Delivering the transformation of children and young people s mental health services

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1 Delivering the transformation of children and young people s mental health services Simon Medcalf Head of Mental Health, NHS England 4 October

2 Context: Implementing the Five Year Forward View for Mental Health 2

3 Five Year Forward View for Mental Health Simon Stevens: Putting mental and physical health on an equal footing will require major improvements in 7 day mental health crisis care, a large increase in psychological treatments, and a more integrated approach to how services are delivered. That s what today's taskforce report calls for, and it's what the NHS is now committed to pursuing. Prime Minister: The Taskforce has set out how we can work towards putting mental and physical healthcare on an equal footing and I am committed to making sure that happens. The report in a nutshell: 20,000+ people engaged Designed for and with the NHS Arms Length Bodies All ages (building on Future in Mind) Three key themes in the strategy: o High quality 7-day services for people in crisis o Integration of physical and mental health care o Prevention Plus hard wiring the system to support good mental health care across the NHS wherever people need it Focus on targeting inequalities 58 recommendations for the NHS and system partners 1bn additional NHS investment by 2020/21 to help an extra 1 million people of all ages Recommendations for NHS accepted in full and endorsed by government 3

4 FYFVMH core priorities Promoting good mental health and helping people lead the lives they want to live Integrating Care Creating a 7-day NHS for mental health (right care, right time, right place & recovery focused) Hard-wiring mental health across health and social care Implement the whole system approach described in Future in Mind, helping at least 70,000 more children and young people to access high quality care each year by Up to 29,000 per year more people should be supported to find or stay in work each year through increasing access to psychological therapies for common mental health problems and doubling the reach of Individual Placement and Support (IPS). Ensure that qualified employment advisers are fully integrated into expanded psychological therapies services. Establish a comprehensive health and justice pathway. Explore the case for using NHS land to make more supported housing available (DH, CLG, NHSE, HMT) 30,000 additional women each year should have access to evidence-based specialist mental health care during the perinatal period. There should be an increase in access to evidence-based psychological therapies to reach 25 per cent of need so that at least 600,000 more adults with anxiety and depression can access care each year. There should be a focus on helping people who are living with long-term physical health conditions 280,000 more people living with severe mental illness have their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and intervention. No acute hospital should be without all-age mental health liaison services in emergency departments and inpatient wards, and at least 50 per cent of acute hospitals should be meeting the core 24 service standard as a minimum. A 24/7 community-based mental health crisis response should be available in all areas across England. For adults, NHS England should invest to expand CRHTTs At least 10% fewer people should take their own lives through investment in local multi-agency suicide reduction plans. Promote equalities and reduce health inequalities in mental health through leadership and transparency Establish comprehensive access pathways and standards for mental health (across conditions, ages and settings) Promote a co-ordinated approach to innovation and research Produce and deliver on a multi-disciplinary workforce plan Improve data and transparency across the life course, including a MH FYFV dashboard Reform payment and incentives to move away from unaccountable block contracts Establish strong leadership (local, national and cross-government) for a mentally health society 4

5 Timeline for investment and improvement 16/17 17/18 18/19 19/20 20/21 Benefits realised Promoting good mental health and helping people lead the lives they want to live 1 Children and young people s mental health services transformation Suicide reduction Individual placement and support (employment) Mental health New Models of Care Secure care transformation Community rehab/ step down By 2020, 70,000 more CYP have access to high quality care each year. 10% fewer suicides Individual Placement & support reach doubled and people find or stay in work Transforming secure services to provide more specialist community provision and step-down care to reduce the dependence on secure inpatient units. Integrating care 2 3 Specialist perinatal care Delivering evidence based psychological therapies to people of all ages with long term conditions and expanding access for adults from 15% to 25% Premature mortality reduction plans in place Creating a 7-day NHS for mental health (right care, right time, right place & recovery focused) Out of area treatment dataset Early intervention in Psychosis to 50% Liaison and Diversion Evidence based physical care screening and interventions for those with SMI Crisis resolution home treatment teams + Out of area treatment reduction Liaison mental health services Early intervention in psychosis service improvement Hard-wiring mental health across health and social care 30,000 more women each year access specialist perinatal care 600,000 more people to access psychological therapies 280,000 people with SMI have physical health needs met intensive home treatment is available in every part of England Liaison in all hospitals with 50% at core 24 60% of people experiencing a first episode of psychosis receive NICE care within 2 weeks Liaison and Diversion schemes (including CYP) across England. 4 STPs development and assurance HEE workforce strategy 5 year data plan STP delivery mechanism including via CCG improvement and assessment framework and regional support Outcomes based payment approach in place CYP LTPs refreshed and integrated into STPs Mental health integral to STPs Outcomes based payment approaches implemented, Data and transparency revolution including scorecard and dashboard Workforce strategy delivered 5

