Munira Wilson
Main Page: Munira Wilson (Liberal Democrat - Twickenham)Mental Health Provision (Children and Young People) Bill
Munira Wilson Excerpts
Munira Wilson (Twickenham) (LD)
I beg to move, That the Bill be now read a Second time.
It is a privilege to speak on my first ever private Member’s Bill. Let me start by thanking the Royal College of Psychiatrists, which has been working with me on the content of this Bill over the past two years; it was initially an amendment to the NHS Funding Bill, back in January 2020. I also thank Young Minds for its support and input. Together, we are united in wanting to shine a light on children and young people’s mental health services in respect of spending and waiting times up and down the country as part of our collective efforts to improve services.
The Bill would put into statute an annual report to Parliament on the provision of mental health services, with data included on both local spending and waiting times. It would enable young people, their parents and their carers to see clearly and easily the actual investment in children’s and young people’s mental health services in their own areas, and enable them to have a true picture of the waiting times for treatment. Only by having that transparency can we really hold ministers to account for their promises.
The issue of children’s and young people’s mental health is very close to my heart, and I have been campaigning for better investment in services since the moment I was elected. Each week, I hear heartbreaking stories of young people in my constituency unable to access the help they need in a timely manner, and I have been recounting a number of those stories in this place for over two years.
The mental health crisis among children and young people was a problem prior to the pandemic. We all know that it is worse today as a result of the various covid lockdowns, which led to social isolation, anxiety about the future, bereavement and, for some young people, having to live in very challenging conditions, due to either lack of physical space or difficult personal circumstances. In December 2021, the number of children and young people accessing mental health services was 15.7% higher than two years earlier.
With one in six children now having a diagnosable mental health condition, additional investment in services at all levels, from preventive measures in schools and community settings right through to acute and crisis services in the NHS, is urgent. While NHS England spending on children’s mental health has increased over the past four years, in far too many areas the money is not necessarily reaching the frontline, resulting in a postcode lottery in funding across the country.
Figures analysed by the Children’s Commissioner showed that in 2020-21, while spending was approximately £165.20 per child in the Isle of Wight, it was less than a tenth of that in Halton, at only £15.90 per child. Despite a specific commitment to children’s mental health spending growing as a proportion of local NHS spending, in the last financial year, the Morecambe Bay NHS saw a drop of over 15% in child and adolescent mental health services spending, and the Buckinghamshire NHS a drop of 11.6%.
Waiting lists are still wholly unacceptable in far too many areas. Just recently, I was contacted by the mother of a seven-year-old—seven, Mr Deputy Speaker; that is the same age as my own daughter. She is a little girl who should be enjoying school, playdates, parties and playgrounds. Her mother said to me, “She isn’t really living—just existing.” She has been waiting since November 2020 for a CAMHS assessment. That is 16 months.
Peter Gibson (Darlington) (Con)
The hon. Lady is making some really important points, particularly about CAMHS. The delay in getting people assessed is a significant issue in my constituency; it impacts my case load, and it delays access to services for young people in my constituency. However, I know from engaging with my local mental health trust that the problem is not so much funding but recruitment. Will the hon. Lady comment on what we can do to recruit the necessary people to help with the backlogs?
Munira Wilson
I completely agree with the hon. Gentleman. Even if there were 1,000% more funding tomorrow, the workforce is not there, as we know it is not in so many parts of the NHS. Interestingly, we know from the British Association for Counselling and Psychotherapy, for example, that there are many counsellors who are trained to counsel young people who want to do more work, but I agree that recruitment is a problem in trying to get timely assessments. The story I was part of the way through telling goes on to explain how long that poor seven-year-old girl has been waiting just for an assessment, let alone for treatment. That is why the Bill refers to waiting times to treatment; there is often a long waiting time to assessment and then another long waiting time to treatment. But I agree with the hon. Gentleman: we need to do a lot more on recruiting the right workforce as well as putting the funding in, because we cannot do very much without the right people.
Jerome Mayhew (Broadland) (Con)
The hon. Lady will recall from a conversation that the two of us had the importance and effectiveness of counselling in the school environment for nipping potential mental health issues in the bud—particularly those associated with the first and second covid lockdowns. Every Member will have experienced in their patch increased anxiety among teenagers, particularly at secondary school—perhaps not so much in primary school. Does the hon. Lady agree that the focus on counselling in the school environment is particularly important?
