Psychosis: Early Intervention — [Sir Roger Gale in the Chair]

– in Westminster Hall at 9:30 am on 7th September 2016.

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Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health) 9:30 am, 7th September 2016

I beg to move,

That this House
has considered access and waiting time standards for early intervention in psychosis.

It is a pleasure to serve under your chairmanship, Sir Roger. May I welcome the Minister to her new role? I spent a great two and a half years in the Department of Health; it was the most invigorating time in my life. I wish her every success.

The debate is on something that I care a lot about: a new standard of access for people who suffer a first episode of psychosis, a cruel and punishing condition that can have a massive impact on people’s lives—incidentally, at enormous cost to statutory services. When I came into my role as Minister, I recognised that there was a complete inequality of access, standards and rights between those who suffer from mental ill health and those who suffer from physical health problems. That inequality of access has existed for many years. In the last decade, the Labour Government introduced comprehensive access standards in the NHS for physical health problems, and they were right to do so—the cancer standards that have transformed cancer care in this country are a leading example of those—but they left out mental health.

It is not just that individuals sometimes end up having to wait interminably for treatment in some parts of the country; that complete imbalance of rights between mental health and physical health drives where the money goes. There is enormous political interest in meeting those demanding access standards. The national media look at the four-hour A&E standard. Certainly in my time in the Department of Health, all the great and the good of the NHS gathered around the Secretary of State’s table every Monday morning to look at spreadsheets showing the performance of every hospital in the country against those access standards. That extraordinary almost micro-management from the centre on access standards in physical health sets the tone for the whole system and makes it clear that meeting them is critical. So what do clinical commissioning groups around the country do? They trim a little bit off funding for mental health, which is still funded primarily through block contracts, to feed the beast of those exacting access standards in physical health.

I was determined from the start to address that injustice—that is what it is; it is a discrimination at the heart of our NHS—and introduce access standards in mental health. We went through a long deliberation before coming up with two specific standards, which were set out in a Government document published in October 2014, that we wanted to introduce as the start of a process that would lead ultimately to comprehensive access standards in mental health so that everyone with a mental health problem had the same right to get treatment in our NHS as anyone else.

The first standard that we identified was a six-week standard for access to psychological therapies. That is part of the improving access to psychological therapies programme, a well-regarded, world-leading programme that does not do everything but has been a significant development. The other was a two-week standard to start treatment when someone suffers a first episode of psychosis. Those people are typically teenagers or perhaps in their 20s—that is the most common age—but such an episode could happen at any time in one’s life.

Photo of David Simpson David Simpson Shadow DUP Spokesperson (Business, Innovation and Skills), Shadow DUP Spokesperson (Environment, Food and Rural Affairs)

I congratulate the right hon. Gentleman on securing this very important debate. He has hit somewhat on the point that I was going to raise about early intervention. At what stage does he believe that we should deal with this condition? He talks about 18 or 20-year-olds, but should we go right back to primary or secondary school and deal with it in younger children?

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

We should always be guided by clinical judgment. That is critical. The standard that was introduced was for people between the ages of 14 and 65, which gives a clue about the appropriate level. This condition could emerge during teenage years, but we know that 50% of adult mental health problems start by the age of 14, so getting in and addressing problems early is critical.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

I thank the right hon. Gentleman for securing this important debate. Does he agree that although not everyone will suffer mental health problems in childhood, it is important that mental wellbeing is focused on in schools—both primary and secondary—to ensure that good mental health is promoted?

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I thank the hon. Lady for that intervention, because I totally agree. When I was Minister, we set up a taskforce to look at how we could modernise children’s mental health services. It published a report last March called “Future in mind,” the whole focus of which is on shifting fundamentally towards prevention: establishing wellbeing, particularly in schools, and intervening much earlier to stop deterioration ever happening. That approach is much more effective. It can help teenagers through difficult years as they grow up, but it also stops the enormous cost to the system later of neglecting those problems.

Psychosis costs the NHS £11.8 billion a year. That is a vast cost. Only 8% of people who suffer from psychosis are in work, so the cost of the illness to society is enormous. The evidence of the effectiveness of early intervention in psychosis is overwhelming. It is clear that if we intervene quickly, we can have an impact on that condition, stop it in its tracks and give sufferers the chance of a good life, which the rest of us take for granted. If we neglect the condition, those people will almost inevitably suffer lives on benefits and with difficult relationships, at—this is critical—enormous cost to the state. Analysis shows that if we invested £1 in services for early intervention in psychosis, the return on that investment over a 10-year period would be £15. We might ask, “What is the reason not to do that?” It is overwhelming common sense. It is both morally right and the economically sensible thing to do.

Photo of Johnny Mercer Johnny Mercer Chair, Defence Sub-Committee

I pay tribute from the Government Benches to the immense work that the right hon. Gentleman did in government, and to my right hon. Friend Alistair Burt, who is no longer in his former position as Minister. Does the right hon. Gentleman agree that it is not acceptable to talk about parity of esteem unless that is matched by parity of provision and parity of funding so that those who suffer from mental ill health have the same provision as those who suffer from physical ill health? Parity of esteem means nothing to our constituents unless we actually deliver it.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I am grateful to the hon. Gentleman for his kind comments. I totally agree. There is an awful danger of a damaging gap emerging between the rhetoric and the reality. The coalition Government legislated for parity of esteem, so it is in the legislation that people should be treated equally, but unless the reality of people’s experience is that they are treated equally, the rhetoric is absolutely meaningless waffle and they lose trust in the Government. That is why I feel so passionately that we must do concrete things to make parity of esteem a reality for people, and that is an example of how we can make a difference to people’s lives.

The standard was announced in October 2014, to be implemented by April 2016—it had to be met by this year. Why is it so important? If we fail on that, we fail so many people whom we have the chance to help and surely it would be scandalous if the NHS neglected a standard accepted by Parliament and introduced by Government that we know makes a massive difference to people’s lives. It gives people the chance of a better life and surely the NHS is fundamentally about giving people the chance to have happy, good lives.

What has happened in that period? We undertook a comprehensive Freedom of Information Act survey—now that I am out of government, I have to rely on such surveys to find out what is going on—and the answers from clinical commissioning groups and mental health trusts are deeply troubling. On the key findings, first the overall conclusion is that the implementation of the standard is just fundamentally flawed. It has failed to deliver what we committed to. If the Minister, on advice from her officials, is tempted to refer to the nationally published data that suggest that the standard is being met, I would discourage her from doing so because the data are a fiction—we have established that through our work.

The first detailed finding is that there is a complete lack of robust commissioning in many parts of the country. The whole purpose of the commissioner-provider split, which of course is fairly controversial in the NHS, is that the commissioners hold the money and are there to design services for their community to meet the needs of that community, yet a third of CCGs could not identify how much funding had been allocated to early intervention in psychosis. That in itself is scandalous. They just say that there is a block contract and that it is up to the mental health trust—a total abdication of responsibility. Later, I will ask what the Government are doing about that, because that is not acceptable and completely contradicts the national guidance that was published.

