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Mental Health Support: Wirral

Volume 731: debated on Monday 24 April 2023

Motion made, and Question proposed, That this House do now adjourn.—(Andrew Stephenson.)

I thank the Speaker, through you, Mr Deputy Speaker, for the opportunity to raise a number of issues relating to mental health care in the Wirral. I thank my constituents, a number of whom have come to see me to share their experience, which is why I requested this debate. I also thank the many community groups across the Wirral that do incredible work to support people with mental health conditions to try to change and improve our borough, to make it a better, more supportive place for all our mental health.

As I said, the need for this debate has arisen because more and more constituents have come to see me in recent years about mental health challenges. I assume that that is common to many of us across the House. More commonly, constituents come to see me about something else, but in the process of the discussion about whatever the problem is—be it social security, education or their life at work—it has come to light that they have an unmet mental health need. I have asked them about the support and care available to them through our NHS, and it has become apparent that the services provided through our NHS in the Wirral—and I am sure across the country—are not sufficient.

It is difficult to unpick this issue sometimes because the shame and stigma that still exist around mental health mean that we are much less likely to hear from our constituents about their mental health problems. Yet if there is a problem with getting through the front door of A&E at Arrowe Park Hospital, I will hear about it almost immediately. If there is a problem with cancer waiting times, or hips and knees treatment, I am convinced that I would know about that. I worry that the problems with mental health treatment services in this country are not brought to our constituency surgeries in the same way. That made me want to have this debate—to shine a light on what is happening.

I am grateful to my hon. Friend for giving way so early in her speech. I recently met a number of local school leaders in my constituency, who are concerned about children having gone through covid, not having the opportunity to play out, to be with their friends and to have regular schooling in the way that children normally do; not being able to play outside, do homework together and have sleepovers—all those bonding situations that are important in childhood. They are concerned about the mental health of their pupils. Does she agree that we need the Government to step up to the challenge, provide more sports for schools and follow Labour’s lead by committing to specialist support for mental health issues in every single school?

I thank my hon. Friend and constituency neighbour for making that point. We could have another Adjournment debate on mental health support services for children and the role that education should play. I will not focus on children and young people today, but I share her concerns and I thank her for putting them on the record.

When trying to find out more about exactly what is going on in the Wirral, it was pretty frustrating and challenging to get clarity on mental health waiting times. That is a big inequality with physical health, partly because our traditional way of measuring waiting times in the NHS is referral to a consultant for treatment. But in mental health, the big focus is on services in which someone, hopefully, will not need to see a consultant. Expanding access to talking therapies, which were previously known as the improving access to psychological therapies service, is not about getting a referral to see a consultant, so I do not think there is the same political eye on mental health waiting times. Will the Minister say what plans the Government have to structurally change that and to try to figure out a way for us to track mental health waiting times more effectively? As constituency MPs, we need to be much more aware of what services are being provided to our constituents and in what timeframe.

I mentioned the NHS focus on talking therapies and the IAPT service. Having prepared for the debate, the Minister may know that unfortunately in the Wirral we have a significant backlog in waiting times for the IAPT service. Through asking questions, I have discovered a significant failure against one of the key measures. As of December 2022, the

“number of individuals accessing IAPT services as a percentage of prevalence in the borough”

was just less than 10%, but the national target is 25%. In my view, that is a big failure. It represents a significant number of people who ought to be accessing talking therapies who are not. What more can the Minister tell me about the oversight that central Government have of that?

The talking therapies staff in the Wirral are brilliant. Having inherited the backlog as a new provider, they have worked incredibly hard to try to get on top of the situation. They are doing significant and important work, but the delays have big consequences for my constituents. Some people who have come to my constituency surgeries have experienced challenging situations but not had the kind of support they needed.

Looking at the figures from NHS Cheshire and Merseyside more closely shows that unfortunately the issues get worse. Within the talking therapies service, the waiting time for the more significant level of counselling support can be up to eight to nine months, and there are nearly 700 people waiting for that counselling support. If I needed counselling and I was told that the waiting time was nine months, I would be really desperate. How is anybody supposed to deal with that wait, when they already know that they need help and support to face a life challenge? That is not fair. If the waiting time related to physical rather than mental health, I think a lot more attention would be paid to it.

