Examination of Witness (Questions 240-249)
Rt Hon Rosie Winterton MP
14 DECEMBER 2006
Q240 Lord Trefgarne: Is it not the case
though that so many mental health problems are in fact the result
of either alcohol problems or drug-abuse problems which of course
add to the stigma which has to be overcome in the wider context?
Ms Winterton: Yes, I think that there have clearly
been indications and sometimes this can be a two-way process,
I guess, in that if somebody has a mental health problem, they
might turn to drugs or alcohol or in some cases drugs and alcohol
can perhaps lead certainly to some quite serious depressions and
so on. I think that taking action on both of those issues is really
quite important and, as I say, that is something that I know,
certainly in terms of mental health promotion and drug-abuse,
Spain has looked at quite effectively
Q241 Baroness Howarth of Breckland: Minister,
although many of those who have any of those problems could fall
foul of mental health problems, we also know that it is more likely
in vulnerable groups, that they are triggered by many of the things
you described earlier in terms of housing and the like. I just
wondered how do you think the mental health issues about these
specific groups in the population should be handled in a European
context? We are particularly interested, and I personally am,
in the position of children who seem to be missed out of the strategic
look in the Green Paper in any great depth by clinicians and how
can you actually ensure that children from black and minority
ethnic groups are also looked at in terms of the European strategy?
Ms Winterton: If I just address the BME situation
to start with, that is a whole programme of work which we have
undertaken through Delivering Race Equality, and one of those
things has been about monitoring. Obviously in some European countries,
I think in France and Germany, the kind of collection of data
in Germany is illegal and in France it is unconstitutional, I
believe, so it is quite interesting to look at how we would capture
some of that information. What we have tried to do through things
like the Count Me In census is to look, for example, at
detention rates amongst people from BME communities and we have
set in train a whole range of measures through our focused implementation
sites which are particular areas which are focusing on how to
implement our Delivering Race Equality strategy. Very often, that
is about getting to particular communities and one of the things
we have pushed very hard there is community development workers
because sometimes the real issue is about coming forward at the
appropriate time, feeling that the services are going to be sympathetic
and not feeling kind of frightened of services and leaving it
until too late, or not too late obviously, but until somebody
can be quite severely ill before coming forward. That is looking
at some of the cultural barriers that there might be, some of
the perhaps fear of discrimination that there might be and making
sure, and this is where community teams come into it again, that
the teams go out to particular communities, and there is a lot
of good work that has been done through the focused implementation
sites in terms of analysing what the problem is and then working
out how to overcome it. I do not know whether any of our people
from the focused implementation sites have given you any evidence
or perhaps we might ask for some to be sent forward, if that would
help.
Q242 Chairman: That would be helpful,
yes.
Ms Winterton: There are some very interesting
projects that are going on in that area. I think in the wider
sense of children, there are some very, very real issues obviously
around that and there have been some improvements, monetary-wise
and personnel-wise, that have certainly taken place, however,
there is no doubt that there is still a long way to go. I actually
think that in terms of the NHS becoming much stronger in its commissioning
abilities, having to show what the needs are of the local population
and then looking at providing services accordingly can be actually
something of a driver for looking at groups which have perhaps
traditionally not had these services which they should be having
and it is about getting people to focus on that. I also think,
probably because it is one of my other areas in terms of patient
and public involvement, that we really do need to strengthen that
and get a specific focus within that on children saying what services
are available locally and how can we improve on those. There is
no doubt there is much further to go in terms of the issues around
children. We have tried to address some of them but I know there
is more that we need to do.
Q243 Baroness Howarth of Breckland: Commissioning
has been recognised as a weakness in both local authorities and
the National Health Service. Are there things we could learn from
Europe about doing that in a better way or do you think they are
even further behind than we are in terms of proper leadership
in commissioning?
Ms Winterton: In a sense, because of some of
the differences in the system through things like social insurance
and the way that operates, it is slightly difficult to draw too
many parallels. I hope that commissioning will improve as well
through things like the Local Area Agreements because when it
comes to things like children's services and the specific emphasis
in local authorities on the Children's Directorate and what we
have tried to do through Local Area Agreements, getting social
services departments and health authorities to work together to
commission services, the ability to have pooled budgets, in some
cases pooled teams, will help with the emphasis that can go towards
children's services.
Q244 Chairman: Minister, I am getting
a little concerned because it is now two minutes past eleven.
Ms Winterton: Am I talking too much?
