£400 million to extend access to psychological therapies
New plans to transform the mental health and well-being of the nation and ensure – for the first time – that mental health is given the same importance as the nation’s physical health, were announced today by the Deputy Prime Minister, Nick Clegg and Andrew Lansley and Paul Burstow from the Department of Health.
The No health without mental health Strategy outlines how a new emphasis on early intervention and prevention will help tackle the underlying causes of mental ill-health. It sets out how the Government will work with the NHS, local government and the third sector to help people recover and challenge stigma.
Central to these plans is an additional investment of around £400 million to improve access to modern, evidence-based psychological therapies over the next four years.
This will extend the current programme available to offer personalised support to 3.2 million people across the country, making available a choice of psychological therapies such as Cognitive Behavioural Therapy (CBT), Counselling for Depression, and Interpersonal Psychotherapy and ensuring access for anyone who needs it.
At least one in four people experience a mental health problem at some point in their life and mental ill-health represents up to 23% of the total burden of ill health in the UK - the largest single cause of illness.
Half of those with mental health problems first experience symptoms before the age of 14 and three-quarters before their mid twenties. Depression is also the most common mental health problem in people aged over 65, with 13-16% having sufficiently severe depression to require treatment.
The Deputy Prime Minister Nick Clegg said:
“The evidence is clear: mental health needs to be addressed with the same urgency as physical health. We need to end the stigma attached to mental illness, to set an example by talking about the issue openly and candidly and ensure everyone can access the support and information they need.
“The strategy today shows how we will put people at the heart of everything we do, from a new focus on early intervention to increased funding for psychological therapy, so that everyone has a fair opportunity to get their lives back on track.”
Care Services Minister, Paul Burstow said:
“For too long mental health has been the poor relation in the NHS. Yet we know that good mental health and resilience are fundamental to our physical health, our relationships, our education, our work and to achieving our potential.
“What this strategy does is ensure that modern, evidence-based therapies are available for all who need them. Working with others, the Government is determined to promote good mental health and wellbeing and challenge the stigma and discrimination that still affects so many people with mental health problems today.
“With one in four of us likely to suffer from a mental health problem at some point in our lives, it’s not a question of them and us. Good mental health is everyone’s business.”
Secretary of State for Health, Andrew Lansley said:
“There is no good health without good mental health. Too often in the past, mental health issues have been marginalised. This cross-government strategy will finally place good mental health at the heart of everything we do.
"The six key aims of this strategy make clear our commitment to improving public health and wellbeing through improving mental health.
“For the first time, people of all ages with mental health problems will be able to receive personalised care to reflect their own needs.
“The NHS will also no longer focus its attention on treatment alone - but will move towards early intervention and prevention to deliver outcomes for patients which are amongst the best in the world.”
This strategy commits to beginning to expand provision of psychological therapies to children and young people, older people, people with long-term physical health problems, those with medically unexplained symptoms and those with serious mental illness. This will help to reduce the burden of ill-health in the UK and ensure that evidence-based therapies are available to these key groups.
Patients will be able to request a referral via their GP or contact the provider directly for a self-referral consultation.
Extending psychological therapies to all those with mental health problems will result in one million people recovering from their condition by 2014 and 75,000 people getting their lives back on track by returning to work, education, training or volunteering. It will also create over £700 million of savings to the public sector in healthcare, tax and welfare gains.
The Government’s priorities are summarised in six main objectives - agreed with partner organisations in the mental health sector - to make clear to individuals, families and communities how the Government’s plans will make a positive difference to them. This Strategy will ensure that by 2014:
- more people will have good mental health;
- more people with mental health problems will recover;
- more people with mental health problems will have good physical health;
- more people with mental health problems will have a positive experience of care and support;
- fewer people will suffer avoidable harm; and
- fewer people will experience stigma and discrimination.
Sarah Brennan, Chair of the Children and Young People’s Mental Health Coalition and Chief Executive of YoungMinds said:
“We commend the Government for putting children and young people at the heart of its mental health strategy for the first time. Thus emphasising the vital importance of giving all young people a good start in life and the effect of this on long term mental health.
“Effective implementation of this strategy however will be challenging in the tough economic climate. We look forward to working with government to make the strategy a reality, resulting in a transformation in the lives of children and young people in Britain today.”
