Dietary Advice and Childhood Obesity Strategy

Debate between Norman Lamb and Alistair Burt

Monday 23rd May 2016 Commons Chamber

[Alistair Burt]

My hon. Friend is absolutely right—that is important. The strategy has been awaited, and if it is to do the job we all want it to do, it should deal with the myths and concerns that have been raised, and do so in a proper evidential manner.

[Norman Lamb (North Norfolk) (LD)]

May I join in a partial, and rather surprising, alliance with the hon. Member for Shipley (Philip Davies) in questioning the sense in taxing just one particular type of product? Would not the Government instead—this is where I part company with him—consider taxing sugar as an ingredient to create an incentive for reformulation of products to reduce sugar content across the board, rather than just picking on one type of product?

[Alistair Burt]

I thank the right hon. Gentleman. He was not on my accumulator, so it has gone down. What he is calling for is exactly what the strategy does. It is designed to be quite wide and to take into account the possibility of other action in other places. He is absolutely correct about that.

Oral Answers to Questions

Debate between Norman Lamb and Alistair Burt

Tuesday 10th May 2016 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

There is growing concern that the additional investment in children’s mental health services committed last year is not getting through to where it is intended. What will the Secretary of State do to guarantee that that money gets through to help children with mental health needs? It would be scandalous if it did not get through. Transparency is not enough.

[Alistair Burt]

I thank the right hon. Gentleman for all the work he did in relation to this. I can assure him that the £1.25 billion committed in the 2015 Budget will be available during the course of this Parliament. As I said to the hon. Member for Liverpool, Wavertree (Luciana Berger), it is absolutely essential to me and to us that we make sure that that money does get through to CCGs. The regime will be more transparent, but there will be a determination to expose it to make sure that the money is spent on child and adolescent mental health services, as it needs to be.

World Autism Awareness Week

Debate between Norman Lamb and Alistair Burt

Thursday 28th April 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

It is just about 24 years since I first walked into Richmond House as Parliamentary Under-Secretary at the then Department of Social Security. In that time, I have had the privilege of being involved in many debates that belie the common view outside this place that we either know nothing about a subject or are not personally involved and do not care. I would put this debate right up there with the very best that demonstrate that neither of those things is true.

We have heard remarkable speeches, including 25 Back- Bench contributions, which is a tribute both to colleagues and to the Chair. As the hon. Member for Liverpool, Wavertree (Luciana Berger) mentioned, it is impossible to cover everything, or even everyone’s speech, as we normally do, but the contributions from my hon. Friend the Member for Berwick-upon-Tweed (Mrs Trevelyan) and the hon. Members for Birmingham, Yardley (Jess Phillips), for Stalybridge and Hyde (Jonathan Reynolds) and for Angus (Mike Weir) were particularly noteworthy in giving a sense of what things must be like. We are indebted to all of them for being able to say what they said in the way that they did.

I want to mention a couple of other speeches, such as that of the right hon. Member for North Norfolk (Norman Lamb). I am trying to do something about the fog, and I will mention that a little later, and many of us heard the moving and difficult story of the nine-year-old boy. The hon. Member for Barrow and Furness (John Woodcock) talked about the media response, and both the programme and the book he mentioned will make a significant contribution. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for the way in which she brought the young man’s case to me, and I assure her that it is not all done and dusted yet. Some very difficult aspects of that case worried me hugely, and we will be talking about it further. I made absolutely certain that the parents were involved in the case review, because, as she and the right hon. Member for North Norfolk said, all too often people are not involved and are somehow excluded, and that has got to stop. It is vital that people will be thoroughly engaged.

I wish to start by commending the Member who moved the motion—I cannot remember who that was now. [Laughter.] Let me add my congratulations to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) on securing the debate and on the extraordinary work she has done over the years in this area. We really are all indebted to her. In a recent Adjournment debate, I recognised the need for a fuller discussion and mentioned that we could do with this debate, and I am grateful that we have had that opportunity today.

