Mental Health Budget: Domestic and Sexual Violence

Lord Bishop of St Albans Excerpts

Thursday 22nd November 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right. The strategy, of course, has a focus on women and men. Women are the greater victims of abuse; indeed, the more severe the abuse, the more likely it is that the victim is a woman. However, I can tell her that it is a broad strategy which encompasses both. We still have a problem, in that men are much less likely to come forward if they have been abused than women.

[The Lord Bishop of St Albans]

My Lords, it is much to be welcomed that the Government are allocating this money. I am also glad that the needs of young people have been highlighted, but the Minister will be aware that statistics show that roughly 340,000 elderly people are suffering abuse in the community each year. If we are not tracking how the money is spent, how can we be sure that the mental health needs of the elderly are being properly addressed at a particularly vulnerable point in their lives?

[Lord O'Shaughnessy]

The right reverend Prelate makes an excellent point. The intention is that there will be greater reach into care home settings as well as domestic settings, so that people who experience abuse in those settings are able to come forward and we can provide such protections for people in homes.

Brexit: Risks to NHS Sustainability

Lord Bishop of St Albans Excerpts

Wednesday 12th July 2017 Lords Chamber

[The Lord Bishop of St Albans]

My Lords, I thank the noble Lord, Lord Warner, for introducing this important topic for us this evening and for his helpful and comprehensive opening remarks.

Ensuring the sustainability of the NHS is undoubtedly a significant challenge, even before the potential consequences of Brexit are considered. The uncertainty surrounding the Brexit negotiations has created significant stress for many working in already pressurised health and social care systems. There is no doubt that urgent action must be taken to ensure the stability of the current system. That being said, I wonder whether we might be able at this time of significant pressure to begin to confront some of the deeper challenges that our health system faces. The challenges of Brexit for our health and social care services might only reveal the deeper, long-term problems of these systems as a whole. It would be unfortunate for Brexit to be only the latest in a long line of short-term crises rather than an additional opportunity for reflection.

The report of the Select Committee on the Long-term Sustainability of the NHS, published in April of this year, stressed:

“Whatever short-term measures may be implemented to muddle through today, a better tomorrow is going to require a more radical change”.


I note particularly its recommendation of,

“a new, independent standing body enshrined in statute to safeguard the long-term sustainability of the NHS and social care”.

The nature of the political cycle means that it is difficult for politicians to rise above the fray and consider the long-term sustainability of the system as a whole, and there is substantial room for a body to oversee and scrutinise independently and to report directly to Parliament. National health and social care service provision affects the lives of citizens in profound ways, quite literally from cradle to grave. It is no surprise that it is of paramount importance to both individuals and politicians, and we should consider novel ways to safeguard these systems. Bold leadership is required, but this should be an area where politicians can show courage in finding common ground to make meaningful and lasting change.

Much has been said in this Chamber about the deep feeling of division in this country in the light of the Brexit referendum. Nevertheless, the NHS, and the importance we place on caring for one another, is at the core of the “British values” discussed in the Queen’s Speech. Indeed, these values are a part of many faiths, including Christianity. Part of what it means to be British is to care for one another, even when it comes at significant cost. We must acknowledge, however, that that cost is increasing, and adjustments must be made at both an individual and societal level. We have a duty to one another and to future generations to ensure that necessary resources are in place and are safeguarded in order for care to be maintained.

It is unfortunate that the NHS is not in a better position to be able to respond to the challenge of Brexit; we are still suffering the consequences of short-term thinking and acting. The waiting list for elective treatment has risen to 3.78 million, which is 5% higher than a year ago, and the number of delayed discharges from hospital caused by waits for home care rose by 45% in 2016-17. Even within my own diocese, two wards in St Albans hospital are scheduled to be closed to cut costs despite the clear demand for beds. By taking a more long-term approach to healthcare, even in the light of Brexit, we may be able to address the issues that have weakened the system substantially and prepare for the additional challenge of our ageing population. If we can work towards preventing weakness in the system, we will be far better placed to respond to sudden challenges.

The potential loss of EU personnel in both the health and social care systems will be an enormous short-term challenge. More than 60,000 people from EU countries outside the UK work in the English NHS and around 90,000 work in adult social care. Support must be provided for these individuals, many of whom work long hours in difficult circumstances and have made significant sacrifices to make the UK their home. We need to take account of them, not just in negotiated discussions but also in any plans, after we leave the EU, to alter immigration policy.

