Mental Health Taskforce Report

James Morris Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris (Halesowen and Rowley Regis) (Con)]

I beg to move,

That this House has considered the report from the independent mental health taskforce to the NHS in England.

It is a pleasure to serve under your chairmanship, Mr Wilson. This is a very important debate on the “Five Year Forward View for Mental Health” report, published in February. I pay tribute to the chair of the taskforce, Paul Farmer, who is the chief executive of the mental health charity Mind, and the vice-chair, Jacqui Dyer, for all their work. I also thank all the other members of the taskforce and the people throughout the country who contributed to its work. It is an excellent study that contains more than 50 concrete recommendations about how we need to go about improving mental healthcare in our country.

The report represents an historic opportunity. There are three reasons why I believe it is pivotal to the whole history of our approach to mental healthcare in Britain. First, both the public debate in Britain about mental health and our social attitudes towards it have been transformed over the past 10 years. The quality of the debate in Parliament, the media and the public square is at a completely different level from where it was for many years. We are addressing issues of stigma and are open to discussing mental health problems in society.

Secondly, there is a general recognition in the Government and across parties that for too long, mental health care has been underfunded in the national health service. There is now a mature debate about how we should fund mental health services over the next decade.

Thirdly, I strongly believe that, as a result of the work of many people from all political parties over a long period of time, mental health is now at the top of the list of public policy priorities. We now have the political will, which is manifested in the Minister himself, who is absolutely committed to delivering on the plan formulated by the independent taskforce. Those are the reasons why I believe the report represents an historic opportunity.

The report provides a route map for change so that we can give hope to those throughout the country who are currently suffering from mental health problems and who may not be getting, or feel that they are getting, the level of service that they should from the NHS. I shall concentrate on the implementation issues highlighted in the report. There have been many reports over the past 20 years, and many strategies have been determined by Governments of both main political parties. I think we would all agree that over that period we have not made sufficient or fast enough progress, given that mental health issues are becoming more visible in society and given the prevalence of the mental health issues we are seeing across the age range and across the social and economic landscape of the country. There is a real urgency that we get this right, and now.

What do we need to do to drive the change that we all want to see in the quality and availability of mental health care in Britain today? The report focuses on four areas that are critical to implementation—commissioning; the importance of research and data; the incentives, levers and payments for services in today’s NHS; and leadership in the NHS and across Government. The truth is that, to achieve our goal of transforming mental health services in Britain, we need urgent action in all four areas.

The report is clear about the challenge we currently face on commissioning. It states:

“The quality of local mental health commissioning is variable. We found a twofold difference in apparent per-capita spend by CCGs, a more than threefold difference in excess premature mortality in people with mental health problems in England and a fourfold variation in mortality across local authorities.”

The reality is that we need better and more effective commissioning at a local level.

The report discusses the model of commissioning set out by the “Future in mind” taskforce, which looked into child and adolescent mental health services and came up with recommendations for improving commissioning. Those recommendations, which are picked up in the “Five Year Forward View” report, speak to the need to improve commissioning across mental health services and across the age range.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I pay tribute to my hon. Friend for securing this debate and for all he has done for mental health in his time in Parliament. He has been an absolute champion of it. Does he share my concern, which is shared by the Royal College of Psychiatrists, that there is currently no proper accountability for local clinical commissioning groups? The Bill on accountability in commissioning that I presented to Parliament last year would have required every CCG in the country to report back to the Secretary of State every year on the resources and spend in the local area. That way we would know exactly what was going on and could ensure parity of esteem in resources and allocation.

[James Morris]

My hon. Friend makes a very important point. He is right, and I will come to the need for greater accountability later in my speech.

On commissioning, the “Five Year Forward View” report states:

“The transformation we envisage will take a number of years and without clear information about what the best care pathways look like and good data on current levels of spending, access, quality and outcomes, it will be hard to assess the impact of organisational change and ensure mental health services are not disadvantaged.”

Its very first recommendation is:

“NHS England should continue to work with Health Education England…Public Health England…Government and other key partners to resource and implement Future in Mind, building on the 2015/16 Local Transformation Plans”—

which I know are in the process of being implemented—

“and going further to drive system-wide transformation of the local offer to children and young people so that we secure measurable improvements in their mental health within the next four years.”

