Young People’s Mental Health

Baroness Blackwood of North Oxford Excerpts

Thursday 27th October 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) and my hon. Friend the Member for South Cambridgeshire (Heidi Allen) for initiating this debate on the Youth Parliament Select Committee report on young people’s mental health. I want to add my voice to those from both sides of the House in paying tribute to the Youth Select Committee for its powerful report—it is an important and timely intervention. As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said, Rhys Hart was, by all accounts, a remarkably effective Chair, and the 10 members were dedicated and focused. They won the admiration of the House of Commons staff who were involved, and they made particular mention of that to me before this debate.

The hon. Member for Ilford North (Wes Streeting) demonstrated quite clearly that he is an elected president of the BYC, with his particularly eloquent speech. He is right that we should thank those young people who have had the courage to speak up on their mental health experiences and opinions, and who have allowed us to refer to them today, because the value of those first-hand stories in this Chamber cannot be overestimated.

I would like to make a particular point of thanking the constituents of my hon. Friend the Member for High Peak (Andrew Bingham), Lucy Boardman and Martha Banks Thompson, and my own Youth Parliament representatives, Tara Paxton-Doggett and Rowan Ibbotson, who spoke to me about the mental health campaign. A number of colleagues have spoken about the impact of meeting the Youth Parliament representatives. As has been said today, what is important now is to prove that we have not just heard them; we have listened to them, and we are taking action on their words. That is why this has been such a moving and necessary debate.

Members have shared some very personal experiences of mental health and the services and support that they and their constituents have received. All of us will know the cases that haunt us. All of us know that we need to do better. As colleagues have said, over half of all mental ill health starts before the age of 14, and 75% has developed by 18. We know the distress that mental health problems cause to individuals and all those who care for them, and we know that the earlier we intervene, the better.

Children’s and young people’s mental health is a priority for this Government. Not only has the Health Secretary made it his personal priority, but so has the Prime Minister. It is time for a step change in the way that we deliver mental health services in the UK, and we are determined to deliver that. But we must not underestimate or under-sell some of the progress that has already been made, because that is thanks largely to the efforts of dedicated NHS staff, stakeholders, voluntary services and others. We have heard some success stories today, and it is important that we praise those involved for the hard work that they do in the face of great challenges.

We agree with recommendation 3 that funding needs to increase, as many colleagues have said. That is why we have increased investment in children’s mental health, with an additional £l.4 billion. While we do believe that it is right that local CCGs, led by clinicians, are best placed to prioritise their spending to meet the needs of local populations, we have been clear that this money is provided for mental health services, and we are requiring CCGs to increase their spending year on year.

[Lyn Brown]

Has the Minister considered the request from my local mental health providers that the Government consider ring-fencing the money for mental health so that it gets passed to the frontline?

[Nicola Blackwood]

I was attempting to deal with that point, but obviously not being very clear. As I said, we have been listening to these requests. We are looking very closely at how effectively the money is getting to the frontline, but at the moment we still believe that local clinicians are best placed to decide how to target these services. However, we have put in place a requirement for CCGs to increase spending on mental health year on year. We are also very clear that STPs must reflect the NHS mandate, which says:

“We expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole”.

That will require great strides to be made in improving care.

[Lyn Brown]

This is happening in Newham, but not elsewhere. How long is the Minister going to wait for it to happen elsewhere before taking action?

[Nicola Blackwood]

One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.

[Barbara Keeley]

Let me make a couple of points in addition to the useful points made by my hon. Friend the Member for West Ham (Lyn Brown). First, it is clear that CCGs are ignoring the Government’s requests, so we will need more action than the dashboards and transparency that the Minister has mentioned. The Secretary of State will need to go back to CCGs and make the position very clear to them. Secondly, as other hon. Members and I have said, there is the question of local authority funding. Over £1 billion has been taken out of various services for children and young people such as children’s centres and youth services. That is a factor too. Those two things need to be addressed.

