Mental Health Provision (Children and Young People) Bill
Debate between Jerome Mayhew and Munira Wilson
Munira Wilson
I completely agree with the hon. Gentleman. Even if there were 1,000% more funding tomorrow, the workforce is not there, as we know it is not in so many parts of the NHS. Interestingly, we know from the British Association for Counselling and Psychotherapy, for example, that there are many counsellors who are trained to counsel young people who want to do more work, but I agree that recruitment is a problem in trying to get timely assessments. The story I was part of the way through telling goes on to explain how long that poor seven-year-old girl has been waiting just for an assessment, let alone for treatment. That is why the Bill refers to waiting times to treatment; there is often a long waiting time to assessment and then another long waiting time to treatment. But I agree with the hon. Gentleman: we need to do a lot more on recruiting the right workforce as well as putting the funding in, because we cannot do very much without the right people.
Jerome Mayhew (Broadland) (Con)
The hon. Lady will recall from a conversation that the two of us had the importance and effectiveness of counselling in the school environment for nipping potential mental health issues in the bud—particularly those associated with the first and second covid lockdowns. Every Member will have experienced in their patch increased anxiety among teenagers, particularly at secondary school—perhaps not so much in primary school. Does the hon. Lady agree that the focus on counselling in the school environment is particularly important?
Munira Wilson
I agree completely. We need that preventive intervention at school and community level, as well as investment in acute services right across the way. There is a huge need, from low-level intervention right through to acute services, and if we do more at an early stage we will prevent waiting lists from growing at later stages. I absolutely think that we should have a professional, trained counsellor in every school. It is the No. 1 issue that every secondary headteacher in my constituency brings up with me, and although the hon. Gentleman says it is less significant in primary schools, it is still a pretty high priority for my primary headteachers. I have witnessed some pretty scary episodes when I have been in primary schools, so it is a problem across both.
Back to my story about the seven-year-old. Her mother told me that she is not really living, just existing. She has been waiting since November 2020 for a CAMHS assessment, which is 16 months. Recently, her mother was told that she may need to wait a further year still. Since her initial referral in November 2020 she was also recommended for arts therapy while she waits for assessment, but that has not materialised either, with local service providers suggesting it may come through in the next couple of months. My caseload suggests this case is not unusual, sadly. Quite apart from the anguish and stress for the whole family, the child’s condition often deteriorates while they wait for assessment and they then need more extensive intervention. Even worse, they can end up at the back of the queue for a new assessment because by the time they are seen they are on the wrong track or the wrong tier for the level of support they need. Indeed, a few weeks ago I shared the story of a 15-year-old girl to whom that had happened.
Munira Wilson
The hon. Gentleman may have missed it, but I did acknowledge earlier in my remarks that for the past four years, at an England level, the spending has gone up. The problem is that that does not always filter through to the local level. I highlighted earlier in my speech the postcode lottery whereby there is a tenfold difference between what is spent in Halton and what is spent on the Isle of Wight. It is increasing at the national level, but without tracking it and having transparency about what is being spent at the local level, we cannot be sure that it is always filtering through.
Where the NHS is committed, based on what the Government have asked of it, to increasing its spend on children and young people’s services as a proportion not only of NHS spending, but of mental health spending, the data is not very clear and the quality is not always very good, so we cannot track it at a local level.
Jerome Mayhew
Is there not a degree of conflict between the need to ensure that support is put in nationally, wherever the need is, and the real desire to have localism, so that local spending more accurately reflects the priorities of individual communities? I do not know the background of what happens on the Isle of Wight, but it may be right that there should be increased spending there compared with the assessed need in Halton. Does the hon. Lady think there is a more serious problem behind that difference, rather than just different prioritisations from local communities?
Munira Wilson
I applaud a Conservative Member for talking to a Liberal Democrat about localism. I wholeheartedly embrace localism and would like to see much more local accountability for spending, and yes, there will sometimes be obvious reasons for variability. However, I would ask whether £15.90 sounds like a reasonable amount to spend per child on mental health. Unless there is a suggestion that in Halton there are pretty much no children struggling with mental health, which I doubt is the case, that tenfold difference does need investigation. Looking at the figures, Halton is one of the areas that has had a massive percentage increase in the past year, presumably to try to correct for that very low level of spending and the need that is there.
My Bill would make the publication of data on the provision of those services a statutory requirement. As such, we could secure a higher quality of data published in a coterminous way across NHS units—currently clinical commissioning groups, but in future integrated care systems—and local authorities by requiring publication on a regional basis. The Bill would also put a specific requirement on Government to publish spending per head on child and adolescent mental health services, as well as the proportion of overall NHS spending and mental health spending on CAMHS by region.
Clause 2 also requests that a statement be included as to whether the expenditure has met the aims of the NHS long-term plan. That is an important requirement to ensure the mental health investment standard is met. The standard is the Government’s tool to ensure CCGs increase how much they spend on mental health every year and, in particular, on children and young people’s mental health. Reporting on that standard has been of variable quality in recent years, with some areas reporting that they met the standard while including one-off, non-recurring pots of money or dementia and learning disability spending, all of which are specifically excluded.