Mental Health Taskforce Report

Rehman Chishti Excerpts

Wednesday 13th April 2016 Westminster Hall

[James Morris (Halesowen and Rowley Regis) (Con)]

I beg to move,

That this House has considered the report from the independent mental health taskforce to the NHS in England.

It is a pleasure to serve under your chairmanship, Mr Wilson. This is a very important debate on the “Five Year Forward View for Mental Health” report, published in February. I pay tribute to the chair of the taskforce, Paul Farmer, who is the chief executive of the mental health charity Mind, and the vice-chair, Jacqui Dyer, for all their work. I also thank all the other members of the taskforce and the people throughout the country who contributed to its work. It is an excellent study that contains more than 50 concrete recommendations about how we need to go about improving mental healthcare in our country.

The report represents an historic opportunity. There are three reasons why I believe it is pivotal to the whole history of our approach to mental healthcare in Britain. First, both the public debate in Britain about mental health and our social attitudes towards it have been transformed over the past 10 years. The quality of the debate in Parliament, the media and the public square is at a completely different level from where it was for many years. We are addressing issues of stigma and are open to discussing mental health problems in society.

Secondly, there is a general recognition in the Government and across parties that for too long, mental health care has been underfunded in the national health service. There is now a mature debate about how we should fund mental health services over the next decade.

Thirdly, I strongly believe that, as a result of the work of many people from all political parties over a long period of time, mental health is now at the top of the list of public policy priorities. We now have the political will, which is manifested in the Minister himself, who is absolutely committed to delivering on the plan formulated by the independent taskforce. Those are the reasons why I believe the report represents an historic opportunity.

The report provides a route map for change so that we can give hope to those throughout the country who are currently suffering from mental health problems and who may not be getting, or feel that they are getting, the level of service that they should from the NHS. I shall concentrate on the implementation issues highlighted in the report. There have been many reports over the past 20 years, and many strategies have been determined by Governments of both main political parties. I think we would all agree that over that period we have not made sufficient or fast enough progress, given that mental health issues are becoming more visible in society and given the prevalence of the mental health issues we are seeing across the age range and across the social and economic landscape of the country. There is a real urgency that we get this right, and now.

What do we need to do to drive the change that we all want to see in the quality and availability of mental health care in Britain today? The report focuses on four areas that are critical to implementation—commissioning; the importance of research and data; the incentives, levers and payments for services in today’s NHS; and leadership in the NHS and across Government. The truth is that, to achieve our goal of transforming mental health services in Britain, we need urgent action in all four areas.

The report is clear about the challenge we currently face on commissioning. It states:

“The quality of local mental health commissioning is variable. We found a twofold difference in apparent per-capita spend by CCGs, a more than threefold difference in excess premature mortality in people with mental health problems in England and a fourfold variation in mortality across local authorities.”

The reality is that we need better and more effective commissioning at a local level.

The report discusses the model of commissioning set out by the “Future in mind” taskforce, which looked into child and adolescent mental health services and came up with recommendations for improving commissioning. Those recommendations, which are picked up in the “Five Year Forward View” report, speak to the need to improve commissioning across mental health services and across the age range.

[Rehman Chishti (Gillingham and Rainham) (Con)]

I pay tribute to my hon. Friend for securing this debate and for all he has done for mental health in his time in Parliament. He has been an absolute champion of it. Does he share my concern, which is shared by the Royal College of Psychiatrists, that there is currently no proper accountability for local clinical commissioning groups? The Bill on accountability in commissioning that I presented to Parliament last year would have required every CCG in the country to report back to the Secretary of State every year on the resources and spend in the local area. That way we would know exactly what was going on and could ensure parity of esteem in resources and allocation.

[James Morris]

My hon. Friend makes a very important point. He is right, and I will come to the need for greater accountability later in my speech.

On commissioning, the “Five Year Forward View” report states:

“The transformation we envisage will take a number of years and without clear information about what the best care pathways look like and good data on current levels of spending, access, quality and outcomes, it will be hard to assess the impact of organisational change and ensure mental health services are not disadvantaged.”

