Mental Health Care: Vulnerable Children

Lord O'Shaughnessy Excerpts

Tuesday 28th November 2017 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what actions they are taking to address the concerns raised by the Care Quality Commission in its review published in October about the particular difficulties faced by children and young people in vulnerable circumstances, such as looked-after children and those with learning disabilities, in accessing mental health care.

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

My Lords, improving children’s and young people’s mental health is a priority for the Government, especially for the most vulnerable. The Government welcome the CQC’s recent report in this area, which was commissioned by the Prime Minister in January. Government initiatives to improve the mental health of vulnerable children include piloting new approaches to the mental health assessments that looked-after children receive as part of their initial health assessment, and testing models for personal budget use for looked after children.

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his response. With the Green Paper promised before Christmas, I hope we will not have to wait until the next CQC review for the urgent action that is needed, given the scale of unmet need for mental health care among vulnerable children. Barnardo’s recent survey showed that one in four looked-after children faced a mental health crisis on leaving care, and yet nearly 65% of them did not receive any statutory support; and whilst in care, local factors such as a lack of permanent or settled placement can lead to support action being denied. On children with learning difficulties, in all my research for this Question I was truly alarmed at the lack of information that is available on the scale and problems of this vulnerable group of children. What action is the Minister taking to ensure that the CQC, Ofsted and, sadly, the police and probation inspectors combine their efforts to investigate this issue as closely as it deserves?

[Lord O'Shaughnessy]

The noble Baroness is right to highlight these disturbing facts about the mental health of looked-after children. Nearly 50% of looked-after children have a diagnosed mental health disorder, so that is what we are up against. In terms of how we are dealing with it, the increases in funding to raise the number of treatments that are taking place by 70,000 will obviously help vulnerable children, and there is the additional assessment that I have talked about. She asked particularly about children with learning difficulties. I am sure that she is aware of it, but I would point her and other noble Lords to the Lenehan review, which set out several recommendations, all of which the Government have adopted. One of the actions that stems from that includes new guidance from the Local Government Association and NHS England on commissioning mental health services for children with learning difficulties.

[Lord Leigh of Hurley (Con)]

Does my noble friend the Minister agree that we can take some comfort from, particularly, chapter 4 of the first phase of the CQC report, which was commissioned by the Prime Minister only in January this year? With 80% of specialist mental health care for children and young people being rated as good or outstanding, there is much, to quote the report,

“we should celebrate and learn from”

[Lord O'Shaughnessy]

My noble friend is right to highlight that overall the provision is good. There is still work to do, particularly in specialist community mental health services. Part of the strategy we are undertaking is to make sure that those services have the staff they need. There will be 21,000 more posts in mental health services to ensure that the average rating improves over time.

[The Lord Bishop of Worcester]

Does the Minister agree that there remains, despite lots of good work, a terrible stigma attached to mental health problems? Will he assure us that the Government are committed to tackling it, as we seek to do in the Church, while also improving provision for identification and treatment?

[Lord O'Shaughnessy]

The right reverend Prelate is quite right: there is stigma attached. There have been a number of important initiatives, not least from His Royal Highness Prince Harry—who I am sure we all want to congratulate on his recent engagement—to reduce stigma and to demonstrate that mental health problems can, unfortunately, strike anyone of any positional station in society at any time in their life. Making that admission is the first step to seeking help.

[Lord Watts (Lab)]

My Lords, what are the Government doing to make sure that health trusts spend the resources available on this area of work? The facilities that these children are being seen in is appalling in some cases. What are the Government going to do about both of those issues?

[Lord O'Shaughnessy]

I can reassure the noble Lord that spending on children and young people’s mental health by CCGs, which are responsible for commissioning those services, increased by 20% between 2014-15 and 2015-16, so spending is increasing. Clearly, one of the areas in which that money is being spent is on better facilities. One of the additional changes is that about 150 new beds will be commissioned in underserved areas so that we can reduce the number of out-of-area placements, which can be quite disturbing for some of the children and young people who have to use them.

[Baroness Jolly (LD)]

My Lords, in England there are around 60,000 looked-after children, and there is evidence that some health providers are denying treatment to looked-after children if they have not yet established a permanent living situation. This is completely unacceptable. What action are the Government taking to ensure that all children’s care is addressed? Will the Minister confirm that the long-awaited Green Paper will be published this year?

[Lord O'Shaughnessy]

I ask the noble Baroness to write to me on that specific case. Of course, health services should never be withheld on such a basis; they should be provided on the basis of need, as we all know. I can confirm that the Green Paper will be published before the end of the year.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain why some looked-after children who have been on waiting lists for mental health care and are then transferred out of the area for foster care have to start their wait for access to mental health services again, if we have a National Health Service?

[Lord O'Shaughnessy]

I think this picture of a fragmented service is one that the CQC report highlights. One of the ways in which the Government are trying to address that is through incentive payments in the tariff system to make sure that trusts are incentivised to join up care, particularly when children are moving from place to place.

[Lord Cotter (LD)]

The Minister mentioned concerns about mental health, but crisis teams are reported not to be available in all parts of the country for under-18s, who are very vulnerable. Will the Minister look into crisis teams not being available for under-18s in many parts of the country?

[Lord O'Shaughnessy]

The noble Lord is highlighting that there is a good deal of variation, which is again highlighted in the CQC review. I think that is what he is describing in terms of crisis teams. I will certainly look into that and write to him with more details.