New Standard NHS Community Contracts Part 2 April 2009 Christian Geisselmann Consultant – Contracts & Commissioning NHS South of Tyne and Wear - Substance Misuse Commissioning Teams

What is the Mental Health Contract? What is it and who will use it? Mandatory policy requirements What you need to do Provider reports/ reviews Contract levers What next?

MH sessions What is the MH contract? The NHS Contract for Mental Health and Learning Disability Services, (the Contract), covers agreements between primary care trusts (PCTs), Local Authorities (where applicable) and providers of Mental Health and Learning Disability care (Providers) The contracts will apply to the following providers of Mental Health and Learning Disability services All NHS Trusts NHS Foundation Trusts Independent and Third Sector (including primary care providers where applicable) PCT provider arms delivering specialist mental health and learning disability services All NHS Trusts NHS Foundation trusts (FTs) – All New FTs and existing FTs whose contracts expire by 31 March 2009 will adopt the contract. FTs whose contracts extend beyond March 2009 may choose to adopt the Contract or retain their existing contracts until the required period of notice to change has expired. Independent (including primary care providers where applicable) and Third Sector PCT provider arms delivering specialist mental health and learning disability services. All New FTs and existing FTs whose contracts expire by 31 March 2009 will adopt the contract. FTs whose contracts extend beyond March 2009 may choose to adopt the Contract or retain their existing contracts until the required period of notice to change has expired.

MH sessions What is the MH contract? Services covered: Adults of working age Older adults Children and adolescents Substance misuse Learning disability Forensic care

MH sessions What is the MH contract? From April 2009 the Contract will be introduced on a one year basis to expire on 31 March 2010 with Providers of Mental Health and Learning Disability services Where both the PCT and the Provider have a well developed contract in place and agree that their current contract arrangements would benefit from continuing until April 2010 then, subject to SHA approval, the parties can continue to contract under existing arrangements. PCTs will ensure that any extension to current contracting arrangements will not continue beyond April 2010. As part of the approval the Parties will agree to vary their contract in accordance with the contract variation procedure to ensure that following policy requirements are introduced:

MH sessions What is the MH contract? Mandatory policy requirements Data Quality improvement plans: each provider should agree an annual data quality improvement plan, as detailed in Clause 29, including timescales and performance management mechanisms Healthcare associated infection improvement plan: each provider should agree a HCAI Plan demonstrating the lowest levels of HCAI appropriate to the care environment Services quality and safety improvement plan: each provider should agree with their Commissioner a safety and quality improvement plan that is aimed to provide a structured process for the improvement of Service User quality and safety of care. The plan will be agreed within a month of the start of each contract year. The Services Quality and Safety Improvement Plan will form part of the Service Quality Reviews under clause 33.

MH sessions What is the MH contract? What you need to do: plans HCAI reduction plan Business continuity plan Essential services continuity plan Mixed sex accommodation plan Services quality and safety improvement plan Data quality improvement plan Emergency response plan Activity plan Service specifications Transfer and discharge protocols Service Development plan

MH sessions What is the MH contract MH sessions What is the MH contract? What you need to do: reports/ reviews Service user, carer and staff experience surveys Quality Assessment Framework Annual review of service quality Quality performance incentive scheme (non-mandatory for 2009/10) Monthly performance reviews Monthly service quality reviews Monthly report of issues in national / local health economy impacting on contract Action Plans / Improvement Plans

MH sessions What is the MH contract? Contract controls Failure of achieve Targets: 10% monthly withholding Contract query re performance: Exception report and liquidated damages Failure to agree Remedial Action Plan: 20% withholding Failure to meet service quality performance indicator: liquidated damages

MH sessions Legal Terms and Conditions Contract controls work on the basis of “Remedy before Penalty” Quality Improvement Plans are the key Financial penalties and withholdings applied only after exhaustive process focussed on gaining solutions Lack of action or failure to take action by either of the parties will generally trigger a withholding or penalty -Clause 29 Information -Clause 32 General Performance -Clause 33 Clinical and Professional Service quality

What’s next? Programme of development work to produce the 3 year contract mandated standard contract 2010/2011-> Active involvement of all stakeholder and the stakeholder reference groups Continue to implement the contracts during 2009 and embed all the new systems with ALL provider

