Child and Adolescent Mental Health Services: North-east

Sharon Hodgson Excerpts

Wednesday 10th July 2019 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

As hon. Members know, it is very difficult sometimes to secure an Adjournment debate—the last one took me over a year to obtain—so I was very pleased when this one was granted, especially as it is on such an important matter, as I will outline in some detail tonight. It is especially welcome that business has fallen early tonight, so I do not need to rush or curtail my remarks to leave time for the Minister. This is such an important matter and I know we will both have plenty of time to deal with this issue.

I would first like to thank my constituents for bringing their case to me, and for waiving their anonymity in the hope that their story can help other families and ensure that something like this does not happen again, as it could so easily have had a tragic ending. Going public like this is a very brave thing to do and I sincerely hope that their story, and today’s debate, will spark a change.

In March this year my constituent, Mr Thomas, wrote to me about his daughter Jane, and the

“deplorable treatment when attempting to access CAMHs support”.

Jane, aged 16 at the time—she is now 17—tragically lost her mother as a result of alcohol abuse. Everyone will appreciate the grief that this will have caused Jane and her family, and the lasting impact of that grief after years of watching a parent decline due to alcohol abuse. Many hon Members, such as my hon. Friend the Member for Leicester South (Jonathan Ashworth), my right hon. Friend the Member for Don Valley (Caroline Flint) and my hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne), have spoken growing up with similar experiences. I pay tribute to them, and to Jane, today.

Having experienced such loss on top of what she would have seen her mum go through over the years, Jane was understandably struggling with her mental health. Mr Thomas therefore felt that Jane needed professional intervention. Having consulted Jane’s GP, Jane was referred to North Durham child and adolescent mental health services at Tees, Esk and Wear Valleys Foundation NHS Trust. This is where Mr Thomas’s frustration begins.

Jane waited weeks for a CAMHS appointment following the referral, but it was not forthcoming. Mr Thomas went back and forth with the GP to ensure that the referral had been made, and was assured that it had. He was even shown the email confirming that. He then contacted the CAMHS team directly over the phone. As you can imagine, he was surprised to hear that they had no record of any referral regarding Jane. Mr Thomas says that this

“set the pattern of misinformation and incompetence that Jane and I were to encounter.”

Mr Thomas contacted CAMHS again to enquire whether an appointment would be made for Jane, and was told that Jane would not be seen as her need had already been assessed and her case was closed. That exasperated him further, as it referred to an earlier episode and a case from several years earlier, not the most recent case following the death of Jane’s mother. Therefore, it did nothing to inspire confidence.

Jane finally saw a CAMHS practitioner at the end of last year and was making positive progress, but her last appointment was on 4 January 2019. It is now July, and Jane has not had another appointment on the national health service in the past seven months. The initial reason for the delay was that Jane’s counsellor had left to start her maternity leave—something that, of course, she is absolutely entitled to do—but the trust will have been well aware for some time that the counsellor’s maternity leave would need to be covered. There also should have been a period of handover so that the service could continue its work smoothly. That did not happen.

Maternity cover was found after a gap of more than two months. However, just days after starting, that person resigned their position, leaving the trust unexpectedly without any cover. I am told that that was for personal reasons. It was at that point that the trust wrote to Jane Thomas, on 8 March, apologising for the delay in her treatment and suggesting that, if she had any inquiries, she should contact the team at North End House or, if she was in crisis, she could call the CAMHS crisis team. It was then three months since her last treatment.

It was upon receiving that letter that Mr Thomas contacted me to bring all this to my attention. There was nothing in the letter to Jane—I have seen a copy of it—to suggest that she should contact the trust to arrange an appointment or alternative provision; it just said to call if she was in crisis. I therefore wrote to the trust on 18 March, asking them to examine this matter further and advise Jane and Mr Thomas.

On 29 March, I received a reply that said that the trust had

“looked at interim solutions, such as part time staff working additional hours.”

It did not say whether that was actually happening, or whether that would include an offer of support to Jane, only that they were looking at it. That was just one of the many opportunities that the trust had to take another look at Jane’s case, to see what interim solutions were in place for her and to make contact with her directly, perhaps by calling her, as they did yesterday—I will come to that in a moment. But that did not happen.

