Mental Health Taskforce

Baroness Tyler of Enfield Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we have strayed somewhat from the subject. On the money, the Prime Minister announced an extra £1 billion in January. It is the same £1 billion and is within the £8 billion—or £10 billion—that was in the settlement in November. The Government asked Paul Farmer to set out in his report where the priorities are and where the money should be spent, and that is exactly what has happened. Interestingly, I saw Don Berwick last week. He is a very distinguished American with a lot of experience in patient safety and health improvement. There is no question: it is going to be tough. It will be very difficult to do on around 7% of GNP, but there is absolutely no doubt, from the work of the noble Lord, Lord Carter, and others, that there is a lot to go at. If it was not tough, we would not be going at it. We must take advantage of the fact that it is going to be tough by addressing some of the difficult issues which we should perhaps have addressed in the past but did not.

[Baroness Tyler of Enfield (LD)]

My Lords, the task force report, which I greatly welcome, points out that, while mental health activity accounts for some 23% of what the NHS does, it accounts for roughly half of that in NHS spending. Worse still, years of low prioritisation within the NHS have meant that clinical commissioning groups have often diverted money earmarked for mental health spending to areas of physical health, and that is harder to quantify because of obscure methods of data collection. Could the Minister say what steps the Government propose to take to ensure that the extra £1 billion announced, whether entirely new or not, is actually spent on improving mental health services. How will that be monitored in practice?

[Lord Prior of Brampton]

My Lords, that is clearly a very good question. At our level, we will monitor this through the mandate given to NHS England. Within that mandate, it has told all CCGs that they must increase their spending on mental health services by, I think, at least 3.7%. The noble Baroness will be interested to know that in the first six months of this year the increase in spending on mental health has been 5.4%, so it is higher than the stipulated 3.7%. Over the next five years I think we will see a trend towards more money going into mental health and primary care and away from acute care. We should not underestimate the very difficult impact that will have on many of our acute hospital services. The transformation will be very difficult. We may not agree on how much money it will take but I think we all agree in this House on the direction of travel—that it must be right for money to be spent in those areas. I hope that answers the noble Baroness’s question.

Health: Adult Psychiatric Care

Baroness Tyler of Enfield Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I reiterate my thanks to the noble Lord for his excellent report: it is 134 pages and reads very well and very quickly. It is obviously highly unsatisfactory that so many people have to travel long distances to get in-patient care. The noble Lord’s report shows that, in one month—in September, I think—500 people had to travel more than 50 kilometres to get to in-patient care. It is a priority for the Government and we are considering the noble Lord’s recommendations. I cannot give a commitment that we can reduce the four years to 18 months now. I can only repeat that we fully understand the importance of addressing this issue.

[Baroness Tyler of Enfield (LD)]

My Lords, the noble Lord’s report rightly points to the need to improve both in-patient care and alternative treatment in the community. Given that, as the report says, the cost of one adult acute bed is the same as that of treating 44 people at home, will the Government say what plans they have at this early stage to increase financial incentives to encourage commissioners to get the right balance of provision?

[Lord Prior of Brampton]

My Lords, if we can improve home treatment and crisis resolution at home it will free up in-patient beds and solve the other problem as well, as people will have to travel less far. That is absolutely critical. I cannot tell the noble Baroness today what NHS England is proposing to do with financial incentives, but I can reiterate that treating more people outside hospital, at home, is a priority for the Government.

NHS: Preventive Medicine

Baroness Tyler of Enfield Excerpts

Wednesday 20th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, clearly, the state has a huge role to play in prevention; I was certainly not questioning that for one moment. I was just saying that I believe that individuals and families have responsibilities as well.

[Baroness Tyler of Enfield (LD)]

My Lords, given that £1 in every £5 of healthcare costs is associated with conditions that could be prevented, what assessment have the Government made of the likely cost savings on NHS spending of using more preventive medicine?

