PARLIAMENTARY DEBATE
Mental Health Provision (Children and Young People) Bill - 18 March 2022 (Commons/Commons Chamber)
Debate Detail
It is a privilege to speak on my first ever private Member’s Bill. Let me start by thanking the Royal College of Psychiatrists, which has been working with me on the content of this Bill over the past two years; it was initially an amendment to the NHS Funding Bill, back in January 2020. I also thank Young Minds for its support and input. Together, we are united in wanting to shine a light on children and young people’s mental health services in respect of spending and waiting times up and down the country as part of our collective efforts to improve services.
The Bill would put into statute an annual report to Parliament on the provision of mental health services, with data included on both local spending and waiting times. It would enable young people, their parents and their carers to see clearly and easily the actual investment in children’s and young people’s mental health services in their own areas, and enable them to have a true picture of the waiting times for treatment. Only by having that transparency can we really hold ministers to account for their promises.
The issue of children’s and young people’s mental health is very close to my heart, and I have been campaigning for better investment in services since the moment I was elected. Each week, I hear heartbreaking stories of young people in my constituency unable to access the help they need in a timely manner, and I have been recounting a number of those stories in this place for over two years.
The mental health crisis among children and young people was a problem prior to the pandemic. We all know that it is worse today as a result of the various covid lockdowns, which led to social isolation, anxiety about the future, bereavement and, for some young people, having to live in very challenging conditions, due to either lack of physical space or difficult personal circumstances. In December 2021, the number of children and young people accessing mental health services was 15.7% higher than two years earlier.
With one in six children now having a diagnosable mental health condition, additional investment in services at all levels, from preventive measures in schools and community settings right through to acute and crisis services in the NHS, is urgent. While NHS England spending on children’s mental health has increased over the past four years, in far too many areas the money is not necessarily reaching the frontline, resulting in a postcode lottery in funding across the country.
Figures analysed by the Children’s Commissioner showed that in 2020-21, while spending was approximately £165.20 per child in the Isle of Wight, it was less than a tenth of that in Halton, at only £15.90 per child. Despite a specific commitment to children’s mental health spending growing as a proportion of local NHS spending, in the last financial year, the Morecambe Bay NHS saw a drop of over 15% in child and adolescent mental health services spending, and the Buckinghamshire NHS a drop of 11.6%.
Waiting lists are still wholly unacceptable in far too many areas. Just recently, I was contacted by the mother of a seven-year-old—seven, Mr Deputy Speaker; that is the same age as my own daughter. She is a little girl who should be enjoying school, playdates, parties and playgrounds. Her mother said to me, “She isn’t really living—just existing.” She has been waiting since November 2020 for a CAMHS assessment. That is 16 months.
Back to my story about the seven-year-old. Her mother told me that she is not really living, just existing. She has been waiting since November 2020 for a CAMHS assessment, which is 16 months. Recently, her mother was told that she may need to wait a further year still. Since her initial referral in November 2020 she was also recommended for arts therapy while she waits for assessment, but that has not materialised either, with local service providers suggesting it may come through in the next couple of months. My caseload suggests this case is not unusual, sadly. Quite apart from the anguish and stress for the whole family, the child’s condition often deteriorates while they wait for assessment and they then need more extensive intervention. Even worse, they can end up at the back of the queue for a new assessment because by the time they are seen they are on the wrong track or the wrong tier for the level of support they need. Indeed, a few weeks ago I shared the story of a 15-year-old girl to whom that had happened.
When young people are not seen in a timely manner, often their condition deteriorates and then they have to be re-referred and go to the back of the queue. The data on waiting times from referral to assessment and from assessment to treatment by area are not routinely and easily available. My hon. Friend the Member for Richmond Park (Sarah Olney) and I have had a long-running battle locally to try to access some of that data, because our case loads on children’s mental health are so high.
Every year, the Children’s Commissioner uses her statutory powers to request information from NHS Digital on referrals, waiting times and spending. The waiting times reporting in that analysis uses a proxy measure of two contacts, even though for a variety of reasons that can be misleading. We should not have to rely on the Children’s Commissioner’s requests, which may not always continue, nor should we have to rely on proxy measures.
Additionally, as the Children’s Commissioner makes clear in her report, the data she is able to access and publish, some of which comes from the dashboard that the hon. Member for Rutland and Melton (Alicia Kearns) referred to, is limited to the NHS and does not include the spending or activity in schools and local authorities, even though those services, as we have heard, are an important part of the vast and complex patchwork of mental health provision for our children and young people. We need a holistic picture.
Where the NHS is committed, based on what the Government have asked of it, to increasing its spend on children and young people’s services as a proportion not only of NHS spending, but of mental health spending, the data is not very clear and the quality is not always very good, so we cannot track it at a local level.
