Mental Health Patients: Discharge

Lord Kirkhope of Harrogate Excerpts

Tuesday 5th March 2024 Lords Chamber

[Lord Markham (Con)]

In a word, yes. We had the rapid review of data in mental health settings. Not surprisingly, in mental health, as in a lot of other settings, ensuring that there is the flow of information so that carers get the right information is paramount.

[Lord Kirkhope of Harrogate (Con)]

My Lords, as a former mental health commissioner, I know that the default position regarding long-term in-patients back in the 1980s and 1990s was to ensure they were given a place in the community. As a result, successive Governments closed down many of our institutions. Can my noble friend comment on the balance between present institutional care and its desirability for many in-patients, and in-patients who are regarded as being in the community but are not necessarily protected sufficiently when they are?

[Lord Markham (Con)]

There is, quite rightly, a balance to be struck. For people with learning difficulties and autism, which noble Lords have debated before, we set a 50% target for that reduction—not 100% because, as has been mentioned, it is not always appropriate as a number of people in those situations need additional support. However, as a general sense of direction I think we all agree that, where we can put support into communities, that is the right thing to do. That is what the £1 billion extra investment is about.

Ultra-processed Food

Lord Kirkhope of Harrogate Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord makes a very good point. A healthy start to life is vital, which is why I am very pleased to say that we have the highest level of free school meals ever, with every infant school kid and a third of children overall having a free school meal. On the composition of those foods, I know that this was planned but was stopped due to Covid. The timing is now being reviewed again, because things move on in terms of the content and healthy foods.

[Lord Kirkhope of Harrogate (Con)]

My Lords, most people would be very concerned to know what ultra-processed food means. People who rely on staples such as bread, cereals, sausages, gravy, fruit juice, baked beans and biscuits would be very surprised to hear us talking about those as ultra-processed food and how bad it is for you. Some people say that five ingredients or more puts food into this category. While we should encourage vegetables, fruit and fresh food of various kinds being eaten, does my noble friend not agree that we are alarming the public too much if we deny them the staples that they are used to?

[Lord Markham (Con)]

That is absolutely correct. My understanding is that ultra-processed foods make up, on average, 60% of a person’s diet. If you were to try a blanket ban, it would have a massive impact. I think we all agree that it is important that we try to discourage things that are bad in ultra-processed food, not ultra-processed food per se. As I have said many times, there are many types of ultra-processed food that we encourage, such as wholemeal bread and many of the cereals.

MMR Vaccine

Lord Kirkhope of Harrogate Excerpts

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct about trying to make sure that we learn the lessons from all these areas. The approach that they have been responding to so far is very much “horses for courses”. In the last six months alone, they have had four different types of campaign. We do not have the results from those campaigns yet, but the point is a very good one and I will make sure that we get those results from the research and share them.

[Lord Kirkhope of Harrogate (Con)]

My Lords, as my noble friend has referred to, it is very important that young people, children, get vaccinations when they are due, but the current government campaign to encourage adults to have a shingles jab, and indeed other areas, seems to point out—I have heard this from GPs—that the fact that adults are not now taking boosters for things such as tetanus, and other areas where vaccination is so important, means that there is a gap. Does my noble friend not think that we ought to do more to encourage adults to take up vaccinations, renewals and boosters where appropriate to safeguard their health?

[Lord Markham (Con)]

Yes. That is where we really see UKHSA coming into its own in terms of taking an intelligence-led approach. The concern came from its modelling: its epidemiologists brought this up as a concern, which led to the alert going out on 14 July. Likewise, it is looking into other categories and, where there are those concerns, it will come out and suggest such outreach programmes.

Mental Health Services: Huntington’s Disease

Lord Kirkhope of Harrogate Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

Yes. The noble Lord has heard me say many times that I have really come to appreciate the Questions format for looking into areas that might otherwise not be seen. I thank the noble Lord and the Huntington’s Disease Association for bringing this to our attention. We have the steps in place but that is a good point about the training.

[Lord Kirkhope of Harrogate (Con)]

I declare an interest as a former Mental Health Act commissioner. Mental health seems to be very much the poor relative when it comes to resources and definitions in our health service. Does my noble friend not feel that we perhaps need to readdress matters such as guidelines for determining mental health? Many issues which arise are about pressures on people in their lives but do not necessarily come within the category of mental health. Would we not be better off having some clearer approach to this in future?

