Questions for Sir Norman Lamb, guest speaker
How do you feel about the role and value of experts by experience?
“My view is that we have to embrace expertise by experience, both in terms of the person who is using our services, we have to collaborate with them to ensure they’re fully part of the decision making process, but we should also embrace peer working.
“In our trust [South London and Maudsley NHS Foundation Trust] we have started, we have a long way to go, to build up our workforce of peer workers. So people who have themselves had experience of mental ill health or experience of caring for others who come to work in an organisation. Indeed not just on the frontline, I believe, that the more people we embrace in employment in our organisation at every level including the board, who have experience of mental ill health the better.
“I think it changes the culture of the organisation. I think we become more empathetic the more understanding and experience we have.
“So the simple answer is embrace totally the understanding and expertise of experts by experience.”
What have you learnt since becoming the chair of a Foundation Trust that you wish you had known when you were a Health Minister?
“Well I say to people often that it sometimes feels like I have moved from talking the talk to walking the walk. What I have learned is that it’s much harder to walk the walk than it is to talk the talk.
“You can pontificate from the centre as a politician and I think it’s important for there to be national political leadership in mental health. I think it’s really important for people in parliament to demonstrate a commitment to mental health and a commitment to equality for mental health. But I think it’s also important to recognise for people in those roles that it’s tougher on the frontline actually delivering change.
“I find it invigorating to be involved in actually changing things that can have an impact on people’s lives but I don’t underestimate the challenges in achieving that change.”
How far do you think we have come towards achieving parity of esteem for mental health services and what needs to happen next?
“Well I think we have made progress. I think first of all in terms of stigma, stigma has reduced I think over the last decade. Many of us have opened up about our own mental health experiences and I always feel every time someone in the public eye, whether it’s a sports person, a musician, someone in politics or in business, every time someone opens up about their own experiences of mental ill health it just makes it a little bit easier for a teenager to seek help.
“Speaking from our own family experience, enabling young people to speak up and seek help is so important.
“So, I think that level of stigma has reduced but I don’t think we should kid ourselves that it’s gone away. The level of stigma that still attaches to conditions such as schizophrenia, psychosis, the diagnosis of personality disorder, these things remain highly stigmatised and people who experience those conditions will often tell you that they feel the stigma still in society very strongly. So, we’ve got a long way still to go on that but progress made.
“I think in terms of the attention and resources we commit to mental health things have started to improve.
“We have something now called the mental health investment standard which is supposed to ensure that when new money comes into the NHS mental health gets its share. I am worried, I have to say, that with this new money announced from the government the political focus is very much on acute hospital waiting list and I worry that mental health trusts won’t get the share that we need because we recognise there is psychological fall-out from the COVID pandemic, as well as a physical health fall out. We also are seeing longer waiting times, longer waiting lists, more pressure on our acute services so it’s really important for the government to maintain fairer treatment of mental health in the allocation of resources.
“We haven’t got there in terms of clear access standards, we have started to introduce them and before Simon Stevens left his job as chief executive of NSH England he announced new access standards, particular in crisis care, but they still have to be introduced and there needs to be investment to make them achievable by the mental health system.
“In my final word before we finish, on 8 October, I will be joining with you chief executive Brent and interim medical director Steve Wright in a webinar, put on by the International Mental Health Collaborative Network, which is this organisation that seeks to deinstitutionalise mental health and to focus on the human rights of people with mental ill health and I wanted to pay tribute to your trust. You’ve been a member of the Collaborative Network for a lot longer than we have … Steve Wright has been involved from the start, I think, and his work, based in York, has been outstanding. And it’s figures like that that have started to rethink our approach to mental health and recognising the importance of respecting people and their human rights.
“You, Steve, and others have led the way and I respect massively what you have done. And it’s brilliant that your chief executive is choosing to get involved in that webinar as well. So it’s brilliant that our two trusts are collaborating together on an approach which I think ultimately will help to achieve that parity of esteem, that equality of treatment and that respect for human rights which I think is so important.”
