• NHS Improvement publishes national improvement model for the mental health sector
  • Report is a collaboration between the regulator and nine mental health trusts
  • Work looks at how quality improvements can be embedded into trusts
  • Warns that sacking leaders and making quick savings can “endanger improvement”

Sacking leaders when mistakes are made and “salami slicing” budgets to make quick savings “endanger improvement” and risk system failure in mental health, a new NHS Improvement report says.

NHS Improvement has published a national improvement model for the mental health sector looking at how to embed quality improvements and improve services.

The report, released today, sets out resources and case studies to help organisations improve services, including:

  • using experts by experience and co-production;
  • improving culture and leadership;
  • understanding national policy and local needs;
  • implementing an improvement methodology;
  • prioritising patient safety; and
  • driving digitisation and innovation.

It warns that blaming people and sacking leaders when things go wrong is a barrier to improvement, but creating an environment that supports them can help drive long term improvement.

It says: “Any tendency to blame people and sack individuals when things go wrong without analysing possible systemic failings endangers improvement.

“Creating an environment of care and support for leaders and prospective leaders is a must to enable leaders at all levels to flourish and to champion the cause of improvement.”

It also warns “salami slicing” budgets by applying the same percentage point cuts to each service could lead to pathway or system failure.

It says cost improvement programme savings can reduce deficits in the short term, but reallocating cash to priorities identified through quality improvement methods can “enhance the care of people who use services and safety within existing budgets”.

The report says: “Trusts often respond to continued pressure on resources by ‘salami slicing’ – trying to cut the same percentage of costs from each team’s budget across an organisation regardless of actual need.

“Applying fewer resources to the same ways of working leads to pathway or even system failure.

“The approach looks fair but will often reduce the quality of care more than it reduces costs, representing a fall in productivity.”

The report was a collaboration between NHSI and nine mental health trusts, with Northumberland, Tyne and Wear Foundation Trust as the lead partner.

The eight other trusts were:

  • Birmingham and Solihull Mental Health FT;
  • Cheshire and Wirral Partnership Mental Health FT;
  • East London FT;
  • Devon Partnership Trust;
  • Tees, Esk and Wear Valleys FT;
  • Lancashire Care FT;
  • Mersey Care FT; and
  • Hertfordshire Partnership University FT.

A new improvement model was initially pledged in the Five Year Forward View for Mental Health implementation plan to “underpin system transformation which is based on improvement science, enables quality improvement and sharing good practice, and complements the pathway approach”.

Today’s report says there is no single correct way to implement quality improvement because every organisation has different needs.

It adds: “We believe that there is a world class model for mental health service delivery in England, the problem is that different bits of it are in different organisations.

“This resource provides examples of good practice, which if brought together would deliver to this standard right across the whole delivery system.”

HSJ understands while the model has been created in collaboration with mental health trusts, it is applicable to any type of provider.