My two passions in healthcare are integrated care and the pursuit of equality for people
who suffer from mental ill health.
And on both of those causes I think we have a very, very long way still to go.
It is I think a remarkable achievement of our system that we manage spectacularly to
neglect the physical health needs of people who have severe and enduring mental ill health,
but we also spectacularly manage to neglect the mental health needs of people with physical
health problems.
The most tragic of all consequences of failure is suicide.
At present there is a failure to join up support for people, to treat the person as a whole
person.
The mother who has just had a baby who is suffering from post natal depression, or from
psychosis after giving birth.
The need absolutely to ensure that in every part of our country they get access, in a
joined up way, to specialist perinatal mental health services, the absolute need to ensure
that mental health is properly integrated within primary care.
The training of doctors needs to be addressed.
Isn’t it remarkable in a system that when we have about 33% of an average GP’s workload,
related in some way to mental health, that we don’t ensure that every GP in our country
is properly trained in mental health?
We need to address these things.
Look at Intermountain Health in Utah in the United States, where they have gone through
a programme of completely integrating, bringing in mental health into primary care, so that
people get access in the primary care setting to support at a much earlier stage, to stop
the remote referral at a later stage when the condition has already become entrenched.
They have found that they are using resources better and making a difference to people’s
lives.
Now I wanted to saying a little bit more about the work that we are doing in the West Midlands,
because it seeks to extend this principle of joining up services a bit more effectively.
And we are looking at key areas where we believe there is a failure of public service to provide
proper support for people.
So we start for example with employment.
Now we know there is loads of evidence that something called individual placement and
support works, if you invest in it, this is the intensive support for people with severe
and enduring mental ill health, to help them back into work, and to continue that support
once they are in work, and if they fall out of work to help them back in again.
We know the evidence shows internationally, on randomised controlled trials, that if you
make the investment you get a return on your investment.
But out of a total of about 250,000 people in our country who could benefit, about 4,000
people actually do benefit.
And it is one of the problems of Government, that so often one area of Government is expected
to make the investment, but another area of Government gets the gain.
So health makes the investment, the Department for Work and Pensions achieves the gain.
So how do we square that circle?
So we are working with an organisation called Social Finance, and what we are exploring
is whether we can raise the social investment from individuals, from charitable organisations
and others, to rollout IPS across the whole of the West Midlands.
This would be internationally significant if we can do it.
And if we can do it on that basis, then we seek to persuade the Government to make the
return on investment to the investors if we do what we know will work and we get people
back into work.
The next area where we completely fail far too often is the link between mental ill health
and housing.
We all know that secure housing is critical to your wellbeing.
But how many parts of the country really join up housing providers with mental health providers
in an effective way?
Housing first is a very interesting emerging model that has been used in Finland, in Canada,
in parts of the United States where again just like IPS you give people intensive support
to get them straight into secure housing and provide them with continued intensive support,
and it might just work.
And then finally the criminal justice system where probably lies the biggest scandal of
all.
The fact that there are so many people in our country who are in prison essentially
because of their mental ill health or their learning disability.
So we introduced in Government a liaison and diversion service, being rolled out now across
the country, now covers 50% of the country.
The aim is provided the business case stacks up to treasury, to get the whole of the country
covered by 2017, so that when someone turns up in the criminal justice system they get
referred to diagnosis and to treatment, to give them the chance of a better life, to
address their mental health problems, which may be the underlying cause of their offending
behaviour.
And when people come out of prison, they are too often just completely neglected, allowed
to return to their offending behaviour, without their mental health issues being properly
addressed.
So we are looking at that in the West Midlands as well.
I take the view that the Government needs to spend more money on the NHS and the care
system.
I have argued the case for a cross party commission to achieve a long term settlement.
But let me just say this, that we cannot just complain about the Government.
All of us who work in the NHS, in the care system, all individually have a moral obligation
to make the system work more effectively for people.
And if we don’t do that, we fail some of the most vulnerable people in our society.
Thank you very much indeed.