I dwell on those recommendations because—this speaks to my hon. Friend’s point—we need more transparency on what clinical commissioning groups are spending and where. The report is clear that there is currently simply too much variability across the country. I have long been an advocate of the importance of local, decentralised decision making. It is important that clinical commissioning groups have the freedom to commission services that they think are appropriate to their local population. The report is clear that we need a more consistent approach on mental health services that focuses on collaboration and more integrated commissioning across the spectrum.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Will my hon. Friend reflect, in the context of the devolved settlement for services, on the importance of substance misuse services and on the impact that the fragmentation of those services away from other mental health services may have had on patient care?

[James Morris]

My hon. Friend makes a powerful point. We need to deal with some of the issues to do with fragmentation in the system—he refers to substance misuse. The thrust of the recommendations in the report is about making sure we have a more integrated approach to commissioning mental health services across the piece.

The second important facet of the implementation challenges that the report throws up is research into mental health services. It mentions the need to have a proper, coherent 10-year plan for research into mental health to fill what are, as many of us would agree, big gaps in the evidence base.

[Norman Lamb (North Norfolk) (LD)]

I congratulate the hon. Gentleman on securing the debate. Does he share my horror at the fact that the Medical Research Council spent 3% of its budget on mental health research in 2014-15? That bears no relation to the degree of disease burden in our country, yet it chose to spend just that much on research.

[James Morris]

I thank the right hon. Gentleman for that intervention and pay tribute to him for all the work that he has done, particularly when he was Minister with responsibility for this area. I agree that we need to spend much more on mental health research, and we need to know what we want to research. For example, there is much talk about the power of peer support in mental health. There is an assumption that it is a good thing and that it works, but we do not have a particularly rich evidence base about whether it does.

On the efficacy of certain psychotherapies, the evidence base shows that cognitive behavioural therapy can be effective for people with mild depression and anxiety, but we do not really know about the effectiveness of other psychotherapies that we may want to promote and develop in the national health service. We clearly do not know very much about a lot of emerging areas that have an impact on mental health. For example, using technology and mobile phone and other apps to help people with mental health problems is a big emerging area, but we do not know much about its effectiveness. We certainly do not know in any coherent sense about the implications of genomic medicine on mental health care. A coherent strategy on mental health research is required over the next decade so that we can extend and expand the evidence base, because the truth is that we are often flying blind.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I congratulate my hon. Friend on securing the debate. It is a pleasure to serve under your chairmanship, Mr Wilson.

Does my hon. Friend recognise that one of the key issues in constituencies such as mine, which is a low-wage, low-skill economy, is tackling depression? That is helping us get everybody into work. If we want growth, it is important that we deal with people who suffer from depression, which is, of course, another mental health problem.

[James Morris]

My hon. Friend is absolutely right. We need to support people with depression back into work. The report makes a number of recommendations, which he may be aware of, on the use of strategies such as individual placement and support to get people with mental health problems back into work.

The report also talks a lot about data, which underpin our decisions about where we should focus our efforts on mental health. It refers to a “black hole” of data and calls for a “transparency revolution” in mental health. As I said earlier, for a long time—probably 20 years or more—we have not been collecting sufficiently robust data about what is actually going on in mental health services. We need better data on what is going on to have a firm basis on which to understand what is working, what is not working and what is going on at local and national level. Recommendation 50 in the report—this pertains to what my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) said about accountability—is at the heart of the implementation challenges that we face. It states:

“The Department of Health and NHS England should require CCGs to publish data on levels of mental health spend in their Annual Report and Accounts, by condition and per capita, including for children and Adolescent Mental Health Services, from 2017/18 onwards. They should require CCGs to report on investment in mental health to demonstrate the commitment that commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall allocation”

of funding. That goes to the heart of our data challenge.

For too long, mental health services have not been properly resourced because we do not have an effective data set on what is actually happening in the NHS or, as the report highlights, an effective model in the NHS for paying for mental health services. They tend to be commissioned on what is called a block contract basis, which often has the effect of focusing on the delivery of a low-cost service, rather than on quality outcomes. We certainly do not have a model of care that focuses on an individual care pathway or a cure for an individual patient.

