Mental Health Nursing journal December 2021/January 2022 – Lead professional officer update

This update featured in the December 2021 / January 2022 Mental Health Nursing journal (Vol 41 #6). For those who aren’t Unite/MHNA members, you can buy your copy online via PocketMags or join and get 6 copies per year posted to your home and access to our back-issues online.

I always refer back to my previous update when I sit down to type out my new one.

With this edition, as it straddles the end of one year and the start of a new one, I also looked back at my update from the December 2020/January 2021 issue of the journal.

I remember at the time thinking about how long or short-lived the excitement would be of consigning the ‘COVID-19’ year to the history books. There was a real sense of hope for the new year.

But now, as we head into the ‘tidal wave’ of Omicron, it certainly feels that I could accurately describe 2021 as a ‘mixed bag’.

I mentioned last year that I had just signed up to support the local vaccination programme in Greater Manchester, as it was only last December that the first non-clinical trial vaccines were being given.

Over the last 12 months, the centre that I work at has given over 360,000 vaccinations and I have carried out more than 1,300 hours of clinical practice in my ‘spare time’.

I have found it an interesting prospect that with 2022 being my NMC registration revalidation year, I could revalidate only using the vaccinating side of my nursing.

Seni’s law

Another issue that I raised 12 months ago was our letter to the then mental health minister raising concern about the delay to the commencement of Seni’s Law.

It was good to see last month that the Mental Health Units (Use of Force) Act 2018 has now been given a commencement date (31 March 2022) and had its new guidance for implementing the law published.

I mentioned last month that I acted as a judge on the recent General Practice Awards, in the mental health category. You can read all about the worthy winners on their website.

As well as this event and the recent Birmingham Nursing in Practice/Pulse Live event, it was good to get out and about and meet people, including MHNA members, face-to-face again.

I did reflect when I wished our MHNA committee and MHN editorial board members a merry Christmas recently that it feels a real shame that opportunities to see them in 2021 have been so lacking.

I hope everyone reading this has an opportunity over the Christmas and New Year period to get, at least, a little break from the amazing work that you are all doing.

Thank you and I look forward to being back in touch with you in 2022. As always, please stay in touch.

Mental Health Nursing journal April/May 2020 – Lead professional officer update

This update featured in the April/May 2020 Mental Health Nursing journal (Vol 40 #2). For those who aren’t Unite/MHNA members, you can buy your copy online via PocketMags or join and get 6 copies per year posted to your home and access to our back-issues online.

As I write this from my kitchen table on bank holiday Monday, now a scene of many a Microsoft Teams, Zoom, WebEx, GoToMeeting, Skype and WhatsApp Video over the last few weeks, it feels amazing that it’s only 25 days since my email to MHNA members to thank you for your efforts so far, in the battles against COVID-19.

So much has happened to our nation and our health service in such a short period of time.

In my responses to various people and organisations in recent weeks as your lead professional officer, I have repeatedly highlighted how we have entered a global pandemic with a much-weakened NHS and society.

It has struck after 10 years of austerity, where the poorest have suffered the most, and a mental health service that has faced cuts, including the 8.2% (between May 2010 and December 2019) drop in the number of mental health nurses working in England’s NHS.

While the government has taken dramatic action in some areas as a result of the pandemic, only time will tell whether this will be a continued change of heart after the initial impact of coronavirus is known.

Key areas of concern

There have been three key areas of concern that members have raised
the most frequently: the number of people working in the health service; the availability and supply of personal protective equipment to health service staff and other key workers; and the availability of COVID-19 testing for members of staff.

These are obviously all singularly important issues, but they also have a co-dependence on each other.

Alongside my role in supporting mental health nurses in Unite, I also have a role supporting our ambulance staff members.

Their concerns also highlight this co-dependency well. For example, one of our representatives has reported that her service, on that particular day, faced a 30% vacancy rate.

The rep providing the report was at home self-isolating as she had a new cough, and was feeling unsure whether she was infected, after having crewed her ambulance without the required range of PPE available.

PPE guidance

As you’ll see elsewhere in this edition, Unite has welcomed the updated PPE guidance issued by the UK public health organisations and the Academy of Medical Royal Colleges, although we remain acutely concerned about the levels of supply and distribution.

Unite has done a number of things including joining with the Trades Union Congress, alongside sister trade unions, to demand government action on this ‘crisis within a crisis’ – and has worked to repurpose members in manufacturing to use their skills, engineering and manufacturing expertise to ramp up production.

Collaborative working

Following requests from mental health professionals, we have been working with the Royal College of Nursing, the Royal College of Psychiatrists

and colleagues from NHS England to produce a poster resource specifically for mental health professionals.

Work on this is well under way, and it will hopefully be published well before this journal hits your doormat.

This has not been the only resources that we have joined together to work on. For the last few weeks we have been working on guidance across

a range of topic areas and services. These, and more, are all available from the Royal College of Psychiatrists’ website.

On this, I would like to offer my thanks to our lead reps from both MHNA and the Applied Psychology Organising Professional Committee, who have suffered the daily requests for feedback that I have made of them, alongside the jobs that they are doing in the NHS, the university sector and elsewhere.

