(3 years, 10 months ago)
Lords ChamberMy Lords, I am not sure whether we are completely stepping back from the production of monoclonal antibodies. I am extremely grateful to the noble Lord for the briefing that he shared with me last month and for the opportunities to look at how we can onshore the manufacturing of monoclonal antibodies. He is entirely right: this is a critical area of life science production where Great Britain is frustratingly massively behind. In the resilience of our healthcare supply chains, we have a huge gap in this country, and it is one that we are keen to address. The Therapeutics Taskforce is looking at monoclonal antibodies as a way of supporting our response to Covid and we have, through Project Defend, a workstream to look at how we can encourage onshore manufacturing of these essential healthcare supplies.
My Lords, recent laboratory tests by scientists at Cambridge University show that one dose of the Pfizer vaccine may not produce sufficient antibodies to kill off the virus, particularly for the over-80s, leaving them at risk of catching the South African variant. Will the Minister say what assessment the Government have made of these findings and what plans they have to speed up the second dose of the Pfizer vaccine for the over-80s and all care home residents?
My Lords, I am grateful for the reminder from the noble Baroness. The analysis we have done of the Pfizer vaccine, and indeed of all vaccines, is extremely encouraging and the impact it has on the body’s antibody production rate is profound. In fact, for many vaccines it might be that a longer delay, of 12 weeks, to the second dose might have an improved impact on the body. The second dose is really important for longevity rather than for efficacy, and therefore, with the data we have at the moment, we do not have any plans to change the pace of the rollout, but we are making sure in absolute terms that the second dose is delivered to all those who have had a first dose, promptly and on time.
(3 years, 10 months ago)
Grand CommitteeMy Lords, I commend the noble Lord, Lord Forsyth, and his committee on this excellent report, proposing clear recommendations in what is a very complex area. I agree with many of them and underline the strong sentiment that we do not need further reviews, consultation or Green Papers; we need government action now or a White Paper with a clear implementation timescale.
Covid has cast a harsh spotlight on a highly fragmented, fragile and underfunded sector reliant on unpaid carers and piecemeal local arrangements, with care providers going out of business or handing back contracts. Other serious flaws in the system include a widespread lack of awareness that social care is not free at the point of use, underpaid staff with little career progression or professional development—leading to high vacancy rates and turnover—and a postcode lottery which leads to unjustifiable variations between places in access to care and its quality, often depending on a local authority’s ability to raise revenue.
The adult social care winter plan commits to providing free PPE to care homes until after the pandemic. What plans do the Government have to extend this pledge until at least late spring? Despite some short-term injections of government funding since 2017, years of significant underfunding, coupled with rising demands and costs, have combined to push adult social care services to breaking point. The Select Committee report points out that funding for adult social care in 2017 was below 2010 levels. It calls for an immediate injection of £8 million to restore care quality and access to 2010 standards, with free personal care available universally by 2025. I fully support these recommendations.
Any long-term reform must take account of the needs of working-age adults, who account for nearly half of the total social care budget, and unpaid carers as well as older people. Many working-age disabled people do not own their own houses—which, unfortunately, is how this political debate is mainly couched—and have not been able to save for care costs.
When it comes to paying for a new system that includes free personal care as a universal entitlement, it will have to be a partnership of public funding and private contributions by the citizen. Like the noble Lord, Lord Lansley, I believe that we should look for a solution through the prism of intergenerational fairness—a way in which all generations contribute but no one generation feels unfairly burdened. The Select Committee report touches briefly on this issue, which is to be applauded.
However, there is one aspect on which I take a different view from the committee. Rather than our relying primarily on raising the money needed from general taxation, I would like to see a funding solution with some element of hypothecation. I had considerable sympathy with the recommendation of the Barker commission that an additional percentage point of employee national insurance contributions for those aged over 40, raising some £2 billion in total, be earmarked for adult social care. This is similar in concept to the proposal put forward by the Intergenerational Fairness Forum of a new system of social care insurance contributions, at a rate of 1%, from the incomes of all working adults from the age of 40 until they stop working. Looking to the over-65s, as I argued in our debate earlier this week on inter-generational fairness, the case for individuals who continue to work beyond state pension age continuing to make national insurance contributions should also be part of the equation.
