The National Health Service

Debate between Norman Lamb and Luciana Berger

Wednesday 23rd October 2019 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (LD)]

It is a pleasure to follow the hon. Member for Hartlepool (Mike Hill) and I share a number of the assessments that he made in his contribution, because as the House pursues our debate on the Queen’s Speech, it is becoming ever more apparent that the casualty of a Tory Brexit will be Britain’s national health service.

The NHS is our greatest national asset; it is the product of the fusion of radical and enlightened minds in the last century that gave us healthcare for all based on need, not means. But now, in this century, the NHS is in great peril from a toxic combination of chronic underfunding and withdrawal from the EU, and responding to very different challenges from those when it was first created so long ago.

Notwithstanding the announcements in the Queen’s Speech, let us be very clear that the NHS is not in receipt of the resources that it needs to be effective. That was discussed only yesterday at the Health and Social Care Committee, when we had with us the Secretary of State and we talked about the backlog of £6 billion in NHS repairs alone, so an announcement of half that really is no cause for celebration. We heard from the Health Foundation, and its assessment of the Queen’s Speech funding announcement says that

“it falls well short of the scale of the challenge.”

We have a Prime Minister who announced 40 new hospitals, which then was downgraded to six within days, and we see demand for healthcare from our growing and ageing population outstripping the availability and quality of services, which means rationing and a diminution of quality of care; many right hon. and hon. Members from both sides of the House have referred to that in the debate this afternoon.

[Norman Lamb]

Does my hon. Friend agree that another sign of a system under unacceptable strain is the fact that teenagers around the country are often waiting a year or more for access to mental health treatment? I know of two teenagers who have recently had their first appointment after a year of waiting, which seems to me to be utterly intolerable.

[Luciana Berger]

I thank my right hon. Friend for making that really important contribution, and waiting times are a particular issue in our NHS, especially in the Cinderella of all Cinderella services, our CAMHS. Too many young people right across our country are struggling to get a referral and then, if they do get that referral, having to wait months on end. Frankly, it is unacceptable.

Mental Health First Aid in the Workplace

Debate between Norman Lamb and Luciana Berger

Thursday 17th January 2019 Commons Chamber

[Norman Lamb]

I absolutely do. I was going to say, “Don’t talk to me about the work capability assessment, because it will get me very angry.” We need reform of the welfare system to help to facilitate people returning to work, rather than just treating them as second-class citizens, as it often does.

[Luciana Berger]

I am listening very carefully to the right hon. Gentleman’s remarks, which are very pertinent. On people being in work or not in work if they are affected by a mental health condition, I was struck to learn that for my local mental health trust, Mersey Care, which provides services for the whole of Merseyside, the latest available figures—not the most recent financial year, but the previous one—show that just 3% of the patients under its care, in both the community and in in-patient services, were in any form of work. That figure is similar for patients under the care of many mental health trusts across our country. Does he believe that people outside this place might not be aware of that fact, but it is staggering and should concern us all? We should be doing everything possible to support people with mental ill health conditions into the workplace.

[Norman Lamb]

I totally agree. My plea to the Government is that, as we hopefully commit to spending more on mental health, we spend at least part of that on preventive measures. If we can get someone into work, it makes a whole difference to their lives. The evidence shows that many people who are helped back into work are then able to stay in work; reducing the burden on the NHS and the benefits system, but giving people dignity and self-respect.

Another initiative we are undertaking in the west midlands is the wellbeing premium. It was my idea, which again is being supported by the Government and I am grateful to them. The idea, which we are trialling over a year, is to give an incentive to employers to improve the way in which they support people in work by training their line managers—the most critical thing one can do—and see whether we can reduce the number of people who end up on sickness absence. The idea is to give them a temporary incentive for one or two years, for example by a reduction in the business rate or a reduction in national insurance payments. If by that we can reduce sickness absence, the number of people falling out of work through ill health and the problem of presenteeism, everyone benefits. It will be interesting to see how that succeeds.

In the west midlands, we are also pursuing the thrive at work commitment, which is trying to build a social movement of companies that all sign up to a commitment to up the level of support that they provide people, changing the culture in workplaces. A toolkit is provided to companies, and that could make a substantial difference across the region.

The action plan also has a commitment to train up 500,000 people across the west midlands in mental health first aid. That is a totally different approach to what we have been used to, which is an NHS very much focused on sickness and providing treatment for sickness after what is often a very long wait, as the hon. Member for Plymouth, Moor View pointed out. Instead, the whole focus of the system should be on prevention. If we do that, we can achieve a real breakthrough.

To conclude, let us amend the legislation and get mental health first aid to become the standard in every workplace. Critically, that should be part of a much wider programme that is focused on prevention and on building good healthy workplaces with the right culture, where people have respect, are engaged in the work they are doing and are treated with dignity. With that commitment is a dedication to the work they are doing and a commitment to raise awareness of mental ill health among all staff and to train managers properly. Through a combination of regulation and incentives, we can make a real difference for people.

Transforming Care Programme

Debate between Norman Lamb and Luciana Berger

Thursday 5th July 2018 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House is concerned at the slow progress made under the Transforming Care programme, which was set up to improve the care and quality of life of children and adults with a learning disability and/or autism who display behaviour that challenges; recognises that a substantial number of people with learning disabilities remain trapped in, and continue to be inappropriately admitted to, Assessment and Treatment Units rather than living with support in the community; is further concerned at the lack of capacity within community services; notes evidence of the neglect, abuse, poor care, and premature deaths of people with learning disabilities; believes that the Transforming Care programme is unlikely to realise the ambitions set out in the Building the Right Support strategy before it ends in March 2019; calls on the Government to establish, prioritise, and adequately resource a successor programme that delivers a shift away from institutional care by investing in community services across education, health and social care; and further calls on the Government to ensure that such a programme is based on lifelong support that protects people’s human rights and promotes their independence and wellbeing.

May I thank the Backbench Business Committee for facilitating this important debate? Although the number of Members who have indicated a desire to speak is low, this incredibly important issue deserves to be debated in the House. I thank the hon. Member for Dulwich and West Norwood (Helen Hayes), together with other Members, for joining me in making the application for the debate. I have worked very closely with her on this issue, which we both care very much about.

I thank a number of voluntary sector organisations that have been incredibly helpful in preparing for this debate. I particularly want to mention the Challenging Behaviour Foundation, which is led by the very impressive Viv Cooper, as well as Mencap, the National Autistic Society, the Voluntary Organisations Disability Group and Shared Lives Plus.

It is perhaps sobering that we are debating this issue on the 70th anniversary of the NHS. I say that as someone who is a very strong supporter of the NHS, but for the people we are talking about in this debate, the record has not been a good one. The system has let down too many individuals and too many families. On this very significant day, it is important to recognise that the NHS has a lot of work to do to repair the damage that has been done to so many people, and to treat them properly.

The origins of the transforming care programme lie in the horror of the Winterbourne View scandal, which Members will remember. In that private hospital, people with learning disabilities and autism were abused and assaulted behind locked doors over a sustained period, and that was only revealed by brave whistleblowers. In the aftermath of that horror, I invited the families of those who had been patients in Winterbourne View to come to the Department of Health—I became a Health Minister in September 2012—to talk to me about their concerns.

I clearly remember a father called Steve Sollars, who talked to me about how he had watched his son become, in his words, increasingly zombie-like as he was pumped full of anti-psychotic drugs. Steve described how he tried to complain to the local authority and the primary care trust, as it was in those days, and said that he was just completely ignored. It really struck home when he said, “I felt guilty that I couldn’t do anything for my son.” I was left thinking how dreadful it was that we had got to a position in which state agencies had left an individual—a father—feeling guilty because they were ignoring his pleas for something to be done.

In the following months and years, I met some other parents of individuals trapped in hospital—sometimes in unattractive institutions—for long periods, all of whom felt that no one was listening to them. I refer in particular to Phill Wills, who campaigned brilliantly on behalf of his son Josh, who was stuck in a hospital in Birmingham for more than two years. The family live in Cornwall, so they had to make an incredible journey just to maintain contact with their little son.

I also met Shahana Hussein, the aunt of a girl called Fauzia, who was in St Andrew’s in Northampton. She talked to me about her fears of how her niece appeared to be trapped there. She was anxious that that might be her life course, and that she would never emerge from that place. I met Lynne McCarrick, whose son Chris had been stuck in Calderstones undergoing inappropriate treatment for a very long time, and Lorna and Sid, the parents of Simone, who is still stuck in hospital nine years after her first admission. For much of that time, she has been a long distance away from home, therefore making it impossible for her parents to visit, which is shocking in this day and age. Many of those families are present for today’s debate, and they remain extremely concerned about their loved ones and others who remain trapped in institutions.

The conclusion that I reached at that time, which I still hold, is that individuals’ human rights are routinely ignored and breached in serious ways. Someone who is convicted of a criminal offence and then sent to prison—other than the cohort who have received indeterminate sentences—generally knows the date of their release. However, people who go into institutions and their families do not know a release date, and many people stay in those institutions for much of their lives, which is shocking. To put it bluntly, they are treated as second-class citizens. I said that at the time, and I still say it now, because not enough has changed for any of us to be comfortable with the situation.

