Homecare Medicines Services (Public Services Committee Report)

Baroness Wheeler Excerpts

Thursday 2nd May 2024 Lords Chamber

[Baroness Wheeler (Lab)]

I too congratulate my noble friend Lady Morris on her usual thoughtful, thorough and robust introduction to this excellent report. I commend the whole committee for shining a laser-like spotlight on such a vital service, upon which half a million people with chronic health conditions living at home depend. Homecare medicines services are some of many services provided to NHS patients that are not publicly well known or understood by the majority of people accessing the NHS, but, as we have heard, they provide and utilise huge NHS expertise and physical and financial resources—over £3 billion per year, as the Government now estimate.

The forensic, in-depth reviews that Lords and Commons committees undertake of such services—which range across NHS provision and underpin the importance of providing quality patient care and safety across the NHS as a whole—are an essential part of parliamentary scrutiny. Today, we have heard support and insight from other committee members across the House—I note my noble friend Lord Carter and the noble Lords, Lord Blencathra and Lord Shipley—and I welcome their perspectives and reinforcement of the committee’s work. I particularly thank the noble Lord, Lord Blencathra, for suggesting the topic in the first place.

The report provides a very thorough analysis of what homecare medicines services cover, their strengths and the significant problems encountered by service users, as well as the recommended ways forward to improve the provision of high-quality care to patients in their homes, which can reduce pressure on hospitals and other NHS services that have to pick up the pieces when delivery services fail.

Since the committee members have stressed that they are open to suggestions, I say that I personally hope that the committee can in the future undertake similar important work on other vital services that are often out of the spotlight. One such service is the continence service, which impacts across major conditions such as heart failure, stroke and dementia, costs the NHS similar sums of billions of pounds a year and involves home delivery of medicines and supplies to patients and hospitals. I realise that this is an issue for another day, so I will leave these thoughts with the committee.

The important starting point on homecare medicines services, heavily underlined by speakers today, is addressing accountability and who is responsible for the whole service. I welcome the DHSC’s and NHS England’s willingness, in the Government’s response to the committee, to recognise the disjointed complexity of the current system, which has largely evolved over the years without a coherent overview and strategy. I also welcome their recognition of the need to come to grips with how HMS operate today and move forward in the future.

Appointing the NHS England senior responsible officer responsible for HMS nationally is just the first step—a crucial point well reinforced today. When appointed, that senior officer, working with the national HMS committee, will face huge challenges identified by the committee and acknowledged in the Government’s response. These include developing consistent performance metrics and updating and rolling out new KPIs, with regular publication of performance data in standardised form to ensure that comparisons can be made and lead to better scrutiny, transparency and improved patient care. All these are promised for a report back to the committee in the summer.

The committee also underlined the importance of ensuring that homecare medicines services are part of, and included in, the NHS long-term workforce plan, or the social care equivalents when they are finally developed. It is astonishing that these two strategies do not include HMS. I look forward to the Minister telling us how this happened and the steps now being taken to address this significant oversight. How is the work on the vital information and data—so essential, as we heard, to assessing the patient experience and identifying the harm that delays, errors and misdeliveries cause patients—progressing under the desktop exercise, in advance of the promised summer report back to the committee on what data is available to assess patient harm?

The Government’s response also accepts that significant improvements must be made in the HMS procurement process to achieve value for money, in developing experts who understand the service and in the support offered to NHS trusts on drawing up and managing procurement contracts. My noble friend Lord Carter, as we know, has huge expertise in this area, working with NHS trusts on productivity, contract development and operational management across NHS trust operations. He has raised a number of key areas on this important aspect of the report, and I look forward to the Minister’s response, particularly on how we move forward towards operational excellence and integrated care records. The committee’s recommendation for government to start work now with the National Audit Office and the CMA to identify barriers to effective procurement makes sense in the light of the current disjointed and impossible-to-navigate system—another summer report-back item. Perhaps the Minister can explain why this work cannot begin now to help NHS England assess future options.

