Health: Multiple Pregnancy

Baroness Walmsley Excerpts

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

The Government may have figures on this. I do not have figures here today, but I shall certainly endeavour to find them as soon as I can and perhaps follow it up with the noble Lord in a meeting outside this House.

[Baroness Walmsley (LD)]

My Lords, given that mothers expecting multiple births need the expert care of qualified midwives and yet we have quite a shortage, and given that the Government are considering giving golden hellos to GPs, what about midwives?

[Lord Prior of Brampton]

My Lords, we are not considering golden hellos to midwives. There are, I think, some 6,400 extra midwives in training at the moment and some 2,100 more midwives today than there were in 2010.

National Institute for Health and Care Excellence

Baroness Walmsley Excerpts

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

I am sorry—I did not quite understand the question. I realise that I cannot ask my noble friend to repeat it, so I wonder whether I could pick it up with her outside the House.

[Baroness Walmsley (LD)]

Is the Minister aware that in Wales 12% of NHS staff have made complaints about staffing levels in the past few years? Will the Minister join me in welcoming the fact that the Labour Government of Wales will be held to account for that next year?

[Lord Prior of Brampton]

From what I understand, the problems in Wales mean that there is a lot more for the Government to be held to account for there.

Health Funding

Baroness Walmsley Excerpts

Thursday 9th July 2015 Lords Chamber

Asked by

[Baroness Walmsley]

To ask Her Majesty’s Government whether they carried out an equality impact assessment before deciding on the recent in-year budget cut to public health funding.

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

My Lords, we pay close attention to equalities considerations when deciding how to distribute the public health grant between local authorities. The Department of Health is about to consult on how to implement the savings and we will address our equalities duties in full when announcing our final decisions.

[Baroness Walmsley (LD)]

My Lords, I thank the Minister for his reply, but given that these cuts will impact on teenage pregnancy programmes for the young, domestic violence programmes for women, HIV prevention programmes for gay men and some members of the BME community and TB prevention programmes for the poor and homeless, will he say where the equality is in that?

[Lord Prior of Brampton]

The noble Baroness will know that decisions on these matters are left to local authorities, and we wish to give them as much discretion as we can.

National Health Service: Sustainability

Baroness Walmsley Excerpts

Thursday 9th July 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, this has been an excellent debate, so ably introduced by the noble Lord, Lord Patel. It is quite clear that the NHS is a national treasure and something that is dear to the hearts of all noble Lords. The principle that it is free at the point of need is something that all political parties continue rightly to support.

Every one of us has cause to be grateful to the men and women from all nations who work in the NHS. We rely on their skills and knowledge, and those from abroad contribute enormously to it. That is why I start by asking the Minister whether he will work to persuade the Home Secretary that her determination to send home some foreign nurses who earn less than £35,000 per year is unjust and detrimental to the NHS and the people of this country.

The prediction is that costs in the NHS will rise at 4% per year, and more and more health trusts are going into deficit, as we have heard. Yet voters are reluctant to pay for this from either raised taxes or cuts in other public services—hence today’s demand for a royal commission, which I support. The Government’s Five Year Forward View needs to act as a catalyst to create new models of delivering care that are better suited to modern health needs and promote more efficient use of NHS resources, contributing to a more sustainable health and social care system.

I think of the NHS as an inflatable bucket with a hole in the bottom. It is impossible ever to fill up such a device with enough money. It is inflatable because the demands on it are constantly growing as we live longer and the birth rate increases. Life expectancy is going up. The number of those aged 65 to 84 will increase by more than a third in the next 20 years, and the number of those aged over 85 will double—I hope to be one of them. In addition, with ever more wonderful developments in treatment, there are more demands for them to be available for patients, but they are usually very expensive.

The hole in the bottom of the bucket is the fact that as we learn to treat, and even eliminate, certain diseases, other preventable diseases are increasing in prevalence because of our lifestyles. Even though the Chancellor promised more money for the NHS in his Budget yesterday, there will still not be enough unless we stop up the hole in the bucket. So I think there are three watchwords: integration, innovation and prevention—the demand side referred to by the noble Lord, Lord Desai.

