Mental Health and NHS Performance Update

Lord Bradley Excerpts

Monday 9th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for her warm welcome. I take that point very seriously. Clearly, parity of esteem is no good unless it is applicable to everybody who is suffering from a particular illness. I am not fully aware of the details of the nature of the disparity with black and minority ethnic families but, if there is a problem, making sure that we fulfil this ambitious and I hope welcome strategy is going to make sure that we can lift performance of those services for people in minority ethnic groups.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. Can the Minister explain why it will take at least four years to stop the appalling situation where children have to go out of their local area to receive their mental health treatment?

[Lord O'Shaughnessy]

I thank the noble Lord for his question. I was not aware that it would take four years for that to stop. What we are dealing with here is an historic challenge, which is that mental health services not just in this country but in countries all over the developed world have not been at the same level as services for physical health. The strategy that we have set out today and the further elements to come will be one way of making sure that those young people can be treated close to home. Clearly, there will always be cases and instances where they need to travel. On Friday, I had my first ever ministerial visit to Oxford mental health trust and was able to observe the fantastic work that it is doing across a wide area but with a specific residential school and, interestingly, linking up with the university psychology research department. There were young people who were coming to take advantage of that from all over the country. I realise that this is, if not unique, an unusual coagulation of good factors. As part of making sure that you can get treatment for mental illness or support to build mental health locally, we need to make sure that there are more centres of excellence that can be accessed by those who are in acute need.

NHS: Mental Health Services

Lord Bradley Excerpts

Monday 14th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, our strategy for this area was set out in Transforming Care, a paper produced by NHS England some six weeks ago. It shows that we are absolutely committed to treating more and more of these people outside institutional settings and back in the community.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. As we have heard, the collection of financial data on the investment in mental health services is crucial. I am grateful to the Minister for writing to me recently to confirm the Government’s support for the Mental Health Task Force’s priority recommendations at an additional cost of £1 billion a year by 2021, with investment beginning in 2016-17. How much additional investment will be expected each year between 2016 and 2021? What financial reports will be available for each quarter over these four years to ensure that clinical commissioning groups make the additional investment in local mental health services?

[Lord Prior of Brampton]

My Lords, the noble Lord is right: we have committed to support the request of the task force to spend an extra £1 billion by 2021. Perhaps I may write to him about the phasing of that money over the next five years; I have seen it but I cannot recall the exact figures at the moment.

Health: Adult Psychiatric Care

Lord Bradley Excerpts

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, reading the noble Lord’s report, I was struck that he said in the foreword that he went through times when he was very depressed and times when he was deeply impressed. In a way, that sums up the mental health system—it is fragmented, and there is a high level of variation. We provide fantastic care in one place but terrible care for somebody else, and very often it is not related to cost. I do not know about the particular instances that the noble Baroness has referred to, but I can fully understand that in certain areas it is much worse than in others.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. I, too, welcome the excellent report and recommendations by the noble Lord, Lord Crisp, and his commission, and also the report and recommendations of the Mental Health Taskforce published last week. I would be grateful for clarification from the Minister on the financial commitments that the Government have made on the crucial implementation of the recommendations of both reports. In particular, can he confirm that the announcement of £1 billion each year for mental health services begins in financial year 2016-17; that, for the next four years, that £1 billion will be additional to the £1.5 billion investment in child mental health services which has already been announced; and, finally, whether this £1 billion annually is additional money or part of the £8 billion which has already been announced and allocated to NHS England for all health services?

[Lord Prior of Brampton]

My Lords, that is a complicated question, or number of questions.

National Health Service

Lord Bradley Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Bradley (Lab)]

My Lords, I congratulate my noble friend Lord Turnberg on obtaining this timely and wide-ranging debate. I declare my health interests as shown in the register. I will concentrate my short contribution on mental health, which I believe has never been higher on the public’s agenda.

The NHS currently spends only about 13% of its budget on mental health treatment and support, including GP time, prescriptions and secondary mental health services. However, evidence from prevalence surveys shows that only 25% of people, including children, with common mental health problems receive any treatment. There has been a great deal of talk in recent years of parity of esteem between physical and mental health and I welcome recent announcements of additional funding for mental health services, but the funding gap is still huge.

The King’s Fund and the Centre for Mental Health identified that a third of people with long-term physical conditions—4.6 million people in England—have a co-morbid mental health problem, most commonly depression and anxiety. The cost of care for this group is 45% extra and more still for those with multiple conditions. This adds up to an additional cost of £10 billion nationally each year. The extra costs are for a variety of reasons, including poorer self-care and condition management. This can increase the cost of prescriptions, cause or lengthen the hospital admissions and dramatically increase both morbidity and mortality.

At least £1 billion more is spent on the cost of staff mental health in the NHS, at least half of which is likely to be hidden, as staff present at work but may be struggling to do their jobs as well as they would wish. A significant part of the £14 billion cost of untreated mental health care could be saved while offering better healthcare. For example, liaison psychiatry in acute hospitals has been found to save £3 to £4 for every £1 invested, cutting costs by an average of £5 million per hospital.