Yesterday, I spoke to Mr Levi Buckley, director of operations at the trust, in advance of this debate. We had been trying to arrange a call for some time and could not get the dates to match, but obviously that changed once I secured this debate. I was told yesterday that alternative arrangements had been put in place for the majority of patients. He told me that when Jane’s counsellor went on maternity leave in January, all those patients should have had their cases reviewed and reassigned to another counsellor or another support network. However, for whatever reason, that did not happen for Jane, although I am told that it did for all the others. Jane had obviously, and shamefully, just slipped through the net. The trust realised that, no doubt prompted by Mr Thomas, and in March, when the new counsellor started and then left after two days, they contacted Jane to apologise with the letter dated 8 March that I mentioned earlier.

There was no concerted effort at any point by the trust to re-establish contact with Jane, who for all they knew was getting no support at all with her mental health. There was just that one letter. Even after I contacted the trust on 18 March to begin this dialogue, they still made no further contact with Jane until yesterday, when she was called within two hours of my conversation with Mr Buckley, prior to this debate. I understand that Jane spoke to the head of the CAMHS service, who apologised and offered her transitional provision to move her into adult services, as she is 18 later this month. It is, of course, entirely up to Jane what she decides to do.

Having spoken to the trust, they agree that they could have done more to make contact with Jane, who obviously was easily contactable, as they spoke to her without delay yesterday. There have been many opportunities available, since March when I first contacted the trust on behalf of Mr Thomas and Jane, to make that direct contact and arrange counselling provision for Jane, but that did not happen. That means that a vulnerable young person had fallen through the gaps because of incompetence, and even when it had been brought to their attention in March, nothing was done to rectify the situation until yesterday.

It does not need me to point out that this could have been fatal, had Mr Thomas not sought and paid privately for mental health provision for Jane. I understand from my call with Mr Buckley yesterday that the situation at the trust was made more difficult because, after advertising the job twice and getting no applicants, they had to lower the grade of the position—meaning that the person would require more supervision—in order to attract someone they could employ. This person is due to start in September—nine months after the counsellor on maternity leave left. Mr Thomas emailed me earlier today to say that the

“analogy of too many Generals and no Soldiers would suggest itself”.

I agree.

In April, when I met Mr Thomas in my constituency surgery, he was very clear that this was about incompetence and bad management within the trust that had allowed his daughter to slip through the cracks. What has most frustrated him about this ordeal is the lack of accountability for what he calls the

“appalling management of the service”.

He went on:

“This CAMHS organisation is poorly led, poorly administered and managed with incompetence.”

Can the Minister please inform the House who should be accountable for these failures?

A freedom of information request made in 2018 to the Care Quality Commission by a concerned parent inquiring into numbers of complaints made against CAMHS went unanswered, with the CQC stating that it did not have full oversight of this organisation and therefore could not provide the requested information. Who does oversee CAMHS? Who should be taking responsibility for the vacancy gap and the real problems that the trust has had in filling the vacancy, and for the impact it has had on vulnerable young people who need access to support? What advice can the Minister give to my constituent, who just wants to help his daughter get the professional treatment she needs, when she needs it, on the NHS? Does the Minister think that trusts should not be able to mark their own homework on such cases? They must surely be held accountable when there are failures and recognise the need for change. I hope that this debate brings about some change.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

I thank my hon. Friend for bringing this debate to the Chamber, and for explaining the importance of mental health services in the north-east. In Scotland in the last five years, there has been a 50% increase in the number of suicides among 15 to 24-year-olds. We need to do something about this national crisis.

[Mrs Hodgson]

I thank my hon. Friend for his intervention. I would encourage him to apply for a debate with the same title, only with “Scotland” at the end instead of “North-east” so that he can explore that 50% increase in greater detail. If he is lucky, he might get a nice long session like me, but I know the Minister will have heard his comments.

Throughout all this incompetence it is Jane who has suffered. If this is an issue of recruitment and retention, which it seems to be, what will the Minister do to ensure that CAMHS staff are both recruited and retained nationally, and specifically in the north-east? Nationally, the number of consultant child and adolescent psychiatrists fell by 4.5% between October 2013 and October 2018, which might account for why it was so hard for the trust to recruit someone, while the Government are on track to miss their mental health workforce target by 15,000 staff. Labour research in January found that the total number of mental health nurses had fallen in every month the previous year. I should be grateful if, in her remarks, the Minister would address the issues that led to this decline in the number of mental health nurses and evaluate the impact that it is having on young people such as Jane.

If an A&E just closed its doors because of a lack of staff and stopped treating people, there would be an outcry—we would not stand for it—so why do we allow it to happen when it comes to mental health? The Prime Minister said she wanted mental health to be a priority, but the Government are nowhere near achieving that goal. Mental health awareness is one thing, but it must be matched by mental health support and treatment services, and that is where the Government are failing, especially with regard to staffing.

According to research carried out by the Children’s Society, more than 110,000 children a year are unable to access mental health support from a CAMHS service, despite being referred for support. Three out of four children with a diagnosable mental health condition do not receive the support that they need, according to similar research conducted by YoungMinds. This is therefore not a problem exclusive to the north-east—or even Scotland, as we have just heard from my hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney)—which is why the Government must take action.

I wrote to Tees, Esk and Wear Valleys NHS Foundation Trust, which informed me that it did not operate a waiting list in County Durham and Darlington CAMHS. However, Jane and other young people, across the north-east and the whole country, are still waiting. It beggars belief that the trust could say that, but it is in the letter that it sent to me.

As I have said, Mr Thomas was left with no choice but to engage a private practitioner. That came at a huge cost to him and his family, but as a loving parent he felt that he had no other option. No parent should be put in that position, and not all parents have the means to step in when the services let them down so badly, as was the case for Jane.

According to the Royal College of Psychiatrists, mental health trusts have less money to spend on patient care in real terms than they had in 2012. Of course, lack of funding means that trusts are strained and unable to provide vital services. Is that what led to the staffing problems in this trust? Was its inability to fill the vacancies down to the salaries being offered, or was the workload that was being demanded of staff too high? Why did that new person leave after only two days? Will the Minister support Labour’s calls for the ring-fencing of NHS mental health budgets and an increase in the proportion of those budgets that is spent on support for children and young people? Increased funding will relax some of the pressure on services, and will ensure that they can be sufficiently staffed and resourced to improve patient experiences.

As I said at the beginning of my speech, Mr Thomas and Jane were very brave to allow me to share their story with the House in so much detail today. However, it should not have come to this. Jane, having mental health problems, should have been referred to CAMHS, been assessed and then been given therapy appointments as necessary to support her recovery—unbroken, with no seven-month gaps in provision. Instead, she and Mr Thomas have been back and forth and have had to fight, and even pay, for the support that she needs and to which she is entitled.

Mr Buckley, from the trust, informed me that North Durham CAMHS had seen an 18% rise in referrals over the last year. It follows that as the number of referrals rises, the funding must also increase to meet that need. The Government must increase the proportion of mental health budgets spent on support for children and young people: they must make mental health a priority, with actions and not just warm words.

While the staffing crisis and mismanagement at Tees, Esk and Wear Valleys NHS Foundation Trust rages on, Jane still has no access to treatment and support on the NHS, although I have been told that she received a call yesterday suggesting that the problem might be resolved shortly. I therefore ask the Minister what she will do for Jane, and young people like her, to ensure that situations like this do not occur in future.

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

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for the sensitive way in which she has outlined the case of her constituent Jane. We often debate NHS issues in this place, and it is often a case of trading statistics and numbers, but the hon. Lady has reminded us all that there are vulnerable people needing help who are potentially at risk of more harm when the NHS fails them. I will write to her in more detail answering some of the questions that she has posed to me today, but for the moment I will address some of the issues with which I am able to deal.

We have articulated clear ambitions for improving children’s mental health services, but, as the hon. Lady outlined extremely well, this follows decades of under- investment in those services, and there is a way to go from where we are now to where we need to be. The waiting times that Jane has experienced, which the hon. Lady outlined, really are not acceptable.

We will be very clear about our ambitions, but the hon. Lady is also right to highlight that we are very dependent on the performance of individual trusts in terms of delivering that. She set out the challenge as regards the Tees, Esk and Wear Valleys NHS Foundation Trust very well. The Care Quality Commission is giving quite a lot of attention to that trust for one reason or another, and the trust will be made much more accountable. I always say that sunlight is the best disinfectant, and one of the issues that we collectively face is that because mental health has for so long been something we have not talked about enough and has been stigmatised, mental health services have been a bit out of sight, out of mind, and have not had the scrutiny that they should have had.

The comparison the hon. Lady draws with an A&E, saying if it was turning away patients like this there would be an absolute scandal, is right, and part and parcel of achieving parity of esteem is that we must expect the same high performance and standards of our mental health services as we do of our physical health services. I know that the hon. Lady will not let me get away with not taking that as seriously as I possibly can.

