Mental Health Services: Leeds

Dan Poulter Excerpts

Tuesday 23rd April 2019 Westminster Hall

[Fabian Hamilton]

I thank the hon. Gentleman for that important intervention. He is absolutely right. It is clear from what I, and all of us, have seen that all GPs need far better training in how to deal with mental health issues.

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

It seems extraordinary that it is not compulsory for GPs to be trained in mental health. That is something that the Royal College of General Practitioners would like to change and something I hope the Minister will be able to pick up and work on. On the capacity in Yorkshire and the Humber, general and adult psychiatry at ST4 in 2017 had 20 places for trainee psychiatrists, only six of which were filled, and for dual general adult and older adult there were two places, none of which were filled. How much does the hon. Gentleman believe that a lack of staff resources contributes towards the poor care available to his constituent?

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[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Hosie. I thank the hon. Member for Leeds North East (Fabian Hamilton) for the passionate and articulate speech he has made on behalf of his constituents.

I often get frustrated by debates about the NHS, which are all about inputs—how much money is being spent, or what the size of the workforce is—and not enough about the direct patient experience and whether what we have is delivering the right outcomes. The story that the hon. Gentleman has shared illustrates that, for a lot of people experiencing mental ill health, their journey towards getting care is not always optimal. That is for a whole host of reasons, including historical issues regarding process and how people interact with their services. I will go away and take a deeper look at what he has highlighted, because it is a very good example of how things can go wrong.

As I say, the issue is not just about money, because we have made money available to all clinical commissioning groups. The hon. Gentleman has asked why, when we are making money available at an increased rate across the board, mental health services are so much worse in Leeds than elsewhere. As is so often the case with these things, a lot of it is about leadership. One issue that has been specifically raised with me is that often, the person responsible for commissioning mental health services within a CCG is not as senior as others. They are not as experienced, and that can cause weaknesses in commissioning.

It is important that we take action centrally to make sure that we deliver services more consistently, and I expect that to be achieved through the Care Quality Commission. The hon. Member for York Central (Rachael Maskell) raised specific concerns about her local trust. The CQC’s inspection report last year said that the trust requires improvement, so I fully expect it to work collaboratively with the CQC to take the steps that it is advised to take, in order to improve its performance when providing care. That CQC scrutiny will continue until the relevant improvement in performance is delivered.

NHS England also demands that CCGs achieve the mental health investment standard. Under that criterion, CCGs are bound to spend more of the additional money they receive on mental health services than their overall increase in budget. We expect NHS England to take direct action to secure that. However, that is not the whole story, because it depends on what CCGs are commissioning.

One of the messages that I have been keen to give CCGs is that delivering good outcomes for people suffering from mental ill health is not just about clinical services; the voluntary sector can play a big role. I have challenged CCGs to use some of their budgets to commission services directly from the voluntary sector. When someone is suffering a mental health crisis, they need help to navigate the system. In the example that the hon. Member for Leeds North East shared, that help was clearly not forthcoming from the GP.

Having someone with an understanding of mental health who can help a person suffering a crisis navigate through the system is clearly beneficial and, frankly, is good value for money. We should not spend all our NHS budgets on clinical staff when that additional support can deliver so much. In the case that the hon. Gentleman outlined, the GP did not do as much as he could have done, so we perhaps need to consider what else we can do to make sure that GPs understand that system. Again, the voluntary sector has a role to play.

My hon. Friend the Member for Morley and Outwood (Andrea Jenkyns) mentioned having more mental health education in schools, which is an issue that we are taking forward. She specifically mentioned Place2Be, which is a good example of how a third-sector organisation can work with the NHS to deliver the right outcomes. We are in the process of rolling out a whole new workforce in our schools to do exactly as my hon. Friend has challenged us to do.

On people who have attempted suicide, I readily concede that patients in such circumstances have not had a joined-up service between their GPs and their primary care providers. However, through the liaison psychiatry teams that we are rolling out in A&E, we intend to make sure that that wrap-around care is provided more readily.

[Dr Poulter]

Will the Minister give way?

[Jackie Doyle-Price]

I will, although I was just about to come to my hon. Friend’s point.

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[Dr Poulter]

Suicides are very unpredictable, and a lot of people who attempt to take their own life were not previously known to services—whether their GP or psychiatric services. The problem with mental health services in Leeds and elsewhere is that community services have been completely hollowed out by funding cuts over many years. Unless we invest in community services to stop people ending up in crisis in the first place, we are not going to solve the problem of suicide or deliberate self-harm, or provide help to those who really need it. I hope that the Government are going to get a grip on that problem and push it through NHS England and CCGs.

[Jackie Doyle-Price]

My hon. Friend is absolutely right. When we try to deliver a transformational step change in the level of service, one of the problems is that we end up raising expectations quicker than we can deliver on them, because we need a whole workforce that is able to deliver. I note my hon. Friend’s points about the number of people applying for psychiatric posts; we need to do much more to encourage people. We have spent a lot of time raising awareness of mental health and put a huge amount of investment into psychological therapies. However, at the heart of the forward plan for the next 10 years is a recognition that we need much more service available in the community, and much more help for people with severe mental ill health. I hope that my hon. Friend is reassured by that.

As I have limited time, I will follow up in writing on the other points made by the hon. Member for Leeds North East. As I said, we have made money available in Leeds, but when we look through the prism of someone who needs help and whose journey in getting that care is less than optimal, we clearly need to consider what is going wrong with that care pathway. If someone is vulnerable and needs help, and perhaps does not have a good understanding of mental health or has no experience of it, the whole process is very confusing and distressing.

How we navigate people through the NHS can often feel very inhuman—it is very reliant on process. The hon. Gentleman gave an example of how people are sent online to register, which feels a bit uncomfortable. We need to make sure that we take every opportunity to ensure that the patient is at the heart of this process and that their experience is pleasant, at a time when they are going through great distress. To say, “Here you are: go to this website—you’re on your own, so see you later,” is not a good start for anyone looking for help.

I am grateful to the hon. Member for Leeds North East for having brought this case to my attention, and I pay tribute to Mr and Mrs Downey for sharing their story, because doing so is incredibly difficult. I will look at the specific points that the hon. Gentleman has raised and come back to him.