This afternoon councillors, NHS officials, patients and voluntary groups are gathering at Manchester town hall to discuss the state of our city’s mental health services.
The one-off inquiry was ordered late last year , after it emerged Manchester Mental Health and Social Care Trust was on the brink of financial collapse – and planning £1.5m of frontline cuts.
We revealed the situation had got so bad it is now to be axed and taken over by another trust .
After years of complaints from staff and patients about mental health provision in the city, which has among the highest demand in the country, today’s inquiry will look in detail at what Manchester’s mental health system should really be providing.
It will look at the finances it needs, as well as hearing from patients about their own expectations.
Recommendations from today’s inquiry will feed back to NHS chiefs ahead of the trust’s takeover – with today also likely to provide an update on the timescale for that process.
We will be covering the session live here between 12.30pm and 4pm.
Why an inquiry ?
Today’s hearing is not specifically about scrutinising the mental health trust or its finances. A meeting on that took place late last year – you can read back my coverage of that here.
Instead today will look at two things.
Firstly, it will ask patients in particular what they want and need from the service going forward. The trust is likely to be taken over in the next few months – so the council’s health scrutiny committee wants to know what expectations there are of mental health provision in the future: what’s needed, where the failings are currently.
Secondly, it is a way to clarify the position of clinical commissioners. Whoever provides mental health in the city going forward will rely on sustainable funding from them.
As a side note, I understand the trust itself will not be present today. Apparently this is to do with diary clashes rather than anything more questionable.
Meeting about to start
Patients, voluntary groups, council officers and NHS officials – from the Manchester clinical commissioning groups, who provide the majority of the funding for the city’s mental health services – are gathering at the town hall.
This four hour inquiry is the result of a shock cuts announcement made by Manchester mental health trust last year. At the same time it became apparent that its finances are in such bad shape the organisation is going to be wound up and taken over by another trust.
This meeting is absolutely rammed for a council scrutiny meeting. Which says something, given that it’s the middle of the day on a Tuesday, about the strength of feeling around this issue.
Poorest health of any city
Before Hazel Summers speaks, public health director David Regan speaks. He stresses the hard work that’s been put in over the years in improving Manchester’s health, but admits we have a problem.
Despite all our efforts, he says, we are have not narrowed the gap between Manchester and the rest of the country.
It’s not a good statistic that we still have the poorest health of any city in the country.
The hearing is starting in earnest now. Hazel Summers, who is the council’s adult social care boss – director of the service – is going to begin.
‘Lowest suicide rate in 15 years’
Suicide rates are actually lower than any time this century, he says. However on the flip side there remains a 12-year life expectancy gap between Manchester and Kensington & Chelsea – and life expectancy for women here has recently slipped.
Public health is under strain, he admits.
The other thing he mentions – and this is still an overview – is the city’s increasing population.
This is something the town hall loves to trumpet as a sign that Manchester is thriving and it’s hard to argue from an economic perspective that it represents bad news. By 2025, the city is expecting its population to surge from around 530k to around 620k.
However if you’re a health chief facing year on year budget cuts, rising population can make life a lot more difficult.
And that’s one of the major challenges facing all health services in the city, including mental health.
More on population rises
Have you done a profile on the people coming in to seek work and so on, asks councillor June Hitchen.
Yes, says David Regan. They are looking in detail at what kinds of people are moving in and also remaining here longer.
He doesn’t provide any more detail though.
But that’s a key point – are the kind of people who are part of that population increase going to be the sort who weigh heavily on mental health services?
Clinical commissioner speaks
Craig Harris of Manchester’s three CCGs is now speaking.
They want to see better access to mental health services, better responses, better dealing with people in crisis, he says – hinting at the problems within the system.
He is now presenting his strategy for the service.
It isn’t just the mental health trust that provides mental health services in the city, stresses Craig Harris. Certain services for psychosis, for example, are provided by Rotherham’s NHS trust.
Why? No idea.
‘Mental health service of the future’
So what do commissioners want from the service?
– Prevention is a major issue and a key focus, he says – but admits it isn’t currently what it should be. He will be aware that the services being cut under this year’s round, of £1.5m worth of community care-based workshops to help keep people well, are exactly the kind of preventative care for which he is emphasising the need.
– Access times: waiting lists for talking therapy are too long, he says. There is ‘sometimes quite a long wait’, he admits.
