Child and Adolescent Mental Health Services

Luciana Berger Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I thank the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), and the other members of her Committee for their thorough and valuable report, and for giving us the opportunity to debate this important issue.

When we discuss complex commissioning and funding arrangements, as we are today, we must not lose sight of the people at the heart of the matter. I remind the House that we are talking about some of the most vulnerable children and young people, who are often scared and in states of high distress and trauma. They and their families deserve the very best care and support that our NHS can offer. However, as the Health Committee found, for too long they have been overlooked.

I think that anyone who has read the report would agree that it is damning in parts. It concludes:

“There are serious and deeply ingrained problems with the commissioning and provision of Children’s and adolescents’ mental health services. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people.”

We have heard that Members from all parts of the House share the concerns that are expressed in the report. It was valuable and helpful to hear not only from members of the Committee, but from other Members who have experience from their constituencies and from before they came to the House.

Many Members in this debate and in previous debates in the House have raised horrifying and tragic cases involving their constituents. Most Members know all too well the pressure that too many parts of CAMHS are increasingly under. Sadly, the reports of children facing long waits for treatment, being sent hundreds of miles for a bed or not getting any help at all are too common. In my capacity as shadow Minister for public health with responsibility for mental health, I have received too many messages from young people across the country that paint a picture of services that are under immense pressure and of waits that pass the three month and six month marks. Indeed, we heard from my hon. Friend the Member for Coventry North West (Mr Robinson) about constituents who have waited 44 weeks.

The Minister is open about the scale of the challenge and acknowledges that there is much to do. The Government accepted in their response to the report that the mental health and well-being support that is offered to children and young people, as well as to their families and carers, often falls short. The Government accept that there is a need to improve the system. Today’s debate has been a much needed contribution to the parliamentary and public understanding of the challenges that the system is facing. It has been an opportunity for the House to hold the Government to account on their response and on the action that they must now take to get to grips with these challenges.

The shortage of beds, which the Select Committee highlighted, is of great concern to many Members. The Government response refers to NHS England’s commitment to commission 50 more beds. We understand that NHS England has opened the majority of those beds. I hope that in his response the Minister will confirm when the remaining few will open. Does he consider the additional 50 beds to be sufficient, in the light of the pressures that CAMHS is facing?

The system clearly is not working in some parts of the country. Members on both sides of the House will have been shocked to read in The Observer a few weeks ago that commissioners from NHS England sent out an e-mail on a Friday night to warn that there would be a national shortage of in-patient beds for children over the weekend and that it was likely that children would need to be placed on adult wards. Almost a year ago, the chief executive of YoungMinds said that the increase in the number of children placed on adult wards was entirely predictable following cuts to mental health services. I hope the Minister will say what more he can do to assess and reassess the situation.

Ensuring that we have enough beds to prevent children from having to travel hundreds of miles from home for treatment or to avoid being detained in police cells is, of course, critical, and Members have addressed that issue. However, as the Committee points out,

“commissioning extra inpatient capacity alone will not be enough to alleviate the current problems being experienced”

in relation to in-patient services.

I appreciate that some of the issues are long-standing historical challenges, but it is certainly fair to say that this Government’s reorganisation has exacerbated those challenges. The Committee’s report states:

“Despite the move to national commissioning over a year ago…NHS England has yet to ‘take control’ of the inpatient commissioning process, with poor planning, lack of co-ordination, and inadequate communication with local providers and commissioners.”

NHS England itself has acknowledged weaknesses in commissioning as a reason for bed pressures and patients being inappropriately admitted to specialised units. The Committee highlighted the concerns that professionals have been raising for more than a year about the new split in commissioning between tier 4 services, which are the in-patient beds commissioned nationally by NHS England, and lower tier services, which are commissioned by clinical commissioning groups. It does not take a genius to work out that that arrangement results in the perverse incentive for CCGs to refer children to tier 4 in-patient services, because they do not have to pay for them, rather than treat them in the community, where they have to fund the places. We know that treatment in the community can be so much better for many of those young people’s outcomes and their long-term recovery, but the current situation is exacerbating many issues and problems.

The Minister himself has said that current fragmented commissioning arrangements make “no sense” and are “dysfunctional”. It would be helpful to hear from him what more the Government plan to do to address the situation. In their response to the Committee, the Government said that their taskforce would look at determining a way in which commissioning can be sufficiently integrated. Given that we had to read about the taskforce conclusions on the pages of The Times a couple of weeks ago, perhaps the Minister will do us the courtesy of updating the House on what action the Government will take.

