Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what provision they plan to make to meet the shortfall of residential care home places for elderly people in the light of home closures and increased demand for social care.
Answered by Lord Prior of Brampton
Adult social care is largely delivered by a market of independent providers. As in any market, there is inevitable change which will give rise to local fluctuations in capacity. We are not aware of any systemic shortfall of residential care home places.
Under the Care Act (2014), local authorities have duties to shape their local market to ensure there is adequate provision of good quality, appropriate services to meet the changing needs of their local population, including for people who do not get state-funding.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what action they propose to take to prevent mental health services from turning away children who seek help.
Answered by Lord Prior of Brampton
Children and young people’s mental health (CYPMH) is a priority area for this Government. It is committed to delivering the vision set out in Future in mind, the previous Government’s report on the work of the Children and Young People’s Mental Health and Wellbeing Taskforce. This report established a clear and powerful consensus about change across the whole system, including health, social care and education. To support this transformation programme the Government is committed to making an additional £1.4 billion available over the course of this Parliament.
As a first step in this transformation programme all clinical commissioning groups working with their partners, have developed Local Transformation Plans to transform their offer for children and young people’s mental health and wellbeing. These plans cover the full spectrum of mental health issues: from prevention and improving access, to support and care for existing and emerging mental health problems, as well as transitions between services.
Whilst the intention is to prevent mental health problems from arising in the first place, improving access for those who have developed problems as early as possible is essential. By 2020, at least 70,000 more children and young people each year will have access to high quality mental health care when they need it. This will require systems for rapid identification of children in need of specialised services, and improved links between different agencies so that children and young people are referred to the most appropriate service. £28 million is being spent on extending and expanding the Children and Young People’s Improving Access to Psychological Therapies programme so that by 2018 all children and young people across England will have access to evidence-based and appropriate interventions. The Government has also invested nearly £3 million into the Mental Health Services and Schools Links Pilots to jointly train designated leads in Child and Adolescent Mental Health Services and schools to improve access to mental health services for children and young people. This should reduce the number of children being turned away from services and lead to the ‘no wrong door’ approach that is integral to the transformation programme.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what analysis has been undertaken about the impact and demands for public health and care services due to loneliness and isolation suffered by pensioners, in the light of the Local Government Association's estimate that more than one million people aged over 65 are lonely.
Answered by Lord Prior of Brampton
The Department recognises that loneliness can have a negative impact on a person’s general health and has prioritised prevention through the Care Act 2014. The Department has not undertaken an analysis of the impact loneliness places on public health and care services. We do take account of research in developing our policies, including or example, the Campaign to End Loneliness report Loneliness: the State We’re In (2012) which shows that loneliness has an effect on mortality that is similar in size to smoking 15 cigarettes a day, is worse for us than obesity, and is also associated with conditions such as cardiovascular disease. A copy of the Campaign to End Loneliness report is attached.
The Local Government Association has highlighted that loneliness is a complex problem. A range of interventions and solutions are required to identify adults who are lonely or socially isolated and to provide them with the support they require.
As part of Public Health England’s programme of work to support local action on health inequalities, we commissioned the UCL Institute of Health Equity to produce a series of resources setting out practical approaches that local areas could adopt to reduce health inequalities. One resource in the series focuses on social isolation across the lifecourse. It provides information and guidance to support local authorities, NHS clinical commissioning groups and their stakeholders to develop effective strategies to prevent and reduce social isolation. A copy of Reducing social isolation across the lifecourse is attached.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what assessment they have made of the implications for the quality of social care and support systems, including independent living of the elderly and disabled people, of not providing extra funding for the Better Care Fund in 2016–17
Answered by Lord Prior of Brampton
The Government’s decision to introduce the adult social care precept from 2016/17 and additional Better Care Fund funding from 2018/19 reflected consideration of social care cost pressures as part of the Spending Review process.
Under the Care Act councils are obliged to ensure that any person in its area wishing to access services in the market has a variety of high quality services to choose from.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what action they are taking to increase the proportion of people with atrial fibrillation who are treated with anticoagulation therapy in order to prevent stroke.
Answered by Lord Prior of Brampton
NHS England has identified improved management of atrial fibrillation as a priority for reducing premature mortality.
NHS Improving Quality (NHS IQ) is taking action on atrial fibrillation. It is promoting the use of GRASP-AF (Guidance on Risk Assessment and Stroke Prevention for Atrial Fibrillation) within GP practices in England. GRASP-AF is an audit tool developed by and trialled in the NHS, which greatly simplifies the process of identifying patients with atrial fibrillation who are not receiving the right management to help reduce their risk of stroke. NHS IQ is currently collaborating with partner organisations, including charities, to support the nationwide roll-out of GRASP-AF.
To support this work, NHS IQ recently published an analysis of the costs and benefits of using the anticoagulant drug warfarin to help prevent stroke in people with AF. A copy of this analysis is attached.
The National Institute for Health and Care Excellence (NICE) also published a Quality Standard on atrial fibrillation in July 2015, which sets out what a high quality atrial fibrillation service should look like and will help drive improvement locally. A copy is attached. The Quality and Outcomes Framework contains indicators for the management of AF which cover the use of anticoagulation therapy. This provides a further incentive for doctors to ensure AF patients receive anticoagulation where appropriate to manage their risk of stroke.
