Claire Murdoch

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

2www.england.nhs.uk
Initial Thoughts
• System working hard. Primary Care and
Acutes
• Innovations
• Great networks
• Housing, Education, Employment – Wider
Society
• The Money
• STPs

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
interventions
Older 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
standard
Older 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 2017
Older 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

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

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
number of CAMHS T4
inappropriate out of area
placements

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.

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

based mental health
care interventions
will have access to
evidence based
and interventions
Intensive home
treatment will be
of England as an
service standard
with SMI who can
have doubled
60% people
will access NICE
2 weeks
10% reduction in
have multi-agency
suicide prevention
women each yearcan
mental health care
Increase access to
evidence-based
people per year
spend, increased
community provision
will have been
acute mental health
care
number of CAMHS T4
area placements
60% people experiencing
a first episode of
psychosis will access
NICE concordant care
within 2 weeks

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,

based mental health
care interventions
will have access to
evidence based
and interventions
Intensive home
treatment will be
of England as an
service standard
with SMI who can
have doubled
60% people
will access NICE
2 weeks
10% reduction in
have multi-agency
suicide prevention
women each yearcan
mental health care
Increase access to
evidence-based
people per year
spend, increased
community provision
will have been
acute mental health
care
number of CAMHS T4
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

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.’

based mental health
care interventions
will have access to
evidence based
and interventions
Intensive home
treatment will be
of England as an
service standard
with SMI who can
have doubled
60% people
will access NICE
2 weeks
10% reduction in
have multi-agency
suicide prevention
women each yearcan
mental health care
Increase access to
evidence-based
people per year
spend, increased
community provision
will have been
acute mental health
care
number of CAMHS T4
area placements
Increase access to
evidence-based
psychological therapies to
reach 25% of need,
people per year

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

based mental health
care interventions
will have access to
evidence based
and interventions
Intensive home
treatment will be
of England as an
service standard
with SMI who can
have doubled
60% people
will access NICE
2 weeks
10% reduction in
have multi-agency
suicide prevention
women each yearcan
mental health care
Increase access to
evidence-based
people per year
spend, increased
community provision
will have been
acute mental health
care
number of CAMHS T4
area placements
spend, increased
community provision

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

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

based mental health
care interventions
will have access to
evidence based
and interventions
Intensive home
treatment will be
of England as an
service standard
with SMI who can
access evidence based
have doubled
60% people
will access NICE
2 weeks
10% reduction in
have multi-agency
suicide prevention
women each year can
mental health care
Increase access to
evidence-based
people per year
spend, increased
community provision
will have been
acute mental health
care
number of CAMHS T4
area placements
The number of people with
SMI who can access
evidence based Individual
Placement and Support
(IPS) will have doubled
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
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

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

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

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

www.england.nhs.uk
• Social Care
• Awareness and Attitude
• Beyond 20/21
• Workforce
• Delivery, Delivery, Delivery

Claire Murdoch

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Claire Murdoch