Mental Health Services
Lord Prior of Brampton Excerpts(10 years, 7 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, I congratulate the noble Baroness, Lady Thornton, on bringing this really important debate to the House. I also pay tribute to the noble Lord, Lord Graham, for his very perceptive and important contribution. He put his finger on it when he said that co-ordination of services for patients who often have huge and very complex difficulties lies at the heart of all we must do. He also said that although little is new in life, the environment in which young people grow up today is very different from that in which he grew up. Although in many ways the environment has improved, the pressures on young people growing up today are probably greater now than when the noble Lord was a boy. The noble Baroness, Lady Massey, referred to this and I will bring it up again later in my speech.
On 18 May, the Prime Minister underlined in his first major speech following the election that mental health, including the mental health and well-being of young people, is a key priority for this Government. The noble Lord, Lord Hunt, can be assured that the Government will hold CCGs and NHS England strongly to account for delivering the substance of parity of esteem. For too long, parity of esteem has fallen into motherhood and apple pie territory. We need serious resource behind it to ensure that we deliver it on the ground.
Last year, the Department of Health asked the Care Quality Commission to review the experiences of people receiving crisis care. The resulting report, Right Here, Right Now, shows that although there is some excellent practice in areas such as Lambeth there is far too much variation across the country in the quality of crisis care—and, as the noble Baroness, Lady Thornton, noted, between services as well as geography.
The report provided powerful insights into the stigma that too many service users face. One patient from the report said:
“A&E was horrible. I felt like I was being judged for inflicting injuries on myself and that certain staff actively didn’t want to treat me”.
As Dr Paul Lelliott, Deputy Chief Inspector of Hospitals at CQC, who led the review, stated, there is a,
“real weakness in mainstream mental health provision as regards 24 hour crisis care. In some cases, the only recourse for people trying to access crisis services is to a phone line telling them to go to their local emergency department”.
As other noble Lords said, going to an A&E department is, for someone suffering a mental health crisis, no solution of any kind.
Another patient said:
“I have a clinical illness. It’s not my fault my brain chemistry fluctuated … To be treated as a drunk, an inconvenience and with visible contempt only makes it worse”.
That points to a need for greater training in some A&E departments and the importance of having a psychiatric liaison nurse in A&E departments. The report also found that in some areas there are still problems with under-18s being detained in police cells under Section 136 of the Mental Health Act. I agree wholeheartedly with the noble Baroness, Lady Thornton, and others that this practice is wholly unacceptable. I will say more on that a little later.
Dr Lelliott stated that there are reasons to be confident for the future as well. We are beginning to see a shift in public attitudes to mental health, away from the stigma of the past. As the report states, there has been huge progress in improving crisis care, thanks to the crisis care concordat and successful approaches such as street triage.
The crisis care concordat was launched in February 2014 and signed by more than 20 national organisations. It seeks to improve the experience of those in crisis and in particular to prevent those detained under Section 136 of the Mental Health Act being held in police cells. I spoke not all that long ago to a young woman of no more than 17 who had had a mental health crisis and tried to take her own life. She spent two nights in a police cell. It is hard to imagine a worse place for a young woman to spend time. That was two years ago.
All localities signed up to the principles of the concordat before the end of 2014. Detailed action plans are now in place across England and set out how local partners will work together to improve service responses for people in crisis. I have taken on board the words of the noble Lord, Lord Hunt, that we must be able to assure ourselves that effective action is taken on the ground and that there is clear accountability.
Since the launch of the concordat in February 2014, the number of times that people of all ages were detained in police cells under Section 136 has fallen by 55% compared to 2011-12. This marks a considerable achievement in meeting the concordat’s ambition. There was also a very big reduction in the number of under-18s detained in police cells under Section 136 for the first time since figures began to be collected in 2011-12, with 145 cases, an almost 40% fall within the year. But I agree wholeheartedly with the noble Baroness, Lady Thornton, that one case is one too many. There is good progress but more work to be done.
In May, my right honourable friend the Home Secretary announced that the Government will reform the law on use of police cells to end this practice altogether for under-18s. I am pleased that the noble Baroness, Lady Tyler, supports that move. The Government will also clarify the legislation so that, for people of all ages, police cells are used only in very exceptional circumstances. A number of noble Lords and noble Baronesses have made the point that there is no point in stopping people going into police cells if alternative provision is not made elsewhere. The Government have committed £15 million to improve the provision of health-based places of safety, so that there is better availability of alternatives to police cells.
The insights from the Right Here, Right Now report will also directly improve crisis care, influencing the Care Quality Commission’s regime for future inspections. In addition, the Department of Health, NHS England and Mind are supporting all localities to develop and improve their local concordat action plans in light of the CQC’s review.