Today’s contributions have all drawn heavily on the crucial evidence of service failures from key patient groups. I join noble Lords in paying tribute to them and to the British Society for Rheumatology for its leading, co-ordinating role in gathering and presenting patients’ first-hand evidence to the committee. We have heard many examples today. The comments from two Cystic Fibrosis Trust respondents sum up what patients can experience. One says:

“It’s terrible … the times are a nightmare and missed deliveries can take ages to rearrange … it’s a horrible system”.


The other says that

“it is a massive burden and on top of everything else we need to do and have to deal with”.

The latter is a familiar sentiment from patients and their carers across many health and social care services.

As my noble friend Lady Morris underlined today, the committee fully acknowledges the “irreconcilable gulf” between the views of clinicians and service users and the leadership and governing bodies of the homecare sector on how well the service is performing. But it rightly underlines that it is

“persuaded by the weight of evidence from service users that there are real and serious problems in the sector”,

despite HMS being a complicated system with multiple variables. The example from the noble Lord, Lord Blencathra, regarding the delivery of his medicines and the testimony of the noble Lord, Lord Willis, clearly demonstrate this. Indeed, one of the most stark conclusions from the committee—the noble Lord, Lord Blencathra, referred to it, but it is worth repeating—is that:

“No one—not the Government, not NHS England, not patient groups, not regulators—knows how often, nor how seriously patients suffer harm from service failures in homecare”.


It is this and the complexity of the system that need to be urgently addressed. It is so important to have accurate and consistent performance data across providers and the services involved to measure the impact of poor performance on patients in the public domain. What are the expected timescales for the newly appointed senior HMS officer and the National Homecare Medicines Committee to develop a strategy and implementation plan for HMS, and how will service users be consulted and involved?

The failure of the regulatory model for homecare comes in for equally heavy criticism from the committee, which describes it as

“failing to ensure the safety and quality of patient care”;

having

“a limited understanding of the sector”

and “no appetite” to find out more; and having only “feeble”—indeed, “toothless”—enforcement action against providers, even where avoidable harm has occurred. The Government recognise that more work has to be done before deciding on undertaking the thematic review called for by the committee—that will be one more summer update to the committee.

Can the Minister confirm that meaningful discussions have begun between the CQC, the General Pharmaceutical Council and the MHRA? Are they just focused on identifying

“opportunities for strengthening collaboration, communication and transparency”,

as referred to in the Government’s response, or will they include more structural issues, including a leading regulator where providers are underperforming and overall responsibility for a patient complaints system? How will the role undertaken by the CQC for its—currently relatively few—HMS provider inspections be levelled up to the much tighter approach taken in inspecting small residential care homes?

With noble Lords’ indulgence, I refer lastly to a related but non-HMS issue: medicine blister packs for people living at home, which are assembled by pharmacies and either collected by patients and carers or delivered to their home. The Minister and I always seem to talk at cross-purposes about this. When I raise the issue, he stresses that they are not suitable for everyone, which I fully agree with, but I always emphasise how essential they are in the delivery of domiciliary personal and social care for people living in the community or in care homes. Care workers often administer these drugs to the client in their homes. This process ensures that the drugs are taken properly and safely and are not missed. Care staff can do this only using blister packs. They would not sort out the daily doses from multipacks, which I as a carer was recently offered. Our local Boots chemist, a large chemist, has stopped providing this essential service. Where it is not provided or where the chemist closes down, the task would again fall back to the carer. This is an important issue related to our discussions on HMS and it needs to be recognised as an essential part—where appropriate—of safe care in the community. I hope I have provided food for thought in the context of today’s debate.

Finally, this has been an excellent debate and I once again congratulate the committee on its searching report and very practical recommendations on ways forward. There has been a good start made on addressing the key problems, and optimism, in the Chamber at least. But, as the British Society for Rheumatology has stressed, both NHS England and the DHSC still have a long way to go to demonstrate that they understand the scale of the problems that need to be tackled if HMS is to achieve its full potential.

