Mental Health Services: Black and Minority Ethnic Communities

Lord Hunt of Kings Heath Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, this has been a very moving and powerful debate. I pay tribute to my noble friend Lord Boateng for leading it. I well remember when, as a Health Minister, I met him at the Home Office to discuss health in prisons. I learned then very clearly his passion and determination. I am glad he has brought that to our discussions tonight. He talked about the issue being injustice rooted in race. I do not think we can describe the problem more explicitly.

We have had an amazing amount of briefing from many organisations, and I thank them. I am certainly not going to repeat them; the case is absolutely made and convincing. However, I looked at the briefing from the University of Essex’s Institute for Economic and Social Research, which showed the clear link between racial and ethnic harassment and mental health. Around one in 10 people from an ethnic minority background living in England has experienced some form of racial harassment in the past year and the briefing showed the connection between that harassment and stress, anxiety, depression and poor mental health. This is a fundamental issue that we have to tackle in society and in the National Health Service, because there are real issues about the way people from black and minority ethnic communities are treated by our National Health Service.

We know that there is forthcoming mental health legislation and we have the Prime Minister’s promise of action, which are both welcome, but the overwhelming message to the Minister is that we cannot wait for this before some determined action needs to take place. I was struck, as my noble friend Lord Boateng said, that we have had so many reports. We know what to do. The report from the noble Lord, Lord Crisp, waited two years for a response from the Government. We have the Five Year Forward View for Mental Health, published in February 2016, with 57 recommendations. I put it to the noble Baroness that we constantly hear from Ministers that this is a priority, but we do not see any real hard-edged action to put these recommendations into practice.

I want to revisit some of the points raised by my noble friend. He set out some issues to be tackled, such as the need for hard recommendations, with timescales for implementation and resources. I agree with him about hypothecation. I know that we are beginning to see extra spending on mental health, but how long has it taken the NHS to do this? I am afraid I do not believe the NHS, left to itself, will ever prioritise funding for mental health services. That is why I firmly believe there will have to be a hypothecated budget.

I also think we have to look at the way in which financial incentives are put in place in the health service, because the Five Year Forward View for Mental Health fundamentally attacked the present funding system. The use of block contracts is rewarding low-cost interventions, regardless of outcomes, and penalising those that increase access or deliver more costly interventions, even though they may improve outcomes. We cannot go on like this. Why do we still have block contracts in mental health? It is because it is regarded as less important within the Government and the Department of Health. We have different, more sophisticated systems for other parts of the health services; why is mental health being left till last? It has produced a horrendous situation where we disincentivise the most effective outcomes.

My noble friend talked about data outcomes. We have to have reliable data so that we can judge outcomes. Spreading good practice, local authority/NHS collaboration, pooled budgets: none of this is rocket science. We know that it can be done—the question is whether there is a will to do it. On the Patient Voice and using community action groups and the voluntary sector, the health service seems to have done its best to cut out many of these groups because of its funding decisions in the last few years. That is a very great pity.

The noble Lord, Lord Ouseley, talked about discrimination and the right reverend Prelate the Bishop of Worcester talked about cultural competence. I fear that the NHS has a long way to go before we can say that it has really tackled those issues. We are focusing on mental health services but I hope that Ministers will reflect on a more general cultural problem within the NHS, which is as much about the workforce, as the noble Baroness, Lady Watkins, said, as it is about service provision. My noble friend Lord Brooke anticipated the report of the noble Lord, Lord Crisp. I totally agree with him about carers being excluded from initial assessment. It is difficult to fathom how that can be justified as a general principle. What he had to say about the workforce race equality standard and patient and carers’ equality standards was very profound and would be very helpful to the boards of organisations, which are probably not aware of some of these issues at the moment.

My noble friend ended by asking how we are going to make it happen. He said, “Let us get on with it”. I agree with him, but my final point for the Minister is this: if the Government stick to the mantra that this can be left to clinical commissioning groups, albeit with some national commissioning advice, we might as well give up and go home now. It simply is not going to happen. CCGs do not have the capacity or the will to do it. At the end of the day, Ministers have to take responsibility; they have to take a grip and there has to be national direction and national hypothecation. We know what needs to be done but at the moment I simply do not see the tools at central government level to enable it to happen. I hope that the noble Baroness will correct me if I am wrong.