Crisis in mental health services

On 25 January 2016 The Guardian exposed the collapse of NHS mental health services, citing figures from the NHS’s Health and Social Care Information centre showing that the number of registered mental health nurses (RMNs) working in psychiatry has decreased by 10.8% since 2010 as funding for the service has been slashed. The following day the paper revealed that the number of unexpected mental health patient deaths had risen by 21% over the last three years. This was inevitable given that mental health service budgets fell 8% in real terms under the last government. Claire Wilkinson reports on the crisis engulfing NHS mental health services.

Working on an acute psychiatric ward for the last four years, my experiences certainly correspond with this data. The North West mental health trust I work for is increasing its training and employment of Assistant Practitioners (APs), a relatively new role where a healthcare assistant is trained to take on many of the duties of a nurse while remaining unregistered in a professional capacity. APs are employed on a Band 4 in the NHS pay scale, whereas an entry-level RMN is employed on the more highly-paid Band 5. There is an obvious financial incentive for trusts to employ fewer RMNs and replace them with the cheaper APs, who are unable to progress past Band 4 or register with a professional body.

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NHS under-funded and under pressure

The Autumn Statement’s proposal to increase NHS funding by £3.8bn in 2016/17 is the minimum required to avoid financial disaster over the next 18 months, but may be too late to avoid a crisis this winter. The NHS needs £30bn by the next general election just to stay still; however, the government has only promised £8bn. The health service will have to find the balance of £22bn through ‘efficiency savings’ – about 20% of its current budget. This is an impossible target: but the government pretends not only that it can be achieved, but also it will be sufficient to meet what it defines as a 24-hour, seven-day-a-week service. The savings require productivity improvements at twice the rate of the past five years, during which time the increase in health spending has averaged 0.8% per year, the smallest five-year rise since the NHS was introduced in 1948. In reality, annual spending has to increase by 4% to keep up with increasing need and escalating costs of new drugs and treatments.

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No solution but to fight for health care

The financial crisis of the NHS is now so deep that Tory Health Secretary Jeremy Hunt has been forced to concede its existence. Typically, however, he has blamed it on factors beyond the government’s control: ‘There’s a triple whammy of the ageing population which means there will be a million more over 70s by the end of the parliament than there are today – that’s a massive impact; the financial pressure which means that the government is not able to increase spending in real terms on the NHS by the amounts it has done historically – that’s something we’ve had to get used to over the last five years; and raised expectations from people who use the NHS about accessing it more easily but also raised expectations post Mid Staffs in terms of the quality and standard of care.’ The underlying message is that capitalism will not provide a decent health service for the mass of the people. There was an £822m deficit in the NHS last year and the NHS is facing a £2bn deficit this year. Had the Department of Health and NHS England not put in £350m, the deficit would have been bigger.

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NHS: More fragmentation, privatisation and rationing

During the election campaign the Conservatives made great play of their commitment to put an extra £8bn into the NHS. This was their response to the Stevens Report from 2014 which identified a £30bn gap in NHS funding by 2020, and which argued that £22bn of this could be met with ‘efficiency savings’. Meeting such a target was always fanciful, and now senior NHS managers are stating openly that it is impossible, and that achieving even £15bn of savings is unlikely. Health Secretary Jeremy Hunt has seized the opportunity to express his doubts about the long-term viability of funding the service through taxation. Further fragmentation, privatisation and rationing are inevitable as part of undermining a universal service free at the point of use.

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The NHS: facing a financial nightmare

As the financial crisis engulfing the NHS deepens, Conservative promises to create a ‘seven-days-a-week’ NHS by 2020 already ring hollow. Its election commitment to invest an extra £8bn a year by 2020 will at best keep the NHS standing still: more likely, it will involve further cuts to an increasingly threadbare service.

Desperate pleas for an immediate cash injection of £1bn into the NHS demonstrate how close it is to a financial abyss. Hospital, mental health and community services collectively ended 2014/15 £821m in deficit, nearly eight times the 2013/14 figure of £107m. The total deficit for acute hospitals was just over £1bn, with Barts £80m overspent and foundation trust Kings College £47m overspent. On current trends, the projected NHS deficit for 2015/16 is in excess of £2bn.

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