Department of Health and Social Care
Central Government
Action Taken
The Department states that GMMH undertook a Root Cause Analysis which did not reveal a shortage of beds as a contributory factor, but patient flow continues to be a main priority. In addition, the Department is investing £150 million for significant improvements in the mental health estate over the course of the Spending Review (2021). (AI summary)
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Dear Ms Mutch,
Thank you for your letter of 28 April 2022, to the Secretary of State for Health and Social Care, about the death of Laura Medcalf. I am replying as Minister with responsibility for Mental Health, and thank you for the additional time allowed. Firstly, I would like to say how saddened I was to read of the circumstances of Ms Medcalf’s death, and I offer my sincere condolences to her family and loved ones. The circumstances your report describes are very concerning and I am grateful to you for bringing these matters to my attention. In preparing this response, my officials made enquiries with NHS England (NHSE), the Care Quality Commission (CQC).
I understand that several actions have been taken following Ms Medcalf’s death. A Root Cause Analysis was undertaken by Greater Manchester Mental Health NHS FT (GMMH) as a result of Ms Medcalf's death in line with the patient safety and serious incident process. This did not reveal that a shortage of beds was a contributory factor in this case. However, patient flow continues to be a main priority for the mental health system at a local, regional and national level. You may wish to know that GMMH are addressing these issues through the purchase of independent sector beds, alongside increased investment in schemes and workforce initiatives to support patient flow. In addition, system partners continue to support All-Age Mental Health Liaison teams in A&E and the advisory capacity they offer across Greater Manchester.
You may also wish to note that the Department is investing £150 million for significant improvements in the mental health estate over the course of the Spending Review (2021). This will be used to support our NHS Long Term Plan ambitions regarding system capacity and pressure reduction. It will cover a range of schemes, including non-medical alternatives to admission, step-down community beds and supported living services.
We are also investing £300 million over this Spending Review to eradicate mental health dormitories by 2024/25. By 2024/25, over 1200 beds in mental health dormitories across more than 50 sites will be replaced with single, en suite rooms. Although this may impact bed availability temporarily, it will support patients by improving their care, safety and sense of dignity. An additional £116 million was invested in the NHS in 2021/22 to support people to be discharged safely and appropriately from mental health inpatient units. Improving flow will help ensure beds are available to those most in need. Major expansion in funding for community mental health services commenced in all areas in 2021/22, which has been key to managing pressures on beds. As set out in the NHS Long Term Plan, our aim is to improve community support for serious mental illnesses
to avoid the need for an inpatient admission where possible. We continue to work closely with NHS England to monitor this. The Department is also fully committed to attracting, training, and recruiting the mental health workforce of the future. Through our plans set out in Implementing the Five Year Forward View for Mental Health1 and Stepping Forward to 2020/2021: The mental health workforce plan for England2, the Department have expanded and diversified the types of roles that are available. "Stepping Forward” set out an ambition for 21,000 new posts (professional and allied) across the mental health system occupied by 19,000 new staff by 2020/21. The 19,000 new staff target has now been met and as of June 2022 there were 133,573 full time equivalent (FTE) from a baseline of 109,118 in March 2016. This includes only those people who work directly on mental health, across NHS Trusts, NHS Foundation Trusts and integrated care boards. In addition to the level of growth set out in “Stepping Forward”, the NHS Mental Health Implementation Plan 2019/20–2023/243 sets out the need for the mental health workforce to grow by over 27,000 during this time frame to support the expansion and transformation of NHS mental health services and give an extra two million people the mental health support they need. The Department invested £111 million in 2021/22 to grow the mental health workforce towards delivering these ambitious commitments. You may also wish to note that Health Education England and NHS England have been working with integrated care systems (ICSs) to confirm plans to 2024 . This will aim to ensure a system-wide effort to meet the Mental Health Implementation Plan ambition, looking across service models, supply, retention, and recruitment. You also raise the matter of Covid-19 measures, including lockdown. The Covid-19 pandemic required the Government to put a number of unprecedented measures in place, including shielding, social distancing and local and national lockdowns. We know that the pandemic and these measures have had, and will continue to have, an impact on the mental health and wellbeing of many people. That is why we published our Mental Health Recovery Action Plan4 in March 2021, backed by an additional £500 million for 2021/22, to accelerate our expansion plans in order to address waiting times for mental health services, give more people the mental health support they need, and invest in the NHS workforce. This is on top of the NHS Long Term Plan commitment to increase spending on mental health services in England by at least £2.3 billion a year by 2023/24. You will be aware that there will be an independent public Inquiry into the handling of the Coronavirus pandemic, which is set to begin its work in Spring 2022. The Prime Minister has appointed the Rt Hon Baroness Heather Hallett DBE as Chair of the Inquiry. The Government is committed to learning lessons from COVID-19 to inform our preparedness for future pandemics and the Department will respond openly and transparently and fully consider all recommendations made by the Inquiry. On patient safety more widely, you may be aware of recent allegations of mistreatment at the Edenfield Centre in Prestwich, another hospital that is part of GMMH. This featured on a recent episode of the Panorama programme, which aired on 28 September.
