Mental Health (Cambridgeshire)

Robert Halfon Excerpts

Wednesday 10th December 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Dr McCrea. I congratulate my hon. Friend the Member for Cambridge (Dr Huppert) on securing this debate and commend him on his ongoing interest in local health matters. I know from meeting the chair of his CCG only yesterday that my hon. Friend is a consistent champion of local services.

I am sorry that the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), cannot be here to respond to the debate, but he has already shown a keen interest in its subject, and I know that he will take action forward. I also echo the tributes that my hon. Friend the Member for Cambridge quite rightly made to NHS staff at the beginning of his remarks.

We all agree that good-quality patient care has to be expected regardless of where in the country we live. As my hon. Friend quite rightly said, for too long, mental health services were the forgotten area of the health service. That is changing under this Government, and I will touch on that later. There is still, however, much to do; I am sure that we would all acknowledge that.

Although I will not dwell on the subject too much in this debate, my hon. Friend was right to comment on prevention and on building resilience. As the public health Minister, those issues are close to my heart. He was also right to talk in broader terms about building resilience in individuals. I know considerable thought is being given to making it possible for people—young people, in particular—to withstand more of what life throws at them.

I move on to questions of national funding. For 2014-15, NHS England allocated £64 billion to CCGs for hospital, community and mental health services—an increase on the previous year of 2.54%, or £1.59 billion. In making allocations, NHS England relies on advice from one of our many health acronyms, ACRA—the Advisory Committee on Resource Allocation. ACRA gives advice on the share of available resources provided to each clinical commissioning group to support equal access for equal need. Much of our debate will revolve around those funding formulas and how they are evolving. The calculation is based on the age of populations, their relative morbidity and unavoidable variations in cost. The objective is to ensure a consistent supply of health services across the country. The greater the health need, the more money is received, because more health services are needed. The CCG model covers only non-specialised hospitals and community care, plus primary care prescribing.

I understand that the baseline varies systematically between locations. To some extent, that reflects different historical commissioning priorities in the predecessor organisations—the primary care trusts—or different mixes between the local and area commissioning responsibilities.

NHS England reviewed the funding formula for 2014-15 and the following years, and it now uses the person-based resource allocation approach, which was developed by the Nuffield Trust. Unlike the previous target models, it allows information about individuals—including their age, gender and recent hospital diagnostic history—to be combined with information about the area in which they live; that information, as my hon. Friend knows, is frequently linked to deprivation. The PBRA formula estimates the relative need of each individual. At a CCG level, the estimates are the most accurate ever used for allocations, so there has obviously been a change in how resources are allocated.

In debates such as this we often discuss the pace of the change from the actual allocation towards the target allocation. The option that NHS England agreed for CCGs reflected the challenge of directing additional funding to the CCGs that are the most under target, while not destabilising areas whose allocations were above target—I have seen that happen in London. If people have had an allocation for a long time, we must ensure that they plan for the change; such things must be done sensibly. That is a continuation of the policy of maximising growth for those furthest below target. We appreciate that CCGs in the east of England are further below their target allocations than those in many other parts of the country—my hon. Friend is right to draw attention to that—and that Cambridgeshire is one of the furthest behind target by some £45 million or 4.85%.

NHS England is already spending £500 million in 2014-15 and 2015-16 to bring under-target CCGs, such as Cambridgeshire, towards their target allocations. That approach was discussed and decided at a public board meeting in December 2013—nearly a year ago. My hon. Friend is pushing us to speak about what will happen in the future. Following my right hon. Friend the Chancellor of the Exchequer’s announcement in the autumn statement of a further £2 billion for front-line services, NHS England is reviewing the 2015-16 allocations. I hope that NHS England shares the hopes of my hon. Friend the Member for Cambridge, and that it will consider how some of that extra £2 billion can be used to help the CCGs that are furthest behind—including Cambridgeshire—to get closer to their fair share. My hon. Friend has already discussed that issue with my ministerial colleague, my right hon. Friend the Member for North Norfolk, who takes it extremely seriously and is committed to raising the matter with NHS England before it makes a decision at its board meeting on 17 December.

Like my hon. Friend the Member for Cambridge, I recognise the commitment and dedication of the staff who provide mental health service, including those who work in specialist trusts and settings, and those who work in primary care and provide services daily. I was pleased that my hon. Friend spoke about the large army of people who are absolutely critical in mental health. They are often not formally part of the NHS composition of services, but their support is invaluable to it. They are the carers and volunteers, who sometimes work in charities or voluntary organisations—my hon. Friend referred to Centre 33 and a number of other organisations in Cambridgeshire. Sometimes they are simply individuals who help or care for a parent, a friend or a neighbour because they think it is the right thing to do. Without those people, the job of the health services would be immeasurably more difficult. Like my hon. Friend, I pay tribute to them.

