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  • Mental health melt down

    Monday 28th April 2014

    There can be no clearer illustration of the abject failure of the Tory-led coalition's competitive market in health care than the disaster facing mental health services.

    Over the last few months the scale of the problem has been more fully revealed, not least the growing gap between the dwindling capacity of the system to deliver care and the growing need - worsened in many cases by this same mean-spirited government's brutal cuts in benefits, bedroom tax and refusal to tackle the problem of affordable housing, all of which take a toll on mental health.

    NHS budgets for mental health in the NHS are not simply frozen, like budgets for physical health needs, while costs and pressures increase, but - for the first time in a decade - actually falling year by year as health bosses inflict cuts where they feel the media will not pay any heed.

    The government response has been to stop compiling the figures that have revealed the cuts.

    NHS England, far from taking steps to address the problem of shrinking mental health budgets, has decided to cut the 'tariff' (the standard fee paid to trusts for treatment) for mental health by 20% more than the cut for other tariffs.

    Health minister Norman Lamb, speaking recently to the NHS Confederation's Mental Health Network, criticised the decision to impose a tariff reduction of 1.8% in mental health contracts, compared with 1.5% in acute care. He told delegates the decision was "flawed, not based on evidence and cannot be defended".

    But then he dumped the problem back onto the mental health trusts, saying they should "fight" with their commissioners over their contracts: "Do not accept a proposed settlement which results in mental health losing out."

    Since his Tory bosses have just forced through legislation that puts all of the financial control in the hands of commissioners, and all of the problems in the court of the mental health trusts, this is a complete evasion.

    We know that in the face of the government's cash squeeze all aspects of mental health have been hit: 1700 beds have closed since 2010, leaving dire shortages in various parts of the country, not least for child and adolescent mental health, where young people are often transported for hundreds of miles to find a spare bed, or even placed on adult wards.

    One area facing especially severe problem is Norfolk and Suffolk, where the mental health trust is simultaneously cutting back on both beds and community mental health provision, while dispatching dozens of patients to beds many miles from their homes and families. Protestors who marched 52 miles from Ipswich to Norwich last week to highlight these savage cuts showed clearly the injustice and the problems from these cuts:

    "If someone had a stroke in Norfolk or Suffolk and had to be taken to Darlington, Somerset, Bradford, Manchester, Harrogate or Glasgow, MPs would be falling over themselves to call for urgent action. But this is the reality for people in Suffolk and Norfolk experiencing a psychiatric emergency."

    The words are from one of the march leaders, Emma Corlett, a Norfolk councillor and UNISON steward, who has been campaigning to stop the cutbacks. In response the Trust chief executive, interviewed by the BBC, desperately tried to deny that there was any crisis - before admitting that his trust, like many other mental health trusts, is facing a squeeze on funding and a shortage of beds.

    Back in 2010 the Care Quality Commission (CQC) expressed concern at the excessive levels of occupancy of the majority of beds on acute mental health wards, with well over half the 486 acute wards in England running at or above 100% occupancy levels, and 35 reported to be running at levels above 125%.

    But last autumn consultants again spoke out on the dire shortage of acute beds: and nothing has been done - instead more NHS trusts are once again using costly and low quality private sector beds, often many miles away, to take their "overspill".

    Clinical Commissioning Groups seem if anything even more willing to cut mental health spending - even intensive care beds - than were the Primary Care Trusts they replaced. But sadly their under-investment in mental health is not new.

    Back in 2010, mental health charity Rethink published a report that showed many of the 1.5 million people suffering from severe mental health problems such as schizophrenia, bipolar disorder, personality disorder and severe depression were not receiving appropriate treatment. As a result they die on average 10 years younger than the rest of the population, are more likely to wind up in prison or homeless, and were much more likely to be unemployed and dependent on welfare benefits.

    In 2012 an LSE report found that only a quarter of the 6 million people suffering from mental illness were in treatment: mental illness then accounted for 23% of the total burden of disease, but received only 13% of NHS expenditure - a share that is shrinking fast.

    The problem is still unresolved. Health minister Norman Lamb, speaking to the NHS Confederation's Mental Health Network, criticised the decision to impose a bigger tariff reduction in mental health contracts than in acute care. He told delegates the decision was "flawed, not based on evidence and cannot be defended".

    But then Lamb dumped the problem back onto the mental health trusts, saying they should "fight" with their commissioners over their contracts: "Do not accept a proposed settlement which results in mental health losing out."

    Since his Tory bosses have just forced through legislation that puts all of the financial control in the hands of commissioners, and all of the problems in the court of the mental health trusts, this is a complete evasion.

    Lamb's speech followed on his appearance with Nick Clegg back in January to launch the Department of Health document Closing the Gap: priorities for essential change in mental health.

    Each of the report's 25 worthy proposals seems light years away from the actual situation in the NHS especially in the last four austerity-squeezed years.

    Proposal number one begins with the statement that "High quality mental health services with an emphasis on recovery should be commissioned in all areas, reflecting local need".

    Who would not agree? Apart that is from NHS England, who are forcing down the tariff for specialist services to unaffordable levels - and the local commissioners who have been spending less on mental health year by year for at least two years, with worse to come.

