Mental Health: Absence from Work

Nigel Adams Excerpts

Wednesday 17th October 2018 Westminster Hall

[The Parliamentary Under-Secretary of State for Housing, Communities and Local Government (Nigel Adams)]

It is a pleasure, as always, to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for North Warwickshire (Craig Tracey) on securing this important debate and on putting his point across with such characteristic eloquence.

I was particularly struck by the recognition in the debate that employers and Government both have a stake in the nation’s mental health. The Government provide the necessary health support, offer a safety net when people are out of work and promote the right action in the workplace. However, employers are increasingly recognising that they have a crucial role to play in creating healthy workplaces to enable their employees to remain in work and thrive, providing a supportive environment in which their employees can discuss health issues, and helping people return to work promptly when they fall ill.

Mental health is a matter of national importance. It is particularly relevant this month, following World Mental Health Day on 10 October, during which the Prime Minister announced that the Government are providing £1.8 million over the next four years to cover the cost of calls to the Samaritans helpline. This will enable more people to receive support when they reach out for help.

The Prime Minister is personally committed to improving mental health services and addressing one of the most burning injustices in our society. As we have heard, the Government are backing that up by investing record levels in mental health, with annual spending reaching just under £12 billion last year. In addition, the Prime Minister announced a five-year funding settlement, which will see the NHS budget grow by more than £20 billion a year in real terms in the next five years. In return, she has asked the NHS to develop a long-term plan for the next 10 years. She has been clear that mental health needs to be a key element of that.

Financial difficulties can have a serious detrimental impact on mental health, but mental health problems can devastate our finances, too. As we heard from the hon. Member for Dewsbury (Paula Sherriff), one in four people who suffer from mental health problems may have debt problems as well. Supporting people with their financial resilience is vital. We are committed to addressing issues faced by people who fall into problem debt. This year, the Government commissioned the Money Advice Service and spent just over £56 million to provide help to more than 530,000 people.

The NHS provides some services to people who may be experiencing the symptoms of debt problems or financial difficulties. Mental health services, including improving access to psychological therapies, may also signpost patients to debt advice services as part of their care. In our 2017 manifesto, we committed to developing a breathing space scheme for people in problem debt. We will publish a consultation shortly and lay before the House regulations on breathing space by the end of 2019. The Prime Minister has also announced a review of the practice of GPs charging patients to complete debt and mental health evidence forms. We are considering options to end the need for GPs to charge their patients to provide this information to their creditors, and I know that that will be welcomed.

We know that too many people with a mental health condition do not participate fully in key activities of society, including work. The figures are stark: people who are unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety. That is why this Government are committed to supporting people with mental health conditions who are out of work, including through our Jobcentre Plus network. All work coaches across the network receive training on supporting people with health conditions and disabilities. In addition, the roll-out of the health and work conversation across the UK supports work coaches to continue to build engagement with claimants who have disabilities and health issues.

The Government also continue to invest in mental health-related trials and studies. These include doubling the number of employment advisers in IAPT services and launching a £4.2 million challenge fund to build the evidence base of what works to support people with mental health conditions, as well as musculoskeletal conditions.

The good news is that staying in or returning to work after a period of mental ill health can help mental health recovery. Good work supports our good health. It keeps us healthy, mentally and physically. It enables us to be economically independent and gives us more choices and opportunities to fulfil our other ambitions in life. Our Command Paper, “Improving lives: the future of work, health and disability”, which was published jointly by the Department of Health and Social Care and the Department for Work and Pensions last November, sets out a comprehensive strategy for achieving the Government’s challenging target of ensuring that 1 million more disabled people are in work by 2027.

Given the scale of this ambition, a key part of our programme is to achieve transformational change by focusing action on three key areas: welfare, workplace and health. We have made good progress. Employment rates are at historic highs and the number of disabled people in work reached 3.5 million in 2017, having increased by nearly 600,000 since 2013. The Government recognise the crucial role of employers in creating mentally healthy workplaces. Too many people fall out of work because of their mental health. We are asking employers to do more to prevent that.

That is why, as we heard from my hon. Friend the Member for North Warwickshire, in January 2017 the Prime Minister commissioned Lord Dennis Stevenson and Paul Farmer, the chief executive of Mind, to conduct an independent review into how employers can better support all employees, including those with mental ill health or wellbeing issues. The review set out a compelling business case for action, with the central recommendation that all employers should adopt a set of six core mental health standards to encourage an open and transparent organisational culture that supports employees’ mental health. Those standards included developing mental health awareness among employees, encouraging open conversations about mental health and routinely monitoring employee mental health and wellbeing.

The review went further by recommending that all public sector employers, and private sector companies with more than 500 employees, deliver mental health enhanced standards, including increasing transparency and accountability through internal and external reporting. We have made progress with implementation and are developing with partners, including employers, a framework for voluntary reporting on mental health and disability. We will publish supporting guidance, including on the important issue of how to encourage employees to disclose health issues.

It will take time before we can call all of our workplaces truly healthy and inclusive, but we have been encouraged by the level of engagement and commitment to this agenda. Momentum is building around the challenge to all employers to adopt the core standards that lay the basic foundations for good workplace mental health, and to larger businesses to adopt the enhanced standards. Following the Prime Minister’s acceptance of the Stevenson-Farmer recommendations as they apply to the NHS and the civil service as major employers, both organisations are making progress.

