The valued care in mental health model does not suggest there is a single ‘right way’ to build capacity and capability in sustainable improvement. Rather, it reflects the group’s experience that continuous improvement results from the interaction of a number of different ingredients. Each section describes the ingredients that have been most important to their improvement journeys so far. Other trusts may decide to use and add to these ingredients in different ways. That said, the group has chosen the order of the ingredients in the model for specific reasons.
The group has chosen the order of the ingredients in the model for specific reasons.
Experts by experience come first because the primary ingredient in any work to improve services is the voice of the people who use those services. Trusts can make sure they hear that voice by integrating people whose use services, their carers and families as experts by experience in all improvement projects. Understanding the difference between these experts’ actual experience of care and what they hope to experience defines the distance an improvement journey aims to cover. By putting this ingredient first, the group is emphasising that the point of mental health services is to improve the lives of people who use them.
Next comes understanding the national picture – the national policy objectives and supporting initiatives comprising the strategic context in which trusts are trying to improve services – and understanding the local area. Understanding the local area involves knowing the social and economic characteristics of the local population – including population health inequalities – that inform current and future demand for mental health services. It also means understanding and working with local partners to improve supply.
Culture and leadership follow because these soft, ‘people’ ingredients of change need to be of a particular quality for improvements to be cumulative, sustainable and systemic. The culture must encourage staff to be open, to test new ideas and to learn from mistakes rather than to blame. The leadership has to strike the right balance between supporting staff, allowing autonomy within boundaries and excellent accountability.
Once these four ingredients are an integral part of an organisation, it will be better placed to gain a holistic understanding of its business and how to manage its resources – human, financial, intangible and physical. If resource constraints seem to have become a constant feature of the NHS environment, then the constant challenge for trusts is how to improve services within the resources available.
Trusts will be looking for a suitable improvement approach or methodology to drive continuous improvement in their business. Successful deployment of an improvement approach takes systematic quality planning and quality control.
Patient safety is a critical ingredient of care quality. So in the course of any improvement journey, patient safety must, as ever, remain a priority. Improvement approaches should complement systems of clinical audit and clinical governance structures in order to raise standards of patient safety.
The final two ingredients – digitilisation and innovation – are further critical drivers or sources of improvement. The slow pace of digital progress in the NHS compared to other sectors offers a significant opportunity. Digital and other kinds of innovation can bring step changes in service quality and value for money. They may also raise new risks, which trusts need to manage explicitly.
The combined learning that informs each ingredient in the model is complemented by a review of current thinking and theory provided at the start of each chapter by Henley Business School. 57 illustrative case studies appear throughout, as well as references to further resources.
The final section is a compendium of stories describing the improvement journeys of the trusts represented by the group. An improvement journey never ends: all of the trusts involved in developing this model would say their journey continues. The model described here is a distillation of what they wish they had known before they started. If it gives encouragement and practical support to other mental health service providers committed to improving for the people they serve, it will be doing its job.