Munira Wilson
I agree completely. We need that preventive intervention at school and community level, as well as investment in acute services right across the way. There is a huge need, from low-level intervention right through to acute services, and if we do more at an early stage we will prevent waiting lists from growing at later stages. I absolutely think that we should have a professional, trained counsellor in every school. It is the No. 1 issue that every secondary headteacher in my constituency brings up with me, and although the hon. Gentleman says it is less significant in primary schools, it is still a pretty high priority for my primary headteachers. I have witnessed some pretty scary episodes when I have been in primary schools, so it is a problem across both.
Back to my story about the seven-year-old. Her mother told me that she is not really living, just existing. She has been waiting since November 2020 for a CAMHS assessment, which is 16 months. Recently, her mother was told that she may need to wait a further year still. Since her initial referral in November 2020 she was also recommended for arts therapy while she waits for assessment, but that has not materialised either, with local service providers suggesting it may come through in the next couple of months. My caseload suggests this case is not unusual, sadly. Quite apart from the anguish and stress for the whole family, the child’s condition often deteriorates while they wait for assessment and they then need more extensive intervention. Even worse, they can end up at the back of the queue for a new assessment because by the time they are seen they are on the wrong track or the wrong tier for the level of support they need. Indeed, a few weeks ago I shared the story of a 15-year-old girl to whom that had happened.
Christine Jardine (Edinburgh West) (LD)
The hon. Lady is giving an excellent account of the problem, and I know we all share her thoughts on it. Does she agree that one reason this is so important is that generations have had their life chances held back because they did not get support when they were children that would have allowed them to develop? If we let children down now, we will be letting another generation suffer a problem that we know we can solve.
Munira Wilson
I could not agree more. If children are not happy and well in themselves they will not thrive. There is plenty of data and research to show that children who are unwell mentally do not do as well in their GCSEs and A-levels, as well as in their social lives, so it is key.
Alicia Kearns (Rutland and Melton) (Con)
I could not agree more with the hon. Lady. Over the last two and a half years it has been devastating to see the impact of the pandemic on children’s health. We should never again lock our children out of their schools and we must ensure that we protect them against the appalling pandemic of abuse that we have seen in our households. I recognise that we need to do more for children and their mental health, and I see that in my local secondary schools. I apologise, however, because I am struggling to understand how the proposal would differ from the quarterly dashboard already published by the Department of Health and Social Care that, as I understand it, already presents such data.
Munira Wilson
The dashboard does not go into the level of detail required in the Bill. I will come on to the different bits of data that the Bill would require to be published, especially on waiting times. That is not particularly transparent, although the Children’s Commissioner requests some of that data on an annual basis. On the dashboard, the spending figures that are reported are not always accurate, which is why there have been a lot of independent audits. That is why I want to put it on to a statutory footing, to give some weight to it and to try to drive up the quality, so that we have that transparency and accountability.
When young people are not seen in a timely manner, often their condition deteriorates and then they have to be re-referred and go to the back of the queue. The data on waiting times from referral to assessment and from assessment to treatment by area are not routinely and easily available. My hon. Friend the Member for Richmond Park (Sarah Olney) and I have had a long-running battle locally to try to access some of that data, because our case loads on children’s mental health are so high.
Every year, the Children’s Commissioner uses her statutory powers to request information from NHS Digital on referrals, waiting times and spending. The waiting times reporting in that analysis uses a proxy measure of two contacts, even though for a variety of reasons that can be misleading. We should not have to rely on the Children’s Commissioner’s requests, which may not always continue, nor should we have to rely on proxy measures.
Additionally, as the Children’s Commissioner makes clear in her report, the data she is able to access and publish, some of which comes from the dashboard that the hon. Member for Rutland and Melton (Alicia Kearns) referred to, is limited to the NHS and does not include the spending or activity in schools and local authorities, even though those services, as we have heard, are an important part of the vast and complex patchwork of mental health provision for our children and young people. We need a holistic picture.
Brendan Clarke-Smith (Bassetlaw) (Con)
I thank the hon. Lady for being generous with her time. Is she aware that the NHS and clinical commissioning group spend has increased year on year since 2016, and does she welcome that?
Munira Wilson
The hon. Gentleman may have missed it, but I did acknowledge earlier in my remarks that for the past four years, at an England level, the spending has gone up. The problem is that that does not always filter through to the local level. I highlighted earlier in my speech the postcode lottery whereby there is a tenfold difference between what is spent in Halton and what is spent on the Isle of Wight. It is increasing at the national level, but without tracking it and having transparency about what is being spent at the local level, we cannot be sure that it is always filtering through.
