Mental Capacity (Amendment) Bill [Lords]

Lord Beamish Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Matt Hancock]

The hon. Lady is not quite right about the three-year period, because there are review points, meaning that it involves a twice-possible one-year extension, so she is not quite right about the relationship between that and what happens under the Mental Health Act. However, she makes an important point about the links between the Mental Capacity Act 2005, this Mental Capacity (Amendment) Bill and the mental health Bill that we propose to bring forward.

We considered putting the two Bills together, but we did not do that for two reasons. First, it would simply be a big Bill that included two separate regimes, and we would not want the full Mental Health Act powers to be applied across the board, and I think there is a broad consensus behind that. Secondly, the view of Sir Simon Wessely, who ran the review into the Mental Health Act, is that we need to get on with this while taking the time to get the Mental Health Act update right. Combining the two was seriously considered, and I considered it again when I became Health and Social Care Secretary and asked for further advice, but we came to this conclusion, which I hope the hon. Lady will support.

[Mr Kevan Jones (North Durham) (Lab)]

I do not disagree with Sir Simon Wessely’s conclusions about that, but the review does contain suggestions that could be transferred into this Bill. For example, the use of tribunals instead of the Court of Protection in some cases would make them a lot simpler, cheaper and better for the person involved.

[Matt Hancock]

The right hon. Gentleman is quite right. To start to deal with the serious number of cases that we need to make progress with, the interface between this Bill—hopefully on the statute book by then—and the Mental Health Act provisions will be considered as we develop the draft mental health Bill. The truth is that the current system causes unnecessary suffering, and the case for reform could not be more urgent. That is why we are bringing forward this Bill now. Age UK, the UK’s largest charity working with older people, says we have a crisis in the current system that is

“leaving many older people with no protection at all… If we lose this opportunity we’re unlikely to get another one in this Parliament and it is profoundly unfair on the older people and their families…to have to wait any longer…doing nothing is not an option.”

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[Mr Kevan Jones (North Durham) (Lab)]

We judge a civilised society by how it treats its most vulnerable citizens, so getting this legislation right is vital. My hon. Friend the Member for Stockton North (Alex Cunningham) said, “There by the grace of God go we all,” and I agree: we could all find ourselves or family members involved in this. The right hon. Member for North Norfolk (Norman Lamb) raised the issue of the Cheshire West case, which demonstrates that we do need change because we have got people whose human rights are being denied at the moment. It is not the case, therefore, that we can just do this at our leisure.

Is the Bill flawed? Yes, in its current state it is, but change needs to happen among the voluntary sector and others and we need to put some principles behind this, and one of them must be putting the person at the centre of the legislation. We should also only use these measures where there are no alternatives; they should not be used as a recourse of first resort or for financial or convenience reasons.

The review of the Mental Health Act 1983 introduced the least restriction principle and that should be written into this Bill. It is also key to ensure that individuals and families not only know their rights, but have access to them. Also, the length of detention should be kept to a minimum, and certainly kept under regular review. The care plans of individuals must be kept up to date with the individual’s situation, too. The access of individuals and families to independent medical advocates must be a central part of this Bill as well, and if people do not have family or relatives an independent advocate should be appointed to them automatically. The possibility of conflicts of interest has been raised and I am not yet happy that this Bill addresses that. There are issues that need to be looked at. Referring to the Mental Health Act again, having second opinions is important; we must tighten that up in this Bill.

A lot of this could be covered in the code of practice. The Government have not yet produced that, and it needs to be produced before the Bill goes any further. It would also be important for it to be incorporated into the Bill.

Reference has been made to the interface with the review of the Mental Health Act. I have read it and know Simon Wessely, and he is clear in that report that he does not want this legislation held up, and he does not think that fusing the two Acts would be a way forward. He makes a suggestion on how to use the two Acts: for objection we use the Mental Health Act, and for not having capacity we use this mental capacity Act. He also deals with the issue of cases that cover both, offering some ideas around tribunals and judges and court protection. I would also like the Minister to address the issue around 16 and 17-year-olds and how this interplays with the Children Act 1989 which gives certain rights to parents.

The right hon. Member for North Norfolk said that the situation needed to change, because people are now being detained who are not having their human rights observed. I have to say that I agree with him, and that is why I cannot support the reasoned amendment. Throwing the Bill out at this stage would be a huge mistake. I plead with the Minister to look at a number of things. The delaying of the Committee stage that the right hon. Gentleman mentioned would be important, and I believe that we should extend the sittings of the Committee if we need to. We ought to take as much time as possible in Committee. With good will, we can get there.

Is the Bill perfect? No, it is not, and I am not happy with it as it is outlined, but we can get some changes into it. I know that the Minister is an advocate for the sector and that she is passionate about doing the right thing, and it is not beyond the wit of man or woman to get to where we should be. To throw the Bill out at this stage would be a mistake, because my fear is that it would not come back, owing to a lack of legislative time. That would mean that the legal crisis would continue. Also we would be missing an opportunity to change the legislation. We can make the necessary changes if the good will is there.

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[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

I will be brief, as I am aware that others wish to speak.

The privilege we have as a Parliament is to defend liberty, so any action we take to seek to deprive a person of their liberty should always be weighed against their best interest. I was not greatly aware of the deprivation of liberty safeguards until the Bill was tabled and I received lots of representations from constituents who work in the social work sector. They are concerned that, although the Bill may be well meaning, it does not necessarily have at its heart protections for the best interests of the people to whom it might apply. I have always listened when a doctor tells me something is not right and I am unwell, and we should listen when a social worker tells us that the Bill’s provisions for depriving a person of their liberty fall short of their expectations.

My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) made two excellent points. First, if we are to take away a person’s liberty, there has to be no possibility that the process could be abused for whatever purpose. I fear that, in some of the arrangements for moving away from a local authority-based system to a responsible body, the potential exists, however small that potential may be, for an unscrupulous person who is not necessarily working in the best interest of an individual to exercise that power simply to maintain a business model in their own facility or care home. Such cases may be few and far between, but we have seen many situations across the country where one or two individuals have taken advantage of people in vulnerable situations, and I am not convinced that the Bill, as currently written, goes far enough to provide safeguards. [Interruption.] The Minister shakes her head, and it would be wonderful if she could address that in her summing up.

[Mr Kevan Jones]

Will my hon. Friend give way?

[Gareth Snell]

I am sorry, but I cannot give way.

My other area of concern is the independence of advocates. I am fortunate to have a family who can speak up if a relative were ever in such a situation, but there are countless people across the country who do not have somebody who can stand up for their best interest and represent what might be right for them. The Bill contains no provision properly to strengthen the independent advocacy rights and make them robust so that everybody who might be subject to the liberty protection safeguards is able to be represented and have their views considered, which is important. [Interruption.] The Minister is nodding, and I would welcome it if she offered some sort of guidance and further clarity on how the Bill will deliver that. From where I sit, from what I have read and from the evidence given to me by social workers, there are several holes in the Bill that do not stand up to scrutiny.

I suspect the Bill will get its Second Reading, and I hope several of those holes will be identified and considered in Committee. At the moment, my fear is that the Bill is well intentioned but simply does not bear scrutiny. There is therefore a potential for exploitative people to take advantage of vulnerable people and, as a Parliament, we must make sure to address that.

Gosport Independent Panel: Publication of Report

Lord Beamish Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

We do have to ask those questions, and we have to be able to respond to the concerns of my hon. Friend and his constituents about how we can be absolutely certain there will not be a closing of ranks. My experience, however, is that doctors are very quick to want to remove those of their number who are letting the profession down because this damages everyone’s reputation. There are some very difficult questions for the GMC and for the NMC. Because their processes took so long, I do not think they can put their hand on their heart and say that they have kept patients safe during that period.

[Mr Kevan Jones (North Durham) (Lab)]

The legislation regulating both doctors and healthcare professionals is now 35 years old. It is inefficient, outdated and—as I know from a constituency case in which the individual concerned is into the fifth year of her complaint to the GMC—not user-friendly for the complainant. The GMC and other healthcare professionals want change and the Secretary of State’s Department has already consulted on change, so will he give a guarantee that he will bring forward legislation to ensure that the system is not only effective, but effective for patients who make complaints?

[Mr Hunt]

The right hon. Gentleman is absolutely right: we have a regulatory landscape that is very complex, does not achieve the results we want, and forces regulators to spend time doing things they do not want to do and does not give them enough time for things they do want to do. Obviously, because of the parliamentary arithmetic, if we are able to get parliamentary consensus on such a change, that would speed forward the legislation.

NHS Long-Term Plan

Lord Beamish Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I am happy to look again at that issue, which I have looked at in the past for my hon. Friend.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome any new money for the NHS, but does the Secretary of State agree that prevention is better than cure? Durham County Council has had its public health budget cut every single year for the last eight years. Can he tell me how much of this new money will be going to public health, or is he now going to have another fight with the Treasury to get it to release more money for public health?

[Mr Hunt]

Today’s announcement is for NHS England’s core frontline services, but the right hon. Gentleman is right about the critical role of public health. Many of those services are delivered by the NHS, and we are very clear in what we are saying today and in a further announcement we will make in due course that there cannot be a transformation of the NHS without a proper emphasis on public health.

