Health: Parity of Esteem

Lord Oates Excerpts

Monday 28th November 2016 Lords Chamber

[Lord Oates (LD)]

My Lords, I am grateful to my noble friend Lord Alderdice for initiating the debate. It is obvious that no one on the Government Benches or on this side of the House will argue that there should not be parity between physical and mental health. As my noble friend said, that commitment was put in legislation by this House in 2012. It is enshrined in the NHS mandate and on the lips of politicians of almost every political hue. But it is one thing to will the ends and quite another to will the means. Despite so much debate and so much agreement, we are still a very long way from providing the means to achieve the end we all purport to support.

Of course, it is naive to think that parity of esteem between mental and physical health can be achieved overnight. I am the first to recognise, as my noble friend and the noble Lord, Lord Lansley, made clear, that money alone is not in itself an answer. There are complex issues related to culture, staffing, training, and effective data and reporting systems. Change is needed not just in our health services but in our education services and in the services provided by a wide range of authorities. It is true that money alone will not change things, but it is also true that without the requisite funds, none of the other things that need to happen can or will happen—and all the time they do not, thousands of lives will continue to be lost and millions more will remain hobbled by mental ill health.

It may be that we cannot achieve parity of esteem overnight, but that is no excuse for complacency. Let us never kid ourselves that we have the luxury of time, because every month we delay, every service we fail to provide and every person we fail to treat adequately has an impact that can last a lifetime. So whatever the response from the Minister this evening, I hope it will recognise the desperate, life-threatening urgency of what we are discussing today.

The Mental Health Taskforce’s five-year forward view reported that suicide deaths are rising after many years of decline: 4,882 deaths by suicide were reported in 2014. That is nearly 2,000 more people than were killed in the horrific attacks on America on 9/11—and it is not a one-off event. It is a death toll happening year after year, a tragic waste of the lives of so many precious people and a terrible toll of grief on so many families and friends. Such is the scale of this tragedy that suicide is now the leading cause of death for men aged 15 to 49. The five-year forward view reports that in recent years the rise in suicides among middle-aged men has been particularly acute.

Those who listened to Radio 5 Live’s “Five Live Investigates” programme on eating disorders yesterday morning will also have heard of the terrible inadequacy of treatment in many areas of the country for those suffering from such disorders. They will have heard of the parents in Oxfordshire forced to make an 800-mile round trip to visit their daughter who could be provided with the care she needed only in Glasgow. That is the level of inadequacy we are dealing with. Those of us—and there are many, I know—who have people dear to them who have suffered from such disorders will know the absolute desperation of parents, family and friends when you cannot get the access to services that are so desperately needed. Those listening to that Radio 5 Live programme will also have heard the research carried out by the programme that indicated that there had been a 65% increase in deaths from eating disorders since 2014.

Of course, it is not just the young and middle aged who are suffering from mental ill health. Older people are, too, particularly those in care homes, 40% of whom are affected by depression. We all know how very far we are from achieving parity of esteem and we need to be very clear with ourselves about the very real and often irreversible impacts on people’s lives that our failure represents. Of course, we should not ignore the very important steps forward in recent years in tackling the stigma of mental ill health and in putting parity of esteem firmly on the agenda. I pay tribute to the many people, of all parties and none, who have made such efforts in that regard, not least the noble Lord, Lord Lansley, who mentioned Paul Burstow and Norman Lamb and other Ministers, including Ministers of other parties, who have shown great commitment to this issue.

Like my noble friend, I wonder how much progress we are actually making. The introduction of waiting time standards and the injection of new resources has been welcome, but there are very worrying signs that the extra money is not getting to the front line. The briefing we have received from the King’s Fund shows that 40% of mental health trusts continue to experience year-on-year cuts to their budgets as the demand for their services increases. With 80% of mental health care provided through the trusts, it is hard to see how we will reach parity of esteem with this approach. It is equally hard to understand how we will deliver the quality and choice of provision that are needed.

The British Association for Counselling & Psychotherapy report, Psychological Therapies and Parity of Esteem, cited NICE research that, of all those receiving treatment in the NHS for common mental health disorders, only one in seven receives psychological therapy; the majority are prescribed medication, despite the fact that most patients say they would prefer talking therapy; and there is no requirement on commissioners or providers to deliver the full range of NICE-recommended therapies. Only one in five service users who responded to the BACP survey had been offered a choice of therapy. As Paul Burstow said when Minister for Care Services in 2010:

“At the moment, IAPT is a little too much like Henry Ford’s business philosophy … you can have any therapy as long as it’s CBT”.

Both my noble friend Lord Alderdice and the noble Lord, Lord Lansley, have been clear that we need to look beyond funding and structures to cultural and societal issues. I agree wholeheartedly with the noble Lord, Lord Lansley, that mental and physical health should not be seen as separate things. Nevertheless, we cannot ignore the resourcing issues, so perhaps the Minister might address a couple of questions. First, what are the Government doing to ensure that funding actually gets to the front line? Secondly, what measures are they taking to ensure that we have effective data on what is actually happening in the NHS with regard to mental health? Thirdly, what are the Government doing to ensure that the range of IAPT therapies are available across the country?

Dr Michael Shooter said in his introduction to the BACP report:

“You will not meet your commitment to parity of esteem for mental health without a significant increase in the quantity and quality of the provision of psychological therapies. If you are serious, this is what you must do”.

I hope that we are serious and that the Minister will tell us that that is what the Government will do.