Crucially, earlier intervention is vital in all areas of mental health care. There is clear evidence that investing in perinatal mental health care, parenting programmes to help families to manage children’s behaviour, treating childhood depression, anxiety and conduct disorder, promoting mental health in schools and early intervention in psychosis all generate savings far in excess of their costs.

I hope that the Government will also invest in liaison and diversion services and that the Treasury will shortly approve the business case for mainstream funding of these services. Huge savings can be made here in the criminal justice system and the health service. By investing wisely in mental health support, the NHS may be better able to sustain itself. Reaching out to people with physical conditions and symptoms whose mental health needs are unmet will improve health at a lower cost. I hope that such integrated proposals will be pursued by the devolution of health and social care in Greater Manchester, building on the work of Salford that my noble friend Lord Turnberg so well described.

Health: Parity of Esteem

Lord Bradley Excerpts

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

That is a very interesting point. We have three principal targets for mental health: two relate to IAPT and the other to access for those who have their first psychotic episode. Clearly, we do not yet have the range of targets for mental health that we have for physical health, although the introduction of those three targets this year is a big step forward. It is important that the targets should be based around outcomes rather than funding.

[Lord Bradley (Lab)]

My Lords, the five-year investment in child and adolescent mental health services is welcome, but the scale of the problem of achieving parity of esteem is huge, as a recent NSPCC report clearly showed. It stated that out of over 186,000 cases referred by doctors from 35 mental health trusts, nearly 40,000 children received no help at all. The investment equates to barely over £1 million per clinical commissioning group each year. Does the Minister believe this is sufficient not only to tackle the chronic bed shortage and the distribution of such beds across the country, but to develop comprehensive prevention and early intervention programmes?

[Lord Prior of Brampton]

The noble Lord makes a good point. I may get these figures wrong, but I think the total spend on mental health across the country is about £11 billion a year, and spending on children and young adolescents is under £1 billion—around £700 million. Therefore, under 10% of the total spend goes on young people. On the face of it, that looks to me to be far too low. That is why the last Government committed to increase that spending by £1.25 billion over the course of this Government and put another £150 million into tackling eating disorders.

Mental Health Services

Lord Bradley Excerpts

Monday 19th October 2015 Lords Chamber

[Lord Prior of Brampton]

I am not aware of the report being prepared by the BMA but I will certainly be very interested in seeing it, reading it and discussing it with it.

[Lord Bradley (Lab)]

My Lords, I declare my health interests. Although I welcome the ban on the use of police cells as places of safety for children under Section 136 of the Mental Health Act by July 2016, barely nine months away, does the Minister believe that the £50 million investment in health-based places of safety will be sufficient to achieve a similar ban on the use of police cells for adults and significantly reduce the thousands of adults who end up in accident and emergency departments each year under Section 136 at a time of severe mental crisis?

[Lord Prior of Brampton]

The noble Lord makes a very good point. Treating people in the right place is fundamental to any notion that we have of parity of esteem. He recognises the successful work that has been done with children, which we are hoping to replicate with adults. As part of the increased spending on mental health, we are also investing £30 million in liaison services in A&E departments, which is very important. A&E departments are not an appropriate place for people with a severe mental health crisis. Certainly, the evidence from Right Here, Right Now, by the CQC, indicates that people with such a condition are often treated extremely badly in A&E departments.

Health: Skin Cancer

Lord Bradley Excerpts

Wednesday 22nd July 2015 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a very sound point. Harpal Kumar’s task force produced a report entitled Achieving World-Class Cancer Outcomes. If anyone wants a little bit of holiday reading, it is well worth reading at least the three-page letter at the front of the report. He recommends in the report that if a GP has a 3% or greater suspicion of cancer, the person in question should be referred for further investigations.

[Lord Bradley (Lab)]

My Lords, there is a clinical trial known as Matilda at the world-renowned Christie Hospital in Manchester, funded by the Medical Research Council and the National Institute for Health Research. This aims to treat patients with melanoma using their own white cells, which can recognise and destroy cancer cells. It was approved in 2014 but then halted because excess treatment costs, which should be funded by the NHS, were not forthcoming. I understand that the Secretary of State for Health has said that this issue will be sorted by early 2015. Can the Minister advise the House when this crucial clinical trial for the treatment of skin cancer will be progressed?

[Lord Prior of Brampton]

I am not aware of the trial at the Christie called Matilda; I will take this issue away and write to the noble Lord.

Health: Multiple Pregnancy

Lord Bradley Excerpts

Monday 13th July 2015 Lords Chamber

[Lord Bradley (Lab)]

My Lords, does the Minister accept that multiple births can sometimes require additional emotional support for mothers? Will he therefore ensure that some of the extra resources allocated to child mental health services are targeted at perinatal healthcare to ensure that all maternity services have access to a perinatal mental health professional as recommended by NICE guidelines?

