Monday 18 October 2010

PIG in a poke?

Let me try to get you excited about something which sounds on the face of it humdrum and technical, namely the snappily-titled "Delivering the Care Programme Approach in Wales: Interim Policy Implementation Guidance" (or "PIG"). Now don't run away - I promise it will get more interesting.

This guidance is interim because it will be overtaken by the Mental Health Measure and accompanying regulations and Code of Practice. So doesn't that make it even less significant and yet more boring, Bill? Well, no, because in this stodgy-sounding publication hidden away in a distant corner of the vast WAG web-site you can...


How so? Well it is my cynical guess that many patients will not notice much difference following publication of the Guidance (I hope I'm wrong but there you are) because it doesn't have the force of law and I suspect insufficient energy will be put into getting the Guidance out to care coordinators. There are also unpromising precedents: care plans prescribed under the Mental Health Act have not taken on board the requirements of the Code of Practice; further, WAG's now longstanding instruction that the Code (in particular chapter 14) should be used for all enhanced CPA plans has not been implemented.

However, the Guidance will form the basis of regulations under the Measure and therefore you can glimpse fairly accurately what the future holds for all patients receiving secondary mental health services. But will the Measure be implemented? Though there will surely be glitches and defaults I believe it will for two reasons: (i) the regulations will have the force of law; and (ii) the regulations will prescibe a format for care plans which will make it hard not to comply (though lip service will remain an enemy of course).

So what can patients expect? Assuming that the regulations don't get watered down then patients can look forward to a comprehensive, holistic care and treatment plan conforming to a national standard including prescribed content. It is worth quoting from the Guidance...

In all cases, care and treatment plans should be proportionate to the level of clinical need and input. The outcomes which mental health services are aiming to achieve should be set out, and the care and treatment plan should proportionately address each of the areas in the table set out below.

Service users with relatively straightforward needs may be able to take any necessary action alone in relation to several of the areas but it is important that this is still recorded: for example, if a service user has rented accommodation that is satisfactory and well managed by them, then it is sufficient simply to state that they will continue to maintain their tenancy. By contrast a service user with complex needs may need more detailed action recorded against several or indeed all of the areas. This methodical approach is important in order to maintain a holistic focus on recovery.

(click chart to enlarge)

You can begin to see the transformatory potential of the Measure. The care plans will not of course of themselves change the world but for the first time there would be a solid, high-quality platform on which to build. You can't sadly say that the Measure marks the end of the long journey towards a Wales with first class mental health services but at least it marks the start of that journey. This is no cat but a proper PIG in the poke - but we must ensure nobody tries to switch it for a cat.

Pedants' Corner...

The expression "to buy a pig in a poke" (meaning to be conned into buying what you think is a tasty suckling pig in a sack but then find it is a worthless cat) is common to many languages but usually, and perhaps more logically, the expression translates as "to buy a cat in a sack" ie what you actually get rather than what you think you are getting: for example the French is "acheter un chat dans un sac" and Welsh "prynu cath mewn cwd" (nice and compact that one). What do the Greeks have in common with the English that they too exceptionally use "pig" not "cat" ("αγοράζω γουρούνι στο σακκί")? And can it really be that across the world wily peasants were in the habit of trying to dupe buyers in this way? And were the buyers so universally gullible that they didn't look in the bag - or was there a conjuring trick to exchange bags? And does anybody care?