Mental Health: Children and Young People

Lord Laming Excerpts

Thursday 23rd November 2023 Lords Chamber

[Lord Laming (CB)]

My Lords, I add my welcome to the most distinguished noble and learned Baroness and congratulate her on an outstanding maiden speech. The House is the richer for having her, and I hope she visits us much more frequently in the future.

We are indebted to the noble Earl, Lord Russell, for enabling the House to debate this subject, which, as previous speakers have said, is of great importance not only to children but to our wider society. It is generally agreed that this generation of young people have had, and are still having, a rather hard time. While many of these young people are able to rise to the challenge and are inspiring, both in their values and achievements, we must nevertheless recognise that the development of many has been badly affected in recent years and that they now need considerable help.

This generation of youngsters has unexpectedly experienced many changes. For example, in the decade following 2010, there were cuts in local government finances. As a result, many of the programmes that were designed to support young people and their families were cut and some, sadly, disappeared altogether, especially in the preventive and support services. We have not recovered from that situation. While the recent increase in funding is most welcome, I am advised that, in many areas, today’s budgets have not returned to where they were a decade ago, in real terms.

What had an even bigger impact on the well-being of young people, however, were the decisions related to Covid. The lockdown of schools and all other related activities not only interrupted their education but, in its wake, created their isolation, which had a marked impact on their intellectual, social and emotional development. As a result, very many young people became anxious, withdrawn and lacking in self-confidence. Here, we are not referring to just a small number of children and young people but, as has already been said, to many thousands.

The Children’s Commissioner’s recently published excellent report on school absences in England supports this. She says that absence figures have risen to “crisis levels” and are not recovering quickly enough. In Spring 2022, the last term for which we have data, 2% of all children were not just occasionally but severely absent. This is equivalent to 140,700 children. Her briefing goes on to say that:

“For some, the pandemic has led to disengagement. Schools and families have said that they feel like the … contract between parents and schools has been broken”.


That is a serious matter.

The fact that these issues are persisting into adolescence is well illustrated in the very helpful report by the Prince’s Trust from 2022 entitled The Power of Potential. That report makes it clear that:

“Young people were hit especially hard by the economic impact of the pandemic. In March 2021, young people accounted for around two thirds of the total fall in employment since the start of the pandemic, and youth unemployment was almost four times higher than the rest of the working-age population”.


Sometimes these children who are seriously absent from school are referred to as “ghost children”. What a terrible expression—and what a terrible situation they find themselves in: they are basically lost to the system and no longer known.

The difficulties of these young people taking these problems into adolescence means that the number who are not in employment, education or training continues to increase to an alarming degree. That is despite the increase in job vacancies. To reinforce this situation, the recently published report by several childcare charities, entitled Children at the Table, makes it clear that:

“Babies, children and young people have been overlooked by policy makers for too long and the impact is clear: more children are living in poverty, they face a growing mental health crisis, and are waiting too long to receive urgently needed support.”


This is what this debate is about: among young people, we are facing a growing number who have mental health problems now but are waiting far too long for the help that they need to be delivered.

It is clear from the number of young people who are not in school, employment or training that they are vulnerable to exploitation from organisations such as county lines and other disturbing influences. We owe it to these children and young people to have them properly supported and protected at this critical stage in their development. This picture emerges at a time when children’s mental health services have never been so overwhelmed and ill-equipped to meet the needs of these children and young people. I recently heard that one family had been told that the gap between referral to those services and the beginning of assessment was longer than a year and could even be much longer in reality. Just imagine what it is like for the child with these problems: a year in this child’s life at a very formative stage is of immense importance. What is it like for their parents, because what can they do? I am told that they just said, “We are waiting. There is nothing that can be done.” That is a sad situation.

The charity Beat said that a report on the mental health of children and young people in England found large increases in the number suffering from eating disorders, which have already been mentioned. The Times reported:

“Between 2017 and this year … Among 11 to 16-year-olds, the prevalence had jumped from 0.5 per cent to 2.6 per cent, and among 17 to 19-year-olds from 0.8 per cent to 12.5 per cent”.


This clearly represents a huge increase. This is not about fads but recognised and serious eating problems.

