Mike Cooke on mental health

I thought it was time to have a short rant about the current and future NHS mental health marketplace.

In 2006 - the start point - we have just over 80 mental health providers; about 60 mental health trusts, 20 primary care trusts, three foundation trusts, differentiated private sector provision and a growing third sector that ranges from nationals to very locals.

Surveys regularly poll 77 per cent of service users rating their NHS experience as good to excellent and 9 per cent rating it as poor to very poor. National service framework teams are now present in great numbers. There are 30 per cent more consultants, 20 per cent more nurses and 50 per cent more psychologists all contributing to a 25-30 per cent increase in mental health spend since 1999.

Knowledge and time spent on mental health and learning disabilities by commissioners is limited. Regulation including terms of authorisation to be on the NHS 'level playing field' is beginning to work through. Cross-cutting government initiatives on respect, anti-social behaviour, mental health and social inclusion and incapacity benefit are all beginning to emerge.

This is accompanied by a fresh suite of policies likely to include choice in mental health, stronger commissioning and procurement and a dash for foundation trust status by most NHS providers. Interestingly, mental health style organisations account for a significant proportion of wave 3 and 3A applicants - subject to the latest diagnostic which has been tailored to mental health. Relative financial stability and ability to create relationships could be differentiating the sector just now.

So let's fast forward to 2011. The supply side is competitive through the secure to non-secure sector, through secondary care and in particular into the primary, community and voluntary sector. Thirty NHS foundation trusts are established, many leading the way on innovative involvement of expert consumers of service, supporting social enterprises and private sector partnerships which are being piloted for both 'exotic' and 'first episode' cases - particularly those with a more elective element.

Mental health has remained a good employment choice for mature workers. The private sector runs service lines to offer choice in secure, criminal justice and psychological therapies sectors - contestability is strong and has raised quality.

It is the third sector that has outperformed others with its abilities to connect with disillusioned service users, to handle social issues, to make money go further, to normalise mental health issues. There are national providers but many are locals, often supported by indirect services from the statutory sector. Regulation is sharp, as is accreditation to continue as authorised. Regulation has come in on the commissioning side too. Procurement consortia standards have set up 'call off' contracts with standards and incentives for choice, preference, intensity and outcomes of interventions.

The currency for trading has been established and workplace, well-being and school initiatives are the subject of incentivised locality-based commissioning. This was built on the success of local area agreements and patient 'involvement for real' schemes. The surprise card is direct payments for long-term service users and carers. This allows more patient influence supported through electronic health and social care records.

Young people are using early intervention IT packages in peer counselling groups as their preferred intervention with DVDs, access to sport (the Olympics are next year) and podcasts on prescription. Surveys find that 90 per cent of service users are happy with the service, engaged and feel treated with dignity and respect. Sounds better to me.

Mike Cooke is chief executive of South Staffordshire Healthcare foundation trust.