The shockingly high number of deaths in care homes in the first wave of the pandemic is a matter of national shame. We owe it to those who died and their families to ensure that a properly funded social care system, providing quality care to all, is a fitting legacy.
(3 years, 10 months ago)
Lords ChamberMy noble friend is right to remind us that this is not a gender-specific condition and that many men have eating disorders of one kind or another. The culture we live in does nothing but encourage that and I think we have to address the underlying causes, both psychiatric and the pressure of social media. We will be putting in place the resources necessary to support that kind of initiative.
My Lords, NHS Digital has reported that admissions for eating disorders have almost trebled since 2007, but there has been very little investment into in-patient treatments since then. With only 400 NHS beds for adult eating disorder sufferers in England, and capacity currently further reduced by the pandemic, what are the Government doing about this chronic shortage of in-patient beds for those suffering from serious eating disorders, which particularly affect young women?
The noble Baroness may not have heard my answer to the previous question, where I cited the large number of beds opened in the last year, totalling more than 30 across the country. I recognise that more beds are needed for those who have particularly acute disease, but the large prevalence of the disease among hundreds of thousands of young girls and boys also means that community care has to be at the heart of our response to this condition.
(3 years, 11 months ago)
Lords ChamberMy Lords, the whole House will welcome this White Paper. The overhaul of the Mental Health Act has been long awaited. It is also to be welcomed that the Government have accepted the majority of the recommendations from Sir Simon Wessely’s independent review of the Mental Health Act. As Sir Simon Wessely’s report highlighted, there is a great need for patients to be heard, for their choices to be respected and for them to be supported to get better in the least restrictive way.
Although legislative changes are important, the best way to prevent people being detained under the Mental Health Act is to prevent them reaching a crisis point in the first place. This means bringing reality to equality for mental health, bringing in investment and training, and introducing a culture change in the NHS.
My first question is whether the investment detailed in the long-term plan will be sufficient to achieve that. Many of the organisations which have championed mental health doubt that it will. Surely we will require greater investment to implement the proposals of the White Paper.
The Government accept almost all the review’s recommendations on advocacy and tribunals, including the funding that will be required to implement them. These are key reforms affecting people’s liberty and will play an important part in making other improvements to people’s rights effective. Can the Minister assure us that planned reforms will be fully funded?
The independent review was published over two years ago. Since then, the murder of George Floyd and the growth of the Black Lives Matter movement have brought the impact of structural racism into greater focus. Among the five broad ethnic groups, the known rate of detention for the black or black British group—321.7 detentions per 100,000 of the population—was over four times that of the white group, which was 73.4 per 100,000. Men and women from African-Caribbean communities in the UK have higher rates of post-traumatic stress disorder and suicide risk and are more likely to be diagnosed as schizophrenic. Does the White Paper go far enough in tackling the racial disparities within our use of the Mental Health Act? It is very much to be welcomed that the Secretary of State has announced the new patient and carer race equality framework, which was recommended by Sir Simon Wessely. Can the Minister tell us the timetable?
On health inequalities in general, children from the poorest 20% of households are four times as likely to have serious mental health difficulties by the age of 11 as those from the wealthiest 20%. Half of LGBT people—52%—have experienced depression in the last year. One in eight LGBT people aged between 18 and 24 say that they have attempted to take their own life in the last year. Almost half of trans people have thought of taking their own life in the last year, and 31% per cent of LGB people who are not trans say the same. People living in the most deprived areas are more likely to be referred to an IAPT service by their GP but are substantially less likely to receive a complete course of treatment or make a successful recovery. Long-term funding decisions will be needed in the next spending review. What will they look like? Will the Government make a long-term commitment to invest when this is required?
I am sure we all welcome the aim to improve how people with learning difficulties and autism are treated under the Act. Will there be limitations to the scope for detention where their needs are due to learning disabilities or autism alone? Do the Government accept all the review’s recommendations on advocacy and tribunals, including the funding that will be required to implement them? These are key reforms affecting people’s liberty and will play an important part in making other improvements come about.
The emergency legislation of the Coronavirus Act 2020 represented a concerning reduction in patient rights and safeguards. While we understood the reasons for their initial introduction, I am sure that everyone is glad that they were never enacted and pleased that they have now been dropped. However, Covid-19 will prove a defining moment for the way in which we discuss and protect our mental health. A rising tide of people who have not previously experienced mental health problems now find themselves in that position. For a lot of people, the pandemic has seen a shift from merely “struggling” to becoming clinically unwell. Funding and reform will be needed more than ever.
