It is just over two years since we began separating the commissioning and provider arms in Walsall teaching primary care trust.
The community services provider became an arm's-length organisation on 1 April and with the creation of a new mental health trust for the towns of Dudley and Walsall on 1 October the separation will be complete - that is, apart from completing a new commissioning structure and getting through the world class commissioning assessment process in one piece.
There has been what feels like a permanent review of mental health services in this area for the last four years and it is more than a year since we resolved to create the Dudley and Walsall single organisation. The creation has been slow because of the perfectly proper but time-consuming processes involved.
In contrast the creation of the provider organisation has been speedy. In part this is due to the ability of the PCT to drive the process itself and not rely on any external permissions.
The separation has required rigour and transparency. We held a number of stakeholder events last year that drove the PCT to conclude this was the right course of action. More than 200 people were involved and although many would not have been entirely happy with the final outcome it was one to which all could assent. This engagement reduced much of the sniping that usually follows this sort of process.
The provider organisation used the Deloitte framework produced for community foundation trust creation and methodically and painstakingly worked through its 60 pages of tables. This has ensured the separation is real.
It also put a massive investment into leadership development for its cadre of top managers, with a comprehensive programme over several months to which there was real commitment.
The creation of the provider has been most sharply defined by the appointment of its own non-executive directors. They were appointed as associate non-executive directors of the board as the provider does not exist as a legal corporate entity, but they have begun to exhibit separate corporate behaviours, especially in their relationship with other non-executives, both in the PCT and the hospital.
This reorganisation has been unique in my view because it is one that we have volunteered for and it has been entirely self-inflicted.
It has been a tough journey, particularly for the non-executives but also for the executive team, many of whom have their heart in provider services, as we have replaced something you can visit and touch with plans and aspirations and with the challenge of a world class commissioning framework.
It will clearly be some time before we know how productive these changes have been and it is clear that the provider organisation can only be a stepping stone to an as yet undetermined next step. However, it has also been a reminder that if you set out to do the right thing, even if it is difficult and tough, with the right leadership people will follow.