A number of hon. Members have highlighted the importance of recognising that autism is not a person’s defining characteristic. Many colleagues, particularly those with children, made moving points about the qualities that autistic people have, and that is very important. In a couple of weeks’ time, I am going to the Hitchin LEGO club, which was started by parents of a child whose particular skills related to detail and the bits and pieces the club does. I am looking forward to going to see that. It is important that we do not just define people in this way, and the changes we make every day to attitudes, services and facilities can mean the difference between ambition thwarted and opportunity fulfilled. The best campaigns, at least those intended for the benefit of the common good, are led not from the top or from some central point of government, but by people on the ground.

Autism awareness is being addressed directly by the National Autistic Society in its excellent new campaign, which was launched during world autism awareness week and to which I gave my support. I went to see not only the little boy who is the subject of the film, but his family, because there are often siblings of those who have autism and they need to be cared for and valued as well. Sometimes issues can arise in that regard. It was nice to see the whole family and it is a remarkable piece of film. I also wish to highlight the work the Department of Health has taken forward with the Autism Alliance UK, a large network of autism charities, on the “Connect to Autism” project, which encourages local organisations, services and companies to become autism champions by training staff in autism awareness—there is a lot more to do.

I have no time to deal with all the subjects that have been raised, but in accordance with what has become my usual practice, because I seem to speak in vastly oversubscribed debates, I will pick out the questions that colleagues have raised and answer them by letter. If colleagues do not mind, I will answer them in the same letter and then put a copy in the Library, so that everybody will get a chance to see all the answers to the various questions that have been raised, which my hard-working team have noted. Let me just say a couple of things in answer on the key issues of what the Government are doing, and of diagnosis and data.

First, although it is easy sometimes to be overwhelmed by what there is still to do, it is important to recognise where we have come from—many Members made that point—and to realise what we are doing on a day-to-day basis. I commend to the House the “Progress Report on Think Autism: the updated strategy for adults with autism in England” which was published in January. I put that together along with the Under-Secretary of State for Disabled People, my hon. Friend the Member for North Swindon (Justin Tomlinson), the Minister for Children and Families, my hon. Friend the Member for Crewe and Nantwich (Edward Timpson) and the Under-Secretary of State for Justice, my hon. Friend the Member for South West Bedfordshire (Andrew Selous), who deals with prisons, probation, rehabilitation and sentencing. It sets out progress against 33 of the “Think Autism” actions and describes some of the work going on across government, because it absolutely involves education, employment and all sorts of other things. The report details case studies and it demonstrates what is being done in different places around the country.

Let me come straight to the challenge of diagnosis, which is so important to many Members. There is no doubt that, in some parts of the country, the demand placed on services—it is often the sheer weight of numbers—means that the NHS and its partners can struggle to meet the standards set out by NICE. The Department of Health’s mandate to NHS England for 2016-17 calls on the NHS to reduce health inequality for people with autism. Waiting too long for a diagnosis can be one of the health inequalities that autistic people face. The mandate has already got that, and it is very important that it relates to autism.

Clinical commissioning groups and NHS England are working to bring down the waits in line with NICE guidelines. What is happening right at this moment is that the Department of Health and NHS England, supported by the Association of Directors of Adult Social Services, have initiated a series of visits to CCGs and local authorities. The visits aim to develop a better strategic oversight of the challenges in securing timely diagnosis across all ages and to share good practice. In essence, that means that we should look at the variability in diagnosis times and do something about it. Sometimes there is an issue of capacity. It is not a question of just pulling a lever and the waiting times will come down. For waiting times to make any sense, we must recognise the capacity to deal with them. NHS England is trying to understand the difference in variation in order to do something about it.

NHS England will complete its work this month and then report to the cross-Government Adult Autism Programme Board in June. That report and the discussion at the board will be made public. The Department of Health is also funding the University of York to report on the type of support that is available after a diagnosis.

My right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) asked that NHS England should collect, publish and monitor key information on how long people are waiting for diagnosis and how many people are known to their GP to have autism. She said that waiting times standards on mental health, which are currently in development, should reflect national guidance that no one waits longer than three months between referral and being seen for diagnosis. I can assure Members that I am keen to ensure that we collect more data and that the data are made public. I am keen that the NHS collects what is known locally and finds a way in which we can use that nationally. New datasets have been put in place—I will say something about them in a minute—but it is important that we acquire more data. I have been made aware of that matter and I am trying to do something about it.