Finally, can the Minister tell us when the legislative programme will commence? Is there to be a joint pre-legislative scrutiny committee? I believe the Minister’s right honourable friend the Secretary of State suggested that that might be the case. That would be very welcome and I hope that it will start very soon indeed. When, finally, will we see the draft Bill?
My Lords, there is much to be welcomed in this White Paper, for which we have waited so long. I am pleased to see patient voices being put front and centre of plans and proposals to address the current shocking disparities in the rates of detention of people from black and minority-ethnic backgrounds. However, the issues that were highlighted in the Wessely review two years ago have continued to scar the lives of too many people during the extremely long gestation period of this White Paper.
The original legislation is 40 years old now and out of date. It is shocking, frankly, that it has taken us so long to amend archaic processes, such as an individual’s father automatically being their advocate in a mental health crisis, whatever the nature of the relationship or preference of the individual patient.
I understand the importance of getting the details right. However, I was concerned by the lack of urgency shown by the Secretary of State when responding to questions from MPs on the Statement last week. Why do we have to wait another year before the legislation can even begin? Can the Minister give us a concrete timeframe for the further consultation? What is the timetable for taking forward the non-legislative reforms in the Wessely review, not least to achieve wholesale cultural change in mental health services?
I am similarly very concerned about workforce issues facing this sector. Many of the workforce aims laid out in the NHS Long Term Plan are not on track to be met, with 12% vacancy levels in many mental health services. Between 2016 and 2019, demand for services increased by over 20%—and that takes no account of the exponential growth in mental health problems during the pandemic. Recent forecasts suggest, for example, that only 71 additional consultant psychiatrists will be added to the NHS workforce by 2023-24, against a requirement of more than 1,000 to deliver the long-term plan. What measures are the Government taking to address the additional workforce requirements of reforming the Mental Health Act?
We then come to the issue of funding. The short-term injection of £500 million is, of course, welcome, but it is sustainable and long-term investment in services—covering the full spectrum from preventive to crisis care—that we so badly need. We need a comprehensive plan for funding all existing and new mental health services, rather than one-off injections of short-term funding. Above all, this means investment in community services. In a survey of Royal College of Psychiatrists members, insufficient access to community health services was cited as the greatest cause of increases in formal admissions. The best way to prevent people being detained under the Mental Health Act is to prevent them reaching crisis point in the first place.
Like the noble Baroness, Lady Thornton, I am deeply worried about the impact of the pandemic on the nation’s mental health. In October last year, the Centre for Mental Health estimated approximately 10 million extra people with mental health needs due to the pandemic—a staggering figure. While it is understandable that we have been focusing on the physical threat of the pandemic and protecting our acute services, when will the Government come forward with proposals to address what some are now calling a mental health emergency?
It is an unpalatable fact that black people are currently 10 times more likely to be placed on a community treatment order. In these situations, patient voices become even more important, ensuring that culturally appropriate services can be provided. The patient and carer race equality framework is a good start; I look forward to hearing more on this issue. I note that cultural advocates are currently being recruited, but can the Minister confirm how many patient and carer advocates will be involved in both the advancing mental health equalities task force and the patient and carer race equality framework steering group? Also, why are the Government not proposing to legislate for a CTO to have a maximum duration of two years or to allow tribunals to change the conditions imposed on an individual by the order, as recommended by the Wessely review?
I end by returning to the issue of prevention. The courses of action covered by this legislation represent the worst-case scenarios for individuals experiencing severe mental health problems. We have so much evidence telling us that investments in preventive measures are highly cost-effective interventions and avoid the trauma of crisis scenarios for patients. While we debate this White Paper, it is vital that we do not lose sight of the bigger picture.
My Lords, I thank both noble Baronesses for their incredibly perceptive, thoughtful and detailed questions, some of which I am afraid are beyond the brief in front of me. I reassure them, particularly the noble Baroness, Lady Tyler, that I will write with detailed answers to some of their more perceptive and searching questions.
We are all enormously grateful to Sir Simon Wessely for his thoughtful, persuasive and thorough report. It has taken some time to work on it, but now that it has arrived we will act on it. I reassure the House that it is an enormous priority.
