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National Health Service: Mental Health Funding

Volume 791: debated on Wednesday 20 June 2018


Asked by

To ask Her Majesty’s Government what proportion of mental health treatment is funded by the National Health Service nationally as against local funding.

My Lords, the Government are committed to increasing spending on mental health. In 2017-18, the NHS spent an indicative figure of £11.86 billion on mental health. Of this total, £9.97 billion was locally funded by clinical commissioning groups, with the remainder for nationally commissioned specialised services.

I hear what the Minister says, but parity between mental and physical health remains a concern. He knows about the facility for mental health in Weston-super-Mare and the problems associated with its future. However, I have found this problem around facilities in local areas to be widespread throughout the country. Their funding is not predominantly mainstream NHS money for mental health services, but NHS money is often used to plug holes elsewhere and local mental health units are struggling. Will the Minister address the issues of parity and funding for local mental health care?

I agree with the noble Lord that we need to increase funding for local mental health services. That has been happening over the past few years; indeed, between 2015-16 and 2018-19 it has gone up by £1 billion. I turn to his point about mental health funding being used for other purposes. I want to be clear that there is NHS England guidance that that should not happen, and from this financial year all CCGs will have to meet what is called the mental health investment standard, which means that they are to increase their spending on mental health at least as much as, if not more than, their spending on physical health.

My Lords, regardless of what the Minister says, does he accept that there has been a systematic destruction of voluntary organisations providing many mental health services? This has had a particular impact on survivors of domestic violence. What are the Government doing to ensure that Women’s Aid and other organisations that provide support for women suffering from and the survivors of domestic violence have funding available through the means to which he has referred?

Although the particular funding the noble Baroness is talking about is a Home Office issue, I can say that £100 million is available until 2020 to support the victims of domestic violence. From the health service perspective, obviously we are increasing the amount of money spent on treating those with mental illness, regardless of the cause that gave them their illness in the first place.

My Lords, does the Minister agree that more oversight is needed—not just through the mental health dashboard—of how and how well clinical commissioning groups meet the mental health investment standard, previously known as parity of esteem? Can he also explain why the mental health investment standard does not include people with learning disabilities who have mental health needs? Further, what assurances are there that clinical commissioning groups will continue with their current level of investment once the national sustainability and transformation fund finishes?

I reassure the noble Baroness that there is independent audit of performance against the mental health investment standard. Anyone with mental health problems, whether they have learning disabilities or not, should certainly be included in the figures. I am alarmed by what she has said and obviously I will look into it and write to her. However, it is important to say that CCGs have been increasing their spending. In 2016-17 they were expected to deliver at least 3.7% growth in mental health spending, but the actual outturn was 6.3% growth, so that is a good story.

My Lords, I speak for one of the most rural parts of England. Does the Minister recognise the higher level of suicide in rural areas? In part, this is due to rural isolation and the sparsity of mental health provision. What plans do the Government have to increase local and accessible provision in these areas?

I agree with the right reverend Prelate that, unfortunately, that is a feature of rural communities. I understand that the MHCLG has a sparsity fund to help with that issue. Indeed, particular funding is going into support and more community-based care for those at risk of suicide and other mental illness.

My Lords, last Thursday, I was walking past Lambeth fire station just before the minute’s silence. Together with Charles Hanks, the station manager, I stood with those brave and professional firefighters. Afterwards, I asked about ongoing support and access to counselling services. Tracey Dennison, from the fire brigade, told me today that there was a slight increase in absenteeism as the anniversary approached and the inquiry began. The Fire Fighters Charity stepped up to provide family support. Can the Minister ensure, in the sad event of another serious tragedy, that emergency capacity for immediate and ongoing counselling support is available for our brave emergency services?

My noble friend is absolutely right to highlight this issue. Individually, our emergency workers did extraordinary deeds of bravery, for which we are all deeply grateful, during the Grenfell fire. In the aftermath of that fire, the north-west London mental health service was the lead trust in providing mental health support for not just the families and individuals who were victims of the fire but emergency service workers who had been through that very traumatic experience. I strongly encourage any emergency service workers who are experiencing trauma—of course, that can happen many months, indeed years, afterwards—to get in contact with mental health services.

My Lords, does the Minister agree that £1 spent today on child and adolescent mental health services is likely to save the NHS a considerable number of pounds in the future? What proportion of the money spent on mental health services is going to child and adolescent services? Will that proportion increase in the future?

The noble Baroness makes an excellent point. The emerging science tells us that heading off mental illness in adolescence is critical to ensuring that it does not deepen and become more severe in later life, with great human as well as economic cost. At the moment, the mental health budget for children and young people does not reflect the burden that children and young people have, which is why the Prime Minister announced an extra £1.4 billion for children and young peoples’ services, as well as £300 million on top of that to support the plans set out in the child mental health Green Paper.

My Lords, the Minister has already referred to the mental health investment standard, but recent figures issued by the Royal College of Psychiatrists show that 15% of clinical commissioning groups are not following NHS England’s instruction to increase the proportion of their spend on mental health. What practical steps are the Government taking to ensure that all CCGs meet this standard?

The noble Baroness is quite right in her figures: it was 85% compliance in 2017-18—175 of the 207 trusts. It has to be 100%. It will be independently audited and reported against. Indeed, interventions will take place if that does not happen.