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Health: Mental Health

Volume 740: debated on Wednesday 21 November 2012


Asked By

To ask Her Majesty’s Government, further to the remarks by Earl Howe on 8 February (HL Deb, col. 273), what action they have taken to ensure mental health is treated on a par with other National Health Service services.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I declare an interest as a director and former chair of Chapel Street community health.

My Lords, the Health and Social Care Act 2012 creates equal status for mental and physical health; the new mandate to the NHS Commissioning Board tasks it with delivering this goal. One of the eight objectives of the mandate is,

“putting mental health on an equal footing with physical health–this means everyone who needs mental health services having timely access to the best available treatment”.

The NHS will be expected to demonstrate progress by March 2015.

I thank the Minister for that Answer. The NHS constitution gives a patient the right to drugs and treatment recommended by NICE for use in the NHS where clinically appropriate. “Recommended” means that they have passed NICE’s technological appraisal. For mental health, the problem with talking therapies is that they are not appraised because they are not technological. Will the Minister reassure the House that “parity of esteem” will mean that the NHS constitution will give someone the right to any therapy or treatment recommended by NICE for use in the NHS, even if it has not passed the technology appraisal, provided that there is good evidence for its efficacy—for example, CBT for schizophrenia?

My Lords, as the noble Baroness made clear, the NHS constitution sets out that patients have the right to drugs and treatments that have been recommended by NICE for use in the NHS if their doctor says that they are clinically appropriate for them; that includes talking therapies for certain problems. The mandate to the NHS Commissioning Board is clear about everyone who needs mental health services having timely access to the best available treatment. The NHS will be expected to demonstrate progress in achieving that by 2015, as I mentioned. For many patients, there are few better therapies than talking therapies. Given that the board must deliver those outcomes, the rest follows.

My Lords, I will press the Minister further on this. In his response to my debate on mental health on 8 October, he undertook to write on a number of issues. True to his word, as we have come to expect, he wrote a long, substantial, constructive and positive letter in which he discussed psychological therapies being available for disturbed people. I want to pick up on what the noble Baroness has said about schizophrenic disorders. There is a tendency for people with the schizophrenias simply to be given medication and social management. There are psychological treatments—family therapy and others—that are appropriate. Can my noble friend ensure that those who suffer from the schizophrenias will also receive appropriate psychological therapies and not simply be abandoned to medication and social management?

My Lords, my noble friend makes an important point, and I can reassure him on that. I know that he is concerned that IAPT services may be displacing other psychological therapies. In fact, having looked into this, I can tell him that data from the NHS finance mapping exercise shows that IAPT services are not displacing other therapies; I have figures here to prove that. Spending on non-IAPT psychological therapies has reduced very slightly, by just over 5%, but the overall picture is one of a dramatic expansion in the availability and range of psychological therapies.

My Lords, as the mover of the amendment that put equality of mental and psychical health in legislation, I am pleased that the Government did not contest it again—albeit that it was won by a Division. I am also pleased that mental health is to be treated equally in the mandate.

I am coming to the question which is important. Having put it in the mandate, would it not now be right for the department to ask the Commissioning Board to produce a framework outcome for mental health so it can assess progress in treatment equality for mental health?

My Lords, we expect the equal priority for mental and physical health to be reflected in all relevant aspects of the NHS’s work. There can be no single measure of parity. As I said earlier, we expect the board to be able to demonstrate measureable progress towards parity by 2015. However, there are some specific areas where we expect progress; for example, relevant measures from the NHS outcomes framework, including reducing excess mortality of people with severe mental illness; delivering the IAPT programme in full and extending it further; addressing unacceptable delays, and significantly improving access and waiting times; and working with others to support vulnerable and troubled families. Those are very detailed objectives for the board, all of which bear upon the key question of parity between mental and physical health.

Given the real terms drop in mental health funding last year, which was even greater for older people’s mental health services—an area which has many challenges ahead for us; will the Minister tell us how the Government will ensure consistency and parity in local commissioning strategies, as clinical commissioning groups can obviously choose to prioritise or exclude what they want to have in those strategies? How will the Government deliver the Prime Minister’s dementia target?

My Lords, the way in which mental health services are commissioned locally is of paramount importance. One of the features of the reforms is to bring together local authorities and the health service to plan services in a much more integrated way. Clinical commissioning groups will ignore the imperative of mental health at their peril, because they will be charged—under the commissioning outcomes framework, which the board will set—to deliver meaningful progress on all the indicators, including mental health indicators. It is an absolute necessity that good commissioning takes place at a local level.

My Lords, the Minister is well aware that only a third of people whose lives are being ravaged by depression and anxiety are receiving treatment. He rightly pointed out that the commissioning board has a responsibility here, but I understand that it does not regard this as one of its priorities. Will the Minister give a very clear signal to the commissioning board that Ministers regard the equal treatment of mental and physical illnesses as important, and that parity must be achieved?

My Lords, that objective is explicitly spelt out in the mandate. I have already spoken about some of the ways in which we expect the board to demonstrate that they have delivered that objective, and I can give the noble Baroness the reassurance that she seeks.