We need a different model of payment for mental health services in the NHS that focuses on quality and outcomes and reflects our aspiration, which is written into the NHS’s operating mandate, for parity of esteem—the integration of physical and mental health. How can we express that aspiration? To give an example, if I suffer from diabetes and a serious mental health problem, my treatment in the national health service is effectively split in two: there is a physical health pathway, which is paid for in one way, and a mental health pathway, which is paid for in another way. I believe that we need to move towards a payment-by-activity model in the NHS that does not discriminate between physical and mental health. That will certainly not happen overnight, but the report goes some way towards arguing for it in recommendation 47, which states:

“NHS England and NHS Improvement should together lead on costing, developing and introducing a revised payment system by 2017/18 to drive the whole system to improve outcomes”.

[Heidi Allen (South Cambridgeshire) (Con)]

Does my hon. Friend think it is right that we have a separate payment model for mental health, or should physical and mental health be treated together? Separating them could cause the very division that we are trying to lose.

[James Morris]

That is precisely what I am arguing for. Over time, we need to move to a model that does not discriminate between mental and physical health, with integrated payment reflecting the fact that there are a lot of conditions and a lot of comorbidity. Getting the payment system right in the NHS is fundamental to everything about the aspiration for parity of esteem. “Parity of esteem” is an interesting set of words, which can be interpreted to mean that we want a culture change or a system change—all of which is right—but to achieve it we need to change the payment model for how services are commissioned and purchased in the NHS.

[Rehman Chishti]

I agree with the model that my hon. Friend is proposing. From my discussions with the Royal College of Psychiatrists, which has backed a Bill on accountability, I believe that such a model would achieve a more holistic approach for patients, which can only be a good thing for outcomes.

[James Morris]

Again, my hon. Friend is absolutely right. The model contained in recommendation 47 and discussed in the report should drive the achievement of parity by moving towards an integrated tariff or pricing model. A lot of detailed work needs to be done to achieve that—I am not saying it is something that the Minister will be able to implement in the next week—but it goes, fundamentally, to the transformation argument that is at the centre of the report.

Perhaps most importantly, the report talks about the importance of, and absolute need for, strong leadership in the NHS and across Government to drive the change and to make things happen. This is not only about the NHS, but about the whole of Government; it is about putting mental health at the heart of our thinking in many different areas. We need a cross-Government approach, with a strong grip at the centre. I say that despite being someone who believes in devolution, because in mental health policy we have reached the stage of consensus, with much agreement about what needs to be done, but we need political will and a grip at the centre of Government to make things happen. The truth is that the existing system needs to be challenged. We need a culture of challenge—if we say that we are allocating money to mental health, why is it not being spent? Why is it not delivering the outcomes that we need?

As the report highlights, successful implementation is about not only co-ordinating our healthcare response but what we need to do on mental health in education, criminal justice and, as my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) said, back to work programmes in the Home Office. Everything should be working together to achieve the goal of supporting the five-year transformation plan for mental health.

The last recommendation of the report, recommendation 58, might sound somewhat technical and bureaucratic, being a little obsessed with governance, but it is fundamental. It states:

“By no later than Summer 2016, NHS England, the Department of Health and the Cabinet Office should confirm what governance arrangements will be put in place to support the delivery of this strategy.”

That process of ensuring that the recommendations are followed through, that there is a performance and accountability framework, and that change is driven from the centre strikes me as fundamental.

The implementation challenges highlighted in the report are substantial and require action on multiple fronts. As I said earlier, the Minister has shown absolute commitment to addressing many of them. Will he give us an update on what progress has been made in the four areas that I have described today, namely commissioning, data and research, new payment mechanisms in the NHS and leadership in the NHS and across Government?

Getting this right is an historic opportunity. As I said at the beginning, to some degree the stars are aligned: we have a high-quality public debate; much more openness about mental health and its discussion; a mature debate on how we fund mental health; and political commitment at the highest level of Government, with the Prime Minister having made several speeches on and commitments about mental health in the past few months. We have the opportunity to drive forward what a 21st-century mental health care system should look like and make it deliver for all the people out there who need care and support. They are relying on the opportunity being realised and on us getting it right.

[Several hon. Members rose—]

--- Later in debate ---

[James Morris]

I thank all right hon. and hon. Members for taking part in this debate. We have got to the stage of knowing where the problem is and what the solutions are. We need the will in Government and across Parliament to make them happen. We owe that to all the people out there who are relying on us to get this right and I think the stars are aligned to make it happen. Let us get it right.

Question put and agreed to.

Resolved,

That this House has considered the report from the independent mental health taskforce ta the NHS in England.