Conception to Age 2: The First 1001 Days

Norman Lamb Excerpts

Thursday 17th December 2015 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to follow the hon. Members for Congleton (Fiona Bruce) and for Sefton Central (Bill Esterson), and I completely endorse their points about foetal alcohol syndrome. It feels like we have not caught up with the evidence, and we need to do so urgently, given the awful carnage being done to babies by this dreadful condition, so I congratulate the all-party group on foetal alcohol spectrum disorder on its work.

I also congratulate the right hon. Member for East Worthing and Shoreham (Tim Loughton)—

[Tim Loughton]

Hon. Member.

[Norman Lamb]

Oh, I do apologise. To me, he is right honourable. He has shown great leadership, both as a Minister and in his work since, and I applaud him for that. I also join others in acknowledging the fantastic leadership shown by the hon. Members for South Northamptonshire (Andrea Leadsom) and for Nottingham North (Mr Allen).

Like the hon. Member for East Worthing and Shoreham, I had the one-to-one seminar with George Hosking from the WAVE Trust. I had it many years ago, but I remember it still very clearly: the evidence he showed me, from Australia and the United States, was compelling. He is rightly on a mission and has had a significant influence, which should be acknowledged, so I join the hon. Gentleman in thanking him for his amazing work.

I want to focus on perinatal mental health. Here, we are dealing with two lives: the mother’s and the baby’s. The impact of mental ill health in the first year after birth is profound. As the hon. Gentleman said, it affects up to 20% of women. We often think of it as post-natal depression, but it goes much wider than that. The London School of Economics’ personal social services research unit and the Centre for Mental Health have produced an important piece of work on the economics of this. They refer to anxiety, psychosis, post-traumatic stress disorder and other conditions, including obsessive compulsive disorder. The impact of these conditions on the mother, but also on the baby and the wider family, can be very profound.

The cost of failure, as the hon. Member for Nottingham North made clear, is enormous. The report by the LSE and the Centre for Mental Health estimates the cost of perinatal ill health as being £8.1 billion at the very minimum. The basis for calculation was the mothers who suffered depression, anxiety and psychosis, but they recognised that other conditions were relevant, too, which have not been costed, so the overall cost is bigger. We must understand that. As the hon. Member for East Worthing and Shoreham made clear, this amounts to £10,000 for every baby born in this country. The cost of failure is just enormous.

How have we responded to this extraordinary impact? Slowly but surely, things are changing, but if we look at the recently published map on the availability of services around the country—this relates to the UK’s specialist community perinatal mental health teams—we see that in 2015, the map is still horribly red. This does not indicate constituencies held by the Labour party—[Interruption.] Thank goodness! This indicates the parts of the country where no specialist team is available. Let us imagine for one moment that this was the case for stroke care or heart conditions: there would be a national outcry.

No party or Government is responsible for this situation. We are dealing with an emerging understanding, and it is about developing a new service. When I look at the whole of East Anglia, my own region, I see that not a single specialist team is available. That is truly shocking. As the hon. Member for East Worthing and Shoreham said, people are dying, and some even take their own lives, yet these are deaths that could be prevented by the application of specialist services around our country. None of us can be comfortable with the fact that so much of our country does not have the ready availability of support for mothers in this situation.

There is an urgency to ensuring that we act to get the whole country covered. I was pleased when in response to the cross-party campaign for equality for mental health, we had the basic simple principle that there should be equal access to care and support—irrespective of whether people have a mental or a physical health problem. At the moment, that does not exist, but the campaign that we launched in the run-up to the spending review secured a response from the Chancellor of an extra £600 million for mental health. In his statement to Parliament, the Chancellor specifically mentioned the importance of perinatal mental health services. That money must be used.

I end by urging the Minister to do everything in his power to instil a real sense of urgency, with a programme and a timetable to get every part of the country covered by specialist services. I find it unbelievable in this day and age that the CCGs mentioned by the hon. Gentleman have not even started to think about this yet. These are the people who hold responsibility in our NHS for commissioning services for our populations, but a significant number of them have not yet even started the process of thinking about the problem. The message needs to go out from the Minister, but also from NHS England nationally, that this situation is intolerable and cannot be sustained. We must ensure that this Parliament reaches the point by 2020 when the whole of that map of the United Kingdom is green, so that every mother, when she is in need, following birth, can get access to the specialist services that can help her to recover.

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[Alistair Burt]

I take the hon. Gentleman’s point and I will raise it with the appropriate Minister.

I have only a couple of minutes left, so I want to cover a couple of other things. Perinatal mental health is really important to me. I am disappointed that we have lost a couple of perinatal mother and baby units over the past few years. The increased emphasis on the issue is absolutely right. An NHS England working group is doing some intensive work on the £75 million that was committed in the last Budget to improve perinatal mental health services over the next five years. The report will come to me in the early weeks of January, as we look at the first tranche of that funding and then beyond. It is not as simple as just providing the units; it is about the community support care and everything else.

I was horrified by last week’s MBRRACE report. The association between people taking their own lives and perinatal mental health issues is very stark. Both of those issues are a very high priority for me. We will return in due course to say more about the detail. I offer the right hon. Member for North Norfolk that assurance.

[Norman Lamb]

Is the Minister satisfied that Health Education England recognises the importance of building the capacity of the workforce in order to ensure that there is a national service?

[Alistair Burt]

Yes, I am. HEE takes a real interest in the issue and I am sure there is more to be done. I take the right hon. Gentleman’s point about urgency as well. I am committed to doing more about that.

I am sure we will come back to this issue. This has been an excellent debate and I want to leave time for the mover of the motion to say a few words.

Madam Deputy Speaker, I wish you and all colleagues in the House a happy Christmas. If we conclude on a consensual note, with a debate as good as this one with very well informed people, the House is more than doing its job and is ready for a break.

Victims of Contaminated Blood: Support

Norman Lamb Excerpts

Wednesday 16th December 2015 Commons Chamber

[Jane Ellison]

I am well aware of the shortcomings of some of the schemes identified by colleagues and those affected by this tragedy, and I have obviously read the details from the all-party group and other Members’ communications. I have confirmed before that reducing the number of schemes will be part of the consultation on reforming the schemes, so my hon. Friend’s point is well made. For the record, though, I should add that I had a meeting recently with the staff of the schemes—the people who man the phones and deal on a day-to-day, week-to-week basis with sufferers—and I am clear that they, as distinct from the people who head up the trusts, are working hard to offer a service to people in difficult circumstances.

[Norman Lamb (North Norfolk) (LD)]

Is this not one of those situations where there is an absolute moral obligation on the Government to act and end the uncertainty and delay? Is the Minister reassured that the spending review gives her the ability to bring a lasting and fair settlement, and will she do everything she can to ensure it is in place by the start of the next financial year?

[Jane Ellison]

I am happy to assure my former colleague in the Department that the Secretary of State and my departmental colleagues take this matter extremely seriously. It is a matter on which we are seeking to move forward. It will be for those who respond to the consultation on the reformed scheme to give their views, but we are seeking to move towards a reformed scheme that responds to the criticisms of the existing schemes and offers sustainability for people who have suffered for so long. I hope I can satisfy the right hon. Gentleman in that regard, although I will be able to say more in the new year, when we publish the scheme details.

Southern Health NHS Foundation Trust

Norman Lamb Excerpts

Thursday 10th December 2015 Commons Chamber

[Mr Hunt]

No one knows more about the Francis report than my hon. Friend, because of the direct impact that it had on his local hospital, and he is right to talk about that culture change. There is an interesting comparison with the airline industry: when it investigates accidents, the vast majority of times, those investigations point to systemic failure. When the NHS investigates clinical accidents, the vast majority of times we point to individual failure. It is therefore not surprising that clinicians feel somewhat intimidated about speaking out. People become a doctor or nurse because they want to do the right thing for patients, and we must support them in making that possible.

[Norman Lamb (North Norfolk) (LD)]

The coalition Government rightly established a public inquiry to look into the appalling care at Stafford hospital, and the Secretary of State has pointed to the challenge to the culture that the Francis report engendered following that scandal. Is this the moment to consider something similar for people with learning disabilities, or those with severe and enduring mental ill health, who too often continue to be treated as second-class citizens in our NHS? Sara Ryan, Connor Sparrowhawk’s mother, has called for a public inquiry. Will the Secretary of State consider that? It seems that it is time to shine a light on what is going on.

[Mr Hunt]

I am happy to consider that. The right hon. Gentleman and I are completely on the same page on these issues. My only hesitation is that a public inquiry will take two, three or four years, and I want to ensure that we take action now. I hope I can reassure him and the House that by, for example, publishing Ofsted-style ratings for the quality of care for people with learning disabilities across every clinical commissioning group, we will shine a spotlight on poor care in the way that the Francis report tells us that we must. I do not see the treatment of people with learning difficulties as distinct from the broader lessons in the Francis report, but if we fail to make progress, I know that the right hon. Gentleman will come back to me, and rightly so.

Mental Health

Norman Lamb Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

I thank my hon. Friend for making that very important intervention. There are too many stories of our blue light services—not just the police, but our ambulance and fire services—being under incredible pressure in contending with such issues. I believe that the Government must do more to address that issue.

[Norman Lamb (North Norfolk) (LD)]

I am pleased the hon. Lady has called this debate. Does she share my view that yesterday’s report on perinatal mental health makes incredibly disturbing reading? Many women have lost their lives because of the absence of services. We must commit to making sure that every part of the country has good services to ensure people get through such difficult times.

[Luciana Berger]

I will come on to the very serious issue of perinatal mental health that the right hon. Gentleman raises. Again, we should all be very concerned about that issue.

I am very concerned that there has been a psychiatry recruitment crisis, with a 94% increase in vacant and unfilled consultant posts. The NHS constitution treats mental health and physical health differently. The Government claim to be increasing mental health budgets, but patients and professionals tell a different story. Ever since Ministers discontinued the annual survey of investment in mental health three years ago, we do not have an accurate picture of spending on mental health in our country.

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

I congratulate the shadow Minister on securing this debate. She spoke powerfully about the shortcomings in mental health provision, and although she was reluctant to recognise the progress being made, she deserves credit for having secured her first debate on her new portfolio.

President Obama recently talked of the need to bring mental health out of the shadows, and I would like to start by congratulating hon. Members on both sides of the Chamber on their bravery in doing exactly that. I recognise the bravery of my hon. Friend the Member for Broxbourne (Mr Walker), who has spoken powerfully about his obsessive compulsive disorder and its impact on his family life; of the hon. Member for Barrow and Furness (John Woodcock), who has talked about his treatment for depression; of the hon. Member for North Durham (Mr Jones), who has also spoken bravely about his battle with depression; and of my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is part of the new cross-party campaign, and who opened up about his mental health challenges during a difficult period in his life.

I also thank my hon. Friend the Member for Croydon Central (Gavin Barwell) for his private Member’s Bill, supported by the Government, that repealed the laws preventing people with mental health conditions from being Members of Parliament, jurors or company directors. I also thank my hon. Friends the Members for Vale of Clwyd (Dr Davies) and for Eastleigh (Mims Davies). I thank the hon. Member for Ashfield (Gloria De Piero) for her leadership of the all-party group, and I thank the right hon. Member for North Norfolk (Norman Lamb)—no one has done more in the House to campaign for mental health. In particular, I would like to recognise the bravery of his son, Archie, who spoke about his mental health challenges. Anyone who saw the joint interview on ITV News will have been extremely moved. I would also like to recognise someone who is not a Member and is not usually praised by Conservative Members: Alastair Campbell is a very powerful advocate for mental health; his bravery and openness is a reminder to us all that depression affects people in all walks of life.

