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Practice comment

Mental health services will be judged on both quality and cost

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The government’s vision for the future of mental health services is ambitious and aims to provide cost effective, quality care, says Mark Hardcastle 


The government’s consultation document on the future of mental health services outlines a vision to provide the sort of services that clients need, want and have been asking for. 

Mental health care has come a long way since the start of the last century. The 1980s and 1990s saw the closure of large county asylums and the development of a new model of community care. However, following high profile public inquiries it was clear these arrangements were not meeting the needs of many with serious mental illness.

In 1999 the policy response was the national service framework for mental health, which stipulated a different type of provision based on functional services such as assertive outreach and crisis response and home treatment. Arguably, the NSF has been the catalyst for unprecedented and ambitious reform that cannot be matched anywhere else in the world.

Ten years on there is a need to build on this successful policy base and it has now arrived as a Department of Health (2009) consultation document, entitled New Horizons.

This document does not prescriptively detail the specification of services in the way that NSFs did.  It is informed more from a value base that supports accessible and quality services that seek wellbeing, early intervention and recovery. It was developed through nationwide consultation events involving a wide range of people and organisations, including service users, carers and professionals.

Several themes emerged including: tackling stigma and strengthening social inclusion; earlier interventions; personalised care; innovation; and value for money.

New Horizons takes forward the NSF’s successful elements and creates the expectation of high quality services based on hope, self determination and opportunity, all of which characterise recovery-based values.

People will have more control over their health through a more personalised service which will include the potential for clients to commission their own service by being given a budget.

The consultation document provides a clear vision of the type of work that will be of greatest benefit to people with mental health problems: psychosocial interventions; addressing physical needs; creating socially inclusive opportunities; and early intervention.

These developments will require services to work more creatively and therapeutically than currently. Investment in our therapeutic practice staff will be required though this will not necessarily be through traditional professional roles. Support time recovery workers, non-medical prescribers, psychological therapists and staff able to address physical and occupational needs will be in demand. Nursing will need to continue to evolve to take advantage of these opportunities.

“This document does not prescriptively detail the specification of services in the way that NSFs did”

Health service providers, however, will have the challenge of not only evolving and developing services to achieve the expectations of New Horizons - they will also need to do so at a time of economic constraint. Commissioning arrangements will mean that provider services will be judged on the basis of both quality and cost.

As a clinical director of a foundation trust, I am aware of both parts of this seemingly contradictory equation. However, I firmly believe that at the heart of New Horizons is a set of values that do not require the huge financial investment that the NSF did.

It is becoming increasingly clearer that commissioning will be more competitive in future. It will be those organisations that can demonstrate how the values of New Horizons can be implemented in the most cost effective way that will win contracts to provide services.

The consultation runs until 15 October 2009. To contribute, go to an online questionnaire here.

MARK HARDCASTLE is consultant nurse and clinical director, Berkshire Healthcare Foundation Trust.



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