Mental Health Care (Older People in Lincolnshire)

Debate between Edward Leigh and Stephen Phillips

Thursday 27th March 2014 Commons Chamber

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

World Health Organisation figures show that mental illness is responsible for the largest proportion of the disease burden, at just over 22%, in the UK. That is greater than that of cardiovascular disease or cancer, each of which stand at about 16%. In our society, mental health simply does not receive the same attention as physical health. People with mental health problems frequently experience stigma and discrimination, not only in the wider community but from services they need to access. This is exemplified in part by lower treatment rates for mental health conditions and an historical underfunding of mental health care relative to the scale and impact of mental health problems.

However this problem may have arisen, it is persistent and the consequences are plain. People with severe mental illness have a reduced life expectancy of 15 to 20 years, even though the majority of the reasons for this are entirely avoidable. I cannot be the only one to think that this can no longer be tolerated in the 21st century. I am glad that the Government have made real progress in promoting the principle of parity of esteem with their commitment to put mental health on a par with physical health in the NHS. Central to this approach is the fact that there is a strong relationship between mental health and physical health, and that the influence works in both directions: poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems.

I sought this debate to raise the particular issue of mental health care for older people in my county, an issue that can only continue to grow in importance as our population ages. The UK is experiencing a significant population shift, with both the size of the older population and projected life expectancies rising considerably faster than previously expected. Significant growth is expected amongst those over 65 in the next few decades, with the oldest age group of those aged 85 and above growing proportionally the fastest. As the population aged over 65 increases, the number of older people with mental health problems will also, inexorably, increase. The largest increase in numbers of any mental health problem will be seen in the rise of the numbers of people with depression, but there will also, undoubtedly, be significant increases in the number of people with dementia.

Surprisingly, perhaps, this will be compounded by co-morbidity with substance misuse in this age group. Although usually regarded as a problem affecting younger adults, abuse is overlooked in the elderly. In the next few decades, there are likely to be increasing numbers of older people exhibiting co-morbid symptoms, as alcohol and drug users from the baby boomer generation reach and pass retirement.

One of my constituents, a community nursing assistant at the Manthorpe centre in Grantham, has spoken to me about his concerns for the future. Although the centre is not in my constituency but in that of my hon. Friend the Member for Grantham and Stamford (Nick Boles), it provides mental health services for older people from all over Lincolnshire. As such, concerns have been raised with me about the reorganisation of services at the centre and elsewhere in the county. The job of a community nursing assistant, as my hon. Friend the Minister will know, is to provide the emotional and practical support needed by elderly patients. Assistants thus deal with a large number of lonely, isolated and vulnerable people. It is not only the mental health diagnoses of those in this group that cause problems, but the simple loneliness. Often, their health care workers are the only people they see or talk to on a regular basis. Indeed, my constituent has told me that he and his colleagues can be the “nearest relative” at funerals, which gives some sense of the acuity of the problem.

It used to be the case that families and communities looked after their older members and supported them, but sadly, as we all know, that is all too often not the case. The disestablishment of those community posts in Lincolnshire is thus causing real concern. Those who fill them save the NHS money by helping those in need directly, without their needing to be admitted to hospital, which is far more costly than being supported while living at home. Yet when I contacted the Lincolnshire Partnership NHS Foundation Trust to ask about these posts, I was told they were intended to provide social intervention rather than health care per se—a function that the trust feels should be carried out by local authorities through their social care staff. So it is that a lack of funding from one part of the system that does not regard itself as responsible for the establishment of these posts runs the risk of costing itself and other parts of the NHS more money in the long term.

I understand from more recent discussions that the trust is now working closely with our local authorities to ensure that patients remain supported, but I understand and share the concerns of many that elderly folk in need may fall through the cracks despite good intentions. Indeed, that is too often the case where NHS care and social care interact—an issue that I know has been raised on numerous occasions in the House by colleagues on both sides. I would therefore be grateful if the Minister told the House what steps his Department is taking to work with trusts that are reducing provision to ensure that robust support networks are maintained and improved for patients with mental health needs.

