Mental Health Services: Leeds

Debate between Jackie Doyle-Price and Dan Poulter

Tuesday 23rd April 2019 Westminster Hall

[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.

--- Later in debate ---

[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.

Non-surgical Cosmetic Procedures: Regulation

Debate between Jackie Doyle-Price and Dan Poulter

Tuesday 12th February 2019 Westminster Hall

[Jackie Doyle-Price]

I am happy to endorse that point. It is worth bearing in mind that in wishing to regulate the sector we do not want to undermine its dynamism and competitiveness. What we really need is to ensure that consumers are properly educated, so that they can make informed choices about where they seek treatment and can protect themselves. Medical professionals are equipped to deliver some of the treatments, but we do not necessarily want that as a monopoly. Provided we have an appropriate system of regulation with everyone signing up to the same expected standards, such a system can be embraced.

We have had reference to Sir Bruce Keogh’s invaluable review, led by my hon. Friend the Member for Central Suffolk and North Ipswich. The Government have acted to improve the regulation and registration of those performing cosmetic interventions, but we clearly need to make much more rapid and substantial progress if we are to protect consumers properly. The industry is ever-expanding. We have heard that treatments are now available on the high street in places such as Superdrug, but this is not like going to have a haircut. When things are injected into a person’s face, if it goes wrong, it takes a lot longer to fix than letting their hair grow again would. We need to be sure that we are properly looking after consumers, including their safety.

[Dr Poulter]

I welcome what the Minister has said about wanting to go further with regulation. Historically, the challenge has been other Government Departments pushing back against the position of the Department of Health, which has wanted to protect people—seeing them as not just consumers but people who would be considered as patients in other capacities—and put in place adequate regulation of this sector. I hope that, given the Minister’s interest in this topic, she will be able to take the challenge to other Government Departments, and overcome the out-and-out free-market instincts that are putting people at risk.

[Jackie Doyle-Price]

I could not agree more with my hon. Friend. He is absolutely right: the priority for us in the Department of Health and Social Care has to be the safety of people undergoing these procedures. Aligned with that, I was pleased to see in the challenge to Superdrug a recognition of the fact that people’s seeking these sorts of treatments can be an indication of dysmorphia and an underlying problem. We need to make sure that all practitioners in this field have the ability to recognise those problems.

ADHD Diagnosis and Treatment

Debate between Jackie Doyle-Price and Dan Poulter

Tuesday 15th May 2018 Westminster Hall

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

I congratulate the hon. Member for Leigh (Jo Platt) not just on the passionate and articulate way in which she has introduced this important subject, but also on setting up the all-party parliamentary group. I am delighted to accept her invitation to come to a meeting and to hear some of the stories. I would also, through her, extend my congratulations to Michelle Beckett for her work in raising awareness.

The hon. Lady has highlighted that this group of people face quite intense, if unconscious, discrimination, because the way that our education system is set up does not really address their needs. That is something we should all wish to tackle. There are similarities with the way that autism and conditions such as dyslexia were treated in the past. If the abilities to learn are not there, people can fall out of the system. The truth is that they have a very different skill set and we should all be endeavouring to draw that out and, at the very least, not make them feel marginalised or discriminated against. As we have heard from other hon. Members, it is that sort of discrimination that leads them to fall out of the mainstream and perhaps fall into the criminal justice system, which is something that could easily be avoided if we were all more sensitive to it.

The hon. Lady mentioned data. I will take that away and look at it. It is fair to say that it is only very recently that the NHS has started to collect data regarding autism, for exactly the reasons highlighted today—the postcode lottery in terms of how different areas treat the condition. Quite often, it depends on having somebody in the area who gives a damn to give some leadership on the issue. Clearly, that is not good enough, as it will fail far too many people. I will go away and look at that. We have just introduced a new dataset for autism and I do not see any reason why we cannot extrapolate that methodology to look at ADHD. There is no doubt that we will continue our dialogue on these issues.

[Dr Poulter]

The Minister is absolutely right to highlight the issue of data, or the lack of it. In the interests of parity of esteem, is it also worth looking at introducing access targets in mental health for access to child and adolescent mental health services, which do a lot of the assessment of people with ADHD? Would that help drive better data collection in the NHS? Measuring against a target forces local healthcare providers to collect the data that is necessary to drive improvements.

