Mental Health Taskforce Report

Oliver Colvile Excerpts

Wednesday 13th April 2016 Westminster Hall

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I congratulate my hon. Friend on securing the debate. It is a pleasure to serve under your chairmanship, Mr Wilson.

Does my hon. Friend recognise that one of the key issues in constituencies such as mine, which is a low-wage, low-skill economy, is tackling depression? That is helping us get everybody into work. If we want growth, it is important that we deal with people who suffer from depression, which is, of course, another mental health problem.

[James Morris]

My hon. Friend is absolutely right. We need to support people with depression back into work. The report makes a number of recommendations, which he may be aware of, on the use of strategies such as individual placement and support to get people with mental health problems back into work.

The report also talks a lot about data, which underpin our decisions about where we should focus our efforts on mental health. It refers to a “black hole” of data and calls for a “transparency revolution” in mental health. As I said earlier, for a long time—probably 20 years or more—we have not been collecting sufficiently robust data about what is actually going on in mental health services. We need better data on what is going on to have a firm basis on which to understand what is working, what is not working and what is going on at local and national level. Recommendation 50 in the report—this pertains to what my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) said about accountability—is at the heart of the implementation challenges that we face. It states:

“The Department of Health and NHS England should require CCGs to publish data on levels of mental health spend in their Annual Report and Accounts, by condition and per capita, including for children and Adolescent Mental Health Services, from 2017/18 onwards. They should require CCGs to report on investment in mental health to demonstrate the commitment that commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall allocation”

of funding. That goes to the heart of our data challenge.

For too long, mental health services have not been properly resourced because we do not have an effective data set on what is actually happening in the NHS or, as the report highlights, an effective model in the NHS for paying for mental health services. They tend to be commissioned on what is called a block contract basis, which often has the effect of focusing on the delivery of a low-cost service, rather than on quality outcomes. We certainly do not have a model of care that focuses on an individual care pathway or a cure for an individual patient.

We need a different model of payment for mental health services in the NHS that focuses on quality and outcomes and reflects our aspiration, which is written into the NHS’s operating mandate, for parity of esteem—the integration of physical and mental health. How can we express that aspiration? To give an example, if I suffer from diabetes and a serious mental health problem, my treatment in the national health service is effectively split in two: there is a physical health pathway, which is paid for in one way, and a mental health pathway, which is paid for in another way. I believe that we need to move towards a payment-by-activity model in the NHS that does not discriminate between physical and mental health. That will certainly not happen overnight, but the report goes some way towards arguing for it in recommendation 47, which states:

“NHS England and NHS Improvement should together lead on costing, developing and introducing a revised payment system by 2017/18 to drive the whole system to improve outcomes”.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Wilson. I thank my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) for this debate.

Among several impossible jobs I have, responding to a debate of this quality in 10 minutes simply cannot be done, so in accordance with my normal practice, if I do not answer any question, I will write to the hon. Member and, with colleagues’ permission, I will link the questions so that everyone gets the same letter, so that virtually everyone who has spoken will get a letter. I will put a copy in the Library so that other colleagues can see it.

There are many things on which there is no disagreement. To give some one-liners, My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said that we now deal with mental and physical illness in an holistic way; that is absolutely right and ensures that money goes to the right place. I will cover that later, but no one disagrees.

On psychiatric liaison, we are on to that. The importance of housing and so on is now understood as part of dealing with mental illness.

My hon. Friend the Member for Halesowen and Rowley Regis spoke about valuing the public sector; yes, that is not said often enough and it is vital to do. The right hon. Member for North Norfolk (Norman Lamb) spoke of the economic case for dealing with mental illness. No one now disagrees with that. The priority that the hon. Member for Coventry North East (Colleen Fletcher) mentioned is absolutely right, and when it comes to waiting times, we are on to those. We are funding waiting times differently from when the right hon. Gentleman set them up, but they are being funded and I am happy to write to him separately on that. His worry is not shared in the Department and I can clear that up.

We are accepting the taskforce’s recommendation that we act on out-of-area placements by 2021. I would like to do it sooner if possible. I am determined to do it, but it takes time and the attitude to tier 4 will need to change. My recent experience in Hull showed me how inept current NHS processes are in deciding where new tier 4 beds should be. The situation is unacceptable and they have got themselves into a complete mess. That must change and be done properly, and I am determined it will be.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) rightly spoke about the importance of early intervention, as did the hon. Member for York Central (Rachael Maskell). I pay tribute to the knowledge and work of the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) in this area. Perinatal care is very much on everyone’s agenda.

