NHS Funding Bill (Money Bill)

Baroness Tyler of Enfield Excerpts

3rd reading & 2nd reading & Committee negatived & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords & 3rd reading (Hansard) & 3rd reading (Hansard): House of Lords & Committee negatived (Hansard) & Committee negatived (Hansard): House of Lords
Wednesday 26th February 2020 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I am pleased to contribute to this Second Reading debate, and—as it is my first opportunity to do so—I welcome the Minister to his new role. I look forward to working with him.

This Bill sets out the current long-term funding settlement for the NHS, as set out in the Long Term Plan published last year. While I welcome the fact that the Government have provided a long-term funding settlement to provide some of the certainty we have heard about, the key question is not whether legislation is needed—frankly, it is not necessary for the Government to commit themselves in primary legislation to something that is already well within their powers—but whether the funding allocation for NHS England increasing to £148.5 billion by 2024 is sufficient to meet a decade of NHS underfunding, to respond to an ageing population and to meet the plan’s commitments to raise standards in healthcare.

As alluded to by the noble Lord, Lord Hunt, and like many external commentators, I note that the King’s Fund, Nuffield Trust and Health Foundation have all said that an increase of at least 4% is required to modernise the NHS and improve standards. In big picture terms, the overriding concern about this Bill is that it does not apply to the whole healthcare budget. As has already been said, NHS England does not operate in isolation, and to improve the health of the population, it is essential that new funding is accompanied by equivalent and sustainable investment in public health, social care and capital funding. Failure to invest now will simply increase the strain on the NHS and store up problems for the future.

I will focus the rest of my remarks on mental health funding, which the Minister focused on in his introductory speech. It was a positive step forward that the long-term plan placed a considerably stronger focus on mental health services, with a commitment that funding for mental health services would grow at a faster rate than the overall NHS budget, increasing by at least £2.3 billion per year by 2024. That is an important figure, which I will come back to. For far too long, people with mental health problems have had to put up with second class services, with too many people struggling to access treatment and support. Decades of underfunding and neglect mean that services are too often delivered in sub-standard and sometimes dangerous facilities and buildings, and there are significant shortages in the mental health workforce.

With that as the overall context, I of course welcome the commitment that funding for mental health services will grow faster than the overall NHS budget and that funding for children’s services will increase faster than total mental health spending per se. However, we must not underestimate the challenge of ensuring that money earmarked for mental health services reaches the front line. This is the crux of the matter that I want to talk about. Although the additional funding for mental health is ring-fenced in the long-term plan, it is unclear how this will work in practice. We need much greater clarity from the Government about how they plan to guarantee that this money is spent on front-line mental health services. Frankly, it is impossible to gauge this from the data currently available. I will say a few more words about this.

During the Commons stages of the Bill, a cross-party group of MPs supported amendments to require the Secretary of State to report to Parliament every year on whether the money received by mental health services was taking us closer to achieving parity of esteem. These amendments were not accepted by the Government—sadly, from my perspective—and, as this is a money Bill, we are of course unable to table any amendments here.

I was particularly enthusiastic about the amendment tabled by my honourable friend Munira Wilson MP, which would have required the Secretary of State to lay before Parliament an annual report on spending on child and adolescent mental health services. In my view, this would have done a lot to strengthen much-needed transparency and accountability in this area. However, to try to remain positive, I noted in Hansard that the Minister replying, Edward Argar, expressed some sympathy with the sentiment behind the amendment and agreed to meet Munira Wilson and other colleagues to discuss further what could be done to improve the reporting on children’s mental health services. I look forward to hearing the outcome of that meeting and hope that the Minister in this House will make a commitment that he will report back to noble Lords on what happens in those discussions.

I want to explain briefly why I think that the CAMHS expenditure is so important. When you analyse it at a national level, it all looks pretty okay; it looks like it is going in the right direction. But this masks continued and really worrying inconsistencies in reporting by CCGs, which prevent parliamentarians and researchers being confident in the figures published at local level. For example, 34 CCGs reported spending less on services for children and young people combined, including on eating disorders services, in 2018-19 compared to the previous years, with nine of those areas having reported spending cuts of at least 27%. This is hardly in line with the public commitment to spend more in this area. I also find it baffling that CCGs which are reporting spending cuts in the dashboard are simultaneously getting a tick to say that they have met the mental health investment standard. I am really perplexed by how this is happening and, if the Minister can shed any light on this, I shall be really grateful.

Something that I have been calling for for some time now is a separate children and young people’s mental health investment standard with a dashboard, so that we can get a more detailed breakdown on the way money is being spent on services for children’s mental health, ranging from preventive to crisis care. In the same way that the mental health dashboard reports on whether each CCG has met the mental health investment standard, it should also report separately on whether each CCG has increased the proportion it is spending on children and young people’s mental health. In addition, if any CCG fails to increase the amount it spends, I really feel that it should provide a public explanation of the reason. Speaking personally, I would also like to see sanctions applied to CCGs which do not provide a satisfactory explanation.

There are a couple of other areas which I would like to cover briefly. One is the workforce. Mental health has one of the most serious workforce shortages in any part of the NHS, and securing and retaining the right workforce is probably the biggest barrier to delivering the Government’s commitments to improve mental health care. We know at the moment that, to meet the promises already made for mental health and to reduce vacancies and cover requirements, we need about 4,500 additional consultant psychiatrists for 2029.

Where are these people going to come from? The recent census by the Royal College of Psychiatrists showed that the rate of unfilled NHS consultant psychiatrist posts had doubled in the last six years and that one in 10 posts is vacant. Despite the shortage of doctors, our medical schools operate under a strict admissions cap, often turning away highly qualified and ambitious students. We need to double the number of medical school places by 2029 to train enough consultants to fill the roles already promised. I would like to see places allocated in particular to schools that have a plan in place to encourage students to choose psychiatry.

Substantial investment in expanding the workforce is urgently required and I eagerly await the publication of the NHS People Plan, which, I hope, will set out how the Government plan to address these shortages. It is vital that the Government use the opportunity of the forthcoming Budget to commit to additional investment to support the recruitment and training of mental health staff.

Finally, on capital funding—this has already been alluded to—the review of the Mental Health Act found that mental health facilities where patients are admitted are often the most out of date in the NHS estate. At times, they have more in common with prisons than hospitals. There are badly designed, dilapidated buildings with poor facilities, which all contribute to a sense of containment and make it difficult for patients to be effectively engaged in therapeutic activities. I was particularly taken with what the review said about how inappropriate it was that we still use dormitory provision in mental health wards for people who have been sectioned under the Mental Health Act. It just does not seem right at all.

The Minister alluded to the fact that the Government have taken some steps to address capital funding issues, including announcing plans to build 40 new hospitals through the health infrastructure plan. However, so far, mental health has been almost totally overlooked in these discussions, despite the review’s findings. Therefore, I again call on the Government to use the 2020 Budget to set out a major, multiyear capital investment programme to modernise the mental health estate and bring it into the 21st century.

To recap, the Government must do more to ensure that the additional funding in the Bill leads to sustained investment in mental health in every local area in England, to address the shortages in the workforce and to commit to much-needed capital investment.