal services, the rest being for children and young people’s mental health services. This is in addition to the announcement in the Autumn Statement of £150 million over five years for eating disorder and self-harm services. This new investment is much to be welcomed, and I do so wholeheartedly.
However we need to remember the broader context. It is no secret that historically CAMHS have been neglected and starved of cash, perennially losing out to other health services deemed to be of higher priority. So we should keep in mind that, even with the additional money, funding for CAMHS makes up only 8% of the total mental health budget, even though children and young people make up 23% of the population. Given this, it is more important than ever that we examine how these funds will be used.
The additional £1.25 billion of funding will be directed to local areas once they have completed and published local transformation plans. In order to develop these plans, the lead commissioning agency, which is most likely to be the clinical commissioning group, needs to work with health and well-being boards, schools, children, young people and families in the locality to decide precisely where the investment should be targeted. To have real teeth, it is vital that transformation plans contain local access and waiting time targets in line with the ambitions contained in the NHS five-year plan, and address the issue of choice of provider for children and young people, including in the rollout of access to psychological therapy.
Considering that most families do not currently feel that CAMHS is anything like meeting their needs, it will be particularly important that CCGs communicate directly with children and their families to help determine the areas where additional investment is most needed. Yet the proposed timeline for formulating these transformation plans, which are to be completed by the end of September, is very short and, given the time of year that they are expected to formulate these plans—between July and September—one has to ask whether is it realistic to expect CCGs to be able to engage with schools, young people and their families in a meaningful way.
I was pleased to see a specific commitment of £15 million per year to improve perinatal mental health services. The task force reports that maternal perinatal mental health problems carry a long-term cost to society of about £10,000 per birth, and nearly three-quarters of this cost has to do with adverse impacts on the child. For example, the odds of a child developing depression are nearly five times greater if their mother experienced perinatal depression. Such outcomes are avoidable. Specialist mother and baby units across the country are delivering excellent results helping new mothers with psychiatric problems bond with their babies. The NSPCC suggests that one in 10 children would benefit if all new mothers with mental illness had access to programmes such as these mother and baby units. Given this, it is simply unacceptable that currently only 15% of localities provide perinatal mental health services at the level recommended in national guidance and that 40% provide no service at all. Worse still, only 3% of CCGs have a strategy for commissioning perinatal mental health services.
Turning to preventive work, I am also pleased to see that the Government have responded to calls from the task force for schools to take a greater role in promoting good mental health and fostering resilience—something we on these Benches have long called for. Some local areas are already doing very good work in this field. For example, Kingston Council decided to appoint health link workers, part of whose role is to help schools and young people identify mental health issues at an early stage. Working in this way, they are able to address issues such as depression, self-harm and eating disorders early on, so that they do not become a bigger problem later. The health link workers are also able to educate staff to recognise the signs, talk directly to the pupils and try to get them help.
I understand that the Department for Education will contribute £1.5 million in 2015-16 to run a joint pilot programme with NHS England to place named CAMHS contacts in schools to act as liaison between staff, students, and community CAMHS. If implemented effectively, this programme has the potential to provide more direct entry points into specialist mental health services and to allow school staff to gain insight into how to cultivate a healthy learning environment.
Schools can provide a very valuable referral route towards specialist services but, as the task force report highlights, this will not reach all the children who need mental health care, particularly the most vulnerable children. The charity YoungMinds reports that one in three young people say that they do not know where to turn to seek help. Indeed, the process of accessing specialist services can be lengthy and confusing. Programmes such as the Well Centre in London offer an alternative. It holds open drop-in hours for young people aged 13 to 20 three afternoons a week, when they can access specialist mental health support easily and confidentially.
For others, accessing care is difficult because of disability or other difficulties in their lives. For example, learning disabled children are likely to have particular difficulty accessing care. Barnardo’s reports that children in care are five times more likely to develop childhood mental health problems, and 10 times more likely than their peers to have significant learning disabilities, meaning that although they need support the most, they are also less likely to be able to access it. I particularly commend the work of the task force’s sub-group, which looked in depth at the issue of vulnerable groups and inequalities. As a result of its work, the task force report makes it clear that in order to engage the most vulnerable children, commissioners and providers across education, health, social services and youth offending teams will need to take an active role in engaging the children and young people who are the least likely to engage with existing services.
