Leading support for those with mental health issues and learning disabilities

Adobe Spark (3)The Chief Nursing Officer has told mental health and learning disability nurses they need to ‘step up and take the lead’ in delivering ambitions set out by NHS England for mental health and learning disability services. Speaking at the NHS Expo in Manchester, Professor Jane Cummings said:

‘Nurses are creative, they’re innovative, they’re leaders, and they can really drive that change that we all want to see.’

Cummings outlined the important leadership role that mental health nurses have in delivering the Five Year Forward View for Mental Health (NHS England, 2016), and that learning disability nurses have in delivering the Learning Disability Transforming Care programme:

‘I think that nurses and midwives should be at the driving edge of change and improvement. I think there is a wealth of knowledge, a wealth of experience. And there’s a huge amount of skill set that nurses can have to really drive the change that everyone wants to see.’

Five Year Forward View for Mental Health

The Five Year Forward View for Mental Health was launched in February 2016 in an attempt to improve mental health outcomes across the health and care system, and includes an additional £1.4 billion of investment in mental health services by 2020/21. The funding will go towards the creation of 21 000 new posts, including 4600 nurses working in crisis care settings and 1200 nurses and midwives in child and adolescent mental health services. Other policies include giving an extra 1 million patients access to mental health services at an earlier stage, round-the-clock services, and the integration of mental and physical health services for the first time.

Cummings said that improvements to mental health services is one of the ‘national priorities’ for NHS England, emphasising how there is a massive amount of work going on around mental health, with a real focus on improving access to services:

‘We are particularly focusing, through the Maternity Transformation Programme, on perinatal health. As part of that we have a big workstream looking at perinatal mental health and supporting women to cope with any problems they get post birth.’

According to Claire Murdoch, National Director for Mental Health, the priorities of the Five Year Forward View for Mental Health are built on a core set of pre-existing services that are transforming and developing to create an ‘absolute, quiet and steady revolution in mental health care.’

Murdoch echoed Cummings by also calling mental health nurses to ‘step forward and step up.’ However, in order to do this she said nurses need to become vocal about their skills, and experts in co-production and working alongside mental health service users in their own care. As part of plans laid out in the Forward View, Murdoch said the NHS will see an additional 1 million extra patients. This will include 70 000 more children and young people, who will have increased access to specialist eating disorder services within the community.

Murdoch explained how further evidence-based interventions, made earlier in the pathway of illness or distress, will ‘fundamentally change the outcomes for people’s lives so that we don’t create unwittingly long-term patients for the future.’ She added that there will be more tier 4 specialist beds for children and young people suffering from serious mental health problems, particularly in London and the south, where occupancy often outstrips demand. Additional improvements in respite care, crisis houses and home treatment teams were also assured.

According to Murdoch, nurses are leading community mental health teams for children and young people. Working alongside psychologists and doctors, she explained that they are playing a key role in the management of conditions such as eating disorders. Community eating disorders services for young people largely did not exist until last year, and Murdoch commended the mental health nurses, who she said were not only leading those teams, but also breaking new ground in having to work alongside families, the young people themselves, and deliver evidence-based care in completely different settings.

One of the greatest concerns Murdoch highlighted was the current pressure on the mental health crisis care pathway. In particular she stressed the need to prevent beds overspilling into the private sector and long waits in accident and emergency (A&E) departments. However, she announced that nurses have led the way in redesigning the care pathway through the ‘development of intensive current treatment teams’ and the ‘establishment  of the psychiatric liaison teams in A&E and acute hospitals more widely.’

She believes nurses will play a ‘fundamental part’ in ‘bringing an end to inappropriate out-of-area placements.’ An example she cited was in Birmingham, where nurses are working alongside the police to dramatically reduce the use of Section 136 of the Mental Health Act, which allows the police to take a person who appears to be suffering from a mental disorder to a place of safety. She said this has enabled better outcomes for people in distress.

Though she raised concerns that large numbers of nurses are leaving the profession and that recruitment will be an additional challenge, she said ‘there has never been a better time to be a mental health nurse.’ However, she urged mental health nurses to be vocal about their skills, whether that is their skill of assessment or complex working in networks of care.

‘We need to become the experts in co-production and working alongside mental health service users in their own care. We need an effort to come up with a care plan that hasn’t been produced at least in partnership, even at times of great crisis. We need to become the experts in that space. Housing, debt, employment, the physical health care, these are the domains of mental health nurses.’

