To the highest of standards

Why standards are important

In every aspect of our lives, we set ourselves standards by which we aim to keep to. These reflect who we are, what we value, and what we believe drives us to a successful outcome.

The services in which we work are no different. Between GMC guidance, clinical best practice, health board staff values, the input of lived and living experience, all aspects of our work are being held to a multiplicity of standards. As clinicians and professionals, we all have a strong inherent desire to consistently deliver the best quality care and to achieve the best possible outcomes for our patients. The tangible difference that mental health services can make in people’s lives is one we have no qualms espousing.

People who access services for their mental health needs have a right to know what they can expect from them. Similarly, professionals who deliver these services have a right to be adequately resourced and supported in order to provide them at the level expected. Standards help define those rights and expectations, both for the people who access services and for the professionals who deliver them.

What we are missing

What we lack though, is consistency across Scotland in what establishing what good care looks like, and how we measure whether this is being delivered. We all have a sense of what good quality services should look like, but it can be surprisingly difficult to describe them in a way that can be measurable and relevant to the experiences of people who utilise those services.

Recent experience during the Covid-19 pandemic highlighted what the lack of a clear national direction on what good looks like can lead to. The pandemic didn’t just create new need, but also festered on pre-existing inequalities in health outcomes, including in experiences of services and outcomes achieved. This is further complicated by the challenges around delivering consistent quality of care in the face of significant variation in resources, geography, and access to other supports.

There have been several previous attempts at introducing standards, targets, performance indicators and care pathways over the years. Indeed, there are several of these already in place that colleagues will be well aware of. But we’ve lacked a set of overarching standards that encompass the whole gamut of adult secondary care MH services.

Our efforts to establish ‘what good looks like’

That’s why the RCPsych in Scotland, alongside the College’s National Collaborating Centre for Mental Health, are helping to develop quality standards for secondary adult mental health care. These standards will be one of a suite which would cover mental health services more comprehensively. We have already developed service specifications for CAMHS and the Neurodevelopmental services for Children and Young People and are developing one for Psychological Therapies.

Throughout our efforts to the engage the workforce, we have sought to ensure your voices are heard and understood in this work, alongside those with lived and living experiences of services. This includes striking a balance between being comprehensive and robust enough to deliver tangible change while not being as onerous in their measurement as to divert valuable resources from the actual delivery of services.

We recognise it will need to be a gradual delivery and implementation of these, and that the workforce implications of this will have to be met through a subsequent mental health workforce strategy. We also recognise that there must be renumeration for our members for inputting to this work, in the form of clear quality measurements of care by which they can target improved care. But in order to achieve any of these objectives, though, we need your help.

That’s why we would urge you to attend any of the remaining workshops that may be suitable for you/your health board, as well as completing the 15-minute survey we are sending to expand our engagement options.

We hope you will participate in this critical work that, if done right, can help transform how our services are understood and understand their patient outcomes.

Dr Pavan Srireddy