London Mental Health Payments and OutcomesProgramme Overview 17/18

National Policy and Guidance Context

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Five Year Forward View • Reform payment and incentives to move away from

unaccountable block contracts. • It recommends national and local outcomes measures

should be used as part of the payment system. Delivering the FYFV for Mental Health: Developing Quality and Outcome Measures • Local footprints to develop a suite of quality and outcome

measures, to help build foundations to support outcomes-based payment for mental health

• Framework approach is proposed that will need to ensure the suite of quality and outcome measures developed reflects objectives and views of key stakeholders and ensure that they are;

• Clinically Relevant• Reflect what people who use services (and carers)

want • Culturally appropriate and reliable • Align with system-wide objectives • Measurable using metrics with reliability and validity

What is the Payment and Outcomes Programme?

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The London Mental Health Payment and Outcomes Programme is a London wide programme supporting value transparency through payment reform and utility of outcomes in Mental Health. This programme is part of the London Mental Health Transformation Programme which is hosted by Healthy London Partnership (HLP) and NHS England (London Region).

The London Payments and Outcomes Programme, is sponsored by a Trust Chief Executive (WLMHT) and a CCG Chief Officer (Kingston and Richmond CCG, SWL SRO) and provides leadership at a London level to ensure providers and commissioners have a collaborative approach to improving how mental health treatment is delivered and paid for.

Some of the programme work streams for this financial year focus on the following;

• Clustering: Auditing of cluster variation and cost, Review of Cluster Practices in and around Crisis.

• Care Packages: Deep Dive Audit of Cluster 10, Develop SNOMED Map for London, review of London Reference Costs

• Outcomes: Agree a Single London PROM, Share best practice on the use of PROM, PREM and CROM.

‘Value’ in Healthcare

The Porter Model

Value=Healthoutcomes

Cost

Toreducecost,thebestapproachmightbetospendmoreonsomeservicestoreducethe

needforothers

Excellentcareisfrequentlythelowestcost

Referstototalcostsofthefullcycleofcareforthecustomer’smedical

condition,notthecostofindividualservices

Thefullsetofoutcomesthatconstitutethequalityofcareforthecustomer

overthecompletecarecycle

VALUE-BASED COMMISSIONING means changing how healthcare is organised, measured and reimbursed in

order to improve the value of services

The unit of analysis is the individual not the organisation

AgreedP&OProgrammeWorkPriorities

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Clustering Carepackages Outcomes

Closingthehealthandwellbeinggapanddevelopingtransparentpaymentmechanisms

• DevelopapanLondonclustertrainingpackagetoprovideconsistencyontheuseofclusters;andsharebestpracticeandresourcesfortraining

• Improvedataqualityandtransparencybycarryingoutanauditofclustervarianceandcost

• UnderstandunwarrantedvariationbyprovidingapanLondondeepdiveauditintocluster10usage

• Facilitatelearningfromanauditofreferencecosts inordertoimprovetransparency

• SharedlearningfromaPanLondonSNOMEDcodemaptosupporttheimplementationofSNOMEDandconsistencyforbenchmarking

• DevelopapanLondon‘useofoutcomemeasures’trainingpackagetosupportclinicalteamswiththeimplementationofoutcomesbasedcare

• SupportconsistentbenchmarkingandtransparencyofcarebyagreeingasingleoutcomemeasuretobecollectedataLondonlevel

• MaptheuseofoutcomesbasedcareacrossLondon

• SharebestpracticeontheuseofCROMS,PREMSandPROMS

• Intheprocessofworkingupaproposalforapieceofmodellingwork:• Takingawholepopulationapproach• ModellingwhatisthecommercialandstrategicviabilityofMHTrustsinmovingtothesenew

paymentmodelsespeciallyasorganisationsmovetobeingpartofthealliancecontract?SpecificallyhowareTrustsandCommissionerssupportedtomanagerisk.

• Providerreadinessframework• Whataretherealtangibleoptions– supportingareastoproducetheircapacity/capabilitybusiness

angle• Whataretheopportunitiesformentalhealthwithinawiderpopulationbasedcontractingsystemat

apersonlevelbasis.(Utilisingnationalandlocalreferencecosts)

Apr

6

May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Payment and Outcomes Programme Deliverables TimelineProjectoverview16/17&17/18

20182017

Activity/Deliverable PartnershipBoardMeeting Payments,OutcomesandCarePackagesgroupmeetings

