mental health learning workshop – nhs england (midlands and east) joanna powell february 4, 2014

Mental Health Learning

Workshop – NHS England

(Midlands and East)

Joanna Powell

February 4, 2014

Plan

• How did we get here?

• Why am I here / my hopes for the day?

• Introduction to Parity of Esteem Programme (PoE)

• Emerging work areas

• E.g. Common ‘narrative’

• MH CQUIN

• Business as usual

• Everyone counts – Planning guidance 2014/15 – 18/19

• Why am I here / my hopes for the day?

NHS | Presentation to NHS England (Midlands and East) | 4 February 20142

A few of our drivers

3NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

4

Health

and Soci

al Care Act

2012

• The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement –

• (a) in the physical and mental health of the people of England, and• (b) in the prevention, diagnosis and treatment of physical and mental illness.

NHS

Mandate

• By March 2015, we expect measurable progress towards achieving true parity of esteem, where everyone who needs it has timely access to evidence-based services• NHS England’s objective is to put mental health on a par with physical health, and close the health gap between people with mental health problems and the population as a whole• Every community to have plans to ensure no one in crisis will be turned away, based on the principles set in the MH Crisis Concordat

Putting People Firs

t

• Parity Included in Priority 8 on the NHS England Balanced Score Care• Deliverable 11 against key deliverable: Put mental health on a par with

physical health, and close the gap between people with mental health problems and the population as a whole. Extend and ensure more open access to IAPT by March 2015, particularly for children and young people, and for those out of work


The vision

What Parity will mean to me:

My family and I all have access to services which enable us to maintain both our mental and physical wellbeing.

If I become unwell I use services which assess and treat mental health disorders or conditions on a par with physical health illnesses.

“Person centred,

coordinated care”

The patient


Cultural change is at the heart of the POE ProgrammeStrategic aim – for POE to be everyone’s business• It cuts across all NHS OF Domains • It is closely aligned to other major transformational

programmes – e.g. integration, person centred care planning and personalisation

• It does however also have to focus on reducing the many disparities which exist between Mental and physical health

How will the programme be delivered?• Specific improvement / change projects • Business as usual to support POE generally*• Ensure alignment with other organisations and groups

PoE Programme - key messages


Emerging PoE narrative

1. What’s the issue?

2. Where are we now?

3. Where do we want to be?

4. How do we get there?

Increasing and more complex

care needs

Poor outcomes for people

with mental illness

Person centred,

coordinated care

‘House of Care’ model

Our mandate from the government requires us to close the gap between mental and physical health services – to achieve parity NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

Mental illnesses are very common

In any one year 1 in 4 British adults experience at least

one mental disorder

Between 8% and 12% of the population experience depression in any year

10% of 5-16 year olds have a mental disorder

5.4% of men and 3.4% of women have a personality

disorder

Among people under 65, nearly half of all ill health is

mental illness

1.2m people in England have a learning disability

There will be over a million people with dementia by

2021

Among people under 65, nearly half of all ill health is mental illness

e.g. heart disease, cancer, diabetes

e.g. mainly depression, anxiety disorders, and child

disorders

% of morbidity in the UK: Physical v Mental illness1 Rates of morbidity in each age group (Equivalent life-years lost per 100 people)2

Morbidity from physical illness rises steadily throughout life,

whereas mental illness especially affects people

aged 15-44

Source: 1&2: Based on WHO, 2008. Further calculations by Mike Parsonage . see: LSE (2012) how mental illness loses out in the NHS


Yet, only a quarter of all those with mental illness such as depression are in treatment

% of population with condition

% of people with condition in treatment

Adults

Schizophrenia or bipolar disorder

1% 80%

Depression 8% 25%

Anxiety disorders 8% 25%

Children (5-16)

Conduct disorder or ADHD 6% 28%

Depression & / or anxiety disorders

4% 24%

Autistic Spectrum Disorder 1% 43%

How does this compare to treatment levels for those with long term physical health problems? (in comparable western countries: 94% diabetes, 91% hypertension, 78% heart disease)


We know significant challenges remain to putting mental health on a par with physical health

78%

54%

71%

48%

26%

40%

1. Accessed hospital services

2. Arrived at A&E by ambulance

3. Classified as an emergency

Mental healthNon-Mental health

Service users

People with mental health problems have a significantly different level of contact with physical health services compared with other patients1:

Source: 1- HSCIC (2013) HES-MHMDS Data linkage report; additional analysis; 2011-12. England (Experimental statistics). See: T.Fowley (2013) Bridging the Gap – p.9

Is this untreated need in the community?

