My Lords, I support Amendment 101B in the name of the noble Lord, Lord Layard. Before I speak to it, I want to say how much I agree with the sentiment expressed by noble Lords on all Benches that true integration will be achieved only if the Bill is as much about social care as it is about health. It is such a fundamental point that I wanted to underline it.
I see Amendment 101B as an important continuation of our deliberations last week on parity of esteem because “parity of esteem” are simply meaningless
words unless they are reflected in the provision of funding. First, like the noble Baroness, Lady Watkins, I acknowledge the welcome fact that NHS England has met its commitment to ensure that the increase in local funding for mental health is at least in line with the overall increase in the money available to CCGs through the mental health investment standard. It is also welcome that, from 2019-20 onwards, as part of the NHS long-term plan, that standard also includes a further commitment that local funding for mental health will grow by an additional percentage increment to reflect the additional mental health funding being made available to CCGs. I recognise all of that.
But—and it is a big but—the investment standard relates only to CCGs, and that total spending had already declined in 2019-20 compared with 2018-19 as a percentage of total NHSE revenue spend. Also, given the urgent need for healthcare, which, as other noble Lords have said, has been much exacerbated by the pandemic, this amendment would help strengthen the consideration of mental health services when large amounts of money are announced for Covid recovery—this is welcome—but it all falls outside the remit of the mental health investment standard.
We need to know how much of the money is currently going to preventive and community services—prevention is the overarching theme of this group of amendments—as opposed to acute services. We also need to know whether the spending increases we are seeing are simply because crisis services are so in demand; indeed, they are overwhelmed in some cases. We know from a recent survey by the Royal College of Psychiatrists that two-fifths of patients awaiting mental health treatment contact emergency or crisis services, with one in nine ending up in A&E. That is not a sustainable position.
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As I think we all know, the burden of mental illness in the UK far outstrips NHS spend. In our debate last week, I quoted from the King’s Fund. I highlighted the fact that mental ill-health makes up around 23% of the burden of ill health in the UK but receives roughly only 11% of the spend. With that burden outstripping demand, we also know that referrals have been at a peak during the pandemic. Indeed, modelling from the Centre for Mental Health estimates that 10 million people—a very large number—will need either new or additional mental health care as a result of Covid-19.
I am also very concerned about the very great regional variation we see at the moment. I will not quote all the figures, although I have them, but there is huge variation in access to CAMHS services depending on which part of the country you live in. That is also the case for access to IAPT services, which the noble Lord, Lord Layard, talked about, and other mental health services.
Given the chronic underfunding of mental health and the frankly egregiously low historical baseline, there is still far to go for mental health to reach parity with physical health services. The foundations provided by the £500 million Covid-19 recovery funding need to be built on in the coming years to ensure that the long-term planned trajectory is restored, the demand
arising from the pandemic can begin to be addressed, the Mental Health Act reforms, which we have not heard very much about recently, are successfully implemented, and the waiting time targets arising from the clinical review of standards can be introduced effectively.