Pandemic Preparedness

Baroness Wheeler Excerpts

Monday 15th April 2024 Lords Chamber

[Lord Markham (Con)]

We definitely look to work closely with our colleagues, and I have spoken to my Health Minister counterparts on this. One of the lessons from the pandemic was that you also need to have your own capability. The work we have done on the100-day mission, and the strategic relationship we have entered into with Moderna—which can develop vaccines in as little as four to six weeks to answer some of those unknowns—is very powerful.

[Baroness Wheeler (Lab)]

My Lords, it is now two years since the UK Health Security Agency replaced Public Health England. As we await the Science and Technology Committee’s report on the threat caused by zoonotic diseases such as Covid, avian flu and Ebola, can the Minister update the House on the progress the agency is making in building resilience in these areas? It reported last year on global work on developing pandemic-fighting tools but not on the nitty-gritty needed to tackle underlying problems still hampering us, such as tackling widespread health inequalities, building systems for vaccine resistance and raising public awareness of the threats we all face.

[Lord Markham (Con)]

I thank the noble Baroness. The UKHSA has been working and there are four main areas we want to be responding on. First, there is the vaccine, and the 100-day mission is all about making sure that we have the vaccines quickly. We have 100 million vaccines prepositioned for flu and 250 million for other diseases. Secondly, there is the manufacturing scale-up. We have a fund in place so that we have UK domestic production capability to produce vaccines quickly. Thirdly, there is the stock of PPE, and, fourthly, there is the diagnostic capability. That is how the UK Health Security Agency is making sure we have all the bases covered.

Stroke Treatment

Baroness Wheeler Excerpts

Wednesday 27th March 2024 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what steps they are taking to improve treatment and care for those of working age who are affected by stroke.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government are taking three major steps to improve treatment and care for strokes: first, a whole series of prevention measures to help avoid a person having a stroke in the first place; secondly, an updated and evidence-based stroke care pathway using AI, the latest technology in stroke rehabilitation, to maximise the chances of recovery; and, thirdly, post-stroke rehabilitation care and support to maximise the chances of recovery.

[Baroness Wheeler (Lab)]

I thank the Minister. We know that one in four strokes happen to working-age people, and that it is also a leading cause of disability. Speech and physiotherapy support after stroke is therefore vital, because it helps recover key skills such as motor functions and cognitive ability, and it can be the difference between returning to work and not returning, or giving up altogether. With serious delays across the country in getting people to hospital and scanned, and in providing the speech and physiotherapy that is needed, and with chronic staff shortages across the country in hospital and community settings, good care is just not the reality for thousands of stroke sufferers. Some 40,000 people missed out last year on essential six-month, post-stroke reviews. When will the up and coming major conditions strategy be published? How will it specifically support effective stroke rehabilitation and recovery, and what timescales will be set for that?

[Lord Markham (Con)]

I thank the noble Baroness for her tireless work in this area. As she quite rightly points out, aftercare and rehabilitation is the vital third leg of the three-step process I spoke about. In the major conditions strategy we talk about how we are basing it on a national model for an integrated stroke care service, based around personalised, wraparound care, for as long as is needed, with reviews every six months. I have seen some fantastic examples when I have been out and about, such as in Royal Berkshire and Leighton. The proof of the pudding is in the results; we have seen the number of people who are achieving a full recovery increase from 16% to 48%. That is the target we are going after.

Sodium Valproate and Pelvic Mesh

Baroness Wheeler Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.

[Baroness Wheeler (Lab)]

My Lords, the Patient Safety Commissioner’s report is all the more valuable because it is drawn from patients’ experiences, including physical, psychological and emotional impacts and their daily struggle with accessing health and other key services such as social security benefits and special educational needs support for the valproate-harmed children they are raising. What is being done to support mothers and families as they cope with the indecision and delay over the Government’s response to the commissioner and await the vital support they need?

[Lord Markham (Con)]

We have completed four of the initial recommendations in the report of my noble friend Lady Cumberlege, and another three are in process. The most important of those, to answer the noble Baroness’s question, is the setting up of these nine specialist centres which can provide the support needed, not just in terms of redress surgically or treatment-wise but in terms of the support that people need to help them cope with the issues.

