Mental health and social care commissioning

1. Mental health and social care commissioning Andrea Wright, Head of Social Care Maureen Begley, Commissioning Manager

2. How commissioning operates in mental health • Head of service and commissioning manager lead on strategic commissioning • NCC funds NSFT (S75 agreement) to provide a social work service for working age adults with mental health needs. NSFT staff lead on micro commissioning for individuals and have day to day responsibility for the management of the care budget • NCC retains overall responsibility for the purchase of care budget (POC) and the management of services under block contracts/ Service Level Agreements • Under the interim S75 agreement for 2013/14 we are looking at NSFT taking over more responsibility for budget management

3. How the NCC cash is spent £9.6m Purchase of care (gross) • £6.42m in care homes • £477k supported living • £1.2m domiciliary care etc • £1.5m day care etc Currently forecasting an overspend of £2.15m £ 4.8m Service agreements (gross with NHS and SP £): • £430k Information advice and advocacy • £1.9m Short term/specialist care home places • £1.85m Supported living and floating support

4. Purchase of care 2013/14

5. Mental health purchase of care trends - service users and spend

6. Admissions to care homes continue to rise

7. Norfolk unit costs for care homes compared

8. What is affecting commissioning • Increasing demand • National drivers • Local drivers including commissioning changes across health and social care

9. Increases /changes in demand General population growth More young people with complex needs Increasing needs of people already receiving service as they get older Increasing customer expectation e.g. to live in the community Section 117 and Ordinary Residence issues

10. National and local drivers • Discussions on revisions to national social care eligibility criteria • Impact of Francis Inquiry into Mid Staffs hospital – expectation of culture change underpinned by CQC • http://www.vodg.org.uk/members/vodg-publications.html • Recovery as a focus • Personalisation • Peer support and experts by experience • National and local Strategic objectives/ performance indicators: To increase the use of Personal Budgets, Carers assessments, numbers of mental health clients in stable accommodation and in employment

11. What we have been doing in commissioning • De-commissioning preventive services and moving services off block contracts e.g. QUEST day opportunities • Re-commissioning in key areas – Information, Advice and Advocacy; Carers; Self directed support (support planning, employment support); IMCA/IMHA; community mental health support services • Re-negotiating block contracts under the open book process • Improving the management of placements in residential care and supported living through the panel process • AMHPs can now commission 7 day respite placements

12. Improved Advocacy • Advocacy funding supported by contracts with clear outcomes • Re-commissioned the mental health advocacy service to have a greater emphasis on self service and welfare rights • Re-commissioning the IMCA/ IMHA service with higher targets • Re-negotiated the Appropriate Adult service contract – looking at increased demand for service to all 17 year olds and out of hours service

13. Norfolk wide commissioning initiatives at present • Market position statement 2011 being updated – providers will be asked to feedback this autumn • Work on cost of care between NCC and NIC. Desk top exercise to update information which will also draw on the findings of national benchmarking • Continuing health care. Joint work (NHS/NCC) to develop new specification and bandings working with NIC to involve providers • New contract for community services e.g. day care, which are not CQC registered co-produced with providers

14. More Choice • Norfolk working to the themes in ‘Think Local Act Personal’ • All who want a personal budget will have one – progress has been slower in mental health but is a key performance indicator • Market will increasingly respond to provide services that meet individual needs • Range of services are becoming available to meet changes in service demand

15. Supported Living/Residential Care • All residents in residential care have been reviewed • NSFT looking at dedicated teams to work with care homes/residents • Continue to maximise use of short term supported living /care homes that focus on rehabilitation • Planning with Housing Providers and Social Landlords and families. • Planning with Residential Providers – diversification • Looking at innovation – what will support moves out of care homes/ maintain people in the community

16. Market Management • Capture and encourage innovation in response to personal budgets and supporting people in the community • Will be looking at progression and outcomes evidence • Use of Assistive Technology

17. Next Steps • To work with providers around the shift from care homes and to increase the Supported Housing options available. In particular to revise supported living standards and create a clear accreditation scheme for providers around supported living. • This work will be undertaken with the DAAT which is working on implementing the recommendations of the recent review of Tier 4 services around residential care and supported housing for people with dual diagnosis, and meeting the needs of people coming out of detox closer to home • Further develop community services to prevent hospital admissions and care home placements, this will include development of personal assistant/ domiciliary care services which can meet the needs of people with mental health needs • To tender supported living schemes provided by the third sector in central Norfolk in 2014