West Midlands Mental Health Triple Aim Gap - West Midlands Strategic Clinical … · 2016. 6....
Transcript of West Midlands Mental Health Triple Aim Gap - West Midlands Strategic Clinical … · 2016. 6....
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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
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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
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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
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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