Category: Policy

Catching up post

Plenty going on in the last week or so. I had the chance to join pre-registration mental health nurses and occupational therapists for a second day as they made preparations for an interprofessional event scheduled for early December. Some of these students have also been giving me drafts of assessed work to comment on, but as the deadline for receipt of these is first thing next week I expect a deluge then. ’twas ever thus.

Elsewhere there has been RiSC reviewing to crack on with, assignment marking, and peer review reports to both consider and write. I’ve also put myself in the frame to act as a reviewer for another university’s proposed new MSc mental health programme, this being the kind of curriculum work I haven’t had the chance to do for a while.

I’m not normally one for formal, suit-and-boot, events, but made an exception last Wednesday (November 27th) to join a posse of colleagues from the School of Healthcare Sciences at the RCN Wales Nurse of the Year awards. These took place at Cardiff City Hall, and the overall winner was Cardiff and Vale UHB ward sister Ruth Owens. Congratulations, Ruth. Congratulations, too, to the individual category winners: including Andy Lodwick (also from Cardiff and Vale) for picking up the Mental Health and Learning Disabilities award and Dr Carolyn Middleton, doctoral graduate from what was the Cardiff School of Nursing and Midwifery Studies, for winning the Research in Nursing award.

This week also brought me to a meeting of the MHRNC Service User and Carer Partnership Research Development Group and, yesterday morning, to the Cardiff City Stadium for an open meeting to discuss NISCHR’s infrastructure and programme funding review. Both were lively events, and on the NISCHR front I see big changes ahead from 2015.

And to close this summary post: via the twitter grapevine I see that the RCN is now giving early notification of the Network for Psychiatric Nursing Research 2014 conference. This will take place at Warwick University on the 18th and 19th of September. I’ll post a link to the call for abstracts once this appears, but for now will reproduce this extract from the event website:

This year [2014] is the 20th international NPNR conference and it’s going to be a celebration.

We wish to celebrate and promote some of the outstanding mental health nursing research that shapes mental health policy and nursing practice across the world. We will also acknowledge some of the best psychiatric and mental health nursing research that helped create the strong foundation for our work today. And we will invite delegates to look ahead to map out the future for mental health nursing research, education and practice.

Standard professions?

The Times Higher Education reports this week on comments made by Vince Cable at an event hosted by the Sutton Trust. According to the THE, the Business Secretary:

[…] has criticised the “qualification inflation” that means entrants to “very standard” professions such as nursing require a degree.

In truth I find the THE‘s report a little disjointed, as elsewhere it quotes Vince Cable on a host of other matters including private schooling, support for postgraduate study and the promotion of social mobility.

But I understand enough of it to take issue with the Business Secretary’s side-swipe at graduate nurses. On what grounds might we distinguish ‘standard’ from ‘elite’ professions, or sustain the argument that only those joining the latter must of necessity possess degrees? We await an explanation. In the meantime, for a considered review of nursing education I refer readers to the report of the Willis Commission, which I wrote about on this blog last year. For a research-oriented post on the division of labour in health care (and particularly, on professions in the mental health field), try this post.

Returning to the REF

Photo by Antony Theobald (ant.photos) Creative Commons 2.0 (CC BY-NC-ND 2.0) licence

This is the month that universities in the UK make their submissions to the Research Excellence Framework (REF) 2014. The REF is a big deal, as I’ve written about before. It is also continuing to attract plenty of commentary, much of it critical. For some time Dorothy Bishop, Professor of Developmental Neuropsychology at Oxford University, has been using her personal blog to critique exercises in research rating. Her objections include their poor cost-effectiveness and the dangers of using journal impact factors as a proxy for the quality of individual papers. In his blog Peter Coles, Professor of Theoretical Astrophysics at Sussex University, has attacked the REF for becoming self-serving. Quoting from a Times Higher Education (THE) story he also writes of the practice in some universities of research-active academics not selected for REF return being shifted onto teaching-only contracts. This week, Professor Peter Scott from the Institute of Education writes in The Guardian that research assessment is now ‘out of control’ whilst the THE has recently reported on the case of Lancaster University historian Professor Derek Sayer who has appealed against the decision to include him in the REF on the grounds that the procedures used to exclude some of his colleagues have been discriminatory.

