Case Study: Mental health services

During 2016/17 two key national developments have been implemented which is having a significant impact on the planning and future commissioning arrangements of specialist secure mental health services. The first is the development of Sustainability and Transformation Plans (STPs) which are local plans that aim to improve health and social care across 44 geographical areas (or ‘footprints’) in England.

The second development is the national Specialist Mental Health Service Review (MHSR) which is aiming to:

• Coordinate a consistent national approach to capacity planning for Adult Secure Mental Health Services in each of the 9 NHS England Specialised Commissioning hubs.
• Look at innovative ways of working with the Adult Secure Mental Health population to reduce reliance on expensive inpatient beds through creating new models of care with an emphasis on pathway development, a recovery focus and better integration across a range of agencies and providers along the pathway.
• Coordinate a series of service developments/reconfiguration in each of the hubs whilst maintaining system stability.

In light of these national developments, NHS England in Yorkshire and Humber have undertaken two regional provider consultation events and one service user event as part of an engagement and development process. Senior managers and clinicians and service users from medium and low secure services have had the opportunity to identify and discuss the priorities that need to be taken forward as part of this transformational plan. From these events a number of key principles have been agreed that will underpin the changes required, and the outcomes of the review.

The transformation process will involve changing current secure bed capacity through the reconfiguring of existing services, the decommissioning of some services where this is over capacity, and the commissioning of new services to fill gaps in provision. This five year process will require the involvement of local commissioners and providers, service users and clinicians, and a range of NHS and non-NHS organisations to deliver a range of innovative pathways and services. Five work streams have also been agreed as a priority to prepare the system for the changes required. These will include a focus on workforce, pathway development and the integration of other agencies.

Quality outcomes have been identified:

Service Outcomes

1. Improved pathways which integrate services effectively and reduce delays.
2. The development of new community-based services.
3. A reduction in the need for inpatient capacity.
4. Increased focus on prevention and early intervention.
5. A reduction in unwarranted variation across secure services.
6. Improved capacity and flexibility of the workforce.

Patient Outcomes

1. Increased reporting of hope and happiness in relation to recovery.
2. Increased reporting of positive relationships with staff, family and friends.
3. Increased community support and positive interaction with criminal justice system and primary care.
4. Reduced length of stay.
5. An increase in shared decision making and involvement between service users, clinicians and commissioners.
6. Greater access to decent, safe accommodation in the community.
7. Greater access to meaningful occupation and paid work.

Commissioning/Contracting Outcomes

1. Increased shared decision making between service users, providers and commissioners in the commissioning process.
2. Contracts that incentivise whole pathway integration and patient outcomes.
3. Commissioning arrangements that do not inhibit or delay patient pathways.

The importance of involving commissioners, clinicians and service users as equal partners in the delivery of these changes cannot be underestimated for without either as key partners the outcomes expected will not be achieved.