Health: Mental Health Strategy

Baroness Barker Excerpts

Monday 14th February 2011 Lords Chamber

[Baroness Barker]

My Lords, I, too, thank the noble Baroness, Lady Murphy, for securing the debate and for the first two minutes of her introduction. I will start by pointing out that both David Cameron and Nick Clegg, very soon after they took over as leaders of their respective parties, chose to highlight mental health as an area about which they felt very strongly and which they believed should be properly addressed in a way that the previous Government were not doing. In one of his first Prime Minister's Question Time, Nick Clegg challenged Gordon Brown on the lack of available access to talking therapies. That was a brave thing to do, because, as noble Lords have said, mental health remains a Cinderella part of the health service and not particularly popular. The Government are to be commended for sticking to promises made before the election and coming forward with a strategy that, as the noble Baroness charitably said, is aspirational. However, it is also comprehensive.

I say to noble Lords, in particular to those who were here a few years ago and who went through the misery of debating what became the Mental Health Act, that there is a stark contrast between the legislation that was passed by the previous Government and this document. I would much rather see a Government committed to, and putting resources behind, some of the aspirations that are in this document. Will it address serious and enduring mental health questions? Probably not. However, it addresses a lot of the issues that were highlighted during the passage of the Mental Health Bill as areas on which the Government needed to work. Therefore, there is much to be commended in it.

In particular, there is much to commend in the way in which the strategy picks up on many discussions that we had in your Lordships' House about how existing mental health legislation was applied disproportionately to different groups in the community, and how certain groups were suffering adversely as a result. It is refreshing to see a document that talks about the mental health of veterans and older people, lesbians and gay men, and people from black and minority communities. That is a refreshing change from the Government, and I strongly welcome it.

I was struck when I read the briefings that we were sent when people outside learnt that we were to have this debate. I looked for the criticisms. Most of them came from organisations such as the NHS Confederation and were not about the contents of this document but about the general position on health funding, to which noble Lords have referred. There was not a great deal to which people took exception in this.

The noble Lord, Lord Touhig, was right to focus on the key question of the ability and capacity of GPs to commission mental health services. At the moment, there is a great hue and cry about GPs’ capacity to commission a whole range of services, and some of the arguments are more compelling than others. It seems that on mental health there is a clear case for the Royal College of Psychiatrists and the Royal College of General Practitioners to work together to inform GPs in very practical ways about how they should go about fulfilling that commissioning process. Can the Minister say whether that is intended to be one of the priority areas in the work of the ministerial advisory group?

There is one very important thing that I wish to dig out from the depths of the strategy document. On page 54, in point 5.84 in the section on improving quality of outcomes, it is stated that payment by results currencies will not be setting-dependent. In lay terms and cutting through the jargon, that means that for the first time we will have a system in which the payment for treatment does not encourage practitioners to keep people in hospital. That is a significant breakthrough. During our discussions on the Mental Health Bill, I remember the noble Baroness, Lady Murphy, talking about the need to make mental health professionals understand that the transition between acute care and community care had to work better for patients. That one measure in itself could have a more profound effect on the organisation of services and outcomes for patients than almost any other, and I was very glad to see it.

Finally, I notice in the document that there is a passing reference to the Mental Health Act and to the increase in the number of community treatment orders issued under it. I well remember people who supported that Bill standing up in this House and saying that we had to support the legislation but that we could review how it was going. I ask the Minister how quickly that will be reviewed and how soon Members of this House and another place will receive evidence on the impact of the legislation. That underpins to a large extent the capacity of professionals to implement what I think is an extremely good strategy overall and one that we should welcome.