[Norman Lamb]

rose—

[Alistair Burt]

I will take just this one intervention, because I am on a tight timetable.

[Norman Lamb]

Will the Minister consider setting a maximum waiting time standard of three months to enter diagnosis? We all know that once we set a standard, the system responds to it, and we need that for anything to change.

[Alistair Burt]

I do understand that, but, equally, the capacity has to be there to do the job. It is a fine balance. To set a waiting time limit as some sort of token, knowing that it cannot be reached, would not work. Equally, the pressure on the system through collecting data, asking for data, and seeking transparency has its effect as well. There is a real sense in the Department that we have to meet that challenge, and I am looking at what data can best be collected, what data need not be collected centrally, but can be handled locally, and how we make the difference and how that is transparent and made known.

The Department of Health does not set out how NHS England should monitor waiting times. How NHS England holds commissioners to account is for it to determine, though it will need to demonstrate effectiveness in meeting the mandate requirement through which we expect NHS England to strive to reduce the health gap between people with mental health problems, learning disabilities and autism and the population as a whole. Even now, in the configuration of the NHS, the NHS does not directly report to me on this particular issue. I am really interested in how the NHS ensures that CCGs are doing their job, and I suspect that Members of the House are very interested, too. I can use that concern and interest and make sure that that monitoring job is done and that it is transparent.

My right hon. Friend also mentioned GPs. GPs already maintain a register of people with learning disabilities, which may include patients on their lists who also have autism where this has been diagnosed. As a number of Members mentioned, autism may not be the only condition that an individual may have.

The Royal College of General Practitioners’ autism initiative, part-funded by my Department, is looking at the idea of an autism indicator in general practice. That work is at an early stage. I hope that is helpful to my right hon. Friend. As recommended by the independent Mental Health Taskforce, the Department of Health is developing a five-year plan for the development of mental health data, to be published by the end of this year. The plan will set out future data requirements and timings for developing data to inform pathways of care, which will include data requirements for autism. This will be of great interest to the hon. Member for Liverpool, Wavertree, and I will make sure that she keeps up to date with data, as she keeps me up to date with data requests.

This has been a terrific debate which has covered many different aspects. To sum up, autism should never be a barrier to enjoying the access and opportunity afforded to others. The National Autistic Society, the Autism Alliance, the all-party parliamentary group on autism and many other charities are doing great work, helping more of us realise that sometimes we are the barrier, beyond legislation. It is only through empathy and understanding that true progress can be made and sustained.

Finally, there are two quotes that everyone should take from this debate—first, “Everybody feels like it’s a fight.” I have heard that too often, as too many of us have. Everything the Department does must make that sense of fight a little easier, until no one needs to fight because their needs are taken for granted. Secondly, “Think differently about thinking differently”—absolutely. That is what we should all do. I hope that that is a message from a very consensual House of Commons this afternoon.

NHS and Social Care Commission

Debate between Norman Lamb and Alistair Burt

Thursday 28th January 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

This has been a really great afternoon. I have thoroughly enjoyed listening to all the speeches. It has been the sort of debate that I think people outside this place appreciate. I thank the right hon. Member for North Norfolk (Norman Lamb) and his colleagues for securing the debate. I also thank him, as always, for the contribution he made when he was in the role I am now in. I thank all right hon. and hon. Members for their contributions, not least those with a medical background. We encourage them to remain in active medicine, because it brings an extra dimension to these debates. If I have time, I will address the comments from each Member. I will first respond briefly to the nub of the debate before responding to colleagues’ remarks and making some comments on the structure.

The sustainability of the NHS and social care system, whether financial or operational, is a key commitment of this Government. However, we do not believe that there is a need to launch an independent commission into its future. The NHS and wider health system has already examined what needs to be done to ensure the sustainability of the health and care system. Part of the purpose of making NHS England independent was to allow it to examine the circumstances of its finances and project into the future. It did so independently and came up with a figure. The Conservative party, uniquely, met that commitment at the last election and was able to carry it into government. It is important for the House to recognise that right at the beginning.