The task force found good examples of workers trained to deliver support in a flexible, approachable and joined-up way to help reach some of the most needy young people. What really brought this to life for me was the case study of Jay, a 17 year-old cannabis dealer involved in gang activity, who was mistrustful of professionals, fearing that talking to him would lead to him being put in prison. His mental health had deteriorated since witnessing several stabbings in his area. He failed to show up for various appointments, so his case was closed. But Jay’s youth offending team worker identified a youth worker in the community who already knew Jay and his family, and they began to meet Jay in places where he felt comfortable, such as at his favourite fish and chip shop. Eventually, the YOT worker was able to gain Jay’s trust sufficiently to convince him to begin treatment for substance abuse. Where most services would have given up on Jay, these workers were able to reach him and put him on a path to recovery from both substance abuse and mental ill health. How do the Government intend to respond to the task force’s recommendations about reaching out to the most vulnerable children and young people?
In my view, the task force report Future in Mind is a landmark document in the much-needed improvement of mental health services in England. My hope is that it fuels transformational change not just for CAMHS but for all the sectors involved in helping young people access appropriate and effective mental health care. The Government’s commitment of additional funding is very welcome and the development of transformation plans in this area is promising, but there is still much to do to ensure that the additional funding is spent to best effect. Will the Department of Health and NHS England therefore commit to publishing an annual progress report on the implementation of Future in Mind?
Mental Health Services
Baroness Tyler of Enfield Excerpts(9 years, 5 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, I congratulate the noble Baroness, Lady Thornton, on securing this important debate. Failures in crisis care for children and young people often make for attention-grabbing headlines. We have all heard the stories of children being admitted to hospitals hundreds of miles away from their families, and of children held in police cells. The Care Quality Commission’s Right Here, Right Now report and other findings tell us that these dreadful situations are not isolated incidents but reflect a larger failure to provide sufficient crisis care for children and young people.
The adoption of the mental health crisis concordat last year was an enormous step forward for the provision of crisis care, pioneered by my right honourable friend Norman Lamb when a Minister. Central and local government and leaders of key services agreed to work towards making sure that compassionate and understanding crisis care would be available 24/7; that a mental health crisis would be treated with the same urgency as a physical health crisis; that people should be treated with dignity and respect in an environment that is conducive to their needs; and that appropriate follow-up services would be provided. That sounds great, but delivering the promises of the concordat will require more than generalised statements of support, very welcome as they are. We need to ensure that promises made in local area action plans are delivered. It will mean tackling long-standing failures in commissioning, which in turn will require strong and sustained local leadership and, crucially, the necessary resources. As we have already heard today, children and young people tend to receive a lower quality of crisis care. I thought it was shocking that the CAMHS 2013 benchmarking report noted that only 40% of CAMHS had crisis care pathways, as they are called.
What happens to those young people who cannot find the care they so desperately need—the other 60%? It is not a particularly encouraging picture. The CQC report found clear differences in the quality of care for children turning up at A&E in crisis compared to the quality of care for adults. In accordance with the rapid assessment and intervention model, adults are generally seen promptly and directed to community services, while 16 and 17 year-olds are assessed with support from CAMHS and those under 16 are referred directly to CAMHS. Your Lordships might say that sounds absolutely right but, as we have already heard today, the reality is that CAMHS are often not offered out of hours and if a CAMHS referral is made after midday, the child will often not be seen until the following day or even until after the weekend.
On the plus side, I was pleased to note that the Department of Health and NHS England have committed in their publication Achieving Better Access to Mental Health Services by 2020 to develop a national all-age liaison psychiatric service in A&E departments. This is both welcome and timely. Such a service should help ensure that children in crisis receive at least some support immediately. However, it is surely unacceptable that access to referral services should be so delayed. Could the Minister say what plans the Government have to establish an out-of-hours mental health service for children, as the recent Children and Young People’s Mental Health and Wellbeing Taskforce report, Future in Mind, recommended?
