All Party Parliamentary Group for
Mental Health
Notes of meeting: December 2004
Portcullis
House, Westminster
Tuesday
9th December 2003
Members
present: Dr
Lynne Jones MP (Chair), Rt Hon John Battle MP, Dr Evan Harris MP, Earl Howe, Earl
Listowel, Tim Loughton MP and Doug Naysmith MP.
Observers: Martin Aaron (JAMI), Stuart Bell (South
London and Maudsley NHS Trust), James Ford (CHI), Caroline Hawkings (Turning Point), Pete
Hillan (Janssen-Cilag Ltd), Guy Howland (Mental Health Matters), Helen Lord (Lilly), Tim
Maybe (Radio 4), Catherine Meaden (CHI), Linda Seymour (Mentality), Mary Teasdale
(Rethink) and Agnes Wheatcroft (Royal College of Psychiatrists).
Results
of the AGM:
Joint
Chairs re-elected: Dr
Lynne Jones MP, Rt Hon Virginia Bottomley MP, Sandra Gidley MP
Secretary
re-elected: Lord
Alderdice
Members
were invited to send suggestions for meetings next year to Agnes Wheatcroft at the Royal
College of Psychiatrists.
Are
Mental Health Services Improving?
Speakers:
·
Dominic Ford, Mental
Health Development Manager and Dr Linda Patterson OBE, Medical Director, Commission for
Health Improvement
·
Angela
Greatley, Director of Policy & Research, Sainsbury Centre for Mental Health
Dominic
Ford
introduced CHI’s latest report, ‘What
CHI has found in: mental health trusts’ (embargoed until 17th
December), which presents an overview of findings made in this sector. He reported that there is significant
dissatisfaction and
frustration at the lack of priority given to mental health and concerns from service users
particularly about acute inpatient care and out of hours services. He
noted that government improvements had been aimed at general adult services but this had
led to other services being left behind, such as those for older people.
Mr
Ford reported that Mental Health Trusts are complex organisations and while some are
operating well, others are failing. He noted that the organisations which are working
well, have resolved staffing shortages, provide good information and benefit from good
leadership. In some areas though, resources for support services are very stretched and
services such as out of hours care are very limited. Provision of a good quality physical
environment is also important, Leeds Mental Health Trust is a good example of an
organisation with modern facilities.
Some
good examples were also found of BME services and services for 16 to 18 year olds with
reduced admission times to hospital. However, more innovations are needed such as better
electronic systems.
Dr
Linda Patterson
then reported on CHI’s findings concerning the treatment of older people. She
reported that this is of particular concern to CHI especially on the in-patient side.
Isolated cases of abuse have occurred, most notably the cases at Rowan Ward in Manchester.
Sedation of older people has also occurred as an alternative to proper care and treatment.
There is also little in the way of an out of hours service for this group of people.
In
hospitals there is often an inappropriate mix of people with very different needs such as
those with dementia and those with psychotic
and functional illnesses,
which makes it difficult for staff to deliver good care to all. Mixed-sex wards still
exist and these need to be converted into single-sex facilities. More risk management is
also needed. CHI has found that the Care Programme Approach (CPA) has not been well
developed.
Dr
Patterson noted that the care of older people with mental illness often falls between the
two national service frameworks i.e. mental health and older people, and they fail to
secure appropriate treatment. At the Rowan Ward in Manchester Mental Health and Social
Care Trust, CHI found an isolated service, which had been left behind. There was poor
leadership and team relationships as well as confused accountabilities between health and
social care. Since CHI published its report into the case the chief executive has left the
Trust, which is faced with financial problems and an action plan is being developed.
The
Department of Health recently held a summit with the health czars and health and social
care groups to discuss lessons from this case. Dr Patterson also met the mental health and
older people’s services czars separately and is to meet the Royal College of
Psychiatrists. Further information will be contained in the bulletin sent to all NHS chief
executives. Stephen Ladyman MP is involved in the issue and is keen to provide robust care
for older people possibly through developing other performance indicators.
