Mental Health Provision (Children and Young People) Bill
Debate between Craig Williams and Munira Wilson
Munira Wilson
I applaud a Conservative Member for talking to a Liberal Democrat about localism. I wholeheartedly embrace localism and would like to see much more local accountability for spending, and yes, there will sometimes be obvious reasons for variability. However, I would ask whether £15.90 sounds like a reasonable amount to spend per child on mental health. Unless there is a suggestion that in Halton there are pretty much no children struggling with mental health, which I doubt is the case, that tenfold difference does need investigation. Looking at the figures, Halton is one of the areas that has had a massive percentage increase in the past year, presumably to try to correct for that very low level of spending and the need that is there.
My Bill would make the publication of data on the provision of those services a statutory requirement. As such, we could secure a higher quality of data published in a coterminous way across NHS units—currently clinical commissioning groups, but in future integrated care systems—and local authorities by requiring publication on a regional basis. The Bill would also put a specific requirement on Government to publish spending per head on child and adolescent mental health services, as well as the proportion of overall NHS spending and mental health spending on CAMHS by region.
Clause 2 also requests that a statement be included as to whether the expenditure has met the aims of the NHS long-term plan. That is an important requirement to ensure the mental health investment standard is met. The standard is the Government’s tool to ensure CCGs increase how much they spend on mental health every year and, in particular, on children and young people’s mental health. Reporting on that standard has been of variable quality in recent years, with some areas reporting that they met the standard while including one-off, non-recurring pots of money or dementia and learning disability spending, all of which are specifically excluded.
Craig Williams (Montgomeryshire) (Con)
The hon. Member is being very generous with her time. On the point she made about the CCGs meeting the investment standard, every CCG met that standard in 2021-22. Of course, this is an English Bill, but as a Welsh Member of Parliament, can I reflect that until recently, Wales had a Labour and Liberal Democrat Government? There was a Liberal Democrat Minister for Education until recently, and the data in Wales is so poor compared with the dashboard. If we just had the right level of dashboard in Wales, we could really dig into the detail, so could the hon. Member reflect on why that is not happening in Wales, given that until recently, her party was in government there?
Munira Wilson
I hope the hon. Member will forgive me, but I am not briefed on what is going on in terms of the data in Wales. He is correct that every CCG is reporting that it meets the mental health investment standard, but as I am trying to explain—I will touch on this a little later—independent audits have shown that some CCGs inaccurately reported that they met the mental health investment standard because they included spending that they should not have included. That suggests they have met the standard, but they have not. That is why this Bill is trying to put some of those standards, and the explanation of how they have or have not been reached, on a statutory footing, so we can all have the clarity we need to hold Ministers and services to account. These requirements to report on CAMHS spending should not put a significant strain on NHS resources because, as has already been alluded to, a lot of that data is already being collected and some of it is being reported on the mental health dashboard.
I have no doubt that in her response, the Minister will refer to the Government’s amendment to the Health and Care Bill in the other place that requires the Secretary of State to lay a written ministerial statement setting out the Government’s expectation on mental health spending by NHS England for the year ahead. That amendment also requires integrated care boards to publish details of this spending in their annual reports. That is a very positive step forward; I welcome that amendment, and am glad—having been lobbying for it for the past two years—that we are making progress in the right direction. However, nothing on the face of the new legislation specifies that those reports should refer to children and young people’s mental health services in particular. Children and young people’s mental health services have always been the Cinderella of Cinderella services in our NHS, so I strongly believe they should be named on the face of the Health and Care Bill if the Government will not accept my Bill today.
With the retrospective reporting requirement on spending being in integrated care board annual reports, aggregating and comparing that data locally and regionally will be much more challenging. Furthermore, given the question marks I have already alluded to that have been raised about the quality of financial reporting by local organisations, which is why independent reviews of mental health spending have been commissioned for the past two financial years and this financial year, I have concerns that what is being done in the Health and Care Bill—the report of what has actually been spent—is just subject to annual reports by ICBs. Again, a report to Parliament would strengthen the basis of that data and its quality.
As I have said, some CCGs have been found to be erroneously reporting whether they are meeting the mental health investment standard, and although NHS England and Improvement has demanded explanations, I am not clear that any of those explanations are published anywhere. To me, the fact that the quality of the data remains an ongoing concern strengthens the need to ensure an annual report is made to Parliament with regional breakdowns.
To turn to data on waiting times, clause 3 of my Bill draws on the recent consultation on the mental health clinically-led review of standards. I welcome the broad support demonstrated for the proposed standards and particularly a four-week waiting time standard for access to community children and young people’s mental health services. However, as expressed by the consultation respondents, there needs to be clarity on what the four-week waiting time is for. Is it for assessment, starting treatment or another intervention?
My Bill would require a report to Parliament showing exactly how long children are waiting to access non-urgent treatment by region. That would better reflect the reality for so many young people, parents and carers who are beside themselves, waiting months or even years for an assessment and even more until they commence treatment. The statutory report that I propose would allow Parliament to hold Ministers to account for the appalling waiting times that every Member of Parliament has heard about in their constituency.