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)
- A shift of emphasis from the service at the centre with the person fitting in, to the person at the centre with flexible services adjusting to the needs of the individual
- An over-arching philosophy of seeing the individual as a person with strengths and preferences, and networks of personal support [something I have long seen as being the ‘strengths approach’]
- Recognising the person as an ‘expert of their own experience’, who knows their own needs and the best ways to meet them
- Seeing people as being able to exercise choices, take responsibility for decisions, taking more control through expressing their needs, wishes and aspirations, but needing information and support in order to do so effectively
- Early intervention and prevention as priorities
- Developing individual budgets to provide genuine purchasing power
- Finding new collaborative ways of working and developing local partnerships
- Transformation of the whole system and culture of thinking, so that it becomes the outcome of a reformed service, not the process of reform itself
What are the potential barriers to implementation? (2)
- Fear of the volume of change represented by phrases such as radical reform and workforce transformation
- Is the current workforce sufficiently geared towards delivering services in these ways (professionals trained to manage will often struggle with the role of enabling)?
- Is there really a full menu of options to choose from? Where is the investment in a wider range of alternative services and treatments?
- Eligibility criteria for many services are being progressively tightened!
- Service users and/or carers taking on employer status, and all the legal and financial implications associated with this development
- Shared responsibility is not about leaving people to decide then blaming them if it goes wrong
- Adequate funding, more so at a time of economic recession
- Is the political will for the outcomes matched by the political will for the process? Is it all about destinations with little or no thought for the actual details of the journeys?
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.
Thursday, November 4, 2010 at 9:28PM