Health: Parity of Esteem - Question for Short Debate

Part of the debate – in the House of Lords at 7:31 pm on 28th November 2016.

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Photo of Baroness Chisholm of Owlpen Baroness Chisholm of Owlpen Lord in Waiting (HM Household) (Whip), Lords Spokesperson (Cabinet Office) 7:31 pm, 28th November 2016

My Lords, this has been an absolutely fascinating debate. As always, many experts have spoken on the subject. I will do my best to answer many of the questions—but I am certainly not the noble Lord, Lord Prior, who is the expert on this issue. If I fail to answer all the questions asked by noble Lords, I will make sure that we get back to them in writing.

I congratulate the noble Lord on securing this debate on parity of esteem between physical and mental health. I know that he has a keen personal and professional interest in this subject. I thank everyone who has contributed to this debate. I will answer their questions at the end of my speech.

The publication of the independent Mental Health Taskforce’s Five Year Forward View for Mental Health in February this year has stimulated discussion and debate across both Houses. As we know, mental ill health is something that can affect any one of us: one in four of us, according to the latest figures. Yet despite the prevalence of mental health problems, the stigma associated with mental health persists, so creating a barrier to people talking about mental health problems and seeking help. We know this only too well. Whenever I go out for a meal with friends, within five minutes everybody is talking about their arthritis—as we are all getting so old in this House—or their recent operations. But how often do people ever say, “Actually, I had a breakdown two years ago”, or, “I have been seeing a counsellor because I am worried about my child who has autism”? Very rarely are these issues brought up. We have a lot to do to try to make those conversations as normal as ones in which people talk about their physical health.

We are committed to tackling this stigma and this year announced a further £12.5 million of support to the national Time to Change anti-stigma programme up to 2020-21, which seeks to change attitudes to mental health. Indeed, since the programme began, about 3.5 million people have reported improved attitudes to mental health.

Mental ill health is still the single largest cause of disability, costing the UK economy around £105 billion per year, and represents 23% of the overall UK health burden. The coalition Government enshrined parity of esteem in the Health and Social Care Act 2012, as the noble Baroness, Lady Tyler, said. They also introduced the first mental health waiting times standards for access to psychological therapies in 2015 and early intervention in psychosis from 2016. These are being met by the majority of the NHS.

Following on from that, we are on the cusp of an ambitious transformation programme in mental health. But, as my noble friend Lord Lansley said, we have to recognise the scale of the challenge. As all noble Lords are only too aware, we are starting from a very low base due to chronic historical underfunding of the service. As the noble Lord, Lord Alderdice, mentioned, mental health has been the Cinderella of healthcare. We are now investing unprecedented amounts in mental health and require CCGs to continue to increase their spending on mental health each year. We have set out additional investment to transform children and young people’s mental health of £250 million each year up to 2020-21 and have set out additional investment to improve services for eating disorders, bringing the total investment to £1.4 billion by 2020-21.

Alongside this, as the noble Lord, Lord Oates, mentioned, we are working across government to deliver a robust five-year mental health data plan to substantially improve data and information about mental health services and young people. But this is not just about data collection and funding; proper investment in the workforce is absolutely essential. So we are working with Health Education England as it develops a workforce strategy, expanding both the skills of existing staff and the workforce itself. Work between the department and NHS England is ongoing to make the best use of mental health beds to ensure that people who need them can get them close to home. We have funded an extra 56 mental health beds for children and young people.

We know that the role of front-line services, including primary and community care, is paramount, particularly for those in crisis. NHS England has invested in crisis resolution and home treatment teams to provide effective intensive home treatment as an alternative to hospital admission. As several noble Lords, including the noble Lords, Lord Oates and Lord Alderdice, mentioned, primary care has a vital role to play in helping people before they even reach a crisis. The taskforce report recommended that by 2020 all GPs should have mental health training, which of course we support. Leading on from this, we have also invested heavily in liaison psychiatry services in emergency departments for patients in crisis. This will save an average hospital £5 million per year by reducing the number and length of admissions to beds. As the noble Baroness, Lady Hollins, mentioned, even more important is the potential for those in crisis to be seen and treated at an early stage. The department has funded nine pilots for street triage, managed by police forces working with NHS front-line partners. Nearly all the street triage pilot schemes resulted in a reduction in the use of Section 136 detentions. All these areas continued the service after the pilots finished. Today, 39 out of 40 police forces in England have access to a street triage service.

