Lack of post-hospital care "leaving mental health patients at risk"

Thousands of vulnerable people are being left at increased risk of suicide because NHS mental health teams in England and Wales are not checking up on them within a week of their discharge from hospital.

At least 11,000 people a year who have recently been in mental health inpatient care are not followed up within a week of coming home, despite guidelines requiring the NHS to contact them.

People discharged after hospital treatment for a mental health crisis should receive a visit or phone call to assess their needs, the National Institute for Health and Care Excellence (Nice) says. But figures obtained under freedom of information laws by the charity Mind show that one in 10 such people are not contacted.

“Patients should only be discharged from specialist mental health services when there are ongoing care arrangements in place for them. Failure to do so can put the person at risk of harm, their condition can relapse and it can mean they are more likely to go going back into hospital,” said Dr Paul Lelliott, the Care Quality Commission’s deputy chief inspector of hospitals.

Mind discovered that the Nice guidelines were often breached after receiving information from 54 of England’s NHS 56 mental health trust and one of Wales’s seven health boards.

“If you don’t get the right care after you leave, if you’re left to cope alone, you end up in a revolving door, going straight back into hospital or being at risk of taking your own life,” said Sophie Corlett, Mind’s director of external relations.

The widespread lack of follow-up “is not good enough. It’s a tragedy so many people so very recently leaving the care of hospitals are losing their lives,” she added.

Separate research by Mind, among 850 patients about their experience of after-hospital care, found that those who were not followed up were twice as likely to attempt to take their own lives and a third more likely to harm themselves.

They are also more than twice as likely to end up back in A&E suffering another crisis, the survey found.

Natalie, 26, from Somerset, who ended up in hospital after trying to take her own life, said the crisis team did not visit her for a week afterwards.

“When you’re that unwell, it’s hard getting through each day. Each hour is tough, so just 24 hours can feel like such a long time. I needed someone to talk to, to help me understand my thoughts and feelings. To see someone only after a week, it’s not enough,” she said.

The CQC’s Lelliott said pressure on mental health services, including to discharge patients to free up beds, should not compromise the aftercare they received.

“We know that hospitals are under increasing pressure to discharge patients as soon as possible but providers must not compromise their ongoing care responsibilities to their patients. It is vital that when they discharge patients into community, it is done in a safe way that ensures people get the continuity of care they deserve and have every right to expect,” he stressed.

Nice guidelines say all such patients should be contacted within a week, and those thought to be at risk of suicide within 48 hours. Last year’s National Confidential Inquiry into Suicide and Homicide found that most suicides occurred on the third day after release.

“Patients leaving hospital can feel unsupported as they return to the problems that may have led to their admission. Those first few days are the time of greatest risk,” said Prof Louis Appleby, the director of the confidential inquiry.

Barbara Keeley, the shadow minister for mental health, said: “Mind’s research is yet more evidence of the gap between rhetoric and reality with this government. We are seeing people in some of the most vulnerable positions with their mental health being put at further risk.”

The Liberal Democrat MP Norman Lamb, who was the mental health minister in the coalition government, backed Mind’s call for all discharged patients to be contacted within 48 hours. “The moral case for this proposal is overwhelming. When we know that the risk of loss of life through suicide doubles if there is no timely follow up, the government and NHS England have an absolute duty to act. But this requires investment in community support which is so often lacking.”

Prof Mark Baker, director of the Nice Centre for Guidelines, said it was reviewing its recommendations to see if they needed to be updated in the light of Mind’s findings.

NHS England said: “Improved access to mental health support for people in the community where they live is part of our plans for the biggest expansion of mental health services in Europe.”

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.
  

Lack of post-hospital care "leaving mental health patients at risk"

Poll shows 60% of European doctors are considering leaving UK

More than half of the doctors from Europe working in the UK are considering leaving the country because of Brexit, a survey by the General Medical Council indicates.

