The country is in mental health crisis - how is our region coping?
As the region’s mental health trust looks set for turbulent times ahead, with the retirement of its chief executive and pending inspection report, health correspondent Geraldine Scott looks at what has changed since this newspaper started its campaign for better mental health services two years ago.
The country is in a mental health crisis.
Demand continues to rise for support while budgets dwindle.
The government has promised investment and the Prime Minister yesterday announced a review of the Mental Health Act to tackle injustice and discrimination in the system.
But still 50pc of cash-strapped clinical commissioning groups (CCGs) will reduce their spending on mental health in 2017/18. And a shortage of staff is rife across the sector.
Services have also been stretched in our region and Norfolk and Suffolk’s mental health trust became the first nationally to be put into special measures in 2015 - prompting this newspaper to launch our Mental Health Watch Campaign.
In the two years since we have pledged to reduce the stigma, raise awareness, and improve services. Have things improved?
Patients being sent out-of-area (OOA) for treatment remains NSFT’s biggest challenge, despite setting themselves various targets to bring numbers to zero.
In January 2014, NSFT and health commissioners set themselves a four month deadline to stop sending mental health patients OOA. In some cases patients are sent hundreds of miles away because there are not enough beds. But three years later, the problem remains - and in June NSFT was named the fourth worst trust nationally for the issue.
More recently, the target of this month was set, but in April interim chief executive Julie Cave set the “more realistic timetable of March 2018 to reduce OOA placements to nil”.
Now, the goal posts seem to have changed yet again, as when asked last week whether March was achievable, a trust spokesman said: “One of our trust’s 2017/18 aims is to reduce OOA bed days by 50pc, compared to 2016/17 activity.”
Since April, rates have again been steadily rising. This costs the trust massively - a total of £4.5m in 2016/17, and for the first five months of this financial year more than £2m has been spent. This was the combined spend of sending patients OOA but also to the private Mundesley Hospital, rated inadequate by the CQC.
Despite this, a review concluded NSFT could have enough beds, and Ms Cave said other options such as crisis cafes and community services were being implemented.
What do the inspectors say?
In February 2014, NSFT was plunged into special measures. But by October last year the trust was upgraded to ‘requires improvement’ by the Care Quality Commission (CQC).
But as Mr Scott announced his immediate retirement last week - as the latest CQC report is due to be released - there is concern over what inspectors found. A spokesman for the Campaign to Save Mental Health Services in Norfolk and Suffolk said: “We fear that Michael Scott’s departure precedes the publication of a new and devastating CQC report in the next few days.”
Less stigma, more awareness
The trust has been vocal about destimatising mental health and raising awareness. In their most recent annual report, it said: “The stigma associated with mental health care must be eradicated.”
The trust has reduced the number of agency staff and spend by £4.3m in 2016/17. However, they still spent more on it last year than the cap set by the health service’s financial regulator. The trust’s vacancy rate was also lower than the national average.
Leigh Howlett, NSFT’s director of strategy and resources, said as well as recruiting new staff the trust was working on retaining staff they already had. Patients are still having to wait
Waiting lists are still too long. In July, 143 patients waited more than the 18-week target - against a trust target of zero. But for children and young people, 95.7pc were seen within the waiting time standard.
Board papers revealed the postcode lottery patients still face. Some 34 adults in central Norfolk were left waiting longer than 18 weeks in June, 25 in July. Whereas in Great Yarmouth and Waveney these numbers plummeted to three for June and 2 for July. However, since April this year the waiting time breaches had dropped in central Norfolk by 63pc.
More funding, more savings
For the first time in many years, the trust saw an increase in its funding to deliver clinical services. But at the same time, it made £10m of savings in 2016/17 and still has an underlying deficit of £3.3m which is aims to clear by the end of the 2018/19.
Mixed results in staff survey
Staff working on the frontline at NSFT had their say in the annual NHS Staff Survey - results of which were obtained through a freedom of information request by the Campaign to Save Mental Health Services in Norfolk and Suffolk.
Results from the survey in 2016 - the most recent results available - painted a picture of staff who truly care about their patients and many who believe the trust was moving in the right direction. But concerns over increasing demand, IT systems and a lack of career progression were rife.
Staff members described the trust as “a great place to work”. One said: “The trust I work for has improved standards of care. I am very happy with my job and feel valued.”
Another added: “There’s been really positive progress within the trust over the last year. Staff are really listened to and their feedback is acted upon.”
Plus staff were proud of their work, another employee said: “I feel privileged to work for this organisation.”
And another said: “I think the trust is getting better and better, we have a clear vision, we know - in the main - what needs to be done and have plans to deliver.”
However, issues were also raised.
NSFT’s IT system, Lorenzo, came under criticism. One person said: “Lorenzo is dangerous and leaves us exposed as practitioners and puts patients at risk. 70pc of time is now spent on this system and leaves less and less time for patient care.”
Another said it was “not fit for purpose, it takes longer to complete records and will often lose data”.
Others were concerned about the “wider political climate which forces the NHS to stop seeing patients and carers as people”, whilst others highlight “the situation nationally causing concern”.
Staff shortages were also a worry. One employee said: “Ongoing staff shortage is compromising quality of care.”
Another added: “Short on staff, high on case loads, too much paperwork.”
Pay was also an issue and mentioned multiple times. One staff member said: “We work long hours as nurses and low pay does not help self esteem and morale in the profession.”