How is the NSF being implemented?
Local health and social care agencies in England are responsible for implementation. Local implementation plans (Lips), addressing issues across the seven standards of the NSF, have recently been published by county councils and health authorities. A second set of Lips, reflecting progress and revised priorites, will be issued this month.
Local milestones, identified in the Lips, will help to meet initial national milestones. These range from agreeing protocols for primary care and the specialist management of mental illness by April 2001 to getting rid of mixed-sex wards from 95% of health authorities and providing an extra 300 secure beds by April 2002.
The new duty of partnership, placed on health and local authorities by the Health Act 1999, provides for pooled budgets and integrated provision and commissioning. Targets will only be achieved through better cooperation between all parties, including the independent sector and user-led organisations.
Practical support will come from the national mental health implementation group, led by the Department of Health and supported by a national implementation team. The NHS mental health modernisation funds will provide £5m to help teams implement the NSF at local level. Assistance will also be provided for organisational and professional development across the NHS and social care.
The five national underpinning programmes - finance; workforce planning, education and training; research and development; clinical decision support systems; and information strategy - will all support implementation. They will also help to adapt milestones in response to need and progress - under the lead of the national mental health implementation group - and play a strong part in ensuring that good practice is shared. The developing NHS learning network, the National Institute for Social Work's electronic library and a national database of NHS service delivery and practice will all help here, too.
How will it be assessed?
It is already acknowledged that too many indicators might overburden services, diverting resources from patient care. However, social services, the NHS and their joint initiatives will all be monitored.
Performance assessment frameworks (PAFs) for the NHS and the personal social services will be used to monitor implementation. PAFs are based on principles of best value. Since April, this duty has underpinned all local government services. Each local authority will publish best value plans annually.
The commission for health improvement, the social services inspectorate and the audit commission will also keep tabs on each NSF.
NHS and social services joint working is vital to the success of the NSF. This is most likely to be reflected by general progress, but it will also assessed by "interface indicators" built into performance assessment frameworks for both the NHS and the social services. For the time being, these will specifically monitor emergency psychiatric readmission rates, to get an idea of the efficiency of care planning and alternatives to hospital.
Plans are also afoot to establish "high-level performance indicators" within the PAFs. These relatively quick assessments, in use from April 2001, will look at input, process and outcome - what resources are going in, what they are used for and whether they are having the desired effect.
What is the role of the workforce action team?
The multidisciplinary team began work in December 1999, its interim report was published in September and its final report is due in spring 2001. It is looking at developing the workforce in order to implement the NSF and, to date, many of its recommendations mirror those of the Department of Health's recent consultation document.
The roles of staff working across mental health - and their interaction with one another - are extremely complex. The action team's key message stresses the need to promote flexibility and innovation in workforce planning, education and training.
The action team has also welcomed various sums of money, allocated for specific purposes:
• £1m to support training of community psychiatric nurses and community nurses in mental health
• £2m to support clinical psychology training in 2000-01
• £2.5m for psychiatry training, increasing consultant numbers by 230 by 2007
• £3.9m to boost social work training
• £4m for mental health nurses in 2000-01
