Tag: Welsh Government

Safe staffing (again)

safe staffingJust over a year ago I posted a short piece on this site on safe staffing, particularly noting the work of Shaun Lintern and John Baker in alerting people to the importance of this in the mental health nursing context. Since then, the Nurse Staffing Levels (Wales) Act 2016 has passed into law, and the Welsh Government has opened this consultation on its draft statutory guidance for Local Health Boards and NHS Trusts. My colleague Aled Jones is coordinating a School of Healthcare Sciences response.

Here in Wales, the duty to calculate nurse staffing levels is currently limited to adult acute medical and surgical inpatient wards. In each NHS organisation with responsibilities in these fields, the Government’s draft document refers to the appointment of a ‘designated person’ with the job of calculating nurse staffing levels using three elements:

  • professional judgement;
  • use of an evidence-based workforce planning tool; and
  • a consideration of the extent to which patients’ wellbeing is sensitive to nursing care.

Making these calculations, I can only imagine, will be a mighty challenging task requiring in-depth understanding of individual wards, the characteristics of patients admitted, and use of a tool which has (so far as I understand it) yet to be finalised.

Meanwhile, via John Baker I learn today of this new publication by NHS Improvement on safe, sustainable and productive staffing in mental health services. This is not about safe nursing staffing, but is about interprofessional staffing in specialist mental health services. Here I read of expectations around right staff, right skills and right place, right time and also spot a rapid review of the relevant literature. This begins with the understated observation that, ‘the issue of safe and sustainable staffing in mental health is complex and research is lacking’. I should say so. The time is ripe, I think, for some serious independent studies in this area.

 

Mental Health Nurse Academics UK meets in Nottingham

I was unable to make Thursday evening’s Skellern Lecture and Journal of Psychiatric and Mental Health Nursing Lifetime Achievement event hosted by Patrick Callaghan at Nottingham University. My congratulations to Ian Norman and to Marion Janner, this year’s very worthy award winners. As it happens, Ian was one of my PhD examiners. My following of Thursday’s proceedings from afar, via Twitter, tells me I missed a treat.

I was, however, able to make the trip to Nottingham for Friday’s summer term meeting of Mental Health Nurse Academics UK (MHNAUK). This was held in the new, and rather impressive, Institute of Mental Health building:

Here’s a picture I took of the sculpture, titled House for a Gordian Knot, displayed at the entrance to the Institute’s main building:

We had three local presentations. First up was  Paul Crawford, who gave a broad overview of the Creative Practice as Mutual Recovery research programme which he leads, followed by Andrew Grundy giving an account of qualitative findings from the Enhancing the Quality of User Involved Care Planning in Mental Health Services (EQUIP) study. EQUIP is an important, NIHR-funded, programme of work which (along with COCAPP and COCAPP-A) is producing evidence of how care planning is being done and how it might be improved. Here’s a photo, taken and shared by Karen Wright, of one of Andrew’s final slides outlining steps to successful user involvement in this process:

Tim Carter talked us through his freshly-minted mixed methods PhD, in which he investigated the use of a preferred-intensity exercise programme for young people with depression. I thought this to be a very well-designed study, which generated considerable discussion around the active ingredients of the intervention and plans for a future follow-up.

Elsewhere Lawrie Elliott, editor of the Journal of Psychiatric and Mental Health Nursing, was welcomed by the group to give an update on developments at the journal in his first year at the helm. I really liked what I heard, and said as much in our discussion. Quality of papers, and relevance to mental health nursing, are being prioritised. Word limits have been increased to allow for more in-depth analysis in accepted articles. To extend its reach the journal now has a Twitter account, which can be followed by clicking the following link:

Ben Thomas from the Department of Health opened a discussion on the future of the Student Mental Health Nursing Conference, the inaugural event having taken place at the O2 Arena in London in February this year. As I understand it, much of the organising was done by staff and students at Greenwich University: well done, them. A group of MHNAUK members representing different universities has agreed to collaborate to keep this initiative going, and with a view to turning it into a cross-UK, rather than an England-only, opportunity.

Following David Sallah’s meeting with MHNAUK in York in March 2015, Joy Duxbury and Steven Pryjmachuk chaired a discussion on the current status of the Shape of Caring review. Since returning from Nottingham I have found that Health Education England is planning to sound out opinion through a series of events running into the autumn. Details are to follow.