[Nicola Blackwood]

It is not fair to say that CCGs are ignoring the funding that is coming through. Moreover, it will not be possible for them to ignore what is going on when transparency and accountability is put in place with data sets that clearly show not only performance down to CCG level but the amount of funding that CCGs are given and the amount they are spending. These data will be much more detailed than before. In January, we introduced the first ever provider-level data set on children’s mental health services, and that will provide data on outcomes, length of treatment, source of referral, and location of appointment.

[Mr Kevan Jones]

The Health and Social Care Act 2012 contained one provision that I welcomed—allowing CCGs and others to commission services in the third sector, for example. A lot of the good work in this area is done in the third sector, but the problem lies in how the contracts are drawn up, because they are either too big or too complex for smaller organisations to bid for. Will the Minister look at that?

[Nicola Blackwood]

I am happy to look at it. We are very clear that there is a vital role for the voluntary sector to play in delivering some of these services. We hope that local transformation plans will be part of the way in which this is clarified. The programme to deliver transparency and accountability will be essential if local areas are not only to design effective services that match the needs of their local populations, but to be held to account for delivering them. I will not beat about the bush. We recognise that a complex and severe set of challenges faces children and young people’s mental health services. This area has been undervalued and underfunded for far too long.

While I am happy to investigate funding formulas such as those mentioned by the hon. Member for Ilford North in relation to Redbridge, I agree with him that leadership and accountability are also key to making the changes that we need. That is why we are committed to delivering real changes across the whole system, not just in funding, and to building on the ambitious vision set out in “Future in mind”. I pay tribute to my predecessors for the work they have done to bring those forward. As the hon. Member for Dulwich and West Norwood has said, we need to go further to drive through these changes, which young people have told us they want to see.

Children want to grow up to be confident and resilient, and they want to be supported to fulfil their goals and ambitions. We are placing an emphasis on building in that resilience, on promoting good mental health and wellbeing, on prevention—it is so important, as the shadow Minister has said—and on early intervention, as a number of the recommendations propose. We are looking, in particular, at how we can do more upstream to prevent mental health problems before they arise.

[Barbara Keeley]

The Minister is about to move on to intervention. Before she leaves funding, which has been pretty key, does she believe that the 8% of the budget spent on young people’s mental health—1% for CAMHS—has been anything like adequate? I did put that question to her. If she does not think that that is adequate, could Ministers tell us what they think it should be? If CCGs are ignoring Ministers’ continual urges to them to make pledges, will there be sanctions against CCGs that do not put in that extra funding?

[Nicola Blackwood]

I think I have already answered those questions. The Government have been clear that we think that mental health funding for children and young people, as well as for other areas of mental health, needs to increase. That is why we have increased mental health funding to local areas and we are putting in place measures to improve accountability and transparency, and the STPs, to make sure that that can be tracked locally. We are going to see how it works in the first instance.

[Wes Streeting]

rose—

[Nicola Blackwood]

I must continue.

Another issue that was raised is the fact that children and young people want to know where to find help easily if they need it. I want to make sure that I respond to all the issues that have been raised, otherwise it will not be fair to the young people who wrote the report. Children want to know that they can trust such help when they find it. Young people are clear that they want a choice about where they can get advice and support; they want to be able to get it from a welcoming place, based on the best evidence about what works; and they want the opportunity to shape the services they receive. Many colleagues have spoken about co-production.

“Future in Mind” committed to sustaining a culture of continuous evidence-based service improvement, as well as improving transparency and accountability across the whole system, as I have mentioned. A big part of that is producing the datasets that I have mentioned, which will give local areas the ability to hold their CCGs to account. Those datasets will include information on funding. As the hon. Member for Neath (Christina Rees) told us so eloquently—Matthew’s maiden speech has made its mark on all of us—young people want, as we all do, to tell their story only once rather than having to repeat it lots of times to lots of different people. We are committed to delivering a much clearer and more joined-up approach, with services coming together and communicating more effectively.