Hon. Members have sent a strong message to the public: when it comes to mental health conditions, you are not alone. One in four adults experiences mental health problems every year. They affect everyone, including our elected representatives. By speaking out, hon. Members send a message to other parliamentarians who may be suffering in silence. Despite the incredible privilege of working in this place, public life can be incredibly stressful. It can destroy not just people’s hopes but their marriages, relationships and families. Being an MP does not make us immune to the pressures that affect everyone. With the support of wonderful campaigning organisations such as Mind, Rethink, the Samaritans and Young Minds, this kind of courage has made a real difference.

In the past couple of years, we have seen huge determination from those on both sides of the House to improve mental health provision. One reason for that is that society’s understanding has improved a huge amount in the past decade. We should celebrate the fact that we know much more than we ever did before about the workings of the brain, the causes, treatment and prevention of mental ill health, and links to other societal issues, such as debt, unemployment and family breakdown. As a result, between 70% and 90% of those treated for serious mental illness see a reduction in their symptoms and an improved quality of life. That percentage is even higher if the illness is caught earlier. The best example is early intervention for psychosis, which can reduce suicide risk from 15% to just 1%.

We should also recognise the progress made on depression. The World Health Organisation describes depression as more disabling than angina, arthritis, asthma or diabetes, but we know it can be treated as successfully as any of them. The BMJ’s research, published today, mentions that talking therapies for moderate and severe depression can be as effective as drugs. Our own programmes of talking therapies have a 50% recovery rate, post-treatment.

[Norman Lamb]

I appreciate the way the Secretary of State is addressing this subject. We are all on a journey on this. He will remember that last October we published a document that painted a vision of achieving genuine equality by 2020; that was not rhetoric. Central to that was introducing comprehensive waiting times standards, so that there was a complete equilibrium of rights: the same right to access timely treatment for both physical and mental health problems. Does he remain committed to that absolutely critical principle?

[Mr Hunt]

I am committed to that principle. As the right hon. Gentleman knows—we have discussed this many times—access to treatment is vital, but so, too, is the quality of treatment at the start of the process. We need to make sure that we keep a close eye on both. I think it was right to ask Paul Farmer of Mind to lead an independent review of the best way to make progress towards parity of esteem during this new Parliament. I want to wait and see Paul Farmer’s recommendations before we decide how to implement the vision that the right hon. Gentleman played such an important part in developing.

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[Norman Lamb (North Norfolk) (LD)]

Let me say at the outset that I strongly support the motion and I think the whole House should unite behind it. Although Members may disagree with aspects of the motion, it is really important that we send out a united message that we are all agreed on the imperative of achieving equality for mental health. Self-evidently, we still have a long way to go, and we should be impatient for change.

The sentiments in the motion were at the heart of the cross-party campaign that I launched with Alastair Campbell and the right hon. Member for Sutton Coldfield (Mr Mitchell). We managed to get more than 200 leaders from across society to come together to make the united case for equality for mental health and for extra investment. Why is it that so many leaders agreed to join that cause? Is it because there is now a growing recognition that we must end this absolute historic injustice and ensure equal access to treatment?

[Mr Kevan Jones]

I commend the right hon. Gentleman for his work. Does he agree that those leaders now need to translate that action into policy, both at a national and a local level?

[Norman Lamb]

I totally agree. We have to set the framework, put the funding in place and deliver services on a local basis. How can anyone in this Chamber possibly justify this: if someone has suspected cancer, they have a right to an appointment with a specialist within two weeks of referral by their GP, but a youngster with an eating disorder has no such right, yet we know that their condition can kill? That is a scandal and an outrage and it must change. There must be equality of access.

When someone does get access to treatment, too often it is a lottery. As we discussed last Friday, we have the continuing scandal—the hon. Member for North Durham (Mr Jones) referred to this earlier—of people being shunted around the country in search of a bed. That would never happen to someone suffering from a stroke or a heart condition. It is inequality of access to treatment, and it is a complete scandal.

[Mr Jones]

There is an issue with the number of beds, but does the right hon. Gentleman also accept that one of the problems is that people are in those beds for far too long? One of the crisis points in London is access to adequate housing so that people can be discharged into the community.

[Norman Lamb]

I was so pleased that the hon. Gentleman made that point in his speech, and I pay tribute to him for the work he has done. The answer is not simply to have more beds; we should also be reducing the length of stay, which often is not therapeutic for the individual. Getting them into secure housing is central to their health and wellbeing.

[Rehman Chishti (Gillingham and Rainham) (Con)]

Will the right hon. Gentleman give way?

[Norman Lamb]

I am afraid that I cannot give way, as I have very limited time.

At the heart of that inequality is the stigma that still attaches to mental health. We have made real progress in combating that stigma, but we have a way to go. My message to the Government is that the inequality of access is morally wrong. We cannot begin to justify one person not getting access in the way that somebody else does in our publicly funded NHS. I am pleased that the Secretary of State has acknowledged that that is a scandal, but the Government now have to deliver that equality of access. We have to deliver by 2020 the vision that he and I set out last October.

That inequality of access is not only morally wrong, but economically stupid, as many Members have mentioned. The Centre for Mental Health reckons that neglecting mental ill health costs us about £105 billion a year, so continuing to neglect it is stupid and completely counterproductive. If we make the investment up front, we will achieve savings further down the track. I therefore welcome the £600 million that the Chancellor indicated in the spending review would be made available over this Parliament for mental health. That is real progress, but it is not enough. We have to keep arguing the case for genuine equality.

We need to do two things. First, we need to spend the money differently. Many hon. Members have made the point that we need to shift resources away from containing people, often in long-stay, secure settings, to early intervention, recovery and ensuring that there is proper crisis support in the community to stop hospital admissions, which can be so damaging to someone’s wellbeing.

Secondly, up-front investment is needed to fund a programme for comprehensive maximum waiting time standards, including for children and young people, so that there is a complete equilibrium, with equal rights of access to treatment. We published that vision last year, and I hope that the Secretary of State will deliver it. If we give up on the right of equal access, if we give up on ending that discrimination at the heart of our NHS, and if we do not end this historic injustice, we will let down countless families across the country, and that would be an utter disgrace.

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[Heidi Allen (South Cambridgeshire) (Con)]

If I may, Madam Deputy Speaker, I would like to ask you to cast your mind back to the summer. As a new MP, I was sitting on the grass on a Sunday reading through my casework. There were many of the usual items of correspondence on housing, planning and so on, and then a letter, and a moment I will never forget. It was from a constituent, Steve Mallen, telling me about the tragic suicide of his 18-year-old son—a brilliant, gifted young man with grade 8 piano, straight A*s at A-level, and a place reserved at Cambridge University. Ten months ago today, Edward Mallen took his own life in front of a train. “Mental health”—they are not dirty words. We all have a state of mental health, just as we all have a state of physical health. We have good days and we have bad days. We all have them, every one of us. For most of us, the good days follow the bad days and overcome them, but tragically this did not happen for Edward.

Today I want to talk about what we in this Chamber can do to make sure that there are no more Edwards. Members will know that I want this House to work together to resolve problems, not to point fingers at failure. So I urge those in all parts of the House to recognise the good work that has been done so far and to commit, from this day, to working together to achieve more. I believe that we are building on the foundations laid by the tremendous work of Norman Lamb and the Health and Social Care Act 2012. We have seen investment of £1.25 billion to help deliver the Future in Mind Initiative, the appointment of Sam Gyimah, and the appointment of Natasha Devon as the Department for Education’s first schools mental health champion—and boy, what a fireball she is! Only this week, we had the announcement of a £3 million pilot programme to support mental health leaders in schools across the country. Given that 10% of children under 16 have a clinically diagnosable mental health problem, and 75% of all mental illness predates higher education, we are focusing on the right things.

Prevention is far better than a cure, because by the time a cure comes, families, communities and the wider economy have been devastated. Ask Steve Mallen, his family and the village of Meldreth, because they know. We could argue all day about whether the Government are spending enough on the cure, but I do not want us to do that.

[Norman Lamb]

The hon. Lady is making a passionate case, particularly in relation to the tragic case of her constituent. Does she agree that we need to get the whole of the NHS to sign up to a commitment to a zero suicide ambition? That is not about setting a target, but about changing the culture so that everyone focuses on saving lives.

[Heidi Allen]

That is fundamental and there should be no alternative. The right hon. Gentleman is absolutely right.

Nobody doubts the need to improve mental health care or the fact that money does not grow on trees. Investment is increasing, but I fear that the scale of the problem is far greater than any Government cheque book. It is so much bigger than that, but the good news is that we are capable of being bigger than that, too. Let us cast aside party politics and make this our issue, not just the Government’s issue.

In South Cambridgeshire, we are pooling together the resources of schools, world-leading academics, mental health charities, business, local authorities, politicians and parents—everyone—to do things differently. With Steve and the memory of his son, Edward, at the helm, we want to roll out a timetabled early intervention and prevention programme in every single one of our schools. We are trialling and developing it, and in March next year we will launch it at an international conference in Cambridge, which Alistair Burt has kindly committed to attend.

Cities and Local Government Devolution Bill [Lords]

Norman Lamb Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Allen]

The right hon. Gentleman talks about moving at pace and then immediately suggests that England should have what Scotland has. I would go with the latter of his contradictory points: in such devolution Bills, England should have everything that has been obtained by the Scottish people. To round out the package, England should in particular have not just the powers but the financial capability to make the powers real.

I will talk later about new clause 5, which says that we can have income tax assignment to England, in just the way it pertains to Scotland, without civilisation as we know it falling apart. I would add that that would renew and strengthen the Union, which will need to happen in future decades, as a federal entity in which the nations of the Union work together very closely as a family, but all retain a degree of income tax in their areas to make their own country work effectively.

[Norman Lamb (North Norfolk) (LD)]

I share the hon. Gentleman’s view about financial powers going alongside the responsibility for providing services, but does he not agree that there is a case for devolving responsibility for income tax to below the England level? Most local services in Sweden, for example, are run through tax raised locally, rather than at national level.

[Mr Allen]

I am delighted to hear the Liberal Democrats proposing something in opposition that, sadly, they did not propose when they were a key member of the coalition Government during the past five years. Before Labour colleagues smile too much, however, the previous, Labour Government also did very little on this matter. [Interruption.] My hon. Friend the Member for Blackley and Broughton (Graham Stringer) says that they did. Obviously, I would never be so disloyal as to underline such remarks by repeating them on the Floor of the House, but—

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[Mr Brady]

I agree wholeheartedly. I devoutly hope that Ministers even at this late hour will recognise that it is very much in their own interests and those of the Government, and entirely in the interests of the people of the combined authority areas which may face these new arrangements of governance, to accept the point. I am especially hopeful given the sterling work my hon. Friend the Minister did in the last Parliament trying to ensure that people had the opportunity to give consent on the arrangements surrounding our membership of the European Union. I know he will recognise that, given his deep commitment to democracy, it would be entirely consistent for him to recognise the wisdom of the proposal.