In
conclusion Dr Patterson stated that CHI’s findings would provide a “wake-up
call” to the NHS to improve services for the most vulnerable people.
All
CHI’s reports can be found on www.chi.nhs.uk
Angela
Greatley
from the Sainsbury Centre for Mental Health (SCMH) spoke about their recent report ‘Money for Mental Health’. The SCMH is a
charity involved in research and training in the field of severe and long-term mental
health problems. The aim of the ‘Money for
Mental Health’ report was to find out what is happening to spending on mental
health services at a national level. The study was conducted by analysing Local
Implementation Teams’ (LITs) financial mapping returns to the Department of Health.
The SCMH also used local studies and Local Delivery Plans to piece together a picture of
spending in the field.
Results
showed real term spending increasing by 3%, however the increase over the whole NHS is 6%
showing that mental health is still lagging behind other areas and still deserves the tag
“Cinderella service”. The Mental Health National Service Framework (NSF)
recommended an injection of 8-9% over ten years, but four years into the implementation of
the NSF the figures do not appear healthy.
Ms
Greatley noted that tensions between PCTs and Mental Health Trusts have had a negative
effect on services, PCTs in particular need to develop their own expertise. Local
authority funds are constrained by other priorities such as child protection, which has
led to variations in spending on mental health across the country.
Sainsbury
Centre reports can be found on www.scmh.org.uk
Discussion:
Lynne
Jones MP expressed concern at the gloomy portrayal of mental health services outlined by
the speakers and opened up the discussion to the group.
Tim
Loughton MP asked whether new staff were being attracted into the service or whether staff
were merely moving within the service. It was noted that there is some churning of staff
and that skilled people are moving from acute services to the newer projects. Ms Greatley
reported that while many assertive outreach teams have been set up, there are still
problems getting crisis resolution teams to function fully and there are few early
intervention teams. Graduate workers (such as psychologists) are being encouraged to enter
these innovative services. Lynne Jones noted that there are parallels with children’s
services where the focus is on glamorous projects such as Sure Start at the cost of core
services.
Ms
Greatley answered a question about whether additional funds have gone into mental health,
saying that though money was announced by government and earmarked it has been hard to
find evidence of the money actually reaching front line services. Money has reached some
areas such as the new teams (such as assertive outreach) and some to child and adolescent
mental health services (CAMHS).
The
Group also discussed the problem of recruitment and retention of staff in mental health
services, particularly concerning consultant psychiatrists. Evan Harris noted that locum
doctors are a problem for the health service as they are expensive and may be less well
qualified than those in permanent posts. Stuart Bell from South London and Maudsley NHS
Trust, noted that Trusts aim to use more bank staff rather than agency staff as they
provide a more effective service. Agnes Wheatcroft is to arrange an update on recruitment
and retention from the Royal College of Psychiatrists at a future meeting.
Lord
Listowel asked what methods are used in involving carers in educating staff about the
needs of patients. Dr Patterson noted that more innovative services do encourage carer
involvement.
The
meeting discussed whether targets are useful in improving services. Stuart Bell noted that
the measurement of improvements in mental health is problematic. Fewer targets have been
set in this area and so it is less of a priority in relation to areas of the health
service which have lots of targets, such as waiting lists. Dr Patterson noted that an
important area for improvement was the physical surroundings in wards and other
facilities. Lynne Jones noted that this might occur through the move towards PFI.
The
meeting also discussed how to value the importance of voluntary and not-for-profit input
into mental health services. It was noted that partnerships are encouraged between Trusts
and users, carers and voluntary groups.
In
conclusion Lynne Jones asked whether CHI has raised standards in the NHS. Dr Patterson
confirmed that the organisation had raised standards through its reports by prompting
action plans to be drawn up for struggling services and the strength of CHI’s
follow-up work. The work of CHI will be passed over to new CHAI in 2004, work will carry
on and its priorities will remain the same.
Lynne
Jones thanked the speakers for their time and for raising such important issues with the
Group.
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