National Health Service: 75th Anniversary

Lord Davies of Brixton Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Davies of Brixton (Lab)]

My Lords, I join other speakers in thanking my noble friend Lord Hunt of Kings Heath for initiating this debate. I am going to focus on the issue of mental health and I declare as an interest my involvement with the Money and Mental Health Policy Institute. My remarks depend a lot on the excellent briefing note produced by the Royal College of Psychiatrists, and there is also the continued information provided by the BMA about the pressures on mental health services in England.

Looking back over the last 75 years, we have seen massive changes in this area. It has improved significantly since the NHS was launched. Treatment options have increased and access to treatment has improved. Most notably, of course, there was the closure of the large institutions—the asylums—and the welcome shift to emphasise treatment in the community. Attitudes have also changed. Social barriers are being broken down, mental health is being talked about more openly and positively than before, and in particular, as has been noted by NICE, young people have a different attitude and will drive the process of achieving progressive change.

Having said that, I endorse the remark made by my noble friend that it is deeply disappointing that we are still waiting for the Mental Health Bill which was first proposed six years ago. Despite all the work that has been done, the issues that prompted the reform process remain unaddressed. Detention rates continue to rise and the detention of black and racialised communities remains hugely disproportionate. I am pleased, therefore, that the Labour Front Bench in the Commons has given a commitment to introduce the Bill in its first King’s Speech, were it to win the next election. I call on the Minister to make a similar commitment. What goes in the manifesto is possibly above his pay grade, but perhaps he can assure us that he will urge it on his colleagues as a priority should we get another term from the Conservatives.

It is worth emphasising that, even without this major legislation, there is much that can still be done to protect people’s dignity, autonomy and human rights when they are subject to the Act. I hope that the Minister will give an assurance that active steps are being taken, failing the Act achieving this objective.

I turn now to where we are and waiting lists, which are highlighted in the Motion. There are a record 1.9 million people currently on waiting lists for NHS mental health services and record numbers of children with a mental illness. One of the main reasons for this is the shortage of staff. We have a workforce plan, but we still lack the ambitious and measurable commitments to expand the mental health workforce, in both hospitals and the community. There are also significant retention challenges affecting the mental health workforce, with professionals reporting high workloads, time pressures and poor work/life balance. Especially, there is the need to address racism and discrimination in the workplace, as well as recruitment.

The problems with staffing result, inevitably, in long waits in A&E, reflecting the difficulties that people have in accessing in-patient provision or community-based crisis alternatives. On top of this, adult acute bed occupancy has not fallen below 95% since May last year. Unfortunately, one of the reasons for this is that more than one in 10 people occupying an adult acute in-patient bed are clinically ready for discharge, but, due to a lack of social care and housing support, they remain in hospital. It also means there is still an unacceptable level of inappropriate out-of-area placements, so perhaps the Minister could say something about that.

There is a special problem with children’s mental health. Over the last few years, we have seen record numbers of children and young people with mental illness. To tackle this problem, it must be recognised that the first five years of life are crucial to a child’s development and to protecting them from future mental health conditions. The Government must invest in early intervention for children and young people—that is widely recognised. The mental health of under-fives should be a priority. The Royal College has identified the need for the urgent introduction of a national network of early support hubs.

Finally, there is the need to address the long-term disinvestment in mental health estates. The mental health sector has some of the oldest buildings across the NHS, with 15% of mental health and learning disability sites built pre-1948—older than the NHS itself—compared to about half of that in the acute sector. Despite this age, and more than 50 bids from mental health trusts for the Government’s “40 new hospitals scheme”, only two were allocated to a mental health trust. Mental health faces the most substantial shortfall in capital investment in cash and percentage terms across all trust types, which is part of a sustained trend in recent years. I hope that the Minister can give us some reassurance in his reply that capital will be put where needed.