Editorial
| Date | 01 September 2004 |
| DOI | https://doi.org/10.1108/13619322200400022 |
| Published date | 01 September 2004 |
| Pages | 2-2 |
| Author | Elizabeth Parker |
| Subject Matter | Health & social care |
Editorial
forum for developing ideas about how to improve the
system. Staff involvement … has been found to have a
significant positive impact on team working and to
engender a real sense of contributing to a workable
solution.’ It seems obvious when spelt out like this
that engagement of frontline staff in improving their
own work practices would be an effective means of
achieving change.
As I am writing this editorial the Social Exclusion
Unit’s report Mental Health and Social Exclusion has just
been published. This seeks to address the full range of
issues affecting people with mental health problems
that prevent them participating fully in society. The
report addresses stigma and discrimination and areas
such as employment, housing, transport, parenting etc,
which so directly affect mental health. It presents an
opportunity for mental health services to actually
deliver what services users and their carers say that
they want.
‘Change needs to happen from the bottom up but
the right conditions need to be created,’ says Steve
Onyett in the second inaugural lecture we have
published. Those conditions include valuing, listening
to, and involving the staff directly responsible for
delivering services and service users and their carers
who clearly articulate what they need from mental
health services. This is the crucial evidence-based
‘lesson to be learnt’ by those who wish to bring about
effective change in mental health services.
Elizabeth Parker
References
Department of Health (1997) The New NHS: Modern,
Dependable. Cm. 8037. London: The Stationery Office.
Office of the Deputy Prime Minister (2004) Mental
Health and Social Exclusion. London: ODPM.
2The Mental Health Review Volume 9 Issue 3 September 2004 ©Pavilion Publishing (Brighton) 2004
n 1997 the newly elected Labour
government had high aspirations for the NHS. In the
prime minister’s words: ‘The NHS will get better
every year so that it once again delivers dependable,
high quality care’ (Department of Health, 1997). One
of the drivers of this sought-after incremental
improvement in quality was to be clinical governance,
described in the White Paper The New NHS: Modern,
Dependable as ‘a new system in NHS Trusts and
primary care to ensure that clinical standards are met
and that processes are in place to ensure continuous
improvement’ (Department of Health, 1997). The
subsequent development of the CHI clinical
governance programme in mental health services,
described in the Framework Feature by Dominic Ford
and Dawn Wakeling, brings together and builds on
elements of clinical governance already in existence to
form a comprehensive review system.
One aspect of clinical audit (itself part of clinical
governance) is the requirement, introduced in 1994, to
hold an independent inquiry in the event of a
mentally ill person committing homicide
(HSC(94)27). Ten years later there has been much
criticism of some homicide inquiries on the grounds of
expense, the length of time taken to report and the
negative effect on staff morale. The recommendations
of the inquiries tend to echo each other and there is
little evidence to show that the ‘lessons to be learnt’
do in fact result in changes in practice.
In order to address these problems a technique
known as root cause analysis (RCA) is being
introduced by the National Patient Safety Agency.
RCA brings a more prescriptive and systematic
approach to homicide inquiries but the major
innovation is that the staff concerned in the incident
are to be closely involved in the inquiry process. As
Suzette Woodward, Mike Rejman and Kathryn Hill
state: ‘Ideally an RCA team will include all the staff
involved in the incident who … should consider the
incident together… This … can … prove a valuable
I
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