Tag: Health and Social Care Act 2012

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).

What future the NHS (2)?

Further to my last post referring to Raymond Tallis’ staunch defence of the NHS, a second excellent health service-related talk at Hay was Andrew Edgar’s. Andrew is a philosopher at Cardiff University, and on Tuesday he gave a customarily considered account of (amongst other things) the principles underpinning the NHS and how these contrast with those associated with health care systems elsewhere in the world. I particularly appreciated Andrew’s view of the NHS as being more than a way of simply (simply?) funding and delivering health care. It is a unifying force, embodying the majority view that some things are best paid for and organised collectively. Insurance based systems, as Andrew observed, are abhorrent to many in the UK because they treat health care as a commodity and pay insufficient regard to need.

Beyond the principles, as Andrew also pointed out, lie some difficult day-to-day health service realities. These include the existence of rationing (which clearly exists, but is rarely talked about in an open way), and the fact that the system retains a capacity to grind down, and sometimes even brutalise, those who work within it. But opening the service up to market forces, along the lines happening in England with the passing of the Health and Social Care Act 2012, is no remedy. Note my reference to ‘England’ here. Quite correctly, in my view, Andrew was careful to talk of not one but four ‘NHSs’ reflecting the divergence in systems across the different countries.

What future the NHS?

Yesterday at the Hay Festival I heard Raymond Tallis deliver a strong attack on the coalition government’s ‘redisorganisation’ of the NHS in England. The Health and Social Care Act 2012 has opened the NHS to the market in unprecedented fashion. Tallis talked of the dominance of private providers on clinical commissioning groups, and gave examples of patients being cherrypicked by organisations more concerned with profit than with meeting need. He also contrasted the upheaval with pre-2010 general election promises by both the Conservatives and the LibDems not to unleash major top-down change on the health service.

Tallis was critical of his own profession (medicine) for having failed to coordinate opposition to the legislation as it worked its way through parliament. He did, though, pick out and praise Clare Gerada of the RCGP for leading the resistance. I’m aware that the RCN was against the proposed Act, but I’m not sure that nurses as a group were particularly visible during the debates.

The first question from the audience asked what needs to be done to prevent the Act infecting Wales. The balance of politics here is different than in England, but it was a good question nonetheless.