Parliament ‘sceptical’ about NHS England’s ability to deliver on mental health targets

An influential committee of MPs released a damning report today into the state of Britain’s mental health system. They found that only 1 in 4 people could access the mental health services they needed.

The cross-party Public Account Committee, in charge of making sure the Government spends money efficiently, said pressure on NHS budgets would make the Department of Health’s new mental health standards ‘difficult to achieve’ without taking money away from other services.

The Department of Health has pledged £1bn over 5 years to improve mental health provision but this is not ring-fenced. With the current financial pressures across the NHS, it will be tempting for NHS managers to use that money to plug short-term holes rather than invest in long-term  mental health provision.

Specific problems cited in the report include:

  • A lack of counselling in some schools meaning many miss the chance to have their symptoms identified early  – half of those who experience mental health problems do so before the age of 14 
  • Variability in the provision of services – in some areas 99% of people are seen in 6 weeks, in others it is just 7%
  • Lack of access to mental health care for current and former prisoners – 9/10 prisoners have a mental health problem, 7/10 have two or more

The Public Account Committee recommended, among other things, that the Department of Health and NHS England did the following:

  1. Figure out how much money they needed to pay for its mental health program, and which areas of spending they prioritised
  2. Join up services across government to improve continuity of care for those with mental health needs e.g. housing, social care
  3. Work out how many extra nurses and additional staff they would require to roll out their programs

Why these things were not done prior to rolling out new nationwide standards is not recorded. However, they do show a continuation of the Department of Health’s remarkably lax approach to planning ahead and gathering evidence, as shown by this argument from their lawyer in yesterday’s court case regarding junior doctor contracts.

 

The letter that shows even Jeremy Hunt doesn’t believe changing junior doctors contracts will improve weekend care

Letter-from- the-Secretary-of-State-for-Health-to-the-Chair-on-seven-day NHS hospital services-page-001

Jeremy Hunt’s most recent letter in which he never mentions junior doctor contracts. An omission or an admission?

Junior doctors have been saying for months that they already work 24/7 and changing their contracts won’t improve patient care. It now seems even the Secretary of State agrees with them…

Four days ago, Jeremy Hunt wrote a letter to a fellow Conservative MP, Dr Sarah Wollaston, trying to explain the ongoing media kerfuffle about the ‘7 Day NHS’, and why it’s so important it needs to be tackled.

This is all fairly standard behaviour. Jeremy Hunt is the Secretary of State for Health. Dr Wollaston is Chair of the Health Select Committee, and the most influential M.P. on health matters outside the Government. It makes sense that they would communicate on a fairly regular basis.

He starts by explaining the 10 clinical standards that NHS England describe for 24/7 care. He explains that four standards are most important. These are:

  1. Consultant presence during initial treatment decisions
  2. Regular consultant review
  3. Access to diagnostic tests
  4. Consultant-led interventions

He then sets out his evidence for why these changes are important. He lists 15 studies that have apparently found worse health outcomes during the weekend than on weekdays. He lists a number of proposed reasons for why this might be, including the possibility of sicker patients being admitted at the weekend.

One group of people he doesn’t mention are junior doctors. Not even once. However he does mention their senior colleagues, the consultants. In fact, he mentions them a lot.

Letter-from- the-Secretary-of-State-for-Health-to-the-Chair-on-seven-day NHS hospital services-page-003
 

The importance of consultant presence at the weekend is mentioned 5 times in one page alone.

 

 

With no less than 10 mentions in what amounts to 3 sides of A4, Jeremy certainly seems to think that changes to how consultants practise their jobs are necessary to stop substandard care.

He’s also quite keen to mention improved access to diagnostic tests (4 mentions) and to suggest improvements to community and primary care services (2 mentions).


 

For those of you wondering if Hunt mentions his ‘20% increase in stroke death at the weekend’ line, yes he does. He then promptly mentions that the implementation of Highly Acute Stroke Units (HASUs) has reduced this figure dramatically. In his words, ‘this clearly demonstrates the link between seven day services and reduced mortality rates.’

And in my words, ‘and it was all achievable under the current junior doctor contract, as are all your other suggestions to improve weekend care.’

Given that Mr Hunt clearly knows what needs to be done to improve weekend care (and its not junior doctor contracts), and has admitted as such, it’ll be interesting to see if he continues to peddle the nonsense that junior doctors don’t work: at all/enough/with enough ‘vocation’ (delete as appropriate) at the weekend when he pops back into the spotlight again.

Doctors of all grades and specialities want to help make all care, including weekend care, better. The implementation of HASUs shows that where problems exist, the NHS can pull together to change them.  What won’t change them is antagonising all the junior doctors to the point where half of them don’t sign up for speciality training, and quite a few of them never come back.


 

Click here to read the full text of Jeremy Hunt’s letter 

If you’re a junior doctor, medical student or anyone at all who cares about how the junior doctors who work in our NHS are treated, email jdcchair@bma.org.uk and make the subject “FAO: David Dalton & Clare Panniker”. The negotiating teams want to know your views and they want to know them ASAP!

 

 

 

 

 

 

 

 

 

 

 

 

Hypocritical Hunt AGAIN avoids Parliamentary emergency

Jeremy Hunt has once again avoided answering an urgent question in Parliament, the second time he has done so in as many months.

Today’s question on junior contracts came just over 24 hours after junior doctors overwhelmingly voted for industrial action.

