Psychosis: Early Intervention

Norman Lamb Excerpts

Wednesday 7th September 2016 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered access and waiting time standards for early intervention in psychosis.

It is a pleasure to serve under your chairmanship, Sir Roger. May I welcome the Minister to her new role? I spent a great two and a half years in the Department of Health; it was the most invigorating time in my life. I wish her every success.

The debate is on something that I care a lot about: a new standard of access for people who suffer a first episode of psychosis, a cruel and punishing condition that can have a massive impact on people’s lives—incidentally, at enormous cost to statutory services. When I came into my role as Minister, I recognised that there was a complete inequality of access, standards and rights between those who suffer from mental ill health and those who suffer from physical health problems. That inequality of access has existed for many years. In the last decade, the Labour Government introduced comprehensive access standards in the NHS for physical health problems, and they were right to do so—the cancer standards that have transformed cancer care in this country are a leading example of those—but they left out mental health.

It is not just that individuals sometimes end up having to wait interminably for treatment in some parts of the country; that complete imbalance of rights between mental health and physical health drives where the money goes. There is enormous political interest in meeting those demanding access standards. The national media look at the four-hour A&E standard. Certainly in my time in the Department of Health, all the great and the good of the NHS gathered around the Secretary of State’s table every Monday morning to look at spreadsheets showing the performance of every hospital in the country against those access standards. That extraordinary almost micro-management from the centre on access standards in physical health sets the tone for the whole system and makes it clear that meeting them is critical. So what do clinical commissioning groups around the country do? They trim a little bit off funding for mental health, which is still funded primarily through block contracts, to feed the beast of those exacting access standards in physical health.

I was determined from the start to address that injustice—that is what it is; it is a discrimination at the heart of our NHS—and introduce access standards in mental health. We went through a long deliberation before coming up with two specific standards, which were set out in a Government document published in October 2014, that we wanted to introduce as the start of a process that would lead ultimately to comprehensive access standards in mental health so that everyone with a mental health problem had the same right to get treatment in our NHS as anyone else.

The first standard that we identified was a six-week standard for access to psychological therapies. That is part of the improving access to psychological therapies programme, a well-regarded, world-leading programme that does not do everything but has been a significant development. The other was a two-week standard to start treatment when someone suffers a first episode of psychosis. Those people are typically teenagers or perhaps in their 20s—that is the most common age—but such an episode could happen at any time in one’s life.

[David Simpson (Upper Bann) (DUP)]

I congratulate the right hon. Gentleman on securing this very important debate. He has hit somewhat on the point that I was going to raise about early intervention. At what stage does he believe that we should deal with this condition? He talks about 18 or 20-year-olds, but should we go right back to primary or secondary school and deal with it in younger children?

[Norman Lamb]

We should always be guided by clinical judgment. That is critical. The standard that was introduced was for people between the ages of 14 and 65, which gives a clue about the appropriate level. This condition could emerge during teenage years, but we know that 50% of adult mental health problems start by the age of 14, so getting in and addressing problems early is critical.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the right hon. Gentleman for securing this important debate. Does he agree that although not everyone will suffer mental health problems in childhood, it is important that mental wellbeing is focused on in schools—both primary and secondary—to ensure that good mental health is promoted?

[Norman Lamb]

I thank the hon. Lady for that intervention, because I totally agree. When I was Minister, we set up a taskforce to look at how we could modernise children’s mental health services. It published a report last March called “Future in mind,” the whole focus of which is on shifting fundamentally towards prevention: establishing wellbeing, particularly in schools, and intervening much earlier to stop deterioration ever happening. That approach is much more effective. It can help teenagers through difficult years as they grow up, but it also stops the enormous cost to the system later of neglecting those problems.

Psychosis costs the NHS £11.8 billion a year. That is a vast cost. Only 8% of people who suffer from psychosis are in work, so the cost of the illness to society is enormous. The evidence of the effectiveness of early intervention in psychosis is overwhelming. It is clear that if we intervene quickly, we can have an impact on that condition, stop it in its tracks and give sufferers the chance of a good life, which the rest of us take for granted. If we neglect the condition, those people will almost inevitably suffer lives on benefits and with difficult relationships, at—this is critical—enormous cost to the state. Analysis shows that if we invested £1 in services for early intervention in psychosis, the return on that investment over a 10-year period would be £15. We might ask, “What is the reason not to do that?” It is overwhelming common sense. It is both morally right and the economically sensible thing to do.

[Johnny Mercer (Plymouth, Moor View) (Con)]

I pay tribute from the Government Benches to the immense work that the right hon. Gentleman did in government, and to my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), who is no longer in his former position as Minister. Does the right hon. Gentleman agree that it is not acceptable to talk about parity of esteem unless that is matched by parity of provision and parity of funding so that those who suffer from mental ill health have the same provision as those who suffer from physical ill health? Parity of esteem means nothing to our constituents unless we actually deliver it.

[Norman Lamb]

I am grateful to the hon. Gentleman for his kind comments. I totally agree. There is an awful danger of a damaging gap emerging between the rhetoric and the reality. The coalition Government legislated for parity of esteem, so it is in the legislation that people should be treated equally, but unless the reality of people’s experience is that they are treated equally, the rhetoric is absolutely meaningless waffle and they lose trust in the Government. That is why I feel so passionately that we must do concrete things to make parity of esteem a reality for people, and that is an example of how we can make a difference to people’s lives.

The standard was announced in October 2014, to be implemented by April 2016—it had to be met by this year. Why is it so important? If we fail on that, we fail so many people whom we have the chance to help and surely it would be scandalous if the NHS neglected a standard accepted by Parliament and introduced by Government that we know makes a massive difference to people’s lives. It gives people the chance of a better life and surely the NHS is fundamentally about giving people the chance to have happy, good lives.

What has happened in that period? We undertook a comprehensive Freedom of Information Act survey—now that I am out of government, I have to rely on such surveys to find out what is going on—and the answers from clinical commissioning groups and mental health trusts are deeply troubling. On the key findings, first the overall conclusion is that the implementation of the standard is just fundamentally flawed. It has failed to deliver what we committed to. If the Minister, on advice from her officials, is tempted to refer to the nationally published data that suggest that the standard is being met, I would discourage her from doing so because the data are a fiction—we have established that through our work.

The first detailed finding is that there is a complete lack of robust commissioning in many parts of the country. The whole purpose of the commissioner-provider split, which of course is fairly controversial in the NHS, is that the commissioners hold the money and are there to design services for their community to meet the needs of that community, yet a third of CCGs could not identify how much funding had been allocated to early intervention in psychosis. That in itself is scandalous. They just say that there is a block contract and that it is up to the mental health trust—a total abdication of responsibility. Later, I will ask what the Government are doing about that, because that is not acceptable and completely contradicts the national guidance that was published.

Incidentally, I should say that one of the excuses used around the country for slowness of implementation is that the final guidance was published in April this year—when the standard was supposed to have been met. That does not demonstrate particularly helpful leadership from the centre. Having said that, the draft guidance had been in place for the best part of a year, so clinical commissioning groups around the country knew the direction of travel and could absolutely have been getting on with the job of preparing for meeting the standard.

When we did the survey back in May and June, well into the financial year, another 18 clinical commissioning groups—that is 11%—were still in negotiation for funding for early intervention in psychosis for a standard that was supposed to have been met in April. The question I will keep repeating is: why is that is not being treated with the same seriousness as the cancer standards? Why do we treat that as less important than someone suffering from cancer? I absolutely support and endorse the cancer standards, because it is critical that people with cancer get access to treatment quickly, but why should not someone with psychosis? It is scandalous. No one stands up for them. The Government have to lead on that. More than one in three clinical commissioning groups could not provide an estimate of the number of people in their area in need of early intervention services, in spite of the national guidance that says that commissioning should be underpinned by estimates of the local incidence to ensure that services are designed to serve the needs in a particular locality fully. If CCGs have no idea because no work has been done to establish the need in that area, how on earth can they commission a service to meet that need?

Next, according to NHS England, the estimated annual cost of providing the full package of treatment is about £8,250 per patient per year. Only 60 CCGs in our study were able to estimate their investment at all and only 11 estimated that they will meet the NHS England guideline on the level of investment. The average investment per patient from those who were able to say was £5,199, but of course an average hides the fact that many are way below that level. To draw an analogy, that is like saying to a cancer patient, “Well, you can have the chemotherapy but we can’t afford the radiotherapy, so you’ll have to put up with what we can offer.” Of course, we would never allow that to happen—the Daily Mail and many others would be up in arms, and they should be about this issue as well because the situation is exactly the same.

On age, which the hon. Member for Upper Bann (David Simpson) raised earlier, as I said in response to his intervention, the access standard is to provide the service to people between the ages of 14 and 65, in line, I should say, with guidelines from the National Institute for Health and Care Excellence, which has done the work and provided the evidence-based guidance. Almost a quarter of trusts—23%—commission services only up to the age of 35, including my own county of Norfolk. How on earth can trusts justify anyone over the age of 35 not getting access to a service that we have deemed it appropriate to provide to people across the country? They are just ignoring the national guidelines. Again, that seems to me to be completely unacceptable. That totally conflicts with the clinical commissioning groups’ responsibility. Out of the 39 CCGs which commission only up to 35, nine said they had plans to expand the service—they have plans, but why are they not doing it now?—and another 10 said that that was under review, but the rest had no plan to provide a service to people over 35. Outrageous, in my view.

Next is staffing and skill mix. We found a widespread failure to provide the full range of interventions required by NICE as part of the package of treatment, which is due to the shortage of staff with appropriate skills to deliver the service. Most trusts reported shortages of staff trained in cognitive behavioural therapy for psychosis and there were many other training shortfalls.

