Memorandum by Changing Faces (PEX 17)
THE SUBMISSION
This submission will provide relevant evidence
into the inquiry on public expenditure, with a focus on the relation
between physical and mental health care and its budgetary implications.
Input will be provided into all areas (apart from public expenditure
on social care services) mentioned in the invitation to submit
written evidence for this Inquiry. However, not all sub areas
will be addressed, as not all are relevant for our client group.
BACKGROUND
Changing Faces is the leading UK charity
that supports and represents people who have disfigurements to
the face, hand or body from any cause. A "disfigurement"
is the generic term for the aesthetic effect or visual impact
of a scar, burn, mark, asymmetric or unusually shaped feature
or texture of the skin on the face, hands or body. It is estimated
that 542,000 (one in 111) people in the UK have a significant
disfigurement to the face and approximately 1,345,000 (one in
44) people to their face and body. "Significant" is
taken to mean "psychologically and socially significant".
The charity was founded in 1992 by James Partridge
OBE, Chief Executive and today we have a team of 30 professionals
with expertise in psychology, education, employment, health and
social care, media and campaigning.
Changing Faces advocates for better access
to and better quality of psycho-social and mental health care
for people with visible differences as a result of an accident
or illness, or from birth. People with disfigurements are significantly
more likely than people without disfigurements to develop mental
health problems, a problem that is currently not fully reflected
in national and local health budgets. "Severe disfigurement"
is included in the Disability Discrimination Act 1995 and the
Equality Act 2010 and thus comes within the remit of public bodies'
Equality Duties.
Changing Faces urges politicians, health
professionals, commissioners and policy makers to recognise and
address the psychological and social (psycho-social) impact of
having a disfiguring condition. It is their responsibility to
develop appropriate services to prevent and/or treat psycho-social
problems if they occur. Psychological services, if provided during
physical treatment as part of a care pathway, result in significantly
better patient outcomes and patient satisfaction.
In addition, we strongly support the development
and extension of multi-agency working as mental health problems
are frequently associated with wider social problems, either as
cause or effect. Multi-agency partnerships are therefore vital.
We would like to stress the importance of partnerships with the
social care sector as well as in the employment and education
sectors.
In addition, there is undoubtedly a role for
Public Health in addressing the stigma and discrimination towards
people with a disfigurement, in partnership with the media—as
we advocate within the Face Equality campaign which has been supported
by several NHS bodies such as Addenbrookes NHS Trust and the Abertawe
Bro Morgannwg University Health Board. However, in the submission,
we focus on provision within the NHS.
STRATEGIC ASSESSMENT
What level of commitment is national government
making to the NHS, and how does it compare with long term trends
of demand, cost and efficiency?
60-70% of children and young people (and parents/families)
being referred to or contacting Changing Faces for help
with psycho-social concerns and 30% of adults have congenital
disfigurements; others acquire a disfigurement as a result of
accident, trauma, violence, warfare, skin or eye conditions, cancer
(and its treatment) and facial paralysis (after Bell's Palsy or
stroke).
The experience of Changing Faces and
other research confirms that to fulfil their potential and lead
active lives the majority of those who live with a disfigurement,
whether acquired at birth or later in life, patients/people can
benefit greatly from a combination of medical and psycho-social
interventions. Such multi-disciplinary intervention best delivered
in partnership between tertiary and primary care, can prevent
the development of mental health problems, ensure that children
fulfil their potential at school and ensure that adults remain
in employment and have positive relationships.
A recent report by the Work Foundation (Body
and Soul, Exploring the connection between physical and mental
health conditions, September 2010) shows that the rate of
mental health conditions is higher amongst those with a chronic
physical health problem. People with disfigurements face the additional
problem of having to adjust to a different appearance in a society
that highly values good looks. Largely as a result of other people's
reactions and the culture in which we live, living with a disfigurement
can be a major challenge for an individual and their family. People
with disfigurements can experience serious problems in social
situations, leading to high levels of social anxiety and depression,
lowered self-esteem and self-confidence, and difficulties in getting
employment. Many children at school experience name-calling and
other forms of bullying as well as being ostracized because of
their appearance. This can often lead to behavioural problems,
poor academic performance and difficulties in making friends.
The report by the Work Foundation also shows
that, for some conditions the chronic physical health condition
provokes a physiological response whereas in others the condition
provokes a psychosocial response. Co-morbid physical and mental
health conditions lead to worse health outcomes. This research
supports the need for multi-disciplinary teams working together
in hospitals to deliver holistic treatment and care.
