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The Royal College of Psychiatrists Improving the lives of people with mental illness

Monthly Parliament Update 2015-2016

Month in Parliament: November to December 2016

Long-Term Lords

A committee in the House of Lords has been trying to tackle the big question of how we can ensure that the NHS survives in the long-term, in an environment of increasing demands and costs. This week they were scrutinising the long-term future of mental health services. Professor Sir Simon Wessely appeared on a panel with Claire Murdoch, Director, NHS National Mental Health and Sophie Corlett, Director of External Relations, Mind.

The meeting started off with two contradictory views on funding for mental health services with Sophie from MIND saying that mental health funding has been cut and Claire Murdoch saying that the newly published CCG ‘dashboards’ show that funding has gone up by 8.6%. Some of the other key points from the meeting were:

  • Claire Murdoch said that the she will not be deciding on whether to sign off Sustainability and Transformation Plans but her team will be looking through all of them and helping to develop those that are lacking in mental health provision.
  • In response to some sceptical questioning Simon Wessely told the Committee about the strength of evidence on the effectiveness of mental health treatments. RCPsych has agreed to submit a paper to the committee outlining the scientific evidence.
  • Claire Murdoch said that she has stopped using the phrase parity of esteem when talking about mental health. This caused some concern in the Committee, as present in the room was Lord Patel, one of the Peers who tabled the amendment to put the phrase parity of esteem into legislation in the first place.
  • The Committee also discussed the issue of not enough medical trainees going on to become psychiatrists. At least four of the committee were surgeons, which led to an interesting discussion about whether other medical professions were guilty of putting trainees off a career in psychiatry.

The Committee closed with each panellist giving their views on what the one thing was that the NHS could do to improve services for people with mental health conditions. Sophie from MIND asked for more money for mental health, Claire Murdoch from the NHS asked for greater transparency while Simon asked for better integration between physical and mental health care.

Dr Peter Aitken in Parliament

Dr Peter Aitken, Chair of the Liaison Faculty, appeared before the MPs of the Health Select Committee to discuss our recommendations for improving suicide prevention programmes. He appeared on a panel alongside Sophie Corlett, Director of External Relations from Mind and Dr Liz England from the Royal College of General Practitioners.

Peter started out by saying that suicide prevention was the area where the views of people with direct experience had most shaped his view. He told the Committee that 8 out of 10 people who almost died from suicide regretted attempting to take their own lives. He also talked about a growing sense of unease amongst the psychiatric community that people were being forced out of acute care too soon with too little support in the community. He also talked about his experience of psychiatrists trying to detain a patient under Section 2 of the Mental Health Act, but finding that there were not any beds available for the patient to go to.

Peter also raised the link between addiction and suicide. He described how various difficulties came about due to the way that drugs and alcohol were treated separately from mental health issues, meaning that responsible agencies struggled to take a joined-up approach. He also raised with the Committee the link between suicide and problem gambling.

His evidence has already been picked up by Tracy Crouch, the Minister with responsibility for Gambling who responded to an oral question by Andrew Selous MP saying that she had read Peter’s evidence and has subsequently raised the issue with GambleAware.

MPs demand answers from their CCGs

In November, the College published analysis of the NHSE Mental Health Five Year Forward View Dashboard, revealing that some Clinical Commissioning Groups (CCGs) have planned to spend as little as £2 per head on child and adolescent mental health services for the 2016/17 financial year.

Securing coverage in national newspapers including The Guardian and The Times, we approached MPs whose CCGs had the lowest CAMHS spend, encouraging them to engage with their local media and CCGs to demand answers about allocation for children and young people’s mental health. Labour Joan Ryan MP wrote to Enfield CCG urging it to ensure the ‘mental health of young people…is given the priority it deserves’, whilst Labour Rushanara Ali MP for Tower Hamlets branded the planned £4.45 per head spend by her CCG ‘a disgrace’. Helen Hayes MP for Dulwich and West Norwood said that our research showed that now was the time for Ministers to take action.

With a handful of CCGs refuting the figures published by the College, it has now emerged there were issues with how some CCGs originally reported their total spending on child and adolescent mental health to NHS England. We hope other MPs will encourage their CCGs to come forward with revised data in the interests of transparency so we are able to see a proper picture of mental health spending in England.

Debating what really matters in children’s mental health

Baroness Tyler of Enfield called attention in the House of Lords to the Report of the Values-Based Child and Adolescent Mental Health System Commission (of which the Royal College of Psychiatrists was a member) What Really Matters in Children and Young People’s Mental Health, published on 7 November. She asked the Government what their response to the report was, calling particular attention to its recommendation that mental health services be better integrated into schools as she sought to impress upon them the pivotal role of education in the general wellbeing of children. The response from The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) was positive and he was particularly sympathetic to the role of education.

