My Lords, I will now repeat as a Statement the response to an Urgent Question given in another place by my right honourable friend the Minister of State for Community and Social Care on the report of the independent Mental Health Taskforce. The Statement is as follows.
“Achieving parity of esteem for mental and physical health remains a priority for this Government. We welcomed the independent Mental Health Taskforce launched by NHS England last year with a remit to: explore the variation in the availability of mental health services across England; look at the outcomes for people who are using services; and identify key priorities for improvement.
The task force was chaired by Paul Farmer, chief executive of Mind, and I want to thank him, the vice-chair, and his team for all their work. The task force also considered: ways of promoting positive mental health and well-being; ways of improving the physical health of people with mental health problems; and whether we are spending money and time on the right things.
The publication of the task force’s report earlier this month marked the first time a national strategy has been designed in partnership with all the health-related arm’s-length bodies in order to deliver change across the system.
This Government have made great strides in the way we think about and treat mental health in this country. We have given the NHS more money than ever before and are introducing access and waiting time targets for the first time. We have made it clear that local NHS services must follow our lead by increasing the amount they spend on mental health and making sure beds are always available.
Despite these improvements, the task force gives a frank assessment of the state of current mental health care across the NHS, highlighting that one in four people will experience a mental health problem in their lifetime and that the cost of mental ill health to the economy, NHS and society is £105 billion a year. We can all agree that the human and financial cost of inadequate care is unacceptable. Therefore, we welcome the publication of the task force’s report, and the Department of Health will work with NHS England and other partners to establish a plan for progressing the task force’s recommendations for improving mental health.
To make these recommendations a reality, we will spend an extra £1 billion on mental health by 2020-21 to improve access to services so that people receive the right care in the right place when they need it most. This will mean increasing the number of people completing talking therapies by nearly three-quarters, from 468,000 to 800,000; more than doubling the number of pregnant women or new mothers receiving mental health support from 12,000 to 42,000; training around 1,700 new therapists; and helping 29,000 more people to find or stay in work through individual placement support and talking therapies.
I can assure all Members of the House that they will have ample opportunity to ask questions and debate issues as we work together to progress the task force’s recommendations”.
My Lords, I am grateful to the Minister for repeating this Statement. The final report, which came out recently, gave a very frank assessment of the state of current mental health services and describes a system which is said to be ruining some people’s lives. It is entirely consistent with the report by the noble Lord, Lord Crisp, on acute in-patient psychiatric care. It makes a number of recommendations which, if implemented in full, could make a significant difference to services that have had to contend with funding cuts and staffing shortages as demand has continued to rise, leaving too many vulnerable people without the right care and support.
We return to a question which was debated yesterday: the £1 billion by 2021. A number of questions remain unanswered. Can the Minister confirm that there is no actual, additional money other than the existing £8 billion that has been set aside for the NHS up to 2020, as previously announced by Her Majesty’s Treasury? Given that mental health services receive just under 10% of the total NHS budget, surely these services would actually expect to receive much of this additional money anyway, as part of the NHS settlement. Will the Minister explain how this can be expected to deliver the transformation that he and the task force say is urgently required?
In a recent Oral Question, there was the usual discussion of whether there should be a national debate about NHS funding. The Government need to get on, not just to debate it but to ensure that the NHS has enough money. Has the Minister studied the advice given by Professor Don Berwick, the Government’s safety adviser? He said, “I know of no nation that is seeking to provide healthcare at the level that western democracies can at 8% of GDP, let alone 7% or 6.7%. That may be impossible”. His advice to the Secretary of State was that it is crucial that the Government reflect on whether they have overshot on austerity. What is the Minister’s response to his own safety adviser?
My Lords, we have strayed somewhat from the subject. On the money, the Prime Minister announced an extra £1 billion in January. It is the same £1 billion and is within the £8 billion—or £10 billion—that was in the settlement in November. The Government asked Paul Farmer to set out in his report where the priorities are and where the money should be spent, and that is exactly what has happened. Interestingly, I saw Don Berwick last week. He is a very distinguished American with a lot of experience in patient safety and health improvement. There is no question: it is going to be tough. It will be very difficult to do on around 7% of GNP, but there is absolutely no doubt, from the work of the noble Lord, Lord Carter, and others, that there is a lot to go at. If it was not tough, we would not be going at it. We must take advantage of the fact that it is going to be tough by addressing some of the difficult issues which we should perhaps have addressed in the past but did not.
