Yesterday I attended the 'Healthwatch' annual event which was held in 'Off The Beaten Track', in Shrewsbury between 1:30 & 4:30. Present were; Carole Hall Chair of Healthwatch Shropshire, Lee Chapman from Shropshire Council, Jo Banks from The Shrewsbury and Telford Hospital NHS Trust, Alison Blofield from South Staffordshire & Shropshire Healthcare NHS Trust, Tina Ward from Shropshire Community Health NHS Trust (specifically CAHMS), and Jim Hawkins from BBC Radio Shropshire.
The meeting opened with each member of the panel giving a 'round up' of what their service had achieved over the last 12 months, and where they were heading over the next 12 months. Each mini presentation was extremely informative, and all acknowledged that they were undergoing massive restructuring in order to reduce costs, and increase efficiencies. After the presentations members of the public were given the opportunity to speak to smaller organisations who are carrying out research on behalf of Healthwatch before returning to their seats, and were then invited to ask questions of the panel.
The Q&A session is where things became both interesting, and in some incidences a little disappointing. The panel were asked about how they are going to ensure communities are supported, particularly those which are increasingly rural, and elderly. Whether CAMHS accepted that their staff members did not always have the best 'bedside manner'. How 'bed blocking' was likely to be overcome, especially with winter just around the corner. I am pleased to say that these questions were answered honestly, and each member admitted that they have learnt from past mistakes, and are working towards a better future.
Unfortunately members from Telford and Wrekin Council, and the Clinical Commissioning Group were not invited to the event. This I believe was a mistake. Particularly when a lady asked a question about the changes to the social care arrangements in Telford, or other questions which were answered with a common theme of 'cuts', or 'no commissions'.
Lastly one thing which really hit home, and unfortunately sums up many peoples experiences of accessing support for mental health difficulties is described below:
A lady in the audience very bravely explained her particular experience of her local service. Presenting with Anxiety, and Panic Attack Disorder at her local GP surgery, and was instructed to carry out her own referral to psychological therapy. She was initially interviewed over the phone to assess her level of need, and two weeks later she was contacted again to find out if she still wanted support. She did, and she started treatment in a group CBT session a few weeks later, with panic attack treatment to follow on from the CBT. The sessions lasted for 6 weeks, and her follow up panic attack therapy was cancelled. She quite rightly asked the panel whether they believed this was acceptable. Unfortunately they believed it was, and we were informed that this follows the guidelines laid out by NICE (National Institute for Health & Care Excellence). I had initially decided that I was not going to ask any questions, but the ladies difficulties, and their answer, stirred up a very emotional reaction and up went my hand. I questioned their 'acceptance' on two separate fronts: 1) how is it acceptable for someone with anxiety to have to contact someone to refer themselves, and 2) how is 6 sessions of CBT acceptable when randomised controlled trials suggest 8 sessions should be the minimum. Again we were told that that is acceptable specifically; people have to make their own referrals because they are more likely to attend, and 6 group sessions are within the guidelines.
I have however since gone onto the NICE website and have checked the 'CBT pathway', and this suggests that 7 sessions are the mimumum... I have also since spoken to non-mental health colleagues and they have confirmed my suspicion that those with physical difficulties do not make their own referrals to specialists - this is completed by the GP...
It is saddening to realise, that while the whole event was trying to raise awareness, and parity between mental and physical health difficulties it appears that this is no more than a smoke screen. On more than one occasion panel members said they were working towards a 'needs based system', but when challenged on this we were told that the service received is correct as it follows the guidelines. We can never change the system if we continue to 'play by the rules'. A recent report suggests that CBT is not effective - I can say with my hand on my heart CBT is a fantastic tool, and highly effective when - and only when - delivered over an appropriate number of sessions, and in the correct manner. If Shropshire wants to be at the forefront of delivering mental and physical health parity then it needs to stop hiding behind the guidelines and commissions, and delivering the services based upon individualistic need.