The noble Baroness, Lady Walmsley, gave an example of police being accompanied by a therapist. The CQC report makes reference to street triage. These are schemes whereby a police officer might be accompanied by a nurse, therapist or someone else, when they meet people going through a crisis. Paul Lelliott particularly marked that in his report as being a very good development. The Department of Health has funded pilots using street triage with nine police forces, and I believe that 25 police authorities are now using that triage as a way in which to make a bad situation at least no worse. There have been some very encouraging results, with the use of Section 136 to take people of all ages into police custody almost eradicated in many of the pilot areas.
Liaison and diversion services are also being used to help children, young people and adults in crisis. They identify, assess and refer people with a wide range of mental health, learning disability and substance misuse vulnerabilities when they first come into contact with the youth and adult criminal justice systems. NHS England has now rolled out a national liaison and diversion standard service specification and operating model serving 50% of the English population, and it is anticipated that that will cover the whole population by 2017-18.
It is clear that we need to do more to ensure that, for those in need, help can be found in the right places at the right time. The noble Baroness, Lady Tyler, made the very strong point that it must be unacceptable that some young people have to travel more than 200 miles to find an appropriate bed. The previous Government supported NHS England with £7 million to provide additional mental health beds for children and young people. This increased the number of beds to more than 1,400, the highest this has ever been. But I agree completely with the noble Baroness, Lady Massey, that, while we must ensure that help can be found for those in crisis when it is needed, it is not enough simply to provide more and more beds. Home treatment is also very important.
Three-quarters of mental health problems in adult life begin in childhood. It is therefore essential that we focus on improving the whole care pathway for children and young people’s mental health, preventing issues arising, and taking action before hospital treatment is required. I can confirm there will be an additional £1.25 billion over the next five years to enable transformation across health, social care and education for children’s mental health and well-being. In addition, we are investing £150 million over the next five years in services for young people with eating disorders and those who self-harm. Although this Government can take credit for that, I pay tribute to the Liberal Democrats, and particularly Norman Lamb, for ensuring that mental health was so high up the agenda.
I take the strictures of the noble Lord, Lord Hunt, when he says that we must have clear accountability for spending that money. I place considerable hope in the report that has been commissioned by NHS England from Paul Farmer, the chief executive of Mind.
I have been told that I have only one minute left. That is the difficulty with debates in the House of Lords: all the comments are so helpful that it is hard to do them all justice. I conclude by saying that we have all talked about parity of esteem, in this and the other House, for too long. Until now it has been just motherhood and apple pie. I hope that the resources that we are putting into mental health and the accountability that needs to back them up will make a reality of that expression. I pay tribute to Paul Lelliott of the CQC for his very valuable report and thank the noble Baroness once again for bringing the debate to the House.
Prisons: Mental Health
Lord Prior of Brampton Excerpts(10 years, 7 months ago)
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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
Lord Walton of Detchant (CB)
Can the Minister say what qualifications are now required of doctors who are recruited to work in prisons? Can he further say what proportion of those who are now employed to work in prisons have had formal psychiatric training?
Lord Prior of Brampton
I thank the noble Lord for that question. I hope he will think it acceptable if I reply to him in writing after this session.
Lord Dholakia (LD)
My Lords, could the Minister explain why we lock up so many mentally ill offenders in prison institutions that are not fit for the purpose? Has he read yesterday’s report by the prisons inspector, which describes one prison as containing “shocking” squalor, high levels of violence and drug abuse, and high levels of staff sickness? Would the Minister explain how many mentally ill offenders are in our prison institutions and what efforts are being made to place them where proper mental health care and social care are available?
Lord Prior of Brampton
There are, as the noble Lord knows, some 85,000 people in prison, of whom more than 70% have two or more mental health conditions. Many of them suffer from drug or alcohol abuse, and I think it is generally accepted that a number of those people could be better treated outside a prison environment. He will also know that the liaison and diversion services that were so highly recommended by the noble Lord, Lord Bradley, now cover 40% of the prison population. There is a proposal that that should cover the whole population by the end of the year, subject to evaluation of those pilot schemes.
Lord Bradley (Lab)
My Lords, it is vital that a prison has all relevant information about an offender’s health needs when they arrive at prison reception. Does the Minister agree that an evaluation of the current health screen should be undertaken to improve the identification of mental health problems at prison reception and that the identification of learning disabilities should be part of that screen?
Lord Prior of Brampton
The noble Lord raised this in his report five years ago and in the follow-up report that was published more recently. A very early assessment of a prisoner when he arrives in prison is of course extremely important.
The Lord Bishop of Bristol
My Lords, given the complex needs of so many prisoners and the fact that those needs have to be addressed consistently, does the Minister agree with me that the risks associated with such prisoners could be greatly reduced were all operational staff in prisons given training on mental health awareness?
Lord Prior of Brampton
The right reverend Prelate’s comments are true throughout the whole healthcare system and would also apply to nurses in physical health surroundings. Training in how to recognise and deal with people suffering from mental health problems would be a huge benefit.
