Minister of State for Care and Support talks about the health and care system, joined up services and equality for mental health at NCAS.
Creating a modern, effective, sustainable health and care system at a time of extraordinary challenge
The challenges that face us are significant – people are living longer, their conditions are becoming more complex. All this leads to rising costs and more pressure on staff.
Since the coalition government came to power, we have supported the health and care service wherever we could. We have increased the budget for the NHS by £12.7bn over this Parliament.
But it isn’t just about the money – it is also about doing things in a better way.
You may have heard last week from Simon Stevens and his Five Year Forward Look that we need to seriously think about the way the health service works. I agree with him.
For one thing, we know how not to arrive at it.
We have tested to destruction centrally imposed change – where diktats came from Whitehall and we expected the same service to work in Manchester and Milton Keynes. This couldn’t go on.
Recently, I challenged FTSE 100 companies to sign up to Time to Change – our programme to raise awareness of mental health, to end the stigma surrounding it and help people find the right emotional support.
Barclays, with nearly 140,000 employees, has signed up to Time to Change. Now we need others to follow their lead. But another part of this is helping people to care for themselves too.
Integration: pioneers, Better Care Fund, prevention
We must make a shift from a horribly fragmented system: healthcare separated from social care, primary care separated from hospital care, and mental health institutionally separated from physical health. That makes no sense from the patient’s perspective.
Instead, we must promote integrated care, joined up around the needs of the individual.
Most of you will have heard Jeremy Hunt talk yesterday about how we will achieve this through our integration work. It is truly ground-breaking.
Many successive governments have tried to introduce integration, but we are introducing it.
The Better Care Fund plans show the ingenuity of the health and care sectors and local government.
And as we made clear in yesterday’s announcement, they will have a huge impact in diminishing the number of people visiting A&E departments across the country.
Originally, we had estimated that there would be £3.8bn made available in the fund. But, on receiving the applications, the sum increased. It’s now £5.3 billion. There is a pent up energy across the system to work innovatively and collaboratively, and we’re helping them realise those ambitions.
Collectively, the 5 plans across Nottinghamshire aim to reduce emergency admissions by 3.7%, equal to £4.5million of savings. Clinical commissioning groups in North Nottinghamshire are investing over £750k in telehealth services to improve care for people with long-term conditions, including:
- home monitoring for people with heart failure to prevent unnecessary hospital trips
- a ‘health coaching’ service to support patients with long-term conditions to help motivate them to achieve their own goals and take better care of themselves.
In Reading, too, they are aiming to reduce emergency admissions by 3.6%, meaning a saving of £1 million by providing integrated care.
They are using a ‘virtual ward’ that allows patients who are clinically stable but have intensive support needs to be cared for at home.
This type of innovation runs throughout out integration pioneers, too. They have been revolutionising the way that people are treated in our health and care service.
Our 14 pioneers have improved care, cut costs and given people more say over their care. The pioneer in Leeds has opened a new recovery centre – with joint working from the NHS and the council – which offers rehabilitative care to help those people recover without being admitted to hospital and, when they are, they discharge them early and promote their independence.
In its first month of operation, it saw a 50 per cent reduction in length of stay at hospital.
Greenwich, too, has seen excellent results.
In the first phase, the pioneer has:
- halved the number of people needing high levels of support, saving over £1m from its social care budget; and
- had 2,000 fewer patient admissions through a joint emergency team that responds to alerts within care homes, departments and GP surgeries.
This is truly excellent work and I am proud to support it.
We have recently announced that another 10 areas are set to become pioneers and I look forward to supporting them to improve care and be as influential as the other pioneers.
The lessons taken from these pioneers will be shared across the country, so other local areas can be inspired and implement their own methods of bringing care closer together.
- Next stage: Better Care Fund must be here to stay and evolve
- ambition: total pooling at local level by 2018
- no model imposed from centre
- development of integrated care organisations
Personal: Care Act, Personal Health Budgets, POET
This rigorous focus on the person’s needs is at the heart of our plans around the Care Act.
The potential in the Care Act, pioneered by Paul Burstow, which I then took through Parliament, is huge: it introduces personal budgets and care support plans into law for the first time, making them the norm for people who need care support and for carers.