New clause 8 is in tune with the essence of the Bill and the essence of the Government’s intentions. There are very few of us on either side of the House who would argue with the proposition that it is generally better for power and decisions to be exercised as close to the people as possible. It is almost invariably better for decisions, including spending decisions, to be taken more locally, and new clause 8 seeks to place an extra protection in the Bill: a safeguard seeking to limit the occasions on which the legislation could be used to permit devolution in the wrong direction. That is not really devolution at all, of course. Rather, it is the opposite of devolution: it is the capacity that exists in the Bill as it currently stands for powers to be moved up, away from the people and away from local authorities which currently exercise powers, to the combined authority or to mayoral authority level. It is a very modest measure—[Interruption.] My hon. Friend the Member for Bury North (Mr Nuttall) endorses that view, and I was surprised at just how modest my aspiration had become during the course of this process, perhaps due to the endless courtesy and charm of the Secretary and State and the Minister.

All new clause 8 seeks to do is ensure that, if a local authority decides to transfer a power to the mayoral level, there would be a cooling-off period before it became permanent, and crucially that a local election must be held before such time that that transfer of power away from the people in the wrong direction—this anti-devolution—can become permanent. That is a modest but important safeguard, and I hope Ministers will accept it would be in their interests and the interests of good governance to incorporate it.

Perhaps the most important measure in this group is amendment 57, which sits, almost naturally, as a part of a couplet with the proposition for a referendum. In a way, if we do not have one of them, it becomes even more important that we have the other. If the Government are not going to consult the people directly on the new governance arrangements that will apply to them by allowing a referendum, it is even more important that the arrangements set out in amendment 57 should be incorporated, which would allow a local authority, in the event that the new arrangements do not work in the interests of that local authority area, to seek at a future date to leave, with a fair distribution of both the liabilities and assets of the combined authority.

I have sought to ensure proper fairness and a reasonable arrangement in the unlikely eventuality that a local authority would reach the point where it was convinced that the new arrangements were not in its best interests. That would provide the necessary reassurance to people that this is not an irrevocable step, and that if it does not work, there is a way out of it. Perhaps most importantly, it would also place a real discipline on an elected mayor and ensure that the holder of that office would at all times seek to behave reasonably and reflect the interests not just of the majority of the area of the mayoral authority, but of the whole of it. The risk that an elected mayor may at some point in the future seek to govern in a way that is clearly contrary to the interests of any one part of a conurbation would be massively greater if the Bill were to proceed unamended. Again, I very much hope Ministers will recognise that the Bill would be strengthened and improved by amendment 57.

[Norman Lamb]

I want to speak in support of new clause 10 and to make a brief comment on amendment 7. The new clause seeks to reinstate in the Bill, as brought from the Lords, the provision to allow votes for 16 and 17-year-olds in local government elections. As a matter of principle, I support the idea of votes for 16 and 17-year-olds, whether in national elections, local government elections or referendums. I supported the case for 16 and 17-year-olds to vote in the Scottish referendum. I have also argued the case, along with many others, for them to be able to vote in the European Union referendum, because it is their future that we will be debating.

In the context of the Bill, I strongly support the case for 16 and 17-year-olds having a say, for goodness’ sake, in the election of their local councillor. I find it extraordinary that the Government oppose the proposal so strongly. I appreciate that the Secretary of State has indicated that there is a debate to be had on the subject, and that we might explore it more fully on other occasions, but how long does this have to take? Those 16 and 17-year-olds can join our armed forces to defend the country, they can marry and they can pay taxes on their income if they are in work, yet they cannot have a say on how those taxes might be raised, on the extent of them or on how they might be applied. As citizens they ought to have the same rights as the rest of us enjoy, and I urge the Government to think further on this.

We often make points about the low turnout among those young people who are entitled to vote, and about the low engagement in the political process. I made the point in our previous debate on the issue that young people are very interested in a range of political issues, but there is no doubt that in many cases many of them are disengaged from the political process. If we are to seek to change that, surely giving these young people the right to a say in the political process would help. The turnout among 16 and 17-year-olds in the Scottish referendum, at about 75%, is indicative of a level of interest in the issues, which the Government ought to recognise.

David Willetts, the well respected former Minister in the coalition Government, has made a point about the breaking of the generational contract. This is a serious concern. Political parties tend to focus a lot of their attention on the interests of older people, who of course tend to vote. I would argue that there is a lack of attention being paid to the interests of young people, particularly 16 and 17-year-olds, who have no vote at all.

[Mr Nuttall]

I am getting confused. A few seconds ago, the right hon. Gentleman was trying to convince the House that 16 and 17-year-olds should be allowed to vote because such an enormous number of them had turned out to vote in the Scottish independence referendum. Now we are told that we are ignoring them because they do not turn out to vote. Will he just clarify which of those two arguments he would like us to accept?

[Norman Lamb]

We saw in the Scottish referendum that, if you seek to engage with young people, they will respond. They turned out in record numbers. I understand from the study that took place following the referendum that the turnout was 75% among that age group. I also made the point, however, that there is a lack of engagement with the political process as a whole among young people. I am sure that the hon. Gentleman would agree with me on that. I believe that it is incumbent on all of us to change that by getting young people to feel part of the process and to participate in it. If we give 16 and 17-year-olds the right to vote, it sharpens their minds and focuses their interest because they have an opportunity to participate in the political process.

[Sir Edward Leigh (Gainsborough) (Con)]

The right hon. Gentleman is making his arguments very well and I do not want to take him to task over them, but I want to ask him a question. Presumably the Bill will again end up in the House of Lords, as the European Union Referendum Bill has done. Does he think it is the place of unelected people in the House of Lords to make a decision on this question, or should it be reserved to the House of Commons?

[Norman Lamb]

I continue to argue strongly that we should have a democratically elected second Chamber, and we sought to achieve that during the coalition Government. Sadly, Conservative Members managed to block that long-overdue reform. [Interruption.] I think the hon. Member for Nottingham North (Mr Allen) is agreeing with me from a sedentary position. But we are where we are, and because Conservative Members ensured during the last Parliament that we still have to put up with an unelected second Chamber, it will just have to do the job as best it can. It is a revising Chamber and I hope that it will again make the argument that 16 and 17-year-olds should have the right to vote. I hope that I have responded adequately to the hon. Member for Gainsborough (Sir Edward Leigh).

David Willetts made the case strongly that there had been a break in the generational contract. I believe that it is incumbent on all of us to address that serious issue and to ensure that all political parties start to show a real interest in the interests of young people. If 16 and 17-year-olds had a vote at local and national levels, there is no doubt that the parties would focus more attention on their interests.

[Graham Stuart (Beverley and Holderness) (Con)]

The right hon. Gentleman said that the interests of young people are not properly reflected, partly because they do not vote, but he then said that giving the vote to even younger people who were even less likely to vote would somehow change the way in which the Government operated. I just do not understand the logic of that. Will he also tell us what is so special about 16? Why not choose 15? Is this about paying tax? We have to draw the line somewhere. What is the principle on which he is basing his argument?

[Norman Lamb]

On the hon. Gentleman’s last point, I of course accept that this is an arbitrary line. The current age at which people can start to vote is also arbitrary. We have chosen to make it 18. My argument is that we can reduce it because people aged 16 and 17 have rights and play a significant part in society. For example, they can join the armed forces, they can work and pay taxes on their income and they can marry. Those are all significant rights and responsibilities, and if they have such rights and responsibilities they ought surely to have a say in the election of our national Government and in the election of local authorities as well.

[Graham Stuart]

If the right hon. Gentleman were charged with a serious offence, would he really want 16 and 17-year-olds serving on the jury and deciding on his guilt or innocence? I certainly would not. We are talking about a certain level of maturity, and the line we have drawn is an appropriate one. If we would not want a 16-year-old sitting on a jury deciding whether or not we went to jail for 10 years, I suggest that we would not want to let them play a part in the election of the Government of the country.

[Norman Lamb]

With all due respect, I think that that is a distraction from the issue we are debating today. I repeat my argument that if 16 and 17-year-olds are able to join the armed forces, pay taxes on their income and marry, which are big responsibilities and rights, they ought to have a say in the election of their Government, either at national level or locally.

[Alison Thewliss (Glasgow Central) (SNP)]

Does the right hon. Gentleman agree that some of the Conservative Members’ arguments do not quite stack up? Maturity is not necessarily to do with age, after all. People of any age can be deemed to be immature, yet they can still serve on a jury and vote in elections.

[Norman Lamb]

I absolutely agree with the hon. Lady about that. The argument made by Conservative Members could be used, by logical extension, to deny democracy entirely or to deny trial by jury. I seek to oppose both those logical extensions and to make the case again for 16 and 17-year-olds to have the right to vote. In this Bill, we are talking about their having a say in the election of their local councillors, for goodness’ sake. If the Conservatives seek to deny 16 and 17-year-olds such a basic right, in their own local community, I strongly oppose them on that. The Government say this issue deserves further discussion, and I welcome that, but why can they not just get on with it, accept the principle and legislate for it today?

[William Wragg (Hazel Grove) (Con)]

I rise to speak to amendment 2, which stands in my name and those of a number of right hon. and hon. Friends. As a former councillor in Stockport, I draw people’s attention to my entry in the Register of Members’ Financial Interests.

The purpose of the amendment is clear: to ensure that a referendum is held in a combined authority area before any mayoral model of governance is adopted. I am pleased that a number of colleagues have felt able to support it by putting their names to it, and I know that a number of others have some sympathy with it. I thank the Secretary of State for his courteous understanding of my concerns. Such a generous and fair approach is, as colleagues from across the House will attest, typical of the thoughtful and decent man he is.

I extend a similar tribute to the Under-Secretary of State for Communities and Local Government, my hon. Friend the Member for Stockton South (James Wharton), who has handled my reservations with good humour and more than a degree of tenacity, and I thank him sincerely for that.

My motivations for tabling the amendment are several. First, this is very much a local issue of concern, given that my constituency is part of the Greater Manchester area, which has been earmarked for an elected mayor in 2017. I can discern no real demand for this innovation among my constituents—indeed, there is a certain degree of reservation. However, despite their and my scepticism, I am prepared, as I argued on Second Reading, to accept that perhaps there is some demand and so I am perfectly willing to let the people have their say at a referendum, in order to allow them to express their view emphatically. Of course, the outcome either way would be something I would respect entirely.

Although not wishing to prejudge the outcome of such a referendum, I remind the House that directly elected mayors were in recent memory rejected by a number of constituent boroughs of Greater Manchester—Bury and Manchester itself—and subject to widespread rejection across the country in 2012. I thought the Conservative party’s policy at the time was absolutely right: mayors in metropolitan areas should be introduced only if there was a referendum and assent was given. The policy of holding a referendum was correct three years ago and I contend that the opportunity to have a democratic decision at a referendum remains equally valid today.

My overriding concern is, I expect, understandable to many colleagues with shared experience in local government: when new models of local government are seen to be imposed on areas, even if more carrot than stick is used, there the danger lurks. Some will still see the Local Government Act 1972 as an act of municipal desecration, with the break-up of centuries’ old counties and the formation of false constructs, but, aside from mocking the quaint fustiness of those dinosaurs—I do not refer to anybody in this House—we should take a valuable lesson from it: people should feel a sense of belonging to the area in which they live. Furthermore, as this amendment proposes, they should feel a sense of ownership over the formation of entities that govern them.