On data recording, NHS England introduced new information standards to support the monitoring of standards so that we could have some confidence that they were being met. Providers are expected to use electronic care record for patients to enable the collection of data and monitoring of performance against the standard. The guidance says that commissioners should assure themselves that local providers have made the necessary updates to the electronic care record system to ensure that clinicians are able to enter the data required to monitor performance against the standard, but we have heard that many trusts have not upgraded their systems and so are incapable of doing what is in the national guidance. We talked to someone who was at the heart of the implementation of the standard in one part of the country who mentioned widespread failure to do that. That means, as I said earlier, that the national data published by the information centre, which we are all supposed to rely on to tell us what is happening in the NHS, cannot be relied on. I put this point to the Minister: can the information centre investigate that further to ensure that the data it publishes tell a true story of what is going on?

There was also a scandalous variation between regions. I met the woman who has been responsible for implementation in the southern region. She was driving a programme of implementation and had a complete handle on the whole of her region. She had enormous variation of performance across her region, but there was someone in charge, doing it. She was an impressive woman. She told me that she was being made redundant; she was told that her job was done, even though palpably it is not. However, in other regions there has been no programme of implementation—no one in charge, to take responsibility for making things happen. The situation in the midlands and east in particular is in my view a disgusting, outrageous shambles, which should not be tolerated.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the right hon. Gentleman on securing the debate. On several occasions he has talked about this important matter in the context of the entire country; he is now discussing comparisons. Does he agree—I have raised this issue on a number of occasions, particularly on health matters—that we need to ensure that best practice is replicated not just in local commissioning groups in England, but across the United Kingdom? Ministers would then share information across the devolved settlements, to ensure that best practice was replicated and improved on for all our citizens.

[Norman Lamb]

I very much agree. We should all be learning from each other—and internationally, as well; but so often we fail to do that in the NHS. People on the outside may think that the NHS is a Stalinist organisation where everyone does the same thing. Far from it—it is too often anarchic. In the context of the NHS England infrastructure that we are considering, there are regions of the country that just have not done their job as they should have, which is scandalous.

[Johnny Mercer]

Does the right hon. Gentleman agree that it is not good enough simply to understand an experience—because it affects someone close to us—when it is part of day-to-day life for the most vulnerable people? In Plymouth we have someone who is intimately involved in the system, and whose daughter is involved in the system, and who really gets mental health. However, it is not good enough in this place just to understand something because it happens to someone close to us. The vulnerable often do not have a voice, and we have to work harder. As the right hon. Gentleman is saying, it is not good enough to push the statistics away.

[Norman Lamb]

I totally agree. Everyone across the country who suffers this damaging, tragic illness has a right, surely, in anything that amounts to a national health service, to get good evidence-based treatment on a timely basis; but, tragically, that is not happening. I appreciate and welcome the fact that the Secretary of State has now taken specific responsibility for mental health. However, if I may be bold enough to offer some advice from my experience as a Minister, I would say that if a new standard of the type in question is to be embedded into the day-to-day life of the NHS, to make it something that happens as a matter of course and that is considered in the Monday morning meeting in the Secretary of State’s office exactly as the physical health standards are, there must be leadership from the top, including from Government. I appreciate that there are changes to Ministers’ roles under the Health and Social Care Act 2012; but they can demonstrate leadership. They can monitor, push, cajole and encourage, and set the moral tone about what is necessary for the approach we are discussing to become standard practice. That level of focus is needed from the Secretary of State downwards.

Will the Government consider the dossier of evidence and data that we have collated, and report back to us on their findings? Will they commit to addressing properly the defects and flaws in the implementation of the programme, as I think is necessary? One thing is clear: the Paul Farmer taskforce report published as part of the five-year forward view process sets out an ambition for mental health—for how we achieve equality for people who suffer mental ill health; however, if the lessons from the flawed implementation are not learned, every other part of Paul Farmer’s programme will fail to deliver the results that are so desperately needed. How will clinical commissioning groups be held to account for failure to implement the programme properly? What is the sanction for those who decided to ignore it—which is unacceptable to their communities? What is the Minister’s response to the findings I have talked about, and how does she respond to the clear evidence that people with mental ill health are not being treated with the same seriousness, or as if they have the same importance, as those suffering physical health problems?

It is time for mental health to come out of the shadows. We have started a national debate about mental health. The issue is much more out in the open than it used to be. However, as the hon. Member for Plymouth, Moor View (Johnny Mercer) said, there is a great danger of a damaging gap, which undermines confidence and trust in Government, between rhetoric and the reality that people experience in their lives. It seems to me that there is an absolute moral responsibility on the Government to ensure that the standard is delivered.

--- Later in debate ---

[Kerry McCarthy]

There is also the issue of whether people feel they are self-medicating by smoking. They may feel that it helps their symptoms, whereas it quite often exacerbates their symptoms.

[Norman Lamb]

I appreciate the constructive and really helpful speech that the hon. Lady is making. She is absolutely right that we need to understand this issue better. Does she agree that whatever the link may be, we should not criminalise people for the use of cannabis in such circumstances? The idea of someone resorting to cannabis as a relief from pain and then being criminalised seems awful.

[Kerry McCarthy]

As I said earlier, I think that diverting mental health issues into the criminal justice system is completely the wrong approach. That includes people who have engaged in taking cannabis, which is an illegal activity. It serves no purpose at all to treat that as a criminal situation when people clearly need the intervention of the health services. The medicalisation of the problem is certainly something I endorse. On that note, I conclude my remarks.

--- Later in debate ---

[Ms Abbott]

It is true of many communities, and in particular the black and minority ethnic community, as the statistics prove, that they are reluctant to take family members into the national health system. When they finally have to engage with the national health service, their symptoms are much worse and it is far harder to get positive outcomes. I tell the Minister that it is really important to look at this issue of black and minority ethnic people and the mental health system, because it is causing real misery and problems within the community. We are less likely to be offered talking therapies and more likely to be offered electroconvulsive therapy. Again, mental health facilities within the prison service, such as Rampton, have disproportionate levels of black and minority ethnic persons inside those institutions.

[Norman Lamb]

I am grateful to the hon. Lady for giving way. She is making an incredibly important point about the over-representation of black and minority ethnic people in the system. Does she agree that they are also more likely to be subject to coercion—to sectioning under the Mental Health Acts—and more likely to suffer restraint and physical force within mental health settings?

[Ms Abbott]

I am grateful to the right hon. Gentleman for that important point. It is absolutely true that, partly because they are presenting late and often have quite advanced psychotic symptoms, they are more likely to experience coercion and restraint. We know that some of those incidents of restraint have had very unhappy outcomes, and families continue to campaign against the misuse of restraint on mental health patients. All these decades after people first started to look at issues relating to black and minority ethnic communities and the mental health service, we have made little progress. Is the Minister willing to meet me to discuss this issue, which I have looked at for many years? One of the basic problems is statistics. It took years to get the health service to keep statistics broken down by ethnicity within the mental health service, and I am not sure what is happening to those data.

As we have heard, it is vital that psychosis is treated early as that prevents complications, improves outcomes and is more cost-effective. We know that psychosis costs £11.8 billion a year and we also know that mental health problems are on the rise. It is very disturbing to find that the research shows that a quarter of CCGs seem to be ignoring the access waiting time standard for psychosis, and the National Audit Office reports that there are insufficient funds available for the strategy to achieve parity of esteem to have any reality. We know, because we have heard, that too many CCGs cannot even specify how much money is devoted to early intervention; that gives rise to the suspicion that not enough is devoted to it.

The right hon. Member for North Norfolk made the fundamental point that this issue is still not being treated with the same seriousness as cancer standards are. This goes back to the issue that many Members have raised of stigma, shame and an unwillingness of the families of psychosis sufferers to speak out in the way that the families of people who suffer from cancer are willing to go into the public space and to the media to speak out.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

It is a pleasure to serve under your chairmanship for my first outing as a Minister, Sir Roger, and I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate. He has rightly pointed out that many areas of our mental health services are not yet meeting the standards that patients and their families deserve and have a right to expect, and he is absolutely right to say that improving access and waiting times for early intervention in psychosis must be a top priority among those. I assure him that both I and the Government share his determination and sense of urgency in such matters.

I think we can agree that for far too long as a nation we tolerated poor mental health services in this country, and we all know the terrible price that some have had to pay for our collective failure to step in earlier. That time is now over and we are in the process of creating a mental health service that we can be proud of—one in which, no matter where someone lives, they will be able to access the services they need when they need them, and just as importantly, one that people feel safe and confident using.

But we have to be honest about this, or we will get discouraged and lose momentum: it is not going to happen overnight. Although there are already some areas of outstanding practice that we should be encouraged by, we are, in general, coming from a low base, and only a sustained effort over the next few years is going to bring about the change that we are all demanding.

For that reason, I would like personally to thank the right hon. Member for North Norfolk for his pivotal role in securing parity of esteem and for supporting the introduction of the first waiting time standards for mental health services. With the previous Prime Minister, the Health Secretary and my predecessor, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the right hon. Gentleman has set us on the road to better mental health services. Now we have to follow it through, no matter how bumpy the journey may become at times. I hope that he will meet me and give the benefit of his advice, because I suspect I am going to need it.

I would also like to thank everybody who has contributed to today’s debate. Some have given moving accounts of personal experiences or those of family members or friends. Others have taken the opportunity to raise difficult constituency cases. I know that all here today are committed to keeping mental health at the top of our agenda as the Government shape their new programme.

That brings me on to the challenges of the early intervention pathway for psychosis, which is designed to deliver the improvements to psychosis care that are urgently needed, as the right hon. Gentleman so clearly laid out. He pointed out that psychosis is more common than people realise: it affects one in 2,000 people in England in any given year. We know that the early intervention in psychosis programme is crucial in ensuring that mental health services maximise their opportunity to intervene at the earliest possible moment to prevent patients from relapsing, so that they are less likely to be admitted to hospital and have less severe symptoms. As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) so expertly described, such services are recognised as the best model for helping young people to recover from the first episode of psychosis. They have the potential not only to save the NHS tens of millions of pounds but to reduce the serious impact of psychosis on those patients’ lives and those of their families and carers.