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

I congratulate the right hon. Gentleman and my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on the leadership they have shown by securing this debate through the Backbench Business Committee. The right hon. Gentleman said that this programme came out of the Winterbourne View scandal, which was back in 2011. Does he share my concern that we are discussing this issue seven years later in 2018 and yet thousands of people in our country—thousands!—are still in institutional care? It is an absolute disgrace that we find ourselves discussing this issue.

[Norman Lamb]

I completely agree. That sense of complete injustice and the denial of human rights still exists. Nothing much has changed, which is why the debate is so important, and I share the hon. Lady’s view that we should not tolerate this scandal. What makes the situation even worse is that this is not a demand for vast amounts of extra public money; it is about how public money is spent. Our demand is that money is spent in a way that respects people’s human rights and gives them the chance of a good, happy life in the community, with the support of care workers, friends and family, rather than being trapped in institutions. It is shocking that the situation for very many people has remained exactly the same as it was all those years ago.

[Norman Lamb]

I do agree, and that is another big subject that I will be pursuing further in the light of the Gosport inquiry, which I established when I was a Minister. In that case, brave nurses tried to blow the whistle in 1991, but they were shut down by management and unable to pursue their concerns. More than 456 people lost their lives as a result of the inappropriate prescribing of opioids, and that was because whistleblowers—brave staff members—were not listened to. In every part of our health service, we must ensure that people feel able to speak up and that they have the legal rights to do so.

The outcome of our deliberations in the Department was to establish the transforming care programme, which was published in December 2012. Interestingly, it was pursued as a concordat and an agreed programme of action. It was supported by an amazing array of organisations, all of whose logos appeared in the document, including—critically—NHS England. Every organisation that signed up to the programme committed to

“working together, with individuals and their families—

note the phrase “with individuals and their families”—

and with the groups that represent them, to deliver real change.”

That was in December 2012.

These organisations that had committed “to deliver real change” also stated:

“Our shared objective is to see the health and care system get to grips with past failings by listening to this very vulnerable group of people and their families, meeting their needs and working together to commission the range of support which will enable them to lead fulfilling and safe lives in their communities.”

To put it bluntly, there has been a shameful failure on that commitment to change, which simply has not happened for the majority of people involved.

At that time we were operating in a fog. No data had been collected historically on the numbers of people in beds in institutions, so we had to rely on periodic censuses to find out whether anything was changing. When we conducted a census about 18 months after the start of the programme, it was shocking to discover that there had effectively been no change—it was business as usual. The really disturbing thing was that many private sector organisations were making substantial investments in new facilities and delivering the wrong model of care. Why did those organisations have the confidence to make major million-pound investments in inappropriate care? It seems to me that to justify such investment, they must have had reassurance from somewhere in the system that things would carry on as they were. It was shocking to discover the extent to which it was simply business as usual.

[Luciana Berger]

I apologise if the right hon. Gentleman is going to come on to this, but I want to reflect on the reports commissioned by NHS England and Sir Stephen Bubb. Back in 2014, Sir Stephen was commissioned to write a report entitled “Winterbourne View – Time for Change”, yet nothing happened in the wake of that report, other than a closure programme that was published back in 2015, on which we have seen little progress. In February 2016, Sir Stephen Bubb published another report entitled “Time for Change – The Challenge Ahead”, which again demanded urgent action. Does the right hon. Gentleman share my concern that although those reports were commissioned, there was very little response or action taken?

[Norman Lamb]

Again, I entirely share the hon. Lady’s view. I work closely with Sir Stephen Bubb and we have exactly the same view about this. He and I attended a meeting about a year ago with NHS England to discuss progress, or the lack of it. The hon. Lady is right to say that there is a culture of looking at things again and again, and then doing nothing about the conclusions reached, which is wholly unacceptable.

At that time, three issues stood out, and they involved perverse incentives that acted to prevent change from happening. First—this is extraordinary—the person who was making the critical decision about whether an individual should stay in a bed or be discharged was, and still is, the clinician employed by the provider organisation that makes money out of the person staying in the bed. That total conflict of interest has never been confronted. As Minister, I kept asking NHS England to act to address that issue, but it has not yet been resolved. If a private sector organisation is earning £4,000 or £5,000 every week from someone being in a bed, there is a strong incentive to keep them in that bed. There is also an incentive for public sector organisations that want to maintain their existence, and that conflict of interest has never been confronted.

Secondly, there is a complete failure to invest properly in community provision. This is all about the need to shift resources from institutional care to community support; in other words, shifting money from NHS England to local authorities. The original transforming care concordat made it clear that there should be a pooling of resources between specialist commissioning, clinical commissioning groups and local authorities. As the hon. Member for Liverpool, Wavertree said, seven years on we are still waiting for a proper pooling of resources so that the money can actually shift and investment can be made in community resources.

The third insight I had at that time was the most extraordinary and wholly unacceptable exclusion of families and individuals from any decisions that were being made about their care. This, I am afraid, continues today. It is very far from the personalised care that the NHS and the Government say they are committed to. In the light of what I saw as our complete collective failure to deliver that change—this was the thing that caused me most distress as Minister—I decided that we had to come up with new proposals for new legal rights, so that families and individuals could challenge decisions that were being made behind their backs about where they would be cared for and treated.

Shortly before the 2015 general election, we published a Green Paper, I think in March 2015, called, “No Voice Unheard, No Right Ignored”. It has an important title, but I am afraid that those rights and those voices are still unheard and ignored because it has never been implemented. Nothing proposed in the Green Paper has been taken forward by the Government. We now have a review of the Mental Health Act 1983, so there is another opportunity to address the scandalous lack of rights for individuals, but the time it will take before there is any legislation will be very long—I doubt whether it will be in this Parliament—and families will just be left waiting.

At that time I worked with Sara Ryan, a remarkable woman and the mother of Connor Sparrowhawk, known as Laughing Boy. He was a young man in the “care” of Southern Health who lost his life while he was within its institution. He drowned in a bath because of neglect. The Health and Safety Executive had decided not to investigate the case. I intervened and asked it to reconsider. It then decided that it could investigate and eventually, years later, prosecutions and convictions followed. The result of the tragedy that struck that family was that Sara Ryan and an amazing group of people worked together to produce a Bill that would have strengthened the rights of individuals. We worked closely with them in the production of that Green Paper.

Because no progress was being made following the 2015 general election, the Government and NHS England embarked on a new process. In October 2015, they published a document called “Building the Right Support”. The plan was to close between 35% and 50% of in-patient beds and, critically, ensure that local areas developed the right community support by—this is the critical date—March next year. The plan involved the creation of 48 transforming care partnerships covering the whole country. These partnerships between NHS England specialist regional commissioners, local authorities and CCGs were to facilitate the shift of money from NHS England to local authorities, so that people could be cared for in the community.

There was a plan for people who had already been in in-patient care for more than five years at April 2016 to be given a dowry to facilitate their transfer into community support. When campaigners asked how many dowries had been provided, NHS England said it did not know because it did not have any records on that. What kind of implementation of a national programme is it when we do not even know, and have no way of telling, how many dowries have been delivered? And why was it just for that one cohort of people? Surely every person stuck in a hospital or institution has the right to have the money go with them on their journey back into the community. I want to know from the Government how many dowries have been delivered so far and whether they will become part of the programme in the future.

As I said, the programme ends in March next year, along with other work on learning disabilities which campaigners are concerned will continue—I will come back to that at the end—including the learning disabilities mortality review. There has already been a lot of concern expressed about how the annual report was slipped out the day after the local election at the beginning of May. The report contained pretty shocking findings, with life expectancy falling massively short of the rest of us—for men by about 22 years; for women, by 29 years—without any clear justification. Some 13% of the cohort of people looked at in the mortality review were cases where the person’s health had been adversely affected by delays in care or treatment, gaps in services or organisational dysfunction, neglect or abuse. Those findings are shocking and concerning. The question for the Government, which I will come back to, is what happens with the findings of mortality reviews. We can all express concern when they are published, but unless there is a plan of action to address the failings identified in them then nothing will change.

The nine principles in the “Building the Right Support” document are very good. They are all focused on personalised care and getting people into the community, which we all agree must happen.

[Luciana Berger]

I normally would not make so many interventions and I hope the right hon. Gentleman is happy to take them—I thank him greatly. I just want to reflect a bit more on the learning disabilities mortality review. The title is quite technical, but it comes back to what he opened his speech with: we are discussing thousands of the most vulnerable people in our country and we have a responsibility to do everything we can to compensate for the fact that they are so vulnerable. The mortality review, launched in May of the previous year, found that one in eight of the deaths reviewed showed there had been abuse, neglect, delays in treatment or gaps in care. Today we celebrate the 70th anniversary of the NHS. Is it not a sad reflection that, amidst all the positivity, we need to do something about this issue so urgently?

