Ministers’ question time

In its summer 2009 issue, One in Four invited readers to put their questions on any issues around mental health to the care services minister, Phil Hope MP, and the shadow health minister, Anne Milton MP. We chose the five best questions and over the summer parliamentary recess the two politicians worked on their answers. We had to edit the responses to fit the available space in the magazine, but we publish here the full replies from Phil Hope MP and Anne Milton MP.

Q.1 Young people should not have to be admitted to adult mental health wards. What are you doing to prevent mental health trusts from carrying out this practice? (Colette Turner)

Phil Hope: Like you, we don’t want young people in this situation. We committed that, by the end of 2008, no one under 16 years old would be treated on an adult psychiatric ward.

We also put a provision in the Mental Health Act which will mean that by April 2010, hospital managers have a duty to ensure that patients aged under 18 are treated in an environment in hospital which is suitable for their age, subject to their needs.

The bed day figures for under 16s on adult psychiatric wards was zero at the end of 2008. The latest figures (January-March 2009) for bed days for under 18-year-olds on adult psychiatric wards in England show three instances of under 16-year-olds having been treated on adult psychiatric wards, each for one day only.

It is unacceptable for young people to be in this situation and those areas where these latest cases have arisen are taking action to prevent this happening again.

We are working to improve services for children and young people with mental health problems everywhere. Spending on child and adolescent mental health services has increased by over 60% in three years to £508 million and we have set up a national advisory council to champion improvements in services and hold the government to account on progress. One of the priorities for the council and the government is to address the transition from child to adult services so that all young people, whatever their age, get the mental health support they need.

Anne Milton: It is vital that tailored mental health services are available for those under 18. Children and young adults with mental health problems have very different needs and often require very different treatment to adults and consequently mental health trusts must cater for this.

Q2. How will you prevent people falling through the gaps in care should they chose to move? All too often it seems as though health authorities and social service departments squabble over who’ll foot the bill. (Jo Phillips)

Phil Hope: It sounds like you are speaking from experience, which must be very frustrating. We have taken action to help prevent this. The main guide the NHS uses to govern services each year is called the Operating Framework and in this year’s version we’ve put an obligation on PCTs to come together with local authorities and carers and others to agree funding plans for health and social care. This means it should be clear to everyone which services are funded where.

We also have an agreement which local authorities have signed up to, called ‘Putting People First’. It encourages local authorities to have a single community-based support system focussed on the health and wellbeing of the local population, bringing together primary care, social care, and wider advice on things like housing, benefits and employment advice.

We’re also consulting on clearer guidance for local councils to help them apply eligibility criteria for social care in a way that’s fairer, more consistent and more transparent. You can contribute to this consultation here.

We know we’re not where we want to be across all of the country yet – but all this will help bring us closer. And in the long term, our green paper on care and support aims to redesign the whole system of social care so it’s fairer too. You can have your say on the future of care and support in our consultation on the Green Paper ‘Shaping the Future of Care Together’ at attend one of our regional events around the country.

Anne Milton: Having talked to many people who have been through the mental health system I have been struck by how variable services are.

Some people have fantastic experiences throughout with coordinated and tailored services but for many service delivery is very variable in quality and quantity. Then there are striking, albeit rare cases, where the lack of appropriate care ends with tragic consequences. Commissioning is one of the keys to improvements.

Commissioning must be led by the needs of service users and we need much more expertise in this field. I am sure the third sector has a key role to play in commissioning. Of course form-filling and bureaucracy all take their toll on front line staff who need to be free to focus on care but we need to be clearer about what services will meet the needs of the clients.

Q3. Voluntary sector organisations have a problem competing with state sector organisations to secure work providing services to support people with mental health difficulties because they lack continuous funding and are not on an equal playing field. How would you encourage more voluntary sector organisations to help? (Phil Ruthven)

Phil Hope: We want the third sector to be able to thrive in delivering health services and reforming them.

Involving service users and third sector bodies at the planning stage of the commissioning process is critical to success, because then it becomes obvious that third sector bodies are often well placed to provide the kind of responsive services people really want.

Through the operating framework, we’ve encouraged PCTs to enter into three year agreements with local partners including the third sector to deliver health and well-being for people.

We’re also supporting the Third Sector in other ways. We set up the Social Enterprise Investment Fund of £100million to invest and support social enterprises in the health and social care sectors. It helps new social enterprises start up and existing ones grow and improve their services. The Fund is open for applications until 2011.

