In-patient Mental Health Services (Children and Adolescents)

Alan Johnson Excerpts

Wednesday 23rd October 2013 Commons Chamber

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

Last week, Dr Martin Baggaley, medical director of the South London and Maudsley NHS Foundation Trust, said that mental health services in England are unsafe and in crisis. At the same time, BBC News and Community Care magazine printed the results of a freedom of information request to mental health trusts around the country, which revealed that 1,500 mental health beds had closed since 2011. The Royal College of Psychiatrists is among the many expert organisations that have expressed concerns about poor in-patient mental health provision, particularly for children and adolescents. In response, the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb) who I am pleased to see is present, said that he was determined to end the institutional bias against mental health. This debate presents an opportunity for him to do something in pursuit of that noble objective.

There is increasing demand for mental health services, and all the research shows that early intervention is essential to prevent mental health problems developing in later life. One in 10 children aged between five and 16 suffer from a diagnosable mental health disorder, half of which, with the exclusion of dementia, start before the age of 14. Yet, although the Government claim to be increasing expenditure on health, child and adolescent mental health services in England have been grappling with unprecedented cuts to their funding over the past two years.

Many MPs will know that from their experience in their constituencies, where social care and education funding, which is such an important part of CAMHS budgets, is having to be reduced dramatically. The charity YoungMinds found that since 2010 two thirds of local authorities in England have reduced their CAMHS budget. The contrast with physical health budgets is a stark manifestation of the institutional bias against mental health.

The West End unit in my constituency was the only in-patient mental health facility for Hull and the East Riding. It closed in March while a consultation on CAMHS—which, incidentally, gave no opportunity for respondents to voice an opinion on whether the unit should remain open—was still under way. So much for “No decision about me, without me”.

Can the Minister confirm that the guidance to section 244 of the National Health Service Act 2006 concerning consultation states:

“No final decisions—even decisions in principle—must be taken until the public has been consulted and the results of the consultation have been considered by the NHS body”?

When I raised that appalling breach of the Government’s own guidance on consultations, I was told that West End was closed by the unaccountable monolith otherwise known as NHS England. It changed the specification for tier 4 services and the West End in-patient unit that provided high-quality services in Hull and the East Riding for 20 years closed as a result.

I felt sure that Hull could not have been the only area affected, so I submitted a parliamentary question asking how many in-patient mental health units had ceased to operate.

[Jim Shannon (Strangford) (DUP)]

In my constituency 33% of young people have depression. That rises to 50% among those who are unemployed. Does the right hon. Gentleman’s area have the same concerns as I have in my area? We have taken steps in Northern Ireland to address the issues, and perhaps the Government need to do the same here.

[Alan Johnson]

This debate is about services in England, but I confirm that part of the problem is the fact that there is a rising need for adolescent and child mental health services and a decreasing capacity to deal with that need.

I asked the Minister in a parliamentary question which other areas had been affected and which units had ceased to operate. I was told by the Minister that no units had ceased to operate as a result of this change and nor were any closures expected when the change was introduced on 1 October. As I said, the unit in Hull closed in March. The change had already happened. Will the Minister take this opportunity to correct that answer?

Not only did West End close in March, but we are beginning to hear of closures across the country, including in Devon and Somerset, where my right hon. Friend the Member for Exeter (Mr Bradshaw) has been pursuing this issue vigorously with the chief executive of NHS England, who confirmed in a letter to him that other units had closed as a result of the change to tier 4 specification well before the spurious 1 October date.

[Mr Ben Bradshaw (Exeter) (Lab)]

Is my right hon. Friend, a former Health Secretary, aware that, in Devon, that has led to young people being admitted to adult mental health residential units, in clear breach of the Mental Health Act 2007—a scandalous position? I hope that the Minister will have something to say about that when he responds.

[Alan Johnson]

I am aware that that has happened. I feel sure that, as the debate gathers momentum, Members from other parts of the country will have similar experiences.

