NHS Mental Health Care

Debate between Norman Lamb and Mike Hancock

Wednesday 11th February 2015 Westminster Hall

[Norman Lamb]

I totally agree. I hope to be able to convey some sense of optimism, actually, because, despite all the challenges that my hon. Friend the Member for Portsmouth South referred to, there are very some exciting things happening, which are laying the foundations for genuine equality for mental health. We have legislated in this Parliament for parity of esteem, but to be honest I am not interested in empty rhetoric—our words must mean something for people in need of help.

My hon. Friend referred to many aspects of the system that need to improve significantly. I will deal briefly with one—the issue of beds. We must be a bit nuanced here. It is absolutely clear that when there is a moment of crisis a bed must be available, and available locally. Incidentally, we should also look at places such as recovery houses. Increasingly, there are lots of third sector organisations that provide recovery houses around the country and it is often better for people to go into a place such as that than to be an in-patient admission, which might not be the best thing therapeutically for them. But the idea that in a middle of a crisis someone is shunted somewhere else in the country, or even put into a police cell, is really an outrage in a civilised society.

The interesting thing is that when I came into this job I realised more and more that I was operating in a fog. The data that we are absolutely used to when it comes to physical health, and the scrutiny of that data and evidence, have simply been lacking when it comes to mental health. Traditionally, we have not collected the information about access to services and what is happening to people on the ground, and that has been a fundamental issue that I have sought to address.

On out-of-area placements, I had no idea from the data that came to me about what actually happens around the country. Last week, we finally got the first sight of real data, which will now be provided on a regular basis, so that we can hold trusts to account if they fail to meet local need. The fascinating thing is that there are many trusts around the country that have no out-of-area placements at all under existing financial circumstances, while there are others that completely fail and are sending many people out of area. We need to understand why that is happening and address the causes, whether they are in commissioning, in the provider organisation or because of lack of funds, because some areas have demonstrated that that is not necessary.

[Mr Mike Hancock]

I entirely accept the idea that, when a bed is needed, a bed needs to be found. However, that person is at the very start of the crisis that made them seek help. They are shifted several hundred miles across the country, settled in and then, because the NHS suddenly finds a bed available half way back to their home, they are moved there without being given a chance to get used to the idea that they are getting help.

[Norman Lamb]

My hon. Friend does not need to convince me of that. I am completely with him and I am determined that we should eradicate this practice, which is unacceptable for people in a moment of crisis.

The use of police cells is a practice that has always gone on. Actually, because of the crisis care concordat that we published last February, for which 20 national organisations came together to set standards for crisis care in mental health for the first time ever, this year we will see a 50% reduction compared with two years ago in the number of people going into police cells. That is a real advance. We must go further and completely eradicate under-18s going into police cells. We have said that we want to ban the use of police cells for under-18s and to make such use an exceptional event for anyone else.

I want to try to deal with what we are doing to convey a sense of optimism, because I think that we are now on the right track. My hon. Friend painted a picture of the situation. There is, in my view, discrimination at the heart of the NHS, where people who suffer from mental ill health are disadvantaged compared with those with physical health problems. That must end. Access and waiting time standards were introduced in the past decade, so those who are thought to be suffering from cancer get to see a specialist within two weeks. Why does a youngster who suffers a first episode of psychosis not get that right? We cannot begin to justify that. We are therefore introducing, for the first time ever, access and waiting time standards in mental health from April so that, for a youngster suffering a first episode of psychosis, the standard will be to start treatment within two weeks. We will start with 50% of people and progressively increase that.

My hon. Friend talked about psychological therapies. There will be a standard of access within six weeks for 75% of people, with a 95% backstop to start of treatment within 18 weeks. That is what transformed care in physical health in the past decade. As Sir Mike Richards, who was the cancer tsar in the last decade, said to me, we can achieve the same transformation in mental health by applying the same rights of access that we have had in physical health for some considerable time. That complete imbalance of rights between mental and physical health dictates where the money goes, and that must end.

[Mr Hancock]

I will be very quick. This issue is made worse: Mind carried out a survey of all local authorities in England and found that, on average, they allocated just 1.36% of their public health budget to help people avoid developing mental health problems. Some planned to spend nothing at all. I want to see the Minister put pressure on local authorities to have such programmes that may, just may, keep people alive.

[Norman Lamb]

Indeed, I have done exactly that. The sense is that this issue is hidden away from public view. It is not recognised that there is an extraordinarily powerful invest-to-save argument to be made, as my hon. Friend said. If we invest in public mental health and early access to therapies, whether psychological therapy or therapy for eating disorders or psychosis, there will be a return on that investment, but, critically, the individual will be helped to recover and to be able to lead a good life again. That is the challenge that we face.

Alongside announcing the first ever waiting time standards, we published a vision for making them comprehensive throughout mental health in the next five years. I want all parties to commit to implement those standards through the next Parliament so that, just as Sir Mike Richards suggested, we can achieve genuine equality for those who suffer mental ill health.

The crisis care concordat set standards for what should happen in a crisis. Across the country, we are seeing a dramatic reduction in the use of police cells, which is a very good thing. We are investing more in liaison psychiatry so that for the first time those who turn up in A and E suffering from mental ill health get access to someone who knows something about it. At the moment, people often turn up in A and E and find that they cannot see anyone with the relevant specialism. That must end, so we are investing in liaison psychiatry.

On children and young people, which my hon. Friend raised in particular, I set up a taskforce last summer, bringing in experts from outside Whitehall such as YoungMinds, the campaigning organisation. We have engaged with young people. The taskforce will publish a report soon. That is the opportunity to fundamentally modernise children’s and young people’s mental health services.

There is a funding issue. More funding is needed—some areas of the country have cut investment ridiculously in young people’s and children’s mental health services—but there is also the question of how the money is spent. Such services are commissioned in a horribly fragmented way and there is not nearly enough focus on what can be done in schools to build resilience and focus on mental well-being. If we were to do that much more effectively, we could stop the deterioration of health.

On liaison and diversion, it is a scandal of our time that so many people suffering from mental ill health end up in prison, largely because their illness drives offending behaviour. Yet so many of those people have never had access to the sorts of therapies that could help them to recover. When someone who is suffering from mental ill health turns up at a police station or a court, liaison and diversion is all about diverting them into treatment. We have 25% of the country covered now and we will cover more than 50% from April with a view to covering the whole country by 2017. No other country in the world is doing that on such an industrial scale, and we should be proud of that.

On access to psychological therapies, which my hon. Friend talked about, waiting times are far too long; that is why we are introducing a maximum waiting time standard. However, in 2010 about 300,000 people got access to psychological therapies. This year that figure will hit about 900,000—a tripling of that number.

[Mr Hancock]

That shows the size of the problem.

[Norman Lamb]

It does, absolutely. The next challenge is to bring the improving access to psychological therapies programme into line with Jobcentre Plus. We are working on that, with pilots around the country. It is ridiculous that there are so many people out of work, languishing on benefits through no fault of their own because of their mental ill health and not getting access to the therapies that could help them recover. That has to change. We must link mental health services much more closely with employment services, schools and the criminal justice programme.

There are significant areas where mental health services fall short and, as my hon. Friend rightly said, they have always done so. However, as the Minister responsible, I am on a mission—[Interruption.]