Its very first recommendation is:

“NHS England should continue to work with Health Education England…Public Health England…Government and other key partners to resource and implement Future in Mind, building on the 2015/16 Local Transformation Plans”—

which I know are in the process of being implemented—

“and going further to drive system-wide transformation of the local offer to children and young people so that we secure measurable improvements in their mental health within the next four years.”

I dwell on those recommendations because—this speaks to my hon. Friend’s point—we need more transparency on what clinical commissioning groups are spending and where. The report is clear that there is currently simply too much variability across the country. I have long been an advocate of the importance of local, decentralised decision making. It is important that clinical commissioning groups have the freedom to commission services that they think are appropriate to their local population. The report is clear that we need a more consistent approach on mental health services that focuses on collaboration and more integrated commissioning across the spectrum.

--- Later in debate ---

[James Morris]

That is precisely what I am arguing for. Over time, we need to move to a model that does not discriminate between mental and physical health, with integrated payment reflecting the fact that there are a lot of conditions and a lot of comorbidity. Getting the payment system right in the NHS is fundamental to everything about the aspiration for parity of esteem. “Parity of esteem” is an interesting set of words, which can be interpreted to mean that we want a culture change or a system change—all of which is right—but to achieve it we need to change the payment model for how services are commissioned and purchased in the NHS.

[Rehman Chishti]

I agree with the model that my hon. Friend is proposing. From my discussions with the Royal College of Psychiatrists, which has backed a Bill on accountability, I believe that such a model would achieve a more holistic approach for patients, which can only be a good thing for outcomes.

[James Morris]

Again, my hon. Friend is absolutely right. The model contained in recommendation 47 and discussed in the report should drive the achievement of parity by moving towards an integrated tariff or pricing model. A lot of detailed work needs to be done to achieve that—I am not saying it is something that the Minister will be able to implement in the next week—but it goes, fundamentally, to the transformation argument that is at the centre of the report.

Perhaps most importantly, the report talks about the importance of, and absolute need for, strong leadership in the NHS and across Government to drive the change and to make things happen. This is not only about the NHS, but about the whole of Government; it is about putting mental health at the heart of our thinking in many different areas. We need a cross-Government approach, with a strong grip at the centre. I say that despite being someone who believes in devolution, because in mental health policy we have reached the stage of consensus, with much agreement about what needs to be done, but we need political will and a grip at the centre of Government to make things happen. The truth is that the existing system needs to be challenged. We need a culture of challenge—if we say that we are allocating money to mental health, why is it not being spent? Why is it not delivering the outcomes that we need?

As the report highlights, successful implementation is about not only co-ordinating our healthcare response but what we need to do on mental health in education, criminal justice and, as my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) said, back to work programmes in the Home Office. Everything should be working together to achieve the goal of supporting the five-year transformation plan for mental health.

The last recommendation of the report, recommendation 58, might sound somewhat technical and bureaucratic, being a little obsessed with governance, but it is fundamental. It states:

“By no later than Summer 2016, NHS England, the Department of Health and the Cabinet Office should confirm what governance arrangements will be put in place to support the delivery of this strategy.”

That process of ensuring that the recommendations are followed through, that there is a performance and accountability framework, and that change is driven from the centre strikes me as fundamental.

The implementation challenges highlighted in the report are substantial and require action on multiple fronts. As I said earlier, the Minister has shown absolute commitment to addressing many of them. Will he give us an update on what progress has been made in the four areas that I have described today, namely commissioning, data and research, new payment mechanisms in the NHS and leadership in the NHS and across Government?

Getting this right is an historic opportunity. As I said at the beginning, to some degree the stars are aligned: we have a high-quality public debate; much more openness about mental health and its discussion; a mature debate on how we fund mental health; and political commitment at the highest level of Government, with the Prime Minister having made several speeches on and commitments about mental health in the past few months. We have the opportunity to drive forward what a 21st-century mental health care system should look like and make it deliver for all the people out there who need care and support. They are relying on the opportunity being realised and on us getting it right.