It should never be overlooked that the NHS is heavily reliant on workers from outside the UK. Despite this, the Royal College of Physicians describes our hospitals as chronically understaffed, almost half of community mental health teams had staffing levels judged as less than adequate in 2013-14, and the Royal College of Midwives believes that in England we need 3,500 more midwives to ensure that every woman can receive one-to-one midwifery care in labour.

Not only must we have sufficient numbers of personnel, we must ensure that they have the correct skills and training that the service needs. This means that we need to invest in those currently serving in the NHS, as well as making sure that we train enough doctors and nurses here in the UK. However, in 2016 there were unfilled nursing places in UK universities, and we know that care homes would collapse without their non-UK workforce. This is in part because these roles are not sufficiently valued and hence do not attract UK applicants. Sustainability of the workforce cannot be achieved, even if all EU workers remain, unless attitudes to some health and social care roles change significantly.

As we seek to manage the staff of the NHS wisely—that staff is undoubtedly one of our greatest assets—prudent financial planning will also be required. The quality of care which we have come to expect and demand comes at a significant cost. Some 86% of the NHS’s sustainability and transformation fund of £2.1 billion has been set aside to sustain current services and meet expected deficits. As deficits increase year on year, a radical rethink of healthcare funding is required. We need a broader social dialogue about funding for health and social care, one to which the Church and other faith communities can contribute.

Along with the right to healthcare, which we are undoubtedly privileged to enjoy, as users of health and social care services we have associated responsibilities. In remembering that we both benefit from and contribute to the NHS, we must consider the impact of our own lifestyles on our ability to care for others. In treating others as we wish to be treated, we must be prepared to think creatively and make sacrifices for all to enjoy a good standard of care.

Health: Medically Unexplained Symptoms

Lord Bishop of St Albans Excerpts

Tuesday 4th July 2017 Lords Chamber

[Lord O'Shaughnessy]

Of course, a suite of training is available for those treating illnesses such as this one, which affects about 220,000 people in England. It is not a rare disease; unfortunately, it is far too common. That treatment is there and also a number of networks exist, such as the Academic Health Science Networks, to spread innovation and best practice for treatments around the NHS.

[The Lord Bishop of St Albans]

My Lords, many of us are glad to have this report published by the Joint Commissioning Panel for Mental Health on services for people with medically unexplained symptoms. There is a welcome stress in it on trying to get integrated care—a both physical and mental approach. Would the Minister comment on the need to have an integrated approach to the spiritual dimension of this as an essential aspect of addressing these medically unexplained symptoms?

[Lord O'Shaughnessy]

Of course, the difficulty for sufferers of these illnesses is precisely the unknown origins of them. There are obviously physical aspects—that is the whole point of this being a neurological condition—as well as mental health aspects in terms of dealing with it. No doubt, spiritual guidance and uplift can help those dealing with these awful conditions.

Mental Health: Young People

Lord Bishop of St Albans Excerpts

Thursday 9th February 2017 Grand Committee

[The Lord Bishop of St Albans]

My Lords, there are few more urgent issues in modern Britain than the state of mental health among our young people, and I thank the noble Baroness, Lady Massey, for tabling this important debate. Referrals to specialist mental health services have risen dramatically in recent years as increasing social pressures on our young people threaten the mental health of a generation. Issues around body image are one area of particular concern, fuelled in part by the rise of social media. I want to take this opportunity to pay tribute to my friend the right reverend Prelate the Bishop of Gloucester for her important work around body image and self-worth.

One statistic that has caused me concern, and which I have already mentioned in the House, is the rise in self-harm among young boys and girls. Some 20% of British 15 year-olds report some form of self-harm, while in the past five years hospital admissions associated with self-harm have gone up by nearly 93% among girls and 45% among boys. It is notable that of the parents who participated in the report mentioned in the Question put by the noble Baroness in tabling this debate, 59% said that their child self-harmed.

The charity selfharmUK, located in my diocese, does amazing work helping parents, youth workers and teachers understand and respond to the issues around self-harm. But for many who do not have access to such resources, parents in particular, knowing how to respond can be very difficult. It is all too easy to panic and thereby sometimes make the situation even worse. What seems to me to be absolutely essential is readily available support and training for parents, teachers and youth workers about how to help children who are struggling with self-harm and similar mental health conditions. I was very moved, as I am sure were other noble Lords, by the comments made in the past week by the broadcaster Mark Austin in the Times about his struggle to understand his daughter’s anorexia. Can the Minister therefore inform the House what steps, in addition to the welcome mental health training for teachers announced by the Prime Minister last month, Her Majesty’s Government will take to make sure that parents and youth workers are able to access proper resources and support when it comes to understanding mental health in young people?

