Mental Health: Young People

Lord Patten Excerpts

Tuesday 30th June 2015 Lords Chamber

[Lord Patten (Con)]

My Lords, parity of esteem between physical and mental illness within the NHS is easier to parrot than to achieve, yet its achievement is morally, personally and practically vital, with an urgency no clearer seen than within young people with mental health problems, as the noble Baroness, Lady Tyler of Enfield, pointed out. It is morally vital because it is always a wrong to sideline or neglect one health problem versus another; personally vital because a young person helped through will be a happier young person, just like someone cured of a physical disease or a crippling condition; and practically vital because better care for the mentally ill young should diminish the need later for physical healthcare because of harmful drinking, drugs, obesity, self-harming, risky personal behaviour and all the rest. Therefore it makes pretty good pragmatic common sense, and if handled in this way will enable young people to improve their contribution to the way we live now. Of course, at its most utilitarian—I am sometimes utilitarian—it will also save money in the medium and longer term, which makes much economic sense for the nation.

Those, therefore, are the three reasons why I am an enthusiast for the direction of travel outlined by this Children and Young People’s Mental Health Task Force report, which has not received the public attention that it might have done had it not been published during the long-run pandemonium of the never-ending general election campaign. However, happily, from my point of view at least, we have a Government with a clear-cut mandate to deal with the long-running problems of young people with mental health. “No health problem sidelined” should be in NHS terms as resonant a phrase as is “No child left behind” in US educational circles. No sidelining—no one left behind.

Since 1945, mental health generally and young people’s mental health in particular has never been in the clearest focus. That is a failure on the part of all of us, at both ends of the Palace of Westminster, over decades. Thus, only perhaps a third at best of young people with a diagnosed mental health problem get full-on treatment, which is too low. Imagine if that was the case for young people diagnosed with cancer, and think of the outcry there would be because help was not available. It is good that so much of the treatment that occurs is of course now outside of longer-stay institutional settings, which I am thoroughly in favour of. However, it is also interesting to reflect that that began only just over half a century ago, back in 1961, when the then Health Minister, Enoch Powell, focused on the asylums of the day, brooded over by those towering chimneys and huge water towers, and started to shut them. However, it took pretty well 20 years after the National Health Service had been founded in 1945 for that process to begin.

We are still in a period of sidelining and stigma for some of the mentally ill young. I find that all the more disturbing, as some 50% of lifetime mental illness starts before the age of 14, and 75% of mental illness overall sets in by the age of 18. Therefore it is no slick judgment on my part to say that our mental health problems as compared to our physical health problems are “young people’s problems” in essence, from when they first set in, unlike most physical problems—although that is sometimes the case for the young, too. If untreated, they roll on into the mental health problems of adulthood, becoming the biggest single cause of disability and, I am also told, the leading single cause of sickness absence in the United Kingdom. Therefore it is a major economic problem. Failure to treat leads to the further compounding of later misery, illness and economic cost. There are lots of moving parts, which are very hard to simplify.

All that must be set against the neo-exponential explosion of additional pressures on young women and men that have grown over the last two or three decades due to the parallel explosion of social media writ large, from innocent selfie to internet troll and back again, leading all too often to mental pressures and, at worst, teenage suicides, that we see among those who started off as mentally ill.

The compounding effects of social media and internet pressures have not yet been fully recognised by wider policy thinkers as they should have been, or by some policymakers. When more results come, they may well point to a growth rather than a diminution of young people’s untreated mental health problems. Perhaps the Minister—if not now, because I have not given him notice, then later by letter—can let us know the Government’s judgment on the effects on mental health caused by the growth of social media, and the relevant studies that should be being done if they are not. It is easy to say, “More research should be done”—it keeps researchers very happy—but we need to know the facts.

These issues have to be dealt with—the noble Baroness, Lady Tyler, has been very generous in her praise for what is happening about funding—within a ring-fenced if huge NHS budget. I do not intend tonight to press for yet more; we must live within our taxpayers’ means—I hope the Minister is pleased with that—and pay our debts. However, I hope that the Minister can give a clearer indication of the next steps that the Government propose within the tight constraints on public expenditure, which I support in full.

Abortion

Lord Patten Excerpts

Thursday 3rd April 2014 Grand Committee

[Lord Patten (Con)]

My Lords, allowing sex-selective abortion would mean that the UK was sleep-walking into a full-blown eugenic society, flying full into the face of humanity and the gift of life. Gender-selective abortion, which is highly discriminatory against females, is not prohibited by any Act or any other legislative instrument nor, for that matter, would be abortion by selection on grounds of likely height, appearance or whatever, which forms of cosmetic abortion could follow.

Neither ministerial exhortation, codes of practice nor medical professional self-regulation will stop this. Only the Government can. Therefore, there is a very urgent need for secondary legislation to do the job—to make clear the illegality of all these practices—as the issue will surely blow up in the Government’s discomfort zone if it is not punctured soon, as the Prime Minister has pointed out and sensed, I believe.

