Health Committee One-off session with the Secretary of State

Link to video of debate

Yesterday the Health Committee met with the Secretary of State, Jeremy Hunt. I watched the broadcast and made comments on the Facebook page about my initial impressions. Here you will find a summary of the items related to mental health. It is not intended to be a word for word account but I have attempted to keep the context of the questions and responses. There are a few links in this piece to documents of interest.

To start, below are the members of the committee:

Health Committee

Dr Sarah Wollaston was elected as Chair of the Health Committee on Wednesday 12 July 2017.

The remaining members of the Committee were formally appointed on Monday 11 September 2017.

Member Party
Dr Sarah Wollaston (Chair) Conservative
Luciana Berger Labour (Co-op)
Mr Ben Bradshaw Labour
Dr Lisa Cameron Scottish National Party
Rosie Cooper Labour
Dr Caroline Johnson Conservative
Diana Johnson Labour
Johnny Mercer Conservative
Andrew Selous Conservative
Maggie Throup Conservative
Dr Paul Williams Labour

Overall I found it to be an interesting and constructive meeting. I sensed a few areas where Jeremy Hunt seemed uncomfortable and defensive, but I generally got quite a good impression of him.

To help with some of the acronyms used:

JH = Jeremy Hunt

CQC = Care Quality Commission

CCG = Clinical Commissioning Group

NICE = National Institute for Health and Care Excellence

The mental health questions start about an hour into the video:

Questions from Luciana Berger

Luciana Berger
Luciana Berger

Q According to NHS Workforce statistics there are 5,168 fewer Mental Health nurses and 106 more doctors. In a recent interview JH quoted 4,000 more people.

Response

There are 4,300 more people working in NHS Trusts than 2010 and 2,700 people in Talking Therapies

Q Who are these people?

Response

There is a whole range of skill sets involved in an NHS Mental Health Trust. The reduction of nursing staff is a consequence of the Francis inquiry into Mid Staffs. Nurses were put in to hospitals which had a direct impact on mental health nursing. But the NHS are treating 120,000 more people every year than 3 years ago which equals 1,400 more every day. There has also been an expansion in therapies.

{Later on in the meeting the Chair requested details about the extra mental health staff and the talking therapies}

Q Why are we seeing an increase in children and adults presenting at A&E in mental health crisis. There is a 47% increase in people being detained under the Mental Health Act

Response

Professor Sir Simon Wessely has been asked to review the Mental Health Act, how it works and whether it needs to be changed. {A copy of the details of the independent review can be found here.}

The Health and Social Care Act 2012 legislation regarding Parity of Esteem between physical and mental health requires that a mental health crisis is dealt with as seriously and quickly as that of a physical health crisis. The NHS are rolling out crisis care including liaison psychiatry across the country. Currently half of the total A&E departments have mental health liaison services. This is part of the Core 24 Standards.

Q Why are so many people are turning up to A&E in crisis who are often having to be detained, instead of being dealt with prior to this through prevention or community services

Response

There is a core responsibility to deal with both crisis and prevention. Resources are being put in to place to deal with preventing crisis

Q CQC reports have highlighted many issues at all stages of accessing mental health care. In regard to resources JH has been quoted as saying that there has been an increase in resources by spending over half a billion pounds more on mental health this year. Why is it that many trusts, including Liverpool, are cutting mental health services

Response

Mental health spending is up 1.4 billion in the last 3 years. Last year out of 209 CCGs 177 spent their mental health target and 32 did not. There are discussions going on with those that did not. The overall impact was that an extra half a billion pounds was spent last year.

Q Money comes in to the trust but there is nothing to hold them to account to make sure it reaches the front line. There is not a requirement for every CCG to meet the required investment.

Response

Last years CCG funding went up. There are ongoing discussions to sort out issues. There has been overall expansions but there are still problems.

Q Locked mental health rehabilitation wards. There are 3,500 patients across the country in 248 wards. The majority are in private hospitals. The CQC report has questioned this model of care

Response

There is a concern about people being locked away in expensive high dependency settings for longer than necessary. If they are far from home they may be forgotten about. JH has had a meeting with officials who are coming up with a recommendation. As an example of good practice, JH quoted that Sheffield have eliminated their dependency on locked rehabilitation by providing better community care.

Questions from Dr Lisa Cameron

Dr Lisa Cameron
Dr Lisa Cameron

Pathway of care from child to adult services. The transition is often fragmented and difficult to streamline. Are you making progress?

Response

This is an area we need to improve. We have a children and young people mental health Green Paper coming out.

Q Access to psychological therapies. How are you monitoring time logged as being access to treatment?

