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Hello all,


Hope this email finds you well.


I am evaluating a mental health service and from my programme architect interviews a theme that has emerged is ‘the role of the commissioning framework within Wales’. To provide some context, the commissioning framework is responsible for assessing the quality of all mental health services within Wales and gives them a rating. This rating is visible to commissioners and is used to help them make decisions about where clients will receive treatment.


The programme architects have suggested that the framework have treated them unfairly due to a number of failings by the Framework, such as advertising the service as full, a low quality rating and not informing the service of the quality rating outcome of their unannounced inspection, pigeon-holing the service into something it is better than. These issues have been met with frustration from the organisation / staff team and resulted in low numbers of referrals to the service.


The programme architects present their narrative of their encounters with the commissioning framework, however the Framework’s narrative is captured within public documents, such as the outcome from an unannounced inspection by the Healthcare Inspectorate Wales, and disagrees with the version presented by the programme architects. Can I use included this external documentation as part of my analysis, or discussion, to address the programme architects perceived issues with the commissioning framework within Wales? If so, I just wondered if anyone could provide me with good realist evaluations where the authors have utilised external documentation, as part of their analysis or discussion, which presents a different version of events and may well disagree with the narrative put forward by programme architects.


I was hoping to do this to present the possibility that there are multiple narratives about the ‘commissioning framework within Wales’ and therefore these differences could equally be playing a role in the difficulties the service has faced in relation to low referrals. Each party places responsibility for the low referrals with the other – so for example, the commissioning framework state that the service was given a low quality rating due to a number of reasons such as not implementing a number of requirements to meet European standards, such as a Psychologist for the service, and the inclusion of health promotion posters in the communal areas… therefore this low quality rating meant the service were at the bottom of the framework listings and would not be visible to commissioners who make decisions about referrals. The reason I am struggling is because both parties have their own agenda, and there is the potential that the service may need to be closed due to its sustainability, therefore there is a lot of blaming / externalising amongst my programme architects interviews and I am unsure how to capture this within a CMOC which doesn’t simply overlook their agenda to protect themselves as an organisation.


I hope that presenting these different narratives will suggest that the assumptions of programme architects, in relation to referrals, may well need to be interpreted with caution as they present their narrative, a one-sided version of ‘the role of the commissioning framework within Wales’ has played in their low referrals and client numbers. And that their perception of contextual factors (the commissioning framework) that have hindered the service may not be presented in the most balanced way due to the reality that the service may well close.


I know this email is a bit convoluted, but I hope it makes sense, if more context is needed please let me know.


All the best and thank you in advance.



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