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The Five Year Forward View for Mental Health: One year on and beyond Claire Murdoch National Mental Health Director NHS England March 2017
Transcript
Page 1: Claire Murdoch

The Five Year Forward View for Mental

Health: One year on and beyond

Claire MurdochNational Mental Health Director

NHS England

March 2017

Page 2: Claire Murdoch

2www.england.nhs.uk

Initial Thoughts

• System working hard. Primary Care and

Acutes

• Innovations

• Great networks

• Housing, Education, Employment – Wider

Society

• The Money

• STPs

Page 3: Claire Murdoch

In response to the taskforce report, and with new funding, the NHS is delivering a programme of transformation across the NHS so that by 2020:

70,000 more children will access evidence based mental

health care interventions

280,000 people with SMI will have access to evidence based

physical health checks and interventionsOlder People

Intensive home treatment will be available in every part of England as an alternative to

hospital. Older People

No acute hospital is without all-age mental health liaison

services, and at least 50% are meeting the ‘core 24’ service

standardOlder People

The number of people with SMI who can access evidence based

Individual Placement and Support (IPS) will have doubled

60% people experiencing a first episode of psychosis will access NICE concordant care within 2

weeks including children

10% reduction in suicide and all areas to have multi-agency suicide prevention plans in

place by 2017Older People

At least 30,000 more women each year can access evidence-

based specialist perinatal mental health care

Increase access to evidence-based psychological therapies to reach 25% of need, helping 600,000 more people per year

Older People

New models of care for tertiary MH will deliver quality care

close to home reduced inpatient spend, increased

community provision including for children and young people

Inappropriate out of area placements (OAPs) will have

been eliminated for adult acute mental health care

There will be the right number of CAMHS T4 beds in the right place reducing the number of

inappropriate out of area placements for children and

young people

Page 4: Claire Murdoch

750 more women should

receive access to specialist

perinatal MH through these

20 sites in 2016/17

8 beds commissioned to

immediately increase in-

year capacity and treat

more women

✓ Four new mother baby

units implemented

Page 5: Claire Murdoch

70,000 more children

will access evidence

based mental health

care interventions

280,000 people with SMI

will have access to

evidence based

physical health checks

and interventions

Intensive home

treatment will be

available in every part

of England as an

alternative to hospital

No acute hospital is

without all-age mental

health liaison services,

and at least 50% are

meeting the ‘core 24’

service standard

The number of people

with SMI who can

access evidece based

Individual Placement

and Support (IPS) will

have doubled

60% people

experiencing a first

episode of psychosis

will access NICE

concordant care within

2 weeks

10% reduction in

suicide and all areas to

have multi-agency

suicide prevention

plans in place by 2017,

At least 30,000 more

women each yearcan

access evidence-based

specialist perinatal

mental health care

Increase access to

evidence-based

psychological therapies

to reach 25% of need,

helping 600,000 more

people per year

New models of care for

tertiary MH will deliver

quality care close to

home reduced inpatient

spend, increased

community provision

Inappropriate out of

area placements (OAPs)

will have been

eliminated for adult

acute mental health

care

There will be the right

number of CAMHS T4

beds in the right place

reducing the number of

inappropriate out of

area placements

70,000 more children will

access evidence based

mental health care

interventions

There will be the right

number of CAMHS T4

beds in the right place

reducing the number of

inappropriate out of area

placements

Page 6: Claire Murdoch

6www.england.nhs.uk

This year, 21,000 more Children and Young People

expected to access treatment compared to 2014/15

• First ever national access standard community-based

treatment for CYP with an ED has begun to be measured

• 674 CYP staff begin new training courses to improve skills

in evidence-based treatment 465 newly recruited staff

have started courses to qualify as therapists

• Children and Young Peoples Improving

access to Psychological Treatment (CYIAPT)

– supporting staff in 92% of population

coverage

In Derby 25% more

children and young

people from the

same number of staff

trained in CYPIAPT

CAMHS tier 4 review:

✓ to ensure that beds available when they are needed

✓ eliminate inappropriate out –of-area placements for

CYP by March 2020.