[Lord Markham (Con)]

Our commitment is very much that mental health should be treated just as seriously as physical health conditions. I was delighted to announce today that on the NHS app we are launching mental health digital therapeutics, which are available for everyone to use. I recommend everyone tries them. The idea behind it all is that it is accessible to everyone at any time in their life.

Hospital Beds: Social Care

Lord Kirkhope of Harrogate Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

Clearly, if we are going to retain and recruit the key staff in this area, it has got to be a good career, and that means that we must listen to their concerns. I know that Minister Whately is talking to and visiting them all, so it is a key part of the plan. As I say, the fact that we are managing to grow the workforce again shows, I think, that we getting on top of it—but absolutely we need to keep close and make sure it is a good place to work.

[Lord Kirkhope of Harrogate (Con)]

Does my noble friend agree that there are main concerns in some hospitals that dialysis patients are having to be retained in hospital over the Christmas period because of their deep concerns about transport arrangements, partly through the threatened ambulance strikes but also in other ways? Is this not another problem with regard to the bed blocking that we are looking at at the moment?

[Lord Markham (Con)]

The best hospital trusts I have seen have got that absolutely organised. We see a difference in different trusts between as low as 6% bed blocking for social care and over 30%. That depends somewhat on local demography and the amount of care homes, but also on how quickly they can arrange transport, and that is what the best ones are doing, so that cases such as the ones brought up by my noble friend do not exist.

Adult Social Care

Lord Kirkhope of Harrogate Excerpts

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Lord that we need to make this an appealing profession and, as the noble Lord says, that involves more than just pay. We know that retention is vital, so I agree that having it properly recognised professionally is the direction of travel. At the same time, I am very glad to say that, for a lot of the money we are talking about—the £2.8 billion next year, for instance—some 70% will trickle down into wages, so I am pleased that it will actually be felt in the pockets of the carers, which again will help with recruitment and retention.

[Lord Kirkhope of Harrogate (Con)]

Can my noble friend advise us what is in place from the Government to look into the necessary social care of those mental patients who have had to be discharged from institutions and elsewhere, where the history is a very poor one. I speak as a former mental health commissioner. I feel that it is very sad that the community is not able to take care of people who should not be in institutions but in the community. What are the Government doing about this?

[Lord Markham (Con)]

I thank my noble friend. I think we agree that, where care can be considered and put in place in the community, that has to be the best place to do it. These funds are not just limited to care homes. The whole reason that they are allocated through local authorities is that it allows them to put the money where it is most needed in their local area. I have to say at this point that, despite all the issues we talk about, 89% of people are satisfied with the care they receive and 64% or so are very or extremely satisfied. In the context of all this, we have to recognise that the numbers are showing us that this is a service that people are satisfied with.

ONS: UK Life Expectancy

Lord Kirkhope of Harrogate Excerpts

Thursday 17th December 2020 Lords Chamber

[Lord Bethell (Con)]

The right reverend Prelate is right to emphasise some of the disappointing figures around children, and the north-east is one area where the challenge is greatest. But I remind him that we have strategies for healthy behaviours in school, we are committing a huge amount of funding for more physical activity in schools, and we think that this will have a major impact on both the fitness and healthy outcomes of children. That kind of project will make a big impact.

[Lord Kirkhope of Harrogate (Con) [V]]

My Lords, can my noble friend give any real explanation as to why the UK is so low down on the OECD figures for average annual increases in life expectancy at birth? On the ONS tables, England is 18th out of 21 countries, with Scotland and Wales faring even worse. Is there a particular reason he can think of—could it be methodology or social habits? Has he any further explanation of the comparative situation here?

[Lord Bethell (Con)]

My Lords, I cannot give an answer in the round and explain every element, but we have to face up as a nation to the fact that some of our habits are unhealthy. In some communities smoking rates are extremely high, and the difference between different communities is profound—1.6% in west London, compared to 25.7% in Blackpool. Our obesity, BMI and consumption of high-calorie food is just too high. This is not the sole explanation, but as a nation we have to face up to some of our behaviours.

Queen’s Speech

Lord Kirkhope of Harrogate Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Kirkhope of Harrogate (Con)]

My Lords, I am very pleased to participate in this debate, which underlines the need for action to be taken to maintain our health provisions and to keep them—despite sometimes expressing to the contrary—among the best in the world. I speak as a founder lawyer member of the multidisciplinary Mental Health Act Commission, so I hope that noble Lords will understand if I concentrate on the issue of mental health this evening.

