1. A commissioning perspective - increasing user involvement to achieve better outcomes Mick Burns Secure Services Commissioning Team Yorkshire and the Humber Specialised Commissioning Group

2. NHS Yorkshire and the Humber 5.17m population (NoS 2007 PCT population estimates) 14 PCTs (North, West, East and South Yorkshire and North and North East Lincs)

3. Regional Commissioning Structure Overseen by Specialised Commissioning Group Specialised Commissioning Team Secure Services (plus a bit of Specialist Mental Health) Commissioning Team All high, medium and low secure services PCT consortium arrangements including financial risk share All activity managed via NHS standard MH contract budget for 2010-11 circa £130m

4. Current Secure in-patient population (month 5 2010 -11) Placement No of in-patients No of providers High Secure 973 Medium Secure 29011 Low Secure 37824 Total76538

5. Secure Services Commissioning Team – Team Structure Associate Director – 1 WTE Assistant Director (Finance 0.6 WTE) Senior Commissioning Manager -2 WTE Regional Forensic Case Manager – 5 WTE Involvement Leads 1.6 WTE Information Staff 2 WTE Admin Staff 2.6 WTE Activity managed across 25 contracts

6. Involvement in SSCT ‘Democratisation’ of mental health services since NSF Two posts partly funded by PCTs partly funded by providers Involvement Strategy ‘Reaching Joint Solutions’ “Involvement is a bit like spinach: no one is against it in principle because it is good for you, but not everyone eats it”

7. Involvement in SSCT cont. RJS sets framework for involvement at 3 levels –Individual Level –Ward/Unit Level –Strategic Level Involvement monitored through Involvement network ‘i4i’ (Improvement through Involvement)

8. Background to CQUIN development in Yorkshire and the Humber Commissioning for outcomes –Improved mental wellbeing –Reduced Risk –Therapeutic Use of Environment –Social Inclusion –Quality of Life User Defined initiatives for improvement –Advanced Directives –CPA Standards –Complete Dining Experience

9. CQUINS 2009-2010 Introduction of system for recording and monitoring outcomes Demonstration of 25 hours meaningful activity (DH best practice) Introduction of ‘My Future Plan’ advanced directive developed by Y&H i4i network Introduction of CPA standards developed by Y&H i4i network CQUIN value 0.5% of contract value as part of 2.2% uplift

10. CQUINS 2010-2011 90% target for use of HONOS secure and HCR-20 Introduction of tool to measure therapeutic use of environment (Essen CES) Services to develop involvement and personalisation strategy in partnership with service users Year 2 of CPA standard implementation, introduction of dining standards from user audit ‘complete dining experience’ Build on 25 hours structured activity plan through i4i network Service implementation of recognised recovery planning tool CQUIN equivalent to 1.5% of contract value with no uplift

11. CQUINS 2011-2012 Still under development, suggested themes –Linking outcomes to model pathway –Project re ‘choice and responsibility’ user defined –Staff development programme (in support of increased involvement agenda), user led audits –Primary Health –Involvement for carers –Standardisation of drug and alcohol interventions Essen CES, Dining Experience and Recovery Tool will roll over from previous year Unclear as to value of CQUIN

12. Advantages to user defined CQUIN schemes Users see real benefit of involvement through inclusion within contract Programme of involvement energises service users improves engagement with staff in services Real change in culture within services, collaborative working becoming more of a reality Services are starting to innovate CQUIN development has helped to consolidate service network Unclear as yet whether outcomes have improved but process has been helpful in itself