Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 17th November 2015 Commons Chamber

[Alistair Burt]

I am grateful to my hon. Friend for raising the subject and for mentioning the forthcoming debate. The subject deserves to be looked at extremely carefully. As I have said, there should be neither complacency nor a sense of inevitability about suicide, and I am very interested in what more can be done. I have met one or two of the families who have experienced these tragedies and I am deeply impressed with their commitment to doing something for those age groups particularly affected. This afternoon I will meet a gentleman who is well known for having been involved in a suicide prevention incident. We are doing work to reduce stigma and to find places for people to talk about their concerns, and the more people are prepared to talk about things that might cause suicide, the better. This is an issue that we can give a higher profile to and do more work on, because every time there is a suicide it leaves a trail of damage for families and friends that is truly distressing to behold.

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

Last week, yet another report—this one from the King’s Fund—warned of a mental health system that is under huge pressure. On this Government’s watch, just 14% of patients feel that they have received appropriate care in a crisis. The number of mental health nurses has dropped, and increasing numbers of people are having to travel hundreds of miles for a bed. What action will the Minister take to turn his rhetoric into reality?

[Alistair Burt]

This is a cross-party matter and it is very important. We believe we have made strides during both the previous and this Government. We are investing more money in mental health services—it was increased to £11.7 billion last year—and this was the first Government to introduce standards for access and waiting times with regard to mental health, to try to put it on a par with other conditions. That was not how it was done before. We will now try to ensure that the money that goes in nationally is used to provide assistance locally, and that the money that is put in for local use is used locally.

There are areas to celebrate. We are world leaders with the improving access to psychological therapies service, which has treated 3 million people since 2009. We want to build on that. We know that the service has lagged behind others in the past, which is why we are determined to do much more about it. I think it is the view of the whole House that we should do more about it, and we will.

[Luciana Berger]

I listened very carefully to the Minister’s response, but I reinforce the point that the suicide rate in this country is going up, not down. It is a national scandal that we need to address.

The Minister mentioned prevention. The Government have confirmed that they will make an in-year £200 million cut to local public health grants. That is a political decision. It is not going to save money and, apart from the devastating human price, it is going to cost our NHS and our local authorities more as they deal with both physical and mental ill health that could have been prevented. How can the Minister justify that?

[Alistair Burt]

First, £1.25 billion is going into creating new services for children and young people’s mental health services during the course of this Parliament. The hon. Lady’s party did not make that commitment before the general election. More work is being done in schools to provide a better base for mental health. We have, for the first time, appointed in the Department for Education a Minister with responsibility for mental health in schools.

The pressures on public health budgets are the same as those on every other budget. Those pressures on the national health service were met by my colleagues during the general election, with a commitment to provide an extra £8 billion—the figure is now £10 billion—by the end of this Parliament. That commitment was not made by the hon. Lady or her party. She asks for more money to be spent, but we have committed to do that and we are finding it. It is very important that we take the position that we have to do as much as we can with what we have got. Mental health services are moving forward and we should take the opportunity to say that and welcome what has been done. We have provided the resources in a way that I am afraid the hon. Lady’s party did not.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 13th October 2015 Commons Chamber

[Alistair Burt]

I believe we are. I will check to be certain, as I know the right hon. Gentleman knows a great deal about this, but I believe we are. We have £150 million for eating disorders, and £30 million is being spent this year, with additional beds allocated. I will check that the waiting target times remain because they have made a significant difference. The right hon. Gentleman’s work has been of powerful import in what we do.

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

Yesterday, the National Society for the Prevention of Cruelty to Children revealed that one in five children in need of mental health treatment are being turned away. Is it not appalling that young people are being denied help, only for them to become more seriously ill later on, and that the number of children turning up at A&E because of mental illness has doubled in recent years? Does the Minister accept that children’s mental health needs more money now—this year, as he promised? I can point to many different organisations across the country that would gladly receive that support now. How is he going to put his broken promise right?

[Alistair Burt]

May I welcome the hon. Lady to her position, not least her Cabinet position—he said carefully—and welcome the prominence that mental health now has among all parties? Let me say rather gently in response to the tirade that I have just received that under this Government we have for the first time introduced parity of esteem for mental health on waiting times and national access targets. We are spending more money—£1.25 billion over the next five years. We have the highest number of beds for young people in emergency situations; we have the first dedicated education Minister for young people’s health; we have £75 million for perinatal health; and in her own constituency, the hon. Lady will be pleased to welcome from her shadow Cabinet position an extra £1.1 million going to Liverpool for mental health treatment for children and young people. I think that is a significant response.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 7th July 2015 Commons Chamber

[Alistair Burt]

Yes, and the adaptation of new and innovative therapies will also assist. Ensuring that GPs are aware of the increased access to psychological talking therapies is making a huge difference. Initial reactions to that programme indicate that, since 2008, nearly 3 million people have had access, 1.7 million have completed their treatment, and 1 million have recovered. Increased awareness of that in primary care will be very important.

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

Last month’s Care Quality Commission report revealed serious shortcomings in emergency mental health care, including that too many people do not have access to urgent help around the clock. The lead mental health inspector said that those findings must act as a wake-up call. How is the Minister ensuring that people in a mental health emergency get the same support that we would expect them to get in a physical health emergency?

[Alistair Burt]

The extremely important report to which the hon. Lady refers was commissioned by the Government. It described the crisis care concordat, which is at the heart of dealing with mental health crises, as a “remarkable initiative”. It states:

“An extraordinary range of public services and other bodies have acknowledged their responsibilities”.

For me, it serves as a baseline for what we should do. The word “efficiency” is pointed out, not least in respect of A&E treatment of those with mental health crises. I regard it as a very good base on which to work and to gauge the success of what we do to deal with mental health crisis care over the next few years. I commend the crisis care concordat—it is in operation all over the country—as a first step towards ensuring that the sort of treatment we want in mental health crises becomes the norm.

