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Squaring the Circle

January 15, 2015

By Basket Press

It’s hard sometimes to reconcile conflicting, almost contradictory, news reports. Let’s look at a few from the last few weeks, shall we?

We have stories about reduced numbers of mental health nursing posts on one hand, stories about new money available for innovation on another, then ones which appear to undercut those…Or even this one or this one…I am just so confused…Cuts have been made, but no, new money is here! Services are hacked to ribbons and staff are lost, but we shall innovate! I’m struggling to put all these things together and make sense of it.

Innovation in Child and Adolescent Mental Health Services (CAMHS) is something I know quite a bit about: for several years I worked in a CAMHS overdose assessment team, one of only a handful in the country. We provided a daily assessment (yes – 7 days a week, 365 days a year) and intensive follow up service for young people who had been admitted to hospital following overdose. Though I say so myself, it was a very good service. The need for it had been researched and demonstrated by our team leader (a nurse), our assessment document and tools were thorough and based on best available evidence and subject to review and change in light of new evidence; we were supported by work from the University of Manchester which showed that nurses and social workers were at least as good as psychiatrists at this sort of assessment, and it was the best job I have ever had…The team was taken down and the service disbanded by a combination of personal animosity and cheapskate thinking from commissioners who decreed us too expensive – well yes, running a service of that sort is never going to be cheap, is it?

I moved to a job in a neighbouring trust which was supposed to be a service development post, looking at streamlining and improving the whole process of CAMHS referrals and access to appropriate services – not just specialist ones but supporting and improving school nursing services and the like to ensure that only those who really needed specialist services were referred on and that support was available elsewhere. The commissioners had given the trust significant money for this work. However I eventually discovered that senior management had spent most of it on a consultant psychiatrist – but only after I spent a long time drawing up strategies and plans, drafting care pathways and training packages, writing job descriptions, agreeing joint approaches with the leads in school nursing and health visiting…None of which could happen because the money to pay for the workers to support all that had been spent on something else entirely different…

To make matters worse within my service other nursing colleagues were coming up with new plans to improve our delivery, such as an intensive day treatment programme to bridge the gap between community and in-patient services or nurse led Attention Deficit Hyperactivity Disorder (ADHD) monitoring clinics using nurse prescribers to take the load off psychiatrists. I helped to draft these proposals and to put together business plans, but to no avail: ‘too expensive’, ‘won’t work’, ‘don’t like it’ were amongst the knee jerk “criticisms” from our managers. The proposals got as far as a rubbish bin, not even going to trust board or commissioners.

In the meantime I was also involved in designing a care pathway for young people who self-harm and developing related training. I was told by my then manager to stop this as it “wasn’t appropriate use” of my time (oh, really? Check out the service development job description!). I ignored them, carried on and both the care pathway and the training won awards for best practice…

What is the relevance of this?” I hear you cry. Well, like I said, my experience of those “innovation pilots” is that managers stifled our attempts to improve and innovate. They showed themselves to be resistant to attempts to develop and improve services. Not only that but they initiated and oversaw cuts to their CAMH teams without a hint of protest. Or downbanded posts, replacing experienced Band 7s, like me, with people who have never worked in the area on a 5 or 6.

Alternatively, other CAMHS managers I have heard about have taken a different view on innovation, decreeing that patients will only be offered six appointments and that if clinicians don’t like this “they can do one!” or justify it to said managers, none of whom have a remotely relevant clinical background…That isn’t enough for an assessment for ADHD or Autism Spectrum Disorders…It isn’t enough to engage a very damaged young person who cannot trust (it took me two years with one young man before he could disclose the abuse he experienced)…This is supposed to be a specialist service, dealing with difficult and complex young people.

So, in the Bizarro World of current health “planning” and “thinking”, especially as applied to mental health, we shall cut funding and reduce both staff numbers and experience levels thus limiting the services which can be provided, then announce that we will give funds for innovation to people who have already demonstrated that they will actively work against their own staff trying to improve services and also spend money on something completely different to what it was intended for…

Or am I missing something? Because that couldn’t be right…Could it? It’s all a bad dream, isn’t it? I’ll wake up back in Kansas soon.

  1. pennyhaswell permalink

    Well written, deserves to be shared! Your stories are so similar to those in other clinical areas, it’s hard to remain upbeat about the situation…Dare I ask have you written a comment on

    I am not at all sure that what is said will have any attention paid to it, but I suppose one must be positive until proved otherwise!

  2. Basket Press permalink

    Thanks for the comment, Penny.

    I have some friends who are service users (EIP, adult in-patient and community services) in other parts of the country and their stories about cuts to services and reduced access are horrific, leading in at least one instance to someone being sectioned because they could not get access to the service they needed.

    I, and several colleagues, were hoarse from trying to explain things to our management, but we were always ignored – all clinicians are merely self-interested and trying to protect their own privileged positions, don’t you know – I have tried to raise some of these issues with politicians various, with a similar result. My view and experience is that those in positions of power or who hold the cheque books do not want to listen to anyone who actually knows something, because they do not like what they will hear.

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