Training Social Workers

In the past the voluntary sector has often been perceived as an amateur if benign resource to which statutory services may throw scraps of funding to undertake peripheral, non-vital work. However, Hafal has made great progress in developing mutually respectful partnerships with statutory health and social care providers and commissioners and in the vanguard of this modern relationship are our Social Work Practice Facilitators providing future social workers with skills, experience and (most important) a work ethos based on equality and respect for clients - nothing really could be more effective in achieving long-term change in mental health services.

Over the last four years and from a very humble operation we now have 17 Facilitators. That alone is a tribute to all involved but in addition there is compelling evidence of the very high quality of the training provided and there are significant waiting lists of students wanting to learn from us. We have excellent feedback from both the students and the staff who place them that the placements are especially successful and more broadly they like how we operate and the methodical, progressive models of work which we employ with both clients and carers.

All this makes a big difference and contributes significantly to Hafal’s mission. The Facilitators are assisting in ensuring that there are well-informed professionals going forward to work in Wales and beyond; they are demonstrating in practice how a relationship of equals between statutory organisations and a user-led organisation can bring benefits to all; and they are ensuring that our local services not only continue to employ best practice but are also beacons of such practice from which others can learn.

Happiness

If the government's new Happiness Inspectors (see the story here) had asked me where I stood on their "well-being" index at 6.00 pm on Friday (as I struggled down the M4 trying to get home) then the result would have set off alarm bells in Whitehall and Cardiff Bay and calls for more nature trails, sensory gardens and soothing paint-work on public buildings - some of the things which the new research might result in we have been told without irony.

By contrast a few hours later the Inspectors would have found me early Saturday morning swimming outside in the (heated) pool of the Esporta Sports Club in crisp sunshine. Only the 3 second dash from the door into the water creates a moment's discomfort (it is still below zero). My cup is full, I would tell them, go find somebody else to cheer up (or, better still, leave us all alone and go and look after the economy, health and education).

Later on spirits remain high walking in the Towy valley (click on the picture for a bigger image). Powdery snow and warm sunshine are making everybody smile and Christmas is around the corner.

Ken Dodd memorably sang:-

I've got no silver and I've got no gold
Just a whole lot of happiness in my soul [a lazy rhyme that one, Doddy!]
I hope when you go to measuring my success
That you don't count my money, count my happiness

Amen to that but I don't think when Ken said "you" he was addressing David Cameron. Mind you, the veteran Scouse funnyman has admitted that he isn't very good at counting his own money - he was found not guilty of tax evasion after his counsel the late great George Carman QC observed "Some accountants are comedians, but comedians are never accountants".

Anyway, if you really want to you can listen to the whole mawkish horror from 1964 here. Tattyfilarious.

I'll Say This Only Once

All the talk among the political chatterati is about the "Squeezed Middle" classes, a meaningless concept as nobody agrees who they are. There just about still exists a (quite different) class of the "Impoverished Genteel", people with very little money trying to keep up appearances and differentiating themselves carefully from people in (horror!) trade even though the tradespeople might be much better off.

This class has a long and frankly ignominious history, one era of which was portrayed in Mrs Gaskell's Cranford (1851). The stage version we saw this week at the Swansea Grand is from 1950 and the date shows because the plot is crassly manipulated to make a humourless democratic point whereas Mrs G (and the recent BBC series) stuck to a more subtle though sentimental line. But in 1950 the public, not just the politicians, still took politics seriously so it was probably expected.

This is slight stuff, made a little more interesting by having Shirley Anne Field in the cast and also Kirsten Cooke who played Michelle of the French Resistance in sophisticated 1980s sitcom 'Allo 'Allo ("Leesten very carefully..." etc). At least 'Allo 'Allo was a bit edgy because it sent up something of deadly importance rather than a reality (19c. provincial life) which was as humdrum as the fiction. I remember reading somewhere that the French warmed to 'Allo 'Allo but it never caught on in Germany.

Wetherspoons' Thursday curry night has a new offering - Piri Piri Chicken - which does the trick on a cold evening (£4.99 including all the trimmings and a pint!).

Guilty As Charged

It is welcome that the UK Government has accepted that the system for assessing people's ability to work (the "Work Capability Assessment") itself doesn't work. In particular, an independent report states, it doesn't work for people with a mental illness.

