Friday, August 15, 2008

Mental Health Bureaucratisation, Choice and LINks


As the new LINKs (Local Involvement Networks) falsely bloom into doom and drop dead petals on the graves of the Patient and Public Involvement (PPI) Forums so the march of the DOH that along with some Trust CEO's hated the PPI's (because some were becoming effective) is becoming cockier and more assured ...It certainly is in Bham with a new NHS connected Host being chosen for the LINks that has "NHS-connected" rubber stamped all over it and which has many of its staff still being heavily networked into the NHS ..The con was that the NHS connected Community Interest Company "Gateway Family Services" (South Bham based) was eligible to bid for the Host position if it had (under EU laws) two years of accounts .. Well it did . In reality it had only formed in Feb 2006 and it out-competed another organisation which had a track record of many more years of effective and truly arms length community engagement.

The past several years have seen the growth of Patient-User-bureaucracy in mental health services which has high-jacked the financial development of direct User-Choice and a viable supported robust front-line economy of that . Costly NIMHE and CSIP led cross organisational orgies called "meetings" sponsored by National MH Charities and Govt have created this unbelievable state of affairs . State supply sides of treatment has been put in the way of everyone too . Those who are psychotic and have serious crisis sycles might have fared a little better with choices of antipsychotics .

I have massive misgivings about the way many people are still excluded (especially in the Personality Disorder "Community") away from being able to get any provision . The total UK spend on PD areas was in 2007 about 9 million .. That's unbelievably small . In Birmingham (2007) nearly 2.5 million was spent seeing only a maximum of 24 people (12 local beds) per year . When I checked this on a number of occasions they were at under-capacity because the pressure was on to save money and make stupid fucking surpluses across the UK for those Trusts becoming Foundation Trusts (who had to qualify for FT status by having a substantial surplus in "their bank") . Some Trusts outside of Birmingham were previosuly purchasing the PD "specialism" that Birmingham offered .

PD is now a topic of change (a push towards community provision) but in Birmingham the proposed change is very tiny because they still wish to hang onto the "specialist unit". This is non-deterministic bollocks really because once you keep people away from good therapeutic support over the longer term they evolve into crisis - hence the false evolution of "specialism" for people who are at base child abused and have suffered shocking attachment experiencies and who often need help navigating massive jags of ascending feelings and partial re-experiences.

These people are not "psychotic" but are usually driven mad enough by what remains as serious imprinted disorder in their emotional and relational capacities .

The Health Service Journal over the past few days has pointed out that some people in broader medicine have been negotiating with their local Primary Care Trusts to "top-up" treatments they need : Cancer Drugs and other applications .


Almost all PCTs stated it was their clear policy - following Department of Health guidance - not to allow patients to mix NHS and private funding.


But freedom of information releases from acute trusts indicate that a number have allowed patients to make co-payments to cover the cost of drugs not normally funded by the NHS.

The commissioning manager at one PCT said this could constitute fraud if the PCT was not aware it was going on.

Leeds PCT recently discovered local nursing homes had charged NHS-funded residents a top-up fee. The PCT suspended any additional placements at those homes.

The DH has tasked the national cancer director, Mike Richards, with reviewing policy on top-up payments. It is due to report in October. "

Ivan Lewis the new Secretary of State for health has pointed out that engaging the public in service redesign is the way forwards. Yet the more people and Users I know have involved themselves in the NHS the greater the expectation on them to begin bureau-speke and slowly turn into voluntary civil servants somehow ideally re-possessing the heart of the values of the NHS .

The NHS though is quite frankly an oppressor for many in mental health and its time it was broken over the rack of any elements of Patient Choice . I welcome any mechanism that breaks down the monopoly of the NHS supply sides - that means "top-ups" too . Why ? Because any erosion of the bureacracy in mental health perversely carrying out socially engineering policies (work orientated social inclusion) and diverting resources falsely into new performance engineered very internalised User-bureacracy avoids frontline treatment for many.

User-democracy is simple when peoples get treatment choices that challenge State supply sides too across ALL ranges and particularly in recovery orientated situations .

A colleague was tipped off professionally about statistical returns at a PCT which if captured into the public domain could well have been used critically to show that counselling for many is non-existent and/or the quality of it is questionable .

The tip off was clear : stat-returns definitely existed of people who had counselling set against things like broken appointments . The point was to penetrate what the quality of the supply was, find out if its crudely inhouse and poorly trained, and set it against rough indicators of public confidence . So a Freedom Of Information request was made based on the tip off of the witnessed and seen stats .

The response was no information existed that was robust .....Oh yeah ....So what did exist and is this meat for the Information Commissioner now ? .....Its so fucking hard to penetrate simple local supply questions even for those in the know .. Control over vision is all in the NHS and its chaos .

LINks will be no match either for the NHS chaos because there's too much bullshit idealised cross organisational partnership within the clamping bureau State and not enough clearly boundarised real inspection that will happen ...


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