Unfortunately, things are even worse in the Wirral. We know that early intervention is important, but the backlog and what was historically going on within our talking therapies service has been mirrored in the community mental health scheme. I have spoken to constituents whose loved ones have experienced significant mental health problems, and they have asked me what is going on with our community mental health team. Unfortunately, there are long waits there, too.

This is really problematic because those people may have experienced in-patient care and may need support after that. The aim may even be to prevent in-patient care. Those people should be supported in the community, but there is an average wait of 11 weeks. I worry that that situation will escalate. We know that we have real problems across our NHS, whether that is access to A&E or other parts of primary care. If people with a mental health condition are not supported as would be expected and given the care they need to improve their situation, they will end up in crisis. That is just how it is, and it will mean a knock-on for our A&E staff. It is a really frustrating situation, and I ask the Minister what the Government’s plans are for resolving it. Do they have a strategy that could support improvement in the Wirral?

As my hon. Friend the Member for Wirral West (Margaret Greenwood) said, we could have the same debate all over again—I will not suggest we do so tonight, because our staff may be hoping for a bit of an early night—about services for children and young people. Waiting times for them in the Wirral and across the rest of the country are really bad. The consequences of not getting support early are often worse for children and young people, who may be realising for the first time that they have a mental health condition. We need a strategy from the Government that includes children and young people, for all the reasons that I am sure the Minister is well aware of.

The gaps in performance and the poor quality of service across the Wirral and, I am sure, across the rest of the country are exacerbating inequality. Somebody who realises how long the wait on the NHS is for talking therapies or counselling, and who is in a well-paid or well-supported job may be able to access support almost immediately through their work plan, particularly if their job comes with an employee assistance programme. That is a good thing, because those people need help, but someone in a less secure job—on a zero-hours contract, perhaps, or on the minimum wage, as many social care staff and other key workers are—cannot access that support, so the situation is exacerbating inequality in our borough. I could say as much again about the structural causes of mental ill health, poor employment, poverty and other things, but I am sure the Minister is as concerned as I am about the exacerbation of structural inequality.

The Royal College of Psychiatrists published a report last year on the number of patients who are receiving support out of area, sometimes hundreds of miles from home. Anecdotally, I have heard about that happening in the Wirral. Does my hon. Friend share my concern about that? May I press the Minister today for an assurance that the Government will tackle the issue as a matter of urgency?

I thank my hon. Friend and constituency neighbour for that intervention, which I am sure the Minister has heard and will respond to.

There are three points on which I would really appreciate a response from the Minister. Having met providers of the talking therapies service and having listened to a whole host of professionals and constituents, I have come to the conclusion that one simple thing is needed to improve our mental health service in the Wirral: we need more staff. We need more people in primary care, especially because it will help to free up our secondary and specialist care. We have to get to people early. At the moment there is a false economy: people cannot be seen when they first present themselves to their GP, so their conditions end up getting worse. We need much more community mental health care in the Wirral. I would love to hear from the Minister what the workforce plan is. How can we get people into counselling and therapeutic roles, so we can get them quickly into a place where they can tackle the problems that people face?

We also need much smarter targets. As I have said to the Minister, I have found it exasperating how hard it is to work out what is going on. I know that targets can sometimes create a perverse culture, and we do not want to impose targets that are unhelpful, but it should be a basic feature of our NHS that people who need care are able to know roughly how long they will wait, and that we as politicians are able to judge whether that is appropriate. That is what we do, as constituency MPs, when it comes to every other aspect of the NHS. I am simply asking the Minister for smarter and more visible targets which will help us to improve the quality of mental health support in the Wirral. As I said earlier, most people do not need to see a consultant, so I do not think that the traditional way of doing things in the NHS works. Can we not have a simpler, basic access-to-service mental health target that will work?

Finally, let me say something about staff targets in respect of treatments and pathways. The Wirral is a very innovative place for mental health care. We are doing great things with social prescribing, which I invite the Minister to investigate if she does not know about them already. We have developed new partnerships with a host of organisations, targeting young people in particular, and considering how we can use the voluntary and community sectors in much better ways. The Minister may be aware of “Open Door”, which has delivered some particularly innovative ways of providing peer-to-peer support. Thinking more about the different kinds of support that are available, how they can help and how they can be delivered in the most cost-efficient way possible is, in my view, an urgent job of analysis for the Department, and I would love to hear more from the Minister about the Government’s plans for putting the various different treatments and pathways in place.

