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West

Midlands

Mental

Health

Triple Aim

Gap

15th June 2016

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Provide West Midlands partners and leaders with an update on :

o The national 5year forward view priorities in mental health

o The progress with the STP

o The findings and emerging recommendations of the Mental Health Commission

Provide the Midlands partner leader with the most up to date available data and intelligence to inform the STPs three components: the Health and Wellbeing gap, the Care and Quality gap and the Social and Economic wealth gap

Enable a discussion among the leadership partners on the key priority opportunities for prevention, implementation of the new mental health standards, and sustainable transformations needed to improve outcomes and value

Agree what platform and supports West Midlands leaders need to inform the ongoing discussions and plans

Why Are We Here?

2

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Dr Geraldine Strathdee – National

Clinical lead, Mental Health

Intelligence Network and

Consultant Psychiatrist

3

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Agenda

4

• Session 1 The National and West Midlands Context

• Session 2 Information & Intelligence on the West Midlands

• Session 3 Planning for the Future

• Next Steps

• Lunch

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Giles Beresford - Deputy Clinical

Director

5

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The future of mental health: the Taskforce 5 year forward view and beyond

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Mental health problems in the

population:

One in ten children between the

ages of 5 to 16 has a diagnosable

mental health problem.

One in five mothers has depression,

anxiety or in some cases psychosis

during pregnancy or in the first year

after childbirth.

One in four adults experiences at

least one diagnosable mental health

problem in any given year.

One in five older people living in the

community and 40 per cent of older

people living in care homes are

affected by depression.

The current state of mental health

Experiences of mental health care:

It is estimated that up to three quarters

of people with mental health problems

receive no support at all.

People with severe mental illness are

at risk of dying 15 - 20 years earlier

than other people.

Suicide rates in England have

increased steadily in recent years,

peaking at 4,882 deaths in 2014.

In a crisis, only 14% of adults surveyed

felt they were provided with the right

response.

“The NHS needs a far more proactive and

preventative approach to reduce the long term impact

for people experiencing mental health problems and

for their families, and to reduce costs for the NHS and

emergency services”.

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Taskforce priorities

Priority 1: A 7 day NHS – Right Care,

Right Time, Right Quality

Priority 2: An integrated approach to

mental health and physical health

Priority 3: Promoting good mental

health and preventing poor mental

health

Priority 4: ‘Hardwiring’ mental health

across the NHS

Moving away

from hospital

care

Community

focus/ Primary

Care

Timely access

to treatment

Evidence based

(NICE

concordant)

care

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Access & Quality More than just a waiting time….

Equivalent standards to physical health:

• Tackle long waits for treatment: ensure access to services is timely

• Reduce the treatment gap: increase the number of people accessing treatment

• Embed NICE-concordant care: ensure that services are evidence-based, clinically effective, safe and recovery-focussed

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Programme to date

• 50% of people experiencing a first episode of psychosis treated with a NICE-approved package of care within two weeks of referral

• £40m recurrent funding

Early intervention in psychosis

• 75% adults treated within 6 weeks, and 95% within 18 weeks

• £10m non-recurrent funding

Psychological therapies

• By 2020, 95% of CYP commence NICE concordant treatment in 4 weeks for routine or 1 week for urgent cases

• Improve CYP access to dedicated, evidence-based community services

• Standard developed and thresholds to be set for implementation by 2017

• £30m recurrent funding

Eating disorders – children and young people

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Further planned programmes to achieve better

access between now and 2017

24/7 U&E ‘blue light’

mental health

response

Perinatal Mental Health

Dementia

Acute Mental Health

Integrated Physical

and Mental Health

CYP Generic

24/7 U&E mental health liaison in acute

hospitals

24/7 U&E community

mental health response

Crisis CYP

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Specialist

Perinatal

Community

Care

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• By 2020/21, all-age mental health liaison services in all

emergency departments and inpatient wards…

• At least 50 per cent of acute hospitals are meeting the

‘core 24’ service standard as a minimum by 2020/21.

• Everyone will have access to CRHTT for all ages by 2020/21

• Eliminate out of area placements as soon as possible

• By 2020/21 increased access to:

• EIS – 60% access to NICE treatment within 2 weeks for

First Episode Psychosis

• Psychological Therapies - 600 000 more people

access IAPT, 350 000 more people complete Rx

for anxiety and depression

• Perinatal Mental Health Service – 30 000 more

women access NICE treatment

13

Five Year Forward View for Mental Health

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Key Principles for

Mental Health Transformation

• Care that puts people who use the services in control

• Care that is fully integrated

• Care that is the most clinically effective

• Care that provides maximum value

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Alison Tonge – Director of

Commissioning Operations – West

Midlands

15

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Achieving the 5YFV vision – the triple aim

