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October 24, 2017

Private Eye Medicine Balls 1450 August 11, 2017
Filed under: Private Eye — Dr. Phil @ 1:49 pm

Pay up or die

Health Secretary Jeremy Hunt’s pledge of £1.3 billion to improve mental health services may repair some of the damage of the last five years but it’s unlikely to provide ‘parity of esteem and provision’ with physical health services. Indeed, it can be divisive and harmful to separate the two as they frequently occur together. Chronic physical illness can have profound psychological consequences, and those suffering severe mental illness are far more likely to die prematurely from physical illnesses (Eyes passim). What’s needed is the holistic care of properly funded GP and community services.

The Health and Social Care Act (2012) made it unlawful to discriminate between physical and mental health, but the NHS has always raided mental health budgets to prop up other, more high profile services. There are now 6,000 fewer mental health nurses and 170 fewer psychiatrists in England than there were in 2010. In 2016, a government report found mental health services can’t cope with demand. Suicide in England was rising following many years of decline, with 4,477 people killing themselves in an average year. There was a 10% increase in the number of people sectioned under the Mental Health Act. One in 10 children and adolescents had a diagnosable mental health problem, but the average wait for a specialist appointment was 21 weeks in 2014, and many appointments were cancelled at short notice due to staff shortages. A quarter of people with severe mental health problems were getting less support than they needed and were high risk for self-neglect and suicide.

The average maximum wait for a community mental health team appointment in 2016 was 30 weeks. Mental health wards were dangerously overfull and routinely in breach of safe staffing guidance, with patients – including children – shunted all over the country for specialist care. One in five women develop a mental health problem during the perinatal period but less than 15% of areas provided effective services for women and 40% provided no service at all. Despite this damning report, 57% of clinical commissioning groups cut their mental health budgets last year, and further services were cut.

Hunt’s belated cash injection is clearly welcome but the idea that an extra 21,000 specialist staff – including psychiatrists and psychiatric nurses – can be trained or recruited in four years is sheer fantasy. The government won most seats by promising to continue austerity, and so sustainable funding for mental health in the future will only come from savings elsewhere. Sustainability and Transformation Plans in England are simply a smokescreen for changes in NHS services at three levels. Specialist changes that improve the quality of care should be welcomed by all. The fact that so many people survived horrific events in Manchester and London is not just down to the excellence of the staff but also that major trauma services have been concentrated in centres of excellence. Improvements in stroke and cardiac care are other examples. The second level of closures and mergers are happening because some services just can’t be safely staffed 24 hours a day. Emergency and maternity departments will close overnight or for good because they can no longer provide safe care. And the third level of changes are simply to save money. Merging services will be inconvenient for those who have to travel further, and may sometimes be dangerous. But for money to be invested into community care, general practice and mental health, if first has to be sucked out of hospitals. And none of this gets anywhere near addressing the crises in social care and the collapse of care homes.

The alternative is to put more money into health and social care, but the electorate had a shit fit at Theresa May’s suggestion that people should use their homes as after-death collateral on social care costs, and the LibDems pledge to put a penny on income tax for NHS and social care also bombed. Brexit is likely to make the economy weaker in the short term and make recruitment and retention of EU staff much harder. 86,035 jobs in the English NHS were advertised in the first quarter of this year, and these vacancies don’t include general practice or the thousands of jobs that aren’t advertised because they simply can’t be filled. Add in the public sector pay cap, abolition of nursing bursaries and real terms cuts in the NHS budget over the next few years, and it’s hard to see how universal care can survive. On a brighter note, the NHS again topped the Commonwealth Fund analysis of the health services in 11 countries, coming top for process, access and equity but – bizarrely – tenth for outcomes. The NHS is a very fair system that isn’t very good at keeping people alive. After 7 years of austerity, increases in life expectancy have ground to a halt. Perhaps this is the secret strategy to take pressure off social care. Allow the poor to die from austerity and poor care, whilst anyone with assets is left to fund their own social care or rely on relatives to do the caring for them. It’s a plan, but perhaps not the plan Nye Bevan envisaged for an NHS approaching its seventieth year.