We have made some progress, but, as the hon. Lady has heard me say before, I am in no way complacent about where we are. It is not just that we need overall improvement; there is great disparity between various regions and areas across the country, and the hon. Lady represents an area that is particularly challenged. She made some points about waiting time standards, and I am getting quite an inconsistent picture as regards the performance of that trust, which suggests to me that there is something wrong with the data and how things are being measured. Again, we need to hold everyone to account so we can be sure that our waiting list and waiting time data are accurate.

[Mrs Hodgson]

When I spoke to Mr Buckley about the sentence in the letter that said a waiting list was not operated, he explained that that probably was not very accurate, because when everyone is seen and triaged, if they need an appointment to see a therapist they are given one in, say, six weeks, eight weeks or 12 weeks. He said that the fact that they are given an appointment explains why there is no waiting list. So as the Minister rightly pointed out, we will have to drill down on that, because I do not think we are measuring the same thing across all trusts if they are all using different forms of words.

[Jackie Doyle-Price]

There might be something we can do on standardising the approach, but that brings us to another challenge. We apply these targets to try to achieve a standardised service and to ensure that people get treated when they need it, but that encourages some perverse behaviours, and the hon. Lady has just outlined one of them. The challenge for us is how we apply standards of behaviour and targets without driving perverse outcomes and bad outcomes for patients. I still think we have a lot to do on that, and probably a lot of learning. We need to identify those areas that really are doing it well so that we can spread good practice throughout the system.

But there is obviously a good reason why we must make sure we get child and adolescent mental health services much better: because we know that people who suffer from mental health issues tend to develop those conditions when they are children—when they are young. We all know that early intervention is the best way, not least for the individual concerned, because they will suffer less harm, but it is also good for the taxpayer because it costs less money to help people sooner. So we must make sure that we continue to give children’s mental health much more priority than it has had hitherto, and central to that will be greater provision of services in the community.

I am really concerned about the story the hon. Lady has just told. The process that Jane has been taken through appears to have completely failed, and the communication with her and her father appears to be extremely poor. Again, I think we can go away and look at how we communicate with patients and their families, and particularly at the tone that is used. We are dealing with people who are in a very vulnerable position, and to put it bluntly, it should not be “take what you’re given”, should it? Ultimately, our NHS is there to serve all of us, and it needs to do so with sensitivity and tact.

The hon. Lady rightly challenged me about money and the need to ensure that it delivers extra appointments. We are ambitious to see many more children, through the investment we are making, but unfortunately I do not have a magic wand and I cannot roll it all out overnight. As she points out, we need to ensure that we are investing in the appropriate workforce to deliver these services.

I would like to make another point about NHS commissioners. While we are delivering this real step change in mental health provision for children, there are other things that can be done by local health commissioners—and by local authorities, for that matter—while people are waiting for referrals and appointments. There is still additional support that can be given by organisations doing good voluntary work to give wraparound support and take some of the pain out of the experience. I often say that good mental health care is not all about clinical interventions; it is about the wider support that can be given in the community as well.

Our reforms to mental health in schools have that kind of support very much in mind. We are rolling out a new workforce, which is going be based on people who are trained in psychology and therapies, but the ethos will be very much that they are working with voluntary sector organisations that will be able to provide that additional support to people who are going through periods of mental ill health. We want to ensure that many more children who are going through mental ill health are seen, not least because we are seeing increased prevalence and it will take substantial extra effort to ensure that we are providing that service.

I turn specifically to waiting times. We have introduced new standards for mental health services, and in particular, we have introduced targets with regard to eating disorders and to a first episode of psychosis. We are making good progress on those, but as the hon. Lady says, Jane had clearly gone through significant trauma and it would not be unanticipated that that would impact on her mental wellbeing. Our targets for psychosis and eating disorders would perhaps not capture someone with that level of need, but it is still important that she has access to that support. Sunderland clearly has longer waiting times than many other areas of the country. I understand that the trust has been successful in bidding for additional NHS England funding as part of a national waiting list initiative, and I sincerely hope that that will improve access for the hon. Lady’s constituents.

When we hear of cases such as that of Jane, I can understand why people feel that our commitments on transformation ring a bit hollow. I know the hon. Lady will understand that we see this as a long-term process of rolling out improved services. That is the only way we are going to embed the change in culture that we really need in how we prioritise mental health, but we need to redouble that progress, as she says. We are determined that NHS funding for children and young people’s mental health services will continue to rise.