Incidentally, I should say that one of the excuses used around the country for slowness of implementation is that the final guidance was published in April this year—when the standard was supposed to have been met. That does not demonstrate particularly helpful leadership from the centre. Having said that, the draft guidance had been in place for the best part of a year, so clinical commissioning groups around the country knew the direction of travel and could absolutely have been getting on with the job of preparing for meeting the standard.

When we did the survey back in May and June, well into the financial year, another 18 clinical commissioning groups—that is 11%—were still in negotiation for funding for early intervention in psychosis for a standard that was supposed to have been met in April. The question I will keep repeating is: why is that is not being treated with the same seriousness as the cancer standards? Why do we treat that as less important than someone suffering from cancer? I absolutely support and endorse the cancer standards, because it is critical that people with cancer get access to treatment quickly, but why should not someone with psychosis? It is scandalous. No one stands up for them. The Government have to lead on that. More than one in three clinical commissioning groups could not provide an estimate of the number of people in their area in need of early intervention services, in spite of the national guidance that says that commissioning should be underpinned by estimates of the local incidence to ensure that services are designed to serve the needs in a particular locality fully. If CCGs have no idea because no work has been done to establish the need in that area, how on earth can they commission a service to meet that need?

Next, according to NHS England, the estimated annual cost of providing the full package of treatment is about £8,250 per patient per year. Only 60 CCGs in our study were able to estimate their investment at all and only 11 estimated that they will meet the NHS England guideline on the level of investment. The average investment per patient from those who were able to say was £5,199, but of course an average hides the fact that many are way below that level. To draw an analogy, that is like saying to a cancer patient, “Well, you can have the chemotherapy but we can’t afford the radiotherapy, so you’ll have to put up with what we can offer.” Of course, we would never allow that to happen—the Daily Mail and many others would be up in arms, and they should be about this issue as well because the situation is exactly the same.

On age, which David Simpson raised earlier, as I said in response to his intervention, the access standard is to provide the service to people between the ages of 14 and 65, in line, I should say, with guidelines from the National Institute for Health and Care Excellence, which has done the work and provided the evidence-based guidance. Almost a quarter of trusts—23%—commission services only up to the age of 35, including my own county of Norfolk. How on earth can trusts justify anyone over the age of 35 not getting access to a service that we have deemed it appropriate to provide to people across the country? They are just ignoring the national guidelines. Again, that seems to me to be completely unacceptable. That totally conflicts with the clinical commissioning groups’ responsibility. Out of the 39 CCGs which commission only up to 35, nine said they had plans to expand the service—they have plans, but why are they not doing it now?—and another 10 said that that was under review, but the rest had no plan to provide a service to people over 35. Outrageous, in my view.

Next is staffing and skill mix. We found a widespread failure to provide the full range of interventions required by NICE as part of the package of treatment, which is due to the shortage of staff with appropriate skills to deliver the service. Most trusts reported shortages of staff trained in cognitive behavioural therapy for psychosis and there were many other training shortfalls.

On data recording, NHS England introduced new information standards to support the monitoring of standards so that we could have some confidence that they were being met. Providers are expected to use electronic care record for patients to enable the collection of data and monitoring of performance against the standard. The guidance says that commissioners should assure themselves that local providers have made the necessary updates to the electronic care record system to ensure that clinicians are able to enter the data required to monitor performance against the standard, but we have heard that many trusts have not upgraded their systems and so are incapable of doing what is in the national guidance. We talked to someone who was at the heart of the implementation of the standard in one part of the country who mentioned widespread failure to do that. That means, as I said earlier, that the national data published by the information centre, which we are all supposed to rely on to tell us what is happening in the NHS, cannot be relied on. I put this point to the Minister: can the information centre investigate that further to ensure that the data it publishes tell a true story of what is going on?

There was also a scandalous variation between regions. I met the woman who has been responsible for implementation in the southern region. She was driving a programme of implementation and had a complete handle on the whole of her region. She had enormous variation of performance across her region, but there was someone in charge, doing it. She was an impressive woman. She told me that she was being made redundant; she was told that her job was done, even though palpably it is not. However, in other regions there has been no programme of implementation—no one in charge, to take responsibility for making things happen. The situation in the midlands and east in particular is in my view a disgusting, outrageous shambles, which should not be tolerated.

Photo of Gregory Campbell Gregory Campbell Shadow DUP Spokesperson (International Development), Shadow DUP Spokesperson (Cabinet Office)

I congratulate the right hon. Gentleman on securing the debate. On several occasions he has talked about this important matter in the context of the entire country; he is now discussing comparisons. Does he agree—I have raised this issue on a number of occasions, particularly on health matters—that we need to ensure that best practice is replicated not just in local commissioning groups in England, but across the United Kingdom? Ministers would then share information across the devolved settlements, to ensure that best practice was replicated and improved on for all our citizens.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I very much agree. We should all be learning from each other—and internationally, as well; but so often we fail to do that in the NHS. People on the outside may think that the NHS is a Stalinist organisation where everyone does the same thing. Far from it—it is too often anarchic. In the context of the NHS England infrastructure that we are considering, there are regions of the country that just have not done their job as they should have, which is scandalous.

Photo of Johnny Mercer Johnny Mercer Chair, Defence Sub-Committee

Does the right hon. Gentleman agree that it is not good enough simply to understand an experience—because it affects someone close to us—when it is part of day-to-day life for the most vulnerable people? In Plymouth we have someone who is intimately involved in the system, and whose daughter is involved in the system, and who really gets mental health. However, it is not good enough in this place just to understand something because it happens to someone close to us. The vulnerable often do not have a voice, and we have to work harder. As the right hon. Gentleman is saying, it is not good enough to push the statistics away.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I totally agree. Everyone across the country who suffers this damaging, tragic illness has a right, surely, in anything that amounts to a national health service, to get good evidence-based treatment on a timely basis; but, tragically, that is not happening. I appreciate and welcome the fact that the Secretary of State has now taken specific responsibility for mental health. However, if I may be bold enough to offer some advice from my experience as a Minister, I would say that if a new standard of the type in question is to be embedded into the day-to-day life of the NHS, to make it something that happens as a matter of course and that is considered in the Monday morning meeting in the Secretary of State’s office exactly as the physical health standards are, there must be leadership from the top, including from Government. I appreciate that there are changes to Ministers’ roles under the Health and Social Care Act 2012; but they can demonstrate leadership. They can monitor, push, cajole and encourage, and set the moral tone about what is necessary for the approach we are discussing to become standard practice. That level of focus is needed from the Secretary of State downwards.

Will the Government consider the dossier of evidence and data that we have collated, and report back to us on their findings? Will they commit to addressing properly the defects and flaws in the implementation of the programme, as I think is necessary? One thing is clear: the Paul Farmer taskforce report published as part of the five-year forward view process sets out an ambition for mental health—for how we achieve equality for people who suffer mental ill health; however, if the lessons from the flawed implementation are not learned, every other part of Paul Farmer’s programme will fail to deliver the results that are so desperately needed. How will clinical commissioning groups be held to account for failure to implement the programme properly? What is the sanction for those who decided to ignore it—which is unacceptable to their communities? What is the Minister’s response to the findings I have talked about, and how does she respond to the clear evidence that people with mental ill health are not being treated with the same seriousness, or as if they have the same importance, as those suffering physical health problems?