Let me be clear. I fully accept that for the majority of young people, a community-based approach to mental health problems will give them the best treatment, but for a number of children and their families, intensive in-patient care is necessary. Those children need an approach that spans the whole network of provision, not just health, but education and social care, which cannot be replicated in a child’s home—if they have a home; many of the children affected are in care.

West End provided such services. Its in-patient facility was judged inadequate because it was available for only five nights a week. But combined with weekends at home, this provided an excellent service, which the parents who experienced it fully supported. Their preference was to extend the unit to a seven-day service, if that was what was necessary to meet the new specification, but that alternative was never offered or discussed.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I am sure that my right hon. Friend has seen the note from the Royal College of Psychiatrists flagging up the point that because of the cuts to tier 3 there is increased pressure on and more likely to be admissions to tier 4, yet here we are discussing closures. That is a real problem.

[Alan Johnson]

My hon. Friend makes an important point. YoungMinds, the charity that deals specifically with child and adolescent mental health, makes exactly the same point. We need early intervention, and if we are cutting back on tier 3 there will be a bigger problem with tier 4. If the problems are not addressed anyway, we are stacking up a host of problems, and costs, never mind the tragedy to the individuals when they reach adulthood.

It is difficult to escape the conclusion that the changes have nothing to do with improving care, and everything to do with saving money. The closure of the West End unit has had a profound effect. I have a constituent who is a single mother, who works for the NHS as a staff nurse, whose 13-year-old daughter suffered a severe mental breakdown two years ago. Her daughter spent nine months at West End, which opened at weekends specifically to accommodate her needs. Her mother believes that the treatment given by the excellent staff at West End saved her little girl’s life.

When my constituent’s daughter needed further treatment this year, after West End had closed its in-patient facility, she was first of all sent to Leeds, 66 miles away, where the inability of her mother and five-year-old brother to spend as much time with her, led to a further deterioration in her health. She was then incarcerated with young offenders in Cheadle, 103 miles from her home. Her mother, coping with a five-year-old son and a job in the NHS, spent nine hours travelling to have just one hour with her daughter. For the rest of the time she was forced to listen to her deeply unhappy daughter sobbing at the other end of a phone. Is this what the NHS has come to? Is this the kind of treatment that any of us would accept for our children?

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate the right hon. Gentleman on securing the debate. Obviously, this is a matter that affects my constituency too. He is right to raise the issue, but sadly this is nothing new. In 2008, my constituency saw all its in-patient mental health beds go, resulting in patients having to travel much further, often to Hull, and their families struggling to be near them, so I agree with him entirely on this point. Does he agree that it is important that people are treated in the community as much as possible, but where necessary, treated at in-patient units in their localities?

[Alan Johnson]

The hon. Gentleman makes an important point. He is talking about the closure of adult in-patient services, which had to move from Goole to Hull. The irony is that in-patient mental health facilities for adults exist in Hull. Providing care close to home is important for adults, but surely it is even more important for six, seven and eight-year-old children. The further away they are from their parents, the more their mental health situation is likely to deteriorate.

[Diana Johnson (Kingston upon Hull North) (Lab)]

I congratulate my right hon. Friend on securing this important debate. I want to raise the case of a constituent of mine whose daughter is having treatment on the other side of Manchester, 115 miles away from their home in Hull. He has not been able to see his daughter for three weeks because of the financial implications of having to travel so far. He is distraught about not being able to give the emotional support that his daughter needs at this time. Does my right hon. Friend share my concern that that is totally unacceptable when we are dealing with the mental health issues of young people?

[Alan Johnson]

My hon. Friend is absolutely right. She has been fighting a battle about the West End unit. It started with one constituent, but we now know that up to 13 have been affected in that way, one of whom she has mentioned.

In medical care we often talk of the need to concentrate operations in fewer locations in order to maximise expertise, but that is not a relevant argument for child and adolescent mental health. In the case of my constituent’s 13-year-old daughter, for instance, the specialist consultant had to travel from Hull to Cheadle to see his patient. It cost the NHS £1,000 a day to provide that appalling service, but that is without the cost of the consultant having to travel to see his patient.

