Two mental health projects in the East Midlands are improving outcomes and cutting costs through better procurement practices.

The East Midlands Re:Source collaborative procurement hub is working with trusts to ensure money is being spent effectively to improve patient outcomes. It is estimated that the current two projects alone will save more than£1m.

Re:Source chief executive Ian Shepherd says: 'We are proud of how quickly our work is translating into improved patient outcomes and cost savings but this is just the tip of the iceberg for us. The NHS spends more than£1bn a year on goods and services across the East Midlands, and we'll be working with NHS trusts to see how that money can be spent more effectively to directly benefit patient outcomes.'

After its inception in 2006, Re:Source began to engage with primary care trusts and providers in mental health to understand how the commissioning system works and to help solve operational problems, in support of plans leading to strategic alignment.

One of the key priorities for PCTs is to continue to improve appropriate care placement to meet patients' care requirements. In many cases, patients no longer need to be in secure facilities but their daily living skills and confidence have deteriorated to such a degree that they are unable to return to the community.

Re:Source recognised that existing practices prevented patients from moving forward on their care pathway and that paying for expensive placements without systemic review would continue to increase the cost of care.

Together with commissioners and providers, Re:Source set about addressing the problems of high-cost placements by identifying a more appropriate care provision, designed to be better for the patient and less expensive for PCTs.

Life skills

The first project, a pilot with Cambian Healthcare, is working to make care placements more appropriate to meet patients' needs.

Cambian, a specialist provider of psychiatric rehabilitation services, is working with a number of PCTs in the East Midlands with a programme of therapy and care designed to rebuild the daily living skills and confidence of patients to enable them to return safely to the community.

The company has shown a 76 per cent success ratio for returning patients to lower-cost, locally based care.

Working together, Cambian and Re:Source identified long-stay patients in secure facilities who might be suitable for step-down psychiatric rehabilitation.

Patients were assessed by Cambian's multi-disciplinary teams, the results were reviewed with the PCTs and new care plans were put in place for suitable patients.

Twenty patients have now benefited and are receiving an intensive programme of rehabilitation with Cambian. Re:Source estimates that£49,000 is saved for each patient moved into Cambian's psychiatric rehabilitation programme. Costs fall even further after an average of 18 months when patients graduate and move into community-based treatment.

It is projected that the Cambian project will save the NHS in the East Midlands at least£500,000 this financial year.

'The NHS is restructuring to help PCT commissioning teams to identify and purchase the most appropriate care pathways for patients,' says Re:Source sourcing manager of purchased healthcare Chris Spark.

'This can be incredibly difficult for complex patients with enduring mental illness. Not all patients are the same, but we have worked closely with East Midlands PCTs to improve the process.'

Increased patient numbers also allow Cambian to plan more accurately for demand, and has led to the formation of a discount system that provides greater savings for PCTs as expenditure increases.

'It's a great example of how we can work in partnership with private providers,' says Mr Spark. 'It‘s not about taking 5-10 per cent out of the market, it's about looking at the total cost of patient outcomes and improving the quality of the services available.'

Improving procurement

The second project stemmed from commissioners working with the Re:Source team, who highlighted an opportunity to minimise annual rate increases from private care providers.

Re:Source invited the top 30 providers, equating to about£25m in spend, to renegotiate annual rate increases. A united front on behalf of all trusts has led to rate increases being minimised and is expected to save the NHS in the East Midlands up to£500,000 this year.

'It's about working together with our providers, market experts, commissioners and patients to find out exactly what their wants and needs are, to then specify patient outcomes, understand current and future demand and then ensure our providers have the capacity and capability to meet these requirements,' says Mr Shepherd. 'Clarity of purpose is the critical factor.'

A key aim for Mr Shepherd is to improve the perception of procurement within the NHS.

'When many people first hear about the procurement hub they think it is only about savings and cutting budgets, which just isn't the case,' he says.

'Procurement is about getting the best quality and value and not about securing the lowest price for an inferior product or service. Within purchased healthcare, we work closely with commissioners and providers with a collective focus on meeting patient needs, with better outcomes at a lower overall cost.'