Building an NHS Fit for the Future

Liz Twist Excerpts

Monday 13th November 2023 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

It is no exaggeration to say that we face an acute crisis in public mental health. Last week, the Government had the opportunity to announce reform of the Mental Health Act and to introduce a rights-based approach that would offer choice, protection and human dignity to people who are sectioned. Their failure to do so is really disappointing. There are many problems with the Act in its current form, from inequalities in the disproportionate use of detentions, to high levels of restraint, particularly experienced by young people, and the removal of patient autonomy. The Act is not fit for purpose and must be changed.

That is why the next Labour Government will reform the legislation, putting an end to the disgraceful detention of people with learning disabilities and autism who do not have other psychiatric disorders. We will remove prisons and police cells as places of safety to ensure that people in crisis are supported in an appropriate setting, and make other reforms to empower mental health patients to have more control over their own care. Reforming the Act was a manifesto commitment for the Conservatives in both 2017 and 2019. Abandoning those critical reforms shows a lack of political will at the heart of Government to tackle the current crisis.

What we desperately need is a much greater focus on prevention of mental ill health. Since the cancellation of the 10-year mental health and wellbeing plan, we have seen little movement towards addressing the social determinants of mental ill health, which should be the business of every Government Department. Public mental health is an asset, and it is vital that the Government see it as such. We need targeted programmes and workplace and community interventions to protect, support and sustain public mental health. I am glad that Labour has committed to providing mental health hubs in every community, which we will pay for by abolishing tax loopholes for private schools and private equity fund managers.

The King’s Speech spoke of “record levels of investment” that are supposedly “transforming” mental health services, which makes me wonder who the Government are talking to. There are an estimated 1.2 million people on NHS waiting lists in England, and the proportion of 17 to 19-year-olds with a probable mental disorder has risen from one in 10 to one in four in the past five years. For organisations I meet through my work on suicide prevention, and for the constituents who come to my door, that is simply not a picture that speaks to their experiences.

Last week I organised a conference in Newcastle on tackling young suicide, coming together with local stakeholders from the NHS, charities, universities and schools across our region. I promised them that I would take their message back to Westminster, and one of their key messages was about funding. Short-term and short-notice grants and funding mean that voluntary and statutory sector organisations are forced to lurch from one insecure position to the next, unable to plan for the future. It is costly and time-consuming for small grassroots organisations to apply properly for those grants, and they feel that the process is too top-down to empower them to fulfil the needs of local communities.

I have worked with many excellent charities in the area of suicide prevention, and one of their key strengths is their ability to be innovative. However, with NHS services struggling, they are carrying large burdens without proper funding or co-ordination from above. The £57 million allocated to local authorities for suicide prevention and bereavement services in 2019 was really important, because it helped to co-ordinate local suicide strategies and local action, but despite the publication of the national suicide prevention strategy, we have seen no reassurance that that money will be renewed or increased in line with inflation. Many of the projects happening at local level have already been forced to end.

Meanwhile, the public health grant has plummeted by around £1 billion on a real-terms, per person basis since 2015. We desperately need the restoration of local suicide prevention funding and a cross-Government, 10-year mental health plan that creates real accountability and incentives for local structures. Many mental health organisations were concerned that the mental health strategy, which was due to be produced this year, was taken into the major conditions strategy. There is much concern about that delay.

It was positive to see in the national suicide prevention strategy the beginnings of a “no wrong door” approach, including training for Department for Work and Pensions staff dealing with distressed callers. I do not want to belittle those efforts, but there is a failure to reckon with the fact that, if people do not have enough money, life is really hard. Polling last year showed that the most common cause of anxiety was not being able to pay the bills. We need the Government to be assessing the impact of all their decisions, not just those being made about the health services. That includes ensuring that essential service providers and creditors have policies and procedures that underpin a compassionate response to customers experiencing financial strain.

I have talked about the need to tackle the mental health crisis, but I also want to talk about adult social care. It was noticeable that there was nothing in the King’s Speech about tackling that very real issue, and it was interesting that it came at a time when the National Audit Office was publishing its report, out last Friday, “Reforming adult social care in England”. It revealed that, of the £1.75 billion committed to reforming the adult social care system in December 2021, more than £1 billion has been diverted to other priorities, meaning that there has been a 58% fall in the budget. We already know that there are significant problems, including long waiting lists and high numbers of staff vacancies, which have increased by 173% over the last decade.

Thousands of people who are medically fit to leave are stuck in hospital beds because the care in the community that they need is not there to support them. It was therefore concerning to read the analysis in the NAO report, which found that the DHSC has not established an overarching programme to co-ordinate its social care reforms, and that six out of eight of its workforce projects are still in development. It also found that the Department does not have a long-term funded plan for transforming adult social care beyond the current spending review period.

Once again, we are seeing sticking-plaster politics and the absence of long-term thinking from this Government. We have serious long-term issues in our mental health and adult social care systems, and we require serious long-term solutions to fix them. After 13 years of failure, the Conservatives are looking to Labour for the ideas to fix the mess that they have made. Come the general election, the country too will be looking to Labour.