On prevention, we need to get people to take more responsibility for their own health—the noble Lords, Lord Patel and Lord Crisp, called for that—and support them in doing so. We need to ensure that young people and their parents understand what a healthy lifestyle looks like and are given the means to live it, with exercise facilities, access to fresh, nutritious food, and warm, dry homes. We need to eliminate child poverty, since poverty is the major factor leading to the health inequality which decreases lifetime opportunity. We need health education to be carried out well in all schools, and public information and treatment programmes so that those adults who missed out on such education can still get the message.

Public information programmes work well—one only has to look at the public information programme on HIV set up by the noble Lord, Lord Fowler, all those years ago to understand how well. In Australia, you cannot move without seeing information about protecting your skin from the sun and skin cancer. We could do with one of those campaigns here. Such programmes are also cost effective because many preventable diseases cost a great deal of money. Smoking costs the NHS £5.2 billion every year, but smoking prevention programmes and anti-bullying programmes in schools can return as much as £15 in savings on physical and mental health for every £1 spent. Obesity costs the NHS £4.2 billion per year and lack of exercise costs it £1.1 billion per year, according to the King’s Fund. Yet despite the fact that every £1 spent on free use of leisure centres returns £23 in reduced NHS use, quality of life and other gains, many local authorities are having to close centres rather than give free access to them. Musculoskeletal problems such as back pain and arthritis are the most common conditions that limit people’s daily lives and the largest single cause of loss of working days. They affect 8.3 million adults in England. Some, but not all, of these problems are preventable by keeping to a healthy weight and taking moderate exercise. The costs to society of poor air quality, ill health and road accidents induced by road transport exceed £40 billion per year. It has been calculated that getting one more child to walk to school can save £768. All these things can be done fairly cheaply and prevent a lot of burden on the NHS.

Most of these preventable diseases are focused on by local authorities in their public health programmes, so I ask the Minister whether any of the extra billions of pounds for health services announced by his colleague the Chancellor yesterday will go towards prevention in the form of the vital public health programmes run by local authorities and schools. A short-term approach which reduces prevention activities, such as we have recently seen, will have a longer-term impact on healthcare services in the future, putting additional and avoidable costs on the health and social care system. Cardiovascular disease is a good case in point, where obesity and lack of exercise cause a great many of the 33,000 premature deaths from that disease every year. Here we see another problem. According to the British Heart Foundation, there is wide variation in both access to and quality of care for patients across the UK. This is of particular concern given the range of evidence-based interventions, commissioning guidance and NICE guidance that exist but which are not universally adopted across the system, resulting in suboptimal care and avoidable use of NHS resources. Significant opportunities to identify and optimally to manage patients are too often missed. Think how much could be saved if the worst lived up to the standards of the best.

Prevention also includes vaccination and screening programmes. There is good news and bad news here. There are still parents who are reluctant to have their babies given the triple vaccine and the measles vaccine despite all the reassurances that have been given by experts, and we now find that whooping cough and measles are rising again. I was shocked to hear that the very good uptake of the human papilloma virus vaccination has recently fallen. This is a group of completely preventable diseases, so what are the Government doing to encourage all teenagers to have the vaccination?

I heard a bit of good news at a presentation in your Lordships’ House recently. I was told about plans for a bowel scope screening programme for all 55 to 64 year-olds. The pilot schemes have shown that this reduced people’s chances of developing bowel cancer by a third and reduced the death rate from this disease by 43% because of early diagnosis. This has the potential to save the NHS £300 million each year plus great human misery. Can the Minister say when this programme will be rolled out across the country and whether it will become available also for those over 64? The breast screening programme has also saved many lives, including mine, but it ends at age 70. Given that we are all living longer, are there any plans to raise the cut-off age for routine screening?

