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A large pile of overlapping, three-dimensional gray question marks fills the entire image, symbolizing confusion and uncertainty often associated with navigating the NHS.

Question mark

HRT…

No, not that HRT… that’s a topic way above my paygrade.

I mean HRT in the sense of talking about the future of the NHS.

Every conversation, every DH headline should be conducted in the linguistic context of HRT. 

‘The High Rising Terminal.’  

Expressed more clearly with a new punctuation mark… the ‘NHS Question Mark’.

… HRT is, ‘the rising intonation at the end of declarative sentences’. The pitch rises at the end, turning ordinary sentences into a question.

It is common in the sociolinguistics of Austria, New Zealand and California. Speech therapists will know the work of Guy & Vonwiller (1989).

Here, in the UK… youngsters use it to invite confirmation, soften assertions. As a way of maintain listener engagement or usually to indicate shared knowledge or if they’re uncertain.

Any announcement by the DH+ should have the prosodic feature of the NHS Question Mark. For instance…

‘NHS to roll out specialised mental health accident and emergency centres.’  

Terrific, good idea but… like so many DH+ announcements, we know it ain’t gonna happen… so it should have the NHS Question mark…

‘NHS to roll out specialised mental health accident and emergency centres?’

For as long as I can remember, NHS mental health services have been the Cinderella of health care. 

There’s not much going on to persuade us otherwise… please add the NHS Question mark if you wish.

  • In September 2023, (and I don’t think much has changed since then) there were approximately 28,600 vacancies in NHS mental health services, accounting for 19% of the total workforce. 
  • Including 1,700 medical and 13,300 nursing positions. 
  • Vacancy rates higher than the overall NHS average across all regions of England.  
  • The workforce has become less experienced over time. For instance, the proportion of junior psychiatrists increased from 15% in 2010 to 27% in 2022. 
  • The skill mix on adult acute mental health wards shifted from 60% registered nurses and 40% support staff in 2012/13 to the reverse by 2022/23.  
  • Retention remains a significant issue; a 19% turnover rate in the year leading up to September 2023… the usual; burnout, work-life balance concerns, workload pressures.  
  • The Approved Mental Health Professionals workforce is 35% short of what is needed to provide a 24-hour service. Despite the number of AMHPs remaining relatively stable…

… the increasing demand for services has exacerbated workforce shortages. 

The NHS Long-Term Workforce Plan, committed £2.4bn to expand training places, new roles, and enhance staff wellbeing… 

… by about 2036/37 when the workforce is supposed to have increased by 73%.  

Bring on the NHS Question Mark. 

New MH units for the NHS… (?)

Bring on the NHS Question Mark.

Already, ten NHS trusts in England have established specialised mental health A&E units, designed to provide targeted support for individuals in mental health crises… suicidal thoughts, psychosis, or mania. 

Units operate 24/7, are staffed by specialist MH professionals and accept walk-ins or referrals from GPs and importantly the police… 

… since 2023 the Peelers no longer attend callouts to MH patients because it ties up their squad cars for too long when they should be busy arresting mothers for confiscating their kids iPads.

New MH units? Good idea… but given the staffing situation…

… and the fact the NHS has to find the money for the unfunded portion of the new pay rise… a gap between 2.8 and 4%

… and the fact it is busy closing things down and making people redundant, in the quest for £6bn savings…

Bring on the NHS Question Mark.

The MH announcement is said to be part of what we can expect in the better-late-than-never, upcoming nine and a half year plan.

Derbyshire FT already has a ‘Making Room for Dignity’ programme, which includes the refurbishment and construction of six mental healthcare facilities. All up, it’ll cost £150m… 

… do the maths… reach for the ‘NHS?’

Bupa plans to open 70 mental health centres, 20 will launch this year. Initially, they’re for Bupa’s insurance customers, then to self-pay customers and perhaps a deal with the NHS? 

Please note the question mark. What’s the upshot?

Discrete MH units… what a great idea! If only we had the people and the capital to make it work.

But why worry… it’s all in the delayed ten year plan, so think about 2030 and beyond.

Bring on the NHS Question Mark.

News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.

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