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Nick Clegg discovers mental health…again

December 2, 2014

By Basket Press

…Or so it seems from recent reports. Great! – except I thought he’d already done this earlier in the year with Closing the Gap, a document full of errors, insults to Mental Health (MH) staff, avoidance of his own complicity in the current state of affairs and general woeful lack of knowledge of many things to do with providing or commissioning decent MH services.

First off, he seems not to know that waiting times for MH services have been around for years. In the Child and Adolescent Mental Health Services (CAMHS) community teams I worked in from 2003 onwards we had targets which by 2013 had come down to 11 weeks for non-urgent cases. Why does he not know?

He talks about services for young people needing to be improved. OK then, he needs to explain why he doesn’t know about the reduction in these services his government has presided over since 2010. Significant cuts have been documented by the likes of children’s and young people’s mental health charity YoungMinds. Anecdotally, as a senior nurse in community CAMHS, I watched my service – which never reached National Service Framework recommended staffing levels in the first place – shed staff of all clinical disciplines. I also saw cuts in school nursing, educational psychology, educational welfare, local authority funding for excellent charitable sector services – you name it, it was cut. Why does Nick Clegg not know? What does a deputy prime minister do? Does he not think through his own policies?

Is the problem that cuts are sometimes subtle and disguised? “Down banding” has become a common trick: remove senior clinicians, say Band 7 nurses or Occupational Therapists, and replace them with Band 5 posts. Numbers look the same, but there is a loss of experience, knowledge and skills leading to poorer services. There is no Band 5 who could do what I did as a Band 7, because developing my skills and knowledge took years. Does Clegg not know this either?

Related issue: why does he not know that CAMHS clinicians, parents and families, etc have for years been telling anyone who would listen that service provision is inadequate? In 1988 when I started work as a staff nurse on a new sub-regional adolescent psychiatric in-patient unit, the entire staff group pointed out that the number of beds was inadequate and that there was no provision for urgent or emergency admissions.

When I was a ward manger on another such unit we continually highlighted the shortages of staff and beds. In my last job the clinicians on the management team, myself included, repeatedly informed senior management of staffing inadequacies and their impact on service provision. The National Service Framework on child and adolescent mental health pointed this out years ago. Clinicians all over the country have been saying these things as far back as I can remember. It is very old news that such services were insufficient for existing need and yet Clegg is the second most senior figure in a government that has cut them even further and seems not to know about it. And nor has he thought to ask the people who do know.

Then we come to investment in improving talking therapies. Aaah yes! Does that money even equal what has already been cut, let alone the cuts in the pipeline for the next financial year? If no, then this is the hollowest of hollow rhetoric. If yes, it’s just a sticking plaster on the wounds inflicted by his government. And what are these talking therapies (which, of course, none of us ever used before)? I assume he means IAPT (Improving Access to Psychological Therapies), which is a fine idea in principle – but rather different in practice.

Previously CBT training had been either part of the doctorate in clinical psychology or a 2 year master’s level qualification – both including much supervised practice – leading to clinical psychology posts starting at Band 7, or senior nurse posts at the same band. My old trust cut money from existing services and diverted it to IAPT. For IAPT practitioners in Band 5 posts, training consisted of a short class-room course of Cognitive Behavioural Therapy (CBT) – only CBT, no other form of therapy. The result is a further dilution of skills and experience, borne out by stories of poor practice I have heard from patients, friends and acquaintances who experienced IAPT. Again why does Clegg not know what is happening on the ground?

Then there is the overall reduction in MH nursing numbers, which even the Royal College of Nursing has noticed. Again, these figures will disguise any down banding, or even the practice engaged in by some trusts of counting Health Care Assistants in nursing numbers (documentary evidence of this is hard to come by, but I have been informed of it by several people in NHS Human Resource departments). These are government figures, publicly available and the subject of frequent news reports, and yet again Clegg does not seem to know what is happening as a direct result oh his government’s actions.

The Guardian item I linked to above refers to Clegg having “a long track record of campaigning on mental health”. If this is actually the case why doesn’t he know all those things I mention above (and a lot more which space and propriety prevent me writing)? Why hasn’t he done anything about them in over four years as deputy prime minister? Why has he helped to enact policies that have done more to damage people’s mental health and services they need than any government in living memory? A charge of significant hypocrisy could be laid at such a person’s door, along with wilful ignorance. The latter especially must have taken a lot of effort – so well done, Nick! Just think what you would know if you were looking and listening! And you wouldn’t even need a task force either.

  1. Basket Press permalink

    Apparently it has been suggested that I am too hard on the Lib Dems: this is a piece about a speech Nick Clegg was making, no-one else; he chose to enter a coalition with the Tories when other options were available; he is deputy prime minister; he makes unsupportable claims; Clegg is also an Orange Booker; he voted in favour of Lansley’s bill.

    Any other politician who has been in a similar position of power for the same period, made the same sort of speech and has done (or didn’t do) the same things would have attracted similar criticism.

    But no-one else did so last week…So Clegg catches it.

    I voted Lib Dem in 2005 and 2010: I will not be doing so in 2015. Clegg’s actions and inactions are part of that, especially going into power with the Tories, which I didn’t vote for.

  2. An impressive blogging debut here from Basket Press. Well done! As a mental health nurse manager working in Early intervention I identify with the reality you (and the RCN report) vividly describe. I have also presided over the insidious diluting of the mental health nursing skill mix, under immense pressure from senior managers who prioritise ‘cost improvements’ over cost effectiveness. We know that every £1.00 spent on Early intervention in Psychosis saves the NHS £18.00 yet, whenever a post becomes vacant, we have to fight to gain approval to replace that post and, if a replacement is grudgingly approved, it is always on the proviso that it be at a band lower than the experienced practitioner who left. A recently qualified Band 5 can often bring fresh enthusiasm and perhaps relatively youthful energy to a service, but there is a tipping point beyond which the gradual loss of years or even decades of hard-earned professional expertise and life experience cannot be compensated for bolstering a critical specialist service with an occasional newcomer to the profession. At the same time, the Band 6s and 7s we do manage to retain continue to provide an excellent service for patients whilst often languishing at the top of their pay band with little hope of career progression in the shrinking health economy.

  3. Basket Press permalink

    Thanks for the comment Tony!

    It beggars belief that EIP should be cut in the way it has in many parts of the country, not just for the money it will save down the line, but also for the human cost…

    I spoke to an ex-colleague the other day: my old CAMH service has worsened in the last year, with non-nursing background team leaders enforcing a “6 sessions and out” policy and bullying staff into adhering to it…I am sure Nick Clegg knows all about that too and can explain how this improves services for children and young people, rather than just saving money in the very short term.

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