It gives more support for carers by giving them the same rights as the people they care for. As the number of people living with chronic conditions grows rapidly, so does the number of carers – selfless individuals giving themselves to support a loved one.
According to Carers UK, family carers currently save the government £119 billion every year. The burden is enormous - both physically and emotionally. Many carers themselves are frail. And if your husband or wife has dementia, the strain can be overwhelming.
We have already made advances. The Care Act introduces important new rights for carers. But we need to do more.
But, crucially, the Act will improve the lives of people needing care and support and carers, building care around them and giving them more choice and control over how they are supported.
We are also making healthcare more personalised, too.
Already we have made sure that those entitled to NHS continuing care have a right from this month to a personal health budget giving them the power to decide how the money is spent.
I saw the power of this in action when I talked to a gentleman who had taken part in the personal health budgets pilot in Kent. He uses a wheelchair. He had been in and out of hospital.
He was existing, not living. Then he got a personal health budget. He took control. He knew what was important to him. His life was transformed and he had avoided hospital admissions for a long time.
In the run up to the implementation of all the changes, I want to make sure that you get the backing you need to make care more personalised.
We are supporting local authorities to put these changes into action. We pledged an additional £23 million this year to help local areas implement their new statutory duties from April 2015.
This will help local authorities to build capacity within their organisations to manage the changes in the Care Act and participate in the joint implementation programme.
Some areas are doing this incredibly well, but as with the provision of personal budgets, the take up and use of self-evaluation tools like POET personal budgets evaluation tool varies wildly across the country.
I wrote to all local authorities earlier this year to challenge you all to use POET and the Making it Real indicators, and I want to repeat this challenge again today– getting the processes right are key to giving people real independence and control over their care is an important way to improve outcomes.
Equality for mental health: ending the discrimination at the heart of the NHS – Mental health
I spoke earlier about how we need to end the fragmentation in our health and care service.
Perhaps the most urgent gap we need to address is how mental health is institutionally separated from physical health and institutionally disadvantaged.
How can it be right that if you have suspected cancer you will see a specialist within a fortnight, yet if you suffer a first episode of psychosis you have no such right?
Many of the people you care for will be deeply affected by mental ill-health. Sadly, depression and dementia often go hand in hand.
Mental ill-health has a twofold impact. The first we are familiar with: the personal impact. Having a condition like anxiety, depression or psychosis can have a dramatic impact on a person’s wellbeing. They often have a shorter life expectancy. There is frequently a great emotional strain on their family, with many people becoming carers.
The second we are perhaps less familiar with: the impact on society and the economic impact.
Since 2009, the number of working days lost to stress, depression and anxiety has increased by 23% and the number of days lost to serious mental illness has doubled.
Unless this problem is addressed, we are offering people no hope of improving their lives, of making something of themselves.
I am determined that we address this inequality – putting more focus on mental health than ever before.
We have published the Crisis Care Concordat – now signed by more than 20 national organisations to improve mental health crisis care, including LGA, ADASS and Association of Directors of Children’s Services.
The Deputy Prime Minister recently announced an extra £120 million to cut mental health waiting times and, for the first time ever, access and waiting times standards for mental health. This is a watershed moment.
We are making progress.
The Health and Social Care Information Centre recently put out a set of statistics on the number of detentions under the Mental Health Act 1983. It showed:
- a 21% increase in the use of health-based places of safety (up from 14,100 in 2012/13 to 17,000 in 2013/14)
- a 24% reduction in the use of police stations (down from 7,900 in 2012/13 to 6,000 in 2013/14)
This is, obviously, a step in the right direction. But I want those police station numbers lower – they are too often used, which is completely wrong.
But, what I want to focus on is young people, who often get treated very unfairly when it comes to mental health.
The world which children are born into today is wildly different to that inhabited by the average 40 to 50 year old when they were young.
There is a constant pressure for them to behave in a certain way - not only from classmates, but from every TV, every computer screen and the constantly refreshing content accessible on the phone in their pocket.
And for some that pressure is too much.
We have a long way to go to combat stigma. This so often prevents youngsters from seeking help.