--- Later in debate ---

[Mr Rees-Mogg]

I was going to say that it was because of my efforts in Glenrothes in 1997, but I think that that would be untrue. I would be accused of misleading the House. I think it is to do with the fact that we have a fantastic leader of the Conservatives in Scotland and an inspired Secretary of State. The two combine to make Conservatism in Scotland the coming force. However, that strays from the main topic of why first past the post is a preferable system. It is important to have a victory for the most popular rather than the least unpopular. It encourages the most charismatic figures and people who have a strong party affiliation to stand. That is important.

I am not a great believer in having huge numbers of independents running our great cities. There is a danger that if we take people outside the party system they do not have a particular badge to stand under and it is not clear at the outset what they represent, other than independence. They have no fall-back as regards having someone senior in the political system to get in touch with to guide them.

[Norman Lamb]

I am very grateful to the hon. Gentleman for giving way, and I totally disagree with everything that he is saying. Does he not think that there is a risk that with first past the post in local government one can end up with a complete one-party state, as has happened in some Liberal Democrat councils, some Conservative councils and, indeed, some Labour councils? The net result is a sort of rotten borough with poor local government and no accountability.

--- Later in debate ---

[James Wharton]

It is entirely a matter for the Isle of Wight whether it would like to be part of any devolution deal. That would not be imposed on any area. Which areas we would want to see a mayor in as part of a deal, would depend on the deal and what was being asked for in the discussions that took place. There is no single fixed model that we would look to apply, cookie cutter-like, to different communities, but I assure my hon. Friend that if the Isle of Wight did not want to be part of something and felt it would not serve its interests, there is nothing in the Bill that would allow us to compel it to do so.

Amendment 57, tabled by my hon. Friend the Member for Altrincham and Sale West, would enable a local authority to leave a mayoral combined authority, and, should that happen, provide for a fair division of resources. The existing combined authorities legislation, section 106 of the Local Democracy, Economic Development and Construction Act 2009, and the Bill already enable an order to be made to remove a local authority from a combined authority with consent from the area, agreement from the Secretary of State and approval from Parliament.

There would, of course, be a number of practical issues to deal with before making such an order: for example, setting up alternative operational arrangements, working out how to divide budgets and any contractual arrangements. However, the 2009 Act and the Bill provide for that. If an order is made to remove a local authority from a combined authority, it must specify an authority to become the local transport authority. The Bill provides further powers to enable such an order to transfer combined authority functions to another public authority or to be ceased.

We consider that the provisions provide all the powers and flexibility necessary to enable a local authority to leave a combined authority, where that is wanted locally; where the Secretary of State considers that to do so is likely to improve the exercise of statutory functions, and has regard to the need to reflect the identities and interests of local communities, and to secure effective and convenient local government; and where Parliament approves the making of such an order. With those assurances, I look to my hon. Friend not to press the amendment.

I now turn to amendments 7, 8, 13, 15, 18, 19, 20, 26 and 54. The Bill already enables one local authority to be removed from a combined authority if it does not wish to agree to the combined authority’s proposal to adopt a position of mayor. I look to my hon. Friend the Member for North East Somerset, who I know from his earlier comments has a particular interest in this matter. The amendments extend the provisions and would mean that, if one or more councils within a combined authority do not wish to adopt particular aspects of a devolution deal, but the combined authority and other councils within it do, then the area of the combined authority is changed to remove the council or councils that do not wish to participate.

[Norman Lamb]

I would like the Minister to reassure the House that the emphasis will be—I think the shadow Minister made the point in his contribution—on consensus and that we should only get to the point of imposing this if all else fails. Will the Government issue guidance to ensure that the emphasis is on local agreement?

[James Wharton]

The emphasis is absolutely on local agreement and consensus. There is no power to impose devolution structures on areas that do not want to be part of devolution. Indeed, the amendments will ensure that areas that do not want to be part of a deal are able to leave that combined authority should they wish to do so. The amendments give greater flexibility to existing combined authorities to implement devolution deals, and to build further on the flexibility of the enabling approach in the Bill.

On amendment 9 and amendments 11, 12, 14, 21, 22, 23, 24, 25, 27, 28, 29 and 50, they are designed to simplify and harmonise the Bill’s provisions relating to the consents needed locally before powers can be conferred or exercised. We have tabled them in response to issues raised during earlier stages of consideration of the Bill in the House. They will standardise the provisions, so that the default position would require the constituent authorities and the combined authority to consent before secondary legislation is made. An exception is that for the dissolution of a combined authority, the consent of a majority of the constituent local authorities is required before such an order can be made. This simply retains the status quo.

I will now speak to amendments 27, 32, 33, 52 and 53, which further increase flexibility within the Bill’s provisions to enable combined authorities to be established and functions conferred. We are bringing them forward in response to our discussions in Committee, where some hon. Members outlined particular challenges in their areas. As is clear, the amendments do not in themselves change any combined authority in any place, but provide the flexibility to allow agreements to be made and delivered.

Mental Health: Out-of-Area Placements

Norman Lamb Excerpts

Thursday 3rd December 2015 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

It is a great pleasure to be able to raise a very important issue for debate, albeit three hours earlier than expected. It is good to see the Minister for Community and Social Care taking his seat.

I want to raise an issue of profound importance. It is a practice which I think is intolerable but which carries on every week of the year and probably every day of the year: the shunting of people around the country, sometimes a long distance away from home, at a moment of mental health crisis. Typically, someone at a moment of acute crisis would be taken into hospital but there would be no bed available for them, so they would be taken away somewhere else in the country. There are numerous stories of people being taken hundreds of miles away from home on a regular basis.

Such practice would never be tolerated in physical health services. Let us imagine, for example, someone who had had a stroke or with a heart condition being taken by ambulance and being told, “I’m sorry, there’s no room at the local hospital. We’re taking you to Cumbria from Norfolk.” It would be an outrage. It would be regarded as a scandal, so it does not happen—yet it happens every week of the year in mental health. I regard that as discrimination at the heart of our NHS and it is one of the very many examples of how people who suffer from acute mental ill health are disadvantaged by the system.

Incidentally, I make no criticism of any individual Government; this practice always happened, but there has been a rise in the number of instances, which I will come to in a little while. In many ways, someone suffering from mental ill health does not get the same right of access to treatment at a moment of need as someone with a physical health problem. If any of us in the Chamber stopped and thought about it for a moment, we would conclude that we cannot begin to justify that, and that there must be a programme designed to achieve genuine equality of access to support at that moment of need.

[Mr Mark Williams (Ceredigion) (LD)]

I congratulate my right hon. Friend on securing this debate about an area in which he has done so much work to date. The debate is about out-of-area mental health placements, but does he agree that there is also a huge problem in some of the vast health board areas—in our case in Wales—where rurality is an important factor? For instance, the closure of the Afallon mental health ward in Bronglais hospital in Aberystwyth means that constituents of mine have to travel or be sent 50 miles away—not over the easiest terrain—to the Morlais ward in Carmarthen. There is a huge problem across the country, but there is a great problem in those great geographic areas too. I do not expect my right hon. Friend to comment on the details of the Welsh national health service, but I am sure the problem is replicated in English health areas.

[Norman Lamb]

I am grateful to my hon. Friend for raising that. He makes an extremely important point. I will come on to address it in more detail later.

There is, for example, evidence of an increased risk of suicide if people are treated a long way from home and family and friends who struggle to visit them. The idea of care close to home is incredibly important in mental health. We should, as far as possible, seek to care for people at home, not take them into hospital unless that is unavoidable. There are times when that is necessary, and as far as possible there should be a place close to home.

[Mr Williams]

I know that what I am about to ask is not a central point of my right hon. Friend’s debate, but does he agree that one of the unacceptable outcomes has been the increased use of the police and police cells for holding people overnight? That has been the situation in my constituency.

[Norman Lamb]

That is a shocking practice. I applaud my hon. Friend for the work that he has done on it in his area. The idea of putting someone who is suffering an acute mental illness into a police cell, which is defined in the legislation, unbelievably, as “a place of safety”, is bizarre and ought not to be tolerated. I am pleased that the Government have indicated an intention to legislate, in effect to eradicate the problem completely for under-18s and to make it an exception for adults. We managed to reduce the numbers in England by 50% in the past two years, which was considerable progress, but we need to go much further and bring an end to an unacceptable practice.

It is interesting that where local passion and drive exist, amazing things are possible. In our capital city, London, last year around 20 people in total ended up in a police cell, whereas in Sussex the number was over 400. That demonstrates that with real drive from both police and mental health services, practices can be changed and people’s lives can be made better. My hon. Friend is right to persist with the issue in Wales, just as I have tried to do in England.

[Kevin Foster (Torbay) (Con)]

I congratulate the right hon. Gentleman on securing the debate and on the work that he has done to bring the issue to the fore. A police cell should be for someone charged with a crime, not for someone who is unwell. Does he agree that to some extent the problem could be overcome with better co-ordination? I had a case in my constituency where a local treatment unit was full so a person was placed in Maidenhead. We then discovered that there was someone from Maidenhead in the local treatment unit in Torbay and arranged a swap.

[Norman Lamb]

Such a story makes one weep and leaves one feeling that there is a degree of incompetence somewhere. I will come to that point. Much of what I want to see happen can be done by better organisation, rather than by providing more money. I strongly believe that we need more investment in mental health services, but a lot can be done just by organising things much better.

[Tom Brake (Carshalton and Wallington) (LD)]

Will my right hon. Friend commend the work that South West London and St George’s Mental Health Trust has done with a number of local authorities in the area, including mine? The police work with a nurse, to ensure that if the police are dispatched somewhere where a person has a mental health problem, there is someone who is able to assess them immediately and ensure that they go to a place of safety, as opposed to going to a police cell.

[Norman Lamb]

Absolutely. My right hon. Friend is talking about something called street triage—I am sure that the Minister is familiar with it—which we introduced in many areas of the country over the past two to three years with a bit of pump-priming grant. Some pioneering areas, such as Leicestershire, just went ahead and introduced it before the national pilots started. The evidence is dramatic. Where we have that collaboration between the police and mental health services, with a nurse embedded in the police team, we achieve amazing results. We completely reduce the number of people being taken in under that legislation, because the nurse can find alternative solutions or provide care at home. Where it is necessary to take somebody to a place of safety, the numbers having to go into police cells falls dramatically. That innovative work was very much part of the crisis care concordat that I pioneered when a Minister, the aim of which was for the first time ever to set standards in mental health crisis care.

[Mr Mark Williams]

It would be wrong not to acknowledge in my area the Dyfed-Powys police and how the health board has embarked on such an initiative. My right hon. Friend will acknowledge that areas such as mine face the challenge of rurality and making those services available where they are needed. There is still a fear that all too often the need is not met.

[Norman Lamb]

I agree. My own county of Norfolk, with its widely dispersed rural communities, suffers from the same challenges. Sometimes having a nurse in a car with a couple of police officers does not work in a big rural area. However, we can do other things, like having a nurse embedded in the police operations room so that whenever an issue arises they can speak immediately by telephone or, if necessary, get a resource to the scene. Depending on the geography, there are ways of dealing with those challenges. We need to be much smarter in doing that. I applaud the innovation across the country.

Our whole approach in the crisis care concordat was rather different from the traditional Government approach, which is sort of to impose a straitjacket. The crisis care concordat said, “These are the principles. You come up with your plan for implementing them, working with the police, mental health services and the local authority, in a way that works for your locality.” That generated the most amazing degree of innovation across the country, and real progress has been made. Although I initiated it, I have enormous admiration for the people on the ground who got on and did it. It was inspiring.

