Health and Social Care Act 2012

Lord Bradley Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Bradley (Lab)]

My Lords, we should first congratulate and celebrate the establishment of the first NHS hospital at Park Hospital, now Trafford General Hospital, in Greater Manchester. But we should also have concern that the devolution deal for health and social care for Greater Manchester is being impeded because of the Health and Social Care Act. What changes would the Minister recommend to ensure that the ambitions of the devolution deal to integrate health and social care and physical and mental health are progressed as rapidly as possible?

[Lord O'Shaughnessy]

I join the noble Lord in congratulating Trafford General Hospital. I think that one of my colleagues is there today, unveiling a plaque. I am grateful to him also for raising the devo deal for Greater Manchester. It is a very important deal that goes further than any other in the area of health and social care. If it is the case that it is impeded by the Act—and I do not think that that is necessarily a given—I would say that the changes that need to be made ought to be promoted and proposed by Greater Manchester and by the clinicians themselves. That is exactly the sort of thing that the Prime Minister has asked for.

The Long-term Sustainability of the NHS and Adult Social Care

Lord Bradley Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I first declare my health and university interests in the register. Secondly, I want to clearly record what a pleasure it was to be a member of the committee; I pay tribute to the diligence with which the noble Lord, Lord Patel, led the committee throughout our deliberations. I want to touch on three aspects of our report: the funding of and investment in the NHS and social care, particularly in respect of mental health; workforce planning; and the function of regulators and current governance arrangements. As a quick aside, I want to give some good news to my noble friend Lord Carter of Coles: I was discharged from the University Hospital of South Manchester 55 hours after my hip replacement operation and I pay tribute to the staff for achieving that outcome, although I am still hobbling slightly.

On funding investment in mental health, let me first put my comments in context. In 2015-16, NHS England’s budget was around £116 billion. Of that, the mental health budget was just 13%, but it is known that one in four people suffer from mental health conditions. The NHS Five Year Forward View estimated that the cost to the economy of not tackling mental health is £100 billion a year—effectively the entire cost of the NHS budget. Furthermore, only 7% of the 13% is allocated to children and adolescent mental health services, and while the recent addition of a £1.4 billion investment in CAMHS is welcome, it represents, spread over four years, a mere £350 million a year for the whole of England. That is less than £2 million for each clinical commissioning group, which will set its own independent priorities.

The current funding is woefully inadequate for adults and children, and the ambition to achieve parity of esteem between physical and mental health clearly has a very long way to go. As our report concluded, this will be achieved only when properly addressed through a genuine, long-term strategy of financial investment to meet the needs of people suffering these conditions. The Five Year Forward View for Mental Health was published in 2016 and the Future in Mind report for children in 2015. Although both reports made good recommendations for service improvement, funding remains the key area of concern to make continued improvement and transformational change for genuine integration of services. An example of this is the funding in the Future in Mind report, which is due to last only until 2021, having been extended by one year. That is a mere three years away, but it is non-recurrent spending that is currently not intended to continue beyond that point. A long-term commitment to continuing to fund improvement to children’s mental health care beyond 2021, for at least another 10 years, is essential if any early progress on better services for children and adults is to be sustained.

My second point concerns workforce planning. As our report made clear, the absence of any comprehensive national long-term strategy represents the biggest internal threat to the sustainability of the NHS. Early indications show that the Government’s reforms to undergraduate nursing education in England are failing to increase the number of nursing students required. Overall, applications to nursing courses have fallen by 33% since March 2016. Furthermore, applications from mature students have been disproportionately affected by the funding reforms, dropping by 28%, but it is mature students who are more likely to choose the shortage areas of mental health and learning disabilities. In addition, crucially, some courses may simply become financially unviable for universities to run, with a disastrous knock-on effect for local workforce planning. This must stop. The Government must urgently review their reforms to nursing training and develop a long-term strategy for the whole workforce in the NHS and social care.

My third point relates to governance and regulation. The committee stressed that the Health and Social Care Act 2012 has created, as we have heard, a fragmented system that is frustrating efforts to achieve further integration and the service transformation aims of the Five Year Forward View, which are crucial for the long-term sustainability of the NHS and social care. Too often, the independence of commissioners, particularly CCGs, on the one hand and the independence of providers, particularly NHS acute trusts, on the other creates silo working and barriers to stability of governance in delivering long-term transformation. This is exacerbated by the failure to implement long-term financial certainty.

