I recently had the privilege and good fortune to spend some time with some very forward thinking Chief Executives of Mental Health Trusts. It was an enlightening experience - not just for the discussion itself but for the opportunity to reflect beforehand on Mental Health and commissioning.
We all know GPs see a lot of patients with mental health problems - some are well known to us, others are new presentations, and undoubtedly some clues are missed with the focus of treatment being placed elsewhere.
When we train as doctors, the priority is physical illness. Hospitals are full of patients who are unwell, who have physical signs, and who fit comfortably with our expectations as doctors. Comparatively little time is given to education for mental health. The temptation is to allow commissioning to focus on the same areas, to monitor easily measurable outcomes, and to concentrate efforts on Acute Trusts.
Why? Because we are most comfortable with these areas. We understand them, they often fit pathways, and there may be a clearer distinction between primary care and specialist input. They are 'manager-friendly'. Diabetes? - lots of measurables. Clear targets. Stroke? - time limits for care, clear FAST guidance for patients and national standards for pathways. Depression? - difficult, multi-factorial, still a stigma for many patients. Addiction? - historically often associated with blame and service variation.
Contracts are a key factor. The lack of meaningful PBR for mental health, and a need to manage risk and QIPP, increases the tendency to look elsewhere. We may not significantly overspend this year on mental health, but can we increase quality, recognise need and explore new ways of working together to promote health? I was extremely encouraged by the Chief Executives I met. They worked together, shared ideas and there was a genuine sense of partnership to improve services. Some had actively worked in acute wards jointly with physicians, others had engaged in partnerships with community services or social housing schemes. I'm sure similar work is happening nationally.
Mental and physical health are not inseparable. The opportunities for joint working are clear, the potential benefits obvious. This will be a key test for CCGs. We talk a great deal about integrated care. Mental Health is an ideal area around which to develop integrated services. Alcohol and dementia services are key challenges for us, and a priority must be to develop services, with local authorities, that deal with the needs of patients rather than organisations.
The planning round is underway. QIPP is important, but Quality comes first.