National Health Service: Mental Health Funding

Lord Cotter Excerpts

Wednesday 20th June 2018 Lords Chamber

Asked by

[Lord Cotter]

To ask Her Majesty’s Government what proportion of mental health treatment is funded by the National Health Service nationally as against local funding.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)]

My Lords, the Government are committed to increasing spending on mental health. In 2017-18, the NHS spent an indicative figure of £11.86 billion on mental health. Of this total, £9.97 billion was locally funded by clinical commissioning groups, with the remainder for nationally commissioned specialised services.

[Lord Cotter (LD)]

I hear what the Minister says, but parity between mental and physical health remains a concern. He knows about the facility for mental health in Weston-super-Mare and the problems associated with its future. However, I have found this problem around facilities in local areas to be widespread throughout the country. Their funding is not predominantly mainstream NHS money for mental health services, but NHS money is often used to plug holes elsewhere and local mental health units are struggling. Will the Minister address the issues of parity and funding for local mental health care?

[Lord O’Shaughnessy]

I agree with the noble Lord that we need to increase funding for local mental health services. That has been happening over the past few years; indeed, between 2015-16 and 2018-19 it has gone up by £1 billion. I turn to his point about mental health funding being used for other purposes. I want to be clear that there is NHS England guidance that that should not happen, and from this financial year all CCGs will have to meet what is called the mental health investment standard, which means that they are to increase their spending on mental health at least as much as, if not more than, their spending on physical health.

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

Lord Cotter Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Cotter (LD)]

My Lords, we all know how serious the issue of mental health is for all ages. It is absolutely vital that we see increased funding for all the NHS but, in particular, for mental health. I ask the Minister to investigate one area of great concern—parity of mental health with physical health. This was announced as a future commitment by the Government. I quote the Select Committee:

“We welcome the greater prominence that mental health has received in recent years”—


that is most important—

“and we are encouraged by the Government’s commitment to a five-year strategy for mental health … Notwithstanding the progress made, there is still a need for sustained and determined action to close the gap between the care received and outcomes achieved by people with mental and physical health issues. Achieving parity of esteem between the two must remain a top priority for service commissioners and regulators”.

Mental health issues are still a major concern.

Local facilities which need local funding can fall down, as is happening in Weston-super-Mare, where I live. It has been announced that a very important facility for mental health called 1in4—it was previously called Friend—is going to be closed on 29 June this year. This is a disaster and I hope that the Minister will undertake to look into the closure of that facility. While I was an MP for the area, I found out how valuable it was. I was encouraged to see how vital it was as a drop-in centre for people with mental health problems. They were certainly made welcome and found opportunities to speak to the staff and to say to other people suffering from mental health problems that their particular concern was this, that or whatever. Time and again, I saw how this encouraged other people with mental health problems to say, “Ah, I thought I was the only person with this problem, but I now see that other people have the problem and I very much appreciate what is happening”. This drop-in centre is one of the most important facilities in the West Country. I urge the Minister to look into this and see what can be done to maintain the service.

Children and Young People: Mental Health

Lord Cotter Excerpts

Wednesday 28th March 2018 Lords Chamber

Asked by

[Lord Cotter]

To ask Her Majesty’s Government what progress they have made in implementing the proposals for support for mental health provision for children and young people in schools, set out in the December 2017 Green Paper, Transforming children and young people’s mental health provision.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, following publication of the Green Paper in December, we are working across health and education to explore options for implementing the proposals, which will be informed by responses from the consultation. This includes consideration of training programmes for the designated leads and mental health support teams, delivery of the four-week waiting time pilot and criteria and processes for selecting the trailblazers. We will publish a response to the consultation in due course.

[Lord Cotter (LD)]

My Lords, I thank the Minister for his reply. As we all know, mental illness is an increasing concern. It is good that the Green Paper to which he referred has been produced. Appendix B refers specifically to schools and says that,

“68% have a designated member of staff”,

for mental health. However, does the Minister not agree that it is equally important that teachers are fully trained and involved in the process of dealing with mental health, since, unwittingly, they can exacerbate young people’s lack of confidence? For example, I heard recently of a young person who needs encouragement being told by a teacher, “Your mother did this work for you”. Teachers need training to deal with this issue.

