Foundation Trusts: Whatever next?
The RCN used to publish a booklet called “So you’ve passed, Nurse”. The implication being that, having reached the necessary standard for professional practice, your career was only just beginning. Perhaps the same thing could be written for Foundation Trusts. Having satisfied the standards set by the Department of Health and Monitor, the work isn’t over, it’s just beginning.
For many Foundation Trusts perhaps this wasn’t a significant step change. They were already treating their organisation as a commercial entity, worrying about the costs of services, consulting with their communities and engaging their service users. But for many others, the application process was a significant change to practice, and the real work is only just beginning, the first task being to keep up the momentum.
So what might be the next issues?
Well, apart from the usual round of targets set by the Health Care Commission (or its future guise), here’s a few to start with. How about trying to improve the service user perspective? Many services users feel disengaged from services, recipients of not participants in their own care. Mental health services, highly unusually amongst health care services, have the power to treat people compulsorily, but that doesn’t mean that service users don’t warrant respect, and being shown the usual courtesies we would expect for valued customers. Remember that advert, “Dr Smith, your patient is ready to see you now”? Wouldn’t it be innovative for services genuinely to work around the service users? As members and constituents, mental health service users need to feel more respected and involved in their own care. If this isn’t an area ripe for improvement I don’t know what is.
Or what about my favourite, the cost of processing care?
As the pressure for service line reporting and accounting increases, and with it demands for more accurate information, the quest for FTs is obviously how to get more return for their investment. We can pay lip service to ‘lean thinking’, whilst considering skill mix reviews, prescribing budgets, increasing occupancy levels and a myriad of other ways in which to cut costs, or ‘increase productivity’. But how far do we really take lean thinking? Has anyone costed the time spent in processing the information requirements of CPA forms, and running reviews with 8 – 10 people in a room? Or even how much time is spent in running ward rounds? Or dealing with complaints? One of the principles in lean thinking is reducing waste. Unnecessary work that could be simplified or prevented is just waste, and surely doing less of it has to increase efficiency, doesn’t it?
With implementing just some of the ten high impact changes, FTs are improving ‘productivity’ (which is what exactly in mental health?). Again, borrowing from lean thinking, reducing variability will improve quality and reduce costs.
How many mental health professionals want to work as individual professionals, and hate completing activity data?
It’s just good business to be able to account for actions (and therefore costs) and to be measured against a standard. I remember as a commissioner discovering that of the 8 Consultant Psychiatrists in the Trust I commissioned from, one had an Average Length of Stay of 15 days, and an average of just 8 patients admitted at anyone time, whilst a colleague of his had an ALOS of over 50 days and around 30 patients admitted at any one time. The trouble was, neither I nor the Trust knew which was appropriate practice (if any). One way or another, something was awry.
I would suggest then, that treating service users like customers, and managing the whole system to reduce cost, waste, and variability are probably going to be amongst the top five things Foundation Trusts will have to face as they grow into their new freedoms.
If you would like to discuss how we can help, contact Nick Moor