Written evidence submitted by Miss Mary Waterworth (RTR0020)

 

PREVENTION IS BETTER THAN CURE by Mary Waterworth (Staff Nurse).

 

The Kings Fund Report ‘Links between Chronic Excessive Workloads and Burnout’ and the rationale for workload planning plus my own experiences as a member of the Ground Workforce have been used as the inspiration for this document in the hope of aiding the Secretary of State and CHSC Committee’s 5 year Plan for Social Care Sector

 

PROPOSED SOCIAL CARE PLAN.

 

 

Date first sent to Committee 18/07/21.

 

Today’s date 14/01/22

 

Dear Commons Health and Social Care Committee (CHSC Committee),

 

My name is Mary Waterworth and I have been a Child and Adolescent Mental Health Service (CAMHS) Staff Nurse at Salford CAMHS for the last 10 years at Manchester University Foundation Trust (MUFT), who have recently successfully merged with North Manchester General Hospital (NMGH) and South Manchester NHS Foundation Trust (UHSM).

 

Manchester University Foundation Trusts has been used in this document as an example for the PILOT PROPOSAL.  It is believed that the following will begin to aid the Secretary of State and yourselves in publishing the first part of the 5 year plan for the Social Care Sector from the point of view of the ground force workers.

 

  1. The commissioning of The Kings Fund (Professor Michael West and his team) for the Following Pilot and for Stages 1-3.Plus the ratification and installation of a Nurse/Care Assistant staffing levels and Social Care (England) Act by 01/08/22.  That also includes realistic Clinical to Admin ratio’s for Adult Mental Health Services, Health Workers, Social Workers and CAMHS workers.

 

    1. All workers stated in this document to be moved to the same grading system as the NHS (Banding) with clear progression pathways put in place, that are negotiated and agreed by 01/08/22, with myself and a Representative from all Bandings with our Union Representatives present.

 

    1. All Bands 3 and 4’s to be classified as training over a period of 3 years and Band 5 to be classed as qualified with each given the appropriate wages in line with the increase of responsibilities expected of them that is negotiated and agreed by 01/08/22, with myself and a Representative from all Bandings with our Union Representatives present.

 

    1. The return and implementation of instant CQC spot check inspections in Hospitals and Care homes.

 

    1. The addition of 2 SENCO’s employed in all schools in England to assist with the needs of those with Learning difficulties) by 01/08/22.

 

    1. A pilot scheme of EdIntervention key stage 3&4 Alternative provisions Manchester www.edintervention.co.uk be used as a model for additional EdIntervention provisions with separate Junior and Teenage provisions in all UK districts starting with the districts surrounding MUFT, NMGH and UHSM areas by 01/08/22 as a pilot and this then to be implemented into all areas in England that do not meet Ofstead or CQC level of acceptable standards by 01/08/23.

 

    1. All Youth Workers training programmes to include ADHD/ASD Behaviour Management (parenting to be renamed BEHAVIOUR MANAGEMENT as the name parenting presents as an obstacle), and the Gold standard CBT in Anxiety and Depression.  Two full time Youth Workers employed by all High School identified by Ofsted as not reaching acceptable national levels and one full time Youth Worker employed by every Primary school in the UK.

 

    1. The implementation of Covert Care Assistants employed by CQC to work in Hospitals and Care homes across England by 01/08/22 starting with those that have not met the national acceptable standards.

 

    1. A review and update on the NHS Managers Code of Conduct NHS Employers 2002 with the Whistleblowing processes to be included in this by 01/08/22.

 

    1. A review of the mandatory national training program for NHS Managers to include managing styles and the prevention of Discrimination, and for this to be delivered by outside appropriate bodies for example Access to Work for Managers and staff regarding disabilities.  At the moment it is felt that there is a bullying culture of Management styles and Managers with more appropriate and encouraging styles need to be brought to the forefront to lead Managers training as an example.