Transforming care for people with learning disabilities

Alongside improvements to mental health services, a national plan to develop community services and close inpatient facilities for people with learning disabilities has meant better care for this patient group. The focus of the Learning Disability Transforming Care programme is on giving people with learning disabilities the opportunity to live in the setting they think is home. It also aims to stop overmedication and improve access to annual health checks.

Vicki Stobbart, a disability nurse and Executive Director of Nursing and Quality for Guildford and Waverley CCG, said that while learning disability nurses may not be as high profile as other areas of nursing, their impact and value in supporting people with learning disabilities should not be underestimated.

‘Learning disability nurses are the only professional group specifically trained to work with people with learning disabilities,’ said Stobbart. ‘This level of preparation, currently provided at degree level, alongside the breadth, competence and knowledge they develop, makes them a unique and critical component on the delivery of comprehensive skills.’

Alongside presentations on the leadership role of mental health and learning disability nurses, Professor Cummings led a panel discussion with healthcare staff and service users on how nurses can play a key role in the care of mental health and learning disability patients. Organised by NHS England, the Health and Care Innovation Expo saw over 5000 delegates learn about developments and innovations taking place across health and social care.

Looking at the progress made since the launch of the Five Year Forward View, it identified a number of key areas of priority, including urgent and emergency care, primary care and general practice, cancer, and mental health.

Taken from British Journal of Mental Health Nursing, published November 2017.

Advertisements

Government’s additional £1.3 billion for mental health services is misleading

Adobe Spark (4)The Government has committed £1.3 billion to transform mental health services by 2021 (Health Education England (HEE), 2017). Stepping Forward to 2020/21: Mental Health Workforce Plan for England was launched by Health Secretary Jeremy Hunt, who called it ‘one of the biggest expansions of mental health services in Europe’ (Department of Health, 2017). The funding will go towards the creation of 21 000 new posts, including 4600 nurses working in crisis care settings and 1200 nurses and midwives in child and adolescent mental health services.

Other policies include giving an extra 1 million patients access to mental health services at an earlier stage, round-the-clock services and the integration of mental and physical health services for the first time.

Examining the plan

The scale of these proposals is commendable and reflects the additional staff required to deliver the transformation set out in The Five Year Forward View for Mental Health (Mental Health Taskforce, 2016). Mental health provision has consistently been underfunded, therefore an update to place it more in line with physical health provision is long overdue.

For this reason, the announcement has been welcomed by many mental health campaigners and professionals. The Royal College of Psychiatrists (RCP) led the way in commending the Government’s plans, with Professor Wendy Burn, President of the RCP, saying the 570 extra consultants promised in the strategy will be ‘crucial to delivering the high-quality, robust mental health services of the future’ (RCP, 2017). NHS Employers said service providers will welcome national support, particularly for ‘improved access to funding for continuing professional development for the mental health workforce, and facilitating increased use of international staff where required’ (NHS Employers, 2017).

However, despite the will to welcome these proposals it would be wise to take them with a pinch of salt. While the Royal College of Nursing (RCN) encouraged the investment, it said the Government’s proposals ‘appear not to add up’ (RCN, 2017). RCN chief executive, Janet Davies, stressed that in order for the nurses to be ready in time, they would have to start training straight away. Additionally, she cites how the scrapping of nursing bursaries has led to a ‘sharp fall in university applications’.

Attrition rates on the rise

Attrition rates for all mental health staff are rising. From 2012/13 to 2015/16, the number of people leaving mental health trusts has risen from 10.5% to 13.6% (HEE, 2017). The NHS currently funds over 214 000 posts to provide specialist mental health services in England. However, over 20 000 of these vacancies are predominantly filled by bank and agency staff (HEE, 2017). It is clear the sheer scale of growth cannot be met via the traditional training routes within this timescale, as in some cases this would mean doubling or trebling the workforce. While investment is needed in the development and reskilling of existing staff, or looking to the global market for recruitment, this is an unrealistic aim.

The Royal College of Occupational Therapists (RCOT) is one of the groups who have raised concerns over vacancy rates. Julia Scott, CEO of the RCOT, said health and care services across the country are experiencing real difficulties in filling existing vacancies, with vacancy rates for occupational therapists of up to 50% (RCOT, 2017). She stressed that rapid action is needed to address this crisis if commitment is to be delivered.

The British Medical Association (BMA) echoed worries over recruitment, stressing insufficient psychiatry trainees across England and a high percentage of trainees not completing training in the specialty. BMA consultants committee deputy chair and consultant child and adolescent psychiatrist, Dr Gary Wannan, said: ‘In 2014, one in five doctors undertaking core psychiatry training did not progress into the final part of their training’ (BMA, 2017).