Where the NHS is committed, based on what the Government have asked of it, to increasing its spend on children and young people’s services as a proportion not only of NHS spending, but of mental health spending, the data is not very clear and the quality is not always very good, so we cannot track it at a local level.
Jerome Mayhew
Is there not a degree of conflict between the need to ensure that support is put in nationally, wherever the need is, and the real desire to have localism, so that local spending more accurately reflects the priorities of individual communities? I do not know the background of what happens on the Isle of Wight, but it may be right that there should be increased spending there compared with the assessed need in Halton. Does the hon. Lady think there is a more serious problem behind that difference, rather than just different prioritisations from local communities?
Munira Wilson
I applaud a Conservative Member for talking to a Liberal Democrat about localism. I wholeheartedly embrace localism and would like to see much more local accountability for spending, and yes, there will sometimes be obvious reasons for variability. However, I would ask whether £15.90 sounds like a reasonable amount to spend per child on mental health. Unless there is a suggestion that in Halton there are pretty much no children struggling with mental health, which I doubt is the case, that tenfold difference does need investigation. Looking at the figures, Halton is one of the areas that has had a massive percentage increase in the past year, presumably to try to correct for that very low level of spending and the need that is there.
My Bill would make the publication of data on the provision of those services a statutory requirement. As such, we could secure a higher quality of data published in a coterminous way across NHS units—currently clinical commissioning groups, but in future integrated care systems—and local authorities by requiring publication on a regional basis. The Bill would also put a specific requirement on Government to publish spending per head on child and adolescent mental health services, as well as the proportion of overall NHS spending and mental health spending on CAMHS by region.
Clause 2 also requests that a statement be included as to whether the expenditure has met the aims of the NHS long-term plan. That is an important requirement to ensure the mental health investment standard is met. The standard is the Government’s tool to ensure CCGs increase how much they spend on mental health every year and, in particular, on children and young people’s mental health. Reporting on that standard has been of variable quality in recent years, with some areas reporting that they met the standard while including one-off, non-recurring pots of money or dementia and learning disability spending, all of which are specifically excluded.
Craig Williams (Montgomeryshire) (Con)
The hon. Member is being very generous with her time. On the point she made about the CCGs meeting the investment standard, every CCG met that standard in 2021-22. Of course, this is an English Bill, but as a Welsh Member of Parliament, can I reflect that until recently, Wales had a Labour and Liberal Democrat Government? There was a Liberal Democrat Minister for Education until recently, and the data in Wales is so poor compared with the dashboard. If we just had the right level of dashboard in Wales, we could really dig into the detail, so could the hon. Member reflect on why that is not happening in Wales, given that until recently, her party was in government there?
Munira Wilson
I hope the hon. Member will forgive me, but I am not briefed on what is going on in terms of the data in Wales. He is correct that every CCG is reporting that it meets the mental health investment standard, but as I am trying to explain—I will touch on this a little later—independent audits have shown that some CCGs inaccurately reported that they met the mental health investment standard because they included spending that they should not have included. That suggests they have met the standard, but they have not. That is why this Bill is trying to put some of those standards, and the explanation of how they have or have not been reached, on a statutory footing, so we can all have the clarity we need to hold Ministers and services to account. These requirements to report on CAMHS spending should not put a significant strain on NHS resources because, as has already been alluded to, a lot of that data is already being collected and some of it is being reported on the mental health dashboard.
I have no doubt that in her response, the Minister will refer to the Government’s amendment to the Health and Care Bill in the other place that requires the Secretary of State to lay a written ministerial statement setting out the Government’s expectation on mental health spending by NHS England for the year ahead. That amendment also requires integrated care boards to publish details of this spending in their annual reports. That is a very positive step forward; I welcome that amendment, and am glad—having been lobbying for it for the past two years—that we are making progress in the right direction. However, nothing on the face of the new legislation specifies that those reports should refer to children and young people’s mental health services in particular. Children and young people’s mental health services have always been the Cinderella of Cinderella services in our NHS, so I strongly believe they should be named on the face of the Health and Care Bill if the Government will not accept my Bill today.
