Mental Health: Children and Adolescents

Debate between Lord Patel of Bradford and Lord Prior of Brampton

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

Debate between Lord Patel of Bradford and Lord Prior of Brampton

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

Debate between Lord Patel of Bradford and Lord Prior of Brampton

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

Debate between Lord Patel of Bradford and Lord Prior of Brampton

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

Debate between Lord Patel of Bradford and Lord Prior of Brampton

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.

Health: Parity of Esteem

Debate between Lord Patel of Bradford and Lord Prior of Brampton

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

Debate between Lord Patel of Bradford and Lord Prior of Brampton

Monday 19th October 2015 Lords Chamber

[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.

Primary Care: Targets

Debate between Lord Patel of Bradford and Lord Prior of Brampton

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness makes a very good point. There is plenty of evidence to suggest that where general practices employ clinical pharmacists, it relieves GPs of a considerable burden. Interestingly, the NHS Alliance produced a report last week called Making Time In General Practice. It identified that up to one in six patients seen by GPs could in fact be seen by someone from a broader skill mix within general practice, so what the noble Baroness says makes a lot of sense.

[Lord Patel of Bradford (Lab)]

My Lords, while one may applaud the intention of the 24/7 NHS service, does the Minister agree that the Government are potentially raising public expectations that are just not going to be achievable, given the deficit of nearly £1 billion that we have seen in the first quarter of this year alone?

[Lord Prior of Brampton]

My Lords, the deficit in the first quarter is indeed a matter of huge concern—I am not going to pretend otherwise—but the Government are wholly committed to seven-day services both within hospitals and in general practice. We are committed to investing £10 billion extra in the NHS over the next five years, and ensuring that we have enough GPs and enough support for them is a key priority.

Police: Ambulance Support

Debate between Lord Patel of Bradford and Lord Prior of Brampton

Thursday 16th July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord raises a very important point. Apart from being an extra drain on the resources of the police, it can often exacerbate a mental health problem if someone who is already very distressed ends up being transported in a police vehicle. Under the mental health concordat, to which all ambulance services are signed up, they are committed to reducing the number of times that people detained under the Mental Health Act are transported in police vehicles. We will monitor performance against that very carefully.

[Lord Patel of Bradford (Lab)]

My Lords, the Mental Health Act code of practice clearly says that people with mental health problems should not be transported by police vehicles. In the Midlands the ambulance service transports roughly 75% of people with mental health problems—that is reasonably good but not acceptable—while in Lancashire the figure is as low as 5% and in London it is 30%. Have the Government made any assessment of this, given what the Home Secretary said about police cells being completely inappropriate places of safety for people with mental health problems? Police vehicles should not, wherever possible, transport mental patients.

[Lord Prior of Brampton]

The noble Lord is right: it is quite wrong for people to be detained under Section 136 in police cells. It is also wrong that people suffering from severe mental health problems are transported in police vehicles. I am not aware of the figures that he gave for the West Midlands in comparison with other parts of the country but I will look at them very carefully.

Prisons: Mental Health

Debate between Lord Patel of Bradford and Lord Prior of Brampton

Wednesday 24th June 2015 Lords Chamber

[Lord Patel of Bradford]

To ask Her Majesty’s Government what steps they are taking to achieve parity of esteem between mental health and physical health in prisons.

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

My Lords, achieving parity of esteem between mental health and physical health in prisons is a government priority. Following the 2009 review by the noble Lord, Lord Bradley, we ensured that prisoners can access equivalent health services to people in the community. The Government’s mandate to NHS England has objectives to achieve parity of esteem, including in health and justice settings, and to develop better offender healthcare that is integrated between custody and community, including developing liaison and diversion services.

[Lord Patel of Bradford (Lab)]

I thank the Minister for that Answer. I am sure he will be aware that a great deal of effort has been made to improve data accuracy and the quality of recording of mental health diagnosis in NHS trusts, including new coding standards, all as part of preparation for a national payment tariff for mental health, similar to those for people in hospitals with physical health conditions. Can the Minister describe, first, how this will be implemented in the prison setting? Secondly, what support will his department be giving to implement the standards for prison mental health services, which the Royal College of Psychiatrists published recently due to, as it said, the lack of a national blueprint for mental health services for people in the criminal justice system?

[Lord Prior of Brampton]

I thank the noble Lord for his two questions. On the first, about coding, it is very important that we get the tariff right and that it does not become just another measure of activity but that outcome is built into that tariff. Paul Farmer, the chief executive of Mind, is preparing a report for NHS England, which will include proposals for the tariff and payment systems. That will include health in prisons as well as outside prisons.

The second question was about the standards issued recently by the Royal College of Psychiatrists. The noble Lord, Lord Bradley, in his foreword to The Bradley Report Five Years On, referred to the importance of having a national blueprint, which of course is now possible given that NHS England is the commissioner of specialist services throughout the country. I will also draw those standards to the attention of Paul Lelliott, the chief inspector of mental health within the CQC. I am sure that the CQC will wish to incorporate those standards into its inspection regime

Mental Health Services: Young People

Debate between Lord Patel of Bradford and Lord Prior of Brampton

Tuesday 23rd June 2015 Lords Chamber

[Lord Prior of Brampton]

I thank the noble Lord for that question. He is right that, out of a class of 30 children, three are probably suffering from diagnosable mental health problems. The Government are commissioning a prevalence survey to establish more precisely what that number is. There is a feeling that it will be increasing with the use of social media and more bullying in schools. I agree with the noble Lord that we must make it easier to access talking therapies in particular and the Government have plans to do that.

[Lord Patel of Bradford (Lab)]

My Lords, will the Minister assure the House that children and young people with serious mental health problems are not treated on adult psychiatric wards, alongside fairly dangerous adults, that they can access appropriate child mental health services, and that they do not have to travel hundreds of miles across the country to do so?

[Lord Prior of Brampton]

The Government have committed to spending £150 million over the next five years on children who are suffering from eating disorders. This may partly answer the noble Lord’s question. They have also now committed to spending £1.25 billion over the next five years to develop mental health services for children and young adults. That is against a background of our current spending of about £700 million, so we are talking about doubling the spend. Doubling the spend does not mean doubling the benefit and output, but the noble Lord can be assured that it is an absolute priority of this Government to tackle mental health problems right where they start: when people are young.