Mental Health: Children and Adolescents

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Wednesday 16th November 2016 Lords Chamber

[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.

Southern Health NHS Foundation Trust

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Tuesday 3rd May 2016 Lords Chamber

[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

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Thursday 28th April 2016 Lords Chamber

[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

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

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

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Monday 14th March 2016 Lords Chamber

[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

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

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

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

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.

NHS: Preventive Medicine

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Wednesday 20th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, clearly, the state has a huge role to play in prevention; I was certainly not questioning that for one moment. I was just saying that I believe that individuals and families have responsibilities as well.

[Baroness Tyler of Enfield (LD)]

My Lords, given that £1 in every £5 of healthcare costs is associated with conditions that could be prevented, what assessment have the Government made of the likely cost savings on NHS spending of using more preventive medicine?

[Lord Prior of Brampton]

My Lords, if the noble Baroness reads the Five Year Forward View, she will see that prevention is a very critical part of that. But, of course, prevention goes much wider than healthcare in the NHS; it goes to employment, housing, education and a whole range of other things. Having a strong and vibrant economy with high levels of employment is vital.

Mental Health Services

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, very briefly on those three points, we will have the waiting time results for IAPT tomorrow. I will publish them in the Library and write to the noble Lord. On the ring-fencing point, the IAPT part of the £150 million extra spending on CAMHS is not ring-fenced, but the £150 million is in total. We will wait to see the results on how effective the IAPT spending is before we come to a final decision on how much should be spent on IAPT and on other parts of the care budget. On the noble Lord’s third point, the CQC published its report, Right Here, Right Now, some six months ago. It found that things were getting better, but there was still far too much variation. By using that report and encouraging local crisis care concordat teams, we hope to address that variation.

[Baroness Tyler of Enfield (LD)]

My Lords, given the current paucity of mental health services in meeting rising demand, will the Minister say what steps the Government are taking to ensure that money earmarked for mental health services is spent on mental health by clinical commissioning groups?

[Lord Prior of Brampton]

It is too early. I cannot give the noble Baroness specific figures for last year’s spending, but we believe that they will show an increase of some £300 million over the year before. We have made it very clear to NHS England in the mandate that we expect spending on mental health services to increase this year and that every CCG in the country will see a real-terms increase in mental health spending compared with the previous year.

Health: Children

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Thursday 10th September 2015 Lords Chamber

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

My Lords, giving every child the best start in life is central to the Government’s approach to reducing health inequalities. This ambition is supported by action across government and the health system at local and national level.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his reply. Is he aware of the report published this week by the National Children’s Bureau—I declare an interest as its president—called Poor Beginnings, which shows very vividly how the place where young children live can dramatically affect their health? In particular, it highlights really dramatic differences in areas such as obesity, tooth decay and getting injured, and shows very significant variations in child health outcomes between deprived local authorities. As local authorities take up responsibility for young children’s public health from this October, what steps are the Government taking to support them in their work to narrow the gap in outcomes?

[Lord Prior of Brampton]

I have indeed read the report by the NCB, although it came out only on Monday so I have not fully digested its conclusions. I think that it very much echoes the work done by Michael Marmot four or five years ago. He said that the first two years, and certainly the first five years, of a child’s life are crucial in determining their subsequent standard of living and health. The variation that the NCB’s report has identified is extremely important. It is a variation not just between rich areas and poor areas but within deprived areas. That level of variation is best tackled at local level by local authorities. The decision to push the commissioning process down to local authorities is probably the right one, but they will be heavily supported by Public Health England.

NHS: Reform

Debate between Baroness Tyler of Enfield and Lord Prior of Brampton

Thursday 16th July 2015 Lords Chamber

[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.