The debate steered to mental health services more broadly as Lord Hunt of Kings Heath expressed his concerns that mental health was peripheral in the design of STPs, Lord Bishop of Carlisle spoke about the inability of teachers to educate their pupils on the importance of mental health when they themselves were feeling the mental health ramifications of work, The Earl of Listowe implored the Government to account homeless children in the design of mental health services and Lord Patel of Bradford asked what was being done to address the overrepresentation of those from the BME community amongst those suffering from mental ill health.

Government agree to pilot new ways to assess the mental health of children in care

The Royal College of Psychiatrists has been briefing members of the House of Lords, as part of the Children in Care Alliance, on the need to ensure that all children in care get a decent mental health assessment. Our concerns are based on evidence that children in care are four times more likely than their peers to have a mental health difficulty and 45% of children entering care have a diagnosable mental health condition including 72% for children entering residential care.

During the debate of the Children and Social Work Bill in the House of Lords the Government responded to pressure to agree that they needed to address this issue. They are now proposing to set up new pilots to improve the way that children in care are given health assessment to improve how they consider a child’s mental health.

Justice Committee

The Justice Select Committee has published the written evidence given by the College for the Committee’s ongoing enquiry into Prison Reform. The evidence shows how the treatment of prisoners with mental health conditions in the penal system is inadequate. The evidence seeks to persuade the Committee that prisons must do more to show a commitment to improving mental health services. This should be done by committing to meet the standards set out in the Royal College of Psychiatrists' Quality Network for Prison Mental Health Services and the Enabling Environment Award Scheme. Moreover, when developing their plans for prison reform, the Government must take on board the recommendations from the review carried out by NICE on the mental health of adults in the Criminal Justice System.

The importance of prison officers is also emphasised. The evidence cites the dramatic decline in prison officers as a contributing problem to the increase in prevalence of problems, so it asks that this be reversed so that there are more staff to help with prisoner wellbeing. It also recommends that any move to give prison governors more control over the commissioning of mental health services needs to be carefully balanced with considerations of what additional support they will need in order to manage a complex system, and in addition how we can make sure we don’t lose the great improvements the NHS has made over the last ten years in commissioning mental health services in.

No more money – the health light Autumn Statement

Philip Hammond delivered his first Autumn Statement on Wednesday as Chancellor of the Exchequer. Despite calls from Jon Ashworth earlier in the week for the Statement to address the current underfunding and future sustainability of the NHS, it was a health-light statement with no additional funding announced for the NHS or social care.

Instead, the Chancellor reiterated the Government’s commitment to provide a real terms funding increase of £10bn by 2020, echoing Theresa May in the earlier PMQs. Jeremy Hunt’s announcement of 1,500 additional medical training places each year from 2018-19 was also reiterated. In preparation for leaving the EU, an extra £2bn of funding each year for science by 2020 was announced.

The Government will transfer the budget for the Work and Health Programme to London and Greater Manchester. Figures have suggested the Government will not raise a beer duty.

The Opposition hit back, noting the councils who were under pressure from rising social care costs, with many elderly people trapped in their homes because of a lack of funding. John McDonnell said that this is the first time since 1948 that spending per head had declined, predicting a care crisis this Winter. Labour presented a united sense of disbelief, with Jeremy Corbyn, Barbara Keeley and Jon Ashworth all shocked that no funding had been allocated to deal with the social care crisis.

 

Month in Parliament: June to July 2016

Impact of Brexit on mental health policy

As the dust settles after the EU referendum things are getting a bit clearer but there is still a lot we do not yet know. For example we do not know what will happen with EU negotiations of freedom of movement and what that would mean about the employment of medical professionals from the EU. The House of Commons Library Service has however published a very useful paper on the issue.

It is however looking increasingly unlikely that there will be an additional £350 million more per week for the NHS. During the campaign the Leave campaign slogan said “Let’s give the NHS the £350 million the EU takes from us every week”. All of the main politicians have now to some extent distanced themselves from this statement. Simon Stevens the Chief Executive of NHS England has however said it will be ‘exhibit A’ when he makes the case that the NHS needs more money.

Brexit also led to exodus of many of the politicians working on mental health policy. On the Labour side Heidi Alexander the Shadow Secretary of State for Health and Luciana Berger the Shadow Cabinet Minister for Mental Health both resigned as part of the Shadow Cabinet attempt to convince Jeremy Corbyn to step down. Diane Abbott has taken over as Shadow Secretary of State for Health and has said that a new Shadow Cabinet Minister for Mental Health will be appointed after the Labour Leadership election.