Student views

This edition of the journal also picks out two other areas that have consumed time and effort.

It is great that we have been able to feature the reflections of three student nurses on how the coronavirus pandemic has impacted on them and their studies, so I send my thanks to the authors Charlotte, Ashleigh and Sandra for their insightful and thoughtful contributions.

Alongside my fellow lead professional officer and lead for regulation Jane Beach, I have been involved in regular discussions with the Nursing and Midwifery Council and others about the progress of changing students’ progress to registration.

Any questions should hopefully now be answered by the relevant guides in each of the four UK countries.

However, if any of our student nurse members have any questions, comments or concerns, please do not hesitate to get in touch with me.

Also, if you are a student then please consider sharing your experience and reflections on the coronavirus situation, and our regular Student Focus feature is the perfect publication opportunity for this. Email the editor via mhneditor@gmail.com if you would like to contribute.

If you want to hear more about our work for students, have a listen to episode one of our new series of The Mental Health Podcast.

The importance of mental health nurses

This issue of Mental Health Nursing also includes a welcome piece by Simon Hall from the University of the West of England, on the importance of mental health nurses, especially during the pandemic.

This has also been an area that has required much thought and consideration.

As in ‘normal’ times, people with mental ill health often get put to the back of the healthcare queue.

It would be a further travesty if this situation is furthered during COVID-19, with various attempts to divert mental health professionals to the ‘physical health fight’.

We have already opposed some plans that have been proposed nationally, which would have had exactly this impact.

Support is vital

It is clear that it will take a long time for the true impact of COVID-19 to become known.

What we know now, however, is that as well as a large death toll, the nation’s mental health will be impacted. And a significant part of this will be the mental health of key workers.

I was pleased to see that a national helpline has been launched for NHS staff in England. Alongside this resource, I would encourage all our members to ask for and get support when they need it.

This could mean phoning a helpline or talking with your colleagues, friends or family. It could also mean getting in touch with your local Unite workplace reps or contacting me.

Such support is vital, and we will all need these support mechanisms over the days, weeks and months ahead.

We also thought about some of these issues when putting together the second episode of season two of The Mental Health Podcast.

I wanted to finish this update by once again saying thank you for all that you are doing at such an exceptionally tough time.

Mental health nursing students – They’re the future… I’ve met them

I was chatting to a NHS England official a few weeks ago and he commented on my job, or at least his interpretation of it, seeing some of my many thousands of tweets: ‘It always looks like you go to some really interesting events’. I’ve done nothing to undermine that view after my last blog focused on the 5th Horatio Festival and now this one reporting back from this weeks ‘Future Mental Health Nursing’ conference. 

The 2019 edition was held in Edinburgh and was my fourth attendance at the near annual event, following prior events in London, Huddersfield and Birmingham. The story of the conferences genesis was retold by Ben Thomas this year… Seeing the decline in mental health nursing numbers whilst working at the Department of Health, he wanted to hold a conference focused on mental health nursing students, and the rest, as they say, is history.

 

Although Ben has been a constant in the conference planing team, each event has been primarily organised by an ever changing group of students who have been helped by some of the university lecturers that are attached to MHNAUK (or Mental Health Nurse Academics UK) a brilliant group of which I’m an associate member.

This year I was asked to have a stand that would share the #MHnursingFuture memes that MHNA developed in 2018 and also give delegates a free copy of the current Mental Health Nursing journal, our special art and therapy edition. Whilst also encouraging budding student authors to write for us. If you’re interested in doing this yourself, have a look at our author guidelines.

Getting to the venue for before 8am, I set up my stand and then waited for the onslaught to begin. With over 400 students from across the UK in attendance, it was certainly hard at times to cope with the numbers mulling around the exhibition area. There was two things that made me smile during this bit of the day. The first was my feeling of getting older. There was a few times when I wasn’t sure whether I was talking to students or university lecturers. This wasn’t because of the students being mature, although some of course were (although maybe not as many as there used to be due to the disastrous cuts to nursing bursaries), it was more the number of lecturers that seemed younger than me! 

The other thing that was lovely was the number of students and lecturers that came up to me to introduce themselves as Twitter followers, and rather than saying; “Hi, I’m [First name] [Second name]” they said; “Hi, I’m @[Twitter handle]”. Sometimes, it can feel that on Twitter you are talking into an echo chamber with no one actually that interested. It’s such a relief when someone says they actually find some of the stuff I share useful.

The keynote sessions started with Scotland’s chief nurse, Fiona McQueen. Reflecting on her session at the end I pondered on Twitter whether non-Scottish students in the hall would be considering heading towards the country when qualified. Not particularly because Fiona was painting an overly rosey picture but that there were lots of threads of work that are happening that made me think the country is heading in the right direction, for example; the creation of a new public health body, the funding arrangements of student nurses, the repeated increases in mental health nurses in the country and the ‘Health and Care (Staffing) (Scotland) Bill‘ which enshrines safe staffing in to law.