Lord Ramsbotham (CB)
My Lords, the figures that the Minister cited come from the last survey of psychiatric morbidity in prisons, published in October 1998. Since then, the morbidity profile has changed. Is there any intention to conduct another survey so that the figures are up to date and people know the size and shape of the problem with which they must deal?
Lord Prior of Brampton
I am not aware of any current plans to conduct a survey similar to the one to which the noble Lord referred from 1998.
Lord Roberts of Llandudno (LD)
My Lords, what action will the Government take in Wales, where health is devolved to the Welsh Assembly but prisons are part of the Home Office remit? How will those two different aspects of government work together?
Lord Prior of Brampton
The noble Lord raises an issue to which, I confess, I have not given sufficient consideration to give a proper reply today. Perhaps I may take that away and come back to him. The simple answer to that question is: dialogue.
NHS: Immigration Rules
Lord Prior of Brampton Excerpts(10 years, 7 months ago)
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government what their response is to the Royal College of Nursing report concerning the impact of immigration rules on the employment of foreign nurses within the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, ensuring we have the right number of nurses is vital. That is why we are taking the issue of nursing recruitment seriously and have prioritised and invested in front-line staff, so there are over 8,600 more nurses on our wards. Health Education England’s workforce plan for England for 2015-16 forecasts that, following further increases in the number of training commissions, the proposed levels for nurse training will deliver over 23,000 more nurses by 2019.
Lord Hunt of Kings Heath (Lab)
My Lords, the noble Lord will know that the RCN report estimates that as a result of the migration rules around 7,000 nurses will be forced to leave the NHS because they do not reach the £35,000 per annum employment threshold. Despite the modest increase in the number of training places, is he confident that that gap can be filled, alongside dealing with the current recruitment crisis, the extra nurses needed for seven-day working, the extra nurses needed for improved patient-staff ratios and the Government’s indication that they want to rule out the use of agency nurses in future? When will all those policies be adopted alongside the 7,000 reduction in overseas nurses?
Lord Prior of Brampton
My Lords, the Royal College of Nursing figure I saw was closer to 3,000 than 7,000, but in a sense that is not what is important. What is important is that over the long run we train our own nurses in this country. Although we recruit some exceptionally wonderful nurses from places such as the Philippines, it does not seem a good long-term strategy to rely on recruiting nurses, often from third-world, quite poor countries, so I am very pleased that we are going to train 23,000 new nurses over the next five years. That is the right answer to any short-term, temporary shortage.
Lord Fowler (Con)
My Lords, surely the central point is that we should review the policy of recruiting nurses from overseas, as I think my noble friend is indicating. Should we not in a bipartisan way now concentrate on training our own nurses in this country rather than permanently taking them from other countries, for example, in Africa, which often desperately need their care?
Lord Prior of Brampton
My Lords, I agree with my noble friend; it cannot be right for a rich country such as ours to recruit nurses from much poorer countries. I will just say that the Philippines, for example, produces more nurses on a deliberate basis than it needs for itself, so that they can go overseas, usually for temporary periods, not permanently. Interestingly, over the last five years, the number of non-EU overseas nurses working in this country has reduced by 41%.
Baroness Walmsley (LD)
My Lords, if we need more home-grown nurses, what are the Government doing to address the flood of nurses leaving the profession, and the appalling attrition rate during training? My noble friend Lord Willis’s report on the Shape of Caring review showed that every year 20% of student nurses do not complete the year, and 40% of nurses do not complete the first five years in the profession. Since it costs £78,000 to train a nurse, is that not a terrible waste of money, and could we not do more to support student nurses to finish their training?
Lord Prior of Brampton
The noble Baroness makes a strong point. The drop-out rate of nurses is between 20% and 30%; it varies hugely from one nursing school to another. I am told that the peak of the drop-out rate is after their first clinical placement, which indicates that the way some nursing schools recruit their students is far from satisfactory. I hope that Health Education England will change the way it remunerates some nursing schools to ensure that they recruit the people with the right qualifications, temperament and vocation before they offer them places.
Baroness Emerton (CB)
My Lords, the Royal College of Nursing’s underlying concern in its report was the safety of patients due to shortage of nurses. The royal college is greatly concerned that there has been a cutback in training places because of the inclusion of overseas nurses over the last three years. Can the Minister see whether the report will result: first, in an increase of nurses in training back to the level of three years ago; and secondly, in revisiting the levels of safe staffing?
Lord Prior of Brampton
As usual, the noble Baroness is more than familiar with the latest developments in the world of nursing. Health Education England is committed to commissioning an additional 23,000 nurses over the next four years. On safer standards of nursing, I know that she has taken a keen interest in the work that has been done around nurse staffing levels in relation to the numbers of patients. It is the Government’s view that the actual decisions about safe staffing should be taken at a local level, based on the acuity of patients on the ward, and should largely be up to the judgment of the ward sister and senior nurses within the hospital.
