The NHS Long Term Plan: Lots to welcome, lots to worry about.

On January 31st I spoke in a debate on the NHS Long Term Plan, which was published in January . While I think there is much to welcome in the plan I also express my worries over areas the plan is silent on. You can read my speech in this debate here and watch the debate here.

One area I particularly worry about is whether the NHS will be able to recruit the workforce to deliver the Long Term Plan. For example, we will need to find over 20,000 extra mental health staff in order to achieve the goal that 100% of children with mental health will be able to access treatment over the next decade. This is why I  questioned the government over whether it would fund a “Mental Health” careers campaign aimed at secondary school and University Students to help plug this hole. You can watch me ask this question here and read it in Hansard here.

“However, there is also much to worry about—mainly things about which the plan is silent. The NHS does not operate in isolation, and I am concerned—like many other noble Lords—that many of the laudable aims of the plan are being directly undermined by cuts elsewhere to public health and social care budgets.”

Supporting Action for Children’s Build Sound Minds Campaign

BSM event – Claire Tyler (30-01-19)

On the 31st January 2019, I joined young people and mental health experts from leading charity, Action for Children, to support the parliamentary launch of Build Sound Minds – a campaign to help children and teenagers build good mental and emotional wellbeing.

It is clear that Children’s Mental Health support needs radically improving. According to Action for Children, a third of 15 to 18-year-olds they assessed were found to be suffering from mental health issues. Pupils in need of support have been taking part in the Blues Programme, the first ever UK-wide early help intervention for teenage depression. Given my work on Children and Young People’s Mental Health, I was

Ahead of Children’s Mental Health Week (4-10 February),  I pledged support for the charity’s campaign, which aims to improve children and teenagers’ mental health by providing families with accessible information, tools and tips. To find out more about the campaign, you can visit their website here or follow them on Twitter at @actnforchildren.

 

Battling for Access: Children and Young People’s Mental Health Services

To mark Children’s Mental Health Week, I wanted to reflect on the work I have been doing recently to highlight the battle many young people face to access mental health support.

On the 30th of January, I led a dinner hour debate on the topic of what assessment the Government has made of the recent concerns expressed by general practitioners that children and young people with mental health problems are unable to access National Health Service treatments; and what steps they will take to address them. I arranged this debate following a recent article in the Guardian, which revealed that a staggering 99% of GPs feared that under-18s would come to harm as a direct result of delays in their mental health care. You can read my speech from this debate here or watch it on parliament live here.

I have also been blogging about the worrying delays to children’s mental health treatment in Politics Home and the Lib Dem Voice.

“Seventy years after the creation of the NHS, families should not be forced to pay for the mental health care that their children so desperately need.”

Corporate Parenting Principles Should Apply to Health Commissioners

On the 29th June, I made a speech in the Lords calling for the new corporate parenting principles to apply to commissioners of physical and mental health services for children in care and care leavers.

You can find my speech in full, as well as the rest of the debate here.

I believe that the corporate parenting principles should be extended to health commissioners, reflecting the vital role that these bodies play in shaping the lives and outcomes of children in care and care leavers. As we know, these children are much more likely than their peers to have poor physical, mental and emotional health. To give one example, children in care in England are four times more likely than the average child to have an emotional or mental health problem. That is an issue we will return to in a subsequent group.

Supporting the Mental Health of Children Entering Care

On the 14th of June, I made a speech in the Lords calling for the Children and Social Work Bill to include a statutory mental health assessment for children entering care. I also underlined the importance of recognising the value of social workers to society.

You can read the full text of my speech here.

Current statutory guidance states that children must receive a physical health assessment when entering care, whereas it is recommended that their emotional well-being should be evaluated through a strengths and difficulties questionnaire. Frankly, this is not sufficient or good enough; we need to be aiming higher. Children entering care often exhibit challenging behaviour resulting from their previous experiences—most often, neglect and abuse. Indeed some 45% of children entering care have a diagnosable mental health condition and some 60% are estimated to have emotional or mental health problems of some kind. But the questionnaires I mentioned earlier are completed by foster carers, who may have—it is not their fault—little or no training in mental health. These assessments should be conducted by professionals with specialist knowledge about the therapeutic needs of children in the care system.

Once the needs of a child entering care have been identified, it is also essential that they are offered the appropriate support to enable recovery. A recent survey conducted by the NSPCC highlighted that almost 80% of professionals think that accessing support for children with a diagnosable mental health condition has become harder in the past five years. The NSPCC’s recent analysis of local transformation plans to support the implementation of the Future in Mind report recommendations, in relation specifically to children in care, is not particularly encouraging.

We badly need to develop a holistic approach towards the mental health and well-being of children in care. It is not rocket science; it just needs to be given a far higher priority. A statutory entitlement to a mental assessment would provide the necessary catalyst to action.

The stereotypical and often very negative portrayal of social workers in the press is far from the reality that I encounter in my daily work. I feel that we in this House have a duty to ensure that their value to society is recognised—indeed, the Minister made that point in his opening remarks—and that their professional standing is enhanced. Of course improvements must be made, but this must be done with a clear understanding of the overall context, which other noble Lords have already referred to. It is one of rising demand leading to ever-larger case loads, of falling resources and high turnover, and a workforce who can often feel beleaguered. We ask social workers to do one of the toughest jobs there is; it is incumbent upon us to give them the support and backing they need. The lives of some of the most vulnerable children in our country depend on it.

Let’s Enshrine Access to Mental Healthcare in Law

Last week, I made a speech in the Lords on why we need to enshrine access to mental health in law in the NHS constitution. You can read the full text of my speech here.

In the debate on the gracious Speech I said that equal access to mental healthcare should be enshrined in legislation. At present, apart from a general reference to parity of esteem between mental and physical health in the Health and Social Care Act 2012, the only specific pieces of mental health legislation of which I am aware are the Mental Health Acts 1983 and 2007 and the Mental Capacity Act 2005, and they deal with completely different issues. So while not generally supporting the use of legislation to send policy signals, my sense, backed up by everything I have heard in the debate today, is that legislation in some form or legislative underpinning is needed to achieve the fundamental culture change we need.

One way of achieving this, in my view, would be for waiting times and access standards to be included in the NHS constitution and the handbook to it which the Secretary of State and all NHS bodies are required to take account of. Then people would know that it is an entitlement, not an aspiration or a discretionary matter subject to funding and other priorities. At present, waiting times and access standards are contained only in the NHS mandate, which does not have the same status.