Mental Health: Children’s Services

Lord O'Shaughnessy Excerpts

Thursday 19th January 2017 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what is their assessment of YoungMinds’ analysis published on 21 December 2016 that 64 per cent of Clinical Commissioning Groups are diverting new funding for children’s mental health services to other areas.

[The Parliamentary Under-Secretary of State, Department of Health (Lord O'Shaughnessy) (Con)]

My Lords, the Government are working with partners in the NHS and elsewhere to deliver an ambitious programme that improves access to high-quality mental health care for children and young people. This is backed by significant additional investment. NHS England’s new five-year forward view for mental health dashboard shows each CCG’s spend and activity on children’s mental health, as part of the robust assurance processes we have put in place.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for that. No one can doubt that Ministers have made all the right noises on developing mental health services for young people. The problem is in the execution. He mentioned extra money, but he will know that the promised £1 billion is simply not getting through to the front line. A recent survey by YoungMinds showed that about 50% of CCGs were simply not using the money that they had been given in their baseline budgets for mental health services for young people. With one in four young people not getting access to services and it being not until 2021 before we stop the appalling practice of young people having residential care hundreds of miles from their homes, there is grave doubt as to whether this will happen in practice. Will the Minister agree to consider ring-fencing this money to ensure that it is actually spent on young people?

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[Lord O’Shaughnessy]

I thank the noble Lord for raising this important issue. I have looked at the YoungMinds research, and who could not agree that the money needs to get through to the front line? Its suggestion of maximising transparency is something with which we wholeheartedly agree. We do not think that ring-fencing is the right approach. It is right that we have a health service in which clinical commissioners, who know their local needs best, take decisions. As he knows, we are trying to redress an historic imbalance in both spending and parity of esteem for services. The approach that NHS England is taking about transparency is improving and working. I think that the YoungMinds research shows an improving picture year on year, although there is a lot to do. Indeed, that is confirmed by data from CCGs themselves on mental health spending, which shows an 8.4% increase year-on-year on money getting through to the front line.

[Lord Laming (CB)]

My Lords, do the Government accept that this is a subject of immense importance? Unless we identify young children with learning difficulties and other problems to do with eating disorders and self-harm, especially in the early years in education, and act quickly and robustly to meet their needs, it will be the beginning of a downward spiral. Society will pay a high cost in terms of both what happens to the individual in the impairment of their development and the costs for society in meeting their needs in their later life.

[Lord O’Shaughnessy]

I could not agree more with the noble Lord. It is significant that the Prime Minister made the announcement on mental health and committed herself to a big improvement in both the amount of funding and the services offered. Part of that is making sure that schools and health work together, with every secondary school in the country being offered mental health and first-aid training, but clearly there is much more to do.

[Baroness Chisholm of Owlpen (Con)]

My Lords, clearly prevention is better than cure. What is being done by the Department for Education and the Department of Health to work together to educate teachers—in fact all those who come into contact with people in our schools and universities—to notice when a young person might be having a mental health episode?

[Lord O’Shaughnessy]

The sad fact is that the prevalence of mental illness among young people, whether it is self-harm or eating disorders, is growing and there is a real problem. Schools have to play a central role along with health services in addressing it. One of the Prime Minister’s announcements was a major thematic review of children and adolescent mental health services, which is being carried out by both the Care Quality Commission and Ofsted, so that is an important point about joint working. Indeed, the Green Paper that we are committed to producing will be put together by both the Department of Health and the Department for Education. That is a very important statement of intent. Clearly there is a lot of work to do to fill it with good content that will make a difference, but there is absolute determination from the PM downwards to make that happen.

[Baroness Tyler of Enfield (LD)]

My Lords, given the frankly shocking revelation that more than half of clinical commissioning groups are diverting the new money they receive to improve children’s mental health services to other priorities, will the Government commit not to sign off any sustainability and transformation plans that do not contain a clear commitment to spend every penny assigned to mental health for those purposes?

[Lord O’Shaughnessy]

The noble Baroness is a great campaigner on these issues, and I have huge respect for the work that she has done. The sustainability and transformation plans will obviously include these local transformation plans for mental health, and it is up to NHS England to ensure that it delivers on the many commitments we now have. Those commitments include the first ever access and waiting times for mental health, which is both access to talking therapies and access to help after psychotic incidents. We have new targets coming up for children and young people who seek help when eating disorders or other generic mental health problems are identified. There are robust targets and there is now a mental health improvement team in NHS England to make sure that those CCGs deliver what they should.