Baroness Wall of New Barnet (Lab)
My Lords, I declare an interest as chairman of Milton Keynes Hospital NHS Foundation Trust. How are we to reconcile the dilemma that we have just heard about from the Department of Health and from Monitor—cutting back on agency staff—with the impact that this legislation will have on nurses in our hospital and in many others? It will affect not just nurses; lots of people who work in hospitals, whether in ophthalmics or pharmacy, will have the same kind of issue. How do we reconcile the fact that we are trying to run a hospital that ensures the best experience for patients while this will have the opposite effect?
Lord Prior of Brampton
The noble Baroness makes a strong point. There is a dilemma, but we have to differentiate between the long term and the short term. In the long term, it is very important that we develop enough nurses for our own healthcare system. In the very short term, there will be ups and downs. Unquestionably, in the light of the Francis report into the awful happenings at Mid Staffordshire, there has been a spike in demand for nurses, particularly those to be employed in acute hospitals. That has caused short-term difficulties, leading to problems with the agency staffing that she referred to. It is worth pointing out that last year 3,500 nurses—largely from the Philippines—came from overseas to this country. In the short term that provides an escape—a way out, if you like—but it is not a permanent solution.
Health: Palliative Care
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Lord Farmer
To ask Her Majesty’s Government, in the light of the Parliamentary and Health Service Ombudsman’s report Dying Without Dignity, what steps they are taking to ensure that everyone in need has access to good palliative care.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
The cases highlighted in the ombudsman’s report are appalling. Everyone deserves good-quality care, delivered with compassion, at the end of their life. Last year we introduced five priorities for care—the key principles that underpin the care that all people at the end of life receive.
Lord Farmer (Con)
My Lords, I thank the Minister for his reply. In the light of the parliamentary ombudsman’s report, Dying Without Dignity, is it the Government’s policy to encourage all schools of nursing to ensure that their graduates have core skills in end-of-life care by having the subject included in the formal assessments of their students’ competencies?
Lord Prior of Brampton
I thank my noble friend for that question. I cannot answer it specifically, but the report prepared earlier by the noble Baroness, Lady Neuberger, and other subsequent reports have stressed the need for nurses to be properly trained. That is true both in hospitals and in community settings. I agree with the sentiments behind my noble friend’s Question but would like to take advice on whether what he is suggesting is indeed incorporated into nurses’ core training.
Baroness Emerton (CB)
My Lords, yesterday I was at the Royal College of Nursing, where a lot of work has gone into producing advice on end-of-life care. It has produced a small pocket handbook—and a larger one that goes with it. If the Minister has not seen the handbook, perhaps he would find it useful from the point of view of spreading it through care homes and hospitals. End-of-life care is in the curriculum for nurses but there is always a need for a reminder. These little cards that are to go in the pocket provide the essentials about end-of-life care.
Lord Prior of Brampton
My Lords, I thank the noble Baroness for those comments. Over the years I have spent quite a lot of time with nurses who are specialists in palliative care and I have always been hugely impressed by their work. I have not seen the booklet produced by the RCN to which the noble Baroness refers and I would certainly like to do so.
Baroness Walmsley (LD)
My Lords, was the Minister as shocked as I was, when reading some of the case studies in this report, to realise that the problems did not require further legislation or regulations but required staff who would follow guidelines and who had common sense, compassion and good communication skills? Why are people who lack these skills and attributes not being weeded out at the training stage, before they get anywhere near a patient?
Lord Prior of Brampton
My Lords, if Members of this House have not read the report by the ombudsman, I recommend it. It consists of 12 short, fairly straightforward case histories, which make for appalling reading. There are many nurses in hospitals and community settings who deliver wonderful care. The issue is their ability. The CQC is now making regular inspections of end-of-life care in all its hospital visits. It is one of the eight core services that it looks at. It has found that in the vast majority of cases, end-of-life care is caring. The noble Baroness asked why such care is so variable. I think that in hospitals it is partly because they are often busy places. They are not ideal places to die in. Who would wish to die in a clinical setting in a very busy ward unless they had to? That may be a part of the explanation.
Lord Wills (Lab)
My Lords, my father-in-law died this February. He died at home, surrounded by those he loved and who loved him. However, he died in profound agitation because he was denied the palliative care that he so desperately needed. The local GP surgery said that that had to be delivered by the local Macmillan nurse. She was rung repeatedly throughout the day but never answered the phone. Finally, at 4.30 pm she picked up the phone and said that she could not come until the next day—even when the nurse who was looking after my father-in-law said that he was likely to be dead by then. She said there was nothing she could do about it and rang off. He died later that evening, without the comfort of any palliative care. What assessment have the Government made of the ability of Macmillan nurses to deliver palliative care at home?
