CNWL launching DIALOG+ across adult mental health services in 2022

From February 2022, CNWL will be launching ‘DIALOG+’ across all community adult mental health services in the London Boroughs and Milton Keynes. This is an approach that puts the individual’s priorities at the centre of the care system.

What is DIALOG+?

The DIALOG+ approach enables healthcare professionals to have supportive and meaningful conversations with service users about the aspects of their lives that are most important to them such as family, relationships, leisure activities and accommodation, in addition to their mental and physical health. It uses a person-centred and patient-rated scale that measures Patient Reported Outcome (PROM) as well as a measure of Patient Experience (PREM).

The diagram below shows a breakdown of the questions that professionals would ask which focus on both the service user’s satisfaction with treatment and the wider aspects of their life:

The service user then rates their experience in response to each of the 11 questions on a scale of one to seven – seven being ‘totally satisfied’.

DIALOG + is a process that builds on the above rating scale to ‘co-produce’ a care plan through conversations focussing on a patient's:

• a patient's specific needs and wishes
• what matters most to them
• steps patients can take to problem-solve and promote their recovery

The output of the DIALOG+ assessment will be a care plan that the service user and health professional create together that is specific, co-produced and clear. The care plan will be digital, easy to change and updated regularly as agreed with the service user.

Why are we using DIALOG+?

In July 2021, NHS England published a formal statement advising all Mental Health Trusts to move away from the Care Programme Approach (CPA) in favour of a Community Mental Health framework. DIALOG+, as part of a wider piece of work, is the tool to enable the move away from CPA whilst providing a clear, co-produced, care plan for service users. In London, it’s been agreed that DIALOG+ will be used in place of the Care Programme Approach (CPA) across Community Adult Mental Health services.

The idea behind DIALOG+ is that all patients within adult community mental health services should have a named worker and a care plan so there is consistency and improved quality of care across the population.

DIALOG+ should inspire meaningful conversations and ensure an amicable experience for service users. It is ultimately a human approach that seeks to reduce any uncertainty a person might have about their treatment.

The DIALOG+ approach is used because:

• The scale has been shown to have good psychometric properties
• It’s simple to use
• Service users report satisfaction in using it – Watch Healthy London Partnership’s ‘This is me’ video to find out more
• It supports the development of co-produced, specific care plans
• DIALOG+ outcomes can be used to measure impact on an individual, service and regional level to better understand our population needs
• It has shown to improve quality of life through a solution-based approach – Read Priebe S Et al (2015) for more details

Next Steps

In February 2022, DIALOG+ will be launched across all London boroughs and Milton Keynes with a phased implementation across all adult community mental health services in CNWL by May 2022. This article should be shared widely with all staff in the adult community mental health teams and staff training will be rolled out across each borough during this time.

For further questions or information please contact either:

• Dr Christopher Whiteley, Chief Psychologist – christopher.whiteley@nhs.net