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Rethink Mental Illness examine co-production in CCG mental health service design and delivery

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A new report by Rethink Mental Illness explores the important role of co-production in mental health commissioning.

‘Progress through Partnership: involvement of people with lived experience of mental illness in CCG commissioning’ argues that co-production should be the norm, not the exception.

Rethink’s report suggests that, while there is national commitment to co-production, the majority of Clinical Commissioning Groups (CCGs) do not have clear plans in place for involving people with experience of mental illness in the design and commissioning of mental health services, also known as co-production. CCGs told Rethink that with enormous pressure on resources and very full remits, it was difficult to prioritise implementing new ways to involve experts by experience.

Rethink submitted Freedom of Information requests to 209 CCGs, with 196 responding. They also undertook a literature review, carried out interviews and drew on qualitative data from their own co-produced services.

The FOI responses showed that:

  • Only 15 percent of CCGs has used a co-production approach at least once in mental health commissioning
  • Only 8 percent had ambition to increase co-production
  • Only 1 percent explicitly stated that co-production was a standard approach to commissioning

The research showed that there are some good examples of CCGs involving people with experience of mental illness in the design of services. CCGs told Rethink that co-producing services has ensured focus on the day-to-day experience of people who use services. Some of these examples include:

  • Primary care and Improving Access to Psychological Therapies (IAPT): 25 percent
  • Crisis services: 22 percent
  • Wellbeing, recovery and peer-based services: 21 percent
  • Children and young people’s services: 19 percent
  • Other services include psychosis (7 percent), nonclinical support services (6 percent) and urgent and acute care (5 percent)

When looking at how CCGs are involving experts-by-experience, the research showed that:

  • 19 percent of CCGs are currently hosting or supporting a mental health focused user group, wellbeing network or similar
  • A further 7 percent of CCGs engage with mental health experts-by-experience via a general group (i.e. not mental health specific) 
  • 15 percent of CCGs host or attend mental health specific engagement events
  • A further 6 percent engage via engagement events that are not specific to mental health
  • 15 percent of CCGs involve experts-by-experience through their participation in advisory forums
  • 8 percent have mental health experts-by-experience as full members of decision-making groups such as Mental Health Partnership Boards
  • Another 7 percent have mental health experts-by-experience attend those groups but without full membership
  • 16 percent of CCGs said they commissioned a third party (such as Local Healthwatch or a voluntary sector organisation) to undertake engagement activities on their behalf.

The report highlights the three main barriers to meaningful co-production as reported by CCGs and makes three recommendations that CCGs feel will help improve co-production in the design and delivery of mental health services:

Barriers:

  • Significant concerns about the role that mental health service users can play in commissioning work
  • Lack of resources to meet the investment required to support meaningful involvement
  • Lack of compelling evidence that co-production can provide measurable financial benefits

Recommendations:

  • NHS England and NHS Improvement should demonstrate leadership through delivering on the Five Year Forward View for Mental Health’s commitment to develop evidence-based approaches to co-production in commissioning by April 2018, embedding co-production in all national policy work, and supporting local areas to embed coproduction via regional teams
  • NHS England should establish mechanisms to hold CCGs to account and encourage CCGs to develop co-produced approaches and measure progress, for example, incorporating measures of co-production in the ‘CCG Improvement and Assessment Framework’ by 2019/20
  • CCGs should use the Rethink Mental Illness Commissioners Co-Production Grid, as well as the National Survivor User Network’s ‘4PI’ national involvement standards, to consider their existing involvement approaches and the steps they could take to develop more meaningful and embedded co-production with experts-by-experience.

Dr Phil Moore, chair of NHS Clinical Commissioners Mental Health Commissioners Network, supported the report for which he wrote the foreword. You can read his Q&A on co-production on Rethink’s website.

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