Future Vision Coalition co-chair Dr Andrew McCulloch said:
“The Government has today made a much needed commitment both to promote good mental health for all and to improve support for those who experience mental ill health.
“People of all ages with mental health problems are too often excluded from the opportunities in life that others enjoy. The strategy shows that all government departments need to work together to improve the mental health of the whole population and to secure better, quicker and more responsive services for those who need them.”
In addition, the Government will:
-
launch the Health Visitors Implementation plan following our announcement last October for 4,200 additional health visitors;
-
through the Early Intervention Grant bring together funding (£2.2bn in 2011-12) for early intervention and preventative services for children, young people and families, which can also be used for Targeted Mental Health in Schools (TaMHS). Local authorities will have greater freedom and flexibility to put in place programmes that can reduce conduct disorder, improve family relationships and reduce costs to social care, youth justice, education and health systems;
-
provide an extra investment of up to £7.2 million to ensure the best treatment possible for veterans with mental health problems;
-
ensure that by 2014 people in contact with the criminal justice system will have improved access to mental health services – as outlined in the Ministry of Justice Green Paper Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders;
-
work in partnership with the Time to Change programme to challenge stigma and discrimination;
-
establish community budgets in 16 local areas for families with complex needs (including mental health problems) as part of a national campaign to turn around the lives of families with multiple problems;
-
ensure that all psychological therapy sites have an employment co-ordinator who will work with Jobcentre Plus offices, employers and occupational health schemes to help people get back into work;
-
launch a consultation to extend to all employees the right to request flexible working, which will help carers of people with mental health problems to manage their caring role alongside work; and
-
publish a new cross-Government suicide prevention strategy in the spring of 2011.
The No health without mental health strategy, a cross-Government mental health outcomes strategy for people of all ages, is the second of a number of outcomes strategies published following on from the White Paper, Equity and excellence: Liberating the NHS.
Outcomes strategies will play a crucial role in translating the underpinning principles of the Coalition Government’s reforms of the health and care services into the steps needed to drive improved health outcomes; putting patients and the public first, empowering professionals and strengthening local accountability.
Notes to editors
1. For media enquiries, and case studies - please contact the Department of Health Newsdesk on 020 7210 5221
2. The Department of Health announced in June 2010 an additional £70 million to extend access to adult psychological therapies.
3. The Health and Social Care Bill 2011 contains provisions covering five themes. The Mental Health Outcomes Strategy will build on these:
• strengthening commissioning of NHS services
• increasing democratic accountability and public voice
• liberating provision of NHS services
• strengthening public health services
• reforming health and care arm’s-length bodies.
4. A range of documents to support the publication of No health without mental health – a cross-government strategy for people of all ages, can be found online at: www.dh.gov.uk/mentalhealthstrategy
5. The full range of NICE approved psychological therapies include:
• Cognitive Behavioural Therapy
• Counselling for Depression
• Interpersonal Psychotherapy
• Couple’s therapy
• Dynamic Interpersonal Psychotherapy
http://nds.coi.gov.uk/content/detail.aspx?NewsAreaId=2&ReleaseID=417742&...
and http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_124018
PDF version Talking therapies: a four year plan of action - Impact Assessment
A supporting document to No Health Without Mental Health: a cross-Government mental health outcomes strategy for people of all ages.
This impact assessment presents evidence of the estimated costs and benefits of the Government’s expansion of talking therapies arising from the 2010 Comprehensive Spending Review.
http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Regulatory...
also see http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
The economic case for improving efficiency and quality in mental health
A supporting document to No health without mental health: a cross-Government mental health outcomes strategy for people of all ages.
This outlines the opportunities to make value for money savings in delivering mental health services using the QIPP approach, and by promoting early intervention and prevention of mental health problems.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...
The government has admitted it risks undermining its plans to help one million people recover from mental health problems by 2014 because of massive cuts in civil service expertise.
At the heart of today's mental health strategy are plans to expand access to talking therapies to all who need them by 2014-15, including children, older people and those with severe mental health problems, building on the work of the existing Improving Access to Psychological Therapies (IAPT) programme.
But 11 of the 14 staff delivering IAPT will leave the Department of Health at the end of March, a government source told Community Care, as part of widespread cuts to DH support schemes to implement policy, which includes the closure of the National Mental Health Development Unit.
