Sunday 13 June 2010

Ymlaen Llanelli

While I am in Edinburgh the VW microbus visits my home County of Carmarthenshire on the "Road to Recovery": pictures show the bus on the coast path in Llanelli (incidentally note the brilliant hill-free cycling for softies from the Loughor bridge all the way to Kidwelly). Hafal's campaign has a particular focus on the forthcoming Mental Health Measure (Welsh law) which is currently under formal scrutiny. On Thursday I attend the WaMH in PC's conference in Cardiff and use my speaking spot at the start of the day to draw attention to the need for enforceable time-limits in the legislation. Health Minister Edwina Hart AM makes a forthright speech including an unscripted lashing of NHS senior managers for not communicating effectively and an aside expressing a new-found warmth towards the USA (what can she be referring to?). I ask her about the time-limit issue and she makes it obvious that for now she is inclined to follow the cautionary advice of some providers that time-limits would be too "inflexible" in respect of the varying needs of patients. This seems a good moment to review this matter...

Hafal's Members believe that there is a need for a legally-enforceable timescale between referral by a GP for assessment for secondary mental health services and the undertaking of that assessment. This is vital because otherwise there will be instances where those requiring secondary mental health services may wait a long time to be assessed and during that period they would not have the Part 2 rights under the Measure. This would be likely to cause anomalies and it cannot be right that a patient, who in the opinion of a GP may well require secondary mental health services, could wait indefinitely before they were assessed as qualifying for the Part 2 rights. We argue that the maximum time limit should be 30 days. There is a further significant weakness in that at the point where an individual does qualify as a relevant patient under Part 2 they could wait indefinitely for the development and completion of their personal care plan. We recognise that the process of developing the care plan must begin at the point where they qualify but without an enforceable time limit there would be instances where many months could go by during which services could argue that they were “setting about” developing the care plan but not actually delivering and completing it. We argue for a maximum time limit of 60 days between qualifying as a relevant patient under Part 2 and the completion of a care plan. Regulations could tighten the timescale (or have varying intelligent timescales) below the 60 days limit.

So what about this issue of flexibility? I think people are misunderstanding what patients are saying about this: time limits enforceable in law do not indicate average or optimal timescales but absolute maximum limits - of course there will be varying urgency within the timescale. If clinicians or others have a problem with this they should tell us what they think the realistic absolute maximum time limits are so we can debate that. One final point: don't be deceived into believing time limits will require additional resources - that is an old fallacy of the NHS bureaucracy. The rest of us know that time and money cannot be saved by putting off doing things (because you still have to do them in the end!): on the contrary delay means additional resources are likely to be required as vulnerable patients deteriorate for want of planned treatment and care.