Letter from Anne Longfield to Simon Stevens, Chief Executive of NHS England
Over the last year, the issue most often raised with me has been children’s mental health, and it was the top of the list in my consultation with children about my priorities for this year. Many told me about their desperate attempts, sometimes lasting years, to access support, and even primary school children raised concerns about anxiety. I also hear from parents, teachers and carers about their repeated frustrations when trying to get help for children who need it. We also know that most adult mental health problems start in childhood and that without treatment children’s problems are likely to get worse.
On the eve of World Mental Health Day this week, I sent a briefing to MPs on the provision of treatment of children with mental health issues in England. The briefing, available here, was prepared using the NHS’s own data. My conclusion on reading, checking and rechecking was that the service that exists at the moment is worryingly poor, a conclusion I stand by.
I was very disappointed that NHS England’s response to our report, and your own personal response in front of the Commons Health Select Committee was to attempt to denigrate the research. Not once did you address the central issues raised. Instead, you and your team sought to undermine the important evidence that we are putting forward and strangely ignore the reality of children’s experiences of the service and the frustrations of their parents.
You and your Communications team have claimed the briefing contained “basic errors and omissions”, and suggested we had not “bothered to check” our report and said that NHSE had not seen the briefing prior to publication. None of these statements are true. We strongly dispute both the language, the implications contained, and further I think it was an inappropriate response in respect of the children on whose behalf we issued the briefing.
In fact, as your staff will confirm, before writing our briefing we exchanged numerous emails with NHSE and NHS Digital. We also held a meeting with a very senior NHS official prior to publication, where these issues were raised. NHSE were given a draft copy on Friday, 72 hours ahead of publication. We even made changes to our final briefing following emails from NHSE over the weekend, so there were not in fact any omissions. Since all three suggestions: that we hadn’t checked, that NHSE hadn’t seen the briefing prior to publication, and that it contained errors and omissions were repeated by you to MPs in the Health Select Committee on Tuesday this letter is being sent to the members of that Committee. My office is entitled to carry out its own independent research independent of Government and answerable to Parliament and I am under no duty or obligation to share my work in advance, yet we did so, out of courtesy.
In response to your comments, we included points your policy team raised about the treatment of eating disorders and that 21,000 more children were being treated overall. Whilst welcome, these developments do not at all annul our wider concerns. We also quickly and prior to publication corrected a typographical mistake in a section heading in the draft sent to your team, who then claimed it demonstrated we had confused the funding model and by implication that there was a fundamental misunderstanding on our part of the entire issue. This is not true, yet you again repeated this to MPs in your evidence to the select committee. Not only was the heading corrected in the briefing that went to MPs it is very clear from even a cursory reading of the subsequent text and a table in our briefing that we had not confused the funding model at all. To overstress a corrected typographical mistake in such circumstances as to infer wider misunderstanding in the briefing suggests NHSE’s position was from the start to dismiss the work of my office, and not address it.
I believe the briefing sent to MPs provides an accurate picture of the level of mental health service based on your own published data. If the NHS has data not in the public domain that disputes the picture we painted, then in the interests of transparency and accountability NHSE should publish it. I think that would be a more constructive approach and will enable the public to make their own mind up on the true state of mental health provision for children and young people in England.
Today I am asking you 5 questions, some of which have already been put to NHSE and remain unanswered, which we would welcome you answering quickly. If the briefing was wrong and you publish fresh data so far unavailable that proves it, I‘m not afraid to correct any error so that we can clarify the position for the children and young people who are finding it so hard to get treatment.
- You stated that we were wrong that there is no data on how long children are waiting, claiming that national NHS data shows what proportion of children are waiting under six weeks and under 18 weeks. We have repeatedly asked where this information is published.
- You stated that we were wrong to say that the current system is not transparent and accountable. When there is no national waiting time target covering all children with mental health problems and no data on how many children are turned away from treatment, we would disagree.
- You claimed a figure for the number of children in inpatient mental health care was incorrect. This figure was from NHS England’s own dashboard and we have asked for clarification on why the dashboard information is wrong but have not been provided with this.
- You claimed that there is data on the number of children seeking treatment. We understand that there is national data on the number of referrals accepted into treatment but not on how many children were referred by their teacher or GP and how many of these were not accepted? This was a point we discussed at length with officials from NHS England prior to publication. If this is incorrect, please point us to this information that we have requested but which has not been forthcoming.
- You claimed that information is published within the Mental Health Data Monthly Statistics (MHDMS) on the number of children who complete treatment. The figure on the MHDMS is for children discharged. We understand that this includes children who are discharged for non-attendance. Can you point to where within the MHDMS the figure for children who complete treatment is?
I hope you will feel able to share this data. As you will know, I am also able to demand such data under Section 2f of the Children’s Act 2014.
The office of the Children’s Commissioner exists to represent the voices, experiences and views of children, and to get the system to listen. We know their view is that the provision of children’s mental healthcare is far from ideal, indeed, as we say, that it is pretty poor. It is this view, and a thorough examination of official NHS England data, which informed the six key findings in my briefing. I notice that you have made no comment on these six findings, or the conclusions I draw from them. I hope in future we could all concentrate our efforts on tackling that rather than trying to undermine the work of those who make valid and constructive criticisms.
Anne Longfield OBE
Children’s Commissioner for England