A Consultation Response
Mike Llywelyn Cox,
- New Horizons appears to have been put together by those whose mindsets are essentially urban. The practice examples in the document are mainly: Marlborough; Oxford; Birmingham and Solihull; Melbourne, Australia; Bournemouth, Southampton and Derby; Time to Change; Wirral and Mersey; Shoreditch; South Tyneside; Manchester, Merseyside, Luton; Bromley, Bexley and Greenwich; North London; South West London; Sheffield; Thames Valley; Newham; Hackney; Glasgow; Sandwell; York; and Poole. Rural areas have some separate and special issues which should be addressed by those who understand those issues. The whole of the document should be Rural Proofed.
- In thirty years of Mental Health Social Work and ASW practice I continually experienced the common lesson that complex bureaucracies can precipitate mental health crises - and I’m talking about such simple things as an overbearing and thoughtless letter from the rent rebate section of the local council. I have seen a summons to a DSS medical examination create real fear and disabling panic. New Horizons should protect vulnerable mental health service users from government initiatives that create unbearable stress, for example, the proposed government suitability for work tests.
- Genuine service user and carer involvement is central to the stated aspirations of New Horizons. New Horizons should seek to outlaw tokenism and involvement should mean full participation in those aspects laid down in the Local Government and Public Involvement in Health Act 2005, Part 14, Section 221 (3) (a) (b) (c) and (6). That means full involvement in the planning, development and delivery of services. The principles of genuine service user and carer involvement should be interlocked with LINks and the funding, functions and profile of LINks should strengthened. The National Association of LINks Members should be given full government backing and recognition.
- The document says: “New Horizons aims to: take forward what we have learned in the lifetime of the NSF about what works, and broaden our scope to include all groups in society, including children and young people and older people; build on the principles and values set out in the NHS Constitution Next Stage Review (the Darzi report) and its vision of local commissioners working with providers, the public and service users to devise local approaches to mental health and mental health causes; use the growing understanding of the wider determinants and social consequences of mental health problems and mental well-being to influence priorities in other parts of central and local government” There are current examples of local government adult social services departments actively dodging and failing their responsibilities in mental health vis a vis the National Health Service and Community Care Act 1990. There are also discrepancies between other government mental health policies, New Horizons and the Personalisation Agenda. In particular, the government’s National Dementia Strategy plays down, by dismissing as a priority, it’s Objective 6, which is, amongst other important aspects, about personalisation and social work support. Local consultations here are reinforcing that and the local authority is gleefully playing along.
- The ringfencing of the local authority mental health budgets was, in my experience, a huge success in the 1990s. While community care services in mental health remain part of the local authority, ringfencing should be reintroduced
- There needs to be full integration of the Care Programme Approach with Community Care Needs Assessments and reviews
- All assessments and reviews should be NHS and local authority integrated.
- 5. CAMHs should be tightly linked to New Horizons and LINks should be tightly coordinated with OFSTED. The principles of service user and carer involvement should be promoted in child and adolescent approaches by involvement of service users in school and family.
- 6. Research into the aetiology of mental disorder should include thatinto the long-term effects of environmental factors, especially the heavy metals mercury and lead.
The New Horizons document is absolutely wonderful as it stands but looking further: - so were these!
NSF for mental health Implementation Guide 1999.
"The MHNSF expressed the case for reform in 11 principles, stating that people with mental health problems should expect that services will:
• involve service users and their carers in planning and delivery of care
• deliver high quality treatment and care which is known to be effective and acceptable
• be well suited to those who use them and be non-discriminatory
• be accessible so that help can be obtained when and where it is needed
• promote their safety and that of their carers, staff and the wider public
• offer choices which promote independence
• be well co-ordinated between all staff and agencies
• deliver continuity of care for as long as this is needed
• empower and support their staff
• be properly accountable to the public, service users and carers
• reduce suicides"
"By the end of March 2001, all health authorities should have in place protocols agreed and implemented between primary care and specialist mental health services for the management of: depression and post-natal depression; anxiety disorders; schizophrenia; those requiring psychological therapies; and drug and alcohol dependence. By the end of March 2002, all health authorities should have reviewed the operation of these protocols to ensure they are being used and operating effectively...information about treatment and services are available for all people (regardless of age) presenting in primary care with mental health problems..." (my emboldening)
The NHS Plan. Updated 27.07.2000
1.14 Many GPs will be working in teams from modern multi-purpose premises alongside nurses, pharmacists, dentists, therapists, opticians, midwives and social care staff. Nurses will have new opportunities and some GPs will tend to specialise in treating different conditions. The consulting room will become the place where appointments for outpatients and operations are booked, test results received and more diagnosis carried out using video and tele-links to hospital specialists. An increasing number of consultants will take outpatient sessions in local primary care centres.
1.15 Changes in primary care will help ease the pressure on hospitals so that they can concentrate on providing specialist care. Appointments will be pre-booked to suit the patient. Tests and diagnosis will be normally carried out on the same day. The next stage of treatment - if it is needed - will be arranged there and then, before the patient leaves the hospital.