Response

The target is for treatment to start within 18 weeks. This has just started to be measured. Demand is increasing and there is also the implementation of the Mental Health Forward View.

Q Target monitoring and parity of definition

Response

JH will write a detailed response

Q Mental Health in older adults. In the transition from health to social care it is important that psychological issues are addressed. Especially around depression and loneliness in older adults,

Response

This is an important issue which is not always given the importance it deserves. 40% of older people in care homes suffer from depression or anxiety compared to 20% of the older population as a whole. Sometimes mental health needs are clouded by physical health needs. The NHS are planning an expansion in the capacity of psychological therapies in order to meet these needs.

Questions from Dr Paul Williams

Dr Paul Williams
Dr Paul Williams

Q Waiting times for Autism diagnosis in children. NICE guidelines state that a multi agency assessment of a child with suspected Autism should start within 3 months. In some parts of the country families are waiting for up to 4 years. Will you consider a Waiting Time Target for Autism assessment. Diagnosis requires health services to work in partnership with Local Authorities. What can be done.

Response

We need to do better. JH will look in to this and will discuss the issues with the NHS

Follow up question from Dr Lisa Cameron

Q Do you have a map of how many clinicians are trained to diagnose autism and where there are gaps?

Response

JH will find out


The next item to be shown on Parliament TV that I am interested in is on 3 November 2017 when the second reading of the Mental Health Units (Use of Force) Bill will be presented in the House of Commons.
A video link will be available on our Facebook page from 9.25 am.

 

 

 

Report of the House of Lords Committee on the Long-term Sustainability of the NHS 24 October 2017

Committee Video

As promised, here is a summary of the Long Term Sustainability of the NHS committee meeting.

Having only ever seen Prime Ministers Questions on the news, the prospect of watching a debate was not very appealing. The idea of watching people talking over each other and cajoling and being unruly isn’t my idea of fun, but I actually enjoyed watching most of it (there was a point where my attention wandered and I wasn’t following everything they were saying). The committee was made up of health professionals who were either current or previous NHS employees as well as GPs and surgeons. There were also members of the House of Lords who had medical connections. They were all very agreeable, listened to each other and actually answered questions appropriately!

Here is the background to the report.

The meeting lasted about 2 hours and I have summarised the points I found interesting and relevant. The timings I have used are approximate as I was stopping and starting the footage to write notes.

14.35 – Summary of report

The authors of the report summarised their findings by saying that all sectors of the NHS worked in a culture where only the short-term was considered – a sort of fire fighting the immediate problems. The only long-term thinking is the 5 Year Forward Plan. Here is a link to a document about the plan. Health Education England were attempting to plan longer term but were thwarted by clashes with other ministerial objectives.

The recommendation was that the 5 year plan was not sufficient.

The Government have not yet responded to the report. The reasons given were that the Election got in the way and there was an email from the Department of Health saying that a response will be given after the Budget.

 

14.40

They discussed the recommendation to set up an Office for Health and Care Sustainability which would look 15-20 years ahead. It would be an Independent Advisory Body which would produce evidence in data form. As this would be an independent body the public would have more confidence in its findings. The lack of long-term planning was partially because Health Ministers change quite frequently and therefore do not have the motivation to think to the future. Therefore an independent agency would be more effective as it would be non political. The body would focus on:

  1. Demographic population changes which might affect health
  2. Requirement for workforce planning
  3. Prevention

14.50

They discussed forward thinking about workforce needs. Regarding the length of time it takes to train doctors and nurses it was deemed necessary to plan ahead for what sort of skills would be needed in the future.

14.55

They discussed the role of GPs, the need for integration between Primary, Secondary and Social care and the need for change in working practices.

15.13

Current Regulation is a barrier to workforce reform and workforce planning. They discussed the need for existing staff to receive on the job training to keep up with new ideas and practices.

This part surprised me as I know a Physiotherapist who works in the Private sector. She goes for regular retraining sessions which I believe is a requirement for membership of the society.

15.17

A question was asked about the effect of Brexit on staffing levels. Figures were given about how many EU and non EU staff the NHS employs. It was agreed that the culture of relying on other countries to provide staff is wrong. An example was given that hiring staff from developing countries adversely affects their country of birth as it deprives them of medical staff which they desperately need.

Retention of staff, career structures and low morale amongst staff were also discussed and the report puts forward that these issues need to be addressed.

15.24

The training issue was broached again with two examples:

  1. A Mental Health nurse not being able to treat a wound
  2. A general nurse not being able to treat mental health patients

The conclusion was that the initial training of all staff should include basic training in disciplines other than those being specialised in

15.40 Funding

This is where I zoned out a bit, but I did understand that the current situation is that the funding of social care is with Local Government but Social Care Policy sits with the Department of Health. It was suggested that the two be brought together.

