Friday 21 October 2011

And Another Thing

Since my last post Hafal's policy expert Peter Martin (pictured above with Darren Millar AM last week) has read the draft Code of Practice more carefully than me and points to the absence of clear timescales for the critical periods (i) between referral and assessment and (ii) between assessment and completion of a Care and Treatment Plan.

Of course we all recognise that there needs to be some flexibility for different circumstances but words like "timely" and "appropriate" aren't good enough: we need a specified range of times including a maximum time only to be exceeded in the most exceptional circumstances.

A particular concern, especially of some carers for obvious reasons, is the problem of creating Care Plans for people who refuse to engage with services - often because they do not accept that they have an illness. These patients can be floridly psychotic and very vulnerable but Hafal staff have lost count of the number of times we have been told that "he/she obviously can't have a care plan because they won't cooperate".

This is entirely wrong. It is difficult to develop a plan in these circumstances but much can be put in place through engaging with carers and others in touch with the patient including their GP. At the very least the Plan needs to include contact with the family to help them support the patient and scheduled checks on the patient's health and safety and attempts to encourage the patient to engage; and some imaginative ways of getting help to patients should be considered, for example through oblique offers of help concerning physical health, housing, etc which the patient may accept (and of course holistic care planning particularly supports this approach).

The Code does address this issue but it also needs to give specific guidance on timescales in relation to these patients, in particular prescribing the necessity to develop a Plan more urgently for them. Otherwise, believe me, development of Care Plans will be delayed on the excuse that the patient would not cooperate.

This is a delicate area but there is no room for political correctness here. It is folly to delay formal care planning because you are waiting for the patient to "come around to it" - the Plan must be created quickly even if the patient isn't cooperating and it can subsequently be reviewed and improved cooperatively just as soon as the patient chooses to engage - which the Code does point out.