Drugs: Ultra-rare Diseases

Luciana Berger Excerpts

Tuesday 16th June 2015 Westminster Hall

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

It is, as ever, a pleasure to speak under your chairmanship, Mr Crausby. I, too, commend the hon. Member for Leeds North West (Greg Mulholland) on securing this important debate on access to medicines for ultra-rare diseases and on his contribution to this debate. He has pursued the issue doggedly through debates and questions, and it is right that he has been allotted time to bring these matters to the attention of the Government today.

I commend the UK parliamentary outreach team for hosting the online debate on this issue yesterday on Twitter, using #RDdebate. The public have had an opportunity to contribute to and inform this debate, and that is valuable. I am aware that many are watching us this afternoon. I also welcome the Minister.

When viewed collectively, it is more than apparent that rare diseases are simply not that rare. One in 17 people will be affected by a rare disease at some point in their life, which means that some 3.5 million people in the UK have a rare disease. About 75% of rare diseases affect children and almost one in three rare disease patients will die before their fifth birthday. These are sobering statistics and it is clear that more must be done.

In June 2009, the previous Labour Government adopted the Council of the European Union’s recommendation on action in the field of rare diseases, which recommended that member states should establish and implement plans or strategies for rare diseases. Following the work set out under the Labour Government, the coalition published the UK strategy in November 2013, and NHS England published its statement of intent with regard to the UK strategy in February last year. Since then, we have had the five-year forward view, which reaffirms NHS England’s commitment to achieving better outcomes for people with rare diseases. While each of the publications is a step in the right direction, so much more needs to be done, as many have said this afternoon. The health reforms of the Health and Social Care Act 2012, which was introduced by the coalition, have seen patients and professionals left to navigate a labyrinth to access particular medicines that in many cases have already been approved and received licences.

We have heard already about tuberous sclerosis complex. It is a rare genetic condition that is estimated to affect 1 million people worldwide. Those with the condition develop non-cancerous tumours, often in the brain, eyes, heart, kidney, skin and lungs. Often, TSC patients are at risk of complications, and surgical removal of the tumours is not always an option. It can have a massive and often severe impact on a person’s quality of life. We have heard about a drug called Everolimus that has been developed to treat some tumours associated with TSC; it has been granted market authorisation by the European Medicines Agency. However, despite being licensed in the UK 28 months ago, it has not been appraised by NICE. It is only available through the NHS on an individual basis or through the cancer drugs fund, resulting in significant inequalities in patient access.

Another example we have heard about throughout this debate, and on other occasions in recent weeks in the House, is Duchenne muscular dystrophy, which leaves many patients wheelchair-dependent by the age of 12. The drug Translarna received conditional approval in the EU in August 2014 for the treatment of DMD. However, almost a year on, too many boys who could benefit are still awaiting a decision on funding from NHS England. I commend my hon. Friend the Member for North Tyneside (Mary Glindon), who has done so much to raise awareness of the issue on behalf of her constituents. As we have heard, many Members from all parts of the House also have constituents who are affected, and the hon. Member for Romsey and Southampton North (Caroline Nokes) made a passionate contribution. Each day of delay sees the boys come closer to losing the ability to walk, by which point they would no longer be eligible for the drug.

Countries across Europe have already approved the drug. The UK has taken a leading role in clinical trials for Translarna, but we are lagging behind other European countries in the delivery of the drug to patients. Will the Minister tell us why we have fallen so far behind? I understand that NHS England is set to take a decision on funding shortly. We often hear the word “shortly”, so will he provide a further update and clarify and qualify what “shortly” actually means?

The system to approve prescription is confusing and frankly chaotic. There are seven pathways through which drugs for rare diseases can be evaluated and made available to patients. I will not go through every one of them, but it is clear that there is no clarity in the process to decide on which pathway a particular drug will be put. In particular, owing to a lack of clarity and transparency in the process, information on how or why one medicine evaluation approach or access route is selected over another is simply not available. Will the Minister outline the steps the Government will take to clarify the process, to speed up decisions and to make those decisions more open, so that patients can better understand the process?

I have specific questions for the Minister on two of the pathways: the highly specialised technology evaluation programme, which is administered by NICE, and Evaluation through Commissioning, which is administered by NHS England. There is significant concern that they could limit access to medicines for people with rare diseases. There are widely held concerns that the process in the highly specialised technology evaluation programme, introduced following the 2012 Act to appraise medicines for rare diseases, is too opaque and that the topic selection process is out of date. Does he have any plans to work with NICE to update the selection criteria for the pathway, as they do not take into account conditions defined by genetics, biomarkers or differences in clinical presentations?

Do the Government have any plans to increase the resources available to NICE to evaluate drugs through the highly specialised technology evaluation programme route, given that it is only resourced for three drugs appraisals a year, despite the European Medicines Agency licensing more than four times that amount? Finally, it is essential that patient groups have input on the process by which the drugs upon which patients rely are appraised, but a consultation on the programme has not yet been announced. When does the Minister expect that to take place?

Evaluation through Commissioning is a specialised commissioning pathway to conduct pilots to collect data to inform the decision-making process on funding for specialised commissioning proposals. It is more than a year since Commissioning through Evaluation was expanded, and a few months since it was rebranded as Evaluation through Commissioning. Will the Minister update members on the progress the process has made in expanding patient access to drugs? As I understand it, no medicine has been selected for the programme. When does he expect that to change? Will he update the House on the effectiveness of the early access to medicines scheme to date?

