Child and Adolescent Mental Health Services

Luciana Berger Excerpts

Monday 2nd February 2015 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the availability of child and adolescent mental health in-patient beds, and on child and adolescent mental health services more generally.

[The Minister of State, Department of Health (Norman Lamb)]

Since April 2013, NHS England has been responsible for commissioning in-patient child and adolescent mental health services—CAMHS—often referred to as tier 4 CAMHS. In 2014, NHS England reviewed in-patient tier 4 CAMHS and found that the number of NHS-funded beds had increased from 844 in 1999 to 1,128 in 2006. That has now risen to more than 1,400 beds, the highest this has ever been. These data are now being collected nationally for the first time, but despite the overall increase, NHS England also found relative shortages in the south-west and areas such as Yorkshire and Humber.

In response, the Government provided £7 million of additional funding, allowing NHS England to provide 50 additional CAMHS specialised tier 4 beds for young patients in the areas with the least provision—46 of these beds have now opened. NHS England has also introduced new processes for referring to and discharging from services, to make better use of existing capacity. A key objective of these actions is to help prevent children and young people from being referred for treatment long distances from home, except in the most specialised cases.

National availability of in-patient CAMHS beds is reviewed each week by NHS England specialised area commissioning teams and the national lead for commissioning, identifying any issues and taking proactive steps to address them. On 30 January, it emerged that the number of general CAMHS beds available was lower than in recent weeks. In response, NHS England implemented contingency plans, including contacting existing CAMHS providers to seek additional capacity and increasing the use of intensive home support packages to allow children and young people to be treated at home or on a non-specialised ward. NHS England has also contacted mental health providers to alert them to the immediate capacity issues in CAMHS and establish what capacity existed in adult in-patient and community services to take cases on a temporary basis, should that option be required.

The Government are committed to improving CAMHS as part of our commitment to achieving parity of esteem between mental and physical health—this is not just for in-patient services, but for services in the community, and for services that seek to intervene early and prevent problems arising. That, ultimately, is where the focus must be to ensure that, as far as possible, we spot issues early and prevent them from worsening, reducing the need for in-patient treatment.

In August 2014, the Department of Health set up the child and adolescent mental health and well-being taskforce. The taskforce brings together a range of experts from across health, social care and education. It will consider how we can provide more joined-up and accessible services built around the needs of children, young people and their families. A Government report on the taskforce’s findings will be published in the spring.

The Government have also invested £54 million in the children and young people’s improving access to psychological therapies programme and will invest £150 million over the next five years in improving services for those with eating disorders.

[Luciana Berger]

All over England, our child and adolescent mental health services are increasingly under pressure. Despite the best efforts of NHS staff, the system is now in crisis. Children are being sent hundreds of miles for treatment or detained in police cells because there is nowhere else for them to go. We are also hearing of young people getting no treatment at all. I was appalled to see the copy of the e-mail that NHS England commissioners sent on Friday night, warning mental health trusts of a national shortage of in-patient beds for children. It was almost one year ago that 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. Why did the Minister not act on that warning and do something to prevent it from happening?

The e-mail from NHS England said that the shortage would make it likely that 16 to 18-year-olds would need to be admitted to adult wards. Senior inspectors at the Care Quality Commission say that under-18s should not be put on adult wards, so why is NHS England issuing guidance that contravenes that advice? Adult mental health wards are no place for young people, but how can the Minister be sure that even in emergencies adult wards can accommodate children and teenagers? Adult mental health wards are operating at well over their recommended capacity, and today the Royal College of Psychiatrists has warned that the lack of acute beds available to mental health patients has left the system at breaking point. If adult mental health wards are full, where will these children go? What assessment was used to determine how many beds were needed? Clearly, it is not working. Does the Minister now plan to reassess the situation?

Why are so many of our children and young people needing in-patient mental health care in the first place? Could it have anything to do with the £50 million of cuts to child and adolescent mental health services? The Minister talked about early intervention, but we have seen cuts to early intervention in psychosis services, cuts to crisis services in the community, and the decimation of the early intervention grant, putting a lot of pressure on in-patient services. Could the problem be the fragmentation of commissioning we have seen across the health service since the Government’s reorganisation of the NHS?

The Government have paid lip service to parity of esteem and brought cuts and crisis in reality. Our children deserve better, and that is why Labour is committed to working to reverse the damage done to child and adolescent mental health services by this Government and why we have pledged to end the scandal of the neglect of child mental health.

[Norman Lamb]

First, let me caution against sanctimony. This is not a new issue: under the previous Labour Government, children did at times end up in adult wards. That is highly undesirable—everyone recognises that—and we must do everything we can to prevent it, but please do not try to claim that this is an entirely new problem. It is not. The Government have significantly increased the number of beds available, so significantly more are available now than there were in the last decade. The hon. Lady says that she sees increasing numbers of children held in police cells, but let us have some honesty and accuracy in this debate. The number of children who end up in police cells is falling, not increasing. The crisis care concordat, published last February, set a commitment to end the practice of children going into police cells. Indeed, we intend to legislate to ban it, but the numbers are lower than they were so she should not suggest that it is a growing problem—[Interruption.] She did suggest that.

The hon. Lady asked about my acting on the warning. That is exactly what we did. NHS England carried out a review of clinical judgment on the capacity required to meet children’s needs. As a result, there was a proposal for an increase of 50 beds nationally, focusing on the areas of the country where there was a significant problem, and the Government provided £7 million of additional funding to ensure that those beds were opened. Forty-six beds have opened. There is a temporary problem in Woking, where beds that were available are no longer accepting new admissions. That is a CQC issue. One thing that we have been absolutely steadfast on is that if standards are not being met, we should not continue to admit children to those wards.

The hon. Lady mentioned psychosis services, but this Government, for the first time ever, introduced a waiting time standard for early intervention in psychosis, which was widely welcomed by everyone in the mental health world. From this April, we start the process of introducing a standard. To start with, 50% of all youngsters who suffer a first episode of psychosis will be seen within two weeks and start their treatment within two weeks. That is an incredibly important advance.

The hon. Lady lectures the Government on mental health services, but perhaps she will consider why the Labour Government left out mental health when they introduced access and waiting time standards for all other health services. That dictates where the money goes and means that mental health loses out. This Government are correcting that mistake.