The problems are set out in a review by Professor Malcolm Harrington, who was asked by Ministers earlier in the year to look at the assessment and recommend improvements. Employment Minister Chris Grayling pledged this week to accept all the recommendations from the review.

The Harrington Review made substantial recommendations including the need to deal with the complexities of cases involving mental health and similar issues by creating a network of "mental health, intellectual and cognitive champions" in each Atos Medical Examination Centre to spread best practice and build understanding of these conditions. In other words the assessors didn't know what they were doing and they need to bring in people with some clue about what mental illness is.

This doesn't surprise Hafal which has encountered a surreal world of total misunderstanding when trying to resolve blatant cases of injustice: some of our experience is so absurd that it would raise a laugh were it not for the fact that getting these matters wrong risks condemning very vulnerable people to months of anxiety, impoverishing them through withdrawal of benefits, and (tough to say but true I am afraid) threatening their lives because many people with a serious mental illness are vulnerable to suicide.

Chris Grayling said:

"It’s in everyone’s interest that we get the WCA right and Professor Harrington’s recommendations will make the assessment fairer and more effective.

"The WCA should be seen as a positive first step towards returning to work. Those who are found fit for work will get the help and support they need to get a job. Those found too sick or disabled to work won’t be expected to and will continue to receive the help and support they need to lead fulfilling lives."

Well, Harrington has brought in a guilty verdict on the operation of the system to date so we will have to see if it can improve itself and do what the Minister promises.

The WCA is already being used to assess new claims for sickness benefits and from early next year will be used to assess all those on incapacity benefits, to see whether they are fit for work, need tailored help to get work ready, or require unconditional support.

Chris Grayling has asked Professor Harrington to continue in his role as Independent Reviewer. Professor Harrington said:

"I have found that the WCA is not working as well as it should. However, this is not about ripping up the current system and starting all over again. So I am proposing a substantial series of recommendations to improve the fairness and effectiveness of the WCA."

I have my doubts.

Meanwhile Hafal's advice to anybody with a serious mental illness who is concerned about their benefits position (or is being assessed) is:

GET ADVICE!

Best approach is to get help both from a benefits specialist like CAB and from an agency like Hafal which understands your illness - and you will need to involve your doctor.

Don't leave it to chance.

Fair Play

No surprise that the UK Government is ruling out revision of the Barnett formula (the means by which Wales' share of UK funding is calculated). Chief Secretary to the Treasury Danny Alexander slammed the door on this yesterday on a visit to the Assembly - see the story here. There is consensus among economists that Wales is losing out from the formula but the UK Government says it doesn't want to tinker with it while they are tackling the deficit, though remarkably the UK Government is prepared in principle (says Mr Alexander on the same visit) to reform the devolution settlement (surely a bigger undertaking?) to allow Wales to raise taxes. But Scotland would be disadvantaged by reform of Barnett (and Mr Alexander is the Lib Dem MP for Inverness). The previous Government also refused to look at Barnett so it is a proper concern (and not a party political one) for Welsh citizens to seek fair play on this, especially in defence of those most reliant on the devolved budget such as people with a serious mental illness.

Meanwhile we are absorbing the Assembly Government's budget plans (see the details here). In fairness the Assembly Government seems to be listening, making the right noises about the NHS and specifically restating the priority for mental health services; they have also stated a priority for secondary and community-based services; and finally they have also given a priority to social care, sending a message to councils to protect the vulnerable. But we will have to make sure that the NHS and councils live up to this rhetoric...

Wheel of Fortune

Lord Young's resignation following his "You've never had it so good" gaffe is followed by some more honest discussion about who in fact are the winners and losers as first recession and now public expenditure cuts wash over us like a double tsunami. Some of the government's embarrassment arising from Lord Young's comments stems from the awkward truth that we are not of course sharing equally in the pain and there are significant beneficiaries as well as real losers. If your job is secure and you have a large, variable-rate mortgage and similar debts then you have had a big bonus in spending power in the last year or two owing to the very low interest rates - but you don't hear people owning up to this, do you?

