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Vicky McNally – 25 years in mental health care

Vicky McNally

As Corporate Governance Director at one of the UK’s largest independent providers of mental health services, Vicky McNally is acutely aware of the challenges facing the sector. Handling the impact of Covid-19 has come on top of existing issues around nursing shortages and the rising demand for mental health services.

“We simply do not have enough nurses coming through into the sector and with a 40,000 deficit, that is not going to get better as more nurses retire” says Vicky, “We need to encourage them and provide more opportunities for them.”

Having chalked up 25 years in the industry, at one time serving as Cygnet’s youngest Hospital Director and becoming an elected Board Member of the Mental Health Network of the NHS Confederation, Vicky is clear about what needs to be done. “As a private provider, we need to get to the position where we do not rely on other organisations to provide student nurses. We need to think creatively about working with universities and creating academies to grow our own nurses and grow nurses for others too.”

“If there has been a positive impact of Covid-19, it has highlighted the importance of people working in health and social care and we’ve already seen an increase in applicants for nursing degrees, but it’s nowhere near enough. We need to do something differently otherwise the sector will continue to rely on agency workers. Cygnet is already doing a lot in terms of encouraging nurse associate roles and has partnerships with Wolverhampton University and the Open University, but I think we also need to look at the types of roles our nurses do and whether these can be done by different professionals.”

Mental health and learning disability can often feel “like the Cinderella of nursing”, says Vicky, who adds; “It’s not seen to be as appealing as the acute side of nursing. Yet it’s so rewarding. You only have to listen to some of the stories of our service users. It’s priceless when you hear their journeys and about the people who helped them turn their lives around.”

Vicky’s own route into the mental health sector was unusual. Over Christmas 1994, she was working a busy shift in a high street store as a management trainee, having completed a law degree. Some of the staff hadn’t turned up and there were chaotic scenes, with Vicky having to firefight a string of problems. What she didn’t know was that she was being watched by the then medical director of Harrow, one of Cygnet’s first hospitals. “It was chance meeting,” she recalls, “He had two young sons and was buying presents for them, and I think he saw that I was managing a difficult situation well and approached me blind, saying he was looking for people to join Cygnet.”

Days later, Vicky was interviewed by the then chief executive, John C Hughes, who clearly saw the same potential in Vicky. After quitting the retail sector, she joined Cygnet as a management trainee, initially working as a patient co-ordinator. “When I started, I was completely unaware of this amazing world, “ she says, “Being involved in the admissions process, where I’d meet families and service users when they first came to the hospital, was quite humbling and exceptionally rewarding. You see people at their lowest ebb, very unwell and then the turnaround, when they’ve had the care and support, is quite remarkable. You want to bottle it, that difference we’ve been able to provide.”

Since Vicky joined Cygnet, the sector has undergone seismic change. “Twenty-five years is a long time and things have improved and progressed beyond measure,” she says, “There was a huge amount of stigma around mental illness, I know that continues to exist now, but not on the same level. I remember we had a rather high-profile celebrity at Harrow and the level of paranoia was such that when he arrived in the service, he would hide behind the seats of the car and not be visible because of the damage being seen might do to his career. People went to extraordinary lengths to conceal their illness.”

“Another big change is that the service user voice is now front and centre” she says, “Twenty-five years ago we were still learning and I’m delighted Cygnet has helped to pioneer this role, working with experts by experience in a really collaborative way, but back then it was unheard of.

“Apart from listening to service users and valuing their feedback, one area as an industry we’ve got better at – although there’s still a way to go – is when things do go wrong, it’s how we engage with the loved ones of individuals. A few years ago, we set up a new group safety committee so we can make sure we’re learning lessons from incidents. We engage with families so we find out what’s important to them and what answers they’re looking for, recognising we’ve known the patient for a short time and actually the families can share so much more knowledge. I think this is really important because it enables us to learn more effectively.”

This year, the global Covid-19 outbreak has tested the limits of the sector’s capacity to adapt. Managing and supporting a workforce, maintaining high standards of infection control and supporting service user needs throughout lockdown required greater sensitivity in mental health and learning disability services, where some patients were unable to fully understand the reason for the changes.

“In terms of demand it has placed on our teams, it has been phenomenal,” says Vicky, “Despite all the challenges we faced, we were fortunate in that there was almost no impact on the local services because of the way staff rallied together, going above and beyond on a daily basis. In a medium secure unit, we had patients clapping staff as they went home after their shifts. When you remember that many of these people are detained, often against their will, this shows a remarkable level of appreciation.”

“When you ask our staff what motivates them every day to work for Cygnet, it’s not because of the benefits, not because of NHS discount scheme or even job security, it’s the work they do with service users. It is in their DNA to care.”

Cygnet uses Perfect Wards, a mobile app that allows an organisation to acquire, receive and analyse information that’s shared in real time. However, while it allows for smarter working, it will never replace physical checks, Vicky insists. “Nothing beats going into the unit, You know what it’s like when you are finding a new school for your children or looking at a new home, it’s something about the way a place feels, you cannot do it remotely. So we’ve increased the number our quality assurance managers and we’ve extended the amount of going out to feel, watch and observe so we have a get more of the cultural feel of a place.”

Looking ahead, Vicky says the sector needs to get better at helping ethnic minorities in Britain access community services when they need them. “The statistics are really clear about how different ethnicities access services and you are more likely as a white woman or man to access IAPT, the counselling service, than your BAME counterpart, which is horrendous. Then there’s all the other statistics that you are more likely to be detained under the Mental Health Act if you are from a BAME background. There are fundamental problems that the sector needs to get better at addressing.. The power of the BlackLivesMatter movement means, thankfully, there are positive things coming out of it.” The new Race and Health Observatory hosted by the NHS Confederation will be an effective vehicle for this.

Last summer, Vicky stepped down from her role at the NHS Confederation’s Mental Health Network, which has become a powerful voice for change. Vicky was selected to sit on the board six years ago as an independent sector representative, joining senior NHS executives. Another three board members are either carers or have personal experience of mental health services, and their contribution to policy is highly valued. While Vicky describes the network as a ‘passionate group’ and feels privileged to have been part of it, her role there is a symbol how far the partnership between the NHS and the private sector has come.

She says: “When I look back to when I started at Cygnet, what was unusual was working with the NHS. Back then, most agreements were on an on-the-spot purchasing basis, so if they ran out of beds, they use us as an overflow. It would probably have been career-limiting to senior NHS people to encourage and promote the idea of joint working. Now, thankfully, that’s a thing of the past, and through the work of organisations like the Mental Health Network, the level of co-operation and partnership we have now is much more effective and that’s better for service users.”

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