1.18 A new range of intermediate care services will build a bridge between hospital and home, by helping people recover and resume independent living more quickly. This will speed up discharge from hospital when patients are ready to leave. The new services will give older people more independence rather than being forced to choose a care home.
Alan Milburn (NHSR&HCP) Bill in Parliament, Jan10, 2001, Hansard
“The second group of people who will be represented is simple and straightforward--the patients who have previously used the health service. That is reasonable. We all use local health services, but the people who really count are the patients themselves, so it is right and proper that they should have an opportunity to put themselves forward to the independent appointments commission, which will make a decision and try to achieve the right balance between different interest groups, genders, races and so on to ensure that every primary care trust and NHS trust has an organisation that it can be legitimately said is standing up for and properly representing the needs of patients.
The forums will be wholly independent. Unlike CHCs, which are partly appointed by the Department of Health, members of each new statutory patients forum will be appointed independently by the new independent NHS appointments commission. Furthermore, every patients forum will have the power to appoint a non-executive director to the trust board. For the first time, patients will elect a patient to the governing bodies of local health services as of right. For the first time, too, a patients' organisation, the forum, will be able to monitor, review and inspect all aspects of local health services from the patients' perspective. It will be able to visit and inspect every place in which patients are treated--hospitals, nursing homes, private health care, and, for the first time, all primary care settings.(Lord Hunt of Kings Heath - presenting the Bill)
PALS (Patient Advice and Liaison Service) will be placed in every trust to have the knowledge and clout to sort out problems for patients before they escalate into serious complaints. To safeguard against their "capture" by NHS trusts or primary care trusts, the independent patients forum will be able to recommend that a patient advocacy service be taken out of the trust and be run independently from it.”
Lord Hunt, introducing the above Bill in Parliament, Hansard:
“We have ensured that PALS will be based in trusts but have also ensured that each independent patients forum will monitor the local PALS and will have the power to remove a failing PAL from the trust.
The patients forum will also oversee the work of the patient advocacy and liaison services, (‘advocacy’ later changed to ‘advice’) which will provide an entirely new tier of service in the NHS: someone to sort out problems within hospital or community services on the spot, be they poor communication, worries about cleanliness or discharge arrangements.”
Strengthening Accountability - Involving Patients and the Public, February 2003:
“The overall aim of section 11 is to make sure patients and the public are involved and consulted from the very beginning of any process to develop health services or change how they operate.”
“The main emphasis from the new duty is that open discussion with patients, the public, and with staff. Needs to begin right at the beginning - before minds have been made up about how services could or should change.”
Tackling Health Inequalities, DoH, 11.08.05.
“As part of the overall goal of reducing health inequalities, the priority is to improve the health of the poorest groups and communities at a rate that brings their standards of health closer to those enjoyed by the rest of the country.”
Our Health Our Care Our Say. White Paper, 31.01.2006.
"12. This White Paper sets a new direction for the whole health and social care system. It confirms the vision set out in our Green Paper, Independence, Well-being and Choice. There will be a radical and sustained shift in the way in which services are delivered - ensuring that they are more personalised and that they fit into people's busy lives. We will give people a stronger voice so that they are the major drivers of service improvement.
• People will be helped in their goal to remain healthy and independent.
• People will have real choices and greater access in both health and social care.
• Far more services will be delivered - safely and effectively - in the community or at home.
• Services will be integrated, built round the needs of individuals and not service providers, promoting independence and choice.
• Long-standing inequalities in access and care will be tackled."
Tony Blair in The Govt White Paper, Our Health, Our Care, Our Say. Jan, 2006.
“These changes will be matched by much better links between health and social care. We will cut back the bureaucracy so local government and the NHS work effectively in tandem and give customers a bigger voice over the care they receive.”
A Stronger Local Voice, July 2006.
"The Government is committed to:
• developing a health and social care system planned around the needs of individual people and those of the wider community;
• creating health and social care services that are, regardless of who provides them, user-centred, responsive, flexible, open to challenge, accountable to communities and constantly open to improvement; and
• devolving decision making to the local level. Some 80% of the NHS budget is now devolved to PCTs, meaning that priorities are decided locally."
"We want people to become active partners in their healthcare and wish to create a system where people are no longer passive recipients of NHS and social care services.
The arrangements will enable genuine involvement in a much wider range of ways, bring real accountability at the commissioning level, and enable a broad spectrum of people to influence how their local services are designed and delivered." (Rosie Winterton Minister of State for Health Services, Foreword, A Stronger Local Voice).
The NHS operating framework for 2007/8
"It is important that patients receive high quality healthcare, no matter where they live in the country, and that where inequalities exist, they are dealt with."
Purple prose taken almost at random from the last ten years. Slithy words which verge on fraud. What real value then can we expect New Horizons to represent.
I don’t know. But what I do know is that this is the last, what I now consider to be empty and meaningless government consultations, I will respond to.
Deeds Not Words
Mike Llywelyn Cox,
13th September, 2009.