NHS: Dementia Commission Report

Baroness Wheeler Excerpts

Thursday 22nd February 2024 Lords Chamber

Asked by

[Baroness Wheeler]

To ask His Majesty’s Government what actions they are taking in response to the NHS Innovation and Life Sciences Commission’s Dementia Commission: 2023 Report.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con) (Con)]

We welcome the Dementia Commission: 2023 Report and are taking steps to address each of the recommendations. The Government remain committed to improving dementia diagnosis rates and providing high-quality care and support following a diagnosis. The Government have committed to double funding for dementia research to £160 million per year by the end of 2024-25. We welcome all research that will help us to improve how we diagnose and care for people with living with dementia.

[Baroness Wheeler (Lab)]

My Lords, the commission’s wide-ranging and comprehensive report is very welcome, but it heavily reinforces the urgent need for radical change in the way we diagnose, treat and care for dementia patients and support their families and carers. To ensure timely, speeded-up diagnosis, the training of primary care practitioners in dementia-specific symptoms and diagnostic methods is crucial. What steps are the Government taking to strengthen general practice and community pharmacy in this regard so that individuals with dementia can receive appropriate care and support as early as possible?

[Lord Markham]

I thank the noble Baroness for this Question. As ever, I have found that one of the real strengths of being in this position is that the questioning here makes me explore an area. This has been another area which I have enjoyed and found fascinating. Early detection is absolutely key, and what I have been learning from that is that, yes, we need to arm primary care staff and a potentially vital front line in terms of primary care staff are opticians, because retinal scans are a really good way to early diagnose. Apparently, people more than ever will have a frequent eye check. I have pulled together a panel to understand this more, and I invite the noble Baroness and others so that we can look at the latest research and really understand this more.

Care of Critically Ill Children

Baroness Wheeler Excerpts

Monday 29th January 2024 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct: the number of young people with life-limiting conditions has gone up, from about 33,000 around 2001-02 to about 87,000 more recently. A lot of that is, conversely, good news in that we have more and more treatments that can keep these children alive for longer. Clearly, that requires the wraparound-type service that the noble Baroness is talking about. It is the responsibility of the ICBs to provide that; I will provide details of the progress of individual ones when we meet.

[Baroness Wheeler (Lab)]

My Lords, I emphasise that the task force recommended by Nuffield to oversee its key recommendations needs to get to work urgently. The family-focused research work with parents, including parent carers, about their experiences of shared decision-making with healthcare professionals on care and treatment, is vital, as is the comprehensive information and guidance for parents and staff that is called for across the 16 Nuffield recommendations. What timescales are the Government envisaging for this crucial work to commence and become operational, including guidance to clinical and ethical committees?

[Lord Markham (Con)]

My understanding, now that the task force composition has been set up, is that this will be arranged shortly. I completely agree with the noble Baroness that these are important, as well as often heart-wrenching, matters, so urgency is required. As I have said, good progress has been made in a number of areas. Already, the MoJ is setting up a round table on this. The regional conflict managers have been established. We have training courses online so that communication can improve. A lot is being done, and the task force will push that forward further.

Dementia

Baroness Wheeler Excerpts

Thursday 18th January 2024 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I thank the noble Baroness, Lady Browning, for this debate and for giving us the valuable—if nowhere near long enough —opportunity to shine a spotlight on many key issues that were at the heart of the scrutiny of the social care cap provisions of the Health and Care Act. In particular, I note its impact on people with dementia and our concerns about how NHS continuing healthcare operates arbitrarily with regard to people receiving free care or having to pay for it themselves, as well as how we move towards genuine parity between the NHS and social care and how good social care is vital for people with dementia and their carers. The current social care system is just not set up to meet these needs.