[Robert Halfon (Harlow) (Con)]

On that point, will my hon. Friend the Minister praise West Essex Mind, whose annual general meeting is this Friday? It does so much to help mental health services in Harlow and across Essex, and it is an example of a charity that is deeply rooted in our community.

[Jane Ellison]

Of course I join my hon. Friend in paying tribute to that organisation. It is obvious from the comments of many hon. Members in this House that local branches of Mind and other groups do terrific work. My hon. Friend clearly has a good relationship with his local branch, and I thank him for placing his regard for it on the record.

The Government have increased funding for mental health by £120 million in 2014-15. Total mental health spending in England will rise from £8.5 billion in 2013-14 to £8.62 billion in 2014-15. The Department of Health and NHS England continue to work together on that important issue. I recognise the challenge faced by the Cambridgeshire and Peterborough health economy. I agree with my hon. Friend the Member for Cambridge about the private finance initiative decisions that the previous Government made about Peterborough, and about the legacy of problems that they left.

As my hon. Friend knows, action is being taken. NHS England, the NHS Trust Development Authority and Monitor are working on a programme to support 11 of the most challenged health economies, of which my hon. Friend’s is one, and to address those with long-term integrated plans. In Cambridgeshire, a programme jointly funded by all local NHS partners and underpinned by a concordat on joint working has been put in place. Its purpose is to find a collectively agreed solution to closing the financial gap facing the economy as a whole, while improving quality of care for my hon. Friend’s constituents and everybody else who is served by the local health economy. That work is due to identify proposals by the end of June 2015.

Mental health is an important part of that work, and emerging ideas focus around closer integration of physical and mental health, and an expanded role for mental health input in a range of hospital settings and community pathways, such as those for long-term conditions. As the Minister with responsibility for public health, I know only too well that people often have extreme co-morbidities, so we must look at them in the round and at all the things that interact with and affect their personal health care.

I know that there are concerns that mental health services could be disproportionately affected, which would not be acceptable. Although payment for mental health services is agreed locally, we expect local commissioners and providers to have regard for the national tariff arrangements. However, they can be flexible when there is good reason to be so.

The tariff arrangements for 2015-16 give a clear signal to the mental health sector to move away from simple block contracts, which currently apply in Cambridgeshire and are not transparent, to local payment models that support recovery and outcomes, as my hon. Friend highlighted, and that reflect the needs of local communities.

My hon. Friend is right that Cambridgeshire and Peterborough CCG invested an additional £1.5 million to address capacity pressures. His CCG is clearly committed to that, and he will continue to champion it. It has also committed to investing a further £2.2 million from next April to deliver the Improving Access to Psychological Therapies programme.

My hon. Friend is right to pay tribute to my ministerial colleague, my right hon. Friend the Member for North Norfolk, who has championed mental health policy in this Parliament very effectively. My hon. Friend the Member for Cambridge drew attention to the Government’s commitment to parity of esteem, which has been made explicit in legislation. Some 2.4 million people have entered treatment under the IAPT programme, and more than 1.4 million have completed that treatment. We invested £54 million in the period from 2011 to 2015-16 in the children and young people’s IAPT programme. My hon. Friend is right that child and adolescent mental health services are a critical part of our local care pathways.

For the first time ever, we have a mental health crisis care concordat to improve the system, signed by more than 20 national organisations. As my hon. Friend said, Cambridgeshire has already put it in place. We invested £25 million to ensure that vulnerable offenders are identified when they first enter the criminal justice system. The aim is to achieve 100% coverage by 2017.

There is a lot going on. We all acknowledge that there is a long way to go on mental health, but we have passed several important milestones on the journey. The NHS—both nationally and in Cambridgeshire—is working hard on the wider funding issues, and I hope I have assured my hon. Friend that progress is being made. He has already had a commitment from my right hon. Friend the Member for North Norfolk, but when I return to the Department I will reiterate that we want to make representations about the points he made to NHS England ahead of the critical funding meeting. I encourage my hon. Friend to keep closely in touch with his local NHS, although I can see that he does that. I thank him for securing this debate. I hope I have given him a measure of comfort and reassured him that considerable progress is under way on this important agenda.