Residential Care

Lord Bishop of St Albans Excerpts

Monday 6th February 2017 Lords Chamber

[Lord O'Shaughnessy]

I am pleased that this Government have introduced the national living wage, which is supported, I believe, across this House and the other place. The noble Baroness is quite right that there is an impact on social care home providers, many of the staff of which are paid at that level. The truth is that there is a cost pressure, of course, in the social care sector—that is one of the reasons that the precept is rising quicker than it would have done otherwise—and the better care fund has been created to support more care provision in the appropriate setting that people want to have it in.

[The Lord Bishop of St Albans]

My Lords, with applications for nursing degrees having gone down by 10,000 and with planned immigration restrictions being imposed, what are Her Majesty’s Government doing to ensure that we have not only sufficient beds but the caring and nursing staff to look after those who are using the beds?

[Lord O'Shaughnessy]

The number of workers in the social care sector has increased by about 165,000 over the last five years: there is an increased demand because we have a growing population. I think that we are going to have another opportunity to talk about the impact on nursing degrees tomorrow, so I do not want to spoil the party. As for the impact of the European Union, of course, a significant section of the workforce comes from the European Union but we are increasing the number of nursing training places and there is also now a nursing apprenticeship scheme which is providing 1,000 places for people who want to enter the profession by that route.

Mental Health: Children’s Services

Lord Bishop of St Albans Excerpts

Thursday 19th January 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is a great campaigner on these issues, and I have huge respect for the work that she has done. The sustainability and transformation plans will obviously include these local transformation plans for mental health, and it is up to NHS England to ensure that it delivers on the many commitments we now have. Those commitments include the first ever access and waiting times for mental health, which is both access to talking therapies and access to help after psychotic incidents. We have new targets coming up for children and young people who seek help when eating disorders or other generic mental health problems are identified. There are robust targets and there is now a mental health improvement team in NHS England to make sure that those CCGs deliver what they should.

[The Lord Bishop of St Albans]

My Lords, this is a very serious and growing problem. Recent research has shown over the last five years that the number of hospital admissions associated with children’s self-harm has grown by 93% among girls and 45% among boys. It seems extraordinary that when money is announced for mental health services it is then not spent. First, how many years will we wait until we need to ring-fence that money, because this is a really important issue? Secondly, to pick up on the previous but one question, will the Government commit to producing guidelines for schools and colleges about preventing and responding to self-harm, so that we have some practical things put in place?

[Lord O'Shaughnessy]

I could not agree more with those points, in the sense that money must get through to the front line. However, we have an NHS that is set up so that clinical decisions are made by clinicians rather than politicians, and that must be right, because the needs vary from area to area and different areas have different priorities. They have different historic legacies in terms of delivering their services. As for the direction that we give to schools and colleges, clearly the thematic review that the CQC and Ofsted are carrying out will provide advice on what works. We are also introducing some randomised control trials to look at interventions that work, so we have a proper evidence-based system. The commitment is to get 70,000 more young people having evidence-based treatments by 2021.

Young People: Self-Harm

Lord Bishop of St Albans Excerpts

Tuesday 6th December 2016 Lords Chamber

Asked by

[The Lord Bishop of St Albans]

To ask Her Majesty’s Government what assessment they have made of the rise in the number of children and young people being treated for self-harm.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Government are aware of the appalling rise in self-harm in children and young people and the misery this reflects. The Government are also acutely aware that self-harm is a leading indicator of risk of suicide and recognise that much more needs to be done to address this issue.

[The Lord Bishop of St Albans]

I thank the Minister for his reply. The research from the World Health Organization shows that around 20% of British 15 year-olds report some sort of self-harm. In the past five years, research shows that hospital admissions associated with self-harm have gone up by nearly 93% among girls and 45% among boys. Having recently visited the outstanding charity selfharmUK, in Luton in my diocese, I have seen what effect a concerted and systematic approach to this problem can have on a very difficult issue, and we need something similar at a national level. Will Her Majesty’s Government commit to publishing guidelines for schools and colleges about preventing and responding to self-harm?