[Tom Brake]

Will my right hon. Friend give way?

[Norman Lamb]

I will give way, but then I really ought to make some progress.

[Tom Brake]

I want to return to the point my right hon. Friend started with. We had an issue in Sutton where the mental health facility is based on what had been the Sutton hospital site—it was shut down mainly because Legionnaires’ bacteria were discovered. Patients now have to travel to Springfield hospital. As we see more people being treated at home, which is what we want, and therefore fewer people in acute crisis, how does he deal with the fact that, because hopefully fewer people will need to be treated in specialist centres, there is likely to be a smaller number of them?

[Norman Lamb]

My right hon. Friend makes a good point. Again, it means that we need to think afresh and innovate. The third sector has been very good at coming up with concepts such as crisis houses, where at quite low cost a facility can be provided in a locality where someone can go at a moment of crisis. They therefore might not need a formal hospital admission, and it might be a much more therapeutic place to be as they get through their crisis. I recently visited the Hertfordshire Partnership NHS Foundation Trust, which, in addition to crisis houses, has host families that someone can go to be with, if that is appropriate, for a week or however long is necessary. That might be exactly what is needed, rather than the cold, clinical environment of a hospital ward. That sort of innovation is what we need in order to ensure that we have services that meet patients’ needs.

I want to share with the House the testimony of a constituent who has experienced an out-of-area placement. It has been anonymised, for obvious reasons, but it is very powerful none the less. It is quite shocking. It reads as follows:

“I was admitted to accident and emergency at Norfolk and Norwich Hospital on a Wednesday afternoon, following a suicide attempt. I regained consciousness the following day, having been transferred to the Acute Medical Unit, and it was quickly decided that I needed to be admitted to a mental health ward.

I had previously been on Glaven Ward at Hellesdon.”

That is the mental health hospital in Norwich. My constituents continues:

“At this point I was very woozy, suffering from a dangerously low mood, and angry that my suicide attempt had failed. I was at grave risk of making another attempt on my life. Throughout the Thursday and Friday efforts were made to find a mental health bed.”

That is what happens in the system.

“My parents were frantically trying to find out what was happening, as they were desperate for me to be looked after locally. For a time we were told that I would be going back to Glaven Ward at Hellesdon, but the news kept changing between there and a unit in London.”

London is between 120 and 130 miles away from Norwich, and further away from my constituent’s home.

“I was expecting to go to Hellesdon on Friday morning, but we were then told later that day that I would be going to south London. During the Friday, I twice walked off the ward and out of the hospital, without my absence being noticed, and went down to the Watton Road”—

which is near the hospital—

“with the intention of walking in front of a bus or a lorry. The main reason I didn’t go through with it was that I did not want the vehicle to swerve into an oncoming car and cause death or injury to someone else.

Meanwhile, my parents resorted to contacting the crisis team, as they could not get any information from the bed team. A member of the crisis team took responsibility for finding out what was happening and he was able to let me and my parents know that I would be transported to south London later that Friday evening.

Finally, after more uncertainty”—

this is really shocking—

“two men arrived to take me to London. At 10 pm, feeling suicidal, frightened and confused, I got into the back of a private ambulance (which was no more than a pretty austere minibus) and was driven away from the Norfolk and Norwich Hospital. Throughout the three-hour drive, I was spoken to just once by one of the two men, and felt more like a prisoner being transported than a patient.”

That is the way our NHS deals with someone who is acutely ill. It is really shocking. It ought not to be accepted. My constituent went on:

“At 1 am, by now completely disorientated, I arrived at the front door of the mental health unit in south London. After lots of knocking at the door, someone answered, and I was handed over with a quick ‘good luck’. I was booked in and shown to my room. I felt isolated and scared. My room was nice, but the unit felt like a prison. The internal doors were like cell doors, and there was a tiny outdoor area, fringed by a high fence with spikes on the top. It was a mixed ward, both in terms of sex and in terms of illness: people with depression and anxiety were alongside those with psychosis, personality disorders and acute problems.”

It is really shocking that a whole load of people with completely different conditions were thrown together like that. It is probably the least therapeutic environment imaginable. That is about containing people, not caring for them, and it ought to be a thing of the past.

[Mr Henry Bellingham (North West Norfolk) (Con)]

I had a similar case in King’s Lynn, although I cannot go into it because it ended in tragedy, with the individual committing suicide, having previously made an attempt. Does the right hon. Gentleman agree that it is absolutely essential in such cases that there is proper monitoring and supervision of the individual, whose life is obviously at risk during such an episode?

[Norman Lamb]

It is absolutely critical that that happens —not only monitoring but proper treatment. As I will go on to describe, that is not what happened in this case.

The constituent continues:

“The following morning, I had a meeting with my named nurse. Extraordinarily, it was the only real conversation I had with him until I was discharged back to Norfolk 10 days later.”

That is not therapeutic care—it is neglect. I have asked whether there are any contractual requirements on the private provider who provided that “care” and received a substantial sum of money for it. I have been told that it was understood that there would be therapeutic care but no apparent requirement that that should be undertaken in return for a substantial amount of public money being spent on his care. He goes on:

“The care was unacceptable. It felt as though I was being kept in a holding facility, and my mental health deteriorated, with my suicidal thoughts increasing. In stark contrast to Glaven at Hellesdon, the staff were holed up in an office with a heavy steel door that you couldn’t see into. I was being checked up on every 15 minutes, as I was a suicide risk.

But I rarely had a conversation with a member of staff. My parents came down from Norfolk twice to see me, and were horrified by what they encountered—both the level of care and my deterioration. They were constantly contacting Norfolk and Suffolk mental health trust to try to get me moved back to Hellesdon. The stress made them both ill.”

That shows the impact there is on families as well. He continues:

“Thankfully their persistence paid off, and after 10 days, I was told that I was going to be recalled. I had a brief period of uncertainty, as I didn’t know whether I would be going to Hellesdon, King’s Lynn or Great Yarmouth.

Eventually, I was told it would be Glaven at Hellesdon, and I got into a taxi with a member of staff and was driven from south London to Glaven Ward.

When I arrived there, I cried, mainly through relief. I was greeted with compassion and understanding by the staff, and—after 10 wasted and expensive days—my recovery finally began.”

That experience, sadly, is repeated day in, day out across the NHS. It is a scandal that it continues. One of the things I will put to the Minister when I conclude is that I want his commitment to end this practice, because it is intolerable that it continues in this day and age.

I mentioned cost. An analysis has been done by the national confidential inquiry into suicide and homicide by people with mental illness, which, having looked at 29 providers, says that the cost of out-of-area placements went up from £51.4 million to £65.2 million in 2014-15. That is an extraordinary amount of money to spend on an unacceptable practice, demonstrating that with smarter use of the resources available it should be possible to bring that practice an end.

The national confidential inquiry also found that being treated out of area increases someone’s risk of suicide. The pattern is most apparent in England, where suicides by in-patients and patients recently discharged from hospital have fallen, although suicides following discharge from an out-of-area ward have increased. The annual number of suicides after discharge from a non-local unit has increased from 68 in 2003-07 to 109 in 2008-12. Experts have warned that mental health patients are at the highest risk of taking their own lives in the first two weeks after being discharged from hospital, and these figures confirm that. When we are talking about a risk of people actually losing their lives, surely we have to see the absolute importance of bringing this practice to an end.

I want to refer to a recent report by the Independent Mental Health Services Alliance called “Breaking Down Barriers: Improving patient access and outcomes in mental health”. It says that we must prioritise something that I have argued for consistently—the introduction of comprehensive waiting time standards in mental health so that someone with a mental health problem has exactly the same right of access to treatment as anyone else. It also says that people who end up in an out-of-area placement, sometimes a long way from home, get “lost in the system”; they are almost forgotten about. They are away from the commissioners and the normal provider, and they can sometimes languish in these centres for far too long. That, again, is completely intolerable.

The report also refers to the problem of delayed discharge. It says:

“We have found that between 2013/14 and 2014/15, the average number of days of delayed discharge per month for trusts providing mental health services increased by 22.2 per cent. This indicates that delayed discharges are having an increased impact on patients’ access to appropriate care.”

In other words, if beds are clogged up by people who are ready to leave and go home or to go to another facility, but they cannot because nothing else is arranged for them, then someone else at a moment of crisis cannot get access to a bed and is shunted off, sometimes to a place a long way from home. That is a completely unacceptable practice.

The report refers to children and young people’s mental health services. The Minister will be particularly aware of the acute concern about children being shunted off, often to places hundreds of miles away from home—an intolerable practice. I know that that has happened in the south-west, where there has been a particular shortage of beds for children. A team within NHS England undertook an inquiry that came up with recommendations for eradicating that problem. The taskforce’s report, “Future In Mind”, which we published shortly before the general election, pointed to the absolute need to care for people close to home and to have better crisis support to avoid admissions where possible. Yet the practice continues, and it must be a priority for the Minister to bring it to an end.

One of the things that “Future In Mind” sought to address is the perverse incentive that exists in the system with the awful tiering of care within children’s mental health services. If a child is put into tier 4 from tier 3 because it is judged that they need more acute in-patient care, then the financial responsibility for their care is transferred to NHS England. There is therefore an incentive for local commissioners to push them into the top tier, which is precisely the opposite of what ought to be happening. We ought to be focusing our incentives on preventing deterioration of health, not shunting people into the most acute care, too often away from home. Imagine what it must be like for the parents of, say, a 14-year-old child who is taken to a unit 100 miles or 200 miles away from home. It is really shocking, and I hope that the Government will feel the need to commit to eradicating that practice as quickly as possible.

When the issue came to my attention as a Minister, I asked my officials to provide me with data to find out what was happening around the country. I was confronted by freedom of information requests by campaigning organisations and by news reports of shocking things that were happening in the system, but I had no information on which to base my own judgment. I was told by the officials that they did not collect data on the issue. The Government are operating in a complete fog, and we have to rely on campaigning organisations to make inquiries under the Freedom of Information Act 2000.

Incidentally, I urge the Minister to use what powers of persuasion he has to argue against undermining the Freedom of Information Act. At the moment, a process is under way that runs the risk of doing precisely that. It seems to me that freedom of information is a really important way of holding the Government to account.

I was faced with having no information or data on that practice, so we initiated a process to collect such data. We have now collected those data. They are still in experimental form, but they are better than nothing. The data show that there is extraordinary variation around the country. That brings me back to the point that this is about not just extra money, but good practice. It is about learning from areas of best practice. We now discover that many mental health trusts have no out-of-area placements, but they are funded in broadly the same way as those in areas that have a persistent and unacceptable problem.

There is a three-month delay before the data are published, so the latest data are those from the end of August, but 2,198 people were in out-of-area placements at that time. We are not entirely clear about whether the drift upwards is caused by the collection of more data or by a worsening of the problem. I do not want to draw the wrong conclusion from the numbers, but they certainly do not appear to be going down.

I want to raise with the Minister the issue that the data are incomplete because some private providers refuse to return data. Under their contractual dealings with the NHS, they are obliged to return those data. When I was a Minister, I raised that matter with officials and with the information centre. Surely, it is completely unacceptable. I have no difficulty with a good private provider providing a good service, but they must absolutely play by the same rules as everybody else.