Exactly the same goes for foetal pain at 20 weeks-plus, in relation both to the provisions of the Abortion Act and current legislation against the wilful infliction of pain contained in Section 134 of the Criminal Justice Act 1988, which enacts the UK’s commitment under the UN Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment. By sheer coincidence, I happen to have taken that Bill through all its stages in another place. Will my noble friend the Minister act on these two issues?

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, it is right for me to begin by thanking my noble friend Lady Knight for her powerful contribution to this important and emotive subject. I express my appreciation to all speakers in this debate. A large number of points have been made and questions have been asked, so I hope noble Lords will forgive me if I do not manage to answer all of them. I undertake to do so, in so far as I do not cover the points in my speech, in a subsequent letter.

The Abortion Act 1967 sets out the terms under which abortion is legal. Since it was passed in 1967, there has been a long-standing tradition that any legislation on this issue is put forward from the Back Benches and is subject to a free vote. I was asked by the noble Lord, Lord Hunt, and others whether the law needs clarifying in the light of events and the statement from the Crown Prosecution Service, which my noble friends Lady Barker and Lady Tonge asked about, making changes to the law. Clarification of the law remains a matter for Parliament, not for government. I say to my noble friend Lord Patten that there is no scope for secondary legislation to amend the grounds on which abortion takes place. It would be a matter for primary legislation.

It is vital for everyone, regardless of their views on abortion, to be assured that the law on abortion is operating as Parliament intended. This is particularly important for clinicians directly involved in certifying and performing abortions who need to know that they are operating within the law and for women seeking an abortion who need access to safe, legal, high-quality abortion services.

The Chief Medical Officer has written twice to all doctors involved in abortion provision to remind them of the need to make sure that they work within the law at all times. It is also important for doctors to be able to explain and evidence their decisions and to record how they have formed an opinion on whether grounds for abortion are met. A number of noble Lords, including my noble friend Lady Knight, raised the issue of doctors forming an opinion on grounds for abortion without seeing or examining the woman. Since the Abortion Act 1967 was passed, the law has required that two doctors certify in good faith that there are lawful grounds for any abortion, and that must be based on understanding the facts of a woman’s case whether or not they personally see or examine the woman.

My noble friend Lord Gordon asked whether we can provide figures for the number of abortions performed without a doctor seeing or examining the woman. I am advised that we do not have figures for that. The 46% figure quoted was wrong, I am sorry to say, and was withdrawn by the department. It is not possible to quantify the figure, but I can say to the noble Lord, Lord Campbell-Savours, that forms being pre-signed is a clear breach of the law and if it is found to be happening, a prosecution should be brought.

I can say to the noble Lord, Lord Gordon, that the Care Quality Commission will continue to cover this issue as part of its inspections and compliance action will be taken against any provider where there is evidence of pre-signing. The CQC has put in place information for its staff to help identify if pre-signing or other instances of non-compliance are taking place to make sure that they would be picked up during inspections.

My noble friend Lady Knight and a number of other speakers expressed concerns about gender-selective abortions, particularly the abortion of foetuses simply because they are female. My right honourable friend the Prime Minister has referred to this practice as “appalling”. The Government’s view has been clearly stated on many occasions—that abortion on grounds of gender alone is illegal. My noble friend Lady Knight stated that the Act is not clear on this point. I confirm to the noble Lord, Lord Hunt of Kings Heath, that the grounds for abortion are set out in the Abortion Act 1967. It is true that these grounds make no reference to gender. While there is an extremely limited number of circumstances in which gender may be a factor in considering other grounds—for example, a gender-related abnormality—the department has made a number of recent public statements through the CMO letters, Answers to Parliamentary Questions and media lines, stating our view that abortion on grounds of gender alone is illegal, and we firmly stick by that view.

Analysis conducted by the Department of Health indicates that birth ratios—that is to say, the ratio of boys born as compared with girls—in this country are within normal limits. This is true for the population overall, and is also true for births to women born abroad who now live in this country. This analysis was first conducted and published in May 2013. This is being updated and we intend to continue to conduct a similar analysis on an annual basis, because we regard this issue as extremely important. We are determined to monitor the situation regularly and remain vigilant. I am also aware that some individuals and organisations have offered anecdotal evidence of gender-selective abortions taking place. I urge anyone who thinks that the law may be being broken to contact the police with their evidence.

The noble Baroness, Lady Hollins, and the noble Lord, Lord Singh, may be interested to know that Department of Health officials recently met representatives from Gina International. The meeting was very useful and Gina International has been signposted to relevant organisations, including abortion providers, with which it can discuss its concerns. The meeting concluded that both sides share the same aims—namely, to spread the message that abortions on the grounds of gender alone are illegal.