Whatever standpoint we take to approach this serious subject, the evidence is starkly clear—and the evidence we have heard from each contributor to the debate so far is in one direction. There is no conflict about this. The number of children in need of the mental health services is seriously increasing, while the service is less able to respond. These children did not invite lockdown or the disruption to their education and their normal social development. They should not be left behind. If we do not respond to their needs now, they will take these problems into adulthood and society will be the poorer for it. So, let us do all we can together to ensure that these children and young people get the help that they need from the specialist mental health services when they need it. We will all be the better for that.

Paediatric Care: Wating Times

Lord Laming Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Markham (Con)]

It is now the legal responsibility of the ICBs to appoint an executive lead in this area, but I think the point generally is a good one. As I said, as a result of this Question I have managed to spend some time looking into this and we clearly need to make sure it is a priority. One of the other things I have been talking about with the executive team of the NHS is how we can introduce this to the tiering measures so that hospitals are given special help in making sure that children’s wait time is one of the key priority areas, and we can put more resources and support towards that and more support where hospitals are not performing well in that area. I agree with the noble Lord.

[Lord Laming (CB)]

My Lords, does the Minister agree that all staff in the front line of these services need to be aware of the dangers of child abuse or child neglect, because the developmental needs of very young children can also be indicators of serious neglect in the home?

[Lord Markham (Con)]

Yes. That is where our colleagues in the Department for Education have a key part to play. Start for Life is a joint initiative with DfE which is trying to look at early diagnosis. At the same time, often some of those issues can manifest themselves in anxieties and mental health issues. That is why we have done a lot of work to expand the number of mental health-aware teachers and assessors in schools, so that we can have early detection.

Mental Health Services: Huntington’s Disease

Lord Laming Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct that they have complex needs and I know from personal experience, with both my mother and my father, the importance of end-of-life palliative care. I thank the noble Baroness for the warning of the question and have been assured that the integrated whole person care approach that the major conditions strategy sets out will include palliative care measures.

[Lord Laming (CB)]

My Lords, the Minister will know that many of the people who suffer from this disease depend very heavily on the support of unpaid carers. I note that his fellow Minister is going to hold a cross-government round table on the needs of carers. Might that lead to the development of a national carers’ strategy?

NHS: Allocation of Financial Resources

Lord Laming Excerpts

Thursday 11th May 2023 Lords Chamber

[Lord Laming (CB)]

My Lords, does the Minister agree that one of the best ways to help the health service would be if the Government would allocate money dedicated to social care services? This would relieve the pressure on beds. Many beds would be relieved—thousands of beds—and it would prevent people having to go into hospital. Is that possible?

[Lord Markham (Con)]

Yes, and we are doing it. We have committed to an up to £7.5 billion increase in funding over the next two years. We announced last month a social care plan which is addressing this and reforming the sector, and we are starting to see the changes.

Adult Social Care: Challenge Procedures

Lord Laming Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for that question. The Government absolutely recognise the role that unpaid carers play—I have fulfilled such a role myself for a number of years—and it something we are working towards. We have introduced the leave provisions and a certain level of payments for them; that may be modest but it is a step in the right direction. Again, the whole idea of getting the CQC in this space is that it can start monitoring local authority provision and ensure that it is identifying unpaid carers, among other things.

[Lord Laming (CB)]

My Lords, last week or perhaps it was the week before—time flies—there was a report on the number of people occupying health service beds who are fit for discharge but are not being discharged, largely due to the absence of social care provision. Are the Government taking seriously reports of that kind?

[Lord Markham (Con)]

Yes, we are taking them very seriously. The House has heard me talk many times about the 13% of beds that are blocked. This is a key issue for the whole flow of the system, which is backed up right the way through. That is why we introduced the discharge fund. Again, Minister Whately is very focused on this issue.

Adult Social Care

Lord Laming Excerpts

Monday 20th February 2023 Lords Chamber

Asked by

[Lord Laming]

To ask His Majesty’s Government what steps they are taking to meet the needs of the 10 million people in England affected by the adult social care system.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, 10 million people in England are affected by the adult social care system, including those drawing on care and support, unpaid carers and the workforce. We have made up to £7.5 billion available over two years to put the sector on a stronger financial footing, improve access to social care and address workforce pressures. We will publish further details this spring, setting out how we intend to make improvements to the system.