[Tom Brake]

To return to my right hon. Friend’s earlier point about freedom of information—in fact, there is a case for extending it—is it not right to ensure that private companies doing public work are covered by FOI in exactly the same way? That applies to the health sector, as well as to many other sectors.

[Norman Lamb]

I agree. There should be a level playing field, which there is not at present. We now have the unacceptable situation that data are incomplete because some private providers refuse to play ball. That leaves one suspicious, because if they do not provide data about how many people are held, it is impossible to hold the system to account or, indeed, to hold such private providers to account. The Minister must find a way to hold those providers to account and to ensure that they return the data they are obliged to provide.

A horrific number of people are still sent a considerable distance away from home. In August, 501 people were sent more than 50 km away from home. Surely that practice is intolerable, given what I have said about the increased risk of suicide, the fact that it does not provide therapeutic care and that it can lead to someone being confined for 10 days at enormous cost to the public purse. It seems to me that this is the most outrageous misuse of public money.

There are areas where that problem is persistently at its greatest. In August, the Devon Partnership NHS Trust had 45 people in out-of-area placements. The caveat is that we do not know precisely where responsibility lies, and whether this is a commissioning or a provider issue. However, that is the local provider, and one would normally expect such people to be in a bed provided by the local provider. The figure of 45 people means that significantly more than one person a day is shunted more than 50 km away from home, which is outrageous.

[Mr Bellingham]

Has any analysis been done of whether the families have been contacted in such cases? It is incredibly important that one strand of support for these patients is through their families. What percentage of cases involve families being informed, having given permission for the patient to be moved?

[Norman Lamb]

We do not have that information—the data are very basic—but that matter is crucial. I imagine that communications often fall down when urgent referrals to another location take place.

I would raise another issue about families. If they have to visit a loved one 50 km or 100 km from home, just imagine the cost involved. Members in the Chamber— any of us could be in this situation—can afford to visit a loved one, but many people cannot do so. That is another reason why the situation is intolerable.

[Kevin Foster]

It is very interesting to hear the right hon. Gentleman’s statistics on my own area of Devon. It is important to get to grips with the issue for the reasons he has mentioned. He raised the point about communications in the example of the expensive round trip from Devon to Maidenhead. In many cases, families may know where their loved one will go, but the reality is they are presented with a choice: “Your loved one needs treatment—this is where it’s going to be. There is not much you can do, other than trying to mitigate all the impacts in the best way you can.”

[Norman Lamb]

Such a situation leaves the family feeling desperate, guilty that they can do nothing to help their child or loved one, and powerless to do anything. That is similar to the case of Josh Wills, a little boy with autism, who lives in Cornwall. He was placed in a specialist unit in Birmingham, so we can imagine the journey his parents had to make every week. He was there for more than three years, and when I was the Minister, I had to intervene personally to get the commissioners to London to try to sort out the case. Josh is now back in Cornwall, but it took far too long for that to happen. Such cases must put families under intolerable pressure and strain.

I should mention the areas where the problem is at its worst. In the Lancashire Care NHS Foundation Trust, there were 30 cases in August. Again, that is one a day. In the Kent and Medway NHS and Social Care Partnership Trust the figure was 30, in West London Mental Health NHS Trust it was 25 and in Birmingham and Solihull Mental Health NHS Foundation Trust it was 25. Again, there is the caveat that we do not know where the responsibility lies, but we should all accept that the practice is not acceptable and has to be brought to an end.

The data focus on non-specialist beds. There will be cases, just as with physical health problems, where a patient needs specialist input and where a referral to a specialist hospital, such as Papworth in the case of a heart condition, is appropriate. However, non-specialist beds and services should surely be provided closer to home. So we got these data together and they now allow us to hold the system to account. As well as establishing the dataset, we got Monitor and the Trust Development Authority to do, to use the jargon, deep dives into a number of organisations, both good organisations and those with a bad record of out-of-area placements, to get a better understanding of what was going on. When they reported back to me, their conclusion was that this problem ought to be solvable.

That is the important point for the Minister. It is not that this problem is something we would all love to solve but find it impossible to do. It is achievable, but it requires drive, ambition and determination to see it through. If I may, as an ex-Minister, I will offer a bit of advice to the incumbent. It is no good saying that we need to make incremental progress to reduce the numbers. We need to establish the principle that this practice is not acceptable. Someone in a mental health crisis who does not require specialist care should not be sent away from home, full stop. This is not a difficult issue. It should become what in the NHS is known as a “never event”—it should never happen. If we know that there is a link between this practice and an increased risk of suicide, how can we tolerate it?

The Minister has to set the objective of ending this practice. I understand that it will take time. Back in March, I wanted to see it end by the end of this calendar year. I recognise that that is now not achievable, but I set the objective of ending it within 12 months. That is achievable, provided that there is drive, ambition and purpose to make it happen.

A related issue is that of money. I have made it clear that I totally sign up to the importance of doing things differently and making better use of resources to achieve good results for people. However, investment is needed in mental health. In the negotiations in the run-up to the March Budget, my right hon. Friend the Member for Sheffield, Hallam (Mr Clegg) secured £1.25 billion of extra investment in children and young people’s mental health services for the five-year period of this Parliament. In year 1, the amount that ought to have arrived on an equitable division of that £1.25 billion was £250 million. The amount that was made available was £143 million, which means there is a shortfall.

We were told that that was because we were part way through the year, we had had the general election and we needed to make sure that the money was spent effectively. I sort of accepted that explanation, but I have since heard from reliable sources that there was a land grab going on and that money was taken away from children and young people’s mental health services to prop up the finances of acute hospitals, for example. I urge the Government to make good the shortfall in future years.

On 13 October, the Minister helpfully reconfirmed that the full £1.25 billion would be spent in this Parliament. I call on him to repeat that commitment today. It is critical that the extra investment that was confirmed in the Budget in March is stuck to. It is a matter of good faith by the Government and I would like to hear that confirmation. I also think, incidentally, that we should make good the shortfall in year 2 because, just as with the rest of the NHS, frontloading the money to invest in change is the best way to use the resources that are available.

I will move towards the end of my contribution, which has been rather elongated owing to the additional time that is available. I will end by asking specific questions of the Minister. I would be grateful if he addressed each of them directly this afternoon. If he is unable answer any of those questions directly, I would be grateful if he wrote to me as soon as possible and responded to them directly.

First is the issue of principle. Does the Minister accept that this practice is intolerable? I am not talking about specialist beds; I am talking about non-specialist beds where someone at a moment of mental health crisis, or in other circumstances, is shunted around the country—a practice that would never be tolerated in physical health. Secondly, will he commit to ending that practice completely within 12 months, and effectively to make it a “never event”? Thirdly, will he personally drive that change, because I know from experience that that is necessary? He needs to be on the case constantly to ensure that the system responds to that moral imperative.

Fourthly, will he ensure that all providers provide the data that their contracts oblige them to provide to the information centre? Anything short of that is completely unacceptable. The data are still in experimental form, and information centre notes state that they provide a “reference point” for a more accurate measurement in the future. There must therefore be an evolution to get to a point where data around the country are completely accurate, so that providers and commissioners can be held to account. Will the Minister commit to ensuring that the experimental data are turned into final-form data that we can all rely on?

Finally, will the Minister reconfirm his total and absolute commitment to ensuring that £1.25 billion of additional investment is spent on children and young people’s mental health services this Parliament? Will he commit to sticking with the vision that we published in October last year and to introduce comprehensive maximum waiting time standards? I did that work—which led to the publication of that document—in collaboration with the Secretary of State, and he was incredibly helpful in supporting me to get that published. The vision was clear, and it recognised that until we have comprehensive waiting time standards for mental health, just as exist for physical health, we will not get equality of access to treatment. An essential principle in a publicly funded service is that all people must have the same right to receive evidence-based treatment on a timely basis. As I have said, will the Minister write to confirm any specific point that he feels unable to deal with this afternoon?

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

We have been fortunate in having rather longer than we normally get for an Adjournment debate, and that has allowed the right hon. Gentleman to speak at greater length about some of the issues affecting the historical imbalance between mental and physical health, with particular emphasis on out-of-area mental health placements. I congratulate him on securing this debate, and I am delighted to respond to it.

I thank other hon. Members who have contributed to this debate, including the hon. Member for Ceredigion (Mr Williams), the right hon. Member for Carshalton and Wallington (Tom Brake), and my hon. Friends the Members for Torbay (Kevin Foster), and for North West Norfolk (Mr Bellingham). My hon. Friend the Member for Halesowen and Rowley Regis (James Morris), who chairs the all-party group on mental health, has dropped in as part of his responsibilities in the House, which I welcome. I also welcome the Whip, my hon. Friend the Member for Truro and Falmouth (Sarah Newton).

Before I come on to respond in more detail, let me make one or two general remarks. The right hon. Gentleman referred right at the beginning to the long-standing nature of some of these problems. These issues have not arisen in the past six months. They have been here—Government in, Government out—for some time. The coalition Government made huge strides in recognising the importance of mental health and drove forward some of the changes that needed to be made. It is certainly clear that part of my responsibilities now is to pick up on that and to build on it.

If I may just make reference to the right hon. Gentleman for a moment, I think his key achievements include: the expansion of psychological therapies; the reduction in the use of police cells for people experiencing a mental health crisis; introducing the first access and waiting time standards; and piloting the sense that there has to be parity of esteem. Those achievements absolutely underpinned what I came in to find in the Department. The intractable nature—or at least intractable up to now—of some of the problems has been graphically illustrated by the right hon. Gentleman’s passionate expression today of some of the things he was not able to do during his time as Minister. They set the baseline for what I hope to do. He asked for a personal commitment to drive forward the changes. Absolutely. The bar has been set quite high.

As the right hon. Gentleman and others have mentioned, what has puzzled me most since being in office is the variability of practice. How is it that in two areas side by side with exactly the same resources there will be one that has a set of procedures in place to ensure that good treatment is provided, while in another that is not the case? It is not always about resources, but management and leadership. I have been puzzled by why there is so much variability.

There is another puzzle that is very pertinent to what we are talking about today and to which the right hon. Gentleman referred: the perverse incentives in the system. Treatment costs are split between local authorities and the NHS. They seem to be based not on what is in the best interests of the patient, but on what suits the budget best. Now, none of us are naive. We all know this goes on. However, his description of the letter from his constituent, which I know about because I responded to him about it this week, illustrates the impact on the individual of decisions that people make for perverse incentive reasons—perhaps relating to budget, if that was one of the reasons. I am interested, as he is, in why there is such variability between areas. Some areas seem to have very few out-of-area places and others do not.

I hope to be able to deal with all the right hon. Gentleman’s questions, but before I do I want to put a few points on the record. The Government’s commitment is clear. We have given the NHS more money than ever before for mental health, with an increase to £11.7 billion last year. We have made it clear that local NHS services must follow our lead by increasing the amount they spend on mental health and making sure beds are always available. In the spending review and autumn statement, we announced an additional £600 million for mental health over the next five years to increase psychological therapies, crisis care and perinatal mental health. This reaffirms our commitment to achieving parity of esteem for mental and physical health.

