Schools cutting mental health services to plug funding gaps, warn MPs

Cash-strapped schools are cutting mental health services such as counsellors and pastoral provision as they try to cover funding gaps, two influential groups of MPs have said.

The health and education select committees joined forces for the inquiry, which called on the government to look at the impact of budget cuts on mental health services for children.

Services to support wellbeing are “the first thing to go” when budgets are under pressure, the inquiry heard. The government announced £1.25bn in additional funding for young people’s mental health in 2015, but almost 80% of primary school headteachers responding to a survey said a lack of money prevented them from providing mental health support in schools such as counsellors.

The MPs wrote: “We know that more than half of all mental ill health starts before the age of 15 and it is therefore a false economy to cut services for children and young people.”

There are “unacceptable” variations in the level of access children have to mental health services because some parts of the country lack strong links between schools and mental health providers, the inquiry found.

The education minister, Edward Timpson, told the inquiry a pilot scheme increasing collaboration between schools and mental health services was being expanded to 1,200 more schools. The MPs called on the government to “commit resources to establish partnerships with mental health services across all schools and colleges”.

The issue of social media was of particular concern for the inquiry, which found that it could help and harm young people’s mental wellbeing. Witnesses told the inquiry that young people tended to contact support services such as Childline on the internet rather than by phone, and social media could help connect young people, especially those with rare conditions, to supportive communities. But cyberbullying and sleep deprivation due to late-night screen use concerned witnesses to the inquiry.

Schools should teach pupils how to make sensible decisions around social media, the inquiry determined, as part of equipping them for the modern world. But they should also teach parents about social media, especially about its impact and that of screen time more generally on children’s sleep.

“Parents have a key role to play in limiting screen time, reducing sleep deprivation and preventing exposure to harmful online activity,” the MPs wrote.

Ofsted inspections could play a key role in raising the importance of mental health and wellbeing in schools, the MPs said, but witnesses said thewatchdog was too focused on academic achievement, with only one-third of Ofsted reports specifically referring to the mental health and wellbeing of pupils. The report called on Ofsted’s chief inspector, Amanda Spielman, who took over in January, to look at ways of making mental wellbeing more prominent “as a matter of priority”.

An Ofsted spokeswoman said: “Personal development, behaviour and welfare of pupils is one of our key judgments in school inspections and is graded in every section five inspection. As part of this, inspectors already evaluate the experience and wellbeing of particular individuals and groups of pupils, including those with mental health needs.

“Ofsted has also started discussions with the CQC [Care Quality Commission] about some future joint survey work in relation to the government’s proposals to transform mental health support for children and young people.”

Sarah Brennan, the chief executive of mental health charity YoungMinds, said: “We are facing a mental health crisis in our classrooms and it is vital that the next government rebalances the education system to ensure that the wellbeing of children is as important as academic achievement in schools.

“Many schools are doing excellent work to promote good mental health. But funding constraints, coupled with a lack of prominence given to wellbeing in the Ofsted inspection framework, mean that when schools face tough decisions about which services to cut, they are under pressure to prioritise other areas.

“At a time when rates of self-harm are rising sharply, and when specialist mental health services are overwhelmed, this cannot be right.”

Norman Lamb, the Liberal Democrat MP and mental health campaigner, said children and young people were being “shortchanged”.

“It is scandalous that much of the additional funding for children’s mental health secured by the Liberal Democrats in 2015 is not getting through,” he said.

“Until the government commits to providing more long-term funding for health and social care, this mental health crisis will not be tackled.”

Schools cutting mental health services to plug funding gaps, warn MPs

Police cannot continue to fill gaps left by mental health cuts, report says

Police cannot continue to pick up the slack for cuts in other public services, especially the shortage in mental health provision, Her Majesty’s chief inspector of constabulary has warned.

In an annual state of policing report, Sir Tom Winsor highlights a “modern tsunami of online fraud” and increased police awareness of crimes against the elderly and child sexual exploitation as among the increasing daily pressures facing officers.

“The police are considered to be the service of last resort. In some areas, particularly where people with mental health problems need urgent help, the police are increasingly being used as the service of first resort. This is wrong,” says the chief inspector.

Winsor, who was appointed by Theresa May when she was home secretary, says the failures of other public services, especially in respect of children’s and adolescent mental health, too often leave the police to fill the gaps long after the chances of effective intervention have been lost.

His annual report identifies 18 of the 43 forces where the need for improvement has been highlighted in at least one of HMIC’s inspection themes of effectiveness, efficiency and legitimacy. Only one, Bedfordshire, was rated as “inadequate” for one category.