Prevention also requires patients to be vigilant about their own health and to go to their GP promptly if they are worried about symptoms. It then requires GPs to recognise the signs and refer people to specialists as soon as possible. Some GPs are reluctant to do this until they have commissioned more tests, but this could cause serious delay to those with disease, on the one hand, and waste a lot of needless tests, on the other, where a specialist might have recognised right away which patients needed tests and which did not. I refer particularly to skin cancers, where it can be difficult for the non-specialist to distinguish the benign from the dangerous.

Early diagnosis is, of course, both a life saver and a money saver. However, it is worrying to note that the uptake of NHS health checks is currently at a disappointing 48%, well below Public Health England’s target of 66%. Some diseases are estimated to be grossly under-diagnosed. For example, four in 10 adults with hypertension, estimated at more 5 million people in England, are currently undiagnosed. This is a preventable killer disease which responds well to treatment and lifestyle changes, so we need to get on top of this under-diagnosis.

I am pleased that the Government plan more support for British scientific and medical research. Britain has the potential to lead the world in the discovery of new personal genomic treatments which match the patient’s DNA with new drugs. As an integrated healthcare system with tens of millions of patient records, the NHS is well placed to exploit the immense potential of genomics. But these treatments have many barriers to breach before they reach the patient, and we know that the United States has a much better track record when it comes to approvals of new drugs. So I would like to hear from the Minister about the progress of the accelerated access review which was initiated in response to this situation by his noble friend Lord Freeman but about which I have not heard much recently. Can the Minister tell the House what progress has been made on that?

Health: Children and Young People

Baroness Walmsley Excerpts

Tuesday 7th July 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I thank the noble Baroness, Lady Hollins, for introducing this debate. I hope she will forgive me, but given the other recent debates on children’s mental health, I feel that I have said all I need to say on that subject for the moment, so I will concentrate on children’s physical health, although I am of course well aware that there is a major link between the two.

There is good news and bad news about the health of our children in the UK. On the good side, according to research from the King’s Fund and the LGA, some damaging health behaviours among children have halved over the past 10 years, with fewer children taking drugs, smoking and drinking alcohol. This is particularly good news, because we know that half of the big adult health-risk factors are initiated in adolescence, so if we can nip it in the bud at that age, we will save lives and money. Smoking is still a big killer in this country and is a particularly large factor in health inequality. Alcohol, too, is particularly harmful to immature livers, and abuse of alcohol also leads to other risky behaviours, so a reduction there is also very good news. The finding about drugs may or may not take into account the so-called legal highs, because the finding was up to the year 2013, but any improvement is good. The paper does not postulate a reason for these improvements but it could have been caused by an improvement in the standard of PSHE in schools. I still regret the fact that this life-skills learning is not mandatory in all schools but I concede that the last Government put a great deal more emphasis on it and took some of the good advice offered by the PSHE Association.

On the other side of the balance we have rising childhood obesity, many children who do not take enough exercise—for various reasons, including lack of facilities—one of the poorest records on child mortality in Europe, far too many unwanted teenage pregnancies, abortions and sexually transmitted diseases among young people, and poor children who can have up to seven years’ shorter lifespan than their well-off counterparts down the road.

Let us talk about obesity. I will not repeat the many and varied serious disease risks that result from obesity. We need to invest in prevention. I am a firm believer that good health begins at home—as does poor health—and that it can be reinforced by schools. Indeed, it is wise for schools to care about their children’s mental and physical health, because they affect academic achievement. Therefore, if we are to have a long-term effect on the health of the population, we need to start, as many noble Lords have said, with the parents, before birth if possible. Again, there are considerable inequalities here. The percentage of premature and low birth-weight babies among deprived communities is much higher than among the higher demographic groups. Some of this, as we were told by Simon Stevens this morning at a seminar, is due to the higher incidence of smoking in pregnant women, but not all of it. Poor nutrition, stress and poor antenatal care are contributors. Stress is a killer and is particularly damaging to the brain development of young babies and children, especially if it is caused by domestic violence.

