On 13th October the EADT and the Ipswich Star reported that our mental health trust – the Norfolk & Suffolk NHS Foundation Trust (NSFT) – had been rated inadequate and placed in Special Measures for the second time. Various reasons were given, but they mostly stemmed from three causes – not enough staff, insufficient beds and poor management. The new Chief Executive Julie Cave was appointed on the day that the report came out, so the Trust is making serious moves to improve the management.
I went to meet the Trust’s management at the Woodlands unit on 13th October. I made it clear to them that I was not there to criticise, or to attack, but to find out what I could do to help them to make our mental health services fit for purpose – or even a service we can be proud of. Problems include:
- A lack of commitment from the rest of the NHS.
- Not enough highly-skilled staff – and too many staff leaving the profession because of over-work and low pay.
- Lack of specialist units.
- Too much money going into private hospitals because of the lack of NHS staff and beds.
- Not enough early intervention services, especially for young people.
- Delayed transfers – as with general hospitals there are too many patients stuck in mental health beds who are well enough to leave with the right help, but who aren’t getting that help either from the NHS or from Social Care.
- People being inappropriately referred to mental health services, or not being referred until much later than they need, which means they end up needing far more extensive treatment.
I am glad NSFT recognises its problems – only by identifying them has it got any chance of putting them right. It is working with the University of Suffolk on recruitment and training, and trying to get better cooperation from hospitals and GPs, and planning new services for young people next year. I will do what I can to encourage the other organisations it needs to work with to take mental health more seriously.
But so many of the problems come down to lack of money. Your paper is today highlighting some of the substantial pay-outs to managers who have now left. I believe there is a real issue about rewarding failure – in the public sector or the private sector. But let’s be clear, the sums involved are small in comparison with the size of the problems NSFT faces.
NSFT’s budget now is about the same, in face value terms, as it was when it was founded in 2012. In that time, the RPI index has risen by 15.4%. So that means that in real terms – the only terms that count – they have had their budget cut by 15.4%.
They now have fewer doctors and nurses than they did five years ago. At the same time, demand for mental health services has soared, at least partly as a consequence of rising homelessness, changes in benefits, and insecurity at work.
The Conservatives’ disastrous health reorganisation in 2012 removed the government’s duty to provide a comprehensive health service. Now, nobody is responsible for providing a consistent and comprehensive NHS. But, if government ministers are not responsible or in charge, who is?
NSFT depends on the clinical commissioning groups (CCGs) to provide funding. NHS England is supposed to give strategic direction, but has never addressed the lack of resources and sound management which have resulted in the mental health crisis. Another quango, NHS Improvement, sends Improvement Directors into the mental health trust – but these trouble-shooters cannot succeed without the full financial support of local commissioners which is not forthcoming. And the so-called market reforms have resulted in the voices of service users, carers and professionals going unheard.
We must not forget the human cost. In 2012-13, there were 88 unexpected deaths of NSFT patients – by 2016-17, this had more than doubled to 182. Often we hear that mental health will affect one in four of us. In fact it affects us all: whether it is a grandparent with dementia, a nephew with a drug problem, a colleague with depression, a cousin with an eating disorder, a suicidal neighbour, or a neglected rough sleeper with schizophrenia.
It is time for the government to stop mouthing platitudes and put in the money that’s needed. The way we treat our most vulnerable members is the true measure of our society. We cannot continue to walk by on the other side of the road.