Agenda item 13 Castle Point & Rochford CCG Governing Body held on 30th March 2017 Title Update on: Mental Health & Learning Disability Services; General Community Services (inc Integration), and Primary care Co-commissioning Submitted by: Kevin McKenny Prepared by: Kevin McKenny / Yvonne Campen / Sipho Mlambo / Maureen Fitzgerald / Ashley King Status: For Noting Executive Summary i) Recommendations The Governing Body are asked to current position on the contract performance and the key service developments across four key core service areas overseen by the CCG’s Integration and Transformation Team at Month 10. This includes: Mental Health (inc Learning Disability); General Community services, Primary Care Co- commissioning, Children’s Services and Transformation Programme. The Governing Body is asked to review and offer comment and discussion on any aspects presented. ii) Overview The ‘Integration’ team encompasses all those non-acute core services that we commission as a CCG. These can be grouped under the following headings: Mental Health & Learning Disability services; General Community Services; Primary Care Co-commissioning; Children’s Services. Integration & Transformation Programme (including Better Care Fund pooled budget encompassing emerging integrated transformation commissioning opportunities) iii) Key issues The Key Issues within each area are summarised below: Mental Health & Learning Disability services: Contract negotiations were successfully completed by national deadline of 23rd Dec 2016. This sees the SEPT contract split into 3 separate contracts: Specialist Mental Health (South Essex) – help facilitate proposed merger; General Community (‘Out of Hospital’) Services), for South East Essex, and; Rawreth & Clifton (Dementia Nursing Homes). Critical elements dominating negotiations included: future investment in IAPT and target delivery Investment in Early intervention in Psychosis (EIP) requirements; the provision of s136 suites and staffing PICU and Learning Disability inpatient activity; The transition of Rawreth & Clifton Wards to (Dementia Challenging Behaviour) Nursing Homes A key challenge was building the contracting negotiation arrangements for 2017/18 in light of the proposed merger of Essex acute mental health providers, SEPT and NEPT. There will remain two contracts at the outset of 2017/18 however we needed to develop contract in partnership where possible to ensure smooth novation next year. There is also specific reference in this report to those Essex-wide work streams that are specifically related to 24/7 mental health crisis care and s135, s136 amendments to the Mental Health Act (see Appendix 4) A full work plan was in place for 2016/17 with 2017/18 work plan currently being finalised. As well as the core ‘business as usual’ activities, significant transformation is being planned for 2017/18 and beyond, in line with recently published Mental Health Strategy (for Greater Essex) and 5YFV for Mental Health with focus on primary care and community services. Perinatal Mental Health Services: A successful Pan-Essex collaborative bid led by North East Essex CCG, with support from CP&R CCG has secured investment for expanding Perinatal Mental Health Specialist Community Teams across Essex over the next 3 years. The bid proposed enhancing and extending the current South East Essex service into South West Essex, and developing a new community service in North Essex where is currently only a specialist Mother and Baby Inpatient unit. IAPT: The Q3 figure for access is 3.32% against the target of 3.75% for the quarter and equates to a gap of 96 patients for Q3 (based on local data). The recovery rate has seen an improvement with an October figure of 59% and a November figure of 49 % against a target of 50%. General Community Services: The Governing Body approved the mainstreaming of Care Coordination service into 2017/18 contracts. Paper focuses on progress on core schemes including: Care Coordination, Geriatrician and End of Life alongside Social Prescribing and Carers Support. Primary Care Co-commissioning: Includes summary of key Primary Care Committee discussions and decisions. The successful submission of CCG’s plan to deliver the ‘GP Forward View’. Key highlights include starting to see impact of the Enhanced Service for Care Homes and issuing Local Enhanced Service for Avoiding Unplanned Admissions and increased focus on use of Electronic Frailty Index (EFI) in primary care and linking high risk patients to Care Coordination services. The project looking to develop the locality ‘GP Enhanced Access Hub’ is progressing a pace working in collaboration with wider STP and Essex LMC. Children’s Services: Includes core contractual discussions and key work streams including ASD