Friday, 8 August 2008

Patient opinions matter? (BLPT)

In this month's Trust Board meeting, I found an interesting item. One thing that interested me was where on the agenda it was placed - it was in the "Information" section, with the following explanation above it:
"These reports are provided for information only and no discussion will take place about them unless there are any specific points of interest arising from them that anyone wishes to discuss"
I wonder whether any discussion did take place, particularly around the following statements within the report:

The Trust has, as in previous years, performed comparatively poorly in the National Patient Survey. The continued poor performance has the potential to damage the Trust’s reputation and, more importantly, is an indication that users of Trust services are not as satisfied with the care they are receiving, as is the case in other mental health Trusts.

...there is the possibility that the Trust’s overall rating for 2007/8 will slip from ‘good’ to ‘fair’ as a consequence of its performance in the National Patient Survey.
It's interesting to me that this connection (between service user opinions and ratings) only seems to be being made at this late point. Perhaps the author of the report felt this too, for he notes that,
The Healthcare Commission is, quite properly, reorienting its performance regime away from the measurement of process towards the measurement of outcomes.
"Quite properly" indeed. In fact, how could it have been otherwise for so long. How could it have been possible for a Trust to be rated relatively well ("Good" and "Fair") when those using the service did not share this opinion. Maybe at last those of us using the services will be listened to. I'm not holding my breath though, especially given these comments:

Over the next 3 months, doctors, team leaders and team administrators are going to be analyzing the lists of service users who have not apparently been seen in the last six months, in order to cleanse the data and discharge service users back to primary care where it is appropriate.

The Trust will need to work with GPs to ensure that they have the confidence both to provide care for people who suffer from mental ill health whose conditions are currently stable, and also that the Trust will respond speedily to referrals if these service users subsequently require the input of secondary services.

Sounds like part of the approach is simply going to be to remove people from the service. And the comment about the Trust responding to referrals is a very pertinent one, in my experience. If I felt that it would be possible to access support speedily if I needed it, there have been several points where I would have wilingly been discharged from CMHT services. Unfortunately, my own (and others') experiences suggest that it is not, as yet, possible to access that support when needed.

As I said, I wonder whether any discussion did arise from what seems to me a very interesting and thought provoking document.


Catherine said...

I was thinking that too, that they were essentially removing those people who were not happy with them (because they wouldn't have come back, would they have?)

The Shrink said...

"Sounds like part of the approach is simply going to be to remove people from the service."

Not sure about this.

This certainly can be the case, it's easy in Secondary Care to do very little by simply refusing most referrals and discharging those few you do accept back to the GP sharpish.

But, seeing it from the other side, it's even easier to just do nothing. Have people on the books but do nothing. When asked you're "giving support."
Managers are happy since is looks like you're obviously really, really busy with case loads of squillions. Poor wee thing.
And GPs are happy as the hospital's "looking after things"
Mental health workers are happy as they've easy case loads with people who aren't troubling them with significant clinical needs.
Only the patient and the system suffers.

Discharging back can mean patients get active care (rather than drifting in a system without purpose) and the system is responsive, rather than filled with lots of folk who don't (at that point in time) need specialist hospital intervention.

Just saying, if it's going to happen, that the changes could be major changes for the better, for patient care.

Disillusioned said...

catherine, I dunno. I think the people who are unhappy (as shown on the survey) are reflecting the lack of service. I suspect some may need to come back though.

Shrink, yes, I agree. My cynicism comes from the reasons for discharge - "We are not providing a service and that is reflected in the HCC survey responses." If the reason were that GPs can provide what is needed better, then great. And I'm also concerned because if these people were in a position to be discharged, why has that not been picked up as part of their care? Could be a good thing, I know - but it worries me that people might be discharged who actually need more of a service than they are currently getting from specialist mental health services rather than them not needing the service at all. I hear what you are saying, but I lack trust in the local mental health services (as do many local GPs, according to trust board reports). I'm also concerned about how readily these patients will be able to access specialist support should they need it in the future - my experience (and that of others who I know) is that it can be really difficult to get support within the system on being referred by a GP.