The National Audit on Schizophrenia A Commissioners Perspective Dr Sohrab Panday General Medical Practitioner Mental Health Clinical Lead Peterborough LCG Amber Valley LCG Hardwick CCG NHS England Clinical Lead East Midlands Strategic Clinical Network Parity of Esteem Commissioning Assembly Group
The Challenge ahead for us all...(1) 2012 The Schizophrenia Commission; Rethink, also NAS1; First National Audit of Schizophrenia Poor monitoring and intervention of risk factors for diabetes and cardiovascular disease 50% BMI, 10% hyperglycaemia followed up Service users if poorly responsive wait too long to be start clozapine Significant gaps in available cognitive behavioural & family therapies Inadequate provision of information and support for carers Inadequacies in information systems Employment support clearly inadequate
The Challenge ahead for us all... (2) 2014; A second look at 5800 SMI (100/MH trust) NAS2 No significant improvement! NICE; Publication of new clinical guideline: NICE CG178, 2014 Psychosis & schizophrenia in adults: treatment & management Clarification of Responsibility for PH checks! MH Trust < 12 months; or until stable Primary Care > 12 months; unless other local arrangements Regional variations are very significant in all aspects Good clinical practice exists in places but outcomes still poor Equally critical is to engage users and destigmatise service
NAS2 Recommendations for Commissioners Clinical Commissioning Groups [CCGs] & Health & Wellbeing Boards 4.1 Work with the DOH & NHS England to improve mental health service access to IT 4.2 Adopt the important recommendation in new NICE Guideline regarding lead accountability for the monitoring of service users' physical health (NICE 1.3.6.5): a) Specialist mental health teams to assume lead responsibility for the first 12 months or until the service user s condition has stabilised. b) Thereafter primary care to assume lead responsibility,unless there are well developed local agreements. To ensure IT systems support rapid sharing of the results of routine monitoring of PH of service users between primary and secondary care (NICE 1.5.3.2) Ensure local agreements between primary and secondary care for collaboration. 4.3 Commission CBT(NICE 1.4.4.1) & family interventions (NICE 1.4.4.2) Map prevalence & review how spending can reduce repeat admissions. 4.4 Commission services to support staying in, or gaining new, work (NICE 1.5.8.1).
Helpful National Mental Health Policy Drivers 1- Parity of Esteem www.england.nhs.uk/wp-content/uploads/2014/02/nhs-parity.pdf 2- Mental Health Crisis Concordat www.gov.uk/government/uploads/system/uploads/attachment_data/ file/281242/36353_mental_health_crisis_accessible.pdf 3- Five Year Forward View www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
Cultural change is at the heart of the POE Programme Parity is everyones business Parity is the written throughout the stick of Blackpool Rock
The NHS England Planning Guidance 2014/15-18/19 Local Area Team Assurance process includes Parity Parity to be embedded into CCG Business as Usual Acute Care Plans - NO negative effect on mental health Mental Health funding to be protected cf acute trust Workforce planning and development Mental health training for non specialists? Support from your Area Team, local SCN and AHSN NEW Funding new 80 million for IAPT, ED and EI
New National CCG Parity Targets 2015/16 IAPT RTT 18 Weeks The proportion of people that wait 18 weeks of less from referral to entering treatment v number of people who finish treatment in same period 95% by April 2016 IAPT RTT 6 Weeks no.waiting < 6 weeks v no. finishing a course 75% by April 2016 No. received a course of treatment v no. received single treatment (no standard set) Average number of treatment sessions (no standard set) First episode psychosis treated with a NICE approved care package within 2 weeks of referral >50% by April 2016 Acute trusts with effective model of liaison psychiatry 100% by 2020
The New Commissioning Landscape NHSE Mandate permission to innovate so long as... GOOD OUTCOMES Quality Care - Triad of Safety, Efficacy and Positive experience Value Based Commissioning - Triad - patients + clinicians+ experts Commissioning for Value for Money all the above plus efficiency Holistic care, person centred, individualised care Community Care, Independence,Self Care and Carer Support LTC Year of Care Model as opposed to acute episodes of treatment Integrated Health and Social Care New future Approaches... Borough specific Multi Specialty Teams Co-Commissioning Primary Care Public Health - prevention and employment emphasis Social Capital and Resilience
The Forward View : 29 New NHS England funded Vanguards - 200M funding http://www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/new-care-models/ Multi-specialty Community Providers (MCPs) Vanguard Erewash; General Practice Community and Mental Health Trusts Larger group practices or Federations of smaller practices to include a multitude of specialist support Shift the majority of outpatient work and ambulatory care out of hospital settings. Run local community hospitals expanding their services - diagnostics, dialysis, chemo New care model Primary and Acute Care Systems (PACS) Vanguard: Mansfield and Ashfield CCGs Vertical as well as Horizontal Integration of acute and community providers New care model enhanced health in care homes Vanguard: Nottingham City CCG
EMSCN Parity Programme Project First phase (to 1.8.2015) supporting mental health commissioners/ providers to achieve: Improved health outcomes for patients with serious mental illness, whatever setting Tackling health inequalities to reduce premature mortality in people with SMI Producing an East Midlands wide response statement to the crisis concordat Supporting stakeholders to implement in line with the best evidence, ie Working with Parity of Esteem leads to ensure engagement at regional and national level Working with CCGs to secure commitment to Parity of Esteem Programme mandate; Liaising with CCG leads to design and deliver a commissioning development programme Goal consistent collaborative commissioning across physical & mental health services
EMSCN Funded Innovation Pilots Parity of Esteem Improving the Outcomes for SMI Northants Mental Health Trust/Nene CCG Incorporate smoking cessation services provided in Northamptonshire within the new well-being service Derbyshire Mental Health Trust Chesterfield and NE Derbyshire Hardwick CCG & Erewash CCG for Derbyshire Develop a clinic to improve access and monitoring of physical health needs of mental health patients under the Crisis & Home Treatment Team Enhancement of VSPA service to support patient with mild, moderate and serious mental illness Lincolnshire West CCG on behalf of Lincolnshire Leicestershire Mental Health Trust To increase the uptake of physical health checks and help develop care pathways and services for people with SMI/LD, through two champions (Experts by Experience) Targeting and engaging BME men and women with SMI, using literature and music based interventions to improve well-being and engagement
In Summary... The Problem is not new however National & Local Commissioning is Changing rapidly Providers are coming together to be accountable Standards are clear... NICE Parity of Esteem is beginning to happen! Hallelujah Money is finally flowing towards mental health Co-produce to improve access and compliance Innovation is everywhere especially the East Midlands 2017 NAS3 should show significant improvements!...thank you Dr Sohrab Panday spanday@nhs.net