[Lord O'Shaughnessy]

The noble Lord hits on an important point. Not only is mental illness unfortunately rising in prevalence, but it is everybody’s responsibility to try to help young people who suffer from it. That is what lies behind the proposals in the Green Paper, which contains a number of elements. He is quite right: there is additional training that will be applicable for all teachers, in mental health first aid, for example. It will also make sure that pupils understand it, changing the PHSE curriculum for more focus on mental health and well-being. That is why the designated leads are so important, because they bring that together at school level. So I agree with the noble Lord that schools have a critical role to play in dealing with this problem of mental health.

Mental Health Care: Vulnerable Children

Lord Cotter Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I think this picture of a fragmented service is one that the CQC report highlights. One of the ways in which the Government are trying to address that is through incentive payments in the tariff system to make sure that trusts are incentivised to join up care, particularly when children are moving from place to place.

[Lord Cotter (LD)]

The Minister mentioned concerns about mental health, but crisis teams are reported not to be available in all parts of the country for under-18s, who are very vulnerable. Will the Minister look into crisis teams not being available for under-18s in many parts of the country?

[Lord O'Shaughnessy]

The noble Lord is highlighting that there is a good deal of variation, which is again highlighted in the CQC review. I think that is what he is describing in terms of crisis teams. I will certainly look into that and write to him with more details.

NHS: Cancer Patients

Lord Cotter Excerpts

Wednesday 9th November 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is right. In 2006 one in five of all new cancers was picked up in an emergency setting. That has reduced to one in four. We are making progress. I think we all accept that our performance on cancer outcomes has lagged behind the best in Europe. The strategy developed by Harpal Kumar is designed to address that. We are making progress but we have some way to go.

[Lord Cotter (LD)]

My Lords, what is being done, additionally, towards the prevention of cancer? There is a lot of feeling that the food chain is adulterated through the use of pesticides and such like. Will the Minister consider doing work in the direction of prevention and investigating possible causes?

[Lord Prior of Brampton]

My Lords, considerable research is going on into precisely the area that the noble Lord refers to. He talked about prevention, which is a hugely important area. Early awareness is also very important. We are running these Be Cancer Aware campaigns; at the moment there is a campaign going on around lung cancer to get early detection. I will investigate further and see what we are doing to investigate the root causes of cancer—whether there is any link to pesticides, for example.

Mental Health: Funding

Lord Cotter Excerpts

Tuesday 18th March 2014 Lords Chamber

[Earl Howe]

My Lords, we have intervened. I have already referred to the action my honourable friend Norman Lamb has taken, making it very clear that not only would there be ministerial oversight of clinical commissioning group plans but that we would ensure that every decision made by a clinical commissioning group with regard to its mental health patients could be justified.

[Lord Cotter (LD)]

My Lords, I welcome the Minister’s repetition of the parity issue but, in practice, many young people nowadays—one in four, perhaps, as has come out in recent surveys—are suffering from mental health problems. I have evidence, which I would be glad to give to the Minister for his intelligence network, that there is no parity when it comes to young people. For example, one GP said that it is a “DIY service”. There are major concerns about mental health across all ages, particularly young people. I would welcome a response from the Minister now but I would also like to give him some evidence to be looked into with regard to specific areas in this country.

[Earl Howe]

I share my noble friend’s concern about this and would be happy to receive the information to which he refers.

NHS: Keogh Review

Lord Cotter Excerpts

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

I am rather sorry that the noble Baroness should have raised that, as I was rather keen to protect the noble Baroness, Lady Young, from any embarrassment, because I think that the whole House respects her. All I can say is that the substance of the letter to which the noble Baroness refers is diametrically opposite in content to the evidence that the noble Baroness, Lady Young, gave to the Mid Staffs public inquiry.

