Mental Health: Funding

Earl Howe Excerpts

Tuesday 18th March 2014 Lords Chamber

[Baroness Brinton]

To ask Her Majesty’s Government what steps they are taking to protect the provision of mental health beds and funding, in the light of their commitment to parity of esteem between physical and mental health.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, we are clear that acute beds must always be available for people who need them. Providers have a responsibility to listen to patients and to offer care in the community as well as in hospitals, when appropriate. The mandate to NHS England sets its specific objectives, including on mental health. It is for NHS England and clinical commissioning groups locally to determine how best to allocate funding in commissioning services to meet local need.

[Baroness Brinton (LD)]

I thank my noble friend for that Answer. Before these cuts come in April the reality is that it is already very difficult to find an urgent mental health bed. Ten days ago in Kent, no emergency level 4 mental health beds were available. Given that the cuts in mental health services are 20% more than for hospital trusts and given David Nicholson’s statement last week that NHS England will not review them, what specifically can the Government do to remedy the situation?

[Earl Howe]

My Lords, my honourable friend Norman Lamb has expressed his concern that the cuts to the mental health tariff have taken the form that they have. I can tell my noble friend that the department will be scrutinising the commissioning plans of clinical commissioning groups and the draft budgets of mental health trusts to make sure that they reflect the central importance, as set out in the Government’s mandate to the NHS, of making measurable progress towards parity of esteem. We know that there are regional differences in access and we are setting up a new national mental health intelligence network to provide comprehensive and up-to-date information about mental health and well-being.

[Lord Patel of Bradford (Lab)]

My Lords, can the Minister confirm that, despite having very clear guidance and legislation in place, we still have an unacceptable number of 16 and 17 year-olds being admitted to psychiatric wards and that, worryingly, many children under the age of 16 are being placed on adult wards many miles from their families and homes? I am sure the Minister will agree that this is totally unacceptable and extremely harmful to the children concerned and their families. What plans do the Government have to put a complete stop to this harmful practice and provide the resources that are clearly needed for appropriate places for young children in mental health services? Does he have an approximation of the number of children we are talking about?

[Earl Howe]

I do not have a figure to quote to the noble Lord, but our aim, as he says, must be to support children and young people with mental health problems wherever possible in the community in which they live. Admission to hospital should be a last resort for a young person. We have done a great deal to improve mental health services for young people in the community. We also recognise the difficulties for young people and their families if they are treated in hospitals some way from home, but the decision about where they are treated is bound to depend on what is available and what facilities are needed to meet their particular clinical needs.

[Baroness Corston (Lab)]

My Lords, given that there should be parity of esteem not only between mental and physical health services but between people in the community and those in prison, and given that up to 70% of women in our prisons are mentally ill, what provision is now given under the Health and Social Care Act regime for the commissioning of those services for these women?

--- Later in debate ---

[Earl Howe]

My Lords, the principle of parity of esteem applies in every clinical setting, including prisons. We have made it very clear in our document Closing the Gap that these matters are not only important in the wider community but also in prison. We will be monitoring the situation very closely, not least in women’s prisons.

[Lord Elystan-Morgan (CB)]

My Lords, does the Minister accept that successive Governments have shown a remarkable lack of kindness in giving information concerning the apportionment of funds between physical and mental health matters? Does he accept that what is asked for is not a detailed breakdown under various headings, but a broad, ballpark figure that will allow the public to judge whether or not mental health has been less than equitably dealt with in this situation? The failure to give this information, which clearly must be shared by all departmental Ministers, will only add to that suspicion.

[Earl Howe]

My Lords, the Government are committed to the principle of transparency in these areas. I can tell the noble Lord that last month NHS England published expenditure data from its programme budgeting data set for 2012-13 which show that expenditure on mental health in that year was £11.28 billion.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Earl cannot escape his own responsibility and that of his ministerial colleagues. He sets the mandate for NHS England. NHS England has specified that for the next financial year mental health trusts are to be discriminated against as compared to acute trusts. Ministers cannot evade their responsibilities. Why do they not intervene?

[Earl Howe]

My Lords, we have intervened. I have already referred to the action my honourable friend Norman Lamb has taken, making it very clear that not only would there be ministerial oversight of clinical commissioning group plans but that we would ensure that every decision made by a clinical commissioning group with regard to its mental health patients could be justified.

[Lord Cotter (LD)]

My Lords, I welcome the Minister’s repetition of the parity issue but, in practice, many young people nowadays—one in four, perhaps, as has come out in recent surveys—are suffering from mental health problems. I have evidence, which I would be glad to give to the Minister for his intelligence network, that there is no parity when it comes to young people. For example, one GP said that it is a “DIY service”. There are major concerns about mental health across all ages, particularly young people. I would welcome a response from the Minister now but I would also like to give him some evidence to be looked into with regard to specific areas in this country.

[Earl Howe]

I share my noble friend’s concern about this and would be happy to receive the information to which he refers.