– Turning 18: here shouldn’t be a jolt when you become an adult. The transition into adult mental health services should be smooth. People often fall between the cracks, he says.
– The whole system should be based on the best practice everywhere, such as Australia and the Netherlands. ‘There’s no need to reinvent the wheel.’
Here are some other top priorities for the commissioners where mental health is concern
– first episode psychosis (particularly an issue for 14-25-year-olds
– depression and anxiety – very common in Manchester
– crisis recovery – how A&Es and so on deal with people suffering a major mental health episode
So, so complicated
There is now a slide on the consultation explaining just how fragmented mental health services are in Manchester.
Rotherham NHS trust provide early intervention psychosis care.
Someone else provides mental health services for offenders (it says Greater Manchester West mental health trust does this, but I’m told it’s actually the charity Lifeline).
Greater Manchester West and Pennine Care mental health trusts provide extra rehab beds. Central NHS Foundation trust provide mental health services for people aged 16 and 17.
It goes on. No wonder people get confused.
New trust could take up to TWO YEARS to take over
According to a very vague timeline now being provided by the trust – which they repeatedly stress is only v indicative – it could take up to two years for a new provider to take over from Manchester Mental Health and Social Care Trust.
It will take between six months and a year for a new provider to be procured, likely to be another mental health trust.
Then it will take another four months to a year for the regulator and secretary of state to approve the choice.
So minimum ten months, maximum two years.
It will either be Pennine Care or Greater Manchester West
Asked in more detail about this process, Craig Harris says one of the above trusts will be invited to bid to run Manchester’s mental health services.
There is no suggestion it could go to a private provider.
The new provider will take over the bits that Rotherham NHS (slightly bafflingly) provide at the moment.
Regulator – not here ?
A quick note on this.
The change in provider is being overseen by the Trust Development Authority, which regulates non-foundation NHS trusts.
Cllr Eddy Newman got quite angry about the TDA last year, arguing it was imposing the eye-watering budget constraints that are causing the £1.5m cut – in order to usher in the new provider.
He said the TDA should attend this meeting.
I don’t think they’re here.
Mental health funding will be frozen
The CCGs ‘have no intention to cut funding’, he says.
In other words, the mental health trust as it stands should not in theory face any more budget cuts in the next 12 months on top of what they are looking at already – although in practice, there are any number of reasons why they could still end up falling further into the red.
Mr Harris nonetheless says next year there will be no further commissioning reductions. This basically means neither the council or CCGs, who jointly fund the trust, will cut their funding to it.
He also says they may invest extra cash into the system but makes no promises.
Children’s and teenage mental health services
There are some bits of care that won’t pass to this new provider, whoever it ends up being.
Children and adolescent care, for example, is likely to remain in paediatric care, provided by Central Manchester NHS Trust.
‘Everything will carry on’
He stresses provision will continue as this process is followed through, to muttering from those sat in the public gallery.
The first thing to spring to my mind is staffing.
Manchester’s mental health trust already has a major staffing shortfall and is having to spend tens of thousands of pounds a month on agency nurses.
In a climate of uncertainty such as this, it’s hard to see recruitment getting any easier.
CCGs being grilled
One councillor is now querying how the CCG is able to give such a positive spin on the future of services – better access, preventative care, therapies etc – when just a couple of months ago it was backing major cuts to all sorts of services providing exactly that.
He says this seems to be a ‘very different conversation’, adding:
I wonder how you kind of weigh the two up ?
The CCGs will be laying out in its criteria to a new provider exactly what it expects, says Craig Harris. That will include the kind of talking therapy services that appear to be under threat at present.
But what about the cuts ?
Councillor Mary Watson notes that Mr Harris has not mentioned the massive cuts looming at the mental health trust.
It’s a good point. I don’t think he mentioned them at all in his presentation.
Pressed on how he squares those ongoing service cuts with what they’re likely to procure from a new provider, he says he doesn’t know what the two trusts in question – GM West and Pennine Care – will offer or suggest in their bids.
I’m a bit confused as to what he’s saying. It seems completely unclear whether the things they’re cutting could somehow come back on the table when someone else takes over.
The CCG has just confirmed the new organisation running Manchester’s mental health services will definitely be an NHS provider.
In other words, this won’t be tendered out on the open market, so no private firms will have the opportunity to run it.