And so it goes on. In the REF proper, outputs (typically articles in journals) will be graded by experts as ‘world leading’ (4*), ‘internationally excellent’ (3*), ‘internationally recognised’ (2*), ‘nationally recognised’ (1*) or as either ‘sub-national’ or ‘not research’. These gradings will be made using the criteria of originality, significance and rigour. Universities get to select which of their staff will be included in their returns, drawing on their preparatory assessments of the quality of eligible outputs and underpinned by strategic ambitions of where they want to be in the HE firmament once the official REF results are published and institutions ranked. My guess is that, for most researchers and their employers, the most important distinction needing to be made will have been between outputs which are internationally excellent (3*) and outputs which are ‘only’ internationally recognised (2*). For reasons of reputation and likely future funding an article assessed as being at least the former is much more likely to be included in a REF submission than one which is not.

Quality assessments informing imminent REF returns will have been made by busy people with varying degrees of expertise in the (sub)areas in which the papers they have been reading lie. I’m going to speculate that there will be many hundreds (thousands?) of academics with outputs which will have attracted inconsistent scores from internal and external reviewers. Who knows, perhaps there are even some with individual outputs assessed by different people as simultaneously being ‘world leading’ and ‘unclassified’. Many will certainly have papers differentially judged as being 2* or 3*, leaving all sorts of tricky decisions to be made on submission or non-submission with all manner of possible consequences for both individuals and universities.

Back in the world of actually doing research, as opposed to the world of assessing research outputs and fretting over returns to assessment exercises, I am pleased to say COCAPP is now receiving questionnaires from service users and RISC is deep into phase 2. If you head over to this NISCHR page you’ll also find news of the Plan4Recovery project, led by Michael Coffey. This is a collaboration involving Hafal, and I’m very pleased to be a co-applicant along with Sherrill Evans and Alan Meudell. Plan4Recovery is advertising for a research officer, and is about to have its first advisory group meetings. Exciting times.

Reviewing health and social care research in Wales

Here in Wales, a month or so ago the National Institute for Social Care and Health Research (NISCHR) published a document outlining ideas for its restructuring, and opened a discussion on how research should be prioritised, organised and supported in the future. NISCHR says that it:

[…] proposes to engage its stakeholders, including patients, the public, the NHS, social care organisations, universities, industry, the third sector and other government departments to review the infrastructure and programmes it currently funds and help determine what changes should be made.

Now, details of a series of open meetings have appeared. I’ve registered for the November 29th meeting taking place at the Cardiff City Stadium. I will also be offering up some ideas for the School of Healthcare Sciences’ collective response.

A number of things are currently brought together under the NISCHR umbrella. Funding is provided for national-level registered research groups (RRGs), regionally based academic health science collaborations (or partnerships) and a biomedical research centre and series of biomedical research units. Social care research is assisted through capacity-building funding. Support is also provided for Involving People, and for all-Wales training in research governance and related matters. Studies on the NISCHR portfolio are eligible for funded, in-the-field, help via a network of clinical studies officers and research nurses. NISCHR also oversees approval processes for NHS research, funds a number of trials units and has (this year) launched a faculty. There is also the small matter of NISCHR’s competitive funding schemes, which provide project-by-project support for high-quality studies of importance to health and social care in Wales.