One case of this nature in Hull would be bad enough, but there have been 13 such cases, and probably more, since we lost in-patient services. Youngsters from Hull and the East Riding have been sent to Manchester, as my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) mentioned, and Northampton as well as to Leeds and Cheadle. That is worsening the condition of the children concerned.

Trying to address the problem in the newly reorganised NHS bequeathed to us by the right hon. Member for South Cambridgeshire (Mr Lansley) is a nightmare. NHS England is responsible for in-patient care, clinical commissioning groups are responsible for out-patient services, local authorities are responsible for public health and the Humber NHS Foundation Trust, the provider, says that it is absolutely powerless in the matter. I have been told by the director of commissioning that, if a proper in-patient service were offered to the mental health trust in Hull and the East Riding, it would have to decline the commission because the tariff is so low. I wonder whether the Minister can comment on that.

The service is removed by NHS England without consultation because it is available for only five nights a week. The CCG then tries retrospectively to justify the closure, saying that it is underused, and we will hear more about that from the Minister—I tell him that there is gaming going on to try retrospectively to justify something that it cannot justify on an intellectual basis. The mental health trust says that it cannot operate it anyway because the tariff is too low.

The public in Hull want the in-patient facility restored. A local business man has even offered the use of Elloughton castle in east Yorkshire as a location for in-patient care, but he can find nobody in the NHS prepared to talk to him—I know how he feels. Only the Department of Health can sort of this mess by ordering the re-provision of in-patient units, including at West End.

The Minister should also reinstate the child and adolescent national psychiatric morbidity survey to begin to address the lack of meaningful data since its cessation. I am pleased that the adult version has been restored, but the child and adolescent version has not. Above all, he needs to address the problem of diminishing funding for mental health.

I hope that the Minister will meet me and my constituent whose daughter has received such appalling treatment in order to begin a proper dialogue about the closures with those who have been genuinely affected. Only then can we begin to say that we are addressing the institutional bias against mental health in this country, which he and I both know exists and both want to eradicate.

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) on securing the debate. It brings back happy memories of the times when I used to shadow him in his previous job as Secretary of State. He raises an incredibly important issue. Let me say right at the start that I would be very happy to meet him, together with his constituent and NHS England. Having read the brief and listened to him, I am conscious that there is some confusion about the number of children involved, the acuity of their condition and so forth. I want to get to the bottom of that and understand exactly what is going on to ensure that we get the right facilities available for children in his part of the country.

The right hon. Gentleman talked in his introduction about the reduction in the number of in-patient mental health beds. That, of course, is a trend that has been going on for the past two decades, under his Government and this Government, and rightly so. There has been a substantial shift towards early intervention and care in the community, rather than institutional care. However, there is still a long way to go. Too many people with mental health issues stay too long in in-patient beds, which tend not to be a therapeutic environment, much as we would want them to be. On the whole, however, the trend has been in the right direction, as the right hon. Gentleman would probably agree.

The right hon. Gentleman also mentioned the data issue. I completely agree. Mental health issues have been a data-free zone. He talked about the loss of one particular data set, but in the mental health sector we struggle in an absence of data and of understanding of the evidence about what interventions work effectively. That has to be addressed and it is being addressed.

The right hon. Gentleman mentioned what I said about the institutional bias. There is absolutely an institutional bias against mental health issues. One example is the 18-week wait for treatment for physical health conditions, which his Government introduced—rightly so, because people were waiting for far too long. But people with mental health conditions were left out. No one with such conditions has any understanding of when they should be seen; there is no access standard. There is no requirement for someone with an eating disorder, which can kill, to be admitted for care and treatment within a defined period. I am determined to end that because such provisions drive where the money goes in the NHS.

The right hon. Gentleman mentioned that, as a result of decisions of commissioners around the country, funding for mental health conditions has gone down whereas that for physical health conditions has gone up. That is because of how money works in the NHS. We have to end that institutional bias. I suspect that we completely agree about that.

