Report for Brighton and Hove Health and Wellbeing Board (HWBB) and Clinical Commissioning Group (CCG) 9.8.13
By John Kapp, 22, Saxon Rd Hove BN3 4LE, 01273 417997

1. Summary of Conclusions

The crisis in the NHS is caused by the following factors, which can be solved locally by councillors initiating culture changes:
a) The overprescribing of drugs, which generally do more harm than good with side effects.

b) The failure of the old Primary Care Trust (PCT) to commission sufficient effective drug-free treatments, so that patients go untreated, even though GPs want to prescribe them, and patients want them.

c) The fear of whistle blowers that will they will lose their jobs if they say things that are politically incorrect (such as the above).

d) The prevalent culture among public sector staff of ignoring representations from members of the public (like me).

The commonest conventional treatment for depression is antidepressant drugs. Talking therapies are commissioned, such as Cognitive Behaviour Therapy (CBT) but it is only effective in only a small minority of patients, and the waiting time is up to a year. Mindfulness courses are much more cost effective, but have such long waiting times as to be unavailable unless patients are suicidal.

To show the disparity between drugs and drug-free treatments, last year in England there were 50 million monthly prescriptions written for antidepressant drugs. Pro rata 1.25 m prescriptions were written in Sussex, and 250,000 written in the city of Brighton and Hove. The latter presumably went to 21,000 out of the 30,000 depressed patients in the city. They may have helped by masking their symptoms, but drugs do not even claim to cure depression.

To prevent, heal and cure depression, patients and sick staff need 16 hours of tuition in mindfulness courses teaching self help tools to cope with it’s cause, which is stress. However, the number of these provided in Sussex last year were less than 8,000 for 160,000 depressed patients, so the waiting time was 20 years. To create a mental health service worthy of the name ‘service’, GPs have to be able to prescribe these courses as easily as Prozac.

My deputation proposes that the Council and NHS jointly plan to commission and provide at least 10,000 patients places annually in the city. This would require 500 courses pa, which could be run by 20 full time facilitators running 25 courses pa, for 20 patients per course. That would cost the NHS about £1.25 mpa, which is only about 2% of the mental health budget of £55 mpa and £200 per patient treated. This is a more cost-effective treatment than the drugs replaced, so should be paid for from the drugs budget. This will also improve staff morale and patient confidence, so help cure the crisis in the NHS.

This scale of provision cannot be achieved by the present public sector tendering process, which is too bureaucratic, (100 page tender documents) long-winded (taking a year) and un-necessary. It was the PCT’s provider-centred way of excluding non-drug treatments, and has no place in a new patient-centred NHS. A scheme should be set up whereby GPs prescribe vouchers which patients can exchange for courses with existing facilitators who are presently running them in the private sector, and are retrospectively paid, as pharmacists are for drugs. I hope that the HWBB will accept and implement this proposal.

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