Thanks particularly to John Baker, in the weeks leading up to this latest meeting MHNAUK published a response strongly criticising the announcement that the National Institute for Health and Care Excellence (NICE) was ending its work in the area of safe staffing. This decision, defended two days ago by Jane Cummings (Chief Nursing Officer at NHS England), has also been challenged by others including Sir Robert Francis and now the Council of Deans of Health. The Safe Staffing Alliance campaigns in this area, and MHNAUK will continue to make a contribution via a further response the outline of which was agreed in Nottingham. As a reminder of some of the key evidence supporting the importance of registered, graduate, nurses for quality and safety follow this link to an earlier post on this site and this link to a recording of Linda Aiken delivering the Winifred Raphael Memorial Lecture at the University of South Wales on October 1st 2014. And, for those interested in how #safestaffing is shaping up differently across the countries of the UK, follow this link for a record of the progress of the Safe Nurse Staffing Levels (Wales) Bill through the National Assembly for Wales. Following this link brings you to a report reviewing the evidence, commissioned by the Welsh Government and produced by a team led by Aled Jones in the Cardiff School of Healthcare Sciences.

Fiona Nolan shared progress on her survey of mental health nursing research interests and expertise in UK higher education institutions. And, finally, on behalf of the organising and scientific committee Russell Ashmore, Laoise Renwick and I took the chance to update MHNAUK members on progress for the 21st International Network for Psychiatric Nursing Research conference.

#NPNR2015 takes place at the Manchester Conference Centre on Thursday 17th and Friday 18th September 2015. We think the programme is shaping up perfectly, with keynote speakers including England’s National Clinical Director for Mental Health Dr Geraldine Strathdee, Prof Shôn Lewis from the University of Manchester, Mark Brown who ran One in Four magazine and is now involved with The New Mental Health, and André Tomlin who runs The Mental Elf service. We have symposia, workshops and concurrent sessions with papers accepted from presenters around the world, a walking poster tour and the opportunity for fringe events. Make your booking now!

Spring election, and the politics of mental health

It hasn’t always been like this, but mental health is something which politicians now talk about. In the run-up to next week’s general election mental health has even featured in public appeals to voters. The Liberal Democrats have particularly campaigned in this area, and in their manifesto promise £500 million per year for better mental health, and specifically make a case for investing in research. Labour talk about giving mental health the same priority as physical health, and the Conservatives say pretty much the same. Reviewing all the main parties’ manifesto promises for evidence of concrete plans for post-election improvements to mental health care, over on his blogsite the Psychodiagnosticator observes ‘that many of them were so vague as to amount to no promise at all‘. I think he has a point.

Possibly the broad manifestos produced in the run-up to a general election are not the places to look for fully worked-up blueprints of what future mental health policy across the UK might look like. Perhaps, more accurately, we should not think about ‘UK policy’ in this context at all. Members of Parliament elected to Westminster next week, from amongst whom a new government will be formed, will have authority to directly shape services in England only. Health and social care remain areas over which devolved authorities have jurisdiction, and for a ballot delivering a government with the power to pronounce on mental health care here in Wales we must look to the National Assembly elections to be held in 2016. I’ve indicated before that mental health policy here is different from that in England, and indeed from other countries in the UK. Consider again the case of the Mental Health (Wales) Measure. This is a piece of legislation for Wales alone, mandating for care and treatment plans, care coordinators, access to advocates in hospital and the right of reassessment within secondary mental health services following discharge. It was introduced in the face of some strong, pre-legislative, criticism from at least one senior law academic (Phil Fennell) who in 2010 began his submission to the National Assembly by saying,

The gist of my submission to the Committee is that this measure, although well-intentioned, is cumbersome, unduly complex, and will lead to a delay in providing services which ought to have been available already to service users and their families in Wales under the National Service Framework for Adult Mental Health and the Care Programme Approach.

