Mental Health Provider Market Development Review - Delphi Exercise Stage II

Dear Colleague,
 
As you will hopefully be aware Mental Health Strategies (MHS) has been commissioned by the Department of Health and NHS Confederation to conduct a review of the NHS funded mental health provider market. This commission sits within a wider contract the Mental Health Network is delivering for the Department of Health.
 
The review is comprised of three core elements:
  1. Clear and comprehensive analysis of the current provider landscape of NHS-funded mental health provision
  2. Assessment of the opportunities, challenges and barriers to further market development
  3. Indication of future trends in market development and their implications for policy development
For the purposes of the review Mental Health Strategies are keen to get the views of key stakeholders within mental health services on current challenges, barriers and trends in the NHS funded mental health market. We are doing this through a Delphi Exercise. Within a Delphi exercise the topic(s) under discussion are circulated (in a series of stages) to interested stakeholders who comment on it and modify the opinion(s) reached at each stage until some degree of mutual agreement is reached. There are three stages to the Delphi exercise.
 
Thank you for participating in stage one of the Delphi exercise. We are now contacting you to request your input into stage two of the Delphi exercise. Stage two of the Delphi exercise is being undertaken using an online e-survey.
 
The survey provides a summary of the key themes and findings for each of the questions that were asked in stage one of the Delphi exercise. Please read the summary and comment in the text box provided below each question. When providing your response please highlight the following:
  • Any  points / themes that they agree with and why?
  • Any points / themes that they disagree with and why?
  • Develop, challenge and amend themes that have been summarised?
  • Offer new views / opinions that have not been detailed in the summary (including differences by market segment and type of provider)?
Please note the views presented are a summary of the responses obtained from stage one of the Delphi exercise. They do not represent the views of Mental Health Strategies, the Department of Health or the NHS Confederation.
 
Please complete and return stage two of the Delphi exercise by 5:00 pm on Friday 2nd December 2011. The information that you provide will be treated confidentially and used solely for the purposes of the project. The information will not be shared with any third parties. For any queries or guidance on completing the exercise please contact Peter O’Neill, the project lead for Mental Health Strategies, on tel: 0161 785 1001 or e-mail: peter.o’neill@mentalhealthstrategies.co.uk 
 
For the review the mental health market has been divided into the market segments detailed below. We are aware that this is not a perfect segmentation of the market and that there may be some overlap between services. However, we think this fits with the way in which the mental health market tends to be organised and provides an appropriate balance of detail and aggregation for undertaking the analysis. Please consider these market segments when providing your answers to the questions in the exercise.
 
Market Segmentation

1

Services for adults with common mental health problems (including depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, post‑traumatic stress disorder and social anxiety disorder )

 

2a

Services for adults with serious and enduring mental health problems

(psychoses (including schizophrenia), bipolar affective disorder and personality disorders)

Inpatient services

2b

Community services

3a

Forensic and secure services for adults (including PICU – but excluding high secure services and learning disability services)

Inpatient services

3b

Community services

4a

Services for organic mental health problems (dementias)

Inpatient services

4b

Community services

5a

Addiction services for adults

Inpatient services

5b

Community services

6a

Eating disorder services for adults

Inpatient services

6b

Community services

7a

Child and adolescent mental health services (including specialist services e.g. CAMHS eating disorder services)

Inpatient services

7b

Community services

 

In addition to core services (e.g. CMHTs) community services  include NHS funded mental health day care, employment support and other NHS funded recovery focussed initiatives.

In this framework inpatient services include NHS funded mental health residential care.

Page 1

 

About you *

*
 

Is the principal function of your organisation commissioning or providing mental health services?

 

If you are a provider of mental health services, please specify the type of organisation?

 
1)    In overall terms what do you think are the key factors that determine the range of services offered by mental health providers?

Delphi Stage One - Summary
 
Respondents to the Delphi exercise highlighted a wide variety of different factors that determine the range of services offered by mental health providers.  Although a range of different factors were highlighted – key factors were identified. These are documented below (not ranked in any particular order):

  • Historical Arrangements
Historical arrangements were identified as a key factor in determining the range of services offered by mental health providers. A number of respondents suggested that current mental health services remain largely determined by historical patterns of provision and previous investment decisions – tied closely to long-standing block contracts. Reorganisations of the NHS were reported to have resulted in different models of service provision – but all still under the structure of geographically based specialist mental health trusts.

  • National Policy and Local Mental Health Strategies
National policy in mental health, both past and present, was identified as a key factor in determining the range of services offered by mental health providers. The National Service Framework (NSF) for Mental Health (1999) was said to have led to the development of a range of services (CMHTs, CRHTs, AOTs, etc....) that are a cornerstone of provision to this day. More recently the national IAPT programme was identified as contributing significantly to the development of psychological therapy services and the promotion of early intervention in mental illness. It was suggested that current policy initiatives (e.g. any qualified provider and mental health PbR) should be a stimulus for further development of the mental health provider market – but with variation of opinion on if (and how) this will be achieved.
  • The Current Economic Climate – Price and Value for Money
The current financial pressures in health and social care were identified as a key driver for current decisions on mental health service provision. The need for of cost-improvement and QIPP efficiency savings was said to be leading to an increased focus on price within mental health services – but potentially at the detriment of service quality.

  • Mental Health Provider Market
The mental health market, both historically and currently, was felt to be a provider driven sector. A number of respondents felt the mental health market is dominated by ‘powerful’ NHS trusts, with the range of services provided often determined by the clinical expertise of the NHS trust and key clinical staff. Within this provider-commissioner divide, commissioners are reported to be struggling to exert power in a number of areas of the country. Although mental health commissioning was reported to have improved in recent years – it was suggested that NHS trusts remain dominant in leading the development of the mental health market. Some respondents felt that the movement to clinical commissioning groups (CCGs) will strengthen mental health commissioning in the future.

  • Local Need and Demand
The above highlights the key factors that the range of services offered by mental health providers is reported to be determined by. Respondents highlighted three key factors that should determine the range of services provided:
  • Local need and demand – informed by a detailed and robust joint strategic needs assessment
  • Service user views and needs
  • The development of Evidence-based services and interventions
Whilst the three above factors were reported to play a role in determining mental health service provision – respondents were clear that these three factors should be central to determining decisions on the range and type of mental health services provided.

1) Please comment on the above summary and key themes in the box below – highlighting:
  • Any points / themes that you agree with and why?
  • Any points / themes that you disagree with and why?
  • Develop, challenge and amend themes that have been summarised?
  • Offer new views / opinions that have not been detailed in the summary?