[Lord Prior of Brampton]

The NICE guidelines for mothers expecting twins or more have an enhanced pathway as well, in which there will be a specialist named obstetrician and a mental health specialist. The Government have committed an extra £75 million over the next five years to increase the availability of mental health expertise to women who have multiple births.

Mental Health: Young People

Lord Bradley Excerpts

Tuesday 30th June 2015 Lords Chamber

[Lord Bradley (Lab)]

My Lords, declaring my health interest, I also congratulate the noble Baroness, Lady Tyler of Enfield, on obtaining this short debate and her excellent contribution to it, and thank noble Lords for all the excellent contributions to this debate this evening.

Child mental health is rightly now very high on the health agenda and there is a huge interest in mental health among the public, for both children and adults, as an ambition for parity of esteem between physical and mental health is progressed.

I shall give just a few facts and figures. According to the 2004 data—the most recent available—one child in 10 has a mental health problem. About half of those children, 5% of all children, meet the criteria for a diagnosis of conduct disorder: severe and persistent behavioural problems. A further 15% of children have a mild or moderate behavioural problem that has an impact on their future health and life chances.

Mental health problems during childhood tend to continue into adult life, especially if untreated. Children with behavioural problems also experience poor outcomes in school and in employment and have a high risk of getting involved in crime as young adults.

However, it is estimated that only 25% of children with a mental health problem get treatment of any kind. As we have heard, the previous Government’s response was the creation of the mental health task force, which reported in March 2015. Its excellent report, Future in Mind, was a template for change in services for children and young people. It made 49 recommendations for better support for children’s mental health. They included far-reaching changes to CAMHS provision, greater emphasis on the role of schools and earlier intervention when children become unwell. Crucially, it called for every local area to be required to produce a transformation plan for improved children’s mental health care.

It is very welcome that in the March Budget investment of £1.25 billion was announced, to be provided over five years. That is £250 million a year for CAMHS, perinatal mental health care and employment support for adults. It equates to only about £1 million per clinical commissioning group per year. I would be grateful if the Minister would comment on whether he is confident that this is a sufficient injection of funds for each CCG to meet Future in Mind’s 49 recommendations at a local level.

As we have heard, plans have also been announced for a new prevalence survey for children’s mental health, replacing the 2004 data which are still in use. Again, this is very welcome and will allow for much more effective and efficient planning of the range of services required for children and those in transition to adulthood.

Another welcome move is the banning of the use of police cells for children detained under Section 136 of the Mental Health Act. I am very pleased that the Minister assured the House that the use of police cells would be at zero by 23 June 2016, but will he also ensure that open adult psychiatric wards are not used as places of safety for children instead of police cells?

While the Future in Mind report is welcome, how will the Government ensure that it is implemented in full across the country? Will it be given a prominent place in the next NHS mandate, and how will local areas be held to account for producing and implementing robust transformational plans? Such plans will be crucial if we are going to make a step change for child and adolescent mental health services at a local level.

Most importantly, will the Government set out clear expectations of schools to promote mental health—for example, through social and emotional learning—and empower Ofsted to include it in its inspections? Should we perhaps follow the example of Wales and make access to counselling mandatory in secondary schools? My own report on mental health and the criminal justice system made clear the importance of mental health awareness training for all staff in schools, but, obviously, principally teachers—not to become experts in mental health but to be effective passporters of children to appropriate CAMHS or other services before their health problems may lead them into trouble.

I also commend the Big Lottery Fund’s HeadStart scheme that the noble Baroness, Lady Walmsley, rightly pointed to and its investment of £75 million in 12 trial sites. This is an important new intervention which will be monitored and, I hope, rolled out more broadly as a consequence.

Finally, perhaps I may ask the Minister about parenting programmes, as recommended by NICE. These have been found to be extremely effective in addressing conduct disorder, as I identified earlier. The cost of such programmes is estimated to be just £1,750 per child, against a lifetime cost of not taking action of £175,000 per child. Can the Minister therefore explain the logic behind the Government’s decision to cut the public health budget by £200 million, a budget which helps fund such programmes?

This debate on the task force’s key recommendations is important and timely. I know that all interested Members in this House will ensure that we monitor the implementation of its key recommendations to ensure that children and adolescents benefit in future from a much more effective mental health service.

Prisons: Mental Health

Lord Bradley Excerpts

Wednesday 24th June 2015 Lords Chamber

[Lord Bradley (Lab)]

My Lords, it is vital that a prison has all relevant information about an offender’s health needs when they arrive at prison reception. Does the Minister agree that an evaluation of the current health screen should be undertaken to improve the identification of mental health problems at prison reception and that the identification of learning disabilities should be part of that screen?

[Lord Prior of Brampton]

The noble Lord raised this in his report five years ago and in the follow-up report that was published more recently. A very early assessment of a prisoner when he arrives in prison is of course extremely important.