My hon. Friend the Member for St Albans (Mrs Main) talked about the importance of work. There is now a joint unit between the Department of Health and the Department for Work and Pensions to do more of that. A White Paper or Green Paper is expected later this year and will show its importance.

On the importance of young people, the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned our work with the Department for Education on new technology, apps and earlier intervention. She is absolutely right.

I do not want to dwell on any of those matters, although I could spend 10 minutes on each, but we have all grasped how important they are. I would like to respond to the key issues raised by my hon. Friend the Member for Halesowen and Rowley Regis and the hon. Member for Liverpool, Wavertree (Luciana Berger). I can cover transparency and implementation right up front.

I thank Paul Farmer, Jacqui Dyer and colleagues for their very important report. I am determined that it will not gather dust and as a way forward I have suggested—and we will do it—that an implementation plan is published by the end of the summer. I am not sure whether that will be in August, but it will be by the end of the summer. It will detail how we intend to implement the recommendation. There will not be one response; there will be a series of responses, and there will be a website where people can see what is being done and monitor what is planned. It will be transparent. There will be monitoring by all those who have been engaged but there will be constant reference back to the taskforce’s work, so that people can see that what is being done is related to that. The Department is putting in place a robust process with people to monitor it. That is how we will do it.

I want to cover the cross-Government issues not by interministerial committee, but by way of bilaterals with colleagues to drive things forward. I think that is the right way to do that.

My hon. Friend the Member for Halesowen and Rowley Regis mentioned data, particularly in the context in which the hon. Member for Liverpool, Wavertree mentioned them. I think there is recognition that the way in which data have been collected in the past has not been good enough, and there is also recognition that we are trying to lever up standards in all places. The “Panorama” programme and the hon. Lady’s questions over a period exposed the difficulty of getting all the data in the right place. This needs a separate debate and a separate set of answers. I have put in place an investigation into where the deficiencies in the data are, and how data that are collected elsewhere but centrally can be brought together. That will not be necessary in some cases and a written question may not provide all the answers.

In relation to the matters raised in “Panorama” on Monday and the difficulty for the right hon. Member for North Norfolk, it should be possible to answer the question. The problem is in terminology and deciding at what point a young person might be in the mental health system. I have agreed to meet Deborah Coles of INQUEST to talk about the information they have gathered. Plainly, it cannot be right that one Minister says “none”, I say “one”, the NHS says “four” and INQUEST says “nine”. That cannot be fair to the people involved.

A lot of attention is paid to the death of any young person with mental health problems. My hon. Friend the Member for Derby North (Amanda Solloway) raised this in a personal context. I can reassure colleagues. There are serious incident reviews, a child death overview panel, and the Care Quality Commission is involved.

[Oliver Colvile]

Will my right hon. Friend give way?

[Alistair Burt]

If my hon. Friend will forgive me on this occasion, there is just too much to cover in a short period.

There is a national confidential inquiry into suicide and homicide by people with mental illness and the Office for National Statistics is involved. Unfortunately, there is a gap in the data between national and local sources due to commission arrangements changing. That is an explanation; it is not an excuse or an answer, so my officials are looking urgently into how we can make sure our data collection is more unified and that we are working collaboratively with INQUEST to make sure we get an accurate number and resolve any discrepancies. Most importantly, as my hon. Friend the Member for Halesowen and Rowley Regis said, we must make sure we learn from every tragedy so that we can apply the learning to make things better. We are on to that. I promise the hon. Member for Liverpool, Wavertree that I will find a way of responding to the House to put that right. I will be in touch with her further.

I thank my hon. Friend for his work with the all-party mental health group. He and other colleagues have been responsible for raising these issues over a period.

A figure from the National Institute of Health Research indicates that it spent £72.6 million on mental health research programmes in 2014-15, which in terms of particular research is £27.7 million higher than in any other disease area, including cancer. We are determined to do more research, but I am not convinced the figures are quite as bad as people say None the less, we need data and we need research. Again, the taskforce is right. The Department has accepted all the taskforce’s recommendations.

I agree with my hon. Friend that there is a need for better commissioning. We are changing the tariff terms. He said it could not be done from tomorrow, but it is being done from April 2017. To end the block payments, there will be two new payment approaches with two different tariffs. I agree with him on leadership.

The funding will be there, but it must build up over time. The money is being delivered through the spending review and how we intend to fund the national health service generally. The commitment for the £1 billion of extra funding the taskforce asked for is very important and I believe it will make a significant difference.

Commitment, money and determination from the whole of Parliament will be of huge importance in this area and I thank colleagues for their engagement.