Liberal Democrats

Norman Lamb's speech to Autumn Conference

This cause is so important for so many people let down by the system.

Meeting people like Matilda MacAttram and hearing the dreadful experiences of some people from the communities that she represents, listening to Frank Bruno, makes me determined to act.

This is an area of real progress, for thousands and thousands of our citizens, after years of neglect. And this has happened only because the Liberal Democrats are in Government. But there is so much more to do.

People with mental ill health get a raw deal. It's always been that way but it's both morally wrong and economically stupid.

Mental ill health costs our economy an estimated £100 billion a year. Sickness absence, lost employment, the cost of benefits, the impact on families. Enormous financial cost but, more important, devastating human cost.

If you are a teenager and you suffer a first episode of psychosis, we know, from loads of evidence, that early intervention can have a massive impact. In many cases you can halt the deterioration. You can give that person a chance in life. A chance of a happy life, of enjoying all the things that we all take for granted.

Yet that youngster's experience today is completely haphazard - and always has been. If you live in Accrington, a brilliant NHS team will support you and your family. When I visited the centre there, I was overwhelmed by the testimonies from youngsters and their families. Young people who had emerged from the darkness and were optimistic about the future.

Parents grateful and full of relief. It was so moving.

But all too often, there is no service, or you have to wait far too long. It’s always been like this. Surely we cannot tolerate that. Just imagine if that same youngster had cancer. Of course he would get treatment quickly. There are clear access and waiting time standards. He would see a cancer specialist within a fortnight of referral from his GP. His treatment would start within one month of diagnosis.

Why the discrimination?

Labour introduced access and waiting time standards and they were right to do so. But they left out mental health. Labour introduced patient choice of hospital treatment. But they left out mental health. Labour introduced payment by results to pay hospitals for the work they do. But they left out mental health.

Liberal Democrats will not stand by and let this continue. All this reinforces an institutional bias against mental health. It dictates where the money goes. Every clinical commissioning group around the country has to make sure it meets the 18 week referral to treatment target, the 4 hour A and E target, the cancer targets. There is enormous political pressure to meet those targets. So as money is sucked into acute hospitals, something has to give - and it's mental health.

The evidence is strong. Treatment for a range of mental health conditions is just as effective as for physical health.

Tomorrow, Nick and I will be making a significant announcement on mental health. And I want to pay tribute to his leadership.

The first party leader to make a speech about mental health for years - possibly ever! He launched our action plan for essential change earlier this year. He has always backed me on this - and for that I am really grateful. No other country in the world is taking the steps that we are pursuing in mental health. We will lead the way.

The impact that we could have on so many people's lives is immense. In many areas exciting things are happening to tackle the bias against mental health: First, crisis care in mental health is perhaps where the contrast of experience with physical health is at its greatest.

Frank Bruno came to talk to me about his experience. He talked about the acute embarrassment and humiliation of 3 marked police cars arriving at his house - as if a dreadful crime had been committed. But he was ill.

And so many people end up completely inappropriately in police cells. It is an outrage. Just imagine being very ill. Perhaps in a state of enormous anxiety. And then you are locked up in a cell. It's inhuman! And it's always been like that.

So I secured an agreement between 20 national organisations to set standards in mental health crisis care - for the first time. It's called the Crisis Care Concordat - we all committed to halving the number of people, this year, who end up in police cells and ending the practice of youngsters being put in police cells.

Today I can confirm that, due to unprecedented collaboration between police and mental health - driven by the Crisis Care Concordat - the numbers this year are falling fast. In London, last year, 87 people ended up in police cells. That, in itself, was a big reduction. This year just 17 people. Just think what it means for those people. A senior London police officer told me just last week that because of the Concordat they now plan to end the use of police cells completely.

This is what happens when you encourage local areas to take control: Change from the bottom up - a Liberal approach.

Second, we are rolling out a national liaison and diversion service to ensure that those with mental health problems who come into contact with the criminal justice system, get referred to treatment. Our ambition must be to end the scandal of our time that so many people with mental health problems languish in prison, wasting lives and costing a fortune. As one leading figure in the mental health world said to me, no other country is doing this on the industrial scale that we are pursuing.

Third, we have published progressive guidance on use of restraint: Positive and Safe. There have been too many stories of excessive use of restraint. The Mind survey last year showed heavy use of face down restraint in many places. As one senior psychiatrist said to me: 'This has no place in a modern mental health service.'

That culture, where it exists, has to be challenged. I have witnessed the brilliant work under way at Broadmoor and at Mersey Care. In the 23 months since a new approach 'No Force First' was introduced on one ward, Mersey Care has seen a massive reduction in staff sickness absences due to injuries at work. 25 days lost compared to 888 days in a similar period before the change. Their wards have been civilised. Patients now enjoy a wholly different experience. A therapeutic environment.