Lord Prior of Brampton
The noble Lord describes a truly tragic situation and I am very sorry for him and his family that this happened. I am afraid that variation is at the root of this. There are many parts of the country where good local care is delivered. The noble Lord’s story illustrates the fact that it is not just where people die but how they die that matters. It is clearly preferable that people should die in their own home with their loved ones, surrounded by the love that the noble Lord described, but symptom control, pain relief and everything that goes with palliative care are just as important. Indeed, most of the stories in the ombudsman’s report are about a lack of symptom control for people dying in pain. That can happen at home, as in his father-in-law’s case, but it can equally happen in hospitals. NHS England is reviewing this whole area and will come to some final views towards the end of this year, when I might report back to the House.
Lord Howard of Lympne (Con)
My Lords, I declare an interest as chairman of Hospice UK. Is the crux of this issue not the fact that most people do not want or need to die in hospital, and that not enough help is given to allow and help those people who do not need to die in hospital to leave hospital and get the palliative care which can be provided in hospices or elsewhere? Is my noble friend the Minister aware that Hospice UK has put forward a plan to the Government which would enable 50,000 people a year to leave hospital before they die so that they can get the proper palliative care that they need? That would save the Government money, and all we need is a modest sum to carry out an evaluation exercise to see what is the best way of achieving this eminently desirable objective. Will he go back to the department and urge his colleagues to make this modest sum available?
Lord Prior of Brampton
I thank my noble friend for that question. Perhaps I could suggest that he and I meet outside this Chamber, along with some colleagues from NHS England, to discuss his proposal in more detail.
The Lord Bishop of Bristol
My Lords, given that both NICE and NHS England have commended the services of spiritual, pastoral and religious care in the care of all people and in delivering great services to patients, clients and staff, can the Minister give us any assurances that a chaplaincy will be funded, going forward, in all NHS facilities that provide palliative care?
Lord Prior of Brampton
I thank the right reverend Prelate for that question. I share his sentiments entirely but that is a decision for local hospitals and local trusts.
Mental Health Services: Young People
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Lord Storey
To ask Her Majesty’s Government what plans they have to develop mental health services for pupils and young people.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, we are committed to transforming children and young people’s mental health and well-being across health, social care and education. The Department of Health is working with the Department for Education and other key partners to develop more seamless and integrated mental health services for pupils and young people. Work is under way to pilot single points of contact in schools and mental health services, and joint training to improve access to mental health advice and support in schools.
Lord Storey (LD)
I thank the Minister for his reply. It is a sobering thought that, in every classroom, three pupils have a diagnosable mental health problem. Does the Minister agree that, when pupils are referred, there should be an agreed, minimum time by which they are seen?
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.
The Lord Bishop of Peterborough
My Lords, mental health cannot be considered in isolation from the rest of life. For example, a number of recent deaths of young people by suicide have been connected to their use of the internet or social media. Is the Minister prepared to work with the Department for Education, other education providers and others to produce a rounded programme of support for the whole person in their context? Will he also indicate the Government’s support for the Online Safety Bill, introduced by the noble Baroness, Lady Howe?
Lord Prior of Brampton
I thank the right reverend Prelate for his question. I am not aware of the Bill to which he refers. I hope he will excuse me for that; I will find out about it after today. The right reverend Prelate asked whether we will work with other parts of the Government, particularly the Department for Education. I assure him that we are doing so.
Baroness Howarth of Breckland (CB)
My Lords, I welcome the Government’s prevalence survey. However, does the Minister’s department have any idea at this time of the length of waiting lists and the number of children waiting for very specialist intervention from psychiatrists and psychologists? I hear from groups of people that the waiting lists are growing and the time children spend waiting is getting longer. For a child with a mental health problem, every day makes it worse. What are the Government doing about that? Does the Minister have the numbers?
Lord Prior of Brampton
I do not have the numbers to hand, but I can tell the noble Baroness that the number of beds that have been commissioned has increased significantly over the last three years and I think 1,250 tier-1 beds are now available. The noble Baroness puts her finger on it: the way we provide treatment for people suffering from mental health conditions—and have done for many years—falls far short of what we would expect for people suffering from equivalent physical conditions. We often talk about parity of esteem quite glibly, without putting the necessary resources behind it. The Government are determined to do so.
Lord Bradley (Lab)
My Lords, it is welcome that the Government have decided to ban the use of police cells for children detained under Section 136 of the Mental Health Act. However, what action is being taken to ensure that there are appropriate places of safety in every locality? Will the Minister confirm that adult psychiatric wards will not be used as places of safety for children?
Lord Prior of Brampton
The use of police cells for anybody suffering a mental health crisis, but particularly for children, is wholly unacceptable. Last year, the number of children who were held in a police cell was 160. That has come down from a much higher number. The Government and my right honourable friend the Home Secretary are determined to stop this happening—indeed, legislation is about to go through the other place to ensure that it does not happen. But that leads to the question of where, if not to a police cell, they should go. I have been told that there is a risk that young people going through a mental health crisis might actually be arrested to make them eligible to come into a police cell, which would of course be equally unacceptable. The number is getting much smaller and I hope that if I am here in a year’s time it will be down to zero.