Given all of this, NISCHR’s review is, I think, an important process to be contributing to. One of the NISCHR schemes mentioned in the review document is the Research Capacity Building Collaboration for Nursing and Allied Health Professionals (RCBC Wales). This has been an excellent initiative, entirely delivering (so far as I can tell) on its ambitions to develop capacity. As such, it deserves to be continued (and better still, expanded). I have to declare an interest here, of course, being an alumni of the RCBC Wales scheme having secured a postdoctoral fellowship in 2006. This was the funding which allowed me to investigate the establishment, work and wider system impact of crisis resolution and home treatment services, as I’ve variously blogged about in the past here, here and here.

The NISCHR document also draws attention to the use of Welsh health and social care research funds to support NIHR NETSCC Programmes. This paves the way for researchers in Wales to apply, on an equal footing to colleagues in England, for support from the HS&DR Programme, the HTA Programme and others. This mechanism facilitates cross-UK collaboration, which has to be a good thing. It is only through this support that Wales-based colleagues and I have been able to work on the COCAPP and RiSC projects.

I also see mention by NISCHR of an ongoing review of the operation of R&D offices, and in this regard I hope that a way is found to further rationalise approval and governance processes. The NHS research passport system could be better (it’s not really much of a ‘passport’ at all), and there are variations still in the ways different R&D offices process applications.

It is also clear that NISCHR is considering the level and type of support it offers to its all-Wales RRGs, and the connections these might have with biomedical research centres and biomedical research units working in overlapping areas. NISCHR is, if I understand this correctly, thinking through how organisations like the Mental Health Research Network Cymru and the National Centre for Mental Health might relate.

So, there we have it: evidence that changes to health and social care research organisation and funding in Wales are on the cards, with plenty of time remaining for people with an interest to get involved in shaping future arrangements.

Mental health services at a time of austerity

Last week I drafted a short, commentary-type, paper for a special edition of Mental Health Nursing which will be focusing on practice and services during a time of austerity. Some years ago I was on the editorial board of MHN. I’m pleased to learn that having disappeared from the library shelves in favour of becoming an online journal (available only to members of Unite the Union) it has made a return in traditional paper form. I’ve been sent a stack of copies, which I’ll be distributing to students.

Anyway: no sooner had I completed my draft and sent it onwards than yesterday’s big health and social care story broke. Under the banner England’s mental health services ‘in crisis’ the BBC ran a report drawing on a joint investigation conducted with Community Care magazine. The headlines were sobering, suggesting over 1,500 mental health hospital beds being lost since April 2011. These bald figures were illustrated with personal stories, revealing people needing crisis admission being transferred to wherever beds could be found around the country, and wards running at over 100% occupancy.

This is very bad news, and suggests a shrinkage back to the way things last were in the early to mid 1990s. In writing my paper for MHN I fished out my copy of this article by David McDaid and Martin Knapp, in which the point is made that at times of economic hardship demand for mental health care increases. And yet, as we are finding, services are actually retracting as austerity bites.

World Mental Health Day 2013 [update]

Now that I have learned how to embed YouTube videos into this blog (it isn’t difficult, really) I can update this morning’s post by adding a clip of Welsh Government Minister for Health and Social Services Professor Mark Drakeford speaking, on the occasion of World Mental Health Day 2013, at the Senedd. My thanks to Hafal for using its twitter account to draw my (and everyone else’s) attention to this:

World Mental Health Day 2013

Today is World Mental Health Day. Here’s a snip from the WHO:

Every year on 10th of October, The World Health Organization joins in celebrating the World Mental Health Day. The day is celebrated at the initiative of the World Federation of Mental Health and WHO supports this initiative through raising awareness on mental health issues using its strong relationships with the Ministries of health and civil society organizations across the globe. WHO also develops technical and communication material and provides technical assistance to the countries for advocacy campaigns around the World Mental Health Day.

The theme of World Mental Health Day in 2013 is “Mental health and older adults”.

