Daily Insight: How many warnings are needed?

The problems within mental health services across Birmingham and Solihull have come under a public spotlight following a string of deaths in 2018 and 2019.

From May 2018 to 2019, 12 people died while in the care of community crisis services run by Birmingham and Solihull Mental Health Trust.

An investigation by HSJ can reveal that ahead of these deaths the senior doctors at Birmingham and Solihull Mental Health Trust were making pleas over the poor state of community crisis teams.

Their warnings included the inability to safely manage patients due to poor staffing and long waits in the community for beds. These warnings came after the trust had cut one of its crisis home treatment teams.

There are of course wider issues at play in Birmingham; the failures are not confined to BSMHT. In fact, coroners highlight concerns over underfunding directly to the clinical commissioning group and NHS England.

However, the fact there were so many warnings from clinicians and no sign of any resources until 2019 for home treatment teams does beg the question of what leaders’ attentions were on at the time.

While the lack of mental health beds is often a focus nationally, the pleas from these clinicians make clear the danger that lies in an under-resourced community crisis system.

It comes as all NHS services nationally begin to gear up for a surge in demand on their services post covid-19, to which community crisis services will be more important than ever.

Rising to the test

The NHS responded impressively fast to scale up its covid-19 testing capacity in laboratories.

Starting from just under 200 daily tests in early March, the health service gradually increased its capacity until it reached more than 20,000 by the end of April.

Since then, capacity has continued to grow – in addition to the roll-out of antibody tests – with estimates suggesting the current figure is between 40,000 and 50,000.

But the task does not stop there.

Pathology chiefs in networks across England have now been instructed to build capacity across their network for 3,000 tests per day.

This applies only to swab tests (also known as PCR/antigen tests), which reveal if a person has covid-19.

If all 29 pathology networks achieve the 3,000 mission it would take the NHS’ testing capacity to 87,000.

But HSJ understands the blanket 3,000 target has been set partly to help testing chiefs identify the “opportunities and limitations of our current technologies in each area”.

This means individual networks’ targets may be tweaked, and will also help testing chiefs work out where vital supplies and equipment should be directed.