Mental Health Act: CQC Report

Lord Beamish Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend reached the nub of the issue in that final point. Commissioning is a matter for local commissioning groups. However, through the CQC report, the work that we are doing through the mental health investment standard and the scrutiny applied by NHS England, we are trying to ensure that there is a consistent application of good-quality services around the country. We find some centres of excellence and some areas in which the service is less patchy, but when it is less good it obviously leads to worse outcomes. We are determined to do our best to promote the best possible services throughout the country.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome the Government’s outlawing of the use of police cells for those experiencing a mental health crisis, and I do not question the Minister’s commitment to improving the service, but the system is fragmented. There have been local authority cuts, including cuts in community services. The Health and Social Care Act 2012 leaves local commissioners to decide where the money goes, which has led to a confusing local picture and fragmentation. Do we not need to give people clear pathways out of hospital, and to ensure not only that the money goes to the right places, but that individuals know their rights and that local agencies know their responsibilities?

[Jackie Doyle-Price]

The hon. Gentleman’s point about people knowing their rights and providers and commissioners knowing their responsibilities is crucial to the whole issue, and I think it probably underlies the lack of parity of esteem hitherto. When it comes to the role of central Government, we want to continue to rely on local provision and local commissioning, but we also need to be clear about the standards of performance that people should be able to expect. We are being more transparent about where services are being delivered well and where they are being delivered less well, but I think the work that Sir Simon Wessely is doing will shine a light on exactly that, and will enable us to engage in a much more meaningful debate about what is appropriate.

Autism Community: Mental Health and Suicide

Lord Beamish Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

That is an extremely important point. We must bear it in mind that for young people with autistic spectrum disorder, there is often a family-systemic approach, with carers are at the forefront of providing support, and they need the best resources possible.

I also thank the many citizens from across these isles who have contacted me to give their own poignant personal accounts. These accounts have been harrowing to read—and more harrowing for them to experience—and make us realise just how absolutely vital this debate is.

I also want to extend a personal warm welcome to the youth patrons up in the Gallery today representing Ambitious About Autism. Their recent campaign and research project, “Know your normal”, has been helping many people and raising important awareness. I pay specific thanks to the hon. Member for South Cambridgeshire (Heidi Allen) and the right hon. Member for Chesham and Amersham (Mrs Gillan), who have worked tremendously hard on this debate, on behalf of people with autistic spectrum disorder, through the all-party group over many years.

As a psychologist, I know that progress has been made on autism and mental health over the many years since I started in 1990, when waiting lists were extremely long—possibly a year and more—and services were very limited. However, much more must be done across the United Kingdom.

[Mr Kevan Jones (North Durham) (Lab)]

I accept the point that the hon. Lady is making, but I have to tell her that waiting lists in Durham are still two years long.

[Dr Cameron]

That is an excellent point, and that situation is clearly unacceptable. The Scottish Government and the United Kingdom Government are introducing waiting times initiatives across the United Kingdom. We are finding that the experience on the ground for young people with autism and their families, and indeed across the lifespan, is that, despite the waiting times initiatives, the waiting times that are expected to be in place are not the reality. We need to address that issue seriously.

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[Mr Kevan Jones (North Durham) (Lab)]

I join right hon. and hon. Members in congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate, and thank the Backbench Business Committee for granting it. The hon. Lady pointed out, as did my hon. Friend the Member for Blaydon (Liz Twist), that the percentage of people who take their own life is nine times greater among people with autism than the general population. As my hon. Friend said, autism is linked to depression and anxiety.

I welcome the debate because it is another example of this House talking about mental health. People know that I think the more we talk about it, the better the debate gets. I think people should be congratulated on that. I place on the record my thanks to the charities and the army of volunteers who work with adults and children with autism, because they are unsung heroes.

I want to raise two points. One is about waiting times; the other, which the hon. Member for East Kilbride, Strathaven and Lesmahagow raised, is about how we develop pathways. In Durham, we currently have a two-year waiting list for autism diagnosis. I have tried to get to the bottom of why that is. It is only when you meet some of the parents of the young people that you see what a tragedy it is. The pressure on those families is so great that I suspect some are developing mental health issues. I am really concerned about the lost opportunity for those children, because everyone only gets one chance at education, and there are cases where children have been out of school for nearly a year, waiting for diagnosis. I am aware, as I think we all are, of the pressures that there are on child and adolescent mental health services and social services, but we must try to streamline the pathway to early diagnosis.

The hon. Member for Bexhill and Battle (Huw Merriman) spoke about schools. The most appalling thing I have seen is that a school excluded a child with autism, even though he had a diagnosis, because “he was too difficult”—and clearly affecting the league tables. We should monitor that, because it is a disgrace. Thankfully, the local authority stepped in and put that right, but the pressure on that parent and the child is unacceptable.

We are talking about mental health and a Health Minister will reply to the debate, but this issue is wider than just health. We have made great strides in terms of parity of esteem, and the point that the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) made is right. We are winning that battle. Now we need to win the next battle, and that is how we hardwire mental wellbeing into public policy. That is not just health; it is education, housing, social care, local authorities—

[Liz Twist]

And employment.

[Mr Jones]

And employment, as my hon. Friend says from a sedentary position.

There is another big problem that a lot of individuals with autism encounter. They go through the school system. Education finishes and they transition into work. I know of quite a few examples of this from my constituency. A lot of these young people, who are perfectly capable of engaging in some type of employment, seem to get lost in the system. The pathway that the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned must therefore continue from diagnosis all the way through an individual’s life and involve a cross-section of services, not just health. To get that idea hard-wired into the system, the Government must make sure that, from Cabinet Committee level downwards, consideration of mental health and mental wellbeing forms part of the process of policy making in each Department. The last Labour Government did something similar with veterans.

[Kevin Brennan]

I am grateful to my hon. Friend for giving way, because I know that time is short. Does he agree that those Cabinet Committee-style discussions should involve ensuring that the Ministry of Justice and the Home Office understand the ways in which people with autism come into contact with the criminal justice system and understand the behaviours—such as stimming, which is often misinterpreted and ends up with people being arrested—that those individuals exhibit?

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[Mr Jones]

I totally agree, because autism is not just a health issue. The hon. Member for Berwick-upon-Tweed made a very good point. How many times have we seen people reacting to a child in a supermarket kicking off, as it were, with no recognition of the fact that the child is on the autism spectrum or of the challenges that that poses for the parents? We need to hard-wire that idea in.

The Government also need to look at health funding. I accept that they have committed to more funding for mental health, but the system that was set up in the Health and Social Care Act 2012—I hate to come back to it—makes it more difficult for the money that goes in at the top to get to where it is needed on the ground. If I were a Health Minister, I would be completely frustrated by the fact that I was pushing a lever that was not connected to anything. Clinical commissioning groups and others are taking money that should be going to mental health and diverting it towards other priorities, which I accept they see as important.

I finish by again congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow and everyone who has spoken. The debate has allowed us to shine a spotlight on mental health again—that is a good thing—on autism, which is not widely understood in the broader community, and on the particular challenges faced by those on the autism spectrum who suffer from mental illness.

Mental Health: Pharmacists

Lord Beamish Excerpts

Wednesday 25th October 2017 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I wish to use tonight’s Adjournment debate to raise the sad case of my constituent Alison Stamps, a 33-year-old pharmacist who sadly took her own life on 25 May 2015. I will outline the circumstances of the case, but will also raise wider concerns that I and her family have around the operation of Boots UK and how it dealt with her death, as well as my broader concerns concerning pharmacists and mental health issues.

Alison was clearly an exceptionally bright and talented individual. After finishing at Pelton Roseberry comprehensive school in my constituency in 2000, she went on to study—

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Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

[Mr Jones]

Alison went on to study biology at Durham University and graduated in 2003. She then began work as an audit and accounting technician at Sunderland city hospital before choosing to return to university—the University of Sunderland—to study for a four-year masters degree in pharmacy. While she was at Sunderland, Alison was awarded the prize for the best overall student in the first year, before going on to be awarded the Royal Pharmaceutical Society’s award for the best student on a masters degree programme in 2012. Her achievements were remarkable, and clearly she was dedicated to public health and the pharmacy profession.

Alison began work at Boots’ Tindale store in Bishop Auckland in August 2013. Her parents tell me that she enjoyed the work but increasingly complained about the long hours and demands it placed upon her. By mid-December 2014 she was clearly overwhelmed by what she was having to do. Her store manager noticed that she was losing weight and looking unwell. Following a conversation with the store manager, Alison expressed how down she felt. The store manager provided her with a phone number for an independent counselling service and encouraged her to speak to her GP and her family. Like many people in Alison’s position, she felt she could not speak to her family or strangers about her situation. Still concerned, her manager arranged an appointment with a GP for Alison and even attended the appointment with her. I understand that the GP indicated that she should take antidepressants, but Alison did not wish to do that. The GP gave her a crisis number to ring and also suggested some other coping mechanisms.

At this point, I would like to commend the actions of the store manager, who I think genuinely tried to help Alison. I understand that she reported her concerns about Alison to her area manager, and I have had it confirmed by the director of human resources at Boots that this case was referred and flagged up with the firm’s central HR department. It appears that all that happened, however, is that the store manager was advised about what counselling was available, but no alarm bells rang in Boots’ central HR department that one of its pharmacists was in a crisis situation and no action seems to have been taken. Instead, it was left to the store manager to do her best to assist Alison in her time of crisis.

This raises serious concerns about how Boots as a company handled the case. Having been made aware of Alison’s situation, no attempt seems to have been made centrally or high up in the organisation to intervene directly. This was a young woman not only holding down a responsible job dispensing medicines but who was clearly in a severe mental health crisis. Throughout this time, the store manager was also aware that Alison was self-harming—she had confided in her that she had cut her legs. For six months, Boots was aware of Alison’s situation but simply left it to the store manager to deal with it, although I put it on the record again that she did a great job in trying to help, and she did it to the best of her ability.