One in four of us will suffer at some time in our lives from some form of mental illness. I do not believe that that statistic is properly understood or appreciated. Other types of illness are easier to accept, and sympathy is more likely to be extended. Proportionally, the percentage of health spending on mental health is only 10%, despite a clear need for greater and more comprehensive resources in that sector. The needs are extensive but are still unmet.

Back in 1983, one of the aims of the new commission was to protect patients’ human rights and examine the legality of detention in appropriate cases. However, we were also obliged to suggest improvements in the system. As a result of our work, which dealt mainly with previously detained patients, we wanted to make sure that when they rejoined the wider community, proper social care and support was available for them. We were also charged with providing a report every two years, and in initial and successive reports we were obliged to point out the inadequacy of the social care in the community situation. That was over 30 years ago, and successive reports and comments that have taken place in the interim have suggested that we have not done nearly enough to put things right.

Since then, society’s attitudes towards those with mental illness have undoubtedly improved, but there remains a level of stigma, at worst, and disinterest, at least, in the subject. Luckily, we now have a much broader understanding of what mental illness may be. Many acknowledged conditions do not appear to fit within the strict category or interpretation but which are either close to it or have the effect of contributing adversely to the mental health of an individual. Obsessive compulsive disorders, depression, anxiety through stress and PTSD are clear examples. The mental health of those who are autistic is also often overlooked. The incidence of mental illness in this group is substantial. All this requires a more individual approach tailored to specific needs. This should include not only sharp-edge treatment and resource but, in appropriate cases, obtaining suitable employment, where discrimination and other obstacles are in the way.

I therefore hope that the Government’s promise of 1,000 more staff—which, if one divides that across the country, I suggest is still inadequate—and the £2.3 billion of extra investment proposed in mental health will be not only implemented but used in a really effective way, and in such a way that the individual needs of more people can be sympathetically and effectively met, along with a greater understanding of mental health issues, which I think we all agree as necessary.

Unpaid Carers: Support

Lord Kirkhope of Harrogate Excerpts

Thursday 13th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

This is a really important question, because the carer’s allowance has increased and is available as a non-means-tested support. I can reveal today that one of the key issues that is being looked at as part of the social care Green Paper is ensuring that financial support and employment status for carers are clearer, so that they can access all the support they are entitled to, but also to try to make things simpler.

[Lord Kirkhope of Harrogate (Con)]

I declare an interest as a former Mental Health Act commissioner. While we are talking about carers, there is a considerable number of people who are caring for members of their family who have been suffering from mental illness and are now in the community. Would my noble friend not agree that we should be more concerned to give assistance there as well, rather than merely to those who care for people with physical ailments?

[Baroness Blackwood of North Oxford]

The burden of ill health, anxiety and depression is an important issue that has been clearly identified, and it can be caused by caring for a loved one. There is specific evidence about the threshold at which the number of hours spent caring causes such challenges. My noble friend is right that we should not only identify those who are caring but signpost them clearly to the support available for carers and make sure that they can access that care easily.

Children: Gaming

Lord Kirkhope of Harrogate Excerpts

Thursday 23rd May 2019 Lords Chamber

[Lord Kirkhope of Harrogate (Con)]

Does my noble friend not agree with me, though, that we should deal with this extremely carefully? I am aware of a number of cases in which children have become obsessed with gaming. In desperation, parents have been in touch with their representatives and medical advisers to try to deal with the effect of the psychosis that results from the obsession with gaming among quite a lot of young people. Can she therefore make sure that, however she looks at the positive effects in certain cases, she also fully recognises the dangers of an open approach to this?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. Hundreds of millions of people globally play videogames, and for the majority it is a positive recreational activity. He is right, however, that there is some evidence of a moderate correlation between gaming and depression and anxiety symptoms in young adults, and evidence that exposure to violent gaming can have an impact on sleep and mood. However, that is dependent on the nature and duration of gaming. We also support the WHO’s classification, which identifies addiction within the classification of diseases. The CMO said in her evidence review, however, that there is insufficient evidence to support a specific evidence-based guideline on screen time. That is why we support more applications to the NIHR for research so that we can have a better understanding of the impact of gaming on young people. We would encourage anyone who is concerned to contact their GP.