[Lord Laming (CB)]

My Lords, I am grateful to the Minister. He will know that, at any time, any one of us could suddenly become responsible for the care of another person who has experienced a life-changing condition—indeed, any one of us might need to be cared for in those circumstances. The evidence to the Adult Social Care Committee was extremely compelling, indicating that unpaid carers feel that they carry a huge burden but are largely unappreciated and ignored. One wrote only last week, saying that, “after years and years of nursing experience, I now feel completely worn out and very lonely”. Could the Minister assure the House that the Government will take note of the recommendations of the report?

[Lord Markham (Con)]

I thank the noble Lord for his Question and for the work he has done around this report. As an unpaid carer for a number of years myself, I am familiar with the circumstances and the fact that unpaid carers are the backbone of the social care sector. I like to think that we are making moves in the right direction. The weekly allowance, the ability to have a one-week break and the ability to go to your local authority for extra support where needed are all steps in the right direction. But there is definitely more we will be announcing that we are doing in this space.

Social Care: Integrated Care Systems

Lord Laming Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Laming (CB)]

My Lords, I hope the Minister can assure the House that he has had an opportunity to read the Adult Social Care Committee’s report, which was published in December. The report makes it abundantly clear that the NHS will not achieve its objectives—some might even say its survival—unless social care is integrated at every level and includes the voice of unpaid carers. Can the Minister assure the House that these matters will be taken seriously?

[Lord Markham (Con)]

Absolutely. It strikes me—again, I mentioned this yesterday—that less than 10% of the 13,000 so-called blocked beds contain people who will need to be in social care full-time in future. Most of them need short-term support and, once they have it, will be able to go back to living in their home, which is the best place for them to be.

Excess Deaths in Private Homes

Lord Laming Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

I totally agree with my noble friend. We all know that it was an unprecedented time, and we learned lessons all the way through: we were much more resistant to locking down as time went on, for all the good reasons mentioned by my noble friend. Yes, that absolutely needs to be a key feature of the report.

[Lord Laming (CB)]

My Lords, the Minister will agree that a very important point in all of this has been the restrictions now in force on primary healthcare services and domiciliary services. We have left housebound people to their fate for a great deal of this time. Is the Minister willing to look at these matters?

[Lord Markham (Con)]

It is a whole-system issue, as I have often mentioned in this House, that takes into account some of the elements of home care, and very much the social care and dom care elements. We know that that is very much a factor in the 13,000 beds that we need to free up through things such as dom care, so yes.

Hospital Beds: Social Care

Lord Laming Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

The best hospital trusts I have seen have got that absolutely organised. We see a difference in different trusts between as low as 6% bed blocking for social care and over 30%. That depends somewhat on local demography and the amount of care homes, but also on how quickly they can arrange transport, and that is what the best ones are doing, so that cases such as the ones brought up by my noble friend do not exist.

[Lord Laming (CB)]

My Lords, the report from the Adult Social Care Committee that was published just a few days ago—which I commend most warmly to the Minister—highlights that in the past 10 years there has been a 29% real-terms reduction in local government spending power. This is despite the increase in the population during that period. Can the Minister assure the House that the Government are taking seriously the reality of life in social care?

[Lord Markham (Con)]

I thank the noble Lord. Yes, we are, and I think that is shown by the investment we are putting into place. As I say, that will be up to £2.8 billion next year and up to £4.7 billion the year after, which will be a 22% increase. That shows that we are very serious about this.

Children in Care: CAMHS Waiting Times

Lord Laming Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I will need to write to the noble Baroness to give a specific response in that case. It is an area of concern where I think we are increasing awareness, and any diagnosis needs to start with awareness. By definition, that means that more people are diagnosed or come forward, which is a good thing, but it then means that often it takes longer to see those people—I do not say that as any sort of excuse but just as an explanation. As we increase our understanding in this area, and I think that we would all agree that over the last 10 to 15 years there has been a huge increase in understanding, that means that more people are coming forward, but it means also that we need up our game in terms of supporting them.

[Lord Laming (CB)]

My Lords, following the noble Baroness’s question, the Minister will well understand that children do not come into care for trivial reasons; most of them have had a very poor and traumatic start to their young lives. The state has taken on the responsibility to be a good parent to those children. Would it be possible for them to be given priority in the waiting lists for these essential mental health services?

[Lord Markham (Con)]

I would agree. In any case, especially where there is high demand in an area, we need a form of triaging so that we can agree the clearest areas of priority, such as those mentioned.