COMMISSIONING INTENTIONS - Public Health
APPENDIX 1 – COMMISSIONING INTENTIONS, OUTCOMES & ACTIONS
Identified outcomes are consistent with, and complement, the anticipated outcomes in the No health without mental health: implementation framework and, as well as being informed by local performance data collection, outcomes will also be measured from data collected via the Adults Social Care Outcomes Framework, Public Heath Outcomes Framework and NHS Outcomes Framework.
While these indicators are likely to change over the lifetime of this plan, the indicators in the table below, which were applicable in 2013, give an example of the type of indicators which may be used to measure outcomes
Adults Social Care Outcomes Framework / 1A: Social care-related quality of life1B: The proportion of people who use services who have control over their daily life
1C: Proportion of people using social care who receive self-directed support, and those receiving direct payments
1D: Carer-reported quality of life
1F: Proportion of adults in contact with secondary mental health services in paid employment
1H: Proportion of adults in contact with secondary mental health services who live independently, with or without support
2A: Permanent admissions to residential and nursing care homes, per 100,000 population
2B: Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services
2C: Delayed transfers of care from hospital, and those which are attributable to adult social care
3A: Overall satisfaction of people who use services with their care and support
3B: Overall satisfaction of carers with social services
3C: The proportion of carers who report that they have been included or consulted in discussion about the person they care for
3D: The proportion of people who use services and carers who find it easy to find information about services
4A: The proportion of people who use services who feel safe
4B: The proportion of people who use services who say that those services have made them feel safe and secure
Public Heath Outcomes Framework / 1.6 People with mental illness and/or disability in settled accommodation
1.7 People in prison who have a mental illness or significant mental illness
1.8 Older person’s perception of community safety
2.9 Emotional wellbeing of looked after children
2.10 Hospital admissions as a result of self harm
2.23 Self reported wellbeing
4.9 Excess under 75 mortality in adults with serious mental illness
4.10 Suicide
4.11 Emergency readmissions within 30 days of discharge from hospital
4.13 Health related quality of life for older people
4.16 Dementia and its impacts
NHS Outcomes Framework / 1.5 Reducing premature death in people with serious mental illness
2.4 Enhanced quality of life for carers
2.5 Enhancing quality of life for people with mental illness
2.6 Enhancing quality of life for people with dementia
4a Patient experience of primary care
4b Patient experience of hospital care
4.7 Improving experience of health care for people with mental illness
PUBLIC HEALTH
In 2011 NHS Salford and Salford City Council published the Mental Wellbeing Strategy for Salford (2011 to 2015). The strategy identifies a number of key priorities to improve public mental health in Salford, detailed below are specific commissioning intentions and key actions for consideration to support both the Salford Mental Wellbeing Strategy and also the wider vision for services outlined in this commissioning plan.
Commissioning Intention / Anticipated Outcomes / RationaleTo improve the emotional and mental wellbeing of the population of Salford over the life-time of this commissioning plan – with a specific and key focus on health promotion, prevention and early intervention / ü Positively influence individuals health and wellbeing
ü Integrated working resulting in a more coherent and consistent response / · The Salford Mental Well-Being Strategy (2011 to 2015) highlights the significant importance of mental ill health in Salford, stating:
“the scale of the problem is so great, the potential benefits from prevention are correspondingly large, improving our population’s mental ill health will have a wider impact on physical health, improved educational attainment, quality of life and reduced sickness and unemployment”
· Mental health promotion, prevention and early intervention are intrinsic to this commissioning plan and other key local strategies in Salford (e.g. Salford’s Sustainable Community Strategy 2009-2024)
· Salford has been a ‘champion’ for the development of public health and the development of non-medical approaches to emotional and well-being (e.g. social prescribing)
· Moreover, there is a commitment in Salford to further develop these approaches as part of the public health agenda.
