An event for members of Worcestershire Mental Health Partnership NHS Trust on June 29 provided some information about the Trust’s plans for the future. The timing of the meeting was unfortunate, in that the plans had been prepared before the change of government, and it was not clear how they related to the new coalition’s ideas about the NHS. Even so, the meeting was revealing.
This was the first NHS-related event that I attended, long before it occurred to me to start a blog, and I did not take detailed notes. As I write this some four months later, it is difficult for me to remember everything about the event. The main presenter was Andrew Ferguson, Associate Director of the Trust. Other Board members and staff were present and took part in the discussion.
The presentation was confusing because its starting point seemed to be a random collection of nice ideas that had appeared out of the blue. Some of the nice ideas were explained quite clearly and had obviously been well thought out, but some were not. I had the impression of patchy tactical planning drifting free from any overall strategic direction.
I asked a question about the decision-making process that had resulted in these plans, but the reply I received was only about the consultations that take place after plans are already prepared. I thought this was unsatisfactory.
Curiously, the title of the event, “Modernising Mental Health Services”, is the same as the title of an old Labour government white paper from the time twelve years ago when Frank Dobson was Secretary of State for Health. The gist of that white paper was that care in the community had failed, and that more people with mental health problems should be treated as in-patients. It was astonishing to hear apparently similar plans being announced by the Trust for less reliance on the Community Mental Health Team (CMHT) and more in-patient facilities.
Some of the plans did appear to make sense. For example, it was suggested that the CMHT could change its focus from maintenance to recovery. That sounds good. It sounds as if patients who are presently being maintained in a state of illness will actually be helped to get better. Some patients would be discharged, we were told, and some shifted to primary care. But it was not clear how “shifting” patients helps them to recover. There seemed to be no clinical basis for this change of focus.
Other plans appeared to indicate worrying deficiencies. For example, one of the bullet points was “Greater clarity around staff roles”, strongly suggesting that there have been recent problems managing clinical staff. Another was, “Service users will have had a planned assessment and agreed treatment plan with defined goals”, strongly suggesting that the present approach may be somewhat haphazard.
Much of the presentation dealt with plans for older adults, with a nod to strategy in the recognition that older adults will form an increasing proportion of the population in future. The solution, it seems, is to build a new hospital in the shape of a doughnut, to make it easier to adapt the building to changing needs. I could not really understand how a hole in the middle of a hospital makes it more adaptable, but Andrew Ferguson seemed very excited by the idea.
Several audience members interrupted the presentation to ask questions, and wide-ranging discussions ensued. Much of the presentation had to be abandoned for lack of time. Unfortunately, these parts of the presentation were also cut from the version distributed to attendees.
The discussions tended to focus on patient experience and clinical issues rather than on planning. The presenter was therefore out of his depth and just stood around for part of the time while his colleagues took part in the discussions. It would have been better for the Trust to have chosen a presenter who understood the Trust’s work in more detail and who could engage with the public.
I had been looking forward to hearing something about the Improving Access to Psychological Therapies (IAPT) programme, because I think it has the potential to change the picture very substantially in adult mental health. I was disappointed that IAPT, along with several other topics, could not be covered in the time available.
After the meeting I got home just in time to hear the new Care Services Minister, Paul Burstow, being interviewed on the radio programme All in the Mind about mental health. The focus of his replies seemed quite different from the meeting I had just attended. He talked about reducing management costs and re-investing the money saved, about productivity and early intervention, about IAPT and the National Dementia Strategy, about personalized support, and about integration with social care. By comparison, the Trust’s plans seemed limited.