In an impact assessment on its plans to roll out talking therapies, the DH admitted that the cuts could put the delivery of its plans at risk.
"Without a well-functioning central team and regional teams to support implementation and data validation locally, there is a danger of the talking therapies roll out stalling or not making the progress intended," it said.
"Also, there is a danger of specific care models for older people, children and young people, those with long-term conditions or medically unexplained symptoms and those with severe mental illness not being developed or piloted, or best practice not being disseminated across the country."
"The departing staff will take policy and process knowledge with them," said the government source, in reference to the cuts to IAPT and other DH programmes. "There are no handover plans in place to assure continuity of programmes and the pressure on existing staff is leading many to leave via the voluntary exit (redundancy) scheme."
Responsibility for the talking therapies programme will pass from the DH to the NHS Commissioning Board from 2012-13, but the DH confirmed support for local delivery would remain "limited".
Andy Bell, deputy chief executive of the Centre for Mental Health, said it would have been preferable to have retained as much continuity as possible in a "challenging landscape".
He said: "The IAPT programme has been well run and it's had very good quality of support and we will need to see what arrangements will be put in place to make sure its [quality is] continued and it's vital that this massive development of the project is done well and to a high quality."
The cuts reflect the DH's focus on making local organisations more responsible for policy delivery.
It has earmarked £400m towards the talking therapy programme's expansion up to 2015, which it anticipates will produce £700m of savings to the public sector in healthcare, tax and welfare gains.
However while this funding has been allowed for in primary care trust funding allocations, the final spend is subject to local discretion.
A DH spokesperson said: "We are clear that at a time when the NHS budget is under pressure, we need to find efficiencies so that we can invest in frontline services.
"We are working with the Royal College of GPs and the Royal College of Psychiatrists to produce robust guidance for commissioners on mental health services. so they have the expertise to commission good mental health services.
"A central policy team within the Department of Health will continue to oversee roll-out of our talking therapies programme."
A four-year plan on delivering the talking therapies expansion, also revealed today, said this "small team" would be responsible for supporting training and commissioning, and setting outcomes for and benchmarking services.
Shadow care services minister Emily Thornberry said she was unclear how the government intended to deliver the outcomes when it was "shaking" the NHS "really hard and cutting local authority funding.
http://www.communitycare.co.uk/Articles/2011/02/02/116215/civil-service-...
User-led groups have welcomed a new government mental health strategy, but fear that spending cuts put its success in doubt.
The new cross-government strategy, No Health Without Mental Health, pledges “parity of esteem between mental and physical health services”, with a focus on “early intervention and prevention” and services for children and young people.
The strategy also focuses on reducing the stigma and discrimination faced by people with mental health conditions, including support for the Time to Change anti-stigma campaign.
Sarah Yiannoullou, manager of the National Survivor User Network, said the initial reaction from mental health service-users and survivors had been to welcome the focus on children and young people, and a more “preventative approach” that would ensure the emphasis was “not just on crisis management”.
But she warned that self-help groups, survivor groups and small voluntary and community organisations that had helped with preventative support were having to close due to funding problems.
She added: “There is such a conflict between what is being said in the strategy and people really believing that this can be delivered in the current climate.”
She said the network was also disappointed with the government’s lack of emphasis on service-users “leading the agenda”.
She said: “We did have some input but at a distance. DH is still going to the large charities, but service-user led organisations need to be there as well.
“There are a lot of issues that only people currently accessing services will be aware of. We need to bridge that gap.”
The government also pledged to introduce legislation later this year to repeal section 141 of the Mental Health Act, which says that MPs who are sectioned for at least six months must lose their seats.
Mark Harper, the Conservative minister for political and constitutional reform, who campaigned for the law to be scrapped in opposition, said section 141 “sends out entirely the wrong message that if you have mental health problems your contribution is not welcome in public life”.
The strategy also allocates £400 million to pay for 1.2 million more people across England to receive psychological therapies over the next four years. This should mean 3.2 million people will use such services between 2011 and 2015.
The mental health charity Mind said the money was “an important step, as we know this is a highly effective and economic way of supporting people”, but warned of the “backdrop of sweeping reforms to the NHS” and spending cuts, and said that “basic services must continue to operate on a local level despite tightening budgets”.