[Norman Lamb]

I just want to challenge the Minister on the suggestion that NHS England came up with the figure and the Government met it, because that is not actually what happened. NHS England and Simon Stevens painted three scenarios. The scenario that the Government have met, and on which both my party and his party stood at the election, is based on assumptions that are heroic in their scale and have never been met in the history of the NHS.

[Alistair Burt]

If I may say so, Simon Stevens said, “Look, it needs £8 billion.” It also needs £22 billion in efficiencies. We have met the challenge and put in even more than £8 billion—by 2020 it will be £10 billion. I understand the pressures in the system and fully appreciate the right hon. Gentleman’s remarks. The King’s Fund stated in its 2015 report:

“‘Business as usual’ is not sustainable. But that does not mean the NHS is fundamentally unsustainable.”

Simon Stevens recently said:

“The NHS has a huge job of work to do ensuring an already lean health service is as efficient as it can be—which, in my assessment, people are entirely up for.”

He recently told the Health Committee, “In headline terms, £22 billion is a big number, but when you think about the practical examples and do the economic analysis, we have some pretty big opportunities in front of us.” We know that the challenge is there; nobody denies that. However, NHS England put its assessment of what it needs to the political parties at the last election. We met that challenge and were elected.

We have spoken about a process, and I will return to that in a moment. What NHS England produced was developed by it, along with Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. The Government back the plan, but we need a strong economy to be able to do that, as a number of colleagues have said. Without trespassing too much into other areas, that is the meat of political debate in this country. The public are not just asked to make a judgment on the delivery of one particular service, however precious it is. It is about whether they think that those who are promoting their view of a particular service have the economic background to deliver it. That question was also comprehensively answered at the general election. We now have responsibility for carrying that forward. People believed that we could put the money into it, and we have done so.

Conception to Age 2: The First 1001 Days

Debate between Norman Lamb and Alistair Burt

Thursday 17th December 2015 Commons Chamber

[Alistair Burt]

I take the hon. Gentleman’s point and I will raise it with the appropriate Minister.

I have only a couple of minutes left, so I want to cover a couple of other things. Perinatal mental health is really important to me. I am disappointed that we have lost a couple of perinatal mother and baby units over the past few years. The increased emphasis on the issue is absolutely right. An NHS England working group is doing some intensive work on the £75 million that was committed in the last Budget to improve perinatal mental health services over the next five years. The report will come to me in the early weeks of January, as we look at the first tranche of that funding and then beyond. It is not as simple as just providing the units; it is about the community support care and everything else.

I was horrified by last week’s MBRRACE report. The association between people taking their own lives and perinatal mental health issues is very stark. Both of those issues are a very high priority for me. We will return in due course to say more about the detail. I offer the right hon. Member for North Norfolk that assurance.

[Norman Lamb]

Is the Minister satisfied that Health Education England recognises the importance of building the capacity of the workforce in order to ensure that there is a national service?

[Alistair Burt]

Yes, I am. HEE takes a real interest in the issue and I am sure there is more to be done. I take the right hon. Gentleman’s point about urgency as well. I am committed to doing more about that.

I am sure we will come back to this issue. This has been an excellent debate and I want to leave time for the mover of the motion to say a few words.

Madam Deputy Speaker, I wish you and all colleagues in the House a happy Christmas. If we conclude on a consensual note, with a debate as good as this one with very well informed people, the House is more than doing its job and is ready for a break.

Mental Health: Out-of-Area Placements

Debate between Norman Lamb and Alistair Burt

Thursday 3rd December 2015 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

We have been fortunate in having rather longer than we normally get for an Adjournment debate, and that has allowed the right hon. Gentleman to speak at greater length about some of the issues affecting the historical imbalance between mental and physical health, with particular emphasis on out-of-area mental health placements. I congratulate him on securing this debate, and I am delighted to respond to it.