It is appalling that in this highly developed country, there are pregnant women who do not have access to good fresh food. There are food deserts: places where people cannot get to shops that sell good fresh food because there are none; moreover, they do not have the means of transport to get to one. The main problems, however, are the lack of cooking skills, and poverty. Cheap food tends to be highly calorific and low in nutrition. As we know, overweight mothers more often have overweight children—and so the cycle continues. I would like to see compulsory cooking lessons in schools and good-quality health education, through which children are taught how to eat well. Many schools have done really well on this. They have school meals staff who are passionate about providing fresh and nutritious food; in some places, they even grow it.

Of course, this requires leadership from head teachers, who have a lot of other things to worry about, but as I said, it pays dividends, because well-fed children learn better. That is why the Liberal Democrats in the last Government were keen to bring in free school meals for key stage 1 children. School meals in local authority schools have to be up to certain nutritional standards, which is why I want to ask the Minister why the Government do not insist that academy schools abide by these standards. Currently, they do not have to.

School food is particularly important for very poor families who may be in houses with poor cooking facilities, who may have had the electricity or gas cut off, who may be in bed-and-breakfast accommodation with no cooking facilities at all, and who may have chaotic lifestyles, meaning that the children do not have regular mealtimes. School food is therefore particularly important to poor children. We really need to pay attention to this issue for the sake of their future health.

You may ask why I am concentrating so much on food—apart from the fact that I like it. The reason is that if we instil healthy eating in children, we are carrying out a major preventive programme against heart disease, diabetes, strokes, musculoskeletal diseases and the rest. Given that resources are scarce and the population is both growing in number and ageing, this strikes me as common sense.

Let me turn from prevention to care. As the noble Baroness, Lady Hollins, said, 40% of GP visits are made by children, so those who suffer most when it is hard to get a GP appointment are children. The Government have a commendable ambition to reduce weekend mortality by making primary care services available seven days a week, but if this is done without more resources, by spreading out what is already there, the result could be disastrous. I have already mentioned our poor child mortality figures. Like the noble Baroness, I was horrified to learn that every day in the UK, five children die who would not have died if we had the same child mortality figures as Sweden. Will the Minister look into this? That is five family tragedies every single day that could have been prevented. If they can do it in Sweden, why can we not do it here?

I am also concerned about services for children with physical and learning disabilities. In the last Parliament, Sarah Teather, as Children’s Minister, initiated education, health and care plans in an attempt to co-ordinate all those services around children. But many of these services are delivered by local government, and there have been many cuts to local government funding. I am therefore concerned that the thresholds above which children become entitled to such services may not be appropriate. Will the Minister say something about that?

Health inequality is worse in this country than in many other developed countries, so we need to focus on child poverty and scrutinise every statement from the Chancellor about taxes and benefits, asking what effect they have on the health of our children. Will the Families Minister be doing this tomorrow, when the Chancellor announces his Budget? I doubt it but I shall be pleasantly surprised if the Minister assures me in a few minutes that she will.

NHS: Whistleblowing

Baroness Walmsley Excerpts

Tuesday 30th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes a very important point. There are many junior doctors from BME backgrounds who do indeed feel that it is difficult to raise concerns. One recommendation in Sir Robert Francis’s report is that every NHS organisation should have a local freedom to speak up guardian, which I hope will help. But whatever we do to change the law or codes from the GMC and others, it will not replace the need to have an open, transparent and learning culture in all NHS organisations.

[Baroness Walmsley (LD)]

My Lords, would it not be more likely that such discrimination as mentioned by the noble Lord, Lord Desai, would be stamped out if there were more black and ethnic minority members of staff at senior levels in the NHS? Is he aware that the proportion in London NHS trusts of those from a BME background is only 8%, compared to 45% in the general population and 41% among NHS staff?