What happens if a young person experiencing a mental health crisis needs to be admitted to hospital? The reality is that in hospitals where in-patient treatment is provided, there are simply not sufficient places for children and young people. Although the prevalence of mental health problems has been increasing, there was a 39% drop between 1998 and 2012 in the number of mental health beds available in England, and this shortage has particularly impacted on children. In a recent survey by the Royal College of Psychiatrists of its trainees, 83% said they had difficulty finding an appropriate bed for children and young people, compared to 70% who had difficulty finding an appropriate bed for an adult. As a consequence, many children end up being admitted to wards for adults or to hospitals far from home. Of those surveyed, 22% reported having to place a child 200 miles away from home—a fact I find truly shocking. What chance does a young person have to recover without the care and support of their family nearby? Could the Minister say what assessment the Government have made of whether there are sufficient beds to ensure that children with severe mental health needs are able to access appropriate in-patient care in their area?
The availability of effective home treatment teams for children and young people can reduce the number of people who end up at A&E or who have to be admitted to hospital, which of course must be desirable. It is encouraging that the task force’s report referred to earlier, Future in Mind, found some good examples around the country of dedicated home treatment teams for children and young people. Could the Minister say what steps are being taken to develop improved information about the provision of these services and, indeed, to expand their provision?
Since the concordat, there has been widespread agreement about the need to stop the practice of holding children and young people in police cells as a so-called place of safety. I was pleased to see a specific commitment in the gracious Speech to legislate to ban this practice. This approach is already starting to make a difference, with numbers starting to fall. However, it remains the case that one-third of children and young people detained under Section 136 are held in police custody. Political commitment and the proposed change in the law, although very welcome, will not be enough. The truth is that the excessive use of police cells as places of safety is largely the consequence of operational and commissioning failures—a key theme running through my remarks today.
Too often, police stations are used as places of safety because health-based places of safety do not accept children. The CQC report found that 35% of the health- based places of safety surveyed do not accept under-16s. Similarly, research from the Howard League estimated that 74% of mental health trusts do not provide a specialised place of safety for children. I warmly welcome the Government’s announcement that they will commit £15 million to deliver health-based places of safety. What steps will be taken to ensure that clinical commissioning groups prioritise investment in this crisis care provision, particularly for children and young people?
To conclude, when people experiencing mental health crises do not have access to the sort of timely, effective and compassionate care that people with physical health problems do, it is not just unfortunate, it is simply unfair. It is even more unfair when children and young people experiencing a crisis relating to mental health problems do not even have access to the level of care that adults do. We can and must do better.
Mental Health Services: Young People
Baroness Tyler of Enfield Excerpts(9 years, 5 months ago)
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The Lord Privy Seal (Baroness Stowell of Beeston) (Con)
My Lords, we have not heard from the Conservative Benches yet on this Question. I think my noble friend Lord Elton is next.
Standardised Packaging of Tobacco Products Regulations 2015
Baroness Tyler of Enfield Excerpts(9 years, 9 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, I congratulate the Minister and the Department of Health on producing a high-quality and thorough set of regulations after a thorough consultation exercise. I join the noble Lord, Lord Faulkner, in adding my congratulations to the department for receiving the Luther Terry Award for Exemplary Leadership by a Government Ministry. It is measures such as these that make Britain a world leader in public health.
In our debates on this subject, I have spoken extensively about the need for these regulations and the evidence that they would make a real difference. The bare facts are these: only one in 10 smokers in the UK started after the age of 19, and two in five started before 16. We have already heard from the Minister the figures on how many people die each year from smoking-related diseases, and the number of children between the ages of 11 and 15 who take up the habit and risk their health by spending hundreds, if not thousands, of pounds a year on a toxic product.
The unconscious trigger of attractive packaging is an extremely successful marketing tool that encourages children and young people to glamorise and take up smoking. Bright colours, sleek designs and slim cigarettes—to name but a few—all make people falsely believe that such cigarettes are less harmful. I remember as an impressionable teenager the impact that some of those cigarette pack designs had on me. It made a big difference and I indeed wanted to start smoking, and did so; and I think I was influenced by some of that marketing material.
