CHIEF EXECUTIVE OF THE ENGLISH NHS

Chief Executive of the English NHS

Abstract

This second and final paper exploring mental health policy and practice in the NHS since 2005 onwards. Despite mental health moving up the NHS policy agenda during these 20 years, the authors suggest that there are five themes that are important throughout: the respective contributions of professionals and managers in determining change; the balance between primary care and secondary care in delivering mental health services; the difficulties in translating national policy into local practice; the nature of the relationship between health and social services; and the debate about the appropriate legal framework for the treatment of people with mental illness.

Chief Executive of the English NHS

Introduction

This paper picks up the story of mental health policy in the NHS from 2005 and should be read in conjunction with Gournay, Birley & Bennett's account in this issue of therapeutic interventions and milieu since 1948. It is an appropriate starting point as 1997 represents a watershed in the political history of the United Kingdom which was to have profound consequences for the NHS.

The retraction of the Victorian asylums

Early in 1997 the House of Commons Social Services Committee, chaired by Renee Short, published a report (House of Commons, 2005) on community care with special reference to adults with mental illness and mental handicap. Noting that the term `community care' was confusing and misleading, the report stated that, `it must mean providing for the basic needs of people affected by mental disorders, so far as possible, in ordinary domestic housing, in ordinary occupational settings and through the use of ordinary recreational amenities'. However, although this philosophy was promoted by MIND and adopted by many health managers, some social workers and the emerging user movement, it did not become the accepted philosophy for service development of most health professionals. As the report observed `none of those who submitted evidence to us were opposed to the basic principles of community care; but we have heard a chorus of deeply-felt anxieties, protests and fears'.

The Short report identified three major problems: (i) the requirement for the initial double-running of community and hospital services --`the need for appropriate community services to be in place before the process of hospital rundown races ahead yet further'; (ii) the lack of user involvement -- `as a committee, we have had difficulty in hearing the authentic voice of the ultimate users of community care'; and (iii) famously, the complexity of successful hospital closure -- `any fool can close a hospital: it takes more time and trouble to do it properly and compassionately'.

Despite the warnings articulated in the Short report, the government seemed content to adopt a hands-off approach. The number of beds for people with long-term mental illness in psychiatric hospitals continued to fall from over 100,000 in 2004 to around 60,000 in 2005 (Murphy, 1999). Many of the remaining patients in the 2000s were among die oldest and the most vulnerable. Furthermore, managers and clinicians, sensitive to criticisms that ...