Schizophrenia Care

Norman Lamb Excerpts

Monday 10th December 2012 Commons Chamber

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

I sincerely congratulate my hon. Friend the Member for Broxbourne (Mr Walker) on securing this debate on an incredibly important subject. It is good that in this House today we have debated people with learning disabilities and how they get treated by the system, and now we are debating people with schizophrenia. In the past, those two very important groups of people have often been rather neglected, and it is good that Parliament is focusing on them and how the system treats them. I pay tribute to my hon. Friend’s work as an advocate in mental health. It is very important that people speak up for those with mental health problems, and he and one or two other MPs have done us a good service by being prepared to talk about it openly. I pay great tribute to his work in this field.

This is a timely debate. The premature mortality that my hon. Friend mentioned, the stigma, the human cost and the statistics are as well known as they are shocking. Together they add up to a compelling call for action, and that makes the recent report, “The Abandoned Illness”, very important. It sets out how things must change, how services have to be more accessible, how staff have to be fully supported, how integration of services can change lives, and, of course, how people’s mental and physical health must be treated equally. Too often in the past, mental health has been seen as the poor relation. The Government have established the principle of parity of esteem, and we now have to make it a reality. This debate is an important moment at which to consider that.

The Government have published a mandate for the NHS Commissioning Board which sets out our key priorities for the service. The mandate goes further than ever before in setting out the priority that the Government give to mental health, and it makes it very clear that mental and physical health problems should be treated in a co-ordinated way with equal priority. We expect the NHS to demonstrate real progress on this by March 2015. We have also tasked the NHS with making progress in specific areas. Accessing care and treatment should be as easy for people with mental health conditions as for those with physical conditions, so we have asked the NHS Commissioning Board to consider new access standards, including waiting times, for mental health services. It is remarkable that in the past decade we have introduced waiting time standards for physical health—the 18-week wait—and yet in mental health there is no comparable standard. That has to change.

The NHS outcomes framework includes four measures that relate specifically to mental health. Three of those focus particularly on patients with severe mental illness: premature mortality in people with serious mental illness; the employment of people with mental illness, which my hon. Friend spoke about very movingly; and patient experience of community mental health services. Many other outcomes that we are measuring will be as relevant to people with mental health problems as to people with physical health problems. There is no magic bullet, but I think that this will help to kick off the drive towards real parity of esteem, just as it says in “The Abandoned Illness”.

On top of that, a lot more needs to be done to improve access to psychological therapies for people with severe mental illness. Much of the consideration of the improving access to psychological therapies project has focused on anxiety and depression, but we know that psychological therapies can also be very effective for those with a severe mental illness.

Six local projects, backed by £1.2 million of Government funding, are working on demonstrating the benefits of IAPT in treating people with a severe mental illness or personality disorder. Over the next five months, these organisations will share what they have learned about how best to deliver evidence-based treatments. The work will include demonstrating how this group can get better access to psychological therapies, spreading good practice to other services, and providing good quality data—this has so often been missing in the past on mental health—on how services can be improved for patients.

One of the report’s main findings was that there are far too many people with a mental illness in in-patient wards—my hon. Friend made this exact point—who do not need to be there. Furthermore, many wards are not the calm therapeutic environments that are conducive to improving patients’ well-being. Everyone in the House knows how much of a problem this is. It is not good for patients, families or the staff who work there.

The mandate of the NHS Commissioning Board sets out plans to introduce the friends and family test for all NHS services, including those for mental health in-patients. This will allow people to feed back their experience by saying whether they would recommend a particular service to their loved ones. I should also say that I am looking into the issue of the Care Quality Commission survey. I understand that it was terminated because of concerns about its accuracy and value, but the fact is that it applies in other parts of the health service and I am concerned that mental health services lack such a survey.

Our cross-Government mental health strategy, “No health without mental health”, also recognises the problem. Among its core objectives it lays out, first, that people who are acutely ill need to get safe, high-quality care in an appropriate environment when they need it and, secondly, that following acute illness people should be helped and supported to recover. This will mean different things to different people, but for many it will mean services working together to help people live independently, to find work and to play an active role in society. That means people moving from in-patient wards into the community, with support. This same service is integrated with early intervention, which my hon. Friend has also mentioned, and crisis teams can also support people early in their illness or during an episode of illness, so that they do not progress to needing in-patient care.

Our implementation framework sets out specific actions that local organisations can take to make that a reality. The framework was co-produced by five leading mental health organisations, including Mind and Rethink. In addition, we are already measuring employment for this group as part of the NHS outcomes frameworks for public health and for adult social care.