I have three points. First, on carers, the 60% of people with dementia drawing on care at home are being cared for by their spouses and relatives—mostly unpaid carers, as my noble friend Lady Pitkeathley again reminded us. As a carer myself, I meet many unpaid carers locally who are daily, for 24 hours, looking after loved ones at various stages of dementia, most of them with breaks of only a few hours a day or a week. The carer role is often rewarding, but it is also relentless for many. We urgently need a comprehensive national carers strategy, and I look forward to the Minister’s explanation of why we do not have one.

I turn, secondly, to care costs and the devastating impact of the financial costs for those living with dementia and their families—an average of £100,000 is spent by individuals over their lifetimes. Despite extensive modelling at the time of the 2022 Act showing that just 19% of people with dementia would reach the care cap, and despite the disproportionately detrimental impact on dementia sufferers in some of the poorest parts of the country, it would have made a start as part of a wider package of reforms that Labour argued for. Instead, the new reform money has been allocated largely to propping up the existing social care system. What action are the Government taking to tackle the staggering care costs faced by individuals with dementia in the absence of the care cap implementation? Can we please be updated on the Government’s plans for social care charging reform?

Thirdly, on NHS continuing care, the excellent Lords Library briefing reminds us of the CHC’s ill-defined primary health need assessment criteria and the huge inequities in the current system, particularly relating to the funding—or lack of funding—for care costs for dementia, either in the home or in care homes. The Alzheimer’s Society has pointed out that NHS England’s stats do not record diagnostic details, so there is no way of knowing how many people with dementia receive CHC or have been turned down. There is also no way of making assessments or comparisons from which transparent criteria could be developed. There are also huge geographical variations in the length of time taken to assess claims and handle appeals. Can the Minister update the House on what work is being undertaken to improve the transparency of CHC processes, procedures and decision-making, and also to address the urgent problem with assessing the eligibility for CHC of people with dementia?

Noble Lords’ priorities for dementia today have focused on urgent improvements to diagnostic rates, speeding up the introduction of vital modifying drugs to help slow down disease progression, investment in the dementia diagnostic infrastructure, and rebuilding the workforce and addressing the 152,000 vacancies in the adult social care workforce. This needs to be a fully comprehensive plan that is fully integrated with the NHS workforce plan if we are to avoid exacerbating the already chronic social care workforce crisis that we have.

Care Home Staffing

Baroness Wheeler Excerpts

Thursday 18th January 2024 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, the Minister told the House on Tuesday that hospital discharges have recently been reduced by 10%. However, he knows that this figure goes up and down as some people leave hospital while more come in at the other end, and it depends on which period of time is measured. From July to November last year there was in fact a steady rise, so we need to be specific about dates when we talk about making progress. On the care settings that patients are being discharged to—care homes—how are the Government keeping track of how the extra funding allocated to deal with chronic local staff shortages has supported the discharge process? Will it continue in the longer term?

[Lord Markham (Con)]

The noble Baroness is correct that the numbers are a result of flow. We are seeing thousands more people hospitalised through A&E, so the fact that we have managed to reduce the back end indicates a positive way forward. To measure precisely what the noble Baroness asked about, we have now set up a kind of flight control system for each integrated care board, as I have mentioned, which looks at data across the system to monitor the number of hospital beds and places needed on a case-by-case basis. The noble Baroness is absolutely correct that having that data is key.

Adult Social Care: Staffing

Baroness Wheeler Excerpts

Tuesday 12th December 2023 Lords Chamber

[Lord Markham (Con)]

I will absolutely clarify the number to the noble Lord in writing. It is of course a range, according to different local authorities, but I think we would all agree that it is a level that, as a percentage, is too high.

[Baroness Wheeler (Lab)]

The Nuffield Trust has called the NAO findings a

“damning indictment of the Government’s progress towards delivering social care change”.

To follow on from my noble friend’s question, the NAO points out that only 7.5% of the much vaunted £265 million allocated by the Government to addressing social care staff shortages and recruitment for 2023-35 has actually been spent, heavily impacted by the DHSC’s staff recruitment freeze. What specific actions are the Government taking to address this and ensure that the money they say is there is actually paid out?