Sadly, on 25 May 2015, Alison took her own life in a room at the Hardwick Hall hotel, having taken an overdose of prescription medication. At the coroner’s inquest, it was determined that Alison had taken her own life while suffering from depression. Her parents, Mr and Mrs Stamps, attended the inquest. So did representatives from Boots, who made no attempt whatsoever to offer sympathy or speak to the family. The coroner invited those present to introduce themselves, but because it was a public hearing, the Boots representatives chose not to do so. Mr and Mrs Stamps felt, I think understandably, that their attitude was very legalistic—that they were concerned with their fears about the possibility of a legal case as a result of Alison’s death, rather than with having a compassionate understanding of how her death had occurred.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on raising an issue in which he takes a great interest, as is clear from other occasions when he has spoken in the House. I believe that this very sad case highlights for all of us the need to ensure that those in the workplace are given adequate training to offer support to workers with depression or other mental health issues. Does the hon. Gentleman agree that the Government must initiate, or make available, courses for all small and medium-sized enterprises, which would be free of charge and which would provide tools for employers that would enable them to help such staff members?

[Mr Jones]

As I have said on other occasions, I think that mental health in the workplace is one of the big issues that we do not talk about. I think the hon. Gentleman’s suggestion should be considered, but what struck me about this case was that it involved not a small employer but a huge multinational company, which should have had the capacity within its organisation to provide assistance.

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that all employers could benefit from having policies to support staff when they are at work, and when, sadly, an employee dies by suicide? Should not employers be encouraged to take up programmes such as those developed by the Samaritans, Business in the Community and Public Health England for the benefit of staff?

[Mr Jones]

I agree with my hon. Friend. I know that she is involved with the Samaritans, and I congratulate her on the work that she does. Yes, there are a lot of tools out there for companies to use, but they must take them seriously rather than treating them as a tick-box exercise. Policies of this kind must actually be used in the workplace, and people must be trained so that if they encounter a case like Alison’s, they do take it seriously. That is what I would have expected from a large company such as Boots.

Anyone who has looked at the details of this case cannot but be moved by its tragic nature, and by the failure of Boots to exercise its duty of care at a national level. Mr and Mrs Stamps are certain that the long hours and the workload that Alison faced were a contributory factor in her death. I have spoken to representatives of the pharmacists’ trade union, the Pharmacy Defence Association. They made it clear that there are increasing demands on pharmacists, not only in terms of workload but as a result of staff cuts. Last year an article in The Guardian highlighted the situation at Boots, including many emails from Boots’ pharmacists claiming that profit was being put in the place of pharmacists’ health, and that they were increasingly being asked to hit targets for medicines use reviews—the company is paid £28 per review by the NHS—rather than concentrating on dispensing and the care of patients.

Those pressures are putting an increasing strain on pharmacists who work for companies such as Boots, but, like Alison, many choose not to complain, because they fear that if they do so they will lose their jobs or their professional qualifications will be withdrawn. That is a particular issue in the context of mental health, and in professions such as pharmacy. People remain silent for fear of the consequences of speaking up. I think that pharmacists need a system like the one that has been introduced for GPs. Many GPs also do not want to talk about their mental health problems because they fear that they will be disciplined. I think that that was Alison’s fear: she feared that if she raised issues relating to her mental health, she would be taken down the disciplinary route and lose her job.

I suggest to the Minister that that needs to be looked at. Pharmacists should have a system similar to that for GPs. I have done some work on this with GPs. The NHS has the GP health service, which is a confidential service for both GPs and trainees. I have met some of its staff, and it works very well in allowing GPs to self-refer confidentially. The GP health service can help doctors with anything to do with mental health, including stress and depression. The effort that has been made to ensure that there is GP support needs to be replicated for pharmacists, because I can say from a personal point of view that, with the best will in the world, giving someone with depression a helpline to ring is not the answer. People do not ring them; I can say from personal experience that I would not have done so when I suffered from depression. The work done for GPs offers a way forward that I ask the Minister to explore.

I also have to raise questions with the Minister about the role of the General Pharmaceutical Council. Following Alison’s death and Mr and Mrs Stamps coming to see me, I wrote to the GPC asking for its opinion of the case. It wrote back saying that its role was to protect patients by

“setting and upholding standards for individual pharmacists and pharmacy technicians.”

I understand that the GPC has been aware of complaints concerning Boots’ working practices for pharmacists, but has taken no action against that company or—so far as I can see—any other company about how pharmacists were being employed. That raises the question of what this regulator is actually doing.

It is also disappointing that the regulator sees itself as a peripheral player on the issue of workplace pressure and stress, and the pressures put on pharmacists. This stance by the regulator allows employers such as Boots to preside over poor working conditions without any threat of sanction. It says that its job is to protect patients, but if a pharmacist has a severe mental health problem that is being created by workplace pressures and stress, that must be putting patients at risk. The potential danger of mistakes being made will be heightened if pharmacists are under such pressure.

In response to Alison’s death it seems as though Boots was most concerned about its own reputation. At the time, its main concern appeared to be whether any controlled drugs were missing from the pharmacy where she worked. It would appear that the drugs that Alison took to end her life came from the unused drugs that were returned to the pharmacy by patients. Although there is a register of these drugs, I wonder whether there should be tighter regulation because it is up to individual pharmacies whether the drugs are recorded. There should be a process of monitoring how the drugs are collected, registered and ultimately destroyed.

While doing the research for this debate I tried to find statistics on mental health problems and suicide among pharmacists. I am not aware of any statistics being held centrally that show this information. We might look into collating such figures to inform this debate, which is clearly ongoing.

Alison Stamps’ death is a tragedy, not only for her family but for us all as citizens, as we have lost a bright, conscientious young lady with much to offer. Her life was, sadly, cut short by circumstances she thought she could not face. It is quite clear that lessons need to be learned and that changes need to be made, not just in the way we regulate pharmacists but in the way we employ them and treat them in the workplace. Alison’s employer, Boots, should take stock not only of how it is dealing with her case but of how it employs other people within its organisation. It would be right to finish with something that Mr and Mrs Stamps said in a letter to me when they first raised the case with me. They said:

“It is clear that Alison was a victim of corporate greed and collateral damage by an uncaring company intent only on its own agenda.”

Oral Answers to Questions

Lord Beamish Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

Our plans envisage treating another 70,000 children every year by 2020-21, but that is still not enough. It will take us from one in four children needing help to one in three. That is why we are publishing a Green Paper on child and adolescent mental health.

[Mr Kevan Jones (North Durham) (Lab)]

One of the staffing shortages is actually in children and young people’s services. In County Durham in my constituency, the waiting time for autism diagnosis is two years. I have raised this with the mental health trust and NHS England, but the problem seems to be with the clinical commissioning group. What can the Secretary of State do to ensure that the extra money that he has pledged to put into the service actually gets to the service?

[Mr Hunt]

I would like to thank the hon. Gentleman for speaking out about mental health, like so many colleagues in this House, which makes a massive difference to the Time2Change campaign. It is unacceptable for someone to be waiting that long, and I do not want to stand here and defend it. I will certainly look into the individual case that the hon. Gentleman raises, but the fact is that many Members will know of similar cases. The money is starting to get through to the frontline. It is not just money, though; it is also capacity, and having trained mental health therapists—nurses; psychiatrists—and that is why we are boosting their training, too.

Clinical Commissioning: North Durham

Lord Beamish Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate my hon. Friend the Member for City of Durham (Dr Blackman-Woods) on securing the debate.

The decision of the North Durham CCG raises some fundamental questions about how the NHS is run in North Durham, and our constituents’ relationship with the NHS. As my hon. Friend described, there was no consultation of my constituents about the decision, which was taken in secret. There was no transparency at all, nor any consultation with Members of Parliament in the CCG area or any local elected officials. The decision changes the fundamental relationship of trust between a patient and their GP. My constituents have never been asked for permission for our private medical information to be passed to a private company—and neither have I or my hon. Friend. We have not been asked whether the company has our individual permissions. In many cases I do not think constituents have even been told by their GPs that the information is being passed to a private company.

What is the legal position on the giving of my private medical information, and that of my constituents, to a third party? Who is responsible for ensuring that it is secure? Do I have a right, given that it is my personal medical information, to withhold permission for it to be passed to a private third sector organisation? I certainly do not think that patients in North Durham are being told that that is happening. As my hon. Friend the Member for City of Durham said, the website does not give the impression that the information is being given to a third party.

The way the decision was taken was shameless. As my hon. Friend has already said, we met the CCG in September and there was no mention of the contract at all. I want to ask why. One of my constituents, Keith Johnson, raised concerns and the CCG responded:

“GPs have responsibility to make best use of NHS resources and need up to date evidence and advice to be able to treat patients in practice or to refer on appropriately. Unnecessary outpatient appointments are a large cost to the NHS.”

I do not think anyone would disagree, but that is the job of GPs; it is not up to a private sector organisation, or anyone else who has never seen the patient, to decide whether they should be referred to a specialist.

My concern is not just the way the decision is being implemented, but the fact that it fundamentally breaks down the trust that we all value, and the confidentiality between us and our GP. I am also concerned that the more articulate constituents and patients will insist on getting care; some others will not. There will be rationing of care, depending on people’s ability to make their case. That goes to the principle at the heart of the NHS—care being free at the point of need.

I have questions about the way the contract was let. We have had no information about how that happened. Was it by competitive tender? Did any individuals employed by the CCG have any pecuniary interest in awarding the contract? How will it be evaluated? What ability will patients have to say whether they agree with the outcomes? I challenge the North Durham CCG to publish the contract and all information and decision making about how it was awarded, because the cloak of secrecy around it is a disgrace. I also challenge it to scrap the contract and answer a basic question: why is it treating its patients with such contempt?

