Mental Health and NHS Performance Update

Baroness Hussein-Ece Excerpts

Monday 9th January 2017 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for her welcome. The global number of psychiatrists across England is increasing: I was not aware of the particular shortage in rural areas. I will certainly investigate and write to my noble friend about it. I know, from my past work in education and the example of head teachers, that the shape of the public sector workforce is now such that senior positions are weighted towards the over 55s. Although I realise that separate pension arrangements are available in the health service, now that retirement and pension ages are increasing we have a reasonable expectation that people might work longer than they did in the past. Therefore the problem described by my noble friend may not be as acute—not just in health but in other sectors as well—as she says. However, there is clearly an issue about the demography of the service and we are backing up GP recruitment with quite a big increase in extra funding for primary care over the course of this spending review period. A large part of that will go on both recruiting new staff and paying those who are in the system now.

[Baroness Hussein-Ece (LD)]

Is the Minister aware of whether GP referrals to CAMHS are now improving? Last year a number of reports highlighted the fact that in some 15 trusts up to 60% of GP referrals were not being dealt with. Only the very urgent, critical cases—those children who were self-harming or attempting suicide—were being dealt with. Has this situation improved and is there now proper access? GPs are the gateway to these services and if their referrals are not being taken seriously, these problems will mount up and we will be failing the next generation. Can the Minister give that assurance?

HIV: Barriers to Treatment

Baroness Hussein-Ece Excerpts

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

I do not like to have two questions on the trot that I cannot answer, but I do not know the answer to the noble Baroness’s question. I shall have to research it and write to her.

[Baroness Hussein-Ece (LD)]

My Lords, what steps are being taken to ensure that prisoners have access to treatment, testing and care while in prison? They are more likely to be drug users, more susceptible and more likely to be from communities that do not get themselves tested, even when they are in good health. Could the Minister say something about prison health?

[Lord Prior of Brampton]

There is a particular problem in prisons, as the noble Baroness refers to. There is a higher incidence of HIV in prisons, for all the reasons that she has alluded to. The NICE guidance and the PHE resources report that came out today echo her point. We have to reinforce and redouble our efforts in prisons to identify HIV earlier through better testing.

Healthwatch England

Baroness Hussein-Ece Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

I honestly do not think that the noble Baroness is correct. I really do not feel that this process has been politicised in the slightest. It is interesting that the chief executive of NHS England and the new chief operating officer were both previous special advisers to a Labour Government, so it is pretty hard to say that we are politicising appointments in the NHS.

[Baroness Hussein-Ece (LD)]

My Lords, I do not think the Minister has sufficiently explained why the patients’ voice, the chairman of Healthwatch, or, indeed, the chief executive should remain subordinate to the chief executive of the Care Quality Commission. Surely the patients’ voice should be a strong, independent voice and not subordinate.

[Lord Prior of Brampton]

I had the privilege of working with Anna Bradley when she was chair of Healthwatch England. I put on public record that she was an outstanding chairman. I do not think any changes have happened that will mean that that role will be in any way diminished.

Health: Black and Minority Ethnic Psychiatric Patients

Baroness Hussein-Ece Excerpts

Monday 29th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, although there is evidence that gender and ethnicity affect the efficacy and tolerability of some medicines, there is no evidence that people from black and minority ethnic backgrounds are prescribed a higher dose of antipsychotics. On the other hand, there is considerable evidence that many people from BME backgrounds are detained more, spend more time in in-patient psychiatric facilities and suffer greater seclusion, and that other aspects of mental health treatment for black and minority ethnic people are entirely unsatisfactory.

[Baroness Hussein-Ece (LD)]

My Lords, I welcome the Minister’s comment that this is a priority for the Government, but is it not the case that this whole issue about the overrepresentation of black and minority ethnic people in the mental health services has been going on for decades and is a scandal? For example, Sarah Reed, a black woman who was incarcerated in Holloway when she was well known to the mental health services, was found dead in her cell in January. She was failed by the Prison Service, mental health services and the criminal justice system. Why are black and minority ethnic people far more likely to be locked up in prison instead of getting proper treatment?

