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Last Updated: Thursday, 10 February, 2005, 12:13 GMT
Redefining mental health
By Nick Triggle
BBC News health reporter

Health chiefs explain how they aim to break the mould and become one of the first mental health trusts to achieve foundation status.
Wheelchair from Victorian asylum
Moving to new premises has helped to destigmatise mental health, officials say

Each afternoon school children crisscross the grounds of Harplands Hospital in north Staffordshire on their way home.

The act may not seem that important at first sight.

But what makes this truly remarkable is that the stylish 25m PFI centre in Stoke is actually a mental health hospital.

Just a decade ago it would have been unheard of for children to even enter the grounds of such a facility.

Hospital bosses believe it is a sign of how the community is now prepared to deal with mental health and could lead to North Staffordshire Combined Healthcare Trust becoming one of the first mental health trusts to be granted foundation status.


The hospital, sandwiched in between two schools, replaced a Victorian asylum situated 10 miles away in a small rural community three years ago.

North Staffordshire medical director Dr Roger Bloor said the trust purposely cited the hospital in a residential area to show the local community that mental health was not something that needed to be hidden away.

"Nothing has done more to destigmatise mental health than the opening of the hospital.

Foundation trusts
Only the top performing NHS trusts are entitled to apply for foundation status
Foundation trusts have more freedom to set their own priorities and decide how best to spend their money
They are also allowed to borrow money and keep the proceeds of sales
To date 25 trusts have been granted foundation status but another 42 are applying

"There was some opposition at first but after much consultation and engagement that changed."

And with the preliminary bid for foundation status already submitted, North Staffordshire chief executive Dr Chris Buttanshaw believes the community could now take an even bigger step.

He said foundation status offered the public the opportunity to roll back the years and embrace the health service in a way not seen since the NHS was formed after the Second World War.

"Before the NHS was set up, health services used to be run on a local level on a voluntary basis.

"But once the taxpayers took on the responsibility it cut off that community spirit."

Public role

Dr Buttanshaw, who has worked for the trust for the past decade, becoming chief executive three years ago, said the public have two roles in the foundation world.

"There is the trust board level to oversee what we do but it is also about whether the whole community wants to take an interest in caring for people with great difficulties."

Unsurprisingly, he remains optimistic the community will take up the challenge.

He also said he was confident mental health trusts - which tend to be smaller than acute trusts - could make the most of foundation status.

Harplands Hospital
Harplands Hospital opened three years ago under a 35m PFI project

He said one of the problems that dogged Bradford Teaching Hospitals NHS Foundation Trust, which had its chairman removed last year amid concerns over a budget deficit, was a breakdown in its relationships with other agencies.

"We, as do all mental health trusts, have close working relationships with lots of agencies such as the voluntary sector and social services.

"I think Monitor [the foundation trust regulator] will find we are financially sound."

He also said mental health trusts have the right "entrepreneurial spirit" to thrive under foundation status.

"We are used to change, we are constantly having to deal with it.


"Four years ago we all tended to be much bigger but then primary care trusts took on some of our services, we have also had to adapt to a changing relationship with local government."

Staff working on the front-line also see the nature of North Staffordshire, which with an 87m budget is smaller than many of the country's 80 mental health trusts, as an advantage.

Rob Grant, an acute ward manager at Harplands Hospital, said being relatively small meant the trust was more flexible than some of its larger cousins.

"It allows us to have a good working relationship with staff and users, which makes us more responsive. Surely that is a good thing if we have foundation status?"

Dr Chris Buttanshaw
Dr Buttanshaw believes mental health trusts are tailor-made for foundation status

Patients also welcomed the bid, if somewhat more cautiously.

Neville Smallwood, director of patients body North Staff Users Group, said: "We would support anything that involves members of the public and patient users in the planning and development of services."

He also acknowledged the trust had helped in recent years to destigmatise mental health, although others have also played a role, he said.

But he added: "I would not say there is a lot of involvement of the community in services at the moment. That will be the challenge."


Other difficulties also lie in wait for the trusts.

There is always the risk it will lose its top three-star status - the Healthcare Commission is due to issue new grades in the summer - which would disqualify the trust from the foundation process.

And the issue is further complicated by the close relationship with neighbours South Staffordshire Healthcare NHS Trust.

The two trusts have submitted "independent but linked" submissions as they share various specialist services.

The move means that if one of them does not achieve foundation status or is subsequently deselected it could have implications for the other.

Dr Ken Barrett, who runs a neuro-psychiatry service for both trusts, acknowledged the problem.

But he said: "I think we will still be looking to innovative things no matter what. The clinicians will still be there, the resources will still be there, the units are not just going to stop."

Everyone, it seems, is singing from the same hymn sheet. It just remains to be seen whether the government is listening.

Hospitals seek foundation status
26 Jul 04 |  England
Q&A: Foundation trusts
07 May 03 |  Health

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