Health and Care Bill

Baroness Tyler of Enfield Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, continuing the outbreak of consensus, a large number of mental health stakeholders welcome the fact that the Government have accepted these amendments, which draw heavily on amendments a number of noble Lords brought forward in Committee. I think I said at that point that they would represent a spine-stiffener for the Government in their commitment to ensure that mental health sees a growing share of the growing NHS budget and an accountability booster for the NHS. I think they do that.

However, before the Minister concludes on this item, will he say whether, when setting the mandate for NHS England for the financial year ahead—the mandate that will therefore be laid at some point within the next 30 days—the Government might set the mental health waiting time standards, the very welcome consultation on which concluded last week, in a way that other amendments in this group would look to advance? None of that should detract from the fact that these amendments have wide support outside this place and will make a real difference to mental health in the years to come.

[Baroness Tyler of Enfield (LD)]

My Lords, I rise to speak to Amendment 184, tabled in my name. I shall first respond briefly to the government amendment introduced as a result of the discussions in Committee, which set the context for my amendment. I welcome the government amendment requiring the Secretary of State to publish his expectations about increases in the amount and proportion of mental health spending by NHS England and ICBs. I also welcome amendments requiring NHS England and ICBs to include information about spending relating to mental health in their annual reports.

However, it is stating the obvious to point out that their ability to do so is ultimately reliant on the Government—that includes the Treasury—prioritising sustained growth and investment in mental health. This is critical to avoid a widening care deficit in mental health and inequity between physical and mental health care standards. When I say “a care deficit” I want to explain briefly that the healthcare system is still operating in the context of a mental healthcare deficit, where not all those who need help and treatment will seek it or be able to access it and it is estimated that 1.7 million people are waiting to access mental health services.

That is the context of my Amendment 148. It is designed to build on the welcome government amendments and to provide what I call the critical third pillar of reform, which is service access standards. I welcome the measures that the Government have already taken in relation to access standards as part of the NHS long-term plan, but I believe we need to go a bit further and give them more teeth. Waiting time standards can play a critical role in making progress towards our shared ambition of achieving parity of esteem, particularly in service response times. Standards are a driver to secure the resources needed for services to be able to meet demand in an effective and timely way.

Key to the successful implementation of the service access standards will be two things: first, the funding to develop services in a way that means they can meet these standards without leading to unintended consequences, such as transfer of delays from accessing the system to further down the care pathway; and secondly, a clear expectation that these standards must be matched with a sufficient workforce so that the standards are delivering better care and not shifting problems further down the line.

Having these service access and waiting time standards underpinned by legislation would be a very effective lever for improvement by helping to identify where additional resources are needed. I have looked very carefully at the two points in the response published last week to the consultation on NHS access standards. I think the key points were clear: new targets cannot be introduced without additional funding to support them; respondents were generally strongly supportive of new targets in mental health; quality as well as speed of response is important; and expanding the range of the targets to include preventive and early intervention services would be beneficial.

I took heart from the news release that accompanied the publication of that response. I saw that the Minister for Mental Health, Gillian Keegan MP, said:

“Improving access to mental health services is a top priority. These new standards would help patients get support faster—including having a face-to-face assessment within one hour of being referred from A&E. I know there is more to do and that’s why we’re transforming mental health services in England with an extra £2.3 billion a year and will soon be launching a national conversation to inform a new long term Mental Health Strategy later this year”.


That is all very welcome. With such an endorsement from the Minister in the other place, I hope that the Minister will feel able to support my amendment, which provides that critical third pillar of funding, workforce and waiting time standards to ensure that all those aspirations become a reality.

--- Later in debate ---

I hope noble Lords will agree that, given the amount of comprehensive work already under way and the reports my right honourable friend the Secretary of State has committed to publish, a report such as the one outlined in the amendment is unnecessary. So I beg to move the amendment in my name and hope that the noble Baroness will consider not pressing hers.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for that very detailed and comprehensive response to my amendment. While in an ideal world I would like to see an amendment or measure in the Bill on waiting time standards to complement the other work, I accept that there is an awful lot going on that the Government are committed to. I think we will need to monitor very carefully how effective that is, but I will not press my amendment when the time comes.

Amendment 2 agreed.