Health Wellbeing and Local Government Committee

HWLG(3)-11-09 paper 15

Committee Inquiry into Mental Health Services In The Community – Evidence from the Royal College of Nursing Cymru

Consultation Response from the Royal College of Nursing, Wales
Presented to the National Assembly for Wales
Health Wellbeing and Local Government Committee
03 April 2009

About The Royal College Of Nursing (RCN)

The RCN is the world’s largest professional union of nurses, representing over 400,000 nurses, midwives, health visitors and nursing students, including 23,000 members in Wales. The majority of RCN members work in the NHS with around a quarter working in the independent sector. The RCN works locally, nationally and internationally to promote standards of care and the interests of patients and nurses, and of nursing as a profession. The RCN is a UK-wide organisation, with its own National Boards for Wales, Scotland and Northern Ireland. The RCN is a major contributor to nursing practice, standards of care, and public policy as it affects health and nursing.

The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies.

Key Messages

• Community Mental Health Services in Wales require increased and sustained investment. It may be necessary for the Welsh Assembly Government to ring-fence funding.

• A workforce development plan (including recruitment & retention issues) is needed to ensure the sustainability and development of the mental health nursing workforce.

• Assertive outreach and crisis resolution teams should be developed, adequately resourced and be accessible across Wales.

• The provision of post registration training for mental health nurses should be strengthened.

• Transition services for adolescents transferring to Adult Mental Health Services should be developed and resourced.

• Counselling services should be available in primary care for young and old.

Introduction

The Royal College of Nursing believes that mental health services should be designed around the recovery model. This model is optimistic, patient centred and contemporary. It looks beyond illness but to a process of recovery which embraces the need for employment and relationships and social inclusion.

The Royal College of Nursing believes that public services (as educators and employers), business and local communities all have a role to play in maintaining good mental health and wellbeing. At their best community mental health services should be providing the connectivity underpinning these vibrant relationships.

Modern mental health services work in collaboration with service users, carers and families to promote recovery and offer timely interventions in crisis.  Mental health nurses can provide a range of evidence based interventions such as: cognitive behaviour therapy, family interventions (both of these are specified in the NICE guidance for schizophrenia), independent and supplementary prescribing, relapse prevention, medication management, risk assessment and management

The Care Programme Approach provides an opportunity for collaborative care planning drawing on strengths rather than a deficit model to enhance and promote recovery.

The capacity and geographical availability of services

The capacity and geographical availability of community mental health services are extremely variable across Wales. Factors influencing this include a low priority placed on these services by health commissioners and complex commissioning arrangements. The RCN would wish to see the new Local Health Boards emerging from the current NHS reconfiguration to prioritise the consistent and sustainable development of these services.  

There are also clear recruitment & retention difficulties influencing the provision of care and the speed at which it is accessible. The Royal College of Nursing believes this is unacceptable and is calling for a national workforce planning strategy for mental health nurses in Wales, to meet the future mental health needs of the people of Wales, be they children or adults. The new Local Health Boards should be able to feed their identified needs into such a plan.

Finally the new Local Health Boards needs to identify funding for post-registration education in mental health to ensure that a variety of modern services are available to clients. Unlike their medical colleagues nurses are not entitled to pay protected time for their continuous professional development (although this is a requirement of their continued registration as nurses). Mental health nurses need to be up to date with the latest changes to mental health legislation. Specialist training is needed in fields such as cognitive behavioural therapy, family work, and personality disorder. It is often not the cost of this training itself that is an issue for the NHS but the effort and cost required by the NHS to backfill the post left vacant while the nurse accesses training. It is professional frustrating and hinders the provision of the best possible service for clients if nurses are unable to access this training and too often nurses are left to pay for such training themselves and access it in Annual Leave.

The provision of services for young people over 16 years in transition from children’s to adult services

Services are being inappropriately withdrawn from young people at 16 with a detrimental effect on the young person and family. Caring for the young is a particular skill set but the service should be designed around the client and too often there is the suspicion (for the client and health care professional alike) that pressure on limited services is resulting in inappropriate ‘gate keeping’.  

The impact of the effectiveness of community based services on hospital admissions and delayed transfers of care

It is far better for the client to receive services tailored around and designed to support every day living in the community. If community services are not existent or limited this will increase the number of hospital admissions and delayed transfers of care. There are clearly areas where this is occurring.

Advanced mental health nursing roles enable these nurses to provide services such as crisis interventions, assertive outreach and home treatment. Such treatment options have facilitated a reduction of inpatient stays and beds. Assertive outreach and crisis resolution teams should be developed, adequately resourced and be accessible across Wales. Moreover small units of support beds in the local community should be developed that can be utilised if necessary on a 1 or 2 night basis. This would avoid the need for an admission to a daunting large-scale hospital where the bureaucracy can make it very difficult for the client to be discharged as swiftly as they were admitted.

Counselling services should be available for the young and old within primary care.

The effective co-ordination of health and social care elements of community mental health services

The effective planning and delivery of community mental health services relies on the effective co-ordination of health and social care. The Royal College of Nursing believes this is a goal that should be prioritised by the new Local Health Boards. Joint guidance and training together of health and social care staff can be a significantly positive factor in influencing this. Structural factors that hinder the effective working together of health and social care include the lack of joint budgets, the lack of a 24hour social care workforce and the small size of some local authorities which can hinder effective planning of services (although equally it can assist in the identification of need).

Equality Issues

The Royal College of Nursing believes that services should be planned and delivered to meet the needs of the local communities they serve. There is evidence from patient groups that this is not always the case and that the needs of certain groups are not always respected.

All healthcare professionals should treat individuals with dignity and respect. The Nursing & Midwifery Code of Conduct (April 2008) for example requires registered nurses to treat patients and their family with dignity and respect, without discrimination and with regard to individual language & communication needs (This is not an exclusive list and there are also many other requirements).

Specific knowledge or skills may be required from the healthcare professionals serving that community (e.g. language skills). It would also be appropriate for the organisation to regularly deliver more general training on diversity and equality issues (e.g. changes to the law on discrimination).

DIRECTOR, RCN WALES
TY MAETH
April 2009