Notts Healthcare Trust recently published its new Clinical strategy. Here is a review of the document by Peter Robinson of the Carers’ Council Executive Committee, presented to it’s meeting on 31st May 2019.

“This document is a clinical strategy for the next 5 years so it’s not surprising that references to carers are slim. However the Trust ‘Positive’ values remain a kingpin of the way the Trust deals with people which embraces ‘Involvement’ including carers. The thrust of the document is an improvement of services through:

  • Adopting a set of six guiding principles to deliver services for three Care groups.
  • A strategy which integrates itself into the overarching strategy (the Integrated Care System ICS) for health and well being across the whole county, embracing primary , secondary and social care services.
  • A refresh of the Trust ‘service model’ of three core components.

If the aims expressed on page 5 of the strategy are delivered it will represent a major improvement in real terms for mental health services. Carers want the best for those they care for so this strategy will improve the lives of carers.

The 3 care groups are Adults; Children,Young people and Families; and Older People

The Guiding principles are (page 15 of the document):

  1. Quality, Safety and Effectiveness
  2. Values based practice
  3. Rehabilitation and Long Term Conditions
  4. Listen, Respond and Improve involvement
  5. Collaboration and Integration
  6. Innovative, proactive and preventative

The Service Model is about: Self care and prevention; Community & integrated care; and Highly specialised Inpatient care.

The Integrated Care System (ICS) of which the Trust is a key partner and stakeholder, will improve the way mental health services are delivered by:

  • Re-design and integrating clinical and care pathways to better meet the needs of local populations
  • Develop population health management approaches that support integration of services
  • Create more robust cross-organisation working to tackle the challenges facing health and care systems
  • Work with key system partners and stakeholders (service users, carers, Vol sector , staff etc)
  • Collective responsibility across all partners for financial & operating performance & quality of care

There is a clear focus on supporting the shift of care from secondary care to settings closer to home. This will need greater collaboration with the range of community providers and Trust services will need to adopt a more joined–up approach across general and mental health particularly in collaboration with primary care (not just GP practices). There will be more of a locality approach to design and delivery of services and a major focus on ‘population health’ which improves physical and mental health outcomes for the whole population. This supports a more ‘holistic’ approach to clinical diagnosis at a individual level.

The focus on 3 care Groups helps to address in a different way the influences on children as they grow up where there is tremendous potential for mental health issues to arise. The focus on families includes improving the ability of parents and carers to access relevant information and guidance.

There are significant improvements to Adult services (page 22) including:

  • Reducing inequalities across communities and improving life expectancy of those in contact with mental health services
  • Develop locality-based multi-disciplinary ‘hubs’ with co-ordinated physical and mental health care.
  • Embed prevention and early intervention across all adult services reducing crisis where possible and strengthen crisis response.
  • Learning from the success of community health approaches in developing other community based service offers.

Improved Older People services include:

  • Maximise the integration of mental and physical healthcare for those with complex health issues
  • Strengthen a proactive preventative approach using ‘risk profiling’ for early identification
  • Re-design of Dementia pathways to ensure care delivered in the right place at right quality, particularly in care Homes.

 Engagement & Involvement

Here the Trust re-affirms its commitment to putting patients, service users and carers at the heart of services. Mention is made of the introduction in 2017-18 of the ’Collaborative Service Change Model’, strengthening partnership with all stakeholders.


There is a lot of service change being proposed in this document and the development of the ICS will support these developments. Some of the services mentioned will better support carers directly but the biggest impact is going to be on the improvement of the lives and outcomes for service users which I believe will have a positive impact on carers. I was involved in the early service introductions in the National Service Framework of 1999 and this document will take service quality and breadth further than I have seen the Trust move in even recent years. The key factor will be financial resources to back up the strategy and we need to make sure we have sight of the review process overlooking these developments. The very elderly amongst us worry at times how our children will be supported when we are gone. I believe my son will be better supported than at any time over the last 20 years.”

Click here for a copy of the document: Trust Clinical strategy and carer impact 31May19