Mental health is one of the most complex areas of health care. Demand for services is rising and pressure to provide faster, more patient-focused services is now commanding a much greater level of attention.
Arden & GEM has worked closely with Clinical Commissioning Groups (CCGs) across Coventry, Warwickshire and Solihull to redesign mental health services for patients, which has resulted in better, more cost-effective patient care as well as improved capability and resilience of local services.
Mental health is a broad term which covers over 200 disorders from depression and dementia to substance abuse and addiction. Traditionally, mental health has been seen as a Cinderella service and it is only since the launch of the Five Year Forward View in 2014 that we have started to see a nationwide shift towards prioritising improvements in mental health services, resulting in positive action.
At the same time, demand has grown, partly due to improvements in understanding of mental health problems and the willingness of patients to seek help.
Alongside growing need, cases of serious neglect and abuse suffered by adults with learning disabilities and autism at the Winterbourne View hospital, prompted calls for services across the country to be radically transformed to prevent any repetition of this kind of treatment.
In a series of projects designed to tackle different aspects of mental health services, Arden & GEM has developed and implemented comprehensive service redesign programmes in partnership with CCGs and providers. These have delivered sustainable improvements in key areas, including perinatal mental health, autism, learning disabilities and local care.
Arden & GEM worked in partnership with the three CCGs in Warwickshire to establish a regional perinatal mental health service. Perinatal mental illness affects around 135,000 women per year, with long-term costs to society of £8.1 billion annually. Of postnatal women who die, 1 in 4 deaths are due to mental illness and 1 in 7 commit suicide, and there is evidence that babies whose mothers suffer with perinatal mental illness can experience long-term emotional, social, behavioural and developmental deficits.
Against that backdrop and thanks to proactive partnership working and a willingness to work across organisational and clinical boundaries, patients in Coventry and Warwickshire now have fast access to perinatal psychologists and psychiatrists throughout pregnancy and postnatal care. In addition, the multidisciplinary team is providing perinatal mental health training to GPs, health visitors, midwives and obstetricians, ensuring early identification of risk and vulnerability, and delivering a more holistic service.
Arden & GEM has been working with CCGs, local authorities, providers and service users across Coventry, Warwickshire and Solihull to radically rethink how services for people with complex learning disabilities and autism were being commissioned and delivered.
The new approach involved taking brave steps to challenge traditional models of care, moving towards alternative community-based solutions. The programme has resulted in a wide range of benefits, including:
A partnership project involving Arden & GEM CSU, Coventry and Warwickshire Partnership Trust, CCGs, local authorities and care providers across the Arden region, has successfully reduced reliance on out of area mental health services, improving patient care and delivering annual savings of £12m to date.
A dedicated Mental Health Repatriation team was established including specialist dementia and learning disability nurses as well as social care, occupational therapy and secondary care specialists. Forward-thinking CCGs funded the project, aware that savings may not be equal across the region and may vary from year to year.
In the first year of the project, which focused exclusively on adults with mental health needs:
The project is now a substantive, self-funding service and has been widened to take in those with dementia and learning disabilities.
These projects demonstrate that while mental health services may be complex, improvements can result not only in efficiency savings but in radical improvements for patients and their families. In all cases, working openly with stakeholders to co-commission services and taking the time to ‘walk in the shoes’ of individual patients has proved invaluable in redesigning successful services.
These projects have all received independent endorsement through industry award schemes.
The Coming Home project won the HSJ Value in Healthcare Award for Mental Health Services in 2015. Learning from the programme has been shared with other CCGs and providers through events and via an HSJ Innovation Network webinar.
The Transforming Care project was highly commended at the HSJ Awards and shortlisted in the Patient Safety Awards, while the Perinatal project was shortlisted for the HSJ Mental Health award, Patient Experience Network awards and the NHSCC Healthcare Transformation Awards.
Our winners clearly demonstrated a really good use of procurement process, from soft market testing, right the way through to contract award. An excellent example of collaborative approach and all CSU’s across the country should be informed of this fabulous work.