STPs risk making mental health worse rather than better, warns Lamb

If the NHS isn’t careful, sustainability and transformation plans (STPs) will make the disparity between mental and physical health worse rather than better, former care minister and Lib Dem MP Norman Lamb warned.

Speaking at a mental health-focused session during this year’s NHS Confederation annual conference, Lamb said the STPs pose a threat to the health system if they do not address mental health on a preventative basis, tightly integrated with physical health needs.

“I don’t want to get across the idea that the STP inevitably marginalises mental health; it’s just what I hear from around the country that in too many cases, that’s what is happening,” he said.

“I think we’ve managed quite spectacularly, really, to neglect the physical health needs of people with mental health needs, and to neglect the mental health needs of people with physical health problems. It’s a remarkable achievement.”

Reminiscing on his time as a care minister, Lamb said NHS leaders and the health secretary used to meet every Monday morning to go over performance spreadsheets of every hospital in England, checking their data against the four-hour waiting time target, the cancer waiting time standard, and the 18-week referral to treatment standard.

“And for an hour and a half, they poured over the performance of each individual hospital. This obsession with those waiting time standards in physical health just drives the whole system,” he added. “When you have nothing on the mental health side, it drives where the money goes; it’s very clear.

“And when you combine that then with paying by results or paying for activity, which sucks money into acute hospitals, then this just reinforces and embeds an inbuilt discrimination against mental health.

“Included in this challenge to the system, I would include the STPs – because I think in much of the country, mental health is completely marginalised, and if we’re not careful, this is going to make the disadvantage worse rather than better.”

Chairing the mental health debate was Dr Phil Moore, chair of the Mental Health Network at NHS Clinical Commissioners (NHSCC) and deputy clinical chair of NHS Kingston CCG.

Moore agreed that he personally “has a problem with the STPs”, adding: “My view is that usually, they’re not transformational, they’re not sustainable and they’re questionably a plan. I think we have to push this – I don’t think that’s what they should be. I think often what’s being done is we’re having to say ‘how do we save the money that we’ve got to save in the next year?’ rather than say ‘how do we deliver real quality of esteem across all conditions, for all people, over the next five to 10 years?’

“But the thing I wanted to show you is, mental health interacts with everything. It’s embedded in everything, and therefore we’ve got to work with all those other groups of people to make sure mental health is reflected in that plan in an embedded way.”

But Dr Giles Berrisford, NHS England’s national clinical director for perinatal mental health, argued that the STPs “area a really exciting opportunity” – yet acknowledged that it necessitates a “huge cultural change”.

“We’re actually asking that clinicians work in a very different way from how they worked before, as well as the commissioners, and what we’re saying is that we don’t want this siloed working – we actually want mental health to be completely integrated with everything that happens in physical health care,” Berrisford said.

“We know how much money this can save, but it only will work if we fundamentally change the way that we practice: every time we see a patient with diabetes, we should be thinking about a mental health problem; every time we see someone with a cardiac problem, we should be thinking about their mental health problems, etc. And vice versa.”

Asked by Moore if the problem with asking providers to implement STPs in a year means plans tend to focus on saving money this year rather than long-term transformational change, Berrisford said: “I think it’s a big ask, isn’t it. It’s a very short space of time, when we know cultural change actually takes a very long period of time.”

The STPs were one of the biggest subject at this year’s conference, mentioned in nearly every speech and debate session. Even health secretary Jeremy Hunt touched on the subject during the Q&A that followed his speech, during which he admitted that “there is a way we can get this wrong and a way we can get this right”.

He also said STPs are “very simply” about reducing hospital bed days per thousand population and reducing emergency admissions, with successful plans likely to be those that have rigorous data in place.

Read about the conference and STPs in the upcoming July/August edition of NHE.


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