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The Royal College of Psychiatrists Improving the lives of people with mental illness

North West Conference Reviews 2014


North West SPRING Conference Review - 16 MAY 2014 in MANCHESTER:

commissioning, funding and service development
how do we pay for quality services in the 21st century?


Lecture 1: The Commissioning Agenda in Mental Health: Dr Neil Deuchar, Director of the RCPsych Commissioning Centre


Dr Deuchar reminded us of the strategic background and the constantly changing agenda in healthcare delivery. He described some of the important developments such as appointment of GP mental health leads and the lack of implementation of the public mental health agenda.


He described the wider issues of sustainability, variability, waste and values. Focusing on the concept of values based commissioning which extrapolates value-based practice into the commissioning environment. This approach gives the perspective of patients and carers equal footing to professional perspectives at each stage of the commissioning cycle. Values such as reciprocity (mutual learning), peer working and the lived experience are emphasised. The Joint Commissioning Panel (JCP) made up of the RCGP, RCPsych, national user organisations and others was formed in 2010. They have produced a series of commissioning guides each one focused on a different strategic area e.g. dementia, children and young people, forensic services etc. I have included the web address for the JCP where the published guides can be downloaded.


In future services will need to integrate patients and families, whole personal care and collaboration between primary and secondary care, seamless commissioning with both physical and social care.


Dr Deuchar brought information about the Strategic Clinical Networks (SCNs) and the College Commissioning Centre – for psychiatrists who wish to get more involved – see website links.


Joint Commissioning Panel for Mental Health – website with commissioner guides


RCPsych Commissioning Centre – virtual centre bringing together the JCP, with aspects of the college


Strategic Clinical Networks – aim to support commissioners and service providers – focus on specific conditions or patient groups.  Contact details for North West SCNs:

Cheshire and Merseyside – Jackie Sanders 0113 825 2770

Greater Manchester, Lancashire, South Cumbria – Janet Ratcliffe 0161 625 7934



Lecture 2: Commissioning: The Role of the Local Psychiatrist: Dr Laurence Mynors-Wallis, Registrar of RCPsych, Medical Director of Dorset HealthCare NHS Foundation Trust


Dr Mynors-Wallis concentrated his lecture on how psychiatrists can influence local commissioning decisions. Even though the government has said there should be parity we are still seeing inequity in the way commissioners fund services. There are local groupings such as the Clinical Senates and SCNs but they have not yet had a major impact.

So how can psychiatrists influence commissioning? Dr Mynors-Wallis suggested that they can start by getting to know local GPs and concentrate on understanding what GPs want. He suggested that this influence would best be exerted through personal contact, informal networks and generating positive perceptions and anecdotes.


He advocated that we find out what local GPs want and they generally want:

Easily accessible, personable, helpful relationship with an individual psychiatrist

Practical assistance with managing difficult cases in primary care

Guidance and advice concerning local systems and care pathways

Coherent arrangements at the margins of the working day and out of hours

Sharing of clinical risk


Dr Mynors-Wallis reminded us that in the ever changing personnel in the management structures of the trust the two constants were the patients and often the senior doctors, we were often a major source of continuity. He proposed that doctors should get involved in restructuring even though it can be a difficult process, that doctors should be active in advising the board in a clear and co-ordinated way.


In conclusion get to know local structures in the CCG, GPs, public health and actively work together as a medical group.



Parallel sessions


Parallel session 1: Getting ready to improve: an introduction to the ‘Model for Improvement’ Maureen McGeorge, Project Manager with the Patients Association


Information from speaker - this session will guide take you on a whistle-stop tour of the Institute for Healthcare Improvement’s ‘Model for Improvement’, stopping off en route to allow you to hear about the experiences of some mental health service teams that have tried using it.  We will conclude the session by allowing you to apply the learning to planning a simple improvement project that you can take away with you.


Parallel session 2: Personal Health Budgets – Tools for Recovery: Dr Vidhya Alakeson, Deputy Chief Executive of the Resolution Foundation


Personal health budgets are an allocation of an individual budget from NHS resources as a route to increase choice and control. In England there are 5 characteristics:

Service user chooses health and wellbeing outcomes

Knows how much money - approximate budget

Enabled to create own care plan - most people need support - often via clinician or independent broker

Choose how budget held and managed - direct, third party, NHS hold notional budget

Able to spend money in ways and at times that make sense


The process is decided locally and money should be allocated on the basis of need with a clear end-point when the budget is signed off. A review of the national pilot found that the condition itself didn’t improve but quality of life improved, there was a reduction in unplanned care and the budgets were cost effective. Most people valued services and bought in additional services such as psychology and others reduced traditional services choosing to use their money to attend college or improve social inclusion.