I thank other hon. Members who have contributed to this debate, including the hon. Member for Ceredigion (Mr Williams), the right hon. Member for Carshalton and Wallington (Tom Brake), and my hon. Friends the Members for Torbay (Kevin Foster), and for North West Norfolk (Mr Bellingham). My hon. Friend the Member for Halesowen and Rowley Regis (James Morris), who chairs the all-party group on mental health, has dropped in as part of his responsibilities in the House, which I welcome. I also welcome the Whip, my hon. Friend the Member for Truro and Falmouth (Sarah Newton).

Before I come on to respond in more detail, let me make one or two general remarks. The right hon. Gentleman referred right at the beginning to the long-standing nature of some of these problems. These issues have not arisen in the past six months. They have been here—Government in, Government out—for some time. The coalition Government made huge strides in recognising the importance of mental health and drove forward some of the changes that needed to be made. It is certainly clear that part of my responsibilities now is to pick up on that and to build on it.

If I may just make reference to the right hon. Gentleman for a moment, I think his key achievements include: the expansion of psychological therapies; the reduction in the use of police cells for people experiencing a mental health crisis; introducing the first access and waiting time standards; and piloting the sense that there has to be parity of esteem. Those achievements absolutely underpinned what I came in to find in the Department. The intractable nature—or at least intractable up to now—of some of the problems has been graphically illustrated by the right hon. Gentleman’s passionate expression today of some of the things he was not able to do during his time as Minister. They set the baseline for what I hope to do. He asked for a personal commitment to drive forward the changes. Absolutely. The bar has been set quite high.

As the right hon. Gentleman and others have mentioned, what has puzzled me most since being in office is the variability of practice. How is it that in two areas side by side with exactly the same resources there will be one that has a set of procedures in place to ensure that good treatment is provided, while in another that is not the case? It is not always about resources, but management and leadership. I have been puzzled by why there is so much variability.

There is another puzzle that is very pertinent to what we are talking about today and to which the right hon. Gentleman referred: the perverse incentives in the system. Treatment costs are split between local authorities and the NHS. They seem to be based not on what is in the best interests of the patient, but on what suits the budget best. Now, none of us are naive. We all know this goes on. However, his description of the letter from his constituent, which I know about because I responded to him about it this week, illustrates the impact on the individual of decisions that people make for perverse incentive reasons—perhaps relating to budget, if that was one of the reasons. I am interested, as he is, in why there is such variability between areas. Some areas seem to have very few out-of-area places and others do not.

I hope to be able to deal with all the right hon. Gentleman’s questions, but before I do I want to put a few points on the record. The Government’s commitment is clear. We have given the NHS more money than ever before for mental health, with an increase to £11.7 billion last year. We have made it clear that local NHS services must follow our lead by increasing the amount they spend on mental health and making sure beds are always available. In the spending review and autumn statement, we announced an additional £600 million for mental health over the next five years to increase psychological therapies, crisis care and perinatal mental health. This reaffirms our commitment to achieving parity of esteem for mental and physical health.

In perinatal mental health services, for example, I want to ensure that women are able to access the right care at the right time, and close to home. I know that provision of specialist perinatal mental health services varies across the country. Some women have access to excellent care and support, while there are serious gaps in provision in other areas. Women suffering the most severe and complex perinatal mental illnesses need access to specialist in-patient mother and baby units, and good quality community support care in the area where they live. There are currently 15 units in England—I understand that the number fell by a couple from between 2010 and 2015—but NICE estimates there is a UK shortfall of between 60 to 80 mother and baby unit beds. That is why we announced in the March Budget that the Government would invest an additional £75 million over the next five years, £15 million a year, to support women suffering from mental ill health in the perinatal period. NHS England is leading a work programme to ensure that this extra money is spent in the right way at the right time and in the right places. The right hon. Gentleman’s work has made that base. I give him as much assurance as I can that in the areas where he set the work in progress, that work is going to continue; in places where the work is going slowly, it will be challenged; and in places where he was not able to make the progress he wanted to make, I set myself the challenge to do just that. I do not have to worry an awful lot about freedom of information requests because I will get the questions from him and from a number of hon. Friends and colleagues who have grasped how important this issue is.

