The forthcoming green paper on adult services is expected to
work towards community care minister Stephen Ladyman’s vision of
empowering clients to determine the care they receive.
Yet it is within this political climate that the Healthcare
Commission last week dropped its indicator on mental health trusts
giving patients copies of their enhanced care plans.
The indicator is one of 14 that the commission has dropped to
reduce the information that trusts have to collect. Unlike other
indicators, this group, which has been cut from 24 to 10, requires
data produced for the star ratings that would not otherwise have
The commission justifies the move by saying that the indicator
has done its job “to a certain extent”. A spokesperson says that it
is no longer a useful way of comparing trusts’ performance because,
according to the 2003-4 star ratings, many trusts are now giving
most patients copies of their plans. It also insists that the
change does not mean that the commission is moving away from
empowering service users.
But Peter Beresford, chair of service user involvement group
Shaping Our Lives, argues that, even if only a few people are not
receiving copies of their plans – a requirement of the National
Service Framework for Mental Health – this is too many. “Most is
not good enough and it [the indicator] has to be there until that
gap has been filled,” he says.
Paul Corry, director of campaigns and communications at mental
health charity Rethink, disputes the commission’s figures. “It is
simply not the case that most service users say that they have a
written copy of their care plan and have been involved in its
development. Until that gap is closed, it would be useful for
service providers to be held accountable for showing that they are
increasing service user involvement,” he says.
Anne Beales, director of service-user-involvement at mental
health charity Maca, believes dropping the indicator calls into
question the commission’s commitment to the care programme
approach. This is seen as the cornerstone of mental health policy
as it involves the development of the care plan and gives patients
more influence over their treatment.
The Healthcare Commission’s decision is particularly troubling
given the rumours of its future merger with the Commission for
Social Care Inspection at a time when the CSCI is trying to change
the way it carries out inspections and give more attention to the
experiences of service users.
Although the Department of Health’s review of arm’s length
bodies, published in December, does not outline an immediate
merger, it says that the CSCI and the Healthcare Commission must
continue to work closely in the “long-term direction of travel
towards combined health and social care inspection”.
Commenting on a possible merger Beresford says: “The worry is
that the CSCI does seem to be trying hard to emphasise service-user
involvement. The record of social care has been much stronger [in
doing this] than it has been for the NHS,” he says.
But a spokesperson for the Healthcare Commission insists its
aims do not go against those of the CSCI. He points to a concordat,
published last June, between the main health care inspection,
review and audit bodies in England, including the CSCI, on working
together on inspection.
The Healthcare Commission will stop producing star ratings in
their current format this year and is holding a public consultation
on how health care organisations should be assessed in future.
Calls for a reinstatement of the indicator may feature in several