Lord Elton
My Lords, the previous answer made it clear that a significant proportion of the pupils and young people the Question refers to are in custody. Can the Minister assure us that there is equality of treatment, within both the spend and the survey he referred to, for those children in these dire circumstances?
Lord Prior of Brampton
I thank the noble Lord for that question. I am not sure that I totally got the question, but I can say that keeping a young person in custody is the absolute last resort. The police do not wish to do it and do so only when there is no bed available in an appropriate, safe setting. The issue is the availability of beds. It is better for a child to be in a single room on an adult psychiatric ward than in a police cell.
General Practitioners
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Baroness Wheeler
To ask Her Majesty’s Government what plans they have to increase the number of general practitioners.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, my right honourable friend the Secretary of State for Health announced on Friday the first steps of a new deal for general practice. This includes working to increase the primary and community care workforce by at least 10,000, including an estimated 5,000 more doctors working in general practice. We will do this through promoting general practice as a career, increasing training places, encouraging people to return and considering how best to retain staff.
Baroness Wheeler (Lab)
My Lords, first, I welcome the Minister to his first Questions in the House. I thank him for his response and for whatever role he played in bringing about Friday’s announcement, ready for this Question. The Health Education England incoming chair recently told the Guardian:
“GP recruitment is what keeps me awake at night”.
Under this new package, will he have to wait until 2020 to get a decent night’s sleep or will the Government take note of the urgent call from the Royal College of General Practitioners for a clear and costed plan, and a timescale for turning it all into reality, so that we can make progress from now onwards?
Lord Prior of Brampton
The noble Baroness will know that NHS England recently published its Five Year Forward View, which is a five-year plan for the future. It will encourage much more care, delivered outside hospitals, in the community, and that will require larger input from general practice. I am very pleased to tell the noble Baroness that we are committed to 5,000 more doctors working in general practice.
Baroness Armstrong of Hill Top (Lab)
My Lords, I, too, welcome the Minister to the Dispatch Box. I wonder whether he agrees that the Government are being very complacent on this issue. I passed my GP surgery in a small ex-mining town in the north-east this weekend. On the door I read that there were 11 or 12 sessions in the next month when the GP practice would not be open—that is, from Monday to Friday. Is it not true that the model is broken and that young doctors coming into GP practice do not want to be partners and have the responsibility of running a small business as well? Is not the model broken? When we look at what is going on in areas where health outcomes are poorer, is it not urgent that the Government pay more serious attention to that?
Lord Prior of Brampton
The noble Baroness speaks a good deal of truth. The model that we have been working with since 1948 in this country is largely broken. We have to deliver more care through vertically integrated units of care, not just independent hospitals. Over the next five to 10 years we will see a huge consolidation of primary care. The old cottage industry model of general practice is probably broken. The Five Year Forward View recognises that and the Government have committed £8 billion to see that forward view put into practice.
Baroness Howarth of Breckland (CB)
My Lords, I do not know where the Minister spends his time, but where I come from, in the country, you have to travel 18 miles to a hospital or a GP practice at the weekend. That is very difficult when you have groups of elderly people. In the rest of the country—even in the city where I spend my city time—GPs are now saying that practices are to be closed and people are waiting three weeks for an ordinary assessment. Can the Minister tell us why the Government are not seeing what is happening on the ground and taking more urgent action?
Lord Prior of Brampton
The Government are committed to seeing 5,000 new GPs. This is probably the biggest expansion of primary care that we have seen for many years. It is not just 5,000 GPs but a further 5,000 people working in primary care, including physician associates, practice nurses, physiotherapists and other allied health professionals.
Baroness McIntosh of Hudnall (Lab)
My Lords, is it not the case that, although the analysis that the noble Lord has given us is very accurate, the solutions that he seems to be putting forward are not very clear? Can he say what incentives he and his colleagues will offer young medical students beginning their training to encourage them to go into general practice? It is fine to say that we will train 5,000 more doctors, but we cannot force them into general practice if they do not want to go.
Lord Prior of Brampton
The noble Baroness is quite right. After five years as a medical student, they then do two foundation years before making the choice whether to become a GP or to go into specialist medicine. That is a crucial time to persuade young doctors that there is a good, long-term career in general practice. Health Education England and NHS England are putting huge resources into persuading young doctors at that stage in their career that there is a good future in general practice. I say to the noble Baroness that there is no doubt at all in my mind that, if we run the clock forward five years, more care will be delivered in primary practice and in the community than in acute hospitals.
The Lord Bishop of Chester
My Lords, I declare inside information, in that my daughter is a trainee GP. I asked her about these issues last night. In Cheshire and Wirral there are vacant training places with no GP trainees to take them. On asking her why people did not want to go into general practice, she said that it is the growing burden of bureaucracy and administration. What do the Government plan to do about that?
