NHiS Mental Health Commissioning Network Dr Liz England - e.england@nhs.net Co Chair Joint Commissioning Panel for Mental Health as RCGP Mental Health Commissioning Lead Clinical Lecturer, Primary Care Clinical Sciences, University of Birmingham GP interested in mental health, Laurie Pike Health Centre, Aston, Birmingham Quality and Safety and Mental Health Lead, Healthworks LCG, SWB CCG

Interests Collaborative care for people with SMI Physical health care in mental health Parity of Esteem for Mental Health and Health Inequalities Transitions for CYP in MH Early Intervention Services for First Episode Psychosis

So…? Encourage networking and collaboration Building or Rebuilding relationships Focus for learning and sharing experiences Sense making of new structures and commissioning landscape Putting the jigsaw together

Commissioning Priorities Closing the gap: priorities for essential change in mental health Mental health commissioning new priority for NHS England Improving commissioning “co-commissioning” “holistic- whole person care” “NICE standards” “JCPMH” 2. Information revolution- MHIN 13. Mental health care and physical health care will be better integrated at every level- PoE 14. We will change the response to self-harm- Crisis care 17. Schools will be supported to identify mental health problems sooner- commissioning for early intervention and across the whole lifespan 18. CAMHS Transitions Improving commissioning. NICE Standards Mental health leadership programme for Clinical Commissioning Groups (CCGs) NHSE Developing best practice specifications for commissioning specialist mental health services- physical HC Integrated approaches to local commissioning also have an important role to play in promoting mental wellbeing and preventing mental illness, as part of the local Health and Wellbeing Strategy. Public Health England (PHE) is working to build up the evidence base around what kind of services and programmes are most effective. Further guidance is provided by the Joint Commissioning Panel for Mental Health focuses on encouraging commissioners to use a values-based commissioning model. We need a truer, more up-to-date and more detailed picture of mental health and wellbeing nationally and in each area. Setting up a new national Mental Health Intelligence Network (MHIN). It will draw together comprehensive information about mental health and wellbeing to provide a greater insight into mental health problems, how they vary with age and in different parts of the country, and what the most pressing needs are in each area. It will also gather information about the services being provided – and how effective they are. The information will be available to all, so that local people can see for themselves how their area is doing. But its main purpose will be to help local Health and Wellbeing Boards, CCGs and other partners to decide what types of health and social care services are needed in their area, and how they can improve the mix of services and support available. The Department of Health has developed a Mental Health Dashboard which tracks the key measures that already exist and highlights the priority outcomes from the outcome . In 2012 we started to introduce a new payment system for adult mental health services. Monitor and NHS England are developing this further in a way which enables commissioners to use payment systems increasingly to reflect quality and outcomes as well as volumes of activity. From April 2014, the Health and Social Care Information Centre will produce monthly reports for commissioners and providers which show how providers are doing against a number of quality and outcome measures.

Coordinating commissioning “To achieve integrated healthcare, policy-makers, service planners and commissioners need to better understand the indivisibility and unitary nature of physical and mental health, which means that distinguishing between them is likely to lead to an incomplete response to people’s needs as well as flawed thinking about mental health. In addition, they should focus on major social and structural influences such as education, unemployment, housing, poverty and discrimination, rather than just on support given to individuals based on a medical diagnosis of mental illness.” Mental health touches all aspects of life. There is no health without mental health. Good mental health or mental wellbeing is more than the absence of mental illness. Mental health encompasses emotional, psychological, spiritual physical health are inextricably linked. Therefore mental health cannot be commissioned in isolation and we need to focus on reducing the fragmentation and coordinating our commissioning efforts and developing integrated services that address the whole person. Crossing Boundaries, MHF 2013

How can we achieve this? Values based Commissioning for Mental Health Commissioning decisions Commissioners and Clinicians skills and experience Commissioning decisions traditionally guided by ‘evidence-based’ practice and research But what about the thoughts, feelings and opinions of service users and carers? To address this the concept of ‘Values based Commissioning’ has been developed as the values counterpart of the evidence-based approach. VbP does not seek to replace EbP, but instead aims to make commissioning decisions on the basis of ‘values’ as well as ‘facts’. Service users and carers can work jointly with commissioners in order to influence decisions relating to the commissioning of mental health services.   In VbC, service users and carers become active and equal participants in decision making about commissioning strategy and therefore engage with the process and outcome to a greater degree. This brings people together around a common set of goals, and by empowering service users and carers (both directly and through representative bodies), places them in the driving seat of commissioning strategy and creates a greater sense of ownership. Commissioners should be aware of the benefits of VbC which include the delivery of more patient-focused services such as an integrated mental health service, potentially improved cost-effectiveness, and the achievement of key outcome measures such as improved physical healthcare. Evidence base Thoughts, feelings, opinions and values of service users and carers: What makes you get up in the morning?

The wobbly stool

Todays focus… Parity of Esteem- Physical health in SMI, LTC and mental health, crisis care, spending, access and choice Alcohol and mental health Commissioning effective services for people with a diagnosis of psychosis

Parity of Esteem Programme: NHS England How the programme will be delivered: Specific improvement/change projects Business as Usual Alignment with other organisations and groups Current Priorities: Addressing and improving crisis care Data, information & intelligence Development of capability and skills in commissioning Delivering improvements to clinical services Improving physical health for people with serious mental illness

MENTAL HEALTH IS EVERYBODY’S BUSINESS THANK YOU FOR LISTENING ANY QUESTIONS?