[Jackie Doyle-Price]

I am just about to come on to issues about waiting times. The methodology that my hon. Friend suggests is absolutely right. Although it is Mental Health Awareness Week and we are looking at the issue through that prism, this is not just about mental health; it is about a learning disorder, and goes beyond that. Compartmentalising people who fall out of the mainstream as those with mental health issues is equally discriminatory, but we do have to ensure that we have the right care pathways for them to meet their needs.

[Dr Poulter]

I did not intend to come across as discriminatory in the point that I made; it is CAMHS professionals—mental health professionals—who tend to do the assessments for ADHD in children. What is the Minister going to do about the recruitment crisis in CAMHS? Without those CAMHS professionals, we shall not be able to provide the diagnosis and delivery of care.

[Jackie Doyle-Price]

My hon. Friend will be aware that we have addressed those issues in the Green Paper. We are investing in a whole new workforce in support of CAMHS, which will have a direct relationship with schools, where it will be possible for a lot of the wraparound help to take place.

I would like to make some progress on the specifics of ADHD and move on from CAMHS. The hon. Member for Leigh highlighted the massive variation in services across the country. I fully acknowledge that there are long delays for some to see a specialist and secure a diagnosis. That will clearly have a negative impact on those living with ADHD and their families, who can also find the experience confusing.

We are determined to see improvements in the patient journey. There are NICE guidelines. The earlier the diagnosis the better, and the better the chance of getting the right support and better outcomes for the individual. The NICE guidelines were published in 2016 and set out the process for managing ADHD for people aged three years and above. The guidelines aim to improve the diagnosis of ADHD, as well as the quality of care and support for people with an ADHD diagnosis.

An updated guideline was published in March this year, which particularly addresses under-diagnosis and misdiagnosis of ADHD in girls. People think it is just about behaviour, but in girls it does not play out in exactly that way; there is a lot to be done in education on exactly what this condition is. As the hon. Lady said, people think it is about bad parenting or bad behaviour when it is much more complex. The guidelines advise practitioners to be alert in such circumstances to the possibility of ADHD. We will be failing girls if we do not raise awareness of how that might be playing out.

The guidelines also recommend that people with ADHD would benefit from improved organisation of care and better integration of child health services, CAMHS and adult mental health services. Although NICE clinical guidelines are not mandatory, we expect health and care professionals and commissioners to take them into account fully as they design and put in place services to meet the needs of their local populations. NICE has published a range of tools to help local areas put the guidance into practice, but that is clearly not happening everywhere. I always find that sunlight is the best disinfectant, so the more we can do to ensure transparency, the better. That is why data is so important, as the hon. Member for Leigh said.

The NICE guidelines do not at this time recommend a waiting time for seeing a specialist for diagnosis, but they do recommend that parents of children whose behaviour is suggestive of ADHD should be offered a referral to group-based ADHD-focused support without waiting for a formal diagnosis. That will clearly be helpful, but we should also look at the waiting times.

An issue that I am particularly concerned about—I look forward to engaging with the APPG on this—is support for schools, which the hon. Lady mentioned. Getting the right support package for children with ADHD can be challenging for some institutions. I am concerned that anecdotal evidence suggests that people are being excluded disproportionately, so we really need to tackle that discrimination. Perhaps I can ask the APPG what we can do together to give schools extra support and better advice about how to support children with this condition, rather than simply marginalise them.

The Children and Families Act 2014 and the special needs code of practice set out ways in which care services should join up, and we need to hold them to account. We expect CCGs and local authorities to work together to support children with special educational needs or disabilities, including ADHD. That includes co-ordinating assessments of individual needs and, for those with the greatest needs, providing an individual education, health and care plan. I am interested in hearing evidence from the APPG about how many children are not receiving such plans.

I am not going to stand here and pretend that everything is perfect, because I know perfectly well that it is not, but we have the opportunity to highlight good practice, help local authorities and CCGs to learn from it, and highlight when people are being failed.