• Joe Rafferty says many mental health trusts are too small
  • Mersey Care chief says trusts risk being “left on the side” in integration plans due to their size
  • The provider chief also suggested the quality of community services may improve if providers achieve “critical mass”

Many mental health trusts are “too small” and risk being “left on the side” in system integration plans, a leading chief executive has warned.

In an interview with HSJ, Joe Rafferty, of Mersey Care Foundation Trust, said he has a “strong view” that mental health trusts should begin thinking about “aggregate architecture.”

He said: “I think there is a real issue that a lot of mental health trusts may be too small to play a significant role in the integrated care piece.

“They may well be left on the side or their voice not heard. This can be seen if you look at the way mental health research has lost out – in my view in part because of scale.”

If mental health is to be seen a “as a distinct area of the NHS”, then Mr Rafferty said trusts in the sector would have to think differently about their structure.

He added: “That could be a group model, a merger model or perhaps a novel network model. Having now worked through two acquisitions it doesn’t mean losing the good stuff, but it does reset thinking. I don’t think the status quo is an option, I think there is a pressure now for change to organisations and therefore pathways to happen more quickly.”

Mersey Care has significantly grown in size over the last two years, with its income almost doubling to around £370m. It acquired the Lancashire-based Calderstones Partnership FT in 2016 and has subsequently taken on contracts for community physical health contracts for South Sefton and Liverpool.

Mr Rafferty also suggested there were too many small community physical health providers, saying: “I think it has been a potential limitation in the community and mental health field that most organisations have been generally small or medium sized,” he argued.

Talking about the development of integrated care models, Mr Rafferty said the success of these models depends on the strength of relationships between organisations, which is often “proportional to the number of organisations around the table.”

Having a greater number of organisations, he argued, means there is “a greater likelihood of arbitrary vetoes being deployed to maintain position.”

“I am an advocate of a smaller number of more capable organisations around the table,” he said.

Below is a table of the 10 smallest mental health and community provider trusts in England. Seven of the 10 have a “good” rating from the Care Quality Commission.

The smallest mental health provider is Tavistock and Portman Partnership Trust, which had an income of £51m in 2017-18. It has a different focus to most other mental health trusts as almost half its income related to its highly regarded education and training courses.

A spokesman said the trust had “grown significantly” over the last decade and is “always open to working more closely with other providers where it makes sense to do so.”

The second smallest trust, Dudley and Walsall Mental Health Trust recently announced it is looking to merge with neighbouring provider The Black Country Partnership FT by 2020.

Smallest mental health trusts

NameIncome (2017-2018) £m

Tavistock and Portman Foundation Trust


Dudley and Walsall Mental Health Partnership Trust


North Staffordshire Combined Healthcare Trust


Black Country Partnership Foundation Trust


Lincolnshire Partnership Foundation Trust


Humber Foundation Trust


2gether Foundation Trust


Sheffield Health and Social Care Foundation Trust


Derbyshire Healthcare Foundation Trust


Bradford District Care Foundation Trust


 Senior leaders are invited to attend the HSJ mental health summit in January, where Mr Rafferty is one of the speakers.