Are people with mental health problems in the region getting better treatment than they were this time last year?
That was our hope more than 12 months ago when this newspaper launched a campaign to improve the under-performing mental health services in Norfolk and Suffolk.
A crucial aim was to end the stigma of people suffering from mental health problems and raise awareness of the issues.
Our Mental Health Watch campaign has highlighted the struggles of the region's mental health service, the Norfolk and Suffolk Foundation Trust (NSFT), as well as its progress and successfully campaigned to save a mental health helpline from closure.
But how have things progressed in the past year?
The Cinderella service
A key hope of our manifesto was for underfunded mental health services to be given more money.
While hospitals are paid on demand, mental health services are given a set amount of money each year, meaning they have often lacked the cash to meet demand.
Services are not better funded than they were a year ago. The trust must make savings of £10m this year.
A leaked letter obtained by this newspaper last month said the NSFT could not expect any new money for specialist services due to NHS England's deficit. It warned a £29m funding gap had emerged in NHS England's Midlands and East's specialist commissioning team, meaning more savings would have to be made.
The NSFT has been running a deficit over the past year, but a spokesman for the trust said its finances were improving. They are planning a deficit of just under £5m this year compared to almost £9m the year before.
Sick, alone and away from home
A lack of mental health beds in the region has meant hundreds of people have been sent out of the area for treatment for years.
They are placed in beds in private hospitals, often at huge cost to the trust, as well as to their own wellbeing. Patients have been sent as far away as Weston-super-Mare, Manchester, Bradford and Darlington to receive care.
We reported in January the number of patients from Norfolk and Waveney sent out of East Anglia for treatment had nearly quadrupled in the past four years. That included teenager Kirsten Cunningham, of Fakenham, who was forced to endure treatment in Northampton, simply because there was nowhere closer for her to receive help.
In 2014-15, £3.3m was spent on placements outside the area compared with £800,000 the year before.
That figure fell to £2.2m last year and the trust said the numbers being sent out of area were falling.
A spokesman for the NSFT said: 'We do not want to send any patient who requires a bed out of area. We understand how distressing this can be for the person and for those close to them, especially at a vulnerable time.'
They said the number of people placed out of area fell from 118 to 46 from April to October this year, compared to the same period in 2015.
The furthest admission was The Dene Hospital, near Brighton – a distance of 165 miles.
But as demand for beds has risen, budgets have not and the NSFT said it was now paying a consultancy firm £75,000 to review its bed stock.
There has been some progress but also some losses.
The trust said it had put £1m into recruiting community staff to avoid the need to send patients into hospital beds.
It also opened a 12-bed acute assessment ward at Hellesdon Hospital, but beds have been lost at the Fermoy Unit in King's Lynn.
The NSFT board was told in October: 'Bed occupancy remains a concern with demand for beds continuing to be high.'
It also has to spend millions of pounds on sending patients to private beds in Norfolk and Suffolk.
Called Out of Trust Placements, it will overspend by £2m on them this year against a budget of £1m.
Many of the patients are sent to the Mundesley Hospital in north Norfolk which opened last year.
No more special measures
The NSFT was placed in special measures in February 2015 after the service was rated 'inadequate' by inspectors.
Key areas of concern in 2015 included low staff morale, poor leadership, insufficient and unsafe staffing levels and lack of availability of beds.
But in October this year it came out of special measures after being upgraded from inadequate to 'requires improvement'. It was rated as 'good' for how caring the service was but was still deemed 'inadequate' for the safety of the service.
NSFT chief executive Michael Scott said the trust was incredibly proud of the progress made.
Inspectors said there had been 'significant improvements' at the NSFT, but highlighted a staff shortage as a concern.
The Campaign to Save Mental Health Services in Norfolk and Suffolk said they remained 'deeply concerned' following the CQC inspection.
'When CQC rated NSFT 'inadequate' for safety, they explicitly stated that NSFT does not have enough beds, doctors or staff and that the number of unexpected deaths is 'high',' a spokesman for the campaign said.
