Tag: NIHR

COCAPP findings published

This morning saw the publication of the full and final report from COCAPP. COCAPP has been led by Professor Alan Simpson from City University London, and (as readers of this blog will know) has been concerned with care planning and coordination in community mental health, and the relationships between these processes and recovery-oriented and personalised care.

Today’s report appears in a single issue of the NIHR’s Health Services and Delivery Research journal. Following the link above takes you to a page from which the complete, 218-page, document can be downloaded. For a shorter read, follow the links instead to either the scientific or the plain English summaries.

Over on the COCAPP blog site, meanwhile, Alan Simpson and Alison Faulkner have written this accessible summary:

Who carried out the research?

The research was carried out by a team of researchers from three universities: City University London in England, and Cardiff and Swansea Universities in Wales. The team was led by Professor Alan Simpson at City University.

Service user and carer involvement:

Of the 13 researchers working directly on the study, six were involved in part time roles as service user researchers: one as co-applicant and the others to interview service users and carers. In addition, there was an advisory group of people with lived experience.

Who funded the research?

The National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (HS&DR 11/2004/12). This is a Government research funding body.

Why did we do the research?

Although there are two different systems in England and Wales, both mean that people receiving mental health services should have a care coordinator, a written care plan and regular reviews of their care. With the introduction of the recovery approach and personalisation, it is now expected that care planning and coordination should be recovery-focused and that people will be taking more control over their own support and treatment.

What were the aims of the research?

We wanted to find out what helps and what hinders care planning for people with mental health problems to be collaborative, personalised and recovery-focused.

By collaborative we mean that care planning is completed in partnership with the service user: the care coordinator works with the service user to plan their care.

By personalised we mean that care is designed with the full involvement of the service user and designed to meet their individual needs.

By recovery, we mean ‘a personal journey … one that may involve developing hope, a secure base and supportive relationships, being more in control of your life and care, social inclusion, how you develop coping skills, and self-management … often despite still having symptoms of mental illness.’

Where was the research carried out?

The research was carried out in six NHS mental health service provider organisations: four in England and two in Wales. One of the reasons for carrying out the research in both England and Wales is that Wales has a legal framework in place called the Mental Health Measure, introduced in 2010. This is intended to ensure that where mental health services are delivered, they focus more appropriately on people’s individual needs. In England, care planning is informed by guidance and is not legally required.

What did we do?

The focus of our research was on community mental health care. We wanted to find out the views and experiences of all of the different people involved: care coordinators (in community mental health teams), managers, senior practitioners, service users and their carers.

  1. We carried out an extensive literature review.
  2. We sent out questionnaires to large numbers of people, and received replies from service users (449) and care coordinators (205); these included questions on recovery, therapeutic relationships, and empowerment.
  3. We interviewed senior managers (12) and senior practitioners (27), care coordinators (28), service users (33) and carers (17).
  4. We reviewed 33 care plans with the permission of the service users concerned.

What did we find?

Summary of the survey findings:

  • There were no major differences between the six sites on the empowerment or recovery scores on the service user questionnaires;
  • There were some significant differences between the sites on therapeutic relationships: where there was good collaboration and input from clinicians, relationships were rated as more therapeutic;
  • We also found significant differences between sites on some recovery scores for the care coordinators: where they saw a greater range of treatment options, the service was rated as more recovery-focused;
  • We found a strong positive correlation between scores on the recovery scale and the therapeutic relationship scale for service users; this suggests that organisations perceived to be more recovery-focused were also perceived as having more therapeutic relationships.

Parity of esteem?

Today’s Guardian interview with Professor Simon Wessely, President of the Royal College of Psychiatrists, reveals how large the mental health care and treatment gap has become. Professor Wessely draws comparisons between mental health and cancer services, saying:

“People are still routinely waiting for – well, we don’t really know, but certainly more than 18 weeks, possibly up to two years, for their treatment and that is routine in some parts of the country. Some children aren’t getting any treatment at all – literally none. That’s what’s happening. So although we have the aspiration, the gap is now so big and yet there is no more money,” he said.

Wessely said there would be a public outcry if those who went without treatment were cancer patients rather than people with mental health problems. Imagine, he told the Guardian, the reaction if he gave a talk that began: “‘So, we have a problem in cancer service at the moment. Only 30% of people with cancer are getting treatment, so 70% of them don’t get any treatment for their cancer at all and it’s not even recognised.”

NHS England places considerable emphasis on ‘parity of esteem‘, with the Improving Access to Psychological Therapies (IAPT) programme intended to be a one, key, part of making this happen. Evidence like Simon Wessely’s, combined with (for example) BBC/Community Care investigatory evidence of cuts in services, points to a chasm between the stated intention and the frontline reality.

This lack of parity extends to research. Within the last week or so the Liberal Democrats made a promise to include in their general election manifesto a commitment to increase mental health research funding by £50m each year. It has often struck me how poorly funded mental health research is. Mental health researchers can apply for support to bodies like the NIHR and NISCHR, and many do with some success (see all my previous posts on this site relating to COCAPP, RiSC and Plan4Recovery, for example). But unlike most other areas of health care the mental health field has no large-scale, dedicated, charitable research funding. Mental Health Research UK was founded in 2008 as (it says on its website) the UK’s first charity devoted specifically to raising funds to support research into the causes and treatments of mental illness. And that’s about it, I think: unless someone is able to tell me differently?