Charlie Massey, the chief executive of the GMC, told the health select committee that while a survey was “not necessarily predictive of future behaviour” the results indicated a potential serious depletion in the workforce.

“It does send a worrying signal in terms of the stock of doctors currently working in the UK,” he said while giving evidence to MPs on Tuesday.

Jonathan Ashworth, the shadow health secretary, said it was “extremely concerning that over half of doctors from the EEA [European Economic Area] feel so undervalued as to consider leaving the UK following the Brexit vote”.

The GMC said 2,106 doctors from the EEA, about 10% of the total who are working in the UK, had responded to the survey.

Of those who responded, 60% (1,280) said they were considering leaving the UK at some point in the future, and, of those doctors, 91% said the UK’s decision to leave the EU was a factor in their considerations.

Separately, a senior Department of Health official told the committee that British people claiming pensions who had emigrated to Europe were saving the UK about £350m a year in healthcare costs. Medical treatment in the most popular countries for British retirees, France and Spain, was cheaper than it was in the UK, said Paul MacNaught, the director of EU, international and prevention programmes at the DoH.

The 190,000 British retirees living elsewhere in Europe, cost the UK an average of £2,300 a year in payments to local health providers. In Britain, the cost of supporting their European equivalents was an annual average of £4,500.

“This is one of the advantages of the current arrangements,” MacNaught said.

The UK paid about £650m to EU countries to compensate for their health services to Britons. The vast bulk of that, £500m, went on the 190,000 retired Britons in Europe. Of those, 70,000 were living in Spain, 44,000 in Ireland, 43,000 in France, and 12,000 in Cyprus.

More than 1,000 respondents in the GMC survey commented on their feelings about Brexit and its impact on their practices.

Massey said two primary reasons were cited for considering abandoning careers in Britain: “Firstly, a question of whether or not doctors felt valued working in the NHS, and secondly, the uncertainty over the continuing future residency status.”

Ashworth said: “The skills and dedication of staff from around the world are integral to our NHS and the government must immediately reassure EU nationals of their right to live and work in the UK. If they don’t, we risk facing a serious staff shortage which will only further worsen pressures on our NHS.”

In a statement, Massey said: “EEA doctors make a huge and vital contribution to health services across the UK. We want to continue attracting overseas doctors in future, and ensure we do not create any unnecessary barriers that would stop them coming here. It’s deeply worrying that some are considering leaving the UK in the next few years. If they leave, this would have a serious impact on patient care and would place the rest of the UK medical profession under even greater pressure.”

Last week the health select committee heard that about 10% of doctors in the NHS were EU nationals, while 5% of nurses had trained in European countries before moving to Britain.

The BMA’s council chair, Mark Porter, warned last week that an exodus of doctors after Brexit could be a “disaster and threaten the delivery of high-quality patient care”.

The EEA consists of all 28 members of the EU along with Norway, Iceland and Liechtenstein.

Poll shows 60% of European doctors are considering leaving UK

English care home closures are leaving vulnerable people at risk, says watchdog

The quality and safety of social care services received by elderly and disabled people in England are in danger, as care homes close and providers pull out because they can no longer make enough money, the care watchdog has warned.

In a bleak assessment of the future of vital services that support millions of people, the Care Quality Commission (CQC) voiced alarm that the care sector as a whole is “at risk”.

Providers are in trouble because their costs have increased by up to 30% in the past year while their profit margins have fallen by more than 40%, it warned. It pinpoints the national living wage (NLW) and the inability of cash-strapped local councils to pay higher fees for these services as the main causes of a growing problem.

The number of care homes overall in England has fallen from 18,068 in September 2010 to 16,614 in July this year, at a time of growing need linked to the ageing population, according to figures released by the CQC.

The total number of beds available in care homes also fell between 2010 and 2016 from 255,289 to 235,799 this summer – a fall of 19,490. While the number of nursing homes increased slightly, from 4,387 to 4,623 in that time, more than one in 10 residential homes – for elderly, often frail, people – have closed. The total of those available has fallen from 13,681 to 11,991 – a drop of 1,690.