Broadly speaking, the strategy focuses on the right areas. It captures issues of long-standing concern for people with mental health problems – such as the pernicious effects of stigma – and also reflects the research evidence, for example, on the profound interconnectedness of mental and physical well-being.
In line with the government’s intention to refrain from telling health professionals what to do, ‘No health without mental health’ contains few centrally mandated actions. Instead, it describes the destination, provides some directions for getting there, and then says how we’ll know if we all get lost.
What this approach means is that if the strategy is to have any force behind it, mental health (and the six objectives in particular) needs to be fully reflected in the outcomes frameworks that will hold the NHS, public health and social care professionals to account for the results they achieve. The objectives will also need to be included in the commissioning outcomes framework to be developed for GP consortia, and any outcomes measures used to monitor contracts locally.
At present the objectives are only partially reflected in the proposed outcomes frameworks. For example, one objective – that more people with mental health problems will recover – is intended to capture not only clinical recovery but also recovery in the broader sense of having a good quality of life, however each individual defines that. However, the NHS outcomes framework will measure this exclusively in terms of employment rates for people with mental health problems.
On the absolutely crucial task of tackling stigma and discrimination, none of the outcomes frameworks contain measures relating to stigma reduction and consequently neither the NHS, nor the social care or public health sectors will be held to account at the national level for meeting this objective.
The most headline-grabbing commitment in the strategy is the announcement of £400 million over four years to expand the Improved Access to Psychological Therapies programme to three new groups of people: children and young people; people with long-term conditions; and people with severe mental illnesses. Although the money is not ring-fenced and must be found from existing budgets, commissioners should be encouraged to make good on this commitment – it would give thousands of people access to much-needed, evidence-based care. It also makes economic sense. As highlighted in a report by The King’s Fund and Centre for Mental Health, improving psychological support for people with long-term conditions, and dealing more effectively with childhood mental health problems, can give a return on investment which justifies the expenditure in financial terms alone.
The government should be commended for its ambitions, but as the strategy itself acknowledges, much work is needed if the vision is to become a reality. And, crucially, the objectives will not be achieved unless all relevant organisations are adequately held to account for delivering them.
Survey of people who use community mental health services will help to assess changes in experience of care
The results of the 2011 survey of people who use community mental health services, published today (9 August) by the Care Quality Commission (CQC), are set to play an important role in the Government’s new mental health outcomes strategy.
The experiences of more than 17,000 people who use services across the 65 NHS mental health trusts in England are reflected in the survey, which asked them questions about their care during the past 12 months.
They received care and support from mental health services outside hospital, such as those offered by outpatient clinics and local teams providing crisis home treatment, assertive outreach, early intervention for psychosis, and generic community mental health services.
Cynthia Bower, CQC chief executive, said: “The new cross-government strategy for mental health outcomes, No health without mental health, was launched in February. One of its overall aims is to improve outcomes for people through high-quality services that are accessible to all.
“The results of the community mental health survey this year and in the future have been identified in the strategy as one of the key sources of information to assess progress in improving people’s experience of care and support.
“I think it’s fair to say that those who took part in this year’s survey were positive about some aspects of the services they received but many found that some of their needs were not fully met.
“I know we are entering a period when resources may be stretched even further than they have been before. But I urge all those who provide community mental health services to strive to maintain, and where possible raise, the levels of care. I also call on commissioners of services to study the survey results and use the levers that are available to them to improve outcomes for people who use these services.”
Ms Bower pointed out that the large majority – 86% – of those who took part in the survey had not spent any time in hospital during the past 12 months, which underlined the importance of mental health services in the community. Such services are the main source of specialist support for around a million people each year across England.
The results of the 2011 community mental health survey suggest there is scope for involving people more in aspects of their care, such as care planning and medication. For instance, less than half said they “definitely” understood their care plan, while more than a quarter of those who were prescribed new medication said they were not told about the possible side effects.
One of the specific objectives of the national mental health strategy is to ensure that more people with mental health problems enjoy good physical health. Of those with physical health needs who responded to the survey, many said they would have liked more help. Thirty-five per cent had “definitely” received support in getting help with their physical health needs and 34% had “to some extent”, but 31% said they had not received any support, although they would have liked it.
