Mental health network

Five Year Forward View for Mental Health one year on

SAVE ITEM
Implementing Five Year Forward View for Mental Health cover

NHS England has published a report outlining the progress made in the first year of the Five Year Forward View for Mental Health

The report sets out which areas are beginning to see improved access to care and outlines examples of good local practice in services. It also recognises the ongoing challenges, adding that there is more to do to "make a reality of the aspirations for transformation in mental health services".

The report concludes by outlining that the infrastructure needed to sustain change has been put in place and in many areas people who use services are beginning to feel the benefits of the new and expanded services on offer. It cautions that this is a long term programme which goes beyond 2020/21, stating that further work will be needed beyond the first five years to continue to expand transformation of mental health services and meet the needs of the whole population.

Finally, the report acknowledges the hard work of staff and finishes by stating that “one year on, there is clear momentum behind this programme nationally and locally: the challenge now is to maintain and build on this to achieve next year and beyond”.

Highlights from year one:

  • Over 120,000 more people are expected to receive mental health care and treatment in priority services in 2016/17.
  • The Mental Health Investment Standard is planned to be met across England as whole in 2017/18 and 2018/19.
  • The first national access standards for mental health treatment have come into effect – with the waiting time targets met.
  • A new Mental Health Dashboard has been launched to provide unprecedented transparency of performance against key indicators.
  • The first comprehensive all-age mental health workforce strategy has been co-produced for publication in April 2017. 
The report also highlights that not all milestones have been met as planned with progress on workforce development taking longer than anticipated due to the complexities of delivering a strategy for such a diverse group of professionals.

Investment

On investment, the report indicates that the number of additional people treated is a strong indication of a greater focus afforded to mental health by local organisations and adds that this is supported by financial reports which demonstrate that across England as a whole, the additional funding expected to be provided in 2016/17 for services has been invested in full to support the programme. 

  • Investment standard is reported to be met across England as a whole and there remain a small subset of CCGs who have not met, or are not yet planning to meet, this expectation.
  • NHS England will be carrying out an exercise in advance of April 2017 to compare commissioner plans with projected allocations and the expectations of local providers.
  • This is in addition to the ongoing transparency of spending provided by the new mental health dashboard and will ensure independent scrutiny of investment to deliver the outcomes of the programme.

STPs

NHS England and NHS Improvement’s national and regional teams will work closely with STPs in 2017/18 to harness the changes needed in STP delivery. Work is currently underway to develop the mental health improvement and support offer across national and regional teams, to ensue successful delivery of mental health care and service elements of STPs and the 5YFV. 

Children and young people

Highlights from 2016/17

  • 21,000 more children and young people are expected to access treatment in NHS-commissioned community teams (compared to 2014/15).
  • 556 staff working in children and young people’s services have begun training courses to improve skills in evidence-based treatment.
  • 150 newly recruited staff have started courses to qualify as therapists. 
  • The first ever national access standard for children and young people with an eating disorder has begun to be measured in community teams.
  • All English regions have developed plans to improve inpatient beds usage and ensure the right capacity so that children and young people receive care as close to home as possible.
The report outlines that CCG financial reports demonstrate that across England as whole there are plans to invest the full sum of £149 million additional funding provided for children and young people’s mental health in 2016/17. A small subset of CCGs have not planned to use this funding in full for this purpose.
Actual spending at CCG level will be published and monitored through the mental health dashboard to support transparency and all CCGs are expected to make sufficient investment over the course of the programme to deliver the commitment. 

Perinatal Mental Health

Highlights from 2016/17

  • At least 750 more women should receive access to specialist perinatal mental health support and care through new services put into place this year.
  • New or expanded specialist community teams for perinatal mental health will begin to be put in place in the first wave of 20 areas receiving targeted transformation funding.
  • Four new inpatient mother and baby units are being commissioned by NHS England to provide services in the areas of greatest need.
  • A further 8 beds have been commissioned in existing units to deliver immediate in year capacity to treat more women – the equivalent to opening a whole new unit.
Additionally to the above, the NHS has also developed a series of projects which will act to improve quality and support the overall programme in later years. These include:

  • Development of the first guidance and supporting tools for the perinatal mental health pathway, setting out evidence based treatment and interventions. Which will underpin how services are measured in future years.
  • NHS England has invested £1.2 million for workforce development to improve awareness and skills related to perinatal mental health.
  • Health Education England has developed a competency framework which, for the first time describes the skills and competences of different multi-disciplinary staff in relation to perinatal mental health.
  • NHS England and Health Education England are working with the Royal College of Psychiatrists to deliver a programme to identify and train specialist perinatal psychiatrists to lead future teams.

