Five Year Forward View for Mental Health: from Planning to Delivery by Karen Turner of NHS England.

1. www.england.nhs.uk
Karen Turner
Director of Mental Health Clinical Policy and Strategy
NHS England
Mental Health Summit
7 June 2016, Southampton
Five Year Forward View
for Mental Health:
From planning to delivery

2. The report in a nutshell:
• 20,000+ people engaged
• Designed for and with the NHS Arms’ Length Bodies
• All ages (building on Future in Mind)
• Three key themes in the strategy:
o High quality 7-day services for people in crisis
o Integration of physical and mental health care
o Prevention
• Plus ‘hard wiring the system’ to support good mental
health care across the NHS wherever people need it
• Focus on targeting inequalities
• 58 recommendations for the NHS and system partners
• £1bn additional NHS investment by 2020/21 to help an
extra 1 million people of all ages
• Recommendations for NHS accepted in full and
endorsed by government
Five Year Forward View for Mental Health
Prime Minister: “The Taskforce has set out
how we can work towards putting mental
and physical healthcare on an equal footing
and I am committed to making sure that
happens.”
Simon Stevens: “Putting mental and
physical health on an equal footing will
require major improvements in 7 day
mental health crisis care, a large increase
in psychological treatments, and a more
integrated approach to how services are
delivered. That’s what today's taskforce
report calls for, and it's what the NHS is
now committed to pursuing.”
2

3. Wessex CYPMH Services 2013/14
An outline for the Wessex CN Children’s Mental Health Service is presented below. Data
was taken from the 2015 Local Transformation Plans and compares Wessex to the
England Average in Mental Health Prevalence, Expenditure and Referrals.
Approximate 5-16 year olds with a diagnosable Mental Health per
1000 children
Approximate Annual Total CYPMH Referrals per 1000 0-17 general
population 2013/14
Approximate Annual total CYPMH expenditure per 1000 0-17 general
population £’000s 2013/14
Thames ValleyWessex
9 CCGs
19.7%
Population aged 0-17 years
9.6% estimated 5-16 year olds
with mental health condition
Accepted
referrals
England
28.38
23.9823.9
18
0
5
10
15
20
25
30
Total referrals per
1000 0-17 general
population
Accepted referrals per
1000 0-17 general
population
Wessex
England
3

4. Wessex 64% 88% 80% 83% 80% 73% 46% 73%
Clinical Network ↓ Participation Whole System Promotion
Vulnerable
Groups
Outcomes
Eating
Disorders
Workforce AVERAGE
AVERAGE by THEME 72% 88% 63% 60% 76% 70% 42% 67%
Overview of Wessex CAMHS Local Transformation Plans
• NEL CSU scored plans using the themes set out in Future in Mind and Eating Disorders.
Wessex scored very highly based on the information provided in the LTPs – however workforce
planning is a concern .
• The information that has been delivered in the trackers from the CCGs in the region is much
weaker.
4

5. LTP Area 2014-15
CCG
spend
reported
in LTPs
(‘000)
2014-15
Local
Authority
Spend
reported
in LTPs
(‘000)
Total
funds
allocated
in 2015-
16 (ED
and
Spring
Budget )
Spring
Budget
Information
reported in Q4
tracker for
generic
capacity
building
Increase in CYP
access to
generic CAMHS
Portsmouth £2,396 £241 £266,297 £154,050 1 FTE 1,478
Southampto
n
£3,622 Unknown £295,253 £170,800 2.0 FTE 2,500
Isle of Wight £1,619 £277 £175,230 £101,369 0 FTE 1
Hampshire £8,910 £1,746 £1,613,41
0
£933,337 0 FTE 0
Dorset Unknow
n
£584 £1,015,75
0
£587,600 8.5 FTE 800
Capacity Building and Spend in CYP MH Services – Q4 information using the
resources from the Spring Budget
5

6. LTP Area 2014-15
CCG
spend
reported
in LTPs
(‘000)
2014-15
Local
Authority
Spend
reported
in LTPs
(‘000)
Total funds
allocated in
2015-16 (ED
and Spring
Budget )
Eating
Disorder
monies
Information
reported in Q4
tracker for
eating
disorders
capacity
building
Increase in CYP
with access to
treatment for
eating disorder
Portsmouth £2,396 £241 £266,297 £122,247 5 FTE 32
Southampton £3,622 Unknown £295,253 £124,453 2.2 FTE 0
Isle of Wight £1,619 £277 £175,230 £73,861 0 FTE 1
Hampshire £8,910 £1,746 £1,613,410 £933,337 4.2 FTE 5
Dorset Unknown £584 £1,015,750 £680,070 8.0 FTE 80
• The Isle of Wight report that they are currently meeting the Access and Wait Standard for Eating
Disorders and seeing 91.7% of eating disorder cases within 4 weeks
• All other LTPs plan to use the new money to reach this target
Capacity Building and Spend in Eating Disorder Services – Q4 information
6

