Monday, 15 February 2016

Time for actions to speak louder than words

I was briefly interviewed today by @BrekkyAliButts for BBC Radio Manchester’s breakfast show. I answered questions on the report ‘The Mental Health Five Year Forward View’ and the current state of mental health in England and specifically Greater Manchester.

I really welcome the report and will say a little more on that later. While I’m proud of all that we achieve in Pennine Care, it was uncomfortable listening to a long list of sobering facts on where mental health care fails people in our communities.

In 2011 the term ‘Parity of Esteem’ was coined with good intentions to ensure mental health care was on a par with physical care. Since then we have gone backwards in my view.

In 1999 as part of a series of ‘National Service Frameworks (NSF)’, the Government of the day launched a report specifically for mental health, from which new investment followed. Click here to read it. I know from my own personal experience at the time not all allocated funding reached the frontline, but it did lead to an overall improvement in some key areas.

However, the mental health NSF barely reached year five of its 10 year plan.  Since then there has been a series of reports and recommendations, including the arrival of Parity of Esteem in 2011 and a six point mental health strategy.

Yet today’s report talks of years of low prioritisation and chronic underinvestment in recent years. How can mental health maintain such a high profile but not receive the investment this report says is needed?

The public support it, the politicians support it, service users, carers and mental health staff all support it. The evidence is also there (in the report) to demonstrate it makes good economic sense and will improve health inequalities too. So why isn’t it happening?

Overcoming challenges

Back to the questions I faced this morning on BBC Radio Manchester (click here to listen again – forward to around 1.13).  If you listen to this you can hear Alison list example after example of where care isn’t working.

Long waits for certain types of care, people having to leave their local area for acute in-patient care, young people not getting access to the care they need. It just isn’t acceptable in my view. Before discussing the report and what I hope it will mean, I’ll share with you the position regarding Pennine Care.

Across the towns we serve we face challenges not dissimilar to the ones set out in the report. There are relatively low levels of investment in mental health, but I am hoping we are entering better times following this report and a Government commitment to invest in mental health.

I would agree with Paul Farmer (Chair of the Taskforce that has produced the report) that we now need transparency on mental health investment and clarity on where funding will go and how it will be used.

Despite some low levels of funding we do not have some of the challenges reported today; I am proud to say that we don’t send any acute patients out of area to distant hospitals - we didn’t have one episode in the last year and only a few brief instances the year before.

I know this isn’t the case elsewhere in the country. It means Pennine Care staff are working tirelessly to keep people close to their home.  However, the pressures are significant and I can’t thank our staff enough for the work they do day and night.

Maintaining quality in the face of adversity

Despite having to deliver nearly £17m of savings since 2010 I am pleased to be able to note that our overall quality has been maintained and access has improved, for example we do provide 24/7 crisis and liaison psychiatry services to hospitals.

Our 24/7 crisis services operate along an open access model and, unusually, we provide a service to children too. Overall we have increased the total number of patients seen from 32,000 in 2010 to nearly 51,000 in 2015.

We still receive good quality ratings and high scores on our Friends and Family Test, relatively low numbers of complaints and, overall, we provide safe services to the people we care for.

I am pleased that our Healthy Minds Service (psychological therapies) now takes referrals from people with long-term physical health conditions.  I think we are one of the first to actively encourage this and it is an area highlighted in today’s report.

However, this is against a backdrop of staff feeling pressures greater than I have had reported to me before. The reductions in local authority services has really been felt in community mental health teams; the work programme has, in my view, put some vulnerable people with mental illness under unnecessary and inappropriate pressure and the level of therapeutic provision (such as psychological care) can never be high enough within such limited resources.

Having listened to staff and patients over the last year, I am personally working with commissioners to call for more investment in our mental health wards.

Despite these pressures I am very optimistic that this report will make a difference. I am already seeing some very positive commissioning intentions emerging and we are revisiting our mental health strategy in Pennine Care.

The devolution work across health and social care in Greater Manchester (GM) has already made mental health a priority for the city region. Paul Farmer, as chair of the taskforce, has led an honest review, reported a plain view of the reality of the current picture and set out a very pragmatic, meaningful way forward.

Please do read the report - with a national drive and a local GM strategy I am hopeful we will see some real progress.

Overcoming the stumbling blocks

I see only two stumbling blocks to making progress.  The public and politicians recognise and call for more investment, as do those who study the evidence for good mental health care (clearly set out in the report launched today).

The first stumbling block is the overuse of hospital care. Over the last several years the wish of commissioners to invest more in mental health has been blighted by increased hospital costs every year.

Once again the Devolution Strategic Case aims to address this and, without wanting to sound blindly optimistic, in fact I am optimistic! There is a key objective to provide more care out of hospital and mental health has to be a key aspect of this movement.

The second obstacle is more difficult to articulate.  To sum it up I would say the continued presence of stigma prevents mental health achieving the parity that society deserves and needs.

I’ve heard examples of stigma shared with me through conversations high up in health departments and have witnessed it locally myself.  Mental health has been too easy to dismiss or ignore by those who influence policy or determine where investment should fall. 

Unless you’ve experienced mental health stigma yourself, or in your family or friendship circle, unless you’ve worked as a nurse, therapist or a doctor with people and their families, I think there are still large numbers of people who don’t fully understand or appreciate the devastating impact it can have.

The Mental Health Five Year Forward View sets out how you are more likely to experience mental health problems if you are from a vulnerable or marginalised group, or don’t have stable housing or employment.

If you don’t experience these issues on a daily basis, policies can be just words on a page and investment plans numbers on a page. I’m not sure I am capturing this well, but I feel certain that, as a society, or maybe even just in the NHS now, we have an inherent bias towards hospital care and physical disease.

The report today says that next steps require ‘a fresh mindset’ and I would urge everyone to reflect on their own contribution and role in ensuring mental health is a priority.
Stigma is nowhere near what it was when I started nurse training in 1984.  It was appalling 32 years ago. Now we live in much more enlightened and educated times, with members of the public leading the way in calling for better mental health care.

I think it’s time for the NHS to catch up with the public mood and deliver against the excellent report published today. 

It is now time for implementation - where actions will speak louder than words.


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