Take a risk, share the vision

Safety of the public, service users and staff is central. Emergency services, assertive outreach, 24-hour staffed care, counselling and services for ethnic minorities are crucial elements. New funding, targeted and ringfenced, will be made available. Importantly, staff health and morale are stated priorities.

It is a time to be grateful and enthusiastic. This is a unique opportunity, much of it what we have always wanted. So why do I perceive a sense of scepticism?

Maybe because it is a big and urgent agenda. Lots of good ideas, lots of priorities and lots of change. Maybe because of the existing pressures, which are unlikely to lighten and may even worsen as a consequence of new polices. Or maybe because of a sense of ambiguity. Is this change for us or against us?

It is difficult to find anyone who can list all the different recent policy papers, let alone explain their implications, especially in combination. I am not simply referring to the mental health policy or the national service framework, nor to the Planning and Priorities Guidance, A First Class Service, Partnership in Action, health improvement programmes guidance, primary care group guidance on mental health or Working Together (the NHS human resources strategy).

Everything has to happen, and it has to happen now. Many staff are involved in service reconfigurations, mergers or developing new models of commissioning. Not just in health, but social services, housing, education and employment. All are struggling to meet their own narrow agenda. But if we want to develop genuine partnership, we need to understand the cultures and the changes affecting our partners because they have implications for ourselves. Just like in a marriage.

Worryingly, much energy is dedicated to policy areas that will be perceived by many involved as unconnected to patient care. Most staff will be suffering anxieties if involved in trust mergers or setting up PCGs, but will be unclear about the reasons and consequences.

I continue to be surprised how even minor organisational changes can cause major demoralisation across the whole workforce. Complaints invariably arise about lack of information. Glossy brochures filled with superficial statements are not the same as empowerment and real two-way communication. Not the ideal context for a massive implementation agenda.

And it is not that we have spare capacity. Messages from around the country suggest that pressure on services is continuing to increase. Community teams and wards are under ever growing pressure to prioritise, constantly having to make finely balanced decisions on admission, caseload and discharge. Policy statements suggesting a broadening of scope can be interpreted as pressure to increase the work burden. The words 'efficiency gain' are best avoided if you wish to get staff on board.

The squeeze on staff morale, a massive change agenda from the top (although poorly understood by the workforce) and relentlessly growing workload pressure from the bottom are not sustainable.

The signs are that we have entered a crisis period, as demonstrated by the growing problems of recruitment and retention. If ever an opportunity arose to show that the culture is changing towards appreciation and support, it is now.

This is being only partly delivered. Two audiences are simultaneously addressed in internally contradictory ways. Ministers repeatedly tell conferences at length how much they appreciate the hard work and commitment of staff. Then they follow up with strongly felt statements about how services have failed public and patients, and that this will not be tolerated.

A mantra is in the making: staff are good, services are bad. What seems to have escaped the attention is that services and their staff cannot be separated, and that audiences identify themselves with both concepts, probably more strongly with the services they believe in.

What is perplexing is how a strong consensus is at risk of turning into antagonism. Staff, even though badly bruised in the present blame culture, are committed beyond reasonable expectation to the most vulnerable people in society. Most staff will strongly support the new vision, since it has been theirs for a long time. There is much appreciation about the personal interest of ministers in mental health who are not washing their hands of it, and the emphasis on inequalities and social exclusion is fully owned. Most will appreciate the need to tackle service failure. This consensus needs recognition, since this will be empowering.

It is ironic that the new policy asks the same staff it implicitly accuses of inadequacies to deliver the services they have always demanded, but were never enabled to develop.

It is also ironic that the need to improve staff morale is recognised as a top priority in various documents.

The bottom line is about partnerships, not just as preached to others, but as demonstrated by ministers - between themselves and the workforce.

It is easy to bear good news. The test comes in times of crisis. Who will protect staff, and speak on their behalf when the pressure is on? Will they be ordered out of their trenches without protection?

It needs to be understood that the new policy is not risk-free, as no mental healthcare can ever be. If vision is to be shared, let risk be shared as well, and let us be clear what the expectations and responsibilities are.