• Three mental health trusts in south London in talks with CCGs over delegation of local mental health budgets
  • Trust leaders hope plans can be in place by next year
  • Would represent major change in commissioning model for mental health

Three London trusts are in talks with clinical commissioning groups to take on responsibility for local mental health budgets, HSJ can reveal.

The South London Mental Health and Community Partnership – a collaboration formed by Oxleas Foundation Trust, South London and Maudsley FT, and South West London and St George’s Mental Health Trust – is in early negotiations to assume commissioning responsibilities for core mental health services from CCGs.

The development follows the partnership’s success with taking on specialised commissioning budgets, for forensic and tier four children and adolescent mental health inpatient services. It is one of 14 mental health provider groups to be delegated budgets from NHS England as part of its new care models programme in 2017.

Earlier this month, HSJ reported NHS England’s plans to transfer the majority of its mental health specialised commissioning budget to more groups of providers by 2020.

A key benefit of this is that providers have greater incentive to reduce out of area placements, as they can retain any savings from doing so, and reinvest in other service areas. The hope is the transfer of local commissioning budgets could have a similar effect.

The six CCGs involved in the discussions – Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark – appointed a single accountable officer last year ahead of moves to merge.

Legally the CCGs would have to remain responsible for the commissioning function, however this can be delegated to providers. 

In an interview with HSJ, chief executive of Oxleas FT, Matthew Trainer, said he hopes providers and commissioners will be in a place to implement the plan next year. If progressed, SLP could be the first provider collaborative to also have responsibility for core as well as specialised mental health services.

According to Mr Trainer, SLP has seen a significant reduction in the number of patients needing a forensic service or child and adolescent mental health bed being sent out of area, as a result of taking on the budgets. The latter has seen the distance children are sent out of area reduced by more than 60 miles.

Mr Trainer said: “Really that [improvement] has been led by the delegation of commissioning [responsibility], as it has allowed clinicians to take a front seat…

“Lots of the delays we are getting in [specialised commissioning] pathways now are because we are trying to manage discharge from what is now a single inpatient system into a multitude of local systems. So, there’s issues around housing, who bears healthcare responsibility, which boundary they are in.

“The [NHS] 10-year plan says we need to streamline commissioning and get providers and commissioners working together. What we’ve said is why don’t we actively do this and start getting in the commissioning functions and let’s start with mental health.

“Let’s look at mental health care services and see how we can learn from the successful new models of care and get the commissioners and providers of core mental health services into a more collaborative space.

“We’re not looking at this as anything about [budget] reduction or cutting costs, we get the money out by streamlining pathways, services and reducing the bureaucracy.

“Rather than any kind of takeover, commissioners and the three trusts are hoping to share responsibility – this is a collaborative process.”