That's why the mental health nurse in the video, Dave Riley, wanted to thank us.
Fourth, We are taking action to address the problem of so many people out of work and on benefits - because they have anxiety or depression, with no-one doing anything to get them access to psychological therapies that could help them recover and get back to work. So we are trialling exciting new approaches to link up jobcentreplus with talking therapies.

The potential here is enormous to help get people's lives back on track.

And fifth, we are modernising children and young people's mental health services. We have spent £56 m over this Parliament on improving access to evidence based therapies. Now I have established a taskforce to redesign the way we commission and organise children and young people's mental health services - and, crucially, we are involving young people in this work.

We will challenge fragmented commissioning. We will look at pooling all the resources available to ensure the best outcomes. And we will learn lessons from other countries such as Australia where they have a really impressive youth service called Head Space - we can learn and improve.

Those five big changes together amount to the biggest ever package of reforms in mental health. And all this is happening because the Liberal Democrats are in Government.

But I also want to talk to you about how we sustain and protect our NHS at a time of unprecedented financial challenge. The Commonwealth Fund has this year rated the NHS the top system globally. The United Kingdom ranks first overall, scoring highest on quality, on access and efficiency despite spending less than half per person compared to the USA.

Yet the challenges we face in sustaining the NHS - and in addressing the ways in which it falls short - are immense. We are all living longer. There's a dramatic increase in the numbers living with chronic conditions - often a mix of both physical and mental health problems.

In 2008, 1.9 m people were living with 3 or more conditions. By 2019 that number will have increased to 2.9 million. A 52% increase! And the system is already under intense pressure. Costs are rising by 4% a year across the developed world. So action to preserve our NHS is essential.

Labour is resistant to change. It puts ideology before people. And they wasted so much money: Never let them forget the billions thrown down the drain on their PFI programme - mortgaging the future of the NHS to the tune of £70 billion; And on the failed National Programme for IT costing nearly £10 billion; And the special favours to Independent Sector Treatment Centres.

They made great promises a fortnight ago about saving the NHS. Yet the central threat to the NHS is the state of public finances. They just do not get it. Ed Miliband of course forgot to mention the deficit. In Labour's world it seems unimportant.

Yet as our national debt grows year by year as we borrow to keep public services going, so the amount we spend on interest to service that debt grows. £52 billion pounds this year alone in interest on debt.

Every pound we spend on interest on debt means a pound not spent to support someone with dementia, to provide therapy for someone with severe mental ill health or to ensure that a cancer patient gets access to drugs that can keep them alive.

It has a direct impact on the sustainability of the NHS. So don't believe the claim that Labour will save the NHS. Their lack of discipline on public finances presents a direct threat to the NHS.

That's why the Liberal Democrats see the need for both a stronger economy and a fairer society. You need one to deliver the other. But just imagine the position if the Tories win next May. They will be constantly under pressure from the right to cut funding to the NHS. Liam Fox has already called for an end to protection of the NHS budget in the next parliament. But that is tantamount to calling for an end to the NHS as we know it.

With a funding gap anticipated to be £30 billion by 2020 the impact of cutting the NHS budget is unthinkable. District nurses made redundant. Hospitals closing, growing waiting lists. So Liberal Democrats must lead the debate on how we make sure that it meets the needs of people today and how we sustain it for the future.

And that's what I want to focus on. A Liberal Democrat vision for the NHS and care. To realise this vision, we need both the funding to deliver it and the willingness to change the way we do things.

So I am delighted that we have announced a funding boost for the NHS. A billion pound transformation fund, over and above inflation, to help the NHS become fit for the future.

We need to achieve 5 big shifts in order to protect, sustain and improve our NHS

1) First, we must shift the emphasis fundamentally from 'repair' to prevention.
Over the last decade, there has been a big investment in the NHS. And Liberal Democrats championed that. But the focus has been at the acute end of the spectrum rather than focusing on preventing ill health and preventing a deterioration of health.

That needs to change.

We need to reform the incentives so that the whole system focuses on helping people to stay healthy.
And we are right to focus part of the additional resources we will invest in the NHS in out of hospital care - ensuring good access to primary care and linking community services much more closely to your local GP practice.

2) Second, we must make a shift from a horribly fragmented system: healthcare separated from social care, primary care separated from hospital care and mental health institutionally separated from physical health. That makes no sense from the patient's perspective. Instead we must promote integrated care, joined up around the needs of the individual.

On a recent visit to Nottingham I was told of a woman who had received 19 different visits from health and care professionals in the course of just one day. Nottinghamshire is showing how the system needs to change. Now, just one person will coordinate that woman's care.

