mental health in topsy turvy


IMG_1710Since the formation of this coalition we have seen a vast increase in Foodbanks and deep cuts to our most cherished public services by this dreadful government. How many more people will have to suffer the long queues at Job Centre Plus and imposed sanctions against them for one reason or another.

The coalition alleged that there are plenty of jobs available in the private sector which hear and read about via Prime Ministers Question Time, and press. The simple answer is there are very little opportunities available to gain employment. Most of the jobs that’s we all apply for are zero hour contracts which you cannot plan for your future and you will have to call up on a daily basis to see if there is any work available at times.

Yet the burning issue the current UK coalition government have failed to address is Mental Health issues and the lack of funding to improve services which have been high on the agenda of leading press and mental health organisations which this coalition is not addressing.

IMG_2041Mental Health organisations are no strangers facing cuts from Central, European and Local Governments funds if anything they have put in conditions for charities bids which makes it virtually impossible to bid for services for them to tender their bids on the one hand but on the other hand the previous Conservative Government under both Thatcher and Major were happy to CCT to contract out NHS mental health services by using Care In The Community and Compulsory Competitive Tendering.

http://www.communitycare.co.uk/2013/12/12/firefighting-mental-health-funding-shortage-thats-hitting-frontline-care/

Under the leadership of John Major the Conservative government pursued Compulsory Competitive Tendering almost as a dogma, often against the wishes of local government. This led to an uncomfortable stand-off between the two, with CCT regulations being produced in increasing detail, and sometimes extending further than would have been the case in the private sector. The government was unambiguous about what was required issue of tender, receipt of tender, selection of provider.

IMG_2045The term compulsory competitive tendering was superseded in 2000 by best value. Labour’s Best Value proved more difficult to define. The notion of Best Value prior to implementation was enshrined within one key consultation document: Modernising Local Government Improving local services through best value (DETR 1998a). This set out four defining elements of Best Value.

The first was the duty to secure economic, efficient and effective services continuously (the ‘3 Es’).

The second required service reviews within which the authority must demonstrate that in the fulfilment of their duties under Best Value they have: compared their service provision with that of other private and public providers; consulted with local business and community; considered competition in provision; and challenged the reasons for, and methods of, provision (the ‘4 Cs’).

The third defining element introduced a regime of audit and measurement of performance, with the broad expectation that, year-on-year, costs would reduce and quality would increase. Performance would be monitored locally through Best Value Performance Reviews (BVPRs), partly through adherence to locally and statutorily determined Best Value performance indicators (BVPIs), and disseminated annually through Performance Plans (BVPPs).

IMG_2088The fourth defining element of Best Value outlined the consequence of performance: Government intervention in cases of Best Value failure, and reward in cases of success.

In turn these four aspects of Best Value are bound by adherence to twelve principles of Best Value mentioned above. The answer to the question of what method of service delivery, precisely, the Government expected to arise from Best Value seemed to centre on local interpretation as satisfactory. The lack of clear definition, in the context of housing services, was explained as follows:

 The paper does not attempt to define what best value in housing is that is primarily a matter for individual local authorities in consultation with local people. The primary intention is to explain the process framework within which local housing authorities will need to operate in obtaining best value in housing (DETR 1999, s.1.3).

Therefore, while the message was unequivocally that Compulsory Competitive Tendering was to be withdrawn, the replacement was to be less prescribed, with the intention that local authorities follow a responsive and locally determined method of service provision within a centrally defined framework. Best Value was not, therefore, about what local authorities should do: it was a framework that prescribed how they should decide what to do.

IMG_2100Specifically Best Value would differ from Compulsory Competitive Tendering in three respects: organisation performance, organisation process, and the relationship between process and performance (Boyne 1999, p. 2).

So in essence it was not only Labour put PFI top of their agenda but a Conservative government under Major that closed and reinvest some Mental Health, and Learning Disabilities Hospitals using both PFI and CCT

A recent report suggests is a grim reading for those involved in mental health care. The survey of GPs revealed that one in five had seen patients harmed as a result of “delays or a lack of support” from mental health services, while shortfalls had forced 82 per cent of doctors to act “outside of their competence”. While this news is shocking, it is just another example of the UK’s mental health care crisis.