Today is Halloween. It is horrendous that, this evening, a young person walking the streets could easily come across someone in a ‘psycho ward’ or ‘schizo patient’ costume – complete with handcuffs and restraints.
From a young age, children are conditioned to fear mental illness – to believe that it is something otherworldly, the stuff of nightmares. Mental illness does exist, and the people who have it are not monsters.
I applaud John Lawlor, chief executive of Northumberland, Tyne and Wear NHS Foundation Trust, for speaking out on this.
He is right – people would never wear a ‘cancer patient’ Halloween outfit, and they should not treat mental health issues so flippantly.
Imagine you’re a young person – someone who is worried about their mental health. You don’t know who you can talk to about it, you don’t know how common it is, you don’t know what’s wrong with you.
Then you see someone on the street, wearing a ‘mental patient’ costume – a torn prison-like shirt, a hockey mask and a blood stained knife. I was very moved when I saw, on Twitter, young people reacting to these costumes. They tweeted pictures of themselves – perfectly normal looking young people, smiling at the camera, with the words ‘this is what a mental health patient looks like’ underneath the picture.
The young woman that started this campaign, who challenged that stigma, was Becki Luscombe.
Becki took her own life recently. Her parents are, obviously, devastated but they are also very proud of her. They’re proud that she spoke up about her own troubles and inspired others to do the same and not feel ashamed. That is real courage. Words cannot match that courage. But actions can.
We need to do more to support our young people’s mental health – there are so many people like Becki who are struggling, and we need to help them.
I have seen some great examples over the past year that show how lives can be turned around when thorough and well-planned support is on offer.
When I visited Liverpool, I heard about the CAMHS service they had built over a number of years to improve choice, access and transition. This partnership brings together commissioners and providers from the NHS, local authorities and voluntary care sectors, seeking to create a single point of access for services where they can easily monitor activity, outcomes and quality.
This has led to significant reductions in specialist CAMHS referrals:
- over 90 per cent of those accessing services showing improvement in mental health
- 90 per cent of users have a high satisfaction with services
- an increase year-on-year of staff accessing training
We are putting £7 million into the system to end the practice of young people being admitted to mental health beds far away from where they live or being inappropriately admitted to adult wards. But we must also challenge this model of ever increasing bed numbers. A different approach is needed.
First we can build on the brilliant work in the Children and Young Peoples IAPT programme. We have already achieved a lot – our initial target was to work with 60% of services for the 0-19 year old population. We have already reached 68%.
My goal is for the Children and Young People’s IAPT programme to cover all of England by 2018.
But we also need to understand much more about the scale the problem today.
Any number is an estimate – many parents don’t talk to their GPs about their child’s mental health issues, and young people don’t always feel comfortable about coming forward, or know where to go for help.
I want you to have the best information possible – to understand how big the issue of mental health in young people is in your area. That’s why the Department of Health is commissioning a new prevalence survey of children and young people’s mental health.
We will have something we have needed for years: an accurate picture.
But I think that many people feel that the way we commission and organise children and young people’s mental health services is broken and dysfunctional, and lets down the great professionals working in services. This is why I commissioned the new Children and Young People’s Mental Health and Wellbeing Taskforce, who met for the first time in September. Recently I asked local areas to submit proposals outlining how they might go further with collaborative, joint commissioning arrangements for young people’s mental health.
I want to see projects spanning across health, social care, education and the voluntary sector for children’s mental health services and I want ideas to detail how the learning from this can be applied across the country.
Further details about the application process will be available from NHS England early in November, but I want to encourage you all to think about how you can support young people’s mental health in your areas.
Central to all of the Taskforce’s work will be the views of children, young people and their families.
I am pleased to tell you we are now starting a new project to gather their views for Taskforce members.
We are also planning wider engagement of professionals from across the country to bring in the creative ideas of those who will be key to delivering the Taskforce’s recommendations. So, when the Taskforce reports back in the next few months, we will have examples of good care and the views of young people, their families and the professionals which support them and we will be making progress toward getting better data. All of this will be invaluable.
I am proud of our health and care service and I am proud of what it has achieved over the last year.