Mental health network

Mental health in the NHS delivery plan

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Overview of mental health in the delivery plan

Two years on from the publication of the NHS Five Year Forward View, NHS England has published an updated delivery plan ‘next steps on the Five Year Forward View’. This outlines the current progress and next steps in delivering the NHS Five Year Forward View and includes a chapter on mental health, outlining key achievements to date, planned changes over the next two years as well as outlining how these will be implemented.

Key achievements over the last three years

  • 120,000 more people getting specialist mental health treatment this year than 3 years ago, including over 20,000 more children and young people.
  • Over two thirds of the country now covered by criminal justice liaison and diversion services, up from under a quarter 3 years ago. Use of police cells as a place of safety for people with mental health problems has seen more than a 3-fold decrease over the past 3 years.
  • The NHS has introduced, and met, the first ever national waiting times standards for mental health services, 25 years after targets were set for surgical operations
  • The publication of the Mental Health Taskforce report, implementation plan and one year on progress report. 

Key improvements for 2017/18 and 2018/19

In the report NHS England state that “With carefully targeted and affordable national funding, supplemented by investment from local CCGs, we are now delivering one of the biggest expansions in access to mental health services currently happening in Europe.”

  • IAPT: 60,000 more people will get treatments for common mental health conditions by the end of 2017/18, rising to 200,000 more people getting care by the end of 2018/19 – an increase of over 20%. Alongside this, they are working with NICE to help facilitate faster access to new digital therapies.
  • Perinatal: 4 new mental health Mother and Baby Units. In East Anglia, the North West, and South West and South East. Boost bed numbers in the current 15 units so that overall capacity is up by 49% by 2018/19. And 20 new or expanded specialist perinatal mental health teams.
  • Children and young people: An extra 35,000 children and young people being treated through NHS-commissioned community services next year compared to 2014/15, growing to an extra 49,000 children and young people getting the care they need in two years’ time.
  • Care closer to home: funding for 150-180 CAMHS Tier 4 specialist inpatient beds in underserved parts of the country to reduce travel distances for treatment, rebalancing beds from parts of the country where more local CAMHS services can reduce inpatient use. For adults investment in crisis resolution and home treatment teams will reduce the need to inappropriately send people out of area for non-specialist inpatient care - from 2018, it should mean a one third reduction in adults sent out-of-area for inpatient psychiatric treatment.
  • A&E: 74 24-hour mental health teams at the Core 24 standard, covering five times more A&Es by March 2019, than now. The service will be available in more than a quarter of acute hospitals by March 2018 and nearly half by March 2019, compared to under 10% today.
  • Physical health care and mental illness: An extra 140,000 physical health checks for people with severe mental illness in 2017/18, rising to 280,000 health checks in 2018/19.
  • Veterans: New specialist Transition, Intervention and Liaison (TIL) mental health services for veterans, accessed through four areas across England from April 2017
  • Secure and detained settings: New specifications for mental health provision to be in place during 2017
  • Investment in mental health provider technology through Mental Health Global Digital Exemplars

How changes will be implemented:

  • Investment - Targeted earmarked national investment for expanded services, alongside an overarching CCG ‘investment standard’ directing growth in mental health funding.
  • Workforce - Expand the mental health workforce – 800 mental health therapists embedded in primary care by March 2018, rising to over 1500 by March 2019.
  • Commissioning: Reform of mental health commissioning so that local mental health providers control specialist referrals and redirect around £350 million of funding. Enables expansion of local services and reduction of inappropriate out-of-area placements.
  • Delayed discharge: Mental health providers to work with their local councils in same way as acute hospitals to reduce delayed discharges for people stuck in psychiatric inpatient units.
  • Targets: Clear performance goals for CCGs and mental health providers, matched by unprecedented transparency using the new mental health dashboard.37 CCG ratings published in July 2016.
  • Green paper: Support the development of the Children and Young People’s Green Paper due for publication in autumn 2017.
  • Management: Single national programme management team led by a national mental health director and national clinical director, aligning the work of NHS England, NHS Improvement, Health Education England, Public Health England, and the other Arm’s Length Bodies. 
  • Key partners: Continue to work closely with key partners, including Mind, Young Minds, the Mental Health Foundation and the Royal College of Psychiatrists.

