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NHS England is establishing 17 pilot sites across the country to test new ways of delivering specialist mental health services.
This is part of the New Care Models in Tertiary Mental Health programme, which aims to make sure people get the support they need as close to home, and their family and friends, as possible. Two directors leading the Devon Partnership NHS Trust, reflect on their experiences:
We lead a partnership of eight providers – the South West Regional Secure Service – which commission medium and low secure mental health services for adults from the South West of England.
We launched in April 2017 as the biggest geographical site in the first wave of the New Care Models for Tertiary Mental Health programme and are already starting to see a huge difference. Many more people are receiving specialist care closer to home, in less restrictive environments and for shorter periods of time. And we’re now planning to reinvest savings in community forensic teams which will reduce reliance on inpatient services.
We, like many other trusts, have found it challenging to meet demand for specialist inpatient mental health services in recent years and, in some cases, have had to send some people out of region to get the support they need. Longer distances can make it harder for friends, family and local clinicians to visit which can affect a person’s recovery, lead to them having to stay in care longer and increase expenditure which could otherwise be invested into community services.
NHS England recognised these challenges and, in line with the Five Year Forward View for Mental Health, is working to address them through programmes like New Care Models for Tertiary Mental Health.
We applied successfully to be a wave one pilot, as a partnership of five NHS organisations, two independent sector organisations and one community interest company. We started working in shadow form, with NHS England in October 2016 and were given delegated responsibility for commissioning and the budget in April of this year.
Key to our success to-date is our partnership working across the South West region. Before the programme, the providers in the region all had the same goal of supporting people but were working individually, often thinking in terms of their county rather than the South-West as a whole.
We’ve since developed a shared vision, clinical model, and business model which are supported by senior clinicians and leaders across our South West Regional Secure Services Partnership. Crucially, this has led to a culture shift: we all now see ourselves as part of a whole region and are planning and supporting each other accordingly, and in real time.
Key actions included:
- Introducing a single point of access across the region and standardising our assessment criteria, which allowed us to admit people more quickly.
- Implementing a regional approach to our bed management, which increased our in-region bed occupancy.
- Developing clinical networks to standardise how we deliver inpatient care, and are currently developing a shared set of clinical and patient outcomes. These networks also enable us to share good practice and difficulties with colleagues.
- Successfully proposing commissioning of extra specialist beds in the region, helping to address the historical under provision of services locally.
- Looking carefully at the needs of our population and identifying services for women are under-provided. We have started to address this by re-profiling the use of some of our in-region beds to provide women’s services, commissioning extra female low secure beds and planning to introduce more women’s services. We are boosting community care, by developing a specification for two community forensic teams during 2017-18 and more in the future.
- Contributing to the design work streams for community forensic teams, prison healthcare, and women’s services.
We’re really pleased that people are already starting to see the benefits. Since October 2016, to date, we have reduced out-area-placements significantly, bringing over 60 people back into the South West and nearer their families.
This was underlined earlier this year by the case of David (name changed to maintain anonymity), a man in his early 30s who was brought back into care in the South West, after four years living in a secure unit out of area. Ever since his family has been able to visit on a weekly basis, rather than a few times a year, and he’s been engaging well in therapy sessions and recently started going out into the community with them, to places like the local college and library. The difference in him has been remarkable. He’s now got more hope and can visualise a future in his own community.
Following our review of the needs of people receiving secure care, we’ve also been able to move some people out of high security care and discharge others back into community services.
Our long-term aim is to stop inappropriate out of area placements altogether and to reduce reliance on inpatient services, by investing in community forensic services with our efficiency savings. There are currently two of these services in the area but we hope to have an additional five over the next five years.