Dr Mike Hobbs looks at how clinical engagement is shaping policy in mental health and emphasises the importance of genuine interactions for positive outcomes

As the NHS marked its 60th anniversary, the final outcomes of Lord Darzi's next stage review were revealed.

As part of the review, eight clinical pathway groups comprising 20 or more clinicians in each of the 10 strategic health authorities generated reports highlighting examples of good clinical practice and priorities for the next 10 years. Highly choreographed consultation events in each SHA engaged more clinicians as well as other NHS staff, service users, carers and the public.

Lord Darzi's report now aims to revolutionise NHS strategic planning and commissioning by turning the rhetoric of engagement into reality.

Common threads

Continuing dialogue between chairs of the 10 mental health clinical pathway groups has established that there is substantial common ground between the 10 regional mental health reports. This includes:

  • a public health perspective for mental health service development;

  • improved early identification and intervention;

  • stepped care pathways that integrate primary and secondary healthcare with services provided by other agencies;

  • attention to the mental/physical health interface;

  • a commissioning framework based on service user agreed outcomes;

  • the need for an agreed contracting currency.

The challenge now will be to ensure key priorities are agreed and implemented in each area, respecting legitimate regional variation but also the imperative of health equality. Methodologies will vary from one area to another, but never has the need for top class commissioning been more urgent. The NHS Confederation's discussion paper on mental health commissioning is timely.

Mental health coalition

A discussion paper has also been published by the Future Vision Coalition, which includes Mind, Rethink, the Sainsbury Centre for Mental Health and the Mental Health Network. The coalition is a significant development in itself. Its vision emphasises four policy areas:

  • an integrated model of mental health (essential, even if the emphasis given to "the medical model" is overstated);

  • a public mental health perspective;

  • the recovery approach;

  • active promotion of self-determination.

These initiatives are complementary and very welcome. It would be good to see the Royal College of Psychiatrists working with the coalition to ensure the vision becomes reality.

Compassion drive

On the subject of outcomes, health secretary Alan Johnson announced at the NHS Confederation's annual conference that nursing teams are to be rated on how "compassionate and smiley" they are. These qualities are seen to be as important for patient recovery and satisfaction as the initial technical intervention.

This insight is neither new nor surprising. We all feel better after encounters with people who are friendly and interactive. Psychotherapy research has demonstrated repeatedly that such "non-specific" therapist attributes as genuineness, empathy (closely related to compassion) and "non-possessive warmth" are as important for outcomes as technical psychological interventions.

However, while surveys that assess patients' experience of staff interpersonal skills may provide good measures of nursing quality, rating NHS staff on a scale would be utterly counter-productive.

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