It is time for mental health to come out of the shadows. We have started a national debate about mental health. The issue is much more out in the open than it used to be. However, as Johnny Mercer said, there is a great danger of a damaging gap, which undermines confidence and trust in Government, between rhetoric and the reality that people experience in their lives. It seems to me that there is an absolute moral responsibility on the Government to ensure that the standard is delivered.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice) 9:55 am, 7th September 2016

It is a pleasure to serve under your chairmanship, Sir Roger. I thank Norman Lamb for securing this extremely important debate. I declare an interest, having worked as a clinical psychologist for 20 years in the NHS, and as a continuing member of the British Psychological Society, our professional body.

I shall start by giving a little context. I am heartened by some of the progress that has been made and by initiatives on mental health taken by Governments in the UK and Scotland over the years. When I started out, it was quite commonplace for patients to wait up to or more than a year for treatment. There appeared not to be any urgency about dealing with the waiting list and waiting times. That has improved very much, and we have waiting list standards. The HEAT targets—health improvement, efficiency and governance, access and treatment targets—focus service providers, policy makers and resources. So things are improving, but we clearly still have much work to do. I concur that we need to work in a conjoined way across the UK and share best practice models in doing so.

The service when I started in practice clearly was not good enough. Patients had been waiting far too long by the time they came into treatment. Often they had been admitted to hospital in an acute situation—perhaps they were suicidal—or had had multiple episodes of psychosis, and we were not providing the best possible standard of care. Psychosis is a distressing illness, which tends to be long-term, although people can recover at an early stage if we pick up their symptoms and provide the appropriate care timeously.

In psychosis, people experience symptoms of paranoia and, often, delusional belief systems that take them outwith reality. They may experience visual and auditory hallucinations. It is distressing for the person and also very much affects their family and those around them, and we must take it very seriously. Although it affects quite a small proportion of the population, it has huge ramifications for family relationships.

Photo of Gavin Robinson Gavin Robinson Shadow Spokesperson (Justice), Shadow DUP Spokesperson (Home Affairs), Shadow DUP Spokesperson (Human Rights)

The hon. Lady is building on an impressive speech by Norman Lamb. Does she accept that while it is right to pay attention to how quickly people get treatment after diagnosis, the biggest barrier to early intervention and treatment is securing diagnosis? I have personal experience, as my wife struggled for two years to get a diagnosis. Once she got it treatment was put in place, but it was far too long to wait. Until we crack that nut and, rather than dismissing people’s symptoms and struggles, deal with them practically, sympathetically and professionally, early intervention is only a myth to be discussed. We need the diagnosis first.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

I thank the hon. Gentleman for that intervention about his personal and family experience. What he says is totally true; the issue is about shortening the gap between presentation and emergence of symptoms, and diagnosis. That is also true of other mental health problems and developmental disorders. Autistic spectrum disorders are the ones that stand out to me, particularly because parents often struggle for years to obtain a diagnosis, and therefore their children do not receive appropriate intervention early enough. They struggle with understanding their child and family relationships can deteriorate as a result, so I very much concur with the hon. Gentleman’s point.

That is why the mental health taskforce setting a standard for England is such a positive development. It is intended to achieve parity of esteem, but again, we cannot just have that in words—we must have the action to follow. The initiative and standard also establish that this is a national priority, which is important, because it has not been in the past. Mental health services have often been seen as an adjunct, which is not good enough, because we know that, for instance, one in four people experience depression in their lives, while many more experience other types of mental health problems, such as anxiety.

Although only a small proportion of the population will experience psychosis, mental health problems and difficulties are widespread. Most of us will at some point experience someone in our life having mental health difficulties, so it is important that we have the standard in place and that care is within two weeks from referral. It is also really important that the data are recorded, because services have to be standardised. That is the other issue to consider, because some trusts can often implement things more quickly than others. We need to ensure there is not a postcode lottery across services and that people can access good mental health provision wherever they may be in the country. I would welcome that.

Psychosis requires multi-professional services, so a specialist team is required. Providing such a team is often labour-intensive and costly, but we should focus on the cost-effectiveness over the long term. As the right hon. Member for North Norfolk said, if we do not intervene early, the cost to society, the health service and people’s lives far outweighs the cost of the NHS provision that we must make. Standards focus policy makers on resources and ultimately improve care. The Scottish Government are currently undertaking a consultation on their mental health strategy, and early intervention and prevention will be key pillars in that. We now have a Mental Health Minister, Maureen Watt, who will be focusing on the delivery of the strategy, which will be informed by carers, service users, professionals, research and best practice.

One project I am aware of is the Esteem project in Glasgow, run by my colleague Suzy Clark, which covers Argyle and Clyde and is an early intervention service for psychosis. I understand that there is no waiting list and patients are usually seen within five days of referral, which is a huge change from the days when I started out. If patients are admitted to hospital they are assessed at the service within 24 hours, so people can feel supported straight away. It is very much a holistic service, looking at psychiatry with a medical model but also looking at psychological interventions and family support.

In the National Institute for Health and Care Excellence guidelines, cognitive behavioural training for psychosis is important. It helps people who are suffering from the positive symptoms of psychosis to begin to reappraise those symptoms, so that they can once again make a connection with reality and begin to be rehabilitated back into day-to-day life. Behavioural family therapy is also extremely important. As I have mentioned, psychosis affects not just the person who suffers but their whole family and social circle.

People can suddenly find themselves in a caring role, and research indicates that spending 10 hours and above per week as a carer can be a challenge to someone’s wellbeing. Once again, we can see the ramifications of avoiding putting best practice in place and not giving early intervention the priority it deserves. Depression is common in carers. They describe a need for information, practical help and emotional support, often from other people in a similar situation. Crucially, the outcome for and individual who suffers psychosis also partially depends on their relationship with their carer and family. That is why services and treatment have to look at the individual in a holistic manner and make sure that the available interventions encompass the family.

The Esteem project provides CBT for psychosis and behavioural family therapy. It also helps individuals to look at early warning signs and identify their symptoms at an early stage when they start to become unwell, so that they can contact appropriate providers if they have a subsequent episode. Outcomes from the first episode study by Professor Gumley at Glasgow University show massively significant and favourable outcomes following early intervention and service involvement. I must mention that Tony Morrison is also leading on the issue at Manchester University, so we can see that areas of expertise are developing right across the UK, which is heartening. We need to focus on early intervention; it is key. It leads to better prognosis, has better outcomes and reduces the risk of further relapse. It helps a person reintegrate into society, assists their carers and family and is cost-effective.

I welcome the Minister to her role, and I urge that the direction that is given is the best practice that has been recommended. We need that for service delivery, patient care, clinical effectiveness and cost-effectiveness. We must ensure there is parity of esteem for mental health.

Photo of Kerry McCarthy Kerry McCarthy Labour, Bristol East 10:07 am, 7th September 2016

As ever, it is a pleasure to see you in the Chair, Sir Roger. I also welcome the Minister to her place.