7. • Total investment from 2015/16 to 2020/21 £365m (Government announced £290m
Jan 2016, building on earlier spring budget announcement).
• February 2016: Mental Health Task Force’s 5YFV for MH recommends additional
investment so that by 2020/21, an additional 30,000 women in all areas of the
country should receive access to evidenced-based specialist support, closer to their
home, when they need it, including access to psychological therapies and right
range of specialist community or inpatient care.
• Enables NHS England to design a phased, five-year transformation programme to
build capacity and capability in specialist perinatal mental health services, with the
aim of enabling women in all areas of England to access NICE-concordant care by
2020/21.
Perinatal Mental Health – Key Announcements
7

8. 2016/17 2018/19 2019/20 2020/212017/18
Preparation and planning: pathways,
networks, workforce development
Building capacity in MBUs
Securing transformation:
• Building capacity in specialist community teams
• Rolling out new model of care for MBUs
• Data, metrics and payment levers
Five year phasing
8

9. • Governance and accountability – national project board launched in April to oversee
implementation delivery with all system partners and develop five-year programme
• Developing MBU provision
• Complete procurement of three new units (South West, North West and East of England)
• Complete existing capacity review and build any additional beds into contracts
• Continued investment in implementation teams and perinatal mental health networks
• Launch and delivery of clinical leadership bursaries
• Workforce and development – support HEE to develop workforce strategy to identify
requirements, training events and development of a tiered skills and competency framework.
• Support for commissioners in planning future requirements through analytics and seminars.
National priorities 2016/17
9

10. • Develop and build effective multiprofessional clinical networks, with leaders from
across the care pathway, to drive service improvement, promote clinical excellence
and support professional development.
• Identify and assess baseline positions in terms of availability and access to specialist
perinatal mental health services (gap analysis in line with NICE guidance) in order to
determine strategic plans for coming years and respond to availability of new
funding.
• Ensure that a broad range of perinatal mental health support is available locally, with
clear pathways available for identification and timely access to psychological
therapies and specialist perinatal services in line with NICE guidance.
• Establish local workforce strategies to inform and deliver the 5 year vision.
• Collaborate between the regional networks and share good practice – including the
Wessex network’s exciting innovation ‘WebBeds’.
Network priorities 2016/17
10

11. “By 2020, there should be 24-hour access to mental
health crisis care, 7 days a week, 365 days a year –
a ‘7 Day NHS for people’s mental health’.”
11
• over £400m for crisis resolution and home
treatment teams (CRHTTs) to deliver 24/7
treatment in communities and homes as a
safe and effective alternative to hospitals
(over 4 years from 2017/18);
• £247m for liaison mental health services in every hospital emergency
department (over 4 years from 2017/18);
• £15m for Health Based Places of Safety in 2016/17 (non-recurrent)
Spending Review – Headlines for Crisis & Acute Care

12. Recommendation 17:
• By 2020/21 24/7 community crisis response across all
areas that are adequately resourced to offer intensive
home treatment, backed by investment in CRHTTs.
• Equivalent model to be developed for CYP
Recommendation 18:
• By 2020/21, no acute hospital is without all-age mental
health liaison services in emergency departments and
inpatient wards
• At least 50 per cent of acute hospitals are meeting the
‘core 24’ service standard as a minimum by 2020/21.
12
Mental Health Forward View – crisis & acute
recommendations (1/2)

13. Recommendation 22:
• Introduce standards for acute mental health care, with the expectation that
care is provided in the least restrictive way and as close to home as possible.
• Eliminate the practice of sending people out of area for acute inpatient care
as a result of local acute bed pressures by no later than 2020/21.
Recommendation 13:
• Introduce a range of access and quality standards across mental health. This
includes:
o 2016 - crisis care (under development)
o 2016/17 – acute mental health care (yet to start)
13
Mental Health Forward View – crisis & acute
recommendations (continued, 2/2)

14. 14
National focus in 2016/17 on ‘preparatory’ national work before new money comes in
– the national levers and incentives to support local delivery:
Develop 5x evidence based treatment pathways for crisis and acute care:
• 24/7 UEC mental health liaison in acute hospitals
• 24/7 ‘blue light’ UEC mental health response
• 24/7 community UEC mental health response
• 24/7 UEC response for children and young people
• Acute mental health care pathway
For each of the above:
 Referral to treatment pathway, including response times and NICE
quality standards
 Implementation guidance
 England-wide quality assessment and improvement scheme
 England-wide baseline audit and gap analysis
 Establish much needed changes to national datasets;
• CCG Improvement and Assessment Framework – Crisis and OATs prominent;
• Development of Sustainability and Transformation plans – new 5 year
approach – including crisis and acute mental health;
• New payment models being developed for mental health and UEC
What next for crisis care & acute care in 2016-18?

