National Perspective - Parity of Esteem – valuing mental and physical health equally

1. National Perspective - Parity of Esteem – valuing mental and physical health equally Joanna Powell 1 April 12014

2. A few of our drivers NHS | Presentation to North Region |1 April 2014

3. NHS | Presentation to North Region |1 April 2014

4. 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 North Region |1 April 2014

5. What is often like now for me? NHS | Presentation to North Region |1 April 2014

6. The NHS England vision of parity NHS | Presentation to North Region |1 April 2014

7. Parity of Esteem Programme • Facilitate NHS England to work to reduce the disparity which currently exists in health outcomes for those with mild, moderate or severe mental health illness • Support integration and personalisation by promotion of whole person care which values everyone’s mental and physical health needs equally NHS | Presentation to North Region |1 April 2014

8. 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 North Region |1 April 2014

9. Current top priorities • 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) • Addressing and improving crisis Care • Improving physical health for people with serious mental illnesses • Discrete improvement project – Business as usual – Collaboration with system partners PoE Programme NHS | Presentation to North Region |1 April 2014

10. An emerging common 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 North Region |1 April 2014

11. 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

12. 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 North Region |1 April 2014 Source: 1&2: Based on WHO, 2008. Further calculations by Mike Parsonage . see: LSE (2012) how mental illness loses out in the NHS

13. 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 North Region |1 April 2014

14. 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 North Region |1 April 2014

15. 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 North Region |1 April 2014

16. …and new service models emerge with huge potential to improve outcomes Examples: Common mental health disorders • 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. Mental illness New service models that put patients in control Severe mental illness NHS | Presentation to North Region |1 April 2014

17. 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 North Region |1 April 2014

18. The House of Care - The House supports National Voices ‘I’ statements • My goals/outcomes e.g. • All my needs as a person were assessed and taken into account. • Communication e.g. • I always knew who was the main person in charge of my care. • Information e.g. • I could see my health and care records at any time to check what was going on • Emergencies e.g. • I had systems in place so that I could get help at an early stage to avoid a crisis. • Decision-making e.g. • I was as involved in discussions and decisions about my care and treatment as I wanted to be. • Transitions e.g. • When I went to a new service, they knew who I was, and about my own views, preferences and circumstances. • Care planning e.g. • I had regular reviews of my care and treatment, and of my care plan.

19. 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 North Region |1 April 2014

20. The 6 Characteristics of sustainable services (emerging from Call to Action) • Citizens included in all aspects of service design and change and patients fully empowered in their own care • Expanded primary care • A modern model of integrated care • Access to the highest quality urgent and emergency care • A step-change in the productivity of elective care • Specialised services concentrated in centres of excellence. NHS | Presentation to North Region |1 April 2014

21. Planning Guidance 2014/15 -18/19 NHS | Presentation to North Region |1 April 2014

22. 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 North Region |1 April 2014

23. Previous events - objectives NHS | Presentation to North Region |1 April 2014

24. Outcomes from the South event NHS | Presentation to [XXXX Company] | [Type Date] NHS | Presentation to North Region |1 April 2014

25. 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 North Region |1 April 2014

26. Thank you ? Joanna Powell, Domain Team Lead Jo.powell2@nhs.net

27. Mental Health CQUIN 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 a national audit process, full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors in patients with psychoses, including schizophrenia. The CQUIN guidance for 2014/15 was reissued in February on NHS England website NHS | Presentation to North Region |1 April 2014

28. Mental Health CQUIN • The following cardio metabolic parameters are assessed and actively managed; • Smoking status • Lifestyle (incl. exercise, diet, alcohol and drugs) • Body Mass Index • Blood pressure • Glucose regulation (HbA1c or fasting glucose or random glucose as appropriate) • Blood lipids NHS | Presentation to North Region |1 April 2014

29. NHS England Parity of Esteem Work-packages Discrete improvement project – Business as usual – Collaboration with system partners NHS | Presentation to North Region |1 April 2014

30. Data, Information and Intelligence NHS | Presentation to North Region |1 April 2014

31. Commissioning skills and capabilities (progress and deliverables) NHS | Presentation to North Region |1 April 2014

32. Improving clinical services (progress and deliverables) NHS | Presentation to North Region |1 April 2014

33. Improving clinical services (progress and deliverables) - 2 NHS | Presentation to North Region |1 April 2014

34. Improving crisis care (progress and deliverables) NHS | Presentation to North Region |1 April 2014