Service Specifications Specifications will include the following: Purpose Scope Service Delivery Referral, Access & Acceptance Criteria Discharge Criteria and Planning Self Care and Patient Information Continual Service Improvement Plans Contract Details and Cost of Service Activity Plans

Service Specifications Quality Standards: Service User Experience Improving Service Users and carers Experience Reducing Inequalities Reducing Barriers Improving Productivity Access Personalised Care Planning Outcomes Quality and Clinical / Integrated Governance Harm Reduction and Healthcare Workforce Development

Service Specifications Activity Performance Indicators: Treatments Care Plans Waiting Times Harm Reduction Vaccinations TOPs A new workbook will populate all of this data

What’s new in the MH and LD contract? HCAI improvement plan (Clause 4) Mixed Sex Accommodation (Clause 4) Quality and safety Improvement plan (Clause 16) Data Protection and FOI (Clause 27) more clearly set out especially in relation to protecting patient identifiable data Variations (clause 38 and Schedule 6) clarified Change of Control (clause 49) sets timescales for Commissioners to consent to change of control

What’s new in the MH and LD contract? Staff (Clause 11) Staff surveys to be carried out Name badges to be carried and displayed as appropriate to the setting Compliances with the Cabinet Office Code on Workforce Matters when employing staff to work on NHS funded contracts in that TUPE shall apply to all staff transfers transferring staff shall be offered membership of a pension scheme which is broadly comparable to the NHS Pension Scheme. new staff should be offered fair and reasonable terms and conditions that are overall no less favourable than those of transferred employees

What’s new in the MH and LD contract? Staff - cont.. for staff who are not eligible for membership of the NHS pensions scheme, staff to have access to good quality pensions arrangements that comply with the pensions provisions of the Cabinet Office Code.

Christian Geisselmann Mental Health – Commissioning for Quality Improvement with effective Contract and Performance Monitoring Christian Geisselmann

Overview Where are we now Work under-way for 09/10 contract Next steps during 09/10 Key Messages

Contracts and Performance Development of a Contract & Performance Management Policy which will form the base for taking contract and performance monitoring forward

Contracts and Performance Management Framework The contract and performance management framework policy has been written for providers to improve understanding of NHS South of Tyne and Wear Substance Misuse Commissioning Teams approach to managing the service level contracts at an operational level

Contract and Performance Policy The policy has 18 sections and 8 appendices A brief overview of the process is as follows:

Contract and Performance Policy Section 1 Includes NHS South of Tyne and Wear Approach to Contract Management Section 2 Explains the Importance of the Contract Service Specification as the basis for Contract Management Section 3 How will the Contract be Monitored? Section 4 Type and Frequency of Contract Management for Providers

Contract and Performance Policy Section 5 Contract Management Meetings Section 6 Contract Management Visits Section 7 Performance Monitoring Procedures Section 8 Quality Assessment Framework (QAF) Section 9 Service User Involvement in Contract Management Section 10 Re-shaping the Market and Supporting Providers to Rise to the Challenge (“Our Commitment to you”)

Contract and Performance Policy Section 11 Dealing with Poor Performance under the Contract Section 12 Options Appraisal Meetings Section 13 Extension of Contracts Section 14 End of Contract Procedures and Options Appraisal Meetings Section 15 Contract Management Outcomes and the Administration of Service Budgets

Contract and Performance Policy Section 16 Data Protection and Contract Management Section 17 Dispute Resolution & Complaints Procedure and Contract Management Section 18 Review of Contract Management Procedures

Contract and Performance Policy Appendix A Service Specification Summary Guide Appendix B Request for variation to Contract Form Appendix C Contract Management Agenda Template Appendix D Improvement Plans Appendix E Quality assessment Framework Self Assessment Summary

Contract and Performance Policy Appendix F Contracts Team Provider Workbook Log Screen Shot Appendix G Performance Notices Appendix H Feedback Form

Work during 09/10 Further develop Quality and Performance Framework at service outcome level Develop within each service specification high level metrics which addresses :- Health gain (outcomes) Patient experience Patient Reported Outcome Measures (PROMS) Further develop CQUIN thresholds and develop weighting

Key Messages Get Systems and Processes right – the rest will follow Can only be done in partnership Focus on small number of areas CQUIN should be a win win.

Contracts Session Part 2 Any Questions???