I should like briefly to turn to some of the objections that have already been advanced by opponents of these regulations in this debate. First, the tobacco industry has claimed that standardised packaging would increase the volume of illicit tobacco on the market. This is flatly contradicted by a recent HMRC assessment and an independent review by Sir Cyril Chantler, both of which indicated that there is no evidence for such a claim. Indeed, there is no evidence that standardised packs would be easier to counterfeit. Standardised packs are not “plain packaging”—that is a misnomer. They would carry the same security systems as current packs. There is no evidence that that there has been an increase in the illicit tobacco trade in Australia since the implementation of the policy. The total weight of illicit tobacco detected by Australian customs has remained roughly static since 2007-08. Indeed, a recent study shows that there was no change in the availability of illicit tobacco in Australian shops since the introduction of standardised packaging. At any rate, it seems logical that the way in which to reduce illicit trade is through more effective regulations, which these regulations clearly are.
Secondly, the tobacco industry has claimed that standardised packaging would damage small businesses because it would make it more time-consuming for shop assistants to retrieve packs, and that this delay would make tobacco less profitable for small businesses as opposed to large supermarkets. Tobacco companies based these predictions on interviews with just a handful of retailers. In contrast, peer-reviewed studies of small shops in Australia before and after the standardised-packaging policy demonstrate that there was no significant increase in serving time.
It is true that standardised packaging is likely to result in reduced tobacco sales. In fact, it is the very purpose of these measures; it is the Government’s hope and certainly mine. Every pound that consumers no longer spend on tobacco they will surely spend on other goods and it is very likely that small businesses will pick up some of this trade. After all, shops, including small shops, have adjusted to the continuous decline in the prevalence of smoking from half of the population in 1960 to roughly one-fifth now and there is no reason to suppose they will not be able to adapt further. On this point, can the Minister confirm that in the interests of reducing costs to retailers the measures will be implemented at the same time as the packaging and labelling measures in the EU tobacco products directive in May 2016? Can he also confirm that retailers will be given a full year after the implementation date to sell through existing stores of non-standardised packs? It comparison, retailers in Australia were given just eight weeks to do that.
The tobacco industry has made what I think is a very convoluted argument that standardised packaging will lower prices and thus increase tobacco consumption. In the process of conducting his review last year, Sir Cyril Chantler was told by tobacco companies that sales had increased slightly, despite the fact that the industry had told its investors the opposite. Analysis by the independent market research company Euromonitor concurred that there had been a decline in sales in Australia between 2012 and 2013.
As we have already heard, it seems to be contested—although frankly I do not know why—what the impact in Australia has been since the introduction of standardised packaging. I have looked very carefully at what the helpful leaflet Standardised Packaging for Tobacco Products, produced by very reputable organisations such as the British Heart Foundation, King’s College London, the University of Waterloo, Cancer Council Victoria and the UK Centre for Tobacco and Alcohol Studies, has said about the impact so far. It shows that there is a reduction in young people taking up smoking and an increase in the proportion of existing smokers who are trying to quit. Indeed, the National Drug Strategy Household Survey in Australia showed that the proportion of 18 to 24 year-olds who had never smoked increased from 72% in 2010 to 77% in 2013.
A 2014 study from Australia that reported in the British Medical Journal shows that the prevalence of smoking among adults fell by 15% in the second half of 2013 alone. Finally, following evidence that smokers find cigarettes in standardised packs less appealing—which of course is the very purpose of it—there is new evidence that calls to Quitline, a free smoking cessation service, have increased by 78% since the introduction of standardised packaging.
It is a credit to the very thorough and painstaking way that this measure has been developed by the Government that these are the best criticisms opponents can level. Above all, it is time to listen to the 72% of Britons and the majority of all political parties and support standardised packaging.
