As health and social care services in Greater Manchester began to plan their local devolution, the future of one of the city’s mental health and social care trusts came under the spotlight. Manchester Mental Health and Social Care Trust had been seen as a struggling organisation for some years and commissioners had been contemplating the future of the Trust.
Having previously received a critical CQC inspection and having been the centre of a well-documented battle over service cuts between staff and a former chief executive, the Trust was struggling to retain senior clinical and managerial leadership. As a result, it posed a barrier to the integration of care that commissioners hoped could challenge issues regarding the delivery of mental health and social care services across the area.
“The emergence of Devo Manc [the devolution of services including health and social care in the Greater Manchester area] made it increasingly clear that something was going to have to be done about the Trust,” says DAC Beachcroft partner Peter Merchant.
“The Trust’s commissioners had previously held off while there was a chance [the Trust] could become a Foundation Trust. But after it became clear two-to-three years ago that FT status was not going to happen there was no other plan in place to secure its future,” explains Merchant.
In 2014, following the decision that it could no longer perform as a standalone organisation (a decision upheld by the then NHS Trust Development Authority Board in January 2015), a merger – or splitting the Trust’s services between different providers – was seriously considered. Its two near neighbours, Pennine Care FT and Greater Manchester West FT, both bid to take the organisation over. Merchant believes it was the long established senior leadership team of the latter, coupled with a positive CQC inspection that won it the right to become the acquiring organisation – a deal announced in August 2016. That the merger was achieved with such speed appears to have been partly because it was overseen by the then regulator, the Trust Development Authority.
And so, at the start of 2017, Greater Manchester Mental Health NHS Foundation Trust emerged. DAC Beachcroft integration specialist, partner Charlotte Burnett, says the challenge now will be “bringing the acquired organisation up to the standards of the acquirer”.
For example, while the most recent CQC inspection deemed the former Manchester Mental Health and Social Care Trust to be largely requiring improvement (though for its ‘caring’ rating it was deemed to be good), Greater Manchester West FT was predominantly found to be good (though requiring improvement on safety).
Burnett also points to the most recent NHS Staff Survey as evidence of differences between the acquirer and acquired. While scores for the then Greater Manchester West FT increased for issues including ‘Recommend my organisation as a place to work’ and ‘Happy with the standard of care [for a friend or relative]’ and were higher than the average, those for the Manchester Mental Health and Social Care trust were consistently lower than the average.
This is in addition to working out how the merged organisation will fit with community and primary care in the devolved region – and how it will reconcile financial constraints with the needs of service users. Already bruised by industrial disputes sparked by service cuts, in 2015 the former Manchester Mental Health and Social Care Trust also faced a judicial review brought by a service user over proposed service cuts that were announced without consultation. The cuts were later withdrawn. “Questions will be faced around efficiencies to be made and a review of services and whether changes need to be made – and how these changes fit with service users,” says Burnett.
Nevertheless, Merchant believes the speed and relative smoothness of the merger process so far means that “while the jury is out on how successful many mergers around the country have been, I believe this will be looked to as a model of how to do a merger”. The former Greater Manchester West FT was itself the result of the merger of three small neighbouring trusts and also runs services outside Greater Manchester that it has bid for under tendering processes.
With Devo Manc gathering pace, plus a trend towards place-based care models, Merchant says locally that Greater Manchester may have an even more collaborative service delivery model across the region.
“Having just the one mental health and social care provider may not happen, but there may be other changes to the services this Trust provides. Others may be better served if they are provided by others, such as the third sector,” adds Merchant. “These challenges will be ongoing. In three-to-five years’ time this new organisation may look very different.”