[Sir Edward Leigh (Gainsborough) (Con)]

The people in Lincolnshire will be grateful to my hon. and learned Friend for raising these issues. Does he agree that they are exacerbated by the rural nature of our county? Frankly, people in a deeply rural county such as Lincolnshire sadly get a worse service than people living in urban areas.

[Stephen Phillips]

I am extremely grateful to my hon. Friend, who makes an important point. All too often, and not just in this area of public service, as he knows, but in so many others, we get a much worse service in rural communities—particularly, it seems, in Lincolnshire —than many other places. That is in part made up for by the fact that we have extremely strong communities, with strong ties between neighbours and families, but as I know he knows, far too often we seem to draw the short straw in this and other areas.

That is in part why I also want to raise with the Minister the apparent disconnect between services for those aged over 65 and those under that age, given our ageing population in the county. In that regard, I have been told that the care provided by the community mental health team in my part of Lincolnshire for those under 65 has been fairly extensive, including a lot of support for those settling back at home after a hospital admission, but that such services are not so readily available for those aged over 65. Why the disconnect and what can the Minister do about it?

I am aware, of course, that the Equality Act 2010 has been vital in shifting mental health services towards age inclusiveness. The Minister will know, and has no doubt acted on the fact, that there is now a duty on health and social care services not to discriminate on age grounds. That ought to mean that older people with mental health problems should have the same access to mental health services that had previously been available only to people under the age of 65. Is this working? No doubt the Minister can tell the House, for there is a great deal of concern, at least in Lincolnshire, that it is not. I understand that the Department of Health has acknowledged the under-representation of over-65s in the IAPT—improving access to psychological therapies—initiative and has made a commitment to undertake various corrective actions to address that in line with the provisions of the 2010 Act. I would be grateful if the Minister could tell the House what his assessment is of the current state of mental health services for those aged over 65 and what steps he is taking to ensure improvements in provision and access in Lincolnshire and elsewhere.

The Royal College of Psychiatrists has said that to integrate older adults’ mental health services into “ageless” services makes no sense. Older people have very different physical, social and psychological issues, which require specialist old-age psychiatrists working in specialist services for older adults. Older people tend to have multiple physical co-morbidities or frailties, which often complicate their mental health treatment. Many older people also have specific cognitive problems, social issues or end-of-life concerns, which may precipitate or sustain mental illness.

It would seem that the key element is flexibility of access. We need to ensure that people do not automatically become ineligible to continue to be treated by a service once they pass the age of 65, so that someone under that age with, for example, early-onset dementia can gain access to the expertise of comprehensive older-adult mental health services. I should be grateful for the Minister’s comments on those points.

The Royal College of Psychiatrists has also identified a “mental health treatment gap”, exemplified by lower treatment rates for mental health conditions, premature mortality among people with mental health problems, and the underfunding of mental health care relative to the scale and impact of mental health problems—the problems that I described at the beginning of my speech. Annual statistics published by the Department of Health on investment in mental health have shown that in 2011-12 there was a 1% decrease in overall investment and a 3% decrease in investment in older people’s mental health services. I know that addressing the funding gap will be challenging—particularly as such underinvestment tends to be exacerbated during times of austerity, when mental health services risk being cut in preference to physical health services—but I venture to suggest to the Minister that things should not go on as they have been.

Given the current challenge to address the high levels of both identified and unmet need, an increasing ageing population will have significant resource consequences for mental health and social care services for older people, which are already struggling to provide care at present. Unless there are major breakthroughs in new cost-effective treatments, or prevention and promotion initiatives succeed in reducing the incidence and prevalence of mental health problems among older people, services will need significant extra resources to meet that demand. In practice, however, mental health spending has in the past followed an erratic pattern nationally, with cuts in some areas and investment in others.

What, ultimately, I want to hear from the Minister tonight is an assurance that he is focusing on this issue, and that enough is being done to ensure that mental health services receive proper funding, in Lincolnshire and throughout the country.

Onshore Wind Turbines (Lincolnshire)

Debate between Edward Leigh and Stephen Phillips

Tuesday 6th November 2012 Westminster Hall

[Stephen Phillips (Sleaford .and North Hykeham) (Con)]

Thank you very much, Mr Chope, for calling me to speak. It is a pleasure and a privilege to serve, for I think the first time, under your chairmanship. It is also a huge pleasure and privilege to be joined today by so many colleagues from throughout Lincolnshire.