Psychosis is incredibly frightening for friends and family to witness, and I speak from personal experience. It means people in effect having lost control of what is going on inside their head but not realising it, and it is difficult to get through to them. It is also an incredibly frightening experience for the people who suffer such episodes— perhaps not at the time, when they are in the grip of psychosis, but it becomes apparent from talking to them afterwards. One person, a veteran of the first Gulf war who has suffered from psychosis for the best part of 20 years, said, “You never know again whether what you are experiencing, feeling and thinking is true, because other people are telling you your experiences were not true.” It is an incredibly distressing place to be.

Early intervention is crucial. Mothers in particular have come to my constituency surgery, desperate to keep their young adult sons out of the criminal justice system, yet that is often the only alternative. These are big lads who can be quite frightening when they are in the grip of psychosis. The last thing a mother wants is to see her son locked up in police cells for the night, but all too often that has been the only alternative. If the lads are not seen as a direct danger to themselves or to others they cannot be sectioned; the mothers do not want them to be sectioned but they desperately want to get them help.

I pay tribute to the police and crime commissioner in my local area, Sue Mountstevens. She is an independent candidate who has just been elected for the second time, and she has made it an absolute priority to try to get people with mental health problems out of the criminal justice system and to make sure there are beds available so they can get the help they need.

We know that psychosis is particularly prevalent among young men of black Caribbean or African origin. Indeed, the three mothers who have come to me about this issue are all of black Caribbean or African descent. It seems to be an established fact that these young men are more vulnerable, but I do not think we have ever got to the root of why that is the case, and I would like to see more research into that.

I agree with what has been said about parity of esteem; I think all parties now recognise that. Mental health has been the poor relation of physical health, but young people’s mental health has too often been the poor relation of adult mental health. Young people struggle.

Photo of Diane Abbott Diane Abbott Shadow Secretary of State for Health

Does my hon. Friend agree that overall people of black Caribbean heritage are over-represented in the mental health system? These young men tend to present late. They tend to be less likely to get talking therapy and tend to have poorer outcomes.

Photo of Kerry McCarthy Kerry McCarthy Labour, Bristol East

I very much agree, and I would love to see more research into the reasons for that. We know that early intervention is crucial and that if there is intervention after the first episode of psychosis, it can be deflected further down the line. It may be that young men’s reluctance or the lack of access to those services means that they go on to develop full-blown psychosis, which then blights their adult lives. There could be all sorts of reason. I have heard my hon. Friend speak about this before. I know she thinks it is a really important issue, and I agree with her.

Young people are even more marginalised. I have the Riverside unit for young people in my constituency at Blackberry Hill hospital. It is part residential, part day placements. I visited it recently. If the spaces are full, a number of young people get sent a considerable distance from home and away from their friends and families for treatment, which is not ideal. If we are trying to deal with young people in very vulnerable circumstances, displacing them from their families and support networks is obviously wrong.

Dr Dominique Thompson, who is in charge of the GP services at the University of Bristol, has given me figures in the past about the proportion of the casework of GPs at universities that is now on mental health-based issues, and it has grown exponentially. That is everything ranging from anxiety, stress and depression right through to severe psychosis. I make a plea that the health services at universities are not the same as ordinary neighbourhood GPs; they need particular support. They deal with young people who are away from home and away from their support networks. We know that GPs are under pressure—particularly in terms of recruitment, which is a debate for another day—and it is important they have the resources to deal with that.

I want to mention briefly one source of help that is available to GPs. I met a group of researchers yesterday who are part of the Avon and Wiltshire Mental Health Partnership NHS Trust and are based at Blackberry Hill hospital in my constituency. They do something called BEST—best evidence summaries of topics—in mental health, which is a web-based service. Basically, these experts look through all the information available and distil it down to easy paragraphs for clinicians, so that rather than having to wade through all the material on the internet, clinicians are given some guidance as to what they are likely to be looking at and the likely best treatments. The funding for that service is under threat. A cross-party group of MPs from the Avon and Wiltshire area met those researchers yesterday. We think that the service should at the very least be piloted, with a view to rolling it out nationally, because it is a really valuable resource. We are going to write to the Minister about that, but I wanted to flag it up today.

Finally, I was looking this morning at the NICE guidance on early intervention in psychosis access. It pays passing reference to substance abuse, saying:

“Around 40% of people with first episode psychosis misuse substances at some point in their lifetime.”

I would like to see more research done into cannabis-induced psychosis. It is clear to me—partly from anecdotal evidence, but there is research out there—that partly because of the stronger strains of cannabis that are now available, more people are presenting with cannabis-induced psychosis. There may be a connection between that and people going on to develop full-blown psychosis, or people may have a cannabis-induced psychotic episode and then recover. Speaking partly from personal observation, I think that in some cases drug use makes it more difficult to diagnose when people are suffering first-time psychotic episodes. I would like to see more research into that.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Climate Justice)

The hon. Lady is making an extremely valid point in terms of comorbidity. Comorbid substance abuse often precludes people from treatment, and they can be turned away from treatment centres. As she said, it is very common and should not mean that people cannot access treatment.

Photo of Kerry McCarthy Kerry McCarthy Labour, Bristol East

There is also the issue of whether people feel they are self-medicating by smoking. They may feel that it helps their symptoms, whereas it quite often exacerbates their symptoms.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I appreciate the constructive and really helpful speech that the hon. Lady is making. She is absolutely right that we need to understand this issue better. Does she agree that whatever the link may be, we should not criminalise people for the use of cannabis in such circumstances? The idea of someone resorting to cannabis as a relief from pain and then being criminalised seems awful.

Photo of Kerry McCarthy Kerry McCarthy Labour, Bristol East

As I said earlier, I think that diverting mental health issues into the criminal justice system is completely the wrong approach. That includes people who have engaged in taking cannabis, which is an illegal activity. It serves no purpose at all to treat that as a criminal situation when people clearly need the intervention of the health services. The medicalisation of the problem is certainly something I endorse. On that note, I conclude my remarks.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Equality) 10:16 am, 7th September 2016

It is a pleasure to be called to speak in this debate, Sir Roger. I congratulate Norman Lamb on initiating this debate. I commend him—I have done it in his absence but will now do it in his presence—for the experience and wisdom he brings to these debates, his passion for the subject matter and for letting us take advantage of his knowledge.

This issue is an essential one that needs to be addressed, and this debate is very timely. Just this week, on Monday past, I heard about a constituent who falls into this category. I was contacted by a residents’ group, which expressed concern about a young man. The young man’s parents have died and he is alone. It turns out that he is clearly not taking good care of himself. There is no electric in his home; I suspect that the bills were not paid, and that he was not even aware the bills were there to be paid. There were no benefit checks either. This is a young man who fell between two stools.

Unfortunately, no one was able to help this young man they were made aware of his problems by the residents and those who lived close by. When the young man was approached, he made it clear that he wanted no help; that was his initial response. The residents’ association worried from afar, and despite calls to the local police, nothing could be done until he was seen with what was perceived to be an offensive weapon. The Police Service of Northern Ireland then intervened, assessed him and realised there was something unusual about his behaviour. It decided he was not a threat initially to anyone other than perhaps himself, and referred him.