With the retrospective reporting requirement on spending being in integrated care board annual reports, aggregating and comparing that data locally and regionally will be much more challenging. Furthermore, given the question marks I have already alluded to that have been raised about the quality of financial reporting by local organisations, which is why independent reviews of mental health spending have been commissioned for the past two financial years and this financial year, I have concerns that what is being done in the Health and Care Bill—the report of what has actually been spent—is just subject to annual reports by ICBs. Again, a report to Parliament would strengthen the basis of that data and its quality.
As I have said, some CCGs have been found to be erroneously reporting whether they are meeting the mental health investment standard, and although NHS England and Improvement has demanded explanations, I am not clear that any of those explanations are published anywhere. To me, the fact that the quality of the data remains an ongoing concern strengthens the need to ensure an annual report is made to Parliament with regional breakdowns.
To turn to data on waiting times, clause 3 of my Bill draws on the recent consultation on the mental health clinically-led review of standards. I welcome the broad support demonstrated for the proposed standards and particularly a four-week waiting time standard for access to community children and young people’s mental health services. However, as expressed by the consultation respondents, there needs to be clarity on what the four-week waiting time is for. Is it for assessment, starting treatment or another intervention?
My Bill would require a report to Parliament showing exactly how long children are waiting to access non-urgent treatment by region. That would better reflect the reality for so many young people, parents and carers who are beside themselves, waiting months or even years for an assessment and even more until they commence treatment. The statutory report that I propose would allow Parliament to hold Ministers to account for the appalling waiting times that every Member of Parliament has heard about in their constituency.
Peter Gibson
The hon. Lady will know that the Government tabled a number of amendments to the Health and Care Bill to improve transparency. Does she welcome them?
Munira Wilson
Yes, I already have. I am sorry that the hon. Gentleman missed that part of the speech, but I welcomed them and pointed out where I thought they were deficient and should go further.
I am introducing the Bill because too many children and young people right across the country are in crisis. Unless our children are happy and well, they cannot learn and thrive. Our children are buckling under the pressure. Last year, a year 11 student at a secondary school in my Twickenham constituency took his own life. Teachers and doctors desperately tried to get CAMHS support for him, but he would not engage, so they said that they could not help. To my mind, that is exactly the sort of person they should work intensively to engage with. When I spoke to the school, they told me that they had five more pupils who were identified as high-risk. Staff in schools are overstretched and trying to provide services that they are neither qualified nor equipped to deliver, nor should they have to do so.
Kerry McCarthy (Bristol East) (Lab)
The hon. Member is making a powerful speech. I am glad that she is talking about children in crisis, because too often, we talk about the softer side of things, including the need for counselling and early intervention. Although that is very important, a significant number of children are very ill indeed and are not getting the help that they need. The number of A&E attendances by young people with a diagnosed psychiatric condition has tripled since 2010. If they are resorting to going to A&E, that means that they are being badly let down by the system. Would her Bill reveal details of how they are dealt with at A&E, how long they have to wait and whether they end up getting treatment?
Munira Wilson
Yes. If the hon. Member looks at clause 3, she will see that it draws on the definitions in the clinically-led review of mental health waiting time standards and mentions both urgent and non-urgent presentations, so that we get data on waiting times for all of them. I completely agree with her point about presentations to A&E; I have heard that from many local NHS leaders in my patch and across London. Indeed, I have heard about paediatric units in hospitals having to look after CAMHS patients—which is totally inappropriate, both for the other children in those wards and the CAMHS patients—because there is such a dire need for beds. We need more provision and intervention from across the lower level that she mentioned right up to the acute and crisis side of things.
Many headteachers tell me that their staff are effectively becoming social workers, trying to support families with their problems outside school and get children to re-engage with schools, as the number of children missing from school has increased since the pandemic. A number of primary schools in my constituency are relying on parental donations to offer therapy and mental health support.
Urgent action and further investment is desperately needed. We should have a trained mental health counsellor in every school, community mental health hubs and additional crisis beds, as has been suggested. We need to track that action and investment properly so that the Government can be held to account. The Bill would be the start of holding Ministers’ feet to the fire on their promises by giving the public, and Members of Parliament as their representatives, the tools to do so. Young people and their parents and carers could ensure that they are no longer short-changed in their own area and see in stark daylight the reality of what is being spent in their area on children and young people’s mental health. We would all have a much clearer idea of just how long those children and young people are languishing on waiting lists.
