In day 5 of our series on the NHS, investigations editor David Powles looks at what 2016 might have in store in terms of mental health care.
Has the tide finally turned? In the week that David Cameron became the first Prime Minister to talk about mental health in a public address, that will be the question on the lips of many of the millions of people in this country whose lives are touched by the condition.
However, there will be as many who harbour concerns Mr Cameron's words will become another example of where politicians talk a good game, but fail to deliver the goods.
Some campaigners claim much of the £1bn pledged by the government only fills the hole created through cuts in recent years. Others believe that, for whatever reason, the money never seems to truly flow down to local services, meaning that ultimately little can be done to improve matters.
But mental health is at least, and at last, on the agenda.
Whatever happens to that cash it will be some time before the benefit is felt locally. For now, the Norfolk and Suffolk Foundation Trust (NSFT), the biggest provider of services in this region, must strive to provide an acceptable standard whilst attempting to reduce an estimated £9m deficit in 2015/16 alone.
Commenting on this, Michael Scott, chief executive of NSFT, said: 'The Prime Minister's announcement this week vindicates our board's stance to campaign for more resources for mental health.
'While we need to get our finances back into a healthy position, we are doing this over a longer period to protect our staff and our service users from further cuts.
'We will also do everything we can to protect frontline services and we will look to make savings by more efficiently managing our estates and back office functions, wherever possible.'
A big aim for 2016 will be for the trust to come out of special measures. That would be an instant indicator it was heading in the right direction in terms of the level of care people receive.
Mr Scott claimed progress was being made, adding: 'This was highlighted in October 2015, when Monitor upgraded our status from red to amber.
'Our trust held a mock CQC inspection at the end of last year. When we receive the results from the inspection's independent chair, we will have a better indication of when we can expect to come out of special measures.'
Mental health care and treatment is so complicated it can be hard to make an overall judgement as to what actual progress, if any, has been made in the last 12 months in the region.
But looking again at the ten manifesto points of our Mental Health Watch campaign, launched last year, there have been improvements.
Out-of-area placements are falling, as is the trusts waiting list. Some schools have taken up the challenge and are starting to do their bit by making youngsters aware of the problems they might encounter.
NSFT said eradicating out-of-area placements, meeting the government's early intervention in psychosis targets and further improving youth services would also be big priorities in 2016.
Debbie White, director of Operations (Norfolk and Waveney), added: 'Our trust is committed to prevention rather than just cure, to keep people as well as possible within the community wherever we can, and thereby keep beds free for those who are in essential need.'
On youth services, she said: 'Working in partnership with other providers, we will be implementing a collective range of improvement measures to provide young people with greater access and support.
'We are also continuing to recruit additional specialist staff to expand our Eating Disorders services in Norfolk and Suffolk. This will help meet an increase in demand while ensuring children and young people can access help at an early stage, before their illness becomes more serious.'
At all levels, local and national, 2016 needs to be the year attention is not just placed on tackling mental health problems when they occur, but stopping them from occurring in the first place.
Prevention is, after all, better than the cure.
Mental Health Watch campaign launched amid perfect storm, writes David Powles
If a subject is to catch the eye of the decision-makers in this country, it needs to be in the open and on the public's radar.
That is where the media can play an important role in the fight to improve the lot for the millions of people with a mental health condition.
Which is one of the reasons why, in October last year, the decision was taken to launch our Mental Health Watch campaign.
It felt like there was something of a perfect storm brewing. In Norfolk and Suffolk the trust tasked with providing the majority of services was in special measures, battling to cope with multi-million pound cuts and seemingly creaking at the seams. All this set against the backdrop of a rising number of people, young and old, looking for help.
Regular calls came into the newsroom about a plethora of problems, including people being sent out of area for care, lengthy waiting lists and services not being up to scratch or even worse, scrapped. It was our duty to try and do something to help. That work continues.
At around the same time a Lowestoft family took the bravest of decisions to talk about the death of their 26-year-old daughter.
Her name was Jacqui Boulton, who had been suffering with depression and eating disorders for years before that battle became too much for her to bare.
In our very first conversation, her grieving father David uttered the words 'I want to do whatever it takes to help ensure this doesn't happen to other families'.
He knew only too well that more needs to be done to ensure friends and family understand the plight sufferers face. And no matter how painful it was, he wanted to get that conversation started.
We all owe it to people like Jacqui to keep that conversation going.
THE NORFOLK AND SUFFOLK FOUNDATION TRUST OUTLINES ITS PLANS AND PRIORITIES FOR 2016
Special measures
Michael Scott, Chief Executive at Norfolk and Suffolk NHS Foundation Trust, said: 'We have been meeting the challenges of the past year head on and been making good progress towards taking our Trust out of special measures. This was highlighted in October 2015, when Monitor upgraded our Trust's status from red to amber.
