In sickness and in health
You can also read this interview by clicking on the link THE INTERVIEW THAT GOT KAREN REISSMANN SACKED
While ministers are promoting social enterprise as a solution to problems in the NHS, campaigners against health service privatisation are sceptical. Karen Reissman is a leading member of anti-privatisation campaigns in Manchester. Sarah Irving heard her concerns about social enterprises in mental health provision…
Karen Reissman is an experienced community psychiatric nurse working in North Manchester, and although she welcomes some of the changes in the NHS over the last decade, she is deeply unhappy about others. “I’ve had 5 employers in the last 13 years,” she says. “Each time the new headed notepaper and name badges costs thousands. Does it improve anything? No.”
She is concerned about the privatisation of NHS services, including by transfer to the voluntary sector and social enterprise, because of the effects she sees for both staff and patients.
She worries that voluntary sector and social enterprise organisations can win tenders through cutting costs, and this can mean lower standards of care and poorer conditions for workers on the mental health front line:
“One of Manchester’s current assertive outreach teams is voluntary sector. One of the main things this has meant is that experienced NHS staff have been replaced with inexperienced staff,” she explains. “This is partly because the voluntary sector organisation pays less, and because staff moving to it lose their NHS or local authority pensions.
“Experienced staff are likely to be older and therefore more concerned about their pensions, so they are very unlikely to want to move to new social enterprise sector organisations. This means that some of the most severely mentally ill people in the area are being cared for by people who themselves are newly qualified or in some cases trained in-house.”
Another concern is that the transfer of mental health services can also mean a shift in the culture and priorities of organisations. While Karen acknowledges that workers in social enterprise organisations are genuinely committed to their patients’ care, she questions whether the organisations themselves can really meet the demands of the sector:
“One of the other areas being shifted to private sector organisations are community living projects, which run schemes such as arts projects and occupational activities,” she describes. “A lot of these have been or are facing being turned into social enterprise organisations. My concern would be that this changes them from primarily being a treatment and therapy service to an entity which has to break even.
“Staff then spend their time looking for funding and subsidies, or trying to cut costs, rather than delivering the care they want to and which patients need. It downgrades the situation for both staff and patients and moves the organisation from being mainly a service to being a commercial organisation which has to keep its eyes on the bottom line.
“There is one award-winning national project which uses art for people with mental health issues, some of whom have been very damaged by their illness, and helps them express themselves and get some fulfilment from life. Some of the artwork produced might be sold, but that happens in individual cases if it’s appropriate and it helps the patient. It faces becoming a social enterprise, and then selling work or being part of projects that bring in funding will become much more of a motivation.”
According to Karen, privatisation of the NHS in Manchester is proceeding quickly, fragmenting teams and cutting resources, including reducing the number of mental health beds in the region and making it harder for community nurses like her to spend adequate time with their patients.
“There are several bits of privatisation going on in the Manchester area at the moment,” she says. “Four of the Community Mental Health Teams are up for private tender at the moment, and it is likely that some of these will go to joint NHS/voluntary sector projects.”
Mental health workers in Manchester are currently balloting for strike action against privatisation and cuts in community mental health teams. “The chaos is frustrating, but it also motivates people to do something if we can get them organised,” argues Karen. “As bad as it is, it would have been worse if we hadn’t acted.
“Thatcher tried to tell people that private was good, public bad. She convinced some, but when they saw the privatised rail services they came to their senses.”
For more information on NHS Campaigns in Manchester see www.stopthecuts.nr