Context of this paper – public concern about the crisis in primary care and the STPs
Launched in Oct 2014, the Sustainability and Transformation Plans (STPs) were intended to solve the crisis in primary care by transforming the mental health service to provide NICE recommended talking therapies at scale, so that inappropriate medication could be decommissioned, as required
by the Improving Access to Psychological Therapies (IAPT) programme 2006, the Health and Social Care Act 2012, the Care Act 2013, the Better Care Fund legislation 2013, the 5 Year Forward View (5YFV) 2014, the 5YFV Mental Health (MH) report 2016, and the prime minister’s speech on 9.1.17, pledging that 1 million more mental patients will be treated by 2020 by 10,000
more talking therapists to be recruited.
Summary of conclusions
a) The elected councillors on the Health and Wellbeing Boards (HWBs) and the leaders of the 220
Clinical Commissioning Groups (CCGs) are statutorily responsible for providing the support
referred to in the title question, which was posed in a judgement (news report 3.8.17) by Sir
James Munby (president of the family division of the Hich Court) who said that those who fail
to provide support for those who self harm or commit suicide after discharge will have ‘blood
on their hands’. (see question 9 b) below).
b) To date, neither those councillors, nor those leaders have accepted that responsibility, with the
result that more and more blood is being spilt by self harmers and those who commit suicide
and homicide while under the care of the public services (NHS, Social Services and Criminal
c) Following charges by the shadow chancellor regarding the Grenfell tower fire, a police
statement was published on 27.7.17 that charges of corporate manslaughter can be made
against those who authorised combustible cladding.
d) The NHS have a more direct duty of care, so commissioners who fail to procure and provide
evidenced based treatments for patients with mental disorders could be called to answer
charges of corporate manslaughter, as this paper is doing.
e) The following 100 questions were compiled by the author to brief a working party on the STP
which was formed in December 2016 by the Brighton and Hove Health and Overview Scrutiny
Committee (HOSC) but they are relevant to every HWB and CCG in England, so I am
publishing them for any councillors on HWBs, CCG leaders, and concerned citizens to put to
Recommendation to councillors on HWBs, and leaders of CCGs
Recommendation for concerned citizens
1 Are the CCG leaders aware of the culture shift from the medical model to the bio
psycho social (holistic) model enshrined in laws and guidelines since 2006?
2 Are the CCG leaders aware of the problems of antidepressant and antipsychotic drugs?
3 Are the CCG leaders aware of the existence of drug-free Mindfulness Based Interventions which are NICE recommended as cost effective for treating mental disorders?
4 Are the CCG leaders aware of other drug free interventions that can help heal and cure mental disorders including addiction?
5 Are the CCG leaders aware of the need for quality improvement in mental care?
6 Are the CCG leaders aware that the purpose of the STPs is to end the crisis in primary care?
7 Are the CCG leaders aware of the need to trial new models of care before
commissioning them at scale?
8 Are the CCG leaders aware of the Health Foundation’sGuide ‘Better Questions, Safer Care’ under the Measuring and Monitoring of Safety Framework (MMSF) June 17
9 Are the CCG leaders aware of their potential liablity to be charged with corporate manslaughter for commissioning harmful treatments, and neglecting to commission life saving treatment?
10 Other questions for CCG leaders
List of appendicies supporting the above questions
Extracts from Appendices 1-11.