Quality standards for adult secondary mental health services

The standards around making services accountable by asking them to publish accurate waiting times seems almost accusatory of services with high demand. If this is the way to make services more accountable, the following should also be published: a summary of the demand faced by the service; the service's staff complement; how often the service has been below complement over the past 5 years. Similarly, what needs to be published are accurate records of how money is allocated to different services (not what was earmarked), to draw attention to the fact that "failing services" are doing so because of chronic underinvestment.

If done properly, standards will be similar across the board, especially those about values.

The standards are trying to fix things that they cannot affect.
Time, Space and Compassion are meaningless platitudes when these qualities have disappeared because services are overstretched. GP's could stop half of all the referrals to Primary Care if they were able to take more than 10 minutes with a patient. Now the same pressures are being placed on secondary care.

The Accountability ideas are oddly fixated with service waiting lists, rather than service staffing or demand. If that attitude is taken, the net result will be that care deteriorates as services reduce the quality of their treatments in order to reduce waiting times (as has happened already in CAMHS).

Notions of "high quality" treatment are problematic when the evidence base for treatments is so contested: antidepressants are used almost across the board, yet their effectiveness disappears from RCT's when side-effects profiles are controlled for; there are several approved talking therapies, despite all of us being aware that RCT is an inappropriate way of measuring quality of talking therapies. This field is complicated enough that many professionals struggle with it - the idea that this can be neatly summarised for service-users is somewhat fanciful.

Teeth - simply restating aspirations to high quality treatment does nothing to address problems caused by chronic underfunding and high demand.

Rearranging deckchairs on the Titanic - material resources are what is needed to fix services, not new standards.