Public Health England (PHE) has recently published their Atlas of Variation which includes data on atrial fibrillation. Full data for all 216 clinical commissioning groups (CCGs) cannot be included in this reply due to its large size, but a map giving an overview of the results is attached. PHE have also collaborated with the Stroke Association to produce individualised CCG level reports on current performance in the detection and management of patients with atrial fibrillation to try and encourage poorly performing areas to improve.
The majority of the Strategic Clinical Networks (SCNs) have made atrial fibrillation management a priority, and in London the three Academic Health Science Networks and the SCN have identified atrial fibrillation as being the first area where there is a collaborative effort to improve performance.
One of the options now available for clinicians managing patients with atrial fibrillation is the novel oral anticoagulants. These drugs are useful when patients are unable or unwilling to tolerate warfarin and should result in a greater proportion of the population with atrial fibrillation being effectively treated. Additionally, NICE have now approved the use of devices to self-monitor warfarin, reducing the need for patients to attend health centres for blood testing. Again this should make anticoagulation easier and more acceptable for some patients.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answer by Lord Prior of Brampton on 12 November (HL3373), what they intend to do to prevent discriminatory treatment of BME mental health patients, and what assessment they have made of the implications of discriminatory treatment for patients in mental health wards.
Answered by Lord Prior of Brampton
We are aware that people from black and minority ethnic (BME) groups often report poorer experiences of mental health services and there is some evidence of people from BME groups experiencing ethnic discrimination in how services are delivered by not ensuring equitable access or meeting diverse cultural needs.
The Human Rights Act 1998 and the Equality Act 2010 make it clear that people should not be discriminated against on the grounds of race or mental impairment. People with mental impairments are included within the groups of people with Protected Characteristics within the Equality Act 2010.
The Mental Health Act 1983 Code of Practice makes it clear that decisions relating to people detained under the Act should be lawful and in accordance with the requirements of the Human Rights Act 1998 and the Equality Act 2010.
The Department established the Mental Health Equalities Working Group (EWG) in 2013 to advise on equality and human rights issues, including BME issues.
The Joint Commissioning Panel published guidance in 2014, Guidance for commissioners of mental health services for people from black and minority ethnic communities, which set out 10 key messages for commissioners to improve services. A copy of the guidance is attached.
The Coalition Government published Closing the Gap: priorities for essential change in mental health in 2014, which included a specific action to tackle inequalities around access to mental health services and we continue to work to achieving that action. A copy of this document is attached.
The Department commissioned the Mental Health Providers’ Forum and the Race Equality Foundation to gather and review evidence of effective mental health services for BME groups, which was published this year. The report, Better practice in mental health for black and minority ethnic communities, found that organisations that were successful in providing mental health services that meet the needs of BME groups had developed local community-based approaches to service delivery which addressed cultural and linguistic differences and sought to actively engage hard to reach groups. A copy of this report is attached.
NHS England is also working with a number of BME groups and community leaders to raise awareness, reduce barriers and improve the uptake of Improving Access to Psychological Therapies (IAPT) to all sections of the community. We are also working with the National Health Service and commissioners to disseminate guidance and good practice of what good mental health services for BME communities look like.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, further to the Written Answers by Lord Prior of Brampton on 2 November (HL2863 and HL2866), and in the light of the fact that data about the detention of different groups of mental health patients under different segregated regimes, and the number of police call-outs to mental patient wards to deal with incidents involving different groups of mental health patients, are not collected centrally, whether they have any plans to change the way in which they collect data about patients in mental health wards.
Answered by Lord Prior of Brampton
The Department of Health and Care Quality Commission (CQC) currently use a range of processes to monitor the quality of mental health services, including inspections, surveys, notification of the CQC by providers of certain events and analysis of national data collections. As part of this process the Health and Social Care Information Centre reviews of the content and frequency of data collection through the Mental Health and Learning Disability Minimums Data Set.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government how many incidents requiring the attendance of the police occurred on mental health wards in the past 12 months; what were the ethnic, gender and age characteristics of the patients involved; and what was the ratio of staff to patients at the time of each incident.
Answered by Lord Prior of Brampton
This information is not collected centrally.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government how many patients are detained in medium and high security psychiatric hospitals; and how many such patients there are broken down by (1) ethnicity, (2) gender, (3) age, and (4) the length of time detained under the different segregated regimes.
Answered by Lord Prior of Brampton
The information is not collected in the format requested.
Asked by: Lord Ouseley (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government what action is proposed to prevent hospital beds being unavailable as a consequence of the number of elderly patients in hospital wards who cannot be sent home or moved to care homes because of the lack of necessary resources.
Answered by Lord Prior of Brampton
Since April local projects across the country have been using the Government’s £5.3 billion Better Care Fund to reduce non-elective admissions and get people out of hospital more quickly, as part of on-going work to bring health and social care services together. Local Better Care Fund plans for 2015-2016 should mean that there are 84,000 fewer days spent in hospital unnecessarily because of delayed transfers of care.