Viscount Falkland (CB)
My Lords, I am a non-smoker but having been in your Lordships’ House for some years one thing that concerns me about this measure is the unintended consequences. One is always worried in this House about them and so we should be. It seems very odd that so few people have expressed the view that tobacco is a legal product. How can you interfere with the marketing and the sales of a legal product? I think the product is undesirable and the arguments of the scientific community about its danger to health are indisputable. However, we have to think rather carefully about what may follow. If you get away with this without too much protest there are all kinds of bien pensants and vigorous politically correct people who will seek to do various things. For example, it could happen quite easily that in some local authority someone of limited life experience might suggest that, with obesity and the compulsion that people have to eat too much, it might be a good idea to prevent restaurants allowing people to eat on the pavement under an awning because that attracts people to sample the restaurant’s delicious wares. Noble Lords may think that this is a trivial, Clarksonesque point, but it bears thinking about.
I am grateful for the efforts that have been made to curb the ill effects of smoking. I am a frequent cinema goer—I have been a film buff since I was a boy. I do not think I would be talking to noble Lords today if they had not banned smoking in cinemas. I may have a husky voice, but I would probably be dead by now, I should think. These are things that have to be considered.
In the speeches so far, there has been scant respect for one thing that is very important to this country, and I hope it will be borne out in the speeches during the election campaign. This is a trading country, and trading countries require freedom in order to encourage the production of goods, to sell them and to market them correctly. If you do not like smoking, then ban it, for heaven’s sake. Do not try to pretend that this is going to deal with it—it is not going to deal with it. We have already seen the unintended consequences on the streets. In some of our best streets in the West End of London you see cigarette ends everywhere because people are smoking at lunchtime in doorways, smoking in the open air and smoking in groups; they are also smoking in their homes because it is unsatisfactory outside so that the smoke filters through badly constructed walls.
There are all kinds of aspects of this whole problem which have not been properly addressed, and I do not think that packaging is the answer. Should the noble Lord who introduced this amendment guide us towards the Lobbies, I shall follow him.
Mental Health Services
Baroness Tyler of Enfield Excerpts(9 years, 9 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, in a rapidly changing world, children and young people face a wide range of risk factors for mental health problems, both now and later in life. It is salutary to note that in an average classroom, 10 children will have witnessed their parents separate, eight will have experienced physical violence, sexual abuse or neglect, and seven will have been bullied.
Those in the particularly vulnerable group, children in care, are typically in care precisely because they have experienced neglect or abuse, and these traumatic experiences can affect them for the rest of their lives. The recent Barnardo’s report, The Costs of Not Caring, showed that children in care are five times more likely to develop childhood mental health problems and, shockingly, are five times more likely to commit suicide later in life.
Despite the widespread concern about the current state of mental health services for children and young people, it is important to acknowledge what the Government have done to improve things, including investing £54 million into the children and young people’s IAPT programme and the recent announcement by the Deputy Prime Minister that £150 million will be invested over the next five years to improve treatment for eating disorders. It is welcome, of course, but nothing like enough.
We are all aware of the impact of budget cuts on CAMHS services. As a consequence, children have too often been transferred far from home or placed in adult wards that are ill equipped to take care of them. Services provided by the voluntary sector have picked up some of the slack, but there is often a lack of awareness about these services and they may be ill equipped to deal with serious mental health problems.
In reality, the help that is available can be hard to find. A 2013 YoungMinds study found that one in three young people does not know where to turn for mental health support; and, as the National Children’s Bureau pointed out, only a quarter of five to 15 year- olds with anxiety or diagnosable depression are in contact with CAMHS. By the time young people do get support it can be too late. More than 80% of parents said that children and young people were at crisis point before they managed to get support.
What is to be done? I greatly look forward to the findings and recommendations of the Government’s Children and Young People’s Mental Health and Wellbeing Taskforce. What is on my wish list? First is far more joined-up commissioning for CAMHS, with young people’s voice at the heart of service design. Secondly, counselling in schools can provide an alternative and valuable route for young people to get therapeutic help. Schools in Wales and Northern Ireland are already required to provide counselling. In my view, children in England should have the same opportunity. Can the Minister say what practical steps the Government are taking to ensure that all children have access to school counselling?
Thirdly, as already stated, children in care are not only more likely to experience mental health problems in childhood, they are also more likely to experience the sorts of problems—emotional instability, substance abuse, self-harm—that lead to worse outcomes later in life. That is why I think that CAMHS, IAPT and school counselling should explicitly prioritise the needs of children in care as part of the corporate parenting role that government plays.
