Dear Colleagues
Here in the Peak District, it is still raining. Since my Summer Newsletter, we have a new Labour government. If not, as Ian Dury and the Blockheads sang, yet a reason to be cheerful[1], we are told by our new Prime Minister, Sir Keir Starmer, there is no money, but there is hope:
“… because if we get this right, people can look back and say, this was the generation that took the NHS from the worst crisis in its history, got it back on its feet, and made it fit for the future”
(Prime Minister’s speech on the NHS, 12th September 2024).
“Reform or Die”, says the Prime Minister to the NHS, apparently without irony, given what is happening to the Tories. (He stole this catchphrase from me, in fact. I have been saying this to psychoanalysis and its institutions for years!). There were two new pieces of legislation promised in the government’s Kings Speech 2024 in July, namely, a new mental health act that will seek to deliver on Professor Sir Simon Wessely’s review back in 2018; and a draft bill to ban conversion therapy that also delivers what the Tories promised but didn’t.
But the starting gun for what the new government intends to do with the NHS was fired by Lord Darzi’s report. All the above deserve more detailed discussion in a future newsletter but for now I will just make a few brief points, and some predictions for what “reform or die” will and will not mean under a new Labour government that is yet to promise ‘cheerfulness’.
- To suggest the NHS might somehow be allowed to ‘die’ is, obviously, utter nonsense. But what it signals is ruling out significant additional investment as the ‘easy answer’ for this budget. Nevertheless, it is an iron law that Labour will end up spending more.
- The LibDems are, in effect. the official opposition party now that the Conservatives are entering the final stage of their own ‘Reform or Die’ melodrama. Astutely, for a change, the LibDems have positioned themselves as the party of NHS and social care investment – calling for an extra £4.8bn to fund NHS running costs and capital spend.
One interesting new development here is the election of Layla Moran as the Chair of the cross-party Health and Select Committee. Could we finally be about to make cross-party progress on reform of social care? That is more a guess than a prediction. - Despite the fact ring-fenced funding to expand mental health has proven to be what the Treasury fears for the whole of NHS funding – a bottomless pit with no return – mental health will be a beneficiary of its own failure to reform. Why? For two unavoidable reasons – which Starmer’s speech on the NHS almost entirely ducked:
a) Sitting at the top of Dr Adrian James’ in-tray (he is our new National Clinical Lead for Mental Health and Neurodiversity), once again, is public safety. The system failed Valdo Calocane, who was suffering from paranoid schizophrenia for three years, twice discharged from hospital, but clearly very unwell, until he tragically killed three people: two young Nottingham University students, Grace O’Malley-Kumar and Barnaby Webber, starting out on adulthood with everything to look forward to, and Ian Coates, a 65-year-old school caretaker, on the verge of enjoying retirement with his family and grandchildren. These deaths were avoidable, as was the death of Jonathan Zito, more than thirty years ago, attacked and killed on the platform of Finsbury Park tube station, by Christopher Clunis, who was equally failed by the mental health system, and who died recently in 2021. Darzi states – or rather understates, conscious of the potential for the media to ignite a moral panic: “there are also concerns about the rigor with which patients who have serious mental illnesses are followed up in the community and how effectively risk is managed.” (p. 47).
For those who have not seen it, the moving Panorama programme[2] shows how the family of Calocane, his mother and brother, were failed by our system, just as much as the families of the victims. It is a horrible irony, however, that mental health is given parity only whenever public safety appears threatened. Will a new mental health act prevent future such tragedies? We wait to see.
b) In August, the Times columnist and former Tory MP, Matthew Parris, continued his polemical attack on mental health: Mental health industry is cheating the public (August 19th). He only needed one statistic: there are 9 million people out of work. Starmer cannot avoid this fact – spending on welfare benefits now amounts to spending on the whole of health and social care. So how come the more we spend, the sicker we get? Lord Darzi points to the 2.8M people on long-term sickness benefits, stating “it is our mental health that appears to have deteriorated most significantly in the past decade” (p. 19). Cheating or not, mental health sits at the intersection of rising public spending.
This might seem an odd reason for us to be cheerful. But the fact is that talking therapies are now seen as indispensable to solving the intractable problem of incapacity, and why Darzi singles out, amongst the litany of things that are broken (345,000 patients on waiting lists for mental health treatment for more than a year!), “a notable success in the Improving Access to Psychological Therapies programme” (p. 44). In other words, expanding the NHS Talking Therapies workforce will continue under Labour. Promoting ‘evidence-based psychoanalysis’, getting ourselves recommended now by NICE, has been our central reform mission within APPPS. In that sense, if what Lord Darzi says carries any weight, we have been ahead of the game!
Before the sun sets on the previous era of mental health policy, then – and who could have guessed that we would be gifted Nadine Dorries as our Minister for Mental Health by Prime Minister Boris Johnson? – I will leave you with the most cheerful part of Lord Darzi’s review:
“Accountability is important. But too many people holding people to account, rather than doing the job, can be counterproductive … Taken together, there are nearly 80 people employed in regulatory and headquarters functions for each NHS provider trust. And there are a multitude of other organisations that produce guidance, recommendations and standards. NHS organisations should focus on the patients and communities they serve, but the sheer number of national organisations that can ‘instruct’ the NHS encourages too many to look upwards rather than to those they are there to serve …” (pp. 10-11).
And with one sentence, Darzi will have earned the lifetime gratitude of many NHS clinicians: “The Care Quality Commission – which inspects the NHS – is not fit for purpose” (p. 11).
The sun sets behind the hills of the Longdendale valley, as the “sick joke” tenure of Nadine Dorries as our Minister for mental health fades into a distant memory …
[1] Another great pop singer, David Byrne, has founded a non-profit organisation that is dedicated to finding reasons to be cheerful. For those of you living in the Big Smoke, for example, they recommend (a Londoner’s version of) one of the reasons that we moved (back) to the Peak District: “walking therapy”. https://reasonstobecheerful.world/london-walk-club-mental-health/
One of the counselling researchers that I most admire, Professor John McLeod, has published a study on how therapists can integrate talking and walking with clients. Is this something we could also explore? https://insight.cumbria.ac.uk/id/eprint/2072/1/Revell_ExperiencesOfTherapistsWhoIntegrate.pdf
[2] https://www.bbc.co.uk/iplayer/episode/m0021zn9/panorama-the-nottingham-attacks-a-search-for-answers#xtor=CS8-1000-%5BEditorialPromo_Box%5D-%5BNewsEditorial_Promo%5D-%5BNewsEditorial_Promo%5D-%5BPS_IPLAYER~N~m0021zn9~P_PanoramaNottinghamAttacks%5D
It should be noted that Panorama did not speak with the families of the three people who were killed.
Jeremy Clarke, Chair
