Psychosis: Early Intervention

David Simpson Excerpts

Wednesday 7th September 2016 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered access and waiting time standards for early intervention in psychosis.

It is a pleasure to serve under your chairmanship, Sir Roger. May I welcome the Minister to her new role? I spent a great two and a half years in the Department of Health; it was the most invigorating time in my life. I wish her every success.

The debate is on something that I care a lot about: a new standard of access for people who suffer a first episode of psychosis, a cruel and punishing condition that can have a massive impact on people’s lives—incidentally, at enormous cost to statutory services. When I came into my role as Minister, I recognised that there was a complete inequality of access, standards and rights between those who suffer from mental ill health and those who suffer from physical health problems. That inequality of access has existed for many years. In the last decade, the Labour Government introduced comprehensive access standards in the NHS for physical health problems, and they were right to do so—the cancer standards that have transformed cancer care in this country are a leading example of those—but they left out mental health.

It is not just that individuals sometimes end up having to wait interminably for treatment in some parts of the country; that complete imbalance of rights between mental health and physical health drives where the money goes. There is enormous political interest in meeting those demanding access standards. The national media look at the four-hour A&E standard. Certainly in my time in the Department of Health, all the great and the good of the NHS gathered around the Secretary of State’s table every Monday morning to look at spreadsheets showing the performance of every hospital in the country against those access standards. That extraordinary almost micro-management from the centre on access standards in physical health sets the tone for the whole system and makes it clear that meeting them is critical. So what do clinical commissioning groups around the country do? They trim a little bit off funding for mental health, which is still funded primarily through block contracts, to feed the beast of those exacting access standards in physical health.

I was determined from the start to address that injustice—that is what it is; it is a discrimination at the heart of our NHS—and introduce access standards in mental health. We went through a long deliberation before coming up with two specific standards, which were set out in a Government document published in October 2014, that we wanted to introduce as the start of a process that would lead ultimately to comprehensive access standards in mental health so that everyone with a mental health problem had the same right to get treatment in our NHS as anyone else.

The first standard that we identified was a six-week standard for access to psychological therapies. That is part of the improving access to psychological therapies programme, a well-regarded, world-leading programme that does not do everything but has been a significant development. The other was a two-week standard to start treatment when someone suffers a first episode of psychosis. Those people are typically teenagers or perhaps in their 20s—that is the most common age—but such an episode could happen at any time in one’s life.

[David Simpson (Upper Bann) (DUP)]

I congratulate the right hon. Gentleman on securing this very important debate. He has hit somewhat on the point that I was going to raise about early intervention. At what stage does he believe that we should deal with this condition? He talks about 18 or 20-year-olds, but should we go right back to primary or secondary school and deal with it in younger children?

[Norman Lamb]

We should always be guided by clinical judgment. That is critical. The standard that was introduced was for people between the ages of 14 and 65, which gives a clue about the appropriate level. This condition could emerge during teenage years, but we know that 50% of adult mental health problems start by the age of 14, so getting in and addressing problems early is critical.