[Norman Lamb]

I totally agree. It is, as I said at the start, sobering. In a way, all of us who strongly support the NHS must not laud it as a perfect institution with nothing to complain about. As far as this group of people are concerned, they have been very badly let down. Fundamentally, in many cases they have died early through neglect. That is intolerable in this day and age.

The nine principles, which are positive and empowering, are really good. I sign up to them completely. It is the implementation that is lacking and has largely failed. I say to the Minister that she is very fortunate to be in her wonderful job. My great frustration is that this programme came early in my time as Minister, but I learned, as I did the job, just how critically important implementation is. You think that by establishing good principles and getting everyone to agree to implement them those organisations will do what they have committed to do. It was probably naïve to think that. The reality was that nothing changed and it still has not changed. One critically important lesson to learn from that failure is to have a total, obsessive focus on implementation and national leadership.

Health and Social Care Committee and Education Committee

Debate between Norman Lamb and Luciana Berger

Thursday 10th May 2018 Commons Chamber

[Luciana Berger]

That is a critical issue that was raised on a number of occasions. A cliff edge exists between the services that young people receive until 18 and what happens when they then try to access adult services. The services are very different. In one part of the country, where services go up to 25, this is working very successfully. That was a recommendation in “Future in mind”, a report published back in 2014. We were firmly of the opinion that the Government should actively address this situation and see it amended across the country.

[Norman Lamb (North Norfolk) (LD)]

I congratulate the hon. Lady on her statement and the Committees on this excellent report, which I endorse. Does she agree—she touched on this issue—that the absence of a real focus on early years before children get to school, and the absence of any real, in-depth understanding of the impact of adverse experiences of trauma, abuse or neglect in early years, is a gaping hole? Does she agree that the Government need to go back to the drawing board to extend the scope of the Green Paper to really focus on this issue, to gain a better understanding of it?

[Luciana Berger]

I thank the right hon. Gentleman for his important contribution. One of our key recommendations was that the Government should publish the evidence review alongside the response to the report. They limited the scope of the Green Paper too early by restricting the terms of that evidence review. In fact, we heard in evidence that evolved during our inquiry that under-fives are completely absent from the Government’s plans, yet that is a time in a child’s life that determines their life chances and life outcomes. Clearly, this is very much a gaping hole that needs to be addressed.

Psychosis: Early Intervention

Debate between Norman Lamb and Luciana Berger

Thursday 15th March 2018 Westminster Hall

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House has considered access and waiting time standards for early intervention in psychosis.

It is a great pleasure to serve under your chairmanship, Mrs Moon, for what I think is the first time. I thank the Backbench Business Committee for facilitating this debate on an issue of real importance and something I care about a lot. I will start with the origins of early intervention in psychosis and then raise my specific concerns about the progress made under the Government’s programme.

The approach dates back to the 1990s. In 1999, the Labour Government decided to give a significant national push to the development of early intervention in psychosis services. There was a mental health policy implementation guide of that date, and at that time the service was to focus on those aged 14 to 35, the years when psychosis was most likely to emerge. Once an individual started their treatment, there was to be a three-year programme. Critical to that was small case loads, so that the professionals in multidisciplinary teams could work closely with the individuals involved. It also involved family interventions. In a 10-year period, the national case load grew to 22,500 for what was widely seen as a valuable innovation.

The National Institute for Health and Care Excellence review of psychosis and schizophrenia in 2014 concluded that early intervention services,

“more than any other services developed to date, are associated with improvements in a broad range of critical outcomes, including relapse rates, symptoms, quality of life and a better experience”

for service users. I will return to that later, but an excellent annual report by the Southern Region EIP programme—for the south of England—specifically highlighted the impact on employment rates. When these services have proper investment, people who experience a first episode of psychosis can often be got into employment or education at far higher levels that has traditionally been the case with generic mental health services. That is an enormous prize to be won, when we think about quality of life and sense of self-worth, and indeed the cost of the condition to the state—so, lots of praise for the impact of early intervention services.

The Schizophrenia Commission said that early intervention services were the “great innovation” of the last 10 years, referring to multidisciplinary working, recovery ethos, co-production, working with people with the condition and achieving high standards. Professor Louis Appleby has described the service as the

“jewel in the crown of the NHS mental health reform because…service users like it…people get better”—

that is important—and

“it saves money”,

which is also critical.

On that point, we know from analysis that for every £1 properly invested in early intervention in psychosis, there is a return of £15 over subsequent years. Of course, one of the complications is that the return is not just concentrated in reduced use of the NHS, but comes through getting people off benefits and into work, bringing in tax revenues and reducing the number of people who end up going through the criminal justice system. For all those reasons—the impact on individuals and the extraordinary return on investment—this seems like a very good thing to do. However, as the NHS’s finances started to get tighter, there was clearly disinvestment in many places—it varied around the country, but it was happening.

My insight, as Minister responsible for mental health from September 2012, was that two particular elements of the way that the NHS works end up massively disadvantaging mental health. First, there are a set of politically demanding access standards in physical health, such as the four-hour A&E standard, the cancer waiting time standards and the 18-week referral to treatment standards. I do not know if it still happens, but in my time at the Department of Health, every Monday morning all the great and the good of the NHS sat around the Secretary of State’s table with a spreadsheet for every hospital in the country, looking at performance against those waiting time standards—in physical health. There was nothing for mental health—a complete imbalance of rights of access.

Then there is payment by results, which is actually payment for activity. It means that when patients get referred to an acute hospital, that hospital receives more income. There have been adjustments and reforms over the years, but the basic principle of incentivising activity in acute hospitals, which is not matched in mental health, combined with those exacting access standards, puts enormous pressure on the system to drive people into acute hospitals to meet those standards. That has the effect of sucking money into acute hospitals. Even during the last five to seven years of tight finances in the NHS, income for acute hospitals has continued to increase, but income for mental health and community services, which do not have those financial incentives, has stayed level or, in places, decreased.

I felt we had to start addressing those perverse incentives that were disadvantaging mental health, which amount to discrimination against people who experience mental ill health. Why should the treatment for someone who experiences psychosis be in any way inferior to the treatment of someone suffering from cancer or any other physical condition? In 2014, we decided across government to publish a vision called “Achieving Better Access to Mental Health Services by 2020”, a joint publication by the Department of Health and NHS England. The vision was to achieve comprehensive maximum waiting time standards in mental health by 2020—if only. The plan was to start with two standards: a six-week standard for access to the IAPT—improved access to psychological therapies—service and a two-week standard for early intervention in psychosis.

Critically, this was not just a two-week standard. When the Government report on whether they are meeting the standard, the focus tends to be on whether more than 50% of people start their treatment within two weeks, which was the standard set at the start. However, the standard was in two parts: to start treatment within two weeks and then to have access to the full evidence-based, NICE-approved treatment package. I will focus on that element because, depressingly, evidence shows that the system is falling far short of what it should be doing.

I want to focus on a freedom of information survey conducted over this financial year to try to establish the position across the country, looking not just at how long people wait but, critically, at whether they get access to the full evidence-based treatment package. The evidence that emerges from that survey is deeply disturbing. First, only 29% of trusts across the country stated that they were meeting the full NICE-approved, evidence-based treatment package. That is 29% on a standard that the Government say is being met. It is not being met. Even 29% is generous, because within that I think there were two trusts that were delivering the service only up to the age of 35, whereas the standard says that people up to the age of 65 should be included. Across the country, people are simply not getting access to the evidence-based treatment that we know works and delivers such an extraordinary return on investment.

I suppose I would put it this way. Can we imagine a cancer service saying to patients, “We’ll give you half the chemotherapy or radiotherapy treatment,” or, “I’m sorry, but there are no professionals available to deliver this part of your treatment”? There would be an outcry. It would be impossible for the Government to get away with it. The Daily Mail would be apoplectic. We know that the result would be that the standard would be met, one way or another—but here, day by day across the NHS, this standard for mental health is routinely being missed in a wholly unacceptable way.

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

I thank the right hon. Gentleman for his important speech and his comments. Does he agree that there is a particular challenge in mental health, in that, in the wake of the Health and Social Care Act 2012, parity of esteem is enshrined in law, and we should be not just aspiring to, but achieving equality for mental health? This is just another indicator of how far we are from achieving that goal.

[Norman Lamb]

I totally agree. The 2012 Act is clear that there should in effect be equal treatment between mental health and physical health, but the evidence shows it is not being delivered. I fully understand that it takes time to get there with a new programme, but it is the way it is being implemented that gives me greatest cause for concern. I will focus on how we are falling short of that standard.

In the south region, there is a brilliant programme; it is always important in these debates to recognise that there are sometimes areas of fantastic practice that should be applauded. In the south of England, an amazing woman called Sarah Amani is the programme manager, and there is a full implementation programme. My argument to the Minister is that what is happening in the south should be happening everywhere. The programme produces annual reports, so it is completely open and transparent about the progress it is making and the obstacles that lie in its way.