The hon. Member for Strangford (Jim Shannon) asked about funding. When waiting times for mental health were introduced for the first time, they were backed by £120 million of investment. In addition, we have invested £33 million in developing EIP services. Further funding for early intervention in psychosis was announced in NHS England’s “Five Year Forward View for Mental Health” implementation plan earlier this year. That funding is designed to support delivery of the target to ensure that 60% of people who experience their first episode of psychosis receive treatment with a NICE concordant package of care within two weeks of referral by 2021.

[Norman Lamb]

I am encouraged by what the Minister is saying. I assume that the money she has talked about that will be allocated is part of the baseline that CCGs will receive and not a separate allocation. The question is how she ensures that CCGs actually spend the money as intended.

[Nicola Blackwood]

As the right hon. Gentleman is aware, this work is in its early stages. He is right that services are working hard to develop this process. NHS England has set out in its implementation plan how the services will need to grow and improve to meet the new standards. In particular, it has noted that the current block contract arrangements can result in poor transparency on spend per patient, as he has seen with his freedom of information request.

NHS England has been looking at alternative funding models that will link an element of payment to achievement of quality and outcomes, including the EIP access and waiting time standard. When there are variations in spend, we will need to consider the reasons for that and ensure that necessary action is taken to address any impact on the quality of care available. I hope that reassures the right hon. Gentleman.

In addition, the Royal College of Psychiatrists College Centre for Quality Improvement has been commissioned to undertake continued assessment and quality improvement work. This will be through a quality improvement network, supported by an annual self-assessment that will be independently validated and scored. All early intervention in psychosis services are going to be expected to participate. The first results will be published in April 2017, but any earlier results will be published before that. It is intended to provide a transparent assessment of services across England. This will give us a clear picture of service provision and enable us to target areas where additional development will be required, so that we can ensure that the standard is met and that people receive the care they need.

The right hon. Gentleman also mentioned the important issue of age caps. The most likely age for a first episode of psychosis to occur is between 14 and 35, as has been pointed out.

Junior Doctors: Industrial Action

Norman Lamb Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

The BMA should talk to its members much more because, as far as I could tell, the consultation over the summer showed that only a minority actually wanted this extreme series of rolling one-week suspensions of labour that the BMA supported in the end. Most junior doctors are perplexed and worried about the situation and would love to find a solution. There was a bitter industrial dispute, but we actually started a process through which trust was being rebuilt on both sides. In a series of meetings, I met the junior doctors’ leader to talk through the areas of her greatest concern and we made progress in addressing two of those four outstanding areas. Building that trust means actually sitting around the table and talking, not having confrontational strikes. I think that that is what most junior doctors want.

[Norman Lamb (North Norfolk) (LD)]

I want to return to the critical issue of how we ensure safe cover during the week if we expect doctors to work more hours at weekends. The Secretary of State has repeated again today that he will employ more junior doctors, but what is the timescale? What will the net increase in doctors be this year, next year and in the rest of the Parliament?

[Mr Hunt]

I do not have figures to hand for exactly what the number will be this year—I will certainly let the right hon. Gentleman know—but around 11,500 extra doctors will be trained during the course of this Parliament.

As I said in the statement, it is important to recognise that the changes involve not only junior doctors. We need more weekend consultant cover—that is particularly important—and more people who are able to do the diagnostic tests. A whole range of people need to take part in the changes to improve standards of care at the weekends.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Hunt]

Without wanting to reopen the debate that concluded on 23 June, the overwhelming view in the NHS is that we are very lucky to have the incredible support of 110,000 EU nationals working in the health and social care system. I want to put on record to this House what a fantastic job they do and how much we are all in their debt.

[Norman Lamb (North Norfolk) (LD)]

Very many of those 110,000 people are now acutely anxious about their future in this country, because of the despicable suggestion that they should be used as a bargaining pawn in negotiations with the EU. Will the Secretary of State ensure that the Government, as a matter of urgency, guarantee their future in this country doing their dedicated work in our NHS and care system?

[Mr Hunt]

I can reassure the right hon. Gentleman that we are incredibly aware of the brilliant work that EU nationals do, not just in the NHS but in the social care system, which he was responsible for, in care homes up and down the country. We recognise that, and I hope that he will be reassured by statements made by the Foreign Secretary and the Home Secretary yesterday that we want to find a way of allowing those people to stay in the UK for as long as they wish to. We recognise the incredibly valuable contribution that they make, and we are confident in the negotiations ahead that we will be able to secure the outcome that they and we all want.

Dietary Advice and Childhood Obesity Strategy

Norman Lamb Excerpts

Monday 23rd May 2016 Commons Chamber

[Alistair Burt]

My hon. Friend is absolutely right—that is important. The strategy has been awaited, and if it is to do the job we all want it to do, it should deal with the myths and concerns that have been raised, and do so in a proper evidential manner.

[Norman Lamb (North Norfolk) (LD)]

May I join in a partial, and rather surprising, alliance with the hon. Member for Shipley (Philip Davies) in questioning the sense in taxing just one particular type of product? Would not the Government instead—this is where I part company with him—consider taxing sugar as an ingredient to create an incentive for reformulation of products to reduce sugar content across the board, rather than just picking on one type of product?

[Alistair Burt]

I thank the right hon. Gentleman. He was not on my accumulator, so it has gone down. What he is calling for is exactly what the strategy does. It is designed to be quite wide and to take into account the possibility of other action in other places. He is absolutely correct about that.

Defending Public Services

Norman Lamb Excerpts

Monday 23rd May 2016 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today’s debate, chosen by the Opposition, is about defending public services, so I want to start by stating very simply that this Government do not believe in private wealth and public squalor; quite the opposite—we believe in prosperity with a purpose, and building high quality public services is perhaps the most important purpose of all. But there is a difference between the two sides of the House. Indeed, there is more than one difference. One is that we on this side are prepared to take the difficult decisions necessary to build the strong economy that will, in the end, fund those public services. A second difference is that we go further and say that securing funding from a strong economy is not enough, and that the battle for higher standards is as important as the battle for resources. Without high standards, we let down not just the taxpayers who fund our public services but the vulnerable citizens who depend on them.

So yes, we are proud to have protected schools funding since 2010, but we are even prouder that 1.4 million more children are in good or outstanding schools. Yes, we are proud to meet our 2% of GDP defence spending pledge, but we are even prouder of the professionalism of our armed forces operating in the Mediterranean today to help to find the wreckage of the tragically lost Egyptian airliner. Yes, we are proud to have protected science and research funding, but we are even prouder that this country continues to win more Nobel prizes than any other, apart from the United States. Yes, we are proud that, since 2010 and despite the deficit, we increased NHS funding by more than was promised by the Opposition at both elections. We are even prouder that failing hospitals are being turned around, that MRSA rates have halved and that cancer survival rates have never been higher.

With that, let me turn to the NHS and say up front that nowhere is the importance of the two challenges of proper funding and high standards more stark. I pay tribute to the 1.3 million staff who work in the NHS. Whatever they have thought over the years about the politicians running their service, their dedication to patients, their hard work, night and day, and their commitment to the values that the NHS stands for make up the invisible glue that has always held it together, whatever the challenge. I know that I speak for the whole House when I thank them for their service.

Let us look at what staff have achieved over the past six years. Compared with 2010, we treat 100 more people for cancer every single day. We treat 1,400 more mental health patients, 2,500 more people are seen within four hours in A&E departments, and we do 4,500 more operations. At the same time as all of that, hospital harm has fallen by a third and patients say that they have never been treated with more dignity and respect. In the wake of the tragedy of Mid Staffs, we should recognise the huge efforts of staff at the 27 trusts that have since been placed into special measures. Eleven have now come out, three of which are now officially rated as good. Neither Stafford nor Morecambe Bay nor Basildon—three of the hospitals of greatest concern—are now in special measures thanks to excellent local leadership and superb commitment from staff.

However, all NHS staff want to know about the funding of their service. The NHS’s own plan, published in October 2014, asked for a front-loaded £8 billion increase in funding not just to keep services running, but to transform them for the future. The then shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), said that the Conservative promise to deliver that funding was a cheque that would bounce, but we delivered that promise to the British people in last autumn’s spending review, and the increase was not £8 billion, but £10 billion. It was not back-loaded, as many had feared, but front-loaded with £6 billion of the £10 billion being delivered this year.

[Norman Lamb (North Norfolk) (LD)]

On the Secretary of State’s point about what the NHS asked for, is it not right that the forward view set out three different efficiency savings scenarios? It was not a case of the NHS asking for £8 billion. Does he really believe that the £8 billion— £10 billion including last year’s increase—will be sufficient to meet the NHS’s demands?

[Mr Hunt]

The right hon. Gentleman will have heard Simon Stevens being asked that question on “The Andrew Marr Show” yesterday. He was clear that £8 billion was the minimum of additional funding that he thought the NHS needed. In fact, we supplied £10 billion, which came with some important annual efficiency saving requirements. Indeed, for that £8 billion, the NHS recognises that £22 billion of annual efficiency savings are required by 2020, because even though funding is going up, demand for NHS services is increasing even faster. I will come on to talk about how we are going to make those efficiency savings. Some in this House have observed that without £70 billion of PFI debt, without £6 billion lost in an IT procurement fiasco, and without serious mistakes in the GP and consultant contracts a decade ago, the efficiency ask might have been smaller.

