Preventing patients falling through the gaps

Responding to the publication of a new report today (26 January 2017) on mental health care in general hospitals, Professor Tim Kendall, National Clinical Director for Mental Health, describes how the NHS is working hard to deliver priorities set out in the Five Year Forward View for Mental Health for changing the way in which mental and physical health have traditionally been viewed and treated.

Treat as One’, a report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD)outlines the findings of a recent review of the mental health care provided to patients who are receiving treatment for physical health problems in UK general hospitals.

Mental and physical health are interdependent, and patients rightly expect care and treatment for both, whatever their primary presenting condition and through whichever door they first enter. We need to improve mental health support in general hospitals alongside bringing together mental and physical health care.  This needs to happen inside hospitals, out in the community and in people’s homes – to break down the barriers, as we now say.

I wrote about the well-rehearsed arguments and evidence for better patient care and cost savings to the NHS last month.

The NCEPOD recommendations echo almost exactly the priorities for integrating physical and mental health that we set out in our implementation plan for the Five Year Forward View for Mental Health.

Firstly there is new money available to CCGs from April this year to improve access to evidence-based physical health assessments and interventions for people with serious mental illnesses. We are supporting them in delivering this with new guidance and other implementation support so that by 2021, 280,000 more people with serious mental illnesses receive the care they need in both primary and secondary healthcare settings.

And secondly, I am very excited to report that there has been vast interest across the country in two new waves of transformation funding, for general hospital liaison mental health services and integrated psychological therapy (IAPT) services.  Bidders across England have obviously been extremely hard at work on their applications over Christmas and the New Year, reflecting their passion and dedication. The bidding process for wave 2 funding for integrated IAPT services closes this week.

These services improve care and outcomes for people with common mental health problems and long term physical health problems, and also distressing and persistent medically unexplained symptoms. This new funding will help to develop sustainable integrated IAPT services at scale, giving 400,000 people access to them by 2021.

Bids for £30m  to bolster general hospital liaison mental health services have also been coming in thick and fast this week.

In total there is £120m of central money earmarked over the next four years to help hospitals to provide 24/7 specialist on-site mental health expertise, to match the 24/7 opening hours of their A&E departments, so that at least half of English hospitals will be able do this by 2021.

Guidance for routine liaison care in physical health settings is currently in development, following our publication of guidance on the urgent and emergency functions of general hospital liaison services in November.

Along with indisputable evidence that these initiatives improve patient care while generating cost savings, the levels of interest in these bidding processes show that commissioners and providers share our appetite and impatience for implementing change. They understand the need for transformation, and are stepping up to the plate, which shows great promise for genuine action in 2017.

One last thought-provoking idea. At the moment, we still tend to first assess and treat our patients through one of two doors: the mental health door or the physical health door. But ours is a constantly-evolving, cutting-edge modern healthcare system – and one in which there are ever-increasing resource and demand issues. So maybe it’s time to think about a shift for the future model of care. Maybe patients just need one door to walk through, and to be treated seamlessly for all of their healthcare needs?

Professor Tim Kendall

Professor Tim Kendall is NHS England’s National Clinical Director for Mental Health. He has been Director of the National Collaborating Centre for Mental Health at the Royal College of Psychiatrists for 15 years and Visiting Professor at University College London for the last eight years.

Tim has also been Medical Director for 13 years and continues as Consultant Psychiatrist for the homeless at Sheffield Health and Social Care NHS Foundation Trust.

As Medical Director, Tim has set up a service user experience monitoring unit, led the reconfiguration of acute care and rehabilitation leading to the elimination of out of area treatments, the modernisation of the acute and crisis care pathways and initiated the development of NICE recommended personality disorder services within the community.

He chaired the first NICE guideline, launched in December 2002, on the management of schizophrenia and the first National Quality Standard (Dementia) for NICE.

