Doctors were shocked to discover the latest cash-saving wheeze from NHS England to axe the dedicated mental health support for hospital doctors offered by the Practitioner Health Programme (PHP), but after an outcry from across the medical profession, the scheme was given a last-minute reprieve.
The service – the largest publicly-funded mental health staff treatment service in the world – costs just £11m a year (0.007% of the NHS budget) to run. It has treated 32,000 since 2008 and currently treats 6,000 patients a year.
On Friday it was announced the PHP would halt new registrations from hospital doctors on April 15, although the closure of similar support for primary care doctors has been held off until March 31 next year.
A cascade of criticism rolled across social media from medics across the NHS and their representatives, including strong condemnation from the BMA. Then in a sudden turnaround, NHS England confirmed that new registrations from hospital doctors would be allowed for another year, but the long-term future of the service remains in doubt.
The outcry against the cut
Former hospital doctor Adam Kay commented:
“This is disastrous, hideous news. NHS England are hacking back the mental health support for hospital staff. One doctor takes their life every three weeks. One nurse takes their life every single week. These numbers will now INCREASE.”
Author and doctor Rachel Clarke, who has published an Open Letter to the Health Secretary and NHS England’s CEO Amanda Pritchard, said on X/Twitter:
“Breaking/ Appalling news that @DHSCgovuk has decided to stop funding mental health services for hospital doctors from Monday. When I was broken & traumatised during Covid, sessions with an @NHSPracHealth psychologist helped me back on my feet. How can the govt suspend this?”
She added: “The government & @NHSEngland know full well the extent of post-Covid trauma & moral injury among frontline NHS staff. To pull the plug on vital psychological support is awful.”
Anton Emmanuel posted: “A statement put out on a Friday afternoon, followed by rushed patch-up comms attempts over the weekend. Calculated disregard for the welfare of staff at a time when morale is rock bottom. A gut punch to vulnerable staff at a time we hear about the importance of retention.”
He went on: “Signposting vulnerable staff to local services is asking traumatised individuals to seek help from within the organisation that is often the source of the trauma. Like our speaking up processes, it therefore is likely to not be accessed by those most in need.”
Another post ironically thanked NHS England: “Thankyou @NHSEngland. We won’t pay you what you deserve. We won’t provide you with the facilities tools and equipment to do your work . We won’t listen to your concerns and suggestions. And now we won’t support you when you burn out.”
The attempted defence
Former NHS providers CEO Chris Hopson, who jumped ship to take a post as NHS England’s “Director of Strategy”, and now claims to be “On a mission to inform and explain what is going on in the NHS” was wheeled out on X/Twitter to attempt to counter the criticisms in a series of posts. He began with an empty and meaningless assurance – but offered no serious explanation. He claimed the PHP had been closed prior to a “review”:
“@NHS England is committed to ensuring all NHS staff receive the mental health support they need. The vast majority of this provision is, and always has been, via their employer’s health and wellbeing schemes. There is no change to those services. … We are reviewing the current Practitioner Health service that is provided for doctors and senior managers in secondary care, as part of a wider review to ensure that all NHS staff groups have the support they need.”
Closing a proven and effective service before any “review” is such a nonsense, and suggesting that trust level occupational health schemes are a valid alternative simply increased the anger. @Catherine Williams posted:
“Anyone who has worked in the NHS will recognise that trusts’ health and wellbeing schemes are entirely inadequate for this: slow, unresponsive, intimately connected with the employer (raising anxiety about safety and confidentiality) and in many cases “not a treatment service.”
Hopson’s efforts triggered a further volley of additional critical comments, and a demand for proper information on who had taken the decision, why and when. Megsenmumdr posted a few telling questions:
“Whose unilateral decision was this anyway? Yours? Coming from @DHSCgovuk? Can you be transparent please & share minutes of the meetings which led to this decision so we can understand rationale & what pro/cos were discussed? Or do we have to FOI to get that?”
Following Friday’s announcement volunteers were primed to step in. Frontline19, a non-profit organisation that offers free counselling support to health care professionals (but which already has a waiting list), has also condemned “this terrible decision to withdraw support”, and urged doctors in need of help “please know that you are not alone.”
The history
The PHP began on a very small scale back in 2008. Last year, as she marked its 15th anniversary, PHP’s CEO Lucy Warner described the early days:
“there were just three of us in the team and we had pilot funding for a year to test the concept in London. I don’t think we could have imagined what the service would grow to be, covering England, Scotland, Isle of Man, Guernsey, and Jersey.”
Little could she imagine after all that progress that PHP would be cut back down again by NHS England.
The service grew because it clearly met a specific need, as The Wounded Healer, the document marking its tenth anniversary in 2018 reported:
“Survey results from PHS patients show:
- 93% are extremely likely/likely to recommend PHS to a friend or colleague
- 88% say PHS has had a very positive or positive impact on their personal wellbeing
- 81% say PHS has had a very positive or positive impact on their family life
- 78% say PHS had a very positive or positive impact on their ability to work or training.”
The same document explained the underlying reason why the service was so essential:
“Briefly, despite having higher rates of mental illness than the general population, doctors have poor access to healthcare, especially mental health services. Doctors have a host of personal, professional and institutional barriers to accessing care when they need it. Some of these barriers are practical – even managing to make an appointment can be difficult due to long, irregular hours or registering with a general practitioner when regularly moving address.”
Whether NHS England could generate any genuine cash savings from this wretched decision is open to doubt: the increased toll of mental ill health will create problems in staffing and sustaining services, and gaps in the medical workforce will lead to more locums being recruited at higher cost.
Impact upon moral
The decision to kill it off was announced on the same day as a General Medical Council report set out some of the reasons doctors were leaving the UK, including:
“Feeling undervalued, a lack of progression opportunities and disillusionment with the UK’s healthcare systems, are just some of the motivations researchers identified that make doctors want to leave.”
The long-term further blow to the morale of a medical profession that has endured the PPE scandals and the Covid pandemic, seen the value of their pay slashed by years of austerity, been forced into repeated strikes in the effort to win a fair settlement, and seen how unwilling trust bosses and NHS England have been to stand up for them will be counted over the coming years.
In the meantime, with NHS England turning deaf ears to protest, the focus is on the faint hope of persuading the latest Health and Social Care Secretary, Victoria Atkins, to intervene and overturn a woeful decision.
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* The pressures are not only getting to doctors. A survey of over 12,000 UNISON health workers across the UK found more than three in ten (31%) had to take time off work with mental health issues in the past year.
Panic attacks, high blood pressure, chest pains and headaches are among physical signs of stress reported by nurses, porters, 999 call handlers and other NHS staff who completed the survey. Some also said they experienced depression, low mood, sleepless nights and flashbacks.
Of those who were off with mental health problems, one in five did not tell their employer the real cause of their absence. The main reason they gave for this was they did not feel their manager or employer would be supportive (45%). More than one in five (22%) said they did not want their colleagues to know they had mental health issues.
Almost a quarter (24%) had felt able to ask their employer for help with their mental health in the previous 18 months. But nearly half (48%) of them said they did not feel supported having done so.
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