[Lord Prior of Brampton]

My Lords, if the noble Baroness reads the Five Year Forward View, she will see that prevention is a very critical part of that. But, of course, prevention goes much wider than healthcare in the NHS; it goes to employment, housing, education and a whole range of other things. Having a strong and vibrant economy with high levels of employment is vital.

National Health Service

Baroness Tyler of Enfield Excerpts

Thursday 14th January 2016 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, these are challenging times for the population’s health and the healthcare system, for reasons already set out very clearly in today’s debate. What some commentators have called a near existential crisis of the social care sector has brought some services close to breaking point.

The much-heralded greater efficiency and productivity improvements in the NHS, very important as they are, are being pushed to their limits and will not close the projected £30 billion funding gap. At best, they are like sticking a plaster on a health and care system that needs major surgery. As we heard the noble Lord, Lord Turnberg, set out so eloquently, for a sustainable and long-term approach we need to set up a totally new model of integrated health and social care.

We all know that the NHS is not only a public good but a top public priority. The Government have acknowledged this priority in the recent spending review, and the commitment to an £8 billion increase in NHS funding by 2020 is very much welcomed. But frankly, that is only going to stabilise NHS services in the short term, and a lot of it will be taken up with addressing the growing deficit facing NHS trusts and foundation trusts. Critically, it will not, in my judgment, allow the implementation of the seven-day services requirement nor the much-needed investment in new care models.

We also need to understand where this £8 billion is coming from. Cuts to other parts of the Department of Health budget will clearly have knock-on implications for the NHS. So it is of real concern that other health spending, such as public health, education and training, and capital, is expected to fall by more than £3 billion. My key point today is that it is critical that the additional money does not come at the expense of funding for mental health or, indeed, social care. The coalition Government pledged a transformation in mental health services with almost a £1 billion investment, something that the Prime Minister made much of in a carefully packaged re-announcement earlier in the week. While this investment is hugely welcome, it still does not properly address the fundamental disparity between the ways in which physical and mental healthcare are funded and delivered.

The NHS England five-year forward plan had many good things to say about new and more joined-up models of care. These models are fundamentally about abolishing long-standing boundaries between GPs and hospitals, between physical and mental health and between the health and social care sectors. There is so much more to do as well joining up the community services, prevention and public health.

As has already been mentioned by my noble friend Lady Brinton, my right honourable friend Norman Lamb has recently proposed the creation of a cross-party commission on the future of the healthcare system. I strongly support this. The work needs to explore the various tax and fiscal options as part of the solution to the funding gap—something, frankly, which politicians of all stripes have long shied away from. I hope the Government will welcome this initiative.

Mental Health Services

Baroness Tyler of Enfield Excerpts

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, very briefly on those three points, we will have the waiting time results for IAPT tomorrow. I will publish them in the Library and write to the noble Lord. On the ring-fencing point, the IAPT part of the £150 million extra spending on CAMHS is not ring-fenced, but the £150 million is in total. We will wait to see the results on how effective the IAPT spending is before we come to a final decision on how much should be spent on IAPT and on other parts of the care budget. On the noble Lord’s third point, the CQC published its report, Right Here, Right Now, some six months ago. It found that things were getting better, but there was still far too much variation. By using that report and encouraging local crisis care concordat teams, we hope to address that variation.

[Baroness Tyler of Enfield (LD)]

My Lords, given the current paucity of mental health services in meeting rising demand, will the Minister say what steps the Government are taking to ensure that money earmarked for mental health services is spent on mental health by clinical commissioning groups?

[Lord Prior of Brampton]

It is too early. I cannot give the noble Baroness specific figures for last year’s spending, but we believe that they will show an increase of some £300 million over the year before. We have made it very clear to NHS England in the mandate that we expect spending on mental health services to increase this year and that every CCG in the country will see a real-terms increase in mental health spending compared with the previous year.

