Bringing together services

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Bringing together community, mental health and learning disability services

January 2023

A key priority for the NHS in Hampshire and the Isle of Wight is ensuring that communities have equal access to services and have the opportunity to achieve the same outcomes. We know that over the coming years the demand for community and mental health services will increase. Our physical and mental health services are already responding to increasing need, both in terms of the number being referred and the complexity of issues they present with. Against this backdrop, continuing to improve and transform service provision, as well as having an even greater focus on integration between mental and physical health, is vitally important. 

In January 2022, the Hampshire and Isle of Wight Integrated Care System commissioned an independent review of community and mental health services. The purpose of the review was to understand how to best meet the current and future demands of our local populations. The review looked carefully at the evidence and involved a range of clinicians, partners and stakeholders, as well as existing insight and feedback from people who use local community and mental health services. 

The review resulted in five key recommendations which are being taken forward in a joint programme of work.

One of the review’s key recommendations is that a new organisation be formed, to bring together all NHS community and mental health services provided in Hampshire and the Isle of Wight, including services provided by Solent NHS Trust, Southern Health NHS Foundation Trust, Isle of Wight NHS Trust and Sussex Partnership NHS Foundation Trust, that delivers Child and Adolescent Mental Health Services (CAMHS) in Hampshire.

The review makes the case that bringing together our services in this way would improve consistency of care between these services and organisations which are currently responsible for different parts of the care pathway. It would also improve equity of access to care. We believe that working even more closely together is the right approach for the benefit of our patients, their families and communities. The rationale for the recommendation is aligned with, and builds upon, the steps we have already taken to work more closely together. And, it will further enable our staff to work together to best meet the needs of the people they support.

Across Hampshire and Isle of Wight, community, mental health and learning disability services are provided by several organisations working closely together.

These organisations are: Solent NHS Trust, Southern Health NHS Foundation Trust, Isle of Wight NHS Trust and Sussex Partnership NHS Foundation Trust (as well as a range of other NHS, local authority and voluntary and independent sector organisations).

Making sure that people in our communities have equal access to these services and experience the same outcomes is our top priority.

We know that over the coming years, the demand for these services will increase.

Our physical and mental health services are already responding to increasing demand, both in terms of the number of people being referred for care and the complexity of issues they present with.

Against this backdrop, continuing to improve and transform our services - as well as having an even greater focus on integration between mental and physical health to support people in our communities to live healthier, longer lives - is vitally important.

In January 2022, Hampshire and Isle of Wight Integrated Care System commissioned an independent review of community, mental health and learning disability services. The review sought to provide an overview of current and future needs of our local populations.

It was the first step in understanding the strengths and weaknesses of existing services, identifying any gaps and areas for improvement.

The review looked carefully at the evidence and involved a range of clinicians, partners and stakeholders, as well as existing insight and feedback from people who use these local services.

Findings

Findings from the review confirmed inequity and variations in services and outcomes, revealing a compelling case for change across Hampshire and Isle of Wight to ensure future provision meets the needs of our population.

A full copy of the review, including all the recommendations, is available here. 

Recommendations

The review resulted in five key recommendations:

  1. A new Trust should be created for all community, mental health and learning disability services across Hampshire and Isle of Wight, with local divisions to focus on our communities. All existing providers are being engaged and are coordinating this work with the ICB, and identifying a roadmap on developing this work further, the risks and mitigations required.
  2. A review of community physical health beds should be undertaken, in a partnership between community, acute and primary care providers and local authorities. This is required to ensure the highest possible levels of patient safety, quality and experience are in place and that patients are receiving care in the most appropriate setting for their needs.
  3. Develop a systemwide clinical strategy for community, mental health and learning disability services that focuses on prevention, early intervention and patient centred care. This will be led by our community and mental health providers, with input from service users and key system partners - such as primary care and local authorities.
  4. A clear, system-wide strategy for place and local leadership is needed. This will help to identify local integration across health and care, and wider determinants such as education.
  5. Establishing a more strategic approach to the funding for community and mental health services to address the current inequities. The approach should acknowledge financial complexities to date and reflect on the overall system performance in communities that have historically had higher levels of investment in community and mental health services, considering how the overall health spend available can be better utilised.

One of the review’s key recommendations is that a new organisation be formed, to bring together all NHS community, mental health and learning disability services provided in Hampshire and the Isle of Wight - including services provided by Solent NHS Trust, Southern Health NHS Foundation Trust, Isle of Wight NHS Trust and Sussex Partnership NHS Foundation Trust.

The review makes the case that bringing together our services in this way would improve consistency of care (between these services and between the organisations which are currently responsible for different parts of the care pathway).

It would also improve equity of access to care.

We believe that working even closer together is the right approach to take for the benefit of our patients, their families and communities.

The rationale for the recommendation builds upon the steps we have already taken to work in partnership. It will further enable our staff to work more closely together to best meet the needs of the people they support.

Please note - local services will continue to be delivered close to home - the recommendation is about improving the way services work together.

The review was just the beginning of a detailed programme of work.

As we move forward, your views are crucial and we will engage with people in our communities, patients, colleagues (working in local community and mental health services) and our partners.

Your views will contribute to the development of a 'strategic outline case' which will describe in more detail the recommendation to create a new organisation - alongside other potential options that the review considered.

The draft 'strategic outline case' will be presented to each provider organisation’s Board with a preferred option on how best we can work together, once developed.

A 'business case' will then be created and submitted to each provider organisation’s Board and the Integrated Care Board before being submitted to NHS England for consideration.

