Health and Social Care Bill

Lord Patel Excerpts

Wednesday 2nd November 2011 Lords Chamber

[Lord Patel]

My Lords, my name is on the amendment and I am pleased to support it. Before I say what I wish to say, I declare an interest as an honorary fellow of the Royal College of Psychiatrists, an honour bestowed on me by the noble Baroness, Lady Hollins, when she was the president of that college, having been introduced in glowing terms to her by the noble Lord, Lord Alderdice—exaggerated glowing terms, I may add.

Noble Lords may wonder why I received that honour—and so do I—but I remember that at the time I was for several years chairman of the Clinical Standards Board for Scotland. It was during that time that I recognised that the provision of services for mental health was quite appalling compared to the services for physical health. It was through writing of standards for illnesses such as schizophrenia, to which the noble Baroness referred, that I discovered how appalling the situation was, not only in the environment where the care was delivered but in the care itself, and how that led not only to limitations in care but to limitations in resources for research and other end-producing standards.

It was of interest to read:

“Everything in my portfolio straddles the interface between health and care—mental health, social care, long-term conditions, cancer. Take for example mental health. The interdependencies between good mental health and good physical health are clear. Mental health sits at the point where health, social care and public health intersect. Delivering better outcomes in physical health will require mental health to be given parity of esteem. So that both mental and physical health problems get equal recognition in the commissioning and delivery of health and social care”.

These are not my words but the words of Mr Paul Burstow, the Minister of State for Health.

“Parity of esteem” is not defined in the document. However, it would be reasonable to expect that this would mean recognition of the equal importance of mental and physical health. Perhaps the Minister will help us with a definition so that we clearly understand what is meant by parity of esteem. You would expect this recognition to be evident in terms of access to mental health services; funding for services proportionate to the disease burden; and mental health being equally at the forefront of the minds of the new clinical commissioning groups and structures.

Sadly, however, this is not the case. For example, for a young person with a physical health problem such as diabetes, to which the noble Baroness referred, who is nearing an age where he is about to start receiving his care in an adult service setting, none of us would expect there to be any problem or difficulty with this move. However, consider a young person with a mental health problem about to make the transition to adult mental health services. Recent research indicates that as many as a third of all the young people who arguably needed continuing care did not make this transition. These young people fall into a gap that would not be acceptable in physical health care. Furthermore, even where a service is available, only 5 per cent of young people experience an ideal transition.

Next, consider the disease burden that is attributable to mental illness. Mental illness is a cause of suffering, economic loss and social problems. It accounts for over 15 per cent of the disease burden in developed countries—more than that caused by all cancers. In the UK, at least 16.5 million people experience mental illness. Despite this burden, a proportionate allocation of funding to mental health services often does not reflect that personal and economic scale. Nationally, some 12 per cent of the total NHS budget is allocated to mental health. While it is difficult to call for increased expenditure in the current economic climate, there is clearly a need.

There are clear benefits from mental health being regarded as the same as physical health. For example, poor mental health is associated with the increase of diseases such as cardiovascular disease, cancer and diabetes, while good mental health is known to be a protective factor. Poor physical health also increases the risk of people developing mental health problems.

The amendments are therefore appropriate. They will ensure that the Bill enshrines the principle of equality of physical and mental health in law so that commissioning bodies know their responsibility to commission high-quality and continuously improving mental health services, as they do for physical health. That commissioning bodies have such a responsibility can in no way be assumed from the present wording of the Bill. While it places a duty on the Secretary of State, the NHS Commissioning Board and the clinical commissioning groups to promote comprehensive health services in respect of both the physical and mental health of the people of England, the Bill makes no specific mention of mental illness with respect to their duty to the improvement in quality of services. It refers simply to the prevention, diagnosis or treatment of illness. I support these amendments and hope that other noble Lords will do the same.

[Lord Patel of Bradford]

My Lords, in speaking in support of these amendments I declare that I was formerly the chair of the Mental Health Act Commission. I have a long-standing interest in working to promote better mental health and in particular how we can best improve quality and outcomes in services. I echo what the noble Baroness, Lady Hollins, and the noble Lord, Lord Patel, have said and shall try to put a little bit more flesh on the bones.

