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House of Commons Hansard
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Mental Health Services: Children and Young People
08 March 2018
Volume 637

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(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the Care Quality Commission’s review of children and young people’s mental health services.

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Not enough scripture is quoted in this House, but I cannot match what was just said. However, I can tell the House that the Care Quality Commission published its “Are we listening? Review of Children and Young People’s Mental Health Services” report this morning, and, yes, we are listening. It was the second piece of work commissioned by the Prime Minister in January 2017 to look at this area of services, and the findings include examples of good or innovative practice and of dedicated people—we thank every one of them—working in every part of the system and a number of areas with strong practice ensuring that patients and families are involved in planning care, but there are also concerns around the join-up between children’s services. We thank the CQC and Dr Paul Lelliott for their work.

The Government have already committed to making available an additional £1.4 billion to improve children and young people’s mental health services to deliver on the commitments in “Future in mind” and NHS England’s five year forward view for mental health, and the CQC welcomes that progress in its report. I know that the hon. Lady and others have worries about this, but spend is reaching the front line. By 2020-21, we have committed to ensuring that 70,000 more children and young people each year will have access to high-quality NHS mental healthcare when they need it. However, there is so much more to do. Claire Murdoch, the national mental health director for NHS England, said in response to the report:

“CAMHS services are now improving, but from a starting point of historic underfunding and legacy understaffing, relative to rapidly growing need”

We see those things across the service.

In December, the Department of Health, jointly with the Department for Education, published “Transforming children and young people’s mental health provision”. That Green Paper responds to a number of the problems raised by the CQC in this report, and sets out a range of proposals to strengthen how schools and specialist NHS mental health services work together and to reduce the amount of time that children and young people have to wait to access specialist help. The proposals are backed by an additional £300 million of funding. We have carried out extensive face-to-face consultation on the Green Paper proposals and have received a high volume of responses to our online consultation, and we thank everyone for that. We will respond to this CQC review, alongside the Green Paper consultation, in the summer.

The report calls for the Secretary of State to use the inter-ministerial group on mental health to guarantee greater collaboration across Departments in prioritising mental health. We agree, and that recommendation is already in hand. The IMG has already contributed to the development of the Green Paper and will continue to provide leadership on the issues that the report raises. The CQC also recommends that everyone who works, volunteers or cares for children and young people is trained in mental health awareness. We are already rolling out mental health first aid training to every secondary school and have committed to rolling out mental health awareness training to all primary schools by 2022. The Government and Ministers remain wholly committed to making mental health everyone’s business and building good mental health for our children and young people.

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The report is the latest piece of recent evidence revealing systematic failures in our mental health services. It follows similar reports of the past few weeks that call into question the Government’s claims to have made mental health a priority equal to physical health. In this report, we see evidence of services actively putting up barriers to treatment, resulting in children and young people having to reach crisis point before being able to get access to the right treatment. Children are suffering because of those high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14 and that 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes more serious? These high thresholds are even prompting GPs to tell children to pretend that their mental health is worse than it is. Will the Minister agree to look into referral criteria as a matter of urgency, so that children and young people get the proper treatment at the right time?

The report links these excessively high eligibility thresholds and reductions in access with funding reductions and not enough capacity for services to respond to local needs, so, whatever the Minister says, clearly not enough money is reaching the frontline. Can the Minister tell us how he plans to address that? The report, like the CQC’s recent report on rehabilitation services, raises concerns about out-of-area placements, which we know are a barrier to recovery. Will he tell the House what action is being taken to increase the number of in-patient beds available locally?

Finally, what will the Minister do to address the clear problems, highlighted in this report and others, associated with the rigid transition at age 18 from child and adolescent to adult mental health services, which is also a barrier to accessing care?

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The hon. Lady rightly raises the issue of spend reaching the frontline; I said in my opening remarks that it is doing so, and she asked what evidence there was of that. Last year, there was a 20% increase in clinical commissioning group spend on children and young people’s mental health, rising from £516 million in 2015-16 to £619 million in 2016-17.

On the broader issues raised in the hon. Lady’s response, I said that we have made up to £1.4 billion available over five years to support transformation of these services, and there is the additional £300 million that I mentioned. I want to touch on waiting times, referral routes and workforce. We are the first Government to introduce waiting time standards, and that is relevant to children and young people’s mental health, too. We are meeting, or on track to meet, both targets. We will pilot a four-week waiting time for specialist children and young people’s NHS mental health services, as was outlined in the recent Green Paper. As I say, we are considering responses to that.

On referral routes, our Green Paper proposes senior designated leads and mental health support teams—a new workforce—based on the findings of the Department for Education’s schools link pilot. They aim to improve the join-up with specialist services and to result in more appropriate referrals.

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indicated dissent.

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The hon. Lady shakes her head; I can only tell her the facts. Health Education England’s workforce plan recognises new ways of working as a cornerstone of delivering these improvements. HEE will also work with our partners to continue the expansion of these newly created roles in mental health services, and to consider the creation of new roles, such as that of early intervention workers, who would focus on child wellbeing as part of a psychiatrist-led team.