Ultimately, it comes down to this simple fact about the Wirral: we are not where we should be when it comes to giving people access to support. We need more counselling, and we need more therapeutic staff. I am keen to work with the Minister to try to deliver that.

I congratulate the hon. Member for Wirral South (Alison McGovern) on securing this important debate. I am always pleased to have the opportunity to talk about the progress that we are making with mental health services, not only locally but throughout England.

Mental health affects us all, and for those of us who experience poor mental health, its impacts can be detrimental to the ability to live well, thrive and achieve personal goals. That is why improving mental health outcomes, particularly for those who experience worse outcomes than the general population, is a top priority for me and, in particular, for the Government. As the hon. Lady said, mental health still has some way to go before it is put on a par with physical health in terms of expectations, help, support and treatment, but we are making progress, in the Wirral and across the country.

The NHS long-term plan commits an additional £2.3 billion a year to the expansion and transformation of mental health services in England by 2024, which means that that 2 million more people will be able to receive NHS-funded mental health support than were able to receive it in 2018-19. For instance, we will have invested nearly £1 billion every year in community mental health care for adults with severe mental illnesses by the end of the current financial year, which will give 370,000 adults with such illnesses—including older adults—more choice and control over their care and support.

Let us not be under any illusion. We have seen a tsunami of referrals as older adults, children and young people have sought help and asked to be referred. In a way we have been successful in breaking some of the taboos and stereotypes related to mental health, which means that people are willing to come forward and ask for help, but our challenge now is to ensure that the services are able to meet that growing demand.

The hon. Lady mentioned targets as a way of being able to give people an indication of how long they should be waiting. Until fairly recently, mental health did not involve any waiting time standards, but we have introduced targets for children and young people with eating disorders. Let me give an example to illustrate the sheer scale of the current demand. The number of children and young people entering urgent treatment for eating disorders has increased by 11% in the last two years, and in the previous year it increased by 73%. A record number of people now need help, and our challenge is to provide the services that will provide it.

NHS England is currently consulting on the introduction of five new access waiting time standards for mental health services, which we hope will address some of the concerns expressed by the hon. Lady. They include introducing a target for urgent referral to a community-based mental health crisis service that patients across all ages should be seen within 24 hours of referral. For very urgent referrals to a community-based mental health crisis service, a patient should be seen within four hours of referral across all ages. Patients referred from A&E should be seen face to face within one hour by a mental health liaison or equivalent children and young people’s service. Children, young people and their families presenting to community-based mental health services should start to receive care within four weeks. Those are the standards we are trying to introduce, and I will commit to updating the House on the progress we are making, because the standards in the Wirral that the hon. Lady has talked about in her speech are the standards that we would like to see across the country.

All those targets are about emergencies, which is important, but I hope that the Government will also be looking at targets for non-urgent care, because that is the way we prevent people from getting to the urgent bit in the first place.

I absolutely agree and I will come on to talk about some of the work we are doing in that space in a moment.

We know that the number of children and young people experiencing mental health problems is rising, and that many of them risk continuing to experience mental health problems throughout their life as a result. This has been exacerbated by the pandemic, which is why there is a further £79 million to address the impact of covid on children’s and young people’s mental health. That has allowed around 22,500 more children and young people to access community health services in order to support them as early as possible.

One of the most exciting things we are doing relates to getting in at an earlier stage, as the hon. Lady has just suggested, and talking about mental health rather than just talking about mental illness. This involves our programme of mental health support teams that have been rolled out in schools and colleges. As of spring last year, there were 287 mental health support teams in place in around 4,700 schools and colleges across the country. The type of support they are able to provide to the young people and the teachers in those schools means that children who need help through early intervention can be signposted to it and that those with more complex needs can get into the system a lot quicker.

Our challenge now is to roll that out across all schools, and we are hoping to be able to do that as quickly as possible. In the hon. Lady’s patch, there are 25 mental health support teams in place or planned in the area covering Cheshire and Merseyside, four of which are in the Wirral. I am hoping that she will start to see them being rolled out and that she will feel they make a difference. Mental health support teams now cover 26% of pupils a year earlier than originally planned, but we fully recognise that that is still a long way off 100%.