Health: Children

Baroness Tyler of Enfield Excerpts

Thursday 10th September 2015 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what plans they have to tackle the variations in health outcomes across the country for children aged under five.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, giving every child the best start in life is central to the Government’s approach to reducing health inequalities. This ambition is supported by action across government and the health system at local and national level.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his reply. Is he aware of the report published this week by the National Children’s Bureau—I declare an interest as its president—called Poor Beginnings, which shows very vividly how the place where young children live can dramatically affect their health? In particular, it highlights really dramatic differences in areas such as obesity, tooth decay and getting injured, and shows very significant variations in child health outcomes between deprived local authorities. As local authorities take up responsibility for young children’s public health from this October, what steps are the Government taking to support them in their work to narrow the gap in outcomes?

[Lord Prior of Brampton]

I have indeed read the report by the NCB, although it came out only on Monday so I have not fully digested its conclusions. I think that it very much echoes the work done by Michael Marmot four or five years ago. He said that the first two years, and certainly the first five years, of a child’s life are crucial in determining their subsequent standard of living and health. The variation that the NCB’s report has identified is extremely important. It is a variation not just between rich areas and poor areas but within deprived areas. That level of variation is best tackled at local level by local authorities. The decision to push the commissioning process down to local authorities is probably the right one, but they will be heavily supported by Public Health England.

NHS: Reform

Baroness Tyler of Enfield Excerpts

Thursday 16th July 2015 Lords Chamber

[Lord Prior of Brampton]

There is no doubt that, looking forward over the next five years, the resource to be put into primary care will be greater, relatively, than it has been in the past. We wish to deliver more care outside hospital. That is why we are committed to training and having in place 5,000 more doctors in general practice by the end of this Parliament—not just GPs, but others who will support GPs.

The model of primary care will change significantly over the next five years, and it is fundamental to the five-year forward view that we reduce the number of people going into acute hospitals and that we discharge people at the other end of their journey through an acute hospital much quicker.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome the principle of working towards a weekend service—indeed, I think it is hard not to—but I certainly do not underestimate the difficulty of achieving it, particularly in a fully joined-up way. This morning, I attended a meeting with many children and young people who had experienced a serious mental health crisis at the weekend and had real difficulty accessing the treatment they needed. Indeed, some of them had turned up at A&E but there had simply been no mental health services available for them. In the light of that, will the Minister reassure me that the principle of seven-day working will apply to consultants from mental health disciplines, particularly those treating children and young people whose access to those services seems to be even harder to secure than it is for adults? Secondly, the Statement talked about CQC quality ratings as well as waiting times being made accessible to patients. Will he confirm that these will include waiting times for mental health services?

[Lord Prior of Brampton]

The Government are committed to parity of esteem, and if we are truly committed to parity of esteem the answer to both the noble Baroness’s questions must be yes. We must have the same standards for physical health as we have for mental health. If someone has a psychotic crisis on a Friday afternoon and they cannot get access to any help until the following Monday, that is clearly extremely poor care. If they end up in an A&E department being looked after by people who have no experience of dealing with mental health problems, it is a very poor environment to be in, so I agree entirely with the noble Baroness.

Mental Health: Young People

Baroness Tyler of Enfield Excerpts

Tuesday 30th June 2015 Lords Chamber

Asked by

[Baroness Tyler of Enfield]

To ask Her Majesty’s Government what plans they have to respond to the recommendations of the Children and Young People’s Mental Health Task Force Report Future in Mind.

[Baroness Tyler of Enfield (LD)]

My Lords, following hot on the heels of our excellent debate last week on young people’s experience of mental health crisis care, I am delighted that today we are able to debate the Government’s response to the children and young people’s mental health task force’s report Future in Mind. Perhaps the focus we now have in your Lordships’ House on mental health—and, recently, on children and young people’s mental health in particular—shows that the tag “The Cinderella of Cinderella services”, which is often used in debates in this House, is starting to become a thing of the past. Let us hope that is indeed the case, but let us also remain vigilant so we can feel confident that the good intentions of the task force’s report will turn into a reality for the alarmingly high number of children and young people in this country experiencing mental health problems.

