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Integration, Culture and Mental Health – reflections on the NHS Providers conference

The MV team were in Manchester this week for the annual NHS Providers Conference. We spoke to a lot of people and heard a lot which will really help shape the support we provide to organisations who are looking to understand and cement their place in the new NHS landscape.

It was great to see our clients and friends from the Manchester Resilience Hub being exhibited as an exemplar. This service was set up by four Manchester NHS Trusts in order to provide mental health support to those impacted by the Manchester terror attacks. Our work with them has involved finding an organisational model which will allow them to continue and spread their important work in the future.

We heard what I thought was a very clear and honest speech from Secretary of State Matt Hancock (who also visited our exhibition stand for a chat). He focused on the capital expenditure the government is putting in place to build new hospitals. He referred to some facilities being in such poor nick that it was like “asking a premiership footballer to play on a ploughed field”. He also returned to his favourite topic of digital transformation and particularly how this was not about individual “flashy aps” but more about ensuring all parts of the system can talk to each other. This is why the government are mandating certain standards which all suppliers in the system (public, private and third sector) must adhere to.

The Secretary of State also spoke about service integration and made it clear he expected Trusts to be bold. It can be very easy to point to real or perceived barriers and say “let’s just do the bare minimum”. He made it clear that he expected primary care, community care, mental health and adult social care to look at all options (including structural/organsiational changes like new joint venture vehicles) to provide a more seamless experience for the patient or service user.

At MV we have experience of designing and implementing integration through both contractual and structural arrangements. Our own experience suggests that a structural change is indeed the best way to establish the right operational and cultural conditions for genuine integration. It takes bravery for sure – but anything short of this risks feeling either temporary or just another set of meetings for staff. As part of this engaging and inspiring the workforce is the only way to achieve effective and lasting integration.

We also heard from some NHS organisations who have had real success integrating services – particularly primary and community care (this being an “NHS” conference, council run adult social care services were not well represented, which is a problem in itself). Vincent Sai from Modality Partnership, a huge Primary Care group, was refreshingly honest about the challenges Primary Care Networks (PCN) are facing as they try to understand their place in the new NHS system and made a convincing argument for the need for scale above the size of a typical Primary Care Network (5-6 practices). This fits with our own experience of talking to GP federations (which are almost always at a significantly larger scale than your average PCN) and how they now see their role as being the primary care voice at the CCG/ICS level as well as offering resilience for individual PCNs (facilitating staff sharing, back office efficiencies etc.). We also heard from two Community Care Trust Chief Executives, Andrew Ridley and Thea Stein and how they are reacting to the emergence of PCNs. Examples of actions include agreeing a number of key shared posts with the PCNs and/or their federations and sharing back office infrastructure is also on the cards for many areas.

As public service consultants, this was all of huge interest to us and it was a real pleasure to hear form these leaders in person. However, the session I was most impacted by was one focused on mental health and featuring journalist Isabel Hardman and Time to Change Director Sue Baker. Their frank and honest accounts of their own experiences with mental health was breathtaking, heartbreaking and inspiring at the same time. I try not to be a “cold male” (Sue’s phrase which recognises that men are more resistant to acknowledging mental illness in themselves or others). At MV we have signed the Time to Change pledge and have put in place various support services should anyone need them. But this isn’t a box ticking exercise. It requires the right behaviours and understanding from each and every one of our team. It requires our entire team to be vigilant, to look out for each other and to always, always be ready to listen to anyone who is struggling.

It was a great couple of days and a pleasure as always to spend time with our friends and partners at Bevan Brittan, with whom we shared as exhibition stand.

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