investigation

Questions to NHS organisations on mental health unanswered

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HMI Welfare wanted to know what help was on hand for people with mental health problems in hospital Accident and Emergency departments. It seemed a simple question: How many mental health staff work in A&E?

What we found, however, was an inconsistency across NHS helplines about who to ask about the services available to mental health patients.

We contacted:

  • NHS England,
  • a number of clinical commissioning groups (CCGs),
  • a central NHS Trust,
  • the Health and Social Care Information Centre (HSCIC)
  • The Bristol Commissioning Support Unit (CSU) press office,
  • the Kings Fund,
  • Avon and Wiltshire Mental Health Partnership Trust and
  • Bristol University Hospitals NHS Foundation Trust

At first it seemed simple: follow the money. We found out that the CCGs allocate the budget for mental health, and NHS England directed us to the CCGs for that reason.

The CCG allocates the money – but can’t say how it’s spent

 

However, Bristol CSU (which services the CCGs) said that although the mental health budget is allocated at CCG partnership meetings, you have to ask the service providers – or those who dispense the budget.

In other words, Bristol CSU said that the CCG has a mental health fund they divide up, with each labelled pot getting a lump sum, these being:

  • mental health trusts,
  • community mental health,
  • hospitals
  • and so on.

So with this in mind, Bristol CCU said at first to approach the hospitals as they are the service providers.

Hospitals – or mental health trusts?

But then the Bristol CSU communications department changed their mind. They said we needed to contact the Mental Health Trusts, because it is they who are the service providers who split up the funding for different services.

However the CSU also said we should in any case approach both the Mental Health Trusts and the hospitals.

It seemed that they – like other sources we called – were not sure.

When we did as the CSU directed and contacted the Avon and Wiltshire Mental Health Trust communications department, they referred us back to the CCGs.

Running in circles: back to the CCGs

We pressed the trust for an answer. Their communications officer said that the Mental Health trust did have some liaison teams that work with services in primary care or the GPs, and invited us to send an email.

But their reply again passed the query back. It said:

“The provision of mental health in A & E departments is the responsibility of the CCGs (having taken over from PCTs earlier this year) as they are the commissioning body.

“As all CCGs have their own Press or Communications team, you can contact them directly.”

So that completed the full circle. NHS England also told us to go to the CCGs, and the Department of Health thought the CCGs might know – but if it was policy we wanted on mental health provision in A & E, to contact the mental health team in the Department of Health.

“Contact mental health charities”

Then the Health and Social Care Information centre (HSCIC) said… to contact mental health charities.

Finally, a specialist NHS employee – a commissioner – explained that usually the hospital will liaise with the NHS Mental Health trusts to agree what provision goes in to Accident and Emergency.

With primary care provision coming under CCGs nobody could inform HMIW who to send Freedom of Information requests to regarding mental health.

What, for instance, are the responsibilities of the MH Trusts liaison teams?

Did Mental Health come under primary care? Are Accident and Emergency departments part of acute care?

“Mental health doesn’t come under primary care and is commissioned differently,” Avon and Wiltshire Mental Health trust informed us.

“We do provide mental health services but if they are in a primary care setting such as an A & E department, it would still be a matter for the commissioners to decide what is needed and how to fund it.”

So it seems that Accident & Emergency is primary care. Relentlessly we rang up the advisory Kings Fund in case they knew more. Their reply to an email, which followed up the telephone call in order for them to consider the question more fully, included fourteen different links which did not answer the question.

So what then did the hospitals say? Those asked were too busy to reply. Aintree NHS hospitals trust did not reply to an email and on telephoning, the hospital switchboard directed to a recorded message with an emergency number.

Again after contacting the Patient Support and Complaints Team at University Hospitals Bristol NHS Foundation Trust, they too said to send an email which they acknowledged. In it they stated they aimed to reply within three working days but they are now well outside that target.