Laudable attempts are being made for effective partnership working through a whole-system approach. The devolution of health and social care in Greater Manchester, my home area, is a prime example of this. We have also heard of the laudable efforts in Salford, which have achieved remarkable integrated results. But I do not believe that the benefits of such an approach can properly be realised until such partnership working has the crucial legislative back-up that is required.

Further, as we commented in our report, the regulatory framework might also not be fit for purpose. We recommended the merger of NHS England and NHS Improvement, but it would be helpful if the Government looked closely at the clear contradictions often displayed by NHS Improvement and the quality regulator, the Care Quality Commission. Strict financial limits are imposed on the NHS providers by NHSI through rigid financial control totals, while the CQC rightly identifies the need to invest in services to ensure quality of care and patient safety. This causes huge difficulties in practice. How on earth can this be addressed if provider bodies cannot invest beyond their strict control totals?

I would welcome the Minister’s views on these points and an assurance that the Government are genuinely committed to their ambition to move to a long-term financial settlement for the NHS and social care, which our report shows is so desperately needed; that there is a relentless emphasis on general integration of mental and physical health; and that more resources will be moved upstream to underpin preventive and early intervention programmes to support the population’s health and well-being, rather than just its ill health.

Social Care

Lord Bradley Excerpts

Thursday 7th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to my noble friend for raising both those points. She is quite right about respite care. Local authorities have a duty to provide it, but I also note that there is pressure on the system. Indeed, the issue of one particular respite home, Nascot Lawn, has been raised. It is something I am interested in and I am looking at it. I will take that point away. We are trying to look at the care service in the round, so respite care must be part of that.

My noble friend is right about paying care workers properly. We have increased the national minimum wage, now moving on to the national living wage, precisely to provide a proper recompense for people who work in that sector and, critically, to start to provide a proper career structure so that people can move on, add to their skills and progress while staying in the caring profession.

[Lord Bradley (Lab)]

My Lords, I was pleased to be a member of the Select Committee on the Long-Term Sustainability of the NHS, the title of which was extended to include social care. The consultation seems to be constructed to continue the siloing of social care away from the broader care system between the NHS and social care. Will the Minister confirm that the whole relationship and integration of the NHS and social care will be included in the consultation? Will he confirm when the Government will respond to our Select Committee report, which was published last April?

[Lord O'Shaughnessy]

I thank the noble Lord for raising that point. I apologise again for the lateness of our response to the Lords committee. What I hope is now the final version is with me for approval, and I hope it will be provided very soon.

On the Green Paper, we all want more integration between health and social care. We know that is important for the people who are increasingly using those services who are in older age, have comorbidities and are moving in and out of different settings of the time. Social care is paid for on a different basis from the NHS. That is critical. We have to get a sustainable financial basis on which we distribute social care while thinking about how it interacts with the health service. The Green Paper is trying to crack a nut that, frankly, has eluded Governments for the last 20 years.

Mental Health and NHS Performance Update

Lord Bradley Excerpts

Monday 9th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for her warm welcome. I take that point very seriously. Clearly, parity of esteem is no good unless it is applicable to everybody who is suffering from a particular illness. I am not fully aware of the details of the nature of the disparity with black and minority ethnic families but, if there is a problem, making sure that we fulfil this ambitious and I hope welcome strategy is going to make sure that we can lift performance of those services for people in minority ethnic groups.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. Can the Minister explain why it will take at least four years to stop the appalling situation where children have to go out of their local area to receive their mental health treatment?

[Lord O'Shaughnessy]

I thank the noble Lord for his question. I was not aware that it would take four years for that to stop. What we are dealing with here is an historic challenge, which is that mental health services not just in this country but in countries all over the developed world have not been at the same level as services for physical health. The strategy that we have set out today and the further elements to come will be one way of making sure that those young people can be treated close to home. Clearly, there will always be cases and instances where they need to travel. On Friday, I had my first ever ministerial visit to Oxford mental health trust and was able to observe the fantastic work that it is doing across a wide area but with a specific residential school and, interestingly, linking up with the university psychology research department. There were young people who were coming to take advantage of that from all over the country. I realise that this is, if not unique, an unusual coagulation of good factors. As part of making sure that you can get treatment for mental illness or support to build mental health locally, we need to make sure that there are more centres of excellence that can be accessed by those who are in acute need.