They also discussed a proposal for a Social Insurance system which would provide personal funding to be spent on social care when needed. Japan and Germany already have such a scheme in place.

16.20 Public health prevention

There is currently no central strategy for keeping people healthy. The UK is 2nd in the world league table for obesity behind the USA. It was noted that preventable diseases cost the health service a lot of money in care that could be used for other people

16.25

There was a brief discussion on a prevention strategy for mental health. It was noted that the idea that mental health being equal to physical health still had a long way to go.

The topic of Mental Health funding will be discussed on 21st November. 

16.33 Patient responsibility

The report also dealt with patient responsibility. This ties in with the area of prevention and it was deemed necessary that a mixture of Government Regulation and effective education could help to keep people healthier for longer.

I will watch out for any other items of interest, especially the Mental Health Funding discussion in November.

 

 

 

 

 

 

 

How to get help in a crisis

There seems to be a lot of coverage of mental health issues and talking about emotions. Which is brilliant.

But how easy is it to actually get help if you are in crisis?

The first step should always be your GP. A GP can listen to your symptoms, prescribe medication, order tests and refer you to more specialist services. The first two, listening and prescribing, are relatively quick. Medication can take a while to start working effectively, but often the knowledge that something is being done can make a huge difference. I know this because the last time I increased my dose I went back for a follow-up appointment a few weeks later. The doctor asked how I was feeling and I told her how wonderful everything was. She then told me that the increased dose won’t actually kick in for another couple of weeks!

Further tests, usually blood tests, can help to diagnose if it is depression or another condition that has similar symptoms. So it is important to follow this up.

Referral to specialist services is something that takes time. On the Transparency Indicators for NHS Trusts there are indicators for:

  • People waiting less than 6 weeks to start treatment
  • People waiting less than 18 weeks to start treatment

If you’re anything like I was and you’ve struggled for years without knowing what’s wrong or what can be done about it, when you need help it is urgent. Six weeks are an eternity if you struggle to get through one day.

So this is why you should seek help as soon as you think you have a problem. This is easier said than done. I struggled for 2 years, probably more, before I sought help of any kind. And when I did get help I was sent to hospital.

If you are in crisis, you can only access the crisis support team if you have already been referred by your GP. Local charities may only help if you have been referred by your GP.

Once you are in the system you can access other services. Referral to a Mental Health team, access to psychiatrists and therapy and access to a crisis support team. These all come with a waiting period. So the trick is to get in the system before you need help. Which doesn’t make sense. To me.

However, there are options open to you if you don’t have a referral: 

Listening and emotional support services via telephone or internet.

Emergency or Out of hours GP appointments

Accident and Emergency

Support Group

Counselling (fee paying)

See our How to get help A-Z page for details. Please tell us of any other services that you are aware of or that have worked well for you.

My research diary

9th October 2017

 

 

It’s been a while since I felt able to do research. I have tried to get other people involved in helping by joining Helpfulpeeps, a website that puts people in touch with each other with the aim of helping each other. No cash involved. I have had a little interest and am still hopeful that help will arrive.

I think I have discovered that researching the services on offer in the UK is not my strong point. So I have decided to concentrate on the things I find easier to do, writing blogs and reporting on news items.

I have decided to turn my attention to researching the history of the NHS and how it was before the NHS came into being.

This sounds like a project more suited to my strengths as it involves history. I have already found a useful article in Wikipedia which I will use to guide me through my research, and I have bought 2 books (another love of mine) which I am hoping will provide some information. The first book is The Citadel by AJ Cronin, which I have downloaded as an eBook. Apparently, this novel published in 1937 instigated criticism about health care in England and it is cited as being  important in laying the foundation for the NHS.

The other book I have ordered is The Dawn of the Health Age by Dr Benjamin Moore. It was published in 1910. This synopsis is a quote from Amazon:

“written by an Englishman, it applies to conditions in the United States as well as in Great Britain. The author endeavors to demonstrate the necessity for an entire remodeling of the present system of medical service in the interest of the whole community, by showing that thousands of lives and millions of money can be saved every year if disease is attacked on scientific principles “instead of being dallied with as at present.” Dr. Moore advocates a system of state medicine by which competent physicians are made officers of the state for the suppression of disease…”

This sounds quite interesting and useful as a reference point. I just hope that it is easy to read as I often find my attention wandering.

That’s where I’m up to at the moment. I shall try to keep you posted as to my progress.

 

 

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