Page 7: Claire Murdoch

7www.england.nhs.uk

Next year, 35,000 more Children and Young People

will access treatment

Additional £170mill investment

to expand community services

35,000 more CYP expected to

receive treatment in 2017/18

Joint Department Health and

Department Education Green Paper

✓ Sponsored by two Secretary of States

✓ Will deliver by Autumn 2017 alongside a

SoS review of effectiveness of

psychiatric interventions in schools

Average of 8% year-on-year increase in

capacity in each community team

Page 8: Claire Murdoch

70,000 more children

will access evidence

based mental health

care interventions

280,000 people with SMI

will have access to

evidence based

physical health checks

and interventions

Intensive home

treatment will be

available in every part

of England as an

alternative to hospital

No acute hospital is

without all-age mental

health liaison services,

and at least 50% are

meeting the ‘core 24’

service standard

The number of people

with SMI who can

access evidece based

Individual Placement

and Support (IPS) will

have doubled

60% people

experiencing a first

episode of psychosis

will access NICE

concordant care within

2 weeks

10% reduction in

suicide and all areas to

have multi-agency

suicide prevention

plans in place by 2017,

At least 30,000 more

women each yearcan

access evidence-based

specialist perinatal

mental health care

Increase access to

evidence-based

psychological therapies

to reach 25% of need,

helping 600,000 more

people per year

New models of care for

tertiary MH will deliver

quality care close to

home reduced inpatient

spend, increased

community provision

Inappropriate out of

area placements (OAPs)

will have been

eliminated for adult

acute mental health

care

There will be the right

number of CAMHS T4

beds in the right place

reducing the number of

inappropriate out of

area placements

60% people experiencing

a first episode of

psychosis will access

NICE concordant care

within 2 weeks

Page 9: Claire Murdoch

9www.england.nhs.uk

This year, more than 10,000 people with a first episode

psychosis started treatment with a specialist team

– National access and waiting time standard was

introduced for mental health, for Early Intervention in

Psychosis (EIP) services

– More than 10,000 people experiencing a first episode

psychosis started treatment with a specialist team,

with more than 77.6% starting treatment within two

weeks, in November 2016

• NHS Benchmarking Network data shows:

- 12% increase in referrals

- matched by 9% increase in staff

- increased coverage of services,

Page 10: Claire Murdoch

70,000 more children

will access evidence

based mental health

care interventions

280,000 people with SMI

will have access to

evidence based

physical health checks

and interventions

Intensive home

treatment will be

available in every part

of England as an

alternative to hospital

No acute hospital is

without all-age mental

health liaison services,

and at least 50% are

meeting the ‘core 24’

service standard

The number of people

with SMI who can

access evidece based

Individual Placement

and Support (IPS) will

have doubled

60% people

experiencing a first

episode of psychosis

will access NICE

concordant care within

2 weeks

10% reduction in

suicide and all areas to

have multi-agency

suicide prevention

plans in place by 2017,

At least 30,000 more

women each yearcan

access evidence-based

specialist perinatal

mental health care

Increase access to

evidence-based

psychological therapies

to reach 25% of need,

helping 600,000 more

people per year

New models of care for

tertiary MH will deliver

quality care close to

home reduced inpatient

spend, increased

community provision

Inappropriate out of

area placements (OAPs)

will have been

eliminated for adult

acute mental health

care

There will be the right

number of CAMHS T4

beds in the right place

reducing the number of

inappropriate out of

area placements

Inappropriate out of area

placements (OAPs) will

have been eliminated for

adult acute mental health

care

Intensive home treatment

will be available in every

part of England as an

alternative to hospital

Page 11: Claire Murdoch

11www.england.nhs.uk

• For the first time, national data has been published; a crucial first

step to eliminating the inappropriate use of such placements

• We will provide targeted local support to promote progress towards

the ambition to eliminate the inappropriate use of adult acute out

of area placement (OAPs)

• 2017/18 new investment to support crisis resolution and home

treatment teams operate in line with evidence

Publish, by June 2017, a formal

response to the review of Acute Adult

Psychiatric Care led by Lord Crisp

Acute Out of Area Placements

‘Out of area treatments cause problems

for patients and for their families and

carers. Geographical separation from a

patient’s support networks can leave them

feeling isolated and delay recovery.’