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[Mr Hunt]

My hon. Friend speaks with great knowledge and as chairman of the all-party group on mental health. He is absolutely right to say that we need system change. The system change we need is to stop putting mental health in a silo, but instead to understand that it needs to be part of the whole picture of treatment when a person is in hospital or with their GP; it needs to be integrated with people’s physical health needs. We need to look at the whole person. We will not get all the way there in this Parliament, but I think the taskforce gives us a good and healthy ambition for this Parliament and I am confident we will realise it.

[Norman Lamb]

I am pleased to hear the Secretary of State acknowledge the importance of quality of care in mental health as well, but of course there are also problems in areas such as learning disability, where there are some highly vulnerable individuals. After the shocking Southern Health exposé, does he really not think that the leadership of that organisation, which presided over some dreadful events and so many unexpected deaths not being investigated, need to be held accountable and to move on?

[Mr Hunt]

As the right hon. Gentleman knows, the chair of that organisation has stepped down, but he is absolutely right about accountability. Accountability needs to be about not just individual organisations within the NHS, but the people commissioning mental health care and care for people with learning disabilities. That is why, from July, we will for the first time be publishing Ofsted ratings on the quality of mental health provision and of provision for people with learning disabilities by clinical commissioning groups, so that we can see where the weak areas are and sort them out.

I conclude on quality by saying that important though a seven-day NHS is, we need to go further if we really are to make NHS care the safest and highest quality in the world. According to the respected Hogan and Black analysis, we have 150 avoidable deaths in our NHS every week. That is 3.6% of all hospital deaths with a 50% or more chance that that death could have been avoided. In the United States, Johns Hopkins University said earlier this month that medical error was the third biggest killer after cancer and heart disease, causing 250,000 deaths in the United States alone every year. That is why this year England will become the first country in the world to lead a transparency revolution in which every major hospital will publish its own estimate of its avoidable deaths and its own plans to reduce them. This year, we will focus particularly on reducing maternal deaths, stillbirths and neonatal death and harm, with plans I hope to outline soon to the House.

If we are to do that, perhaps most difficult of all will be transforming a blame culture found in too many parts of the NHS that still makes it far too hard for doctors and nurses to speak openly about medical error. Among other measures, we have set up a new healthcare safety investigation branch to conduct no-blame investigations when we have tragedies. It is modelled on the highly successful air accidents investigation branch. As in the airline industry, our model for reducing avoidable death must be transparency, openness and a learning culture that supports rather than blames front-line professionals, who in the vast majority of cases are only trying to do their best. Part of that new culture of responsibility and accountability must be a return to proper continuity of care, which is why this Government have brought back named GPs for every patient, which had been abolished in 2004, and are introducing lead consultants for people who go to hospital with complex conditions.

In conclusion, for this Government defending the NHS involves higher standards of care, wise use of resources and secure funding from a strong economy. Because the challenges we face in England are the same as in Wales, Scotland and Northern Ireland— indeed, the same as in developed countries all over the world—we should exercise caution in politicising those pressures, or we simply invite scrutiny of the relative performance of the NHS in different parts of the UK, which often shows that those who complain loudest about NHS performance in England are themselves responsible for even worse performance elsewhere.

What this Government want is simple: a safer seven-day service, backed by funding from a strong economy. Already we have delivered more doctors, more nurses, more operations and better care than ever before in NHS history.

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[Keith Vaz (Leicester East) (Lab)]

It is always a pleasure to follow the right hon. Member for Wokingham (John Redwood). He speaks with huge passion about these matters, and of course he has always been consistent in his opposition to being a member of the European Union. He also speaks eloquently about why he feels the way that he does.

The European debate—I say this as a former Minister for Europe—has dominated the Government’s agenda to such an extent that this Queen’s Speech is a shadow of what it should be. There is no great ideological commitment in it, so it is difficult to attack too much of it. It is important that, when we get past 23 June, we can then settle down to an intelligent legislative programme that is not dominated by people banging on about Europe —I include myself in that. Although crime has gone down in England and Wales, blue-on-blue crime has increased as far as the EU debate is concerned.

As I mentioned earlier, last Thursday the Minister for Employment was in my constituency with a very big red bus parked outside the biggest temple telling everyone that if we remained in the European Union, there would be a curry crisis and people would not be able to eat curry any more. It is important that we get the European debate into perspective.

As a fellow east midlands MP, you would expect me to say this, Madam Deputy Speaker, but I was surprised that there was no mention in the Gracious Speech of Leicester City winning the Premier league, but perhaps that will come next year.

I agree with the Government’s proposals regarding the revolution in the Ministry of Justice and our prisons. I and members of the Select Committee on Home Affairs have been very concerned about, for example, the number of people who go into prison with no interest in drugs and come out addicted to drugs. We are concerned that our prison system is not doing what it was intended to do: to punish, but also to rehabilitate. Although we expected the right hon. and learned Member for Rushcliffe (Mr Clarke), when he was Lord Chancellor, to talk about changing the way we look at prisons, we did not expect this from the current Lord Chancellor, and we are delighted that he has embraced the reform agenda. Ensuring that when people go to prison they are first punished, then rehabilitated and they do not pick up bad habits, so that when they come out of prison they do not reoffend and go back again, is one of the big issues that has confronted this Parliament for all the 29 years that I and the right hon. Member for Wokingham have been Members of it. How do we break the cycle?

I remember on a visit to a prison in the south of England speaking to a young man who was there because he had committed murder. He told me that his father had had a life sentence and he had a life sentence; he just hoped that his young son, who was then a year old, would not end up in prison. How do we break the cycle? I think we should work with the Government to make sure that our prison system does what it is intended to do.

The second issue I am interested in and concerned about is extremism. Although the Government are proposing legislation on extremism, I do not think they have gone far enough on the counter-narrative. The Select Committee is about to conclude its year-long inquiry into counter-terrorism. I am concerned, as is the rest of the House, about the number of young British citizens who decide to give up their life in this country and go and fight abroad. The current figure for those who have done so is 800, and 400 have returned so far. I cannot understand why we are not doing enough while they are still here to prevent them from going in the first place. Also, although there are programmes to detoxify those who return to this country, there is always the risk that having gone abroad to fight, whether in Syria or elsewhere, on their return they will retain the poison that was drilled into them abroad. It is important that we treat the counter-narrative seriously. We need to support our police and intelligence services in working out who is going, and work with families so that we can try to persuade people not to go.

[Norman Lamb]

Does the right hon. Gentleman agree that our prisons are a breeding ground for extremism and radicalisation, and that until we address that the flow of new extremists will continue?

[Keith Vaz]

The right hon. Gentleman is absolutely right. It is not just about preventing people without a drugs habit going to prison and coming out with one. We have been sending people to places like Belmarsh, which has been described as a place where jihadists seem to be able to influence young people. Knowing his great passion for mental health issues, the right hon. Gentleman reminds me that Simon Cole, the chief constable of Leicestershire, who is the lead on counter-terrorism in the Prevent programme, has talked about the number of jihadists who have mental health problems. These are all issues that we need to confront. We cannot necessarily do it by legislation, but we need to make sure that we have the framework in legislation to provide the resources, the time and the effort to work with people.

My final point concerns the sugar tax. I was delighted when the Chancellor of the Exchequer introduced it. We should acknowledge the fact that today is his 45th birthday. I hope he is having a sugarless cake because, as we know, a spoonful of sugar may help the medicine go down, but it is also one of the steps on the way to diabetes. As someone who suffers from type 2 diabetes and chairs the all-party parliamentary diabetes group, I believe the proposed sugar tax will send a clear message out to the retail companies. However, the manufacturers of drinks such as Coca Cola and Red Bull do not have to wait until the sugar tax comes into effect; they can start promoting sugarless drinks now.

I got into a lot of trouble because I did not want the Coca Cola van to come to Leicester at Christmas. I was accused by some people of robbing them of their Christmas. They had decided that the Coca Cola van was so strongly associated with the Christmas spirit—forget about Christianity, the birth of Christ and so on; it was the Coca Cola van that gave them Christmas—that I was severely criticised. I will make a deal with Coca Cola from the Floor of this House: if the company sends its van to promote non-sugar drinks, I will be happy to welcome it, but promoting a drink containing seven to 10 teaspoons of sugar, cannot be good for the health of our nation.

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[Norman Lamb (North Norfolk) (LD)]

I am one of many speakers in this debate who feel that in significant ways this Queen’s Speech falls short of addressing some of the big challenges of our time in this country. I want to address two of those.

The NHS and the social care system face an existential challenge. I agree with the right hon. and learned Member for Rushcliffe (Mr Clarke), who says that it is not just about money. The system often seems to be completely dysfunctional as a result of the inappropriate divide between health and social care, between physical health and mental health, and between primary care and secondary care. This must be addressed so that we can shape care around the needs of patients.

There is no escaping the fact that there is a financial issue. It makes no sense that between now and 2020 we are projected to spend a decreasing percentage of our national income on the health and care system, at a time when demand is rising rapidly. There are consequences from that trend. I believe the Secretary of State for Health when he says that he cares passionately about patient safety, but as the hon. Member for Dulwich and West Norwood (Helen Hayes) pointed out so effectively, the underfunding of mental health services in our country has massive consequences. As we heard last week, there has been an increase in the past year in the number of people who are shunted around the country in search of a bed. That is a scandalous practice. We know that it is associated with an increased risk of suicide, yet it continues to happen in increasing numbers.

When the pressure increases, crisis management takes over. We cut preventive services in order to prop up acute hospitals, and the services that we cut are the very services that prevent people from going into hospital in the first place. It makes no sense and it needs to change. I have two proposals which the Government need to consider.

