by Terry Skyrme, social worker and Approved Mental Health Professional
I have been a qualified social worker since 1972, right at the birth of the generic social services department. In a few weeks time I will complete my last shift. I’ve felt driven to retirement. This post aims to explain why.
For the last five years I’ve worked as a social worker for a mental health crisis team and as an Approved Mental Health Professional (AMHP) in Norfolk.
When I joined, the team had five social workers. We managed to carve out the space to do proper social work. We worked at times of crisis with patients and their families to help resolve social and family problems. We carried out our duties as AMHPs and had a degree of pride in our work. We truly felt we were making a difference, protecting patients’ rights, advocating for their entitlement to services and using our knowledge of local resources.
I realise now we were lucky. When our mental health trust became a foundation trust in 2009 things changed. The trust claimed this as a great achievement. In retrospect, it heralded the beginning of serious cutbacks.
It brought in a culture where the thing that mattered most was balancing the books or else Monitor would takeover. Then came the so-called Nicholson challenge – the quest to find £20bn of ‘efficiency savings’ across the NHS. In our trust, that led to a £40m cost-saving programme, the ‘radical redesign of services’.
Suddenly our community services were cut back and there were not enough beds to meet the demand for inpatient admissions. By 2012 we were finding it difficult to admit patients to our local psychiatric hospital due to no beds being available. Gradually the crisis has worsened and it can now be a weekly event that no psychiatric beds will be available in Norfolk and Suffolk.
We reached a peak this year where 40 patients from our area ended up placed in private hospitals all across the country. What this meant for us as AMHPs is that we could no longer practise safely, professionally, ethically, and sometimes, it felt, not lawfully. Informal admissions (as opposed to compulsory admissions under the Mental Health Act) became more difficult to arrange; the safe, human conveyance (transport) of patients became more difficult to ensure, and alternatives to hospital admission ceased to exist.
Locally we saw a rise in unexpected deaths of patients under our so-called care. As AMHPs we called for meetings with the chief executive, we wrote to the CQC, to Norman Lamb, our local NHS commissioners and others but to little substantial effect. Our own trust continued to deny a crisis and even claimed they were enhancing community services.
Since November last year, I have been part of a group that launched a Campaign to Save Mental Health Services in Norfolk and Suffolk. We have been successful in uniting staff, patients, relatives, trade unions and community groups under our banner.
Personally I’m exhausted. Days on AMHP duty are becoming a nightmare. The delay in finding beds and arranging conveyance means that AMHPs are working incredibly long hours when on duty. The other week I started at 8am and finished at 1am the next day. We are losing AMHPs rapidly, some to sickness and some are giving up altogether. We calculate that we have lost 14 AMHPs this year.
Things have reached the point where the police are so concerned about the infringements of people’s rights that they are now issuing letters to AMHPs when we are unable to detain someone who is in police custody because there is no bed.
I’ve chosen October 1 as my day to retire. The same day our AMHPs and mental health social workers are being transferred back to Norfolk council as the section 75 agreement the council had with the trust broke down earlier this year.
I’m not in the scope for the TUPE transfer and the trust has not indicated to me that they want me to stay on. In any case, I fear that the opportunity for real social work will no longer exist. Best of luck to my colleagues who remain; I will be devoting more energy to the campaign to save mental health services.