[Lord Prior of Brampton]

The noble Baroness makes a very important point and that is why the Prime Minister has asked David Lammy to conduct an inquiry into this precise issue. In his recent report, the noble Lord, Lord Crisp, recommended that there should be a patients and carers race equality standard. The Five Year Forward View for Mental Health, produced recently by Paul Farmer, recommended an equalities champion. I hope that we will be able to do both those things in the near future.

National Health Service: Workforce Race Equality Standard

Baroness Hussein-Ece Excerpts

Wednesday 24th February 2016 Lords Chamber

Asked by

[Baroness Hussein-Ece]

To ask Her Majesty’s Government what progress has been made to improve race equality at senior management and board level in the National Health Service since the introduction of the National Health Service Workforce Race Equality Standard.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, It is outrageous that we have so few people from BME backgrounds in senior management and on NHS boards. We need to take action to improve the experiences of BME staff and their representation.

NHS trusts submitted their baseline data against the workforce race equality standard indicators in July 2015, and NHS England will publish an analysis of those data in April. Reports will then be published annually, outlining the progress that NHS organisations are making.

[Baroness Hussein-Ece (LD)]

I thank the noble Lord for that reply. Can he say why, since the report by Roger Kline on the,

“snowy white peaks of the NHS”,

progress in ensuring that senior management and trust boards are more equal has been so disappointing? It does not reflect the diverse workforce and local populations. Will he ensure that trusts walk the walk and use NHS Executive Search rather than commercial recruitment agencies which all too often, apart from a few exceptions, present all-white shortlists, normally with no people with disabilities, drawn from a very narrow pool for senior positions at enormous financial cost to the health service?

[Lord Prior of Brampton]

My Lords, I shall give the House a few figures. Some 22% of all staff in the NHS are from BME or minority ethnic backgrounds, 28% of all doctors and 40% of hospital doctors. Yet only 3% of medical directors are from BME backgrounds and 7% are in senior management roles. We have two chief executives and six chairmen from BME backgrounds out of 250 trusts. So the performance across the NHS is, as the noble Baroness has mentioned, absolutely terrible and we have to take some serious action to change it. The noble Baroness has given one example but I think that there are many others. The NHS workforce race equality standard is a new initiative which, by introducing some transparency into the health service, will improve matters.

Sex-selective Abortion

Baroness Hussein-Ece Excerpts

Monday 7th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I encourage anyone with an interest in this matter to read some of the case stories put together by Jeena International—they are really quite shocking. They are anecdotal, but they are very real for a small minority of women who lack self-worth. That is, tragically, part of some of the cultures in England and we must do everything we can to improve women’s self-worth. I think that, in the long run, that will be done by education, education, education.

[Baroness Hussein-Ece (LD)]

My Lords, if, as anecdotal evidence suggests, there are such terminations of female foetuses, surely that would be reflected in the overall population of girls being born. The figures I have seen show that women are, thankfully, still in the majority in this country.

[Lord Prior of Brampton]

The statistical evidence is absolutely clear and points to the fact that there is no widespread gender abortion happening in this country. One would expect a ratio of 105 to 100 boys to girls and it is actually 105.2 to 100 in England, Scotland and Wales, so it is exactly where we would expect it be. There is one exception, which is the third and fourth born of Nepalese women, but this has been looked at two or three times and it is just a random variation in the statistics that we use.

Mental Health Services

Baroness Hussein-Ece Excerpts

Wednesday 26th November 2014 Lords Chamber

[Earl Howe]

My Lords, I fully agree with the noble Lord. He may like to know that my department is currently working with the Department for Education to revise the statutory guidance on promoting the health and well-being of looked-after children. We plan to consult on this later this month and to publish the final guidance early next year. It will make it clear that the CCGs and local authorities are responsible for providing services for looked-after children to give equal importance—parity of esteem—to their mental and physical health and to follow the concordat that I referred to.