There are more than 6,000 rare conditions. A disease can be described as rare, but having a rare disease is clearly anything but. Improving access to medicines and treatments for the 3.5 million people affected by rare diseases is crucial in improving their quality of life. We have heard moving personal stories from Members from all parts of the House in this debate. I was looking on Twitter at some of the contributions made by members of the public in the past 24 hours. One tweeter said:

“If I could go on the #vimizim I could start to work and pay taxes for others to get hold of the drugs they need”.

That is just one contribution among many, and I ask the Minister to reflect on them after the debate. Many issues need addressing to improve the system of medicine appraisals, and we have touched on just a few today. I hope the Minister will take on board what Members have said, and I look forward to his reply.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

The right hon. Gentleman is quite right. Tackling obesity is one the great public health challenges of our age. Right across the developed world we are looking at all the things that are going on around the world—the new science and the new research. The right hon. Gentleman is right to say that industry has a role to play, as has every part of Government—national Government and local government—as well as families, GPs and the NHS. This will be a whole-nation approach to tackling obesity. We are working on our plans, which I look forward to discussing with him in due course.

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

Type 2 diabetes is costing our NHS £9 billion a year, and obesity, as we have heard, is the major risk factor. Does the Minister agree with the previous Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), who said the other week that

“Just taking a passive approach to”—

obesity—

“is not going to work…we have to go further than we’ve gone up to now in the responsibility deal”?

Does the Minister agree and what more is she going to do about it?

[Jane Ellison]

I welcome the hon. Lady back to her place. It is good to see her back in that job and not on the Government Benches. It is far from the case that we took a passive approach—far from it. Some important things were learned from the way we have worked with industry and we are looking to build on those, but as I have said, there is no silver bullet. There is not a single academic study in the world that says that the way to respond to obesity in the developed world is through a single mechanism. We have to look at a whole-system approach, and that is what we are doing.

Vaccine Damage Payments Act

Luciana Berger Excerpts

Tuesday 24th March 2015 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Caton. I pay tribute to my hon. Friend the Member for Dumfries and Galloway (Mr Brown) for securing this important debate and for his work as chair of the all-party group for vaccine damaged people. His tireless campaigning on behalf of his constituents, and others who have been affected by vaccine damage, is commendable.

I also thank all hon. Members and right hon. and hon. Friends for their contributions throughout the debate, which are testament to the strong feelings about this issue on both sides of the House. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) talked about the challenges experienced by her constituents. The hon. Member for Strangford (Jim Shannon) made a large contribution and I was specifically interested in hearing what he said about the emotional trauma experienced by families. The hon. Member for Newbury (Richard Benyon) and my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) both talked about their constituents’ experiences of the HPV vaccine.

Vaccinations are crucial to our NHS as a way of preventing disease and the spread of infection. The research and discoveries made every day by the scientific community lead us closer to disease prevention that could not have been imagined when the Vaccine Damage Payments Act 1979 was passed. The improvements in vaccine uptake in recent years have resulted in a greater proportion of children being vaccinated now than ever before.

As my hon. Friend the Member for Dumfries and Galloway made clear the purpose of today’s debate is not to question the importance of the national vaccination programme to the health of our population; instead, it is to bring to the House’s attention those occasions on which vaccinations have gone wrong, with deeply distressing and life-changing consequences, and the challenges surrounding the support system in place for those people who are sadly affected.

I recently attended a meeting of the all-party group in Parliament and at another meeting I met a group of parents and their daughters who had been affected by the HPV vaccination. The stories I heard in both meetings highlighted that, in the event of such tragedies, it is vital that people who suffer from vaccine injury can expect to receive support to ease the burden on them and their families. They certainly should not have to battle to get what they are entitled to.

At those meetings, the deep sense of injustice felt by many of the families who live every day with the burden of disability caused by vaccine damage was clear. In response to my right hon. Friend the Member for Wolverhampton South East, I should say that I hope that the parents and people affected believe that I was at that meeting to listen to them. I very much appreciate that they feel that they are not being listened to, on top of the challenges that they have faced over many years.

As we heard, the vaccine damage payments scheme was established under the Vaccine Damage Payments Act in 1979 to provide tax-free lump sum payments to people severely disabled as a result of vaccination against specific diseases. Despite the gradual expansion of support under numerous Governments and some important reforms made in 2000 following a review of the scheme, the system has many challenges today. We have heard many compelling reasons for reform.

Since the scheme was first introduced, the number of payments made has fallen dramatically. As my hon. Friend the Member for Dumfries and Galloway said, since 2010-11 no vaccine damage payments have been made at all. That may be down to vaccines and vaccine safety, but it is troubling that, despite hundreds of applications from people whose disability was sufficient for them to be considered to have a strong enough case, not one payment has been made. I hope that the Minister will explain why such a gulf exists between applications for support and actual payments made. I hope she will share her view on why the number of payments has gone down to zero in recent years.

I understand that there is a robust qualification process and that, to qualify for compensation, a person must be assessed to be 60% permanently disabled for life. In considering cases, it is right that medical advisers have regard to whether informed medical opinion suggests that there may be a causal link between the claimed adverse event and vaccination. I appreciate that the line must be drawn somewhere, but will the Minister share with us whether any flexibility is built into the system to allow a person assessed as being very close to the 60% qualification point—perhaps they are 59% permanently disabled—to receive support under the scheme? Surely a person suffering such a level of disability has a substantial need, which the scheme is intended to accommodate. It seems unjust that, by just missing out on the threshold, they would receive no payment at all under the scheme, so it is left to the family to shoulder that burden.

Has the Minister considered the case for reforming the minimum level of disability required for a person to qualify? We have heard today that, even when a person does qualify as having a serious disability, the Government have fought against such decisions. Take the case of people who suffer from narcolepsy as a result of the swine flu vaccine, which we have heard about today. Despite a causal link with the vaccine having been established and a tribunal having concluded that that should be considered a “serious disability,” the Department for Work and Pensions appealed against the decision. Will the Minister share with us why the DWP would go against such a decision? Will she clarify how her Government reach a decision on whether to appeal against a tribunal decision?