[Lord Prior of Brampton]

The noble Baroness has probably read The “Snowy White Peaks” of the NHS, which sets out very clearly for all to see the really shocking lack of representation of people from BME backgrounds at senior levels of the NHS. This is an absolute priority. NHS England has appointed Yvonne Coghill to look at all the racial inequality issues, and she and NHS England have my full support in their endeavours.

Mental Health: Young People

Baroness Walmsley Excerpts

Tuesday 30th June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I congratulate my noble friend Lady Tyler of Enfield on introducing this important debate. We have heard some very thoughtful speeches, ranging widely across the subject. My noble friend called for wise spending of very scarce resources and emphasised the need to consult children themselves and their families when putting together the transformation plans that are so important. She called for better access to services for young people, particularly the most vulnerable groups, and for some monitoring as to how well we are doing through an annual report.

The noble Lord, Lord Patten, emphasised the importance of parity of esteem for physical and mental health and called for early intervention. He was particularly concerned about the effects of social media on young people—something that of course did not affect your Lordships when we were growing up.

The noble Earl, Lord Listowel, in his usual way championed, as he has done so wonderfully over the years, looked-after children. He called for services to take account of their particular vulnerability to mental health problems and their need for emotional well-being, which they may well not have grown up with given their difficult backgrounds.

The right reverend Prelate the Bishop of St Albans talked about the good work of charities. He called for more data about prevalence and emphasised the difficult position of 16 and 17 year-olds being very inconsistent in legislation.

For my own part, like the noble Lord, Lord Patten, I am particularly interested in the prevention of mental health problems. Like him, I believe that that is the cost-effective approach. There is so much evidence that perinatal mental health, proper parental attachment and early intervention are not only more effective for the human beings involved but more cost effective for the taxpayer. So I welcome those elements of the report that focus on early intervention.

My noble friend emphasised perinatal mental health services, and I would like to start by asking the Minister what progress has been made on the recommendation that there should be a specialised mental health clinician available to all perinatal units by 2017? How much emphasis is given in antenatal classes, for example, to making mothers aware that they need to focus on their own well-being, minimise stress and ensure that they bond well with their baby when it arrives? One cannot start too early when fostering good mental as well as physical health.

There are some excellent charities working in this field, such as OXPIP, which focus on good attachment. They have learned many lessons about what works well in relation to identifying poor attachment and addressing the situation. What is being done to ensure that these lessons are being used all over the country?

The report focused on the need for early support initiatives, and it is clear that health visitors are key to this ambition. However, some health visitors have been in the profession for many years. Although their long experience is enormously valuable, since it allows them to develop deep knowledge and good judgment, it may also mean that they have not had time in their busy schedule to keep up with the latest on early intervention. Can the Minister assure us that they will be allowed enough time for this sort of continuous professional development?

Learning the lessons of what works is a key element of the new HeadStart initiative funded by the Big Lottery Fund and this is to be very welcomed. The project is focused on a key group, those aged between 10 and 14, to better equip them to deal with difficult life experiences and develop their resilience as protection against future events that might damage their mental health. Since half of all adult mental health patients first had problems before they were 14, this is exactly the right target group. Although £75 million sounds like a lot of money, there is a big task ahead. I understand that 12 pilot projects are under way, providing early support to children who need it, both in and out of school. Lessons learned will be shared with schools, youth groups and decision-makers. Partners include, as they should, GPs, local authorities, schools, youth groups et cetera. Some of these are used to working in partnerships, but others are not—I hope that the worst come up to the standard of the best.

Schools, of course, play an enormous role. With others in your Lordships’ House, I have long called for compulsory PSHE in schools, starting early in an age-appropriate way. Some people think that we are just talking about sexual health and relationships, but we are not. We are talking about developing self-esteem, self-confidence and resilience, as well as the life skills and knowledge to help the child cope with the modern world when he or she leaves school. Will the Minister go back to his colleague the Secretary of State for Education—who I think has more of an open mind about the matter than her predecessor—and encourage her to change the Government’s mind about this, because it is a vital weapon in our armoury against the epidemic of mental health issues among young people?