15. Organisation
Reliable
Improvement:
Monthly average
August 2015-
January 2016
6 weeks
Completed
Treatment:
Average August
2015- January
2016
Recovery:
Monthly
average
August 2015-
January 2016
Access:
Annualised
Monthly
average
August
2015-
January
2016
At least
60% of
clients
completing
a course of
treatment
A high level of
problem
descriptor
identified at
assessment
January 2016
data only
Wessex
NHS DORSET CCG 70.5% 91.2% 54.8% 15.8% 63.8% 89.8%
NHS FAREHAM AND GOSPORT
CCG 63.9% 83.8% 49.6% 9.0% 65.0% 99.1%
NHS ISLE OF WIGHT CCG 63.5% 88.7% 48.4% 23.1% 75.5% 79.6%
NHS NORTH EAST HAMPSHIRE
AND FARNHAM CCG 62.6% 73.3% 47.7% 15.9% 88.9% 95.0%
NHS NORTH HAMPSHIRE CCG 64.4% 83.0% 51.2% 10.3% 86.9% 99.1%
NHS PORTSMOUTH CCG 70.2% 93.9% 49.7% 16.8% 72.0% 62.4%
NHS SOUTH EASTERN
HAMPSHIRE CCG 66.3% 82.6% 51.4% 8.7% 80.4% 99.1%
NHS SOUTHAMPTON CCG 68.0% 95.2% 50.6% 14.3% 75.0% 95.2%
NHS WEST HAMPSHIRE CCG 66.6% 81.2% 51.3% 9.8% 84.6% 99.0%
15
Performance challenges in achieving national standards for access and
recovery in current services
Adult IAPT: Current Performance

16. Mental Health Forward View commits to:
• Expand IAPT services to meet 25% of need by 2020/21.
o The majority (2/3rds) of the expansion will be ‘Integrated IAPT’
services – co-located in and integrated with physical health
services, and focused on people with co-morbid mental and
physical health conditions. Services should lead to physical health
savings which can be re-invested in further expansion.
o ‘Core’ IAPT services will also expand. Focus on maintaining
quality, improving productivity, support for women in the
perinatal period and continuing to support therapies as
recommended by NICE (e.g. introducing mindfulness based CBT
for depression relapse prevention)
• At least double the number of employment advisors in IAPT services
(led and funded by DH and DWP)
16
IAPT Expansion

17. • Developing new curricula for IAPT practitioners working with people
with long term conditions / Persistent Physical Symptoms
• Developing the service model for new integrated services – planning
to focus attention and investment on primary care
• Initial work with a group of early implementer local health economies
testing and improving the Integrated service model
• NHS England & HEE collaboratively commissioning training for first
wave of new services
• Putting in place the necessary infrastructure to quantify the benefits
and savings of new integrated services
17
National work in 16/17

18. 5%
4% 2%
8% 7%
10%
4%
15%
5%
0%
5%
10%
15%
20%
NHS Dorset
CCG
NHS Fareham
And Gosport
CCG
NHS Isle Of
Wight CCG
NHS North East
Hampshire And
Farnham CCG
NHS North
Hampshire CCG
NHS
Portsmouth
CCG
NHS South
Eastern
Hampshire CCG
NHS
Southampton
CCG
NHS West
Hampshire CCG
IAPT use by BME groups: % of referrals (in quarter) which are for people
of black and minority ethnic groups - Q2 2015/16 (18+ yrs)
3%
2%
1%
4%
3%
4%
1%
8%
2%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
NHS Dorset CCG NHS Fareham
And Gosport
CCG
NHS Isle Of
Wight CCG
NHS North East
Hampshire And
Farnham CCG
NHS North
Hampshire CCG
NHS Portsmouth
CCG
NHS South
Eastern
Hampshire CCG
NHS
Southampton
CCG
NHS West
Hampshire CCG
Use of mental health services by BME groups: % of people in contact with
mental health services who are in black and minority ethnic groups -
2014/15 (18+ yrs)
18
How successful is IAPT at meeting a range of needs?