In opening, I venture to suggest that this is perhaps a timely debate. I want to make it clear to the House that I applied for it well before the Minister of State, Department of Energy and Climate Change, my hon. Friend the Member for South Holland and The Deepings (Mr Hayes), made comments on this subject last week with which so many of us agreed. Perhaps the strength of this coalition—not its weakness—has been its ability to allow those of us with different views to come together at a time when the country required strong Government to deal with the appalling legacy that we were bequeathed by our predecessors. That appalling legacy may not be the subject of today’s debate, but it is of course a fact.

The full truth about climate change, which is inescapably taking place, and the role played by mankind in our changing weather patterns, which is less clear, has yet to emerge. What is clear is that the risks are sufficient that, for the sake of future generations, we ought not to ignore them. How we tackle our over-dependence on fossil fuels is another question, however.

Whether one is a believer or a sceptic when it comes to man’s responsibility for climate change, we all ought to be able to agree that moving towards renewable sources of energy is beneficial, not only in reducing emissions but in ensuring our future energy security, particularly when we have passed peak oil and when fossil fuel supplies will inevitably become scarcer in the future. I do not doubt that by diversifying the nation’s energy mix we will move towards a cleaner and more sustainable energy portfolio in the future, with greater security of supply. If correctly placed—I repeat, if correctly placed—onshore wind can perhaps play a part in that process.

However, as hon. Members from all parties will know, many parts of rural Lincolnshire are affected by hugely unpopular decisions and proposals for onshore wind turbines—an issue that all of us here today have been contacted about by constituents on numerous occasions. Lincolnshire MPs are very lucky to live in and represent an area with beautiful countryside, but it also seems, regrettably, to be an area ripe for the construction of turbines, perhaps because of our large open spaces.

Currently, 10 wind projects are in operation in Lincolnshire, comprising 93 turbines in total, with a further three turbines being constructed. Thirteen projects are in the planning stage, with proposals for another 94 turbines.

[Mr Edward Leigh (Gainsborough) (Con)]

All Lincolnshire MPs are very supportive of my hon. and learned Friend in his endeavours. Does he think it a cruel paradox and irony that while thousands of Lincolnshire folk are being forced into fuel poverty because they have to pay extra on their fuel bills—and we are not a high-wage area—a few very rich farmers are being awarded sums of up to £250,000 by the taxpayer for doing nothing other than irritating their neighbours, and are also making no contribution to the economy?

[Stephen Phillips]

I have considerable sympathy with the point my hon. Friend makes; indeed, I will come on to the subsidies provided by the Government to those who go forward with these proposals. However, I think we can all agree that it is certainly right that those subsidies have to be kept under constant review.

[Karl MᶜCartney (Lincoln) (Con)]

I congratulate my hon. and learned Friend, and neighbour, on securing this debate. Does he agree that the point he was making, which has just gone out of my mind, regarding our area of Lincolnshire—I have completely forgotten what I was going to say.

Sovereign Grant Bill

Debate between Edward Leigh and Stephen Phillips

Thursday 14th July 2011 Commons Chamber

[Mr Leigh]

My hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) is desperate to get in, so I give way to him.

[Stephen Phillips]

I am not sure that I have ever been desperate to get into anything. I think it was in 2005, when my hon. Friend was the Chairman of the Public Accounts Committee, that the Committee published a report, which he will probably remember, that drew attention to a potential conflict of interest between the Duke of Cornwall and future Dukes of Cornwall. That is not addressed at all in the Bill. Does he share my hope that my right hon. Friend the Chancellor of the Exchequer will deal with that point in his wind-up, and that the Government will look at the issue in future?

[Mr Leigh]

That is a serious and important point. We have had mention of the Duchy of Cornwall; I should say that we did some trailblazing work in our hearing about the duchy. The hon. Member for Glasgow South West will remember that we ranged widely over all aspects of its management. One of the issues that we raised was whether we should maximise resources—income and capital—for the present Duke of Cornwall, or for future generations. I hope that the Chancellor can also reply to that point when he winds up.