[Lord Cotter]

In the report there are, quite rightly, robust words about poor management. However, I refer the Minister to a point that I and others have raised in the past. There is a great concern in the health service about untrained, or poorly trained, healthcare assistants. Nurses have said to me that they are held responsible for the work done, often by untrained or inadequately trained people. I have raised this before. Can I ask the Minister to look at it again as a very serious issue?

[Earl Howe]

We are indeed looking at it very urgently at the moment in the light of the review published a few days ago by Camilla Cavendish, which focuses on exactly that issue.

Medical Research: International Rare Diseases Research Consortium

Lord Cotter Excerpts

Thursday 28th February 2013 Lords Chamber

[Earl Howe]

My Lords, the funding for expensive treatments will be very much the responsibility of the Commissioning Board. However, of course the noble Lord is right, because a patient with a rare disease will need to be treated along a pathway of care, some of which will be specialised and some of which will be more routine. It is therefore important that we build into our UK plan for rare diseases an awareness of that pathway so that this is a seamless process. The commissioning must be joined up between the board, clinical commissioning groups and, indeed, local authorities that provide social care.

[Lord Cotter]

My Lords, I thank my noble friend the Minister for his interest in rare conditions. I declare an interest as my wife, like many others, has suffered from birth from arthrogryposis, a neuromuscular condition. She received a correct diagnosis only at the age of 52 years. Even now, in her 70s, she is struggling to receive appropriate treatment. Would the Minister consider seriously Rare Disease UK’s recommendation for designated care co-ordinators to oversee the situation to ensure consistent treatment and to provide single oversight to help patients and to avoid wasting resources and duplication within the NHS?

[Earl Howe]

I am grateful to my noble friend and I extend my sympathies to his wife. Unfortunately, with many very rare diseases, it often takes a great deal of time for a fully fledged diagnosis to be arrived at. I welcome the suggestion put forward by Rare Disease UK for co-ordinators and we will certainly look at that idea positively. I can tell him that the imperative to look at rare developmental disorders in children is the focus of a project that the NIHR and the Wellcome Trust are funding through the Sanger Institute in Cambridge. Scientists are analysing the genomes of 12,000 children with developmental disorders who could not be diagnosed following routine genetic evaluation. We are hopeful that that will produce some interesting results.

Winterbourne View

Lord Cotter Excerpts

Tuesday 30th October 2012 Lords Chamber

[Earl Howe]

My Lords, there is more than a nugget of truth in what the noble Baroness says. Many of us have been troubled for a long time that work of this kind is insufficiently valued by society, and that is reflected in the rates of pay. That is why I am a firm believer in raising skills in this sector as a reflection of the value we place on care workers. The programme that we have in train over the coming months should steadily deliver that. To come back to the commissioning question, I am also a believer in ensuring that commissioners should be satisfied that the settings to which they send individuals have an appropriate mix of skills to look after the people concerned. That has not always happened. There is no single answer to this, but I identify myself with the particular point she has raised about remuneration.

[Lord Cotter]

My Lords—

--- Later in debate ---

[Baroness Northover]

I think it is the turn of the Liberal Democrats and then maybe the Cross-Benchers after that.

[Lord Cotter]

My Lords, I very much welcome the mention of training once again today. It is so important that support workers are trained. One issue that has come to my notice quite frequently is that through a lack of training, support workers question the trained professionals an awful lot. The management also need to be trained to back up the professionals who are trained in their job as a vocation, so that the less well trained support workers respect their decisions.

[Earl Howe]

I agree with my noble friend. Where supervision is required, it is the job of the manager to ensure that it takes place, and that the supervision, staff ratios and so on are appropriate. We come back to the question of the responsibility placed on the shoulders of managers and proprietors of care homes. As the Statement made clear, this is very much a responsibility of providers, who need to be held to account for the quality of care that they provide.

