Should we be doing it like Dorset?

Following the publication of Professor Michael Williams’ proposal for an all-Wales mental health organisation, “Iechyd Meddwl Cymru,” service users in Wales have been listening to the experiences of patients in England who receive their services under a similar system.

There are many examples in England of specialist mental health Trusts delivering mental health services for large populations. Discussion has identified one example of particular interest: Dorset Healthcare NHS Foundation Trust.

Dorset has a population a little less than half the size of Wales, and has just one Trust delivering mental health and social care services for the whole county. So what is the result of having a single mental health organisation catering for a large population?
Speaking exclusively to Mental Health Wales, Chief Executive of Dorset Healthcare NHS Foundation Trust Roger Browning listed several benefits:-
• You have a dedicated focus on improving the quality of lives of services users and carers.
• Service users and carers have one organisation that they can relate to and influence strongly rather than have to deal with lots of different organisations providing different bits of services.
• You have staff and Non-Executives who want to work in mental health services and want to make a positive different to help people.
• You have an organisation that has passion, commitment and determination to achieve improvements for local people with mental health problems and is not diverted by other priorities.

We also asked if mental health services could become more isolated or stigmatised if they are managed by an independent organisation like the Dorset Trust. Roger Browning finds the opposite is the case.
“We have not found this an issue,” he told us. “We have found that other bodies have a better impression of mental health, thereby reducing stigma, because they are impressed by the positive approaches of the Trust and by the staff working in the Trust. “We have also found that service users feel they have a strong voice relating to one organisation. It also enables a prime focus on wellness and good mental health promotion programmes.”

What about the quality of services provided by the Trust? Recent reviews of the Trust’s performance suggest it is achieving excellence. In the Healthcare Commission’s patient survey, 86% of service users felt they were treated with dignity and respect by the Trust’s staff, 82% of service users agreed they had been cared for well enough in the community not to need a hospital stay in the last 12 months, and more than three quarters of all patients rated their overall care as good, very good or excellent.

Furthermore, the Trust has been awarded the highest 3-star score in the Government’s national performance rating for 4 consecutive years. The Healthcare Commission’s 2006-2007 report rated the Trust ‘Excellent’ for the quality of its services, and ‘Good’ for use of resources (encompassing financial management). The level of service user and carer involvement was judged to be “excellent”, and acute services were shown to be “excellent” at promoting inclusion. This combined score puts the Trust into the top 12% of all 397 NHS Trusts in England.

Richard Timm, a service user from Swansea, is impressed. “When we looked at the experience of people in the same situation as us in Dorset, it seemed to be more positive,” he said.

“We don’t for a second think it’s because staff in Dorset are better at their jobs than they are up here. In fact we all agreed that we have a really dedicated workforce in Wales. I think it’s down to the better structure they have there. Because there’s one specialist mental health organization covering the whole population, there’s no variation in service across the area and the service is very high quality.”

Professor Williams has made it clear, however, that what he wants for Wales is more than an NHS Trust. He wants a body that will deliver a comprehensive, integrated mental health and well being service with functions that include promoting mental well-being for the whole Welsh population as well as planning, commissioning and delivering services.

Service users have been positive about this broader role. A service user from Colwyn Bay said: “The good thing is that, unlike Dorset, there would be a mental health body that can work directly alongside the government in Wales.

“Iechyd Meddwl Cymru would cover the whole of Wales – just as the Assembly does – and that means it would have a direct link to the Assembly and a clear national role. At the same time Professor Williams proposes three Regional Boards working under the overall umbrella of Iechyd Meddwl Cymru: that would help ensure the right decisions were made on services in North Wales, for example.

“We agreed this is an exciting possibility: it means that the all-Wales body can improve the mental health of the whole Welsh population, north and south.”

So what do service users feel are the benefits of the large Dorset Trust which can be repeated in Wales? Service user discussion groups in Wales identified these advantages:
• a seamless service provision both across age ranges and geographical areas
• a concentration of expertise and best practice
• transparency and protection of financial resources
• opportunities for user and carer involvement at all levels
• clear accountability for delivering national mental health policy.

Based on the evidence from Dorset, service users and carers appear convinced that a single mental health organisation for Wales could be an important step forward in improving services. John Abbott, Hafal’s Campaigns Manager, commented: “Dorset teaches us that an independent, specialist body can drive up standards. And in Wales having an independent organisation coterminous with our government at the Assembly would have the potential to achieve even more.”

To read “Iechyd Meddwl Cymru”, go to:

For more information on Dorset Healthcare NHS Foundation Trust, go to:

Chief Executive of Dorset Healthcare NHS Foundation Trust Roger Browning