Tuesday 9 November 2010

Sausages and Laws

I have deliberately paused for a few days following the passing of the Mental Health Measure by the National Assembly last week in order to reflect first on the implications of the late amendments and the important undertakings given by the Minister during the debate.

First let's check what the Minister said in the debate about holistic care plans...

When the amendment that included these eight important areas was tabled during Stage 2 proceedings, I did explain my misgivings about the requirements to include those areas in every care plan in every case. I remain concerned that to do so would risk losing sight of the importance of individualised care and treatment planning, which is outcome based. I am therefore pleased to see that this amendment does not require all care plans to include all these areas, and its effect is therefore quite different.

As currently drafted, the proposed Measure does not set out the kind of outcomes that the provision of mental health services is designed to achieve. The proposed amendment would make provision for that, and would mean that the agreed outcomes must include at least one of the areas listed. I believe that it is appropriate and necessary for full assessments to be undertaken by practitioners and that such assessments should consider at least these eight areas. Assessments may also consider other matters. As such, it is right that care co-ordinators consider these areas when working with the service user and service providers to develop and agree outcomes for the provision of services. These areas are well-enshrined in existing mental health policy guidance. For example, they are set out in the chapter on care and treatment planning in the code of practice introduced under the 1983 Act. They are also referenced in the interim guidance on the care programme approach, which was issued to local health boards and local authorities in July. Given that amendment 4 sets out prescriptively the areas where outcomes may be achieved and does not require each care plan for each service user to list outcomes in all these areas, I am happy to give the amendment the Government’s support.

On timescales, which an opposition amendment would have required to be included in statutory guidance, she resisted the amendment but said...

On the issue of whether the timescale[s] should be included in the guidance, I am happy to take away the views that have been expressed and consider them further.

On balance I think patients are winning but we have much more to do. The successful opposition amendment putting the 8 "life areas" onto the face of the Measure (under Part 2) has useful but mainly symbolic value – it does count for something that the principle that care and treatment plans should be holistic is flagged up even if the amendment alone would not place a duty on practitioners in practice to deliver holistic plans.

The Minister’s remarks about assessment are welcome – even a positive movement from the last debate. We seem to have an undertaking to ensure that assessments of patients will cover the 8 "life areas" and presumably care plans will cover them where a need is identified in those assessments. This is definitely moving in the right direction but we need a bit more! One of the difficulties we have faced is making our argument for holistic care plans has been the counter-argument that there is no point in recording something in a plan for life areas where there are no needs identified and therefore no outcomes to record. That argument sounds plausibly unbureaucratic and reasonable but ignores the fact that the "life areas" are all matters which every person with a serious mental illness needs a plan for (with the exception in some cases of parenting or caring responsibilities). Take the example of housing: who among us does not need a plan for our housing over the next year? It may not be written down but we all have a plan to pay our mortgage or rent, pay bills, deal with problems that arise, etc. Now in many cases patients may be fully competent and content to fulfil their plans for some life areas without help from professionals or family carers but that doesn't mean it is not part of their plan - what indeed could be more patronising! And there is no bureaucracy problem as it is not complex or irrelevant (in fact on the contrary it is therapeutic for the client and very helpful to the Care Coordinator) to write down something to the effect that "the client is confident that they can look after their own housing needs".

We need to ensure that care plans are holistic and, as night follows day, THEY WON'T BE if this is not required in the regulations...

Je weniger die Leute darüber wissen, wie Würste und Gesetze gemacht werden, desto besser schlafen sie nachts (the less the people know about how sausages and laws are made, the better they sleep in the night) - not Edwina this time but Bismarck.