I fully appreciate the right hon. Gentleman’s concerns about child and adolescent in-patient mental health services, and I am aware that this is not the first time he has raised them. We have corresponded about the issue and can consider it further when we meet. Caring for children and young people with mental health problems is incredibly serious and it is a priority for the Government. We want to achieve parity of esteem between physical and mental health, which should be regarded as just as important as each other. Historically, that has not been the case—that is not a party political point, but a fact.

The Health and Social Care Act 2012 sets out the equal status for mental and physical health. Our overarching goal is to ensure that everyone who needs it has timely access to the best care and treatment available. We have made improving and treating mental health conditions a key priority for NHS England. One of the 24 objectives in the mandate, which sets out the Government’s priorities, is to put mental health on a par with physical health and close the health gap between people with mental health problems and the population as a whole.

Why do those with mental health problems die years earlier than those with physical health problems? We will hold the NHS to account for the quality of services and outcomes for mental health patients through the NHS outcomes framework, which at last assesses what results we are achieving for individuals as a result of the money spent. There is a strong desire for change across the health sector—and the justice sector as well.

We are working with a range of agencies and representative organisations to develop a single national crisis care concordat. Crisis care for children and adults is simply not acceptable in too many parts of the country. What we are trying to achieve together is a joint statement of intent and common purpose—an agreement about what each service everywhere should do, and when it should do it. It will help to ensure that people who find themselves in need of immediate support for their poor mental health get the right services when they need them and the help they need to move on from their episodes of personal crisis.

Of course, our aim must be to support our children and young people with mental health problems in the community wherever possible. I absolutely share the right hon. Gentleman’s concern and that of other Members who talk about children being sent long distances from home. As a parent, I would feel exactly the same. The most important thing is that such children should be in the right facility with the right care and treatment. As we are trying to care for more youngsters in the community, the specialist units become more specialist. It is not right for a child with an eating disorder, for example, to be put into an in-patient unit that does not specialise in eating disorders. Getting the right facility is crucial, but that sort of distance causes me great concern, and I accept that we need to address it.

[Alan Johnson]

Will the Minister give way?

[Norman Lamb]

Of course, very briefly.

--- Later in debate ---

[Alan Johnson]

I thank the Minister, and I am pleased that he is going to meet me and my constituent. Will he confirm the consultation process set out in the 2006 Act? Will he also say something about the tariff, which I am told by the clinical commissioning group in the East Riding would prevent the provider from accepting in-patient care, even if it were restored, because it means that it loses money?

[Norman Lamb]

. The right hon. Gentleman raises the tariff, and that is what I want to get to the bottom of. I genuinely want to understand the issue and reach a conclusion on it, and I hope that by meeting we will be able to do that.

We want to ensure excellent child and adolescent mental health services facilities across the country. That is why we are investing £54 million over four years in the children’s and young people’s IAPT—improving access to psychological therapies—programme. That will drive service transformation in CAMHS, giving children and young people improved access to the best mental health care by embedding evidence-based practice which has been absent in these services until now and making sure that they use session-by-session outcome monitoring. The IAPT programme is fundamental to the success of our mental health programme. Our children’s IAPT programme is ambitious in its objectives. Its aim is service transformation with an emphasis on evidence-based practice and a rigorous focus on frequent session-by-session outcome monitoring. It differs from the adult IAPT programme in working across existing community-based CAMHS rather than creating new services.

[Norman Lamb]

I do not think it has been waffle at all. I have tried to answer very directly the concerns that have been expressed. I will absolutely look into the cases that the right hon. Gentleman raises. When I hear reference to children being placed in adult services, I find that as unacceptable as he does. I want to understand how it has happened and bring it to an end. NHS England is carrying out a review over a three-month period to assess the facilities for tier 4 services to ensure that sufficient services are available in all parts of the country. Because of the nature of the specialism, they cannot be in every town and city, but they must be within reasonable reach. That is exactly what the review is seeking to undertake.

[Alan Johnson]

I have just heard in the last 10 minutes that the staff of the West End unit have been told that its day services will close on 20 December. There has been no consultation and it is the first I have heard of it. Will the Minister look into that immediately? This is no longer about in-patient mental health services; it is about all mental services in Hull and the East Riding.