[The Lord Bishop of St Albans]

My Lords, this is a very serious and growing problem. Recent research has shown over the last five years that the number of hospital admissions associated with children’s self-harm has grown by 93% among girls and 45% among boys. It seems extraordinary that when money is announced for mental health services it is then not spent. First, how many years will we wait until we need to ring-fence that money, because this is a really important issue? Secondly, to pick up on the previous but one question, will the Government commit to producing guidelines for schools and colleges about preventing and responding to self-harm, so that we have some practical things put in place?

[Lord O'Shaughnessy]

I could not agree more with those points, in the sense that money must get through to the front line. However, we have an NHS that is set up so that clinical decisions are made by clinicians rather than politicians, and that must be right, because the needs vary from area to area and different areas have different priorities. They have different historic legacies in terms of delivering their services. As for the direction that we give to schools and colleges, clearly the thematic review that the CQC and Ofsted are carrying out will provide advice on what works. We are also introducing some randomised control trials to look at interventions that work, so we have a proper evidence-based system. The commitment is to get 70,000 more young people having evidence-based treatments by 2021.

[Lord Watts (Lab)]

My Lords, is it not clear that the present system of “hands off” is not working? People working in this service are desperate to make sure that the Government take action to ring-fence this funding so that vulnerable children are not put at risk.

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[Lord O'Shaughnessy]

I do not think that anybody disagrees with the scale of the problem that we are dealing with, but I do not believe—and the Government do not believe—that having an NHS in which politicians can direct pots of money is the right approach. These are clinical decisions that need to be made locally. It is not true to say that there is no pressure going on—that is what NHS England is for, to make sure that CCGs are committing not just on mental health but on other health issues to spend the money and meet the targets that they are committed to meeting.

[Baroness Butler-Sloss (CB)]

Does the Minister accept that to start looking at mental health issues in secondary school is too late? There is no doubt a shortage in terms of looking at it at primary school level, but it is extremely important. The earlier that children are looked at for their problems, the better.

[Lord O'Shaughnessy]

The noble and learned Baroness may know that over the past five years I have been setting up primary free schools, with an explicit focus on developing character, well-being and resilience in young people, so I could not agree with her more—it has to start early. Indeed, it does not have to start in primary; it must start in early years and, of course, it must start with parenting and giving parents the skills that they need to teach resilience in their children.

[Lord Roberts of Llandudno (LD)]

Is the Minister aware that half the immigrant children in the Calais or Dunkirk camps were diagnosed with mental health problems? As we are supposed to accept 20,000 refugees in the next three years, is there sufficient funding and awareness of the need to add to our commitment?

[Lord O'Shaughnessy]

I was not aware of that fact, but it is clearly an important one and I shall write to the noble Lord with the information about what we are doing to support those children who come to this country.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister will be aware that there is an issue around identifying people in need of treatment, but there is also an issue about the sustainability of the workforce to deliver that treatment. What are the Government doing to encourage more trainee professionals, both doctors and other kinds of mental health professionals, to pursue a career in relation to mental health, which as I understand it is still fairly unpopular as a specialisation?

[Lord O'Shaughnessy]

That is an extremely good point. The people need to be there in order to deliver. There are two parts to the answer—first, that within the additional £1.4 billion going into children and adolescent mental health services over the course of this Parliament, about £130 million is for workforce development. Secondly, because of our reforms to workforce training, there are another 1,500 doctor training places. By removing the cap on nurse, midwife and allied health professional training, universities will be able to offer up to 10,000 more places a year for those positions.

[Lord Clark of Windermere (Lab)]

My Lords, might I press the Minister a little further on his very last sentence, when he referred to the increased availability of nursing? I know that he is aware that there is a projected 20% drop in nurse training at this stage but, for specialist nurse training, especially mental health nurse training, the drop is even larger than 20%.

[Lord O'Shaughnessy]

This is something that we had the opportunity to discuss yesterday. I am aware of the concerns on this issue. The reforms are designed to take the cap off the number of places, making more places available. In the last year, something like 37,000 applicants were turned away from nursing places, which is clearly not something that we want. When there is a change in regime, clearly there may be an impact on numbers in the first year—as there have been when tuition fees have been introduced in the past—but historically that has tended to rebound.