On the Conservative side there has been of course change at the very top of Government. The new Prime Minister, Theresa May, has already shown her commitment to improving mental health care saying that it is a burning injustice that someone with mental health problems may struggle to access services Alistair Burt the Minister with responsibility for mental health has also stepped down. The Secretary of State has now personally taken on responsibility for mental health. The other Health Ministers are:

  • Philip Dunne – Minister of State for Health: responsible for hospital care, NHS performance and operations, NHS workforce, patient safety and maternity care.
  • Nicola Blackwood – Parliamentary Under Secretary of State for Public Health & Innovation: responsible for public health, health protection, innovation and data & security.
  • David Mowat – Parliamentary Under Secretary of State for Community Health & Care: responsible for adult social care, carers, cancer, dementia, learning disabilities, all elements of primary care – including dentistry and pharmacy, 7 day services and overseeing Allied Health Professionals.
  • Lord Prior of Brampton – Parliamentary Under Secretary of State for Health: responsible for NHS and DH finance including, spending review, NHS financial performance, CCG allocations, budgets for arm's length bodies, NHS England including, overall commissioning policy and clinical commissioning groups, NHS Mandate and NHS Outcomes Framework, NHS operations and performance, ambulance services, elective and emergency, NHS 111, urgent care, winter planning, NHS Estates and facilities, Life sciences.
All Party Parliamentary Group on Mental Health Session on Children’s mental health

Dr Peter Hindley Chair of the CAMHS faculty and Dr Jon Goldin Chair of the Westminster Parliamentary Committee appeared at a roundtable in Parliament on children’s mental health. They described how 1 in 10, 5-16 year olds have a mental disorder, but only about 25% receive any help and that annual short-term costs associated with childhood mental health problems are £1.58 billion, and the long-term costs £2.35 billion.

There was a strong turnout for the event with eight Parliamentarians joining the discussion along with a great range of stakeholders including Anne Longfield the Children’s Commissioner, Sarah Brenan Chief Executive of Young Minds, Tony Draper a head teacher and a number of young people who were able to talk about their own experiences.

The group discussed how important it was to keep pressure on the new Government to keep children’s mental health high on the agenda.

All Party Parliamentary Group on complex needs

Dr Tony Rao represented RCPsych at an event in Parliament looking at complex health needs for older adults. Despite some early problems with the room booking and some of the guests being told the event had been cancelled, it ended up as a successful event.

Dr Rao told the Parliamentarians that there had been an 87% rise in the number of admissions for mental and behavioural problems associated with alcohol in 60-75 age group over past 10 years.

  1. He described that addressing dual diagnosis will need to centre around the following 4 areas:
  2. Housing (Social care and the Third Sector)
  3. Specialist care (long term care and residential rehabilitation)
  4. Integrated care (interface between Addictions/Old Age psychiatry/Geriatrics/Primary care)
  5. Complex needs (alcohol related brain damage, illicit drugs and opiate containing prescribed medication)

More evidence and action points around policy, service delivery, public health, treatment interventions and training can be found in the RCPsych publication Invisible Addicts.

Policing and Crime Bill Second Reading in the Lords

The Lords had their first chance to debate the Policing and Crime Bill. The Labour Shadow Home Affairs Spokesman Lord Rosser raised concerns that banning inappropriate places of safety alone will not solve the problem a lack of beds and alternative places of safety. He asked the Government for a firm commitment that there will be a commissioning strategy in the NHS that ensures that alternative places of safety are available for people in mental health crisis.

This was supported by the Liberal Democrat Spokespeople Lord Paddick and Baroness Harris of Richmond who specifically referenced concerns raised by the Royal College of Psychiatrists in its briefing to parliamentarians ahead of the debate. Baroness Harris said that the Liberal Democrat Peers will be looking to place amendments to later stages of the Bill to ensure better access to mental health services.

The Lord Bishop of Southwark spoke to back a policy change being pushed by a group of children’s charities for all victims of child sexual exploitation and abuse to receive an automatic referral to their local child and adolescent mental health service when they disclose their abuse.

Baroness Howe said that she will be pushing to change the Bill so that people detained waiting for the completion of a mental health assessment have access to an appropriate adult. She also called for the clock that measures how long someone can be held for a mental health assessment to start when they are first detained and not when they reach the place of safety.

Lord Hayes asked the Government if there will be enough health based places of safety to take people and if they will be able to take people with mental health conditions who are under the influence of drugs and alcohol.

Baroness Hamwee referenced an earlier amendment by Norman Lamb on the banning of the use of tasers in mental health hospitals.