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Order. Many right hon. and hon. Members are seeking to catch my eye, but I remind Members that there are business questions immediately after these exchanges, followed by an important statement by the Home Secretary. Thereafter, the debate on International Women’s Day is heavily subscribed, so there is a premium on brevity from Back and Front Benchers alike, and I want to move on, whether we have incorporated everybody or not, no later than 11 o’clock. Single-sentence questions are much to be preferred.

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I commend the Government for promoting the Emotionally Healthy Schools project, which, in my constituency, is working well and engaging not just children who have challenges, but their families. Does the Minister agree that helping children with their mental health challenges needs to involve, wherever practical, their families, family relationships and inter-parental relationships, as recommended by the Early Intervention Foundation?

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As ever, my hon. Friend makes a point about families. I said that we are already rolling out mental health first aid training to every secondary school, which is of course important, and we are also committed to rolling out mental health awareness training to all primary schools by 2022, but to coin a phrase, it takes a village. This is about the state—of course, schools are part of that—but also the third sector, which has an important role to play. It is also absolutely about the love, support and Christian embrace of families.

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This is a very important issue, especially given that half of mental health problems are established by the age of 14. It is therefore particularly shocking that some children are receiving assistance only after attempting suicide. Claire Murdoch, the national mental health director of NHS England, has stated:

“Child and Adolescent Mental Health Services are now improving, but from a starting point of historic under-funding and legacy under-staffing”.

This report is surely an example of the latest reports in recent years demonstrating the impact of this Government’s austerity-driven agenda on public services. By comparison, in Scotland, which had the UK’s first ever dedicated mental health Minister, we have seen staffing for Scotland’s psychology and children and young people’s mental health care services at a record high, with a 79% increase since 2006. Surely as part of the Minister’s response to these findings he will wish to look at the actions being taken in Scotland and learn from them.

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We always look at the actions being taken in Scotland and in all the devolved Administrations. The hon. Gentleman is right to touch on prevention, which was the first point he made. The proposals in the Green Paper are focused on providing significant support for schools to develop the work they already do on prevention and early intervention. Today’s report talks about the many good things that are going on and, as I said, some of the things we have already taken forward with the Green Paper. While we are kicking this about, let us just remember in these exchanges that this is about the health of young people in England, whom we all represent.

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The CQC has recommended that Ofsted should be charged with looking at what schools are doing to support mental health. Will the Minister take that up with his ministerial colleagues in the Department for Education?

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I am sure my colleague the Under-Secretary of State for Health, the hon. Member for Thurrock (Jackie Doyle-Price), who is responsible for mental health, will be taking that up as she considers responses to the Green Paper. My hon. Friend the Member for Horsham (Jeremy Quin) is absolutely right to raise that issue and I thank him for doing so.

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With increasing numbers of university students having mental health problems, what action will the Minister take to ensure better joined-up care, with better communication between home and university GPs and student welfare services?

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As a former student union president, I think that is a very good point. One key proposal in the Green Paper is about the new mental health support teams, which will be very important in that. The hon. Lady is right to say that they should work across higher education as well as the earlier forms of education.

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In the next few weeks, work will begin on the construction of a new mental health residential unit for young people in Cornwall, which is long overdue and much anticipated. It is a clear sign that this Government are investing in young people’s mental health. However, we continue to have a problem with our clinical commissioning group in delivering frontline services, even though the Government are providing more money, so what steps will the Minister take to ensure that CCGs allocate the money provided to those services?

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I do not know the specific example that my hon. Friend raises, but he may wish to take it up with the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock. I did say that there was a 20% increase in clinical commissioning spend for children and young people’s mental health between 2015-16 and 2016-17. We have all been frustrated about spend reaching the frontline, and we have made it very clear that we expect it to do so. I am pleased to see progress in the right trajectory.

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These damning findings come three years after we secured £1.25 billion extra over a five-year period. We know that that money has fallen well short of what was committed to three years ago. Will the Minister absolutely commit to make good the shortfall of money getting through to children’s mental health services?

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I thank our former ministerial colleague for that. We have not exactly been shy in investing in this area, both when he was a Minister in the Department and now. We have made £1.4 billion available over the five years to support the transformation of services—and the extra £300 million. He says this is a damning report, but we must remember that it is a report we commissioned. We do not hide from these things. The last time I responded to an urgent question from the hon. Member for Worsley and Eccles South (Barbara Keeley) it was on a CQC report on social care. We must not hide from these things and we do not want to bury our heads in the sand. We must recognise and build on the examples of good person-centred care that are taking place in our country at the moment, and that is why we are putting the money behind it. The right hon. Gentleman is right to raise this issue.

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I welcome the priority and funding that are coming from my hon. Friend. What is he doing to co-ordinate and support the devolved nations in this regard, such as Scotland where adolescent mental health waiting time targets were actually missed? We want to make sure that no British child is left behind, no matter what part of the UK they live in.

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That is an excellent point. I will make sure that my colleague, the Under-Secretary of State for Health, is talking, as I know she is, to the devolved Administrations as she considers the responses to the Green Paper, which I am sure include responses from them.

