Mental Health Learning Workshop – NHS England (Midlands and East)

1. Mental Health Learning Workshop – NHS England (Midlands and East) Joanna Powell February 4, 2014

2. Plan • How did we get here? • Why am I here / my hopes for the day? • Introduction to Parity of Esteem Programme (PoE) • Emerging work areas • E.g. Common ‘narrative’ • MH CQUIN • Business as usual • Everyone counts – Planning guidance 2014/15 – 18/19 • Why am I here / my hopes for the day? NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

3. A few of our drivers NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

4. NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

5. The vision What Parity will mean to me: My family and I all have access to services which enable us to maintain both our mental and physical wellbeing. If I become unwell I use services which assess and treat mental health disorders or conditions on a par with physical health illnesses. The patient “Person centred, coordinated care” NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

6. Cultural change is at the heart of the POE Programme • Strategic aim – for POE to be everyone’s business • It cuts across all NHS OF Domains • It is closely aligned to other major transformational programmes – e.g. integration, person centred care planning and personalisation • It does however also have to focus on reducing the many disparities which exist between Mental and physical health • How will the programme be delivered? • Specific improvement / change projects • Business as usual to support POE generally* • Ensure alignment with other organisations and groups PoE Programme - key messages NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

7. Emerging PoE narrative 1. What’s the issue? 2. Where are we now? 3. Where do we want to be? 4. How do we get there? Increasing and more complex care needs Poor outcomes for people with mental illness Person centred, coordinated care ‘House of Care’ model Our mandate from the government requires us to close the gap between mental and physical health services – to achieve parity NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

8. Mental illnesses are very common 1.2m people in England have a learning disability There will be over a million people with dementia by 2021 In any one year 1 in 4 British adults experience at least one mental disorder 5.4% of men and 3.4% of women have a personality disorder 10% of 5-16 year olds have a mental disorder Among people under 65, nearly half of all ill health is mental illness Between 8% and 12% of the population experience depression in any year

9. Among people under 65, nearly half of all ill health is mental illness % of morbidity in the UK: Physical v Mental illness1 Rates of morbidity in each age group (Equivalent life-years lost per 100 people)2 e.g. mainly depression, anxiety disorders, and child disorders Morbidity from physical illness rises steadily throughout life, whereas mental illness especially affects people aged 15-44 e.g. heart disease, cancer, diabetes NHS | Presentation to NHS England (Midlands and East) | 4 February 2014 Source: 1&2: Based on WHO, 2008. Further calculations by Mike Parsonage . see: LSE (2012) how mental illness loses out in the NHS

10. Yet, only a quarter of all those with mental illness such as depression are in treatment How does this compare to treatment levels for those with long term physical health problems? (in comparable western countries: 94% diabetes, 91% hypertension, 78% heart disease) NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

11. We know significant challenges remain to putting mental health on a par with physical health People with mental health problems have a significantly different level of contact with physical health services compared with other patients1: Service users Non-Mental health Mental health 1. Accessed hospital services Is this untreated need in the community? 78% 48% …and stayed in hospital around 30% longer 2. Arrived at A&E by ambulance 26% 54% 3. Classified as an emergency Why aren’t we picking up earlier? 40% 71% Source: 1- HSCIC (2013) HES-MHMDS Data linkage report; additional analysis; 2011-12. England (Experimental statistics). See: T.Fowley (2013) Bridging the Gap – p.9

12. People with poor physical health are at higher risk of experiencing mental health problems… 27% Diabetes 29% Hypertension % of people affected by depression 31% Stroke People who experience persistent pain are four times as likely to have an anxiety or depressive order as the general population 33% Cancer 44% HIV / AIDS NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

13. Mental health problems impose a total economic and social cost of over £105bn a year • £14bn is already spent on mental health services • Nearly a third of people with long term physical conditions have at least one co-morbid mental health problem. This can exacerbate the person’s physical condition and increase the cost of treatment by between 45% and 75% at a cost to the NHS of an estimated £10bn per year • Medically unexplained symptoms cost the NHS some £3bn per year • Mental illness has a significant impact on public finances: estimated that the costs of depression through lost working days are 23 times higher than the costs to the health service • 1 in 4 unemployed people has a common mental health problem • Childhood mental health problems can have a significant economic effect on society. It is estimated that a child with a conduct disorder will, by the age of 28, have generated costs (such as to the health, education, benefits and criminal justice systems) ten times as high as a child without conduct problems Medical costs Hidden costs NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

14. Culturally we have started to see attitudes to mental health shift over the past 10 years… Public attitudes to mental health1: This shift in attitude is hugely important in the way we think about future service design – rather than see the community as a ‘barrier’ we need to start seeing as an ASSET. How can we enable people to help other people? How do we unlock underutilised resources in our community (i.e. people) to improve the well being of themselves and those around them? % agreeing with statement Key question: how do enable new and innovative health (and other public) services so people are seen as ‘active participants’ in their care and individual / community outcomes rather than passive recipients? Source: 1- The health and social care information centre (2011) Attitudes to mental illness – 2011 survey report

