Below is the text of a speech made by the Health Minister, Norman Lamb, to the Royal College of General Practitioners on 10th October 2013.
Good morning everyone, I would like to thank you for inviting me here today.
I was greatly encouraged by the positive views on integration that have already been spoken about today.
I think we are living in a time of great opportunity. For any Western democracy, I believe the stars are aligned to deliver better and more integrated care for people with mental illness.
Today’s conference covers both integration and mental health – two things which I am incredibly passionate about.
But from the patient’s point of view, despite the advances in mental health, too many people don’t get access to the care and support they need – they don’t get holistic care.
And, if we are being honest, there is an institutional bias against mental health within the NHS.
But we are also here to talk about the potential for integrated care and to focus on that care from the patient’s view point.
This is not about organisational change but about the model of care which is shaped around the needs of the individual patient, not the needs of the organisation.
Unfortunately, over the years we have institutionally separated mental health and physical health in the NHS.
Later today I will be making a speech to colleagues in the department about the importance of mental health.
I know that poor mental health can start in the workplace – 1 in 4 workers will experience stress, anxiety, depression or another condition during their working life.
Mental health is the single biggest cause of disability in the UK, bigger than cancer and cardiovascular disease. So it is important for people to feel that they can speak up when they feel like their mental wellbeing is suffering.
But it is also important to remember today what ramifications someone’s mental health can have on their physical wellbeing.
A few weeks ago, Rethink released a shocking set of statistics.
People with serious mental health problems – like schizophrenia – on average die 20 years younger than people with no mental health issues. And more than 30,000 people with severe mental health problems die needlessly every year.
These statistics make for difficult reading. But they are well-known.
Those people died because their poor mental wellbeing had a dramatic impact on their physical health. Conditions like heart problems, diabetes and addiction to smoking, physical health problems which were exacerbated by their mental health.
And last week, new research from Taiwan suggested that people with depression are three times more likely to develop Parkinson’s disease.
I am pleased to mention here that the Department will shortly be embarking on a major new strand of work on reducing premature mortality. Mental health will form an absolutely integral part of this – and that is crucial. To address these frightening figures, we have to tackle physical co-morbidities and adopt a whole-person approach.
There are organisations out there doing some incredibly innovative work around improving people’s mental health so their physical health doesn’t suffer.
In fact, one of them has helped organise this conference.
The emergency mental health service at South London and Maudsley FT – or the A&E of the Mind as it has been called – where people who come in to A&E with severe mental health issues are seen quickly, diagnosed and discharged – is incredibly innovative.
I want to see this sort of service replicated elsewhere. I want to see this become the norm, not the exception.
The health service is very good at treating physical health emergencies.
The system may be under pressure, but when someone breaks their leg, the health service swings in to action. When someone has a stroke, there are a raft of doctors, nurses and specialists at the scene to deal with them quickly.
But is this replicated for mental health emergencies? In some areas yes – having a positive impact on wellbeing and lowering the pressure on local services – but often, mental health services are slower to act.
I’m not the only one who thinks this.
I’ve heard from many charities and health organisations that crisis care for people with mental health problems is not reliable.
One example of this is a constituent of mine. A lady who had recently moved to Norfolk, her son had suffered severe mental health problems in his 20s. One day she found ligature marks on his neck, she took him to the local A&E, they both had a half hour discussion with a junior doctor.
This put that doctor in an invidious position – he had no mental health training up – and then the patient was released, with no mental health specialist being involved in the process.
The next day, she found him hanged in her own home.
I found it heart wrenching and shocking to hear that, but I know it is not isolated. This happens too often.
I was in an A&E Department recently, I was there for some hours looking at some really amazing work in that Department, but out of hours there is no mental health specialist there. Yet we know that a mental health crisis often happen in inconvenient times of the day or night.
And we are working with a range of organisations to develop a single national Crisis Care Concordat – one national agreement setting out what local areas should provide for people who have a mental health crisis.
The A&E of the mind is a great way to treat people with mental health issues in a timely fashion, in exactly the same way that physical health emergencies are treated.
I would like to see more services like the Rapid Assessment, Interface and Discharge – or RAID – in Birmingham. I visited them to hear about the great work that they are doing.
They offer training and support for City Hospital Birmingham A&E staff for when there is a person attended who has both a physical and mental health emergency – like people who have self-harmed, or people who have alcohol problems and mental health difficulties. We know that many people who have self-harmed turning up at A&E do not get the assessment and referral that they so desperately need. Out of everyone who turns up to A&E, they are the ones who are most prone to taking their own lives.
In Birmingham, they have managed to provide around the clock care as well as make huge savings. For every £1 spent in the RAID service, it makes £4 worth of savings from dealing with people’s mental health issues before they become a crisis.
These kind of innovative approaches make it obvious that we need to change the way we think about how we look after people’s mental health.
And, more to the point, we need to look at how we can improve the way health and mental health services can work together.
My overarching goal is to make sure that mental health has equal priority with physical health, and that everyone who needs it gets access to the best available treatment.
It is outlined in the Health and Social Care Act that there needs to be equal importance given to mental health with physical health, and we will be able to hold them to account for the quality of services.
