When cuts have gone on this long, there is a danger they can start to look a bit samey, to barely pass as news.
A million from this service. Two million from that. This council has shrunk by this percent. This other public body is about to fall over.
But there are so many reasons why the latest cuts – expected by Manchester Mental Health and Social Care Trust this morning – should break through that fatigue.
It is hard to think of a more counter-productive or utterly pointless saving. And that’s saying something.
There are also few cuts that will affect anyone more vulnerable than this.
After months of watching on in bafflement, enough is enough. These are my reasons why.
Because people could die
According to Manchester’s mental health trust, the services due to be cut this morning are ‘not essential’.
Its regulator, the NHS Trust Development Authority, has been ‘assured’ they are not essential, it promised in a statement yesterday.
Patients would disagree, obviously, but never mind that.
The kind of community-based treatments on the chopping block this morning may not be ‘essential’ to those making the cuts, but for those who use them, they are a lifeline.
Social interaction can be the key, particularly if you suffer from depression or anxiety, to keeping your head above water.
So can the routine of getting up for something, of being occupied and distracted, of doing something that feels productive but not too stressful.
It also allows community mental health workers to keep an eye on how people are coping, to pick up on signs of deterioration and move to address them – before things get any worse.
What happens when people get worse but it isn’t picked up?
They get more isolated. Sometimes they start to panic, or stop taking their medication, particularly when other community mental health services are so overstretched.
Ultimately people can end up in crisis, in a police car or ambulance.
Or, sometimes, they don’t even get that far.
Because everyone keeps going on about how important mental health is
The government, the region’s new NHS devolution board, both prospective Labour mayoral candidates, council bosses, Her Majesty’s Opposition, NHS England, clinical commissioners.
Most of those people listed above have some power to do something about these cuts.
And yet none of them have stopped them.
Where politicians are concerned, mental health appears to be the latest big thing to shout about.
I’m considerably less cynical about politicians than most of the general public, because generally I come across them first-hand trying to do some good, even if it can sometimes be misguided or have unintended consequences.
Yet none has actually managed to cause enough fuss about this – to lobby loudly enough, or to have the right word in the right ear – to get it stopped.
Perhaps that says more about the NHS than it does about them.
Nonetheless if it was a cancer ward, I daresay things would not have got this far.
It’s no wonder the public gets disillusioned.
Because it’s pointless
Manchester Mental Health and Social Care Trust is not going to be a thing in 18 months’ time.
When it’s taken over, commissioners have already indicated that the kind of services expected to be scrapped this morning may well be commissioned all over again.
Equally, if my information is correct – and certainly this was the case last time these cuts were discussed by the council a couple of months ago – this will not actually balance the trust’s books.
Mental health statistics in Manchester
Average stay in hospital
Cost per week in overtime
Shortfall of in-patient staff
Even when they were first proposed, the trust admitted it had only managed to find around half of the total shortfall it needed. Asked in a public meeting about it, its chief executive admitted she didn’t know where the rest would come from.
So unless there’s a George Osborne-style couch somewhere in trust HQ with three million quid stuffed down the back of it, it’s unlikely to bring the organisation into financial balance.
In fact it doesn’t really achieve any kind of useful end goal, apart from leaving another 500 vulnerable people without a lifeline.
Because it is counter-productive
Further to it being pointless, it will almost certainly cost more money in the long run.
The trust will need to find redundancy costs for the 30-odd staff it’s letting go, for a start.
It’s already spent £2,000 hiring an outside consultant – Enventure Research, in case you’re interested – to carry out a consultation it is going to ignore.
In its comment yesterday – and even in its board paper on the issue – the trust basically says it was ALWAYS going to ignore it.
But the real cost will be in the knock-on effects of cutting comparatively cheap, low-level preventative work that stops people falling deeper into the system, costing more and more and more.
Why are there so many people with mental health problems rocking up to A&E these days?
Because more people are getting into crisis.
And crisis, as the police, hospitals, social workers and the ambulance service would all testify, costs a lot of money.
Because it was preventable
Campaigners have been warning for YEARS that this would happen, long before the last half a decade of austerity.
That’s one reason it is not enough just to point the finger at government, as Labour is prone to do. This is also the fault of local leaders – largely Labour – and the last Labour government, as well as NHS bosses.
Senior community nurse Karen Reissmann was sacked nearly a decade ago for daring to suggest this would be the end result of stupid financial decisions and under-funding.
And now here we are.
These cuts are the straw that broke the camel’s back. It isn’t just that commissioners have been prioritising physical health in the last few years.
It isn’t just the PFIs that cost exorbitant amounts of money. Or the lack of local beds that have seen oodles of cash chucked gaily up the wall as people are sent hundreds of miles away for care.
It’s also that mental health funding has never kept pace with demand – and especially not in Manchester.
As Karen Reissmann says: instead of admitting it’s impossible to knit ten jumpers out of one ball of wool, everyone keeps pretending you can just knit one very thin, rubbish one and nobody will notice the holes.
But those holes are starting to become very noticeable indeed.