The next keynote was delivered by Tommy Whitelaw, a son, carer and campaigner who started a one man mission to raise awareness of dementia by telling the story of his “wee mum, Joan”. I’ve heard Tommy speak at least three times before, but it’s a testament to the emotion that he puts in to his sessions that I can still feel the tears well as he speaks. 

He spoke about the impact that a district nurse had on him, transforming his fears that he “couldn’t manage and he was a bad son”, to someone who was doing “a great job”. Tommy also spoke about ‘What Matters To You Day’, an annual event on the 6th June. Take a look at what’s involve and think about signing up. He finished his session by encouraging an impromptu karaoke. 

Before we headed to a couple of different concurrent sessions, we had a quick word from one of the sponsors, @worktheworld.

In the first concurrent sessions there were two options for delegates. One was to listen to Jennie Young. I knew this would be a good session as I’ve heard Jennie speak at least twice, most recently at this years Nursing In Practice Glasgow event, where she took one of the MHNA stream spots. She also spoke at the 2017 MHNA Scottish conference.

The second concurrent was delivered by Lin Anderson, crime novelist, and James King, Head of Education at Scottish Prisons. They both described their respective work in supporting the education of prisoners. 

With the morning done, we had chance for lunch, which included the chance to head to the chill out space and the ‘Welcome Hut’. With such gorgeous weather in Edinburgh that day, it was unsurprising that many headed outside rather than sticking in the hall. 

During the afternoon, we had 3 further keynote sessions (and a concurrent but I missed that so can’t comment). David McCollom spoke about his experiences of growing up taking drugs and encouraged people to reflect on his recovery, now being 17 years drug free. 

Andy Lowndes spoke about ‘Playlist For Life’. This was probably the most enjoyable and interesting session for me during the day. He spoke about the formation of Playlist For Life with Sally Magnusson, following her experience in caring for her mother. The session started with everyone being asked to think of one song that should be in their own playlist, including the reason why it would be there. A few people shared their songs and their reasons and Andy played these. I shared mine on social media, ‘Sway’ by Bic Runga, which was our first dance at my wedding. We were then shown a few clips of people with dementia hearing their playlists played to them. I hope that we’ll share more in a future #MHNjournal, although I was told after the event that it has already been featured in our sister publication, Community Practitioner. 

The third, and final, keynote was from comedian Luisa Omielan. She promised to talk about topics too important to ignore, but in a funny way so people will listen. She didn’t disappoint. You can see a chat she did with Emily-May Barlow just before her show here.

After last weeks exhausting Horatio Festival, I have to say I was anxious how I’d get through the Future Mental Health Nursing conference. I really shouldn’t have worried as it was a really excellent event and there was no chance of me flagging. The eventual product was a real credit to the excellent organising team!

5th Horatio Festival of Psychiatric Nursing

Last week, I was lucky to attend the 5th Horatio Festival of Psychiatric Nursing as part of a mini-delegation from Unite/Mental Health Nurses Association. I was joined by its vice-chair, Hollie Roblin. It was actually my third trip to a Horatio conference (and Hollie’s second) having attended Prague and Malta (in 2017). If you’re interested in what happened in Malta, you can see all the blogs I wrote here.

Horatio is a grouping of mental health nurse organisations, mainly from across Europe, but it also has organisations from further afield involved too. MHNA has been a long term member of this group and on top of the events I have attended, we’ve also sent delegate members to other events including Istanbul and Portugal.

This years festival was in Copenhagen, Denmark’s capital city. This would be my second journey to the city, having visited as part of a Scandinavian family holiday a few years earlier. Happily, unlike many of the events that I attend, the conference is built in such a way that even when you go to each and every session, there’s still time for city exploration and relaxing, which is most welcome. Normally it’s; leave home, travel, go to conference, travel back, sleep. So as well as seeing the Little Mermaid and Nyhavn, attending a civic reception in Copenhagen City Hall and the conference dinner, Hollie and I attended over 45 sessions, listened and watched singing, dancing and fairy tales and met with mental health nurses from 22 different countries. 

The theme of this years festival was participation. The definition the scientific committee used was:

Participation means the active involvement and empowerment of stakeholders. Participation gives nurses the opportunity to collaborate with the service-users and through their work learn to do things better. Participatory mental health, is what makes it possible for nurses to work effectively as equal partners within a multi-disciplinary team and together with patients.

In keeping with this, all of the keynotes had this thread running through them. As with any conferences, some sessions will stay with me longer than others. There were two that definitely stood out. My favourite of the whole event was delivered by Søren Dixen, a schizoform laywright, scholar of Nordic literature and a recovery-mentor at the Mental Health Services of the Capital Region of Denmark. He sessions focused on 3 different projects that he had helped to create:

• ‘Projekt Råkunst‘ [The Raw Art Project]
• ‘Maskine Maskine‘ [Machine Machine]
• Værekstedet MMA

At the conference he was also joined by schizoform artist, Nikolaj Brie Petersen, who was both exhibiting some of his work and painting a new canvas. His work also acted as visuals for much of the conference materials, bags, programmes, etc.