The many people who rely on care homes and receiving help in their own homes with washing, dressing and eating could be affected if more and more of the private companies that dominate the market go out of business, the CQC fears.

Andrea Sutcliffe, the CQC’s chief inspector of adult social care, was responding to the leak to the BBC of a recent internal briefing document that spells out how rises in providers’ costs and the squeeze on local councils’ budgets are leaving care services in an unsustainable position.

“We know that the adult social care sector faces many financial pressures which, worryingly, could undermine the quality and safety of care that people receive and rely upon every day,” said Sutcliffe.

She confirmed that information from care providers detailed in the CQC document “does highlight a concern that the long-term sustainability of high-quality care within this sector could be at risk. Given the impact this would have on people’s lives, it is important that we continue to monitor these trends closely.”

The document emerged less than 48 hours before the CQC, which is the NHS and social care watchdog for England, is due to present its annual report on performance and emerging issues, called State of Care, to parliament on Thursday. It is expected to highlight how worsening problems in social care are having a serious impact on the NHS, for example, by leading to patients who are fit to go being trapped in hospital because no package of social care support is available to allow that.

The regulator is worried that more and more home closures could leave needy, vulnerable older and disabled people with nowhere to go.

Its analysis document says that with care homes the “market position is undoubtedly hardening – increasing the pace of home closures”.

The CQC’s anxieties echo those voiced with increasing urgency in recent years by old people’s charities such as Age UK, the Local Government Association, health thinktanks and MPs that deep cuts to town hall budgets since 2011 have led to a major deterioration in social care at the same time as demand for it was increasing.

The CQC document, called “adult social care market insight” and based on data received from 39 major providers, states that: “This is a local authority-funded service user problem. Notwithstanding recent fee increases, the historic level of underfunding remains and in some cases has probably increased as a result of [the] national living wage.”

On the fees that councils pay providers either to care for individuals in a home or to help meet their basic needs while they are still living in their own home, it says: “Fees – At what point will the ongoing focus on fees adversely impact the quality of service being purchased?”

The CQC also warns that businesses have been left out of pocket by having to pay staff more because of the national living wage. It adds: “NLW – Provider sentiment suggests fee increases have generally not covered the cost of NLW. This position is unsustainable.”

It is also worried that the same pressures could push providers of domiciliary care to the wall. “Provider exit and large-scale contract handbacks demonstrate the fragility of this market. At what point can the replacement providers only make the returns work by compromising on the quality of care?” the briefing paper asks.

Barbara Keeley, Labour’s shadow minister for social care, said: “These figures are an alarming reminder of the desperate state of care services in this country. Despite all the spin from ministers, the Tories have left social care on the brink of collapse, with thousands of people’s care at risk as a result. It’s not enough to turn a blind eye to this crisis. We need ministers to step up and guarantee that they will properly fund care services. Anything less will be a betrayal to the most vulnerable in our society.”

Norman Lamb MP, a Liberal Democrat former health minister in the coalition government, urged ministers to prop up social care before the system collapses. “This briefing confirms that the care system is teetering on the brink of collapse. The government has known this for some considerable time yet still they refuse to act. The whole system is now living on borrowed time as more and more providers contemplate leaving publicly funded care and face going out of business because the sums don’t add up,” he told the Guardian.

“The real scandal is that we are rapidly moving to a position where you will be able to get great care if you can afford to pay privately – but if you can’t you will be left with nothing or substandard care. That situation is intolerable and a stain on our country. It would be grossly negligent and morally wrong for the government not to act now. There is an urgent need for additional emergency funding.”

English care home closures are leaving vulnerable people at risk, says watchdog

A&Es are closing and doctors are leaving. It should be Jeremy Hunt who goes | The Secret Doctor

Getting ready for work this week, as I grabbed my stethoscope and NHS badge, I caught a radio discussion on the latest crisis in accident and emergency wards and all I could do was shrug in resignation. A&E departments are having to close their doors because of the lack of correctly trained staff required to safely run their departments, with Chorley A&E doing so in April and Grantham looking set to shut at night due to staff shortages.