Lord Prior of Brampton
The right reverend Prelate is right. Many GPs are concerned about the level of bureaucracy in their practices. As he probably knows, we have reduced the number of QOF indicators by a third—that is, by 40—from a staggering 120. This is a big concern. NHS England is looking at other ways in which we can reduce the bureaucracy. If the right reverend Prelate’s daughter has any ideas, perhaps she will be kind enough to give me them.
Baroness Gardner of Parkes (Con)
What is the position as regards assistants in surgeries? This morning, we heard about the shortage of nurses that we are going to have. The abolition of the SEN position has been fatal, as a lot of the right people who wanted to enter nursing have not done so because they do not have the necessary academic qualifications. However, would not these SENs now be extremely valuable in taking some of the workload, particularly form filling, off GPs, who are burdened with huge amounts of paperwork?
Lord Prior of Brampton
My noble friend is quite right. We are looking carefully at introducing a new position of a qualified nurse who would not have to have the same academic qualifications as existing nurses. As she may know, we are also introducing a new position of physician associates, who will be able to take some of the burden off GPs.
NHS: Innovation
Lord Prior of Brampton Excerpts(10 years, 8 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con) (Maiden Speech)
My Lords, first, I congratulate the noble Lord, Lord Wills, on introducing this debate today. As I would have expected, we have heard five powerful speeches and I stand here in some awe. This is my maiden speech and I want to say what a huge privilege and honour it is for me to join your Lordships’ House. I still have to pinch myself every time I come here to check that it is really true.
It goes without saying that I wish that my father were here today and not taking a leave of absence. I would have liked the chance at least once in my life to have addressed him as “my noble kinsman”—more respectful, if more other-worldly, than other epithets that I may have used to describe him in the past. He was elected to the other place in 1959 and introduced to this House in 1987. The spirit of “one nation” that inspired his politics is, I am glad to say, alive and well in today’s Conservative Party. What inspired him back in 1959 still inspires me today.
I follow in the footsteps of my noble friend Lord Howe, who is in the Chamber. He held the office that I now have with huge distinction in both government and opposition for some 18 years. Over that time, he deservedly won a reputation, on all sides of the House, for charm, humour, intelligence, integrity, good sense and fair play.
Lord Prior of Brampton
He embodies all that is best about this House and he will be a very hard act for me to follow, although I shall do my best.
I also pay tribute to the former Minister for Care Services in the last Government, Norman Lamb. If not for him, I might well have still been in another place representing the constituency of North Norfolk. I congratulate him especially on his work on raising awareness of mental health issues and improving the standing of mental health services in this country. Both our families have been touched in different ways by the tragedy and tragic consequences of mental illness, and I imagine that many others in this House will have been similarly touched.
I am grateful to the noble Lord, Lord Wills, for raising the important issue of innovation in the National Health Service. If he will give me a little latitude, I will come back to him later on the points that he raised. We have already spoken outside the House about his particular concern, but I will address it towards the end of my speech.
Before I respond to the observations of the noble Lord, Lord Hunt, I would like to say how much I look forward to working with him. We have worked together over the last two years. He has a deep knowledge of and commitment to the National Health Service, and I know that there is much more that unites us than divides us. It is a shame that, sometimes, the adversarial nature of politics intrudes so deeply into health and social care. I endorse his words about his noble friend, Lord Carter, who has produced an extremely valuable report that will help the National Health Service to drive costs out of the way that we deliver care in acute hospitals, which can then be used more for innovation, new drugs and the like.
The noble Lord, Lord Hunt, was a Minister back in 2000, when the then Secretary of State for Health, Alan Milburn, described the NHS as a,
“1940s system operating in a twenty first century world”.
I think the noble Lord will agree that the project of transforming the system so that it is fit for today’s world is still far from complete.
The NHS Five Year Forward View is, I believe, a vision for the transformation of the NHS that all of us in this House can support. It is a vision for the NHS created not by the Prime Minister or the Secretary of State for Health—who is sitting to my left—or by any politician. It is a vision of the NHS by the NHS, for patients and taxpayers alike. It describes a future built on innovative new models of care and integrated models of care, which the noble Baroness, Lady Walmsley, mentioned in her speech, to meet the needs of today’s population.
My time as chairman of the Care Quality Commission taught me a great deal, but especially that great organisations require great leadership and very high levels of staff engagement. Staff engagement is probably the best predictor of care quality and overall performance of hospitals and, indeed, of primary care and social care. Doctors, nurses and other healthcare professionals are not primarily motivated by targets, financial incentives or contracts; they are driven overwhelmingly by their vocation. I much appreciated the words of a former president of the Royal College of Physicians, the noble Lord, Lord Turnberg, who understands that probably more than I or many others in the House do. We must never forget that it is their vocation that drives healthcare professionals.
I want particularly to mention how delighted I am that NHS England has appointed Yvonne Coghill to champion the cause of race equality. It is sad and wrong that so many people from BME backgrounds do not have the same opportunities as others in the NHS. This is not just morally wrong but has a direct impact on patient care.
