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.

Advertisements

Dental Nursing News February 2016

DN News FebPatients test positive for Hepatitis C

dental nurse who spoke out about hygiene conditions at a dentist’s surgeries in Ayrshire—sparking an HIV scare for 5600 patients—was told by the practice manager: ‘no one has caught anything yet,’ a disciplinary hearing has heard.

The nurse, who remains anonymous and is identified only as ‘Dental Nurse One’, contacted the NHS Ayrshire and Arran health board on 16 September 2013, after she was told of the routine reuse of equipment in an area known for high drug dependency.

Dentist Alan Morrison is accused at a General Dental Council Committee of failing to sterilise instruments between treating patients and reusing dirty gloves at his clinics in Cumnock and Drongan.

An investigation was launched into the dentist’s practices after the nurse blew the whistle, sacrificing her new job. At a hearing in London, the nurse recalled how she was offered a job on the spot, but was told by the practice manager, Lorraine Kelly, of procedures that put patients at risk.

‘She then told me that, “We would do things a bit differently here”…She proceeded to tell me that the practices reuse gloves and matrix bands and did not sterilise aspirators.’

The nurse said that she was shocked at Mrs Kelly’s remarks but that the manager replied in a ‘flippant manner’ that ‘no one’s caught anything yet.’ The whistleblower went on to say: ‘Both practices are in areas of high levels of drug use and therefore are likely to have contact with patients with blood-borne viruses. Although Mr Morrison was not present in this conversation, it was obvious he was aware of procedures and practices as owner of the practices and a practising dentist.’

Many patients underwent testing as a result of being sent a letter. No patients had contracted HIV, however four adult patients tested positive for Hepatitis C. Of these, three had evidence of chronic infection and one showed signs of a previous infection.

It emerged at a health board meeting that two of the patients had received dental treatment on the same day.

However, it could not be established whether the infection was picked up from the practice or from outside their dental treatment.

Mr Morrison has admitted falsifying invoices for medical supplies handed to NHS investigators, which showed phoney purchases of single-use equipment, including matrix bands, but denies the rest of the allegations.

Morrison and Kelly are accused of failing to adhere to infection control guidelines and of being dishonest during the health investigation.

NHS England guide to unscheduled care

NHS England has published a quick guide to unscheduled dental care to help provide practical tips for dental providers and commissioners, and relieve pressure on frontline services.

Within the guide, dental health professionals are advised to ensure accessibility of services by keeping their NHS Choices profile and Directory of Services profile up to date, and ensuring their answerphone provides correct details for signposting to 111 for urgent dental care.

To relieve winter pressures on services, it is recommended that patients are encouraged to seek oral care early. Winter campaign materials should be used to promote oral health and seek early advice for oral symptoms, social media and practice websites should be used to provide information about oral health and access to services, and patients should be advised about taking good care of their own oral health.

The guide goes on to say that self-care advice and management of pain is essential during times when dental treatment services are not available. The dental case mix should be managed by suitably trained dental care professionals (DCPs), who should have the capability to book treatment slots directly with dental providers. Where DCPs cannot provide advice, it is recommended that there should be a mechanism for them to refer to a pharmacist or seek additional clinical advice.

The effective triage of patients with dental problems is also emphasised within the guide. It is noted there are a number of options for triage that could be used and the configuration will depend on local requirements, such as the Dental Nurse Triage service that is being procured in London. This service will receive patient information via NHS 111; return calls and carry out a clinical telephone triage using established dental algorithms; and provide information, reassurance and advice to callers and allocate patients to same day, next day treatment slots or signpost to an NHS dental service.

The service will be delivered by trained and experienced dental care professionals, and is planned to operate between 6pm and 8am during the week. It is also planned to operate 24 hours during weekends and bank holidays. The service will have a phased implementation from 1 April 2016 and align with NHS providers in London.

BDA suspends strike action

The British Dental Association (BDA) suspended industrial action planned for 26–28 January in support of the British Medical Association (BMA), as it seeks to rekindle talks to resolve the differences over the proposed new contract for hospital juniors in England.

The BDA has been following the BMA’s lead in disputing the proposed contract, and supporting hospital junior dentist members to ensure a safe and fair junior contract is put in place. BDA junior hospital dentists took action on 12 January, protesting against the erosion of patient safety and the potential impact on dentists’ working lives.

An announcement from the BDA on the proposed contract, said: ‘We feel it removes vital safeguards for both dentists and their patients. We want to ensure dentists are protected from being required to work excessive hours in a week. We oppose the plans for the extension of standard time from the current 7am to 7pm, Monday to Friday to 7am to 10pm, Monday to Saturday, as we don’t feel this values dentists’ time appropriately.

‘We also object to the proposals on pay progression, which may mean some dentists are discouraged from entering specialist training, due to the plans to increase pay only when a trainee moves to the next stage of training and responsibility. We feel this particularly disadvantages those with families, because of the financial worries of taking time out of training for maternity leave or to work part time. It will also discourage those already in training from undertaking research or retraining in a preferred specialty, to the long-term detriment of the NHS.’

Further action for a full withdrawal of labour is still planned for Wednesday 10 February 2016.

Sound bites

Parliament calls for ‘complete overhaul’ of the General Dental Council (GDC). Members of the House of Commons debated the Section 60 Order which, if laid, will allow the GDC to introduce case examiners into its fitness to practise (FTP) process. This followed a debate in the House of Lords on the same subject, during which Shadow Health Minister Lord Hunt repeatedly called for resignations within the GDC.While the debates in both Houses were held to discuss these changes to the Dentists Act 1984, the main focus of the discussions was the performance, and the fitness to regulate, of the GDC. Shadow Health Minister Justin Madders raised the need for a ‘complete overhaul’ of the GDC, calling it the most expensive and least efficient of the health regulators, and noting the lack of confidence the profession has in the GDC.

The National Institute for Health and Care Excellence (NICE) has published new guidelines on oral health promotion in general dental practice, placing a focus on giving patients the ability to make an informed decision about their care. The guidelines cover how general dental practice teams can give advice about oral hygiene, the use of fluoride, as well as how areas such as diet, smoking, smokeless tobacco and alcohol intake affect oral health in order to help patients make informed decisions about their own care and encourage preventive treatments. Dr Ben Atkins, a dentist and Trustee of the British Dental Health Foundation, was a member of the committee for the NICE guidelines. Dr Atkins said: ‘These guidelines outline a patient-centred approach to ensure patients who are using the services are actively involved in discussions and able to make informed decisions about their care.’

Taken from Dental Nursing, published 29 January 2016.

DN_Feb_2016_News_DPS