Commitment to reality: services for early intervention in psychosis in England

Abstract

This paper is no doubt as accurate a reflection as we can get of the progress made with the development of early intervention services in England. Concerning the history – in 2000 there was much pressure from Ministers to develop new services as there had been so much criticism of the new Labour Governments first term in office and poor progress on health generally. The Government had pledged to bring the level of health investment up to the level of the European average, which would result in a significant increase in resources. The key document for National Health Service (NHS) investment and reform was the NHS Plan (2000), which set out new plans for service investment and development across the whole of the NHS. Concerning early intervention (EI) it was agreed that 50 million UK pounds would be invested in early intervention services and the key target (in my opinion) was that all young people who develop a first episode of psychosis would be in receipt of early intervention services by 2005, and that they would continue to be supported for 3 years. Ministers realized the importance of these services to young people. The target number of teams and caseloads was the result of standardized system of recording delivery against targets and was very unsophisticated and based on the only model available at the time, which was the EI service in Birmingham with some reductions for non-urban areas. In my opinion the key targets were – number of teams, meeting the criteria for teams contained in the ‘planning and implementation guidance’ (so called fidelity) and meeting the stated aim that – all young people would be in receipt of such services, who needed it, by 2005’. We did not know the numbers at the time; we had to make a best but unsophisticated guess! The paper does not mention whether all young people needing such services are getting them. Also we knew in 2000 the teams would not function properly or be successful if they did not meet the fidelity to the model and 50% are still reporting they do not meet the criteria! Finally the NHS Plan was funded but, as usual, the NHS did more than was required with investment in other lower priority areas. Also the new general practitioner contract cost substantially more than planned and the new system for rewarding staff (Agenda for Change) led to largely significant but unplanned pay rises. This led the NHS into a significant overspend last year even with massive and unprecedented levels of new investment! All in all, in my opinion the reforms were not properly managed and implemented by senior managers, with the highest priority given, as usual, to waiting lists and general hospital services. The most crucial question is whether or not the Government is still committed to meeting its targets on early intervention that it set 6 years ago and whether the new Department of Health’s planning and strategic frameworks are still requiring this. A substantial start has been made, however, as the authors conclude. But if we are ever going to stop ‘bailing out the bath’ in psychiatry we have to make a real effort to turn off the tap!