The task force also recommended that there should be a CAMHS contact in all schools. Earlier this year, the Department for Education proposed to implement pilot schemes in 15 areas. Can the Minister say whether this has begun and how the schemes’ success will be assessed, since we have heard nothing about it since March?

Many schools, of course, are not waiting for government to catch up. They have counsellors, anti-bullying programmes and partnerships with excellent organisations, such as Place2Be, which does wonderful work in schools at a very moderate cost. However, it is not easy for hard-pressed head teachers to find a room for them to work in and the small amount of money to fund their programmes.

The noble Earl, Lord Listowel, talked about the importance of training those professionals who work with looked-after children. But I have become very concerned just recently to realise how few doctors are trained in psychiatry in their initial training. Given that one quarter to 50% of patients presenting to GPs have mental health problems at the root of their illness, it really is important that we have some consistency across the training of doctors in this country, and in particular those Jacks of all medical trades, the very important GPs working in primary care.

I await the Minister’s response with interest, particularly on those questions about prevention.

NHS: GP Clinics

Baroness Walmsley Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is quite right. We do need GPs, and they will be at the heart of the renaissance in general practice. The Government are committed to recruiting an extra 5,000 GPs into general practice over the next five years—that figure is net of people retiring. We accept entirely the noble Baroness’s proposition that we must persuade more newly qualified junior doctors to opt for general practice rather than for working in hospitals.

[Baroness Walmsley (LD)]

My Lords, what discussions have the Government had with the Royal College of Emergency Medicine about the idea of collocating GP clinics in A&E departments? Surely such a strategy has the potential for killing two birds with one stone.

[Noble Lords]

Oh!

Mental Health Services

Baroness Walmsley Excerpts

Thursday 25th June 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I thank the noble Baroness, Lady Thornton, for introducing this debate. I was delighted that she and her colleagues felt able to support the Liberal Democrat amendment on parity of esteem. The noble Baroness has given a very comprehensive outline of the problems highlighted by the report and I will not repeat them. Suffice it to say that we on these Benches will support anything the Government do to alleviate the problems of young people with mental health issues before and during crisis situations. Early access to treatment is the key to reducing the number of crisis occurrences and good planning of adequate services and information to patients are key to making sure that people in crisis can get the help, as the CQC says, “right here, right now”.

We are proud of the record of our Liberal Democrat Ministers, Paul Burstow and Norman Lamb, in the last Government. They were involved in announcing: parity of esteem for physical and mental health; an increase in funding for mental health, including more in-patient beds; increased focus on child and adolescent mental health; and equal waiting time targets. The Children and Young People’s Mental Health Taskforce report Future in Mind is an excellent blueprint for the five-year national programme of improvement commenced under the auspices of my right honourable friend Norman Lamb and it is part of his excellent legacy in the Department of Health. The mental health crisis care concordat was another great achievement and it is good to know that everyone has now signed up to it and that most local authorities have a plan to deliver it. However, resources have been scarce for most of the past five years so this progress has to be seen in the context of an earlier reduction in the number of mental health beds and years of insufficient focus on children and young people.

I welcome the Government’s proposal to ban the use of police cells for young people in crisis. However, I want to talk about timing. There are times when Governments, in their rush to do the right thing, forget that if they do not put other things in place before acting, they can make things worse. I can think of the spare room subsidy which the previous Government imposed without ensuring that sufficient smaller properties were available for people to downsize. That is why my party put forward a Private Member’s Bill to ensure that tenants would not have to contribute for spare rooms unless they had been offered suitable smaller accommodation and refused it. Sadly, that was defeated in another place. Another potential example is the current Government's plan for seven-day availability of GP services at a time when we have not even got enough GPs to fulfil current demand.

