Nurses to adopt more holistic approach to service users on both sides of the border

The English and Scottish reviews of mental health nursing have been warmly welcomed. But the reviews diverge when it comes to implementation plans, writes Simeon Brody

The English and Scottish reviews of mental health nursing look surprisingly similar despite being carried out independently of each other (Service users should have role in nurse recruitment, review argues , 27 April).

Both are responding to continuing recruitment difficulties by making mental health nursing a more attractive career, and both have won the backing of nursing unions.

Service users and professional stakeholders were consulted and overwhelmingly said nurses should engage more positively with patients.

The recovery model is a key phrase used in both, with an emphasis on working with service users to develop realistic life goals, promoting social inclusion and having an optimistic outlook about change.

Also both reports want nurses to spend less time on administration and more with patients, to train them to deliver more psychological therapies and allow a greater role for service users and carers.

But the English review has greater emphasis on physical health and spirituality, while the Scottish one focuses more on older people and the role of health care support workers.

Terry Bamford, director of mental health campaign group the Social Perspectives Network, gives the English review a warm welcome.

He says it makes clear that the values that have increasingly been governing community mental health nursing, such as seeing people in their social context and not just as passive recipients of medication, must move into hospital practice.

But Bamford warns that the review, like its Scottish counterpart, does not carry any extra resources, a point also made by Unison.

This is in the context of widespread nursing redundancies across the NHS. Sainsbury Centre for Mental Health research associate Ines Garcia says staff shortages would make it hard to meet the English review’s recommendation of greater clinical supervision, and suggests trusts will focus on those recommendations that are cost neutral.

There are also fears it risks becoming the “motherhood and apple pie review” because while much of what it says is difficult to disagree with, it is harder to implement.

The review has recommendations, not requirements. Speaking at the launch, chief nursing officer Christine Beasley said all the evidence suggested that giving professionals a general direction was more useful than telling them what to do.

In terms of enforcement, the document promises a review of progress in 2008, but little else.

The Scottish review is accompanied by a five-year action plan, which will be monitored by a national implementation group. Each NHS board will also set up a local implementation group that will report to the national body.

Despite the stronger framework, Scottish Association for Mental Health chief executive Shona Neil believes there are still questions about how it will be delivered.

Organisational barriers may stand in the way of implementation, she says, with some mental health nursing teams in the country line-managed by mainstream rather than mental health nurses. And changing in-patient services will be a difficult job, she says, because many of the best trained and motivated nurses have moved to community services.

Implementation, she says, will require strict performance management to create incentives. “There’s a recognition you can’t just float something out into the services and expect people to take it on board, because there’s so much around at the moment.”

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