In perinatal mental health services, for example, I want to ensure that women are able to access the right care at the right time, and close to home. I know that provision of specialist perinatal mental health services varies across the country. Some women have access to excellent care and support, while there are serious gaps in provision in other areas. Women suffering the most severe and complex perinatal mental illnesses need access to specialist in-patient mother and baby units, and good quality community support care in the area where they live. There are currently 15 units in England—I understand that the number fell by a couple from between 2010 and 2015—but NICE estimates there is a UK shortfall of between 60 to 80 mother and baby unit beds. That is why we announced in the March Budget that the Government would invest an additional £75 million over the next five years, £15 million a year, to support women suffering from mental ill health in the perinatal period. NHS England is leading a work programme to ensure that this extra money is spent in the right way at the right time and in the right places. The right hon. Gentleman’s work has made that base. I give him as much assurance as I can that in the areas where he set the work in progress, that work is going to continue; in places where the work is going slowly, it will be challenged; and in places where he was not able to make the progress he wanted to make, I set myself the challenge to do just that. I do not have to worry an awful lot about freedom of information requests because I will get the questions from him and from a number of hon. Friends and colleagues who have grasped how important this issue is.

Let me return to the source of the debate. I greatly appreciate the work that the right hon. Gentleman put in train earlier in the year with NHS England and mental health provider organisations to understand the pressures that lead to people being sent away from home for treatment that should be available locally. This has helped to provide a picture of the scale of the problem and to raise its profile. We know that the principle should always be for care close to home in the least restrictive setting. It is not acceptable for people to be travelling for miles when they are acutely unwell.

I know about the case that the right hon. Gentleman raised because I dealt with it this week, and I agree with him that some of the attitudes expressed by some of those responsible for people’s care are just not good enough. It cannot be acceptable and it cannot have been acceptable to listen too little to those who are in care or who are being cared for when they have made complaints about treatment. I am well aware of the problem—I am occasionally chased on Twitter about it—and I say to one or two of the groups that I am looking carefully at how to deal with it better. Sometimes people feel that they have not been listened to, and I suspect that the sort of example revealed in the right hon. Gentleman’s constituent’s letter might be rather more common than we think. Accordingly, I want to ensure that the inspection and regulation regime really picks things up. I know that there will sometimes be differences in opinion and that things will need to be clarified, but I do worry about the attitudes sometimes expressed, and I want to make sure that the Department has really got hold of ensuring that those sort of complaints are picked up and, whenever possible, really burrowed into to find out what might have gone on.

[Norman Lamb]

I appreciate the Minister’s reassurance. One of the issues highlighted in my constituent’s case was the fact that he was transported very late at night, arriving at about 1 am, and there was another person from Norfolk in the same unit that same week who was collected at 1 am from the unit to be brought back to Norfolk. This treats people like chattel; it does not treat them as human beings. Is the Minister prepared to highlight to the Care Quality Commission that it should investigate and explore that particular aspect—the transporting of people—because having to travel in a minibus with someone who does not talk to them for three hours, and arriving very late at night is simply outrageous?

--- Later in debate ---

[Alistair Burt]

Yes. It seems very puzzling that that should be a regular practice, if it is. That should not be the case. Of course there are all sorts of different pressures on the system, and it would probably not be appropriate to say that it should never happen, but, in principle, people who are in a state of anxiety should be moved with the maximum care, at the time that is of greatest benefit to them and their health needs.

As I was saying, it is not acceptable for people to be travelling for miles when they are acutely unwell. It is also not acceptable for staff to be spending time phoning around to find beds for their patients.

Let me return briefly to the impact of social media. A couple of weeks ago, I read in a tweet from a frustrated doctor—I hope he will pick up on today’s debate—that on that particular day no bed had been available for a woman anywhere in England. Along with the hon. Member for Liverpool, Wavertree (Luciana Berger), who had raised the matter with me, I made inquiries and found that that was not technically true; beds were available. The response from the doctor was, “You may be technically correct, Minister, but it is very difficult to find them”, and the results of my inquiries suggest that that is true. We need to establish a better system of identifying beds that may be available, because that too is part of the problem. People should not be spending time looking for beds. I have an idea about that, which I shall mention later in my speech.

I had to tell the clinician that I did not think that, technically, what he had said was true. However, I recognise that for those who are in the business of finding beds for people, it should not be as difficult as it appears to be, and I want to establish what we can do to help.

We know that the need to place people out of area, away from home, family, friends and networks, is a “warning sign” of a mental health system that is under pressure, and we know that no one wants to spend scarce resources on sending people out of area. However, we cannot look at out-of-area treatments in isolation, because they are part of the mental health acute care pathway as a whole. I welcome the interim report of Nigel Crisp’s commission, which was set up to review the provision of acute in-patient psychiatric care for adults, and I look forward to reading his final report and recommendations early in the new year.

Lord Crisp’s interim report made it clear that—as I am sure the right hon. Member for North Norfolk knows—the situation is more complex than a shortage of beds. We know that there has been a long-term reduction in the number of psychiatric beds in England, but the report suggests that in many areas there would be enough beds if improvements were made to other parts of the system and integrated, community-based services were commissioned. That very point has been made this afternoon in relation to the variability of practice. The report also made it clear that the so-called bed crisis, or admissions crisis, is a problem of discharges and alternatives to admission, and can be dealt with only through changes in services and in the management of the whole system.

As the right hon. Gentleman pointed out, that can be done, as has been demonstrated in a number of local areas. Sheffield, for example, has almost entirely eliminated adult acute out-of-area treatments, and has reduced average bed occupancy to 75% by redesigning the local system, That has included investing in intensive community treatment, and working in partnership with housing. In the right hon. Gentleman’s own constituency, Norfolk and Suffolk NHS Foundation Trust has begun to reduce its historical problem of out-of-area treatments through a combination of investing in more acute adult beds and working with commissioners to develop community and crisis resolution services.

I understand that the independent Mental Health Taskforce has spent some time discussing these issues. I hope that its report, which will be published in the new year, will be an important driver for improving mental health services over the next five years, and will address many of the key issues raised in Lord Crisp’s interim report.

[Norman Lamb]

Can the Minister confirm the likely publication date of the taskforce’s report? I think he said it would be in the new year, but can he give me his best estimate of a specific date? Also, I would like to acknowledge that the Norfolk and Suffolk NHS Foundation Trust has made real progress. The number of people being sent out of area has come down significantly, and that needs to be recognised.

[Alistair Burt]

I am grateful for the right hon. Gentleman’s comment about his trust. My understanding is that the taskforce’s report will come through very shortly. I am not sure whether it will be done this month or by the start of next month, but it is imminent.

I appreciated the right hon. Gentleman’s kind remarks about the Secretary of State for Health. The Secretary of State has already agreed an action plan to tackle out-of-area treatments for adult acute in-patient care. Where out-of-area treatments are a problem, local areas will be asked to put in place clear action plans demonstrating how they can reduce out-of-area treatments, in the best interests of patients, during the course of 2016-17. Now I come to one of the right hon. Gentleman’s challenges. Building on this, I intend to go further and put in place a national ambition to address out-of-area treatments. I will do this in consideration of the Crisp commission and the taskforce report, and I will communicate details of this ambition by the end of March 2016—that is, by the start of the next financial year.

I want to wait and see what Lord Crisp and the Mental Health Taskforce say and then consider exactly what the ambition should be. Should it be an ambition for complete elimination? Should it provide a much tighter variation? I want to see those reports before I set the ambition, but I will set it, and the targets, and come back to the right hon. Gentleman and the House before the end of March next year to communicate those decisions. I hope that helps.

I also commend the right hon. Gentleman for recognising the need to improve mental health crisis care and for launching the mental health crisis care concordat, which we have discussed today. This debate has given us an opportunity to talk about variation in practice, the quality of street triage and the fact that we can do different things in different areas. I saw the work being done in Bradford, for example, where the mental health practitioner is located in the control room, as opposed to being on the street. The galvanising of local groups to work together by giving them the responsibility of doing the job has been absolutely vital. The way in which we are reducing the number of people detained in police cells is a clear example of how that process is working.

The Government are equally committed to reducing out-of-area mental health treatment for children and young people. In-patient child and adolescent mental health services—CAMHS—admission is a relative rare event. At any one time, however, there are approximately 1,300 children and young people from England in CAMHS in-patient services. Services themselves are usually subdivided into different specialties, such as eating disorder units or low secure units. That means that it is highly challenging to provide complex care in all areas, and on occasion, some children and young people may need to be referred for specialist treatment at a distance from their home, if that is in the best interests of their care. However, we are committed to ensuring that that is as rare an event as possible, and much progress has already been made.

[Norman Lamb]

One of the recommendations from the taskforce that NHS England established to look at tier 4 services, at the number of beds required across the system and at the variability of the services was that treatment should always be contained within a region —in other words, that no child who lives in the south-west should ever go out of the south-west for treatment. I cannot remember where the child from Torbay had to go—

[Kevin Foster]

Berkshire.

[Norman Lamb]

Indeed. Is the Minister going to stick to that? Is he going to ensure that that is the objective, and will he monitor it to ensure that he meets it?

[Alistair Burt]

As much as possible, absolutely, yes. There will be occasions when very specialised treatment has to be given, and that will on occasion be outside the area. But apart from that, absolutely. We want to provide care that is appropriate to people in a place that is closest to where they are, as much as possible.

In 2014, NHS England published the tier 4 CAMHS review. This found a relative shortages of beds in some regions, meaning that some children and young people had to travel long distances to access a bed, owing to an uneven distribution around the country. As the right hon. Gentleman knows, there was an immediate response to this: £7 million in additional funding, taking the total number of beds now to 1,440, the highest number there has ever been. In addition, NHS England has introduced new national protocols for referrals and discharge, and a new “live” bed monitoring system to make the best use of existing capacity. I am interested in whether that capacity has reference and relevance to the adult acute beds, and could it make the job of my friend the clinician doctor that bit easier?

But while these measures have helped in the short term, we want to build on this progress still further and ensure long-term, sustainable improvements. In January this year, NHS England commenced a comprehensive review of the procurement and commissioning of inpatient beds. The aim of this is to establish the long-term requirements for inpatient services and ensure quality, sustainable services are commissioned in the right place, based on population need.

It is not enough simply to provide more and more beds. In order to ensure that improvements are sustainable, we need to improve the community-based support we offer to children and young people. This is at the heart of the vision set out in “Future in mind”, and we are determined children and young people have easy access to the right support, from the right service, at the right time and as close to home as possible.

Key to achieving this vision are the local area transformation plans now being put in place. CCGs have been asked to work with NHS specialist commissioning teams responsible for inpatient services in the creation of these plans.

I have two final points. I have been interested in what data are available and what are not, and I answer a number of questions by saying, “The data for these are not collected centrally.” I am looking hard at each and every one of those questions, asking, “Are there occasions when we should be doing more on the data?” There is a lot still to do, but I entirely take the right hon. Gentleman’s point.

On data, we are looking at the limitations. The right hon. Gentleman was right to talk about the problems in getting this dataset right, but, again, I am on to that; it is essential, and I will take the challenge of driving and moving on that data.

On providers, the responsibility seems to come down to CCGs. It is unacceptable that private providers do not submit data. Some more have started submitting since the summer. It is the responsibility of CCGs, who have the contractual levers, and need to use them. That is not good enough; if we need this information, we need this information. I am going to look at whether the CCGs are using those contractual levers, and if not, why not. If they are not, and a sanction can be applied, we will apply the sanction. That information is necessary, and I am going to do this. The right hon. Gentleman is absolutely right on that.

