• No evidence new care models in adult secure care made “significant savings”, says evaluation for NHSE
  • But children and young people’s inpatient models did deliver, and the models are generally endorsed
  • Recommends further roll out
  • NHSE says more recent data shows savings across the adult secure services sites

Half of NHS England’s flagship new care models for mental health did not make “significant savings”, an independent evaluation has suggested.

In 2017, NHS England launched 17 new care model projects in mental health services. This involved delegating its specialised commissioning powers to local “provider collaboratives” for: adult secure services, eating disorder services and tier four children and adolescent mental health services.

An evaluation, commissioned by NHS England, by consultancy firm Niche found no evidence the eight adult secure services models had produced significant savings in inpatient costs compared to non-new care model sites.

However the report, which has been published on Niche’s website but not otherwise publicised, did find good evidence the seven CAMHS models had made savings, reduced avoidable inpatient admissions and were treating more patients closer to home than non-new care models.

It also found similar positive evidence in the one eating disorder site which had gone live. The other two had not been launched at the time of the evaluation (carried out between early 2018 and March this year).

Meanwhile, HSJ reported earlier this year that a wave one CAMHS site, lead by Surrey and Borders Partnership Foundation Trust, was dropped in October last year.

Across all sites the evaluation did not find statistical evidence there had been changes in quality, patient experience or outcomes as, they said, the data was not available. There was also no evidence lengths of stay had decreased in NCM sites compared to the rest of the country.

However, overall, the consultancy firm said findings were positive and evidence was in favour of the new care model programme “improving, or being likely to improve, services’ effectiveness and efficiency”.

It said the models encouraged local collaboration and service redesign, and for patients placed closer to home significantly improved their experience of care.

Among various recommendations for NHS England, the report said it should give serious consideration to: fully delegating all CAMHS inpatient services to local commissioners, as well as the most highly specialist; managing adult secure and eating disorder services through lead provider models; and fully delegating the commissioning of independent sector mental health services to new care model sites. 

NHSE has signalled a major expansion of the NCM programme, planning for the entire country to be covered by provider collaboratives with delegated responsibilities by 2022.

It said the new care model approach to commissioning – via complex delegation – was “transitional, not something which is sensibly sustainable to the longer-term”.

The consultants said prospective new care models for the future should not assume there will be substantial savings from reducing lengths of stay or admissions, and said sites should be sustainable even without savings.

Authors of the review also suggested it was an “unrealistic ambition” that the programme would not destabilise the position of independent sector providers.

The evaluation was primarily based on 2017-18 data, HSJ understands from NHS England, data for 2018-19 shows adult secure sites saved £23m and recent quarterly data shows 50 per cent of all sights have reduced thier length of stay. 

However, it provided a statement from Tim Kendall, national clinical director for mental health, which said: “Actually, the new models have already reduced out of area placements by more than 20 per cent in two consecutive years – saving at least £35m in the process, which can be reinvested into patient care.

”There is widespread enthusiasm across mental health trusts for the impact this programme is having, as it means resources can be freed up from costly out of area placements to invest in more locally appropriate services.”

Existing new care model sites

Wave 1 sites – Live on 1 April 2017

CAMHs Tier 4

NCM site: North East and North Yorkshire | Lead Provider: Tees, Esk and Wear Valley FT.

NCM site: West London  | Lead Provider: West London NHS Trust | Partner: Central and North West London FT.

Adult Secure

NCM site: South London Partnership | Lead provider: Oxleas FT | Partners: South London and Maudsley FT; SW London and St George’s NHS Trust.

NCM site: South West  | Lead provider: Devon Partnership NHS Trust | Partners: Avon and Wiltshire FT; Cornwall FT; 2gether FT; Cygnet; Elysium; Livewell; Somerset Partnership FT.

NCM site: Thames Valley and Wessex | Lead provider: Oxford Health FT | Partners: Berkshire FT; Dorset FT; Central and North West London FT; Solent NHS Trust; Southern Health FT; Isle of Wight NHS Trust; Response.

NCM site: West Midlands | Lead provider: Birmingham and Solihull FT | Partners: South Staffordshire and Shropshire Healthcare FT; St Andrews.

Wave 2 sites – Live as at 1 October 2018

CAMHS Tier 4

NCM site: Northumberland, Tyne and Wear  | Lead provider: Northumberland, Tyne and Wear FT.

NCM site: Hertfordshire Partnership | Lead provider: Hertfordshire Partnership University Foundation Trust.

NCM site: South London Partnership | Lead provider: South London and Maudsley FT | Partners: Oxleas FT and South West London and St Georges Mental Health NHS Trust.

NCM site: West Yorkshire Lead provider: Leeds Community Healthcare NHS Trust Partners: Bradford District Care FT; Leeds and York Partnership FT and South West Yorkshire Partnership FT.

Adult secure

NCM site: North East and Cumbria  | Lead provider: Tees, Esk and Wear Valleys FT | Partner: Northumberland, Tyne and Wear FT.

NCM site: North London | Lead provider: Barnet, Enfield and Haringey Mental Health Trust; Central and North West London; NELFT; East London and West London Mental Health.

NCM site: Kent, Surrey and Sussex  | Lead provider: Sussex Partnership FT | Partners: Kent and Medway Partnership Trust and Surrey and Borders Partnership FT.

Adult Eating Disorder

NCM site: West Yorkshire | Lead Provider: Leeds and York Partnership FT. Partners: Bradford District Care FT and South West Yorkshire Partnership FT.

Go-live to be confirmed:

Adult secure

NCM site: The Prospect Partnership  | Lead provider: Mersey Care FT | Partners: Cheshire and Wirral Partnership FT; NW Boroughs FT; Elysium Health Care and Cygnet Health Care.

Adult Eating Disorder

NCM site: Thames Valley and Wessex  | Lead provider: Oxford Health FT | Partners: Avon and Wiltshire FT; Berkshire Healthcare FT; Surrey and Borders Partnership FT; Southern Health FT and 2gether FT; Priory/Partnerships in Care.

HSJ Transforming Mental Health Summit

The HSJ Transforming Mental Health Summit, taking place at the Hilton Leeds from 28-29 November 2019, unites 120+ senior figures from across the NHS, local authority and wider mental health service delivery landscape to discuss how to realise the visions of the NHS long-term plan and ensure successful local implementation of national priorities.

Held under the Chatham House Rule, attendees will quiz Paul Farmer and other national figures on general policy direction and co-develop solutions to their local challenges with NHS and local government colleagues from across the country. The summit is free to attend for senior NHS and public sector figures.

Register your interest