Child and Adolescent Mental Health Services

Debate between Alan Johnson and Norman Lamb

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

The hon. Lady is absolutely right. Unless we understand the prevalence of the problem, it is impossible to plan services effectively. I am delighted that we have secured the funding for an updated prevalence survey in 2015-16. It will be an expanded survey compared with the previous one. We want to cover as wide an age range as possible, to cover early years. That will give us the data, information and evidence we need, but I would then want us to do regular repeats to ensure that we maintain an understanding of prevalence.

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

The excellent in-patient facility in Hull and East Yorkshire closed under this Government in 2013 with no consultation whatever. Despite an excellent report by the Health Committee, despite criticism by the CQC and despite NHS England identifying a problem, we have waited two years. Does the Minister believe that the Health and Social Care Act 2012 has made him powerless to act in such cases? If not, why does he not do something?

[Norman Lamb]

Ultimately, it has to be down to clinical decisions. Indeed, the whole thrust of policy, which was very much started under the right hon. Gentleman’s Government and during the period that he was Secretary of State for Health, is to devolve decision making about the make-up of services to local areas. That approach has been maintained. Ultimately, he would probably agree that such issues cannot all be determined in a Whitehall office.

None the less, the right hon. Gentleman raises serious concerns. I have tried to engage with him on them and am happy to talk to him and meet him further. I share his concerns about the lack of sufficient response to the concerns he raises, but I will repeat one other point I have made: the emphasis of policy should be on building up crisis response services and better and stronger community support services to reduce the need for in-patient care as much as possible. It is not therapeutic to put children and young people on in-patient wards, and particularly not away from home.

In-patient Mental Health Services (Children and Adolescents)

Debate between Alan Johnson and Norman Lamb

Wednesday 23rd October 2013 Commons Chamber

[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.