Here in Wales, the day is being marked by (amongst other things) the organisation Hafal bringing its latest campaign, Lights! Camera! ACTION!, to the Senedd in Cardiff. From Hafal’s website I see that this event will be attended by the Welsh Government Minister for Health and Social Services, Professor Mark Drakeford. I hope this all goes well, as I’m sure it will. Last month’s revelation that Asda, Tesco and Amazon were selling ‘mental patient fancy dress costumes’ reminds us (as if it were needed) of the progress still to be made to improve public understanding of mental health issues and to tackle stigma and discrimination.

For a general overview of mental health priorities and challenges around the world, here’s a five minute video produced by the World Health Organization:

MHNAUK meeting at Teesside University

This afternoon I’m off to Darlington (a place I’ve never visited before) ahead of tomorrow’s Mental Health Nurse Academics UK (MHNAUK) meeting. As a reminder, MHNAUK’s website can be found here, and its blog can be found here.

This is going to be a considerable train journey (check out the map below), so I’ll be bringing work to be getting on with and plenty of light refreshments. The other thing I’ll be doing en route is catching up with friends and colleagues, where in the course of a normal working week it can be difficult to find time to converse.

The meeting itself is being hosted by Gordon Mitchell from Teesside University, and is being chaired by Michael Coffey. Taken from the MHNAUK website here is the agenda:

9.15 – 10.00 Arrival and Refreshments

10.00 – 10.10 Welcome from the Chair and Introductions – Michael Coffey

10.10 – 10.20 Welcome to the School and Teesside University – Dean Prof Paul Keane OBE

10.20 – 10.50 Safewards and coercion – Professor Len Bowers

10.50 – 11.20 Department of Health commissioned report on physical interventions – Ian Hulatt, RCN Mental Health Nurse Advisor and Professor Joy Duxbury

11.20 – Discussion re MHNAUK statement on research and education in physical interventions

11.30-11.45 Comfort Break

Main Business

11.45-12.45 Research Priority Setting: a proposal – Professor Len Bowers

Lunch and Networking

13.15 – 13.45 Revisiting Cardiff Proposals – Michael Coffey

13.45 – 14.00 Mental Health Nurse recruitment and selection – Enkanah Soobadoo

14.00 -14.15 NPNR News – Michael Coffey

14.15 – 14.25 Feedback on Academy of Nursing, Midwifery and Health Visiting Research – Professor Alan Simpson

14.25 – 14.35 Mental Health Nurse Metrics – Sue McAndrew

14.35 – 14.45 MHNAUK statement on Dementia care, education and research – Grahame Smith

14.45 – 14.50 Doctoral student network: fringe event at NPNR – Julia Terry

14.50 AOB – Mental Health Nursing history archive – Michael Coffey and MHNAUK new journal discussions – Ben Hannigan

15.00 Close of Meeting

Divergence and difference in mental health policy

Yesterday’s main business was a there-and-back trip to the University of Nottingham to act as a PhD external examiner. Reading this (very interesting) thesis in advance, discussing with the candidate at viva and talking with supervisory and examiner colleagues over lunch has reminded me (again) how mental health policy and services in Wales and England are diverging.

As an example, there really is no equivalent to the Mental Health (Wales) Measure on the English side of the Severn Bridge. For those not in the know here, ‘measure’ in this context means ‘law’. The Welsh Government’s brief public summary of this piece of legislation says:

