COMMENT
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ur health service is once again being set up to be the key contested area in the next general election. Last time round Cameron promised ‘I’ll cut the deficit, not the NHS’ ran the billboard poster. Perhaps the Labour Party can use exactly the same poster next year. So, should I also be skeptical about Cameron’s Deputy Nick Clegg who, in his party leader speech at the Lib Dem conference (2014), his last before the election, pledged to tackle ‘the ‘Cinderella status’ of mental health services’? That’s an emotive term we used to hear a lot in mental health (and seemingly forgotten learning disability) services in the 1980s and 1990s.This situation was initially much improved when mental health services were separated by trusts, and became independent of general services. Mental healthcare funding was significantly improved through The NHS Plan (Department of Health, 2000) to deliver its innovative model of National Service Frameworks. So what about the next last 5 years? I agree with what Clegg presents as areas for investment, but it has to be acknowledged it continues the work started by the Labour Government to improve access to psychological treatments (IAPT) (Care Services Improvement Partnership, 2007). Clegg supports developments in other areas; although the increasing demand for dementia care was not highlighted.These developments will be part funded in the same way Simon Stevens, NHS Chief Executive, suggests improvements can be delivered in his Five Year Forward View (NHS England et al, 2014) by efficiency savings. What is critial here is a recognition of the importance of time; people with mental health problems need time to talk, and we as service providers need time to deliver change. So, is another waiting list target, to reduce waiting for talking therapy, helpful? At what point does meeting the target become more important than how the target is met? How will nurses be involved in improving services and how will this impact on our role? We will be the ones left to translate policy intentions, service contracts and management priorities to meet fundingrelated targets into a meaningful and caring service. I am increasingly concerned by how externally driven we are, and the feeling of having less and less influence on the use of our time. Perhaps the greatest challenge to our time is the now universal but dubious discovery that one in four of us will be experiencing some aspect of a mental health problem (Health & Social Care Information Centre, 2009). This has inevitably increased expectation on our health services, and I profoundly agree with an approach that starts with talking rather than prescribing. Much of NHS funding is for people with long-term conditions. Mind (2014) reports that local authorities,
now responsible for public health, are underfunding mental health services, augmenting the problem of central government cuts to local authority funding, where local services have been reduced, leaving the NHS to pick up the resulting increase in need for care. These changes have been incremental and their impact slowly building, it can be likened to the increase in traffic on roads, where only a small change can eventually cause flow problems and gridlock. Given the interdependent nature of services, the increasing demand on our health system problems is first noticed at the entrance points to services, emergency and acute hospital and primary care. It is here we see targets of 4-hour A&E wait limits (often a challenge for mental health services), and Clegg’s ‘innovation’ for mental health waiting times. But this ripples through our system, as full hospitals reduce flow elsewhere, relationships and confidence in other services are challenged, resulting in stress and its fallout. Ironically, the NHS has become a much less healthy place to work. Are we given the space to reflect on our own practice, to identify areas for development, and the stability to work to a timescale for implementation? These are all aspects of a healthy working environment and profession, and I struggle to see how unhealthy, unhappy people can deliver an optimum service. There is one further issue that goes to the heart of what the NHS stands for. In my experience, my sense of purpose is increasingly set by objectives to meet the expectations of a system, to meet demand and turnover, to fulfil the requirements of contracts, so where do I as a person contribute? I believe that it is our capacity to be compassionate that is most under threat, because this requires a personal sense of agency, and that how we feel about the people we care for actually matters. Let’s hope that the next 5 years start with a recognition that change and improvement requires time and stability. And, if Cinderella is the right analogy, BJN we need to be aware that time is running out. Care Services Improvement Partnership (2007) Commissioning a brighter future: improving access to psychological therapies–positive practice guide. http://tinyurl.com/l9u4y6j (accessed 29 October 2014) Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform. Department of Health, London Health & Social Care Information Centre (2009) Adult Psychiatric Morbidity in England–2007 http://tinyurl.com/l9blxws (accessed 28 October 2014) Mind (2014) Mind reveals ‘unacceptably low’ spending on public mental health. http://tinyurl.com/pw4vl9x (accessed 28th October 2014) NHS England, Public Health England, Monitor, Health Education England, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://tinyurl.com/ kcjenmc (accessed 28 October 2014)
Mervyn Morris Director, Centre for Mental Health Policy Birmingham City University
© 2014 MA Healthcare Ltd
Editorial Board David Aldulaimi, Consultant Physician, Gastroenterologist, Worcestershire Acute Hospitals NHS Trust Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Lizzy Bernthal, Research Fellow and Lead Nursing Lecturer, Medical Directorate, Birmingham Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Emma Collins, Senior Sister, Practice Development Lead, Brighton and Sussex University Hospitals NHS Trust Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland David Delaney, Charge Nurse, Clinical Research, Alder Hey Children’s Hospital Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Joanne McPeake, Acute Specialist Nurse/Senior Staff Nurse in Critical Care; Honourary Lecturer/Practitioner in Critical Care, University of Glasgow Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Anne-Maria Olphert, Chief Nurse, Director of Quality, Erewash CCG, Derbyshire Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Bernadette Porter, Nurse Consultant, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Angela Robinson-Jones, Consultant Nurse, Gynaecology, Liverpool Women’s Hospital John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Will the NHS find time for mental health nursing?
British Journal of Nursing, 2014, Vol 23, No 20
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.237.122.245 on November 15, 2015. For personal use only. No other uses without permission. . All rights reserved.