Responding for the Government on these points was Lord Keen of Elie, who said that the Government have announced additional funding for the NHS of up to £15 million to invest in additional health-based places of safety. He added that the Bill increases the flexibility for local areas and clinical commissioning groups to explore innovative options to create additional places of safety to try to ensure that police cells are resorted to in only the most exceptional cases. He also rejected the proposal to change when the clock starts on the suggested 24 hour time limit of someone being held while they wait for an assessment but did not give a specific reason.

 

Month in Parliament: April to May 2016

Queen’s Speech

There were not many surprises for the College in this year's Queen's speech.

  • The new Bills which are most likely to be of interest to the College and our members:
    Bill of Rights
    The Government are going to consult on introducing a British Bill of Rights. It is still pretty hard to see what this is going to mean in practice. The College has set out our concerns about reforming Human Rights law because of the impact it might have on people with mental health conditions.
    NHS (Overseas Visitors’ Charging) Bill
    The Bill will mean that visitors and migrants will be charged for more NHS services and fewer people coming to the UK from the European Economic Area will be entitled to free NHS services. It is unclear what impact this will have on the provision of psychiatric services.
    Prison and Courts Reform Bill
    In the speech itself the Queen specifically said that action will be taken to ensure better mental health provision for people in the criminal justice system. The Bill is going to create Reform Prisons which will be similar to academy schools giving the governors more control over education, training, healthcare and security for prisoners. It would also require prison to produce statistics on areas such as prisoner education, reoffending and employment on release. It is unclear what else they are planning to do around the provision of better mental health for people in the justice system and it will probably be worth engaging with the Government to see what we can influence.
  • Carrying over from the last Parliament:
    Policing and Crime Bill
    We will continue to lobby on this Bill. Amongst other things we are calling on the Government to ensure there are adequate mental health provisions to help people in crisis so they are not held in police cells or delayed for long periods of time.
  • Non legislative announcements:
    Seven Day NHS
    The Government recommitted to their manifesto pledge for a seven day NHS and described a bit more of what this will mean in practice. The main points are that people will be able to see a GP in the evenings and on weekends, patients who need urgent or emergency hospital care will have access to the same level of consultant assessment, diagnostic tests, review and treatment seven days a week.
    This means, for example, they will be seen by consultant no more than 14 hours after arrival at hospital and have seven day availability of diagnostic tests with a one hour turnaround for the most critically ill patients and that the NHS111, the NHS non-emergency number, will become an integrated and more personalised urgent care service – the “front door” to advice, assessment and treatment.
    It is worth noting that the document published on the goals of the seven day NHS made no mention of ‘excess mortality’ or the ‘weekend effect’.
Parliamentary meeting on supporting people with mental health conditions back to work

The All Party Parliamentary Group on mental health held the second of their roundtables in Parliament on implementing the recommendations of the Mental Health Taskforce. This one focused on how to support people with mental health conditions get back to work.

The meeting was chaired by James Morris MP, with Baroness Hollins, Heidi Allen MP and Kevan Jones MP amongst the attendees.

Dr Charlotte Harrison represented RCPsych at the meeting. She described her experience of how the current system lets down many of her patients and the importance of moving towards an IPS based model which supports people with mental health within the workplace. This view was supported by Andy Bell from the Centre for Mental Health who outlined both the economic case for IPS and how it would help patients.

Parliamentary meeting on drug dependency

Professor Allan Young chair of the RCPsych Psychopharmacology Committee spoke to a meeting in Parliament organised by the All Party Parliamentary Group on drug dependency. He was asked to respond to a presentation by the American journalist Robert Whitaker which put forward a theory that an increase in the prescription of antidepressants has led to an increase in people with mental health conditions.

Professor Young described how psychiatrists have to look at what is best for each individual patient based on clear guidance from NICE guidelines. These guidelines are based on an exhaustive analysis of the available data. He also pointed to evidence comparing different Swiss Cantons which showed how antidepressants have reduced suicide rates and that they can serve an important purpose for many people with depression; dismissing them completely is “throwing the baby out with the bathwater”.

Oral Health Question on mental health funding

In Health oral questions Shadow Mental Health Minister Luciana Berger asked why new research by NHS Providers had found that half of mental health trusts had not seen an increase in funding in 2015-16 and only a quarter were confident they would see an increase for 2016-17. She suggested that the Government’s commitment to properly support mental health was not being met.

Responding, Community and Social Care Minister Alistair Burt said the Government was working to ensure that CCGs passed on additional funding to mental health services, and argued that the report she cited vindicated the Government’s approach.

