Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)
It is a pleasure to serve under your chairmanship for my first outing as a Minister, Sir Roger, and I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this important debate. He has rightly pointed out that many areas of our mental health services are not yet meeting the standards that patients and their families deserve and have a right to expect, and he is absolutely right to say that improving access and waiting times for early intervention in psychosis must be a top priority among those. I assure him that both I and the Government share his determination and sense of urgency in such matters.
I think we can agree that for far too long as a nation we tolerated poor mental health services in this country, and we all know the terrible price that some have had to pay for our collective failure to step in earlier. That time is now over and we are in the process of creating a mental health service that we can be proud of—one in which, no matter where someone lives, they will be able to access the services they need when they need them, and just as importantly, one that people feel safe and confident using.
But we have to be honest about this, or we will get discouraged and lose momentum: it is not going to happen overnight. Although there are already some areas of outstanding practice that we should be encouraged by, we are, in general, coming from a low base, and only a sustained effort over the next few years is going to bring about the change that we are all demanding.
For that reason, I would like personally to thank the right hon. Member for North Norfolk for his pivotal role in securing parity of esteem and for supporting the introduction of the first waiting time standards for mental health services. With the previous Prime Minister, the Health Secretary and my predecessor, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), the right hon. Gentleman has set us on the road to better mental health services. Now we have to follow it through, no matter how bumpy the journey may become at times. I hope that he will meet me and give the benefit of his advice, because I suspect I am going to need it.
I would also like to thank everybody who has contributed to today’s debate. Some have given moving accounts of personal experiences or those of family members or friends. Others have taken the opportunity to raise difficult constituency cases. I know that all here today are committed to keeping mental health at the top of our agenda as the Government shape their new programme.
That brings me on to the challenges of the early intervention pathway for psychosis, which is designed to deliver the improvements to psychosis care that are urgently needed, as the right hon. Gentleman so clearly laid out. He pointed out that psychosis is more common than people realise: it affects one in 2,000 people in England in any given year. We know that the early intervention in psychosis programme is crucial in ensuring that mental health services maximise their opportunity to intervene at the earliest possible moment to prevent patients from relapsing, so that they are less likely to be admitted to hospital and have less severe symptoms. As the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) so expertly described, such services are recognised as the best model for helping young people to recover from the first episode of psychosis. They have the potential not only to save the NHS tens of millions of pounds but to reduce the serious impact of psychosis on those patients’ lives and those of their families and carers.
The hon. Member for Strangford (Jim Shannon) asked about funding. When waiting times for mental health were introduced for the first time, they were backed by £120 million of investment. In addition, we have invested £33 million in developing EIP services. Further funding for early intervention in psychosis was announced in NHS England’s “Five Year Forward View for Mental Health” implementation plan earlier this year. That funding is designed to support delivery of the target to ensure that 60% of people who experience their first episode of psychosis receive treatment with a NICE concordant package of care within two weeks of referral by 2021.
Norman Lamb
I am encouraged by what the Minister is saying. I assume that the money she has talked about that will be allocated is part of the baseline that CCGs will receive and not a separate allocation. The question is how she ensures that CCGs actually spend the money as intended.
Nicola Blackwood
As the right hon. Gentleman is aware, this work is in its early stages. He is right that services are working hard to develop this process. NHS England has set out in its implementation plan how the services will need to grow and improve to meet the new standards. In particular, it has noted that the current block contract arrangements can result in poor transparency on spend per patient, as he has seen with his freedom of information request.
NHS England has been looking at alternative funding models that will link an element of payment to achievement of quality and outcomes, including the EIP access and waiting time standard. When there are variations in spend, we will need to consider the reasons for that and ensure that necessary action is taken to address any impact on the quality of care available. I hope that reassures the right hon. Gentleman.
In addition, the Royal College of Psychiatrists College Centre for Quality Improvement has been commissioned to undertake continued assessment and quality improvement work. This will be through a quality improvement network, supported by an annual self-assessment that will be independently validated and scored. All early intervention in psychosis services are going to be expected to participate. The first results will be published in April 2017, but any earlier results will be published before that. It is intended to provide a transparent assessment of services across England. This will give us a clear picture of service provision and enable us to target areas where additional development will be required, so that we can ensure that the standard is met and that people receive the care they need.