Let me return to the source of the debate. I greatly appreciate the work that the right hon. Gentleman put in train earlier in the year with NHS England and mental health provider organisations to understand the pressures that lead to people being sent away from home for treatment that should be available locally. This has helped to provide a picture of the scale of the problem and to raise its profile. We know that the principle should always be for care close to home in the least restrictive setting. It is not acceptable for people to be travelling for miles when they are acutely unwell.

I know about the case that the right hon. Gentleman raised because I dealt with it this week, and I agree with him that some of the attitudes expressed by some of those responsible for people’s care are just not good enough. It cannot be acceptable and it cannot have been acceptable to listen too little to those who are in care or who are being cared for when they have made complaints about treatment. I am well aware of the problem—I am occasionally chased on Twitter about it—and I say to one or two of the groups that I am looking carefully at how to deal with it better. Sometimes people feel that they have not been listened to, and I suspect that the sort of example revealed in the right hon. Gentleman’s constituent’s letter might be rather more common than we think. Accordingly, I want to ensure that the inspection and regulation regime really picks things up. I know that there will sometimes be differences in opinion and that things will need to be clarified, but I do worry about the attitudes sometimes expressed, and I want to make sure that the Department has really got hold of ensuring that those sort of complaints are picked up and, whenever possible, really burrowed into to find out what might have gone on.

[Norman Lamb]

I appreciate the Minister’s reassurance. One of the issues highlighted in my constituent’s case was the fact that he was transported very late at night, arriving at about 1 am, and there was another person from Norfolk in the same unit that same week who was collected at 1 am from the unit to be brought back to Norfolk. This treats people like chattel; it does not treat them as human beings. Is the Minister prepared to highlight to the Care Quality Commission that it should investigate and explore that particular aspect—the transporting of people—because having to travel in a minibus with someone who does not talk to them for three hours, and arriving very late at night is simply outrageous?

--- Later in debate ---

[Alistair Burt]

Yes. It seems very puzzling that that should be a regular practice, if it is. That should not be the case. Of course there are all sorts of different pressures on the system, and it would probably not be appropriate to say that it should never happen, but, in principle, people who are in a state of anxiety should be moved with the maximum care, at the time that is of greatest benefit to them and their health needs.

As I was saying, it is not acceptable for people to be travelling for miles when they are acutely unwell. It is also not acceptable for staff to be spending time phoning around to find beds for their patients.

Let me return briefly to the impact of social media. A couple of weeks ago, I read in a tweet from a frustrated doctor—I hope he will pick up on today’s debate—that on that particular day no bed had been available for a woman anywhere in England. Along with the hon. Member for Liverpool, Wavertree (Luciana Berger), who had raised the matter with me, I made inquiries and found that that was not technically true; beds were available. The response from the doctor was, “You may be technically correct, Minister, but it is very difficult to find them”, and the results of my inquiries suggest that that is true. We need to establish a better system of identifying beds that may be available, because that too is part of the problem. People should not be spending time looking for beds. I have an idea about that, which I shall mention later in my speech.

I had to tell the clinician that I did not think that, technically, what he had said was true. However, I recognise that for those who are in the business of finding beds for people, it should not be as difficult as it appears to be, and I want to establish what we can do to help.

We know that the need to place people out of area, away from home, family, friends and networks, is a “warning sign” of a mental health system that is under pressure, and we know that no one wants to spend scarce resources on sending people out of area. However, we cannot look at out-of-area treatments in isolation, because they are part of the mental health acute care pathway as a whole. I welcome the interim report of Nigel Crisp’s commission, which was set up to review the provision of acute in-patient psychiatric care for adults, and I look forward to reading his final report and recommendations early in the new year.

Lord Crisp’s interim report made it clear that—as I am sure the right hon. Member for North Norfolk knows—the situation is more complex than a shortage of beds. We know that there has been a long-term reduction in the number of psychiatric beds in England, but the report suggests that in many areas there would be enough beds if improvements were made to other parts of the system and integrated, community-based services were commissioned. That very point has been made this afternoon in relation to the variability of practice. The report also made it clear that the so-called bed crisis, or admissions crisis, is a problem of discharges and alternatives to admission, and can be dealt with only through changes in services and in the management of the whole system.

