Young People’s Mental Health

Helen Hayes Excerpts

Thursday 27th October 2016 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House notes the recommendations of the Youth Select Committee report of November 2015 on Young People’s Mental Health; endorses the findings of that report on the need for more support from the Government for mental health services for young people; acknowledges steps taken by the Government, since its response of January 2016 to that report, with regard to some of its recommendations; and calls on the Government to set out what further progress has been made since its response and what its plans are further to improve mental health services for young people.

The motion concerns the report of the Youth Select Committee on young people’s mental health and the Government’s response to that report. I am grateful to the Backbench Business Committee for allocating time for the debate, the application for which was supported by more than 50 members from across the House, and to the hon. Member for South Cambridgeshire (Heidi Allen) for co-sponsoring the debate.

I start by paying tribute to the many health professionals and voluntary sector organisations working in mental health services for young people, the teachers and teaching assistants who support young people with mental health difficulties in classrooms every day of the week and the youth workers seeking to support our young people in many different ways. This debate is not about the commitment of those who work tirelessly to support our young people but about the resources and the framework within which they are working, which affect our collective ability to deliver the outcomes we need.

The Youth Select Committee report on young people’s mental health was published in 2015, as a consequence of more than 90,000 young people voting for the subject of mental health in the 2014 Make Your Mark ballot. It is an exceptionally important piece of work because it is a report on mental health by young people, about young people. Since I was elected last year, I have been struck by how often young people’s mental health issues have been raised with me; whether by individual constituents struggling to access the support that they or their children need, doctors in my local accident and emergency department or teachers in our local schools. The issue is raised very frequently, and no one thinks the current situation is even close to being acceptable.

I pay tribute to the Youth Select Committee for its excellent, rigorous report and clear recommendations, which fall into three areas: funding and the state of services; a role for education; and awareness, stigma and digital culture. The report concludes that mental health services are significantly underfunded, and young people’s mental health services even more so, and that the challenge posed today by young people’s mental health is unprecedented. It highlights significant problems in accessing services, particularly in relation to first contact through GPs, and raises the urgent need for every young person in the UK to leave school with a good understanding and awareness of mental health, empowered and equipped to look after their own mental health.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend agree that some of the issues on access that are raised by this very good report could apply equally to adult services, so there is clearly a read-across between the two?

[Helen Hayes]

My hon. Friend is absolutely right to say that, although today we are debating young people’s mental health, many of the same issues apply to mental health services across the board for all members of our communities.

The Government published a response to the Youth Select Committee report in January 2016. That response was, on the whole, disappointing. It referred mainly to work that the Government were already doing rather than the additional work that they and other agencies clearly need to do. Most disappointing of all, the response rejected the key recommendation that statutory levels of attainment in mental health education should be introduced for all young people. I welcome the fact that the Government have subsequently announced some additional funding for young people’s mental health, but I remain very concerned about the current state of mental health services for our young people and the resourcing of those services.

I will focus, therefore, on the current state of services, and what I believe to be evidence of a crisis that is growing, not diminishing, and demands a response far bolder and more comprehensive than that which the Government are currently offering. I will also return to the conclusions of the Youth Select Committee report.

One in four of us will experience mental ill health in any given year. That means that mental health is something that affects every one of us. All of us have a friend or family member who has mental ill health, and many of us will experience mental ill health ourselves. I have known close friends and family members who have suffered from severe anxiety that impacted on their daily lives, clinical depression and eating disorders. There are few worse feelings than the worry for a loved one who seems unreachable in the pit of depression, except perhaps the worry when that loved one is a child. All any of us wants for our own children and the young people we represent is that they grow up happy, healthy and resilient to the stresses and strains of our world. Watching a precious child struggle with clinical depression, severe anxiety or an eating disorder is absolutely devastating.

According to NHS statistics, around one in 10 children and young people has a diagnosable mental health condition; that is around three students in a typical classroom. Many more young people do not have a diagnosable condition but experience a period of mental ill health or emotional distress during their childhood or adolescence. The Government’s own measures of children’s wellbeing found that almost one in four children showed some evidence of mental ill health. Half of mental health problems are established by the age of 14 and three quarters by the age of 24.

Shockingly, suicide is the most common cause of death for boys aged between five and 19, and the second-most common for girls of that age, after traffic accidents. A recent survey by Girlguiding found that 69% of girls aged seven to 21 feel that they are not good enough. It is thought that around one in eight young people self-harm between the ages of 11 and 16.

[Ms Karen Buck (Westminster North) (Lab)]

I know that my hon. Friend also has concerns, which a number of us share, about serious youth violence. Does she agree with me that mental ill health is now understood to be a key trigger in gang and serious youth violence, and that this deserves a serious and concentrated focus from within the health service and the Government? There is some very good practice out there. It is, sadly, nothing like widely available enough to help us deal with this problem.

[Helen Hayes]

My hon. Friend makes a very powerful and important point. This is an issue that affects both our constituencies to a significant degree.

Only 0.7% of NHS funding is spent on young people’s mental health and only 16% of that funding is spent on early intervention. The Royal College of Psychiatrists also reports that additional funding the Government have committed to young people’s mental health is not getting to the frontline. Responses to a recent freedom of information request from my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) revealed that although the Secretary of State made a commitment that the proportion of funding for mental health services should be increasing everywhere this year, and this is desperately needed, 57 of the country’s clinical commissioning groups are actually reducing the proportion of funding for mental health services.