Maybe like the study that shows if you think about red cars, you’re more likely to see red cars on the road, I don’t know whether it’s just that my mind is more focused on it at the moment, but I’ve seen lots of examples of ‘art and therapy’ in mental health over the last few weeks, both at Horatio and at other events that I’ve attended. It fits in perfectly with out two-part Mental Health Nursing journal special editions on art and therapy and mental health. I’ll also be meeting up with colleagues from Bethlem Gallery soon to record an episode of our upcoming #MHNjournal podcast.

The second keynote highlight was Professor Alan Simpson’s session ‘Reflections on service user involvement and participation in mental health nursing research‘. I have to own up to being a pal of Alan’s so my review may be a bit biased, however it was a session that was spoken positively of and quoted by lots of other Horatio Fesitval’goers. He spoke at the importance of using participation throughout research, and similar to Søren’s, giving a number of examples where this had worked in the real world. It was also a really helpful session as Alan could talk about some of the pitfalls that he’s faced over the years, hopefully saving some of the delegates in the room from making similar mistakes. 

Of the concurrent sessions I attended, I thought the one delivered by Thomas Kearns was the best. Although his topic was ‘Advanced practice expanding across the scope of mental health nursing’ the sections I enjoyed most was his description of how nurses should engage in the politics of the profession and the world at large. He could also call on his experience of acting as the chief executive for the International Council of Nurses to talk about how we as nurses should fit in with the efforts of the World Health Organisation and their Sustainable Development Goals. 

There were other topics discussed during the festival that either brought in new thoughts or questions into my head. A couple of the sessions looked at the importance of physical health for people suffering from mental ill health. In the UK, we’re lucky to have the blossoming Equally Well UK collaborative, led by the Centre for Mental Health. It made me think about whether we’ll have space for a wider European dimension in our upcoming Mental Health Nursing journal special on the subject, which will be guest edited by Andy Bell. 

Another session looked at employing peer supporters in Germany and Switzerland. We were told how in Switzerland, peer supporters were being paid. I did a quick bit of working out and it seemed that their pay was below the 25th centile for wages in the country. I wondered how this compares across Europe? A question from the audience also made me think. It went along the lines of; How long does a peer supporter have currency in their role due to their time spent working in the healthcare environment. For me, all employment should be an act of growing your workers, either for bigger and better roles in or outside of your organisation. Why should this be any different for people recruited as peer-workers?

Conversations outside of session included discussions about UK nurses influence in the world (You’ll be unsurprised to hear, due to the conference I was attending, that I’m an advocate for increasing this where ever possible). It was also interesting to talk to student mental health nurses from Denmark who in the main part had qualified as general nurses some years previous and now were taking on the specialist qualification. This obviously compares with the UKs approach of having our four fields of practice. Again, it was interesting to consider different nurses perspectives on this, especially in relation to the importance of nurses having good grounding in physical and well as mental health care and the impact this has on the work being done by Equally Well UK. 

If this all sounds wonderful exciting, you can submit your abstracts for the 2020 Horatio Congress which will be held in Berlin between the 14th and 16th May. The theme of that event will be ‘complex interventions in mental health’.

If this quick exploration of some of the highlights of the 5th Horatio Festival of Psychiatric Nursing isn’t enough, you can also have a look at the Twitter threads from each of the conference days:

• Horatio Festival 2019 – Day 1 http://twitter.com/davidamunday/status/1126382899543068672
• Horatio Festival 2019 – Day 2 http://twitter.com/davidamunday/status/1126743858178486272
• Horatio Festival 2019 – Day 3 http://twitter.com/davidamunday/status/1127140654767845376

25th-31st March 2019: A video update

Here’s my second video blog, giving a look into what I got up to between 25th and 31st March. You can watch it on Facebook or YouTube.

As promised in the video, here’s some links to the topics covered:

– NIHR Mental Health PRU conference. You can watch the recorded sessions and companion podcasts from @Mental_Elf here: http://beyondtheroom.net/after-the-mha-review/.

– You can read the Hearing Voices Network Alternative Mental Health Act Review here: http://www.hearing-voices.org/news/alternative-mental-health-act-review/

– You can read more about the Maternal Mental Health Alliance’s Everyone’s Business campaign here: https://maternalmentalhealthalliance.org/campaign/

– If you want to hear more about Andrea Sutcliffe’s work at the NMC, including regular blogs and vlogs, follow her on Twitter via: https://twitter.com/Crouchendtiger7. The Unite in Health lead professional officer, Jane Beach can be followed via: https://twitter.com/Beach_Jane

– You can see more about the Dangoor Lecture on this Twitter thread: https://twitter.com/i/moments/1111004712701181963. You can also learn more about the Money and Mental Health Policy Institute from their website: https://www.moneyandmentalhealth.org/ or Twitter feed: https://twitter.com/mmhpi.

