Rosie Winterton – 2004 Speech to Forensic Psychiatric Nurses’ Association Conference

Below is the text of the speech made by Rosie Winterton, the then Minister of State for Health, at the Imperial Hotel in Blackpool on 14 October 2004.

Thank you very much for inviting me here today. Hope you have had a good conference so far.

It is a particular pleasure for me to be here today – not least because nurses make up the largest staff group working within the NHS.

And there are around 45,000 nurses working in mental health in England today providing treatment to some of our most challenging patients – as nurses working in forensic settings, you don’t need reminding how challenging this work can be, and how important it is to get it right.

So thank you for the invaluable work you do. I know that in the past mental health nurses’ skills have often been undervalued. I know this has contributed to difficulties in recruiting and retaining nurses – and to difficulties that you, as nurses have experienced in delivering the quality of treatment and care you were trained to deliver.

Yet nurses are absolutely essential to the delivery of effective mental health services – essential to our plans to modernise and improve care and treatment for people with mental health problems.

And why do we want to that? Why have we made mental health one of the top three priorities for the NHS? For me as a politician it is about a belief – a belief that people with mental health problems are some of the most vulnerable in our society – some of the most socially excluded. And I believe that our society should be judged by how we treat vulnerable people – how we eradicate social exclusion. And that’s why I believe we should strive as a government to ensure we provide high quality mental health services, assessable to all who need them. That we create a working environment where we value our staff and maximise their potential. No longer a cinderella service but a service people have confidence in using and real satisfaction in working for.

And I believe we have the means to make that happen. When we came to power in 1997 £30 billion was spent on the NHS each year. By 2007 that will have risen to £90 billion. That is a huge increase. But for that people will expect good, high quality services – and not just for a few but for everyone.

And in 1997, we made reform of mental health services a key priority – tackling years of underinvestment and neglect.

The national service framework for mental health, the first NSF to be published, was a major milestone. For the first time ever, it set standards for mental health services.

It gave a clear message that mental health was important. But we also know that change would take time – up to ten years. We knew it would take money; and we knew it would take support for our staff.

That is why we backed up the NSF by £300 million extra investment on mental health services. And that is why we developed the National Institute for Mental Health in England to support local services.

So where are we, five years on?

The Local Delivery Plans submitted to us by Strategic Health Authorities show a commitment to deliver all the mental health targets in the NHS Plan that build on the NSF.

Already we have :

Over 253 assertive outreach teams

– 41 early intervention teams – supporting young people with the first signs of psychosis

– The caseload for community mental health teams has increased to 310,000 from 252,000 in 2001.

– 174 Crisis resolution teams

– Improvements mental health care for people in prison is improving

– We are creating 140 high security beds and more medium security places for Dangerous and Severe Personality Disorder pilots.

– There are also more places available for people who no longer need secure care.

– Perhaps most importantly of all – the suicide rate is starting to fall. The latest three-year average [a rate of 8.9 people per 100,000] was the lowest rate yet compared to the baseline in 1997.

And this is possible because of the work that you do, in partnership with us and with other parts of the service.

I am very aware of the pressure that there can be on staff. There is much more to do but we have worked to try to relieve some of those pressures.

We now have half as many more psychologists as there were in 1997. Over a third as many more consultants in psychiatry. And almost six thousand more nurses – an increase of over 14%. In absolute terms, this a good number. But in relative terms, it suggests we have more to do

We must keep up our overall recruitment programme – but obviously my concern is mental health. So what can we do to recruit and retain?

First, we must protect the work that nurses and only mental health nurses can do. This is why many in-patient units are helping to ensure that nurses are free to nurse by introducing housekeepers onto wards.

Some Trusts are also developing roles for support workers. This means qualified nurses to concentrate on activities where their skill and experience are most needed.

Second, we must ensure that our nurses working in a safe environment, and, of course, that they themselves are managing their patients safely. This is why, in 2002, we set up the Cross-Government Group on the Management of Violence in Mental Health Settings, and why in January of this year, NIMHE and the National Patient Safety Agency employed two project managers to offer a consultancy and advice to help service providers review their current policies and procedures on education, training and the safe and therapeutic management of aggression and violence.

