Children’s Cancer Services
Earl Russell Excerpts(8 months ago)
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Lord Markham (Con)
First, I thank my noble friend for the tireless work she does on behalf of the Royal Marsden, and convey the views of probably all noble Lords on the fantastic work the Royal Marsden does. The current situation, as I think noble Lords know, is that the NHS has reached a decision. The Secretary of State does have the power to call in exceptional cases, and as a result of that, Minister Stephenson is undertaking a fact-finding mission. I have set up a meeting with him to discuss this, and my noble friend is very welcome to join me at that meeting.
Earl Russell (LD)
My Lords, structural healthcare decisions are among the most challenging, and my worry is that there are greater risks now the Evelina has been chosen. It will be the only principal treatment centre in the UK where neurosurgery is not carried out on-site. St George’s has over 25 years’ experience in caring for children with cancer and a dedicated staff team of over 430 people, only four of whom will be moving to the Evelina. What actions will the Government be taking to monitor and ensure a continuing standard of cancer care for children?
Lord Markham (Con)
Ministers are on a fact-finding mission. I understand the points the noble Earl makes; the NHS made the point that it wants cancer treatment to be co-located alongside an intensive care unit. Following Professor Sir Mike Richards’ review, it believes that it is best to have those services co-located, which is why it has chosen the Evelina. There are pros and cons to every decision, and that is why Ministers are doing further fact-finding.
NHS: Drug Shortages
Earl Russell Excerpts(10 months ago)
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Lord Markham (Con)
We find that each one is a different case in point. HRT is an example: we actually saw a 50% increase in demand for it over the last year, so suddenly that is quite a dislocation for the market, and you need to gear up very quickly in terms of the supply chain issues. Strep A was the example last year that we will all be familiar with; normally, it does not come until later in the year, but suddenly there was a very early outbreak in October, which caused the demand there. You find that every single drug tends to be a different case in point. There is a range of tools that they work with; it is working with the NHS, MHRA suppliers and pharmacists, and it is case by case. As I say, sometimes it is the MHRA expediting medicines to get new supply in; sometimes it is working on alternative suppliers; sometimes it is buying internationally—that is what we did in the case of strep A—and sometimes you do have to go as far as the serious shortage protocols, finding substitutes or, in extreme cases, changing doses. There is a range of programmes on it, which by and large are managing to tackle it.
Earl Russell (LD)
My Lords, can I ask the Minister specifically about the continued lack of supply of ADHD medication? The department said that the supply shortages would continue until April, when previously it had indicated that this supply issue would have been resolved by now. Do the Government understand the serious impacts that these shortages have, and the impact that the inability some people are facing to get any medication at all is having on their daily lives?
Lord Markham (Con)
There are 78 medicines for ADHD, 10 of which are particularly affected. We have put export restrictions in place on that, and we are working it through so that we can hopefully get it resolved by April. It is something we are working very closely on, because we know the importance.
Mental Health: Children and Young People
Earl Russell Excerpts(12 months ago)
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Earl Russell
That this House takes note of the current state of mental health support for children and young people in England.
Earl Russell (LD)
My Lords, I am delighted to have secured this debate. There is no more important issue, to my mind, than ensuring that we are adequately supporting our children and young people when they are not well and at their most vulnerable. I thank the Members of your Lordships’ House who have put their names on the speakers’ list for today.
I have been moved to bring this debate as I have personal experience of poor mental health and the impact it has on young people, following my own daughter’s five years of struggle. As a parent, it has been one of the most challenging periods of my life. No parent ever wants to see their child unable to keep themselves safe. It is important that we, as politicians, share our personal experiences as part of the fight for change. I am proud of the progress she has made. I wish to use my experience to help fight for better outcomes for other children who find themselves in similar positions. I know that others in this Chamber will have had similar personal experiences.
I have also brought this debate as I want all children out there who are struggling to keep themselves safe and well right now to know that everyone in this House and across government are working together to help make things better for them. This is not a political issue nor is this a political debate; I know we are all united in wanting to improve services and outcomes for children and young people. As my daughter might say, “We got you”.