It is important to remember that innovation, the subject of today’s debate, needs the full engagement and alignment of clinicians, staff and managers alike if it is to deliver the change that we want and need. Innovation in medicine has prompted enormous advances in healthcare. From the discovery of penicillin, through the pioneering of major organ transplantation and keyhole surgery, to increasingly targeted modern cancer treatments and, as I found out last week, the development of 3D-printed hip replacements, there is much to be proud of and indeed thankful for.
The noble Baroness, Lady Walmsley, mentioned infection control. The noble Baroness is right: it is not just about the high tech; sometimes it is about just washing your hands. The extraordinary improvements that we have seen in the reduction of MRSA and C. difficile in our hospitals—although there is further to go—is testament to that.
As the noble Lord, Lord Giddens, rightly identified in last week’s Queen’s Speech debate, we now stand at the brink of a new technological revolution in healthcare, with the emergence of advanced digital technologies, greater connectivity and the widespread use of smartphones opening up unprecedented opportunities for treatment and prevention. In addition to the wide array of wearable technologies, there are no fewer than 100,000 health apps, allowing people to take more control over their health and well-being. I think that self-care will be a major addition to the armoury of health prevention as we go forward.
We are determined to seize these opportunities and have established the National Information Board to drive the digital transformation of the health and care system. I share the concerns expressed by noble Lords in this House that restoring public confidence and trust in care.data is an imperative and is very important.
Noble Lords will know that in its Five Year Forward View, NHS England and all the ALBs have committed to driving improvements in health through developing, testing and spreading innovation across the health system. This aspiration is evident in the creation of the Vanguard programme. Noble Lords will be aware that in January the NHS invited organisations to apply to become vanguard sites for the new care models programme—a highly innovative programme. More than 260 organisations expressed an interest in developing such a model, with the aim of transforming how care is delivered locally. In deciding which models of care to support, NHS England and ourselves will be guided by the view of a previous Prime Minister, recently repeated by Liz Kendall MP, that “we will back what works”.
Let me provide a few further examples of where we are making progress. First, the test beds initiative, launched in March this year, will produce real-world sites for evaluating innovations that integrate new technologies and other novel approaches that offer the prospect of better care at lower cost. Secondly, noble Lords will be aware that England was the first country in the world to establish a system of academic health science networks, supporting local economies to improve local health outcomes, and maximising the NHS’s contribution to economic growth by enabling and catalysing change through collaboration. This builds on the success of our six world-leading academic health science centres, designated following review by international experts. Having met with the Chief Medical Officer, Dame Sally Davies, this afternoon, anyone in this House who believes that research will not have a high priority for this Government will have to tangle with Dame Sally. It is remarkable for a country the size of England to have six world-class institutions in this field.
Thirdly, I am proud that we are leading the world in whole-genome sequencing. NHS England is a key partner in the landmark 100,000 Genomes project, working to sequence 100,000 genomes of NHS patients with cancer or rare diseases. The 11 genomics medicine centres across the country are playing a vital role in identifying patients with rare diseases and cancers with a view to providing more personalised and targeted treatment. It will not be long before we are the first mainstream health service in the world to offer genomic medicine as part of routine care for patients.
Last but not least, to pick up the concern expressed by the noble Lord, Lord Turnberg, the accelerated access review was launched by the Minister for Life Sciences in March and is independently chaired by Sir Hugh Taylor. It will make recommendations later in the year on how we can speed up patients’ access to innovative medicines and medical technologies, taking time and cost out of the development pathways for new products. This will have wide benefits for innovators, for pharma companies, the NHS and, of course, for patients.
We must not, of course, become complacent. Health has always been a hotbed of innovation, and innovation has allowed the NHS to provide ever more advanced care to patients. But the wider world offers many examples of innovation in the way care is delivered from which we can take huge inspiration—whether it is Kaiser Permanente in California, Aravind in India, or the extraordinary work that is being done with data in Singapore and Australia. We must never fall into the trap of “not invented here”.
Finally, turning to the issue raised by the noble Lord, Lord Wills, concerning giant cell arteritis, I should add that this is not as specific as I thought and raises more general issues about NHS England than were raised by the noble Lord opposite. The Government recognise that early diagnosis and treatment of giant cell arteritis is extremely important to prevent sight loss. I was touched by the human concerns and the human impact of giant cell arteritis expressed by the noble Lord as well as the financial issues that he raised.
I have raised the issue with Sir Bruce Keogh, the national medical director of NHS England, who is happy to meet the noble Lord, along with the Minister for Life Sciences, George Freeman. But in view of the more generic issues that have been raised, and the fact that it is not just this specific matter, I would like to join the meeting—to discuss not only Professor Dasgupta’s work but the wider issues around commissioning treatments for these rare and specialised conditions. I hope that the meeting is productive.
I am conscious that I have not addressed all the questions today, but on this occasion I hope that your Lordships will forgive me as it was my maiden speech. I want to say how much I am looking forward to working with noble Lords on all sides of the House in the years to come.