Whilst the first ever vote for strike action by Britain’s doctors might sound like a big deal to most people, Jeremy Hunt decided against attending today’s debate on it. It was left to  junior minister Alistair Burt to answer the questions out to him by Heidi Alexander, the Shadow Health Secretary, and other MPs.

Mr Hunt avoided a question on NHS finances on the 12th October 2015,  and here’s what I wrote then:

“Urgent questions are the parliamentary equivalent of a heart attack. They are serious, don’t happen that often and are granted only if there’s no other way of asking for the information you want.

 

Given that Hunt is continuing to say he’s open to negotiations, one would expect him to take the chance to discuss the contracts in Parliament. Mind you, you’d also expect him to take up the offer of fresh contract talks.

In fairness to him, there was the small matter of the worst ever NHS financial crisis to deal with today. However if his excuse is that he’s got too many crises to deal with at once then there will be very little sympathy for him in the world.

There has long been a feeling amongst junior doctors that Jeremy Hunt is either incompetent at his job or deliberately messing things up. This feeling is not helped by the fact he appears to do his best to avoid any kind of honest debate.

If he continues to avoid debate over important issues, you can only help but wonder before this total lack of trust starts to carry over to his political masters.

NB: The full debate can be viewed here. Scroll down on the right-hand side to 11:00 to ‘Urgent Question – Junior Doctor Contract’.

Health and Politics: This Week’s Agenda

This is the first in a weekly series of posts that aim to explain what our politicians are doing about health-relates issues. 

Published each Sunday, these articles will look at the Parliamentary agenda for the week ahead. This series aims to clarify what events are happening, which ones matter and why you should care.

Monday 16th

The Public Accounts Committee (PAC) is looking at the management of adult diabetes services in the NHS. The PAC looks at how government departments spend their money, and is widely respected. It can drag anyone in front of it for questioning, and doesn’t always treat them nicely when they get there.  This session’s victims include Simon Stevens, the head of NHS England

It’s usually pretty scathing in its reports, and recently eviscerated the Government for its handling of Kids Company, a charity which collapsed into financial ruin despite huge grants from central government.

This session, and its report that’ll come out later, won’t produce any changes in law. However, it’s evidence carries a lot of clout and influences many future decisions on policy and management.

Tuesday 17th 

The monthly pantomime that is Health Questions, where for three hours, Jeremy Hunt and his junior lackeys will avoid answering questions from other MPs.

A disappointing set of questions this time around, as at least six look like they’ve been tabled just to give a chance for Jeremy Hunt to hear how well he’s doing (despite all evidence to the contrary).

There’s still a slight chance of something interesting happening though. Things to look out for include:

  • The inevitable row over junior doctor contracts
  • Quite how badly the Government answers a question on the availability of off-patent drugs, given that a heath minister Alistair Burt, blocked a bill that would’ve made such drugs cheaper just two weeks ago.
  • The likely spat between Phillip Davies and Jo Cox over hospital car-parking costs. Davies infamously blocked a bill that would have made hospital parking cheaper for visiting carers.
  • Ministers trying to appear informed about genomic medicine, and the genetic issues around first cousin marriages.

Wednesday 18th

The House of Lords is having a chat over dinner about improving stroke care. In what is delightfully called ‘Dinner Break Business‘, peers get to chat about whatever issues they feel are important whilst everyone else is having food. These debates can get quite technical and detailed, and generally are a lot more informed than Commons debates.

Thursday 19th

Backbench MPs have organised a debate on ‘A New Cancer Strategy’. Backbenchers are those who don’t hold senior positions in the government or opposition.

David Tredinnick, Parliament’s very own witch doctor, was involved in getting it organised. Tredinnick is famous for believing surgeons don’t like operating in the full moon as blood doesn’t clot properly, so there’s potential for some very wacky ideas to get thrown about.

Almost as equal a nutball is the previously mentioned Phillip Davies, MP for Shipley. Davies’ claims to fame include being Parliament’s biggest producer of hot air and for getting in a recent argument over whether to debate International Men’s Day.

Davies got his way but will be talking in Westminster Hall. If the Commons chamber is the Premiership, Westminster Hall is the Vanarama League. Seems about right for as silly an idea as International Men’s Day. It’s a great shame that the very serious topic of male suicide is being discussed alongside it.

Friday 20th

Despite many members returning to their constituencies on Thursday, apparently the House of Commons thinks Fridays are great times to discuss new laws. Specifically, they debate Private Members Bills, which are introduced by normal MPs, rather than the Government.

Unfortunately, these bills can be ‘talked out’ by MPs who think they’re a bad idea. Basically, this involves chatting enough nonsense so that there’s no time to vote.

Phillip Davies, who by now is seeming like a thoroughly disagreeable human being, does this quite a lot.  Ideas up for debate include:

  1. Introducing compulsory emergency first aid education to secondary schools
  2. Increasing provision of independent mental health advocates in England
  3. Making service commissioning more equal towards those with mental illness and learning disabilities
  4. Increasing provisions for mothers, and expecting mothers, with mental illness

Unfortunately, if the first aid bill uses up all available time, then every other bill can be blocked by just one MP shouting object. If this happens, bills get shoved to the bottom of the debate pile for next time and have no practical chance of becoming law. This might be the single stupidest thing in Parliament, which is quite impressive given the intelligence of some of its occupants.

The Lords are also debating a bill which will give more money to mesothelioma research. A commendable idea, but it won’t ever happen, unless an MP in the Commons decides to pick it up.