I am acutely aware that, the whole time we discuss parity of esteem, we need to continually challenge the health system to make certain we can make a reality of this.
Yet often, the health service provides few interconnecting bridges between the two. And where those bridges are present, sometimes they are rickety, not up to scratch for people to traverse.
The discussions that are happening today are going to be hugely important in improving and building those bridges, those services.
I hope that this leads to a ground swell in new evidence and research on building more integrated services across the health service.
What I also wanted to cover today is how my department is trying to make the health service more integrated – more bridges being built between physical and mental health services.
We want to forge together new bonds between health and care settings, but also inspire the health service to be creative and think around the issues of integration, much like you will be doing later today.
This focus on holistic care has, frankly, been lost recently.
And when it was, it was normally in spite of the system, rather than working with it.
Now, integration is written throughout primary legislation.
Now, there is a legal process for encouraging this type of joined-up working.
There has never been a legal duty on the NHS to specifically promote the integration of services, and the Care Bill will place the same duty on local authorities.
But an important point on this is giving professionals the power and the freedom to decide for themselves how this should work.
Although it isn’t enough to point to legislation and say “now go and become integrated”.
A line of legislation isn’t going to cause in itself an eruption in the creative minds of the health and care service which I mentioned earlier.
The term ‘silo working’ is often employed to describe the health and care system.
And when we look at any local health service in the abstract, yes, it is a series of people, working in a series of buildings, often miles apart from one another.
But that separation isn’t just physical, it is also cultural. Our NHS is a diverse and mixed institution, and each part of that system works differently.
How do you make those services work together?
It takes encouragement.
And there are two parts to this.
The first part is to show that they need to work like this.
Because the simple fact is that doing nothing would provide us with a health service that is not value for money and ultimately be sustainable.
The statistics scream out for action.
By 2026, 3 million people will have three long-term conditions. There are 1.9 million people with them now.
Between now and 2030, the number of people over 85 will double.
And we know that the rate of the England population with a mental health problem increased from 15.5% in 1993 to 17.6% in 2007. An increase of 2.1% might not sound like a lot, but we are talking about over a million more people being affected by a mental health condition.
The health makeup of our society is changing, and we need to change with it if we’re going to rise to the challenge of an aging population with more complex health needs.
The second part of the encouragement is about inspiring people to work together.
And I believe we are leading by example on this.
My department is working across the health sector – with NHS England, the Local Government Association, Monitor and others – and has set out a vision of how health and care can become better integrated.
But we will also be working alongside a number of pioneering organisations that have really exciting ideas for integrating health and care.
We put a call out for bids in May, and the response has been really positive.
We have had over 100 bids from across the country, across a wide range of services – an overwhelming, and in all honesty, unexpectedly high level of interest.
It showed to me just how creative and efficient our health and care services can be, shaking off the idea that these services are systemically bureaucratic.
It also showed me that there is an extraordinary pent up energy out there. People want to do things different, people wanting to work better for their patients.
These have been whittled down to a shortlist and we will select the very best proposals, sharing their learning right across the country.
We are not too far off announcing who these trailblazers are going to be, and I am looking forward to the prospect of exciting new approaches to treating both physical and mental health in a holistic way.
Nor do I want to limit the number of pioneers to those we select within this process. This is about championing exemplars to encourage others everywhere.
The culture I want to instil in the Department and in NHS England is one of experimentation, to say that you can do things differently if it makes sense, if it is rational and if it offers better care for patients.
What I consider the most exciting part of our integration work is how we are funding integration across the country.
Through the Integration Transformation Fund, we are providing £3.8 billion to encourage people to work better together.
What I want to see is exactly what is in the name of the fund: a transformation.
It plans to make sure that health and care services work together;
That organisations act earlier to prevent people reaching crisis point;
That seven-day services are offered so people can access them when they need to; and
That care that is centred on individual needs, rather than what is convenient for the system.
It is ambitious, that’s true. But I want organisations to be ambitious and think what they could do with some of this money.
What I want to see is the funding used to break through the barrier to integrated health and care, including mental health.
I want to see plans to improve the care that people receive.
I want simple, clever and creative ideas that present a way for people to move seamlessly through the health and care system.
Another example, which I am happy to be able to announce today, is the clinical trial which Kings Health Partners are going to be undertaking into medically unexplained symptoms.
You will be hearing more about this later today from the team themselves, but it will be taking place in Lambeth and Southwark and will focus on people who experience unexplained symptoms like dizziness, chest pains, headaches and fatigue, which can disrupt people’s day to day lives.
They will bring a team of physicians, psychiatrists and psychologists together, who will assess and treat people who present with medically unexplained symptoms, backed by £2.5m of funding. This kind of cross-cutting work is incredibly exciting – and important – and I wish them luck in their trial and look forward to hearing about the results.
So in closing, I want to wish you the best for what I know will be a thoroughly interesting conference.
One of the great frustrations of this job is that the schedule is so heavy that you can’t stay to listen to the work being presented.
I think the conversations you will be having today will help end the mind-body dualism of the health service.
If we want to offer better care for patients and those that use the health service, we need to be able to treat a person holistically.
In short, we need them to be treated as a person, something much greater than the sum of their parts.