The charity YoungMinds reports that three quarters of young people with mental health problems may not get access to the treatment they need. Child and adolescent mental health services, on average, turn away nearly a quarter of children referred to them for treatment by concerned parents, GPs, teachers and others. That finding is supported by evidence from the Association of Colleges, which reports that, of 127 colleges responding to a survey, many reported real difficulties referring students on to health services in times of crisis, with 61% of respondents reporting that their relationship as a college with local mental health services is only “fair” or “not very good/non-existent”. The thresholds for support are going up at precisely a time at which demand for services is increasing. This has the potential to create a ticking time bomb of mental ill health for the future.

The average waiting times for all CAMHS providers was six months for a first appointment and almost 10 months for the start of treatment; and an investigation by Pulse recently found that three in five referrals from GPs to CAMHS are being batted back to primary care without any access to specialist support. When early intervention is not available, it is very often schools and colleges that end up dealing with the consequences, and they are woefully under-resourced to do so. A recent survey by the National Association of Head Teachers found that only a third of primary schools have access to a school-based counsellor, and that of those who do have access, 59% have a counsellor on the school site for one day a week or less.

[Helen Whately (Faversham and Mid Kent) (Con)]

I commend the hon. Lady for securing this debate on this very important subject, which often comes up in my constituency work. She makes a point about schools struggling to find support. That is certainly something I have experienced in my constituency, so I want to reiterate the point that primary and secondary schools know they have children who could really benefit from more specialist support and it is very hard for them to access it.

[Helen Hayes]

I agree with the hon. Lady completely. As we focus on prevention and early intervention, we need to think about early intervention in terms of age, as well as the stage of mental ill health.

As a consequence of the lack of early intervention support, the number of young people attending A&E because of a psychiatric condition has more than doubled since 2010. I have spoken to many doctors who tell me that when this happens and a seriously unwell young person presents at A&E needing a CAMHS in-patient bed, they frequently wait a very long time—sometimes days—for a bed to be identified. Often that bed is hundreds of miles away from home. One south London hospital has provided me with data that show a 37% year-on-year increase in the number of under-16s being seen in A&E with a mental health condition, and a 193% year-on-year increase in the number of those children being admitted to an in-patient bed.

[Mr Kevan Jones]

Does my hon. Friend agree that while there is a shortage of beds, another issue, particularly in cities such as London, is poor quality housing? In cases where individuals could perhaps have been treated at home and in the community, that treatment cannot be delivered because of the lack of proper housing.

[Helen Hayes]

My hon. Friend is right. There are multiple causes and contributory factors to mental ill health, and multiple contributory factors that present obstacles to addressing that and providing the treatment people need, where they need it. Housing is certainly one of them.

In London, 69 young people from Lambeth, Lewisham, Southwark and Croydon were unable to receive in-patient care in the South London and Maudsley Trust. Of those, 45 were sent out of London for their care. This issue, of seriously unwell young people being sent a long distance away from home to access in-patient care, needs to stop. It is distressing for families, it stops young people receiving the maximum possible support from family and friends to help them recover, and it makes them more vulnerable. When young people are admitted to a CAMHS in-patient unit, very often the service is not what it should be. The Care Quality Commission found that 62% of CAMHS in-patient wards and units were inadequate or required improvement.

The goal of parity of esteem for mental and physical health was introduced into the Health and Social Care Act 2012 via an amendment by Labour peers, and was a landmark in the way that mental health services are considered. However, we only need to think for a moment about what our response would be if some of the statistics on young people’s mental health related to a physical condition to realise just how far away we are from the stated objective of parity of esteem being realised. Just imagine if 75% of people with a bacterial infection struggled to get access to treatment; if almost a quarter of referrals for cataracts were turned away; if people with a chest infection were routinely forced to wait until they had pneumonia before any help was provided; or those with a broken leg were forced to wait for days in A&E only to be sent to a hospital hundreds of miles away to be treated. It would be a national scandal. The state of our mental health services, particularly those for young people, is a national scandal: it just is not being recognised as such. Words alone cannot achieve parity of esteem; the Government must start to act differently.

What action, then, is necessary to transform mental health services for our young people? I want to return now to the conclusions of the Youth Select Committee report. The Royal College of Psychiatrists highlights three recommendations in the report, which it believes are key. First, the Government must increase funding for young people’s mental health services and ensure that this funding is ring-fenced to guarantee that the money “reaches the ground” to CAMHS. There is particular concern at the moment about the introduction of sustainability and transformation plans across the NHS, and the resourcing implications of those plans. The Royal College of Psychiatrists recommends that the Government introduce ring-fenced funding for CAMHS and rejects any sustainability and transformation plans that do not clearly set out a plan to improve children’s mental health services in their area. I hope the Minister will commit to that today.

Secondly, health services must pursue co-production, in which young people themselves are involved in the process of formulating policy to improve CAMHS. Research shows that where young people have a clear voice in service design, the end result much better reflects the real needs of the patients.

Thirdly, the Government must focus on improving mental health education in schools, with the aim of ensuring that young people leave school with not only an understanding of mental health, but an understanding of how to help their own mental wellbeing. This recommendation was made by the Youth Select Committee and it is supported by the Education Committee, the National Association of Head Teachers and other teaching unions, the United Nations and many others. The Government have introduced new lesson plans for the personal, social, health and economic curriculum, but there is a broad consensus across the health and education sectors that the role of mental health education in developing resilience, preventing mental ill health and safeguarding young people is so important that it should not be left to chance, and that along with sex and relationships education it should be a compulsory part of the curriculum. I hope the Government will reflect on the urgency of the situation and the consensus around the need for compulsory education, and will make a commitment to introduce it.