1 https://www.england.nhs.uk/wp-content/uploads/2016/07/fyfv-mh.pdf 2 https://www.hee.nhs.uk/sites/default/files/documents/Stepping%20forward%20to%20202021%20- %20The%20mental%20health%20workforce%20plan%20for%20england.pdf 3 https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20- 2023-24.pdf 4 https://www.gov.uk/government/publications/covid-19-mental-health-and-wellbeing-recovery-action-plan
In response, NHS England’s National Mental Health Director, Claire Murdoch, wrote to the Chief Executives of all NHS mental health, learning disability and autism service providers in England asking them to review the safeguarding of care in their organisations and identify any immediate issues requiring action now, review how the patient voice is being heard in their organisations and how it is being acted on, and take steps to tackle and reduce the use of restrictive interventions. Also, as part of the NHS Patient Safety Strategy, the NHS Long Term Plan commits to a new Mental Health Safety Improvement Programme, which has set up mental health Patient Safety Networks covering all regions in England. 47 NHS Trusts and 5 private providers of NHS inpatient services for people with poor mental health, people with a learning disability and autistic people are being provided with improvement support by the regionally-based Patient Safety Collaboratives, made up of NHS providers and commissioners. The Patient Safety Networks have also recruited Trusts to focus on reducing restrictive practices. But I know there is much more to do to improve the experiences, and outcomes for people needing support with their mental health. The Government launched a public call for evidence on what can be done across government in the longer term to support mental health, wellbeing and suicide prevention. The call for evidence closed on 7 July 2022 and we are currently analysing over 5,000 responses received. Finally, for the workforce as a whole, we have commissioned NHS England to develop a high-level long-term workforce plan. The plan will look at the mix and number of staff required across all parts of the country for the whole NHS workforce and will set out the actions and reforms that will be needed to reduce supply gaps and improve retention. NHS England are engaging with a broad range of stakeholders in developing this plan and it is due to be completed by the end of 2022 It is unacceptable that this death has happened, and we will take the shared learnings from this case to push progress forward. I hope this reply helps to reassure you that partners across the health system are working to make improvements on the basis of this report to prevent this happening in future.
MARIA CAULFIELD MP
Thank you for your letter of 28 April 2022, to the Secretary of State for Health and Social Care, about the death of Laura Medcalf. I am replying as Minister with responsibility for Mental Health, and thank you for the additional time allowed. Firstly, I would like to say how saddened I was to read of the circumstances of Ms Medcalf’s death, and I offer my sincere condolences to her family and loved ones. The circumstances your report describes are very concerning and I am grateful to you for bringing these matters to my attention. In preparing this response, my officials made enquiries with NHS England (NHSE), the Care Quality Commission (CQC).
I understand that several actions have been taken following Ms Medcalf’s death. A Root Cause Analysis was undertaken by Greater Manchester Mental Health NHS FT (GMMH) as a result of Ms Medcalf's death in line with the patient safety and serious incident process. This did not reveal that a shortage of beds was a contributory factor in this case. However, patient flow continues to be a main priority for the mental health system at a local, regional and national level. You may wish to know that GMMH are addressing these issues through the purchase of independent sector beds, alongside increased investment in schemes and workforce initiatives to support patient flow. In addition, system partners continue to support All-Age Mental Health Liaison teams in A&E and the advisory capacity they offer across Greater Manchester.
You may also wish to note that the Department is investing £150 million for significant improvements in the mental health estate over the course of the Spending Review (2021). This will be used to support our NHS Long Term Plan ambitions regarding system capacity and pressure reduction. It will cover a range of schemes, including non-medical alternatives to admission, step-down community beds and supported living services.