As I leave the gym on Saturday morning a pundit on Radio 4 specifically names Swansea as a place which will suffer much more than most areas because it has a high proportion both of public sector workers and also of benefits claimants (and not a few of the latter are clients of Hafal). But it too will have beneficiaries, no doubt keeping a low profile.

The city is certainly looking shabby and forlorn in the drizzle with leaves and fast food detritus blowing around Oxford Street. This pall is only a little mitigated by a sarcastic town cryer announcing Santa's arrival ("but you don't deserve it" he bellows, apparently to everybody's amusement) and two moth-eaten reindeer sitting bemused in a pen. Nearby the slightly rusty-looking "Waterfront Wonderland" is getting few punters but no doubt it will become more popular nearer the holiday - I recommend the big wheel as it gives an unusual view of the city centre (as indeed does the one by the Civic Centre in Cardiff); and maybe this year I will dare try the skating (my last attempt at the Queens ice-rink in central London in 1976 formed the central plank of a strategy to impress a girl - terrifying and unsuccessful in all respects).

Over lunch at the Alfresco cafe next to the Waterfront Museum (bacon and egg bap £3.50 - not that cheap but with a nice aspect overlooking the Marina) I ponder that for all Swansea's lack of overt wealth you won't find a friendlier place of this size - that morning I have chatted warmly and at length to strangers in the queue at Sainsbury's, in Lidl contemplating those German chocolate decorations, in the market, and at the new art gallery in the old Exchange. Had I had time to cross the road into the Queen's Hotel I could still be there now.

Taking Over The Asylum

Hafal's large-scale conference last week gave us a chance to step back from the immediate campaigning concerns (about Measure regulations and the like) and consider the wider priorities of our mass membership. 200 attended the conference and we held forums for both clients and carers which, together with much informal networking, will help to guide Hafal’s campaigning up to the Assembly elections in May 2011 and beyond.

Distilling all that we heard I have identified 5 big themes, all overlapping and interconnected...

(1) Let’s call this one the “respect and rights” agenda. Clients are plain angry and fed up with disrespectful services which say “You’ve got such–and–such illness and this is the medicine you need to take. Oh, and here’s some desultory drop-in you can go to if you feel like it". Dress it up how you will this is still a typical experience of many mental health patients. No holistic approach, no mention of recovery, no empowerment offered, no choice. There is growing realisation that, whatever we do to improve the sensitivity of services to the needs of clients, in reality there will never be a first-class service until clients take control over their own recovery - by which we mean not just being consulted but making decisions about the use of funds available for their health and social care. Of course respect also means not facing discrimination and we need to help clients and families to achieve equality and fair play from the community at large.

(2) Protection of resources for mental health services. Until clients do have the control they need over resources they remain beholden to global NHS and social care budgets and we need to understand and influence those. At present a shaky ring-fence is supposed to protect NHS mental health funding but everywhere we go NHS insiders talk of the limitless "discretion" of LHB finance departments to assign costs as they see fit when reporting on expenditure. Further, some LHBs seem to be snaffling savings made from Continuing Health Care funding as if this wasn’t a part of the mental health budget. Ring fences aren't a great way to manage resources but it’s almost all we’ve got for now so Hafal must help clients and families fight back and support mental health managers to get the resources they need.

(3) Though it links to (1) and (2) above you can’t not have a priority theme about people struggling is the murkiest depths of mental health services, in particular in-patients and those enmeshed in the criminal justice system (especially those in prison who should be in hospital). The public would be amazed if they knew more about the experience of people in hospital – not only the lack of care, especially the minimal personal contact with staff let alone access to talking therapies, but the fear and real danger of neglect and abuse. For prisoners with a serious mental illness the position is dire: it beggars belief that the most vulnerable patients with florid psychotic symptoms and in a desperate state can be left to deteriorate and face real danger in an environment which is almost calculated to make people worse not better.

(4) Benefits are high on the list of concerns for both clients and families. The changes made by the last government and those planned now by the new government are both objects of considerable suspicion and fear. In theory those genuinely unable to work should be protected but Hafal knows otherwise - mistakes are being made and vulnerable people exposed to anxieties which can severely damage their health. It is hard to deny that the remarkable increase over a generation in the number of people assessed as unable to work through disability needed to be challenged (as both governments have agreed) but the targeted decrease in that number is so very bold. Can we believe that the right decisions will be made?

