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Health: Adult Psychiatric Care

Volume 769: debated on Monday 22 February 2016


Asked by

To ask Her Majesty’s Government what is their response to the report Old Problems, New Solutions: Improving acute psychiatric care for adults in England.

My Lords, the Government very much welcome this report and are considering its recommendations. We have asked NHS England to reduce out-of-area treatments and eliminate their inappropriate use. NHS England published its independent Mental Health Taskforce report last week, backed by a £1 billion investment announced in January. NHS England will develop standards on access to mental health treatment.

My Lords, I thank the Minister for that reply, and I am delighted to see the commitment to parity of esteem between mental and physical health and to the funding allocated last week. Parity of esteem means equal standards for people with mental and physical conditions. The report recommends that requiring people to travel long distances to be treated should be phased out within 18 months, and there is evidence as to why that is a good target; and yet the Government have indicated in their response to the task force that it would take four years to phase it out. Will the Minister explain why that is and say whether there is scope for the Government to reconsider the timing?

My Lords, I reiterate my thanks to the noble Lord for his excellent report: it is 134 pages and reads very well and very quickly. It is obviously highly unsatisfactory that so many people have to travel long distances to get in-patient care. The noble Lord’s report shows that, in one month—in September, I think—500 people had to travel more than 50 kilometres to get to in-patient care. It is a priority for the Government and we are considering the noble Lord’s recommendations. I cannot give a commitment that we can reduce the four years to 18 months now. I can only repeat that we fully understand the importance of addressing this issue.

My Lords, the noble Lord’s report rightly points to the need to improve both in-patient care and alternative treatment in the community. Given that, as the report says, the cost of one adult acute bed is the same as that of treating 44 people at home, will the Government say what plans they have at this early stage to increase financial incentives to encourage commissioners to get the right balance of provision?

My Lords, if we can improve home treatment and crisis resolution at home it will free up in-patient beds and solve the other problem as well, as people will have to travel less far. That is absolutely critical. I cannot tell the noble Baroness today what NHS England is proposing to do with financial incentives, but I can reiterate that treating more people outside hospital, at home, is a priority for the Government.

My Lords, does the Minister realise that there are real problems in many regions? I chair a charity which deals with the most vulnerable—people with complex needs. We have evidence that the number of people whose mental health needs have increased has risen significantly over the past five years, and yet three centres in Tyneside—both residential and day care—which deal with the mentally ill are closing this year. How will we meet those people’s needs in such circumstances?

My Lords, reading the noble Lord’s report, I was struck that he said in the foreword that he went through times when he was very depressed and times when he was deeply impressed. In a way, that sums up the mental health system—it is fragmented, and there is a high level of variation. We provide fantastic care in one place but terrible care for somebody else, and very often it is not related to cost. I do not know about the particular instances that the noble Baroness has referred to, but I can fully understand that in certain areas it is much worse than in others.

My Lords, I declare my health interests. I, too, welcome the excellent report and recommendations by the noble Lord, Lord Crisp, and his commission, and also the report and recommendations of the Mental Health Taskforce published last week. I would be grateful for clarification from the Minister on the financial commitments that the Government have made on the crucial implementation of the recommendations of both reports. In particular, can he confirm that the announcement of £1 billion each year for mental health services begins in financial year 2016-17; that, for the next four years, that £1 billion will be additional to the £1.5 billion investment in child mental health services which has already been announced; and, finally, whether this £1 billion annually is additional money or part of the £8 billion which has already been announced and allocated to NHS England for all health services?

No, it is not very simple, or at least it is not simple to me; but then I perhaps have a smaller brain than the noble Lord opposite. It is certainly additional to the £1.5 billion for children and young people. I cannot tell the noble Lord now, without fear of making a mistake, whether it will be £1 billion every year from 2016-17 to 2021. It is certainly £1 billion in 2021. If it is all right, I will write to the noble Lord to confirm and clarify that.

How do the Government intend to monitor the efficacy of this investment, and against what performance indicators will this investment be audited?

My Lords, that is a very hard question to answer. The talking therapies, for example, seem to be effective in about 50% of the cases, and whether they are effective is clearly a clinical decision. As for other standards, we tend to rely, as the noble Baroness will know, on proxies such as waiting times and the four-hour standard, which the noble Lord recommended in his report. We are considering the introduction of a four-hour waiting-time standard for people suffering from psychotic problems, in the same way as we have for physical health.

My Lords, can I give the Minister an easy question? What discussions has he or any of his colleagues in the Department of Health had with his counterparts in the Scottish Administration to exchange experience and ideas?

My Lords, I am not aware that we have had any discussions in the Scotland Office. However, there is no doubt that in Scotland they are approaching quality improvement extremely effectively. I had a recent meeting with people who have been involved in that, so I can assure the noble Lord that, at that level, if we can learn things from what they are doing in Scotland, we will do so.

My Lords, will the Minister give an undertaking that the very good system of encouraging treatment at home is not at the expense of families where children are the primary carers? When children are trying to cope with someone in very difficult circumstances they are often alone for long periods and are unable to cope with a mother or father whose behaviour can even be frightening.

My Lords, the noble Baroness raises an important point. So much of this comes down to judgment, and so much of that judgment is judged with hindsight. We put a huge onus on clinicians and people working in health and social care to make the right judgments on where to treat people. In normal circumstances, where people can be treated at home rather than in an in-patient setting, that will be best; but there will be exceptional circumstances such as those that the noble Baroness mentioned, where it may not be.