Health and Social Care Bill

Lord Cotter Excerpts

Monday 19th March 2012 Lords Chamber

[Baroness Masham of Ilton]

My Lords, I have my name to the amendment. During the passage of this Bill, some of us have been trying very hard to improve the care of vulnerable patients in hospital and in the community. I felt healthcare support workers should be registered and regulated, as many vulnerable patients, being frail and elderly or disabled in many diverse ways, have to rely on their carers. Your Lordships have heard that patients have been put at risk or died through neglect or assault in care homes and hospitals up and down the country. Many people wait in anticipation for the result of the review of the Mid Staffordshire Foundation Trust. This must not be covered up; lessons should be learnt in memory of the hundreds of patients who received poor care, were neglected and died. Surely it is our duty to try to help rectify this deplorable situation.

I have every admiration for the Minister, who has worked tirelessly over this Bill, but I do not agree with him that nurses who have been struck off their register can go back to caring for patients as unregistered healthcare assistants. We are exposing the most vulnerable in our society to greater risks and poorer care if we do nothing to prevent struck-off nurses continuing to work in a caring profession. This amendment is a compromise, but even so it has a very important part. Subsection (2) of the proposed new clause in the amendment states:

“The assured training programme shall be mandatory for all new health care support workers from 1 April 2013”.

Not to train people who care for vulnerable patients is deplorable. Last year I was involved in a case of a person living at home and using a respirator. The patient was left brain damaged when the agency nurse turned off the wrong switch. Adequate, appropriate training should be given; in that case, it was a health care worker who was also a nurse.

Many disabled people are living in the community, which is good, but many of them use technical equipment that needs training and understanding, such as hoists, pressure mattresses, peg feeds, catheters, complicated electric wheelchairs, ventilators, nebulisers, diabetic management, colostomies, adapted vehicles and many other complicated devices. An assured training programme should include where to place a patient’s food and drink and to assess whether the patient can feed themselves. If not, the healthcare worker should know how to do this; how to wash and bathe and deal with personal needs such as toileting; how to prevent pressure ulcers; moving and handling; and complications with patients who have problems and may be difficult and have a problem communicating. There are many needs, but kindness and common sense should prevail.

If the Minister and the Government do not agree with this amendment, it will mean they do not understand the needs of vulnerable patients’ care. If training is mandatory, I am sure employers will take notice.

[Lord Cotter]

My Lords, I thank the noble Baroness, Lady Emerton, for introducing this amendment, which I hope the Minister will agree gives an opportunity for a very important issue to be aired. Many noble Lords have aired it in the past; indeed, I raised it on the very first day of the Bill. It is an area that remains of concern, and I have been pleased to hear from the Ministers that they are well aware of this. I recollect at the beginning of the Bill speaking to a nurse who, with an air of concern in her voice, said that when she asked assistants to carry out work the responsibility remained with her if that work was not carried out correctly. I welcome this opportunity for the Minister I hope to give a very strong response to indicate the Bill will cover this issue. As the noble Lord, Lord Patel, said, we are talking about 450,000 healthcare assistants: many people of varying abilities and knowledge.

I will say no more except to thank the noble Baroness for her amendment and, in anticipation, to thank the Minister for his response, which I hope will be robust and clear as to what we are going to do to address this concern.

[Baroness Finlay of Llandaff]

My noble friend Lady Emerton, in tabling this amendment, has come up with something very sophisticated and really rather clever. By requiring education, she will ensure that the next group has its standards driven up. People enter into a caring group and learn from others around them; the problem is that at the moment they are learning bad practice as well as, hopefully, learning good practice.

Making sure that these are assured training programmes is eminently sensible. Modern educational techniques using e-learning, DVDs and other ways of training mean that you do not have to take people away from the job and put them in college. They could be given provisional registration while they worked through some of these training programmes. Modern ways of teaching also allow you to train those with very low literacy skills. It is worth remembering that some of the very high-standard care assistants in the system providing care in people’s homes often have low levels of literacy, so they need to be taught using modern techniques. This will allow that to happen. As for tracking their attendance, with electronic records it becomes quite easy to monitor what they turned up for and how they performed and to assess them in the tasks that need to be undertaken.

This amendment seems to meet all the criticisms that the Government laid at the door of previous amendments. I hope that it will get a better reception than its predecessors.