Public Health England is developing a mental health prevention concordat focusing on suicide prevention which will be published next year. We will strengthen the cross-government suicide prevention strategy, including addressing self-harm. NHS England will develop an evidence-based treatment pathway for self-harm during 2017-18 and 2018-19. We also plan to roll out liaison and diversion services nationally by 2020-21, ensuring that people who come into contact with the criminal justice system have their needs assessed, thus helping magistrates and judges divert vulnerable offenders to the most appropriate place of treatment. This work is already beginning to have some success—and I can endorse that. I work closely with an addiction charity in Gloucester, called the Nelson Trust, and it accepts exactly these kind of vulnerable people into the charity’s care for treatment, having been referred from the CJS.

The department and NHS England will continue accountability and ensure equal priority for mental and physical health through a number of mechanisms, such as the CCG improvement and assessment framework and the five-year forward view for mental health dashboard. These will monitor progress on commitments to transform mental health services, and the public availability of data will improve accountability for patients and the public.

I want to cover some of the points that have been raised. My noble friend Lord Lansley asked how much progress has been made for 2016-17 in securing access standards and when people will be made aware of the objectives for 2017-18. We have standards on IAPT access and on EIP and CYP eating disorders, and further plans for developing pathways are set out in the NHS England task force’s implementation plan. Independent experts at the Royal College of Psychiatrists are reviewing and supporting implementation and will report next year.

The noble Lord, Lord Oates, talked at length about suicide, and the noble Lord, Lord Cotter, also referred to this. It is a very important point. As noble Lords will know, the Five Year Forward View for Mental Health set out the ambition that the number of people taking their own lives will be reduced by 10% nationally compared with the 2016-17 level. To support this, by 2017 all CCGs will contribute fully to the development of the plans.

We are absolutely committed to improving access to mental health services. We introduced the first waiting times for mental health talking therapies—mentioned by the noble Lord, Lord Oates—as well as early intervention in psychosis. By 2020-21 we will implement a comprehensive range of community-based mental health pathways of care and standards. We are also expanding access to the successful talking therapies programme so that by 2020-21 a further 600,000 people will be able to receive the care they need.

The noble Lords, Lord Oates and Lord Cotter, also mentioned children and young people. By 2020-21 there will be a significant expansion of access to high-quality mental health care for children and young people. At least 70,000 additional children and young people each year will receive evidence-based treatment, representing an increase in access to NHS-funded community services to meet the needs of at least 35% of those with diagnosable mental health conditions. To support this objective, by 31 October 2016 all local areas should have expanded, refreshed and republished their local transformation plans for children and young people’s mental health. Refreshed plans should detail how local areas will use the extra funds committed to support their ambitions across the whole local system.

The noble Lord, Lord Hunt, and the noble Baroness, Lady Hollins, mentioned tariffs and funding. We recognise that block contracts are an issue and make it less transparent. We are working to address this. NHS England has proposed new payment approaches for adults and older people. These outcome-based payment requirements focus on improvements of care by linking payment to quality outcomes.

I think I have covered most of the questions asked. If not, I will of course write to noble Lords. What has really come out tonight is that it is not as simple as legislating for or discussing these issues. We must work with the NHS professionals and beyond to truly establish equal priority for mental and physical health. As the noble Lord, Lord Alderdice, said, this needs to be a cross-party, multifaceted approach. We need to challenge the stigma surrounding this issue and look at the role of primary care, which is paramount in this. I thank noble Lords again for all the points raised in the debate.

House adjourned at 7.44 pm.