Faster waiting times
We’d want Manchester residents to be seen within two weeks and be treated within 18 weeks, says Craig Harris
I absolutely agree some of those waiting times are unacceptable
“We’re proposing that to meet those standards, we need more money,” he says.
Indeed. I don’t think he actually said the CCG was definitely going to invest more cash in the trust though, although I might have missed that.
Mental health advice line
A GP called Dr Thompson – I haven’t caught her first name – says she has been pushing Manchester Mental Health and Social Care Trust to bring in an advice line for years.
Not instead of medical care, but for when people don’t necessarily see a consultant.
For areas like rheumatology, she says, there is an advice line for people to call that negates the need to see a consultant if they don’t need one.
That should be the case with mental health, she says.
Out of area beds
This has been a huge area of overspend historically in Manchester – because there are simply too few beds in the city.
Committee chair Bev Craig asks: If a new provider was able to reduce the spend on out of area placements, would that money still be spent within mental health services, or would it move elsewhere in the CCG?
We want to make sure any potential bidder knows exactly what money is in the pot, says Craig Harris.
Any savings made on things like out of area beds would stay in the mental health budget, not be taken out and spent elsewhere.
I need to go back and check the quote as I missed it verbatim, but I think Craig Harris just said there would be new leadership at the top of whoever takes over.
In other words you can only assume somewhere along the line some substantial redundancy costs will be incurred for the current management.
Representatives from voluntary groups – including those providing support for homeless young people and the LGBT community – are now going to talk about how they think mental health services could and should be provided.
What the voluntary sector wants
Here are some of the key points being put forward by voluntary groups and charities – what they would recommend to improve the city’s mental health services
– more mentoring and peer support: help from other people who have experiences mental health problems is extremely effective
– 24/7 services. Monday to Friday 9-5 doesn’t work for people with mental health and/or drug and alcohol issues
– eating disorders. this area has been under resourced and is only targeted at people with very severe problems
– suicide prevention: specific care is needed for families who have already been bereaved by suicide and are therefore at greater risk
– LGBT mental health care. Almost one in five counsellors surveyed – I’m unclear surveyed by who, I missed that – admit to trying to ‘cure’ people of their sexuality. This is an added problem for a group already susceptible to mental health issues, particularly depression
There have been big improvements in crisis care in the city in recent years, says a representative from one voluntary group. But:
Dare I say it, maybe there are just not enough beds in Manchester.
People are still being put in beds in York, Bradford, south of England, she says. People are being ordered to get taxis to A&E and left there.
It could be better but in our experience it’s better in other cities and boroughs… The good intentions are there but the there are still issues.
Current voluntary sector groups ‘not affected’ by trust takeover
Any charities or voluntary groups currently contracted to provide mental health care in Manchester will not be affected by the trust takeover, Craig Harris confirms.
However any new groups not already involved may find there are new opportunities to bid for services.
‘Don’t leave people on the edge of crisis with nothing’
Nicky Lidbetter, chief officer of the charity Self Help, is making an important point.
A full list of crisis services – including those provided by charities and the voluntary sector – should be clearly provided to patients and those working in the system, she says.
NHS 111 tends to send people on the verge of crisis to A&E automatically, which is not necessarily the best place for them. Often they just get discharged again.
A discharge back to the GP does not necessarily mean ‘that person’s distress has gone away’, she says – therefore if they don’t need the NHS’s ‘crisis’ threshold then they must ‘not just be left with nothing’.
‘In A&E they’re awful to you’
Patients are now addressing the committee.
A woman who has asked to stay anonymous is speaking very tearfully – and articulately – about her care.
She has borderline personality disorder and has heart problems, she says. When she goes into A&E with her heart problems, it’s ok, she says.
But when she goes in with her mental health problems it’s completely different.
In A&E they’re awful to you because you have not got a physical illness. They don’t care
She also talks about chronic pain, the support service for which is under threat thanks to the cuts. Nobody ever talks about suicide rates as a result of her kind of chronic care, she says.
They go on about parity of esteem but it’s not happening.
She says she used to have a ‘circle’ of mental health professionals – including her psychiatrist and community psychiatric nurse – who looked after her.
Now she says that care is ‘splintered’.
This is a familiar story. I’ve heard this from many patients who used to have continuity of care.
