Published: 11/11/2004, Volume II4, No. 5931 Page 14
It may have taken a while, but it seems the pace of change in modern mental health services is really starting to speed up. 'The key thing is the impact of new national service framework-led services (such as early intervention and crisis resolution teams); we are seeing a complete change in this shift to a community-centred focus, ' says one Eastern region director.
In addition to establishing new services, the modernisation agenda is also being used to redevelop current teams and adapt to difficult situations - such as staff shortages.
'We have a shortage of psychiatrists, but we are now looking at new ways of using them as part of a service-user, community-centred approach that has them as part of a team, ' says the director.
He adds that the Agenda for Change pay reforms have been an unusual ally in the work to remodel current roles.
'The timing could not have been more perfect. If we wanted to make real change we would have no option but to work outside the traditional nursing grades. I would struggle to think of any of our nurses who only do traditional work, as they are now being trained in other areas, such as therapies. Agenda for Change allows us to reward that.'
However, other managers attempting to implement modernisation agendas admit to feeling frustrated by the inertia of some of their colleagues. Psychiatrists come in for particular flack from one senior nurse.
The consultants are 'traditional if not Jurassic', he complains. 'As much as frontline staff have made significant changes in cultures, attitudes and service delivery, consultant psychiatrists remain the procrastinators against change driven by their own fragile egos and insecurities. Staff get enthused about driving forward government legislation, but medics seem to take an 'opt out' stance.
And on a day-to-day level, managers are frustrated by familiar pressures that continue to stretch budgets.
'Our services are relatively well resourced, but every penny is accounted for. So you go into a fire-fighting mentality. The unit I work in costs£4m a year, but I can't get£500 a year to get a few luxuries for our patients, such as putting on a show or employing an arts co-ordinator, ' says one London-based ward manager.
The manager blames much of this on poor internal systems and widespread ignorance about where the money entering mental health is actually spent.
'We are run on a shoestring budget and there is no investment in support services.Mental health trusts are way behind in the implementation of IT and information gathering. Relationships with external agencies are often complicated and it all becomes a big squabble for money. There is no proper trail to follow.'
One manager says that there is not enough communication between those who run the services and those who run the organisation, and that the sheer amount of bureaucracy she has to do means she often lacks the the time to focus on service development with her team. Internal management and lack of communication is a widespread issue.
A senior manager at one care trust says those working within the organisation are still at a loss to explain what his organisation actually is: 'It is like in the days of the old community mental health teams.We put a social worker and a mental health nurse in the same room and said we had an integrated team. Some of us have worked with social care for years, but we are still operating separately and working on different systems. It is about trying to get the detail right.'