The Youth Select Committee report made many other practical recommendations, including the introduction of regional commissioning, the development of an app to provide mental health advice and support, and the introduction of plans to support students through periods of exam stress. I would welcome an update from the Minister on the progress that is being made to deliver these excellent ideas.

Finally, we know that one of the greatest barriers to delivering the mental health support and services that our young people need has always been the stigma that surrounds mental health. I want to pay tribute to a brilliant piece of work that was recently published by the YMCA in partnership with the NHS. Called “I Am Whole”, the research sought to identify the extent and impact of mental health stigma and included the finding that three quarters of the young people spoken to believe that people experiencing difficulties with their mental health are treated negatively as a result of stigma. The project also sought to address stigma directly by publishing a series of stories from young people about their experiences of mental health difficulties. These make for very challenging and moving reading.

Before I close, I want to read a quotation from the foreword to “I Am Whole”, from Connie, aged 22:

“Having mental health difficulties is like being trapped inside a thousand invisible prisons. There are a thousand reasons that as a young person you are driven deeper into that colossal void. Not only isolated by the struggles you’re facing mentally, but further enveloped in a thick, suffocating darkness. The darkness descends, comprised of a tangled web of myths, harmful language, misconceptions and misunderstandings. This is stigma. It is time for these myths to be dispelled, the web broken and the isolation to end. It is time for us to be free to talk about our mental health difficulties openly, so that we can access the services we need. Once the conversation begins, you promote understanding for others and break down misconceptions people hold…It is like being stood in the dark, untangling parts of that web until the sun’s warmth breaks through…the light reaches your eyes, and you look around to see you are not alone.”

When we talk about young people’s mental health, we are talking about the wellbeing of our precious children, about their health and happiness, about the resilience of the next generation and about the ability of young people to fulfil their potential and be everything they can be. We are talking about the ways to stop more families living with the heartbreak of a young person with mental ill health and about ways to stop more families suffering the devastation of a loss to suicide. There are few things more important than this and it is time the Government got it right.

--- Later in debate ---

[Tim Loughton]

I do agree. Believe it or not, my hon. Friend is older than me and was in the year above me at school. He has aged rather better than me, but then he has not been in the House quite as long as I have. He is right about the dynamics of the stresses and strains in those days. How children communicate has also changed. For example, one of my daughters once put in her request for supper by text message from her bedroom to my wife and me in the kitchen—supper’s off! In an age when communicating has never been easier with email, social media, mobile device, tablet or whatever, the irony is that face-to-face communication between human beings has never been more rare or remote. Therein lies part of the problem. Communication between children and parents does not happen as regularly, and the fault lies with the parents as much as the children. Some people cannot talk frankly about the real pressures, strains and stresses on our children and about grooming, sex matters or drugs. In my hon. Friend’s day and my day, we perhaps talked more to our parents or other family members.

I will now pick out a few points from the report—I know that other hon. Members want to speak. We have reached a point at which one in 10 school-age children will have some form of mental disorder, and the age at which that happens is getting younger. Some 340,000 five to 10-year-olds have a form of mental disorder. If it is not detected early and acted on, it just festers and gets worse. Too often, the only immediate response if someone gets access to a clinician is the chemical cosh of drugs, which is in many cases inappropriate for younger children. Talking therapy, for example, might be more appropriate, but we increasingly find that when people have to wait weeks or months for them a call has to be made between waiting longer or giving some form of antidepressant.

The report flags up the big issue of the transition from childhood to adulthood. Nothing changes physically or mentally when someone receives an 18th birthday card from their Member of Parliament. The last thing that an 18-year-old needs if they are going through the stresses of mental health is to have a completely new process and system to deal with because they have suddenly become an adult even though their condition has not changed. There is a particular issue around children in care, who too often used to leave at the age of 16. Fortunately, we now have a new scheme, which I was proud to have piloted at the Department for Education, based on staying put, allowing for a longer lead-in time. Every child is different and different children will be ready to go into the big wide world at different ages. The report contains some good examples of best transition practice. Southampton general hospital has a 0 to 25 age range for its “Ready Steady Go” scheme, under which every person is treated differently—people have different “go” ages.

Turning to the report’s recommendation about GP training, it is right, certainly for younger children, that GPs will be the first port of call for clinical services. Training for GPs to deal with younger people’s mental health problems is not good. Young people may need a lot of confidence to go along to see a GP with a parent or whomever, and there must be a clear understanding of how to tease the best out of children, so we need better guidance. As the hon. Member for Dulwich and West Norwood mentioned earlier, young people should absolutely be in on the genesis of that guidance.

Another recommendation that we have heard a lot about relates to what happens in schools. The hon. Member for Dulwich and West Norwood quoted the National Association of Head Teachers briefing, which states:

“When children do not meet CAMHS thresholds, schools often become responsible for children’s mental health.”

In too many cases, they are ill-equipped to do so. We are dealing with potentially one in 10—three in a class of 30—children suffering from some diagnosable mental health disorder, and the chief medical officer says that three quarters of them will receive no treatment at all. That will obviously have an impact on the child, but there will be an impact on the class as well and it is very much in the school’s interest to do something about that.

We need better teacher training so that they are able to identify the signs that point towards a mental illness. They also need better awareness of where to signpost children to get the treatment that they require. They should also be able to talk about things more generally in class. We can argue whether PSHE should be compulsory—I have some sympathy with that—and whether mental health should be a formal part of it, but it must be done in an environment in which young people will feel engaged. It should not be just another lesson, but a place where they feel free to talk openly, to absorb and to learn.