'We still have more to do and the Board is working closely with our staff to ensure these improvements are made from the comprehensive plans we have in place, to further improve the quality of services we provide.
'The Board has been monitoring the progress of these plans and our Trust held a mock CQC inspection at the end of last year. When we receive the results from the inspection's independent chair at the end of February/early March, we will have a better indication of when we can expect the Trust to come out of special measures.'
Out of area and waiting times
Debbie White, NSFT's Director of Operations (Norfolk and Waveney), said: 'From December 2014 to December 2015, our Trust achieved a 43% reduction in the number of patients placed out of area. This follows our Trust achieving zero out of area placements for a number of days and weeks throughout autumn 2015. We are endeavouring to do all that we can to manage placements within the Trust to make that our status quo.'
'A major factor that has led to reducing the need for placing patients out of area has been that our Trust has been focusing on enhancing our community mental health services in central Norfolk. We invested almost £1million last year to recruit more staff, which has helped to significantly lower those services' waiting lists from around 500 in September 2015 to just 43 by December.
'This year will see our Trust continue this work by co-locating our Norfolk Crisis Resolution Home Treatment team with Norfolk County Council's Assistant Mental Health Practitioners to make access to our community mental health services even easier for patients.
'Another development will see the introduction of an assertive outreach approach aimed at helping patients who are more difficult to engage with. There is independent evidence that shows assertive outreach helps reduce the need for hospital admission, as well as reducing caseloads for care co-ordinators.
'Our Trust is committed to prevention rather than just cure, to keep people as well as possible within the community wherever we can, and thereby keep beds free for those who are in essential need.
'This is why we have also been working closely with local authority social care and third sector colleagues – such as Julian Support, MIND and Stonham Housing - to avoid delayed transfers of care and to ensure we can effectively discharge people to a safe place when their need is no longer for an inpatient bed.'
Latest situation with finances and how will they be improved
Michael Scott, Chief Executive at Norfolk and Suffolk NHS Foundation Trust, said: 'The financial pressures that our Trust faces are by no means unique in the NHS – mental health services are underfunded nationally.
'The Prime Minister's announcement this week about an additional £1 billion being invested in mental health services vindicates our Board's stance to campaign for more resources for mental health.
'Last year saw our Trust reduce out of area placements, agency and locum staffing, and non-clinical spend such as administration. In the longer term, our Trust is reviewing its clinical strategy so as to deliver long-term financially sustainable services, and to help eradicate the £9.4m deficit over the next two to three years. While we need to get our finances back into a healthy position, we are doing this over a longer period to protect our staff and our service users from further cuts.
'We will also do everything we can to protect frontline services and we will look to make savings by more efficiently managing our estates and back office functions, wherever possible.
'We have a clear plan to make savings with the focus not only on balancing the books but also on maintaining safe and high quality services.
'We will be doing this by working with our commissioners (CCGs and NHS England) on income and ensuring we receive appropriate funding for every service our Trust provides.
'We will also be ensuring that we have implemented all financial controls and budgetary management measures that would be expected of any large organisation. This includes controls over all discretionary spend, ensuring our Trust receives the best value on contracts with suppliers, and that agency costs for staff are further reduced through recruitment to our vacancies.
Other priorities for 2016
Early Intervention In Psychosis targets
Michael Scott, Chief Executive, said: 'One of our key priorities for the coming year is to work with our commissioners to develop our existing Early Intervention In Psychosis (EIP) services in order to meet the new NICE guidelines targets due to be introduced in April.
'Our Trust is currently commissioned to provide an EIP service for people aged under 35 years only, in Norfolk and Waveney.
'We are working closely with the clinical commissioning groups (CCGs) about their commissioning a service for people aged over 35. The next few weeks will see our Trust and the CCGs holding discussions about staffing and the funding levels required to meet these standards, and to manage this additional cohort of patients, assessments and treatment.'
Youth services
Debbie White, Director of Operations (Norfolk and Waveney), said: 'Working in partnership with other health and children's services providers, we will be implementing a collective range of improvement measures to provide young people with greater access and support. This is the result of an additional £1.9m in recurrent funding in Norfolk and Waveney over five years pledged by NHS England to improve child and adolescent mental health services (CAMHS).
'The improvements to CAMHS services will include more early intervention and prevention to reduce the need for inpatient admissions, and therefore the risk of out of area placements for young people.
'We are also continuing to recruit additional specialist staff to expand our Eating Disorders services in Norfolk and Suffolk. This will help meet an increase in demand while ensuring children and young people can access help at an early stage, before their illness becomes more serious.'
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