Mental health and NHS performance

Jeremy Hunt, Secretary of State for Health, talks about mental health service improvements and maintaining NHS performance standards.

With permission Mr. Speaker, I would like to make a statement on mental health and NHS performance.

This government is committed to a shared society in which public services work to the highest standards for everyone. This includes plans announced this morning by the Prime Minister on mental health.

I am proud that, under this government, 1,400 more people are accessing mental health services every day compared to 2010 and we are investing more in mental health than ever before, with plans for 1 million more people with mental health conditions to access services by 2020. But we recognise that there is more to do so as will proceed with plans to further improve mental health provision including:

• formally accepting the recommendations of the Independent Taskforce on Mental Health which will see mental health spend increase by £1 billion a year by the end of the parliament
• a green paper on children and young people’s mental health to be published before the end of the year
• enabling every secondary school to train someone in mental health first aid
• a new partnership with employers to support mental health in the workplace
• up to £15 million extra invested in places of safety for those in crisis following the highly successful start to this programme in the last parliament
• an ambitious expansion of digital mental health provision
• an updated and more comprehensive suicide prevention strategy

Further details of these plans are contained in the written ministerial statement laid in the House this morning.

However turning to winter, as our most precious public service, the NHS has been under sustained pressure for a number of years. In just 6 years the number of people over 80 has risen by 340,000 and life expectancy has risen by 12 months. As a result, demand is unprecedented: the Tuesday after Christmas was the busiest day in the history of the NHS and some hospitals are reporting that A&E attendances are up to 30% higher compared to last year. I therefore want to set out how we intend to protect the service through an extremely challenging period and sustain it for the future.

First Mr. Speaker, I would like to pay tribute to staff on the frontline. 1.3 million NHS staff, alongside another 1.4 million in the social care system, do an incredible job which is frankly humbling for all of us in this House. An estimated 150,000 medical staff, and many more non-medical staff, worked on Christmas Day and New Year’s Day. They have never worked harder to keep patients safe and the whole country is in their debt.

With respect to this winter, the NHS has made more extensive preparations than ever before. We started the run up to the winter period with over 1,600 more doctors and 3,000 more nurses than just a year ago, bringing the total increase since 2010 to 11,400 more doctors and 11,200 more hospital nurses. The NHS allocated £400m to local health systems for winter preparedness; it nationally assured the winter plans of every trust; it launched the largest ever flu vaccination programme, with over 13 million people already vaccinated; and it also bolstered support outside A&Es with 12,000 additional GP sessions offered over the festive period.

The result has been that this winter has already seen days where A&Es have treated a record number of people within 4 hours, and there have been fewer serious incidents declared than many expected. As Chris Hopson, head of NHS Providers said, although there have been serious problems at some trusts, the system as a whole is doing slightly better than last year.

However there are indeed a number of trusts when the situation has been extremely fragile. All of last week’s A&E diverts happened at 19 trusts, of which 4 are in special measures. The most recent statistics showed that nearly three-quarters of trolley waits occurred in just 2 trusts. In Worcestershire in particular there have been a number of unacceptably long trolley waits and 2 deaths whilst patients were in A&E. We are also aware of ongoing problems in North Midlands with extremely high numbers of 12 hour trolley waits.

Nationally the NHS has taken urgent action to support these trusts, including working intensively with leadership and brokering conversations with social care partners to generate a joined up approach across systems of concern.

As of this weekend, there are some signs that pressure is easing both in the most distressed trusts and across the system. However, with further cold weather on the way this weekend, a spike in respiratory infections and a rise in flu there will be further challenges ahead.

So NHS England and NHS Improvement will also consider a series of further measures which may be taken in particularly distressed systems on a temporary basis at the discretion of the local clinical leaders. These may include:

• temporarily releasing time for GPs to support urgent care work
• clinically triaging non-urgent calls to the ambulance service for residents of nursing and residential home before they are taken to hospital
• continuing to suspend elective care, including, where appropriate, suspension of non-urgent outpatient appointments
• working with the CQC on rapid re-inspection where this has the potential to re-open community health and social care bed capacity
• working with community trusts and community nursing teams to speed up discharge

Taken together these actions will give the NHS the flexibility to take further measures as and when appropriate at a local level.

However, looking to the future, it is clear we need to have an honest discussion with the public about the purpose of A&E departments. There is nowhere outside the UK that commits to all patients that we will sort out any urgent health need within 4 hours. Only 4 other countries, New Zealand, Sweden, Australia and Canada, have similar national standards which are generally less stringent than ours.

This government is committed to maintaining and delivering that vital 4 hour commitment to patients. But since it was announced in 2000, nearly 9 million more people are using our A&Es, up to 30% of whom NHS England estimate do not need to be there, and the tide is continuing to rise.

So if we are going to protect the 4 hour standard, we need to be clear it is a promise to sort out all urgent health problems within 4 hours, but not all health problems however minor. As Professor Keith Willett, NHS England’s Medical Director for Acute Care, has said, no country in the world has a standard for all health problems, however small, and – if we are to protect services for the most vulnerable – nor can we. So NHS England and NHS Improvement will continue to explore ways to ensure that at least some of the patients who do not need to be in A&Es can be given good alternative options, building on progress underway with the streaming policy in the NHS England A&E plan. This way we will be able to improve the patient experience for those with more minor conditions who are currently not seen within 4 hours as well as protect the 4 hour promise for those who actually need it. In the meantime, when it comes to NHS provision more broadly, we will not let up on our commitment to a shared society in which public services work to the highest standards for everyone. This includes plans announced by the Prime Minister this morning on mental health.

Mr Speaker, taken together what I have announced today are plans to support the NHS in a difficult period, but also plans for a government that is ambitious for our NHS, quite simply, to offer the safest, highest quality care available anywhere for both mental and physical health. But they will take time to come to fruition, and in the meantime all of our thoughts are with NHS and social care staff who are working extremely hard over the winter, and throughout the year, both inside and outside our hospitals and I commend this statement to the House.


Department of Health
The Rt Hon Jeremy Hunt MP