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”.

It is commissioners who hold the keys to making the changes to public services that are needed to achieve any vision for the future. Health and local authority commissioners need to be in the lead for this process, promoting the need for change and using their buying power to achieve it.

As an example of the key role of commissioners in making change happen, Sainsbury Centre is today (12 June) publishing About Time, a guide to re-commissioning day and vocational services for people with mental health problems.

Having social contacts and being in work are good for health. They play an especially important part in recovery from mental ill health. Thus it is now government policy to give people with mental health problems an equal chance of achieving their ambitions in life. Yet people with severe mental health problems experience remarkably high levels of social isolation and unemployment.

Adult mental health day and vocational services are crucial to give people a realistic chance of achieving their hopes and aspirations and of participating fully in their communities. Too often they are under-achieving in that regard despite costing over £150 million a year.

Commissioners must lead they way in hearing what people want from services and driving the changes needed. But when posed with conflicting questions and polarised perspectives on existing services, commissioners are faced with both a dilemma and a challenge. How do they build on and change the configuration of services to meet both current needs and future aspirations in the absence of appreciable amounts of new money?

Modernising day and vocational services is not easy. It can mean de-commissioning services that do not meet people’s needs and transferring some statutory services into the voluntary sector or to become social firms. But we have now shown that the re-commissioning process can make a real difference to people’s lives. That opportunity should be ignored no longer.

About Time is available from Sainsbury Centre, price £25, on 020 7827 8300 or at www.scmh.org.uk/employment.

Angela Greatley, Chief Executive of the Sainsbury Centre for Mental Health

Here, I share with you the key themes that have emerged from our discussions.

• Information, data and knowledge management for effective commissioning (including better integration of public health and developing the mental health component of Joint Strategic Needs Assessments).
• Developing a range of outcomes for better commissioning.
• Workforce development and retaining knowledgeable, skilled and innovative mental health commissioners.
• Effective partnerships & “whole system” commissioning frameworks. Joint commissioning best practice; reducing fragmentation between commissioners; age inclusive commissioning and the wider role of local authorities.
• Public, service user and carer engagement. Placing service users at the centre of commissioning – a joint NHS and Social Care responsibility.
• Strengthening clinical and professional engagement – and an increased use of the evidence base in commissioning.
• Commissioning for quality – procurement; contracts & incentives (in the absence of a national tariff); and performance management.
• Joining up NHS and Social Care system reforms within the MH commissioning context – Practice-Based Commissioning, Individual Budgets and Personalisation. The impact of current models of joint commissioning on social care transformation with potential for extension of individual budgets across NHS and Social Care.
• Commissioning for wellbeing and inclusion – including physical health, health promotion, action on stigma and employment. Also considering mechanisms for influencing commissioning in other sectors to prioritise mental health needs.

NIMHE have appointed Kieron Murphy to lead a programme on “Effective Mental Health Commissioning and System Reform” which will look at how we can respond to these challenges in partnership with other stakeholders. Kieron has extensive background in this as a former PCT Chief Executive and having held senior appointments in provider organisations, Social Care, and the Department of Health. If you would be interested in more information about NIMHE’s work on commissioning please visit our website at www.nimhe.csip.org.uk.

I look forward to your comments.

- by Dr. Ian McPherson, Director
National Institute for Mental Health in England (NIMHE)