[Helen Hayes]

The point about the proposal that mental health education should become compulsory is simply that its presence on the curriculum is too important to be left to chance. I entirely agree with the hon. Gentleman that it should be undertaken in a way that is engaging and effective at educating young people, but does he agree that whether it happens at all should not be left to chance?

--- Later in debate ---

[Helen Hayes]

I very much thank the 10 Back Benchers, the Opposition Front Benchers and the Minister for taking the time to be in the House to contribute to this debate. It has been an excellent debate, with some very powerful speeches. Members have acknowledged the scale of the crisis in young people’s mental health, very effectively represented those of their constituents who face mental health issues, brought to bear their direct experience in this field and called on the Government to take a different approach. We have discussed many statistics, and they paint a picture of a heartbreaking reality for young people and families across this country. Many Members have also highlighted the false economies involved in failing to invest properly in young people’s mental health, with the additional costs to the health service, local authorities, the criminal justice system and, indeed, to human beings themselves.

Many Members have paid tribute to the work of the British Youth Parliament, and I want to add my voice to those saying that the work of the Youth Parliament should be debated in Government time. We must continue to build the institution of the Youth Parliament as the voice of young people in our democratic process. It is right and proper that it should be given such a status. The debate has, on the whole, been very consensual, and it has shown the House at its best. I hope that Members on both sides of the House have communicated to the British Youth Parliament, the Youth Select Committee and young people across this country the seriousness with which we take this issue.

I very much welcome the Minister’s response, and her commitment to address this issue and to deliver a step change in young people’s mental health. She is right to point out that this will require resources, leadership and work across Departments. She mentioned work with the Department for Education, but work with the Department for Communities and Local Government will also be very important. As the Minister also has responsibility for public health, she will know the extent to which public health expenditure is so challenged at the moment. We heard from several Members during the debate about the impact of such cuts on mental health and as a direct consequence of them. I welcome her response, but it must be backed up by action, following through and delivering on those commitments.

I hope all Members from both sides of the House who have contributed to this debate will join me in holding the Government to account on delivering the step change we need to protect our vulnerable young people and on delivering a framework of support that will help them to be resilient, confident and healthy as they grow into adulthood.

Question put and agreed to.

Resolved,

That this House notes the recommendations of the Youth Select Committee report of November 2015 on Young People’s Mental Health; endorses the findings of that report on the need for more support from the Government for mental health services for young people; acknowledges steps taken by the Government, since its response of January 2016 to that report, with regard to some of its recommendations; and calls on the Government to set out what further progress has been made since its response and what its plans are further to improve mental health services for young people.

NHS Commissioning (Pre-Exposure Prophylaxis)

Helen Hayes Excerpts

Tuesday 7th June 2016 Commons Chamber

[Jane Ellison]

My hon. Friend is right to recognise that PrEP has potential. It is, in fact, being used in some places internationally. The point I was making was that there is no simple, one-size-fits-all solution. Different countries have different challenges. For example, the level of HIV prevalence and the services available to manage that prevalence, and to manage testing, are very different in different countries. That forms different landscapes into which PrEP might fit. To give an example from Africa, PrEP was licensed last year, and it will be available for sex workers in selected sites. HIV prevalence among female sex workers is estimated to be just under 60% in South Africa. There are different contexts in which PrEP is being taken forward, and that is just one of them.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

Local authorities’ public health budgets are being stretched to breaking point, and this is arguably one of the false economies of this Government’s approach, in terms of its impact. Does the Minister agree that in the context of such stretched budgets, the implication that local authorities should fund PrEP is simply unworkable, and will she make it clear that her position is that NHS England is the natural commissioner of PrEP?

[Jane Ellison]

I have been very clear about NHS England’s position, and I have said that no decision has yet been made about commissioning. I do not accept the hon. Lady’s challenge about spending on public health. We have committed to spend £16 billion over the next five years on the public health grant. In addition to that, we have committed more than £1 billion this year alone in the section 7A agreement and £300 million on vaccines that we buy in the Department of Health, plus system-wide leadership through things such as the sugary drinks levy and the forthcoming childhood obesity strategy. All in all, this is the radical upgrade in prevention that was talked about in the NHS “Five Year Forward View”.

Defending Public Services

Helen Hayes Excerpts

Monday 23rd May 2016 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

It is a pleasure to follow the hon. Member for Dudley South (Mike Wood), who spoke with passion about the NHS, a theme to which I will return. There can be no denying that the legislative programme outlined in the Gracious Speech is thin and aimed at preserving Tory party unity in the run-up to the EU referendum rather than at tackling head on the issues that the country faces, which is a great pity. This evening, I will concentrate on an issue affecting many of my constituents that was almost entirely absent from the Gracious Speech: the appalling state of mental health provision, and emergency provision in particular, across the country.

Our NHS currently faces an unprecedented financial crisis. Under Labour in 2009-10, the NHS reported a surplus of £2 billion. In the last financial year, the NHS in England reported a record deficit of £2.45 billion. It was the worst ever performance in the history of the NHS and worse than that predicted by NHS England. The deficit is kept from being significantly higher only by a series of creative accounting steps taken in a vain attempt to reduce the number of negative press reports about such disastrous performance.