I start by thanking all the members of the children and young people’s mental health task force for producing an excellent report. Since its publication in March this year, it has clearly had a major impact on mental health policy. In his March Budget, the Chancellor announced that mental health services for children and young people would receive an additional £1.25 billion in funding over the next five years. This amounts to £250 million annually, £l5 million of which is for perinatal services, the rest being for children and young people’s mental health services. This is in addition to the announcement in the Autumn Statement of £150 million over five years for eating disorder and self-harm services. This new investment is much to be welcomed, and I do so wholeheartedly.

However we need to remember the broader context. It is no secret that historically CAMHS have been neglected and starved of cash, perennially losing out to other health services deemed to be of higher priority. So we should keep in mind that, even with the additional money, funding for CAMHS makes up only 8% of the total mental health budget, even though children and young people make up 23% of the population. Given this, it is more important than ever that we examine how these funds will be used.

The additional £1.25 billion of funding will be directed to local areas once they have completed and published local transformation plans. In order to develop these plans, the lead commissioning agency, which is most likely to be the clinical commissioning group, needs to work with health and well-being boards, schools, children, young people and families in the locality to decide precisely where the investment should be targeted. To have real teeth, it is vital that transformation plans contain local access and waiting time targets in line with the ambitions contained in the NHS five-year plan, and address the issue of choice of provider for children and young people, including in the rollout of access to psychological therapy.

Considering that most families do not currently feel that CAMHS is anything like meeting their needs, it will be particularly important that CCGs communicate directly with children and their families to help determine the areas where additional investment is most needed. Yet the proposed timeline for formulating these transformation plans, which are to be completed by the end of September, is very short and, given the time of year that they are expected to formulate these plans—between July and September—one has to ask whether is it realistic to expect CCGs to be able to engage with schools, young people and their families in a meaningful way.

I was pleased to see a specific commitment of £15 million per year to improve perinatal mental health services. The task force reports that maternal perinatal mental health problems carry a long-term cost to society of about £10,000 per birth, and nearly three-quarters of this cost has to do with adverse impacts on the child. For example, the odds of a child developing depression are nearly five times greater if their mother experienced perinatal depression. Such outcomes are avoidable. Specialist mother and baby units across the country are delivering excellent results helping new mothers with psychiatric problems bond with their babies. The NSPCC suggests that one in 10 children would benefit if all new mothers with mental illness had access to programmes such as these mother and baby units. Given this, it is simply unacceptable that currently only 15% of localities provide perinatal mental health services at the level recommended in national guidance and that 40% provide no service at all. Worse still, only 3% of CCGs have a strategy for commissioning perinatal mental health services.

Turning to preventive work, I am also pleased to see that the Government have responded to calls from the task force for schools to take a greater role in promoting good mental health and fostering resilience—something we on these Benches have long called for. Some local areas are already doing very good work in this field. For example, Kingston Council decided to appoint health link workers, part of whose role is to help schools and young people identify mental health issues at an early stage. Working in this way, they are able to address issues such as depression, self-harm and eating disorders early on, so that they do not become a bigger problem later. The health link workers are also able to educate staff to recognise the signs, talk directly to the pupils and try to get them help.

I understand that the Department for Education will contribute £1.5 million in 2015-16 to run a joint pilot programme with NHS England to place named CAMHS contacts in schools to act as liaison between staff, students, and community CAMHS. If implemented effectively, this programme has the potential to provide more direct entry points into specialist mental health services and to allow school staff to gain insight into how to cultivate a healthy learning environment.

Schools can provide a very valuable referral route towards specialist services but, as the task force report highlights, this will not reach all the children who need mental health care, particularly the most vulnerable children. The charity YoungMinds reports that one in three young people say that they do not know where to turn to seek help. Indeed, the process of accessing specialist services can be lengthy and confusing. Programmes such as the Well Centre in London offer an alternative. It holds open drop-in hours for young people aged 13 to 20 three afternoons a week, when they can access specialist mental health support easily and confidentially.