SupportingcompliancewithSNOMED

Jan Feb Mar

2016

Snomed Mapping

Deepdiveintocluster10

Clustertrainingpackage

InitialuseofOutcomesWorkshop–includinginitialresultsofsharingPROM

AuditandMappingofclustervariance

ReviewofReferenceCostData

PanLondonSNOMEDCodeMap

Outcomesmapping

UseofOutcomeMeasuresTrainingPackage

SinglePROMforLondonProposal

DeliveryofUseofOutcomeMeasuresTrainingPackage

London Mental Health Payment and Outcomes Governance

London Mental Health STP Delivery Group

London Payment and Outcomes Partnership

Board

Clinical Group

Technical Group

London Mental Health Dash Board

London Mental Health Transformation Board

National Steering Group Payment and Outcomes

Group (Chair: Tim Kendell)

London CFO Leads Meeting

Payment and Outcomes Partnership Board dates:Strategic Board

Chairs: • Carolyn Regan (CEO, WLMHT)• Tonia Michaelides (Managing Director, Richmond and Kingston

CCG, SRO Mental Health SWL STP)

Membership :• CFO CCG – Lambeth CCG• DOF Trust – CNWL• Representation from NHS I / NHS E National Policy • Clinical Representation (from various trusts) • Commissioning Representation • Quality Representation

Payment and Outcomes Technical and Clinical Group:Technical and Operational Group

Chairs: • Debbie Taylor (Technical Chair, NELFT) • Dr. Niraj Arora (Clinical Chair, WLMHT) • Dr. Justin Earl (Clinical Chair, SWSTG)

Membership: • Clinical Reps from various Mental Health Trusts• Technical Leads from various Mental Health Trusts • Finance Leads from various Mental Health Trusts • Commissioning Representation

ProgrammePartners

ProgrammeNetwork

ProgrammeTeam

ProgrammeSponsor

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Proposed Programme Structure

PaymentandOutcomesProgramme

PMO:DarrenVella–Programme

ManagementMentalHealthClinical

NetworkNHSEngland&HLP

PMOSupport:CarlyMonaghan,ProjectSupportOfficer

LondonPaymentandOutcomesClinicalandCarePackages

TechnicalGroup

LondonPaymentsandOutcomesPartnershipBoard

(MeetBi-Monthly)

NHSImprovement,NHSEngland(NationalTeam)

MHTrust:CarolynRegan(WLMHTCEO)

CCG:ToniaMichaelides(KingstonCCGCEO)

Chairs:CarolynRegan(WLMHTCEO),ToniaMichaelides(KingstonCCGCEO)

Chair:DebbieTaylor(TechnicalChair– ELFT),JustinEarly(ClinicalChair,SWSTLG),Niraj

Arora,ClinicalChair,WLMHT)

Payment and Outcomes Programme Proposed Operating Model Matrix working approach where different deliverables are co-produced by system experts and leaders across different MH Trust / CCG organisations to create system ownership and understanding.

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DeliveryArea

ü Participateindata-capturingexercises

ü CommissioningFinanceInputfromCCG/Trust

ü ClinicalLeadfromCluster10Services

ü TechnicalLeadonClustering

ü ProgrammePMO

Co-ProductionMatrix SystemInputs

UndertakeapanLondondeepdiveauditintoCluster10

ü Shapemethodologyused

ü SystemOwnershipofOutputs

DeliveryofPanLondonDeepDiveAuditintoCluster10

London Mental Health Programme Governance

LondonMentalHealthTransformationBoard

LondonMentalhealthClinicalNetworkNHSEngland

(LondonRegion)

LondonMentalHealthParityBoardNHSEngland(London

Region)

LondonTransformationGroup

SustainabilityandTransformation

ExecutiveNHSEngland(London)

LondonCCGs

LondonMentalHealthTransformationProgramme

U&ECMentalhealthsub-group

Mentalhealthpartnership

board

CCGMHClinicalLeads

SPGMHChiefOfficersCommissioningGroup

StolenYearsProjectLondonPerinatalNetworks

DMWAgileTeam

Crisiscare PrimaryCareMH HardwiringSMIMortalityGap MHAccessStandards

DigitalMentalWellbeing

FirstInterventionPsychosis

Coordinationfunction

LondonPaymentandOutcomesBoard

NewModelsofCare

ClinicalGroup

TechnicalGroup

LondonMentalHealthDashBoard

PhysicalHealthandMentalHealthLeads

STPMHLeadsGroup

LondonThrive(Prevention)

Stigma

CYP

Suicide

Employment(IPS)FIPWorkForceProject

FIPStandard(2/2)

ImplementationSupport

IAPTClinicalLeads

Programme Alignment

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NHSEngland(NationalTeam)

NHSImprovement

LondonMentalHealth

TransformationProgramme

P&O

SpecificPolicyDirectionandImplementation

IdentifyingOnceforLondonOpportunitiesforLondonandRegionaldeliveryplatform

Developmentofspecificanddetailedfinancetoolsandguidance