Oral Answers to Questions

Debate between Paul Williams and Jackie Doyle-Price

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend is right: people with mental health conditions do tend to develop them as children. Clearly, the earlier we can give them support to help them manage those conditions, the better for their long-term wellbeing. Equally, however, we need to make sure we have sufficient community services when they leave school and get older, so that having invested in their wellbeing, it can be continued through later life.

[Dr Paul Williams (Stockton South) (Lab)]

Is the Minister confident that the mental health of the 5,000 children with special educational needs who spent time in school isolation booths last year was not harmed, and if not, what representations has she made to the Secretary of State for Education about this practice?

[Jackie Doyle-Price]

The hon. Gentleman, as usual, raises a very important issue indeed. Of course, people with special educational needs will be at risk of mental ill health more than any other cohort of children. I am having regular meetings with the Under-Secretary of State for Education, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), who has responsibility for children and families, about this very vulnerable group. Having targeted mental health provision across mainstream schooling generally and put in such investment, we now really need to home in on the groups at highest risk.

Oral Answers to Questions

Debate between Paul Williams and Jackie Doyle-Price

Tuesday 18th June 2019 Commons Chamber

[Jackie Doyle-Price]

It is essential that we end the practice of out-of-area placements because, as my hon. Friend rightly says, being in close proximity to family and friends is clearly going to aid the recovery of anyone suffering from mental ill health. This has been a particular problem for children and young people, and a particular problem in the south-west, but I can report to him that NHS England is making sure that we have more adequate bed provision across the country, and we will continue to drive down these out-of-area placements.

[Dr Paul Williams (Stockton South) (Lab)]

Somebody is much more likely to need mental health services if they have experienced childhood adversity. The all-party group on the prevention of adverse childhood experiences has looked in detail at the evidence base on policies to prevent this adversity. What is the best thing the group can do to influence the Government’s prevention strategy?

[Jackie Doyle-Price]

I have to say, the hon. Gentleman does it very well: he continually makes noise about this important issue. He is absolutely right that adverse childhood experiences inform people’s future mental health, or mental ill health. We are currently looking at our provision for early years intervention and the first 1,001 days—the hon. Gentleman and I have discussed the importance of that—but we need to make sure that state organisations take advantage of every contact they have with children, to ensure that we pick people up when they are vulnerable.

Health and Social Care Committee

Debate between Paul Williams and Jackie Doyle-Price

Thursday 28th February 2019 Westminster Hall

[Dr Williams]

I thank my hon. Friend for emphasising maternal mental health. The Government have made significant progress in improving services, particularly for people with more severe perinatal health problems, but we still have too many cases where people are likely to develop mental health problems, even if those problems are not predicted, and who say they have mental health problems in the perinatal period, but services do not detect those problems. The National Childbirth Trust has estimated that perhaps up to 50% of mothers with perinatal mental health problems never get asked about their mental health. It is welcome that some areas of the country are responding to that issue in an assertive way and seeking to prevent perinatal mental health problems, rather than just detecting them early. However, we are left with a lottery, whereby some areas do this work exceptionally well, and other areas still have to catch up.

The idea of a local authority-led plan, with some central accountability, might help to bring the kind of services that are obviously being provided already in Dewsbury to many other parts of the country.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

May I, too, thank the Committee for its excellent report?

As Members are aware, tackling inequalities is part of my brief and, frankly, there is no more obvious place to start than in the very early years. If we can get all children a good start, we will not only be well on the way to making life better for them, but will, as the hon. Member for Stockton South (Dr Williams) has observed, make savings for the taxpayer, too. I encourage him to continue pushing this work. As he is aware, prevention is very much at the heart of this Secretary of State’s agenda, and what we can do in the first 1,000 days is clearly a big part of prevention.

I note that the hon. Gentleman will meet the Leader of the House very shortly. He will find that she is very enthusiastic about and receptive to a lot of the themes that are discussed in this report, so my message—indeed, my plea—to him is this: please carry on with this work.