For others, accessing care is difficult because of disability or other difficulties in their lives. For example, learning disabled children are likely to have particular difficulty accessing care. Barnardo’s reports that children in care are five times more likely to develop childhood mental health problems, and 10 times more likely than their peers to have significant learning disabilities, meaning that although they need support the most, they are also less likely to be able to access it. I particularly commend the work of the task force’s sub-group, which looked in depth at the issue of vulnerable groups and inequalities. As a result of its work, the task force report makes it clear that in order to engage the most vulnerable children, commissioners and providers across education, health, social services and youth offending teams will need to take an active role in engaging the children and young people who are the least likely to engage with existing services.

The task force found good examples of workers trained to deliver support in a flexible, approachable and joined-up way to help reach some of the most needy young people. What really brought this to life for me was the case study of Jay, a 17 year-old cannabis dealer involved in gang activity, who was mistrustful of professionals, fearing that talking to him would lead to him being put in prison. His mental health had deteriorated since witnessing several stabbings in his area. He failed to show up for various appointments, so his case was closed. But Jay’s youth offending team worker identified a youth worker in the community who already knew Jay and his family, and they began to meet Jay in places where he felt comfortable, such as at his favourite fish and chip shop. Eventually, the YOT worker was able to gain Jay’s trust sufficiently to convince him to begin treatment for substance abuse. Where most services would have given up on Jay, these workers were able to reach him and put him on a path to recovery from both substance abuse and mental ill health. How do the Government intend to respond to the task force’s recommendations about reaching out to the most vulnerable children and young people?

In my view, the task force report Future in Mind is a landmark document in the much-needed improvement of mental health services in England. My hope is that it fuels transformational change not just for CAMHS but for all the sectors involved in helping young people access appropriate and effective mental health care. The Government’s commitment of additional funding is very welcome and the development of transformation plans in this area is promising, but there is still much to do to ensure that the additional funding is spent to best effect. Will the Department of Health and NHS England therefore commit to publishing an annual progress report on the implementation of Future in Mind?

Mental Health Services

Baroness Tyler of Enfield Excerpts

Thursday 25th June 2015 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I congratulate the noble Baroness, Lady Thornton, on securing this important debate. Failures in crisis care for children and young people often make for attention-grabbing headlines. We have all heard the stories of children being admitted to hospitals hundreds of miles away from their families, and of children held in police cells. The Care Quality Commission’s Right Here, Right Now report and other findings tell us that these dreadful situations are not isolated incidents but reflect a larger failure to provide sufficient crisis care for children and young people.

The adoption of the mental health crisis concordat last year was an enormous step forward for the provision of crisis care, pioneered by my right honourable friend Norman Lamb when a Minister. Central and local government and leaders of key services agreed to work towards making sure that compassionate and understanding crisis care would be available 24/7; that a mental health crisis would be treated with the same urgency as a physical health crisis; that people should be treated with dignity and respect in an environment that is conducive to their needs; and that appropriate follow-up services would be provided. That sounds great, but delivering the promises of the concordat will require more than generalised statements of support, very welcome as they are. We need to ensure that promises made in local area action plans are delivered. It will mean tackling long-standing failures in commissioning, which in turn will require strong and sustained local leadership and, crucially, the necessary resources. As we have already heard today, children and young people tend to receive a lower quality of crisis care. I thought it was shocking that the CAMHS 2013 benchmarking report noted that only 40% of CAMHS had crisis care pathways, as they are called.