We have commissioned the National Institute for Clinical Excellence to produce guidance on the short-term management of violence. Their interim guidance has been issued for consultation and the final guidance is due later in the year.

The National Patient Safety Agency has also identified patient safety in acute mental health settings as a priority. They launched the mental health programme of work at the end of June and their emphasis will be identifying and understanding the complex inter-relation of systems that exist on acute psychiatric wards and how these can be managed to improve safety.

Third, we can support and develop nurses to work in an increasingly diverse range of non-traditional settings, in new role, including in new community teams. This is one reason we have put in place a comprehensive workforce programme, led by NIMHE, to support further development of nurses’ roles.

I believe that work to develop new roles will strengthen the mental health care system as a whole, but it will also help us to respond to individual nurses’ needs for personal and professional development. In particular, I think it will:

– support the delivery of health promotion

– promote early intervention so we can prevent more serious

– problems developing in the future – particularly in relation to the pathways into the criminal justice system that some troubled young people take help in the long term to reduce dependence on traditional psychiatric beds as the mainstay of the mental health service;

– and last but not least improve the quality of care, promote choice, and promote social inclusion for people with mental health problems who can too easily get disconnected from work, education, their families and friends.

Of course, I am aware that nurses already work in a wide range of different settings, and that nurses roles are already very diverse. I am also aware that this has sometimes been portrayed as professional weakness. I absolutely disagree. More than any other group of NHS staff, nurses have the in-depth knowledge of service users as individuals that comes from working in the closest proximity for the most extended periods of time.

By showing a willingness to adopt new ways of working, nurses show that their priorities lie in improving the quality of care for their patients, and that they are keeping pace with modern practice and a newly emerging evidence base about the most effective approaches to care.

In this way, nurses are helping to ensure that nursing remains at the forefront of modern mental health care – for example, I know that there are more Nurse Consultants in Forensic Care than in any other mental health speciality – and this is something you should be proud of.

Fourth, I believe there are changes in the law that will make a significant difference to the lives of nurses working in mental health settings. I’d like to highlight two – the new Mental Health Bill, and growth in the scope for Nurse Prescribing

The Mental Health Bill

As you know, the draft Mental Health Bill was published for pre-legislative scrutiny by a Parliamentary committee last month.

“This scrutiny committee is made up of 24 members of the House of Commons and House of Lords, from across Government. It is very important that this committee should scrutinise the Bill, because there have been a lot of misunderstandings about the Bill, and the committee will ensure that there is an informed, constructive debate.

For example, there have been claims that the Bill has been driven by public safety. This is not the case. What this Bill does is to make significant improvements to patient safeguards; to provide a modern legal framework more in line with modern patterns of treatment and with human rights law; and to protect the health and safety of patients and others by enabling the right treatment to be given at the right time. Like the 1983 Act, the Bill balances an individual’s rights with the need to prevent harm. It provides for the lawful application of compulsion to people with mental health problems where it is necessary for their health and safety and/or for the protection of others.

There have also been claims that the Bill creates new powers to detain people who have not committed an offence. This is not true. The power to detain people who have not offended, but who need treatment to protect them or others, has been with us at least since 1959. It has also been said that the Bill will enable people to be detained without treatment if they are dangerous, because it has removed the “treatability test” from the 1983 Act. Again, this is not true. The Bill does not permit anyone to be detained without treatment. Instead of the small minority of patients to whom the treatability test currently applies under the 1983 Act, under the Bill nobody can be made subject to compulsion unless there is treatment available which is specifically addressed to their personal needs.”

The Bill – like the current Act – makes provision for people with serious mental disorders who come before the courts. I know that this is a group of patients with whom many of you, as nurses working in forensic settings, are very familiar.

The purpose of this part of the Bill is to make sure we deal appropriately with offenders who have mental health needs, so that they can get the treatment they require. These parts of the Bill are generally similar to those in the current Act.