I should have mentioned that our survey showed that across the country not much more than 50% of the total amount that NHS England says must be invested per patient is being spent per patient on delivering the service. If we are only spending a bit more than 50% of the amount we need to spend, it will fall short. What NHS England in the south is doing is admirable. It highlights that in many areas things have improved over the last year in its region, because it is driving that, but it also says:

“There is four-fold variation between the most and least funded EIP teams in the South of England.”

A fourfold variation would never happen with the cancer service. Furthermore:

“None of the providers have investment recommended to provide a NICE concordant package of care”.

In the best region of the country, no provider is meeting what it needs to spend to deliver the full package of care.

On workforce, the report says:

“Recruitment has been in part hindered by lack of extra investment and compounded by a national reduction in the number of qualified staff, particularly nurses”.

On intelligence, it says:

“Although all mental health providers use Electronic Health Record (EHR) systems, the majority (13 out of 16) of providers have yet to automate reporting, resulting in clinicians having to manually troll through whole caseloads for multiple data requests.”

In this day and age, that should not be necessary. There should be a system across the country to enable us to monitor performance against that important standard. When we go through the elements of the NICE-approved treatment package, such as cognitive behavioural therapy for psychosis, across the best region in the country there is enormous variation in the amount of therapy available to people. Some trusts provide what is required, but most fall short.

If we then look at comprehensive physical health checks, there is a target of 90%. We know that people with severe and enduring mental ill health die 15 to 20 years younger than other people, and that part of that can be addressed by having physical health checks. There is a Commissioning for Quality and Innovation standard established for 90% of people with severe and enduring mental ill health to have physical health checks. Across the south of England it is 56%, not 90%. Individual placement and support is a critical element of getting into work, with loads of evidence to support its effectiveness; 30% in the south of England have access to individual placement and support. Going back to what I have said, we must look at the results that flow if we make the investment. It is not only morally wrong but economically stupid to avoid making that investment.

I come now to the evidence on outcomes. The programme can show that where it does the work, hospital admissions are substantially reduced. The evidence is clear for anyone looking at the report to see. The report then looks at employment and education, where it is achieving substantially better rates of employment than generic mental health services, at 46%. Fascinatingly, it even analyses the relationship between investment and outcomes, so it can show that the more we invest in these evidence-based interventions, the better the outcomes. What a surprise: more people get into work, more people get into education and lives are transformed.

The report then talks about securing investment. Bear in mind that I am not quoting a politician but an internal document, led by the Oxford Academic Health Science Network:

“If the Five Year Forward View commitment of £40 million for EIP teams in 2015-16 had been honoured, EIP teams in the South of England would have seen a total growth in budgets of around £15 million. Instead, in 2015-16 the South region EIP teams saw a meagre increase of £3 million.”

That is £3 million instead of £15 million. The report continues:

“Between 2016-18, this trend of lack of investment has continued with a £3.5 million increase in EIP team budgets compared to the £15 million that was expected. Of the 16 providers delivering EIP in the South of England, none have the £8,250 investment per patient recommended to deliver a NICE concordant package of care. The South of England has a poor track record of investment in EIP services”.

That is the best region in the country. It leaves me feeling frustrated that such a prize—such an opportunity—is being squandered through lack of investment and lack of effective implementation.

I then look to the midlands. I have received an email from someone who is working on early intervention in psychosis in the west midlands, which reads as follows:

“There is wide variation in service quality, data reporting, outcomes, resourcing and resource allocation. This has not been made public, presumably because it is politically inexpedient to do so…Many trusts have chosen to disband EIP teams as a cost saving exercise (in Nottingham), or to allow caseloads to rise from 1:15 to 1:30”—

the whole essence of this approach is low case loads, so that people can get the personal attention that they need—

“not provide enough of the NICE mandated therapies, to not appoint psychologists or enough support workers, leading to expensive but ineffective teams…There is currently no governance or accountability in place, which enables the triangulation of proper resources, recommended service levels and outcomes.”

No governance or accountability in place across the midlands. That leaves me totally bewildered. Would this ever have happened when they implemented the cancer standards in the last decade? Of course not. Yet that is what has happened.

“There are systems in place in the north…and in the south…to provide the mechanism by which the accuracy of data, resourcing, services and outcomes can be verified and addressed…The Midlands region of England (west, central, east midlands, and East of England) are the only areas without any established regional development programmes and therefore have no reliable mechanism to prevent the inexorable decline of standards in EIP.”

That is from the frontline and, it seems to me, ought to be taken extremely seriously.

In a presentation given recently in February, in the west midlands, a west midlands clinician said:

“We are really struggling to provide an EI service that meets the NICE quality standards. Most of the focus of the Trust has been on meeting the two week access standard, which we have done most of the time. We did get some additional money, but it was non-recurring. Caseloads are way above the national average and we are really struggling”.

It then goes through the various elements of the NICE-approved programme.

“Referral rates are very high and we are discharging people sooner than we should.”

That should not be happening in a programme that the Government ought to be really proud of. It is a gem that ought to be nurtured and developed in order to get the very best from it.

When we published the survey that we did earlier this year, the response from NHS England was deeply disappointing. The official was quoted as saying:

“10,000 people each year are now receiving treatment through the early intervention in psychosis programme, with over three-quarters of patients getting treatment within two weeks…The analysis inevitably gives only a partial and dated picture of progress in these services.”

Well, I do not think that public bodies should be making misleading statements like that, because the analysis was full and complete across the whole country. It was not dated in any way. But this quote from NHS England—an anonymous quote—was designed to discredit the analysis. Rather than discrediting the analysis, it seems to me that a public body should be acknowledging the problem and addressing how it will try to solve it. This sort of denial approach is unhelpful. I wrote to the UK Statistics Authority, because I think it is inappropriate for public bodies to respond to analyses in that way.

Before I finish I want to deal with some asks of the Government. This is part of the five-year forward view. The Government have stated that it is a clear priority, so I want the Government to make it a priority. I want the Government to look at the implementation of this programme and to recognise that in some regions, nothing is happening to drive the implementation of these national standards. Personally, I think that it is intolerable that someone with psychosis in Dudley, in the west midlands, gets a raw deal compared with someone in the south of England, but that is what is happening now, because NHS England has no implementation programme in the west midlands, or across the entire midlands, including my own region—the East of England.

First, it needs sufficient investment. Given that there is a return on investment of £15 for every £1 spent, my plea to the Government is to make the investment because they will see a return on it, and benefit from improved employment rates and everything else. Secondly, address the staff shortages that are clearly—according to our survey—holding back services all over the place. It really means that Health Education England needs to create a credible plan to address the workforce shortages in early intervention in psychosis services, so that no area falls short because it cannot recruit the right people to deliver the service. Again I ask, would it happen in cancer? Of course not.

Thirdly, end the outrageous age discrimination. A quarter of the trusts that responded to our survey still have a limit of 35 on the service that is delivered, which means that anyone over the age of 35 is not getting access to the evidence-based treatment programme. Fourthly, get back on track with the two-week standard. We are also seeing that even though the standard is being met, the performance is deteriorating. The figures for early this year are worse than the whole of last year, suggesting increasing pressure on services around the country. That is important for the Government to address as well.

Fifthly, the standard applies not only to people who experience a first episode of psychosis, but to people who are at risk of psychosis; but many services simply say, “We don’t deliver a service to those people.” Of course, that is the best early intervention. If we can intervene before the psychosis has occurred, everyone benefits massively, particularly the individual concerned. In many areas, though, there is simply no service, despite the standard being very clear about what is required. Sixthly, the Government need, as I have said, to fund implementation programmes for every region, modelled on the plan and programme in the south of England, so that everywhere gets access to the same level of service.

Finally, our vision of comprehensive maximum waiting time standards in mental health by 2020 was published not just by Lib Dems, but by Conservatives. It was the Government’s vision. The point of it was to end such discrimination in a publicly funded service. It is not justifiable to have rights of access to treatment for physical health services, but not for mental health services. Why should people be left waiting, sometimes for months on end, for access to treatment? Treatment should be based on evidence and clinical need. But that vision, it seems to me, although included in the “Five Year Forward View”, is not being funded. There is no resource available to implement it. So my plea to the Government is: return to that vision. It was a good vision in 2014.

I will end by making this point: nothing that the Government could do would have a bigger impact on the wellbeing of our communities than to end the under-investment in mental health services. The best example, where the evidence is at its strongest, where you can reduce the flow of people into long-term support from secondary mental health services, is early intervention in psychosis services. There is an enormous prize to be had, but it needs investment and attention, which is lacking at the moment.

Children’s Wellbeing and Mental Health: Schools

Debate between Norman Lamb and Luciana Berger

Tuesday 10th January 2017 Westminster Hall

[Norman Lamb]

I am grateful to the hon. Gentleman for that intervention. I totally agree. As I will explain later, giving professionals the tools to manage the issues in front of them seems to me to be fundamental to a sensible approach.