Related: Hospital A&E wards ‘in crisis over shortage of emergency doctors’

Six years ago, when I started my career as an A&E doctor, departments had plans in place to cope with extreme pressures. If a department became so busy that it was deemed “unsafe” by senior A&E staff, they would request a “divert”, where ambulances would be redirected to other nearby A&E departments until the workload had been eased. Now there is nowhere to divert to since everywhere is in exactly the same position. So when they get too unsafe they have no choice but to turn people away.

This is not because too many people are becoming acutely unwell and arriving en masse to well stocked and staffed A&E departments. Departments are being forced to close their doors because they lack the manpower to cope. This is the result of long-term tactics at government level, aimed at changing the NHS as we know it by causing the erosion of both services and the morale of those who are on the frontline trying desperately to make it work.

After years of working through various A&E crises, with the backdrop of doom-monger headlines about the care we are providing, I am currently an emergency medicine doctor on respite. I have worked in some of the busiest A&Es in the country and now, for the sake of sanity and well-being, I am having a change. I just needed a breather, time to take stock, to have a life and to re-evaluate. So I am working on a rehabilitation ward, and while my patients recover, so do I. I am not here permanently – it’s a locum position in a rural area that is finding it a challenge to recruit staff. A situation replicated all over the country.

Jeremy Hunt has bulldozed NHS morale into the ground and yet his stampede continues

I have an A&E job lined up for later in the year, but I have been tactical about where. I am going to Wales. I can’t work in a place where Jeremy Hunt has jurisdiction to implicate his unethical plans. It will mean an upheaval of my personal life, maybe having to pay for two sets of accommodation to make it work and living in a different place to my husband. But these are decisions we are having to make to find ways to keep being A&E doctors. My morale is at an all-time low and I need to get it back to continue to do the job I love.

You have to psyche yourself up for every A&E shift, mentally and physically. Get your game face on, focus, blast through and take it as it hits you full force. Times that by 10 for a night shift or a weekend when chances are you won’t know your colleagues as they will be locums brought in to make up the shortfall.

Related: Jeremy Hunt has saved his own skin but let the NHS sink | Polly Toynbee

We are fed up of hearing about how overcrowded and understaffed hospitals are. The workforce pulls together and makes it work. Even the most senior emergency medicine doctor in the country, Clifford Mann, president of the Royal College of Emergency Medicine: after completing his duties in London, he gets on a train, back to his own A&E department in Somerset for a shift finishing late into the night. It’s gruelling work and only for the committed.

My A&E colleagues are finding alternatives all around me. Some have left for academia, some have left medicine and some have left the country. Working in A&E, with a severely unwell patient arriving in extremis does not just need someone with a medical degree certificate. It needs expertise, skill and experience. And a significant number of those who fit this brief are leaving. We should be worried.

Jeremy Hunt has bulldozed NHS morale into the ground and yet his stampede continues. For the sake of patients and staff, someone who really should be getting a new job is him. As Hunt stays in his role, implementing bullishly his unsafe plans, A&E doctors are leaving theirs in droves.

A&Es are closing and doctors are leaving. It should be Jeremy Hunt who goes | The Secret Doctor

We are failing our frightened young children, leaving them with no a single to speak to| Rhiannon Lucy Cosslett

‘One in seven councils in England have been deemed by Ofsted to be failing vulnerable youngsters.’ Photograph: Alamy

What do you do if, aged twelve, you discover your self feeling hopeless and terrified of the planet around you? To whom do you flip? Melvyn Bragg has uncovered that his struggle with depression started at this age. “I had clinical depression but I did not know who to speak to,” he explained. “I never think anybody who has not been through depression is aware of what it truly is like to be frightened out of your thoughts each and every day from the second you wake up to the moment you go to rest.”