As we have heard in the debate, there are many other anomalies in the coverage provided by the Act. I note the recent additions this year of the rotavirus and influenza vaccinations to the list of specified diseases to which the Act applies. Despite that, it does not provide a comprehensive safety net. Will the Minister explain the review process that takes place before a vaccine is included on that list? Why are some vaccines, such as pandemic influenza and hepatitis A and B vaccines, excluded? The current scheme focuses largely on the childhood immunisation programme, but it covers people over the age of 18 for certain diseases. We have heard the word “patchy” used today, which is a fair assessment.

I was concerned to learn that 814 applications had been rejected on non-medical grounds because they were made either out of time or outside the scheme’s scope. The scheme allows for no extension to the time limit, even when the applicant did not have knowledge of the scheme or did not know that they might qualify for a claim. To refuse someone the support they need on the grounds that they have not made the deadline seems inflexible. Does the Minister have plans to build more flexibility into the rules about the time frames in which applications need to be made?

There are other anomalies. In the event that a child under two dies from an adverse reaction to a vaccine, their family are not eligible to receive any payment under the scheme. The logic for that is unclear. Why should the family of a child who dies after their second birthday be more deserving of compensation than one whose child died a day before? I would welcome clarification from the Minister on whether she plans to review that.

In a written answer to me at the end of last year, the Minister said that the Government had

“no plans to make changes”

to the 1979 Act. Has she reconsidered that position since then? If not, does she have any plans to review that decision?

The debate has raised issues that need to be tackled if we are to ensure that we have a comprehensive support system for vaccine damaged people and to promote confidence in the uptake of vaccines. The support scheme put in place by the 1979 Act was of its time and intended to be an interim solution. However, it has become—albeit with some changes over the years—a permanent one.

People need to be assured that, in the unlikely event that something goes wrong, they will be looked after. My hon. Friend the Member for Dumfries and Galloway made a powerful case for reform, which I hope the Minister will take away and give her full consideration. I look forward to her response.

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.

Health Service Commissioner for England (Complaint Handling) Bill

Luciana Berger Excerpts

Friday 27th February 2015 Commons Chamber

[Mr Arbuthnot]

It is worrying that my right hon. Friend is persuading me that I am wrong. It is very worrying, while one is on one’s feet, to be persuaded out of one’s own arguments. If he will allow me to cling on for just a few moments, I will get to the dregs of my argument.

The ombudsman might be the only champion of someone who is already vulnerable because they have been incapacitated to one extent or another by their health needs. Therefore, it would be a good idea to encourage the ombudsman to give as much information as possible to the complainant at the outset of the complaint, although my right hon. Friend is right, given his fourth or fifth Eric Forth principle on keeping laws as minimalist as possible, that we possibly should not put it into law.

As I said, 99% of complaints are completed within 12 months—that is, those that are taken on by the ombudsman. We will have to come back on Third Reading to whether the ombudsman takes on enough of the complaints that are made to them, because that issue arose in the evidence sessions of the inquiry of the Public Administration Committee into the ombudsman. If my new clauses were accepted and the ombudsman had to make an estimate of how long it would take, it is quite possible that they would simply have to tick a box to say that it would take less than 12 months. Therefore, the new clauses might, as my right hon. Friend might say, add very little but a formality. As I have said, I do not think that this reflects the way in which the health service commissioner operates. If there is an issue, she does as much as she can to keep people informed about what is happening.

The new clauses are probing amendments and, as I say, I will not die in the ditch for them. However, I look forward to hearing the views of my right hon. Friend the Member for Haltemprice and Howden, my hon. Friend the Minister and the Opposition spokesman about this minor attempt to be helpful.

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

I will give a brief response on the two proposals of the right hon. Member for North East Hampshire (Mr Arbuthnot) in new clauses 1 and 2. On Third Reading we will perhaps talk at greater length about the merits of the Bill and why it is important that we are here today. I acknowledge that these are intended to be probing amendments to provoke discussion and debate.

New clause 2 is important. We know from many of our constituents who are going through this process that it often comes at a difficult time. Any more information that they can receive about how long they should expect to wait would be helpful. We are all familiar with the card that the ombudsman already provides to us on receipt of our applications to them, so any further information that we could provide to our constituents about how long they should expect to wait would be helpful.

I see no problem with new clause 2, which seeks to provide a complainant, at the outset of an investigation, with

“an estimate of the period within which the investigation is likely to be completed.”

The key point is that it is an estimate. My only concern, although I acknowledge that the overwhelming majority of cases are completed within a year, is that we must manage the expectations of anyone who submits a complaint to the ombudsman. I reiterate that cases often come at a difficult time for people, and the concern is about complainants having to wait for months beyond the time set out by the ombudsman.

We will talk more on Third Reading about why a complaint might be brought, but we often support constituents at a time when they have had a loss or gone through a difficult medical procedure, and we know that it is important to manage expectations. Anything that we can do to provide assurance will be positive, but I do not want any period that the health service commissioner sets out to give people a false sense of security that they will receive a response within a certain time, when it could be many months after that.

I look forward to the Minister’s response, but I do not think there is much to take issue with in new clause 2 if the right hon. Member for North East Hampshire decides to press it to a Division. As I said, my only concern is about the broader provision of information to the public. I would not want to place on the health service commissioner too onerous a duty to provide a wide audience with expectations of when complaints might be responded to. We know from the commissioner that there is already an expectation that complaints will be responded to within 12 months, which is helpful, but new clause 2 would help to give people who are bringing a complaint some expectation of when it might be responded to.

