Tag: cuts

Turning back the clock?

Here’s a post to draw attention to the RCN‘s newly published Report on Mental Health Services in the UK. This looks to be the latest document from Frontline First, a campaign revealing the effects of funding cuts on NHS care and nursing.

Working with the charity Rethink Mental Illness, and drawing on publicly available data, the RCN shows how (since 2010) the number of staffed mental health hospital beds across all four countries of the UK has reduced. The number of nurses working in NHS mental health services has also fallen, those remaining being revealed as an ageing group. Year on year, an increasing proportion is shown to be over the age of 50.

Here’s a chart showing reductions in the mental health nursing workforce, which I’ve extracted from page 16 of the report:

And, right at the front of the document, I see a clear case for investment contained in these recommendations which I reproduce word-for-word:

1) Governments must ensure there is equal
access to mental health services and that
the right treatment is available for people
when they need it.

2) Governments and NHS providers must
ensure that the commitment to parity of
esteem is directly reflected in the funding,
commissioning of services, workforce
planning, and patient outcomes.

3) Local commissioners and health boards
must make available enough local beds
to meet demand.

4) The principle of least restriction must
be embedded across all mental health
services. Detention under mental health
legislation should always be based on
clinical opinion and never be a result
of local failures to provide appropriate
care. Due to the significant increase in
detentions under the Mental Health Act
there should be a national objective set
to reduce detention rates in England.

5) There must be a consistent shift across
the UK from inpatient acute care to
community-based services which
recognises that prevention and early
intervention results in better outcomes,
reduces the pressure on acute services,
and reduces the overall cost to the NHS
in the long term.

6) Urgent action must be taken to address
the workforce shortages. Resources must
be committed to training and recruiting
enough mental health nurses who are able
to deliver specialist care in the changing
health and social care landscape.

7) NHS providers must invest in the current
mental health nursing workforce.
Band 6, 7 and 8 mental health nurses
should be developed to become advance
practitioners to deliver effective
recovery-led care in mental health
services.

8) There must be a sustainable and
long-term workforce planning strategy
which acknowledges the current
challenges facing the mental health
nursing workforce.

Disinvesting in mental health?

National Survey of Investment 2011-12Writing for The Guardian’s Healthcare Professionals Network this week, David Brindle reports that spending on mental health care in England has fallen for the second year in a row. He references unpublished figures disclosed last week to the House of Commons Health Committee, along with the 2011-12 National Survey of Investment in Adult Mental Health Services which appeared last August, and from which I have clipped these first two headline findings:

National Survey of Investment 2011-12b

The key figure here is the bit I have circled in red: that, in real terms, investment in mental health services in England in 2011-12 reduced by 1%. Last summer The Guardian reported the publication of this finding under the banner of mental health spending having fallen for the first time in 10 years, and if I am understanding David Brindle’s latest article correctly evidence of further cuts has been gathered since. Elsewhere in this piece Dr Hugh Griffiths, the Department of Health’s National Clinical Director for Mental Health, is quoted as having told the Health Committee last week of being ‘disturbed’ by reports of cutbacks to services in some English regions.

Meanwhile, via this piece in The Telegraph I see that the former coalition government Care Minister and LibDem MP Paul Burstow is heading up an independent Mental Health Commission with the liberal think-tank CentreForum. The Commission’s task is to ‘examine the state of mental health care provision in England’. This is a task made all the more urgent in the light of the finding, also contained in last August’s National Survey, of a £29.3 million reduction in investment in crisis resolution, assertive outreach and early intervention services.

All this paints a very bleak picture indeed. Reductions in funding and in services threaten to roll back the investments made in dedicated mental health care in the years following the publication, in England in 1999, of the National Service Framework for Mental Health. New Labour acted at tremendous speed in prioritising the mental health field. When in government Labour took action to develop community care through the creation of new types of services. It changed the law, put resources into improving access to psychological therapies and rewrote professional role boundaries. Some of the specifics were contentious, sure, but I for one did not doubt that the challenges of improving mental health and developing services were finally being taken seriously. In fact, Michael Coffey and I wrote about this period of policymaking in our wicked problems paper (which can be downloaded here). In this we urged careful consideration of the cumulative impact of policy actions, and the perils of trying to change everything in a complex system of health and social care all at the same time. But needless to say we made no case for cuts, which is what is evidently taking place around large parts of the country now.

As it happens, I can’t immediately find a Welsh equivalent for the Department of Health’s National Survey for England. If it’s out there, perhaps someone can point me in the right direction? It would be good to know the trends for investment in mental health services here in Wales. More generally, now I come to think of it, I want to learn more of the prospects for the future of the mental health system in this part of the UK now that the Welsh Government has a new Health Minister in Professor Mark Drakeford. The Minister is a Cardiff University Professor of Social Policy and Applied Social Sciences, and it will be interesting to see how future policy and services shape up under his direction.