General Practitioners: Shortage

Lord Patel of Bradford Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

As part of the joint NHS England and NHS Improvement and DHSC bureaucracy review—there is such a thing—we have been working across government to reduce unnecessary bureaucratic burdens. There have been a number of key work streams, including a new appraisal process and digitisation of the signing of some notes, along with work to reform who can provide medical evidence and certificates and who can provide notes—nurses, occupational therapists, pharmacists and others. We are continuing to look through the process to engage with GPs to see how we can remove more such administrative burdens.

[Lord Patel of Bradford (Non-Afl)]

My Lords, looking at wider health workforce issues, I understand that we need another 2,000 radiologists in the next five years and that it is highly unlikely that we will be able to produce them. That is the pessimistic note. On an optimistic note, I heard recently that Apollo, the large healthcare provider in India, in partnership with the royal college and the GMC, has been training up 150 high-quality radiologists every year, some of whom are coming to this country. Does the Minister approve of such schemes, and is the department doing more work in places such as India where we can recruit high-quality medical staff?

[Lord Kamall (Con)]

I thank the noble Lord for his question, but also pay tribute to his commitment to tackling racism in our society.

We know that there are countries that train more people than they have places for in their country. They do that, first, to help those people get a better life elsewhere, but also because remittances are much better than foreign aid for many of those countries. I frequently mention the fact that it was immigrants from the Commonwealth who saved public services in this country after the war. We should remember that and continue to encourage people from the Commonwealth to come to this country. Sadly, for some reason, noble Lords quite often do not want them and make up all sorts of excuses for trying to block non-white people from outside Europe.

Mental Health: Young People

Lord Patel of Bradford Excerpts

Thursday 9th February 2017 Grand Committee

[Lord Patel of Bradford (Lab)]

My Lords, I am grateful to my noble friend Lady Massey for giving us the opportunity to debate this important and pressing issue. She has great expertise in the care and welfare of children and young people, which is evident in all the contributions that she makes to the House. It has been an interesting debate and noble Lords have raised a number of important questions. I look forward to the Minister’s response; given the challenging environment, I do not envy him.

The Government pledged £1.25 billion for improving children’s mental health services and £250 million to improve CAMHS provision for each year of this Parliament. However, in spite of these commitments at a national level, those funds are not reaching children’s mental health services and disinvestment is taking place at local level. The Government would argue that there have been no reductions in funding; in essence, that is correct, as there have been no direct cuts from central government. However, we know that the NHS is underfunded and social care is in crisis. The cuts to CAMHS budgets are the result of reduced funding to the NHS and local authorities, which then make cuts to local services and staffing levels. The impact of all this, as so graphically highlighted by a number of noble Lords, is that children and young people and their parents are unable to access services when they most need them.

In January this year, the Government announced that they would be publishing a Green Paper on children and young people’s mental health. Will the Minister give us an indication of when this will be published? I understand that the Green Paper will contain new proposals for improving services across the system and increasing the focus on preventive activity across all delivery partners. I warmly welcome this, but with a note of caution.

I have four questions for the Minister. First, will he assure us that the proposals will be adequately funded? Secondly, as the Government will not interfere with local decision-making or ring-fence money, how can he assure us that any national funding is used as intended by the local commissioning groups? Thirdly, I welcome the focus on preventive activity across all delivery partners—education, health, social care and the voluntary sector—which I believe is a crucial part of the solution to developing a good quality of care, a point echoed by the noble Baroness, Lady Chisholm. Are the Government proposing to issue guidance that will direct these partners to develop new ways of delivering children and young people’s mental health services that are collaborative and integrated? They should look at innovation, given the point raised by the noble Baroness, Lady Lane-Fox, around technology—I think that the noble Baroness, Lady Fall, mentioned that, too.

Fourthly, any new proposals must involve service users. Will the Minister assure us, in the spirit of the report “There for you”, that the people who use services and their families are placed firmly at the centre of any plans in a meaningful, not tokenistic, way, in order to ensure that their voices are listened to, heard and acted on, especially those very vulnerable young people whom my noble friend Lord Cashman highlighted in his speech? It is vital that we build a sustainable future for children and young people’s mental health services. To do anything less risks failing an entire generation of children and young people.