[Mr Nuttall]

It is always a pleasure to follow the shadow Minister, whose remarks were pithy and straight to the point. I will try to be equally pithy in dealing with these short new clauses. I am grateful to my right hon. Friend the Member for North East Hampshire (Mr Arbuthnot) for tabling them, because they give us an opportunity to consider whether it is appropriate to include in the Bill a requirement for information to be provided to the public in general, and a complainant in particular.

New clause 1 states:

“The Health Service Commissioner shall make available to anyone considering making a complaint, an estimate of the period within which investigations are to be completed.”

Frankly, I wonder whether there is any need for the new clause. I do not want to pour cold water on my right hon. Friend’s attempts to improve the Bill, which I know are well intended, but I wonder whether he is aware of any occasion when someone has approached the commissioner and said, “I am thinking of making a complaint. Can you tell me how long you think it might be?”, and the commissioner has said, “I’m sorry, I can’t tell you that. We’re not going to tell you.” If there are a lot of people in that position, I agree that we need to address it in legislation, but I have certainly never had anybody approach me and say, “I was thinking of making a complaint, but they won’t tell me how long it will take.” I am not sure that there is a particular problem that we need to address, but I am sure that my right hon. Friend will enlighten us about that.

--- Later in debate ---

[Mr Davis]

I am not sure that the legal liability relates simply to the person bringing the complaint. It could relate to other people too, such as those contracting services. It also relates very much to reputation. Someone may, in effect, be asked to make a confession according to a timetable, which is not a good idea in a statute.

I agree with my hon. Friend the Member for Bury North (Mr Nuttall) in his critique of amendment 5. On amendment 4, I would leave that to practice guidelines, rather than putting it into law. It is dangerous, as I said earlier, to create lots of onerous responsibilities in law. The aim of the Bill is to exert pressure and give a degree of public guarantee, not to try to tell the ombudsman how to cross every t and dot every i.

The one amendment with which I felt some sympathy but am still uncertain about is amendment 3. I presumed from the Bill that the ombudsman’s department would respond close to the 12-month point when it knew that it might go past it. Earlier, it is likely to have to adjust the timetable; later is not tolerable. I am uncertain whether it may lead to perverse or unintended consequences if we do exactly what my hon. Friend the Member for Christchurch has proposed. I will have to think about that. The Bill has to go through a Lords stage. I ask my hon. Friend not to press the amendment today, but I give him an undertaking that I will look at the matter closely and see if I can come up with a form of words that I can suggest as a change in the Lords; I will let him know if I am not able to do that.

[Luciana Berger]

I shall not speak for long, but I think it right to respond to the contributions, and to speak on the options proposed by the hon. Member for Christchurch (Mr Chope). As we know, new clause 3 proposes to make it a statutory duty for complaints to be resolved within 12 months. We do not think that that is necessary. It is clear that the Bill sets out sufficient steps to achieve that. I agree with the right hon. Member for Haltemprice and Howden (Mr Davis) that, as we know, the overwhelming majority of cases are dealt with within that time, but there are obviously reasons why it may sometimes take longer. As hon. Members suggested, there may be complex cases, other agencies may be involved, or there may be a historical or long-running case that requires the extraction of data from decades past, which it may take a long time to collate. It is often not the ombudsman’s fault that these things take time. We therefore do not think it appropriate to make meeting the 12-month deadline a statutory duty.

On the amendments, it is proposed that when the ombudsman contacts complainants, she gives them an estimate of how long the investigation might take. We discussed the point earlier in relation to new clause 2. We Members of Parliament can get updates from the ombudsman on the progress of cases and share those with our constituents if they want further updates. To be fair, if we think about all the processes in which we support our constituents, this is one in which updates are provided, and complainants are provided with information about how their complaints are progressing and when an outcome might be provided.

Amendment 1 would require the commissioner to keep the complainant informed of progress. There is nothing wrong with this in principle. We should encourage the ombudsman to do this anyway. As I mentioned, as Members of Parliament supporting those complaints, we can receive updates. On the point about financial resource, I have looked closely at the amendment and listened to the debate this morning, and think that where delays occur in the progress of complaints, more often than not that is down to the complexity of the cases, rather than a lack of financial resources, so amendment 5 is not necessary. We do not believe that new clause 3 or the five amendments are necessary.

[Jane Ellison]

I understand the sentiments behind new clause 3, tabled by my hon. Friend the Member for Christchurch (Mr Chope), and each of the five amendments. I shall try to respond to some of the points that have been made, without reiterating them.

New clause 3 would place a duty on the health service ombudsman to resolve any complaint within 12 months of the date it was received, regardless of its complexity. We all have sympathy with the reason behind it, and we all want investigations by the health service ombudsman, and indeed the NHS, carried out as efficiently as possible. None the less, it would be wrong to rush cases, or to seek to put an artificial time limit on them. What is most important to us as Members acting on behalf of our constituents is that the investigation is conducted appropriately and robustly, which depends on the facts of the case. This is particularly true, as others have said, when the investigation deals with serious or complex issues.

We are all familiar with the fact that the cases investigated by the health service ombudsman generally tend to be complex and serious because they often involve an element of loss, personal tragedy, illness or disability, so they are inevitably sensitive. It is important that those investigations are conducted in a timely fashion, but on the odd occasion when they need to continue beyond the defined period, it is important that there are not artificial constraints, and that we do not constrain the handling of a complaint by focusing on the deadline, rather than the requirements of the case. That may have an unintended impact on the quality of the investigation and the complainant’s expectations about the outcome.

The Bill as drafted will hold the ombudsman more accountable for delays of over 12 months than at present, which is right, but it acknowledges that there will be some cases, albeit very few, where it is appropriate and justifiable for an investigation to take longer. Some of my right hon. and hon. Friends have alluded to the reasons for that. In other aspects of my portfolio, I have seen some of those reasons. My hon. Friend the Member for Christchurch made a working assumption throughout his comments that one reason may be delay on the part of the investigator, but sometimes it is due to other players in that investigation.