 

Month in Parliament: March to April 2016

Junior doctors contract dispute debated in Parliament

On the day before the first all out junior doctors strike the debate in Parliament showed how politically divisive the dispute has become. The Labour, SNP and Liberal Democrat MPs used the debate to call on Jeremy Hunt to pilot the introduction of the contract so that it can be independently assessed on what impact it had on safety and moral of the workforce. Heidi Alexander the Labour Shadow Secretary of State for Health stated that the cross party plan had the backing of a number of Royal Medical Colleges.

In response the Secretary of State stated that the Labour plan was opportunistic and the first he heard about it was in the press. He reaffirmed that he was going to introducing the contract, claiming he needed to introduce the manifesto commitment to introduce a 7 day NHS. He said that it is going to already be introduced slowly with only 11% of junior doctors are going on to the new contract in August. He blamed the BMA for not engaging with the review being led by Sue Bailey Chair of the Academy of Royal Colleges and quoted, the president of the Royal College of Surgeons who said on the Today Programme that she would not strike herself in the situation.

A number of Conservative MPs spoke in support of Jeremy Hunt telling him not to give in to the BMA including some who called on the Government to change the law so that doctors in emergency specialities were banned from striking.

MPs debate the Mental Health Taskforce Report

This month MPs debated the Mental Health Taskforce Report where a number of MPs spoke about some of the issues raised by the College in our briefing.

Speaking for the Opposition, Shadow Mental Health Minister Luciana Berger raised concern that the £1bn came from the £8bn set aside for the NHS up to 2020 and would not meet the taskforce’s recommendations. Given that mental health was ten per cent of the NHS budget already, she said, ten per cent of the additional funding would already have gone to NHS in the normal state of affairs.

She specifically raised concerns about the proportion of funding given to CAMHS, and asked for a response to the suggestion that the funding could be ring-fenced. While welcoming the rule that CCGs must increase the amount of their budget that they allocate to mental health at a rate that is at least in line with the general growth in their budget, she suggested that there would be no way to enforce this, echoing the College’s concerns over accountability of CCGs.

The former health minister Norman Lamb highlighted the College’s concerns that there needed to be a clear implementation plan for the report’s recommendations and cited the Acute Psychiatric Care Commission report challenging the Government on how quickly will they end the practice of out-of-area placements.

The Conservative MP Rehman Chisti also cited the College and raised our concerns that were currently no proper accountability for local CCGs.

Responding to the debate, Community and Social Care Minister Alistair Burt discussed the recommendations the Government were implementing. In response to Norman Lamb’s comment, Alistair stated he would push for an implementation plan/report to be published by the end of summer detailing how the recommendations would be implemented. This would include a website where people can see what is being done and stated that there would be constant reference back to the taskforce’s work.

With regards to out-of-area placements, the Minister said the Government would act on this by 2021. He wished to take action sooner but was not able to do so because of the time it would require. Discussing funding, he said that the commitment for £1bn of extra funding the taskforce asked for was “very important and believed it will make a significant difference”.

Health Select Committee publishes report on Primary Care

The Health Select Committee has published their report this week on Primary Care. On launching the report, the Chair of the Committee, Sarah Wollaston said “the priority for the government should be the workforce and to make sure that we train, develop and retain the multidisciplinary teams as well as the facilities and technology they will need to provide the best care for patients”.

The College submitted evidence to the Committee showing how joined up working between primary care and mental health services can offer efficient and cost effective interventions. In response regarding mental health the Committee endorse the Primary Care Workforce Commission that “practices or groups of practices should have access to a named consultant psychiatrist and to a named mental health worker or community psychiatric nurse”.

 

Month in Parliament: February to March 2016

New Bill to change law on crisis mental health

A new Bill has been introduced which is going to amend the Mental Health Act. The Bill is going to ban holding children in police cells while they wait for mental health assessments and only ever use them in extreme circumstances for adults. It will also limit the amount of time people can be held anywhere waiting for an assessment.

RCPsych has briefed MPs that simply banning slow assessments and inappropriate places of safety is not going to ensure that there are good services available to take their place. To ensure that the changes in this Bill can be implemented on the ground we believe that the Bill should be amended to include:

  • A provision for the Secretary of State for Health to report to Parliament a detailed assessment of what provisions each local area has to support people in mental health crises and ensure they don’t end up in police cells.
  • A new right for patients to access acute psychiatric care beds within four hours in the same way that they can acute beds for psychical health conditions.

  • Introduce statutory guidance so that Clinical Commissioning Groups and NHS England need to take account of the Mental Health Act to bring them into line with local authorities. 