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The Care Quality Commission’s review found that children were waiting up to 18 months to receive treatment for their mental health conditions. In Lewisham, the Government are cutting the budget for child and adolescent mental health services by 5%. The Green Paper will not help children currently waiting. What will the Government do to address this?

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We will put the money in, publish a sensible strategy in a Green Paper, consider the responses and then take it forward, backed by the investment we think we need to deliver the strategy. That will be the same in Lewisham as in Winchester.

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I am sure that both sides of the House will welcome the commitment to 21,000 more personnel in mental health service provision by 2021, but can the Minister assure me that this will lead to more children accessing mental health services within the four-week target period?

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We talked about testing the four-week target in the Green Paper—it was one of its key pillars—and we hope to pilot the idea to test the impact of our additional investment on reducing waiting times. We will then assess the benefits and challenges and provide information on how the waiting time standard should be adapted to avoid perverse incentives—around thresholds, for instance.

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The Minister’s description of mental health provision will not be recognised by anyone providing or using services. Does he think that cutting the funding for the north west boroughs partnership year on year since 2011 has led to improved services for young people in St Helens?

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I do not know about the issue in St Helens. I will look into it, or ask my colleague, the Under-Secretary of State for Health, to do so, and get her to write to the hon. Gentleman.

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I very much welcome the Government’s commitment to mental health workers throughout England’s schools. Will my hon. Friend update the House on its timely roll-out?

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As I have said, we will be considering the four-week pilot as part of the Green Paper. We want to see these mental health first-aiders in schools, and as soon as we can give my hon. Friend an exact timetable on the situation Crawley, as well as elsewhere, I am sure that my colleague the Under-Secretary will do so.

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Some 75% of mental health problems start before the age of 18, but less than 10% of funding goes to young people. What can the Minister do to prioritise more funding for CAMHS?

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As I have said, the overall budget is the money we have promised in the Green Paper, but the hon. Gentleman is absolutely right. The Green Paper has at its heart a focus on prevention and significant support—in early years, through schools and, as the hon. Member for Heywood and Middleton (Liz McInnes) mentioned, through higher education—to prevent issues from snowballing in the first place.

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With the understaffing of mental health services and the recent Health Select Committee report on the nursing shortage, does the Minister accept that the Government’s decision to remove nursing bursaries, which has particularly affected the number of students training to be mental health nurses, was a mistake?

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No, I do not accept that it was a mistake. We need to increase the number of people coming into nursing, and we were turning away far too many who wanted to come into it. The workforce is obviously a huge challenge across the NHS, in primary care—my area—in secondary care and, of course, in mental health, which is why the Secretary of State has said we will create 21,000 new posts by 2021 to support one of the biggest expansions in mental health services in Europe.

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The Minister will know from his own background that primary care does not always have the necessary expertise in mental health. How will he guarantee that every GP surgery will have the necessary capacity to deliver excellence in mental health services for our young people?

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That is a good point—and one that sits at the centre of my portfolio. GPs are generalists. As the Minister for cancer, I know that there is always criticism of their specialism in that, but, by their very nature, GPs cannot be specialists in everything. That is why the mental health support teams, which are at the heart of the proposal in the Green Paper, are a key part of our strategy, and we expect them to work closely with GPs and the Royal College of General Practitioners to upskill GPs, working within the multi-disciplinary teams, to help young people when they need that help.

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Tomorrow, I am meeting the chief executive of my local mental health trust because we are so desperately worried about the mental health provision for young people in York. We are not only short of staff but short of resources. It takes time to train mental health staff, so what are the Government going to do in the interim to ensure that we have staff in the service?

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I hope that when the hon. Lady meets that person in her constituency tomorrow she will recognise the good work that is going on and the number of people who are going over and above to deliver the services to children and people. I should also say that one of her responsibilities as a Member of Parliament, as it is ours as Ministers, is to see to it that the sustainability and transformation partnerships in her area collaborate with all the various organisations in her constituency and that the traditional health and social care services are joined up with schools, police, probation services and mental health services, because ultimately it is one NHS.

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Will the Minister listen more carefully to the voice of parents? All my experience as chair of the Westminster Commission on Autism tells me that if parents think there is something wrong with their child—whether it is a mental health challenge or autism—they want early diagnosis and treatment, and they want it at the standard that they have in Sweden.

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I am very aware of the hon. Gentleman’s work on the Westminster Commission on Autism—he has a big event coming up in the next few weeks that I hope to go to. I completely agree with him, which is why it was so welcome that the CQC report highlighted Government proposals such as establishing dedicated mental health support teams in schools.

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Phase 1 on the CQC review noted that there were unacceptable variations in quality. How can quality be provided more consistently throughout the country?

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That is an excellent point. The NHS is very good at sharing best practice; the challenge comes in implementing it. The report rightly says that there are very good examples of good person-centred care throughout the country. The challenge is to make sure that is rolled out everywhere. I suppose the answer is to focus on the workforce and the investment, and to make sure that we have in place the agreed strategy to take the sector with us and do that.