Tuesday 22 April 2014

Not Pie In The Sky

I like this poster on our excellent Facebook platform.

This is a simple and fun reminder of our long-term but vital campaign to accord real choice and control to people with a serious mental illness and their families. That doesn't just mean "take it or leave it" (some choice! But that's typical unless you are subject to the Mental Health Act in which case there are services and treatments you will simply be forced to accept).

No, choice and control means giving power over resources to patients and families so that they choose and commission what they want.

There has been a sorry history of delivery on this: a grudging and bureaucratic option to control funds in social care (through Direct Payments) and no commitment in Wales on choice in health care.

Not that it is all rosy in England where individual budgets are still in troubled infancy. We don't need the English solution; we need to learn from their mistakes and find a Welsh solution which is transparent, human in scale, and practicable.

This is a ten year project because Wales isn't yet ready for choice politically but believe me it will come to health as well as social care in some shape or form - it's the future in modern, consumerist western democracies, whether services like it or not - but the challenge is to make it work well and in particular to work well for people with a mental illness.

Wouldn't it be great if we could see a time when even patients compelled to receive inpatient care could insist on their choice of hospital? This isn't pie in the sky - patients and families are already consulted sometimes about a choice of beds where staff exercise best practice.

That, above all things, would change the culture of provision. Choice is not a substitute for inspection and accountability but in the end it is the most effective driver of quality because patients and families will vote with their feet if they don't get a decent and respectful service.


"Pie in the sky"? We all know what it means but it was coined by American labour activist Joe Hill who was executed for allegedly murdering two grocers in a robbery. Actually Hill didn't mean by the phrase that the prospects were negligible; rather he meant (as a satire on the Salvation Army which he despised for helping the poor but not mobilising them) you wouldn't get the pie until you died (and went to heaven). A sort of variant on religion being the opium of the people.