Page 12: Claire Murdoch

70,000 more children

will access evidence

based mental health

care interventions

280,000 people with SMI

will have access to

evidence based

physical health checks

and interventions

Intensive home

treatment will be

available in every part

of England as an

alternative to hospital

No acute hospital is

without all-age mental

health liaison services,

and at least 50% are

meeting the ‘core 24’

service standard

The number of people

with SMI who can

access evidece based

Individual Placement

and Support (IPS) will

have doubled

60% people

experiencing a first

episode of psychosis

will access NICE

concordant care within

2 weeks

10% reduction in

suicide and all areas to

have multi-agency

suicide prevention

plans in place by 2017,

At least 30,000 more

women each yearcan

access evidence-based

specialist perinatal

mental health care

Increase access to

evidence-based

psychological therapies

to reach 25% of need,

helping 600,000 more

people per year

New models of care for

tertiary MH will deliver

quality care close to

home reduced inpatient

spend, increased

community provision

Inappropriate out of

area placements (OAPs)

will have been

eliminated for adult

acute mental health

care

There will be the right

number of CAMHS T4

beds in the right place

reducing the number of

inappropriate out of

area placements

Increase access to

evidence-based

psychological therapies to

reach 25% of need,

helping 600,000 more

people per year

Page 13: Claire Murdoch

Aim to achieve 3,000 new therapists co-

located in primary care

New employment advisors supporting

people in IAPT in Quarter 1, 2017/18

1000 addition people

already seen.

30,000 people will be

treated in integrated

settings including

primary care in 2017/18

Ahead of targets:

• 87.8% people entering treatment waited less than 6 weeks

• 98.3% waited less than 18 weeks

Over 600 new training places available to increase skilled therapists

Page 14: Claire Murdoch

70,000 more children

will access evidence

based mental health

care interventions

280,000 people with SMI

will have access to

evidence based

physical health checks

and interventions

Intensive home

treatment will be

available in every part

of England as an

alternative to hospital

No acute hospital is

without all-age mental

health liaison services,

and at least 50% are

meeting the ‘core 24’

service standard

The number of people

with SMI who can

access evidece based

Individual Placement

and Support (IPS) will

have doubled

60% people

experiencing a first

episode of psychosis

will access NICE

concordant care within

2 weeks

10% reduction in

suicide and all areas to

have multi-agency

suicide prevention

plans in place by 2017,

At least 30,000 more

women each yearcan

access evidence-based

specialist perinatal

mental health care

Increase access to

evidence-based

psychological therapies

to reach 25% of need,

helping 600,000 more

people per year

New models of care for

tertiary MH will deliver

quality care close to

home reduced inpatient

spend, increased

community provision

Inappropriate out of

area placements (OAPs)

will have been

eliminated for adult

acute mental health

care

There will be the right

number of CAMHS T4

beds in the right place

reducing the number of

inappropriate out of

area placements

New models of care for

tertiary MH will deliver

quality care close to

home reduced inpatient

spend, increased

community provision

Page 15: Claire Murdoch

15www.england.nhs.uk

We have launched a new care model programme for

mental health Via planning guidance, local areas asked to

come forward to express an interest in

secondary providers managing budgets for

tertiary services

By July 2016

Six sites selected to deliver new models of care

to provide better treatment, much closer to

home, for hundreds of adults and young people

October 2016

Sites went ‘shadow live

A further nine urgent and emergency care ‘vanguard’ areas have been

chosen to test models of crisis care for children and young people,

supported by investment of £4.4 million

Page 16: Claire Murdoch

16www.england.nhs.uk

Progress made in many other areas of work…

Secure care pathway

• First national audit of MH secure services at individual and service level

• model developed for community forensic services

• focused work with black men using the secure care system,

Health and justice

• Liaison and diversion services expanded to cover police custody suites

and courts in areas = representing 68% of population

• ahead of the indicative implementation plan trajectory and on track to

meet the planned 100% coverage by 2019/20.

Suicide prevention

• National Suicide Prevention Strategy refreshed by Government

• Local suicide prevention plans are in place or being developed in 95% of

local authorities in England

CQUINS

Page 17: Claire Murdoch

70,000 more children

will access evidence

based mental health

care interventions

280,000 people with SMI

will have access to

evidence based

physical health checks

and interventions

Intensive home

treatment will be

available in every part

of England as an

alternative to hospital

No acute hospital is

without all-age mental

health liaison services,

and at least 50% are

meeting the ‘core 24’

service standard

The number of people

with SMI who can

access evidence based

Individual Placement

and Support (IPS) will

have doubled

60% people

experiencing a first

episode of psychosis

will access NICE

concordant care within

2 weeks

10% reduction in

suicide and all areas to

have multi-agency

suicide prevention

plans in place by 2017,

At least 30,000 more

women each year can

access evidence-based

specialist perinatal

mental health care

Increase access to

evidence-based

psychological therapies

to reach 25% of need,

helping 600,000 more

people per year

New models of care for

tertiary MH will deliver

quality care close to

home reduced inpatient

spend, increased

community provision

Inappropriate out of

area placements (OAPs)