PRIMARY CARE
Commissioning Intention / Anticipated Outcomes / RationaleTo improve partnership working between primary care and secondary care services – ensuring expedient access to services that are responsive to the needs of service users and GPs / ü Improved and more timely referral pathways
ü Improved communication across services resulting in an increase in appropriate referrals
ü Improved patient experience of community mental health services
ü Improved partnership working to support early intervention / · GPs were largely felt to have good access to specialist mental health services in Salford. However, some key issues were identified, including:
Ø The need for access to specialist advice in CMHTs when GPs are considering making a referral to specialist mental health services
Ø The need to ensure that information on any changes made to mental health services and care pathways in Salford are clearly communicated to GPs and primary care staff
Ø A desire to develop approaches to providing mental health services directly into GP practices.
FUNCTIONAL MENTAL ILLNESS
To continue to improve access to psychological therapy services in Salford for all client groups / ü More people have access to evidence based treatments
ü More choice regarding treatment options
ü More integrated approach resulting in a smoother transition and patient experience / · Six degrees provides low intensity IAPT services in Salford, with:
Ø Low waiting times (3 weeks)
Ø Good recovery rates (>40%)
· In the 2011 National Mental Health Strategy ‘No Health without Mental Health’ announced plans to invest £400 million to further develop and improve psychological therapies - including provision for children and young people and older age adults.
· Nationally only 4% of people accessing IAPT services are aged >65. The national target is 12%.
· Within the stakeholder engagement a need to review access to psychological therapy services for older age adults was identified – following the reconfiguration of services to implement ‘ageless’ functional CMHTs in Salford.
· Demand for psychological therapy services is expected to increase over the life-time of this commissioning plan.
· Meeting high and rising demand for psychological therapy services within resources will require new approaches and interventions.
· There are key targets to achieve by 2014/15 including:
Ø 15% of population prevalence for anxiety/depression to enter treatment (for Salford that equates to circa 5500 people)
· 50% of all people who receive treatment to enter recovery
To support more people with mental health problems to remain at home and to return home more quickly where inpatient admissions do occur / ü More people living independently
ü More people being repatriated back to Salford
ü Reduction in length of stay in acute inpatient services
ü Reduction in readmissions to acute inpatient services / · A key focus of the national mental health QIPP programme is on the mental health acute care pathway – reducing admissions and lengths of stay.
· Previous projects identified Salford as having above average length of stay – although significant work has now been undertaken to address this
· Delayed discharges are also identified as a key issue in Salford. This is thought to often be related to access to mental health supported accommodation
· This commissioning intention supports wider national and local objectives to treat people closer to home and fits with other key programmes of work and service re-design in Salford (see opposite).
Personality Disorder Services and Services for Mentally Disordered Offenders
Commissioning Intention / Anticipated Outcomes / RationaleAgree and implement new service model for the treatment and management of people with personality disorders / ü More people with Personality Disorders supported appropriately
ü Improved cross sector working and joined up responses
ü Reduction in bed occupancy / · The existing service models in Salford for personality disorders and services for MDOs are currently being reviewed
· It is hoped and anticipated that re-modelling of both services will support wider commissioning intentions to reduce both acute mental health inpatient admissions and ‘revolving door’ A&E admissions at Salford Royal Hospital.
Develop improved support for Mentally Disordered Offenders (MDOs) / ü Improved diversion and liaison of people with mental health problems from the Criminal Justice System
ü Improved cross sector working and joined up responses
Inter-face with Drug and Alcohol Services
Commissioning Intention / Anticipated Outcomes / RationaleImprove pathways around treatment and management for service users with dual diagnosis and partnership working between mental health and drug and alcohol services in Salford / ü Improved pathways for service users
ü Integrated working resulting in a more coherent and consistent response
ü Improved management of mental health and drug and alcohol problems
ü Reduction in A&E admissions / · Patients with a dual diagnosis are currently either managed by one of the three functional CMHTs or by the drug and alcohol team
· Within the pilot 20-30 ‘complex cases’ with a dual diagnosis will be identified and intensively case managed
· It is hoped and anticipated that the service pilot will reduce A&E admissions at Salford Royal and acute mental health inpatient admissions (at Meadowbrook)
· This service model of intensive case management, if successful, could be used with other client groups .