The hon. Lady asked me about making sure there is a proper ring fence. We have demanded that CCGs increase mental health spending on children’s services by more than their budget rises, but I think we will be taking a more interventionist approach. I know that NHS England is having robust discussions to ensure that all commissioners do exactly what is expected of them. We expect to have been able to treat an additional 345,000 children by 2024 through the additional funding, and we are already seeing some benefits.

I understand that in Sunderland, local commissioners have commissioned Mind to work with young people aged 11 to 25 and give direct support in that way. In addition, there is the new Lifecycle service, which includes access to adult therapies—one of the issues the hon. Lady raised. I am told that in Tyneside 90% of young people are seen within five days for triage into the service, but on the basis of what the hon. Lady has told me, I would like to do a bit more digging to make sure that the figure is robust.

We know that the mental health sector is showing imagination and innovation in filling the skills gaps in mental health nursing and psychiatry, but it is worth noting that one of the upsides of us talking about this subject and giving so much more attention to mental health is that it is raising the profile of the sector as somewhere to work. The really nice thing is that people do care about it. Applications for psychiatry are increasing, in part, I guess, because would-be psychiatrists can see that there will be plenty of demand for their services. Although we are making the sector more attractive, providing the workforce will be a big challenge, so we need to encourage more imagination about how that is delivered.

New roles are emerging, such as peer support workers, making use of lived experience. It strikes me that people going through mental health issues often find it intimidating to talk about it and to respond to treatment. Getting support from someone who has been through a similar experience can be enormously important to their recovery, and we want to encourage much more of that. We have the new nursing associates, and we want to encourage more mature workers—perhaps women re-entering the labour market—to explore careers in mental health. We will need much more imagination in the coming years if we are to continue to deliver the workforce we need.

[Mrs Hodgson]

I am sure the Minister can guess what I am about to say. Previously, the nursing bursary was so important for older people going back into the workforce or making a career change, and especially the group of people who now do not even apply for those opportunities. Is there any influence she can exert on the Government, any hope that at some point in this Parliament they will bring back that bursary?

[Jackie Doyle-Price]

I walked right into that one, didn’t I? The hon. Lady is right in the sense that we need to enable people to learn and earn. That is the key. I have conversations with Health Education England about how we can meet our ambitious workforce targets, and I am sure that it will have noticed what she just said and my reply. Applications are increasing despite the removal of the bursary, but I believe we could do more to encourage people who are considering entering the sector, perhaps later in life, when they have a family and they need to earn.

The NHS long-term plan, which contains some very ambitious commitments on mental health, is a huge opportunity for commissioners to think much more creatively about how they deliver their local services, because we are going to have to deliver a step change in the provision of services available in the community.

I have talked a bit about the mental health support teams going into schools, and it is pleasing to see that they are being rolled out. I do not believe we currently have a trailblazer that serves the hon. Lady’s constituency, but clearly if the local trust could work with local schools on delivery, it would make a huge difference to delivering services for children and young people. I believe teams are now covering Newcastle Gateshead, Northumberland and south Tyneside, and they will be testing the four-week waiting time, which she will believe is important, particularly when viewed through the prism of Jane’s experience. Later this week, we will be delivering the next wave of those sites, so let us watch this space—hopefully we will be able to get more provision.

The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned the issue of suicide and self-harm, which is clearly a considerable priority for me. We have been fortunate in seeing declining rates of suicide for a number of years, but we are beginning to see it on the rise again among children and young people. We could all speculate as to the reasons for that. They will be complex, because every suicide has its own story, and it is usually an escalation of factors that leads to someone taking their own life. We need to take a good look at exactly what pressures our young people are facing. Clearly, Jane had had adverse childhood experiences. We know they contribute to mental ill health, but other things are involved, too. If we can identify people who are at risk early—clearly, adverse childhood experiences are a good indicator—we can make sure we give that support sooner and then we will genuinely be able to tackle suicide prevention. We are on it, but we have a lot more learning to do on that.

I am really grateful for the sensitivity with which the hon. Member for Washington and Sunderland West has outlined Jane’s case, and I will take that away and respond in detail to the issues she has raised. As a pathway of experience, that clearly is not good enough, but I suspect it is all too common. Sometimes it is useful to use a particular case study to see exactly what is going wrong and what we can learn from. I would, however, say that I am proud of the progress we are making on improving services. We need to do much more. I wish I could do it quicker, but I will do the best I can.

Question put and agreed to.