NHS: Dermatology Services

Lord Bradley Excerpts

Wednesday 17th December 2014 Lords Chamber

[Earl Howe]

My Lords, as my noble friend has said, there are clear standards in any referral to treatment situation. That includes dermatology. Where those standards are being breached, we expect commissioners to monitor that and bear down on the failure.

[Lord Bradley (Lab)]

My Lords, I am sure the Minister is aware that the psychological and social impact of skin disease, such as psoriasis, can be devastating. But is he aware of the 2011 survey by Dr Anthony Bewley, which found that of 127 hospitals across the UK only one had a dedicated dermatology psychiatric clinic, only seven had a psychodermatology service, and only one had a children and adolescent psychodermatology service? What action will the Government take significantly to improve psychodermatology services across the country?

[Earl Howe]

I was not aware of that survey but the noble Lord’s point is well made. Guidance for the management of both common and complex skin conditions set out by NICE and NHS England makes it very clear that access to psychological services for patients should be considered where appropriate. Through the IAPT—Improving Access to Psychological Therapies —programme, NHS England is looking at how best to support people with psychological problems arising from their physical problems, including, very significantly, skin conditions.

Hospitals: Voluntary Sector and Emergency Readmissions

Lord Bradley Excerpts

Monday 1st December 2014 Grand Committee

[Lord Bradley (Lab)]

My Lords, I congratulate the noble Baroness on initiating this debate. Although she said that it was put down some time ago, it could not be more timely with the discussions around the health service being so relevant at the present time, and particularly today. So, although there are few us here, as she pointed out, it is a part of a wider debate and conversation about the development of services within the National Health Service.

I have fond memories of the WRVS as a former MP. We were regularly asked to do, and willingly undertook, voluntary work with it in our local hospitals. Often it was one of the most pleasurable days of the year, going round the wards with tea trolleys and seeing day after day the commitment to and enthusiasm for supporting the professionals within that setting and ensuring a high-quality service to patients within those hospitals.

To add briefly to the context of today’s debate, I looked at the King’s Fund report of 2013, Volunteering in Health and Care. Securing a Sustainable Future, which states:

“The health and social care system is under extreme pressure to improve the quality and efficiency of services. To meet the challenges ahead, service providers will need to think differently about how they work and who they work with … One important group in these debates is the millions of people who volunteer in health and social care, in both the voluntary sector and within public services—an estimated 3 million people across England. These people”—

as the noble Baroness said—

“add significant value to the work of paid professionals, and are a critical but often under-appreciated part of the health and social care workforce”.

The King’s Fund research indicates that,

“volunteers play an important role in improving people’s experience of care, building stronger relationships between services and communities, supporting integrated care, improving public health and reducing health inequalities. The support that volunteers provide can be of particular value to those who rely most heavily on services, such as people with multiple long-term conditions or mental health problems”.

It suggests that, to achieve the best scenario, the critical role of volunteers in building a sustainable approach to health and social care must be acknowledged, and the research recognises five key areas, which I hope we can debate at a future time.

I just want to add topically that, as the noble Baroness pointed out, today the Government are responding to NHS England’s five-year forward plan. In the paragraph on encouraging community volunteering, they acknowledge the importance of volunteers, as I have just described, and they put forward examples of how those volunteers might be utilised most effectively. I hope that the Minister will comment on that. I do not want to stray into the response or the Statement that is to follow but I hope that there will be some recognition of the vital role of volunteers in this country.

As the noble Baroness pointed out, an excellent report on the Hospital 2 Home scheme was produced by the RVS a short while ago. It gave some interesting statistics about the scale of the issue, particularly regarding the over-75s. It is estimated that there are now 5.1 million over-75s in this country, up from 4.4 million in 2010, with there being an estimated 7 million by 2035. Forty-six per cent of those over-75s live alone, and 38% of 75 year-olds now return home from hospital—up from 10% in 2004. The RVS’s report was very timely in showing that a much greater number of over-75s go home from hospital and that they need support to ensure that they are not readmitted, as this debate is about. Before they are discharged, they often feel anxious and not ready to go home. That is often because they know that they are going home alone and that they will not get the support that they require to give them confidence, or may not get the immediate services that are required to ensure that they return home in a satisfactory way and are not looking for early readmission. Early readmission can be a consequence of that anxiety. I am not suggesting that no people in this age group will have to return to hospital, but let us see whether there is a mechanism to ensure that the services that are required to wrap around them at the point of discharge are most satisfactory.

From my experience of working in the voluntary sector with people with mental health problems—particularly those who come into contact with the criminal justice system—I have found that there is very poor evaluation of the cost benefits of the work of the voluntary sector. In the RVS report, it is estimated that savings on readmission are around £40 million a year but there is no solid evidence to support that figure. It is a very good estimation of what those savings can be but the Government should look rigorously at better models for considering outcomes and for assessing the real value to society of volunteers. As I said, from my work with the mental health and criminal justice system, I know that there is a paucity of information about the support that mentoring can give, for example, to people with mental health problems who may come back into the community from the criminal justice system. That value of that to society is completely underestimated. I am not comparing it directly with readmission to hospital but there is a great value to society to be had when we are talking about readmission to the criminal justice system as a result of not having that support. I urge the Government to look very carefully at how we can assess more effectively the savings that can be made through effective mentoring and the use of volunteers.

