A commissioning perspective - A commissioning perspective - increasing user involvement to increasing user involvement to

achieve better outcomesachieve better outcomes

Mick BurnsMick BurnsSecure Services Commissioning Team Secure Services Commissioning Team Yorkshire and the Humber Specialised Yorkshire and the Humber Specialised

Commissioning GroupCommissioning Group

NHS Yorkshire and the HumberNHS Yorkshire and the Humber

5.17m population 5.17m population (NoS (NoS

2007 PCT population estimates)2007 PCT population estimates)

14 PCTs (North, 14 PCTs (North, West, East and South West, East and South Yorkshire and North Yorkshire and North and North East Lincs)and North East Lincs)

Regional Commissioning StructureRegional Commissioning Structure

Overseen by Specialised Commissioning GroupOverseen by Specialised Commissioning Group

Specialised Commissioning TeamSpecialised Commissioning Team

Secure Services (plus a bit of Specialist Mental Secure Services (plus a bit of Specialist Mental Health) Commissioning TeamHealth) Commissioning Team

All high, medium and low secure servicesAll high, medium and low secure services

PCT consortium arrangements including PCT consortium arrangements including financial risk sharefinancial risk share

All activity managed via NHS standard MH All activity managed via NHS standard MH contract budget for 2010-11 circa £130mcontract budget for 2010-11 circa £130m

Current Secure in-patient population (month 5 2010 -11)Current Secure in-patient population (month 5 2010 -11)

PlacementPlacement No of in-patientsNo of in-patients No of providersNo of providers

High SecureHigh Secure 9797 33

Medium SecureMedium Secure 290290 1111

Low SecureLow Secure 378378 2424

TotalTotal 765765 3838

Secure Services Commissioning Team – Secure Services Commissioning Team – Team StructureTeam Structure

Associate Director – 1 WTEAssociate Director – 1 WTEAssistant Director (Finance 0.6 WTE)Assistant Director (Finance 0.6 WTE)Senior Commissioning Manager -2 WTESenior Commissioning Manager -2 WTERegional Forensic Case Manager – 5 WTERegional Forensic Case Manager – 5 WTEInvolvement Leads 1.6 WTEInvolvement Leads 1.6 WTEInformation Staff 2 WTEInformation Staff 2 WTEAdmin Staff 2.6 WTEAdmin Staff 2.6 WTE

Activity managed across 25 contractsActivity managed across 25 contracts

Involvement in SSCTInvolvement in SSCT

‘‘Democratisation’ of mental health Democratisation’ of mental health services since NSFservices since NSFTwo posts partly funded by PCTs partly Two posts partly funded by PCTs partly funded by providersfunded by providersInvolvement Strategy ‘Reaching Joint Involvement Strategy ‘Reaching Joint Solutions’Solutions’

““Involvement is a bit like spinach: no one is Involvement is a bit like spinach: no one is against it in principle because it is good for against it in principle because it is good for you, but not everyone eats it”you, but not everyone eats it”

Involvement in SSCT cont.Involvement in SSCT cont.

RJS sets framework for involvement at 3 RJS sets framework for involvement at 3 levelslevels– Individual LevelIndividual Level– Ward/Unit LevelWard/Unit Level– Strategic LevelStrategic Level

Involvement monitored through Involvement monitored through Involvement network ‘Involvement network ‘i4ii4i’ (Improvement ’ (Improvement through Involvement) through Involvement)

Background to CQUIN development in Yorkshire Background to CQUIN development in Yorkshire and the Humberand the Humber

Commissioning for outcomesCommissioning for outcomes– Improved mental wellbeingImproved mental wellbeing– Reduced RiskReduced Risk– Therapeutic Use of EnvironmentTherapeutic Use of Environment– Social InclusionSocial Inclusion– Quality of LifeQuality of Life

User Defined initiatives for improvementUser Defined initiatives for improvement– Advanced DirectivesAdvanced Directives– CPA StandardsCPA Standards– Complete Dining ExperienceComplete Dining Experience

CQUINS 2009-2010CQUINS 2009-2010

Introduction of system for recording and Introduction of system for recording and monitoring outcomesmonitoring outcomesDemonstration of 25 hours meaningful Demonstration of 25 hours meaningful activity (DH best practice)activity (DH best practice)Introduction of ‘My Future Plan’ advanced Introduction of ‘My Future Plan’ advanced directive developed by Y&H i4i networkdirective developed by Y&H i4i networkIntroduction of CPA standards developed Introduction of CPA standards developed by Y&H i4i networkby Y&H i4i networkCQUIN value 0.5% of contract value as CQUIN value 0.5% of contract value as part of 2.2% upliftpart of 2.2% uplift

CQUINS 2010-2011CQUINS 2010-201190% target for use of HONOS secure and HCR-2090% target for use of HONOS secure and HCR-20Introduction of tool to measure therapeutic use of Introduction of tool to measure therapeutic use of environment (Essen CES)environment (Essen CES)Services to develop involvement and personalisation Services to develop involvement and personalisation strategy in partnership with service usersstrategy in partnership with service usersYear 2 of CPA standard implementation, introduction of Year 2 of CPA standard implementation, introduction of dining standards from user audit ‘complete dining dining standards from user audit ‘complete dining experience’experience’Build on 25 hours structured activity plan through i4i Build on 25 hours structured activity plan through i4i networknetworkService implementation of recognised recovery planning Service implementation of recognised recovery planning tooltoolCQUIN equivalent to 1.5% of contract value with no upliftCQUIN equivalent to 1.5% of contract value with no uplift

CQUINS 2011-2012CQUINS 2011-2012Still under development, suggested themesStill under development, suggested themes– Linking outcomes to model pathwayLinking outcomes to model pathway– Project re ‘choice and responsibility’ user definedProject re ‘choice and responsibility’ user defined– Staff development programme (in support of Staff development programme (in support of

increased involvement agenda), user led auditsincreased involvement agenda), user led audits– Primary HealthPrimary Health– Involvement for carersInvolvement for carers– Standardisation of drug and alcohol interventionsStandardisation of drug and alcohol interventions

Essen CES, Dining Experience and Recovery Essen CES, Dining Experience and Recovery Tool will roll over from previous yearTool will roll over from previous yearUnclear as to value of CQUINUnclear as to value of CQUIN

Advantages to user defined CQUIN Advantages to user defined CQUIN schemesschemes

Users see real benefit of involvement through inclusion Users see real benefit of involvement through inclusion within contractwithin contractProgramme of involvement energises service users Programme of involvement energises service users improves engagement with staff in servicesimproves engagement with staff in servicesReal change in culture within services, collaborative Real change in culture within services, collaborative working becoming more of a realityworking becoming more of a realityServices are starting to innovateServices are starting to innovateCQUIN development has helped to consolidate service CQUIN development has helped to consolidate service networknetworkUnclear as yet whether outcomes have improved but Unclear as yet whether outcomes have improved but process has been helpful in itselfprocess has been helpful in itself