Health: Mental Health Strategy

Lord Touhig Excerpts

Monday 14th February 2011 Lords Chamber

[Lord Touhig]

My Lords, I join others in congratulating the noble Baroness, Lady Murphy, on securing this debate. She seems to have a knack of securing debates of this nature at an important time. In 2009, she secured a debate on dementia, and anyone who reads it will realise the power, information and knowledge that a debate of that sort in your Lordships House brings to the issue.

It seems that society increasingly expects GPs to have the answer to every health problem. While the demands on the National Health Service grow, more and more patients turn up at GP surgeries expecting answers to ever more complex medical problems, compared with, say, just 10 years ago. The plain fact is that GPs are inadequately equipped to provide the overspecialist diagnosis that many patients, perhaps unreasonably, expect from them. For me, the big worry is that the Government intend to place an even greater burden on GPs by making them the local health commissioners through GP commissioning.

Under the Government’s Health and Social Care Bill, local commissioners and GP consortia will be responsible for ensuring that the mental health needs of their local communities are properly and adequately met. The worry is that they are inadequately trained and prepared for this. GPs have a small degree of training in mental health and their knowledge of it is varied, sometimes with worrying consequences. In my former constituency of Islwyn, we have a wonderful group called SHADE. It is a self-help group of ladies who have suffered with a range of mental health problems, especially depression. When I first got to know the group many years ago, one lady who was suffering with depression told me that when she went to see her doctor he listened carefully to her problems and then said, “Nothing wrong with you, love. Go home and get your husband to buy you a new dress”. What worries me about the Government’s plans is the lack of any proposal to remedy such ignorance.

The one exception—and as a former Minister for Veterans I welcome this—is on page 45 of No Health without Mental Health, where there are proposals to provide training for GPs and other NHS staff who may come into contact with veterans with mental health needs. That is most welcome. If the Government propose to do this for veterans, it is an admission that there is a training gap, and the Government should extend this sort of training on general mental health matters to GPs. This would significantly decrease the risk of poor-quality mental health provision posed by some of the plans to give GPs commissioning powers over health provision.

As I understand the Government’s NHS changes, only a small number of specialist high-cost low-volume services, such as secure mental health services, will be commissioned directly by the new GP commissioning board. The majority of mental health services will be commissioned by GP consortia in place of primary care trusts. It will therefore be vital that GPs properly understand mental health and the services needed to help people with mental health problems. Yet, the Government’s own evidence on page 58 of No Health without Mental Health shows that only one in every six older people with depression discusses their symptoms with their GP, and fewer than half of those receive adequate treatment.

In my time as a Member of Parliament, too many elderly people came to see me and complained that they were unhappy with the care offered by their GP, who would often say: “What do you expect at your age?”. Senior citizens expect a first-class health service. Citizens of whatever age are entitled to and deserve that. The evidence suggests that if GPs are going to take responsibility for commissioning mental health services, it will be necessary for them to receive further training on how best to treat mental health problems. At the very least it will be necessary for the Government to carry out a full assessment of whether GPs are in a position properly to commission mental health services.

On page 51 of No Health without Mental Health, the Government say that they want GP consortia to be,

“well placed to understand the broad range of mental health problems experienced by people in the local population and to commission high-quality services across primary and secondary services”.

We can all sign up to that aspiration, but GPs will need further training. I fear that the proposal from the Government may simply be storing up even greater expectations of what GPs can do for their patients that will not be fulfilled, leaving many with undiagnosed and inadequately cared for mental health problems. Like other noble Lords, I welcome this document, but I see it as a work in progress rather than as the final answer to our difficulties.