The national strategy places a strong emphasis on early intervention – through identification and referral by GPs – linked with expanding people’s access to psychological therapies such as talking therapies. Thirty-nine per cent of those who responded to the survey had received talking therapy during the past year, but 47% said their mental health or social care worker had not discussed talking therapy with them in the past 12 months.
Where possible, we have compared this year's results with some of last years.
- Most people again responded positively to questions about the health or social care worker they saw most recently, saying they took time to discuss their condition and treatment with them, took their views into account and treated them with respect and dignity.
- There were improvements in aspects of crisis care, with more participants saying they had the number of someone to call in their local NHS mental health team outside office hours, increasing from 56% in 2010 to 58%, and of those who called the number, 16% did not get the help they needed (an improvement from the 19% in last year’s survey).
- There was a less positive response when those surveyed were asked if NHS mental health services had involved a member of their family, or someone close to them, as much as they would like, as 49% said they had “definitely” been involved as much as they would like, compared with 52% in 2010.
People who have complex mental health needs and require multi-agency support are cared for within a framework called the Care Programme Approach (CPA). For service users who are not on the CPA, the focus is mainly on addressing their clinical needs, whereas policy guidance states that people who are on the CPA should also receive support with day-to-day matters such as employment, housing and financial advice.
Forty-two per cent of respondents to the survey were on the CPA. Of those who were on the CPA and said they needed support with day-to-day living:
- Thirty-five per cent said they had not received help from anyone in NHS mental health services in the past year with finding or keeping work, such as being referred to an employment scheme.
- Twenty-seven per cent said they had received no help with finding or keeping their accommodation.
- Twenty-seven per cent said they had not been given any help with financial advice or benefits.
People on the CPA should receive a formal review of their care at least once a year. In the past year, 40% of respondents on CPA said they had had more than one review, 33% had received one and 26% had not had a review at all.
End
For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232143.
Notes to editors
- Read the full national results and a briefing note here
- Visit the Care directory to see the results for each trust and whether they performed better, worse or about the same as other trusts
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=37515&FAAre...
Minister Paul Burstow this week visited Duke McKenzie’s fitness centre in Crystal Palace, where Time to Change has sent scores of young men and women with mental health problems.
Speaking at Duke’s, Paul Burstow said:
“One in four of us will experience some form of mental health problem during our lives. Unfortunately, people often have to cope with stigma and discrimination alongside their condition, in their families, their classrooms and their work places.
“Time to Change is already making a big difference. Many of the young people who go to Duke’s went with low confidence having never had the chance to talk to others in an open environment. Its helped boost self-confidence; and the people at the gym get to see that people with mental health problems are no different to the rest of us.
“Coping with a mental health condition is difficult enough without the added burden of overcoming discrimination too. That’s why I am committing up to £16 million over the next three and a half years to Time to Change to help fight the negative attitudes people have towards mental health conditions.”
Comic Relief Chief Executive, Kevin Cahill, said:
“Comic Relief has a long standing commitment to helping people with mental health problems across the UK and has been working on this particular campaign since 2007. Four years on, we’re really starting to see some positive results - but we understand change takes time, and this next phase of the campaign will build on the success to date and the important lessons we have learned so far.
“All too often people with mental health problems are blighted by the prejudice, ignorance and fear that surround it and Comic Relief is committed to working with Time to Change to overcome this.”
Time to Change Director, Sue Baker, said:
“Stigma and discrimination ruin lives, and prevent people with mental health problems using their full potential and playing an active part in society. We have worked hard over the last four years to secure the beginnings of change in society, and have seen robust evidence of a reduction in discrimination. But it takes more than four years to overturn decades of prejudice – this is the work of a generation. Mind and Rethink Mental Illness are grateful for this new funding which will make a difference to the lives of millions of people – those with mental health problems and those around them.”
The funding will help Time to Change continue its work until March 2015 and help change attitudes and behaviours on a mass scale, empowering individuals to tackle discrimination across all sectors and communities.
It will fund the next phase of this highly successful campaign, including testing new approaches to tackling mental health stigma and discrimination amongst children and young people, and starting with some specific work with the African Caribbean community.