As numerous other colleagues have said, young people do not want to have to wait until they are really unwell—until they have reached a higher threshold—to get help. Asking for help should not be embarrassing or difficult. They should know what to do and where to go. If they do have to go to hospital, they should be on a ward with people around their age and close to home. So we are delivering a step change in how care is provided and ensuring that access is improved so that children and young people can easily access the right support from the right service at the right time, as close to home as possible. I recognise that this is a process.

“Future in Mind” is more than just a report. It is more than just words. It has already brought together key players, focused efforts and given us a clear trajectory for improving services. It is only the start of the journey, however, and we need to maintain the effort, focus and political momentum from this place and in our local areas.

In February 2016, the “Five Year Forward View for Mental Health” set out the start of a 10-year journey to transform NHS care across all ages. The hon. Member for North Durham (Mr Jones) was absolutely right to say that similar problems can be tracked across to adult services. The report was clear:

“The NHS needs a far more proactive and preventative approach to reduce the long term impact for people experiencing mental health problems and for their families, and to reduce costs for the NHS and emergency services”.

A lot of it is simply common sense. The five year forward view for mental health is underpinned by additional funding, which I have already spoken about, and the NHS England implementation plan sets out in detail where and when that money will become available. It builds on the foundation of local investment in mental health services and the ongoing requirement, which I have referred to, to increase that baseline by at least the overall growth in allocations.

“Implementing the Five Year Forward View for Mental Health” sets out clear objectives, which will support improvements to the services that young people will receive. I think it would be helpful if I say exactly what they will be, as they will make practical changes. The first is a significant expansion in access to high-quality mental healthcare for children and young people. At least 70,000 additional children and young people each year will receive evidence-based treatment. By 2020-21, evidence-based community eating disorder services for children and young people will be in place in all areas, ensuring that 95% of children receive treatment within one week for urgent cases and four weeks for routine cases. By 2020-21, in-patient stays for children and young people will take place only when clinically appropriate; will have a minimum possible length of stay; and will be as close to home as possible, to avoid inappropriate out-of-area placements. Inappropriate use of beds in paediatric and adult wards—this has already been referred to—will be eliminated.

All general in-patient units for children and young people will be commissioned on a place basis by localities, so that they are integrated into local pathways. That is designed to address some of the concerns that have been raised today. As a result, the use of in-patient beds should reduce overall, with more significant reductions possible in certain specialised beds.

Those objectives are supported by a refresh and republication of the local transformation plans, which have been mentioned. The plans set out how local areas will work together to improve services for children and young people with mental health problems across the whole care pathway. The plans are, in fact, the richest source of information available to date about the state of children and young people’s mental health services across England.

NHS England has also commissioned a number of thematic reviews as part of an analysis of the LTPs. In July, it published the children and young people’s mental health LTPs, which provide a summary of the key themes. It is fair to say that, essentially, they found that there was a lot of variation in local areas in terms of approaches, quality and priorities. We have heard about that in some of the stories that have been told today. The LTPs are a starting point. They are living documents and are not designed to just go in a drawer. They are reviewed and refreshed at least once a year, and we are clear that children, young people, families and carers must be involved in the process, for the exact reason given by the shadow Minister, which is to increase accountability and effectiveness and to make sure that the plans actually work.

A number of key themes have emerged from the report recommendations and the LTPs. Recommendations 5 and 6 comment on the need to support the workforce. We acknowledge the need to address the capability and capacity needs of the workforce—from GPs and A&E, to the mental health specialist—to deliver on our ambition to transform mental health services. In line with the eight specific workforce recommendations of the taskforce report, we will work with Health Education England and others to develop a five-year mental health workforce strategy, which we will publish in 2017. That is a serious response to a serious problem, and it is designed to address a lot of the challenges that have been raised today.

As many Members have rightly said, access to services is a priority area and we need to address it. We know that young people do not want to wait until they are really unwell to access services, and we do not want that to be the case, either, so we are tackling the issue. In August 2015, NHS England published an access and wait standard for children and young people with eating disorders, as I have said. From January, compliance with that standard has been monitored via the data collected through the mental health services dataset. It is, therefore, being held accountable and the aim, as I have said, is that 95% of young people will be seen within a clinically appropriate timeframe by 2020. That is just the first of the waiting time standards.