--- Later in debate ---

[David Mowat]

I was explaining the purpose of the policy and the fact that this referral mechanism was used widely in 2007. A King’s Fund report from 2010 sets out the pros and cons of using referral management—I suggest the hon. Lady reads it.

These things are not new. They are a mechanism by which a consultant, or a GP with a specialist interest in the area of what is being referred—there are six areas of referral in this CCG, as the hon. Lady said—has two to three days to either accept that the referral goes on to the secondary system, or to contact the GP and have a discussion about what the best alternative pathway might be. There is an appeals process if the GP does not agree with that decision.

The hon. Lady asked where else such referral management was being done across the NHS in England. It was introduced in 2007, as I said, and it is being done very commonly. It is being done in Bromley, Cambridge, Peterborough, Imperial in London, and Southampton. I saw a similar system in Tower Hamlets to the one working in her area—indeed, the GP was very proud of the way they reacted, with an email referral system, when there was every possibility of things not going ahead.

This is not rationing. It is completely wrong to say that. It was brought in by the CCG, which is GP-led. If the GPs in the CCG do not agree with it, they have the mechanism to replace the chairman of the CCG.

[Mr Kevan Jones]

I understand what the Minister is saying, but what about the patient? Where does the patient come into this? If I go to my GP and he says I need a referral, that is between me and my GP. If it was not for my hon. Friend the Member for City of Durham (Dr Blackman-Woods) or the BBC raising this, none of my constituents—or myself and my hon. Friend, who are patients of the CCG—would have known about it. Will the Minister please answer the point about the patients?

[David Mowat]

The point I was in the middle of making—which I will finish making—is that if the GPs in the CCG have difficulty with the scheme, they have the mechanism to replace the CCG chairman and therefore to not go ahead with the scheme, so the GPs in his area are presumably content with it.

[Mr Jones]

The patients are not being consulted.

[David Mowat]

The fact is that the GPs vote for the head of the CCG who has put the scheme into place. On the patient issue, which is a fair one, if the patient expresses a preference to go to a secondary or an acute hospital and have an appointment, which could typically be six to eight weeks away, of course that is part of the process, and of course the referral management schemes will take that into account.

[Mr Jones]

I am sorry, that is not the case. In North Durham, patients have not been told about it. If I went to a GP who said I needed a referral, I would not be told that. What the Minister is saying is in complete contrast to what he told me during a debate on coeliac disease a few weeks ago, in which he condemned CCGs for not consulting people before awarding contracts.

[David Mowat]

We are moving around a little bit here, but I will come to the point about consultation. The GP that the hon. Gentleman refers to is a part of a CCG that has made the decision to extend the North Tyneside pilot to North Durham. All I am saying is that those GPs are part of the CCG and that presumably the CCG is doing this because it believes the clinical out-turns are right. We have a locally driven system. I will make some progress on the benefits of this for patients.

--- Later in debate ---

[David Mowat]

I am going to talk about the About Health situation and the people who have been awarded the contract in North Durham. It is a one-year pilot that builds on the one-year scheme in North Tyneside. I think it started last month; it covers six disciplines and it does not cover urgent referrals, in particular cancer. All the national requirements for referral-to-treatment times still count in exactly the same way. The local CCG performed a risk analysis before it decided to take the scheme forward and build on what happened in North Tyneside, and the scheme is monitored.

I have been told that a very important feature is that there is a clear GP appeals process. If they are not happy with a decision that has been taken, that process can happen very quickly.

[Mr Kevan Jones]

What about the patients?

[David Mowat]

The GP represents the patients in the health system; that is the fact of the matter. If there are out-turns that are detrimental to patients, as the hon. Member for City of Durham implied, that is a serious situation and should be investigated.

About Health is CQC-regulated—with all that goes with that—in exactly the same way as a GP practice. It is staffed by NHS consultants and GPs with a particular interest. As I said, there is a two or three-day turnaround, and they have to have the same indemnity cover as everybody else. Part of what the CCG is doing is to save money—that is true. Inappropriate outpatient appointments mean that more people than necessary are working. If that can be reduced, there is a cost saving to the national health service. It is about optimising pathways.

[Mr Jones]

Will the Minister give way?

[David Mowat]

I will make a little bit more progress and let the hon. Gentleman in later.

This is about stopping inappropriate treatment; it is absolutely not about rationing. If it was about rationing, the whole referral management system would not have been first introduced by the last Labour Government. I think it is incredible that that point has not come across more strongly.

One of the concerns is that About Health is a private company. It is a private organisation that has won the contract, and the local CCG made that decision. Fair questions were asked about the confidentiality of patient records, in terms of them going across a boundary to a private company. My first point, which is an obvious one, is that GP practices are all private companies. Every partner that works in a GP practice works in a private company, in the same way that the GPs who work for About Health are working for a private company. However, all the requirements around patient confidentiality that About Health needs to make sure are in place apply in exactly the same way as they do in every other part of the national health service.

[Mr Jones]

The point about that is that I, as a patient, have not given permission for that. The way this has been done—with no consultation, which the Minister says is wrong—means that no one knows what is actually happening.

[David Mowat]

I was going to come to the point about consultation—I do not have a great deal of time left now. It is right to say there was no consultation on this, and that is because this is an administrative process change. There is no service change—

[Mr Jones]

That is absolute nonsense.

[Geraint Davies (in the Chair)]

Order.

Coeliac Disease and Prescriptions

Lord Beamish Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I beg to move,

That this House has considered coeliac disease and prescriptions.

It is a pleasure to serve under your chairmanship, Mr Bailey. I am grateful for the opportunity to hold a debate that raises awareness of the problems facing those who suffer from coeliac disease and of access to gluten-free food prescriptions. It would be remiss of me not to thank the work of Coeliac UK, the national charity that represents people with coeliac disease, for not only supporting the campaign around the prescription of gluten-free food, but for its work to support sufferers.

Coeliac disease affects one in every 100 people in the UK. I declare an unwelcome interest: I actually suffer from coeliac disease, although I do not get prescriptions for gluten-free food. It is also worth noting that there are some half a million people in the UK who are completely undiagnosed, according to Coeliac UK.

Coeliac disease is a serious medical condition in which the body’s immune system attacks its own tissue when gluten is eaten. The only medical treatment currently available for sufferers is a strict adherence to a gluten-free diet for the rest of their lives. In the late 1960s, gluten-free food was first prescribed to prevent long-term health complications. However, that rationale has now been challenged by some clinical commissioning groups, despite the fact that their position lacks supporting evidence for withdrawing such prescriptions.

[Jack Dromey (Birmingham, Erdington) (Lab)]

I am grateful to my hon. Friend for bringing such an important debate on an issue that affects so many people. Does he agree that it is absolutely wrong that David Lissaman, a pensioner in my constituency, who thus far has been able to get gluten-free food on prescription, now faces the prospect of losing that as a consequence of the clinical commissioning group’s review? He is a good man who served his country well. In his own words, he will “have to find ways” of significantly reducing the amount of food that he eats, which, because of his other health problems, could put him at risk.

[Mr Jones]

I agree, and I shall refer to certain demographics—pensioners being one—that are particularly affected by these proposals.

Some 40% of CCGs in England are now choosing to restrict or remove support for patients with coeliac disease, which is leading to increasing health inequalities and, basically, a postcode lottery for NHS care, depending on where someone is diagnosed. The CCG’s rationale for going down that route seems to be justified on cost grounds alone. Indeed, Coeliac UK has made a number of freedom of information requests to try to get more details on why CCGs are changing their policies.

I will take a moment to read an example of a response to Coeliac UK’s FOI request, which came from North East Essex CCG, where sweeping assumptions have been made that are completely devoid of any systematic research. That CCG stated:

“We appreciate that there is a large cost-differential between supermarket value brands and GF [gluten-free], but many people within the CCG buy their bread from bakers or do not buy the supermarket value brands and the cost differential is therefore much reduced.”

That type of anecdotal evidence, used by CCGs to justify their decisions about patient care, is in direct conflict with a paper produced in September last year entitled “Cost and availability of gluten-free food in the UK: in store and online”. It said:

“There is good availability of gluten-free food in regular and quality supermarkets as well as online, but it remains significantly more expensive. Budget supermarkets which tend to be frequented by patients from lower socioeconomic classes stocked no GF foods. This poor availability and added cost is likely to impact on adherence in deprived groups.”

[Mr Jim Cunningham (Coventry South) (Lab)]

I congratulate my hon. Friend on securing this debate. The issue does not apply only to elderly people. I have had a number of young people write to me about this, who are very concerned that they may not be able to get gluten-free foods on prescription any more. Has he looked at the possible costs for people who are at the lower end of the earnings scale?

[Mr Jones]

My hon. Friend raises an interesting point. There is evidence—including from my own family—that gluten intolerance and coeliac disease run in families. If a young family includes several children with this condition, the cost could be significant.

[Sir Gerald Howarth (Aldershot) (Con)]

To reinforce the point, my constituent Sheryl Rees has drawn my attention to the fact that her son was diagnosed with coeliac disease when he was two. He is now 11. She pointed out the cost of gluten-free items. For example, a small loaf is £3. A pizza is £4. Pasta is £2 a pack. Basically, she is paying double. She has a family of six. This is really impacting on her family’s budget.

[Mr Jones]

The hon. Gentleman raises an interesting point, especially in terms of families with children. There is also a question of availability in some rural areas. Larger supermarkets stock some of these products at the prices he mentioned and higher, but in other areas the products are not available.

[Kevin Foster (Torbay) (Con)]

Will the hon. Gentleman give way?

[Mr Jones]

I will make a bit more progress.

