Commissioners and providers as partners (third sector organisations)

Background

Sharing Voices is a Bradford based organisation devoted to delivering community based mental health services. They started as a group in the local voluntary sector Asian Disability Network, but in 2004 became an independent not-for-profit organisation. Now, Sharing Voices deliver a broad range of services for people with mental health, going far beyond conventional treatment to include providing training and employment opportunities, and community development to reduce health inequalities. This holistic approach to consider not just the patient, but their environment and circumstance, is a key part of their mission. This way of working is essential when working in inner city Bradford, where there is a very ethnically diverse community and high levels of socio-economic deprivation.

As a small organisation they are also able to start innovative services, such as the Listening Imam project, training local Islamic religious leaders about mental health services, and so when approached for advice, they can refer people to other support systems. Third sector organisations like Sharing Voices can also have many different funding streams available to them, although sustainability of additional services is always a challenge. Staff at Sharing Voices are also able to lobby and take part in developing initiatives such as an idea for a international academy for mental health practitioners, sharing learning and best practice in mental health across the globe.

Partnership working

One of the key factors to the success of Sharing Voices as an organisation has been their strong relationship with the local Primary Care Trust (PCT) and the Bradford District Care Trust. While the provider trust and Sharing Voices both deliver on-the-ground mental health services, each has evolved their own specialities, which mean they can deliver a comprehensive package of services. While both Sharing Voices and the Care Trusts provide services for people from all ethnic backgrounds, in some areas Sharing Voices has a greater depth of community engagement with BME populations, and acts as a gateway and promoter of other services, such as the drug and alcohol prevention services.

Sharing Voices also has ‘in-reach’ services: in contrast to outreach workers, who assist people out in the community, these specially trained staff make visits to patients admitted to hospital wards with mental health issues. They provide tailored support to patients at a difficult and confusing time, and act as conduits for feedback from patients with additional needs.

This equal partnership approach can also apply to data and evidence, for example, both the NHS Trusts and Sharing Voices have critical information on their populations, which when shared can ensure good strategic and operational service development. Sharing Voices keep very detailed anonymous case studies on service users, which illustrate the complex case history clients have, and the importance of understanding an individual’s personal and cultural backgrounds to be able to recommend effective and appropriate interventions. The NHS Trusts have quantitative data on a much larger number of service users, and so putting this evidence together could enable them to identify trends in service need, and tailor the best interventions for each target group.

Sharing Voices also benefits from being a small and rapidly adaptable service, and can pilot new ideas and systems much quicker than the larger providers. For example, Bradford and Airedale PCT asked Sharing Voices to help with the evaluation of a mental health scoring tool called ‘SUNSHINE’. By working with their staff and clients, a quick pilot showed the tool could be translated well into many languages, but would not be appropriate in initial sessions with their clients. Their findings were used in the main SUNSHINE evaluation report produced by the PCT.

The provider / commissioner split

The work on mental health in this area demonstrates the benefits when organisations go beyond a commissioner and provider binary, and have a much more interactive engagement. Ideally, both should be equal partners where providers want to deliver better services, and commissioners want better services to commission. In some situations, it is appropriate for commissioners to work closely with local providers to ‘develop the market’ and encourage promising organisations to grow into strong providers. Innovation and improvement can be suggested from both sides, where both grass-roots and top down information and feedback provide the best dynamic. Yet, there is still room for improvement, especially around evidence use. Sharing Voices has comprehensive ethnicity data on their service users, and the Bradford District Care Trust is one of the better providers at ethnic monitoring. However, it is not clear how effectively the PCT is using this ethnicity data, and whether it is influencing strategy and commissioning. Commissioners need to be clear what data they need from providers, who in turn need to provide this in an appropriate format. Once the data is collated, commissioners must ensure that they are using it at all stages of the commissioning cycle, to assess need, evaluate current services, design improvements, and ensure the equitable delivery of services.