I reassure both noble Baronesses that funding is absolutely in place for mental health. If I may briefly run through that, an extra £2.3 billion a year for mental health services is committed by 2023-24. Some £500 million in mental health investment in the NHS workforce was announced in the spending review, and it will go towards addressing waiting times for mental health services.
The noble Baroness, Lady Tyler, referred to the challenge of recruiting psychiatrists. As she knows, that area is extremely challenging. The employment brand of mental health services is not as strong as it is for, say, surgeons, but we have done an enormous amount through HR and the people plan to find new ways of attracting people to rewarding and challenging roles in psychiatry, and those investments are beginning to pay off.
We have invested more than £10 million this year in supporting national and local mental health charities to continue their vital work in supporting people across the country. I will move on to the mental health effects of the pandemic in a second. We have invested £8 million in the Wellbeing for Education Return programme, which will provide schools and colleges all over England with the knowledge and resources to support children and young people, teachers and parents. We have announced more than £400 million over the next four years to refurbish mental health facilities to get rid of dormitories in such facilities across 40 trusts.
The noble Baroness, Lady Tyler, asked me about urgency and whether the Government were truly committed to moving quickly. I reassure her that money has already been announced and plans are in place to address some of Sir Simon’s most urgent recommendations.
Both noble Baronesses asked about the timetable for legislation. I reassure them that the consultation began last Wednesday; it is a 14-week consultation and we have committed to responding to it this year. If I may advertise to noble Lords, this is a terrific opportunity for all those with views on mental health to contribute to that important engagement. It is our plan to publish the Bill next year on the back of that consultation and for legislative scrutiny to take place next year. The question of whether that will be joint legislative scrutiny is not clear to me right now, but I undertake to both noble Baronesses to inquire and press the case for joint scrutiny when I return to the department. I shall write to both of them accordingly.
The noble Baroness, Lady Thornton, raised the impact of the racial dimension highlighted in the report. The numbers in Sir Simon’s report are incredibly striking and it is crystal clear that this is an issue that we absolutely have to deal with. Will we go far enough? Yes, indeed we will. The framework recommended is extremely powerful and we are already putting it into place. We have learned an enormous amount from the report. The ability for those with mental health issues to nominate their own advocate is an extremely powerful innovation that I think will have a big impact on this issue, but we still have further to go. We are engaged with those who are both representative and expert in this area to ensure that we are challenged to go far enough.
Likewise, on learning difficulties and autism, noble Lords will remember that we have had powerful and moving debates in this Chamber in the last few months on that very issue. I reassure the noble Baroness, Lady Thornton, that we note Sir Simon’s recommendation in his report for a 28-day cap on the detention of those with learning difficulties and autism. It is just not good enough for those with learning difficulties and autism to be detained under a Mental Health Act restraint for an interminable period. That point is thoroughly recognised, and the report’s recommendations are extremely well made.
On the question of the pandemic, the noble Baroness, Lady Thornton, put it extremely well: there has been a shift in many people’s response to the pressures and the isolation of lockdown, from being stressed and anxious to having genuine clinical challenges. The full effects of that have not worked their way through the system so it is difficult to get a nuanced and complete view from the numbers today, but we are very much on the balls of our feet to understand and react to the pressures
If I may draw out one issue, young girls seem to be a demographic who have particularly felt the loneliness, anxiety and uncertainty around the pandemic and lockdown. We are particularly concerned to ensure that support goes to families and individuals who present clinical mental health issues as a result of the pandemic.
On the other, very detailed questions asked by the noble Baroness, Lady Tyler, I undertake to answer them in writing at the earliest possible opportunity.
(3 years, 11 months ago)
Lords ChamberMy Lords, as we debate these regulations—after the event, as ever—we are in the throes of a national emergency the like of which I have not witnessed in my lifetime. We must learn lessons from the handling of the pandemic so far. The overriding need is to act fast, early and with consistency of message. We need to treat the population like grown-ups who prefer to hear it straight, even if the news is bad.