It seems that they do not really know or do not want to say. Sending in an FOI might make them find out. In any case, it is not a small area of concern. As Professor Sue Bailey, Royal College of Psychiatrists said in a Centre for Commissioning report :

“Commissioners need to know that 5% of accident and emergency attendances, 30% of acute inpatient bed occupancy, and 30% of acute readmissions are mental health related (RCPsych, 2004)”

It seems that if they do not know, they do need to find out.

Related: Guidance for commissioning integrated Urgent and Emergency care, A ‘whole system’ approach.

data

Get the UCU data: further education zero hour contracts

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Sixty-one percent of further education colleges in England, Wales and Northern Ireland have teaching staff on zero-hour contracts, according to the University and Colleges Union (UCU).

200 colleges responded to Freedom of Information requests from UCU. A further 75 failed to reply within the 4 weeks required by the Freedom of Information Act.

We’ve obtained the UCU FE data (published here) that shows the numbers of teaching staff or assistant staff per college on zero hour contracts and how the contracts are used in the industry. Continue reading Get the UCU data: further education zero hour contracts →

links

Useful links to Sept 27: Hurt from the cuts; Loan policy supports unwise lending

Communities, Disability, Homelessness, Housing

Useful links to Sept 16th: reassess mental illness; axe bedroom tax; the new poor; CPAG update

These are some welfare links we found interesting during the second week of September.

What were Ian Duncan Smith’s ‘welfare reforms’ really about?. Guardian, Sue Marsh, spokeswoman and author of Diary of a Benefit Scrounger says the reforms are frightening the most vulnerable.

Hard evidence: are migrants draining the welfare system?. The Conversation. The evidence is to the contrary.

Patrick Kennedy: ‘Speak up’ for mental illness. Politico, A call to reassess mental injuries caused in military combat.

UN housing expert’s call to axe bedroom tax ‘a disgrace’ – senior Tory. Guardian, Bedroom tax. Conservative party chairman, Grant Shapps takes issue with the UN special rapporteur’s views of the bedroom tax.

Ed Milliband to pledge crackdown on zero-contracts . BBC. In his address to the TUC, Ed Milliband will set out plans to tackle the spread of zero-hour contracts.

Child Poverty Action Group update: The reality of striving and surviving on benefits. Video with single parent, A Girl called Jack.

Europe could have up to 25 million ‘new poor’ if austerity drags on .Oxfam. The report states that damage caused by austerity measures will take at least two decades to reverse.

data

Get the UCU data: higher education zero hour contracts

We’ve been reporting on the use of zero hour contracts in higher education, following FOI requests by the University and Colleges Union (UCU). Of 162 requests sent by the UCU, 142 replied.

Edinburgh and Glasgow universities – both members of the Russell research group which attracts billions in grants – and the Royal College of Art are among the elite institutions using zero hour contracts.

Understanding the HE FOI data:

The HE employees are divided into three groups:

  • teaching staff,
  • researchers, and
  • academic support services (for example librarians, administration, or computing).

The first column gives the total number of employees on zero-hour contracts in that institution. The three beige columns on the right break this down into teachers/lecturers (T), researchers (R), and academic support (AR). Between the two are staffing numbers according to the Higher Education Statistics Agency.

data, investigation

Teachers at top universities on zero hour contracts

Four of the UK’s top universities are among those employing the most lecturers on zero hour contracts leading to insecure and uncertain work.

Research from University and Colleges Union (UCU) shows Bath, Edinburgh, Lancaster and Glasgow universities together employ 5,500 teachers, researchers or academic services staff with no guarantee of work.

When contacted some universities were quick to qualify their use:

  • Lancaster University said the contracts were only for students.
  • At Cambridge where they have 83 staff on zero hours, a spokesperson said in a statement they were only used in very specific situations:

“Typically, such contracts are used for seasonal work, and are advantageous to employees who are taking a second job that they need to fit around other commitments, or students wishing to do some flexible working alongside their studies.”

