Residential Care

Lord Bishop of St Albans Excerpts

Monday 6th February 2017 Lords Chamber

[Lord O'Shaughnessy]

I am pleased that this Government have introduced the national living wage, which is supported, I believe, across this House and the other place. The noble Baroness is quite right that there is an impact on social care home providers, many of the staff of which are paid at that level. The truth is that there is a cost pressure, of course, in the social care sector—that is one of the reasons that the precept is rising quicker than it would have done otherwise—and the better care fund has been created to support more care provision in the appropriate setting that people want to have it in.

[The Lord Bishop of St Albans]

My Lords, with applications for nursing degrees having gone down by 10,000 and with planned immigration restrictions being imposed, what are Her Majesty’s Government doing to ensure that we have not only sufficient beds but the caring and nursing staff to look after those who are using the beds?

[Lord O'Shaughnessy]

The number of workers in the social care sector has increased by about 165,000 over the last five years: there is an increased demand because we have a growing population. I think that we are going to have another opportunity to talk about the impact on nursing degrees tomorrow, so I do not want to spoil the party. As for the impact of the European Union, of course, a significant section of the workforce comes from the European Union but we are increasing the number of nursing training places and there is also now a nursing apprenticeship scheme which is providing 1,000 places for people who want to enter the profession by that route.

Mental Health: Children’s Services

Lord Bishop of St Albans Excerpts

Thursday 19th January 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is a great campaigner on these issues, and I have huge respect for the work that she has done. The sustainability and transformation plans will obviously include these local transformation plans for mental health, and it is up to NHS England to ensure that it delivers on the many commitments we now have. Those commitments include the first ever access and waiting times for mental health, which is both access to talking therapies and access to help after psychotic incidents. We have new targets coming up for children and young people who seek help when eating disorders or other generic mental health problems are identified. There are robust targets and there is now a mental health improvement team in NHS England to make sure that those CCGs deliver what they should.

[The Lord Bishop of St Albans]

My Lords, this is a very serious and growing problem. Recent research has shown over the last five years that the number of hospital admissions associated with children’s self-harm has grown by 93% among girls and 45% among boys. It seems extraordinary that when money is announced for mental health services it is then not spent. First, how many years will we wait until we need to ring-fence that money, because this is a really important issue? Secondly, to pick up on the previous but one question, will the Government commit to producing guidelines for schools and colleges about preventing and responding to self-harm, so that we have some practical things put in place?

[Lord O'Shaughnessy]

I could not agree more with those points, in the sense that money must get through to the front line. However, we have an NHS that is set up so that clinical decisions are made by clinicians rather than politicians, and that must be right, because the needs vary from area to area and different areas have different priorities. They have different historic legacies in terms of delivering their services. As for the direction that we give to schools and colleges, clearly the thematic review that the CQC and Ofsted are carrying out will provide advice on what works. We are also introducing some randomised control trials to look at interventions that work, so we have a proper evidence-based system. The commitment is to get 70,000 more young people having evidence-based treatments by 2021.

Young People: Self-Harm

Lord Bishop of St Albans Excerpts

Tuesday 6th December 2016 Lords Chamber

Asked by

[The Lord Bishop of St Albans]

To ask Her Majesty’s Government what assessment they have made of the rise in the number of children and young people being treated for self-harm.

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

My Lords, the Government are aware of the appalling rise in self-harm in children and young people and the misery this reflects. The Government are also acutely aware that self-harm is a leading indicator of risk of suicide and recognise that much more needs to be done to address this issue.

[The Lord Bishop of St Albans]

I thank the Minister for his reply. The research from the World Health Organization shows that around 20% of British 15 year-olds report some sort of self-harm. In the past five years, research shows that hospital admissions associated with self-harm have gone up by nearly 93% among girls and 45% among boys. Having recently visited the outstanding charity selfharmUK, in Luton in my diocese, I have seen what effect a concerted and systematic approach to this problem can have on a very difficult issue, and we need something similar at a national level. Will Her Majesty’s Government commit to publishing guidelines for schools and colleges about preventing and responding to self-harm?

