Psychosis: Early Intervention

Gregory Campbell Excerpts

Wednesday 7th September 2016 Westminster Hall

[Norman Lamb]

I am grateful to the hon. Gentleman for his kind comments. I totally agree. There is an awful danger of a damaging gap emerging between the rhetoric and the reality. The coalition Government legislated for parity of esteem, so it is in the legislation that people should be treated equally, but unless the reality of people’s experience is that they are treated equally, the rhetoric is absolutely meaningless waffle and they lose trust in the Government. That is why I feel so passionately that we must do concrete things to make parity of esteem a reality for people, and that is an example of how we can make a difference to people’s lives.

The standard was announced in October 2014, to be implemented by April 2016—it had to be met by this year. Why is it so important? If we fail on that, we fail so many people whom we have the chance to help and surely it would be scandalous if the NHS neglected a standard accepted by Parliament and introduced by Government that we know makes a massive difference to people’s lives. It gives people the chance of a better life and surely the NHS is fundamentally about giving people the chance to have happy, good lives.

What has happened in that period? We undertook a comprehensive Freedom of Information Act survey—now that I am out of government, I have to rely on such surveys to find out what is going on—and the answers from clinical commissioning groups and mental health trusts are deeply troubling. On the key findings, first the overall conclusion is that the implementation of the standard is just fundamentally flawed. It has failed to deliver what we committed to. If the Minister, on advice from her officials, is tempted to refer to the nationally published data that suggest that the standard is being met, I would discourage her from doing so because the data are a fiction—we have established that through our work.

The first detailed finding is that there is a complete lack of robust commissioning in many parts of the country. The whole purpose of the commissioner-provider split, which of course is fairly controversial in the NHS, is that the commissioners hold the money and are there to design services for their community to meet the needs of that community, yet a third of CCGs could not identify how much funding had been allocated to early intervention in psychosis. That in itself is scandalous. They just say that there is a block contract and that it is up to the mental health trust—a total abdication of responsibility. Later, I will ask what the Government are doing about that, because that is not acceptable and completely contradicts the national guidance that was published.

Incidentally, I should say that one of the excuses used around the country for slowness of implementation is that the final guidance was published in April this year—when the standard was supposed to have been met. That does not demonstrate particularly helpful leadership from the centre. Having said that, the draft guidance had been in place for the best part of a year, so clinical commissioning groups around the country knew the direction of travel and could absolutely have been getting on with the job of preparing for meeting the standard.

When we did the survey back in May and June, well into the financial year, another 18 clinical commissioning groups—that is 11%—were still in negotiation for funding for early intervention in psychosis for a standard that was supposed to have been met in April. The question I will keep repeating is: why is that is not being treated with the same seriousness as the cancer standards? Why do we treat that as less important than someone suffering from cancer? I absolutely support and endorse the cancer standards, because it is critical that people with cancer get access to treatment quickly, but why should not someone with psychosis? It is scandalous. No one stands up for them. The Government have to lead on that. More than one in three clinical commissioning groups could not provide an estimate of the number of people in their area in need of early intervention services, in spite of the national guidance that says that commissioning should be underpinned by estimates of the local incidence to ensure that services are designed to serve the needs in a particular locality fully. If CCGs have no idea because no work has been done to establish the need in that area, how on earth can they commission a service to meet that need?

Next, according to NHS England, the estimated annual cost of providing the full package of treatment is about £8,250 per patient per year. Only 60 CCGs in our study were able to estimate their investment at all and only 11 estimated that they will meet the NHS England guideline on the level of investment. The average investment per patient from those who were able to say was £5,199, but of course an average hides the fact that many are way below that level. To draw an analogy, that is like saying to a cancer patient, “Well, you can have the chemotherapy but we can’t afford the radiotherapy, so you’ll have to put up with what we can offer.” Of course, we would never allow that to happen—the Daily Mail and many others would be up in arms, and they should be about this issue as well because the situation is exactly the same.

On age, which the hon. Member for Upper Bann (David Simpson) raised earlier, as I said in response to his intervention, the access standard is to provide the service to people between the ages of 14 and 65, in line, I should say, with guidelines from the National Institute for Health and Care Excellence, which has done the work and provided the evidence-based guidance. Almost a quarter of trusts—23%—commission services only up to the age of 35, including my own county of Norfolk. How on earth can trusts justify anyone over the age of 35 not getting access to a service that we have deemed it appropriate to provide to people across the country? They are just ignoring the national guidelines. Again, that seems to me to be completely unacceptable. That totally conflicts with the clinical commissioning groups’ responsibility. Out of the 39 CCGs which commission only up to 35, nine said they had plans to expand the service—they have plans, but why are they not doing it now?—and another 10 said that that was under review, but the rest had no plan to provide a service to people over 35. Outrageous, in my view.

Next is staffing and skill mix. We found a widespread failure to provide the full range of interventions required by NICE as part of the package of treatment, which is due to the shortage of staff with appropriate skills to deliver the service. Most trusts reported shortages of staff trained in cognitive behavioural therapy for psychosis and there were many other training shortfalls.

On data recording, NHS England introduced new information standards to support the monitoring of standards so that we could have some confidence that they were being met. Providers are expected to use electronic care record for patients to enable the collection of data and monitoring of performance against the standard. The guidance says that commissioners should assure themselves that local providers have made the necessary updates to the electronic care record system to ensure that clinicians are able to enter the data required to monitor performance against the standard, but we have heard that many trusts have not upgraded their systems and so are incapable of doing what is in the national guidance. We talked to someone who was at the heart of the implementation of the standard in one part of the country who mentioned widespread failure to do that. That means, as I said earlier, that the national data published by the information centre, which we are all supposed to rely on to tell us what is happening in the NHS, cannot be relied on. I put this point to the Minister: can the information centre investigate that further to ensure that the data it publishes tell a true story of what is going on?

There was also a scandalous variation between regions. I met the woman who has been responsible for implementation in the southern region. She was driving a programme of implementation and had a complete handle on the whole of her region. She had enormous variation of performance across her region, but there was someone in charge, doing it. She was an impressive woman. She told me that she was being made redundant; she was told that her job was done, even though palpably it is not. However, in other regions there has been no programme of implementation—no one in charge, to take responsibility for making things happen. The situation in the midlands and east in particular is in my view a disgusting, outrageous shambles, which should not be tolerated.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the right hon. Gentleman on securing the debate. On several occasions he has talked about this important matter in the context of the entire country; he is now discussing comparisons. Does he agree—I have raised this issue on a number of occasions, particularly on health matters—that we need to ensure that best practice is replicated not just in local commissioning groups in England, but across the United Kingdom? Ministers would then share information across the devolved settlements, to ensure that best practice was replicated and improved on for all our citizens.

[Norman Lamb]

I very much agree. We should all be learning from each other—and internationally, as well; but so often we fail to do that in the NHS. People on the outside may think that the NHS is a Stalinist organisation where everyone does the same thing. Far from it—it is too often anarchic. In the context of the NHS England infrastructure that we are considering, there are regions of the country that just have not done their job as they should have, which is scandalous.