Other points of note from the plan:

STPs

  • Accountable care systems, which are an evolved version of an STP that is working as a locally integrated health system Demonstrate how they will simultaneously also operate as a vertically integrated care system, partnering with local GP practices formed into clinical hubs serving 30,000-50,000 populations. In every case this will also mean a new relationship with local community and mental health providers as well as health and mental health providers and social services.
  • NHS National leadership bodies will offer ACSs  a devolved transformation funding package from 2018, potentially bundling together national funding for GPFV, mental health and cancer

Public Health

  • In 2017/18, all mental health trusts will become smoke-free
  • Individual Placement and Support - supporting three trials involving around 12,000 people in Islington, the West Midlands and Sheffield City Region. These trials apply well-evidenced approaches derived from Individual Placement and Support – a model that helps people with severe mental illness return to work – to help people with more common physical and mental health conditions get and stay in work. These randomised control trials will report interim findings in 2018 and final results in 2020, providing a strong evidence base on which to consider wider roll-out.

Cut the costs of corporate services and administration (NHS England and NHS Improvement)

  • The two organisations will create unified programme management groups to deliver key clinical priorities in this Plan. These will have a single jointly appointed leader, including for mental health.

Financial accountability and discipline for all trusts and CCGs

  • Ensuring money is not taken from other areas to counter overspending: Some organisations and geographies have historically been substantially overspending their fair shares of NHS funding and in effect they have been living off bail-outs arbitrarily taken from other parts of the country or from services such as mental health. This is no longer affordable or desirable. So going into 2017/18 it is critical that those geographies that are significantly out of balance now confront the difficult choices they have to take. Where necessary this may mean explicitly scaling back spending on locally unaffordable services, so that they go in to the next two years with a viable and balanced income and expenditure plan, delivering locally the Government’s Mandate requirement for the NHS to balance its books.

NHS workforce

  • New fast track ‘Nurse First’ programme. We will consult on creating a Nurse First route to nursing, similar to the Teach First programme. It will provide financial support for graduates from other related disciplines to undertake a fast track ‘top up’ programme to become a graduate registered nurse - in the first instance targeting mental health and learning disability nursing.

NHS apps

  • In Spring 2017 they will launch the NHS Digital Apps Library with the initial offer including at least 20 apps with categories for Mental Health and Diabetes

Digitising hospitals

  • Over the past few months NHS England has conducted a search for Mental Health digital exemplars. These organisations are seen as advanced and have committed to work to become world class exemplars for others learn from. Subject to HM Treasury capital approvals, successful organisations will be:
    • Berkshire Healthcare NHS Foundation Trust
    • Birmingham and Solihull Mental Health NHS Foundation Trust
    • Mersey Care NHS Foundation Trust
    • Northumberland, Tyne and Wear NHS Foundation Trust
    • Oxford Health NHS Foundation Trust
    • South London and Maudsley NHS Foundation Trust
    • Worcestershire Health and Care NHS Trust

NHS 111 telephone

  • From summer 2017 NHS England will be developing and testing new specialist modules of clinical triage for Paediatrics, Mental Health and Frailty and demonstrating the impact of risk stratification.

Patient information

  • By December 2017 40% of A&Es will have access to mental health crisis records

Responding to NHS England’s delivery plan (31 March 2017), Mental Health Network Chief Executive Sean Duggan said:

“We welcome NHS England’s reaffirmation of the importance of mental health services and their vital role in overall public health.

“Mental health services are working hard to deliver the Five Year Forward View and are frontrunners in NHS local engagement and transformation of care.

“However significant shortfalls in funding threaten to undermine local progress. Mental health services are still not receiving funding they were promised and are not receiving parity with physical services, even in areas where they are incredibly stretched.

"NHS England is beginning to help us track investment and identify gaps, however delays are already forcing many mental health trusts to make difficult choices about what services to provide. Mental health is worsening among children and there is too much variation in the care available to people of all ages, so we need to get these problems fixed.”

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