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My Lords, I refer to my interests as listed in the register.
In reflecting on the Queen’s Speech and its relevance for the nation’s mental health, I wondered how, in 2019, we would now understand Nye Bevan’s assertion that no society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means. Over the past 71 years we have deepened our understanding of what it means to be sick and what it means to be healthy. We have seen the futility of separating health from social care, and learned that a person’s capabilities are as essential a resource as their finances.
One of the earliest debates that I was involved with in this House related to the Health and Social Care Act 2012 and the issue of parity of esteem for mental health. Informally, in preparing for that debate, I asked Members of your Lordships’ House what they understood by “health” and “illness”. Your Lordships spoke about strokes, heart attacks, diabetes and so on, but at that time there was little mention of mental illness or mental health.
The conversation has changed since 2012. There is more and better-informed talk about mental health. However, despite the commitment to parity, only 40% of people with mental illness receive treatment, and only £1 in £10 of NHS spending goes on mental health. There has been a 14% fall in the number of mental health beds since 2014 and community services have not been equipped to compensate for this change. For example, at least seven people are known to have died between June 2018 and March 2019—people who had been assessed as requiring admission but for whom no mental health bed was available.
When people are admitted to hospital, as we have already heard from many noble Lords, they are likely to experience some of the worst estate within the health service. The Government’s recent announcement of,
“the biggest, boldest hospital building programme in a generation”,
contained no new funding for psychiatric hospitals.
We are now more cognisant of the social determinants of health. Theresa May noted in her first address as Prime Minister that people born into poverty will live nine years less on average, and we have heard again today about the reduction in life expectancy for black and minority-ethnic users of mental health and learning disability services.
We also better understand the detrimental effects on adult mental health of adverse childhood experiences, including abuse, neglect and parental death or separation. I hope that the Government will seriously consider the effects of proposed longer criminal sentences and the consequent further break-up of families on intergenerational cycles of mental ill-health.
It is difficult to recover from severe mental illness if you do not have shelter, yet half of delayed discharges from mental health beds are due to difficulties in securing appropriate housing and care packages, with some patients choosing to discharge themselves and be homeless rather than remain on understaffed mental health wards, while others remain detained under the Mental Health Act for prolonged periods because of their vulnerability should they be discharged to inadequate provision. This is clearly an inappropriate use of the Mental Health Act and of hospital beds, and it is a problem based on a deficit of adequate housing and social care.
Offering psychotherapy to someone who cannot be sure that tomorrow they will have a roof over their head is like providing medication to a patient in hospital but not feeding them. For people with serious mental illnesses, learning disability and autism, the division between health and social care is not just artificial but harmful.
It is time to extend the parity principle to social care as well as healthcare and ensure that both are adequately funded. Can the Government commit to employing the principle of parity of esteem in their response to the social care crisis by placing the social care needs of people with long-term mental disability on an equal footing with the social care of people with physical illness and frailty in later years?
Just because the health service does not cost money to use does not mean that everyone has the means to use it. Many people are unable to navigate an increasingly complicated healthcare system by themselves. Fragmented and ever-changing services are difficult enough for the professionals working in them to fathom, and it takes effort and luck for any patient to get the best out of the NHS.
With the failure of the Transforming Care programme and the abuse reported at Whorlton Hall eight years on from Winterbourne View, fears that a hospital admission could lead to abuse or even death are understandable. Ongoing review by the CQC into the use of segregation for young people with learning disabilities and autism is essential. These are some of society’s most vulnerable and overlooked people and we need to understand what has gone wrong, without apportioning blame. For this, the newly announced health service safety investigations Bill is welcome.
I hope that some of the difficulties I have highlighted will be addressed through increased integration of services in line with the Government’s commitment to the NHS long-term plan. I want to end by applauding my noble friend Lady Audrey Emerton’s extraordinary contribution both in this House and as a leader in nursing in enabling better life chances for people with learning disabilities. I personally will miss her wisdom and good humour and I wish her a contented retirement.