This is ReQoL day, in a grey and rainy Sheffield.
I'm not usually somebody who gets at all excited about psychometric 'instruments' (as their manufacturers rather grandly call them sometimes) - but ReQoL feels a bit special. In the same way that CORE did three decades ago - something that can really let us and our service users know how we're doing. And this one is based on a value set that comes from research showing what matters to service users themselves - not by clever academics in a university, or powerful doctors in the clinic, saying what should matter. And even more fun was meeting a mystery man on the way into the conference room, who knew me, but wouldn't tell me who he was (though I recognised him, despite 20+ years since last meeting). When he stood up to speak - about the scientific process behind the new measure - I knew: it was Mike Barkham, one of the main developers of the CORE - and regular in the snooker room at the Raven Hall Hotel at the annual Society for Psychotherapy Research (UK) bashes in the 1990s.
The morning was quite energising,
and felt like this was a good new measure that was designed around measuring
something that really mattered – and could help us all coordinate across
services, research, commissioning and policy.
But then the afternoon came along.
I found Tim Kendall very dispiriting – his vision extending no
further than which bits to spend a little bit of extra money on, and a rather
nihilistic mood agreeing it’s all bad and won’t get much better (in my working
lifetime, at least!)
And as for the best thing Andrew Lansley did was to make the
NHS even more hierarchical and driven top-down– I was close to passing out with
despair.
It was probably worse because I found the afternoon ‘café’ workshop
perhaps the dullest event I have ever been to – and annoying in confirming
my fear that legions of clever people are running round feeding the machine – and getting
quite excited about it.
But where are the service users in it all?
And where were they today? A: not there, because it was all
about the experts doing clever and complicated things without them.
And as Tim said, their scores aren’t what really matters, because
it’s the measures that show how well that machine is working that he is interested
in.
Then he goes and says that an ‘official’ PD measure is being
written – probably by people none of us have ever heard of, with a big grant
that’s not connected to any of the other work that’s been done in the field over
many years, or is currently going on.
And he was extremely lukewarm about ReQoL, which I thought
was going to get his backing - as a sensible and robust outcome measure for us
all to coordinate ourselves around (and, dare I say, more democratic and meaningful
to service users than bureaucratic old warhorses like HoNOS). But no. Aargh.
So NHSE is even more of a disorganised and fragmented mess than
I thought – as a personality disorder consultant colkleague, from the Cassel, exactly put her finger on in questioning him. It’s not
harder hierarchical management it needs – it relationality at all levels (not
performativity) and real service user co-production!
And as for the withering scepticism he expressed in his aside about
‘being human’ (or something like that) …my blood ran cold.
In the old days, like when he was chairing the Borderline
NICE group, he used to wear a black polo-neck and tight black jeans – like a
baddie out of a Bond film. But I find the new look, with suit and tie, and Robin Day glasses,
much more sinister!
