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Pausing for thought on the Health and Social Care Bill
Posted Wednesday 6 April 2011
It’s probably fair to say that the Government’s plans to reform the NHS have hit a wall in recent days. Concerned at the level of opposition to the proposals, Cameron’s had a bit of a wobble and put the brakes on. In effect, this means that the passage of the Health and Social Care Bill through Parliament will come to a halt for a few months while the Government attempts to address people’s concerns.
A panel of experts has been set up to consider what changes need to be made, and Cameron and Clegg are touring the country meeting health professionals to explain the reforms and to listen to people’s worries. It’s just a shame they don’t seem to be as willing to hear what patients have to say.
All of this presents Andrew Lansley, the Secretary of State for Health, with a challenge. He is very closely associated with these reforms, and the concerns that they have generated in number 10 have left him increasingly isolated. The challenge for him is to keep the momentum behind the reforms going while simultaneously addressing the opposition that the proposals have generated.
So what does all this mean for mental health? There’s been a lot of talk in the press about the changes we need to see to make these reforms work. There’s a real focus on how the potential privatisation of the NHS can be avoided; how private firms can be prevented from cherry-picking the best services to provide; and how to ensure that people other than GPs can be involved in the commissioning process – such as nurses, consultants and patients.
However, these issues don’t really address Mind’s concerns about the reforms. Over the past few weeks, we’ve been working with Parliamentarians to ensure that our worries are heard. We’re focused on ensuring that the reforms don’t interrupt the services that people with mental health problems currently access: ultimately, we want to see these services improved.
Our main areas of concern are:
- Many GPs admit to having poor understanding of mental health services. If GPs are to commission these services, they will have to be provided with support from the centre.
- The danger that public involvement in influencing the commissioning process could be limited to those that can shout the loudest. It is imperative that the views and concerns of marginalised and disadvantaged groups, such as many mental health service users, are actively sought and listened to.
- The potential fragmentation of care pathways. People with mental health problems often have to access a range of services. If any willing provider will be able to provide each one of these individual services, then mental health service users could find themselves on care pathways that are fragmented and poorly-joined up. This could have a negative impact on an individual’s road to recovery.
The pause in the Bill’s progress through Parliament gives us an opportunity to make sure that these concerns are addressed. While Cameron and Clegg are clearly very keen to listen to the concerns of professionals, they must show the same willingness to listen to the concerns of the public. We’ll be working to make sure that they do.
It’d be great to hear about your top three concerns around the impact that the Government’s reforms will have on the services you use. Please let us know either by commenting on this blog post or emailing our Campaigns team.
Colin Walker, Mind Policy and Campaigns Manager (Mental Health Services)
4 Comments
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The GPs I've spoken to are usually pretty biomedical in their thinking for obvious reasons, especially the older ones. They usually have little depth of knowledge about the science of mental health so would blindly accept the misuse of positivistic evidence in mental healthcare just like Lord Layard and the We Need to Talk coalition did when they initially commissioned the IAPT scheme. Originally it was only for anxiety and depression and excluded people with severe mental illness from getting access.
This means important services for people with mental illnesses may not be commissioned. The social care side of things is where GPs know least and there's the least supporting evidence. Techniques which offer benefits for some people may be stopped because they're seen as not being cost effective because of the lack of evidence base. There's a significant danger that without patient involvement people will be denied access to services and support which works for them. For example many day centres were closed and no real replacements provided for the people who used them.
There's also the problem of what GPs read. This sounds like a dumb point but bear with me. They don't read Mind's reports. They don't read government strategies often. They rarely read psychiatric or social care research. They read the BMJ, Pulse, GP, NICE's clinical guidelines and other publications relevant to what their main role is: being good doctors.
Few have the knowledge which is necessary to effectively commission services. They're already running the business side of their practices as well as ensuring they keep up with the latest advances and treatments as well as treating their patients.
GPs are already trying to understand the entire spectrum of physical and mental illnesses to provide detection at primary care level. The consultants and associate specialists are the experts in their specialities. In my opinion it may be unsafe for GPs to take on more demands. Medical science is advancing quickly and if they don't have the time to keep up with the latest developments then they're going to be putting patients at risk.
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It is positively dangerous handing over everything to GP's, their representatives have already stated they don't have the training or time. Many people are being removed from mental health services right now because commissioners have told consultants to reduce their caseloads, so those who are unable to fight their corner, or don't look 'dangerous' enough are being dischraged back to GP's they will never see for ongoing support. The average GP appointment time of 4-5 minutes doesn't lend itself well to mental health where it might take that long to calm down enough from a busy GP surgery with officious receptionists and screaming babies to then spill your guts about what's happening in your head. This is like watching a car crash in slow motion.
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Thanks for what you do.all the points that you put are very true. Can you please send me an address for your area etc so that I can compose a letter about the mental health magazine I produce and our web site pluss the Rugby User Group we have just set up in Rugby because there is not a lot for service users in Rugby. A letter for me is better as I am NOT very good with computers - my wife sets most things up for me. Thank you Gordon.
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In 2009 in my area, the PCT commissioned a survey that included getting feedback from service users about plans to move their care back to GPs from secondary services. The results of this survey revealed overwhelming opposition to these steps, the main reason being that GPs don't know anything about mental health.
Why then, do the government wish to hand over commissioning to these people?
They state endlessly that the reason for these reforms is to put patients back in the driving seat, yet they never even asked patients their views before formulating these plans, and still aren't.
GPs, like the previous commenter said, don't bother reading most of the info sent to them. It was a source of great frustration for my PCT to try and implement things like educating GPs on the greater physical health risks that exist for people with mental health conditions, when they were powerless to force GPs to listen. Most won't even do physical health checks on people with mental health problems despite financial incentives, I was told by a frustrated mental health charity.
If you read NICE guidelines, you will often find on the back that patient group representatives recommended alternative therapies that had been found helpful by patients, but these were turned down for inclusion due to lack of medical evidence. The medical system in this country, unlike Germany or Australia and many other places, is based purely on a medical and pharmacological model of care. It is not preventative with lack of knowledge of nutrition quite shocking. The last GP training consultation contained nothing about alternative therapies except where they interacted with their own medication. Mental health recovery requires a holistic, recovery approach, that embraces such things as personal relationships, work, diet, lifestyle, hobbies, work-life balance, stress reduction, etc...What on earth do GPs know about these things when all they know how to do is write prescriptions?
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