Policy and Service Development, Practice Guidance and Commissioning

 

Values-based practice, with its focus on diversity of individual values, has been used alongside evidence-based practice in a number of recent initiatives aimed at promoting multidisciplinary teamwork as the basis of person-centered practice. This section gives examples of these initiatives in

Policy and Service Development
Practice Guidance
Commissioning

Although many of these initiatives were in mental health and related areas of primary care they serve as exemplars for any area of health and social care where diversity of values presents a challenge for implementing multidisciplinary person-centered services.

Policy and Service Development

The NIMHE Values Framework
The NIMHE Framework
NIMHE (the National Institute for Mental Health England) was set up by the UK government to support implementation of mental health services.
The work of NIMHE was guided by a framework of shared values produced co-productively by a group of service users and service providers. The ‘3 Rs’ of the Framework makes explicit three key features of values-based practice: Recognition (of the pervasiveness of values), Raised Awareness (as the primary skills area for values-based practice), and Respect (mutual respect being the essential premise of values-based practice). Further elements of values-based practice are built into the body of the Framework.

Department of Health (2004, 2005 and 2008) NIMHE Values Framework. Originally published on-line at: http://nimhe.csi.org.uk/ValuesBasedPractise. Also published in the Ten ESCs (see below) and in ‘Whose Values?’ (see above).

Further details and full-text downloadable copy available at: Full Text Downloads

Examples of Service Development Initiatives

The Values Framework underpinned a series of service development initiatives from NIMHE and its successor organization CSIP (the Care Services Improvement Partnership) focusing on person-centered and multidisciplinary workforce development. These initiatives were built on a capabilities approach, The 10 ESCs (Essential Shared Capabilities), based on the twin resources of values-based and evidence-based practice.

The Ten Essential Shared CapabilitiesThe Ten Essential Shared Capabilities Diagram

Department of Health. (2004) The Ten Essential Shared Capabilities: A Framework for the Whole of the Mental Health Workforce. Developed by the National Institute for Mental Health England and the Sainsbury Centre for Mental Health Joint Workforce Support Unit in conjunction with NHSU. London: Department of Health.

Many of these service development initiatives are still available on the Department of Health Website.

Mental Health Care Group Workforce TeamNational Steering GroupCommunity Development workers
Department of Health (2004) (40276) Mental Health Care Group Workforce Team: National Mental Health Workforce Strategy. London: National Institute for Mental Health England; Changing Workforce Programme; Trent Workforce Development Confederation and Social CareDepartment of Health (2004) (40379) Interim Report of the National Steering Group: Guidance on New Ways of Working for Psychiatrists in a Multi-disciplinary and Multi-agency Context. London: The Royal College of Psychiatrists; National Institute of Mental Health in England, and the Modernisation Agency – Changing Workforce ProgrammeDepartment of Health (2004) Mental Health Policy Implementation Guide: Community Development Workers for Black and Minority Ethnic Communities. Department of Health.

For further policy publications in this series see Read More about Policy and Service Development, Practice Guidance and Commissioning.

On-going Policy and Service Development

Although not always explicitly values-based, successor policy and service developments have continued to include elements of values-based practice. Most now build on a set of explicit guiding values and principles that, being co-produced between stakeholders, serve as frameworks of shared values for values-based implementation. Many also make direct reference to the need for services to engage with the unique values of individual service users.

Refocusing the Care Programme Approach

Department of Health (2008) Refocusing the Care Programme Approach: Policy and Positive Practice Guidance. London: Department of Health.

A review of the CPA (Care Program Approach) for example drew on these sources emphasizing the importance of personalized care ‘tailored to individual need and choices’ (page 6); it anticipated (page 8) the Three Keys to a Shared Approach to assessment in mental health (see also below, Practice Guidance); and it noted on-going development of training materials based on the 10 ESCs at Lincoln University (from where they are available free of charge as below or via Ian McGonagle)

lincoln.ac.uk/ccawi following the links to ESC learning resources.
No Health without mental health
Department of Health (2011) No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages. London: Department of Health.

The Department of Health’s (2011) ‘No Health without Mental Health’ includes among its Guiding Values and Principles a requirement that services help those who use them to ‘… identify and achieve the outcomes that matter to them, including a suitable and stable place to live, educational opportunities, jobs and social contact …’ (section 2.3, emphasis added).

Read More about Policy and Service Development

Further examples of policies building on the above resources are given in Read More about Policy and Service Development, Practice Guidance and Commissioning. For on-going training and policy developments at Lincoln University based on The 10 ESCs see Ian McGonagle.

