English Experience of Setting up Acute and Crisis Services

1. English Experience of Setting up Acute and Crisis Services Iain Tulley Chief Executive Devon Partnership NHS Trust

2. Outline • Lesson in Geography and History • Description of the current position • Risks and Opportunities

3. Geography and Historyose • Broad picture across England • Position in Devon • Last 25years • Last 10 years • Last 3 years

4. Map of England Spend £22.5 billion – 2010 £32.6 billion – 2026 £47.5 – dementia 63 million population Beds 150,000 – 1955 27,000 - 2007

5. Map of Devon Spend £140 million Population 850,000 Acute Beds 2006 142 2011 92

6. Last 25 years • Major hospital closure programme • Care in the Community • Profile and Resources • Organisational Structures

7. Last 10 years • Establishment of Mental Health Trusts • Resources • National Service Framework • Early Intervention Teams • Crisis Intervention Teams • Assertive Outreach Teams

8. Impact of Crisis Intervention Teams • Gate-keeping function • Acute bed reduction • Case-mix • Risk management

9. Last 3 years • Mental Health Profile • Access to Psychological Therapies • Dementia • Prison Healthcare Policy • Regulation • Risk management

10. Risks and Opportunities • In-patient levels of dependency • Lack of alternatives to hospital • Reform programme • Maintaining coherence • Risk aversion • Public attitudes

11. Conclusions • Rapid change • Resources • Growing demands • Further bed reductions • Managing Paradox