Last year I launched our Integrated Care Pioneer Programme. The philosophy is about encouraging change from the bottom up - a Liberal approach - not imposing it from Whitehall. We have tested that to destruction.
99 areas put themselves forward to become Pioneers. No offer of cash but an encouragement to do things differently and an offer to remove barriers to change. And in the 14 Pioneer areas selected, we see great local leaders doing things differently, putting body and soul into improving care

In Torbay they are developing plans to integrate mental health into primary care.

In East London, they identify patients most at risk of going in and out of hospital. They focus their attention on these people, supporting them better at home and ending the revolving door of crisis admissions to hospital.

I want to encourage the development of integrated care organisations with the acute hospital coming together with primary care, mental health and community services with agreements to share the risks and rewards of more effective joint working. Not imposed from Whitehall but encouraging diversity and local dynamism.

And this Government is putting its money where it's mouth is: our Better Care Fund brings together health and social care. It has got every part of the country developing their own plans, pooling their share of £3.8 billion, focusing on joining up care: 7 day working, sharing information to improve care, preventing crises in care and reducing admissions to hospital.

I want the entire health and care budget pooled by 2018. The divide makes no sense. Lib Dems will end it but leave it to local areas to decide how to do this. No single model imposed from the centre;

3) Third, we need to shift from a system which is too often paternalistic - we know best what's good for you - to one that is acutely personal.
Already Liberal Democrats have made sure that those entitled to NHS continuing care have a right from this month to a personal health budget giving them the power to decide how the money is spent, what their priorities are.

I saw the power of this in action when I talked to a gentleman who had taken part in the personal health budgets pilot in Kent. He uses a wheelchair. He had been in and out of hospital. He was existing, not living. Then he got a personal health budget. He took control. He knew what was important to him. His life was transformed and he had avoided hospital admissions for a long time.

And we should promote the potential for combining resources in the NHS and care in a single personal budget. We must also do more to help people to self care.

4) Fourth, we must instil a culture where the whole NHS and care system has a total focus on achieving the best possible results for patients.
Let's end the rewards to hospitals for just doing more and instead reward patient safety, compassionate care and achieving the best outcomes.

5) Finally, the NHS and care services must work collaboratively with the wider community.
Go to Sandwell in the West Midlands. There, a fantastic organisation, Friends and Neighbours, has built a network of volunteers supporting people living alone. One lady, for whom Church was a really important part of her life, had not been able to get there for two years. The simple human act of a volunteer, who was willing to take her, gave her a renewed purpose in life. Gave her some happiness.

Or go to the Cornwall Pioneer - there you will find a brilliant collaboration between GPs and volunteers combating loneliness. Giving people their lives back and, as a result, reducing dependency.

The result: big reductions in hospital admissions. And central to this recognition of the role of the wider community is a new deal for carers. As the number of people living with chronic conditions grows rapidly, so does the number of carers. Selfless individuals giving of themselves to support a loved one.

According to Carers UK, family carers currently save the Government £119 billion every year. The burden is enormous - both physically and emotionally. Many carers themselves are frail. And if your husband or wife has dementia, the strain can be overwhelming.

We have already made advances. The Care Act, pioneered by Paul Burstow, which I then took through Parliament, introduces important new rights for carers. But we need to do more. Paul Burstow, widely respected across the care world, deserves enormous credit for the work he has done both in Government and in developing new proposals as chair of the ageing society working group to help support carers.

So we propose:

A new annual Carers bonus worth £250 which full time carers can spend on whatever they want, be it a short break, someone to look after their loved one, to help with the bills or even just a treat for themselves.

A carers passport to help identify carers and get them extra support, such as free hospital parking or vouchers for the gym or the cinema. Enabling more people to work and receive the carer's bonus. We would raise the amount you can earn before losing your carer’s allowance to £150 a week.

And I am announcing this week that we will get part of the way there in this parliament, as we will raise the maximum earning limit for the carers allowance to £110 per week, stopping the scandal of carers not even being able to work on the minimum wage for up to 16 hours before losing their benefits.

It has only happened because the Liberal Democrats are in Government. The NHS is a Liberal triumph. That great Liberal William Beveridge set out his plan for a better post war Britain. A Liberal plan to tackle the five giant evils of squalor, ignorance, want, idleness and disease. That led to the National Health Service being established. A Liberal idea.

Health care free for all - one of our country's greatest achievements - a Liberal idea. Everyone here in this room believes in the NHS; Everyone here will fight for it; Everyone here will do what it takes to make sure it that it remains the envy of the world. So my message is this:

If you believe that it is intolerable to discriminate against those with mental ill health; If you agree with us that everyone must have the same right to access treatment whatever their illness; If you believe in the NHS and want to ensure that the money is there to protect and enhance it; Then join with us as we keep fighting.

Fighting to end discrimination against mental health. Fighting to stand up for carers. Fighting to build a fairer society.

That is our purpose. And that is why our people. That is why our country and that is why our next Government need Liberal Democrats.

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