 

    1. The work Force of Family Support Workers to be doubled in all areas of England identified by Ofstead and CQC as not reaching the acceptable national standard levels.  This number of Family Support Workers to continue for a further 5 year period in these areas after they reach Ofstead and CQC standards before integrating the numbers into the wider population.

 

    1. For Family Support Workers training programmes to include the Gold Standard of ADHD/ASD Behaviour Management (Parenting)and CBT for Anxiety and Depression.

 

    1. People who are found guilty of racial abuse outside of work for example at football games, employers to be informed of these convictions.

 

 

A request for the following:

 

2.0   The Royal College of Physicians have published the 90 Organisations United behind the Call for Strengthened workforce planning in the Health and Care Bill:

 

https://www.rcplondon.ac.uk/guidelines-policy/strengthening-workforce-planning-health-and-care-bill-coalition-principles

 

If the 90 Organisations listed are in agreement to jointly invest equally with the Secretary of State to pay for the commissioning of the PILOT to be researched by Professor Michael West and his team at the Kings Fund until 01/08/23.

 

PILOT - Salford CAMHS and all MUFT CAMHS to be the first to pilot the research.

 

2.1   The Secretary of State and the CHSC Committee to then commission the Kings Fund for:

 

2.2   Stage 1 Medium scale a comparison against the Pilot at MUFT against NMGH and UHSM CAMHS who have recently merged successfully with MUFT, as this will give a good indication on a medium scale of what is required for the plan for the NHS in England over the next 12 months.

 

2.3   Stage 2 Large scale investigation of how this compares and needs to be implemented with the gathering of all NHS Hospitals Trusts and private Hospitals information within England.

 

2.4   Stage 3 implementation by June 2026

 

2.5   The Kings Fund Report ‘Links between Chronic Excessive Workloads and burnout’ explored the causes and consequences of poor mental Health and wellbeing among Nurses and Midwives and sought to identify solutions to these issues and examples of good practice.  It is felt that Professor West and his team have produced a good foundation identifying good practices for such a pilot to be run from. It is therefore asked that the Secretary of State appoint the (CHSC Committee) to work with the 90 Organisations United Behind the call for Strengthening workforce planning in the Health and Care Bill in the commissioning of the following investigations so that no bias occurs, and for the sake of transparency that all proceedings from the beginning to be overseen by a working group of delegates from 90 Organisations.

 

The CHSC Committee report (June 2021) states:

 

‘There is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.’ (Paragraph 184).

 

3.0   For those who work on the frontline in the Mental Services our policy for ourselves and for those we work with is ‘Prevention is better than cure’.  Meaning the focus should be on maintaining ours and the populations Mental Health and Wellbeing to stay in good order.  However it needs to be considered if there is correlations with regard to:

 

a)      How many Clinicians work directly with patients in CAMHS/Adult Mental Health Outpatient Services.

b)      The allocated time they are given to work with both low level and high level of risky patients and how that ratio is calculated.

c)       The waiting time for patients to be seen.

d)      The number of patients being re-referred back into the CAMHS and Adult Mental Health Services.

e)      The number of young people and adults who have taken their own lives who were open to CAMHS/ Adult Mental Health services.

f)        The number of young people and adults who have taken their own lives who had previously been open to CAMHS/ Adult Mental Health services but were closed to the services at the time when they committed suicide.

g)       The number of staff going off sick in the CAMHS and Adult Mental Health services and the length of time they are off.

h)      The number of staff leaving their jobs in the CAMHS and Adult Mental Health Services.

i)        The number of complaints from Patients and their families in the CAMHS and Adult Mental Health Services.

j)        The comparison of the figures of all the above issues from March 2016 to March 2021 that will include the start of covid in March 2019.

 

4.0   It is believed that all of the above could be contributing to not supporting children and adults with Mental Health Conditions.  

 

 

4.1.1         An increase in the recruitment of Band 3 staff to perform clinical duties is required but first a Training program, Job Description or Policies and Guideline measures put in place first. These duties could include clinical assessments for Autistic Spectrum Disorder (ASD), Attention Deficit Hyperactive disorder (ADHD), Learning Disabilities and Safeguarding issues. 