I am concerned that if the ban on use of police cells is brought in before the problems highlighted in this thematic report from the CQC are addressed, we will be leaving young people in crisis with nowhere to go. I do not want to see police officers disciplined for bringing young people into police stations when there are no age-appropriate therapeutic services available for them and that is the only thing they can do. I do not want to see A&E departments trying to cope with these young people, who need time that the staff do not have and a calm atmosphere—which is not going to be found in A&E. I do not want to see young people failing to call for help when they need it because they know that the police cannot protect them—often from themselves—and neither can A&E.

It really does not seem right that people are being turned away from services when they ask for help only to be detained when their condition deteriorates. However, although they are not the appropriate service to help in mental health crises, it has to be said that the police do their best, and many patients in this situation report that they get better help from them than from some other services. Some forces have implemented rather creative strategies. I have heard of at least one force where officers called out after hours to a person who clearly is having a mental health crisis take a community psychiatric nurse with them. These nurses are able to assess the situation and calm the patient, allowing him to be dealt with appropriately. This is an excellent example of thinking outside the box and is to be commended.

I ask the Government to ensure that before this very welcome ban comes into force they have all their ducks in a row, so to speak. My question, therefore, is: how will the Government assess when this is the case so that the ban can be safely implemented once the legislation has gone through?

There is one large group that is particularly at risk in these situations: young people who have recently left care, many of whom develop mental health issues soon after having to live independently. Many of these young people do not have a responsible adult to turn to and do not access services early, and far too many of them suffer a crisis and harm themselves or even commit suicide.

There is evidence that the problems overall may be understated by the official figures. Although only 53 under-15s and 312 16 to 17 year-olds were admitted to adult mental health wards in 2013-14, people were counted only once no matter how many times they were admitted in the year. These figures come from an Answer to a Written Question from Luciana Berger.

Another problem is poor anticipation of a future crisis and poor communication between services. The report we are discussing found that the rate of people admitted to acute hospital via A&E for a mental health condition varied across the country. In 2012-13, more than 4,000 people had attended A&E multiple times—on average, at least once a month—in the five years before being admitted. This is likely to be a sign that local services are not working well together and that people are not getting the specialist help they need. Should there not be guidelines that a red flag is raised when these multiple attendances occur?

Given that the pathways into help in a crisis are several, can the Minister reassure us that local concordat teams are covering all the bases, ensuring good communication and providing services at the right time? Will he emphasise that patients need to know who to call to get help? One of the worst findings in the report was the large number of patients at risk of a crisis who said that they did not know who to call in an emergency—no wonder they land up in A&E.

I realise that the task for local commissioners is a difficult one. They need to predict what crisis services will be needed and at what times, and make those services available. This requires a deep knowledge of the status of patients in their area and a commitment to providing therapies which will prevent problems reaching crisis point. So my final question is: how are the Government assessing how well this is being done?

NHS: Immigration Rules

Baroness Walmsley Excerpts

Wednesday 24th June 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I agree with my noble friend; it cannot be right for a rich country such as ours to recruit nurses from much poorer countries. I will just say that the Philippines, for example, produces more nurses on a deliberate basis than it needs for itself, so that they can go overseas, usually for temporary periods, not permanently. Interestingly, over the last five years, the number of non-EU overseas nurses working in this country has reduced by 41%.

[Baroness Walmsley (LD)]

My Lords, if we need more home-grown nurses, what are the Government doing to address the flood of nurses leaving the profession, and the appalling attrition rate during training? My noble friend Lord Willis’s report on the Shape of Caring review showed that every year 20% of student nurses do not complete the year, and 40% of nurses do not complete the first five years in the profession. Since it costs £78,000 to train a nurse, is that not a terrible waste of money, and could we not do more to support student nurses to finish their training?

[Lord Prior of Brampton]

The noble Baroness makes a strong point. The drop-out rate of nurses is between 20% and 30%; it varies hugely from one nursing school to another. I am told that the peak of the drop-out rate is after their first clinical placement, which indicates that the way some nursing schools recruit their students is far from satisfactory. I hope that Health Education England will change the way it remunerates some nursing schools to ensure that they recruit the people with the right qualifications, temperament and vocation before they offer them places.