Child and Adolescent Mental Health Services: North-east

Jackie Doyle-Price Excerpts

Wednesday 10th July 2019 Commons Chamber

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

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for the sensitive way in which she has outlined the case of her constituent Jane. We often debate NHS issues in this place, and it is often a case of trading statistics and numbers, but the hon. Lady has reminded us all that there are vulnerable people needing help who are potentially at risk of more harm when the NHS fails them. I will write to her in more detail answering some of the questions that she has posed to me today, but for the moment I will address some of the issues with which I am able to deal.

We have articulated clear ambitions for improving children’s mental health services, but, as the hon. Lady outlined extremely well, this follows decades of under- investment in those services, and there is a way to go from where we are now to where we need to be. The waiting times that Jane has experienced, which the hon. Lady outlined, really are not acceptable.

We will be very clear about our ambitions, but the hon. Lady is also right to highlight that we are very dependent on the performance of individual trusts in terms of delivering that. She set out the challenge as regards the Tees, Esk and Wear Valleys NHS Foundation Trust very well. The Care Quality Commission is giving quite a lot of attention to that trust for one reason or another, and the trust will be made much more accountable. I always say that sunlight is the best disinfectant, and one of the issues that we collectively face is that because mental health has for so long been something we have not talked about enough and has been stigmatised, mental health services have been a bit out of sight, out of mind, and have not had the scrutiny that they should have had.

The comparison the hon. Lady draws with an A&E, saying if it was turning away patients like this there would be an absolute scandal, is right, and part and parcel of achieving parity of esteem is that we must expect the same high performance and standards of our mental health services as we do of our physical health services. I know that the hon. Lady will not let me get away with not taking that as seriously as I possibly can.

We have made some progress, but, as the hon. Lady has heard me say before, I am in no way complacent about where we are. It is not just that we need overall improvement; there is great disparity between various regions and areas across the country, and the hon. Lady represents an area that is particularly challenged. She made some points about waiting time standards, and I am getting quite an inconsistent picture as regards the performance of that trust, which suggests to me that there is something wrong with the data and how things are being measured. Again, we need to hold everyone to account so we can be sure that our waiting list and waiting time data are accurate.

[Mrs Hodgson]

When I spoke to Mr Buckley about the sentence in the letter that said a waiting list was not operated, he explained that that probably was not very accurate, because when everyone is seen and triaged, if they need an appointment to see a therapist they are given one in, say, six weeks, eight weeks or 12 weeks. He said that the fact that they are given an appointment explains why there is no waiting list. So as the Minister rightly pointed out, we will have to drill down on that, because I do not think we are measuring the same thing across all trusts if they are all using different forms of words.

[Jackie Doyle-Price]

There might be something we can do on standardising the approach, but that brings us to another challenge. We apply these targets to try to achieve a standardised service and to ensure that people get treated when they need it, but that encourages some perverse behaviours, and the hon. Lady has just outlined one of them. The challenge for us is how we apply standards of behaviour and targets without driving perverse outcomes and bad outcomes for patients. I still think we have a lot to do on that, and probably a lot of learning. We need to identify those areas that really are doing it well so that we can spread good practice throughout the system.

But there is obviously a good reason why we must make sure we get child and adolescent mental health services much better: because we know that people who suffer from mental health issues tend to develop those conditions when they are children—when they are young. We all know that early intervention is the best way, not least for the individual concerned, because they will suffer less harm, but it is also good for the taxpayer because it costs less money to help people sooner. So we must make sure that we continue to give children’s mental health much more priority than it has had hitherto, and central to that will be greater provision of services in the community.

I am really concerned about the story the hon. Lady has just told. The process that Jane has been taken through appears to have completely failed, and the communication with her and her father appears to be extremely poor. Again, I think we can go away and look at how we communicate with patients and their families, and particularly at the tone that is used. We are dealing with people who are in a very vulnerable position, and to put it bluntly, it should not be “take what you’re given”, should it? Ultimately, our NHS is there to serve all of us, and it needs to do so with sensitivity and tact.

The hon. Lady rightly challenged me about money and the need to ensure that it delivers extra appointments. We are ambitious to see many more children, through the investment we are making, but unfortunately I do not have a magic wand and I cannot roll it all out overnight. As she points out, we need to ensure that we are investing in the appropriate workforce to deliver these services.

I would like to make another point about NHS commissioners. While we are delivering this real step change in mental health provision for children, there are other things that can be done by local health commissioners—and by local authorities, for that matter—while people are waiting for referrals and appointments. There is still additional support that can be given by organisations doing good voluntary work to give wraparound support and take some of the pain out of the experience. I often say that good mental health care is not all about clinical interventions; it is about the wider support that can be given in the community as well.

Our reforms to mental health in schools have that kind of support very much in mind. We are rolling out a new workforce, which is going be based on people who are trained in psychology and therapies, but the ethos will be very much that they are working with voluntary sector organisations that will be able to provide that additional support to people who are going through periods of mental ill health. We want to ensure that many more children who are going through mental ill health are seen, not least because we are seeing increased prevalence and it will take substantial extra effort to ensure that we are providing that service.

