Mental Health Services: Children and Young People

Baroness Keeley Excerpts

Thursday 8th March 2018 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the Care Quality Commission’s review of children and young people’s mental health services.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Not enough scripture is quoted in this House, but I cannot match what was just said. However, I can tell the House that the Care Quality Commission published its “Are we listening? Review of Children and Young People’s Mental Health Services” report this morning, and, yes, we are listening. It was the second piece of work commissioned by the Prime Minister in January 2017 to look at this area of services, and the findings include examples of good or innovative practice and of dedicated people—we thank every one of them—working in every part of the system and a number of areas with strong practice ensuring that patients and families are involved in planning care, but there are also concerns around the join-up between children’s services. We thank the CQC and Dr Paul Lelliott for their work.

The Government have already committed to making available an additional £1.4 billion to improve children and young people’s mental health services to deliver on the commitments in “Future in mind” and NHS England’s five year forward view for mental health, and the CQC welcomes that progress in its report. I know that the hon. Lady and others have worries about this, but spend is reaching the front line. By 2020-21, we have committed to ensuring that 70,000 more children and young people each year will have access to high-quality NHS mental healthcare when they need it. However, there is so much more to do. Claire Murdoch, the national mental health director for NHS England, said in response to the report:

“CAMHS services are now improving, but from a starting point of historic underfunding and legacy understaffing, relative to rapidly growing need”

We see those things across the service.

In December, the Department of Health, jointly with the Department for Education, published “Transforming children and young people’s mental health provision”. That Green Paper responds to a number of the problems raised by the CQC in this report, and sets out a range of proposals to strengthen how schools and specialist NHS mental health services work together and to reduce the amount of time that children and young people have to wait to access specialist help. The proposals are backed by an additional £300 million of funding. We have carried out extensive face-to-face consultation on the Green Paper proposals and have received a high volume of responses to our online consultation, and we thank everyone for that. We will respond to this CQC review, alongside the Green Paper consultation, in the summer.

The report calls for the Secretary of State to use the inter-ministerial group on mental health to guarantee greater collaboration across Departments in prioritising mental health. We agree, and that recommendation is already in hand. The IMG has already contributed to the development of the Green Paper and will continue to provide leadership on the issues that the report raises. The CQC also recommends that everyone who works, volunteers or cares for children and young people is trained in mental health awareness. We are already rolling out mental health first aid training to every secondary school and have committed to rolling out mental health awareness training to all primary schools by 2022. The Government and Ministers remain wholly committed to making mental health everyone’s business and building good mental health for our children and young people.

[Barbara Keeley]

The report is the latest piece of recent evidence revealing systematic failures in our mental health services. It follows similar reports of the past few weeks that call into question the Government’s claims to have made mental health a priority equal to physical health. In this report, we see evidence of services actively putting up barriers to treatment, resulting in children and young people having to reach crisis point before being able to get access to the right treatment. Children are suffering because of those high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14 and that 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes more serious? These high thresholds are even prompting GPs to tell children to pretend that their mental health is worse than it is. Will the Minister agree to look into referral criteria as a matter of urgency, so that children and young people get the proper treatment at the right time?

The report links these excessively high eligibility thresholds and reductions in access with funding reductions and not enough capacity for services to respond to local needs, so, whatever the Minister says, clearly not enough money is reaching the frontline. Can the Minister tell us how he plans to address that? The report, like the CQC’s recent report on rehabilitation services, raises concerns about out-of-area placements, which we know are a barrier to recovery. Will he tell the House what action is being taken to increase the number of in-patient beds available locally?

Finally, what will the Minister do to address the clear problems, highlighted in this report and others, associated with the rigid transition at age 18 from child and adolescent to adult mental health services, which is also a barrier to accessing care?

[Steve Brine]

The hon. Lady rightly raises the issue of spend reaching the frontline; I said in my opening remarks that it is doing so, and she asked what evidence there was of that. Last year, there was a 20% increase in clinical commissioning group spend on children and young people’s mental health, rising from £516 million in 2015-16 to £619 million in 2016-17.

On the broader issues raised in the hon. Lady’s response, I said that we have made up to £1.4 billion available over five years to support transformation of these services, and there is the additional £300 million that I mentioned. I want to touch on waiting times, referral routes and workforce. We are the first Government to introduce waiting time standards, and that is relevant to children and young people’s mental health, too. We are meeting, or on track to meet, both targets. We will pilot a four-week waiting time for specialist children and young people’s NHS mental health services, as was outlined in the recent Green Paper. As I say, we are considering responses to that.

On referral routes, our Green Paper proposes senior designated leads and mental health support teams—a new workforce—based on the findings of the Department for Education’s schools link pilot. They aim to improve the join-up with specialist services and to result in more appropriate referrals.

[Barbara Keeley]

indicated dissent.

[Steve Brine]

The hon. Lady shakes her head; I can only tell her the facts. Health Education England’s workforce plan recognises new ways of working as a cornerstone of delivering these improvements. HEE will also work with our partners to continue the expansion of these newly created roles in mental health services, and to consider the creation of new roles, such as that of early intervention workers, who would focus on child wellbeing as part of a psychiatrist-led team.