    Number three promises to establish "clear waiting time limits for mental health services" - at a point where we know children and adolescents are waiting up to 18 months for treatment, and many other services are hopelessly inadequate to deliver swift treatment. Number four promises to tackle "inequalities around access to mental health services" - with no serious explanation of how this might be done.

    Number seven promises that the "most effective services will get the most funding" - but we already know that's not what's happening either: everything is being cut.

    And so it goes on: the document has some good and necessary policies, but has no connection to the current, tightening resource squeeze that is set to run at least to 2021.

    If words alone could fix mental health, there would be no crisis. But at present a small but growing private sector, with limited capacity, limited skills and no wish to take on any complex cases, is profiting from the gaps opened up in the NHS.

    The gaps in social care are perhaps even greater, with massive cuts across the board, also hitting mental health the hardest: a recent report shows that there has been a 48% cut in numbers of people with mental health problems receiving social care since 2005; one in three councils have cut their mental health services by 50% or more.

    The coalition government has set up a dysfunctional NHS that has fragmented services, divided drug addiction services from alcohol misuse, and forced CCGs to seek cost "savings" by opening up services to "any qualified provider" - whether this be cherry picking voluntary sector organisations exploiting unpaid and untrained staff, or profit-hungry private companies.

    For CCGs and NHS England, the bottom line is short term, often illusory cash savings, while quality takes a back seat. This means the mental health trusts, with their superior skill mix, their staff training and their multi-disciplinary teams are facing deficits and loss of contracts, while cheap and cheerless services from less qualified providers win the day - and tens of thousands of mental health patients lack the care they need.

    In East Anglia, and recently in the west of Greater Manchester there have now been small but important recent protests as a fight develops to defend mental health. These protests need to be echoed loud and clear by any politicians claiming to stand up for the NHS this year or next.

    It's not fine words we need from weasel politicians, but hard cash and commitment.

  • 30 years of Health Emergency

    Tuesday 8th April 2014

    30 years ago the first issue of Health Emergency newspaper was published by the GLC-funded London Health Emergency campaign. Its purpose from the outset was to reach out to trade unions and campaigners beyond the capital, and to build a fightback against cuts and privatisation.

    Health Emergency won affiliations from all of the health unions, many of them working with us at national level.

    After the GLC was abolished two years later, LHE was funded as a source of independent information on the NHS for another 12 years by various London boroughs - while the campaigning work has from then on always been financed fromy affiliation fees, donations, and later by commissioned work for the unions.

    This has enabled us to be at the forefront of the fight on every major issue in three decades of camaigning.

    The governments have changed, the ministers have changed, the unions have changed - but 30 years later, with no grant funding, LHE is still functioning, despite the efforts of some who do not share our principles to close us down - and Health Emergency exists as an occasional newspaper, a website, a wealth of experience and published material, and as a consistent voice fighting privatisation in all its forms.

    Health Emergency could not have survived this length of time and these pressures without the loyal support of activists - and some courageous officials - in the health unions who have stood by us, made donations, organised campaigns, commissioned work. They are the real spirit of the NHS.

    Now we are faced with the most reactionary Tory-led government in living memory, with the NHS fighting for its life against threats of a decade-long freeze on funding, the deliberate fragmentation of the NHS and privatisation of the Health & Social Care Act with the dead hand of Blairism still blocking Labour from a full-blooded campaign to defend our most popular public service.

    Health Emergency is proud to stand firm with its supporters, to defy its detractors, and to wage the key fight in the next 12 months to ensure that Cameron and all remnants of the vicious coalition are removed from office, and that the government that takes over commits itself it advance to break from Tory cash limits, reverse the Health & Social Care Act, restore the duty of the Secretary of State to provide universal health care, clear out the private profiteers, and put our NHS back together.

    We remain a non-party political campaign: this means we will work with anyone from any party or none who will fight to keep our NHS fully funded, and keep it public: and we are also proud to work with Keep Our NHS Public, the campaign that emerged from the fight against Labour's market reforms, and remains at the centre of the fight against the Tory attacks today.

    We know that on these issues we have majority support: the challenge is to translate that into a movement that can defend the NHS and defeat the aims of the current government.

    Together we can win!

  • Peoples Inquiry into London's NHS

    Wednesday 19th March 2014

    The People's Inquiry into London's NHS, supported by Unite the Union, held seven public hearings in the final months of 2013, heard from 95 witnesses plus many more written submissions and compiled over 140,000 words of evidence in transcripts.

    The Inquiry's independent 6-strong panel has since deliberated over the information they accumulated and formulated 18 unanimous recommendations.

    The full Report from the Inquiry, London's NHS at the Crossroads, is to be published on Thursday March 20, and the report and summary will be available online.

    The Panel invites further discussion and comment on the Report and in particular on the conclusions, which aim to shape policy for this and future governments.

    One thing that emerged clearly from the Inquiry was that while London as Europe's biggest and most diverse city is unique, its problems with government spending limits and the coalition government's half-baked "reforms" in the Health & Social Care Act are not a special case.

    Almost all of London's problems can also be found in other parts of the country: the recommendations therefore call for national action as well as specific intervention to prevent the capital's health services deteriorating as a result of squeezed budgets and organisational fragmentation.

    The Inquiry can be contacted at www.peoplesinquiry.org

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