[Lord Markham (Con)]

There were five parts to the programme of reforms mentioned and the £265 million. There was international recruitment, which we have done; it has worked well, and we need to continue doing that. The second part was a volunteer programme, which, again, we have done and it is working well. Thirdly, there were digital skills passports, so that staff could swap from place to place and take their qualifications with them; we have done that. The two other things will take longer. The care workforce pathway is out for consultation. It will mean that people can have a long- term qualification that can get them into other professions as well, such as nursing. Lastly, there is the care certificate qualification. That takes time. Everyone knows that, for that qualification to be meaningful, it will take time to set it up. That is the key expense item. The digital platform is going to be launched next June, so it will be rolling out from there.

Mental Health: Children and Young People

Baroness Wheeler Excerpts

Thursday 23rd November 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, this has been an excellent debate, with the knowledge and expertise we expect from across the House and from the very moving and comprehensive introduction from the noble Earl, Lord Russell, in particular on the consequences of family poverty for children’s and young people’s mental health. I too I congratulate the noble and learned Baroness, Lady Hale, on her powerful maiden speech. This is an appropriate debate for her to make her first Chamber contribution to the work of the House. We fully understand the reasons for the long wait to hear her.

As we have heard, this debate is taking place in the context of deep concern over the realities and consequences of the Government’s failure to provide for the genuinely “oven-ready” update of the Mental Health Act in their legislative programme for the rest of their time in office. We are also considering the mental health of children and young people, with the timely report from the noble Baroness, Lady Hollins, on the impact of the long-term segregation of people with learning difficulties and autistic people in mental health settings and in assessment and treatment units in the forefront of our minds.

The updated Bill provides clear provisions for improving recognition of and information on the legal rights of detained children and adults in terms of treatment choices and information that must be provided to them, their parents, carers and families. Patients’ choices would have been given greater weight and it would have been easier for people with learning difficulties and autism to be discharged from hospital. As we have heard underlined by the right reverend Prelate the Bishop of St Albans, the discrimination and inequalities that leave black people four times more likely to be detained under the 1983 Act would have been addressed.

I look forward to hearing from the Minister how these and other steps can be implemented in the absence of the framework of the new Bill and within the continued constraints, approaches and outdated attitudes in the current 40 year-old Act. How will care and treatment of people detained under this Act be “improved” by the “‘non-legislative commitments” that Ministers promised in the King’s Speech and in response to the continuing concerns raised by noble Lords about the impact and consequences of the Government’s decision?

The noble Baroness’s report is the subject of the short debate following this one, so we will revisit this later. I welcomed the Minister’s promise last week during the Oral Question on mental health to meet with the noble Baroness, my noble friend Lord Touhig and others from these Benches, including me, on this very serious issue.

As the House will know, Labour, if it wins the next election, is firmly pledged to reform the Mental Health Act in its first Session of Parliament in the King’s Speech. We have had the expert pre-legislative scrutiny by a Joint Committee on the draft Bill that should have been laid before us—the result of a huge amount of valuable and informed cross-party work and wide consultation among stakeholders. The Government have run out of time on this, and we stand ready, if elected, to meet this pledge, to recruit the thousands more mental health professionals to cut waiting lists and ensure more people can access treatment, and to guarantee treatment inside four weeks for anyone who needs it. We will create an open access mental health hub for children and young people in every community and expand mental health support in schools.

Many noble Lords have rightly underlined the importance of the workforce and the need for more staff across the range of CAMHS, including nurses, psychologists, therapists, social workers and other professionals who specialise in working with children and families. The CQC’s recent annual State of Care report identifies that almost one in five mental health nursing posts is vacant, and that this contributes to an overuse of restrictive practices in mental health settings and ATUs, including restraint, seclusion and segregation.

We have heard how the Government’s failure to honour their pledge on the mental health Bill has caused widespread consternation among key stakeholders, parliamentarians and the wider public—all of us expecting, after such a long wait, the Bill to be a key part of the King’s Speech. As the mental health charity Mind summed it up, the Government have missed the chance to

“overhaul the way the system works when people are in a mental health crisis”

and to

“prevent people being stripped of their dignity, voice and independence when they are sectioned”.

