Wednesday 16 October 2013

Institutional Bias

Pen-y-Fal hospital 1851-1996

Disturbing revelations this morning about the running down of mental health services for people with a serious mental illness in England - see the story on our Facebook platform here. Beds have been closed and those that remain are rammed so that patients frequently have to travel long distances to get a bed (extremely distressing in an emergency) or indeed don't get one at all.

Common sense tells us that you always need spare capacity - 15% is about right - because admissions can't be planned: that's the nature of mental illness. But in England at least 1,711 beds have been closed since April 2011 (277 between April and August 2013) - a staggering 9% reduction. And, remember, this is in the context of a protected NHS budget in England.

How can this be? Well, we all know, don't we? Mental health remains the Cinderella service. When health budgets come under pressure managers feel much less ill at ease if they cut mental health than they do cutting other services. And why is that? Not because they are wicked people but they assume rightly or wrongly that their political masters and the public care much less about mental health services.

And yet...

Care Minister Norman Lamb tells us "There is an institutional bias in the NHS against mental health and I am determined to end this". Good for him for being so candid and let us hope he gets the message across to NHS managers that the unfair treatment of these patients has to stop.

So, can Wales smile complacently from the sidelines? I fear not. As in England successive Ministers have proclaimed varying degrees of priority for mental health services and there is useful legislation and many of the right words in the new strategy Together for Mental Health.

But there is nothing to suggest that Welsh mental health services are superior to those in England - indeed it is pretty obvious that modernisation in terms of hospital care lags behind - not the same thing as bed capacity but still a significant deficiency.

One of the weaknesses of the Welsh strategy is that it is light on prescribed levels of service - ie concrete things you can count in terms of what is available. Rather the strategy concentrates on "outcomes" ie targets in terms of improvement of mental health. Nothing wrong with that but it may not be enough to persuade hard-nosed NHS and council commissioners and providers to give due weight to resourcing mental health services.

It is a kind of acknowledgement of this that the Welsh Government remains committed to ring-fencing NHS mental health funding - a crude, unsexy instrument but, in the end, easily the most important part of the Welsh strategy if you are a realist. We badly need to make the ring-fence work effectively through transparent reporting - it remains near impossible to hold the Local Health Boards to account for the ring-fence, something we must focus on relentlessly.

You bet mental health services will be run down if we don't keep right on the case.