6 FYFVMH into action (1): The implementation plan For the first time, implementation plan (July 2016) sets out national objectives, expected trajectories and funding available for all priority areas within the FYFVMH. Chapters cover: 2. Children and young people s mental health 3. Perinatal mental health 4. Adult mental health: common MH problems 5. Adult mental health: community, acute and crisis care 6. Adult mental health: secure care pathway 7. Health and justice 8. Suicide prevention 9. Securing transformation: testing new models of care 10. Securing transformation: healthy NHS workforce 11. Securing transformation: infrastructure and hard-wiring 12. The support offer

7 FYFVMH into action (2): Planning guidance 17/18-18/19 Two year timeframe for NHS planning guidance. National must dos for NHS include all relevant commitments in FYFVMH over these years. Separate annex on mental health including detailed actions. Expectations that guidance will drive STPs and local contract negotiations to be completed by end December

8 FYFVMH into action (3): STPs Guidance for STPs describes key MH challenges and objectives. MH should be mainstreamed and not just its own section in an STP. Success in 2020/21: Improve access for CYP, perinatal, and IAPT. Develop community services to reduce inpatient bed usage. Provide holistic care across physical and mental health. Actions in 2016/17: Co-produce plans with local people and system partners. Refresh LTPs and set ambition. Deliver new standards. Baseline current services, design pathways and plan for improvement. Improve data and reporting.

9 Focus on children and young people s mental health 9

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11 Children s Mental Health Mentioned at least once Number of mentions of children s mental health in UK newspapers Year

12 Key issues Access Waiting times Vulnerable groups Transition Economics of investment Infrastructure/resources Systems 78 Average spend per child 0-17 yrs 6.6% Not enough is being spent CYPMH as proportion of MH spend (2012/13) The high cost of getting it wrong YP with a MH problem are 8x more likely to have contact with YJS Twice as likely to be claiming benefits 0.7 Number of WTE CYPMH clinical workforce per 1, yr olds in England. 270k Low workforce capacity 102 Number of 5-16 yr olds with a diagnosable MH condition per 1,000 in England. High numbers of referrals Approx annual total CYPMH referrals 14/15 Tiered system Step-care models CCGs 0-25s Varied approaches Thrive Integrated pathways LAs The low cost of investing early Long waiting times Various commissioners 229 Unit cost Group CBT 7,252 Total lifetime benefit 32 weeks Average maximum wait for first appointment (NHS benchmarking) NHSE MoJ Schools 12

13 Children and young people s mental health: Current performance of the system Increasing referrals: 11% increase in past year 60% increase since 2012/13 Remain constant at approx. 75% of referrals accepted Increasing waiting time: Average maximum wait for routine appointment = 32 weeks (up from 22 weeks in 2013/14) Average of all waits TBC in October Increasing contacts: Increase by 46% in two years (80% of contacts are face-toface) DNA rates unchanged (c10%) Reducing workforce capacity: Total CYPMH workforce c10,000, of whom 58% are part time. Over 1,000 current vacancies in CYPMH teams. Balance of funding: Total CCG spend on CYPMH in 15/16 = 476m NHSE spend on Tier 4 services = 279m Represents 6% of total CCG MH budget broadly unchanged since 1990s. Source: NHS Benchmarking, NHS England 13