We were also asked to give evidence Dr Julie Chalmers Specialist Advisor to the Royal College of Psychiatrists for Mental Health Law highlighted the College’s concerns to the amendments of the Mental Health Act 1983, in her evidence session with the Public Bill Committee.

Health Committee meeting on the impact of the Comprehensive Spending Review (CSR) on health and social care

MPs on the Health Select Committee heard evidence from NHS Providers, NHS Clinical Commissioners and the Royal National Orthopaedic Hospital Trust. Opening the session, Committee Chair Sarah Wollaston enquired what the root causes of the deficits in the sector were. The responses included agency staff costs following the Francis inquiry, demands of an ageing population and the rising cost of litigation.

The discussion included the implications of the Spending Review and mental health services. The NHS Providers Chief Executive, Chris Hopson, said he fully endorsed the findings of the Mental Health Taskforce but raised concerns that there was not enough funding to fully deliver all of the report’s recommendations.

Julie Wood, Chief Executive of NHS Clinical Commissioners, added that figures seen from NHS England suggested that the vast majority of CCGs had increased the level of investment in mental health.

Government wins ping pong with Lords

The Government has won a battle of wills with the House of Lords to push through their plans to cut £30 a week from the amount people in the Work Related Activity Group on the disability benefit ESA. First the Lords voted down the cut only for the MPs to reinstate it.

Once again Lord Low introduced an amendment which would prevent the cut from happening until the Government had made a report to Parliament on what impact it would have on disabled people. However, despite opposition from at least one Conservative MP, the Government overturned Lord Low’s amendment. The Government has now declared that this part of the Bill is a financial measure which means that the Lords can no longer make changes to it.

 

Month in Parliament: January to February 2016

Launch of the Acute Psychiatric Care Commission report

On 9th February Lord Crisp held an event in Parliament to launch the Commission’s report. Speaking at the launch were James Morris MP chair of the mental health APPG giving the political perspective, Jacqui Dyer giving the perspective of a service user and Launce Mynors-Wallis representing psychiatrists and the College.

The report proposed twelve recommendations to address the problems that currently mean over 500 mentally ill people have to travel over 50km to be admitted into hospital every month. These include:

  • The introduction by October 2017 of a maximum waiting time of four hours for admission to an acute psychiatric ward for adults or acceptance for home based treatment following assessment.
  • Phasing out nationally the practice of sending acutely ill patients long distances for non-specialist treatment by October 2017.

A full copy of the report can be found here

Parliamentary meeting on triage in mental health services

The All Party Parliamentary Groups on Suicide Prevention and Mental Health held a joint session to hear from Dr Colgate, a psychiatrist from Bridgend, about a mental health triage system operating in South Wales. The event was well attended by Parliamentarians including the Department of Health Minister Alistair Burt and the Shadow Minister for Mental Health Luciana Berger.

Dr Colgate described how his team ran a triage system to identify which patients needed emergency mental health referrals and which could be seen over a longer timescale.  He said that in his experience it has led to significant improvements in the efficiency of the service and can also help demonstrate to commissioners the value of investing in more services.

MPs debate junior doctors’ contract

Jeremy Hunt Secretary of State announced this week to the Commons that he was imposing a new contract on junior doctors. He described the contract as “safer for patients and fair and reasonable for junior doctors”.

He was challenged by the Labour MP Mike Kane who quoted from the Royal College of Psychiatrist statement on the contract imposition which said that “the decision will exacerbate the recruitment and retention issues that the NHS currently faces”. The Secretary of State responded by saying that the new contracts include a premium to attract more people to psychiatry.

The full RCPsych statement on the junior doctors’ contract can be found here.

Health Select Committee publishes RCPsych evidence on impact of spending review on health and social care

This week the Health Select Committee published the written evidence we sent them on the impact of the spending review on health and social care. Our evidence spelt out how increased funding for mental health care will lead to fewer lives impacted by illness, fewer families existing rather than living, fewer constraints on the care provided.

We did however express concerns that there is still a lot to do as there is a long way to go until we reach true parity of esteem with a real need to roll out the commitment for additional access and waiting time standards. We pointed out the big impact that cuts in public health and social care will have on mental health care.

Welfare Reform and Work Bill

The Government suffered a heavy defeat in the Lords on their proposals to cut £30 a week from people in the Work Related Activity Group on Employment Support Allowance.

During the debate on the Welfare Reform and Work Bill the crossbench Peer Baroness Meacher raised concerns from the Royal College of Psychiatrists that the majority of people affected by this cut will suffer from mental health problems. She questioned the Government’s logic that cutting support to these people will incentivise them into work. She said that from her experience “faced with severe financial hardship, people with psychiatric and psychological problems will find it extremely difficult to function at all”.