Oral Answers to Questions

Debate between Paul Williams and Jackie Doyle-Price

Tuesday 15th January 2019 Commons Chamber

[Jackie Doyle-Price]

I am grateful to my hon. Friend for his question, because this was top of my list of asks as we were developing the forward plan. The NHS has reiterated its commitment to ensure that a 24-hours-a-day, seven-days-a-week community-based mental health crisis response for all adults is in place across England by 2020-21. All adults experiencing a mental health crisis will be able to be directed to support via NHS 111. This is based on best practice as shown by the Cambridgeshire and Peterborough NHS Foundation Trust. I am grateful to my hon. Friend for his interest in this, and I can assure him that NHS England, all the commissioners and I are very much on it.

[Dr Paul Williams (Stockton South) (Lab)]

Half of all women who experience depression or anxiety in the perinatal period say that their problem was not asked about by health services. There are some genuinely positive things to say about the NHS long-term plan’s proposals for specialist services, but what is the point in having services if half the people with a problem do not have it diagnosed? What are we going to do about that?

[Jackie Doyle-Price]

The hon. Gentleman has quizzed me about this a number of times, and I know that he cares very deeply about it. One of the specific issues he has raised with me is the awareness of GPs and their involvement in diagnosing these problems. Obviously we are taking that forward as part of the GP contract. I can also advise him that there is a significant expansion in perinatal services. We are confident of achieving the national trajectory of 2,000 more women accessing specialist care this year, and more than 7,000 additional women accessed such care as of March 2018.

Perinatal Mental Illness

Debate between Paul Williams and Jackie Doyle-Price

Thursday 19th July 2018 Westminster Hall

[Jackie Doyle-Price]

As I have often said, the real focus of the Green Paper is on schools and measures that we are taking with the Department for Education. However, the hon. Lady and others will be aware that we have committed to extra funding for the NHS and we are working with NHS England on what we can all expect with that extra funding. I am open to representations as we develop that 10-year plan as to what else we can do in this space. As we are in discussions with NHS England, I cannot make any commitments but this is exactly the time when we should rigorously be testing policy suggestions and interventions that we might be able to deliver.

[Dr Paul Williams]

It was reported in the Health Service Journal two days ago that the chief executive of the NHS, Simon Stevens, has outlined five priorities for the 10-year plan and that one is reducing health inequalities. Does the Minister think that a serious focus on reducing health inequalities—particularly those that are embedded from the beginning of life—should be a focus for the 10-year plan?

[Jackie Doyle-Price]

The hon. Gentleman earlier used the phrase “spend to save”, so the answer is yes, because obviously if we make interventions earlier and they help people to help themselves, there is a long-term saving to the NHS. That is the exact spirit in which we are entering the 10-year plan for the NHS. I look forward to hearing suggestions from the APPG—get in touch with us soon.

I thank everyone who has contributed to the debate and hope that we can go forward with the shared objective of doing the best we can for new mothers. By that I mean not only improving services, but giving support in general to women who are going through the experience of motherhood. As many Members have said, we are offered a fairy tale fantasy about how everything is perfect and wonderful, when actually there is a lot of associated vomit, pain and misery—joyful as the experience is overall. We need to tackle the taboo, because the fact that we think that everything is a perfect fairy tale means that the pressure on those women who are struggling makes them feel like failures. They are not: it is all entirely normal.

I am always struck by the fact that one in three women suffers from incontinence. People do not know about it, because everyone suffers in silence and just gets on with it. I often ask, “How would it be if one in three men suffered from incontinence?” We would hear about that a lot more. We need to be generally more open and give women the message: “Do you know what? It is normal to feel you are struggling, and feel miserable, because you have gone through a life-changing experience and a physical trauma. It is inevitable that it will affect your mental health.” Giving them the message that it is normal is half the battle, because they will realise that they are not a failure but just need to manage and work through the situation. We need the right services in place to help them.

--- Later in debate ---

[Jackie Doyle-Price]

I will write to the hon. Lady with some detail on the figures, but the point is that the access is there. Obviously, it will take time to become embedded. We have a good direction of travel to deliver against that commitment and we will continue with that. Community-based provision is key, but we also need to ensure that there are sufficient specialist perinatal mental health beds in mother and baby units for particularly severe cases. NHS England has taken a more strategic approach to commissioning, so that there is a level of access that does not involve wide-scale moving out of area.