But one important change, is that the Bill will allow mentally disordered offenders who are not dangerous to be given mental health disposal in the community as an alternative to prison. This will mean that those for whom this is a safe and meaningful option can more easily receive the mental health treatment they need, and support to reduce the risk of re-offending.

The Bill also proposes ways to open up new roles for you in the future – including the role of Approved Mental health Practitioner, Mental Health Tribunal member, or Clinical Supervisor. As the number of nurses working in new community teams continues to grow, I am optimistic that there will be a positive and constructive synergy between these things. I am confident that there will be important opportunities for nurses with experience of work in forensic settings to develop and extend their role outside traditional hospital environments.

Nurse prescribing

Supplementary Prescribing will, I believe, allow you as nurses, make better use of your knowledge and skills. I am very pleased to be able to announce that the Department of Health is to invest £140,000 on a research project specifically to look at Supplementary Prescribing by Mental Health nurses. This demonstrates the importance we attach to this new role for nurses and its huge potential for the future. It also shows that we are determined to check that new developments are safe and beneficial to service users. It will help to promote the delivery of choice by service users, and will improve the responsiveness of service as a whole.

One example of someone making the most of the new roles available to nurses is well known to many of you. Barrie Green is a Nurse Consultant from Humberside Regional Secure Unit. He combines clinical work, for example in the area of anger management, with research interests, and he has a professional leadership role across a number of forensic and other services.

Now, Barrie is about to take on another role to complement these – as a Nurse Supplementary Prescriber. I believe this will help him make the service more responsive to service users and help to build on the therapeutic relationships that Barrie and his colleagues strive to maintain.

BME programme

Before I finish, I want to mention one other area of work that has recently received extra attention. It concerns race equality. It concerns the evidence we have had for some time that people with mental health problems from black and minority ethnic communities receive a less than equal service.

There are complex reasons for this. However, the research and service users tell us that people with mental disorders from BME communities are more likely to be detained under Section of the Mental Health Act if they have a severe mental disorder; they are less likely to be offered a psychological therapy, and more likely to be offered a drug treatment. Overall, they are less likely to receive services that are tailored to their needs and less satisfied than their White counterparts.

This is why race equality is an issue of central importance to the work you do. And why it has a very high priority for me.

As many of you will be aware, we issued Delivering Race Equality in October last year for consultation. This was a major milestone in the development of our thinking. We intend to publish the final version later this year – taking the necessary time to ensure that we get it right – and incorporating the Government’s response to the inquiry into the death of David Bennett.

We also began a significant programme of work through the National Institute for Mental Health, reporting directly to the Secretary of State, consisting of:

– 80 Community Engagement Projects

– a target to develop 500 Community Development Workers by 2006

– A diversity package for services

– A census of service users so changes can be monitored

– Nine senior Regional Equality Leads in NIMHE to support and assist local service development and

– Work to look at pathways to care and suicide prevention

More recently, I am delighted to report that Professor Kamlesh Patel, Head of the Centre for Ethnicity & Health at the University of Central Lancashire, has agreed to oversee our work to deliver this. He will help us make sure that work to assure race equality in mental health services connects to the wider Government programme on equality and human rights.

Many of you will be aware that Kamlesh is a prominent national figure who currently chairs the Mental Health Act Commission. He is also a Board member with the new Healthcare Commission and the National Treatment Agency for Substance Misuse. He has led the work undertaken by NIMH(E) since its inception. He has enormous experience, which will be of immeasurable value in the challenges ahead. And of course he’ll be working closely with Surinder Sharma, the first ever equality and human rights director for the NHS.

Conclusion

Let me finish by emphasising something I believe very strongly. It is you – not me – who hold the ability to mobilise the passion and power of the NHS to improve people’s lives; it is what you do that makes the difference.

I will continue to fight my corner for better mental health services, and to secure the resources and the support I know you need. I will continue to encourage managers to work with you – not around you – to raise quality and deliver efficient and effective care. I hope you will be encouraged by the place that mental health issues continues to have in the new Planning Framework.

Thank you once again for giving me the opportunity to be here with you today. I hope you have an excellent conference, and that it provides the opportunity to network and to have some fun as well as to work. I shall look forward to hearing how it goes.