Community Care have an exclusive interview with Paul Burstow this week where he discusses his approach to mental health care. Useful, as he is the Department of Health minister responsible for care services.
In the article he makes a link between poverty and mental health – nothing particularly ground-breaking there except a vague indication that the government acknowledges this and their responsibility to approaching this issue as he says
But, in facing up to poverty, we must acknowledge another truth: that poor mental health is often a key link in that miserable chain.
Of course there is a side swipe which is not altogether unmerited, at the previous government and their lack of action on tackling both poverty and mental health. Interestingly, he picks up on the New Horizons document as big on principles but short on detail.
Believe me, I’m no great defender of the last government but I am not sure that’s entirely fair criticism seeing as the point of the New Horizons document, which, after all was only published in December 2009 – was to set a vision of the agenda for mental health care in the coming decade rather than to detail some of the plans of delivery which was always going to take place after the document was published – or at least, that was my understanding of the process. Indeed, New Horizons is subtitled ‘A shared vision for Mental Health’.
Fair criticism would be on the actual actions of the previous government and he does get stuck in there as well although not necessarily in the ways that I would have expected him to.
He praises the IAPT programme – for example (Improving Access to Psychological Therapies). I have to say I’m not wholly au fait with the nature of the roll out of IAPT – one of the difficulties highlighted is the ways that the roll-out has depended considerably on local services and issues. I do know that a part of the problems with the roll-out have been cuts in spending which took place prior to the general election.
Burstow commits to an increased funding in this area. I hope there is a consideration to the access to referrals across the board and across all age groups and the funding isn’t clustered around adults of working age, I don’t remain particularly hopeful however.
This little sentence made my heart droop a little bit
Our NHS White Paper – with its plans to replace process targets with a new focus on patient outcomes – will help to achieve this.
Over this summer, we are discussing with patients and clinicians which “outcome” measures should be used to judge the health service in the future.
Targets or outcomes – perhaps because I’m not involved in the ways and means of measurements but I don’t see the benefits of one over the other as both can be massaged in any way chosen. Measured outcomes sounds good. We absolutely want people to ‘get better’. But who is judging how ‘better’ someone is and what is the baseline? It is still a bit too ‘tidy’ when ‘better’ means many different things. It might mean someone getting back to work if they have been off for a long period of time – it might mean being able to do things previously they weren’t able to but it is often as not a snapshot judgement and while I know it is the way we are going – we are being measured currently on outcome delivery, it doesn’t seem to guarantee a quality service is being delivered.
I can’t think of a way around quantifying the work we do – which is what is demanded. The only measure I can get my head around is actually asking the people we work with and their family members if our input has been more positive and useful but that isn’t ‘measureable’. Maybe it is due to the ways the outcome measures work that I feel a little cynical about them and the ease with which they can be manipulated – not necessarily maliciously but judging someone who has a fluctuating mental state between one week and the next may deliver different outcomes as might completely unrelated external factors – a recent bereavement, a new relationship – things over which the role of the professional would not make a difference.
Back to Burstow though and he does seem to be saying the ‘right’ things about tackling mental health through pubilc health initiatives and it shows that at least there is a sensitivity to the needs of mental health services in the country.
I do both wonder and worry where the next steps of this government will take us. As long as there is an agenda to stigmatise those who are dependent on state benefits and to cut preventative services across the board, there is not likely to be a whole person approach to mental health across different departments. Maybe if the Department of Health spoke to the Department of Work and Pensions a little more openly there would actually be some government money being saved in terms of prevention.
As a front-line practitioner, it’s easy for me to say that money should be pumped in here, there and everywhere and I’m aware of that. I know it won’t be. I am no macro-economist.
What I do see though is false savings in chronic care which lead to more expensive acute needs.
What I see is financial responsibilities for individuals between pushed between health and social services because neither want to take up the budgets and where the only person to suffer is the one for whom we should be caring.
As long as issues are dealt with within siloed budget streams of one department or another, it’s unlikely that the more global savings despite earlier outlays will be accounted for.
As for Burstow, he has the right honeyed words but he will be judged purely on what he and his government deliver.