My Lords, the task force report, which I greatly welcome, points out that, while mental health activity accounts for some 23% of what the NHS does, it accounts for roughly half of that in NHS spending. Worse still, years of low prioritisation within the NHS have meant that clinical commissioning groups have often diverted money earmarked for mental health spending to areas of physical health, and that is harder to quantify because of obscure methods of data collection. Could the Minister say what steps the Government propose to take to ensure that the extra £1 billion announced, whether entirely new or not, is actually spent on improving mental health services. How will that be monitored in practice?
My Lords, that is clearly a very good question. At our level, we will monitor this through the mandate given to NHS England. Within that mandate, it has told all CCGs that they must increase their spending on mental health services by, I think, at least 3.7%. The noble Baroness will be interested to know that in the first six months of this year the increase in spending on mental health has been 5.4%, so it is higher than the stipulated 3.7%. Over the next five years I think we will see a trend towards more money going into mental health and primary care and away from acute care. We should not underestimate the very difficult impact that will have on many of our acute hospital services. The transformation will be very difficult. We may not agree on how much money it will take but I think we all agree in this House on the direction of travel—that it must be right for money to be spent in those areas. I hope that answers the noble Baroness’s question.
My Lords, this Statement does not deal with children. The Government have promised to spend an extra £1.4 billion on children and young people over the next five years. I cannot recall the impact that it will have on the number of beds but there will certainly be more beds for children experiencing severe eating disorders. I will have to write to the noble Lord with that information if that is all right.
No doubt the noble Lord will tell me if I am wrong, but I believe that attracting people who are in training, particularly as doctors, into psychiatry and other mental health-related parts of the profession is still very difficult. What work are the Government doing with the medical training institutions to encourage more people to regard psychiatry and related professions as a proper way to use their skills?
The noble Baroness is right: psychiatry is one of the shortage areas, along with general practice and a few other specialties. Premia will be available in the new junior doctor’s contract to encourage people to do psychiatry. That does not answer the noble Baroness’s question all that fully; this is something I should like to look into more myself. However, within the extra spending that has been announced, there will be money for, I think, 1,700 therapists who are experienced in IAPT—cognitive behavioural therapy and the like—which should also help.
Given the problems experienced by emergency departments when they have an acutely distressed and ill mental health patient who cannot be cared for in the community and who needs to have a bed found for them, do the Government recognise that, at the moment, beds in the emergency department have to be blocked off—sometimes for hours, occasionally for days—while a bed is sought for this person, who could not possibly be cared for in the community because they are so acutely disturbed? Will the task force be asked to look specifically at that area of acute provision, separately from some of the other areas of more chronic mental health provision?
My Lords, it is very serious when someone going through a severe psychotic episode ends up in an A&E department, there is no local bed available in a mental health hospital, and they therefore spend time being specially guarded by two or three people, often in wholly inappropriate surroundings. This is the issue that the noble Lord, Lord Crisp, addressed in his report which came out a week earlier than the task force’s: people are moved, often many hundreds of miles away, out of their area, to find a bed. Sometimes they get there and the bed is full and they are a long way from their family. It is a highly unsatisfactory, often very dangerous, situation. The approach of the task force is to try to ensure that more money goes into the home treatment and home resolution area, to free up beds in the acute sector. By providing more care in the community, more beds are freed up in acute hospitals, increasing capacity and enabling people who are in A&E departments to be transferred more quickly to the right place. This is clearly a very serious issue.
My Lords, of the £1 billion, £290 million has been earmarked for perinatal spending on pregnant women and mothers suffering from postnatal depression. I cannot tell the noble Baroness how many extra beds that might provide, or how much of that is being provided away from beds, but I will write to her on that matter.
My Lords, does my noble friend the Minister agree that in order to secure parity between physical and mental health services, it is important to ensure that mental health service providers are properly and fairly reimbursed for the activity they undertake rather than subject to a block grant system where physical health service providers are paid for the work they do? In that respect, will the Government commit to working with NHS England and NHS Improvement to make progress now in the development of tariff-based systems for mental health services which fairly reimburse for delivering quality in outcomes?
My noble friend is absolutely right. I am glad he finished by referring to quality in outcomes rather than just activity. That is the critical thing about getting the tariff right, that it is based not just on activity but on quality in outcomes.