Five years on the Measure has not only passed into law, but been subjected to a round of post-legislative scrutiny by the National Assembly’s Health and Social Care Committee (see my post here), to which the Welsh Government has now responded. With data from across both England and Wales, COCAPP (and in the future, COCAPP-A) will have something to say about how care planning and care coordination are actually being done, and readers will be able to draw their own conclusions on the extent to which changes in the law trigger changes to everyday practice. And, whilst we’re in policy comparison mode, for a view from Scotland try Paul Cairney. He argues that divergence in mental health policy across the UK, exemplified by contrasting English and Scottish experiences of reforming the law, reflect differences in both the substance of policy and in policymaking style.

In all of this I am, again, reminded of the wicked problems facing all policymakers who seek to intervene in the mental health field. Whatever direction it takes, future policy will be open to contest and will surely trigger waves of consequences.

Taking Measure

Here in Wales we have the Mental Health Measure. This is a piece of legislation passed in 2010 and implemented in phases in 2012, and which is intended to improve the quality and timeliness of mental health services. Specifically, it provides for:

  • primary mental health care;
  • care and treatment planning and care coordination;
  • the right for an automatic reassessment of needs in secondary mental health services for people discharged within the previous three years;
  • advocacy in hospital.

This month the National Assembly for Wales Health and Social Care Committee has reported on its post-legislative scrutiny of the Measure. The Welsh Government has already committed to conduct a formal evaluation of the legislation through a duty to review, built in as the Measure passed into law. In pursuit of this an inception and an interim report have already appeared, with a final document due in 2016. With the Health and Social Care Committee’s report appearing this month it is clear that the Mental Health Measure is becoming seriously scrutinised.

When the Committee published its call for evidence last year the COCAPP research team submitted a response alerting Assembly Members to our ongoing study. It would have been ideal had we been able to report key findings, given that COCAPP is an examination of care planning and care coordination and is, therefore, of interest to anyone wanting to know how part 2 of the Measure (dealing with care and treatment planning) is being experienced. But the Health and Social Care Committee’s timescales and those of COCAPP were not aligned, meaning the best we could do was to draw attention to our project.

This month the Committee praises many aspects of the Measure but also makes ten recommendations. They address:

  1. meeting demands for primary mental health care, particularly in the case of children and young people;
  2. improving the collection of data to better support the evaluation of primary mental health services;
  3. taking action to improve the form, content and quality of care and treatment plans, with a view to increasing service user involvement and spreading best practice through training;
  4. making sure that rights to self-refer for reassessment are properly understood and communicated to all;
  5. improving staff awareness of service users’ eligibility for independent mental health advocacy in hospital;
  6. setting timescales for new task and finish groups reviewing the Measure, and setting out plans to respond to their recommendations;
  7. during evaluations of the legislation, consulting with as wide a range of people as possible using traditional and novel approaches;
  8. ensuring that information is available in a variety of formats, so that all groups of people are able to access this and to understand;
  9. following the publishing of new plans for the improvement of child and adolescent mental health services, making clear how these will be realised;
  10. carrying out a cost benefit analysis of the Measure.

Clearly, Assembly Members have detected evidence of an uneven pace in the development of primary mental health care across Wales, and are particularly concerned to make sure that the mental health needs of children and young people are properly identified and met in timely fashion. As a COCAPP-er, I am interested to read that the Committee thinks care and treatment planning for everyone can be improved, informed by examples of best practice and through investment in staff training. I also pick out the recommendations on improving service user collaboration, and estimating the costs and benefits of the Measure. These resonate, to me, with current concerns in Wales with prudent health care and co-production.

And as for COCAPP’s findings? Suffice to say our draft final report is now under review with the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme. More to follow in due course…

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:

Vivas, research projects and the Welsh Government on the Francis Report

There’s plenty going on in the continuing baking sun this week. I was pleased to spend yesterday at Sheffield University (where I was once a student) examining, and recommending awarding, a doctorate addressing the use of problem based learning in mental health nursing education.

Meanwhile COCAPP is now generating data, and the RiSC project has reached a critical point as a search strategy is devised for its second phase. And tomorrow and on Friday I’ll be in the classroom with a group of professional doctorate students, talking and learning about systems and complexity.

Elsewhere, via the twitter account of the Minister for Health and Social Services, Mark Drakeford I’ve spotted the Welsh Government’s response to the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. I see there will be an annual Quality Statement for the NHS in Wales from next year, and a future NHS Wales Quality Bill.