1060
O
ur health service is once again being set up to be the key contested area in the next general election. Last time round Cameron promised ‘I’ll cut the deficit, not the NHS’ ran the billboard poster. Perhaps the Labour Party can use exactly the same poster next year. So, should I also be skeptical about Cameron’s Deputy Nick Clegg who, in his party leader speech at the Lib Dem conference (2014), his last before the election, pledged to tackle ‘the ‘Cinderella status’ of mental health services’? That’s an emotive term we used to hear a lot in mental health (and seemingly forgotten learning disability) services in the 1980s and 1990s.This situation was initially much improved when mental health services were separated by trusts, and became independent of general services. Mental healthcare funding was significantly improved through The NHS Plan (Department of Health, 2000) to deliver its innovative model of National Service Frameworks. So what about the next last 5 years? I agree with what Clegg presents as areas for investment, but it has to be acknowledged it continues the work started by the Labour Government to improve access to psychological treatments (IAPT) (Care Services Improvement Partnership, 2007). Clegg supports developments in other areas; although the increasing demand for dementia care was not highlighted.These developments will be part funded in the same way Simon Stevens, NHS Chief Executive, suggests improvements can be delivered in his Five Year Forward View (NHS England et al, 2014) by efficiency savings. What is critial here is a recognition of the importance of time; people with mental health problems need time to talk, and we as service providers need time to deliver change. So, is another waiting list target, to reduce waiting for talking therapy, helpful? At what point does meeting the target become more important than how the target is met? How will nurses be involved in improving services and how will this impact on our role? We will be the ones left to translate policy intentions, service contracts and management priorities to meet fundingrelated targets into a meaningful and caring service. I am increasingly concerned by how externally driven we are, and the feeling of having less and less influence on the use of our time. Perhaps the greatest challenge to our time is the now universal but dubious discovery that one in four of us will be experiencing some aspect of a mental health problem (Health & Social Care Information Centre, 2009). This has inevitably increased expectation on our health services, and I profoundly agree with an approach that starts with talking rather than prescribing. Much of NHS funding is for people with long-term conditions. Mind (2014) reports that local authorities,
now responsible for public health, are underfunding mental health services, augmenting the problem of central government cuts to local authority funding, where local services have been reduced, leaving the NHS to pick up the resulting increase in need for care. These changes have been incremental and their impact slowly building, it can be likened to the increase in traffic on roads, where only a small change can eventually cause flow problems and gridlock. Given the interdependent nature of services, the increasing demand on our health system problems is first noticed at the entrance points to services, emergency and acute hospital and primary care. It is here we see targets of 4-hour A&E wait limits (often a challenge for mental health services), and Clegg’s ‘innovation’ for mental health waiting times. But this ripples through our system, as full hospitals reduce flow elsewhere, relationships and confidence in other services are challenged, resulting in stress and its fallout. Ironically, the NHS has become a much less healthy place to work. Are we given the space to reflect on our own practice, to identify areas for development, and the stability to work to a timescale for implementation? These are all aspects of a healthy working environment and profession, and I struggle to see how unhealthy, unhappy people can deliver an optimum service. There is one further issue that goes to the heart of what the NHS stands for. In my experience, my sense of purpose is increasingly set by objectives to meet the expectations of a system, to meet demand and turnover, to fulfil the requirements of contracts, so where do I as a person contribute? I believe that it is our capacity to be compassionate that is most under threat, because this requires a personal sense of agency, and that how we feel about the people we care for actually matters. Let’s hope that the next 5 years start with a recognition that change and improvement requires time and stability. And, if Cinderella is the right analogy, BJN we need to be aware that time is running out. Care Services Improvement Partnership (2007) Commissioning a brighter future: improving access to psychological therapies–positive practice guide. http://tinyurl.com/l9u4y6j (accessed 29 October 2014) Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform. Department of Health, London Health & Social Care Information Centre (2009) Adult Psychiatric Morbidity in England–2007 http://tinyurl.com/l9blxws (accessed 28 October 2014) Mind (2014) Mind reveals ‘unacceptably low’ spending on public mental health. http://tinyurl.com/pw4vl9x (accessed 28th October 2014) NHS England, Public Health England, Monitor, Health Education England, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://tinyurl.com/ kcjenmc (accessed 28 October 2014)
Mervyn Morris Director, Centre for Mental Health Policy Birmingham City University
© 2014 MA Healthcare Ltd
Editorial Board David Aldulaimi, Consultant Physician, Gastroenterologist, Worcestershire Acute Hospitals NHS Trust Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Lizzy Bernthal, Research Fellow and Lead Nursing Lecturer, Medical Directorate, Birmingham Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Emma Collins, Senior Sister, Practice Development Lead, Brighton and Sussex University Hospitals NHS Trust Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland David Delaney, Charge Nurse, Clinical Research, Alder Hey Children’s Hospital Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Joanne McPeake, Acute Specialist Nurse/Senior Staff Nurse in Critical Care; Honourary Lecturer/Practitioner in Critical Care, University of Glasgow Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Anne-Maria Olphert, Chief Nurse, Director of Quality, Erewash CCG, Derbyshire Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Bernadette Porter, Nurse Consultant, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Angela Robinson-Jones, Consultant Nurse, Gynaecology, Liverpool Women’s Hospital John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
Will the NHS find time for mental health nursing?
British Journal of Nursing, 2014, Vol 23, No 20
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.237.122.245 on November 15, 2015. For personal use only. No other uses without permission. . All rights reserved.
