Shropshire and Staffordshiren

Published: 11/11/2004, Volume II4, No. 5931 Page 14 15

If mental health is a Cinderella service then There is no sign of the clock striking midnight at Shropshire and Staffordshire strategic health authority.

All three trusts providing mental health services in the SHA area - South Staffordshire Healthcare, North Staffordshire Combined Healthcare and Shropshire County primary care trust - received a three star-rating in July.

And if their fairy godmother grants their wish, the two Staffordshire trusts will be among the first mental health trusts in the country to achieve foundation status in April 2006.

South Staffordshire trust chief executive Mike Cooke says aiming for foundation status would give trusts a new impetus and 'crank up standards' of mental health services nationally.

'That might give us a chance to assert our views as an important sector of the NHS. About 40 per cent of what is in front of GPs has some form of mental health element. About one in four people during their lifetime will have some quite debilitating mental health condition. So It is not a small business - what we need to do is normalise it and modernise it, ' says Mr Cooke.

The national service framework for mental health 'created a lot of energy' for services, according to Mr Cooke, whose trust is moving from one reliant on beds and inpatient settings to one that focuses more on community-orientated options for patients and offers more choice.

As part of this, South Staffordshire established an early intervention service two years ago, an achievement Mr Cooke sites as his proudest.

'If you can identify somebody who has a psychosis at 15, 16 or 17, their life chances are very much more improved than if you identify it when they are 19, 20 or older, ' says Mr Cooke, whose trust also has responsibility for learning disabilities and children's services.

'Some of the best professionals I have are working in these sort of areas to try to identify, screen people and make sure they put in quite intensive work with that group at an early stage. They are the type of people who would have filled our institutions in the past.'

Mr Cooke says the board of the SHA has shown strong leadership when it came to tackling mental health services.

'It is a team effort, but it does need recognition that these services are important and [SHA chief executive Professor] Bernard Crump, by his leadership, has helped us move forward.'

Aside from the glowing mental health section of the SHA's CV, the performance across the rest ofthe sector is facing some difficult issues.

Seven out of ten PCTs dropped a star in the 2004 ratings with two - East Staffordshire and Shropshire County - going from a three to a two-star rating.

Meanwhile, a monumental error in transferring patient details to a new information system at Mid Staffordshire General Hospitals trust appeared to play a part in Cannock Chase and South Western Staffordshire PCTs falling from two to one star.

Consequently, the acute trust received a 'significant underachievement' in its management of inpatient and outpatient waits and had the ignominy of slumping from three to zero stars.

Professor Crump explains the problem only related to the first six to eight weeks of the year and that in the final three-quarters there were no more breaches.

'I am certainly expecting a significant improvement in their star-rating this year, ' he adds.

Other parts of the health community are facing interesting times.Royal Shrewsbury Hospitals and single-star Princess Royal Hospitals trusts merged in October 2003. The new Shrewsbury and Telford Hospitals trust was awarded three stars in the 2004 ratings.

Last month, chief executive Neil Taylor resigned.And last week the NHS Counter Fraud Service launched an investigation into fraud allegations concerning an unnamed individual at the trust.

Now trust medical director Andrew Prichard has been appointed acting chief executive.

He is unable to comment on either the fraud case or the resignation of his predecessor. But he admits that the trust already had challenges on its hands.

Mr Prichard admits it had huge problems convincing the communities of Telford and Shrewsbury that the merger was a wise move.

'There was a lack of trust between the two health communities in and around the two towns and there was different party politics in different parts of the county, ' says Mr Prichard.

'People were fighting, in effect, for their hospital rather than the bigger picture, which was to plan for services on a county-wide basis, based on what the patient needed, ' he adds.

Now the trust has set up a programme board to examine whether cutting duplication of services would help solve some of the trust's financial problems. It had a deficit of more than£3m following the merger, reduced to around£400,000 at the end of the financial year following planned brokerage.

Across the whole SHA, Professor Crump says accident and emergency targets - to deal with 98 per cent of patients within four hours by the end of this year - are looking challenging. He believes the target is looking 'quite close'. He also admits some 'risk' areas identified in trust budgets are 'becoming more prominent than anticipated'.

But he says the SHA is doing well on hitting key targets on waiting times and primary care access. He also expects medical recruitment in north Staffordshire to blossom after the opening of Keele University medical school last year.

When Shropshire and Staffordshire SHA came into being in April 2002, seven of its 10 PCTs were born on the same day. It meant supporting many people who were taking on their first chief executive role.

'The different parts of this SHA had not had to work particularly close together in the past - it was a whole culture shift, ' says Professor Crump.

'The biggest thing we have done is create a sense that there is a Shropshire and Staffordshire way of working together that, while it comes under pressure from time to time, is nonetheless a community of organisations and chief executives who are keen to work in a collective and co-ordinated way.'