assessments and Maternity services, 0 – 19yr pathway work and QIPP programme for 2016/17. Commissioners are working in partnership with Southend CCG to consider proposals on future ASD provision.. Transformation: The CCG currently commissions its community services – adult, children, physical and mental health – utilising a range of traditional activity counts, performance indicators and information requirements. In order to move toward the vision of integrated care, and the improvement of outcomes, there is a need to change this contracting relationship and form. Early work around outcomes has been started, with the development of the contractual arrangements to be progressed through the contract management process. Whilst this will look different to existing arrangements it will be important to manage the risk associated with the transformation through the creation of robust transitional metrics. Future reports will provide progress updates. iv) Associated papers Nil TITLE: Update on: Mental Health & Learning Disability Services; General Community Services (inc Integration), and Primary care Co-commissioning ___________________________________________________________________ 1. PURPOSE The purpose of this paper is to provide the Governing Body with a Month 10 update on some core service performance and service developments for key areas of responsibility within the CCG’s Integration and Transformation Team. This includes: Mental Health (inc Learning Disability); General Community services, Primary Care Co-commissioning, Children’s and Transformation Programme. The Governing Body is asked to review and offer comment and discussion on any aspects presented 2. BACKGROUND The ‘Integration’ team encompasses all those non-acute core services that we commission as a CCG. These can be grouped under the following headings: Mental Health & Learning Disability services; General Community Services; Primary Care Co-commissioning; Children’s Services. Integration (including Better Care Fund pooled budget encompassing emerging integrated transformation commissioning opportunities) MAIN BODY OF REPORT 3. Mental Health, Learning Disabilities Commissioning Update A comprehensive MH/LD work programme is in place for 2016/17. The work streams are set out in: the Service Development Improvement Plan (SDIP) embedded in SEPT contract; our QIPP plans, and; the remainder included in the team’s work plan. Key areas of focus that the Mental Health Commissioning team wish to highlight are as follows: 3.1 Mental Health Strategy and Transformation 3.1.1 24/7 Crisis Care Transformation This year sees a major focus on improving the mental health crisis pathway. Thurrock CCG have been given the mandate to oversee this programme of work on behalf of Essex, Southend and Thurrock CCGs. Mental Health Crisis Care has wide stakeholder involvement including many key partners across Essex including; Essex Police, Essex County Council, East of England Ambulance Service, SEPT, NEP, Public Health, Pan-Essex CCGs, Primary Care and GP representatives and 3rd Sector organisations. RAID The RAID team is currently funded to provide a core 24/7 psychiatric liaison and assessment service. Centrally funded non-recurrent psychiatric liaison money was recently used to enhance the 24/7 model which enabled the operation of the dedicated Mental Health Suite pilot within the Emergency Department (ED) at SUHFT. The operation of the Mental Health Suite enables the ED to discharge patients to the care of the suite and thereby reduce delays in the ED in addition to improving patient experience. South East Essex CCGs have now confirmed commitment to fund the RAID team to the level required to operate the Mental Health Suite until 31 March 2016. The amended RAID service specification is has undergone contract variation into 2016/17 with funding for the MH Suite element included and this is now included within the 2017/18 contract. South Essex CCGs worked collaboratively across the New Year period to produce an Urgent and Emergency Care bid to NHS England for psychiatric liaison funding to enhance capacity and interventions and BTUH and SUHFT in line with the CORE 24 model. The bid was supported by the STP leaders and submitted in mid-January. The outcome is due around the end of March 2017. If funds are available this will improve the response times for psychiatric assessment in SUHFT A&E and facilitate further psychosocial interventions and follow up where relevant. Section 136 legislative changes Legislation in relation to Section 136 detentions will come into effect from April 2017. The most significant changes include the almost total restriction on the use of police custody suites as a place of safety for any person detained under S136 of the MHA, with the exception