In response to the points raised by Baroness Meacher, the Minister Lord Freud said that the Government is investing £43 million over three years to trial ways to provide support for people with mental health conditions and an OECD report found that higher benefit could sometimes act as a disincentive for people to find work. (He did however admit that this report did not specifically look at benefits for people with disabilities).

Now that the Government has been defeated in the Lords they will have to decide if they are going to use the weight of their majority in the Commons to reintroduce the cut or accept the Lords amendment.

 

Month in Parliament: December 2015 to January 2016

Prime Minister speech tackling the mental health taboo

In an attempt to break the mental health taboo, The Prime Minister gave a speech on life chances and spoke about tackling mental illness by being open about it. In his speech he set out the reasons why he thinks it is important to tackle mental health problems:

  • He believes that some people with mental health problems today are almost guaranteed to live a life in poverty.
  • One in 5 new mothers develop a mental health problem around the time of the birth of their child.
  • Up to one in 4 of us will have a problem – perhaps a form of depression or anxiety – this year alone.
  • Suicide has become the leading cause of death for men under 50.
  • Mental illness isn’t contagious; there’s nothing to be frightened of.

Outside of the rhetoric he made the following commitments:

  • Invest £230 million so that at least 30,000 more women each year will have access to evidence-based, specialist mental health care during or after pregnancy.
  • An extra £250 million to deliver Core 24/7 psychiatric liaison services in 50% of A&E departments, and to ensure that all A&E departments have at least some liaison psychiatry provision even if it is not 24/7.
  • £400 million for crisis home resolution teams to deliver 24/7 treatment in communities and homes as a safe and effective alternative to hospitals.
  • Deliver a guarantee that more than half of patients with psychosis – the most serious cases – will be treated within 2 weeks.
  • More help for teenagers suffering from eating disorders like anorexia.

Dr Ananta Dave gives evidence to education committee

Dr Dave, a member of the RCPsych Child and Adolescent Faculty appeared before the Education Select Committee to give evidence on the issue of mental health provisions for children in care. She stressed to the Committee that while some areas had good services to help this particularly vulnerable group, the coverage was very patchy.

The Committee discussed whether the rules should change so it is mandated that all CAMHS should run from age 0-25. Dr Dave agreed with other experts on the panel that while age 0-25 services can be very good it should not be mandated nationally. Another area of discussion was the value of Strengths and Difficulties Questionnaires (SDQ). Dr Dave said that SDQs can be a valuable tool but should not just be used for data collection but also for helping to determine individual support.

Access to Medical Treatments (Innovation) Bill

Following a number of meetings and briefings with MPs the RCPsych has welcomed the new amendments tabled to the Access to Medical Treatments (Innovation) Bill which removed plans to change the law around medical negligence.

RCPsych was concerned that this Bill (often referred to as the Saatchi Bill as it was similar to an earlier Bill tabled by Lord Saatchi) was going to be potentially dangerous to patients and harm real innovation. We are pleased that now the Bill will focus on the sharing of data and the awareness of innovative treatments and off-label use. We will continue to engage with the policy to ensure it takes account of our members’ medical expertise.

Transparency day or Taking out the trash day

Thursday 17 December was the last day before Parliament broke up for Christmas when they have to publish all the documents and statements they need to get out before the end of the year. This is sometimes known as the ‘taking out the trash day’ (from an episode of the TV programme the West Wing) as it is a good day to bury bad news with newspapers only able to cover one or two bad stories at a time. The Cabinet Office, however, prefers to call it transparency day.

In total the Government released 424 documents on a wide variety of subjects so unsurprisingly some are of interest to the RCPsych. Fortunately not all are bad news being released by cynical spin doctors - there were also some good news stories being buried in the avalanche of reports.

Some of the reports that are of the most interest to us are:

Of less importance to us but always interesting to be nosy if you would like to know how much Jeremy Hunt’s special advisers get paid you can find out here or how much senior staff at NHS England are paid you can find out here.

 

Month in Parliament: November and December 2015

Debate in Mental Health

The House of Commons was packed for a debate on mental health. It was a debate secured by the Labour Party but had speakers from all sides of the political spectrum, talking about the importance of mental health. In her opening speech Luciana Berger the Shadow Cabinet Minister for Mental Health called on the Government to do more to tackle the crisis in a shortage of psychiatrists saying that there was a “94% increase in vacant and unfilled consultant posts”.

Other interesting contributions by MPs included.

