Collaboration & Prevention Exploring new models of care in tertiary mental health. Colin Martin Chief Executive

Transcription

1 Collaboration & Prevention Exploring new models of care in tertiary mental health Colin Martin Chief Executive

2 Scope of Presentation New Care Model Pilot Accountable Care Partnership Director of Finance to Chief Executive

3 Geography and Major sites

4 New Care Model Tier 4 CYP Dates back to Planning Guidance for 2016/17 Secondary providers to pilot managing the budget for tertiary services Adult Secure and Tier 4 CYP One of 6 pilots 4 Adult Secure 2 Tier 4 CYP Moved to shadow form on 1 October 2016 Went live 1 April year pilot initially

5 New Care Model Tier 4 CYP WHY? Lack of sufficient community services Use of beds too high A lot of children in out of area placements Experience and evidence of impact enhanced community services can make Lack of local PICU beds Number of high cost packages Lack of incentives in the system to change the care pathway WHY WOULDN T WE?

6 Our Aims Crisis and Intensive Homes Treatment Services available in all localities Improved pathway with greater alignment between inpatient and community services Reduced number of admissions Reduced Length of Stay Reduced overall use of beds (reduction of 50%) Reduction in Out of Area admissions and distance travelled Improved patient and carer experience Financial savings for reinvestment in children s mental health

7 What s been achieved so far (1) We ve taken over the budget for young people from the Trust area who need an in-patient admission (spans 2 NHSE hubs and 9 CCGs) Communication across the system has increased including availability of home treatment options to support home leave / discharge planning, at least weekly conversations between project manager and community CAMHS team managers / NHSE Case Managers / in-patient provider in York

8 What s been achieved so far (2) We ve appointed Crisis and Home Treatment staff across North Yorkshire and York and the service is now available 10am to 10pm every day Feedback from acute hospitals has been extremely positive. Something has changed, and I can only put this down to the crisis team s work. What your team is doing certainly feels to be working We ve examples of the team being able to support young people, families and carers at home, avoiding admissions to mental health units

9 Initial 6 month data (1) Median Distance from Home snapshot at Total all current admissions: 27 Reason for admission: Target Month 6 Assessment & Treatment achieved Eating Disorders achieved PICU achieved Low Secure achieved Medium Secure - 97 Repatriations since Total : 15 discharged home with community support 7 transferred to unit closer to home 8

10 Initial 6 month data (2) Repatriations in 2017/18 OOA OBD baseline 16/ Target for 17/ April September surpassed target by 7% Total OBD in 2017/18 OBD baseline 16/ Target for 17/ April September missed target by 14% M6 Sept on target

11 Finance - Plan Total Budget inclusive of TCP Patients 11.8m TCP cohort excluded 2.1m Total Budget for NCM 9.7m across 15 Providers of which 7 NHS and 8 Independent Sector Plan to reduce expenditure in 17/18 by 1.4m with 1.3m investment into Crisis and Home Treatment Team in North Yorkshire and York Further net savings planned for 18/19 of 1.3m

12 Finance Month 7 17/18 Position Planned Expenditure as at October 5.6m Actual Expenditure as at October 4.8m 0.8m saving against savings profile of 0.5m Investment in Crisis Team 0.7m as at Month 7 Caveats: Ongoing discussions regarding Transforming Care Cohorts Savings mitigated by Medium Secure / Over 18 year old patients

13 Challenges Working with two NHSE Regional Teams NE&C and Y&H Availability of accurate data Legal frameworks ie ability of NHSE to delegate contract management Running alongside service reviews being undertaken by NHSE nationally Variance in service provision/utilisation across the areas we serve

14 New Care Models Wave 2 Secure Care Partnership with NTW Covering Cumbria & North East Including Learning Disabilities

15 Accountable Care Partnership or What happens when you have a coffee with a CCG Chief Officer who has just paid 700k for a Package of Care!

16 What is it all about? A unique partnership, recognising where the expertise is and using that together Making sure we work with our LA and other partners to ensure the best for our people wherever they are. Avoiding another Winterbourne Doing the right thing for the right reasons Building trust, assuming we all want the best Being brave enough to try something new and being happy to push the boundaries to achieve better lives Commitment to LD/MH including ring-fencing resource

17 Why? Lack of assurance on quality Need to bring together the expertise most complex people Want to get it right for the future Emptying beds but not checking back Pressure to deliver transforming care requirements (enhanced high cost community services) Fragmented system (multiple providers, multiple commissioners) Challenge to deliver system transformation in context of above Escalating cost pressures in LD (CHC, IPOCs, sec 117s) Mental Health 5yr FV asks for greater transformation and integration

18 The Who Organisations All five CCGs and TEWV, Spec Comm, LA partners Positive involvement of our providers, Vol sector and people who use services People Incrementally planned, but initially LD Specialist Packages of Care CHC/117/Joint Packages (NHS funding) All age groups Could include ALL mental health and learning disability provision

19 The What Clear focus on outcomes not process enhanced MDT oversight of all cases enhanced people and system outcomes increased assurance on most complex packages Better flow and transition from Spec comm.(ncm) increased quality assurance Moving investment to community focussed services inc. vol. and comm. sector providers enhanced contract management enhanced performance management

20 The How Clear governance Commissioning Hub for Learning Disabilities all LD services and (potentially MH health) spend managed through an accountable care partnership, Partnership with local authorities is key to success Mutual support for all - inc support for providers ACP responsible for delivering on NHS local and national outcomes ACP responsible for the quality assurance for NHS across the system ACP responsible for the NHS budget

21 What might the concerns be Lack of governance How are people able to influence? Conflict of Interest with TEWV as a provider and lead ACP partner Are we pulling money into specialist services not pushing money out to community infrastructure Clash with LA as lead for LD Who will do what? Is it all set, can we influence things? Will we squeeze out voluntary sector partners Does it affect our local integration of services

22 Vision The Accountable Care Partnership will work together as one responsive system to plan, buy and deliver high quality, best value health services for those living with learning disability or mental health needs

23 Director of Finance to Chief Executive