In another part of my portfolio, something extremely important has been unexpectedly delayed by the bereavement of the chief investigator. That could not have been anticipated, but it has added greatly to the delay. Cases brought to the ombudsman nearly always involve illness, and evidence may need to be taken from someone who is still ill or in recovery. It may be difficult to get that evidence, or to ask them to respond to a point made during the investigation. If the person is still suffering the effects of their illness, there may need to be an appropriate delay to allow them to recover sufficiently to give their evidence.

The Bill’s promoter, my right hon. Friend the Member for Haltemprice and Howden (Mr Davis), made an extremely good point about expertise. Complex medical issues are rarely black and white. In a debate that has already alluded to corsets and seductions, I hesitate to speculate on the number of shades of grey that might be involved in investigations, but it is clear that they exist. Sometimes, tracking down the right expert may be not a national endeavour, but an international endeavour, if the case involves a rare illness or there is a dispute about the medical opinion. Drawing on my experience of nearly 18 months as a Health Minister, I know that that is sometimes the case and we should allow for it, because it would not benefit the investigation if we did not. For those reasons, I hope that my hon. Friend the Member for Christchurch will agree not to press the new clause, and that he will feel not that he is condoning poor or slow administration, but that he is merely accepting that some things just take longer to address.

--- Later in debate ---

[Luciana Berger]

I add my congratulations to the right hon. Member for Haltemprice and Howden (Mr Davis) on the progress of his private Member’s Bill, which contains important reforms that we support.

The measures will rebalance the complaints procedure in favour of the citizen and away from the bureaucracy. If someone feels that they have been mistreated or have been the victim of a medical accident or malpractice, they deserve swift redress. What many complainants want is a clear decision, communicated swiftly, and assurances that the medical procedures and administrative processes have changed to prevent unnecessary harm or pain from happening to someone else. In fact, only last night, I met one of my constituents who is going through the process, and their primary motivation is that no other friend or family member should experience what they have gone through.

For most complainants, it is not about financial compensation. It is about justice. When a service such as the NHS lets someone down, the injustice feels so much worse because of the high regard in which it is held. I echo the comment of the right hon. Member for North East Hampshire (Mr Arbuthnot) that we should commend the thousands of men and women who work in our national health service and do such a wonderful job on a daily basis, but there are of course occasions when things do not go right. That is why the Bill is so important.

Long delays in getting answers to complaints merely exacerbate a problem and build a sense of grievance and alienation. People feel like they will never get answers and are being strung along, and of course that is not good enough. The right hon. Member for Haltemprice and Howden should therefore be congratulated on his Bill, which is entirely straightforward and has a simple, non-partisan approach and purpose. As others have said, it has wide support throughout the health service and in the ombudsman service itself, and I hope it will have support in all parts of the House when we conclude the debate.

Anyone listening to the tragic case of little Sam Morrish, which the right hon. Gentleman outlined this morning, cannot fail to recognise that this reform is needed. As the House has heard, it took the ombudsman more than two years to investigate and report on the national health service’s handling of Sam’s case. During that time, a series of factual errors were made, which Mr and Mrs Morrish repeatedly had to correct. It is fair to say that they were let down badly by the NHS. They lost their little boy, and the process that they had to endure to seek justice and redress took too long and compounded their tragedy. They deserve every ounce of sympathy that the House is capable of offering. I hope that they are listening and hear that we really are on their side.

The Patients Association, which supported the Morrish family in their complaints, said at the time that the ombudsman was not fit for purpose. Hon. Members of all parties will have had to refer constituents’ treatment in the NHS to the Parliamentary and Health Service Ombudsman, and some of those cases—not many—will have taken a great deal of time to be processed. One thing is clear: when the ombudsman falls short, it is essential that it is open and transparent. The idea of an annual report setting out the details of how long investigations and complaints have taken to be concluded is welcome. It makes a great deal of sense, because it will allow the public to see the amount of work that the ombudsman has had to do in a 12-month period and understand why, in some cases, it has had to take longer than 12 months to reach some kind of conclusion and resolution.

The Bill’s provision on accountability to Parliament and the public is an important change. It is a small one, but it will make a great difference to the ombudsman’s work and people’s confidence in it. It is also important to note that the ombudsman welcomes the call for greater transparency and openness about its performance.

Perhaps it is worth reflecting at this point on the fact that, since the ombudsman was established in 1967 to help Parliament to hold public services to account, there have been many reforms and changes. To its credit, it has embarked on a modernisation programme since 2012, and its statutory annual report to Parliament, “A voice for change”, explains how, as a result of the first phase of that programme, it concluded six times more investigations in 2013-14 than in the previous year, completed 99% of cases within 12 months and halved the average length of investigations from 432 days to 223 days. That represents solid progress, and I congratulate the ombudsman’s staff on the work that they have done.

The reality is that there is still progress to be made, however, and I wish to press the Minister on two points, to which I hope she will be able to respond. On 31 March 2013, the ombudsman had a maximum of 30 NHS complaints that it had not concluded within 12 months. No figure was given in the annual report for 2013-14. Can the Minister share with us today, or perhaps in a letter, why there has been a delay in releasing the figure? I believe that we agree about the Bill, but I would like to hear why she thinks it will work.

I note that some have called for much wider changes to the ombudsman service—we have had an extensive debate about it over the past two and a half hours. I draw Members’ attention to the recommendations in the Public Administration Committee’s recent report, “Time for a People’s Ombudsman Service”, which included proposals for different scrutiny arrangements that would make it easier for Parliament to hold public services to account. The Cabinet Office has given a commitment to the Committee that it will carry out a review of the ombudsman landscape, and the Opposition look forward to the outcome. With the indulgence of the House, perhaps the Minister will update us on whether that review has begun and what its scope is or will be, because that will shape the way in which the Bill is introduced.