– You can watch The Kings Fund webinar on the NHS Long Term Plan and mental health via: https://www.kingsfund.org.uk/events/nhs-long-term-plan-and-mental-health or watch a Twitter moment from Dave here: https://twitter.com/i/moments/1111267927133749248

– You can get your own subscription to the Mental Health Nursing journal, including our upcoming art and mental health special edition via: https://pocketmags.com/mental-health-nursing-magazine

– If you don’t parkrun, take a look at what your missing out on via: http://www.parkrun.org.uk/. If you think you’re the mental health nurse who has run the most, or if you want to get in touch about anything else, get in touch on Twitter @davidamunday or email: dave.munday@unitetheunion.org.

Mental Health Nursing journal February/March 2018 – Lead professional officer update

This update featured in the February/March 2018 Mental Health Nursing journal (Vol 38 #1)

This year is the 70th anniversary of the founding of the NHS. To celebrate, each month Unite in Health is celebrating one or more of the professions that make up our organisation. The MHNA OPC has chosen October as mental health nursing month. This makes perfect sense for at least two reasons: it coincides with World Mental Health Day on 10 October and it gives us more time to put plans in place. We’re hoping to hold conferences in London (at the beginning of the month) and Edinburgh (possibly on 31 October, so save the date).

While you’ve got your diaries out, I’m also really pleased to announce that we are continuing our partnership with Nursing In Practice to deliver mental health streams at three of their events in 2018. These start with their Scottish event in Glasgow on 6 March, followed by returning to their London and Birmingham events later in the year. Nursing in Practice offers a great way to get some free CPD, and not just in these locations, and I recommend that you take a look at their website to look at where they will be visiting.

We have submitted evidence to the House of Commons Health Committee Nursing Workforce inquiry. The committee launched its final report on 26 January. It was good to see its call for the government to increase the number of nurses ‘at scale and pace’ and that it again highlighted the problems that different parts of our nursing family face, including those of mental health nurses. In my response to the report I highlighted my frustrations that it did not take up our recommendations to work towards safer staffing, especially in mental health services [I also wrote a blog on the report].

As an example of the benefits we would see from such legislation, in the same week of the committee’s report, the Care Quality Commission, in their report ‘Mental Health Act – The rise in the use of the MHA to detain people in England’, highlighted that “Some of the factors at play in the rising rates of detention, both nationally and locally, are also signs of a healthcare system under considerable strain. Detentions under the Act can be influenced by gaps in support and provision in the system.”

The independent review of the Mental Health Act continues. We submitted a response to the call for evidence and we’re currently working with the RCN to develop a survey for mental health nurses. We’ll share the link via our social media pages and in an email with members. Please help us to get this survey out far and wide. The review is also looking for responses to a service user survey. Please help them by visiting the review website and sharing the link with your networks.

In other consultation news, we’re currently formulating our response to the government’s green paper on children’s mental health. As we’ve reported in this months news feature, we believe the green paper is nowhere near ‘bold’ enough, a claim that it makes in its conclusion. I’ve written a blog that helps with some background and thoughts. If you want to contribute your thoughts, on this or any other issue, please get in touch.

Since my last update, I’ve attended a few different meetings and events. These include the Mental Health and Smoking Partnership. See p14 for an update on this group.

On a similar theme, I also attended the launch of the NHS Smokefree pledge. If you’re interested in these or other events I attend on behalf of MHNA, take a look here. I’ve included Twitter moments that hopefully give you a flavour of what went on.

In my last update I mentioned our [Evri Anagnostara, Hollie Roblin and I] meeting with Jeremy Corbyn. One issue we raised was increasing his ministerial team on mental health.

We originally argued for a minister with a focused responsibility for mental health. Recently this brief was widened to also cover social care, when Barabara Keeley took up the role. We were therefore really pleased to welcome Paula Sherriff to her new [shadow] ministerial role focusing on mental health. I had my first meeting with her the week after she was appointed and really look forward to working with her into the future.

I’ve also been busy over the last few months working to improve our e-MHN journal offering. I’ll be sending emails to members in February to update you on a new way to access your journal from PocketMags. We hope that it makes your access even easier than before.

Professions within a profession failed

Today the House of Commons Health Committee have published their report on the nursing workforce inquiry. This brings to an end, a long process for the committee, which started last September. I’ve been involved with that process, contributing to the writing of the Unite in Health written evidence, supporting a colleague with their appearance in front of the committee to give oral evidence and following other aspects of the work. There’s a huge amount of material that can be shifted through on the inquiries website, including the final report which runs to 55 pages in length.

There are 17 conclusions and recommendations, across the 5 topics;

1. Retention – keeping the current workforce
2. New nurses
3. Nursing associates
4. Nurses from overseas, and
5. Workforce planning

There’s worthy stuff in there, but before I look at some of this I wanted to address one of the big issues; nurses have been spectacularly failed by the current government, and here’s why…

Listening to Jeremy Hunt speak, he focuses on talking about the increase in ward nurses. A recent tweet he shared highlighted that in 1 year, there were ‘800 more nurses on wards’. There is truth in that statistic. In fact looking at the total number of nurses and health visitors in the NHS, we’ve seen a 2.2% increase in their number since 2010.