Anne Milton: We need to embrace third sector organisations who have considerable expertise in providing mental health services and leading on service developments. Often they are best placed to deliver services, and if that is the case we must make sure that the commissioning process acknowledges and acts on that.

Q4. I am really excited about the prospect of self-directed support as I believe it could transform my life. However, it seems that every area in the country is doing its own thing and we are going to end up with some councils offering really good services and others a watered-down version. We are seeing a service emerging that is very different to the one thegovernment envisaged. What will the government be doing to ensure that everyone in the country can get access to the same support?   (Kaarina Elisabeth)

Phil Hope: We’ve invested an extra £520million to transform social care and help councils offer self directed support, but we are in the second year of a 3-year programme rolling this out, so we know there is still more work to do.

The department of health is working with local government and the third sector to support councils in transforming their services to make them more personal. Jeff Jerome from the Association of Directors of Adult Social Services (ADASS) has been appointed to lead this work within local government.

A lot of effort is going in to showing councils what good support should look like. We are developing resources and tools that share good practice and advice, and we are making that information widely available through regional networks, events and websites. The progress being made by councils is also being monitored by the Care Quality Commission.

In May this year, the ADASS reported that nearly 93,000 people had benefited from a personal budget. This was above our expectations for the first year of the programme but we will work with councils to make sure progress continues.

Anne Milton: I think that for many self-directed, support can and will be a crucial component of their care, and I think all political parties now acknowledge this.

I am a strong supporter of personal budgets. We need to celebrate the successes in self-directed care and if we measure the outcomes then the success will speak for itself and good practice will spread.

A Conservative Government would make sure that personal budgets are rolled out across the UK and make sure that the right drivers are in place to get high quality services. A focus on outcomes, patient reported outcomes in particular, will drive up the standard of services available.

Q5. How do you think the voice of the service user or client can be most effectively heard when defining our own health and social care needs? What do you think are the main barriers to people with severe and/or ongoing mental health conditions being accepted and respected, how can these be overcome, and how will we know when things have improved? (Kay Sheldon)

Phil Hope: I think that getting involved with self-directed support is a great way for service users to make their voices heard, because they are in control of their own care, so they define what their needs are.

We are helping councils understand how they can properly involve people who use services and their carers. This is essential in providing good, safe support that is tailored to people’s needs.

We are also supporting local user-led organisations that are run and controlled by disabled people so they can provide vital information, advice, peer support and advocacy to other disabled people.

The Department of Health also has a range of stakeholder groups that involve members from service user representative organisations and they regularly feedback their views and opinions on Department of Health policies.

I think that stigma and discrimination are still a very significant barrier to the acceptance of people with mental health problems. We need to do a lot of things to overcome this – not just the government but the public and others too. The Disability Discrimination Act now gives legal protection to people with mental health problems from discrimination, for instance by employers.

We have also set up a body called Shift which is working with employers to improve how they handle mental health problems in the workplace and with the media to improve how it represents on mental illness. Plus, the charity sector campaign Time to Change is running an advertising and marketing campaign to challenge public perceptions about mental illness.

We do measure change, for example in our annual Attitudes to Mental Illness survey, which tracks whether public attitudes are improving or not. Shift is also funding a survey tracking whether people are experiencing less stigma and discrimination. But I think the true measure of change won’t come from surveys but from people’s everyday lives. For example, when someone can go to a job interview and admit to a mental health problem without fear, that’s when we will have won the battle. There’s some way to go yet.

Tackling stigma is a major theme in New Horizons – our new strategy for mental health for 2010 and beyond. You can tell us what you think of it at

Anne Milton: The main barrier to people with severe and ongoing mental health conditions is sadly still the stigma associated with it.

Campaigns such as ‘Time to Change’ are good steps in the right direction, however combating mental health stigma will be tough, and unfortunately, will take time. The media have a crucial role to play as do television and other media. But politicians can make a difference too.

Talking about mental health, the difficulties people face and how many people it affects all go to relieve the stigma and so the barriers back to recovery.

We also need work and benefits policies that recognise the difficulties people may have and cater for those difficulties, and we need to educate and incentivise employers to recognise the importance of promoting the well being of their staff.

We need strong advocates, probably from the third sector so that the voice of service users is heard in an NHS where there are many competing priorities. Many charities and organisations already do this but we need to amplify that voice.

This article first appeared in the Autumn 2009 edition of One in Four magazine

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