Mental Health Taskforce Report

Dan Poulter Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris]

My hon. Friend makes a very important point. He is right, and I will come to the need for greater accountability later in my speech.

On commissioning, the “Five Year Forward View” report states:

“The transformation we envisage will take a number of years and without clear information about what the best care pathways look like and good data on current levels of spending, access, quality and outcomes, it will be hard to assess the impact of organisational change and ensure mental health services are not disadvantaged.”

Its very first recommendation is:

“NHS England should continue to work with Health Education England…Public Health England…Government and other key partners to resource and implement Future in Mind, building on the 2015/16 Local Transformation Plans”—

which I know are in the process of being implemented—

“and going further to drive system-wide transformation of the local offer to children and young people so that we secure measurable improvements in their mental health within the next four years.”

I dwell on those recommendations because—this speaks to my hon. Friend’s point—we need more transparency on what clinical commissioning groups are spending and where. The report is clear that there is currently simply too much variability across the country. I have long been an advocate of the importance of local, decentralised decision making. It is important that clinical commissioning groups have the freedom to commission services that they think are appropriate to their local population. The report is clear that we need a more consistent approach on mental health services that focuses on collaboration and more integrated commissioning across the spectrum.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Will my hon. Friend reflect, in the context of the devolved settlement for services, on the importance of substance misuse services and on the impact that the fragmentation of those services away from other mental health services may have had on patient care?

[James Morris]

My hon. Friend makes a powerful point. We need to deal with some of the issues to do with fragmentation in the system—he refers to substance misuse. The thrust of the recommendations in the report is about making sure we have a more integrated approach to commissioning mental health services across the piece.

The second important facet of the implementation challenges that the report throws up is research into mental health services. It mentions the need to have a proper, coherent 10-year plan for research into mental health to fill what are, as many of us would agree, big gaps in the evidence base.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is a pleasure to serve under your chairmanship, Mr Wilson, and to speak in the debate. I pay tribute to my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for bringing the debate, for his continued advocacy of the needs of mental health patients and for pushing continually during his time in the House on an important issue in ensuring that we hold our Government and NHS providers to account, so that genuine parity of esteem is delivered for mental health patients.

In the brief time available, I want to talk about a few points raised in the mental health taskforce’s good report, focusing on the need for more holistic care and joining up physical and mental healthcare for people with mental illness. I want to talk about access to care, recognising that some people struggle to access physical healthcare owing to their ethnicity or because English is not their first language. Such problems are compounded for those who have mental illness. I will also focus on some of the challenges in joining up what is a very fragmented health and care system, particularly for people with complex and enduring mental illness.

On holistic care, we know that somebody who is mentally unwell and has a chronic and enduring or severe and enduring mental illness can live a life up to 20 years shorter than somebody without that mental illness. That fact alone makes the point that we need to join up physical and mental healthcare better. My hon. Friend talked about a patient with diabetes. Such a patient may well develop diabetes because they are mentally unwell and do not have the right physical healthcare and support, or they may develop it as a side effect of some of the medication they are taking. We know that antipsychotic medications, for example, are linked with high cholesterol and developing diabetes.

We need to do much more to join up physical and mental healthcare. It is quite frankly scandalous and wrong that someone who is mentally unwell has a 20-year shorter life expectancy than someone who does not have that condition. That is something we must focus on and get right. We need to improve the physical and mental healthcare services for those with chronic and enduring mental illness.

We talked a little about the commissioning opportunities in that, and we must recognise that, at a local level, despite the Government’s best intentions, commissioners do not often put additional money into mental health services. Certainly in Suffolk, which I represent, the NHS funding increases—small though they may be—went largely to physical health and local CCGs failed to increase the money going to mental health conditions adequately.

The question is: how do we improve holistic care and join up physical and mental healthcare for those with long-term mental illness? We can and must learn lessons from the care in the community programme in the 1980s. The purpose of the programme—to deliver more care in the community and move away from the old asylums—was right, but the programme was not properly resourced. We must face up to that. Also, a lot of the money freed up by that was swallowed up by the physical healthcare sector and did not go into mental healthcare in the community. If we are talking about putting all the money for physical and mental healthcare in one place, we have to be careful that, by doing what sounds like a good thing, we do not effectively end up propping up the acute provider sector, which already consumes 55% of the NHS budget—that figure has risen over the last five years, as the Minister will be aware—and inadvertently further disadvantage mental healthcare, which receives only around 10% of NHS funding.

It may be appropriate—the report touches upon the importance of this—to improve liaison services on both sides of the divide between physical and mental healthcare. We could improve psychiatric liaison services for people with complex physical healthcare problems or enduring physical illnesses and, for people with long-term and enduring mental illness, we could improve medical liaison services in hospitals and properly involve and support physical healthcare in the community through GPs. I will not expand on that, as I do not have very long, but I would be grateful if the Minister responded to that point.

On access to services, we have to recognise that there is a fragmented care environment, in particular for people with chronic and enduring mental illness. Addressing that is not just about providing money for the health service, but about having appropriate housing—we know there is a shortage of appropriate housing to look after people with mental ill health in areas such as London—and dealing with the challenges in delivering proper social services care for such people. We also have to recognise that the state is often the only mechanism of support for such people. The only people caring for some of the poorest and most disadvantaged people in our society—people with long-term mental illness—work for the state; they are NHS and council workers. Unless we properly value and recognise their roles and properly fund—and increase funding—in a holistic, meaningful and long-term way, we will be unable to deliver the care that we need. There needs to be more money, more key workers and joined-up physical and mental healthcare. I endorse a lot of what the report says and I look forward to hearing the Minister’s response.