Sustainable services

Guidance for commissioners of financially, environmentally, and socially sustainable mental health servicesThis guide supports commissioners, local health authorities and providers to think broadly, but practically, about building sustainable, resilient communities that have the potential, over time, to reduce mental ill health.

Sustainable commissioning involves making sure services make the most effective use of financial, environmental and social resources. This includes commissioning services that support secondary (reducing relapse) and tertiary (improving rehabilitation) prevention. It is these aspects, rather than primary preventative measures, that are the focus for this guide. The issue of primary prevention is discussed in the Guidance for commissioning public mental health services.

Download Guidance for commissioners of financially, environmentally, and socially sustainable mental health services

This guide has been written by a group of experts in mental health and sustainability, in consultation with service users and patients, and strengthened by input from a local government and public health perspective. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included. By the end of this guide, readers should:

  • understand the concept of sustainability in mental health care, and how using this commissioning framework can create sustainable services
  • be aware of the legislation relating to sustainability that the NHS is required to meet
  • understand what sustainable commissioning looks like in practice
  • understand how and why improving the sustainability of mental health interventions will contribute to achieving the aims of both the mental health, public health, NHS, and social care strategies, as well as improving quality and productivity
  • be able to commission sustainable mental health services and interventions.

Ten key messages for commissioners

What is sustainable commissioning?

  1. Sustainable commissioning is about ‘future-proofing’ mental health care. This simply means ensuring better outcomes for patients both now and in the future, despite increasing resource constraints.
  2. Sustainable commissioning will help reduce financial costs, reduce environmental impacts and improve social outcomes – this guide provides examples of sustainable mental health services and outlines their evidence base (see pages 16-28).
  3. Using this guide will help commissioners to understand what sustainable services are, how to commission them, and how to evaluate their success. It aims to provide a framework for the difficult process of making commissioning decisions (see page 11).

What are its basic principles?

  1. ‘Sustainable commissioning‘ is an approach that requires commissioners to:
    1. adopt four basic principles (see A-D opposite)
    2. apply these principles in every decision about commissioning mental health care.
  2. These four principles are well known, but too rarely employed as a framework for decision-making among commissioners:
    1. prioritise prevention – preventing poor mental health can reduce mental health need and therefore ultimately reduce the burden on health services (prevention involves tackling the social and environmental determinants alongside the biological determinants of health).
    2. empower individuals and communities – this involves improving awareness of mental health problems, promoting opportunities for self-management and independent living, and ensuring patients and service
      users are at the centre of decision- making. It also requires supporting community projects that improve social networks, build new skills, support employment and ensure appropriate housing.
    3. improve value – this involves delivering interventions that provide the maximum patient benefit for the least cost by getting the right intervention at the right time, to the right person, while minimising waste.
    4. consider carbon – this requires working with providers to reduce the carbon impacts of interventions and models of care.
  3. Commissioners need to adopt a sustainable approach because there is a legal requirement for the NHS to consider economic, social and environmental value, and not just price, when procuring and commissioning services (see page 9).

What should commissioners do?

  1. Commissioners should work with service providers, patients, their families and communities to:
    1. create new models of contracting that give providers greater flexibility with longer-term goals
    2. ensure that patients, their carers and communities are central to service design
      develop outcomes that are aligned with patient benefit.
  2. Commissioners should develop sustainability key performance indicators and use Service Condition Clause 18 from the NHS Standard Contract to ensure providers are delivering change against a baseline (see page 12).
  3. Commissioners should seek to involve all public services that can play a role in improving mental health outcomes including social care, education, police, employment and housing services.
  4. Commissioners should implement payment mechanisms based on patient or population-level outcomes.