(5) Carers and families continue to get a bad deal for themselves and this results in a bad deal for clients and for the rest of us – because supporting and training families to do a good job (where it is fair to ask them to do so ) can help clients get better quicker and conserve precious resources. Some of the right noises are made by the Welsh Assembly Government but we are a long way from integrating families into the care planning process and respecting them properly for their essential input. The Carers Measure shows willing but actually offers little beyond a right to information.

In the next few weeks Hafal will be putting together its campaigning strategy for next year. No doubt we will address the issues set out above but my sense is that to do justice to the mood of our members we should not just be making demands of mental health services but inviting patients and families to take matters into their own more capable hands - not perhaps by storming the hospitals Bastille-style (happy thought!) but, to give some examples, by exploiting new rights under the Measure to take control of their recovery plans, by seeking Direct Payments, by exercising their right to change care providers, by expanding the range of services which can be managed by client-led organisations, by taking up appointments to management groups or indeed LHBs, by taking legal action on inadequate services and discrimination, etc. The old saying about inmates "taking over the asylum" (suggested to us recently as an edgy slogan - I like it) does not describe such a bad policy...

Bubblegum

It's been a long week. From last Sunday night and throughout a busy though successful Monday to Friday (including our best ever AGM/Conference) I had a nasty cough and sinus headache which only lifted yesterday. This morning it took a supreme effort to get up early, go to the gym, and put in a long session to open up the lungs and generally jump-start my creaking mortal carapace.

While puffing along on the running machine I watch Match of the Day with nice Gary Lineker whose good manners make up a bit for the soporific Premier League "highlights" (what an earth can the rest of these matches be like?) followed by Andrew Marr who is usually good value but the report from Burma is spoilt by John Simpson sweatily telling us nothing at all - what is the point of sending "senior reporters" to news hot-spots about which they clearly know nothing? Anyway, I won't comment myself on Aung San Suu Kyi's welcome release beyond saying what everybody else must be thinking but not daring to say for fear of sounding trivial: I want some of whatever she's on, making her serene and perfectly poised as well as looking hardly a day older than when she was banged up 20 years ago, in spite of her husband dying without her and all the other shocking treatment which would have made a lesser mortal bitter and twisted in both mind and body. Notwithstanding the media frenzy she really is inspirational, very like old Nelson M who surprised everybody when he emerged from prison looking like a mature film star and, even more impressively, with a sunny and generous disposition belying his terrible experience of captivity.

Then to Lush in Swansea for two tubs of their "Prince" shaving cream, a hideously expensive luxury which I allow myself. The hovering neo-punk shop assistant volunteers that her boyfriend uses it, and when I go to the counter the girl on the till says she uses it - I give her a look and she adds without blinking "for under me arms". This does not surprise me as it is evidently part of their training to make you think you have made the smart choice and I've heard the same about Sex Bomb "bath ballistics", Iridescent Glitterbug massage bars, and "Honey I've washed the kids" soap, among many joyful purchases. I love Lush with its charming if implausible staff and crazy fruit and veg aromas, unlike Bodyshop with its indifferent service and cheap smell reminiscent of old bubblegum found stuck under the table of a Great Western train.

Hell's Kitchen

Yesterday's AGM, a daunting enough event for any chief officer who recognises the uncompromising authority of the membership thus legally assembled, is a stroll in the park compared with the final "turn" of the day - me and Company Secretary Nicola Thomas preparing a three course meal in 25 minutes from scratch featuring ribald and frankly disruptive commentary from me and infinite patience and studious attention to the task in hand from Nicola. But we did it, and I think the grub looked okay. I promised a couple of people that I'd publish the recipes so here goes...

First Course
Tomato and Mozzarella salad with vinaigrette. I won't insult you with details of how to slice up the ingredients but the vinaigrette (aka French dressing) is important. Contrary to common practice in the UK it is a crime to add more than about 1 part vinegar to 6 parts oil (Hafal Deputy Chief Exec Alun Thomas' half-and-half admission was truly shocking). Greek olive oil is my other tip - bog-standard Kalamata better than most fancy Italian brands. Add seasoning, spot of mustard, and garlic to taste. We plonked a sprig of basil on top of the dressed dish for dinner-party presentation.

