BBC News: Norfolk and Waveney mental health: Dissatisfaction with care

Nic Rigby of the BBC reports:

More than 80% of people are dissatisfied with mental health services for adults in Norfolk and Waveney, a report has found.

The survey, by the Norfolk and Waveney Sustainability and Transformation Partnership (STP), said 40% did not know how to access services at all.

A patients group criticised the “inadequate” provision of mental health care in the area.

Its report looked at care provided the Norfolk and Suffolk Foundation Trust (NSFT) – which is the main NHS mental health services provider for the two counties, Norfolk Community Health and Care Trust, Norfolk County Council social care and individual GP surgeries.

The report said primary care by GPs was “under pressure” with doctors having to deal with 18% more patients than the national average.

It said the NSFT, which is in “special measures” after repeated criticism from the Care Quality Commission (CQC) standards watchdog, has problems with recruitment of staff, while its “bed capacity was stretched”.

Yet again, the commissioners refuse to acknowledge their own culpability in failing to provide adequate funding for mental health services. This report, produced at great expense by US management consultancy firm Boston Consulting Group, ignores inadequate funding.

Since the Norfolk clinical commissioning groups were founded (13/14), referrals have risen 48 per cent but the share of the NHS budget received by secondary mental health services (NSFT) has fallen. They were almost bound to fail.

According to recent research by the Royal College of Psychiatrists, NSFT is one of only nine mental health trusts in the country to have seen year on year decreases in mental health funding.

The report said Norfolk County Council’s social care services had a workforce which was “stretched and in places dissatisfied with the working environment”.

Mearl Brown, from Cromer, Norfolk, sought help from the NSFT after his 19-year-old son Nyall first attempted to take his own life in January.

He said the care was disorganised and at one point the family were advised to seek private medical help for their son.

Nyall went on to take his own life in May.

Mr Brown described the family’s dealings with the trust as “inadequate, poor and shocking”.

A spokesman for the Campaign to Save Mental Health Services in Norfolk & Suffolk, an independent patients’ group, said: “The problem is not so much the current model of care but rather inadequate commissioning, funding, management and supervision of mental health care.

“Elsewhere in the country, properly run and financed services using a virtually identical model of care to that in Norfolk achieve outstanding ratings from CQC.”

The STP report made six recommendations:
A focus more on prevention and wellbeing

Which is great if it works. But until it does and in the absence of miracle cures, we need decent secondary mental health services.

Laughably, the report talks about preventing dementia, the two largest risk factors of which are old age and genetics. 

A need for clear routes into and through services and make these transparent to all

We have been campaigning for this for more than five years.

But ‘signposting’ alone is insufficient and commissioners don’t seem to realise this. There actually need to be services to signpost to.

Support for the the management of mental health issues in the primary care setting

Cuts saw the withdrawal of link workers, the restoration of which has been one of our aims for more than five years.

This report seems to have been written almost entirely from the perspective of primary care and commissioners but it is people who have severe and enduring mental illnesses and rely on secondary specialist care, such as people with psychosis, dementia or bipolar disorder, who have already suffered most with the cuts to crisis and community teams and the closure of homeless and assertive outreach teams.

Now, this document appears to be advocating the closure of existing community mental health teams (CMHTs) in a disruptive and expensive reorganisation which will have a devastating effect on continuity of care, service quality and staff retention and recruitment.

The provision of appropriate support to those in crisis

Another issue we have been campaigning about for more than five years after the savage cuts to crisis teams.

Effective in-patient care for those that really need it

In January 2014, commissioners promised that there would be no out of area placements beyond April 2014. Instead, many millions of pounds has been wasted at private and sometimes inadequate private hospitals as people in crisis have been transported across the country at huge personal and financial cost.

It will be fascinating to discover what ‘really need it’ means when the police are forced to handcuff people in acute to distress to their own beds overnight because there are no available mental health beds.

A system focused on working in an integrated way to care for patients

We’d just settle for a system that works.

Melanie Craig, of the STP, and Frank Sims, chief officer of the NHS Clinical Commissioning Groups for North Norfolk and South Norfolk, said: “It will be important to take a ‘whole system’ approach to improving mental health and wellbeing, working with schools, police, the voluntary sector and other partners.”

All very ambitious and largely out of their control. We heard all of this guff at the time of the disastrous ‘radical redesign’. Just saying ‘whole system’ approach will not deliver decent mental health services.

What we’ve seen is that while commissioners have spoken about integration, the polar opposite has occurred with the collapse of the Section 75 Agreement between Norfolk County Council and NSFT and savage cuts to addiction services and mental health support provided by Norfolk County Council. As well as the cuts to NSFT.

Maybe commissioners should focus on the matters they do control? The commissioners have failed to properly commission, fund and oversee mental health services over the past five years. Perhaps doing their jobs is just too difficult or more boring than paying US management consultancy firms hundreds of thousands of pounds from NHS coffers to produce reports commissioners can publish as their own after adding an introduction page in a different font?

Click on the image below to read the article in full on the BBC News website: