Yesterday the Health Committee met with the Secretary of State, Jeremy Hunt. I watched the broadcast and made comments on the Facebook page about my initial impressions. Here you will find a summary of the items related to mental health. It is not intended to be a word for word account but I have attempted to keep the context of the questions and responses. There are a few links in this piece to documents of interest.
To start, below are the members of the committee:
Health Committee
Dr Sarah Wollaston was elected as Chair of the Health Committee on Wednesday 12 July 2017.
The remaining members of the Committee were formally appointed on Monday 11 September 2017.
| Member | Party |
|---|---|
| Dr Sarah Wollaston (Chair) | Conservative |
| Luciana Berger | Labour (Co-op) |
| Mr Ben Bradshaw | Labour |
| Dr Lisa Cameron | Scottish National Party |
| Rosie Cooper | Labour |
| Dr Caroline Johnson | Conservative |
| Diana Johnson | Labour |
| Johnny Mercer | Conservative |
| Andrew Selous | Conservative |
| Maggie Throup | Conservative |
| Dr Paul Williams | Labour |
Overall I found it to be an interesting and constructive meeting. I sensed a few areas where Jeremy Hunt seemed uncomfortable and defensive, but I generally got quite a good impression of him.
To help with some of the acronyms used:
JH = Jeremy Hunt
CQC = Care Quality Commission
CCG = Clinical Commissioning Group
NICE = National Institute for Health and Care Excellence
The mental health questions start about an hour into the video:
Questions from Luciana Berger
Q According to NHS Workforce statistics there are 5,168 fewer Mental Health nurses and 106 more doctors. In a recent interview JH quoted 4,000 more people.
Response
There are 4,300 more people working in NHS Trusts than 2010 and 2,700 people in Talking Therapies
Q Who are these people?
Response
There is a whole range of skill sets involved in an NHS Mental Health Trust. The reduction of nursing staff is a consequence of the Francis inquiry into Mid Staffs. Nurses were put in to hospitals which had a direct impact on mental health nursing. But the NHS are treating 120,000 more people every year than 3 years ago which equals 1,400 more every day. There has also been an expansion in therapies.
{Later on in the meeting the Chair requested details about the extra mental health staff and the talking therapies}
Q Why are we seeing an increase in children and adults presenting at A&E in mental health crisis. There is a 47% increase in people being detained under the Mental Health Act
Response
Professor Sir Simon Wessely has been asked to review the Mental Health Act, how it works and whether it needs to be changed. {A copy of the details of the independent review can be found here.}
The Health and Social Care Act 2012 legislation regarding Parity of Esteem between physical and mental health requires that a mental health crisis is dealt with as seriously and quickly as that of a physical health crisis. The NHS are rolling out crisis care including liaison psychiatry across the country. Currently half of the total A&E departments have mental health liaison services. This is part of the Core 24 Standards.
Q Why are so many people are turning up to A&E in crisis who are often having to be detained, instead of being dealt with prior to this through prevention or community services
Response
There is a core responsibility to deal with both crisis and prevention. Resources are being put in to place to deal with preventing crisis
Q CQC reports have highlighted many issues at all stages of accessing mental health care. In regard to resources JH has been quoted as saying that there has been an increase in resources by spending over half a billion pounds more on mental health this year. Why is it that many trusts, including Liverpool, are cutting mental health services
Response
Mental health spending is up 1.4 billion in the last 3 years. Last year out of 209 CCGs 177 spent their mental health target and 32 did not. There are discussions going on with those that did not. The overall impact was that an extra half a billion pounds was spent last year.
Q Money comes in to the trust but there is nothing to hold them to account to make sure it reaches the front line. There is not a requirement for every CCG to meet the required investment.
Response
Last years CCG funding went up. There are ongoing discussions to sort out issues. There has been overall expansions but there are still problems.
Q Locked mental health rehabilitation wards. There are 3,500 patients across the country in 248 wards. The majority are in private hospitals. The CQC report has questioned this model of care
Response
There is a concern about people being locked away in expensive high dependency settings for longer than necessary. If they are far from home they may be forgotten about. JH has had a meeting with officials who are coming up with a recommendation. As an example of good practice, JH quoted that Sheffield have eliminated their dependency on locked rehabilitation by providing better community care.
Questions from Dr Lisa Cameron
QÂ Pathway of care from child to adult services. The transition is often fragmented and difficult to streamline. Are you making progress?
Response
This is an area we need to improve. We have a children and young people mental health Green Paper coming out.
Q Access to psychological therapies. How are you monitoring time logged as being access to treatment?
Response
The target is for treatment to start within 18 weeks. This has just started to be measured. Demand is increasing and there is also the implementation of the Mental Health Forward View.
Q Target monitoring and parity of definition
Response
JH will write a detailed response
Q Mental Health in older adults. In the transition from health to social care it is important that psychological issues are addressed. Especially around depression and loneliness in older adults,
Response
This is an important issue which is not always given the importance it deserves. 40% of older people in care homes suffer from depression or anxiety compared to 20% of the older population as a whole. Sometimes mental health needs are clouded by physical health needs. The NHS are planning an expansion in the capacity of psychological therapies in order to meet these needs.
Questions from Dr Paul Williams
Q Waiting times for Autism diagnosis in children. NICE guidelines state that a multi agency assessment of a child with suspected Autism should start within 3 months. In some parts of the country families are waiting for up to 4 years. Will you consider a Waiting Time Target for Autism assessment. Diagnosis requires health services to work in partnership with Local Authorities. What can be done.
Response
We need to do better. JH will look in to this and will discuss the issues with the NHS
Follow up question from Dr Lisa Cameron
Q Do you have a map of how many clinicians are trained to diagnose autism and where there are gaps?
Response
JH will find out
The next item to be shown on Parliament TV that I am interested in is on 3 November 2017 when the second reading of the Mental Health Units (Use of Force) Bill will be presented in the House of Commons.
A video link will be available on our Facebook page from 9.25 am.
CMHS UK - Challenging Mental Health Services UK 