Mental Health: Children and Adolescents

Lord Patel of Bradford Excerpts

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, transparency is critical to this and every CCG will have its improvement assessment framework. Unless I am badly mistaken, they will all be in the public domain and it will be possible to look at the relative performance of each CCG. NHS England will also produce its own matrix and integrated dashboard, which will have all the key information about funding, the numbers of people accessing mental health provision and the improvements that those people achieve once they are in the system.

[Lord Patel of Bradford (Lab)]

My Lords, from the mental dataset it is very clear that black and Asian minority ethnic adults are overrepresented in the mental health field, but the data on CAMHS are very inconsistent. They show that young black and Asian people are underrepresented, despite the fact that they are overrepresented in the criminal justice system, excluded from school more and overrepresented in the care system. Is it a recipe for disaster if young black people with challenging behaviours are being pressed through the criminal justice system as opposed to receiving good, early mental health care? Is that the reason why 40% of young people in secure institutions are from a BME background?

[Lord Prior of Brampton]

If it is indeed the case that young black and Asian people are not attending school and are going into the criminal justice system because they cannot get access to mental health services on the same basis as other children, it will be a national scandal, to be honest. I will certainly take away those figures. I have not seen David Lammy’s report, which I gather came out this morning. The noble Lord said that 40%, I think, of all young people in secure detention are black or Asian—I think in London it is 80%, which is a staggering statistic.

Psychiatric Units: Child and Adolescent Patients

Lord Patel of Bradford Excerpts

Wednesday 13th April 2016 Lords Chamber

[Lord Prior of Brampton]

My honourable friend Alistair Burt, the Minister for Care Services, and I accept that the lack of clear knowledge on how many deaths there have been in psychiatric care settings is not satisfactory or acceptable. I think the difference from the figure of nine in the “Panorama” programme is partly because the figure of four is from 2013 whereas the figure of nine probably goes back to 2010. Nevertheless, it is essential that we clear that up and get those facts straight. Alistair Burt has agreed to meet Inquest to do so.

As far as investigating these awful tragedies when they happen and learning from them, where someone is detained under the Mental Health Act and a suicide happens there is a requirement to inform the CQC, as the noble Lord will know. For example, where a child is not detained under the Mental Health Act, there is no such requirement. We are looking at this very thoroughly and when my honourable friend in the other place has completed his work I will write to the noble Lord with our findings.

[Lord Patel of Bradford (Lab)]

My Lords, I want to carry on the discussion about admission to psychiatric hospitals. During the passage through this House of the 2007 mental health legislation, we identified that more than 350 children were placed inappropriately on adult psychiatric wards every year. One assumes that, almost 10 years on, that figure should have dramatically dropped and we should not see children placed on adult psychiatric wards. Can the Minister shed any light on whether we know how many children are still placed on adult psychiatric wards and what is being done to stop that happening?

[Lord Prior of Brampton]

My Lords, I think the figure for children on adult psychiatric wards is 391. It is far too high. It was described in the “Panorama” programme as the Cinderella service of a Cinderella service. What has come to light in the work done by the Sunday Times, “Panorama” and Norman Lamb in the other House is that we have a very serious problem here. It is not going to be solved overnight. The Government have committed to spend £1.4 billion over this Parliament to improve child and adolescent mental health care, but we have a long way to go.

NHS: Mental Health Services

Lord Patel of Bradford Excerpts

Monday 14th March 2016 Lords Chamber

[Lord Prior of Brampton]

We agree entirely with the recommendations in the task force report regarding the need for a revolution in transparency of information about mental health, and that will include spending. Even when adjusted for need, I think that there is almost a twofold variation in the spending on mental health from one CCG to another, so we entirely accept the recommendations.

[Lord Patel of Bradford (Lab)]

My Lords, going back to the noble Baroness’s comment about children and young people, given that one in 10 six to 15 year-olds suffers from a diagnosable mental health condition but that only 25% to 35% access the support they need, can the Minister provide assurances that there are no plans to change the funding for the training of psychotherapists, who do valuable work with these children in the NHS?