NHS: Mental Health Services

Lord Bradley Excerpts

Monday 14th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, our strategy for this area was set out in Transforming Care, a paper produced by NHS England some six weeks ago. It shows that we are absolutely committed to treating more and more of these people outside institutional settings and back in the community.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. As we have heard, the collection of financial data on the investment in mental health services is crucial. I am grateful to the Minister for writing to me recently to confirm the Government’s support for the Mental Health Task Force’s priority recommendations at an additional cost of £1 billion a year by 2021, with investment beginning in 2016-17. How much additional investment will be expected each year between 2016 and 2021? What financial reports will be available for each quarter over these four years to ensure that clinical commissioning groups make the additional investment in local mental health services?

[Lord Prior of Brampton]

My Lords, the noble Lord is right: we have committed to support the request of the task force to spend an extra £1 billion by 2021. Perhaps I may write to him about the phasing of that money over the next five years; I have seen it but I cannot recall the exact figures at the moment.

Health: Adult Psychiatric Care

Lord Bradley Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, reading the noble Lord’s report, I was struck that he said in the foreword that he went through times when he was very depressed and times when he was deeply impressed. In a way, that sums up the mental health system—it is fragmented, and there is a high level of variation. We provide fantastic care in one place but terrible care for somebody else, and very often it is not related to cost. I do not know about the particular instances that the noble Baroness has referred to, but I can fully understand that in certain areas it is much worse than in others.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. I, too, welcome the excellent report and recommendations by the noble Lord, Lord Crisp, and his commission, and also the report and recommendations of the Mental Health Taskforce published last week. I would be grateful for clarification from the Minister on the financial commitments that the Government have made on the crucial implementation of the recommendations of both reports. In particular, can he confirm that the announcement of £1 billion each year for mental health services begins in financial year 2016-17; that, for the next four years, that £1 billion will be additional to the £1.5 billion investment in child mental health services which has already been announced; and, finally, whether this £1 billion annually is additional money or part of the £8 billion which has already been announced and allocated to NHS England for all health services?

[Lord Prior of Brampton]

My Lords, that is a complicated question, or number of questions.

National Health Service

Lord Bradley Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I congratulate my noble friend Lord Turnberg on obtaining this timely and wide-ranging debate. I declare my health interests as shown in the register. I will concentrate my short contribution on mental health, which I believe has never been higher on the public’s agenda.

The NHS currently spends only about 13% of its budget on mental health treatment and support, including GP time, prescriptions and secondary mental health services. However, evidence from prevalence surveys shows that only 25% of people, including children, with common mental health problems receive any treatment. There has been a great deal of talk in recent years of parity of esteem between physical and mental health and I welcome recent announcements of additional funding for mental health services, but the funding gap is still huge.

The King’s Fund and the Centre for Mental Health identified that a third of people with long-term physical conditions—4.6 million people in England—have a co-morbid mental health problem, most commonly depression and anxiety. The cost of care for this group is 45% extra and more still for those with multiple conditions. This adds up to an additional cost of £10 billion nationally each year. The extra costs are for a variety of reasons, including poorer self-care and condition management. This can increase the cost of prescriptions, cause or lengthen the hospital admissions and dramatically increase both morbidity and mortality.

At least £1 billion more is spent on the cost of staff mental health in the NHS, at least half of which is likely to be hidden, as staff present at work but may be struggling to do their jobs as well as they would wish. A significant part of the £14 billion cost of untreated mental health care could be saved while offering better healthcare. For example, liaison psychiatry in acute hospitals has been found to save £3 to £4 for every £1 invested, cutting costs by an average of £5 million per hospital.