However, we should never presume that volunteers are in some way a cheap option within the development of public services. They have to be valued as part of the team, and we have to ensure that, when services are commissioned using the voluntary sector, the sector has sufficient support and infrastructure to ensure that it can be an effective part of service delivery. I am always concerned that, as we move into the new contracting arrangements within the commissioning of services, the value of volunteers or the voluntary sector is not adequately taken into account as those contracts are developed to ensure that the high quality and local nature of those services are properly recognised and become integrated into the way in which the 3 million volunteers so willingly give their time and expertise.

I again congratulate the noble Baroness on this debate, and the debate will go forward very effectively now because, as we struggle to ensure that we support people whatever their illnesses or age group, the voluntary sector will become an even more important part of our civic life.

Mental Health Services

Lord Bradley Excerpts

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My noble friend is absolutely right: there is a high prevalence of mental health issues in those leaving care. The Government are dedicated to supporting NHS England’s work to develop a service specification for the transition from CAMHS that is aimed at CCG-commissioned services. CCGs and local authorities will be able to use the specification to build on the best measurable services to take into account the developmental needs of the young person. A separate specification for transition from CAMHS to adult services is also in development.

[Lord Bradley (Lab)]

My Lords, does the Minister agree with me and the recent Health Select Committee report into child and adolescent mental health services that it is wholly unacceptable that so many children and young people suffering a mental health crisis face detention under Section 136 of the Mental Health Act in police cells rather than an appropriate place of safety? What action are the Government taking to eradicate this practice immediately?

[Earl Howe]

My Lords, it is unacceptable for a child in a mental health crisis to be taken to a police cell. The mental health crisis care concordat, launched in February this year, reinforces the duty on the NHS to make sure that people aged under 18 are treated in an environment that is suitable for their age, according to their needs. It also makes it clear for the first time that adult places of safety should be used for children if necessary so long as their use is safe and appropriate. We have seen a reduction in the use of police cells across the country but there is still further work to do.

Health: Mental Health

Lord Bradley Excerpts

Tuesday 28th October 2014 Lords Chamber

[Earl Howe]

My noble friend makes an extremely important point. NHS England is currently reviewing the never events framework. My honourable friend the Minister of State for Care and Support will shortly be meeting NHS England officials to discuss the possibility of including suicide following in-patient care as a never event and how the new never events framework will support parity of esteem.

[Lord Bradley (Lab)]

My Lords, NHS England made it clear last week that mental illness costs the economy an estimated £100 billion annually, which is roughly the cost of the entire NHS budget. How do the Government justify only 5.5% of the UK’s health research budget being allocated to mental health and, according to MIND today, a paltry 1.4% of Public Health England’s budget being spent on mental health? Is this what the Government mean by parity of esteem?

[Earl Howe]

My Lords, investment in mental health research by the National Institute for Health Research has nearly doubled over the past four years from £40 million in 2009-10 to £72 million in 2013-14. I hope that the noble Lord will take from that that we put a priority on this. Of course, it is very important that local authorities do not downplay the significance of mental health. We have made it very clear that disinvestment is not an option for them. We are discussing with local authorities this very issue.

NHS: Five Year Forward View

Lord Bradley Excerpts

Thursday 23rd October 2014 Lords Chamber

[Lord Bradley (Lab)]

My Lords, noting my health interests, I am grateful to the Minister for repeating the Statement. We warmly welcome the report, Five Year Forward View, particularly as it endorses key elements of Labour’s plans for the National Health Service. However, there are many questions still to be answered, which will unfold over the coming weeks and months and will form the basis of that measured and intelligent debate in this House. The report endorses Labour’s visions for new models of integrated care, including hospitals evolving into integrated and accountable care organisations, with more salaried GPs. Does the Minister accept these proposals, and does he agree that there should be a greater role for health and well-being boards in helping to deliver this strategy? On public health, does the Minister agree with the report that the time has come for radical action on obesity, and does he accept that the voluntary responsibility deal is clearly inadequate? On GP services, does he agree with the report that primary care has been under-resourced and that people are struggling to get appointments? Will he accept the need to stabilise funding of GP budgets and match our plans to recruit 8,000 more GPs? Finally, does he accept that much more urgent action is needed to deliver the commitment on parity of esteem between mental and physical health and that proper integration of those services is particularly important and will ensure better outcomes for all patients?

Mental Health: Beds

Lord Bradley Excerpts

Tuesday 29th July 2014 Lords Chamber

Asked by

[Lord Bradley]

To ask Her Majesty’s Government what action they are taking to stop patients being unnecessarily sectioned because of shortages of mental health beds.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, we are not aware of any incidents of patients being unnecessarily sectioned. In June 2013, the Care Quality Commission asked for notification of such cases. It is for local clinical commissioning groups to commission the right number of in-patient beds to meet the mental health needs of their local population.