With the new, more aggressive strain of the virus, we are in a race against time, as my honourable friend Munira Wilson said yesterday, and we need a military-style response. Above all, we must introduce a 24/7 vaccination programme, bringing the vaccine to every high street in the country, including on Sundays. We must make maximum use of volunteers for all the nonclinical tasks involved and remove unnecessary barriers to recruitment. Critically, we must make full use of the roughly 11,400 local pharmacies that already administer millions of flu jabs every year. They have the capacity to vaccinate about 1.3 million people each week, which will save the lives, particularly, I suggest, of people who are not registered with a GP. What assurances can the Minister give that this will now happen?
The next few weeks will put huge strain on the mental health of millions, particularly the vulnerable, the marginalised and young people. What assurances can the Minister give that mental health services will be fully resourced and will stay open to respond to the ever-growing mental health need?
Finally, with the number of Covid patients in UK hospitals topping 30,000, and having witnessed the harrowing scenes in last night’s news coverage of the intensive care unit at University College London Hospital, will the Minister say what specific steps the Government are taking to support the mental health needs of front-line health and social care workers who are suffering from exhaustion, burnout and flagging morale? You can only stretch a piece of elastic so far, and many are close to breaking point.
(4 years ago)
Lords ChamberThe noble Lord speaks with great humanity and compassion, but I perhaps need to give a bit of perspective. I am not sure if our UK aid budget is enough to solve all the problems that he describes. The UK remains extremely committed to international aid. In the Covid epidemic and recession, we have reduced our commitment in a small way and have promised to revisit it at a later date. That commitment is very clear, and we will do that in due time.
My Lords, cuts to local authority public health budgets of some £700 million in real terms over the last five years have led to sexual health budgets being cut by 25% in this period. The King’s Fund has estimated that restoring spending to the former level
“would require additional investment of £1 billion.”
Given the Government’s commitment to zero new HIV transmissions by 2030, will the Minister tell the House what plans they have to increase investment in HIV preventive services delivered by local authorities? Can the Minister also confirm that there will still be national funding for a prevention programme?
The Covid epidemic has disrupted things, but I reassure the noble Baroness that in the spending review 2020 we have confirmed that the public health grant will be maintained into next year, enabling local authorities to meet pressures and continue to deliver important public services. DHSC will confirm final allocations in the coming week, including the position on HIV PrEP. I reassure the noble Baroness that PrEP has proved to be an enormously valuable contribution to our fight against transmissions, and we continue to back it.
(4 years ago)
Grand CommitteeMy Lords, removal of the mental health provisions from the Coronavirus Act, which represented a significant reduction in protection and safeguards for people subject to the Mental Health Act is, as the noble Lord, Lord Blunkett, said, very welcome. Serious concerns have been raised about whether it would ever be human rights-compliant to enact the provisions. Even before the Covid-19 crisis hit, mental health services were severely stretched, with waiting times and barriers to access which would be considered unacceptable in any other area of medicine.
Turning to the scale of need, psychiatrists have reported an increase in patients needing urgent and emergency care during the crisis, and the latest NHS Digital figures show the highest recorded figures for mental health contact. According to the Centre for Mental Health, there are approximately 10 million extra people with mental health needs due to the pandemic. A survey conducted in late spring by the charity Rethink showed that almost 80% of people with pre-existing mental illnesses reported that their mental health had got worse or much worse as a result of the pandemic, and the ONS found that almost one in five adults in Britain experienced depressive symptoms in June 2020—roughly twice the number before the pandemic. Against this backdrop, it is crucial to the nation's Covid-19 recovery that existing mental health funding commitments in the NHS long-term plan are delivered in full and that services are resourced to support those who had new or worsening mental health difficulties because of the crisis. It is not either/or, it is both/and.
It is of course welcome that eventually an extra £500 million was promised in the mental health winter plan, published on Monday, to help with discharge to community care, workforce issues and addressing waiting times. This is a good start, but unlikely to be sufficient and, crucially, does not come onstream until the next operational year, leaving a gaping hole in the tough winter period ahead. What commitments can the Minister give that some of this new money will be spent on preventive work and early intervention to stop mental health issues escalating to crisis point and putting additional pressures on expensive police, A&E and in-patient services?
In the long term, it is not just a case of mental health services surviving the pandemic; they will need drastically to expand and improve to deal with the long-term impact of social isolation, mass unemployment and pandemic-induced anxiety.