I understand that the ombudsman has now launched the second phase of its modernisation programme, focusing on what people can expect from investigations and examining the quality of its service. I understand that it will consult NHS users and patients’ groups on the development of a new service charter, which is very welcome.

The age of deference has passed, and citizens expect high standards of service, real choices and accountability from their public services. The digital revolution allows the citizen to be more informed about their medical conditions and treatments than any other generation in history. The NHS in England treats 1 million people every 36 hours, and when things go wrong, as they inevitably will in an organisation of the size and complexity of the NHS, citizens have the right to honesty, transparency and swift redress. The Bill takes some important steps in the right direction. I look forward to its being passed.

Oral Answers to Questions

Luciana Berger Excerpts

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

The local Members of the Youth Parliament the right hon. Gentleman met make an incredibly important point. I refer him to the children and young people’s mental health and well-being taskforce, which will report very soon. I think that the role of schools will be crucial in its conclusions, and I encourage him to look at the report when it emerges.

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

The latest figures show a huge rise in the number of young people with a mental illness turning up at A and E. Young people not getting the help they need early on and becoming so ill that they need hospital care shows that the system is failing. Does the Minister accept that this Government’s decision to cut children’s mental health services at the same time as wasting £3 billion on a reorganisation has been a key factor in that failure?

[Norman Lamb]

This Government have absolutely not made any decision to cut children’s mental health services, and the hon. Lady knows it is misleading to suggest otherwise. These decisions are taken by local commissioners in local authorities and CCGs. Indeed, we have legislated for parity of esteem for mental health. I urge her to look at the outcome of the work of the children and young people’s mental health and well-being taskforce, which I think gives us a real opportunity to improve the way in which services operate.

Mental Health and Well-being of Londoners

Luciana Berger Excerpts

Thursday 12th February 2015 Commons Chamber

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

I thank my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) and the other sponsors of this debate for ensuring that the House can discuss such an important issue. I also thank hon. Members on both sides of the House for their contributions, which are testament to how much mental health is a vital challenge, not just in London but across the country.

In recent years we have seen a growing appreciation that mental health is just as important as physical health in ensuring the well-being of the population. Almost three years ago my colleagues in the House of Lords tabled amendments to the Health and Social Care Bill on parity of esteem between mental and physical health. As this debate has shown, however, there are challenges in how that measure is put into practice.

Since then, mental health has risen up the agenda as more evidence emerges not only of the scale of mental health illness, which affects one in six of us at any one time, but of the huge costs involved. In London, meeting the mental health needs of the large and diverse population poses a challenge, and it is welcome that tackling the cost of mental illness has been identified as a priority by the London Health Board. Of course the challenges are significant. In London almost £7.5 billion is spent each year addressing mental illness, while the wider health, social and economic impacts of mental illness cost the capital an estimated £26 billion.

As we heard from my hon. Friend, the pressures that mental health services face across the country are being acutely felt in London. Last week the Care Quality Commission published a report that found that last year the mental health in-patient system was again running over capacity. By the last quarter of 2013-14, the number of available mental health NHS beds had decreased by almost 8% since the first quarter of 2010-11. That is putting mental health professionals under extreme pressure, and more vulnerable people have to travel hundreds of miles to get the treatment they need, or they are getting no treatment at all.

I have had the privilege of visiting many fantastic services across the country and in London, such as the Channi Kumar perinatal unit at Bethlem Royal hospital, the Camden psychotherapy unit, and most recently the mental health service users group, the Lancaster Centre in Enfield. In response to the right hon. Member for Uxbridge and South Ruislip (Sir John Randall), I should say that I have also visited Dagenham council, which is training 1,000 front-line workers in mental health first aid. That is an example we can all learn from.

I have seen at first hand the pressures our mental health professionals are experiencing. They are working extremely hard in very challenging circumstances. I would be very interested to hear the Minister’s immediate plans to ease the pressure on in-patient mental health services in London. I think the key question we should be asking is why so many people in London need in-patient mental health care in the first place. Could it have anything to do with the fact that mental health spending has been cut in real terms for the first time in a decade? There are thousands fewer mental health nurses and hundreds fewer mental health doctors now working in the NHS. Is it because of the fragmentation of commissioning across our health service since the introduction of the Health and Social Care Act 2012?

My hon. Friend rightly talked about the pressures on child and adolescent mental health services in London. The right hon. Member for Uxbridge and South Ruislip said that we do not talk about this issue, but I challenge that. In recent weeks, we have seen front pages of newspapers covering this specific issue. I echo the concerns raised by my hon. Friend that the CAMHS budget has been cut in real terms by £50 million a year since 2010. We have seen other false economies, such as: cuts to early intervention and psychosis services; a reduction in the number of social workers; and the decimation of the early intervention grant, which we know is putting so much pressure on in-patient services.

Just today, I received a letter from the Danshell Group, an organisation that provides 20% of CAMHS provision across the country, including in London. It wrote to me because it is very concerned about the state of CAMHS, particularly in London. The contract they have been offered by NHS London for the next financial year will see a 40% reduction in the number of CAMHS beds it can offer, down from 26 to 16. NHS London has said this is because of its “financial envelope”. This reduction will have a very real impact on many young people. The provider is already forced to reject more than 30 patients every month. Its concern, which I share, is that these young people will end up in A and E, have to go to medium secure facilities if no low secure facilities are available, or be sent home because there is nothing or nowhere that can help them. This is simply unacceptable and cannot carry on.