Second Course
Prawn stir-fry with noodles. For elf 'n' safety reasons we used an electric wok which worked quite well in spite of my sniffy contempt. The problem arose when trying to get the completed dish out onto the plates - short of tipping up the whole gadget we had to spoon the gloop out messily. We fried chopped spring onions and peppers plus carrot strips, mangetout peas, ginger and garlic in neutral oil with a dash of sesame oil then added prawns, fresh noodles and soy sauce, finishing off with torn coriander. For a veggie version leave out the prawns.

Third Course
Knickerbocker Glory. This was a healthy version (sounds unlikely, doesn't it?) based on a Mrs Blog trick, namely use of a pressurised canister of pure cream (watch out - most have sugar and other muck added but Anchor do a pure one). Basically you put fruit - we used raspberries, bilberries and blackberries - plus some crushed meringue interspersed with squirts of cream and finished off with a big Mr Softee-style squirt on top with a lone raspberry and sprig of mint. Total calories only about 150. How's that? Because the cream is expanded with a vast amount of air. However, do not prepare in advance - within minutes the cream collapses into a microscopic drip at the bottom of the glass.

A Degree of Deception

I am very proud to show you a picture from my graduation with a Hafal degree in "Recovery Studies" from our AGM/Conference yesterday (lots of pics on Hafal's Facebook will follow here). Caroline Jones, Hafal's manager in Denbighshire, was doing a brisk trade in these "fraudulent-but-fun" qualifications among many other activities which informed and entertained 200 delegates in Builth Wells.

Caroline's isn't the only dodgy academic body flogging degrees in return for no work whatsoever. Indeed I confess this is not the first time I have picked up a qualification by doing precisely nothing. Many years ago I struck a shabby deal with a shifty outfit in East Anglia which knocked out an M.A. to me in return for an "administration fee" of £8. No work at all required - just wait 3 years after you've done a normal B.A. degree (not a vast amount of work required for that either if truth be told) then send in your cheque. In fact I didn't even have to pay for it myself because my canny late uncle Gwyn Williams coughed up, figuring it was a good value means of discharging his duty as my godfather to see that I was suitably brought up.

This neat trick, shared I understand with a similarly shameless institution in Oxfordshire, has quietly been pulled for centuries and provides an enhanced CV to its beneficiaries and understandable irritation to everybody else (don't tell those student rioters - I don't want them round my place).

In ongoing discussion with our Learning Centre Principal Irene Hogan about my training needs (see this post) I have adduced my M.A. as evidence that I clearly don't need to learn anything ever again and, when that ploy comprehensively failed to convince, suggested that a course of study be found on a similar basis (i.e. fancy qualification but no work required). I suppose I could try waving my equally valid Caroline degree at Irene but meanwhile negotiations continue.

More on the conference to follow...

Sausages and Laws

I have deliberately paused for a few days following the passing of the Mental Health Measure by the National Assembly last week in order to reflect first on the implications of the late amendments and the important undertakings given by the Minister during the debate.

First let's check what the Minister said in the debate about holistic care plans...

When the amendment that included these eight important areas was tabled during Stage 2 proceedings, I did explain my misgivings about the requirements to include those areas in every care plan in every case. I remain concerned that to do so would risk losing sight of the importance of individualised care and treatment planning, which is outcome based. I am therefore pleased to see that this amendment does not require all care plans to include all these areas, and its effect is therefore quite different.

As currently drafted, the proposed Measure does not set out the kind of outcomes that the provision of mental health services is designed to achieve. The proposed amendment would make provision for that, and would mean that the agreed outcomes must include at least one of the areas listed. I believe that it is appropriate and necessary for full assessments to be undertaken by practitioners and that such assessments should consider at least these eight areas. Assessments may also consider other matters. As such, it is right that care co-ordinators consider these areas when working with the service user and service providers to develop and agree outcomes for the provision of services. These areas are well-enshrined in existing mental health policy guidance. For example, they are set out in the chapter on care and treatment planning in the code of practice introduced under the 1983 Act. They are also referenced in the interim guidance on the care programme approach, which was issued to local health boards and local authorities in July. Given that amendment 4 sets out prescriptively the areas where outcomes may be achieved and does not require each care plan for each service user to list outcomes in all these areas, I am happy to give the amendment the Government’s support.