· The co-morbidity of mental ill health with drug and alcohol problems are well reported .
· This commissioning intention to improve partnership working between services links to our wider commissioning intentions to improve integration and partnership working across all services.
ORGANIC MENTAL ILLNESS
This section of the report details commissioning intentions that we have developed for organic mental disorders. In parallel to this NHS Salford and Salford City Council have developed an action plan for dementia services in Salford. The action plan maps and identifies progress against the 17 key objectives outlined in the National Dementia Strategy – with a key focus on information, awareness, and early diagnosis and support. The commissioning intentions detailed in this section of the plan are intended to support and compliment the Salford Dementia Action Plan.
Commissioning Intention / Anticipated Outcomes / RationaleIncrease the capacity of the Salford Memory Assessment Service (MATs) in accordance with local prevalence estimates and national policy guidance to improve pre and post-diagnostic support for people with dementia in Salford / ü More people receiving a formal memory assessment.
ü Improved identification and diagnosis rates
ü Integrated working resulting in a more coherent and consistent response
ü Earlier intervention / · General Practitioners will be required to identify and assess patients with memory/cognitive problems and refer as appropriate.
· High and rising demand for services locally – with over 100 new referrals per month to the MATs
· The existing MATs is at capacity
· Expansion of the MATs meets with local priorities and national priorities to provide early diagnosis and supports long-term commissioning intentions to support more people to remain at home (reducing the use of inpatient and residential care).
· Pre and post diagnostic support for dementia was identified a significant gap in current service provision in Salford (particularly for carers)
· It was also identified as a key issue for those with vascular dementia (that are not on medication)
· Improving pre and post diagnostic support for dementia links with the planned expansion of the MATs and provides good opportunities to work in partnership with the Dementia Support Service provided by Age UK Salford.
Improve the quality and provision of dementia services at Salford Royal NHS FT / · Improving the quality of dementia care in acute hospitals is a key priority in the National Dementia Strategy
· Evidence suggests that people with dementia stay longer in acute hospitals
· Dementia is a CQUIN target at Salford Royal NHS FT and is part of their Quality Accounts
· Significant progress has been made in improving dementia services at Salford Royal in the last 12 months – but with significant opportunities for further improvement
· A National Dementia Audit has identified priorities for service improvement at Salford Royal that this commissioning plan should work towards achieving.
· Identified need to improve dementia support services for patients post discharge from Salford Royal and ‘frequent flyers’ coming through A&E (including those that are not admitted).
TRANSITIONS to adult mental health services
Commissioning intentions for CAMHS in Salford are fully outlined in the (draft) ‘Emotional Health and Wellbeing Strategy for Children and Young People in Salford 2012-15’ (currently being developed by NHS Salford and Salford Council). The primary focus of this commissioning plan (as previously documented) is on adult mental health services. Detailed below, however, are specific commissioning intentions for children and young people with mental health problems that are in transition to adult mental health services (AMHS).
Commissioning Intention / Anticipated Outcomes / RationaleEnsure the provision of high quality and integrated mental health services for children and young people in transition to adult mental health services) / ü Improved patient experience of transition
ü Improved parent/carer experience
ü Integrated working resulting in a more coherent and consistent response
ü Earlier intervention / · The national configuration of mental health services creates gaps through which young people can fall as they move from CAMHS to AMHS
· Commissioning effective transitions services should lead to reduced numbers of young people lost to services at this critical time and reduced periods of untreated illness (eg. Self harm)
· This should, in turn, lead to reduced morbidity, thus reducing downstream service demand on adult services