I will make three key points. First, children and young people are facing an expediential crisis from the combination of the impacts of Covid and a general increase in poverty that has overwhelmed previously overstrained systems, so real and immediate action is needed. We are facing a young persons’ mental health emergency. Secondly, the systems in place are not working; there is a need for a full root-and-branch review and reform of the systems and services. Thirdly, I will call for a more integrated national mental health service for children and young people to be established, with an emphasis on early intervention, extra support in schools and a call on the Government to take urgent measures to provide additional funding. I note the Government’s decision not to bring forward the promised mental health Bill in the King’s Speech. It is disappointing that the mental health Bill has been dropped and parliamentary time has been diverted to other measures.
There has been an 89% increase in the number of children and young people coming into contact with mental health services between August 2022 and August this year. NHS Digital conducts a regular survey of children and young people, with results published between 2017 and 2022, and the fourth wave published just this week. The most recent key findings show that one in five of our young people aged eight to 25 had a probable mental health disorder. Rates remain at elevated levels following the pandemic and for 17 to 25 year-olds, rates were twice as high for young women as they were for young men. In 2023, 20.3% of children in England aged seven to 16 had a probable mental health disorder, up from 18% in 2022 and 12% in 2017. Rates among young people aged 17 to 19 with a probable mental health disorder rose from 10.1% in 2017 to 17.7% in 2020 and 25.7% in 2022, and they remain high at 21.7% now.
Not only are we seeing rising numbers; we are also seeing increases in the severity and complexity of the mental health needs of our children and young people. For example, we are treating double the numbers of children and young people with eating disorders who need urgent care than before the pandemic. This is a staggering and highly alarming increase. The reasons and causes for this rise in cases are many and complex, as are the solutions. We have very little understanding of the real root causes; more research must be done and young people themselves must be given greater opportunities to have their voices properly heard and understood. Isolation during Covid was a serious shock, taking away the normality of everyday life and children’s own sense of autonomy over their daily lives. Home education was a challenge for us all.
The rise in poverty and the collapse of youth services are also relevant. Poverty brings family stress and an increased prevalence of family breakdown. For children, poverty all too often creates feelings of shame. More than one in four children aged eight to 16 with a probable mental health disorder had a parent who could not afford for their child to take part in activities outside of school or college.
Social media is also to blame. Our children are constantly plugged in and susceptible to harmful content, bullying and harassment. Pernicious phones get in the way of real family quality time, often leading to social isolation in the home and an increased sense of worthlessness. The modern world we are creating for our children is undoubtedly toxic. Pressures at school are ever-growing and many children feel that they are already failures before they are even at the starting line. The transition from primary to secondary school is a crucial time in young people’s development and not enough is done to support it.
Waiting times for treatment are skyrocketing. Research conducted by the House magazine, based on FoI requests to 70 UK NHS trusts and boards published this year, found that a quarter of a million children in the UK with mental health problems have been denied help, with some NHS trusts failing to offer treatment to 60% of those referred by GPs. The research also uncovered a postcode lottery, with spending per child four times higher in some parts of the country than others. Average wait times varied from 10 days to three years. In 2021-22, trusts were forced to raise thresholds for treatment to tackle backlogs, resulting in hundreds of thousands of children being turned away altogether. The research showed that, overall, 32% of all GP referrals were denied treatment. I ask your Lordships to reflect on that shocking statistic for a moment.
Young people who are seriously ill are routinely being denied any access to treatment. Research from YoungMinds has indicated that a third of children and young people are not seeking support for their poor mental health, despite acknowledging that they are struggling. Stigma around mental health issues continues to be s problem, and these figures indicate a further unmet demand. An estimated 1.5 million children and teenagers will need new and additional support for their mental health over the next three to five years, including seeking treatment for eating disorders.
Research conducted by the Children’s Commissioner for England has shown that the threshold for any treatment is now so high that, in many areas of the country, the first help children receive is only after they have made multiple attempts at suicide. The first attempt does not always provide access to any support. If parents acted in that way, it would rightly be classed as child neglect.
Young people are left self-harming and attempting suicide for months, without support. While they are struggling to stay safe, many of them end up engaging in risky behaviours such as self-medicating with illegal drugs. New data from YoungMinds has revealed that urgent referrals of children to emergency mental health services have tripled since 2019. There is no early intervention or support. We only help when cases are extreme and children are in imminent danger. By this point, much damage has already been done.
