What we have learnt…recap and reflections

1. What we have learnt…recap and reflections BOND Tees Valley Pilot Workshop 5 12.7.12

3. Re-cap on what we have learnt during workshops • Barriers and challenges • Input from the BOND team • Reflections on the learning • This presentation;

4. Commissioners – with a budget and an interest in supporting CYP emotional and mental health in order to improve their outcomes i.e. health, education, welfare, etc • Providers of not-for-profit services for CYP which provides therapeutic or psychological interventions, and/or support to CYP with mental health problems • Who has been on the journey

5. CVSOs have an important role to play and often offer good access in local communities, to a broad range of services • Commissioners need to be confident in the VCS • CYP mental health is often perceived as statutory CAMHS’ business – demand for clinical services outstrips capcity • Early intervention works and is cost effective • Schools increasingly engaging in commissioning – and need to know about VCS services • Need a broad range of services to meet a broad range of need • Why?

6. ACCESS TO SERVICES? Access 1 4 Service ‘tiers’

7. Access to mental health expertise? Mental health expertise 1 4 Service ‘tiers’

8. What happens to children and young people? Mental health expertise Access GP School LA 1 4 Service ‘tiers’

9. Where does the VCS fit in? D.V. Mediation Activity based Young Carers Mental health expertise Access Drop in School Mental Health Services Counselling 1 4 Service ‘tiers’

10. VCSOs Challenges • Funding • Competition vs partnership • Specialist vs generic • Statutory service domination of partnerships • Capacity to compete –process excludes smaller organisations or less ‘networked’ VCSOs • New requirements e.g. PBR, outcome measures • Business planning on shifting sand– personnel, policy, environment • Need for new business approaches – marketing, cost benefit analysis, etc

11. Commissioner’s Challenges • Ensuring services are ‘safe’ and high quality • Fully understanding the market • Developing services for the most difficult to reach groups • Ensuring timely access to appropriate MH expertise in the right part of the system • Identifying best value for money

12. Schools’ Challenges • Identifying pupils with a mental health problem and getting help quickly • Want to refer directly to CAMHS • Want information back from services about pupils so that can help them in school setting • Knowing what works and the difference between services • Services must show an impact on a pupils’ ability to learn

13. Market and competition • Commissioning and delivery system • Policy and drivers • MH spectrum/definitions • Commissioning environment • Quality assurance • External Environment Information gathering & exchange Opportunities for… Identifying critical issues and barriers

14. Levels of competition in CYP mental health provider market Numerous providers + commissioners Large + small organisations More VCS Less clinical governance Smaller contracts Frequent tendering Increasing levels of competition Some variety of providers More frequent tendering + increasing competition (usually LAs, NHS) Infrequent competition amongst larger MH provider trusts Limited contestability Tier 4: Inpatient Care Tier 3: Clinical/ medical care (diagnosis/ medication) Tier 3/2 interface: Primary MH services LAC, YOS, other targeted CAMHS Tier 2/1 interface: ‘Generic’ School + community based e.g. counselling + IAG services Related services e.g. drop-in, youth support, family support

15. Emotional wellbeing, mental health, mental disorders? • Early intervention mental health services? • Types of interventions • Settings/age groups • TaMHS • Evidence based practice? • What do we mean by ……

16. Different labels same children Children at risk; in need; Social Care vulnerable Children with emotional          and behavioural difficulties; Education special needs Children with mental illnesses; psychiatric disorders Health

17. The mental health spectrum From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Moderate mental health Mental disorder Flourishing Languishing Number of symptoms or risk factors

18. The effect of shifting the mean of the mental health spectrum From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Flourishing Moderate mental health Mental disorder Languishing Number of symptoms or risk factors

