Thursday 7 July 2011

Could Do Better

No great surprises in the Wales Audit Office's "school report" on mental health services in Wales released today (see here for the full report). "Could do better" is the predictable message.

The recommendations in the report are fair enough as far as they go but they don't recognise sufficiently that the "only show in town" for making decisive progress in mental health services is the Mental Health Measure. This has the potential to give much better focus not only on individuals' pathways to recovery but also on the planning and commissioning of mental health services generally.

In a nutshell around 80% of mental health resources are presently spent - and will continue to need to be spent - on secondary mental health services. The Measure means that all the patients receiving secondary services will have a standard-format Care and Treament Plan setting out their goals and the services required to achieve them, whether those services are a £300,000 a year high secure bed or a £3,000 a year, light-touch, community-based or peripatetic service.

Now if I was an LHB Director of Finance (or local authority equivalent) I'd be demanding that all spending on secondary mental health services must in future be justified squarely - and exclusively - on delivering those Care and Treatment Plans. On what other basis could any spending be justified? In saying this the DoF would have the support of patients who are fed up with being told "These are the services we provide - we must see how we fit you into them". The money should follow patients' Plans not the other way round.

My impression is that services have so far not sufficiently grasped the legal duty coming their way next year to negotiate the new Plans with individual patients. Still less have senior planners worked out the great opportunity which the Measure offers for them to focus secondary services efficiently and systematically where they are needed.

The Measure can truly be "win-win" for patients, their families, practitioners and senior planners but that will require getting on the front foot, not waiting for the legal duties to roll over them and then whinging about "additional workloads".

For our part Hafal means to help patients and their families to get on the front foot, embrace the Measure, and help the people helping them to make the most of the great opportunities which the Measure presents. The Welsh Government needs to awaken the NHS and social services not just to their new duties but also to those wider opportunities.

The other clear message from the report is that the evidence for protection of mental health resources through the "ring fence" isn't really there. We badly need consistent and transparent audit of NHS spending - too much discretion and opportunities for obfuscation are accorded to the LHBs' finance departments: now that's an area where the Directors of Finance won't have the support and confidence of patients until they clean up their act!

Let's hope mental health services pay attention to the report...