15. …and new service models emerge with huge potential to improve outcomes Examples: • Improving Access to Psychological Therapies (IAPT) programme had major impact in it’s first 3 years: • treating more than 1 million people in IAPT services • more than 680,000 people completing a course of treatment • recovery rates consistently in excess of 45% • Personalised Health Budgets: the national pilot programme indicated that personal health budgets “had a significant positive impact on care-related quality of life, psychological wellbeing and subjective wellbeing” of the people taking part. People with mental health problems reported improvements in their physical health, and people with physical health problems likewise reported better mental health • Suicide prevention strategy : Findings from three mental health promotion pilot projects to address the raised suicide risk in young men show that: • multi-agency partnership is key to promoting young men’s mental health; • community locations, such as job centres and young people-friendly venues, are more successful in engaging with young men than more formal health settings such as GP surgeries; • front-line staff feel better able to engage with young men if they receive training; • community outreach programmes are seen by young men as more acceptable and approachable than services provided in formal healthcare settings. Common mental health disorders Mental illness New service models that put patients in control Severe mental illness NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

16. The current design of our health system doesn’t ensure ‘whole-care’ packages Most people with Serious Mental illness don’t receive physical health checks We run a national programme of health checks within school, but we only check physical health There are significant delays in diagnostic treatment for people with learning disabilities National audit of schizophrenia – only 29% of service users getting proper metabolic monitoring NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

17. To realise the vision we are developing a ‘House of Care’ framework to support delivery… Patients, carers and professionals will have the right information needed to provide the right care at the right time (e.g. medical care in hospital and social care at home) Services will be available as and when needed by people without undue difficulty in transferring between agencies and settings. People will know where and to whom to turn for assistance in managing their conditions. NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

18. Mental Health CQUIN for 2014/15 Improving physical healthcare to reduce premature mortality in people with severe mental illness (SMI) Indicator 2: 35 per cent of funding for completion of a programme of local audit of communication with patients’ GPs, focusing on patients on the Care Programme Approach (CPA), demonstrating by Quarter 4 that, for 90 per cent of patients, an up-to-date care plan has been shared with the GP Indicator 1: 65 per cent of funding for demonstrating, through the National Audit of Schizophrenia, full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with psychoses, including schizophrenia. NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

19. The following cardio metabolic parameters (as per the 'Lester tool' and the cardiovascular outcome framework) are assessed; • Smoking status • Lifestyle (inc. exercise, diet, alcohol and drugs) • Body Mass Index • Blood pressure • Glucose regulation (HbA1c or fasting glucose or random glucose as appropriate) • Blood lipids • Hepatitis C Mental Health CQUIN for 2014/15 NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

20. Current top priorities • Addressing and improving crisis Care TOP one for 2014/15 • Data, Information and Intelligence • Development of capability and skills in commissioning – including need to focus on cultural change / behaviour of commissioners change • Delivering improvements to clinical services (including IAPT and increasing timely diagnosis and post diagnostic care for dementia) • Improving physical health for people with serious mental illnesses – CQUIN – talk about later • Discrete improvement project – Business as usual – Collaboration with system partners PoE Programme NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

21. Planning Guidance 2014/15 -18/19 Headlines • Outcomes drive everything we do • Significant financial challenge: no change is not an option • 2014/15 – transformation year in preparation for 2015/16 (Better Care Fund) What’s new? • Support available to support commissioners • Operational (2 years) strategic (5 years) plans • Integration / collaborative working a key feature • Monitor / NHS TDA (providers and commissioners) • Local authorities (Better Care funding) • Unit of planning to support Health and Social Care planning NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

22. Part 1 • Outcomes – NHS OF – linked to 7 ambitions • Key measures (3) • Service characteristics (6) - to drive transformation • Essential elements (4) for service delivery • Strategic, operational and financial plans – process and overview (including direct commissioning) • Bold, developed in partnership and locally led (unit of planning) • Better Care Funding Plan @ Health & Wellbeing Board level • Planning support Part 2 NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

23. Level of ambition NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

24. Level of ambition (cont.) Guide developed by Commissioning Assembly Quality Working Group NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

25. Key measures (3) • Improving health, Health and Wellbeing Boards, Commissioning for Prevention. Every contact really does count • Reducing health inequalities. Ensure the most vulnerable in our society get better care and better (integrated) services to improve health outcomes • Parity of esteem focus on improving mental and physical health and ensuring that patients with mental health problems don’t suffer inequalities, either because of the mental health problem itself or because they then don’t get the best care for their physical health problems NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

26. Support available Universal support can be found here http://www.england.nhs.uk/ourwork/sop/plan-sup-tools/ NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

27. Example of support available NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

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29. Planning Guidance 2014/15 -18/19 NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

30. High quality care for all, now and for future generations • High Quality – ‘Driven by quality in all we do – our patients rightly expect the best possible service’ • For all – ‘…whether need is for mental or physical help and support. We must put the greatest effort in providing care for the most vulnerable and excluded in society’ • Fornow – ‘Need to get better at sharing good practice rapidly across the NHS’ • For future generations – ‘Strategic plans developed in partnership working between commissioners, providers and local government to deliver models of care that will be sustainable in the longer term’ NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

31. In summary • The NHS Mandate clearly sets out priorities for the system • We all need to collaborate in order to deliver the mandate • NHS England National Support is there to support you and your local CCGs to deliver the NHS mandate • What do you and your local CCGs need us to do to help you to deliver the mandate? NHS | Presentation to NHS England (Midlands and East) | 4 February 2014

32. Any questions and thank you Joanna Powell, Domain Team Lead NHS England Jo.powell2@nhs.net NHS | Presentation to NHS England (Midlands and East) | 4 February 2014