As the right hon. Gentleman pointed out, that can be done, as has been demonstrated in a number of local areas. Sheffield, for example, has almost entirely eliminated adult acute out-of-area treatments, and has reduced average bed occupancy to 75% by redesigning the local system, That has included investing in intensive community treatment, and working in partnership with housing. In the right hon. Gentleman’s own constituency, Norfolk and Suffolk NHS Foundation Trust has begun to reduce its historical problem of out-of-area treatments through a combination of investing in more acute adult beds and working with commissioners to develop community and crisis resolution services.

I understand that the independent Mental Health Taskforce has spent some time discussing these issues. I hope that its report, which will be published in the new year, will be an important driver for improving mental health services over the next five years, and will address many of the key issues raised in Lord Crisp’s interim report.

[Norman Lamb]

Can the Minister confirm the likely publication date of the taskforce’s report? I think he said it would be in the new year, but can he give me his best estimate of a specific date? Also, I would like to acknowledge that the Norfolk and Suffolk NHS Foundation Trust has made real progress. The number of people being sent out of area has come down significantly, and that needs to be recognised.

[Alistair Burt]

I am grateful for the right hon. Gentleman’s comment about his trust. My understanding is that the taskforce’s report will come through very shortly. I am not sure whether it will be done this month or by the start of next month, but it is imminent.

I appreciated the right hon. Gentleman’s kind remarks about the Secretary of State for Health. The Secretary of State has already agreed an action plan to tackle out-of-area treatments for adult acute in-patient care. Where out-of-area treatments are a problem, local areas will be asked to put in place clear action plans demonstrating how they can reduce out-of-area treatments, in the best interests of patients, during the course of 2016-17. Now I come to one of the right hon. Gentleman’s challenges. Building on this, I intend to go further and put in place a national ambition to address out-of-area treatments. I will do this in consideration of the Crisp commission and the taskforce report, and I will communicate details of this ambition by the end of March 2016—that is, by the start of the next financial year.

I want to wait and see what Lord Crisp and the Mental Health Taskforce say and then consider exactly what the ambition should be. Should it be an ambition for complete elimination? Should it provide a much tighter variation? I want to see those reports before I set the ambition, but I will set it, and the targets, and come back to the right hon. Gentleman and the House before the end of March next year to communicate those decisions. I hope that helps.

I also commend the right hon. Gentleman for recognising the need to improve mental health crisis care and for launching the mental health crisis care concordat, which we have discussed today. This debate has given us an opportunity to talk about variation in practice, the quality of street triage and the fact that we can do different things in different areas. I saw the work being done in Bradford, for example, where the mental health practitioner is located in the control room, as opposed to being on the street. The galvanising of local groups to work together by giving them the responsibility of doing the job has been absolutely vital. The way in which we are reducing the number of people detained in police cells is a clear example of how that process is working.

The Government are equally committed to reducing out-of-area mental health treatment for children and young people. In-patient child and adolescent mental health services—CAMHS—admission is a relative rare event. At any one time, however, there are approximately 1,300 children and young people from England in CAMHS in-patient services. Services themselves are usually subdivided into different specialties, such as eating disorder units or low secure units. That means that it is highly challenging to provide complex care in all areas, and on occasion, some children and young people may need to be referred for specialist treatment at a distance from their home, if that is in the best interests of their care. However, we are committed to ensuring that that is as rare an event as possible, and much progress has already been made.

[Norman Lamb]

One of the recommendations from the taskforce that NHS England established to look at tier 4 services, at the number of beds required across the system and at the variability of the services was that treatment should always be contained within a region —in other words, that no child who lives in the south-west should ever go out of the south-west for treatment. I cannot remember where the child from Torbay had to go—

[Norman Lamb]

Indeed. Is the Minister going to stick to that? Is he going to ensure that that is the objective, and will he monitor it to ensure that he meets it?

[Alistair Burt]

As much as possible, absolutely, yes. There will be occasions when very specialised treatment has to be given, and that will on occasion be outside the area. But apart from that, absolutely. We want to provide care that is appropriate to people in a place that is closest to where they are, as much as possible.