Winsor says that in many cases, police leaders are “still too sluggish” to ensure their plans are sound to the new demands on their forces. He says for too long a culture of insularity, isolationism and protectionism has prevented chief constables from making the most effective use of new technology: “The blinkers have to come off,” he says.

Winsor also warns that the police are behind many other organisations in their use of technology, saying it should be giving them unprecedented ability to exchange, retrieve and analyse intelligence.

“The provision of mental healthcare has reached such a state of severity that police are often being used to fill the gaps that other agencies cannot. This is an unacceptable drain on police resources and it is a profoundly improper way to treat vulnerable people who need care and help,” he says.

“The obligation of the police is to prevent crime. This is not only because this makes society safer – both in reality and in perception – but also because it is far cheaper to prevent a crime than it is to investigate and arrest the offender after the event. The same is true of mental ill health, which is not a crime.

“It is an old adage that an ounce of prevention is better than a pound of cure, and this is particularly true when the cure fails and an emergency intervention is required to protect the safety of an individual in distress and, often, people nearby.

“By the time depression or some other mental disorder has been allowed to advance to the point that someone is contemplating suicide, or engaging in very hazardous behaviour, many opportunities to intervene will have been missed by many organisations.

“When that intervention takes place on a motorway bridge or railway line, or when someone is holding a weapon in a state of high distress, the expense to all concerned is far higher than it should be. The principal sufferer is the person who is ill, especially when it is realised that his or her suffering could have been much less or even avoided altogether,” concludes Winsor.

Police cannot continue to fill gaps left by mental health cuts, report says

"Night cover is almost always short-staffed. It’s terrifying": doctors on rota gaps

The Guardian has discovered that dozens of hospitals are struggling to recruit doctors to fill gaps in their rota. They are sending out urgent emails and text messages, often hours before a shift needs covering, asking for medics to come in. They are also offering increased hourly rates – of up to £95 an hour – in an attempt to encourage staff to cover.

But, despite this, doctors say many shifts are going unfilled, putting patient safety at risk. Doctors are being spread too thinly, they say, often having to leave other departments to offer help where its needed. They are also missing out on training due to staff shortages and being asked to work long hours back to back as a result.

We heard from dozens of NHS doctors about this. Here are a selection of responses.

Michael, a trainee surgeon: ‘We often have to cancel our emergency clinic because of a lack of staff’

We’ve had a rota gap for well over half a year now in my department. It has a knock-on effect. First, it means that my colleagues and I are constantly asked to cover extra 12-hour on-call shifts, despite already working long hours. Second, it affects services. We often have to cancel our emergency clinic because of lack of staff. But most importantly as a trainee surgeon in the past, I have not been able to attend theatre sessions to get training. This is worrying because when I am asked to perform certain life-saving procedure I may not be confident doing them on my own.

All junior doctors needs training to progress. When there are long-term rota gaps, this falls by the wayside and covering the services become the priority. Without adequate training, the service we provide will inevitably get worse as years go on.

It’s terrifying: you’re the most junior doctor in the hospital and you’re responsible for so many people

Brian

Jack, A&E locum: ‘One hospital had just two doctors for their A&E department – they called an emergency meeting’

I am working as a junior doctor in A&E. Since the tax rule changes (known as IR35) the gaps in A&E rotas in hospitals in the Midlands have got bigger. They were present before but not as visible.

One hospital I was in had only two doctors for a large A&E department overnight. They had to call emergency meetings and take doctors from other areas of the hospital. It meant patients needing treatment had to wait longer. Doctors stayed on for hours to try to bridge the gap. I stayed for as long as I could but in the end I was so tired I wasn’t safe. On the drive home I rolled the windows down and played music loudly just to try and stay on the road.

I work in three hospitals across the Midlands and the majority of the time there is not a full rota of doctors. When I arrive in the morning for handover, I have been told someone needs to go home and come back for the night shift as there isn’t enough cover. One consultant who was on call for 72 hours was in the hospital for the majority of that time trying to see patients and find more staff. A&E is the worst hit. This is because it has the lowest percentage of filled posts in training schemes and is most heavily reliant on locums. Its training schemes are underfilled because it has difficult hours, difficult time pressures, and it is one of only two ways into the NHS system. The GPs close, but the emergency department never closes so it’s always on the frontline.

