Norman Lamb, the Lib Dem MP for North Norfolk, has exposed serious failings in the implementation of a flagship new policy to improve care for people with severe mental illness in Norfolk.
As Health Minister in the coalition government, Norman Lamb introduced new standards for Early Intervention in Psychosis (EIP) to guarantee that patients experiencing a first episode of psychosis should receive an specialist package of treatment within 2 weeks of being referred. This was an important step towards achieving equality for mental health, which was due to be rolled out to at least 50 per cent of patients by April 2016.
However, a Freedom of Information audit by Mr. Lamb shows that CCGs have only commissioned Norfolk and Suffolk NHS Foundation Trust to provide an EIP service for people aged 14-35 this year, despite the new standard applying to people up to the age of 65. None of the CCGs in Norfolk were able to specify how much overall funding has been allocated for EIP in 2016/17, sparking concerns over a lack of robust commissioning of the service within the county.
There is also “limited provision” of the key skills needed to provide the full range of treatment which meets the national standard, including cognitive behavioural therapy for psychosis, family interventions to support families and reduce rates of relapse, and specialist employment support which has been shown to improve recovery and reduce long-term costs to the NHS and welfare system. The Trust said it was “not possible to say when or if” it will be able to provide a service in line with NICE guidelines this year, even for the restricted cohort of patients who are offered EIP, and that further investment is required.
CCGs said that they hoped to extend EIP to an all-age service by March 2017 with an in-year amendment to the current contract – a whole year after the new standards came into effect.
The findings reflect a bleak national picture regarding the implementation of the new standards. Among the key findings of the Liberal Democrats’ national audit were:
- A lack of robust commissioning of EIP, with many CCGs leaving it to trusts to deliver EIP within a block contract for mental health services;
- Despite official guidance saying that the standard should apply to everyone from 14-65, almost a quarter of CCGs (23%) had only commissioned services for people up to the age of 35, while the same proportion of health trusts were only providing EIP for this age group;
- A third of the CCGs (32%) who responded could not identify how much funding has been allocated to EIP in 2016/17;
- Out of those CCGs and Mental Health Trusts who provided an estimate of their average investment per patient in EIP, this figure was £5,199 for CCGs and £5,085 for Mental Health Trusts. According to NHS England, the estimated annual cost of treatment in a fully-compliant EIP team is approximately £8,250 for each patient. This indicates that people are being let down with less than the full package of care; and
- There is evidence of a widespread lack of training and skills mix to provide the full range of treatment which meets the national standard.
These findings come weeks after Theresa May acknowledged on her first day as Prime Minister that there is currently not enough support for people suffering from mental ill-health. The Liberal Democrats are now seeking to hold Mrs. May to account to ensure that this rhetoric is translated into action, and that equality for mental health is at the heart of her Government’s priorities. Ensuring new standards to improve care are properly implemented is a vital step towards this.
Commenting on these findings, Norman Lamb said:
“The half-hearted implementation of this standard in Norfolk and in many other parts of the country is nothing short of scandalous, and highlights the historic inequality between the way in which physical and mental ill health are treated in our NHS.
“It would rightly be seen as a national scandal if the NHS failed to provide the evidence-based treatment required in cancer, so why is it acceptable for people suffering psychosis? The negligent approach to delivering the new standards in mental health should be met with similar outrage.
“The variation around the country is extremely disappointing, but it also shows that failure is not inevitable. These new standards would change people’s lives and lead to significant savings for the NHS and benefits system. We know that for every £1 invested you can save £15 – yet in so many areas, they are falling short. It would be horrific and intolerable if this opportunity was missed.
“Genuine equality for mental health can only be achieved if the new standards for mental health are given the same level of political importance and public scrutiny as those in physical health. It is critical that NHS England and the Government learn the lessons of this flawed implementation, to ensure that other proposed treatment standards in mental health do not fail.”
- The annual cost of psychosis to society is estimated at £11.8bn due to healthcare costs, lost productivity due to unemployment or death, and the impact on families and carers. In the UK, only 8% of people with schizophrenia are in work, while people with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people.
- There is strong evidence that the early provision of evidence-based specialist treatment has a significant impact on recovery, long-term quality of life, and the overall cost of care. EIP services significantly reduce the rate of relapse, mortality, and hospital admissions, while improving employment, education and wellbeing. An analysis has shown that £15 is saved in the long-term for every £1 spent on early intervention (attributed to the reduction in use of crisis and inpatient services, and improved employment outcomes).
- A full Early Intervention in Psychosis service, delivered in accordance with NICE guidelines, will include psychological therapy; physical health assessments and wellbeing support (including support for healthy lifestyles and smoking cessation); employment, education and training support; and support, information and advice for families and carers. It involves an integrated team of psychiatrists, psychologists, education and employment specialists, and care co-ordinators who will typically be nurses, occupational therapists or social workers.