I got confirmation yesterday that a social worker has been initiated to come in and assist the young man. Hopefully this is now an example of a response taking place, but there was the delay that Members have mentioned. Indeed, my hon. Friend Gavin Robinson gave a very personal example of that. It is about diagnosis and the system that is in place trying to help. That is something we believe has, at long last, happened, but it happened because of the residents’ group—the people who lived close by who had concerns and cared enough to raise them and assist when this man needed it. This is someone who obviously needed help for a long time and yet had fallen through the cracks. It is my belief that the onset of psychosis this young man is going through is not a new issue; it is historical, and yet nothing has been in place to help him in his situation.

Health is a devolved matter, and the Minister is not responsible for health issues in Northern Ireland, but I wanted to contribute to this debate to support what the right hon. Member for North Norfolk and others have said, and to comment about Northern Ireland.

The background information states that some 75% of mental illness in adult life begins before the age of 18 and that 17,000 people a year experience psychosis. It also indicates that many people aged under 16 also suffer psychosis—the right hon. Gentleman referred to that. There is clearly a massive issue to be addressed, and I know that the Minister will respond helpfully. I welcome her to her new position and look forward to her contribution.

The circumstances I have outlined underline the need for this debate. There must be a system in place to enable concerns to be raised and to provide a break for those with psychosis. There must be clear and dedicated guidelines for people to follow to get the necessary help. Without the observation of neighbours and the residents’ group, the person I mentioned would not have received help. The circumstances could have been dire and terrible to contemplate.

On standard waiting times for intervention by psychosis services, I understand that from 1 April 2016 more than 50% of people experiencing a first episode of psychosis will be treated with a care package approved by the National Institute for Health and Care Excellence within two weeks of referral. The previous Prime Minister—this is not a criticism, but an observation for the record—committed £1 billion to mental health; perhaps the Minister will say where that money is. Is it in the system, and has it been used for its intended purposes? If not, with respect to the Minister, we need to know why, and I look forward to her response.

The standard is targeted at people aged 14 to 65. It is two-pronged—both the following conditions must be met for the standard to be deemed to have been achieved: a maximum wait of two weeks from referral to diagnosis and the start of treatment, because it is so important to have early diagnosis and to respond immediately with the necessary help; and treatment delivered in accordance with NICE guidelines and quality standards for psychosis and schizophrenia. I am not sure whether my constituency is different from others, but I know from experience and my workload that I now have more people with mental health issues. Whether I notice them more now or they are coming to the door more, it is certainly a big issue.

Those are the guidelines, but what is happening in practice? Currently, the constituent I referred to has been placed under arrest by the Police Service of Northern Ireland for his safety and the safety of others while social workers and medical professionals determine a plan of action. That is what we need. In Northern Ireland between 2013 and 2014, there were 996 compulsory admissions to hospital under the Mental Health (Northern Ireland) Order 1986, of which 54.7% were of males. I will give some other statistics that give an idea of the gender and age of people involved. Some 45.3% were female, 2.4% were aged under 18, 47.1% were aged 18 to 44, 28.2% were aged 45 to 64, 7.1% were aged 65 to 74, and 15.2% were aged 75 or over.

This issue is massive not just for the NHS on the mainland but for us in Northern Ireland, and indeed for Scotland. Dr Cameron referred to that, as will the Scottish National party spokesman, Anne McLaughlin. We must resolve to make the situation more acceptable and ensure that there is adequate funding for earlier diagnosis and response so that people go into the appropriate care system, whether at home with the trauma team or in a dedicated facility.

Recurrent funding of £40 million has been allocated to support early intervention and the psychosis standard for England, in addition to the previous Prime Minister’s commitment to provide £1 billion for mental health. NHS England’s report on implementing the recommendation of a mental health taskforce estimates the cost of treating an additional 10% of people within two weeks at £70 million per annum when fully implemented, including the cost of developing the workforce. The figures do not add up. How does the Minister expect to reach the goal within the specified time without adequate funding? I know she is up to the task, and I am confident that she will give a good response. We need to see action on the ground.

I ask about that for selfish reasons. Those who know me know that I have no problem flying the flag for Northern Ireland in any debate in the House, especially one as relevant as this. In Northern Ireland, the devolved Assembly determined that the appropriate guidelines were that at least 80% of patients should wait no longer than nine weeks for a first out-patient appointment and that no patient should wait longer than 15 weeks. However, it is clear that those guidelines are not being reached. The matter must be addressed at home, but that can come about only if adequate funding is committed by the Northern Ireland Assembly, and by the Government here, to the Department of Health, Social Services and Public Safety.

In an intervention, my hon. Friend Mr Campbell referred to a UK strategy. We have many debates on such issues in this Chamber, and the Minister will know that I always ask whether there have been talks with the regional devolved Governments—the Northern Ireland Assembly in my region, the Scottish Parliament and the Welsh Assembly—to ensure that we have a UK strategy. The right hon. Member for North Norfolk, who moved the motion, referred in an intervention to the need to learn from one another’s regions. Where there has been good practice, let us use it. If there has been good practice in Northern Ireland, we should use it here in England, and if Scotland has an appropriate strategy, let us use it in Wales and elsewhere. Let us exchange ideas and work towards ensuring that a UK strategy is in place and that funding is ring-fenced for that purpose. Access to mental health intervention should be not a matter of postcode, but a right. One in five adults in Northern Ireland will show signs of a mental illness. The figures also show that one in four people will experience mental health problems during their lifetime.

We had a conflict in Northern Ireland for some 30 years, and we have the highest level of mental health illness in the whole United Kingdom. Johnny Mercer, who serves on the Select Committee on Defence, served in Northern Ireland and is well aware of the issues facing those who served in the Army and the trauma they sometimes experience. In addition, families and other people in Northern Ireland have experienced at first hand the threat of terrorism. For us in Northern Ireland, mental illness is a massive issue. I cannot underline that enough, and we must be aware of it.

Figures have shown that when matched against 17 other countries, Northern Ireland had the second highest rate of ill health and problems with mental illness in 2015. It was 25% higher than in England. I urge the Minister to take note of that and to work with the devolved Assemblies—the Northern Ireland Assembly and the others— to ensure that in five years, the statistics are different from those in 2015. Let us set a target and a goal for change. If we aim for that, we can achieve some of what we want to do.

A lot of hard work has been carried out to remove the stigma attached to those who need help with mental health problems. Sometimes I wonder whether we can use different terminology. “Mental health” seems to flag up for people that they should perhaps be careful. People may have emotional problems that are not as bad as they seem. Perhaps we could use other terminology.

We need a system in place to deal with the rising number of people with mental health problems, and that is not currently the case. We need a target for reducing that number. Major changes are needed, and that is the reason for today’s debate. I fully support the calls that are being made, and I look forward to hearing from the Minister about how my constituent—she is not responsible for him—and those like him across the entire UK will be able to get the help they need to function and live in society.

Again, I congratulate the right hon. Member for North Norfolk on bringing the matter to this Chamber, and I look forward to the shadow Minister’s response and particularly that of the Minister.