Just last week, data obtained from freedom of information requests led to claims that the NHS treated mental health care as a “second-class service”. Indeed, thousands of mentally ill patients have been forced to travel “hundreds of miles” for treatment in recent years. Extreme cases have seen patients being forcibly sectioned so that they can receive care in overcrowded wards. Even medical students have resorted to asking for greater teaching on psychiatry, highlighting the derisory attention that mental health issues receive. Yet the state of mental health services is unsurprising considering that they receive only 13 per cent of the NHS budget, despite mental illness affecting around a quarter of the UK population.

IMG_2083Worse still, national spending on mental health has consistently decreased over the past three years. And the trend isn’t limited to adult care; mental health services for children and adolescents have also seen a fall in funding. This decline seems even more irrational considering adolescence is the period when many mental illnesses first manifest, and that hospitals are recording a rise in hospital admissions for conditions such as eating disorders.

The budget cuts have had a noticeable impact, with doctors citing the changes as a cause of “avoidable deaths and suicides,” while mental health organisations claimed that the cuts “put lives at risk”. Mental illness also has a significant impact on a patient’s quality of life, and is thought to contribute to poor physical health, having been associated with diabetes, cancer and cardiovascular disease. As well as the ethical concerns of these cases, such neglect of the mentally ill also has practical implications; a report by the London School of Economics found that the NHS could save over £50m a year by reversing budget cuts to preventative and early intervention therapies.

Yet perhaps the most striking aspect of the decrease in funding comes from the comparison with other areas of health care. The government, for instance, took great pride in announcing that the Cancer Drugs Fund would be ring-fenced until 2016. While it would be wrong to question the severity of diseases such as cancer, it is worth considering that this budget is reserved for treatments that aren’t ordinarily commissioned because they are not cost-effective. Given the nature of the NHS’s funding crisis, it seems unfair to fund relatively inefficient treatments, while the NHS’s most vulnerable patients are left without basic care.

IMG_2095 This is the problem. Eager to brand their “reform” of the NHS as good for patients, the coalition has protected the emotive areas of health care that already benefit from public awareness. Aware that severely cutting the budget for paediatrics or cancer care would result in public outrage, the government are cynically withdrawing care from those most lacking a voice in society: the mentally ill.

Although this current crisis is alarming, such disregard of mental health isn’t a recent phenomenon. IMG_2036Plagued by a history of taboo and prejudice, mental health care has historically been chronically underfunded. With a media happy to brand mentally ill people as “psychos” and a threat to society, it has been relatively easy for politicians to excuse this injustice. But public perceptions are changing; a report by the charity Rethink Mental Illness found that public understanding and tolerance of mentally ill people is improving, while 63 per cent were aware of a close friend having a mental health problem.

This is important; for a politician to stand up for mental health care now wouldn’t just be a principled action, it’d be a popular one. With time, and the excellent work of campaign groups, this positive trend in public attitudes will only continue, allowing society to grow in confidence to discuss one of our greatest health challenges. The mental health charity Mind suggests that the next government commits to a 10 per cent rise in the NHS’s mental health budget over the next five years. Considering the state of mental health care and the current funding disparity between health services, this is not an unreasonable request.

IMG_2058 Past governments have chosen an area of health care to focus on, in order to target voter demographics. In 1999, Blair announced his “crusade against cancer”. Seeking the “grey vote”, David Cameron called for a “national challenge” to beat neurological diseases such as dementia. But the disgrace of the NHS’s mental health provision goes beyond party politics. Regardless of who wins the general election, the next government must embrace bold reform to end our longstanding neglect of the mentally ill.

For further read checkout:

This is what Labour Manifesto proposes to address Mental health Issue http://www.labour.org.uk/issues

http://www.labour.org.uk/issues/detail/patients-before-profits

http://www.labour.org.uk/issues/detail/whole-person-care

http://www.meetnigelfarage.com/#slide-2

Conservatives Manifesto

https://www.conservatives.com/ShareTheFacts.aspx

UKIP Manifesto:

http://www.ukip.org/ukip_launch_nhs_policy

 

 

 

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