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Sectorised mental health services in England

Sectorised mental health services in England. Alan Yates – Director, Unique health solutions. Introduction. Previously Chief Executive of three Trusts in England with mental health services Latterly, the Chief Executive of Mersey Care NHS Trust for 13 years: Treatment to 34,000 patient pa

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Sectorised mental health services in England

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  1. Sectorised mental health services in England Alan Yates – Director, Unique health solutions

  2. Introduction • Previously Chief Executive of three Trusts in England with mental health services • Latterly, the Chief Executive of Mersey Care NHS Trust for 13 years: • Treatment to 34,000 patient pa • 672 In-Patient beds • 520,000 out patient contacts per year • 33 buildings • €250m pa • 4,600 staff • Retired in September 2012 and with four colleagues established UHS – a healthcare management consultancy • Advise clients about integration, finance, quality and service redesign

  3. History and Reasons • Long tradition of the asylum – hospitals which withdrew people from society if they showed mental health or social “maladjustment” • In England In-Patient beds peaked in 1954 at 148,000 • These beds have reduced to 19,000 in 2011/12 as a result of psychotropic drugs, the development of community services and scandals of abuse and neglect in large out of town hospitals. • Before 1980 about less than 20% of English mental health services were sectorised and community based • After 1990 80% of English mental health services were sectorised and community based • In 1999 the UK Government produced the National Service Framework for Mental Health describing a good service and over 6 years it was implemented

  4. National Service Framework for MH (1999) • A strategy based on evidence rather than political preference for the first time, • Prof Francis Creed (1997) and others demonstrated that IP care was mostly no better than day care and more expensive, • Assertive outreach was effective in keeping people out of hospital at no increased risk • Early intervention in Psychosis significantly increases the number of patients who have only one episode of psychotic illness. • NSF supported Community Mental Health Teams (CMHTs) as the basis of diagnosis, treatment and care • NSF created Crisis and intensive home care teams, Early intervention teams, Assertive outreach teams and Criminal Justice Liaison teams as well as CMHTs

  5. Model

  6. General context in england - 2012 • Adult acute beds • Median beds per 100,000popl.22 • Median bed occupancy90% • Median admissions per 100,000popl. 240 • Median length of stay29 days • Community • Referrals to CMHTs per 100,0004000 • CMHTs caseload per 100,0001700 • CMHT contacts per 100,00033,000 • Crisis caseload per 100,00025 • Crisis contacts per 100,0004000

  7. The range is great For Beds

  8. And for community services

  9. A sectorised service In england • Typical organisationin England and Wales which I have supported has: • Population of 500,000 with • 8 sectors • Each sector will typically have: • Average population per sector of 75,000-100,000 • Multi-disciplinary team with Psychiatrists, Nurses, Psychologists, Occupational Therapists, Social workers, Care assistants and Administration – a team of perhaps 30 • In-patient beds of 20 – 25 per sector • 3000-4000 referrals per year • A caseload of 1500 patients • 28,000 appointments per year

  10. The future • Two problems: • Difficulty of managing the community and the in-patient service • Challenge of integrating the work of the generalist mental health teams (CMHT) and the specialist teams (assertive outreach, early intervention, crisis, criminal justice liaison etc) • Solutions • “Acute care model” which provide separate In-patient teams • Merge specialist teams and CMHTs

  11. Conclusion • The French had “La politique du secteur” before the English in the 1960s • However UK Government policy in the 1980s and 1990s enabled the establishment of well resourced community based services • UK spend as a % of total health spend is 14% - in France it is 8% • Sectorisation is very dependent on the use of other community resources such as housing, employment, social care and these have been reduced by 25% in England in the last 3 years – very difficult circumstances • The English mental health services are moving into increased social and educational approaches to recovery. This is a challenge for Community Mental Health Teams. • Sectorisation has worked well in England but is now coming under strain.

  12. So onwards and ever upwards! alanyates@uhsltd.co.uk

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