My Bill would make the publication of data on the provision of those services a statutory requirement. As such, we could secure a higher quality of data published in a coterminous way across NHS units—currently clinical commissioning groups, but in future integrated care systems—and local authorities by requiring publication on a regional basis. The Bill would also put a specific requirement on Government to publish spending per head on child and adolescent mental health services, as well as the proportion of overall NHS spending and mental health spending on CAMHS by region.
Clause 2 also requests that a statement be included as to whether the expenditure has met the aims of the NHS long-term plan. That is an important requirement to ensure the mental health investment standard is met. The standard is the Government’s tool to ensure CCGs increase how much they spend on mental health every year and, in particular, on children and young people’s mental health. Reporting on that standard has been of variable quality in recent years, with some areas reporting that they met the standard while including one-off, non-recurring pots of money or dementia and learning disability spending, all of which are specifically excluded.
I have no doubt that in her response, the Minister will refer to the Government’s amendment to the Health and Care Bill in the other place that requires the Secretary of State to lay a written ministerial statement setting out the Government’s expectation on mental health spending by NHS England for the year ahead. That amendment also requires integrated care boards to publish details of this spending in their annual reports. That is a very positive step forward; I welcome that amendment, and am glad—having been lobbying for it for the past two years—that we are making progress in the right direction. However, nothing on the face of the new legislation specifies that those reports should refer to children and young people’s mental health services in particular. Children and young people’s mental health services have always been the Cinderella of Cinderella services in our NHS, so I strongly believe they should be named on the face of the Health and Care Bill if the Government will not accept my Bill today.
With the retrospective reporting requirement on spending being in integrated care board annual reports, aggregating and comparing that data locally and regionally will be much more challenging. Furthermore, given the question marks I have already alluded to that have been raised about the quality of financial reporting by local organisations, which is why independent reviews of mental health spending have been commissioned for the past two financial years and this financial year, I have concerns that what is being done in the Health and Care Bill—the report of what has actually been spent—is just subject to annual reports by ICBs. Again, a report to Parliament would strengthen the basis of that data and its quality.
As I have said, some CCGs have been found to be erroneously reporting whether they are meeting the mental health investment standard, and although NHS England and Improvement has demanded explanations, I am not clear that any of those explanations are published anywhere. To me, the fact that the quality of the data remains an ongoing concern strengthens the need to ensure an annual report is made to Parliament with regional breakdowns.
To turn to data on waiting times, clause 3 of my Bill draws on the recent consultation on the mental health clinically-led review of standards. I welcome the broad support demonstrated for the proposed standards and particularly a four-week waiting time standard for access to community children and young people’s mental health services. However, as expressed by the consultation respondents, there needs to be clarity on what the four-week waiting time is for. Is it for assessment, starting treatment or another intervention?
My Bill would require a report to Parliament showing exactly how long children are waiting to access non-urgent treatment by region. That would better reflect the reality for so many young people, parents and carers who are beside themselves, waiting months or even years for an assessment and even more until they commence treatment. The statutory report that I propose would allow Parliament to hold Ministers to account for the appalling waiting times that every Member of Parliament has heard about in their constituency.
I am introducing the Bill because too many children and young people right across the country are in crisis. Unless our children are happy and well, they cannot learn and thrive. Our children are buckling under the pressure. Last year, a year 11 student at a secondary school in my Twickenham constituency took his own life. Teachers and doctors desperately tried to get CAMHS support for him, but he would not engage, so they said that they could not help. To my mind, that is exactly the sort of person they should work intensively to engage with. When I spoke to the school, they told me that they had five more pupils who were identified as high-risk. Staff in schools are overstretched and trying to provide services that they are neither qualified nor equipped to deliver, nor should they have to do so.
Many headteachers tell me that their staff are effectively becoming social workers, trying to support families with their problems outside school and get children to re-engage with schools, as the number of children missing from school has increased since the pandemic. A number of primary schools in my constituency are relying on parental donations to offer therapy and mental health support.
Urgent action and further investment is desperately needed. We should have a trained mental health counsellor in every school, community mental health hubs and additional crisis beds, as has been suggested. We need to track that action and investment properly so that the Government can be held to account. The Bill would be the start of holding Ministers’ feet to the fire on their promises by giving the public, and Members of Parliament as their representatives, the tools to do so. Young people and their parents and carers could ensure that they are no longer short-changed in their own area and see in stark daylight the reality of what is being spent in their area on children and young people’s mental health. We would all have a much clearer idea of just how long those children and young people are languishing on waiting lists.
Through the Bill, we would have a much clearer idea of how long young people are languishing on waiting lists, often with their conditions deteriorating, and sometimes with tragic consequences. Progress is needed now. Our children cannot wait. I commend the Bill to the House.
It is fair to say that some of the most profound experiences that I have had since I was elected in December 2019 are those of helping parents who have had terribly sick children, generally for mental health purposes. It has been so profound to see the extent to which young children who are five, six, seven or eight years old have been in such a desperate place and have had to wait quite some time to get help. I therefore have great sympathy with the hon. Lady’s wanting to bring the Bill to the House for debate.
