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Mental Health

Mental health nurses should be able to issue fit notes

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Image: © Monkey Business

The Thriving at Work report suggests doctors are not always best equipped to provide advice to people with mental health conditions.

The Thriving At Work report, commissioned by Theresa May, recommends that mental health nurses alongside other multidisciplinary healthcare professionals be allowed to sign ‘fit notes’ for patients as the report suggests they can be better equipt to offer advice.

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Currently, ‘fit notes’, commonly known as ‘sick notes’, can only be issued by doctors. The ‘fit note’ outlines the support a patient should be receiving from their employer and when they are expected to be able to return to work.

The Thriving At Work report says;

“There is limited evidence that the current fit note process is effectively encouraging GPs and patients to discuss work and health.

“Currently, only GPs and hospital doctors can sign a fit note, and many think that they are often not best equipped to provide employment advice for people with a mental health condition.

“Many are concerned about the implications of ticking “may be fit for work” when support might not be available to the individual.

“We recommend that the responsibility for completing fit notes is extended to mental health professionals, and that the government considers how to further improve communication between health professionals, employees and employers where appropriate”.

The currently ‘fit note’ system is under review by the government.

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Mental Health

Steep rise in reported assaults against NHS staff

There were 18,720 assaults in 2016/17 compared to 15,469 the previous year.

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Last year in England physical assaults on NHS staff rose by nearly 10% compared to 2015/16, according to new figures published today by UNISON and HSJ.

The figures were obtained following a Freedom of Information request – submitted by HSJ working on behalf of UNISON – to all the 244 NHS trusts in England. Answers were received from 181 organisations.

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The biggest increase was in the acute sector, with reported attacks on health workers in hospitals with an A&E department up a staggering 21%, says UNISON. There were 18,720 assaults in 2016/17 in the acute trusts who responded, compared to 15,469 the previous year.

The data collected suggests that last year NHS trusts struggling to meet their performance targets were likely to fare particularly badly. Trusts who treated 90% or fewer of their patients within 18 weeks of referral saw an average increase in reported assaults of 36.2% in 2016/17, up 1,857 on the previous year.

Similarly, NHS trusts struggling with huge financial deficits were also likely to have witnessed a big rise in the number of reported attacks on staff, according to the data.

The HSJ/UNISON figures suggest that assaults in the trusts that are more than £20m in the red were up 23.1% on the previous year. This compares to an increase of just 1.5% for organisations that were comfortably in the black, and had surpluses in excess of £5 million.

The trusts responding to the FoI request reported physical assaults on staff of 56,435 in 2016/17, a 9.7% increase on the 2016/16 data.

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If these figures are extrapolated to cover the whole of the NHS in England, the number of reported violent incidents in 2016/17 is likely to be closer to 75,000, the equivalent of 200 every single day.

When measured per 1,000 staff, the rise in reported assaults was 6% on the 2015/16 figures.

UNISON asked HSJ to carry out the research, as it is concerned that since the abolition of NHS Protect last year, there is no meaningful collation or comparison being made of the data on assaults.

Commenting on the figures, UNISON head of health Sara Gorton said: “Across the entire NHS, staff shortages are harming patient care and helping to create a hostile environment where health workers are increasingly at risk of being assaulted.

“It’s no accident that trusts where the pressures seem the most extreme – where there are huge financial deficits or where it’s a struggle to meet growing demands on services – have seen the steepest rise in the number of attacks. This desperate situation is only set to worsen as the squeeze on resources gets tighter.

“Now that there is no NHS or government organisation collecting data on assaults nationally, the picture is growing increasingly unclear. The safety of staff, who care for us when we are sick or injured, and their patients should be paramount. The government should reverse its ill-thought out decision to axe NHS Protect immediately”

Although staff working in mental health are seven and a half times more likely to be attacked, this was a smaller increase from 2015/16 of 5%. This seems to suggest the sector is having some success in preventing a difficult situation from getting any worse.

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Mental Health

NHS short of more than 100,000 staff

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New research estimates that the NHS is short of 42,855 Nurses, 11,187 Doctors and 12,219 Healthcare Support Workers.

