As the National Service Framework (Department of Health, 1999) completes its 10 year plan there is cause for cautious optimism that the path has been set for a national standard in delivering responsive mental health services through functional teams. However, this is tinged with concerns when we scratch the glossy surface and examine the depth of quality and consistency. The focus of attention has been about getting structures and systems consistent, but at the ground level it is arguable just how much attention is being paid to nurturing and developing the complex arrangements we call multidisciplinary teams.
The framework, and accompanying NHS Plan (Department of Health, 2000) set the scene for establishing a national network of assertive outreach teams, crisis resolution & home treatment teams, and early intervention teams to complement the existing network of in-patient psychiatric units and community mental health teams that constituted the statutory sector service provision. These are now largely in place, and underpinned by the overarching mantra of ‘working to principles of recovery’ and ‘promoting social inclusion’.
This latter statement can be used to illustrate the gap between the rhetoric of policy and the reality of practice, as many practitioners and service users express anything from confusion to concern about what these statements mean; particularly where teams are re-branded as ‘support and recovery teams’ with little to illustrate what the change actually means. For some service user activists this has come to represent yet another usurping of their good ideas, as the service providers find another change of language to liberally sprinkle over their latest policy initiatives.
Pockets of good practice have undoubtedly flourished, providing a genuine service user-focused approach to delivery, and this has to be a tribute to determined practitioners and team managers who have finely tuned their values and attitudes to shape the way they provide a service, even while being bombarded with an avalanche of initiatives, targets and measures. We need to hear more of the voice of the service users experiencing these types of services, so that the new policy agenda can be driven by good experiences rather than the more usual need for change predicated on failures in services.
The next step in UK policy seems to raise the profile of what I would consider to be good practice in isolated initiatives, seeking to set a service user-focused agenda for all public services (not just social care and health, but housing, leisure and welfare benefits, etc) under the banner of personalisation. It is an agenda supported by all major political parties, and is already being seen as the picture of what the 21st century service imprint will look like. However, it is worryingly caged in grand gestures about ‘radical reform’ and ‘workforce transformation’; not particularly motivating mantras to people on the ground already giddy from the constant process of change proffered by the policy makers. The following sets out ideas and challenges underpinning this concept of personalistion.
What is personalisation? (1)
What are the potential barriers to implementation? (2)
1. Carr, S. and Dittrich, R. (2008) Personalisation: a rough guide. Adult Services Report 20. London: Social Care Institute for Excellence.
2. Bird, A. and Wooster, E. (2008) Personalise this! Openmind, 153: 6-9.