'Some people think the quiet revolution in mental health, with the closure of the asylums and the introduction of community care alternatives, is a model for the rest of the NHS. But I am the first to admit that we did not.always get it right'

A longstanding dream came true recently when I was asked if I would like to become a regular columnist for HSJ. My enthusiastic response may have been slightly overwhelming but here I am, a few weeks later, sharing some insights from the world of mental health.

I am in my sixth year as chief executive of various trusts. Sussex Partnership trust.is going for foundation trust status - I will tell you how that feels along the way. Happily, our configuration is set and we can stop moving deckchairs, at least for a while. For my first article, I thought I would.take a look at reorganisation.

As someone who ought to be able to comment on the mental health of the NHS, what do I think about where we are right now? Depending on.who you ask, morale is either at rock bottom, the same as usual, or better than ever. My personal view is that how our people are feeling is very important. How can we expect staff to provide good care and be empathetic if they do not.feel valued or are worried about their own futures?

With the restructure of primary care trusts, we are in the midst of unprecedented turmoil. We have undoubtedly lost good people as well as pace on necessary reforms. Some of those lost.are people with diverse backgrounds who could have been future leaders, better reflecting the communities we serve.

We are moving into choppy waters, with fundamental changes to the provision of acute care, as well as arrangements for vital community services that help people stay well and out of hospital. What insights can mental health services offer on how to manage change? What experience have we had that can be translated?

Making changes

As ever, there are conflicting views. Some people think that the quiet revolution in mental health, with the closure of the asylums and the introduction of community care alternatives, is a model for the rest of the NHS. In part, I support that view. But I am the first to admit that we did not.always get it right (Read the NHS Confederation publication Time and Trouble to get the balanced picture). Hospitals were closed before alternative services had been properly developed. New service models were designed for inner-city populations, not necessarily suited to other areas. And in designing new services, the people they were meant to help were not always listened to.

Sound familiar? The same could be said about any change - ideals are great, but policy must be flexible and implemented with the purpose of the policy in mind.

For any problem, there are many solutions. There is.no single right answer but there are quite a few wrong ones. I am increasingly convinced that it is the way a change is delivered, and the account taken of those it affects, that really matters.

I would like politicians and NHS leaders to remember this. Middle-aged, middle-class people run the NHS. At the top, it is almost exclusively white and mainly male. But more than.90 per cent of NHS care is provided to the very young or very old, to people whose health is compromised by disability or social disadvantage. Around 65 per cent of our clients are women. In planning services, we must listen to those who need them and to those who are marginalised by them. And we must listen to our staff and help them become our greatest advocates.