Talking therapy #1
She also speaks passionately about talking therapy, which is being raised by a number of patients here today.
The waiting list is two years, she says. There’s no anger management anymore. And there are serious issues with eating disorder provision.
All they see is a fat woman on a mobility scooter.
But the eating is her way of self harm, she says.
GPs: Don’t just hand out drugs
A second patient, who suffers from a range of problems – including post traumatic stress disorder as the result of being involved in a bomb in London – is also speaking passionately about services, particularly talking therapy.
Talking therapy needs to be available ‘as soon as possible’ when people need it, he says.
But also people need to be given it for long enough. By the time you’ve got to trust the therapist, the therapy is over. Yet as his mental health has deteriorated his physical health has followed suit – he’s now on 17 different medicines a day, including for blood pressure.
How much is this costing the NHS, he asks, for want of dealing with his mental health problems.
To GPs, he asks them to put down the prescription pad and ask questions.
Probe, ask. Don’t just dispense.
Patients are left weeks, months when their care co-ordinators are off sick…. Patients have no confidence in commissioners.
That’s Alan Hartman, who has schizo-affective disorder. We’ve interviewed him before about the problems in mental health services several times.
He is a member of the Manchester Users Network lobby group, which is pushing for the current cuts here to be reversed.
One of his biggest arguments is that patients are finding – as the lady below alluded to – that their care is now not continuous. These days if a person’s care coordinator is off sick, nobody steps in, even if the patient is high risk.
From the people I’ve spoken to, this is simply a direct result of ongoing cuts.
Mess ups that could cost lives
The anonymous lady I quoted earlier is underlining another point – the need for community based mental health workshops and groups, which often keep people from deteriorating. These are among the main services facing the axe by the mental health trust.
I’m a recluse and the only thing that’s given me hope in the last two years is through service user engagement. They are trying to step me down…
Stepping down is when a patient is sent back, effectively, to their GP and discharged from specialist mental health services.
This is a common complaint among patients and staff. They report a major drive to drop patients from the mental health system as quickly as possible, only for them to get more and more poorly, before coming back in.
A revolving door, essentially.
On some of the problems she’s faced in the system, she adds:
All those mess-ups could turn into big mess ups… that could cost lives
Summing up – Manchester CCG
I can personally guarantee that the specification that will change now as a result of today’s conversation.
To translate, that’s commissioners saying that they will now change their plans and expectations for the city’s mental health service in the future – as a direct result of this afternoon’s meeting.
How it will change is unclear.
But here’s some of the key points raised repeatedly:
– stop just stepping down patients when they’re not ready, with no safety net
– prioritise talking therapy
– look again at the crisis service – and make sure the voluntary sector is properly wrapped into it
– provide continuous support for people instead of shifting them from one psychiatric professional to another to another
‘Beds in Manchester’
Craig Harris is stressing that the new system will be about bringing back patients into the city – rather than sending them elsewhere.
However that means opening more beds in Manchester. The only reason they are going elsewhere is the lack of beds in our own hospitals.
Councillor Chris Paul is also asking about this.
I’m not sure Craig Harris is going to get the chance to answer though.
As they wrap up, the committee is raising concerns – expressed particularly clearly by that lady earlier – about the way A&E handles mental health admissions.
The chair says members have previously visited acute trusts and been told there’s only one secure ambulance in the north of England.
Craig Harris says a ‘new model’ for people being admitted into A&E is being introduced in April, a plan due to be agreed next week.
An extra £500k is being put in for this, he says.
And finally, recommendations
Broadly they’re covering these areas:
– the committee wants to be kept updated about the takeover of the trust
– further discussions need to be had about mental health care for older people under the new system
– more detail is needed from the CCG on bed numbers, waiting times for talking therapy, and so on. This will presumably be discussed at a further hearing
– A&E problems: this needs to come back in detail to the committee
As with anything like this, the wheels grind slowly. The process of even getting a new provider for Manchester’s mental health services will not be complete overnight.
But one key thing from today is that the commissioners have vowed to change their ‘specification’ – ie what it will expect from that provider – as a result of what people have said.
Indeed patients and voluntary groups spoke very clearly on a range of priorities, which I’ll be summing up in a piece later.
Additionally we now know either GM West or Pennine Care will take over Manchester’s mental health services, plus that funding will not be cut further next year.
In the meantime, thanks for following