Commissioning Mental Health Services from the Third Sector

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Commissioning Mental Health Services from the
Third Sector 

• MENTAL HEALTH PROVIDERS FORUM

10 May 2006
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Judy Weleminsky

• Chief Executive MHPF - December 05
• Previously
• consultant with Compass Partnership
• CE of NCVO
• CE of Rethink (NSF)
• CE of Community Matters

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FORUM AIMS

• To improve
• the lives of people
• with mental health problems
• and their carers
• through enhancing the contribution of voluntary
  sector
• mental health service providers

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FORUM MEMBERS

• New Members since Dec 05
• Mind Birmingham
• Mental Health Concern
• Second Step
• St Andrews
• The Avenues
• 2Care
• St Jamess House
• P3
• Mind in Birmingham
• Tulip
• Umbrella
• Volition
• BOARD
• All Chief Executives
• Chair Gary Lashko Carr-Gomm

• FOUNDERS
• Advance Housing and Support
• Alternative Futures
• Carr-Gomm
• Making Space
• MCCH
• Mental Health Matters
• Mind
• Rethink
• Richmond Fellowship
• Stonham
• Together
• Turning Point
• United Response

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FORUM MEMBER STATISTICS

• Over 20,000 clients use our services
• Over 400 million expenditure
• Combining statutory and voluntary income
• Over 15,000 staff
• Over 40,000 members/supporters
• Many thousands of volunteers
• Community based and responsive

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OUR VALUES

• Recovery based approach
• Service user involvement
• Diversity
• Code of practice
• Partnership working

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OUR PRIORITY

• Promoting voluntary sector providers as first
  choice partners in the design and delivery of
  modern mental health services that support
  recovery

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Working together

• To achieve a stronger voice
• To share learning
• To promote best practice
• To prevent poor practice
• To highlight the strength, diversity and values
  of the voluntary sector

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Working nationally with

• CSIP/Nimhe
• NCVO and ACEVO
• NHS Confederation
• National Care Forum
• Telephone Helplines Association
• Mental Health Helplines Partnership

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IMPORTANCE OF MENTAL HEALTH

• Economic and social costs of mental health exceed
  77billion
• Early intervention can substantially reduce long
  term harm
• Statutory services are all too often
• delayed
• health episode focussed
• overstretched
• managing symptoms not recovery
• not addressing social care
• Lacking user and carer involvement

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OVERCOMING SOCIAL EXCLUSION

• mental health problems often lead to and
  reinforce social exclusion
• stigma and discrimination
• low expectations
• lack of clear responsibility for promoting
  vocational and social outcomes
• lack of support for working
• barriers to engaging in the community
• Employment and supportive social contacts are
  strongly associated with improved health
  outcomes.

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RECOVERY APPROACH

• Optimistic and positively oriented
• a broad values based approach
• identifying realistic life goals
• taking control of their lives.
• tackling social exclusion
• achieving valued roles
• Recovery approach is fundamental to the voluntary
  sector

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IMPORTANCE OF EARLY INTERVENTION

• Accessing the window of opportunity
• Before institutionalisation
• Before the loss of social networks
• Before the loss of optimism
• Before deterioration and harm
• Early intervention is a highly desired objective
  of the voluntary sector

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WHY CHOOSE THE VOLUNTARY SECTOR?

• We have the
• Competence
• Training services and Infrastructure
• Enthusiasm, Commitment, Energy
• Flexible, innovative and responsive
• participation of users
• participation of carers
• Reaching the hard to reach
• To develop great services meeting needs and
  involving users, carers and the community

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VOLUNTARY SECTOR

• Provides over 10 of all state funded mental
  health and rising, bringing
• Innovation
• Diversity
• User responsiveness
• Carer responsiveness
• Holistic approach
• Community networked

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Strategy and how CSIP can help!

• Shaping the market and building credibility
• Profile building
• Influencing commissioning processes
• Support to strengthen key systems and processes
• Clinical governance
• Contracting
• Intelligence sharing
• NHS as commissioner
• Other NHS partnerships
• Expanding workforce/enhanced skill mix
• Clinical capability

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Challenging double speak

• National policy sees voluntary sector involvement
  as highly desirable
• Locally commissioners often marginalise the
  voluntary sector
• National policy talks of full cost recovery and
  fully funded services
• On the ground commissioners refuse to fund
  legitimate overheads and dont fund cost of
  living increases

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Challenging cheap services

• Best value requires services which meet needs and
  promote well being
• Cheapest providers use the lowest paid staff,
  poorly trained with minimal management delivering
  unreliable low quality services which dont meet
  needs overall they are more expensive

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MHPF focus on specific needs

• Project groups
• Service Governance
• Outcomes
• Employers Consortium
• Proposed initiatives
• involving users groups
• involving BME groups
• Joint web services

• Specialists groups
• HR Directors
• Proposed groups
• Development Directors
• IT
• Information

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Mapping Clinical Governance

• Nimhe in partnership with MHPF 2004
• For far too long it has been assumed that the
  voluntary sector cannot work in equal partnership
  with the statutory sector to meet the needs of
  people with mental health problems ...not only
  can the voluntary sector deliver services, it is
  vital that it does so.

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Developing a common risk strategy

• Developing a common risk pathway
• Agreed approaches to risk information sharing
• Empowering appropriate risk decisions
• Clarity of language and understanding across
  agencies

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Developing an Employers Consortium

• Investigating the possibility of Forum members
  working together on staffing issues
• Recruitment
• Retention
• Training
• Staff development
• Staff moving between members

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Developing an information and networking portal

• Designing a website to meet member needs
• Promoting learning and information sharing
• Attracting commissioner and guiding them to
  members and services
• Attracting job seekers and guiding them to
  opportunities

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Member marketplace

• Event planned for July to
• Enabled senior managers and specialists to meet,
  network, share and learn
• Promote joint initiatives
• In localities
• In specialities
• In new approaches
• In development and delivery

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Involvement inHigh level taskforces
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Forum member views

• Optimism for future growth
• Commissioners opening up to the voluntary sector
• Mixed experience with full cost recovery
• Problems getting cost of living increases
• Want better commissioners who value quality and
  outcomes not cheapness

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Opportunities in the White Paper

• Goals in tune with the voluntary sector
  aspirations and directions
• Translating user influence into more effective
  care
• Stigma tackling public awareness campaign
• Require good practice commissioning
• Social enterprise unit for health and social care
• Good practice models in commissioning

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Challenges in the white paper

• Direct payments making them work in mental
  health
• Payment by results
• Developing real co-operation and understanding
  between commissioners and providers
• National commissioning and contract template
  which works?

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Threats in the white paper

• Increasing services to the 50 in distress
  squeezing the expensive services for the 1 with
  severe and enduring problems
• Practice based commissioning and LAAs being too
  small to meet severe health needs
• Independent commercial providers moving faster
  and having more resources to entice commissioners
• Nothing about training and skills of
  commissioners or hard severe mental health targets

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Bigger picture issues

• Resources, resources, resources
• Change fatigue
• Shifting political interests
• Complexity
• Handling risk

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Headlines were aiming for

• Not for profits make perfect sense says Minister
• Were up for change says Chancellor
• We trust charities say user groups
• Outcomes better from voluntary sector says
  Strachan/Mori poll
• Voluntary sector community provision delivers 30
  of mental health services.dramatic drop in
  need for acute services
• 11 3 says NHS Chief Executive one year on!
• BME groups choose not for profits
• New approach to mental health services is working
  Society Guardian!