Can we be aspirational about quality standards for mental health when resources are so tight?

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Last week, NICE published guidance that aims to provide adult users of mental health services with the best possible experience of care from the NHS. The guidance includes a set of quality standards – specific, concise statements with associated measures – to ensure that staff in mental health services know precisely what this means. It covers every stage of the process of care, in every context: community; assessment and referral in crisis; hospital care; discharge; transfer of care; and detention under the Mental Health Act. It also makes clear to service users what they should expect from the service.

But when times are hard and resources are being squeezed is there any point in producing aspirational guidance? What hope is there of delivering these quality standards reliably across the system?

For instance – compare the following aspirational statement from the new guidance with the findings of the last national survey of mental health service users, when 22 per cent of respondents said that the service overall was fair, poor or very poor:

'When you first arrive at mental health services for assessment, all staff should welcome you in a warm, friendly, respectful and professional manner. The waiting room should be comfortable, clean and warm, and have a private area you can use if you are distressed, have children with you, or prefer to wait on your own. You should not have to wait for longer than 20 minutes after the agreed appointment time. If your appointment is delayed you should be told the reason for this.'

In fact, I believe that the statement above illustrates why this guidance is such a fantastic breakthrough: by placing patients' and service users' experience at the forefront of care, and identifying it as a crucial component of health care quality, it has given patient experience equal consideration alongside clinical effectiveness and safety.

The guidance recognises that the quality of communication plays a crucial role in the relationship between service users and professionals, as well as identifying that the physical environment can help service users feel respected and reassured. In addition, there are clear expectations about the process of care (see the 20 minutes' waiting time) and good information provision – with the latter seen as not only a basic courtesy, but as a means of preventing unnecessary anxiety should a delay occur. I think that it is particularly vital now – when resources are tight – not to be distracted from these basic humanising aspects of care that are low cost but can deliver such high impact.

This guidance has already succeeded in raising awareness of service users' experiences, and hopefully others will learn from its development. The National Collaborating Centre for Mental Health, based at the Royal College of Psychiatrists, worked with a group of health care professionals (including consultants, GPs and nurses), service users, carers and technical staff, who carefully and thoroughly reviewed the evidence and drafted the recommendations. The voice of service users and carers has come through loud and clear.


Brian Hockley

Project Manager,
Comment date
22 December 2011
On a practical level, the Quality Standards will need commissioners to include them as reportable key performance indicators from their local providers ideally backed up by an independent service user led local assessment. Too frequently the response to "provide evidence" is "do a questionnaire". A more robust approach is required.

Rod Whiteley

Comment date
22 December 2011
Phrases like "every stage of the process of care" and "best possible experience of care" don't actually appear in the quality standard. In fact, page 1 of the standard makes it clear that it has quite limited scope and the much more limited aim to "contribute to improving the
effectiveness, safety and experience of care".

For example, the first quality statement only requires that people "feel optimistic that care will be effective". Care doesn't actually have to be effective. People only have to be optimistic about it. It would be an exaggeration even to call that a step in the right direction — it's more like a reluctant shuffle in the right direction.

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