The Blog: 28 October 2024

As I enter my final week as Chief Executive Officer of Mersey Care I thought I’d reflect on a few issues of learning from our significant growth and transformation over the last 12 years. It’s interesting to observe that across the country NHS trusts are starting to operate in models that are about ‘aggregation’. Sometimes this is about merger, acquisition and other times it’s about ‘group models’ or similar.

Whatever the mechanism, there’s a logic in driving up service standardisation, improving quality and safely reducing cost that is probably easier if done across the appropriate scale. I say this because it is precisely what Mersey Care has been doing over the last six years, tripling in size and expanding our services and footprint significantly.

We now offer a wider variety of services including physical community health, specialist learning disability care, talking therapies, children’s and young people’s community services in Liverpool, and support some of the most vulnerable and challenging mental health patients within the NHS. The scale and scope of provision has meant we’re able to focus on better, more standardised approaches, that have and will result in better outcomes, satisfaction and value for the public.

We see evidence of this in CQC visits, dropping waiting times, stable financial performance, the level of mutual aid we provide, stabilising recruitment and retention, the development of The Life Rooms and the incredible transformation of our inpatient estate. Moreover, in this time of growth, we’ve demonstrated signs of a safer culture with early adoption of Patient Safety Incident Response Framework (PSIRF), more and better quality reporting of incidents, focused learning to improve care and a safety and quality escalation culture that is a critical part of our strategy, not just a set of transactions.

All of these developments were accompanied by a real maturation of our digital and ‘data into action’ culture, much of that aided by a great collaboration with national digital colleagues, industry side partnerships and also some world class academics at the University of Liverpool. You can see the breadth of our services in the infographic below and how crucial our work is to the wider NHS system within Cheshire and Merseyside over the past year.

I don’t think we would have achieved such or as much sustainable change if, a number of years ago, we hadn’t decided to ‘open ourselves’ and take a good hard look at our culture and tackle many of the conscious and unconscious biases that existed and that were hardwired into our processes. This was the advent of what we now call Restorative and Just Culture and Learning. The learning bit is really critical – we’ve discovered you cannot regulate or performance manage your way to a learning culture. Instead, a mindset change is needed that supports and grows a psychologically safe operating model.

To this end I’m very proud of the work the trust has developed by focusing on improving organisational performance through focus on organisational health. Our work on culture has been the most difficult but rewarding work of my time in the NHS. CEOs carry the additional title of ‘Accountable Officer’ and this work has made me examine the meaning of accountability in a very different way by seeing personal and organisational accountability as a means to learn rather than (an often unintended) stick to harm people working in difficult circumstances. I know that my replacement, Trish Bennett, shares this view, which is great news for the years to come.

Much of the work carried out over the last 12 years has been heavily influenced by the insight provided by those with lived experience. Early on in my time, we started to talk about side-by-side honest, quiet conversations as well as larger set piece events like Your Voice, Your Change. My thanks to those who have contributed their energy and voice to supporting change; I have really appreciated the insight and candour with which we have worked together.

Those conversations with our ‘experts with experience’ began by the Trust embracing their knowledge to inform changes and improvements. One of the first innovations we introduced was to develop and improve the expertise of our service users and patients in everything we do. From the onset I was impressed with the idea of a clinician and patient sitting down together, having a conversation, and working together to improve our services.

Co-production was already taking place when I arrived, but it consisted of a small group of around 30 paid service users involved in all aspects of the Trust’s work. We took the decision to stop the payments and instead offer more opportunities in different roles, training and qualifications, which in turn provided a more representative volunteer base of more than 100 volunteers working across the organisation. Where possible our service users also take part in recruitment interview panels and provide important insights into better ways of working and how design in our new builds can provide more therapeutic environments that support recovery.

