Health and Social Care Committee and Education Committee — House of Commons, 2018-05-10
Topic: Health
Luciana Clare Goldsmith (Berger) (Labour, Centre-left): Mr Deputy Speaker, thank you for allowing me to address the House on behalf of the Health and Social Care Committee and the Education Committee. I am addressing the Select Committees’ report on the Government’s Green Paper on transforming children and young people’s mental health provision, which was published yesterday If I tell the House that the subtitle of our report is "failing a generation", hon. Members will get a sense of our shared disappointment at the scope and scale of the Government’s Green Paper. We welcome the Green Paper but have serious concerns that it lacks ambition, as well as concerns about the very specific measures that it contains. It represents a huge missed opportunity. Every right hon. and hon. Member across the House will know that our mental health services are under enormous strain. There is growing demand that local services are often unable to meet. This is especially apparent when it comes to child and adolescent mental health services, or CAMHS. Our Committees reflect on the fact that half of all mental health conditions occur by the age of 14, and three quarters by the age of 24 Around one in 10 children are living with some form of diagnosable mental health condition, but this figure stems from a prevalence study that was conducted back in 2004, and the results of a repeated study are not due until autumn this year. We heard from Jonathan Marron, the director general of community care at the Department of Health and Social Care, in an evidence session who said that this figure is not expected to go down. This represents hundreds of thousands of children and adolescents who will be affected by mental ill health, but for whom life should be filled with hope, opportunity and promise If ever there was a case for early intervention and, crucially, for preventive measures, it is children’s mental health. The earlier we diagnose and treat a child’s mental health condition when it appears, the better it is for the patient, their family and the NHS. If we leave it until there is a crisis, it is so much worse for those concerned, and costs the NHS and our country far more. So we might have hoped for a raft of preventive measures, tackling the root causes of mental ill health to keep our young people well. Instead, as we report, the Green Paper "fails to consider how to prevent child and adolescent mental ill health in the first place." This is a terrible omission, for if we can tackle the causes of mental ill health in children, we can prevent a lifetime of mental ill health in adults There is a significant evidence base for the importance of the first 1,001 days of a child’s life in their development and wellbeing. The Green Paper itself indicated how early years brain development is a key factor for a child’s future and their mental and physical health. We know that there are key factors that are more likely to give rise to child mental health problems, such as parental mental health problems—especially perinatal mental health—and adverse childhood experiences. They were referenced in the Green Paper, but only in passing. If the Government really want to effect change, they need to adopt a preventive approach and do much more work to address the needs of key vulnerable groups at risk of adverse childhood experiences, and very young children as well What about the scale of the Green Paper? We report that it lacks ambition. The majority of children will not benefit from the Government’s proposals to roll out "trailblazer" pilot schemes to tackle waiting time targets. These schemes will only affect between a fifth and a quarter of the country, and will not come into effect until 2022-23. That means that between three quarters and four fifths of children who need the extra support will simply not get it. We predict that hundreds of thousands of young people will be left without the proper care that they need, even if the Government’s strategy is a success on its own terms. We express concerns that funding is not guaranteed post-2021 and is dependent on an unspecified level of success. This strategy strikes us as being utterly devoid of ambition, negligent of the true level of need and storing up trouble for the future Then there is the question of tackling health inequalities. We heard from many witnesses—in both oral and written evidence—about the correlation between social disadvantage and mental health. The Centre for Mental Health told us that "the Green Paper makes little recognition of the wide inequalities in children’s mental health. At age 11 children from the poorest 20% of households are four times more likely to have a serious mental health difficulty as those in the wealthiest 20%" We asked how the Government’s mental health strategy was integrated in the Government’s other plans to contend with the issue of social mobility, but the Minister for School Standards told us that the two were not linked. Our Committees felt that this was a disappointing response and a massive missed opportunity We highlighted the need for services to be tailored for specific vulnerable groups—for example, looked-after children and children in care. The Green Paper’s current proposals will not deliver the support needed for these groups and will miss out others entirely, including children in the criminal justice system, young people who are not in education or training, excluded children and young people who are in further education or undertaking apprenticeships Further disappointment was visited upon us when we investigated the degree to which the Green Paper embodied joined-up government. Mental health services for children and adolescents is the archetypal area of policy that needs co-ordination across a range of agencies and Departments—from schools to the criminal justice system, and from the NHS to our youth services and social care. We were very disappointed that there was no reference at all to social workers in the Green Paper. We got no sense whatever that this Green Paper intends to break down the barriers, explode the silos and provide person-centred services. Our report states that "there must be effective coordination with other initiatives from across Government when building a new strategy." Beyond these strategic concerns and issues, our Committees had a number of concerns about specific areas of the Green Paper, and I hope that the House will not mind if I outline some of these We looked at the factors affecting children’s mental health, and the fierce system of high-stakes exams was highlighted both by the young people we heard from and educational professionals as a cause of mental ill health. We heard that very much while taking evidence. We reasserted the recommendation of our predecessor Committees that personal, social and health and economic education should be compulsory in all maintained and academy schools to educate young people about wellbeing and to give them a language to discuss their concerns and a space to build resilience We were especially concerned about the transition from child to adult mental health services at the age of 18, which was described to us as a "cliff edge". We recommend that the Government commit to a full assessment of the current transition arrangements between child and adult mental health services. Our Committees looked at the mental health workforce and heard how stretched it already is. We recommend that Health Education England sets out how it will address concerns about the impact of the Green Paper’s proposals on the entire CAMHS workforce, including psychiatrist roles and community services, in its upcoming workforce strategy, which is due to be published in July We were concerned by the lack of detail about the training provided for designated senior leads for mental health in schools and the fact that the roles will be voluntary and unfunded. We recommend that the Government should set out an assessment of the feasibility of providing an additional responsibility payment for teachers who take on the designated senior lead role in schools. Further, we recommend that the Government develop contingency plans to ensure that the role could be delivered by qualified professionals. In those plans, they should also consider whether this should actually be the first course of action, rather than a contingency plan Overall, we were concerned that the health and education workforce may not have the capacity or capability to meet the extra demands of the proposals in the Green Paper. We recommend that the Government set out and publish plans to ensure that the existing workforce are not overburdened by the demands of the Green Paper. We were specifically concerned that the implementation of the four-week waiting time target for CAMHS referrals could have unintended consequences by making the threshold for accessing services even higher, and we recommend that adequate resource is made available to ensure that this does not happen We heard from witnesses that what is needed is a "seismic shift" in the approach to mental health for our young people. We need a system built around prevention, early intervention and personalisation. We need adequate resources and joined-up government to do everything possible to keep our children well and deliver a world- class service. On the evidence of the Green Paper, the Government’s strategy will deliver no more than a minor tremor, not the seismic shift that we want to see. This is a missed opportunity.