Brian, a foundation doctor: ‘It’s terrifying when staffing gaps leave you responsible for loads of people’

Night cover is almost permanently short-staffed. It’s terrifying: you’re the most junior doctor in the hospital and you’re responsible for so many people. I am also seeing the effects on the more senior members of the team. They are sometimes expected to be in two or three places at once (somehow simultaneously covering the ward and clinic). I don’t understand how the problem seems to be taken so lightly. It’s a threat to patient safety.

Tensions run high as ridiculous last-minute rota changes result in people getting angry that a staff member they were planning on using has now been seconded elsewhere. The government capped rates for locums, the doctors who cover when staff members are ill or on holiday. Given that we sometimes already do 70-hour weeks (yes, that’s legal too somehow) our free time is very precious. The extra work is heavy enough as it’s short staffed, so the pain and risk just isn’t worth what we’re being offered.

Mandy, middle grade doctor: ‘Remaining staff take up the slack – teaching falls away and morale drops as a result’

Every rota has rota gaps. Obstetrics and gynaecology requires seven registrars; we have 1.8 doctors at our hospital. In intensive care, they are at least six registrars short. Every day we receive messages requesting staff to work extra shifts. Today working on renal the issue wasn’t a rota gap with doctors but with nurses: patients who needed dialysis couldn’t receive it due to not enough nurses to care for them on it.

The issue is the remaining staff take up the slack and go above and beyond every day to ensure patients remain safe. This makes our lives fairly miserable: teaching falls away, morale drops and tensions rise.

‘Rota gaps are ubiquitous, a daily occurrence. As a junior doctor you become desensitised to them.’ Photograph: Peter Byrne/PA

Al, a core medical trainee: ‘Not a day goes by where we don’t get emailed about a need for cover’

Rota gaps are ubiquitous, a daily occurrence. As a junior doctor, you become desensitised to them, which is a scary thing to say. Not a day goes by where we don’t get emailed about a need for cover. Sometimes phone calls are made to all the employed staff asking of they can work an evening shift or a weekend shift.

You become desensitised to gaps in the rota, which is a scary thing to say

Al

If this fails, then the vacancy is put out to the preferred locum agency dealing with the hospital who then have thousands of doctors at hand. Often these medics have not worked at the hospital before and although they agree to step in, they are nowhere near as efficient or diligent as the staff doctors.

My trust are also employing long-term locums to fill these gaps in the rota. This a positive step as these doctors become well acquainted with the hospital policies and procedures

Iman, consultant physician: ‘Highly-skilled surgeons are sometimes pulled out of theatre’

I have been given the thankless task of coordinating the junior doctor rota, a role which no one wants, but is almost forced on you. The reason people are reluctant to take it on is the almost daily severe shortage of staff which means that you are firefighting all the time.

I have rota gaps more often than not. The number of junior doctors allocated to the hospital by deanery is less than what we are supposed to have. We try to cover the rest by recruiting locums, which is often unsuccessful partly due to locum pay caps.

The remaining juniors are often under a lot of stress due to manpower shortages and consequently the sickness rates are high. On several occasions some of the wards have no juniors at all, which then requires senior staff to act down. This is a waste of resources as it means a highly-skilled surgeons or physicians are pulled out of the operating theatre or clinic to do these jobs.

On several occasions some of the wards have no juniors at all, which then requires senior staff to act down.

Iman

It’s hugely concerning. I have raised these repeatedly with the trust board, but they are powerless to do anything. We do not have enough junior doctors full stop. Deanery cannot recruit enough in specialities such as medicine and A&E due to onerous on-calls. The 1% pay caps have eroded pay and the imposition of contract has resulted in many juniors leaving the country, depleting the pool further.

Tom, general surgery registrar: ‘Increasing rota gaps is one of the factors driving doctors out of the profession’

Most hospital doctors are extremely worried about the impact of rota gaps on patient care. Clearly, having doctors who have stayed on for up to an additional 12 hours beyond a normal 12-hour shift means they are far too tired to make reliable clinical decisions, especially for the sickest emergency patients. Beyond fatigue, the routine reassignment of doctors from their ward duties to the emergency department leaves vast numbers of patients with too few doctors to look after them. It is often the most junior doctors who are left caring for large numbers of vulnerable post-operative and/or elderly patients without quick recourse to or support from more experienced colleagues.

In the 10 years since I qualified, I have seen nothing but a relentless increase in the demands put upon hospital staff. Increasing rota gaps have compounded the pressure on staff and is one of the factors driving doctors out of the profession and into mental health problems.

• All names have been changed.

"Night cover is almost always short-staffed. It’s terrifying": doctors on rota gaps

NHS doctors: how are rota gaps affecting your hospital?

