Audio diary project recording - full report

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Summary of report content

Healthwatch Camden carried out an audio project to record the diaries of the service users and their experience of the service change at the Highgate Centre. This was recorded from 30th November 2015 to 20th June 2016. This work was done as part of a programme of engagement on mental health day centres and to inform mental health service development. The report identifies a number of key issues. The service at the day centre underwent significant changes. The major change proposed was the abolishment of the Associate Membership, meaning those who completed their programme as Core Members would no longer be able to retain access to the Centre for support or peer contact. Other changes included cuts to staffing levels, ending the provision of the daily hot lunch, and making changes to the activities and groups programme. The audio diaries showed that changes to the service had a negative impact on service users’ experience. Consultations on service change were poorly managed and not clearly communicated to service users. The value of relationships and peer support to service users at the centre was underestimated by commissioners and providers. This resulted in confusion and uncertainty and declining mental wellbeing. The report made the following recommendations: - the concerns of existing service users must be respected as valuable evidence for planning service change. - Service user engagement around changes to existing services should be rigorous in methodology and serious in intent. It should not be restricted to open consultation meetings but must also include other proven options for meaningful engagement, for example, co-design or in-depth one to one interviews with systematic analysis of findings. - The support needs of existing service users should be a priority concern during changes to services. Support provided should begin early, remain consistent, and be designed to respond to the specific concerns identified by service users themselves. - If consultation about service change cannot achieve sufficient consensus among key stakeholders (including existing service users) then appropriate accountability mechanisms should be used to insist on robust evidence to support the arguments for change. - The Health and Adult Social Care Scrutiny Committee should take a more forensic approach to challenging contradictions in accounts given under questioning and should seek to test assurances given to service users at committee meetings. - Change management should ensure consistency and transparency in feedback loops for the communication of decision making to service users. Senior management must do what they say, avoid making promises that can’t be kept, and provide early and clear explanations for changes in plan. - The Council and the Trust should issue a joint formal apology to service users at the Highgate Centre for the negative impact on their wellbeing that resulted from the changes and poor management of the change process. Camden Council, and Camden and Islington Foundation Trust responded to the report. They welcomed Healthwatch Camden’s observations and apologised that the service users felt not listened to. they acknowledged the ongoing challenge of balancing central government’s cuts and local demand. However, they have a number of comprehensive support mechanisms already in place to mitigate the impact of service changes. This included reviewing every risk and crisis plan of the day centre members, both associates and core members, carrying out regular meetings with members at higher risk, increasing staff at the centre during the transitional process, besides other mechanisms.

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General details

Report title 
Audio diary project recording - full report
Local Healthwatch 
Healthwatch Camden
Date of publication 
Monday, 10 July, 2017
Date evidence capture began 
Monday, 30 November, 2015
Date evidence capture finished 
Monday, 20 June, 2016
Type of report 
Report
Key themes 
Access
Quality of care
Healthwatch reference number 
Rep-1409

Methodology and approach

Was the work undertaken at the request of another organisation? 
No
Primary research method used 
Focus group
How was the information collected? 
Third Party

Details of health and care services included in the report

Mental health services 
Community mental health team (CMHT)
Psychiatry / mental health (other services)

Details about conditions and diseases

Types of disabilities 
Mental health

Details of people who shared their views

Number of people who shared their views 
11
Age group 
All
Gender 
All
Ethnicity 
All
Specific ethnicity if known 
All
Sexual orientation 
Not known
Does the information include public's views? 
No
Does the information include carer's, friend's or relative's views? 
No
Does the information include staff's views? 
No
Does the information include other people's views? 
No
What was the main sentiment of the people who shared their views? 
Mixed

Outcomes and impact

Were recommendations made by local Healthwatch in the report? 
Yes
Does the information contain a response from a provider? 
No
Is there evidence of impact in the report? 
No
Is there evidence of impact external to the report? 
No

Network Impact
Relationships that exist locally, regionally, nationally have benefited from the work undertaken in the report
 
Implied Impact
Where it is implied that change may occur in the future as a result of Healthwatch work. This can be implied in a provider  response, press release or other source. Implied impact can become tangible impact once change has occurred.
 
Tangible Impact
There is evidence of change that can be directly attributed to Healthwatch work undertaken in the report.