Mental Health Nursing

easy to see why many staff have become disillusioned with HoNOS; this
is unfortunate since the implementation of HoNOS is clearly a useful first
step in moving towards a shift in service culture towards one which is
orientated around outcome measurement. Outcome measurement will not
become a day-to-day reality until clinicians view it as an essential part of
good practice and it is supported with adequate IT systems (Gallagher and
Teesson, 2000).
It would be optimistic to believe that every Trust or Social Services
Department will acquire state-of-the-art IT equipment in the short or medium
term but this should not prove to be an insurmountable hurdle in implementing
a data management strategy. One administrative assistant with a
personal computer would be all that is needed for an organisation to store
data electronically and allow staff to question the database. Obviously,
giving staff direct access is preferable and this is already happening in some
instances but the majority of organisations may have to work towards this
ideal. Whatever the mechanism used locally, care should be taken to
ensure that there are controls in place to ensure the quality and reliability
of the data entered onto the system.
Training of raters and their ongoing supervision is also a major issue
for organisations planning to introduce HoNOS. There are known links
between the quality of training and the quality of data from the wider
literature on rating scales (Ventura et al., 1993) and although HoNOS is
much simpler to use than many tools, the same principles apply (Amin
et al., 1999; Bebbington et al., 1999; Trauer et al., 1999). It is suggested
that all potential raters undergo a structured training programme before
being expected to use HoNOS routinely in clinical practice. HoNOS is
undoubtedly a straightforward tool to use but there are guidelines for its
use which raters have to understand and follow if HoNOS ratings are to
be valid and reliable. Experience has shown that despite its simplicity
misunderstandings do frequently occur when raters do not have a sufficient
grasp of the basic principles of rating. In addition, it is thought
that a brief one-off training course is not sufficient to guarantee comparability
between individual raters or between groups of raters and that
practice and ongoing supervision are required to maintain reliability and
data quality.
Conclusion
Measuring health and social functioning using HoNoS 45
As stated at the beginning of the chapter, there are numerous measures of
outcome in mental health care; the debate surrounding the effective use of
outcome data to inform clinical practice and service evaluation obviously