Doctors feel they are spread to thinly to provide good care to patients, a survey found last month. The poll of more than 2,100 members of the Royal College of Physicians found 84% had experienced staffing shortages across their team, while 82% believed the workforce was demoralised. Many believed patient safety has deteriorated over the 12 months.

It comes after The Royal College of Physicians annual census of British consultants showed the pressure NHS staff were under. Doctors who were polled said they worried there were not enough medics to keep patients safe. A quarter of those who responded expressed concern about rota gaps, when a hospital or department is unable to cover the working shift pattern due to a lack of staff.

Share your experiences

The Guardian wants your stories about this. How often do shifts go unfilled where you work? What pressure does this put on remaining staff members? Are some medical specialties more affected than others? Have you found yourself working long hours to fill gaps? Are you concerned that this is affecting patient safety?

Share your stories and experiences, anonymously if you prefer in our encrypted form, only the Guardian has access to your contributions. We will do our best to keep you anonymous.

NHS doctors: how are rota gaps affecting your hospital?

Warning above "shocking gaps" in mental overall health companies for new mothers

Dr Dan Poulter, a wellness minister, stated the government had ensured each trainee midwife would get instruction in perinatal psychological health. Photograph: Felix Clay

The NHS offers patchy and at instances dangerously inadequate care to ladies who suffer psychological overall health problems linked to possessing a infant, new research displays, prompting claims that it is neglecting mothers at risk of suicide.

Ladies in virtually half the Uk can’t achieve access to support and treatment method from expert teams to aid them cope with mental well being difficulties that develop while they are carrying their baby or in the very first yr following giving birth.

The Maternal Mental Overall health Alliance (MMHA), which collated the figures, said the lack of devoted providers was “an embarrassment for the NHS” and a trigger of alarm, given that, if left untreated, such difficulties could have devastating results.

“The figures are an embarrassment for the NHS. Pregnancy and the 1st postnatal yr are a vital time, with numerous pressures, demands and responsibilities, when girls and their families must obtain the greatest top quality care,” said Dr Alain Gregoire, chair of the alliance.

Despite the vital role of professional perinatal mental well being solutions, there are “shocking gaps in United kingdom maternal mental overall health companies” for the one particular in ten ladies who expertise postnatal depression or other childbirth-associated mental issues, the MMHA explained. It extra that suicide was 1 of the major brings about of death for girls during pregnancy and one 12 months soon after birth.

Making use of data provided in 2013 by members of the Royal School of Psychiatrists’s perinatal faculty, the MMHA located that 106 of the 237 clinical commissioning (CCG) regions in England and well being board areas in Scotland, Wales and Northern Ireland offered no such care at all. Just thirty of the 237 offer you what the alliance says is the highest degree of provision, all of which are in England, plus NHS Higher Glasgow and Clyde in Scotland. They all have the very best sort of professional community perinatal community psychological health team to help such ladies.

Female psychological health

More than 40% of England’s 211 CCGs have no professional group. The scenario is the same for about forty% of Scottish, 70% of Welsh and 80% of Northern Irish wellness boards. There is large variation: inside London, for illustration, seven of the 32 CCG areas provide the highest degree of provision but nine give none.

There is also a continual shortage across the United kingdom of mother and little one units, which admit women with critical mental health troubles late in their pregnancy or soon after possessing their child, and monitor how they are bonding with their infant.

The Royal School of Midwives explained each birthing unit across the United kingdom should have a dedicated, specially qualified midwife to help girls in this kind of situations.

Dr Dan Poulter, a wellness minister, said the coalition had ensured each and every trainee midwife would receive mandatory coaching in perinatal psychological overall health so that each maternity unit would have a professional member of personnel from 2017.

The Department of Health’s mandate to NHS England also calls for them to reduce the incidence and impact of postnatal depression via earlier diagnosis and better intervention and assistance, a DH spokesman extra.

“The NHS mandate also consists of an objective that each and every girl has a named midwife who is accountable for making certain she has personalised care all through pregnancy, childbirth and throughout the postnatal period. This will aid clinicians to determine perinatal psychological well being troubles as early as feasible and to give women the support they require,” he additional.

Warning above "shocking gaps" in mental overall health companies for new mothers

Hospital chiefs "ignoring midwives shortage rather than paying out to fill gaps"

The figures, compiled by BBC Radio 4’s Woman’s Hour, showed that 80 per cent nonetheless had vacancies in funded midwife positions. Even so, the rate was now at its lowest for three years.

Births in England have increased by a quarter in the previous decade, according to current statistics.