We know that there is more to do in terms of capital investment in mental health services so that local communities can have the infrastructure to see people earlier, rather than waiting until they are in crisis and need to be seen in A&E or in-patient facilities. That is why recently we provided £150 million of capital investment to be rolled over in the next two years via NHS England. From that fund, £408,000 is being invested in improvements in NHS 111 and crisis line infrastructure at the Cheshire and Wirral Partnership NHS Foundation Trust, to try to start that process of getting early intervention to people as quickly as possible.

The hon. Lady has pointed out that waiting times for some mental health services are longer than we would like, and I am happy to put my hands up and admit that that is the case. I can assure her that both locally and nationally we are doing all we can to ensure that people are getting the support they need as quickly as possible. Her local foundation trust has implemented a series of measures to help reduce those waiting times, and the number of young people waiting for appointments has been reduced by 68% since March last year. Her trust has also recruited 13.4 whole-time equivalent roles and made provision for additional sessions of consultant psychiatry. Again, there is lots more to do, but we are starting to make inroads into some of those long waits.

I have already pointed out that NHS England is consulting on five new waiting time standards, and I will update the House as soon I have the information on when they are likely to be rolled out in practice. It is also important to note that many patients with mental health needs also suffer poorer physical health outcomes, which is why we announced in January that mental health will be part of the major conditions strategy so that we deal with both issues for people who are struggling with mental illness.

It is important that we talk about the local issues in Cheshire, Merseyside and the Wirral, and the hon. Lady’s local integrated care board is currently undertaking a transformation programme within its mental health services. I understand from NHS England that local services in the Wirral are establishing a community model of mental health as part of their long-term plan ambition, with the aim of removing the gap between primary and secondary mental health services.

We want people to be seen much earlier when they go into crisis. Nationally, we are already seeing fewer people turning up to A&E because crisis teams are able to see them in the community much quicker and much earlier, with better outcomes for managing their symptoms. Talking Together Wirral has achieved the national target of 50% recovering through talking services since January 2023, and the Every Mind Matters website enables people to self-refer to talking therapies. We are doing quite well in getting first appointments, but our challenge is where people need further sessions, which is often where the long waits occur. I reassure the hon. Lady that we want to make it as easy as possible for people to self-refer into the system and, locally, the Wirral is starting to recover the waiting times for such services, but of course I am happy to work with her to see what more can be done.

The hon. Lady mentioned the fantastic, proactive work of her local health system. Cafe Create is a pilot programme launched in April 2022 as a joint commissioning venture between health services and Wirral Borough Council, and it provides an informal place for young people at risk of mental health crisis to drop in and access support from professionals and peers, counselling and drug and alcohol support. We want to support more programmes like that.

The myHappymind programme is rolling out in the Wirral, reaching 22 primary schools by the end of last year. Plans, including a business case, are now in place to bring the programme to every primary school in the Wirral by 2024, and I am happy to work with the hon. Lady on that because it is important to establish in every school that mental health is on a par with physical health. We teach young people and children about the importance of a good diet and exercise, and it is equally important to teach them about what mental wellbeing looks like and when to reach out for help.

There is a lot of work to do, and I do not dismiss in any way the hon. Lady’s point about the significant number of people who want help and the sometimes long waits to access services, but we are making progress on trying to deal with the large number of cases coming forward and on supporting local communities such as the Wirral to roll out services.

I hope I have been able to reassure the hon. Lady of our commitment to improving mental health services, to introducing some of the standards she mentioned—I take her point that it needs to be about more than just urgent care standards—and to supporting local communities to address crises in the community rather than waiting for a person to need admission, sectioning or in-patient care. I hope we will be able to demonstrate the progress we have made.

Let me touch on one final point about staff. We have an ambition to recruit 27,000 more mental health workers and we are on track to meet that. That covers a wide range of mental health practitioners, from mental health nurses to psychiatrists, counsellors and psychologists. They are working in a wide range of roles, and I wish to reassure the hon. Lady that we are on track to meet that target. It is the key to providing these extra services; without the staff, we will not be able to provide the services we need. I hope I will be able to update the House fairly soon on further work we are doing, not only on recruitment, but on the retention of our fantastic staff, who do a really hard job. When we hear news about the health service being under pressure, we often hear about accident and emergency, intensive care units and hospital beds, but mental health workers do some of the hardest jobs in health and social care, and I pay tribute to them

I hope that I have reassured the hon. Lady that we are working hard. I absolutely identify with the points she has made and look forward to working with her to improve mental health services in the Wirral.

Question put and agreed to.

House adjourned.