Other questions answered by members of our executive team at the AGM
Why are the physical and mental health departments separated instead of patients being treated as a whole?
Elizabeth Moody, director of nursing and governance:
“It’s very historic and very much opposed to how we want to think and treat people and how we’d like to be treated ourselves because we know everybody has both psychological and physical needs. We’re working really hard with partners to try and change this where we can. So breaking down those barriers between primary and secondary care as well as between mental health and acute hospitals because that’s where we know it leads to much poorer outcomes for people. We know most people who have long term physical health condition, it’s very common for those people, I think about a third of people, to have mental health needs, and vice versa.
“The NHS long term plan provides a framework for us to be more joined up and try and remove these boundaries. Within the new integrated care system this is a workstream that we’ve been working on for while. We have done what we can in our mental health units – we have much more focus on physical health now, on screening and looking at the knowledge, skill and roles of our staff to support people’s physical health needs. Likewise, we’re working really closely with the acute hospitals in terms of liaison and strategies like Treat as One to upskill their staff to recognise mental health, metal health distress and psychological support.
“There is still more to do to treat people as a whole but we very much we want to be an organisation that embraces that holistic care.”
How do you share an idea with the NHS on a technique that can be used to help people manage their mental health needs?
Dr Steve Wright, interim medical director:
“I think there are answers and also we can create some more I think. Part of what’s going on is that there are forums which we can take these forwards. If there’s people working with a clinician within the trust then that’s always a good starting point because it’s about an alliance, it’s about sharing ideas and then taking them forward so they can be implemented. So that’s the simple way.
“Through our website it’s easy to navigate to how we can get involved. There’s a research link, or getting involved in improving services and sharing ideas. Having a single point of contact in which to share an idea is something that might be considered in terms of adding to our website, in some trusts they have that. But I do hope that we have sufficient mechanisms to capture that through our current website even though the ambition would be to simplify it.
“And the other thing that is really key is co-creation. We’re looking to be involving people with experience and people with ideas in shaping our services and some of those may be tried and tested evidence based NICE concordant interventions and some of them are no less meaningful on a personal level which can make a difference and can be picked up, through word of mouth, and tried out in practice.
“On a more formal basis there are research networks. There is a research for patient benefit programme with the National Institute of Health Research and also health technology assessments. Which even though it sounds very technological, it can also just be a very simple idea. I’d go back to that sometimes the best ideas are the simplest ones and we need to try and understand and exploit those effective ideas without getting too caught up in the bureaucracy that can follow.”
Regarding the Trieste experience. This is something you’ve been involved in with quite heavily for some time. Someone has personal connections with Italian doctors through their family and they’re saying, if it is so good why hasn’t it been adopted here?
Dr Steve Wright, interim medical director:
“It’s slightly complicated. The situation in Italy was created by a change in the law, law 180, which made it, effectively, illegal to admit people to psychiatric hospitals. They were a very different beast in those days. But the law was the law and as ever when the law is involved it gets interpreted in different ways. Across Italy it was interpreted in different ways, it was fudged rather badly in some places and it was taken in the spirit of its intention in some places, and one of those was Trieste which was where Franco Basaglia , one of the main proponents of it was.
“Why it hasn’t been adopted in the UK is more complicated than that. There have been lots of proponents who have been to Trieste and seen what’s happening, one of which is the national clinical director. He went as a senior house office and reported back and is still closely linked to what’s going on there. I think the barriers were felt to be inherent in the system in the UK and that’s what held people back. The argument was well Italy’s Italy, the UK’s the UK, and actually it increasingly has been and is being adopted across the UK, including Wales and Hertfordshire.
“As you heard from Norman, they are exploring it at SLAM and in fact the truth is it underpins a lot of what is in the community mental transformation framework. A lot of the inspiration for that comes directly from Trieste. It may have been a convoluted route and there may have been a lot of barriers but actually a lot of the principles of Trieste are finding their way into the reforms that are taking place, the most obvious of which is the community mental health transformation framework.”
