Career in Management and Organisation Development primarily in Social Services, Health and Criminal Justice.
Worked part time in the Hospice movement for five years until May 2015 (Quality & Compliance).
HealthWatch Plymouth volunteer and representative on the Plymouth Health & Wellbeing Board.
Practicing Psychotherapist Reg MBACP.
Volunteer with the Community Advice & Support Service (charity working with offenders and victims of crime).
Chartered Member, Institute of Personnel & Development.
The CQC is doing good work and is an essential provider of quality assurance. However, it is working within an institutional-political-economic framework that is abusive in its effects. Paying care workers minimum pay rates and 15-minute care visits are consequences of Local Authorities setting care contract funding at absurdly low levels. Care providers are expected to compete for the privilege of under-funding. All of this contributes to an institutional failure of care. We are all guilty here - the next time a politician tries to win your vote by promising to reduce taxes, remember the need for better funded care. Oh, and please don't buy rubbish 'newspapers' that cynically promote selfishness and consumerism and fail to report what is really going on. A random comment? NO! without accurate information none of us can work out what really needs doing about the things that really matter. Stop moaning and get involved - this is a democracy in which you can make a difference if you try. If you want better care, then join your local HealthWatch.
It is a move in the right direction to provide increased MH diversion support, but this is an inefficient use of NHS resources. There are existing projects demonstrating the value and low cost of third sector provision of triaging and diversion. Effective diversion requires referral to a range of support, not just to NHS services. Nurses do not have the training or opportunity to develop the extensive networking and knowledge required by the client-needs-driven approach necessary in this context. They are also very expensive and spend a lot of down time waiting in custody suites - nor are they available at peak demand times. It is surely better to keep nurses in NHS locations using the skills they have in providing MH treatments. Bring in specialist providers to undertake the triaging and referral process - much more effective and much lower cost. Remember that the MH nurses working in the justice context are being moved from other areas equally in need of their expertise, this is not 'new' money but a reallocation. Please, look outside the NHS and see how other models work so well at much lower cost, letting the NHS stick to what it does well. Ref: www.cassplus.org
Comment on: Exploring the role of CBT in mental health
I use CBT in my private practice and also as a volunteer counsellor with an Agency - it has its uses and is a valuable tool as part of a pluralistic approach. As this article briefly says, CBT does not address underlying issues, which are the primary source of problems for many people with mental difficulties. This is illustrated by the 3rd wave of CBT development including mindfulness and other techniques to fill the gap that CBT leaves. The current popularity of CBT in the UK derives from several points: it is highly structured and more easily 'measurable' than other therapies, so appeals to the medical profession - even when such measurement is largely spurious in practice. It is superficially cheap to commission - the usual limited number of sessions keeping costs down. There is a perception that in depth training of CBT practitioners is not needed. This latter is incorrect in that it is often impossible to assess a client's needs in the early stages of therapy - only when a client trusts the therapist sufficiently will they reveal the key experiences that are troubling them. This can take many sessions to achieve. Limited time interventions are OK for superficial problems or as a palliative/emergency measure but are, at base, disrespectful of the client ("we can fix you in quick time"). Admittedly, some therapy is usually better than none, and it may start the client on a journey to wellness. It is time to recognise however that the emphasis on CBT is being driven by cost constraints and it represents a form of rationing, not what is appropriate for clients. We need more recognition of the importance of deeper, longer term therapy responding to clients' needs.
IAPT staff refer clients with more complex needs to NHS Mental Health specialist teams, acknowledging the limits of their provision. But the specialist teams are massively overstretched and cannot accept all those who need their services. We need a much more intelligent, balanced approach using a range of therapies and more innovative modes of provision. The combination of NHS MH Teams plus IAPT CBT is insufficient and failing a very large number of people. (Although it is better than what was provided before.) CBT in this context represents a salve for policy makers' (and senior professionals') consciences - they can pretend that they are making provision, while in fact they are rationing services. Hard words but I believe they are true, based on the experiences of my clients, and a lot of study.
Nurses have perfectly legitimate personal interests in these developments, such as implications for pay. I suggest that the Profession also has a wider responsibility with regard to policy. There is a range of complex questions here, not least the structure of terms and conditions. Is this social enterprise classed as 'NHS' in government statistics, or does it represent privatization? More and more services are being transferred to CICs - are these still 'NHS'? Do the contractual arrangements require nurses qualified to NHS standards? Do European regulations (and trade agreements with the US) mean that contracts with CICs must be opened up to wider competition in future? Since CICs are private companies, what are the implications for standards, sharing patient information, Information Governance, service accreditation (and continuing recognition by NHS employers, including GPs). What about training, qualification and pay structures in the longer term? Is it legitimate for the NHS/government to subsidize training of staff in privately owned CICs? I am not aware of anyone who has answers to these questions yet. If you have, please let us know! CICs may provide the innovations that the NHS needs, but they may also be the Trojan horse that breaks the NHS into pieces; there is a vital need for open debate on this before we go further. The public we serve does not understand the implications because they have not been given the information - that is no less than a failure by politicians (of all colors) to follow democratic process. There is an important principle here for NHS and Local Authority Officers - politicians are avoiding public debate on changes like this because they are frightened of public reaction. Any 'bureaucrats' (to use Mr Cameron's expletive) who are complicit in their pretenses can expect the blame if (when?) it goes wrong. It is vital that the public becomes more informed and engaged. A failure by those responsible for planning and contracts to ensure this happens is simply that - a failure, to serve the public properly.
NB - for Nursing Times - please include a British-English spell checker in this facility!
At last - good on the Lib-Dems for addressing this problem, though the money allocated is nowhere near enough (as acknowledged by the 25% target). Please let's use the money wisely - insisting that IAPT therapist qualifications must be at Masters level is unnecessary and expensive, and insistence on time-limited CBT is often ineffective and inappropriate. We should be taking a client-centered, more flexible approach. I support the NHS and don't agree with privatization in principle, but the NHS way is not the only way. Invite the third sector in as the most cost-effective and innovative means of addressing this challenge. Work together to achieve wellbeing.