Photo of Anne McLaughlin Anne McLaughlin Shadow SNP Spokesperson (Civil Liberties) 10:29 am, 7th September 2016

I commend Norman Lamb on securing this debate and on his long-standing commitment to this and related issues. He clearly cares very deeply about them. He is shining a light on some of the problems with the way in which the targets are being handled across NHS England.

The principle of early intervention and access to treatment for psychosis is fundamentally a moral one: at its heart it asks how readily we respond to some of the most vulnerable people in our midst. As others have asked, is there parity with people suffering physical ill health? We know that treating patients early improves outcomes significantly, not only in their mental health by reducing the rate of relapse and boosting recovery, but by reducing the knock-on impact of psychosis in other areas of a patient’s life. Kerry McCarthy gave us an insight into the impact on the person themselves and their wider network of family and friends.

If someone is struggling to deal with an untreated episode of psychosis, there can be rapid deterioration in many of their life circumstances, particularly their financial circumstances. I would like to draw attention to the excellent work being done by the Money and Mental Health Policy Institute to look at how mental illness, which includes psychosis, can impact negatively on personal finances. It is investigating ways to support people in those circumstances and is taking expert guidance from people who have been there. Jim Shannon highlighted the case of an individual whose bills had not been paid—the chances are that he did not even know they had to be paid.

I want to give a simple example of something that the institute has come up with, with the support of the experts it is working alongside. Someone who may well suffer psychotic episodes in the future but is currently well lays out the key signs that they are experiencing such an episode. For example, they may say, “If I try to spend money between midnight and eight in the morning, that is a clear sign that I am suffering a psychotic episode. Don’t let me do it.” The banks are working with the institute and individuals to find ways for people to set parameters for their spending and be given support if that does not work out. As I said, the institute is taking guidance from people who suffer from mental health problems, but also from those who live and work with them, because they are the experts. I encourage anyone who has anything to say on the issue to join the expert panel; all they have to do is go to moneyandmentalhealth.org.

As many hon. Members have mentioned, particularly the right hon. Member for North Norfolk, £15 is saved in the long term for every £1 spent on early intervention. That is a powerful illustration of the importance and efficacy of that approach. It takes courage for Governments to commit to a course of action that might not produce results while they are in power or when they need votes but that will provide better outcomes for those who need them, so I am very pleased that the Scottish Government are now developing a 10-year strategy. I was interested to hear what my hon. Friend Dr Cameron had to say about that.

As we have heard, many individuals have their first psychotic episode at an early age, but as many Members have said, we cannot exclude those over the age of 35 from the early intervention approach, which appears to have been happening in some parts of England. If roughly one quarter of men and one third of women experience their first incidence of psychosis after 35, CCGs are shifting the goalposts if they are applying the target only to the younger age group.

I hope that some of the progress that we have made on these issues in Scotland may be of benefit to the other nations of these islands, so I will mention a few of the key measures. However, I want to be clear that I am not claiming that all is perfect in the mental health world in Scotland, nor do I seek to set countries against each other. We are not competing. As many hon. Members have said, we should be sharing good practice. I want us to learn from the other countries in the UK and, as others have said, from international examples. However, I do think it is useful that, as my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow mentioned, the Scottish Government have appointed a Minister whose remit is dedicated wholly to mental health. That level of focus is vital and rightly reflects the impact of mental health issues right across society and across all Government directorates. As the right hon. Member for North Norfolk said—although perhaps not in exactly these words—we need a Government champion for mental health.

As I said, the Scottish Government are also developing a 10-year mental health strategy that focuses on early intervention and prevention. That longer-term vision is important for changing the way in which stakeholders across the public sector work and support mental health so that they are tackling issues head-on as early as possible. That is summed up by the principle of “Ask once, get help fast”, which is being put at the heart of the Scottish approach across this Scottish parliamentary term.

However, it is important for healthcare workers to understand that many people with mental health problems do not ask for help. Many of those they see on perhaps a six-monthly basis do not report what is happening to them, either because their mental health problem means that they do not want to be a bother or because they do not want to say what is happening to them. It is crucial that the holistic approach that my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow mentioned is taken so that families are involved and can give the person the support that is needed. Tackling mental health problems is not just the job of a psychiatrist and patient; it involves, or should involve, everyone the patient feels comfortable with.

On waiting time targets, the landscape in Scotland is slightly different in that, as we have heard, we have two key targets for mental health. One is that 90% of all those who are subject to a mental health referral should commence treatment within 18 weeks. I place on record my thanks to the mental health team at NHS Greater Glasgow and Clyde, which is currently meeting that target.

I would like to highlight the impact of Brexit and the British Bill of Rights on mental health provision. I make no apologies for raising those two issues, as it is surely self-evident that the country’s constitutional arrangements will have an impact across all policy areas. The Human Rights Act 1998 protects many vulnerable people who rely on health and social work support, and those safeguards must also be maintained for those suffering from psychosis.

I have a specific question for the Minister. The president of the Royal College of Psychiatrists, Simon Wessely, has stated that the UK’s decision to leave the EU will hamper the development of new treatments for illnesses such as psychosis. He said:

“I don’t believe there is a single scientist who does not think that being in the EU makes it easier to develop new treatments for mental disorder, and then to make them available.”

I would therefore be pleased if the Minister could tell us today how she will ensure that research and targeted funding for mental health from Europe is maintained or replaced.

I speak as someone who has close-up experience of significant mental health problems, including psychotic episodes. I will not say who the person is, not because I or they are at all ashamed or embarrassed but because there is still a lot of prejudice against people in that position. There is a lot of unnecessary fear. All of that only adds to the complications of trying to manage the condition. I mention this only because I hope the fact that someone close to me is currently in recovery from a traumatic psychotic episode, which I believe could have been prevented or at least been less traumatic had the person been able to access the services to which they were entitled, will add some weight to my words. Sometimes we have to look beyond the paperwork, policies and targets, important as they are, and find out what is happening on the ground, because people do slip through the net, and the impact on them and their networks can be catastrophic.

I commend the right hon. Member for North Norfolk again, and I also commend everyone else who has spoken in the debate. I thank my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow and others for the very useful information that I have gleaned from them today. As someone with a close family member who is currently struggling and who initially did not get the help that they needed despite being entitled to it, I want to add my personal thanks to everyone in the room who continues to campaign for people such as my family member.

Photo of Diane Abbott Diane Abbott Shadow Secretary of State for Health 10:38 am, 7th September 2016

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate Norman Lamb on securing this very important debate. The House appreciates his engagement with this issue, given all his wisdom and experience as a former Health Minister, and his continuing work since the 2014 paper “Achieving Better Access to Mental Health Services by 2020”.

Every Member of Parliament, on both sides of the House, will have had the experience in their own advice sessions of people coming to see them who either are experiencing mental health problems or are a family member trying to get help for a child or partner with mental health problems. I think that every Member of Parliament will also have somebody struggling with mental health issues within their own family or among their wider acquaintanceship, but it remains the case that the stigma around mental health issues means there is more concealment, more shame and more delay in reaching out to the NHS for the treatment and support that people need. We know that mental health issues are on the rise. We know that there is a relationship between recession, unemployment and mental health issues and we can see it in our communities across the country.

