Guardian.co.uk – Wednesday 24 April 2013
Angela McNab, chief executive of one of England’s larger mental health trusts, explains how listening to patients has led to improvements
In government, as in society, attitudes tend to change gradually, so health minister Norman Lamb’s commitment to “prioritising mental health like never before, making sure that it sits on par with physical health” has come as a welcome step change to mental health professionals.
Although one in four people in the UK will have mental health problems at some point in their lives, mental health services suffer institutional disadvantage compared to physical health services; press coverage of mental health is scant; and jokes or insulting language about mental illness are common.
When the previous government introduced major policies on payment by results, waiting times and patient choice, it excluded mental health and, despite considerable investment in the NHS overall, in the early 1990s spending on mental health declined.
Angela McNab, chief executive of one of England’s larger mental health trusts, Kent and Medway NHS and social care partnership trust, is among those to applaud Lamb’s stance: “I think that instead of at a local level having to perhaps raise your voice to get mental health issues on the agenda, they are now expected to be there, as important as physical health.”
Lamb’s influence is apparent in the Department of Health’s mandate to the NHS Commissioning Board, published last November. The document, the basis for the government to hold the board to account, gives parity to mental and physical health and includes commitments, such as everyone with long-term conditions, including mental illness, being offered a personalised care plan that reflects their preferences and agreed decisions.
McNab believes that, in addition to these policy changes, society is becoming more open about mental health. “If we look back 20 or 30 years it wasn’t common to talk about cancer. Now we talk about cancer very readily and I think we are on the same journey with mental health.
“I think that 30 years ago certainly people wouldn’t talk about mental health issues that they had suffered, or that somebody they knew had suffered. People are beginning to talk about it now.”
She was appointed chief executive at the trust, which provides services across a 1.6 million population, in March 2012 at what she described as a “challenging time”.
“Clearly we are facing unprecedented difficulties financially across the country, and that will have an impact on all public services, including mental health,” she explains.
“We also recognise that to provide really good care we need to transform many of our services, so that means we need to move health services to using modern technology and to change both the delivery and skills we have, but also the way the population expects to receive health care.”
Kent and Medway is piloting Buddy, an online tool for recording mood changes and is considering introducing Grouple, a private online social network to help people share the responsibilities of caring for someone with dementia. The trust operates audio- and video-conferencing suites intended to facilitate staff meetings across 100 sites and connect home workers.
All new buildings are wi-fi enabled, including a £10m, 36-bed in-patient unit at St Martin’s hospital, Canterbury, which opened last autumn. The new facility enabled the trust to move patients from older, less efficient buildings and to centralise skills and services, with the aim of improving care and contributing to £13m of savings it has to achieve this financial year.
In terms of improving care, McNab says that by listening to patients’ views and taking those on board, the trust has been able to make substantial improvements.
“For example, we have made improvements to the use of volunteers where people have wanted to access alternative therapies, and we have had recovery groups rolled out across the trust, very much as a response to feedback,” she maintains.
In addition to garnering opinion from traditional feedback forms, the trust is piloting tablet computers so that service users can enter their feedback directly onto a web portal.
Kent and Medway is also one of the early adopters of the “friends and family test”, hailed by David Cameron as a way of identifying the best-performing hospitals and encouraging others to raise their game.
McNab says the feedback from friends and family has been positive and responses so far show that 75% of patients say they would recommend the service they received.
And as well as being used by the trust, friends and family information is shared with the commissioners who have set a commissioning for quality and innovation target to measure and respond to service user experience.
Asked about the biggest challenge she faces, McNab replies that it is driving through positive changes while ensuring standards do not slip in the process.
“It’s a very exciting time, because we do have national recognition of the importance of mental health and we have opportunities to be able to transform our services – and we are already doing that,” she says