ENDS
Additional supportive comments
Paul Farmer, Chief Executive of Mind said:
“For generations we have swept mental illness under the carpet as a society. We've been afraid to talk about it and afraid to understand it.
“The consequences for those experiencing mental health problems has been devastating. Stigma and discrimination has stopped people working, socialising and living life to the full. Over the last few years, Time to Change has made real progress in changing societal attitudes but we won't give up until the job is done. We thank the Government and Comic Relief for their support and look forward to a future when anyone with a mental health problem has the opportunity to realise their ambitions.”
Paul Jenkins, Chief Executive of Rethink Mental Illness said:
“This is a fantastic opportunity to improve the lives of the thousands of people affected by mental illness and Rethink Mental Illness is proud to be playing its part in this movement for change.
“It means in particular new focus on the stigma faced by children, young people and people from African Caribbean communities, offering hope to a new generation that they can grow up without the fear of discrimination blighting their lives.
“The funding is an acknowledgement of both the importance of continuing to tackle stigma around mental illness and also the excellent results Time to Change has achieved so far.”
Notes to Editors
1) For more information on Time To Change see link http://www.time-to-change.org.uk/
2) Time to Change is a programme run by the charities Mind and Rethink Mental Illness, set up in 2007, that tackles mental health stigma and discrimination. It works closely with people with mental health problems to build their confidence and leadership skills to address stigma.
As a result of this campaign, so far there has been a four per cent reduction in the discrimination that people with mental health problems report, as well as improvements to public attitudes. According to data from the Institute of Psychiatry, King’s College London, the reduction in discrimination equates to 23,500 more people living lives completely free from discrimination compared to at the start of the campaign and 71,540 fewer people experiencing discrimination when looking for work.
3) The source of statistics in this press release: Mental Health of Children and Adolescents in Great Britain, Office of National Statistics, 2005.
http://nds.coi.gov.uk/content/detail.aspx?NewsAreaId=2&ReleaseID=421534&...
Andrew Lansley (Secretary of State, Health; South Cambridgeshire, Conservative)
The Government are today publishing "No health without mental health: A Cross-Government mental health outcomes strategy for people of all ages" for England.
At least one in four of us will experience a mental health problem at some point in our life, and around half of people with lifetime mental health problems experience their first symptoms before the age of 14. The society-wide costs of mental health problems have recently been estimated at £105 billion, and the costs of treatment alone are expected to double in the next 20 years.
We knew that change is needed and there are two powerful themes to our new approach. The Government must deliver a co-ordinated cross-Government focus, which genuinely supports local action. Equally, local strategies and more equal patients' voices enable more decisions about mental health to be taken locally based on evidence of effective practice and delivering the best value for our society.
Our approach is based on the principles that Government have laid down for all their health reforms:
patients would be more involved in decisions about their treatment and care so that it is right for them-there will be "no decision about me without me";
the NHS would be more focused on results that are meaningful to patients by measuring outcomes such as how successful their treatment was and their quality of life, not just processes like waiting list targets;
clinicians would lead the way-GP-led groups will commission services based on what they consider their local patients need, not on what managers feel the NHS can provide;
there will be real democratic legitimacy, with local councils and clinicians coming together to shape local services; and
they will allow the best people to deliver the best care for patients-with those on the front line in control, not Ministers or bureaucrats.
It is clear that the coalition Government's success will be measured by the nation's well-being, not just by the state of the economy. We know the conditions that foster well-being and, in recent years, much more about the interconnections between mental health, housing employment and safe communities. This strategy builds on that knowledge and the Government are investing around £400 million on psychological therapies to support people who need them across England. In all, this strategy captures this Government's ambitious aim to mainstream mental health in England and our commitments include:
making mental health a key priority for Public Health England, the new national public health service;
agree and use a new national measure of well-being;
ensure that mental health remains high on the Government's agenda by asking the Cabinet Sub-Committee on Public Health to oversee the strategy at national level; and
challenge stigma by supporting and working actively with the "Time to Change" programme.
"No health without mental health: A Cross-Government mental health outcomes strategy for people of all ages" has been placed in the Library. Copies are available to hon. Members from the Vote Office and to noble Lords from the Printed Paper Office.
http://www.theyworkforyou.com/wms/?id=2011-02-02a.45WS.1