This week, my family has again been profoundly grateful for the NHS. My mother, who spent many years working in the NHS, was admitted a week last Sunday after attending A&E. She was admitted at the weekend, but there was no absence of either diagnostic tests or expert healthcare at any level of the NHS. I am grateful to the dedicated staff who cared for her, and I am glad to say that she was discharged today. Over the past week, my family have seen NHS staff stretched to the limit, including nurses working 12-hour shifts without time for a break. My mother was not in the correct ward for the condition from which she was suffering, but an overspill patient on another ward, because no beds were available. She was admitted with a physical illness, but of all the pressures caused by the financial crisis facing our NHS it is mental health provision that is one of the biggest casualties.

Since May 2010, clinical commissioning groups across the country have reduced the amount spent on mental health, and we are seeing the consequences. In my constituency, for example, funding for first episode psychosis treatment has seen huge cuts and the number of mental health in-patient beds has been reduced, meaning that people in need of mental health care are in many cases left waiting for extended periods, either at home unable to cope or all too often in A&E. My constituency is served by King’s College hospital, a leading teaching hospital, and the Maudsley, a world-leading psychiatric hospital. Yet despite that combination of exceptional skills, expertise and facilities, the provision for mental health patients in A&E is simply not good enough. Despite the previous Labour Government setting aside funds for a dedicated waiting and assessment area for patients with mental health needs in A&E, it is yet to be delivered. On far too many occasions, patients attending A&E and requiring admission are unable to access a bed, because patients on the wards have yet to be discharged due to a lack of social care provision when they leave hospital.

I welcome the additional spending, although it is limited, on mental health that was announced in the Budget for tackling eating disorders, improving perinatal mental health services and providing mental health liaison services in every A&E, and the Government’s stated ambition of parity of esteem for mental and physical health. But much of the funding has previously been announced, and the overall budget assumes, incorrectly, that NHS trusts, including mental health trusts, will be able to attain unachievable levels of efficiency savings—the failure to do so being one of the main causes of the £2.45 billion deficit the NHS in England currently faces.

The commissioning of in-patient beds for child and adolescent mental health services within England is a national disgrace. Young people in urgent need are shuttled from one end of the country to another as a matter of routine. On the same day as a young person from Liverpool was placed on a ward in London, a young person from my constituency in London was admitted to a ward in Liverpool. No one would think it acceptable for a patient in cardiac arrest to be sent from London to Liverpool, and we should not accept a young person in mental health crisis being moved around the country in this way. Too many young people find themselves in hospitals dozens of miles from home, thus increasing their vulnerability, inhibiting the support that family and friends are able to provide to aid their recovery, and complicating their discharge planning.

The shortage of tier 4 CAMHS beds also means that young people frequently find themselves waiting in A&E for unacceptably long periods—often days at a time. We must see this for the scandal it is; we would not regard it as acceptable for a young person with a broken leg to spend days in A&E with only the most basic triage care, and it is just as unacceptable for someone with a mental health crisis to have to do that. The first step in achieving parity of esteem for mental health is to acknowledge these failures for the scandal that they are.

In my constituency, as across too many parts of the country, there is also an unacceptable shortage of places of safety for people who are detained under section 136 of the Mental Health Act 1983. That shortage delays the help that people who are desperately unwell urgently need. It is clear that there is too little co-ordination of the planning of the provision of places of safety, with police services, A&E departments and mental health services failing to work together to address the need. In London, the Metropolitan police have taken welcome steps to work towards eliminating the use of police cells as a place of safety for people in a mental health crisis who have committed no crime, but, without adequate multi-agency planning, this unilateral decision has exacerbated the pressure on A&E, resulting in situations where NHS staff are responsible for detaining patients and keeping them safe without having the required resources or an appropriate environment in which to do so.

One of the most shocking illustrations of the lack of parity of esteem between mental health and physical health is life expectancy: people suffering from serious mental illnesses such as schizophrenia or bipolar disorder can have a life expectancy 10 to 15 years lower than the UK average. Many mental health patients are dying early from heart attack, stroke and cancer rather than any cause linked directly to their mental health. Suicide is now the leading cause of death for men aged 18 to 49, with close to 5,000 people tragically taking their own lives in 2014. The recent Mental Health Taskforce report recommended the creation of local, area-based, multi-agency prevention plans, with a particular focus on high-risk locations and supporting high-risk groups. I urge the Government to implement the recommendations in full.

Our mental health services are failing too many people. One in four of us will suffer from mental ill health at some time each year, and all of us will know someone close to us who suffers from mental ill health. We are falling very far short of achieving parity of esteem for mental health. I find it astonishing that the Government do not seem to recognise this for the urgent priority that it is, and have failed to include any measures to address it in the Gracious Speech. The absence of significant measures in the Queen’s Speech to tackle these important issues speaks volumes about the priorities of this Government and how out of touch they are with the day-to-day needs and concerns of so many of the people I represent.

World Autism Awareness Week

Helen Hayes Excerpts

Thursday 28th April 2016 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am grateful for the opportunity to speak in the debate, and I too pay tribute to the right hon. Member for Chesham and Amersham (Mrs Gillan) for securing it and for her long-standing commitment and hard work on this issue.

Over the past year, I have been contacted by several parents of children with autism—parents who are proud of their children’s abilities and who, like any parent, simply want their children to receive the support they need to live the best life possible.

I have been contacted by enough parents to be able to see what some of the problems and challenges are—they are many, and they cut across different areas of public sector responsibility. I have represented parents of autistic children who are struggling to get a diagnosis for their son or daughter, which is a significant problem. Just as worrying, however, are the families whose child has a diagnosis but who are still struggling to secure the additional resources and support they need, whether that is support in the classroom, transport to get to and from school, help to access housing that is appropriate to their needs, or help with the welfare system or healthcare.