There appears to be growing evidence of increasing mental health problems among young girls. In August 2016 a survey for the Department for Education found that rates of depression and anxiety have risen among teenage girls in England, although the rates appear to be more stable among boys. The survey found that 37% of girls reported feeling unhappy, worthless or unable to concentrate; that was more than twice the percentage for boys. According to the Children’s Society’s latest “Good Childhood” report, a gender gap has opened up between girls and boys in relation to both happiness with life as a whole and appearance. One in seven girls aged 10 to 15 felt unhappy with their lives as a whole, and the figure had gone up over a five-year period. We need to seek to understand that situation better in order to make the right response. I pay tribute to the Children’s Society, which has supported me in bringing this debate to Parliament. I also thank, as I should have done at the start, the MPs who joined me in applying for the debate.

There also appear to be problems among women between the ages of 16 and 24, according to a major report by NHS Digital. Reports of self-harm in that group trebled between 2007 and 2014, so something very serious is going on. Research is urgently needed to understand the causes of the trend. Social media appear to be part of the picture—there are concerns about sexting, cyber-bullying and so on.

We must also remember the issues that relate to boys and young men. Horrifically, suicide remains the biggest killer of men under the age of 45 in the UK, and the rate has been increasing in recent years. In 2014 the male suicide rate was three times higher than the female rate. I am pleased that the Government focused on suicide in yesterday’s announcements. Ultimately, there is nothing more serious or important than seeking to prevent lives from being lost in that horribly tragic way, with the impact that it has on families—my family, along with many others in this country, have gone through that experience—so we need to give it the greatest possible attention.

The overall lifetime costs associated with a moderate behavioural problem amount to £85,000 per child, and with a severe behavioural problem they are £260,000 per child. That is why it is so important to deal with these issues early, rather than allowing them to become entrenched.

The Children’s Society has highlighted school-based counselling, which can be highly effective for children experiencing emotional difficulties. It can be used as a preventive measure, an early intervention measure, a parallel support alongside specialist mental health services, and a tapering intervention when a case is closed by the specialist services to help a child or teenager through to recovery. Research shows that children perceive it as a highly accessible, non-stigmatising and effective form of early intervention.

Studies have also shown that attending school-based counselling services has a positive impact on studying and learning. In 2009 Professor Mick Cooper assessed the experiences of and outcomes for 10,000 children who had received counselling in UK secondary schools. More than 90% reported an improvement, which they attributed to counselling, and 90% of teachers reported that counselling had a positive impact on concentration, motivation and participation. So we end up achieving better academic attainment if we make the investment for those children who need it. It can be cost-effective, given the long-term cost to the economy of problems that continue into adulthood; some studies have indicated that the long-term savings can be in the region of £3 saved for every £1 invested, and data from Wales indicate that the average cost of school-based counselling is significantly lower than the specialist treatment children get if that is the only alternative. So we save money by giving children access to school-based counselling rather than delaying intervention and referring the child to a distant service, probably with a long waiting time, which is also far more stigmatising.

The British Association for Counselling and Psychotherapy has estimated that the overall cost of statutory provision of school-based counselling across all of England’s state-funded secondary schools would be in the region of £90 million per year. On the basis that 60% of schools are already delivering it, the additional delivery would cost around £36 million. I suggest that that investment is well worth making given the improved preventive care.

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

I am grateful to the right hon. Gentleman for giving way and apologise for being a few minutes late for the start of his important speech. I am sure that he, like me, will have had the privilege of visiting a number of schools, not only in his own constituency but across the country, that are really committed to their students’ mental health and have invested in school-based counselling. Does he share my concern that in this past year we have already seen cuts to those services within schools because they have seen their budgets reduced and they are having to incur the additional costs of pensions, for example? The prospect for the years ahead is to see some schools that fund counsellors five days a week going down to three, or three days down to one, and some having to scrap the provision altogether because they simply do not have the resources to make this very important service available in their schools.

[Norman Lamb]

I thank the hon. Lady for that intervention and pay tribute to the tremendous campaigning work that she does on mental health. Her point highlights the gap between the rhetoric, which is often well intentioned, and the reality. There is now a much greater focus on prevention in the Government’s argument, but what too often happens with a system under impossible strain is that the preventive services are cut first because there is a desperate need to prop up acute services within the system. She makes an important point.

Let me address the issue of stigma in schools. Stigma can exacerbate mental health conditions and prevent people from speaking out and seeking help. In October 2016 the YMCA launched a nationwide campaign aimed at tackling the stigma associated with mental health difficulties and to help to encourage young people to speak out. It found that more than one in three young people with mental health difficulties had felt the negative impact of stigma. School is where most young people experience stigma, and more than half of those who have experienced stigma said it came from their own friends. There is often a lack of understanding among young people—teenagers—about what mental health really is. That is why it is so important that we get this on the curriculum so that every teenager learns about their mental, as well as physical, health and wellbeing, and about how they can become more robust in coping with the challenges they face.

The impact of stigma is profound and pervasive, affecting many areas of a young person’s life. Young people reported that the stigma affected their confidence and made them less likely to talk about their experiences or to seek professional help. I can remember the moment when our eldest son said to me, “Why I am the only person who is going mad?” I just thought that here is a teenager feeling that and having stored it up inside himself, having not been able to talk about it for a long time. We can just imagine the strain of trying to cope with that on top of all the normal pressures of being a teenager. We have to do far more to combat stigma if we are to improve young people’s experiences.

I want to mention “Future in mind”, which is the blueprint we published in March 2015 just before the coalition Government came to an end. It was widely welcomed across the sector. We involved educationalists, academics, practitioners and young people, in particular, in the work we did. Central to the recommendations was the role of schools, and among the recommendations was the proposal that there should be a specific individual responsible for mental health in every school to provide a link to the expertise and support available, to discuss concerns with an individual child or young person and to identify issues and make effective referrals.

There should be someone taking responsibility but also a named contact point in specialist mental health services—too often we find that schools do not have the faintest idea who to contact when a child needs support—and also joint training. The hon. Member for Upper Bann (David Simpson) made the point about the training of teachers. If we can get teachers working alongside specialist mental health workers in schools, everybody will benefit.

[Norman Lamb]

I pay tribute to the hon. Lady for the incredibly valuable work that she has done, particularly on suicide. I join her in paying tribute to the work of the Samaritans and the army of volunteers who give up their own time to save people’s lives. The sort of initiative that she described is incredibly important. Do the Government remain committed to implementing “Future in mind”? There is a danger in Government that we just replace one initiative with another. There is a very good plan there, which has all the right principles, and the important thing is just to do it and make sure that the money—I will come to that in a moment—actually gets through to where it is required.

[Luciana Berger]

I am grateful to the right hon. Gentleman for kindly giving way again. May I echo his very important points? “Future in mind”, the report for which he was responsible, was released in March 2015. We are nearly two years down the line and, despite the fact that the “Five Year Forward View” explicitly stated that it accepted the recommendations of the “Future in mind” report, we are yet to see the vast majority of them implemented. I echo what he said and urge the Government to address that very important point in their response.

[Norman Lamb]

I thank the hon. Lady for that intervention. Given that I was responsible for that report, I feel very strongly about its absolute importance. I chaired a commission for the Education Policy Institute that reported last November, and we were pleased that the Secretary of State for Health came to speak at the launch, which I thought was important in itself. We looked at what has happened since “Future in mind” and in some parts of the country they are doing great work, but in others very little is happening. Very little has changed, with the bulk of the money still going to the acute end of the spectrum and not being reinvested in preventive care.

Critically, in many areas of the country, as the YoungMinds survey showed, 50% of clinical commissioning groups are not spending all the money—the additional investment secured in the coalition Government’s last Budget. They are not spending the full allocation on children’s mental health. I think that is scandalous. It amounts to theft of money solemnly pledged by the Government for children’s mental health, yet in many areas it is being diverted to prop up local acute hospitals. We cannot tolerate that. The Government have to find ways of ensuring that all that money is spent as intended. I know that the Government plan to have greater transparency, with Ofsted-style ratings for CCGs, but frankly there needs to be more than that. When a CCG is under financial stress, it is just too easy to shave a bit off children’s mental health to spend it where the public are clamouring for action, because ambulances are stacked up outside the A&E department.

In the first year after “Future in mind”, the system that we designed meant that local areas would get the money only if they produced a transformation plan to show how the money would be spent on changing the system to focus more on prevention. My proposition to the Government—the EPI commission report said this—is that every year the money should be tied to a commitment from the CCG that every penny of it is spent on children’s mental health. The CCG must also demonstrate that it has stuck with the plan from the previous year and that it has a plan to continue the change in the subsequent year. Unless we use the money to drive change in local areas, it will not happen because the system is under so much strain.

The other point argued for by the Education Policy Institute commission was that the Prime Minister should launch her own Prime Minister’s challenge on children’s mental health, as the former Prime Minister did on dementia, because that sort of prime ministerial stamp of importance for this subject would be incredibly valuable. Yesterday was a start, but I challenge the Prime Minister to go further and launch a formal challenge of that sort.

