Inexperienced managers cause NHS funding woes, says Carter

It is timely that the new nurses’ head has a background in mental health. But Peter Carter tells Simeon Brody he will act for nurses across the board

Some campaigners might be disappointed to hear that, despite his strong mental health background, incoming Royal College of Nursing general secretary Peter Carter insists he will represent all types of nurse equally.

The former psychiatric and general nurse takes up his position this week after 12 years as chief executive of Central and North West London Mental Health NHS Trust.

But although mainstream health issues such as NHS restructuring and a pension crisis within the RCN will be high on his agenda, mental health issues are also likely to be taxing.

The NHS financial crisis has had a heavy impact on mental health services, with charity Rethink claiming 11 areas have announced cuts totalling £37m in the past six months (news, page 8, 23 November).

Although many areas have suffered, Carter says the London trust he ran managed to prevent any of the financial problems in other parts of the health services being passed on through tough negotiating and “good joint working”.

Under his leadership, the trust always balanced its books. Indeed, he blames the NHS for many of its own funding problems.

“The NHS has done well from this government,” he says. “There are copious examples where the money has not been well spent.”

In a paper he presented to MPs in June, Carter said the crisis had been caused by the creation of too many primary care trusts with inexperienced management bureaucracies.

He noted that mental health services in England were under severe pressure to make cuts, reducing the number of acute beds and paring some of the new early intervention and assertive outreach teams.

Carter believes the lack of investment in such services is particularly disappointing because the payback would be significant.

He says the development of crisis resolution teams helped his trust cut the number of acute admission beds from 41 to 29 since 2000 and save millions of pounds. “Payback is not decades away, it’s just a few years away. There’s a clinical benefit but there’s also a financial benefit.”

Carter started as a psychiatric nurse in 1968 since when he says there has been a “revolution” away from remote, impersonal institutional care. But he is clear there will always be a need for in-patient beds.

“It’s important that the NHS and society recognises that there are some people who will need very long-term residential care.”

But the new community teams are seen as a more attractive option for psychiatric nurses, with vacancies in acute in-patient care more difficult to fill. Carter says: “The work in acute admission wards is incredibly demanding and at times unrewarding.

Many are full most of the time and people on them are profoundly ill and very difficult and disturbed.”

Carter says more resources must be invested in training, development and infrastructure in acute settings. And nurses’ pay must be reviewed.

He also believes more bespoke facilities must be developed to treat people with personality disorders.

The challenges presented by people with severe personality disorders are at the centre of the debate on the Mental Health Bill, now making its way through parliament. Carter has sympathy for both sides of the argument over abolition of the “treatability” test, which requires people to be considered treatable before they can be sectioned.

“It’s about having due respect for the individual’s civil rights, while trying to ensure that where people do think ‘this man is going to be dangerous’ steps are taken to help the individual as well as society.”


FAVOURITE BOOK: The Catcher in the Rye by JD Salinger

INSPIRATION: “Dr Peter Bruggen: a psychiatrist from whom I learned so much”


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Simeon Brody


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