With all these figures you’ve got to remember that over a similar time period, the population in England has increased by 2.6 million, or 5%, so even a 2.2% increase is really a 2.8% ‘real terms’ cut.

Looking at adult nurses, the picture unusually shows one of an actual real terms increase. Their number has increased by 6.5% since May 2010 (before considering that population growth I’ve mentioned above).

When you go a little further down the NHS Digital spreadsheet however, things don’t look anywhere near as ‘marginally getting better’.

Community health nurses, well they’ve gone down by 14.7%…

Learning disability nurses, down by a staggering 37.4%….

School nurses, down by 20.1%….

And although health visitors have seen a 5.9% increase, since their transfer from NHS to local authority commissioning, they’ve been cut in the NHS by 19.0%.

For mental health nurses, their number have reduced by 11.4%.

All these are despite warm words about the importance of community services, early intervention, mental health, et al. Is enough being done to alter their steep downward trajectories? Again, although we’re told there is, I think the proof is sorely lacking.

And these cuts to staff have great and grave impact on patients and service users. For example earlier this week, the Care Quality Commission, in their report, ‘Mental Health Act – The rise in the use of the MHA to detain people in England‘ identified that a growing number of people were being detained under the Mental Health Act due, in part, to gaps in support and provision.

The calamitous decision to remove NHS student bursaries for new students has seen a marked decline in the number of people putting themselves forward to run the education gauntlet. What’s even more perverse about this is that the report makes clear that this decision has impacted the choices made by those in older age groups, and in their graph on page 21, they show how these groups, aged 30 or over, make up a larger percentage of two of the nursing fields that are facing some of the worst drops in numbers, 39% in learning disability nursing and 40% in mental health (62).

The report talks about monitoring the bursary issue ‘very closely’ (71). As a colleague, Jane Beach says however, “…we don’t have the luxury of waiting another year to know how this will play out. The evidence of nursing shortages from NHS Digital is already stark and alarming”.

Thinking on Jane’s point about the luxury of time, as I’ve shown above, the cuts to many professions in nursing have been significant, constant and going back 7+ years. This long period of failing the professions means that the response now should be more immediate and have a greater impact. As in many things, I have no confidence that the Government will take the necessary action.

One area that our Mental Health Nurses Association have argued for is to have safer staffing legislation. Unfortunately the report does not make a recommendation on this. It should have.

Another recommendation that Unite made was to look to improve public protection by better protecting the nurse title. As Prof. Alison Leary uncovered in her recent research, the current situation is not fit for purpose. Again the report is silent.

One area that the report does encourage is more accurate data collection (115). This would be excellent. As I was reading this through I noticed an answer to a Parliamentary Question from Sir Nicholas Soames (MP), answered by Jackie Doyle-Price (MP), which suggests we’re heading in the wrong direction. When asked about health visitor numbers, the answer is now, one the one hand ‘we don’t know’ and on the other a misleading response given about ‘800 new training places being made available in 2016/17’. This is misleading as, was reported by Nicola Merrifield in the Nursing Times, one third of these courses places were left vacant.

There’s more that could be said about the report and its recommendations, for example I’ve not even got started on the issues of pay and retention rates. I’m getting tired though, as I’ve just got back from the NHS rally in London. As this report is on the nursing workforce, I wanted to give the final words to Siobhan, a specialist nurse, who spoke at the #NHSrally, as they seem fitting:

“Our NHS is not beyond repair… I believe it is our countries greatest achievement. We must and we will defend it”.

World Mental Health Day 2017

Every year on 10th October the world is encouraged to focus on mental health with World Mental Health Day. This annual event was first held in 1992, and to help focus minds, every year there is a theme. In 2017, it’s 25th anniversary, the theme is ‘Mental health in the workplace’.

Work and mental health share a very important relationship. There is no doubt that work is good for you. It is also true that a ‘negative working environment’ can lead to physical and mental health problems.

WHO, in their information sheet for #WMHD2017, highlight that “depression and anxiety have a significant economic impact” with the estimated cost to the global economy of US$1 trillion per year in lost productivity. 

Looking closer to home, the Centre for Mental Health stated that 91 million days are lost every year due to mental health problems in Britain with the total cost to employers estimated at nearly £26 billion each year. This is equivalent to £1,035 per employee in the UK workforce. 

Although it’s important to state the economic case, it’s also just as important to consider the impact on the people ‘behind’ these dollars and pounds.

WHO, highlights some of the work-related risk factors for mental health. These include;

• inadequate health and safety policies;
• poor communication and management practices;
• limited participation in decision-making or low control over one’s area of work;
• low levels of support for employees;
• inflexible working hours; and
• unclear tasks or organisational objectives.

I would argue that these risks are also a check-list for the issues that each and every trade union rep across the UK try to address. I’d suggest to the government that if they are serious about supporting people with mental illness to access and remain in work, they should be making the job of a trade union rep, and trade unions themselves, easier, and not harder as they have been doing.

