Mental Health: Spending

Debate between Lord Alderdice and Baroness Jolly

Monday 27th January 2014 Lords Chamber

[Baroness Jolly]

The noble Lord is absolutely right: parity of esteem is critical. The Government are very intent on holding NHS England completely to account on parity, which is woven into the NHS outcomes framework and the mandate. As I said in my Answer, the Department of Health is working very carefully and closely with NHS England to determine what the most appropriate data are to ensure that patient care is maximised.

[Lord Alderdice (LD)]

My Lords, I, too, welcome my noble friend to her first Question Time. I welcome what she says about the department working with NHS England in order to have the most useful way of bringing figures together. It is not a question of having figures for the sake of them. Can I seek her reassurance that those discussions will include finding a way not just of measuring psychological treatments against other treatments in mental health, but of ensuring that the range of psychological therapies is measured and available, so that we can indeed see whether there is an improvement in the situation?

[Baroness Jolly]

My noble friend has much experience and expertise in this matter. He will know that NICE has recommended in its guidelines a whole range of psychological therapeutic interventions. Available therapies include interpersonal therapy, brief dynamic interpersonal therapy, couple therapy for depression, counselling for depression and behavioural family therapy, as well as cognitive behavioural family interventions. These therapies are all delivered by IAPT services and are included in IAPT training. Since 2010, more than 1,000 therapists have been trained or are currently in training. With regard to new therapies, I assure my noble friend that the IAPT programme will consider evidence-based therapies recommended by NICE for anxiety and depression as they arise.

Health and Social Care Bill

Debate between Lord Alderdice and Baroness Jolly

Tuesday 25th October 2011 Lords Chamber

[Baroness Jolly]

My Lords, it seems that we are now getting an outbreak of agreement that there should be a duty on the Secretary of State regarding education and training in the Bill. This is to be welcomed.

The noble Lords, Lord Mawhinney and Lord Kakkar, put it really well, and I will slightly paraphrase what they said. The delivery of high-quality patient care is absolutely predicated on quality training. It is also critical, however, that standards are set, maintained and monitored, not only for doctors and nurses—we have heard a lot today from very eminent doctors—but for allied health professionals.

There will, however, be a plethora of local healthcare providers: some within the NHS and some outside. We are anxious to ensure that the local responses to the delivery of training will meet these standards. We hope that proper checks and balances will be put in place to give some sort of national oversight on this. The noble Baroness, Lady Finlay, alluded to this in her remarks. I was going to carry on by giving a couple of examples about the need for co-ordination across providers and talking about these independent treatment centres. I will refer only to phase 1 and not to phase 2; we will have got it right by then.

There were complaints, certainly in my local district general hospital, that doctors were seeing only quite complicated operations and not standard ones. It was to do with hips there, and we have already heard about elbows or shoulders elsewhere. Similarly, the noble Lord, Lord Winston, cited hernias and I have a hernia example, which I shall not share with the House.

With this Bill, there is a wholesale need for a total change of culture within the NHS about the way we work. If we put patients at the centre it will create a huge need for training. It will be one-off training in the first instance but it will also need to be ongoing. This is something that I had hoped the Future Forum might be considering as part of its deliberation.

We are assured that the Government are keeping deaneries in place at present, but we share the anxiety of some of the royal colleges about their future. I have to repeat what others have said—and I heard it only this morning: there really is anxiety about this second Bill. The first assurance was that it would come in the next Session but now organisations are worried that the delay might be even longer. Therefore, we need something from the Minister that will help to focus people’s attention and give them confidence that things are in place.

I have spoken to universities and other providers of training. They need reassurance and certainty, too. They need to plan their staffing and, in this, they form part of the health economy. It is in no one’s interest to destabilise them. Can the Minister offer such reassurance on this?

We welcome the duty for Monitor to have regard to the need for high standards in the education and training of healthcare professionals. How will this interact with the potential for insufficient caseloads, in some circumstances, to train new healthcare professionals properly? How will national oversight of education and training be carried out to ensure higher quality? All these areas need to be teased out further, and we will come back to them on Report.

We all acknowledge the critical need for training and for standard setting. Can my noble friend give the House some reassurance that he will look at these issues again and, where possible and appropriate, consider regulation as a way of moving some of them forward in advance of the Bill?

[Lord Alderdice]

My Lords, I do not wish to repeat what other noble Lords have said very eloquently, but there are one or two issues which have not been referred to, to which I wish to draw attention. First, I pay my own tribute to the noble Lords, Lord Walton of Detchant and Lord Patel, and indeed other noble Lords who have kept fighting the good fight on education and training.

It is important, however, that we see this in as broad a fashion as possible. I am a doctor but I intend to speak mostly on non-medical education within the health service, since it has not, perhaps, received as much attention as it might. Like everyone else, I will undoubtedly speak from my own experience, which is, perhaps, a little different because it is in psychiatry and the psychological services. That is not just about treating patients; it is often also about training doctors in communication skills and the capacity to understand the psychological aspects of disease.

The noble Lord, Lord Hunt of Kings Heath, knows that I am not a recent convert to this question of trying to get regulation of psychotherapists and counsellors so that they can properly become part of an overall healthcare system.