14 2020 vision By 2020/21, there will be system-wide transformation of the local offer to children and young people underway, with LTPs embedding Future in Mind principles and fully integrated into STPs across the country: At least 70,000 more CYP receiving swift and appropriate access to care each year Completed national roll-out of CYP IAPT programme with at least 3,400 more staff in existing services trained to improve access to evidence based treatments 1,700 additional new staff to support improved access to evidence based treatments Evidence based community eating disorder services for CYP across the country 95% of those in need of eating disorder services seen within 1 week for urgent cases & 4 weeks for routine cases. Improved access to and use of inpatient care, having the right number and geographical distribution of beds to match local demand with capacity, and leading to an overall reduction in bed usage. Improved crisis care for all ages, including investing in places of safety 14

15 Additional CCG funding ( m) CYP receiving treatment (% of need) Improving access At least 70,000 more children and young people receiving evidencebased treatment each year: Increasing access to meet at least 35% of local need (to be reviewed pending new national prevalence survey in 2018). Treatment = at least two contacts with CAMHS team. Equates to c33% real terms increase in provision for average CAMHS teams but many areas will need to go further. Based on recommended caseloads, expect this increase to require an additional 1,700 new staff. Not just about access but also quality of the care received and outcomes. Will be supported by new generic CAMHS standards setting out evidenced-based interventions across the pathway.

16 Funding CYP MH transformation supported by 1.4bn additional funding announced during 2014/15: 1.25bn over for wider transformation (including 15m per year for perinatal mental health) 30m per year for eating disorders

17 Vision and commitments By 2020 At least 70,000 more CYP receiving swift and appropriate access to care each year, increasing access to meet at least 35% of local need. NHSE DWP DfE HEE CYP IAPT national rollout with at least 3,400 more staff in existing services trained. 1,700 additional new staff. PHE Evidence-based community eating disorder services for CYP across the country. MoJ 95% of those in need of eating disorder services seen within 1 week for urgent cases and 4 weeks for routine cases. DH By 2020 there will be system-wide transformation of the local offer to children and young people underway, with LTPs embedding Future in Mind principles and fully integrated into STPs across the country. Improvement of inpatient care; reduction of bed usage. Improved crisis care for all ages, including investing in places of safety. LAs NHS Digital DCLG 17

18 It s a whole system.. 18

19 CYPMH delivery plan on a page Project Outcome/deliverables Date 1. Supporting transformation 2. Workforce development Refresh and republish 123 LTPs, incorporate into STPs Embed regional MH improvement teams Commissioner development programme: guidance, training and tools Pilot and report on proposed CAMHS currencies for payments Develop national data/mhsds/dashboard of metrics CYP IAPT: increase to 100% coverage by 2018 Support provision of new workforce for improved access (HEE) 3. CAMHS pathway Develop generic CAMHS care pathway First point of contact; scheduled care; intensive interventions 4. Eating disorders Deliver dedicated community ED teams to meet standards Whole-team training and service specification Extend pathway guidance to include in-patient services 5. Crisis care Develop 24/7 emergency response pathway and access standard Test new models of care for CYP in crisis in UEC vanguards 6. Specialised commissioning Recommissioning of Tier 4 beds Roll out bed management system Guidance to support development of plans for collaborative commissioning with CCGs 7. Vulnerable groups Develop forensic CAMHS/complex needs service and pathway Specialised framework of integrated care across YOIs, SCHs etc. Health and justice collaborative commissioning networks and JSNAs Ensure Care and Treatment Reviews for CYP are in place at transition Test personal budgets for looked after children Annual cycle March 2017 March 2017 March 2018 Ongoing 2018/ /21 March 2017 (guidance) March 2018 (assmt) 2020/21 March /18 October 2016 March /18 19

20 A five-year programme Year /18 Seeing different delivery across the whole-system, Increasing staff, Knowing the remaining challenges Year /19 LTPs focusing on remaining whole-system gaps Year /20 and beyond. At least 35% of CYP with diagnosable need accessing treatment Year /16 Vision/destination, LTPs, investment New Models, innovation Knowing the challenges Year /17 Delivery Measurement Innovation and Impact Living systems contain their own solutions. Somewhere in the system are people already practicing a solution that others think is impossible or they posses information that could help many others. Or they defy stereotypes and have the very capability we need. Margaret J Wheatley 20