[Lord Prior of Brampton]

I think the right reverend Prelate has raised an incredibly important issue. Around 300,000 young people go to A&E every year through self-harm, after cutting or burning themselves very badly. The right reverend Prelate asked about advice and guidance. In 2004, NICE put out explicit guidance that all those people should receive, at the very least, a psychosocial assessment; today, only 53% of those people—young people in the main—receive such an assessment. That means that 100,000-plus people are going to A&E with this very nasty self-harm and are really being sent home with very little. That is quite an indictment of our system and the words that we have about parity of esteem. I entirely take on board exactly what the right reverend Prelate said. There is a lot more we can do, and perhaps in response to subsequent questions I shall try to say what we are doing.

Public Health England: Alcohol

Lord Bishop of St Albans Excerpts

Tuesday 5th July 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said earlier, I think that the CMO’s guidelines are based on independent scientific advice. How that advice is communicated to the public is a different issue and the CMO is currently consulting on how we should express that scientific advice in ways that will have the maximum impact so that the public will take due notice of it.

[The Lord Bishop of St Albans]

My Lords, back in 2011 the Scottish Government passed legislation which meant that there was no financial advantage in multibuy alcohol purchases so that each can or whatever it was would be the same price. That has discouraged the bulk buying of alcohol and as a consequence has reduced levels of harmful drinking. Have Her Majesty’s Government considered a similar law, and if not, why not?

[Lord Prior of Brampton]

I apologise to the right reverend Prelate, but I missed the first part of his question. He is perfectly entitled to repeat the question, or if not, perhaps I may write to him after this session of Question Time.

--- Later in debate ---

[The Lord Bishop of St Albans]

The legislation passed by the Scottish Government in 2011 means that there is no financial advantage in the bulk buying of alcohol; each can is the same price. That has discouraged people from buying large amounts of alcohol and has reduced the level of alcohol dependency.

[Lord Prior of Brampton]

I cannot plead that I did not hear the question again, but I am going to have to say that I do not know the answer, so I shall write to the right reverend Prelate later.

Psychiatric Units: Child and Adolescent Patients

Lord Bishop of St Albans Excerpts

Wednesday 13th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think the figure for children on adult psychiatric wards is 391. It is far too high. It was described in the “Panorama” programme as the Cinderella service of a Cinderella service. What has come to light in the work done by the Sunday Times, “Panorama” and Norman Lamb in the other House is that we have a very serious problem here. It is not going to be solved overnight. The Government have committed to spend £1.4 billion over this Parliament to improve child and adolescent mental health care, but we have a long way to go.

[The Lord Bishop of St Albans]

My Lords, part of the answer to this difficult problem must be to ensure that we get the very best mental health care for young people at the earliest stage possible. I notice that earlier this week a report was published by the think tank CentreForum pointing out that mental health providers turned away 23% of the referrals of under-18s made to them. That includes illnesses such as anorexia, and sometimes young people are turned away because at that stage they have an insufficiently low BMI to justify being treated, despite the evidence that early diagnosis and treatment produce the best results. In the light of that, can the Minister reassure the House that Her Majesty’s Government are keeping under review the criteria by which people are able to access these mental health services, to ensure that we get the best outcomes?

[Lord Prior of Brampton]

My Lords, there is no question but that early intervention is critical. There is a huge amount of unmet need. I expect that everyone in this House will know someone who has a child who has suffered from mental health problems, whether anorexia, self-harm or other aspects of mental ill health. It is a complete disaster, and for anyone who watched that “Panorama” programme it will have been brought very close to home. What the right reverend Prelate says is absolutely right. As I said in answer to the earlier question, we have a long way to go.

Health and Social Care: State Pension

Lord Bishop of St Albans Excerpts

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

I know my noble friend feels very strongly that we should have a royal commission to look at the long-term affordability and funding of the NHS. That is not the Government’s view.

[The Lord Bishop of St Albans]

My Lords, in last week’s NHS debate, which very helpfully explored a number of areas, a number of noble Lords referred to the independent American research pointing out that among the—I think—11 most developed countries, our health service came out right at the top, except in the area of prevention. The worry that many of us have is that a lot of the money is being front-loaded on to the NHS, which is responding to immediate needs, but that the long-term need for a cross-party agreement on how we get much better at preventing illness and having health programmes is lacking. Can we yet again press the Minister to see how we can get some sort of cross-party agreement on this proactive approach?

[Lord Prior of Brampton]

The right reverend Prelate is right to remind the House of the report by the Commonwealth Fund which indicated that the National Health Service is the most efficient and overall the best healthcare system in the world. He also referred to prevention. The childhood obesity prevention strategy is due to be announced by the Government in the next couple of months. We have made huge progress on reducing smoking and in other areas of prevention, but I agree with the right reverend Prelate that prevention is a critical part of our long-term approach to healthcare.