Five year plan for mental health gets a detailed 'road map'
No one argues with the Five Year Forward View’s plan to give mental health equal status with physical health. Implementing it could be an exciting challenge for mental health nurses – as long as they can be persuaded to stay in the workforce.
No one argues with the Five Year Forward View’s plan to give mental health equal status with physical health. Implementing it could be an exciting challenge for mental health nurses – as long as they can be persuaded to stay in the workforce
The Five Year Forward View could mark a turning point in the long battle to get mental health parity with physical health, address long waiting times and unmet need, and ensure people get care closer to home.
NHS England says extra funding to support the mental health plans will rise to £1billion a year by 2020-21 in addition to the cumulative £1.4billion earmarked specifically for children’s and adolescents’ services. Local health economies have been told to ensure that mental health is included in their Sustainability and Transformation Plans, the blueprints for development over the next few years.
The recently published implementation plan for the Five Year Forward View’s mental health side has set out a vision of how services can be improved. ‘There is a clear road map for all parts of the system to see what should be done,’ say Paul Farmer, chief executive of MIND and chair of a taskforce behind the mental health plan.
‘In the past mental health policy documents have not often enough been followed up with plans about what needs to happen for things to be achieved.’
RCN mental health adviser Ian Hulatt welcomes the focus on ensuring people with mental health conditions get their physical health needs met as well – something which will require the involvement of nurses in many settings.
More mental health nurses are likely to be needed to deliver many of the changes – and numbers of other staff groups, such as therapists, will also need to increase. Liaison teams – planned to be in all acute hospitals – will need about 25 people per team to meet the standard for 24-hour care, for example, while crisis resolution and home treatment teams require 20 to 30 to cover a population of around 150,000.
The RCN’s Frontline First report revealed that the number of mental health nurses dropped by nearly 4000 – close to 10% – between May 2010 and November 2014. Health Education England (HEE) is already developing new workforce plans, but will enough student places be commissioned or students attracted to provide the needed workforce? Mr Hulatt says: ‘We know that, although the commissioning of places for mental health nurse training has improved, we are still many hundreds of mental health nurses short.
‘We will need to see the effect of the loss of the bursary and how universities will expand their intakes. But it is the clinical placements that are the probable pinch point.’
However, HEE’s predictions already show the number of mental health nurses in the NHS could increase significantly by 2020 – by between 6% and 22.5%, depending on what assumptions are used. The HEE points out that retention of existing staff, reducing attrition among students and getting more nurses to work in the sector is needed to move towards the higher projections. Its existing projections already expect a small (under 1%) increase in the demand for mental health nurses by 2020 but the plans for the Five Year Forward View implementation could increase this.
Coping with change
In the shorter term, the NHS will need to deliver existing services and plan enhanced or new ones using existing staff. Helping them cope with change will be important, says Mr Hulatt: ‘The workforce is working under very difficult circumstances and will need support to work in a different way.’
Mr Farmer adds: ‘It is important that the health and wellbeing of the current workforce is encouraged, promoted and protected.’ This is acknowledged in the implementation plan, although money to support it seems to come from the £450m put forward to improve staff health and wellbeing across the NHS as a whole.
The mental health workforce has an older demographic structure than nursing generally meaning the next few years could see a significant number of nurses leaving the workforce. Mr Hulatt expects many older mental health nurses to retire at 55. ‘Older and mature nurses may be persuaded to stay with flexible working,’ he says. ‘The loss of their knowledge and experience could be mitigated by such practices.’
Whatever else happens the mental health sector needs a period of organisational stability as it changes services, he adds.
Another challenge will be releasing savings from some of the transformative changes which are proposed – such as earlier intervention reducing the need for inpatient acute care. Money released by reductions in demand will be part of the way community-based services will be funded. Making this happen, and identifying savings as a result, against a backdrop of increasing demand will be tough. However, much of the extra funding for mental health is coming through an uplift in general funding for clinical commissioning groups: ensuring this reaches mental health services.
Despite all the challenges – and ensuring staff in all settings think about physical and mental healthcare needs will take time and a mindset shift – Mr Farmer says he is ‘cautiously optimistic’.
And he adds: ‘There is a strong message to people who are thinking about career choice that mental health nursing is going to be a really exciting place to work in over the next five to 10 years.’
The Five Year Forward View and mental health
The implementation plan offers a detailed picture of the trajectory the NHS will need to meet as it tries to improve access and treatment.
It proposes that by 2020-21 the following objectives should have been met:
- 70,000 more young people and children with a diagnosable condition will get treatment.
- ‘Inappropriate’ out-of-area placements should have largely ended.
- 30,000 more woman each year should be able to get evidence based perinatal treatment close to home (only 500 extra in 2016-17). This will need ‘a significant expansion in workforce capacity’.
- 25% of people with common mental health conditions will get access to psychological therapists including 3000 new mental health therapists based in general practice.
- All acute hospitals will have 24/7 cover by mental health liaison teams, 50% of whom will meet core standards (only 7% do at the moment). All areas will have crisis resolution and home treatment teams resourced to operate 24/7 and in line with best practice.
- 10% reduction in the number of people taking their own lives.
Treatment closer to home
Children and young people who need inpatient care often end up being admitted away from their home care – sometimes hundreds of miles away.
Reducing the use of those inappropriate admissions is one of the areas Tees, Esk and Wear Valley Foundation Trust wants to concentrate on as it takes over the budget for ‘tier 4’ mental health care for children and adolescents from NHS England in a pilot project.
At the moment the trust – which covers around two million people, 400,000 of whom are children – is establishing exactly how much is spent on tier 4 services for this age group. It then wants to look at how they could be provided locally, if appropriate, and whether better community-based services, such as enhanced crisis teams, could reduce the need for them.
Brent Kilmurray, the trust’s chief operating officer, says this could be better for patients and families but could also offer additional opportunities for staff. ‘We have experience of developing skillsets and staff to help young people in a crisis,’ he says. ‘Our senior clinicians are really enthused.’
Alison Moore is a freelance health writer