Mental Health: Children and Young People

Baroness Vere of Norbiton Excerpts

Wednesday 30th January 2019 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, I start by thanking the noble Baroness, Lady Tyler, for introducing this debate and for giving us the opportunity to discuss a very important issue. I know that she is a great campaigner on this issue. Regrettably, it remains true that many young people who seek help find it difficult to access the right support at the right time, as she has clearly identified.

I also thank all other noble Lords for their contributions to this incredibly important debate. As the noble Baroness, Lady Thornton, said, there certainly is not sufficient time to address all the very important issues that have been raised today in the four minutes that Back-Benchers have been given to speak.

I reassure my noble friends Lady Wyld and Lady Chisholm and the noble Baroness, Lady Tyler, that this Government are committed to ensuring that our children and young people, and their families, get the support they need at the right time from the NHS, schools, colleges, local authorities and our dedicated partners in the voluntary sector. As part of this long-standing commitment, we have already laid strong foundations for a step change in the quality and scale of support available through improving and expanding NHS mental health services for children and young people, and through the 2015 Future in Mind strategy, the 2016 five-year forward view for mental health and the NHS Long Term Plan, published earlier this month, as noble Lords have identified.

I say to the noble Baronesses, Lady Tyler and Lady Massey, and other noble Lords that we know that the current system is not perfect but we are working tirelessly to improve the quality and availability of support for children. This will take time. The noble Baroness, Lady Massey, rightly identified that collaborative working across the system is key to ensuring that we get it right.

I am grateful that noble Lords have recognised the additional funding going into mental health services. As my noble friend Lady Chisholm noted, after years of underinvestment, NHS funding for children’s and young people’s mental health services is now rising and will continue to rise as we work towards the goals set out in the NHS Long Term Plan.

I reassure my noble friend Lady Wyld that mental health services will grow faster than the overall NHS budget, creating a new ring-fenced local investment fund worth at least £2.3 billion a year by 2023-24. In addition, the plan includes a new commitment that funding for children’s and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending. This transformative investment will mean that by 2023-24 an extra 345,000 children and young people up to the age of 25 will receive mental health support via NHS-funded mental health services.

I say to the noble Baroness, Lady Parminter, that we recognise that the standard of service provision varies for children and young people around the country, and I acknowledge the arguments that she has made. An increasing proportion of young people are seeking help from the NHS. We are responding by already ramping up capacity, and the NHS Long Term Plan has set out further priorities for the years ahead.

I hope that the noble Baroness, Lady Thornton, is reassured that we are on track to meet our commitment to improve access. By 2020-21, 70,000 more children and young people will be accessing treatment each year. This equates to 35% of children and young people with a mental health condition.

I say to the noble Baroness, Lady Tyler, the noble Lord, Lord Brooke, and the noble Baroness, Lady Parminter, that we have introduced the first ever access and waiting standards for mental health services, as they acknowledged, including two relevant to children and young people—on eating disorders and on early intervention for people experiencing a first episode of psychosis. Indeed, we have a target to ensure that treatment begins within two weeks for more than 50% of people experiencing their first episode of psychosis. Nationally, the NHS is exceeding the target, with 78.5% of patients having started treatment within two weeks by October 2018.

More young people are getting the treatment that they need for eating disorders, and there has been a significant improvement in treatment times for NHS care. An extra £30 million is going into children’s eating disorder services every year, with 70 new or expanded community-based teams covering the whole of the country. We are nationally on track to meet the target of 95% of children and young people with an eating disorder accessing treatment with a one-week referral for urgent cases and four weeks for routine cases by 2020-21. The most recent data shows that 80.2% of young people started treatment for a routine case within four weeks.

The noble Baronesses, Lady Tyler, Lady Massey and Lady Thornton, and my noble friends Lady Chisholm and Lady Wyld also noted the importance of recognising that there is no single defined service or model that can address the needs of all ages and developmental needs across mental health, and that existing services will need to work together. I am of course in total agreement.

