Health: Mental Health Strategy

Lord Layard Excerpts

Monday 14th February 2011 Lords Chamber

[Lord Layard]

My Lords, I, too, welcome the debate. It is extremely timely, because it is a time of great opportunity for mental health services but also a time of great danger, as many noble Lords have said. I should like to begin with the opportunity. We have here an excellent strategy which provides a better deal for mentally ill people, especially the one in six adults with depression or anxiety disorders and the one in 10 children with mental health problems. If we take those two groups, we are starting from a very poor base where only a quarter of those people are at present in any form of treatment. It is great that the Government are giving that group a major boost through a specific strategy, the Improving Access to Psychological Therapies programme. I must declare an interest as a national adviser to the programme.

In the spending review, the Government have backed the strategy, with £400 million allocated. This must be the first time that specific money for mental health has appeared in the top six priorities for health spending in a spending review. That is wonderful progress. It is also very satisfying that the spending has been extended to include CAMHS, the Child and Adolescent Mental Health Services. Of course, the task is to ensure that the money gets spent to good effect. A key issue here is the role of local commissioners. The NHS operating framework gives clear instructions because, for the first time, improved access to psychological therapy has been made a national rather than a local priority for local commissioners. Again, that is major progress. The framework also requires session-by-session monitoring of outcomes and reporting, so that commissioners can see what they are getting for their money in both access, where there is a clear standard of 15 per cent of the mentally ill population, and in the quality of service, represented by the recovery rate, which is intended to be at least 50 per cent of those treated.

However, it is important that those key performance indicators are made publicly available, because that is the only way in which local commissioners, as well as providers, will be held to account by the public. It is important that commissioners understand that they really have to do something to deliver the key performance indicators. Perhaps the most important thing that they have to do, which was assumed in the calculations for the spending review, is to make sure that providers are employing sufficient qualified therapists—at least 40 for every 250,000 population. We should consider those as some of the most important jobs in the country. It is very exciting that the Government have a training programme in parallel with local service delivery to provide that number of therapists and it is important that the local commissioners then ensure that they are employed. We are starting from a situation where the NICE guidelines for depression and anxiety simply cannot be implemented in at least 40 per cent of the country. But, if the spending settlement is properly implemented, the whole country will be covered by 2013.

This is a major challenge and a real revolution if it can be brought about. It is in everyone’s interest that it is, including the whole of the NHS, because the waste in the current situation is terrible. It is not just a waste of lives and taxpayers’ money: one can show that improved access to psychological therapy will pay for itself twice over as regards the taxpayer. First, it will save more in incapacity benefit and lost taxes than it will cost. Secondly, the programme will save the NHS as much money as it costs.

We have evidence, unfortunately, only from the US, but we also have good evidence from 28 randomised control trials of cognitive behavioural therapy. Data were collected on the cost of the therapy and the subsequent healthcare costs of those treated and of the control group. In 26 of the 28 trials, the savings in subsequent healthcare costs were greater than the cost of the initial therapy, which is a cast-iron case. However, the danger is that we are in a world of cuts. In all previous worlds of cuts, mental health expenditure has been cut more than physical health. The studies that I have quoted show how incredibly short-sighted that would be even in terms of the costs of physical health. It must not be allowed to happen again.

Finally, I want to ask the Minister two simple questions. First, is it government policy that mental health expenditure should be cut by no more than expenditure on physical health? Secondly, if that is their policy, what steps will the Government take to make sure that this is what happens? I think that these are the key questions which lie behind much of what noble Lords have said today. I hope that the noble Earl will be able to help us when he replies.