Simon Baynes (Clwyd South) (Con)
The hon. Lady has been extremely generous with her time. I very much respect what she is saying and I fully understand her point about the statutory requirements to support mental health. However, to take the discussion slightly to one side, as she has given the matter huge thought and consulted others, how can we help young people with mental health conditions as part of a holistic approach aside from whatever the state can contribute, which is obviously central and vital to the process?
Munira Wilson
I have been arguing for some time that we need a holistic approach, including in schools—there has been a real narrowing of the curriculum and we need more extracurricular activities and other, softer skills to be built back into the curriculum and school time, because that all helps wellbeing—as well as specific services and interventions to support young people who may start to get into either crisis or lower-level anxiety and other issues. We also need provision of youth services. I am sure that we can all cite fantastic examples of projects and things in our constituencies that enable young people to improve their physical and mental wellbeing. There is a whole host of things. The Bill would be just one tool, measuring what is going in right across the board—whether in the NHS or by local authorities or schools—and what the waiting times are. I think there is unanimity across the House that there is a problem and that we need to do more. I have acknowledged that the Government are attempting to do more, but we need to improve transparency and accountability.
Through the Bill, we would have a much clearer idea of how long young people are languishing on waiting lists, often with their conditions deteriorating, and sometimes with tragic consequences. Progress is needed now. Our children cannot wait. I commend the Bill to the House.
Chris Loder (West Dorset) (Con)
Thank you for calling me in the debate, Mr Deputy Speaker. It is a pleasure to contribute to this very important discussion. I pay tribute to the hon. Member for Twickenham (Munira Wilson). It is important that she has brought her Bill to the House for us to debate, and I am pleased that we can have that discussion.
It is fair to say that some of the most profound experiences that I have had since I was elected in December 2019 are those of helping parents who have had terribly sick children, generally for mental health purposes. It has been so profound to see the extent to which young children who are five, six, seven or eight years old have been in such a desperate place and have had to wait quite some time to get help. I therefore have great sympathy with the hon. Lady’s wanting to bring the Bill to the House for debate.
The Bill very much focuses on the need for more reporting, with the Government to report still further to this House on child mental health statistics. I am afraid that I do not entirely agree with her on that point, and I would like to take the opportunity to explain why. I hope she will not misunderstand me, because I care deeply about this. In Dorset, we have also seen some terrible circumstances. Systemic issues are the core reason why these children have not got the help they have needed; they have fallen down the gaps in provision between the local authority, the education authority and the NHS.
The Government have introduced the extensive Health and Care Bill. I recognise that it does not enjoy the support of the whole House; indeed, I think I am right in saying that the hon. Lady has not supported the Bill so far. However, I think the Government’s intention to change the CCG setup and move towards an integrated care system for all parts of the country, and the steps that they have already taken on that in anticipation of the Health and Care Bill, are the single most important thing that will improve children’s mental health. It is one of the reasons why I am such a keen supporter of my hon. Friend the Minister and her colleagues.
We have to take great care before we put more bureaucracy and cost into the system. It is already far too heavy with bureaucracy, which distracts from core delivery. I looked carefully at the notes that the hon. Lady sent me a few days ago—I thank her very much for doing so—and I have read her Bill. We have to be careful not to change the priorities to finances and money, rather than looking after the individual child. I agree that considerable improvement is needed when it comes to holding to account the relevant organisations in the three groups that I have just mentioned. I have found that quite difficult when I have supported parents who have come to me in desperation for help. She is right to highlight that point, and it is right that the Government hear it. I am sure that it is already well heard, although I am hoping that the Bill may be further strengthened to address it.
In a vast number of cases, young children have had to wait not days, weeks or months but in excess of a year to get the help they need. The hon. Lady is absolutely right to highlight the challenges with CAMHS, and the difficulties that parents often face with getting the assistance that they require.
Munira Wilson
If the hon. Member is so concerned about those year-long waits—we all have constituents who have experienced them—why is he so opposed to better reporting on that? He complains about bureaucracy, but some level of reporting is required for accountability. It is not just bureaucracy for bureaucracy’s sake, which I hate.
Chris Loder
The hon. Lady makes a valid challenge, but she misunderstands me. I am not necessarily wholly opposed to changes in reporting and changes in how local integrated care systems approach the matter, but I am not sure it is right or good for the UK Parliament to legislate in that level of detail. I repeat that I fear we run the risk of losing focus on the child or children amid all the bureaucracy of the reporting. That is a concern; I see that today to an extent. I do not want us to always resort to having to wait for annual reports to come out before we can bring up such matters with Ministers and others.