Clive Rennie, Head of Integrated Commissioning for Mental Health & Learning Disabilities

1. Norfolk Clinical Commissioning Groups and Norfolk County Council Adult Social CareThe Commissioning Environment Clive Rennie, Head of Integrated Commissioning for Mental Health & Learning Disabilities

2. Coverage • National MH Strategy • Current Funding Environment(s) • CCG’s • NCC • Organisational Arrangements • Commissioning Intentions

3. National Picture – The Messages Commission high quality, cost effective general and specialist health services for people with learning disabilities. Jointly commission services for people who challenge services and those with complex needs. Work with local authorities and others to address the social factors which adversely affect the health of people with learning disabilities.

4. National Picture – The Messages Wider interlink across Government Departments Cross Cutting Strategies Health Inequalities Poor experience of Health provision Primary Care Annual Health check Reasonable adjustments to enable equitable access to services

5. National Picture – The Messages Increase Employment Listen to the Patient experience - Winterbourne Carers needs Mental Capacity Act training

6. Current Funding EnvironmentClinical Commissioning Groups • 2.3% extra funding in 2013/14 • CCG’s have a recurrent deficit position based on PCT end position • All CCG’s have to save 2% non-recurrent usage • All CCG’s have to have a 1% surplus • Activity, demographics and technology advances are adding cost pressure of 2% and above per annum • Continuing Health Care Restitution Costs – 15% growth per annum

7. Current Funding EnvironmentClinical Commissioning Groups • Increased funding passed across to Social Care from CCG’s • 3% cost savings need to be made through Quality Innovation Productivity and Prevention (QIPP) plans • Equates to: • £20Billion nationally • £30M locally across the 4 CCG’s Norwich, West, South, North • No indication of the funding settlement for 2014/15 until December 2014

8. Current Funding EnvironmentClinical Commissioning Groups - Increase funding pass through to Social Care - Increased pressure on Acute i.e. A&E/ Beds/ Dementia - Community provision focus -What currency? Block/ Cost and Volume/ PbR Care Clusters

9. Current Funding EnvironmentNorfolk County Council Adult Social Care Comprehensive Spending Review 2011 NCC savings 140M 2011-2014 – 50.62M savings in Adult Social Care Comprehensive Spending Review 2014 2014 – 2017 – 189M savings in NCC 2014/15 – 73M savings

10. Current Funding EnvironmentNorfolk County Council Adult Social Care 2014 – 2017 – Adult Social Care share of the savings 56.6M (1% of the Adult Social Care budget) 2014/15 – 21M 2015/16 – 26.7M 2016/17 – 8.2M Consultation - Norfolk Putting People First – starts 19th September

11. Integrated CommissioningOrganisational Arrangements • Integrated Commissioning Team for Mental Health and Learning Disabilities • Legal agreement under Section 75 of the Health and Social Care Act 2012 between: • Norfolk Clinical Commissioning Groups • Norfolk County Council • NHS Anglia Commissioning Support Unit

12. Integrated CommissioningOrganisational Arrangements Head of MH and LD Commissioning for 4 Norfolk CCG’s and NCC Commissioning Lead for Adult Social Care (Community Services) Head of Service, Mental Health Commissioning Lead - Adults with Learning Disabilities Commissioning Lead - Dementia Commissioning Lead – Autism/ Aspergers Commissioning Lead - IAPT

13. CommissioningOrganisational Arrangements Creation of the NHS England and Area Teams Linkage to the Department of Health Creation of Commissioning Support Services (Hosted) Transfer of Public Health

14. Integrated CommissioningOrganisational Arrangements Mental Health and Learning Disability Commissioning Board – Norfolk CCG’s, Norfolk Adult Social Care, Public Health, Healthwatch CCG Board’s Adult Social Care – Senior Management Team NCC - Cabinet NSFT – Contract and Performance Meeting Contract meetings with other providers Information and Performance Sub Group IAPT Contract Sub Group Clinical Quality and Patient Safety Reference meeting Access and Assessment Service Reference Group GP Leads clinical meeting

15. Organisational Arrangements – Providers • Learning Disabilities • Norfolk County Council – Social Care provision • Hertfordshire Partnership NHS Foundation Trust – Healthcare provision – Assessment and Treatment • Joint Funding for individual placements – Cawston Park, St Johns, Rowan House • Social Care Individual funding packages • Supported Housing placements • Primary Care - Direct Enhanced Services • NNUH/ QEH/ JPH – Specialist Learning Disability Nurses

16. Organisational Arrangements – Budgets/ Expenditure approximations • Health 18M • Social Care 86M • Total 104M

17. Draft Commissioning Intentions 2014/15 To undertake the financial instruction (deflator)as outlined in Operating Framework for the NHS for all Mental Health and Learning Disability contracts with Health funding streams To review all Health funded third sector contracts in line with the principles established by Norfolk CCG’s To undertake the necessary actions to reduce the spending commitments on services in line with the budget reductions set by NCC Cabinet

18. Other Draft Commissioning Intentions 2014/15 Dementia diagnosis trajectory to meet national calculator uplift between 2% - 5% per annum – requirement for additional resource to meet the early/ timely diagnosis of patients. To ensure the pathway for patients assessed and referred under the FAIR scheme (Dementia CQUIN into the Acute Trusts 2012/13/14) is opened to direct referrals from Acute Trusts to Memory Services and to ensure that the current low level waiting times are not compromised by this change of pathway. To implement the Dementia Direct Enhanced Service agreement for GP’s to ensure that accurate recording of all patients with Dementia is on the Quality and Outcome Framework

19. Draft Commissioning Intentions 2014/15 The system of activity and currency is changing in 2014/15 for the main Mental Health FT contracts to shadow Payment By Results as opposed to the current Block contract arrangements. This change will need to translate into the 2014/15 main contract The restructuring of Mental Health services under the Radical Redesign process and the Payment By Results Care Clusters requires new clinical specifications to be agreed and costed. Specific work is being undertaken for the design and modelling of the Psychiatric Liaison Service at QEH

20. Draft Commissioning Intentions 2014/15 The Improving Access to Psychological Therapies service across all the CCG’s in Norfolk will be re-commissioned in 2015. To undertake options appraisal leading to the tendering and procurement process in 2014/15 Specific work is being undertaken for the design and modelling of the Psychiatric Liaison Service at QEH To ensure that the self-assessment of Autism commissioning and provision is undertaken and to plan the implementation of the outcomes of any deficits within the Norfolk system that are identified

21. Draft Commissioning Intentions 2014/15 To appraise the options as regards the potential establishment of a new Section 75 arrangement for Social Care provision in Mental Health To agree the Section 75 arrangement between NCC and the Norfolk CCG’s for Learning Disability Services To have staffed 136 suites in place throughout Norfolk. This is in line with recent CQC and HMIC report recommendations To adopt, in Norfolk, the pilot and standards set in the North Essex agreement for the conveyancing of Mental Health patients by EEAST.