The powers we are debating weakened an Act that was already in need of major reform. The independent review of the Mental Health Act put forward proposals to improve the system and increase patient rights. Can the Minister update the Committee on when the Government will provide a full response to the independent review and publish their proposals to take forward reform of the Mental Health Act, with a clear implementation timescale? The two-year anniversary of the publication of the Mental Health Act review will be 6 December 2020. I strongly hope that the Government’s response will not be delayed beyond that point.
(4 years ago)
Lords ChamberMy noble friend makes a very good point. Diagnosis is phenomenally difficult and, quite often, patients who present with seemingly one condition have something altogether different. It may be that a face-to-face appointment will be the moment when that difference is spotted and caught. She is entirely right to say that we cannot omit that format for the right circumstances, but a great many patients see their GPs very regularly. Their journeys may be onerous, uncomfortable and stressful, and telemedicine might offer them an alternative opportunity. There are others for whom speed is of the essence, and having telemedicine, particularly when it is supported by apps that provide essential information about their condition, can be an important and urgent alternative.
My Lords, according to the June edition of the British Medical Journal, the biggest change for mental health services has been the rapid adoption of video and phone consultations, an approach that had rarely been used in a field where relationships and trust between clinicians and patients are vital and where body language and eye contact are often a key part of the assessment. Many in the sector have reported that virtual appointments are at best inferior, particularly with young people, those with learning disabilities and the elderly. What assurances can the Minister give that face-to-face appointments will continue to be made available for those who need them in this field?
The noble Baroness has raised an important point. I saw the BMJ article to which she has referred; it was a very interesting warning shot, whereby we should not overshoot in this area. But perhaps I can also emphasise that other interesting evidence shows that some mental health services have been better provided by online consultations. For instance, some young people do not like visiting clinics, where they feel uncomfortable, and prefer video conferences. I think it is too early to call it on this one, because we need to analyse closely the benefits and disbenefits in the area of mental health. We must ensure that we have the right format for the right occasion, but I completely take on board the warnings of the noble Baroness.
(4 years, 3 months ago)
Lords ChamberThe noble Baroness refers to recent statistics, which are, as she rightly points out, subject to change, as coroners’ investigations land on the desk at PHE. I reassure her that the statistics suggest a difference between stress and anxiety, and clinical mental health issues. It seems that one aspect of the coronavirus pandemic is that it has not translated into a massive mental health tsunami, as feared. This is hugely encouraging and a great relief. None the less, we are committed to the mental health support that the Government provide, and continue to support charities such as the Samaritans and CALM, including through the £9.2 million recently given to them for suicide prevention and support.
My Lords, sadly, self-harm is a major risk factor for future suicide and is growing among young people. Later this month, the All-Party Parliamentary Group on Suicide and Self-Harm Prevention will be publishing a report of its inquiry looking at the support available for young people who self-harm. Having been closely involved in this inquiry, I ask the Minister whether he will commit to the Government looking seriously at its findings, which were informed by young people who had self-harmed, and to responding in due course.
The noble Baroness is entirely right that self-harm is an alarming, distressing and rising phenomenon among young people. I welcome the report that she describes, and commit to having a good look at it, when it is published.
(4 years, 3 months ago)
Lords ChamberThe noble Baroness has a point on the importance of targeting the right populations and there are certainly some demographics that incur higher incidences of obesity and for which the health disbenefits of obesity are higher. For these, we have special programmes to support them in schools with vouchers and medical interventions. However, obesity is a national problem that affects all parts of society. In Britain we have got it wrong and we need to address this issue as a nation.
My Lords, the noble Baroness, Lady Massey, rightly emphasised the link between deprivation and childhood obesity. Therefore, while welcoming the announcement of the Government’s obesity strategy, I ask the Minister: what specific steps are the Government taking to address the links between deprivation and obesity; how will this be funded; and what plans do they have to introduce policies with a more explicit focus on early years to reduce childhood obesity rates?
My Lords, there are individual programmes specifically targeting those from deprived backgrounds. I emphasise the childhood obesity trailblazer programme, which has funding for several councils to pioneer forward-thinking ideas to address childhood obesity among those target populations.
The other area that I emphasise is exercise in school. Of course, obesity is linked to intake, not exercise, but exercise helps to get the disciplines right around looking after one’s mind and body. The £320 million going into school sports facilities is a massive bonus in this area.