A full timeline is being developed and will be shared, once available.

We will be sharing more information here as the plans develop - and we will be carrying out an extensive engagement programme.

Throughout, we will work together with people who use our services, their families, our partners and people working in health and care across Hampshire and Isle of Wight.  It is these groups that have the knowledge, experience and expertise to help us determine how we take the next steps and your views are vital.

If you would like to get involved, or have any questions or concerns, please contact us at people.participation@southernhealth.nhs.uk 

What are the timescales and key milestones?
Our ambition is to create a new organisation by April 2024.

The creation of a new organisation will be a starting point from which we will continue to develop our services – it won't all be done by day one.

We are working with service users, Healthwatch, and the local authority to help develop our priorities. 

There are some key decision points along the way, including development of a Strategic Outline Case and then a Full Business Case, which will both be considered by our Boards, the Integrated Care Board and NHS England.

Is this about cost savings?
This is about providing better outcomes and more equitable services. There may be opportunities to do things more efficiently as one organisation and managing the cost is important, but this is not the driving reason behind this work. 

How will this impact staff?
We expect that these changes will not directly impact the vast majority of staff.

With the national workforce challenges, we need more, not fewer, frontline staff and creating a single organisation will not change this.

It is completely natural for changes like this to bring feelings of uncertainty and we will work with staff to bring as much clarity as possible and to involve people in this process.

How can I stay up to date on all the developments?
Please keep eye on our website and social media channels. We will be sharing information about how you can hear more and get involved.

How are clinicians being involved?
A clinical delivery group has been set up as one of the workstream steering groups, led by senior clinicians from all the organisations involved. This brings together operational and clinical executives from across Solent NHS Trust, Southern Health NHS Foundation Trust, Isle of Wight NHS Trust and Sussex Partnership NHS Foundation Trust. The group will support clinical strategic transformation to improve consistency of care and equity of access.

How are patients, carers and families being involved?
The review was just the beginning of a detailed programme of work and we are now undertaking an  extensive engagement with our communities, colleagues working in local community and mental health services and partners. 

Involving our patients, carers and families in this process is important and we are developing a detailed engagement plan to ensure we do this effectively.

Conversations have already started with our local patient and carer groups and with our community partners. We will continue to build upon this work in the coming months.

How can you be sure to capture the good things about each of the Trusts, so it's not lost?
We are already talking about the great work that happens within all the organisations and thinking about what learning we can take from one another.

We have set up a working group that will specifically work to ensure that we capture and bring forward what's best about each Trust and build upon this as we work more closely together.

Will the organisation still be focussed on working with local communities and places?
Absolutely. Local care is central to patient outcomes and this will not change if we become a single organisation.

How are you learning from other acquisitions and mergers that have happened before?
Many colleagues in our organisations will have memories of previous organisational integrations. It is very important that we learn from these lived experiences, as well as taking the positives, and it is integral for us to learn from other changes that have happened in the wider NHS.

As a patient, what will be different on ‘day one’?
On day one, you will continue to receive the same services from the same teams.  The only difference you should notice when we merge is our new name.

As a newly merged organisation, we will have opportunities to improve access to our existing services.

Will you be reducing the number of buildings you provide services from?
Making the best use of our estate is a key NHS priority and something we are already looking at. This work will continue if we become a single organisation.

Any estates changes will be led by the clinical needs of the organisation and enable our staff to work in the best way.

I've heard that a review of community hospital beds is happening, is this the case?
One of the recommendations in the independent review, which was undertaken to explore these proposals, was to review the use of community beds across Hampshire and the Isle of Wight.

This will be explored further as part of the next phases of the programme, working in partnership with colleagues from the Integrated Care Board and local acute partners.

How is all this work being paid for?
We are working across our organisations and with our colleagues in the Integrated Care Board to ensure there is enough resource to carry out this programme.

Will there be more investment in community, mental health and learning disability services as a result of this?
One of the recommendations from the Community and Mental Health Services Review is to establish a more strategic approach to the funding of community, mental health and learning disability services to address current inequalities.

We will be working with our Integrated Care Board colleagues to take this recommendation forwards.

How will you maintain safe, high quality care during this process?
During the process, services will continue as normal. There is a dedicated programme to manage the changes in a way which minimises the impact on day to day services.

Is this a merger or an acquisition?
We will be carrying out this work as a coming together of equal partners, taking what's best from all organisations and building upon this. No one organisation will be leading this work.

Technically and practically, when organisations come together like this, it can be done as a merger or by having the underlying framework of one organisation remaining in place and the other organisations' services joining onto this. This second option is much more practical, cost effective, and can be done more swiftly. When there is a Foundation Trust involved, the coming together of organisations is transacted as an acquisition by the Foundation Trust.   

Whatever the technical approach of the transaction, we will be working with staff, patients, and stakeholders to develop a brand-new organisation, with a new identity, culture, name, and structure.

Will the merger impact on how my data is shared?
Any newly merged organisation would be legally responsible for all data and if merged would develop one clinical information system The same standards of confidentiality and security that apply to all NHS organisations will remain in place. As now, your information will only be accessed by those who need to provide you with care, and in very limited circumstances, others with a specific legitimate and lawful need.

What does this mean for Child and Adolescent Mental Health Services (CAMHS) in Hampshire?
The service will continue to be available and delivered as usual.

Sussex Partnership, who delivers CAMHS in Hampshire, is in conversation with the service commissioners to ensure that any future changes focus on improving access to services and supporting clinical care, in line with the independent report's recommendations.

 

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