This week: Sir Norman Lamb, Liberal Democrat MP for North Norfolk
Why he matters: A former care minister in David Cameron’s coalition government, Sir Norman remains very active on a wide range of health issues, particularly mental health. He often works across party lines in an attempt to find solutions.
With his usual air of informality, Norman Lamb recalls an incident that occurred during his years as minister of state for care, a portfolio which included responsibility for mental health.
“[HSJ reporter] Shaun Lintern rang to tell me about a decision on funding for the next financial year which adversely effected mental health. This was a decision by NHS England and Monitor, and no one had actually consulted me.
“I was absolutely incandescent, the comms team were trying to shut me up and I said ‘no, they [NHS England and Monitor] are now independent under the Health and Social Care Act and I’ve got a right to criticise them’. They had taken a decision, at board level, over which they had not consulted the minister affected.
“I made the point: we have legislated for parity of esteem and here is a decision which directly discriminates against mental health – there was no justification for the differential approach.”
Seven years later and the mental health sector’s financial position has certainly improved. The introduction of the investment standard and the sector’s higher profile means that it is now much harder to “disadvantage mental health”, says Sir Norman.
Could this be in part due to Theresa May making mental health one of the “burning injustices” she swore to tackle?
He replies: “I don’t want [to] dismiss the role of the prime minister or current government, because I think it would be completely churlish and unfair to dismiss what she said [about mental health] and what I think was a genuine desire to see change, and a recognition of the failures of the system.
“My challenge would be, you’ve got to will the means as well as the end. It’s no good just saying ‘this is a burning injustice; we’ve got to end it’. You’ve got to drive persistently the means to get to that end.
“I think that’s what’s been lacking, and you need people in government who really can champion this cause with a persistence and passion that sees the job done and that’s what I sometimes get frustrated by.”
When the money wasn’t flowing
Serving during a period of severe financial austerity meant daily effort to keep mental health on the government agenda recalls the former minister.
“Suddenly I found myself in 2012, doing a job I totally cared about in very difficult circumstances, because there was a government who was trying to sort out the [national] deficit, which did need to be sorted out. But I would have loved to have been mental health minister when the money was flowing.
“It felt often like fighting a rearguard action, fighting for mental health, sitting at a Department of Health meeting saying, ‘what about mental health?’ You do need to have that passion and focus week after week.”
He suggests that passion is even more important in the current climate, when the Commons, which would usually go until 10pm, is “running out of business by 7pm” because of Brexit.
Although mental health is enjoying increased attention, the MP warns: “So many important priorities are at risk of getting neglected because of the quagmire. So, I’m desperate to get this [Brexit] resolved, so we can return to the things that so many families desperately need us to resolve.”
Horrible thoughts you can’t escape from
One area he would like concentrated effort on is the quality of children and young people’s mental health services. It is a subject which is of particular personal significance for Sir Norman.
Now outlined as a key priority in the NHS’s long term plan, the former minister pondered how different his own family’s experience would have been had his eldest son Archie received access to mental health support earlier in his childhood.
‘If you think about being a 14-year-old thinking ‘oh my God I could kill my mother’ you start to think you’re an awful person and a bad person, who you can’t talk to anyone aout it’
“I think of our own family situation and our eldest son Archie, [who was] diagnosed with obsessive compulsive disorder at the age of 15. We only really discovered subsequently that probably for two years or so before he finally spoke out about it, he’d been suffering in silence, becoming increasingly worried.
“OCD in its true form is about dark thoughts, really cruel, horrible thoughts you can’t escape from, and it is all completely irrational.
“I’ve got no idea of the dark thoughts that dominated Archie’s mind, but for example it might be a teenager standing in a kitchen holding a knife and thinking I could kill my mother with this knife and how the hell do I stop myself.
“If you think about being a 14-year-old thinking ‘oh my God I could kill my mother’ you start to think you’re an awful person and a bad person, who you can’t talk to anyone about it – you feel trapped.”
“So along with all of the other pressures of growing up you’re petrified by your life completely, and then you do the rituals as a sort of coping mechanism.”
Within the next 10 years NHS England’s long-term plan aims to increase access rates for children and young people to mental health services from 30 per cent to 100. It has since committed to testing a four-week waiting time.
For Sir Norman, who has recently been made chair of online counselling provider Xenzone’s advisory committee, technology is vital to meeting these targets.
“Had Archie had access to support on his phone, where anonymously he could’ve said, ‘I’m really frightened about this what can I do’. I think of the impact that could’ve had on him, the relief it would’ve offered him from this feeling of being completely alone.
“I remember when he said to me ‘why I am the only person whose going mad, Dad?’ That’s quite painful for a parent to hear. But if you’re going through those thoughts you think you are the only person whose going mad.”
He added: “We won’t be able to get the support that children and teenagers need on a timely basis unless we embrace technology. Where on earth are all the traditional clinicians going to come from to get from 30 per cent to 100 per cent? Its unimaginable, so we have to think more creatively about how we meet children and young people’s needs more effectively.”
Just another green paper
It is with frustration that the former minister sees the transformation of children and young people’s mental health has not yet moved on from its planning phase.
“When I was minister, I commissioned a working group on how we need to modernise children’s mental health services which led to Future in Mind, which published in 2015.
“One of my frustrations with government was if only they’d just focussed on implementing Future in Mind, rather than setting about another green paper on children’s mental health, than I think we would’ve made more progress in the last four years than we have done.”
‘There needs to be a profound shift from repairing the damage once it’s done to prevention, but what actually happens in practice is lip service’
At the heart of Future in Mind he explained was the need for NHS, local authorities and education, to plan together, focussing on services which prevent mental ill health.
“Obviously, education has a stake in improving the mental wellbeing of teenagers. We can be much more creative with using money much earlier on with a fusion of education and NHS budgets.”
In what may prove to be one of her last announcements as prime minister Theresa May said prevention would be the “next great revolution in mental health.”
The LibDem MP is sceptical.
“Prevention is fundamentally vital and there needs to be a profound shift from repairing the damage once it’s done to prevention, but what actually happens in practice is lip service.”
To go beyond a lip service for children and young people’s mental health, Sir Norman explains, there will need to be a shift away from reliance on beds.
“The average length of stay in a CAMHs bed is 72 days, that’s over 10 weeks often away from home. If you think about trying to reintegrate that teenage into their school, friend group, every day that goes on makes it more difficult.
“In Australia the average length of stay is 10 days. That’s not to say everything in Australia is right, but it highlights a different approach. We spend an awful lot of the budget on beds and of course the number of beds in CAMHs has just gone up and up and up in the last decade.
“I always remember as a minister going to visit a site in Accrington, and meeting with a guy called Warren Larkin, and he said when you’re addressing the need for beds in children and adolescent mental health services, don’t just address beds because we need to keep children at home [and] out of beds.”
Coming up: NHS VAT campaigner Karin Smyth MP, and public health guru Professor Michael Marmot
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