Skip to main content

Mental Health Outcomes (Measurement)

Volume 572: debated on Tuesday 17 December 2013

Motion for leave to bring in a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to require the Secretary of State to record certain statistics relating to people receiving treatments for mental health conditions; and for connected purposes.

The Bill is not about a headlong drive towards box-ticking and bureaucracy in our NHS, but about finding the most effective way of achieving true parity of esteem between physical and mental health. Parity of esteem, or equal priority for mental health and physical health, has been enshrined in statute by the Health and Social Care Act 2012—a very welcome measure.

A year ago, the Department of Health published the NHS mandate, in which it identified a number of areas in which it expects particular progress to be made. One of those priorities is to deliver

“a service that values mental and physical health equally.”

Amen to that. How will that be achieved? The Government state in the mandate that they expect NHS England to be able comprehensively to identify levels of access to, and waiting times for, mental health services in the community. Again, that is welcome, but let us take a moment to look at the current ways in which performance in mental health services is measured. The NHS outcomes framework is the mechanism, and it is working well to cover physical health outcomes. When it comes to mental outcomes, however, the picture remains incomplete.

What I am seeking is an improvement in the range and depth of information. I am after quality, not quantity. Why? It is because I want to see developing in our local communities mental health services that genuinely reflect local need. I welcome the publication this month by the Minister, who is in his place, of the mental health dashboard, which brings together existing information about mental health provision. I note that in that document there is an acceptance that the range and type of information available will have to develop, but there is a concern that consistency and stability in what the dashboard measures are maintained. My proposals today will, I believe, deepen the quality evidence while maintaining that stability.

I further welcome the creation of the mental health intelligence network by NHS England and Public Health England. It sounds a bit James Bond, but it is a practical means which will be launched next year to devise more effective ways in which quality information can be gathered. However, unless more work is done to fill in the gaps in relation to mental health outcomes, I fear that important opportunities will be missed.

What measurements do we have so far? We have mortality rates of adults under 75 with severe mental health conditions. That information is being collected and it is relevant to the first part of the NHS outcomes framework. Those statistics reveal that life expectancy is 15 to 20 years shorter than the average in England; they also reveal the extent of co-morbid physical conditions. Already, we can see how such information is crucial to making the right interventions and tackling those appalling statistics. There are also measurements related to improving access to psychological services, which have helped to drive the commissioning of more and more services at a local level. I warmly welcome that. However, like the proverbial Swiss cheese, gaps both in the range and quality of measurement remain. I believe that mortality data should be broken down further to clinical commissioning group level, which would help to identify particular local needs—not just mental health needs, but physical needs.

Part 3 of the NHS outcomes framework aims to measure how well NHS services help people to recover from illness or injury. A useful measurement of recovery is the number of people who have or have had mental health conditions who are able to gain employment. There are national measurements, but they are not reflected in local indicators. If we are to drive more locally based employment support services, that needs to change. The outcomes framework is very much focused on acute services, so measurement of their use by mental health patients, broken down locally, would be very useful in helping to determine the extent of our community services or where, to put it bluntly, firefighting is taking place, as opposed to interventions in the community.

Part 4 of the outcomes framework deals with how well health services provide a positive experience of care, so measures of psychiatric in-patient or secure services have to be made. In-patients at acute hospitals undergoing treatment for physical conditions are rightly asked for a lot of information, all designed to make services more attuned to aspects such as age and gender, for example. We owe this to mental health patients using acute services too. They are among the most vulnerable people in our society and a service that is better attuned to their individual needs will yield better results. At present there is no collection of information about the duration of untreated psychosis—in other words, the length of time it takes between someone presenting with a psychosis and their treatment. How will we comprehensively identify problems with delays in referral and treatment if this is not done?

In relation to people detained under the Mental Health Act, let us not forget that we still have far too many people, including children, being detained in police cells, rather than in an appropriate place of safety. The number of incidences is recorded, but not the outcome. That is another example of how a lack of quality information prevents this issue from being properly prioritised and prevents local analysis of need.

One in four of us will experience some form of mental health condition in the year ahead, and 10% of children in the United Kingdom have a mental health condition. Many children and adults will have co-morbid physical and mental health problems. The division between physical and mental health is an artificial one which must be removed. They need—we need—commissioned services that are truly responsive to our demands. Parity of esteem must become a reality. I commend my Bill as a means of achieving that.

Question put and agreed to.


That Mr Robert Buckland, supported by Caroline Nokes, Annette Brooke, Mike Freer, Yasmin Qureshi, Mrs Madeleine Moon, James Morris, Mike Thornton, Caroline Lucas, Grahame M. Morris, Oliver Colvile and John Hemming present the Bill.

Mr Robert Buckland accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 28 February 2014, and to be printed (Bill 147).