We are also investing £300 million over this Spending Review to eradicate mental health dormitories by 2024/25. By 2024/25, over 1200 beds in mental health dormitories across more than 50 sites will be replaced with single, en suite rooms. Although this may impact bed availability temporarily, it will support patients by improving their care, safety and sense of dignity. An additional £116 million was invested in the NHS in 2021/22 to support people to be discharged safely and appropriately from mental health inpatient units. Improving flow will help ensure beds are available to those most in need. Major expansion in funding for community mental health services commenced in all areas in 2021/22, which has been key to managing pressures on beds. As set out in the NHS Long Term Plan, our aim is to improve community support for serious mental illnesses
to avoid the need for an inpatient admission where possible. We continue to work closely with NHS England to monitor this. The Department is also fully committed to attracting, training, and recruiting the mental health workforce of the future. Through our plans set out in Implementing the Five Year Forward View for Mental Health1 and Stepping Forward to 2020/2021: The mental health workforce plan for England2, the Department have expanded and diversified the types of roles that are available. "Stepping Forward” set out an ambition for 21,000 new posts (professional and allied) across the mental health system occupied by 19,000 new staff by 2020/21. The 19,000 new staff target has now been met and as of June 2022 there were 133,573 full time equivalent (FTE) from a baseline of 109,118 in March 2016. This includes only those people who work directly on mental health, across NHS Trusts, NHS Foundation Trusts and integrated care boards. In addition to the level of growth set out in “Stepping Forward”, the NHS Mental Health Implementation Plan 2019/20–2023/243 sets out the need for the mental health workforce to grow by over 27,000 during this time frame to support the expansion and transformation of NHS mental health services and give an extra two million people the mental health support they need. The Department invested £111 million in 2021/22 to grow the mental health workforce towards delivering these ambitious commitments. You may also wish to note that Health Education England and NHS England have been working with integrated care systems (ICSs) to confirm plans to 2024 . This will aim to ensure a system-wide effort to meet the Mental Health Implementation Plan ambition, looking across service models, supply, retention, and recruitment. You also raise the matter of Covid-19 measures, including lockdown. The Covid-19 pandemic required the Government to put a number of unprecedented measures in place, including shielding, social distancing and local and national lockdowns. We know that the pandemic and these measures have had, and will continue to have, an impact on the mental health and wellbeing of many people. That is why we published our Mental Health Recovery Action Plan4 in March 2021, backed by an additional £500 million for 2021/22, to accelerate our expansion plans in order to address waiting times for mental health services, give more people the mental health support they need, and invest in the NHS workforce. This is on top of the NHS Long Term Plan commitment to increase spending on mental health services in England by at least £2.3 billion a year by 2023/24. You will be aware that there will be an independent public Inquiry into the handling of the Coronavirus pandemic, which is set to begin its work in Spring 2022. The Prime Minister has appointed the Rt Hon Baroness Heather Hallett DBE as Chair of the Inquiry. The Government is committed to learning lessons from COVID-19 to inform our preparedness for future pandemics and the Department will respond openly and transparently and fully consider all recommendations made by the Inquiry. On patient safety more widely, you may be aware of recent allegations of mistreatment at the Edenfield Centre in Prestwich, another hospital that is part of GMMH. This featured on a recent episode of the Panorama programme, which aired on 28 September.
1 https://www.england.nhs.uk/wp-content/uploads/2016/07/fyfv-mh.pdf 2 https://www.hee.nhs.uk/sites/default/files/documents/Stepping%20forward%20to%20202021%20- %20The%20mental%20health%20workforce%20plan%20for%20england.pdf 3 https://www.longtermplan.nhs.uk/wp-content/uploads/2019/07/nhs-mental-health-implementation-plan-2019-20- 2023-24.pdf 4 https://www.gov.uk/government/publications/covid-19-mental-health-and-wellbeing-recovery-action-plan
In response, NHS England’s National Mental Health Director, Claire Murdoch, wrote to the Chief Executives of all NHS mental health, learning disability and autism service providers in England asking them to review the safeguarding of care in their organisations and identify any immediate issues requiring action now, review how the patient voice is being heard in their organisations and how it is being acted on, and take steps to tackle and reduce the use of restrictive interventions. Also, as part of the NHS Patient Safety Strategy, the NHS Long Term Plan commits to a new Mental Health Safety Improvement Programme, which has set up mental health Patient Safety Networks covering all regions in England. 47 NHS Trusts and 5 private providers of NHS inpatient services for people with poor mental health, people with a learning disability and autistic people are being provided with improvement support by the regionally-based Patient Safety Collaboratives, made up of NHS providers and commissioners. The Patient Safety Networks have also recruited Trusts to focus on reducing restrictive practices. But I know there is much more to do to improve the experiences, and outcomes for people needing support with their mental health. The Government launched a public call for evidence on what can be done across government in the longer term to support mental health, wellbeing and suicide prevention. The call for evidence closed on 7 July 2022 and we are currently analysing over 5,000 responses received. Finally, for the workforce as a whole, we have commissioned NHS England to develop a high-level long-term workforce plan. The plan will look at the mix and number of staff required across all parts of the country for the whole NHS workforce and will set out the actions and reforms that will be needed to reduce supply gaps and improve retention. NHS England are engaging with a broad range of stakeholders in developing this plan and it is due to be completed by the end of 2022 It is unacceptable that this death has happened, and we will take the shared learnings from this case to push progress forward. I hope this reply helps to reassure you that partners across the health system are working to make improvements on the basis of this report to prevent this happening in future.
MARIA CAULFIELD MP