Crucially, earlier intervention is vital in all areas of mental health care. There is clear evidence that investing in perinatal mental health care, parenting programmes to help families to manage children’s behaviour, treating childhood depression, anxiety and conduct disorder, promoting mental health in schools and early intervention in psychosis all generate savings far in excess of their costs.

I hope that the Government will also invest in liaison and diversion services and that the Treasury will shortly approve the business case for mainstream funding of these services. Huge savings can be made here in the criminal justice system and the health service. By investing wisely in mental health support, the NHS may be better able to sustain itself. Reaching out to people with physical conditions and symptoms whose mental health needs are unmet will improve health at a lower cost. I hope that such integrated proposals will be pursued by the devolution of health and social care in Greater Manchester, building on the work of Salford that my noble friend Lord Turnberg so well described.

Health: Parity of Esteem

Lord Bradley Excerpts

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

That is a very interesting point. We have three principal targets for mental health: two relate to IAPT and the other to access for those who have their first psychotic episode. Clearly, we do not yet have the range of targets for mental health that we have for physical health, although the introduction of those three targets this year is a big step forward. It is important that the targets should be based around outcomes rather than funding.

[Lord Bradley (Lab)]

My Lords, the five-year investment in child and adolescent mental health services is welcome, but the scale of the problem of achieving parity of esteem is huge, as a recent NSPCC report clearly showed. It stated that out of over 186,000 cases referred by doctors from 35 mental health trusts, nearly 40,000 children received no help at all. The investment equates to barely over £1 million per clinical commissioning group each year. Does the Minister believe this is sufficient not only to tackle the chronic bed shortage and the distribution of such beds across the country, but to develop comprehensive prevention and early intervention programmes?

[Lord Prior of Brampton]

The noble Lord makes a good point. I may get these figures wrong, but I think the total spend on mental health across the country is about £11 billion a year, and spending on children and young adolescents is under £1 billion—around £700 million. Therefore, under 10% of the total spend goes on young people. On the face of it, that looks to me to be far too low. That is why the last Government committed to increase that spending by £1.25 billion over the course of this Government and put another £150 million into tackling eating disorders.

Mental Health Services

Lord Bradley Excerpts

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

I am not aware of the report being prepared by the BMA but I will certainly be very interested in seeing it, reading it and discussing it with it.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. Although I welcome the ban on the use of police cells as places of safety for children under Section 136 of the Mental Health Act by July 2016, barely nine months away, does the Minister believe that the £50 million investment in health-based places of safety will be sufficient to achieve a similar ban on the use of police cells for adults and significantly reduce the thousands of adults who end up in accident and emergency departments each year under Section 136 at a time of severe mental crisis?

[Lord Prior of Brampton]

The noble Lord makes a very good point. Treating people in the right place is fundamental to any notion that we have of parity of esteem. He recognises the successful work that has been done with children, which we are hoping to replicate with adults. As part of the increased spending on mental health, we are also investing £30 million in liaison services in A&E departments, which is very important. A&E departments are not an appropriate place for people with a severe mental health crisis. Certainly, the evidence from Right Here, Right Now, by the CQC, indicates that people with such a condition are often treated extremely badly in A&E departments.

Health: Skin Cancer

Lord Bradley Excerpts

Wednesday 22nd July 2015 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a very sound point. Harpal Kumar’s task force produced a report entitled Achieving World-Class Cancer Outcomes. If anyone wants a little bit of holiday reading, it is well worth reading at least the three-page letter at the front of the report. He recommends in the report that if a GP has a 3% or greater suspicion of cancer, the person in question should be referred for further investigations.

[Lord Bradley (Lab)]

My Lords, there is a clinical trial known as Matilda at the world-renowned Christie Hospital in Manchester, funded by the Medical Research Council and the National Institute for Health Research. This aims to treat patients with melanoma using their own white cells, which can recognise and destroy cancer cells. It was approved in 2014 but then halted because excess treatment costs, which should be funded by the NHS, were not forthcoming. I understand that the Secretary of State for Health has said that this issue will be sorted by early 2015. Can the Minister advise the House when this crucial clinical trial for the treatment of skin cancer will be progressed?

[Lord Prior of Brampton]

I am not aware of the trial at the Christie called Matilda; I will take this issue away and write to the noble Lord.