Care in the Community

Many young readers ( anyone below 60 ) may recall the famous Health Secretary, Frank Dobson MP.  He was a gritty, ‘tell it as it is’ bureaucrat who thought that Care in the Community was too expensive and hopelessly ineffective and, generally, unmanageable.  There were also concerns about the streets being terrorised by ‘mentally ill patients’, that would be hell-bent on causing problems for themselves and, of course, other so-called ‘sane’ citizens.  Quite simply, it was a mess, caused by a lamentable lack of planning by the Mandarins of the health service, who appeared to be ignorant, well-paid, graduates in suits who, in reality, had little idea how to run any organisation, let alone one as large and complex as the National Health Service.

Twenty plus years later, nothing has changed, except that the administration of the behemoth has become more unmanageable by an increasing number of University graduates, who expect large salaries, because their degrees were in subjects such as ‘60s Pop Music’ or  Stage Lighting’.  In common with their older colleagues they wrote in the type of gobbledegook that provoked Churchill to say “Up with this, I will not put”.  In other words ‘Bureacrats talking Bureaucrap’. Which brings me neatly to the, ‘Technical Outline and Financial Business Case’ entitled, “Development of the Adult Mental Health Inpatient Unit”, or, as I would call it ‘How to say absolutely nothing that could be interpreted as; meaningful, traceable by any evidence, incriminating or remotely factual, – in only 400+ pages' ( I couldn’t be bothered to count the pages of this 2” thick document ).  This entire document is full of empty rhetoric, construed financial information intended on misleading any poor reader, with totally vacuous summaries and – inevitably - a truckload of  B.S. ( business statistics, of course – what did you think I meant ?).

I am speaking from some considerable experience and, if there is anyone wishing to know ANYTHING about the construction and detailed model of the new unit, they should avoid trying to understand this document.  The only conclusion I am able to make is that there can be no genuine intention to build this unit, where the plan seeks only to hide all other capital costs of hospital alterations being made now, and over the next five years.  They truly believe that we are stupid enough to believe that this is a document fit to justify the expenditure of £80m+ of public money ( OUR money ) on a 125 bed Mental Health unit ( ca£700k per bed, as compared with £123K per bed for the recently built 57 bed Llanfair unit).

Reverting to Care in the Community, this document gives no ‘Who, What, How, Where, or When.  However it gives thousands of words in answer to the question ‘Why’ but not one them is understandable or reasonable to the bemused and confused service users.  Needless to say, the details of - or the money required to put - ‘bed-equivalent’ services in the community is completely ignored.  There isn’t even a clue as to what resources will be increased in order to cope with the increasing number of patients, being denied inpatient care.  Here, let me assure you that anybody subject to being sectioned under the revised 1983 Mental Health Act, is defined to be in need of inpatient care at times of crisis. Of course, we do have a 'Crisis Team' already operating from a remote corner of Cardiff and the Vale, however this resource is as inadequate as a sugar-paper umbrella in a monsoon.

There is some good news for those needing Care in the Community, and that is that some Community Mental Health Teams provide an excellent service, at current high case loads.  The finest and most efficient one of these is, unquestionably, Hafan Dawel in Penarth, where the psychiatrists, psychologist , Community Mental Health Nurses and administrators epitomise how proper mental health care should be implemented ( as I am sure is the same in all CMHTs ). So, as with the Health Board's rhetoric on inpatient care, nothing about Care in the Community is clarified, in a way that could possibly be of comfort to those poor vulnerable souls who will be expected to suffer from this lamentable lack of planning.  There is no Epidemiology Study or any Needs Assessment that would show the therapeutic care necessary for mental ( or physical ) health now, or in the future.  Be sure of one thing that is absolutely certain, the effects of this negligence will be felt most by the Elderly and the young – the Elderly Mentally Infirm or the desperate teenagers who lack the support that would enable them to cope with too much pressure, too early in life. Frankly, as long as politicians and incompetent bureaucrats have controlling influence of our health service, we are condemned to an inadequate, less accessible, and financially wasteful service. We must keep in mind that a One Billion Pound budget is in that hands of people who have repeatedly demonstrated their incompetence for decades, and this has to end – soon !  

( Next week 'Sullygate - the Cover-up exposed' )