A kid with such feelings is clearly in need of urgent support from grownups, but for many, all these years soon after Bragg 1st struggled, help is still not forthcoming. These who operate with youngsters know this, and have been calling urgently for an overhaul of psychological overall health providers. The charity Children Business has launched a campaign referred to as “See the little one. Change the program”, supported by some of Britain’s foremost children’s authors – they are shocked that a single in 7 councils in England have been deemed by Ofsted to be failing vulnerable children. The mental health charity Young Minds is also campaigning, following a freedom of data request that revealed sweeping freezes and cuts to mental overall health service budgets for children and youngsters.

Voices are rising, but whether politicians will pay attention is an additional matter. Children Business founder, Camila Batmanghelidjh, has explained vulnerable young children are “relegated to the bottom of the political pile”, and social staff describe getting unable to supply adequate assistance due to cuts. Childline stated that reviews in self-harm in 2013 had risen by 41% from 2012, even though reviews of suicidal ideas increased by 33%.

Media retailers are quick to blame social media for the deterioration in children’s mental health – an effortless, practical scapegoat. There has been a amount of broadly reported suicides of shockingly youthful children who had been bullied online, foremost to rampant speculation. But no matter what the perceived causes, we know that to leave a vulnerable kid unassisted can lead to the really worst of outcomes. If the youngster survives their formative many years with no appropriate help, they can be left to struggle with mental health issues all through adulthood.

Given the dearth of providers, youngsters and households come up with other coping mechanisms. Lately, whilst getting a clear-out, I came across a small yellow box inside of which have been five worry dolls. Originating in Guatemala, be concerned dolls are vessels for a child’s nervousness – the child talks to them, tells them their fears, then spots them below their pillow. It struck me that I had spent my childhood surrounding myself with talismans in an energy to fight the reality I was scared and anxious all the time. There had been dream catchers to cease the nightmares, comfort blankets cuddled way previous the acceptable age, a present of worry beads (there was a lot of fear) in an try to get me to quit selecting at my skin compulsively until finally it bled.

Twelve was the worst year. My mother and father split up, I was being viciously bullied, and it was turning into clear that my brother, then 6, was so severely disabled he would never ever lead a normal daily life. My mum tried several times to get me counselling, and even though our household was acknowledged to social providers the waiting listing was limitless. I’m most likely nevertheless on it.

I resorted to books, angry music and writing horrible poetry Melvyn Bragg buried himself in schoolwork. Other folks use medication or alcohol. None of these is adequate. In hindsight, I realise I talked a lot more to people fear dolls than I ever did to an grownup, and that is what it all boils down to. The country’s grownups are failing kids – children far worse off than I ever was – and unless we do one thing now, we will proceed to allow them down.

We are failing our frightened young children, leaving them with no a single to speak to| Rhiannon Lucy Cosslett

False economies are leaving the mentally sick vulnerable

Young individuals are not receiving the support companies they want. Photograph: Alamy

Mental overall health solutions are dealing with critical monetary pressures. From hospitals to local community care, from children’s solutions to people for adults, budgets for mental health help are getting reduce across the nation. And this is getting an impact on a range of solutions, particularly these that support folks to stay nicely and to recover their lives.

In 2010-eleven, the final yr for which we have dependable investing data, funding for grownup mental wellness services fell in true terms for the initial time in a decade. Freedom of info requests given that then have unearthed proof of additional cuts in a lot of areas the two for adults’ and children’s mental wellness solutions. In some regions, this signifies specialist community teams are being “merged” into generic providers. In other people, help is restricted to people with the most urgent needs although value-efficient early interventions like college and parenting programmes are scaled back. In such circumstances, quick-term savings to stability the books could end up costing the public purse significantly a lot more as people’s demands escalate and become a lot more complicated.