[Lord Prior of Brampton]

My Lords, I can give the noble Lord the assurance he wants. There are no plans to change the way in which funding for the training of psychotherapists is done at the moment.

Health: Black and Minority Ethnic Psychiatric Patients

Lord Patel of Bradford Excerpts

Monday 29th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I will certainly have a word with Alistair Burt, the Minister of State for Health, who is having the meeting to which the noble Baroness referred. I will bring her comments to his attention.

[Lord Patel of Bradford (Lab)]

My Lords, the Minister was chairman of the CQC so he will be well aware that the Care Quality Commission has a responsibility to lay before Parliament an annual report on the monitoring of the Mental Health Act, which it took over from the Mental Health Act Commission when it was abolished. The Mental Health Act Commission used to produce a biannual report with a very significant chapter on the details that the Minister just talked about—the disproportionate number of BME detained patients, the disproportionate use of antipsychotic drugs, and their use at levels above BNF recommendations. Why does the CQC not present that level of data and evidence any more on a yearly basis? Without the evidence and data, how can it take steps to tackle this important area?

[Lord Prior of Brampton]

The noble Lord raises an interesting point. I do not have an answer to his question except the straightforward, “I do not know”. I hope that when the WRES data on staff come through, they can be extended to patients and carers as well—as suggested in the recent report by the noble Lord, Lord Crisp. That information and evidence should then be made available.

National Health Service: Workforce Race Equality Standard

Lord Patel of Bradford Excerpts

Wednesday 24th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I shall give the House a few figures. Some 22% of all staff in the NHS are from BME or minority ethnic backgrounds, 28% of all doctors and 40% of hospital doctors. Yet only 3% of medical directors are from BME backgrounds and 7% are in senior management roles. We have two chief executives and six chairmen from BME backgrounds out of 250 trusts. So the performance across the NHS is, as the noble Baroness has mentioned, absolutely terrible and we have to take some serious action to change it. The noble Baroness has given one example but I think that there are many others. The NHS workforce race equality standard is a new initiative which, by introducing some transparency into the health service, will improve matters.

[Lord Patel of Bradford (Lab)]

My Lords, I congratulate the noble Lord because I know that, as chair of the WRES committee, he is very committed to this issue. But does he agree that the targets set will be incredibly difficult to meet in the space of a couple of years? It will mean making changes to tackle the huge inequality that has existed in the NHS for a number of years. I suggest that one way of achieving this is to ask CQC inspectors, when they carry out their inspections, to target specifically the WRES and look for action plans that show improvement year on year. If the improvement is not there, no trust should be getting a “good” on the CQC’s well-led domain without addressing this specific issue.

[Lord Prior of Brampton]

My Lords, the whole purpose of the WRES is to shine a light on the performance of each trust in the country. The CQC will be including it in its well-led domain from March of this year and has already begun to incorporate it into its inspection processes. As the noble Lord knows, in Bradford where he is the chairman of a trust, we have a huge amount of progress to make.

Drugs

Lord Patel of Bradford Excerpts

Thursday 4th February 2016 Grand Committee

Asked by

[Lord Patel of Bradford]

To ask Her Majesty’s Government what is their response to the Office for National Statistics’ report on deaths related to drug poisoning in England and Wales in 2014.

[Lord Patel of Bradford (Lab)]

My Lords, I am grateful to have the opportunity to raise the important issue of deaths related to drug poisoning. I thank the noble Baroness, Lady Walmsley, and my noble friend Lord Hunt for speaking on this today. The Office for National Statistics report on deaths related to drug poisoning highlights a number of concerns which I have been raising in questions and debates in this House for some time. I cannot begin to cover all these issues today. Suffice it to say that I have grave concerns that the Government’s drugs policy may have contributed to the increase in drug-related deaths in England. I am aware that this is a serious assertion and I hope the Minister will take my concerns with the sincerity with which they are meant.