I repeat again that I think this is the time for a 21st-century Beveridge report, bringing the parties together to come up with a new long-term settlement for the NHS and, critically, for the social care system. Also, we should consider the case for a dedicated health and social care tax. That has been proposed by people from across the political spectrum. It is the only area of public policy where there is an inexorable rise in demand, yet by protecting the NHS we disproportionately cut other areas of public service. It therefore seems to me that there is a very strong case for carving health and social care out and introducing a dedicated tax. Lord Patten on “Any Questions?” last week made the case for it. Lord Finkelstein for the Conservative side has also argued for it, as has the right hon. Member for Birkenhead (Frank Field).

We are losing pace with other European countries in our spend on health and social care, and there are consequences from that. I know, as I have said, that the Secretary of State cares about patient safety, but the safety of patients is being put at risk by the financial pressure that the NHS faces.

Finally, I want to address the prison reform Bill. I welcome the reforms in it, but something much more fundamental is needed. I encourage the Secretary of State for Justice, with his reforming instincts, to go further. A fundamental failure of public policy is reflected in the number of people in our prisons with mental ill health, learning disability and autism, and the number of people in prison in connection with drug addiction or offences relating to the criminal market in drugs. We are seeing a spike in the number of suicides in our prisons, which should horrify all of us. We need to do something about that.

The Secretary of State needs to go beyond the civilising proposals that he has for our prisons and look at radically reducing the number of people who end up inappropriately in our prisons. Germany and Finland imprison about half the number of people that we do. Those are not lawless countries, yet they manage to adopt a much more civilised approach. There should be a presumption against short sentences. We know that people leave prison and reoffend in vast numbers. That does not protect the public. There should be a much greater use of mental health treatment orders as an alternative to putting people in prison, and a renewed focus on restorative justice to address the causes of crime.

There needs to be the long overdue declaration of an end to the war on drugs, which has failed so fundamentally internationally. It criminalises vast numbers of our fellow citizens. Every year in our country, it puts billions of pounds—about £7 billion—into the hands of organised crime. It is associated with extreme violence in our communities. This makes no sense, and too many people end up in our prisons as a result of this misplaced policy. Just as many states in the United States are now moving towards a much more rational policy, and just as Canada has now committed to legislating to regulate the market for cannabis rather than leaving it in the hands of organised crime, I believe that in this country we should follow the same route, with a rational, evidence-based policy that does not criminalise people inappropriately for doing exactly the same as many members of this Government will have done in their youth. Instead, we need to take money away from criminals and collect tax revenue to spend on our essential and vital public services. It is time for a more rational approach. I hope that at some point this Government recognise that if they are to address the problems of crime in our society, ending this futile war on drugs is one of the steps that they must take.

Junior Doctors Contract

Norman Lamb Excerpts

Thursday 19th May 2016 Commons Chamber

[Mr Hunt]

My hon. Friend speaks, as ever, very wisely on medical matters. I particularly agree when he talks about palliative care; it has got better, but there is a long way to go. We have recent evidence that it is particularly in need of improvement where we are not able to offer seven-day palliative support.

[Norman Lamb (North Norfolk) (LD)]

I welcome this settlement and thank everyone involved for securing it. However, many junior doctors remain concerned that, as the hours worked at the weekend increase, cover is inevitably reduced during the week, unless more junior doctors are employed to bridge that gap. With many rotas already left unfilled around the country during the week, how can the Secretary of State guarantee that we will not make the situation worse during the week, thereby impacting on patient safety?

[Mr Hunt]

I understand the concern. The short answer is that we need to increase the NHS workforce, which we are doing. We will see more doctors going into training during this Parliament, as indeed we did during the previous Parliament. More doctors in the workforce will be an important part of the solution.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 10th May 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

I do recognise the unique geographical circumstances in my hon. Friend’s constituency. That is precisely why the success regime is being led by local clinicians. I hope and expect that in formulating plans they take account of all the views and all the clinical needs of his constituents and his own views.

[Norman Lamb (North Norfolk) (LD)]

There is growing concern that the additional investment in children’s mental health services committed last year is not getting through to where it is intended. What will the Secretary of State do to guarantee that that money gets through to help children with mental health needs? It would be scandalous if it did not get through. Transparency is not enough.

[Alistair Burt]

I thank the right hon. Gentleman for all the work he did in relation to this. I can assure him that the £1.25 billion committed in the 2015 Budget will be available during the course of this Parliament. As I said to the hon. Member for Liverpool, Wavertree (Luciana Berger), it is absolutely essential to me and to us that we make sure that that money does get through to CCGs. The regime will be more transparent, but there will be a determination to expose it to make sure that the money is spent on child and adolescent mental health services, as it needs to be.

World Autism Awareness Week

Norman Lamb Excerpts

Thursday 28th April 2016 Commons Chamber

[Mrs Gillan]

Absolutely. It is clear that, despite the best intentions of the Government, getting such a diagnosis is still crucial, as my hon. Friend says.

[Norman Lamb (North Norfolk) (LD)]

Will the right hon. Lady give way?

[Mrs Gillan]

I will give way for the last time, because I must make some progress.

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[Norman Lamb]

May I join in with the overwhelming tributes that have been made to the right hon. Lady for the work that she has done on this incredibly important subject? I do not know whether she saw the in-depth report in The Economist a couple of weeks ago. It reported that a Swedish study has found that the cost of lifelong care for someone with autism could be cut by two thirds with early diagnosis and treatment. Again, the moral case and the economic case for this are overwhelming.

[Mrs Gillan]

I agree. NHS England should collect, publish and monitor key information on how long people are waiting for diagnosis, and how many people are known by their GP to have autism. It should also ensure that waiting times standards on mental health, which are currently in development, reflect national guidance that no one should wait longer than three months between referral and being seen for diagnosis. The Government must share this commitment and ensure that NHS England meets its aims. Timely access to an autism diagnosis should be written into the Government’s mandate to NHS England.

I want to touch on autism and mortality. A recent Autistica report highlighted distressing findings from research in Sweden. The research found that autistic people, taking the population as a whole, have a lower life expectancy than the overall average. The research from Sweden shows that autistic people are at risk of dying younger from almost every cause of death. On average, this is 18 years earlier than the general population. For autistic people with a learning disability, the gap is even larger. The research shows that autistic people with a learning disability in that country die on average 30 years before their time. It also shows that autistic people who also have a learning disability are more likely to die early from epilepsy, and that those without a learning disability are at greater risk of suicide. It is worth remembering that the Swedish healthcare system is different from ours, but given the seriousness of those research findings, it is vital to find out whether they also apply in the UK, and if so, to understand the reasons for that. The Autistica report calls for this to be investigated as a matter of urgency, and I urge the Government to heed that call.

I want to comment briefly about the autism hospital passport, which has been endorsed by the Department of Health. The passport is designed to help people on the autism spectrum to communicate their needs to doctors, nurses and other healthcare professionals. It has been developed by Baroness Angela Browning in collaboration with the NAS. The motivations for starting the project were simple: when it comes to healthcare, the passport enables people on the spectrum and their families to have a much better experience of their interaction with the health service and to gain better, more timely and more fitting healthcare at the right time and in the right place.

I want to touch on various areas that I hope other Members will pick up, so I now turn to education. In specialist schools—the NAS is about to open a new one in the Epping forest area, supported by the Anderson Foundation—we have no fears about teachers’ ability to understand autism. But the training that teachers receive on autism has to be looked at carefully. Nearly 60% of children who responded to a survey said that the single factor that would make school better for them was if teachers understood autism. Teachers agree, and they want that training. A 2013 survey by the NASUWT found that 60% of teachers believed that they did not have enough training in autism. I am aware that work is going on to develop a new framework of core content for initial teacher training courses, but we need to make sure that no teacher enters the classroom without the tools they need to support those in their charge.

An intervention touched on employment, so I turn now to what children on the spectrum want after they leave education. They want the same things we all want out of life: stable, secure and fulfilling opportunities that allow them the same opportunities to lead independent lives. However, currently too few people on the spectrum enjoy the opportunity to find a job to help them maintain that independence. The Government have pledged to halve the disability employment gap—that was welcomed by Members on all sides of the House—and we await the Government’s White Paper, to be published soon; we also note recent assurances from the Secretary of State for Work and Pensions that that is a key priority for him. However, research by Scope has shown that the disability employment gap has remained static over the past year. Clearly the Government cannot rely on an improving economy alone to fix the issue. More will need to be done to close the gap.

The autism employment gap is even worse. The latest data indicate that only 15% of autistic adults are in full-time paid work at all and that 26% of graduates on the autism spectrum are unemployed, by far the highest rate of any disability group. The NAS hears from autistic people that the Government’s mainstream generic programmes do not feel relevant to them and are not addressing the specific and long-term needs of people with autism.

More autism-specific programmes are needed. Research shows them to be more successful. For example, research into one specialist support scheme found that 70% of adults found work when supported by autism professionals. The all-party parliamentary group on autism plans to return to that work later this year. In the meantime, I have several questions. Will the Government’s disability employment White Paper include proposals for ensuring that people on the autism spectrum can access specialist support? Will the Minister report on progress by condition in seeking to halve the disability employment gap, so that low employment rates of people with conditions such as autism can be specifically tackled? Crucially, will he ensure that the new work and health programme records whether someone on the programme is on the autism spectrum?

Autism touches so many areas of Government work that it is difficult to address them all today. For example, I have not discussed social care, mental health issues or benefits. I know many colleagues want to speak and so I do not want to take up too much more time. In summing up, I return to public awareness. Survey after survey of people on the spectrum tells us that better understanding of the condition among both the public and professionals would be the one thing that would help them to feel more secure and allow them to have fulfilling lives. People on the spectrum are reasonable, and do not expect an ordinary member of the public with no knowledge of the condition to be aware of technical details about the diagnostic criteria for autism. However, they feel that just a little more understanding, compassion and awareness would make all the difference to their lives. If we see a child having a meltdown in a supermarket or an adult acting a bit differently on a train, we should stop and think for a moment. They may be autistic, and need our kindness, not our judgment.