 

Mid-May catch-up post

RiSC front pageWork on the RiSC and COCAPP studies means that, of necessity, I’ve had to let this blog site (and pretty much everything else) take something of a back seat in recent weeks. The picture on the left is a screen shot of the RiSC study final report, which is now perilously close to completion. Once submitted to the funding body (the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme) it will be peer reviewed, and once accepted for the NIHR Journals Library progress through an editorial process before (hopefully sometime before the end of this year) appearing online.

Elsewhere, I see that the call for abstracts for this year’s NPNR conference remains open for a little while yet, as this tweet from Laura Benfield who works for the RCN Events team indicates:

I’m pleased to say that both the RiSC and COCAPP teams have already submitted abstracts. The conference will again be at Warwick University, and promises to a special affair. Here’s a snip from the event’s website:

This year 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.

Whilst my head has been somewhere else I see that the Department of Health has now published Positive and Proactive Care: reducing the need for restrictive interventions (something which members of Mental Health Nurse Academics contributed to) and that, yesterday, it was announced that NICE is about to step into the debate on nursing numbers. Here’s how The Guardian reported this:

Nurses in hospitals should not have to look after more than eight patients each at any one time, the body that sets NHS standards will urge next week in a move that will add to pressure to end what critics claim is dangerous understaffing.

Responding to concerns about standards of patient care in the aftermath of the Mid Staffs scandal, the National Institute for Health and Care Excellence (Nice) will warn that registered nurses’ workloads should not exceed that number because patients’ safety could be put at risk.

The regulator’s intervention will intensify the pressure on hospitals, growing numbers of which are in financial difficulty, to hire more staff to tackle shortages even though many have little spare money. Campaigners on the subject believe at least 20,000 extra nurses are urgently needed at a cost of about £700m.

This looks to be a very important intervention indeed, with all sorts of potential implications. It will be interesting to see how policymakers respond. I also wonder how this debate will play out in the context of community health care, and whether we might expect some kind of consideration of caseload sizes. This is a fiendishly difficult area, and is far more complex than simply saying that (for example) ‘each community mental health nurse should have a caseload of no more than x‘.

I also see that Community Care has been continuing to highlight the extraordinary pressures facing people working in, and using, the mental health system. Austerity is very harmful, and Community Care is drawing necessary attention to the problems of lack of beds, funding cuts and retractions in community services.

Before I get my head back down into report-writing here’s a final plug, this time to a piece Michael Coffey has written over on the MHNAUK blog:

As we roll up to the end of April and summer is just around the corner the planning of our next meeting is starting to fall into some sort of shape. MHNAUK meetings usually take the form of morning presentations and afternoon group business items. After a meeting devoted to group strategy and plans in Cardiff in the Spring of 2013 we have attempted to get work done in our meetings and be much more strategic in terms of themes for presentations and outputs arising from these. This has meant that in the past year we have focused on dementia care and produced a position paper from this and in subsequent meetings we have discussed restrictive practices and physical health care in mental health which will result in further position papers.
For our coming meeting this June we are currently discussing ideas around the history of mental health nursing as one possible theme alongside plans to further our relationships with the mental health nurse consultants group. In addition we will revisit our plans for future themes so that we keep the focus firmly on supporting education and research in our field. Agendas are never truly fully complete and over the next few weeks new items will arise and suggestions will arrive that members feel we must discuss. This is as it should be and I welcome this as evidence of the vitality of the wider group, anyone fancy discussing yet another review of nurse education for instance?

Michael Coffey
Chair of MHNAUK

Welcome meeting for the RiSC project

Yesterday brought a there-and-back trip to Southampton, with esteemed colleagues Nicola Evans and Deborah Edwards, for an NIHR Health Services and Delivery Research Programme welcome meeting for our RiSC project. This was an opportunity to meet with other funded researchers (and very interesting they were, too) and to learn more about how the HS&DR Programme works with investigators over the lifetime of projects and beyond. We also had the chance to present our study, and to field questions from the floor.

On its website the HS&DR Programme says that it:

aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS including research on implementation and a range of knowledge mobilisation initiatives. It will be keen to support ambitious evaluative research to improve health services.

And that it:

aims to support a range of types of research including evidence synthesis and primary research. This includes large scale studies of national importance. This means primary research projects which:

  • Address an issue of major strategic importance to the NHS, with the cost in line with the significance of the problem to be investigated
  • Are likely to lead to changes in practice that will have a significant impact on a large number of patients across the UK
  • Aim to fill a clear ‘evidence gap’, and are likely to generate new knowledge of direct relevance to the NHS
  • Have the potential for findings to be applied to other conditions or situations outside the immediate area of research
  • Bring together a team with strong expertise and track record across the full range of relevant disciplines
  • Will be carried out across more than one research site.

A search through the programme’s portfolio of projects turns up a raft of studies of national and international significance, including work (ongoing and completed) led by or involving nurses. Well worth a look, in my view…