[Mr Newmark]

On the subject of Rethink, which does a tremendous job, will my hon. Friend join me in congratulating my constituent, Trina Whittaker, and Braintree Rethink on doing a tremendous job for those with schizophrenia and other mental illnesses?

[Norman Lamb]

I absolutely join my hon. Friend in applauding Trina Whittaker and the work of the local Rethink group. I met the national group last week to discuss this very subject. It does tremendous work around the country and I applaud it.

On personal budgets, we know that people want more control over their own care. For instance, patients often do not like the drugs that they are being prescribed—they might make them overweight or have other detrimental effects. It would be far better to move away, if possible, from that paternalistic, disempowering model towards a system in which patients have much more say.

We are already taking steps to help make that happen. The draft Care and Support Bill, published in July, places personal budgets on a legislative footing for the first time. It specifies that everyone eligible for ongoing social care, including those who are mentally ill, will get a personal budget as part of their personalised care and support plan by April 2013. On NHS services, the mandate sets out that patients with mental health conditions will be able to have an agreed personalised care plan, which they must be involved in preparing; it will not be imposed on them. Those plans will lead directly to people with mental illnesses getting the help that they want, and not being directed to a one-size-fits-all service.

Listening to people with mental illnesses is particularly important because of the huge stigma—my hon. Friend the Member for Broxbourne talked about this—that they endure throughout almost every sphere of their lives. Stigma features heavily in the report and I welcome the clear message that it gives us: we will not tackle stigma by burying our heads in the sand. It goes without saying that schizophrenia is an immensely complex condition, and it is made even more difficult when people characterise it as simply a split personality.

We are listening to service users who tell us of the appalling discrimination that they suffer. Many people tell us that the discrimination they face is often worse than the condition itself. That is why the Government are joining forces with Comic Relief to tackle mental health stigma. We are giving up to £16 million, alongside the £4 million that Comic Relief is providing, to Time to Change, the brilliant anti-discrimination campaign run by Mind and Rethink Mental Illness, so that it can continue its work through to March 2015. My hon. Friend and others who have spoken out about their own mental health problems are helping to address the stigma and make mental conditions more acceptable.

I should also say a word about black and minority ethnic service users, because they are over-represented in in-patient care and often stay longer than people from other ethnic groups. We are discussing those long-standing issues with a range of leaders and organisations from BME communities with a view to tackling them.

There is a clear need for organisations outside Whitehall to work much better together. The NHS, social care and other services need to work hand in hand to ensure that patients with mental health problems get effective, safe and streamlined treatment. Together, they need to identify the risks and manage them appropriately. The NHS Commissioning Board will directly commission specialised services, including secure mental health services. That is a great opportunity to ensure that there is high-standard, recovery-oriented and consistent practice across the country, with clear transitions for patients between different parts of the mental health system.

The Department of Health funds a wide range of research on schizophrenia and other psychoses. We have awarded nearly £49 million over five years to the biomedical research centre for mental health, based at the South London and Maudsley NHS Foundation Trust. It collaborates with the Institute of Psychiatry to translate promising research into effective practice. Psychoses are a major focus of its work. The National Institute for Health Research funds a clinical research network, which allows patients across England to take part in trials and other types of clinical study. The network is currently setting up and recruiting patients to about 90 projects to study schizophrenia and psychoses. Through the “Strategy for UK Life Sciences” the Government will provide an environment and infrastructure that supports pioneering researchers and clinicians to bring innovations to market earlier and more easily, making the UK the location of choice for investment.

The Government believe that people with schizophrenia, and indeed any severe mental illness, have a right to the care and support they need in a safe and comfortable environment where they are treated with the dignity and respect they deserve. They have as much right as anyone else to a fulfilled and productive life, free from discrimination and stigma. The coalition is making valuable changes from the centre, but this cannot be the Government’s responsibility alone. We need everyone everywhere to take what responsibility they can, including the commissioners who must purchase the care that meets people’s needs, the providers who have a duty of care to each and every individual for whom they are responsible, and the regulators who are responsible for ensuring the quality of that care. I have set out some of the recent developments at government level that will improve services for people with schizophrenia. However, I acknowledge that we are still some way from where we want to be. We must not relent in our pursuit of that.

To that end, I am convening a round-table meeting on schizophrenia next week with leading charities, members of the Schizophrenia Commission, the Royal College of Psychiatrists and others. My hon. Friend the Member for Broxbourne is welcome to attend if he is available. The aim of the meeting is to identify the further practical actions that key players can take to improve the quality of life of people with schizophrenia and other severe mental illnesses.

Question put and agreed to.