1 Health &

Wellbeing

Gap

Radical upgrade

in prevention

• National action required on major health risks such as

smoking, drinking and obesity

• Targeted prevention initiatives e.g. diabetes

• Much greater patient awareness

• Harnessing the ‘renewable energy’ of communities

2 Care &

Quality Gap

New Care

Models +

new support

• Defining and measuring quality and tackling unwarranted

variation

• A menu of New Care Models for local areas to consider,

backed by investment and flexibility in implementation

• New whole systems intervention regimes to transform local

health economies and raise standards

3 Funding and

Efficiency

Gap

Efficiency &

investment

• Action required on three fronts: demand, efficiency and

funding

• Action on prevention and care could deliver significant

efficiency gains

• The Government has committed to an additional £8.4bn in

funding by 2020/21 and, with this investment and

implementation of new care models we believe that we could

close the known finance gap

For the NHS to meet the needs of future patients in a sustainable way, we need to close

all three of these gaps:

West Midlands Health System

West Midlands health and economic growth partnership

“HEP” STP +

Programs at scale Right care delivered at scale- variation reduced WM Quality measurement /standards approach WM accountable care approach for specialist care WM health + innovation and jobs

Place (s) - right strategy at right place’ STPs population centred Strong on out of hospital care, prevention STP networks for local acute services West midlands specialist and complex care flows WiderSTP++ Public service reform, research innovation and jobs

Health Economy (STP)

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Tier 2 Sub Region

Tier 3 Health Economy

• Services commissioned centrally for whole of

country

• NHS England legally and financially responsible,

with national risk pool

• Services commissioned by NHS England in collaboration

with CCGs Sub Regional Level

• NHS England legally and financially responsible, but with

sub-regional shared risk and/or incentive

• Services with the potential to be commissioned by

groups of CCGs or combined authority through S75

arrangements or delegation

• NHS England legally responsible, with CCG and

LA/CA leading and holding financial risk on budgets

Tier 1 National/Regional

Tiers of Commissioning

18

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Common Priorities Across the

West Midlands

Pri

ori

tie

s

Mental Health - 3 STP’s (H&W, Black County and C&W)

Cancer - 2 STP’s (H&W, Black Country)

Maternity - 2 STP’s (Black Country and C&W)

Frailty & End of Life - 2 STP’s (H&W and C&W)

Common Care Model Priorities that SHOULD have been visible

Prevention and early intervention

Integration out of hospital and into hospital

Acute care networking

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Priorities for STPs

STPs should identify the top 3-6 big issues that the STP partners will together solve

Be big, bold and decisive

Start with service change priorities; organisational detail can follow

Be clear about the financial challenge

Transformation funding will be available; the rules for access are being worked out

We are here to support you

This is the only show in town – make best use of it

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Mental Health - What we know

• Mental illnesses are very common

• Among people under 65 years, nearly half of ill health

is mental illness

• We tend to view mental health and physical health in

separate silos

• Mental health problems impose a total economic and

social cost of over £105bn a year

• Yet, only a quarter of people with mental illness, such

as depression, are in treatment.

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“People with poor physical health are

at higher risk of experiencing mental

health problems

And

People with poor mental health are

more likely to have poor physical

health”

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Success for Mental Health in 2020/21

Three key areas:

• Improve access to and availability of mental health

services

• Develop community services, taking pressure of

inpatient settings

• Providing people with holistic care, recognising their

mental and physical health need

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A Workforce For Mental Health

Workforce Challenges

• Shortages of mental health

and LD nurses

• Shortages of psychiatrists

• Wider workforce mental

health skills

Mental Health

Advanced Practitioners

Liaison and Perinatal

Psychiatry

Nursing associates

IAPT Dementia

Skills

Eating Disorders

Skills

Perinatal Mental health

skills

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How do we get there?

• Work with experts by experience and other partners to develop the mental health aspects of your plans

• Foster engagement and leadership at all levels

• Baseline current provision

• Work with local government and other partners to reduce suicides

• Challenge stigma “Time to change”

• Continue transformation of CAMH services

• Improve data and reporting returns to MH data set

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How do we get there?

• Deliver two thirds dementia diagnosis rate and improve the support for people living with dementia and their carers

• Deliver recovery rates of 50% for those with common mental health disorders

• Embed new access standards for those experiencing fist episode of psychosis

• Design integrated physical and mental health services to improve the physical health of people with sever mental illness

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New Payment Approaches

Consider different payment approaches:

• Capitation

• Year of Care

• Episode payments with associated outcomes

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Key Principles for

Mental Health Transformation

• Care that puts people who use the services in control

• Care that is fully integrated

• Care that is the most clinically effective

• Care that provides maximum value

www.england.nhs.uk 29

Rt Hon Norman Lamb MP

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Sarah Norman Chief Executive

Dudley Metropolitan Council and

lead Chief Executive

Productivity / Output Gap £19bn WMCA Economy

Public Sector Gap £.3.4bn