This is a cruel and inefficient way to provide essential health services. We do little or no prevention work and ignore alarming presenting symptoms. This failure to provide treatment causes pain and long-term damage, leaves lasting psychological scars and damages children’s long-term life chances. Vital self-development, education and life chances are permanently missed. This also places increased pressures and costs on other health and educational services.
Another impact is the huge increase in long-term absences from schools’ rolls since Covid. The Children’s Commissioner for England, Rachel de Souza, said in a recent report:
“I fear that attendance has become the issue of our time. The number of children regularly missing school has more than doubled compared to pre-pandemic … Worryingly, over 120,000 children are missing at least half of their time in school.”
While the causes of persistent absence from school are complex, one key factor is the lack of mental health support. Indeed, her report calls for the rollout of mental health support teams to be expedited, to reach all children by 2025.
Delaying or denying treatment and providing treatment that is too little and often too late is unfair on our children and young people. It fails to meet basic needs or to protect the welfare and well-being of children. Prevention is better than cure. Even when first appointments are given, they are often highly administrative, providing little or no treatment. The waits for second appointments are often even longer. Even when treatment is provided, it often results only in the prescription of medication. I am not against medication—it has a valuable role in treating children—but medication alone is not an adequate treatment plan in most cases.
We need more talking therapies. Evidence increasingly suggests that trauma and feelings of shame and worthlessness need to be discussed in order to be processed by the human brain and thus resolved. We need whole-family-based approaches; we need family therapy to be made available; we need dedicated support in schools to help keep children in school and turning up for life.
I welcome the steps the Government have already taken to increase funding, including the introduction of the mental health care standard in 2018. I recognise that government spending on CAMHS has gone up year on year. I am delighted that my party has put forward detailed proposals to provide a dedicated mental health professional in all 22,000 state-funded schools in England, so that every child has someone to turn to. The estimated cost is £620 million per year. My party has proposed that this be funded by trebling the digital services tax.
I kindly ask the Minister to acknowledge the scale of the problems and inadequacies of service provision that children and young people face. I ask him also to ring-fence CAMHS funding and work to provide equality of service provision. The Government must provide additional funding and work urgently, in the words of YoungMinds, to “end the wait”. The Government must provide mental health services with long-term and sustained investment to help meet demand. According to the NHS Confederation, that means an extra £900 million per year by 2024-25.
The rollout of mental health support teams in schools and colleges nationwide must be accelerated. I call on the Government to commit to bringing forward their target of 50% access by 2024-25 and make it 100%. I believe this is one of the most urgent and achievable things they can do. It is essential that children have access quickly and that there is a triage service available to children who are in crisis. This is one of the easiest ways the Government could really make a difference to a huge number of young people’s lives.
Finally, I call on the Government to commit to a full implementation of the four-week piloted clinical access standard for children and young people’s community mental health services, and to produce a fully funded plan for the sector to show how they plan to reach this target.
This issue is personal to me, but I really wish to work with the Minister and across the House to raise these issues for our children and young people. It is not right that our children are suffering in these ways. We must do more to help them. It is not beyond our capabilities to do more to make sure that their needs are met and that they are supported. We should not be leaving them to suffer. I beg to move.
Earl Russell (LD)
My Lords, it has been a pleasure to bring the debate to the House today. I thank everyone who has spoken. It is an immense privilege and honour to have heard the wonderful maiden speech from the noble and learned Baroness, Lady Hale, on which I congratulate her.
I am new to this place, but I have been struck today by the uniformity of feeling and desire for change and to work together cross-party, in the interests of helping our children and young people and of getting a better understanding of the causes of this rapid increase so that we can plan budgets and provide help. I thank the Minister for his response. I recognise him to be a deeply thoughtful and caring Minister. I appreciate his talking about his family experiences in the issues of mental health. I welcome his offer of continuing this debate at the round table, and I welcome the fact that he will report back to us on the points raised today.
One thing that has not been mentioned that I would like to mention is the particular mental health concerns of LGBT+ people, and young LGBT+ people, of which there is increasing evidence.
It has been a privilege to introduce the debate. I hope that it helps to galvanise the Government into further action, and that some of that action results in further funding. I thank all those who have taken part.