I thank all the organisations that have contributed to the knowledge of Members here today, in particular those charities and groups with whom we work closely, including the National Autistic Society, which provides the secretariat for the APPG, Ambitious about Autism, Autistica and the Children’s Services Development Group. I also thank the many individuals who have got in touch with me, and with all other Members here, in the past week. I hope that together we can improve the lives of those with autism and make some real progress in this area.

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[Norman Lamb (North Norfolk) (LD)]

I have done it already, but I will do it again because everyone is doing it: I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on her leadership on this matter. What she has been involved with, and what we are all involved with as a society, is learning how to understand autism much better and recognising that we fail people badly through our ignorance of the potential and capacity of people with autism to lead fulfilling lives and to contribute massively to society. The hon. Member for Livingston (Hannah Bardell) and the right hon. Member for Clwyd West (Mr Jones) made the point strongly that there is much that people with autism can do in the employment sphere. They can be fantastic employees, contributing a great deal and leading fulfilling lives, but we often fail them. Also, it costs the Government and the economy a great deal when people with autism end up depending on the state because we have failed to provide them with the necessary support early on. That is the big challenge.

[Mrs Gillan]

I notice that we have just been joined on the Front Bench by my hon. and learned Friend the Member for South Swindon (Robert Buckland), who was my predecessor as chair of the all-party parliamentary group on autism. I want to pay tribute to the work that he did. I also want to stress that in bringing in the Autism Act 2009 and in securing this debate today, I was supported by many other Members across the House. It was not just me on my own; it was a real team effort.

[Norman Lamb]

That brings me nicely on to my next point, because I was going to say that this is not one Government’s responsibility; we all have to learn and understand more. The article in The Economist made clear the strong economic case that if we invest in diagnosis and early intervention, we will save a fortune in lifetime care. As we learn, the Government have to respond. That is the challenge. This Government, because they are here now and because new learning can lead to improvements, have a responsibility to respond.

[Hannah Bardell]

The Library briefing paper states that

“the Government does not collect data specifically on employment rates for people with Autistic Spectrum Conditions”.

We should campaign, cross-party, to change that and work with business to get interviews that are friendly to those on the autistic spectrum.

[Norman Lamb]

I totally agree with that. As a former Minister, I recognised during my time in the Department of Health that, whether it be mental health, autism or learning disabilities, we operate in a fog. There is an absence of data that have been analysed and understood. If we are to make the improvements of which we are capable, we have to understand the evidence, which involves the collection of data.

I want to highlight the failures of society and the extent to which we treat people with autism as second-class citizens by referring to two cases. The case of Connor Sparrowhawk, who tragically lost his life through drowning in July 2013, has been much documented recently, and his mother, Sara Ryan, has been an amazing campaigner, fighting for justice. The Oxford Mail reported this morning about a recently leaked report, produced for the NHS trust some 11 months before Connor lost his life, that demonstrated failures of care in his unit. The article states:

“The report found Slade House was particularly poor, flagging up issues with a ‘lack of clarity of care plans’, ‘no clear understanding of a ‘locked door policy’

and so on. What is the point of commissioning reports at enormous expense if their conclusions and recommendations are ignored?

There has been great focus this week on the importance of the accountability of public bodies following the shocking conclusion of the inquest into the Hillsborough tragedy, but that importance stretches across all public bodies and into healthcare. It is important that organisations recognise their responsibility to involve the families of those who lose their lives in investigations and to have an open and learning culture, rather than a closed culture that excludes families. The trust’s treatment of Sara Ryan in the investigation of Connor’s death has been truly shocking. There must be accountability and a willingness to learn from mistakes and to take account of any recommendations.

As we try to get people out of assessment and treatment units, where they are often left for too long, the Health & Social Care Information Centre has found that 15% of the transforming care cohort, of which the Minister will be aware, have autism and no learning disability and that 23% have autism and a learning disability. When looking at the transforming care partnership plans and the outcomes for individuals, it is important that the Department ensures that the specific needs of autistic people are included and addressed.

Finally, I want to refer to the case of an extraordinary constituent of mine. A nine-year-old boy wrote a letter for his parents to take to a meeting that I had on his behalf with the authorities at Norfolk County Council, and he ended up being interviewed—at the age of nine—on the “Today” programme, and it was a remarkable interview. He movingly wrote in his letter:

“I normally say to myself you have to keep on going. I normally also say ‘is it worth it’. I could just kill myself. I wouldn’t have to face today.”

That comes from a nine-year-old boy. His family has been left waiting some two years for a diagnosis without any real support. They have been told that he does not meet the threshold for care from the Child and Adolescent Mental Health Services. Other hon. Members have highlighted similar cases, with the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) talking movingly about her experience, for example. The family, by borrowing from relatives, have managed to pay for some support for their little boy, but what about all those families who cannot afford it? It is intolerable. We cannot justify a society in which children get help if they have articulate parents or parents with money, but where those without go without.

As we seek to implement maximum waiting time standards in mental health, something which I have made my mission, my plea to the Minister is that we include autism and follow the NICE guidelines that the first diagnostic assessment should start no later than three months after GP referral—not 36 months, as I am told is sometimes the case in Norfolk, or 24 months, as in many other parts of the country. The result will be that society and the Government will save money in the long run if we make the investment in diagnosis and treatment at an early stage.

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[The Minister for Community and Social Care (Alistair Burt)]

It is just about 24 years since I first walked into Richmond House as Parliamentary Under-Secretary at the then Department of Social Security. In that time, I have had the privilege of being involved in many debates that belie the common view outside this place that we either know nothing about a subject or are not personally involved and do not care. I would put this debate right up there with the very best that demonstrate that neither of those things is true.

We have heard remarkable speeches, including 25 Back- Bench contributions, which is a tribute both to colleagues and to the Chair. As the hon. Member for Liverpool, Wavertree (Luciana Berger) mentioned, it is impossible to cover everything, or even everyone’s speech, as we normally do, but the contributions from my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) and the hon. Members for Birmingham, Yardley (Jess Phillips), for Stalybridge and Hyde (Jonathan Reynolds) and for Angus (Mike Weir) were particularly noteworthy in giving a sense of what things must be like. We are indebted to all of them for being able to say what they said in the way that they did.

I want to mention a couple of other speeches, such as that of the right hon. Member for North Norfolk (Norman Lamb). I am trying to do something about the fog, and I will mention that a little later, and many of us heard the moving and difficult story of the nine-year-old boy. The hon. Member for Barrow and Furness (John Woodcock) talked about the media response, and both the programme and the book he mentioned will make a significant contribution. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for the way in which she brought the young man’s case to me, and I assure her that it is not all done and dusted yet. Some very difficult aspects of that case worried me hugely, and we will be talking about it further. I made absolutely certain that the parents were involved in the case review, because, as she and the right hon. Member for North Norfolk said, all too often people are not involved and are somehow excluded, and that has got to stop. It is vital that people will be thoroughly engaged.

I wish to start by commending the Member who moved the motion—I cannot remember who that was now. [Laughter.] Let me add my congratulations to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) on securing the debate and on the extraordinary work she has done over the years in this area. We really are all indebted to her. In a recent Adjournment debate, I recognised the need for a fuller discussion and mentioned that we could do with this debate, and I am grateful that we have had that opportunity today.

A number of hon. Members have highlighted the importance of recognising that autism is not a person’s defining characteristic. Many colleagues, particularly those with children, made moving points about the qualities that autistic people have, and that is very important. In a couple of weeks’ time, I am going to the Hitchin LEGO club, which was started by parents of a child whose particular skills related to detail and the bits and pieces the club does. I am looking forward to going to see that. It is important that we do not just define people in this way, and the changes we make every day to attitudes, services and facilities can mean the difference between ambition thwarted and opportunity fulfilled. The best campaigns, at least those intended for the benefit of the common good, are led not from the top or from some central point of government, but by people on the ground.

Autism awareness is being addressed directly by the National Autistic Society in its excellent new campaign, which was launched during world autism awareness week and to which I gave my support. I went to see not only the little boy who is the subject of the film, but his family, because there are often siblings of those who have autism and they need to be cared for and valued as well. Sometimes issues can arise in that regard. It was nice to see the whole family and it is a remarkable piece of film. I also wish to highlight the work the Department of Health has taken forward with the Autism Alliance UK, a large network of autism charities, on the “Connect to Autism” project, which encourages local organisations, services and companies to become autism champions by training staff in autism awareness—there is a lot more to do.

I have no time to deal with all the subjects that have been raised, but in accordance with what has become my usual practice, because I seem to speak in vastly oversubscribed debates, I will pick out the questions that colleagues have raised and answer them by letter. If colleagues do not mind, I will answer them in the same letter and then put a copy in the Library, so that everybody will get a chance to see all the answers to the various questions that have been raised, which my hard-working team have noted. Let me just say a couple of things in answer on the key issues of what the Government are doing, and of diagnosis and data.

First, although it is easy sometimes to be overwhelmed by what there is still to do, it is important to recognise where we have come from—many Members made that point—and to realise what we are doing on a day-to-day basis. I commend to the House the “Progress Report on Think Autism: the updated strategy for adults with autism in England” which was published in January. I put that together along with the Under-Secretary of State for Disabled People, my hon. Friend the Member for North Swindon (Justin Tomlinson), the Minister for Children and Families, my hon. Friend the Member for Crewe and Nantwich (Edward Timpson) and the Under-Secretary of State for Justice, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who deals with prisons, probation, rehabilitation and sentencing. It sets out progress against 33 of the “Think Autism” actions and describes some of the work going on across government, because it absolutely involves education, employment and all sorts of other things. The report details case studies and it demonstrates what is being done in different places around the country.

