North Norfolk MP and Minister of State at the Department of Health responsible for mental health, Norman Lamb, has been very quiet about the collapse of the Section 75 agreement between Norfolk and Suffolk NHS Foundation Trust (NSFT) and Norfolk County Council (NCC) Social Services Department.
Section 75 is the legal mechanism which enables health and social services to INTEGRATE and for services to be delivered by one organisation in a coordinated, combined fashion. Norman Lamb and Jonathon Fagge argue constantly that improving mental health services is primarily a question of organising current resources in a more efficient, INTEGRATED way, not one of Central Government funding; Lamb also claims to argue for “Parity of Esteem”, i.e. equal funding for physical health and mental health.
Norman Lamb completely ignores the fact that both health and social care have been drastically cut under his regime as the Health Minister responsible for mental health services. The Section 75 agreement has collapsed primarily under pressure from funding cutbacks under the weight of austerity. Resources for mental health have been disproportionately cut by the ‘no top-down reorganisation of the NHS’ bureaucracy that his government created.
Norfolk County Council has cut social care services to the point that there are now long waiting lists for assessments of people’s basic needs under the Community Care Act; this particularly applies to services for older people and people suffering from dementia. In many areas there is only a service once vulnerable people in need reach absolute crisis point. In mental health the so-called Nicholson Challenge meant a £40,000,000 cut to mental health services in Norfolk and Suffolk. The Community Mental Health Teams in particular lost one third of their staff; social workers who were supposed to be delivering essential care services and personal budgets spent much of their time acting as generic mental health workers, compensating for the overall lack of medical staff. The result of this has been a failure of NSFT to carry out essential statutory duties for NCC, a subsequent collapse of the Section 75 agreement and the DISINTEGRATION of social care and mental health services.
On Wednesday 1st October, mental health social workers reverted to the employment of Norfolk County Council, who henceforth will be responsible for the social care aspects of mental health services, while NSFT will be responsible for the health aspects, as if these can be separated. This step takes us back 20 years. We will see the return of demarcation disputes between health and social services as each comes under pressure from funding cuts. NSFT will apply a strict pseudo-medical and inefficient accounting model (clustering, which is clinically useless but preparation for payment by results, competitive tendering and privatisation – the same flawed obsession that led to the AAT disaster). Social Services will apply narrow statutory criteria in an attempt to meet massive budget cuts. In the middle will be the vulnerable patient who will lose out and inevitably fall through the safety net. Already, NSFT and NCC are giving staff contradictory information resulting in misunderstandings and chaos.
For some reason Norfolk County Council have driven through this process of disintegration at a rapid pace. Responsibility for organising urgent assessments under the Mental Health Act reverted to Norfolk County Council on 1st October. NCC created a new organisational structure for this service, but strangely enough no one has applied for the key managerial posts in this service. A number of Approved Mental Health Professionals (AMHPs)/social workers have taken the opportunity to hand in their warrants and give up the vital role of assessing those in mental health crisis. This is a direct result of the bed crisis and the lack of managerial support for AMHPs who still have an outstanding grievance dispute with NSFT over Health and Safety issues.
More than any other health condition, mental health requires an integrated, holistic approach. Many inquiries into tragic events in the past identified poor communication between agencies, lack of communication with relatives and lack of care coordination as major factors. We are now going back to a flawed model of care under pressure from financial cutbacks. Norman Lamb and the Coalition Government are responsible for this, and it will take more than a sponsored bike ride raising a few pounds from constituents to compensate for the millions of pounds of cuts and the subsequent disintegration of mental health services in Norfolk.