Psychological Therapies

Dan Poulter Excerpts

Wednesday 16th October 2013 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Sir Edward. I pay tribute to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for securing this debate, for his tremendous work on the all-party group in highlighting the importance of mental health and the need to continue to raise mental health issues, and for his supporting the Government in seeking parity between physical and mental health, to which we have been committed since the coalition came to power in 2010. I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on her promotion to her new role and commend her largely bipartisan approach to the debate and on recognising that some of these issues are bigger than party politics.

Before I deal with some important issues raised by my hon. Friend the Member for Halesowen and Rowley Regis, I want to touch on the contributions of other hon. Members and talk about the context in which we are operating. We recognise, as a Government—I think that all hon. Members in this debate have recognised—that for far too long we focused on crisis management in health care generally, particularly in mental health, rather than on upstream interventions, which is where IAPT plays such an important role to keep people well in their own homes and communities, instead of picking up the pieces when they become so unwell at the other end. There is a good economic argument for that, but it also provides much better care for the patients and the people we all care about as Members of Parliament, and whom I care about as a doctor.

The hon. Member for Strangford (Jim Shannon) raised some important issues about veterans’ health. He knows that I have personally committed to improving the provision of physical and mental health care for our armed forces veterans. There are now 10 dedicated teams in England, focusing on supporting our veterans who have post-traumatic stress disorder and other mental health problems, post-discharge. A lot of work is going on—much more collaborative work—between the NHS and the armed forces, to ensure that general practitioners and health care professionals in England are much more aware of armed forces personnel coming back into their care, after serving in the armed forces, that a more holistic approach is taken, that people do not present too late in crisis and that GPs can be much more proactive in offering reassurance and support to veterans who may be running into the early signs of difficulties. My counterpart in Northern Ireland has been working hard on that and he should be commended for it.

My hon. Friends the Members for South West Bedfordshire (Andrew Selous) and for Eastleigh (Mike Thornton) made important contributions about the holistic approach to health care in general, about how mental health needs to be considered holistically and about the benefits to wider society of upstream interventions. Getting health care right can also provide additional benefits for the economy; for example, by supporting families to stay together and bring up their children. All these things are beneficial and at the heart of my work on early interventions projects. My hon. Friend the Member for Hornchurch and Upminster (Dame Angela Watkinson), who is no longer in this Chamber, and I are working closely on that.

[Huw Irranca-Davies (Ogmore) (Lab)]

I apologise for being late. I was at another meeting. I, too, congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) on securing the debate. Has the Minister already secured a meeting with Welsh Government Ministers, or will he do so in future, to discuss the approach towards veterans that he outlined? That issue is close to my heart, because I am aware of emergency rescue situations in which things have gone too far, when services, including mental health services, have been stretched way beyond their means in dealing with them. There would be benefits from sharing best practice across all the regions and nations.

[Dr Poulter]

The hon. Gentleman is right. We UK Health Ministers work collaboratively on many issues. However, on veterans, we have to recognise that, although we have UK-wide armed forces, health is a devolved responsibility. We need to share different initiatives better between the devolved Administrations. Some remote areas of Wales, in particular, could learn from best practice in the NHS about how we are using, to good effect, specialist mental health teams for veterans. I should be happy to share that and meet my counterpart in Wales to talk that through in greater detail.

I will focus in particular on the important contribution of my hon. Friend the Member for Halesowen and Rowley Regis. He addressed a number of issues that are central to the provision of good mental health care, and he threw down some challenges on how we could make things better. In particular, he praised the scale of the Government’s ambition to have genuine parity between physical and mental health, which has to be right; it is at the centre of everything that we are looking towards in the good commissioning of services locally.

I reassure the hon. Member for Liverpool, Wavertree that, with the addition of IAPT, there has been a substantial increase in the NHS’s total investment in psychological therapies. As she will be aware, however, it is down to local commissioners to prioritise their resources to meet local need, based on the local population that they serve. In the past, the challenge has been that good commissioning has too often been seen purely through the framework of physical health. Through the NHS Commissioning Board’s mandate, we are now ensuring that there is parity between mental and physical health. That journey is already well under way to ensure that good commissioning is no longer just about commissioning for acute services, such as stroke and heart attack, but about looking at the whole patient and considering the importance of upstream interventions, which are central to IAPT’s role in looking after patients.

My hon. Friend the Member for Halesowen and Rowley Regis also talked about the need to consider CBT and its evidence base. As he knows, it is not the role of Ministers to question the integrity of NICE, but NICE keeps its criteria under review, and there is a very strong evidence base to support CBT. The evidence base for IAPT is continually being developed and adapted, and a number of pilots are already in place to consider the potential to extend the scope of therapies, including to older people. I hope that that is reassuring. NICE will be listening to this debate, and it continues to evaluate the evidence. With mental health, there has always been controversy on how evidence is collated, because mental health is different from physical health, and NICE will keep that under review when it adapts and introduces future guidelines.

The debate has been called because all hon. Members in the room believe that, for too long, there has been too much focus on crisis management and acute response when patients with mental health conditions become very unwell. We would all like to see much more focus on upstream intervention, which is what IAPT is all about. We need to move the focus away from SSRIs—selective serotonin reuptake inhibitors—and drug-based therapy towards upstream, proactive intervention for what is sometimes a very vulnerable patient group.

The benefits of early intervention have been outlined by many hon. Members. There are clear health benefits, but there are also economic benefits, benefits to the family and benefits from getting people back to work, education and training, and from supporting people to have more productive and happier lives. That is why we will continue to ensure parity of esteem in commissioning for physical and mental health, and it is why we will continue to support upstream interventions in the early years—I will address early-years IAPT later. We will also ensure that we continually drive good commissioning to encompass mental health as well as physical health. That holistic approach to health care, by prioritising mental health, is good for people’s health care, good for families and good for the economy. That is why we will ensure that it remains a priority.

As hon. Members will be aware, the mandate set by the Government for NHS England last year establishes a holistic approach as a priority for the whole NHS for the first time. Improving access to psychological therapies is fundamental to the success of improving mental health. The mandate makes it clear that everyone who needs them should have timely access to evidence-based services. That is particularly important for mental health. By the end of March 2015, IAPT services will be available to at least 15% of those who could benefit—an estimated 900,000 people a year. We are also increasing the availability of services to cover children and young people with long-term physical health problems and those with severe mental illness to ensure that everyone can access therapies. There is an emphasis on those who are out of work, the black and minority ethnic populations and older people and their carers.

IAPT is being made available throughout the country. The programme was started by the previous Government in 2008, and we now have an IAPT service in every clinical commissioning group. There are more than 4,000 trained practitioners, and more than 1 million people are entering and completing treatment. Recovery rates have consistently been in excess of 45%, and they are much greater in many areas. The programme already has a clear track record of evidence-based success, and it is helping to reach some of the most disadvantaged and marginalised people in our society, which we would all say is a good thing.

[Andrew Selous]

My hon. Friend is absolutely right about the evidence. Although this is a little premature, he might be aware that the Department for Education has just commissioned evidence on the efficacy and cost-benefits of couple counselling. I have sometimes heard it said that there is no evidence for anything other than CBT, so will he say a little about the range of provision available under IAPT, specifically in relation to couple counselling?

[Dr Poulter]

My hon. Friend is absolutely right. I will address children’s IAPT in a moment, because the hon. Member for Upper Bann (David Simpson) made an important point on that.

My hon. Friend is right that, through not only IAPT but other programmes that consider health care more holistically—particularly the family nurse programme, which is aimed at vulnerable teenage mums—upstream intervention supporting those vulnerable groups helps to keep couples together and helps reduce rates of domestic violence. The programmes also support a stronger bond between mum and baby, so the child does better at school and mum and dad are supported to get back into education, training and work. So it is a win-win situation for the economy, and it helps vulnerable younger parents to have a better start in their own lives and provides a better start in life for their children. That is not exclusive to family nurses; we are also considering how the approach may be developed with IAPT, so that we can have a more joined-up approach both to children’s health generally and to families.

Earlier this year, I launched a system-wide pledge across education, local authorities, the voluntary sector and the NHS to do everything we can to give each and every child the best start in life. Part of the pledge is to do exactly what my hon. Friend outlines, which is to focus on getting early and upstream interventions right to support children in having the best start in life. We are also seeing the benefits of supporting families and reducing rates of domestic violence. I hope that is reassuring, and we will continue to develop and press those policies.

Briefly, our children’s IAPT programme is no less ambitious in its aim to transform services. In 2011, we announced funding for children and young people’s IAPT of £8 million a year for four years, and in 2012, we agreed significant additional investment of up to £22 million over the next three years, which is a total of £54 million up to 2015. That additional funding will be used to extend the range of evidence-based therapies to include systematic family therapies and interpersonal psychotherapy, to extend the range, reach and number of collaborators within the project and to develop interactive e-learning programmes to extend the skills and knowledge of professionals such as teachers, social workers and counsellors. Again, there is a multi-agency approach to improving the support and care available to children, because this is not just about the NHS, but about local authorities and education working together to get it right for young people. Behind those facts and figures are the people whose lives and services have been transformed by IAPT.

To conclude, it might be worth outlining a recent conversation that I had with a GP. When talking about IAPTs in West Sussex, he said, “I hear from GP colleagues that this is the single most positive change to their medical practice in the last 20 years, and I echo this. Our local service reaches out to the community, and it is always looking at ways to improve. It is continually developing new evidence-based interventions for people with anxiety and depression, delivered one-on-one and in groups in a flexible way that means patients have real choice. They have filled a huge gap in need and are a force for good.” That is absolutely right, and it is why we will continue to develop parity between mental and physical health and continue to expand the IAPT programme.