Let me come straight to the challenge of diagnosis, which is so important to many Members. There is no doubt that, in some parts of the country, the demand placed on services—it is often the sheer weight of numbers—means that the NHS and its partners can struggle to meet the standards set out by NICE. The Department of Health’s mandate to NHS England for 2016-17 calls on the NHS to reduce health inequality for people with autism. Waiting too long for a diagnosis can be one of the health inequalities that autistic people face. The mandate has already got that, and it is very important that it relates to autism.

Clinical commissioning groups and NHS England are working to bring down the waits in line with NICE guidelines. What is happening right at this moment is that the Department of Health and NHS England, supported by the Association of Directors of Adult Social Services, have initiated a series of visits to CCGs and local authorities. The visits aim to develop a better strategic oversight of the challenges in securing timely diagnosis across all ages and to share good practice. In essence, that means that we should look at the variability in diagnosis times and do something about it. Sometimes there is an issue of capacity. It is not a question of just pulling a lever and the waiting times will come down. For waiting times to make any sense, we must recognise the capacity to deal with them. NHS England is trying to understand the difference in variation in order to do something about it.

NHS England will complete its work this month and then report to the cross-Government Adult Autism Programme Board in June. That report and the discussion at the board will be made public. The Department of Health is also funding the University of York to report on the type of support that is available after a diagnosis.

My right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) asked that NHS England should collect, publish and monitor key information on how long people are waiting for diagnosis and how many people are known to their GP to have autism. She said that waiting times standards on mental health, which are currently in development, should reflect national guidance that no one waits longer than three months between referral and being seen for diagnosis. I can assure Members that I am keen to ensure that we collect more data and that the data are made public. I am keen that the NHS collects what is known locally and finds a way in which we can use that nationally. New datasets have been put in place—I will say something about them in a minute—but it is important that we acquire more data. I have been made aware of that matter and I am trying to do something about it.

[Norman Lamb]

rose—

[Alistair Burt]

I will take just this one intervention, because I am on a tight timetable.

[Norman Lamb]

Will the Minister consider setting a maximum waiting time standard of three months to enter diagnosis? We all know that once we set a standard, the system responds to it, and we need that for anything to change.

[Alistair Burt]

I do understand that, but, equally, the capacity has to be there to do the job. It is a fine balance. To set a waiting time limit as some sort of token, knowing that it cannot be reached, would not work. Equally, the pressure on the system through collecting data, asking for data, and seeking transparency has its effect as well. There is a real sense in the Department that we have to meet that challenge, and I am looking at what data can best be collected, what data need not be collected centrally, but can be handled locally, and how we make the difference and how that is transparent and made known.

The Department of Health does not set out how NHS England should monitor waiting times. How NHS England holds commissioners to account is for it to determine, though it will need to demonstrate effectiveness in meeting the mandate requirement through which we expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole. Even now, in the configuration of the NHS, the NHS does not directly report to me on this particular issue. I am really interested in how the NHS ensures that CCGs are doing their job, and I suspect that Members of the House are very interested, too. I can use that concern and interest and make sure that that monitoring job is done and that it is transparent.

My right hon. Friend also mentioned GPs. GPs already maintain a register of people with learning disabilities, which may include patients on their lists who also have autism where this has been diagnosed. As a number of Members mentioned, autism may not be the only condition that an individual may have.

The Royal College of General Practitioners’ autism initiative, part-funded by my Department, is looking at the idea of an autism indicator in general practice. That work is at an early stage. I hope that is helpful to my right hon. Friend. As recommended by the independent Mental Health Taskforce, the Department of Health is developing a five-year plan for the development of mental health data, to be published by the end of this year. The plan will set out future data requirements and timings for developing data to inform pathways of care, which will include data requirements for autism. This will be of great interest to the hon. Member for Liverpool, Wavertree, and I will make sure that she keeps up to date with data, as she keeps me up to date with data requests.

This has been a terrific debate which has covered many different aspects. To sum up, autism should never be a barrier to enjoying the access and opportunity afforded to others. The National Autistic Society, the Autism Alliance, the all-party parliamentary group on autism and many other charities are doing great work, helping more of us realise that sometimes we are the barrier, beyond legislation. It is only through empathy and understanding that true progress can be made and sustained.

Finally, there are two quotes that everyone should take from this debate—first, “Everybody feels like it’s a fight.” I have heard that too often, as too many of us have. Everything the Department does must make that sense of fight a little easier, until no one needs to fight because their needs are taken for granted. Secondly, “Think differently about thinking differently”—absolutely. That is what we should all do. I hope that that is a message from a very consensual House of Commons this afternoon.

Junior Doctors Contracts

Norman Lamb Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. and learned Friend is right about that, which is why when we announced our decision to proceed with the current contracts we also said that we would set up a process to look at all the quality of life issues that could make a difference to the current junior doctor workforce and to their morale. One of those issues is that it is currently too difficult for doctors who are partners to work in the same city, because of the processes we have—we want to reform that. There are many other things we could do in terms of improving the predictability and reliability of shift patterns, but to do that we need the BMA to co-operate with the Bailey review, which we have set up and which is led by the president of the Academy of Medical Royal Colleges. We could then sort out these problems, but at the moment we do not have that co-operation, which is why we are not making the progress we want.

[Norman Lamb (North Norfolk) (LD)]

May I say to the Secretary of State that it is because I have very real anxieties about the impact on patients of a strike involving emergency services, not because of political opportunism, that I signed that letter? I urge him, even at this eleventh hour, to meet all of us to discuss this in a reasonable and rational way. Ultimately, we all have a responsibility to try to avert this strike.

[Mr Hunt]

I absolutely agree with that, but I gently say to the right hon. Gentleman that if that was the case, he has my mobile phone number and he could have contacted me, and he did not need The Sunday Times to be the first place I saw his proposal. If the people involved were genuinely serious about brokering a deal, that was not the way to go about it. We all have a duty to do everything we can to avert tomorrow’s strike, but his proposal to change the Government’s plans into pilots would mean, as he knows perfectly well, that seven-day care would get kicked into the long grass and would probably not happen. That would be wrong. As he well knows, we have a responsibility to patients to deliver our manifesto promises, and that is what we are going to do.

Mental Health Taskforce Report

Norman Lamb Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris]

My hon. Friend makes a powerful point. We need to deal with some of the issues to do with fragmentation in the system—he refers to substance misuse. The thrust of the recommendations in the report is about making sure we have a more integrated approach to commissioning mental health services across the piece.

The second important facet of the implementation challenges that the report throws up is research into mental health services. It mentions the need to have a proper, coherent 10-year plan for research into mental health to fill what are, as many of us would agree, big gaps in the evidence base.

[Norman Lamb (North Norfolk) (LD)]

I congratulate the hon. Gentleman on securing the debate. Does he share my horror at the fact that the Medical Research Council spent 3% of its budget on mental health research in 2014-15? That bears no relation to the degree of disease burden in our country, yet it chose to spend just that much on research.

[James Morris]

I thank the right hon. Gentleman for that intervention and pay tribute to him for all the work that he has done, particularly when he was Minister with responsibility for this area. I agree that we need to spend much more on mental health research, and we need to know what we want to research. For example, there is much talk about the power of peer support in mental health. There is an assumption that it is a good thing and that it works, but we do not have a particularly rich evidence base about whether it does.

On the efficacy of certain psychotherapies, the evidence base shows that cognitive behavioural therapy can be effective for people with mild depression and anxiety, but we do not really know about the effectiveness of other psychotherapies that we may want to promote and develop in the national health service. We clearly do not know very much about a lot of emerging areas that have an impact on mental health. For example, using technology and mobile phone and other apps to help people with mental health problems is a big emerging area, but we do not know much about its effectiveness. We certainly do not know in any coherent sense about the implications of genomic medicine on mental health care. A coherent strategy on mental health research is required over the next decade so that we can extend and expand the evidence base, because the truth is that we are often flying blind.

--- Later in debate ---

[Norman Lamb (North Norfolk) (LD)]

I, too, congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) and thank him for all the work he has done in advocating for mental health. I also congratulate Paul Farmer, Jacqui Dyer and their whole team on their substantial piece of work.

This is a historic injustice. The disadvantage suffered by people with mental ill health in accessing treatment is not the responsibility of any particular Government; it has always been there, but the report gives us the opportunity to end that historic injustice, and we have an absolute responsibility to ensure that that happens. It is both morally wrong and economically stupid to ignore mental ill health. The case is made so well on page 5 of the report, where it says:

“Those with conduct disorder—persistent, disobedient, disruptive and aggressive behaviour—are twice as likely to leave school without any qualifications, three times more likely to become a teenage parent, four times more likely to become dependent on drugs and 20 times more likely to end up in prison. Yet most children and young people get no support. Even for those that do the average wait for routine appointments for psychological therapy was 32 weeks in 2015/16.”

That encapsulates the problem. It is scandalous that children with such needs do not get access to treatment. It destroys their life chances, and the cost to society of the outcomes described in the report is enormous.

I am conscious of the time available to me, so rather than highlight a number of issues from the report I will address some key points directly to the Minister. First, we know that there will be £1 billion of additional funding, but it is due to come late in this Parliament. Between now and then, the NHS Confederation believes that mental health will lose out on funding and that in 2016-17 the bulk of the front-loaded money will go to acute hospitals. I have a real concern that the ambition in this document will not be realised unless that investment is made. Will the Minister ensure that that investment is delivered?

[Daniel Zeichner (Cambridge) (Lab)]

Will the right hon. Gentleman give way?

[Norman Lamb]

I do not have time; I want to ensure that others can speak.

Secondly, there needs to be a clear implementation plan—others, including the Royal College of Psychiatrists and NHS Providers, have made this point. We need to understand exactly the practical mechanism for making these things happen. NHS providers say the plan should be delivered by August of this year. Can the Minister confirm that that will happen and that there will be reporting back on progress, so that we understand exactly what is happening? We need proper governance arrangements to make sure that these things happen.

