HEALTHCARE FOR LONDON Conference

1. HEALTHCARE FOR LONDON Conference

2. Mental HealthServicesin London JOHN NAWROCKYI Director of Adults and Older Peoples Services London Borough Of Greenwich HELEN SMITH Deputy Chief Executive Oxleas Foundation Mental Health NHS Trust

3. Mental ill health is one of “the biggest causes of misery in our society… at least as important as poverty ” Prof. Richard Layard” It costs England, directly and indirectly, £77bn a year 40% of people on incapacity benefit have a mental health problem More people with mental ill-health draw incapacity benefit than unemployed people on Jobseeker’s Allowance 1 in 3 GP appointments have a significant mental health component

4. London has 10 specialist Mental Health Trusts (c£1.7bn) and….. • A greater burden of mental ill health than any other English region • 1 million Londoners at any one time with a common mental health problem • Highest rate of compulsory psychiatric admissions in England • 1 in 5 of (your) constituents will have a mental health problem • 26,000 inpatient admissions & 455,000 outpatient appointments every year • 23% of inpatients with psychotic disorders compared to 14% in England • Over representation of people from Black groups in inpatient and forensic services • 1/5 of patients in medium/low secure care; 1/3 of patients in high secure hospitals

5. The Healthcare for London strategy focuses on three fundamentals • Early Intervention – intervening earlier to promote and maintain health through health promotion, prevention and health education • Localisation – benefits created through the physical integration of primary and secondary care (polyclinics) • Specialisation – better clinical outcomes through specialisation for certain conditions e.g. stroke

6. These fundamentals are highly relevant to mental health: • Health need – if you have a serious mental illness in London you are likely to die 10 years earlier that rest of population • Public benefit – social inclusion is a top priority for mental health requiring strong partnerships with Local Government • High quality life time care – mental health goes-hand-in-hand with physical health; integrated care pathways are vital if Healthcare for London is to work • Early intervention – is well tested in mental health • Localisation through Polyclinics – provide an important vehicle for enhancing integrated care and achieving improved outcomes for service users

7. Mental Health Trusts can bring three propositions to Healthcare for London: • Significant experience with regard to the management of change • Large and flexible estate and experience of downsizing and redevelopment • Significant experience of multi-disciplinary working in community settings

8. Critical issues for mental health which need to be considered in Healthcare for London: • Developing a common understanding of need between all agencies • Developing a care pathway currency and national tariff • Promoting social inclusion, including supporting service users in employment and extending direct payments • Securing a strong contractual, performance and regulatory framework • Developing benchmarking in health and social care services

9. Challenges: • Putting in place a multi-agency approach to social inclusion – needs ‘localisation’ to be working well and in a healthy state • Influencing others – taking full account of the economic and social benefits of reducing mental illness and promoting good mental health • Taking a broad view – linking ‘localisation’ and ‘specialisation’ from prevention, improving mental well being, treatment, and recovery

10. ADASS (1) • 10 YEAR, CROSS – GOVERNMENTAL NATIONAL STRATEGY FOR MENTAL HEALTH • “FUTURE OF MENTAL HEALTH = A VISION FOR 2015” • - ADASS/ LGA/ Sainsbury/ NHS Confederation • ENABLING ORDINARY LIVES • - Social Inclusion • PUTTING PEOPLE FIRST • - Personalisation • SAFEGUARDING PEOPLE • - Individual and Public

11. ADASS (2) • DEVELOPING EFFECTIVE AND ACCESSIBLE SERVICES • - Outcomes and Localisation • CREATING A MENTALLY HEALTHY SOCIETY • - Lifestyles and attitude • SUPPORTING CARERS • BUILDING CAPACITY IN PUBLIC SERVICES

12. RECOMMENDATIONSLOCAL GOVERNMENT INTERFACE (1) • YOUNG PEOPLE 14-25 • CHILDRENS TRUSTS & CHILD AND ADOLESCENT MENTAL HEALTH SERVICES • SCHOOLS (ATTAINMENT, ISOLATION, COUNSELLING, BULLYING) • EXTENDED SCHOOLS AND CHILDRENS CENTRES • Not in Education, Employment, or Training (NEET) • CHILDREN LOOKED AFTER AND CARE LEAVERS • YOUTH OFFENDING TEAMS (PERPETRATORS AND VICTIMS) • CRIME AND DISORDER REDUCTION PARTNERSHIP

13. LOCAL GOVERNMENT INTERFACE (2) • FEAR OF SERVICES • - Stigmatisation and Normalisation • - New Communities • - Voluntary Sector Compacts • - Community engagement • CLEARER CARE PATHWAYS • - Care management and practice – Based Commissioning • - Carers Strategies • - Safer Neighbourhood Teams / PCSO’s • CBT AND OTHER THERAPIES • - Social workers • - Lifestyle and healthy communities • - Direct Payments

14. CHOICE • INDIVIDUAL BUDGETS & IN-CONTROL TOTAL PILOTS • INCAPACITY BENEFITS & WORKLESSNESS • - Councils as Employers – work & stress • - Regeneration and the Economy (GLLaB) • - Chambers of Commerce • PARTNERSHIPS • - Local Area Agreements • - Local Strategic Partnerships • - Joint Boards • - Supporting People Inclusive Forums

15. NEW DEVELOPMENTS • MENTAL HEALTH ACT 2007 • APPROVED MENTAL HEALTH PROFESSIONALS • MENTAL CAPACITY ACT ( 1.M.C.A. SERVICES) • DEPRIVATION OF LIBERTY GUIDELINES