Across the public sector, there is a lack of understanding of autism and its impact on families. Families face stigma and stereotyping. The complexity of autism is not understood, and that results in parents facing weekly and sometimes daily battles on behalf of their children, just to secure the basics.

Earlier this year, I was privileged to meet Isabelle and Robin Garnett, whose 15-year-old son Matthew has autism. Isabelle came to see me at my surgery to tell me about the terrible experiences Matthew was having because of his mental health needs. I would like to focus today on the particular problems of people with autism who also have mental health needs.

Last summer, Matthew Garnett’s behaviour and level of distress deteriorated, and his family were finding it more and more difficult to cope. Eventually, Matthew assaulted his father, resulting in his parents calling the police—an absolutely heart-breaking situation for any family. Matthew was sectioned under the Mental Health Act and taken to a psychiatric intensive care unit in Woking, many miles from his south London home.

Psychiatric intensive care units are for short-term assessment; they are designed to diagnose a patient and to determine the treatment and support they need, and then to make an onward referral within six to eight weeks. Matthew’s doctors quickly identified that the most appropriate place for him was a unit at St Andrew’s, Northampton. St Andrew’s accepted the referral, but to Isabelle and Robin’s great distress, Matthew remained in Woking for a further six months, moving to Northampton only after a persistent campaign by his family, and after I had repeatedly raised the case in Parliament and with the Minister.

I am grateful to the Minister for meeting me and Matthew’s family, for recognising the extent of their suffering and the many serious issues with Matthew’s care, and for initiating a review of his case. I look forward to seeing the results of the review and to discussing it with the Minister.

One of the most troubling aspects of Matthew Garnett’s situation was the absolute absence of autism awareness or specialism from the care he received while he was in Woking for six months. There was no recognition of his need for routine and structure, of the impact of his diet on his condition or of the detrimental impact of too much screen time on his mood and level of anxiety. As a consequence, his physical and mental condition deteriorated while he was in Woking. He gained weight, became more withdrawn and broke his wrist; his social skills and reading ability regressed; and he became more anxious and frightened.

Matthew’s parents launched a brave campaign to get him the treatment he needed. In doing so, they engaged with many other parents of children with autism and mental health needs. Working with the National Autistic Society, they launched a questionnaire for parents of children with autism and mental health needs. Within a few days, more than 800 parents had filled out the questionnaire, and the results are very troubling. Almost half the respondents said that, prior to their child being admitted to hospital, they had received no support in the community for autism or mental health needs. Some 85% of those whose child had been admitted to hospital said they had received no autism-specific support. Almost half said they did not feel consulted about, or involved in, decisions about their child’s care when they were in hospital. Finally, 61% said that, after their child was discharged, no arrangements at all were made for suitable support back in the community.

Children with autism, and their parents and carers, deserve better than this. While I am grateful to the Minister for his engagement with Matthew Garnett’s family to date, I urge him to pick up the wider set of issues and challenges in the mental health care system and across other areas of the public sector and to ensure we have a fairer deal for families who face these daily, heart-breaking struggles and appropriate resourcing of the support they need.

Mental Health Taskforce

Helen Hayes Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

My hon. Friend makes a good point. GPs are often contacted first when a problem is developing, as I know from my contacts with the British Medical Association and with the Royal College of General Practitioners, which was also very interested in the taskforce report. Those organisations want to ensure that doctors have enough training, because training levels tend to vary according to interest. I know that all GPs are concerned about the matter and want to ensure that they have the skills. Equally, they need to know that they can then refer to the right place. That is what the increased support for both emergency and community services is all about. It is to ensure that there are proper pathways so that people do not get stuck at any particular stage.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

My 15-year-old constituent Matthew Garnett, who has autism, has spent the past six months in a psychiatric intensive care unit 30 miles from home. The unit does not have the specialism to meet Matthew’s needs and he has deteriorated significantly. The specialist bed that Matthew needs is in Northampton, where Matthew’s family have been told there are five young people who are ready for discharge but whose ongoing care cannot be arranged. Clearly, there is a crisis in mental healthcare for children and adolescents. When will the Minister bring a plan to the House to address that, and will he intervene to secure the bed that Matthew Garnett so desperately needs?

[Alistair Burt]

I thank the hon. Lady for her question. If she wants to make a particular approach on that case, I am ready to listen.

[Helen Hayes]

I have already done that.

[Alistair Burt]

It is already in the works. Okay, thank you. Let me say a couple of things with regard to specialist care. First, even though we want most young people to have access to care close to home, there will always be some specialist care that will require out-of-area treatment—perhaps those are the circumstances to which the hon. Lady is referring. It is then a question of getting the place.

That issue emphasises why it is so important to have the community care available. We need to be able to discharge patients and put in place a proper care package. That is precisely what the taskforce considered and made recommendations on. That work is already ongoing. As my time in office has shown me, there are variations in practice in different places. Discharges are handled better in some areas than in others. The practice of the best must become the practice for all. Everything must be done to ensure that people are treated in the appropriate place at the appropriate time, and keeping people in hospital unnecessarily is not what anyone wants. That work is already going on, and I will make sure that the hon. Lady gets an answer to her particular question.

