Tuesday, 28 February 2012

Health bill puts aftercare of mental health patients at risk

Health bill puts aftercare of mental health patients at risk:

In the Lords, an amendment is being put forward that seeks to retain a vital level of protection for vulnerable people

Peers are set to further scrutinise the health and social care bill as the House of Lords debates a proposed amendment on Monday evening that, while not among the most high-profile elements of the legislation, could have a drastic impact on the recovery of mental health patients.

The proposed amendment, being put forward by Lord Patel of Bradford, concerns clause 39 of the bill. This clause addresses section 117 of the Mental Health Act, which guarantees aftercare provision for a vulnerable group of patients who have been detained, or "sectioned", because of their mental health.

Crucially, section 117 requires primary care trusts and local authority social services to work together to jointly provide necessary aftercare. Examples of aftercare include visits from a community psychiatric nurse, attending a day centre, administering medication, and providing counselling services or accommodation within the community.

As things currently stand, a patient can expect their PCT and local authority to provide an appropriate aftercare package, and to sort out the funding between them. The services cannot be withdrawn until both the PCT and local authority are satisfied that the patient no longer needs them.

In practice, this joint duty means that the patient is more likely to get access to the integrated health and social care services they need and has an enforceable right to those services.

The services provided under section 117 are free of charge because the people who benefit are exceptionally vulnerable members of society. If they do not receive the aftercare services, there is a real risk of relapse, self-harm, and falling out of mainstream society into homelessness or social isolation.

Clause 39 makes a number of worrying changes to the provision of aftercare services in England. The most concerning of these will remove the joint duty so that the new clinical commissioning groups (CCGs) and local authorities will be able to take separate decisions.

In practical terms, this means either health or social services could be withdrawn from individuals without the other provider being consulted, seriously damaging that person's care package at a time when they are incredibly vulnerable.

Section 117 will no longer be a freestanding duty and, instead, CCGs will only provide health services under the NHS Act 2006. As the NHS Act includes provision for charging for aftercare, this opens up the possibility of the individual having to pay for their vital services.

Clause 39 flies in the face of the government's rhetoric about health and social care integration. It does precisely the opposite of this, removing the need for each provider to communicate with the other and increasing the likelihood of codependent services being removed, at great risk to the individual.

At present, section 117 does not make any distinction between what is a health or social aftercare service. PCTs and local authorities are required to provide and fund whatever treatment is necessary. But if the duty is split, CCGs will be able to stop providing "health care" services when they decide that the person no longer needs them, and local authorities will be able to stop providing "social care" services, and they will not have to reach this decision together as they do now.

We are greatly concerned that this will lead to disputes between providers over which authority pays for a particular aftercare service, and, where services are not clearly in the remit of either health or social care, they may not be funded at all.

Patel's amendment proposes that the joint duty for CCGs and local authorities to co-operate is retained, and that the current safeguards against charging for aftercare is kept. Section 117 provides a vital level of protection for vulnerable people and it is essential that it remains a key part of mental health care. Mind strongly support Patel's amendment and we hope that his fellow peers will also do so in Monday's debate.

Louise Kirsh is parliamentary manager for Mind.

Guardian Professional.

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