COMMERCIAL: A controversial procurement of mental health services for young people could have ‘catastrophic’ consequences for related services and the people who rely on them, according to an independent impact assessment.

The document, which has been leaked to HSJ, identified a string of concerns and risks that have arisen as a result of efforts to establish a new mental health service for young people in Birmingham.

It recommended the new service go live at least six months later than planned – this would be on top of delays of six months which have already been confirmed.

And, the impact assessment says commissioners should find “bridging funding” of at least £1.5m to enable the transition of some adult services to occur safely.

The document was commissioned by Birmingham South Central Clinical Commissioning Group, and was produced last month. It assesses the effects of transferring mental health services for young adults into a new combined service for people aged 0-25. Its findings are detailed at length below.

Adult mental health services in the city are provided by Birmingham and Solihull Mental Health Foundation Trust, but the 0-25 service will be provided by Forward Thinking Birmingham, a consortium led by Birmingham Children’s Hospital FT, which has long provided local child and adolescent mental health services.

The contract has an annual value of £23.7m per year for five years, and will result in the mental health trust losing £14.2m a year through the transfer.

The new service was procured via a competitive tender by Birmingham South Central CCG on behalf of Birmingham’s three CCGs.

After the impact assessment was finalised, Peter Lewis, medical director and Sue Hartley, nursing director at the mental health trust wrote to Birmingham’s CCGs appealing for the implementation timescales to be relaxed.

The letter said there was a “range of unmitigated issues” associated with the transfer of services, and a “lack of engagement and communication with patients and carers”, which had caused their concerns over the contract to escalate. They said: “We believe that it is unsafe for you to continue with the transfer of any services” until commissioners produce a firm mitigation plan.

CCGs have not responded either the letter, dated 25 September, or the impact assessment, dated 17 September. A spokeswoman for the CCGs said they have not yet had time to consider either.

Discussions around bridging funding are understood to be ongoing.

A spokeswoman for Birmingham and Solihull FT said the trust agrees with the findings of the impact assessment.

Forward Thinking Birmingham would not comment on the impact assessment as, it said, it had not been shared with them, however a spokeswoman said full implementation was still planned for April.

The impact assessment found:

  • The complexity of transferring services for young adults from the mental health trust to the new consortium would likely lead to a “loss of focus” on the most vulnerable adults over 25. This could result in very serious harm or loss of life, and was rated as “likely to happen” with “catastrophic” consequences. Even if these risks were mitigated by identifying the people most in need of close attention and carefully planning their care for the coming months, there remains a residual risk around new service uses not currently known to the mental health trust.
  • There was a likelihood of increased staff turnover and vacancies as Birmingham and Solihull Mental Health FT, and an accompanying issue around staff morale.
  • A range of other risks relating to the need for the mental health trust to reconfigure itself to accommodate the loss of services and revenue.
  • Mitigating the risks will require additional capacity, and this will require “bridging funding” of at least £1.5m, which commissioners should pay for.
  • Birmingham and Solihull Mental Health FT will be left with “overhanging costs” of around £2m which cannot be easily eliminated because they mainly relate to estates.
  • Implementation of the new service should be delayed beyond the current April 2016 go live date. “The volume of patients whose care is to be transferred, if this is to be managed safely, is such that a single date cannot sensibly be considered as the transfer date.” New services will need to be established, and gradually take on the transferred caseload. This process should begin on 1 April next year and take at least six months.
  • The new service creates “confusion as to who is actually responsible for care” for some patient groups, such as those requiring early intervention in psychosis.