It is clear to me from my work over the years in this area that we cannot and should not try to separate physical and mental illness. The separation of mind and body has been the focus of philosophical debate for many years but it is obvious to anyone who has at some time been unwell that physical problems have a profound impact on our mental well-being and that being unwell from a mental illness has profound impacts on our physical well-being. To quote the great American author and thinker, Henry David Thoreau:

“Good for the body is the work of the body, good for the soul the work of the soul, and good for either the work of the other”.

I could cite a great many examples that demonstrate that truth. As the noble Lord, Lord Patel, said, compared with the general population, people with depression are twice as likely to develop type 2 diabetes, three times more likely to have a stroke and five times more likely to have a myocardial infarction. Approximately 10 per cent of people have serious depression, but this rises among those with cerebrovascular disease, where rates of major depression are twofold. Among those with diabetes or cancer it rises to threefold, and among those with recurrent epilepsy it can be as high as a fivefold increase. In fact, living with a physical illness can adversely affect our relationships, causing isolation and anxiety, which can be just as debilitating as the physical illness itself.

Apart from the obvious common sense of these amendments, I am keen to see them passed because there is a need to bring these issues to the fore. Mental illness has for far too long been perceived as a Cinderella service lacking the serious attention it needs as part of a fully integrated health service. By creating parity between these twin aspects of our well-being and health, we can ensure that the improvements in quality that we all want to see are realised that much more effectively. In fact, I would go as far as to say that this is one of the single most effective things we could do to bring about these improvements.

By emphasising parity in health and mental illness for the Secretary of State, the clinical commissioning groups and the NHS Commissioning Board, we will see some very tangible benefits. For example, we could see a broadening of the Government’s health inequality agenda so that their indicators of disadvantage include mental illness and learning disability. The Royal College of Psychiatrists and the Disability Rights Commission have called for that. That would also help ensure that clinical commissioning groups seek improvements in health through the inclusion of mental illness in the annual health checks undertaken by GPs.

The implications for improvement in commissioning are profound and speak directly to the stated aims of the Bill: that is, continuous improvements in health and in the quality of services. While it is correct that the Bill calls on the NHS Commissioning Board and clinical commissioning groups to promote a comprehensive health service with,

“respect to both physical and mental health”,

there is still a need to be absolutely clear about the need for parity of esteem in physical and mental illness. This is not clear from the Bill as it stands. As the noble Lord, Lord Patel, said, it simply refers to,

“prevention, diagnosis or treatment of illness”.

That is likely to perpetuate the current imbalances which exist with respect to mental illness services and needs. For example, we currently spend approximately 12 per cent of health and social care expenditure on mental health services. The actual burden of disease is as high as 20 per cent when taking account of all disability adjusted life years. Bear in mind also that there will be only one secondary care specialist on the clinical commissioning group boards, who in all probability will be a representative from the physical health services. This amendment does not mean that there should also be a representative from mental health services but it will ensure that the clinical commissioning group is absolutely clear that it must commission equally high- quality and continuously improving mental health services.

By ending the unhelpful dualism between mental and physical health that has so characterised our services, we will see a holistic approach to health and healthcare. At the same time we will start to end the stigma that so many people have lived with and that has been the cause of so much misery and lost opportunities to help people be well. I am sure all noble Lords will agree that the stigma attached to mental illness has caused service users and their families a great deal of harm. I am pleased to say that public attitudes to this have been changing. In the 2011 Attitudes to Mental Illness survey, the percentage of people agreeing that,

“mental illness is an illness like any other”,

increased from 71 per cent in 1994 to 77 per cent this year. We should continue to support this positive trend in attitudes by emphasising the parity across mental and physical illness as these amendments seek to do.

The statistics show that this is not just a technical or even a semantic issue. The potential benefits are profound. In the same attitude survey, we learn that only 50 per cent of people would feel comfortable talking to their employer about mental illness and nearly a third said they would not be comfortable talking to a close family member or friend. The trends are moving in a positive direction compared to previous years but I am sure noble Lords will agree that we still need to do a great deal more to ensure that people are able to access help quickly and appropriately. Parity between physical and mental illness is one way in which we can strengthen that process.

I know that the Minister is a great supporter of issues related to mental health. I hope that he will support these vital amendments.