Clinicians in Essex are worried about commissioners’ plans to send patients previously referred to secondary mental health professionals to a less specialised service, the chief executive of one of the trusts involved has told HSJ.

  • Clinicians raise concerns about use of IAPT services for patients previously referred to secondary mental health professionals
  • Trust leader says “cherry picking” of key contracts is threatening sustainability of mental health providers
  • Providers hope to decide on whether to merge or not in coming months

North Essex Partnership University Foundation Trust chief executive Andrew Geldard said “a number” of his clinicians had concerns about the “substitution of current secondary health services [for] increasing access to psychological therapies services”.

He said: “A number of my clinicians have got some concerns about that, but it’s probably too early to tell whether that experiment has worked or not.”

Mr Geldard added that “at one level IAPT are a really good way to get patients some good low level help”, but that some issues had been raised because the “whole IAPT movement was not [originally] about a substitution of current secondary health services”.

The IAPT service substitution was discussed earlier this month in a strategy paper about the FT’s potential merger with South Essex Partnership University FT.

What’s driving the merger talks?

Merger talks between the two Essex mental health trusts have been prompted by a “shrinking market”, the “cherry picking” of key contracts, and concerns that if the two trusts remain single entities, services in the county will become unsustainable, the providers’ chief executives have told HSJ.  

The North Essex Partnership University North Essex Partnership University Foundation Trust and South Essex Partnership University FT leaders said that in addition to shrinking funding settlements in recent years for the mental health sector, commissioners’ decisions to “cherry pick” out some services, such as IAPT, for individual tender exercises, were threatening the sustainability of providers.   

A bigger single organisation may be able to achieve economies of scale not possible at present, they told HSJ.

Analysis of the options open to the trusts concluded that merging with another organisation outside the county – such as North East London FT or Norfolk and Suffolk FT – would be too slow and could dilute the focus on patients and carers in Essex, according to the North Essex Partnership strategy paper.

The paper said: “All Essex clinical commissioning groups plan to shift income from specialist mental health services into IAPT, by decommissioning secondary community services for most patients in non-psychotic mental health clusters.”

IAPT services, which North Essex Partnership does not provide on its patch, are a less specialised form of mental healthcare designed to address less severe illness for a larger patient population. Low intensity IAPT staff are in pay bands 4 or 5, while the high intensity IAPT therapists can be in band 7.

However, Mr Geldard said his bigger concern was that IAPT services were being commissioned in a way that was “not part of a strategic approach” and that the IAPT contracts were contracted out in “more of a cherry picking approach”, which could threaten the sustainability of core secondary mental health services.

His concerns were shared by South Essex Partnership chief executive Sally Morris. She told HSJ: “We are losing economies of scale with small services being taken off and potentially tendered… This is affecting the sustainability of individual organisations.”

She added: “The more that you have, it is easier [to stay sustainable]. There are some services where it is quite appropriate for them not to be delivered in secondary care. I am not saying everything has to be done by mental health organisations. But the assumption that you can continue to take small bits out [is a problem].”

As well as IAPT services, other services routinely tendered out by local commissioners include programmes such as child and adolescent mental health services.

The chief executives spoke to HSJ to discuss the market conditions that had prompted the trusts to consider a merger.

Mr Geldard said: “I am really concerned about secondary mental health services. We hear parity of esteem being talked about by politicians, which is very welcome, but, to be perfectly honest, I don’t see any of that translating to on the ground.”

Ms Morris said: “The key driver is the sustainability of mental health services at a time when we are seeing a shrinking market.

“The opportunity of making genuine efficiency savings are pretty much drying up so you are looking at service transformation.

“We have been working as two organisations quite closely for the last year and a half to try and make efficiencies… but there is a limit as to how much you can do that when you are separate organisations.”

Both leaders stressed that no decision had been taken as to whether or not a merger would go ahead, although it is hoped a decision could be made in the coming months.