Government pledge still insufficient

Currently, 15.8% of people with common mental conditions access psychological therapies each year. However, even with the Government’s proposals this will only increase to 25% by 2020/21 (HEE, 2017). This is still an unacceptable figure
and one that is emphasised by the UK Council for Psychotherapy (UKCP), who said the announcement falls far short of what is needed to offset the growing demand for NHS mental health services.

According to UKCP Chair Martin Pollecoff: ‘To meet even existing demand, the Government should take advantage of the vast existing workforce of therapists. UKCP alone has more than 8000 highly qualified trained psychotherapists from different backgrounds, and many of them have medical experience’ (UKCP, 2017).

Origin of investment misleading

This is not the first time the introduction of £1 billion for mental health services has been proposed. In 2016, then Prime Minister David Cameron announced almost £1 billion of investment as part of a ‘revolution’ of mental health treatment (Prime Minister’s Office et al, 2016). This commitment from the Government sounds impressive, but has to be considered in the context of cash terms rise in the NHS budget generally. The Government has pledged to increase NHS spending in England to £120 billion by 2020/21
(HM Treasury, 2015). For mental health spending to grow at the same rate as the rest of the NHS, around 11.9% of the extra funding given to NHS England needs to be spent on mental health (Full Fact, 2016). This works out at roughly £2.2 billion. This figure far exceeds the £1.4 billion pledged in the most recent announcement and clearly represents a slower rise in spending than other parts of the NHS.

Simply not good enough

At first glance, the Government’s proposals appear to be the desperately needed boost to mental health services, which should be welcomed. However, the explanations of how additional posts will be funded or the recruitment issues overcome does not add up and are simply not good enough.

The Government has sugar-coated the amount of investment pledged and the figure still falls far below what is needed for mental health. It therefore comes as no surprise that Labour’s Shadow Minister for Mental Health, Barbara Keeley MP, said the workforce plan: ‘offers little hope to those working in the sector faced with mounting workloads, low pay and poor morale’ (The Labour Party, 2017).

References

British Medical Association (2017) BMA responds to Department of Health mental health workforce plans. BMA, London. https://tinyurl.com/ybtgxye8 (accessed 29 August 2017)

Department of Health (2017) Thousands of new roles to be created in mental health workforce plan. DH, London. https://tinyurl.com/y9akdjdr (accessed 31 August 2017)

Full Fact (2016) Unanswered questions on “extra £1 billion” for mental health. Full Fact, London. https://tinyurl.com/y7oyy8qc (accessed 1 September 2017)

Health Education England (2017) Stepping forward to 2020/21: The mental health workforce plan for England. HEE, Leeds. https://tinyurl.com/ycebebna (accessed 25 August 2017)

HM Treasury (2015) Spending Review and Autumn Statement 2015. The Stationery Office, London

The Labour Party (2017) Tory Government promising jam tomorrow when action is needed today to tackle the staffing crisis in mental health – Keeley. The Labour Party, Newcastle upon Tyne. https://tinyurl.com/y7db35pf (accessed 29 August 2017)

Mental Health Taskforce (2016) The Five Year Forward View for Mental Health. NHS England, Leeds. https://tinyurl.com/gvc4or3 (accessed 25 August 2017)

NHS Employers (2017) NHS Employers welcomes plan to prioritise mental health services. https://tinyurl. com/ydg8h3ca (accessed 29 August 2017)

Prime Minister’s Office, 10 Down-ing Street, Department of Health, NHS England, The Rt Hon David Cameron, The Rt Hon Jeremy Hunt MP (2016) Prime Minister pledges a revolution in mental health treatment. Department of Health, London. https://tinyurl.com/z69jcpc (accessed 1 September 2017)

Royal College of Psychiatrists (2017) RCPsych response to HEE’s Mental Health Workforce Plan. RCPsych, London. https://tinyurl.com/yc2p93k8 (accessed 25 August 2017)

Royal College of Nursing (2017) RCN responds to Mental Health Workforce Plan. RCN, London. https://tinyurl.com/yavm3ulq (accessed 25 August 2017)

Royal College of Occupational Therapists (2017) Royal College of Occupational Therapists welcomes an expansion in the mental health workforce. RCOT, London. https://tinyurl.com/ycl9bss2 (accessed 25 August 2017)

UK Council for Psychotherapy (2017) We urge the Government to use existing therapist workforce to plug treatment gap. UKCP, London. https://tinyurl.com/ydfojrpk (accessed 29 August 2017)

Taken from British Journal of Mental Health Nursing, published September 2017.