My final point—I am conscious that other Members wish to contribute to the debate—relates to the importance of ensuring that when a child needs specialist treatment, they get it on time. This goes to what I regard as a discrimination within the NHS, because anyone who has a physical health problem benefits from a maximum waiting time. Whatever their issue is, they know that a standard maximum waiting time applies nationally. It is accepted that those standards are under strain, but at least they exist, and I know that they drive the system, from the Secretary of State’s office downwards, in looking at every individual hospital’s performance across the country.

On mental health, however, apart from the two maximum waiting time standards that we introduced in the last two years, there are no other maximum waiting time standards. There is no standard for children. Families across the country can be left waiting, sometimes for months, to get any treatment at all, and when they get referred too often they have to clear high thresholds. In other words, someone has to prove that they are really sick before they get any help at all. That dysfunctional and irrational approach completely contradicts the principle of early intervention.

When you have a child aged 15—as I did, a girl—who had an eating disorder and was turned away from treatment because her body mass index was not low enough, and who then got admitted as a crisis case two months later because the problem had been neglected, you are left in a state of despair. We need to ensure that children with mental health problems have the same right to timely, evidence-based treatment as anyone with a physical health problem does, and that they should be treated close to home rather than being shunted sometimes hundreds of miles away.

These are the burning injustices that exist for many families across the country who cannot pay to opt out of the system. We have a duty and a responsibility—the Government, in particular, have a duty—to ensure that those children get the treatment they need on a timely basis.

Mental Health Taskforce Report

Debate between Norman Lamb and Luciana Berger

Wednesday 13th April 2016 Westminster Hall

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

It is a real pleasure to serve under your chairmanship this afternoon, Mr Wilson. I congratulate the hon. Member for Halesowen and Rowley Regis (James Morris) both on securing this vital debate on the final report of the independent taskforce on mental health and on his excellent contribution. I am pleased that we have the opportunity to examine this incredibly important piece of work and to hear a detailed response from the Government. I thank all Members who have spoken in the debate; the quality of the speeches we have heard is testimony of the strength of feeling on both sides of the House on the issue of mental health.

I echo previous contributions today in saying that the taskforce report is an extremely comprehensive piece of work. I pay tribute to all those who were involved in delivering it. The recommendations it makes are robust and wide-reaching and signal what the chair of the taskforce—Paul Farmer CBE from Mind—has rightly described as a

“landmark moment for mental health”.

I also thank vice-chair Jacqui Dyer for her commitment and passion.

If implemented in full, the changes could make a huge difference to a system that is under increasing and unsustainable pressure. The real challenge lying before us now is ensuring that the aspirations set out in the report are actually delivered. For too long the rhetoric on mental health has not matched the reality on the ground. Members today have reflected the concerns felt by the people whom we represent across the country—people who themselves suffer from mental health conditions, their families and the services and professionals that care for them—who are anxious to ensure that the opportunity we now have to transform mental health in our country is not wasted.

I will focus my remarks on implementation and three key areas where unanswered questions remain—funding, transparency and accountability. Turning first to the money, the taskforce identified a £1.2 billion funding gap in mental health services each year by 2020. The Government responded to the publication of the report with an announcement of an additional £1 billion of investment for mental health services up to 2020. That is, of course, very welcome but I understand that the £1 billion will be taken from the £8 billion set aside for the NHS up to 2020. If that is the case—perhaps the Minister can confirm that for us today—I struggle to see how it will meet what the taskforce says is required.

Given that mental health receives just under 10% of the total NHS budget, it is difficult to see how the funding announced could be considered as additional, particularly in the context of the £600 million cut that mental health trusts have experienced over the course of the last Parliament. I should have thought that the Minister would have allocated that proportion of the £8 billion to mental health anyway, so I am keen to hear his response on that point.

There are also real concerns about how this funding will be distributed and what systems will be in place to ensure that it reaches the front-line services for which it is intended and not siphoned off to plug the deficits of acute trusts. That point has already been made by the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Bexhill and Battle (Huw Merriman). The Minister is right to prescribe that CCGs must increase the amount of their budget that they allocate to mental health at a rate that is at least in line with the general growth in their budget. However, as that budget information is not published centrally, I have yet to see any evidence from the Government that they are able to guarantee that CCGs are fulfilling that commitment. In fact, I have had to make freedom of information requests, which have exposed the fact that more than one in three CCGs are not meeting that expectation.

Just before Christmas, the Health Secretary announced that from June there will be independently assured Ofsted-style ratings for mental health provision by CCG area that will expose the areas that are not making the commitment to mental health that they should. I asked then if he would clarify whether that commitment would include publishing a clear picture of mental health spending for every CCG. I am still awaiting a response to the follow-up letter I wrote seeking clarification on that very important point, and I would be pleased if the Minister were able to confirm that for us today. As he will know, the Opposition strongly believe that the annual survey of investment in mental health must be reinstated. It was stopped in 2011, and it is an absolutely crucial piece of information.

That is especially important given the concerns that have been raised not only by many hon. Members today, but by the Mental Health Network, which represents mental health trusts, who have said that providers of mental health services are yet to see the difference from the investment in child and adolescent mental health services that the Government announced last year. During this debate, many hon. Members have raised specific concerns about CAMHS and the imbalance in the amount that they are allocated from the overall mental health budget. It is less than 10%, and it is a significant challenge. I am interested to hear the Minister’s response both to those very serious concerns and to the proposal from many mental health leaders that the cash should be ring-fenced—I am very keen to hear what he thinks about that.

That brings me to the second key theme of the report—the startling lack of transparency and accountability in our mental health system, which was mentioned by my hon. Friend the Member for York Central (Rachael Maskell) and the hon. Member for Gillingham and Rainham (Rehman Chishti). The significant gaps in the information that the Government collect on mental health present a significant obstacle to their ability to deliver what they have promised on mental health. On Monday we saw further shocking evidence of that information gap during the BBC’s “Panorama” programme, which highlighted the discrepancy between the data that the Government hold on the number of children who have died in in-patient mental health trusts and units and the figures from the charity Inquest’s research. I raised that in the House yesterday.

[Norman Lamb]

I totally agree with the point that the hon. Lady is making. I always took the view that I was operating in a fog, without access to the proper data. The “Panorama” programme made reference to the fact that I gave a parliamentary answer saying there had been no deaths in children’s mental health services—an answer that was wrong, because I was given the wrong information. I have asked the Secretary of State for a full investigation into how that happened. We have to have absolutely accurate reporting of these things.

[Luciana Berger]

I thank the right hon. Gentleman for his intervention. I believe it is absolutely imperative that we are able to see how deaths in psychiatric care are not only treated and recorded, but investigated and learned from. We have heard from the Minister that there will be progress on that front.

The situation is particularly concerning given the ongoing case of Southern Health NHS Foundation Trust, which was found to have failed to investigate more than 1,000 unexpected deaths of mental health and learning disability patients since 2011. Only last week, more than two years since the very tragic death of Connor Sparrowhawk, Southern Health trust was found by the Care Quality Commission not to have addressed serious concerns that were raised about the safety of its patients and was issued with a warning notice. I would be grateful if the Minister shared with us what the Government are doing specifically to improve the mental health data that are being collected, published and made accessible to the public. When will we have a further update on avoidable deaths in the area of mental health and learning disability? Data are absolutely critical, not only to enable the Government to understand the realities of what is happening on the ground, but to allow us to check that the Government are delivering on what they have promised.

That brings me to the final point I wish to cover today—accountability for the implementation of the taskforce’s recommendations. The taskforce asked NHS England, the Department of Health and the Cabinet Office to announce what governance methods they intend to introduce for the delivery of the recommendations. That really is needed as a matter of urgency. We need greater transparency than before in the way that the recommendations are implemented. I note that one recommendation of the taskforce report is that the Government accept the recommendations from the previous taskforce on CAMHS—another issue raised by many Members during today’s debate—which reflects the fact that the delivery of these recommendations has been too slow. I should be grateful if the Minister would confirm what plans there are to publish and publicise updates on implementation of the taskforce’s recommendations.

The Centre for Mental Health has produced a fantastic report for NHS England, exploring what helps and what hinders the implementation of policies and strategies relating to mental health. I do not know whether the Minister has had a chance to read the report but, among other things, it calls for a robust implementation infrastructure to support local agencies in delivering the report’s recommendations. I should be grateful if the Minister would share with us today what plans there are to support local authorities, CCGs and mental health trusts to deliver on that strategy.

Many recommendations in the taskforce report also require Government Departments—such as the Ministry of Justice, the Department for Work and Pensions and the Department for Education—to deliver their own areas of work that relate to mental health. I was very pleased to see those recommendations, and as I have said and will continue to say, we will not address the challenges of our nation’s mental health just from the Department of Health. Prevention and early intervention are absolutely crucial, which was a point made by my hon. Friend the Member for Coventry North East (Colleen Fletcher).

Take the work of the Ministry of Justice, for example. The report calls for the completion of the roll-out of liaison and diversion services, as well as the increased uptake of mental health treatment requirements and improvements to prison mental health care. At a time when, as a country, we are seeing one person take their life every four days in our prisons, it is absolutely crucial that we address this very serious issue.