Working in partnership is vital. The Government recognise the collaborative approach that has created the new mental health at work gateway, which is aimed at employers, senior management and line managers, to help them to support a colleague, challenge the stigma or learn more about mental health in the workplace. Looking at the wider system in which employers make decisions, the Government are committed to reforming the current system of statutory sick pay so that it supports more flexible working, which can help people to return to work after a period of sickness.

I will use this opportunity to take a moment to address some of the points raised by hon. Members in the debate. I will come on to my hon. Friend the Member for North Warwickshire shortly. The hon. Member for Strangford (Jim Shannon), who gave a characteristically eloquent exposition of the issues, talked about employees sharing responsibility. I could not agree more, and nor could the Government. Employers have a key role to play in creating good working conditions and providing supportive line management so that people have the opportunity to speak out about issues and keep in contact with employees. I was encouraged by what he said about ensuring that his own staff took breaks and had some downtime during the working day.

It is also important that we keep in contact with employees who happen to go off sick. The Government have worked with Mind to produce a new website resource, and we are reviewing current obligations and incentives to see what we can do to encourage more good behaviour. The hon. Gentleman talked about suicide prevention; as hon. Members will be aware, on World Mental Health Day the Prime Minister announced not only the appointment of my hon. Friend the Member for Thurrock (Jackie Doyle-Price) as Minister for suicide prevention, but, as I mentioned earlier, almost £2 million to cover the costs of calls to the Samaritans helpline, where there will be help for people who reach out.

The hon. Gentleman also talked about parity of esteem for mental and physical health. It was this Government who legislated for parity of esteem by making mental and physical health an equal responsibility for the NHS in the Health and Social Care Act 2012. We are also backing our commitment with a significant increase in funding.

We are all extremely delighted to see the hon. Member for Motherwell and Wishaw (Marion Fellows) in her place, and it was a genuine pleasure to hear from her. It takes enormous courage to admit that one has suffered mental health problems, so to hear that from the hon. Lady was incredibly moving, and it was a privilege to be in the Chamber for that moment. It is important that employers create the right supportive environment. One thing we are doing is investing to make sure that there are 1 million mental health first aiders in the workplace, which is crucial.

The hon. Lady talked about the impact of low wages, and I agree with her. That is why we introduced the national living wage and are providing in-work financial support through tax credits and now through universal credit. That also makes it easier for people to move in and out of work, removing difficult transitions. She mentioned work capability assessments; it is true that they are designed to determine benefit eligibility, but they should not be viewed in isolation. We provide personalised and tailored support through work coaches in our jobcentres.

Moving on to the remarks of the hon. Member for Dewsbury, I politely and gently remind her that the funding picture in the NHS is not quite so gloomy as she painted it. We are backing our commitments with some significant funding increases in this space. We have record levels of investment in mental health, with annual spending reaching just under £12 billion just last year. The Prime Minister, as I have mentioned, has announced a five-year funding settlement. That is not the picture that the hon. Lady paints.

[Paula Sherriff]

How would the Minister respond to the professionals I speak to every single week, who tell me that mental health services—particularly child and adolescent services—are in crisis; that on some weekends there is not a single psychiatric bed available in the country; and that people are travelling up to 300 miles to get an inpatient psychiatric bed? Perhaps there are positives out there, but it is difficult to say that things are not so gloomy when that is what I hear every week.

[Nigel Adams]

The hon. Lady makes a fair point. The need to travel hundreds of miles out of area, in some cases, for inpatient treatment is something that we desperately need to tackle, and we are tackling it. That is why we are putting in the investment. I gently remind her again of the additional £20 billion a year in real terms for the NHS over the next five years. Nobody is saying that this is a perfect situation, but we are matching our words with real-terms cash and investing a further £1.4 billion for mental health services for children and young people, which I am sure she would support.

We briefly mentioned the Stevenson-Farmer report, and I remind the hon. Lady that we responded in full through the “Improving Lives: the Future of Work, Health and Disability” Command Paper and fully supported all 40 recommendations of the Stevenson-Farmer review. Progress is being made, and has been made, on implementing those recommendations.

My hon. Friend the Member for North Warwickshire raised the role that the insurance industry can play. We recognise the positive aspects of group income protection for helping to retain sick employees, in particular access to expert-led health services and the financial certainty it offers individuals. I am not entirely sure that the product is widely known out there in the business space; I have run businesses for the last 20-odd years and was not aware that such insurance products were available. I very much hope that my former colleagues are tuned in at this precise moment and will do some research on it.

GIP is clearly a product that works well for those employees who choose to buy it, and we encourage the industry to continue to promote its benefits. I am sure the Association of British Insurers is doing a good job of that. However, we believe that small and medium-sized enterprises, in particular, lack sufficient incentives to invest in GIP as it is currently structured, because they often choose not to offer sick pay for periods beyond statutory requirements. That is why we have been looking more broadly at incentives and obligations on employers. We will continue to engage with the industry, and I know that the ABI will play a big role in that as well. We are listening closely to employers’ views about the appropriate products that retain the positive aspects of GIP and that overcome the existing barriers to increasing take-up.

By working with our partners, including employers, the Government can continue to tackle poor mental health, ensuring that disabled people, and people with physical and mental health conditions, go as far as their talents can take them.