1. English Experience of Setting up Acute and Crisis Services Iain Tulley Chief Executive Devon Partnership NHS Trust

2. Outline Lesson in Geography and History Description of the current position Risks and Opportunities

3. Geography and History ose Broad picture across England Position in Devon Last 25years Last 10 years Last 3 years

4. Map of England Spend £22.5 billion – 2010 £32.6 billion – 2026 £47.5 – dementia 63 million population Beds 150,000 – 1955 27,000 - 2007

5. Map of Devon Spend £140 million Population 850,000 Acute Beds 2006 142 2011 92

6. Last 25 years Major hospital closure programme Care in the Community Profile and Resources Organisational Structures

7. Last 10 years Establishment of Mental Health Trusts Resources National Service Framework 1. Early Intervention Teams 2. Crisis Intervention Teams 3. Assertive Outreach Teams

8. Impact of Crisis Intervention Teams Gate-keeping function Acute bed reduction Case-mix Risk management

9. Last 3 years Mental Health Profile  Access to Psychological Therapies  Dementia Prison Healthcare Policy Regulation Risk management

10. Risks and Opportunities In-patient levels of dependency Lack of alternatives to hospital Reform programme Maintaining coherence Risk aversion Public attitudes

11. Conclusions Rapid change Resources Growing demands Further bed reductions Managing Paradox