Oral Answers to Questions

Helen Hayes Excerpts

Tuesday 5th January 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

I am delighted to do so. First responders have been a valued addition to the frontline of allied health professionals whom we can all support, and I am delighted to pay tribute to Brian for the work that he has done. I am sure that I speak for everyone in the House in saying a warm thank you to all those who have been part of the first responder scheme for the effort they have put in.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

T3. On too many occasions, children in my constituency who need to be admitted to a psychiatric in-patient bed have to wait for more than a day in accident and emergency before a tier 4 bed is found. Too often, available beds are outside London, and sometimes as far away as Nottingham, Glasgow or Southampton. How long does the Minister believe it is acceptable for a child to wait in A&E for a tier 4 child and adolescent mental health services in-patient bed to become available? Does he consider it acceptable for very unwell children to be sent such a long way from home for the treatment and care that they need?

Junior Doctors’ Contracts

Helen Hayes Excerpts

Wednesday 28th October 2015 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

Last week I met junior doctors in my constituency, many of whom told me that they cannot afford to live in London. One reported that she was sleeping on the sofas of friends and family members in order to cover her night shifts while working in London. The doctors also reported unfilled vacancies in departments in the hospital which serve and look after the sickest patients. Does my hon. Friend agree that the recruitment and retention of junior doctors is a bigger threat to patient safety than the issues to which the Secretary of State alludes?

[Heidi Alexander]

I do agree. I was talking about a seven-day NHS. A truly 24/7 NHS does not just mean consultants being more readily available; it means 24/7 access to diagnostic tests, social care, occupational therapists—the list goes on. If the Secretary of State has a magic pot of money to pay for all that, bearing it in mind that the NHS can barely pay for the work that it is currently doing, I am all ears. If his plan is to deliver seven-day services by spreading existing services more thinly, he should come clean and say so.

NHS (Contracts and Conditions)

Helen Hayes Excerpts

Monday 14th September 2015 Westminster Hall

[Helen Whately]

The hon. Lady is correct to distinguish clearly between correlation and causation, but I did feel that the tone of her remarks seemed to question the evidence of increased mortality over weekends and out of hours. I will say that I agree with her on the need for increased investment in IT to enable the clinical workforce to spend more time on clinical work. I agree with her on that point.

I have observed over recent years that the Secretary of State has championed the NHS. He has fought for its budget to be protected at a time when many other budgets have been cut. He has secured the Chancellor’s commitment to an extra £8 billion of annual funding by 2020, and he has truly focused on patients and clinical quality over finances and structures. I wonder whether any other Secretary of State has spent as much time with his sleeves rolled up in hospitals, not just listening to the sound of bedpans but actually emptying them.

I am a supporter of the Care Quality Commission and observe that three years ago it was close to collapse, but it is now widely praised, particularly by the acute sector. I know that GPs are unhappy about the inspections, but 70% of providers say that the CQC’s inspections have given them information that has helped to improve their service. That has been supported by the Secretary of State.

Along with that focus on quality and transparency, the Secretary of State is to be applauded for trying to improve the culture of the NHS—to make it more open, supportive and connected and to ensure that NHS leaders are in touch with patients and staff.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

If the Secretary of State is doing the marvellous job that the hon. Lady suggests, why did so many of the front-line staff in our NHS, who work so hard day in, day out, take to Twitter to express their lack of confidence in him?

[Helen Whately]

I believe that the Secretary of State has done a good job of driving the NHS in the right direction, and I know that a large proportion of the workforce have been very supportive of him.

We are all in this room because we value the NHS, but we must not be complacent. We have to recognise when it lets people down. It is intolerable that if someone has the misfortune to get ill and be admitted to hospital at the weekend, they may be more likely to die. I am not going to repeat the statistics on that, because my hon. Friend the Member for Totnes (Dr Wollaston) helpfully updated us, and I suspect that my figures are not as recent as hers. She made a strong case, as have others, for why the NHS needs to have proper seven-day care, which must include the support services mentioned by the hon. Member for Warrington North.

The Royal College of Surgeons strongly supports seven-day care. It has said that one reason why outcomes are worse at weekends is that patients are less likely to be seen by the right mix of junior and senior staff; that such patients experience reduced access to diagnostics; and that earlier senior consultant involvement is crucial. Research from the NHS National Health Research Institute shows that 3.6 more specialists attend acutely ill patients on Wednesdays than on Sundays. More senior doctors need to be available at weekends—not just on call, as many consultants are at the moment, but present in hospitals.

The changes should not be about getting doctors to work intolerable hours, and that is not what is being proposed. As has been mentioned, only a small proportion of consultants exercise their opt-out. One could argue that the changes to the workforce, and to the consultant contract in particular, are about bringing the contract into line with what is actually happening. Looking at the terms of the workforce gives us an opportunity to ensure that there is an appropriate package for doctors in A&E, where there are large numbers of vacancies. That is the case in hospitals in and around my constituency in Kent, which is an area with a high proportion of out-of-hours work. It also gives us an opportunity to ensure that clinicians are recognised and rewarded for taking on management and leadership responsibilities. We really need clinicians to step up and take on those responsibilities. It gives us an opportunity to make sure that consultants are treated as professionals who take responsibility for their patients, their team and the whole service that they provide.

The NHS faces an incredibly tough time over the next five years. It faces rising demand for its services and rising expectations, and even with an extra £8 billion on its way, things will have to change. Senior doctors, along with senior nurses and other health professionals, will have to lead those changes. When I worked in hospitals grappling with the challenges of transformation, ideas came from everyone: junior doctors, senior doctors and patients. When it comes down to it, consultants, matrons and senior staff have to lead from the front and make things happen. They often face opposition from colleagues, so they need to be courageous and put in extra hours.

