Wednesday 8 December 2010


The Welsh Assembly Government's budget could have been a lot worse for mental health services (see my previous post here) and the position was very honestly set out by the Health Minister Edwina Hart in the recent plenary...

"Mental health remains a key priority, as does the development of mental health facilities. We have a good track record on delivering capital projects in that area...It will be a question of looking at priorities, and seeing whether we can keep the momentum up in this area. However, ring fencing, and the robust approach that we have taken to mental health expenditure, will make a difference. As I indicated when we took the mental health legislation through, it was a joy to take it through, and we had excellent cross-party support for it. That means that the outside world will be watching to ensure that the resource is in place to make the legislation a reality".

Of course there is no room for complacency and in particular we will have to make sure that the NHS and the councils live up to the government's expectations for mental health - they have a pretty decent settlement in the circumstances and should be able to make necessary economies in their back-room bureaucracy.

There are also efficiencies to be made in mental health services but any savings from those will be needed to meet the continuing deficiencies in those services - that is what the ring-fence and the priority for mental health must mean if they are to mean anything. Hafal has already pointed out two major efficiency savings which could be made both of which would also benefit patients -

(1) Plan strategically and accelerate the "repatriation" of patients currently placed in expensive and untherapeutic services away from their community.

(2) Rationalise the proliferation of community-based teams into single, multi-tasking teams. This would have to include a step change in the approach of CMHTs which well-meaning commissioners have bypassed over the years because they don't believe they can deliver progressive services: taking the best practice and ethos from some of the added-on, specialist teams would be best. Incidentally it would be good to find a new name for new, integrated teams, to help leave behind the old CMHT reputation whether it is deserved or not.

Notwithstanding the potential for such efficiencies it is only realistic to recognise that there isn't going to be a lot of new money for mental health services in the next few years. So how can a major improvement be made using not much more than the existing resources? The key to this is to reform the traditional approach of handing down services to patients and start trusting them to choose what they need on an individual basis.

The platform for such an approach is about to be put in place through implementation of the Mental Health Measure which accords a right for every secondary mental health patient to have a care and treatment plan drawn up to a required standard. Let's spell this out - secondary mental health services should only exist to serve these care plans and they should be commissioned either directly by the patient (wherever possible to maximise personalisation and choice) or, where collective commissioning is necessary, by direct reference to a number of care plans which demand a similar service. For clarity, yes, that includes hospitals and secure services, for example, not just community services.

By this means we could ensure in a clear and systematic way that the only services paid for are ones which individual patients need. By contrast if commissioners see the Measure as just another thing to worry about and pay for on a long list they will have completely missed the point and will not make best use of the 80% of mental health resources which is spent on secondary services.

It is good to see that the Mental Health Programme Board is dedicating a meeting to the Measure this week - I strongly urge them to seize the opportunity to use the Measure and individual care planning as the focus of all its work on secondary services. That is what patients want.

Postscript: some advice for the lovelorn...

Looking for an image to illustrate "momentum" took me to this intriguing news.