Rosie Winterton – 2003 Speech on Mental Health

Below is the text of the speech made by Rosie Winterton on mental health on 28th October 2003.

I am delighted to have the opportunity to address this fifth annual mental health forum organised by the SCMH. It is a good moment to take stock, and to set out the direction for the future in this time of transition for mental health care.

As most of you know when this government came into office, mental health was set as a priority for reform alongside cancer and CHD. Why? Because we inherited a legacy of under-investment in mental health services; a host of damaging inquiries into service failures, and a de-moralised under-supported workforce. Community services were in a sorry state.

There are no short term solutions to what needs to be done. This is a challenging time for mental health services.  It needs investment to build capacity – in new services and in the workforce, but it also needs reform in the way that those services are provided and that workforce cares for and treats people – modernised in-patient facilities, services that reach out into the community, making a reality of user involvement and recognising the key role that primary care needs to play in mental health services that treat people when and where it is most appropriate to do so.

This is why we have set out on a radical programme of modernisation so that the NHS and social services can improve access to effective treatment and care, reduce unfair variation, raise standards, and provide quicker and more convenient services.  We produced clear and comprehensive plans for improving mental health services that present the best opportunity and the biggest investment to improve the lives of a large and neglected group of people.

Thus underlining the importance of developing modern mental health and social care services for the one in six people, at any one time, who suffer from a mental health problem.

Our National Service Framework for Mental Health, developed in partnership with service users, professionals and stakeholders set out the action that was needed. It was the first NSF to be published and set out standards across the full spectrum of care from stigma and self care, to the action needed to prevent suicide amongst those with the most severe conditions.

But in publishing the NSF we knew the service faced a legacy of under-investment and a de-moralised workforce. This is why, though I am pleased we are making progress, I know that progress will not be easy or quick. I want to set out some of the steps that we have taken.

Over £300m new investment has been allocated for mental health services to ‘fast forward’ the national service framework  – over and above the 2001/02 baseline.

Second, we are directing it towards new teams and services for the most vulnerable: at Crisis Resolution and Home Treatment Teams, and Assertive Outreach teams; at services for people with severe personality disorder, and to improve mental health services in prisons.

We have also prioritised recruiting new staff, new ways of working and we are taking action to reduce stigma and strengthen primary care. Why? Because this is what service users and carers and other expert stakeholders said was most important.

I want to address directly the criticisms made of this ambitious plan. It is said that new money has not gone where it was supposed to go.  However, the Autumn assessment of mental health services shows absolutely unequivocal evidence of very significant increases in spend in the last financial year. For example, we know that £262 million went in to modernising mental health services in 2002-03. We are continuing to monitor this carefully.

With a number of major NHS Plan targets deadlines looming and resource pressures hitting hard, services in many areas are finding it hard to keep up. It is said that progress is slow on meeting targets. But there are now over 100 crisis resolution teams and over 200 assertive outreach teams in place, and targets for early intervention teams, and new staff and new ways of working are progressing. Mental health trusts have taken some very significant steps towards providing alternatives to inpatient care, where this is appropriate and safe. And I know that most people prefer treatment and care provided in this way. Home treatment, where possible and safe, helps avoid the stigma associated with hospitalisation and ensures people can stay in touch with their families and social networks.

It is said that workforce issues represent a risk to the programme – and I agree that this is a major challenge. But I am pleased to say that the number of consultant psychiatrists has risen by over 20% since 1997; the number of nurses by over 25% and the number of psychologists by over 50%. Work with the Royal College of Psychiatrists and the NHS Leadership Centre is progressing well. I am also very encouraged by plans being developed to employ new kinds of workers and by the establishment of 12 new training schemes to support primary care mental health.

We are now beginning to see Graduate mental health workers being employed to provide talking therapies and Gateway workers helping people access the full range of services they need. Early intervention in psychosis services are making a real breakthrough – we are now able to reach out to young people experiencing a first episode of psychosis faster and improve their treatment outcomes. And where they operate, Home Treatment services are giving people real choice in where they get the help and treatment they need.

It is said that commissioners and managers fail to give mental health the priority afforded to other areas; that Shifting the Balance of Power diverted attention away. But we shifted the balance of power so that resources could be more closely matched to the needs of local people; so that PCTs and their partner organisations could take full account of strengths or gaps in their area. Mental health is a priority and I believe we are starting to see some of the benefits. But local support is vital.

