This time mind is addressing the appalling state of the acute services within mental health. A project that has taken considerable time and effort and can be found here:
There are many things to note within the pages of this report however I am unimpressed with some of the very much needed changes but I find it idealist. I worry that without any prescription leaving a community to assess its’ own needs will leave this piece meal system in exactly the same state that it is now.
This is from the summery page 41:
And while we heard about the pros and cons of different ways of organising services, we did not try to create a blueprint. We think this is for local communities and organisations to negotiate, learning from best practice. We think individuals should be offered personalised options not just a prescribed list.
However when trying to create a system of best working practise I really think that using some of the lauded services as blueprints for the poorer rated services would be very valuable; spread, the good practise, the knowledge, the infrastructure to services that are not working so well and put in place systems for updating the quality of services, for instance patient/ relative questionnaire on satisfaction and improvement.
Equally I don’t think that personalising services should negate a prescribe list being in place. I feel that it should be expanded to encompass some if not all of the ideas that this report is stressing people feel is appropriate. To provide and keep a quality check on a service there needs to be internal structure with which to work and too much personalising would make that unworkable.
The biggest problem I find with services is that they do not have the money to do all that they feel is appropriate. It seems this document is asking for a miracle and expecting it to be found and sadly it won’t be. The government does not have the money and though the inclination is lacking too it will not change their priorities if you cannot give them a cost to them to work with.
I feel that to consider change they will want to know the gain and the cost and this really only gives the gain and sadly even that is not quantifiable. It is obvious but really if you want change then you need to address the economics.
So what do I suggest?
Scale down you ideals and get a game plan. Use the services that have good reports and recommendations and look into the specifics of how each works. Good services are already out there all you need to do is copy them and implement them in the poorer areas. All the suggestions in this report came from system itself so use them, augment what’s already there. Lastly I would say find a way to expand the in-patient survey the quality care commission does to include all crisis care partiularly about how much patient improvement happens when they also feel a good quality of service and care is being given so the gain is in some way quantified,
because I, like I feel many will, will take one look at how you gathered your information and think
...ummm and how many of those who were just satisfied with the service would come forward? How many who had good but not outstanding care came forward? I wonder how many specifically came forward because they have an axe to grind or a wonderful plaudit to give.
And frankly the worth and accuracy of what is being said may well be lost on them because of it. An approach that appears unbiased will get a better hearing than one that is not seen to be.
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