…and stayed in hospital

around 30% longer

Why aren’t we picking up

earlier?

http://socialwelfare.bl.uk/subject-areas/services-client-groups/adults-mental-health/centreformentalhealth/155138bridgingthegap_fullreport.pdf

People with poor physical health are at higher risk of experiencing mental health problems…

Diabetes

Hypertension

Stroke

Cancer

HIV / AIDS

27%

29%

31%

33%44%

% of people affected by depression

People who experience persistent pain are four times as likely to have an anxiety or

depressive order as the general population


Mental health problems impose a total economic and social cost of over £105bn a year

• £14bn is already spent on mental health services

• Nearly a third of people with long term physical conditions have at least one co-morbid mental health problem. This can exacerbate the person’s physical condition and increase the cost of treatment by between 45% and 75% at a cost to the NHS of an estimated £10bn per year

• Medically unexplained symptoms cost the NHS some £3bn per year

• Mental illness has a significant impact on public finances: estimated that the costs of depression through lost working days are 23 times higher than the costs to the health service

• 1 in 4 unemployed people has a common mental health problem

• Childhood mental health problems can have a significant economic effect on society. It is estimated that a child with a conduct disorder will, by the age of 28, have generated costs (such as to the health, education, benefits and criminal justice systems) ten times as high as a child without conduct problems

Medical costs

Hidden costs


Culturally we have started to see attitudes to mental health shift over the past 10 years…

% a

gre

eing

with

sta

tem

ent

Public attitudes to mental health1:

Source: 1- The health and social care information centre (2011) Attitudes to mental illness – 2011 survey report

This shift in attitude is hugely important in the way we think about future service design – rather than see the community as a ‘barrier’ we need to start

seeing as an ASSET. How can we enable people to help other people? How do we unlock underutilised resources in our community (i.e. people) to improve

the well being of themselves and those around them?

Key question: how do enable new and innovative health (and other public) services so people are seen as ‘active participants’ in their care and individual / community outcomes rather than passive recipients?

…and new service models emerge with huge potential to improve outcomes

• Improving Access to Psychological Therapies (IAPT) programme had major impact in it’s first 3 years:

• treating more than 1 million people in IAPT services • more than 680,000 people completing a course of treatment • recovery rates consistently in excess of 45%

• Personalised Health Budgets: the national pilot programme indicated that personal health budgets “had a significant positive impact on care-related quality of life, psychological wellbeing and subjective wellbeing” of the people taking part. People with mental health problems reported improvements in their physical health, and people with physical health problems likewise reported better mental health

• Suicide prevention strategy : Findings from three mental health promotion pilot projects to address the raised suicide risk in young men show that:

• multi-agency partnership is key to promoting young men’s mental health;• community locations, such as job centres and young people-friendly venues, are

more successful in engaging with young men than more formal health settings such as GP surgeries;

• front-line staff feel better able to engage with young men if they receive training; • community outreach programmes are seen by young men as more acceptable

and approachable than services provided in formal healthcare settings.

Common mental health disorders

Severe mental illness

Mental illness

Examples:

New service models that put patients in control


The current design of our health system doesn’t ensure ‘whole-care’ packages

Most people with Serious Mental illness don’t receive physical health

checks

National audit of schizophrenia – only 29% of service users getting

proper metabolic monitoring

There are significant delays in diagnostic treatment for people

with learning disabilities

We run a national programme of health checks within school, but we

only check physical health


To realise the vision we are developing a ‘House of Care’ framework to support delivery…

Patients, carers and professionals will have the right information needed to provide the right care at the right time (e.g. medical care in hospital

and social care at home)

People will know where and to whom to turn for

assistance in managing their conditions.

Services will be available as and when needed by people without undue difficulty in transferring between agencies and

settings.


Improving physical healthcare to reduce premature mortality in people with severe mental illness (SMI)

Indicator 1: 65 per cent of funding for demonstrating, through the National Audit of Schizophrenia, full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with psychoses, including schizophrenia.

Indicator 2: 35 per cent of funding for completion of a programme of local audit of communication with patients’ GPs, focusing on patients on the Care Programme Approach (CPA), demonstrating by Quarter 4 that, for 90 per cent of patients, an up-to-date care plan has been shared with the GP

Mental Health CQUIN for 2014/15


The following cardio metabolic parameters (as per the 'Lester tool' and the cardiovascular outcome framework) are assessed;• Smoking status• Lifestyle (inc. exercise, diet, alcohol and drugs)• Body Mass Index• Blood pressure• Glucose regulation (HbA1c or fasting glucose or random

glucose as appropriate)• Blood lipids• Hepatitis C

Mental Health CQUIN for 2014/15


PoE Programme

20

Current top priorities• Addressing and improving crisis Care TOP one for

2014/15 • Data, Information and Intelligence • Development of capability and skills in commissioning –

including need to focus on cultural change / behaviour of commissioners change

• Delivering improvements to clinical services (including IAPT and increasing timely diagnosis and post diagnostic care for dementia)

• Improving physical health for people with serious mental illnesses – CQUIN – talk about laterDiscrete improvement project – Business as usual –

Collaboration with system partnersNHS | Presentation to NHS England (Midlands and East) | 4 February 2014

Planning Guidance 2014/15 -18/19

Headlines

• Outcomes drive everything we do

• Significant financial challenge: no change is not an option

• 2014/15 – transformation year in preparation for 2015/16 (Better Care Fund)

What’s new?