In 2014, NHS England published the tier 4 CAMHS review. This found a relative shortages of beds in some regions, meaning that some children and young people had to travel long distances to access a bed, owing to an uneven distribution around the country. As the right hon. Gentleman knows, there was an immediate response to this: £7 million in additional funding, taking the total number of beds now to 1,440, the highest number there has ever been. In addition, NHS England has introduced new national protocols for referrals and discharge, and a new “live” bed monitoring system to make the best use of existing capacity. I am interested in whether that capacity has reference and relevance to the adult acute beds, and could it make the job of my friend the clinician doctor that bit easier?

But while these measures have helped in the short term, we want to build on this progress still further and ensure long-term, sustainable improvements. In January this year, NHS England commenced a comprehensive review of the procurement and commissioning of inpatient beds. The aim of this is to establish the long-term requirements for inpatient services and ensure quality, sustainable services are commissioned in the right place, based on population need.

It is not enough simply to provide more and more beds. In order to ensure that improvements are sustainable, we need to improve the community-based support we offer to children and young people. This is at the heart of the vision set out in “Future in mind”, and we are determined children and young people have easy access to the right support, from the right service, at the right time and as close to home as possible.

Key to achieving this vision are the local area transformation plans now being put in place. CCGs have been asked to work with NHS specialist commissioning teams responsible for inpatient services in the creation of these plans.

I have two final points. I have been interested in what data are available and what are not, and I answer a number of questions by saying, “The data for these are not collected centrally.” I am looking hard at each and every one of those questions, asking, “Are there occasions when we should be doing more on the data?” There is a lot still to do, but I entirely take the right hon. Gentleman’s point.

On data, we are looking at the limitations. The right hon. Gentleman was right to talk about the problems in getting this dataset right, but, again, I am on to that; it is essential, and I will take the challenge of driving and moving on that data.

On providers, the responsibility seems to come down to CCGs. It is unacceptable that private providers do not submit data. Some more have started submitting since the summer. It is the responsibility of CCGs, who have the contractual levers, and need to use them. That is not good enough; if we need this information, we need this information. I am going to look at whether the CCGs are using those contractual levers, and if not, why not. If they are not, and a sanction can be applied, we will apply the sanction. That information is necessary, and I am going to do this. The right hon. Gentleman is absolutely right on that.

On the principle in respect of determination, I will come back to the right hon. Gentleman by March next year and set out the national ambition. Do I commit to ending the practice completely? I do not know yet, because I want to get the result of the commission. It is right that it should be reduced to an absolute minimum. I want to know technically whether it is possible to eliminate it, or whether that would actually not do the job that is necessary. I want to see what the commission has to say.

Will I drive these changes? Yes, I will. Will all providers provide data? Yes, they will. Will I commit to the £1.25 billion? Yes, I will. I have said that enough times in enough places to make this a very difficult Government commitment to slip away from. It is over the course of the next five years, but I am happy to repeat that.

[Norman Lamb]

I am grateful to the Minister for his patience in allowing me to intervene again. I am conscious that there is a risk that the shortfall in the first year is made up in 2020 or something like that. Because of the principle of frontloading to invest in change, it would be incredibly helpful if we could get the commitment to make good the shortfall in 2016-17. Can he commit to doing that?

[Alistair Burt]

There are things I can do and things it is unwise to take a flyer on, standing at the Dispatch Box.

[Norman Lamb]

You can try.

[Alistair Burt]

I will try, but we need to make sure all the money is used sensibly. There are a lot of pressures on the system, and I am trying to be as bold as I can without being foolishly bold and saying things just for the sake of it. I understand the importance of this £1.25 billion. I have spoken about it a great deal; I want to see it all used. I am not responsible entirely for the timescale, but I understand the right hon. Gentleman’s point and I suspect it will come up in the Opposition day debate we have next year.

I will talk to the Secretary of State about the right hon. Gentleman’s last point about comprehensive maximum waiting times. I will see where we can go further and include it in a comprehensive letter to the right hon. Gentleman.

I hope that this has been helpful. I am delighted that we had extra time to cover the ground. I am pleased to take up the challenge to do some of the things that could not be done in the past few years, and I will do my best to live up to the expectations of the House, as expressed by a number of Members today.

Question put and agreed to.