How Can Finance Directly Impact in the Reduction of Mental Health Inequalities

Back in 2019, the Kent and Medway Sustainability and Transformation Partnership (STP) and KMPT got together to agree how they could jointly work together to focus on our patients that were in Specialist Mental Health Providers situated outside of their General Practice (GP) locality and outside of Kent and Medway. Sadly, it was clear that more could be done to support these patients and their families in particular how we could bring them back closer to home for their care.  The patients had an average length of stay was 3 ½ years. In some cases, they were hundreds of miles away from their family and friends who could only visit them occasionally.  Annual spend was also in excess of £20m.

I joined KMPT in late 2019 with the immediate task of assisting the KMPT and the STP soon to be the NHS Kent and Medway Clinical Commissioning Group (CCG) and now Integrated Care Board (ICB) in clarifying the entire mental health budget. My secondary focus was to then concentrate on our patients who were in specialist placements with varying diagnoses. The question was “How do you do this?”

An invoice for payment for services received (someone’s care) is a mighty powerful tool. For me it was a detailed insight into an inpatient care spell. Over a period of around 5 months and working with 8 CCGs and numerous staff involved in patients care I reviewed over 7,000 invoices. I collated bed cost, specialist nursing, admission, discharge and looked at every single provider’s latest CQC report and their current rating to assure myself of the standard care our patients were receiving.

With the help of a very experienced registered mental health nurse, we quickly established a caseload of patients who were individually reviewed.  This cohort consisted of 166 patients.  Our focus was to work with Providers and establish whether the patient was receiving the right care in the right place at the right time.,

This resulted in me drafting a business case to be presented to the CCG and KMPT asking them to consider supporting a clinical team (Review and Resettlement Team (RRT)) who would routinely review and support our patients, their families and providers alike to determine whether patients when receiving the most appropriate care could be moved closer to home.

With the business case approved, the entire team were in place by April 2021. Work continued between June 2020 and March 2021 and the size of the cohort reduced to just under 120. Year on year the team has effectively reduced the cohort and brought patients back closer to their families.  In addition, financial efficiencies have been delivered to re-invest in front line care.  The team now manage 43 patients and have delivered efficiencies of £4m. Since April 2021, the average length of stay for patients now under 12 months, a significant reduction due to the level of support the patients are receiving

Success breeds success and just this month we have started to look at expanding the model to Learning, Disability and Autistic (LDA) in-patients and I am looking at supporting the gap between Child and Adolescent Mental Health Services (CAMHS) and the Young People group as they transition to adult services.

My final thoughts would be, never be afraid of what could seemingly be too big a job. Finance as a function is here for many reasons, most importantly the function is here to ensure we deliver the best care to our patients.  In doing so we must ensure the financial viability of the services we provide to our population. We all have a part to play in reducing health inequalities, however small and remember this extraordinary piece of transformational work started with an invoice.