[Lord Prior of Brampton]

I think the right reverend Prelate has raised an incredibly important issue. Around 300,000 young people go to A&E every year through self-harm, after cutting or burning themselves very badly. The right reverend Prelate asked about advice and guidance. In 2004, NICE put out explicit guidance that all those people should receive, at the very least, a psychosocial assessment; today, only 53% of those people—young people in the main—receive such an assessment. That means that 100,000-plus people are going to A&E with this very nasty self-harm and are really being sent home with very little. That is quite an indictment of our system and the words that we have about parity of esteem. I entirely take on board exactly what the right reverend Prelate said. There is a lot more we can do, and perhaps in response to subsequent questions I shall try to say what we are doing.

Public Health England: Alcohol

Lord Bishop of St Albans Excerpts

Tuesday 5th July 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said earlier, I think that the CMO’s guidelines are based on independent scientific advice. How that advice is communicated to the public is a different issue and the CMO is currently consulting on how we should express that scientific advice in ways that will have the maximum impact so that the public will take due notice of it.

[The Lord Bishop of St Albans]

My Lords, back in 2011 the Scottish Government passed legislation which meant that there was no financial advantage in multibuy alcohol purchases so that each can or whatever it was would be the same price. That has discouraged the bulk buying of alcohol and as a consequence has reduced levels of harmful drinking. Have Her Majesty’s Government considered a similar law, and if not, why not?

[Lord Prior of Brampton]

I apologise to the right reverend Prelate, but I missed the first part of his question. He is perfectly entitled to repeat the question, or if not, perhaps I may write to him after this session of Question Time.

--- Later in debate ---

[The Lord Bishop of St Albans]

The legislation passed by the Scottish Government in 2011 means that there is no financial advantage in the bulk buying of alcohol; each can is the same price. That has discouraged people from buying large amounts of alcohol and has reduced the level of alcohol dependency.

[Lord Prior of Brampton]

I cannot plead that I did not hear the question again, but I am going to have to say that I do not know the answer, so I shall write to the right reverend Prelate later.

Psychiatric Units: Child and Adolescent Patients

Lord Bishop of St Albans Excerpts

Wednesday 13th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think the figure for children on adult psychiatric wards is 391. It is far too high. It was described in the “Panorama” programme as the Cinderella service of a Cinderella service. What has come to light in the work done by the Sunday Times, “Panorama” and Norman Lamb in the other House is that we have a very serious problem here. It is not going to be solved overnight. The Government have committed to spend £1.4 billion over this Parliament to improve child and adolescent mental health care, but we have a long way to go.

[The Lord Bishop of St Albans]

My Lords, part of the answer to this difficult problem must be to ensure that we get the very best mental health care for young people at the earliest stage possible. I notice that earlier this week a report was published by the think tank CentreForum pointing out that mental health providers turned away 23% of the referrals of under-18s made to them. That includes illnesses such as anorexia, and sometimes young people are turned away because at that stage they have an insufficiently low BMI to justify being treated, despite the evidence that early diagnosis and treatment produce the best results. In the light of that, can the Minister reassure the House that Her Majesty’s Government are keeping under review the criteria by which people are able to access these mental health services, to ensure that we get the best outcomes?

[Lord Prior of Brampton]

My Lords, there is no question but that early intervention is critical. There is a huge amount of unmet need. I expect that everyone in this House will know someone who has a child who has suffered from mental health problems, whether anorexia, self-harm or other aspects of mental ill health. It is a complete disaster, and for anyone who watched that “Panorama” programme it will have been brought very close to home. What the right reverend Prelate says is absolutely right. As I said in answer to the earlier question, we have a long way to go.

Health and Social Care: State Pension

Lord Bishop of St Albans Excerpts

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

I know my noble friend feels very strongly that we should have a royal commission to look at the long-term affordability and funding of the NHS. That is not the Government’s view.

[The Lord Bishop of St Albans]

My Lords, in last week’s NHS debate, which very helpfully explored a number of areas, a number of noble Lords referred to the independent American research pointing out that among the—I think—11 most developed countries, our health service came out right at the top, except in the area of prevention. The worry that many of us have is that a lot of the money is being front-loaded on to the NHS, which is responding to immediate needs, but that the long-term need for a cross-party agreement on how we get much better at preventing illness and having health programmes is lacking. Can we yet again press the Minister to see how we can get some sort of cross-party agreement on this proactive approach?

[Lord Prior of Brampton]

The right reverend Prelate is right to remind the House of the report by the Commonwealth Fund which indicated that the National Health Service is the most efficient and overall the best healthcare system in the world. He also referred to prevention. The childhood obesity prevention strategy is due to be announced by the Government in the next couple of months. We have made huge progress on reducing smoking and in other areas of prevention, but I agree with the right reverend Prelate that prevention is a critical part of our long-term approach to healthcare.