On timescales, which an opposition amendment would have required to be included in statutory guidance, she resisted the amendment but said...

On the issue of whether the timescale[s] should be included in the guidance, I am happy to take away the views that have been expressed and consider them further.

On balance I think patients are winning but we have much more to do. The successful opposition amendment putting the 8 "life areas" onto the face of the Measure (under Part 2) has useful but mainly symbolic value – it does count for something that the principle that care and treatment plans should be holistic is flagged up even if the amendment alone would not place a duty on practitioners in practice to deliver holistic plans.

The Minister’s remarks about assessment are welcome – even a positive movement from the last debate. We seem to have an undertaking to ensure that assessments of patients will cover the 8 "life areas" and presumably care plans will cover them where a need is identified in those assessments. This is definitely moving in the right direction but we need a bit more! One of the difficulties we have faced is making our argument for holistic care plans has been the counter-argument that there is no point in recording something in a plan for life areas where there are no needs identified and therefore no outcomes to record. That argument sounds plausibly unbureaucratic and reasonable but ignores the fact that the "life areas" are all matters which every person with a serious mental illness needs a plan for (with the exception in some cases of parenting or caring responsibilities). Take the example of housing: who among us does not need a plan for our housing over the next year? It may not be written down but we all have a plan to pay our mortgage or rent, pay bills, deal with problems that arise, etc. Now in many cases patients may be fully competent and content to fulfil their plans for some life areas without help from professionals or family carers but that doesn't mean it is not part of their plan - what indeed could be more patronising! And there is no bureaucracy problem as it is not complex or irrelevant (in fact on the contrary it is therapeutic for the client and very helpful to the Care Coordinator) to write down something to the effect that "the client is confident that they can look after their own housing needs".

We need to ensure that care plans are holistic and, as night follows day, THEY WON'T BE if this is not required in the regulations...


Je weniger die Leute darüber wissen, wie Würste und Gesetze gemacht werden, desto besser schlafen sie nachts (the less the people know about how sausages and laws are made, the better they sleep in the night) - not Edwina this time but Bismarck.

Slightly Unwashed

Exhausted after a long but productive week I have done no walking and little work this weekend aside from installing my new wireless router courtesy of Talktalk. I carefully meditate myself into the necessary Zen frame of mind to undertake such tasks but while meticulously following the instructions I am told on-screen by the installation disk that "We are struggling (sic) to find your wireless card/adapter" - that would be because I don't have one and you didn't tell me I needed one! Techies among you will scoff at my ignorance but I think I was owed the advice in advance. Grim-faced I drive to Carmarthen to source the required device from PC World. Unwisely I patronise the teenager serving me by suggesting we will need advice from the middle-aged professor-type at the "geek" desk but she of course knows it all (it is uniquely true of IT that you know more the younger you are) so I am patronised back, get the tiny but expensive hardware, and finally complete the challenge not exactly calmly but at any rate without hurling anything across the room.

Having my feet up allows me to finish reading Sebastian Faulks' "A Week in December", a satire on modern Britain which offers a surprisingly sympathetic view of Islamic fundamentalism in the person of a prospective suicide bomber. After 380 pages describing the hypocrisy, casual substance-abuse, greedy materialism, and pointless wage-slavery of our society I can see why some young idealists would want to establish a Caliphate on our shores. Of course they aren't going to convince anybody by blowing them up but they do have something to sell against the alternative of what we have now. It may be my classical education - or is it just contrariness? - which draws me to take seriously radically different models of civilisation.

Faulks is interested in serious mental illness (see my previous post here) and in this book portrays a young man - not the bomber - succumbing to schizophrenia as a consequence of living in western society. He apparently gets the illness by using heavy-duty cannabis in the context of disinterested, money-obsessed parents. Disturbingly in this analogy Faulks blurs the distinction between metaphor and real cause, making this difficult reading I suggest for people personally affected. In the end I fear Faulks is not really sympathetic to people with serious mental illness but uses them in his books to explore human nature.