 

 

4.1.2         It is however PARAMOUNT that increasing Band 3, 4 staff and Band 5 Nurses work and responsibilities should be done with consultation, negotiations, and agreements, so as to reflect these increase of duties and responsibilities in their pay.  This should also be started from the beginning with clear Job progression pathways.

 

4.1.3         That CAMHS Clinicians ratio of Clinical time and Admin time needs to be no less than 30% Admin time and 70% Clinical time.  These ratios will also relate to similar professions such as Social Workers, Health Visitors etc.

 

4.1.4         The allotted times that were my own calculations at the time was that 12.5% was given to complete admin tasks.  This does not allow sufficient time for Clinicians to complete Patient records and admin responsibilities to the Trust record keeping standards, and puts both young people at risk and causes higher levels of stress and anxiety in the service with the addition of lowering the confidence levels of staff.  It is PARAMOUNT that the correct ratio’s of Admin time and Clinical time is calculated to include the level of complexity of patients rated 1-4 and other additions such as Continual Development Training, mandatory training etc to be taken into consideration.

 

4.1.5         The NHS is under unprecedented pressure that is acknowledged but it needs to be investigated if CQC inspections are being pre-prepared for so as to meet a high standard for the CQC Grading.  If a true reflection of standards is not given then, the NHS System is deemed to be working better than it really is and no improvements will be required.  It is understandable that Managers will want their areas to be seen as exemplary but is this giving a false indication of what improvements are really needed?

 

 

5.0   It is felt that it would be in the best interest of our Patients, Children and all Care Workers for the Secretary of State to agree by 01/08/22 to commission Professor West and his team to then collate and review the following Information from NHS England for all NHS Hospitals Trusts and private Hospitals information within England by 01/08/23 so that Stage 3 can be implemented and Completed by June 2026:

 

5.1.1         The number of CAMHS Outpatients patients for each Hospital in England from March 2016 to March 2021 and staffing ratio with Banding levels.

 

5.1.2         The number of Adult Mental Health Outpatients patients for each Hospital in England from March 2016 to March 2021 and staffing ratio with Banding levels.

 

5.1.3         The number of patients seen by CAMHS Clinicians per week and the allocation of admin time to Clinician ratio in each hospital in England from March 2016 to March 2021.

 

5.1.4         The number of patients seen by Adult Mental Health Clinicians per week and the allocation of admin time to Clinician ratio in each hospital in England from March 2016 to March 2021

 

5.1.5         The average waiting time in each hospital in England before a patient was seen after being referred to CAMHS from March 2016 to March 2021.

 

5.1.6         The average waiting time in each hospital in England before a patient was seen after being referred to Adult Mental Health Service from March 2016 to March 2021.

 

5.1.7         How many patients in each hospital in England were re-referred back into the CAMHS Service between March 2016 to March 2021 and how many times were they re-referred back into CAMHS?

 

5.1.8         How many patients in each hospital in England were re-referred back into the Adult Mental Health Service between March 2016 to March 2021 and how many times were they re-referred?

 

5.1.9         How many suicides in each hospital in England occurred for patients open to the CAMHS Outpatients Service from March 2016 to March 2021? Plus the individual Suicide Investigation reports.

 

5.1.10      How many suicides in each hospital in England occurred for patients who were closed but had previously been open to the CAMHS Outpatients Service? Plus the individual Suicide Investigation reports from March 2016 to March 2021.

 

5.1.11      How many suicides in each hospital in England occurred for patients open to the Adult Mental Health Outpatients Service from March 2016 to March 2021.

 

5.1.12      How many suicides occurred in each hospital in England for patients who were closed but had previously been open to the Adult Mental Health Outpatients Service from March 2016 to March 2021.

 

5.1.13      The number of staff going off sick from CAMHS in each hospital in England from March 2016 to March 2021, plus the length of time they were off sick.

 

5.1.14      The number of staff going off sick from Adult Mental Health Services in each hospital in England from March 2016 to March 2021, plus the length of time they were off sick.