National Health Service

Lord Bishop of St Albans Excerpts

Thursday 14th January 2016 Lords Chamber

[The Lord Bishop of St Albans]

My Lords, I am glad to congratulate the noble Baroness, Lady Watkins, on her maiden speech. Due to the pressure on time, I want to focus on one very small area, which has been alluded to by various noble Lords but which I want to develop a little. It is the pressing and vital need to reboot the concept of a social contract, which lay at the heart of the national health system as envisaged by Beveridge and which balanced rights and responsibilities, not least against the background of living in a time when people have increasingly emphasised rights and perhaps downplayed the sense of duty and responsibility.

In 2013, PricewaterhouseCoopers produced a report on the 65th anniversary of the NHS, which identified two key factors that would be essential for the future of the NHS. One of them was the extent to which people took personal responsibility for their own health and care, and that of their families. Then last year, when the independent research published by the Commonwealth Foundation revealed the UK’s health system to be at the top of the league among nations in the developed world, the one area where we did not score highly was in the prevention of illness. That report highlighted the particular problem of large numbers of people in this country with unhealthy lifestyles.

It is deeply concerning that so many illnesses are caused by addictions to alcohol and smoking, while we have the highest rate of child and adult obesity in Europe. Estimates of their cost vary but just those three areas could well be costing as much as £17 billion per annum. To address these issues requires a deep cultural change across our nation, along with a renewed emphasis on personal responsibility for our health and for exercise, for people of all ages. But of course these sorts of changes are some of the hardest to make. The need for a new social contract between citizens and the NHS is urgent, with a much greater emphasis on what we need to do in response to what the NHS provides. Indeed, this message needs to be reinforced every time anyone comes in contact with the NHS.

While laws and taxation have a contributory factor, we need to create a climate which celebrates health and people taking responsibility for it, for them and their families. There is a great deal of evidence that one of the most powerful factors in bringing about such behavioural change is the influence of peer groups. We need to work consistently with health campaigns, sports and leisure clubs, statutory and voluntary youth and children’s groups, schools, colleges, churches and everybody from the Mothers’ Union to the WI and the University of the Third Age to think how we can celebrate the need for personal responsibility. It needs to be undertaken over the long term; we are talking in terms of decades. If we are to see significant change then the evidence of the campaign to reduce smoking, which has halved since the 1970s, shows that it can be done but will take time and consistency.

Health: Parity of Esteem

Lord Bishop of St Albans Excerpts

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

NHS England is committed to ensuring that every CCG in the land increases its spending on mental health. The general allocation to CCGs was 3.7%, and the CCGs’ commitment to spending 4.6% of their allocation on mental health will hold NHS England to account for achieving that.

[The Lord Bishop of St Albans]

My Lords, the NSPCC report on achieving emotional well-being among young people in care found that 45% of them experience mental health problems, many of which continue to remain undiagnosed. It recommends that those young people should have not only an automatic physical health assessment but an automatic mental health assessment. Will Her Majesty’s Government consider introducing legislation to give that right to all young people as they enter care?

[Lord Prior of Brampton]

I am not sure that legislation is necessarily the right way forward, but perhaps we can pick up that issue with NHS England to ensure that it is written into the NHS mandate for next year. It is certainly something I will explore with them. It is worth noting that we are spending £94 million a year on IAPT for children, and we have increased spending on tackling eating disorders in young people by £150 million over the course of this Parliament. We are beginning to rectify what has historically been an area of huge underfunding of mental health for young people.

Health: Children

Lord Bishop of St Albans Excerpts

Thursday 10th September 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I do not have the numbers for paediatricians—whether or not there is a shortage. Certainly, there are shortages in some specialties, particularly in A&E and other emergency specialties. I cannot give the noble Baroness a definitive answer on the shortage of paediatricians but perhaps she will allow me to go back, look at the figures and write to her.

[The Lord Bishop of St Albans]

My Lords, one of the most significant aspects of child health is to do with access to health services, which is a particular problem in rural areas. The phenomenon of distance decay, the further away you are from where the service is provided, is well documented. Will the Minister tell us what Her Majesty’s Government are doing to increase access to health services for those 900,000 rural households living in income poverty?

