Children and Mental Health Services — [Mark Pritchard in the Chair]

Part of the debate – in Westminster Hall at 3:46 pm on 16th July 2019.

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Photo of Jackie Doyle-Price Jackie Doyle-Price The Parliamentary Under-Secretary for Health and Social Care 3:46 pm, 16th July 2019

I thank all hon. Members who have contributed to this afternoon’s debate, which has given me a lot to think about and a lot to address. I pay particular tribute to my hon. Friend Andrew Griffiths, who gave an excellent exposition of the challenges before us. I welcome the contributions of all Members. We have covered a lot of content, and I will do my best to address all the points that have been made—there are a hell of a lot.

As Mr Jones said, for a long time we have not talked about mental health enough. It has been a taboo subject, and these issues have been left to fester. As a consequence, mental health has been a Cinderella among public services. People with mental ill health have suffered discrimination at the hands of the state in many ways.

We have identified that children’s mental health services have been underfunded for generations, and we will have to fix that—of that there is no doubt. Unfortunately, that takes more than a magic wand. It requires investment and all commissioners to step up to the plate. It requires good partnership working between NHS organisations, local authorities, schools and everyone involved in the system. It is, frankly, a massive culture change, but we need to deliver it. We have heard examples this afternoon of individual children who are being failed by poor service. Frankly, that is the state’s failure, and we are all duty-bound to put it right.

I am grateful that hon. Members have given me these examples, challenging though they are, because they are a helpful reminder to the system that these are individual people. People like Drew should not have to wait 15 months for an appointment. John Woodcock, Tim Farron and I have talked about the challenges in Cumbria. In terms of delivering the transformation and improvement we are aiming for, we are seeing a real lack of consistency in the speed and quality of services as they are rolled out. Again, that is a challenge for us as a system. In my contacts with NHS England, I am keen to ensure that we get more uniformity in provision.

In answer to the point Mr Reed made about ring-fencing funding for mental health services, NHS England will challenge CCGs very directly about how much money they spend on mental health services. We are very clear that they should spend more than the increase in their budgets. Although we have always rejected the suggestion of a ring fence on the basis that they can often be seen as a ceiling, which we do not want, there is now room for some very challenging comments. We really need to start thinking about whether what we have in place is delivering the outcomes that we in this Chamber and we as a society ought to be able to expect.

There is so much to cover that I am sure I will miss something, but there are some points that I really want to emphasise. The right hon. Member for North Durham talked about the role of the voluntary sector. That was music to my ears. I have said repeatedly that good support for people with mental ill health does not necessarily have to be medical—in fact, the wrap-around service that can be provided by just company and comfort is far better delivered by organisations in the voluntary sector, but it is part of our health offering. I am very challenging in telling CCGs and commissioners that they should be thinking about commissioning services from the voluntary sector. Taxpayer funding should deliver the outcomes we want, and the voluntary sector can do that better and cheaper than we can by medicalising the problem. I cannot emphasise that enough.

On delivering more efficient pathways, clearly, the ability to triage people to services that are not medical, are more fleet of foot and can react more immediately provides an opportunity for early intervention that will deliver the better outcomes we want for people.

Looking particularly at individual groups, we heard reference to people with neurodiverse conditions—people with ADHD, ASD and dyslexia. Often, those things go undiagnosed. We need to ensure that, in schools, those people are not just treated as difficult but signposted to places where they might get additional help. We know that earlier diagnosis of those conditions can be the difference between developing mental ill health and not, so we must do better on that. Obviously, the next wave of delivering a transformation for children will involve continuing our pressure on the need to deliver a better mental health service for children, but key to that for me is getting earlier diagnosis of autism and ADHD.

I am not shy about articulating the benefit of that for society; early diagnosis is not just for the benefit of those children, although of course they deserve the best services. We heard about the impact of trauma, and everyone who mentioned it was absolutely right. We have no excuse for failing those people and not putting support around them when they need it. Not only do they deserve that, but by doing so, we win as a society. As I said, those people end up in the care system at best and in prison at worst. Our prisons are full of people who have been failed by the state because we did not give them that hand up when we needed to. We must grasp this issue, and I am not shy about raising that challenge. Yes, it is good value for money—I am sure I speak for all hon. Members when I say that I would rather spend more on health than on prisons, thank you very much. We must ensure that we support people when they need it and recognise the impact of trauma.

Hon. Members will be aware of the work that my right hon. Friend Andrea Leadsom led when she was in Government on the support given to people in the first 1,001 days of life. She has a debate on that subject in the main Chamber later this afternoon—in fact, she is speaking now. I am sure she will echo some of the points the hon. Member for Croydon North made. We can see the children who are at risk. The state has every opportunity to support those people and, frankly, we should be a lot more assertive in doing so. As I said, those individuals will benefit, society will benefit and, of course, the taxpayer will benefit because we will not be spending money on failure.

Hugh Gaffney spoke movingly about the increase in suicide among young people. Collectively across Government, we need a better understanding of the pressures facing young people, which seem to be a lot more acute than they were when I was growing up. Bluntly, I used to play at “Charlie’s Angels”; I did not expect to look like them. That might seem a trite thing to say, but body image puts massive pressure on our young people.

We used to think that kids would be safer in their bedrooms than if they went out to play on their bikes. That is no longer true, because the way people are routed through content when tackling social media leaves them very much at risk. Although we can celebrate the revelations and opportunities that the internet and social media have given our young people, they bring with them risks, and we need to be a lot more on top of those. I am glad to say that I am now in regular dialogue with those companies. To be fair, they are stepping up to the plate at this stage, but that is not to say that we should not consider legislation where we can see that that would bring value in protecting young people.

Obviously, we have made commitments to increase funding. We will continue to do that, because we need to ensure that we meet the unmet need that was alluded to. As I say, money spent early is money spent wisely and money spent less, so we must absolutely continue to do that. The value of early intervention is totally unarguable when expenditure on acute service is so much costlier.

Waiting times were mentioned, and I will take that away. We need to get a much better handle on areas with particularly long waiting times. We have set targets. Some 80% of young people with urgent cases are seen within a week. Again, this comes back to the extent to which we triage services. The really important thing about early intervention and getting support to children at an early stage is our proposals for mental health support teams to work directly with schools—my hon. Friend the Member for Burton alluded to the project starting in his constituency. Those teams will be able to equip the schools themselves with more material and support to help them embed mental wellbeing throughout the curriculum, but they will also be the place for additional support and the place where services are referred.

I thank all hon. Members who contributed to the debate. We are on it, but I would be the first to admit that we still have a long way to go to deliver mental health services for children that we can all be proud of.