The Trust has seen lots of service change and reconfiguration in the last two to five years. Please see below for information on the reasons behind this and the overall vision.

What is service line management and why does the Trust have to do this?

Service line management is a management system introduced to the NHS by Monitor, based on learning from international health and business systems. It is a way of bringing together groups of services, based on patient diagnosis or need, with the staff and interventions required to treat them and the resources to support this. This allows clinicians to lead services focusing on service user outcomes and making sure teams of staff are skilled to deliver what is needed for the quality and performance of services so they continually improve and are efficient. All Foundation Trusts have to implement service line management as a condition of their authorisation. All NHS services will need to part of a Foundation Trust by 2014.

Why are teams under service lines changing?

In mental health services it has always been difficult to group patients according to diagnosis because these do not adequately represent needs, interventions or intensity of input. Mental health payment by results' development nationally has used a clinically based tool to group patients by similar needs. This allows staff skills and training to be aligned with the treatment and support required for similar groups of service users to deliver the best outcomes for these service users. Mental health payment by results adopts a recovery approach in which achievable goals are jointly identified aiming towards a discharge from secondary mental health services.

At the Trust we have aligned the groups for mental health payment by results with our management groups. This means that clinicians and the staff in services can focus on the interventions which are based on the best evidence for similar groups of service users. This provides for a more expert trained workforce, delivering specific care which will lead to better outcomes for service users, fewer interfaces between teams and more efficient service delivery. Most of the services required by any service user at any time will be line managed by the same manager and clinician driving up quality and reducing waste. Money earned through payment by results or activity will be aligned to the service where the activity happens so we can monitor the impact carefully.

Why are staff in the teams changing?

We need to move our staff to deliver treatments where they are needed. We have careful training plans to ensure our staff have the right skills to treat service users as expertly as possible. We also want to make sure that service users have support from more than one worker so that there are no gaps in care when staff are unavailable.

We have huge efficiencies to deliver as part of the savings the NHS has to make. We have had to deliver a 20% reduction in spend over three years and over 70% of our annual spend is on pay for staff. We have allocated our staff so that their skills are best used to deliver skilled interventions. Many support tasks can be done safely by trained support workers under the supervision of the care coordinator. We have also reduced the number of staff managing services to increase the number of staff delivering care and skilled treatments.

We know that this means some long term support relationships for particular servicer users will be disrupted and this is difficult for them and staff. We will work hard to minimise the disruption.