When we think about children’s mental health we should think not only about the 10% who already have a diagnosable condition. Relatively minor problems in childhood often snowball and develop into fully fledged mental health disorders in adulthood. There are good examples of effective early intervention, such as specialist support to help parents develop a healthy connection with their young babies, and parenting programmes, as we have already heard.
I believe that schools should have a responsibility to prepare children not only for exams but for the difficulties they may face in later life. That is why I would like to see PSHE programmes to address issues such as bullying, drugs and alcohol, and mental health being compulsory for all primary and secondary schools.
Finally, preventive mental health support should be offered to all children in care and care leavers so that they can access the support they need to overcome past trauma and achieve stability later in life. I thank the noble Earl, Lord Listowel, for having secured this debate.
Smoke-free (Private Vehicles) Regulations 2015
Baroness Tyler of Enfield Excerpts(9 years, 10 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, I, too, welcome these regulations and congratulate my noble friend Lord Ribeiro on his unstinting efforts in this area. I stress that this new law and these regulations are not designed to turn smokers into criminals or to demonise them; they are about protecting children from the avoidable dangers that tobacco smoke presents to their health and welfare. For me, that is what it is all about. Right through these discussions, I always saw this legislation primarily as a matter of child protection. If noble Lords will excuse the terrible pun, it was about putting children in the driving seat.
When we had those early debates, I was very taken with the number of children who said that they felt that they had no control over the situation and that they were either too embarrassed or too scared to ask adults to stop smoking. The survey mentioned by the noble Baroness, Lady Finlay, referred to how children really want this legislation. In my professional life, we often talk about the voice of the child being at the centre of what we do. Based on that survey, we have a clear mandate from children and young people to take these regulations forward.
The Minister said that the start date will be October. In an ideal world I would have liked to have seen it earlier, but I accept the reasons that he gave. It will be incredibly important legislation in addressing health inequalities, and will go some way at least towards protecting children from the most disadvantaged backgrounds from smoke and enable them to have a healthier start in life. As others have said, this is very much about behaviour change. Certainly, the experience that we have seen on similar issues, such as public smoking and compulsory seat belts, suggests that educational campaigns, which are important, are most effective in changing behaviour when accompanied by appropriate legislation. For the effect of legislation on the proportion of people wearing seat belts, I have a figure that shows an increase from 25% to 91%, which seems extraordinarily large. Just imagine how many children’s lives will be improved if this legislation has even half that success.
The Minister referred to success being measured in terms of positive behaviour change rather than the number of fines handed out. I am sure that that is right, and I approve of that approach, but will he confirm precisely how that behaviour change will be measured?
There are very high levels of public support for the law. In previous debates, as one would expect, we heard that parents were very much in favour of this legislation. However, we also heard about recent surveys and the number of adults, including adult smokers, in favour of this legislation and the number of car drivers who support it. There is a real and growing consensus that these regulations are a good thing and should be introduced without delay.
I very much hope that, without much further delay, we will very soon debate the regulations on standardised packaging.
Mental Health Services: Sign Language Users
Baroness Tyler of Enfield Excerpts(9 years, 10 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, I thank the noble Lord, Lord Ponsonby, for securing this debate and drawing attention to this important issue. A few weeks ago, I opened a debate in this House about the many challenges confronting mental health services as well as the important new policy and service development instigated by this Government. I particularly appreciate the chance to speak today about the problems that deaf people face in accessing effective mental health care.
It is really important to remember that when we speak of deaf people, we speak of a large and extremely diverse group. There are 9 million deaf or hard-of-hearing people and 700,000 severely or profoundly deaf people in the UK, 50,000 of whom use British Sign Language as their first or preferred language. While some deaf people were deaf at birth or from a young age, others become deaf late in life. The mental health needs of deaf people will differ depending on these factors.
Nevertheless, deaf people as a group share a disproportionately pressing need for mental health care. It has been estimated that 40% of deaf people have a mental illness. The prevalence of common mental disorders such as anxiety and depression in the deaf community is nearly double that of the hearing population and behavioural and personality disorders are between two and five times more common among sign language users.
