1. Update on standards for ICPs for mental health Name

2. Summary of Feedback  IT systems & extra resources needed  Too medical  Difficult to read / navigate through document  Dividing into 5 ICPs not helpful  Concern over being too prescriptive on outcome tools  What about when diagnosis takes a long time

3. Response to Feedback  A more generic approach taken  Removed duplication and inconsistencies  Removed requirement for specific outcome measures  Acknowledged that resources are needed  Removed some medical jargon

4. Initial Focus A gradual implementation of ICPs is recommended Initial focus on secondary care mental health services (except for depression) A small number of variance points In the longer term, ICP care to be expanded to whole journey of care (NHS and partner agencies)

5. ICP Standards  Process standards (how ICPs are developed) genericcondition specific  Care standards (content of ICPs)  Service standards (how ICPs are implemented)

6. Generic ICP Standards Process standards Care standardsService standards 1. named leads 10. integrated assessment 38. reviewing & acting on variances 2. stakeholder involvement 11. risk assessment 39. staff and service user feedback 3. process mapping 12. risk assessment for women 4. links to care governance 13. physical health check 5. training needs assessment 14. recording diagnosis 6. diagnostic information 15. suitability for psychological therapies 7. recording & sharing of information 16. person centred care 8. recording & analysing variances 17. single care plan 9. referral systems 18. medication decisions 19. treatment of substance misuse 20. admission & discharge 21. needs assessment & outcome tool

7. Process Standards 1. named leads 2. stakeholder involvement 3. process mapping 4. links to care governance 5. training needs assessment 6. diagnostic information 7. recording & sharing of information 8. recording & analysing variances 9. referral systems

8. Generic ICP Care Standards Generic: 10integrated assessment 11risk assessment 12risk assessment for women 13physical health check 14recording diagnosis 15suitability for psychological therapies 16person centred care 17single care plan 18medication decisions 19treatment of substance misuse 20admission & discharge 21needs assessment & outcome tool

9. Service Standards 38. reviewing & acting on variances 39. staff and service user feedback

10. Generic ICP Standards Process standards Care standardsService standards 1. named leads 10. integrated assessment 38. reviewing & acting on variances 2. stakeholder involvement 11. risk assessment 39. staff and service user feedback 3. process mapping 12. risk assessment for women 4. links to care governance 13. physical health check 5. training needs assessment 14. recording diagnosis 6. diagnostic information 15. suitability for psychological therapies 7. recording & sharing of information 16. person centred care 8. recording & analysing variances 17. single care plan 9. referral systems 18. medication decisions 19. treatment of substance misuse 20. admission & discharge 21. needs assessment & outcome tool

11. Bipolar Disorder ICP Care Standards 10integrated assessment 11risk assessment 12risk assessment for women 13physical health check 14recording diagnosis 15suitability for psychological therapies 16person centred care 17single care plan 18medication decisions 19treatment of substance misuse 20admission & discharge 21needs assessment & outcome tool 22management of acute mania 23management of bipolar depression 24keeping well and recovery 25monitoring medication

12. BPD ICP Care Standards 10integrated assessment 11risk assessment 12risk assessment for women 13physical health check 14recording diagnosis 15suitability for psychological therapies 16person centred care 17single care plan 18medication decisions 19treatment of substance misuse 20admission & discharge 21needs assessment & outcome tool 26medication guidance

13. Dementia ICP Care Standards 10integrated assessment 11risk assessment 12risk assessment for women 13physical health check 14recording diagnosis 15suitability for psychological therapies 16person centred care 17single care plan 18medication decisions 19treatment of substance misuse 20admission & discharge 21needs assessment & outcome tool 27treatment for cognitive impairment 28interventions for behavioural symptoms 29end of life care

14. Schizophrenia ICP Care Standards 10integrated assessment 11risk assessment 12risk assessment for women 13physical health check 14recording diagnosis 15suitability for psychological therapies 16person centred care 17single care plan 18medication decisions 19treatment of substance misuse 20admission & discharge 21needs assessment & outcome tool 30early intervention 31psychological therapies 32medication

15. Depression ICP Care Standards For people who meet criteria for referral into mental health services: 10integrated assessment 11risk assessment 12risk assessment for women 13physical health check 14recording diagnosis 15suitability for psychological therapies 16person centred care 17single care plan 18medication decisions 19treatment of substance misuse 20admission & discharge 21needs assessment & outcome tool 37specialist assessment & treatment available For people who do not meet criteria for referral into mental health services: 33objective measure 34assessment of need leading to self-help and signposting 35psychological therapies within 6 weeks 36therapy after measure of severity

16. What Next?

17. Timescale 1. NHS QIS publish ICP standards Late ‘07 2. Initial baseline assessment Early ‘08 3. Local action plans 4. NHS boards invited to apply for accreditation Mid ‘08 5. Assessment of ICP standards Late ‘08 2009 on 6. Accreditation of whole ICP including care & service stands. Developing Implementing Getting Accredited

18. Baseline Assessment Questions 1. Do you have a project plan for developing ICPs for mental health (please forward us a copy if you do)? 2. Have you appointed ICP leads and facilitators for the 5 conditions and who are they? 3. What plans do you have in place for involving stakeholders? 4. How is the ICP development process linked to your care/clinical governance structures? 5. What resources (human and financial) have been put in place to support ICP development? 6. Will your local information system support ICP data collection and sharing (only a small number of variance points are going to be required initially for accreditation)? If not, what plans have you got to address these issues? 7. Are there any specific obstacles or concerns you have about being able to develop and implement ICPs in the timescale?

19. Accreditation

20. Accreditation Principles  Incremental  Facilitative and supportive approach  Based on standards for ICPs  Emphasis on recovery, outcome measures and variance tracking  Linked to Clinical Governance and Risk Management standards

22. Delivering together NHS Education Scotland NHS QIS National ICP Co-ordinators ICP pack SEHDSocial Work Improvement Support TeamService users and carers National Regional Local Voluntary sector Workforces

23. Main issues 1.Early focus: Process standards or Generic ICP 2.Adaptability to local circumstances 3.Opportunity to link with Clinical Governance & Risk Management standards 4.Opportunity to link with other reviewers / inspectorates

24. Local ICP Process Standards Service standards information Management of variance / decision making Care standards Assessment Care Planning Outcomes Care Delivery Mechanism for tracking variations from plan Level 1: variance leading to individual care redesign Level 2: Local management teams Level 3: NHS Board and LA Performance Management & Governance Level 4: National

25. Generic Bipolar BPD Dementia Depression Schizophrenia Assessment Care Planning Care Delivery Outcomes Care Standards