It may be a damp, grey November morning, but Paul Burstow doesn't flinch when asked to clamber up a ladder onto the roof of the five-storey building of the west London NHS trust that he now chairs for a photo shoot with CYP Now. In fact, the former Liberal Democrat MP for Sutton and Cheam appears to enjoy the chance to take in the central London skyline in the distance and is quick to point out the Palace of Westminster just visible through the murk.
Burstow spent 18 years in parliament, two as care minister, during which time he was renowned for his tireless work championing the mental health needs of children and young people. But after losing his seat in May's general election, he wasted little time in finding his next challenge - he was appointed chair of the Tavistock and Portman NHS Foundation Trust in September, and took up the position on 1 November.
"It is an opportunity to see an evolution from my policy interest into practice," he says.
In addition to having a "clear line of sight" on finance, performance and good governance of the trust, Burstow says he will also play an "ambassadorial role". "What stood out for me was they were looking for someone who could build relationships with a range of stakeholders who had connections into Whitehall and NHS England. I think I bring a lot of that."
The Tavistock is an unusual trust in that much of its work is devoted to providing education and training for the mental health workforce. However, it also delivers services, and has a long history of developing and delivering evidence-based psychological interventions for children and adults.
"It's extraordinary the number of people I've met in the NHS who have been trained here," he says. "It gives the sense of mission and of being a custodian and developer of those traditions.
"What the board and governors wanted was for the new chair to ensure the legacy we have is engaged in today's issues and seen to be part of the future."
In that sense, Burstow seems a perfect match for the trust. As care minister in the coalition government between May 2010 and September 2012, he was responsible for overseeing, alongside then Deputy Prime Minister Nick Clegg, the No Health Without Mental Health strategy, which provided £400m of funding to expand access to talking therapies.
The development of the children and young people's Improving Access to Psychological Therapies (IAPT) programme followed soon after, with £32m going towards training children's mental health practitioners across a third of the country in cognitive behavioural therapy techniques to treat a range of childhood conditions.
A good listener
In addition to his recent policy pedigree, he cites being a "good listener" as a strength honed while in parliament, a quality that will be useful in his new role.
"You're there (as an MP) to properly understand as well as broadcast," he explains. "To work with constituents often with chaotic lives, that ability to listen well is a very valuable skill and very relevant to board-level roles."
Burstow explains that children's IAPT - which will cover all of England by 2018/19 - came out of a meeting with local constituent Barbara Rayment, chair of the children's mental health charity Youth Access, in 2010.
"She told me that half of lifetime mental health problems began in adolescence, which I didn't know, but probably should have," he says. "That was the epiphany for me; it was the spark that led to conversations with Karen Turner (deputy director for children's mental health at the Department for Education) and then Peter Fonagy (professor of psychology at University College London) being commissioned to write the original training curriculum for children's IAPT."
Unlike the model for adults, Burstow says children's IAPT is not "top down or bolted on" to existing services, but instead "is an attempt to rethink how existing child and adolescent mental health services (CAMHS) operate". As such, it is a precursor to reforms announced by the government in its Future in Mind children's mental health strategy published in March 2015 following a nine-month review of services.
"It is an essential building block of that, getting a focus on outcomes and really listening to the service users."
Another key element of Future in Mind is the recognition it gives to intervening early and improving access to therapy when the first signs of a mental disorder appear in childhood. Waiting time targets for getting help for a range of conditions, including eating disorders, psychosis and depression, will be introduced by 2020 under the plans.
Burstow says key to delivering more timely interventions is improving the recognition among the children's workforce of the signs and symptoms of early mental health distress.
"The model we have across the system is we ration too much and set thresholds too high," he says. "It means you get access to services much too late for the full benefit of the therapeutic intervention to be felt. Timeliness is really key and that is about having a whole workforce that understands child development better and has an awareness of mental health issues.
"The evidence is clear: the earlier the intervention, the better the outcomes."
But with social workers, teachers and youth justice practitioners under increasing funding and workload pressures, how realistic is it for them to be able to find the time to train in identifying mental health problems among the young people they work with? Part of the solution lies in better pooling of budgets between different agencies involved in a child's care, says Burstow.
"All too often the saving upstream lands into someone else's budget," he says. "There's an inevitable institutional disincentive to act in a way that will save another money. The risk and reward needs to be shared. It's what gave birth to the Better Care Fund in adult services (which pools adult social care and NHS spending). We have to see more of that to effectively deliver some of the reforms in CAMHS."
He cites the trust's work with Gloucester House independent special school in north London as an example of how education and mental health services can work together to improve children's outcomes. Tavistock clinicians and teachers are co-located at the school to provide a fully integrated service.
In addition, the trust has worked with the Anna Freud Centre to develop a model of working and "common language" that has been adopted by social workers and CAMHS staff that "makes the conversations easier" between them. He says this is an area he wants to develop further.
"I want to make sure we do everything we can to amplify the voice of this trust," he says.
"This trust has a lot to contribute in terms of how CAMHS develop and to give some insight into how to create more psychological services whether in education, youth justice or other parts of the health care system."
With local authority non-statutory budgets set to come under further pressure as a result of funding decisions in the Spending Review, there is a risk that councils' role in prevention could be reduced further. But Burstow is "optimistic" this will not affect the Future in Mind reforms, particularly as the NHS is to receive an extra £3.8bn over the next year.
Expanding mental health teams
He says: "There are very few parts of NHS England that are expanding, but mental health teams are – they're tooling up to deliver the transformation plans."
He also remains confident that the government will stick to its commitments to provide an additional £1.25bn to deliver the strategy – "so much has been said publicly that it would look very strange for them to abandon it now" – but warns that this will only go so far.
"The danger is that these pots of money will get 'spent' several times so that it will become impossible to deliver everything that gets attached to it with the money available," he adds.
While Burstow is adamant the raised policy and funding profile for children's mental health would not have happened without his party being in coalition government, he admits not enough has changed to "shift the dial on the money".
Only 6p in every £1 spent by the NHS on mental health goes on CAMHS, a figure he describes as "woefully low". Future in Mind funding will help improve the picture but "won't be enough to deliver the full ambition", he adds. Despite this, he hopes to see the investment and strategy making a difference to young lives "within five years" with this translating to reduced prevalence of mental health problems in young adults within a decade. But tackling problems, such as parental attachment, that lead to poor child mental health is a generational issue.
He says: "We work in some deprived communities and our staff on the frontline see the impact of other changes in public expenditure and how that washes up in terms of people with mental distress.
"Spending on improving mental health is a great thing to do. But it's in a context and that isn't necessarily one that is conducive to supporting good mental health."
PAUL BURSTOW CV
- Nov 2015 Appointed chair of Tavistock and Portman NHS Foundation Trust
- May 2015 Loses Sutton and Cheam seat at the general election
- 2012 Replaced as care minister by Norman Lamb
- 2010 Appointed care minister in the coalition government
- 2003 Lib Dem health spokesperson
- 1997 Elected MP for Sutton and Cheam
- 1994-97 Deputy leader of Sutton Council
- 1987 Research assistant, London borough of Hounslow