Deaf children are particularly in need of mental health services as the particular challenges of their life make it more likely that they will experience mental health problems. More than 90% of deaf children are from families with no first-hand experience of deafness, which can lead to isolation and troubled relationships with their families. It is salutary to note that deaf children are twice as likely to be abused or neglected as hearing children.
Let me now turn to the issue of prevention. For many people who lose their hearing as adults, the experience of becoming deaf can adversely affect their mental health. For example, research shows that older people with hearing loss are twice as likely to develop depression as their peers without hearing loss as well as increased feelings of loneliness and social isolation. Like, I am sure, other noble Lords, I am conscious of this from the first-hand experience of close relatives. By providing people with hearing aids, we can reduce these risks. Those who wore hearing aids experienced less depression and anxiety, had more and better family and social relationships, and felt better about themselves than those who did not.
It is impossible to avoid the issue of funding and it is complex. To set the overall context, while very welcome additional funding has been made available for specific mental health initiatives, our recent debate made clear that mainstream mental health services have suffered from disproportionate cuts in comparison with physical health services for both adults and children. Within this context, specialist services for deaf people remain a particular concern, not least given the current architecture of health service commissioning. In short, while secondary and tertiary mental health services for deaf people are commissioned on a national basis, primary mental health care is the responsibility of local clinical commissioning groups, and this, of course, includes mental health services for deaf people. So while the specialist in-patient units for deaf people in London, Birmingham, and Manchester that we have already heard about may receive adequate funding, commissioning for community services is extremely patchy. That is mainly because the deaf community within the area covered by each CCG is relatively small and there is therefore little incentive for it to prioritise the needs of deaf service users. The result is that only a handful of services receive local commissioning.
Let me try to bring this to life. Until early last year, deaf service users were able to access a deaf therapist fluent in sign language through the British Sign Language Healthy Minds IAPT service developed by the charity SignHealth, which was referred to by the noble Lord, Lord Ponsonby, with funding from the Department of Health. The programme was extremely successful and nearly doubled the rate of recovery from 44% to 75%, which is extremely impressive and important. However, in the restructuring of the NHS, clinical commissioning groups were often hesitant to commission the service, preferring to use hearing therapists with interpreters, even though the evidence shows that this is not as effective. Meanwhile, the service was often considered too small scale to qualify for national commissioning. Because of these challenges, the service is rapidly shrinking and some staff have been made redundant. Can my noble friend the Minister say what the Government are doing to support CCGs to increase the data collected in their local community to help inform mental health commissioning for deaf people?
In such circumstances, deaf people seeking talking therapies, which I greatly support, often have little choice but to resort to mainstream services. Deaf people are often not given adequate access to interpreters, as we have heard. Indeed, a 2012 survey of British Sign Language users found that 68% of respondents did not get an interpreter for their GP appointment, despite having asked for one. Many others must wait longer for treatment and travel further in order to secure access to an interpreter. What plans do the Government have to increase the provision of medically skilled interpreter services?
Even when there is access to an interpreter, going through therapy with an interpreter can present significant challenges. The 2012 survey indicated that 41% of deaf patients felt confused following their appointment as they had trouble understanding the interpreter. This may be due to cultural reasons. It is important to recognise that the life experiences of deaf people differ in ways that go well beyond language, especially if they have been deaf from birth or a very young age. The relationship between a hearing therapist and a deaf service user can be made more difficult by cultural barriers as well as linguistic ones. It is no surprise or indeed criticism that mainstream mental health service providers often lack the specific expertise necessary to understand the unique life experiences of deaf people and work effectively with deaf clients. It is just that a specialist service requiring specialist expertise is needed.
Moreover, the inclusion of an interpreter, as the noble Lord, Lord Ponsonby, said, inevitably changes the dynamic in a therapeutic situation in ways that can be detrimental. For example, the sorts of topics discussed in therapy can be difficult enough to tell to a therapist without having to wonder whether one’s words will be faithfully conveyed by the interpreter. As the deaf community is small and close knit, there is a real chance that the patient will know the interpreter, and because qualified interpreters are hard to come by, the options are limited and there are few alternatives if a patient is uncomfortable with his or her interpreter.