Jill Thistlethwaite’s recent book in the Cambridge University Press series explores many of the links between values-based practice and interprofessional teamwork
values based interprofessional collaboration

Thistlethwaite, J. E., (2012) Values-Based Interprofessional Collaborative Care: Working Together in Healthcare. Cambridge: Cambridge University Press

Practice Guidance

Alongside the generic 10 ESCs and related service development initiatives, NIMHE and CSIP also produced combined values-based and evidence-based guidance on a number of specific areas of mental health practice.

These included in particular, two controversial areas: assessment (how a mental health issue is understood) and involuntary (or compulsory) treatment.

The 3 Keys to a Shared Approach in Mental Health Assessment

3 Keys to a Shared Approach

National Institute for Mental Health in England (NIMHE) and the Care Services Improvement Partnership (2008) 3 Keys to a Shared Approach in Mental Health Assessment. London: Department of Health

Person-centered care has tended to mean people ‘having a say’ in how their problems are managed. The aim of the 3 Keys program was to extend person-centered care (at least in mental health) to people having a say also in how their problems are understood.

The ‘shared approach’ of the 3 Keys title reflects a strongly co-productive methodology in which service users (patients and carers) worked together with service providers (from a range of clinical disciplines) at all stages in the production of the guidance including identification of the good practice examples that make up 80% of the final report.

On-going development of the 3 Keys has been undertaken by the Bristol Co-production Group

Further details and full-text downloadable copy of the original 3 Keys publication is available at: Full Text Downloads

Training Materials for the Mental Health Act 2007
Training Manual Mental Health Act

Care Services Improvement Partnership (CSIP) and the National Institute for Mental Health in England (NIMHE) (2008) Workbook to Support Implementation of the Mental Health Act 1983 as Amended by the Mental Health Act 2007. London: Department of Health.

A values-based approach to involuntary treatment was adopted in a set of training materials produced by CSIP to support implementation of the UK’s revised (2007) Mental Health Act.

As with The 3 Keys a strongly co-productive methodology was used with all stakeholder perspectives being included in the group commissioned by CSIP to produce and pilot the materials. The program lead was a social worker with extensive training experience, Malcolm King. The evidence-base for the training materials was provided by the work of a service user researcher, Sarah Dewey, who had personal experience of involuntary treatment.

The model adopted was explicitly values-based in that the skills and other process elements of values-based practice supported balanced decision making under the Act within a framework of shared values represented by the Act’s Guiding Principles as set out in the Code of Practice.

Further details and full-text downloadable copy available at: Full Text Downloads

Read More about The 3 Keys and the MHA Training Materials

Further reading on The 3 Keys and the MHA Training Materials are given in Read More about Policy and Service Development, Practice Guidance and Commissioning. Both continue to present challenges to implementation described in Research and On-going Issues.

Commissioning of services

Commissioning of services in England and Wales has been devolved in recent years to local CCGs (Clinical Commissioning Groups) with the aim of gearing service provision more directly to locally defined priorities.

Values-based Commissioning

Building on the work of Christopher Heginbotham the West Midlands CCG co-chaired by Neil Deuchar (a psychiatrist) and Liz England (a GP) adopted values-based commissioning.
Values based commisioning of h & sc

Heginbotham, C (2012) Values-Based Commissioning of health and Social Care. Cambridge: Cambridge University Press

Available at CUP Series

The NSUN Report

West Midlands CCG commissioned a review and evaluation of their model of values-based commissioning led by Emma Perry from the National Service User Network (NSUN)
The Network for Mental Health
Perry, E., Barber, J., and England, E., (2013) A review of values–based commissioning in mental health
: An evaluation of the West Midlands mental health commissioning modelling group and consultations with service users and carers. London: National service User Network (NSUN)
 in partnership with NHS East Midlands

NSUN has carried out further work on values-based commissioning in partnership with Mind published in 2014 as Influencing Mental Health Services, Guide to Values Based Commissioning.

http://www.mind.org.uk/media/977059/influencing-mental-health-services-guide.pdf?ctaId=/about-us/policies-issues/influencing-local-services/slices/influencing-local-services/

The Joint Commissioning Panel

The UK’s Joint Commissioning Panel for Mental Health co-chaired by Neil Deuchar and Liz England now require values-based approaches to be used nationally across a range of commissioning programs.
Values based Commissioning in Mental Health
Guidance for Commissioning Values-based Commissioning in mental Health, Joint Commissioning Panel for Mental Health, 2014 http://www.jcpmh.info/resource/guidance-values-based-commissioning-mental-health/

Read More about Values-based Commissioning

For more on values-based commissioning see Read More about Policy and Service Development, Practice Guidance and Commissioning

The various approaches adopted to values-based commissioning include elements of values-based practice in different combinations and to different effect – see comments on The Values Alphabet in the section of the Reading Guide on the Values Toolkit.