Q245 Chairman: Not at all, no, it is
just that you have given us very full answers. I am concerned
from your point of view, I do not know what your timetable is.
I am afraid that at about this time the Committee begins to slightly
dissolve at the edges because people have to go off and do other
things. How would you like to handle this? One way of handling
it would be to put a couple of questions on the side, as it were,
for you to give us written answers, if that would be more helpful
to us, or we can battle on. I am concerned about your timetable.
Ms Winterton: I have a meeting with some Members
of Parliament at 11.30 that I would like to get to.
Q246 Chairman: So you have not got to
go very far perhaps for that.
Ms Winterton: I have to have a slight briefing.
If I could maybe go at quarter past.
Chairman: That would be very generous.
Let us press on and see where we get to by quarter past and if
there is something left over then we might ask you to send us
a note or something about what has been left out.
Q247 Baroness Greengross: You did talk
about collaboration in answer to one of the other questions and
the collaborative approach with your teams coming from different
areas, but would you say overall this has been very successful
in the UK? If it has, do you think that this Green Paper approach
can stimulate collaboration which is much more difficult, I think,
across the different EU Commission policy areas?
Ms Winterton: I think what is going to be quite
important in terms of the Green Paper is the way that it sets
out very clearly some of the issues about the importance of employment,
the importance to the economy of good mental health strategies.
I know that under the Finnish Presidency—it was not just
mental health, it was health in general—we had some meetings
together with employment ministers, or DTI, and we had a meeting
which looked across all sectors and the different roles that people
could play. I suspect that the more that message gets out, the
more it is important at national and, by the way, local level
as well. I suspect that one of the main ways that the strategy
will stimulate that kind of discussion and that kind of collaboration
is by showing how in different countries there is best practice
and being a platform for that exchange of ideas as to what has
worked well and looking at how in some of the work that I hope
would be un-siloed, if you like, if that is a word, between different
parts of the Commission to look at what employers have done in
terms of healthy workplaces, what social security has done to
encourage work as a means of stimulating better quality of life,
better health promotion in general.
Chairman: Thank you. I think it is back
to Lady Howarth.
Baroness Howarth of Breckland: I would
like to get to the next two questions.
Chairman: I felt the same myself. Lord
Wade on minimum standards.
Q248 Lord Wade of Chorlton: I would like
to raise with you the question of minimum standards for mental
health and ask you how realistic do you feel would be the aim
of achieving minimum standards for mental health across the European
Union? How far could the Platform approach achieve this aim? What
would be your view on the need for European legal instruments,
which might be a Directive, a Regulation or a Resolution?
Ms Winterton: I am not sure that minimum standards
setting would be particularly helpful. The general attitude that
we have in health service matters, as I am sure you know, is that
this is something that we certainly do try to keep within the
Member States' remit, if you like, because of some of the very
real differences in healthcare systems and legislation is not
generally considered to be something that we would want to be
particularly tied to at a European level because we do want to
make sure that we have the ability to decide our health systems,
particularly because of the uniqueness of the National Health
Service. I know that the WHO at the moment are collecting some
baseline information about what is provided in terms of mental
health services in different countries. I would say that in terms
of UK provision we would be at quite a high standard so I cannot
see it as being something that would necessarily alter the standard
that we would be offering. I am not sure I would go for the standards
approach. The platform for exchange of ideas will act, as I said
earlier, as a kind of stimulus for people to be able to go back—this
comes again to the point of the service users—and say, "This
is what is available, how can we look to copy these?"
Chairman: Thank you. Lord Moser has a
question on people with learning disabilities.
Lord Moser: Chairman, I would have thought
we could skip this one. It is just the question whether learning
disabilities should be part of our general concern. We have been
advised differently: the Commission puts it in in its Green Paper;
the WHO says it is not in. Unless you particularly want to talk
about this, Minister, we could save time on this one.
Q249 Chairman: What I would suggest,
Minister, is when your officials look at what has been said and
perhaps what has not been said and the questions we have left
out, if there is something that you feel from your own point of
view you want to tell us about, either on the question about the
co-ordination of activities across the countries of the UK or
people with learning disabilities, we would be very grateful to
hear that. Obviously you are now very near your deadline and rather
than go on about that now, it would be much nicer to be able to
say thank you very much indeed for being with us for such a long
time and for being so open, frank and willing to discuss the innermost
bits of how these things are done. We have all valued your evidence,
thank you very much for being with us.
Ms Winterton: Thank you very much.
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