• Support available to support commissioners

• Operational (2 years) strategic (5 years) plans

• Integration / collaborative working a key feature

• Monitor / NHS TDA (providers and commissioners)

• Local authorities (Better Care funding)

• Unit of planning to support Health and Social Care planningNHS | Presentation to NHS England (Midlands and East) | 4 February 2014

• Strategic, operational and financial plans – process and overview (including direct commissioning)

• Bold, developed in partnership and locally led (unit of planning)

• Better Care Funding Plan @ Health & Wellbeing Board level

• Planning support

Part 1

Part 2

• Outcomes – NHS OF – linked to 7 ambitions

• Key measures (3)• Service characteristics (6) - to drive

transformation• Essential elements (4) for service

delivery


Level of ambition

NHS Outcome framework Outcome ambitions (7)

Domain 1: Preventing people from dying prematurely

1: Securing additional years of life for the people of England with treatable mental and physical health conditions

Domain 2: Enhancing quality of life for people with long-term conditions

2: Improving the health related quality of life of the 15 million+ people with one or more long-term condition, including mental health conditions 3: Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital.

Domain 3: Helping people to recover from episodes of ill health or following injury

4: Increasing the proportion of older people living independently at home following discharge from hospital.


NHS Outcome Framework Outcome ambitions (7)

Domain 4: Ensuring that people have a positive experience of care

5: Increasing the number of people having a positive experience of hospital care 6: Increasing the number of people with mental and physical health conditions having a positive experience of care outside hospital, in general practice and in the community

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

7: Making significant progress towards eliminating avoidable deaths in our hospitals caused by problems in care

Level of ambition (cont.)

Guide developed by Commissioning Assembly Quality Working Group


Key measures (3)

• Improving health, Health and Wellbeing Boards, Commissioning for Prevention. Every contact really does count

• Reducing health inequalities. Ensure the most vulnerable in our society get better care and better (integrated) services to improve health outcomes

• Parity of esteem focus on improving mental and physical health and ensuring that patients with mental health problems don’t suffer inequalities, either because of the mental health problem itself or because they then don’t get the best care for their physical health problems


Support available

26

Universal support can be found herehttp://www.england.nhs.uk/ourwork/sop/plan-sup-tools/


http://www.england.nhs.uk/ourwork/sop/plan-sup-tools/



Example of support available

27NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

NHS | Presentation to [XXXX Company] | [Type Date]28

Planning Guidance 2014/15 -18/19

Level Summary Relevance to POE

Ambition for NHS

• Outcomes NHS OF 5 Domains

• 7 measureable ambitions AND

• 3 key measures is

QOL / LTC ambition - IAPT and dementia referenced Trajectory for Dementia diagnosis and Trajectory for IAPT coverage and recoveryPOE is a key measureable

Steps CCGs are expected to undertake in order to deliver these ambitions

Local ambitions linked to the 7 measureable ambitions Planning fundamentals National conditionsIntegration /holistic care

POE is a planning fundamentalAcute Care -Plans not to have a negative impact on the level and quality of mental health services. Integration / holistic care - Dementia services particularly important Assurance process – POE to be included

Underpinned by CQUINS for Dementia and Mental Health - DES for dementia and learning disability - Quality Premium for IAPT Standard contract sanctions – MH MDS focus NHS OF – IAPT indicator


High quality care for all, now and for future generations

• High Quality – ‘Driven by quality in all we do – our patients rightly expect the best possible service’

• For all – ‘…whether need is for mental or physical help and support. We must put the greatest effort in providing care for the most vulnerable and excluded in society’

• For now – ‘Need to get better at sharing good practice rapidly across the NHS’

• For future generations – ‘Strategic plans developed in partnership working between commissioners, providers and local government to deliver models of care that will be sustainable in the longer term’


In summary


• The NHS Mandate clearly sets out priorities for the system

• We all need to collaborate in order to deliver the mandate

• NHS England National Support is there to support you and your local CCGs to deliver the NHS mandate

• What do you and your local CCGs need us to do to help you to deliver the mandate?

Any questions and thank you

Joanna Powell, Domain Team Lead NHS England

[email protected]


mailto:[email protected]

mental health learning workshop – nhs england (midlands and east) joanna powell february 4, 2014

Documents

nhs services

nhs of domains

drivers3 nhs presentation

physical health services

mental health disorders

mental health issues

health outcomes

physical health illnesses