What happens to those young people who cannot find the care they so desperately need—the other 60%? It is not a particularly encouraging picture. The CQC report found clear differences in the quality of care for children turning up at A&E in crisis compared to the quality of care for adults. In accordance with the rapid assessment and intervention model, adults are generally seen promptly and directed to community services, while 16 and 17 year-olds are assessed with support from CAMHS and those under 16 are referred directly to CAMHS. Your Lordships might say that sounds absolutely right but, as we have already heard today, the reality is that CAMHS are often not offered out of hours and if a CAMHS referral is made after midday, the child will often not be seen until the following day or even until after the weekend.

On the plus side, I was pleased to note that the Department of Health and NHS England have committed in their publication Achieving Better Access to Mental Health Services by 2020 to develop a national all-age liaison psychiatric service in A&E departments. This is both welcome and timely. Such a service should help ensure that children in crisis receive at least some support immediately. However, it is surely unacceptable that access to referral services should be so delayed. Could the Minister say what plans the Government have to establish an out-of-hours mental health service for children, as the recent Children and Young People’s Mental Health and Wellbeing Taskforce report, Future in Mind, recommended?

What happens if a young person experiencing a mental health crisis needs to be admitted to hospital? The reality is that in hospitals where in-patient treatment is provided, there are simply not sufficient places for children and young people. Although the prevalence of mental health problems has been increasing, there was a 39% drop between 1998 and 2012 in the number of mental health beds available in England, and this shortage has particularly impacted on children. In a recent survey by the Royal College of Psychiatrists of its trainees, 83% said they had difficulty finding an appropriate bed for children and young people, compared to 70% who had difficulty finding an appropriate bed for an adult. As a consequence, many children end up being admitted to wards for adults or to hospitals far from home. Of those surveyed, 22% reported having to place a child 200 miles away from home—a fact I find truly shocking. What chance does a young person have to recover without the care and support of their family nearby? Could the Minister say what assessment the Government have made of whether there are sufficient beds to ensure that children with severe mental health needs are able to access appropriate in-patient care in their area?

The availability of effective home treatment teams for children and young people can reduce the number of people who end up at A&E or who have to be admitted to hospital, which of course must be desirable. It is encouraging that the task force’s report referred to earlier, Future in Mind, found some good examples around the country of dedicated home treatment teams for children and young people. Could the Minister say what steps are being taken to develop improved information about the provision of these services and, indeed, to expand their provision?

Since the concordat, there has been widespread agreement about the need to stop the practice of holding children and young people in police cells as a so-called place of safety. I was pleased to see a specific commitment in the gracious Speech to legislate to ban this practice. This approach is already starting to make a difference, with numbers starting to fall. However, it remains the case that one-third of children and young people detained under Section 136 are held in police custody. Political commitment and the proposed change in the law, although very welcome, will not be enough. The truth is that the excessive use of police cells as places of safety is largely the consequence of operational and commissioning failures—a key theme running through my remarks today.

Too often, police stations are used as places of safety because health-based places of safety do not accept children. The CQC report found that 35% of the health- based places of safety surveyed do not accept under-16s. Similarly, research from the Howard League estimated that 74% of mental health trusts do not provide a specialised place of safety for children. I warmly welcome the Government’s announcement that they will commit £15 million to deliver health-based places of safety. What steps will be taken to ensure that clinical commissioning groups prioritise investment in this crisis care provision, particularly for children and young people?

To conclude, when people experiencing mental health crises do not have access to the sort of timely, effective and compassionate care that people with physical health problems do, it is not just unfortunate, it is simply unfair. It is even more unfair when children and young people experiencing a crisis relating to mental health problems do not even have access to the level of care that adults do. We can and must do better.

Mental Health Services: Young People

Baroness Tyler of Enfield Excerpts

Tuesday 23rd June 2015 Lords Chamber

[Lord Elton (Con)]

My Lords—

[Baroness Tyler of Enfield (LD)]

My Lords—

[The Lord Privy Seal (Baroness Stowell of Beeston) (Con)]

My Lords, we have not heard from the Conservative Benches yet on this Question. I think my noble friend Lord Elton is next.