will have been

eliminated for adult

acute mental health

care

There will be the right

number of CAMHS T4

beds in the right place

reducing the number of

inappropriate out of

area placements

The number of people with

SMI who can access

evidence based Individual

Placement and Support

(IPS) will have doubled

No acute hospital is

without all-age mental

health liaison services, and

at least 50% are meeting

the ‘core 24’ service

standard

Psychiatric Liaison

New transformation funding

successful sites to put in

place services which meet

the Core 24 service , drew

nearly 70 bids

Intensive home treatment

will be available in every

part of England as an

alternative to hospital

And there is much more to come in 2017/18 …

Alternative to hospital

Further implementation

guidance will follow in 2017

for community-based urgent

Baseline audit of IPS

services will be completed

over 2017/18.

Will inform the investment

strategy in IPS services from

April 2018

Armed services

Roll out of the commissioning

of Transition, Intervention

and Liaison (TIL) services

for veteran’s MH across

England

Implementation for

Psychiatric Liaison sites in

2017/18 …on track to meet

the target of at least 50%

achieving Core 24 standard

Community Adult MH review

the operation of the Care

Programme Approach

(CPA) within local health and

care systems

Page 18: Claire Murdoch

18www.england.nhs.uk

We are also putting enablers in place to ensure

successful delivery of the FYFV for Mental Health

Five Year Forward View Mental Health Dashboard

• Provides transparency on where the money goes

• Identifies CCG not meeting national standards and distance to travel for

those underperforming

• Includes new measures on CYP accessing treatment, enables to track

physical health for people with SMI etc.

Harnessing digital delivery

• First digital strategy for mental health

• Improving use of NHS 111 and NHS Choices to facilitate access to

Mental Health services

Payment by outcomes

• Traditional’ payment methods for mental health services -

unaccountable block contracts - do not do enough to reward value.

• The national tariff 2017-19 allows flexibility in choice of which payment

approach - but overarching requirement for a payment component

linked to outcomes

Page 19: Claire Murdoch

www.england.nhs.uk

We are working closely with CCGs and STPs: Assurance

that the money goes were it is meant to

19

Checking and triangulating

funding via planning returns

Supporting STPs to improve plans

for mental health

CCGs to confirm total mental health funding

including contract values +investment in 5yfv

programmes (e.g., CYP MH) for 17/18-18/19

Mental health provider CEs asked to confirm

CCG return as accurate reflection of

investment inc. investment in others

CCGs and mental health providers asked to

confirm that investment will deliver required

transformation set out in planning guidance

Outstanding issues resolved with regional

finance and operational colleagues and if

necessary national intervention

Reviewing the content and quality of STP

plans and STP performance against national

expectations

Providing targeted support to those who need

rapid support to develop plans that will deliver

5yfv mental health transformation

Offering wider support to STPs, CCGs and

providers through new improvement ‘menu’

Ongoing monitoring and support to STPs via

performance information and intelligence

nationally and regionally

Every STP area has a credible funded plan to deliver transformation to mental health services to

meet the needs of its local population and deliver the local share of the 5 year forward view for

mental health implementation plan meeting national commitments made for patients

Page 20: Claire Murdoch

www.england.nhs.uk

v

And are working closely with STPs to support

them deliver their share of the FYFV ambition

20

How confident are STPs at delivering?

• Increased access to evidence based mental health services in your local health economy for

• Children and young people

• People with depression and anxiety (IAPT services) –particularly those with comorbid LTC

• People experiencing a first episode of psychosis

• People who need rapid access to emergency mental health care from intensive home treatment services or liaison mental health services

• People needing specialist mental health care during the perinatal period

• People with severe mental illness (access to physical health care interventions)

• People needing employment support in addition to mental health care (e.g., IPS)

• A complete elimination of out of area placements (OAPs) for acute mental health care by 2020/21?

• Access and waiting times standards including access to NICE concordant care for children and young people’s eating disorder services, first episode psychosis and IAPT services

• Co-commissioning or delivering New care models for tertiary mental health services such as tier 4 CAMHs and low and medium secure care jointly with specialised commissioning colleagues

What support would be helpful to assist in building confidence and ensuring delivery of the mental health agenda?

• STP dial in with peers and national teams

• STP data packs

• Hands on clinical or managerial support

• Support from clinical networks

• Peer support and mentoring from successful health economies?

• Consultancy-type support

• Quality improvement support

Page 21: Claire Murdoch

www.england.nhs.uk

• Social Care

• Awareness and Attitude

• Beyond 20/21

• Workforce

• Delivery, Delivery, Delivery


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