19. 7% 7%
3%
2%
0%
2%
4%
6%
8%
NHS Dorset CCG NHS Fareham And
Gosport CCG
NHS Isle Of Wight
CCG
NHS North East
Hampshire And
Farnham CCG
NHS North
Hampshire CCG
NHS Portsmouth
CCG
NHS South Eastern
Hampshire CCG
NHS Southampton
CCG
NHS West
Hampshire CCG
% Care Programme Approach adults in employment
- Q2 2015/16 (18-69 yrs)
5
10 10
20
0
5
10
15
20
25
Value(£000)
Referrals receiving employment support: Number of referrals finishing a
course of treatment who received employment support (Annual) -
2014/15
19
How successful is IAPT at meeting a range of needs?

20. • Consistent and reliable data in mental health still lags behind other areas.
• The FyFV for mental health sets out a vision for a data and transparency
revolution.
• To support this, in 2016/17 NHS England will be:
o working with the Department of Health and NHS Digital to ensure the new
MHSDS is capturing and reporting the data we need.
o supporting the mental health and dementia intelligence network to develop a
source of high quality data to underpin intelligent commissioning.
o developing a dashboard for mental health to track progress at a national level
and allow benchmarking of services. This will form the basis of the CCG
Improvement and Assessment framework and will help monitor the success of
our national work programmes.
Driving service improvement through transparency
20
Timely and accurate data are essential. We will also be working to remind CCGs
of their contractual responsibility to ensure all the services they are
commissioning are flowing high quality data into the national minimum dataset.

21. • Payment mechanisms can help drive local health economies to improve outcomes
that are of value to people with mental health problems.
• However, over half of mental health trusts are still paid using block contracts,
unrelated to local needs or the quality of care; few providers have moved to contracts
that reward quality and outcomes.
• Our vision is that payment across mental health and dementia should reward access
to evidence based care, integrated care provision, health outcomes and quality,
therefore all payment systems must be transparent and accountable.
To support this, in 2016/17 NHS England will be:
• producing support materials to develop quality and outcome measures which can be
linked to payment - summer
Improving consistency in payment approaches
21

22. • The CCG Improvement and Assessment Framework has been introduced to
empower CCGs to deliver the transformation necessary to achieve the FyFV.
• The focus is on practical support, rather than assurance and monitoring.
• In June 2016 a simple assessment based on a limited number of indicators. The five
measures for mental health are:
• An overall rating for mental health will based on performance against the national
standards for IAPT and EIP, measured against a four-point scale.
• Data from the transformation indicators will be published alongside the overall
rating on MyNHS.
• These measures will be revised for the end 2016/17 to support a more complete
overview of CCG performance in mental health.
National standards Transformation indicators
IAPT recovery rate Children and Adolescent MH
EIP 2 week wait Crisis
Out of Area Treatments
Driving service improvement through transparency
22

23. • Are geographically based and cover health and care needs of the
population
• A place for commissioners and providers to collaboratively develop plans
for a sustainable future over a 5 year period
• Should have multi-agency engagement including health and social care
partners as a minimum
• Include physical and mental health care providers including acute trusts,
primary care and secondary mental health care
• Include specialised services that are provided within that geography (even
when they provide services to a wider population base)
• Cover a larger geography than the usual planning footprints
What are the properties of STPs?
STPs and Mental Health: The Opportunities
23

24. • Invest to save where savings realised beyond the 1 year commissioning
cycle
• Invest to save where savings realised in a different setting (e.g., provide
specialist MH care, save in acute physical health)
• Specialist services that require planning over a geography bigger than a
single CCG
• Delivering care pathways that require a whole system approach (e.g., need
care from primary, secondary physical and mental and social care)
• Investing in preventative or early intervention care to reduce costs of care
later in the cycle
What kinds of activities therefore are best articulated at an STP rather than
a CCG level?
24

25. The CCG improvement and assessment framework transformation indicators to incentivise better
planning and measurement during 2016/17 to eliminate OATs:
1) Has the CCG established a process to monitor mental health out of area placements by bed type,
which includes (at individual patient level)
i how many are made?
ii. the reasons for them?
ii. the duration?
iv. the cost?
2) Does the CCG have a plan in place to reduce all types of mental health out of area placements, with
a specific focus on placements for non-specialist acute mental health beds during 2016/17?
3) Can the CCG demonstrate that it is on track to deliver a reduction in non-specialist acute mental
health bed out of area placements by quarter 4 2016/17?
25
Out of Area Treatments (OATs) – what should be done now?
• Some areas have already managed to eliminate OATs, e.g. Bradford, Sheffield and NE London – by
redesigning the acute care pathway to ensure CRHTTs are able to offer intensive, therapeutic home
treatment as a genuine alternative to admission.
• The money saved with a lower inpatient bed base and fewer costly OATs has been reinvested into
community mental health services to ensure care is delivered in as close to home as possible in the
least restrictive setting, and pressures on the inpatient system are reduced