  • Debbie Abrahams the Labour lead on disability raising the RCPsych concerns about the impact on people with mental health of the plans to cut £30 a week from those in the Work Related Activity Group on Employment and Support Allowance.
  • Dr Lisa Cameron praised the SafeSpot project set up by Dr Fiona Mitchell a specialist registrar in child and adolescent psychiatry. SafeSpot is an application, website and school intervention to promote positive coping skills, safety planning and access to information about mental health services for young people.
  • Simon Danczuk raised the evidence in our briefing that the money given to councils for public health will fall by 3.9%, year on year; that will be an 18% fall by the end of this Parliament.
  • A number of MPs including Helen Whately and Robin Walker said how important it was for hospitals to have a comprehensive psychiatric liaison service.
  • Rachael Maskell called for an independent inquiry into the closure of Bootham Park Hospital.
  • John Howels quoted how the Royal College of Psychiatrists statement that the additional £600 million for mental health was ‘good news’.
  • Kate Osamor said how despite only 26% of Lambeth’s population being black, 70% of the borough’s residents in secure psychiatric settings are of African or Caribbean origin and called for a comprehensive investment in mental health that takes racial differences into account.
  • Barbara Keeley quoted figures from The Royal College of Psychiatrists that we estimate that 85% of older people with depression receive no help at all from the NHS. She went on to say “The Government are letting older people down by reducing their access to the services they need.”
  • Rehman Chishti was able to raise the issues in both his private members bills saying “local commissioning group spending should reflect commitments made at a national level on parity of esteem” and that mothers should be able to get support with mental health crisis within a reasonable distance from home—75 miles.
  • James Morris the chair of the Mental Health APPG called on the Government to put more investment into research into mental health.

In response to the debate, the Health and Social Care Minister, Alistair Burt said that his ambition was for the UK to be recognised as providing the world’s best mental health services. He also added that he recognised the importance of parity of esteem being clearly referred to in the NHS Mandate so committed that when the final version of the new mandate is published in March it will have a clear reference to parity of esteem.

 

Lords debate cuts to disability benefits

Lord Freud rejected attempts to water down the Government’s plans to cut £30 from the benefits of people in the WRAG of ESA. Lord Low and Baroness Grey-Thomson raised the findings of the recent Inquiry into ESA they chaired. This report found that cutting people’s benefits would actually make it harder to go to work. One example quoted was a claimant who said that if they had their benefits cut “I would have to cancel my phone and my internet which would make it really hard to contact people in my life who support me such as my social worker, parents and doctor”.

 

MPs debate premature births and maternal mental health

Chris Heaton Harris hosted a debate in Parliament on premature births highlighting the work of the charity Bliss. He said how a report by Bliss showed that 41% of neonatal units have no access to a trained mental health worker. He added that “It is not just parents who need trained mental health workers available to them; the staff also need them to help them cope in such situations”.

MP Steve Reed brought up a campaign based in his constituency of Croydon called The Smallest Things set in 2014 by a couple whose lives were turned upside down because of the needs of their children and the fact that they did not feel that they were adequately prepared or supported to provide the care and love that their children needed. He said “There is a huge risk of depression for mothers of premature babies that arises from the anxiety and stress that they experience in having a child who has to struggle for their life for such a long period in their very early and very formative years” and added that if their issues are not identified early enough it can cause long term problems.

Victoria Prentice also quoted Bliss “40% of mothers of premature babies are affected by postnatal depression soon after birth, compared with 5% to 10% of mothers generally”. She said that more should be given counselling and all of them whose baby die. She therefore called on the Government to accept Rehman Chishti’s private members bill.

The Minister Ben Gummer highlighted that although the medical care is fantastic, the support for parents is inadequate. On perinatal mental health provision he said that “The services, as provided, are not sufficiently good and we need to do much to improve them” he said that is why the Government has committed an extra £75 million for perinatal mental health.

 

Debate on out of area mental health services

Norman Lamb MP held a debate in Parliament this month on an issue he has long been passionate about. He said it would be inconceivable that someone with a stroke or heart attack would be told that there were no beds in their local area and that they had to travel hundreds of miles to get treatment, but that it happened all the time for people with mental health problems.

A fair number of MPs contributed to the debate with Kevin Foster MP raises the example of a patient in his constituency had to be moved to Maidenhead because there were no beds in Torquay at the same time someone in Maidenhead was placed in Torquay because they were told there were no beds in Maidenhead. Henry Bellingham MP raised the link between suicide and being placed out of area.

The Minister Alistair Burt said that he intends to put in place a national ambition to address out-of-area treatments and that he will first consider the recommendations in I will The Crisp Commission and the Mental Health Taskforce report. He said he will communicate details of this ambition by the end of March 2016—that is, by the start of the next financial year.

 

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