Changing Faces is very concerned that
a reduction in the expenditure growth in the NHS will at best
impede any development of multi-disciplinary teams, and at worst
lead to the reduction of the number of psychologists and allied
professionals.
It is these professionals who are well placed
to directly support adults and children with a disfigurement and
to train other staff in how best to support their clients to adapt
to their changed circumstances and to have the confidence to live
successful lives. Children and adults with disfigurements encounter
a wide range and high number of NHS professionals. These NHS professionals
need to be trained in effective communication with patients with
disfigurements and also in how to make effective referrals to
other professionals.
The Centre for Appearance Research (CAR), based
at the University of the West of England (UWE) acts as a focus
and centre of excellence for psychological and interdisciplinary
research in appearance, disfigurement and related studies. CAR
has demonstrated that most, albeit not all people with disfigurements,
have long term physical health problems and, at some stage of
their rehabilitation, receive regular care from specialists or
primary care providers.
The ability of NHS staff to communicate effectively
with their patients involves an understanding of the particular
challenges encountered by those with disfigurements. Changing
Faces has seen a reduction in the number of requests for dedicated
training suggesting that NHS training budgets have already been
reduced. If this trend continues the range of medical and other
professionals in oncology, dermatology, ophthalmology and burns
will be at risk of overlooking the emotional, social and practical
implications of living with a disfigurement.
The medical professionals should ideally be
able to rely on a psychologist to make a psycho-social assessment
of all their patients with a disfiguring condition. However as
many teams work without the presence of a psychologist, those
medical professionals must also be trained in assessment skills
so that they can identify those as greatest risk and make appropriate
referrals. They need also to be confident that there are services
to which they can refer.
Both children and adults need access to community
services which can offer them non-urgent interventions to help
develop their confidence and manage the challenges that having
a disfigurement creates for them.
Changing Faces would be very concerned
that if the NHS budgets are tightened, non-urgent community services
which could offer psycho-social support outside hospital will
be reduced.
There is already anecdotal evidence reaching
Changing Faces from our clients that there are long waiting
lists for Child and Adolescent Mental Health Services (CAMHS)
and that many children have to wait a considerable period of time
before being seen. CAMHS often only have the resources to see
children considered as most urgent. Similarly for adults the provision
of non-urgent mental health interventions could be at serious
risk in a constrained NHS. The continuing lack of the provision
of intervention for those with less serious problems will mean
more children and adults developing entrenched mental health problems.
From over 18 years of work in this area, Changing
Faces knows there is a strong demand for better care by this
particular group of patients; patients' needs continue to be unmet.
We urge the national government for a high level of commitment
to address this problem, which should be reflected in its public
expenditure.
ON CENTRALLY
FUNDED HEALTH
SERVICES
What services are procured from this "top-sliced"
budget, and how do the government's plans for those services compare
with long term trends of demand, cost and efficiency?
More clarity needs to be given to how resources
are going to divided in terms of mental and physical health care
and within mental health care (acute and non-acute) both at a
national as well as at a local level.
Although various political statements have confirmed
that there will be increased attention on a better connection
between physical and mental health care (for example, statement
by Paul Burstow MP, Minster for Care Services Lib Dem conference
Sept. 2010) no detail seems to be available on how this will affect
expenditure.
RESOURCE ALLOCATION
WITHIN THE
NHS
How is the formula for allocation of NHS resources
between PCTs constructed and reviewed?
Changing Faces seeks further information
about the formula which will be used in future for the allocation
of NHS resources between physical and mental health care services?
Additionally how will it be ensured that mental
health resources are spent appropriately on both acute and non-acute
care? The clients at Changing Faces report that there is
a lack of access to local mental health services and a lack of
understanding amongst all health professionals of the psychosocial
issues associated with disfigurement.
As most of our clients need non-acute mental
health care, Changing Faces would like to hear what measures
will be used to guarantee that non-acute services do not receive
a low priority in times of financial difficulty and what will
be done to stop services from being under resourced.
LOCALLY COMMISSIONED
HEALTH SERVICES
What proportion of locally commissioned health
services are absorbed by services which are:
— Demand-led according to nationally
prescribed formulae?
— Driven by demand for emergency
or urgent care?
— Available for elective or non-urgent
services?
Again, Changing Faces is concerned about
the risk of local, non-urgent needs being unmet in times of financial
restraints. Early intervention leads to long term savings.
A disproportionate investment in only the short
term physical health needs of those with a disfigurement at the
expense of longer term psycho-social needs will not be cost effective
in the medium and longer term.
September 2010
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