19. Types of mental health work in schools (from TaMHS national evaluation 2012)

20. Levels of evidence for intervention studies (from National Iinstitute of Clinical Excellence) Level of evidence Type of evidence 1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1+ Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias 1– Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias* 2++ High-quality systematic reviews of case–control or cohort studies High-quality case–control or cohort studies with a very low risk of confounding, bias or chance and a high probability that the relationship is causal 2+ Well-conducted case–control or cohort studies with a low risk of confounding, bias or chance and a moderate probability that the relationship is causal 2– Case–control or cohort studies with a high risk of confounding bias, or chance and a significant risk that the relationship is not causal* 3 Non-analytic studies (for example, case reports, case series) 4 Expert opinion, formal consensus *Studies with a level of evidence ‘–‘ should not be used as a basis for making a recommendation

21. Commissioning (what’s involved? Where does procurement fit in? CYP participation?) • Outcomes? Value for money? • What do we mean by ……

22. Strategic process for allocating resources Identify needs Outcomes? Resources? Priorities? What have we learnt about needs? Plan and design pattern of services how well is the service delivering outcomes? Look to the market - Does it provide what we need? Tender & Procure Disinvest? Develop market?

23. Commissioning practice varies widely……. Intelligent Commissioning Maximise value from total local public sector budget Outcome driven Empowering users and local communities Widespread embracing of behavioural change Some community led commissioning Semi-autonomous personalisation Driven by customer experience Many organisations operate here • Effective Commissioning • Commissioners engaging with communities on the pattern of services required • Commissioners shaping structure of delivery • Active redesign of services • Personalisation • Decommissioning • Adequate Commissioning (status quo) • Good control over existing contracts • Narrow approach to commissioning around procurement and purchasing • Weak Commissioning • Historically and provider led • Little effective challenge Aiming to be here…. REACTIVE COMMISSIONING

24. What added value can you offer? • Volunteer capacity (how cost effective is this?) • Organisationally held knowledge and expertise • Non-profit making – will this demonstrably make it cheaper than the competitor’s? • Local brand (how strong is your brand? What is the perception locally?) • Accessibility and less stigma - how do you demonstrate the benefit? • Attract other funding – have you promoted your track record?

25. The ACE–Value Commissioning Ready Framework • Twelve compulsory components must all be evidenced to demonstrate the provider is “commissionable”. • These are spread across: • Accountability • Compliance • Empowerment • ... with an opportunity to shine through evidence of added Values

26. Policy and national drivers • Increased access to psychological therapies (IAPT) • Payment by Results • DfE – devolved decision making – pupil premium • Funding environment for VCS • Health reforms…

27. Public Health England (Local health improvement in LAs) The new health system Department of Health NHS NHS Commissioning Board Monitor (economic regulator) CQC (quality) HealthWatch Clinical Commissioning Group Providers Localauthorities (via health & wellbeing boards) Local HealthWatch

28. External environment…summary • The only constant characteristic is change • Competition is increasing • Have to look outside usual funding sources • Some providers are joining together in order to try and strengthen position of VCS • Relationships are highly valued and building trust and reputation remains important • Communication from and between services and schools is part of quality provision

29. Market and competition • Commissioning and delivery system • Policy and drivers • MH spectrum/definitions • Commissioning environment • Quality assurance VCSOs… where are you in this? • External Environment • Internal Environment • Marketing • Cost effectiveness • VfM • Outcomes Information gathering & exchange Opportunities for… Identifying critical issues and barriers

30. Group exercise • In ‘discipline’ groups • As a result of the workshop programme; • what have you been prompted to think about • changes you have in mind to make • any action you have taken already • Prompts on sheets to help • Discuss and record main points

31. Review • Market and competition • Commissioning and delivery system • Policy and drivers • MH spectrum/definitions • Commissioning environment • Quality assurance VCSOs… where are you in this? • External Environment • Internal Environment • Marketing • Cost effectiveness • VfM • Outcomes Change management Information gathering & exchange Opportunities for… Identifying critical issues and barriers Needs & priorities? Partnership? Competition? Opportunities? What does this mean for our… Local external environment • Participate • Influence • Challenge • Find out Organisational Plan Based on strategic plan Based on Bryson, J. 1988