We have a situation where, in places such as east Essex, the needs of patients are being discounted despite a complete lack of any type of research. I am concerned that more CCGs across the country will begin to use inadequate justifications as a precedent and follow a similar path. That leads me back to my earlier point about the big problem of under-diagnosis. I am afraid we will see a bigger problem if gluten-free prescriptions are not made available to those on low incomes.

[Dr Julian Lewis (New Forest East) (Con)]

On the specific point of failure to diagnose, until 20 years ago I had never heard of coeliac disease, and then I went out with a young lady who, as a teenager, had repeatedly gone to her GP knowing something was wrong. Coeliac disease was never diagnosed until she suffered something analogous to a stroke, which left her permanently all but unable to read. Although she has bravely developed coping strategies over the years, there is no doubt that her life and career have suffered, and she should never have been put in that situation.

[Mr Jones]

The right hon. Gentleman raises a serious point about the life-changing effects that coeliac disease can have. I was only diagnosed by accident, in my 30s; my mother was not diagnosed until she was over 70. Early diagnosis is important, but it is not uncommon for people to live a long time without one being made.

The Health and Social Care Act 2012 included a duty on CCGs to have regard for National Institute for Health and Care Excellence quality standards, but NICE guidance on prescribing gluten-free food for the management of coeliac disease has only recently been published. It says:

“Gluten-free products are more expensive and are usually only available from larger retailers, making access more difficult for people on low incomes or with limited mobility. As coeliac disease can affect more than one member of a family it can also be an additional burden on the family budget”—

as the hon. Member for Aldershot (Sir Gerald Howarth) said.

“To address this, healthcare professionals should help people who may need support to find suitable gluten-free food products on prescription to enable them to maintain a gluten-free diet.”

[Mims Davies (Eastleigh) (Con)]

I declare an interest, having been diagnosed in my late 20s. My cousin and all my second cousins are exactly the same. In fact, at university I was diagnosed with ME because I was so unwell and unable to work at various points.

This debate is an opportunity also to talk about the low incomes and limited mobility that can affect people’s access to these basic items. We must also make a plea through Coeliac UK to supermarkets to ensure that what they provide, which is very expensive, is of better nutritional quality, with lower levels of salt and fat. Although these foods are gluten-free, they might be full of some awful stuff as well.

[Mr Jones]

The hon. Lady raises an interesting point, but I assure her that the products available today are completely different from when I was first diagnosed. The bread then was like cardboard, and today it is very much different.

There is a general duty for GPs to prescribe treatments for health conditions via the FP10 prescribing system where treatment is available, and in the case of coeliac disease that is a gluten-free diet. There is also a duty in legislation for CCGs to reduce inequalities with respect to patient access to services and outcomes, but because of the lack of explicit recommendations on prescribing from NICE, CCGs are being given a fairly free hand to make decisions that run contrary to reducing health inequalities.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on securing this debate. Prescription of gluten-free food as medication clearly needs to be regulated by the NHS across the United Kingdom. One of my constituents said to me this week:

“The disease is antisocial and can lead to isolation.”

Does the hon. Gentleman agree that the supply of food on prescription can have social benefits, as well as mental, physical and emotional benefits?

--- Later in debate ---

[Mr Jones]

It can. There is some anecdotal evidence about the connection between coeliac disease and mental health. The hon. Gentleman raises an interesting point.

This situation is creating considerable uncertainty for those who rely on access to gluten-free staples on prescription, and it is the vulnerable who are most adversely affected. Individuals with the disease are not eating gluten-free food out of choice or because it is some type of fad or Hollywood diet. They do so because they have to. It is people on fixed incomes or on benefits who receive free prescriptions and those whose households rely on deliveries from community pharmacies who will suffer most if prescriptions are withdrawn.

A number of people have written to me ahead of this debate, and I would like to draw Members’ attention to their cases. Patricia said:

“The diet I and many others follow is not a fad. It is necessary as it will affect my health and wellbeing if not followed, and might actually result in my admission to hospital—an extra strain on the NHS.”

[Rebecca Pow (Taunton Deane) (Con)]

Will the hon. Gentleman consider students in this category? Many of them are on low budgets. They might be tempted not to buy the right food and then end up being sick and in the NHS, costing the state more money.

[Mr Jones]

That is the main point. What some CCGs are doing is a false economy, because one hospital admission will cost more than the annual cost of prescriptions for an individual who adheres to a gluten-free diet.

Another person living with coeliac disease, Janice, who is a constituent of mine, wrote to me saying:

“I strongly believe that these plans will cause more expense to the government when coeliac patients can’t afford shop priced gluten-free foods and don’t stick to their diet and end up with cancer of the bowels”,

as well as other conditions. She went on:

“I am a pensioner and find it increasingly hard to afford luxuries like biscuits and cakes. If I have to add gluten free bread, pasta and cereals to my shopping list this will cause more stress. I cannot have any form of gluten, even in small doses, as I am violently ill.”

As well as a failure to consider the evidence before making decisions to withdraw gluten-free prescriptions, there is also evidence of a lack of public consultation by CCGs. Coeliac UK has been doing a good job of holding CCGs to account. One example it provided is of Trevor, who told Coeliac UK that he has never received confirmation in writing that the policy had changed; he was informed only when Coeliac UK told him. He was diagnosed 10 years ago and has only ever had bread on prescription. He is unable to work and has ongoing medical problems. His nearest shop is a Co-op, which does not stock gluten-free products, and the nearest shop that does is some six miles away. That creates problems for people such as him.

The CCGs that have already removed access to prescriptions for gluten-free products have not outlined or implemented policies that offer alternatives to safeguard patients, such as access to specialist dietary or nutritional advice. When a coeliac patient is taken out of a CCG’s responsibility because their gluten-free food prescription has been withdrawn, that CCG can no longer monitor them or determine the changed policy’s impact on that patient’s health. This is an important factor, and I am concerned that it has not been taken into account by a number of CCGs.

In areas where gluten-free products are not prescribed, there is now no opportunity to encourage dietary adherence nor a prevention strategy for long-term management of people with coeliac disease. Effectively, patients who suffer the condition in these areas will be offered no support by the NHS. Although CCGs are engaged with local authorities and wellbeing boards to explore alternatives, none has yet been put in place.

The NHS has a good track record of involving the public in consultation, but the lack of consultation on the decision to withdraw prescriptions for gluten-free products is a disgrace, added to the fact that charities such as Coeliac UK are not consulted before such decisions are made.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on securing this debate. The point he is making is direct and correct. The nine-year-old daughter of my constituent, Helen Frost, has coeliac disease and Helen is worried that prescriptions for gluten-free products may be taken away. The uncertainty is adding stress to a situation that is already difficult to manage.

[Mr Jones]

That is not even taken into consideration, as my hon. Friend says.

My concern is that cutting prescriptions for gluten-free products is a simple and easy target for CCGs under financial pressure. The entire prescription cost to the NHS in 2014 was £26.8 million or 0.27% of the total prescription budget—£194 per patient. The procurement system that the NHS has in place is not working. The market for gluten-free products in the UK in 2014 was some £211 million, but the annual NHS budget was around £27 million or 13% of that total market. I do not know why the NHS cannot negotiate contracts with some commercial companies. Failure in procurement will clearly have an impact.

I turn to the issue of pharmacists. Back when we had primary care trusts, some pharmacy-led supply pilot schemes were set up in a handful of regions in England. When a patient was diagnosed with coeliac disease, the pharmacy-led scheme allowed patients to access gluten-free food and to manage their coeliac disease. However, with the establishment of CCGs, that seems to have gone out of the window—except in Scotland, which has a national gluten-free food service: a pharmacy-led scheme based on pilots in the UK.

Will the Minister seriously consider introducing such a scheme in England? It would save time and money and be a better way of managing people with coeliac disease. It is worth noting that the annual cost of gluten-free food is lower than the annual cost of items that the NHS provides that cost less over the counter—for example, paracetamol and so on. I beg the Minister to consider that, if properly done, what I suggest would save money.

I know the Minister has been in post for only a few months and I am sure he receives many demands for things to be provided by the NHS, but I am also sure his officials have briefed him on the principles of the NHS: that it is a comprehensive service available to all with access to NHS services based on clinical need, not individual ability to pay, and that it aspires to put patients at the heart of everything it does. This issue is about limiting choice because of cost.

In conclusion, the issue needs urgent intervention. It is not fair to individuals and there is a postcode lottery. A pharmacy-led system could be delivered better and more effectively. At the of the day, the people affected have no choice but to have a gluten-free diet. We should not ration care for some of the most vulnerable in our society.

Young People’s Mental Health

Lord Beamish Excerpts

Thursday 27th October 2016 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House notes the recommendations of the Youth Select Committee report of November 2015 on Young People’s Mental Health; endorses the findings of that report on the need for more support from the Government for mental health services for young people; acknowledges steps taken by the Government, since its response of January 2016 to that report, with regard to some of its recommendations; and calls on the Government to set out what further progress has been made since its response and what its plans are further to improve mental health services for young people.

The motion concerns the report of the Youth Select Committee on young people’s mental health and the Government’s response to that report. I am grateful to the Backbench Business Committee for allocating time for the debate, the application for which was supported by more than 50 members from across the House, and to the hon. Member for South Cambridgeshire (Heidi Allen) for co-sponsoring the debate.

I start by paying tribute to the many health professionals and voluntary sector organisations working in mental health services for young people, the teachers and teaching assistants who support young people with mental health difficulties in classrooms every day of the week and the youth workers seeking to support our young people in many different ways. This debate is not about the commitment of those who work tirelessly to support our young people but about the resources and the framework within which they are working, which affect our collective ability to deliver the outcomes we need.