The right hon. Gentleman also mentioned the important issue of age caps. The most likely age for a first episode of psychosis to occur is between 14 and 35, as has been pointed out.
Nicola Blackwood
Currently, the block contracts make it less transparent than it should be and we are working to address that.
I had moved on to talk about the age cap. As I was saying, psychosis is most likely to occur between the ages of 14 and 35; consequently, services have traditionally been commissioned in this age range. However, a sizeable proportion of presentations take place after that, which is why NHS England guidance is clear that services should be available to people up to the age of 65. We are working with local commissioners to ensure that service provision is expanded to cover all age ranges. A regional assurance process is under way to assess providers’ and commissioners’ progress in making that happen. This is intended to deliver transparency across England on the plans currently in place, and, where it is not happening, to highlight where further development is required. Again, the Royal College of Psychiatrists CCQI’s assessment work and the development of robust data, which I will come on to in a minute, will enable us to see areas that are not providing services for people up to 65 and to target development accordingly.
However, none of that will happen without the right people to deliver it. To improve access to NICE-recommended psychological therapies, we have to ensure that there are the staff numbers and the appropriate skills mix to deliver the full range of treatment to those who need it. The modelling undertaken by NHS England for additional investment to achieve the new standard incorporates the costs of the necessary workforce development. Health Education England has a targeted work programme under way to increase the number of EIP staff trained to deliver cognitive behavioural therapy for psychosis and family interventions, with £6 million invested in training this year.
Finally, as the shadow Secretary of State pointed out, to ensure consistently good performance against this standard and future waiting times standards, we need robust data. I am very happy to meet her to discuss that point. We know that the data need to improve and we are working hard to make that happen. The right hon. Member for North Norfolk is well aware that we are starting from a low base on data availability and quality in mental health, but we cannot let that stop our progress or our ambition.
We are implementing the EIP waiting time standard with a clear expectation that providers will meet that standard. We are working simultaneously with the NHS, NHS England and NHS Digital to ensure that the data become robust enough so that we can hold providers and commissioners to account for meeting that standard. Data on mental health are behind that of physical health, and it will take time to get the data of the same quality. We know that from the improving access to psychological therapies data, which took some time to develop to a good quality. However, the IAPT pathway and standards are now an exemplar and represent a good model for development of other data sets. Encouragingly, data have started to flow via the mental health services data set from March this year, including experimental data on EIP. That is not robust, but there has been significant progress so far. We are currently working across Government to deliver a robust five-year mental health data plan to take us to 2020. The data plan, as recommended by the “Five Year Forward View for Mental Health”, will address the need for substantially improved data and information about mental health services for adults and children.
I hope that this response will show that we are committed to ensuring that there is no gap between rhetoric and reality on the ground. The right hon. Gentleman was right to identify funding, age caps, staffing and skills shortages and data limitations as the key challenges that we are grappling with in the implementation of the EIP, but we have in place work streams to address all those factors. We also agree that we require a systemic review of implementation to challenge and support local areas to implement the EIP more effectively. That is why we have asked independent experts at the Royal College of Psychiatrists to do exactly that. As I have said, they will be reporting in April 2017, but they will report as they go along with any earlier information so that we can make progress as quickly as possible. In the meantime, I will certainly write to him with a response on the detail of his dossier, and I entirely agree with all those who have made the point that we need to share best practice between devolved nations on these issues.
Today’s debate has been very important not just on the details of the EIP, but to test the Government’s commitment to health equality. I am grateful to all colleagues who have raised concerns today. I hope that our commitment to reforming our mental health services is now beyond doubt, but I know, as I look around the Chamber today, that I have heard in speech after speech the determination to see change, and I take courage. Great reform requires long-term vision and non-partisan partnership. I have heard all three of those here today and that truly is a firm foundation for the task that we have ahead.
Motion lapsed (Standing Order No. 10(6)).