The Bill very much focuses on the need for more reporting, with the Government to report still further to this House on child mental health statistics. I am afraid that I do not entirely agree with her on that point, and I would like to take the opportunity to explain why. I hope she will not misunderstand me, because I care deeply about this. In Dorset, we have also seen some terrible circumstances. Systemic issues are the core reason why these children have not got the help they have needed; they have fallen down the gaps in provision between the local authority, the education authority and the NHS.
The Government have introduced the extensive Health and Care Bill. I recognise that it does not enjoy the support of the whole House; indeed, I think I am right in saying that the hon. Lady has not supported the Bill so far. However, I think the Government’s intention to change the CCG setup and move towards an integrated care system for all parts of the country, and the steps that they have already taken on that in anticipation of the Health and Care Bill, are the single most important thing that will improve children’s mental health. It is one of the reasons why I am such a keen supporter of my hon. Friend the Minister and her colleagues.
We have to take great care before we put more bureaucracy and cost into the system. It is already far too heavy with bureaucracy, which distracts from core delivery. I looked carefully at the notes that the hon. Lady sent me a few days ago—I thank her very much for doing so—and I have read her Bill. We have to be careful not to change the priorities to finances and money, rather than looking after the individual child. I agree that considerable improvement is needed when it comes to holding to account the relevant organisations in the three groups that I have just mentioned. I have found that quite difficult when I have supported parents who have come to me in desperation for help. She is right to highlight that point, and it is right that the Government hear it. I am sure that it is already well heard, although I am hoping that the Bill may be further strengthened to address it.
In a vast number of cases, young children have had to wait not days, weeks or months but in excess of a year to get the help they need. The hon. Lady is absolutely right to highlight the challenges with CAMHS, and the difficulties that parents often face with getting the assistance that they require.
This debate also gives us the opportunity to highlight some of the difficulties in the NHS in terms of the provision of services. For example, in Dorset, there have been several situations where those in need of care have been unable to access it because The Retreat centre in Dorchester has been closed because of a workforce difficulty.
I was making a point, before the intervention, about the provision of services for young children in Dorset, and I referred to The Retreat, a mental health facility in Dorchester. I also thank and pay tribute to those at St Ann’s Hospital in Poole who look after many children who have great difficulties.
I will bring my remarks to a close by saying that the hon. Member for Twickenham has brought a very important debate to the Floor of the House. While I do not agree with her on all of her points, I thank her for her tireless campaigning. Even if we do not agree about all the Bill’s components, by bringing the Bill to the House of Commons she has enabled us to have a debate that has caused a great deal of interest, as we can tell by the number of interventions that those of us who have spoken have taken. It is an important issue, and I am delighted that the Ministers are on the Front Bench to hear the debate. Having discussed the subject with the Minister, I know she understands fully the difficulties that we face, and I look forward to seeing if there are learning points that the Government can take from the debate to further improve the Bill.
We in Her Majesty’s Opposition are always happy to support legislation that improves transparency and makes it easier to hold the Government to account on children and young people’s mental health. It is shame that we do not have more time to get this Bill beyond today’s stage—I fear there are more speakers than time allotted, but I hope the hon. Lady, or another hon. Member, brings forward this Bill again in another Session. It is absolutely crucial that we tackle the real problems with children’s and adolescents’ mental health. I and the Opposition support this Bill, but it is saddening that we do not have time to take to the next stage today.
As we know, waiting lists in the UK for CAMHS range from one to two and a half years, depending on where people live. The fact that our children are waiting so long for a consultation is pretty immoral. The key point for me is that GPs cannot prescribe medication or any form of mitigation for symptoms of attention deficit disorder or obsessive compulsive disorder without a diagnosis from CAMHS, so the two-and-a-half year waiting list for CAMHS impacts families across the UK.
However, in my view three factors weaken the argument of the hon. Member for Twickenham (Munira Wilson). First, the Government are providing £2.3 billion a year to expand NHS mental health provision. Such provision is currently provided for 345,000 children, and that will expand. Secondly, £79 million has been invested in children’s mental health services in 2021-22. Thirdly, the NHS mental health dashboard marks progress against the delivery of the five-year plan.
Crucially, the special educational needs and disabilities review is inbound. As somebody who takes a keen interest in this subject and who has been through this myself over many years, I am waiting for the SEND review to come out. The point I want to make in these last few seconds is that the Government need to be on notice if, ultimately, we do not deliver the improvement to the services we need, if we do not shorten the waiting lists for CAMHS, if we do not invest more money in CAMHS and reprioritise across the NHS, and if we do not give these children and their families the solace they desperately need. The Bill has huge merit and I urge the hon. Lady to keep going with it.
Ordered, That the debate be resumed on Friday 6 May.
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