Heroin is involved in more fatal overdoses than any other illegal drug. The most common form of treatment for dependence on heroin is opioid substitution therapy. Under this treatment, the street heroin to which a person has become addicted is replaced by a pharmaceutical substitute, usually methadone. The evidence is clear that this treatment can halve a patient’s risk of death for as long as they remain in treatment but, because relapse is common, the patient’s risk of death increases significantly when treatment ends. So the longer a patient remains in treatment, the better their chances of staying alive. However, rather than being evidence-based, I strongly suggest that the 2010 drug strategy reflects the Government’s concerns that there were too many people on methadone for too long—a point vigorously reinforced by the Work and Pensions Secretary, lain Duncan Smith, who said that he felt too many people were “parked on methadone”. Therefore the Government introduced a payment-by-results system to incentivise service providers to encourage drug users to more quickly complete treatment and achieve abstinence.

What is wrong, you may ask, with encouraging more drug users to become abstinent more quickly? Surely that is a good thing. However, UK and international evidence clearly shows that there are major risks in pressuring drug users to withdraw from treatment. The Government’s own Advisory Council on the Misuse of Drugs stated that there was strong evidence that time-limiting opioid substitution therapy would increase the rate of overdose death. Of course I understand that the Government’s decision-making must include public opinion and there is a fear of being seen as soft on drugs—there has been from every Government who have been in power. However, I know from working with drug users myself for many years that the first treatment a drug user receives must be about stabilising the chaos in their lives, and abstinence should be about providing the right range of treatment options at the right time. The evidence shows that heroin addiction is a long-lived condition, averaging around 10 years, so drug users must be ready to achieve abstinence, because if they relapse after they have left treatment they are at a high risk of fatal overdose, since their tolerance to heroin is obviously greatly reduced.

What has been the result of the Government’s approach? On a positive note, between 2011 and 2012 an estimated 8.9% of adults used an illegal drug. This is the lowest level of drug use since figures were first collected in 1996. The number of people who completed drug treatment, free of dependence, is at record levels. However, perversely, in 2014 there were 3,346 drug-poisoning deaths in England and Wales, the highest number since records began in 1993. Deaths involving heroin increased by almost two-thirds between 2012 and 2014, from 579 to 952.

More worryingly, Public Health England’s own network—the National Intelligence Network on the health harms associated with drug use, which exchanges intelligence on blood-borne viruses, new and emerging trends in drug use and drug-related deaths—reported in December 2015 that the number of drug-related deaths is increasing, and that the rate of increase is probably accelerating. Amphetamine and cocaine deaths have also been increasing in recent years. However, the network’s analysis showed that treatment is protective against drug-misuse deaths.

I have cited a number of facts and figures, but let me put a human face on this and highlight some wider impacts. A number of local areas have conducted their own drug-related death reviews. Some have found an increase in female drug-related deaths, some individuals are parents, some people were released from prison and needed further support and treatment. In fact, in 2010 I produced a national report reviewing drug treatment in prisons and highlighted the importance of ensuring good continuing care for vulnerable people leaving prison to prevent relapses and drug-related deaths.

More people had complex health issues involving repeated presentations to hospital wards and A&E departments. Some have mental problems requiring treatment and repeated admission to mental health wards. They have a dual diagnosis of substance misuse and mental ill health. Only last week, as the Minister will know, we heard that the number of deaths annually among mental health patients in England rose by 21% over the past three years, from 1,412 to 1,713. The number of those killing themselves or trying to do so has also increased, by 26%, from 595 in 2012-13 to 751 in 2014-15. I wonder how many of those people had a dual diagnosis.

In light of this, will the Minister agree to see if an investigation can be set up to look into the causes of the drug-related deaths and the mental health deaths, and to see how many had a dual diagnosis? I understand that an update of the UK clinical guidelines on drug misuse and dependence is expected this year. In fact, I thought it was going to be published by February. These are essential guidelines for all clinicians who provide pharmacological interventions for drug misusers as part of their drug-treatment programme. This is a positive move, but I strongly suggest that it is also time that the Government carried out not just an annual review but, more importantly, a full impact assessment of the current drug strategy. Will the Minister therefore agree to ask the relevant government department that a risk and impact assessment of the current drug strategies be carried out, ensuring that an evidence-based approach be developed that tackles the failures and weaknesses of the current strategy, including, obviously, reducing drug-related deaths; training, employment and housing for drug users; integrating prison and community services; and, as I have already mentioned, the important issue of provision of dual diagnosis?

