Market Position Statement: MH Specialist Services 2013-2014
North East Lincolnshire Clinical commissioning Group (CCG) wishes to develop a diverse market for the care and wellbeing of its population, offering real choice for people with mental health difficulties. To achieve this vision the CCG recognises that it needs to know how best to influence, help and support the local market to achieve better outcomes and value for people. This Market Position Statement is an important part of that process, initiating a new dialogue and relationship with the providers in our area, in which the CCG will
- Meet the Government’s requirements as set out in the Care Act 2014 and the financial challenge facing the health and social care system.
- Evidence its committment to providing people with choice and control, and work with providers to ensure that they are transparent about the way they intend to strategically commission and influence services in the future in order to meet the personalisation agenda for both health and social care.
Financial context : currently our actual spend on mental health services within North East Lincolnshire
One in four people in the UK will suffer a mental health problem in the course of a year. The cost of mental health problems to the economy in England have recently been estimated at £105 billion, and treatment costs are expected to double in the next 20 years. Mental health is high on the government's agenda, with a strategy, 'No Health without Mental Health', published by the Department of Health in 2011. The strategy takes across government approach with a focus on outcomes for people with a mental illness
Future demands and needs
There is a wide range of social, economic and environmental factors that influence the health and well-being of individuals and populations, and these factors can be used to provide an indication of the potential for mental illness and related conditions.
In North East Lincolnshire we expect demand for mental health services to be influenced by:
- An ageing population
- Social deprivation
NEPHO publish comprehensive mental health profiles NEL 2013 profile. Highlighted the Percentage of adults with depression, 2011/12 = significantly better than England average
- Directly standardized rate for hospital admissions for mental health, 2009/10 to 2011/12 = significantly worse than England average L
- Directly standardised rate for hospital admissions for unipolar depressive disorders, 2009/10 to 2011/12 = significantly worse than England average L
- Directly standardised rate for hospital admissions for Alzheimer’s and other related dementia, 2009/10 to 2011/12 = significantly worse than England average L
- Directly standardised rate for hospital admissions for schizophrenia. Schizotypal and delusional disorders, 2009/10 to 2011/12 = significantly worse than England average L
- People with mental illness or disability in settled accommodation, 2011/12 = significantly better than England average J
- Directly standardised rate for emergency hospital admissions for self-harm, 2011/12 = significantly worse than England average L
- Indirectly standardised mortality rate for suicide and undetermined injury, 2010/11 = No significant difference to England average
Understanding how the market in mental health works is critical - both for the development of future government policy, and for the implementation of existing policy relating to competition and choice. Ensuring we as a CCG have a clear understanding of the way in which the market currently operates in the mental health sector will be central to developing effective commissioning arrangements and examining how a more level playing field for providers might be achieved.
Our view of the current state of supply
Overall, the evidence suggests that the mental health market in North East Lincolnshire is dominated by statutory NHS provision now developed by a social enterprise. Most focus and resource is on acute needs; those elements of the market concerned with the early identification of emerging problems and community-based support for those with ongoing problems are less well developed.
Services can be categorised as follows:
- Services for people with common mental health problems
- In-patient, crisis and home support
- Community and acute mental health and memory service: services for people with dementia
- Support in the community
- Employment & training
There needs to be more choices given to people that require long term care, especially to focus on support and enablement as opposed to residential care.
Personalisation needs to be more actively promoted to people with mental health issues in order that they can have control over there recovery.
Commissioning principles and aims, including timings for any significant developments in commissioning
As part of the national direction, all mental health services are required to implement payment by results (PBR) for all mental health services from 2015. This year will be a shadow year in which we will be monitoring all the activity with NAViGO and aligning pathways for people across the clusters. The set-up entails assessing service users into one of 21 clusters; for example ‘(6) non-psychotic disorders of overvalued ideas’ or ‘(19) Cognitive impairment or dementia (low need)’.
Within these a 1-4 scale indicates the seriousness of the condition, and clusters are pegged to various maximum review periods ranging from four weeks to annual. Each cluster is linked to a care package – under PBR this is what commissioner’s pay for, as opposed to the traditional ‘block contracts’ that are commonly used to fund care. The theory is that resources follow the patient. We are working with Navigo to ensure the pathways remain integrated by providing patients with an enhancement of care which will keep integration at the heart of our mental health service.
Part of the CCG’s strategy as set out in Healthy Lives Healthy Futures and the Adult Social Care Strategy is to better manage demand to ensure the right professional responds to situations at the right time. To help deliver this vision we are currently working with NAViGO to find ways of better integrating NAViGO into our single point of access arrangements. We believe there are huge benefits from having mental health workers sit alongside community nurses, social workers and other care professionals. This will be a commissioning intention for 2014/2015. This will mean there will be one single access point for all adults in North East Lincolnshire, regardless of their need.
Provider implications – how the CCG expects the market to respond
Over the last 2 years we have being working with the providers whom we appointed on the framework to support them to develop services that are fit for purpose. This has involved reviewing and remodeling residential care and undertaking a review of all people under the age of 65 currently in residential care and looking at moving people on to more supported living services.
The care market is now in a much better place to meet the demands of people requiring long term support with much more focus on enablement and independence.
We will be focusing on preventive and implementing the government’s policy on “No health without mental Health“
Providers need to be in a position to offer people choice and control and look at ways of supporting personalisation in order for people to have a market in which they can purchase person centered care.
Quality and performance monitoring
Current performance against other mental health providers
The two measures within the CCGs performance framework that NAViGO either solely deliver or influence are set out below along with current performance and how we benchmark against other CCGs. There are no current issues relating to patients being followed up within 7 days of discharge from inpatient care. The concern is around the number of people receiving psychological therapies.
The performance shown here only includes activity undertaken by the IAPT service provided by NAViGO. Some practices have in-house provision which isn’t included however the activity undertaken by these practices would see the CCG achieve its target. The CCG are currently reviewing the contract for the primary care provision to ensure that any in-house service meets the full IAPT requirements and therefore activity can be included.
The alternative is that the practices currently not referring or referring low numbers in to the NAViGO service change the pathway for their patients and refer those that need IAPT support to NAViGO.
Wherever possible tender procedures have and will continue to include services users and community members to guide the tender process and choice of provider to win the tender. The CCG will ensure that the Any Qualified Provider procurement model will reduce barriers to entry for potential providers, and so improve patient choice, access, and deliver value for money.