The Commissioning Circle

Mental Health World Class Commissioning – Working in partnership with survivors, users, and citizens

Author: Professor Bob Sang

11July

A post Conference ‘blog’ by Professor Bob Sang, scribe and critical friend

Background and Introduction

Humana’s Sam Allen and her team, working in co-operation with the Healthcare Commission, supported a genuinely user-led workshop at the World Class Mental Health Commissioning Conference, facilitated by Anne Beales and Tina Coldham (both from NSUN, the National Survivor/User Network), ably chaired by Gary Needle.

This blog endeavours to capture the essence of what turned out to be a lively, provocative and constructive process, producing questions and challenges that will enhance the debates among aspiring world class commissioners well beyond the main event itself.

My note here is not to represent or replicate Anne and Tina’s brilliant contribution, but to reflect on and raise the themes that are important to all those engaged in Commissioning for improved mental health and well-being.

The Starting Point: The User-Survivor Perspective

‘We’ – users, survivors, citizens – experience a very variable quality of engagement in Commissioning. We experience different roles, or none at all; an effective voice, or marginalisation; being taken seriously, or tokenism. We also observe that, in the main, commissioning remains finance and provider focused and highly transactional. Investing in and attaining mental wellbeing is a holistic, experiential and collaborative process. There are many gaps here – opportunities to be taken!

Survivors and users, working as active citizens and as paid consultants, can offer a great deal of insight and expertise to World Class Commissioning:

• They are creative problem solvers
• They have good networks and peer support
• They provide local leadership and learning

These talents, and more, can be applied to the key tasks of mentally healthy commissioning:

• Challenging prejudice and stigma from the outset
• Improving inclusivity; reducing inequalities
• Developing credible standards and criteria
• Enabling others to engage
• Drawing on the wider experience of the disability movement
• Learning from direct payments and personal budgets: user-led commissioning

The Implications for Commissioners

Here are three new tasks:

• Reframing ‘Return on Investment’, pursuing on mentally healthy outcomes (not ‘episodes of care’);
• Developing a new business model focussed on delivering sustainable recovery and independent living;
• Valuing ‘experts by experience’: investing in people and in the places where they live.

AND?

• Who is holding the power at the very beginning of the Commissioning process?
• Where are the conflicts of interest: among commissioners and providers?
• Are there fair and transparent ‘rules of engagement’?
• Whose information is used: from the personal to the population?

Mentally Healthy Commissioning is about the money and co-creating a fair and mentally healthy return; working and learning together with local citizens – especially those with valuable experiences to share. It is a beautiful paradox: ‘World Class Commissioning’ will be local and personal; inclusive and community accountable. “Adding years to life and Quality to living – together”.