The NHS is now committed via its mandate from the government to perform in the direction of putting mental well being on a par with physical overall health. At existing we are a long way from achieving this. Mental unwell well being accounts for a quarter of all sickness in the Uk however it will get just 13% of NHS funding. And expert children’s psychological well being solutions get less than one%.

Long-term under-investment and quick-phrase cuts combine to place providers beneath critical strain. From the continued use of police stations as “locations of security” for folks in a mental wellness emergency to inappropriate admission of young children to adult psychiatric wards, these pressures influence some of the most vulnerable folks at the most difficult times in their lives.

It is vital that all mental well being providers, be they publicly or privately presented, are needed to meet the exact same large requirements we have of other NHS-funded hospitals and clinics. Neighborhood health and care commissioners want to assure themselves they know the demands of their local populations and that they are capable to meet them making use of providers that meet the standards of the quality regulator, the Care Good quality Commission. This is particularly the situation for the steadily increasing amount of individuals who are detained in hospital under the Psychological Well being Act, whose rights and dignity need to never be compromised.

Our children’s psychological wellness can’t be left to opportunity. One particular little one in 10 has a psychological well being difficulty. 3 quarters never receive any therapy or support. Nevertheless youngsters with poor mental health go on to become grownups with bad mental well being. And these with the most typical childhood mental health dilemma, carry out disorder, can search forward to substantially harder, poorer and shorter lives than their classmates. We want to take action now to produce a entire system of mental wellness assistance for children that boosts resilience and protects people who turn into unwell.

We want colleges to turn out to be vigilant for the indications of psychological ill overall health, supporting healthy little one growth, tackling bullying and teaching emotional wellbeing. We need to have to invest, as well, in the psychological health of mothers and fathers, supporting these whose children are most at risk to produce constructive parenting strategies.

We need to have to hold building on the government’s initiative to boost accessibility to psychological therapies for kids and younger people (and their dad and mom) to ensure that all who could advantage from verified expense-successful treatments are presented timely assistance from engaging and highly experienced staff.

And we need to have to make sure that care is there in a crisis for kids who are at their most vulnerable. All providers that operate with young children and families must be vigilant for the indications of tension that lead to a crisis. And in each spot of the nation the NHS need to have to supply appropriate beds for younger men and women who require emergency psychological health care, diversion companies at the point of arrest for youthful men and women who get into difficulty with the police, and on-get in touch with help and tips in A&ampE units from liaison psychiatry teams.

False economies are leaving the mentally sick vulnerable

Victor Dzau Leaving Duke To Head The Institute Of Medicine

Really don’t miss this critical update: Newly Elected President Of Institute of Medicine Is On The Pepsico Board Of Directors 

Cardiologist Victor Dzau will depart his positions as the chancellor for health affairs at Duke University and the CEO of the Duke University Wellness Method to turn into the next president of the Institute of Medication. He will replace Harvey Fineberg, who has been the IOM president for the last 12 years.

“I am humbled and honored to be picked to lead the IOM at a time of unprecedented opportunities and issues in health, well being care, and biomedical sciences,” said Dzau in a statement from the IOM. “Harvey Fineberg has been an outstanding leader of the IOM, and I am committed to creating on his outstanding perform and advancing the impact of the IOM on the nation and globally.”

Before moving to Duke almost a decade in the past Dzau was the chair of the department of medicine and director of analysis at Brigham and Women’s Hospital and the Hersey Professor of the Concept and Practice of Physic (Medicine) at Harvard Medical College. Prior to that he had been the chair of the department of medicine at Stanford University. In his job as a researcher Dzau played a essential role in comprehending the renin-angiotensin-aldosterone program.

Robert Califf, director of the Duke Translational Medication Institute, sent the following comment:

This appointment is a genuine honor for Victor and for Duke. In the course of his tenure, the instituiton has grown into an academic wellness and science method, created numerous scientific contributions and thrived financially.

Dzau was initial elected to the IOM in 1998. He will get started his 6-12 months term as president on July 1.

Victor Dzau Leaving Duke To Head The Institute Of Medicine