Mind, in their research confirmed a culture of fear and silence around mental health is costly to employers, including;

• More than one in five (21%) agreed that they had called in sick to avoid work when asked how workplace stress had affected them.
• 14% agreed that they had resigned and 42% had considered resigning when asked how workplace stress had affected them.
• 30% of staff disagree with the statement “I would feel able to talk openly with my line manager if I was feeling stressed”.
• 56% of employers said they would like to do more to improve staff wellbeing but don’t feel they have the right training or guidance.

In a report, ‘Mental health and employment’, published earlier this year, the TUC analysed official employment statistics. This analysis showed:

• Only 1 in 4 (26.2%) people with a mental illness lasting (or expected to last) more than a year are in work.
• Less than half (45.5%) of people with depression or anxiety lasting more than 12 months are in work.

The TUC highlighted at the time that one area where people with mental health conditions would be further disadvantaged was in the Governments imposition of employment tribunal fees. It is therefore welcome and hugely significant that these fees were ruled as unlawful in July. This is just one more example where the Government has work in opposition to its own stated aims to improve the situation. 

Turning to the NHS, more recently I’ve been involved in a number of pieces of work focused on the subject in respect of health workers. The most recent, with the Tavistock and Portman NHS Foundation Trust National Workforce Skills Development Unit. At ‘Enhancing management of psychological trauma & resilience experienced by staff working in the NHS’ we heard stats from an ongoing literature review that ‘in some papers up to 78% of nurse were reporting secondary trauma/compassion fatigue’. I’m hoping to blog about the event in the next few days to provide even more info about what went on. 

One of the things that most impressed me was, even though resilience was used as a term, I’m often struck how this can be interpreted as ‘staff need to learn how to cope better with the problems that they face’. At the event it was stated on a number of occasions how the aim of this work is to reduce the need for staff resilience in NHS employers. We’ve got an article on this subject coming up in a future #MHNjournal. 

BBC Radio 5 Live also recently picked up on the subject of people working in mental health organisations increasingly needing over 4 weeks sick leave to recover from their own mental health conditions. Their FOIs on the subject uncovered a 22% increase in the issue. You can hear some of my thoughts from two of the clips they used when I was interviewed on the subject here.

Even more recently, UNISON published stats from their own survey that showed a ‘rise in violent attacks by patients on NHS mental health staff’ on this subject though it’s important that this doesn’t become a health professional versus service user dispute, as John Baker highlights rather than ensuring workers get the best support to do their job in a compassionate way. 
I’ve also seen provisional results from a Unite in Health survey which adds to the concerns being highlighted by mental health workers who desperately want to do the best job they can. This will be out soon. 

Looking to the future, there’s a number of pieces of work that I’ll be developing over the next few months. One that I hope will have a positive impact on this issue is #MHNfuture. 

Having worked with more and more mental health professionals since World Mental Health Day in 2016, I’ve been struck by the commitment of the people I’ve met to improve the care they provide to fellow citizens. No matter what the hurdles they have to jump over the next year, I have no doubt that when I reflect back in 2018, they’ll be closer to their goals of doing an even better job. 

Is it me, or you Jeremy? Mental health nursing numbers in 2017

On 5th July, at Prime Ministers Questions, Theresa May (MP) answered a question from Jeremy Corbyn (MP); “Of course we now have more nurses in our hospitals than we had in 2010“.

First off, that statement is true. In May 2010 we had 280,950 nurses in England and in March 2017 (the most up to date stats we have from NHS Digital) we had 285,893. This is an increase of 4,943 or 1.6%.

But first…

Before heading off on the point of this blog however, I want to highlight that this isn’t as ‘good’ as it sounds as during a similar time, the population of England has increased by 2.6 million people, or 5%.

If you changed the governments reporting system so we looked at number of population per nurse, it’s increased (so got ‘worse’) by 3.2% (187 people per nurse in 2010 to 193 people in 2017).

What about mental health nurses?

George Coxon, the chair of Unite/Mental Health Nurses Association, and I, wrote to May to highlight that at the time of her making this statement the MHNA national committee was meeting in Salford with one of the agenda items, to discuss the cut in mental health nurses (MHNs).

Between 2010 and 2017, the number of MHNs has been cut by 4,942 (from 40,630 to 35,688) or 12.2%. Using the number of people per nurse reporting system I’ve used above, it means a change from 1,296 people/mental health nurse to 1,549 or a 19.5% increase.

I’ve produced a few iterations of a graph that shows the situation for MHNs and I updated it with these latest stats.

Alongside this data from NHS Digital, I’d had a conversation with Rachael Maskell (MP) to ask whether she could help to uncover some more detail. She submitted 4 questions to parliament which uncovered some more information regarding MHN education commissions. The answers from Philip Dunne (MP) shows that between 2009/10 and 2016/17 there has been an 11% cut in the number of MHN commissions (or 3,755 to 3,343).

Maskell also asked for the commissions for next year. You’ll see from the answer that the system is changing in 2017/18. There’s much to worry about in this new approach, and just a few news stories from this week highlight some of the possible impending problems ahead:

• Exclusive: English universities reducing nurse training places – Nicola Merrifield in Nursing Times.
• Driving students away from nursing is a spectacular act of political self-harm – Polly Toynbee in The Guardian.
• Drop In University Applications Of 25,000 Shows Impact Of Fees, Says Rayner – Emma Bean in Labour List.