[Baroness Hussein-Ece (LD)]

My Lords, my noble friend will be aware that early diagnosis in terms of getting support for children is very important, but very often these children are excluded from school—they end up in pupil referral units and are just generally not in school when they really need help. Is he satisfied that local authorities are doing what they can to make sure that these children who are excluded are getting mental health support?

[Earl Howe]

My noble friend raises a very important point. My department has invested £3 million in MindEd, which provides clear guidance on children and young people’s mental health for any adult working with children, young people and their families so that, for example, school teachers and those working with children in schools can recognise when a child needs help and can make sure that they get that help early.

NHS: Ambulance Response Times

Baroness Hussein-Ece Excerpts

Monday 21st July 2014 Lords Chamber

[Earl Howe]

My Lords, we owe a great deal to the air ambulance services across the country, all of which, I think I am right in saying, are organised as charities. However, it is the case that in every instance the NHS pays for the clinical staff on those ambulances while the charity pays for the helicopter and the pilot. That is the balance we have struck and successive Governments have taken the view that it is the most cost-effective model for the NHS. However, that is not to downplay the very important role that ambulances perform in our society.

[Baroness Hussein-Ece (LD)]

My Lords, will the Minister give an assurance that, when ambulances are called out for patients who are having prolonged epileptic seizures, there will be qualified paramedics in attendance and that we shall not go back to the situation we had of several tragic cases where paramedics were not in attendance and patients with prolonged epileptic seizures died before they got to hospital?

NHS: Mental Health Funding

Baroness Hussein-Ece Excerpts

Wednesday 2nd April 2014 Lords Chamber

[Earl Howe]

My Lords, as the noble Lord will know, the tariff for mental health services is determined locally. Having said that, we are clear that it is important that these tariffs and the priority given to mental health are scrutinised very carefully indeed, which is why my honourable friend the Minister of State for Care and Support has said he will do just that in the case of every single clinical commissioning group. If he determines that the plans are unsatisfactory, we as Ministers will work with NHS England, which we do regularly, to ensure that there is indeed that progress to parity of esteem that we all want to see throughout the country.

[Baroness Hussein-Ece (LD)]

My Lords, is my noble friend aware that there is significant evidence that two-thirds of local authorities have reduced their child and adolescent mental health service budgets since 2010, draining money from early intervention services, which, I think he will agree, is short-sighted and stores up problems for the future? Will he ensure that NHS commissioners and councils provide comprehensive services to address the deepening damage caused by further cuts to children and young people’s mental health services?

Health: Local Healthwatch Funding

Baroness Hussein-Ece Excerpts

Wednesday 19th March 2014 Lords Chamber

[Earl Howe]

I do not believe that anybody has nicked £10 million, my Lords. The issue here is the one raised by the noble Lord, Lord Harris, and others: the absence of ring-fencing should not be seen as something negative. It has enabled councils to take a strategic approach to allocating their resources, in line with local needs and priorities. It has given them freedom to deploy their resources across the piece to achieve value for money. It is now, as I said earlier, up to local communities, but also local Healthwatch itself, to hold their local authority to account and thereby to demonstrate the impact that they are having, and make the case for more money if they feel that they merit it.

[Baroness Hussein-Ece (LD)]

My Lords, the Minister said that this was about transparency, which of course it is. However, is it not also about consistency? There must be regions, boroughs or councils that are not using the money that has been allocated, which is surely to the detriment of the local community and to patients there. Surely we need to know where that money is not being spent and where patients and users of the health service are being sold short.

[Earl Howe]

We do need to know if people are being sold short. I would say to my noble friend that that is one of the reasons why local Healthwatch has a seat at the table of the health and well-being board, where it is eminently able to make its voice heard if it feels that it does not have sufficient resources to do the job which local authorities are legally obliged to commission.