In the 99 trusts, there had been 561 vacancies at the flip of the 12 months, ranging from a 17.eight per cent vacancy price at West Hertfordshire Hospitals NHS Believe in to the entirely-staffed Hull and East Yorkshire Hospitals NHS Trust.

Cathy Warwick, the college chief executive, mentioned the figures on the delays in assessments have been “worrying”.

“Four in every single five NHS trusts say they have midwife vacancies, a scenario that we truly feel is obtaining worse, not better,” she explained. “This has to change.

“The stress on maternity units becomes worse when there is a combine of insufficient midwives to commence with. On top of this, midwifery vacancies are not getting filled.

“This is a recipe for disaster and can have a disastrous affect on staff morale, burnout and sickness prices, which only make a maternity services even much more short staffed.

“We hear from some heads of midwifery that trusts are not conducting suitable assessments of staffing specifications simply because they know they will not be in a position to afford to put into action the findings.

“So they bury their heads in the sand and stick with their out-of-date assessments that no longer bear relation to their requirements and the requirements of mothers and babies.

“Our evaluation is that we want close to four,800 a lot more midwives in England. The Government is escalating the amount of midwives, and that is welcome, but more wants to be carried out.”

Dr Dan Poulter, the health minister, explained: “The NHS is a secure spot to give birth, with ladies reporting high ranges of believe in and self confidence in staff.”

Hospital chiefs "ignoring midwives shortage rather than paying out to fill gaps"

Grey army of five million volunteers "plugging gaps in social care"

RVS spokesman Steve Smith stated: “Local authorities have lower back on social care in the final few years and we know that austerity is here for a couple of many years to come.

“When you add to that the reality that the number of in excess of-80s is going to rise from three million nowadays to eight million by 2030, there is going to be an increasing role for the voluntary sector to step in and plug the gaps.

“Older men and women are going to be an escalating component of that, by delivering meals on wheels, day centres or other providers that would have been offered by the welfare state in the past.”

Local authorities minimize paying on adult social care by two per cent in real terms between 2012 and 2013, according to the Wellness and Social Care Data Centre. Nevertheless the need to have for social care continues to rise sharply.

When the NHS was set up in 1948 practically half of Britons did not reach retirement age. In contrast a little one born nowadays has a one particular in three chance of residing to be 100.

In addition, the informal “social glue” of households and neighbours seeking after OAPs has fragmented, with relatives more and more moving away from their parents and grandparents to find work and a million pensioners feeling unable to contact on neighbours for help, in accordance to a latest survey.

But the RVS is keen to get across the message that pensioners are not a burden on society: a current report advised that above-65s created a net contribution of £40 billion to the economic system via taxes and investing, a figure expected to rise to £77bn by 2030.

The figure is far larger if the hidden worth of volunteering is additional. More than-60s contribute the equivalent of £10bn in unpaid operate each and every yr, the RVS says.

They include Alan Alford, 74, from Bristol, who will be 1 of 12 Diamond Champions presented with awards by the Duchess of Cornwall at Thursday’s reception.

He clocks up an average of 25 hrs unpaid operate per week by pushing a snacks trolley around Frenchay Hospital, driving pensioners to day centres and volunteering at a regional hospice.

Since he offered his burglar alarm business and took early retirement in 1997, he has contributed much more than 22,000 hrs of unpaid work.

He stated: “When I was 21 I had a significant motorbike accident that left me in hospital for 9 months, and I received this kind of fantastic care I usually stated I desired to give something back a single day.

“Volunteering gives me such fulfillment, simply because you see the big difference if helps make to people’s lives.

“Just the other day a lady in hospital asked if I could arrange for her phone to be topped up, and when I had finished undertaking the trolley I received her a new card and took it to her. She hugged me and burst into tears, just for undertaking one thing as straightforward as that.

“I also drive a chap who is blind and has Parkinson’s to a day centre once a week, and he’s a distinct man or woman when he will get there. It’s fantastic.”

Scientific studies have proven that as well as benefiting people who are getting assisted, volunteering improves the psychological and physical health of volunteers.

It can also decrease the charge of hospital admissions. “We discovered final 12 months that 150,000 older men and women got no help when they returned property from hospital,” stated Mr Smith. “Nationally there is a 15 per cent re-admission charge within 28 days of discharge amid in excess of-75s.

“We carried out a task in Leicester and made positive men and women had support when they acquired back residence, like producing confident there was food in the cupboards and the heating worked, and the rate of hospital readmissions halved in six weeks.”

Grey army of five million volunteers "plugging gaps in social care"