 

5.1.15      The number of staff leaving their jobs in CAMHS in each hospital in England from March 2016 to March 2021, plus the reasons they gave for why they were leaving.

 

5.1.16      The number of staff leaving their jobs in Adult mental Health Services in each hospital in England from March 2016 to March 2021, plus the reasons they gave for why they were leaving.

 

5.1.17      The number of complaints from Patients and their families in the CAMHS in each hospital in England from March 2016 to March 2021, plus the reasons for the complaints.

 

5.1.18      The number of complaints from Patients and their families in the Adult Mental Health Service in each hospital in England from March 2016 to March 2021, plus the reasons for the complaints.

 

6.0   How are ALL Children’s Care Assistant/Nurse staffing levels in each hospital in England calculated and maintained? The latest version of the guidance regarding this would be required.

 

7.0   How are ALL Adult Care Assistant/Nurse staffing levels in each hospital and Care Home in England calculated and maintained in England? The latest version of the guidance regarding this would be required.

 

7.1.1         How are Health Boards in England regulated to comply with safe staffing levels?

 

7.1.2         How do ALL the above compare with the statistics of Australia and Wales.  Plus those of Scotland who as well as Staffing levels have included Social Care into their Act? (The Secretary of State would only need to ask the Government leaders of Australia, Wales and Scotland for this information because it is in the best interest for ALL People they surely will give it freely, as it is hoped that the Secretary of State would also give this information freely to the Irish Government and any International countries of Development).

 

7.1.3         How do the statistics for elderly care homes in England compare with those of Switzerland. (The Secretary of State has only to ask the Government leader of Switzerland for this information, because it is in the best interest for ALL People they surely will give this freely, as surely the Secretary of State The Rt Hon Priti Patel will give this information freely to the Irish Government and any International countries of Development.

 

8.0    

8.1.1         In the CHSC Committee report (June 2021) it also states:

 

‘After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.’ (Paragraph 182)

 

 

8.1.2         As the Health and Social Care Committee was appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health & Social Care, it is asked that for the sake of transparency the Committee include Professor Michael West’s team (Kings Fund), and the delegates from the 90 Organisations in all meetings and decisions, with the additional provision that a member of all these Unions from the 90 Organisations can also attend all or any of these meetings taking place.

 

8.1.3         So that agreements are honoured made by the Secretary of State, needs to be brought to the attention of the Court and ratified in the presence of 3 High Court Judges recommended:

 

 

 

This proposal was forwarded to the below people so that they are able to make an informed decision for themselves on this issue:

 

 

Final Words

 

As some-one who has worked on the shop floor for the last 15 years and has extensive knowledge and experience of working as, and with; Care Assistants, Youth Workers, Teaching Assistances, Family Support Workers, SENCO’s, General Adult Nursing, General Paediatric Nursing and now as a CAMHS Staff Nurse, it is very much hoped that the committee will accept that the above proposal is what is required from the ground force workers point of view for both their wellbeing and for that of the people that they care for.

 

It is felt that the NHS and the work its staff do has now been recognised by the nation, but for such a plan to succeed it would require not just an increase in the NHS workforce and their responsibilities but also that of other services.  It is hoped that the Committee will recognise the importance of all lower paid Bands responsibilities being increased, and that this should be reflected in a fair wage and progression pathways from the start.

As stated in the document the latest version of the guidance of how ALL Adult Care Assistant/Nurse staffing levels in each Hospital and Care Home in England are calculated and maintained; with the same for Children’s Care Assistants/Nurses in each hospital is required. Also required is information on how Health Boards in England are regulated to comply with safe staffing levels at this moment in time.

 

January 2022

 

Royal College of Physicians:

https://www.rcplondon.ac.uk/guidelines-policy/strengthening-workforce-planning-health-and-care-bill-coalition-principles

 

Commons Health and Social Care Committee Report:

https://publications.parliament.uk/pa/cm5802/cmselect/cmhealth/22/2202.htm

 

Clerk for the Commons Health and Social Care Committee hsccom@parliament.uk