Audio diary project recording - full report

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.