Dr Steve Wright would also like to add that the system transformation in Trieste was much more effectively coproduced with patients, families and communities with the help of Franco Basaglia’s “bright young things” who were able to start with a clean slate.
For people who work in involvement roles can they have support. One of the examples is the SIG (special interest group) process, part of our strategy development approach, it was somewhat lacking – how can we do this without offering support to people who are giving their time and putting themselves out to work with us.
Sharon Pickering, Assistant Chief Executive:
“Through Our Big Conversation and the development of Our Journey to Change we were really, really clear that co-creation is something that is going to underpin the organisation as we go forward. The special interest groups, which were set up to try and develop the busines plans in line with Our Journey to Change, they were a first attempt at that and I absolutely acknowledge that we didn’t get it right first time. We did try hard, we were moving at significant pace in order to try and get the business plan developed which in itself makes it difficult to truly get that co-creation.
“I do recognise what was said and we have committed to co-creation. With Ann Bridges now in post as director of corporate affairs and engagement I am hoping that as we go forward, how we engage service users and carers in our planning and in our busines planning we can improve. We are certainly trying to increase those numbers. We have a couple of events coming up with the board and we are increasing the number of service users and carers who are attending those. Obviously, we will be looking to give support as well to that.
“Absolutely we hold our hands up, we didn’t get it quite right but we need to learn and the commitment is there to ensure that we continue to learn and that we continue to engage with service user and carers in the planning process.”
There are a number of people that are transitioning in our services that are on the wrong wards – what are we going to do about this?
Elizabeth Moody, director of nursing and governance:
“First of all I am sorry to hear if that’s the care I don’t have enough information to hand to talk about the specifics. Clearly any transgender service user or individual would want to be treated with respect and sensitivity in our care and feel safe on any ward where they’ve been admitted.
“We do say anyone who has been admitted should go to a ward based on the gender that they identify with.
“I think this is something we do need to take away. As you say it is a very sensitive and very important subject. We will take this back to our equality and lived experience networks and think through carefully. If anybody who raised this question would like to support us with that they would be most welcome.”
Other questions submitted at the AGM:
When are we going to have a service user and carer on the Board?
We are currently in consultation about a proposed new structure for our trust. This includes having two localities which support the two integrated care system areas that we cover. We’re also proposing two care groups, both of which will include a group patient director.
One thing that I think hinders parity of esteem is our use of language. There’s this movement towards “servicer user” instead of “patient”, but in physical medicine you would almost never be referred to as a service user. I think you won’t ever have parity until you use the same terms, and I think the move to service user was well intentioned but counterproductive.
The language we use is really important to us. That’s why we’re carrying out a big piece of work right now to make sure we get it right for people.
We’re involving patients, carers, staff and partners to understand how people want us to talk about our services and what we do. We know that getting it right will improve people’s experience of the trust.
I am so impressed with the listening service. I am really embracing it and I would love to work in mental health but voluntarily.
We have an amazing group of volunteers who support us all across the trust in a variety of roles. There is more information on how to get involved on our website.
Where did the 9/10 patients gave positive feedback come from? Who was asked? No one I know was asked as to the thoughts about the service given.
We have a patient experience survey which is distributed to all patients across the Trust (all localities and specialities). All inpatients receive a survey on discharge or at monthly intervals for specialities where lengths of stay are longer e.g. Forensic and some Learning Disability Patients. All community patients also receive a survey on discharge or at review points in their care. A patient or carer can complete a survey at any time if they choose to do so.
The results of this survey in 2020/21 demonstrated that 90.71% of patients gave positive feedback reporting their overall experience of the Trust as excellent or good – we believe this is the figure you’re referring to.
The data from this survey is sent each month to NHS England’s Insight and Improvement team and the answer to the overall experience question forms part of the Family and Friends Test (FFT).
More information on patient and carer feedback and how you will be asked can be found on our website.
We do recognise that we need to do more on increasing the number of patients who do give us feedback in order to ensure that the views shared are representative of the wider experience