I turn specifically to waiting times. We have introduced new standards for mental health services, and in particular, we have introduced targets with regard to eating disorders and to a first episode of psychosis. We are making good progress on those, but as the hon. Lady says, Jane had clearly gone through significant trauma and it would not be unanticipated that that would impact on her mental wellbeing. Our targets for psychosis and eating disorders would perhaps not capture someone with that level of need, but it is still important that she has access to that support. Sunderland clearly has longer waiting times than many other areas of the country. I understand that the trust has been successful in bidding for additional NHS England funding as part of a national waiting list initiative, and I sincerely hope that that will improve access for the hon. Lady’s constituents.

When we hear of cases such as that of Jane, I can understand why people feel that our commitments on transformation ring a bit hollow. I know the hon. Lady will understand that we see this as a long-term process of rolling out improved services. That is the only way we are going to embed the change in culture that we really need in how we prioritise mental health, but we need to redouble that progress, as she says. We are determined that NHS funding for children and young people’s mental health services will continue to rise.

The hon. Lady asked me about making sure there is a proper ring fence. We have demanded that CCGs increase mental health spending on children’s services by more than their budget rises, but I think we will be taking a more interventionist approach. I know that NHS England is having robust discussions to ensure that all commissioners do exactly what is expected of them. We expect to have been able to treat an additional 345,000 children by 2024 through the additional funding, and we are already seeing some benefits.

I understand that in Sunderland, local commissioners have commissioned Mind to work with young people aged 11 to 25 and give direct support in that way. In addition, there is the new Lifecycle service, which includes access to adult therapies—one of the issues the hon. Lady raised. I am told that in Tyneside 90% of young people are seen within five days for triage into the service, but on the basis of what the hon. Lady has told me, I would like to do a bit more digging to make sure that the figure is robust.

We know that the mental health sector is showing imagination and innovation in filling the skills gaps in mental health nursing and psychiatry, but it is worth noting that one of the upsides of us talking about this subject and giving so much more attention to mental health is that it is raising the profile of the sector as somewhere to work. The really nice thing is that people do care about it. Applications for psychiatry are increasing, in part, I guess, because would-be psychiatrists can see that there will be plenty of demand for their services. Although we are making the sector more attractive, providing the workforce will be a big challenge, so we need to encourage more imagination about how that is delivered.

New roles are emerging, such as peer support workers, making use of lived experience. It strikes me that people going through mental health issues often find it intimidating to talk about it and to respond to treatment. Getting support from someone who has been through a similar experience can be enormously important to their recovery, and we want to encourage much more of that. We have the new nursing associates, and we want to encourage more mature workers—perhaps women re-entering the labour market—to explore careers in mental health. We will need much more imagination in the coming years if we are to continue to deliver the workforce we need.

[Mrs Hodgson]

I am sure the Minister can guess what I am about to say. Previously, the nursing bursary was so important for older people going back into the workforce or making a career change, and especially the group of people who now do not even apply for those opportunities. Is there any influence she can exert on the Government, any hope that at some point in this Parliament they will bring back that bursary?

[Jackie Doyle-Price]

I walked right into that one, didn’t I? The hon. Lady is right in the sense that we need to enable people to learn and earn. That is the key. I have conversations with Health Education England about how we can meet our ambitious workforce targets, and I am sure that it will have noticed what she just said and my reply. Applications are increasing despite the removal of the bursary, but I believe we could do more to encourage people who are considering entering the sector, perhaps later in life, when they have a family and they need to earn.

The NHS long-term plan, which contains some very ambitious commitments on mental health, is a huge opportunity for commissioners to think much more creatively about how they deliver their local services, because we are going to have to deliver a step change in the provision of services available in the community.

I have talked a bit about the mental health support teams going into schools, and it is pleasing to see that they are being rolled out. I do not believe we currently have a trailblazer that serves the hon. Lady’s constituency, but clearly if the local trust could work with local schools on delivery, it would make a huge difference to delivering services for children and young people. I believe teams are now covering Newcastle Gateshead, Northumberland and south Tyneside, and they will be testing the four-week waiting time, which she will believe is important, particularly when viewed through the prism of Jane’s experience. Later this week, we will be delivering the next wave of those sites, so let us watch this space—hopefully we will be able to get more provision.

The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned the issue of suicide and self-harm, which is clearly a considerable priority for me. We have been fortunate in seeing declining rates of suicide for a number of years, but we are beginning to see it on the rise again among children and young people. We could all speculate as to the reasons for that. They will be complex, because every suicide has its own story, and it is usually an escalation of factors that leads to someone taking their own life. We need to take a good look at exactly what pressures our young people are facing. Clearly, Jane had had adverse childhood experiences. We know they contribute to mental ill health, but other things are involved, too. If we can identify people who are at risk early—clearly, adverse childhood experiences are a good indicator—we can make sure we give that support sooner and then we will genuinely be able to tackle suicide prevention. We are on it, but we have a lot more learning to do on that.

I am really grateful for the sensitivity with which the hon. Member for Washington and Sunderland West has outlined Jane’s case, and I will take that away and respond in detail to the issues she has raised. As a pathway of experience, that clearly is not good enough, but I suspect it is all too common. Sometimes it is useful to use a particular case study to see exactly what is going wrong and what we can learn from. I would, however, say that I am proud of the progress we are making on improving services. We need to do much more. I wish I could do it quicker, but I will do the best I can.

Question put and agreed to.