This is why we are putting in more effective systems– such as better information systems – and we are supporting growth in capacity through the National Institute for Mental Health in England.  We are doing this: –

– Through careful deliberation of Local Delivery Plans

– Through quarterly meetings with mental health leads in all SHAs

– Through support for Local Implementation Teams to make effective partnerships between health and social care

– Through action to promote engagement amongst people with mental health problems from black and minority ethnic (BME) communities (and not forgetting the BME implementation document I launched last week)

– Through the promotion of self-management of illness via NIMHE’s expert by experience programme

And when things go wrong – as they sometimes do – we will intervene. By the end of this month there will be an NHS Improvement Programme in every zero, one and two star NHS organisation that sets out how sustainable improvements in performance will be achieved. The Department has established a Recovery and Support Unit which can, in partnership with the Strategic Health Authority, help zero star trusts to:

– set up staff exchanges to bring additional support and help introduce new ways of working

– bring in expert providers from within or outside the NHS to advise on and implement improved systems and management practices

– and, as a last resort, to introduce new senior managers

But what about the future? We have to ‘mainstream’ health and social care services; to prevent problems developing, and promote healthier lives, and this goes much wider than the Department of Health. We have taken action to tackle poverty and low incomes; we are breaking down the barriers preventing people on Incapacity Benefit from getting back to work and the Supporting People programme is giving local authorities greater flexibility to support vulnerable people, including people with mental health problems, to retain tenancies and stay in their own homes.

So I am particularly pleased that the Prime Minister and Deputy Prime Minister asked the Social Exclusion Unit to consider what more can be done to reduce social exclusion amongst adults with mental health problems. This will help us think about how to improve rates of employment, social participation, and better access to services – of central importance to mental health service users and carers.

I would also like to mention the Choice Consultation being undertaken this autumn to listen to the concerns of service users and carers and to explore the scope to make services more responsive and more fair. I am personally very excited by the opportunities that both the Social Exclusion Unit Project and the Choice consultation provide. In working closely with service users and carers, they will help us understand what makes a real difference to people with mental health problems – a model for how I think we should be working in the future and I look forward to working with you to make that difference.

Finally, I’d like to come on to the draft Mental Health Bill. It is important that we get a Bill that more accurately reflects and supports modern health services, not only as they are today, but as they will be in the future.

We want to see a modern legislative framework for mental health service initiatives and investment to reflect modern patterns of care and treatment and human rights law. I want to see significant improvements to patient safeguards. But also to protect public safety by enabling patients to get the right treatment at the right time.

I would like to spend a moment to highlight some of the new safeguards which were set out in the draft Bill.

For the first time, all compulsion beyond 28 days will be authorised independently by the new Mental Health Tribunal.

For the first time, wherever possible the patient’s own choice of a nominated person can help and represent them.

For the first time, patients will have access to new specialist mental health advocacy to support them and their nominated person.

Under the changes there would be a requirement for every patient to have an individual written care plan.  And tribunals and courts will be independently advised by experts drawn from a new expert panel.

These are significant steps forward in ensuring a transparent system and support for people with a mental disorder.

I am aware that there has been a long silence following the consultation last year, and I appreciate the frustrations that many of you have felt.  We have been evaluating your response to consultation very carefully, and will be publishing our response before the Bill is introduced.  However, the dialogue with key stakeholder groups has continued over the last few months.

Before joining the Department of Health, as part of my work in the Department of Constitutional Affairs, I was responsible for bringing in the draft Mental Incapacity Bill. During this process, I met with as many stakeholders as possible to obtain their views.

However, there is some overlap, and work is continuing to ensure that there is consistency between the Mental Incapacity Bill and both the Mental Health Act and the new Mental Health Bill.

In my new job, I have made it a priority to meet with people concerned with the Mental Health Bill.

In recent months I have been participating in a series of meetings with stakeholders to road-test issues in some detail – issues such as how the Bill’s powers will work in the community and improving patient safeguards.

These meetings have been highly focussed, and have brought together service users, clinicians, managers and other interested parties.

Real progress is being made in these meetings – sometimes giving solutions and at other times just a much clearer idea of the problems!

I have found the meetings incredibly helpful, and have been impressed with the commitment of participants- many of whom feel strongly about the Bill- to look for practical solutions that will benefit service users.  This work is still ongoing.

While we may not always agree on the difficult issues that are involved in reforming the Mental Health Act, we must work together. Many of you in this room will have already influenced the Government’s plans for the better.

Of course there will be differences, but my suggestion to you today is that we build on the positive work that has already been done and keep looking for those practical solutions together.