The Mental Health (Wales) Measure 2010 is a new law made by the Welsh Government which will help people with mental health problems in four different ways.
Local Primary Mental Health Support Services
The Measure will make sure that more services are available for your GP to refer you to if you have mental health problems such as anxiety or depression. These services, which may include for example counselling, stress and anxiety management, will either be at your GP practice or nearby so it will be easier to get to them.
You will also be told about other services which might help you, such as those provided by groups such as local voluntary groups or advice about money or housing.
Care Coordination and Care and Treatment Planning
Some people have mental health problems which require more specialised care and support, (sometimes provided in hospital). If you are receiving these services then your care and treatment will be overseen by a professional such as a psychiatrist, psychologist, nurse or social worker. These people will be called Care Coordinators and will write you a care and treatment plan – working with you as much as possible. This plan will set out the goals you are working towards and the services that will be provided by the NHS and the local authority and other agencies to help you reach them. This plan must be reviewed with you at least once a year.
Assessment of people who have used specialist mental health services before
If you have received specialised treatment in the past and were discharged because your condition improved, but now you feel that your mental health is becoming worse, then you can go straight back to the mental health service which was looking after you before and ask them to check whether you need any further help or treatment. You don’t need to go to your GP first, although you may wish to talk it through. You can ask for this up to three years after you are discharged from the specialist team.
Independent Mental Health Advocacy
If you are in hospital and you have mental health problems you can ask for help from an Independent Mental Health Advocate (IMHA). An IMHA is an expert in mental health who will help you to make your views known and take decisions in relation to your care and treatment (but will not take decisions on your behalf!)

COCAPP, as some readers of this blog will already know, is investigating care planning and care coordination in community mental health: so the Care Coordination and Care and Treatment Planning component of the Measure is a really important part of the study’s context. It will be interesting to see how far national-level legal and policy differences are ‘felt’ at the level of everyday practice.

There are other important differences in emphasis across the two countries, too. I hear anecdotally that to save money some of the work done by England’s assertive outreach and early intervention teams is being called back into comprehensive, locality-based, community mental health teams (CMHTs). Assertive outreach and early intervention teams, alongside crisis resolution and home treatment services, sprung up in England in the first decade of this century following the publication of the National Service Framework for Mental Health, the Policy Implementation Guide and the NHS Plan. Here the strategy document Adult Mental Health Services for Wales, which appeared in 2001, was strong in its commitment to CMHTs and as a result (I have always thought) we never had quite the range of differentiated services which England had. We have, of course, got crisis services in Wales, as I have previously written about here, here and here.

And it’s not only in the mental health field that policy and services are diverging. We have no clinical commissioning groups in Wales, for the obvious reason that the Health and Social Care Act 2012 applies to England only (for more on this, check out this post dating back to the time I heard Raymond Tallis speak at the Hay Festival).

Evidence syntheses and the RiSC study

I’ve been working on a document associated with the RiSC study today. RiSC is an evidence synthesis of ‘risk’ for young people moving into, through and out of inpatient mental health services. To guide our review we’re using a framework developed by members of the the EPPI-Centre, about which more can be found by clicking on the logo below:EPPI Centre

Distinct about the EPPI-Centre approach is the emphasis placed on engaging with representatives of groups and communities with interests in the area under review. In their Methods for Conducting Systematic Reviews document the EPPI-Centre people write:

Approaches to reviewing
Involving representatives of all those who might have a vested interest in a particular systematic review helps to ensure that it is a relevant and useful piece of research.
User involvement
Everyone has a vested interest in public policy issues such as health, education, work and welfare. Consequently everyone, whether they wish to be actively engaged or not, has a vested interest in what research is undertaken in these fields and how research findings are shared and put to use.
Reviews are driven by the questions that they are seeking to answer. Different users may have different views about why a particular topic is important and interpret the issues within different ideological and theoretical perspectives.
Involving a range of users in a review is important as it enables reviewers to recognise and consider different users’ implicit viewpoints and thus to make a considered decision about the question that the review is attempting to answer. The aim is to be transparent about why a review has the focus that it does, rather than assuming it is, or is attempting to be, everything to everyone.

In our review (as you’ll see if you download our protocol from the link given at the top of this post above) we’re combining a broad descriptive mapping of the territory with a more selective, in-depth, review guided by the priorities of stakeholder representatives. These are people with experience of using, working in or managing child and adolescent mental health services.

I like this approach to conducting evidence reviews, appreciating the commitment it demands to the agreement of topic areas and to being open in decision-making. All going well I’ll be continuing with some RiSC work tomorrow.