The Youth Select Committee report on young people’s mental health was published in 2015, as a consequence of more than 90,000 young people voting for the subject of mental health in the 2014 Make Your Mark ballot. It is an exceptionally important piece of work because it is a report on mental health by young people, about young people. Since I was elected last year, I have been struck by how often young people’s mental health issues have been raised with me; whether by individual constituents struggling to access the support that they or their children need, doctors in my local accident and emergency department or teachers in our local schools. The issue is raised very frequently, and no one thinks the current situation is even close to being acceptable.

I pay tribute to the Youth Select Committee for its excellent, rigorous report and clear recommendations, which fall into three areas: funding and the state of services; a role for education; and awareness, stigma and digital culture. The report concludes that mental health services are significantly underfunded, and young people’s mental health services even more so, and that the challenge posed today by young people’s mental health is unprecedented. It highlights significant problems in accessing services, particularly in relation to first contact through GPs, and raises the urgent need for every young person in the UK to leave school with a good understanding and awareness of mental health, empowered and equipped to look after their own mental health.

[Mr Kevan Jones (North Durham) (Lab)]

Does my hon. Friend agree that some of the issues on access that are raised by this very good report could apply equally to adult services, so there is clearly a read-across between the two?

[Helen Hayes]

My hon. Friend is absolutely right to say that, although today we are debating young people’s mental health, many of the same issues apply to mental health services across the board for all members of our communities.

The Government published a response to the Youth Select Committee report in January 2016. That response was, on the whole, disappointing. It referred mainly to work that the Government were already doing rather than the additional work that they and other agencies clearly need to do. Most disappointing of all, the response rejected the key recommendation that statutory levels of attainment in mental health education should be introduced for all young people. I welcome the fact that the Government have subsequently announced some additional funding for young people’s mental health, but I remain very concerned about the current state of mental health services for our young people and the resourcing of those services.

I will focus, therefore, on the current state of services, and what I believe to be evidence of a crisis that is growing, not diminishing, and demands a response far bolder and more comprehensive than that which the Government are currently offering. I will also return to the conclusions of the Youth Select Committee report.

One in four of us will experience mental ill health in any given year. That means that mental health is something that affects every one of us. All of us have a friend or family member who has mental ill health, and many of us will experience mental ill health ourselves. I have known close friends and family members who have suffered from severe anxiety that impacted on their daily lives, clinical depression and eating disorders. There are few worse feelings than the worry for a loved one who seems unreachable in the pit of depression, except perhaps the worry when that loved one is a child. All any of us wants for our own children and the young people we represent is that they grow up happy, healthy and resilient to the stresses and strains of our world. Watching a precious child struggle with clinical depression, severe anxiety or an eating disorder is absolutely devastating.

According to NHS statistics, around one in 10 children and young people has a diagnosable mental health condition; that is around three students in a typical classroom. Many more young people do not have a diagnosable condition but experience a period of mental ill health or emotional distress during their childhood or adolescence. The Government’s own measures of children’s wellbeing found that almost one in four children showed some evidence of mental ill health. Half of mental health problems are established by the age of 14 and three quarters by the age of 24.

Shockingly, suicide is the most common cause of death for boys aged between five and 19, and the second-most common for girls of that age, after traffic accidents. A recent survey by Girlguiding found that 69% of girls aged seven to 21 feel that they are not good enough. It is thought that around one in eight young people self-harm between the ages of 11 and 16.

--- Later in debate ---

[Helen Hayes]

I agree with the hon. Lady completely. As we focus on prevention and early intervention, we need to think about early intervention in terms of age, as well as the stage of mental ill health.

As a consequence of the lack of early intervention support, the number of young people attending A&E because of a psychiatric condition has more than doubled since 2010. I have spoken to many doctors who tell me that when this happens and a seriously unwell young person presents at A&E needing a CAMHS in-patient bed, they frequently wait a very long time—sometimes days—for a bed to be identified. Often that bed is hundreds of miles away from home. One south London hospital has provided me with data that show a 37% year-on-year increase in the number of under-16s being seen in A&E with a mental health condition, and a 193% year-on-year increase in the number of those children being admitted to an in-patient bed.

[Mr Kevan Jones]

Does my hon. Friend agree that while there is a shortage of beds, another issue, particularly in cities such as London, is poor quality housing? In cases where individuals could perhaps have been treated at home and in the community, that treatment cannot be delivered because of the lack of proper housing.

[Helen Hayes]

My hon. Friend is right. There are multiple causes and contributory factors to mental ill health, and multiple contributory factors that present obstacles to addressing that and providing the treatment people need, where they need it. Housing is certainly one of them.

In London, 69 young people from Lambeth, Lewisham, Southwark and Croydon were unable to receive in-patient care in the South London and Maudsley Trust. Of those, 45 were sent out of London for their care. This issue, of seriously unwell young people being sent a long distance away from home to access in-patient care, needs to stop. It is distressing for families, it stops young people receiving the maximum possible support from family and friends to help them recover, and it makes them more vulnerable. When young people are admitted to a CAMHS in-patient unit, very often the service is not what it should be. The Care Quality Commission found that 62% of CAMHS in-patient wards and units were inadequate or required improvement.

The goal of parity of esteem for mental and physical health was introduced into the Health and Social Care Act 2012 via an amendment by Labour peers, and was a landmark in the way that mental health services are considered. However, we only need to think for a moment about what our response would be if some of the statistics on young people’s mental health related to a physical condition to realise just how far away we are from the stated objective of parity of esteem being realised. Just imagine if 75% of people with a bacterial infection struggled to get access to treatment; if almost a quarter of referrals for cataracts were turned away; if people with a chest infection were routinely forced to wait until they had pneumonia before any help was provided; or those with a broken leg were forced to wait for days in A&E only to be sent to a hospital hundreds of miles away to be treated. It would be a national scandal. The state of our mental health services, particularly those for young people, is a national scandal: it just is not being recognised as such. Words alone cannot achieve parity of esteem; the Government must start to act differently.

What action, then, is necessary to transform mental health services for our young people? I want to return now to the conclusions of the Youth Select Committee report. The Royal College of Psychiatrists highlights three recommendations in the report, which it believes are key. First, the Government must increase funding for young people’s mental health services and ensure that this funding is ring-fenced to guarantee that the money “reaches the ground” to CAMHS. There is particular concern at the moment about the introduction of sustainability and transformation plans across the NHS, and the resourcing implications of those plans. The Royal College of Psychiatrists recommends that the Government introduce ring-fenced funding for CAMHS and rejects any sustainability and transformation plans that do not clearly set out a plan to improve children’s mental health services in their area. I hope the Minister will commit to that today.

Secondly, health services must pursue co-production, in which young people themselves are involved in the process of formulating policy to improve CAMHS. Research shows that where young people have a clear voice in service design, the end result much better reflects the real needs of the patients.

Thirdly, the Government must focus on improving mental health education in schools, with the aim of ensuring that young people leave school with not only an understanding of mental health, but an understanding of how to help their own mental wellbeing. This recommendation was made by the Youth Select Committee and it is supported by the Education Committee, the National Association of Head Teachers and other teaching unions, the United Nations and many others. The Government have introduced new lesson plans for the personal, social, health and economic curriculum, but there is a broad consensus across the health and education sectors that the role of mental health education in developing resilience, preventing mental ill health and safeguarding young people is so important that it should not be left to chance, and that along with sex and relationships education it should be a compulsory part of the curriculum. I hope the Government will reflect on the urgency of the situation and the consensus around the need for compulsory education, and will make a commitment to introduce it.

The Youth Select Committee report made many other practical recommendations, including the introduction of regional commissioning, the development of an app to provide mental health advice and support, and the introduction of plans to support students through periods of exam stress. I would welcome an update from the Minister on the progress that is being made to deliver these excellent ideas.

Finally, we know that one of the greatest barriers to delivering the mental health support and services that our young people need has always been the stigma that surrounds mental health. I want to pay tribute to a brilliant piece of work that was recently published by the YMCA in partnership with the NHS. Called “I Am Whole”, the research sought to identify the extent and impact of mental health stigma and included the finding that three quarters of the young people spoken to believe that people experiencing difficulties with their mental health are treated negatively as a result of stigma. The project also sought to address stigma directly by publishing a series of stories from young people about their experiences of mental health difficulties. These make for very challenging and moving reading.

Before I close, I want to read a quotation from the foreword to “I Am Whole”, from Connie, aged 22:

“Having mental health difficulties is like being trapped inside a thousand invisible prisons. There are a thousand reasons that as a young person you are driven deeper into that colossal void. Not only isolated by the struggles you’re facing mentally, but further enveloped in a thick, suffocating darkness. The darkness descends, comprised of a tangled web of myths, harmful language, misconceptions and misunderstandings. This is stigma. It is time for these myths to be dispelled, the web broken and the isolation to end. It is time for us to be free to talk about our mental health difficulties openly, so that we can access the services we need. Once the conversation begins, you promote understanding for others and break down misconceptions people hold…It is like being stood in the dark, untangling parts of that web until the sun’s warmth breaks through…the light reaches your eyes, and you look around to see you are not alone.”

When we talk about young people’s mental health, we are talking about the wellbeing of our precious children, about their health and happiness, about the resilience of the next generation and about the ability of young people to fulfil their potential and be everything they can be. We are talking about the ways to stop more families living with the heartbreak of a young person with mental ill health and about ways to stop more families suffering the devastation of a loss to suicide. There are few things more important than this and it is time the Government got it right.

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[Tim Loughton (East Worthing and Shoreham) (Con)]

I declare my entry in the Register of Members’ Financial Interests. I apologise for missing the opening couple of minutes of the speech made by the hon. Member for Dulwich and West Norwood (Helen Hayes).

