New Horizons Consultation

[nickh]

The Department of Health have launched a period of public consultation on their New Horizons document - this is supposed to map out policy in Mental Health for the next decade. The consultation document can be found at...

http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_103144

and the consultation closes on 14th October 2009. There is a facility for responding on-line. I haven't read the document yet but will try and do so at some point (it is long!) but would be very interested to hear from anyone who manages it what their views are.

Nick.

 

[Op.cit]

NH

I have read to document. Two things, the first is that we are highly likely to see a change of government in the not to distant future. The present government can’t admit they are likely to lose but like it or not that is the context.

The second is that the tone of the document fits well with general direction the rest of the health service is being pushed in. For instance the use of phrases like “making it easier to make healthier choices”.

This sounds good but what is behind it is a philosophical frame work that is predicated on the notion that bad choices lead to poor health. In other words “your illness, your fault”. The alternate view is that poor health is the result of and exacerbated by social factors like poverty, poor housing and sanitation. Just for instance.

The other notion contained in the doc. is that choice will lead in itself to better services. Setting aside the truth of this or not as it is another debate, you might take offence that the government has taken it upon themselves to define your relationship with your health provider as consumer and provider. When what you might like the relationship to be citizen and provider.

In summary the vision is fine but there is nothing about the mechanism for reaching it. Instead of mechanisms we have platitudes that obscure the political agenda to make health services like any other consumer product. Its not a cynical agenda, the government is right to take a point of view and pursue its aims. I am not sure that it is what people really want though. To be fair we need to see what the next government comes up with, probably more of the same.

Op.cit

 

[nickh]

Thanks op cit - very insightful comments and many congratulations on actually reading it right through . I am still waiting to get a paper copy before I do that. The general opinion I have encountered in rl is that as a 'consultation' it is like many of these exercises something of a sham and the outcome is predetermined.

'Choice' in MH seems to me particularly problematic both because of the vulnerability of some MH Service Users and because of the actual lack of choices available (as this Forum attests to almost every day). When I am really ill and offered a choice I will tend to accept it whatever it is - certainly I did so in the past in respect of hospitalisation, medication, ECT etc.. if I had been offered the choice of jumping off a cliff I would probably have agreed

Nick.

 

[Op.cit]

NH

Thanks and glad you are better.

I agree with you about choice and your own example demonstrates the difficulty with exercising choice when some one is unwell. It’s not the ideal time. To that extent MH has that in common with other illness.

The evidence from other parts of the health service is that people make choices based on waiting time lists, the size of the hospital car park (honestly), or if they get on with their doctor. Waiting lists are not correlatated with quality, neither are good transport links and the like. Dr Shipman was loved by his patients. Choice just doesn’t stack up for me. (I draw a distinction between choice as a mechanism for driving up standards and being involved in decisions about treatment and drawing up a care plan for instance)

Your other point about resources really gets to the heart of the matter because not every one can have a real choice in the context of limited resources. Any one trying to choose a school for their children can attest to this. Clearly resources are always going to be limited to an extent so the lesson to my mind is that we need another mechanism to ensure quality services. My suggestions for this are cooperation between provider organisations to share good practice, rather than competition, and most of all involvement and engagement of service users to find out what really works for people. I think the difficulty is that this approach is rather harder to implement because provider organisations just don’t have a culture of involvement and engagement. You also need the belief as a starting point that users have something useful to contribute in the first place.

Op.cit

 

[nickh]

Thanks op cit - I am in full agreement about the need for SU involvement of course : and about the lack of it!

Having said this, and noted with amusement what you say about the car parks, I do think that a 'choice' agenda could have a very important part to play in MH services if it were properly implemented. That is if people were given genuine choices from a real range (all kinds of talking therapies, art therapy, mediation, exercise, bibliotherapy, music therapy, heck yes even video game therapy if that is what they want etc.). This would depend on people being able to sample each option and see if it worked or did not work for them, and then being provided with the resources to pursue it. The fact is that this would be, in the short term, very expensive to establish so is highly unlikely (to be euphemistic!) to happen (of course in the long-term it would probably be cost-effective since there would be more people coping, less in crisis, and it is the latter which is really expensive whether it involves hospital or home treatment teams).

Nick.

 

[Op.cit]

NH

I think the direct payments program is a way of getting the sorts of things that you mention. I agree with you about having a what ever works approach as well. At the moment you can apply for just about anything using direct payments. The challenge that it presents is to the non statutory sector as it is these organisatons that will get thier budgets "stolen" from to fund direct payments. If enough people take up direct payments then thier wont be enough to fund a day centre for instance. So it depends what you think is best. If enough people chose direct payments every one else will find thier day centre/drop in shut. So again I would say that in a world where resources are limited not every can have a real choice.

I am not making a value judgement about dropins or day centers I am just saying that choice wont always have the consequences that every might hope for. It is just an example of what could happen.

The other point I would make is that direct payments are much cheaper than block purchasing services so the net result will be a drop in total funding.

At the moment you can apply for just about anything to be funded on a personal basis. What I fear in the end is that once targets for the total number of people getting support by direct payments has been met, and other services shut as a result lets not forget, what will happen is that exactly what is funded will come under much greater scrutiny. Its not likely that interventions that have no evidence base to suggest they really do work will continue to be funded. No one is building that evidence base either.

My other concern is that most of the budget will be swallowed up by the "worried well" or "worried but actually quite recoverd" and truely vulnerable people will be the people who lose out because they just wont apply.

That is just my take on it and perhaps I am just a bit cynical about the whole end game.

 

[nickh]

No op cit I agree with everything you say - and in fact that is exactly what is happening in Birmingham with the shutting of Day Centres which has seriously affected very vulnerable people. I was merely positing a 'what if' situation of maximum desirability; in such a scenario I think a choice agenda would play a valuable role. In actuality I think that it will be used as a device for cutting services as you suggest. As always the gap between the rhetoric and the reality is terrific and what, in terms of campaigns etc., we should always be concentrating on.

Nick.

 

[penelope]

My other concern is that most of the budget will be swallowed up by the "worried well" or "worried but actually quite recoverd" and truely vulnerable people will be the people who lose out because they just wont apply.


There are people out there already not claiming and the 'worried well' would have to be accessed by social services through this system to actually get the payments. Its a legal time bomb. Not sure attacking within is a good idea.The framework of 'the care services' with cutting dla and help being offered only in the ' care services' is a frightening prospect.

If I wasn't worried earlier I am now .

 

[Op.cit]

NH

Nick,

No worries, I am sorry if I came over as critical of your point of view....I really didnt mean to.

I do think it is hard to resolve involvement and engagement on the one hand and choice, marketisation and consumerism on the other. Involvement is about planning and co operation between services and service users. The other is about competition between services as they compete to create services that service users want.

I dont mean to portray it as a battle between one or the other but really just highlight the tension between the two approaches.

In the UK we have a bit of both approaches as governments of diffrent complexions have come and gone, leaving service providers in a bit of muddle. That at least is unlikely to ever change.

Regards,
Op.cit

 

[Op.cit]

NH

Penelope,

Not sure attacking within is a good idea

I am sure you are right about this.

Regards,
Op.cit

 

[nickh]

Thanks op cit - you have given me a great deal of food for thought .

Nick.