Another area that I wanted to investigate was the rate of graduation versus the number of students that took up the commission. Parliament wasn’t up for answering this one. They did point us towards HESA’s website. The page they pointed to, or any other I could find, didn’t seem to help. However Twitter came to my partial aid. When I asked for numbers of students enrolled and completed B760, they sent me the following:

This answer hasn’t helped fully as I’m guessing they’re not England specific and I don’t know the numbers who enrolled to result in the 2,890/595 qualifiers in 2015/16. I’ve asked but not reply so I’ll need to follow this up!

A reply from Jeremy

The next part to this story started with a tweet from Dr Rachel Clarke. She was asking Jeremy Hunt (MP) how much it would take before he acted on the dangers of NHS understaffing. He replied by arguing that he was acting because he was ‘dramatically increasing‘ the numbers of doctors that are being trained. He had his own graph (more of this later!):

I took the opportunity to ask for his thoughts on my (MHN) graph and unusually he replied to me:

I was intrigued by his response. I’d heard second hand before that he’d stated that MHN was the fastest growing nurse speciality, at this years CNO Summit. I hadn’t seen or heard it direct however. Now I had, I wanted to know more! I asked what his reference period was for this claim, but I must have used up my Twitter replies as I’ve not heard back.

Without a reply, I thought I’d do a bit more data crunching. I found out the following:

• Between 2010 and 2017, MHN fared 3rd worse when compared with 6 NHS Digital ‘headings’.

• Guessing what Hunt might mean by ‘now’ I thought I’d also compare for the period of March 16 – March 17. This resulted in MHN’s faring 4th worst/3rd best.

If you’re interested in the overall graph for the 6 groups between May 2010 and March 2017 here it is:

Jeremy, I’m not sure whether there is a reference period that does show MHNs being the ‘fastest growing’ but if there is I think you’ve got to be pretty selective to find it. I’m happy to be proven wrong however!

On the other point that Hunt raised, that ‘120,000 more people are treated every year’. I’m not surprised by this. Unite/MHNA asked its members last year about how things were going, and the results were pretty shocking, showing the effect that this increase in work, on top of the cuts that I have outlined above, has had on them.

What about the doctors?

Before hanging up my scientific calculator, I did a bit more number crunching as I was interested in Hunt’s point re. doctors. I found out that:

• The ‘psychiatry’ doctor grouping showed an increase of 32 (8,699 to 8,732) or 0.4% between 2010 and 2017. Using a new people per psychiatry doctor stat this means a change of 6,052 people per psychiatry doctor to 6,329 people per psychiatry doctor (an ‘worsening’ of 4.6%).

• There’s a real variety in the increase and decrease in the different doctor specialities, but when you take them as a whole, in 2010 there was 556 people per doctor vs. 519 people per doctor in 2017 (an improvement of 6.7%).

England population:

• Mid-2010 population: 52,642,452
• Mid-2016 population: 55,268,100
• Difference in population: 2,625,648

World Mental Health Day 2016 – UiH Comment

Originally posted on Unite in Health Comment on 10th October 2016
Today is World Mental Health Day 2016. For those unaware, it’s an annual event first set up in 1992 by Dick Hunter. The World Federation for Mental Health (WFMH) today recognises that he was a ‘man with a dream that mental health concerns would be recognized as an integral part of overall health, and who felt that the mission of WFMH was to seek parity for mental health alongside physical health’. This aim is today recognised around the world and is a key aim in providing mental health services with both ‘parity of esteem‘ and ‘no health without mental health‘ being key terms. 

Since 1994, an annual theme has been selected, with the Federation assembling a briefing that could be sent to everyone, free of cost, to allow them to follow the theme in their own way, holding local events within their own budgets. It was a practical way to spread mental health advocacy, drawing attention to the needs of people with mental illnesses and to the importance of mental health. 2016’s theme is ‘Psychological and Mental Health First Aid’. 

When you think about this year’s theme, you can see straight away where parity of esteem, or the principle by which mental health must be given equal priority to physical health, is lacking. Think of how many people in our society have, or are encouraged to, take part in CPR training. So if you walk down the street and have a heart attack, you at least have the chance if someone who has received some training coming to your aid. Can we say the same is true when it comes to someone facing a mental health emergency? 

Just like the DRABC in CPR, the World Health Organisation highlights ‘Prepare…Look, Listen and Link‘ and Mental Health First Aid International recommends ‘ALGEE‘. 

Unite is already playing a leading role in this by skilling up its reps in many parts of the UK with training on mental health basics. With a membership of over 1.4 million it certainly has an important opportunity to help. And at last week’s Unite/Mental Health Nursing Association meeting, the committee discussed further about what extra we could do. 

I want to finish by wishing you a thoughtful, productive and enjoyable #WMHD16 and if you want to share any of those thoughts, get in touch! I’ll be at the Future MHN Conference in Huddersfield. Follow @Unite_MHNA for more!