I’ve also been very proud about the way Mersey Care has developed new practices, such as embracing a Restorative Just and Learning Culture with many other Trusts now following suit. We also developed a ‘No Force First’ regime into our mental health care, which emphasises the need to support those experiencing acute distress to protect their rights and autonomy and increases the speed and depth of a person's recovery. That initiative has now expanded into the HOPE(S) model where a human rights approach is adopted for those in long term segregation

I’ve had some lovely, congratulatory messages from staff and colleagues outside of the organisation since I announced my decision to retire, but Mersey Care’s progress is due to a large team of talented people, right across the organisation, embracing a mindset and culture of kindness and continuous improvement, and always asking ‘how can we do things better?’

Steve Jobs, the founder of Apple, gave one of my favourite quotes about leadership and teamwork, saying: “It doesn’t make sense to hire smart people and tell them what to do – we hire smart people so they can tell us what to do.” That has certainly been the case here at Mersey Care where our clinical and support services expertise has helped to shape the way our services work today.

I just want to say how magnificent our teams were during the Covid-19 emergency. It was a set of circumstances that we’d not experienced before and for most of us it was a professional and personal challenge that I hope we don’t experience again. I spent time doing a second role during Covid-19 working to coordinate ‘out of hospital’ care and maintaining continuity and connection for many vulnerable people and communities. My thanks to all in the NHS, voluntary sector and Local Authorities who supported that work.

When I look back to how we’ve changed since I first walked through the door as the proud Chief Executive in 2012, the progress is incredible. More information about how we transformed from an organisation that specialised in mental health but needed serious investment into Mersey Care’s current state can be found on the website under the ‘Our Journey’ tab. Possibly the most significant progress during my time has been the strategic estates plan, which I’ve written about in great detail in a previous blog.

The Life Rooms has been an important part of this journey and has played a central role in mental health care. In many ways they were ahead of the game when we first opened the doors to our first Life Rooms at Walton Library in 2016, bringing together support for many factors which can affect mental health into one place. We now have four Life Rooms covering Southport, Bootle and Lee Valley, each providing a Pathways Advice service, a host of different courses such as building confidence, managing anxiety and support and advice on housing, debt and employment issues.

For about 25 years Mersey Care has had a limited research presence. Thanks to funding from the NIHR Mental Health Mission, we’ve now developed the Mental Health Research for Innovation Centre (M-RIC), a partnership with the University of Liverpool which will make sure we remain at the forefront of mental health research for years to come. M-RIC currently has 23 active clinical research trials for patients and service users and a further four trials due to start and span across mental health, primary care, respiratory and infection areas. 

Innovation is often de-prioritised amidst other NHS challenges, but is crucial to enhancing productivity and healthcare outcomes. I’m proud of the ‘can do’ culture at Mersey Care, which led to us being identified as the national mental health incubator, promoting innovation through new care models, multidisciplinary teams, and digital health solutions.

In conclusion, there are so many landmarks which I could have included in this blog, but simply can’t include everything. Similarly there are so many people within and beyond the trust and my time at Mersey Care that I want to acknowledge and thank for shaping me and my approach to leadership; in fact so many that this blog would be even longer than it is if I listed them all! So, I’ve decided to name no one in particular but please know that I am grateful to have worked with some of the most talented, generous and humble people imaginable and anything that I have achieved has only been possible because of them.

For decades, there has been broad consensus that to overcome the challenges facing the NHS, we must focus on providing more care in the community, so hospitals are able to treat the sickest patients, make better use of technology, and do more to prevent ill health. I am pleased to have left Mersey Care very well positioned to play a pivotal role in responding to these NHS Plan ambitions.

When I retire at the end of October, I am sure that the new leadership of Mersey Care, with Trish Bennett as the new Chief Executive Officer and Rosie Cooper as the Chair will improve us further, in the context of the new NHS Plan coming to life.

A huge thanks to everyone for the support over the years. I wish you and yours every joy and success.

Prof Joe Rafferty CBE

Chief Executive Officer

Mersey Care NHS Foundation Trust