Providing high quality, locally based services to patients
Working collaboratively to put patients at the heart of healthcare can drive real improvements in quality as well as reducing costs. Working with Coventry and Warwickshire Partnership Trust, we identified an opportunity to improve services and reduce costs by bringing mental health patients back to local providers.
Benefiting patients, providers and commissioners, this project has delivered over £12 million in cost savings to three local Clinical Commissioning Groups (CCGs) while providing high quality, locally based services to patients. In 2015, the project was recognised at the HSJ Value in Healthcare Awards, as winner of the mental health category.
The challenge
Working with Coventry and Warwickshire Partnership Trust to improve quality and efficiency, we analysed spend on mental health services across the region.
Statistics showed less than 50% of the mental health budget was being spent on local services. A number of patients were being treated out of the area, often in costly care settings that were not being reviewed sufficiently frequently and robustly.
Further assessment showed patients outcomes could be improved if they were treated closer to home, while costs could be reduced and more carefully managed through local provider contracts.
Delivering the right solution
Designing and implementing a successful solution required a collaborative problem solving approach involving all the different partners including commissioners, local authorities and the mental health trusts.
Together, we looked at the whole system and the elements required to make the repatriation project work, from clinical governance, service changes, training, right down to new paperwork, all of which was designed to support treating mental health patients closer to home.
Mindful of the potential benefits to everyone involved, we were able to facilitate effective joint working with providers to clinically assess patients being treated out of the area, identify gaps in local solutions, deliver service improvements and identify training needs to implement a more comprehensive range of mental health services with local providers.
In its second year, the project was expanded to include a wider cohort of patients including those with dementia. The experience and processes established for Mental Health Repatriation have stood the region in good stead to respond to the Winterbourne review recommendations, and in 2014/15 the project was expanded again to encompass people with learning disabilities.
The outcomes
In the first three years of the project over 100 people have been repatriated, which has resulted in £12 million of cost savings for NHS Coventry and Rugby CCG, NHS Warwickshire North CCG and NHS South Warwickshire CCG.
Mental health patients can only be brought home if the right services are available locally. Close partnership working and information sharing has enabled local independent, NHS and voluntary sector providers to broaden the range of services they offer, enabling higher levels of need to be accommodated within the region. The increase in specialist beds and services locally also means fewer people are now being placed out of area, but when it is necessary, there is a clear process in place which identifies when and how that person could be brought back
Most importantly, this initiative has been particularly positive for patients and their families. The quality of services has improved following detailed clinical reviews, and patient needs are regularly monitored to ensure the right service is being delivered in the right place.
How did we do it?
NHS Arden & GEM CSU specialises in providing bespoke solutions, drawing on expertise across our integrated team. Our approach was crucial in delivering this ambitious and complex project. Led by our service transformation team, we worked with colleagues in business intelligence and finance to understand the issues and design workable solutions, while our contracting team were able to support successful implementation, quality assurance and performance monitoring.
"Some of our service users told us that being sent out of the local area made them feel they weren’t welcome. This project has given real hope to those people, many of whom are becoming more independent and taking on positive roles in their local community."
Sue Smith, General Manager, Secondary Care Mental Health Services
HSJ Value and Improvement in Mental Health Award winner
In 2015 this project was recognised at the HSJ Value in Healthcare Awards. In evaluating the project, the judges said: “The work being done here is exemplary and sustainable, in a complex area with often challenging patients.”
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