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Bringing specialist mental health services closer to home

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.

Anne Forbes

Anne Forbes is the Programme Director for New Care Models for Devon Partnership NHS Trust and is responsible for directing the transformation programme on behalf of South West Regional Secure Services

Anne has a background in finance, governance and business intelligence and has held various roles as part of executive and senior teams over the past 20 years, within the NHS and commercial sector.

Dr Jason Fee

Dr Jason Fee is the Clinical Director for South West Regional Secure Services New Care Models programme. He is leading the re-design of clinical care pathways and service provision across the South West, in order to ensure that individuals in receipt of secure care are treated as close to home as possible, for the shortest possible period, within the least restrictive level of security.

Jason is an experienced Consultant Forensic Psychiatrist and Clinical Director within good/outstanding rated secure services, and has worked within healthcare settings both internationally and within the NHS over the course of his career.

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11 comments

  1. Kassander says:

    Anne has a background in finance, governance and business intelligence

    A sign of the times?

  2. Brian Darnley says:

    Such an exciting initiative, tremendous work!

  3. Francesco Palma says:

    Good progress being achieved in the South West which is encouraging.How will the views,narrative and perspective of service users and carers been captured to this pilot and who will evaluate the South West RS Pilot.
    Service users,Carers/staff from all the partners pilot footprint in the South West are always welcome to attend the quarterly South West Recovery and Outcomes Group which would be useful to connect and learn.

    • Anne Forbes says:

      Dear Francesco

      Thank you for your interest in our blog and also for your comment

      There will be a formal evaluation of the pilot, which will led by NHS England, and this will capture the views of individuals who have used our services

      We are ensuring that we take into account the views and experience of individuals as we develop our services, and we would very much welcome attending your South West Recovery and Outcomes Group

      Kind regards

      Anne Forbes

      • Francesco Palma says:

        Hi Anne

        Many Thanks for your response.

        What is your preferred method to be contacted as I have a date and venue confirmed for the next South West Recovery & Outcomes Group meeting in March.

        Kind Regards

        Francesco Palma

  4. Shawn Tait says:

    Inspiring work and it is great being part of this transformative programme and the team which is improving patient and carer experiences, connecting patients and their carers/supporters and bringing care closer to their homes.

  5. Simon Barber says:

    Sounds amazing and interesting, with great steps taken for a lot of people.

  6. Wallace Brink says:

    Great initiative that is well-led and affecting real change for people and their families. May your success continue to grow.

  7. Mark Trewin says:

    Hello – are you doing this in partnership with local councils who have s117 aftercare role for people in forensic services and housing providers for accommodation on discharge?

    • Anne Forbes says:

      Hi Mark

      Thank you for your comment and for your interest in our programme

      We are in the process of developing the specification for two new community forensic teams in the South West. As part of this, we plan to engage key stakeholders where investment will occur – key stakeholders will include housing providers, local authorities, and others involved in the aftercare for people in forensic services.

      Within the partnership, we have the opportunity to learn from two of our partners who have already developed community forensic teams, and have good working relationships with their local authority and housing providers

      Kind regards

      Anne

  8. Adrian James says:

    Thanks Anne and Jason. The programme has made a real difference to patients on the ground. Great stuff
    Adrian James