Freedom of Information requests by the Labour Party has revealed that the NHS is short of nearly 100,000 Doctors, Nurses and Healthcare Support Workers. These figures show a significant rise over the last year and come only a month after NHS Employers said staff shortages in the NHS pose a fundamental risk to patient safety.

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The figures show that 82 NHS trusts had 35,993 unfilled full-time equivalent posts, representing a 9% vacancy rate. With some of the worse trusts being;

  • Guy’s and St Thomas’ NHS Trust in London had 1,610 vacancies – 10% of its overall workforce.
  • Central Manchester University hospitals had 1,304vacancies.
  • Heart of England in Birmingham had 1,236vacancies.
  • London’s Royal Free had 1,225vacancies.

The information demonstrated that mental health services are experiencing some of the worst understaffing, raising questions over ministerial pledges to boost the workforce by 21,000 by 2022.

Janet Davies, Chief Executive and General Secretary of the Royal College of Nursing, responding to Labour analysis on vacancy levels in the NHS, said:

“This analysis pulls back the curtain on the state of staffing in the NHS this winter. Despite Ministers’ rhetoric on the importance of safety, it will enter a perilous January without enough staff to give safe care.

“Nurses are spread too thinly and starting to blow the whistle on falling standards. Hospital wards and care homes alike increasingly rely on unregistered healthcare assistants, especially at night. The Government must no longer allow nursing on the cheap – patients, particularly vulnerable and older individuals, can pay the highest price.

“The NHS has never been busier and yet it is haemorrhaging experienced nurses quicker than it can find new ones. A lethal cocktail of pressure inside the NHS and falling pay has left people heading for the door. The NHS advertises for nurses but, too often, new uniforms stay in the box.

“It is time to draw a line under this false economy with a new law and investment in nurse education. We need legislation that makes Ministers and others accountable for proper workforce planning and safe and effective staffing levels.”

The report has sparked fresh concerns over patient safety as nursing and medical roles remain unfilled.

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Mental Health

Urgent winter plan is needed to give homeless access to NHS care

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The lack of NHS care for homeless and rough sleepers must be addressed in time for the hardest winter months.

Writing in The Big Issue, Janet Davies calls for an urgent plan from ministers and the NHS to encourage people without a fixed address to register with a GP surgery. Too many do not have their health concerns addressed and are repeatedly admitted to A&E at ‘crisis point’, she adds.

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The Royal College of Nursing (RCN) Chief Executive and General Secretary calls on ministers to “pull out all the stops” to prevent people being discharged from mental health hospitals back onto the streets. In a piece to launch a partnership with the charity, she calls for investment in specialist mental health care for homelessness people after services saw funding cuts.

Davies says that too many homeless people mistakenly believe that proof of address is required to join a doctor’s surgery and highlights a scheme by London’s NHS to raise awareness through cards at shelters and food banks. Emergency admissions to A&E occur at least four times more often for somebody who is homeless than the rest of the population.

From this month, the RCN becomes an official partner of The Big Issue in a three-year arrangement that includes sole sponsorship of the iconic red tabards worn by vendors.

Janet Davies also calls for improved training for nursing staff and NHS professionals on the causes and consequences of homelessness and where wider support can be found in order to make the most from every encounter.

In the article, Davies writes:

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“Winter is fast approaching and the four Governments of the UK and their NHS must agree a rapid plan to make routine care and treatment more easily available during these harsh months. They must redouble efforts to let those without a fixed address know that GPs are able to make exceptions and make sure surgeries are left in no doubt.

“The barriers to accessing healthcare – getting through the door of the NHS in some form – must not be underestimated. And these obstacles can mean health problems remain untreated until somebody reaches crisis point, with a cycle of repeated A&E visits and overnight stays that fail to deal with underlying issues.

“Rough sleeping makes it harder to access longer-term health support too such as mental health services. Specialist homelessness mental health teams have been subject to major funding cuts and even disappeared entirely while other services struggle to support people who face multiple complex problems. For others, not having a GP means there is nobody to make the necessary specialist referral.

“Ministers should pull out all the stops to make sure people being discharged from mental health hospital have a real alternative to the street.

“A nurse’s role focuses on maximising potential and enabling independence – which is why we believe supporting the work of The Big Issue is so relevant for us. Nursing staff are ready to play a part in making this winter and the year that follows it a much-needed moment of change.”

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