Another point made by the taskforce was about housing and the local housing allowance, which the Government seriously need to address. During today’s debate other Members have talked about the importance of employment and what more needs to be done to support employers to help people with mental health conditions into the workforce, and to support people who might be experiencing those issues. It was disappointing that the Government accepted only formally the taskforce’s recommendations relating to the Department of Health and its arm’s length bodies. I hope the Minister will confirm today whether other Departments will accept and implement the other recommendations.

In conclusion, for the many thousands of people who could benefit from these changes and the others set out in the taskforce’s final report, Ministers must keep their promise and deliver the vital reforms that are long overdue and desperately needed. We have heard a lot of rhetoric and warm words on mental health. Now is the time for real action and to translate parity of esteem into reality. I look forward to the Minister’s reply.

Mental Health

Debate between Norman Lamb and Luciana Berger

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

I thank my hon. Friend for making that very important intervention. There are too many stories of our blue light services—not just the police, but our ambulance and fire services—being under incredible pressure in contending with such issues. I believe that the Government must do more to address that issue.

[Norman Lamb (North Norfolk) (LD)]

I am pleased the hon. Lady has called this debate. Does she share my view that yesterday’s report on perinatal mental health makes incredibly disturbing reading? Many women have lost their lives because of the absence of services. We must commit to making sure that every part of the country has good services to ensure people get through such difficult times.

[Luciana Berger]

I will come on to the very serious issue of perinatal mental health that the right hon. Gentleman raises. Again, we should all be very concerned about that issue.

I am very concerned that there has been a psychiatry recruitment crisis, with a 94% increase in vacant and unfilled consultant posts. The NHS constitution treats mental health and physical health differently. The Government claim to be increasing mental health budgets, but patients and professionals tell a different story. Ever since Ministers discontinued the annual survey of investment in mental health three years ago, we do not have an accurate picture of spending on mental health in our country.

Oral Answers to Questions

Debate between Norman Lamb and Luciana Berger

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

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

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

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

[Norman Lamb]

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

Child and Adolescent Mental Health Services

Debate between Norman Lamb and Luciana Berger

Monday 2nd February 2015 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the availability of child and adolescent mental health in-patient beds, and on child and adolescent mental health services more generally.

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

Since April 2013, NHS England has been responsible for commissioning in-patient child and adolescent mental health services—CAMHS—often referred to as tier 4 CAMHS. In 2014, NHS England reviewed in-patient tier 4 CAMHS and found that the number of NHS-funded beds had increased from 844 in 1999 to 1,128 in 2006. That has now risen to more than 1,400 beds, the highest this has ever been. These data are now being collected nationally for the first time, but despite the overall increase, NHS England also found relative shortages in the south-west and areas such as Yorkshire and Humber.

In response, the Government provided £7 million of additional funding, allowing NHS England to provide 50 additional CAMHS specialised tier 4 beds for young patients in the areas with the least provision—46 of these beds have now opened. NHS England has also introduced new processes for referring to and discharging from services, to make better use of existing capacity. A key objective of these actions is to help prevent children and young people from being referred for treatment long distances from home, except in the most specialised cases.

National availability of in-patient CAMHS beds is reviewed each week by NHS England specialised area commissioning teams and the national lead for commissioning, identifying any issues and taking proactive steps to address them. On 30 January, it emerged that the number of general CAMHS beds available was lower than in recent weeks. In response, NHS England implemented contingency plans, including contacting existing CAMHS providers to seek additional capacity and increasing the use of intensive home support packages to allow children and young people to be treated at home or on a non-specialised ward. NHS England has also contacted mental health providers to alert them to the immediate capacity issues in CAMHS and establish what capacity existed in adult in-patient and community services to take cases on a temporary basis, should that option be required.

The Government are committed to improving CAMHS as part of our commitment to achieving parity of esteem between mental and physical health—this is not just for in-patient services, but for services in the community, and for services that seek to intervene early and prevent problems arising. That, ultimately, is where the focus must be to ensure that, as far as possible, we spot issues early and prevent them from worsening, reducing the need for in-patient treatment.

In August 2014, the Department of Health set up the child and adolescent mental health and well-being taskforce. The taskforce brings together a range of experts from across health, social care and education. It will consider how we can provide more joined-up and accessible services built around the needs of children, young people and their families. A Government report on the taskforce’s findings will be published in the spring.

The Government have also invested £54 million in the children and young people’s improving access to psychological therapies programme and will invest £150 million over the next five years in improving services for those with eating disorders.

[Luciana Berger]

All over England, our child and adolescent mental health services are increasingly under pressure. Despite the best efforts of NHS staff, the system is now in crisis. Children are being sent hundreds of miles for treatment or detained in police cells because there is nowhere else for them to go. We are also hearing of young people getting no treatment at all. I was appalled to see the copy of the e-mail that NHS England commissioners sent on Friday night, warning mental health trusts of a national shortage of in-patient beds for children. It was almost one year ago that the chief executive of YoungMinds said that the increase in the number of children placed on adult wards was entirely predictable following cuts to mental health services. Why did the Minister not act on that warning and do something to prevent it from happening?

The e-mail from NHS England said that the shortage would make it likely that 16 to 18-year-olds would need to be admitted to adult wards. Senior inspectors at the Care Quality Commission say that under-18s should not be put on adult wards, so why is NHS England issuing guidance that contravenes that advice? Adult mental health wards are no place for young people, but how can the Minister be sure that even in emergencies adult wards can accommodate children and teenagers? Adult mental health wards are operating at well over their recommended capacity, and today the Royal College of Psychiatrists has warned that the lack of acute beds available to mental health patients has left the system at breaking point. If adult mental health wards are full, where will these children go? What assessment was used to determine how many beds were needed? Clearly, it is not working. Does the Minister now plan to reassess the situation?

Why are so many of our children and young people needing in-patient mental health care in the first place? Could it have anything to do with the £50 million of cuts to child and adolescent mental health services? The Minister talked about early intervention, but we have seen cuts to early intervention in psychosis services, cuts to crisis services in the community, and the decimation of the early intervention grant, putting a lot of pressure on in-patient services. Could the problem be the fragmentation of commissioning we have seen across the health service since the Government’s reorganisation of the NHS?

The Government have paid lip service to parity of esteem and brought cuts and crisis in reality. Our children deserve better, and that is why Labour is committed to working to reverse the damage done to child and adolescent mental health services by this Government and why we have pledged to end the scandal of the neglect of child mental health.

[Norman Lamb]

First, let me caution against sanctimony. This is not a new issue: under the previous Labour Government, children did at times end up in adult wards. That is highly undesirable—everyone recognises that—and we must do everything we can to prevent it, but please do not try to claim that this is an entirely new problem. It is not. The Government have significantly increased the number of beds available, so significantly more are available now than there were in the last decade. The hon. Lady says that she sees increasing numbers of children held in police cells, but let us have some honesty and accuracy in this debate. The number of children who end up in police cells is falling, not increasing. The crisis care concordat, published last February, set a commitment to end the practice of children going into police cells. Indeed, we intend to legislate to ban it, but the numbers are lower than they were so she should not suggest that it is a growing problem—[Interruption.] She did suggest that.

The hon. Lady asked about my acting on the warning. That is exactly what we did. NHS England carried out a review of clinical judgment on the capacity required to meet children’s needs. As a result, there was a proposal for an increase of 50 beds nationally, focusing on the areas of the country where there was a significant problem, and the Government provided £7 million of additional funding to ensure that those beds were opened. Forty-six beds have opened. There is a temporary problem in Woking, where beds that were available are no longer accepting new admissions. That is a CQC issue. One thing that we have been absolutely steadfast on is that if standards are not being met, we should not continue to admit children to those wards.

The hon. Lady mentioned psychosis services, but this Government, for the first time ever, introduced a waiting time standard for early intervention in psychosis, which was widely welcomed by everyone in the mental health world. From this April, we start the process of introducing a standard. To start with, 50% of all youngsters who suffer a first episode of psychosis will be seen within two weeks and start their treatment within two weeks. That is an incredibly important advance.

The hon. Lady lectures the Government on mental health services, but perhaps she will consider why the Labour Government left out mental health when they introduced access and waiting time standards for all other health services. That dictates where the money goes and means that mental health loses out. This Government are correcting that mistake.

Oral Answers to Questions

Debate between Norman Lamb and Luciana Berger

Tuesday 25th November 2014 Commons Chamber

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

The Minister talks about parity of esteem, but it is under this Government that mental health budgets have been unfairly cut, and 1,500 beds and 3,300 nurses have been lost. He has already received a damning Select Committee report on child and adolescent mental health services. Ill people are being locked in police cells, or are travelling hundreds of miles to find a bed. The Minister could not have brought about more disparity if he had tried—and now we hear that there is to be yet another review. He is the Minister in charge. I ask him again: what action is he going to take today?

[Norman Lamb]

Inexplicably, when the last Labour Government introduced access and waiting time standards, they left out mental health. That was an extraordinary decision, and it drives where the money goes. The introduction of mental health waiting time standards next year, for the first time ever, will help to achieve equality for mental health. We have also published a vision of the next five years explaining how we will secure genuine equality for mental health, which is something that the last Labour Government did not achieve.

