Centre for Mental Health

Re-commissioning in Eastern Surrey

About Time draws on our experiences in a number of areas, but in particular the re-commissioning process in Eastern Surrey two years ago.

Prior to the re-commissioning process, day and vocational services had mainly been provided by the local NHS Trust, and were purchased as part of a much larger service level agreement which covered all the mental health services (i.e. acute in-patient services, community mental health teams, vocational services). The agreement was with two Primary Care Trusts.

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"The main emphasis of the NHS trust services was on providing meaningful, but segregated, occupation and social support. There was very little opportunity for service users to move on from them. ... Commissioners had been looking to modernise these services, with a particular focus on providing more one-to-one support to enable service users to gain and sustain mainstream employment."

Extract from Case Study A, About Time

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The re-commissioning process:

• Took over two years
• Included the transfer of some NHS staff to the voluntary sector organisations that were delivering the new services
• Saw two social firms move to independence from the NHS to establishment of themselves as limited companies - Travel Matters Ltd and Netherne Printing Ltd
• Involved some service closures over time alongside the development of new ones.

The effects of change

"...a great leap forward has taken place, most particularly in the culture that underpins services, and this is most welcome". (from the evaluation)

Sainsbury Centre commissioned consultants to assess the impact of the change process in Eastern Surrey. They identified key achievements and made recommendations for further development to the services in Surrey. Their findings revealed that, despite the complexities and the time involved, taking a whole-systems approach and involving service users as equals in the commissioning process resulted in improved outcomes, a change in culture and the realisation of services with a focus on community involvement and participation.

In Eastern Surrey, all providers of day and vocational services are now from the voluntary, community or social enterprise sectors and work closely with both the mental health clinical teams and community organisations to provide pathways of support for individuals. All providers have a clearly defined contract through one joint commissioning arrangement between the PCT and the local Authority. For each contract, there is a detailed service specification drawn up in line with the needs and aspirations of the local population and evidence-based practice. Providers are now clearly accountable for service delivery and outcome monitoring.

What does change feel like?

Service users' comments collected during the evaluation of services in Eastern Surrey:

Work experience - 'I am doing work experience at a social firm and a computer course too which I feel is really getting me into the swing of work.'

Getting the support - 'I have tried to work before but I was not getting the support that I needed and I lost lots of jobs. If I had known my employment advisor in the past, I am sure that I could have got a job sooner and kept it too.'

Non-judgemental - 'One of the best things about my employment advisor is that I feel she is not judging me. Setting short term goals and targets really helps me to think that the long term target of getting a job is possible one day.'

At work support - 'Help and support at work is vital - little problems can so easily get out of hand and if they are not sorted out they can grow out of all proportion.'

Individual goals - 'I was a nurse but became ill through stress. I am working with my community connections advisor and I now do creative activities... This was always an interest of mine but I never explored it before. I can see that in the future I will get another job but in a different field, connected to my creativity.'

For more about how the change feels, read Carole Millard's personal view of the re-commissioning process.

Key achievements of the re-commissioning process

• Services offer greater choice and diversity of activities
• Both providers and service users are focused more on skills and abilities rather than mental ill health
• Services are more tightly monitored and are focused on positive outcomes for service users
• A foundation has been laid for future facilitation of social inclusion and recovery
• People have increased their aspirations, particularly in relation to employment as a realistic and desired goal

Key recommendations for commissioners and providers

• Develop more opportunities to promote and support service user involvement in leading, running, monitoring and evaluating services.
• Place more emphasis on service users having the opportunity and support to join in mainstream activities.
• Base activities in local communities and ensure greater provision closer to people's local communities.
• Develop one referral form that ensures a seamless pathway between providers/services and opens up a 'passport'-type system.
• Encourage service providers to work together to establish a framework for 'easy-access' services.
• Consider the needs of women as service users and the local black and minority ethnic communities and develop appropriate responses to those needs.
• Find ways to ensure that service users know about opportunities/activities that are on offer.
• Develop ways to give information in an easy to understand format.

See case studies A and B in Appendix 2 of About Time for more details of the process in Eastern Surrey.