The Government have also announced that NHS England has funded eight pilots looking into collaborative joint commissioning arrangements for children and young people’s mental health, so it would be really helpful to have an update on the progress of those pilots.

The commissioning confusion caused by the NHS reorganisation would be a challenge in itself, but, combined with the cuts to local authority CAMHS and early intervention services, it is having a devastating impact. There has been £50 million-worth of cuts to CAMHS since 2010. There have also been cuts to local authority CAMHS and to early intervention in psychosis services, a reduction in social workers and a decimation of the early intervention grant in many parts of the country, which is putting pressure on in-patient services, particularly in areas with higher levels of deprivation.

I listened to the speech by the hon. Member for Brigg and Goole (Andrew Percy), but Liverpool’s budget has been cut by 56%. The idea that Liverpool city council is not interested in youth services could not be further from the truth, but the reality is that applying the funds available to it to youth services is incredibly challenging.

According to research by YoungMinds, two thirds of councils in England have reduced their CAMHS budget since 2010. When the charity asked NHS trusts and councils about other mental health spending targeted at children and young people, such as youth counselling or specific services for schools, it found that more than half of them had cut their budgets, some by as much as 30%. It is therefore unsurprising that the Committee reported that poor provision of lower tier services has likely been a key factor in the increase in the number of children and young people requiring admission to in-patient services.

In their response the Government refer to extra funding for early intervention in psychosis services and crisis care, but will that not merely take us back to where we were before these cuts? What proportion of the new funding that the Minister has announced will be directed towards services for under 18s? I am particularly interested in the work of the Government’s taskforce on ways to incentivise investment in early intervention—again, it would be helpful to have an update on that. Will the Minister match the Opposition’s ambition to increase the proportion of the mental health budget that is spent on children over time—again, that point has been raised by hon. Members on both sides of the House?

Schools are an obvious place for prevention work to take place, and I was interested to hear the intervention from the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald) about the experience of schools in his area. The Committee found that in too many schools counselling services are unavailable, even though they can provide lower level preventive intervention that can stop problems subsequently becoming more serious. Again, will the Minister update the House on his work with colleagues in the Department for Education to improve that situation? Will he meet the Opposition’s commitment to produce a strategy to help local authorities with their local NHS and schools to work together, to ensure that all children can access school-based counselling or therapy if they need it? Does he agree that in future all teachers should have training in child mental health so that they are equipped to identify, support and refer children with mental health problems?

A few other issues were raised in the debate, although I am conscious that we want to hear from the Minister and I have just three minutes to respond. The work force were mentioned, as was ensuring that all GPs are trained in mental health. The Opposition have committed to ensuring that training for all professional staff in the NHS includes mental health. Does the Minister support that ambition? Data were mentioned by Members on both sides of the House, and up-to-date data and information are critical to provide safe and effective services that meet the needs of children, young people, their families and carers.

I share the Committee’s concern that the most recent data from the Office for National Statistics on children and young people’s mental health are now 10 years old, and the Minister said that CAMHS has been operating in a fog without that information. I welcome the commitment to a new national prevalence survey of child and adolescent mental health data, and that that is a priority. Again, it would be helpful to have an update on that. Can the Minister set out the time frame for work that will take place before February 2016 when we understand that that data set will start?

In conclusion, as we have heard, significant questions remain. Much of the Government’s response to the Committee’s report has referred to the work of the CAMHS taskforce, which the Minister has established and is yet formally to publish its report, even though elements of it have been leaked to the press. It would be helpful for the Minister to update the House on when the taskforce report will be published in full, and to say whether he intends to follow it with tangible action—I appreciate that there will be recommendations, but it would be helpful to know what the Government intend to do.

Children and young people are struggling with mental illness, and in some cases their illness is becoming so severe that they are turning up in A and E—just this week a response to a parliamentary question showed that young people are turning up in A and E with mental illness not just once but two, three, four or five times. They often wake up in hospital beds too many miles from their families and friends, and are simply not receiving any help at all. We are having this debate on their behalf, and I hope the Minister will tell the House what action he will be taking to put that situation right.

We must get to a point where a child can feel that it is as safe to talk about their mental health as about their physical health, and where all children feel that they can tell someone about their anxiety as easily as they can speak about their headache or a stomach bug. Crucially, when they do that they must get the help they need, when and where they need it. I look forward to the Minister’s response.