Oral Answers to Questions

Debate between Norman Lamb and Luciana Berger

Tuesday 21st October 2014 Commons Chamber

[Norman Lamb]

Yes, I agree that it is totally unacceptable for patients to be sent a long way away from home. In children’s services, we are investing £7 million extra this year to produce 50 more beds, and we are holding NHS organisations to account to ensure that they provide beds locally so that people do not have to travel long distances.

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

Research published yesterday by the Centre for Mental Health and the London School of Economics shows that perinatal mental illness is costing our economy more than £8 billion each year. Does the Minister think it is acceptable that half of mums do not have access to a service, are being separated from their babies, are being forced to travel hundreds of miles for a bed, or are not getting any help at all? What is he going to do about it?

[Norman Lamb]

The position has actually improved significantly. Last week, I visited a fantastic perinatal mental health service in Torbay where mums are getting support locally, as, indeed, they should be. I totally agree with the hon. Lady that it is unacceptable that people have to travel long distances, but across the country things are changing, and changing rapidly.

Oral Answers to Questions

Debate between Norman Lamb and Luciana Berger

Tuesday 15th July 2014 Commons Chamber

[Norman Lamb]

I completely agree with my hon. Friend. It seems to me to be inherent in the nature of therapy that people go into it willingly. The idea that we could frogmarch them into therapy against their will simply would not work. We could end up with a dangerous and costly tick-box exercise that achieved nothing, so there is no plan to introduce compulsion to access therapy.

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

I listened carefully to what the Minister said in answer to the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), but will he confirm that there is no truth to reports that the Government are considering plans that would mean that people with mental illness would have their benefits stopped if they refused treatment? Rather than people refusing treatment, are not the increasing shortage of beds and ever longer treatment delays under this Government the real reasons why people are not receiving the help that they desperately need?

[Norman Lamb]

I can confirm, as I already have done, that there is no truth in the rumour. Indeed, in August we anticipate publishing the start of trial programmes to bring together IAPT—improving access to psychological therapies—with Jobcentre Plus. The idea of ensuring that people who are out of work and have mental health problems get access to psychological therapies is incredibly important, and I am very excited about the pilots that we will launch in August.

Oral Answers to Questions

Debate between Norman Lamb and Luciana Berger

Tuesday 10th June 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question, and it is a legitimate one. A lot of work is being undertaken by NHS England and the national clinical director Geraldine Strathdee, a highly regarded individual, to strengthen the quality of commissioning of mental health services. It falls short in many areas at the moment and it is essential that it is improved.

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

Ministers say that they are committed to parity of esteem between mental and physical health, yet we have already learned from an NHS England report that three quarters of children with anxiety or a diagnosable depression are not receiving the treatment they need. This is plainly unacceptable. It would not happen to children presenting with a broken arm or asthma, so can the Minister please tell the House when he will translate his rhetoric into reality?

Care Homes

Debate between Norman Lamb and Luciana Berger

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

My hon. Friend makes a really important point. In ensuring that we have decent, civilised standards of care for older people, but also for people with learning disabilities and others in vulnerable positions, it cannot be any one party on its own that achieves that objective. It is a challenge for the whole of society, and we must recognise that. Government have their part to play in setting very clear standards and making it absolutely clear that where these standards are not met there are consequences. Through the integration pioneers that we have around the country, we are demonstrating that with better collaboration between statutory services and families, wider communities and neighbours, we can achieve better care for people. The state cannot do this on its own. It has a crucial role to play, but this is a challenge for the whole of society.

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

I think the whole country was appalled last night when the BBC’s “Panorama” programme exposed the neglect and abuse of vulnerable older people at the hands of their carers. When older people and their families take a decision to move into residential care, they must be assured of high standards. Poor care must be stamped out and those responsible properly held to account.

First, I want to press the Minister on the specific case at Oban House. He will be aware that concerns were first raised about the home by whistleblowers back in 2012. What action was taken to address those concerns, and were they brought to the attention of Ministers? In its latest inspection in February, the Care Quality Commission reported that the home had too few staff and that some residents waited too long for staff to answer their calls. Will the Minister set out precisely what action was taken after those failures were highlighted back in February?

The Minister will be aware that following the awful abuse exposed by “Panorama”, a number of staff have been suspended, and HC-One has said it will increase staffing levels and improve training at the care home. However, is he fully satisfied that the safety and well-being of residents at Oban House is not still at risk?

This case raises serious questions about not only the inspection of care homes but the role of local councils. Councils and local authorities, which are much closer to care homes, should have a strong role in monitoring and driving up care standards. They should be the first safety net. Was it not a major error, therefore, to remove in the Care Bill the CQC’s powers to check that local councils are commissioning care services properly?

Care home bosses who fail to ensure that their residents are treated properly must face tough consequences. I heard what the Minister said about holding those bosses to account. My hon. Friend the Member for Blaenau Gwent (Nick Smith), as he outlined, proposed an amendment to the Care Bill to introduce a new criminal offence so that negligent care home owners can be fined or sent to jail. Is it not disappointing that the Government voted against that amendment?

In the first three years of this Parliament, social care budgets have been slashed by £1.8 billion. Yesterday, the growing abuse of zero-hours contracts, particularly in the care sectors, was revealed. Does the Minister accept that we will never get the standard of care that we aspire to from a social care system that has been cut to the bone? Should the coalition not revisit its brutal cuts to social care, which make such a situation more, not less, likely to occur?

This shocking case is yet another reminder that the time has come for a radical rethink of how we care for older people. These abuses must stop. How many more “Panorama” programmes exposing appalling cases such as at Oban House must we see before proper action is taken? Today, the Government must explain how they plan to prevent older people facing further abuse and indignity.

[Norman Lamb]

I thank the hon. Lady for those questions. I completely agree that unacceptable practices, and abuse and neglect, must be stamped out. I hope she is pleased that the Government are taking action to ensure that we can prosecute care providers who have allowed unacceptable practices. When I came into my job and had to respond to the scandal at Winterbourne View, the question I asked officials was, “What has happened to the company? How has it been held to account?” I was told that the Care Quality Commission could not prosecute because it had to serve a notice first, and if the company complied with the notice, nothing could be done.

A flawed regulatory regime was established when the CQC came into being. We are changing that so that providers of care can be prosecuted if they fail to meet fundamental standards of care. [Interruption.] I am answering the question. That is precisely what we are doing. The hon. Lady mentioned the issue of corporate accountability and corporate neglect, and that is exactly what we are addressing: we are giving the CQC the power to prosecute when there is corporate neglect.

We are also going further by introducing a fit-and-proper-person test so that every director of every care company will have to demonstrate that they are a fit and proper person. That should already be the case, but this is the first time it has happened. We are also introducing proper standards of training for all staff.

On the care home concerned, I hope it will be helpful if I write to the hon. Lady setting out the whole sequence of events and the entire timeline of the steps taken by the CQC. I commit to doing that in the next few days so that she will have the full picture.

We have made sure that the CQC is independent—we have strengthened its independence. We are introducing a far more robust inspection regime and we are addressing a problem. When the CQC was introduced by the Labour Government, the design of the inspection system was for generalist inspectors who might inspect hospitals one week and care homes the next. We are introducing specialist inspections. When inspectors go into a care home, they will talk to relatives, residents and staff, to get a much fuller picture of what is going on. Care homes will then be rated on their standards of care, so everyone will know what their local provider’s standards are.

I hope the hon. Lady will feel that real, substantial steps are being taken to address unacceptable standards of care and to ensure that people are properly held to account when bad things happen.

Oral Answers to Questions

Debate between Norman Lamb and Luciana Berger

Tuesday 1st April 2014 Commons Chamber

[Norman Lamb]

My hon. Friend raises an incredibly important point. One thing that I am very proud of is that under this Government 80,000 more people a year are getting access to psychological therapies through the improving access to psychological therapies programme—something we that should be very proud of. We have also done some joint work with the Department for Work and Pensions on how we can link up IAPT much more effectively with Jobcentre Plus to get people back to work, rather than paying them benefits.

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

The Minister was right to point out that from today people who use mental health services are supposed to be able to choose where they get their treatment. However, the payment mechanisms still are not in place and the guidance has not been issued. Is it not the case that the only choice for many teenagers is whether to be treated on an adult ward or travel hours to the nearest bed? The Health and Social Care Act 2012 was meant to deliver parity of esteem. The Minister is not a commentator or a bystander. I listened to his answers a moment ago. Can he explain what has gone so wrong and how he intends to fix it?

[Norman Lamb]

I agree that I am not a bystander. That is why I have acted to introduce choice for mental health patients for the first time—something that the Labour Government completely failed to do. Perhaps the hon. Lady could explain to the House why on earth they would leave out mental health patients from the legal right of choice. It is extraordinary. This Government are taking decisive action to ensure that there is real parity—real equality—in the way that mental health patients are treated.