Leak shows NHSE ‘sorry’ for endorsing service which ‘hurt patients’

The serenity integrated mentoring model was launched in 2013 in the Isle of Wight and Hampshire. It quickly became viewed by mental health trusts as an “innovative approach” to helping support frequent users of the emergency services.

A core element of the scheme involves placing a local community police officer within the healthcare team charged with supporting those patients. These police officers are sometimes involved in delivering therapy – for example, sitting in on sessions or contributing to care plans.

In 2021, the pressure group StopSIM raised concerns about the model, which included a belief that police involvement was potentially coercive, criminalised mental health crises, and could result in withholding healthcare from people, which would breach human rights legislation. The group also argued the SIM programme had not been robustly and clinically evaluated.

As a result, NHSE committed to co-producing policy guidance on SIM with StopSIM. This guidance has not been formally published, but a draft has now been made public by StopSIM. 

In the draft document, NHSE admits to promoting SIM, and apologises for doing so.

The draft document states: “NHS England did not apply sufficient scrutiny to the decision [to endorse SIM] and involve the voice of lived experience sufficiently. This compromised the safety and quality of care for service users and has caused hurt to patients. For this, NHS England is sorry.”

It adds that in endorsing and facilitating SIM’s rollout “without sufficient scrutiny and critical evaluation to identify concerns with the model… NHS England did not meet this responsibility [to ensure public confidence in how decisions are made to support people]”.

A draft position statement produced by NHSE and obtained by HSJ in February said three key features of the SIM scheme were of “serious concern” and must cease. These included involvement of police in the delivery of planned and therapeutic community mental healthcare.

It describes other elements of SIM-like models as “punitive, exclusionary, and discriminatory”.

The draft policy leaked today also provides some results of trust-level reviews carried out by national clinical director Tim Kendall after concerns were first raised with him in summer 2021.

It reveals 26 trusts stated they had used SIM or a SIM-like model at some stage, 14 trusts appeared to be continuing key features of the SIM model while making changes to name and branding, and five intended to continue such schemes without committing to making any significant changes.

NHSE’s official position statement on the SIM model arrived two years after the trust-level reviews in March 2023. It warned key elements of the scheme and similar models must be “eradicated” from mental health services.

A separate letter sent from national mental health director Claire Murdoch suggested NHSE had confirmed with the Care Quality Commission that it will check whether any of the “concerning” practices associated with SIM are being used in mental health services during future inspections.

NHSE’s decision not to publish the results of its national review and the draft policy it had co-produced with campaigners prompted anger among high-profile supporters such as the Centre for Mental Health and the National Survivor User Network. HSJ understands there was a legal challenge to the publication of the policy.

Campaigners also raised concerns about the involvement of the national network of Academic Health Science Networks which worked to support spread and adoption of SIM between 2018 and 2020.

In March, AHSN said it planned to publish an independent review into internal processes which led to the rollout of SIM.

An NHSE spokesman said: “We are grateful for the work of the StopSIM coalition, which has highlighted significant policy concerns and helped us mobilise to address them.

“We are committed to ensuring the practices of concern related to SIM and other similar models are no longer used.

“Our review of SIM was based on the voices of people with lived experience, with efforts made to ensure that the views of the SIM coalition were acted upon, while we are strengthening our processes to ensure the voices of patients remain central to our future policy-making.”