[Lord Prior of Brampton]

My Lords, access to health services is not just a rural issue; it relates also to deprivation, be it urban or rural. I would point out to the House the increase in the number of health visitors, which has gone up from 8,000 to nearly 12,000 over the past five years, and also to the Family Nurse Partnership scheme, which now has 16,000 places on it for younger and teenage mothers. So the Government are doing a lot to improve access. I guess they could always do more.

Mental Health: Young People

Lord Bishop of St Albans Excerpts

Tuesday 30th June 2015 Lords Chamber

[The Lord Bishop of St Albans]

My Lords, I, too, am grateful to the noble Baroness, Lady Tyler, for introducing this debate, for the excellent work of the task group and for the commitment that Her Majesty’s Government have already made to this area.

I also pay tribute to the many excellent charities that are working in this area. Just round the corner from where I live in St Albans is a small charity. I do not suppose that any of your Lordships will have heard of it. It is called Youth Talk and it was set up some years ago, in 1997, by a local GP after she realised that there was a need for a safe place where young people could come for counselling and support. In the intervening years, more than 2,000 young people have used the service. Every year around 190 young people are seen and up to 50 sessions are offered each week. The service is free at the point of access to all 14 to 25 year-olds. It is one of the many unsung charities in our nation that are offering support in this extremely important area. Alongside the crucial statutory work, we need to think about encouraging the voluntary sector.

However, there is still a great deal to be done. As the former Minister Norman Lamb admitted about a year ago, for children and mental health services the prevalence data were out of date and the commissioning services were fragmented. It is good that some of these deficiencies are now being addressed. Therefore, I am supportive of the proposal in the Future in Mind report that good research in the form of a prevalence survey should be conducted by the Department of Health every five years. That would give us a wide range of data, including factors such as ethnicity and socioeconomic background, with a special emphasis on vulnerable groups.

I want to comment on two other areas. First, I strongly support the recommendation that,

“designated professionals”,

should,

“liaise with agencies and ensure that services are targeted and delivered in an integrated way for children and young people from vulnerable backgrounds”.

We are all aware of the problem of statutory and voluntary agencies working in silos, resulting in young people falling through the net. The troubled families programme has shown us the value of having a champion —a co-ordinator whose role is to focus on getting change and who can draw together all the different parties to ensure that the help can be delivered effectively and consistently. Without such “designated professionals” who are given the appropriate power and resources, it is unlikely that we are going to solve the problems that have dogged this area for such a long time.

I also want to commend to your Lordships’ House a campaign launched last Friday by the Children’s Society called Seriously Awkward. The campaign is based on empirical research of more than 1,000 teenagers of 16 and 17 years of age, and it relates directly to many of the points made in the Future in Mind report. However, it argues cogently that there are a number of areas that need urgent attention. In particular, the campaign points out that the legislation relating to 16 and 17 year-olds is highly inconsistent and is causing problems regarding where they fit and who is responsible for them. We need some clarity in this area. The campaign argues that the Government should establish a right for 16 and 17 year-olds to be entitled to support from CAMHS when they need it. This support must be available as early as possible, and long before mental health needs become acute. It argues that the Department of Health should, as it is in the process of recommissioning a new prevalence study, include 16 and 17 year-olds in that study, and there seems to be some lack of clarity about that.

Tailored information should be produced by CAMHS providers about mental health symptoms and conditions for adolescents to support them in understanding their experiences. Information also needs to be available to their families, to help them both in parenting adolescents appropriately and meeting their emotional needs. In addition, services working with vulnerable adolescents should consider their mental health needs within the family context and offer appropriate support to the young person and their family, working together.

Local authorities and health and well-being boards should evaluate the levels of mental health support available to vulnerable groups of young people. The commissioning of effective mental health services needs to be underpinned by robust and reliable data on the use of mental health services, particularly by vulnerable groups.

Finally, at present, support for victims of child sexual abuse is often dependent upon children displaying symptoms of diagnosable conditions. Child victims should, as a matter of course, receive support to help them overcome the trauma of abuse. Therefore, what are the Government doing to ensure that older adolescents have access to mental health support? Will the Government ensure that 16 and 17 year-olds are included in the upcoming mental health prevalence study of children and young people’s mental health? Will the Government ensure that some of the additional funding is ring-fenced to ensure that victims of child sex abuse have access to mental health support?