Thirdly, the report endorses the approach that I took of implementing comprehensive maximum waiting times standards. That is an essential component of achieving equality—an equal right to treatment on time, whether someone has a physical or mental health problem. The Government have endorsed the report, yet there is no funding attached to ensuring we get comprehensive waiting times standards. How will the Government ensure that that happens? It is fundamental to ensuring that we end the historic injustice.

I am delighted that there is now a commitment to end the outrageous practice of out-of-area-placements. It is outdated, it treats people appallingly, and we know that there is a higher risk of suicide among people who end up being sent out of area. To do it by 2020 takes too long. The Royal College of Psychiatrists report—Lord Crisp’s report—says it could be done by October next year, so I urge the Minister to follow that timescale. Will he also commit to implementing all the recommendations in Lord Crisp’s report, which has been widely welcomed? Everyone recognises that it makes sense, so I hope he will confirm that.

There is a responsibility on all of us to ensure that we do everything we can to implement the recommendations. I chair a commission on mental health in the west midlands. Is the Minister interested in a briefing on the progress we are making? There is a real opportunity to implement early some of the recommendations in the report.

Finally, I will make the case for preventive healthcare. Relate, the organisation, has made a powerful case for the value of couple therapy and ensuring that every provider of IAPT—improving access to psychological therapies—provides that among the other evidence-based interventions.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

It is a real pleasure to serve under your chairmanship this afternoon, Mr Wilson. I congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) both on securing this vital debate on the final report of the independent taskforce on mental health and on his excellent contribution. I am pleased that we have the opportunity to examine this incredibly important piece of work and to hear a detailed response from the Government. I thank all Members who have spoken in the debate; the quality of the speeches we have heard is testimony of the strength of feeling on both sides of the House on the issue of mental health.

I echo previous contributions today in saying that the taskforce report is an extremely comprehensive piece of work. I pay tribute to all those who were involved in delivering it. The recommendations it makes are robust and wide-reaching and signal what the chair of the taskforce—Paul Farmer CBE from Mind—has rightly described as a

“landmark moment for mental health”.

I also thank vice-chair Jacqui Dyer for her commitment and passion.

If implemented in full, the changes could make a huge difference to a system that is under increasing and unsustainable pressure. The real challenge lying before us now is ensuring that the aspirations set out in the report are actually delivered. For too long the rhetoric on mental health has not matched the reality on the ground. Members today have reflected the concerns felt by the people whom we represent across the country—people who themselves suffer from mental health conditions, their families and the services and professionals that care for them—who are anxious to ensure that the opportunity we now have to transform mental health in our country is not wasted.

I will focus my remarks on implementation and three key areas where unanswered questions remain—funding, transparency and accountability. Turning first to the money, the taskforce identified a £1.2 billion funding gap in mental health services each year by 2020. The Government responded to the publication of the report with an announcement of an additional £1 billion of investment for mental health services up to 2020. That is, of course, very welcome but I understand that the £1 billion will be taken from the £8 billion set aside for the NHS up to 2020. If that is the case—perhaps the Minister can confirm that for us today—I struggle to see how it will meet what the taskforce says is required.

Given that mental health receives just under 10% of the total NHS budget, it is difficult to see how the funding announced could be considered as additional, particularly in the context of the £600 million cut that mental health trusts have experienced over the course of the last Parliament. I should have thought that the Minister would have allocated that proportion of the £8 billion to mental health anyway, so I am keen to hear his response on that point.

There are also real concerns about how this funding will be distributed and what systems will be in place to ensure that it reaches the front-line services for which it is intended and not siphoned off to plug the deficits of acute trusts. That point has already been made by the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Bexhill and Battle (Huw Merriman). The Minister is right to prescribe that CCGs must increase the amount of their budget that they allocate to mental health at a rate that is at least in line with the general growth in their budget. However, as that budget information is not published centrally, I have yet to see any evidence from the Government that they are able to guarantee that CCGs are fulfilling that commitment. In fact, I have had to make freedom of information requests, which have exposed the fact that more than one in three CCGs are not meeting that expectation.

Just before Christmas, the Health Secretary announced that from June there will be independently assured Ofsted-style ratings for mental health provision by CCG area that will expose the areas that are not making the commitment to mental health that they should. I asked then if he would clarify whether that commitment would include publishing a clear picture of mental health spending for every CCG. I am still awaiting a response to the follow-up letter I wrote seeking clarification on that very important point, and I would be pleased if the Minister were able to confirm that for us today. As he will know, the Opposition strongly believe that the annual survey of investment in mental health must be reinstated. It was stopped in 2011, and it is an absolutely crucial piece of information.

That is especially important given the concerns that have been raised not only by many hon. Members today, but by the Mental Health Network, which represents mental health trusts, who have said that providers of mental health services are yet to see the difference from the investment in child and adolescent mental health services that the Government announced last year. During this debate, many hon. Members have raised specific concerns about CAMHS and the imbalance in the amount that they are allocated from the overall mental health budget. It is less than 10%, and it is a significant challenge. I am interested to hear the Minister’s response both to those very serious concerns and to the proposal from many mental health leaders that the cash should be ring-fenced—I am very keen to hear what he thinks about that.

That brings me to the second key theme of the report—the startling lack of transparency and accountability in our mental health system, which was mentioned by my hon. Friend the Member for York Central (Rachael Maskell) and the hon. Member for Gillingham and Rainham (Rehman Chishti). The significant gaps in the information that the Government collect on mental health present a significant obstacle to their ability to deliver what they have promised on mental health. On Monday we saw further shocking evidence of that information gap during the BBC’s “Panorama” programme, which highlighted the discrepancy between the data that the Government hold on the number of children who have died in in-patient mental health trusts and units and the figures from the charity Inquest’s research. I raised that in the House yesterday.

[Norman Lamb]

I totally agree with the point that the hon. Lady is making. I always took the view that I was operating in a fog, without access to the proper data. The “Panorama” programme made reference to the fact that I gave a parliamentary answer saying there had been no deaths in children’s mental health services—an answer that was wrong, because I was given the wrong information. I have asked the Secretary of State for a full investigation into how that happened. We have to have absolutely accurate reporting of these things.

[Luciana Berger]

I thank the right hon. Gentleman for his intervention. I believe it is absolutely imperative that we are able to see how deaths in psychiatric care are not only treated and recorded, but investigated and learned from. We have heard from the Minister that there will be progress on that front.

The situation is particularly concerning given the ongoing case of Southern Health NHS Foundation Trust, which was found to have failed to investigate more than 1,000 unexpected deaths of mental health and learning disability patients since 2011. Only last week, more than two years since the very tragic death of Connor Sparrowhawk, Southern Health trust was found by the Care Quality Commission not to have addressed serious concerns that were raised about the safety of its patients and was issued with a warning notice. I would be grateful if the Minister shared with us what the Government are doing specifically to improve the mental health data that are being collected, published and made accessible to the public. When will we have a further update on avoidable deaths in the area of mental health and learning disability? Data are absolutely critical, not only to enable the Government to understand the realities of what is happening on the ground, but to allow us to check that the Government are delivering on what they have promised.

That brings me to the final point I wish to cover today—accountability for the implementation of the taskforce’s recommendations. The taskforce asked NHS England, the Department of Health and the Cabinet Office to announce what governance methods they intend to introduce for the delivery of the recommendations. That really is needed as a matter of urgency. We need greater transparency than before in the way that the recommendations are implemented. I note that one recommendation of the taskforce report is that the Government accept the recommendations from the previous taskforce on CAMHS—another issue raised by many Members during today’s debate—which reflects the fact that the delivery of these recommendations has been too slow. I should be grateful if the Minister would confirm what plans there are to publish and publicise updates on implementation of the taskforce’s recommendations.

The Centre for Mental Health has produced a fantastic report for NHS England, exploring what helps and what hinders the implementation of policies and strategies relating to mental health. I do not know whether the Minister has had a chance to read the report but, among other things, it calls for a robust implementation infrastructure to support local agencies in delivering the report’s recommendations. I should be grateful if the Minister would share with us today what plans there are to support local authorities, CCGs and mental health trusts to deliver on that strategy.

Many recommendations in the taskforce report also require Government Departments—such as the Ministry of Justice, the Department for Work and Pensions and the Department for Education—to deliver their own areas of work that relate to mental health. I was very pleased to see those recommendations, and as I have said and will continue to say, we will not address the challenges of our nation’s mental health just from the Department of Health. Prevention and early intervention are absolutely crucial, which was a point made by my hon. Friend the Member for Coventry North East (Colleen Fletcher).

Take the work of the Ministry of Justice, for example. The report calls for the completion of the roll-out of liaison and diversion services, as well as the increased uptake of mental health treatment requirements and improvements to prison mental health care. At a time when, as a country, we are seeing one person take their life every four days in our prisons, it is absolutely crucial that we address this very serious issue.

Another point made by the taskforce was about housing and the local housing allowance, which the Government seriously need to address. During today’s debate other Members have talked about the importance of employment and what more needs to be done to support employers to help people with mental health conditions into the workforce, and to support people who might be experiencing those issues. It was disappointing that the Government accepted only formally the taskforce’s recommendations relating to the Department of Health and its arm’s length bodies. I hope the Minister will confirm today whether other Departments will accept and implement the other recommendations.

In conclusion, for the many thousands of people who could benefit from these changes and the others set out in the taskforce’s final report, Ministers must keep their promise and deliver the vital reforms that are long overdue and desperately needed. We have heard a lot of rhetoric and warm words on mental health. Now is the time for real action and to translate parity of esteem into reality. I look forward to the Minister’s reply.