What are the Government’s plans for their formal response to the Joint Committee, which is still awaited? Will they detail exactly how the Bill’s provisions will be taken forward and implemented without new legislation? How, for example, will the proposed new duties on ICBs, local authorities and commissioners to strengthen community provision and services, the new powers for mental health tribunals to direct services in the community, and access to independent mental capacity advocates to support people with autism and learning disabilities, be acted on and enforced?

Emphasising the very serious consequences of the delay is important because the Bill is essential to help reset the culture, tone and attitudes that are needed right across the provision of services in NHS mental health settings, ATUs and local authority education and social care. The CQC’s annual report is the latest of many acknowledging the depth of the crisis in mental health. The continuing impact of the pandemic on the mental health of children—highlighted by every speaker today—the record number of urgent referrals of children to crisis teams, and the NHS Confederation’s estimate that, in the next three to five years, 1.5 million children and young people will need new or additional support for their mental health, as the noble Earl underlined, all reinforce the CQC’s warning that services across the country face one of their most challenging years.

Access to mental health services and the quality of care remain a key area of concern for the CQC, with providers struggling to keep pace with surging demand, alongside staffing shortages and a lack of capacity in community and in-patient care. Long waits for services for children and young people, and children presenting with more complex or specialist needs, are particularly emphasised as worse than before the pandemic.

This impact has been reinforced by speeches today addressing what is behind the huge numbers, with a unique set of pressures for a generation growing up: the pandemic, the cost of living crisis and ongoing global instability. A wide range of emotional and behavioural problems—anxiety, depression, self-harm, eating disorders, bullying at school, and children embroiled in gambling, as the right reverend Prelate underlined—are all in play at a time of ever-increasing demand for mental health services across the NHS and local government. In the last two years, the number of children and young people being referred for urgent support for eating disorders has increased by nearly three-quarters. The noble Baroness, Lady Hollins, spoke very movingly about the experience of a teenager she is aware of, and the noble Earl, Lord Russell, and the noble Lord, Lord Laming, both referred to this issue.

Under the circumstances, the crucial importance of early intervention in an individual’s childhood and teenage years to avoid future mental health difficulties has been emphasised by all noble Lords. The report in June this year from the LGA and Children and Young People’s Mental Health Coalition called for community-based early support hubs, along with a full national rollout of mental health support teams in schools and colleges. The recent Children’s Commissioner’s mental health annual briefing on early intervention is also an important contribution to charting the way forward on this; the noble Baroness, Lady Tyler, underlined that.

However, the LGA and the coalition warned that progress in expanding support provided to families, children and young people is at the risk of being undermined by

“a lack of coordinated vision and action both locally and nationally”.

Can the Minister tell the House what action, particularly cross-government, is being taken to address these concerns and to ensure that early intervention support will be provided?

Finally, earlier this year, the Government shelved their 10-year plan for mental health and well-being, with the focus instead on the major conditions strategy, wrapping up mental health with several physical health conditions. This was cited by the charity YoungMinds as having further delayed the Government’s action for young people’s mental health, which could have paved the way for reforms that support young people and reduce the prevalence of poor mental health. The noble Baroness, Lady Tyler, mentioned this important strategy, but the Government do not seem to fully understand the widespread concern across the mental health sector that abandoning the 10-year strategy has caused. Added to abandoning the mental health Bill, small wonder that they are questioning the Government’s commitment to mental health as a key priority.

We have had the interim report on the major conditions strategy, but it remains very unclear how the full strategy will address and reduce the highest number of open referrals to CAMHS of children and young people undergoing treatment or waiting to start care—as we have heard, a record 466,250 referrals in May. When will the full strategy be published? Can the Minister explain how it will address the issues that were expected to be outlined in the previous mental health and well-being plan?

Labour’s shadow Health Secretary, Wes Streeting, has stressed that Labour, if elected, intends to revolutionise mental health treatment in this country. We are determined to deliver on this and keep every promise we make. I look forward to the Minister’s response to this excellent debate.