On the principle in respect of determination, I will come back to the right hon. Gentleman by March next year and set out the national ambition. Do I commit to ending the practice completely? I do not know yet, because I want to get the result of the commission. It is right that it should be reduced to an absolute minimum. I want to know technically whether it is possible to eliminate it, or whether that would actually not do the job that is necessary. I want to see what the commission has to say.

Will I drive these changes? Yes, I will. Will all providers provide data? Yes, they will. Will I commit to the £1.25 billion? Yes, I will. I have said that enough times in enough places to make this a very difficult Government commitment to slip away from. It is over the course of the next five years, but I am happy to repeat that.

[Norman Lamb]

I am grateful to the Minister for his patience in allowing me to intervene again. I am conscious that there is a risk that the shortfall in the first year is made up in 2020 or something like that. Because of the principle of frontloading to invest in change, it would be incredibly helpful if we could get the commitment to make good the shortfall in 2016-17. Can he commit to doing that?

[Alistair Burt]

There are things I can do and things it is unwise to take a flyer on, standing at the Dispatch Box.

[Norman Lamb]

You can try.

[Alistair Burt]

I will try, but we need to make sure all the money is used sensibly. There are a lot of pressures on the system, and I am trying to be as bold as I can without being foolishly bold and saying things just for the sake of it. I understand the importance of this £1.25 billion. I have spoken about it a great deal; I want to see it all used. I am not responsible entirely for the timescale, but I understand the right hon. Gentleman’s point and I suspect it will come up in the Opposition day debate we have next year.

I will talk to the Secretary of State about the right hon. Gentleman’s last point about comprehensive maximum waiting times. I will see where we can go further and include it in a comprehensive letter to the right hon. Gentleman.

I hope that this has been helpful. I am delighted that we had extra time to cover the ground. I am pleased to take up the challenge to do some of the things that could not be done in the past few years, and I will do my best to live up to the expectations of the House, as expressed by a number of Members today.

Question put and agreed to.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 17th November 2015 Commons Chamber

[Ben Gummer]

We are preparing for the winter on an unprecedented scale, having learnt from the experience of last winter. Specific support has already been provided for Norfolk and Norwich University hospital, and support will be provided consistently throughout the winter to enable us to deal with the additional challenges that are, I am afraid, being thrown in the way of hospitals throughout the country by the junior doctors and their industrial action.

[Norman Lamb (North Norfolk) (LD)]

Is the Secretary of State doing everything he can to ensure that we secure extra dedicated investment in mental health in the spending review? He will know that introducing the access rights that everyone else already enjoys requires hard cash. I am sure he will agree that we must end the outrageous discrimination against those who suffer from mental ill health.

[Mr Hunt]

I congratulate the right hon. Gentleman on his timing, given that the Prime Minister is now present. I assure him that we are committed to putting extra resources into the NHS, and to ensuring that we increase the proportion of those resources that go into mental health. I also congratulate the right hon. Gentleman on the mental health award that he received last week, which was extremely well deserved.

Junior Doctors’ Contracts

Norman Lamb Excerpts

Wednesday 28th October 2015 Commons Chamber

[Mr Hunt]

The contract will not do that. The contract we are proposing will give more reward to people who work the most antisocial hours. I will explain the details of that later.

The shadow Secretary of State talked about academic studies, so let us look at what the academic studies on the weekend effect say. The Freemantle study, published in the British Medical Journal, which is owned, incidentally, by the British Medical Association, said in September that the mortality rate for those admitted to hospital on a Sunday is 15% higher than for those admitted on a Wednesday. It said the weekend effect equated to 11,000 excess deaths. Let us be clear about what that means. It does not mean that every one of those 11,000 deaths is avoidable or preventable—it would be wrong to suggest that. It means that there are 11,000 more deaths than we would expect if mortality rates were the same as they are on a Tuesday, Wednesday or Thursday. Professor Sir Bruce Keogh, the NHS England medical director, called it

“an avoidable ‘weekend effect’ which if addressed could save lives.”

It is not just one study. In the past five years, we have had six independent reviews. Another study in the British Medical Journal, by Ruiz et al, states:

“Emergency patients in the English, US and Dutch hospitals showed significant higher adjusted odds of deaths…on Saturdays and Sundays compared with a Monday admission.”

The Academy of Medical Royal Colleges—the body that represents all the royal colleges—said in 2012 that deficiencies in weekend care were most likely linked to the absence of skilled and empowered senior staff and the lack of seven-day diagnostic services.

[Norman Lamb (North Norfolk) (LD)]

rose—

[Mr Hunt]

I am happy to give way to my former colleague.

[Norman Lamb]

During my travels across the country, I recently spoke with the chief executive and the chair of an acute trust. They said that they have no difficulty at all with junior doctors and ensuring that there is cover at weekends; their problem is with consultants—and the Secretary of State has just made that point. Has he not chosen the wrong target?

[Mr Hunt]

Chief executives of trusts and NHS employers have been very clear that this is about reform of contracts for both consultants and junior doctors, because the reduction in medical cover at weekends happens with both the consultant and the junior doctor workforces. Also, as I will go on to say, it puts huge pressure on junior doctors at the time when they do not have senior support and the ability to learn from it, and that is exactly what we want to sort out.

Junior doctors are not to blame for the weekend effect. The situation would actually be far worse without them, because they perform the lion’s share of medical evening, night and weekend work. In many ways, they are the backbone of our hospitals. However, the BMJ study this year showed that there is evidence that junior doctors felt clinically exposed at weekends, and nothing could be more demotivating for a doctor than not being able to give the standard of care they want for a patient.

--- Later in debate ---

[Lady Hermon (North Down) (Ind)]

rose—

[Norman Lamb]

rose—

[Mr Hunt]

I am going to make some progress before I give way again.

[Norman Lamb]

rose—

[Mr Hunt]

As the right hon. Gentleman is my former colleague, I will give way once more.

[Norman Lamb]

I want to ensure that I fully understand the commitment that the Secretary of State gave about not a single doctor losing out. I think he said that that is “provided they are working within maximum legal hours”. Does that mean people working up to 48 hours, which is the maximum working week under the working time directive? What about doctors who have opted out of that and are working 60 or 70 hours? Could they lose out?

[Mr Hunt]

It applies to all doctors working within the legal limit. If they opted out of the working time directive, it would apply up to 56 hours. For people who are working more than the legal limits, even after opting out, the right answer is to stop them working those extra hours because it is not safe for patients. But yes, that is the commitment to people even if they have opted out.

--- Later in debate ---

[Norman Lamb (North Norfolk) (LD)]

It is a pleasure to follow the hon. Member for South West Wiltshire (Dr Murrison), who made a thoughtful and valuable speech. As a principle, we must be willing to accept the importance of debating the reform of working arrangements if we believe that there is evidence that current arrangements are undermining the best possible patient care, and I know that junior doctors absolutely accept that view. But I have to say that I am not convinced by the Government’s arguments.

I mentioned earlier that I had talked to hospital leaders, who shared their view that junior doctors’ arrangements are not the problem. It was striking, listening to the Secretary of State, that he referred to a shortage of consultants at weekends. It was notable also that when I talked to hospital leaders, they spoke of a concern that some senior consultants in some specialties make outrageous demands for additional pay for weekend work. There is a problem there, and I would support reform of that situation, but I am not convinced by the case for reform of the sort that the Government are pursuing. The Secretary of State also rightly talked about juniors being clinically exposed at weekends. Again, the issue is a shortage of consultants at weekends, not issues relating to junior doctors.

I met some junior doctors yesterday and found them all to be very passionate and completely dedicated to the NHS. I found them to be not driven and motivated by pay. I have to say to the Secretary of State and the Under-Secretary of State for Health, the hon. Member for Ipswich (Ben Gummer), that junior doctors find it frankly insulting to be told that they have been misled by the British Medical Association. They are intelligent enough to make up their own minds, and they have done. The Secretary of State should choose very carefully the arguments that he puts to them. The Government must also recognise a basic reality—the contract will work only if it is attractive to junior doctors. If it is not, they will vote with their feet and do what the daughter of the hon. Member for Totnes (Dr Wollaston) has done and go to Australia—or Scotland or the United States—to work instead of in the NHS.

The reform and extension of plain time gives rise to real concerns about its impact on emergency medicine, on acute medicine, on intensive care and on maternity services—those areas where there is a particular need for substantial evening and weekend working.

[Rehman Chishti]

I have immense respect for the right hon. Gentleman’s work on mental health. In relation to the shortage of specialists, does he agree with the Royal College of Psychiatrists that psychiatrists should be put in that category?

[Norman Lamb]

I totally agree, and I am very grateful to the hon. Gentleman for raising that point.

Will the Minister clarify what the Secretary of State said with regard to no loss of pay for individual junior doctors because I fear that those may have been weasel words? He talked about working up to the legal maximum. Is he talking about working up to 48 hours or up to 56 hours? He has given no guarantee that those doctors who may still work 60 to 70 hours in a week will not end up losing their pay. It is very important that the Government are clear on that.

The Government seek to extract too much from a limited pot of money. We all know that £10 billion is not enough to keep the NHS going until 2020. We need to work together. I repeat the Liberal Democrat call for a non-partisan commission to ensure that we achieve a new settlement for the NHS and for care, and to engage with the public and the workforce to ensure that we get this right.

Oral Answers to Questions

Norman Lamb Excerpts

Tuesday 13th October 2015 Commons Chamber

[Mr Speaker]

Never mind. These things can always be recycled on subsequent occasions. I have been there and I have done it, and the hon. Lady should fear not.

[Norman Lamb (North Norfolk) (LD)]

The Minister referred to the additional money for eating disorders in the autumn statement last year, the purpose of which was to introduce a maximum waiting times standard from next April. We all know that early intervention is critical. It is a condition that kills too many people. Will he confirm that he remains committed to introducing a maximum waiting times standard for eating disorders from next April?

NHS: Financial Performance

Norman Lamb Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

I thank my right hon. and learned Friend for his assurances on what needs to be done: he, more than anyone in the House, knows how to do it. Had the Government taken the Opposition’s advice and cut the money going into the NHS, we would not have achieved record numbers of doctors and nurses; we would not have halved MRSA and clostridium difficile rates; we would not have eliminated mixed-sex wards; and we would not have achieved record high cancer survival rates. All that has been made possible because of the funding commitments that the Government have made, to which the Opposition failed to commit at the election.

[Norman Lamb (North Norfolk) (LD)]

The Minister will be aware that failure to finance social care adequately has a significant knock-on effect on NHS finances. He will also be aware that the finances of NHS organisations are deteriorating rapidly, and that senior people across the system do not believe that the system can achieve the £20 billion of efficiency savings that are required. Before the election, I proposed a non-partisan commission engaging with the public, burying our political differences and working together to safeguard the NHS. I welcome the fact that he has indicated the need for that sort of approach, but will he now commit to it? The Secretary of State agreed to it in the election campaign, so will the Minister commit to work with all parties to come up with a new settlement making the necessary changes but also coming up with the necessary finances?

[Ben Gummer]

I thank the right hon. Gentleman, who was an exceptional care Minister in the coalition Government, but I am a little confused by his question. He was in post when the five-year forward view was delivered by the chief executive. Within that five-year forward view is a commitment to £22 billion of efficiency savings, and he did not raise his concerns at that stage. It is precisely those efficiency savings, presented by the NHS itself and on which we have embarked, that will allow the transformation to better care that we know is possible within the service.