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CLIVE Stevenson is a very optimistic person. He greets you with a beaming smile and makes you feel instantly comfortable. But behind the amicable personality, there is a man who knows he has a lot of work on his hands.

Just half way through the year, South Buckinghamshire NHS Trust is already £500,000 over budget, largely due to the cost of treating mental health patients out of the county.

Patients at the Haleacre Psychiatric Unit of Amersham Hospital are being sent to other parts of the country for more specialised treatment at a cost to the taxpayer of between £50,000 and £75,000 for each patient every year.

Government figures show that each Bucks' patient costs £5,960 - £720 more than the national average - and emergency re-admission rates from mental health units such as Haleacre remain high.

Despite the statistics, Mr Stevenson is confident that the next 12 months will see a massive improvement in terms of both cost and quality of services.

The Government has introduced a national service framework for adult mental services which sets specific targets for trusts.

One of them is a round-the-clock, seven-day-a-week service for patients with severe mental health problems. At present, people with 'out of hours' problems have to go to their GP in the first instance.

Mr Stevenson, who expects the initiative to be in place by next April, said: 'The form it will take locally is still being worked on and I can't give specifics, but it will provide services over that timeline to people who have a severe mental health need.

'It does not mean that the full range of community services will be provided over those 24 hours but at least someone who presents a crisis should be able to get through to someone who should be able to provide some help.'

By the same deadline, the trust is also aiming to introduce a system called assertive outreach, by which mental health services are delivered where the person is rather than at some central point.

The plan, says Mr Stevenson, is to make sure contact between services and patients is provided on a continual basis.

He seems a little less confident, though, when asked if the trust will be able to find staff to fill these new roles. Frith Ward at Haleacre had to be closed last December because of a recruitment crisis.

Mr Stevenson said it had become impossible to employ enough agency staff to prevent the ward becoming 'unsafe'.

The trust solved the problem by appointing 17 nurses from Trinidad and Canada, and the ward was re-opened in mid-June.

Mr Stevenson said: 'Recruitment of mental health professionals is a national problem. If we take nursing, I recently heard a report of London mental health trusts in desperation thinking of establishing staff hotels in London to try to provide accommodation at a reasonable rate.

'We've filled virtually all of our nurse vacancies. On the acute ward, where we have experienced a particular problem in recruiting people, we have one qualified nurse vacancy right now. It's a lot easier now but I'm not complacent about it. We do have difficulties in recruiting staff, primarily because of the price of accommodation locally.'

The cost of treating patients out of the county has hit the trust hard, but Mr Stevenson said the opening of a new intensive care service at the Amersham site will go a long way to solving the problem.

The facility, which is expected to open in March, will provide ten beds.

'What we are looking to is a unit that is a locked facility but primarily provides intensive nursing care to a client group who are in the most acute phase of their illness. It would mean fewer people having to go out of the county,' he said.

'We have been making bids for an intensive care unit for six or seven years. We've known what we've needed to develop, and we have been making strenuous efforts to obtain funding to develop those services. Lately, we have been successful in getting those funds.'

A recent report by the Revolving Doors Agency said that, over the last few years, hundreds of people with mental health problems in High Wycombe have fallen through the net of helping services.

The charity has helped these people, who often become involved with the criminal justice system, to gain access to mainstream services.

The findings have not gone unnoticed by Mr Stevenson, but he argues the problem is a national one.

'Falling through is a much mooted phrase - it's a clich which has existed for a long time. I have to say, nationally yes, people have fallen through the net and there have been a number of high profile inquiries pointing out some problems with how services tick together.'

The way in which services tick together in Bucks is set for a fundamental change with the creation of a new specialist mental health trust by April.

South Buckinghamshire NHS Trust and Aylesbury Vale Healthcare NHS Trust are combining to create the new body.

'We are convinced it will provide an opportunity to develop even better mental health services then we currently do. It will allow us, from the trust executive board downwards, to focus purely on the needs of the mentally ill within our catchment area,' said Mr Stevenson.

The new trust will work closely with users of mental health services and carers. Mr Stevenson said that a non-executive member of the trust board will be a person with experience of using mental health services.

With his smile still in place, he added: 'We are acutely aware of where our services need to be further delivered. We have some gaps which we are working on and filling and we are clearly working towards improving some of those services.'