Protocol for assessing services for people with severe mental illness

The Clinical Standards Advisory Group was asked by UK health ministers to advise on the standards of clinical care being achieved for people with schizophrenia. A subcommittee commissioned a review of standards, followed by research into how far these were reflected in contracts and met by providers.

No comprehensive but practical set of standards was found. A protocol of 143 items of good service practice was constructed, and applied by teams visiting services in II UK districts. The team appraisals were summarised in 20 key points, each scored 0 (absent) to 4 (excellent performance). Seven points were used to assess standards of commissioning and 13 for standards of service provision.

When placed into rank order, the mean key point scores for commissioners and providers in the same district tended to be very similar. Total district scores were then used to assign districts to one of three groups. Four performed reasonably well, five were moderate and two were poor.

One of the key elements associated with these differences was the local level of morale. After wide consultation, a revised protocol of 26 key points for direct rating was drawn up and has since been further tested.