I have to declare an interest because my mother was a mental health nurse until she retired. She worked in a mental hospital called Storthes Hall in West Yorkshire, and like a lot of mental health facilities it was a former workhouse. Despite the dedication of the nurses and doctors who worked there, this former workhouse on the edge of the Yorkshire moors exemplified, in a very physical way, the Cinderella nature of mental health services.

All parties in this House are committed to parity of esteem between mental health and physical health, but this important debate tests that reality. As we heard earlier, mental health is not just an issue for the individuals concerned; it can have a very sad and serious effect on their families. My hon. Friend Kerry McCarthy touched on the issue of black and minority ethnic men and psychosis. This subject is not often discussed in this House, so I will be forgiven for saying a little about it. It has been an issue for many decades that black and minority ethnic people are disproportionately represented in our mental health system at every level. If someone goes on to the wards of the Maudsley in south London or of mental health hospitals across London, they will see that a disproportionate number of the beds are filled by people of black and minority ethnic origin. In some cases, nearly all the beds are filled by people of black and minority ethnic origin.

This subject has been examined and studied since the book “Aliens and Alienists: Ethnic Minorities and Psychiatry”, which is by Dr Lipsedge, I think, and goes back to the ’80s. First, the issue is disproportionate representation, but then it is what sort of access to treatment people from black and minority ethnic backgrounds get. The first problem is their presenting late, and one of the reasons why black and minority ethnic people present late is that they are so frightened of the mental health system. I have dealt time after time with mothers who are struggling with sons with very serious psychosis whom they cannot manage and feel physically threatened by. When I say to them that they need to approach the national health service, they are often very resistant because they are so frightened. They believe that if they let their sons go into the mental health system, they will just be pumped full of—

Photo of Roger Gale Roger Gale Conservative, North Thanet

Order. I am sorry to interrupt the hon. Lady. I understand that she wishes to address the Member who moved the motion, but she is off-microphone and it is making it difficult for the Hansard reporter. That is why, traditionally, Members address the Chair.

Photo of Diane Abbott Diane Abbott Shadow Secretary of State for Health

It is true of many communities, and in particular the black and minority ethnic community, as the statistics prove, that they are reluctant to take family members into the national health system. When they finally have to engage with the national health service, their symptoms are much worse and it is far harder to get positive outcomes. I tell the Minister that it is really important to look at this issue of black and minority ethnic people and the mental health system, because it is causing real misery and problems within the community. We are less likely to be offered talking therapies and more likely to be offered electroconvulsive therapy. Again, mental health facilities within the prison service, such as Rampton, have disproportionate levels of black and minority ethnic persons inside those institutions.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I am grateful to the hon. Lady for giving way. She is making an incredibly important point about the over-representation of black and minority ethnic people in the system. Does she agree that they are also more likely to be subject to coercion—to sectioning under the Mental Health Acts—and more likely to suffer restraint and physical force within mental health settings?

Photo of Diane Abbott Diane Abbott Shadow Secretary of State for Health

I am grateful to the right hon. Gentleman for that important point. It is absolutely true that, partly because they are presenting late and often have quite advanced psychotic symptoms, they are more likely to experience coercion and restraint. We know that some of those incidents of restraint have had very unhappy outcomes, and families continue to campaign against the misuse of restraint on mental health patients. All these decades after people first started to look at issues relating to black and minority ethnic communities and the mental health service, we have made little progress. Is the Minister willing to meet me to discuss this issue, which I have looked at for many years? One of the basic problems is statistics. It took years to get the health service to keep statistics broken down by ethnicity within the mental health service, and I am not sure what is happening to those data.

As we have heard, it is vital that psychosis is treated early as that prevents complications, improves outcomes and is more cost-effective. We know that psychosis costs £11.8 billion a year and we also know that mental health problems are on the rise. It is very disturbing to find that the research shows that a quarter of CCGs seem to be ignoring the access waiting time standard for psychosis, and the National Audit Office reports that there are insufficient funds available for the strategy to achieve parity of esteem to have any reality. We know, because we have heard, that too many CCGs cannot even specify how much money is devoted to early intervention; that gives rise to the suspicion that not enough is devoted to it.

The right hon. Member for North Norfolk made the fundamental point that this issue is still not being treated with the same seriousness as cancer standards are. This goes back to the issue that many Members have raised of stigma, shame and an unwillingness of the families of psychosis sufferers to speak out in the way that the families of people who suffer from cancer are willing to go into the public space and to the media to speak out.

Photo of Johnny Mercer Johnny Mercer Chair, Defence Sub-Committee

I wholeheartedly agree with the hon. Lady about that. This week, in Plymouth we have been running a campaign called “Talk Don’t Suffer”, in conjunction with The Herald. I pay tribute to the Plymouth Herald for what it has done. Getting people to come forward and printing their stories is such a powerful testimony for those who suffer with mental health, because they know that other people are suffering too and about the impact on families. To talk about it is very important to improving the situation.

Photo of Diane Abbott Diane Abbott Shadow Secretary of State for Health

I again congratulate the right hon. Member for North Norfolk on securing this important debate. He spoke about discrimination and injustice, and that is what strikes people so strongly. There is the human misery of people suffering from psychosis, whether intermittent bouts or lifelong psychosis, and there is the misery and worry of their family members. We need to be a society in which the promise from all parts of the House for parity of esteem between mental and physical health becomes reality. We want to be a society in which people are not marginalised or almost warehoused just because they have mental health challenges, including psychosis, but have some promise of the support they need and of a better life. I look forward to the Minister’s response to questions asked by my Opposition colleagues. I assure her that I will return to this issue—not only black and minority ethnic mental health, but mental health in general.

Photo of Nicola Blackwood Nicola Blackwood The Parliamentary Under-Secretary of State for Health 10:49 am, 7th September 2016

It is a pleasure to serve under your chairmanship for my first outing as a Minister, Sir Roger, and I congratulate Norman Lamb on securing this important debate. He has rightly pointed out that many areas of our mental health services are not yet meeting the standards that patients and their families deserve and have a right to expect, and he is absolutely right to say that improving access and waiting times for early intervention in psychosis must be a top priority among those. I assure him that both I and the Government share his determination and sense of urgency in such matters.

I think we can agree that for far too long as a nation we tolerated poor mental health services in this country, and we all know the terrible price that some have had to pay for our collective failure to step in earlier. That time is now over and we are in the process of creating a mental health service that we can be proud of—one in which, no matter where someone lives, they will be able to access the services they need when they need them, and just as importantly, one that people feel safe and confident using.

But we have to be honest about this, or we will get discouraged and lose momentum: it is not going to happen overnight. Although there are already some areas of outstanding practice that we should be encouraged by, we are, in general, coming from a low base, and only a sustained effort over the next few years is going to bring about the change that we are all demanding.

For that reason, I would like personally to thank the right hon. Member for North Norfolk for his pivotal role in securing parity of esteem and for supporting the introduction of the first waiting time standards for mental health services. With the previous Prime Minister, the Health Secretary and my predecessor, my right hon. Friend Alistair Burt, the right hon. Gentleman has set us on the road to better mental health services. Now we have to follow it through, no matter how bumpy the journey may become at times. I hope that he will meet me and give the benefit of his advice, because I suspect I am going to need it.

