Reflections on the TC landscape in the UK

Citation

Gallagher, K. (2017), "Reflections on the TC landscape in the UK", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 38 No. 4, pp. 203-204. https://doi.org/10.1108/TC-10-2017-0027

TCTC is a membership charity based in the UK which supports, promotes, develops and represents the application of therapeutic community (TC) practice across a wide range of settings and sectors.

As we approach the end of 2017, the environment for TCs in the UK continues to be fragmented and somewhat hostile but the topography of this landscape varies significantly from sector to sector. Within the NHS, TCs continue to close and be threatened with service redesign and an increasing creep towards manualisation and payment by results. This is often driven by financial pressures and the divide and lack of dialogue between those with frontline practice experience and those who commission and procure appears to widen. There are still innovative green shoots here and there – as always, driven by passionate individuals working hard to make a difference. There has been a significant positive development with the first published randomised control trial which demonstrated TC effectiveness (Pearce et al., 2017).

There is a steady and relatively (politically) consistent portfolio of TC wings within the prison estate. The model here seems more manualised and centrally quality assured and audited (an outsider observation) and whilst there will be those reading who will feel their stomach flip at this language, in many ways it is this “procedural harness” which actually helps to shelter the TC concept from some of the issues affecting those in the NHS. Having the TC model built into a service specification linked to a contract provides a degree of certainty of operation for the individual TCs. There has been a more deliberate and conscious purchasing commitment to the TC approach. I am sure those working in the system can describe the limitations and “strings” that may well be attached.

One sector that continues to see growth and increased interest is that for children and young people. This sector has been driven by market forces for almost 20 years now with almost 80 per cent of residential care delivered by the independent sector. This has driven an increase in therapeutic models and providers seeking a clearer framework to adopt. For some this is a genuine move to develop people and practice, for others it is a strategic or commercial decision to support marketing or points of difference with competitors without the systemic support or understanding to deliver this in real terms. This pattern has unfolded over the last few years and now, gradually, local authority commissioning is beginning to catch up and become sharper and ask better questions. This is a slow process. At the same time, this increase in interest (echoed in both TCTC and Community of Communities (C of C) membership) has seen many services struggling to meet TC service standards in the peer review process. In response, C of C has developed Therapeutic Child Care Standards as an alternative model – overlapping with TCs, but more reflective of their small group, often matrixed organisational structures. This better reflects a continuum of shapes, models (and tasks) of residential care.

The other live developments in the UK include several academic training courses that support and underpin TC practice – notably the BA Therapeutic Communication and Therapeutic Organisations programme at the Essex University and the BA in Therapeutic Child Care at the Glyndwr University (Wrexham) which has a foundation phase to provide greater access to the residential workforce. TCTC is also supporting the work of Rex Haigh and others in developing an accredited TC curriculum and this is set to launch in 2018. One of the core texts for this training is the recent publication The Theory and Practice of Democratic TC Treatment (Pearce and Haigh, 2017).

As ever, it feels like there is a continued tension between the operational, frontline reality – hanging onto the underpinning theory and knowledge built through experience and the powerful forces of commissioning, procurements and narrowly measured evidence of outcomes. Whist the landscape is challenging, we have our guides (both written and human) to help us navigate and forge a path and so for this writer, hope and resilience.