The Daily Telegraph first brought this issue to light during its investigation in February 2012. I am aware that the announcement in September 2013 that the Crown Prosecution Service declined to prosecute two of the doctors involved in this issue has been disappointing for some. In explaining why it felt that prosecution was not in the public interest, the Crown Prosecution Service noted that it could be difficult to determine whether doctors had worked within the Act in forming an opinion in good faith. It felt that further guidance to doctors on this issue would be helpful for doctors themselves, as well as for any authority who may need to investigate an allegation of poor practice or lawbreaking. The department therefore intends to issue further guidance for doctors, which will set out the Government’s interpretation of the law on gender-selective abortions, as well as further information about reaching and recording an opinion formed in good faith. We intend to issue this guidance shortly.

I say to the noble Baroness, Lady Hollins, that we believe that the department’s analysis, which is based on birth registrations, is more accurate than the Independent’s analysis, which was based on household composition. The department’s analysis showed that birth ratios were within normal limits.

All abortion providers must be registered with the Care Quality Commission, and independent sector providers must also be approved by the Secretary of State for Health. In order to be approved, independent sector providers must adhere to the required standard operating procedures. There has been considerable concern that the consultation that the department has recently completed on updating these procedures has somehow changed the legal position on abortion. As I have highlighted, the legal requirements on abortion are set out in the 1967 Act. Nothing has changed. A response to the consultation will be published once all the responses have been analysed.

[Lord Patten]

My noble friend, for whom I am full of admiration in every way, has said that the law forbids abortion on grounds of sex selection, and forbids pre-signing. However, there has never been a successful prosecution or, indeed, a prosecution of any sort. It seems to me that nothing at all is actually being done.

[Earl Howe]

That is not the case but, if my noble friend will forgive me, I will respond to that point in a letter. I can assure him that things have been done. It is not a case of these issues not being followed up.

South London Healthcare NHS Trust

Lord Patten Excerpts

Thursday 31st January 2013 Lords Chamber

[Earl Howe]

I apologise. Monitor is an independent body; it will have to look at, as it is duty-bound to do, the effect of these proposals on the foundation trusts concerned—namely, Kings and Oxleas—and whether it is satisfied that all legal requirements are met. The TSA was confident in that regard, but we cannot take it for granted. As regards the transitional funding, I mentioned that all three trusts are now working towards having signed heads of terms in place, and the principles of the transactions and the basis for the final deal will include the financial aspects of the mergers. It is important for the department to work to get the best deal for the taxpayer in these transactions. Although an indicative sum of money has been quoted in the TSA’s report for this, it would be wrong, I think, for the department to commit a precise sum of money at this stage. It is important that as much money as possible is saved by the trusts working through these proposals for themselves, before the department steps in. However, we will step in to do what is necessary to ensure that these proposals are properly implemented.

[Lord Patten]

My Lords, I remember a particularly torrid period of campaigning in Lewisham when in the other place which almost led me to seek the assistance of the A&E department at Lewisham hospital. Does the Minister not agree that on every occasion, however understandable, attachments to institutions and to buildings that have been there for a long time are always trumped by patient outcomes and patient care?

[Earl Howe]

My Lords, my noble friend has raised a very good point. It is entirely understandable for a local Member of Parliament, and local people, to feel an attachment towards a particular building that, for them, represents the best of what the NHS has to offer. However, as my noble friend points out, what really matters in a healthcare economy is the quality of the service delivered to those people. Services can be delivered in a variety of ways. It is the view of local clinicians—five out of the six local CCGs support these proposals—that the TSA’s recommendations will deliver better quality care and will save lives. It is that wider consideration that my right honourable friend has had in mind throughout.

Hospices and Palliative Care Services

Lord Patten Excerpts

Wednesday 15th December 2010 Lords Chamber

[Lord Patten]

My Lords, I am very happy to follow the noble Lord, Lord Judd, who put his finger with great accuracy on the importance of localism in support for hospice movements, whether in hospitals or hospices in the community—a point also reflected by my noble friend Lord Selborne. That localism underpins much of what my noble friend Lord Bridgeman described in his speech, which was absolutely spot on.

I wish only to address the spiritual aspects of palliative care, whether in home, hospital or hospice. I guess that when in centuries past hospice-like or palliative care was given it was largely the preserve of the religious. Pain relief must have been very difficult in comparison to the spiritual solace that was doubtless always available on tap and in plenty. Today, the reverse may be the case, thanks to the great leaps forward that have been made in pain control and pain management. If it is hard to provide a hard-nosed, cost-benefit analysis of such pain relief, which I think it is, how very much harder it is to do the same for the spiritual solace given to those facing death and their families. But this spiritual dimension is vital.

While I warmly welcome the extra sums that have been found in these hardest of times by the coalition—the £40 million for hospices and the extra money for palliative care for children—as well as the review that is being undertaken, I ask my noble friend Lord Howe whether he will ensure that the needs of the dying who wish to see a representative of the British Humanist Society, an imam, a rabbi or a priest are not forgotten. That very valuable body, the Association of Hospice & Palliative Care Chaplains, does a great deal to spread good practice in the area of palliative care—it must be terribly demanding and emotionally draining work—helping both patients and their families. As more emphasis is put on dying at home, ways to enhance the good work of this network of chaplains and their colleagues in more community-based care must be developed and the spiritual dimension must not be forgotten.