30 June - Mental health network webinar

01 July 2022

This week’s guest speaker was Claire Murdoch, Chief Executive, Central and North West London NHS Foundation Trust and National Director for Mental Health, NHS England. To kick off the event, Claire to provide an update on Mental Health in the UK today.

First, she noted: “although suicide rates did not rise during Covid, rates often rise in" recessions and times of economic hardship and as such there is a need to be cognizant.” Claire then detailed current NHS priorities as she thinks the Long Term Plan promises can still be delivered.

“The first priority is delivery, including: challenging the inappropriate out of area placement issue, CYP, including those up to 25 years old, the implementation asks regarding community mental health transformation and UEC pathways.”

“The second priority relates to ICBs and the need to continue maximizing the opportunities they bring and ensure value is being added. Trusts have a part to play in shaping the changing architecture of both ICBs and provider collaboratives.”

“The third priority is planning for the future. The Long Term Plan runs until 23-24, and there is a further years’ funding beyond this.” Claire is building priorities for the next four-year plan, including neurodiversity and autism, following exposure of significant unmet need triggered by the pandemic, and the need for proper funding, policy and planning behind this, as well as how to meet and prevent eating disorders, including early intervention. “CYP remains a priority and there is a need to support the development of a network of CYP hubs across the country, ensure 100% of mental health support teams in schools by the end of the next term of parliament and ensure 1- and 4-week access and waiting time standards are in place for specialist services.”

Claire also spoke of influencing the Secretary of State’s cross government plan on mental health to ensure it considers housing, education, and employment.

Concerns were raised around a lack of mental health on the national agenda and a resulting loss in morale from staff. Claire advised of NED vacancies on the NHS England board and spoke of support from Amanda Prichard and positive feedback from No 10 regarding effective delivery of the plan.

Some attendants spoke of the change in national representation of mental health and a feeling amongst some that representation in mental health charities is not as robust as it could be. There may be upcoming opportunities to recalibrate.

“Until recently, a constructive approach was seen to be most effective for charities, however there is likely to be a move towards more assertive forms of campaigning.”

The conversation then turned to the lack of honors for mental health chair trusts and questioned how the 111 system can provide a better service for mental health patients; and a growing interest in data regarding suicide rates by sector and campaigning for NHS staff to be fast tracked.

Work with regional directors and David Sloman regarding easier ways of illustrating UEC data has been highlighted. Claire spoke of initiatives that currently fast track staff, including staff hubs and a contact with Practitioner Health for more complex issues. She also discussed how staff mental health is most influenced by team culture, proper debriefs and proper rest days.

Some asked for suggestions on how to get the best out of the Better Care Fund and aligning with the recommendations of the Fuller stocktake. Claire noted the alignment of the Fuller stocktake with the community transformation in terms of closing the gap between primary and secondary care. Amanda Doyle has been appointed as the National Director for Primary Care and Community and will work with Claire and regions regarding practical support and sharing best practice.

CAMHS has been described as the fastest growing NHS specialty, but a lack of funding, given the accelerated increase. The contrast between England and Sweden regarding early intervention in the community was referred to when questioning whether the department, NHS England and No 10 consider international exemplars.

Claire agreed more beds for CYP is not the solution and encouraged respite and crisis houses.

“There is a need to look at the rare exceptions where there are no nearby facilities. The NHS is aware of international exemplars.”

Claire feels early intervention is key, as per the Long Term Plan, and component parts of the community investment pathway are in place.

“Financial backing is required in order to do more.”

It has been discussed that Claire would be invited to a future meeting, along with Amanda Prichard, to further explore the issues raised today.

The group spoke of an upcoming GGI session to address the code of governance, the added value of modern governance and what this looks like. They also spoke about board composition, including a working definition of diversity, and the challenges regarding board responsibility in relation to culture and wellbeing.

Some attendants felt there is a gaping hole regarding board responsibility for establishing a just culture, with a lack of scaffold and journey to copy. They spoke of examples in the American military and noted an observation from General Messenger that armies always have the elite as reserve – in the NHS, the elite is forever deployed. There is no time for reflection, decompressing and re-engaging.

“We need a better process for appointments, whereby staff believe the best person got the job.” Someone spoke of the implementation team mentioned in the Messenger recommendations, and the need for those in mental health to be involved here. The group then discussed mandatory training, which used to be face to face and is now mostly e-learning. They agreed it is less effective and has resulted in a loss of ability to know what staff think.

Finally, the group concluded that the NHS is more rank-conscious than the police and fire service, and that we as a collective need to dismantle this culture, along with consideration of the approachability of line managers.

“This is the way forward for ICBs!”