There is a similar challenge to convention in Claude Chabrol's "Le Boucher" (1970) which I watch last night for the first time in many years having saved on the Humax. The butcher in question is a sympathetic character in spite of slaying a number of women in a sleepy Dordogne community; by contrast his teacher girl-friend gets the blame because she won't let him have his wicked way. Very French, as is the smouldering, slightly unwashed charm of Stéphane Audran. Chabrol was certainly charmed because unlike the butcher he got to marry her, lucky man. Most of the film is rather surreal and improbable but I take notes when the butcher gives authoritative advice on cooking a leg of lamb. He says it is a crime to use any garlic and to cook for just 30 minutes(!).

The idyllic scenery filmed around Perigueux is familiar and I recall that I was in fact in the area on a school trip at about that time, visiting the prehistoric Cougnac grotto where Mlle Hélène (Ms Audran) takes her school-children and discovers a body when blood drips from the cliff above onto one poor pupil's sandwiches. Outside the same cave but less dramatically I picked up shards of flint which our ancestors had napped off while making tools. I am glad we didn't discover a corpse although it would have been worth that risk if our teacher had looked anything like Mlle Hélène (which sadly he did not). We also visited an ancient farm-house foie gras factory including a matter-of-fact demonstration of the machine for force-feeding the geese which did not disturb us at all. Somehow you just expect the countryside to be brutal.

A470

I am gently chided for whinging by Hafal Vice-Chair Chris Eastwood. I complained about having to drive the whole length of the A470 from (south) coast to (north) coast – but Chris, a keen driver who unusually has not lost the taste for what used to be called the “open road”, says I’m lucky because it is a scenic and interesting route. He’s right of course and in truth it was a good drive with little traffic, at least up to Dolgellau where some fog lowered the spirits but that soon dispersed and I rolled into Llandudno Tesco’s to buy a picnic to set out on the bed and consume in the Premier Inn (the "Lenny Henry" chain - personally I am a Travelodge man by choice but there isn't a handy one for our North Wales centre in Colwyn Bay).

I am up here for the quarterly meeting of North Wales staff and Trustees (users and carers). Morale is good but there is proportionate concern about the gathering grey clouds of public spending cuts due to give us all a chilly drenching from April onwards. For all that everybody agrees that for our clients the overwhelming concern is the ongoing review – and future changes – to benefits. Hafal’s leaflet on this used during the summer has been especially welcomed and all agree we could do a lot of good by updating and reissuing it early in 2011.

Meanwhile we discuss the good progress made on the Measure (more on this next week) and we hatch plans to build on the new legislation next year both by encouraging clients to make maximum use of their new rights, in particular the right to an holistic care plan, and by awakening managers of mental health services to the implications of those new rights for their management and commissioning of services.

If anybody still doubts the important role - no, I should say essential role - of care-planning for people with a serious mental illness then see Hafal's Dave Smith eloquently describing his experience on ITV (link here).

Time for the Measure

I've received some feedback seeking precedents for setting out specific timescales for providing services to people with serious mental illness...

In the case of assessment the Welsh Assembly Government evidently thinks it is reasonable to be specific about timescales, as can be seen from this snippet from their guidance for Community Mental Health Teams...

The CMHT will offer timely assessment of the needs of people referred to the service. Assessments will be prioritised according to apparent need and risk... A supervised triage approach to response times for assessments to be undertaken, namely:

- Emergency referrals will be seen within 1-4 hours;
- Urgent referrals will be seen within 48 hours;
- Routine referrals will be seen within a maximum of 4 weeks, but usually much sooner

In the official Guidance (or Code of Practice) which sits below the Measure we need to see this kind of intelligent, flexible advice not only for the time taken to undertake assessment but also for completion of Care Plans following assessment.

What would this mean? In a nutshell it would mean patients would have legal redress if the guidance wasn't followed reasonably well and without good reason not to follow it - so allowing for delays where particular circumstances genuinely warrant them. By contrast without such guidance a court would have to assess from scratch when a delay becomes unreasonable, not a fair or practical position either for the patient or indeed for the practitioner with the legal duties in question: everybody is entitled to know where they stand.

For more about the Measure see my recent post below and Hafal's Briefing Note here.