Tessa Denham / , Mental Health

Joint commissioning as a developing approach across health and social care aims to provide services in an all round multi agency way. Mental health service providers are working together with colleagues in the NHS, local authorities, other charities, the youth service, the criminal justice system and so on. Under this approach providers are finding themselves collaborating in new ways and with new partners.

Collaborative working will need strong local connectedness and leadership. Working with partner organisations may be attractive to funders who see the added value of two or more effective organisations working together. Working in this way may lead to strengthened delivery however it could also lead to mission drift where the compatibility of organisations’ objectives is not similar enough. Working in a multi agency way may lead to the need to address issues around different of organisational cultures.

Organisations might consider reviewing their charitable objectives to ensure they are up to date and reflect their mission in the current operating environment. What are essential strengths they would bring to collaboration and what are the costs. It may also be to think about what your organisation may benefit from in a partner. An analysis of potential partners that could strengthen your work may be a useful exercise, as might a series of informal introductory conversations. Might your organisation consider what risks and benefits there are in collaborative working?

Within mental health ‘personalisation’ is used in relation to people with mental health needs having choice and control over their care. Support and resources are provided by the local authority and other funding streams such as Independent Living Fund and Access to Work through personal budgets. Personalisation is linked to individual budgets and direct payments.

Personalisation is a new initiative in the field of mental health that recognises the important contribution of social factors in mental wellbeing. It can support a user-centred idea of an individual’s mental health as part of a life long journey, incorporating all other aspects of a life that also includes the experience of short or long term needs for mental health support.

With consideration being given to individuals managing their own care it is part of a growing anti-stigma movement. It is also likely to contribute to the emergent shift in public attitudes to people with experience of mental health.

The increase in individual choice that personalisation brings is likely to impact on the nature of service provision particularly day services as people may chose to opt in / out of traditional services. A significantly broadened range of providers may develop.

Personalisation is likely to impact on how staff work with individuals. Staff will need to support people to design and purchase the best personalised support for themselves from the public, private or voluntary sectors.

Where organisations want to provide services to individual purchasers they will need to understand the issues around individual control and flexibility. They are likely to need to be aware of the types of support people are likely to choose. Working in partnership with a range of other providers to present a broad choice is likely to be important. Personalisation may provide opportunities to improve work with individuals from BME communities as emphasis on outreach work may increase.

It appears likely that organisations will need to devise innovative ways of ensuring the voice and experience of users are heard within the development of Personalisation. The demand for outreach work into marginalised communities or isolated individuals might increase. It is probable that people will need support to assess their own needs and present them to care coordinators. Expertise in supporting people to accurately represent their needs, especially when they may fluctuate, will be vital.

Alongside responding to personalisation organisations might want to consider how they influence the continued provision of directly provided services for those who want or need them.

• Is your organisation ready to respond?

• What opportunities might there be?

• What challenges might there be?

• How might an increase in personalised services impact on the services your organisation currently provides, its funding, and / or the staff?

Localism and ‘small government’ are terms we are increasingly hearing. With the forthcoming general election and consequent uncertainly of the nature of the next government it is hard to foresee where the localism agenda will go. Nevertheless localism is likely to accelerate.

Mental health organisations with strong histories in service user involvement and those rooted in their communities may be well placed to develop their local engagement and work with local planners. The opportunities for people with experience of mental distress to be involved in needs assessment and planning are likely to increase. Working with individuals to respond to these opportunities will be increasingly important.

What other issues in relation to perhaps funders, local people or the composition of your governing board does your organisation need to consider: such as the impact on your local accountability and transparency; your relationship with the local media and other community organisations; and developing the local knowledge base of your trustees?

The likely reduction in public service funding may have a significant impact on voluntary sector mental health service providers. Funding streams may change, be trimmed or dry up completely. Maintaining both the range and quality of services may be challenging should funders and commissioners come under pressure from shrinking funding pots.

This may lead to a disproportionate impact on organisations where a significant proportion of income comes from public funds. The need to ensure organisations are able to demonstrate value for money and evidence of impact is likely to increase. The potential increase in pressure to meet funder priorities may lead to a tendency to reduce focus on service user concerns.

The importance of local influence and negotiating skills is likely to be heightened in the potential increased competition for limited funds.

Organisations might consider reviewing areas such as the number of funding sources and the diversity of funders, data collection systems, the make up of your governance board, and user involvement.

• Do you have only one or a small number of contracts? If you do, how might you survive if that source of funding is reduced or dries up?
• Are your organisation’s IT systems up to the level of data collection and analysis that demonstrating value to stakeholders requires?
• Is it time for trustees to review the skills mix needed in the current climate?
• Are you confident you can work with users to design services and bid for tenders using business like skills from within your value base?

Procurement is the specific activity, within commissioning, of buying services from a third party supplier under a legally binding contract. One element of the National Mental Health Development Unit’s focus in 2009 is to support the improvement of procurement practice within World Class Commissioning.

Procurement may become a more important part of the commissioning cycle if public spending levels fall. The balance between added value and best price within commissioning may shift towards best price. Demonstrating value for money is likely to become increasingly important.

The place of procurement within the commissioning cycle - needs assessment / gap analysis, development of strategy, purchasing and procurement of services (often via tendering), setting up and managing contracts with providers, and service review and evaluation - needs to be fully understood by mental health service providers in order to ensure full cost recovery is achieved to the extent possible and to avoid the pitfalls of under or over pricing.

Local commissioning strategies, how decisions are made and how service contracts are awarded needs to be fully understood by all stakeholders, particularly trustees. Participating in local needs assessment and planning opportunities and ensuring service user voices are heard as part of strategy development seems to be becoming increasingly important.

Organisations may need to review their tender bid writing skills including financial budgeting and consider how to minimise overhead costs for example by sharing back office costs and / or partnership working.

For further information see:

• NHS institute for innovation and improvement World class commissioning website

• Department of Health World Class Commissioning website

• National Mental Health Development Unit (previously NIMHE)

• The Compact is all about better partnership working and creating better outcomes for individuals and local communities. Examples of Local Compacts