An example of how this Government are encouraging partnership working between services is the Green Paper on children’s and young people’s mental health, which will deliver a new schools and college-based service to help children and young people and will be staffed by a new workforce. This brings together health and education to provide early intervention mental health support for children, as advocated by the right reverend Prelate. We are taking cognisance of preventive services for mental health, which is key and fundamental. Every school will be encouraged to have a designated senior lead for mental health, as well as access to mental health support teams that will sit in and around colleges and schools. This commitment was confirmed in the NHS Long Term Plan and will be rolled out to between one-fifth and a quarter of the country by the end of 2023.

This new schools-based service is in addition to existing provision for children and young people with mental health needs. Last month we announced 25 trailblazer sites, which will run the first wave of mental health support teams. Twelve of those sites will also test a four-week waiting time for children and young people to get mental health support from the NHS.

The workforce is, of course, integral to everything we are doing. I agree with the noble Lords, Lord Brooke and Lord Bradley, on the issues that they raised. We have always recognised that a skilled and confident workforce is at the heart of delivering improvements to mental health services. That is why we have set an ambition to create 21,000 new posts in the mental health workforce in priority growth areas to be occupied by 19,000 NHS staff. The Children and Young People’s Improving Access to Psychological Therapies programme has trained both new and existing staff in evidence-based therapies. Our ambition is to have 1,700 newly trained therapists working in children’s mental health services and 3,400 existing mental health staff trained in evidence-based interventions by 2021.

As the noble Baroness, Lady Tyler, and the right reverend Prelate the Bishop of Carlisle said, some children will, unfortunately, experience a mental health crisis and will need rapid mental health support. I want to thank the noble Baroness for contacting my noble friend Lord O’Shaughnessy on this important matter last month, when he was the Minister. Like the noble Baroness and the right reverend Prelate, I am pleased with the strong focus on crisis care in the NHS Long Term Plan, which sets out around £250 million of investment in crisis care by 2023-24.

Improving provision of children’s and young people’s urgent and emergency mental health care is a priority for NHS England as part of the wider transformation of mental health support. We have supported the development of children’s and young people’s urgent and emergency mental health care services and intensive community support services, including testing and evaluating models for crisis support. The NHS Long Term Plan is clear that the expansion of age-appropriate crisis care services for children and young people is vital, and I share that view.

I am conscious that I have only two minutes left, but there are lots of questions to which I want to give answers—I have been told to keep going.

[Baroness Vere of Norbiton (Con)]

Four minutes.

[Baroness Manzoor]

I have four minutes; that is good. I shall answer some specific questions. The noble Baroness, Lady Tyler, asked how the target in the long-term plan of 100% access would be measured. The NHS will publish further details about how the long-term plan will be taken forward, in an implementation plan due this spring, with more detailed plans in the autumn. She also asked about the timetable for introducing the four-week waiting time. As she may know, we have recently announced 12 areas that will test how we might introduce the four-week waiting time without the risk of perverse incentives, such as raising thresholds. Fuller plans will then be drawn up, informed by learning from those pilots.

The right reverend Prelate the Bishop of Carlisle asked about better community service and support for those with learning disabilities. I agree that we need to increase community services, particularly for those with learning disabilities. That is why the long-term plan’s significant investment in children’s mental health services is so crucial. As I said, by 2024 an additional 345,000 children will receive this support.

My noble friend Lord Leigh and the noble Lord, Lord Bradley, also raised the issue of CCGs perhaps diverting funding for mental health services to other things. I reassure them—and the noble Baroness, Lady Thornton, who will probably know more, because she sits on the board of a CCG—that in 2017-18, 90% of CCGs met the mental health investment standard, which requires them to increase funding for mental health at least in line with their overall financial allocation.

I can tell the noble Lord, Lord Brooke, and others who raised crisis care and A&E that we are committed to rolling out liaison mental health services to every A&E by 2021. The long-term plan builds on this by committing to 70% of these teams meeting the “core 24” standard by 2024. We are committed to developing alternatives to hospital.

I have already addressed the issues around eating disorders. Of course, it is vital that we continue to build on the good progress that has been made. More details of the implementation plan will be available in the spring.

To conclude, we are aware that there is much work to be done, but I am enormously proud of the work that the Government are doing to improve access to mental health services, ensuring that many more children and young people can access high-quality vital mental health support. I am confident that by continuing record levels of investment, improving access and waiting times, and championing parity of esteem through high-quality mental health support services, we will provide a brighter and healthier future for our children and young people. They deserve nothing less.