Change in Mind � Update on Implementation by dEiSQrA


                                                  Paper No      J

                 Manchester PCT Board Meeting – 7 February 2007

Report of:                             Director of Commissioning

Paper prepared by:                     Chris O’Gorman (Head of Joint Mental
                                       Health Commissioning) and Sarah
                                       Cantwell (Project Manager)

Signed off by:                         Sara Radcliffe

Date of paper:                         3 January 2007

Subject:                               Change in Mind

Background papers and links to         Chief Executive’s report to the Board,
priorities/objectives                  January 2007

Implications for Access and            Change in Mind will effect an increase
Inclusion                              in access to specialist mental health
                                       services in Manchester for all adults; it
                                       will contribute to advancing social
                                       inclusion amongst mental health
                                       service users.

Purpose of the paper:                  To advise the Board of progress in
                                       implementing changes in Manchester’s
                                       mental health services

Action/Decision required: To note the contents of the report

                    Report of the Director of Commissioning

A.   Change in Mind - background

1.   Change in Mind is the name given to a modernisation programme for Manchester’s
     specialist mental health services for all adults. Change in Mind primarily aims to

        Full implementation of the key elements of the National Service Framework (NSF)
         for Mental Health (1999) and the NSF for Older People (2001) for people with
         serious mental health problems, thus addressing a long-standing failure to meet
         key NSF targets

        Reduction in demand for inpatient beds, especially for adults aged 16-64 where
         bed pressures are especially acute

        An innovative approach to managing emergency mental health needs across the
         city by the creation of a ‘psychiatric emergency assessment, referral and liaison’
         service (PEARL)

        A greater emphasis on recovery and social inclusion within mental health services
         with the aim of reducing the number of people with mental health problems who
         are dislocated from mainstream society

2.   The origins of Change in Mind are in the multi-agency ‘visioning project’ undertaken
     in 2004 to identify what changes were required to Manchester’s specialist mental
     health services in order to improve access and reduce pressure. The visioning
     project ultimately led to the Change in Mind proposals that were publicly consulted
     upon during the late 2005 and early 2006. Following final decision making in July
     2006, the proposals have been subject to detailed implementation planning.

3.   Change in Mind is underpinned by additional investment of £3.9m from Manchester
     Primary Care Trust and Manchester City Council.            Programme management
     responsibility for commissioning Change in Mind rests with the two commissioning
     bodies working through the joint mental health commissioning team (JCT). Delivery
     responsibility rests with Manchester Mental Health and Social Care Trust and the
     organisation(s) that are successful in winning those services that have been put out
     to tender as part of the Change in Mind package. A programme board which is
     chaired by the Primary Care Trust’s Chief Executive, and whose Vice-chair is the
     Director of Adult Social Care, Manchester City Council, oversees the project as a

B.   Commissioning intentions

4.   The main services currently planned to be purchased from Manchester Mental Health
     and Social Care Trust are:

           10 community mental health teams for adults 16-64

            6 community mental health teams for adults 65+
            4 crisis resolution and home treatment teams
            PEARL

      These services will be formed by both service redesign and new investment.

5.    Services that are currently out to tender are:

            1 early intervention teams
            3 assertive outreach teams

      Assertive outreach services, depending on the outcome of the tender process, may
      also be established through a combination of redesign and new investment.

6.    Services which are currently still under review are the ‘social inclusion teams’ which
      were agreed under Change in Mind but require further work to identify how they might
      best be provided.

C.    Position in January 2007

7.    The Primary Care Trust and City Council and their provider partners have been
      working towards a go-live date for the services covered by Change in Mind of 1 April
      2007. It has been planned that the first new services will commence providing
      services to users from this date and that full implementation will have been
      completed, i.e., all services will be operating at their commissioned capacity, by June

8.    In relation to services that have been put out to tender, the commissioning timetable
      is being adhered to; shortlisting for assertive outreach and early intervention service
      providers has taken place and panel interviews will take place in February 2007.
      There will be a challenge for the provider(s) of these services to commence service
      provision on 1 April 2007.

9.    In relation to services that have been commissioned from Manchester Mental Health
      and Social Care Trust, there has been both progress and also difficulties.

10.   As required by its organisational change policy, the Care Trust completed over 90
      days of staff consultation in early January 2007, and has presented the outcomes of
      the consultation to its Board on 25 January 2007. Opposition to the implementation
      of Change in Mind has been strong from the health branch of Unison, which has
      balloted successfully for industrial action. A one-day stoppage by Unison members
      has been planned for 31 January 2007 and further stoppages have been indicated
      thereafter. The Care Trust remains, however, committed to implementation of
      Change in Mind and has implementation plans in place to commence service delivery
      from 1 April 2007.

11.   Project management processes and delivery around the implementation of Change in
      Mind by the Care Trust have, nevertheless, not always been optimal, and there have
      been delays in delivery of aspects of the Change in Mind programme, e.g., the
      production of draft service specifications in response to commissioners’ service
      mandates, and reported delays in the planned opening of the ‘mental health accident
      and emergency’ service, PEARL. This second point is of particular concern to all
      parties, as PEARL is in some respects the flagship element of the Change in Mind
      programme given that it is United Kingdom first in service terms.

12.   Perhaps of greater significant is the continuing financial challenge faced by
      Manchester Mental Health and Social Care Trust which is forecasting a deficit of £3m
      at year end despite over £3m of additional resources provided by commissioners.
      Whilst commissioners and the Care Trust continue to work together to resolve the
      deficit situation, the materialisation of a £3m deficit would be likely significantly to
      jeopardise the implementation of the Change in Mind programme.

13.   The importance of avoiding real difficulties in achieving full implementation is fully
      recognised by commissioners:

         Manchester’s mental health services have demonstrated serious shortcomings in
          relation to established national targets since the introduction of the NSFs; Change
          in Mind is essential to remedy these shortcomings

         Manchester people have experienced problematic access to mental health
          services, and have not had available to them the evidence-based services offered
          to residents of many other parts of the country; Change in Mind will help
          Manchester achieve parity with service levels elsewhere

         Health inequalities in mental health – whilst also requiring action from a wide
          range of partners – will nevertheless be concretely addressed through the
          Change in Mind programme (especially through early intervention services, the
          system-wide emphasis on social inclusion and recovery, and the modernisation of
          day services)

14.   Manchester Primary Care Trust and Manchester City Council will continue to maintain
      close monitoring of the implementation of Change in Mind to ensure that these goals
      are achieved.

D.    Recommendations:

15.   The Board is asked to note the contents of this report

Chris O’Gorman
Head of Joint Mental Health Commissioning
Manchester PCT/City Council

Sarah Cantwell
Project Manager
Joint Commissioning Team
Manchester PCT/City Council

24 January 2007


To top