Fourteen of the top twenty universities in the Complete University Guide for 2014 are using zero hour contracts. Only London School of Economics (LSE), Exeter, York, Leicester, University of Birmingham and King’s College London do not. An LSE spokesman said:

“LSE has not and does not employ any staff on formal zero hours contracts of employment.”

Locations of the twenty Higher Education institutions with the most zero hour contracts.

More than 1 in 8 of those employed in higher education survive on zero hour contracts, the University and College Union (UCU) survey shows.

Of those in teaching or research it is almost 1 in 6.

The data shows that of 141 HE institutions, more than half use zero hour contracts.

Back in May, on learning about the spread and impact for its members, UCU began making Freedom of Information requests to find out how widely the contracts were used. 87% of institutions responded.

The survey defines zero hour contracts in use in Higher Education (HE) as an arrangement where the employer has no obligation to offer work or guarantee a minimum number of hours.

After seven years in higher education, for example, a PhD student on a zero hour contract would have no security of income. Visiting lecturer Carrie Dunn wrote about the high workload and the insecurity this brings.

Some say the unpredictability of research grants and lecturers on sabbaticals demands flexibility but those facing sudden drops in hours may have been unaware of their terms when they radically altered without warning. As an alternative, centres have offered short term or minimum hour contracts.

Since the UCU survey, Edinburgh University has agreed to stop using zero hour contracts and signed an agreement with UCU after the survey revealed they were the worst employers having the highest number on zero hours at 2712.

Related reports:

Communities, data, Disability, Housing, links

Useful posts to Sept 6: welfare reforms mauled;whose upturn? dreading UC

These are some welfare links we found interesting during the first week of September.

Uncategorized

Help build an interagency map across the UK

As scores of citizens battle to keep food on the table, supporting agencies try to be effective while facing more pressure due to welfare cuts.

But where are they based? From the Citizens Advice Bureau to the Trussell Trust what is in your area? To populate the map, please enter the details of an organisation you know of in the form below.

Who is doing what in your neighbourhood?

Key for map icon colours
Welfare areas: Children or Youth Red, Mental Health Green, Welfare Blue Homelessness Yellow Poverty Purple

 

 

Communities, Disability, Homelessness

Useful links to August 30th: living costs crisis; intern death; DWP zero hours; modern workers

These are some welfare links we found interesting during the second two weeks of August.

Communities

Cafcass applications, Blackpool the most, Scilly Isles the least

The number of children in care applications is on the rise, shown by figures released by the adoption and care process body, Cafcass June 2013.

Blackpool, Stockton-on-Tees and South Tyneside had the highest number of care applications per 10,000 children. But in which areas are the applications increasing? St Helens, saw the number almost double, to become the fourth highest nationally.

Thurrock, a town which finished last on the government’s wellbeing survey July 2012, has seen an even larger rise, more than double the numbers of children for care and now among the top twenty.

Overall, London-Havering, Thurrock and St Helens saw the largest relative increase amongst the English authorities between 2012-13. Out of the top eleven, five were in London.

Which care applications fell the most in the same period?  York which more than halved the number, at 60%.

In the City of London, the care applications rocketed, 2009 – 2012, before dropping again. Why?

“The City of London used to be on the Croydon duty rota (we took unaccompanied asylum seeking children) but we came off in 2009 due to a lack of resources,” said Shaista Afzal, City of London team manager.

What is the difference between the authorities having the highest number of applications and those having the lowest, per number of children?

The biggest is between Blackpool with 32 and the Isles of Scilly with zero.

The Isles of Scilly comes top not having a single application in 2012 or again in 2013.

Seaside towns are reportedly suffering above average levels of deprivation so are receiving funding from the Coastal Communities Fund.

Margate, Clacton, Blackpool and Skegness in Lincolnshire are on that list, the Independent said.

Here are the calculations on the Cafcass data, Pages 7 – 11.

Download the original data at : Cafcass care application figures June 2013

Helping connect those investigating the welfare system