As we have heard, there are specialist in-patient psychiatric units for deaf people in London, Manchester, and Birmingham, but the quality of care that deaf people receive is adversely affected by a lack of community resources. A recent report by the National Deaf Mental Health Service has shown that deaf adults in specialist and general in-patient programmes were in hospital for twice as long as hearing patients, not because of actual clinical need but because the community services they would need on discharge were not available. The current dearth of specialist services for deaf people is not inevitable. As Dr Sally Austen, a specialist for deaf people with mental health problems and a former chair of the British Society for Mental Health and Deafness has pointed out, if specialist deaf services were to include partially deaf people, the economies of scale would change. Dr Austen has also suggested that what is called “tele-mental health”, including online services, may also provide a solution for deaf patients with poor access to appropriate providers having to travel very long distances.
This is an extremely important discussion, and yet is not one that we often have. The last government strategy on the topic was back in 2005. If nothing else, what we have already heard—and more is to come—about the wide array of challenges that deaf people face in securing access to mental health care should surely convince us of the importance of updating our aims for this type of healthcare provision. I therefore, finally, ask my noble friend the Minister what plans the Government have to update the 2005 Mental Health and Deafness: Towards Equity and Access document so that it can become the cornerstone of all our work.
The UK has had a proud history of providing excellent mental health services for deaf people. It would be a tragedy to neglect that history by failing to give deaf people the access to therapy that they so clearly need and deserve.
London Health Commission: Smoking
Baroness Tyler of Enfield Excerpts(9 years, 11 months ago)
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Baroness Tyler of Enfield (LD)
My Lords, I rise to speak briefly in the gap. The UK is a world leader in tobacco control, of which I feel very proud. I have worked and lived in London for virtually all my life, and I would love to see London set a real lead and a real example by becoming a smoke-free city in the way described by the noble Lord, Lord Darzi. I congratulate the noble Lord on securing this debate, on all his work and on the recommendations of the London Health Commission, which were very far-reaching.
I also pay tribute to the Government for all their work on tobacco control and, indeed, to the Minister personally for everything that he has done. I remember very clearly the strength of feeling in this House when we debated the Children and Families Act 2014 around the standardised packaging of tobacco and about banning smoking in cars carrying children. The way the Government responded to that strength of feeling, looked at the evidence and then came back and accepted those things was an example of Parliament at its very best. The fact that the work was done very much on a cross-party basis really showed what can be done in this House when people come together and work together very sensibly.
I had the great privilege during that period of briefly meeting with the Minister in Australia, who was personally involved in steering this measure through in her country. It was wonderful to hear from her how they had got that through and the impact that it was starting to have. I want to add my voice to others in this afternoon’s debate to say how important it is that the standardised packaging regulations are laid in sufficient time for them to be considered, and for a vote to take place before the election. I also hope that the Minister will be able to give us some comfort on that because so much has been achieved in this Parliament that it would be a real travesty if we fell at the final hurdle.
Mental Health Services
Baroness Tyler of Enfield Excerpts(10 years ago)
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Earl Howe
My Lords, on the noble Earl’s second point, yes, a survey is most certainly being actively considered. On his first point, he is absolutely right. One of the task force’s focuses will be to consider and make recommendations on how we can provide more joined-up, more accessible services built around the needs of children and young people, looking at sometimes innovative solutions about how to get there and how to improve access to health and support across different sectors, including in schools, through voluntary organisations and online. I am very encouraged by the task force’s terms of reference.
Baroness Tyler of Enfield (LD)
Given that some 60% of children and young people in care are currently reported to have emotional and mental health problems, can the Minister say what plans the Government have to set access standards for these children as part of their wider drive to increase access to mental health services, to ensure that these very vulnerable people get the support that they need?
Earl Howe
My noble friend is absolutely right: there is a high prevalence of mental health issues in those leaving care. The Government are dedicated to supporting NHS England’s work to develop a service specification for the transition from CAMHS that is aimed at CCG-commissioned services. CCGs and local authorities will be able to use the specification to build on the best measurable services to take into account the developmental needs of the young person. A separate specification for transition from CAMHS to adult services is also in development.