Further information:


Introduction to personal health budgets and the toolkit


The personal health budget pages of the Royal College of Psychiatrists website


Personal Health Budget story 1


Personal Health Budget story 2


Personal Health Budget story 3



Evaluation reports:


Personal Health Budgets Evaluation  (final report is November 2012)


A qualitative report on a recovery budget pilot in early intervention which might feel more relevant because a lot of the participants were young adults


Recovery Budgets in a Mental Health Service



Afternoon Session


Parallel session 3: The Business of Addiction Psychiatry: Dr Prun Bijral, Consultant Psychiatrist and Associate Medical Director for CRI


Information from speaker - this session will explore the potential role for psychiatrists in the business element of retaining and winning services, illustrated through the experiences of a doctor working for one of the main providers of addiction treatment services in England and Wales


Parallel session 4: Approaching service development through the application of service logic, Dr Mark Spurrell, Consultant Psychiatrist at Calderstones NHS Partnership Trust


Dr Spurrell suggested that we had a long tradition of patient centred care and that we should be looking at emerging ideas such as value driven healthcare (Porter) and service dominant logic (Vargo and Lusch). He described value driven health care as one where the patient is a customer and the focus is on outcomes such as functional improvement and cycle time. Service dominant logic is based on the idea that service is the application of logic and skills for a benefit and so service is part of an exchange. He emphasised the ideas of co-production and co-creation with customers or patients making choices.


He went on to discuss the different types of market, are we selling to the customer (patient) or another business (B2B marketing). He described a piece of work he had undertaken to apply these concepts to the CPA process. He concluded that trusts are brokers or a confederation and suggested they needed a shared platform with commissioners and an overarching framework.



Lecture 3: Commissioning for Better Mental Health and Better Lives: Andy Bell, Deputy Chief Executive of Centre for Mental Health


The NHS spends £14 billion treating mental health but needs another £14 billion to treat unmet needs. The centre for mental health carried out a systematic review of 100 strategies and interviewed members of ten health and wellbeing boards to find out how far they have included mental health issues as a priority and what they have focused upon.


Health and wellbeing boards bring together local authorities and health and care system leaders to improve the health and wellbeing of their local populations. They are tasked with identifying key health needs in their area through a joint strategic needs assessment and then set priorities through a strategy.


The review found 9/10 aimed to tackle at least 1 mental health issues, 55% prioritised children's mental health and 46% prioritised better access to services. They recommended that mental health organisations should concentrate on influencing those strategy priorities intimately connected with mental health, but where the link with mental health has not been made such as alcohol, smoking and obesity.


Mr Bell also recommended supporting mental health champions (they sit on the health and wellbeing boards after being appointed by local councils) as they can raise the profile of mental health and offer expertise on implementation of priorities.


He spoke of the key features of recovery oriented services - bigger role for peer support, co-production, recovery colleges, safer inpatient wards (no force first), help with employment needs, housing, other basic needs, support for family and friends.


Mr Bell emphasised the importance of welfare advice in mental health services as 83% of people using mental health services have welfare rights issues. He gave the example of Sheffield CAB paid for by the mental health trust in 1976. If they were able to shorten an inpatient stay by even 1 day the trust saved over £300. He suggested that all secondary services should offer consistent access to welfare advise, to offer it early, embed it in the recovery model and that they assess welfare needs.


For further information:


Mental Health Challenge


Centre for Mental Health


Centre for Mental Health A Place for Parity Report



Lecture 4: Quality and Service Improvement: What Healthcare has been learning from other Sectors: Dr Nathan Proudlove, Senior Lecturer, Operational Research at Manchester Business School, University of Manchester

Dr Proudlove started by describing how the service improvement model known as LEAN was developed by W Edwards Demming an American statistician. This work started in the car industry and was imported to healthcare in the 1980s. He described several other models.

He suggested that we started by developing our own measurements of change or metrics – how will we know that a change is an improvement? The next step was to test ideas before implementing changes by experimenting and suggested using the PDSA (plan, do, study, act cycle) cycle. He suggested using PDSA in small cycles, failing early, small and often.

Dr Proudlove recommended finding clinically meaningful data that was based on local performance measures, using visually presented data that could at a glance show any changes occurring. He proposed that often data was already being collected but not being used or examined in a useful way. He recommended the work of Simon Dodds (software developed).

Other approaches described included the fishbone diagram which supported a structured brainstorming process and the search for potential causes. Using the 5 Whys to get to the root cause. The 80 20 rule - 20% of variable causes 80% of problems. Pathway mapping using post-it notes to understand the flow and what needs to be done.

Dr Proudlove gave us a detailed description of classic LEAN  describing the seven wastes in healthcare (transport, inventory, motion, waiting, over production, over burden, defects), looking at the flow with the push (own pace) and pull (customer demand) and the use of visual management for project management. He described several examples within healthcare such as Salford Royal and Tees, Esk and Wear Trust that had adopted the use of LEAN in a significant way with its use being driven by the board.

He concluded that as clinicians we should start small with issues that niggled at us.


North West Conference Autumn 2014 – Update on treating personality disorders – review coming soon

North West conference Spring 2015 – Neuropsychiatry


A Khawaja
Academic Secretary, North West Division

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