I am delighted that we are having this debate, and to be participating in it, for two main reasons, which I am sure you will share, Madam Deputy Speaker, because I know your interest in this matter. First, this is an important subject. It is something that we are failing on, so it is right, proper and beneficial that hon. Members talk about it openly, especially because, as we heard from my hon. Friend the Member for High Peak (Andrew Bingham), young people are much more prepared than ever to come forward with their own stories of their problems and issues, hopefully so that solutions can be found through them.

Secondly, I am delighted to participate in this debate because it is part of the UK Youth Parliament’s work. It is significant that we are giving up mainstream parliamentary time in the main Chamber of the House of Commons to discuss a report by the Youth Select Committee, an offshoot of the UK Youth Parliament. It is a shame that we have to do it in Backbench Business Committee time rather than Government time, but I pay tribute to the hon. Member for Dulwich and West Norwood for securing the debate and giving it such an excellent start—this will clearly be a high-quality debate. I take the view—I think that you share this view, Madam Deputy Speaker—that the Youth Select Committee has now taken on such status and stature, with its production of reports of such high quality involving such good research, that not only should the Government produce a formal response to the reports, as they have, but they should give up Government time in this Chamber on an annual basis—just once a year—so that we can formally debate the work of the Youth Select Committee. I have put that idea forward for some time, so I hope that the Whips and Government business managers are listening.

I am a big supporter of the UK Youth Parliament. It was founded during my time in Parliament, and I always try to attend its annual parliamentary sittings, which are a great spectacle. It is always exceedingly frustrating for Members when we return on the Monday and the Speaker inevitably says, “Why don’t you lot behave as well as the UK Youth Parliament members who were here on Friday; they are very smart, very concise, very well behaved, don’t heckle and set an example?” It is a shame that the media coverage of the Youth Parliament sitting is not more extensive because it is a great event for a great organisation, and it is great that we are discussing its work today.

When I was the Minister for children and young people, we produced the “Positive for Youth” document, which was all about promoting that sort of youth engagement. One of the things I most treasure having done is helping the transition of the UK Youth Parliament across to the British Youth Council to secure its future. I pay tribute to all its work over the past few years. It is a mainstream part of the youth voice in this country and in this Chamber.

I was the first witness ever to be called before the Youth Select Committee. It was an awesome and intimidating experience. I was called for its first inquiry back in 2012 along with the then Transport Minister, Norman Baker. We rather too nonchalantly rocked up before this group of young people in the Boothroyd Room. They were exceedingly well-rehearsed and well-researched, and were certainly not taking any BS from anybody. I have appeared in front of Select Committees—mostly the Education Committee—on many occasions, but I have to say that this was the most intimidating experience I ever had as a Minister in front of a Select Committee, and it was fantastic. That shows why the work of this Committee, and this, its fourth report, need to be taken seriously.

This Youth Select Committee report is difficult to distinguish, other than by its cover, from a House of Commons Select Committee report, and I congratulate Rhys Hart and his team on their work on it. They did all the things they should have done: they visited experts and sufferers of mental illness, and took no fewer than 148 submissions from expert witnesses and others—if only all the other Select Committees had as many well-informed and well-researched submissions as it did.

The Youth Parliament also has a substantial democratic endorsement. In 2014, when its priorities and the subject of the Youth Select Committee report were decided upon in the “Make Your Mark” ballot—which includes a debate in this House in the Youth Parliament’s annual sitting—no fewer than 875,000 young people from up and down the country bothered to turn out and vote. Of them, more than 90,000 voted specifically for the subject of mental health services, which is why we are debating this report in the Chamber today. That is a huge democratic mandate.

Every year I hold an event in the House of Commons to present democracy awards to schools in West Sussex, including my constituency, that have achieved a high turnout in the elections that are held every February. Each year the turnout gets higher, so more and more trophies have to be given out, and an ever bigger room has to be booked to accommodate everybody. Last year, one school had a 100% turnout—all its pupils turned out to vote for its UKYP members, which is absolutely fantastic.

This report is a chunky piece of evidence that needs to be appreciated, looked at and, importantly, acted upon. I am delighted that we are giving time to it today, and I am also pleased that the Government produced a formal response to it, whatever we may think about the shortcomings of what they said. That was produced jointly by the then Health Minister, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt), and the then Education Minister, my hon. Friend the Member for East Surrey (Mr Gyimah). Neither of them are still in those ministerial posts, but I welcome the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), to her new position. I am sure she has learned the ropes quickly and that she will continue to do so. We need consistency in our approach to mental health, however, and a much more joined-up approach—and not just between education and health, because there are many other aspects as well.

This subject is clearly important to young people, as is this report, so it should be important to the House and the Government. There are many useful lessons that we can learn.

I am also very frustrated, however. I have been in the House for almost 20 years. I have been shadow Minister for mental health, and I was shadow Minister for children and young people for some nine years, as well as Minister for children and young people. I currently chair the all-party group on children and the 1001 group, which is all about perinatal mental health. I have seen mental health Bills come and go, too, and have been involved in them. I saw the 2011 mental health strategy “No health without mental health”, which was a very important statement about the parity of esteem we need to achieve, although we still have not. In 2014, I saw “Closing the gap: priorities for essential change in mental health”, with specific commitments to improve mental healthcare for children and young people. I saw the rolling out of talking therapies and the improving access to psychological therapies programme. In March 2015, as has been mentioned, we had the mental health taskforce, which produced “Future in mind”. I have seen lots of good work in the Department of Health, in particular, such as that done by my right hon. Friend the Member for North East Bedfordshire, and in February this year the mental health taskforce produced the “Five Year Forward View for Mental Health”. There has been a lot of talk about the importance of mental health and the necessity of achieving parity of esteem but, as the hon. Member for West Ham (Lyn Brown) rightly said, there is still a very big disparity. And here we are again: we are still here talking about this, and record numbers of children and young people still have mental health problems.

[Mr Kevan Jones]

Does the hon. Gentleman agree that we can have reports, taskforces and recommendations, but the real problem is that mental health is seen as a Department of Health issue, whereas what we actually need is a completely cross-Government approach so that mental health and wellbeing can be part of every single piece of policy development?

[Tim Loughton]

The hon. Gentleman is right; he pre-empts a couple of my comments. From my experience as a former Minister—and, I am sure, from his—the term “joined-up government” is a complete illusion. Joined-up government does not happen in practice. On becoming a Minister, one is cocooned in a Department, and instead of having a dialogue with colleagues in the Division Lobby or wherever, a huge wall suddenly comes between you. Trying to get interdepartmental action becomes really frustrating.

I remember setting up something called the youth action group, which consisted of Ministers from nine or 10 Departments and representatives of six major children’s charities. It was co-chaired by the Prince’s Trust and Barnardo’s. The charities came to us with problems—often complex ones—affecting young people. One example related to housing benefit and accommodation for children in care. I cannot remember what the specific problem was, but it involved housing, which was the remit of the Department for Communities and Local Government, and benefits, which were the remit of the Department for Work and Pensions, as well as children in care, who came under the remit of the Department for Education. Normally there was a vicious circle that involved people being pushed from pillar to post. Alas, that committee has not met for the past 15 months or so, but our meetings used to consist of at least six actual Ministers—not just civil servants—from the relevant Departments as well as their officials. We would get Ministers together and ask them to go away and solve the problem.

Mental illness falls into that category, in that it is not simply the remit of the Department of Health or the Department for Education. There are many other implications and knock-on effects that can relate to the underlying cause of somebody’s mental illness problems. The hon. Gentleman is absolutely right that the structure of government needs to be much better. We need taskforces that genuinely cut across Government Departments, but in my experience they will flourish only if they have the buy-in and direct engagement of Ministers at the top. One welcome initiative from the hon. Gentleman’s party was the appointment of a Cabinet-level Minister for mental health. I think that that appointment has slightly gone by the wayside now, but the principle behind it was absolutely right, in that it tried to join up all the relevant Departments at the top table.

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[Mr Kevan Jones (North Durham) (Lab)]

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing this debate and thank her for it. I also thank the Backbench Business Committee for allowing time for the House to discuss this issue. May I also put on record my thanks to the British Youth Council, the UK Youth Parliament and the Youth Select Committee for this excellent report? May I also give them another big thank you for allowing us again to talk about mental health on the Floor of the House? People perhaps get a bit sick of me saying this, but I say it again: the way to address some of the stigma is by talking about this more. Talking about this report as we have done today will mean that young people know we are taking this subject seriously.

As I said in an intervention, the report raises issues that cross over into those relating to adult mental health services. As the hon. Member for High Peak (Andrew Bingham) said, the unique thing about the report is that it gives those of us more advanced in years an insight into pressures on young people today that were not there when we were younger and into the challenges for parents and schools in dealing with them. The core of the report is very important, because it deals with a lot of issues that also affect adult mental health services.

I wish to concentrate on two aspects of the report: how young people get access to mental health services; and the vital issue of prevention and being able to address not just mental health, but mental health well-being. As has been said, how people access these services is important. The report talks about mental health services to young people being:

“The Cinderella of Cinderella services”.

Is this about money? Yes, it is, in some cases. My hon. Friend the Member for West Ham (Lyn Brown) eloquently mentioned that we can have all the aspirations in the world, but if the funding is not there locally to provide services, the services will not be there and people will not access them. I agree with the report that this is therefore about more cash, but it is also about how we structure our mental health services in this country.