In addition to the 50 extra beds NHS England has commissioned across the country for CAMHS, I am keen to know what steps the Minister is taking to address the bed shortage in London and across the country. The letter I received said that NHS London is going to reduce the number of beds even further. This is a very particular and significant concern. At least one in 10 children is thought to have a clinically significant mental health illness, which equates to 111,000 young people in London. The impacts of childhood psychiatric disorders cost London’s education system approximately £200 million a year. For people to be presenting at hospital, particularly to specialist mental health services, means their mental illness has usually become much more serious. Waiting until that point to address problems is not only worse but more expensive too, as it requires more specialist health care from other services.

We need more focus on prevention and promoting good mental health. The principle of prevention has long been the driving force behind public health policy for physical health, but there is no comparable body for public policy interventions for mental health. Will the Minister share with the House what actions she and her Department are taking to ensure we are doing everything we can to prevent mental illness in the first place?

My hon. Friend referred to the distinct challenges London faces, particularly in relation to mental health. I note that she uses “well-being” in the title of today’s debate. This is not all about mental illness. London has the UK’s highest proportion of the population with high levels of anxiety. Nearly half of Londoners are anxious, and almost a third report low levels of happiness. Life satisfaction and feelings of worth in London are lower than the national average.

Mental health is shaped by the environment in which we live our lives and for most people that is not in the NHS, but in our homes, communities, schools, colleges and workplaces. These institutions can help or harm mental health, sometimes quite profoundly, and this is particularly true for Londoners, who experience stark and unacceptable differences in well-being and length of life. If we can begin to address these basic and too-often-ignored problems in the capital, we can begin to unburden ourselves of both the moral and economic costs of mental ill health.

I want to deal with the issues raised by hon. Members. On poverty, insecurity and disadvantage, there is a social gradient for many types of mental health, such as depression, with those in lower income groups more likely to experience them than those in higher income groups. The incidence of mental illness varies sharply between boroughs in London, with some mental illnesses twice as common in deprived parts of London as in the least deprived. We have heard today how Government policy can be a major factor, and the National Housing Federation estimates that one in seven households affected by the bedroom tax is now at risk of eviction. Given the cross-cutting nature of these challenges, I am keen to hear what steps the Minister is taking to ensure that all Departments take mental health into account when developing policy. We are concerned that the Cabinet Sub-Committee on Public Health, which brought together all those cross-cutting Departments, no longer exists.

We are keenly aware that we are in the midst of a housing crisis, but this is particularly acute in London. In all but two of London’s 33 boroughs, at least one in 20 people are on council waiting lists, and across London as a whole more than one in 10 are on waiting lists. Behind these shocking statistics, however, are thousands of families living in overcrowded, temporary and often poor-quality private rented accommodation. The impact on family life, and the life opportunities particularly of children, is huge. My hon. Friend also referred to the spiralling costs of housing. The average rent in London is well over £1,000, which has a significant impact on many families. Poor housing, overcrowding, insecurity and lack of access to community facilities can have a harmful impact on mental health as well. Will the Minister tell us what actions she is taking nationally to ensure that health and housing needs are considered together by both service commissioners and providers?

My hon. Friend rightly raised the particular experience of the black, Asian and minority ethnic communities in London. People from BAME communities in the UK are more likely to be diagnosed with a mental illness. For example, they have a threefold increased risk of psychosis, and for black African and black Caribbean groups, this rises to a sevenfold increase. It is completely unacceptable that people from BAME groups living with mental illness are more likely to experience poor outcomes from treatment. There is so much work to be done to tackle these inequalities, particularly in a city as culturally diverse as London. What steps is the Minister taking to ensure that mental health services are culturally relevant to service users?

The previous Government’s action plan on BAME mental health, “Delivering Race Equality in Mental Health Care”, ended in 2010 and has not been renewed or replaced. We believe we need a renewed focus and leadership on tackling race inequality in our mental health services. Does the Minister have a plan for a new national strategy to tackle race inequality in our mental health services and to ensure improved outcomes for BAME communities? My hon. Friend also rightly raised the particular challenges of the lesbian, gay, bisexual, and transgender community in accessing mental health services, and I hope the Minister will address that too.

My hon. Friend the Member for Islington North (Jeremy Corbyn) raised the serious issue of the recent INQUEST report into the deaths of people in treatment or in-patient care. Anyone who saw the “Newsnight” report this week will have been very concerned, and again I would be interested to hear from the Minister about that.

[Jeremy Corbyn]

Would my hon. Friend support an investigation, on the basis of the INQUEST report, with a view to changing the regime of inspection, inquiry and appeal where there are tragic deaths in custody? She must be aware, as must the rest of the House, that many people in mental health institutions are completely alone, never get any visitors or support and are at the mercy of what we, the state, are prepared to provide and do for them.

[Luciana Berger]

I thank my hon. Friend for his important intervention, and for raising the point earlier. It is right to look at this issue. It is very clear from the report that INQUEST has outlined and provided that many serious challenges have not been addressed. Part of the challenge is that people find themselves isolated because they are placed in care and treatment, which can be hundreds of miles away from their homes, families and support structures. This means they are less likely to have visitors. Seeing the footage of one family’s experience—of their child’s in-patient care and the quality of her surroundings—was frightening. I hope that the Minister will address this specific report and share with us what the Government intend to do to look at the issue a lot more closely.

We have heard today that mental health is one of the most unaddressed health challenges of our age. Mental health services across our country are increasingly facing significant challenges, and as we have heard today these pressures are being acutely felt in London. Meeting the mental health needs of London’s population is critical to ensuring the future health and economic sustainability of the capital. In order fully to tackle these pressures, we must end the false economies and the stripping back of preventive and early intervention services that we have seen under this Government, and achieve a new focus on prevention and early intervention. I look forward to the Minister’s response.