[Lord Bradley (Lab)]

I am grateful to the Minister for that reply, although I am slightly surprised. Does the Minister agree that it is wholly unacceptable that, according to the Royal College of Psychiatrists, doctors are still being forced to section patients to get them their in-patient care? That follows a warning by the Health Select Committee last July on the need to investigate urgently whether patients are being sectioned for them to access psychiatric units, and report to Parliament on the prevalence of that practice. What action have the Government taken on that committee report? Will the Government, if they look carefully at those findings, consider making emergency funding available, similar to that which they made available to A&E departments in the winter, to immediately ease the mental health crisis in beds for adults and children?

[Earl Howe]

My Lords, I am certainly aware that a number of concerns have been raised about the lack of mental health beds and that there are occasions when patients do not receive care quickly enough because approved mental health professionals cannot locate an appropriate bed. As I said in my original Answer, that is essentially a failing of local clinical commissioning. However, AMHPs—approved mental health professionals—should not be put in that position. We are consulting at the moment on a revised code of practice for the Mental Health Act. That consultation includes a specific question which asks what additional guidance should be included to ensure that AMHPs are not put in that position.

Health: Dementia

Lord Bradley Excerpts

Monday 14th July 2014 Lords Chamber

[Earl Howe]

It is generally recognised—although some GPs disagree—that early diagnosis of dementia is vital. It is vital for ensuring that a person with dementia can access the relevant advice, information and care and support that can help them live well with the condition. My noble friend is right that there is currently no cure for dementia, but there are drugs that can help with some of the symptoms and people with dementia have the right to know that they have the condition so that they can better plan for the future.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. The Alzheimer’s Society says that one person in five who suffer from dementia gets no support or information after diagnosis. Will the Minister say what specific actions the Government are taking now to try to improve the situation?

[Earl Howe]

My Lords, NHS England is investing £90 million in diagnosing two-thirds of people with dementia by March next year. We have amended the GP contract so that everyone over 75 has a named, accountable GP and the most vulnerable 2% in each practice will receive an enhanced service. The NHS Choices website has been enhanced. NHS England has provided CCGs with tools and guidance to help them set a local ambition to improve dementia diagnosis. The post-diagnostic support that the noble Lord mentions is absolutely central. There is a post-diagnosis working group to identify what good looks like in this area and roll out best practice.

Health: Patient Safety

Lord Bradley Excerpts

Tuesday 24th June 2014 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I thank the Minister for repeating the Statement on patient safety.

As we said in the other place, an open learning culture across all parts of the NHS is an ambition shared across the House and builds on the work of the previous Government following care scandals in the 1990s. It is right to call for openness, transparency and accountability, but I ask the Minister how he will guard against the risk, as pointed out by Martin Bromiley, of creating a naming, shaming and blaming culture.

Secondly, the Minister has told the House that one-fifth of hospitals are failing to report properly. How does he plan to address this? Will he extend full transparency to all providers of NHS services, including the private sector?

Thirdly, the Commonwealth Fund found cause for concern on infection compared to 2010, with the NHS now ranked worst in the world for patients reporting infection in hospitals or shortly after. What is he doing to turn around this very worrying trend?

Lastly, the Secretary of State for Health talks about his new target to save 6,000 lives over three years, which we all clearly welcome. I welcome the appointment of Sir David Dalton, a person I know well, to the position of leading this initiative. However, will the Minister explain further today how this will actually be achieved with the current pressures on NHS budgets?

Mental Health: Social Work

Lord Bradley Excerpts

Monday 23rd June 2014 Lords Chamber

[Earl Howe]

My noble friend makes some excellent points, and I acknowledge her role as a member of the programme board for the Think Ahead programme, which is designed to attract, in particular, new graduates into social work, and specifically into mental health social work. Good-quality social work can transform the lives of people with mental health conditions. It is an essential part of multidisciplinary and multiagency working. As we move forward into new ways of working, particularly in the context of integrating care, my noble friend’s point about other professionals understanding and appreciating the value that mental health social workers can give will be key, not just in terms of earlier intervention but by building resilience, reducing and delaying dependency and ensuring that people have all the information and enabling support that they need to look after themselves better.

[Lord Bradley (Lab)]

My Lords, I note my health interests. What is the Government’s assessment of the scale of shortages of mental health social workers? In particular, what assessment has been made of the capacity to respond to requirements under the Mental Health Act, particularly Section 135, for approved social workers?

[Earl Howe]

My Lords, we need more social workers, particularly in mental health. The Think Ahead programme is certainly one way in which we hope to improve the numbers. Social work is not always seen as an attractive career option. We know that there is a growing appetite among graduates to work in mental health; unfortunately that enthusiasm has not filtered through to the social work profession. We need to focus on that. Much will depend also on finding a greater number of placements in social work, particularly relevant to mental health, so that there is on-the-job training for those trainees.