Page 5 of the report sums it up well. It contains a diagram of a pyramid showing a list of organisations that commission mental health services—schools, local authorities, clinical commissioning groups and NHS England—and calls for a lead commissioner. I totally agree with that, but I would go one step further. When we talk about commissioning services, we need to talk about the treatment pathways and how people get into those systems. Adults trying to navigate the mental health system find that it is like a maze. Not only do they have to find their way through it, but when they get into it they on many occasions find that, as my hon. Friend said, they can wait weeks, months or years to get help—this help is available in some areas but it should be provided more quickly. Early intervention, especially for young people, can prevent problems further down the line.

I sympathise with parents today, because how do they know who to go to if their child has mental health problems? What do they need to ask for? We assume that, somehow, people are well versed not only in issues around mental health, but in how to access help—that is also true for families of adult sufferers. We do need that pathway.

The report quite rightly highlights the issue around GPs and GP training, but, as I have said many times, therein lies the problem. I am not criticising GPs, because there are some very good ones who do help, who are sympathetic and who can access services. I support the recommendation in the report for more training for GPs, but we need a more open system—a system of self-referral—which does not necessarily mean going through a GP.

That brings us to the issue around commissioning and how we provide mental health services in this country. Mental health services very much follow the medical model, but I am not sure whether that needs to be the case. What we need in this country is an open system, which involves the community and voluntary sector. I am suggesting this not because it is a cheap option, but because it is perhaps a better way of providing mental health services. However, those voluntary groups need to be funded, as my hon. Friend the Member for West Ham said. It is no good saying that we are going to pass this work over to some very good voluntary sector organisations and expect them to do it without the funding. Therein lies the problem. I give credit to the former Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), who was a great champion of parity of esteem and of concentrating on how to make the system better. As I said in an intervention on the hon. Member for East Worthing and Shoreham (Tim Loughton), it is no good just looking at mental health in terms of the Department of Health, because the cuts that have taken place in local government are having a direct impact on the provision of mental health services—I am talking about the closure of youth services and voluntary sector organisations that provide mental health services locally. This is a false economy. If we are putting more money into health and taking it out from elsewhere in the system, we will create an ongoing problem.

We also need a fundamental review of CAMHS, as it is a complete failure. I am not for one minute criticising the dedicated individuals who work in that service, because I have met them and know that they work very hard. Given their workload and the way that they get their referrals, they are doing a fantastic job, but the system is broken. We cannot have this situation in which young people are waiting possibly six months for an assessment, and in which families and the individual young person are somehow expected to cope.

[Mark Tami (Alyn and Deeside) (Lab)]

Does my hon. Friend agree that, in some cases, children have to become badly ill before the problem is addressed? The problem should be addressed in the first place so that they do not get into that state.

[Mr Jones]

That is the case, yes. I can say from personal experience that the longer a person leaves the problem undiagnosed or untreated, the worse it gets.

I wish to touch on this idea that parents are, somehow, geniuses and know how to deal with children with mental illness. They do not. I work with Kinship Carers in Durham, which is run by Lyn Boyd, a friend of mine. It deals with grandparents, uncles, aunts and others who often find themselves, later on in life, looking after young people and children. Many of them have quite horrifying stories to tell. They often end up with the children, because of abuse, because the parents cannot cope, or because they want to save them from the care system.

I had a case earlier this year in which a six-year-old was self-harming. When I looked at his background and talked to his grandparents who were looking after him, I could understand why, but the issue is how does he access CAMHS. They were told that he had to wait six months. There we have a couple, who are not the biological parents, looking after a six-year-old. All they can say is, “What do we do?” The child is also disruptive at school. That leads to pressure on the school, which then seeks to exclude him. What happens to the child then? We are talking about not just the trauma, torment and heartache of a six-year-old self-harming, but the knock-on effect on the family and the school.

We do need a new system. It may be a community-based provision. I would certainly like to see open access services—they could be run by well-funded voluntary sector organisations or by the local authorities and councils—where people can go for help or even on occasion just information. Those grandparents, for example, did not have a clue what to do. What does a person do in that situation? The system is certainly failing those individuals. It should not be up to me as a Member of Parliament to contact a mental health trust to enable those people to gain access to services. That is where we are failing.

The problem is not just about ensuring that we have joined-up local services—I have already said that local authority budget cuts are having a direct impact on the working of such services—but the changes in the national health service and GP commissioning, which has made things worse for many voluntary organisations. Contracts are being let for a whole host of services, many of which are too large and too complex. The idea that local community groups can bid for such services does not work because those services are just too big, which means that those groups are being excluded from the money that is available. I am not for one minute saying that anyone who works in the voluntary community sector providing mental health services wants a free ride. Those groups are quite happy to be evaluated. My hon. Friend the Member for West Ham mentioned a project in her constituency that secured lottery funding. That project will certainly have had to ensure that the outcomes were there and that it was accountable. There is no way that many of those small organisations, which in many cases would provide a cheaper and better option for delivering the service, can manage those contracts that are currently being let by the NHS.

The way in which the Government should look at this matter—it is perhaps very difficult in this age of austerity—is that if they deal with it properly, they could save taxpayers’ money. It would save not just the heartache of the individuals who are going through the system, but, if done properly, money as well. On page 9 of the report, the chief medical officer said:

“Early intervention services that provide intensive support for young people experiencing a first psychotic episode can help avoid substantial health and social care costs over 10 years perhaps £15 in costs can be avoided for every £1 invested.”

If the Government really want value for money, this is a way to do it. However, there is a problem, which is that, in this country it is said that we know the cost of everything, but the value of nothing. The investment now in young people will possibly not pay for itself for another 10 or 20 years, but when it does, the payback to society will be quite large, and not just in terms of our having a healthier and happier society.

Another area I would like to touch on, which is covered in the report, is prevention—through the work done in schools and by making sure that we mainstream wellbeing. The hon. Member for East Worthing and Shoreham mentioned the difficulties of Whitehall Government and the silos people are in. We have enough reports on some of these areas now, and we do not need any more; what we need to do now is to hardwire mental wellbeing into all public policy across Whitehall. Can it be done? Yes, it can. I was involved when the last Labour Government mainstreamed veterans policy. Bob Ainsworth, who was the Minister at the time, commissioned a report on veterans. He made sure that the issue was taken forward and that each Department, when it was coming up with public policy, took veterans into account. We need a similar approach to mental health and mental wellbeing. The only way to do that is to have a Cabinet Sub-Committee so that this is dealt with at Cabinet level and the main Departments make sure, when they are coming up with a policy, that they take into account mental health and mental wellbeing.

As I said, early investment saves money, but it also makes for a better society. Another issue where I totally agree with the report is supporting school counsellors. Counsellors could be something of a pressure valve in the system. If they are properly trained, and there is a proper network of them across schools, they could intervene early on and prevent some of these issues. The hon. Gentleman said he was reluctant to make it mandatory for schools to carry out this work, but, as the report says, we have national standards and curricula for physical education, so we should have them for mental health as well.

Again, it is a patchy picture. There is some good work going on in schools across the country, with teachers taking the initiative. In my constituency, Simon Westrip, a lecturer at Northumbria University, has done some work around mindfulness with local community groups, and he is now taking that into secondary schools. If we look at some of the feedback on and evaluation of mindfulness in schools, it is clear that this is not just about the effect on individuals; it actually raises standards in many cases. However, the approach to these issues is patchy, and unless they have dedicated time in the curriculum, or they are something governing bodies need to take into account, people will not do that. Done properly, such work will not only address the pressures that a lot of our young people face now, so that they are happier going through school, but it will save lives and, in some cases, save money in the long term. Is this rocket science? I am not sure it is. We in this country have to change our attitude to mental wellbeing. If we get it right in children, as the report highlights, the payback for this country and its economy in the long term will be tremendous.

Let me finish where I started, by thanking the British Youth Council for its work. I also thank it for giving us another opportunity today to talk about mental health on the Floor of the House.

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[Nicola Blackwood]

It is not fair to say that CCGs are ignoring the funding that is coming through. Moreover, it will not be possible for them to ignore what is going on when transparency and accountability is put in place with data sets that clearly show not only performance down to CCG level but the amount of funding that CCGs are given and the amount they are spending. These data will be much more detailed than before. In January, we introduced the first ever provider-level data set on children’s mental health services, and that will provide data on outcomes, length of treatment, source of referral, and location of appointment.

[Mr Kevan Jones]

The Health and Social Care Act 2012 contained one provision that I welcomed—allowing CCGs and others to commission services in the third sector, for example. A lot of the good work in this area is done in the third sector, but the problem lies in how the contracts are drawn up, because they are either too big or too complex for smaller organisations to bid for. Will the Minister look at that?

[Nicola Blackwood]

I am happy to look at it. We are very clear that there is a vital role for the voluntary sector to play in delivering some of these services. We hope that local transformation plans will be part of the way in which this is clarified. The programme to deliver transparency and accountability will be essential if local areas are not only to design effective services that match the needs of their local populations, but to be held to account for delivering them. I will not beat about the bush. We recognise that a complex and severe set of challenges faces children and young people’s mental health services. This area has been undervalued and underfunded for far too long.

While I am happy to investigate funding formulas such as those mentioned by the hon. Member for Ilford North in relation to Redbridge, I agree with him that leadership and accountability are also key to making the changes that we need. That is why we are committed to delivering real changes across the whole system, not just in funding, and to building on the ambitious vision set out in “Future in mind”. I pay tribute to my predecessors for the work they have done to bring those forward. As the hon. Member for Dulwich and West Norwood has said, we need to go further to drive through these changes, which young people have told us they want to see.

Children want to grow up to be confident and resilient, and they want to be supported to fulfil their goals and ambitions. We are placing an emphasis on building in that resilience, on promoting good mental health and wellbeing, on prevention—it is so important, as the shadow Minister has said—and on early intervention, as a number of the recommendations propose. We are looking, in particular, at how we can do more upstream to prevent mental health problems before they arise.