Knowing the People Planning (KPP)

1. Knowing the People Planning (KPP) Dr Barry Welsh Principal Advisor Ministry of Health New Zealand

2. History • In 1998 David King and I were asked if clients with highest needs in the South Island of New Zealand were • getting a good service, and…… • benefiting from it? • In the context of - significant variation in acute bed use (x2) • - perception of high unmet need for people with long-term serious mental illness • Appreciative enquiry approach with clients, family, clinicians, managers in 5 DHBs led to the development of KPP

3. Who are the ‘High Needs’ people? • Defined as those with greater than 2 years service contact. • Well documented as being high cost. • Small numbers • - in New Zealand’s 4.2 m population 15,000 long term people • - consistently across the country (<0.5% of the population) • The long-term clients until KPP (Knowing the People Planning) were ‘not known’ to the system but ‘known’ to many working in it.

4. Knowing the People Planning (KPP)– what is it? • KPP assesses the needs of long-term mental health adult clients according to 10 key features • 10 key features are a basic set of service requirements, which were defined as necessary, by all stakeholders in order to meet the needs of long-term clients. • Four of the key features relate to the client six relate to the service and how the service delivers to the four client features

5. KPP client features • Treatment plans are regularly reviewed and updated • Relapse prevention plans are accepted and used by the community mental health team (CMHT), the crisis team and the acute unit • Health advice for mental health (psychiatric) and physical conditions (GP) • Social support, where needed — work, housing, education, and social contact

6. KPP Organisation features • 5. A personal growth focus and self-management: the purpose • 6. Guaranteed client access and recognition on re-entry • 7. Accountability — a comprehensive service with common aims • 8. Co–ordination point for health and social support • 9. Contact is maintained with client • 10. Evaluation, learning from experience and involving patient information, when making improvements to services (the KPP annual plan).

7. Evaluation • PhD evaluation occurred in 8 DHBs, 2021 long term clients over 4 years • Initially • 50% of clients did not have treatment/care/recovery or relapse prevention plans • 11% required a GP • 13% required a housing change • 7% required a medication change • 10% in paid employment (FTE)

8. Evaluation • Regression analysis of KPP results showed two factors impacted on acute bed use: • -treatment and relapse prevention plans, and • -funding • Increasing the rate of plans from 50-90% decreased acute bed use by 26% while half as much funding again was required to reduce acute bed use by 10%

9. Evaluation

10. Evaluation • KPP also identified areas of unmet need that management provided assistance to address. • After one year: • - housing requirements decreased by 8% (to 5%), • - medication change requirements decreased by 3% (to 4%), • - GP change requirement decreased by 5% (to 6%) • - employment rates improved from by 7% (to 17%)

11. Evaluation • When comparing 8 KPP DHBs and 13 Non-KPP DHBs no significant differenceswere found pre and post KPP implementation in: • Access rates • Discharge rates • Antipsychotic medication costs • Nursing staff turnover • Funding

12. Accountability measures : Health target • 95% of long term mental health clients have a relapse prevention plan. • Relapse prevention plans identify early relapse warning signs of clients. What the client can do for themselves and what the service will do to support the client. • Ideally, each plan will be developed with involvement of clinicians, clients and their significant others. The plan represents an agreement and ownership between parties.

13. Long term adult client acute bed days

14. KPP and Co-production • KPP recognises the person as being a co–producer of the service rather than simply a consumer/end user. • Co–production recognises the client as a resource, in that value cannot easily be created or delivered, unless the person actively contributes to the service.

15. Conclusion • Essentially KPP better enables clients to co-produce their health outcome by ensuring clients have plans and services that better enable them to manage their illness. • This in turn creates value by significantly reducing costs to the system. • A win/win situation for both the client and the health service. • barry_welsh@moh.govt.nz • www.tepou.co.nz