I would also like to thank everybody who has contributed to today’s debate. Some have given moving accounts of personal experiences or those of family members or friends. Others have taken the opportunity to raise difficult constituency cases. I know that all here today are committed to keeping mental health at the top of our agenda as the Government shape their new programme.

That brings me on to the challenges of the early intervention pathway for psychosis, which is designed to deliver the improvements to psychosis care that are urgently needed, as the right hon. Gentleman so clearly laid out. He pointed out that psychosis is more common than people realise: it affects one in 2,000 people in England in any given year. We know that the early intervention in psychosis programme is crucial in ensuring that mental health services maximise their opportunity to intervene at the earliest possible moment to prevent patients from relapsing, so that they are less likely to be admitted to hospital and have less severe symptoms. As Dr Cameron so expertly described, such services are recognised as the best model for helping young people to recover from the first episode of psychosis. They have the potential not only to save the NHS tens of millions of pounds but to reduce the serious impact of psychosis on those patients’ lives and those of their families and carers.

Jim Shannon asked about funding. When waiting times for mental health were introduced for the first time, they were backed by £120 million of investment. In addition, we have invested £33 million in developing EIP services. Further funding for early intervention in psychosis was announced in NHS England’s “Five Year Forward View for Mental Health” implementation plan earlier this year. That funding is designed to support delivery of the target to ensure that 60% of people who experience their first episode of psychosis receive treatment with a NICE concordant package of care within two weeks of referral by 2021.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I am encouraged by what the Minister is saying. I assume that the money she has talked about that will be allocated is part of the baseline that CCGs will receive and not a separate allocation. The question is how she ensures that CCGs actually spend the money as intended.

Photo of Nicola Blackwood Nicola Blackwood The Parliamentary Under-Secretary of State for Health

As the right hon. Gentleman is aware, this work is in its early stages. He is right that services are working hard to develop this process. NHS England has set out in its implementation plan how the services will need to grow and improve to meet the new standards. In particular, it has noted that the current block contract arrangements can result in poor transparency on spend per patient, as he has seen with his freedom of information request.

NHS England has been looking at alternative funding models that will link an element of payment to achievement of quality and outcomes, including the EIP access and waiting time standard. When there are variations in spend, we will need to consider the reasons for that and ensure that necessary action is taken to address any impact on the quality of care available. I hope that reassures the right hon. Gentleman.

In addition, the Royal College of Psychiatrists College Centre for Quality Improvement has been commissioned to undertake continued assessment and quality improvement work. This will be through a quality improvement network, supported by an annual self-assessment that will be independently validated and scored. All early intervention in psychosis services are going to be expected to participate. The first results will be published in April 2017, but any earlier results will be published before that. It is intended to provide a transparent assessment of services across England. This will give us a clear picture of service provision and enable us to target areas where additional development will be required, so that we can ensure that the standard is met and that people receive the care they need.

The right hon. Gentleman also mentioned the important issue of age caps. The most likely age for a first episode of psychosis to occur is between 14 and 35, as has been pointed out.

Photo of Diane Abbott Diane Abbott Shadow Secretary of State for Health

Is the Minister saying that there is currently no way of making sure that CCGs spend the requisite proportion of their funding on mental health?

Photo of Nicola Blackwood Nicola Blackwood The Parliamentary Under-Secretary of State for Health

Currently, the block contracts make it less transparent than it should be and we are working to address that.

I had moved on to talk about the age cap. As I was saying, psychosis is most likely to occur between the ages of 14 and 35; consequently, services have traditionally been commissioned in this age range. However, a sizeable proportion of presentations take place after that, which is why NHS England guidance is clear that services should be available to people up to the age of 65. We are working with local commissioners to ensure that service provision is expanded to cover all age ranges. A regional assurance process is under way to assess providers’ and commissioners’ progress in making that happen. This is intended to deliver transparency across England on the plans currently in place, and, where it is not happening, to highlight where further development is required. Again, the Royal College of Psychiatrists CCQI’s assessment work and the development of robust data, which I will come on to in a minute, will enable us to see areas that are not providing services for people up to 65 and to target development accordingly.

However, none of that will happen without the right people to deliver it. To improve access to NICE-recommended psychological therapies, we have to ensure that there are the staff numbers and the appropriate skills mix to deliver the full range of treatment to those who need it. The modelling undertaken by NHS England for additional investment to achieve the new standard incorporates the costs of the necessary workforce development. Health Education England has a targeted work programme under way to increase the number of EIP staff trained to deliver cognitive behavioural therapy for psychosis and family interventions, with £6 million invested in training this year.

Finally, as the shadow Secretary of State pointed out, to ensure consistently good performance against this standard and future waiting times standards, we need robust data. I am very happy to meet her to discuss that point. We know that the data need to improve and we are working hard to make that happen. The right hon. Member for North Norfolk is well aware that we are starting from a low base on data availability and quality in mental health, but we cannot let that stop our progress or our ambition.

We are implementing the EIP waiting time standard with a clear expectation that providers will meet that standard. We are working simultaneously with the NHS, NHS England and NHS Digital to ensure that the data become robust enough so that we can hold providers and commissioners to account for meeting that standard. Data on mental health are behind that of physical health, and it will take time to get the data of the same quality. We know that from the improving access to psychological therapies data, which took some time to develop to a good quality. However, the IAPT pathway and standards are now an exemplar and represent a good model for development of other data sets. Encouragingly, data have started to flow via the mental health services data set from March this year, including experimental data on EIP. That is not robust, but there has been significant progress so far. We are currently working across Government to deliver a robust five-year mental health data plan to take us to 2020. The data plan, as recommended by the “Five Year Forward View for Mental Health”, will address the need for substantially improved data and information about mental health services for adults and children.

I hope that this response will show that we are committed to ensuring that there is no gap between rhetoric and reality on the ground. The right hon. Gentleman was right to identify funding, age caps, staffing and skills shortages and data limitations as the key challenges that we are grappling with in the implementation of the EIP, but we have in place work streams to address all those factors. We also agree that we require a systemic review of implementation to challenge and support local areas to implement the EIP more effectively. That is why we have asked independent experts at the Royal College of Psychiatrists to do exactly that. As I have said, they will be reporting in April 2017, but they will report as they go along with any earlier information so that we can make progress as quickly as possible. In the meantime, I will certainly write to him with a response on the detail of his dossier, and I entirely agree with all those who have made the point that we need to share best practice between devolved nations on these issues.

Today’s debate has been very important not just on the details of the EIP, but to test the Government’s commitment to health equality. I am grateful to all colleagues who have raised concerns today. I hope that our commitment to reforming our mental health services is now beyond doubt, but I know, as I look around the Chamber today, that I have heard in speech after speech the determination to see change, and I take courage. Great reform requires long-term vision and non-partisan partnership. I have heard all three of those here today and that truly is a firm foundation for the task that we have ahead.

Motion lapsed (Standing Order No. 10(6)).