Enabling innovation and improvement
Mental health trusts are working to innovate and to improve patient access, experience and outcomes. One way they have progressed is by working together for a number of years – principally via mental health, learning disability and autism provider collaboratives – to take on the devolved management of budgets and resources for specialist mental health services. This has enabled them to more effectively support those patients, who are often some of the most vulnerable and who have the most complex needs, closer to home. Trusts have successfully demonstrated the capability to transform services and patients’ access, experience and outcomes from them through this approach. There is a significant opportunity to harness and further capitalise on the sector's experience and track record of delivery in this area as NHS commissioning evolves in the months and years ahead.
To enable new research, treatments and services to be translated into care delivery, many mental health providers need enhanced capacity and processes dedicated to adopting new innovations. It is a real challenge for trusts and ICBs to deliver transformation while also delivering pressing operational priorities in the here and now. We have heard ICBs could play a helpful role in supporting providers to focus on and deliver improvement work related to the adoption of good clinical practice and new pathways, as opposed to financial challenges which is where improvement work is currently often focused. Relationships between universities and trusts have also been highlighted as key to supporting trusts to innovate rapidly.
A significant enabler to further innovation and improvement would be addressing the overly bureaucratic processes that trusts currently need to go through to be able to pilot new ideas. Trust leaders have also highlighted that further autonomy to manage their finances more flexibly, for example, to enable them to borrow money to develop modern facilities, would help to encourage innovation and development.
A systematic, long-term approach to quality improvement is needed more broadly, with providers adequately supported to deliver improvements through systematic data collection across key areas of concern, such as ADHD waiting lists and service utilisation. Robust digital infrastructure and an empowered workforce are further key enablers. Trusts that are better at delivering and adopting improvement embed improvement into their organisation's DNA. For example, they often have less hierarchical structures and ways of working, a greater commitment to staff and patient empowerment and involvement, and a greater emphasis on multidisciplinary working.
To enable innovation and improvement in mental health services, we need to:
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Support embedding a culture of improvement and building capacity and capability within mental health services, and maintain consistency and clarity at national level about the role of improvement in delivering more sustainable, high quality mental health services.
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Increase trust autonomy to manage their finances more flexibly and reduce the inappropriate bureaucracy linked to the piloting of new ideas.
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Harness the mental health sector's experience of improving services through the devolved management of budgets and resources to mental health collaboratives.
Case study
East London NHS Foundation Trust is supporting its teams to use quality improvement approaches to improve equity of access and treatment within their local areas. 30% of participating teams delivered improvements in outcomes, such as increasing referrals, access to services and appointment attendance for individuals from ethnic minorities, as well as increasing the number of people with serious mental illness receiving physical health checks.
Case study
Hampshire and Isle of Wight NHS Foundation Trust and Berkshire Healthcare NHS Foundation Trust are two trusts that are further advanced in using quality improvement methodologies to transform services and the value they deliver, with a strong commitment of involving staff, service users, carers and partners. Berkshire Healthcare NHS Foundation Trust has been able to demonstrate results in key areas such as reducing self-harm incidents, increasing physical health checks for people with severe mental illness, and reducing waits for a first appointment with children and adolescent mental health services.
Case study
The East Midlands Alliance for Mental Health Learning Disabilities and Autism was established in 2019 and brings together the largest providers of mental health, learning disability and autism services in the region. The Alliance was created to improve the quality and effectiveness of services in the region to improve patient experience and outcomes, through working together, sharing best practice and learning, as well as working to influence national policy. Trust leaders have highlighted the alliance has benefited significantly from being able to work together to decide how to most effectively use funding from the centre. One recent example of the alliance’s impact is the demonstrable improvements that have been made in individual’s access to assessments across the East Midlands.