As ever with transformation programmes, change takes time, but we are on track to meet our commitments. We are investing £63.5 million this financial year to support the development of those specialist perinatal mental health community services across England. Our pace of change is to enable 2,000 more women to access specialist care. Last year that was exceeded, so we should maintain the pace that we planned in the five-year forward view.

I have visited one of the new in-patient mother and baby units in Chelmsford, where there are four new beds. That centre is expanding its capacity. As well as opening new centres, we are expanding the capacity of existing ones to give more support. In Devon, the trust opened a four-bed mother and baby unit in a reused space in April this year while the new unit is being built, so we still have that provision even though there is not the physical space. By the end of this financial year, we will have expanded the capacity of those beds by 49% since 2015 and there should be more than 150 beds available for mothers and babies in those units.

We are also expanding psychological therapy services, which successfully treat many women who experience common mental health conditions such as depression and anxiety disorders during the perinatal period. We have set an ambition for at least 25% of people with common mental health conditions to access services each year by 2020-21, including extending provision to ensure swifter access for new and expectant mothers. However, as we have heard today, getting perinatal mental healthcare right is not just about expanding specialist services in isolation. Many professionals in different parts of the health and care system are well placed to support women in the perinatal period. NHS England is working with partners to ensure that care for women is integrated and joined up effectively. More than £1 million was provided in 2017 to enable the training of primary care, maternity and mental health staff, to increase perinatal mental health awareness and skills.

NHS England has also invested in multidisciplinary perinatal mental health clinical networks, which will include GPs across the country to support that strategic planning, working across services to ensure that those wider services are in place. The role of GPs is central in identifying when someone is suffering from perinatal mental illness, and to ensure that those women are directed towards treatment. The role includes monitoring early-onset conditions, including pre-conception counselling, referring women to specialist mental health services, including access to psychological therapies, and specialist perinatal community teams where necessary.

I am aware of the NCT’s #HiddenHalf campaign; I am grateful for its campaigning on this important issue. The National Institute for Health and Care Excellence recommends post-natal checks for mothers and new-born babies. NHS England expects commissioners and providers of maternity care to pay due regard to the NICE guidelines. My hon. Friend the Member for South West Bedfordshire raised this issue and said that, since this was part of what we should expect from GPs, it seemed anomalous that so many mothers and babies were not getting such checks. We make clear to GPs what we expect of them, as part of their contract, but ultimately we rely on clinical commissioning groups to ensure that GPs deliver against the obligations that we expect of them. This is not the only case where this happens—many GPs are not delivering learning disability health checks either. We need to be clear with NHS England that we expect that obligation to be delivered.

[Dr Paul Williams]

The hon. Member for South West Bedfordshire referred to a maternity additional service that only four general practices have opted out of. Is the Minister aware of what period of time that additional service covers?

[Jackie Doyle-Price]

I will come back to the hon. Gentleman, but this area requires further exploration because we need to be clear about how we deliver on those things.

[Dr Williams]

I will gladly tell the Minister: the period of time covers pregnancy but ends 14 days after birth. Whereas it may be very appropriate for a GP to provide care during that time, the additional service that the hon. Member for South West Bedfordshire referred to ends 14 days after birth. We are talking about a different issue: the opportunity to do a check six weeks after birth. There is no commissioning of that check at the moment. It is helpful that the Minister says that she expects commissioners to commission that check, but is that a commitment from the Government to ensure that commissioners are funded to be able to commission that six-week check?

[Jackie Doyle-Price]

I was coming to that—I was just dealing with the point made by my hon. Friend the Member for South West Bedfordshire.

Moving on from the NICE guidelines, we clearly expect GPs to do their part in identifying and supporting women. We are aware of the campaign, but any changes to GP contracting arrangements to specifically include the six-week check-up would need to be negotiated with the GP committee of the British Medical Association. Those negotiations are taking place and will be completed by September. I cannot give any firmer commitment than that, other than to say that we obviously want to see GPs make their contribution.