Tim has published numerous articles and papers and often represents the NCCMH, NICE or the Royal College of Psychiatrists in the media. In 2004, he was awarded “Lancet Paper of the Year” for showing the impact of selective publishing by the drug industry about antidepressants in the treatment of childhood depression; and with others was awarded the Paper of the Year Award for the Health Economic Journal ‘Value in Health’ in 2012 for work on schizophrenia.

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  1. Mark Deevey, GP Practice Manager says:

    You say above “there is new money available to CCGs from April this year to improve access to evidence-based physical health assessments and interventions for people with serious mental illnesses” Is this money for GP Surgeries also or just hospitals? I Manage a GP Surgery and we have a major problem with homeless/mental health and admissions and constant recurrence of a&e attendances, costing a lot to NHS. we have approached our CCG for many years asking for funding for this particular group of patients (homeless) and keep on getting no funding available. We put in a bid for resilience fund for this and was told this isn’t the criteria and we need to approach our ccg to setup a homeless scheme (for which they say there is no funding) So we are banging our heads against a wall with no help form NHS England or our CCG, yet other parts of the country have homeless schemes funded and in place. Is any of the monies from April available for something like a homeless project?

    • NHS England says:

      Hi Mark

      The programme to deliver the 5YFVMH, including physical health checks, does not include additional money specifically for homelessness and mental health, however, services should be providing mental healthcare for anyone in their catchment with a mental health problem severe enough to be seen, irrespective of their abode or lack of one.


      NHS England

  2. Rosemary Jones says:

    According to an Independent newspaper report on the NHS 14.2.17, ‘The Cambridge and Peterborough NHS is one of the most, if not the most challenged systems in England’. I have to report that anyway as far as head injury related mental ill health is concerned it is one of the most, if not the most contaminated. My son and other head injured neurology patients with consequent mental health problems are being closed down as a result of their accurate diagnoses either denied or refused in the first place, and being replaced by labels with no causal integrity, and what is essential to their long levity kept from them. The collusion appears to reach the patient monopolising GPs and even contaminates Addenbrookes Hospital.

    Why ? Because psychiatrists cannot publicly accept that, like in the differently caused vascular dementia, head injuries can result in cognitive problems.

    Please stop this slow homicide. Stop the CPFT hurting my son.

  3. Sue Sibbald says:

    What does it mean by SMI? It usually means not people with a ‘Personality Disorder ‘ I’m hoping not or we are still a diagnosis of exclusion please let me know because our consensus report will be out soon it’s important we are not forgotten . Thank you .. Sue

    • NHS England says:

      Dear Sue,

      I am sorry I’ve fallen into the trap of using the term SMI as interchangeable with people with psychosis/schizophrenia and bipolar disorder, many of whom smoke and take antipsychotics and therefore have significantly raised physical healthcare needs. It’s a shame SMI has become shorthand for this group as this implies that ONLY they have any serious problems, which plainly isn’t true. Please be assured that improving support for people with needs associated with a diagnosis of personality disorder, across primary and secondary care, is key to our adult mental health programme – particularly our upcoming work on developing an evidence-based treatment pathway for community mental health services.


  4. David Sims says:

    I find it very encouraging that mental health is being addressed as an inextricable link to physical well being. As a cardiac specialist nurse I always highlight the holistic approach of social, physical and psychological health.

    Our population is increasingly becoming older, thus the financial support from central government to the CCG’s is fantastic news.

  5. kathleen Fitzgerald says:

    12 times sectioned since 1984 , because Inever rreceived any support or advice about my ccondition, Ihad prurpal psychosis after my son wwas born and diagnosed manicddepressive, still suffering, my son has since been killed,

  6. Dr RF Travers FRCPsych says:

    I am unsure what Prof Kendall means by two doors! I dont recognise his binary world vision. Most patients initially present to their GP…one door, via A&E…one door or via the s136 suite…one door. That’s at least three doors, two being generic and the third determined by the police and not mental health practitioners