NHS England has commissioned the National Institute for Health and Care Excellence and the National Collaborating Centre for Mental Health to develop a new evidence-based treatment pathway for children’s mental health. The project will report in March, recommending maximum waiting times for referral to treatment. An England-wide quality assessment will then be used to establish a baseline and trajectory to achieve those national waiting time standards in local areas. The matter was also raised by the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who is no longer in her place.

We are also taking action on particularly vulnerable groups of children and young people. In April, Alison O’Sullivan and Professor Peter Fonagy were appointed as the co-chairs of the expert working group for looked-after children, established to lead the development of models of care for looked-after children’s mental health, which has historically been a blind spot. The expert working group is about practical outcomes—not just what is needed but how it should be delivered, without jargon, proposing concrete milestones and measures. We expect that work to conclude by October 2017.

However, ensuring access to services will not be enough if young people do not feel confident and safe seeking help. All children and young people should feel able to go for help when they need to, without fear of discrimination or stigmatisation. We have made a lot of progress in tackling stigma in recent years. The fact that young people have been willing to tell their stories demonstrates that.

Time to Change is a campaign that aims to tackle the stigma around mental health. In October, it was given £20 million in funding from the Department of Health, Comic Relief and the Big Lottery Fund. We are committed to ensuring that the Time to Change initiative, which is run by charities such as Mind and Rethink Mental Illness, will work with schools, employers and local communities to do more and go further to reduce discrimination and to raise awareness. It is developing a targeted campaign for young people, working with experts by experience.

As “Future in mind” and “The Five Year Forward View For Mental Health” both made clear, co-production is now a fundamental principle in the way we seek to develop and improve services, and anti-stigma campaigns are no exception. However, as many colleagues have said, to make that work, and to see the progress that is so desperately needed, we also have to work closely with colleagues across government, in particular the Department for Education, but not exclusively.

We are determined to continue that collaboration, as recommendation 2 proposes. We have been working closely together to ensure that the vision of “Future in mind” becomes a reality. We are also working together to consider what more can be done upstream to intervene early—an issue raised by the hon. Member for West Ham (Lyn Brown) and many others—and to provide the right interventions as soon as they are needed. The report’s recommendations will be a valuable resource for us as we do that, including the recommendations on attainment, Ofsted, teacher training and a whole-school approach, which was highlighted by my hon. Friend the Member for High Peak. We know that this is the weakest link in our current process and we are prioritising activity in that area to ensure that young people get the support they need right from the start.

A number of colleagues have mentioned the issue of online pressures and cyber-bullying. That matter has been taken extremely seriously by the Government Equalities Office, which announced in September £4.4 million of funding to tackle bullying. That includes a number of measures to underpin the fact that all schools are required by law to have a behaviour policy with measures to tackle bullying among pupils, and they are held clearly to account for their effectiveness by Ofsted. However, we know that more needs to be done, including to support parents. That is why the GEO has also invested £500,000 in the UK Safer Internet Centre to provide advice to parents on how to keep children safe and provided support to the Child Exploitation and Online Protection Centre to support a national roll-out of parent information through schools.

Today’s debate has been important because it has provided an opportunity not just to reply to the details in the Youth Select Committee report, which is so important, but to test the Government’s commitment to mental health reform. I am grateful to colleagues for the time they have taken today to raise concerns, to champion good practice and to propose innovative solutions. I hope that, in my response, our commitment to reform mental health services is beyond doubt. I also hope that it is clear that I believe that it is only through concerted political will, allied with the extraordinary and selfless determination of the mental health workers throughout this country, that we will have any hope of achieving our goal of mental health services that are accessible when and where they are needed.

I look around the Chamber and I hear speech after speech expressing determination to see a change. It gives me courage because great reform requires long-term vision, non-partisan partnership and fine minds. I have seen all three of those today, not just in the excellent Youth Select Committee report, but in all colleagues’ speeches. That truly is a firm foundation for the tough task ahead.