To ensure that that happens, and to get the NHS from where it is now to where we want it to be in five years’ time, there has to be a sense that we are all in it together. We cannot have a situation in which doctors blame managers and politicians, while politicians and managers point fingers at doctors. We absolutely have to move on and focus on doing what is best for patients, and what will achieve the best clinical outcomes. We have to build trust among all who are involved in healthcare and work out how we can have, and how we can afford, excellent care seven days a week, day and night. We have to support the healthcare professionals—consultants, nurses, managers and everyone else who is going to make that happen.

--- Later in debate ---

[Paul Scully]

The hon. Gentleman will also find that the NHS improved over those years. We were second when the Labour Government were in power, so we have improved, and more data are still coming through. That is backed by public confidence, which has gone up by 5 percentage points to its second-highest level in the period covered by the report. The number of people in England who think that they are treated with dignity and respect increased from 63% in 2010 to 76% last year, according to Ipsos MORI. Record numbers say that their care is safe, and the number who think that the NHS is one of the best systems in the world has increased by 24 percentage points in the seven years since Mid Staffs. That is a great base from which to start, but we need to continue working with healthcare professionals to secure the seven-day NHS that we need and people want to see. Shouting and using the NHS as a political football will not get us very far.

[Helen Hayes]

The hon. Gentleman talks about the need to work with NHS staff. One of my constituents, who is a trainee anaesthetist, wrote to me in great detail with her concerns about the impact of the proposed contract change. At the end of her email, she said:

“As a final insult, Simon Stephens, Chief Executive of NHS England, has announced plans to pay for fitness classes for NHS workers, to improve our health and reduce absenteeism. NHS staff are screaming out to be cared for so we can care for others—by employing enough of us on fair contracts, with adequate resources to do our jobs well. Zumba will not achieve this.”

Although there is nothing wrong with employers investing in fitness classes for their employees, does the hon. Gentleman agree that, in a crisis situation, this is simply adding insult to injury?

[Paul Scully]

In his King’s Fund speech, the Secretary of State talked about working with professionals, including the British Medical Association and other organisations, throughout September. That example is why we need to keep the dialogue going. I have seen nothing substantive in speeches by Ministers to pitch them into conflict with the vast majority of NHS staff. It is about change management. Change is always difficult, but change we must do. We can achieve much more together.

National Breastfeeding Week

Helen Hayes Excerpts

Wednesday 24th June 2015 Westminster Hall

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I thank the hon. Member for Glasgow Central (Alison Thewliss) for securing this important debate.

I breastfed my two children, who are now aged nine and six. I was fortunate because that experience was relatively straightforward, but it was not without issues or a need for support. A few days after having my first baby, I remember experiencing toothache and wondering, in my slightly dazed state as a new mother, how toothache could possibly be a post-natal complication. I then realised that I had given myself toothache from clamping my teeth so hard because of the pain every time my baby fed. Those first few days were difficult and painful, and there were tears, but once I had mastered it, it was a hugely rewarding experience. My second baby could not tolerate cow’s milk, which made the transition to any type of formula very difficult, but I was glad to continue breastfeeding her for much longer because it benefited her health enormously. The health benefits of breastfeeding for mothers and babies are well established and proven, as rehearsed by the hon. Lady.

I want to highlight a pressing issue in my constituency: the potential loss of the breastfeeding cafés that operate in Sure Start centres in my constituency, in Streatham and in Camberwell and Peckham. Those cafés, which are resourced by experienced midwives from King’s College hospital, are a vital resource for new nursing mothers. They are under threat because the support from King’s College hospital is going to be withdrawn, due to the midwives who staff the cafés being needed on the labour wards. The hospital is otherwise unable to recruit to a series of vacancies in its midwifery department.

This is a grave situation. The breastfeeding cafés operate in Sure Start centre locations where many mothers are deprived, successfully extending the reach to those areas and increasing breastfeeding rates there. The benefits of addressing nutritional disadvantages, helping those babies to be healthier and getting them off to a good start in life are vital. I am concerned that a shortage of midwives elsewhere in the health service is putting those breastfeeding cafés at risk. I will certainly raise the issue with King’s College hospital when I meet staff there on Friday, and I will talk to the local authorities in Lambeth and Southwark about whether there is any way that those vital services could be continued.

I call on the Minister to help us in that endeavour and to help make additional resources available, so that experienced midwives can continue to staff breastfeeding cafés in my constituency and beyond. Extending breast- feeding to deprived communities in particular will save the health service money in the long term, so resourcing this service is money spent positively and spent well.

A&E Services

Helen Hayes Excerpts

Wednesday 24th June 2015 Commons Chamber

[Ben Gummer]

That is precisely the sort of policy on which we will seek consensus in the months and years ahead. There is a choice for Opposition Members. I know there are many new Members who wish to make their maiden speech in this debate, and I would just say to them that the choice is this: to come together to try to model better care within the NHS and better outcomes for patients, or to seek division.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I want to raise a point of substance that affects my constituents. There are young people in my constituency who would love to train as nurses and work in the NHS, but by cutting the number of training places in London by 25%, the Government have made that much harder. At the same time, when I last spoke to the recently retired chief executive of King’s College Hospital NHS Foundation Trust, he told me that he was recruiting nurses in the Philippines, because there are not enough nurses—

[Madam Deputy Speaker (Natascha Engel)]

Order. When the Chair is on her feet, Members sit. I have said before that interventions need to be very short and kept to a minimum. That was too long.