Waiting times
Fewer patients are having to wait to get mental health treatment but the numbers are still too high.
The target for the number of NSFT patients waiting for more than 18 weeks for treatment is zero.
In August there were 98 patients waiting longer than the 18-week target, but that number has fallen from around 500 in January.
Waiting times also show how much of a postcode lottery care can be. In central Norfolk, 47 patients were waiting for longer than 18 weeks in August. In West Norfolk there was one, while in west Suffolk there were 22.
What about the staff?
CQC inspectors said in their October report that the NSFT had 'insufficient staffing levels to safely meet patient's needs'. The trust also scored badly in the latest NHS staff survey for 2015. It was among the worst in England on several measures including staff motivation, staff engagement and job satisfaction.
But on the positive side the CQC inspectors said in October staff morale had 'significantly improved' since their previous inspection.
The NSFT also highlighted improvements in their own staff survey scores as a sign of progress.
Their latest internal staff survey showed 58pc would recommend the trust as a good place to receive care – an increase from 44pc in 2015.
Just under 48pc would recommend the trust as a good place to work, an increase from 32pc in 2015.
But problems with staff recruitment in Norfolk and Suffolk remain.
The NSFT spent £24.8m on agency staff in 2014, diverting much-needed cash from other important areas.
This year they hope to spend just under £11m on temporary staff.
Spending on agency staff has fallen by £3.9m this year, compared with first seven months of the last financial year.
Deaths
The trust has come in for criticism repeatedly over the last year for the high number of what are called 'unexpected deaths'.
That includes deaths of any patients which have been seen by the NSFT in the last six months.
It can be suicide, natural causes, a physical illness or an accident.
A review into the number of these deaths and serious incidents at the trust was published in May by a company called Verita.
They found the number of suicides was not higher at the NSFT than the national average.
But campaigners criticised the report and figures earlier this year showed a spike in the number of unexpected deaths to 21 in May.
The number of unexpected deaths in September was 13 and in October the figure was 14.
In September, NSFT chief executive Michael Scott told Norfolk County Council's Health Overview and Scrutiny Committee that the trust was a 'high reporter' of deaths.
The Trust said it had seen a year-on-year reduction in suicide of 4.5pc
But a spokesman for the Campaign said: 'We've been campaigning for three years but NHS England, local commissioners and NSFT have failed to act as the number of unexpected deaths has climbed ever higher, year after year.
'On many measures, mental health services have become even worse.
'Mental health services must be properly-funded and competently run or people in crisis will continue to die unnecessarily.'
The national picture
Millions of pounds pledged nationally for mental health services a year ago are yet to reach the frontline.
A recent report found that money which had been earmarked for children's mental health appeared to have disappeared into the NHS.
Health secretary Jeremy Hunt was expected to invest £1.25bn in children's mental health services over five years, including £250m in the first year of the project.
But a report from the Children and Young People's Mental Health Commission found £143m was given and of that £75m actually went to frontline mental health services.
In December Mr Hunt also said local clinical commissioning groups were 'committed to increasing the proportion of their funding that goes into mental health'.
But this hasn't happened nationally either.
Figures obtained by Labour MP Luciana Berger found at least 73 CCGs would cut mental health budgets this financial year.
Theresa May mentioned mental health in her first speech as prime minister. 'If you suffer from mental health problems, there's not enough help to hand,' she said. But there's little evidence of this being backed up with money.
A campaign called Equality For Mental Health, which was founded last year by cross-party MPs and former health ministers, said government promises on mental health funding were yet to materialise.
They said: 'Despite the warm words, one year on, we see the same enduring injustice, the massive economic cost of neglect of mental ill health – estimated to be £105bn a year – and the distress suffered by countless families across the country because of failures of the system adequately to support people in need.'
The campaign, which was co-founded by North Norfolk MP Norman Lamb, is calling for more mental health funding.
•Tomorrow: We look at the state of children's mental health services in the region.
•What are your experiences of mental health services in Norfolk and Suffolk? Email nicholas.carding@archant.co.uk
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