Jon Glasby and Laura Griffith, Health Services Management Centre, University of Birmingham
When finances get tight, a major irony usually occurs. To make the most of scarce resources, we start to ask ourselves more searching questions about how to make sure that best practice is embedded in everyday practice (if one area can do something really well, then can’t the next area?). At the same time, we usually cut or abolish some of the national and regional bodies that have been set up to support and disseminate innovation, thus prioritising front-line services in the short-term but potentially producing false economy in the long-run.
Against this background, HSMC has published a new policy paper – ‘Mental health matters’ – in conjunction with the West Midlands Academic Health Science Network (AHSN). This looks at a model of mental health support in A&E (‘Raid’) which is perceived to have been really successful in an initial Trust and which has subsequently been rolled out across the region more generally with the active encouragement of the AHSN. As with many such initiatives, there seem to have been a number of different responses:
- Some areas have tried to replicate the initial model as faithfully as possible, whilst recognising that they may need to make legitimate changes in response to different local contexts.
- Some have adapted the model, but may inadvertently have failed to grasp some of its key features and thus blunted its potential contribution. On some occasions, they seem disappointed that the service hasn’t seemed to work as well as they were led to believe it would (albeit champions of the model would argue that it was never really given a chance).
- Others have decided not to implement at all. With this group, it’s not always clear whether this is because existing services are felt to work well and because there are other priorities locally, or whether it’s the product of the infamous ‘not invented here syndrome’ which seems so common in parts of the NHS.
In one sense, therefore, the policy paper isn’t really about ‘Raid’ at all – or about which approach to new ways of working is ‘right’ or ‘wrong’. Instead, it raises broader questions about how innovation spreads (or not), about the need for local adaptation, about the risk of failing to implement a feature that later turns out to have been crucial, and about the role that intermediaries can play in supporting change. Too often, policy makers say that they want to promote innovation – but then try to do this by disseminating information and encouragement compliance. For us, embedding new ideas in front-line practice requires more than simply dissemination/encouragement - and the current policy paper is a good case study of what can happen when new ideas spread, local areas respond in different ways and initial models are adapted and change. Perhaps unsurprisingly, helping to spread innovation is much harder than simply identifying ‘what works’ and telling others about it. Although this is important, its’ only the start of the process – and what happens next as innovation lands locally is arguably much more interesting and certainly much more difficult.
For further discussion, see Glasby, J. (ed.) (2012) Evidence: policy and practice (why evidence doesn’t influence policy, why it should and how it might). Bristol: The Policy Press.