Adult Mental Health – common mental health problems 

Highlights from 2016/17

  • Over 72,500 more people with common mental health problems will access psychological therapies compared with the previous year.
  • New integrated services have been set up so that an additional 6,000 people will receive integrated treatment – with 22 new sites starting in January 2017.
  • Latest data show 87.8% of people entering treatment waited less than six weeks, and 98.3% waited less than 18 weeks – both exceeding national access standards.
  • Almost half of people completing treatment (49.0%) moved to recovery.
  • Over 600 new training places have been made available to continue to increase the number.
Additionally, during 2016/17 a new project was initiated to develop the future model and achieve the aim of the Five Year Forward View for Mental Health that therapies be more closely integrated with physical health services. In January 2017, 22 new ‘early implementer’ projects were launched across 30 CCGs with the objective of providing psychological therapies wherever people receive their physical healthcare and using the opportunity to build a more holistic approach to the person’s care and treatment which delivers better outcomes and reduces pressure on acute NHS services.

Adult mental health: community acute and crisis care. Highlights of 2016/17

  • More than 10,000 people experiencing a first episode of psychosis have started treatment with a specialist team. In November 2016, more than 75% of people starting treatment did so within two weeks in line with the new national standard.
  • New transformation funding to develop mental health liaison services in acute hospitals drew nearly 70 bids ahead of implementation in 2017/18.
  • The use of police cells as places of safety continued to decline, accounting for only 7% of detentions and having more than halved since 2014/15.
  • For the first time, national data has been published to show the number of adults being placed out of area for acute mental health inpatient care; a crucial first step to eliminating the inappropriate use of such placements.

Adult mental health: secure care pathway

Highlights from 2016/17

  • NHS England has carried out the first national audit of mental health secure services at individual and service level, providing new information about who is using the service, where they are placed, and how long their stay is in hospital.
  • As a result, a model for community forensic services has been developed in partnership with those using secure services and clinicians, which will be tested more widely in 2017/18.
  • To support a focus on equalities, NHS England has conducted focused work with black men using the secure care system, to ensure that their perspectives and needs are incorporated into the development of the community model.

Health and justice

Highlights from 2016/17

  • NHS England published the first strategy for improving the mental and physical health of people in the criminal justice system.
  • Liaison and diversion services have been expanded to cover police custody suites and courts in areas representing 68% of the population of England.
  • Over the first half of the year, 7,180 more people have received liaison and diversion services than in the previous six months.
In October 2016, NHS England published Strategic direction for health services in the justice system 2016-2020: Care not custody, Care in custody and Care after custody. This document set out for the first time the NHS’s strategy for improving the health of people in the justice system, and how services in all relevant settings need to evolve and improve between now and 2020.

Liaison and Diversion services - expansion has progressed over the course of the year and services now work across 68% of police custody suites and courts in England, ahead of the indicative trajectory in the mental health implementation plan and on track to meet the planned 100% coverage by 2019/20.

Suicide Prevention

Highlights from 2016/17

  • The National Suicide Prevention Strategy was refreshed by Government to support a renewed focus on key at risk groups and activity to deliver the national ambition of reducing suicides by 10% by 2020/21.
  • Local suicide prevention plans are in place or being developed in 95% of local authorities in England, supported by national guidance issued by Public Health England and partners.

Testing new approaches

The new care model programme will give mental health trusts the incentives and responsibility to greatly improve local services and end the practice of sending people long distances to receive treatment, unless this is clinically necessary. The six sites cover adult secure services and inpatient services for children and young people. They will take responsibility for a commissioning budget of around £362m and, by reducing admissions and lengths of stay, are predicting savings of £50m within two years.

Harnessing Digital Delivery

Over the past year, the NHS has developed the first digital strategy for mental health, bringing together investment of £67.7 million over three years. The strategy sets a direction for digitalisation within mental health services, balancing both the technical and systems requirements of interoperable organisations and the need to test and develop digital means of therapy and other services for people with mental health needs

Infrastructure and hard-wiring the system

Highlights from 2016/17

  • Health Education England will publish the first comprehensive all-age mental health workforce development strategy to underpin the full range of commitments.
  • The Five Year Forward View for Mental Health Dashboard was published, providing an unprecedented oversight of national and local performance and outcomes against key indicators.
  • Public Health England has co-produced materials to support local partners to deliver plans which prevent mental illness and promote good mental health.
  • The CCG Improvement and Assessment Framework included a number of mental health metrics and milestones, supporting an independent assessment and rating of each CCG for the first time.
  • NHS Improvement published a new Single Oversight Framework for provider organisations, including a suite of specific indicators for mental health.
  • New guidance for the NHS was published setting out outcome-based payment approaches for mental health.
  • The CQC has tested approaches to assess the care given to people with mental health needs in inspections of acute trusts.

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