Finally, we know that there is a major funding issue within the NHS, and this is having an impact on services that work for these vulnerable people. Drug and alcohol treatment are no longer part of the protected NHS spend, but will have to compete for resources in the much harsher local government public health environment, which is likely to result in a reduction in services. In fact, I have seen a reduction in services in many environments already.

As for mental health, suicides among people in touch with crisis resolution home treatment teams, which are there to support people in crisis to stay in their own homes rather than being admitted to hospital, have increased significantly. It has been reported that these teams have lost their funding and have been disbanded or merged into community teams. So their specialist function has been lost, at a time of increasing demand. We also know that the number of specialist mental health nurses has fallen by more than 10% in the past five years.

In conclusion, I ask the Minister to say in his reply what steps are being taken to tackle the lack of funding for drug misuse and mental health services, which deal with some of the most vulnerable people in our communities, particularly those with a dual diagnosis of drug misuse and mental health problems. Because I have the time, I shall also make one other point. I understood that the evaluation of the payment-by-results pilot studies was to be published either last year or early this year. Can the Minister update me on when publication will happen? I look forward to hearing from other noble Lords, and to the Minister’s response.

Health: Parity of Esteem

Lord Patel of Bradford Excerpts

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

I look forward to reading the report; perhaps the noble Lord would like to send me a copy. I cannot comment specifically on mindfulness, but there is no doubt that talking therapies are having a big impact. The evidence shows that some 45%, perhaps up to 50%, of people who have been introduced to IAPT talking therapies—CBT, psychotherapy and the like—have experienced considerable improvements.

[Lord Patel of Bradford (Lab)]

My Lords, my understanding was that, in an effort to ensure parity of esteem between physical and mental health, clinical commissioning groups were directed to increase spending on mental health in line with the increase in their 2015-16 budgets. What evidence and assurances can the Minister give that that has taken place?

[Lord Prior of Brampton]

NHS England is committed to ensuring that every CCG in the land increases its spending on mental health. The general allocation to CCGs was 3.7%, and the CCGs’ commitment to spending 4.6% of their allocation on mental health will hold NHS England to account for achieving that.

Mental Health Services

Lord Patel of Bradford Excerpts

Monday 19th October 2015 Lords Chamber

Asked by

[Lord Patel of Bradford]

To ask Her Majesty’s Government how they will improve mental health services, as outlined during Prime Minister’s Questions on 16 September (HC Deb, col 1039).

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton)]

My Lords, the Government are committed to putting mental health on a par with physical health. We invested more than £120 million to introduce the first waiting times standards for mental health services from April 2015. We have expanded access to psychological therapies. Our crisis care concordat has ensured that we have halved the number of cases of people going through a mental health crisis being held in police cells.

[Lord Patel of Bradford (Lab)]

The Minister gave three significant areas of development. First, on the investment to introduce the first waiting times standards for mental health services from April 2015, will the Minister say what the results of the waiting times standards have been in the first quarter, from April to June? Secondly, he mentioned the expansion of IAPT services, but as I understand it there is no ring-fencing for IAPT services. What evidence and assurance can the Minister provide that these services are being provided across the country, especially for children and young people?

Finally, the Minister mentioned the excellent crisis care concordat, which says that we have halved the number of people in crisis being held in a police station. He will be aware that just this June the CQC report said that people in mental health crises, even those who are suicidal, are not getting the care that they need in emergency situations. What assurances and steps are the Government taking to deliver care to those people in an emergency situation?

[Lord Prior of Brampton]

My Lords, very briefly on those three points, we will have the waiting time results for IAPT tomorrow. I will publish them in the Library and write to the noble Lord. On the ring-fencing point, the IAPT part of the £150 million extra spending on CAMHS is not ring-fenced, but the £150 million is in total. We will wait to see the results on how effective the IAPT spending is before we come to a final decision on how much should be spent on IAPT and on other parts of the care budget. On the noble Lord’s third point, the CQC published its report, Right Here, Right Now, some six months ago. It found that things were getting better, but there was still far too much variation. By using that report and encouraging local crisis care concordat teams, we hope to address that variation.